Divertículo vesical congénito: causa de obstrucción al tracto urinario

ResumenSe presenta el caso clínico de un paciente masculino de 2 meses de edad quien ingresa a servicio de Cirugía Pediátrica del Hospital G. Parres por cuadro de urosepsis por enterococus. Con antecedente de cursar con hidronefrosis bilateral y vejiga distendida visto por ecografía. Se realiza derivación urinaria con sonda, y se envía a nuestra institución por uropatía obstructiva.Se realizan estudios de imagen para abordaje diagnóstico. El 29.09.09 se realiza cistograma miccional donde se observa vejiga septada que comunica directamente con la uretra y reflujo vesicoureteral derecho grado iii (GIII). Se solicita uro-TAC en la cual se observa divertículo vesical paraureteral derecho y reflujo vesicoureteral GII.Se decide realizar uretrocistoscopia donde se observa divertículo vesical en pared derecha muy grande, no se observa meato ureteral izquierdo. El 14.12.09 se realiza gammagrama renal que evidencia pieloectasia bilateral, ureterocele derecho, reflujo vesicoureteral bilateral GIII. Función de riñón derecho, 46.1 (41%) y función de riñón izquierdo, 66.2 (59%).El 15.02.10 se realiza resección de divertículo y reimplante ureteral derecho tipo Politano Leadbetter con reparación de piso vesical. El 04.05.10 en el cistograma miccional se observa vejiga de bordes irregulares con capacidad de 50cc, cuello con adecuada apertura, sin reflujo y uretra permeable en todo su trayecto. A los 11 meses, paciente asintomático ya sin profilaxis.AbstractThe clinical case of a 2-month-old male infant is described herein. The patient was admitted to the Pediatric Surgery Service of the Hospital G. Parres with symptoms of urosepsis due to Enterococcus. His past history included bilateral hydronephrosis and an ultrasound study revealed a distended bladder. A urinary diversion with catheter was performed and the patient was referred to our institution due to obstructive uropathy.Imaging studies were carried out for the diagnostic approach. A voiding cystogram was performed on 29.9.09 that showed a septate bladder communicating directly with the urethra and grade III vesicoureteral reflux. Computed tomography urography was ordered and revealed a right paraureteral bladder diverticulum and grade II vesicoureteral reflux.Urethrocystoscopy was performed and showed a very large bladder diverticulum at the right wall; the left ureteral meatus was not observed. A kidney scintigram done on 14.12.09 identified bilateral renal pelvis dilation, right ureterocele, and grade III bilateral vesicoureteral reflux. Kidney function was within normal limits: right kidney 46.1 (41%) and left kidney 66.2 (59%).The diverticulum was resected and a right Politano-Leadbetter ureteral reimplantation with bladder floor repair was performed on 15.02.10. A voiding cystogram carried out on 04.05.10 showed a bladder with irregular borders and a capacity of 50 cc, a neck with adequate opening, no reflux, and a permeable urethral tract. At 11 months the patient was asymptomatic and no longer undergoing antibiotic prophylaxis

Search for charginos in e+e- interactions at sqrt(s) = 189 GeV

An update of the searches for charginos and gravitinos is presented, based on a data sample corresponding to the 158 pb^{-1} recorded by the DELPHI detector in 1998, at a centre-of-mass energy of 189 GeV. No evidence for a signal was found. The lower mass limits are 4-5 GeV/c^2 higher than those obtained at a centre-of-mass energy of 183 GeV. The (\mu,M_2) MSSM domain excluded by combining the chargino searches with neutralino searches at the Z resonance implies a limit on the mass of the lightest neutralino which, for a heavy sneutrino, is constrained to be above 31.0 GeV/c^2 for tan(beta) \geq 1.Comment: 22 pages, 8 figure

Search for composite and exotic fermions at LEP 2

A search for unstable heavy fermions with the DELPHI detector at LEP is reported. Sequential and non-canonical leptons, as well as excited leptons and quarks, are considered. The data analysed correspond to an integrated luminosity of about 48 pb^{-1} at an e^+e^- centre-of-mass energy of 183 GeV and about 20 pb^{-1} equally shared between the centre-of-mass energies of 172 GeV and 161 GeV. The search for pair-produced new leptons establishes 95% confidence level mass limits in the region between 70 GeV/c^2 and 90 GeV/c^2, depending on the channel. The search for singly produced excited leptons and quarks establishes upper limits on the ratio of the coupling of the excited fermio

Search for lightest neutralino and stau pair production in light gravitino scenarios with stau NLSP

Promptly decaying lightest neutralinos and long-lived staus are searched for in the context of light gravitino scenarios. It is assumed that the stau is the next to lightest supersymmetric particle (NLSP) and that the lightest neutralino is the next to NLSP (NNLSP). Data collected with the Delphi detector at centre-of-mass energies from 161 to 183 \GeV are analysed. No evidence of the production of these particles is found. Hence, lower mass limits for both kinds of particles are set at 95% C.L.. The mass of gaugino-like neutralinos is found to be greater than 71.5 GeV/c^2. In the search for long-lived stau, masses less than 70.0 to 77.5 \GeVcc are excluded for gravitino masses from 10 to 150 \eVcc . Combining this search with the searches for stable heavy leptons and Minimal Supersymmetric Standard Model staus a lower limit of 68.5 \GeVcc may be set for the stau mas

Hadronization properties of b quarks compared to light quarks in e+e- -> q qbar from 183 to 200 GeV

The DELPHI detector at LEP has collected 54 pb^{-1} of data at a centre-of-mass energy around 183 GeV during 1997, 158 pb^{-1} around 189 GeV during 1998, and 187 pb^{-1} between 192 and 200 GeV during 1999. These data were used to measure the average charged particle multiplicity in e+e- -> b bbar events, _{bb}, and the difference delta_{bl} between _{bb} and the multiplicity, _{ll}, in generic light quark (u,d,s) events: delta_{bl}(183 GeV) = 4.55 +/- 1.31 (stat) +/- 0.73 (syst) delta_{bl}(189 GeV) = 4.43 +/- 0.85 (stat) +/- 0.61 (syst) delta_{bl}(200 GeV) = 3.39 +/- 0.89 (stat) +/- 1.01 (syst). This result is consistent with QCD predictions, while it is inconsistent with calculations assuming that the multiplicity accompanying the decay of a heavy quark is independent of the mass of the quark itself.Comment: 13 pages, 2 figure

El Apego Va a Juicio: Problemas de Custodia y Protección Infantil1

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. This article is divided into two parts. In the first part, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child’s need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration