Search for Neutrinoless Double-ß Decay in

The Majorana Collaboration is operating an array of high purity Ge detectors to search for neutrinoless double-ß decay in ^{76}Ge. The Majorana Demonstrator comprises 44.1 kg of Ge detectors (29.7 kg enriched in ^{76}Ge) split between two modules contained in a low background shield at the Sanford Underground Research Facility in Lead, South Dakota. Here we present results from data taken during construction, commissioning, and the start of full operations. We achieve unprecedented energy resolution of 2.5 keV FWHM at Q_{ßß} and a very low background with no observed candidate events in 9.95 kg yr of enriched Ge exposure, resulting in a lower limit on the half-life of 1.9×10^{25} yr (90% C.L.). This result constrains the effective Majorana neutrino mass to below 240-520 meV, depending on the matrix elements used. In our experimental configuration with the lowest background, the background is 4.0_{-2.5}^{+3.1} counts/(FWHM t yr).

[Anterior urethral valves and anterior urethral diverticulum, are they same entity?] / Válvulas de uretra anterior y divertículo de uretra anterior, ¿son la misma entidad?

OBJECTIVE: We present our experience in the diagnosis and management of anterior urethral valves (AUV) and anterior urethral diverticula (AUD) as well as review of the bibliography. MATERIALS AND METHODS: We retrospectively evaluated all the cases of the AUV and AUD treated in our hospital during the last 10 years. The clinical exploration, renal function study and renal and bladder ultrasound were evaluated in all the children. The diagnosis was completed with voiding cystography (VCUG) and cystoscopy as well as nuclear study in the relevant patients. RESULTS: Four patients have been treated in our center. AUV was suspected in those children with narrowing of the anterior urethra and thickened bladder with trabeculations at the VCUG. These findings were noticed in 50% of the patients, which also had a neonatal presentation. The diagnosis was confirmed by cystoscopy that allowed the endoscopic resection at the same procedure. The boys with AUD were managed by excision of the diverticulum with urethroplasty. On the follow up, one patient who had AUV, presented renal involvement in the nuclear scans with normal renal function. CONCLUSION: In our experience, the AUV and AUD behave as two different entities in terms of clinical presentation and treatment. The AUV have been effectively treated with endoscopic surgery and the AUD have pointed out open surgery, as described in the literature.

OBJETIVOS: Presentamos nuestra experiencia en el diagnóstico y manejo de los divertículos de uretra anterior (DUA) y de las válvulas de uretra anterior (VUA), junto con revisión de la bibliografía. MATERIAL Y METODOS: Se ha realizado un estudio retrospectivo de casos con DUA o VUA tratados en los últimos 10 años en nuestro servicio. En todos los casos se efectuó exploración física, estudio de función renal y ecografía renal. El diagnóstico se completó con cistografía miccional y cistoscopia, así como estudio nuclear, en los casos subsidiarios. RESULTADOS: Han sido diagnosticados 4 niños. Se sospechó la presencia de VUA en aquellos pacientes en los que se objetivó en la cistografía un cambio de calibre de la uretra anterior con imagen sugestiva de vejiga de lucha. Estos hallazgos, observados en la mitad de los casos, coincidieron con los niños con presentación neonatal. El diagnóstico se confirmó mediante cistoscopia, que permitió la resección endoscópica simultánea. Los pacientes con DUA fueron tratados quirúrgicamente mediante resección del divertículo y uretroplastia. Solo un caso, el cual presentaba VUA, ha tenido afectación renal en el estudio nuclear, sin repercusión en la filtración glomerular. CONCLUSIONES: En nuestra experiencia, las VUA y DUA se comportan como dos entidades diferentes en cuanto a clínica y necesidad de tratamiento. Las VUA han sido tratadas eficazmente con cirugía endoscópica y los DUA aislados han precisado de cirugía abierta, al igual que se describe en la literatura.

[Administration of water-soluble contrast for the treatment of adhesive intestinal occlusion]. / Administración de contraste hidrosoluble para el tratamiento de las oclusiones intestinales por adherencias.

OBJECTIVE: The water-soluble contrast has shown its effectiveness for the resolution of adhesive small bowel obstruction (SBO) in adults. The objective of this study is to compare the value of water-soluble contrast in children with SBO versus control group. METHODS: We conducted a case-control trial. Patients with a history of abdominal surgery and SBO diagnosed between 2008 and 2013 were included as controls. Conservative treatment or surgery depending on clinical evolution was performed in control group. The patients with SBO diagnosed from December 2012 were treated with water-soluble contrast. The main variable was the number of patients requiring surgery and the hospital stay and complications were the secondary variable. RESULTS: Twenty controls and 8 cases were admitted with SBO. Surgery was required in 50% of control group patients and 25% in the contrast group (p>0.05). The hospital stay length was 6 days in control group versus 4 days in study group (p>0.05). No complications were attributed to the use of water-soluble contrast and 20% of complications happened in control group. CONCLUSIONS: The need for surgery was lower in study group but not statically significant due to the small size of the sample. We concluded that water-soluble contrast is safe and effective in the management of SBO in children. We propose a multicentre study.

OBJETIVOS: El tránsito gastrointestinal con contraste hidrosoluble se utiliza desde hace años en el tratamiento de las obstrucciones intestinales por adherencias (OIA) en adultos. Nuestro objetivo es comparar un grupo de niños con OIA tratados con contraste hidrosoluble con un grupo control. MATERIAL Y METODOS: Realizamos un estudio de casos y controles que incluye pacientes con antecedentes de cirugía abdominal y OIA entre 2008 y 2013. Los controles fueron tratados de forma conservadora o cirugía según evolución y los casos admitidos como OIA a partir de diciembre de 2012 se les aplicó tratamiento con contraste hidrosoluble. La variable principal es la necesidad de cirugía y las variables secundarias, la estancia hospitalaria y las complicaciones. RESULTADOS: Se han recogido 20 controles y 8 casos. La necesidad de cirugía en el grupo control ha sido del 50% y del 25% en los casos tratados con contraste (p>0,05). La estancia hospitalaria en el grupo control ha sido de 6 días frente a 4 días en el grupo a estudio (p>0,05). Se han observado un 20% de complicaciones entre los controles y ninguna complicación en los casos. CONCLUSIONES: Aunque no hemos encontrado diferencias significativas debido al pequeño tamaño de la muestra, sí se ha observado una tendencia de menor necesidad de cirugía en los casos tratados con contraste hidrosoluble. Nuestra experiencia preliminar sugiere que el contraste hidrosoluble puede ser una alternativa eficaz y sin complicaciones en el tratamiento de la oclusión intestinal por adherencias en niños, por lo que proponemos la realización de un estudio multicéntrico para aumentar la muestra y poder definir conclusiones más certeras.

[Balanitis xerotica obliterans, underdiagnosed pathology of clinical relevance]. / Balanitis xerótica obliterante, patología infradiagnosticada de relevancia clínica.

OBJECTIVES: Balanitis xerotica obliterans (BXO) is a chronic inflamatory disease, a genital form of Lichen Sclerosus in males. MATERIAL AND METHODS: This retrospective and descriptive analysis was carried out by rewiew of the medical records of boys who underwent circumcision from April 2013 to April 2014. The study group consisted of boys that were circumcised due it persistant phimosis at 4 years of age, urinary symptoms or painful erection. The histopathological examination was performed only in patients with clinical suspicion of BXO. RESULTS: 339 patients were circumcised. The mean age of surgery was 6.5 years (Median 5, Mode 4). BXO was confirmed in eleven boys (3.9%) out of 16 biopsies (5.7%), with a mean age of 8.2 years (6-12). Of all the biopsies that were analysed for clinical BXO, 9 had scarring phimosis (2 meatal stenosis), 2 had balanitis and 1 had acute urinary retention, 2 presented descamative foreskin or glands, and 1 had recurrent phimosis. The histopathological examination revealed lichen sclerosus in 10 patients. Meatotomy was performed in 3 boys, one of them in during the follow-up period. 10 patients with BXO were treated with topical corticosteroid cream after circumcision. CONCLUSIONS: Our incidence is low in compared to literature (10-40%) as we did not refer the foreskin routinely to histopathological analysis. The clinical suspicion underestimates the incidence of BXO up to 49%. The circumcision is curative in most cases with BXO. The BXO may produce meatoestenosis and urethral abnormalities, and it is associated with a high incidence of penile carcinoma of the penis.

OBJETIVOS: La balanitis xerotica obliterante (BXO) es una enfermedad crónica inflamatoria, variante del liquen escleroso, que afecta a los genitales masculinos. Presentamos nuestra incidencia de BXO y una revisión de la literatura. MATERIAL Y METOODS: Estudio retrospectivo descriptivo de pacientes operados de circuncisión entre abril de 2013 y abril 2014 por fimosis persistente a los 4 años, clínica miccional o con la erección. Se enviaron muestras para estudio patológico de aquéllos con sospecha clínica de BXO. RESULTADOS: Se circuncidaron 339 pacientes. La edad media de intervención fue 6,5 años (Mediana 5 y Moda 4). Once casos (3,9%) fueron diagnosticados de BXO, con una edad media de 8,2 años (6-12 años). Se enviaron 16 muestras (5,7%) para análisis anatomopatológico (AP) por sospecha clínica de BXO, 9 presentaban fimosis cicatricial (2 con estenosis del meato uretral), 1 balanitis, 2 fimosis con prepucio o glande descamativo, 1 retención urinaria aguda por balanitis y 1 reestenosis prepucial. En 10 casos se confirmó liquen escleroátrofico, 2 inflamaciones crónicas, 1 patrón liquenoide y otro normal. Tres pacientes precisaron, además, meatotomía. Los pacientes con BXO fueron tratados con corticoides tópicos postcircuncisión en 10 casos. CONCLUSIONES: Nuestra incidencia es baja en relación a la literatura (10-40% según las series) ya que no remitimos a estudio AP el prepucio de forma rutinaria. La sospecha clínica subestima la incidencia real de BXO hasta en 49% según algunos autores. La circuncisión es curativa en la mayoría de los casos con BXO. La BXO además de producir estenosis del meato y alteraciones uretrales, está relacionado con una alta incidencia de carcinoma de pene.

Assessment of by-products from fresh-cut products for reuse as bioactive compounds.

The fresh-cut industry is constantly growing and generating wastes. The major challenge for this industry consists in an environmentally sustainable production through re-utilization of by-products, for instance, in extraction of bioactive compounds. In this paper, the nutritional and functional compounds of apple, potato, cucumber, melon and watermelon by-products were investigated. The amount of by-product produced was of 10.10 to 30.80% of initial fresh weight depending on the product. By-products were characterized by low protein (<20 g/kg fresh weight) and fatty acid content (<5 g/kg fresh weight) and high levels of minerals. Carbohydrates content ranged from 43.7 to 235 g/kg fresh weight, while total dietary fibre was between 20 and 150 g/kg fresh weight The content of antioxidants (53.6 to 3453.2 mg/kg fresh weight) and total polyphenols (124.5 to 4250.2 mg/kg fresh weight) depended strongly on the type of by-product. In most cases, the nutritional and bioactive content was higher in the peel than in whole product. Apple peel was rich in carbohydrates, total dietary fibre, antioxidants and total polyphenols. Potato peel was high in iron. Melon was rich in magnesium. Watermelon peel was characterized by the level of potassium, and cucumber peel was rich in manganese, zinc, phosphorous, calcium and sodium. All these data demonstrate than natural by-product from fresh-cut industry could potentially be utilized as ingredients to design new functional foods with a future market.

[Fertility survey of patients operated on of cryptorchidism in the pediatric age]. / Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica.

OBJECTIVES: To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. METHODS: A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. RESULTS: A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no significant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. CONCLUSIONS: There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw significant conclusions in regards to fertility and other clinical situations.

[Currarino triad: different forms of presentation]. / Triada de Currarino: sus diferentes formas de presentación.

BACKGROUND: We describe our experience in Currarino syndrome (CS) and our clinical findings. METHODS: Case 1: Newborn female with prenatal diagnosis of myelomeningocele which was confirmed at birth as a lipomyelomeningocele, associated with partial sacral agenesis, horseshoe kidney and complex anorectal malformation with colonic vascular anomaly. Case 2: A 14-month-old male with constipation. The physical examination detected an anal stricture and radiological findings of a presacral lipomeningocele plus teratoma and a partial sacral agenesis. Case 3: An 8-month-old male with recurrent meningitis associated with anterior sacral meningocele and rectal fistula. An anal stricture and hemisacrum were also demonstrated. RESULTS: In case 1, an abdomino-perineal pull-through was performed but it failed because of her colonic vascular anomaly. Nowadays she is 3 years old and has a cecostomy, controls her micturition and is able to walk. Case 2 is two years old with satisfactory flow-up-after the teratoma and meningocele removal plus anal dilation. In case 3 a colostomy was necessary because after mass excision a recto-cutaneous fistula appeared during postoperative period. A ventriculoperitoneal valve implantation due to his hydrocephaly was also performed. CONCLUSIONS: The constipation is the most common symptom in the CS. Recurrent meningitis has a high mortality rate (56%) due to rectomeningeal fistula. The most common anorectal malformation is the anal stricture, and the more complex the malformation is, higher will the risk of incontinence be. The success of the management and follow-up is a multidisciplinary responsability.

[The PEG: why wait?]. / La PEG: ¿Por qué esperar?

UNLABELLED: The swallowing disorder is an impediment to feed the patient. The percutaneous endoscopic gastrostomy (PEG) offers importants advantages over nasogastric tube feeding in patients who need long-term enteral nutrition with difficulty to swallow and to failure to thrive. METHODS: We have achieved 40 PEG in our department over the past 10 years. We registered date of the age, weight, indications, types of PEG, the time to first change, evolution of weight and percentiles and the complications. RESULTS: The average age of our patients was 5 years, 30% under 1 year. We used mostly tubes between 9 and 15 Fr and increasing the size according to nutritional needs. The average weight at the time of PEG placement was 13 kg. The main indications were the impossibility to swallow and failure to thrive and the principal diagnosis was the encephalopathy in 45% of cases. The surgical technique was successful in 100%. Of the complications, only two patients required surgery, a gastrocolic fistula and a laparotomy about broken tube of gastrostomy that has been caught in the cecum. In our series we reported 11 cases of mortality from causes unrelated to the gastrotmy. CONCLUSIONS: The PEG is a good alternative to nasogastric tube in patients with swallowing disorders or failure to thrive in chronic diseases, even in children under one year. The early placement of the PEG support the growth development in these patients with chronic disease who require enteral nutrition for long periods. Probably, the time of placement should be more precocious in chronic patients as well tolerated and may have a long life with a good care.

[Differential diagnosis of the interlabial masses in girls under 5-years-old]. / Diagnóstico diferencial de las masas interlabiales en niñas menores de 5 años.

UNLABELLED: The masses that we can be found at interlabial in a girl are a extensive spectrum of heterogenous lesions and often there is a confusion in diagnosis, management and prognosis. METHODS: We present 5 cases of interlabial masses, prolapsed urethra, two paraurethral Skene cysts, botryoid sarcoma and fibroepithelial polyp, and its clinical of debut. RESULTS: A prolapsed urethra is presented in a 4-year-old black girl with vaginal bleeding from edamatous periurethral mass. The paraurethral cyst is a yellowish cystic mass displacing the urethral meatus in two newborn girls. The fibroepithelial polyp is presented in a newborn girl as polipoid and wartlike tumor and not bleeding injury in the introitus. The botryoid sarcoma appears in a 1-year-old girl with ulcerated polypoid mass of 2 cm from vagina. All cases were treated with surgery except the paraurethral cyst that drained spontaneously and the rhabdomyosarcoma was also treated with chemotherapy. CONCLUSIONS: There must be a good clinical examinations about interlabial masses distinguishing genital or urological origin. The surgery is indicated mainly to reject malignancy because the presentation of sarcoma and polyp could be similar. The prognosis of rhabdomyosarcoma vaginal is good with surgery and chemotherapy. The prolapsed urethra is more common in prepubertal black girls and it is important to exclude sexual abuse. The management of paraurethral cyst is controversial but some authors are advised first observation because they may regress.

[Our experience in the poly-traumatized pediatric patient with criteria for admission to the ICU]. / Nuestra experiencia en el paciente politraumatizado pediátrico con criterios de ingreso en UCI.

OBJECTIVE: To present our experience with severe pediatric trauma. The pediatric trauma is the leading cause of death in children under 2 years. METHODS: We achieved a retrospective study from 78 pediatric patients admitted to the Intensive Care Unit (UCI) for multiple trauma between 2000 and 2008. Age, sex, season, location, mechanism, Glasgow and ITP, type of injuries, complications, days of hospitalization and deaths were reviewed. It was performed descriptive and analytical study using the SPSS 15.0 and chi square and Pearson correlation were applied. OUTCOMES: The mean age of patients was of 8.5 +/- 4.2 years with 70% boys. Most accidents occurred in summer (37%) and the most common site was the road (47%). There was 15% of mortality, which the 75% occurred in the first 24 hours. There is an association between abdominal trauma and type of mechanism (p < 0.05). The most common mechanism was the traffic accident (45%) followed by a direct hit. Both ITP as Glasgow score were associated significantly with mortality and complications and with the hospital stay in the UCI there was a weak association but significant and negative (p < 0.05). CONCLUSIONS: Mortality is higher than other series but it may be because that these series include minor injuries. The fall down is the most frequent in pediatric emergencies but it was the mechanism that involves less admission to the UCI. Both ITP as Glasgow score are good indicators of severity and if their values decrease, the hospital stay in UCI and the mortality increase.

[Our experience with the use of alpha-lithic therapy in the treatment of voiding dysfunction]. / Nuestra experiencia con el uso de alfa-líticos en el tratamiento de la disfunción de vaciado.

INTRODUCTION: Dysfunctional voiding (DV) is due to a dysfunction in the pelvis floor muscles caused by hyperactivity of the urethral sphincter and the musculature of this zone during the voiding phase of the micturition cycle. The treatments used are recommending correct micturition habits, biofeedback and pelvic relaxation exercises. Currently, drugs are also used, such as alpha lithic drugs and injection of botulinic toxin, however its experience in children is limited. OBJECTIVES: Show our experience with the use of alpha-lithics in patients with DV. MATERIAL AND METHODS: Review of patients with DV treated with alpha-lithics in our institution. RESULTS: 6 patients with DV were treated with alpha-lithics (Alfuzosin or Doxazosin). Girl (12 years) with Wolfram Syndrome with significant post-void residual urine, who initially rejected intermittent catéter. Residual urine decreases slightly with treatment, but isn't enough. Boy (7 years) with uretral duplicity and difficulty urine flow without observable stenosis. He had initial improvement but then required continent bladder diversión and vasectomy due to recurrent orchiepididymitis. Boy (5 years) with ureteral-bladder stenosis and ureteral reimplantation with urinary tract infection and vesico-ureteral reflux that did not improve (an anatomic obstruction was subsequently found). Boy (12 years) with tethered cord and pyelonephritis, who rejected intermittent catheter. He hadn't improvement and he required continent bladder diversión. Boy (7 years) with Syringomyelia, operated in another center for vesico-ureteral reflux with ureteral reimplantation, with recurrent urine infections, who hadn't improvement and required continent bladder diversion. Boy (10 years) with resected urethra valves and normal cystoscopy, with episodes of urine retention, without improvement with treatment. CONCLUSION: The role of alpha-lithics in the treatment of dysfunctional voiding in children is limited and of doubtful efficacy. It may be useful in patients with significant post-micturition residue.

[Proposal for a new microsurgical model for the study of induced endometriosis in Wistar rats. Preliminary results]. / Propuesta de un nuevo modelo microquirúrgico para el estudio de la endometriosis inducida en rata Wistar. Resultados preliminares.

The current knowledge status on the patogenesis of endometriosis as well as devastating consequences of disease evolution in women's reproductive health, have promoted researchers advances in a great manner during last years. The immunologic and neangiogenesis systems implication have opened new ways of knowledge over classic theories from the beginning of the xx century. The experimental resesearch, using animal induction models. Below we explain the first steps a new induction model ("PGR1-HotDog"), based on Wistar rats using a new disease autogeneration system, created for te study of the early stages of the endometriosis.

[Pancreatic pseudocyst: less is more]. / Pseudoquiste pancreático: cuando menos es más.

UNLABELLED: Pancreatic pseudocysts (PQP) are rare in childhood and management tends to be individualized and controversial, and it is a challenge for the pediatric surgeon. The aim of this study is to determine the best management strategies in each patient. MATERIAL AND METHODS: Retrospective review of children admitted to our institution with the diagnosis of PQP and review of literature between 1990 and 2007. RESULTS: We report two children with postraumatic PQP that respond to non-operative management and 284 cases that were reported in literature (76% after blunt abdominal trauma). 26% of these patients had complete resolution of PQP with conservative management and the others patients required surgical intervention: external percutaneous drainage (18.6%), non-percutanueous external drainage drenaje (3.87%), cystogastrostomy (28.87%), cystojejunostomy o pancreaticojejunostomy (9.5%), endoscopic drainage (9.5%) or distal pancreatectomy (3.5%). CONCLUSION: The choice of treatment depends on the surgeon's experience and management of the endoscopic techniques, as well as the availability of interventionist radiology. Asymptomatic PQP in children does no require any specific intervention other than expectant management, especially in patients with trauma-induced PQP. Children with persistent clinical symptoms or those who developed complications may require further intervention.

Alternative sanitizers to chlorine for use on fresh-cut "Galia" (Cucumis melo var. catalupensis) melon.

Chlorine is commonly used to reduce microbial load in fresh-cut vegetables. However, the production of chlorinated organic compounds, such as trihalomethanes, which are potential carcinogens, has created the need to investigate the efficiency of nontraditional sanitizers and alternative techniques. The effects of 4 novel sanitizers were tested in fresh-cut "Galia" melon: chlorine dioxide (ClO(2)) at 3 mg/L, peracetic acid (PAA) at 80 mg/L, hydrogen peroxide (H(2)O(2)) at 50 mg/L, and nisin at 250 mg/L plus EDTA 100 mg/L (nisin + EDTA). A chlorine treatment (NaOCl at 150 mg/L) was used as a control. Pieces of melon were packed in polypropylene trays under passive modified atmosphere (3 to 4 kPa of O(2) and 10 to 11 kPa of CO(2)) and stored up to 10 d at 5 degrees C. Microbial growth, firmness, respiration rate, gas composition, sensory evaluation, color, total soluble solids (TSS), and tritable acidity (TA) were evaluated at days 0, 7, and 10. The novel sanitizers PAA, H(2)O(2), and nisin + EDTA, in the studied concentrations, reduced the microbial growth to a more efficient range than chlorine and ClO(2). In addition, those sanitizers delayed softness, did not affect the respiration rate, SST, or AT. The sensorial parameters were kept above the upper limit of marketability and they did not impart an "off flavor." These sanitizers maintained quality and shelf life of fresh-cut Galia melon for 10 d of storage at 5 degrees C. Nevertheless, other concentrations, in particular for ClO(2,) could be tested to study an extended shelf life in melon pieces.

[Must we change the surgical treatment of gallstones?]. / Hay que cambiar el planteamiento quirúrgico en las litiasis biliares?

UNLABELLED: The incidence of gallstones in childhood is 0.15%-0.22%. Frequency has increased in recent years due to a real increase or to a better diagnosis by ultrasound. The aim of our study is determinate the best treatment for every patient. MATERIALS AND METHODS: A retrospective study of 71 children with cholelithiasis admitted to our hospital in the last 20 years. RESULTS: The male to female ratio was 43:28. Seventeen patients present predisposing factors that might be related to the formation of gallstones. This disease was a casual event in half the cases. In 24 patients the diagnosis was made during a study for inspecific abdominal pain and 14 children showed typical symptoms. Only one patient suffer from acute cholecystitis. In 21 cases we find a single stone and in the other cases there were a lot of stones. The gallstones disappeared spontaneously in two patients. Nine children received treatment with ursodeoxycholic acid, but this treatment was ineffective in 8 of them. 27 patients were operated: Six laparoscopic cholecystectomy, 9 open cholecystectomy, 9 cholecystolithotomy and 3 cholecystectomy with splenectomy. CONCLUSIONS: We recommend periodic checks with ultrasound and conservative management is suggested in asymptomatic children. Operative intervention is recommended for symptomatic patients. The surgical treatment of choice in our centre for patients with solitary gallstones and without inflammatory changes in the gallbladder is cholecystolithotomy. We didn't find reappearence of gallbladder after cholecystolithotomy. Laparoscopic cholecystectomy is the best treatment for children with non working gallbladder, "porcelain gallbladder" and in patients with haematologic disease and gallstones.

Quality changes of fresh-cut kohlrabi sticks under modified atmosphere packaging.

The aim of this study was to determine the effect of different gas compositions on quality attributes and shelf life of kohlrabi sticks stored in modified atmosphere up to 14 d at 0 degrees C. Two commercial films were tested: oriented polypropylene (OPP) and amide-polyethylene (amide-PE). As a control, a microperforated OPP film was used. In order to study the changes in metabolic activity by minimal processing, the respiration rate and ethylene production at 0 degrees C were monitored for both intact stems and sticks. Changes in color, chemical parameters, sugars and organic acid contents, and sensorial quality of kohlrabi sticks were evaluated. An initial ethylene production of sticks was 13-fold higher than that of intact stems; meanwhile CO(2) production was 2-fold higher. However after 4 d of storage, a similar respiration rate for stems and sticks was found. Also the ethylene production of sticks and stems was steady around 15 to 20 nL/kg(/)h after 10 d. Kohlrabi sticks showed a little change in chemical parameters and very low weight losses during cold storage. Sticks under an equilibrium atmosphere of 7 kPa O(2) and 9 kPa CO(2) at 0 degrees C reached by amide-PE kept an acceptable sensorial quality for 14 d.

Extending the shelf life of kohlrabi stems by modified atmosphere packaging.

Kohlrabi stems (without leaves) were stored under modified atmosphere packaging (MAP) for 60 d at 0 degrees C. An additional retail sale period of 3 d at 12 degrees C after each cold storage evaluation (30 and 60 d) was applied. Under high relative humidity (RH) and 0 degrees C, the stems showed low metabolic activity, as no changes in sugars and organic acids were found. From day 21 at 0 degrees C, air-stored stems showed a yellowing of stalks and later they fell down. This disorder severely affected the appearance of stems. A gas composition of 4.5 to 5.5 kPa O(2) plus 11 to 12 kPa CO(2) was reached using antimist oriented polypropylene plastic bags of 20-mum thicknesses. The stems in MAP conditions kept a high sensorial quality. It was enough for commercial purpose of 2 mo. The storage of kohlrabi stems in plastic bags, either MA or in perforated (control) packages, provided an additional protection reducing physical damage. The MAP conditions delayed the weight loss and development of bacterial soft and black rot, extending the shelf life of kohlrabi stems to 60 d at 0 degrees C plus 3 d at 12 degrees C. Stems are not chilling injury sensitive.

[Nutrients and energy intake assessment in the critically ill patient on enteral nutritional therapy]. / Valoración de la ingesta de nutrientes y energía en paciente crítico bajo terapia nutricional enteral.

INTRODUCTION AND OBJECTIVES: The critically ill patient is especially susceptible to malnutrition due to his/her hypermetabolic state that leads to an increase in the nutritional requirementes, which many times are not compensated with the administered enteral formulas. The assessment of nutritional intake is essential in this kind of patients to know to what level their energetic and nutritional requirements are fulfilled, improving and monitoring in the most individualized possible way to indicated clinical and nutritional therapu. METHODOLOGY: This is a retrospective study in which all patients admitted to the Intensive Care Unit of Virgen de las Nieves Hospital were studied from January to December of 2003, aged more than 18 years, and on enteral nutrition. A total of 90 patients (52 men and 38 women) were studied, 81% of which were older than 50 years, and 57% had hospital stays longer than 8 days, with a 21% mortality rate. Intake was assessed from time of admission and throughout the whole hospitalization period. Energetic requirements were calculated according to the modified Long's formula and micronutrients intakes were compared to existing general recommendations for the Spanish, European and American populations, and to vitaminic requirements in critically ill patients. RESULTS: Percentages of mean energy and nutrients intakes in relation to theoretical calculated requirements for both genders are presented in figure 1. Mean energy intake was 1,326 cal in men and 917 cal in women. With regards to micronutrients intake, the values found for proteins, falts, and carbohydrates were lower than 50% of the requirements for both genders. The percentage of adequacy as referred to requirements for vitamins and minerals intake is shown in figure 2. Reference recommendations used correspond to sufficient intakes to cover the healthy individual requirements, therefore, the values obtained in our study show and adequacy greater than 75%, with the exception of particular elements such as vitamin A and magnesium. However, by taking a look at figure 3, which shows the adequacy of vitamins intake at recommended does for sick patients, the intake is lower than 25% of the requirements in all cases, and these deficiencies significantly interfere with wound healing, the immune, cardiovascular and nervous systems, as well as with metabolism of the remaining macronutrients leading to an unbalanced situation of the antioxidant system, worsening the patient's clinical status. CONCLUSIONS: The present study confirms the need for monitoring individually the nutritional requirements in the critically ill patient and adapting recommendations to his/her metabolic changes, since currently these recommendations are not clearly defined for these situations. It is necessary to provide micronutrients doses closer to the patient's demands, so that the nutritional status and the balance of the antioxidant system may be preserved or improved, making the adopted clinical treatment more effective.

Microbial and sensory quality of commercial fresh processed red lettuce throughout the production chain and shelf life.

Red pigmented 'Lollo Rosso' lettuce was processed under usual and controlled conditions in an industrial plant. At different steps of the production chain (reception, shredding, washing, draining, rinsing, centrifugation, and packaging), microbial counts were evaluated. Following industrial practices, processed lettuce was packaged at 5 degrees C in sealed polypropylene (PP) bags with an initial atmosphere containing 3 kPa O(2) and 5 kPa CO(2). The numbers of psychrotrophic bacteria, coliform and lactic acid bacteria (LAB) were influenced by all the studied steps of the production chain of the fresh processed 'Lollo Rosso' lettuce. Shredding, rinsing and centrifugation in particular increased bacterial counts. During a storage period of 7 days at 5 degrees C, sensory attributes (general appearance, texture, aroma, translucency, initial and persistent off-odors, leaves superficial browning, leaves edges browning, and decay) as well as microbial counts (psychrotrophic and mesophilic bacteria, coliforms and lactic acid bacteria) were monitored. Due to high microbial counts and off-odors evaluation, a shelf life shorter than 7 days should be considered for fresh processed 'Lollo Rosso' lettuce.