Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia. / Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago.

OBJECTIVE: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. MATERIALS AND METHODS: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. RESULTS: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). CONCLUSION: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

OBJETIVOS: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. RESULTADOS: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7; p = 0,1). CONCLUSION: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.

Influencing variables on total and free 25(OH)D levels in healthy population.

INTRODUCTION: Vitamin D plays a fundamental role in calcium homeostasis and bone metabolism. It mainly comes from cutaneous synthesis through the action of sunlight. Therefore, variations in exposure to this radiation modify serum levels. We studied two different analytes of vitamin D in the healthy Spanish population and the influence of seasonality, climate, and latitude on its levels. METHODS: This work is a cross-sectional, descriptive study. A total of 206 blood donors from Burgos and Valencia between 18-60 years of age were recruited during March-April and October-November 2018. Total and free serum 25-hydroxycholecalciferol (25(OH)D) were analyzed. RESULTS: After summer, total and free serum 25(OH)D medium levels were 24.31 ±â€¯5.25 ng/mL and 5.01 ±â€¯1.25 pg/mL in Burgos and 25.99 ±â€¯6.87 ng/mL and 8.97 ±â€¯2.82 pg/mL in Valencia. After winter, they were 17.66 ±â€¯5.04 ng/mL and 4.08 ±â€¯0.66 ng/mL in Burgos and 21.38 ±â€¯3.77 ng/mL and 7.23 ±â€¯2.44 ng/mL in Valencia. The seasonal changes were statistically significant for both components studied both in the sample as a whole and in the separate populations. The differences found between the two populations in total and free 25(OH)D levels were statistically significant except for total 25(OH)D after summer (24.07 ng/mL vs. 26.03 ng/mL; p = .408). Latitude was also shown to be a factor that influences concentrations of both analytes in summer and winter. CONCLUSIONS: Our study shows lower vitamin D levels than expected for a healthy Spanish population. Seasonality, climate, and latitude were demonstrated to influence total and free 25(OH)D levels.

Future care for long-term cancer survivors: towards a new model.

PURPOSE: The increase in the prevalence "long-term cancer survivor" (LCS) patients is expected to increase the cost of LCS care. The aim of this study was to obtain information that would allow to optimise the current model of health management in Spain to adapt it to one of efficient LCS patient care. METHODS: This qualitative study was carried out using Delphi methodology. An advisory committee defined the criteria for participation, select the panel of experts, prepare the questionnaire, interpret the results and draft the final report. RESULTS: 232 people took part in the study (48 oncologists). Absolute consensus was reached in three of the proposed sections: oncological epidemiology, training of health professionals and ICT functions. CONCLUSION: The role of primary care in the clinical management of LCS patients needs to be upgraded, coordination with the oncologist and hospital care is essential. The funding model needs to be adapted to determine the funding conditions for new drugs and technologies.

[Applicability of a clinical score in patients with suspected foreign body aspiration]. / Aplicabilidad de un score clínico en pacientes con sospecha de aspiración de cuerpo extraño.

OBJECTIVE: To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS: Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS: Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS: The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.

OBJETIVOS: Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). RESULTADOS: Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. CONCLUSIONES: El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas.

Selective Indication of T-Tube in Liver Transplantation: Prospective Validation of the Results of a Randomized Controlled Trial.

BACKGROUND AND AIMS: T-tube placement during choledochocholedochostomy (CCS) associated with liver transplantation (LT) remains controversial. This study was designed to validate the results of an earlier prospective randomized controlled trial (RCT) on use versus nonuse of the T-tube during CCS associated with LT. METHODS: Prospective cohort study. The primary outcome was the overall incidence of biliary complications (BCs). RESULTS: In total, 405 patients were included, and the median overall monitoring period was 29 months (interquartile range: 13-47 months). Selective use of the T-tube reduced BCs (23% vs 13%; P = .003), of which 75% were type IIIa or less in the Clavien-Dindo classification. The overall BC rate did not differ between patients with versus without T-tube placement. CONCLUSIONS: We confirmed that selective use of a rubber T-tube during CCS associated with LT, following the principles established in our prospective RCT, reduced the rate of BC by 10% without detriment, even after enrolling patients at an a priori greater risk of BCs than were the RCT patients.

[Splenectomy in hemolitic disorders. Influence of Gilbert's disease in the occurrence of biliary complications]. / Esplenectomía en enfermedades hemolíticas. Influencia de la enfermedad de Gilbert en la aparición de complicaciones biliares.

INTRODUCTION: In patients with hemolytic disorders (HD) splenectomy is recommended between 6-12 years. A higher risk of biliary complications (BC) has been described in those with associated Gilbert's disease (GD), but the ideal surgical age has not been stablished yet. Our aim is to quantify the risk of BC in patients with HD and GD to assess the benefit of early splenectomy. MATERIAL AND METHODS: Retrospective study of splenectomies performed in patients with HD between 2000-2017. The incidence of BC, its clinical consequences (admission or invasive treatment) and time of onset were analyzed. Two groups were considered: patients with GD and without GD. Survival curves were obtained and compared with log-rank test. RESULTS: Fourty-four patients underwent splenectomy, 15 of them (34.1%) with HD+GD. The median age at surgery was 10.3 years (range 5.4-14.8). Twenty-nine (65.9%) had BC. Half of the patients with GD had BC before 8 years vs. 10,5 years in the cases without GD (log-rank 3.9, p= 0.05). Patients with GD had more BC (86.7% vs. 55.2%; Chi2= 4.37, p= 0.037). In the HD+GD group, 8 cases (53%) required admission vs.8 patients (31%) in the group HD without GD (Chi2= 2, p= 0.1). Invasive treatment was performed in 2 patients (13%) in the HD+GD group and 2 others (7.6%) in the group HD without GD (Chi2= 0.3, p= 0.6). CONCLUSIONS: In our series, the BC incidence was higher in patients with HD and GD. There was a trend towards an earlier presentation of BC in this group, but neither this data nor its clinical consequences allow us to recommend early splenectomy.

INTRODUCCION: En pacientes con enfermedades hemolíticas (EH) se recomienda esplenectomía entre 6-12 años. En aquellos con enfermedad de Gilbert (EG) asociada se ha descrito mayor riesgo de complicaciones biliares (CB), sin establecerse edad quirúrgica óptima. Nuestro objetivo es cuantificar el riesgo de CB en pacientes con EH y EG para valorar el beneficio de esplenectomía temprana. MATERIAL Y METODOS: Estudio retrospectivo de las esplenectomías realizadas en pacientes con EH entre 2000-2017. Se analizó la incidencia de CB, su repercusión clínica (ingreso o tratamiento invasivo) y momento de aparición. Se consideraron dos grupos: pacientes con EG y sin EG. Se obtuvieron curvas de supervivencia y se compararon mediante log-rank test. RESULTADOS: Se realizaron 44 esplenectomías, 15 de ellas (34,1%) en pacientes con EH+EG. La edad mediana en la cirugía fue 10,3 años (rango 5,4-14,8). Veintinueve (65,9%) presentaron CB. El 50% de los pacientes con EG las presentaron antes de los 8 años vs.10,5 años en los casos sin EG (log-rank 3,9; p= 0,05). Los pacientes con EG presentaron más CB (86,7% vs. 55,2%; Chi2= 4,37, p= 0,037). En el grupo EH+EG, 8 casos (53%) necesitaron ingreso vs. 8 (31%) en el grupo sin EG (Chi2= 2, p= 0,1). El tratamiento invasivo fue necesario en 2 pacientes (13%) del grupo EH+EG y 2 pacientes (7,6%) del grupo sin EG (Chi2= 0,3, p= 0,6). CONCLUSIONES: En nuestra serie, la incidencia de CB fue superior en los pacientes con EG. Existió una tendencia a la presentación más temprana de CB en este grupo, pero ni este dato ni su repercusión clínica nos permiten recomendar la esplenectomía temprana.

Influence of altitude and enhanced ultraviolet-B radiation on tuber production, seed viability, leaf pigments and morphology in the wild potato species Solanum kurtzianum Bitter & Wittm collected from an elevational gradient.

Climate change could lead to an upward shift in plant distribution, exposing populations to higher levels of ultraviolet (UV)-B radiation. In the framework of an in situ strategy for conserving potato wild relatives, we evaluated the effect of high UV-B levels on natural population of Solanum kurtzianum. The hypothesis is that plants from naturally higher altitudes are more adapted to increased UV-B radiation. Two populations from low and high altitudes were field supplemented using UV-B-lamps (+UV-B) or excluded from it with plastic filters. Additionally, to assess in which extent the plant responses to these artificial experimental conditions are reproducible in natural conditions, three genotypes were cultivated in two mountain experimental gardens (EG) at different elevations. +UV-B treatment induced changes in leaf morphology and increases in phenolic compounds in both populations, indicating plant adaptation, since chlorophylls and reproductive structures were not negatively affected. These results indicate that this environmental factor may not limit the displacement of populations towards sites with higher UV-B levels. Meanwhile, in higher-altitude EG a tubers yield reduction, mainly through a decreased tuber number and a bigger accumulation of phenolic compounds than in +UV-B treatment were observed, suggesting that UV-B is not the only factor involved in plants adaptation to high altitude environments.

Interdependency of the maximum range of flexion-extension of hand metacarpophalangeal joints.

Mobility of the fingers metacarpophalangeal (MCP) joints depends on the posture of the adjacent ones. Current Biomechanical hand models consider fixed ranges of movement at joints, regardless of the posture, thus allowing for non-realistic postures, generating wrong results in reach studies and forward dynamic analyses. This study provides data for more realistic hand models. The maximum voluntary extension (MVE) and flexion (MVF) of different combinations of MCP joints were measured covering their range of motion. Dependency of the MVF and MVE on the posture of the adjacent MCP joints was confirmed and mathematical models obtained through regression analyses (RMSE 7.7°).

Using kinematic reduction for studying grasping postures. An application to power and precision grasp of cylinders.

The kinematic analysis of human grasping is challenging because of the high number of degrees of freedom involved. The use of principal component and factorial analyses is proposed in the present study to reduce the hand kinematics dimensionality in the analysis of posture for ergonomic purposes, allowing for a comprehensive study without losing accuracy while also enabling velocity and acceleration analyses to be performed. A laboratory study was designed to analyse the effect of weight and diameter in the grasping posture for cylinders. This study measured the hand posture from six subjects when transporting cylinders of different weights and diameters with precision and power grasps. The hand posture was measured using a Vicon(®) motion-tracking system, and the principal component analysis was applied to reduce the kinematics dimensionality. Different ANOVAs were performed on the reduced kinematic variables to check the effect of weight and diameter of the cylinders, as well as that of the subject. The results show that the original twenty-three degrees of freedom of the hand were reduced to five, which were identified as digit arching, closeness, palmar arching, finger adduction and thumb opposition. Both cylinder diameter and weight significantly affected the precision grasping posture: diameter affects closeness, palmar arching and opposition, while weight affects digit arching, palmar arching and closeness. The power-grasping posture was mainly affected by the cylinder diameter, through digit arching, closeness and opposition. The grasping posture was largely affected by the subject factor and this effect couldn't be attributed only to hand size. In conclusion, this kinematic reduction allowed identifying the effect of the diameter and weight of the cylinders in a comprehensive way, being diameter more important than weight.

A New Surgical Model of Skeletal Muscle Injuries in Rats Reproduces Human Sports Lesions.

Skeletal muscle injuries are the most common sports-related injuries in sports medicine. In this work, we have generated a new surgically-induced skeletal muscle injury in rats, by using a biopsy needle, which could be easily reproduced and highly mimics skeletal muscle lesions detected in human athletes. By means of histology, immunofluorescence and MRI imaging, we corroborated that our model reproduced the necrosis, inflammation and regeneration processes observed in dystrophic mdx-mice, a model of spontaneous muscle injury, and realistically mimicked the muscle lesions observed in professional athletes. Surgically-injured rat skeletal muscles demonstrated the longitudinal process of muscle regeneration and fibrogenesis as stated by Myosin Heavy Chain developmental (MHCd) and collagen-I protein expression. MRI imaging analysis demonstrated that our muscle injury model reproduces the grade I-II type lesions detected in professional soccer players, including edema around the central tendon and the typically high signal feather shape along muscle fibers. A significant reduction of 30% in maximum tetanus force was also registered after 2 weeks of muscle injury. This new model represents an excellent approach to the study of the mechanisms of muscle injury and repair, and could open new avenues for developing innovative therapeutic approaches to skeletal muscle regeneration in sports medicine.

Evaluación de presencia y severidad de periodontitis en pacientes chilenos con artritis reumatoide atendidos en el Hospital Padre Hurtado / Frequency and severity of periodontitis among patients with rheumatoid arthritis

Background: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. Aim: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. Patients and Methods: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). Results: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. Conclusions: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.

[Pneumomediastinum and cutaneous necrosis in dermatomyositis: Report of one case]. / Neumomediastino y necrosis cutánea en asociación a dermatomiositis: presentación de un caso clínico y revisión de la literatura.

We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

Neumomediastino y necrosis cutánea en asociación a dermatomiositis: presentación de un caso clínico y revisión de la literatura / Pneumomediastinum and cutaneous necrosis in dermatomyositis: Report of one case

We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.

[Frequency and severity of periodontitis among patients with rheumatoid arthritis]. / Evaluación de presencia y severidad de periodontitis en pacientes chilenos con artritis reumatoide atendidos en el Hospital Padre Hurtado.

BACKGROUND: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. AIM: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. PATIENTS AND METHODS: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). RESULTS: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. CONCLUSIONS: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.

An introductory study of common grasps used by adults during performance of activities of daily living.

This paper presents the results of a descriptive survey on human grasps. Sixty-four videos were selected to represent tasks performed in the main areas of activities of daily living (ADL) (personal care, meal preparation, eating, housekeeping, etc.). All the participants were right-handed. Elementary grasps were identified for each hand, and the grasp type (from a 9-type classification), the hands involved, and the duration were registered for each case. The results show that the most commonly used grasps are: pinch, non-prehensile, cylindrical, lateral pinch and lumbrical. The presence of these grasps in the areas of ADL is, however, very different (e.g., pinch is widely used in food preparation and very little in driving). Some grasps were used more frequently with one hand or when both hands were used simultaneously (e.g., special pinch was hardly used by the left hand). Knowing the grasp types most frequently used in ADL is essential to be able to assess grasp rehabilitation processes or hand prostheses development.

Paediatric and adolescent traumatic gastrointestinal injuries: results of a European multicentre analysis.

AIM: Paediatric gastrointestinal injuries (GIIs) are rare, and the aim of this multicentre study was to evaluate their outcomes in a large cohort. METHODS: Hospital databases of 10 European paediatric surgical centres were reviewed for paediatric traumatic GIIs managed between 2000-2010. RESULTS: Ninety-seven patients with a median age of 9 years (0-17 years) were identified, with 72 blunt and 25 penetrating GIIs. Initial diagnostics in 90 patients led to correct diagnosis in 71%. Diagnostics were delayed in 26 patients (median 24 h). Eighty-two patients required surgery (67 laparotomy, 12 laparoscopy and three other approaches). There was a 50% conversion in the laparoscopic group. Median hospital stay was 10 days (range 1-137 days), with longer duration influenced by associated injuries (n = 41). Diagnosis <24 h was associated with significantly shorter hospital stay compared to more than 24 h (p = 0.011). In one-third of patients, morbidities were not related to a diagnostic delay or type of injury. There were five lethal outcomes, four due to associated injuries. CONCLUSION: Initial diagnostics in traumatic paediatric GIIs provide false negatives in one-third of patients. Diagnostic delay <24 h is associated with a significantly shorter hospital stay. Although laparoscopy is associated with a conversion rate of 50%, it can be used for diagnosis in suspected cases to avoid nontherapeutic laparotomy.

[Liver cell therapy in the treatment of inborn errors of metabolism in children]. / Terapia celular hepática en el tratamiento de las metabolopatías congénitas en niños.

Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant. The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient. This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation. The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

[Robotic surgery: first pediatric series in Spain]. / Cirugía robótica: primera serie pediátrica en España.

OBJECTIVES: Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to robotic laparoscopy. METHODS: Retrospective review of all the pediatric laparoscopic surgery assisted by the da Vinci robot (Intuitive Surgical), in our center, between April 2009 and February 2010. RESULTS: 8 patients were operated (7-15 years), with an average weight of 42 Kg (18 to 83 Kg). 11 procedures were performed: bilateral salpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4), splenectomy (2), resection of pancreatic mass (1), fundoplication (1), adrenalectomy (1). All proceedings, except two, were completed with the robot. As complications, there was one intraoperative bleeding that required blood transfusion, and in the postoperative period, there was a surgical wound infection. There were no conversions to open surgery. The average time of preparation before surgery was 130 minutes. The three-dimensional vision and lack of tremor are the main advantages cited by all surgeons. CONCLUSIONS: The learning curve of Robotic Surgery is shorter than that of conventional laparoscopy. Trained surgeons can perform complex procedures laparoscopically from the outset. The main difficulty in children is the proper planning of trocar placement, due to the smaller size of the surgical field. The organization of surgery is complex and success depends on close collaboration of all stakeholders.