Prognostic factors and treatment outcomes for female urinary incontinence rehabilitation.

INTRODUCTION: Urinary incontinence (UI) is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Rehabilitation is established as the first-line treatment, although its use has not been protocolized. OBJECTIVE: To identify which personal risk factors and type of treatment applied are statistically related to patient improvement. STUDY DESIGN: Retrospective cohort study. METHODS: Retrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks. The presence or absence of improvement was evaluated according to seven objective and subjective variables, and improvement was established as positive evolution in at least five of the seven variables. RESULTS: A total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement. The most used rehabilitative treatment was kinesitherapy+biofeedback (51%) which showed a statistically significant relationship with the improvement of these patients (P=.037) together with biofeedback+posterior tibial nerve electrostimulation (PTNS) (P=.044). CONCLUSION: Biofeedback combined with kinesitherapy or PTNS are established as the most effective rehabilitative procedures.

Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain.

BACKGROUND: Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. METHODS: A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS: In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101-€300 for a 1-2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS: WTP for COS therapies exceeds current cost. Additional WTP exists for 1-2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.

Bence Jones proteinuria in smoldering multiple myeloma as a predictor marker of progression to symptomatic multiple myeloma.

The diagnosis of smoldering multiple myeloma (SMM) includes patients with a heterogeneous risk of progression to active multiple myeloma (MM): some patients will never progress, whereas others will have a high risk of progression within the first 2 years. Therefore, it is important to improve risk assessment at diagnosis. We conducted a retrospective study in a large cohort of SMM patients, in order to investigate the role of Bence Jones (BJ) proteinuria at diagnosis in the progression to active MM. We found that SMM patients presenting with BJ proteinuria had a significantly shorter median time to progression (TTP) to MM compared with patients without BJ proteinuria (22 vs 88 months, respectively; hazard ratio=2.3, 95% confidence interval=1.4-3.9, P=0.002). We also identified risk subgroups based on the amount of BJ proteinuria: ⩾500 mg/24 h, <500 mg/24 h and without it, with a significantly different median TTP (13, 37 and 88 months, P<0.001). Thus, BJ proteinuria at diagnosis is an independent variable of progression to MM that identifies a subgroup of high-risk SMM patients (51% risk of progression at 2 years) and ⩾500 mg of BJ proteinuria may allow, if validated in another series, to reclassify these patients to MM requiring therapy before the end-organ damage development.

Typical isolated ectrodactyly of hands and feet: early antenatal diagnosis.

Ectrodactyly is a rare dominant autosomal malformation with variable expression. Herein we report a case early diagnosed by ultrasound at 15 weeks of gestation of isolated ectrodactyly involving the four limbs. The sonographic findings were bilateral split hands and split foot. Diagnosis of typical isolated ectrodactyly was pathologically confirmed. Clinical forms, pathogenesis, differential diagnosis, and early prenatal diagnosis are discussed.

Effect of vascular smooth muscle relaxants on the protein kinase C-mediated contraction in the rat pulmonary artery.

In the rat pulmonary artery, phorbol 12,13-dibutyrate induces a contraction due to the activation of the protein kinase C. We investigated the sensitivity of this protein kinase C-mediated contraction to a variety of vascular smooth muscle relaxants. Pretreatment of rat pulmonary artery with relaxant compounds altered the subsequent concentration-response curve to phorbol 12,13-dibutyrate (0.05-2 microM) in a variable manner. Isoprenaline (0.1-10 microM), nifedipine (0.01-1 microM) and cromakalim (0.1-10 microM) had no effect, whereas vasoactive intestinal peptide (VIP, 1-10 nM), forskolin (0.1-2 microM), theophylline (0.1-2.5 mM), 4-(3-butoxy-4-methoxybenzyl)-2-imidazolidinone (RO 20-1724, 2-20 microM), dipyridamole (10-100 microM), 8 bromo-cyclic GMP (8-br-cGMP, 5-500 microM) and dibutyryl cyclic AMP (db-cAMP, 100-500 microM) shifted the concentration-response curve to phorbol 12,13-dibutyrate to the right and decreased the maximal response. When cumulative concentrations of relaxants were applied on the plateau of the contraction induced by 0.2 or 2 microM phorbol 12,13-dibutyrate, again, isoprenaline, nifedipine and cromakalim failed to decrease the protein kinase C-mediated contraction, whereas the other agents produced concentration-dependent relaxation. From their inhibitory effect on the 0.2 microM phorbol 12,13-dibutyrate-induced contraction, the rank order of potency of these relaxants was: VIP >> forskolin > RO 20-1724 > 8-br-cGMP > theophylline > dipyridamole > db-cAMP. In chemically (beta escin) skinned preparations, cGMP (5-500 microM) and cAMP (50-1000 microM) antagonized in a concentration dependent manner the contraction induced by phorbol 12,13-dibutyrate at constant Ca2+ concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Eosinophilic inflammation assessed by induced sputum in corticosteroid-dependent asthma.

Sputum induction can be used to study airway inflammation in asthmatics. However, it has not been used in patients with corticosteroid-dependent asthma requiring long-term oral corticosteroids. The aim of the study was to assess the number of eosinophils and the levels of eosinophil cationic protein (ECP) in sputum of 17 corticosteroid-dependent asthmatics by comparison with nine mild untreated asthmatics, 10 moderate asthmatics receiving inhaled steroids (ICS) and 11 healthy subjects. In the 17 corticosteroid-dependent asthmatics, we examined sputum eosinophil markers on two occasions and correlated with the control of asthma. Eosinophils were undetectable in controls and were detected in 63.8% of asthmatics. There were no significant differences between the three groups of asthmatics. ECP levels were significantly increased in ICS or corticosteroid-dependent asthmatics by comparison to controls and mild asthmatics. There was no significant difference between ICS and corticosteroid-dependent asthmatics. During follow-up, corticosteroid-dependent asthmatics with a controlled disease had no significant change in eosinophil numbers or ECP levels. On the other hand, corticosteroid-dependent asthmatics with recent exacerbations had a non-significant increase in eosinophil numbers and a significant increase in ECP levels. This study shows that ECP levels may be more accurate than eosinophil numbers in assessing exacerbations in corticosteroid-dependent asthmatics.

Cardiac defects in chromosomally normal fetuses with increased nuchal translucency at 10-14 weeks of gestation.

OBJECTIVE: To examine the prevalence, distribution and spectrum of cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness. PATIENTS AND METHODS: During a 4-year period, targeted fetal echocardiography was used in 353 chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks' gestation. The cardiac scan was performed at 18-22 weeks. In the last 138 cases enrolled, an additional scan at 12-16 weeks was carried out. The follow-up included the findings at necropsy or in the pediatric examination. A complete follow-up was achieved in 97%. RESULTS: Cardiac defects were present in 32 (9.1%) cases, increasing from 5.3% in those with a nuchal translucency thickness of > or = 95th centile (3.9 mm) to 24% when thickness > or = 6 mm (p < 0.001). In 31 cases (97%), the cardiac defect was diagnosed antenatally; in 24 cases (77%) this diagnosis was confirmed later. In the remaining seven cases, the autopsy examination was not available. A wide range of cardiac defects was observed, with the most common being atrioventricular septal defect and tricuspid atresia. CONCLUSIONS: Euploid fetuses with increased nuchal translucency thickness have a significantly increased risk of cardiac defects. This is a marker of different types of heart anomalies and constitutes an additional indication for targeted fetal echocardiography. Most of the cardiac defects can be detected by fetal echocardiography.

[Fetal supraventricular tachycardia]. / Taquicardias supraventriculares fetales.

BACKGROUND: Fetal supraventricular tachycardia is an infrequent and difficult to manage disease. Several therapeutic approaches have been proposed. We report our experience in its diagnosis and management. OBJECTIVES: Evaluation of the clinical features of fetal supraventricular tachycardia and efficacy of maternal and fetal medications in use for treatment. Immediate neonatal evolution is commented on. A therapeutic schema is proposed. PATIENTS: Nineteen fetuses with echocardiographically (M-mode and/or Doppler two dimensionally oriented) supraventricular tachycardia were diagnosed. RESULTS: Mean gestational age was 32 weeks; 8 fetuses had developed hydrops; 3 patients had dilated cardiomyopathy (two of them were hydropic). Two cases were prenatally diagnosed as atrial flutter (both of them without hydrops). Sixteen fetuses received transplacentary treatment: 8 with digital, 6 more associated with flecainide, direct administration of amiodarone to the fetus was added in two cases. Three patients died during follow-up (one postnatally, at third week of life), all of them had developed hydrops; arrhythmia characteristics were unmodified in three and control of cardiac rhythm was achieved in ten cases. CONCLUSIONS: In the majority of cases there are no cardiac malformations associated. It is possible to control the tachycardia, even if hydrops is present. It is not indicated to abbreviate the gestation. First election drugs are maternal digoxin and flecainide, they do not produce significant fetal or maternal secondary effects. Occasionally it is necessary to add or to change to other drugs or to propose more aggressive approaches.

Hysteroscopic myomectomy: our experience and review.

OBJECTIVE: To analyze the results of hysteroscopic myomectomy in our center and to compare the results to those published in the literature. METHODS: We performed a retrospective study of the clinical histories of patients who had undergone hysteroscopic myomectomy with a resectoscope between January 1992 and December 1999. Procedures were performed at a hysteroscopic clinic in the Department of Obstetrics and Gynecology at the University Public Hospital in Madrid's south zone. One hundred twenty pre-, peri-, and postmenopausal women with submucous myomas were included in the study. All patients underwent hysteroscopic resection with a monopolar loop. RESULTS: We performed 120 hysteroscopic myomectomies. The patients' median age was 44.8 years (23 to 74). Abnormal uterine bleeding (AUB) was the most frequent indication (84.1%). Inability to reproduce was the indication in 14 (11.6%) cases. GnRH analogue preparation was used in 60% of cases. We operated on 52 (43.3%) type 0, 51 (42.5%) type I, and 17 (14.1%) type II myomas, according to Wamsteker and Blok classification. A median of 32.5 (10 to 105) minutes was required for the interventions. The myomectomy was combined with another operation (12 polypectomies, 24 endometrial resections, and 1 laparoscopic ovarian cystectomy) in 32 patients. The median retention of glycemia was 281 cc (0 to 1300). We could not complete the resection in 22 patients. Twelve underwent reoperation (3 hysterectomies and 9 second myomectomies). No serious complications occurred, and the median hospital stay was 25.4 hours. The histological study confirmed leiomyoma in all the cases. The intervention results were satisfactory after a follow-up period of 12 months to 7 years, AUB being controlled in 88.5% of the patients. CONCLUSION: Hysteroscopic myomectomy is a reliable procedure that is effective in controlling abnormal uterine bleeding. It is a good alternative to hysterectomy and has an acceptable surgical time and minimum hospital stay. To reduce the need of reintervention, appropriate patient selection and improved technique are necessary. The technique also offers significant economic savings compared with the conventional surgical methods.

[Changes in acid-base equilibrium according to the type of delivery]. / Evolution de l'équilibre acido-basique selon le type d'expulsion.

The changes in fetal acid-base equilibrium in the second stage of labour have been studied in two groups of patients: first, one of 48 women who delivered spontaneously and the second of 79 women who pushed as instructed. In each case blood was taken from the fetus at the beginning of the second stage and another sample was taken from the umbilical artery before the newborn could take his first breath. In the first group the mean value of fetal pH at the start of the second stage was 7.34 +/- 0.007 and in the umbilical artery 7.32 +/- 0.006 (p greater than 0.05; on the other hand in the second group the mean value of the intra-uterine pH was 7.35 +/- 0.06 and in the umbilical artery it had gone down to 7.25 +/- 0.009 ( p Less than 0.0005). The mechanisms by which active pushing as instructed causes a drop in pH in the fetus can be attributed to several possible haemodynamic modifications so that one must question the advantages of pushing under instruction.

[Corticoid therapy and bronchial inflammation in asthma. The use of bronchial biopsy]. / Corticothérapie et inflammation bronchique de l'asthmatique. Apport des biopsies bronchiques.

The development of fibreoptic bronchoscopy has enabled significant progress in the understanding of the pathogenesis of asthma. It has brought to the fore the importance of bronchial inflammation even in asymptomatic patients and/or in patients who have only mild disease. The practice of bronchial biopsy in vivo is an excellent method of studying bronchial inflammation. The purpose of this general review is to recall the value of bronchial biopsies in the understanding of the effects of steroids on asthma: effects on the epithelium, the basement membrane and the blood vessels. Their cellular contents consist equally of cytokines, enzymes and adhesion molecules. At the level of the bronchial epithelium steroid therapy engenders a diminution in eosinophils, mast cells an lymphocytes. It restores the ratio of ciliated to other cells back to normal and increases the number of nerve synapses. Regarding the interstitium the corticoids diminish the number of eosinophils, mast cells and T lymphocytes. The effect on different lymphocyte subtypes is controversial, as is the effect of the basal membrane. Steroid therapy diminishes the proteins, GM-CSF.RANTES and IL-8 as well as the messengers IL-4, IL-13 and IL-5. It seems to increase the messengers for IFN-gamma and IL-12 and favourably modulates the vascular composition to inflammation in asthma. Nevertheless it is to be regretted that too few studies have looked at the correlations between histological changes and clinical and respiratory function improvement engendered by steroid therapy.

[Usefulness of tranexamic acid in cranial remodeling surgery]. / Utilidad del ácido tranexámico en la cirugía de remodelación craneal.

OBJECTIVES: To assess the usefulness of tranexamic acid (TA) in pediatric cranial remodeling surgery, by analyzing its effects on bleeding and transfusion requirements, number of days of cranial drainage required, and time spent in the postoperative recovery unit. MATERIAL AND METHOD: A single-blind, controlled study was designed with 20 patients (10 cases and 10 controls) randomly assigned to receive or not receive 15 mg/kg of intravenous TA upon anesthetic induction, every 4 hours during surgery, and every 8 hours throughout the 48 hours after surgery. Variables analyzed were results of blood tests, blood loss, volume transfused, time in the recovery unit, and complications related to TA infusion. RESULTS: The group treated with TA experienced less bleeding during surgery than did the controls (199 +/- 60 vs 290 +/- 43 mL) and had less need of intraoperative (176 +/- 104 vs 206 +/- 70 mL) and postoperative transfusion (9 +/- 28 vs 52 +/- 72 mL) 24 hours after surgery. TA group patients also spent less time in the recovery unit (60 +/- 14 vs 72 +/- 11 hours). Blood test variables in TA-treated children were also better 24 hours after surgery with regard to hemoglobin (12.1 +/- 2 vs 11.6 +/- 1.3 mg/dL) and platelet (261 +/- 68.5 vs 181.6 +/- 58.1 platelets/mm3) concentrations, and cephalin time (33 +/- 12 vs 49 +/- 16 seconds). No complications related to TA treatment were observed. CONCLUSIONS: TA can reduce perioperative bleeding in the context of pediatric cranial remodeling surgery. TA-treated patients have less need of transfusion and this may reduce the rate of related complications as well a make care more efficient.

Factores pronósticos del resultado del tratamiento rehabilitador en la incontinencia urinaria femenina / Prognostic factors and treatment outcomes for female urinary incontinence rehabilitation

Introducción La incontinencia urinaria es la pérdida involuntaria de orina. Presenta una alta prevalencia en el sexo femenino y un gran impacto biopsicosocial. Son numerosos los factores de riesgo asociados con esta entidad. El tratamiento rehabilitador se establece como de primera línea, aunque su uso no ha sido protocolizado. Objetivo Identificar qué factores de riesgo personales y tipo de tratamiento aplicado se encuentran relacionados estadísticamente con la mejoría de las pacientes. Material y método Estudio de cohortes retrospectivas de las pacientes de sexo femenino diagnosticadas de incontinencia urinaria y que acudieron a la consulta de Rehabilitación de Suelo Pélvico del Hospital Universitario Río Hortega de Valladolid, recibiendo tratamiento rehabilitador a lo largo del año 2021. El periodo de seguimiento mínimo fue de 12 semanas, evaluando la mejoría o no según 7 variables objetivas y subjetivas, estableciendo la mejoría como la evolución positiva en al menos 5 de las 7. Resultados Se analizaron 114 mujeres con incontinencia urinaria. Los tipos de incontinencia más frecuentes fueron: de esfuerzo (53%) y mixta (36%). Los factores de riesgo y enfermedad asociada más importantes fueron la episiotomía (68%), infecciones de orina de repetición (61%) y el estreñimiento (40,9%). Ninguno de estos factores demostró una relación estadísticamente significativa con la mejoría de las pacientes con una p>0,05. El tratamiento rehabilitador más empleado fue cinesiterapia+biofeedback (51%), que demostró una relación estadísticamente significativa con la mejoría de estas pacientes (p=0,037), junto con biofeedback+electroestimulación del nervio tibial posterior (p=0,044). Conclusión Los resultados están en consonancia con los de otros estudios publicados. El biofeedback junto con la cinesiterapia o la electroestimulación del nervio tibial posterior se establecen como los procedimientos rehabilitadores más efectivos (AU)

Background Urinary incontinence is the involuntary loss of urine. It is highly prevalent in women and has a great biopsychosocial impact. Numerous risk factors are associated with this entity. Rehabilitative treatment is established as the first line, although its use has not been protocolized. Aim To identify which personal risk factors and type of treatment applied are statistically related to patient improvement. Methods Retrospective cohort study of female patients diagnosed with urinary incontinence who attended the Pelvic Floor Rehabilitation Clinic of the Río Hortega University Hospital of Valladolid, receiving rehabilitation treatment during the year 2021. The minimum follow-up period was 12 weeks, evaluating improvement or not according to 7 objective and subjective variables, establishing improvement as positive evolution in at least 5 of the 7. Results A total of 114 women with urinary incontinence were analyzed. The most frequent types of incontinence were stress (53%) and mixed (36%). The most important risk factors and associated pathology were episiotomy (68%), repeated urinary tract infections (61%), and constipation (40.9%). None of these factors showed a statistically significant relationship with patient improvement with a p>0.05. The most used rehabilitative treatment was kinesitherapy+biofeedback (51%), which showed a statistically significant relationship with the improvement of these patients (p=0.037), together with biofeedback+posterior tibial nerve electrostimulation (p=0.044). Conclusion The results are in line with other published studies. Biofeedback together with kinesitherapy or posterior tibial nerve electrostimulation are established as the most effective rehabilitative procedures (AU)

Púrpura de Schönlein-Henoch en la edad pediátrica / Henoch-Schönlein purpura in the pediatric age group

El Púrpura de Schönlein-Henoch es la vasculitis sistémica más frecuente de la infancia, caracterizada por el depósito de inmunocomplejos de IgA1 en vasos de pequeño ca-libre. Su tétrada clínica clásica incluye púrpura palpable no trombocitopénico, artritis no erosiva o artralgia, dolor abdominal y compromiso renal. Este último es menos frecuente en niños y es marcador de mal pronóstico. Su diagnóstico se realiza según criterios clínicos, siendo pocas veces necesaria la confirmación histológica, que cons-tituye el gold-standard, con manifestaciones de laboratorio inespecíficas. Se descri-ben variadas complicaciones de distinta severidad, tales como invaginación intestinal, hemorragia digestiva, déficit neurológico, insuficiencia respiratoria, torsión testicular, entre otras. Por esta gran variabilidad clínica constituye un importante diagnóstico diferencial en contextos clínicos altamente prevalentes en pediatría tales como el sín-drome purpúrico y el abdomen agudo. El curso en general es autolimitado y el trata-miento es sintomático una vez que se descartan complicaciones.

Henoch-Schönlein purpura is the most common systemic vasculitis in children, char-acterized by deposition of IgA1-immune-complexes in small-vessels. Its classic clin-ical tetrad includes non-thrombocytopenic palpable purpura, arthritis o arthralgia, abdominal pain and renal involvement. The latter is less frequent in children, but it is a poor prognostic marker. Diagnosis is made through clinical criteria, and in only a few cases a histological confirmation is necessary, which is the gold standard, with unspecific laboratory features. Many complications have been described, such as in-tussusception, gastrointestinal bleeding, neurological deficit, respiratory failure and testicular torsion. Because of its great clinical variability, it constitutes an important differential diagnosis in highly prevalent pediatric clinical scenarios, such as purpuric syndrome and acute abdomen. It is usually self-limited, and its treatment is focused in symptom relief once complications are ruled out.

Prenatal management of placental chorioangioma: value of the middle cerebral artery peak systolic velocity.

Placental chorioangiomas are benign tumors of the placenta. Large chorioangiomas may cause severe complications such as fetal anemia, hydrops and fetal death. We report the use of sonographic findings and peak systolic velocity in the middle cerebral artery in the diagnosis and management of fetal anemia without the occurrence of hydrops fetalis in a pregnant woman with a large placental chorioangioma. Successful intrauterine blood transfusion was performed at 26 weeks. Spontaneous thrombosis of the main supplying blood vessel of the chorioangioma was detected at 33 weeks. The child was delivered at 39 weeks of pregnancy in normal clinical condition.

Pulmonary balloon valvuloplasty in a fetus with critical pulmonary stenosis/atresia with intact ventricular septum and heart failure.

Outcome of fetuses with critical pulmonary stenosis (critical PS) or atresia of the pulmonary valve (PA) with intact ventricular septum (IVS) is closely related with right ventricle hypoplasia and its consequent hemodynamics. Fetal echocardiography not only allows early detection of this condition but also monitors its normally unfavorable evolution. These cases may benefit from intrauterine intervention relieving outflow tract obstruction in order to achieve a biventricular circulation. Successful valvuloplasty of the pulmonary valve was performed in a fetus with critical PS-IVS and heart failure at 25 weeks. After the procedure there was a significant improvement in fetal hemodynamics. Follow-up scans at 34 weeks detected a significant restenosis with signs of circulatory failure leading to premature delivery of the baby. An immediate postnatal valvuloplasty successfully completed the ultimate objective of biventricular repair. Fetal pulmonary valvuloplasty is feasible and may change the natural history of the disease in fetuses with critical PS-IVS.