Litotricia extracorpórea en pacientes pediátricos / Pediatric Extracorporeal Shock Wave Lithotripsy

Introducción. La Litotricia Extracorpórea por Ondas de Choque (LEOC) constituye el pilar fundamental de la urolitiasis infantil. En este trabajo pretendemos objetivar la tasa de fragmentación y expulsión de cálculos mediante LEOC. Material y Métodos. Revisión retrospectiva de procedimientos de LEOC pediátricos, analizando etiología, clínica, tasa de éxito, factores asociados al mismo y complicaciones. Análisis: SPSS 17.0. Resultados. Se revisaron 90 niños (edad: 8 meses-10 años -mediana 2,9 años) que habían presentado 122 litiasis y precisaron 162 procedimientos de LEOC entre 2003 y 2012. Mediana de seguimiento: 20 meses. Diámetro medio del cálculo: 12,2 mm (rango 4-25 mm). La clínica más habitual fue Infección del Tracto Urinario (ITU) (55,6%, 50 niños). El 3,3% de los cálculos se localizaron en vejiga, el 21,3% en uréteres y el 75,4% en riñón. Se realizó una media de 1,41 LEOC por episodio litiásico. Se consiguió fragmentación y expulsión en el 80,3% (98) de los cálculos. Esta tasa fue mayor en niños menores de 5 años (86,1% vs. 69,8%, p=0,03) y en cálculos asociados a prematuridad y estancia prolongada en UCI (100% vs. 78,4%, p=0,19); y peor en cálculos coraliformes (66% vs. 87,2%, p=0,021), y en los de cistina (30% vs. 84,8%, p< 0,001). Entre los 162 procedimientos, hubo 17 complicaciones (10,4%): (6 ITUs -3,7%-, y 5 ITUs asociadas a calle litiásica -3%-), todas relacionadas con cálculos grandes, coraliformes y/o de estruvita. Conclusión. Los mejores resultados en LEOC se objetivan en los pacientes de menor edad. La LEOC pediátrica es eficaz y segura

Introduction. Extracorporeal Shock Wave lithotripsy (ESWL) is the cornerstone of pediatric urolitiasis management. We evaluated its efficacy and complications in a series of children. Material and Methods. Children who were managed with ESWL between 2003 and 2012 were retrospectively reviewed. We studied etiology, clinical presentation, stonefree ratio and relevant complications. SPSS 17.0 software was used. Results.-90 children aged 0 to 10 years (median 2.9 years) were included in the study; that accounted for 122 stones and 162 ESWL sessions. Mean follow up was 20 months. Mean stone diameter was 12.2 mm. (range 4-25). Most prevalent clinical sign was urinary infection (55.6%, 50 patients). 75.4% of the lithiasis were found in renal pelvis or calices. A mean of 1.42 ESWL sessions per stone was performed. Stonefree status was reached in 80.3% (98) of the lithiasis. This rate was higher in patients below 5 years of age (86.1% vs., 69.8%, p=0.03), and worse in staghorn calculi (66% vs. 87.2%) and cystine ones (30% vs. 84.8%, p< 0.001). We observed 17 complications (10.4% among 162 sessions), 6 UTIs, 6 episodes of fever and 6 episodes of UTI associated with steinstrasse. Almost all complications were associated with bigger size, staghorn calculi and struvite. Discussion. Best results are found in younger patients and small calculi. ESWL is a safe and efficient procedure in pediatric patients

[Pediatric Extracorporeal Shock Wave Lithotripsy]. / Litotricia extracorpórea en pacientes pediátricos.

INTRODUCTION: Extracorporeal Shock Wave lithotripsy (ESWL) is the cornerstone of pediatric urolitiasis management. We evaluated its efficacy and complications in a series of children. MATERIAL AND METHODS: Children who were managed with ESWL between 2003 and 2012 were retrospectively reviewed. We studied etiology, clinical presentation, stonefree ratio and relevant complications. SPSS 17.0 software was used. RESULTS: 90 children aged 0 to 10 years (median 2.9 years) were included in the study; that accounted for 122 stones and 162 ESWL sessions. Mean follow up was 20 months. Mean stone diameter was 12.2 mm. (range 4-25). Most prevalent clinical sign was urinary infection (55.6%, 50 patients). 75.4% of the lithiasis were found in renal pelvis or calices. A mean of 1.42 ESWL sessions per stone was performed. Stonefree status was reached in 80.3% (98) of the lithiasis. This rate was higher in patients below 5 years of age (86.1% vs., 69.8%, p=0.03), and worse in staghorn calculi (66% vs. 87.2%) and cystine ones (30% vs. 84.8%, p<0.001). We observed 17 complications (10.4% among 162 sessions), 6 UTIs, 6 episodes of fever and 6 episodes of UTI associated with steinstrasse. Almost all complications were associated with bigger size, staghorn calculi and struvite. DISCUSSION: Best results are found in younger patients and small calculi. ESWL is a safe and efficient procedure in pediatric patients.

INTRODUCCION: La Litotricia Extracorpórea por Ondas de Choque (LEOC) constituye el pilar fundamental de la urolitiasis infantil. En este trabajo pretendemos objetivar la tasa de fragmentación y expulsión de cálculos mediante LEOC. MATERIAL Y METODOS: Revisión retrospectiva de procedimientos de LEOC pediátricos, analizando etiología, clínica, tasa de éxito, factores asociados al mismo y complicaciones. Análisis: SPSS 17.0. RESULTADOS: Se revisaron 90 niños (edad: 8 meses-10 años -mediana 2,9 años) que habían presentado 122 litiasis y precisaron 162 procedimientos de LEOC entre 2003 y 2012. Mediana de seguimiento: 20 meses. Diámetro medio del cálculo: 12,2 mm (rango 4-25 mm). La clínica más habitual fue Infección del Tracto Urinario (ITU) (55,6%, 50 niños). El 3,3% de los cálculos se localizaron en vejiga, el 21,3% en uréteres y el 75,4% en riñón. Se realizó una media de 1,41 LEOC por episodio litiásico. Se consiguió fragmentación y expulsión en el 80,3% (98) de los cálculos. Esta tasa fue mayor en niños menores de 5 años (86,1% vs. 69,8%, p=0,03) y en cálculos asociados a prematuridad y estancia prolongada en UCI (100% vs. 78,4%, p=0,19); y peor en cálculos coraliformes (66% vs. 87,2%, p=0,021), y en los de cistina (30% vs. 84,8%, p<0,001). Entre los 162 procedimientos, hubo 17 complicaciones (10,4%): (6 ITUs ­3,7%­, y 5 ITUs asociadas a calle litiásica ­3%­), todas relacionadas con cálculos grandes, coraliformes y/o de estruvita. CONCLUSION: Los mejores resultados en LEOC se objetivan en los pacientes de menor edad. La LEOC pediátrica es eficaz y segura.

Nutritional knowledge and concerns about meat of elderly French people in the aftermath of the crisis over BSE and foot-and-mouth.

The aim of this study was to compare elderly people with young adults in France for nutritional knowledge and concerns about meat in the aftermath of the rises with bovine spongiform encephalopathy and foot-and-mouth disease. Between March and April 2001, 99 healthy elderly people and 93 younger adults living in France were interviewed. Most of the elderly and young participants knew that meat contains proteins but were unaware of the role of proteins in body metabolism. The elderly knew that meat also contains iron and vitamins and is necessary for growth and for physical activity. However, elderly people had little awareness of the importance of consuming meat and were convinced that they had to reduce meat consumption because of their lower physical activity. On the other hand, they knew more than younger adults about animal diseases and were less worried about 'mad cow disease'. Thus, although the elderly people were confident about the safety of meat and recognised its nutritional properties, they did not consider it to be an essential food.

[Effects of speech therapy with poetry on heart rate variability and well-being]. / Wirkungen der Therapeutischen Sprachgestaltung auf Herzfrequenz-Variabilität und Befinden.

BACKGROUND: Anthroposophical Therapeutic Speech uses poems and exercises which typically induce rhythmical breathing. Speaking influences respiration and thus directly heart rate variability (HRV), in particular via respiratory sinus arrhythmia which, together with the slower rhythms of HRV, may be regarded as an indicator of sympathovagal balance. In chronomedicine numerous frequency ratios between physiological rhythms, especially in trophotropic phases, have been established. Integer ratios occur frequently and seem to be associated with the optimization of physiological processes. In larger groups the average pulse respiration quotient is about 4:1. QUESTION: Can systematic effects on HRV, and thus on autonomic balance, be established through special speech therapy? SUBJECTS AND METHODS: In two trained therapists and 7 untrained subjects the influence of different speech exercises and texts on HRV was investigated. With untrained subjects a total of 105 one-hour sessions, divided into speech and control exercises, was performed. The overall well-being and quality of well-being were assessed with questionnaires. Control evaluations were made in the same setting. RESULTS: As a simultaneous effect, during speech exercises and texts typical intra- and inter-individually reproducible patterns in heart rate variability were observed. Reciting poems with a hexameter metric generates 2 oscillations with a 2:1 frequency ratio in the HRV spectrum. As immediate effects there were a significant drop in heart rate after speech sessions as well as a strengthening of vagus-related HRV parameters, especially after hexameter exercises. In comparison to control sessions the subjects felt significantly better, too. The different metric and poetic character of the texts was reflected clearly in the results.

Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis.

BACKGROUND: Self-management teaching programs are becoming an important asset in the management of pediatric asthma. OBJECTIVE: The study was designed to evaluate the impact of self-management teaching programs on the morbidity of pediatric asthma. METHODS: The meta-analysis included randomized clinical trials, published between 1970 and 1991, addressing the outcome of morbidity. Studies were retrieved from searches of MEDLINE, American Journal of Nursing International Index, and Dissertation Abstracts Online Database. The quality of studies was assessed with the scale of Chalmers. The pooled effect size was calculated by the method of Hedges. RESULTS: The literature search retrieved 23 randomized clinical trials, but 12 studies had to be excluded. Global score of quality of studies (Chalmers' scale) was fair, 51.6% +/- 9.9%. As indicated by the effect size (ES) of the pooled studies, self-management teaching did not reduce school absenteeism (ES: 0.04 +/- 0.08), asthma attacks (ES: 0.09 +/- 0.14), hospitalizations (ES: 0.06 +/- 0.08), hospital days (ES: -0.11 +/- 0.08), or emergency visits (0.14 +/- 0.09). CONCLUSION: Self-management teaching programs do not seem to reduce morbidity, and future programs should focus more on intermediate outcomes such as behavior.

Immunohistochemical demonstration of the lysosome-associated glycoprotein CD68 (KP-1) in granular cell tumors and schwannomas.

The monoclonal antibody KP-1 that recognizes the lysosome-associated glycoprotein CD68 was used together with antibodies to other antigens (actin, glial fibrillary acidic protein, keratin, neurofilaments, chromogranin, synaptophysin, S-100 protein, HMB-45, lysozyme, and HLA-DR) in a labeled streptavidin biotin immunoperoxidase method to phenotypically characterize 27 granular cell tumors, five schwannomas, five neurofibromas, two ganglioneuromas, three ganglioneuroblastomas, five carcinoid tumors, five malignant melanomas, and five examples of histiocytosis X. The neoplastic cells in all 27 of the granular cell tumors and four of the five schwannomas strongly stained for CD68, whereas none of the neurofibromas, ganglioneuromas, ganglioneuroblastomas, or carcinoid tumors contained CD68-positive tumor cells. These findings further strengthen previous observations, suggesting a histogenetic relationship between granular cell tumors and Schwann cells. KP-1 reactivity also was demonstrated in cells of histiocytosis X and malignant melanoma, complementing other studies that extend the tumor types positive in immunoperoxidase stains using this antibody.

Regulation of branched chain amino acid metabolism in ruminants.

The regulation of branched-chain amino acid (BCAA) metabolism has been studied in ruminants mainly during the last decade. Evidences support that the rate of BCAA catabolism is lower in ruminants than in monogastrics. This is associated with a low specific BCAA aminotransferase (first catabolic enzyme) activity and a relatively low degree of activation of the second catabolic enzyme in post-natal ruminant tissues. Similarly to monogastrics in vivo BCAA catabolism involves an interorgan cooperation in ruminants. The benefic effect of leucine excess in protein turnover has also been raised. By contrast leucine excess does not stimulate the rate of isoleucine and valine catabolism in ruminants as much as in monogastrics.

[Metabolic adaptation in hyperthyroidism. Implication of insulin]. / Adaptation métabolique en hyperthyroïdie. Implication de l'insuline.

Hyperthyroidism is associated with intense metabolic disturbances. Thus, an increase of basal metabolism and thermogenesis is noted. Glucose data include increased muscle utilization and hepatic production. Its oxydative catabolism is enhanced, while its use for glycogen synthesis is reduced. Lipid turnover is also increased. In vivo and in vitro improvement of muscle proteolysis in animals induces a reduction of total body protein content; protein synthesis is also paradoxically stimulated. In contrast, this mechanism remains unproved in man. The role of insulin, whose levels usually increase during glucose tolerance tests, is also studied. Glucose tolerance impairment may be related to lower insulin-inhibited glucose production whereas insulin-stimulated glucose peripheral utilization is unmodified. In man, receptor assays demonstrate reduced amount of binding-sites on various cell, while animals studies lead to contradictory results; thus, receptor studies do not demonstrate any clear mechanism for insulin resistance in hyperthyroidism.

[Findings and hormonal coordination of protein metabolism in ruminants]. / Orientations et coordination hormonale du métabolisme protéique chez les ruminants.

Protein metabolism roughly exhibits the same characteristics in ruminants and non-ruminant species. Changes in whole-body protein mass are the result of the balance between the simultaneous protein synthesis and breakdown. Essential amino acids are either incorporated into protein or degraded. Insulin, growth hormone and glucagon have been shown to regulate those metabolic pathways in ruminants. Alteration of food intake both decreases protein synthesis and protein breakdown. Protein synthesis is affected to a greater extent than protein breakdown. So protein synthesis is the main factor controlling N balance in response to alteration of food intake. The decrease in protein synthesis may be related to an impairment of plasma insulin. Protein synthesis and breakdown both decrease throughout development. Protein deposition decreases throughout development because protein synthesis declines more rapidly than protein breakdown. The hormonal coordination of those changes depends on the age of the animals. For example the decrease in protein synthesis in the postnatal growth period may be due to either the decrease in plasma growth hormone or to the impairment in cellular insulin receptors. Due to milk protein synthesis in the mammary gland, lactating animals exhibit a large increase in whole-body protein synthesis. Surprisingly, protein synthesis decreases in some non-mammary tissues. This represents a mechanism for a greater partitioning of amino acids towards milk at the expense of body proteins. We recently demonstrated that insulin could be involved in that adaptative process.

Dietary control of protein turnover.

The balance between protein synthesis and breakdown (protein turnover) regulates whole-body protein mass. The relationships between dietary changes (amount and composition of food) and protein synthesis, protein breakdown and amino acid oxidation have been explored in order to better understand adaptations of protein and amino acid metabolism. Methods for measuring protein synthesis, especially whole-body protein synthesis, can be divided into two groups: the 15N end-product method (urea and/or ammonia), and the incorporation of labelled amino acid(s) into proteins. Assumptions and limitations of the widely used two-pool model (free amino acid and protein pools) are discussed. Results obtained with different methods and for amino acids have been compared, to assess their ability to detect changes in protein synthesis rates. Methods of measuring protein breakdown have also been described briefly. Food intake affects whole-body and tissue protein turnover throughout development of animals and humans in different ways. Protein metabolism fluctuates during the 24-hour period in response to intermittent food intake. During the post-prandial period, a net whole-body protein deposition occurs. This is essentially due to increased protein synthesis. The free amino acid pool and amino acid oxidation rates also increase. Consequently, amino acids are used to a great extent as energy substrates. In contrast, a decrease in protein breakdown could enhance protein deposition. During fasting, the rates of whole-body protein synthesis are lower than those of protein breakdown. This results in protein loss, essentially because the drop in protein synthesis rate in muscle is pronounced. N balance is controlled by the amounts and composition of the diet and by changes in protein synthesis and breakdown. Increasing food intake above levels of energy equilibrium can produce growth by enhancing both the whole-body protein synthesis and breakdown rates. Below energy equilibrium, whole-body protein loss occurs because of decreased protein synthesis which becomes lower than protein breakdown. Protein synthesis rate is the main factor controlling N balance in response to alterations in food intake. Increasing dietary protein, especially the essential amino acids, involves increased rates of whole-body protein synthesis and breakdown. The improved N balance obtained by enhancing dietary non-protein energy (carbohydrate, fat) can be brought on by reducing amino acid oxidation and slightly increasing protein synthesis. The effects of dietary protein and energy on protein turnover are apparently additive.

[Toxic effect of four heavy metals on the growth of unicellular marine algae]. / Action toxique de quatre métaux lourds sur la croissance d'algues unicellulaires marines.

The growth inhibition of phytoplankton, resulting from Cd, Cu, Hg and Pb in sea water, has been studied on 18 monospecific strains belonging to different taxonomic groups. Data obtained pointed out that all species are very susceptible to Hg, and slightly to Pb. Effects of Cu and Cd vary with species, but Cu appears to be more toxic with dinoflagellates than with diatoms. In the authors' opinion, these results, obtained under laboratory conditions, cannot immediately be extended to the natural environment.