Litiasis úrica coraliforme bilateral de origen intestinal. Presentación de un caso tratado con la combinación quirúrgica NLP/RIRS/ECIRS / Uric bilateral staghorn lithiasis of intestinal origin. Report of a case treated with surgical combination NLP / RIRS / ECIRS

La cirugía endoscópica renal (por vía percutánea o por vía retrograda) se ha consolidado como una técnica de elección para los cálculos renales. En los más voluminosos (mayores de 2-3 cm de diámetro mayor) está indicada la nefrolitotomía percutánea (NLP) y en los menores la cirugía retrógrada intrarrenal RIRS (exceptuando los tratables con litotricia extracorpórea por ondas de choque). La ECIRS es una modalidad mixta. La litotricia endoscópica con láser es un tratamiento eficaz en las tres técnicas. En NLP es necesario usar altas energías La litiasis de AU representan un 10% del total de cálculos en España. Entre los factores etiológicosfiguran la dieta, los procesos inductores de lisis celular (ciertas neoplasias, quimioterapia) y algunos trastornos digestivos. Aunque la bilateralidad es muy frecuente es más raro encontrar coraliformes bilaterales. Presentamos un caso de litiasis renal úrica bilateral coraliforme (AU)

Renal endoscopic surgery (percutaneously or via retrograde) has become a technique of choice for kidney stones. In the more bulky (greater than 2-3 cm in diameter) is indicated percutaneous nephrolithotomy (PCNL). In smaller is indicated intrarenal retrograde surgery (RIRS), excluding those that can be treated with extracorporeal shock wave lithotripsy. The ECIRS is a mixed mode. Endoscopic laser lithotripsy is an effective treatment in the three techniques. In NLP is necessary to use high energy. The uric acid stones account for 10% of all stones in Spain. Etiologic factors include diet, conditions inducing cell lysis (certain malignancies, chemotherapy) and some digestive disorders. Although it is very frequent bilaterality is rare to find bilateral staghorn. We report a case of bilateral staghorn uric kidney stones secondary to intestinal disorder treated with a combination of three pocedures (AU)

Pólipo ureteral fibroepitelial. Revisión de la literatura / Fibroepithelial ureteral polyp. Review of the literature

Los pólipos fibroepiteliales (PF) del uréter son poco frecuentes para plantear un serio problema de diagnóstico diferencial con el carcinoma urotelial. Entre ambos existen algunas diferencias radiológicas pero no siempre es fácil reconocerlas. Históricamente, se ha realizado nefroureterectomia innecesariamente en muchos casos de pólipos. Con el avance de la instrumentación, la ureterorrenoscopia es una prueba de gran utilidad para el diagnóstico de los defectos de repleción ureteral. La biopsia confirma el diagnóstico. Los PF que provocan obstrucción del tracto urinario superior precisan de tratamiento endourológico o laparoscópico (AU)

Fibroepithelial polyps (FP) of the ureter are infrequent benign tumors often not easily distinguished from malignant transitional-cell carcinomas by radiologic means. Historically, many patients have undergone unnecessary nephroureterectomy for these lesions. With the advancement in endourologic instrumentation, the ureteroscopy is the gold standard of diagnosis for ureteral filling defect. When FP causes upper urinary tract obstruction can be treated with endourology or laparosocopy (AU)

Versión española del cuestionario USSQ: evaluación de la tolerancia clínica al catéter ureteral doble jota / Spanish version of the USSQ questionnaire: evaluation of clinical tolerance to double J uretheral catheter

INTRODUCCIÓN: La evaluación de los síntomas debidos a catéter ureteral doble jota (CUJJ) precisa de una herramienta fiable como el cuestionario USSQ. Se presenta una versión traducida al español de este cuestionario (USSQ-E). MATERIAL Y MÉTODOS: La versión en inglés del USSQ ha sido traducida al español siguiendo una sofisticada sistemática lingüística. Una vez obtenido el USSQ-E ha sido probado en un grupo de 70 pacientes portadores de CUJJ. Como grupo control se han tomado 40 personas sin catéter. RESULTADOS: Se ha evaluado el USSQ-E con pruebas de consistencia interna, test-retest, validez convergente, sensibilidad al cambio y validez discriminatoria, siendo todas ellas satisfactorias. CONCLUSIÓN: El USSQ-E es una herramienta válida y fiable para evaluar la sintomatología derivada del CUJJ en población hispanoparlante (AU)

INTRODUCTION: The assessment of symptoms due to double J ureteral catheter (CUJJ) requires a reliable tool like USSQ questionnaire. A translation in Spanish of this questionnaire (USSQ-E) version is presented. MATERIAL AND METHODS: The English version of USSQ has been translated into Spanish language following a systematic sophisticated. After obtaining the USSQ-E has been tested in a group of 70 patients with CUJJ. A control group of 40 people have been taken without catheter. RESULTS: We evaluated the USSQ-E with evidence of internal consistency, test-retest reliability, convergent validity, sensitivity to change and discriminant validity, all of which are satisfactory. CONCLUSION: USSQ-E is a valid and reliable for assessing symptomatology derived CUJJ tool in speaking population (AU)

Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez.

INTRODUCTION: in his Libro del exercicio y de sus provechos (Book of exercise and profits), the Spanish Renaissance physician Christopher Mendez (1500-1553) describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico. This is the first description of a surgical procedure in America. MATERIAL AND METHODS: Biographical data were collected on Christopher Mendez. The electronic facsimile of the Book of exercise and profits was read. The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed. RESULTS: In chapter seven of the third treatise (page 120), Mendez speaks about the removal of a bladder stone in a boy named «Villaseñor¼. It uses the word «open¼ to describe the procedure, corresponding to a lithotomy more than a necropsy. It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology. DISCUSSION: Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones. The technique was very invasive and was improved over the centuries. CONCLUSIONS: The surgery described by Mendez for the child called Villaseñor most likely corresponds to a perineal lithotomy. A congenital cause could play a role in its etiology.

Recomendaciones dietéticas en la litiasis de oxalato cálcico / Dietary recommendations in calcium oxalate lithiasis

La dieta puede afectar a los enfermos con litiasis oxálica, aumentando los factores de riesgo para la formación. Una vez completado el estudio metabólico se deben dar algunas normas dietéticas basadas en los datos científicos disponibles. Existen pocos trabajos que hayan analizado de forma completa el contenido de oxalatos en los alimentos de la dieta humana. Se debe insistir en la ingesta hídrica abundante, la reducción de sal y de proteínas animales, manteniendo un correcto aporte de calcio. En el presente trabajo se adjuntan algunas tablas de contenidos de oxalato en diversos alimentos. Los más ricos en oxalato (acelgas, espinacas, coliflor, té, cacao, kiwis) deben ser restringidos

Diet affect oxalic lithiasis patients, increasing the risk factors for stone formation. Upon completion of the metabolic study should give some dietary guidelines based on scientific data. Few studies have analyzed completely the oxalate content in foods of the human diet. It must be emphatized abundant fluid intake, reducing salt and animal protein, maintaining proper calcium intake. In this paper, some tables about oxalate content in various foods are attached. Most rich in oxalate (chard, spinach, cauliflower, tea, cocoa, kiwis) must be restricted

Principios físicos y aplicaciones quirúrgicas y urológicas del láser / Physical principles and surgical and urological applications of laser

El láser es una tecnología que se basa en la estimulación de fotones. Se consigue un haz de luz de gran potencia y alta precisión capaz de cortar y coagular, así como de destruir lesiones de todo tipo, incluidos los cálculos. Cada especialidad tiene sus indicaciones. En urología se utilizan para la ablación de la próstata con hiperplasia benigna (HBP) y de tumores de urotelio (superficiales) así como para destruir cálculos urinarios (litiasis). Se realiza una breve revisión de los principios del láser y su aplicación en algunas especialidades quirúrgicas (AU)

The laser is a technology based on the stimulation of photons, getting a beam of high power and high accuracy can cut and coagulate and destroy all kinds of tissues and stone. Each specialty has its indications. In urology is used to ablate benign hyperplasic prostate (BPH) and urothelial tumours (surface) as well as to destroy urinary calculi (stones). It is a brief review of the principles of the laser and its applications in some surgical specialties, particularly urology (AU)

Ureterolitotomía laparoscópica en litiasis ureteral proximal de gran tamaño / Laparoscopic ureterolithotomy in proximal uretheral litiasis of great size

Se presenta el caso de ureterolitotomía laparosocópica en un paciente joven con un grueso cálculo en uréter lumbar izquierdo. La operación se realizó tras el fracaso de dos sesiones de litotricia extracorpórea por ondas de choque. La técnica resulta eficaz y presenta mínimas complicaciones. Cada vez más se indican casos de laparoscopia en el tratamiento quirúrgico de la litiasis. Ello se debe a la falta de eficacia de otras técnicas menos invasivas como la LEOC, y a las limitaciones de la ureterorrenoscopia en cálculos ureterales cercanos a los 20 mm (AU)

We present a case of laparoscopic ureterolithotomy in a young patient with a thick left lumbar ureter stone. The operation was performed after the failure of two sessions of extracorporeal shock waves lithotripsy (ESWL). The technique is efficient and has minimal complications. Increasingly, The laparosocopy is increasingly recommended in cases of urolithiasis. This is due to the lack of effectiveness of other less invasive techniques such as ESWL, and the limitations of ureteroscopy against ureteral stones close to 20 mm (AU)

Lesión en el colon como complicación de la nefrolitotomía percutánea / Injury to the colon as a complication of percutaneous nephrolithotomy

La cirugía percutánea es una opción quirúrgica efectiva y segura para el tratamiento de cálculos renales, tumores del sistema colector y para realizar endopielotomía anterógrada por síndrome de la unión pieloureteral. La lesión colónica yatrogénica es poco frecuente, pero puede tener consecuencias graves. El diagnóstico de la misma es habitualmente difícil, y las estrategias de tratamiento son controvertidas. Se presenta un caso de lesión de colon descendente durante una nefrolitotomía percutánea tratado con éxito aplicando medidas conservadoras (AU)

Percutaneous endoscopic renal surgery is usually a safe and effective treatment for patients with complex renal calculi, tumors of the collecting system, and ureteropelvic junction obstruction. A unique set of complications, however, can occur with this surgical approach that may involve the targeted kidney and surrounding structures. Iatrogenic colon injury is an uncommon but serious complication. Diagnosis is sometimes delayed, and treatment strategies are still controversial. We report a case of descending colon injury during percutaneous nefrolithotomy successfully treated using conservative measures (AU)

Vinculación de la afectación artrósica, la discapacidad funcional y la calidad de vida mediante un modelo de ecuación estructural / Association between arthritis, functional disability and quality of life using a structural equation

Objetivos. Establecer un modelo conceptual que vincule la afectación artrósica, la discapacidad funcional en las actividades cotidianas y la calidad de vida (CdV). Métodos. Estudio multicéntrico, observacional y transversal. Se registró clínicamente la afectación artrósica (presencia/ausencia), según la localización; se valoró la discapacidad mediante el índice de discapacidad del cuestionario de evaluación de la salud y se determinó la CdV mediante el cuestionario EQ-5D-3L. El vínculo entre la artrosis, la discapacidad y la CdV se evaluó mediante la modelización de ecuación estructural (SEM). Resultados. Pacientes: 965 pacientes con artrosis (edad media=64 años; 75% mujeres). Artrosis: zonas medias afectadas: 2,8. Zonas afectadas con más frecuencia: rodillas (67%); columna lumbar (60%) y cervical (45%). CdV: la mayoría de los pacientes no refirió problemas graves en los 5 dominios evaluados. Discapacidad: «otras actividades» (media=1,2); «alcanzar» (media=1,1) y «caminar» (media=1,0) fueron las categorías que mostraron mayor discapacidad. La SEM presentó la artrosis, la discapacidad y la CdV como variables relacionadas latentes. Aunque el 92% de la CdV explicó la discapacidad, solo el 5% de la discapacidad se debió a la presencia/ausencia de artrosis. El modelo global que describió la artrosis como causante de discapacidad y discapacidad que afectaba a la CdV, tuvo un buen ajuste general (CMIN/DF=5,42; RMR=0,026; RMSEA=0,069). Conclusiones. La discapacidad funcional puede explicar la disminución de la CdV. En teoría, la artrosis se relaciona estrechamente con la discapacidad y la CdV, pero el modelo no consiguió explicar por completo este vínculo. Como las técnicas estadísticas requieren buenos modelos de medición para determinar correctamente las relaciones, los registros clínicos convencionales parecen insuficientes para este propósito. Se precisan otras mediciones válidas de la afectación artrósica para proporcionar pruebas de su efecto directo en la discapacidad y la CdV (AU)

Objectives. To establish a conceptual model that links arthritis, functional disability in activities of daily living, and quality of life (QoL). Methods. A multicentre, cross-sectional, observation study was performed. The location of the arthritis (presence/absence) was recorded. Disability was measured using the Health Assessment Questionnaire Disability Index and the QoL determined using the EQ-5D-3 Level questionnaire. The relationship between the arthritis, disability, and the QoL was evaluated using the structural equation model (SEM). Results. Patients: 965 patients with arthritis (mean age=64 years, with 75% females). Arthritis: mean areas affected: 2.8. Areas most frequently affected: knees (67%); lumbar spine (60%) and cervical spine (45%). QoL: The majority of patients did not mention serious problems in the five domains assessed. Disability: «other activities» (mean=1.2); «reach» (mean=1.1) and «walking» (mean=1.0) were the categories that demonstrated greater disability. The SEM showed arthritis, disability and QoL as associated latent variables. Although 92% of the QoL explained the disability, only 5% of the disability was due to the presence/absence of arthritis. The global model that describes arthritis as a cause of disability, and disability was affecting the QoL, had a reasonable goodness of fit (CMIN/DF=5.42; RMR=0.026; RMSEA=0.069). Conclusions. Functional disability can explain the decrease in QoL. In theory, arthritis is closely related with disability and QoL, but the model did not mange to fully explain this link. As statistical techniques required good measurement models to correctly determine relationships, conventional medical records seem to be insufficient for this purpose. Other valid measurements of arthritis are needed to provide tests of its direct effect on disability and QoL (AU)

Evaluation of patients' and physicians' expectations and attributes of osteoarthritis treatment using Kano methodology.

PURPOSE: To evaluate expectations regarding osteoarthritis (OA) treatment of patients (PT) and physicians (PH) (Orthopedic Surgeons) in Spain. METHODS: Multicenter, cross-sectional study in adult patients with OA with at least 1 year of disease progression and with at least one prescription of anti-inflammatory drugs within the last year. Sociodemographic, clinical, and treatment characteristics as well as patient-reported outcomes were obtained by phone interview. Using a treatment expectations questionnaire and applying Kano methodology, treatment attributes were classified as: must-be; one-directional; attractive; indifferent; reverse or questionable. RESULTS: A total of 965 adult patients with OA [mean age: 64 years (SD: 11); 75% women] and 383 PH [mean age: 47 years (SD: 10); 14% women] were surveyed. None of the treatment attributes showed a dominant "must-be" characteristic. The attributes that led to a greater dissatisfaction when absent were non-occurrence of long-term adverse effects, no discomfort upon administration, and achievement of symptoms relief. The two attributes that were considered most important by PT were as follows: achievement of both total disappearance of the symptoms and lasting symptom relief. Conversely, for PH, the two most important attributes were related to short- and long-term safety. CONCLUSIONS: A clear different perspective regarding treatment expectation was noted among PT (effectiveness) and PH (safety). Therefore, when selecting the most appropriate treatment for OA, PH should invite PT to participate in the decision making.

[Association between arthritis, functional disability and quality of life using a structural equation]. / Vinculación de la afectación artrósica, la discapacidad funcional y la calidad de vida mediante un modelo de ecuación estructural.

OBJECTIVES: To establish a conceptual model that links arthritis, functional disability in activities of daily living, and quality of life (QoL). METHODS: A multicentre, cross-sectional, observation study was performed. The location of the arthritis (presence/absence) was recorded. Disability was measured using the Health Assessment Questionnaire Disability Index and the QoL determined using the EQ-5D-3 Level questionnaire. The relationship between the arthritis, disability, and the QoL was evaluated using the structural equation model (SEM). PATIENTS: 965 patients with arthritis (mean age=64 years, with 75% females). Arthritis: mean areas affected: 2.8. Areas most frequently affected: knees (67%); lumbar spine (60%) and cervical spine (45%). QoL: The majority of patients did not mention serious problems in the five domains assessed. Disability: «other activities¼ (mean=1.2); «reach¼ (mean=1.1) and «walking¼ (mean=1.0) were the categories that demonstrated greater disability. The SEM showed arthritis, disability and QoL as associated latent variables. Although 92% of the QoL explained the disability, only 5% of the disability was due to the presence/absence of arthritis. The global model that describes arthritis as a cause of disability, and disability was affecting the QoL, had a reasonable goodness of fit (CMIN/DF=5.42; RMR=0.026; RMSEA=0.069). CONCLUSIONS: Functional disability can explain the decrease in QoL. In theory, arthritis is closely related with disability and QoL, but the model did not mange to fully explain this link. As statistical techniques required good measurement models to correctly determine relationships, conventional medical records seem to be insufficient for this purpose. Other valid measurements of arthritis are needed to provide tests of its direct effect on disability and QoL.

Hiperplasia benigna de próstata: valoración inicial y tratamiento médico. Revisión a partir de guías clínicas internacionales y ensayos clínicos multicéntricos / Benign prostatic hyperplasia: initial assessment and treatment. Review from international clinical guidelines and multicenter clinical trials

INTRODUCCIÓN: La hiperplasia benigna de próstata (HBP) es una enfermedad prevalente en varones adultos de más de 45-50 años, aunque no siempre presenta manifestaciones clínicas. La aparición de síntomas del tracto urinario inferior (STUI) puede estar relacionada con la HBP en muchos casos. MATERIAL Y MÉTODOS: Se realiza una revisión de artículos relevantes sobre abordaje diagnóstico y terapia médica en HBP, así como ensayos clínicos publicados en los últimos años: MTOPS y PLESS y combAT. RESULTADOS: Para establecer la relación entre STUI y HBP es necesario realizar un buen interrogatorio al paciente (IPSS) y realizar una serie de exploraciones complementarias como análisis de sangre, con PSA, análisis de orina, ecografía y flujometría miccional. Una vez establecido el diagnóstico existen diversas opciones de tratamiento médico en función del IPSS, volumen protático y valor de PSA, avalados por diversos ensayos clínicos (AU)

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a prevalent disease in male adults aged 45-50 years, although not always clinical manifestations are present. The occurrence of lower urinary tract symptoms (LUTS) can be related to BPH in many cases. MATERIAL AND METHODS: A review of relevant articles on medical diagnostic and therapeutic approach in BPH, and clinical trials published in recent years: (MTOPS, PLESS and combAT) was performed. RESULTS: To establish the relationship between LUTS and BPH is necessary to make a good anamnesis of the patient (IPSS) and additional tests such as blood tests with PSA, urianalysis, ultrasound and urinary flow measurement. Once the diagnosis there are several medical treatment options in terms of IPSS, prostate volume and PSA value, backed by several clinical trials (AU)

Hipogonadismo secundario a tratamiento con zolpidem / Hypogonadism due to a treatment with zolpidem

La disfunción sexual masculina, especialmente la disminución del deseo y la disfunción eréctil, puede ser debida a un descenso en los niveles de testosterona. Una de las causas de hipogonadismo es el efecto inhibitorio de la secreción de andrógenos debido a una hiperprolactinemia. El aumento de la secreción de prolactina hipofisaria puede tener un origen farmacológico. Presentamos el caso de un varón afecto de disfunción sexual secundaria a un tratamiento inadecuado con zolpidem (AU)

No disponible

Síndrome hemorrágico agudo en un servicio de urología. Aplicación de las técnicas de imagen / Acute haemorrhagic syndrome. Use of imaging techniques

Las técnicas de imagen ofrecen hoy un amplio abanico de posibilidades. Su aplicación no está exenta de riesgos por lo que su uso está sujeto a una metodología escalonada y rigurosa. En ocasiones, cada vez más a menudo, se orientan no sólo al diagnóstico sino a la dirección de elementos de tratamiento. Las situaciones clínicamente críticas exigen aún mayor rigor en su aplicación. Se describen y analizan dos situaciones concretas ene l uso de técnicas de imagen en el diagnóstico y tratamiento de un síndrome hemorrágico tras sendos procedimientos urológicos (AU)

Imaging techniques offer a wide range of possibilities. Its implementation is not without risk and therefore its use is subject to a rigorous methodology. Sometimes, more and more often, are aimed no only at diagnosis but to treatment. Clinically critical situations require more rigour in their implementation. The authors describe and analyze two situations in the use of imaging techniques in diagnosis and treatment of hemorrhagic syndrome after urological proceedings (AU)

Cáncer insignificante de próstata: ¿existe realmente? Criterios diagnósticos en la pieza de prostatectomía radical / Insignificant prostate cancer. Does it really exist? Diagnostic criteria of the radial postatectomy specimen

El incremento del uso del PSA para la detección precoz del cáncer de próstata ha comportado el hallazgo en biopsias de adenocarcinomas que, al hacer las prostatectomías, demuestran ser muy pequeños y con signos de baja agresividad, por lo que se ha empezado a pensar en la posibilidad de que algunos de estos carcinomas quizás no serían de importancia vital para el paciente, es decir que serían clínicamente insignificantes. Este artículo presenta algunos de los aspectos que se están considerando en el intento de reconocer qué carcinomas son insignificantes y cuales no (AU)

Increasing use of PSA for prostate cancer early detection has brought about the discovery of adenocarcinomas in the biopsies that, when performing prostatectomy, prove very small and show low signs of aggressiveness; consequently, the concept has arisen that it sis possible that perhaps some of these carcinomas are not critically important for the patient, i.e, they are not clinically significant. This article discusses some of the aspects now being considered when attempting to know which carcinomas are significant and which are not (AU)

Long-term NSAID treatment directly decreases COX-2 and mPGES-1 production in the articular cartilage of patients with osteoarthritis.

OBJECTIVE: To simultaneously study the effect of a selective cyclooxygenase-2 (COX-2) inhibitor and that of a classic non-steroidal anti-inflammatory drug (NSAID) on the expression of pro-inflammatory genes in the cartilage of patients with severe knee osteoarthritis (OA) and in cultured human OA chondrocytes. METHODS: A 3-month clinical trial was carried out on 30 patients with severe knee OA scheduled for knee replacement surgery. Patients were randomized into two groups: patients treated with celecoxib (CBX) and patients treated with aceclofenac (ACF). OA patients who did not want to be treated served as the control group. After surgery, cartilage was processed for molecular biology studies. We also employed cultured chondrocytes from different OA patients to examine NSAID effects on pro-inflammatory gene expression in cells stimulated with interleukin (IL)-1beta. RESULTS: Both CBX and ACF inhibited COX-2, microsomal prostaglandin E synthase-1 (mPGES-1) and inducible nitric oxide synthase (iNOS) synthesis in the articular cartilage of OA patients. In cultured chondrocytes, both NSAID decreased COX-2 and mPGES-1 synthesis and prostaglandin E2 (PGE2) release induced by IL-1beta, while no effect was observed on nitric oxide or iNOS synthesis. In OA patients, only CBX decreased tumor necrosis factor alpha and IL-1beta expression in the cartilage, while both NSAID diminished IL-1beta induced cytokine synthesis in cultured OA chondrocytes. CONCLUSIONS: Both NSAID diminished PGE2 release and induced a decrease in COX-2 and mPGES-1 synthesis in the cartilage from OA patients and in OA chondrocytes. These data suggest that prolonged therapy with PGE2 blocking agents decreases PGE2 production not only by direct inhibition of COX-2 activity, but also by down-regulating COX-2 and mPGES-1 synthesis in the cartilage. However, CBX and ACF seem to have a different anti-inflammatory profile in controlling pro-inflammatory gene expression in the cartilage.

Long term NSAID treatment inhibits COX-2 synthesis in the knee synovial membrane of patients with osteoarthritis: differential proinflammatory cytokine profile between celecoxib and aceclofenac.

OBJECTIVE: To compare the effect of celecoxib with that of a classic non-steroidal anti-inflammatory drug (NSAID) on synovial inflammation and on the synovial expression of proinflammatory genes in patients with knee osteoarthritis (OA). METHODS: 30 patients with severe knee OA scheduled for total knee replacement surgery were included in a 3 month clinical trial. They were randomised to two groups: patients treated with celecoxib (CBX) (200 mg/24 h) and patients treated with aceclofenac (ACF) (100 mg/12 h). Those patients with OA who did not want to be treated with NSAIDs served as a control group. During knee surgery, synovial fluid (SF) and synovial membrane (SM) were collected. A SM specimen was fixed and embedded in paraffin and another part was frozen for molecular biology studies. RESULTS: At the end of study both CBX and ACF treated patients showed a significant improvement in pain and knee function compared with controls. Both drugs significantly reduced prostaglandin E(2) (PGE(2)) SF concentration and down regulated COX-2 mRNA and protein expression at the SM. However, synovial macrophage infiltration (CD68 antigen staining) and expression of proinflammatory mediators, such as interleukin 1beta and tumour necrosis factor alpha, were decreased only by CBX treatment. CONCLUSION: Both drugs improved joint pain and function, inhibited SF PGE(2) concentration, and induced a decrease in synovial COX-2 expression and synthesis not related to the tissue inflammatory status. These data suggest that PGE(2) blocking agents may decrease PGE(2) production not only by direct COX-2 inhibition but also by down regulating COX-2 expression and synthesis. However, CBX and ACF appear to have different anti-inflammatory profiles in controlling OA synovial macrophage infiltration and proinflammatory expression.

[Posterior perineal hernia. Report of a case and review of the literature]. / Hernia perineal posterior. Informe de un caso y revisión de la literatura.

We report a case of a seven months old female patient with diagnosis of generalized primary elastosis or cutis laxa, that also presented a posterior perineal hernia; it was treated with surgery (abdominal and perineal) and the postoperatory evolution was favorable. In the literature it had been reported around 100 cases of posterior perineal hernia; but most of them occurred in adults patients of the female sex, with a high proportion of pregnancy or as a result of radical cancer surgery like pelvic exenteration. This is the first case of posterior perineal hernia in the Hospital Infantil de Mexico Federico Gomez and the third founded in pediatric age in the literature.