Search

Introduction: The range of indications for endoscopic treatment of vesicoureteral reflux opens more and more until including correction of secondary reflux (VUR) after ureteral reimplantation. However these cases suppose a technical challenge due to postoperative changes. The aim of this work is to present our experience on endoscopic treatment for VUR in ureteral units with Cohen reimplantation surgery, with special interest in the technical peculiarities of the procedure., Material and Methods: A retrospective study of cases of secondary VUR after reimplantation surgery treated by subureteral injection., Technique: We put the needle perpendicular to submucous tunnel and inject medially to hole forming a wheal on the anterior face that occludes the meatus RESULTS: During the 1993-2016 period 21 injections were performed in 15 ureteral units. The ureteral pathology included primary VUR (4), duplex system with lower pole reflux (4), megaureter (3) and ureterocele (2). Average patient age was 5.7 years old (2-12). Succesful outcome had been got in 10 ureteral units (66.67%), a decrease of VUR grade in 4 (26.67%) and perseverance/no resolution of grade IV VUR in 1 (6.67%) DISCUSSION: The anti-reflux mechanism of reimplantation depends on optimizing the submucosous tunnel. This subgroup of pacients is small and there are few studies, hindering the agreement on the most appropiate technique., Conclusion: Endoscopic treatment of secondary reflux after reimplantation surgery is a procedure with certain technical feature, but safe and effective offering an alternative prior to surgical reoperation., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response., Objectives: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them., Material and Methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP)., Results: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP., Conclusions: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED., (Copyright © 2011 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.)

Objective: To identify antituberculosis treatment outcomes among the immigrant population and determine the variables associated with treatment default., Methods: We performed a prospective cohort study that included cases of tuberculosis in immigrants older than 15 years diagnosed in 15 public hospitals of the Community of Madrid in 2003. Firstly, a descriptive study was performed. Subsequently, a bivariate/multivariate analysis was performed using logistic regressions. The dependent variable was treatment default vs successful treatment., Results: Of 296 cases, 75.0% successfully completed the treatment, 8.4% defaulted, 2% died, 0.7% showed treatment failure, and 7.1% transferred out; information loss occurred in 6.8%. The variables independently associated with treatment default were female sex (odds ratio [OR]: 0.18; 95% confidence interval [95%CI]: 0.03-0.95), living with relatives (0.23 [0.08-0.66]) and moving to another autonomous community (5.52 [1.17-25.93]) compared with not moving., Conclusions: Antituberculosis treatment outcomes in the immigrant population need to be improved. To achieve this aim, healthcare coordination should be improved in the mobile population and strategies to increase treatment compliance among persons not living with relatives are required.

A case of urticarial vasculitis syndrome is described in which the gastrointestinal disease was the main clinical manifestation. The gastroduodenal barium meal demonstrated signs compatible with intestinal ischemia which reversed upon medical treatment. The colonoscopy with biopsy showed changes compatible with unspecific colitis. The role of reversible acute vasculitis as a pathogenic factor implicated in the gastrointestinal manifestations in this entity is discussed. Although the response to treatment with corticoids and cochicine was not constant, there was good response to dapsone in successive relapses of the disease. Despite some antibodies becoming positive during the third year of follow up, the patient did not fulfill the clinical criteria for the diagnosis of systemic lupus erythematosus.