Association of isolated preauricular tags and nephrourological anomalies: case-control study

Isolated preauricular tags (IPT) are considered minor malformations whereas nephrourological anomalies (NUA) are considered major malformations. Their incidences fluctuate between 5 and 10 per 1,000 and 1–3 per 100 live births, respectively. There is contradictory evidence regarding the incidence of NUA in infants with IPT. The objective of this study is to determine if there is a clinical association between IPT and NUA. A case-control study was made in a Pediatric hospital in Santiago, Chile, with infants born between April 2000 and April 2005, considering as cases those with IPT, and controls those infants born following the cases, paired by sex and without IPT. All subjects had a complete physical examination and a renal ultrasound to assess for the presence of congenital anomalies and NUA, respectively. One hundred cases and an equal number of controls were included. There were 41 females in each group. In the case group, two infants presented renal anomalies in the RUS: one left hydronephrosis and one case of left kidney agenesis. In the control group, two infants with anomaly were found: one with a left ureterocele and one case of bilateral duplex kidney. The observed incidence of NUA was similar in both groups to that reported in the literature for the general population. No significant statistical difference was found in the incidence of these abnormalities between patients who presented with IPT and those who did not. From our study, we suggest that RUS is not necessary in the routine evaluation of infants with IPT.     

Gastric band erosion as complication of bariatric surgery. Case report and review of the literature

Gastric banding has become a common procedure amongst bariatric surgery techniques. Because of the possibility of using a laparoscopic route to achieve a good technical result and low complication rates, this method has become the most frequently used options in the treatment of morbid obesity in Chile. We report an uncommon complication that, if left undiagnosed, could lead to considerable morbidity and even mortality: gastric band erosion and intragastric migration. Radiologists, gastroenterologists and surgeons should be able to recognize this event to provide a prompt diagnosis.     

The figure of the head of service (Chairman): what profile should have?

Great social-health care changes in the short term have been predicted that will seriously affect the departmental structure and care hierarchy of future hospital, universitary, public or private. The Spanish Association of Urology (AEU) wondered whether in these circumstances, in which the welfare and economic management of the hospital so-called "industrial" will dominate over other traditional aspects of the scientific hierarchy, social welfare and teaching of head Urology of service, will change his image, goals, functions, and ultimately its authority. Likewise which must be the attributes of this new generation of department heads. To this end the AEU call a roundtable requesting opinions and comments which are reflected in the enclosed text.     

Mortality risk scales in esophagectomy for cancer: their usefulness in preoperative patient selection

BACKGROUND/AIMS: To improve esophagectomy outcome, preoperative identification of high-risk patients should allow the surgical approach to be modified or alternative treatment methods to be employed. METHODOLOGY: Preoperative risk assessment of 114 patients with resected esophageal cancer. One half of the cases affected the middle third of the esophagus. The tumor stage was III (33.3%) or IV (29.8%). The combined thoracoabdominal approach was the preferred route for resection (88.6%). We analyzed the influence of different variables (epidemiological, clinicopathological and surgical) affecting postoperative mortality. RESULTS: Sixty-six (57.9%) patients developed postoperative complications, mainly pulmonary. The mortality rate was 12.3% (14 patients). Multivariate analysis of preoperative variables found significant association between postoperative death and previous neoplasm (p=0.01), liver cirrhosis (p=0.001), abnormal functional respiratory test (p=0.01) and low serum cholesterol (p=0.005) and albumin (p=0.01). Using those variables, we created a composite scoring system that provides a separation of patients into three postoperative death risk groups. If this knowledge was used, we could avoid 50% of postoperative mortality via improved patient selection. CONCLUSIONS: The development of risk scales based on preoperative mortality risk factors may be useful in the selection and preparation of patients suitable for esophageal resection in order to diminish postoperative mortality.     

Aspectos histopatológicos iniciales de la hiperplasia benigna de próstata: nódulos mixo-inflamatorios

ObjectivesInfiltration of benign prostatic hyperplasia (BPH), nodular prostatic hyperplasia (NPH) or prostatic adenoma by mononuclear cells, predominantly lymphocytes, is a common finding in surgical specimens. The biological significance of this infiltration, very similar to chronic inflammation, is unknown, but it is suspected as being related to the pathogenesis and progression of the BPH. The identity and number of the infiltrating cells is not well known. The objectives of the present study were: 1) to describe in more detail the histologic pattern of early lesions BPH, that is “myxoid” nodules. 2) to count and locate these myxoid nodules and to analyse the possible influence of age 3) and describe the patterns of mononuclear cell infiltration in BPH.Materials and methodsOne hundred and seventy-three specimens of BPH tissue were reviewed. These samples were processed routinely for histological examination and immunohistochemical examination was performed in selected cases in order to further define the cellular composition of the described lesions. The immunohistochemical stains were performed automatically. Vimentin, specific smooth muscle actin an desmin were use to show the stromal cells and CD₃, CD₂₀ and CD₆₈ monoclonal antibodies were used to quantify the populations of T-lymphocytes, B-lymphocytes and macrophages, respectively.The number of myxoid nodules identified in each patient was counted and the maximum and minimum diameter measured. These data have been compared in two groups of patients, those younger than 57 years and those over 80. Statistical analysis has been performed with SPSS 13.0. Student′s t test was used for bivariate analysis and Pearson's r for correlation.ResultsInterstitial infiltration involving T and B lymphocytes with less macrophages was a constant finding of the early nodules of BPH.The bivariate analysis with Student's t has shown a statistically significant difference between the mean number of myxoid nodules (p=0.02), significantly lower in the younger patients. Although we have found differences between the mean diameters of the smallest and the largest nodules in both groups, these differences did not reach statistical significance. We have not shown any significant correlation between the number of nodules and the patient age (p=0.11) in the Pearson's r correlation.ConclusionInflammatory cells and myxoid nodules are a constant finding in BPH surgical samples. The mean number of myxoid nodules is significantly lower in younger patients. Interstitial distribution is the most common pattern of mononuclear cell infiltration. B and T-cell lymphocytes are the most frequently found inflammatory cells in early myxoid nodules.