To investigate the value of prenatally detected hydronephrosis (PNH) as a prognostic factor for vesico-ureteral reflux (VUR). The MEDLINE database was searched for articles on PNH and VUR published between 1980 and 2004. A total of 18 studies were identified and reviewed for various aspects. Results were separated for primary and/or secondary VUR whenever possible, because of the different underlying pathogenic mechanisms. There was considerable variation between the different studies with respect to methodology and study design. One of the main discrepancies was the way in which postnatal abnormalities were ascertained: by postnatal ultrasound, voiding cystourethrogram (VCUG) alone, or combined or sequential ultrasound and VCUG. Taking these limitations into account, the published data showed there to be a mean prevalence of 15% for postnatal primary VUR after PNH. Of all patients with PNH, 53% had no postnatal anomalies, whereas 29% had other anomalies, such as duplex collecting systems. Of all infants with PNH, 15% had primary VUR proven postnatally and 53% had no other anomalies detected. We suggest a standardized protocol for future studies, to enable better comparison of follow-up protocols.

Disponible en www.citeulike.org

sccp/colombia

Disponible en www.citeulike.org

sccp/colombia

Computed tomography (CT) is the modality of choice in the evaluation of blunt renal injury. Intravenous urography is used primarily for gross assessment of renal function in hemodynamically unstable patients. Selective renal arteriography or venography can provide detailed information regarding vascular injury. Retrograde pyelography is valuable in assessing ureteral and renal pelvic integrity in suspected ureteropelvic junction injury. Ultrasonography is useful in detecting hemoperitoneum in patients with suspected intraperitoneal injury but has limited value in evaluating those with suspected extraperitoneal injury. Occasionally, radionuclide renal scintigraphy or magnetic resonance imaging may prove helpful. Renal injuries can be classified into four large categories based on imaging findings. Category I renal injuries include minor cortical contusion, subcapsular hematoma, minor laceration with limited perinephric hematoma, and small cortical infarct. Category II lesions include major renal lacerations extending to the medulla with or without involvement of the collecting system and segmental renal infarct. Category III lesions are catastrophic renal injuries and include multiple renal lacerations and vascular injury involving the renal pedicle. Category IV injuries are ureteropelvic junction injuries. CT is particularly useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help assess the extent of penetrating injuries in selected patients with limited posterior stab wounds. Integration of the imaging findings in renal injury with clinical information is critical in developing a treatment plan.

Disponible en www.citeulike.org

sccp/colombia

Epispadias is a rare diagnosis and most commonly described as a part of the bladder exstrophy complex. Epispadias is characterized by failure of the urethral plate to tubularize on the dorsum with the defect ranging from a glandular to a penopubic location. In addition, male patients demonstrate a dorsal chordee whereas female patients exhibit a bifid clitoris. The goal of surgical correction is the placement of the meatus in its anatomical position and the creation of functional genitalia with good cosmetic outcomes. Two different major reconstruction principals, the modified Cantwell-Ransley and the Mitchell Bagli repair, are used in specialized centers worldwide. Both procedures comprise the major principles of epispadias surgery but differ in timing and the extent of urethral mobilization. In addition, both techniques have advantages and specific risks involved, and reports from supporting institutions demonstrate favorable results. Regardless of the approach, the reconstruction should be performed by experienced surgeons.

Disponible en www.citeulike.org

sccp/colombia

Epispadias is a rare diagnosis and most commonly described as a part of the bladder exstrophy complex. Epispadias is characterized by failure of the urethral plate to tubularize on the dorsum with the defect ranging from a glandular to a penopubic location. In addition, male patients demonstrate a dorsal chordee whereas female patients exhibit a bifid clitoris. The goal of surgical correction is the placement of the meatus in its anatomical position and the creation of functional genitalia with good cosmetic outcomes. Two different major reconstruction principals, the modified Cantwell-Ransley and the Mitchell Bagli repair, are used in specialized centers worldwide. Both procedures comprise the major principles of epispadias surgery but differ in timing and the extent of urethral mobilization. In addition, both techniques have advantages and specific risks involved, and reports from supporting institutions demonstrate favorable results. Regardless of the approach, the reconstruction should be performed by experienced surgeons.

Disponible en citeulike sccp

Circumcision Comes Under Attack in San Francisco

A S. Francisco group opposed to circumcision is one step closer to the city banning the practice after submitting 12,000 signatures to the local Department of Elections – nearly twice the required number – requesting a November ballot measure on the issue. If approved by voters, the law would classify circumcision of boys under the age of 18 as a misdemeanor carrying a maximum punishment of one year in prison and a $1,000 fine.

Both rabbis and legal experts across the United States have raised a collective eyebrow at the proposed ban, calling into question its constitutionality as a breach of religious freedom as guaranteed by the First Amendment.

“This is a tradition not only practiced by Jews, but by Muslims and members of secular society,” stated Rabbi Yosef Langer, director of Chabad-Lubavitch of S. Francisco. “Unfortunately, the Bay Area is renowned for people jumping on the bandwagon of anything that walks or crawls. To think that a very small faction of opponents [to circumcision] has gotten the attention of the entire community is preposterous.”

Circumcision, known as brit milah in Hebrew, has been a fundamental cornerstone of the Jewish people for the last 3,000 years, commanded in the Torah to be performed on the eighth day following birth. Muslims also practice circumcision when their sons are 13, tracing the ritual to Abraham’s son Ishmael. In the general population, a procedure similar to Jewish circumcision is commonly performed on infants in hospitals around the world.

But led by area resident Lloyd Schofield, 59, supporters of the ban call circumcision an act of physical abuse. They say it mutilates the body and inflicts excruciating pain upon men at their weakest and most vulnerable.

Rabbi Levi Heber, a Brooklyn mohel – or ritual circumciser – and director of the International Bris Association calls the charges outlandish.

“Circumcision attests to the everlasting covenant that G-d established with the Jewish people,” asserted the rabbi, whose Circumcision.net Web site promotes understanding and education about Jewish circumcision. “It is one of the most fundamental commandments to the Jewish people, religious and non-religious.

“Any attempt to restrict its practice would be a direct assault on the Jewish way of life and a blatant violation of religious freedom,” he added.

Constiutional Protection

Josh Davis, professor and associate dean for faculty scholarship at the University of S. Francisco School of Law, predicts the proposed ban will have a difficult time holding up under constitutional scrutiny, and not only because of its First Amendment implications.

“The right of parents to control the upbringing of children could also come into play,” said Davis, who cited the 1972 U.S. Supreme Court case Wisconsin v. Yoder, where the court ruled that the Amish community was not required to enroll its children in the public school system because it interfered with their religious beliefs. “An attack on the law might rest upon the precedent set by that case.”

Jerald F. Saval, a political scientist who taught constitutional law in the Massachusetts public school system for more than 30 years, said the law would likely be struck down because of the First Amendment’s Free Exercise Clause forbidding government intrusion into a group’s religious practices.

“Since the right of circumcision is such an integral part of Judaism where you cannot separate the practice from the belief, the First Amendment Free Exercise Clause would make that attempt [to outlaw it] in S. Francisco blatantly unconstitutional,” he explained.

Heber, who has been performing Jewish circumcisions since the late 1980’s, points to secular medical authorities who regard circumcision as a health-enhancing practice. But he is quick to point out that not all circumcisions are done in a way compliant with Jewish law.

Rabbinical authorities denounce hospital circumcisions, where a child is strapped to a table and his foreskin placed in a clamp. It can take several hours for the tissue to die in the procedure, whereas Jewish circumcisions are done in one swift motion using a very sharp knife to remove the foreskin.

For Heber, the issue is very simple: Jewish circumcision is in no way traumatic.

“Just because there are a few individuals that try to dress up this assault on the Jewish way of life in words that don’t have any basis doesn’t mean it’s the proper thing to do,” he said. “There should be an outcry against this effort.”

For his part, Langer remains hopeful that the city’s board of supervisors will reject the motion to place the ban on the fall ballot. But if it does not, he is ready to respond with educational and spiritual gusto.

“The Jewish community will unilaterally rise to the occasion and squash this absurdity,” the rabbi declared. “We have to stand unified and strong against the uninformed and the ignorant that are trying to uproot the covenant of Jewish life that’s been practiced from almost the beginning of time.”

Dr. Carlos Melo Hernández

@ camelo@emcali.net.co, camelociruped@yahoo.com

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Dr. Ricardo Álvarez
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