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Introduction: Diagnostic delay of inflammatory bowel disease in children might be responsible for complications and a poor response to treatment. The study of diagnostic delay and its determining factors may help implement corrective measures and improve the prognosis of the disease. Patients and methods: A retrospective study of the information collected from primary care medical records and that from the paediatric gastroenterology service at a tertiary hospital between 2000 and 2012 was carried out in 53 patients: 31 with Crohn's disease, 19 with ulcerative colitis, and 3 with unclassified paediatric inflammatory bowel disease. The main response variable was the interval from the first physician–patient contact to diagnosis. Results: The median time to diagnosis was 12 weeks (interquartile range 5–24). However for 26.3% of the ulcerative colitis cases and 25.8% of the Crohn's disease cases, the interval was longer than 1 year. There was a more marked delay trend in Crohn's disease cases, but it was not statistically significant. None of the evaluated risk factors were associated with a relevant diagnostic delay, although it tended to be longer in younger children. Conclusions: Whereas the median delay for paediatric inflammatory bowel disease seems to be acceptable, the diagnostic time spans are considerable for a large proportion of children with heterogeneous clinical characteristics. Further research into lost diagnostic opportunities needs to be carried out. Resumen: Introducción: El retraso diagnóstico (RD) de la enfermedad inflamatoria intestinal pediátrica (EII-P) puede conllevar la aparición de complicaciones y una menor respuesta al tratamiento. Estudiar el RD y los factores que lo condicionan ayudaría a implementar medidas correctoras y mejorar la evolución de la enfermedad. Pacientes y métodos: Un total de 53 casos (31 de enfermedad de Crohn [EC], 19 de colitis ulcerosa [CU] y 3 EII-P no clasificadas) entre 2000 y 2012 se evaluaron de forma retrospectiva a través de la información recogida en las historias clínicas de atención primaria y las de un Servicio de Gastroenterología infantil de un hospital terciario. La variable respuesta principal fue el tiempo entre el primer contacto médico-paciente y el diagnóstico. Resultados: El tiempo mediano de RD fue de 12 semanas (rango intercuartílico 5-24). Sin embargo, un 26,3% de las CU y un 25,8% de las EC presentaron un RD superior a un año. Ninguno de los factores de riesgo estudiados se asoció significativamente a un RD relevante pero los niños de menor edad presentaron una tendencia a un mayor RD. Conclusiones: Aunque el RD mediano de la EII-P parece aceptable, existe una proporción importante de niños con unas características clínicas heterogéneas y unos tiempos diagnósticos considerables. Se debería profundizar en el análisis de las oportunidades perdidas de diagnóstico.

Objetivo: Los tumores hepáticos malignos (THM) pediátricos son el resultado final de la combinación variable de los factores de riesgo (FR) constitucionales y ambientales. La presente revisión pretende divulgar los principales FR asociados a los THM pediátricos para fomentar su prevención primaria y el diagnóstico precoz en los síndromes constitucionales. Método: Revisión sistemática de la bibliografía de los últimos 25 años, obtenida del Medline, Embase, Cancerlit, Lilacs y SciElo. El perfil de búsqueda utilizado fue la combinación de “etiology/risk factor/epidemiology” and “malignant liver tumors/hepatic cancer” or “hepatoblastoma/hepatocarcionoma”. Resultados: Los THM en la época pediátrica constituyen el 1% del total de cánceres pediátricos. Los dos tipos principales, el hepatoblastoma (HB) y el hepatocarcinoma (HC), engloban el 98-99% de los THM. Diversos FR constitucionales y ambientales están asociados a un mayor riesgo de desarrollar dichas neoplasias. Los principales FR constitucionales son los siguientes: a) síndrome de Beckwith-Wiedemann (BW); b) síndrome de hemihiperplasia aislada (HA); c) poliposis adenomatosa familiar; d) hemocromatosis; e) tirosinemia hereditaria tipo 1; f) deficiencia de alfa-1 antitripsina; g) porfirias; h) cirrosis; i) esteatosis no alcohólica, y j) colangitis esclerosante primaria. Los principales FR ambientales son los siguientes: a) virus de las hepatitis B (VHB) y C (VHC); b) aflatoxina B1 (AFB1); c) radiación ionizante; d) alcohol; e) tratamientos hormonales; f) exposiciones laborales a solventes, pesticidas, cloruro de vinilo y metales; g) tabaquismo; h) arsénico; i) prematuridad y muy bajo peso al nacimiento, y j) tremátodos. Conclusiones: El cribado clínico, analítico y ecográfico de los principales síndromes genéticos comentados, especialmente el de BW y HA, durante los primeros años de vida, facilitan el diagnóstico precoz del HB. La vacunación universal de los recién nacidos con el VHB, constituye el pilar básico de la prevención primaria de los THM. El control del VHB y VBC en la sangre, hemoderivados, donaciones de órganos y en drogadictos también es de gran utilidad. Otras medidas efectivas en la prevención primaria de los THM son: la reducción/ eliminación de alimentos con AFB1, la abstención alcohólica pediátrica y la reducción de las exposiciones prenatales al tabaco, radiaciones ionizantes, solventes, pesticidas, cloruro de vinilo, metales y tratamientos hormonales. : Objective: Pediatric Hepatic Malignancies (PHMs) are the result of the interaction between constitutional and environmental risk factors (RFs). We review the evidence on the main RFs associated to PHMs. Method: Systematic review of the literature published in the last 25 years on Medline, Embase, Cancerlit, Lilacs and SciElo using the following key words: “etiology/risk factor/epidemiology” and “malignant liver tumors/hepatic cancer” or “hepatoblastoma/hepatocarcionoma”. Results: PHMs account for 1% of all pediatric malignancies. The main types, hepatoblastoma (HB) and hepatocarcionma (HCC) make up 98-99% of PHM. The main constitutional RFs are: a) Beckwith-Wiedemann (BW) syndrome; b) isolated hemihyperplasia syndrome (IHS); c) adenomatous polyps of the colon; d) hemochromatosis; e) Hereditary Tyrosinemia Type 1; f) α-1-antitrypsin deficiency; g) porphyrias; h) cirrhosis; i) nonalcoholic steatosis; and j) primary sclerosing cholangitis. The main environmental RFs are: a) hepatitis B virus (HBV) and C virus (HCV); b) B1 aflatoxin (B1AF); c) ionizing radiation; d) alcohol; e) hormonal treatments; f) occupational exposure to pesticides, solvents, vinyl chloride and metals; g) smoking; h) arsenic; i) prematury and very low birth weight; and j) trematodes. Conclusions: The clinical, analytical and ultrasound screening facilitate the early diagnosis of HB in the previously mentioned genetic syndromes, particularly BW and IHS during the first years of life. HBV universal vaccination of newborns provides the biggest opportunity to prevent a substantial proportion of PHMs. Also systematic monitoring of HBV and HCV in blood, hemoderivates, donated organs and drug addicts, are very useful. Other effective measures are: the reduction/elimination of B1AF in food, zero alcohol intake during childhood and adolescence as well decreasing prenatal exposure to the tobacco, solvents, pesticides, vinyl chloride, metals, ionizing radiation and hormonal treatments.

Objetivo: Obtener un mejor conocimiento del comportamiento deuna población de pacientes con diagnóstico de atresia de vías biliares en las distintas fases de la enfermedad Pacientes y métodos: Estudio retrospectivo, transversal y descriptivo, tipo serie de casos clínicos. Pacientes con diagnóstico de atresia de vías biliares atendidos en la Unidad de Gastroenterología del Hospital Infantil La Fe de Valencia desde enero de 1990 a diciembre del 2000 Resultados: De los 16 niños controlados, en el momento actual permanecen estables ocho, han precisado trasplante hepático seis y han fallecido dos. La edad media al diagnóstico es de 47,5 días de vida. La manifestación clínica más frecuente es la ictericia (87,5 %), y el hallazgo analítico más importante el aumento de la gammaglutamiltranspeptidasa (GGT) (3–4 veces su valor de referencia) en el 100 % de los casosLas imágenes ecográficas son diagnósticas en el 85,7 %. El Hepato-Hida ofrece una sensibilidad del 100 %. El tratamiento quirúrgico mediante portoenterostomía se realizó en todos los pacientes, con biopsia hepática en el mismo acto. La precocidad en la intervención se refleja en un mejor pronóstico a largo plazo, siendo mejor si ésta se realiza antes de los 65 días de vida Conclusiones: Un alto índice de sospecha permite el tratamiento quirúrgico precoz, única medida terapéutica que puede condicionar un pronóstico menos desfavorable : Objective: To gain further insight into the natural history of patients with biliary atresia Patients and methods: We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included Results: Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5 %) and the most common biochemical finding was raised γ-glutamyltransferase (3–4 times its standard value), which appeared in 100 % of the patientsAbdominal ultrasonography was diagnostic in 85.7 % of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100 %. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life Conclusions: Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome

Objetivo: Estudiar la incidencia de infección perinatal por citomegalovirus en los recién nacidos ingresados en nuestro hospital en los últimos 3 años, las posibles fuentes de contagio, los datos serológicos y microbiológicos y la evolución clínica de los niños. Métodos: Estudio retrospectivo. Revisión de historias clínicas de los neonatos con diagnóstico de infección por citomegalovirus. Resultados: Se encontraron 24 niños con este diagnóstico. El 85% de los niños eran prematuros, con peso menor de 1.500 g, los cuales representan el 6% de los niños con ese peso ingresados en este período. El porcentaje de transfusión y lactancia materna fue elevado (87 y 91 %, respectivamente), por lo que la fuente de contagio no pudo establecerse. Nueve (34 %) de los niños presentaron afectación hepática y 3 (12 %) tuvieron un cuadro clínico grave que precisó tratamiento antiviral. Conclusiones: La infección perinatal por citomegalovirus es una enfermedad frecuente en el grupo de niños prematuros, que puede llegar a ser grave. Es importante pensar en su diagnóstico e insistir en la prevención. Objective: To study the incidence of perinatal cytomegalovirus infection in neonates admitted to our hospital in the last three years, as well as the mode of transmission, serologic and microbiologic data, and the clinical outcome of these infants. Methods: :We performed a retrospective study by reviewing the medical records of neonates with a diagnosis of cytomegalovirus infection. Results: Twenty-four neonates received this diagnosis. Of these, 21 (85%) were premature infants with a birthweight of less than 1500 gr, representing 6% of all neonates with this birthweight hospitalized during the study period. The percentage of transfusion and breastfeeding was high (87% and 91 %, respectively) and consequently the route of transmission could not be identified. Nine neonates (34%) presented associated hepatic dysfunction and three (12%) developed severe disease requiring antiviral treatment. Conclusions: Perinatal cytomegalovirus infection is frequent in preterm infants and may be serious. It is important to detect cytomegalovirus infections and to develop preventive methods.

Introduction L’infection de prothese articulaire de genou (IPG) est une complication severe de la chirurgie orthopedique. Le changement en 2 temps operatoires est considere comme le traitement de reference. Le changement en 1 temps est une alternative qui pourrait permettre un controle satisfaisant de l’infection ainsi qu’une amelioration des resultats fonctionnels. Materiels et methodes Etude retrospective monocentrique de patients traites pour IPG par changement de prothese et antibiotherapie ciblee entre le 1 er janvier 2009 et le 31 decembre 2014. Les objectifs de l’etude etaient de comparer l’evolution de l’infection et les resultats fonctionnels entre les changements de prothese en 1 et en 2 temps. Le choix du type d’intervention etait fait en RCP par l’equipe multidisciplinaire. Les resultats fonctionnels etaient evalues au-dela d’un an apres la chirurgie a l’aide du score International Knee Society (IKS), du score Knee injury and Osteoarthritis Outcome Score (KOOS) et du score de qualite de vie SF-12. Resultats Soixante-deux patients ont ete inclus. L’âge moyen etait de 71 ans (ecart-type = ± 9 ans) et la duree moyenne de suivi apres la chirurgie de 22 mois (ecart-type = ± 13 mois). Quarante et un patients ont eu un changement en 2 temps et 21 patients ont eu un changement en 1 temps. Une guerison de l’infection a ete obtenue chez 78 % des patients avec changement en 2 temps et 90 % des patients avec changement en 1 temps ( p = 0,3). Un Staphylococcus aureus , un staphylocoque a coagulase negative ou un streptocoque etait respectivement identifie dans 19 %, 33 % et 24 % des changements en 1 temps et dans 34 %, 36 % et 2 % des changements en 2 temps. Les amplitudes articulaires en flexion etaient significativement plus grandes pour les patients avec changement en 1 temps (102°) que pour les patients avec changement en 2 temps (86°) ( p p = 0,048), satisfaction ( p = 0,046) et score clinique objectif ( p = 10 −3 ). Les resultats du score KOOS etaient meilleurs chez les patients avec changement en 1 temps pour les sous-categories symptomes ( p = 0,042) et vie quotidienne ( p = 0,03). Il n’y avait pas de difference pour le score SF-12. Conclusion Les changements en 1 temps pour IPG sont associes a une frequence de guerison semblable a celle des changements en 2 temps et a une meilleure fonction du genou, lorsque realises par une equipe entrainee. La decision prise en RCP parait correcte mais des criteres plus precis du choix 1 temps vs 2 temps restent a definir.

Study Objective: To test venous endothelial function in long-term climateric therapy with tibolone. Design: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine (NE), bradykinin (BK), NG-monomethyl l -arginine ( l -NMMA) and sodium nitroprusside (SNP). Setting: Plethysmography and Menopause Units. University Hospital Valdecilla. Santander. Spain. Patients: Eleven postmenopausal women having continuous treatment with oral tibolone (2.5 mg/day) for 6 months. Interventions: Three plethysmography studies were made: at baseline, and at three and six months of treatment. Main outcome measures: Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of NE, BK, l -NMMA and SNP. Results: (a) Baseline study: maximum dilation with BK was 54.2±10.2%. (b) Three-month study: BK dilation of 71.5±11.9%, with a significant increase of 17.3% ( P =0.019) compared with baseline. (c) Six-month study: BK dilation of 77.5±11.9%, with a significant increase 23.3% ( P =0.002) compared with baseline. Maximal vasodilation was reached with SNP in the three studies and l -NMMA infusion has a similar vasoconstrictor response in the three studies. Conclusions: Long-term climateric therapy with tibolone improves vein endothelium-dependent vasodilation suggesting a positive impact of this drug on endothelial function.

Micron level resolution is required to image tightly spaced annual bands in speleothems. These same bands must be viewed over several millimeters and sometimes centimeters in order to ensure continuity. We report luminescence imaging results from several speleothem specimens using a novel confocal scanning laser macroscope instrument. The macroscope can non-destructively image specimens as large as 7.5×7.5 cm using reflected light and photoluminescence with a 10 μm lateral resolution in under 10 s. A high-resolution version of the macroscope can image specimens up to 1–2 cm in size with lateral resolutions ranging from 1 to 2 μm depending upon the laser scan lens utilized. The combination of both these instruments allows for entire specimens to be imaged even beyond 7.5×7.5 cm fields of view via tiling. Confocal imaging improves overall resolution of the instrument by eliminating light originating from outside the focal plane which tends to blur the image. High-contrast, crisp images are achieved in this way. We show photoluminescence imaging results for speleothem specimens where emphasis is placed on resolving to the level of annual bands.

We report the fabrication of photovoltaic devices by the anodization of microcrystalline silicon films on single-crystal silicon substrates. The porosity of the films was varied from 20% to 60% by changing the anodization conditions. The influence of the porosity on the series resistance ( R s ), the reflectance, and the spectral response of the devices was studied. In order to determine R s , the current–voltage characteristics were analyzed, both in the dark and under illumination. We observed that the value of R s increased from 3 to 100 Ω and the value of the reflectance decreased from 24% to 7% when the porosity increased from 20% to 60%. The optimum device performance (fill factor of 0.53 and efficiency of 7.2%), which was achieved for a porosity of 40% and can be improved further, resulted from a trade-off between good electrical and optical properties. From optical beam-induced current images, the homogeneity of the devices was found to be excellent and no defects were detected. Our results indicate that the fabrication of commercial solar cells based on porous microcrystalline Si (PMSi) is possible.

This paper describes a confocal scanning beam MACROscope/Microscope which can image specimens up to 7 × 7 cm in size using reflected light, photoluminescence and optical beam induced current. The MACROscope provides a 10 μm spot size at various wavelengths and generates 512 × 512 pixel images in less than 5 s. When used in combination with a conventional confocal scanning laser microscope sub-micron spot sizes become possible providing resolutions as high as 0.25 μm laterally and 0.5 μm axially in reflected light. The main function of this imaging system is to spatially resolve any defects within solar cells and similar devices. Several reflected-light, photoluminescence and OBIC images of CdS CuInSe 2 and CdZnS CuInSe 2 thin film solar cells are presented.

High resolution, large area photoluminescence mapping with scanning stage microscopes has proven to be a useful, but slow, quality control technique for compound semiconductor wafers. This paper describes a confocal scanning beam MACROscope-Microscope which can image specimens up to 7.5×7.5 cm in size, in less than 10s, using reflected light, photoluminescence, and optical beam induced current. MACROscope mode provides 5 μm lateral resolution and 300 μm axial resolution. Microscope mode provides 0.25 μm lateral and 0.5 μm axial resolution, with a minimum field of view of 25×25 μm. This instrument can be used to evaluate preparation parameters involved in the manufacture of porous silicon as well as to provide quality control at a macroscopic and microscopic level for the fabrication of porous silicon specimens, wafers, detectors, and similar devices. A brief introduction to confocal microscopy and porous silicon is given. Several confocal and non-confocal photoluminescence and reflected-light images of a porous silicon wafer are shown at macroscopic and microscopic levels. A 3D profile of porous silicon structures reconstructed from confocal slices is also shown.