Variational and diffusion quantum Monte Carlo calculations with the CASINO code.

We present an overview of the variational and diffusion quantum Monte Carlo methods as implemented in the casino program. We particularly focus on developments made in the last decade, describing state-of-the-art quantum Monte Carlo algorithms and software and discussing their strengths and weaknesses. We review a range of recent applications of casino.

[Use of ultrasound for placement of central venous catheters in pediatrics: results of a national survey]. / Uso de la ecografía en la colocación de catéteres venosos centrales en pediatría: resultados de una encuesta nacional.

OBJECTIVES: To study the variability of techniques used for vascular access of central venous devices, totally implanted and external tunneled, as well as polling the use of ultrasound by pediatric surgeons in Spain. MATERIAL AND METHODS: Descriptive study of a survey results, conducted by phone, email and online, about 20 items related to the placement of these devices in children and the use of ultrasound in this procedure. RESULTS: We analyzed 71 surveys from 31 national hospitals. The response rate was 54%. In 66% of the cases the pediatric surgeon is the one who carries out the vascular access. 75% of the respondents place less than 25 catheters/year. Only 28% have attended to an ultrasound-guided vascular puncture course. The vein used more often is the internal jugular (55%), followed by the subclavian (17.4%), with preference for the right side in most of the cases (87%). 64% perform the ultrasound-guided technique, 29% the venous cutdown and 7% the landmark approach. There is no significant association between the technique chosen (landmark vs ultrasound-guided) and the vein used (p= 0,062). The majority of the respondents does not modify the usual approach in case of coagulopathy. We describe the complications associated with the three techniques. CONCLUSIONS: The preferred via for the vascular access by pediatric surgeons is the internal jugular vein, being this access ultrasound-guided in most of the cases. 91.5% consider the use of ultrasound decreases the number of associated complications. Nevertheless, just a minority has attended to a training course.

OBJETIVOS: Estudiar la variabilidad de técnicas en el acceso vascular de catéteres intravenosos centrales totalmente implantados y tunelizados externos, así como indagar sobre la utilización de la ecografía por parte de los cirujanos pediátricos en España. MATERIAL Y METODOS: Estudio descriptivo de los resultados de una encuesta realizada por vía telefónica, correo electrónico y on-line, acerca de 20 ítems relacionados con la colocación de estos dispositivos en niños y el uso de la ecografía. RESULTADOS: Se analizaron 71 encuestas de 31 hospitales españoles. La tasa de respuesta fue del 54%. En el 66% de los casos es el cirujano el que realiza el acceso vascular. El 75% de los encuestados coloca menos de 25 catéteres/año. Solo el 28% realizó algún curso de punción ecoguiada. La vena más utilizada es la yugular interna (55%), seguida de la subclavia (17,4%), prefiriendo la mayoría el lado derecho (87%). Un 64% realiza punción ecoguiada, un 29% venotomía y un 7% punción por referencias anatómicas, sin asociación significativa entre la técnica de punción elegida (referencias anatómicas vs ecoguiada) y la vena utilizada (p= 0,062). La mayoría no modifica la técnica habitual ante la presencia de coagulopatía. Se describen las complicaciones asociadas a las tres técnicas. CONCLUSIONES: La vía preferida por los cirujanos pediátricos encuestados para el acceso vascular es la vena yugular interna, siendo ecoguiado en la mayoría de los casos. Un 91,5% opina que la ecografía disminuye el número de complicaciones asociadas, sin embargo solo una minoría ha realizado algún curso de formación.

[Long-term results of hypospadias surgery. Urinary and sexual function, and psychological impact]. / Resultados a largo plazo de la cirugía de hipospadias. Función urinaria, sexual e impacto psicológico.

OBJECTIVES: To determine the current status of the patients operated on for hypospadias in our region, in order to adapt the surgical technique to their real needs. MATERIAL AND METHODS: A descriptive and observational study. Interviews were conducted with hypospadias surgery patients in our hospital between 1976 and 1996, focusing on their urinary and sexual function and psychological impact. We performed a descriptive statistical analysis and comparisons between types of hypospadias (SPSSv19). RESULTS: 566 patients were operated on for hypospadias during the study period, interviewing 100 aged between 18 and 40 years. The 73% were distal and 27% proximal. Of all patients, 30% do not have an orthotopic meatus, 10% have fistula, 18% have some degree of stenosis and 52% have penile curvature. The 13% feel to have had disadvantages in their life. They consider they have a different penis in: size (19%), glans shape (17%), curvature (14%), scars (10%) and lowest hole (7%). Sexual satisfaction was valued at 8.9 on a scale of 1 to 10, with no differences between the types of hypospadias. Proximal hypospadias patients have more ejaculation problems: 42% versus 11% in distal hypospadias. The 68% of the proximal ones would like to improve compared to 20% of the distal in: appearance (17%), size (11%) and way to urinate (11%). CONCLUSIONS: Anatomic abnormalities are maintained but the aspects that values the adult patient differ from those persecuted by practiced surgeries. A significant percentage of patients would try to get another surgery. Keeping the size of the penis and natural appearance of the glans should be a priority in hypospadias surgery.

OBJETIVOS: Conocer el estado actual de los pacientes intervenidos por hipospadias en nuestra región, para adaptar la técnica quirúrgica a sus necesidades reales. MATERIAL Y METODOS: Estudio descriptivo y observacional. Se entrevistó a pacientes intervenidos de hipospadias en nuestro hospital entre 1976 y 1996, incidiendo en su función urinaria, sexual e impacto psicológico. Realizamos análisis estadístico descriptivo y comparaciones entre tipos de hipospadias (SPSSv19). RESULTADOS: 566 pacientes fueron intervenidos de hipospadias en el período estudiado, entrevistándose a 100, con edades entre 18 y 40 años. El 73% fueron distales y 27% proximales. En el 30% el meato no es ortotópico, 10% presenta fístula, 18% presenta algún grado de estenosis y 52% presenta curvatura. El 13% siente haber tenido desventajas en su vida. Consideran su pene diferente en: tamaño (19%), forma glande (17%), curvatura (14%), cicatrices (10%) y orificio más bajo (7%). La satisfacción sexual fue valorada en 8,9 en una escala del 1 al 10, sin diferencias entre los tipos de hipospadias. Los proximales presentan mayores problemas de eyaculación: 42% frente al 11% de los distales. El 68% de los proximales desearían mejorar frente al 20% de los distales, en apariencia (17%), tamaño (11%) y forma de orinar (11%). CONCLUSIONES: Se mantienen alteraciones anatómicas pero los aspectos que más valora el paciente adulto difieren de los perseguidos en las cirugías que se practicaban. Un porcentaje importante de pacientes se reoperaría de nuevo. Mantener el tamaño del pene y aspecto natural del glande debe ser un objetivo prioritario durante la cirugía de hipospadias.

Long-term outcome of insulin pump therapy: reduction of hypoglycaemia and impact on glycaemic control.

AIMS: To determine the long-term outcome of continuous subcutaneous insulin infusion (CSII) in Type 1 diabetes according to Catalan National Health Service indications. METHODS: Retrospective observational study including 178 patients with Type 1 diabetes who started CSII treatment in our centre (2003-2008). All patients were followed in our CSII programme for outpatients for at least 5 years. Data on annual HbA1c levels were collected, and the main indication for starting CSII was analysed. RESULTS: Twenty-seven of 178 patients were excluded because of loss to follow-up or withdrawal from CSII, thus 151 patients (aged 37.4 ± 10.5 years, 64% women) were analysed. The main indications for starting CSII were suboptimal metabolic control (60.9%), severe hypoglycaemia/hypoglycaemia unawareness (25.5%) and others (13.6%). HbA1c was 64 ± 13 mmol/mol (8.0 ± 1.2%) at the start of CSII and 62 ± 13 mmol/mol (7.8 ± 1.2%) after 5 years in the total cohort (P = 0.1). The severe hypoglycaemia rates were 0.66 ± 1.61 and 0.17 ± 0.42 episodes/patient/year (P < 0.001). In patients with suboptimal metabolic control, HbA1c decreased from 68 ± 12 mmol/mol (8.4 ± 1.1%) to 64 ± 14 mmol/mol (8.0 ± 1.3%) (P = 0.016), with 37.4% of those in this group having an HbA1c ≤ 58 mmol/mol (7.5%) after 5 years. In patients starting CSII due to severe hypoglycaemia the problem was considered resolved in 93%, and in 64% of those starting CSII because of suboptimal glycaemic control, HbA1c improved significantly. CONCLUSIONS: CSII therapy achieves and maintains its efficacy mainly in terms of reducing severe hypoglycaemia. In the whole group of patients, the reduction in HbA1c is transient and disappears after 5 years.

Accuracy of immunoassay and mass spectrometry urinary free cortisol in the diagnosis of Cushing's syndrome.

PURPOSE: Urinary free cortisol (UFC) determination by highly specific methods as mass spectrometry instead of commercially available antibody-based immunoassays is increasingly recommended. However, clinical comparisons of both analytical approaches in the screening of Cushing's syndrome (CS) are not available. The aim of this study was to evaluate the diagnostic value of mass spectrometry versus immunoassay measurements of 24 h-UFC in the screening of CS. METHODS: Cross-sectional study of 33 histologically confirmed CS patients: 25 Cushing's disease, 5 adrenal CS and 3 ectopic CS; 92 non-CS patients; and 35 healthy controls. UFC by immunoassay (UFCxIA) and mass spectrometry (UFCxMS), urinary free cortisone (UFCo) and UFC:UFCo ratio were measured, together with creatinine-corrected values. Sensitivity, specificity, AUC and Landis and Koch concordance index were determined. RESULTS: AUC for UFCxIA and UFCxMS were 0.77 (CI 0.68-0.87) and 0.77 (CI 0.67-0.87) respectively, with a kappa coefficient 0.60 and strong Landis and Koch concordance index. The best calculated cutoff values were 359 nmol/24 h for UFCxIA (78 % sensitivity, 62 % specificity) and 258.1 nmol/24 h for UCFxMS (53 % sensitivity, 86 % specificity). The upper limit of UFCxIA and UCFxMS reference ranges were 344.7 and 169.5 nmol/24 h respectively. Sensitivity and specificity for CS diagnosis at these cutpoints were 84 and 56 % for UFCxIA and 81 and 54 % for UFCxMS. CONCLUSIONS: According to our data, both methods present a very similar diagnostic value. However, results suggest that lower cutoff points for mass spectrometry may be necessary in order to improve clinical sensitivity.

[Utility of ultrasonography in the placement of long-term venous catheters in newborns and infants]. / Utilidad de la ecografía en la colocación de catéteres venosos de larga duración en neonatos y lactantes.

OBJETIVES: The implantation of long duration intravenous catheters in pediatric population constitutes a challenge due to the size of vascular structures. Because of that, ultrasound is an important tool for vascular accesses in newborns and infants. The objective is to analyze our experience in ultrasound-guided implantation of reservoir type and tunneled catheters, as well as to compare it between both age groups. MATERIAL AND METHODS: Review of the ultrasound-guided implantable catheters placed from October 2010 to December 2014 in children under 18 months. RESULTS: 32 devices were placed in 4 neonates and 28 infants. Mean age was of 252 days and mean weight of 6,7 kg. 23 of them were reservoir type devices and 9 tunneled. No statistically significant differences were found for mean surgical time (55 versus 52 minutes). In tunneled catheters implantation there was no difference in surgical time between neonates and infants, but there was difference for reservoir type catheters (72 minutes in neonates vs 53 minutes in infants). In 78,5% of infants it was possible to place the catheter in the first puncture, versus 50% of neonates, although it was not statistically significant. As complications, one hematoma and one postoperative infection were described. CONCLUSIONS: We found that implantation of reservoir type catheters in infants constituted less surgical time compared with neonates, and puncture on left axillary vein was the most effective. Axillary vein ultrasound-guided approach is a safe and reproducible procedure that needs a process of formation and training.

OBJETIVOS: La colocación de catéteres intravenosos de larga duración en Pediatría constituye un reto debido al tamaño de las estructuras vasculares. Por ello, la ecografía es una herramienta importante para los accesos vasculares en recién nacidos y lactantes. El objetivo es analizar nuestra experiencia en la colocación guiada por ecografía de los catéteres tipo reservorio y tunelizados así como compararla en estos dos grupos etarios. MATERIAL Y METODOS: Revisión de los catéteres colocados mediante punción ecoguiada desde octubre de 2010 a diciembre de 2014 en niños menores de 18 meses. RESULTADOS: Se colocaron 32 dispositivos en 4 neonatos y 28 lactantes. La media de edad fue 252 días y el peso medio, 6,7 kg. 23 fueron dispositivos tipo reservorio y 9 tunelizados. No se encontraron diferencias estadísticamente significativas para el tiempo quirúrgico medio empleado en ambos dispositivos (55 vs 52 minutos). En la colocación de catéteres tunelizados no hubo diferencia en el tiempo quirúrgico entre neonatos y lactantes, pero sí para los reservorios (72 minutos en neonatos vs 53 minutos en lactantes). En el 78,5% de los lactantes se logró canalizar en el primer intento frente al 50% en los neonatos, aunque esto no fue estadísticamente significativo. Como complicaciones se describieron un hematoma y una infección postoperatoria. CONCLUSIONES: Encontramos que la colocación de reservorios en lactantes supuso un menor tiempo quirúrgico comparado con los neonatos, y la punción sobre vena axilar izquierda fue más efectiva. El abordaje ecoguiado de la vena axilar es un procedimiento seguro y reproducible, que requiere un proceso de formación y entrenamiento.

[Animated biofeedback for the dysfunctional voiding syndrome]. / Biofeedback animado para el tratamiento de la micción disfuncional.

OBJECTIVES: To analyze clinical and electromyographic treatment outcome of dysfunctional voiding (DV) with animated Biofeedback (Bfb). Clinical or electromyographic variables associated with higher success rate were checked. PATIENTS AND METHODS: Cross-sectional study of patients with DV, that in 2010- 2015 followed animated Bfb program. Efficacy was measured with Uroflowmetry, Electromyography (EMG) and validated clinical questionnaire. Inclusion criteria: no myelodysplasia, no anatomical malformations and a minumin of 3 Bfb sessions. Clinical variables: age, number of sessions, daytime leaks, nocturnal enuresis, constipation, UTI, VUR. Flow measurement variables: morphology of curves, electromyogram, flows, and elevated post void residual (PVR). RESULTS: Of 37 patients who received Bfb, 27 girls who met inclusion criteria were selected. Mean age: 7.8 years (2.5). Twelve (44%) had detrusor overactivity on urodynamics concomitantly. Globally, all clinical and flowmetry parameters improved. Clinically 33.5% had complete resolution of symptoms, 37% improved (> 50% of symptoms according to criteria ICCS) and 29% had no improvement. In EMG, 74% achieved normal perineal relaxation. Constipation at baseline is associated with lower rates of success (cure: 13 vs. 58%, p = 0.019; cure + improvement: 60% vs. 83% p> 0.05). The absence of RPM at the end of the study was associated with clinical improvement (cure: 66.7% vs. 0%, p = 0.012; cure + improvement: 89% vs. 60%, p> 0.05). CONCLUSIONS: Bfb in DV provides cure or improvement and electromyographic resolution are 69 and 74% respectively. The absence of constipation is associated with higher success rates. The High RPM correlates with persistence of clinics.

OBJETTIVOS: Se pretende analizar resultado clínico y electromiográfico del tratamiento de la micción disfuncional (MD) con Biofeedback (Bfb) animado. Además, se estudia si existen variables clínicas o electromiográficas asociadas a mayor tasa de éxito. PACIENTES Y METODOS: Se realizó corte transversal de pacientes con MD, que en 2010- 2015 siguieron programa de Bfb animado. El control post-tratamiento se realizó con Uroflujometría más Electromiografía y cuestionario validado. Se excluyeron los pacientes con mielodisplasia, malformaciones anatómicas, y a los que recibieron menos de 3 sesiones. Las variables clínicas estudiadas fueron: edad, número de sesiones, fugas diurnas, enuresis nocturna, estreñimiento, ITU, RVU. Las flujométricas fueron: morfología de curvas, electromiograma, flujos, y residuo postmiccional (RPM) elevado. RESULTADOS: De 37 pacientes que recibieron Bfb, se seleccionaron 27 niñas que cumplieron criterios de inclusión. Edad media: 7,8 años (DE: 2,5). Doce (44%) presentaron hiperactividad del detrusor asociado a la MD. De manera global, todos los parámetros clínicos y flujométricos mejoraron. Clínicamente 33,5% presentó resolución completa de síntomas y el 37% mejoraron (desaparecieron más del 50% de los síntomas según criterios ICCS). El 29% no presentó mejoría. Electromiográficamente el 74% logró flujometrías normales. El estreñimiento al inicio del estudio se asocia a tasas menores de éxito (curación: 13 vs. 58%, p= 0,019; curación + mejoría: 60% vs. 83% p > 0,05). La ausencia de RPM al final del estudio se relacionó con la mejoría clínica (curación: 66,7% vs. 0%, p= 0,012; curación + mejoría: 89% vs. 60%, p > 0,05). CONCLUSIONES: El Bfb en la micción disfuncional proporciona tasas de curación/mejoría clínica y de resolución electromiográfica del 69 y 74%, respectivamente. La ausencia de estreñimiento se asocia a mayores tasas de éxito. La persistencia de clínica se relaciona con RPM elevado post-tratamiento.

[Hysteroscopic polypectomy, treatment of abnormal uterine bleeding]. / Polipectomía histeroscópica para el tratamiento del sangrado uterino anormal.

OBJECTIVES: To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. METHODS: A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. RESULTS: The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. CONCLUSION: Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

[Testicular and paratesticular tumors in prepubertal children]. / Tumores testiculares y paratesticulares en la etapa prepuberal.

OBJECTIVES: To describe our experience in testicular and paratesticular tumors during the prepubertal stage, focusing especially on its character of benignity/malignancy and surgical treatment used. MATERIAL AND METHODS: Retrospective review of all testicular tumors in children under 12 years diagnosed and treated in our clinical setting from 1998-2015. Data on their presentation, study and management were collected. RESULTS: 17 children with prepubertal testicular tumors were identified. The clinical presentation as palpable testicular mass occurred in 12 cases (70.5%). Levels of tumor markers (alpha-fetoprotein and ßhCG) were only increased alpha-fetoprotein in two cases. In the histopathological study, 64.7% of the tumors were benign (five mature teratomas, four Leydig cells tumors, one immature teratoma and one sexual cords-stromal tumor). Malignant tumors were three rhabdomyosarcoma (17.6%), two yolk-sac tumors (11.8%) and one Burkitt lymphoma (5.9%). The mean age of benign was 5.9 years old and malignant 2.9 years old (p=0.68). From neoplastic lesions nine were non-germline (53%) and eight germline (47%). In the management testis-sparing surgery was performed in six benign tumors, and orchiectomy in five benign tumors and in all malignant tumors except lymphoma which received chemotherapy. CONCLUSIONS: Benign primary testicular and paratesticular tumors are more frequent in prepubertals and testis-sparing surgery is indicated by inguinal approach.

OBJETIVOS: Describir nuestra experiencia en tumores testiculares y paratesticulares en la etapa prepuberal, incidiendo sobre todo en su carácter de benignidad/malignidad y el tratamiento quirúrgico empleado. MATERIAL Y METODOS: Revisión retrospectiva de todos los tumores testiculares en menores de 12 años, diagnosticados y tratados en nuestro ámbito clínico desde 1998 hasta 2015. Se recogieron datos sobre su forma de presentación, estudio y manejo. RESULTADOS: 17 niños con tumores testiculares prepuberales fueron identificados. La presentación clínica como masa palpable testicular se dio en 12 casos (70,5%). De los niveles de marcadores tumorales (alfa-fetoproteína y ßhCG), solo estuvo aumentada la alfa-fetoproteína en dos casos. En el estudio anatomopatológico, el 64,7% de los tumores fueron benignos (cinco teratomas maduros, cuatro tumores de células de Leydig, un teratoma inmaduro y un tumor de los cordones sexuales-estromal). Los tumores malignos fueron tres rabdomiosarcomas (17,6%), dos tumores del saco vitelino (11,8%) y un linfoma de Burkitt (5,9%). La edad media de los benignos fue 5,9 años y de los malignos 2,9 años, (p=0,68). De las lesiones neoplásicas nueve fueron de estirpe no germinal (53%) y ocho germinales (47%). En el manejo quirúrgico se realizó tumorectomía en seis tumores benignos, orquidectomía en cinco tumores benignos y en todos los tumores malignos salvo el linfoma que sólo recibió quimioterapia. CONCLUSIONES: Los tumores testiculares y paratesticulares primarios benignos son más frecuentes en la etapa prepuberal y en su tratamiento se acepta indicar cirugía conservadora por vía inguinal.

[Ultrasound markers in the follow up of pyeloplasty]. / Evolución de los parámetros ecográficos tras pieloplastia en la población infantil.

INTRODUCTION: There are few studies on the long term follow up of pyeloplasty. Is there a residual pelvis dilatation in all successful procedures? How is the long term evolution of the ecographic parameters and measures postoperatively (PO)? PATIENTS AND METHODS: We reviewed all successful Anderson-Hynes pyeloplasties performed on obstructed renal pelvis with an anterio-posterior diameter >15 mm during 2001-2010. Ultrasound controls were made at 3 and 6 months postoperatively and then yearly afterwards. We aimed to describe time course of hydronephrotic changes following unilateral pyeloplasties, using three parameters: pelvic anterior-posterior diameter (APD), pelvis/córtex ratio (P/C R) and the percentage of improvement in APD (PI-APD). RESULTS: 41 patientswereincluded. Age at intervention ranged from 2 months to 10.3 years (mean 13 months, 83% were operated in the first year of life). Median of follow up was 4 years (range 1-12 years). Mean APD preoperatively was 25 mm (range 16-54). At the third month PO, PI-APD was 28%. At the sixth month control, it was 51%, and remained stable during the next consecutive yearly controls, without statistically significant variations (50%, 57%, 60%, 51%, 39%, 46%, 38%, 42%). P/C R diminished significantly already in the third month control (4.6 vs. 1.8, p=0.03). We observed complete disappearance of hidronephrosis in 8 patients (19.5%). DISCUSSION: Although early postoperative ultrasound changes occur, the ultrasound parameters remain often stable during long term follow up. We documented the complete normalization of renal pelvis (no hydronephrosis) in one of every five patients.

INTRODUCCION: Hay pocos estudios sobre la evolución postquirúrgica a largo plazo de la estenosis de la unión pieloureteral (EUPU). ¿Existe una dilatación residual en todos los pacientes que presentan resultados satisfactorios tras la cirugía? ¿Cuál es la evolución en los parámetros ecográficos? PACIENTES Y METODOS: Revisión retrospectiva de pacientes con EUPU intrínseca, con diámetro anteroposterior (AP) de la pelvis >15 mm (e hidronefrosis grado III o superior), y seguidos tras pieloplastia de Anderson-Hynes en el periodo 2001-2010 (10 años), no reintervenidos, asintomáticos y con función renal normal. Los controles ecográficos se hicieron a los 3 y 6 meses postoperatorio (PO) y posteriormente anuales. Se midieron tres parámetros: diámetro AP, ratio pelvis/córtex (R P/C) y porcentaje de mejoría (PM). RESULTADOS: Se seleccionaron 41 pacientes, intervenidos entre 2 meses y 10,3 años (media 13 meses, 83% en primer año de vida), mediana de seguimiento: 4 años (rango: 1-12). El diámetro AP de la pelvis renal medio pre-quirúrgico fue de 25 mm (rango 16-54). A los 3 meses la disminución media del diámetro AP (o PM) fue del 28% (respecto a diámetro prequirúrgico). A los 6 meses PO, fue del 51%, permaneciendo estable durante los siguientes años: 50%, 57%, 60%, 51%, 39%, 46%, 38%, 42% (controles anuales durante los primeros 8 años). La relación pelvis/córtex disminuyó de manera significativa ya en las ecografías al tercer mes (4,6 vs. 1,8; p= 0,03). En 8 pacientes (19,5%) se pudo objetivar ausencia de dilatación piélica en la evolución. CONCLUSIONES: Aunque los cambios ecográficos tras la pieloplastia se pudieron objetivar desde los controles precoces, permanecieron a menudo sin cambios durante los controles posteriores. Sin embargo, en uno de cada cinco pacientes se objetivó la desaparición de la dilatación piélica.

[Neonatal use of propranolol for segmental facial hemangiomas]. / Uso neonatal del propranolol en hemangiomas segmentarios faciales.

INTRODUCTION: Segmental cervico facial hemangiomas are defined as those longer than 5 cm, affecting a specific facial area. These lesions can be eventually associated with the PHACE syndrome. Our aim is to propose neonatal treatment with propranolol, showing its efficacy/safety, given the scarce evidence on its neonatal use. CLINICAL OBSERVATION: After written informed consent, four patients with segmental facial hemangioma were treated with propranolol in the neonatal period. Adverse effects were registered during initial admission. Three of the four patients had PHACE syndrome. Propranolol was effective in 100% of patients, showing hemangioma´s involution without any adverse effect. COMMENTS: In our series, propranolol was effective and showed no side effects in the neonatal period. If propranolol benefits are greater than its risks, administration of the lowest effective dose is recommended, under hospital surveillance, starting shortly after diagnosis, in order to achieve improved efficacy.

INTRODUCCION: Los hemangiomas cérvico-faciales son considerados segmentarios cuando afectan a un área específica de la cara y miden más de 5 cm y, en ocasiones, forman parte del síndrome de PHACE. Nuestro objetivo es proponer el tratamiento de dichos hemangiomas con propranolol en etapa neonatal, mostrando su eficacia/seguridad dado que existe poca evidencia al respecto. OBSERVACION CLINICA: Revisamos 4 pacientes diagnosticados de hemangioma segmentario facial. Los neonatos fueron tratados de forma hospitalaria inicial con propranolol, tras firma de consentimiento informado, y fueron ingresados para control de aparición de complicaciones. Tres de los cuatro casos clínicos fueron diagnosticados de síndrome de PHACE. El propranolol fue efectivo en el 100% de los pacientes, demostrando involución de los hemangiomas. COMENTARIOS: En nuestra serie el propranolol fue eficaz sin evidenciar complicaciones en el período neonatal. Si los beneficios del propranolol sobrepasan los riesgos, se recomienda administrar la menor dosis eficaz, de forma hospitalaria y precoz para obtener mejores resultados.

[Neonatal surgical site infection: multicentric survey on prophylactic measures]. / Infección de herida quirúrgica neonatal: encuesta multicéntrica sobre medidas profilácticas.

OBJECTIVES: Surgical site infection (SSI) has a considerable impact on neonatal morbidity. There are known risk factors such type of surgery (clean/contaminated), prematurity, surgical length, hypoalbuminemia, previous infection, prolonged mechanical ventilation, and so on. Many perioperative factors have not been studied, opposite to adults. We have developed a survey on intraoperative attitudes and measures, as surgical wound management in Neonates among pediatric surgeons, to seek for a wider consense. METHODS: Multi-response survey with 22 items, based on the Surgical Infection Society NIH 2008 clinical guideline. Each item poses a question on perioperative attitudes, surgical aspects and wound management. Each question is subdivided in two categories, depending on urgency and type of surgery (clean/contaminated). RESULTS: 159 surveys were sent. Among those, we received back 51 (32%). 69% of the interviewed surgeons use clorhexidin to prepare surgical field, 25% use Iodine solutions. 69% never use diathermy to incise skin. There was no agreement on the use of sterile plastic adhesive drapes, intra-cavity lavage, changing surgical gloves/material, or wound irrigation during closure. 82% never use cyanocrilate dressing. Intracuticular skin suture and simple stitches were used indistinctly. Wound management and dressings were not uniform and depended on each pediatric unit. CONCLUSIONS: The survey reflects the lack of consensus regarding prophylactic measures and wound management among pediatric surgeons who care after surgical neonates.

OBJETIVOS: La infección de herida quirúrgica (IHQ) es una causa frecuente de morbimortalidad en Neonatología. Existen factores de riesgo conocidos: tipo de cirugía (sucia/contaminada/limpia), prematuridad, duración de intervención, hipoalbuminemia, infección previa, ventilación mecánica prolongada y contaminación de vía central. Otros factores perioperatorios no han sido estudiados en neonatos, sí en adultos. Desarrollamos una encuesta sobre las actitudes y las medidas, intraoperatorias y de manejo de herida. Pretendemos dilucidar si existe consenso sobre la profilaxis de IHQ neonatal. METODOS: Encuesta con 22 ítems, basada en la guía de prevención de la IHQ en adultos (Surgical Infection Society, 2008). Cada ítem cuestiona temas sobre hábitos perioperatorios, intra y postoperatorios, relacionados con el manejo de la herida quirúrgica en el neonato, y consta de dos preguntas, según sea cirugía sucia/urgente o limpia/contaminada. Las opciones de respuesta son 4: siempre, con frecuencia, raramente y nunca. Enviamos la encuesta a cirujanos pediátricos españoles mediante correo electrónico en el primer trimestre del 2012. RESULTADOS: Se enviaron 159 encuestas. 51 (32%) respondieron. 69% emplean clorhexidina para preparar campo, 25% usan povidona iodada. Solo el 51% refirió dejar actuar siempre un minuto el antiséptico. 69% nunca usan bisturí eléctrico en piel para ampliar herida. No hubo respuestas unánimes en cuanto al uso de paños adhesivos protectores del campo, la irrigación de planos con suero o antisépticos durante el cierre, el empleo de drenajes, cambio de guantes y/o material al iniciar el cierre (cirugía sucia). El 72% y el 82% nunca emplean cianocrilato como cierre o apósito en neonatos, respectivamente. En cirugía sucia, 43% suturan piel con intradérmica y 49% con puntos sueltos. CONCLUSIONES: La distribución de respuestas refleja la falta de consenso sobre los aspectos de la técnica quirúrgica y el manejo perioperatorio que podrían estar relacionados con la profilaxis de IHQ neonatal.

[Study of bacteriology and resistances in pediatric appendicitis]. / Estudio de la flora patógena y resistencias en apendicitis pediátricas.

UNLABELLED: There is controversy about the convenience of performing a bacteriological peritoneal culture in pediatric appendicitis. We performed a sero-epidemiological survey of the bacteria found in peritoneal swabs from pediatric appendicitis operated in our hospital. METHODS: Ambispective study. Retrospective revision of the bacteriological results from peritoneal swabs performed in pediatric appendicitis from january 2009 to december 2010 (2 years) and prospective study of peritoneal swabs collected between january 2011 and december 2011 (one year). RESULTS: We found 728 pediatric patients (mean age 7.1, range: 2-11 years). Among these, 108 were < 5 years. Cultures were performed in 328 (45.1%). A positive result was found in 155 swabs, (47.3%). Positive cultures were more frequent in patients < 5 years (69.2% vs 40.4%, p < 0.001). The most frequent pathogens were E. coli: 122 specimens, Streptococcus spp (50 swabs), P. aeruginosa: (45) and B.fragilis: (35) Younger age was strongly associated with P. aeruginosa: (30.8% vs 8.4%, p < 0.001. OR: 4.8. IC 95%: 2.3-9.8). So was the detection of E. coli (50% vs 33.2% p = 0.01). 21.3% (26 swabs) of E. coli were resistant to amoxicillin-clavulanic acid. There were 15 (12.3%) multiresistant (ESBL) E. coli. Among the Streptococcus, 32% (16 out of 50) were resistant to clindamicin, and so were 28.6% of the B. fragilis (10 out of 35). DISCUSSION: . The most frequent pathogens were E. coli, Streptococcus spp and P. aeruginosa. P. aeruginosa is five times more frequent in patients < 5 years. Resistance of E. coli to amoxiclavulanate was high: 21.3% of the specimens. We found that 12.3% of the E. coli produced ESBL.

[Quality of life and long term results in Hirschsprung's disease]. / Calidad de vida y resultados a largo plazo en pacientes con enfermedad de Hirschsprung.

INTRODUCTION: The most frequent long term side effects of Hirschsprung's disease (HD) surgery are obstructive problems and fecal incontinence. In this study, we analyse long term functional results of the two most used surgical techniques (Duhamel-D- and De la Torre-dlT-) from the patient's point of view, through quality of life and functionality questionnaires. METHODS: We selected short segment HD patients ≥ 4 years) that were operated in our unit from 1996 until 2011. We employed two validated questionnaires: Bowel Function Score (BFS) and Gastrointestinal Quality of Life Index (GIQLI). Both questionnaires were also tested in two control age matched groups, each for every arm (controlD or control dlT). RESULTS: Among 28 preselected patients, 22 (78.6%) answered both questionnaires. Group D (10 patients) showed more constipation: 60% vs. 16.7% ( p = 0.01). Patients in group dlT (12 patients) showed more leaks: 58.3 vs. 10% (p = 0.03). Results of both questionnaires were higher (better) in Group D: 16 vs. 12.8 points (BFS, p = 0.007) and 74.1 vs. 69.8 (GIQLI, p = 0.17). The control group showed an overall better scores than HD patients: 17.2 vs. 14.3 (BFS p = 0.001) and 75.9 vs. 71.8 (GIQLI, p = 0.04). Separately, both groups of patients showed worse scores when compared with each control group. DISCUSSION: Our results are similar to other studies, where global scores of functional results and quality of life are worse in operated HD patients than in age matched controls. Fecal incontinence has more impact on social scores than constipation. Due to the fact that our dlT patients have more frequently fecal leaks, their scores are worse than in the D group. Nevertheless, patients in dlT group are younger and may improve their results as they get older, as it is often the case in operated HD patients.

Quantum Monte Carlo computations of phase stability, equations of state, and elasticity of high-pressure silica.

Silica (SiO(2)) is an abundant component of the Earth whose crystalline polymorphs play key roles in its structure and dynamics. First principle density functional theory (DFT) methods have often been used to accurately predict properties of silicates, but fundamental failures occur. Such failures occur even in silica, the simplest silicate, and understanding pure silica is a prerequisite to understanding the rocky part of the Earth. Here, we study silica with quantum Monte Carlo (QMC), which until now was not computationally possible for such complex materials, and find that QMC overcomes the failures of DFT. QMC is a benchmark method that does not rely on density functionals but rather explicitly treats the electrons and their interactions via a stochastic solution of Schrödinger's equation. Using ground-state QMC plus phonons within the quasiharmonic approximation of density functional perturbation theory, we obtain the thermal pressure and equations of state of silica phases up to Earth's core-mantle boundary. Our results provide the best constrained equations of state and phase boundaries available for silica. QMC indicates a transition to the dense alpha-PbO(2) structure above the core-insulating D" layer, but the absence of a seismic signature suggests the transition does not contribute significantly to global seismic discontinuities in the lower mantle. However, the transition could still provide seismic signals from deeply subducted oceanic crust. We also find an accurate shear elastic constant for stishovite and its geophysically important softening with pressure.

A novel human glycoprotein ACA is an upstream regulator of human hematopoiesis.

A central issue in stem cell biology is a better understanding of the molecular mechanisms that regulate self-renewal of human hematopoietic stem cells (HSCs). Control of the specific function of HSCs like self-renewal and differentiation might be regulated by a common set of critical genes. However, the regulation among these genes is yet to be elucidated. Here, we show that activation by a novel human GPI-linked glycoprotein ACA at the surface of human peripheral blood progenitor cells induces via PI3K/Akt/mTor/PTEN upregulation of WNT, Notch1, Bmi-1 and HoxB4 genes thus, promoting self-renewal and generation of primitive HSCs. ACA-generated self-renewing cells retained their lympho-myeloid repopulating potential in NOD/SCID mouse xeno-transplantation model with long term functional capacity. We conclude that ACA is an essential regulator of the genes involved in maintaining hematopoiesis and its use in clinical praxis could overcome many of the barriers present so far in transplantation medicine.

[Hepatopulmonary hydatidosis treatment through minimally invasive surgery in our hospital: report of 4 cases]. / Tratamiento de la hidatidosis hepatopulmonar con cirugía mínimamente invasiva en nuestro hospital. A propósito de 4 casos.

OBJECTIVES: The aim of this review is to present our experience in minimally invasive surgical procedures as treatment of hepatic and pulmonary hydatidosis in the last five years. MATERIAL AND METHODS: Retrospective review of patients with pulmonary and hepatic hydatid cysts treated in our hospital between 2008-2012 with minimally invasive surgery. RESULTS: We identified 4 cases, all of them Moroccan origin, the mean age was 6.7 years. Only one patient with hepatic cyst and three with hepatopulmonary cysts. All of them were treated with albendazole before surgery. Laparoscopy and/or thoracoscopy was performed and, in one case a transdiaphragmatic approach was used, as a way to reach a posterior hepatic injury unapproachable by laparoscopy. The technique used was the sterilization of the contents of the cyst with hypertonic saline solution, cyst opening and cystic membrane removal. We didn't do capitonage or pericystectomy. The resolution rate of residual cavities of the cysts was 100% and there was no recurrence or intraoperative complications. CONCLUSIONS: In children surgical treatment can be performed using endoscopic techniques with the same safety and efficacy as open surgery. Treatment with albendazole before surgery is helpful in preventing recurrences and as unique treatment in small lesions. Surgery must be as sparing as possible avoiding unnecessary liver or lung resections. Treatment of the residual cavity seems unnecessary. The thoracoscopic transdiaphragmatic approach should be considered as an alternative treatment, for those liver lesions in posterior segments, which are intractable with laparoscopy.

[Uroflowmetry values among asymptomatic children who underwent tubularized incised plate urethroplasty]. / Flujometría en varones asintomáticos intervenidos mediante la técnica de Snodgrass.

PURPOSE: Tubularized incised plate uretroplasty (TIPU) technique for hypospadias repair or Snodgrass procedure has become increasingly popular since its description in 1994. The elasticity of the neouretra is reduced and several studies have pointed out that flow parameters of the patients operated on this procedure show some grade of asymptomatic functional obstruction, although there are reports on the improvement of these parameters on the mid term. We evaluated the functional outcome in the form of urinary flow in asymptomatic children following uncomplicated TIPU. PATIENTS AND METHODS: We reviewed the urine flow rate of asymptomatic toilet trained children who underwent TIPU at our institution between 2005 and 2012. Uroflowmetries were performed in a serial fashion, during the follow up visits at the first months after the repair and yearly afterwards. Unfavourable values were plateau or interrupted curves and peak flow below the 5th percentile of a validated Nomogram for children (Gutiérrez-Segura). Statistical work up: SPSS 15.0. RESULTS: 85 patients were eligible. The mean age at surgery was 2.7 years. Median follow up was 29 months (6-82 months). Hypospadias was distal penile in 76 (89.5%) and mid penile in 9 (10.6%). We obtained 131 uroflowmetries (1.54 per patient) at a mean age of 5.1 years (2.5-8). 66.7% of the peak flow values and 55% of the average flow values were below the 5th percentile of the Nomogram. Flow curve was normal (bell- shaped) in 35 charts (26.5%), irregular in 38 (28.8%) and plateau in 56 (42.4%). Peak flow values improved in the second year after surgery (compared to the first year values): 7 ml/sgvs 8.09 ml/sg (p=0.07). The difference was significative in low volumes (<100 ml) (6.3 vs 7.8 ml/sg, p=0.04). Bell-shaped curve rate also grew: 21% (6/29) vs 28% (29/74), p> 0.05. We constructed a specific Nomogram for this population. CONCLUSIONS: Our data confirm that many asymptomatic patients who undergo TIPU repair present altered flow patterns. Spontaneous partial improvement is the norm after the first year of surgery.

[Preliminary results of a multidisciplinary approach to gastroschisis]. / Resultados iniciales de un protocolo de manejo terapéutico de la gastrosquisis.

INTRODUCTION: In gastroschisis, premature birth may avoid the development of intestinal peel and favour the primary closure. We present the preliminary results obtained after following a multidisciplinary approach to gastroschisis. After prenatal ultrasound diagnosis, preterm caesarean delivery at 34-35 weeks of gestation is programmed. METHODS: Prospective design of a study, where we included all prenatal diagnosed gastrosquisis neonates, from July 2007 to January 2012. RESULTS: We followed 9 infants (3 male). Average weight at birth: 1,927 gr. (+/- 370). Primary closure was successfully accomplished in the first 3 hours of life all cases. We found two cases of slight peel. We found no associated intestinal malformations, except for one small bowel stenosis. No significant neonatal distress respiratory syndrome developed. Mean parenteral nutrition time was 13.9 days (+/- 3.8). 4 neonates developed central line associated infection. No surgical site infection developed. Enteral nutrition was started at day 8th (+/- 2.8). Enteral requirements were fulfilled at day 15th (+/- 3.6). Mean hospital stay was 31 days (+/- 10). Mean follow-up was 30 months. 4 cases developed a small (< 5 mm) umbilical hernia CONCLUSION: Programming premature cesarean section delivery at 34 weeks of gestation was beneficial to the neonates with gastroschisis, yet it avoided peel development, and rendered primary closure without serious difficulties possible. This diminishes hypoperistalsis time and allows rapid instauration of enteral feeding, so hospital stays may be shorter.

[Functional results of Hirschsprung's disease patients after Duhamel and De la Torre procedures]. / Resultados funcionales en pacientes con enfermedad de Hirschsprung intervenidos mediante las técnicas de Duhamel y De la Torre.

INTRODUCTION: Long term results of different surgical techniques in Hirschsprung's Disease (HD) are contradictory. There are still no long term large or multicentric reports about functional results of De la Torre technique. We have studied the mid term functional results of the patients operated on Duhamel (D) and De la Torre (dlT) pull-through procedures. PATIENTS AND METHODS: We collected data from medical records and telephone interviews of the HD patients operated in our unit in the last 16 years. RESULTS: 38 patients were found. Ages ranged from 1.5 to 21 years. Mean age was 7.7 years. Median follow up was 5.9 years. 33 (86.8%) had rectosigmoid disease and 5 (13.2%) had long segment disease. D procedure was performed in 17 (44.7%), Soave in 1 (2.6%), Duhamel-Lester-Martin in 4 (10.5%) and dlT pull-through in 16(42%). In the last visit record, 12 (31.6%), had constipation, and fecal leaks were noted in 11 (33.3%) of the 33 patients > or = 4 years old.. 10 patients (29.4% of the > or = 4 years old group) referred encopresis along the follow-up. Patients from the D group referred higher rates of constipation than those in the dlT group (53.3% vs 20% p=0.048). dlT patients referred more frequency of leaks (46,1% vs 13,3%, p=0,05) Children with very short resections (< or = 10 cm) were more prone to constipation than children with longer resections (66,6% vs 17.4% p=0.007), and less prone to present leaks (12.5% vs 47.3% p=0.08). Encopresis was similar in all groups. DISCUSSION: Both techniques show similar functional results in the mid term, although children in the D group were more prone to constipation and those in the dlT group presented more fecal leaks. All patients with EH need long follow-ups.