Living myocardial slices for the study of nucleic acid-based therapies.

Gene therapy based on viral vectors offers great potential for the study and the treatment of cardiac diseases. Here we explore the use of Living Myocardial Slices (LMS) as a platform for nucleic acid-based therapies. Rat LMS and Adeno-Associated viruses (AAV) were used to optimise and analyse gene transfer efficiency, viability, tissue functionality, and cell tropism in cardiac tissue. Human cardiac tissue from failing (dilated cardiomyopathy) hearts was also used to validate the model in a more translational setting. LMS were cultured at physiological sarcomere length for 72-h under electrical stimulation. Two recombinant AAV serotypes (AAV6 and AAV9) at different multiplicity of infection (MOI) expressing enhanced green fluorescent protein (eGFP) were added to the surface of rat LMS. AAV6 at 20,000 MOI proved to be the most suitable serotype without affecting LMS contractility or kinetics and showing high transduction and penetrability efficiency in rat LMS. This serotype exhibited 40% of transduction efficiency in cardiomyocytes and stromal cells while 20% of the endothelial cells were transduced. With great translational relevance, this protocol introduces the use of LMS as a model for nucleic acid-based therapies, allowing the acceleration of preclinical studies for cardiac diseases.

Impact of digestive-surgical cross-disciplinary management in patients with esophageal atresia. / Impacto del manejo multidisciplinar digestivo-quirúrgico en los pacientes con atresia de esófago.

OBJECTIVE: The objective of this study was to analyze whether patients undergoing esophageal atresia (EA) surgery benefit from a cross-disciplinary follow-up program, based on current clinical guidelines, implemented in our institution. MATERIALS AND METHODS: An observational, analytical, retrospective study of patients undergoing EA surgery from 2012 to 2022 was carried out. The results of a joint pediatric surgery and gastroenterology consultation program -which was implemented in 2018 and applies a protocol based on the new ESPGHAN-NASPGHAN guidelines- were analyzed. Patients were divided according to whether they had been treated before or after 2018. Quantitative variables -follow-up losses, anti-reflux treatment initiation and duration, and enteral nutrition initiation- and qualitative variables -prevalence of gastroesophageal reflux, anti-reflux surgery, respiratory infections, anastomotic stenosis, re-fistulizations, dysphagia, impaction episodes, need for gastrostomy, and endoscopic results- were compared. RESULTS: 38 patients were included. 63.2% had gastroesophageal reflux. 97.4% received anti-reflux treatment in the first year of life, with treatment being subsequently discontinued in 47.4%. Discontinuation time decreased by a mean of 24 months following program implementation (p< 0.05). A 4.6-fold increase in the frequency of pH-metries was noted following program implementation. The protocol standardized endoscopies in asymptomatic patients when they turn 5 and 10 years old. 25 endoscopies with biopsy were carried out after 2018, with histological disorders being detected in 28% of them. The number of follow-up losses significantly decreased following protocol implementation (p< 0.05). CONCLUSIONS: Digestive-surgical cross-disciplinary follow-up of EA patients has a positive impact on patient progression. Applying the guidelines helps optimize treatment and early diagnosis of complications.

OBJETIVOS: El objetivo de este estudio es analizar si los pacientes intervenidos de atresia de esófago (AE) se benefician de un programa de seguimiento multidisciplinar, basado en las guías clínicas actuales, implantado en nuestro centro. MATERIAL Y METODOS: Estudio retrospectivo, observacional y analítico incluyendo los pacientes intervenidos de AE entre 2012 y 2022. Se analizaron los resultados de la implantación en 2018 de un programa de consultas conjuntas de gastroenterología y cirugía pediátrica aplicando un protocolo basado en las nuevas guías ESPGHAN-NASPGHAN. Se dividieron a los pacientes tratados antes y después de 2018 y se compararon las variables cuantitativas: pérdidas de seguimiento, inicio y duración del tratamiento antirreflujo e inicio de nutrición enteral, y cualitativas: prevalencia de reflujo gastroesfoágico, realización de cirugía antirreflujo, infecciones respiratorias, estenosis de la anastomosis, refistulizaciones, disfagia, episodios de impactación, necesidad de gastrostomía y resultados de las endoscopias. RESULTADOS: Se incluyeron 38 pacientes. Un 63,2% presentaron reflujo gastroesofágico. El 97,4% tomaron tratamiento antirreflujo el primer año de vida que posteriormente se retiró en el 47,4%. El tiempo de retirada se redujo una media de 24 meses tras la aplicación del programa (p< 0,05). Se realizaron 4,6 veces más pHmetrías tras la implantación del programa. El protocolo estandarizó la realización de endoscopias en pacientes asintomáticos al cumplir 5 y 10 años. Se realizaron 25 endoscopias con tomas de biopsia después de 2018, detectando alteraciones histológicas en un 28%. El número de pérdidas de seguimiento se redujo de forma significativa tras la implantación del protocolo (p< 0,05). CONCLUSIONES: El seguimiento multidisciplinar digestivo-quirúrgico de los pacientes con AE genera un impacto positivo en su evolución. La aplicación de las guías facilita la optimización del tratamiento y el diagnóstico precoz de las complicaciones.

Laparoscopic surgery of congenital paraesophageal hernia in newborns and infants. / Cirugía laparoscópica de la hernia paraesofágica congénita en neonatos y lactantes.

INTRODUCTION: Congenital paraesophageal hernia (CPH) is a rare pathology in pediatric patients. Clinical signs may occur as early as in newborns, which means it requires early surgical repair. CLINICAL CASES: This is a series of three patients under 1 year of age diagnosed with type IV CPH - with symptoms occurring since they were newborns - who underwent laparoscopic surgical repair. One patient had been diagnosed prenatally. Age at surgery was 6 days, 36 days, and 9 months, respectively. Weight at surgery was 3.60 kg, 3.79 kg, and 8.20 kg, respectively. The patients underwent laparoscopy, with removal of the hernia sac, closure of the diaphragmatic pillars, placement of a reinforcement absorbable mesh, and Nissen fundoplication. Mean operating time was 130 minutes. No intraoperative complications were recorded. One patient developed a sliding hernia, which was subsequently repaired without complications. Mean follow-up time was 24 months.

INTRODUCCION: Las hernias paraesofágicas congénitas (HPC) son una patología poco frecuente en la edad pediátrica. Pueden presentar clínica desde la época neonatal precisando una reparación quirúrgica temprana. CASOS CLINICOS: Presentamos 3 casos diagnosticados de HPC tipo IV en pacientes menores de 1 año, que presentaron síntomas desde la época neonatal, en los que se ha realizado reparación quirúrgica laparoscópica. Un paciente presentaba diagnóstico prenatal. La edad en el momento de la cirugía fue 6 días, 36 días y 9 meses. El peso en el momento de la cirugía fue de 3,60 kg, 3,79 kg y 8,20 kg. Los pacientes fueron intervenidos por laparoscopia realizando excisión del saco herniario, cierre de pilares diafragmáticos, colocación de malla reabsorbible de refuerzo y una funduplicatura Nissen. El tiempo medio de cirugía fue de 130 minutos. No hubo complicaciones intraoperatorias. Un paciente presentó una hernia de deslizamiento que se reparó posteriormente sin complicaciones. El tiempo medio de seguimiento es de 24 meses.

Thyroid surgery in pediatric patients: causes and results. / Cirugía tiroidea en la edad pediátrica: causas y resultados.

OBJECTIVE: Even though thyroid surgery is rare in pediatric patients, frequency has increased in the last years. The objective of this study was to analyze the causes and results of these procedures in a pediatric surgical facility. PATIENTS AND METHODS: Retrospective study including all patients requiring thyroid surgery in our department from 2000 to 2019. Demographic data, diagnostic data, associated pathology, type of surgical procedure, pathological results, and intraoperative and postoperative complications were recorded. RESULTS: 47 patients with a mean age of 8.9 ± 3.9 years at surgery were included. The most frequent diagnosis was MEN syndrome (n = 30, 29 MEN 2A and 1 MEN 2B), followed by thyroid papillary carcinoma (n = 5), follicular adenoma (n = 5), multinodular goiter (n = 4), follicular carcinoma (n = 1), thyroglossal duct papillary carcinoma (n = 1), and Graves-Basedow syndrome (n = 1). 38 total thyroidectomies (73.7% of which were prophylactic), 3 double hemithyroidectomies, 5 hemithyroidectomies, and 5 lymphadenectomies were performed. No intraoperative complications or recurrent laryngeal nerve lesions were noted. Mean postoperative hospital stay was 1.3 ± 0.6 days. 7 patients had transitory asymptomatic hypoparathyroidism, and 1 patient had persistent symptomatic hypoparathyroidism. Pathological results of prophylactic thyroidectomies were: 18 C cell hyperplasias, 7 microcarcinomas, and 3 cases without histopathological disorders. CONCLUSIONS: Thyroid surgery in pediatric patients is safe if performed by specialized personnel. Even though it remains rare, frequency has increased in the last years.

OBJETIVO: La cirugía tiroidea es poco frecuente en la edad pediátrica, aunque ha aumentado su frecuencia en los últimos años. El objetivo de este estudio es analizar las causas y los resultados de estos procedimientos en un centro quirúrgico pediátrico. METODOS: Estudio retrospectivo que incluyó a todos los pacientes que necesitaron cirugía tiroidea en nuestro servicio entre 2000-2019. Se recogieron datos demográficos, diagnóstico, patología asociada, tipo de procedimiento quirúrgico realizado, resultados anatomopatológicos y complicaciones intra y posoperatorias. RESULTADOS: Se incluyeron 47 pacientes con una edad media en el momento de la intervención de 8,9 ± 3,9 años. El diagnóstico más frecuente fue síndrome MEN2 (n = 30, 29 MEN2A y 1 MEN2B), seguido de carcinoma papilar de tiroides (n = 5), adenoma folicular (n = 5), bocio multinodular (n = 4), carcinoma folicular (n = 1), carcinoma papilar del conducto tirogloso (n = 1) y síndrome de Graves-Basedow (n = 1). Se realizaron 38 tiroidectomías totales (el 73,7% fueron profilácticas), tres dobles hemitiroidectomías, cinco hemitiroidectomías y en cinco casos fue necesario realizar una linfadenectomía. No se presentaron complicaciones intraoperatorias ni lesiones de nervio laríngeo recurrente. La estancia media posoperatoria fue de 1,3 ± 0,6 días. Siete pacientes presentaron hipoparatiroidismo transitorio asintomático y en un caso, persistente sintomático. Los resultados anatomopatológicos de las tiroidectomías profilácticas fueron: 18 hiperplasias de células C, 7 microcarcinomas y 3 sin alteraciones histopatológicas. CONCLUSIONES: La cirugía tiroidea en la edad pediátrica es segura en manos de equipos especializados. Aunque sigue siendo un procedimiento poco habitual, su frecuencia está aumentando en los últimos años.

Pediatric surgical activity during the SARS-CoV-2 pandemic: experience at a tertiary hospital. / Cirugía pediátrica durante la pandemia de SARS-CoV-2. Experiencia en un hospital de tercer nivel.

OBJECTIVES: The primary objective was to describe the characteristics and demographics of the surgical procedures carried out at a tertiary hospital during the SARS-CoV-2 pandemic. The secondary objective was to study the impact of the pandemic on the acute appendicitis cases treated at our healthcare facility and to compare them with a pre- SARS-CoV-2 period. MATERIAL AND METHODS: A retrospective study of all patients undergoing surgery at the pediatric surgery department in the pandemic period, from the beginning of the state of emergency in Spain until the first restrictions were removed, was conducted. RESULTS: A total of 61 patients underwent surgery in 58 days vs. 406 patients in the same 2019 period (p < 0.00001). 59.01% of surgeries were urgent. 5.1% of patients had a positive SARS-CoV-2 diagnostic test. 30 different procedures were carried out, with appendectomy being the most frequent one (n = 13, 19.6% of patients). 61.5% of appendicitis cases were complicated vs. 42.4% in the non-COVID period (p = 0.17). Surgical approach was open in 46.1% of patients vs. 6.1% in the non-COVID period (p = 0.004). No statistically significant differences were found in terms of complication rate or hospital stay. CONCLUSIONS: During the SARS-CoV-2 pandemic, a significant decrease in the number of daily procedures was noted, with more than half being urgent. Appendicular pathologies were in a more advanced stage than usual, with a clear trend towards open surgery vs. laparoscopy.

OBJETIVOS: Describir las características y demografía de los procedimientos quirúrgicos realizados en un hospital de tercer nivel durante la pandemia del SARS-CoV-2. Como objetivo secundario se estudia el impacto de la pandemia en las apendicitis agudas tratadas en nuestro centro y su comparación con un periodo previo al SARS-CoV-2. MATERIAL Y METODOS: Estudio retrospectivo incluyendo a todos los pacientes intervenidos por parte del Servicio de Cirugía Pediátrica durante el periodo de pandemia. Abarca desde el primer día del estado de alarma hasta la desescalada de las restricciones. RESULTADOS: Se intervinieron un total de 61 pacientes en 58 días frente a 406 pacientes durante el mismo periodo de 2019 (p < 0,00001). El 59,01% de las intervenciones eran de carácter urgente. Un 5,1% de los pacientes tuvieron un test diagnóstico de SARS-CoV-2 positivo. Se realizaron 30 procedimientos distintos, siendo el más frecuente la apendicectomía (n = 13, 19,6% de los pacientes). El 61,5% de las apendicitis fueron complicadas frente a un 42,4% en periodo no COVID (p = 0,17). El abordaje quirúrgico fue abierto en un 46,1% de los pacientes frente al 6,1% no COVID (p = 0,004). No hubo diferencias estadísticamente significativas en la tasa de complicaciones o la estancia hospitalaria. CONCLUSIONES: Durante la pandemia por SARS-CoV-2 se ha producido una importante disminución del número de procedimientos diarios, pasando a ser más de la mitad de carácter urgente. La patología apendicular se ha presentado más evolucionada de lo habitual, habiendo una clara tendencia a la cirugía abierta frente a la laparoscopia.

Bronchoalveolar lavage usefulness in the pediatric population. / Rentabilidad del lavado broncoalveolar en la población pediátrica.

OBJECTIVE: To analyze bronchoalveolar lavage diagnostic effectiveness and impact on therapeutic management in pediatric patients. MATERIAL AND METHODS: Retrospective study of patients undergoing bronchoalveolar lavage at the pediatric surgery department from 2009 to 2019. The sample was divided into two groups: hemato-oncological patients and non-hemato-oncological patients. Demographic variables, bronchoalveolar lavage result, and subsequent therapeutic attitude were collected. RESULTS: 45 bronchoalveolar lavages were carried out in 38 patients. The hemato-oncological group consisted of 25 bronchoalveolar lavages. Patient mean age was 9.99 ± 2.34 years. 80% of patients had received anti-infective treatment prior to bronchoalveolar lavage. Bronchoalveolar lavage culture was positive in 52% of cases. Bronchoalveolar lavage results translated into therapeutic management change in 24% of cases (6/25). 3 postoperative complications were recorded, all mild. In the non-hemato-oncological group (n = 20), mean age was 6.70 ± 5.17 years. Bronchoalveolar lavage was positive in 25% of cases, and translated into management change in 5% of patients. Complication rate in this group was 30%. 2 patients required mechanical ventilation. CONCLUSIONS: According to our results, bronchoalveolar lavage in hemato-oncological patients helps achieve microbiological diagnosis in infectious respiratory conditions and is relatively well-tolerated. In non-hemato-oncological patients, diagnostic and therapeutic usefulness is low, and complication rate is not negligible. The risk-benefit balance should be individually considered in each patient.

OBJETIVO: Analizar la eficacia diagnóstica del lavado broncoalveolar y su impacto en el manejo terapéutico en pacientes pediátricos. MATERIAL Y METODOS: Estudio retrospectivo incluyendo a los pacientes a los que se les realizó un lavado broncoalveolar por parte del Servicio de Cirugía Pediátrica entre 2009 y 2019. Se ha dividido la muestra en dos grupos: pacientes hemato-oncológicos y no hemato-oncológicos. Se han recogido variables demográficas, el resultado del lavado broncoalveolar y la actitud terapéutica posterior. RESULTADOS: Se realizaron 45 lavados broncoalveolares en 38 pacientes. El grupo hemato-oncológico constaba de 25 lavados broncoalveolares. Los pacientes tenían una edad media de 9,99 ± 2,34 años. El 80% de los pacientes tenían tratamiento antiinfeccioso previo al lavado broncoalveolar. El cultivo del lavado broncoalveolar fue positivo en el 52% de los casos. El resultado del lavado broncoalveolar influyó en un cambio de manejo terapéutico en un 24% (6/25). Se produjeron 3 complicaciones postoperatorias, todas leves. En el grupo no hemato-oncológico (n = 20) la edad media era de 6,70 ± 5,17 años. El lavado broncoalveolar fue positivo en el 25% y supuso un cambio de manejo en un 5% de los pacientes. Este grupo tuvo una tasa de complicación del 30%, 2 pacientes requirieron ventilación mecánica. CONCLUSIONES: Según nuestros resultados, el lavado broncoalveolar en los pacientes hemato-oncológicos ayuda al diagnóstico microbiológico en procesos respiratorios infecciosos y es relativamente bien tolerado. En los no hemato-oncológicos, tiene una baja rentabilidad diagnóstico-terapéutica con una tasa de complicaciones no desdeñable. Sería necesario individualizar el balance beneficio-riesgo en cada paciente.

Measuring esophageal anastomotic stricture index as a predictor of dilatation following esophageal atresia surgical repair. / Medición del índice de estenosis de la anastomosis esofágica como predictor de dilatación tras la corrección quirúrgica de la atresia esofágica.

INTRODUCTION: Anastomotic stricture is the most common complication following esophageal atresia (EA) surgical repair. The objective of this study was to evaluate Anastomotic Stricture Index (ASI: relationship between pouch and stricture diameters in the postoperative esophagram) as a predictor of the need for esophageal dilatation. METHODS: A retrospective review of all patients undergoing EA repair in our healthcare facility from 2009 to 2017 was designed. Proximal pouch ASI (proximal ASI) and distal pouch ASI (distal ASI) in the first and second postoperative esophagram were calculated, and correlation with the number of esophageal dilatations required was studied. For statistical analysis purposes, Spearman's correlation test and ROC curves were used. RESULTS: Of the 31 patients included, 21 (67.7%) required esophageal dilatation, and 11 (35.5%) required 3 or more dilatations. The relationship between ASIs in the first esophagram and the need for esophageal dilatation was not statistically significant (p >0.05). The relationship between proximal ASI (RHO = 0.84, p <0.05) and the number of dilatations in the second esophagram was statistically significant. None of the patients with <0.55 proximal ASI required dilatation; patients with 0.55-0.79 proximal ASI required less than 3 dilatations; and patients with >0.79 proximal ASI had a high risk of requiring 3 or more dilatations. CONCLUSION: According to our study, measuring ASI in the second esophagram proves useful in predicting EA patients' postoperative management, especially when it comes to identifying patients with lower risk of undergoing multiple dilatations.

INTRODUCCION: La estenosis esofágica es la complicación más frecuente tras la corrección de la atresia esofágica (AE). El objetivo de este estudio es el análisis de los Índices de estenosis de la anastomosis (IEA: relación entre los diámetros de los bolsones y de la estenosis en el esofagograma postoperatorio) como predictores de la necesidad de dilatación esofágica. METODOS: Se diseña un estudio retrospectivo incluyendo los pacientes con AE y anastomosis esofágica en nuestro centro entre 2009-2017, calculando los IEA del bolsón proximal (IEA-proximal) y distal (IEA-distal) en el primer y segundo esofagograma postoperatorio, analizando su correlación con el número de dilataciones esofágicas que necesitaron. Para el análisis estadístico, se ha empleado el test de correlación de Spearman y las curvas ROC. RESULTADOS: Se incluyeron 31 pacientes: 21 precisaron dilatación esofágica (67%), y 11 de ellos (35%) 3 o más dilataciones. No se demostró relación estadísticamente significativa entre los IEA del primer esofagograma con la necesidad de dilatación esofágica (p >0,05). Se observó una relación entre el IEA-proximal (rho = 0,84, p <0,05) y el número de dilataciones en el segundo esofagograma. Ningún paciente con ASI-proximal <0,55 necesitó dilatación; los pacientes con ASI-proximal entre 0,55-0,79 precisaron menos de 3 dilataciones y los pacientes con ASI-proximal >0,79 presentaron alto riesgo de necesitar 3 o más dilataciones. CONCLUSION: Según los resultados de nuestro estudio, la medición de IEA en el segundo esofagograma constituye una herramienta útil para predecir el manejo postoperatorio en pacientes con AE, especialmente en la identificación de aquellos con menor riesgo de someterse a múltiples dilataciones.

Dispositivos intravasculares centrales de inserción subcutánea en el paciente oncológico pediátrico, ¿podemos minimizar su infección? / Subcutaneously inserted central intravascular devices in the pediatric oncology patient: can we minimize their infection

Los dispositivos intravasculares centrales de implantación subcutánea(DICIS) son utilizados frecuentemente en pacientes pediátricos. Su principal complicación es la infección, que puede requerir su retirada. El objetivo de nuestro trabajo es estudiar los factores de riesgo relacionados con su infección y retirada. Estudio retrospectivo de 120 pacientes oncológicos en los que se implantó un DICIS entre los años 2003-2009. Estudiamos factores epidemiológicos, quirúrgicos, clínicos y microbiológicos. Realizamos un análisis comparativo entre: grupo A, pacientes que presentaron infección, grupo B, el resto. El grupo A se dividió en subgrupos: infección precoz(primer mes postimplantación)/tardía, retirados/no retirados. Los datos fueron analizados mediante el programa estadístico SPSS. De 120 niños, 29 sufrían leucemia,19 linfoma y 72 tumor sólido. Un31% presentaron infección (grupo A), siendo precoz en un 36%. Un 16%de los dispositivos infectados requirió retirada. Analizando los factores relacionados con la infección se encontró diferencia estadísticamente significativa en la edad (p=0,015) y en el hecho de recibir quimioterapia previa a la implantación (p=0,034). El resto de parámetros analizados no arrojaron resultados significativos, si bien es cierto que se observó una tendencia a ésta en los pacientes con diagnóstico de leucemia, en los portadores de vía subclavia, en los que el dispositivo se colocó através de una guía sobre una vía central previa y en los trasplantados. En (..) (AU)

Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation) / late infection, removed /not removed. Data were analized with statistical program SPSS.29 suffered from leukemia, 19 from lymphoma and the main part,72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but (..)(AU)

[Subcutaneously inserted central intravascular devices in the pediatric oncology patient: can we minimize their infection]. / Dispositivos intravasculares centrales de inserción subcutánea en el paciente oncológico pediátrico, ¿podemos minimizar su infección?

Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation)/late infection, removed/not removed. Data were analized with statistical program SPSS. 29 suffered from leukemia, 19 from lymphoma and the main part, 72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but could be guess a relationship among infection and leukemia, subclavian catheters, those patients whose deviced was introduced using a guide over a previous catheter and also transplanted. Related to early infection the only associateon founded was with the subclavian access (p=0.018). In conclusion, in our serie long-term central venous access infection was more frequent in the younger patients and also in those who had received chemotherapy the week before the catheter implantation. The tendency towards infection in leukemia, transplanted and subclavian carriers has to be studied in a prospective way with a larger number of oncologic children.

[Effectiveness of high pressure balloon dilatation in the treatment of postsurgical strictures of urinary tract in children]. / Efectividad de la dilatación retrógrada con balón de alta presi6ón de estenosis posquirúrgicas de la vía urinaria en la edad pediátrica.

INTRODUCTION: Endoscopic dilatation using a high pressure balloon is a widely used technique for the treatment of strictures of the urinary tract secondary to surgery in adult patient. Several studies have evaluated its usage in the treatment of primary and secondary strictures of the urinary tract of child with a disparity of results. GOAL: Evaluate Effectiveness and Safetiness of high pressure balloon dilatation and double "J" implantation in the treatment of postsurgical strictures of urinary tract in children. PATIENTS AND METHODS: Retrospective study of endoscopic dilatation of secondary to surgery strictures performed in our unit during the last past 18 months. Demographical data, surgical records, symptoms, renal function, dilatation technique, postsurgery complications and ultrasonography and isotopic data (pre and post dilatation) were evaluated. RESULTS: Six children, aged 13 months-9 years (media = 4.3 years) were treated in our unit. Four presented ureteropelvic junction obstruction (UPO) after Anderson-Hynes pyeloplasty and 2 vesico-ureteral junction stenosis (VUO) in 3 reimplants units, (one with Cohen tecnique and two with Politano tecnique). All 6 patients showed dilatation of urinary tract and isotopic diuretic renogram prior to dilatation that showed for all cases an obstructed pattern with T1/2 > 20 minutes. Two of the children presented lumbar pain and one of them had suffered an urine infection. Time interval between surgery and dilatation varied between 23 and 118 months. Surgical technique used for all cases was high pressure retrograde balloon dilatation and placement of double "J" before retrograde pielography. In all patients a double J catheter was implanted and left in place for 4 to 9 weeks. Technical inability to place the catheter after the expansion forced to the accomplishment of a percutaneus nephrostomy echo guided in one case. One of the children showed hematuria up to 7 days after dilatation procedure. Hospilatization varied between 24 hours to 10 days being (moda = 3 days). The patient that needed nephrostomy underwent ulterior sucessful dilatation 4 months after first procedure. The 2 children presenting vesico-ureteral junction stricture underwent calibration 10 and 12 months after dilatation, showing both good caliber. Diuretic renogram curve Improvement was confirmed for all patients but one of the VUO children that showed renal function deterioration after dilatation procedure. Lumbar pain disappear for both 2 children that had referred it. CONCLUSIONS: Endoscopic dilatation of strictures of urinary tract using balloon in children that were previously sommeted to surgical interventions is technically available and shows good results in the short-medium term with low index of post procedural complications, so, it should be considered as initial treatment for these patients.

[Therapeutic strategy in cloacal exstrophy]. / Estrategia terapéutica en la extrofia de cloaca femenina.

Cloacal exstrophy is a complex multisistemic anomaly that involves gastrointestinal and genitourinary issues. The aim of our paper is to report our experience in dealing with genital reconstruction and faecal and urinary continence in patients with female cloacal anomalies. We reviewed the clinical records from the three patients we have achieved a final reconstruction. We recorded the surgical management and both functional and anatomic results. The three of them required a bladder neck closure associated with a continent stoma, they are dry with intermittent catheterization and free of upper urinary complications. Genital reconstruction required a unique plan for each one, according to their anatomy and their cosmetic desires. One of the patients reported satisfactory sexual intercourse. Management of patients with cloacal exstrophy has major concerns about urinary and fecal continence and about genital reconstruction and function. Knowing the long-term results may help to develop management strategies and improve counselling for patients who have under-gone reconstruction.

Fractionation of the naringinase complex from Aspergillus terreus by dye affinity chromatography.

Affinity chromatography with immobilised triazine dyes was used to separate the main enzymes present in the naringinase complex produced by Aspergillus terreus CECT 2663. One alpha-L-rhamnosidase and two beta-D-glucosidases (beta G1 and beta G2) were separated by a simple two-step procedure involving chromatography with Red HE-3B immobilised on Sepharose 4B first at pH 5.5 and then at pH 4.7. Maximum activity of the beta-D-glucosidases was from pH 4 to 6 and at 65 degrees C. Both glucosidases were active on p -nitrophenol glucoside and prunin with respective Km values of 1.9 mm and 1.6 mm for beta G1 and 2.1 mm and 0.25 mm for beta G2. Only beta G1 hydrolysed cellobiose (Km = 5.7 mm).

Liesegang rings in a dermoid cyst of the floor of the mouth. Report of a case with cytologic findings.

BACKGROUND: Eosinophilic, ring-shaped structures, referred to as Liesegang rings (LRs), have been identified in aspirates from many organs, usually in relation to cystic or inflammatory lesions, but never before in relation to a dermoid cyst. CASE: LRs were intermingled with squamous cells in aspirates from a cyst of the floor of the mouth. The patient, a 23-year-old man, presented with a sublingual mass that had recently grown. Histopathologic study showed a ruptured dermoid cyst with mural foci of granulomatous foreign body reaction mixed with numerous ringlike structures, LRs. CONCLUSION: To the best of our knowledge, this is the first reported case of LRs in a dermoid cyst. Pathologists should be aware of this association when diagnosing cystic lesions.

Foot and mouth disease virus concentration and purification by affinity chromatography.

Foot and mouth disease virus, (FMDV) from a crude cell lysate was purified in a single step by affinity chromatography with heparin as a ligand. The virus eluted from an Heparin-Ultrogel A4R column at 1M sodium chloride in 10 mM sodium phosphate buffer, pH 7.0, while most cell protein and albumin did so at lower concentrations of sodium chloride in the same buffer. Purity of the eluted fraction containing the virus was assessed by SDS-PAGE, HPLC, ultracentrifugation, and UV absorption spectrum. With this method, intact viral particles are recovered in high yield (over 90%) and specific virus purity increases nearly 1000-fold. The capacity of the chromatographic matrix for the virus was found to be 1.1 mg viral mass per mL of hydrated gel.

Tratamiento de la roncopatía crónica con láser CO2, (LAUP) / Treatment of chronic snoring with CO2 laser - LAUP

La uvulopalatoplastia con Láser C02 es un procedimiento muy efectivo en el tratamiento quirurgico de la roncopatia cronica. Se hace bajo anestesia local y de forma ambulatoria, ampliando el espacio aereo orofaringeo y tallando una neouvula, actuando además sobre el veto y ambos pilares. Este metodo mejora el SAS y el de resistencia de las vias aereas superiores, pudiendose asi mismo usar el laser en el resto de factores coadyuvantes siguiendo las directrices de los procedimientos clasicos, como p.e. a nivel de la base de la lengua y exeresis total o parcial de las amigdalas (LAUP ampliada), pero en este ultimo caso bajo anestesia general. Hemos empleado la LAUP en 112 pacientes tratados en los últimos tres años logrando la curación en el 87.5 por ciento

[Epidemiologic aspects of cancer of the nasopharyngeal cavum]. / Aspectos epidemiológicos del cáncer de cávum.

We have made a retrospective study of 22 patients with CC. We have studied epidemiologic and clinical factors and we related them with similar studies.

[The anamnesis as a global strategy with the vestibular patient. A model presentation]. / La anamnesis como estrategia global ante el enfermo vestibular. Presentación de un modelo.

An anamnesis model for management patient with vertigo or dizziness caused by disturbance of vestibular system were presented. Data were sorted in eight axis: Axis I (symptoms), Axis II (physical examination), Axis III (electrophysiological findings), Axis IV (associate pathology), Axis V (laboratory tests), Axis VI (psychosocial), Axis VII (therapeutic response) and Axis VIII (familiar antecedents).

[Neoadjuvant chemotherapy with cis-platin and 5-fluorouracil in continuous infusion (96 h.), in stages III and IV of carcinomas of the upper aerodigestive tract]. / Quimioterapia neoadyuvante con Cis-Platino y 5-Fluoracilo en infusión contínua (96 h.), en los estadíos III y IV de los carcinomas de vías aerodigestivas superiores.

We have studied 37 patients with advanced head and neck cancer. A combination of Cis-Platinum and 5-Fluorouracil, both administered four days continuously as infusion, was assessed. There were 15 complete responses (40.5%), 15 partial responses (40.5%) and the number of objective responses was 30 (81.5%). Survival is 79.1% at 22 months and none of the patients in complete responses has relapsed during this period.

Serum TATI levels and clinical correlation in tumors of the head and neck.

By radioimmunoassay (RIA) we studied tumor-associated trypsin inhibitor (TATI) in 152 serum samples, divided into three groups: 35 healthy subjects, used as controls; 25 individuals with benign pathology of the ear, nose and throat (ENT) region; 92 serial samples obtained from 69 patients with malignant disease of the head and neck. The malignant ENT group were classified in four stages according to the degree of tumor activity. The TATI concentrations (mean +/- SD) were as follows: control group, 16.0 +/- 3.4; benign group, 17.1 +/- 6.7; A0, 14.8 +/- 11.5; A1, 12.1 +/- 3.5; A2, 17.01 +/- 1.4; A3, 43.0 +/- 54.9.