Pielonefritis enfisematosa (xantogranulomatosa) en niña con litiasis renal / Emphysematous (xanthogranulomatous) pyelonephritis in a young girl with renal lithiasis

Introducción: se reporta un caso clínico de pielonefritis enfisematosa (PE) en el riñón derecho de una niña de 4 años de edad, con litiasis en pelvis renal de 2.9 cm. Existen pocos casos publicados de PE, la mayoría de ellos en adultos con diabetes mellitus. Discusión: los hallazgos de una hidronefrosis en el ultrasonido renal y una masa dolorosa en el flanco derecho la cual crepitaba a la palpación, hizo sospechar de esta rara enfermedad. La paciente fue sometida a nefroureterectomía derecha de urgencia luego de estabilizar su estado clínico general, el curso clínico posquirúrgico fue satisfactorio.

Introduction: we report a clinical case of right kidney emphysematous pyelonephritis (EPN) in a 4-year-old girl with a 2.9 cm renal pelvic calculus. Few cases of EPN have been published, most of them occurring in adults with diabetes mellitus. Discussion: the presence of hydronephrosis detected by a renal ultrasound and a painful crepitant mass in the right flank upon palpation, arose suspicion of this rare disease. The patient underwent an emergency right nephroureterectomy following stabilization of her clinical status. The postoperative course was satisfactory

Implications of gut and oral microbiota in neuroinflammatory responses in Alzheimer's disease.

A diverse and stable microbiota promotes a healthy state, nevertheless, an imbalance in gut or oral bacterial composition, called dysbiosis, can cause gastrointestinal disorders, systemic inflammatory states and oxidative stress, among others. Recently, gut and oral dysbiosis has been linked to Alzheimer's disease (AD), which is considered the most common form of dementia and a public health priority due to its high prevalence and incidence. The aim of this review is to highlight the implications of gut and oral microbiota in the neuroinflammation characteristic of AD pathology and the subsequent cognitive impairment. It is a systematic review of the current literature obtained by searching the PubMed, Web of Science and Scopus databases. The characteristic intestinal dysbiosis in AD patients leads to increased permeability of the intestinal barrier and activates immune cells in the central nervous system due to translocation of microbiota-derived metabolites and/or bacteria into the circulation leading to increased neuroinflammation and neuronal loss, thus generating the cognitive impairment characteristic of AD. The presence in the central nervous system of Porphyromonas gingivalis can cause an increased neuroinflammation and beta-amyloid peptide accumulation.

Glucocorticoid Effect in Cancer Patients.

The use of glucocorticoids is very varied in the context of cancer patients and includes the treatment of symptoms related to cancer, but also the management of the most common side effects of antitumor treatments or adverse events related to the immune system. There is a quantity of experimental evidence demonstrating that cancer cells are immunogenic. However, the effective activation of anticancer T cell responses closely depends on an efficient antigen presentation carried out by professional antigen-presenting cells such as dendritic cells (DCs). The classic strategies to improve the medical management of inflammation are aimed at exacerbating the host's immune response. Although successful in treating a number of diseases, these drugs have limited efficacy and variable responses can lead to unpredictable results. The ideal therapy should reduce inflammation without inducing immunosuppression and remains a challenge for healthcare personnel.

Analysis of Knowledge of Smoking-Related Diseases in Spanish Nursing Students.

Smoking causes significant morbidity and mortality worldwide, mainly in developed countries. In addition, it is the cause of numerous diseases in the body, despite the fact that the prevalence of tobacco use is decreasing. Nursing students, as future professionals, should be aware of action plans for cessation and information designed for smokers. To determine the level of knowledge among nursing students about smoking-related diseases and analyze the prevalence of student who smoke at the University of Leon, Spain, a descriptive cross-sectional study was carried out in which students were given an anonymous questionnaire, which was previously validated, during the 2021-2022 academic year. In a sample of 477 (79.5%) nursing students, a smoking prevalence of 17.6% was obtained. In addition, students' knowledge about the diseases directly caused by tobacco consumption and others associated with exposure to environmental smoke was assessed, and in both cases (8.03 points of 9 for consumption and 5.24 of 6 to exposure), scores were obtained that allow us to state that students do not know for sure the types of diseases that are related to tobacco use and passive smoking. In spite of this, it is necessary to continue to reduce the prevalence of smoking through different programs implemented in schools and universities, as it is also necessary to improve teaching plans when explaining smoking-related diseases, so that students, in the future, will be able to advise patients correctly.

La importancia de estar incluido en el Emerging sources Citation Index para las revistas y autores españoles / The importance of being included in the emerging sources citation index for spanish journals and authors

La evaluación de la actividad de los investigadores, de sus publicaciones y de las revistas donde se publican dichos trabajos, es un proceso continuo y necesario para poder valorar la calidad y el impacto de los mismos. Estas revistas están indexadas en diferentes bases de datos, siendo la Web Of Science una de las más importantes, junto con Scopus, debido a la cantidad de información que tiene recogida y a los rigurosos criterios que deben cumplir las revistas para ser incluidas en ella. Una nueva herramienta de esta base de datos es el Emerging Sources Citation Index, que contiene revistas que o bien están en proceso de evaluación, o bien son revistas que presentan una calidad científica acreditada en su disciplina, pero que nunca llegarán a integrarse en la Web of Science ya que su área de conocimiento es limitada y previsiblemente nunca llegaran a tener un factor de impacto suficientemente alto. El estar incluido en este recurso, como lo está ROL Revista de Enfermería, tiene un gran valor para las revistas y para los autores que publican sus trabajos en ellas ya que supone un mérito valorado en la mayoría de los procesos de evaluación de los investigadores, como por ejemplo en la Agencia Nacional de Evaluación de la Calidad y Acreditación (ANECA). (AU)

The evaluation of the activity of researchers, their publications and the journals where these works are published, is a continuous and necessary process to assess their quality and impact. These journals are indexed in different databases, being Web Of Science one of the most important, together with Scopus, due to the amount of information it has collected and the rigorous criteria that journals must meet to be included in it. A new tool of this database is the Emerging Sources Citation Index, which contains journals that are either in the process of evaluation, or are journals that have a proven scientific quality in their discipline, but that will never be included in the Web of Science because their area of knowledge is limited and they will probably never have a sufficiently high impact factor. Being included in this resource, as ROL Revista de Enfermería is, has a great value for the journals and for the authors who publish their work in them, since it is a merit valued in most of the evaluation processes of researchers, such as the National Agency for Quality Assessment and Accreditation (ANECA). (AU)

Implicaciones para la enfermería española del informe de referencia sobre la década del envejecimiento saludable 2021-2030 / Implications for spanish nursing of the reference report for a decade of healthy ageing 2021-2030

La Década del Envejecimiento Saludable reabre oportunidades para invertir en entornos adaptados a las personas mayores y en sistemas integrados de atención sanitaria y social. El objetivo de este trabajo es analizar esas ventanas de oportunidad para Enfermería. El envejecimiento saludable implica que las personas mayores contribuyen a la sociedad durante más tiempo, con oportunidades para gozar de buena salud, y para mantener y desarrollar las capacidades, y que está determinado por la capacidad funcional, la capacidad intrínseca y el entorno físico y social. Para ello, son precisos sistemas sociales y de salud integrados, transformadores y centrados en las personas, en lugar de sistemas basados únicamente en la enfermedad. Enfermería puede contribuir cambiando la forma de pensar, de sentir y de actuar con respecto a la edad y el envejecimiento, ofreciendo una atención integrada y centrada en las personas, adaptando el modelo de cuidados, con el foco en la promoción de la salud y la prevención de la enfermedad, y la atención de las personas mayores potenciando sus capacidades y su autonomía, en especial desde la Atención Primaria. Luchar contra el edadismo, formar a enfermeras en competencia de práctica avanzada, mejorar la accesibilidad, formar a las personas mayores y sus familias en materia digital, investigando sobre estos factores, son oportunidades que vuelve a abrir el Informe sobre la Década del Envejecimiento Saludable para Enfermería. (AU)

The Decade of Healthy Ageing reopens opportunities to invest in age-friendly environments and integrated health and social care systems. The aim of this paper is to analyse these windows of opportunity for Nursing. Healthy ageing implies that older people contribute to society for longer, with opportunities to have good health, and to maintain and develop capabilities, and that it is determined by functional ability, intrinsic capacity and the physical and social environment. This requires integrated, transformative and people-centred health and social systems, rather than systems based on disease. Nursing can contribute by changing the way we think, feel and act about age and ageing, offering integrated and person-centred care, adapting the model of care, with a focus on health promotion and disease prevention, and care for older people by enhancing their capabilities and autonomy, especially in primary care. Fighting against ageism, training nurses in advanced practice competency, improving accessibility, training older people and their families in digital matters, researching on these factors, are opportunities that the Decade of Healthy Ageing Report reopens for Nursing. (AU)

[Analysis of Bullying and Harassment Experienced by Fourth-Year Nursing Students in their Clinical Practice.] / Análisis de la intimidación y acoso experimentado por estudiantes de Enfermería de cuarto curso durante sus prácticas clínicas.

OBJECTIVE: Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/or harassment experienced by Nursing students during their clinical practice. METHODS: A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student's t-test and Mann Whitney U test were used for statistical analysis. RESULTS: A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients. CONCLUSIONS: The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.

OBJETIVO: Los estudiantes de Enfermería, con su inexperiencia y el desafío frecuente de encontrarse con nuevos entornos, son un grupo potencialmente vulnerable para sufrir intimidación y acoso en el ámbito del trabajo. El objetivo de este trabajo fue analizar la intimidación y/o acoso padecidos por los estudiantes de Enfermería durante sus prácticas clínicas. METODOS: Se realizó un estudio descriptivo transversal en la Universidad de León. La población a estudio fueron los estudiantes del Grado en Enfermería de cuarto curso. El instrumento de medida fue un cuestionario que constó de 24 items y que se aprobó por el Comité de Ética de la Universidad. Para el análisis estadístico se utilizó la prueba de chi-cuadrado, t de Student y la U de Mann Whitney. RESULTADOS: Se observó una prevalencia del 26,5% (n=83) de estudiantes que sufrieron episodios de intimidación y/o acoso; los estudiantes de menor edad padecieron estos hechos por parte de los médicos, pacientes y familiares y/o acompañantes en mayor medida. Esto produjo un impacto en su bienestar psicológico e hizo que se sintieran deprimidos, humillados e incapaces, lo que afectó negativamente al nivel de atención prestado a los pacientes. CONCLUSIONES: El problema global estudiado presenta una prevalencia inferior a la obtenida en otros trabajos llevados a cabo en el resto del mundo. Como consecuencia, existe un impacto en el bienestar psicológico de los estudiantes que afecta a su nivel de atención en las tareas que están llevando a cabo y a su forma de trabajar con los demás.

Análisis de la intimidación y acoso experimentado por estudiantes de Enfermería de cuarto curso durante sus prácticas clínicas / Analysis of Bullying and Harassment Experienced by Fourth-Year Nursing Students in their Clinical Practice

FUNDAMENTOS:Los estudiantes de Enfermería, con su inexperiencia y el desafío frecuente de encontrarse con nuevos entornos, son un grupo potencialmente vulnerable para sufrir intimidación y acoso en el ámbito del trabajo. El objetivo de este trabajo fue analizar la intimidación y/o acoso padecidos por los estudiantes de Enfermería durante sus prácticas clínicas. MÉTODOS: Se realizó un estudio descriptivo transversal en la Universidad de León. La población a estudio fueron los estudiantes del Grado en Enfermería de cuarto curso. El instrumento de medida fue un cuestionario que constó de 24 items y que se aprobó por el Comité de Ética de la Universidad. Para el análisis estadístico se utilizó la prueba de chi-cuadrado, t de Student y la U de Mann Whitney. RESULTADOS: Se observó una prevalencia del 26,5% (n=83) de estudiantes que sufrieron episodios de intimidación y/o acoso; los estudiantes de menor edad padecieron estos hechos por parte de los médicos, pacientes y familiares y/o acompañantes en mayor medida. Esto produjo un impacto en su bienestar psicológico e hizo que se sintieran deprimidos, humillados e incapaces, lo que afectó negativamente al nivel de atención prestado a los pacientes. CONCLUSIONES: El problema global estudiado presenta una prevalencia inferior a la obtenida en otros trabajos llevados a cabo en el resto del mundo. Como consecuencia, existe un impacto en el bienestar psicológico de los estudiantes que afecta a su nivel de atención en las tareas que están llevando a cabo y a su forma de trabajar con los demás.(AU)

BACKGROUND: Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/ or harassment experienced by Nursing students during their clinical practice. METHODS: A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student’s t-test and Mann Whitney U test were used for statistical analysis. RESULTS: A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients. CONCLUSIONS: The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.(AU)

Percepción de los pacientes sobre los cuidados de enfermería en el contexto de la crisis del COVID-19 / Patient perception of nursing care in the context of the COVID-19 crisis

Antecedentes: La pandemia de COVID-19 ha alterado considerablemente los procedimientos habituales de los sistemas sanitarios en todo el mundo. El trabajo diario se ha vuelto física y emocionalmente agotador para los profesionales sanitarios, obligados a afrontar y adaptarse a nuevos retos y situaciones estresantes. Esta situación pesa sobre la práctica diaria de enfermería. Objetivo: El presente estudio tuvo como objetivo determinar la percepción del paciente sobre los cuidados de enfermería humanizados recibidos durante su estancia hospitalaria. Método: Se realizó un estudio descriptivo, cuantitativo, transversal, en el que se realizaron entrevistas telefónicas a 357 personas >18 años que ingresaron durante más de 24 horas en el Hospital de León con el fin de evaluar la percepción del paciente. Uno de los instrumentos utilizados fue la Escala de Percepción de Conductas del Cuidado de Enfermería Humanizado (PCHE), para evaluar en tres dimensiones (D): cualidades de la práctica de enfermería (D1), apertura a la comunicación enfermera-paciente (D2) y disposición al cuidado (D3). El otro instrumento utilizado fue una encuesta de satisfacción institucional para conocer la opinión sobre la calidad de la atención al cliente en el área de hospitalización. Resultados: El porcentaje de pacientes que puntuaron como “siempre” cada dimensión fue: D1 = 91,2%; D2 = 81,4%; y D3 = 87,8%. La satisfacción del paciente obtuvo una puntuación media de 4,6 sobre 5. Conclusión: A pesar del impacto negativo del COVID-19 en el sistema de salud, los pacientes percibieron la atención de enfermería humanizada recibida como muy satisfactoria. (AU)

The Influence of Nutrition in Alzheimer's Disease: Neuroinflammation and the Microbiome vs. Transmissible Prion.

Alzheimer's disease (AD) is a primary, progressive, neurodegenerative disorder. Many risk factors for the development of AD have been investigated, including nutrition. Although it has been proven that nutrition plays a role in AD, the precise mechanisms through which nutrition exerts its influence remain undefined. The object of this study is to address this issue by elucidating some of the mechanisms through which nutrition interacts with AD. This work is a qualitative systematic bibliographic review of the current literature searchable on various available databases, including PubMed, Web of Science, and Google Scholar. Our evidence comprises 31 articles selected after a systematic search process. Patients suffering with AD present a characteristic microbiome that promotes changes in microglia generating a proinflammatory state. Many similarities exist between AD and prion diseases, both in terms of symptoms and in the molecular mechanisms of pathogenesis. Changes in the composition of the gut microbiome due to dietary habits could be one of the environmental factors affecting the development of AD; however, this is probably not the only factor. Similarly, the mechanism for self-propagation of beta-amyloid seen in AD is similar to that seen in prions.

Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review.

"Postoperative delirium" is defined as delirium occurring in the hospital up to one week after a procedure or before discharge (whichever occurs first) that meets the DSM-5 diagnostic criteria. Objectives: To describe the risk factors related to this pathology and identify effective non-pharmacological forms of treatment. An integrative review of the available literature was performed. The search results considered included all quantitative studies published between 2011 and 2019 in both English and Spanish. A total of 117 studies were selected. Advanced age was identified as the principal risk factor for postoperative delirium. Nursing interventions appear to be the key to preventing or reducing the seriousness of delirium after an anaesthetic episode. The aetiology of postoperative delirium remains unknown, and no treatment exists to eliminate this pathology. The role of nursing staff is fundamental in the prevention, diagnosis, and management of the pathology.

Antibiotics Therapy in the Multi-Resistant Patient.

Antibiotic resistance is not only a European or American problem: it is a global crisis. The emergence of resistance to multiple antimicrobial agents has become a major threat to public health. The main objective of the institution's antimicrobial policy is to adapt the effective treatment to each patient, with a minimum of complications, avoid adverse reactions, control the development and spread of strains of resistant microorganisms as well as reduce hospital costs whenever possible. World Health Organization published a global list of priority pathogens of antibiotic-resistant bacteria to help prioritize research and development of new and effective antibiotic treatments. We must take into account the risk factors related to multiresistance, as well as factors that favor horizontal and vertical transmission. The need to prioritize implementation of these global strategies is complex and involves a lot of effort and valuable time; this point favors the rapid development resistance.

Lesiones de uretra posterior secundarias a fractura pélvica tratadas a través de abordaje perineal progresivo. Breve revisión de la literatura. / Pelvic fracture posterior urethral injury repaired by progressive perineal approach: A brief review of the literature

Objetivo: Revisar los resultados operatorios de nuestros pacientes con rotura traumática de uretra posterior, tratados a través del abordaje perineal progresivo y realizar una breve revisión de la literatura. Materiales y métodos: fueron analizadas las historias médicas de 7 pacientes en edades comprendidas entre 2 y 12 años, con lesiones uretrales asociadas con fracturas pélvicas, producidas entre marzo de 2005 y enero de 2017. Después del diagnóstico de la lesión, se realizó cistostomía derivativa en los 7 casos; en 2 de ellos con lesión rectal asociada se realizó, además, colostomía tipo Hartman en el momento de la derivación urinaria. La evaluación urológica preoperatoria para la uretroplastia definitiva incluyó uretrografía anterógrada y retrograda simultánea para determinar la separación entre los segmentos uretrales. Se decidió la reparación retardada de la uretra a través de abordaje perineal progresivo con un mínimo de 6 meses posterior al trauma. Resultados: El mecanismo de producción del trauma fue arrollamiento por vehículos a motor en 6 pacientes y aplastamiento por balancín petrolero en uno. La lesión uretral fue completa en todos. Tres presentaron complicaciones quirúrgicas; 2 estenosis uretrales que mejoraron con dilataciones y una fístula uretroperineal que cerró en forma espontánea sin consecuencias. Todos los pacientes se encuentran asintomáticos; ninguno ha requerido una nueva uretroplastia. Comentarios: Nuestros hallazgos con la implementación de este abordaje terapéutico coinciden con lo reportado en la literatura.

Objective: To evaluate the postoperative outcomes of our patients with posterior urethral traumatic rupture repaired by progressive perineal approach, and to conduct a brief review of the literature. Materials and methods: The clinical records of 7 patients aged between 2 to 12 years with urethral injuries due to pelvic fracture produced between March 2005 and January 2017, were reviewed. A suprapubic cystostomy for urinary drainage was constructed in the 7 patients immediately after diagnosis; two of them had concomitant rectum injuries thus a Hartmann's colostomy was also performed in them. The preliminary urologic appraisal for definite urethroplasty included a synchronous anterograde and retrograde cysto-urethrogram to determine separation of the urethral segments. The final selection of surgical procedure was delayed urethral repair by progressive perineal approach minimum 6 months after the trauma event. Results: The mechanism of injury was, blunt trauma after being struck by a moving vehicle in 6 patients and a crash injury caused by an oil rocker in one patient. The urethral disruption was complete in all patients. Three patients developed surgical complications: 2 urethral strictures which improved with dilatation and one urethral-perineal fistula with spontaneous closure and no associated complications. All patients remain asymptomatic; no patient has required a redo urethroplasty. Commentaries: Our findings through the implementation of this therapeutic approach are consistent with those reported in the literature. Conclusions: Progressive perineal access allows performing an anastomotic urethroplasty with good clinical outcomes in most patients.

[Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature]. / Asociación de fistula rectovaginal congénita con ano normal (Fístulas Tipo H) y atresia rectal en una paciente. Reporte de un caso y breve revisi6n de la literatura.

Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.

Asociación de fistula rectovaginal congénita con ano normal (Fístulas Tipo H) y atresia rectal en una paciente. Reporte de un caso y breve revisión de la literatura / Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature.

Las malformaciones ano-rectales del tipo de fístulas recto-urogenitales congénitas con ano normal y atresia rectal son anomalías poco frecuentes. Se discute el caso de una niña con la asociación de estas dos entidades, acompañada además de una vagina doble, quien fue llevada a la consulta a los siete días de vida por la expulsión de heces a través de los genitales. Las malformaciones fueron corregidas a través de un abordaje sagital posterior, con descenso del recto hasta el ano sin disección perineal. El tabique vaginal fue resecado a través de la vulva. En la actualidad no hay evidencia de recurrencia de la fístula recto-vaginal.

Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.

[Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias. A case report]. / Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal. reporte de un caso clínico.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal: Reporte de un caso clínico / Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias: A case report

Se presenta el caso de un paciente masculino quien requirió tratamiento por agenesia anorrectal con fístula rectouretral y transposición pene-escrotal con hipospadias perineal, acompañados de una masa perineal. La tumoración perineal se encontró íntimamente adherida y en continuidad al recto, lo que la hace compatible con una duplicación rectal extrofiada. La reconstrucción quirúrgica de la anomalía se realizó en etapas hasta lograr resultados funcionales y estéticos aceptables.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

[Minimally invasive approach of extramedullary intradural spinal tumours. Review of 30 cases]. / Abordaje mínimamente invasivo de las lesiones espinales intradurales extramedulares. Revisión de 30 casos.

OBJECTIVE: To analyse the safety and effectiveness of a microsurgical unilateral approach in minimally invasive surgery of extramedullary, intradural spinal tumours. MATERIALS AND METHODS: This was a retrospective study of 29 patients with 30 extramedullary, intradural spinal tumours approached through unilateral laminectomy -hemilaminectomy. Epidemiological data, location and histology of the lesions and radiological and clinical evolution of the patients were recorded. The Nurick scale was used in the preoperative and postoperative functional assessment conducted during the last follow-up consultation. The mean age of patients was 60 years and there was a predominance of the female gender. The mean time elapsed from the onset of symptoms to diagnosis was 11.6 months. Sensitive and motor deficits were the most common symptoms. Meningioma was the most frequent lesion, followed by neurinoma and ependymoma. The most commonly affected level was the dorsal, followed by the lumbar and cervical. RESULTS: Total resection was performed in all cases except for one cervical neurinoma with extraforaminal extension. Three patients presented postoperative complications -cerebrospinal fluid fistula, asymptomatic pseudomeningocele and postoperative functional worsening- which were resolved with conservative treatment. The mean time of clinical and radiological follow-up was 33.4 months, with no tumoural recurrences being observed except for two cases of meningiomas. After the follow-up period, patients without functional disorders remained stable and all patients with functional disorders presented a clinical improvement of at least one point in the Nurick scale. CONCLUSIONS: We consider that the microsurgical unilateral approach is a safe and effective technique for the resection of most extramedullary, intradural spinal tumours.

Gonadectomía bilateral e histerosgalpingectomía laparoscópica en un adolescente con desorden de desarrollo sexual ovotesticular: reporte de caso / Bilateral gonadectomy and laparoscopic hysterosalpingectomy in an adolescent with ovotesticular disorder of sexual development: case Report

Los desórdenes de desarrollo sexual hacen referencia a niños cuyos genitales al nacer presentan características de ambos sexos o aquellos que, teniendo un fenotipo normal, presentan alteraciones del desarrollo en la pubertad o adolescencia. Estos desórdenes representan un reto diagnóstico y terapéutico, debido a que pueden ser desencadenados por diferentes entidades nosológicas, y por otro lado, pacientes portadores de las mismas patologías pueden presentar diferentes alteraciones anatómicas. La laparoscopia juega un importante papel en el abordaje diagnóstico de estos pacientes; permite la visualización de los genitales internos y la toma de muestras de tejidos para estudios histológicos. Desde el punto de vista terapéutico, la cirugía laparoscópica permite la extirpación de estructuras internas opuestas al sexo definitivo del paciente. Se reporta el caso de un adolescente con desorden del desarrollo sexual ovotesticular (Hermafrodita verdadero) a quien una vez definido el sexo social como varón, se le extirparon a través del abordaje laparoscópico, los remanentes embrionarios derivados del Müller. Se practicó mamoplastia reductora e implantación de prótesis testiculares a través de cirugía convencional.

Disorders of sexual development in adolescents refer to children whose genitals at birth present characteristics of both genders, or to those children with normal phenotype that present a development alteration during puberty or adolescence. These disorders represent diagnostic and therapeutic challenges, because they can be triggered by different nosological entities; and on the other hand, patients carrying the same pathologies can present different anatomical alterations. Laparoscopy plays an important role in the diagnostic approach of these patients because, besides the fact that it allows an excellent visualization of the internal genitals anatomy, it also allows tissue sample taking for histological studies. On the other hand, from a therapeutic point of view, laparoscopic surgery allows removal of internal structures opposed to the patient’s definite gender. We report the case of an adolescent with ovotesticular disorder of sexual development (True Hermaphrodite) from whom, once his male gender was socially defined, the embrionary remnants derived from Müller were removed through laparoscopic approach. Mamoplastic reduction and testicular prosthesis implantation were also practiced through conventional surgery.