Long-term cardiovascular assessment of women who had a pregnancy complicated by a hypertensive disorder.

BACKGROUND: Women with hypertensive disorders of pregnancy (HDP) are at increased risk of developing hypertension and cardiovascular disease later in life. However, from studies so far, it is difficult to define whether this association reflects preexisting maternal cardiovascular risk or merely reflect a potentially causal relationship between HDP and later cardiovascular risk. OBJECTIVES: We performed detailed cardiovascular assessment in women at mid-gestation, prior to development of a HDP and at 2 years post-partum aiming to identify cardiovascular changes prior to development of HDP and to assess persistent cardiovascular alterations long after the HDP event. METHODS: This was a prospective observational study in which we performed detailed cardiovascular assessment at mid-gestation and at median of 2.3 years (interquartile range 2.1 to 2.4 years) post-partum. We examined 112 women who developed a HDP and 451 women whose pregnancy was not complicated by hypertension. We used conventional and more advanced echocardiographic techniques, i.e. speckle tracking, to accurately determine left ventricular systolic and diastolic function. We used M-mode measurements to determine left ventricular remodeling and estimate left ventricular mass. Maternal vascular status was assessed using ophthalmic artery Doppler and by calculating peak systolic velocity (PSV) ratio, as a marker of peripheral vascular resistance. RESULTS: At mid-gestation, women who subsequently developed HDP had increased ophthalmic artery PSV ratio. These women also had mild cardiac functional and morphological alterations which were mostly accounted for by maternal cardiovascular risk factors. At 2 years post-partum, women who experienced HDP, compared to those who did not, had cardiovascular abnormalities with reduction in left ventricular systolic and diastolic function which remained after multivariable analysis. Longitudinal analysis demonstrated that the evolution of cardiovascular changes in the HDP and non-HDP groups was similar. CONCLUSION: Mild cardiac functional and morphological alterations precede the development of HDP and such changes persist for at least 2 years postpartum. The cardiac changes are likely to be the consequence of preexisting maternal cardiovascular risk factors rather than an adverse consequence of HDP. This article is protected by copyright. All rights reserved.

Impact of hypertensive disorders of pregnancy on offspring cardiovascular function: from fetal life to early childhood.

OBJECTIVE: Epidemiological studies suggest that, following in-utero exposure to hypertensive disorder of pregnancy (HDP), children may be at increased long-term cardiovascular risk, but data in early childhood are lacking. We aimed to investigate the independent influence of HDP on infant cardiac structure and function, after accounting for differences in childhood risk-factor profile. METHODS: This was a longitudinal study of 71 children born of a pregnancy complicated by HDP (gestational hypertension or pre-eclampsia) and 304 children born of a normotensive pregnancy. Detailed cardiovascular assessment was performed at mid gestation and at a median of 2.3 (interquartile range, 2.1-2.4) years postnatally. Linear mixed-effects modeling was used to determine the independent influence of HDP on infant cardiac function and structure after accounting for differences in childhood risk-factor profile. RESULTS: There were no differences in demographic characteristics between children whose mother developed HDP and those born of a normotensive pregnancy, but delivery was earlier and birth weight was lower in the HDP group. In fetal life, there were no significant differences in cardiac function or structure between the HDP and non-HDP groups. In early childhood, in the HDP group compared with the non-HDP group, there was greater relative wall thickness (mean ± SD, 0.7 ± 0.3 vs 0.6 ± 0.3; P = 0.047) and increased left ventricular mass (indexed to body surface area) (mean ± SD, 80.9 ± 20.4 g/m2 vs 75.7 ± 16.5 g/m2; P = 0.024); however, these differences did not persist on multivariable analysis. Longitudinal analysis revealed that there was no difference in the change in cardiac functional indices from fetal life to early childhood between the HDP and non-HDP groups. CONCLUSION: There is no evidence that HDP has an adverse effect on offspring cardiovascular health in fetal life or in early childhood. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Following the Nonthermal Phase Transition in Niobium Dioxide by Time-Resolved Harmonic Spectroscopy.

Photoinduced phase transitions in correlated materials promise diverse applications from ultrafast switches to optoelectronics. Resolving those transitions and possible metastable phases temporally are key enablers for these applications, but challenge existing experimental approaches. Extreme nonlinear optics can help probe phase changes, as higher-order nonlinearities have higher sensitivity and temporal resolution to band structure and lattice deformations. Here the ultrafast transition from the semiconducting to the metallic phases in polycrystalline thin-film NbO_{2} is investigated by time-resolved harmonic spectroscopy. The emission strength of all harmonic orders shows a steplike suppression when the excitation fluence exceeds a threshold (∼11-12 mJ/cm^{2}), below the fluence required for the thermal transition-a signature of the nonthermal emergence of a metallic phase within 100±20 fs. This observation is backed by full ab initio simulations as well as a 1D chain model of high-harmonic generation from both phases. Our results demonstrate femtosecond harmonic probing of phase transitions and nonthermal dynamics in solids.

Role of Spin-Orbit Coupling in High-Order Harmonic Generation Revealed by Supercycle Rydberg Trajectories.

High-harmonic generation is typically thought of as a sub-laser-cycle process, with the electron's excursion in the continuum lasting a fraction of the optical cycle. However, it was recently suggested that long-lived Rydberg states can play a particularly important role in high harmonic generation by atoms driven by the combination of the counterrotating circularly polarized fundamental light field and its second harmonic. Here we report direct experimental evidence of very long and stable Rydberg trajectories contributing to high-harmonic generation in such fields. We track their dynamics inside the laser pulse using the spin-orbit evolution in the ionic core, utilizing the spin-orbit Larmor clock. We confirm their effect on harmonic emission both via microscopic simulations and by showing how this radiation can lead to a well-collimated macroscopic far-field signal. Our observations contrast sharply with the general view that long-lived Rydberg orbits should generate negligible contribution to the macroscopic far-field high harmonic response of the medium.

Anaphylaxis to Vespa velutina nigrithorax: Pattern of Sensitization for an Emerging Problem in Western Countries.

OBJECTIVE: To define the sensitization pattern of patients with anaphylaxis to Vespa velutina nigrithorax (VVN). METHODS: We studied 100 consecutive Spanish patients with anaphylaxis to Hymenoptera venom and systematically determined specific IgE (sIgE) to whole venoms (Vespula species, Polistes dominula, Apis mellifera, Vespa crabro, and Dolichovespula maculata) and their molecular components (rApi m 1, rApi m 5, rApi m 10, rVes v 1, rVes v 5, rPol d 5, and cross-reactive carbohydrates). Specific IgE to VVN venom and its antigen 5 (nVesp v 5) were measured in a subsample. RESULTS: Seventy-seven patients had anaphylaxis to VVN. Of these, only 16 (20.8%) reported previous VVN stings, but were stung by other Hymenoptera. Positive sIgE (>0.35 kUA/L) to each of the whole venoms was detected in >70% of patients (Vespula species in 100%). The components showing >50% positivity were rApi m 5 (51.4%), rPol d 5 (80.0%), and rVes v 5 (98.7%). This pattern was similar to that of Vespula species anaphylaxis (n=11) but different from that of A mellifera anaphylaxis (n=10). Specific IgE to nVesp v 5 was positive in all patients (n=15) with VVN anaphylaxis and was correlated with sIgE to both rVes v 5 (R=0.931) and rPol d 5 (R=0.887). CONCLUSIONS: VVN has become the commonest cause of Hymenoptera anaphylaxis in our area. Most cases report no previous VVN stings. Their sensitization pattern is similar to that of patients with anaphylaxis to other Vespidae. Specific IgE to antigen-5 from VVN, Vespula species, and P dominula are strongly correlated in patients with VVN anaphylaxis.

The addition of Lactobacillus spp. negatively affects Mycoplasma bovis viability in bovine cervical mucus.

BACKGROUND: Mycoplasma bovis is an important pathogen for the cattle industry worldwide causing significant economic losses. Several transmission routes, including those related to reproduction, have been described. Indeed, the pathogen can colonize the female reproductive tract after artificial insemination (AI) with contaminated semen. Lactobacillus spp.-based probiotics have been used for vaginal dysbiosis treatment in women and cows although their role in controlling cervico-vaginal infections due to M. bovis is unknown. The objective of the present work is to assess the viability of M. bovis (PG45, NCTC 10131) in experimentally contaminated cervical mucus after the addition of Lactobacillus spp. at different concentrations as a competing agent and pH acidifier. RESULTS: The addition of probiotic at a concentration higher than 108 colony forming units (CFU/mL had a detrimental effect (P < 0.05) on mycoplasma viability in cervical mucus. This coincided with a significant LAB growth and an important decrease in pH from 8.4 to 5.6 (P < 0.05). However, after the addition of less concentrated probiotic, M. bovis survival was not affected and there was no significant LAB growth despite the drop of pH from 8.4 to 6.73 (P < 0.05). CONCLUSION: The addition of concentrations higher than 108 CFU/mL of Lactobacillus spp. negatively affects M. bovis viability in bovine cervical mucus under in vitro conditions. Although the effect observed on the pathogen viability seems to be related to the pH decrease after LAB proliferation in cervical mucus, further studies are necessary to elucidate if other factors are implicated. Nevertheless, the administration of Lactobacillus spp.-based probiotics might be used in the future to control M. bovis proliferation in the cervico-vaginal tract of cows.

Unravelling the effect of macro and microscopic design of dental implants on osseointegration: a randomised clinical study in minipigs.

Several dental implants are commercially available and new prototype design are constantly being fabricated. Nevertheless, it is still unclear what parameters of the design affect most the osseointegration of dental implants. The purpose of this study is to assess the effects of the microscopic and macroscopic design of dental implants in the osseointegration by comparing three macroscopic designs (Straumann tissue level (STD), essential cone (ECD) and prototype design (PD)) and six surface treatments. A total of 96 implants were placed in 12 minipigs. The implant stability quotient (ISQ), was assessed at the time of implantation, as well as at 2, 4 and 8 weeks. Histomorphometric and statistical analyses were conducted at the different sacrifice times, being 2, 4 and 8 weeks, to analyse the bone to implant contact (BIC), the bone area density (BAT) and the density of bone outside the thread region (ROI). The macroscopic design results showed higher ISQ values for the ECD, whereas the histomorphometric analysis showed higher ossoeintegration values for the STD. Regarding the microscopic design, both Sandblasted plus acid etching (hydrochloric/sulphuric acid) in a nitrogen atmosphere (SLActive) and Shot-blasted or bombarded with alumina particles and posterior alkaline immersion and thermal treatment (ContacTi) showed superior results in terms of osseointegration and reduced the osseointegration times from 8 weeks to 4 weeks compared to the other analysed surfaces. In conclusion, each of the macroscopic and microscopic designs need to be taken into account when designing novel dental implants to enhance the osseointegration process.

[Perinatal factors for necrotizing enterocolitis (NEC). A case-control study]. / Factores perinatales en el desarrollo de enterocolitis necrotizante. Un estudio de casos y controles.

AIM OF THE STUDY: The aim of this study is to identify potential perinatal risk or protective factors associated with NEC. MATERIALS AND METHODS: Single-center, retrospective case-control study of newborns admitted to the neonatal intensive care unit with NEC from 2014 to 2015. Clinical charts were reviewed recording maternal factors (fever, positive recto-vaginal swab and signs of corioamnionitis or fetal distress), and neonatal factors analyzed were: birth-weight and weeks gestation, umbilical vessel catheterization, time of enteral feedings and the use of probiotics, antibiotics and antifungal agents. Cases and controls were matched for all of these factors. Parametric tests were used for statistical analysis and p < 0.05 deemed significant. RESULTS: We analyzed 500 newborns of which 44 developed NEC (cases) and 456 controls. Univariate analysis did not identify any maternal risk factors for NEC. We did not found statistical differences between patients either time of enteral feedings or probiotics. Nevertheless, patients with signs of fetal distress and early sepsis had a higher risk of NEC (p < 0.0001). CONCLUSIONS: Infants with history of fetal distress and signs of early sepsis are at a higher risk of NEC. The use of prophylactic catheter infection or orotracheal intubation with antifungal treatment seemed to elevate the incidence of NEC. However, antibiotic treatment couldn´t be demonstrated to increase the risk of NEC.

OBJETIVOS: Identificar factores perinatales que favorezcan el desarrollo de enterocolitis necrotizante (ECN) en las unidades de cuidados intensivos neonatales (UCIN). METODOS: Estudio de casos y controles de los recién nacidos (RN) tratados entre 2014-2015. Se evaluaron factores de riesgo materno-fetal (fiebre, corioamnionitis, cultivos rectovaginales y sufrimiento intrauterino) y neonatales (edad gestacional, canalización de vasos umbilicales, hemocultivos, sepsis, nutrición y probióticos) y su asociación a la ECN. Estudiamos también la existencia de tratamiento antibiótico y antifúngico intravenoso previo al cuadro de ECN. Se estimó la odds ratio con un nivel de significación p < 0,05. RESULTADOS: Se analizaron 500 neonatos: 44 ECN y 456 controles. En el análisis univariante ninguno de los factores de riesgo maternos se relacionó con el desarrollo de ECN. No se encontraron diferencias significativas en los RN que recibieron alimentación enteral o probióticos. Los RN con sufrimiento fetal y los diagnosticados de sepsis precoz presentaron mayor riesgo de desarrollo de ECN (p < 0,0001). CONCLUSION: La pérdida de bienestar fetal y la sepsis precoz favorecen el desarrollo de ECN, que también parece aumentar con el uso de antibioterapia sistémica así como el tratamiento antifúngico profiláctico para las infecciones de catéter o intubaciones orotraqueales prolongadas.

[Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]. / Resultados a largo plazo del tratamiento endoscópico precoz de las estenosis subglóticas y traqueales adquiridas: 10 años de experiencia.

INTRODUCTION: Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years. MATERIAL AND METHODS: Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms. RESULTS: 32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully. CONCLUSIONS: Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.

INTRODUCCION: La estenosis adquirida de la vía aérea es una complicación frecuente tras la intubación endotraqueal. La dilatación endoscópica ha sido aceptada como tratamiento de elección en los casos detectados de forma precoz. Nuestro objetivo es conocer el estado actual de los pacientes tratados en nuestro centro mediante dilatación endoscópica en los últimos 10 años. MATERIAL Y METODOS: Estudio de cohorte retrospectivo de pacientes con estenosis subglóticas y traqueales adquiridas (ESTA) tratadas endoscópicamente mediante dilatación con balón en nuestro centro en los últimos 10 años. Se realizaron broncoscopias de control a las 2 semanas, al mes, a los 3 y 6 meses postdilatación y posteriormente en función de la clínica. RESULTADOS: Se trataron 32 pacientes de ESTA de reciente aparición en dicho periodo. La mediana de edad fue de 4,5 (3-120) meses. Fueron necesarias 2,5 (1-5) dilataciones por paciente. Todos los pacientes fueron extubados en quirófano o en las 24 horas siguientes al procedimiento. No hubo complicaciones durante los procedimientos ni durante el postoperatorio. El tiempo de seguimiento fue de 6 (1-10) años. Solo 1 de los 32 pacientes presentó recidiva de la estenosis 2 años después que fue secundaria a reintubaciones por nuevas intervenciones quirúrgicas; la cual se dilató nuevamente. CONCLUSIONES: La dilatación endoscópica precoz en las estenosis adquiridas de la vía aérea es un procedimiento seguro y eficaz a largo plazo. Los resultados avalan el uso de esta técnica como tratamiento de elección en estos pacientes.

[Mesenteric edema as a prenatal ultrasound sign of poor prognosis in gastroschisis]. / El edema mesentérico como signo ecográfico prenatal de mal pronóstico en gastrosquisis.

INTRODUCTION/AIM OF THE STUDY: Gastroschisis is a congenital malformation with an easy and early prenatal diagnosis, however, it has a variable post-natal outcome. Our aim was to determine if certain ultrasound markers or early delivery were related with a worse postnatal outcome. PATIENTS AND METHODS: Retrospective study of a cohort of patients with gastroschisis diagnosed between 2005-2014, with emphasis on prenatal ultrasounds, gestational age at delivery and post-natal outcome. Oligohydramnios, peel, mesenteric edema, fixed and dilated bowel with loss of peristalsis and small wall defect were considered ultrasonographic markers associated with poor prognosis. Outcome variables included: length-of-stay, complications, nutritional and respiratory factors. Non-parametric statistical analysis were used with p < 0,05 regarded as significant. RESULTS: Clinical charts of 30 patients with gastroschisis were reviewed (17M/13F). Gestational age at diagnosis was 20 (12-31) and at delivery 36 (31-39) weeks (33% of the patients over 36+3 weeks). A 73% of the patients presented at least one ultrasonographic marker factor during follow-up. Univariate analysis showed that mesenteric edema was associated with poor outcome variables: short-bowel syndrome (p= 0,000), PN-dependence (p= 0,007) and intestinal atresia (p= 0,02). The remaining risk factors analysed, including late delivery (> 36+3 weeks) were not associated with length-of-stay, ventilatory support, digestive autonomy, complications or mortality. CONCLUSIONS: Neither the presence of ultrasonographic markers classically associated with unfavorable outcomes, nor early delivery (< 36 weeks) resulted in worse postnatal outcome. Mesenteric edema was the only alarming ultrasound marker and that may suggest the need of closer follow-up.

INTRODUCCION: La gastrosquisis es una anomalía congénita de fácil diagnóstico prenatal y pronóstico postnatal variable. Nuestro objetivo es determinar si los signos ecográficos prenatales o el momento del parto se relacionan con peor pronóstico postnatal. PACIENTES Y METODOS: Se realiza un estudio retrospectivo de la cohorte de pacientes con gastrosquisis diagnosticados entre 2005-2014, registrando las ecografías prenatales, edad gestacional al parto y evolución postnatal. Se valoraron los hallazgos ecográficos prenatales: oligohidramnios, peel, edema mesentérico, asas fijas, aperistálticas y/o dilatadas y defecto pequeño de pared. Se consideraron variables resultado: la estancia hospitalaria, complicaciones, mortalidad y factores nutricionales y respiratorios. Se utilizaron pruebas no paramétricas, considerándose significativo un valor p < 0,05. RESULTADOS: Se analizaron 30 pacientes con gastrosquisis (17V/13M). La edad gestacional al diagnóstico fue de 20 (12-31) y al parto de 36 (31-39) semanas (33% mayores de 36+3 semanas). El 73% de los pacientes presentaron al menos un signo ecográfico de mal pronóstico. El análisis univariante asoció el edema mesentérico al síndrome de intestino corto (p= 0,000), falta de autonomía digestiva (p= 0,007) y mayor incidencia de atresia (p= 0,02). El resto de los factores, incluyendo la edad gestacional > 36+3 semanas, no tuvieron repercusión negativa en términos de estancia, asistencia respiratoria, autonomía digestiva, complicaciones o mortalidad. CONCLUSIONES: Ni la presencia de signos ecográficos considerados generalmente como desfavorables ni la tendencia a acercar el parto a la semana 36ª tienen repercusiones significativas en el curso postnatal. Únicamente el edema mesentérico parece un signo alarmante que sugiere la necesidad de aumentar la frecuencia de intervenciones (ecografías, pruebas de bienestar fetal).

[Intestinal complications in twin-to-twin transfusion syndrome (TTTS) treated by laser coagulation (LC)]. / Complicaciones intestinales en el síndrome de trasfusión feto fetal (STFF).

AIM OF THE STUDY: The hemodynamic imbalance due to placental vascular anastomoses in TTTS but also vascular changes generated after intrauterine treatment may lead to hypoxic-ischemic complications. Different intestinal complications in TTTS are reviewed in this paper. METHODS: Retrospective review of TTTS cases treated by laser coagulation (LC) from 2012-2015. Demographic data, fetal therapy, prenatal diagnosis (US, MRI) and perinatal outcome were recorded. We describe cases with intestinal complications and their postnatal management. Results are expressed by median and range. RESULTS: 29 monochorionic pregnancies with TTTS were treated (23 LC, 4 cord occlusions and 2 cord occlusions after LC). The diagnosis was made at 19 (16-26) weeks and 86% presented stage of Quintero ≥ II. In 70% of mothers survived at least one fetus with a median of 31 (24-37) weeks at birth. Four patients had intestinal complications (1 jejunal atresia, 2 ileal atresia, 1 perforated necrotizing enterocolitis), half of them had prenatal diagnosis. Postnatal resections of the affected segments and ostomies were performed. Intestinal transit was restored and there were no severe digestive sequelae after 21 (8-38) months of follow up. CONCLUSIONS: Different types of intestinal complications were associated with TTTS and LC. US and MRI enable prenatal diagnosis of these complications and this allows prompt decisions after birth.

INTRODUCCION: El desequilibrio hemodinámico secundario a la presencia de anastomosis vasculares placentarias en el STFF así como los cambios hemodinámicos generados durante y tras su tratamiento mediante fotocoagulación con láser (FC) puede dar lugar a complicaciones hipóxico-isquémicas en distintos sistemas. Revisamos nuestra experiencia en el tratamiento del STFF con FC y presentamos las complicaciones intestinales encontradas. MATERIAL Y METODOS: Estudio retrospectivo de casos tratados intraútero entre 2012 y 2015. Recogimos datos sociodemográficos, terapia fetal, pruebas diagnósticas prenatales (ecografía, RM) y resultados perinatales. Expresamos las medidas en medianas y rangos. RESULTADOS: Se procedió al tratamiento intraútero de 29 gestaciones monocoriales complicadas con STFF (23 FC, 4 oclusiones de cordón y 2 FC seguidas de oclusión). La edad gestacional en el procedimiento fue 19 (16-26) semanas y en el 86% de los casos se trataba de un estadio de Quintero ≥ II. El 70% de las madres tuvieron al menos 1 recién nacido vivo, con mediana de edad gestacional al parto de 31 (24-37) semanas. Presentaron problemas intestinales 4 pacientes (1 atresia yeyunal, 2 atresias ileales, 1 enterocolitis necrotizante con perforación), con sospecha prenatal diagnóstica en 2 de ellos. Postnatalmente se realizó resección del segmento afecto y ostomía. Actualmente se ha restablecido el tránsito intestinal en todos sin secuelas digestivas graves tras 21(8-38) meses de seguimiento. CONCLUSIONES: Hemos descrito distintos tipos de complicaciones intestinales asociadas al STFF y/o su tratamiento con FC. Es posible hacer el diagnóstico prenatal de dichas complicaciones mediante ecografía y RM. Su conocimiento pone al cirujano en alerta y es importante en la toma de decisiones postnatales.

[Venous aneurysms associated with lymphatic malformations]. / Aneurismas venosos asociados a malformaciones linfáticas.

OBJECTIVES: To analyze and describe the association between the development of venous aneurysms of the mayor vessels in patients with lymphatic malformations. MATERIAL AND METHODS: Retrospective review of patients diagnosed with both VA and LM from 1993 to 2014 and a descriptive analysis of clinical course was performed. RESULTS: We found 6 patients, 50% females, who had LM and VA confirmed with imaging techniques. All were diagnosed between 20 weeks- 12 years of age. LM were found within the thoracic cavity (n= 4), intrathoracical-cervical area (n= 1) and lower extremities (n= 1). In most cases the dilated veins were near the LM and thus, the mediastinal vessels were most commonly affected (superior vena cava-innominated (n= 1), venous jugulosubclavian confluence (n= 2), superior vena cava (n= 2) and popliteal vein (n= 1)). A total of 4 patients required surgical treatment of the LM with complete excision in 2 of the cases. Patients with a prenatal diagnosis of lymphatic malformation were most likely to present venous aneurysms at birth (n= 2), however the remaining patients (without prenatal diagnosis) developed them later on (average 6 years). Unlike lower extremity aneurysms, none of these aneurysms grew or required antiplatelet therapy; local thrombosis developed in one which resulted in pulmonary thromboembolism and one developed mitral valve insufficiency (regurgitation?) which required valve replacement. CONCLUSION: VA is extremely rare, and there is not therapeutic algorithm, therefore treatment should be individualized.

OBJETTIVOS: Analizar y describir la asociación entre el desarrollo de aneurismas venosos (AV) de grandes troncos en pacientes con malformaciones linfáticas (ML). MATERIAL Y METODOS: Estudio retrospectivo de los pacientes de nuestro centro entre 1993-2014, y análisis descriptivo de la asociación AV y ML. RESULTADOS: Se identificaron 6 pacientes, 50% mujeres, con una ML confirmada mediante prueba de imagen y una dilatación aneurismática de un tronco venoso. Los pacientes tenían edades entre 20 semanas-12 años y las ML se encontraban intratorácicas (n= 4), intratorácicas-cervical (n= 1) y en miembro inferior (n= 1); y las venas dilatadas en sus proximidades, siendo afectadas con mayor frecuencia los grandes vasos mediastínicos (vena cava superior- innominada (n= 1), confluencia venosa subclavioyugular (n= 2), vena cava superior (n= 2) y la vena poplítea (n= 1)). Se intervinieron n= 4, no pudiéndose extirpar completamente en 2 casos. Los niños que presentaron un diagnóstico prenatal de la malformación linfática presentaban una dilatación aneurismática de una gran vena en el control neonatal de la malformación (n= 2). En cambio, los pacientes con diagnóstico tardío de ML no presentaban dilatación vascular hasta pasados varios años (media 6 años). Ningún AV ha iniciado tratamiento antiagregante, y no han aumentado bruscamente su tamaño, uno desarrolló un trombo y posteriormente un tromboembolismo pulmonar, y otro debutó una insuficiencia mitral necesitando un recambio valvular mitral. CONCLUSION: El AV es una entidad poco común, y no existe algoritmo terapéutico, siendo una máxima el tratamiento individualizado de cada paciente.

[Growth in children with choledochal cyst]. / Crecimiento en el niño con quiste de colédoco.

AIM: In patients with a choledochal cyst, the malformation and subsequent biliodigestive reconstruction lead to a non-physiological state in the digestive tract and biliary excretion that could affect the child's growth. The effect of this malformation and its surgical treatment are reviewed here in a large patient cohort. MATERIAL AND METHODS: Retrospective review of patients undergoing surgery for choledochal cyst in the last 20 years. Nutrition and liver function parameters, weight and height data were collected from medical records. Patients presenting other serious diseases affecting growth were excluded. RESULTS: From 1994-2014 forty-five patients were diagnosed for choledochal cyst (75% female). All underwent cyst resection followed by Roux-en-Y hepaticojejunostomy. Eight patients were excluded for comorbidities and 37 selected for the study, with a median age at diagnosis and surgery of 16 (0-120) and 24 (1-149) months, respectively. The median follow-up was 76 (1-215) months. At diagnosis, 10.8% of patients had low weight, which was entirely resolved within 6 months after surgery (p< 0.05). CONCLUSIONS: The choledochal cyst induces a situation of moderate malnutrition in around 10% of the patients. Surgical correction quickly reverses this situation, despite the decreased absorption surface and deviation of biliary secretion to the jejunum instead of the duodenum.

OBJETIVO: En pacientes con quiste de colédoco, la malformación primaria y reconstrucción biliodigestiva posterior condicionan una situación no fisiológica del tracto digestivo y de la excreción biliar que, en niños, pueden teóricamente alterar el patrón de crecimiento. Revisamos en una amplia cohorte de pacientes el efecto de esta malformación y de su tratamiento quirúrgico sobre dicho patrón. MATERIAL Y METODO: Revisión retrospectiva de pacientes intervenidos por quiste de colédoco en los últimos 20 años, recogiéndose parámetros nutricionales y de función hepática, peso y talla a través de las historias clínicas. Se excluyeron pacientes con otras patologías graves donde el crecimiento haya podido verse afectado secundariamente. RESULTADOS: De 1994 a 2014 se diagnosticaron 45 pacientes con quiste de colédoco (75% niñas). En todos se realizó una hepaticoyeyunostomía en Y de Roux. Fueron excluidos 8 pacientes por pluripatología y seleccionados 37 para el estudio, con una mediana de edad al diagnóstico e intervención de 16 (0-120) y 24 (1-149) meses respectivamente. El seguimiento fue de 76 (1-215) meses. El 10,8% de pacientes presentaba bajo peso al diagnóstico, situación que desapareció totalmente a los 6 meses del tratamiento quirúrgico (p< 0,05). CONCLUSIONES: El quiste de colédoco supone en algo más de un 10% de los pacientes una situación de desnutrición moderada. La corrección quirúrgica, a pesar de condicionar una disminución de la superficie de absorción y una separación de la secreción biliar, revierte en poco tiempo dicha situación.

[Gynecological abnormalities in patients with rectovestibular fistula]. / Malformaciones ginecológicas en pacientes con fístula recto vestibular.

Patients with recto vestibular fistula may have gynecological malformations that could be unnoticed at the initial examination. The aim of this paper is to demonstrate the incidence of these malformations and propose a study method to help diagnose these malformations, avoiding unnecessary surgeries. We reviewed the records of patients treated with rectovaginal fistula (RVF) in the last 18 years and studied their gynecological malformations, time at diagnosis and treatment received. Of the 39 patients treated, 5 of them (13.1%) demonstrated 9 gynecological malformations: Hemivaginas (2), hemiuteros (2), uterine agenesis (2), vaginal agenesis (2) and vaginal septum (1). The diagnosis was made after the posterior sagittal approach (PSA) in two patients (acute abdomen and hydrometrocolpos), during the PSA in 2 patients and only one of them was diagnosed before the PSA. The 2 patients with hemivaginas and hemiuterus underwent a hemihysterosalpinguectomy and a vaginoplasty later in adolescence. The patient with vaginal and uterine agenesis diagnosed prior to PSA underwent a posterior sagittal anorectoplasty and a vaginoplasty with colon in the same procedure. The patient with vaginal and uterine agenesis (age 13 months) is waiting for vaginal replacement. The patient with vaginal septum (intraoperative finding) underwent a septum resection during the PSA. Gynecological defects are part of RVF spectrum. Girls with RVF require a complete gynecological examination prior to the definitive repair. Preoperative examinations assist in the timing and type of repair, and ultimately avoids complications and unnecessary interventions.

La fístula recto-vestibular se puede asociar a anomalías ginecológicas que, en numerosas ocasiones, pasan inadvertidas en la exploración inicial. Su reconocimiento en el momento adecuado puede cambiar el plan terapéutico y el pronóstico. Se revisan las historias de las pacientes con fístula recto-vestibular de los últimos 18 años y se describen las malformaciones ginecológicas asociadas, el momento del diagnóstico, el tratamiento y resultado postoperatorio. De 39 pacientes, en 5 (12,8%) se observaron 12 malformaciones ginecológicas: hemivaginas (2), hemiúteros (2), agenesia uterina (2), agenesia vaginal (2) y tabique vaginal (3). En dos pacientes el diagnóstico se realizó durante la anorrectoplastia, en otras dos después de la anorrectoplastia sagital posterior a causa de hidrometrocolpos y solo en una de ellas, antes de la intervención. En las pacientes con hemivagina y hemiútero se realizó, en una, la extirpación del hemiútero y la trompa y, en la otra, plastia vaginal transformándola en una única vagina. Cuando el diagnóstico se hizo antes de la intervención se pudo planificar la plastia adecuadamente. En la paciente con tabique vaginal y hallazgo intraoperatorio la anomalía genital fue tratada durante la anorrectoplastia. La paciente con agenesia vaginal y uterina aún no ha sido intervenida. Las malformaciones ginecológicas se asocian con relativa frecuencia a la fístula recto-vestibular. Por ello se requiere una exploración ginecológica adecuada antes de la anorrectoplastia para poder planificar de manera correcta el momento de la reparación, evitando complicaciones e intervenciones innecesarias. intraútero, la invaginación intestinal postnatal en el prematuro y la invaginación intestinal postnatal en el neonato a término.

[Intussusception: hospital admission for risk of recurrence or early discharge?] / Invaginación intestinal: ¿alta precoz o ingreso por riesgo de recidiva?

INTRODUCTION/PURPOSE: There is current debate about the need of hospitalization of patients with enema-reduced intussusception. The purpose of this study is to describe intussusception recurrence in a tertiary care children's hospital in order to evaluate the feasibility of ambulatory treatment. PATIENTS AND METHODS: Retrospective review of children diagnosed with intussusception from January 2009 to December 2013, identifying early recurrences as those that occurred between 12-72 hours after successful enema reduction and comparing the results with current literature. RESULTS: A total of 121 children (77 male - 44 female), with a mean age of 18,9±2,7 months and weight of 10,77±0,57 kg (CI 95%) were treated for intussusception. Enema reduction was attempted in 90,7% (n= 88) of the cases, with a success rate of 76,1% (n= 67). Early recurrence rate was 6% (n= 4), without associated complications, which is similar to recent meta-analysis results (5,4%); however, three patients required surgical exploration. Mean length of stay was 2 days for enema-reduced intussusception, which resulted in a total cost of 2,076.67 euro per patient. CONCLUSION: The low recurrence rate and scarce risk of complications suggests that an 8 to 12 hour observation is a feasible alternative to hospital admission, which results in social advantages including family welfare as well as management costs. These results are a starting point for prospective randomized controlled trials comparing both treatment modalities.

INTRODUCCION/OBJETIVO: En la literatura actual existe debate en cuanto a la necesidad de ingresar a los pacientes con invaginación intestinal (II) después de la reducción exitosa mediante enema. El propósito de este estudio es caracterizar la recidiva de las II en nuestro medio para valorar la posibilidad del tratamiento ambulatorio. PACIENTES Y METODOS: Estudio retrospectivo de los niños atendidos por II entre 2009 y 2013 definiendo como recidiva temprana la que ocurre entre las 12-72 horas post-reducción, comparando los resultados con la literatura actual. RESULTADOS: Se trataron 121 niños (77 varones - 44 mujeres), con edad de 18,9±2,7 meses y peso de 10,77±0,57 kg (IC 95%), por II. Se intentó reducción mediante enema en 90,7% (n= 88) de los casos, siendo efectivo en un 76,1% (n= 67). La tasa de recidiva temprana fue del 6% (n= 4), sin complicaciones asociadas, similar a lo referido en estudios de meta-análisis recientes (5,4%); tres precisaron tratamiento quirúrgico. La estancia hospitalaria media es de 2 días para las II tratadas conservadoramente, lo que supuso un gasto promedio de 2.076,67 euros por ingreso. CONCLUSION: Dada la baja tasa de recidiva temprana y escaso riesgo de complicaciones, la observación durante 8-12 horas es una alternativa al ingreso hospitalario, lo que conllevaría ventajas de bienestar socio-familiar y de gestión. Estos resultados sirven como punto de partida para estudios prospectivos randomizados entre ambas modalidades de tratamiento.

Results of uncemented hemiarthroplasty as primary treatment of severe proximal humerus fractures in the elderly.

OBJECTIVES: The purpose of this study was to analyze functional and radiologic results of a consecutive series of elderly patients who underwent uncemented hemiarthroplasty as primary treatment of complex proximal humeral fractures. METHODS: Twenty-one patients with severe proximal humerus fracture (three or four fragments and three- or four-fragment fracture dislocations) were treated with uncemented proximal humerus hemiarthroplasty. Patients were evaluated using the Constant-Murley Score, the Quick scale Disabilities of Arm, Shoulder and Hand (Quick-DASH) Score, range of motion, residual pain, radiographic parameters, and complications including clinical and radiologic data of mobilization. RESULTS: After a mean postoperative period of 20.57 months (range 12-42 months), the mean Constant-Murley Score was 44 points (20-57), the mean Quick-DASH score was 24 points (16-39), postoperative pain according to a mean visual analogue scale was 1 (0-8), active abduction was 50° (30-135), and active flexion 70° (20-120). There were no cases of infection, deep vein thrombosis, dislocation, blood transfusions, or reoperation because of prosthetic loosening. Bivariate analysis of demographic data, radiologic findings, and other variables showed associations between duration of surgery and a higher Quick-DASH score (0.606; p = 0.037), and the number of sessions of rehabilitation with a higher Quick-DASH score (0.708; p = 0.015). CONCLUSIONS: The results of treatment of severe proximal humerus fractures in the elderly with an uncemented hemiarthroplasty are safe and promising; however, a comparative cohort study (cemented vs. uncemented) and long-term follow-up are still needed.

[Analysis of neutrophil gelatinase-associated lipocalin in the critical patient]. / Análisis de la lipocalina asociada a la gelatinasa de neutrófilos en el paciente crítico.

OBJECTIVE: To determine if NGAL value exceeding 150 ng/mL is a good diagnostic test for acute renal failure in critically ill patients. DESIGN: Prospective, observational cohort. SETTING: Intensive Care Unit and Cardiac Surgery Intensive Care Service at Hospital Germans Trias I Pujol. PARTICIPANTS: Patients admitted to the Intensive Care department the Designated days in the studio. INTERVENTIONS: Analysis of serum creatinine blood given from 7 days prior to the start of the study, and daily during 4 weeks and by determination of NGAL urine test in frozen sample, analyzer ARCHITECT (Abbott Diagnostics) determined by immunoassay the day baseline and 2 times a week for 4 weeks, analysis of the stay and mortality. RESULTS: A total of 529 NGAL samples were obtained from 46 patients. 37% of patients had a value of NGAL>150 ng/mL. The Sensivity of the test to diagnose acute renal failure was 69%, Specifity was 75,7%. However, the Positive Predictive Test Value was 53%, which means that 47% of patients with high NGAL did not develop AKI. A NGAL >150 mg/dL was associated with a significantly higher SOFA and a longer stay in the ICU. The mortality of patients with elevated NGAL was 58.8%. CONCLUSIONS: A NGAL>150 ng/mL does not seem to be an excellent test for AKI in critically ill patients but is associated with a worse prognosis.