Validation of the Spanish Version of the PURE-4 Questionnaire for the Early Detection of Psoriatic Arthritis in Psoriatic Patients. / Validación de la versión española del cuestionario PURE-4 para la detección precoz de la artritis psoriásica en pacientes con psoriasis.

BACKGROUND AND OBJECTIVE: Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS: This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS: A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS: The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.

Consistency between POLARS and LARS scores regarding the incidence of low anterior resection syndrome in a Chilean population undergoing rectal surgery secondary to cancer in a high-volume hospital.

AIM: The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high-volume hospital. METHOD: The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland-Altman plot with Lin's concordance correlation coefficient. RESULTS: A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor. CONCLUSION: In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales.

[Translated article] Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Requirements for Accessing New Dermatology Drugs in Spain: Results of the EQUIDAD Study. / Condicionantes de acceso a nuevos medicamentos dermatológicos en España: resultados del proyecto EQUIDAD.

BACKGROUND: Although the Spanish Ministry of Health prepares national therapeutic positioning reports (TPRs) and drug reimbursement policies, each of the country's 17 autonomous communities (ACs) is responsible for health care services and prescription requirements in its territory. The aim of the EQUIDAD study was to describe and explore potential differences in prescription requirements for new dermatology drugs across the autonomous communities. MATERIAL AND METHODS: Cross-sectional study conducted in April and May, 2023. Two dermatologists with management responsibilities from each autonomous community reported on territorial and more local prescription requirements for drugs covered by national TPRs issued between 2016 and 2022. RESULTS: Thirty-three researchers from 17 autonomous communities participated. The data submitted revealed between-community inequities in access to new drugs. Overall, 64.7% of the regions imposed additional prescription requirements to those mentioned in the TPRs for psoriasis. This percentage was lower for atopic dermatitis (35.3%) and melanoma (11.8%). The most common requirement for accessing a new drug was a previous prescription for another drug. Differences and additional requirements were also detected at the local level (i.e., differences between hospitals within the same autonomous community). CONCLUSIONS: Spain's autonomous communities have multiple regional and local prescription requirements that are not aligned with national TPR recommendations. These differences result in inequitable access to new drugs for both patients and practitioners across Spain.

Consultas nutricionales en menores de 9 años en la región del Maule, Chile, entre 2017-2021, efecto de estallido social y pandemia COVID-19

Introducción: La consulta nutricional es la primera línea de atención en niñas y niños en salud pública que presentan condiciones de malnutrición por déficit o exceso. Sin embargo, la atención a estos niños y niñas fue afectada por las movilizaciones sociales y la pandemia por COVID-19. Objetivo: Evaluar la tendencia de las consultas realizadas a menores de 9 años por profesional nutricionista en la región del Maule, Chile, desde el año 2017 a 2021. Métodos: Estudio descriptivo de corte longitudinal histórico basado en los datos de los Registros Estadísticos Mensuales (REM) del Servicio de Salud del Maule, las tendencias fueron analizadas con coeficiente de determinación (R2) mediante la regresión de Prais-Winsten. Resultados: Se analizaron 274.377 consultas nutricionales de niños/as menores de 9 años. 53,8% en clasificación de malnutrición por exceso y 12,1% en déficit. Se registró una disminución de 56,8% en las consultas nutricionales durante las movilizaciones sociales y un 92% al inicio de pandemia. Se observó una tendencia al aumento de las consultas por déficit nutricional, especialmente en menores de 12 meses (R2 0,633, β=4,45, p<0,001). Conclusión: La situación social y epidemiológica afectaron significativamente las atenciones nutricionales en salud pública. Es necesario dar una mayor visibilidad de los profesionales nutricionistas y promover el desarrollo de estrategias innovadoras para afrontar este escenario epidemiológico.

Background: The nutritional appointments is the first line of care for children with malnutrition or overweight in public primary health, but its normal functioning was affected by social mobilizations and the COVID-19 pandemic. Objective: To evaluate trends in consultations among children under 9 years of age in the Maule region, Chile, between 2017 and 2021. Methods: Descriptive longitudinal study based on data from the Monthly Statistical Records (REM) of the Maule Health Service, the trends were analyzed with coefficient of determination (R2) using Prais-Winsten regression. Results: 274,377 nutritional consultations were analyzed, of which 53.8% were overweight and 12.1% with malnutrition. A 56.8% decrease in nutritional consultations was recorded during social mobilizations and 92% at the beginning of the pandemic. A tendency to increase consultations due to malnutrition was observed, especially in children under 12 months of age (R2 0.633, β=4.45, p<0.001). Conclusion: The social and epidemiological situations significantly affected nutritional care in public health. It is necessary to give nutrition professionals greater visibility and promote the development of innovative strategies to deal with this epidemiological scenario.

Modelo de intervención de riesgos psicosociales en la red asistencial de salud / Intervention model of psychosocial risks in public health facilities

Resumen: En Chile, la normativa exige que todas las empresas e instituciones evalúen y gestionen los riesgos psicosociales en sus lugares de trabajo. Uno de los sectores donde se produce la mayor cantidad de casos de patologías de salud mental de origen laboral es, justamen te, en el ámbito de la atención en salud. Motivados en esta situación, el presente estudio abordó los datos obtenidos en dos establecimientos públicos de salud y generó un tratamiento estadístico capaz de identificar los principales factores de riesgo para la población estudiada.

Abstract: In Chile, the regulations require that all companies and institutions evaluate and manage psychosocial risks at their workplaces. One of the work areas where the greatest number of cases of mental health pathologies related to work occurs, is precisely in the field of health care. Motivated by this situation, this study addressed the data obtained in two Public Health Facilities to generate a statistical treatment capable of identify the main risk factor's for the population studied.

Compromiso nodal y extranodal detectado con PET/CT en linfoma en etapificación / Nodal and extranodal involvement detected by PET/CT in staging lymphoma

Objective: To describe visible nodal and extra-nodal involvement using PET/CT in the different types and subtypes of lymphoma in staging. Patients and method: PET/CT with F18-FDG were reviewed in patients with lymphoma staging, determining frequency and location of nodal and extra-nodal involvement, and intensity of F18-FDG uptake measured by SUVmax. Results: Of the 102 patients with NHL (average SUVmax 13.0 ± 9.7), 86.3% had nodal involvement (51.9% on both sides of the diaphragm, 24.5% only above the diaphragm), and 66.7% extra-nodal compromise (42.6% bone marrow, 22.1% muscle, 16.2% renal). Of the 30 patients with HL (average SUVmax 14.6 ± 6.0), 100% had nodal involvement (63.3% only above the diaphragm, 36.7% above and below the diaphragm), and 30% had extra-nodal involvement (66.7% bone marrow, 22.2% lung). Conclusion: PET/CT is the method of choice in the staging of lymphoma, allowing the detection of nodal and extra-nodal disease in both HL and NHL.

Objetivo: Describir el compromiso nodal y extranodal visible con PET/CT en los distintos tipos y subtipos de linfoma en etapificación. Pacientes y método: Se revisaron los PET/CT con F18-FDG realizados a pacientes con linfoma en etapificación, determinando frecuencia y localización del compromiso nodal y extranodal, e intensidad de captación de F18-FDG medida mediante SUVmax. Resultados: De los 102 pacientes con LNH (SUVmaxpromedio 13,0±9,7), un 86,3% presentó compromiso nodal (51,9% a ambos lados del diafragma, 24,5% sólo sobre el diafragma) y 66,7% compromiso extranodal (42,6% médula ósea, 22,1% muscular, 16,2% renal). De los 30 pacientes con LH (SUVmax promedio 14,6±6,0), el 100% tuvo compromiso nodal (63,3% sólo sobre el diafragma, 36,7% sobre y bajo el diafragma), y 30% compromiso extranodal (66,7% médula ósea, 22,2% pulmón). Conclusión: El PET/CT es el método de elección en la etapificación del linfoma, permitiendo detectar enfermedad nodal y extranodal, tanto en LH como en LNH.

Stent vs. tutor ureteral en el trasplante renal pediátrico / Ureteral stent vs. reimplantation in pediatric kidney transplantation

Antecedentes y Objetivos: La práctica de la colocación de stent en la anastomosis ureteral en trasplante es controvertido. Los beneficios del stent incluyen: descompresión continua del uréter con menor tensión anastomótica y alineamiento ureteral que protege de la obstrucción. Las desventajas: infección urinaria, obstrucción a largo plazo de la unión ureterovesical, hematuria por erosión mucosa y el retiro del mismo bajo sedación por vía endoscópica. Es nuestro objetivo investigar la incidencia de complicaciones con la utilización de stent ureteral vs. tutor ureteral en el trasplante renal pediátrico. Material y Métodos: Valoración retrospectiva de pacientes trasplantados renales en nuestra institución con técnica de Lich-Gregoir en el implante ureteral en el período febrero 2008 a marzo 2014. Dos grupos de pacientes para investigar complicaciones: aquellos con tutor ureteral por período de 5 dias vs. los pacientes en los que se utilizó catéter doble jota (stent) por período de 30 días. Se identificaron los pacientes con uropatía y nefropatía como causa de insuficiencia renal crónica terminal (IRCT) y se asociaron a las complicaciones que fueron divididas en no infecciosas (urológicas) y en infecciosas (infección urinaria). Resultados: Se evaluaron 183 pacientes. En el grupo con tutor ureteral (n=68) se presentaron complicaciones urológicas en 8 pacientes (11.76%), 2 urópatas y 6 nefrópatas y las complicaciones infecciosas se observaron en 15 pacientes (22.06%). En el grupo stent (n=115) se presentaron complicaciones urológicas en 3 casos (2,61%), 2 urópatas y un nefrópata y las complicaciones infecciosas se observaron en 43 pacientes (37.39%). Conclusiones: La asociación de la técnica de Lich Gregoir con stent mejora la morbilidad evitando complicaciones no infecciosas, pero aumenta la incidencia de complicaciones infecciosas independiente del origen de la causa de la IRCT (AU)

Background and aims: Stent placement in ureteral anastomosis is controversial. Benefits of the stent include: continuous decompression of the ureter with less anastomotic tension and ureteral alignment with better protection from ureteral narrowing. Disadvantages: urinary infection, long-term stricture of the vesicoureteral junction, hematuria due to mucosal erosion and its endoscopic removal under sedation. Our aim was to assess the incidence of complications of the use of a ureteral stent vs. ureteral splint in pediatric kidney transplantation. Material and methods: Retrospective assessment of kidney transplant patients in whom the Lich-Gregoir technique was used for ureteral implantation between February 2008 and March 2014. Two groups of patients were selected to assess complications: Patients with a ureteral splint for 5 days vs. patients in whom a double J catheter (stent) was used for 30 days. Patients with uropathy and nephropathy due to end-stage chronic renal failure (ESRD) were identified and associated complications were divided into non-infectious (urological) and infectious (urinary infection) complications. Results: 183 patients were evaluated. In the ureteral splint group (n=68), urological complications were observed in 8 patients (11.76%), 2 uropathic and 6 nephropathic, and infectious complications were observed in 15 patients (22.06%). In the stent group (n=115), urological complications were observed in 3 cases (2.61%), 2 uropathic and 1 nephropathic, and infectious complications were seen in 43 patients (37.39%). Conclusions: The association of the Lich Gregoir technique with stent placement improves morbidity avoiding non-infectious complications, but increases the incidence of infectious complications regardless of the cause of ESRD (AU)

Heminefrectomía en pacientes con doble sistema renal. Experiencia en el Hospital Garrahan / Heminephrectomy in patients with a duplex kidney. Experience at the Garrahan Hospital

La heminefrectomía puede constituir el tratamiento definitivo en el 85% de los pacientes con diagnóstico de doble sistema con uno de los mismos no funcionante. Actualmente el abordaje laparoscópico es de elección tanto por sus resultados estéticos como evolución postoperatoria. Materiales y métodos: se efectuó una revisión y análisis retrospectivo de todos los pacientes operados de heminefrectomía desde el año 2000 a 2014. Resultados: 44 pacientes fueron operados de forma convencional durante el período 2000-2010 y 30 de forma laparoscópica transperitoneal durante el período 2010-2014. La media de duración del procedimiento fue menor para el grupo convencional (89,6 vs 128 min, p = 0,000) mientras que la media de estadía hospitalaria fue menor para el grupo laparoscópico (4,2 vs 5,1, p = 0,19). La tasa de reoperación fue mayor en el grupo convencional (20,4% vs 6,7%, p = 0,18) y la principal causa fue por la presencia un muñón ureteral sintomático. En los controles por centellograma DMSA (en 19 pacientes del segundo grupo) no se objetivó la pérdida de función de la unidad remanente en ningún individuo. Conclusiones: La heminefrectomía es un procedimiento seguro con baja tasa de complicaciones cuya tendencia actual es realizar la cirugía de forma laparoscópica obteniendo resultados similares y menor tasa de complicaciones que en la forma convencional (AU)

Heminephrectomy may be the definitive treatment in 85% of patients diagnosed with a duplex kidney system of which one is not working. Currently, a laparoscopic approach is the treatment of choice because of both esthetic results and postoperative outcome. Material and methods: A retrospective analysis of all patients who underwent heminephrectomy between 2000 and 2014 was conducted. Results: 44 patients underwent conventional surgery in the period 2000-2010 and 30 underwent transperitoneal laparoscopy in the period 2010-2014. Mean duration of the procedure was less in the conventional group (89.6 vs 128 min, p = 0.000), while the mean hospital stay was less in the laparoscopic group (4.2 vs 5.1, p = 0.19). Reoperation rate was higher in the conventional group (20.4% vs 6.7%, p = 0.18) and the main cause was presence of a symptomatic ureteral stump. On DMSA whole body scan controls (in 19 patients in the second group) no loss of function of the remaining unit was observed in any of the patients. Conclusions: Heminephrectomy is a safe procedure with a low complication rate and a current trend to be performed using laparoscopy with similar results and a lower complication rate than in conventional surgery (AU)

Rol de onabotulinumtoxin A en el tratamiento de niños con vejiga neurogénica / The rol of Onabotulinumtoxin A in the treatment of children with a neurogenic bladder

Introducción: Onabotulinumtoxina es una alternativa terapéutica de segunda línea en pacientes sin respuesta a los anticolinérgicos. Objetivo: Evaluar los efectos de repetidas inyecciones de onabotulinumtoxina en vejigas neurogénicas refractarias al tratamiento clásico. Pacientes y métodos: Se evaluaron 82 pacientes menores de 18 años con vejiga neurogénica, en su mayoría por disrafia espinal. Todos fueron refractarios a oxibutinina oral. Si luego del tercer mes de la primer inyección en el detrusor se constataba mejoría clínica y/o urodinámica; se reinyectaban entre los 9 y 12 meses, nuevamente. De lo contrario, se indicaba cistoplastia de aumento. En algunos casos se utilizaron otros procedimientos endoscópicos - quirúrgicos accesorios. Resultados: Se reinyectaron con Onabotulinumtoxina, dos, tres, cuatro y cinco veces: 20 casos, 7, 4 y un caso, respectivamente. En el 51% promedio se logró continencia urinaria total (score cero-seco). En la primera y segunda inyección hubo incremento significativo en la media de capacidad cistométrica: de 254 a 331 ml (p: 0.007) y de 257 a 367 ml (p: 0.014); respectivamente. En algunos casos, luego de la primer inyección mejoró significativamente la compliance: de 6,9 a 11,4 ml/cmH2O (p: 0.05). La media de presión del detrusor al final del llenado disminuyó en promedio de 37 a 34,4 cmH2O. La sobreactividad del detrusor (n:22) se atenuó en el 54,4% luego de la primer inyección. No se registraron efectos adversos mayores con las reinyecciones. En 15 pacientes refractarios a OnabotulinumtoxinA se realizó ampliación vesical. Conclusión: Luego del tratamiento con onabotulinumtoxina, la continencia urinaria alcanzada fue del 50% promedio. La capacidad cistometrica se incrementó significativamente con las dos primeras inyecciones; aunque no se acompañó paralelamente de un importante descenso de presiones endovesicales. El uso de onabotulinumtoxina ha logrado suprimir o retrasar la clásica indicación de cistoplastia de aumento en niños refractarios a los anticolinérgicos (AU)

Introduction: OnabotulinumtoxinA is a second-line alternative therapy for patients who do not respond to anticholinergics. Aim: To evaluate the impact of repeated injections of OnabotulinumtoxinA in neurogenic bladders refractory to conventional treatment. Patients and methods: 82 patients younger than 18 years with a neurogenic bladder, in the majority due to spinal dysraphism, were evaluated. All were refractory to oral oxybutynin. If in the third month after the first injection in the detrusor clinical and/or urodynamic improvement was observed, between 9 and 12 months later a second injection was given. If not, augmentation cystoplasty was indicated. In some cases other endoscopic/surgical procedures were used. Results: Twenty, seven, four, and one case were reinjected with OnabotulinumtoxinA, two, three, four, and five times, respectively. In a mean of 51% of the patients total urinary continence was achieved (score zero - completely dry). On the first and second injection a significant increase of the maximum cystometric capacity was observed: from 254 to 331 ml (p: 0.007) and from 257 to 367 ml (p: 0.014), respectively. In some cases, after the first injection compliance improved significantly: from 6.9 to 11.4 ml/cmH2O (p: 0.05). Mean end filling detrusor pressure diminished from 37 to 34.4 cmH2O. Detrusor overactivity (n: 22) attenuated in 54.4% after the first injection. No major adverse effects were recorded after the reinjections. In 15 patients that were refractory to OnabotulinumtoxinA augmentation cystoplasty was performed. Conclusion: After OnabotulinumtoxinA treatment, 50% urinary continence was achieved. Cystometric capacity increased significantly after the first two injections; however, it was not associated with an important decrease of intravesical pressure. The use of OnabotulinumtoxinA may avoid or delay the classical indication of augmentation cystoplasty in anticholinergicrefractory children (AU)

Sobrevida de pacientes e injerto en niños con trasplante renal: experiencia del Hospital Garrahan en dos períodos / Patient and graft survival in children with a kidney transplant: The experience at Garrahan Hospital over two periods

En adultos y niños con trasplante renal (TxR) la sobrevida de paciente e injerto ha mejorado. En Argentina no existen datos de sobrevida en niños con TxR en diferentes décadas. El objeto de este trabajo fue valorar en niños con TxR sobrevida de paciente e injerto y analizar causas de muerte, perdida de injerto y factores de riesgo de pérdida. Dado que desde el año 2001 se unificaron prácticas de diagnóstico y tratamiento, se compararon dos periodos: 1988-2000 y 2001-2015. Se incluyeron 773 niños. A 1, 3, 5, 7 y 10 años, En TxR de DV (n=327), la sobrevida del paciente fue de 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% y 96% (p=0.74); la del injerto de 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81% y 76% (p=0.81). En TxR de DC (n=446) la sobrevida de paciente fue de 97%, 93%, 90%, 89% y 87% en el 1er. periodo vs. 100%, 99% y 98% 98% y 98% en el 2do (p<0.001); la del injerto de 83%, 75%, 68%, 64% y 52% vs. 95%, 87%, 83%, 76% y 61% respectivamente (p<0. 001). El Rechazo Crónico fue la 1er causa de perdida (61% vs 62%); la 2da la muerte del paciente con injerto funcionante. La sepsis bacteriana fue la 1era causa de muerte (56% vs 67%). Ningún niño falleció por neoplasia entre el 2001 y 2015. En DV, fueron predictores de perdida de injerto: DGF (HR: 4.8; p<0.001), edad al TxR > 12 años (HR: 2.7; p=0.002) y RA tardío (HR: 2.1; p=0.009). En DC la necesidad de diálisis en la 1er semana post TxR (DGF): (HR: 4.4; p<0.001), el rechazo agudo (RA) tardío (HR: 3.7; p<0.001), GSFS como causa de IRC (HR: 2.5; p=0.01), y RA temprano (HR: 2.2; p=0.02). Conclusión: En el 2do periodo la sobrevida de paciente e injerto los TxR con DC mejoro, y en los TxR con DV no tuvo cambios. El rechazo crónico continúa siendo la 1era causa de perdida. Ningún paciente tuvo neoplasia (AU)

Patient and graft survival in kidney transplantation (KTx) has improved. In Argentina there are no data comparing transplant outcomes in children over different eras. The aim of this study was to evaluate patient and graft survival in children with KTx and to analyze cause of death, graft loss, and risk factors of graft loss. As diagnostic and treatment practices were unified in 2001, two periods were compared: 1988-2000 and 2001-2015. Overall, 773 children were included. Survival at 1, 3, 5, 7, and 10 years after a living-related donor (LRD) KTx was 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% and 96% (p=0.74); graft survival was 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81%, and 76% (p=0.81). Patient survival after deceased donor (DD) KTx (n=446) was 97%, 93%, 90%, 89%, and 87% in the 1st period vs. 100%, 99% y 98% 98%, and 98% in the 2nd (p<0.001); graft survival was 83%, 75%, 68%, 64%, and 52% vs. 95%, 87%, 83%, 76%, and 61%, respectively (p<0. 001). Chronic rejection was the first cause of graft loss (61% vs 62%); the second was death of the patient with a functioning graft. Bacterial sepsis was the first cause of death (56% vs 67%). None of the patients died because of malignancies between 2001 and 2015. Among LRD transplants predicting factors of graft loss were: DGF (HR: 4.8; p<0.001), age at KTx >12 years (HR: 2.7; p=0.002), and late acute rejection (AR) (HR: 2.1; p=0.009). Among DD need for dialysis in the first week post-KTx (DGF): (HR: 4.4; p<0.001), late AR (HR: 3.7; p<0.001), FSGS-related CFR (HR: 2.5; p=0.01), and early AR (HR: 2.2; p=0.02). Conclusion: In the second period patient and graft survival after DD improved, while that of KTx with LRD remained unchanged. Chronic rejection continues being the first cause of graft loss. None of the patients developed malignancies.

Effectiveness of a three-dimensional anorectal ultrasound in perianal Crohn's disease: incompatibility with clinical and surgical examinations.

PURPOSE: We have correlated the 3D anorectal ultrasound (3D ARU) findings with clinical examination and the surgical findings and examined its capacity to provide ancillary information, which potentially alters patient management. PATIENTS AND METHODS: This is a prospective analysis conducted at a tertiary academic hospital. A total of 95 patients were included. We screened for sphincter defects and the presence of perianal Crohn's disease (PACD)-related lesions. RESULTS: We performed 150 3D ARUs. Exploratory ultrasound coincided with the rationale for diagnosis in 67.7% of cases, and fistulae were detected in 79% of cases where there was clinical suspicion. Fistulae were associated with abscesses in 29 cases, and isolated abscesses were identified in 19 cases (17.7%), only 12 of which (63.2%) were clinically suspected. Sphincter defects were observed in 15 cases with 7 cases (77.8%) presenting with clinical fecal incontinence. The operative findings coincided with ultrasonographic findings in 81.3% of the analyzed cases. The inter-observer variability of endosonographic classification resulted in a kappa score of 0.86. Ultrasonographic data altered the therapeutic plan of management in 73 cases (48.6%). CONCLUSIONS: Three-dimensional ARU is accurate in the diagnosis of fistula type in PACD and in the delineation of ancillary suspected and unsuspected abscess collections. Its use impacts therapeutic management in about half the cases examined. A new ultrasonographic-based PACD classification system is presented which has high inter-observer agreement but which requires future prospective validation in clinical PACD patients.

Renal autotransplantation for the treatment of renovascular hypertension in the pediatric population.

PURPOSE: To evaluate the effectiveness of renal autotransplantation (RA) for the treatment of renovascular hypertension (RVH) in a selected group of children in whom medical care, a percutaneous transluminal angioplasty or vascular reconstruction failed or was technically impossible, in addition to the short-term and long-term morbidity. MATERIALS AND METHODS: A retrospective case review of 13 pediatric patients with severe or complicated RVH who underwent RA between May 1993 and August 2008 was conducted. We defined blood pressure (BP) response as follows: Cured: normal BP values with no need of antihypertensive medication (AM); Improved: normal BP values with AM requirements; Failed: abnormal BP values despite treatment with AM. RESULTS: 16 RA were performed in 7 female and 6 male patients. Bilateral RA were performed in 2 females and in 1 male. The average age at consultation for hypertension was 8.5 years (range 4-12 years) and the time of transplantation was 9.12 years (range 6-13 years). Etiological diagnoses were: Takayasu disease (n = 5); renal artery fibrodysplasia (n = 3); mid-aortic syndrome (n = 3) and neurofibromatosis type I (n = 2). Results after RA were: Cured: 61.5%; Improved: 38.5%. No patient presented therapeutic failure during follow up time (median = 53.4 months). Only 1 case presented a postoperative complication. CONCLUSIONS: RA is a procedure with no mortality and low morbidity rates that renders very satisfactory therapeutic results in the pediatric population.

[Botulinic toxin type A in the treatment of children with neurogenic bladder]. / Toxina botulínica-A en el tratamiento de niños con vejiga neurogénica.

UNLABELLED: INTRODUCTION. Botulinum toxin A (BoNTA) is an alternative in children with neurogenic bladder refractory to anticholinergics. OBJECTIVE. To evaluate the initial effects of BoNTA in neurogenic bladders. PATIENTS AND METHODS 12 patients (9 myelomeningoceles, 1 tethered cord, 1 medullary astrocytoma, 1 Ewing's sarcoma) were studied. The pretreatment evaluation included: voiding diary, incontinence score, renovesical ultrasound, cystourethrography and urodynamic parameters. Patients received 300 UI of BoNTA via detrusor injections. They were re-evaluated at months 1, 3 and 6. After the third control, if improvement was confirmed, patients were injected again. Otherwise, surgery was indicated. RESULTS: After the initial injection, 50% of patients achieved complete continence and 20% remained with minimal leaks. The mean maximum bladder capacity increased from 264 +/- 117 ml to 324 +/- 170 ml (P = 0.322). The mean detrusor pressure decreased from 46 +/- 17 cm H2O to 42 +/- 14 cm H2O (P=0.596). The mean bladder compliance increased from 7.6 +/- 5.9 ml/cm H2O to 10.4 +/- 6.4 ml/cm H2O (P = 0.290). The reflex voiding contractions disappeared in 2 patients; 8 presented trabeculae. Ten patients were reinjected and two underwent surgery. CONCLUSION: 70% urinary continence was achieved after the initial injection. No significant urodynamic changes were observed. A longer follow-up with subsequent injections is needed.

Búsqueda prenatal de bloqueo aurículo ventricular congénito en población de riesgo: experiencia Universidad Católica de Chile / Congenital heart block in risk population: Universidad Catolica de Chile experience

Congenital heart block is a fetal arrhythmia detected by routine prenatal ultrasound. Natural history and risk factors for this condition are known. Patients having Ro/La antibodies have 2 to 4 percent risk of affected child and recurrence of up to 25 percent. There are standarized protocols for measuring the PR interval by ultrasound, as well as reference curves for different gestational ages. The experience at Hospital Clínico de la Universidad Católica de Chile is reported, describing follow up of 37 patients over a period of more than 4 years. A protocol based on monthly monitoring of risk group was adopted.

El bloqueo aurículo ventricular congénito constituye una de las arritmias fetales detectables mediante ultrasonido prenatal de rutina. Se conoce su evolución natural y la población de riesgo de sufrir esta afección. En portadoras de anticuerpos Ro/La el riesgo de un hijo afectado es entre 2 y 4 por ciento, y la recurrencia de hasta un 25 por ciento. Existen protocolos estandarizados para medir el intervalo PR mediante ultrasonido, como también curvas de referencia para las distintas edades gestacionales. Reportamos la experiencia en el Hospital Clínico de la Universidad Católica de Chile, con un seguimiento de 37 pacientes en un periodo de más de 4 años. Se adoptó un protocolo de seguimiento mensual del grupo de riesgo.

Evaluación del transplante renal en pacientes con tracto urinario anormal / Evaluation of kidney trnasplantation in patients with urinary tract abnormalities

Objetivo: Determinar si los procedimientos quirúrgicos del tracto urinario inferior, previos y complementarios al trasplante renal en pacientes que llegaron a la insuficiencia renal por causa urológica, afectan la evolución del mismo en cuanto a complicaciones y sobrevida del injerto. Material y método: Entre diciembre de 1988 y noviembre de 2007 se realizaron 156 trasplantes renales en 150 pacientes de 11 años edad promedio (94 varones y 56 niñas) con insuficiencia renal crónica terminal (IRCT) de causa urológia. El promedio de seguimiento fue 67 meses. Los pacientes se clasificaron en tres grupos: grupo A (n:66): Los que no requirieron procedimientos quirúrgicos en tracto urinario bajo; grupo B (n:46): Los que necesitaron de procedimientos quírúrgicos en tracto urinario bajo y conservaron adecuada función vesical y grupo C (n:38): Los que necesitaron procedimientos quirúrgicos en vía urinaria baja por inadecuada función vesical. Resultados: la sobrevida del implante, al año, fue del 93.38 por ciento para el grupo A; 95,45 por ciento para el B y 93 por ciento para el C. A los cindo años del trasplante renal las sobrevidas respectivas para los mismos grupos fueron: 82.45 por ciento, 79.85 por ciento y 85.58 por ciento (p: 0.9 no significativo). Complicaciones: Estenosis ureterovesicales: 2 en el grupo A (3.0 por ciento), 3 en el grupo B (6,3 por ciento) y 1 en el grupo C (2,5 por ciento). Reflujo vesicoureteral: 1 paciente del grupo A (1,5 por ciento); 1 del grupo B (2 por ciento) y en 10 del grupo C (25 por ciento). La necrosis del uréter distal ocurrió en dos casos en el grupo A (3.0 por ciento), en dos del grupo B (4.2 por ciento y en uno del grupo C (2,5 por ciento). Infección tracto urinario bajo (ITUB): 9 por ciento, 7,5 por ciento y 27,8 por ciento en el grupo A, B y C respectivamene. Infección tracto urinario alto (ITUA): 12 por ciento, 25 por ciento y 42,5 por ciento en los grupo A, B y C, respectivamente.

Trasplante renal 1988 - 2008 / Kidney transplantation 1988- 2008

Evaluación retrospectiva de 575 trasplantes (TX), 64,3 por ciento con donante cadavérico (DC), en 550 pacientes (311 varones) edad por x: 10.8 más menos 4.2 años, efectuados entre 1988 y 2008. edad por de donante: DC 22.5 más menos 14 años y DVR: 37.3 más menos 7.7 años. Principales causas de IRC: nefropatía por reflujo: 34,1 por ciento, hipo-displasia: 15.1 por ciento, SUH; 12.9 por ciento, GSF: 9.82 por ciento, glomerulonefritis varias: 16.4 por ciento. Inmunosupresion: en la mayoría de los pacientes, Cicloporina A; Azatioprina o micofenolato mofetil o ácido micofenólico y esteroides con linfo o timoglobulina secuencia en TXDC y profilaxis con gaciclovir en riesgo de infección por CMV. La sobrevida actuarial funcional renal (SA) a 1.3 a 5 años fue 96.5 por ciento, 94.4 por ciento y 86,2 por ciento TX DVR y 90,1 por ciento, 85,5 por ciento y 77.6 por ciento TX DC, p= 0.04, similar a resultados en EEUU (NAPRCTS 1999 - 2002). La GSF con 45.5 por ciento de recurrencia del síndrome nefrótico, tuvo inferior SA al 5to año, p= 0.001, comparado con otras etiologías de IRC. Los TX sin diálisis (D) previa, p= 0.003. Tuvieron trombosis 2.61 por ciento de los TX, más frecuentes con DPCA pre tx que con hemo D o sin diálisis, p= 0.01, con TXDC, p= 0.02 y con TX de donantes < de 6 años, p = 0.02. Los pacientes que requirieron diálisis post trasplante, tuvieron mayor creatinina al año D: 1.8 más menos 2.27 mg/dl.SD: 1.19 más menos 1.2, p < 0.01, e inferior SA al quinto año, p=0.001. Con tiempo de isquemia fria superior a 24 horas, 31,6 por ciento de los DC necesitaron diálisis. El rechazo celular agudo se dianosticó en el 14,8 por ciento de los pacientes. Las causas más frecuentes de fracaso del trasplante fueron: nefropatía crónica (69,8 por ciento) asociado a inadecuada adherencia en 54.7 por ciento, trombosis (12.6 por ciento), recurrencia (5.9 por ciento), ausencia de función (5 por ciento) rechazo severo (5 por ciento)Desarrollaron enfermedad.

Persistent hepatic venous plexus in a patient with Sturge-Weber syndrome.

A patient with extensive facial and intracranial features of Sturge-Weber syndrome was found to have a persistent primitive hepatic venous plexus, characterized by three additional vessels arising from the inferior vena cava, circulating between liver segments, which formed a common trunk in the supra-hepatic region that flowed into the right atrium. To the best of our knowledge, this hepatic finding has not been previously described in association with Sturge-Weber syndrome.