Long-term outcomes of an acellular dermal matrix for the treatment of complex cryptoglandular anal fistula: a pilot study.

BACKGOUND: Effective, standardized treatments for complex anal fistula (CAF) still represent a clinical challenge. Emerging procedures attempted to achieve the healing rates of fistulotomy whilst preserving sphincter function. Acellular dermal matrix (ADM) used as a plug inserted through the fistulous tract is among newer treatment options. Varying success rates have been reported, most with short-term follow-up. The aim of this study was to report the long-term results of ADM-plug for CAF. METHODS: Retrospective analysis of a prospective database of patients treated with CAF. All consecutive patients presenting at two tertiary centers (Vall d'Hebron University Hospital and Bellvitge University Hospital, Barcelona, Spain) between November 2015 and March 2019 with a single, cryptoglandular CAF were evaluated for treatment with an ADM-plug were included. The primary endpoint was absence of discharge at clinical examination at 12 month follow-up. RESULTS: Twenty-two patients were included [7 women and 15 men, median age 56 (33-74) years]. Most patients had high transsphincteric fistulas (63.6%). The median follow-up was 42 (21-53) months. The 12 month success rate was 68.2%, with an overall healing rate of 59.1%. 77.8% of recurrences occurred within 12 months from surgery. One plug extrusion was observed. No major complications or mortality occurred during the follow-up. Patients did not report any worsening of fecal continence. CONCLUSIONS: This pilot study showed that more than half of patients with CAF could benefit from ADM-plug placement, preserving continence. A minimum follow-up of 12 months is recommended, because most recurrences occur during the first year.

Intra-articular calcaneal fractures. Do locking plates keep the reduction better than conventional plates? / Fracturas intraarticulares de calcáneo. ¿Las placas bloqueadas mantienen la reducción mejor que las convencionales?

INTRODUCTION: Since the development of locking plates, calcaneal fractures have been considered ideal for this type of fixation, due to the need to maintain the height of the subastragaline joint after depression fractures in a location where bone quality tends to be poor. However, there are no comparative studies that support the theoretical superiority of these plates over conventional plates. The aim of this study was to compare the results of intraarticular calcaneal fractures treated using locking plates vs. conventional plates in terms of radiological reduction, complications and number of reinterventions. MATERIAL AND METHODS: We designed a comparative study of calcaneal fractures operated in our centre using the "L" approach. Two groups were established: group B, comprising 15 patients operated between 2010 and 2015 with calcaneal locking plates, and group A, comprising a stratified random sample of 23 patients taken from a historical cohort of 90 patients operated in our centre between 1997 and 2007 using conventional calcaneal plates. Demographic data were recorded (age, sex, diabetes mellitus, smoking) and data relating to the fracture (type of fracture according to Sander's classification system, complications, presurgical delay). To evaluate loss of reduction, varus angulation of the calcaneus (measured from the axial view), Böhler's angle and Gissane's angle were assessed radiographically. These angles were measured preoperatively, immediately postoperatively, and at the end of follow-up. Finally, we recorded complications and the number of reinterventions. RESULTS: There were no differences in terms of age, sex or fracture type between the 2 groups. There was greater loss of varus angulation in group A, 0.6 vs. 0.41°, and there was greater reduction in Böhler's angle in group A, 3.79 vs. 2.6°, while Gissane's angle decreased more in group B, 4.13 vs. 2.52°. There were no significant differences in the proportion of complications and reinterventions between the 2 groups. CONCLUSION: In our study we observed no significant differences between the 2 groups in terms of radiological reduction, complications or number of reinterventions. However, we did observe a greater loss of reduction of Böhler's angle in the patients who were operated using conventional plates.

Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes.

BACKGROUND: Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy (Doppler-guided THD) seems to be associated with better short-term outcomes than conventional hemorrhoidectomy, but there are little data about long-term recurrence. The aim of this study was to compare Doppler-guided THD for grade III-IV hemorrhoids with conventional hemorrhoidectomy with regard to long-term postoperative morbidity and recurrence. METHODS: This was a single-center longitudinal and comparative study of a cohort of patients who underwent either distal Doppler-guided THD with low ligation of the hemorrhoidal artery and mucopexy or conventional excisional hemorrhoidectomy (Milligan and Morgan or Ferguson) for grade III and IV hemorrhoids. Short- and long-term postoperative morbidity was recorded. Severity of hemorrhoid symptoms (bleeding, prolapse, manual reduction, discomfort or pain and impact on quality of life) and fecal continence status (Vaizey score) were evaluated before surgery and at minimum of 1 year after surgery. RESULTS: Eighty-three patients were included in the study. Forty-nine patients (59%) underwent Doppler-guided THD, and 34 (41%) patients underwent conventional hemorrhoidectomy. The 30-day postoperative surgical morbidity was 26.5% in the Doppler-guided THD group and 8.82% in the conventional hemorrhoidectomy group (p = 0.085). No significant differences between the groups were observed in terms of persistence of bleeding, prolapse, need for manual reduction in prolapse and pain. One (2%) patient in the THD group and 2 (5.4%) patients in the conventional hemorrhoidectomy group needed further surgical procedures. Minor fecal incontinence occurred only after conventional hemorrhoidectomy in 2 (5.4%) patients. CONCLUSIONS: Our results showed that Doppler-guided THD is not inferior to conventional excisional hemorrhoidectomy for advanced hemorrhoidal disease in terms of postoperative complications and long-term recurrence of symptoms.

Anastomic urethroplasty in bulbar urethral stricture. 13 years experience in a department of urology. / Uretroplastia anastomótica en el manejo de estenosis de uretra bulbar. Experiencia de 13 años en un Servicio de Urología.

UNLABELLED: Urethral stenosis is a common disease in the clinical practice of urology, with a major impact on the quality of life of patients. The anastomotic urethroplasty is a technique with very precise indications usually membranous or bulbar urethra stenosis with a length of 3 cm or up to 7 cm when it is secondary to urethral disruptions (no stenosis) after pelvic trauma. OBJECTIVE: We review anastomotic urethroplasty performed in our department between 2002 and 2015. METHODS: A retrospective, descriptive and inferential analysis on 107 patients out of 482 treated with Anastomotic urethroplasty by urethral strictures at the Urology Department of the Hospital "Virgen de la Victoria" (Malaga) from January 2002 to September 2015, establishing effectiveness and safety of the technique, as well as factors that might influence the results. The main diagnostic method was retrograde urethrography and voiding cystourethrography in 100% of patients undergoing surgery, using voiding uroflowmetry for subsequent monitoring. The definition of success was a postoperative flowmetry with Qmax>15 ml/s, and in case of lower flow, we perform a cystoscopy to verify recurrence of stenosis or exclude other pathology. RESULTS: The median age was 42 years, with a mean follow up of 59 months. The length of stenosis valued by retrograde urethrography and voiding cystourethrography was in 91.6% of cases of >1 cm and <2 cm. The most common etiology was idiopathic in 72.9%, followed by iatrogenic with 15.9%. Regarding the location, it was observed that the area most often affected was the bulbar urethra with 82.2%, with the membranous urethra in second place. In 77.6% of patients anastomotic urethroplasty was the initial treatment, followed in frequency by direct vision internal urethrotomy 9.3%. In the case of comorbidities associated with treatment with anastomotic urethroplasty it was observed that only Diabetes Mellitus had a tendency to statistical significance, with p=0.092, not demonstrating such significance in the case of hypertension or when the subject presented Diabetes Mellitus together with hypertension. Finally, the intervention was successful in 102 cases (95.3%), with only 5 cases (4.7%) where it failed, 4 of them treated with a new Anastomotic urethroplasty, with resolution of the stricture. CONCLUSIONS: Anastomotic urethroplasty is the treatment of choice for short bulbar urethral stricture, with high success rate and low complication rate, as well as low recurrence of these.

Effect of virgin and refined olive oil consumption on gut microbiota. Comparison to butter.

There is increasing evidence of the health benefits of olive oil consumption in the diet. Some authors have studied the effect of high fat/high calorie diets and have detected changes on the microbiota. However, these studies are mainly based on saturated fats. Here we present a study on the specific effect on gut bacterial populations of extra virgin olive oil, rich in monounsaturated fatty acids and phenolic compounds, in comparison to refined olive oil, rich in monounsaturated fatty acids but low in phenolic compounds, and to butter, rich in saturated fatty acids and cholesterol. Four groups of animals were studied: one group of mice received a standard chow diet, and the other received three high fat diets, rich in extra virgin olive oil, refined olive oil or butter. Evolution of symbiont population in feces was studied using culture-dependent and culture-independent methods. In the latter, the V3 region of 16S rDNA was amplified and separated by denaturing gradient gel electrophoresis; followed by sequencing of the most representative bands. Culture-dependent studies and comparison of the different DGGE profiles throughout the experiment demonstrated that different dietary fats had different effects on gut microbial composition. Butter-induced changes in the microbial counts resembled those previously described in obese individuals. Interestingly, a different behavior between extra virgin and refined olive oil was also observed, extra virgin olive oil being most different from butter. To our knowledge, no studies have analyzed gut microbiota depending on diets with different fatty acid saturations including different types of olive oil. This may offer new data supporting the benefits for health of extra virgin olive oil, so important in the Mediterranean diet.

Isolation and characterization of a nisin-like bacteriocin produced by a Lactococcus lactis strain isolated from charqui, a Brazilian fermented, salted and dried meat product.

A Lactococcus lactis subsp. lactis strain (L. lactis 69) capable to produce a heat-stable bacteriocin was isolated from charqui, a Brazilian fermented, salted and sun-dried meat product. The bacteriocin inhibited, in vitro, Listeria monocytogenes, Staphylococcus aureus, several lactic acid bacteria isolated from foods and spoilage halotolerant bacteria isolated from charqui. The activity of the bacteriocin was not affected by pH (2.0-10.0), heating (100 °C), and chemical agents (1% w/v). Treatment of growing cells of L. monocytogenes ScottA with the cell-free supernatant of L. lactis 69 resulted in complete cell inactivation. L. lactis 69 harbored the gene for the production of a nisin-like bacteriocin, and the amino acid sequence of the active peptide was identical to sequences previously described for nisin Z. However, differences were observed regarding the leader peptide. Besides, the isolate was able to survive and produce bacteriocins in culture medium with NaCl content up to 20%, evidencing a potential application as an additional hurdle in the preservation of charqui.

Effects of sulphate addition and sulphide inhibition on microbial fuel cells.

The effects of adding sulphate in: (i) standard activated sludge microbial fuel cells (MFCs) and (ii) larger-scale leachate-treating columns - both as individual units and as a system connected in cascade - are reported. S-replete power output was ∼2-fold higher than that of the S-deplete MFC. Furthermore, the effects of evolved sulphide (S(2-)) inhibition were investigated. The overall decrease in power output from the sulphide inhibitor (Na(2)MoO(4)) additions was 83% for the S-replete and 90% for the S-deplete. The second phase with the leachate treating units shows an improvement of 32-86% (depended on leachate strength) in current output as a result of adding sulphate. When leachate column MFCs were connected fluidically in series, the amount of Na(2)SO(4) made available downstream was decreasing (increase in power was 99%, 40% and 12% for columns in cascade). Results demonstrated the beneficial effects of added sulphur sources to both activated sludge and leachate-treating MFCs.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]. / Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera.

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Hipertensión intra-abdominal: visión del gastroenterólogo / Intra-abdominal hypertension: perspective of the gastroenterologyst

Elevated intra-abdominal pressure (IAP) has deleterious effects in distant organ function. Sustained increase of IAP is known as intra-abdominal hypertension (IAH) and is associated with significant morbidity and mortality in critically ill patients. The aim of this article is to review basic pathophysiologic and clinical concepts about diagnosis and medical-surgical management of IAH and its most severe expression: the abdominal compartment syndrome, with emphasis on certain conditions as severe acute pancreatitis and end stage liver disease as these commonly associate with IAH.

El aumento de la presión intra-abdominal (PIA) se asocia a una serie de efectos deletéreos en la función de otros sistemas. El aumento sostenido de la PIA se denomina hipertensión intra-abdominal (HTIA) y es una entidad que aumenta la morbi-mortalidad en pacientes graves. La siguiente revisión expone los conceptos fisiopatológicos y clínicos básicos respecto al diagnóstico y manejo médico y quirúrgico de laHTIA y su grado máximo de expresión: el síndrome compartamental del abdomen, con énfasis en ciertas condiciones gastroenterológicas que se acompañan con frecuencia de HTIA como la pancreatitis aguda grave y el daño hepático crónico descompensado.

[Effect of a physical activity program on the anthropometric and physical fitness of women over 60 years]. / Incidencia de un programa de actividad física sobre los parámetros antropométricos y la condición física en mujeres mayores de 60 años.

This paper wants to determine the incidence of twelve weeks of physical activity on physical capacity and morphology of women over 60 yrs without disabilities in the district of Iquique, Chile. Before and after the intervention period was determined anthropometric characteristics and physical fitness status of the sample. Anthropometric variables were weight, height and waist and hip circumferences. The Body Mass Index (BMI) and Waist Hip was determined. To evaluate the status of the physical condition was used handgrip dynamometry test, countermovement vertical jump and get in and out. The balance was tested through the test of visual reference monopodal balance and flexibility through the test of trunk flexion (sit and reach test). Results show a positive effect of the intervention program on the performance of every physical test (p < 0.05). Anthropometric parameters showed a reduction in waist-hip ratio (p = 0.029) and waist circumference (p = 0.014), without rest of the variables analyzed showed changes of interest. Among the observed associations, vertical jump test showed a negative correlation with balance test and getting in and out test, both before and after treatment (R = -0.495, R = -0.699 in PREtest and R = -0.373, R = -0.463 at the POSTtest for the CMJ relation and balance and CMJ and Ln S-L test respectively, P < 0.05). In conclusion, a program of physical activity lasting 12 weeks, improves physical capacity (balance, grip strength, leg strength and flexibility) and anthropometric parameters (waist-hip ratio and waist circumference), in healthy women over 60yrs of the district of Iquique, Chile.

[Superficial femoral vein thrombosis due to large psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de vena femoral superficial por bursitis del psoas posterior a artroplastía total de cadera.

Male, 76 year-old patient with a history of total hip arthroplasty who presents with a mass in the iliac fossa with swelling of the thigh and hip pain upon flexion and extension. Complementary ultrasound and computed tomography scan studies show a giant lobulated cystic mass in the left iliac fossa, 7 cm in diameter, near the prosthesis. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent. We present a case of large psoas bursitis secondary to the release of polyethylene particles which caused superficial femoral vein compression and thrombosis.

[Prediction of intestinal histological lesions in paediatric patients with coeliac disease]. / Predicción de lesión histológica intestinal en pacientes pediátricos con enfermedad celíaca.

INTRODUCTION: Serological markers are of great interest in coeliac disease (CD), although intestinal biopsy is still the gold standard for establishing the diagnosis. Tissue transglutaminase IgA antibodies (AATGt-IgA) and antiendomysial antibodies IgA (AAE-IgA) are closely correlated to intestinal damage observed in biopsies. Villous atrophy (Marsh 3) plays a major role in CD diagnosis. Marsh 2 stage (crypt hyperplasia) as a CD marker is still under debate. OBJECTIVE: To ascertain an AATGt-IgA level that corresponds to a positive predictive value (PPV) of 100% for a histological CD diagnosis. MATERIAL AND METHODS: A series of 120 patients younger than 14 years, non- IgA deficient, who underwent an intestinal biopsy and were positive for both serological markers (AATGt-IgA and AAE-IgA). For AATGt-IgA, according to the manufacturer's recommendations, a value greater than 16 IU/mL is considered as a positive value. The PPV of AATGt was determined for different cut-off points. RESULTS: The histological findings distribution is directly correlated to the AATGt-IgA cut-off point. When the cut-off point is set above 7.5-10.6 times the commercial reference value, there is a 2.1% of Marsh 2 lessions and 93.4% of Marsh 3; above 10.6 times the reference value, all biopsies where Marsh 3 (100%). The PPV that considers Marsh 3 is (93.4%). The PPV, for considering Marsh 3 is low (55%) when AATGt-IgA serology is positive with levels between 16 and 67 IU/ml (1-4.2 times the cut-off point) and a higher value (92%) for concentrations between 68 and 118 IU/ml (4.3-7.4 times) and for cases with 69-170 IU/ml (7.5-10.6 times); above 170 IU/ml (>10.6 times) PPV is 100%. CONCLUSION: The use of values higher than the recommended cut-off point must logically improve specificity and PPV. In 31.6% patients positive for AATGt-IgA and AAE-IgA (38/120) it would have been possible to diagnose the disease without intestinal biopsy as of the PPV was 100%. It is not possible to standardise results as there are different commercial kits with variable cut-off points, so we must be cautious when setting recommendations based on AATGt-IgA.

[Thrombosis of the superficial femoral vein due to psoas bursitis secondary to particle disease in total hip arthroplasty]. / Trombosis de la vena femoral superficial por bursitis del psoas secundaria a enfermedad de las partículas en artroplastía total de cadera.

The case of a male 76 year-old patient with a history of total hip replacement surgery is presented herein. The patient had tumors in the iliac fossa with swelling of the thigh and pain upon hip flexion and extension. The complementary ultrasound and computed tomography show a large lobed cystic tumor in the left iliac fossa, 7 cm in diameter, close to the prosthesis. The diagnosis was psoas bursitis secondary to the release of polyethylene particles that caused compression and thrombosis of the superficial femoral vein. Cyst formation caused by polyethylene disease after total hip arthroplasty is infrequent.

[Plasma citrulline as a marker of loss of enterocitary mass in coeliac disease in childhood]. / Citrulina plasmática como marcador de pérdida de masa enterocitaria en la enfermedad celíaca en la infancia.

INTRODUCTION: Plasma citrulline is not incorporated in endogenous or exogenous proteins so it is a theoretical marker of villous atrophy. Our aim was to correlate plasma citrulline levels with severity of villous atrophy in celiac patients. METHODS: Observational case-control study longitudinal in children 16 month-old to 14 year-old: 48 with untreated celiac disease, 9 celiac children under gluten free diet and 35 non-celiac healthy children. Plasma amino acids concentration is determined, expressed in µmol/L, and so are other clinical and analytical data. RESULTS: No statistically significative difference found in the referring to BMI, age or renal function. Small increase in fecal fat in celiac children. Citrulline, arginine and glutamine are significantly lower in cases (17.7 µmol/l, 38.7 µmol/l, 479.6 µmol/l respectively) than in controls (28.9 µmol/l, 56.2 µmol/l, 563.7 µmol/l). Citrulline levels are significantly lower in the severe degrees of atrophy than in mild ones (13.8 µmol/l vs. 19.7 µmol/l, p < 0.05), not happening so with rest of amminoacids. SUMMARY: Postabsortive mean of plasma citrulline is a good marker of reduction in enterocyte mass in celiac patients with villous atrophy; secondary reduction in plasma arginine too. Just a small histological alteration in intestinal biopsy is enough to differentiate citrulline in cases and controls and besides it can be seen that high levels of atrophy present with lower plasma citrulline.

Estado nutricional y hábitos alimentarios en indígenas embera de Colombia / Nutritional status and food patterns in embera indigenous people from Colombia

Objective: To analyze food habits and nutritional status in indigenous people. Methodology: Study of prevalence of two communities with different patterns of food acquisition: dependency of rainforest resources (Tausig) and farmers with a degree of acculturation (Nusidó). The usual daily intake (24 hours recall and nutrient analysis) and nutritional status by anthropometry (height-age, height-weight andIMC) were studied. Ethnography of foods was undertaken. Results: the traditional dietary ideal (hunting, fishing and harvesting), is not sustainable due to the low productivity and the socio-economic conditions. The prevalence of deficiency in daily intake (Atausí> Nusidó) is high: energy 73,2 percent, roteins 36,6 percent, folic acid 34,2percent,calcium 93,0 percent, vitamin A 61,4 percent and zinc 75,7 percent. Chronic under-nutrition appeared in 68,9 percent (0-10 years), and short stature in 77,1 percent (10-19 years),overweight in 45 percent (adults). Both communities have greater under-nutrition than the national level and the community more dependent on forest (Atausí) has worse nutrition outcomes. Conclusion: Current dietary habits do not guarantee the coverage of food requirements and have influence on under nutrition, along with other factors that increase food insecurity of Embera indigenous compared to the general Colombian population.

Objetivo: analizarlos hábitos alimentarios y el estado nutricional en indígenas. Metodología: estudio de preval encías en dos comunidades con patrones diferenciales para conseguir alimentos: con recursos de selva (Atausí) y campesinos más aculturados (Nusidó). Se estudió la ingesta (por recordatorio de 24 horas) y el estado nutricional por antropometría (estatura-edad, peso-estatura e IMC). Se realizó etnografía sobre la alimentación. Resultados: el ideal dietario (caza, pesca y recolección) tradicional, es insostenible por la baja productividad y las condiciones socioeconómicas. La prevalencia de deficiencia en la ingesta diaria (Atausf>Nusidó) es alta: energía 73,2 por ciento, proteínas 36,6 por ciento, ácido fólico 34,2 por ciento, calcio 93 por ciento, vitamina A 61,4 por ciento y cinc 75,7 por ciento. La desnutrición crónica se presentó en el 68,9 por ciento (0-10 años), y talla baja en 77,1 por ciento (10-19 años), el sobrepeso en el 45 por ciento (adultos) y a otras edades se asoció con el patrón alimentario y la baja estatura. Ambas comunidades poseen mayor desnutrición que el nivel nacional y la más dependiente de la selva (Atausí) presenta mayores problemas nutricionales. Conclusión: los actuales hábitos alimentarios no cubren los requerimientos nutricionales e influyen en la desnutrición crónica encontrada, junto con otros factores que incrementan la inseguridad alimentaria en indígenas embera, en relación a la población general colombiana.

Emulsifying properties of chemically deamidated corn (Zea mays) gluten meal.

Corn gluten meal is a by-product of starch production that is readily available. Corn protein isolates have limited applications due to their hydrophobic nature, low solubility and limited functionality as emulsifiers. In this study, a mild acidic treatment of corn gluten meal was performed in order to achieve deamidation of asparagine and glutamine residues and modify the interfacial behavior of this byproduct. A 0.1 N HCl treatment for 6 h at 70 °C rendered a deamidation degree of 20.4%, which increased the emulsification activity index of corn gluten meal from 6.8 to 16.8 m(2)/g protein, with a remarkable increase in emulsion stability from 0 to 90.6% oil retention. Proteins participating in the emulsion were separated by SDS-PAGE and the main polypeptides were identified as alpha and beta-zeins. After deamidation, protein dissociation and unfolding due to the obtained negative charges resulted in enhanced functionality.

[Antegrade colonic enemas for intractable constipation in non-mentally retarded children]. / Lavados colónicos anterógrados para el estreñimiento refractario en niños sin encefalopatía.

A descriptive review of 12 patients who underwent appendicocecostomy or caecostomy for antegrade colonic lavage from January 2002 to February 2008. There were 9 appendicocecostomies performed patients from 3 to 13 years suffering from myelomeningocele, of which 8 of them had a very good outcome, with one case withdrawn due to poor use by the family. Three caecostomies were performed in non-mentally retarded constipated children. One was an otherwise healthy 7 year-old boy with hard stools since he was 10 months old, in spite of multiple laxative treatments, with normal morphology and function. He had a percutaneous caecostomy five years ago, with some improvement and a good quality of life, but still some occasional partial impactions. Another healthy 12 year-old boy with daily constipation associated faecal incontinence since he was 3 years old (normal manometry and rectal biopsy with signs of mild neuronal dysplasia) had a percutaneous caecostomy performed three years ago, with improvement in the faecal incontinence and better psychological outcome. The last caecostomy patient was an 8-year-old boy, with a similar clinical history and good progress in last three years after placing a Chait's button using an endoscopic procedure. Stubborn constipation continuing into adult life has a negative impact on the social and emotional adaptation of the paediatric patient, affecting family interactions. Antegrade colonic lavage allows independence and improves the quality of life in patients affected by recurrent faecal impactions. This technique needs to be performed on more patients to find out its true effectiveness.

The effect of adding antimicrobial peptides to milk inoculated with Staphylococcus aureus and processed by high-intensity pulsed-electric field.

The use of high-intensity pulsed-electric field (HIPEF) and antimicrobial substances of natural origin, such as enterocin AS-48 (AS-48), nisin, and lysozyme, are among the most important nonthermal preservation methods. Thus, the purpose of this study was to evaluate the combined effect on milk inoculated with Staphylococcus aureus of the addition of AS-48 with nisin or lysozyme, or both, together with the use of HIPEF. Synergy was observed in the reduction of Staph. aureus counts with the following combination methods: i) addition of AS-48 and nisin, ii) addition of AS-48 plus use of HIPEF, and iii) addition of AS-48 and nisin plus use of HIPEF. Specifically, when 28 arbitrary units/mL of AS-48 and 20 IU/mL of nisin were added to the milk, and it was treated with HIPEF for 800 mus, over 6 log reductions were observed in the microorganism. In general, Staph. aureus inactivation was dependent on HIPEF treatment time, antimicrobial doses, and medium pH. During storage of the treated milk, survivor population was related to peptide concentration and temperature. Final cell viability was influenced by the sequence in which the treatments were applied: the addition of AS-48 or AS-48 and nisin was more effective before than after HIPEF treatment. The results obtained indicate that the combination of HIPEF and antimicrobials could be of great interest to the dairy industry, although it is necessary to study further the way in which the combined treatments act.