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International audience; Octreotide, a somatostatin analogue, has been used for more than 20 years in children with gastrointestinal bleeding, chylothorax or chylous ascites, intestinal lymphangiectasia, pancreatitis, intestinal dysmotility, and severe diarrhoea; however, until now, there is a lack of randomised clinical trials evaluating the efficacy of this compound in childhood. Hence, we aimed to review the literature in order to determine the evidence of its use and safety in children, using PubMed from 2000 to 2021 with the search terms "octreotide" and "children" and "bleeding or chylous ascites or chylothorax or acute pancreatitis or lymphangiectasia or diarrhoea or intestinal dysmotility".

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.

Objective Selective granulocyte-monocyte adsorption (GMA) apheresis is a safe technique that has shown efficacy in inflammatory bowel disease (IBD), especially in adult steroid-dependent and steroid-refractory ulcerative colitis. GMA apheresis is performed with Adacolumn, a direct blood perfusion system that selectively adsorbs circulating granulocytes and monocytes. Studies on efficacy of GMA apheresis in paediatric IBD are scarce. Our aim was to evaluate efficacy, safety, and tolerability of GMA apheresis in paediatric IBD patients followed for 1 year. Patients and methods Nine patients with a mild to moderate flare-up (6 boys, 3 girls; 5 ulcerative colitis [UC], 4 Crohn disease [CD]) were included. Mean age at inclusion was 13 years and 9 months, and mean disease duration before inclusion was 28 months. All of our patients with UC were steroid-dependent; patients with CD had been unsuccessfully treated with other therapies. GMA apheresis consisted of 5 consecutive weekly sessions lasting 60 minutes each. Results After the 5 sessions, 4 of 5 patients with UC and 1 of 4 patients with CD achieved remission. This remission was maintained in 2 of 4 patients with UC and in the single patients with CD. Patients taking steroids could begin to taper their daily doses after the second apheresis, and 3 of 5 of these patients reached the end of the study steroid-free. GMA apheresis was well tolerated and no severe side effects related to the technique were observed. Conclusions GMA apheresis is a safe, well-tolerated technique in paediatric IBD. As previously reported, we have observed a better efficacy in promoting and maintaining remission, and reducing conventional drugs in patients with UC than in patients with CD.

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.

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development.On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infant diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect.In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet. Resumen: En el momento actual existe una situación de indefinición con respecto a cuándo, cómo y de qué forma debe introducirse el gluten en la dieta del lactante. Durante años ha prevalecido la recomendación del Comité de Nutrición de la ESPGHAN de evitar tanto la introducción precoz, antes de los 4 meses, como la tardía, después de los 7 meses, y de introducir el gluten gradualmente mientras el lactante recibe leche materna; se pretendía con ello reducir el riesgo de enfermedad celiaca, diabetes y alergia al gluten. Sin embargo, 2 estudios independientes publicados en octubre de 2014 en The New England Journal of Medicine llegan a la conclusión de que la edad de introducción del gluten no modifica el riesgo de desarrollar la enfermedad celiaca y que la lactancia materna a cualquier edad tampoco confiere protección.Por otra parte, según la evidencia científica disponible, en general, se recomienda la introducción de otros alimentos en la dieta distintos de la leche materna o de fórmula alrededor de los 6 meses de edad, ya que la introducción antes de los 4 meses se asociaría a un riesgo aumentado de enfermedades autoinmunes y alergia alimentaria, y retrasarla más allá de los 7 meses no tendría efecto protector.En este contexto, un grupo de expertos ha considerado pertinente elaborar un documento de consenso basado en las evidencias científicas actuales y establecer unas recomendaciones generales para la introducción del gluten en la práctica clínica diaria.

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.

Resumen: El trasplante hepático (TH) es el único tratamiento efectivo existente para las enfermedades hepáticas en fase terminal. La desproporción entre demanda y oferta de órganos constituye su principal limitación, planteando la necesidad de buscar alternativas de tratamiento.El trasplante de hepatocitos humanos o trasplante celular hepático (TCH) constituye, en el momento actual, la mejor opción terapéutica puente al restablecimiento de la función hepática o al trasplante hepático. Consiste en trasplantar hepatocitos humanos totalmente diferenciados a un órgano receptor, en cantidad suficiente para que estos sobrevivan y restauren la función hepática normal, basándose en la capacidad de regeneración hepática.El TCH consta básicamente de 4 pasos: el aislamiento de los hepatocitos a partir de injertos hepáticos descartados para TH, la preparación de las suspensiones celulares, la criopreservación de los hepatocitos aislados y, finalmente, su implante en el receptor.Esta terapia se ha llevado a cabo en pacientes con insuficiencia hepática aguda de distintas etiologías con intención de sustituir o servir de puente al TH y en el tratamiento de pacientes pediátricos con errores congénitos del metabolismo con objetivo de reemplazar el déficit enzimático causante de la enfermedad.En el Hospital La Fe de Valencia hemos puesto en marcha una Unidad de Terapia Celular Hepática y llevado a cabo el primer TCH en España, abriendo una nueva línea de trabajo dentro del Programa de Trasplante Hepático. Abstract: Liver transplantation has been remarkably effective in the treatment of patients with end-stage liver disease. However, disparity between solid-organ supply and increased demand is the main limitation, resulting in longer waiting times and an increase in the mortality of transplant recipients. This situation creates the need to seek alternatives to orthotopic liver transplantation. Hepatocyte transplantation or liver cell transplantation has been proposed as the best method to support patients, a bridge to restore liver function or liver transplant.The procedure consists in transplanting individual cells in a recipient organ in enough quantity to survive and restore the function. The capacity of hepatic regeneration constitutes the biological basis of hepatocyte transplantation. Liver cell transplantation is carried out by means of the isolation of hepatocytes from donor liver rejected for orthotopic transplantation, to prepare a cell suspension for infusion, cryopreservation and, finally, hepatocytes are implanted into the recipient.This may be an optional therapeutic procedure in some patients with inborn errors of metabolism, fulminant hepatic failure, and acute and chronic liver failure, as a bridge to orthotopic liver transplantation.The first hepatocyte transplantation in Spain was performed in the Cell Therapy Unit of the Hospital La Fe of Valencia, creating a new research line in the transplant program.

En los ultimos 10 anos, una serie de estudios previos sobre la enfermedad celiaca (EC), y en particular los de Ivarsson et al. sobre la llamada epidemia sueca de celiaquia de mediados de los ochenta, han dado origen a la hipotesis de que la introduccion de pequenas cantidades de gluten, preferiblemente durante un periodo de lactancia materna, podria contribuir a reducir el riesgo de EC. Pero ademas de esos estudios, otro de Norris et al. mostraba que la introduccion del gluten en lactantes con riesgo genetico en una edad igual o inferior a los 3 meses, o igual o superior a los 7, se asociaba a un mayor riesgo de autoinmunidad celiaca y desarrollo de EC. Todo ello llevo a la comunidad cientifica a aceptar mayoritariamente la existencia de una «ventana de oportunidad» para la introduccion del gluten entre los 4 y 6 meses de edad. En consecuencia, el Comite de Nutricion de la ESPGHAN recomendo evitar la introduccion del gluten antes de los 4 meses o despues de los 6 meses de edad. Para investigar el potencial concreto de la intervencion dietetica en la prevencion de la EC se llevo a cabo un estudio multicentrico prospectivo europeo, el Prevent Coeliac Disease (PreventCD, www.preventcd.com, FP6-2005-FOOD4B-36383-PREVENTCD), en el que, desde el Centro Medico de la Universidad de Leiden, en los Paises Bajos, se coordino la colaboracion entre hospitales, universidades, laboratorios e industria de 7 paises europeos e Israel. Los resultados de

A multicentric, open, prospective, observational and no-randomized clinical trial was carried out in Spain with 190 postmenopausal women receiving a soy preparation rich in isoflavones (PHYTO SOYA, capsules containing 17.5 mg isoflavones). The main object of the present study was to investigate its efficacy in alleviating the symptomatology derived from the lack of estrogen, mainly hot flushes, but also other symptoms such as sleep disorder, anxiety, depression, vaginal dryness, loss of libido and bone pain. Each patient received 35 mg isoflavones per day in two doses. During the four months' treatment, a statistically significant decrease in the number of hot flushes with PHYTO SOYA was experienced by 80.82% women; only 5,48% patients did not improve with the treatment. The average reduction was 47.8%, which is equivalent to 4 hot flushes. All the other studied parameters also showed a statistically significant decrease. No severe side-effects were reported and tolerance was excellent. Treatment with PHYTO SOYA resulted in a significant improvement of the symptomatology that accompanies the lack of estrogen during menopause.

Objective: To test venous endothelial function during long-term hormone replacement therapy (HRT) and after treatment withdrawal. Design: Measurement of dorsal hand-vein diameter by venous occlusion plethysmography during infusion of norepinephrine, bradykinin, NG-monomethyl l-arginine, and sodium nitroprusside. Setting: Plethysmography and menopause units, University Hospital Marques de Valdecilla, Santander, Spain. Patient(s): Twenty postmenopausal women, of whom 10 were assigned to receive no hormone replacement therapy (HRT) for 6 months after plethysmography (group A) and 10 were assigned to receive HRT for 6 months (group B). After 6 months, HRT was administered to group A and withdrawn from group B for another 6 months. Intervention(s): Plethysmography at baseline and at 6 and 12 months. Main Outcome Measure(s): Dorsal hand-vein diameter measured by venous occlusion plethysmography during infusion of norepinephrine, bradykinin, NG-monomethyl l-arginine, or sodium nitroprusside. Result(s): At 6 months, the maximum dilation obtained with bradykinin was 48.8 ± 7.58% in group A and 76.7 ± 12.9% in group B. At 12 months, maximum bradykinin dilation increased to 74.3 ± 14.2% in group A and decreased to 54.0 ± 15.9% in group B. Conclusion(s): Long-term HRT with estrogen plus progestin improves endothelium-dependent vasodilation, but this effect is lost in a relatively short time. Endothelial function in dorsal hand veins is an easy-to-use plethysmography model that can be used in serial studies.

This study aimed to assess the value of IgA-antigliadin and antiendomysium antibodies for coeliac disease screening in children with short stature. In 118 children with height less than the 3rd percentile for age preliminary work-up included absorption, hormonal and genetic studies, sweat test, X-ray for bone age, serum immunoglobulin levels and antigliadin antibodies. In 65 patients antiendomysium antibody and a small-intestinal biopsy were performed. Forty-three children had a normal mucosa and 22 a subtotal villous atrophy. Three coeliac children were negative for both antigliadin and antiendomysium antibodies; one further 11-year-old boy was negative only for antiendomysium antibodies. Sensitivity and specificity for antigliadin antibodies were 94.75% and 93%, respectively, and for antiendomysium antibodies 88.3% and 90.5%. Our results show that the use of antiendomysium antibodies as a confirmatory test to select patients for biopsy could result in coeliac disease going undiagnosed in adolescents.

P2.12.04 P2.12.06 VENOUS ENDOTHELIAL FUNCTION IN POSTMENOPAUSAL WOMEN ON LONG-TERM HORMONAL TREATMENTS, OESTROGENS AND PROGESTIN C. Ceballos, J.R. Berrazueta, M.T. Garcia-Unzueta, J.A. Amado, I. de Mier, C. Ribes. Cardiology and Gynecology Departments. Universitary Hospital M. Valdecilla. Santander. Spain PERCEFTION OF VARIOUS MENOPAUSAL SYMPTOMS AMONG POST-MENOPAUSAL WOMEN ATTENDING THE GYNECOLOGICAL OUT-PATIENT CLINIC AT MO1 TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA S.R. Mishra, Dept. of Reproductive Health, Faculty of Health Sciences, Moi University, Eldoret, Kenya.

Dans le but de connaitre avec precision la chronologie de la gestation chez le blaireau europeen ,une etude du developpement embryonnaire et foetal in utero a ete menee afin d'etablir des courbes de croissance staturale et ponderale