Long-term followup of primary nonrefluxing megaureter.

PURPOSE: We evaluated outcomes of nonoperative management of primary nonrefluxing megaureter at long-term followup to identify clinical predictors of spontaneous resolution. MATERIALS AND METHODS: A total of 75 patients (88 primary megaureters) were diagnosed between 1990 and 2005 and followed for more than 6 months. Of the patients 63 (74 primary megaureters) were included in the main study population. Indications for surgery were obstructive hydroureteronephrosis, functional impairment and persistent symptoms. RESULTS: Of the 74 primary megaureters 20 (27%) required surgery up to 7 years after diagnosis. Surgery was not indicated in 82% of primary megaureters with grade I or II hydronephrosis vs 62.9% of those with grade III or higher hydronephrosis (difference not significant), nor in 76.5% of types I and II primary megaureters vs 33.3% of type III primary megaureters (p = 0.040), 78.7% of renal units with differential function 40% or greater vs 0% with differential function less than 40% (p = 0.027), 80% of primary megaureters with a nonobstructive washout pattern vs 44.4% with an intermediate/obstructive pattern (p = 0.032), 67.9% of patients with perinatal presentation vs 25% with postneonatal presentation (p = 0.008) or 63.2% of patients presenting with symptoms vs 76.4% of those who were asymptomatic (difference not significant). On multivariate analysis age at presentation and washout pattern were significant predictors of spontaneous resolution. CONCLUSIONS: Most cases of primary megaureter resolve spontaneously or improve without loss of function or development of symptoms. Careful observation allows surgery to be delayed beyond the neonatal period in most patients. Long-term followup is recommended because symptoms can develop years later. Washout pattern and age at presentation are statistically significant predictors of spontaneous resolution.

The history of the pediatric inguinal hernia repair.

The history of inguinal hernia repair is a rich one. For centuries, hernia healers, doctors, anatomists, surgeons and quacks have been devoted to this pathology that has afflicted mankind throughout its evolution. The development of surgical correction mainly focused on adult pathology, with treatments that often involved the loss of the testis. Hernia management in children, however, also dates from antiquity. Described as a swelling on the surface of the belly in ancient papyri, it was treated with tight bandages by the early physicians of Alexandria. For centuries, conservative treatment had been used for the child using primordial trussess, many prayers, and often pagan rituals as the arboreal passage of children described by Marcello of Bordeaux, doctor of the Emperor Theodosius I (347-395 AD), reserving medical intervention only for cases of strangulation in which only reduction was attempted. The middle ages were characterized by an increase in cultural and scientific exchange, during which the first comprehensive surgical textbooks and atlases were written. Different approaches to the inguinal hernia were not taught and passed down through generations of surgeons. The modern era brought a better understanding of the inguinal anatomy, which led to surgical techniques associated with less post-operative complications. Today, the pediatric inguinal hernia repair is one of the most common pediatric operations performed. It is considered a safe procedure with very low complication rate.

Rising Tides: Challenges and Opportunities for Women in the Urologic Workforce.

The number of practicing female urologists has increased from < 2% in 1980 to 9.2% in 2018. Despite this increase, urology trails far behind medical fields overall and surgical subspecialties, in achieving gender parity. Barriers, such as pervasive biases and institutional policies, exist at the medical student, resident, and practicing urologist levels. Once recognized as detrimental, action can be taken to combat these forces to allow for advancement of women in the field of urology. This will result in a richer workforce better able to serve its patient population and advance the field.

[Neurodevelopmental Pediatrics in Portugal: Hospital Patient Volume, Resources and Needs - Changes After Ten Years]. / Pediatria do Neurodesenvolvimento em Portugal: Movimento Hospitalar Assistencial, Recursos e Necessidades ­ Evolução em Dez Anos.

INTRODUCTION: Neurodevelopmental disorders are, in modern societies, the most common chronic pediatric conditions. Many remain in adulthood. Organizing the national health care network to respond efficiently and effectively requires grounded knowledge of care needs. The Neurodevelopmental Pediatrics Society of the Portuguese Society of Pediatrics in order to know the current hospital care reality of Neurodevelopmental Pediatrics, carried out a national survey in 2007, repeating it ten years later. Material e Methods: In the 2016-2017 biennium, a survey of 45 hospital units was conducted on the patient volume of Neurodevelopmental clinics, the allocation of human resources, and the needs for professional reinforcement. RESULTS: We obtained a 100% response rate. The total number of Neurodevelopmental Pediatrics consultations rose from 38 238 (2007) to 99 815 (2017). The number of professionals has also increased: pediatricians increased from 82 to 156. A median of 101 children were awaiting first consultation, compared with 185 in 2007. DISCUSSION: In a decade, the patient volume almost tripled. The reinforcement of professionals, even though it was beneficial, did not increase accordingly; even so, the number of children on the waiting list for their first appointment has almost halved, reflecting the commitment of professionals. CONCLUSION: It is noteworthy that the overall improvement of the national response in the area of Neurodevelopmental Pediatrics is remarkable. However, the requested reinforcement of human resources from a multidisciplinary perspective should not be neglected in view of the continuous improvement in care delivery in an area of great chronicity and complexity.

Introdução: As perturbações do neurodesenvolvimento são, nas sociedades modernas, as patologias crónicas mais frequentes da idade pediátrica. Muitas permanecem na vida adulta. A organização da rede de cuidados de saúde nacional carece de conhecimento fundamentado das necessidades assistenciais para lhes responder de um modo eficaz, eficiente e efetivo. Com o objetivo de conhecer a realidade assistencial hospitalar atual da Pediatria do Neurodesenvolvimento, a Sociedade de Pediatria do Neurodesenvolvimento da Sociedade Portuguesa de Pediatria procedeu a um levantamento nacional em 2007, repetindo-o dez anos depois.Material e Métodos: No biénio 2016-2017 procedeu-se a um inquérito dirigido ao universo de 45 unidades hospitalares abrangendo o movimento assistencial das consultas de Pediatria do Neurodesenvolvimento, a alocação de recursos humanos, e as necessidades de reforço de profissionais.Resultados: Obteve-se 100% de respostas. O número total de consultas de Pediatria do Neurodesenvolvimento subiu de 38 238 (2007) para 99 815 (2017). O número de profissionais também aumentou: os pediatras passaram de 82 a 156. Uma mediana de 101 crianças aguardavam primeira consulta, contra 185 em 2007.Discussão: Numa década, o movimento assistencial quase triplicou. O reforço de profissionais, apesar de positivo, não teve o mesmo incremento; ainda assim, o número de crianças em lista de espera para primeira consulta reduziu-se quase para metade, o que reflete o comprometimento dos profissionais.Conclusão: É de salientar a melhoria global da resposta nacional na área da Pediatria do Neurodesenvolvimento. Contudo, o reforço dos recursos humanos numa perspectiva pluridisciplinar não deve ser negligenciado, tendo em vista a melhoria contínua da prestação de cuidados numa área de grande cronicidade e complexidade.

Individualized care for patients with intersex (disorders/differences of sex development): Part 3.

The focus of this article is to review the complex determinants of gender assignment in a child with a disorder of sex development using four different clinical cases. While the care of patients with DSD may be shared across several specialties and opinions regarding their management may vary, this may be further complicated by psychosocial, cultural and economic factors. In this regard, access to behavioral health specialists with experience and specialization in the treatment of patients with DSD should be a foundational component of the standard of care and can greatly assist in the complex decision-making regarding gender assignment. We recommend an individualized approach by a multidisciplinary team utilizing a range of evolving strategies, including outcome data (or lack thereof) to support families during the decision-making process.

Effect of Byrsonima sericea DC. leaf extracts on mice gastrointestinal tract.

Byrsonima sericea DC. (Malpighiaceae) leaves are popularly folk medicine in Brazil used to treat gastro-intestinal disorders including diarrhea and gastric diseases. Ethanol extract (BSEE), ethyl acetate extract (BSEAE) and hexane extract (BSHE) of the leaf part of Byrsonima sericea DC were characterized for their total phenolics, proanthocyanidins and flavonoids content. The total antioxidant capacity of extracts was determined. The ethnopharmacological use of B. sericea leaves was evaluated by assaying BSEE for gastroprotective activity in stomach ulcer induced by indomethacin, intestinal motility and toxicity. Abundance of phenols mainly tannins was found in BSEE. Total phenolics, flavonoids and proanthocyanidins content in BSEE were found to be 0.371, 0.172 and 1.3 × 10-4 (mg/g) respectively. BSEE showed concentration dependent significant scavenging of DPPH values 90.0 (%) respectively. Moreover, oral doses of 500 and 1000 mg/kg did not cause mortality, and there was no difference in animals weight, organs relative weight and alanine transaminase (ALT) and aspartate transaminase (AST), as compared to the control group. Doses of 250, 500 and 1000 mg/kg inhibited the gastric lesions induced by indomethacin in 52, 60 and 62 % respectively. The dose of 1000 mg/kg decreased intestinal motility in animals. The presence of phenolic compounds, including tannins could be associated with the anti-diarrheal action and the antioxidant properties could collaborate to the gastroprotective and anti- diarrheal activities, confirming its popular use of the plant.

Bladder Bowel Dysfunction.

Bladder bowel dysfunction (BBD) describes a spectrum of lower urinary tract symptoms associated with bowel complaints. The true incidence of BBD is unknown; however, BBD symptoms represent approximately 40% of pediatric urology consultations. Given the close interaction between the bladder and bowel due to their common innervation as well as associated pelvic floor muscles, patients often present with bowel complaints as well. Increasing awareness of BBD over the past 30 years has led to better diagnostic criteria and treatment methods. In this article, we review the clinical presentation, diagnostic approach, pathophysiology, and treatment options for children with BBD.

The Representation of Women in Urological Leadership.

INTRODUCTION: While urology has historically been a male dominated field, the number of female urologists is increasing. In 2015 women made up 7.7% of practicing urologists and 17.1% of urologists younger than age 45 years. In the medical field overall females have been markedly underrepresented in leadership positions. We assess the current prevalence of women in urological leadership roles. METHODS: Using data from the Accreditation Council for Graduate Medical Education, and society and journal leadership boards, we compiled a list of editorial staff, boards of directors, department chairs and program directors in July 2016. Queried societies included the American Board of Urology, American Urological Association, Society of Genitourinary Reconstructive Surgeons, Societies for Pediatric Urology, Society of Urologic Oncology, Society of Academic Urologists, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, and the Large Urology Group Practice Association. Editorial boards examined were from The Journal of Urology® and Urology. We also included committee members who wrote American Urological Association guidelines between 2011 and 2016. RESULTS: Women represent 10% of leadership positions in the queried organizations and are underrepresented in advanced leadership positions. There were no women on the American Urological Association board of directors and women made up 1.6% of department chairs. Of the committees 76% included at least 1 woman. Overall, 75% of women on committees were urologists. By comparison, 95% of men on committees were urologists. CONCLUSIONS: Overall, women are fairly represented in a broad cross-section of leadership roles. Women are less well represented in the upper echelon of urological leadership, especially department chairs.

Histopathology in Ureteropelvic Junction Obstruction With and Without Crossing Vessels.

OBJECTIVE: To determine if the histopathology of the ureteropelvic junction differs between those with and without crossing vessels who present with a ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS: Our database was queried for patients undergoing pyeloplasty (Current procedural terminology 50400, 50405, and 50544) between June 1, 2002, and March 10, 2016. We excluded patients with other renal anatomic abnormalities and patients undergoing surgery for upper tract tumor. One genitourinary pathologist reviewed all slides for muscle hypertrophy, fibrosis, edema, and inflammation. Statistics were modeled in SAS 9.4 (SAS, Cary, NC) using logistic regression with maximum likelihood. RESULTS: A total of 178 patients met the inclusion criteria, and pathology slides were available for 136 patients. Thirty-three patients had crossing vessels in association with a UPJO. The degrees of muscle hypertrophy (P = .89) and fibrosis (P = .17) were not predictive of etiology. The odds of a crossing vessel increased by 4.3 times (95% confidence interval 1.8-9.9) when edema was present (P = .009) and by 4.4 (95% confidence interval 1.4-13.7) times when inflammation was present (P = .0103). CONCLUSION: In the largest pathology series to date, histopathology showed increased inflammation in the presence of a crossing vessel but a similar composition of muscle and fibrosis. These data suggest that UPJO with an associated lower-pole vessel may represent a chronic process, which would explain why patients with a crossing vessel present later in life.

A Case of High-grade Transitional Cell Carcinoma of the Bladder in a Pediatric Patient With Turner Syndrome.

Transitional cell carcinoma is a rare entity in children, especially in the first decade of life. The majority of these tumors are of low grade and noninvasive. We report an interesting case of a high-grade superficial transitional cell carcinoma in a 3-year-old girl with Turner syndrome.

Antispasmodic effects of a new kaurene diterpene isolated from Croton argyrophylloides on rat airway smooth muscle.

OBJECTIVES: The effects of rel-(1S,4aS,7S,8aS)-7-(1-vinyl)-tetradecahydro-1,4a-dimethylphenanthrene-7,8a-carbolactone-1-carboxylic acid (TCCA), a new ent-kaurene diterpene isolated from Croton argyrophylloides, on rat tracheal preparations were investigated. METHODS: Tracheae were removed and cut into two-cartilage segments that were mounted in organ baths containing Tyrode's solution. RESULTS: TCCA reduced the contractions induced by electrical field stimulation, relaxed K(+)-induced contractions, and inhibited both phasic and tonic components of the K(+)- and ACh-induced contractions. TCCA reduced the serotonin-induced contraction, abolished that evoked by K(+) in the presence of epinephrine, and also reduced the ACh-induced contractions under Ca(2+)-free conditions. TCCA blocked contractions that depend on divalent cation inflow through voltage-operated Ca(2+) channels (VOCCs) and receptor-operated Ca(2+) channels (ROCCs), but had greater potency to block VOCC- than ROCC-dependent contractions or contractions induced by ACh in Ca(2+)-free conditions. TCCA relaxed the phorbol 12,13 dibutyrate (1 µm) induced contraction, but with slight potency. CONCLUSIONS: TCCA induces an antispasmodic effect through several mechanisms including blockade of either VOCCs (with greater potency) or ROCCs, blockade of IP(3)-induced Ca(2+) release from sarcoplasmic reticulum (with intermediate potency) and reduction of the sensitivity of contractile proteins to Ca(2+).

Ação antioxidante de chás e condimentos de grande consumo no Brasil / Antioxidant action of teas and seasonings more consumed in Brazil

Antioxidantes são compostos que atuam inibindo e/ou diminuindo os efeitos desencadeados pelos radicais livres e compostos oxidantes. Os chás são bebidas populares e fontes significativas de compostos fenólicos, sendo considerados importantes integrantes das dietas devido às suas propriedades antioxidantes. O presente trabalho teve como objetivo avaliar a ação antioxidante de uma variedade de chás e condimentos mais consumidos no Brasil. Os chás analisados foram das plantas: Pneumus boldus Mold., Matricaria recutita L., Cymbopogon citratus (DC) Stapf, Baccharis trimera (Less.) DC, Camelia sinensis (L) O. Kuntze (fermentado), Camelia sinensis (não-fermentado), Lippia alba N.E. Brown,Mentha arvensis L., e Pyrus malus L. Os condimentos analisados foram: Eugenia aromatica Baill, Cinnamonum zeylanicum Blume, Laurus nobilis L. e Origanum vulgare L. O método utilizado para avaliar a ação antioxidante foi o da atividade seqüestradora de radicais livres DPPH em solução metanólica. Todas as amostras analisadas demonstraram atividade em suas diferentes concentrações. Camelia sinensis (não-fermentada) foi a mais ativa com CI50= 0,14 mg/mL, cujos principais compostos antioxidantes são epigalocatequinas. Os condimentos mais ativos foram Cinnamonum zeylanicum (CI50 = 0,37 mg/mL), Eugenia aromatica Baill (CI50 = 0,46 mg/mL) e Laurus nobilis (CI50 = 0,76 mg/mL), cujo principal antioxidante relatado foi o eugenol.

Antioxidants are compounds that remove free-radicals or minimize their availability to generate oxidative stress. Teas are popular beverages providing a significant source of phenolic compounds, important components of the human diet due to their antioxidant properties. The present work had the objective of evaluate the antioxidant action of teas and seasonings more consumed in Brazil. The analysed teas were from the plants: Pneumus boldus Mold., Matricaria recutita L., Cymbopogon citratus (DC) Stapf, Baccharis trimera (Less.) DC, Camelia sinensis (L) O. Kuntze (fermented), Camelia sinensis (not-fermented), Lippia alba N.E. Brown, Mentha arvensis L. and Pyrus malus L. The studied seasonings were: Eugenia aromatica Baill, Cinnamonum zeylanicum Blume, Laurus nobilis L. and Origanum vulgare L. The antioxidant activity was measured by the DPPH free radical scavenging method. All analysed samples demonstrated antioxidant activities. Camelia sinensis (not-fermented) (IC50= 0.14 mg/mL), was the most active and active principles are epicalocatechins. The stronger antioxidant seasonings were Cinnamonum zeylanicum (IC50 = 0.37 mg/mL), Eugenia aromatica Baill (IC50= 0.46 mg/ mL and Laurus nobilis (IC50 = 0.76 mg/mL), which presented as main antioxidant component eugenol.