New tissue bulking agent (polyacrylate polyalcohol) for treating vesicoureteral reflux: preliminary results in children.

PURPOSE: We report the preliminary results of endoscopic treatment of vesicoureteral reflux in children using polyacrylate polyalcohol copolymer. MATERIAL AND METHODS: We performed a prospective multicenter review of pediatric patients treated with subureteral injection of a new nonabsorbable substance. Only patients with 1 year of followup were included. RESULTS: A total of 83 patients underwent injection of polyacrylate polyalcohol copolymer at our institutions between 2005 and 2006. Among this group 18 males and 43 females with a median age of 58 months (range 9 months to 18 years) completed 1 year of followup. Reflux was bilateral in 27 patients (44.3%) and unilateral in 34 (55.7%). Number of injected ureters was 88. Reflux grade was V in 3 ureters (3.4%), IV in 12 (13.6%), III in 41 (46.6%) and II in 32 (36.4%). Mean +/- SD injected volume per unit was 0.76 +/- 0.43 ml. Median followup was 20 months (range 16 to 24). Complications after injection included dysuria in 6 patients (9.8%), fever in 3 (4.9%) and lumbar pain in 4 (6.6%). Reflux was eliminated in 78 renal units (88.6%), decreased to grade I in 6 (6.8%) and persisted in 4 (4.5%). Ureteral obstruction developed in 1 patient and was treated operatively. Overall success rate was 83.6%. CONCLUSIONS: Polyacrylate polyalcohol copolymer can be used to treat vesicoureteral reflux with comparable efficacy to other substances currently used, with a low rate of complications.

[Biliary atresias operated with favourable results: predictable outcome]. / Atresias de vías biliares intervenidas con buen resultado. Evolución previsible.

Since 1975, our experience in the treatment of biliary atresia with Kasai's technique has improved little by little, achieving 65% favourable outcome in the last five years. We define "good results" as the complete restoration of biliary flow and normalization of bilirrubin levels. The long-term evolution of these good results can be diverse. The objective of the present work is to analyze the outcome of patients in our series in whom a favourable initial response was achieved, as well as evaluating their present situation and future perspectives. The authors present a total of 17 patients operated by Kasai's technique since 1985, that constitutes the group with good results in our series. The controls were based on general analysis, liver function and periodic ultrasound explorations. All received a standardized medical treatment consisting of vitamin supplements (A, D3, E, K) minerals (zinc, calcium, phosphate, iron) ursodexoxicolic acid, luminal,as well as close control of calorie intake. In two patients the levels of bilirrubine were progressively increased with time, stabilizing at between 5/6 mgs/100 ml, with progressive hepatic hardening, appearance of splenomegalia, indirect signs of portal hypertension and a slight deterioration of hepatic function. One received a transplant at age 12 with Quick levels below 50%. The other, aged 16, continues with an acceptable hepatic function and good quality of life under recommendation of transplant. Eleven patients with ages ranging from fourteen months to seventeen years presented slight and firm hepatomegalia, moderate portal hypertension, GOT 71 +/- 8 mg/100 ml, GPT 97 +/- 11 mg/100 ml and normal bilirrubine levels. From this group, 3 patients, all under five years of age, experienced bleeding from esophageal varices which were controlled by sclerosis and medical treatment (propanolol and isosorbide dinitrate). Recently, one three year-old patient developed a hepatocarcinoma of rapid, mortal evolution. Since then, the determination of alfa-feto protein in follow-up controls has been introduced. Four other patients of 5, 6, 14, 16, years of age are completely assymptomatic with an excellent clinical evolution. In our experience,the patients that overcome the third year after surgery without serious complications seem destined to reach puberty with a good quality of life. However, some cases show signs of hepatic fibrosis and portal hypertension, 77% in our series. Only 23% of patients with a favorable initial evolution appear to present a complete normalization of their hepatic lesion in the long term.

Atresias de vías biliares intervenidas con buen resultado. Evolución previsible / Biliary atresias operated with favourable results: predictable outcome

Nuestra experiencia en el tratamiento de la atresia de vías biliares mediante la técnica de Kasai ha ido mejorando con el tiempo hasta conseguir en los últimos 5 años un 65% de «buenos resultados», incluyendo en ese término a pacientes con restauración del flujo biliar y normalización de las cifras de bilirrubina. El objetivo del presente trabajo es analizar el comportamiento de los pacientes de nuestra serie en los que se consiguió ese buen resultado inicial, valorar su situación en el momento actual y sus perspectivas de futuro. Presentamos un total de 17 pacientes intervenidos mediante técnica de Kasai desde 1985, con la característica común de pertenecer al grupo de buenos resultados de nuestra serie. Los controles se basaron en analítica general, función hepática y ecografías periódicas. A todos ellos desde el momento del diagnóstico se les aplicó un tratamiento médico estandarizado consistente en suplementos polivitamínicos (A, D3, E, K) minerales, zinc, calcio, fósforo, hierro, ácido ursodesoxicólico y luminal y una vigilancia estricta de los aportes calóricos. En dos pacientes se elevaron progresivamente las cifras de bilirrubina estabilizándose entre 5/6 mg/100 ml con progresivo endurecimiento hepático, aparición de esplenomegalia, signos indirectos de hipertensión portal y deterioro relativo de la función hepática. Uno de ellos con cifras de Quick inferiores al 50% se trasplantó a los 12 años de vida. El otro con 16 años continúa con una función hepática aceptable y buena calidad de vida en situación de trasplante aconsejable. Un grupo de 11 pacientes con edades comprendidas entre los 14 meses y los 17 años presentan discreta hepatomegalia firme, moderada hipertensión portal, moderada elevación de las transaminasas y bilirrubina normal. De este grupo 3 pacientes, siempre por debajo de los cinco años, han tenido sangrados por varices esofágicas controlados mediante esclerosis y tratamiento médico (propanolol y dinitrato de isosorbide). Un paciente desarrolló un hepatocarcinoma al tercer año de vida de evolución rápidamente fatal. Desde entonces se introdujo la determinación de alfa-fetoproteína en los protocolos de seguimiento. Cuatro pacientes de 5, 6, 14 y 16 años están clínica y exploratoriamente asintomáticos y previsiblemente continuarán así a largo plazo. En nuestra experiencia, los pacientes que superan sin incidencias graves el tercer año postoperatorio, parecen destinados a sobrepasar la pubertad con buena calidad de vida. Un 77% con signos de fibrosis hepática e hipertensión portal moderada y un 23% de ellos con la normalización completa de su lesión hepática a largo plazo (AU)

Since 1975, our experience in the treatment of biliary atresia with Kasai’s technique has improved little by little, achieving 65% favourable outcome in the last five years. We define «good results» as the complete restoration of biliary flow and normalization of bilirrubin levels. The long-term evolution of these good results can be diverse. The objective of the present work is to analyze the outcome of patients in our series in whom a favourable initial response was achieved, as well as evaluating their present situation and future perspectives. The authors present a total of 17 patients operated by Kasai’s technique since 1985, that constitutes the group with good results in our series. The controls were based on general analysis, liver function and periodic ultrasound explorations. All received a standardized medical treatment consisting of vitamin supplements (A, D3, E, K) minerals (zinc, calcium, phosphate, iron) ursodexoxicolic acid, luminal,as well as close control of calorie intake. In two patients the levels of bilirrubine were progressively increased with time, stabilizing at between 5/6 mgs /100 ml, with progressive hepatic hardening, appearance of splenomegalia, indirect signs of portal hypertension and a slight deterioration of hepatic function. One received a transplant at age 12 with Quick levels below 50%.The other, aged 16, continues with an acceptable hepatic function and good quality of life under recommendation of transplant. Eleven patients with ages ranging from fourteen months to seventeen years presented slight and firm hepatomegalia, moderate portal hypertension, GOT 71 +/- 8 mg/100 ml, GPT 97 +/-11 mg/100 ml and normal bilirrubine levels. From this group, 3 patients, all under five years of age, experienced bleeding from esophageal varices which were controlled by sclerosis and medical treatment (propanolol and isosorbide dinitrate). Recently, one three year-old patient developed a hepatocarcinoma of rapid, mortal evolution. Since then, the determination of alfa- feto protein in follow-up controls has been introduced. Four other patients of 5, 6, 14, 16, years of age are completely assymptomatic with an excellent clinical evolution. In our experience,the patients that overcome the third year after surgery without serious complications seem destined to reach puberty with a good quality of life. However, some cases show signs of hepatic fibrosis and portal hypertension, 77% in our series. Only 23% of patients with a favorable initial evolution appear to present a complete normalization of their hepatic lesion in the long term (AU)

Evaluación de la ecografía abdominal en trauma cerrado en población pediátrica / Evaluation of abdominal sonography for trauma in pediatric population

Antecedentes: La ecografía con el método basado en FAST (foccused assessment with sonography for trauma) ofrece la posibilidad de ser realizada por el cirujano, otorgando una rápida y básica información de la presencia de líquido intraperitoneal. Repetible, inocuo y sin containdicaciones, no requiere traslado del paciente y permite un seguimiento clínico evolutivo especialmente cuando se decide no operar. Objetivo: Valorar la sensibilidad y especificidad del Ecotrauma (ecografía FAST sumada a la detección de lesiones en órganos sólidos). Lugar de aplicación: Hospital de Niños Ricardo Gutierrez de Buenos Aires, Argentina. Diseño: Trabajo prospectivo, cerrado y comparativo realizado en un solo centro. Población: 50 pacientes con trauma abdominal cerrado internados en forma consecutiva. Método: 50 casos incorporados al Registro de Trauma mediante un protocolo de estudio denominado Ecotrauma (ecografía FAST sumada a la detección de lesiones en órganos sólidos). Se utilizó un equipo Aloka 500 con transductor de 5 MHz. Medidas de evaluación: La comparación del método (cotejo) se efectuó analizando los resultados obtenidos por los cirujanos de trauma vs especialistas en imágenes, entendiendo que el juicio del especialista debería considerarse correcto. Se realizó análisis estadístico a través del cálculo de probabilidades estadísticas. Resultados: De los 50 pacientes, 35 fueron varones y 15 mujeres, la edad media fue de 7 años con una dispersión de 9 meses a 14 años. Valor del método para detectar líquido intraperitoneal=Sensibilidad=0.91 y Especificidad=1. Valor del método para detectar lesión de vísceras sólidas=Sensibilidad=0,75 y Especificidad=1. Conclusiones: A pesar de la rápida y útil información que se consigue con el método FAST hemos pensado en completar la información obtenida identificando ambos tipos de hallazgos patológicos: la presencia de líquido libre y su probable origen. Por consiguiente, proponemos al Ecotrauma que le suma al FAST el barrido ecográfico hepático, esplénico y renal

Evaluación de la ecografía abdominal en trauma cerrado en población pediátrica / Evaluation of abdominal sonography for trauma in pediatric population

Antecedentes: La ecografía con el método basado en FAST (foccused assessment with sonography for trauma) ofrece la posibilidad de ser realizada por el cirujano, otorgando una rápida y básica información de la presencia de líquido intraperitoneal. Repetible, inocuo y sin containdicaciones, no requiere traslado del paciente y permite un seguimiento clínico evolutivo especialmente cuando se decide no operar. Objetivo: Valorar la sensibilidad y especificidad del Ecotrauma (ecografía FAST sumada a la detección de lesiones en órganos sólidos). Lugar de aplicación: Hospital de Niños Ricardo Gutierrez de Buenos Aires, Argentina. Diseño: Trabajo prospectivo, cerrado y comparativo realizado en un solo centro. Población: 50 pacientes con trauma abdominal cerrado internados en forma consecutiva. Método: 50 casos incorporados al Registro de Trauma mediante un protocolo de estudio denominado Ecotrauma (ecografía FAST sumada a la detección de lesiones en órganos sólidos). Se utilizó un equipo Aloka 500 con transductor de 5 MHz. Medidas de evaluación: La comparación del método (cotejo) se efectuó analizando los resultados obtenidos por los cirujanos de trauma vs especialistas en imágenes, entendiendo que el juicio del especialista debería considerarse correcto. Se realizó análisis estadístico a través del cálculo de probabilidades estadísticas. Resultados: De los 50 pacientes, 35 fueron varones y 15 mujeres, la edad media fue de 7 años con una dispersión de 9 meses a 14 años. Valor del método para detectar líquido intraperitoneal=Sensibilidad=0.91 y Especificidad=1. Valor del método para detectar lesión de vísceras sólidas=Sensibilidad=0,75 y Especificidad=1. Conclusiones: A pesar de la rápida y útil información que se consigue con el método FAST hemos pensado en completar la información obtenida identificando ambos tipos de hallazgos patológicos: la presencia de líquido libre y su probable origen. Por consiguiente, proponemos al Ecotrauma que le suma al FAST el barrido ecográfico hepático, esplénico y renal (AU)

Rheological properties and biocompatibility of endodontic sealers.

AIM: To determine the flow characteristics and subcutaneous tissue reactions to five endodontic sealers. METHODOLOGY: The materials used were Procosol, AH26, Endomethasone, Sealapex and Endion. The sealers were prepared following the manufacturers' instructions, and 0.075 mL of each material was placed on a glass surface, which was then rotated 90 degrees. The samples were stored at 37 degrees C and 95% humidity. The displacement of the sealer was recorded by measuring the difference between its original position and the position recorded at 15 and 60 min. Three samples of each material were used. Two pockets were created in the back of Wistar rats, and one silicone tube, 1 mm in diameter and 1 cm in length, was implanted in each. One was filled with one of the materials under study, and the other empty tube was implanted as a control. Fourteen days after implantation, the animals were sacrificed, and samples of the skin containing the tubes were histologically processed. Histological and histomorphometric evaluations of the tissues adjacent to the open end of the tube were carried out the volume of tissue reaction was measured histomorphometrically according to standard stereological principles. Results were statistically analysed using analysis of variance and Duncan's test. RESULTS: The highest flow values were obtained with Sealapex and AH26. Time significantly affected the flow and the material (P < (1001). Procosol and Endion produced the most severe histological reactions: these were outlined by fibrous tissue; AH26. Endomethasone and Sealapex produced reactions of smaller size and with more moderately defined limits. CONCLUSIONS: The flow did not correlate with the degree of inflammatory response. Procosol and Endion produced the most severe tissue reactions, whereas Endomethasone, Sealapex and AH26 produced only minimum reactions.

Tube angulation effect on radiographic analysis of the implant-abutment interface.

The purpose of this study was to determine the maximum permissible x-ray tube angulation that can be used to verify the fit of an abutment. An implant and an abutment were assembled with an abutment screw. A variety of openings were created between the abutment and the implant. Radiographs were taken combining the different gaps with various x-ray tube angulations. The radiographs were randomly presented to 8 clinicians, who judged the interface as open or closed. The results indicate that a radiographic analysis of interface openings becomes subjective with tube angulations of more than 5 degrees.