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Background: Postoperative intussusception is an unusual complication in children; the incidence is 0.01-0.25%., Clinical Case: Female of 11 months who underwent colostomy, 48 h later presents abdominal pain, vomiting gastrobiliar and abdominal distension. A laparotomy was performed, finding a double ileo-ileal invagination 60 cm from the ileocecal valve., Discussion: The postoperative intestinal invaginations are extremely rare and most of them occur within the first 7 days. The etiology of postoperative intussusception is unknown., Conclusions: Postoperative children with intestinal occlusion, intussusception should be suspected and an immediate laparotomy should be performed., (Copyright: © 2020 Permanyer.)

Background: Hernia repair represents about 25% of all pediatric surgeries. Repair can be done using an open or laparoscopic technique. The open approach has a reported recurrence rate of 1.2% but requires an additional incision to repair for a contralateral hernia. With the laparoscopic approach, no additional incision is needed but the recurrence rate has been reported to be as high as 4%. The objective of this study was to assess the safety and efficacy of a novel sutureless laparoscopic inguinal hernia repair that has the advantages of both approaches., Methods: Since April 2014 up to March 2017, 26 children (12 girls and 14 boys) aged 3 months to 13 years underwent sutureless laparoscopic inguinal hernia repair. The peritoneum around the internal inguinal ring was severed and folded into the inguinal canal. Regeneration of the peritoneum around the inguinal ring creates a scar that effectively closes the internal orifice., Results: No recurrences or complications were observed in any of the 26 cases after a follow-up of 1-35 months (median, 14 months)., Conclusions: Sutureless laparoscopic inguinal hernia repair provides a new option for the management of patients with a pediatric inguinal hernia. The procedure does not require advanced laparoscopic skills, is easily reproducible, and is safe., Therapeutic Study: Level of Evidence IV.

Introducción: El divertículo de Meckel es un remanente del conducto onfalomesentérico y su prevalencia es del 2%., Caso Clínico: Niño de 12 años con dolor abdominal, acompañado de evacuaciones mucosanguinolentas y hematemesis, con masa en cuadrante inferior derecho. En la laparotomía quirúrgica se encontró invaginación, y se realizó desinvaginación y resección del divertículo de Meckel., Conclusión: La asociación de divertículo de Meckel con tejido pancreático heterotópico en niños es poco frecuente. Clínicamente, su principal manifestación es la invaginación intestinal en la literatura revisada, y el ultrasonido constituye el mejor estudio para el diagnóstico de invaginación intestinal, no así para el divertículo de Meckel o el tejido pancreático heterotópico, en los que la tomografía sería una opción., Introduction: Meckel’s diverticulum is a remnant of the omphalomesenteric duct and its prevalence is 2%., Clinical Case: A 12-year-old male with abdominal pain, accompanied by muco-sanguineous evacuations and hematemesis, with right lower quadrant mass. In the laparotomy, invasion was found; intussusception reduction and resection of the Meckel’s diverticulum was performed., Conclusion: The association of Meckel’s diverticulum with heterotopic pancreatic tissue in children is rare, its main manifestation is intussusception and ultrasound is an option for diagnosis., (Copyright: © 2018 Permanyer.)

Background: Intestinal obstruction in children may be congenital, acquired, intrinsic or extrinsic. Most intestinal obstructions in children are the result of postoperative adhesions. Those caused by anomalous congenital band are extremely rare., Clinical Case: Patient of a 1-year-old male, with no previous history of abdominal surgery or trauma. He suffered with vomiting of bile content and loss of appetite at home three days before admission. On physical examination, he was irritable, with abdominal distention, absence of peristalsis and abdominal tenderness, with no signs of peritoneal irritation being found. The blood count reported leucocytosis and the x-rays show dilated small bowel loops, fluid levels and absence of air in rectal ampulla. An open laparotomy was subsequently performed, and the intraoperative findings were consistent with a congenital band extending from the anti-mesenteric wall of the jejunum to the root of mesentery, compressing the ileum at 50cm from the ileocecal valve, causing ischaemia. The band was ligated and divided, with an uneventful postoperative course. He was discharged 4 days later without complications., Conclusions: The anomalous congenital band is not associated with abdominal problems, such as remnants of previous laparotomies or embryological structures, such as vitelline vessels or omphalomesenteric yolk duct. These bands seem to have a congenital origin and cause bowel obstruction by trapping between the band and the mesentery. The diagnosis of anomalous congenital band is extremely difficult and no imaging study is useful for the diagnosis, and only exploratory laparotomy or laparoscopy is useful for diagnosis and treatment of this problem., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.)

The production of efficient, tunable, and switchable circularly polarized laser emission would have far reaching implications in optical communications or biophotonics. In this work, it is demonstrated the direct generation of circularly polarized (CP) laser emission in achiral and isotropic dye laser systems without the use of extracavity polarizing elements, and without resorting to chiral dyes, chiral liquid crystal matrices, or interferometric methods. The origin of this ellipticity arises from the dynamic birefringence induced by the strong and polarized laser pumping and the subsequent orientation anisotropy of the excited molecular dipoles. A complete polarimetric characterization of the polarization state of conventional dye laser oscillators as a function of different experimental parameters is performed and it is shown that the generated light always possesses a certain level of circularity that changes in a distinctive way with pump energy and polarization. These results demonstrate that it is possible to generate and modulate CP laser light from efficient and photostable conventional laser dyes.

Unlabelled: The voluntary discontinuation of dialysis by patients is a common mode of death in dialysis programmes. Unfortunately the Spanish experience has not been related in the nephrological literature. Initiation of, and withdrawal from, dialysis pose ethical questions for medicine in the 21st century. The dialysis population is aging and they have multiple medical problems. The choice may be between prolongation of quantity or quality of life. We evaluated a protocol for initiation of dialysis in patients with end stage renal failure and their subsequent withdrawal. We determined the factors predicting withdrawal of dialysis and revised the protocol to take account of these. We carried out an opinion poll of doctors and nurses about the effectiveness of the protocol. We studied prospectively the reasons for death of patients in the last seven years., Results: Thirty patients were withdrawn from dialysis out of 116 who died during treatment by hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) in the last seven years. Vascular nephropathy is the principal disease predicting withdrawal from dialysis; the main precipitating cause is mental incapacity. The availability of a protocol for withdrawal of dialysis is well received by doctors and nurses and it engenders moral and legal calm when facing difficult decisions. Twenty-six per cent of deaths on regular dialysis are the result of withdrawal of treatment.