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Extraction of a bladder stone in a child as described by the renaissance physician Cristóbal Méndez
Extracción de un cálculo vesical a un niño según el relato del médico renacentista Cristóbal Méndez
F.M. Sánchez-Martína,
Corresponding author
fsanchez@fundacio-puigvert.es

Corresponding author.
, A.M. Hostalotb, J.M. Santillanaa, O. Angerria, F. Millána, H. Villavicencioa
a Servicio de Urología, Fundacio Puigvert, Barcelona, Spain
b Unidad de Pediatría, CAP Plana Lledó, ICS, Mollet, Barcelona, Spain
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The first description of perineal lithotomy corresponds to Aulus Cornelius Celsus &#40;25 BC&#8211;50 AD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The technique was performed regularly perineally well into the nineteenth century<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> with little evolution over the centuries&#58; first <span class="elsevierStyleItalic">apparatus minor</span>&#44; then <span class="elsevierStyleItalic">apparatus major</span>&#44; and more myophilactic incisions and with more sophisticated instruments&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In children&#44; bladder lithiasis was endemic due to an imperfect diet&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a> those being the ones undergoing the intervention routinely&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our goal is to argue about the surgical nature and not autopsic of the incident reported by Crist&#243;bal M&#233;ndez and review the ethiopathogenesis of bladder stones in the Renaissance&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Data collection on the Internet&#58; Google&#44; Pubmed&#44; and repositories of electronic books&#46; Reading &#40;Castilian&#44; 16th century&#41; of the facsimile of <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> in the Virtual Library of Bibliographical Heritage &#40;Junta de Comunidades de Castilla-La Mancha&#44; 2010&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Selection of paragraphs on the removal of a child bladder lithiasis and its etiology&#46; Historical contextualization of the event with a review of classical texts of the 16th&#8211;20th centuries on lithotomy and historical reference works&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the third treatise of the <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> &#40;1553&#41;&#44; we can find the &#8216;Chapter Seven of the exercise&#58; which in every age is required to maintain health&#46; And it says here of childhood and boyhood&#8217;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> where &#40;page 120&#41; Crist&#243;bal M&#233;ndez recounts his own experience to witness the removal of a stone to a child about 4&#8211;5 years old&#44; the son of a so-called Villase&#241;or&#46; It reads&#58;<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#8220;And because sometimes if after eating&#44; they do too much movement&#58; they usually have this unfortunate disease&#58; which is bladder stone &#91;&#46;&#46;&#46;&#93; although they can have the disease from the womb of their mother&#46; I saw in Mexico a child son of a very honest man called Villase&#241;or being opened&#58; and he was not five years old&#58; and a stone nearly as big as an egg was taken out&#58; and no doubt according to its quantity&#58; which was done before being born&#46; So the very big move after eating &#91;&#46;&#46;&#46;&#93; increases the heat&#58; they sweat a lot &#91;&#46;&#46;&#46;&#93;&#44; attract the indigestible delicacy from the stomach&#58; and the same heat gets weak&#58; and there are many superfluities&#58; and through the urinary tract they go to the bladder&#58; and since they are sticky they stay there&#58; and with once a little&#59; and then more &#91;&#46;&#46;&#46;&#93; and the same natural heat that is unstable there consumes the subtle and hardens the thick part&#59; and it becomes a stone&#58; and thus it increases until it becomes big&#58; and it cannot leave and it goes to the bottom of the bladder &#91;&#46;&#46;&#46;&#93; until it comes to kill the man&#44; or to kill him by opening him&#58; or remain healthy as it happens to many&#8221;&#46;</p></span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">Doctor Crist&#243;bal M&#233;ndez lived the time when Spain enjoyed great territorial domain under the reigns of Charles I and Philip II&#44; in contrast to a growing resistance to openness cultural movements &#40;reform&#41; that took place in Europe&#44; led by Erasmus of Rotterdam &#40;1466&#8211;1536&#41;&#46; Counter-reformist politics started excluding Spanish intellectuals from European scientific currents from the sixteenth century&#44; often leading physicians to face the Inquisition&#46; M&#233;ndez himself had warnings of the Holy Office&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The Spanish medicine of his time had collected Islamic influences &#40;Razhes&#44; Averroes&#41; assimilating it to classicism &#40;Aristotle&#44; Galen&#41; prevailing in the Middle Ages&#44; evolving into the Renaissance Humanism&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> provides a detailed overview of the benefits of physical activity and is considered the first treatise on kinetotherapy or sports medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Framed in classicism &#40;humoral medicine&#44; Aristotelian anatomical model&#41; when the counter-reform was still incipient&#44; it shows progressive displays&#58; plea for care of the vital functions and rediscovery of the human body&#44; framed in Renaissance humanism&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> in line with secularization when interpreting the body morphology and its functions &#40;Servet&#44; Vesalius&#44; Harvey&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> There are 4 remaining copies of the original book by M&#233;ndez&#58; National Library of Spain &#40;2 copies&#41;&#44; Library of Castilla &#8211; La Mancha in Toledo&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and one at Yale &#8211; the best preserved&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;13</span></a> The National Academy of Medicine of Mexico &#40;1991&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and the Community of Madrid &#40;1998&#41;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> printed facsimiles&#46; Guerra made an English translation in 1960&#44; adding some comments&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Crist&#243;bal M&#233;ndez traveled to Mexico as court physician and lived there for 12 years&#46; He served the nobility&#44; including the wife of Hern&#225;n Cort&#233;s &#40;1485&#8211;1547&#41; &#8211; who he was a friend of &#8211; and the Viceroy Antonio de Mendoza &#40;c&#46; 1490&#8211;1552&#41;&#46; The Book&#44; written on his return to Andalusia&#44; includes many autobiographical notes&#44; including witnessing the removal of the bladder stone to the child Villase&#241;or around 1529&#46; There is general agreement that M&#233;ndez observed the intervention but did not perform it&#46; Considered the first surgical registry of America&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> there is controversy over whether it was a live lithotomy or a necropsy due to the use of the word &#8216;cut&#8217; to describe the technique and the lack of technical details in the narration&#46; The supporters that it was a surgical intervention&#44; cited by Quijano&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> are the historians of medicine Antonio Hern&#225;ndez Morej&#243;n &#40;1773&#8211;1836&#41; and Francisco Fern&#225;ndez del Castillo &#40;1899&#8211;1983&#41;&#44; while those who think it was necropsy are Germ&#225;n Somolinos d&#8217; Ardois &#40;1911&#8211;1973&#41; and Francisco Guerra &#40;1916&#8211;2011&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We must start from the basis that any view on this is imaginary due to the lack of data of the Book&#46; Guerra in its version translated into English in 1960 &#40;page 65&#44; footnote 17&#41; says&#58; &#8216;The autopsy was certainly the earliest made in the western hemisphere&#8217;&#44; without offering any argument that supports this claim&#44; and it includes directly in the index the entries Autopsy on child and Autopsy&#44; child in M&#233;xico&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> For his part&#44; Somolinos takes a conceptual approach to the subject on page 261 of his monograph&#44; but without objective data&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The chronologically closest interpretation to the book by M&#233;ndez is that of Hern&#225;ndez Morej&#243;n&#46; In his <span class="elsevierStyleItalic">Biblioteca escogida de medicina y ciruj&#237;a</span> &#40;Volume III&#44; page 14&#41; 1843<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> he discusses the findings of the book by M&#233;ndez&#58; &#8216;Carving operation conducted in Mexico to the author&#44; and extraction of a stone the size of an egg&#8217;&#46; He conjectures that it was surgery&#44; without providing further explanations&#44; although the temporal proximity and the &#8216;normality&#8217; of the bladder size that persisted in the early nineteenth century support this interpretation&#46; Meanwhile&#44; Fern&#225;ndez del Castillo in his book <span class="elsevierStyleItalic">La Cirug&#237;a mexicana en los siglos <span class="elsevierStyleSmallCaps">xvi</span> y <span class="elsevierStyleSmallCaps">xvii</span></span> &#40;page 7&#41;&#44; published in 1936&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> refers to Morej&#243;n but without consulting the book by M&#233;ndez in the absence of specimens in his environment&#46; He regrets it and says&#58; &#8216;it would have been interesting to investigate whether he brings the data about those who performed the operation&#44; where it was made&#44; and with what results&#8217;&#46; Viveros&#44; in his <span class="elsevierStyleItalic">Hipocratismo en M&#233;xico</span>&#44; empirically attributed the practice of autopsies in the New World to M&#233;ndez&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> which cannot be extrapolated to the observation of the child Villase&#241;or&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We think that the literal text of M&#233;ndez is more suited to a live lithotomy than to an autopsy&#44; since the author uses the term &#8216;open&#8217; not only to describe the maneuver&#44; but later&#44; when referring again to the risks of lithotomy he says&#58; &#8216;killing by opening&#8217;&#44; leaving implicit that death is a risk of opening the living&#44; logically with surgery&#46; Juli&#225;n Guti&#233;rrez de Toledo &#40;second half of the fifteenth century &#8211; 1529&#41; in his book <span class="elsevierStyleItalic">Cura de la piedra y dolor de la yjada y colica rrenal</span> he uses &#8216;open&#8217; to describe a lithotomy &#8216;when the stone is big there is no choice but to open and remove it&#8217;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> So does Francisco D&#237;az &#40;1527&#8211;1590&#41; on page 210 of his book &#8216;Newly printed treatise of all the diseases of the kidneys&#44; bladder&#44; and proud flesh of the penis&#44; and urine&#8217; of 1588&#44; when he explains the lithotomy to Bachelor Salamanca&#58; &#8216;all doctors tried with great instance to open with relatives &#91;&#46;&#46;&#46;&#93; and then it opened&#44; and we found between the two membranes of the bladder&#44; at the top&#44; a stone over seven ounces &#91;&#46;&#46;&#46;&#93; that horrified everyone&#8217;&#46; A few pages later D&#237;az tells other cases of lithotomy and refers to the good prognosis of the intervention in children&#58; &#8216;in my presence many of these works have been performed&#58; and they were healed and very well&#8217;&#46; However&#44; the word &#8216;open&#8217; is also used by the author to refer to anatomical studies on cadavers&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the sixteenth century&#44; 2 significant technical advances occur in the lithotomy&#58; Giovanni da Romanis advocates the urethral tutor to lead the cut&#44; and his disciple Marianus Sanctus Barolitanus &#40;1488&#8211;1565&#41; describes a more lateral incision with more sophisticated instruments&#44; being called <span class="elsevierStyleItalic">apparatus major</span>&#44; <span class="elsevierStyleItalic">sectio mariana</span> or &#8216;the Italian way&#8217;&#44; indicated in adults&#46; In 1595 <span class="elsevierStyleItalic">Les Oeuvres de M&#46; Ambroise Par&#233;&#44; Conseiller et Premier Chirvrgien dv Roy</span> was published in Paris&#44; which included new instruments&#44; being one of the most popular texts on lithotomy<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Francis Rosset of Montpellier in 1590 and Pierre Franco &#40;1505&#8211;1578&#41; in 1556 advocated unsuccessfully for the hypogastric route &#40;Apparatus Altus&#41;&#44; which John Douglas finally imposed in 1719&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In New Spain a surgical practice was established according to the criteria prevailing in the Peninsula&#46; The Protomedicato &#40;regulatory official body of medical practice established by the Catholic Monarchs&#41;&#44; which M&#233;ndez himself joined in M&#233;xico&#44; gives an idea of the high organization that the medical and surgical practice was under in the dependent territories of the Spanish Crown&#44; which supports the presence of hispanic medical personnel overseas&#46; Coinciding with the introduction of printing and with the epidemic of 1545&#44; the Royal University of Mexico was founded in 1551 which&#59; however&#44; did not open any chair of medicine but could grant and revalidate degrees to surgeons and practitioners coming from Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> This situation led to the dissemination of indigenous books on surgery&#46; In 1578 the first medicine treatise printed in America appeared&#58; <span class="elsevierStyleItalic">Svmma&#44; y Recopilaci&#243;n de Chirvurgia&#44; con Vn Arte para Sangrar mvy Vtil y provechosa Compvuesta por Alonso L&#243;pez</span>&#44; extended in 1595 by the author&#46; In 1579 <span class="elsevierStyleItalic">Tractado breve de anothomia y chirvrgia y de algunas enfermedades que m&#225;s suele haver en esta Nueva Espa&#241;a</span> was published&#44; by the Augustinian Agust&#237;n Farf&#225;n&#44; already trained in America&#46; A college of physicians and surgeons<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> was thus formed who served as a basis for the subsequent consolidation of novohispana academic medicine in an environment organized by the associations-guilds<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> who attended the local medical needs in combination with the native medicine&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The perineal lithotomy was a very common operation from classicism to the nineteenth century&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> It was performed perineally with the technique known as <span class="elsevierStyleItalic">apparatus minor</span> o <span class="elsevierStyleItalic">sectio celsiana</span>&#44; which required only a sharp knife and some clamps&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#44;31</span></a> The surgeon introduced his fingers into the rectum of the patient&#44; fixed the stone at the bottom of the bladder and practiced a cut in the middle of the perineum &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; up to reaching the bladder and removing the stone&#46; The complications&#44; sequelae&#44; and mortality of the lithotomy were very high&#46; There were no anesthetic or hemostatic means&#46; As a solution&#44; Celso offers the horrifying possibility of immersing the patient in vinegar&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Fran&#231;ois Tolet &#40;1647&#8211;1724&#41;&#44; in his treatise on lithotomy of 1682&#44; says&#58; &#8216;It would be better to have fewer viewers&#44; because the presence of many people can greatly disturb the operator&#44; frighten the patient&#44; and compromise erroneous construction on accidents that sometimes accompany the operation&#46; It is both suitable and convenient that a priest is present to talk to the patient from time to time&#44; as it can help distract his pain and increase his patience during the operation&#8217;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The intervention was performed when the patient was on the verge of despair due to his illness&#44; as recounted by Luis Montero in his <span class="elsevierStyleItalic">Observacion de operaci&#243;n Lithot&#243;mica</span>&#46;&#46;&#46; 1748&#46; These are superimposable statements to those that must have occurred at the time of M&#233;ndez due to the relative stagnation of lithotomy in the fifteenth to eighteenth centuries&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Crist&#243;bal M&#233;ndez exposes 2 possible etiologies for childhood bladder stones&#44; one associated to excess postprandial mobility &#40;&#8216;they attract the indigestible delicacy from the stomach &#91;&#46;&#46;&#46;&#93; and through the urinary tract they go to the bladder&#8217;&#41; and another one prenatal &#40;&#8217;a stone &#91;&#46;&#46;&#46;&#93; that was formed before being born&#8217;&#41;&#46; Although he erroneously attributes it to excessive movements&#44; he is right when he associates lithiasis to digestion&#44; as in ancient times diet was based on cereals &#40;theory of the only cereal&#41;&#44; promoting the childhood bladder stones&#44; an issue that has been proven in studies of Asian populations of low income in the early twentieth century with similar nutritional pattern to the European one several centuries ago&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11&#44;32</span></a> To M&#233;ndez stone formation is a result of the exit of successive digestions through the urine&#46; Although due to a different pathogenesis&#44; diet continues to play a key role in the current lithogenesis&#46; M&#233;ndez makes another interesting point when he emphasizes that the stone could be formed in the child &#8216;before being born&#8217;&#44; assessing with great clinical smell the precocity of the case &#40;under 5 years of age&#41;&#44; which opens the possibility of inherited disorders such as cystinuria and hyperoxaluria&#46; Elsewhere in the book he states that gout and calculosis are courtesan diseases derived from idleness&#44; recommending &#8216;playing ball games&#44; shooting games&#44; and riding&#8217;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">The story of the removal of a bladder stone to a boy named &#8216;Villase&#241;or&#8217; &#40;1529&#41; in the work <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> &#40;1553&#41; by Crist&#243;bal M&#233;ndez &#40;1500&#8211;1553&#41; probably corresponds to a perineal lithotomy&#46; Arguments for&#58; high incidence of childhood bladder stones in the old times and usual practice of perineal lithotomy in the sixteenth century&#46; The main coetaneous hispanic texts &#40;Renaissance&#41; on lithotomy use the term &#8216;open&#8217; to define the lithotomy&#46; Historian Hern&#225;ndez Morej&#243;n &#40;1773&#8211;1836&#41; points to it at a time when the operation was still practiced&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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            2 => "Urology"
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            1 => "Litiasis vesical"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">in his <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> &#40;Book of exercise and profits&#41;&#44; the Spanish Renaissance physician Christopher Mendez &#40;1500&#8211;1553&#41; describes extracting a bulk stone from the bladder of a child younger than 5 years in the land of colonial Mexico&#46; This is the first description of a surgical procedure in America&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Biographical data were collected on Christopher Mendez&#46; The electronic facsimile of the <span class="elsevierStyleItalic">Book of exercise and profits</span> was read&#46; The historical aspects of perineal lithotomy and etiology of bladder stones were analyzed&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In chapter seven of the third treatise &#40;page 120&#41;&#44; Mendez speaks about the removal of a bladder stone in a boy named &#8220;Villase&#241;or&#8221;&#46; It uses the word &#8220;open&#8221; to describe the procedure&#44; corresponding to a lithotomy more than a necropsy&#46; It attributes the etiology of excess movements after ingestion and suggests a possible hereditary etiology&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Perineal lithotomy was a common practice in ancient times for children due to the high incidence of bladder stones&#46; The technique was very invasive and was improved over the centuries&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The surgery described by Mendez for the child called Villase&#241;or most likely corresponds to a perineal lithotomy&#46; A congenital cause could play a role in its etiology&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El m&#233;dico renacentista espa&#241;ol Crist&#243;bal M&#233;ndez &#40;1500&#8211;1553&#41; relata en su obra <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span> la extracci&#243;n de un grueso c&#225;lculo de la vejiga de un ni&#241;o menor de 5 a&#241;os en el M&#233;xico colonial&#44; siendo la primera descripci&#243;n de un procedimiento quir&#250;rgico en Am&#233;rica&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Recopilaci&#243;n de datos biogr&#225;ficos sobre Crist&#243;bal M&#233;ndez&#46; Lectura del facs&#237;mil electr&#243;nico del <span class="elsevierStyleItalic">Libro del exercicio y de sus provechos</span>&#46; An&#225;lisis de los aspectos hist&#243;ricos sobre la litotom&#237;a perineal y etiolog&#237;a de la litiasis vesical&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">En el cap&#237;tulo 7 del tercer tratado &#40;p&#225;gina 120&#41; M&#233;ndez narra la extracci&#243;n del c&#225;lculo vesical a un ni&#241;o llamado &#171;Villase&#241;or&#187;&#46; Emplea la palabra &#171;abrir&#187; para describir el procedimiento&#44; correspondiente a una litotom&#237;a m&#225;s que a una necropsia&#46; Atribuye la etiolog&#237;a al exceso de movimientos tras la ingesta y apunta una posible etiolog&#237;a hereditaria&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Discusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La litotom&#237;a perineal era una pr&#225;ctica habitual en ni&#241;os de la antig&#252;edad por la alta incidencia de litiasis vesical&#46; La t&#233;cnica era muy cruenta y fue mejorando a lo largo de siglos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La intervenci&#243;n descrita por M&#233;ndez al ni&#241;o Villase&#241;or corresponde con mayor probabilidad a una litotom&#237;a perineal&#46; En su etiolog&#237;a pudo intervenir una causa cong&#233;nita&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; S&#225;nchez-Mart&#237;n FM&#44; Hostalot AM&#44; Santillana JM&#44; Angerri O&#44; Mill&#225;n F&#44; Villavicencio H&#46; Extracci&#243;n de un c&#225;lculo vesical a un ni&#241;o seg&#250;n el relato del m&#233;dico renacentista Crist&#243;bal M&#233;ndez&#46; Actas Urol Esp&#46; 2014&#59;38&#58;476&#8211;482&#46;</p>"
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        "fuente" => "From the book by Francois Tolet &#40;o Tollet&#41;&#44; <span class="elsevierStyleItalic">Traite de la lithotomie&#44; ou de l&#8217;extraction de la pierre&#44; hors de la vessie&#46;</span> La Haya&#58; Marchand Libraires&#59; 1682&#46;"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos