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Abstract In a prospective observational study, seroconversion to a specific pathogen can serve as a marker of an incident infection, whether or not that infection is symptomatic or clinically diagnosed. While self-reported symptoms can be affected by reporting bias, seroconversion is likely to be free of this bias as it is based on objective measurements of antibody response. Non-invasive salivary antibody tests can be used instead of serum tests to detect seroconversions in prospective studies. In the present study, individuals and families were recruited at a Lake Michigan beach in Wisconsin in August 2011. Data on recreational water exposure and baseline saliva samples (S1) were collected at recruitment. Follow-up data on gastrointestinal symptoms were collected via a telephone interview approximately 10 days post-recruitment. Follow-up saliva samples were self-collected approximately 2 weeks (S2) and 30–40 days post-recruitment (S3) and mailed to the study laboratory. Samples were analyzed for immunoglobulin (Ig) G responses to recombinant antigens of three noroviruses and Cryptosporidium, as well as protein purification tags as internal controls, using an in-house multiplex suspension immunoassay on the Luminex platform. Responses were defined as ratios of antibody reactivities with a target protein and its purification tag. Seroconversions were defined as at least four-fold and three-fold increases in responses in S2 and S3 samples compared to S1, respectively. In addition, an S2 response had to be above the upper 90% one-sided prediction limit of a corresponding spline function of age. Among 872 study participants, there were seven (0.8%) individuals with seroconversions, including six individuals with seroconversions to noroviruses and two to Cryptosporidium (one individual seroconverted to both pathogens). Among 176 (20%) individuals who reported swallowing lake water, there were six (3.4%) seroconversions compared to one (0.14%) seroconversion among the remaining 696 individuals: the crude and age-standardized risk differences per 1000 beachgoers were 32.7 (95% confidence limits 5.7; 59.6) and 94.8 (4.6; 276), respectively. The age-adjusted odds ratio of seroconversion in those who swallowed water vs. all others was 49.5 (4.5; 549), p = 0.001. Individuals with a norovirus seroconversion were more likely to experience vomiting symptoms within 4 days of the index beach visit than non-converters with an odds ratio of 34 (3.4, 350), p = 0.003. This study contributed further evidence that recreational water exposure is associated with symptomatic and asymptomatic waterborne infections, and that salivary antibody assays can be used in epidemiological surveys of norovirus and Cryptosporidium infections.

Introdução: A toxoplasmose de sistema nervoso central (SNC) está em terceiro lugar como a infecção oportunista definidora de AIDS mais prevalente no Brasil, sendo o encéfalo o local mais comum de acometimento. A mielite pelo Toxoplasma gondii é considerada rara mesmo nos casos de imunossupressão, mas sua hipótese deve ser considerada e está amplamente associada a gravidade e desfecho desfavorável. Objetivo: Relato de caso de toxoplasmose de SNC com acometimento de medula espinhal em paciente HIV sem tratamento prévio. Método: Paciente do sexo masculino, 49 anos, branco, HIV positivo há 15 anos com carga viral detectável e CD4 29 células/mm³. Foi admitido devido cervicalgia com irradiação para face lateral de membros superiores associado a parestesia e paraparesia de membro inferior direito há 15 dias. Na ressonância magnética de crânio foram vistas lesões com realce anelar e áreas de edema vasogênico perilesional na porção posterolateral direita da ponte, lobo occipital esquerdo e pedúnculo cerebelar direito. Devido a síndrome clínica e o exame de imagem, compatíveis com neurotoxoplasmose, foi iniciado o tratamento com Sulfadiazina, Pirimetamina e ácido folínico. Resultados: Durante a internação, o paciente apresentou incontinência fecal e urinária seguida de paraplegia. Feita ressonância magnética (RNM) de neuroeixo, evidenciando lesão grosseiramente nodular expansiva de situação intra-raquídea, intradural e intramedular de C7 a T1. Realizada abordagem cirúrgica pela equipe da neurocirurgia, com diagnóstico definitivo de neurotoxoplasmose através do anatomopatológico. O paciente evoluiu a óbito um mês após início do tratamento. Conclusão: A neurotoxoplasmose é uma doença oportunista grave, estando sempre no escopo dos diagnósticos diferenciais em portadores do vírus da imunodeficiência que se apresentam com sintomas neurológicos focais. Revisões sugerem que, nestes pacientes, a evidência sorológica da infecção por T. gondii e sintomas de mielite, devem receber tratamento empírico imediato vista alta taxa de mortalidade e complicações neurológicas, sendo a biópsia reservada para casos de não melhora clínica. O nosso paciente teve uma evolução fatal mesmo com tratamento instituído, o que corrobora a severidade da doença. A morbimortalidade pela doença vem diminuindo devido o acesso a terapia antirretroviral (TARV), mas a infecção por T. gondii ainda representa um determinante de mau prognóstico na história natural do HIV.

Se comunica la observación, quizá única en la literatura, de un aneurisma cirsoide de la rama izquierda de la arteria cística. Clínicamente es probable que fuera la causa de los cólicos hepáticos que presentaba la paciente. Radiológicamente se manifestaba en el colecistograma por un defecto de repleción vesicular fijo y de aspecto !acunar. Fue tratado por resección completa a expensas de una colecistectomía. Se analiza la infrecuente, pero variada patología de la arteria cística. Se discuten los diagnósticos presuntivos y la conducta a seguir frente a los defectos de repleción vesicular en el estudio colecistográfico.

This study presents the technique of percutaneous wire-target access of the superior vena cava (SVC) in patients with bilateral jugular-subclavian vein occlusion requiring a tunneled hemodialysis catheter. A 3-year retrospective review of five patients was performed. The femoral vein is accessed percutaneously and a 5F sheath inserted. This is followed by placement of a pigtail catheter (wire-target) in the SVC with cavography. The SVC is percutaneously cannulated at the level of the pigtail under fluoroscopy, and a guidewire is passed into the vena cava with confirmation by injection of contrast material. A tunneled hemodialysis catheter is then placed. The wire-target technique of SVC access can be used safely and effectively to establish upper body catheter access when traditional techniques are not possible. Keywords: Wire-target access, Bilateral jugular-subclavian vein occlusion

In this paper we present the development of photonic integrated circuit (PIC) biosensors for the label-free detection of six emerging and endemic swine viruses, namely: African Swine Fever Virus (ASFV), Classical Swine Fever Virus (CSFV), Porcine Reproductive and Respiratory Syndrome Virus (PPRSV), Porcine Parvovirus (PPV), Porcine Circovirus 2 (PCV2), and Swine Influenza Virus A (SIV). The optical biosensors are based on evanescent wave technology and, in particular, on Resonant Rings (RRs) fabricated in silicon nitride. The novel biosensors were packaged in an integrated sensing cartridge that included a microfluidic channel for buffer/sample delivery and an optical fiber array for the optical operation of the PICs. Antibodies were used as molecular recognition elements (MREs) and were selected based on western blotting and ELISA experiments to ensure the high sensitivity and specificity of the novel sensors. MREs were immobilized on RR surfaces to capture viral antigens. Antibody–antigen interactions were transduced via the RRs to a measurable resonant shift. Cell culture supernatants for all of the targeted viruses were used to validate the biosensors. Resonant shift responses were dose-dependent. The results were obtained within the framework of the SWINOSTICS project, contributing to cover the need of the novel diagnostic tools to tackle swine viral diseases.

Objective: To examine potential differences in children's physical activity and parent support of their children's physical activity based on family income within the rural setting. Methods: A cross-sectional survey of 566 parents of children (5–15 years-old; mean = 7.7 years; standard deviation = 2.4) living in rural West Virginia from 2010 to 2011 was conducted. Children were recruited and had participated in a school-based health screening program. Results: Overall, parents from a rural setting reported that their children engaged in an average of five days of physical activity for at least 60 min. Upon closer examination, children from lower-income families engaged in more physical activity, on average, than children from higher income families per parent report (mean = 6.6 days, confidence interval 95% = 4.9–6.0 vs. middle-income mean = 5.0, confidence interval 95% = 4.4–5.3 and highest-income mean = 4.5, confidence interval 95% = 4.1–4.7; p = .01). Rural parents supported their children's physical activity in numerous ways. Parents with the lowest incomes were more likely than parents from higher income families to encourage their children to be active and use their immediate environment for play and to be directly involved in physical activity with their children. More affluent parents were more likely to transport their children to other activity opportunities than parents from the lower income brackets. Conclusions: Lower income families may utilize their immediate environment and encourage activity among their children whereas more affluent families focus on organized opportunity more often than lower income families. These findings emphasize the need to conceptualize the role family income plays in physical activity patterns and the potential benefit it provides to some families.

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In this paper, we present the concept of a novel diagnostic device for on-site analyses, based on the use of advanced bio-sensing and photonics technologies to tackle emerging and endemic viruses causing swine epidemics and significant economic damage in farms. The device is currently under development in the framework of the EU Commission co-funded project. The overall concept behind the project is to develop a method for an early and fast on field detection of selected swine viruses by non-specialized personnel. The technology is able to detect pathogens in different types of biological samples, such as oral fluids, faeces, blood or nasal swabs. The device will allow for an immediate on-site threat assessment. In this work, we present the overall concept of the device, its architecture with the technical requirements, and all the used innovative technologies that contribute to the advancements of the current state of the art.

Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection.

: Persistent Gastrocutaneous Fistula (GCF) is common problem encountered in the pediatric population. Several management options for intervening on pediatric persistent GCF have been described and range from open surgical management to medical management. Here we describe a novel adaptation on a previously described technique that utilizes a punch biopsy to excise the GCF we have coined as Punch Excision of Epithelialized Tracts (PEET). : The steps to this procedure include passing a punch biopsy tool over a Foley catheter. The catheter is inserted into the GCF tract, the balloon is inflated, the catheter is retracted against the abdominal wall, and the punch biopsy instrument is pushed through the skin and subcutaneous tissue circumferentially excising the tract. : Four patients at our institution have undergone GCF excision using the PEET approach. Mean duration of the GCF in our four patients was 9 months. Mean follow-up after GCF excision using the PEET approach was 7.8 months. No patients in the cohort had any post-operative complications including surgical site wound infection, emergency department visits, or re-hospitalizations related to their surgical care. : Based on our preliminary findings in this small patient cohort, we believe the PEET approach for managing persistent pediatric GCF has short-term efficacy and has the potential upside of utilizing fewer hospital resources to perform the procedure in a time-efficient manner. [ABSTRACT FROM AUTHOR]

No consensus guidelines exist for timing of enterostomy closure in neonatal isolated intestinal perforation (IIP). This study evaluated neonates with IIP closed during the initial admission (A1) versus a separate admission (A2) comparing total length of stay and total hospital cost. Using 2012 to 2017 Pediatric Health information System (PHIS) data, 359 neonates with IIP were identified who underwent enterostomy creation and enterostomy closure. Two hundred sixty-five neonates (A1) underwent enterostomy creation and enterostomy closure during the same admission. Ninety-four neonates (A2) underwent enterostomy creation at initial admission and enterostomy closure during subsequent admission. For the A2 neonates, total hospital length of stay was calculated as the sum of hospital days for both admissions. A1 neonates were matched to A2 neonates in a 1:1 ratio using propensity score matching. Multivariate models were used to compare the two matched pair groups for length of stay and cost comparisons. Prior to matching, the basic demographics of our study population included a median birthweight of 960 g, mean gestational age of 29.5 weeks, and average age at admission of 4 days. Eighty-seven pairs of neonates with IIP were identified during the matching process. Neonates in A2 had 91% shorter total hospital length of stay compared to A1 neonates (HR: 1.91; 95% CI for HR: 1.44–2.53; p <.0001). The median length of stay for A1 was 95 days (95% CI: 78–102 days) versus A2 length of stay of 67 days (95% CI: 56–76 days). Adjusting for the same covariates, A2 neonates had a 22% reduction in the average total cost compared A1 neonates (RR: 0.78; 95% CI for RR: 0.64–0.95; p-value = 0.014). The average total costs were $245,742.28 for A2 neonates vs. $315,052.21 for A1 neonates (p < 0.001). Neonates with IIP have a 28 day shorter hospital length of stay, $75,000 or 24% lower total hospital costs, and a 22 day shorter post-operative course following enterostomy closure when enterostomy creation and closure is performed on separate admissions. Prognosis Study. Level II. [ABSTRACT FROM AUTHOR]

To improve opioid stewardship for umbilical hernia repair in children. An educational intervention was conducted at 9 centers with 79 surgeons. The intervention highlighted the importance of opioid stewardship, demonstrated practice variation, provided prescribing guidelines, encouraged non-opioid analgesics, and encouraged limiting doses/strength if opioids were prescribed. Three to six months of pre-intervention and 3 months of post-intervention prescribing practices for umbilical hernia repair were compared. A total of 343 patients were identified in the pre-intervention cohort and 346 in the post-intervention cohort. The percent of patients receiving opioids at discharge decreased from 75.8% pre-intervention to 44.6% (p < 0.001) post-intervention. After adjusting for age, sex, umbilicoplasty, and hospital site, the odds ratio for opioid prescribing in the post- versus the pre-intervention period was 0.27 (95% CI = 0.18–0.39, p < 0.001). Among patients receiving opioids, the number of doses prescribed decreased after the intervention (adjusted mean 14.3 to 10.4, p < 0.001). However, the morphine equivalents/kg/dose did not significantly decrease (adjusted mean 0.14 to 0.13, p = 0.20). There were no differences in returns to emergency departments or hospital readmissions between the pre- and post-intervention cohorts. Opioid stewardship can be improved after pediatric umbilical hernia repair using a low-fidelity educational intervention. Retrospective cohort study. Level II. [ABSTRACT FROM AUTHOR]

Biliary dyskinesia (BD) is a common indication for pediatric cholecystectomy. While diagnosis is primarily based on diminished gallbladder ejection fraction (GB-EF), work-up and management in pediatrics is controversial. We conducted a multi-institutional retrospective review of children undergoing cholecystectomy for BD to compare perioperative work-up and outcomes. Six hundred seventy-eight patients across 16 institutions were included. There was no significant difference in gender, age, or BMI between institutions. Most patients were white (86.3%), non-Hispanic (79.9%), and had private insurance (55.2%). Gallbladder ejection fraction (EF) was reported in 84.5% of patients, and 44.8% had an EF < 15%. 30.7% of patients were initially seen by pediatric surgeons, 31.3% by pediatric gastroenterologists, and 23.4% by the emergency department with significant variability between institutions (p < 0.001). Symptoms persisted in 35.3% of patients post-operatively with a median follow-up of 21 days (IQR 13, 34). On multivariate analysis, only non-white race and the presence of psychiatric comorbidities were associated with increased risk of post-operative symptoms. There is significant variability in evaluation and follow-up both before and after cholecystectomy for BD. Prospective research with standardized data collection and follow-up is needed to develop and validate optimal care pathways for pediatric patients with suspected BD. Case Series, Retrospective Review. Level IV. [ABSTRACT FROM AUTHOR]

Abstract Purpose Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS. Methods PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation. Results There are no standards for the practice of PSPBUS. Conclusions As the role of the pediatric surgeon continues to evolve, PSPBUS will influence practice patterns, disease diagnosis, and patient management. Type of Study Review Article. Level of Evidence Level III. [ABSTRACT FROM AUTHOR]

Se hacen consideraciones sobre la patología de los tumores·de testículo en el niño, presentándose una serie de 18 casos, donde predominan los tumores germinales, y dentro de ellos, los del saco vitelino. La evolución, en general ha sido buena, falleciendo 3 pacientes de la serie.

Se practicaron, en una serie de catorce pacientes, fistulas arteriovenosas con la interposición de un ho• moinjerto de safena cadavérica, en pacientes cuyo territorio venoso superficial estaba disminuido. El procedimiento nos dio buenos resultados, obteniendo en doce pacientes fistulas arteriovenosas funcionantes y utilizables en hemodiálisis crónica. Es de señalar: 1) que este tipo de injertos son de fácil obtención; 2) que el costo es más bajo que el de los materiales sintéticos; y 3) que son especialmente útiles dadas nuestras carencias y dificultades para obtener materiales sintéti• cos o liofilizados.

Se analizan 46 malformaciones del aparato urinario observadas en 30 neonatos. El diagnóstico fue realizado en el periodo fetal en 15 de ellos y en el periodo neonatal en los otros 15.

Se analiza la experiencia en la cirugía vascular del transplante renal a propósito de 50 observaciones. La variedad de presentación del pédiculo renal ha hecho necesaria la utilización de una amplia gama de procedimientos que prácticamente llevó a realizar casi todas las variables posibles en este campo. Hay una sola complicación directamente vinculable a la cirugía vascular; oclusión arterial aguda por placa de ateroma desprendida embolizada. Se enumeran las complicaciones y se señala que los resultados globales a un año son comparables con los obtenidos en otros medios.

Se presenta nuestra experiencia de 4 años consecutivos en cirugía urológica transuretral: se realizaron 399 procedimientos en 316 pacientes, abarcan• do casi toda la patología quirúrgica que ocurre en el adulto a nivel del ureter pelviano, la vejiga, el cuello vesical, la próstata y la uretra. Se analiza esta casuística según la patología en juego y su cirug(a transuretral, concluyendo que nuestros resultados y nueatra morbi-mortalidad son equiparables a los referidos en la literatura extranjera.

Al encarar los aspectos quirúrgicos del carcinoma renal elegimos los capítulos que a nuestro criterio despiertan mayor inquietud e interés tanto a urólogos como a cirujanos generales.

Se presenta nuestra experiencia urológica en los 20 primeros trsplantes renales realizados en el Uruguay. Se hace paricular referencia a la metodología seguida en la valoración del donante vivo y. cadavérico, la valoración del receptor, la cirugía pretraplante del receptor, la cirugía del donante vivo y cadaverico, el reimplante del nt1ón en el receptor, raconducción postoperatoria, el manejo de ls complicaciones quirúrgicas y el seguimiento alejado. Se señala la importancia de la organización y coorinación necesarias para la realización de trasplantes con riñón cadavérico. Se reune toda la bibliografía nacional sobre el tema y una selección de la bibliografía extranjera eferente a los spectos urológicos y a los resultados del procedimiento. Aunque nuestro número de casos y el período de seguimiento no permiten aún una adecuada correlación de reultados con la literatura extranjera, no se advieren diferencias significativas. La presente serie nos ha proporcionado valiosa experiencia en muchas de las alenatvs tan particulares que ocurren en esta cirugía.

De acuerdo a la investigación bibliográfica y a la experiencia de múltiples cirujanos uruguay. os llegamos a la conclusión que· a pesar de los años que lleva su discusión y de los -adelantos diagnósticos y terapéuticos, la.s contuóones de abdomen siguen presentando problemas impor· tantes en la práctica diaria.

En un grupo de 35 ntños con reflujo vésico-ureteral, 23 se han intervenido quirúrgicamente con la técnica recientemente desarrollada de "avance" ureteral de Cohen. La misma fue aplicada en 36 hemisistemas (incluyendo 3 duplicidades: 39 uréteres) obteniendo el 97,3 % de buenos resultados, a pesar de tratarse de casos avanzados cou signos de lesión renal en el 58. % de los mismos. Se efectúa una breve reseña fisiopatológica y se insiste en la necesidad de un diagnóstico más temprano de la afección.

En las distintas clínicas urológicas de la capital: Facultad de Medicina y Ministerio de Salud Pública, hemos comprobado una serie de casos clínicoo que fueron vistos en primer término en los servicios de urgencia y en las clínicas quirúrgicas generales, interpretados como cuadros de abdomen agudo de origen intraperitoneal tratados como tales y cuyo diagnóstico era de etiología urinaria. El deseo de este grupo de trabajo es traer estas situa·ciones clínicas a la consideración de ustedes.

Presentación de 4 casos de nefrocarcinoma hipervascularizado tratados por oclusión :mbólica pe·rcutánea mediante cateterismo de· la arteria renal, seguida de nefrectomia en 3 de ellos. Se comentan las indicaciones, tolerancia y posibles variantes del procedimiento. Discute1 la oportunidad más apropiada para ,efectuar la nefrectomia y describen los hallazgos histopatológicos. Cuando la embolización es completa, involucrando toido el riñón, la nefrectomia efectuada luego de un intervaio corto se ve notoriamente faci!.t;da y puede cómeuzar por la ligadura primaria de la vena renal, reduciendo al mínimo el riesgo de diseminación neoplásica intraoperatoria.

Se presenta un caso de uréter retrocava diagnosticado en forma completa y tratado exitosamente mediante operación plástica correctora. Los· autores reseñan las características embriológicas y etiopatogénicas de esta rara anomalía, cuya causa primitiva es venosa, aunque sus consecuencias aparecen en el aparato urinario (hidronefrosis). Los síntomas clínicos y los signos radiológicos son analizados; dentro de éstos, la asociación del contraste ureteral con la cavografía permite un diagnóstico de certeza. El tratamiento corriente es la cirugía conservadora \ transposición del uréter), aunque en casos incipientes está justificada la abstención con control periódico; cuando la afección está muy evolucionada sólo cabe la nefrectomía.

Hasta los 12, (doce) años de edad, loG tumores de testículo constituyen una afección rara, ya que representan del 0,5 al 2 % de los cánceres a esa edad. La bilateralidad es aún más rara

Background Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy. Methods A retrospective chart review was performed for patients ≤ 18 years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for < 24-h, and admission for > 24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p < 0.05 considered significant. Results Of the 171 patients identified, 63 (37%) were discharged from the PACU, 94 (55%) were admitted < 24-h, and 14 (8%) were admitted > 24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission < 24-h and > 24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter. Conclusion Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources. Level of evidence III (Treatment: retrospective comparative study). [ABSTRACT FROM AUTHOR]

Se comenta la ind,icación quirúrgica de· la Litíasis Coraliorme y la táctica y la técnica a seguir.

Se comunica la experiencia de 100 Resecciones Transuretrales d,e hiperplasia prostática benigna, con resultados equiparables a los señalados en la literatura.

Abstract Purpose The low perioperative mortality rate in pediatric surgery precludes effective analysis of mortality at individual institutions. Therefore, analysis of multi-institutional data is essential to determine any patterns of perioperative death in children. The aim of this study was to determine diagnoses associated with 24-hour and 30-day perioperative mortality. Methods A retrospective review of the 2012-2015 Pediatric Participant Use Data File (PUF) was performed. Statistical comparisons were made between survivors and nonsurvivors and between those with 24-hour and 30-day mortality using Fischer's exact tests. P-values ≤ 0.05 were considered significant. Results 103,444 patients who underwent a pediatric surgical operation were evaluated. There were 732 deaths with a 30-day perioperative mortality of 0.7% (732/103,444). Necrotizing enterocolitis (NEC) was the diagnosis associated with the highest 30-day perioperative mortality (175/901, 19%). A significantly higher proportion NEC deaths occurred in the first 24 hours (67% (118/175) vs 33% (57/175) 30 day mortality, p < 0.001). Compared to patients who survived following operation for NEC, those who died were statistically more likely to require inotropic support (56% vs. 15%, p < 0.001), be diagnosed with sepsis (52% vs. 22%, p < 0.001), and undergo blood transfusion within 48 hours of operation (49% vs. 34%, p < 0.001). Conclusion Although the overall pediatric surgical operative mortality rate is low, the largest proportion of perioperative deaths occur secondary to NEC. Based on the high immediate mortality, optimization of operative care for septic patients with NEC should be targeted. Type of Study Prognosis Study Level of Evidence Level II [ABSTRACT FROM AUTHOR]

Abstract This is a case with associated radiologic images for a pediatric patient who developed portomesenteric and splenic vein thrombosis (PMSVT) after Roux-en-Y gastric bypass with subsequent development of portal cavernoma and gallbladder varices (GBV). This case highlights both the importance of post-operative prophylactic anti-coagulation after gastric bypass and detailed imaging following a diagnosis of PMSVT. This case is relevant for pediatric surgeons as they are performing this operation more frequently with the increase in pediatric obesity. [ABSTRACT FROM AUTHOR]

Se expone la forma de funcionamiento de una unidad de cirugía endoscópica transuretral en que se han realizado 215 procedimientos de este tipo en 173 pacientes en el curso de 12 meses con buenos resultad.os. Se trataron afecciones de la uretra, la próstata, el cuello vesical, la vejiga y el uréter terminal. No existió mortalidad.