Extraction of phenolic compounds from grape pomace using ohmic heating: Chemical composition, bioactivity and bioaccessibility

This study addresses the effectiveness of ohmic heating technology (OH) for the sustainable recovery of phenolic compounds from Grape Pomace (GP) by hydroethanolic extraction. GP extracts biological potential was evaluated in terms of antioxidant activity, cytotoxicity and preventive effect against reactive oxygen species (ROS). To understand if GP extracts can be used as a functional ingredient, simulated gastrointestinal digestion was performed to evaluate the bioaccessibility. OH-assisted hydroethanolic extraction proved to be an effective process for the recovery of GP phenolic compounds with high antioxidant capacity. The digestion process increased the concentration of total phenolics and the biotransformation of high-molecular phenolics (anthocyanins, flavonoids and resveratrol) in simpler phenolic acids, improving bioaccessibility. GP extract displayed a selective action against cancer cells (Caco-2 and HeLa) and promoted ROS prevention. The results highlighted the ability of OH to extract bioactives from GP and its potential application as a nutraceutical or for functional food formulations.

Purification and Characterization of a Thrombolytic Enzyme Produced by a New Strain of Bacillus subtil

Fibrinolytic enzymes with a direct mechanism of action and safer properties are currently requested for thrombolytic therapy. This paper reports on a new enzyme capable of degrading blood clots directly without impairing blood coagulation. This enzyme is also non-cytotoxic and constitutes an alternative to other thrombolytic enzymes known to cause undesired side effects. Twenty-four Bacillus isolates were screened for production of fibrinolytic enzymes using a fibrin agar plate. Based on produced activity, isolate S127e was selected and identified as B. subtilis using the 16S rDNA gene sequence. This strain is of biotechnological interest for producing high fibrinolytic yield and consequently has potential in the industrial field. The purified fibrinolytic enzyme has a molecular mass of 27.3 kDa, a predicted pI of 6.6, and a maximal affinity for Ala-Ala-Pro-Phe. This enzyme was almost completely inhibited by chymostatin with optimal activity at 48°C and pH 7. Specific subtilisin features were found in the gene sequence, indicating that this enzyme belongs to the BPN group of the S8 subtilisin family and was assigned as AprE127. This subtilisin increased thromboplastin time by 3.7% (37.6 to 39 s) and prothrombin time by 3.2% (12.6 to 13 s), both within normal ranges. In a whole blood euglobulin assay, this enzyme did not impair coagulation but reduced lysis time significantly. Moreover, in an in vitro assay, AprE127 completely dissolved a thrombus of about 1 cc within 50 min and, in vivo, reduced a thrombus prompted in a rat tail by 11.4% in 24 h compared to non-treated animals.

Ultrasound intensification suppresses the need of methanol excess during the biodiesel production with Lipozyme TL-IM

The synthesis of biodiesel from sunflower oil and methanol based on transesterification using the immobilized lipase from Thermomyces lanuginosus (Lipozyme TL-IM) has been investigated under silent conditions and under an ultrasound field. Ultrasound assisted process led to reduced processing time and requirement of lower enzyme dosage. We found for the first time that oil to methanol ratio of 1:3 was favored for the ultrasound assisted enzymatic process which is lower than that observed for the case of conventional stirring based approach (ratio of 1.4). Our results indicate that intensification provided by ultrasound suppresses the need of the excess of the methanol reactant during the enzymatic biodiesel production. Ultrasound assisted enzymatic biodiesel production is therefore a faster and a cleaner processes.

Candida albicans VPS4 contributes differentially to epithelial and mucosal pathogenesis

We have previously demonstrated that the C. albicans pre-vacuolar protein sorting gene VPS4 is required for extracellular secretion of the secreted aspartyl proteases Sap2p and Saps4-6p. Furthermore, the vps4Δ null mutant has been shown to be markedly hypovirulent in a murine tail vein model of disseminated candidiasis. In these experiments, we sought to further define the role of the pre-vacuolar secretion pathway mediated by the pre-vacuolar sorting gene VPS4 in the pathogenesis of epithelial and mucosal infection using a broad range of virulence models. The C. albicans vps4Δ mutant demonstrates reduced tolerance of cell wall stresses compared to its isogenic, complemented control strain. In an in vitro oral epithelial model (OEM) of tissue invasion, the vps4Δ mutant caused reduced tissue damage compared to controls. Further, the vps4Δ mutant was defective in macrophage killing in vitro, and was attenuated in virulence in an in vivo Caenorhabditis elegans model representative of intestinal epithelial infection. In contrast, the vps4Δ mutant caused a similar degree of tissue damage in an in vitro uroepithelial model of Candida infection compared with controls. Furthermore, in an in vivo murine model of vaginal candidiasis there was no reduction in fungal colony burden and no differences in vaginal histopathology compared to wild-type and complemented controls. These results suggest that VPS4 contributes to several key aspects of oral epithelial but not uroepithelial infection, and in contrast to systemic infection, plays no major role in the pathogenesis of Candida vaginitis. By using a wide range of virulence models, we demonstrate that C. albicans VPS4 contributes to virulence according to the specific tissue that is infected. Thus, in order to gain a full understanding of C. albicans virulence in relation to a particular gene or pathway of interest, a selected range of infection models may need to be utilized.

Drug-induced anaphylaxis survey in Portuguese Allergy Departments

BACKGROUND AND OBJECTIVE

Drug-induced anaphylaxis is an unpredictable and potentially fatal adverse drug reaction. The aim of this study was to identify the causes of drug-induced anaphylaxis in Portugal.

METHODS

During a 4-year period a nationwide notification system for anaphylaxis was implemented, with voluntary reporting by allergists. Data on 313 patients with drug anaphylaxis were received and reviewed. Statistical analysis included distribution tests and multiple logistic regression analysis to investigate significance, regression coefficients, and marginal effects.

RESULTS

The mean (SD) age of the patients was 43.8 (17.4) years, and 8.3% were younger than 18 years. The female to male ratio was 2:1.The main culprits were nonsteroidal anti-inflammatory drugs (NSAIDs) (47.9% of cases), antibiotics (35.5%), and anesthetic agents (6.1%). There was a predominance of mucocutaneous symptoms (92.2%), followed by respiratory symptoms (80.4%) and cardiovascular symptoms (49.0%). Patients with NSAID-induced anaphylaxis showed a tendency towards respiratory and mucocutaneous manifestations. We found no significant associations between age, sex, or atopy and type of drug. Anaphylaxis recurrence was observed in 25.6% of cases, and the risk was higher when NSAIDs were involved.

CONCLUSIONS

NSAIDs were the most common cause of anaphylaxis in this study and were also associated with a higher rate of recurrence. We stress the need for better therapeutic management and prevention of recurring episodes of drug-induced anaphylaxis.

Low metabolic activity of biofilm formed by Enterococcus faecalis isolated from healthy humans and wild mallards (Anas platyrhynchos)

It is widely known that Enterococcus faecalis virulence is related to its biofilm formation. Although Enterococci are common commensal organisms of the gastrointestinal tract, the difference between commensal and pathogen strains remain unclear. In this study, we compare the biochemical profile of the biofilms formed by two groups of medical and two groups of commensal strains. The medical strains were isolated as pathogens from infections of urinary tract and other infections (wounds, pus and bedsores), and the commensal strains were taken from faeces of healthy volunteers and faeces of wild mallards (Anas platyrhynchos) living in an urban environment. The properties of biofilms formed by medical and commensal strains differed significantly. Commensal strains showed lower metabolic activity and glucose uptake and higher biofilm biomass than the medical ones. Consistent with glucose uptake experiments, we found that the glucose dehydrogenase gene was more expressed in medical strains. These results indicate that higher metabolic activity and lower protein concentration of E. faecalis cells within biofilms are formed during infections.

Assessment of asthma control: clinical, functional and inflammatory aspects

BACKGROUND

Asthma is a complex disease with numerous markers of severity/activity. Clinical assessment,functional parameters and inflammation biomarkers are the most used A correlation between them is difficult, as each one evaluates a particular aspect of the disease.

OBJECTIVE AND METHODS

To explore the possible association between asthma control, pulmonary function and inflammation in patients with asthma, consecutive asthmatics underwent simultaneous spirometry (measurement of FEV1), exhaled nitric oxide (eNO) evaluation and Asthma Control Test (ACTTM) questionnaire.

RESULTS

The study included 232 asthmatics (mean age: 37.48 years; 78.4%female): 43% had uncontrolled asthma (ACTTM < or = 19) with FEV1 mean values of 83.3% +/- 21.8; 48% partially controlled (ACTTM: 20-24) with FEV1 of 87.6% +/- 17; 9% complete control (ACTTM = 25) with FEV1 of 93.1 +/- 20.6. The relation ACTTM/FEV1 and ACTTM/FEF 25-75% was statistically significant (p = 0.001 and p = 0.034, respectively). Among patients with eNO < 35 ppb, 66% had FEV1 > 80% and 52% had ACTTM > 19. No association was found combining ACTTM/eNO or FEV1/eNO. A subgroup of 66 patients was evaluated twice.

CONCLUSION

An association was found between ACTTM and spirometry, with higher ACTTM scores reflecting less bronchial obstruction. The authors advise a combined approach in asthma follow-up, involving clinical aspects, functional parameters and inflammation biomarkers, although in some circumstances ACT could be a valid instrument to be used alone to assess control.

Determining the negative predictive value of provocation tests with beta-lactams

BACKGROUND

The beta-lactam allergic work-up is mostly standardized. However, the negative predictive value of drug provocation tests is not yet well established.

METHOD

A historical-prospective multicentre cohort study was conducted in four centres (one in France, one in Portugal, two in Italy) to assess the negative predictive value of provocation tests with beta-lactams in patients initially tested for a suspicion of drug allergy/hypersensitivity. Patients were contacted at least 6 months after the work-up, between 2003 and 2007. A new allergic work-up was proposed to reacting patients.

RESULTS

Among the 457 patients included, 365 (79.9%) were followed up (159 [79.1%] from France, 153 [82.7%] from Italy and 53 [74.6%] from Portugal). Only 118 (25.8%) were re-exposed to the negatively tested beta-lactam. Nine (7.6%) reported a non-immediate (occurring more than 1 h after drug administration) reaction: five urticaria, three exanthema and one undefined cutaneous reaction. None were severe. Only four accepted a re-challenge, negative in two cases and positive in the two others. The negative predictive value was 94.1% (89.8-98.3) (111 out of 118 patients).

CONCLUSION

Although the negative predictive value of drug provocation tests may not be 100%, none of the false negative patients experienced a life-threatening reaction. This should reassure doctors who might hesitate to prescribe beta-lactams, even in patients with negative allergic work-ups.

Immediate hypersensitivity to penicillins with negative skin tests--the value of specific IgE

The determination of specific IgE in patients with history of penicillins hypersensitivity is simple, safe and widely available. The positive and negative predictive values of this determination, however, are not yet established. In order to evaluate them, we performed specific IgE determination and diagnostic drug challenges in a group of 22 patients with a clear history of immediate penicillins hypersensitivity but negative skin tests. In this sample, the positive and negative predictive values were 29% and 87%, respectively. This seems to indicate that a positive specific IgE is not enough to confirm the diagnosis, and further study is necessary.

Work up of patients with history of beta-lactam hypersensitivity

INTRODUCTION

Beta-lactam antibiotics are the most frequent cause of antibiotic hypersensitivity reactions. The study of all cases of suspected beta-lactam hypersensitivity is highly important, to avoid the use of less efficient or more expensive alternatives, for fear of a reaction.

MATERIALS AND METHODS

Sixty-seven consecutive patients with suspected beta-lactam hypersensitivity reactions were studied. Skin prick tests (SPT), intradermal tests (IDT) and specific IgE determination were performed. In non-immediate reactions, epicutaneous testing was also done. If all were negative, a drug challenge was performed.

RESULTS

Sixty-seven patients (54 female symbol), with a mean age + or - SD of 36.6 + or -19.3 years (4-78 years) were studied. The self-reported antibiotics were amoxicillin and amoxicillin/clavulanic acid in 30 (45%), penicillin in 24 (36%), cephalosporins in 11 (16%) and flucloxacillin in 2 (3%). SPT and IDT were positive in 6 patients (9%) and specific IgE in 11 (16%). Only one patient had both positive specific IgE and skin tests. Of the remaining 51 cases, 33 underwent a drug challenge with the culprit antibiotic, with a positive reaction in 2 (6%). In all positive cases and when a drug challenge with the suspected antibiotic was not indicated, a challenge with an alternative drug was done, all with negative results.

CONCLUSIONS

Of the 67 studied cases with history of beta-lactam hypersensitivity reactions, 18 (27%) were confirmed after testing. A combination of skin testing, specific IgE determination and drug challenge is necessary since none has sufficient sensitivity to be used alone.

Allergic contact blepheroconjunctivitis with phenylephrine eyedrops--the relevance of late readings of intradermal tests

Allergic reactions to midriatic eyedrops are rare despite extensively used by ophthalmologists. Phenylephrine is responsible for 54-95% of cases reported in literature. We present the case of a 56-year-old man with blepharoconjunctivitis after instillation of phenylephrine 5%, tropicamide 0.5%, oxibuprocaine eyedrops. The patient reported good tolerance to the mentioned drugs. Immediate readings of prick and intradermal tests, performed with the suspected drugs, were negative. Late readings (48 and 72 hours) of epicutaneous tests were also negative. At 72 hours, prick and intradermal tests to phenylephrine were positive. Allergic blepharoconjunctivitis to phenylephrine was diagnosed. Phenylephrine is an extensively used midriatic that can act as a potent sensitizing agent and can be the cause of allergic contact reactions in exposed patients. With this case we illustrate the relevance of late readings of intradermal tests in the diagnosis of late hypersensitivity drug reactions. The authors discuss about possible mechanisms responsible for negative results of epicutaneous tests.

Encéphalocèle intra-diploïque de l’adulte

We describe a rare case of parietal intradiploic encephalocele in a 51-year-old woman with no history of head trauma. The patient presented with a 1-month history of left hemiparesthesia. A hard indolent scalp lesion was palpable on examination in the right parietal area. Skull x-rays and cranial computed tomography examination demonstrated a lytic lesion that was consistent with a malignant osteolytic skull lesion. Magnetic resonance imaging of the head revealed an intradiploic cyst that included a round tissue mass contiguous with the parietal cortex. Surgery confirmed the diagnosis of encephalocele and the patient underwent surgical resection of the herniated brain, duraplasty, and cranioplasty. The presenting hemiparesthesia persisted at the 6-month follow-up. Encephaloceles of the cranial vault are a rare complication of skull fractures and rarely occur in adults. These lesions can be difficult to distinguish from congenital encephaloceles in patients with no history of head trauma. The pathogenesis, clinical and radiological nuances and the role of surgery are discussed.

Jaw avascular osteonecrosis after treatment of multiple myeloma with zoledronate

PURPOSE

Multiple myeloma, the second most common haematopoietic cancer, which represents the collection of plasma-cell neoplasms that invariably becomes fatal when self-renewing myeloma cells begin unrestrained proliferation. The major clinical manifestation of multiple myeloma is related to the loss of bone through osteolysis. This can lead to pathologic fractures, spinal cord compression, hypercalcaemia, and pain. It is also a major cause of morbidity and mortality in these patients, who frequently require radiation therapy, surgery and analgesic medications. Bisphosphonates are specific inhibitors of osteoclastic activity, and are currently used to prevent bone complications and to treat malignant hypercalcaemia in patients with multiple myeloma, or bone metastases from breast and prostate cancers. Hence, osteonecrosis of the mandible has been reported in three patients from Centro Hospitalar de Vila Nova de Gaia (CHVNG) with multiple myeloma treated for over 18-48 months with intravenous zoledronate, commonly prescribed for multiple myeloma therapy. Although, this report alerts clinicians about the potential complication of bone necrosis in patients receiving bisphosphonate therapy, many questions remain concerning the underlying pathogenesis of this process.

PATIENTS AND METHODS

The medical and dental records of three patients with multiple myeloma, who were treated in CHVNG in the past 4 years, were reviewed. These three patients presented exposed bone and osteonecrosis of the mandible, and shared one common clinical feature: all of them were treated with bisphosphonate zoledronate, administered intravenously for long periods. Sequential orthopantomograms (OPGs) and histological evaluation have been analysed from the biopsies of the non healing dental extraction sites of these patients.

RESULTS

After a routine dental extraction, these patients developed avascular osteonecrosis of the mandible and secondary bone infection with Actinomyces israelii (actinomycotic osteomyelitis), with no evidence of metastatic disease evaluated by biopsy. In these three described clinical cases, surgical debridment without flap elevation, intensive antibiotherapy and the suspension of the zoledronate treatment allowed a partial recovery of the patients. The purpose of this clinical report is to point out that patients suffering from multiple myeloma can develop bone osteonecrosis induced by treatment with bisphosphonates. Research to determine the mechanism of this dental phenomenon is needed to fully validate and substantiate the possible link between bisphosphonate treatment of multiple myeloma or other cancer diseases and avascular osteonecrosis of the jaws. Until then, clinicians involved in the care of patients at risk should consider this possible complication.

Silicon addition to hydroxyapatite increases nanoscale electrostatic, van der Waals, and adhesive interactions

The normal intersurface forces between nanosized probe tips functionalized with COO(-)-terminated alkanethiol self-assembling monolayers and dense, polycrystalline silicon-substituted synthetic hydroxyapatite (SiHA) and phase pure hydroxyapatite (HA) were measured via a nanomechanical technique called chemically specific high-resolution force spectroscopy. A significantly larger van der Waals interaction was observed for the SiHA compared to HA; Hamaker constants (A) were found to be A(SiHA) = 35 +/- 27 zJ and A(HA) = 13 +/- 12 zJ. Using the Derjaguin-Landau-Verwey-Overbeek approximation, which assumes linear additivity of the electrostatic double layer and van der Waals components, and the nonlinear Poisson-Boltzmann surface charge model for electrostatic double-layer forces, the surface charge per unit area, sigma (C/m(2)), was calculated as a function of position for specific nanosized areas within individual grains. SiHA was observed to be more negatively charged than HA with sigma(SiHA) = -0.024 +/- 0.013 C/m(2), two times greater than sigma(HA) = -0.011 +/- 0.006 C/m(2). Additionally, SiHA was found to have increased surface adhesion (0.7 +/- 0.3 nN) compared to HA (0.5 +/- 0.3 nN). The characterization of the nanoscale variations in surface forces of SiHA and HA will enable an improved understanding of the initial stages of bone-biomaterial bonding.

[Imaging in acute toxic encephalopathy]

Neuroimaging, particularly MR imaging, plays a major role for the diagnosis of many acute toxic encephalopathies. Toxic disorders are related to drugs (immunosuppressive agents, chemotherapeutic agents, anti-epileptic drugs, heroin...), to metals (lead, manganese, mercury...), and to industrial and environmental chemicals (solvent, carbon monoxide...). MR imaging with diffusion and perfusion imaging provides information regarding brain lesions induced by the toxic agents (vasogenic edema, cytotoxic edema, infarction, hemorrhage, demyelination...).

[The influence of smoking on fertility, pregnancy and lactation]

OBJECTIVE: To decribe the influence of smoking on different phases of the reproductive process, fecundation, pregnancy and lactation, drawing special attention to the mechanisms of action of the main toxic components found in cigarettes. To suggest prophylactic measures for environmental control and how to reduce childreńs exposure to tobacco smoke. METHODS: Nonsystematic literature review using MEDLINE database. RESULTS: Smoking has a negative effect on different phases of the reproduction process, by direct action of main toxic components, nicotine and carbon monoxide. Smoking reduces fertility, compromises the length of gestation and infant birthweight. Smoking mothers also have reduced breast milk production and shorter lactation, which affects infant weight gain through unclear mechanisms in which prolactin may probably be involved. CONCLUSIONS: Smoking compromises reproductive function quality in different phases, acting mainly on intrauterine and extrauterine development of infants. Since during pregnancy and lactation women are in closer contact with health professionals, antismoking campaigns should be especially addressed to this period.

[Clinical profile in children under five year old with acute respiratory tract infections]

OBJECTIVE: To describe the clinical and epidemiological profile of acute respiratory infections (ARI) in children younger than five years old, of both sexes, diagnosed at the University Hospital Júlio Müller.METHODS: This is a descriptive and cross sectional study. A standard questionnaire was answered by the childreńs parents, during the period of October/1996 to February/1997. The cases were classified according to the Health Ministry criteria in Upper Airway Infection (UAI) or Acute Lower Respiratory Infection (ALRI). The following data were analyzed: signs and symptoms, clinical diagnosis, socioeconomic variables, nutritional appraisal and passive smoking. The data were analyzed with EPI-Info 6.02b program. The X(2) test was used with confidence interval of 95% (a = 5%).RESULTS: The ARI prevalence in children under five years was 25.6%. From the total number of 491 children, 76.4% (n=375) had UAI and 23.6% (n=116) ALRI. The most frequent diagnosis was nasopharyngitis. The most frequent respiratory symptoms were nasal discharge (82.1%) and cough (80.4%). Around 6.1% of the total number of the cases were due to pneumonia (77.7% of the cases involving hospitalization). There were no associations of ARI with children s nutritional status, family income or passive smoking. There was statistical association between maternal educational status and ALRI (X(2)= 16.57).CONCLUSIONS: The findings show that most of the children presented nasopharyngitis (UAI), being most of them male. Pneumonia (ALRI) was the main cause of hospitalization. The most common symptoms were nasal discharge and cough. Besides, the most important risk factor associated was the mothers educational status.

Preliminary results on the seasonality and life cycle of the parasitic dinoflagellate causing bitter crab disease in Alaskan tanner crabs (Chionoecetes bairdi)

Tanner crabs (Chionoecetes bairdi) from the Sullivan Island area of southeast Alaska were sampled for 1 year to determine the prevalence and intensity of the parasitic dinoflagellate which causes bitter crab disease (BCD). The prevalence and intensity of infection were the greatest in the summer, declined in the fall and winter, and increased again in the spring. A possible relationship between softer, newer shells and higher levels of parasitism was also observed. In vivo transmission studies in the laboratory suggested there are several morphologically different forms of the vegetative cell of the BCD dinoflagellate which occur prior to sporulation of the parasite. In addition, it appears that both the two spore types produced by the parasite are infectious by injection and that there is no ploidy difference between the two spore types and the vegetative cell, suggesting that the two spore types may not represent separate sexes.

[Migratory flow of cases of malaria in Cuiabá/MT, 1986]

Foram estudadas 2.406 pessoas que procuraram a SUCAM/Cuiabá para diagnóstico e tratamento da malária. Destes, 1.151 tiveram lâminas positivas através da gota espessa: 720 P. vivax, 421 P. falciparum e 10 forma mista; 1.255 foram negativos à pesquisa de hematozoários. As entrevistas foram realizadas através de questionário padronizado onde procurou-se categorizar as pessoas conforme o sexo, idade, profissão, naturalidade, renda mensal, procedência e destino. Da análise efetuada vimos que os casos de malária originaram-se mais da micro-região Norte-Matogrossense para a Baixada Cuiabana (56,5%), colocando em risco toda a população desta micro-região, que encontra-se com borrificaçâo suspensa (DDT) na maioria das localidades. É também importante o fluxo de casos de malária do Estado de Rondônia (20,6%) e para os Estados da região Sul e Sudeste (4,4%) do país. Concluímos que medidas urgentes devam ser tomadas para a reformulação da campanha de controle da malária, planejando a intervenção nos aspectos sociais, políticos e econômicos.

[Respiratory manifestations in Plasmodium falciparum and vivax malaria]

Foram selecionados 110 pacientes que procuraram a SUCAM/CUIABÁ para diagnóstico e tratamento de malária, com queixa de febre e procedente de área malarígena. Nestes pacientes foram realizados: gota espessa para a pesquisa de Plasmodium; aplicação de questionário padronizado para detectar sintomas respiratórios presentes no momento da entrevista; gasometria arterial e espirometria para avaliar a função pulmonar. Desta amostra, 62 pacientes foram positivos para malária sendo 41 P. vivax, 20 P. falciparum e 01 forma mista (grupo Malárico); 48 mostraram-se negativos à pesquisa de hematozoários através da gota espessa (grupo Não Malárico). As manifestações respiratórias encontradas nesta população quando comparadas os grupos Malárico e Não Malárico, foram respectivamente: 1º) Sintomáticos Respiratórios de 46,8% para 22 9% (p < 0,05); 2°) Alterações Espirométricas de 53,2% para 20,8% (p < 0,05); 3°) Alterações Gasométricas de 62,9% para 25,0% (p < 0,05). Com estes resultados concluímos que há nítida associação entre a Malária produzida pelo P. vivax e P. falciparum e as manifestações respiratórias apresentadas, nesta população de estudo.

Primary vaginal calculus in a patient with meningomyelocele

The development of a rare vaginal calculus in a 12-year-old girl with meningomyelocele since birth is attributed to urinary stasis resulting from prolonged urinary incontinence, decubiti of long duration and almost complete lack of medical or rehabilitation care. After surgical removal of the calculus without complications, a series of elective orthopedic procedures has been gradually undertaken and a program of intermittent catheterization has been started.