Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study. / Comparación de dos técnicas de sección vascular en la varicocelectomía laparoscópica. Estudio prospectivo.

INTRODUCTION: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution. MATERIALS AND METHODS: A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence- were analyzed according to the method employed. RESULTS: A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence. CONCLUSIONS: The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences.

INTRODUCCION: El varicocele es la dilatación anormal del plexo pampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducir hipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones, incluyendo la recurrencia del varicocele, dependiendo de la técnica de oclusión vascular utilizada: clip y sección o sellador vascular, en la técnica de Palomo laparoscópico en nuestro centro. MATERIAL Y METODOS: Estudio longitudinal prospectivo que se realiza de 2017 a 2021. Se crean dos grupos terapéuticos según el método de oclusión vascular utilizada durante la varicocelectomía laparoscópica: clip y sección o sellador vascular. Los pacientes son incluidos en un grupo mediante asignación sistemática consecutiva alternante. Se realiza el análisis de las variables: edad, grado de varicocele según la clasificación de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento y recurrencia del varicocele, según el método empleado. RESULTADOS: Se intervinieron un total de 37 niños, con edad media de 12 años (10-15 años) y una media de seguimiento de 12 meses. En 20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes (45,9%), sellador vascular. El 24,3% presentaba varicocele Grado II sintomático y el 75,7%, Grado III. El 32,4% de los niños presentó alguna complicación postquirúrgica durante el seguimiento. El 29,7% de los pacientes presentó hidrocele tras la intervención, perteneciendo 8 niños al grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisó reintervención por este motivo. Ningún paciente presentó recurrencia del varicocele. CONCLUSIONES: La técnica de Palomo laparoscópica es una técnica segura y efectiva que presenta buenos resultados en pacientes pediátricos, ya que presenta pocas complicaciones postquirúrgicas, independientemente del dispositivo de oclusión vascular que se utilice. En nuestro estudio, no se ha demostrado que existan diferencias estadísticamente significativas en cuanto al uso de clip o sellador vascular en esta técnica laparoscópica. No obstante, es preciso realizar más estudios con mayor tamaño muestral para hallar posibles diferencias.

Comparación de dos técnicas de sección vascular en lavaricocelectomía laparoscópica. Estudio prospectivo / Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Introducción: El varicocele es la dilatación anormal del plexopampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducirhipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones,incluyendo la recurrencia del varicocele, dependiendo de la técnica deoclusión vascular utilizada: clip y sección o sellador vascular, en latécnica de Palomo laparoscópico en nuestro centro.Material y métodos: Estudio longitudinal prospectivo que se realizade 2017 a 2021. Se crean dos grupos terapéuticos según el método deoclusión vascular utilizada durante la varicocelectomía laparoscópica:clip y sección o sellador vascular. Los pacientes son incluidos en ungrupo mediante asignación sistemática consecutiva alternante. Se realizael análisis de las variables: edad, grado de varicocele según la clasifica-ción de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento yrecurrencia del varicocele, según el método empleado.Resultados: Se intervinieron un total de 37 niños, con edad mediade 12 años (10-15 años) y una media de seguimiento de 12 meses. En20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes(45,9%), sellador vascular. El 24,3% presentaba varicocele Grado IIsintomático y el 75,7%, Grado III. El 32,4% de los niños presentó algunacomplicación postquirúrgica durante el seguimiento. El 29,7% de lospacientes presentó hidrocele tras la intervención, perteneciendo 8 niñosal grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisóreintervención por este motivo. Ningún paciente presentó recurrenciadel varicocele. Conclusiones: La técnica de Palomo laparoscópica es una técnicasegura y efectiva que presenta buenos resultados en pacientes pediátricos...(AU)

Introduction: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males.Varicocele diagnosis is important since it can induce testicular hyper-trophy and fertility issues in adulthood. The objective of this studywas to assess whether complications, including varicocele recurrence,depend on the vascular occlusion technique used –clipping + divisionvs. vascular sealer–in the laparoscopic Palomo technique used inour institution. Materials and methods: A longitudinal, prospective study wascarried out from 2017 to 2021. Two therapeutic groups were createdaccording to the vascular occlusion method used during laparoscopicvaricocelectomy –clipping + division vs. vascular sealer. Patients wererandomly allocated to the groups in a systematic alternating consecutivemanner. Variables –age, varicocele grade according to the Dubin-Amelarclassification, postoperative complications, follow-up, and varicocelerecurrence– were analyzed according to the method employed.Results: A total of 37 boys, with a mean age of 12 years (10-15years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17(45.9%), the vascular sealer was employed. 24.3% had symptomaticGrade II varicocele and 75.7% had Grade III varicocele. 32.4% of thechildren had postoperative complications during follow-up. 29.7% ofthe patients had hydrocele following surgery –8 boys from the seal-ing group and 3 boys from the clipping group–, with 13.5% requiringre-intervention as a result of this. None of the patients had varicocelerecurrence. Conclusions: The laparoscopic Palomo technique is safe and ef-fective, with good results in pediatric patients and few postoperativecomplications, regardless of the vascular occlusion device used...(AU)

Effect of FeCl3 concentration in chemically enhanced primary treatment on the performance of a conventional wastewater treatment plant. A case study.

The effect of coagulant dosage in a chemically enhanced primary treatment (CEPT) on the performance of a conventional wastewater treatment plant (WWTP) has been investigated. Lab-scale experiments simulations were carried out in order to evaluate the effect of coagulant addition on the primary settling performance. In these experiments, FeCl3 was used as coagulant. Later, the WWTP was theoretically simulated using a commercial software (WEST®) to evaluate the effect of coagulation/flocculation on the global system, based on the results obtained at lab-scale. According to these results, the CEPT modifies the organic matter balance in the WWTP, decreasing the contribution of readily (SS) and slowly (XS) biodegradable fractions of COD to the aerobic biological process up to 27.3% and 80.8%, respectively, for a dosage of FeCl3 of 24 mg L-1. Consequently, total suspended solids in the aerobic reactor and the secondary purged sludge decreased up to 33% and 13%, respectively. However, the influence on effluent quality was negligible. On the contrary, suspended solids concentration in the sludge to be treated by anaerobic digestion increased, mainly regarding the Ss and Xs fractions, which caused an 8.1% increase in biogas production potential, with approximately 60% of CH4 concentration.

Effect of coadministration of Lactiplantibacillus fabifermentans and linear/branched fructans mixtures on the intestinal health of Wistar rats.

A completely randomized experimental design was conducted to evaluate the effect of the coadministration of Lactiplantibacillus fabifermentans (Lpb. fabifermentans) and inulin/agave fructans mixtures on gut microbiota of healthy Wistar rats. Inulin, Agave salmiana fructans or fructan mixtures (1:1) at 12.5 % w/w, and Lpb. fabifermentans at 109 CFU/mL/day were used in the rats' diet for 35 days. Biochemical parameters, short-chain fatty acids (SCFA), structural changes and the bacterial abundance in rats' cecum were evaluated. A significant decrease (p < 0.05) in glucose, cholesterol and triglycerides levels with fructan mixtures combined with Lpb. Fabifermentans was observed. The weight of the small and large intestines, and cecum was higher than the control; no changes were observed in the heart, liver, spleen and kidneys. SCFA concentration mainly, propionate and butyrate was improved (p < 0.05) throughout the gastrointestinal tract in all treatments. Finally, the administration of Lpb. fabifermentans alone or combined with the fructan mixtures promoted an increase in the abundance of cecum intestinal microbiota: Lactobacillus, Bifidobacterium, Prevotella, Blautia, Faecalibacterium, Butyricimonas, Coprococcus, Akkermansia, Methanobrevibacter, Adlercreutzia, Collinsella, Odoribacter, and Roseburia. The inclusion of fructan mixtures in combination with Lpb. fabifermentans could be a good alternative for the development of functional foods that enhance consumer health.

Clavien-Dindo classification: a tool to assess complications following surgical treatment in children with acute appendicitis. / Clasificación de Clavien-Dindo. Herramienta para evaluar las complicaciones tras el tratamiento quirúrgico en niños con apendicitis aguda.

INTRODUCTION: In pediatrics, there are few standard criteria to classify and consolidate postoperative complications, particularly in appendectomy, where according to the literature, complications range from 5% to 30%. METHODS: A cross-sectional, observational, retrospective study of patients undergoing surgery as a result of suspected acute appendicitis (AA) from December 2018 to January 2020 was carried out. Complications were grouped and consolidated according to the Clavien-Dindo (CD) classification. Postoperative complications and factors involved were analyzed by conducting a bivariate and multivariate statistical study using SPSS statistical software, version 25. RESULTS: A total of 124 patients were studied. Mean age was 9 years (3-14 years). 62% were boys, and 38% were girls. All patients underwent appendectomy - 80.6% through laparotomy, and 19.4% through laparoscopy. 20% of patients had postoperative complications, which were grouped according to the CD classification (p = 0.002). Most complications were included in the CD I group (64%). Collections treated with antibiotic therapy were included in the CD II group (28%). Intra-abdominal collections requiring re-intervention for drainage purposes were included in the CD IIIb group (8%). The main factors driving complications were complicated AA (81% gangrenous and perforated) (p < 0.001) and progression time (80% > 24 h of progression) (p = 0.036), which increased mean hospital stay by 7 ± 4 days (p = 0.016). 137 ± 37 CRP levels were associated with plastron identification (p < 0.001), whereas 109 ± 19 CRP levels were associated with peritonitis (p < 0.001). CONCLUSIONS: The Clavien-Dindo classification allows post-appendectomy complications in pediatric surgery to be classified using a common language, by associating complication grade with treatment complexity.

INTRODUCCION: En pediatría hay pocos criterios estándares para clasificar y unificar las complicaciones postquirúrgicas y en particular en la apendicectomía, donde, según la literatura, las complicaciones varían de un 5-30%. METODOS: Realizamos un estudio retrospectivo, observacional tipo transversal de los pacientes intervenidos por sospecha de apendicitis aguda (AA) durante diciembre 2018 a enero 2020. Las complicaciones fueron agrupadas y unificadas según la clasificación de Clavien-Dindo (CD). Se analizan las complicaciones postoperatorias y factores implicados, aplicando estudio estadístico bivariante y multivariante según el programa estadístico SPSS versión 25. RESULTADOS: Un total de 124 pacientes incluidos. Edad media 9 años (3-14 años). 62% niños, 38% niñas. A todos se les realizó apendicectomía, el 80,6% apendicectomía abierta, 19,4% por laparoscopia. El 20% presentó algún tipo de complicación en el postoperatorio y fueron agrupadas según la clasificación de CD (p = 0,002). En CD I (64%) se incluyen la mayoría de las complicaciones, En el grupo CD II (28%) colecciones tratadas con antibioticoterapia. En el grupo CD IIIb (8%), colección intraabdominal que requirió reintervención para su drenaje. Los principales factores implicados en la aparición de complicaciones fueron: AA complicadas (81% gangrenosas y perforadas) (p < 0,001), tiempo de evolución (80% > 24 h de evolución) (p = 0,036) que incrementó la estancia media 7 ± 4 días (p = 0,016). El valor de proteína C reactiva (PCR) (137 ± 37) se relacionó con la identificación de plastrón (p < 0,001), y el valor de PCR (109 ± 19) con peritonitis (p < 0,001). CONCLUSIONES: La clasificación de Clavien-Dindo permite utilizar un lenguaje común para clasificar las complicaciones postapendicectomía en cirugía pediátrica, expresando el grado de estas según complejidad del tratamiento utilizado para su resolución.

Occurrence of antibiotics and antibiotic-resistant bacteria (ARB) in the Nervión river.

The main hydrometeorological, microbiological and physico-chemical characteristics of the Nervión river were monitored during a year, including 10 antibiotics and the presence of bacteria resistant to these antibiotics among faecal coliforms (FC) and total aerobic bacteria at 22 °C (TAB22). The characteristics of the river water were variable without a clear seasonal component, strongly influenced by rainfall, with a good quality for drinking water production throughout the year according to the physico-chemical parameters. The antibiotic resistant bacteria isolated from the water of the Nervión river were especially resistant to ß-lactams and macrolide antibiotics, highlighting the absence of resistance to derivatives of tetracyclines among strains of TAB22. A third of the isolated strains were multi-resistant to antibiotics with a seasonal component in its presence, with multi-resistant FC more abundant during summer and multi-resistant TAB22 more abundant during winter. The presence of antibiotics in the waters of the Nervión river was not very significant, with total absence of ß-lactams, minocycline and ciprofloxacin. Erythromycin and clarithromycin can be considered ubiquitous with mean concentrations of 2.5 ± 2.3 ngL-1 and 5.7 ± 4.6 ngL-1 respectively, and the presence of sulfamethoxazole and trimethoprim was also noticeable with maximum concentrations of 78.3 ngL-1 for sulfamethoxazole. Dilution due to the increase of rainfall was observed for several analysed antibiotics, but without significant seasonal differences.

Nitrogen retention in hair sheep lambs with a gradient of Haemonchus contortus infection.

The impact of Haemonchus contortus infections on nitrogen retention (NR) of hair sheep lambs is unknown. This study estimated the feed intake, digestibility, NR, haematocrit (HT), and their relationship with the gradient of H. contortus infection in hair sheep lambs. Twenty-four hair sheep lambs, 3-4 months old, reared parasite-free were used (live weight (LW) 16.7 ± 1.7 kg). Six lambs were kept parasite-free, nine lambs received a dose of 300 H. contortus infective larvae (L3)/kg LW, and the remaining nine lambs received 500 H. contortus L3/kg LW. Infection doses ranged from 3870 to 9,500 L3. Lambs were individually fed for an average daily gain (ADG) of 100 g. On days 1 (P < 0.01) and 7 (P < 0.001) post-infection (PI), the L3 doses were positively associated with HT, possibly due to platelet recruitment. On week 1 PI, the infection (L3) reduced the crude protein (CP) intake (g/kg metabolic LW) (P < 0.05). A reduction of 1% HT corresponded to 1200 eggs per gram of faeces (EPG) for day 21 PI (P < 0.05), 2300 EPG for day 28 PI (P < 0.001), 2400 EPG for day 35 (P < 0.001), and 1300 EPG for day 41 PI (P < 0.001). However, the HT levels were never lower than 21 %. A lower CP digestibility was associated with EPG only on week 5 PI (P < 0.05). There was no significant association between EPG, Total egg in faeces, or worm burden (WB) with intake, dry matter digestibility (DMD), ADG or NR. The NR of lambs was positive along the different weeks of study irrespective of infection level. The WB was negatively associated only with HT on day 41 PI (P < 0.001), where a 1 % HT reduction was estimated for every 257 worms hosted. In conclusion, no relationship was found between H. contortus infection and DMD, ADG or NR in hair sheep lambs. The cost of H. contortus infection resulted only from the HT reduction and depended on the gradient and stage of the infection.

Efficacy of a topical combination of fipronil-permethrin against Rhodnius prolixus on dogs.

A controlled clinical trial was carried out to assess the mortality and repellency of a new topical combination of fipronil-permethrin (Effitix® Virbac, Mexico) against Rhodnius prolixus in dogs. Ten medium-size dogs (10-15 kg) with short hair were used. The dogs were exposed to 8 adult triatomines once weekly for 7 weeks. On the control day (D0), the dogs were exposed to the insects without treatment. On D7, the dogs were immediately treated with a spot-on 2.2 ml pipette containing 134 mg of fipronil and 1200 mg permethrin after exposure to the insects. The dose was repeated after 4 weeks following the manufacturer's instructions. Repellency at D0 was, 0 % and the insects had a high blood content. After 12 h post-contact, repellency was 86.3 % and slowly decrease though D21 and D28. On D7, none of the insects survived after 3 h of feeding on the treated dogs. On D14, D35 and D42, all insects died within 12 h post-feeding, whereas no mortality was observed in the control D0 (P < 0.05). The results of this study indicated that administration of the product following the manufacturer's instructions was efficacious at inducing rapid mortality of R. prolixus and therefore could be useful to prevent the transmission of American trypanosomiasis in dogs.

Effects of different extracts of three Annona species on egg-hatching processes of Haemonchus contortus.

This study assessed the in vitro anthelmintic (AH) activity of methanol and acetone:water leaf extracts from Annona squamosa, A. muricata and A. reticulata against Haemonchus contortus eggs. The egg hatch test was used to determine the effective concentrations required to inhibit 50% of eggs hatching (EC50). The role of polyphenols on AH activity was measured through bioassays with and without polyvinylpolypyrrolidone (PVPP). Methanolic extracts mainly caused the death of eggs at the morula stage (ovicidal activity). Meanwhile, acetone:water extracts caused egg-hatching failure of developed larvae (larvae failing eclosion (LFE) activity). The lowest EC50 values against H. contortus eggs were observed for the methanolic extracts from A. reticulata and A. muricata (274.2 and 382.9 µg/ml, respectively). From the six extracts evaluated, the methanolic extracts of A. muricata, A. reticulata and A. squamosa showed the highest ovicidal activity, resulting in 98.9%, 92.8% and 95.1% egg mortality, respectively. When the methanolic extract of A. squamosa was incubated with PVPP, its AH activity increased. Similarly, when acetone:water extracts of A. muriata and A. reticulata were incubated with PVPP, their LFE activity increased. Alkaloids were only evident in methanolic extracts, irrespective of PVPP incubation. The presence of acetogenins was not observed. In conclusion, methanolic extracts obtained from leaves of A. muricata, A. reticulata and A. squamosa showed ovicidal activity affecting the morula of H. contortus eggs, with minor LFE activity. Meanwhile, acetone:water extracts showed mostly LFE activity, with a lower proportion of ovicidal activity.

Safety of nivolumab in metastatic renal cell carcinoma patients: A real-life experience in a Spanish urology setting. / Seguridad de nivolumab en pacientes con carcinoma de células renales metastásico: experiencia española en urología en la práctica clínica real.

INTRODUCTION AND OBJECTIVES: Nivolumab is an immunotherapy agent that has been an approved treatment for previously treated patients with advanced renal cell carcinoma (RCC). Experience in real-life settings, especially regarding immune- related adverse events, is scarce. We present our experience with reference to the safety of nivolumab in patients with metastatic RCC (mRCC) treated in 9 hospitals in Spain. MATERIAL AND METHODS: Retrospective, multicentre study of patients with mRCC treated with nivolumab between 2016 and 2018. Data on baseline socio-demographic and clinical characteristics and drug-related adverse events were collected. RESULTS: The mean age of the 26 patients included was 63.7±11.5 years; 96% were ECOG 0-1 and 78% had favourable or intermediate MSKCC risk scores; 73% had the clear cell histological subtype and 30% metastatic disease. Median follow-up was 9 months (range 1-14). All patients experienced an adverse event at different grades, with fatigue, fever and anaemia being the most common (27%). Grade 3 adverse events occurred in 23% of patients. Adverse reactions led to treatment suspension in 3 patients (11%). CONCLUSION: In the real-life clinical setting, nivolumab shows favourable outcomes, similar to those reported by other studies.

[Clinical characteristics and complications in patients with OHVIRA (obstructed hemivagina and ipsilateral renal anomaly) syndrome. Our experience]. / Síndrome de OHVIRA: características clínicas y complicaciones, nuestra experiencia.

INTRODUCTION: Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA) syndrome is a rare variant of Müllerian anomalies. Delay in diagnosis and treatment can produce serious complications in patient's life and fertility. The aim of this study is to present our experience in clinical presentation, diagnosis and complications of patients with OHVIRA syndrome in a 20-year period. PATIENTS AND METHODS: Retrospective analysis of 9 women under 25 years old with OHVIRA syndrome between 1997 and 2017. Analysis included clinical characteristics, demographic, diagnostic methods, follow-up, treatment and complications. RESULTS: A total of 9 patients were studied, 5 diagnosed in prepuberal age and 4 postpuberal. 55% had prenatal diagnosis of renal agenesis and in 3 was incidentally diagnosed. Follow up period for single kidney to diagnosis was 3.6 years (range: 0-13,4 years). Right side was affected in 55%. Symptoms were dysmenorrea (44%), recurrent abdominal pain (22%), urinary dysfunction (22%). Complications were present in postpuberal patients and included hydrometrocolpos (22%) and pyocolpos (11%) requiring septostomy or septum resection. Surgical removal of the septum was performed in 44%). Prepuberal patients were asymptomatic. CONCLUSIONS: OHVIRA syndrome is a rare anomaly in the development of Müllerian ducts with variable clinical presentation. High suspect in patients with single kidney is necessary to avoid potential complications by providing surgical treatment.

INTRODUCCION: El síndrome de OHVIRA (SO) es una rara y compleja variante de las anomalías de los conductos de Müller caracterizado por hemivagina obstruida, útero didelfo y anomalía renal ipsilateral. Su diagnostico prepuberal es raro y el retraso en su diagnóstico y tratamiento compromete la vida y fertilidad de la paciente. MATERIAL Y METODOS: Análisis retrospectivo de las historias clínicas de las pacientes diagnosticadas en nuestro centro en un período de tiempo de 20 años. Los datos se recogen en un protocolo que incluye: características clínicas, diagnóstico, tratamiento y complicaciones. RESULTADOS: Nueve pacientes en total, 55% diagnosticadas en edad prepuberal y 45% postmenarquia. En el 55% se realizó diagnóstico prenatal de malformación renal. En el 33% antecedentes familiares de primer grado de enfermedades nefrourológicas. La media de seguimiento por riñón único, previo al diagnóstico, fue de 3,6 años (rango 0-13,4 años). En el 55% de los casos el lado afecto fue el derecho. Los síntomas fueron ginecológicos en el 44%, miccionales en el 22% y dolor abdominal recurrente en el 22%. Presentaron complicaciones en el 33%, correspondiendo a hidrometrocolpos (22%) y piocolpos (11%). Se realizó septostomía y resección del tabique vaginal como tratamiento en el 44%, todas en edad postpuberal. Las pacientes prepuberales continúan en seguimiento con actitud conservadora y están asintomáticas. CONCLUSIONES: El SO es una rara anomalía del desarrollo de los conductos müllerianos de presentación clínica variable. El alto índice de sospecha y el diagnóstico precoz en niñas con anomalías renales, facilita el tratamiento quirúrgico antes de la presentación de complicaciones.

[Manual detorsion and elective orchiopexy as an alternative treatment for acute testicular torsion in children]. / Detorsión manual y cirugía diferida en la torsión testicular aguda.

AIM: To present our experience in pediatric patients with testicular torsion (TT) treated by manual detorsion (MD). PATIENTS AND METHODS: Retrospective analysis of patients treated by MD in a 10-year period in a single center. Description of symptoms, detorsion technique, follow-up and complications. RESULTS: 76 patients diagnosed with TT were studied in a 10-year period. 16 patients were treated by MD. Mean age was 12 years (Range: 10-13 years) and time from onset of pain was 5.25 hours (±4,2). Left testicle was affected in 75% (n=12). Detorsion maneuver was performed by a pediatric surgeon at the radiology room, in counter-clockwise direction in the right testicle and clockwise direction in the left testicle in all cases. The success was defined as the relief of pain, normal physical examination and was confirmed by Doppler ultrasound performed immediately after MD. MD was effective in 75% (n=12) and orchiopexy was performed under elective conditions at median time of 2 weeks (0-5 weeks). MD was unsuccessful in 3 patients and emergency orchiopexy was performed with no testicular loss. 1 patient had a second MD maneuver for incomplete detorsion. No short or long term complication nor testicular atrophy was observed. CONCLUSION: MD and elective orchiopexy seems to be an efficient and reliable procedure in the treatment of TT in children. Further studies may be necessary to establish its safety and indications.

OBJETIVO: Presentar nuestra experiencia, protocolo e indicaciones de la detorsión testicular manual (DM) como tratamiento en la torsión testicular (TT). MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TT tratados mediante DM en los últimos 10 años. Analizamos tiempo de evolución, técnica de detorsión, evolución y complicaciones. RESULTADOS: 76 pacientes diagnosticados de TT en los últimos 10 años, de los cuales 21% (n=16) fueron tratados mediante DM. Edad media de 12 años (rango: 10-13 años) y duración del comienzo del dolor de 5,25 horas (± 4,2 horas), mayor frecuencia en el testículo izquierdo (75%, n=12). La técnica de DM se realizó ecoguiada, en dirección horaria y antihoraria en el lado derecho e izquierdo, respectivamente. El éxito se definió como el alivio inmediato de los síntomas, hallazgos normales en el examen físico y comprobación de la recuperación del flujo mediante ecografía tras la maniobra de detorsión. Fue efectiva en el 75% (n=12), siendo dados de alta a las 24 horas, tras realizar nueva ecografía de control y comprobar normalidad en el flujo. Orquidopexia vía escrotal diferida a las 2 semanas (rango: 0-5,4 semanas). En tres pacientes (18,8%) se realizó cirugía urgente por insuficiente recuperación del flujo y en otro paciente (6,2%) fue necesario realizar una segunda maniobra de detorsión. No hubo complicaciones tras DM a corto/largo plazo, ningún caso de atrofia testicular. CONCLUSIONES: La DM ecoguiada y orquidopexia diferida es una opción terapéutica en pacientes con TT de corta evolución. Es necesario series más amplias y realizar estudios prospectivos para establecer su seguridad y eficacia.

[Peritoneal drainage as definitive treatment in necrotizing enterocolitis of preterm infants with low weight]. / Drenaje peritoneal como tratamiento definitivo en la enterocolitis necrotizante de prematuros de bajo peso.

OBJECTIVES: The management of advanced necrotizing enterocolitis (NEC) in preterm birth with low weight remains controversial. The aim of this study consists in the analysis of the results of treatment in these patients, as well as the evaluation of the role of peritoneal drainage as a definitive therapeutic option. METHODS: Observational and descriptive study of 31 patients under 1,500 g of weight with advanced NEC, whom have had surgery in our center in the last 15 years. They were classified in two groups: G1 (n = 21) <1,000 g and G2 (n = 10) 1,000-1,500 g. RESULTS: Average weight in G1 patients was 791.7 ± 137.5 g and 1,280.7 ± 207.9 g in G2 patients (p <0.01). Average gestational age was 26 ± 1 weeks in G1 patients and 30 ± 2 weeks in G2 patients (p <0.01). Mean time to the start of the advanced NEC was 9,4 ± 4.4 days in G1 patients and 16.7 ± 13.5 days in G2 patients (p = 0.031). In group G1, 95.2% of the patients were treated throughout peritoneal drainage, and 4,8% (n = 1) with laparotomy. In G2, 60% (n = 6) of the patients were treated throughout peritoneal drainage, and 40% (n = 4) with laparotomy (p = 0.027). The peritoneal drainage was a definitive treatment in 84.2% (16/20) of the G1 patients, with a survival rate of 56.3% (n = 9); G2 patients had a definitive treatment in 50% of the patients (3/6), with a survival rate of 66.7% (n = 2) (p = 0.261). In G1 patients, 50% (2/4) of the drains which required subsequently laparotomy, died 0% (0/3) in G2 patients. CONCLUSIONS: Peritoneal drainage is primarily a valid therapeutic option in extremely premature infants and can be used as definitive treatment.

OBJETIVO: El manejo de la enterocolitis necrotizante (ECN) avanzada en prematuros de bajo peso continúa siendo controvertido. El objetivo de este estudio es analizar los resultados del tratamiento en estos pacientes, así como valorar el papel del drenaje peritoneal como opción terapéutica definitiva. MATERIAL Y METODOS: Estudio observacional y descriptivo de 31 pacientes menores de 1.500 g de peso, intervenidos en nuestro centro, con ECN avanzada en los últimos 15 años. Se clasificaron en dos grupos en función del peso: G1 <1.000 g (n = 21) y G2 1.000-1.500 g (n = 10). RESULTADOS: El peso medio en los pacientes del G1 fue de 791,7 ± 137,5 g y de 1.280,7 ± 207,9 g en el G2 (p <0,01). La edad gestacional media de 26 ± 1 semanas en el G1 y de 30 ± 2 semanas en el G2 (p <0,01). El tiempo medio hasta el comienzo del cuadro de ECN avanzada fue de 9,4 ± 4,4 días en el G1 y de 16,7 ± 13,5 días en el G2 (p = 0,031). En el G1 el 95,2% (n = 20) de los pacientes se trataron mediante drenaje peritoneal y el 4,8% (n = 1) mediante laparotomía; en el G2 el 60% (n = 6) se trataron con drenaje peritoneal y el 40% (n = 4) mediante laparotomía (p = 0,027). El drenaje peritoneal fue el tratamiento definitivo en el 84,2% (16/20) del G1, con una supervivencia del 56,3% (n = 9); en el G2 el 50% (3/6), con una supervivencia del 66,7% (n = 2) (p = 0,261). En el G1 fallecieron el 50% (2/4) de pacientes que tras el drenaje precisaron posteriormente laparotomía, mientras que en el G2 no falleció ningún paciente (0/3). CONCLUSION: El drenaje peritoneal es una opción terapéutica válida fundamentalmente en prematuros extremos y puede ser empleado como tratamiento definitivo.

[Retrospective analysis of morbidity and mortality of intestinal atresias in newborns]. / Análisis retrospectivo de la morbilidad y mortalidad de las atresias intestinales diagnosticadas en el periodo neonatal.

OBJECTIVE: Intestinal atresia (IA) is the most common obstructive congenital malformation in the gastrointestinal tract. The aim is to describe the morbidity and mortality of AI in our series. METHODS: Retrospective study in infants with AI who underwent surgery in our hospital in the past 15 years. Descriptive analysis was performed by collecting clinical and epidemiological variables. Qualitative and quantitative statistical analysis were performed. RESULTS: A total of 32 patients, 40.6% (13) women and 59.4% (19) males, maternal age 31 ± 5 years. Prenatal care in 96.8% (30) and prenatal diagnosis in 68.8% (22). Gestational age 35 ± 3 (SG 25-41), birth weight 2,506 ± 516 g (920-3,470 g). 53% (17/32) were localized in duodenum (65% extrinsic, 35% type I); 37.5% (12/32) jejunoileal (16.6% type I, 25% type II, 16.6% type IIIa, 16.6% type IIIb and 25% type IV); 6.5% (2/32) were colonic and 3% (1/32) pyloric. In 65.6% (21/32) it was associated with other congenital malformation. 81.3% (26) were operated within the first 48 hours of life. 15.6% (5/32) required enterostomy. 21.8% (7/32) had complications requiring reoperation in 71% (5/7) with 1 case of short bowel syndrome. Median time to enteral nutrition onset was 10 days (IQR 7-15), higher in patients with ileal atresia. Hospital stay was 33 days (interquartile range 23-66 days) and overall mortality of 9.3%. CONCLUSION: In our series the congenital malformations associated with intestinal atresia were determinant in the prognosis and mortality of these patients.

OBJETIVOS: La atresia intestinal es la malformación congénita obstructiva del tubo digestivo más frecuente. Nuestro objetivo es describir la morbilidad y mortalidad de las atresias intestinales en nuestro medio. MATERIAL Y METODOS: Estudio retrospectivo de neonatos con atresia intestinal intervenidos en nuestro centro en los últimos 15 años. Se realiza un análisis descriptivo de variables clínicas y epidemiológicas. RESULTADOS: Un total de 32 pacientes, 40,6% (13) mujeres y 59,4% (19) varones, edad materna de 31 ± 5 años, controles prenatales en el 96,8% (30) y diagnóstico prenatal en 68,8% (22). Edad gestacional de 35 ± 3 (25-41 SG), peso al nacer 2.506 ± 516 g (920-3.470 g). El 53% (17/32) de localización duodenal (65% extrínseca y 35% tipo I); el 37,5% (12/32) yeyunoileal (16,6% tipo I, 25% tipo II, 16,6% tipo IIIa, 16,6% tipo IIIb y 25% tipo IV); el 6,5% (2/32) colónica y 3% (1/32) pilórica. El 65,6% (21/32) asociaba otra malformación congénita. El 81,3% (26) fueron intervenidos en las primeras 48 horas de vida, precisando derivación intestinal un 15,6% (5/32). El 21,8% (7/32) presentaron complicaciones, de los cuales el 71% (5/7) requirieron reintervención, con un caso de intestino corto. El tiempo medio de inicio de nutrición enteral fue 10 días (RIQ 7-15), mayor en los pacientes con atresia ileal; la estancia hospitalaria fue de 33 días (RIQ 23-66 días) y la mortalidad general, del 9,3%. CONCLUSIONES: Las malformaciones congénitas asociadas en pacientes con atresia intestinal son un factor determinante en el pronóstico y mortalidad de los mismos.

[Management and description of neonatal tumours in a surgical oncology unit]. / Tumores neonatales: experiencia en una Unidad de Cirugía Oncológica.

AIM: Neonatal tumours represents less than 2% of all childhood cancers. The biological behaviour of this tumours will differ in older children. The tumours's biological differences and the immature physiological characteristics of newborns represent a great therapeutically challenge making newborns vulnerable. The aim of this study is to describe the clinical characteristics, associated malformations, diagnostic methods, treatment and the outcomes of neonatal tumours. METHODS: Retrospective review of patients ≤ 28 days-old with diagnosis of neonatal tumour between 2000-2016. Statistical analysis of clinical characteristics, histology, diagnostic methods, treatment and morbimortality. RESULTS: A total of 26 tumours were diagnosed in newborns with a mean age of 4.85 ± 8.9 days and 69.2% of boys. Prenatal diagnosis was achieved in 38.5% (n = 10) and 38.5% (n = 10) in the first week of age. Associated malformations were found in 30.6% (n = 8). The most frequent tumours were hepatic hemangioma 23.1% (n = 6), neuroblastoma 15.4% (n = 4) and sacrococcygeal teratoma 11.5% (n = 3). Medical treatment was indicated in 7.7% (n = 5), surgical 57.7% (n = 15) and observation 30.8% (n = 7). Global mortality was 19.23% (n = 5) of which 42.9% (n = 3/7) were perioperatively. CONCLUSIONS: The management of neonatal tumours require a multidisciplinary approach to minimize the consequences and assure the best outcome. Global mortality is low and depends primarily of the physiologic and association of other malformations of the newborn.

OBJETIVO: Los tumores neonatales representan menos del 2% de los tumores pediátricos, sin embargo, el comportamiento biológico difiere de los desarrollados en otros grupos de edad. Estas características, junto a la inmadurez neonatal, dificultan el tratamiento, convirtiéndolos en un grupo muy vulnerable. El objetivo de este estudio es describir las características clínicas, anomalías asociadas, diagnóstico y repercusión del tratamiento de los tumores neonatales. MATERIAL: Estudio retrospectivo de pacientes ≤ 28 días diagnosticados de tumor neonatal entre 2000-2016. Se realizó análisis estadístico de las principales características clínicas, histológicas, métodos diagnósticos, tratamientos establecidos y morbimortalidad. RESULTADOS: Se diagnosticaron 26 recién nacidos con tumores. El 69,2% varones, con edad media al diagnóstico de 4,85 ± 8,9 días. El diagnóstico fue prenatal en 38,5% (n = 10) y 38,5% (n = 10) en la primera semana de vida. El 30,6% (n = 8) asoció otra malformación. Los tumores más frecuentes fueron los hemangiomas hepáticos, 23,1% (n = 6), neuroblastoma, 15,4% (n = 4) y teratoma sacrococcígeo, 11,5% (n = 3). Se realizó tratamiento médico en 7,7% (n = 5), quirúrgico en 57,7% (n = 15) y conservador en 30,8% (n = 7). La mortalidad global fue del 19,23% (n = 5), de los cuales 42,9% (n = 3/7) casos ocurrieron durante el periodo perioperatorio. CONCLUSIONES: El manejo de los tumores neonatales requiere un equipo multidisciplinar para minimizar las secuelas y garantizar el mejor resultado. El manejo conservador es una opción terapéutica válida en determinados tipos de tumores. La mortalidad global es baja y depende principalmente de las características fisiológicas del neonato y de sus malformaciones asociadas.

Susceptibility of ten Haemonchus contortus isolates from different geographical origins towards acetone:water extracts of polyphenol-rich plants. Part 2: Infective L3 larvae.

This study explored the variation in susceptibility to acetone:water plant extracts between infective larvae (L3) of ten Haemonchus contortus isolates from different geographical origin. The L3 of 10 different isolates were exposed either to the acetone:water extract of a temperate plant (Onobrychis viciifolia) or a tropical plant (Acacia pennatula) and were evaluated with the larval exsheathment inhibition assay (LEIA). The L3 of each isolate were incubated with different concentrations of each extract (0, 25, 50, 100, 200, 400, 600, 800, 1000 and 1200µg/mL of phosphate buffered saline (PBS)). After incubation, the exsheathment process of L3 was induced using a solution with sodium hypochlorite (2%) and sodium chloride (16.5%). The proportion of exsheathed L3 was determined for each concentration at 0, 20, 40 and 60min. Effective concentrations 50% (EC50) and the corresponding 95% confidence intervals (95% CI) were calculated for every isolate with both extracts. Moreover, a resistance ratio (RR) was calculated for each extract to compare isolates, using the most susceptible isolate as the respective reference for each extract. To determine the role of polyphenols on the reported effect, a second set of incubations was made for each isolate and each extract, using the extracts at a concentration of 1200µg/mL PBS with or without polyvinylpolypyrrolidone (PVPP), a polyphenol blocking agent, and controls without extract. The ten different H. contortus isolates showed variation in susceptibility for each of the 2 extracts tested (P<0.05). The EC50 values for A. pennatula extract ranged from 36 to 501µg/mL (RR: 2.11-13.68). Meanwhile, the EC50 values for O. viciifolia extract ranged from 128 to 1003µg/mL (RR: 1.25-7.82). The use of PVPP revealed that polyphenols were responsible for the anthelmintic activity recorded for both extracts. However, tested H. contortus isolates suggested that susceptibility to one polyphenol-rich extract did not determine the susceptibility to the other polyphenol rich extract. The latter result indicated that the different H. contortus isolates varied in their susceptibility to the polyphenols present in each extract evaluated.

Behaviour of the main nonsteroidal anti-inflammatory drugs in a membrane bioreactor treating urban wastewater at high hydraulic- and sludge-retention time.

The behaviour and removal efficiency of ibuprofen (IBU), diclofenac (DCF), ketoprofen (KPF), and naproxen (NPX) during the real urban wastewater treatment by an experimental full-scale MBR working at high sludge and hydraulic retention time (SRT, HRT) were determined. The MBR worked in denitrification/nitrification conformation at 35.4h of HRT (Q=0.45m3/h), 37 d of SRT and a recirculation flow rate of 4Q. The experiments were made under steady-state conditions, reaching a biodegradable organic matter removal higher than 99.5%. The MBR system showed similar removal capacity for IBU, NPX, and KTP (>95%), whose main transformation occurred in the aerobic reactor with a low contribution from the anoxic reactor. The system worked with complete nitrification, also achieving an effective retention of the unbiodegradable organic matter due to recirculation. DCF removal was low with negative removal yields for several samplings. Both removal and increase transformation of DCF also occurred in the aerobic reactor, this not being observed in the anoxic one. DCF tends to accumulate in the system and to be recirculated. Thus, during the sampling in which DCF influent concentration decreases, removal yields turn negative. The increase of DCF concentration in the aerobic bioreactor also contributes to the negative removal yields.

Ultrasonic irradiation for ultrafiltration membrane cleaning in MBR systems: operational conditions and consequences.

Ultrasonic irradiation is one of the most promising membrane cleaning techniques for membrane bioreactors (MBRs) because of several advantages such as high flux-recovery capacity and in situ application without interrupting the filtration process. However, significant contradictions may be found and, consequently, this method has not yet been widely developed. In this paper, four MBRs equipped with hollow-fibre polyvinylidene fluoride ultrafiltration membranes were operated continuously. The cleaning method applied consisted of sonication at low power (15 W) with different frequencies (20, 25, 30, and 40 kHz) for each module and aerated backwashing. The different MBRs were analysed comparatively between them and with a conventional MBR in order to check the effects of the irradiated waves on membrane integrity, effluent quality and process performance. Effluent turbidity and chemical oxygen demand, total and volatile suspended solid concentration and activated sludge viscosity were affected by biomass fragmentation or membrane cake removal, mainly at lower frequencies. The best transmembrane pressure control was achieved at the frequency of 20 kHz without a significant effect on membrane integrity. The results showed that under these operational conditions, no negative effects on effluent quality or membrane integrity were found, suggesting that this method was suitable for this type of membrane.

[Compliance with the surgical safety checklist and surgical events detected by the Global Trigger Tool]. / Cumplimiento del listado de verificación quirúrgica y los eventos quirúrgicos detectados mediante la herramienta del Global Trigger Tool.

INTRODUCTION: The implementing of the WHO Surgical Safety Checklist (SSC) has helped to improve patient safety. The aim of this study was to assess the level of compliance of the SSC, and incorporating the non-compliances as «triggers¼ in the Global Trigger Tool (GTT). SETTING: Acute Geriatric Hospital (200 beds). Retrospective study, study period: 2011-2014. The SSC formulary and the methodology of the GTT were used for the analysis of electronic medical records and the compliance with the SSC. The NCCP MERP categories were used to assess the severity of the harm. RESULTS: Out of all the electronic medical records (EMR), a total of 227 (23.6%) discharged patients (1.7% of interventions in the four year study period) were analysed. All (100%) of the EMR included the SSC, with 94.4% of the items being completed, and 28.2% of SSC had all items completed in the 3 phases of the process. Surgical adverse events decreased from 16.3% in 2011 to 9.4% in 2014 (P=.2838, not significant), and compliance with all items of SSC was increased from 18.6% to 39.1% (P=.0246, significant). CONCLUSIONS: The GTT systematises and evaluates, at low cost, the triggers and incidents/ AEs found in the EMR in order to assess the compliance with the SSC and consider non-compliance of SSC as «triggers¼ for further analysis. This strategy has never been referred to in the GTT or in the SCC formulary.