The Tropical Andes Biodiversity Hotspot: A Comprehensive Dataset for the Mira-Mataje Binational Basins.

We present a flora and fauna dataset for the Mira-Mataje binational basins. This is an area shared between southwestern Colombia and northwestern Ecuador, where both the Chocó and Tropical Andes biodiversity hotspots converge. We systematized data from 120 sources in the Darwin Core Archive (DwC-A) standard and geospatial vector data format for geographic information systems (GIS) (shapefiles). Sources included natural history museums, published literature, and citizen science repositories across 13 countries. The resulting database has 33,460 records from 6,821 species, of which 540 have been recorded as endemic, and 612 as threatened. The diversity represented in the dataset is equivalent to 10% of the total plant species and 26% of the total terrestrial vertebrate species in both hotspots. The dataset can be used to estimate and compare biodiversity patterns with environmental parameters and provide value to ecosystems, ecoregions, and protected areas. The dataset is a baseline for future assessments of biodiversity in the face of environmental degradation, climate change, and accelerated extinction processes.

Isolation, characterization, and experimental infection of Streptococcus gallolyticus subspecies pasteurianus from commercial turkeys with acute septicemia: a pilot study.

Streptococcus gallolyticus (SG) is a Gram-positive cocci found as commensal gut flora in animals and humans. SG has emerged as a cause of disease in young poults between 1 and 3 wk of age. SG is associated with septicemia resulting in acute mortality with no premonitory signs in turkeys. Three SG isolates were obtained from clinical field cases of acute septicemia of commercial turkeys and used in three independent experiments. In Experiment 1, embryos were inoculated 25 d of embryogenesis with varying concentrations of SG1, SG2, or SG3. In Experiment 2, day of hatch, poults were inoculated with varying concentrations using different routes of administration of SG1, SG2, or SG3. In Experiment 3, day of hatch, poults were inoculated with only isolate SG1 using different paths. Poults were randomly selected for necropsy on d 8 and d 15 and sampled to collect spleen, heart, and liver for SG on d 21, the remaining poults were necropsied and cultured. Samples were plated on Columbia nalidixic acid and colistin agar (CNA) (40°C, 18-24 h). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) confirmed suspect colonies. Data were analyzed using the chi-square test of independence, testing all possible combinations to determine significance (P < 0.05). Weight data were subjected to ANOVA using JMP with significance (P < 0.05). No differences were found in BW or BWG on d 0, 8, 15, or 22. Splenomegaly, focal heart necrosis, and pericarditis were observed in all groups in experiments 1 through 3. In Experiment 3, only airsacculitis was observed in a negative control in separate isolation (P > 0.05). On d 21 of Experiment 3, increased (P < 0.05) recovery of SG from spleens were observed in co-housed negative controls, as well as poults challenged by oral gavage (P > 0.05 for d 7 and d 14). These results confirm numerous previous studies indicating that SG subsp. pasteurianus is a primary infectious microorganism that causes septicemia in young poults.

Clasificación, diagnóstico y tratamiento de los trastornos miccionales en la infancia / Classification, diagnosis and treatment of urinary disorders in childhood

La disfunción vesical o disfunción del tracto urinario inferior(DTUI), traducción literal del inglés de Lower urinary Tract Disfunction (LUTD) puede ser causa del 40% de las consultas en pediatría. Estos trastornos suponen una alteración en cualquiera de las fases del ciclo miccional y pueden responder a causas neurológicas, anatómicas o funcionales. Es muy importante realizar una adecuada historia clínica que nos permita conocer al paciente de manera global de manera que podamos lograr un correcto diagnóstico de la causa de la disfunción y así poder realizar un tratamiento dirigido. La evaluación de la mayoría de los niños con disfunción vesical puede limitarse a una anamnesis exhaustiva, un examen físico y pruebas no invasivas, como un análisis de orina y un urocultivo. En niños seleccionados, una evaluación más extensa incluye estudios de imagen urológicos, mediciones del flujo urinario y determinación del residuo postmiccional. En cuanto a las herramientas terapéuticas, partiremos de pautas higiénico-dietéticas básicas y de aplicación global a las que podremos asociar terapia conductual, farmacológica, fisioterápica o quirúrgica, siempre de manera individualizada.(AU)

Vesical disfunction or Lower urinary Tract Dysfunction (LUTD), can be the cause of 40% of pediatric consultations. Dysfunctions of the lower urinary tract involve an alteration in any of the phases of the voiding cycle and may respond to neurological, anatomical or functional causes. It is very important to take an adequate clinical history that allows us to know the patient globally so that we can achieve a correct diagnosis of the cause of the lower urinary tract dysfunction and thus be able to carry out targeted treatments. The evaluation for most children with bladder dysfunction can be limited to a thorough history, physical examination, and noninvasive testing, such as a urinalysis and urine culture. In selected children, more extensive evaluation includes urologic imaging studies, measurements of urinary flow, and post-void residual determination. As for therapeutic tools, we will start from basic hygienic-dietary guidelines of global application to which we can associate behavioral, pharmacological, physiotherapy or surgical therapy, always in an individualized manner.(AU)

Patrones de recaída y respuesta patológica según tipo subrogado en pacientes con cáncer de mama y axila negativa al inicio tratadas con quimioterapia neoadyuvante / Patterns of relapse and pathological response according to surrogate type in breast cancer patients treated with neoadjuvant chemotherapy and negative axillary involvement

Objetivos: Determinar los patrones de recaída y la respuesta patológica en relación con los diferentes tipos subrogados de cáncer de mama tras tratamiento neoadyuvante para analizar supervivencia y optimizar la vigilancia. Material y métodos: Análisis retrospectivo de 112 pacientes con 116 tumores, con axila clínicamente negativa, tratados con quimioterapia neoadyuvante en nuestro Centro entre 2008 y 2014, y operadas posteriormente con cirugía conservadora o radical. Analizamos respuesta patológica en función de los tipos subrogados, tasas de recurrencia y sus patrones, supervivencia libre de enfermedad (SLE) y supervivencia global (SG). Resultados: Se logró una respuesta patológica completa (RPC) en el 52,6%, constatando que estas pacientes tenían mejor supervivencia (p<0,05). En cuanto a los tipos subrogados, observamos RPC en el 85% de los tumores Her-2/neu positivos puros, el 65,6% de los triple negativos, el 43,8% de Luminal B Her-2 positivo, el 40% de Luminal B Her-2 negativo y en el 25% de Luminal A (p<0,05). Con un tiempo medio de seguimiento de 53 meses encontramos una tasa de recaídas del 9%. Los tipos menos agresivos tenían un tiempo a recaída loco-regional de 38,5 meses y a recurrencia sistémica de 74 meses. Los tipos más agresivos mostraron un tiempo medio a recaída loco- regional de 36,2 meses y a recurrencia sistémica de 8 meses. Conclusiones: La quimioterapia neoadyuvante adaptada al tipo subrogado es una estrategia válida para intentar alcanzar una RPC. Las diferencias observadas en el patrón de recurrencia permiten optimizar el seguimiento.(AU)

Purpose: To determine relapse patterns and pathological response in relation to surrogate types of breast cancer after neoadjuvant treatment to analyse survival and optimize surveillance. Material and methods: Retrospective analysis of 112 patients with 116 tumours, with negative axillary involvement, treated with neoadjuvant chemotherapy at our hospital, between 2008 and 2014, who systematically underwent surgery. We analysed pathological response according to surrogate subtypes, rates and patterns of recurrence, disease free survival (DFS) and overall survival (OS). Results: Pathological complete response (pCR) was achieved in 52.6%, finding that these patients had better survival (p<.05). Looking at surrogate subtypes, we observed a pCR in 85% of pure Her-2/neu positive tumours, 65.6% of triple negatives, 43.8% of Her -2 positive Luminal B, 40% of Luminal B and 25% of Luminal A (p<.05). With a median follow-up of 53 months, we found a 9% rate of relapses. The less aggressive types had a median loco-regional relapse time of 38.5 months and a systemic recurrence time of 74 months. The more aggressive types showed a loco-regional relapse time of 36.2 months and systemic recurrence time of 8 months. Conclusions: Neoadjuvant chemotherapy according to surrogate type is a useful strategy to attempt pCR. Loco-regional relapse and systemic recurrence patterns allow surveillance adjustments.(AU)

Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study.

OBJECTIVE: To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS: This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS: Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION: HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

MRI guided ROLL/SNOLL in breast cancer patients treated with neoadjuvant chemotherapy. / ROLL/SNOLL guiado por resonancia magnética en pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante.

PURPOSE: To describe the results of MRI (magnetic resonance image) guided ROLL (radioguided occult lesion localization) and SNOLL (sentinel node occult lesion localization) in the localization of residual disease after neoadjuvant chemotherapy for breast cancer, as well as assessing the surgical results obtained and disease free survival. METHODS: Prospective observational analysis of 132 patients with 136 tumors, treated with neoadjuvant chemotherapy at our hospital between 2011-2017. Residual disease was located presurgically with MRI guided ROLL/SNOLL technique. We analyzed technical aspects of localization, and variables corresponding to surgical procedures and events occurred during follow-up. RESULTS: The median tumor size was of 20.5mm (interquartilic range [IQR]: 14-28). The majority (96.3%) were invasive ductal carcinomas. Sentinel lymph node detection rate was 98.9%. Complete pathological response (CPR) in the breast was achieved in 58.1% of cases. The rate of affected margins in 89 cases operated by conservative surgery was 2.2%. With a median follow-up of 50 months (IQR: 37-61) we found a 7.4% rate of relapses. Of these, seven were loco-regional and three at distant sites. The estimated mean of disease-free survival time was 83.2 months (Confidence Interval [CI] 95%: 79.6-86.6). CONCLUSIONS: MRI guided ROLL/SNOLL is a great tool for breast cancer residual disease localization following neoadjuvant chemotherapy. In addition, this technique attains good loco-regional control of the diseases and has excellent surgical results.

[Boussignac continuous positive airway pressure device during inter-hospital transportation in infants aged less than three months]. / Dispositivo de presión positiva continua en la vía aérea de Boussignac durante el transporte interhospitalario en lactantes menores de tres meses.

BACKGROUND: The present study aims to evaluate the safety and effectiveness of the Boussignac continuous positive airway pressure device (CPAPB) when used during the transportation of infants under three months of age with bronchiolitis. METHODS: Transversal analytical observational study of four years duration. Data was collected on 25 infants who needed inter-hospital transportation to the reference Paediatric Intensive Care Unit (PICU), with CPAPB and Helmet interface. The epidemiological characteristics of the transportation and evolution in the PICU were registered, as well as the cardiorespiratory gastronomic parameters prior to transfer and on arrival at the PICU. RESULTS: The median level of continuous airway pressure (CPAP) used during the transfer was 7 cm H2O (6-7.25). No patient required endotracheal intubation during transportation, while one patient required this during the first six hours of admission in the PICU. The following cardiorespiratory parameters presented a statistically significant improvement on arrival at the PICU: modified Wood-Downes score [8.40 (2.1) vs 5.29 (1.68)], respiratory frequency [60.72 (12.73) vs 47.28 (10.31)], cardiac frequency [167.28 (22.60) vs 154.48 (24.83)] and oxygen saturation [92.08 (5.63) vs 97.64 (2.27)]. CONCLUSIONS: Application of CPAPB proved to be a safe method of respiratory support in infants under three months of age. Its use during transportation brought an improvement in cardiorespiratory parameters.

Tratamiento quirúrgico del reflujo vesicoureteral en la infancia. Actualización / Surgical treatment of vesicoureteral reflux in childhood. Updat

El tratamiento endoscópico (ET) y quirúrgico, es una de las opciones fundamentales para alcanzar la curación del Reflujo vesicoureteral (RVU) en el paciente pediátrico. La tasa de éxito del tratamiento quirúrgico del RVU, es superior al 90%. Existe controversia a la hora de elegir la modalidad de tratamiento óptimo, e individualizada por cada paciente. El objetivo de esta revisión es actualizar conocimientos, conocer las nuevas modalidades diagnósticas y terapéuticas, y obtener un algoritmo de manejo individualizado según las características propias de cada paciente. El tratamiento quirúrgico es el pilar fundamental y el más efectivo, para un tratamiento exitoso del RVU en pacientes pediátricos

Endoscopic and surgical treatment is one of the fundamental options to achieve cure of Vesicoureteral Reflux (VUR) in the pediatric patient. The success rate of surgical treatment of RVU is greater than 90%. There is controversy when choosing the optimal treatment modality, and individualized by each patient. The objective of this review is to update knowledge, learn about new diagnostic and therapeutic modalities, and obtain an individualized management algorithm according to the characteristics of each patient. Surgical treatment is the fundamental and most effective pillar for successful treatment of RVU in pediatric patients

Importancia del reflujo vesicoureteral en Pediatría. Seguimiento conjunto del paciente entre Nefrología y Cirugía Pediátrica / Importance of vesicoureteral reflux in Pediatrics. Joint patient follow-up between Pediatric Nephrology and Pediatric Surgery

El reflujo vesicoureteral (RVU) es la malformación nefrourológica más frecuente del recién nacido, pudiendo aparecer de forma secundaria en otras patologías malformativas, como en el caso de las valvas de uretra posterior, o ser secundario a una disfunción de la unión ureterovesical. De esta manera se distinguen dos fenotipos de pacientes, por un lado los diagnosticados en época prenatal o neonatal, generalmente varones, con afección anatómica y/o funcional de la unión ureterovesical, lo que se conoce con el nombre de "RVU primario", frente a formas postnatales en el escolar mayor, generalmente mujeres con disfunción vesical y de la unión ureterovesical, conocidas como "RVU secundario". Estas formas clínicas presentan distinta evo-lución clínica y pronóstico, con desarrollo de enfermedad renal crónica (ERC) debida a un mal desarrollo nefrourológico asociado o no a infecciones urinarias recurrentes. La técnica gold standard para diagnosticar daño renal es la gammagrafía renal DMSA Tc99 mientras que la prueba diagnóstica de RVU es la cistouretrografía miccional seriada (CUMS). El tratamiento inicial debe ser conservador optimizando medidas higiénicas, dada la posibilidad de resolución espontánea del mismo con el tiempo, principalmente de las formas leves de RVU, reservando el tratamiento quirúrgico correctivo en las formas severas y con mala evolución clínica, por el probable desarrollo de ERC que puede conducir al paciente a una enfermedad renal terminal con necesidad de técnicas de depuración extrarrenal o incluso trasplante renal. Dicho tratamiento quirúrgico será preferentemente endoscópico. Aún existe controversia en el uso de profilaxis antibiótica, recomendándose en casos concretos. Un manejo integral multidisciplinar del paciente mejorará su pronóstico renal y vital, así como su calidad de vida y la de su familia

Vesicoureteral reflux (VUR) is the most frequent nephrourological malformation of the newborn, and may appear secondary in other malformative pathologies, such as in the case of the posterior urethral leaflets, or be secondary to a dysfunction of the ureterovesical junction. In this way, two phenotypes of patients are distinguished, on the one hand those diagnosed in the prenatal or neonatal period, generally males, with anatomical and/or functional affection of the ureterovesical junction, which is known as the "primary VUR", compared to postnatal forms in the older schoolchild, generally women with bladder and ureterovesical junction dysfunction, known as "secondary VUR". These clinical forms present different clinical and prognostic evolution, with development of chronic kidney disease (CKD) due to poor nephrourological development frequently associated with recurrent urinary infections. The gold standard technique for diagnosing kidney damage is nuclear renal scanning with dimercaptosuccinic acid (DMSA), while the diagnostic test for VUR is voiding cystourethrography (VCUG). Initial treatment should be conservative, optimizing hygienic measures, given the possibility of spontaneous resolution of it over time, mainly in mild forms of VUR, reserving corrective surgical treatment in severe forms and with poor clinical evolution, due to the probable development of CKD that can lead the patient to end-stage kidney disease with the need for extrarenal clearance techniques or even kidney transplantation. Surgical treatment will preferably be endoscopic. There is still controversy in the use of antibiotic prophylaxis, being recommended in specificcases. A comprehensive multidisciplinary management of the patient will improve their renal and vital prognosis, as well as their quality of life and that of their family

mTORC1 directly phosphorylates and activates ERα upon estrogen stimulation.

Breast cancer is the leading cause of cancer-related deaths among women. Approximately 75% of breast cancers are estrogen receptor-α (ERα) positive, underscoring the dependence of cancer cells on estrogen for growth and survival. Patients treated with endocrine therapy often develop resistance, either de novo or acquired, which in some cases is caused by aberrations within the growth factor signaling pathways. The mechanistic target of rapamycin complex 1 (mTORC1) has emerged as a critical node in estrogenic signaling. We have previously shown that mTORC1 can phosphorylate and activate ERα on S167 via its effector-the 40S ribosomal S6 kinase 1 (S6K1). Presently, we have uncovered a direct link between mTORC1 and ERα. We found that ERα binds to regulatory-associated protein of mTOR (Raptor) and causes it to translocate to the nucleus upon estrogen stimulation. In addition, we identified mTOR as the kinase that phosphorylates ERα on S104/106 and activates transcription of ER target genes. Our findings show a direct link between mTORC1 and ERα, which further implicates mTORC1 signaling in the pathogenesis of ER-positive breast cancer and provides rationale for FDA-approved use of mTORC1 inhibitors in combination with endocrine agents for treatment of this disease.

Asymptomatic peritoneal carcinomatosis originating from benign cystic peritoneal mesothelioma.

Benign multicystic mesothelioma is a rare tumour that originates from the abdominal peritoneum with a predisposition to the pelvic peritoneum. It typically affects women of reproductive age. There have been less than 200 cases of this rare neoplasia reported to date. We present the case of a 35-year-old woman who was referred to our centre because of the detection of a peritoneal carcinomatosis during a gynaecological exam. A diagnostic laparoscopy was performed. The findings included multiple cysts appearing as 'a bunch of grapes' occupying the omentum. Biopsies were taken during the surgery and the results showed benign multicystic peritoneal mesothelioma. Benign multicystic mesothelioma can simulate other conditions, such as malignant ovarian tumours or cystic lymphangioma. It is often diagnosed accidentally during surgery performed for another reason. The diagnosis is interoperative, observing multicystic structures grouped as a 'bunch of grapes' containing clear fluid with thin walls made of connective tissue. Immunohistochemistry confirmed mesothelial origin. Surgery is considered the treatment of choice and is based on the removal of the cysts from the abdominal cavity. Hyperthermic intraperitoneal chemotherapy can be considered as a primary treatment in patients with recurrences or even as a part of primary treatment associated with surgery. Survival at 5 years is 100% and invasive or malignant progression is extraordinary. The treatment approach should be multidisciplinary, and the patient should be referred to a referral centre.

Synchronous fire activity in the tropical high Andes: an indication of regional climate forcing.

Global climate models suggest enhanced warming of the tropical mid and upper troposphere, with larger temperature rise rates at higher elevations. Changes in fire activity are amongst the most significant ecological consequences of rising temperatures and changing hydrological properties in mountainous ecosystems, and there is a global evidence of increased fire activity with elevation. Whilst fire research has become popular in the tropical lowlands, much less is known of the tropical high Andean region (>2000 masl, from Colombia to Bolivia). This study examines fire trends in the high Andes for three ecosystems, the Puna, the Paramo and the Yungas, for the period 1982-2006. We pose three questions: (i) is there an increased fire response with elevation? (ii) does the El Niño- Southern Oscillation control fire activity in this region? (iii) are the observed fire trends human driven (e.g., human practices and their effects on fuel build-up) or climate driven? We did not find evidence of increased fire activity with elevation but, instead, a quasicyclic and synchronous fire response in Ecuador, Peru and Bolivia, suggesting the influence of high-frequency climate forcing on fire responses on a subcontinental scale, in the high Andes. ENSO variability did not show a significant relation to fire activity for these three countries, partly because ENSO variability did not significantly relate to precipitation extremes, although it strongly did to temperature extremes. Whilst ENSO did not individually lead the observed regional fire trends, our results suggest a climate influence on fire activity, mainly through a sawtooth pattern of precipitation (increased rainfall before fire-peak seasons (t-1) followed by drought spells and unusual low temperatures (t0), which is particularly common where fire is carried by low fuel loads (e.g., grasslands and fine fuel). This climatic sawtooth appeared as the main driver of fire trends, above local human influences and fuel build-up cyclicity.

[Laparoscopic assisted percutaneous treatment of inguinal hernia in infants]. / Tratamiento percutáneo asistido por laparoscopia de la hernia inguinal infantil.

INTRODUCTION: Thanks to the generalization of minimally invasive surgery in pediatric patients some classic techniques are being replaced. Inguinal hernia repair may be an example. MATERIAL AND METHODS: We present the technique and our first results in 10 patients treated by percutaneous laparoscopic assisted herniotomy. For this purpose we used an umbilical port, for a 5 mm camera and an optional 2 mm grasper. By laparoscopic guidance we make two inguinal punctures with a 20G needle that introduces a non absorbable suture that crosses the whole inguinal defect and allows it closure by extracorporeal knot tying. RESULTS: The ages ranged between 1 month and 8 years with a median age of 10 months. 50% of the patients were boys. 50% of the patients had previous diagnosis of inguinal bilateral hernia. 30% of patients presented a postoperatory diagnosis different from the previous one. The average time of intervention was 32 minutes in bilateral hernias, and 19 in the unilateral ones. Follow-up time was 6 months without complications. The aesthetic result was ideal. CONCLUSION: Percutaneous laparoscopic assisted herniotomy is an effective, simple and feasible option for inguinal hernia in chidren without a high rate of complications.

A comparison of two types of preperitoneal mesh prostheses in stoma surgery: application to an animal model.

INTRODUCTION: The aim of this study is to compare the integration of two types of prostheses (high and low density, written as HD and LD, respectively) implanted around the stoma to reinforce the abdominal wall to prevent parastomal eventration. The surgical technique used for preperitoneal placement of the prostheses is also described. MATERIALS AND METHODS: We performed terminal sigmoid colostomies on 16 porcine animals. In 8 of the animals, HD prostheses were placed around the stoma in preperitoneal position, while in the other 8, we implanted wide-pore LD prostheses using the same surgical technique. The following macroscopic variables were then measured: adhesion, extrusion, stenosis, and retraction. A morphological study was also carried out to evaluate the foreign body reaction and the formation of neovascularization and collagen. All animals were killed 3 months after surgery. RESULTS: Differences were observed with regard to retraction (47 ± 17.8 % for HD vs. 55 ± 19.4 % for LD) and extrusion (50 % for HD vs. 0 % for LD). These differences did not reach statistical significance. There was a great amount of scarring for both types of prostheses, with stomal stenosis being observed in all cases. The number and consistency of intra-abdominal adhesions was low and similar for both types of prostheses. Neither eventration nor necrosis was observed for either type. With regard to the tissue response, we observed both fibrosis and calcification phenomena in the peristomal areas of the LD prostheses. In the HD group, there was both a lower scarring response and a higher foreign body response, with the areas of the prostheses remaining intact. CONCLUSIONS: Both types of prostheses are appropriate for preperitoneal placement in the experimental model used, leading to few intra-abdominal adhesions. Still, due to their integration characteristics, LD prostheses are more appropriate for implanting around the colon since they do not seem to lead to extrusions. When using prostheses, however, it is also essential to consider the important phenomenon of retraction, which is more common with LD mesh.

Evolución del desarrollo neurosensorial de los recién nacidos de peso extremadamente bajo (<1.000g) en nuestro medio / Evolution of neurosensory development of very low weight newborns (<1.000 g) in our setting

Objetivo. Estudiar la situación y evolución neurológica de los recién nacidos de peso extremadamente bajo (<1.000g) en nuestro medio. Material y métodos. Estudio retrospectivo sobre la evolución de 148 RNMBP nacidos entre 1993-2004 después de un período de seguimiento de aproximadamente 27,5 meses. Se realizó estudio estadístico con el programa SPSS 15.0 para Windows de un amplio número de variables correspondientes a gestación, parto, edad gestacional, peso al nacimiento, complicaciones postnatales y evolución neurológica. Las secuelas se clasificaron leves, moderadas y graves según las alteraciones funcionales y necesidades del paciente y las alteraciones ecográficas por la gravedad de las lesiones. Se analizaron también la incidencia y mortalidad de los recién nacidos de peso extremadamente bajo. Resultados. La incidencia de los RNEBP se ha ido incrementado en los últimos años, alcanzándose un máximo de 11,3% en el 2007 así como su supervivencia, siendo esta del 45% en el 2005, 62,5% en 2006 y del 82% en el 2008. Resaltaba alto porcentaje de pretérmino de bajo peso gestacional (BPEG), gestaciones múltiples, embarazos por reproducción asistida, patología obstétrica, cesáreas, complicaciones neurológicas y extraneurológicas y tratamiento recibidos. El porcentaje global de secuelas fue del 42%, clasificándose como leves el 55,9%, moderadas el 25,5%, y graves el 18,6%. En relación al tipo de secuela, predominaron las motoras puras (45%), seguidas por las mixtas 824%) y plurideficiencias (14%). Hipoacusia neurosensorial en un 4% de la población y de retinopatía en el 43,2%. El 27% cumplían criterios de parálisis cerebral, predominando la tetraparesia. El 53,7% presentó alteraciones en la ecografía transfontanelar (HPIV 31,7%, LPV 12,8%, ventriculomegalia 26,3%, hidrofelaia posthemorragica (4,1%). Tuvieron alta correlación estadística con la aparición de secuelas especialmente la edad gestacional y las alteraciones ecográficas, así como los días de ventilación mecánica y de ingreso en UCI, la membrana hiailina, displasia broncopulmonar, persistencia de ductus arterioso, enterocolitis necrotizante y diversos tratamientos. Conclusiones. Se observa un incremento en la incidencia y supervivencia de los prematuros de pesio extremadamente bajo en nuestro medio. La proporción de secuelas es alta en relación con otras series, predominando las leves o no discapacitantes y se relacionan principalmente con la edad gestacional y la patología que presentan, principalmente del sistema nervioso central (AU)

Objective. To study the neurological evolution and situation of extremely low birth weight (<1.000 g) newborn in our area. Patients and Methods. Retrospective study of the evolution of 148 ELBW born between 1993-2004 after a follow up period of approximately 27.5 months. The statistical study was done with SPSS 15.0 and Windows. Many variables were studied related to pregnancy, delivery, gestational age, birth weights, postnatal complications and neurodevelopmental evolution. The disability was classified as mild, moderate and severe according to functional alterations and patient needs; and ultra sound abnormalities depending on severity of injuries. The prevalence and mortality of ELBW newborn were also analyzed. Results. The ELBW incidence has increased during the last years, reaching a maximum of 11,3% in 2007 and as well as their survival, this being 45% in 2005, 62,5% in 2006 and 82% in 2008. It is remarkable the high percentage of low weight, multiple gestations, assisted reproduction, obstetric pathology, caesareans, neurological and extraneurological complications and treatments received. Neurodevelopmental disability was detected in 42%, being mild in 55,9%, moderate in 25,5% and severe in 18,6%. In relation to the type of disability, pure motor predominated (45%), followed by mixed disabilities (24%) and multiple disabilities (14%). Neurosensorial deafness in 4% of the population and premature retinopathy in 43.2%. Cerebral palsy in 27%, being the most frequent the tetraparesis. 52,7% had abnormalities on transfontanelle ultrasound (intraventricular hemorrhage 31.7%, 12.8% leukomalacia, ventriculomegaly 26.3%, post-hemorrhages hydrocephalus (4.1%). Te sequelae had high statistical correlation with the gestational age, the ultrasound abnormalities and the days of mechanical ventilation and ICU stay, membrane hyaline disease and bronchopulmonary dysplasia. Conclusions. We have observed an increment in the incidence and survival of the ELBW newborn in our area. The proportion of sequelae is high in relation to other series with a predominance of mild sequelae. The most predictive variables are gestacional age and pathology, especially in the central nervous system (AU)

Tratamiento percutáneo asistido por laparoscopia de la hernia inguinal infantil / Laparoscopic assisted percutaneous treatment of inguinal hernia in infants

Introducción. Gracias a la generalización de la cirugía mínimamente invasiva en pacientes pediátricos se están sustituyendo algunas técnicas clásicas, como el tratamiento de la hernia inguinal, por nuevos abordajes asistidos por laparoscopia. Material y métodos. Presentamos nuestra técnica y nuestros primeros resultados de 10 pacientes tratados mediante herniotomía inguinal percutánea asistida por laparoscopia. Para ello utilizamos un puerto umbilical, por el que introducimos una óptica de 5 mm y una pinza opcional de 2 mm. Mediante dos punciones a nivel inguinal con una aguja de epidural de 20 G se introduce un hilo de sutura de 3/0 irreabsorbible que recorre todo el trayecto del orifico y permite que, al traccionar de este es de la piel, se cierre el orifico inguinal, quedando el nudo de sutura bajo una incisión subcutánea de 2 mm. Resultados. Las edades de los pacientes varían entre 1 mes y 8 años con una mediana de 10 meses. El 50% de los pacientes fueron niños. El 50% de los pacientes tenían diagnóstico previo de hernia inguinalbilateral y el resto, unilateral, 3 de los 10 pacientes presentaron un diagnóstico postoperatorio distinto al previo. El tiempo de intervención medio fue de 32 minutos en hernias bilaterales, mayor en varones, y 19 (..) (AU)

Introduction. Thanks to the generalization of minimally invasivesurgery in pediatric patients some classic techniques are being replaced. Inguinal hernia repair may be an example. Material and methods. We present the technique and our first results in 10 patients treated by percutaneous laparoscopic assisted herniotomy. For this purpose we used an umbilical port, for a 5 mm camera and an optional2 mm grasper. By laparoscopic guidance we make two inguinal punctures with a 20G needle that introduces a non absorbable suture that crosses the whole inguinal defect and allows it closure by extracorporeal knot tying. Results. The ages ranged between 1 month and 8 years with a median age of 10 months. 50% of the patients were boys. 50% of the patients had previous diagnosis of inguinal bilateral hernia. 30% of patients presented a postoperatory diagnosis different from the previous one. The average time of intervention was 32 minutes in bilateral hernias, and 19 in the unilateral ones. Follow-up time was 6 months without complications. The aesthetic result was ideal. Conclusion. Percutaneous laparoscopic assisted herniotomy isan effective, simple and feasible option for inguinal hernia in chidren without a high rate of complications (..) (AU)

Hidronefrosis: manejo prenatal y postnatal / Hydronephrosis: perinatal and postnatal management

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