Care entanglements: Upholding difference through the uses of mental health diagnosis in Chilean schools.

This article draws upon findings from fieldwork conducted with Chilean mental health practitioners and school staff to explore how children's mental health diagnoses can be used in the school setting as a particular rationale to mobilise and convey new forms of care practices (Mol, The logic of care: Health and the problem of patient choice, 2008). Inspired by the framing of care as an interrelational, interdependent and more-than-human affair promoted by Science and Technology Studies, and drawing from conceptual tools offered by post-humanist approaches, we focus our examination on the diagnosis of attention deficit-hyperactivity disorder (ADHD). Following the diagnosis since its formulation by clinicians in the public sector to its enactment in an urban school in Santiago, Chile, we explore how certain caring/uncaring practices are enacted in relation to the diagnosis, reconfiguring the classroom by incorporating (non)human actors to care for the diagnosed child. However, care is ambivalent, and the diagnosis can be put into action for other purposes as it interweaves with educational policies and other agendas. Thus, to produce policies that truly foster inclusion, attention must be given to the micropolitical level where disabilities and disorders are enacted, developing appropriate ethico-political and affective sensitivities to care accordingly.

Spectralities of ADHD: hauntological diagnosis amidst agency, politics and pedagogies.

Hauntology has become an increasingly alluring concept in social sciences to reflect upon everyday life and how subjects dwell upon scenarios pervaded not only by the potency of the actual but also the haunting of the past and the virtual. Drawing on the concept of 'hauntology', we inquire about recurring temporalities and spectrality themes concerning the 'controversial' diagnosis of attention deficit hyperactivity disorder (ADHD) in Chile. Using participant observation and in-depth interviews with health practitioners, teachers, school staff, diagnosed children, and their peers from 3-year-long research, we examine how the performance of the diagnosis by clinicians at times can produce a modification of the temporality of the diagnosed children from that moment forth. Amidst tension created by educational policies, ideas of well-being, pedagogical practices, and everyday living, the diagnosis keeps repeating its agentic capacity while resisting its decay, becoming ever-present and actual. Once cast, the diagnosis acts as a repeating force that can shape every experience, cancelling the possibility for the child to become different by unfolding out of the diagnosis.

Paratesticular tumors. Description of our case series through a period of 25 years.

INTRODUCTION: Paratesticular tumors are masses of slow and indolent growth and in most cases of benign nature (70 %), being that the case, the treatment of choice is simple extirpation of the lesion and follow-up, based on observation only. On those identified as malignant (30 %), treatment is more complex, consisting in radical orchiectomy with adjuvant chemotherapy or radiotherapy. This work tries to describe our case series of paratesticular tumors over the last 25 years and to make a comparative analysis with the information published in the world literature. OBJECTIVE: To describe our experience with paratesticular tumors, their incidence, demographic data and treatment over a period of 25 years. METHODS: Descriptive study where we analyzed clinical data of 16 patients with the diagnosis of paratesticular tumor treated at Mostoles Hospital between 1984 and 2010 analyzing the age, type of tumor, treatment and follow-up. RESULTS: Mean age was 50 years (range: 16-88), benign tumors were detected in 76 % of the cases and malignant in 24%. The tumor more frequently found in our series was leiomyoma (23.5%), with slight predominance of the right side (53 %); the most frequent location was the epididymis (50%) and mean size was 4.9 cm of diameter. The mean follow up was 34 months without complications or tumor relapse in any patient. CONCLUSIONS: Despite only three-quarters of paratesticular tumors are non-malignant, it is always advisable to do intraoperative pathological analysis of all this masses. Having a non-malignant diagnosis, the treatment of choice is simple extirpation of the mass. In our study the majority of the tumors were diagnosed in adult age (average 51 years), the most frequent was leiomyoma and the most common location was the epididymis.

Morphological and Semi-empirical Study of the Pluronic F68/Imogolite/Sudan III Intersurfaces Composite for the Controlled Temperature Release of Hydrophobic Drugs.

Some PluronicF68 (F68) triblock copolymer properties demonstrate surprising applications in selective drug administration, such as the transportation of hydrophobic anti-inflammatories through epithelial barriers. Nuclear magnetic resonance (1H-NMR) spectroscopy was carried out for micelle precursor dispersions and F68 films modified with a synthetic imogolite (IMO) biocompatible hydrogel. Theoretical calculations and morphological assessment for the process of morphogenesis of dendritic crystallization were performed by molecular docking and atomic force microscopy (AFM) of the Sudan III-IMO-F68 composite, which was more hydrophobic than Sudan III-F68 and carried out the prolonged release of the Sudan III "drug" captured by a water-octanol interface determined by standard absorbance. Surface fusions were measured and compared to the unmodified matrix. However, despite the superior properties of the composite, the critical micelle concentration (CMC) was practically unmodified because solitary IMO strands attached to Sudan III formed Sudan III-IMO. These strands unraveled in a stable manner by expanding like a "spiderweb" in hydrophilic interfaces according to NMR analysis of the hydrogen one H1 polarization of Sudan III and F68 methyl, whose correlation relates hydrophobicity of Sudan III-IMO-F68 with dendrite properties from F68 concentrations. CMC and surface fusions equivalent to F68 surface properties, calculated by differential scanning calorimetry and dynamic Raman spectroscopy, were determined by AFM and high-resolution ellipsometry. Our results show highly specialized pharmacological applications since micelle surfaces expand, triggering maximum deliveries of "Drugs" from its interior to the physiological environment. The implanted sensor prototype determined equilibria reached Sudan III according to temperature (32-50 °C) and time it took to cross the membrane model 1-octanol (48 h). The findings suggest that the targested design of a F68-IMO-"Drug" would function as a microdevice for the prolonged release of hydrophobic drugs. In addition, the said microdevice could regenerate the damaged tissue in the central nervous system or other organs of the body. This is due to the fact that it could perform both tasks simultaneously, given the properties and characteristics acquired by the compatible material depending on the temperature of the physiological environment.

Effect of short-term exposure to dichlorvos on synaptic plasticity of rat hippocampal slices: involvement of acylpeptide hydrolase and alpha(7) nicotinic receptors.

Dichlorvos is the active molecule of the pro-drug metrifonate used to revert the cognitive deficits associated with Alzheimer's disease. A few years ago it was reported that dichlorvos inhibits the enzyme acylpeptide hydrolase at lower doses than those necessary to inhibit acetylcholinesterase to the same extent. Therefore, the aim of our investigation was to test the hypothesis that dichlorvos can enhance synaptic efficacy through a mechanism that involves acylpeptide hydrolase instead of acetylcholinesterase inhibition. We used long-term potentiation induced in rat hippocampal slices as a model of synaptic plasticity. Our results indicate that short-term exposures (20 min) to 50 microM dichlorvos enhance long-term potentiation in about 200% compared to the control condition. This effect is correlated with approximately 60% inhibition of acylpeptide hydrolase activity, whereas acetylcholinesterase activity remains unaffected. Paired-pulse facilitation and inhibition experiments indicate that dichlorvos does not have any presynaptic effect in the CA3-->CA1 pathway nor affect gabaergic interneurons. Interestingly, the application of 100 nM methyllicaconitine, an alpha(7) nicotinic receptor antagonist, blocked the enhancing effect of dichlorvos on long-term potentiation. These results indicate that under the exposure conditions described above, dichlorvos enhances long-term potentiation through a postsynaptic mechanism that involves (a) the inhibition of the enzyme acylpeptide hydrolase and (b) the modulation of alpha(7) nicotinic receptors.

Pharmaceutical entanglements: an analysis of the multiple determinants of ADHD medication effects in a Chilean school.

This article draws upon findings from ethnographic fieldwork conducted in a Chilean school to explore how the effects of globally circulating ADHD medications emerge within the localized contexts of everyday users. An analysis of observations of children on ADHD medications within classroom settings is developed which challenges the assumption, pervasive within biomedical paradigms, that the effects of such medications can be understood as resulting directly from their chemical properties and biological modes of action. Our case study highlights the significance of multiple, interacting determinants of drug effects in an everyday setting, focusing in particular on classroom dynamics, teacher-student relations, and the agency of children taking the medications. We conclude that while ADHD medications may act in part by altering physiological processes, an adequate account of their effects requires that analytic attention extends to the sociomaterial contexts in which medications and users are embedded.

[Treatment approach for vesicogenital fistula. Retrospective analysis of our data]. / Planteamiento terapéutico de las fístulas vesicogenitales. Análisis retrospectivo de nuestra serie.

The vesicogenital fistula are abnormal communications between female genitalia and urinary bladder. We recorded all the vesicogenital fistula diagnosed since 1986, analyzing aetiology, treatment applied, complications and results. Total number of fistula have been 20 (18 vesicovaginal and 2 vesicouterine). The distribution in vesicovaginal fistula was iatrogenic in 15 cases (83%) and tumoral in 3 cases (17%). Vesicouterine fistula were due to cesarean. The initial treatment of the iatrogenic fistula was conservative using foley catheter. Twenty percent of the patients were cured with this treatment (3 cases). Surgical repair was necessary for the other patients, using different surgical approach according to the type of the fistula, intensity and patient age. It was successful in 91% of the patients. The results shows that simple surgical approach generate less morbidity and the early intervention is not less efficient.

[Progression and prognosis of in situ carcinoma of the bladder treated with BCG]. / Evolución y pronóstico del carcinoma in situ vesical tratado con BCG.

OBJECTIVES: In situ carcinoma (isT) of the bladder is a poor prognostic tumour with a natural progressive evolution. Treatment with BCG achieves a significant improvement in survival. This paper analyses our experience in the management of isT patients with endovesical BCG. MATERIAL AND METHODS: Between 1983 and 1997 the Urology Unit in the Móstoles Hospital saw 636 patients with transitional carcinoma of the bladder. Of these, 498 (78%) were surface tumours, and 138 (22%) were infiltrant. isT: 80 patients (13%), 14 of which were primary (17%), 37 associated to a surface tumour (46%), and 29 to infiltrant tumours (36%). All surface tumours: isT was present in 51 patients (10%) 44 of which were managed with 2 courses of BCG Connaught (81 mg), for 6 weeks each followed by vesical reassessment. Quarterly follow-up was conducted during a 2-year period. Patients not managed with BCG were treated with radical cystectomy. An analysis was made of patients without complete response to BCG, as well as actuarial analysis of disease-free survival (DFS), survival until progression (SUP) and specific survival (SS). All possible prognostic factors are analyzed: sex, focal isT (a single focus) or diffuse isT (more than one focus). Primary or secondary isT and association to G1, G2 or G3 tumours. RESULTS: In all 44 patients managed with BCG: males 37 (84%), females 7 (16%), primary 14 (32%), focal 22 (50%), diffuse 22 (50%). Six patients died (5 because of the tumour). Mean follow-up of living patients: 3.7 years (0.5-7.5 years). After the 2 BCG courses, 36 (82%) showed complete response. Thirteen patients (30%) had no complete response during follow-up, and 11 (85%) continued to progression. In total 7 patients underwent cystectomy. Of 5 patients directly cystectomized due to persistence of isT or T1G3 tumour at monitoring after BCG, 2 (40%) had infiltrant tumour and one (20%) nodular metastasis. Three patients with persistent isT or T1G3 after BCG were not initially cystectomized: two that were treated with other endovesical therapies because of their age progressed, and the third one underwent a third BCG course and required cystectomy due to tumour persistency. 5-year DFS: 56%, being diffuse isT vs. focal isT (p = 0.0206) was an unfavourable prognostic factor. 5-year SUP: 63%, no significant prognostic factor. 5-year SS: 79%, being a female was an unfavourable prognostic factor (p = 0.0201). CONCLUSIONS: Based on our results and the analysis of the literature we recommend treatment with 2 BCG courses of all isTs of the bladder that present some of the following factors: Diffuse cancer associated to T1G3, involvement of prostatic urethra or overexpression of p53 over 20%. In the rest of vesical tumours, one BCG course followed by a second one if lack of response to the first. After failure of both BCG courses, cystectomy must be performed in both groups.

[Clinical course and mid- and long-term prognosis of superficial bladder tumors]. / Evolución y pronóstico a medio y largo plazo de los tumores vesicales superficiales.

OBJECTIVES: To evaluate the outcome of 551 patients with superficial transitional cell carcinomas of the bladder. To determine prognostic factors in these patients by means of the log-rank analysis of the Kaplan-Meier curves and a multivariate analysis with Cox regression model for the disease free survival (DFS), time to progression to infiltrating lesions (TTP) and overall survival (OS). MATERIAL AND METHODS: Between 1983 and 1998 we have seen 551 patients with superficial transitional cell carcinomas of the bladder in our Hospital. Fifteen patients included in this series had been diagnosed in other hospitals before 1983. The clinical records were actualized between 1998 and 2000 and only 21 patients were lost to follow-up (3.8%). The mean follow-up time was 6.2 years (median time: 5.3). One hundred and eleven patients (20%) died with a mean of 4.5 years (median time 3.4). Four hundred and forty patients were still alive on completion of the study with a mean follow-up time of 6.6 years (range 2-24 years; median 5.7). RESULTS: Four hundred and fifty-nine patients were men (83%) with a mean age of 64 years and 92 were women (17%) with a mean age of 70 years. In 347 patients there was only one tumour (63%). The tumours were stage Ta in 79 cases (14%). T1 in 431 (78%) and Tis in 41 (7%). The histological grade was G1 in 406 cases (74%), G2 in 96 (17%) and G3 in 33 (6%). There were recurrences in 253 patients (46%) with a mean time of 2.2 years. The DFS was 55% at 5 years, 44% at 10 years and 38% at 15 years. The multivariate analysis has shown a negative prognostic influence on DFS of the presence of multiple tumours (RR 1.4 CI 1.19-1.69), increasing age (analysed as a continuous variable) and the sex (being worse for females; RR 1.2 CI 0.98-1.52). In 40 patients (7.3%) the tumour became infiltrative in a mean of 3.3 years. The TTP was 93% at 5 years, 91% at 10 years and 90% at 15 years. The negative prognosticators in the multivariate analysis were G3 tumour (RR: 5.1 CI 2.7-9.6), the group of tumours Ta-T1G3 or multiple T1G2 or Tis (RR 4.6 CI 2.6-7.9) and the age > 70 years (RR 2.14 CI 1.2-3.7). Thirty-one patients (5.6%) died of the tumour in a mean time of 4.6 years. The OS was 95% at 5 years, 93% at 10 years and 91% at 15 years. Significant prognosticators in the multivariate analysis for OS were the group of risk tumours Ta-T1G3 and multiple Tis or T1G2 (RR 5 CI 2.7-9) and age > 70 years (RR 4.56 CI 2.2-8.8). CONCLUSIONS: The recurrence rate is very high in all the patients, but the risk is highest when the tumours are multiple. The risk of progression is low, but still exits even in patients with tumours of low malignant potential. The highest risk is associated with Ta-T1G3 of Tis or multiple T1G2.

[Clinical course of superficial transitional carcinoma of the bladder without poor prognostic factors]. / Evolución clínica de los carcinomas transicionales superficiales de vejiga sin factores pronóstico desfavorables.

OBJECTIVES: Surface carcinoma of the bladder shows a high incidence of tumour recurrence that require frequent examinations associated to potential morbidity. This paper analyses our series of patients with vesical tumours with no known unfavourable clinical prognostic factors, aiming to detect low risk groups where it may be feasible to change the usual follow-up criteria. MATERIAL AND METHODS: Between 1983 and 1996, 503 patients with vesical cancer, 388 of which 388 were primarily surface tumours, were monitored. The study analyzed 24 patients with surface transitional carcinoma with no unfavourable prognostic factor, i.e. Ta tumours, grade 1, single, under 1 cm, negative urine cytology and multiple negative vesical biopsies. This group was then compared to a control group comprising all other patients with surface tumours in our series (364 patients), and the prognostic factors were assessed based on the disease-free interval, progression-free interval, and overall and tumour-specific survival. Also the recurrence-free interval from the first endoscopic control at 3 months after transurethral resection, were studied according to Parmar's criteria. RESULTS: With a mean follow-up of 53 months, 37% patients in the study group have relapsed versus 41% in the control group (n = 0.9), after 2 years on average. Actuarial curves in the control group reveal statistical significance for higher degree tumours recurrence. No grade progression has occurred in the study group versus 9% in the control group. No patient evolved to T2 versus 5% in the control group; also in this group, 5% patients died because of their tumour versus none in the study group. The 24 patients in the study belong to group 1 in Parmar's low risk, while the remainder of patients in the control group ranked according to these criteria have demonstrated an unfavourable statistical significance (p < 0.01) in patients with early relapse. CONCLUSIONS: Good results obtained in the evolution of patients with surface tumours with no unfavourable prognostic factors are due to the strict monitoring they undergo in order to detect early relapses. However, 37% of recurrences in this group does not allow to modify the usual follow-up schedule. In our experience, Parmar's criteria does not contribute any benefit over classical criteria to evaluate prognostic factors in surface vesical cancer.

[Epidemiologic indicators of adenocarcinoma of the prostate. Results on 436 patients]. / Indicadores epidemiológicos del adenocarcinoma de próstata. Resultados sobre 436 pacientes.

OBJECTIVE: To conduct a populational study by analyzing the major epidemiological indicators in a group of 436 patients with prostate adenocarcinoma. MATERIAL AND METHODS: The population reference for the study involves a total of 396,294 people, of which 197,500 are male. Between 1983 and 1996, 436 patients were diagnosed with prostate adenocarcinoma in the Urology Service of Mostoles Hospital. Gleason Index has been used to determine the histological grade, while the 1992 TNM rating was used for staging purposes. Gleason rating is known for 395 patients, distribution being as follows: 26.6% with Gleason 2, 3 or 4; 44.6% with 5, 6 or 7 and 28.9% with 8, 9 or 10. T1 tumours accounted for 21.1% cases; T2: 45.6%; T3: 22.2% and T4: 11%. There were 58.3% M0: 32.8% M1 and 8.9% Mx tumours. Approach for local disease: radical prostatectomy or radiotherapy. Approach for disseminated disease; hormonal blockade. Deaths: 130 (29.8%); cancer related deaths: 91 (70%). Mean follow-up of survivors: 3.4 years (0.25-14 years). Major variables analyzed: age, incidence, prevalence, mortality, Gleason's evolution and overall and specific survival. RESULTS: Mean age: 71.3 years. Prior to 1990 there were 55.5% patients under 70 years old; in 1995-96 there are 39.4%. Incidence has increased up to 36.5% per 100,000 people/year in 1996. Mean mortality in 1993-1996: 5.6 per 100,000 people/year. Prevalence in 1996: 155 per 100,000 people/year. Family background for prostate cancer: 8%. Incidence of second tumours: 10.5%. Increased proportion of patients with moderate to high versus low Gleason grades. Overall survival at 5 years: 53%, at 10 years: 33%. Tumour related survival at 5 years: 65%; at 10 years: 48%. Older age, higher PSA, higher Gleason, advanced stages and metastasis are all unfavourable prognostic factors for both overall and specific survival (p = 0.000). Significant prognostic factors in multivariate analysis have been a higher Gleason grade and non metastatic tumour at diagnosis. CONCLUSIONS: Incidence of prostate adenocarcinoma has increased in our milieu, reaching 36.5 per 100,000 people/year in 1996, far from the figures in the US. Actual mortality in our series is somehow lower than data published in other national series. This condition shows very high prevalence rates which results in increasingly growing and highly significant economic costs.

[Evolution and prognostic factors of adenocarcinomas of the prostate metastasizing at diagnosis]. / Evolución y factores pronósticos de los adenocarcinomas de próstata metastásicos al diagnóstico.

OBJECTIVES: In 30-40% patients, prostate adenocarcinoma is diagnosed already in the metastatic phase, a percentage that will depend on the number of patients with localized cancer that we are unable to detect. Hormonal suppression is the most widely accepted therapeutical option, although there are doubts on the value of rescue treatment after the hormone-refractive stage. This paper analyses those parameters as well as the main prognostic factors in a series of 135 patients with metastatic prostate cancer at diagnosis. MATERIAL AND METHODS: Between 1983 and 1996, 414 patients were diagnosed with prostate adenocarcinoma in the Urology Unit. Móstoles Hospital, 135 of which (32.6%) were metastatic at the time of diagnosis and were managed as follows: 113 (84%) were treated with maximum androgenic blockade (MAB). 13 (9.6%) with orchiectomy and antiandrogens, 5 (3.7%) with various treatments, and only 4 received symptomatic treatment. Of those treated with MAB, 97 (72%) continued treatment after the hormone-refractive stage and 16 (12%) were given stramustine phosphate instead of the antiandrogen. Response monitoring was done basically by means of serial PSA determination. The parameters analyzed included survival and the following potential prognostic factors: age, performance status, metastatic bone pain, tumour diagnosis based on number of metastasis, prior PSA level, Gleason, local stage, M1 type at diagnosis based on the 1992 TNM classification, and response to the various treatment applied. RESULTS: Mean age: 72 years. Over an average of 25 (0-127) months, 80 (59%) patients have died; mean follow-up of patients alive at end of study: 24 months (3-111). Lost to follow-up: 6 patients (4.4%). Up to 1991, the proportion of patients with metastasis was 48%; since 1992, 24%. Percentage of patients diagnosed due to clinical manifestations of the metastasis (25 patients) over these two periods increased, mean age decreased and the proportion of patients with highly aggressive tumours increased. Mean overall survival, 26 months: influential prognostic factors: diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy, with no differences between drug versus surgical treatment. Tumour-dependent mean survival, 32 months; influential prognostic factors: performance status, metastatic bone pain, diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy. Progression-free interval, 19 months; influential prognostic factors: metastatic bone pain, PSA higher or lower than 90. Gleason greater than 7 and local stage: no differences between treatments. Mean survival after progression, 6 months; influential prognostic factors: diagnosis due to metastasis, M1b versus M1c patients: increased survival in patients rescued with stramustine phosphate. CONCLUSIONS: The proportion of prostate adenocarcinomas with metastasis at diagnosis shows a trend to decrease, although the percentage of patients who are diagnosed by the sings and symptoms of their metastasis is increasing. These patients should be treated with pharmacological or surgical hormone-suppression. Rescue treatment with stramustine phosphate prolongs survival. Influential prognostic factors: Gleason greater than 7, metastatic bone pain, tumour extent and previous PSA.

Nuevas subjetividades: una aproximación posthumanista y material a los procesos de encuentro entre niñas, niños y psicoestimulantes / New subjectivities: a posthumanist and neo-materialist approach to the processes of encounter between children and psychostimulant medication / Novas subjetividades: uma abordagem pós-humanista e material dos processos de encontro entre meninas, meninos e psicoestimulantes

Resumen: Este artículo propone un abordaje complejo y posthumanista a los diversos modos mediante los cuales niñas, niños y psicofármacos se co-afectan, determinando diversos devenires ontológicos a partir de esta interacción, en el nicho provisto por dos escuelas ubicadas en la zona oriente de Santiago de Chile. A partir de los resultados de una praxiografía que se extendió por ocho meses con niñas y niños de 9 y 10 años, se sostiene que es necesario pensar esta relación entre niñas, niños y psicofármacos desde coordenadas distintas a las provistas por las tesis de la medicalización. Esto, en tanto ellas reducen y achatan la noción de subjetividad a una posesión interna del individuo, y a una separación radical con el mundo, sostenida en una discutible idea de excepcionalismo humano. En respuesta a esta idea de subjetividad, se propone otra que permite un abordaje diferente al problema, en tanto es una subjetividad entendida en sus aspectos procesales, dinámicos, y últimamente sostenido en base a entramados con el mundo y con la medicación.

Abstract: This article advances a posthumanist and complex approach to the different ways in which children and psychostimulants can co-affect each other, enabling different ontological becomings thanks to the processes of coming together that took place in the niche provided by two schools located in East Side of Santiago, Chile. Grounded in the results of an 8-months praxiography with children aged 9 and 10-years old, I argue for the need of new coordinates to reflect upon these interactions, coordinates different to those granted by the medicalization thesis. This, inasmuch as their approach tends to flatten and reduce the subjectivity of the medicated child to an inner essence, radically separated from the world, which is sustained under a disputed idea of human expectionalism. In respond to this, I advance an idea of subjectivity which is relational, processual and sustained on entanglements with the world and with the medication.

Resumo: Este artigo propõe uma abordagem complexa e pós-humanista aos vários modos pelos quais meninos, meninas e psicofármacos se co-afetam, determinando diferentes devires ontológicos dessa interação, no nicho prestado por duas escolas localizadas na zona oriente de Santiago do Chile. A partir dos resultados de uma praxiografía que durou oito meses com meninas e meninos com idade entre 9 e 10 anos, argumenta-se que é necessário pensar sobre a relação entre crianças e psicofármacos a partir de coordenadas diferentes das previstas pelas teses da medicalização. Neste aspecto, estas teses reduzem e achatam a noção de subjetividade a uma posse interna do indivíduo, e uma separação radical do mundo, realizada em uma ideia discutível do excepcionalismo humano. Em resposta a esta idéia de subjetividade, propõe-se uma abordagem diferente para o problema, a partir de uma subjetividade entendida em seus aspectos processuais, dinâmicos e, finalmente, sustentada com base nas associações com o mundo e com a medicação.

Synaptic localization of acylpeptide hydrolase in adult rat telencephalon.

Acylpeptide hydrolase (ACPH), a serine protease present in the central nervous system (CNS), is believed to have a function in modulating synaptic plasticity, cleavage of beta amyloid peptide and degradation of aggregated oxidized proteins. In this report, we demonstrate for the first time the presence of ACPH in the synapse and its preferential localization at the pre-synaptic side. We isolated subcellular fractions from the rat telencephalon enriched in pre- versus post-synaptic components by using differential centrifugation steps to evaluate ACPH catalytic activity and expression level. Relative ACPH levels were determined by Western blot techniques while antibodies against synaptophysin and PSD-95 were used as positive pre- and post-synaptic markers, respectively. Our results show that ACPH protein levels are significantly increased at the synapse, which correlates with a 56% increase in ACPH activity. Furthermore, Western blot experiments show that ACPH is preferentially located at the pre-synaptic side and this is consistent with the increase of its enzymatic activity in fractions enriched in pre-synaptic components. These results give new insights regarding the localization and a putative role of ACPH in the CNS.

[Endoscopic treatment of the vesicoureteral reflux in children: preliminary experience with the subureteral injection of Coaptite]. / Tratamiento endoscópico del reflujo vesicoureteral en pediatría: experiencia preliminar con la inyección subureteral de Coaptite.

OBJECTIVE: To review our experience in the endoscopic treatment of vesicoureteral reflux (VUR) in children with the subureteral injection of calcium hydroxyapatite (Coaptite). METHODS: The serie includes thirteen children whose age ranged between 6 and 13 years. The Coaptite implant was injected subureterally to 20 ureteral units (UU) affected by VUR grades I-IV. VUR was unilateral in six patients (46%), bilateral in seven (54%). There were 7 primary cases and 6 secondary to bladder dysfunction and duplex systems. RESULTS: Mean follow-up was 19 months (6-28 months). VUR was cured in 75% of cases after a single injection. A second injection resolved 2 out of 4 treated UU (50%) rendering a global success rate of 85%. This cure rate was achieved for 13 and 7 procedures treating primary and secondary VUR, respectively. 77% of patients reported no adverse events with only 23% of them complaining of transient mild lumbar and hypogastric discomfort limited to the first postoperative day. In 2 children postoperative urinary infection was detected. CONCLUSIONS: Endoscopic subureteral injection with Coaptite is a simple technique well tolerated in children. In 85% of primary and secondary cases cure was achieved with minimal morbidity.

[Cerebellum and lower urinary tract]. / Cerebelo y tracto urinario inferior.

OBJECTIVES: To review the role of cerebellum on the lower urinary tract dynamics. METHODS: Anatomic-functional methodology including structural, functional and neurotransmitters study. RESULTS: We describe the complex connections of the cerebellum and its influence on the lower urinary tract function. CONCLUSIONS: It is surprising the functional relationship between cerebellum and lower urinary tract, playing a inhibitory modulating role during the filling phase and facilitating the voiding phase.

[Urogenital alterations in hereditary and sporadic neurodegenerative ataxias]. / Alteraciones urogenitales en las ataxias neurodegenerativas hereditarias y esporádicas.

INTRODUCTION: Sporadic and hereditary ataxias (HA) represent a group of clinically and genetically heterogeneous syndromes characterized by spinocerebellar degeneration producing a motoneuron coordination disorder. In these diseases urinary and sexual symptoms are commonly associated to the neurological alterations. OBJECTIVE: To define the prevalence of functional low urinary tract symptoms in an ataxic population and to compare them with the symptomatology control a group of in healthy subjects. PATIENTS AND METHODS: An observational, descriptive, transversal study of 491 subjects recruited from the HA regional associations of Spain was conducted. In addition, a case-control study of prevalent ataxic patients and healthy subjects matched by sex and age was also performed. RESULTS: Among 195 patients included, 138 (70.8 %) had Friedreich ataxia (FA) and 57 (29.2 %) non-Friedreich ataxia (nFA). Global mean age was 32.3 years in FA and 43.7 in nFA patients (p < 0.05). Combined irritative and obstructive symptoms were present in 48.7 %, only irritative in 16.4 % and obstructive in 15 % of patients. Erectile dysfunction in 30.3 % (p < 0.01) and decreased libido in 13.4 % (p < 0.01), were the most common sexual problems. CONCLUSIONS: In HA, urinary symptoms are present in 80 % of patients, with mainly irritative symptoms in 2/3 of them. A complete urodynamic evaluation in symptomatic patients is recommended in order to characterize potential neurogenic vesico-urethral dysfunction. Even though sexual dysfunction may be related to neurological causes, additional etiologic organic factors should be excluded.

[Ultrasonic diagnosis of the complications of renal transplantation]. / Diagnóstico ultrasónico de las complicaciones del transplante renal.

To evaluate the usefulness of ultrasound in the diagnosis of urologic complications in renal transplants, we reviewed the ultrasonographic studies performed in 107 renal transplants. Ultrasound disclosed 13 perirenal collection of fluid without hydronephrosis, 4 hydronephrosis without perirenal mass, 2 hydronephrosis from a perirenal fluid mass, 2 urinomas from polar infarction, 1 subcapsular hematoma, and 1 graft vascular atrophy. Ultrasound proved to be the most efficient technique in the diagnosis of hydronephrosis and perirenal fluid collection. Although it does not distinguish the nature of the latter, it permits control of diagnostic or therapeutic (75%) puncture. Moreover, it is useful in controlling percutaneous nephrostomy in transplant obstruction and permits its noninvasive follow-up.

[Renal candidiasis: percutaneous endoscopic treatment of the pyeloureteral fungus-ball]. / Candidiasis renal: tratamiento endoscópico percutáneo del fungus-ball pieloureteral.

We report three cases of pyelic fungus ball from Candida albicans in two patients (one bilateral) with lithiasic urinary obstruction that were treated endo-urologically by percutaneous nephroscopy and with adjuvant antifungal medication. The infection mechanism, nephroscopy procedure and results obtained are discussed.

[Endo-urologic treatment of the uretero-intestinal stenoses in patients subjected to diversion]. / Tratamiento endourológico de las estenosis ureterointestinales en pacientes derivados.

Surgical repair of uretero-enteric strictures in patients with enteric conduit urinary diversion (incidence rate 4-8%) is difficult and has a high morbidity. With the development of endo-urologic techniques and ureteral catheters, long-term insertion of stents in the treatment of strictures has become possible and safe. We have performed long-term uretero-enteric stenting with 7-8 Fr double-J catheters in 5 patients with 6 strictures: 3 ureteroileal and 3 uretero-colic. In three cases (2 colonic conduits, 1 ileal conduit) the stent was inserted anterogradely following intercostal renal percutaneous punctures and dilatation of the stricture with teflon dilators (1 case), balloon catheter (1 case), or following the incision of the stricture (1 case). In one patient with a double uretero-enteric stricture of the ileal conduit, guide-wires were successfully inserted retrogradely which permitted subsequent high pressure dilatation of the uretero-ileal strictures with a 15 Fr balloon catheter. We used the same approach in another patient with a right uretero-colic stricture. The catheters were left indwelling for 7 to 35 months and were changed every 3 months with no remarkable observations other than 3 episodes of fever which quickly resolved with antibiotic treatment. Although is has been reported that uretero-enteric strictures are particularly refractory to endo-urologic treatment and a significant morbidity rate has been associated with long-term ureteral stenting, our results show that the approach was well-tolerated by all of the patients.