[Surgical treatment of tracheal stenosis. A 11-year report in a pediatric hospital]. / Tratamiento quirúrgico de la estenosis traqueal. Reporte de 11 años en un hospital pediátrico.

OBJECTIVES: To report our experience in the surgical treatment of patients having acquired and congenital tracheal stenosis. MATERIAL AND METHODS: Fifty eight patients with tracheal stenosis were surgically treated between July 2005 and May 2016, 29 were females and 29 were males. Thirty patients had acquired stenosis and 28 had congenital stenosis. RESULTS: Five to 12 rings were resected (median 5) in 26 patients, in 2 cartilage was grafted in the anterior wall, in another carinostomy was performed, and in the remaining, the trachea was replaced using an aortic cryopreserved graft. In those with congenital stenosis, 14 patients underwent slide technique; in eleven, 3 to 6 rings were resected (median 5); in 3 a patch was grafted in the anterior tracheal wall. Seven patients died: 2 with acquired stenosis and 5 with congenital stenosis. Global survival was 88% (28 of 30 patients with acquired stenosis and 23 of 28 with congenital). From 28 living patients operated on due to acquired stenosis, 26 are asymptomatic, one presents graft stenosis, and one has a stoma in the aortic graft. From 23 living patients operated on due to congenital stenosis, 20 remain asymptomatic and 3 have tracheal stents placed on. CONCLUSIONS: Surgical treatment of acquired stenosis is easier and presents less severe complications. Congenital stenosis often requires more than one procedure to control the disease, and presents a higher mortality rate.

OBJETIVOS: Describir nuestra experiencia en el tratamiento quirúrgico de pacientes con estenosis traqueal adquirida y congénita. MATERIAL Y METODOS: Cincuenta y ocho pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005 y mayo de 2016, 29 eran de sexo femenino y 29 de sexo masculino. Treinta pacientes tenían una estenosis de origen adquirido y 28 de origen congénito. RESULTADOS: Fueron resecados entre 5 y 12 anillos (mediana 5) en 26 pacientes con estenosis adquirida, en 2 se efectuó injerto de cartílago en cara anterior, en 1 carinostomía, y en el restante (a este paciente se le había realizado previamente una resección laringotraqueal) se efectuó un reemplazo traqueal con aorta criopreservada. De los veintiocho pacientes con estenosis congénita, en 14 se empleó la técnica de deslizamiento, en 11 se resecaron entre 3 y 6 anillos (mediana 5), y en 3 se colocó un injerto en cara anterior de la tráquea. Fallecieron 7 pacientes: 2 con estenosis adquirida y 5 con estenosis congénita. La supervivencia global fue del 88% (28 de 30 pacientes con estenosis adquirida y 23 de 28 con congénita). De los 28 pacientes vivos operados por estenosis adquirida, 26 se encuentran asintomáticos, uno presenta estenosis del injerto y otro tiene un estoma en el injerto de aorta. De los 23 pacientes vivos operados por estenosis congénita, 20 se encuentran asintomáticos y 3 tienen endoprótesis colocadas. CONCLUSIONES: En nuestra experiencia, la resolución quirúrgica de la estenosis traqueal adquirida resultó más sencilla y presentó menos complicaciones. Los pacientes con estenosis traqueal congénita necesitaron generalmente más de un procedimiento para el control de su sintomatología, y presentaron mayor mortalidad.

Trend in predictive factors of choledocholithiasis: the key to the management of pediatric patients with suspected gallstones. / Tendencia en los factores predictivos de coledocolitiasis: la clave para el manejo de pacientes pediátricos con sospecha de cálculos en la vía biliar.

OBJECTIVES: To reduce the overuse of magnetic resonance cholangiopancreatography and the rates of non-therapeutic endoscopic retrograde cholangiopancreatography in pediatric patients suspected of choledocholithiasis. MATERIALS AND METHODS: Retrospective study of patients suspected of choledocholithiasis between January 2010 and June 2023. Patients with cholangitis or two or more of the following predictive factors of choledocholithiasis in initial laboratory tests and ultrasound were categorized as high-risk group: total bilirubin level ≥ 2 mg/dl, common bile duct > 6 millimeters on ultrasound; and detection of choledocholithiasis by ultrasound. Patients were recategorized according to the results of the second set of laboratory and ultrasound analysis. Confirmatory modalities (magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and/or intraoperative cholangiography) were used to evaluate the presence of choledocholithiasis. Finally, we assessed the predictive capability of both the initial high-risk group and the group after recategorization. RESULTS: A total of 129 patients were included. After initial studies, 72 (55.8%) patients were classified into the high-risk group. After recategorization, only 29 (22.5%) patients were included in this group. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of the initial high-risk group were 89.3%, 53.5%, 34.7%, 94.7%, and 61.2%, respectively, while after recategorization, they were 82.1%, 94.1%, 79.3%, 95.0%, and 91.5%, respectively. CONCLUSIONS: Recategorization of the risk of choledocholithiasis would significantly improve the diagnostic accuracy of choledocholithiasis and help reduce the overuse of more complex and unnecessary studies/procedures.

OBJETIVOS: Disminuir la sobre indicación de la colangiorresonancia y las tasas de colangiopancreatografía retrógrada endoscópica o terapéuticas en pacientes pediátricos con sospecha de coledocolitiasis. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con sospecha de coledocolitiasis entre enero de 2010 y junio de 2023. Los pacientes con colangitis o dos o más de los siguientes factores predictivos de coledocolitiasis en las pruebas de laboratorio y ecografía iniciales, se categorizaron como grupo de alto riesgo: nivel de bilirrubina total ≥ 2 mg/dl, colédoco > 6 milímetros en ecografía; y la detección de coledocolitiasis por ecografía. Los pacientes fueron recategorizados de acuerdo a los resultados del segundo conjunto de análisis de laboratorio y ecografía. Para evaluar la presencia de coledocolitiasis se utilizaron modalidades confirmatorias (colangiorresonancia, colangiopancreatografía retrógrada endoscópica y/o colangiografía intraoperatoria). Finalmente, evaluamos la capacidad predictiva tanto del grupo de alto riesgo inicial como del grupo después de la recategorización. RESULTADOS: Se incluyeron 129 pacientes. Luego de los estudios iniciales, 72 (55,8%) pacientes se clasificaron en el grupo de alto riesgo. Luego de la recategorización, solo 29 (22,5%) pacientes fueron incluidos dentro de este grupo. La sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y precisión diagnóstica del grupo de alto riesgo inicial fueron de 89,3%, 53,5%, 34,7%, 94,7% y 61,2%, mientras que luego de la recategorización fueron de 82,1%, 94,1%, 79,3%, 95,0% y 91,5%, respectivamente. CONCLUSIONES: La recategorización del riesgo de coledocolitiasis, mejoraría significativamente la precisión diagnóstica de coledocolitiasis y ayudaría a disminuir la sobre indicación de estudios/procedimientos complejos e innecesarios.

Evaluación de riesgos y mejora de la seguridad biológica y radiológica en la toma de radiografía torácica a pacientes con COVID-19.

INTRODUCTION: Health workers are at high risk of becoming infected with COVID-19. The objective of the study was to evaluate the risks and improve the biological and radiological safety measures for taking chest X-rays in patients with COVID-19 in a Social Security hospital in Utcubamba (Peru). MATERIAL AND METHODS: Quasi-experimental intervention study type before and after without a control group, carried out between May and September 2020. A process map and an analysis of failure modes and effects (FMEA) of radiological care were prepared. The gravity (G), occurrence (O), and detectability (D) values ??were found and the risk priority number (RPN) was calculated for each failure mode (FM). FM with RPN ≥ 100 and G ≥ 7 were prioritized. Improvement actions were implemented based on the recommendations of recognized institutions and the O and D values ??were re-evaluated. RESULTS: The process map consisted of 6 threads and 30 steps. 54 FM were identified, 37 of whom had RPN ≥ 100 and 48 had G ≥ 7. Most of the errors occurred during the examination 50% (27). After entering the recommendations, 23 FM had RPN ≥ 100. CONCLUSIONS: Although none of the measures applied through the FMEA made the failure mode impossible, they made it more detectable and less frequent and reduced the RPN for each failure mode; however, a periodic update of the process is necessary.

[Myofibroblastic tumor of the lung: clinical features and results in 9 children]. / Tumor miofibroblástico de pulmón: aspectos clínicos y resultados en 9 niños.

INTRODUCTION: Primary lung tumors in children are rare, being the myofibroblastic lung tumor (MLT) reported as the most common. Nevertheless the literature about it is scarce, and mostly consistent of case reports. The aim of this article is to describe the results obtained in a group of patients with this tumor treated in a tertiary pediatric hospital. METHODS: A single institution retrospective chart review was performed with institutional review board approval. All patients treated between 1990 and 2010 with diagnosis of MLT were included. Age, symptoms at presentation, surgical procedures, complications, histopathology and follow-up were reviewed. RESULTS: 9 patients were identified. The commonest symptoms at presentation were fever and cough (n=6), and seizures (n=2). Surgical treatment consisted in complete resection in 8 patients and partial resection in 1. To achieve this 3 patients underwent pneumonectomy and 6 lobectomy. Two of the patients with pneumonectomy required also a partial resection of the right atrium and both had cerebral lesions. The mean follow-up was 2.8 years (r:0.16-12) and all the patients that remained in follow-up (66%) are alive at the moment. DISCUSSION: Complete surgical resection in MLT is possible, however, to achieve this complex procedures and a multidisciplinary approach might be needed. Although the potential of distant metastasis is not clearly reported, we think that it is a topic that must be carefully revised.

Gastroschisis: deferred closure with releasing incisions. A case report. / Gastrosquisis: cierre diferido con incisiones de descarga. Reporte de caso.

Primary defect closure is the surgical treatment of choice in gastroschisis. When this is not feasible, a silo is required to progressively reduce the organs and perform a deferred closure of the wall. We present the case of a newborn with gastroschisis that required the use of a silo. Once the silo had been created, the distance between borders did not allow the defect to be closed, so decision was made to conduct releasing aponeurotic incisions for mobilization purposes.Progression was uneventful, and enteral nutrition was initiated at 24 days of life. Total enteral total nutrition was achieved at 40 days of life. He received parenteral nutrition for 36 days. He was discharged at 59 days of life. Abdominal wall treatment through releasing incisions allows prostheses to be avoided and represents an alternative for these patients.

El tratamiento quirúrgico de referencia en la gastrosquisis es el cierre primario del defecto. En los casos en que esto no es posible es necesario confeccionar un silo para reducir progresivamente las vísceras y realizar así el cierre diferido de la pared. Presentamos el caso de un recién nacido con gastrosquisis, que luego de confeccionar un silo, la distancia entre los bordes no permitía cerrar el defecto, por lo que se decidió realizar incisiones de descargas aponeuróticas para movilizar los mismos. El paciente evolucionó sin complicaciones, iniciando alimentación enteral a los 24 días de vida, alcanzando el aporte enteral total a los 40 días de vida. Recibió nutrición parenteral durante 36 días. Fue dado de alta a los 59 días. El tratamiento de la pared abdominal mediante incisiones de descarga permite evitar el uso de prótesis y agrega otra alternativa para el tratamiento de estos pacientes.

[Prevalence of tobacco use among teenagers and its relation with family environment]. / Prevalencia del consumo de tabaco en adolescentes. Influencia del entorno familiar.

OBJECTIVE: To determine the prevalence of tobacco use among 12-18 year-olds in Biscay (Spain) and its relation with the family environment. SUBJECTS AND METHOD: We performed a cross-sectional study in 12-18 year-olds. A self-administered, anonymous questionnaire was distributed in different schools of the region selected by stratified sampling, based on the type of school (public school or subsidized private school) and on the linguistic model. The final study sample comprised 1921 students. Information was obtained on tobacco, alcohol and other drug use, as well as on family and sociodemographic characteristics. RESULTS: A total of 51.8 % of the students had used tobacco. One-third (29.9%) of the teenagers were current smokers and 50.4% were daily smokers. The mean age of first tobacco use was 13.1 +/- 1.85 years. The prevalence of tobacco use was higher in girls and increased with age until the age of 15-16 years. More than 90 % of smokers had experimented with alcohol, 86.3 % had used cannabis at some time and 11 % had used other illegal drugs. In multivariate analysis, the variables associated with a higher odds of smoking were age, female sex, available money, use of other drugs, and smoking by siblings in front of the adolescent. CONCLUSIONS: The prevalence of tobacco use among 12-18 year-olds increased in relation to female gender, age, having siblings who smoked in their presence, available money, and the use of alcohol, cannabis and other illicit drugs. Maternal and sibling disapproval of smoking may be associated with lower tobacco use among adolescents.

Comparación de vía mediastinal posterior versus vía retroesternal para el reemplazo de esófago con ascenso gástrico parcial. Motivo de un cambio de estrategia / Comparison of posterior mediastinal versus retrosternal route for esophageal replacement with partial gastric pull-up. Rationale for a change in strategy

Introducción: existen dos rutas para realizar el reemplazo de esófago (RE), la retroesternal (RRE) y la mediastinal posterior (RMP). El objetivo del estudio es comparar los pacientes que recibieron un ascenso gástrico parcial empleando estas dos rutas. Material y métodos: Se revisaron las historias clínicas de 51 pacientes con ascenso gástrico parcial, en 27 años en el Hospital Garrahan. Se utilizó la vía RRE en 25 casos y la RMP en 26. Fueron comparados los datos epidemiológicos de los grupos y las variables para valorar la dificultad del acto quirúrgico, evolución inmediata y alejada. El estudio es comparativo, retro-prospectivo y longitudinal. Resultados: las características generales de los pacientes fueron similares. Los que recibieron el ascenso gástrico por vía RMP presentaron una menor incidencia de dehiscencia (p=0,017), de enfermedad por reflujo gastroesofágico (ERGE) (p=0,001) y de dumping (p=0,0001). No hubo diferencias estadísticamente significativas entre los dos grupos al comparar la duración del procedimiento, días de internación total y en Unidad de Cuidados Intensivos (UCI), días de permanencia en asistencia respiratoria mecánica (ARM), inicio de alimentación oral y estenosis de la anastomosis. Se observó una tendencia clínicamente relevante, que no alcanzó significancia estadística en las complicaciones intraquirúrgicas y número de dilataciones postoperatorias. No hubo necrosis del ascenso. Fallecieron 2 pacientes. Conclusiones: considerando la menor incidencia de dehiscencia, ERGE y dumping reemplazados por RMP, elegimos a ésta como nuestra primera opción para el reemplazo esofágico en la infancia (AU)

Introduction: The two routes for esophageal replacement (ER) are retrosternal (RRE) and posterior mediastinal (PMR). The aim of the study was to compare patients who received a partial gastric pull-up using either of these two routes. Material and methods: The clinical records of 51 patients who underwent partial gastric pull-up over 27 years at the Garrahan Hospital were reviewed. The RRE route was used in 25 and the RMP in 26 cases. The epidemiological data of the groups and the variables to evaluate the complexity of the surgical procedure, and shortand long-term outcome were compared. A comparative, retroprospective, and longitudinal study was conducted. Results: the general characteristics of the patients were similar. Those who underwent gastric pull-up via PMR had a lower incidence of dehiscence (p=0.017), gastroesophageal reflux disease (GERD) (p=0.001), and dumping (p=0.0001). No statistically significant differences were found between the two groups when comparing the duration of the procedure, days of total hospital and intensive care unit (ICU) stay, days on mechanical ventilation (MV), initiation of oral feeding and stenosis of the anastomosis. A clinically relevant trend, which did not reach statistical significance, was observed in intraoperative complications and number of postoperative dilatations. There was no necrosis of the pull-up. Two patients died. Conclusions: considering the lower incidence of dehiscence, GERD, and dumping associated with PMR, this was our first choice for esophageal replacement in infancy (AU)

Regulatory peptides in gastric endocrine cells of the rainbow trout Oncorhynchus mykiss: general distribution and colocalizations.

The endocrine cells of the rainbow trout (Oncorhynchus mykiss) stomach have been investigated using the immunocytochemical techniques of peroxidase-anti-peroxidase and avidin-biotin-peroxidase complexes on paraffin sections. 33 antisera were tested and eight immunoreactivities were detected: somatostatin-, glucagon- bombesin-, substance P-, serotonin-, met-enkephalin-, CCK/gastrin-, and chromogranin-like containing cells. All of them were present throughout the gastric mucosa except CCK/gastrin-like containing cells that were restricted to the pyloric epithelium. Somatostatin 25 and chromogranin immunoreactive cells are described for the first time in fish stomach. Serotonin immunoreactive cells were also positive for the Grimelius technique and some of them were immunoreactive to anti substance P or anti CCK/gastrin. Immunoreactivities for gastrin 17, gastrin 34 and CCK appeared in the same cells and the absorption controls showed that a molecule containing the carboxi-terminal pentapeptide of this family was present in trout stomach.

Endocrine cells and nerves in the stomach of the lizard Podarcis hispanica detected by immunocytochemistry.

The general identification of endocrine cells in the stomach of the lizard Podarcis hispanica was carried out by their response to the Grimelius and Masson-Fontana techniques. 11 immunoreactive cell-types, positive for chromogranin-, serotonin-, caerulein/gastrin/ cholecystokinin (CAER/G/CCK)-, glucagon-like-peptide-1 (GLP-1)-. glucagon-, bombesin-,somatostatin-, pancreatic polypeptide (PP)-, peptide tyrosine tyrosine (PYY)-, neurotensin-and calcitonin gene related peptide (CGRP)- antisera were detected by immunocytochemical methods. Co-existence of glucagon with GLP-1, and PP with PYY were observed in some cells. Furthermore, immunoreactivities for members of gastrin and PP families were also found to co-exist in a few cells. In the muscular layer, vasoactive intestinal peptide (VIP)- and substance P-immunoreactive nerve fibers were also found.

Pre-arrest heparinization and ventilation during warm ischemia preserves lung function in non-heart-beating donors.

BACKGROUND/PURPOSE: To solve the problem of donor scarcity, many attempts have been made including improved community education, relaxed organ acceptance criteria, increased reliance on single lung transplantation, and the use of partial organ donation. Unfortunately, these efforts have produced only modest increases in lung allograft availability; therefore, the so-called non-heart-beating organ donation must be considered. The aim of this study is to assess the viability of the non-heart-beating donor (NHBD) lung transplant rat model and determine the best strategy to manage the donor before and after cardiac arrest. METHODS: Fifty-five inbred Fischer rats were used as donors and recipients in an isogenic model of left lung transplantation. The rats were divided into 6 groups (n = 5): group I, normal controls without transplant; group II, heart-beating donor controls (HBD); group III, NHBD, no heparin, no ventilation during warm ischemia; group IV, NHBD, heparin, no ventilation; group V, NHBD, no heparin, ventilation; group VI, NHBD, heparin, ventilation. All lungs were stored at 4 degrees C for 4 hours. Animals were killed 24 hours after implantation. Gas exchange, pulmonary artery pressure, compliance, chest x-ray score, and histological score were assessed. RESULTS: Heparinized and ventilated animals during warm ischemia (group VI) had similar performance than those transplanted without warm ischemia time in a scenario of heart-beating donor (group II). Groups III, IV, and V transplanted lungs showed severe damage. CONCLUSIONS: The authors conclude that the rat lung transplantation model is useful to study the phenomena that occur in a setting of transplantation using NHBD and that heparinization and ventilation before cardiac arrest is the best strategy to manage non-heart-beating donors in this model.

[Characteristics of lung cancer in patients exposed to silica at work. A comparison of exposed and non-exposed individuals]. / Características del cáncer de pulmón en pacientes con exposición laboral a la sílice. Estudio comparativo entre individuos expuestos y no expuestos.

INTRODUCTION: In 1977 silica was listed as a group 1 carcinogen (demonstrated in humans) by the International Agency for Research on Cancer. However, conflicting results from various studies have kept debate alive as to its carcinogenic capacity. The interest of this debate lies in the large number of workers exposed to silica. OBJECTIVE: To analyze the differential characteristics of lung cancer among silica exposed and silica non-exposed individuals, to identify indirectly a possible carcinogenic effect of silica. METHODS: For all males with a diagnosis of lung cancer over a period of 22 consecutive months at the National Silicosis Institute (Oviedo, Spain), we recorded work history, age, smoking habits, spirometry, the presence of pneumoconiosis and histology. RESULTS: Comparing the results for silica exposed and non-exposed individuals, we found significant differences for age (63.7 8.8 and 66.7 8.6 y, respectively; p < 0.05), smoking (44.1 22.4 and 48.9 22.3 packs/year; p < 0.05) and a Tiffeneau index under 70% (in 78% of exposed vs. 55% of non-exposed patients; p < 0.05). No significant differences in histology, signs and symptoms or radiographs were observed between the two groups. In the multifactorial analysis in function of age of onset, exposure to silica continued to be an independent predictor. CONCLUSION: Our results show that the clinical and radiological signs and histology of patients exposed or non-exposed to silica did not differ. However, lung cancer appears earlier among individuals with work-related exposure to silica and lower rates of tobacco smoking, suggesting some carcinogenic effect for silica.

[Impact of a nutrition education program on the lipid profile and food habits of a working adult population]. / Impacto de un programa educativo nutricional sobre el perfil lipídico y los hábitos alimentarios de una población adulta laboralmente activa.

To evaluate the influence of health care education of the diet, we studied, in a sample of 68 workers (47 men and 21 women), the usual food intake (by means of a weekly registration technique), the anthropometry and the lipid profile, before and after giving a nutritional information program which lasted one year. At the end thereof, we observed a significant reduction in the global caloric intake, at the expense of a lower supply of proteins and fats (mainly saturated fats), which translated into a percentile distribution of macronutrients, which more closely resembles the dietary recommendations. The average anthropometric parameters did not vary. With respect to the lipid profile, a decrease of the plasma levels of LDL and HDL cholesterol was observed. These results confirm the capacity of educational interventions in changing the eating habits to a more healthy style, with repercussions on the lipid profile.

Validación de la escala de riesgo quirúrgica en pacientes operados por los servicios de cirugía general, urología y trasplante hepático / Validation of the surgical risk scale in patients who underwent surgery at the departaments of general surgery, urology and liver transplantation

Objetivo: Aplicar la escala de Riesgo quirúrgico (ERQ) a procedimientos de cirugía general y urología y comparar su capacidad predictiva de complicaciones en relación a otras escalas utilizadas en el hospital. Material y métodos: Estudio prospectivo de 1191 procedimientos quirúrgicos primarios con anestesia general realizados por el Servicio de Trasplante Hepático, cirugía general y urología del Hospital Garrahan durante el periodo comprendido entre 1 de Julio al 30 de Noviembre del 2011. Los resultados quirúrgicos fueron evaluados en relación al nivel de riesgo quirúrgico medido por el ERQ, la escala de riesgo anestésico (ASA) y la escala Fraire –Prieto-Boglione. Resultados: Del total de procedimientos 898 (75%) fueron realizados por cirugía general, 225 (19%) urología y 68 (6%) trasplante hepático. La tasa global de complicaciones posquirúrgicas tempranas reportadas fue de un 9% (n: 108), siendo graves solo el 3% (37) con una mortalidad quirúrgica del 0, 4% (5). La ERQ presentó capacidad de discriminación para el desarrollo de complicaciones posquirúrgicas graves con un área bajo la curva de 0, 83 (IC 0, 76-0, 90). La asociación de desarrollo de complicaciones quirúrgicas graves (STROC = 3) se incrementa en procedimientos de complejidad superior a ERQ > 5 con RR de 4, 3 (IC 2, 1- 8, 7), ERQ>6 con RR9, 3 (IC 4, 4-19, 5) y ERQ> 7 con RR 37(IC 26, 3-52, 1). Conclusión: ERQ es un instrumento útil y perfectible para objetivar la complejidad quirúrgica en relación al riesgo y que utilizada con la escala de Clavien para medir las complicaciones posquirúrgicas constituyen un punto de partida para iniciar procesos de mejora continua en cirugía pediátrica. El desarrollo de modelos matemáticos de predicción del riesgo posquirúrgico requiere de estudios multicéntricos que incluya variables del paciente, acto quirúrgico, equipo y centro dado el escaso número de complicaciones y mortalidad que tiene la cirugía pediátrica.

Immunocytochemical and ultrastructural characterization of endocrine cells in chicken proventriculus.

The endocrine cells of the chicken proventriculus were investigated immunocytochemically, using the peroxidase-antiperoxidase technique on paraffin and semithin sections for light microscopy, and immunogold staining in osmium-fixed material for electron microscopy. The fixation procedure also allowed a detailed ultrastructural investigation. Twenty-three antisera were tested and 7 immunoreactive cell-types were identified: D-cells containing somatostatin-like peptide; EG-cells immunoreactive to anti-glucagon, anti-GLP1 and anti-neurotensin; NT-cells labelled only with anti-neurotensin; BN-cells containing bombesin-like material; ENK-cells showing met-enkephalin immunoreactivity; EC-cells reactive to anti-serotonin; and APP-cells positive to anti-avian pancreatic polypeptide. In addition, enterochromaffin-like (ECL) cells, were also detected by electron microscopy. The presence of ENK-cells and the ultrastructure of these and NT-cells are described for the first time in chicken proventriculus, and glucagon. GLP1 and neurotensin are shown to be colocalized in the EG-cells.

[The consumption of food of animal origin distinct from milk: meat, fish, eggs in the school-age population of the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Ingesta de alimentos de procedencia animal distintos de la leche: carnes, pescados y huevos, en la población escolar de la Comunidad de Madrid. Grupo CAENPE.

The aim of this study was to assess the intake of foods of animal origin other than milk, as well as their role in the diet of children, in a representative sample of a school-aged population from the Community of Madrid (CAENPE study). A 4 day assessment of the dietary intake was conducted by applying a combination of the methods of 24-hour recall and a written record of the estimated consumption. We studied 2,608 schoolchildren between the ages of 6 and 14 years. The subjects were divided into groups according to age and sex. We found that the average meat intake was 213 +/- 87 g/person/day. The consumption of meat was significantly higher in boys (p < 0.05) and increased with age both in boys (p < 0.001) and girls (p < 0.05). Meat provided 40% of the saturated fat, 34% of the cholesterol and 33.5% of the protein in the diet. Fish intake was 77 +/- 64 g/person/day, with higher consumption in boys (p < 0.05) and with no influence of age. Fish supplied 11% of the dietary protein and only 1.2% of the saturated fat. Egg consumption was 31 +/- 20 g/day/person, which represents 3 eggs per week. The consumption of eggs was also higher in boys than in girls (p < 0.05) and provides 28% of the dietary cholesterol. We conclude that meat provides more than one third of the dietary protein and alone covers the RDA for protein. In addition, meat also contributes the highest amount of dietary saturated fat and cholesterol. Egg and fish intake is adequate; hence, it would be desirable to reduce the excessive meat intake in order to equilibrate the macronutrients and cholesterol supplied by the diet.

[The consumption of dairy products and their contribution to the nutrients in the diet of schoolchildren in the community of Madrid. The Food Consumption and Nutritional Status of the School-Age Population of the Autonomous Community of Madrid Group]. / Consumo de lácteos y su contribución al aporte de nutrientes en la dieta de los escolares de la Comunidad de Madrid. Grupo CAENPE.

The aim of this report, included in the CAENPE study, was to assess the actual intake of milk products by children from Madrid and their nutrient contribution to the diet. In a sample of 2,608 children, 1,343 boys and 1,265 girls, between 6 and 14 years of age, representative of the school child population from Madrid, a dietary assessment of 4 non-consecutive days was carried out by applying a combination of the methods of 24-hour recall (2 days) and an estimated food intake record (2 days). We found that the average total milk product intake was 410 +/- 173 g/person/day, with this being significantly higher in boys (p < 0.0001) and increasing with age (p < 0.001). Milk products are the primary source of calcium, 1,076 +/- 374 mg/person/day, which represents 61% of the total calcium intake and is below the RDA for children over 10 years of age. In addition, following meat and meat products, dairy products are the second largest source of saturated fat (28% of total intake). They also supply 31% of the dietary phosphorus, 17% of protein, 16% of total fat, 15% of the cholesterol, 10% of the carbohydrates and 14% of the the energy intake. We conclude that milk products are the major source of calcium in the diet of schoolchildren. Their low consumption explains the insufficient calcium intake in certain age groups, which might be associated to a higher risk of osteoporosis in later life. We encourage an increase in the intake of milk products, especially milk, and a reduction in the consumption of sweets and meat in order to decrease the dietary saturated fats.

Apoptosis en trasplante de pulmón. Influencia del lavado y la reperfusión del órgano / Apoptosis in lung transplantation. Influence of lavage and reperfusion on the organ

Objetivo: Determinar el rol de la irrigación con soluciones de preservación, la reperfusión y el rechazo en la apoptosis pulmonar en un escenario de trasplante pulmonar. Material y método: Venticuatro cerdos Landrace con un peso de 15 a 30 kilogramos fueron usados como donantes y receptores en un modelo de trasplante pulmonar izquierdo, con 5 días de sobrevida. Las muestras se obtuvieron en la siguiente secuencia: 1A: Donante, pulmón izquierdo inmediatamente luego de la apertura del torax. 1B: donante, pulmón derecho, inmediatamente luego de la apertura del tórax. 2A: Donante pulmón izquierdo, inmediatamente luego de la irrigación del organo. 2B Donante, pulmón derecho, sin irrigar. 3A: Pulmón izquierdo implantado, 1 hora luego de reperfundido en el receptor . 3B: Pulmón derecho (nativo), 1 hora luego de reperfundido el pulmón donante en el receptor. 4A: Pulmón izquierdo, biopsia transbronquial a las 48 horas postrasplante. 4B: Pulmón derecho, biopsia transbronquial a las 48 horas postransplante. 5A: Púlmón izquierdo, 5º día postrasplante (sacrificio). Todos los pulmones fueron irrigados con solución de Euro-Collins fría (4Cº) durante la ablación. Seis receptores no recibieron inmunosupresión y otros 6 receptores recibieron 15 mg/KG/ día de ciclosporina intravenosa. Los niveles plasmáticos de ciclosporina fueron dosados en tiempo 0 al 2º y 5º día postrasplante. Cada muestra fue analizada por un observador ciego para determinar el grado de rechazo (A0 y A1 negativo. A2. A3 y A4 positivo), proliferación celular, y el índice de apaptosis en neumonocitos I y II empleando la técnica de TUNEL y Caspasa. Las pruebas de Chi cuadrado; prueba de t de student y kruskal Wallis fueron utilizadas para el análisis estadístico. Se consideró significativo un valor de p menor a 0.05. Resultados: El grado de rechazo fue negativo en todas las muestras excepto en 4A (1 animal) y 5A (5 animales sin ciclosporina y 3 animales de los que recibieron ciclosporina) (p<0.05)

Tumores primitivos de pulmón en niños: imágenes y hallazgos / Primitive lung neoplasmas in children: imaging and findings

Los tumores primitivos pulmonares endobronquiales o parenquimatosos, son extremadamente raros en niños por lo que la experiencia individual en el diagnóstico, tratamiento y pronóstico es limitada. Nuestro trabajo muestra las formas de presentación, métodos de diagnóstico empleados y resultados en 21 pacientes que se atendieron en nuestro hospital entre los años 1991 a 2005. Los métodos de imágenes utilizados fueron: la radiología simple que permitió evaluar la sospecha de masa pulmonar, el US que demostró su naturaleza sólida, quística o mixta y la presencia o no de derrame pleural, mientras que la TC delimitó su localización extensión y metástasis, datos imprescindibles para el tratamiento quirúrgico adecuado. En los pacientes pedátricos que tienen lesión pulmonar ocupante de espacio, así como en los que debutan con neumotórax o hemotórax espontáneos debe tenerse en cuenta la posibilidad de tumor primitivo de pulmón, debiéndose profundizar los estudios mediante US, TC y endoscopia. Las lesiones congénitas quísticas tienen riesgo de malignización, por lo que su tratamiento debe ser quirúrgico.