Vesicoureteral reflux in patients diagnosed with pyeloureteral junction obstruction. Is screening justified? / Reflujo vesicoureteral en pacientes diagnosticados de estenosis de la unión pieloureteral. ¿Está justificado el screening?

INTRODUCTION: The prevalence of vesicoureteral reflux (VUR) concomitant with pyeloureteral junction obstruction (PUJO) ranges from 5.2% to 18%. Today, there is no consensus on whether routine screening should be performed or not to rule out reflux, and it can be limited to selected patients. OBJECTIVES: To study VUR prevalence in patients diagnosed with PUJO, estimate reflux levels in patients with positive study, and limit serial voiding cystourethrogram (SVCU) or ultrasound cystography to selected patients (dilated ureter at ultrasound imaging and previous UTI). MATERIALS AND METHODS: Observational, retrospective study carried out in 74 patients undergoing surgery for PUJO. Information on sex, preoperative VUR screening, results (positive or negative for VUR), and reflux levels was collected. RESULTS: 53 cases (71.6%) were male and 21 (28.4%) were female. Reflux screening was performed in 55 patients (74.3%), vs. 18 (24.3%) where no study was carried out. 16.2% of cases with VUR preoperative study were managed using ultrasound cystography. The preoperative study was positive in 6 out of the 73 patients (1 patient was excluded after being diagnosed with posterior urethral valves), which means VUR prevalence in patients already diagnosed with PUJO was 10.7%. Of the six cases, one case was grade I, two cases were grade II, one case was grade III, one case was grade IV, and one case was grade V. CONCLUSIONS: VUR has a slightly higher incidence in patients diagnosed with pyeloureteral junction obstruction than in the general population. Routine screening of vesicoureteral reflux is unnecessary, unless in case of previous urinary infection, dilated ureter at ultrasound imaging, or suspected secondary cause.

INTROUCCION: La concomitancia entre la estenosis de la unión pieloureteral (EPU) y el reflujo vesicoureteral (RVU) se sitúa entre el 5,2 y el 18%. Actualmente, no existe consenso sobre la realización de screening rutinario para descartar dicho reflujo, pudiendo limitarlo a pacientes seleccionados. OBJETIVOS: Estudiar la prevalencia del RVU en los pacientes diagnosticados de EPU. Estimar el grado de reflujo en aquellos pacientes con estudio positivo. Limitar la realización de cistouretrografía miccional seriada CUMS o de ecocistografía a pacientes seleccionados (uréter dilatado visible en ecografía, ITU previa). MATERIAL Y METODOS: Estudio observacional y retrospectivo sobre 74 pacientes intervenidos de EPU. Se ha recogido información acerca del sexo, realización de despistaje preoperatorio de RVU, los resultados (positivo o negativo para RVU) y grado de reflujo. RESULTADOS: 53 casos fueron masculinos (71,6%) y 21 (28,4%) femeninos. El despistaje de reflujo fue realizado en 55 pacientes (74,3%) frente a 18 (24,3%) en los que no se realizó ningún estudio. El 16,2% de los casos en los que se realizó el estudio preoperatorio de RVU fueron abordados mediante ecocistografía, siendo el estudio preoperatorio positivo en 6 pacientes del total de 73 estudiados (un paciente fue excluido por ser diagnosticado de válvulas de uretra posterior), lo que sitúa la prevalencia de RVU en pacientes ya diagnosticados de EPU en un 10,7%. De estos, un caso fue de grado I, dos grado II y un caso grado III, IV y V, respectivamente. CONCLUSIONES: El RVU en pacientes diagnosticados de estenosis de la unión pieloureteral presenta una incidencia ligeramente mayor que en la población general. El screening rutinario del reflujo vesicoureteral es innecesario, debiendo realizarse en casos que presenten infecciones urinarias previas, visualización del uréter dilatado en la ecografía o sospecha de causa secundaria.

Reflujo vesicoureteral en pacientes diagnosticados de estenosis de la unión pieloureteral. ¿Está justificado el screening? / Vesicoureteral reflux in patients diagnosed with pyeloureteral junction obstruction. Is screening justified?

Introducción: La concomitancia entre la estenosis de la unión pieloureteral (EPU) y el reflujo vesicoureteral (RVU) se sitúa entre el 5,2 y el 18%. Actualmente, no existe consenso sobre la realización de screening rutinario para descartar dicho reflujo, pudiendo limitarlo a pacientes seleccionados. Objetivos: Estudiar la prevalencia del RVU en los pacientes diagnosticados de EPU. Estimar el grado de reflujo en aquellos pacientes con estudio positivo. Limitar la realización de cistouretrografía miccional seriada CUMS o de ecocistografía a pacientes seleccionados (uréter dilatado visible en ecografía, ITU previa). Material y métodos: Estudio observacional y retrospectivo sobre 74 pacientes intervenidos de EPU. Se ha recogido información acerca del sexo, realización de despistaje preoperatorio de RVU, los resultados (positivo o negativo para RVU) y grado de reflujo. Resultados: 53 casos fueron masculinos (71,6%) y 21 (28,4%) femeninos. El despistaje de reflujo fue realizado en 55 pacientes (74,3%) frente a 18 (24,3%) en los que no se realizó ningún estudio. El 16,2% de los casos en los que se realizó el estudio preoperatorio de RVU fueron abordados mediante ecocistografía, siendo el estudio preoperatorio positivo en 6 pacientes del total de 73 estudiados (un paciente fue excluido por ser diagnosticado de válvulas de uretra posterior), lo que sitúa la prevalencia de RVU en pacientes ya diagnosticados de EPU en un 10,7%. De estos, un caso fue de grado I, dos grado II y un caso grado III, IV y V, respectivamente. Conclusiones: El RVU en pacientes diagnosticados de estenosis de la unión pieloureteral presenta una incidencia ligeramente mayor que en la población general. El screening rutinario del reflujo vesicoureteral es innecesario, debiendo realizarse en casos que presenten infecciones urinarias previas, visualización del uréter dilatado en la ecografía o sospecha de causa secundaria

Introduction: The prevalence of vesicoureteral reflux (VUR) con-comitant with pyeloureteral junction obstruction (PUJO) ranges from 5.2% to 18%. Today, there is no consensus on whether routine screening should be performed or not to rule out reflux, and it can be limited to selected patients. Objectives: To study VUR prevalence in patients diagnosed with PUJO, estimate reflux levels in patients with positive study, and limit serial voiding cystourethrogram (SVCU) or ultrasound cystography to selected patients (dilated ureter at ultrasound imaging and previous UTI). Materials and methods: Observational, retrospective study carried out in 74 patients undergoing surgery for PUJO. Information on sex, preoperative VUR screening, results (positive or negative for VUR), and reflux levels was collected. Results: 53 cases (71.6%) were male and 21 (28.4%) were female. Reflux screening was performed in 55 patients (74.3%), vs. 18 (24.3%) where no study was carried out. 16.2% of cases with VUR preoperative study were managed using ultrasound cystography. The preoperative study was positive in 6 out of the 73 patients (1 patient was excluded after being diagnosed with posterior urethral valves), which means VUR prevalence in patients already diagnosed with PUJO was 10.7%. Of the six cases, one case was grade I, two cases were grade II, one case was grade III, one case was grade IV, and one case was grade V. Conclusions: VUR has a slightly higher incidence in patients diagnosed with pyeloureteral junction obstruction than in the general population. Routine screening of vesicoureteral reflux is unnecessary, unless in case of previous urinary infection, dilated ureter at ultrasound imaging, or suspected secondary cause

Classical biological control of the African citrus psyllid Trioza erytreae, a major threat to the European citrus industry.

Citrus greening or huanglongbing (HLB) is the main threat to the European citrus industry since one of its vectors, the African citrus psyllid, Trioza erytreae, has recently become established in mainland Europe. In this context, classical biological control programmes should be implemented to reduce the spread of the psyllid. The aims of this study were to: i) disentangle the parasitoid complex of T. erytreae combining morphological and molecular characterization; and ii) to study the biology of its main parasitoids in its area of origin in South Africa for their future importation into Europe. The main citrus producing areas of South Africa were surveyed during 2017. In contrast to previous studies, the parasitoid complex of T. erytreae included three species of primary parasitoids: Tamarixia dryi, Psyllaephagus pulvinatus and another parasitoid of the genus Tamarixia. Molecular analysis showed that it is a new species closely related to T. dryi. Tamarixia dryi was the most abundant parasitoid but its relative abundance varied among sampling sites. The sex ratio (males/females) of T. dryi and Tamarixia sp. decreased with T. erytreae size and became female biased when psyllid nymphs were larger than 0.6 and 1.2 mm2, respectively. These parasitoids were attacked by three species of hyperparasitoids, Aphidencyrtus cassatus, Marietta javensis and a species of the genus Aphanogmus. Aphidencyrtus cassatus, the most abundant hyperparasitoid, tended to emerge from large nymphs, and adult females lived as long as those of T. dryi. The implications of these results are discussed within the framework of the introduction of T. dryi into Europe.

Aggregation Patterns, Sampling Plan, and Economic Injury Levels for the New Citrus Pest Delottococcus aberiae (Hemiptera: Pseudococcidae).

Delottococcus aberiae De Lotto (Hemiptera: Pseudococcidae) is the latest exotic mealybug species introduced in citrus in the Mediterranean basin. It causes severe distortion and size reduction on developing fruits. Due to its first interaction with citrus, D. aberiae economic thresholds are still unknown for this crop and the current Integrated Pest Management programs have been disrupted. The objectives of this study were to determine the aggregation patterns of D. aberiae in citrus, develop an efficient sampling plan to assess its population density, and calculate its Economic and Economic Environmental Injury Levels (EIL and EEIL, respectively). Twelve and 19 orchards were sampled in 2014 and 2015, respectively. At each orchard, population densities were monitored fortnightly in leaves, twigs, and fruit, and fruit damage was determined at harvest. Our results showed a clumped aggregation of D. aberiae in all organs with no significant differences between generations on fruit. Fruit damage at harvest was strongly correlated with fruit occupation in spring. Based on these results and using chlorpyrifos as the insecticide of reference, the EIL and EEIL were calculated as 7.1 and 12.1% of occupied fruit in spring, respectively. With all this, we recommend sampling 275 fruits using a binomial sampling method or alternatively, 140 fruits with an enumerative method bimonthly between petal fall and July.

Analytical investigation of Mudéjar polychrome on the carpentry in the Casa de Pilatos palace in Seville using non-destructive XRF and complementary techniques.

The pigments, execution technique and repainting used on the polychrome wood ceilings and doors in the Casa de Pilatos (Seville, Spain) were studied using portable X-ray fluorescence equipment. Cross-sections of small samples were also analysed by optical microscopy, SEM with EDX analysis, micro-Raman and micro-infrared spectroscopy and X-ray diffraction. These carpentry works are magnificent examples of the Mudéjar art made in Spain in the early 16th century. Portable X-ray fluorescence gave good information on the different components of the polychrome. The SEM-EDX study of the surfaces of small samples gave information on their components and also characterized the compounds that had been deposited or formed by environmental contamination or by the alteration of some pigments. The SEM-EDX study of cross-sections facilitated the characterization of all layers and pigments from the support to the most external layer. The following pigments were characterized: red (cinnabar/vermillion, lead oxide, iron oxides and orpiment/realgar), black (carbon black), white (white lead and titanium barium white), yellow-orange-red-brown (orpiment/realgar and iron oxides), green (chromium oxide), blue (indigo blue and ultramarine blue), and gilding (gold leaf on bole). False gold, bronze and brass were also found. The pigments were applied with the oil painting technique over a support layer that had been primed with animal glue. This support layer was gypsum in some cases and white lead in others. This study is essential to the polychrome conservation of the studied artwork, and it will help clarify uncertainties in the history and painting of Mudéjar art.

Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología / Recommendations on making decisions and end of life care in neonatology

Los profesionales sanitarios que trabajamos en las unidades de neonatología consideramos que una parte muy importante de nuestro trabajo es el cuidado del recién nacido enfermo y su familia, cuando el neonato presenta una enfermedad incurable o va a morir. El esfuerzo se centra en evitar tratamientos desproporcionados e inútiles, que producen dolor, disconfort y separan al niño de su familia. Estas situaciones suelen ocurrir cuando el neonato tiene una enfermedad incurable, inmadurez extrema con complicaciones o graves malformaciones congénitas. En este documento, el Grupo de Trabajo de Ética de la Sociedad Española de Neonatología realiza una reflexión sobre la toma de decisiones en esta edad de la vida. Se han revisado los aspectos éticos de la limitación de los tratamientos, las bases del proceso de toma de decisiones que deben incluir la información adecuada, la relación de confianza y la deliberación entre padres y profesionales para tomar una decisión correcta. Se destaca la importancia del cuidado de la familia con una situación compleja y de gran sufrimiento, cuando se enfrenta a la recomendación de los profesionales de limitar tratamientos al presentar su hijo una enfermedad de mal pronóstico. La atención al neonato enfermo al final de la vida, y a sus familiares, requiere un considerable esfuerzo, dedicación y formación de todo el personal sanitario. La experiencia cercana de forma reiterada al sufrimiento y a la muerte puede afectar negativamente a los profesionales implicados. Para finalizar, se realiza una reflexión de los aspectos jurídicos de la limitación del tratamiento, la retirada del soporte vital y cómo se deben de realizar y documentar el proceso de decisión, la retirada del soporte vital, la valoración de síntomas y el control del dolor y la sedación(AU)

Healthcare-professionals who work in neonatal units believe that a very important part of their work is the care of sick newborns, and their families if the neonate has an incurable disease or will die. The effort is focused on preventing disproportionate and unnecessary treatments that result in pain and discomfort, and also separate the child from his family. These situations usually occur when the infant has a terminal illness, extreme immaturity with complications, or severe birth defects. The care of the sick neonate care at the end of life, and their families requires a considerable effort, dedication and training of all health personnel. The repeated experience of being close to suffering and death can adversely affect the professionals involved. Finally, there is mention of the legal aspects of limiting treatment, how to perform and document decision process, the withdrawal of life support, assessment of symptoms and pain control and sedation. In this paper, the Ethics Working Group of the Spanish Society of Neonatology reflects on decision making at this time of life. The ethical aspects are reviewed, including, limiting treatment, the basis of decision-making process (that should include adequate information), the relationship of trust, and deliberation between parents and professionals to make the right decision. It highlights the importance of caring for the family in a complex situation and of great suffering, when faced with the recommendation of professionals to limit treatment because their child suffers from a disease with a poor prognosis(AU)

El Servicio de neonatología en el Hospital Universitario La Paz en el año 2012 / Neonatology Department in the Hospital Universitario La Paz in the year 2012

En relación con el estado actual del Servicio de neonatología (SN), tras señalar la misión y visión del mismo, se concreta la información estructural y cartera de servicios. A continuación se describen la actividad asistencial en el paciente ingresado y en consulta de seguimiento, la actividad docente de pregrado, médicos residentes y formación continuada y las estrategias de mejora de la calidad del SN en el seno de redes nacionales e internacionales. Por último, se destacan objetivos asistenciales y de investigación actuales del SN. Repetidas veces se hace alusión a participación de la familia en todas las actividades del SN del H. Materno Infantil La Paz (AU)

The current situation, objectives and level of care provided by the Neonatal Unit of La Paz Children´s Hospital are specified. Data ate reported of clinical activity in inpatient care and follow-up programs for high risk patients. Undergraduate teaching, pediatrics residency programs, continued quality improvement and education strategies with participation in specific national and global neonatal databases are described. Future clinical and research objectives are highlighted. Family centered and parental involvement in care is considered a major aim in all activities in the neonatal unit (AU)

Risk factors for the development of necrotizing enterocolitis: a case-control study.

AIM: To determine risk or protective factors for the development of necrotizing enterocolitis in very low birth weight infants. METHODS: This retrospective case-control study was conducted at La Paz University Hospital including infants with a birth weight of <1500 g for three years. Cases with confirmed diagnosis of necrotizing enterocolitis were evaluated; each one was paired with a control infant of the same gestational age. Statistical analysis included unadjusted and multivariable analyses. RESULTS: A total of 576 very low birth weight infants were admitted; of them 30 infants (5.2%) developed necrotizing enterocolitis. The main clinical and demographic characteristics did not differ between the two groups. The frequency of infants transfused with packed red blood cells was similar in cases (63%) and control patients (77%). However, a greater number of transfusions increased the odds of necrotizing enterocolitis [OR 1.5, 95%CI (1.01 to 2.24)]. CONCLUSIONS: A greater number of transfusions of packed red blood cells are associated with an increased risk of necrotizing enterocolitis in very low birth weight infants. The other analyzed variables in this study do not identify the infants at risk. Caution is advocated in using transfusions in newborns.

[Recommendations on making decisions and end of life care in neonatology]. / Recomendaciones sobre toma de decisiones y cuidados al final de la vida en neonatología.

Healthcare-professionals who work in neonatal units believe that a very important part of their work is the care of sick newborns, and their families if the neonate has an incurable disease or will die. The effort is focused on preventing disproportionate and unnecessary treatments that result in pain and discomfort, and also separate the child from his family. These situations usually occur when the infant has a terminal illness, extreme immaturity with complications, or severe birth defects. In this paper, the Ethics Working Group of the Spanish Society of Neonatology reflects on decision making at this time of life. The ethical aspects are reviewed, including, limiting treatment, the basis of decision-making process (that should include adequate information), the relationship of trust, and deliberation between parents and professionals to make the right decision. It highlights the importance of caring for the family in a complex situation and of great suffering, when faced with the recommendation of professionals to limit treatment because their child suffers from a disease with a poor prognosis. The care of the sick neonate care at the end of life, and their families requires a considerable effort, dedication and training of all health personnel. The repeated experience of being close to suffering and death can adversely affect the professionals involved. Finally, there is mention of the legal aspects of limiting treatment, how to perform and document decision process, the withdrawal of life support, assessment of symptoms and pain control and sedation.

Mortalidad infantil en un hospital de nivel terciario. Limitación de esfuerzo terapéutico, correspondencia clínico-patológica y precisión diagnóstica / Infant mortality in a third level paediatric hospital. therapeutic effort limitation, clinical-pathological agreement and diagnostic accuracy

Objetivo: Analizar la mortalidad en un hospital infantil de tercer nivel y alta complejidad. Material y métodos: Se revisaron los fallecidos en el Hospital Infantil La Paz durante los años 2007, 2008 y 2009. Se analizaron datos epidemiológicos, diagnósticos clínicos y de autopsia y su correspondencia, y si se llegaba a un diagnóstico etiológico definitivo. La limitación del esfuerzo terapéutico y la previsibilidad del fallecimiento también fueron recogidas. Las variables fueron prospectivamente definidas al inicio. Resultados: Se estudiaron 253 fallecimientos (6,08 por mil ingresos). El 43,4% eran menores de 1 mes y el 63,9% menores de un año. La patología neonatal y la hemato-oncológica fueron las causas más frecuentes. Fallecieron en las tres unidades de cuidado intensivo el 87%. Se practicó autopsia a 53% de los fallecidos y se detectó un 7,8% de nuevos hallazgos significativos, aunque solo en un caso podría el tratamiento haber modificado el pronóstico. Limitación de esfuerzo terapéutico y cuidado paliativo se instauró en el 41,9%. El fallecimiento era esperado al inicio del proceso en 83,9%, En 92% se consideró que existía un diagnóstico definitivo y en 86,4% un diagnóstico etiológico de los procesos que condujeron al fallecimiento. Conclusiones: El análisis de la mortalidad hospitalaria permite evaluar la calidad de la asistencia pediátrica y detectar resultados adversos. La autopsia continúa proporcionando información relevante. La limitación de esfuerzo terapéutico y cuidado paliativo es una medida cada vez más frecuente en la edad pediátrica. El número de niños que muere sin diagnóstico etiológico sigue siendo alto(AU)

Objective: To study infant and child mortality in a third level children's hospital treating highly complex patients. Patients and methods: All children dying in the period 2007- 2009 at La Paz Children's Hospital were evaluated. Epidemiological data, autopsy rate, clinical and autopsy diagnoses and their correspondence and the number of, patients with precise final diagnoses were analysed. Therapeutic effort limitation and palliative care were also evaluated as well as if the final result was expected according to the initial disease or clinical condition of the patients. All the variables were prospectively defined at the start of the study period. Results: A total of 253 cases (6.08‰ admissions) were analysed. The two leading causes of death were disorders related to prematurity and low birth weight, and haematology oncology malignant diseases. Most patients (87%) died in an intensive care unit (neonatal or paediatric). During the study period 134 autopsies (53%) were performed, and new clinically significant findings were observed in 12 of these (7.8%) but in only one case the treatment could have possibly modified the prognosis (class I discrepancy). Therapeutic effort limitation and palliative care were implemented in 41.9%. Death was initially expected in 83.9% of cases. An accurate final diagnosis was defined in 92%, and the aetiology of the disease was considered to be identified in 86.4% of all deaths. Conclusions: Hospital mortality analysis is useful to evaluate the quality of the paediatric care and to detect adverse results that could be corrected. Paediatric autopsy continues to provide clinically significant data for paediatricians and families. Therapeutic effort limitation and palliative care is increasingly applied in paediatric end of life care. The number of infants and children dying without a final aetiological diagnosis is still considerably high(AU)

XRF, µ-XRD and µ-spectroscopic techniques for revealing the composition and structure of paint layers on polychrome sculptures after multiple restorations.

This paper presents the novel application of recently developed analytical techniques to the study of paint layers on sculptures that have been restored/repainted several times across centuries. Analyses were performed using portable XRF, µ-XRD and µ-Raman instruments. Other techniques, such as optical microscopy, SEM-EDX and µ-FTIR, were also used. Pigments and other materials including vermilion, minium, red lac, ivory black, lead white, barium white, zinc white (zincite), titanium white (rutile and anatase), lithopone, gold and brass were detected. Pigments from both ancient and modern times were found due to the different restorations/repaintings carried out. µ-Raman was very useful to characterise some pigments that were difficult to determine by µ-XRD. In some cases, pigments identification was only possible by combining results from the different analytical techniques used in this work. This work is the first article devoted to the study of sculpture cross-section samples using laboratory-made µ-XRD systems.

[Infant mortality in a third level paediatric hospital. therapeutic effort limitation, clinical-pathological agreement and diagnostic accuracy]. / Mortalidad infantil en un hospital de nivel terciario. Limitación de esfuerzo terapéutico, correspondencia clínico-patológica y precisión diagnóstica.

OBJECTIVE: To study infant and child mortality in a third level children's hospital treating highly complex patients. PATIENTS AND METHODS: All children dying in the period 2007- 2009 at La Paz Children's Hospital were evaluated. Epidemiological data, autopsy rate, clinical and autopsy diagnoses and their correspondence and the number of, patients with precise final diagnoses were analysed. Therapeutic effort limitation and palliative care were also evaluated as well as if the final result was expected according to the initial disease or clinical condition of the patients. All the variables were prospectively defined at the start of the study period. RESULTS: A total of 253 cases (6.08‰ admissions) were analysed. The two leading causes of death were disorders related to prematurity and low birth weight, and haematology oncology malignant diseases. Most patients (87%) died in an intensive care unit (neonatal or paediatric). During the study period 134 autopsies (53%) were performed, and new clinically significant findings were observed in 12 of these (7.8%) but in only one case the treatment could have possibly modified the prognosis (class I discrepancy). Therapeutic effort limitation and palliative care were implemented in 41.9%. Death was initially expected in 83.9% of cases. An accurate final diagnosis was defined in 92%, and the aetiology of the disease was considered to be identified in 86.4% of all deaths. CONCLUSIONS: Hospital mortality analysis is useful to evaluate the quality of the paediatric care and to detect adverse results that could be corrected. Paediatric autopsy continues to provide clinically significant data for paediatricians and families. Therapeutic effort limitation and palliative care is increasingly applied in paediatric end of life care. The number of infants and children dying without a final aetiological diagnosis is still considerably high.

Lesiones neonatales perinatales: desgarro rectovaginal / Perinatal neonatal lesions: retrovaginal tears

Las lesiones neonatales producidas durante el parto o en las maniobras de reanimación tienen una alta morbilidad y suponen la 8ª causa de mortalidad en recién nacidos. El objetivo de este artículo es revisar nuestra casuística en los últimos 10 años y presentar un caso clínico de desgarro rectovaginal, revisando las posibles opciones terapéuticas publicadas en la literatura .Se recogieron un total de 8 lesiones neonatales perinatales, siendo la mayoría de ellas heridas inciso-contusas (5) en cuero cabelludo, pabellón auricular y tórax. Los demás casos afectaban al periné: un desgarro anal y dos desgarros rectovaginales. En el caso clínico presentado, el periné fue reparado de forma primaria, realizándose posteriormente una colostomía y perineo plastia por dehiscencia. Solo un pequeño porcentaje de las lesiones neonatales perinatales son valoradas por el cirujano pediátrico. Algunas de ellas son graves y pueden tener importantes consecuencias. La colostomía y cierre primario o secundario es una opción terapéutica segura en desgarros rectovaginales (AU)

Neonatal injuries produced during the childbirth or in the maneuvers of resuscitation they have a high morbidity and suppose the 8th reason of mortality in newborns. The aim of this article is to check our casuistry in the last 10 years and to present a case report of rectovaginal tear with the possible therapeutic options published in the literature. There were gathered a total of 8 perinatal neonatal injuries, being the majority of them clause-contused (5) in hairy leather, pinna and thorax. Other cases were affecting the perine: an anal tear and two rectovaginal tears; one of these patients needed colostomy and surgical repair of the perine. Only a small percentage of the perinatal neonatal injuries are valued by the paediatric surgeon. Some of them are serious and can have important consequences. The colostomy and primary or secondary closing is a therapeutic sure option in rectovaginal tears (AU)

[Perinatal neonatal lesions: retrovaginal tears]. / Lesiones neonatales perinatales: desgarro rectovaginal.

Neonatal injuries produced during the childbirth or in the maneuvers of resuscitation they have a high morbidity and suppose the 8th reason of mortality in newborns. The aim of this article is to check our casuistry in the last 10 years and to present a case report of rectovaginal tear with the possible therapeutic options published in the literature. There were gathered a total of 8 perinatal neonatal injuries, being the majority of them clause-contused (5) in hairy leather, pinna and thorax. Other cases were affecting the perine: an anal tear and two rectovaginal tears; one of these patients needed colostomy and surgical repair of the perine. Only a small percentage of the perinatal neonatal injuries are valued by the paediatric surgeon. Some of them are serious and can have important consequences. The colostomy and primary or secondary closing is a therapeutic sure option in rectovaginal tears.

Murillo's paintings revealed by spectroscopic techniques and dedicated laboratory-made micro X-ray diffraction.

This paper describes one of the first case studies using micro-diffraction laboratory-made systems to analyse painting cross-sections. Pigments, such as lead white, vermilion, red ochre, red lac, lapis lazuli, smalt, lead tin yellow type I, massicot, ivory black, lamp black and malachite, were detected in cross-sections prepared from six Bartolomé Esteban Murillo paintings by micro-Raman and micro-XRD combined with complementary techniques (optical microscopy, SEM-EDS, and FT-IR). The use of micro-XRD was necessary due to the poor results obtained with conventional XRD. In some cases, pigment identification was only possible by combining results from the different analytical techniques utilised in this study.

[Endotracheal tube fire during laryngeal surgery: analysis of the root cause of a sentinel event]. / Ignición del tubo endotraqueal durante cirugía laríngea. análisis causa-raíz de un suceso centinela.

Endotracheal tube fire during laryngeal surgery is a rare complication but one that has serious consequences. Surgeons, anesthesiologists and others involved with this type of surgery should become familiar with how to manage this difficult situation, which should be considered a sentinel event requiring prompt analysis of the root cause and surrounding circumstances. Measures to improve management should be implemented and training provided in order to prevent the recurrence of a similar unfortunate event. We report a case in which a patient's airway caught fire during use of an electrocautery device. The patient died as a result of the lesions sustained. We report the results of the investigation and the protocols for prevention and response implemented in our surgical department, in the hope that the experience will be of interest to others working in similar settings.

Advanced combined application of micro-X-ray diffraction/micro-X-ray fluorescence with conventional techniques for the identification of pictorial materials from Baroque Andalusia paintings.

The process of investigating paintings includes the identification of materials to solve technical and historical art questions, to aid in the deduction of the original appearance, and in the establishment of the chemical and physical conditions for adequate restoration and conservation. In particular, we have focused on the identification of several samples taken from six famous canvases painted by Pedro Atanasio Bocanegra, who created a very special collection depicting the life of San Ignacio, which is located in the church of San Justo y Pastor of Granada, Spain. The characterization of the inorganic and organic compounds of the textiles, preparation layers, and pictorial layers have been carried out using an XRD diffractometer, SEM observations, EDX spectrometry, FT-IR spectrometry (both in reflection and transmission mode), pyrolysis/gas chromatography/mass spectrometry and synchrotron-based micro-X-ray techniques. In this work, the advantages over conventional X-ray diffraction of using combined synchrotron-based micro-X-ray diffraction and micro-X-ray fluorescence in the identification of multi-layer paintings is demonstrated.

Characterization of illuminated manuscripts by laboratory-made portable XRD and micro-XRD systems.

Illuminated Arabic manuscripts have been studied, employing two laboratory-made X-ray diffraction (XRD) systems developed recently in the C2RMF laboratory. The validity of the micro-XRD and XRD portable systems for the study of this type of artworks has been demonstrated. A common observation in all the analyses is the presence of calcite and rutile; also, hematite, goethite, cinnabar, brass, anatase and barite were detected in the various colours. Differences between the results obtained by both techniques due to acquisition mode are discussed. In addition, other techniques such as X-ray fluorescence (XRF) and micro-Raman were used for the complete characterization of the manuscripts.

Study of the gilding technique used in polychromed stones and ceramics by dedicated laboratory-made micro X-ray diffraction and complementary techniques.

This work describes the use of a new dedicated laboratory-made micro X-ray diffraction system for detecting the phases present in cross-sections of artworks. As an example, the phases present in samples from gilding ceramics and stone sculptures from the heritage of Seville (Spain) were successfully detected using this new system, which takes advantage of various devices developed for synchrotron radiation, and is complemented by the information provided by other techniques.

[Pain and anxiety in pediatric surgery]. / Dolor y ansiedad en cirugía pediátrica.

INTRODUCTION: Postsurgery pain is a common complaint in children and significant postoperative pain may last for weeks. Severe perisurgery pain may aggravate long-lasting negative effects. In order to prevent harmful effects, children should be provided with effective-secure analgesia. The aim of this work was to determine current practice of postsurgery pain management in children. MATERIAL AND METHODS: An observational prospective study in pediatric patients undergoing surgery in our hospital was performed. Children's (< 14 years old) having elective major surgery and outpatient surgery were collected prospectively. Clinical stage, surgery and anaesthesia procedures, postsurgery analgesia and perioperative complications were recorded. Pain control was measured by an analogic visual scale (AVS) before surgery, in post-anaesthesia recovery unit (PARU), in one-day unit (ODU) and 24 h after surgery (24hU). STATISTICAL ANALYSIS: mean values +/- sem or SD, frequency and percentage of incidence of N cases, t-test, ANOVA of one and several ways, chi-square, correlations of two variables, linear and logistic regressions depending of variables' types. RESULTS: 77 patients with mean age of 5 years old and mean weight of 22 kg were studied. The most frequently employed anesthetic technique was the general one. Forty per cent of the patients were pre-medicated with midazolam. Little pain before surgery is observed and after surgery it is moderate. Anxiety is higher after surgery and immediately after it in the recovery room or the Post Anesthesia Care Unit (PACU), subsequently it diminishes, especially patients with same-day admission surgery. Positive correlations between pain and anxiety intensities were found in each determination done. CONCLUSIONS: Is observed that pain and anxiety round surgery in children had insufficient treatment, reason why we think we should make treatment protocols, adapted at this population, its necessities and the different types of procedures they can be subjected.