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Resumen Introduccion y objetivos Los nodulos tiroideos requieren con frecuencia evaluacion mediante ecografia y puncion aspiracion con aguja fina (PAAF). No obstante, la PAAF no permite la diferenciacion entre adenoma y carcinoma folicular en lesiones de tipo IV segun la clasificacion de Bethesda. Esto provoca numerosas intervenciones quirurgicas innecesarias porque no es posible garantizar el caracter benigno de las lesiones, ni siquiera cuando la mayoria de las muestras corresponden a adenomas o incluso a otras lesiones benignas. El objetivo de este estudio es establecer si hay caracteristicas ecograficas que nos ayudarian a pronosticar el riesgo de malignidad de los nodulos con un diagnostico anatomopatologico de neoplasia folicular para conseguir un abordaje mas conservador de los nodulos sin sospecha de malignidad. Material y metodos Estudiamos 61 nodulos en 61 pacientes (51 mujeres y 10 varones) que se habian sometido a intervencion quirurgica de la glandula tiroides y tenian resultados histopatologicos de adenoma o carcinoma folicular. Se analizaron diversas caracteristicas ecograficas de los nodulos (composicion, ecogenicidad, borde, estado de calcificacion, presencia de halo y sospecha general de malignidad segun el observador) y se establecio su correlacion con el analisis histopatologico. Resultados Observamos una relacion estadisticamente significativa entre el carcinoma folicular y la presencia de calcificaciones, bordes mal definidos y la sospecha o impresion general del observador (definida por sospecha clara de signos ecograficos de malignidad, como calcificacion, borde mal definido y un nodulo solido marcadamente hipoecoico; y signos ecograficos de benignidad, como composicion ecogenica predominantemente quistica y presencia de halo hipoecogenico perinodular). Sin embargo, todas estas caracteristicas han mostrado una sensibilidad baja en el estudio que nos ocupa (30%, 30% y 50%, respectivamente). En cambio, la ausencia del signo de halo ha demostrado una sensibilidad del 100% y un valor predictivo negativo del 100% en nuestro estudio. Conclusiones La presencia de calcificaciones, los bordes mal definidos y la impresion o sospecha general de malignidad se asocian con un riesgo mayor de carcinoma folicular en nodulos tiroideos de tipo IV segun la clasificacion de Bethesda, pero su ausencia no permite pronosticar el caracter benigno de estos nodulos. En cambio, cuando se observa una lesion con signo de halo, deberia considerarse una neoplasia folicular benigna.

The idiopathic chronic cholangitides comprise a group of hepatobiliary diseases of probable autoimmune origin that are usually asymptomatic in the initial stages and can lead to cirrhosis of the liver. Elevated cholestatic enzymes on blood tests raise suspicion of these entities. Among the idiopathic cholangitides, the most common is primary sclerosing cholangitis, which is associated with inflammatory bowel disease and with an increased incidence of hepatobiliary and digestive tract tumors. It is important to establish the differential diagnosis with IgG4-associated cholangitis, primary biliary cholangitis, and secondary cholangitides, because the therapeutic management is different. Magnetic resonance cholangiopancreatography (MRCP) is the best test to evaluate the intrahepatic and extrahepatic biliary tract, and MRI also provides information about the liver and other abdominal organs. An appropriate MRCP protocol and knowledge of the different findings that are characteristic of each entity are essential to reach the correct diagnosis.

This research aimed to explore the variability in the distribution of muscle, perivisceral, and retroperitoneal fat in Diplodus sargus during the pre-spawning period (the period of maximum accumulation of fat reserves) and its possible relationship with the abnormally tough specimen syndrome (ATS) affecting this species. Since pollutants accumulate in adipose tissue, trace metal load in the fattest specimens were also analyzed. Muscle fat content and abdominal fat were highly correlated, and larger individuals had more abundant abdominal fat. However, given its great variability (26% of the specimens had no abdominal fat at all), abdominal fat is likely a transitional fat to be quickly transferred to other tissues. The liver appeared to have a minor role as a fat deposit in D. sargus since HSI varied relatively little. None of the fishes without lipidic reserves were ATS individuals; by contrast, the only ATS individual found, a 28 cm male, showed a muscle fat content above the observed average and one of the highest amounts of perivisceral and retroperitoneal fat. Therefore, we conclude that flesh hardness is not directly related to the low lipid reserves. However, this ATS individual showed a very high liver copper concentration, suggesting a potential link between fat content, copper concentration, and ATS syndrome that should be explored in the future Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research was carried out as part of a project funded by the University of Girona (UdG/3/Ref. MPCUdG2016-071)

Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective in this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules.We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis.We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study.The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy are associated with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence does not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

Recurrence of spontaneous pneumothorax (SP) is more frequent in pediatric patients. The purpose of our study was to identify factors associated with this recurrence.Retrospective review of the chart of patients with SP treated at our institution between 2004 and 2014. Statistic methods (χ2 and logistic regression) were used analyzing age, gender, side and size of pneumothorax and therapeutic approach as possible predictive factors of SP recurrence.A total of 81 SP cases in 43 patients (29 men, 14 women) were reviewed: 50 primary (PSP) and 31 secondary (SSP). Median age at presentation was 15,1 years (0.5-18.59). Follow up was 3.52 years (0.21-18.59). Twenty-three cases (28.4%) underwent surgery (22 thoracoscopies, 1 thoracotomy), consisting of bleb resection with abrasive and chemical pleurodesis. Ipsilateral recurrence after surgery was 21.7% (22.2% in PSP, 20% in SSP, p = 0.096) and 41.4% after non-surgical treatment. Age was a risk factor for recurrence (p= 0.049; OR = 1.16), especially between 10 and 15 years (44.6% in front of 19%, p = 0.013). Male gender and size20% were associated with higher recurrence risk in SSP that received non-surgical treatment (p0.05).Recurrences of SP in children are frequent even after surgical treatment. Age (preadolescence and early adolescence), male gender and initial size of pneumothorax may be factors associated with higher recurrence risk.Las recurrencias de los neumotórax espontáneos (NE) son más frecuentes en niños que en adultos. Nuestro objetivo es analizar qué factores pueden estar asociados a su recidiva.Análisis retrospectivo de los casos de NE tratados en nuestro centro entre 2004 y 2014. Se utilizaron métodos estadísticos (χ2 y regresión logística) para identificar factores asociados a su recurrencia analizando edad, sexo, lateralidad, tamaño del neumotórax y tratamiento recibido.Se recogieron 81 episodios en 43 pacientes (29 hombres, 14 mujeres): 50 primarios y 31 secundarios (14 pacientes: 10 procesos bronquíticos, 1 displasia broncopulmonar, 1 fibrosis quística y 2 fibrosis pulmonares) con una mediana de edad de 15,1 años (0,5-18,59). El seguimiento fue de 3,52 años (0,21-9,93). Veintitrés casos (28,4%) fueron intervenidos (22 toracoscopias, 1 toracotomía), realizándose resección de bullas asociada a pleurodesis abrasiva. La tasa de recidiva ipsilateral tras la cirugía fue del 21,7% (22,2% en los primarios y 20% en los secundarios, p = 0,92) y del 41,4% en pacientes no intervenidos (p = 0,096). La edad se comportó como factor de riesgo para la recidiva (p = 0,049; OR = 1,16), principalmente entre los 10 y los 15 años (44,6% frente al 19%, p = 0,013). El sexo masculino y el tamaño20% se asociaron a la recidiva de los NE secundarios no intervenidos (p0,05).Las recurrencias de los NE en niños son frecuentes incluso tras la cirugía. La preadolescencia y el inicio de la adolescencia, el sexo masculino y el tamaño inicial del neumotórax pueden ser factores asociados a un mayor índice de recidiva.

The aim of the study is to ascertain the most relevant aspects of the current management of renal replacement therapy (RRT) in critically ill patients, and to analyze renal function recovery and mortality in patients undergoing RRT.A non-interventional three-month observational study was made in 2012, with a follow-up period of 90 days, in 21 centers in Catalonia (Spain). Demographic information, severity scores and clinical data were obtained, as well as RRT parameters.patients aged ≥ 16 years admitted to Intensive Care Units (ICUs) and subjected to RRT.A total of 261 critically ill patients were recruited, of which 35% had renal dysfunction prior to admission. The main reason for starting RRT was oliguria; the most widely used RRT modality was hemodiafiltration; and the median prescribed dose at baseline was 35mL/kg/h. The median time of RRT onset from ICU admission was one day. The mortality rate at 30 and 90 days was 46% and 54%, respectively, and was associated to greater severity scores and a later onset of RRT. At discharge, 85% of the survivors had recovered renal function.Current practice in RRT in Catalonia abides with the current clinical practice guidelines. Mortality related to RRT is associated to later onset of such therapy. The renal function recovery rate at hospital discharge was 85% among the patients subjected to RRT.

Aim Childhood malignant chest wall tumors may require extensive surgical resection and reconstruction with musculoskeletal flaps or non-resorbable prosthetic materials. Implant-related complications and scoliosis often occur. This study analyzes the outcomes of chest wall reconstruction using resorbable plates as an alternative approach. Methods Retrospective review (2007–2015) of patients who underwent resection of malignant primary chest wall tumors in 2 tertiary pediatric centers. Reconstruction was performed using copolymer (l-lactic and glycolic acid) plates, fixed to the ribs and surrounding structures with copolymer screws and/or polyglactin sutures. Results Eight patients aged 10.6+2.6years were treated. There were no operative complications, and implant removal was not required in any case. Six patients received postoperative radiotherapy. Over follow-up (39.6months, range 9.4–78), chest wall shape was maintained in all, and there were no radiological artifacts. Three patients developed scoliosis (Cobb 17°–33°), but treatment was needed only in one, who had undergone hemivertebrectomy. There were no cases of local tumor relapse. One patient died because of metastatic spread. Conclusions Implantation of bioabsorbable l-lactic and glycolic acid copolymer plates with a relatively simple technique provided a rigid, stable reconstruction with only mild mid-/long-term complications. Resorbable plates may be a good alternative for pediatric chest wall reconstruction. Level of evidence: IV.

Resumen Objetivo Las drogas de diseno son principalmente consumidas por los jovenes. Presentamos el caso clinico de un varon de 22 anos, que es trasladado a urgencias por perdida de conciencia tras haber consumido 2 comprimidos de extasis. Material y metodos Analizamos el caso clinico de un varon que es trasladado a urgencias en ambulancia de madrugada, tras perder la conciencia y presentar convulsiones despues de haber ingerido 2 pastillas, probablemente de extasis, y algo de alcohol. Resultados Se realiza el diagnostico de intoxicacion aguda (?por metilenodioximetanfetamina [MDMA]?), y se consideran los posibles diagnosticos que puedan surgir como complicacion del anterior. Se realiza lavado gastrico y se aplican las medidas fisicas, fisiologicas y farmacologicas necesarias para el tratamiento del paciente con posterior traslado a la unidad de cuidados intensivos. Conclusiones El consumo de drogas de diseno, y mas concretamente MDMA, puede producir cuadros clinicos de gravedad inmediata y potencial con posibles secuelas del sistema nervioso central.

This study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L4-5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg-1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median [range] maximum block height was T5[T4-T7] in the lateral group and T5[T4-T5] in the sitting group. The median [range] duration of motor blockade was 67 [50-85] min in the lateral group and 63 [50-80] min in the sitting group. Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg-1 in the lateral or sitting position is equally effective and is associated with minimal side effects.

This case report presents the finding of an aberrant right subclavian artery during the routine dissection of 230 human adults specimens. The case which we describe appeared in an 82-year-old male donor, in whom the right retro-esophageal subclavian artery was observed as the last branch of the aortic arch. The rate of occurrence of this variation is stated to be less than 1%. This variation is described in detail; embryology and anatomy are reviewed and we discuss it in relation to other cases. The aortic arch was dissected, and its branches were described as regards their relations, length and diameter. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276-002-0047-0

Catalysts, comprising gold supported on titanium nitride and oxynitride, have been prepared by deposition-precipitation from HAuCl 4 .3H 2 O. For the synthesis conditions used, no loss of the nitrogen content or specific surface area of the supports was detected. Metallic Au is homogeneously dispersed on the surface of TiN samples, with particle sizes ranging from 3nm to 1 μm. However, for TiON samples, where TiN and TiO 2 phases coexist, the Au agglomerates forming large particles (>10 μm) and nanometric gold is only detected in association with the more basic TiN phase.

This study indicated that the life-history traits of European barracuda Sphyraena sphyraena are apparently better suited to their environmental conditions compared to the more physically restricted life-history traits of the yellow-mouth barracuda Sphyraena viridensis, which co-habit the north-western Mediterranean Sea. The latter thermophilic species has a considerably higher reproductive potential as it invests its energy reserves in larger numbers of hydrated eggs per spawning batch. This would favour its population growth rates within the study area, especially if sea warming continues, in which case it is likely that the spawning phenology of this species would give it an advantage.

Resumen Se revisan la epidemiologia, historia natural, metodologia diagnostica y recomendaciones para el tratamiento quirurgico y endovascular de los aneurismas intracraneales. Las recomendaciones propuestas deben considerarse como una guia general de manejo de esta patologia. Sin embargo, pueden ser modificadas, incluso de manera significativa por las circunstancias propias de cada caso clinico, o las variaciones en los recursos diagnosticos y terapeuticos del centro hospitalario que reciba al paciente.

Resumen Presentamos el caso de un paciente de 61 anos, quien tras tres semanas de una rinitis alergica, desarrolla un cuadro neurologico agudo de afectacion bulbar y vias largas El cuadro clinico neurologico y la resonancia nuclear magnetica dieron el diagnostico de presuncion. La paciente fue intervenida de urgencia mediante una craniectomia suboccipital y acceso microquirurgico. Se aspiro un contenido purulento de una cavidad quistica alargada que se extendia desde el bulbo a la union bulbo medular. La evolucion fue muy favorable y la enferma fue dada de alta con un pequeno deficit del nervio glosofaringeo derecho que esta recuperando paulatinamente. Se revisa la bibliografia y se discuten las distintas opciones terapeuticas.

Growth failure is an important consequence of chronic liver disease in childhood. Insulin-like growth factor-I (IGF-I), which is synthesized and released by the liver, plays an important role as a growth regulator in humans. We examined the growth hormone (GH)/IGF-I axis before and after orthotopic liver transplantation (LT) in 14 children aged between 2 and 11 years (mean 5.6 +/- 1.1 years). Pre-transplantation serum GH levels (7.5 +/- 1.2 ng/ml) were significantly higher (P0.001) compared with controls (5 +/- 0.5 ng/ml). However, post-transplantation levels (1.8 +/- 0.8 ng/ml) did not differ from those in the control group. Serum IGF-I levels showed a statistically significant increase after LT (20.1 +/- 9.4 vs 190 +/- 66.2 ng/ml; P0.001) and became indistinguishable from the levels in the control group (180 +/- 96 ng/ml). In comparison with pre-transplantation data (z - 2.70), there was an increase in height 4 years postoperatively (z - 1.68). Catch-up growth was highly significant, in particular during the 1st year after LT (z -1. 58 +/- 1.63 vs 2.59 +/- 5.29; P0.01). We conclude that a GH resistance state found in patients with severe chronic liver disease reverted following LT. Given that IGF-1 depends upon liver function, this could be one of the main factors in the significant catch-up growth in pediatric LT recipients.

Resumen Se presenta el caso de una mujer de 50 anos con una hemorragia en el seno de un quiste simple de la glandula pineal, que debuta con intensa cefalea, vomitos y signos radiologicos de hidrocefalia aguda, siendo tratada con una derivacion ventriculo-peritoneal de urgencia y posteriormente con la reseccion total, mediante craniectomia suboccipital, via supracerebelosa infratentorial. La localizacion de la lesion se establecio con TC y RM. El diagnostico anatomopatologico resulto ser el de un quiste simple glial de la epifisis con hemorragia en su interior. Se realiza una amplia revision de la bibliografia y se estudia este tipo de lesion, que, por su comportamiento clinico y por su aspecto radiologico, produce controversias en el diagnostico y en la eleccion del tratamiento mas oportuno. Se comenta la tecnica quirurgica empleada y su resultado y, finalmente, se analiza su naturaleza y su origen.

Chronic kidney disease (CKD), including patients on peritoneal dialysis (PD), is linked to an important increase in mortality risk. Within the new systemic term CKD-MBD, alterations in vitamin D metabolism are also included. Many adverse events have been associated with vitamin D deficiency or lack of vitamin D receptor (VDR) activation both in the general population and CKD patients, and these associations seem to be maintained in PD patients. Particularities of PD in vitamin D metabolism, calcium balance, low PTH levels and the high prevalence of adynamic bone disease are discussed. We also review the associations of clinical or survival benefits with vitamin D supplementation, VDR or selective VDR activation, although they are low-graded and most of them obtained from HD databases. Nevertheless, we think that the combined approach to secondary hyperparathyroidism seems also to be appropriate in PD patients, and vitamin D (native plus VDR or selective VDR activation) seem an important part of the required integral approach. The later may provide additional benefits but definitive prove is still lacking.

A medium-term (10 year) stochastic forecast model is developed and presented for mixed fisheries that can provide estimations of age-specific parameters for a maximum of 10 stocks and 10 fisheries. Designed to support fishery managers dealing with complex, multi-annual management plans, the model can be used to quantitatively test the consequences of various stock-specific and fishery-specific decisions, using non-equilibrium stock dynamics. Such decisions include fishing restrictions and other strategies aimed at achieving sustainable mixed fisheries consistent with the concept of maximum sustainable yield (MSY). In order to test the model, recently gathered data on seven stocks and four fisheries operating in the Ligurian and North Tyrrhenian Seas are used to generate quantitative, 10 year predictions of biomass and catch trends under four different management scenarios. The results show that using the fishing mortality at MSY as the biological reference point for the management of all stocks would be a strong incentive to reduce the technical interactions among concurrent fishing strategies. This would optimize the stock-specific exploitation and be consistent with sustainability criteria.

Gastroschisis (GS) is a congenital abdominal wall defect that permits bowel exposure to amniotic fluid (AF). Intestinal damage is related to the chemical action of AF and constriction. After birth at term, a thickened intestinal wall with inflammation and, in some cases, intestinal atresias were observed. Surgical repair and intestinal reubication may be difficult, and thus staged silo repair could be necessary. These patients require a long hospital stay owing to bowel damage causing severe intestinal hypoperistalsis and poor absorptive capacity. Total parenteral nutrition (TPN) is required for a long period.The aim of this prospective study is to evaluate the benefits of a preterm delivery to avoid bowel damage and its post-natal consequences.Six cases of prenatally-diagnosed GS have been treated following a new strategy since July 2002. A preterm Cesarean section (c-section) delivery was programmed at 34-35 weeks of gestational age (GA). Some hours after birth, at bedside in the NICU, bowel reduction through the defect hole was performed under general anesthesia. This preterm group (PT) was compared the past 6 cases at term (AT) from January 1998 to July 2002. Macroscopic appearance, atresia existence, surgical technique, silo requirement, neonatal outcome, TPN and hospital stay were analyzed.All six cases AT (mean GA: 36.3 weeks) presented bowel inflammation and thickened wall. Only 2/6 cases allowed the intestine to be housed in a primary closure after laparotomy. 4/6 cases required staged silo repair. 1 patient presented intestinal atresia and other had perforations who died at 17 days of life from intestinal sepsis. Mean postoperative intubation period was 16.2 days. Mean TPN was 41.2 days and mean hospital stay 69.8 days. PT group was monitored by prenatal sonography seeking bowel sonolucency. After programmed PT c-section delivery (mean GA: 34.8 weeks) in all 6 cases, bowel loops presented normal appearance and intestinal thickening was absent, except in one case. No prematurity-related respiratory complications were observed. Easy bowel reduction without abdominal compression was performed in all cases. 1/6 cases required surgical release of occlusive intestinal adherence. Mean postoperative intubation period was 0.4 days (9.6 hours). Oral feeding was started at 6 days. Mean TPN was 13.4 days and mean hospital stay 28.6 days.The third trimester is a critical period for fetal bowel development. Intestinal damage rises with increasing exposure time to amniotic fluid. This strategy of preterm delivery for the treatment of GS avoids intestinal damage, prevents "peel" and intestinal atresia, renders surgical reduction easier, reduces the hypoperistalsis, need for TPN and hospital stay. Multidisciplinary coordination between obstetricians, neonatologists and pediatric surgeons is required.

Persistent neonatal and infantile hyperinsulinemic hypoglycemia (PNHH) is a rare entity which remains to be elucidated but associated with severe lesions in pediatric patients. The aim of this study is to present our current surgical strategy face to this disease, based on our pathology findings and clinical experience.It is a retrospective study of 29 patients treated at our centre, medically and surgically. In 15 surgical patients, morphologic, morphometric and immunohistochemical studies for insulin, somatostatin and glucagon were performed and consequently it has been possible to establish a focal and different forms of a diffuse type.Out of 29 patients studied, 25 were diagnosed before their first year old and 4 patients between the first and second infancy. Of the 25 first patients, one died at 7 hours postpartum. Twelve patients only received medical treatment, one of them died at 45 days of life and the remaining 11 patients had good outcome. Another 12 patients received in addition surgical treatment. In 2 of them we observed adenoma which was removed and patients cured. In the remaining 10 patients a subtotal pancreatectomy was performed. (One case was informed as normal and cured and the other 9 had the diffuse type). Of these 9 patients with diffuse type, 4 died, 3 cured and 2 underwent second surgery. Out of the 4 patients diagnosed in infancy, 3 underwent surgery (2 adenomas and 1 diffuse type) and the other one received only medical treatment.Currently, we give medical treatment in all types and forms of PNHH. If the patient is resistant, we dismiss adenoma. If this is diagnosis we remove it. If the type is diffuse, near-total pancreatectomy is performed with a peroperatory biopsy. In cases of hyperplasia or mixed form we recommend a total pancreatectomy and in case of nesidioblastosis we recommend a partial pancreatectomy.

It has been suggested a different biodevelopment in the differentiated thyroid cancer in pediatric age. General and pediatric surgeons from different centres has coincided to operate this kind of pediatric pathology that finally conclude the treatment in the nuclear medicine department from the reference hospital. The objectives of this revision is, to confirm de difference in thyroid cancer in pediatric age and to know few factors implicated.A review of 57 patients with differentiated thyroid cancer, medullary and anaplastic were excluded, treated in the nuclear medicine department during the last 20 years. 28% were10 years old (16 cases) and 72%10 years old (41 cases). This 57 young patients were operated in 22 hospitals and 79% by a general surgeon and 21% by pediatric surgeon. The analysis was performed with SPSS MS Windows 6.0 (chi cuadrado, t-Student-Fisher).There are more reinterventions in patients operated by a general surgeon. There aren't differences between the number of total neck dissections between both groups of surgeons, but when is performed, the incidence of complications is significantly high. In patients10 years old, there are more metastasis and more surgical complications. In spite of, all patients still alive.Children10 years old, the illness is more local aggressive and the recurrence and lung metastasis is high, more surgical complications. We recommend to concentrate this pathology in a few hospitals to achieve more experience and to avoid complications.

The thermic wounds in childhood are the third cause of morbility at hospital in our ambiance. The knowledge about incidence, the causal agents more frequent, and the detailed analysis of different variants about the subject are the unique manner to try to establish precautions against. The aim of this project is to analyse the factors and situations associated with thermic wound, through the retrospective study about the patients admitted.During three years, 362 patients were admitted at hospital, between 0 and 14 years old, following the criterion: barge burn size more than 10%, critical location (hands, face, neck), causal agent (electricity, chemical) or social situation. Different facts were analyzed about provenance, place, causal agent, burned part of the body, degree of lesion and the average stay at hospital.There were 59.6% males, and 40.3% females. Children between 1 and 5 years old, represented the largest group of patients, 205 cases. The 66% were from other hospital were they receive the first aid. The 98.7% were burned at home, and the place more frequent was kitchen, 51%. The causal agent was liquid in 65.4%, specially scald with water about 104 cases. The zones more affected were the face (39.2%), and the superior extremities, about 81% second degree superficial or deep. The size was 10 to 20% in 19% of patients, and more than 40% in 0.2% of children. The average stay was 17.47 days at hospital.

Unilateral Wilms' tumor has been treated according to 9301 SIOP protocol, with good results. The new pre protocol that SIOP is developing has a high inclusion rate. From 1993 to 1999, 11 patients with unilateral Wilms' tumor were treated in our center; in 6 cases preop chemotherapy was done, in the other 5 cases pre and postoperative chemotherapy were used. Nine of the 11 patients could be included in the pre protocol this was due to a thrombosis of the vena cava in one case, and in the other the middle renal in area was widely affected. Wilms' tumor has a good prognosis with the actual protocol, SIOP. New pre protocol could give a better quality of life due to the amount of functional renal parenchyma, without decreasing the actual high cure rate.

Intracerebral hemorrhage is very frequently one of the most ignored aspects of cerebrovascular disease.To review many aspects of intracerebral hemorrhage ranging from its epidemiology to its etiology, pathogenesis, clinical manifestations, diagnosis and prognosis.A thorough review of literature has been carried out paying special attention to papers published over the last few years. Actual tendencies in both medical and surgical treatment have been analyzed and some ideas for treatment have been derived from this review.It is obvious that there are important lacunes that affect many aspects of intracerebral hemorrhage management. Therefore we should assist in the near future to the performance of different trials that would come to offer data which reduce the uncertainties that affect this pathology.

This study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L4-5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg-1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median [range] maximum block height was T5[T4-T7] in the lateral group and T5[T4-T5] in the sitting group. The median [range] duration of motor blockade was 67 [50-85] min in the lateral group and 63 [50-80] min in the sitting group. Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg-1 in the lateral or sitting position is equally effective and is associated with minimal side effects.

Introduction: L'hypoglycemie hyperinsulinique persistante neonatale et infantile (PNHH) est une entite rare qui doit etre elucidee, mais qui est souvent associee a des lesions severes chez les patients pediatriques. Le but de cette etude est de presenter notre strategie chirurgicale habituelle pour cette maladie, basee sur nos constatations pathologiques et notre experience clinique. Materiel et Methodes: Ceci est une etude retrospective de 29 patients traites medicalement et chirurgicalement dans notre centre. Chez 15 patients, la morphologie, la morphometrie et l'immunohistochimie pour l'insuline, la somatostatine et le glucagon ont ete realises et il a ete possible d'etablir qu'il s'agissait d'une forme focale ou diffuse. Resultat: Chez 29 patients etudies, 25 etaient diagnostiques avant un an et 4 entre la premiere et la seconde annee de vie. Parmi les 25 patients, un est decede 7 heures apres l'accouchement. Douze patients ont recus un traitement medical seul: un est decede a 45 jours de vie et les autres ont un devenir correct. Les autres 12 patients ont ete traites chirurgicalement. Chez 2 de ceux-ci, un adenome etait observe et enleve et les patients gueris. Une pancreatectomie sub-totale etait realisee chez les 10 autres. (Un cas etait normal et gueri et les 9 autres avaient une lesion de type diffuse). Parmi les 9 patients avec une forme diffuse, 4 sont morts, 3 sont gueris et 2 ont necessite une reintervention chirurgicale. Parmi les 4 patients diagnostiques plus tard, 3 ont subi une intervention chirurgicale, 2 avec un adenome et 1 avec une forme diffuse. Les autres ont recu un traitement medical seul. Conclusion: Nous donnons regulierement un traitement medical pour tous les types et formes de PNHH. Si le patient est resistant au traitement, un adenome est recherche. Si cet adenome est diagnostique, il est enleve. S'il s'agit d'une forme diffuse, une pancreatectomie sub-totale est realisee avec une biopsie per-operatoire. En cas d'hyperplasie ou de forme mixte, nous recommandons une pancreatectomie totale et en cas de nesidioblastose, une pancreatectomie partielle.

The phrenic nerve is the only motor nerve in the diaphragm. The injury will lead to a diaphragmatic paralysis or eventration with paradoxical movements during breathing. The aim of this review is to analyze the diagnostic criteria, surgical indications, and the patients that are not treated by surgery. We review 53 cases with diaphragmatic pathology in the last 5 years; 19 females and 20 males. One was a diaphragmatic rupture, 13 were diaphragmatic hernias, and 39 had diaphragmatic paralysis. Diaphragmatic paralysis was diagnosed by fluoroscopy in 97%, electromiography 5.1% or ultrasounds. The ethiology was 64% after cardiac surgery and 10% after thoracic oncologic surgery. The age at diagnosis was less than 1 month in 41% cases. In 29 patients the paralysis was well tolerated and were extubated between 24 h and 4 days after the diagnosis, frequently was in the first 48 h. 4 patients need a traqueostomy and 2 went to another hospital. In 5 we performed a diaphragmatic plication because the inability to be extubated or the persistence of respiratory distress. The paralysis was demonstrated by fluoroscopy. 2 patients are asymptomatic, 2 are in mechanical ventilation and 1 died (sepsis). The most frequent cause of diaphragmatic paralysis was related to cardiac or thoracic surgery. In general, is well tolerated, almost asymptomatic, the patients were extubated between 24 or 48 h. In pediatric population they are few cases that need surgical treatment. The patients that we operated on were less than 2 months old, because is at that age were the repercussion is more important. We must follow strict criteria, without precipìtation for the surgical indications.

We present two cases of spontaneous spinal extradural hematoma, which occurred in 1996 and were admitted to and operated on by our Department. Both patients were women. No cause for the bleeding was found in either case. Both presented with the site of the lesion in the thoracic spine, although at different levels. There was acute onset of the clinical condition. The best diagnostic procedure was MR. The treatment of choice was surgical and the results related to the rate of onset of the clinical picture and the time elapsed before operation.The form of presentation is discussed, together with the importance of early diagnosis and the relation to emergency surgical treatment.

The authors show their experience in the use of the laparoscopic approach in 18 cases of unilateral exploratory anorchia. They highlight the advantages that this method offers in efficiency, speed, security and minimal aggression compared with conventional exploration of the inguinal channel in the search of the undetectable testis. In the 18 cases studied through the insertion of 5 mm lense in the umbilical area, it was established that a testicular hypoplasia was present in 8 cases. In another 5 cases testicular agenesia was diagnosed, and in the remaining 5, intraabdominal testis were found. In four of these testicles, a laparoscopic approach helped in their correct placement and also in the removal of the fifth in a patient with recurrent leukemia.

The appearance of the new lecture systems for the manometry studies by computer, like the Polygram by Synectics (vector volume), offer the possibility to see the circumferential pressure forces, that even in rest conditions as in voluntary contraction, they keep coaptation of the anal canal, and this will act as a continent closure system in the most distal part of the G.I. tract. The study is with the normal parameters obtained in 14 individuals, considered as normal, getting the mean +/- sd pressure of the anal canal convey in mm Hg, from de anal canal profile in rest as in voluntary contraction, and the maximum variability that could exist between the six profile waves, that are obtained in the same individual to develop an image of the anal canal. This valves will allow the author's to get to the bottom of fecal incontinence derivative from anorectal malformations, defining the pressure valves of muscular hypoplasia or surgical outcomes of the malformations.