Treatment of thyroglossal cyst using Koempel's technique: initial experience. / Tratamiento del quiste tirogloso mediante técnica de Koempel. Experiencia inicial.

INTRODUCTION: In spite of being inaccurate in terms of suprahyoid dissection, Sistrunk's procedure is the gold-standard technique in the treatment of thyroglossal cyst. Since it was first described in 2014, the modifications introduced by Koempel have allowed for a more reproducible suprahyoid approach. We present our initial experience with this technique. METHODS: A retrospective study of patients with thyroglossal cyst undergoing Koempel's technique in our institution from 2021 to 2022 was carried out. Demographic, clinical, and histological data was collected. RESULTS: In the study period, 5 patients -3 girls and 2 boys- underwent surgery. Median age and weight were 5 years (2-6) and 16 kg (14-25), respectively. All patients had suffered from previous infections, with 60% having cutaneous fistulization. In 2 patients, surgery was indicated following Sistrunk's procedure as a result of recurrence. Median operating time was 77 minutes (57-110), with the genioglossal muscle plane being identified in the 5 patients. No immediate complications were recorded, and diagnosis of thyroglossal cyst was histologically confirmed in all cases. One of the formerly recurrent patients had recurrence following surgery, but it was subclinical and incidentally diagnosed at control ultrasonography. The remaining patients had no recurrences after a median 8-month (1-12) follow-up period. CONCLUSIONS: Koempel's technique allows for a safe and reproducible approach of the suprahyoid segment. It is an attractive option in complicated cases as a result of previous infection or recurrence.

INTRODUCCION: La intervención de Sistrunk es el gold-standard en el tratamiento del quiste tirogloso pese a su imprecisión en cuanto a la disección suprahioidea. Tras su descripción en 2014, las modificaciones introducidas por Koempel, han permitido un abordaje suprahioideo más reproducible. Presentamos nuestra experiencia inicial con esta técnica. METODOS: Estudio retrospectivo de los pacientes con quiste tirogloso intervenidos mediante técnica de Koempel en nuestro centro en el periodo 2021-2022, recogiéndose datos demográficos, clínicos e histológicos. RESULTADOS: Durante el periodo de estudio se intervinieron 5 pacientes (3 mujeres/2 varones), con una mediana de edad y peso de 5 años (2-6) y 16 kg (14-25) respectivamente. Todos los casos habían sufrido infecciones previas presentando fistulización cutánea el 60%. En 2 de los pacientes se indicó la cirugía por recidiva tras intervención de Sistrunk. La mediana del tiempo quirúrgico fue de 77minutos (57-110) identificándose el plano del músculo geniogloso en los 5 pacientes. No hubo complicaciones inmediatas y el diagnóstico de quiste tirogloso se confirmó histológicamente en todos los casos. Uno de los pacientes del grupo con recidiva previa, presentó recidiva tras la intervención, siendo esta subclínica y diagnosticada incidentalmente tras ecografía de control. El resto de los pacientes no presentó ninguna recurrencia tras un seguimiento mediana de 8 meses (1-12). CONCLUSIONES: La técnica de Koempel permite un abordaje seguro y reproducible del segmento suprahioideo siendo una opción atractiva en casos complicados por infección o recidiva previa.

Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in Pediatrics. / Colecistectomía laparoscópica urgente por colecistitis aguda litiásica en Pediatría.

INTRODUCTION: In spite of the increase in the prevalence of cholelithiasis in the last decades, no recommendations regarding the best treatment of acute calculous cholecystitis (AC) in Pediatrics have been developed. CLINICAL CASE: 4-year-old, 20kg male patient with no significant history referred to our institution as a result of abdominal sepsis. The blood count showed leukocytosis, with normal hemoglobin and bilirubin levels, and a normal liver function. The abdominal ultrasonography revealed cholelithiasis, gallbladder hydrops, and an inflammatory process compatible with appendicular plastron. In the diagnostic laparoscopy, the appendix was macroscopically normal, and acute cholecystitis was observed. Given the patient's situation, and in cooperation with the General Surgery Department, laparoscopic cholecystectomy was carried out. The patient recovered uneventfully on hospitalization day 5 under piperacillin-tazobactam treatment. DISCUSSION: There are no recommendations regarding AC treatment in children. In septic patients, cooperation between general and pediatric surgeons allows urgent cholecystectomy to be considered as a safe option.

INTRODUCCION: Pese al aumento en la prevalencia de colelitiasis durante las últimas décadas, no se han desarrollado recomendaciones sobre el mejor tratamiento de la colecistitis aguda litiásica (CA) en Pediatría. CASO CLINICO: Paciente varón de 4 años y 20 kg de peso sin antecedentes de interés, que acude derivado por sepsis de origen abdominal. Analíticamente destaca leucocitosis con hemoglobina, función hepática y bilirrubina normales. La ecografía abdominal muestra colelitiasis, hidrops vesicular y proceso inflamatorio compatible con plastrón apendicular. En laparoscopia diagnóstica se observa apéndice macroscópicamente normal y colecistitis aguda. Ante la situación del paciente se realiza, conjuntamente con Cirugía General, colecistectomía laparoscópica. El paciente se recupera sin incidencias tras 5 días de ingreso bajo cobertura con piperacilina-tazobactam. COMENTARIOS: No existen recomendaciones sobre el tratamiento de la CA en niños. En los pacientes sépticos, la colaboración entre cirujanos pediátricos y cirujanos generales permite contemplar la colecistectomía urgente como una opción segura.

Global cardiovascular risk, COVID-19 severity and post-COVID-19 syndrome: a clinical study.

OBJECTIVE: Post-COVID-19 is a syndrome defined by signs and symptoms present until 12 weeks after COVID-19, lasting for more than 8 weeks, not explained by an alternative diagnosis. The present study aimed to assess whether the cardiovascular risk (CVR) of patients with COVID-19 correlates with symptoms and changes in respiratory function parameters in post-COVID-19. The association between CVR and the severity of acute disease was also considered. PATIENTS AND METHODS: Between 21/04/21-01/09/21, we enrolled 1,782 consecutive patients with COVID-19. We divided these subjects into (i) 4 levels, based on the severity of COVID-19 (home care; hospitalized/no oxygen therapy; hospitalized/oxygen therapy; hospitalized/NIV-ICU), (ii) 2 levels, according to CVR calculated with the European Society of Cardiology SCORE tables (low-intermediate risk; high or very high risk). All subjects underwent a 3-month follow-up considering post-COVID-19 symptoms. RESULTS: In post-COVID-19 patients, high or very-high CVR was associated with (i) increased risk of hospitalization for COVID-19 (p<0.0001), (ii) higher prevalence of severe clinical manifestations and ICU admission (p<0.0001), (iii) development of post-COVID-19 (p<0.0001) and (iv) increased risk of a larger post-COVID-19 burden of disease. CONCLUSIONS: We found a statistically significant association between CVR, severity of COVID-19, and post-COVID-19 syndrome three months after the end of acute disease.

Management of splenic and/or hepatic pseudoaneurysm following abdominal trauma in pediatric patients. / Manejo del pseudoaneurisma esplénico y/o hepático después de un traumatismo abdominal en pediatría.

INTRODUCTION: Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA. MATERIAL AND METHODS: A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed. RESULTS: A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6). CONCLUSION: Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.

INTRODUCCION: Los pseudoaneurismas (PA) esplénicos y hepáticos son lesiones arteriovenosas raras que se pueden desarrollar tras un traumatismo abdominal. La rotura tardía es su complicación más frecuente que puede conducir a inestabilidad hemodinámica. El objetivo del presente es presentar nuestra experiencia en el manejo de los PA viscerales. METODOLOGIA: Estudio retrospectivo en pacientes menores de 15 años con traumatismo abdominal cerrado con lesión esplénica y/o hepática, entre 2012-2020. Se analizó el desarrollo de PA y el manejo realizado. En todos los pacientes se realizó tomografía computarizada estableciendo el grado del traumatismo, y estudio control en la primera semana postratumatismo mediante ecografía con contraste (CEUS). Si se confirmaba un PA se procedió a angiograma ± embolización percutánea. RESULTADOS: Un total de 32 pacientes con traumatismo cerrado, edad media 8,7 ± 3,2 años (2-15 años), 68,7% (n = 22) hombres y mediana de grado de traumatismo grado III (grado II-IV), 33,3% (n = 5/15) desarrollaron un PA esplénico y 5,8% (n = 1/17) desarrollaron un PA hepático con tiempo diagnóstico medio de 3,7 ± 3 (3-8) días. El desarrollo de PA se asoció a mayor puntuación en el índice de severidad con una diferencia de medias de 15,6 ± 5,3 (CI 95% 4,37:26,14 p < 0,008). Todos los PA se trataron mediante embolización un 85,7% (n = 5/6) excepto una esplenectomía urgente. CONCLUSION: Los PA viscerales están infradiagnosticados, con una incidencia mayor a la reportada. Consideramos que un estudio de imagen (CEUS) debe ser realizado previo al alta en los traumatismos severos. El tratamiento sigue siendo controversial: sin embargo, recomendamos la embolización percutánea reservando la esplenectomía para paciente inestables.

Initial experience with 3D printing in the use of customized Nuss bars in pectus excavatum surgery. / Experiencia inicial en la impresión 3D para el uso de barras de Nuss personalizadas en la cirugía del pectus excavatum.

INTRODUCTION: Pectus excavatum (PE) surgical repair according to Nuss procedure is based on the intrathoracic insertion of one (or more) metallic bars for anatomical defect repair. Number of bars, bar length, bar shape, and thoracic insertion site are established during surgery, according to patient morphology, CT-scan, and especially the surgeon's experience. OBJECTIVE: To assess the usefulness of the design, simulation, and 3D printing of customized Nuss bars for each patient. MATERIAL AND METHODS: A prospective descriptive study of all patients undergoing PE surgery under 3D printing from June to December 2019 was carried out. Curvature, bar length, and optimal intercostal space were designed based on diagnostic CT-scan, and they were 3D printed full size. The resulting model was reproduced preoperatively on the usual prosthetic material, sterilized, and kept until surgery. RESULTS: The study cohort consisted of 6 patients. Median age was 15 years old (interquartile range: 14.25-15.25), median Haller index was 4.05 (interquartile range: 3.5-4.49), and repair index was 36.98% (interquartile range: 33.86-38.48%). A Nuss bar was introduced in all cases, without requiring removal or re-insertion. Median operating time was 79.5 minutes (interquartile range: 72.5-103). No postoperative complications were noted during follow-up (12 months). CONCLUSIONS: The preoperative design of Nuss bars with customized shape and size facilitates surgical planning. It also allows for the most optimal and accurate morphological repair possible, according to patient anatomy, thus reducing the risk of requiring removal and/or re-insertion, and therefore, of surgical complications.

INTRODUCCION: La corrección quirúrgica del pectus excavatum (PE) con técnica de Nuss, se basa en la inserción intratorácica de una (o más) barras metálicas para la corrección del defecto anatómico. El número de barras, su longitud, forma y punto de inserción torácico, se deciden durante la cirugía, según la morfología del paciente, el TC y, fundamentalmente, la experiencia del cirujano. OBJETIVO: Evaluar la utilidad del diseño, simulación e impresión 3D de barras de Nuss personalizadas para cada paciente. MATERIAL Y METODOS: Estudio descriptivo prospectivo, incluyendo a todos los pacientes intervenidos de PE bajo impresión 3D entre junio-diciembre 2019. Se diseñó la curvatura, longitud de la barra y espacio intercostal óptimo, en base al TC diagnóstico, y se imprimió en 3D en tamaño real. El modelo resultante se reprodujo prequirúrgicamente sobre material protésico habitual, se esterilizó y se reservó hasta la cirugía. RESULTADOS: Se recogieron 6 pacientes, mediana de edad 15 años (rango intercuartil 14,25-15,25 años). Mediana del Índice de Haller 4,05 (rango intercuartil 3,5-4,49) e índice de corrección 36,98% (rango intercuartil 33,86-38,48%). Se introdujo una barra de Nuss en todos los casos, sin precisar retirada ni reinserción. Mediana del tiempo quirúrgico 79,5 minutos (rango intercuartil 72,5-103 min). Ninguna complicación postquirúrgica durante el seguimiento (12 meses). CONCLUSIONES: El diseño prequirúrgico de la barra de Nuss, mediante forma y tamaño personalizados, facilita la planificación del procedimiento. A su vez, permite conseguir la corrección morfológica más óptima y precisa posible, según la anatomía del paciente, disminuyendo el riesgo de precisar retirada y/o reinserción de la barra, y por ende de complicaciones quirúrgicas.

Arterial tortuosity syndrome: relevance in pediatric surgery. A case report. / El síndrome de tortuosidad arterial y su relevancia en cirugía pediátrica. A propósito de un caso.

INTRODUCTION: Arterial tortuosity syndrome (ATS) is an extremely rare autosomal recessive disorder of the connective tissue. It is characterized by tortuosity and elongation of medium and large arteries, with multiple disorders associated with the widespread involvement of the connective tissue. CASE REPORT: Newborn diagnosed with ATS, with multiple vascular malformations, hiatal hernia, and bilateral inguinal hernia. He underwent surgery at three months of age. The hiatal hernia was closed, and bilateral inguinal hernia repair was performed. The inguinal hernias required up to 4 surgeries as a result of recurrences.During follow-up, the patient had retrocardiac diaphragmatic hernia. It was operated on, with subsequent incisional hernia. 8 years later, he was admitted as a result of septic shock secondary to intestinal occlusion. Emergency surgery was scheduled, demonstrating gastric herniation in the right pleural cavity, with perforation of the fundus. The patient died at the ICU 24 hours later. DISCUSSION: The pediatric surgeon should be familiar with ATS, since it may cause multiple surgical pathologies, it is difficult to manage, and it is associated with a high risk of recurrence and complications.

INTRODUCCION: El síndrome de tortuosidad arterial (STA) es un trastorno autosómico recesivo del tejido conectivo muy infrecuente, caracterizado por tortuosidad y elongación de arterias de medio y gran calibre y múltiples trastornos derivados de la afectación generalizada del tejido conectivo. CASO CLINICO: Neonato diagnosticado de STA, con múltiples malformaciones vasculares, hernia de hiato y hernia inguinal bilateral. Intervenido a los tres meses, practicándose cierre de hernia de hiato y herniorrafia inguinal bilateral. Estas últimas requirieron hasta cuatro intervenciones por recidiva. Durante el seguimiento presentó hernia diafragmática retrocardiaca, siendo intervenida, con posterior eventración. A los ocho años ingresó por shock séptico secundario a oclusión intestinal. Se intervino urgente objetivando herniación gástrica en cavidad pleural derecha con perforación en fundus. El paciente falleció en la UCI tras 24 horas. COMENTARIOS: El cirujano pediátrico debe conocer el STA debido a la múltiple patología quirúrgica que puede presentar, difícil manejo, riesgo de recidiva y complicaciones.

Polyorchidism in pediatric patients: a case report and a literature review. / Poliorquidismo en la edad pediátrica: a propósito de un caso y revisión de la literatura.

Polyorchidism or testicular duplication is defined as the histologically confirmed presence of more than two testes. This is the case of a full left testicular duplication in an 11-year-old patient presenting with occasional pain in the left hemiscrotum. At physical exploration, a palpable scrotal mass was detected. An ultrasonography was performed, which revealed the presence of testicular duplicity. Diagnostic suspicion was confirmed by means of a nuclear MRI and a histopathological study following excision. Polyorchidism is a rare abnormality requiring a high degree of suspicion in the presence of an extratesticular mass. Most authors advocate conservative treatment and follow-up in the absence of pain, cryptorchidism, tumors, and unclear diagnosis.

El poliorquidismo o duplicación testicular se define como la presencia de más de dos testículos confirmados mediante histología. Se presenta un caso de duplicación testicular izquierda completa en un niño de 11 años de edad que consultó por dolor ocasional en el hemiescroto izquierdo. En su exploración física destacaba una masa escrotal palpable. Se practicó ecografía que reveló la presencia de una duplicidad testicular. La sospecha diagnóstica fue corroborada mediante resonancia magnética nuclear y el estudio histopatológico tras la exéresis, confirmó el diagnóstico. El poliorquidismo es una anomalía excepcional que require un alto índice de sospecha ante la presencia de una masa extratesticular. La mayoría de autores abogan por un tratamiento conservador y seguimiento si no causa dolor o si no existen dudas diagnósticas, criptorquidia o excepcionalmente, tumores.

SiO, 29SiO, and 30SiO emission from 67 oxygen-rich stars. A survey of 61 maser lines from 7 to 1 mm.

Circumstellar environments of oxygen-rich stars are among the strongest SiO maser emitters. Physical processes such as collisions, infrared pumping and overlaps favors the inversion of level population and produce maser emission at different vibrational states. Despite numerous observational and theoretical efforts, we still do not have an unified picture including all the physical processes involved in the SiO maser emission. The aim of this work is to provide homogeneous data in a large sample of oxygen-rich stars. We present a survey of 67 oxygen-rich stars from 7 to 1 mm, in their rotational transitions from J = 1 → 0 to J = 5 → 4, for vibrational numbers v from 0 to 6 in the three main SiO isotopologues. We have used one of the 34 m NASA antennas at Robledo and the IRAM 30 m radio telescope. The first tentative detection of a v = 6 line is reported, as well as the detection of new maser lines. The highest vibrational levels seem confined to small volumes, presumably close to the stars. The J = 1 → 0, v = 2 line flux is greater than the corresponding v = 1 in almost half of the sample, which may confirm a predicted dependence on the pulsation cycle. This database is potentially useful in models which should consider most of the physical agents, time dependency, and mass-loss rates. As by-product, we report detections of 27 thermal rotational lines from other molecules, including isotopologues of SiS, H2S, SO, SO2, and NaCl.

Radon alpha track counting on solid state nuclear track detector by an ImageJ-based software macro.

Radon (222Rn) is a radioactive gas emanating from geological materials. Inhalation of this gas is closely related to an increase in the probability of lung cancer if the levels are high. The usual methodology for the quantification of radon by passive methods is the use of etched solid-state nuclear track detectors, frequently in combination with optical microscopes or image scanning for image acquisition and software-based image processing for track counting. Currently available commercial instrumentation, as the Radosys microscopy system, is quite expensive, so the development of alternative methodologies is desirable. In this work, a simple, fast and low-cost image acquisition system for the determination of tracks in chemically etched CR-39 solid-state nuclear track detectors to quantify 222Rn alpha tracks has been proposed. The image of the detector surface is obtained by a conventional light stereoscopic microscope, transmitted by a CCD camera into the computer, and analyzed by the ImageJ open-source software. This methodology was employed to analyze 45 samples collected in dwellings and caves located in the region of Extremadura (Southwest Spain). Results show a good correlation coefficient of r2 = 0.98 between the reference and purposed methodology and excellent repeatability, demonstrating that the system enables routine counting tracks for radon measurement as an alternative to the Radosys microscopy instrument.

Thyroid hormone action in epidermal development and homeostasis and its implications in the pathophysiology of the skin.

Thyroid hormones (THs) are key endocrine regulators of tissue development and homeostasis. They are constantly released into the bloodstream and help to regulate many cell functions. The principal products released by the follicular epithelial cells are T3 and T4. T4, which is the less active form of TH, is produced in greater amounts than T3, which is the most active form of TH. This mechanism highlights the importance of the peripheral regulation of TH levels that goes beyond the central axis. Skin, muscle, liver, bone and heart are finely regulated by TH. In particular, skin is among the target organs most influenced by TH, which is essential for skin homeostasis. Accordingly, skin diseases are associated with an altered thyroid status. Alopecia, dermatitis and vitiligo are associated with thyroiditis and alopecia and eczema are frequently correlated with the Graves' disease. However, only in recent decades have studies started to clarify the molecular mechanisms underlying the effects of TH in epidermal homeostasis. Herein, we summarize the most frequent clinical epidermal alterations linked to thyroid diseases and review the principal mechanisms involved in TH control of keratinocyte proliferation and functional differentiation. Our aim is to define the open questions in this field that are beginning to be elucidated thanks to the advent of mouse models of altered TH metabolism and to obtain novel insights into the physiopathological consequences of TH metabolism on the skin.

Immediate impact of the COVID-19 pandemic on pediatric surgery: analysis of a tertiary healthcare facility. / Impacto inmediato de la pandemia por COVID-19 en cirugía pediátrica: análisis de un centro terciario.

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIAL AND METHODS: A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS: A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS: The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.

INTRODUCCION: La pandemia surgida como consecuencia del virus SARS-CoV-2 ha provocado una situación inaudita, el confinamiento de la población, el colapso de los recursos sanitarios, la suspensión de la actividad programada en los servicios quirúrgicos, el miedo al contagio y la demora en la atención de pacientes. El objetivo es analizar el impacto de esta situación en la actividad del Servicio de Cirugía Pediátrica de un centro de referencia. MATERIAL Y METODOS: Se ha realizado un estudio comparativo de la actividad realizada en el ámbito de Cirugía Pediátrica de un centro de referencia español, incluyendo consultas ambulatorias, cirugía programada y actividad en urgencias durante el periodo de confinamiento (marzo-mayo 2020) frente al mismo periodo de tiempo en 2019. Se recogen el número de consultas e intervenciones, el tipo de cirugía practicada y/o anulada y el grado de evolución de las patologías atendidas. RESULTADOS: Se ha registrado un descenso del 98% de las cirugías programadas, del 84% de la presión asistencial desde urgencias pediátricas, un 55,24% menos de cirugías urgentes y un 82% la actividad ambulatoria en Consultas Externas. Se ha registrado un descenso en los traslados interhospitalarios del 94% y un incremento del 66% de la gravedad de la patología urgente. CONCLUSIONES: La pandemia por COVID-19 ha supuesto la anulación de la práctica totalidad de la actividad del Servicio de Cirugía Pediátrica, con la consiguiente demora en el tratamiento de patologías graves y un aumento en la morbilidad de procesos urgentes habituales.

Applicability of Clavien-Dindo classification in Nuss procedure surgical complications. / Aplicabilidad de la clasificación Clavien-Dindo en las complicaciones quirúrgicas del procedimiento de Nuss.

OBJECTIVES: Nuss procedure is a safe surgery but not exempt from complications. Clavien-Dindo classification (1992) allows complications of any surgery to be recorded. Our objective was to prove its applicability in the study of Nuss procedure complications. MATERIAL AND METHODS: We present a retrospective series of PE patients undergoing surgery from January 2010 to January 2018. Nuss procedure associated morbidity prior to bar removal was studied. Complications were stratified according to Clavien-Dindo classification. RESULTS: A total of 31 patients were included. Mean age was 14.67 years (4-27 years), with a mean Haller index of 6.06 (3.35-14.14) and a mean correction index of 41.2% (16-87%). Clavien-Dindo classification I-IIIb mild complications were recorded in 35.48% of patients. Seroma was found in 4 patients (12%), of whom 1 had superinfection and 1 had wound dehiscence. In 6 patients, bar and/or stabilizer mobilization was noted, and in 1 patient, postoperative acute pulmonary edema (3%) was observed. Of the 11 patients with complications, only 6 required re-intervention -5 as a result of prosthesis mobilization, and 1 as a result of infection not resolved with intravenous antibiotic therapy. CONCLUSIONS: Clavien-Dindo classification is being increasingly used as a way of unifying surgical complication criteria by comparing results. Our study demonstrated that such classification is a feasible and reproducible method when it comes to reflecting Nuss procedure morbidity and comparing it with other groups.

OBJETIVOS: La intervención de Nuss es una cirugía segura pero no está exenta de complicaciones. La clasificación de Clavien-Dindo (1992) permite registrar complicaciones de cualquier operación. Nuestro objetivo es demostrar la aplicabilidad de dicha clasificación para el estudio de las complicaciones de la cirugía de Nuss. MATERIAL Y METODOS: Presentamos una serie retrospectiva de pacientes afectos de PE intervenidos entre enero 2010 y enero 2018 y su morbilidad asociada a la cirugía de Nuss hasta la retirada de la barra. Dichas complicaciones se agruparán mediante la clasificación de Clavien-Dindo. RESULTADOS: Se recogen un total de 31 pacientes. La media de edad fue 14,67 años (4-27 años), con una media de índices de Haller de 6,06 (3,35-14,14) y una media de índices de corrección de 41,2% (16-87%). Se observaron complicaciones leves I-IIIb de la clasificación de Clavien-Dindo en el 35,48% de los pacientes. Se constató seroma en 4 pacientes (12%), de los cuales 1 presentó sobreinfección y otro, dehiscencia de herida. En 6 pacientes se observó movilización de la barra y/o estabilizador y en 1 paciente, edema agudo de pulmón postoperatorio (3%). De los 11 pacientes que presentaron complicaciones, solo 6 requirieron reintervención: 5 de ellos por movilización de la prótesis y uno por infección no resuelta con antibioterapia endovenosa. CONCLUSIONES: La clasificación de Clavien-Dindo se emplea cada vez más como una forma de unificar los criterios de las complicaciones quirúrgicas permitiendo comparar los resultados obtenidos. Comprobamos que es perfectamente factible y reproducible para reflejar la morbilidad del procedimiento quirúrgico de Nuss y poder compararla con otros grupos.

[Surgical treatment of primary hyperhidrosis and post-surgical satisfaction. Our 5-year experience]. / Tratamiento quirúrgico de la hiperhidrosis primaria y satisfacción postquirúrgica. Nuestra experiencia en 5 años.

INTRODUCTION: Primary palmar hyperhidrosis is a pathology that begins during childhood and can represent a significant reduction in the quality of life of adolescents. The current treatment of choice is thoracoscopic sympathicolysis. The aim of our study is to evaluate the results of surgery in paediatric patients. MATERIAL AND METHODS: Retrospective study of patients with primary palmar or palmo-axillary hyperhidrosis who underwent thoracoscopic sympathicolysis in our hospital during the last 5 years. RESULTS: We operated and included in the study 28 patients, 10 men and 18 women. Mean age was 13.8 (8-18) years. Bilateral thoracoscopic sympatholysis was performed with monopolar cautery, between T2-T4 ribs. Mean operative time was 63 minutes and mean hospitalisation time was 1.1 days. The incidence on intraoperative complications was zero. 2 patients presented postoperative subcutaneous emphysema. There were no other postoperative complications. 1 patient presented partial recurrence. In all the rest, sweating completely disappeared and they were totally satisfied with the surgery (96.42%). Temporary compensatory sweating appeared in 57.14% of the cases, a collateral effect that did not change their level of satisfaction. CONCLUSIONS: Palmar hyperhidrosis can be a major problem for socialization and quality of life for the child or adolescent who suffers it. Thoracoscopic sympatholysis in the pediatric patient is an effective treatment, highly resolutive and with low morbidity. Despite compensatory sweating, patients are highly satisfied with the results of surgical treatment.

INTRODUCCION: La hiperhidrosis primaria palmar es una patología que comienza ya en la niñez y puede representar una importante reducción de la calidad de vida del adolescente. El tratamiento de elección actual es la simpaticolisis toracoscópica. El objetivo de nuestro estudio es evaluar los resultados de la cirugía en pacientes pediátricos. MATERIAL Y METODOS: Hemos estudiado retrospectivamente los pacientes diagnosticados de hiperhidrosis palmar y/o palmoaxilar que han sido tratados en nuestro centro durante los últimos 5 años. RESULTADOS: En este periodo han sido tratados 28 pacientes (10 varones y 18 mujeres), con una edad media de 13,8 años (8-18 años). La simpaticolisis toracoscópica bilateral se practicó, con monopolar, entre los niveles T2-T4 con un tiempo quirúrgico medio de 63 minutos. La estancia media fue de 1,1 días. No se registraron neumotórax ni otras complicaciones intraoperatorias. Dos casos presentaron enfisema subcutáneo postoperatorio. No hubo otras complicaciones postoperatorias. Excepto un caso de recurrencia parcial, en el resto de pacientes la sudoración desapareció por completo y quedaron totalmente satisfechos con la cirugía (96,42%). Apareció sudoración compensatoria transitoria en el 57,14% de los casos, efecto colateral que no modificó su nivel de satisfacción. CONCLUSIONES: La hiperhidrosis palmar puede ser un problema importante para la sociabilización y la calidad de vida del niño o adolescente que la padece. La simpaticolisis toracoscópica en el paciente pediátrico es un tratamiento efectivo, altamente resolutivo y de escasa morbilidad. A pesar de la sudoración compensatoria, los pacientes están altamente satisfechos con los resultados del tratamiento quirúrgico.

[Caudal regional anesthesia: a safe anesthetic procedure for abdominal and inguinal surgery in newborns and toddlers]. / Anestesia caudal en neonatos y lactantes como procedimiento anestésico en cirugía abdominal y del canal inguinal: nuestra experiencia.

OBJECTIVES: Caudal anesthesia is a safe and effective technique in children. Some surgical procedures, such as abdominal or inguinal surgeries, could be performed avoiding general anesthesia in newborns and babies, reducing the risk of respiratory depression and neurotoxicity. Our objective is to analyze the experience in a tertial referral center. MATERIAL AND METHODS: We carried a retrospective study in patients under 1 year of age who underwent abdominal or inguinal procedures under caudal regional anesthesia, between 2016 and 2018. Demographics, diagnosis, comorbidity, surgical procedure, operation time, oral intake, perioperative complications and hospital stay were recorded. RESULTS: We included 87 patients under 1 year of age. In 56 patients (23 males, 33 females) surgery was performed under caudal anesthesia (37 scheduled, 19 urgent). Mean age was 2 months (0-11). Comorbidity: 25 associated prematurity, 3 severe tracheomalacia, 1 apnea and 8 bronchopulmonary dysplasia. Surgical procedures: 34 inguinal hernia repair, 9 incarcerated inguinal hernias, 5 neonatal testicular torsions, 8 pyloromyotomies. Mean operation time was 35 min (15-80) and mean anesthetic time 30 min (20-60). Oral intake started 2 h after surgery in 55 patients. Discharge was given in 24 h (12-36). Complications were not noticed. Any patient needed conversion to general anesthesia. CONCLUSIONS: Caudal anesthesia should be the anesthetic technique of choice in newborns and babies who undergo abdominal or inguinal surgeries, especially in those with comorbidity. This procedure could be performed safely, avoiding respiratory or neurological complications, with a fast recovery of patients and short hospital stay.

OBJETIVOS: La anestesia caudal es una técnica que permite la realización de diversos procedimientos quirúrgicos en neonatos y lactantes evitando complicaciones respiratorias y neurotoxicidad asociada a la anestesia general, permitiendo un inicio precoz de la ingesta y una menor estancia hospitalaria. Presentamos la experiencia en un centro terciario. MATERIAL Y METODOS: Estudio retrospectivo en neonatos y lactantes intervenidos de cirugía abdominal o inguinal (2016-2018) mediante anestesia caudal asociada a sedación. Se recogieron datos epidemiológicos, comorbilidad, procedimientos quirúrgicos, tiempo quirúrgico y anestésico, inicio de ingesta, estancia hospitalaria y complicaciones asociadas a la técnica. RESULTADOS: Se intervinieron 87 pacientes menores de 1 año en nuestro centro, en 56 (23 varones, 33 mujeres) se realizó cirugía bajo anestesia caudal (37 programadas,19 urgentes), edad media 2 meses (0-11). En 25 se asociaba prematuridad, 3 traqueomalacia severa, un paciente monitorización de apneas y 8 displasia broncopulmonar. Procedimientos: hernia inguinal no complicada (34), hernia inguinal incarcerada (9), torsión testicular (5), piloromiotomía (8). Tiempo medio de cirugía 35 minutos (15-80), tiempo anestésico de 30 min (20-60) y tiempo quirúrgico total 60 min (40-120). La ingesta se inicio a las 2 horas salvo un paciente que precisó antieméticos. El alta hospitalaria se produjo a las 24 horas (12-36). No se registraron complicaciones durante la realización de la anestesia caudal ni necesidad de conversión a anestesia general. CONCLUSIONES: Consideramos la anestesia caudal de elección en neonatos y lactantes en determinadas cirugías, con escasa morbilidad asociada. Permite un rápido inicio de la ingesta acortando la estancia hospitalaria y minimiza las complicaciones respiratorias y neurotoxicidad a largo plazo, incluso en pacientes prematuros con comorbilidad grave.

RADIATION EXPOSURE FROM NATURAL RADIONUCLIDES IN BUILDING MATERIALS.

Building materials from Iberian Peninsula (Portugal and Spain) were collected and analysed for 226Ra, 232Th and 40K using HPGe gamma-ray spectrometers. The results show that the highest mean value of 226Ra and 232Th activities are 2168 and 390 Bq kg-1, respectively, measured in zircon. For 40K, this value is 1290 Bq kg-1, measured in granite. The mean concentrations of the three radionuclides in the different building materials, excluding the zircon and the industrial by-products (ashes, gypsum and phosphogypsum), are 62, 31 and 519 Bq kg-1 for 226Ra, 232Th and 40K, respectively. The radiological health hazard parameters: radium equivalent activity (Raeq), activity concentration index (I) absorbed and effective dose rates, associated with these radionuclides, were evaluated. These values are within the EU recommended limits in building materials, except for same samples of aggregates, granites, ceramics, phosphogypsum and zircon. This study will contribute for the worldwide data pooling on the radioactivity of the building materials.

Presence of 236U and 239,240Pu in soils from Southern Hemisphere.

236U, 239Pu and 240Pu are present in soils mainly as a result of the local- and global-fallout from the atmospheric nuclear weapons tests carried out mainly in the 1950's and 1960's. In this work we provide new data on the presence of 236U and 239,240Pu in surface soils (i.e. up to 5 cm depth) from Chile and Africa. The results were obtained by low-energy Accelerator Mass Spectrometry (AMS). In the case of the Chilean samples, 236U/239Pu atom ratios show a high variability and are in general higher than the reported value for the global fallout in the Northern Hemisphere, ranging from 0.2 to 1.5. The 236U atomic concentrations range from 3.5 × 106 to 9.1 × 106 atoms/g, and are at least two orders of magnitude lower than the reported values in the Northern Hemisphere. The measured 240Pu/239Pu atom ratio in soils from South-Africa and Mozambique are of about 0.17, in agreement with the expected one for global-fallout at those coordinates. To best knowledge of the authors the present work is the first publication on 236U concentrations and 236U/239Pu atom ratios in soils from South-America and Africa.

ASSESSMENT OF RADIUM ACTIVITY CONCENTRATION AND RADON EXHALATION RATES IN IBERIAN PENINSULA BUILDING MATERIALS.

Radium (226Ra) is a natural radioactive element of the uranium decay series, which could also be present in building materials. Radon (222Rn) is continuously produced by the decay of 226Ra and its presence inside buildings can contribute to the increase of the population exposure to ionizing radiation. In this work, the amount of radium activity concentration and radon exhalation rates in several types of building materials that are commonly used in the Iberian Peninsula have been tested. The radium activity concentration was measured by gamma-ray spectrometry, whereas the radon exhalation rates were carried out using a continuous radon monitor (active measuring technique) and a solid state nuclear track detectors (passive measuring technique). The 226Ra mean values range from 5.0 to 123.4 Bq kg-1. As expected, the results show that the radon exhalation rate is higher in granites samples relatively to others building materials analysed. A positive correlation was found between radium activity concentration and radon exhalation rates in both techniques. The emanation fraction and alpha index were also calculated.

Development of a couple of methods for measuring radon exhalation from building materials commonly used in the Iberian Peninsula.

Radon is considered to be the main contributor to the worldwide population exposure to natural sources of radiation and so a lot of efforts have been made in most countries to assess indoor radon concentrations. Radon exhales from the earth's surface and is part of the radioactive decay series of uranium, which is also present in building materials. In this work, measurements of radon exhalation rates in building materials commonly used in the Iberian Peninsula have been carried out by using two different methods: active and passive techniques. In the first technique, the radon exhalation rate was measured following the radon activity growth as a function of time, by using a continuous radon monitor. The second technique is based on integrated measurements by using solid-state nuclear track detectors and a Spark Counter reading equipment. The results obtained by both measuring methods were found to be consistent.

Retrospective study assessing the role of MRI in the diagnostic procedures for early breast carcinoma: a correlation of new foci in the MRI with tumor pathological features.

BACKGROUND: Use of breast magnetic resonance imaging (MRI) to detect breast cancer has generated significant debate. We analyze the role of breast MRI in the detection of additional disease and the need to perform additional biopsies in early breast carcinoma patients. In addition, we correlate the detection of new foci with tumor pathological features. METHODS: Early breast carcinoma patients that had undergone an MRI as well as a mammography as diagnostic procedures were included in the study. The following pathologic features were studied: carcinoma type, histological grade, estrogen receptors (ER), progesterone receptors (PR), HER2 and Ki67. Univariate analysis was conducted to ascertain significant correlation among detection of new foci and each of the tumor pathological features. RESULTS: Data from 98 patients have been analyzed: median age 49 years (range 35-79); carcinoma type: (a) infiltrative ductal carcinoma (n = 73, 74 %), (b) infiltrative lobular cancer (n = 12, 12 %), (c) ductal carcinoma in situ (n = 6, 6 %); amplified HER2 (n = 18, 18 %); grade III (n = 33, 33 %); Ki67 ≥ 25 % (n = 33, 33.67 %); positive ER and PR (n = 79, 80 %); triple negative tumors (n = 8, 8 %). MRI detected additional disease in 38 cases (39.58 %), and 20 led to an additional biopsy (20.4 %). Thirty-eight patients (39 %) underwent mastectomy. We found a statistically significant correlation between new foci in MRI and high Ki67 ≥ 25 % (p < 0.005). No other statistically significant correlation was established. CONCLUSION: MRI detected additional disease in 39 % cases, requiring an additional biopsy 20 %. Tumors with high proliferative index were significantly correlated with the detection of new foci in MRI.

Characteristic times in the English Channel from numerical modelling: supporting decision-making.

A numerical model that simulates the dispersion of radionuclides in the English Channel has been applied to study the dispersion of conservative and non-conservative radionuclides released from the La Hague nuclear fuel reprocessing plant. The model is based upon previous work and now is able to simulate dispersion over long timescales (decades), explicitly including transport by instantaneous tidal currents and variable wind conditions. Wind conditions are obtained from meteorological statistics using a stochastic method. Outputs from the model are treated using time-series analysis techniques. These techniques allow the determination of characteristic times of the system, transport velocities and dispersion factors. This information may be very useful to support the decision-making process after an emergency situation. Thus, we are proposing that time-series analysis can be integrated with numerical modelling for helping decision-making in response to an accident. The model is first validated through its application to actual releases of 99Tc and 125Sb, comparing measured and computed concentrations, and characteristic times for three radionuclides are given next: a perfectly conservative one, a very reactive one ((239,240)Pu) and 137Cs, which has an intermediate behaviour. Characteristic transport velocities and dispersion factors have been calculated as well. Model results are supported by experimental evidence.