A THOROUGH STUDY AND META-ANALYSIS OF THE PROGNOSTIC RELEVANCE OF THE C-REACTIVE-ALBUMIN RATIO IN ACUTE PANCREATITIS

Although most cases of acute pancreatitis (AP) are minor, severe cases are associated with a substantial risk of death. Acute pancreatitis (AP) is a common illness. Therefore, it is critical to assess AP severity as soon as possible. This review aimed to ascertain the predictive significance of the CRP to albumin ratio in individuals with AP. We searched PubMed, Science Direct, and Cochrane Library electronic databases Until January 2023. Studies that reported the CRP/alb ratio at admission and its relationship to the severity or death of patients with AP were included. Using a random-effects model, we computed the pooled mean difference (MD) and 95% confidence interval (CI). The quality of the included studies was evaluated using the Newcastle-Ottawa scale. This meta-analysis combined data from six trials with a total of 2244 patients. Upon admission, the CRP/alb ratio was higher in patients with severe AP than in those with mild to moderate AP (pooled MD:3.59; 95% CI:2.51-4.68; p<0.00001). Additionally, non-survivor AP patients had a substantially higher CRP/alb ratio than survivor AP patients (pooled MD:2.12; 95% CI:0.43-3.8; p<0.01). Individuals with AP may benefit from a high CRP/ALB ratio as a preliminary indicator of poor prognosis.

Myocardial injury in patients with acute ischemic stroke detected by cardiovascular magnetic resonance imaging

BACKGROUND

Patients with acute ischemic stroke (AIS) are at high risk of adverse cardiovascular events. Until now, the burden of myocardial injury derived from cardiovascular magnetic resonance imaging (CMR) has not been established in this population.

METHODS

Patients with AIS underwent CMR at 3 Tesla within 120 h after the index stroke as part of a prospective, single-center study. Patients with persistent atrial fibrillation were excluded. Morphology and function of both cardiac chambers and atria were assessed applying SSFP cine. Myocardial tissue differentiation was based on native and contrast-enhanced imaging including late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol for focal fibrosis and parametric T2- and T1-mapping for diffuse findings. To detect myocardial deformation global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain was measured applying feature tracking. Cardiac troponin was measured using a high-sensitivity assay (99th percentile upper reference limit 14 ng/L). T2 mapping values were compared with 20 healthy volunteers.

RESULTS

CMR with contrast media was successfully performed in 92 of 115 patients (mean age 74 years, 40% female, known myocardial infarction 6%). Focal myocardial fibrosis (LGE) was detected in 31 of 92 patients (34%) of whom 23/31 (74%) showed an ischemic pattern. Patients with LGE were more likely to have diabetes, prior myocardial infarction, prior ischemic stroke, and to have elevated troponin levels compared to those without. Presence of LGE was accompanied by diffuse fibrosis (increased T1 native values) even in remote cardiac areas as well as reduced global radial, circumferential and longitudinal strain values. In 14/31 (45%) of all patients with LGE increased T2-mapping values were detectable.

CONCLUSIONS

More than one-third of patients with AIS have evidence of focal myocardial fibrosis on CMR. Nearly half of these changes may have acute or subacute onset. These findings are accompanied by diffuse myocardial changes and reduced myocardial deformation. Further studies, ideally with serial CMR measurements during follow-up, are required to establish the impact of these findings on long-term prognosis after AIS.

Knowledge and attitude of physicians toward child abuse and reporting in a tertiary hospital in Riyadh

Background

Child abuse is a common global devastating issue for the patient and physician. It can lead to much unpleasant and danger and even death. One of the most essential parts of a doctor's job is to help people in need and a child should be top priority as they are dependent for protection and care.

Objectives

To analyze the experience and knowledge of Saudi residents from both specialty family medicine and pediatrics working in Riyadh city toward the recognition and diagnosis of child abuse and neglect and spot the light on the barriers that prevent its reporting and to assess the need for further training.

Method

A cross-sectional study was conducted in four major tertiary hospitals in Riyadh (KKUH, National Guard Hospital, King Fahad Medical City, Prince Sultan Medical City) from March 2019 to January 2020.

Results

Most participants did not have sufficient knowledge regarding the physical assessment of suspected child abuse and neglect. The result showed no significant difference in terms of knowledge and attitude between family physicians and pediatrics working in tertiary centers in Riyadh.

Conclusion

The study concluded that the Saudi residents from both specialties, that is, family medicine and pediatrics, had insufficient knowledge regarding child abuse. In addition, the residents had positive attitudes toward child abuse prevention. Finally, the study recommends conducting awareness campaigns to increase the knowledge of physicians about child abuse and the predictive factors.

POS1278 THE PREVALENCE AND CLINICAL SIGNIFICANCE OF ULTRASONOGRAPHIC FINDINGS OF DISTAL MEDIAL HAMSTRING TENDONS IN PATIENTS WITH POSTEROMEDIAL KNEE PAIN

Background:

Periarticular abnormalities are common ultrasonographic (U/S) findings in individuals with knee pain. Incidental U/S observations, including thickening of the distal hamstring tendons, require explanations for their clinical importance. Tendon thickness may be a good indicator of tendinopathy and tendon dysfunction. Also, it is uncertain whether these tendon changes are correlated with knee pain or not?

Objectives:

The aim of this study was to determine U/S findings of distal medial hamstring tendons in patients with posteromedial (PM) knee pain and assess the diagnostic values of tendon thickness in predicting tendinopathy.

Methods:

We studied distal medial hamstring tendons (semimembranosus [SM] and semitendinosus [ST]) of 104 patients (104 knees) with non-traumatic unilateral PM knee pain and 118 healthy controls (236 knees). U/S evaluations included tendon thickness, echogenicity, the presence of intrasubstance tears, calcification, and vascularity.

Results:

The mean age (standard deviation) of the patients and control groups were 51.7 (10.4) years and 49.8 (9.9) years, respectively. The mean visual analogue scale (VAS) for pain among patients was 5.1 and 58.6% of them located the pain at medial joint line. The studied patients had significantly higher mean SM thickness (7.17 mm vs. 5.46 mm, respectively) and ST thickness (3.93 mm vs. 3.45 mm, respectively) than the controls. U/S abnormalities among patients were hypoechogenicity (62.5%), intrasubstance tears (31.7%), loss of fibrillar pattern (23.1%), Baker cyst (20.2%), calcification (18.3%), Anserine bursitis (11.5%), and neovascularization (6.7%). We found significant correlations between tendon thickness and VAS (r=0.752, p=0.004), and pain location (r=0.680, p=0.008). SM thickness had higher accuracy to predict tendinopathy than ST thickness (80.6% vs. 68.9%, respectively).

Table 1.

Diagnostic values of tendon thickness in predicting tendinopathy.

TendonsCutoffSensitivitySpecificity+PV-PVAccuracyAUCSM>6.670.289.885.776.880.60.835ST>3.756.779.671.167.668.90.696

SM: semimembranosus, ST: semitendinosus, +PV: positive predictive value, -PV: negative predictive value, AUC: area under curve.

Conclusion:

U/S changes are frequently present in patients with PM knee pain. Tendon thickness is an accurate predictor of tendinopathy. These findings suggest that U/S screening of all individuals with PM knee pain is a useful tool for improving patients’ outcomes and decreasing tendon-related disability.

Disclosure of Interests:

None declared

Men's knowledge, attitude, and barriers towards emergency contraception: A facility based cross-sectional study at King Saud University Medical City

Background

Male partners have a considerable role in influencing women’s contraceptive decision making to reduce the chance of unintended pregnancy. Most studies are focused on women’s knowledge and barriers for emergency contraception (EC) use. There is limited research on this topic from the male perspective. This study aimed to gather baseline data on men’s knowledge, attitudes and barriers about EC.

Methods

Descriptive analytic cross-sectional study was conducted from Dec 2019 –May 2020 at the King Khalid University Hospital (KKUH); a teaching facility with general and subspecialty medical services in King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Data were collected using a structured pretested questionnaire and analyzed using SPSS version 23.0. Descriptive statistics and Chi square tests were used. Multivariate logistic regression analysis was used to find significant predictors for EC awareness and use. A p value < 0.05 was considered statistically significant.

Results

A total of 461 participants completed the questionnaire (response rate 86%). The majority (82%) of the participants were unaware of EC; with only 18% having some knowledge. Knowledgeable men had positive attitudes (73.5%) about EC as compared to non- knowledgeable ones (55.0%). Factors found to be associated with less knowledge of EC were cultural [0.46, 95%CI 0.22. 0.96] and religious unacceptability [OR 0.51, 95%CI 0.29, 0.89)]. Higher level of education [OR 1.83, 95%CI 0.94, 3.53] was associated with more knowledge regarding EC. The study showed that correct information about using contraceptives within 3 days of unprotected sex [OR 4.96, 95%CI 1.81, 13.60]; availability without prescription [OR 5.06, 95%CI 1.68, 15.30], EC advertisement [OR 4.84, 95%CI 0.96, 24.27] and receipt of information from family/friends [OR 18.50, 95%CI 5.19, 65.93] were factors that contributed to men using EC.

Conclusion

The current knowledge of EC among men is limited. Social determinants affect these levels of knowledge, as well as the usage of EC. Factors that were associated with the use of ECPs were correct knowledge, advertisement, availability and receipt of information from family/friends. The findings highlight the need to educate men on this important topic to avoid unintended pregnancy, keeping in view cultural and social values. Future qualitative studies are needed to understand the male perspective.

Myocardial Fibrosis Among Antiretroviral Therapy-Treated Persons With Human Immunodeficiency Virus in South Africa

BACKGROUND

Heart failure is a prominent cardiovascular disease (CVD) manifestation in sub-Sarahan Africa. Myocardial fibrosis is a central feature of heart failure that we aimed to characterize among persons with human immunodeficiency virus (PWH) in South Africa.

METHODS

Cardiovascular magnetic resonance (CMR) imaging was performed among PWH with viral suppression and uninfected controls, both free of known CVD. Plasma levels of N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured. Comparisons by human immunodeficiency virus (HIV) status were made using linear and logistic regression, adjusted for age, sex, and hypertension.

RESULTS

One hundred thirty-four PWH and 95 uninfected persons completed CMR imaging; age was 50 and 49 years, with 63% and 67% female, respectively. Compared with controls, PWH had greater myocardial fibrosis by extracellular volume fraction ([ECV] absolute difference, 1.2%; 95% confidence interval [CI], 0.1-2.3). In subgroup analyses, the effect of HIV status on ECV was more prominent among women. Women (vs controls) were also more likely to have elevated NT-proBNP levels (>125 pg/mL; odds ratio, 2.4; 95% CI, 1.0-6.0). Among all PWH, an elevated NT-proBNP level was associated with higher ECV (3.4% higher; 95% CI, 1.3-5.5).

CONCLUSIONS

Human immunodeficiency virus disease may contribute to myocardial fibrosis, with an effect more prominent among women. Research is needed to understand heart failure risk among PWH within sub-Saharan Africa.

The learning environment of four undergraduate health professional schools: Lessons learned

Background and Objectives:

Learning is an interplay between cognition and environmental factors. Any learning environment, that fulfills the intrinsic and extrinsic needs of the students will probably lead to better and more promising learning outcomes. This study aimed to investigate the student perceptions of Learning Environment (LE) in four health schools of a large university and compare between schools, years of study, and gender.

Methods:

Dundee Ready Education Environment Measure (DREEM) questionnaire and a socio-demographic questionnaire were completed by 1185 undergraduate students enrolled in the school of Medicine, Dentistry, Nursing and Applied Medical Sciences (AMS) of a large university during the academic year 2012-2013. Chi-square test was used to compare categorical variables. Independent student t-test or ANOVA (with Tukey post-hoc test) was used for continuous variables at a significance level of p≤0.05.

Results:

The mean total DREEM score was 89.23±33.3. The total DREEM mean scores for Dentistry (120.54±23.45) and Medicine (110.72±19.33) were higher compared with AMS (63.48±21.36) and Nursing (57.48±22.80) (p=0.000) (Post hoc Tukey p=0.000). First year students gave significantly higher positive perceptions ratings than the rest of the years (p=0.000). Total scores were significantly higher for male (92.78±33.86) than female students (84.70±32.25) p=0.000.

Conclusion:

The LE significantly differed by year and gender. The students from non-integrated curricula (nursing and AMS) perceived the LE less positively than their integrated curriculum counterparts (medicine and dentistry). A qualitative study is needed to investigate the variation in the perception of LE among these groups.

Controversies in Candida management

Invasive candidiasis (IC) is associated with increased morbidity and mortality. Although advances in diagnosis and management of this infection have been reached, there remain several controversies. The aim of this review is to tackle some of these controversies and shed light on studies that support the different sides of the arguments. Regarding central line-associated candidaemia, the current evidence appears to be more in favour of early central line removal whenever possible. Otherwise, antifungal agents such as echinocandins or polyenes should be the preferred agents. In the setting of infection with Candida parapsilosis and in light of the high minimum inhibitory concentrations (MICs) to echinocandins, azoles have been considered the preferred treatment agents. However, a recent study appears to indicate that empirical echinocandin use was not associated with a worse outcome when the isolated species was C. parapsilosis. Different strategies of antifungal treatment have been considered, namely prophylactic, empirical, pre-emptive or directed therapies. Whilst there is consensus on the need for prophylaxis in high-risk cancer patients, especially haematological malignancy and stem cell transplant populations, it remains debatable whether prophylaxis is of benefit in very low birthweight infants and in intensive care unit (ICU) patients. In the era of antifungal resistance and where antifungal stewardship has been advocated, pre-emptive therapy based on predictive models with various Candida risk scores and sensitive non-culture-based biomarkers such as β-d-glucan appears to be a more cost-effective approach. Future efforts should be directed to optimise clinical predictive models and reliable biomarkers for early detection of IC.

A One-Day Dental Faculty Workshop in Writing Multiple-Choice Questions: An Impact Evaluation

Long training workshops on the writing of exam questions have been shown to be effective; however, the effectiveness of short workshops needs to be demonstrated. The aim of this study was to evaluate the impact of a one-day, seven-hour faculty development workshop at the College of Dentistry, King Saud University, Saudi Arabia, on the quality of multiple-choice questions (MCQs). Kirkpatrick's four-level evaluation model was used. Participants' satisfaction (Kirkpatrick's Level 1) was evaluated with a post-workshop questionnaire. A quasi-experimental, randomized separate sample, pretest-posttest design was used to assess the learning effect (Kirkpatrick's Level 2). To evaluate transfer of learning to practice (Kirkpatrick's Level 3), MCQs created by ten faculty members as a result of the training were assessed. To assess Kirkpatrick's Level 4 regarding institutional change, interviews with three key leaders of the school were conducted, coded, and analyzed. A total of 72 course directors were invited to and attended some part of the workshop; all 52 who attended the entire workshop completed the satisfaction form; and 22 of the 36 participants in the experimental group completed the posttest. The results showed that all 52 participants were highly satisfied with the workshop, and significant positive changes were found in the faculty members' knowledge and the quality of their MCQs with effect sizes of 0.7 and 0.28, respectively. At the institutional level, the interviews demonstrated positive structural changes in the school's assessment system. Overall, this one-day item-writing faculty workshop resulted in positive changes at all four of Kirkpatrick's levels; these effects suggest that even a short training session can improve a dental school's assessment of its students.

[Changes in kidney stones type according to sex and age in Tunisian patients]

BACKGROUND

Studies that evaluate the effect of age and gender on the stone composition are scarce. The aim of this study is to highlight the modification of epidemiological characteristics of this pathology according to patients' sex and age.

PATIENTS AND METHODS

We studied 1269 urolithiasic patients ranging from 6 months to 92 years old and known as having urinary stones (752 males and 517 females). Stone analysis was performed respectively using a stereomicroscope and infrared spectroscopy to determine, respectively, the morphological type and molecular composition of each.

RESULTS

The annual average incidence of new stone formation was 30.25 per 100,000 inhabitants. In 1041 patients (81%), calculi were located in the upper urinary tract. Children and old man were more affected by bladder stone. Calcium oxalate monohydrate remains the most frequent stone component even if its frequency fell according to age (63.2% in teenagers and 40.6% in elderly [p<0.05]) in favour of the increase of uric acid stones (3,5% in teenagers and 41.5% in elderly [p<0.05]). Struvite stones were rare (3.5%) and more frequent in children.

CONCLUSION

The analysis of these data shows that urinary stones in Tunisia are tending to evolve in the same direction as in industrialized countries.

[Tethered cord syndrome: an unusual cause of adult bladder dysfunction]

Tethered cord syndrome is a complication of spinal dysraphism. The tethering of the cord does not permit the normal cranial migration of the conus within the vertebral canal. The result is a neural dysfunction due to a traction neuropathy. Although this condition commonly presents in childhood, less severe degrees of tethering may remain asymptomatic until adult life. The authors report a new case of tethered cord syndrome in a 25-years-old young girl, cause of bladder dysfunction. Clear improvement of urinary repercussions is obtained after surgery.

Amifostine reduces mucosal damage after high-dose melphalan conditioning and autologous peripheral blood progenitor cell transplantation for patients with multiple myeloma

High-dose melphalan (HDM) has been adopted as standard therapy in the treatment of multiple myeloma. This treatment is associated with non-selective cytotoxicity, causing oral mucositis as the major non-hematological side-effect. Amifostine is a cytoprotector which prevents toxicity induced by anticancer therapy. We prospectively compared two groups of patients who either received (group A, n = 21) or did not receive (group B, n = 20) amifostine (740 mg/m(2)) before HDM (200 mg/m(2)) followed by autologous peripheral blood progenitor cell transplantation. The occurrence of severe oral mucositis was significantly decreased in group A in comparison to group B (33% vs 65%, P < 0.05). Six patients in group A required opioid analgesic therapy during a mean period of 4.8 days as compared to eight patients for 6.5 days in group B (P = NS). Delayed vomiting was less frequent in group A (43% vs 70%, P = 0.07) and significantly less severe in group A (grade 2-4) vomiting: two patients vs nine patients, P < 0.02). No difference was observed between the two groups in either hematological toxicity after HDM or in response rate. Grade I emesis was the only immediate side-effect observed after amifostine administration. We conclude that amifostine can reduce mucositis induced by HDM.

Pyridazine derivatives and related compounds, part 9. tetrazolo[1,5-b]pyridazine-8-carbohydrazide: synthesis and some reactions

The reaction of the hydrazide of 6,7-diphenyltetrazolo[1,5-b]pyridazine-8-carboxylic acid 3 with aromatic aldehydes gave 8-arylidenecarbohydrazide derivatives. The reaction of 3 with methanesulfonyl chloride, benzenesulfonyl chloride, phenyl and benzylisothiocyanate afforded the corresponding N-substitute derivatives. The reaction of 3 with potassium ethylxanthate gave 5-(6,7-diphenyltetrazolo[1,5-b]pyridazin4-yl)-1,3,4-oxadiazole-2-thione 7. The alkylation of this product in an alkaline medium proceeds at the sulfur atom, while the aminomethylation and acylation proceed at the nitrogen atom. Compound 3 was also reacted with N-aminothiosemicarbazide to give 5-(6,7-diphenyltetrazolo[1,5-b]pyridazin-8 yl)4-amino-1,2,4-triazole-3-thione 11.

[Imaging features of retained surgical foreign bodies]

PURPOSE

To study the clinical and radiological manifestations in patients with retained surgical foreign bodies.

PATIENTS AND METHODS

Over the last five years, seven patients were found to have retained surgical foreign bodies after abdominal surgery. An analysis of the clinical signs, laboratory findings and imaging features was performed.

RESULTS

The clinical and laboratory data were non-specific. The diagnosis of textiloma was suggested based on imaging findings and surgical history before surgical exploration. The characteristic imaging findings at ultrasound and computed tomography consisted of a fluid collection with internal wavy structures. The differential diagnosis includes pyogenic abscesses, hematomas and ruptured hydatid cysts.

CONCLUSION

Ultrasonography and computed tomography are essential for the diagnosis and management of retained surgical foreign bodies after abdominal surgery.

The importance of right atrial pacing electrode position and pacing configuration for intra-atrial and inter-atrial conduction times

Pace prevention of atrial tachyarrhythmias is based in part on the reduction of intra-atrial (IAA) and/or inter-atrial (IEA) conduction. We previously introduced a novel pacing mode using floating atrial ring electrodes on a VDD-lead (BIdirectional MO nophasic impulSe: BIMOS). The effects of BIMOS pacing on IAA and IEA conduction times has not been studied. In nine Merino sheep electrode catheters were placed at the His-Bundle (HBE), high right atrium (HRA), coronary sinus ostium (Cs-Os), and left lateral atrium (LLA). A VDD-lead was introduced with floating electrodes in the high and mid right atrium (Floating). IAA (S/P-HRA, S/P-Cs-Os, S/P-HBE, S/P-Floating), IEA conduction times (S/P-LLA), and P-wave duration (PD) were measured during sinus rhythm (S), during bipolar cathodal pacing (P) in the HRA, in the Cs-Os position, as well as during BIMOS floating pacing. The mean PD during S was significantly shorter than during HRA- (66. 6+/-12.8ms; vs. 116.2+/-11.1ms; p<0.05) and Cs-Os-P (66.6+/-12.8ms vs. 94.4+/-9.0ms; p<0.05). In comparison to HRA-P, BIMOS configuration lead to a significant reduction of the P-wave duration (116.2+/-11.1ms vs. 85. 4+/-8.8ms; p<0.05). During BIMOS pacing, the global atrial conduction time was significantly shorter than during pacing in the HRA and Cs-Os position. The results of this study demonstrate a clear reduction of IAA and IEA conduction times using BIMOS configurations compared to conventional HRA-P. Furthermore, BIMOS pacing produced a more homogeneous atrial activation when compared with conventional HRA- and Cs-Os-P.

Modulation of C3a activity: internalization of the human C3a receptor and its inhibition by C5a

The C3a receptor (C3aR) is expressed on most human peripheral blood leukocytes with the exception of resting lymphocytes, implying a much higher pathophysiological relevance of the anaphylatoxin C3a as a proinflammatory mediator than previously thought. The response to this complement split product must be tightly regulated in situations with sustained complement activation to avoid deleterious effects caused by overactivated inflammatory cells. Receptor internalization, an important control mechanism described for G protein-coupled receptors, was investigated. Using rabbit polyclonal anti-serum directed against the C3aR second extracellular loop, a flow cytometry-based receptor internalization assay was developed. Within minutes of C3a addition to human granulocytes, C3aR almost completely disappeared from the cell surface. C3aR internalization could also be induced by PMA, an activator of protein kinase C. Similarly, monocytes, the human mast cell line HMC-1, and differentiated monocyte/macrophage-like U937-cells exhibited rapid agonist-dependent receptor internalization. Neither C5a nor FMLP stimulated any cross-internalization of the C3aR. On the contrary, costimulation of granulocytes with C5a, but not FMLP, drastically decreased C3aR internalization. This effect could be blocked by a C5aR-neutralizing mAb. HEK293-cells transfected with the C3aR, with or without Galpha16, a pertussis toxin-resistant G protein alpha subunit required for C3aR signal transduction in these cells, did not exhibit agonist-dependent C3aR internalization. Additionally, preincubation with pertussis toxin had no effect on C3a-induced internalization on PMNs. C3aR internalization is a rapid negative control mechanism and is influenced by the C5aR pathway.

[Repeated renal transplantation]

From October 1987 to June 1992, 359 renal transplantations were performed, while, over the same period, 25 patients with a follow-up of more than six months underwent repeat renal transplantation: 23 for a second transplant and 2 for a third transplant. The initial disease was glomerular for 17 patients and interstitial for 6 patients. The mean age of the patients at the time of the repeat transplantation was 36.9 years (range: 20 to 53 years). The mean survival after the first transplantation was 3 years and 10 months (range: 1 week to 10 years). The reasons for loss of the first transplant can be classified as follows: acute rejection (n = 5), chronic rejection (n = 14), surgical failure (n = 5) or sepsis (n = 1). 9 patients received conventional immunosuppressant therapy, while 16 patients (64%) received four-drug therapy including cyclosporin. The actuarial one-year survival of the patients and the transplants was 100% and 92%, respectively. The mean serum creatinine was 136.4 +/- 65 mumol/l (range: 59 to 298 mumol/l). Ten patients developed rejection after a mean of 18.6 days (range: 6 to 30 days) and 2 patients suffered from 2 episodes of rejection within 4 months. These results illustrate the low postoperative surgical and immunological complication rate in this group of patients whose long-term results are at least comparable to those of first transplantations in our group.

[Posterior vertical lumbar incision in the treatment of pyelo-ureteral junction anomaly: report of 71 cases]

Posterior vertical lumbar incision, described for the first time in 1869 by Simon, provides a simple access to the kidney and offers excellent exposure of the ureteropelvic junction. The technical modifications proposed by Gil Vernet facilitate access to the kidney and reduce the morbidity. The operative technique is described in detail and the authors report their retrospective experience of 71 cases of correction of ureteropelvic junction anomalies (stage 2, 3 and 4). The morbidity was low (19%). Patients returned to work by the 3rd week. 88% of good results were observed at 3 months (84% in initial stage and 4 lesions). This approach should be preferred to the lateral incision or the percutaneous approach due to the simplicity of the technique and the low complication rate.

New Polyindolenine Alkaloids from Calycodendron milnei

Four new alkaloids, representing the first members of new groups of polyindolinic alkaloids, have been isolated from the aerial parts of CALYCODENDRON MILNEI along with other alkaloids. The names vatine, its stereoisomer vatine A, vatamine, and vatamidine are proposed. They are polymers of six, seven, and eight N(b)-methyltryptamine units, respectively.