Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia. / Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago.

OBJECTIVE: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. MATERIALS AND METHODS: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett's esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett's esophagus. Conventional parameters and substantially impaired values of the tests were compared. RESULTS: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). CONCLUSION: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.

OBJETIVOS: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. RESULTADOS: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7; p = 0,1). CONCLUSION: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.

Momento adecuado para las pruebas diagnósticas de reflujo esofágico en pacientes con atresia de esófago / Adequate timing of diagnostic tests for gastroesophageal reflux in children with esophageal atresia

Objetivos: Recientemente se han publicado recomendaciones para el manejo del reflujo gastroesofágico en pacientes con atresia de esófago (AE). Sin embargo, el momento de realización de algunas pruebas no está completamente aclarado. Esta investigación evalúa las pruebas para reflujo gastroesofágico en niños de 1 año y niños de 2-3 años. Material y métodos: Estudio retrospectivo de pacientes con AE sometidos a impedanciometría-phmetría (IMpH) y a endoscopia-histología. Los pacientes con 1 año en el momento de la prueba formaron el grupo MEN, y los pacientes con 2-3 años, el grupo MAY. Se consideró IMpH sustancialmente alterada aquella con un número total de reflujos >105 o >85 (según la edad), o un índice de reflujo >10%. La endoscopia se consideró sustancialmente alterada si presentaba esofagitis erosiva o esófago de Barrett. La histología se consideró sustancialmente alterada si presentaba esofagitis severa-moderada o esófago de Barrett. Se compararon los parámetros convencionales y los sustancialmente alterados. Resultados: Se estudiaron 24 pacientes. Se realizaron 23 IMpH (12 en el grupo MEN y 11 en el MAY); los porcentajes de los parámetros convencionales patológicos no fueron estadísticamente diferentes en ambos grupos. Se realizaron 20 endoscopias (7 en el grupo MEN y 13 en el MAY); los porcentajes de esofagitis no fueron estadísticamente diferentes. El 26,9% de todas las pruebas en el grupo MEN resultaron sustancialmente alteradas, frente al 10,8% en el MAY (χ2 = 2,7;p = 0,1). Conclusión: Teniendo en cuenta el porcentaje de resultados alarmantes en el grupo MEN, sería recomendable realizar una IMpH y una endoscopia con biopsias a los pacientes con AE a la edad de un año.(AU)

Objective: Recent guidelines made recommendations for the management of gastroesophageal reflux in patients with esophageal atresia (EA). However, the timing for some diagnostic tests remained somehow unclear. This investigation studied the tests for gastroesophageal reflux in children aged one year old and children aged two or three. Material and methods: Patients with EA who underwent Multichannel Intraluminal Impedance-pH monitoring (MII-pH) and endoscopy-histology were studied retrospectively. Patients aged one when the test was performed were the YO group and patients aged two or three years old formed the OL group. Substantially impaired MII-pH was defined as total number of reflux episodes >105 or >85 (depending on age), or reflux index >10%. Substantially impaired endoscopy was defined as erosive esophagitis or Barrett’s esophagus. Substantially impaired histology was defined as moderate-severe esophagitis or Barrett’s esophagus. Conventional parameters and substantially impaired values of the tests were compared. Results: Twenty-four patients were studied. Twenty-three MII-pH were performed (12 in YO and 11 in OL): percentages of abnormal conventional parameters of MII-pH were not significantly different in both groups. Twenty endoscopies with biopsies were performed (7 in YO and 13 in OL): percentages of esophagitis were not significantly different. Interestingly, 26.9% of all the tests performed in YO were substantially impaired vs. 10.8% of all the tests in OL (χ2 = 2.7; p = 0.1). Conclusion: Considering the percentage of alarming results of diagnostic tests in the YO group it would be advisable that patients with EA undergo MII-pH and endoscopy-histology at one year of age.(AU)

Assessing the performance of environmental management in academic research laboratories.

Managing environmental risk is essential to ensure organisations minimise their impact on the environment, comply with environmental legislation and maintain their reputation in an increasingly environmentally aware society. Organisations frequently use management systems to plan and execute routine environmental assessments, however environmental impacts may still arise from routine activities or accidents that could be avoided by effective environmental management. Currently there is no method for an organisation to assess the level of awareness their employees have of activities that may lead to an environmental impact, or the level of uptake of environmental management processes. Therefore, the Environmental Management Performance Assessment (EMPA) process was developed to enable organisations to self-assess existing environmental management processes by survey of their employees. The EMPA process was aligned to key phases of the Deming Cycle and involves development and distribution of a survey to organisation employees. The responses are then used to recognise areas for improvement by progression through a bespoke flow chart integrated with the initial survey. This enables demonstration of how particular hazards arise from insufficient awareness at different stages in the Deming Cycle and how these hazards can have wider, reputational, economic, and legislative consequences. The process was trialled by surveying academic researchers on the environmental management processes in their laboratories as a sample set.

Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. / Tratamiento con adhesivo de fibrina asociado o no a diatermia para las fístulas traqueoesofágicas recurrentes: resultados tras más de 20 años de experiencia.

INTRODUCTION: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.

INTRODUCCION: La fístula traqueoesofágica recurrente (FTER) representa una complicación frecuente (5-10%) en los pacientes con atresia de esófago (AE). La cirugía abierta de FTER implica una alta morbimortalidad, por lo que los abordajes endoscópicos suponen una alternativa prometedora. Presentamos los resultados a largo plazo de la aplicación broncoscópica de adhesivo de fibrina (AF) en pacientes con FTER secundaria a AE, técnica utilizada por primera vez en 1994 por nuestro equipo. METODOS: Revisión retrospectiva de 1993 a 2019, incluyendo a todos los pacientes diagnosticados de FTER tras la reparación de AE, y tratados con aplicación broncoscópica de AF. En la mayoría de los casos se aplicó diatermia previamente al sellado con AF. El número máximo de sesiones endoscópicas se estableció en cinco; en caso de persistir FTER tras la quinta sesión, se procedió a cirugía abierta. RESULTADOS: 14 pacientes con FTER fueron tratados con AF; en todos salvo los primeros 3 casos (11 pacientes, 78,6%) se aplicó diatermia concomitante. El día promedio del primer tratamiento fue el día 85 de vida (14 a 770). Los pacientes recibieron una media de 2,1 (1-5) sesiones endoscópicas. El seguimiento medio fue de 12,1 (10-20) años. El éxito global fue del 71,4%, sin apenas variar con la aplicación o no de diatermia concomitante (72,7% vs. 66,6%). CONCLUSIONES: La aplicación broncoscópica de adhesivo de fibrina asociado o no a diatermia representa una excelente opción para el tratamiento de FTER en pacientes con AE. El abordaje endoscópico debe considerarse como tratamiento de primera elección para FTER.

Tratamiento con adhesivo de fibrina asociado o no a diatermia para las fístulas traqueoesofágicas recurrentes: resultados tras más de 20 años de experiencia / Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience

INTRODUCCIÓN: La fístula traqueoesofágica recurrente (FTER) representa una complicación frecuente (5-10%) en los pacientes con atresia de esófago (AE). La cirugía abierta de FTER implica una alta morbimortalidad, por lo que los abordajes endoscópicos suponen una alternativa prometedora. Presentamos los resultados a largo plazo de la aplicación broncoscópica de adhesivo de fibrina (AF) en pacientes con FTER secundaria a AE, técnica utilizada por primera vez en 1994 por nuestro equipo. MÉTODOS: Revisión retrospectiva de 1993 a 2019, incluyendo a todos los pacientes diagnosticados de FTER tras la reparación de AE y tratados con aplicación broncoscópica de AF. En la mayoría de los casos se aplicó diatermia previamente al sellado con AF. El número máximo de sesiones endoscópicas se estableció en cinco; en caso de persistir FTER tras la quinta sesión, se procedió a cirugía abierta. RESULTADOS: 14 pacientes con FTER fueron tratados con AF; en todos salvo los primeros 3 casos (11 pacientes, 78,6%) se aplicó diatermia concomitante. El día promedio del primer tratamiento fue el día 85 de vida (14 a 770). Los pacientes recibieron una media de 2,1 (1-5) sesiones endoscópicas. El seguimiento medio fue de 12,1 (10-20) años. El éxito global fue del 71,4%, sin apenas variar con la aplicación o no de diatermia concomitante (72,7% vs. 66,6%). CONCLUSIONES: La aplicación broncoscópica de adhesivo de fibrina asociado o no a diatermia representa una excelente opción para el tratamiento de FTER en pacientes con AE. El abordaje endoscópico debe considerarse como tratamiento de primera elección para FTER

INTRODUCTION: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIALS AND METHODS: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTE

Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos / Aortic dissection class 3: a little-known entity. Presentation of 4 cases

La disección aórtica es la patología aguda más frecuente de la aorta y presenta una elevada mortalidad, por lo que constituye una urgencia radiológica de vital importancia. Actualmente se diferencian cinco subtipos, siendo la clase 3, también conocida como disección aórtica limitada o sutil, la variante más desconocida. Este tipo de disección es infrecuente y exige un conocimiento claro de su semiología radiológica para que no pase desapercibida. Desde el punto de vista de la imagen, esta entidad se caracteriza por un pequeño abultamiento focal del contorno aórtico y/o dilatación circunferencial localizada del segmento aórtico afectado por el desgarro intimal. Recientemente se ha destacado la baja familiaridad del radiólogo con esta patología. Con la finalidad de ilustrar los principales hallazgos de imagen y revisar los aspectos más relevantes de esta entidad, presentamos cuatro casos de disección aórtica de clase 3 diagnosticados en nuestro hospital

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital

Aortic dissection class 3: a little-known entity. Presentation of 4 cases. / Disección aórtica de clase 3: una entidad poco conocida. Presentación de 4 casos.

Aortic dissection (AD) is the most common acute condition of the aorta and has a high mortality. Therefore, it is a radiological emergency of vital importance. Currently, five subtypes are distinguished, among which AD class 3 -also known as limited or subtle AD- is the less recognised. This type of dissection is infrequent and needs to be acknowledged radiologically in order not to go unnoticed. Regarding its imaging features, this entity is characterized by a small focal bulging of the aortic wall outline and/or a limited round dilation at the region affected by the intimal tear. Recently, the low familiarity of the radiologist with this condition has been emphasized. With the aim of illustrating the main imaging findings of this entity and reviewing its most relevant aspects, we present four cases of AD class 3 diagnosed in our hospital.

[Applicability of a clinical score in patients with suspected foreign body aspiration]. / Aplicabilidad de un score clínico en pacientes con sospecha de aspiración de cuerpo extraño.

OBJECTIVE: To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS: Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS: Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS: The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.

OBJETIVOS: Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). RESULTADOS: Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. CONCLUSIONES: El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas.

Aplicabilidad de un score clínico en pacientes con sospecha de aspiración de cuerpo extraño / Applicability of a clinical score in patients with suspected foreign body aspiration

Objetivos. Validar el score clínico de Valdivieso y cols. en el manejo de los pacientes con sospecha de aspiración de cuerpo extraño en un hospital de tercer nivel. Dicho score plantea escenarios diferentes según la puntuación obtenida: broncoscopia, TAC, observación o alta. Material y métodos. Estudio retrospectivo de los pacientes a los que se realizó una broncoscopia por sospecha de cuerpo extraño entre noviembre de 2015 y noviembre de 2018. Se recogieron las variables propuestas por el score (atragantamiento presenciado, estridor, sibilancias, hipoventilación unilateral, radiografía alterada y cuerpo extraño de riesgo) y su puntuación para cada paciente, analizando el rendimiento de la prueba mediante la curva COR (característica operativa del receptor). Resultados. Se realizó broncoscopia en 81 pacientes con una edad media de 2,1 años (7 meses-11 años), encontrando cuerpo extraño en el 33,3%. El área bajo la curva COR del score fue de 0,803 (0,695-0,911). En 6 (22,2%) pacientes con cuerpo extraño confirmado el score indicaba inicialmente observación en 5 casos y alta en 1. Excluyendo a los 49 pacientes con atragantamiento con fruto seco o con auscultación alterada unilateral, a los que en nuestro medio se indica directamente broncoscopia, el score clasificó correctamente a los 32 pacientes restantes, lo que hubiese reducido el porcentaje de broncoscopias "blancas" en un 21%. Conclusiones. El score presenta en nuestra muestra un alto rendimiento diagnóstico pero una tasa de falsos negativos no despreciable. En cambio, tiene una especial utilidad en los pacientes que no presentan atragantamiento con fruto seco y/o auscultación alterada unilateral, permitiendo reducir broncoscopias blancas

Objective. To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. Material and methods. Retrospective study of patients who under-went a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. Results. Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. Conclusions. The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies

Decision Framework for the environmental management of explosive contaminated land.

The environmental risks from explosive manufacturing and testing activities are usually evaluated using a qualitative process such as environmental impact prioritisation as recommended by legislation and guidance. However, standard environmental management system (EMS) guidance rarely provides detailed information on how to objectively assess the significance of the environmental impacts based on a rational scientific evidence. Quantitative exposure and eco-toxicity assessments are frequently used in combination with environmental threshold limit guidelines, but these omit important environmental impacts such as physical damage to land, nuisance and contribution to climate change. These impacts are particularly relevant to the explosives industry where noise nuisance and physical damage are given high priority. In addition, contamination from explosive compositions may comprise mixtures of multiple legacy and new generation explosives such as 1,3,5-trinitro-1,3,5-triazinane (RDX), 2,4,6-trinitrotoluene (TNT), 5-nitro-1,2,4-triazol-3-one (NTO), 2,4-dinitroanisole (DNAN) and nitroguandine (NQ), which may have combined impacts not captured by conventional eco-toxicity assessments. Further, threshold limits for energetic materials in soil and water have not been established for most nations. Additionally, in the explosive industry wider concerns such as legislative compliance and stakeholder concerns may help to provide a more broadly applicable assessment of environmental impact. Therefore in this study a novel decision framework was developed to integrate empirical data with business risks to enable rational decision making for the environmental management of explosive manufacturing facilities. The application of the framework was illustrated using three case studies from the explosive manufacturing industry to demonstrate how the framework can be used to justify environmental management decision making. By linking the environmental impacts to business risks, we demonstrate that manufacturers are able to assess a wide spectrum of issues that might not be identified in the initial environmental assessment such as non-toxic pollution incidents, breaches in legislation and stakeholder perceptions.

Linfangiohemangiomas múltiples con afectación torácica y abdominal. Presentación de un caso / Multiple lymphangiohemangiomas with thoracic and abdominal involvement: a case report

Presentamos un caso de linfangiohemangiomas múltiples (hemolinfangiomas, hemangiolinfangiomas o malformación vascular combinada linfática venosa) con afectación torácica y abdominal en un paciente asintomático. Describimos los hallazgos en imagen de esta patología, que son bastante característicos y pueden permitir un diagnóstico preciso. En nuestro conocimiento, no existen referencias en la literatura científica de un caso similar

We present a case of multiple lymphangiohemangiomas (hematolymphangiomas, hemangiolymphangiomas, or combined lymphatic venous malformation) with thoracic and abdominal involvement in an asymptomatic patient. We describe and illustrate the imaging findings in this disease, which are quite characteristic and can enable an accurate diagnosis. To our knowledge, there are no other reports of similar cases in the scientific literature

Multiple lymphangiohemangiomas with thoracic and abdominal involvement: a case report. / Linfangiohemangiomas múltiples con afectación torácica y abdominal. Presentación de un caso.

We present a case of multiple lymphangiohemangiomas (hematolymphangiomas, hemangiolymphangiomas, or combined lymphatic venous malformation) with thoracic and abdominal involvement in an asymptomatic patient. We describe and illustrate the imaging findings in this disease, which are quite characteristic and can enable an accurate diagnosis. To our knowledge, there are no other reports of similar cases in the scientific literature.

[Multidisciplinary approach on subglottic pathology: a 5-year review]. / Manejo multidisciplinar de la patología subglótica: revisión a 5 años.

INTRODUCTION: Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. MATERIAL AND METHODS: Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. RESULTS: Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. CONCLUSIONS: Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results.

OBJETIVOS: La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. RESULTADOS: Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. CONCLUSIONES: El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos.

Manejo multidisciplinar de la patología subglótica: revisión a 5 años / Multidisciplinary approach on subglottic pathology: a 5-year review

Objetivos. La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. Material y métodos. Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. Resultados. Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. Conclusiones. El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos

Introduction. Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. Material and methods. Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. Results. Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. Conclusions. Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results

Infección por Aspergillus flavus en prótesis aórtica: hallazgos por imagen / Aspergillus flavus infection in an aortic graft: imaging findings

No disponible

Advanced Inorganic Nanosystems for Skin Drug Delivery.

On/into/through the skin drug delivery represents an attractive alternative for the oral route, providing local and/or systemic drug delivery. Due to its complex and well-organised structure, most of the drugs show difficulties to penetrate the human skin. Therefore, enormous efforts have been invested to develop intelligent drug delivery systems overcoming the skin barrier with particular emphasis on increasing therapeutic activity and minimizing undesirable side-effects. Most of these strategies require the use of singular materials with new properties. In particular, and on the basis of their inherent properties, including biocompatibility, biodegradability and relative low-cost, inorganic nanoparticles are ideal candidates for the development of skin drug delivery systems. This review provides an updated and comprehensive overview of the state of the art in the trends towards skin drug delivery with a particular focus in the attractive alternative offered by inorganic-based nanosystems.