Motoric Cognitive Risk Syndrome: Prevalence and Risk of Cognitive Impairment in a Population Studied in the Mexican Health and Aging Study 2012-2015.

OBJECTIVES: The aim of this study was to determine the prevalence of Motoric Cognitive Risk (MCR) syndrome, describe associated risk factors and to determine the risk of progression to cognitive impairment after three years of follow-up, in a sample of Mexican older adults. DESIGN: A prospective panel study of health and aging in Mexico. SETTING AND PARTICIPANTS: Baseline and follow-up information was obtained from the Mexican Health and Aging Study's 2012 and 2015 waves. A total of 726 subjects aged 60 years or older with normal cognition at baseline were classified into 4 groups: 1) with MCR, 2) with memory complaint only, 3) with slow gait speed only and, 4) without MCR. Cox regression analysis controlling for confounder factors was performed to determine the risk of progression to cognitive impairment in the MCR group. MEASURES: Data such as gait speed, functional status and cognitive performance (standardized by age and sex in Mexican population) was collected. RESULTS: MCR prevalence was 14.3%. When compared with non-MCR subjects, the presence of MCR was associated with older age (p<0.01), lower educational status (p=0.05), having two or more comorbidities (p<0.05) and diabetes mellitus diagnosis (p<0.05). At follow-up and after adjusting for confounders, MCR was associated with a 2.4-fold increased risk (95% CI: 1.28-4.26, p=.000) of cognitive impairment. CONCLUSIONS: MCR syndrome increases the risk of cognitive impairment in Mexican older adults. Simple measurements such as gait evaluation in subjects with memory complaints could allow early identification of those at risk of developing cognitive impairment.

Avances en las técnicas intervencionistas para incrementar la seguridad / Advances in interventionist techniques to increase safety

El síndrome lumbociático es una las patologías más frecuentes en la práctica clínica habitual, siendo el dolor lumbar postlaminectomía y el síndrome de estenosis de canal lumbar dos de los principales exponentes. El tratamiento de ambos síndromes es un reto para todos los profesionales que han de tratarlos, no respondiendo en un porcentaje elevado de los casos a la terapia farmacológica ni intervencionistas. En las ocasiones en las que no son efectivos los tratamientos menores ni los farmacológicos, la epiduroscopia es una de las técnicas intervencionistas que se han de emplear, no solo como un arma diagnóstica sino también como un específico tratamiento activo en la liberación de la fibrosis epidural o bien en la eliminación de la hipertrofia del ligamento amarillo. Presentamos una novedad en el empleo de esta terapia que aporta un importante avance que permite aumentar la seguridad de la técnica y ayuda a la localización de estructuras nobles en el espacio epidural por la posibilidad de realizar una estimulación sensorial y motora antes de realizar el tratamiento definitivo, de manera que permitirá diferenciar entre el tejido noble que pretendemos preservar y la fibrosis o el ligamento que pretendemos eliminar (AU)

Lumbosciatic syndrome is one of the most frequent pathologies in the chronic pain clinical practice, being postlaminectomy syndrome and lumbar spinal stenosis two of its major causes. The treatment of these two syndromes represent a challenge for the treating physician, because in a high number of patients they don't respond to pharmacological therapy or to interventional techniques. When the conservative treatment and the minimally invasive procedures fail to treat the lumbosciatic pain, the epiduroscopy becomes one of the indicated techniques, not only as a diagnostic tool, but as a specific treatment implement that allows the release of epidural fibrosis or the elimination of part of the hypertrophied flavum ligament. In this paper we present a novelty in the use of this therapy, which we consider an important advance to increase the safety of the technique, because of the possibility to locate noble tissue in the epidural space by applying sensitive and motor stimulation before makig any definitive treatment, this allows to differentiate between noble tissue, which we aim to preserve, and fibrosis o ligamentum flavum, which we pretend to eliminate (AU)

Caracterización de una población con discapacidad visual (baja visión y ceguera) atendida en dos instituciones prestadoras de salud de Medellín / Characterization of a population with visual disabilities (low vision and blindness) attended in two health institutions from Medellín / Caracterização de uma população com incapacidade visual (baixa visão e cegueira) atendida em duas instituições prestadoras de saúde de Medellín

Objetivo: caracterizar, en los ámbitos clínico y sociodemográfico, una población de pacientes con discapacidad visual atendidos en dos instituciones de salud de la ciudad de Medellín (departamento de Antioquia/Colombia), con énfasis en la etiología del déficit visual irreversible. Metodología: estudio observacional descriptivo. Estudio macro sobre deficiencias visuales unilaterales y bilaterales en 1 742 registros de historias clínicas para identificar pacientes con baja visión o ceguera. Aplicación de un formato de investigación orientado a validar los pacientes con discapacidad visual y se seleccionaron 107 historias clínicas. Resultados: el 56.6% presenta discapacidad visual tipo baja visión y el 43.4% discapacidad visual tipo ceguera. El déficit visual responsable de la discapacidad visual fue del 39% por causas oftalmológicas, 20% por alteraciones neuro-oftalmológicas y 17% por trastornos neurológicos de cortezas visuales. Además de la agudeza visual, se encontraron otras deficiencias de la función visual: atrofia óptica, alteración electrofisiológica de la conducción visual y encefalomalacia en cortezas visuales. El 82% de los pacientes tiene al menos una comorbilidad no oftalmológica. Conclusiones: es fundamental un adecuado registro de las características biológicas, sociales, psicológicas y de las actividades de rehabilitación de los pacientes con baja visión y ceguera, para entender en forma integral no sólo la discapacidad sino el impacto que produce.

Objective: to characterize the clinical and socio-demographical characteristics of a population of patients with visual impairment attended at two health institutions in Medellín (Antioquia, Colombia), with an emphasis on the etiology of irreversible vision loss. Methodology: Observational, descriptive study of unilateral and bilateral visual impairment in 1 742 medical records to identify patients with low vision or blindness. A research form was used to validate patients with visual impairment, and 107 medical records were selected. Results: 56.6% presented low vision and 43.4% presented blindness. Vision loss was due to ophthalmic causes in 39% of cases, 20% were caused by neuro-ophthalmic alterations and 17% by neurological disorders of the visual cortex. In addition to visual acuity, other visual impairments were found, such as optic atrophy, electrophysiological alteration of the visual pathway, and encephalomalacia in visual cortices. 82% of patients had at least one nonophthalmic comorbidity. Conclusions: Adequate registration of rehabilitation activity, biological, social, and psychological characteristics of patients with low vision and blindness is essential in order to fully understand both the impairment and its impact.

Objetivo: caracterizar, nos âmbitos clínico e sócio-demográfico, uma população de pacientes com incapacidade visual atendidos em duas instituições de saúde da cidade de Medellín (departamento de Antioquia/Colômbia), com énfase na etiologia do déficit visual irreversível. Metodologia: estudo observacional descritivo. Estudo macro sobre deficiências visuais unilaterais e bilaterais em 1 742 registros de histórias clínicas para identificar pacientes com baixa visão ou cegueira. Aplicação de um formato de investigação orientado a validar os pacientes com incapacidade visual e se selecionaram 107 histórias clínicas. Resultados: 56.6% apresenta incapacidade visual tipo baixa visão e 43.4% incapacidade visual tipo cegueira. O déficit visual responsável da incapacidade visual foi de 39% por causas oftalmológicas, 20% por alterações neuro-oftalmológicas e 17% por transtornos neurológicos de córtex visual. Ademais da agudeza visual, se encontraram outras deficiências da função visual: atrofia óptica, alteração eletrofisiológica da condução visual e encefalomalácia em córtex visual. 82% dos pacientes têm pelo menos uma comorbilidade não oftalmológica. Conclusões: é fundamental um adequado registro das características biológicas, sociais, psicológicas e das atividades de reabilitação dos pacientes com baixa visão e cegueira, para entender em forma integral não só a incapacidade senão o impacto que produz.

Diabetes mellitus como factor de riesgo de demencia en la población adulta mayor mexicana / Diabetes mellitus as a risk factor for dementia in the Mexican elder population

Introducción. La diabetes mellitus y las demencias constituyen dos problemas crecientes de salud entre la población adulta mayor del mundo y, en particular, de los países en desarrollo. Hacen falta estudios longitudinales sobre el papel de la diabetes como factor de riesgo de demencia. Objetivo. Determinar el riesgo de demencia en sujetos mexicanos con diabetes mellitus tipo 2. Pacientes y métodos. Los sujetos diabéticos libres de demencia pertenecientes al Estudio Nacional de Salud y Envejecimiento en México fueron evaluados a los dos años de la línea de base. Se estudió el papel de los factores sociodemográficos, de otras comorbilidades y del tipo de tratamiento en la conversión a demencia. Resultados. Antes de iniciar el estudio, 749 sujetos (13,8%) padecían diabetes. El riesgo de desarrollar demencia en estos individuos fue el doble (riesgo relativo, RR = 2,08; intervalo de confianza del 95%, IC 95% = 1,59-2,73). Se encontró un riesgo mayor en individuos de 80 años y más (RR = 2,44; IC 95% = 1,46-4,08), en los hombres (RR = 2,25; IC 95% = 1,46- 3,49) y en sujetos con nivel educativo inferior a siete años. El estar bajo tratamiento con insulina incrementó el riesgo de demencia (RR = 2,83; IC 95% = 1,58-5,06). Las otras comorbilidades que aumentaron el riesgo de demencia en los pacientes diabéticos fueron la hipertensión (RR = 2,75; IC 95% = 1,86-4,06) y la depresión (RR = 3,78; IC 95% = 2,37-6,04). Conclusión. Los sujetos con diabetes mellitus tienen un riesgo mayor de desarrollar demencia. La baja escolaridad y otras comorbilidades altamente prevalentes en la población mexicana contribuyen a la asociación diabetes-demencia (AU)

Introduction. Diabetes and dementia are growing problems throughout the world and especially in developing countries. Aim. To determine the risk of developing dementia in subjects with type 2 diabetes mellitus. Patients and methods. Diabetic elders free of dementia from the Mexican Health and Aging study, a prospective communitybased cohort research were followed after two years. Socio-demographic factors, comorbid conditions and type of diabetes treatment were analyzed in subjects who become demented. Results. At baseline, 749 participants (13.8%) had diabetes mellitus. During the follow-up period (mean: 2.02 years; range: 1-3 years), 306 of 749 persons with diabetes mellitus developed dementia, yielding a relative risk (RR) of 2.08 (95% confidence interval, 95% CI = 1.59-2.73). The effect was strongest in persons aged 80 years or older with a RR of 2.44 (95% CI = 1.46-4.08), men had a greater relative risk than women (RR = 2.25; 95% CI = 1.46-3.49 vs. RR = 1.98; 95% CI = 1.08-1.11) and subjects with low education (< 7 years of schooling) had a significant RR while those with higher education didn’t. Individuals treated with insulin where at highest risk of dementia (RR = 2.83; 95% CI = 1.58-5.06). Hypertension (RR = 2.75; 95% CI = 1.86-4.06) and depression (RR = 3.78; 95% CI = 2.37-6.04) where the two comorbidities which increased the risk of dementia. Conclusions. Subjects with diabetes mellitus have an increased risk of developing dementia. Sociodemographic factors and other comorbidities highly prevalent in the Mexican population contribute to the diabetes-dementia association (AU)

[Calyceal fistula in a renal allograft treated with N-Butyl-2-cyanoacrylate]. / Fístula calicilar en injerto renal tratada con N-butyl-2-cyanoacrylate.

BACKGROUND: Calyceal fistulas are common and difficult to treat after surgery of urinary collecting system. METHODS: A 30-year old woman. The fifth day after receiving a cadaver donor renal allograft presented an acute rejection episode; fourteen days later presented an urinoma treated with a percutaneous drainage tube. Five days later surgical exploration was made, lower pole infarction and ischemic necrosis of distal ureter were found. Parcial nephrectomy and neo-ureterovesical anastomosis were performed. Later, an inferior calyceal fistula was evidenced, persisting during several weeks in spite of a percutaneous drainage tube. Under fluoroscopic guidance the fistulous tract was embolized with N-butyl-2-cyanoacrylate. RESULTS: The fluoroscopic control confirmed the total closure of the fistula. After 22 months no reappearance of the fistula, no stenosis has been shown at this level. CONCLUSIONS: This is a useful technique for the treatment of calyceal fistulas. This is the first time that N-butyl-2-cyanoacrylate is use in the treatment of a calyceal fistula.

Fístula calicilar en injerto renal tratada con n-Butyl-2-cyanoacrylate / Calyceal fistula in a renal allograft treated with n-butyl-2-cyanoacrylate

INTRODUCCIÓN: Las fístulas calicilares son frecuentes y difíciles de tratar después de la cirugía del sistema colector del tracto urinario. MATERIAL Y MÉTODO: Paciente mujer de 30 años de edad. El quinto día después de recibir un injerto renal procedente de cadáver, presentó un urinoma que se trató inicialmente con un drenaje percutáneo. Cinco días después se llevó a cabo exploración quirúrgica, evidenciando infarto polar inferior del injerto y necrosis isquémica distal del injerto. Se realizó entonces una nefrectomía parcial y reimplantación ureteral. Posteriormente se evidenció la presencia de fístula a nivel calicilar inferior del injerto, que persistió durante varias semanas a pesar de correcto drenaje percutáneo. Bajo control fluoroscópico el trayecto fistuloso fue embolizado exitosamente con N-butyl-2-cyanoacrylate. RESULTADOS: El control fluoroscópico confirmó el cierre total de la fístula. Después de 22 meses de seguimiento no se ha demostrado reaparición de la fístula ni presencia de estenosis a este nivel. CONCLUSIÓN: Esta es una técnica útil en el tratamiento de las fístulas calicilares. Esta es la primera vez que el N-butyl-2-cyanoacrylate es utilizado en el tratamiento de fístulas calicilares (AU)

Evaluación de la calidad de vida y su relación con la cognición hacia la enfermedad en pacientes colostomizados con diágnóstico de cáncer colorectal / Living standards assessment and its relation with the cognition towards the disease in colostomized patients with a colorectal cancer diagnosis

El objetivo de la siguiente investigación fue evaluar la calidad de vida y su relación con la cognición a la enfermedad, en pacientes colostomizados con diagnóstico de cáncer colorectal. Para esto se trabajó con 65 pacientes, de ambos géneros, a partir de 6 meses posteriormente del tratamiento médico quirúrgico. Como instrumentos de medida para la calidad de vida se utilizó el SF36 versión española de Alonso y Cols, 1998 y el cuestionario de cognición a la enfermedad ICQ, versión Holandesa de Evers, 2001. Los resultados fueron analizados con el paquete SPSS, encontrándose diferencias significativas entre las medidas españolas del SF 36 y las medidas de nuestra población de pacientes colostomizados, en las dimensiones de función física, rol físico, dolor corporal, función social, rol emocional y salud mental. Con respectoal ICQ los niveles de desesperanza y aceptación a la enfermedad fueron más elevados en nuestras medidas que las muestras originales de pacientes con Artritis reumatoide y Esclerosis múltiple (Evers, 2001).

The objective of the following investigation was evaluate the quality of the life and their relationship with thee illness cognition, in patient colostomizados with diagnostic of cancer colorectal. For this work with 65 patients, of both genders, starting from 6 posterior months of the medical surgical treatment. Like instrument of measuring for the quality of life it was used the SF36 Spanish version of Alonso and Colds, 1998 and the questionnaire of the illness cognition ICQ. Dutch version of Evers and Cols, 2001. The results were analyzed with the SPSS package , being significant differences between the Spanish means of the SF36 and the means in our population of patients colos-tomizados, in the dimensions of physical Function, role physical, cor-poral pain, social function, role emotional and metal health. With respect to the ICQ the levels of helplessness and acceptance to the illness was more high in our means that in the...

[Our experience with the implant of single component integrated prostheses (Hydroflex-Dynaflex)]. / Nuestra experiencia en el implante de prótesis integradas de un solo componente (Hydroflex--Dynaflex).

INTRODUCTION AND OBJECTIVES: To present our experience with Hydroflex and Dynaflex self-contained inflatable penile prosthesis. MATERIAL AND METHODS: Between october 1988 and december 2000 a total of 63 men underwent implantation of 8 Hydroflex and 55 Dynaflex penile prosthesis. The follow-up period ranged from 12 and 127 months (mean 54.5). RESULTS: A total of 124 cylinders were implanted (in 2 cases only 1 cylinder was implanted). During implantation 3 corpora cavernosun ruptures were present, but implantation was possible in 2. Specific complication rates after implantation were as follow: early infection, 3 patients (4.7%); late infection, 1 patient (1.6%); pain that needed readmission 2 cases (3.2%); mechanical device failure, 7 cylinders in 6 men (mean time 83.5 months). 7 men (11.1%) needed prolonged teaching time to operate the prosthesis. Only 6 men (9.5%) wer dissatisfied with the prosthesis. It was possible to change only 1 cylinder when needed. CONCLUSIONS: Self-contained inflatable prosthesis brings good results on long time use. The mechanical malfunction rate is low and it is possible to change only one cylinder if needed. An important number of patients need intensive and prolonged teaching time to obtain a successful result.

Nuestra experiencia en el implante de prótesis integradas de un solo componente / Our experience with Hydroflex and Dinaflex self-contained prosthesis

INTRODUCCIÓN Y OBJETIVOS: Presentamos nuestra experiencia en el implante de prótesis de pene hinchables, Hydroflex y Dynaflex. MATERIAL Y MÉTODOS: Entre octubre de 1988 y diciembre del 2000, implantamos en 63 pacientes, 8 prótesis de pene Hydroflex y 55 Dynaflex. El período de seguimiento estuvo entre los 12 y 127 meses (media 54,5).RESULTADOS: Implantamos un total de 124 cilindros (en 2 casos se implantó 1 solo cilindro). Durante la implantación tuvimos 3 rupturas de cuerpos cavernosos, siendo posible el implante en 2 casos. Las complicaciones aparecidas en el seguimiento fueron: 3 casos de infección precoz (4,7 per cent); 1 caso de infección tardía (1,6 per cent); dolor persistente que requirió reingreso en 2 casos (3,2 per cent); fallos mecánicos en 7 cilindros de 6 pacientes (tiempo medio de aparición 83,5 meses), 7 pacientes (11,1 per cent) necesitaron un entrenamiento prolongado después de la operación de la prótesis, sólo 6 pacientes (9,5 per cent) se declararon insatisfechos de la prótesis. Es posible el cambio de 1 solo cilindro si se necesita. CONCLUSIONES: Las prótesis integradas de un solo componente presentaron buenos resultados a largo plazo. La aparición del fallo mecánico fue tardía, y además es posible cambiar un solo cilindro. Un importante número de pacientes necesitó una enseñanza intensiva y prolongada en el tiempo para obtener resultados satisfactorios (AU)

Lesión peneana y uretral por anillo metálico. Reconstrucción con colgajo radial libre / Penile and urethral injury by methalic ring. Reconstruction using a forearm free flap

Se describe el caso de un paciente con lesión peneana grave ocasionada por un anillo metálico alojado durante 48 horas en la base peneana que cursó con sección parcial de uretra peneana y necrosis isquémica de la práctica totalidad del recubrimiento cutáneo del pene y dartos. Fue solucionado mediante una exéresis quirúrgica de todo el tejido necrótico en una primera instancia y posterior reconstrucción utilizando un colgajo radial anastomosado a los vasos epigástricos caudales, utilizando piel lampiña de la cara anterior del antebrazo en la uretroplastia. Los resultados estéticos y funcionales que se obtienen son exitosos (AU)

[Partial nephrectomy in renal cell carcinoma]. / Nefrectomía parcial en el carcinoma de células renales.

INTRODUCTION AND OBJECTIVES: Renal Cell Carcinoma (RCC) represents 3% of all neoplasm. The growing incidental diagnosis of small renal tumor has allowed the application of nephron sparing surgery (NSS), even in those cases with a normal contralateral kidney. We present the results of NSS at our center in the last decade. MATERIAL AND METHODS: A retrospective analysis of all NSS that were made at our center in cases of renal masses. Difference is made between elective surgery (tumors less than 4 cm with a normal contralateral kidney) and obligatory surgery (all other cases). RESULTS: From 1990 since 2000 a total of 65 NSS were made from a total of 436 surgeries for renal tumors (14.9%). In 22 patients NSS was obligatory, while in 43 was elective. Mean (SD) age was 59.1 years (+/- 11.7), mean tumor size 3.4 cm (+/- 1.4), mean hospital staying was 9.2 days (+/- 7). Renal normothermic ischaemia was use during surgery in all cases, with a mean ischaemic time of 25.7 min. Nine tumors (13.8%) were benign. Morbidity: 10.8%. Mortality: 1.5%. The cancer specific survival at 36 months of follow-up (mean 37.4) is 98.4% and global survival is 90.3%. CONCLUSIONS: Nephron Sparing Surgery is a valid alternative in the treatment of RCC, specially for tumors less than 4 cm in diameter and having a normal contralateral kidney; NSS is also an effective technique for patients bearing renal tumors in a solitary kidney.

Nefrectomía parcial en el carcinoma de células renales / Nephron sparing surgery in renal cell carcinoma

INTRODUCCIÓN Y OBJETIVO: El carcinoma de células renales representa el 3 por ciento de todas las neoplasias. El incremento del diagnóstico incidental de tumores pequeños ha favorecido la aplicación de técnicas de cirugía renal conservadora aún en pacientes con riñón contralateral normal. Nos interesa analizar de los resultados de la aplicación de la cirugía parcial por tumor renal en la última década. MATERIAL Y MÉTODOS: Se realiza un estudio retrospectivo de todas las cirugías parciales por tumor renal. Se diferencia entre cirugía electiva (menos de 4 cm con riñón contralateral normal) y cirugía obligada (el resto de los casos). RESULTADOS: Desde 1990 hasta 2000 se han efectuado 65 cirugías parcelares sobre 436 intervenciones por masa renal (14,9 por ciento). 43 pacientes tenían indicación electiva y 22 obligada. Edad media 59,1 años (desviación standard: 11,7), tamaño medio del tumor 3,4 (ñ 1,4 cm), se requirieron una media de 9,2 (ñ 7) días de ingreso. Se utilizó isquemia renal normotérmica en todos los casos con un tiempo de isquemia medio de 25,7 min. Nueve tumo-res (13,8 por ciento) fueron benignos. Morbilidad: 10,8 por ciento y mortalidad: 1,5 por ciento. Seguimiento medio: 37,4 meses. A los 3 años la supervivencia cáncer-específica es 98,4 por ciento y la supervivencia global 90,3 por ciento. CONCLUSIONES: La cirugía parcial renal en el tratamiento del tumor renal es una alternativa válida para tumo-res de menos de 4 cm, exorenales con riñón contralateral normal, igualmente es una técnica efectiva y resolutiva para aquellos pacientes monorenos o con riesgo de insuficiencia renal en el post-operatorio (AU)

La vandellia cirrhosa, un parásito urológico poco conocido / Vandellia cirrhosa: an unknown urological parasite

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[Penile and urethral lesion caused by metallic ring. Reconstruction with radial free flap]. / Lesión peneana y uretral por anillo metálico. Reconstrucción con colgajo radial libre.

We report a case of a man with a severe penile injure caused by a metallic ring placed in the penile shaft for 48 hours, it coursed with partial urethral section and ischemia of the whole penile skin and dartos. It was solved with surgical excision of all death tissue and posterior reconstruction using a forearm free flap, the vascular supply came from epigastric vessels, we used hair-free skin from forearm for the urethroplasty. Ethetic and functional results obtained are successful.

[Current treatment of lithiasis in congenital renoureteral malformations]. / Tratamiento actual de la litiasis en malformaciones congénitas renoureterales.

OBJECTIVE: To evaluate the treatment of urinary calculi in renoureteral malformations. METHODS: From April 1988 to December 2000, we have treated 158 patients with renoureteral malformations (36 horseshoe kidneys, 32 caliceal diverticula, 2 megacaliosis, 2 crossed renal ectopy, 3 polycystosis, 7 hydrocalyx, 24 complete duplex ureter, 18 incomplete duplex ureter, 22 ureterocele, 2 segmental megaureter). RESULTS: Renoureteral malformations were diagnosed in 158 of 19,000 patients that were treated in our stone unit from April 1988 and December 2000. Horseshoe kidney: 54% of the patients treated by ESWL are stone-free; PNL was performed in 2 patients and conventional surgery in another 2 patients. Caliceal diverticulum: 42% of the patients treated by ESWL are stone-free; 3 patients underwent conventional surgery. Other renal malformations: 62% of the patients treated by ESWL are stone-free. Ureteral malformations: duplex ureter and megaureter: 82% of the patients treated by ESWL are stone-free. Ureterocele: due to the poor results achieved by ESWL, we performed endoscopic transurethral meatotomy. CONCLUSIONS: These results indicate that ESWL alone can be considered to be the treatment of choice for small calculi in patients with renal malformations, although we consider it to be mandatory to perform individual assessment of the urinary tract and stone size in these patients in order to choose the best therapeutic option. The same criteria for the normal urinary tract can be applied in ureteral malformations except ureteroceles, for which we advocate performing endoscopic surgery for stone removal.

Clinical classification of glaucomatous visual field loss by frequency doubling perimetry.

PURPOSE: To determine whether the frequency doubling perimeter (FDP) can grade glaucomatous visual function loss in a clinically relevant manner. Sinusoidal gratings < 1 cpd that undergo counterphase flicker > 15 Hz appear to have twice as many bands of light, a phenomenon referred to as the "frequency doubling illusion." Evidence suggests that this psychophysical effect is mediated in part by large-diameter ganglion cells, which are reported to be lost early in the glaucomatous disease process. A portable, commercially available FDP has already demonstrated high diagnostic potential for glaucoma screening. METHODS: Sixty-four eyes of 42 glaucomatous patients and 22 eyes of 14 normal subjects were evaluated by means of both frequency doubling perimetry and Humphrey perimetry. A clinical scoring algorithm modeled after the Hodapp-Parrish-Anderson criteria for scoring Humphrey visual field defects was derived for the FDP at the halfway point of the study, and all participants were reassessed with this algorithm upon its completion. RESULTS: FDP mean and pattern deviation showed strong linear correlations with Humphrey 30-2 mean deviation (R = 0.75; P < .0001) and corrected pattern standard deviation values (R = 0.64; P < .0001). Despite this, neither global index could consistently categorize the graded glaucomatous visual fields in a manner consistent with the Hodapp-Parrish-Anderson criteria. The new FDP scoring algorithm did provide good segregation (73% precise parity, 93% parity within one Humphrey grade). CONCLUSIONS: Sixteen-zone frequency doubling perimetry can segregate glaucomatous visual field loss into pathologic categories approximating those obtained with Humphrey 30-2 perimetry by means of a formula modeled after the Hodapp-Parrish-Anderson criteria.

Sex pheromone ofStenoma cecropia Meyrick (Lepidoptera: Elachistidae).

(Z,E)-9,11-tetradecadienal (Z9,E11-14: Ald; 11%), (Z,E)-9,11,13-tetradecatrienal (Z9,E11, 13-14: Ald; 67%), (Z,E)-9,11-tetradecadienyl acetate (Z9,E11-14: Ac, 5.5%), and (Z,E)-9,11,13-tetradecatrienyl acetate (Z9,E11,13-14: Ac; 16.5%) were identified in the extracts of female pheromone glands ofStenoma cecropia (Lepidoptera: Elachistidae). From electroantennograms and single sensillum recordings, receptors toZ9,E11,13-14:Ald andZ9,E11-14: Ald were found on male antenna. Behavioral data were obtained from olfactometric tests in the laboratory and field trapping experiments in Colombia. It appeared that a blend ofZ9,E11,13-14:Ald (83%) andZ9,E11-14:Ald (17%) was attractive to males. These aldehydes are assumed to be components of the sex pheromone ofS. cecropia, whereas the acetates found in gland extracts might be precursors of the pheromone.