Pthc 2011 Cat 178 !!HOT!!

Pthc 2011 Cat 178 !!HOT!!

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Aunque poco se sabe aún acerca de la susceptibilidad genética a las toxinas en el humo del cigarrillo, en múltiples estudios se ha presentado una asociación positiva entre hábito de fumar cigarrillos por la madre durante la etapa gestante y el desarrollo de fisuras orofaciales (55). Más recientemente en un estudio de caso-control desarrollado en China en 2011, se evaluó el riesgo de incremento en FLAP en niños cuyas madres fumaron durante la gestación y se encontró un riesgo de aproximadamente 3 veces y media de mayor probabilidad de que los niños nazcan con fisuras si provienen de madres fumadoras (15); sin embargo el mecanismo de acción del tabaco a nivel epigenético sobre el ADN aún no se encuentra totalmente explicado. Los hallazgos sugieren una explicación hacia el polimorfismo genético asociado a variantes polimórficas de la N-acetil transferasa fetal (NAT1) (15), una enzima que interviene en la fase II de desintoxicación de los constituyentes del humo del tabaco (56). Las NAT transfieren un grupo acetilo a una amina, hidracina, hidroxilamina y resto de un compuesto aromático. El tipo NAT1 contribuye en la mayor parte de la N-acetilación durante el primer trimestre del desarrollo embrionario. Por lo tanto, la capacidad fetal para la biotransformación de aminas aromáticas puede contribuir al desarrollo potencial de toxicidad (56). Así mismo, en otro estudio se evaluó la óxido nítrico sintasa endotelial (NOS3), la cual se encarga de regular la producción de óxido nítrico y se expresa en células endoteliales humanas y de embriones de ratón. El polimorfismo de un solo nucleótido (SNP) se asoció con las concentraciones de homocisteína. Algunos investigadores han propuesto que el óxido nítrico modulado por los niveles de homocisteína genera un efecto en el catabolismo de folato. Otros estudios han demostrado que la actividad de la NOS3 es alterada tras fumar cigarrillos. Dado que el riesgo de fisura se ha asociado con el tabaquismo materno y la falta de suplementos de ácido fólico (que da lugar a concentraciones plasmáticas de homocisteína superiores), se concluyó que la variación genética en NOS3 puede interactuar con estas dos exposiciones (16).

2. Bhaskar LV, Murthy J, Venkatesh Babu G. Polymorphisms in genes involved in folate metabolism and orofacial clefts. Arch Oral Biol 2011;56(8):723-37. DOI: 10.1016/j.archoralbio.2011.01.007. Epub 2011 Feb 18. [ Links ]

15. Zhang B, Jiao X, Mao L, Xue J. Maternal cigarette smoking and the associated risk of having a child with orofacial clefts in China: a case-control study. J Craniomaxillofac Surg 2011;39(5):313-8. DOI: 10.1016/j.jcms.2010.07.005. Epub 2010 Sep 15. [ Links ]

49. Chavarriaga J, González M, Rocha A, Posada A, Agudelo A. Factores relacionados con la prevalencia de Labio y Paladar Hendido en la población atendida en el Hospital Infantil \"Los Ángeles\". Municipio de Pasto (Colombia), 2003-2008. Revista CES Odontología 2011;24(2):33-41. [ Links ]

Historically, percutaneous nephrostomy drainage following percutaneous nephrolithotomy (PNL) has been considered the standard of care. More recently, however, an increasing number of centers are performing tubeless (with insertion of JJ ureteric stent) or totally tubeless (with no internal or external drainage) PNL with impressive outcome data. This systematic review is to compare the clinical therapeutic efficacy and safety of nephrostomy tube-free (NT-free) and standard PNL. We searched PubMed (1966 to April 2011), Embase (1966 to April 2011), and the Cochrane Library without language restriction. All randomized controlled trials that compared NT-free PNL (using a double-J stent) with standard PNL were enrolled in this review. The Cochrane Collaboration's RevMan5.0.2 software was used for statistical analysis. Nine studies involving 547 patients were included. Patients were divided into 4 groups: NT-free group, small tube group (8-9 Fr), middle tube group (16-18 Fr), and large tube group (20-24 Fr). Meta-analysis showed that: (1) with regard to hospital stay (h) and visual analog scale scores for postoperative pain on day 1, there was no significant difference between the NT-free group and the small tube group, but there were differences between the NT-free group versus the middle and large tube groups; (2) for puncture site urinary leakage, no significant difference was found between the NT-free group and the small and middle tube groups; (3) no significant difference was found with regard to transfusion, fever or infection, operative time between the NT-free group and the 3 tube groups. The clinical efficacy and safety of NT-free and small tube are similar in all measurements. Compared with the middle and large tubes, NT-free PNL could reduce hospital stay and postoperative analgesia requirement without increasing other complications. Copyright 2012 S. Karger AG, Basel.

The purpose of this study was to determine the efficacy and safety of tubeless percutaneous nephrolithotomy (PNL) using a non-absorbable hemostatic sealant (Quikclot()) as an adjunct compared to nephrostomy tube placement in patients exhibiting significant parenchymal bleeding following PNL. We identified 113 PNL cases performed between May 2011 and October 2014. For patients with insignificant parenchymal bleeding following stone removal, defined as a clear visualization of the surgical field at full irrigation of the nephroscope, tubeless PNL was performed. For patients with significant parenchymal bleeding, we introduced the tubeless Quikclot() technique as of September 2013 and have performed it ever since. Formerly, nephrostomy placement PNL was performed. In this study, 40 Quikclot() applied PNL cases were matched with an equal number of nephrostomy placement cases by propensity scoring based on body mass index, stone size, and Guy's stone score. The mean postoperative drop in hematocrit was comparative between the Quikclot() group and the nephrostomy group on both postoperative days 1 (p = 0.459) and 2 (p = 0.325). Quikclot() application was associated with lower VAS scores throughout the postoperative period, lower cumulative analgesic requirement (p = 0.025), and with shorter hospitalization (p = 0.002). Complication rates were comparable with no need for blood transfusions in any patients. Tubeless Quikclot() PNL was safe and provided effective hemostasis of significant parenchymal bleeding. By avoiding nephrostomy placement, we were able to reduce postoperative pain, analgesic requirements, and hospitalization. Application of Quikclot() may be considered prior to nephrostomy placement in patients with significant parenchymal bleeding.

Symptomatic hypermobile kidney is treated with nephropexy, a surgical procedure through which the floating kidney is fixed to the retroperitoneum. Although both open and endoscopic procedures have a high success rate, they can be associated with risk of complications, relatively long hospital stay and high cost. We describe our percutaneous technique for fixing a hypermobile kidney and evaluate the efficacy of the percutaneous nephrostomy insertion in management of symptomatic nephroptosis. Between January 2005 and December 2011, 11 patients diagnosed with a symptomatic right nephroptosis of at least 1 year duration were treated with a single point percutaneous nephrostomy technique. All data were retrieved from patients' medical records and then retrospectively analysed. Nephropexy through a single point percutaneous nephrostomy technique was successfully accomplished in 11 women. The mean operative time was 20 min. The intraoperative estimated blood loss was minimal in all cases. No major or minor intraoperative complications were noted. The average postoperative hospital stay was 2 days. Women returned to their usual activities 14 days following the surgery. Nine women had complete resolution of their pain, and 2 patients continued to complain of discomfort in their lumbar area. One patient was re-operated upon with satisfactory subjective and objective outcomes achieved. One patient refused re-operation. Percutaneous nephropexy is simple, inexpensive and effective for treatment of symptomatic hypermobile kidney. It remains a valuable alternative to open, laparoscopic, and robotic methods for fixing a floating kidney.

BK virus (BKV) is a human polyomavirus that remains latent in the urinary tract epithelium in most individuals. However, in immunocompromised states, including after hematopoietic stem cell transplantation (HSCT), BKV may reactivate and cause infection predominantly affecting the bladder, commonly manifested as hemorrhagic cystitis. Renal insufficiency, occasionally requiring hemodialysis, is not uncommon and was previously attributed to medications or the development of tubulointestitial nephritis. We report a series of 6 HSCT recipients who developed obstructive uropathy of the upper urinary tract system secondary to inflammation and hemorrhage involving the upper uroepithelium, causing ureteral stenosis. Temporary placement of a percutaneous nephrostomy catheter relieved the obstruction and significantly improved kidney function, successfully preventing progression to more advanced renal disease in these patients. Copyright 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

To estimate the least costly routine exchange frequency for percutaneous nephrostomies (PCNs) placed for malignant urinary obstruction, as measured by annual hospital charges, and to estimate the financial impact of patient compliance. Patients with PCNs placed for malignant urinary obstruction were studied from 2011 to 2013. Exchanges were classified as routine or due to 1 of 3 complication types: mechanical (tube dislodgment), obstruction, or infection. Representative cases were identified, and median representative charges were used as inputs for the model. Accelerated failure time and Markov chain Monte Carlo models were used to estimate