Effects of metabolizable energy intake on post weaning lamb growth performance, carcass tissue composition and internal fat depend on animal characteristics: A meta-analysis.

This study aimed to establish the quantitative relationship between metabolisable energy intake (MEI) and growth performance, carcass tissue composition and internal fat, taking into consideration animal precocity, maturity and tail nature. Data from 67 publications were used in the meta-analysis. Diets were characterized and three classes were identified (low medium and high energy density diets). Breeds were characterized according to tail nature, precocity and maturity stage. Average daily gain (ADG) responded to MEI in all animals weighing less than 60% of their adult weight regardless their precocity or their tail nature. At the same level of MEI, the higher the diet energy density, the higher the ADG. In animals weighing less than 42% of adult weight and receiving a high starch diet, carcass muscle and internal fat responded to MEI. Whereas, for animals that weighed between 43% and 75% of adult weight, increases in MEI influenced carcass adipose tissue.

Net hepatic release of glucose from precursor supply in ruminants: a meta-analysis.

For their glucose supply, ruminants are highly dependent on the endogenous synthesis in the liver, but despite the numerous studies that evaluated hepatic glucose production, very few simultaneously measured hepatic glucose production and uptake of all precursors. As a result, the variability of precursor conversion into glucose in the liver is not known. The present study aimed at investigating by meta-analysis the relationships between hepatic glucose net release and uptake of precursors. We used the FLuxes of nutrients across Organs and tissues in Ruminant Animals database, which gathers international results on net nutrient fluxes at splanchnic level measured in catheterized animals. Response equations were developed for intakes up to 41 g DM intake/kg BW per day of diets varying from 0 to 100 g of concentrate/100 g DM in the absence of additives. The net hepatic uptake of propionate, α-amino-N and l-lactate was linearly and better related to their net portal appearance (NPA) than to their afferent hepatic flux. Blood flow data were corrected for lack of deacetylation of the para-aminohippuric acid, and this correction was shown to impact the response equations. To develop response equations between the availability of precursors (portal appearance and hepatic uptake) and net glucose hepatic release, missing data on precursor fluxes were predicted from dietary characteristics using previously developed response equations. Net hepatic release of glucose was curvilinearly related to hepatic supply and uptake of the sum of precursors, suggesting a lower conversion rate of precursors at high precursor supply. Factors of variation were explored for the linear portion of this relationship, which applied to NPA of precursors ranging from 0.99 to 9.60 mmol C/kg BW per h. Hepatic release of glucose was shown to be reduced by the portal absorption of glucose from diets containing bypass starch and to be increased by an increased uptake of ß-hydroxybutyrate indicative of higher body tissue mobilization. These relationships were affected by the physiological status of the animals. In conclusion, we established equations that quantify the net release of glucose by the liver from the net availability of precursors. They provide a quantitative overview of factors regulating hepatic glucose synthesis in ruminants. These equations can be linked with the predictions of portal absorption of nutrients from intake and dietary characteristics, and provide indications of glucose synthesis from dietary characteristics.

Gas filaments of the cosmic web located around active galaxies in a protocluster.

Cosmological simulations predict that the Universe contains a network of intergalactic gas filaments, within which galaxies form and evolve. However, the faintness of any emission from these filaments has limited tests of this prediction. We report the detection of rest-frame ultraviolet Lyman-α radiation from multiple filaments extending more than one megaparsec between galaxies within the SSA22 protocluster at a redshift of 3.1. Intense star formation and supermassive black-hole activity is occurring within the galaxies embedded in these structures, which are the likely sources of the elevated ionizing radiation powering the observed Lyman-α emission. Our observations map the gas in filamentary structures of the type thought to fuel the growth of galaxies and black holes in massive protoclusters.

Molecular gas in the halo fuels the growth of a massive cluster galaxy at high redshift.

The largest galaxies in the universe reside in galaxy clusters. Using sensitive observations of carbon monoxide, we show that the Spiderweb galaxy-a massive galaxy in a distant protocluster-is forming from a large reservoir of molecular gas. Most of this molecular gas lies between the protocluster galaxies and has low velocity dispersion, indicating that it is part of an enriched intergalactic medium. This may constitute the reservoir of gas that fuels the widespread star formation seen in earlier ultraviolet observations of the Spiderweb galaxy. Our results support the notion that giant galaxies in clusters formed from extended regions of recycled gas at high redshift.

The chemical composition of carcasses can be predicted from proxy traits in finishing male beef cattle: A meta-analysis.

Management practices can contribute to improving carcass quality if carcass quality could be simply evaluated under a wide range of conditions. The objective of this study was to derive quantitative relationships between the most accurate (but laborious) measurements of carcass chemical composition and proxy traits easily obtainable at slaughter (yield grade, subcutaneous fat thickness, marbling, ribeye area and hot carcass weight) by meta-analysis. Data from 34 publications using male beef cattle were used to develop and validate the models. The breeds were characterized according to origin, rate of maturity, production purpose and frame size. The results indicated that the changes in carcass fat and protein can be predicted from the yield grade or subcutaneous fat thickness, and hot carcass weight, with prediction errors ranging between 9 and 12%. Including the breed characteristics in the models did not improve the fit. The relationships are applicable to group values of male beef cattle having light and fatty carcasses from early-maturing British breeds.

Empirical prediction of net splanchnic release of ketogenic nutrients, acetate, butyrate and ß-hydroxybutyrate in ruminants: a meta-analysis.

For energy feeding systems for ruminants to evolve towards a nutrient-based system, dietary energy supply has to be determined in terms of amount and nature of nutrients. The objective of this study was to establish response equations of the net hepatic flux and net splanchnic release of acetate, butyrate and ß-hydroxybutyrate to changes in diet and animal profiles. A meta-analysis was applied on published data compiled from the FLuxes of nutrients across Organs and tissues in Ruminant Animals database, which pools the results from international publications on net splanchnic nutrient fluxes measured in multi-catheterized ruminants. Prediction variables were identified from current knowledge on digestion, hepatic and other tissue metabolism. Subsequently, physiological and other, more integrative, predictors were obtained. Models were established for intakes up to 41 g dry matter per kg BW per day and diets containing up to 70 g concentrate per 100 g dry matter. Models predicted the net hepatic fluxes or net splanchnic release of each nutrient from its net portal appearance and the animal profile. Corrections were applied to account for incomplete hepatic recovery of the blood flow marker, para-aminohippuric acid. Changes in net splanchnic release (mmol/kg BW per hour) could then be predicted by combining the previously published net portal appearance models and the present net hepatic fluxes models. The net splanchnic release of acetate and butyrate were thus predicted from the intake of ruminally fermented organic matter (RfOM) and the nature of RfOM (acetate: residual mean square error (RMSE)=0.18; butyrate: RMSE=0.01). The net splanchnic release of ß-hydroxybutyrate was predicted from RfOM intake and the energy balance of the animals (RMSE=0.035), or from the net portal appearance of butyrate and the energy balance of the animals (RMSE=0.050). Models obtained were independent of ruminant species, and presented low interfering factors on the residuals, least square means or individual slopes. The model equations highlighted the importance of considering the physiological state of animals when predicting splanchnic metabolism. This work showed that it is possible to use simple predictors to accurately predict the amount and nature of ketogenic nutrients released towards peripheral tissues in both sheep and cattle at different physiological status. These results provide deeper insight into biological processes and will contribute to the development of improved tools for dietary formulation.

Relation of net portal flux of nitrogen compounds with dietary characteristics in ruminants: a meta-analysis approach.

Decrease of N intake (NI) with the aim of increasing efficiency of N utilization and decreasing the negative environmental effects of animal production requires assessment of the forms in which N is absorbed. A meta-analysis was conducted on 68 publications (90 experiments and 215 treatments) to study the effect of NI on net portal appearance (NPA) of nitrogenous nutrients [amino acids (AA), ammonia, and urea] in ruminants. In addition, the effect of several dietary energy and protein factors on this relationship was investigated. These factors were: dry matter intake; proportion of concentrate; diet concentrations and intakes of nonfiber carbohydrates and neutral detergent fiber (NDF); diet concentrations of total digestible nutrients (TDN) and crude protein; rumen-degradable protein and rumen-undegradable protein, as percent dry matter or percent crude protein. The effect of species and physiological stage was also investigated. Within-experiment analyses revealed that the NPA of AA-N and ammonia-N increased linearly, whereas the NPA of urea-N decreased (or recycling of urea-N increased) linearly with NI. Besides NI, many significant covariates could be introduced in each NPA model. However, only TDN and neutral detergent fiber intake (NDFi) were common significant covariates of NI in each NPA model. In this database, ruminants converted 60% of incremental NI into NPA of AA-N with no species effect on that slope. However, at similar NI, TDN, and NDFi, sheep absorbed more AA-N than did cattle and dairy cows. On the other hand, species tended to affect the slope of the relationship between NPA of ammonia-N and NI, which varied from 0.19 for the sheep to 0.38 for dairy cows. On average, the equivalent of 11% of incremental NI was recycled as urea-N to the gut through the portal-drained viscera, which excludes salivary contribution, and no species difference was detected. Overall, at similar TDN and NDFi, sheep and cattle increased their NPA of AA-N relative to NI increment by a similar magnitude. The higher absorption of AA-N observed in sheep compared with cattle, at similar NI, TDN, and NDFi, might result from lower losses of AA through portal-drained viscera metabolism.

[Frequency and risk factors of biological adrenal insufficiency screened by the 250 microg Synacthene stimulation test after a prolonged course of systemic glucocorticoid therapy. A study of 100 patients]. / Fréquence et déterminants de l'insuffisance surrénalienne biologique dépistée par le test au Synacthène à 250mug lors du sevrage d'une corticothérapie prolongée. Etude chez 100 patients.

PURPOSE: The frequency of adrenal insufficiency after a prolonged, continuous course of oral high-dose corticosteroids is poorly documented. We evaluated it retrospectively in our internal medicine department. METHODS: The patients were included between February 2000 and June 2007 and were administered a Synacthene 250 microg test (ST250) before tapering prednisone dose below 5mg per day. A non-responsive test was defined by a cortisol increase below 18 microg/dL, 60 min after stimulation. We also studied the risk factors associated with biological adrenal insufficiency by a multivariate logistic regression analysis. RESULTS: Hundred patients were included (mean age: 61.5+/-16.3 years). Mean initial dose of corticosteroids was 65.5+/-112 mg/d. Forty-five patients failed to respond to the ST250. A normal ST250 was negatively associated with a duration of corticosteroids therapy longer than 19.5 months (OR=0.38 [0.15-0.94]; p=0.04) and positively with an age over 63.5 years (OR=2.5 [1.1-6.4]; p=0.05). Two patients experienced a clinical adrenal insufficiency crisis. CONCLUSION: Biological adrenal insufficiency is very common after a prolonged course of oral high-dose corticosteroids. The risk does not seem to increase with age. The clinical benefit of a systematic ST250 at the time of corticosteroids withdrawal followed by hydrocortisone substitution if the test is non responsive remains unknown, and this practice is still a matter of debate.

[Pericarditis as the presenting manifestation of giant cell arteritis]. / Péricardite inaugurale d'une maladie de Horton.

INTRODUCTION: Pericarditis is rarely the presenting manifestation of giant cell arteritis. We report two additional patients. CASE REPORTS: Two patients aged over 70 years presented with acute chest pain. Echocardiography evidenced a pericarditis. Laboratory features showed increased level of acute phase reactants. On questioning, both patients had cephalic symptoms related to giant cell arteritis. Temporal artery biopsy histopathology was characteristic of giant cell arteritis in both. Oral prednisone therapy (20mg/D) led to a complete remission with no clinical relapse of pericarditis after a follow-up of one year and three years, respectively. CONCLUSION: Giant cell arteritis must be evoked in elderly patients with pericarditis because corticosteroids are necessary to avoid ischemic complications of the disease. However, fortuitous association can also be considered. No severe complication of pericarditis has been reported in the literature on corticosteroid therapy.

Technical note: correction of net portal absorption of nitrogen compounds for differences in methods: first step of a meta-analysis.

The objective of this study was to evaluate the usefulness of correcting net portal absorption (NPA) of urea-N, ammonia, and AA-N for differences in methods before their inclusion into a meta-analysis. It was hypothesized that the difference, or portal-drained viscera (PDV) balance, between N inputs (apparently digested N plus urea-N) and outputs (ammonia plus AA-N) was 0 in the absence of measurement errors and based on the assumption that other sources of N inputs and outputs were relatively small and balanced each other. A database was built from 44 publications that reported data from 129 treatments (sheep, n = 71; beef cattle, n = 32; and dairy cows, n = 26). When necessary, NPA of urea-N (n = 38) and ammonia (n = 35) results were recalculated on a whole-blood basis, whereas NPA of AA-N (n = 87) was recalculated for all the N from AA transferred across the PDV rather than only the N from the alpha-amino group. Before corrections, PDV balance averaged 22.9% of N ingested (SD 29.0) for all treatments; after corrections, PDV balance significantly decreased to 10.2% of N ingested (SD 34.7). No difference in PDV balance was observed among species before or after corrections. Correcting NPA of urea-N, ammonia, and AA-N increased the accuracy without improving precision. Therefore, from a biological perspective, recalculating reported data seems appropriate to reduce bias due to differences in methods because this approach reduces the excess in N inputs relative to N outputs.

Empirical prediction of net portal appearance of volatile fatty acids, glucose, and their secondary metabolites (beta-hydroxybutyrate, lactate) from dietary characteristics in ruminants: A meta-analysis approach.

The current trend in energy feeding systems for ruminants toward a nutrient-based system requires dietary energy supply to be determined in terms of amount and nature of absorbed energy-yielding nutrients. The objective of this study was to establish response equations on the net portal appearance (NPA) of VFA and glucose, and their secondary metabolites beta-hydroxybutyrate (BHBA) and lactate, to changes in intake level and chemical dietary characteristics based on the Institut National de la Recherche Agronomique Feed Evaluation System for Ruminants. Meta-analyses were applied on published data compiled from the FLORA database, which pools the results on net splanchnic nutrient fluxes in multi-catheterized ruminants from international publications. For each nutrient, several prediction variables were tested. We obtained robust models for intakes up to 30 g of DM x d(-1) x kg of BW(-1) and diets containing less than 70 g of concentrate per 100 g of DM. These models were designed to predict the NPA (mmol x h(-1) x kg of BW(-1)) of total VFA based on the amount of ruminally fermented OM (RfOM) intake [adjusted R(2) (R(2)(adj)) = 0.95; residual means square errors (RMSE) = 0.24], to predict VFA profile (mol/100 mol of total VFA) based on type of RfOM intake (acetate: R(2)(adj) = 0.85, RMSE = 2.2; propionate: R(2)(adj) = 0.76, RMSE = 2.2; butyrate: R(2)(adj) = 0.76, RMSE = 1.09), and to predict the NPA (mmol x h(-1) x kg of BW(-1)) of glucose based on the starch digested in the small intestine independent of ruminant species, and while presenting no interfering factors on the residuals and individual slopes. The model predicting the NPA (mmol x h(-1) x kg of BW(-1)) of BHBA based on the amount of RfOM intake (R(2)(adj) = 0.91; RMSE = 0.036) was species-dependent, and the model predicting NPA (mmol x h(-1) x kg of BW(-1)) of lactate based on starch digested in the rumen (R(2)(adj) = 0.77; RMSE = 0.042) presented a wide dispersion. However, the NPA (mmol x h(-1) x kg of BW(-1)) of BHBA was related to the NPA of both butyrate (R(2)(adj) = 0.85; RMSE = 0.054) and acetate (R(2)(adj) = 0.85; RMSE = 0.052), and the NPA (mmol x h(-1) x kg of BW (-1)) of lactate was related to the NPA of propionate (R(2)(adj) = 0.51; RMSE = 0.096). This research showed that it is possible to accurately predict the amount and nature of absorbed nutrient fluxes based on dietary characteristics in both sheep and cattle. This work aims to quantify the consequences of digestion and portal-drained viscera metabolism on nutrient availability. These results can provide deeper insight into biological processes and help develop improved tools for dietary formulation.

Responses of hepatic blood flows to changes in intake in sheep: a meta-analysis.

This work set out to establish the response equations for hepatic blood flows in sheep and the contribution of hepatic arterial flow to hepatic venous blood flow due to changes in intake levels at constant diet composition. The FLORA (FLuxes across Organs and tissues in Ruminant Animals) database was used, and meta-analysis performed. The meta-analysis involved selection of published papers, identification of studies, description and coding of the selected dataset and statistical analysis using a covariance model. Meta-analyses were carried out using a within-study approach. To ensure absence of bias, the analysis incorporated interfering variables and factors studied in between-study comparisons. Variables concerned diet composition; qualitative factors concerned the physiological state of the animals and the methods used to measure blood flow. The results obtained showed that hepatic blood flows were positively related to intake in sheep. The magnitude of the response (as indicated by the slope) varied with the level of intake and the blood vessel (portal, hepatic venous or arterial). Nine linear relationships were established for the portal, hepatic venous and arterial blood flows as a function of dry matter intake (DMI) with below- and above-maintenance levels considered separately. Data obtained at below- and above-maintenance levels were considered together and four quadratic relationships were established for hepatic blood flows as a function of DMI. These relationships expressed a strong effect of intake on hepatic blood flows. The contribution of hepatic arterial to hepatic venous blood flow averaged 18.2%, with a wide variability. It did not vary significantly with level of intake. Although in between-study comparisons the arterial/venous blood flow was positively influenced by the organic matter digestibility of the diet, the relationships we obtained were robust. They can be used in models of net hepatic nutrient fluxes to predict variations and absolute values of hepatic blood flows from variations and absolute values of DMI.

[Use of mitomycin C in esophageal stenosis]. / Empleo de la mitomicina C en las estenosis esofágicas.

INTRODUCTION: Esophageal stenosis, due to its important implications on the patients' quality of life, poses a serious problem, often difficult to resolve, that requires therapeutical solutions that could irreversibly affect vital conditions and quality of life of those affected. For this reason our group has tried over the last thirty years to employ conservative solutions in the damaged aesophagus, showing that a complete cure is possible in most cases although the way to achieve this can be dramatically long. MATERIAL AND METHODS: We present our experience employing topical Mitomicyn C over the last year and a half in eight patients, six of them affected with caustic stenosis and two with secuelae of esophageal atresia, highlighting the three cases that received at least five applications of the product. We describe the method employed that consists in the spraying of the correct dose using a flexible fibroscope on the dilated area, loading the dose in the container of the cleaning water of the fibroscope, employing a system that permits only to apply the exact quantity necessary of the product. The application time is five minutes and the dose is 0.4 mg/ml applying 5ml or 10 ml according to the patient's weight ( under 12 kg = 2.5 ml and over 25 kg=5 ml). Upon completion of the application, a washing of the product is performed using the same fibroscope. RESULTS: From the eight cases in which it was applied, we analysed the three that received at least five doses. These were two boys of seven and eight years and a 25 year-old woman. In the children the dilatations interval has passed from 4-5 weeks to 8-11 respectively. The woman has passed from 12 to15 weeks. The children have been in the dilatation program more than 3 years and the woman more than 18. CONCLUSIONS: Although the time period that we have been applying Mitomicyn C is still short, the symptom-free interval after dilatations is proving to be highly promising. This fact is highlighted in those patients included in the dilatation program recently. We have not seen any adverse side effect from the application of the product.

Empleo de la mitomicina C en las estenosis esofágicas / Use of mitomicyn C in esophageal stenosis

Introducción. Las estenosis esofágicas por las importantes implicaciones que tienen en la calidad de vida de los pacientes constituyen un grave problema, en general de difícil solución, que obliga a tomar decisiones terapéuticas que pueden condicionar de un modo irreversible las condiciones vitales y el confort de aquellos que las padecen. Por ese motivo, nuestro grupo optó desde hace más de 30 años por soluciones conservadoras sobre el esófago lesionado, demostrando que la curación completa es posible en la mayoría de los casos aunque el camino para conseguirla puede ser en ocasiones desesperantemente largo. Material y métodos. Presentamos el empleo tópico de mitomicina C en el ultimo año y medio en ocho pacientes afectos, seis de ellos de estenosis de tipo cáustico y dos casos de atresia de esófago, centrándonos fundamentalmente en los tres casos que han recibido al menos cinco aplicaciones del producto. Se describe el método empleado que consiste en el rociado de la dosis adecuada empleando un fibroscopio flexible sobre el área dilatada, cargando la dosis en el frasco de líquido de lavado del fibroscopio mediante un sistema que impulsa sólo la cantidad de producto deseado. El tiempo de aplicación es de cinco minutos y la dosis es de 0,4 mg/ml aplicando 2,5 o 5 ml según el peso del paciente (5 ml peso > 12 kg y 2,5 ml peso < 12 kg). Completada la aplicación se efectúa un lavado del producto con el mismo fibroscopio. Resultado. De los ocho casos en los que se ha aplicado, se analizan los tres que han recibido al menos cinco dosis. Se trata de dos niños de 7 y 8 años y una mujer de 25. En los niños el intervalo de dilataciones ha pasado de 4 y 5 semanas a 8 y 11 respectivamente. La mujer ha pasado de 12 a 15 semanas. Los niños llevaban más de tres años en programa de dilatación y la mujer más de 18. Conclusiones. Aunque el tiempo que llevamos aplicando la mitomicina C es todavía muy corto, resulta altamente prometedor el incremento del intervalo de tiempo libre de síntomas tras las dilataciones, hecho especialmente destacable en los pacientes con menos tiempo en programa de dilatación. No hemos evidenciado ningún efecto secundario tras la aplicación (AU)

Introduction. Esophageal stenosis, due to its important implications on the patients’ quality of life, poses a serious problem, often difficult to resolve, that requires therapeutical solutions that could irreversibly affect vital conditions and quality of life of those affected. For this reason our group has tried over the last thirty years to employ conservative solutions in the damaged aesophagus, showing that a complete cure is possible in most cases although the way to achieve this can be dramatically long. Material and Methods. We present our experience employing topical Mitomicyn C over the last year and a half in eight patients, six of them affected with caustic stenosis and two with secuelae of esophageal atresia, highlighting the three cases that received at least five applications of the product. We describe the method employed that consists in the spraying of the correct dose using a flexible fibroscope on the dilated area, loading the dose in the container of the cleaning water of the fibroscope, employing a system that permits only to apply the exact quantity necessary of the product. The application time is five minutes and the dose is 0.4 mg/ml applying 5ml or 10 ml according to the patient’s weight ( under 12 kg = 2.5 ml and over 25 kg=5 ml). Upon completion of the application, a washing of the product is performed using the same fibroscope. Results. From the eight cases in which it was applied, we analysed the three that received at least five doses. These were two boys of seven and eight years and a 25 year-old woman. In the children the dilatations interval has passed from 4-5 weeks to 8-11 respectively. The woman has passed from 12 to15 weeks. The children have been in the dilatation program more than 3 years and the woman more than 18. Conclusions. Although the time period that we have been applying Mitomicyn C is still short, the symptom-free interval after dilatations is proving to be highly promising. This fact is highlighted in those patients included in the dilatation program recently. We have not seen any adverse side effect from the application of the product (AU)

Anal canal duplication: a retrospective analysis of 12 cases from two European pediatric surgical departments.

Anal canal duplication (ACD) represents an extremely rare intestinal congenital anomaly of unknown origin. Usually evidenced within 2 years of age, nearly 45% of reported cases present associated malformations such as presacral mass, anorectal malformation (ARM) and genitourinary anomalies. The confirmative diagnosis is histopathological, with evidence of an anal mucosal lining (squamous +/- transitional epithelium), surrounded from a smooth muscle coat and anal glands. We review a conjoined experience from two European pediatric surgical departments. From 1970 to 2005, 12 patients were observed, seven in Pescara, Italy (1997-2005), five in Barcelona, Spain (1970-2004) - mean age at diagnosis 17.8 months, range 0-60; M:F = 1:11. Clinical presentation, diagnostic-surgical approach, and complications were reviewed. According to clinical presentation, patients could be divided in three age groups: asymptomatic (mean age 4.8 months, six patients - one with an associated complex genitourinary malformation, one with a presacral mature teratoma, one with ACD evidenced hysthologically on a retroanal mass removed during the correction of an ARM), mildly symptomatic - constipation, mucous discharge (mean age 29.2 months, four patients - one with associated presacral ependymoma and intestinal neuronal dysplasia type B, one with presacral mass) and complicated - perineal abscess, recurrent fistula (mean age 34 months, two patients). In 11 cases a perianal orifice was evident (ten posteriorly located). The pelvic-MRI was the preferred diagnostic tool in Pescara (5/7, with presacral mass in two patients), fistulography in Barcelona (5/5), where one presacral mass was discovered intraoperatively. Eleven patients underwent surgical removal of the ACD (five perineal approach, five posterior sagittal approach, and one PSARP). Histopathological findings confirmed the diagnosis in operated cases (11). The parents of the male patient denied the consent to surgical treatment. The only major post-operative complication was a sphincteric insufficiency (one case), surgically treated. When facing a perianal orifice, attention should be paid to ACD, particularly in female patients with coexistent genitourinary or intestinal malformations. Pelvic US and MRI are the gold standard to evidence the not rarely associated presacral mass. Surgical early removal (mucosectomy or perineal/posterior sagittal approach, depending on length of ACD and associated presacral mass) is warranted, also in asymptomatic patients, because of the risk of inflammatory complications and cancer (the latter reported in literature in adults).

[Hirschsprung-neurointestinal dyspasia: diferential diagnosis and reliability of diagnostic procedures]. / Diagnóstico diferencial Hirschsprung-neurodisplasia intestinal. Fiabilidad de las pruebas diagnósticas.

The suspicion of Hirschsprung's disease (HD) or Neurointestinal Dysplasia (NID) arises with the appearance of a common symtomatology : delay in meconium evacuation, abdominal distention, vomiting, intestinal occlusion and ultimately, chronic constipation. The need to perform a correct differential diagnosis between both pathologies is essential, given that the treatment of HD is surgical while NID is expectant. The objective of this paper is to define the necessity of using or not all the diagnostic tests simultaneously to obtain a precise diagnosis. The authors performed a complete clinical review of a series of 42 HD and 18 NID analysing the results of diagnostic procedures (Radiology / transition zone, anorrectal manometry / absence of anal inhibitory reflex, and suction biopsy / AcHE study). The authors concluded that is necessary to perform all the three diagnostic procedures simultaneously in all patients with symtomatology given that not one test has the capacity to provide a diagnosis alone. Anorectal manometry has proven to be the most reliable test to diagnose HD. The authors agree with the guidelines published by Meier Ruge in 2004 to diagnose NID.

Diagnóstico diferencial Hirschsprung-neurodisplasia intestinal. Fiabilidad de las pruebas diagnósticas / Hirschsprung-neurointestinal dysplasia: differential diagnosis and reliability of diagnostic procedures

La sospecha de enfermedad de Hirschsprung (EH) o de neurodisplasia intestinal (NID) se produce ante la aparición de una misma sintomatología: retraso en la evacuación meconial, distensión abdominal, vómitos, oclusión-suboclusión, o más tardíamente estreñimiento crónico. La necesidad de realizar un diagnóstico diferencial correcto entre ambas patologías es imprescindible, dado que el tratamiento de la EH es quirúrgico y el de la NID, madurativo. El objetivo de este trabajo es conocer la necesidad de utilizar o no todas las pruebas diagnósticas simultáneamente para obtener un diagnóstico diferencial correcto. Se realiza una revisión de las historias clínicas en una serie de 42 EH y 18 NID, analizando los resultados de las pruebas diagnósticas (radiología- zona de transición, manometría anorrectal-ausencia reflejo inhibidor de ano, biopsia por succión-tinción de AChE). Se concluye la necesidad, hoy por hoy, de realizar las tres pruebas diagnósticas simultáneamente en todos los pacientes con sintomatología, ya que ninguna tiene la capacidad completa de orientar hacia un diagnóstico, aunque sí se ha mostrado en este trabajo como de mayor fiabilidad la manometría anorrectal en el diagnóstico de la enfermedad de Hirschsprung. Los autores se adhieren a los criterios publicados por Meier Ruge en 2004 para el diagnóstico de la NID (AU)

The suspicion of Hirschsprung’s disease (HD) or Neurointestinal Dysplasia (NID) arises with the appearance of a common symtomatology : delay in meconium evacuation, abdominal distention, vomiting, intestinal occlusion and ultimately, chronic constipation. The need to perform a correct differential diagnosis between both pathologies is essential, given that the treatment of HD is surgical while NID is expectant. The objective of this paper is to define the necessity of using or not all the diagnostic tests simultaneously to obtain a precise diagnosis. The authors performed a complete clinical review of a series of 42 HD and 18 NID analysing the results of diagnostic procedures ( Radiology / transition zone, anorrectal manometry / absence of anal inhibitory reflex, and suction biopsy / AcHE study ). The authors concluded that is necessary to perform all the three diagnostic procedures simultaneously in all patients with symtomatology given that not one test has the capacity to provide a diagnosis alone. Anorectal manometry has proven to be the most reliable test to diagnose HD. The authors agree with the guidelines published by Meier Ruge in 2004 to diagnose NID (AU)

[Organ donation in Switzerland]. / Organspende in der Schweiz.

Since 1985 Swisstransplant coordinates all allocations for organ transplantations in Switzerland. During these 20 years the number of deceased donors decreased, while the number of living donors increased. In the same period the number of patients on a waiting list for organ transplantation increased significantly, up to more than 1000 at the end of2004. During the year 2004 412 patients were transplanted, 43 (4%) died while waiting on the list. In comparison to other European countries the frequency of organ donation from deceased donors is relatively low in Switzerland, only 13 per million inhabitants. In order to treat the high number of patients needing organ transplantation, additional efforts have to be undertaken in future. The measures include the development of alternative therapies preventing or treating organ failure, the amelioration of legal conditions of organ transplantation with the new law, an increase of resources and knowledge to improve donor evaluation and donor pools in the donor hospitals, a further improvement of the allocation process, the enhancement of information and motivation of the population by the patient organisations, the medical staff, Swisstransplant and eventually public means.

[Biliary atresias operated with favourable results: predictable outcome]. / Atresias de vías biliares intervenidas con buen resultado. Evolución previsible.

Since 1975, our experience in the treatment of biliary atresia with Kasai's technique has improved little by little, achieving 65% favourable outcome in the last five years. We define "good results" as the complete restoration of biliary flow and normalization of bilirrubin levels. The long-term evolution of these good results can be diverse. The objective of the present work is to analyze the outcome of patients in our series in whom a favourable initial response was achieved, as well as evaluating their present situation and future perspectives. The authors present a total of 17 patients operated by Kasai's technique since 1985, that constitutes the group with good results in our series. The controls were based on general analysis, liver function and periodic ultrasound explorations. All received a standardized medical treatment consisting of vitamin supplements (A, D3, E, K) minerals (zinc, calcium, phosphate, iron) ursodexoxicolic acid, luminal,as well as close control of calorie intake. In two patients the levels of bilirrubine were progressively increased with time, stabilizing at between 5/6 mgs/100 ml, with progressive hepatic hardening, appearance of splenomegalia, indirect signs of portal hypertension and a slight deterioration of hepatic function. One received a transplant at age 12 with Quick levels below 50%. The other, aged 16, continues with an acceptable hepatic function and good quality of life under recommendation of transplant. Eleven patients with ages ranging from fourteen months to seventeen years presented slight and firm hepatomegalia, moderate portal hypertension, GOT 71 +/- 8 mg/100 ml, GPT 97 +/- 11 mg/100 ml and normal bilirrubine levels. From this group, 3 patients, all under five years of age, experienced bleeding from esophageal varices which were controlled by sclerosis and medical treatment (propanolol and isosorbide dinitrate). Recently, one three year-old patient developed a hepatocarcinoma of rapid, mortal evolution. Since then, the determination of alfa-feto protein in follow-up controls has been introduced. Four other patients of 5, 6, 14, 16, years of age are completely assymptomatic with an excellent clinical evolution. In our experience,the patients that overcome the third year after surgery without serious complications seem destined to reach puberty with a good quality of life. However, some cases show signs of hepatic fibrosis and portal hypertension, 77% in our series. Only 23% of patients with a favorable initial evolution appear to present a complete normalization of their hepatic lesion in the long term.