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DiGeorge Syndrome (DGS) is a congenital disorder that affects the thymus, parathyroid glands, and heart and brain. Thymus involvement in DGS may vary between absence/hypoplasia of thymus to various forms of reduced T cell function. TBX1 deficiency causes a number of distinct vascular and heart defects, suggesting multiple roles in cardiovascular development, specifically, formation and growth of the pharyngeal arch arteries, growth and septation of the outflow tract of the heart, interventricular septation, and conal alignment. Here the authors describe a case of DGS presenting with severe combined immunodeficiency, esophageal atresia, and tracheoesophageal fistula (TEF). DGS is an important differential diagnosis in TEF.

Scientific knowledge is in constant change. The flow of new information requires a frequent re-evaluation of the available research results. Clinical practice guidelines (CPGs) are not exempted from this phenomenon and need to be kept updated to maintain the validity of their recommendations. The objective of our review is to systematically identify, describe and assess strategies for monitoring and updating CPGs. We conducted a systematic review of studies evaluating one or more methods of updating (with or without monitoring) CPGs or recommendations. We searched MEDLINE (PubMed) and The Cochrane Methodology Register (The Cochrane Library) from 1966 to June 2012. Additionally, we hand-searched reference lists of the included studies and the Guidelines International Network book of abstracts. If necessary, we contacted study authors to obtain additional information. We included a total of eight studies. Four evaluated if CPGs were out of date, three updated CPGs, and one continuously monitored and updated CPGs. The most detailed reported phase of the process was the identification of new evidence. As opposed to studies updating guidelines, studies evaluating if CPGs were out of date applied restricted searches. Only one study compared a restricted versus an exhaustive search suggesting that a restricted search is sufficient to assess recommendations' Validity. One study analyzed the survival time of CPGs and suggested that these should be reassessed every three years. There is limited evidence about the optimal strategies for monitoring and updating clinical practice guidelines. A restricted search is likely to be sufficient to monitor new evidence and assess the need to update, however, more information is needed about the timing and type of search. Only the exhaustive search strategy has been assessed for the update of CPGs. The development and evaluation of more efficient strategies is needed to improve the timeliness and reduce the burden of maintaining the validity of CPGs.

Objectives: 1) To analyse differences in the self-perceived health and mental health status between the Spanish population and immigrants from the seven leading countries in terms of number of immigrants; 2) to examine whether differences are accounted for by socio-economic charateristics, and 3) to determine whether the patterns of associations differ by gender. Methods: Data come from the 2006 Spanish National Health Survey. The sample was composed of all 20–64 year old Spaniards and immigrants from the seven countries with most immigrants in Spain (Argentina, Bolivia, Colombia, Ecuador, Peru, Romania and Morocco) [n=20,731]. Results: In both sexes, people from Bolivia had poorer health outcomes, above all Bolivian males. Conversely, people from Argentina and Colombia had the best health outcomes. For the rest of countries results varied depending of gender, country and health indicator was found. Conclusions: Differences in health status between people born in Spain and foreign-born people depend on relationships between country of birth, characteristics of the migration process, gender, ethnicity and the health outcome analysed. © 2012 Elsevier Ltd

Objective To report a modified colostomy technique for permanent fecal diversion in calves with colonic atresia. Study Design Prospective study. Animals Calves (n=19) with colonic atresia. Methods Clinical findings, white blood cell counts, radiologic, ultrasonographic, and intraoperative findings were recorded. Calves were randomly divided into 2 groups: group 1 (n=9) had conventional colostomy and group 2 (n=10) had a modified colostomy. Technique efficacy was evaluated by postoperative observation, owner satisfaction, and calf survival. Results Fifteen (79%) calves were discharged from the hospital; 4 (21%) group 1 calves died within 24 hours after surgery. Two (40%) group 1 calves died 18 and 30 days after surgery and 5 (50%) group 2 calves died 2-60 days after surgery. Eight calves reached slaughter weight (120 +/- 10 kg); 5 group 2 calves grew normally but the 3 group 1 calves had lower weight gain. Owners of the calves with conventional colostomy reported that the evacuation of feces was continuous whereas owners of calves with the modified colostomy reported that feces were released through the stoma in intervals. Conclusion Modification of conventional colostomy by forming an hourglass shaped stoma lessens fecal incontinence but there was no difference in survival rate. Clinical Relevance Modified colostomy was considered advantageous because of intermittent fecal discharge from the stoma compared with continuous fecal release in conventional colostomy. The modified technique seemingly has a beneficial effect on growth of the calf.

The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. To protect the length of the cavity, it is necessary to ensure the complete epithelialization of the apex of the ncovaginal cavity. The author prefers to tailor 2 pieces of full-thickness skin grafts longitudinally oil a vaginal stent that is molded into bullet shape. Six girls with vaginal agenesis underwent neovaginal construction using this method. The apex of the neovaginal cavity was perfectly epithelialized using this vaginal stent. The length of the ncovaginal cavity that is dissected during the operation was protected. The follow-up period ranged from 24 to 93 months (median, 57.2 months). Postoperative stricture or contracture of the neovagina did not occur in all patients. As a result, full-thickness skin graft is an efficient method for vaginal construction in patients with vaginal agenesis.

To monitor the ischemic and/or reperfusion injury after porta hepatis occlusion (Pringle maneuver) in livers subjected to hypotension, serum alanine amino transferase (ALT), liver malondialdehyde, (MIDA), and liver glutathione (GSH) levels were measured. MDA is a by-product of oxidant-induced lipid peroxidation, and GSH is an endogenous antioxidant. The effects of lactated Ringer's (LR) and hypertonic saline (7.5%)/Dextran (6%; HSD) resuscitation on liver injury, if any, was investigated. Rats in sham (S, n = 8) and five other groups (n = 8) underwent femoral artery and vein catheterization and laparotomy. The hemorrhage and ischemia (HI) group was bled 30% of their blood volume and had their porta hepatis occluded for 30 min. The HI, LR, and HSD groups underwent both hemorrhage and occlusion. Thirty minutes after hemorrhage, the LR and HSD groups received either LR (equivalent to three times the shed blood) or HSD (10 mL/kg) resuscitation over 30 min. Both LR and HSD resuscitation lowered the increased ALT and liver tissue MDA seen in the HI group. ALT was decreased from 348 +/- 93 IU/L in the HI group to 200 +/- 98 IU/L in the LR and 139 +/- 74 IU/L in the HSD groups. Liver tissue MDA was 353 +/- 22 nmol/g/tissue in the HI group and LR decreased it to 261 +/- 17 nmol/g/tissue, whereas HSD decreased it to 273 +/- 20 nmol/g/tissue. The decrease in ALT and the increase in liver GSH were more pronounced with HSD resuscitation (P < 0.05). HSD seems to be more effective than LR in decreasing the liver tissue damage produced by total hepatic inflow occlusion under hypovolemic conditions.

This study describes the concept of prevention and identifies the knowledge, perceived benefits and barriers, as well as the practices of early detection of breast cancer among women from different cultural backgrounds and socioeconomic levels. A socioconstructivist qualitative study was conducted in Barcelona. The study population consisted of women who were either native (Spanish) or immigrants from low income countries, aged 40 to 69 years. Narrations of the 68 informants were subjected to sociological discourse analysis. Place and culture of origin, social class and the migratory process can either facilitate or constitute barriers to breast cancer prevention. © 2012 Elsevier Ltd