[Continent urinary diversion: the Mitrofanoff principle]

INTRODUCTION

Continent urinary diversion (based on Mitrofanoff's principle), despite its complexity, is the gold standard in the treatment of those vesicourethral disfunctions that need clean intermittent catheterization (CIC) to achieve complete vesical voiding, in patients with non easily catheterizable native urethra.

AIM

To analize our experience in continent urinary diversion at our centre.

PATIENTS AND METHODS

We have reviewed the records of the 14 cases of continent urinary diversion in the last 8 years. They were grouped in order to the underliying condition: 1-Bladder exstrophy group (n=5): Mean age at diversion time was 5.5 years (range 3-7). In all patients the original Mitrofanoff s technique was performed (continent cutaneous appendicovesicostomy). Associated procedures were: ureterovesical reimplantation in all 5 cases; bladder neck reconstruction also in all 5 (3 of them needed vesicourethral transection); and bladder augmentation in two cases, using ileum and sigmoid respectively. 2- Myelomeningocele group (n=9, 10 procedures): Mean age was 11.5 years (range 6-16). Appendicovesicostomy was performed in 7 cases and a reconfigured ileum with the Casale technique was used in 3 cases (primarily in 2 and as an alternative in one). Associated procedures were: ureterovesical reimplantetion in 5 cases and bladder augmentation in 7 (using sigmoid in 4, ileum in 2 and urether in one case).

RESULTS

In all patients complete continence was achieved. Complications found were: one appendicostomy prolapse, one appendix necrosis (that was then diverted with Casale's technique), one appendicular conduit stenosis and one case with catheterization difficulties that needed a tappering of the ileum conduit. Nowadays, 13 out of 14 pacients follow the CIC program each 3-4 hours without complication.

CONCLUSION

Continent urinary diversion improves autonomy and life quality in those patients that need a definitive urinary diversion and have a long life expectancy. We have used these procedure with good results in patients with severe vesicourethral disfunction (of an intrinsic or neuropathic origin) in which clean intermittent catheterization was not possible through native urethra, or in patients with refractary incontinence in which vesicourethral transection was the only effective treatment.

[Thoracoscopic thymectomy]

BACKGROUND/PURPOSE

The use of videothoracoscopy in thoracic pediatric pathology has been progressively accepted in different diagnostic and therapeutic procedures along last decade. The aim of this work is to analyze our initial experience in thymectomy through this approach.

PATIENTS AND METHODS

We have used the thoracoscopic approach in the last two cases of thymus pathology with surgical indication. Case 1: 9 year-old patient recently diagnosed on myasthenia gravis and several hospital admissions because of clinical worsening. Case 2: 9 year-old patient with a 7x8x3.5 cm. cervico-mediastinal tumour.

FINAL DIAGNOSIS

Multilocular cystic thymoma. In both cases we used right approach in lateral decubitus, and the harmonic scalpel.

RESULTS

Mean operating time was 125 minutes. No procedure-related complications. They were discharged on the 6th and 4th postoperative day. After 6 and 7 month follow-up, no incidences have been found, and case 1 has shown a sympthomatic improvement and a decrease in drug dosage.

CONCLUSIONS

Thoracoscopy is a good alternative in thymus approach. Its cosmetic and recovery advantages upon transcervical and transsternal are obvious. Despite our very initial experience, we believe that this approach at least equals classic ones in the ability to resect the whole thymus.

Two novel naturally occurring alpha-methoxy acids from the phospholipids of two Caribbean sponges

The novel (5Z)-2-methoxy-5-hexadecenoic acid (1) was identified in the phospholipids of the sponge Tethya crypta while the also novel acid (6Z)-2-methoxy-6-hexadecenoic acid (2) was found in the phospholipids of the Caribbean sponge Spheciospongia cuspidifera. The methoxy-fatty acids were mainly associated with phosphatidylethanolamine. The double bond positions were determined by gas chromatography/mass spectrometry on the corresponding dimethyl-disulfide adducts and the double bond stereochemistry was ascertained by gas chromatography/Fourier transform infrared spectroscopy. The fatty acid composition of the two sponges is reported.

[Autoimmune phenomena in the elderly]

We analyzed sera from 102 subjects older than 65 years of age with no clinical evidence of autoimmune disorders, inflammatory diseases or pharmacological interventions. Positive titers for antinuclear antibodies were found in 18.6%, anti-smooth muscle fibre in 16.6%, and rheumatoid factor in 11.8%. These values were significantly higher than those of a control group of healthy younger adults (p < 0.0001). Anti mitochondrial antibodies were present in 1% (NS). Thus, a greater proportion of autoimmune phenomena is demonstrated in the elderly.