Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia. / Tiroidectomía transoral endoscópica con abordaje vestibular (TOETVA): una nueva opción para el tratamiento de pacientes pediátricos.

Pediatric pneumonectomies are exceptional nowadays, being reserved for cases with destroyed lungs with frequent exacerbations and reinfections and only two cases of thoracoscopic pneumonectomy have been previously published. We present the case of a 4-year-old patient with no relevant history who developed complete atelectasis of the left lung (LL) after influenza A pneumonia, followed by secondary recurrent infections. A year later a diagnostic bronchoscopy without alterations was performed. A complete loss of volume and hypoperfusion of the LL (right lung perfusion 95%, LL perfusion: 5%) with bronchiectasis and hyperinsufflation and herniation of the right lung into the left hemithorax was observed in a pulmonary perfusion SPECT-CT. After unsuccessful conservative management and recurrent infections a pneumonectomy was indicated. The pneumonectomy was performed through a five-port thoracoscopy. The dissection of the hilum was made using hook electrocautery and sealing device. The left main bronchus was sectioned with an endostapler. There were no intraoperative complications. An endothoracic drain was removed the first postoperative day. The patient was discharged on the fourth postoperative day. The patient has not presented any complications 10 months after surgery. Although pneumonectomy is an exceptional surgery in children, it can be performed by minimally invasive surgery with success and safety in centers with extensive experience in pediatric thoracoscopic surgery.

Hoy en día, las neumonectomías pediátricas son algo excepcional. El procedimiento se reserva para aquellos casos en los que los pulmones están destruidos y presentan exacerbaciones y reinfecciones frecuentes, con tan solo dos casos de neumonectomía toracoscópica publicados hasta la fecha. Presentamos el caso de un paciente de 4 años sin antecedentes de interés que desarrolló atelectasia completa del pulmón izquierdo (PI) tras neumonía por gripe A, seguido de infecciones secundarias recurrentes. Un año después, se le practicó broncoscopia diagnóstica, sin que esta mostrara alteraciones significativas. Tras realizársele un SPECT-CT de perfusión pulmonar, se evidenció pérdida completa de volumen e hipoperfusión del PI (perfusión del pulmón derecho: 95%; perfusión del pulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y herniación del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar el manejo conservador y registrarse infecciones recurrentes, se estableció la indicación de neumonectomía. La neumonectomía se llevó a cabo mediante toracoscopia por cinco puertos. La disección del hilio se realizó mediante gancho de electrocoagulación y dispositivo de sellado. El bronquio principal izquierdo se seccionó con endograpadora. No se registraron complicaciones intraoperatorias. El drenaje endotorácico se retiró al día siguiente de la intervención, mientras que el paciente fue dado de alta a los cuatro días, sin que haya presentado complicaciones transcurridos 10 meses desde la cirugía. Aunque la neumonectomía es una intervención excepcional en niños, puede llevarse a cabo de manera exitosa y segura por cirugía mínimamente invasiva en centros con amplia experiencia en cirugía toracoscópica pediátrica.

Neumonectomía toracoscópica en un niño de 4 años con el pulmón destruido tras neumonía vírica / Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia

Hoy en día, las neumonectomías pediátricas son algo excepcional. Elprocedimiento se reserva para aquellos casos en los que los pulmones estándestruidos y presentan exacerbaciones y reinfecciones frecuentes, con tansolo dos casos de neumonectomía toracoscópica publicados hasta la fecha.Presentamos el caso de un paciente de 4 años sin antecedentes deinterés que desarrolló atelectasia completa del pulmón izquierdo (PI) trasneumonía por gripe A, seguido de infecciones secundarias recurrentes.Un año después, se le practicó broncoscopia diagnóstica, sin que estamostrara alteraciones significativas. Tras realizársele un SPECT-CT deperfusión pulmonar, se evidenció pérdida completa de volumen e hi-poperfusión del PI (perfusión del pulmón derecho: 95%; perfusión delpulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y hernia-ción del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar elmanejo conservador y registrarse infecciones recurrentes, se establecióla indicación de neumonectomía.La neumonectomía se llevó a cabo mediante toracoscopia por cincopuertos. La disección del hilio se realizó mediante gancho de electro-coagulación y dispositivo de sellado. El bronquio principal izquierdose seccionó con endograpadora. No se registraron complicaciones in-traoperatorias.El drenaje endotorácico se retiró al día siguiente de la intervención,mientras que el paciente fue dado de alta a los cuatro días, sin que hayapresentado complicaciones transcurridos 10 meses desde la cirugía.Aunque la neumonectomía es una intervención excepcional enniños, puede llevarse a cabo de manera exitosa y segura por cirugíamínimamente invasiva en centros con amplia experiencia en cirugíatoracoscópica pediátrica.(AU)

Pediatric pneumonectomies are exceptional nowadays, being re-served for cases with destroyed lungs with frequent exacerbations and einfections and only two cases of thoracoscopic pneumonectomy havebeen previously published.We present the case of a 4-year-old patient with no relevant his-tory who developed complete atelectasis of the left lung (LL) afterinfluenza A pneumonia, followed by secondary recurrent infections.A year later a diagnostic bronchoscopy without alterations was per-formed. A complete loss of volume and hypoperfusion of the LL(right lung perfusion 95%, LL perfusion: 5%) with bronchiectasisand hyperinsufflation and herniation of the right lung into the lefthemithorax was observed in a pulmonary perfusion SPECT-CT. Afterunsuccessful conservative management and recurrent infections apneumonectomy was indicated.The pneumonectomy was performed through a five-port thoracos-copy. The dissection of the hilum was made using hook electrocauteryand sealing device. The left main bronchus was sectioned with an en-dostapler. There were no intraoperative complications.An endothoracic drain was removed the first postoperative day. Thepatient was discharged on the fourth postoperative day. The patient hasnot presented any complications 10 months after surgery.Although pneumonectomy is an exceptional surgery in children,it can be performed by minimally invasive surgery with success andsafety in centers with extensive experience in pediatric thoracoscopicsurgery.(UA)

Endourological treatment of ectopic ureterocele. Our experience in the last 15 years. / Tratamiento endourológico del ureterocele ectópico. Experiencia en los últimos 15 años.

OBJECTIVE: To assess the efficacy of the endourological treatment of ectopic ureterocele in children in a large series and with a long-term follow-up. MATERIALS AND METHODS: A retrospective, descriptive study of patients with ectopic ureterocele who had undergone surgery in our institution in the last 15 years was carried out. All patients were treated using an endourological approach, both for ureterocele and postoperative vesicoureteral reflux (VUR). RESULTS: 40 patients were treated -55% with left involvement and 5% with bilateral involvement. Mean age at diagnosis was 4.97 months, with diagnosis being established prenatally in 54.1% of cases. In all patients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery was performed on an outpatient basis in 94.9% of patients. No perioperative complications were recorded. In the last 30 patients, preoperative voiding cystourethrography was not carried out. 72.5% of patients had postoperative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon, 17.2% into both, 6.9% into the contralateral system, and 20.7% into the bilateral system), but it was resolved with a single endoscopic procedure in 48.1% of cases (65% of patients were healed with two procedures). VUR was not endoscopically resolved in 3 patients who required ureteral re-implantation. 6 patients required heminephrectomy (n=3) or nephrectomy (n=3) as a result of functional impairment and infections. CONCLUSION: The endourological treatment of ectopic ureterocele is a little aggressive and little invasive technique that allows the obstruction to be resolved on an outpatient basis, which means bladder surgery -if required- can be performed outside the neonatal period.

OBJETIVO: Evaluar la eficacia del tratamiento endourológico del ureterocele ectópico en niños en una serie amplia y con seguimiento a largo plazo. MATERIAL Y METODOS: Estudio retrospectivo descriptivo de los pacientes con ureterocele ectópico intervenidos en nuestro centro en los últimos 15 años. Todos los pacientes se tratan por vía endourológica, tanto el ureterocele como el reflujo vesicoureteral (RVU) postoperatorio. RESULTADOS: Se trataron 40 pacientes, 55% eran izquierdos y 5% bilaterales. La edad media al diagnóstico fue de 4,97 meses siendo de diagnóstico prenatal el 54,1%. En todos los pacientes menos uno se realizó una punción endourológica del ureterocele. La edad media en el momento de la cirugía era de 6,96 meses (0-1,11). La cirugía fue ambulante en un 94,9% de los pacientes. No se registraron complicaciones perioperatorias. En los últimos 30 pacientes no se realizó cistouretrografía miccional preoperatoria. Un 72,5% de los pacientes presentaron RVU postoperatorio (44,8% a pielón superior, 10,3% a pielón inferior, 17,2% a ambos, 6,9% al sistema contralateral y 20,7% bilateral), pero este se resolvió con un único procedimiento endoscópico en un 48,1% de los casos (curación del 65% de los pacientes con dos procedimientos). El RVU no se resolvió de forma endoscópica en 3 pacientes que requirieron un reimplante ureteral. Seis pacientes precisaron heminefrectomía (n= 3) o nefrectomía (n= 3) por anulación funcional e infecciones. CONCLUSION: El tratamiento endourológico del ureterocele ectópico es una técnica poco agresiva invasiva que consigue la resolución de la obstrucción de forma ambulante permitiendo diferir la cirugía vesical (si fuera necesaria) fuera del periodo neonatal.

Tratamiento endourológico del ureterocele ectópico. Experiencia en los últimos 15 años / Endourological treatment of ectopic ureterocele. Our experience in the last 15 years

Objetivo: Evaluar la eficacia del tratamiento endourológico delureterocele ectópico en niños en una serie amplia y con seguimientoa largo plazo. Material y métodos: Estudio retrospectivo descriptivo de los pacientes con ureterocele ectópico intervenidos en nuestro centro en losúltimos 15 años. Todos los pacientes se tratan por vía endourológica,tanto el ureterocele como el reflujo vesicoureteral (RVU) postoperatorio. Resultados: Se trataron 40 pacientes, 55% eran izquierdos y 5%bilaterales. La edad media al diagnóstico fue de 4,97 meses siendo dediagnóstico prenatal el 54,1%. En todos los pacientes menos uno serealizó una punción endourológica del ureterocele. La edad media enel momento de la cirugía era de 6,96 meses (0-1,11). La cirugía fue ambulante en un 94,9% de los pacientes. No se registraron complicacionesperioperatorias. En los últimos 30 pacientes no se realizó cistouretrografía miccional preoperatoria. Un 72,5% de los pacientes presentaron RVUpostoperatorio (44,8% a pielón superior, 10,3% a pielón inferior, 17,2%a ambos, 6,9% al sistema contralateral y 20,7% bilateral), pero este seresolvió con un único procedimiento endoscópico en un 48,1% de loscasos (curación del 65% de los pacientes con dos procedimientos). ElRVU no se resolvió de forma endoscópica en 3 pacientes que requirieronun reimplante ureteral. Seis pacientes precisaron heminefrectomía (n= 3)o nefrectomía (n= 3) por anulación funcional e infecciones. Conclusión: El tratamiento endourológico del ureterocele ectópicoes una técnica poco agresiva invasiva que consigue la resolución de laobstrucción de forma ambulante permitiendo diferir la cirugía vesical(si fuera necesaria) fuera del periodo neonatal.(AU)

Objective: To assess the efficacy of the endourological treatmentof ectopic ureterocele in children in a large series and with a long-termfollow-up. Materials and methods: A retrospective, descriptive study ofpatients with ectopic ureterocele who had undergone surgery in ourinstitution in the last 15 years was carried out. All patients were treatedusing an endourological approach, both for ureterocele and postoperativevesicoureteral reflux (VUR). Results: 40 patients were treated – 55% with left involvement and5% with bilateral involvement. Mean age at diagnosis was 4.97 months,with diagnosis being established prenatally in 54.1% of cases. In allpatients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery wasperformed on an outpatient basis in 94.9% of patients. No perioperativecomplications were recorded. In the last 30 patients, preoperative voidingcystourethrography was not carried out. 72.5% of patients had postoper-ative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon,17.2% into both, 6.9% into the contralateral system, and 20.7% into thebilateral system), but it was resolved with a single endoscopic procedurein 48.1% of cases (65% of patients were healed with two procedures).VUR was not endoscopically resolved in 3 patients who required ureteral remplantation. 6 patients required heminephrectomy (n=3) ornephrectomy (n=3) as a result of functional impairment and infections. Conclusion: The endourological treatment of ectopic ureterocele isa little aggressive and little invasive technique that allows the obstructionto be resolved on an outpatient basis, which means bladder surgery – ifrequired – can be performed outside the neonatal period.(AU)

T cells isolated from G-CSF-treated multiple myeloma patients are suitable for the generation of BCMA-directed CAR-T cells.

Autologous cell immunotherapy using B cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR)-T cells is an effective novel treatment for multiple myeloma (MM). This therapy has only been used for relapsed and refractory patients, at which stage the endogenous T cells used to produce the CAR-T cells are affected by the immunosuppressive nature of advanced MM and/or side effects of previous therapies. An alternative pool of "fitter" T cells is found in leukocytoapheresis products that are routinely collected to obtain hematopoietic progenitor cells for autologous stem cell transplantation (ASCT) early in the treatment of MM. However, to mobilize the progenitor cells, patients are dosed with granulocyte colony-stimulating factor (G-CSF), which is reported to adversely affect T cell proliferation, function, and differentiation. Here, we aimed to first establish whether G-CSF treatment negatively influences T cell phenotype and to ascertain whether previous exposure of T cells to G-CSF is deleterious for anti-BCMA CAR-T cells. We observed that G-CSF had a minimal impact on T cell phenotype when added in vitro or administered to patients. Moreover, we found that CAR-T cell fitness and anti-tumor activity were unaffected when generated from G-CSF-exposed T cells. Overall, we showed that ASCT apheresis products are a suitable source of T cells for anti-BCMA CAR-T cell manufacture.

Telorragia: revisión de la literatura a propósito de dos casos / Telorrhagia: literature review on two cases

La telorragia es infrecuente en la edad pediátrica y un signo de alarma en la edad adulta. Estos pacientes se remiten a la consulta de Cirugía para valorar intervenciones agresivas por la amenaza de la malignidad. Sin embargo, su principal etiología es la ectasia ductal mamaria, un proceso benigno y autorresolutivo. Se presentan dos pacientes varones de 4 y 5 meses con telorragia. Una vez realizadas la exploración, la ecografía y la citología, se descartó un proceso maligno y se resolvió con manejo conservador en un periodo de 12 meses. A continuación, se realiza una revisión de la literatura incluyendo los pacientes pediátricos (0-16 años) con telorragia monosintomática. Encontramos un total de 59 casos publicados. Es más frecuente en varones (1,5:1) y el 74% de los casos ocurren en el primer año de vida. En los estudios revisados se realizan diversas pruebas complementarias (cultivo, citología, analítica hormonal) pero solo parece aportar información de utilidad la ecografía, que se encuentra alterada en un 69,2% de los pacientes. El abordaje terapéutico clásico ha sido la resección quirúrgica de la glándula mamaria, pero en la literatura más reciente se ha demostrado que, ya que se trata de una patología limitada en el tiempo, el manejo conservador es el más adecuado. Se reserva la cirugía para los casos con diagnóstico dudoso o persistentes. La recidiva es infrecuente (9,8%). Conclusiones: pese a ser un síntoma alarmante, la telorragia en lactantes debe de manejarse de forma conservadora evitando las intervenciones quirúrgicas agresivas, que podrían condicionar secuelas posteriores (AU)

Nipple discharge in children is uncommon, whereas it is considered a warning sign in adulthood. Hence these patients are referred to the Paediatric Surgeon to assess whether it is necessary to perform aggressive procedures to avoid the risk of malignancy. However, the most common ethology is ductal ectasia, a benign and self-limited process.We present two cases of a 4 and 5-month-old male patients with bloody nipple discharge. Once malignancy was ruled out by physical examination, ultrasound and cytology, a conservative approach was adopted and the symptoms disappeared over a period of 12 months. Then we conducted a systematic review including pediatric patients (0-16 years) with monosymptomatic bloody nipple discharge.We found a total of 59 cases published. It is more prevalent in male patients (1,5:1) and 74% present before the age of 12 months. In the articles reviewed several tests are mentioned (secretion culture, cytology, hormonal blood test) but only ultrasound provided useful information, showing altered results in 69.2% of the patients. The classical therapeutic approach was breast surgical resection but in more recent reports ductal ectasia has been shown to be a self-limited pathology. Therefore, conservative treatment is now advocated while surgery is reserved for persistent symptoms or cases where there is a diagnostic doubt. Relapse is infrequent (9.8%).Conclusions: despite of being a disturbing sign, bloody nipple discharge in infants should be managed conservatively, avoiding aggressive surgical procedures that might cause permanent consequences. (AU)

Laparoscopic surgery of congenital paraesophageal hernia in newborns and infants. / Cirugía laparoscópica de la hernia paraesofágica congénita en neonatos y lactantes.

INTRODUCTION: Congenital paraesophageal hernia (CPH) is a rare pathology in pediatric patients. Clinical signs may occur as early as in newborns, which means it requires early surgical repair. CLINICAL CASES: This is a series of three patients under 1 year of age diagnosed with type IV CPH - with symptoms occurring since they were newborns - who underwent laparoscopic surgical repair. One patient had been diagnosed prenatally. Age at surgery was 6 days, 36 days, and 9 months, respectively. Weight at surgery was 3.60 kg, 3.79 kg, and 8.20 kg, respectively. The patients underwent laparoscopy, with removal of the hernia sac, closure of the diaphragmatic pillars, placement of a reinforcement absorbable mesh, and Nissen fundoplication. Mean operating time was 130 minutes. No intraoperative complications were recorded. One patient developed a sliding hernia, which was subsequently repaired without complications. Mean follow-up time was 24 months.

INTRODUCCION: Las hernias paraesofágicas congénitas (HPC) son una patología poco frecuente en la edad pediátrica. Pueden presentar clínica desde la época neonatal precisando una reparación quirúrgica temprana. CASOS CLINICOS: Presentamos 3 casos diagnosticados de HPC tipo IV en pacientes menores de 1 año, que presentaron síntomas desde la época neonatal, en los que se ha realizado reparación quirúrgica laparoscópica. Un paciente presentaba diagnóstico prenatal. La edad en el momento de la cirugía fue 6 días, 36 días y 9 meses. El peso en el momento de la cirugía fue de 3,60 kg, 3,79 kg y 8,20 kg. Los pacientes fueron intervenidos por laparoscopia realizando excisión del saco herniario, cierre de pilares diafragmáticos, colocación de malla reabsorbible de refuerzo y una funduplicatura Nissen. El tiempo medio de cirugía fue de 130 minutos. No hubo complicaciones intraoperatorias. Un paciente presentó una hernia de deslizamiento que se reparó posteriormente sin complicaciones. El tiempo medio de seguimiento es de 24 meses.

Cirugía laparoscópica de la hernia paraesofágica congénita en neonatos y lactantes / Laparoscopic surgery of congenital paraesophageal hernia in newborns and infants

Introducción: Las hernias paraesofágicas congénitas (HPC) sonuna patología poco frecuente en la edad pediátrica. Pueden presentarclínica desde la época neonatal precisando una reparación quirúrgicatemprana. Casos clínicos: Presentamos 3 casos diagnosticados de HPC tipoIV en pacientes menores de 1 año, que presentaron síntomas desdela época neonatal, en los que se ha realizado reparación quirúrgicalaparoscópica. Un paciente presentaba diagnóstico prenatal. La edaden el momento de la cirugía fue 6 días, 36 días y 9 meses. El pesoen el momento de la cirugía fue de 3,60 kg, 3,79 kg y 8,20 kg. Lospacientes fueron intervenidos por laparoscopia realizando excisión delsaco herniario, cierre de pilares diafragmáticos, colocación de mallareabsorbible de refuerzo y una funduplicatura Nissen. El tiempo mediode cirugía fue de 130 minutos. No hubo complicaciones intraoperato-rias. Un paciente presentó una hernia de deslizamiento que se reparóposteriormente sin complicaciones. El tiempo medio de seguimientoes de 24 meses.(AU)

Introduction: Congenital paraesophageal hernia (CPH) is a rarepathology in pediatric patients. Clinical signs may occur as early as innewborns, which means it requires early surgical repair. Clinical cases: This is a series of three patients under 1 year of agediagnosed with type IV CPH – with symptoms occurring since they werenewborns – who underwent laparoscopic surgical repair. One patient hadbeen diagnosed prenatally. Age at surgery was 6 days, 36 days, and 9months, respectively. Weight at surgery was 3.60 kg, 3.79 kg, and 8.20kg, respectively. The patients underwent laparoscopy, with removal ofthe hernia sac, closure of the diaphragmatic pillars, placement of a rein-forcement absorbable mesh, and Nissen fundoplication. Mean operatingtime was 130 minutes. No intraoperative complications were recorded. One patient developed a sliding hernia, which was subsequently repairedwithout complications. Mean follow-up time was 24 months.(AU)

Pediatric surgical activity during the SARS-CoV-2 pandemic: experience at a tertiary hospital. / Cirugía pediátrica durante la pandemia de SARS-CoV-2. Experiencia en un hospital de tercer nivel.

OBJECTIVES: The primary objective was to describe the characteristics and demographics of the surgical procedures carried out at a tertiary hospital during the SARS-CoV-2 pandemic. The secondary objective was to study the impact of the pandemic on the acute appendicitis cases treated at our healthcare facility and to compare them with a pre- SARS-CoV-2 period. MATERIAL AND METHODS: A retrospective study of all patients undergoing surgery at the pediatric surgery department in the pandemic period, from the beginning of the state of emergency in Spain until the first restrictions were removed, was conducted. RESULTS: A total of 61 patients underwent surgery in 58 days vs. 406 patients in the same 2019 period (p < 0.00001). 59.01% of surgeries were urgent. 5.1% of patients had a positive SARS-CoV-2 diagnostic test. 30 different procedures were carried out, with appendectomy being the most frequent one (n = 13, 19.6% of patients). 61.5% of appendicitis cases were complicated vs. 42.4% in the non-COVID period (p = 0.17). Surgical approach was open in 46.1% of patients vs. 6.1% in the non-COVID period (p = 0.004). No statistically significant differences were found in terms of complication rate or hospital stay. CONCLUSIONS: During the SARS-CoV-2 pandemic, a significant decrease in the number of daily procedures was noted, with more than half being urgent. Appendicular pathologies were in a more advanced stage than usual, with a clear trend towards open surgery vs. laparoscopy.

OBJETIVOS: Describir las características y demografía de los procedimientos quirúrgicos realizados en un hospital de tercer nivel durante la pandemia del SARS-CoV-2. Como objetivo secundario se estudia el impacto de la pandemia en las apendicitis agudas tratadas en nuestro centro y su comparación con un periodo previo al SARS-CoV-2. MATERIAL Y METODOS: Estudio retrospectivo incluyendo a todos los pacientes intervenidos por parte del Servicio de Cirugía Pediátrica durante el periodo de pandemia. Abarca desde el primer día del estado de alarma hasta la desescalada de las restricciones. RESULTADOS: Se intervinieron un total de 61 pacientes en 58 días frente a 406 pacientes durante el mismo periodo de 2019 (p < 0,00001). El 59,01% de las intervenciones eran de carácter urgente. Un 5,1% de los pacientes tuvieron un test diagnóstico de SARS-CoV-2 positivo. Se realizaron 30 procedimientos distintos, siendo el más frecuente la apendicectomía (n = 13, 19,6% de los pacientes). El 61,5% de las apendicitis fueron complicadas frente a un 42,4% en periodo no COVID (p = 0,17). El abordaje quirúrgico fue abierto en un 46,1% de los pacientes frente al 6,1% no COVID (p = 0,004). No hubo diferencias estadísticamente significativas en la tasa de complicaciones o la estancia hospitalaria. CONCLUSIONES: Durante la pandemia por SARS-CoV-2 se ha producido una importante disminución del número de procedimientos diarios, pasando a ser más de la mitad de carácter urgente. La patología apendicular se ha presentado más evolucionada de lo habitual, habiendo una clara tendencia a la cirugía abierta frente a la laparoscopia.

Cirugía pediátrica durante la pandemia de SARS-CoV-2. Experiencia en un hospital de tercer nivel / Pediatric surgical activity during the SARS-CoV-2 pandemic: experience at a tertiary hospital

OBJETIVOS: Describir las características y demografía de los procedimientos quirúrgicos realizados en un hospital de tercer nivel durante la pandemia del SARS-CoV-2. Como objetivo secundario se estudia el impacto de la pandemia en las apendicitis agudas tratadas en nuestro centro y su comparación con un periodo previo al SARS-CoV-2. MATERIAL Y MÉTODOS: Estudio retrospectivo incluyendo a todos los pacientes intervenidos por parte del Servicio de Cirugía Pediátrica durante el periodo de pandemia. Abarca desde el primer día del estado de alarma hasta la desescalada de las restricciones. RESULTADOS: Se intervinieron un total de 61 pacientes en 58 días frente a 406 pacientes durante el mismo periodo de 2019 (p < 0,00001). El 59,01% de las intervenciones eran de carácter urgente. Un 5,1% de los pacientes tuvieron un test diagnóstico de SARS-CoV-2 positivo. Se realizaron 30 procedimientos distintos, siendo el más frecuente la apendicectomía (n = 13, 19,6% de los pacientes). El 61,5% de las apendicitis fueron complicadas frente a un 42,4% en periodo no COVID (p = 0,17). El abordaje quirúrgico fue abierto en un 46,1% de los pacientes frente al 6,1% no COVID (p = 0,004). No hubo diferencias estadísticamente significativas en la tasa de complicaciones o la estancia hospitalaria. CONCLUSIONES: Durante la pandemia por SARS-CoV-2 se ha producido una importante disminución del número de procedimientos diarios, pasando a ser más de la mitad de carácter urgente. La patología apendicular se ha presentado más evolucionada de lo habitual, habiendo una clara tendencia a la cirugía abierta frente a la laparoscopia

OBJECTIVES: The primary objective was to describe the characteristics and demographics of the surgical procedures carried out at a tertiary hospital during the SARS-CoV-2 pandemic. The secondary objective was to study the impact of the pandemic on the acute appendicitis cases treated at our healthcare facility and to compare them with a pre- SARS-CoV-2 period. MATERIALS AND METHODS: A retrospective study of all patients undergoing surgery at the pediatric surgery department in the pandemic period, from the beginning of the state of emergency in Spain until the first restrictions were removed, was conducted. RESULTS: A total of 61 patients underwent surgery in 58 days vs. 406 patients in the same 2019 period (p < 0.00001). 59.01% of surgeries were urgent. 5.1% of patients had a positive SARS-CoV-2 diagnostic test. 30 different procedures were carried out, with appendectomy being the most frequent one (n = 13, 19.6% of patients). 61.5% of appendicitis cases were complicated vs. 42.4% in the non-COVID period (p = 0.17). Surgical approach was open in 46.1% of patients vs. 6.1% in the non-COVID period (p = 0.004). No statistically significant differences were found in terms of complication rate or hospital stay. CONCLUSIONS: During the SARS-CoV-2 pandemic, a significant decrease in the number of daily procedures was noted, with more than half being urgent. Appendicular pathologies were in a more advanced stage than usual, with a clear trend towards open surgery vs. laparoscopy

Bronchoalveolar lavage usefulness in the pediatric population. / Rentabilidad del lavado broncoalveolar en la población pediátrica.

OBJECTIVE: To analyze bronchoalveolar lavage diagnostic effectiveness and impact on therapeutic management in pediatric patients. MATERIAL AND METHODS: Retrospective study of patients undergoing bronchoalveolar lavage at the pediatric surgery department from 2009 to 2019. The sample was divided into two groups: hemato-oncological patients and non-hemato-oncological patients. Demographic variables, bronchoalveolar lavage result, and subsequent therapeutic attitude were collected. RESULTS: 45 bronchoalveolar lavages were carried out in 38 patients. The hemato-oncological group consisted of 25 bronchoalveolar lavages. Patient mean age was 9.99 ± 2.34 years. 80% of patients had received anti-infective treatment prior to bronchoalveolar lavage. Bronchoalveolar lavage culture was positive in 52% of cases. Bronchoalveolar lavage results translated into therapeutic management change in 24% of cases (6/25). 3 postoperative complications were recorded, all mild. In the non-hemato-oncological group (n = 20), mean age was 6.70 ± 5.17 years. Bronchoalveolar lavage was positive in 25% of cases, and translated into management change in 5% of patients. Complication rate in this group was 30%. 2 patients required mechanical ventilation. CONCLUSIONS: According to our results, bronchoalveolar lavage in hemato-oncological patients helps achieve microbiological diagnosis in infectious respiratory conditions and is relatively well-tolerated. In non-hemato-oncological patients, diagnostic and therapeutic usefulness is low, and complication rate is not negligible. The risk-benefit balance should be individually considered in each patient.

OBJETIVO: Analizar la eficacia diagnóstica del lavado broncoalveolar y su impacto en el manejo terapéutico en pacientes pediátricos. MATERIAL Y METODOS: Estudio retrospectivo incluyendo a los pacientes a los que se les realizó un lavado broncoalveolar por parte del Servicio de Cirugía Pediátrica entre 2009 y 2019. Se ha dividido la muestra en dos grupos: pacientes hemato-oncológicos y no hemato-oncológicos. Se han recogido variables demográficas, el resultado del lavado broncoalveolar y la actitud terapéutica posterior. RESULTADOS: Se realizaron 45 lavados broncoalveolares en 38 pacientes. El grupo hemato-oncológico constaba de 25 lavados broncoalveolares. Los pacientes tenían una edad media de 9,99 ± 2,34 años. El 80% de los pacientes tenían tratamiento antiinfeccioso previo al lavado broncoalveolar. El cultivo del lavado broncoalveolar fue positivo en el 52% de los casos. El resultado del lavado broncoalveolar influyó en un cambio de manejo terapéutico en un 24% (6/25). Se produjeron 3 complicaciones postoperatorias, todas leves. En el grupo no hemato-oncológico (n = 20) la edad media era de 6,70 ± 5,17 años. El lavado broncoalveolar fue positivo en el 25% y supuso un cambio de manejo en un 5% de los pacientes. Este grupo tuvo una tasa de complicación del 30%, 2 pacientes requirieron ventilación mecánica. CONCLUSIONES: Según nuestros resultados, el lavado broncoalveolar en los pacientes hemato-oncológicos ayuda al diagnóstico microbiológico en procesos respiratorios infecciosos y es relativamente bien tolerado. En los no hemato-oncológicos, tiene una baja rentabilidad diagnóstico-terapéutica con una tasa de complicaciones no desdeñable. Sería necesario individualizar el balance beneficio-riesgo en cada paciente.

Rentabilidad del lavado broncoalveolar en la población pediátrica / Bronchoalveolar lavage usefulness in the pediatric population

OBJETIVOS: Analizar la eficacia diagnóstica del lavado broncoalveolar y su impacto en el manejo terapéutico en pacientes pediátricos. MATERIAL Y MÉTODOS: Estudio retrospectivo incluyendo a los pacientes a los que se les realizó un lavado broncoalveolar por parte del Servicio de Cirugía Pediátrica entre 2009 y 2019. Se ha dividido la muestra en dos grupos: pacientes hemato-oncológicos y no hemato-oncológicos. Se han recogido variables demográficas, el resultado del lavado broncoalveolar y la actitud terapéutica posterior. RESULTADOS: Se realizaron 45 lavados broncoalveolares en 38 pacientes. El grupo hemato-oncológico constaba de 25 lavados broncoalveolares. Los pacientes tenían una edad media de 9,99 ± 2,34 años. El 80% de los pacientes tenían tratamiento antiinfeccioso previo al lavado broncoalveolar. El cultivo del lavado broncoalveolar fue positivo en el 52% de los casos. El resultado del lavado broncoalveolar influyó en un cambio de manejo terapéutico en un 24% (6/25). Se produjeron 3 complicaciones posoperatorias, todas leves. En el grupo no hemato-oncológico (n = 20) la edad media era de 6,70 ± 5,17 años. El lavado broncoalveolar fue positivo en el 25% y supuso un cambio de manejo en un 5% de los pacientes. Este grupo tuvo una tasa de complicación del 30%, dos pacientes requirieron ventilación mecánica. CONCLUSIONES: Según nuestros resultados, el lavado broncoalveolar en los pacientes hemato-oncológicos ayuda al diagnóstico microbiológico en procesos respiratorios infecciosos y es relativamente bien tolerado. En los no hemato-oncológicos, tiene una baja rentabilidad diagnóstico-terapéutica, con una tasa de complicaciones no desdeñable. Sería necesario individualizar el balance beneficio-riesgo en cada paciente

OBJECTIVE: To analyze bronchoalveolar lavage diagnostic effectiveness and impact on therapeutic management in pediatric patients. MATERIALS AND METHODS: Retrospective study of patients undergoing bronchoalveolar lavage at the pediatric surgery department from 2009 to 2019. The sample was divided into two groups: hemato-oncological patients and non-hemato-oncological patients. Demographic variables, bronchoalveolar lavage result, and subsequent therapeutic attitude were collected. RESULTS: 45 bronchoalveolar lavages were carried out in 38 patients. The hemato-oncological group consisted of 25 bronchoalveolar lavages. Patient mean age was 9.99 ± 2.34 years. 80% of patients had received anti-infective treatment prior to bronchoalveolar lavage. Bronchoalveolar lavage culture was positive in 52% of cases. Bronchoalveolar lavage results translated into therapeutic management change in 24% of cases (6/25). 3 postoperative complications were recorded, all mild. In the non-hemato-oncological group (n = 20), mean age was 6.70 ± 5.17 years. Bronchoalveolar lavage was positive in 25% of cases, and translated into management change in 5% of patients. Complication rate in this group was 30%. 2 patients required mechanical ventilation. CONCLUSIONS: According to our results, bronchoalveolar lavage in hemato-oncological patients helps achieve microbiological diagnosis in infectious respiratory conditions and is relatively well-tolerated. In non-hemato-oncological patients, diagnostic and therapeutic usefulness is low, and complication rate is not negligible. The risk-benefit balance should be individually considered in each patient

Congenital Hypopituitarism During the Neonatal Period: Epidemiology, Pathogenesis, Therapeutic Options, and Outcome.

Introduction: Congenital hypopituitarism (CH) is characterized by a deficiency of one or more pituitary hormones. The pituitary gland is a central regulator of growth, metabolism, and reproduction. The anterior pituitary produces and secretes growth hormone (GH), adrenocorticotropic hormone, thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. The posterior pituitary hormone secretes antidiuretic hormone and oxytocin. Epidemiology: The incidence is 1 in 4,000-1 in 10,000. The majority of CH cases are sporadic; however, a small number of familial cases have been identified. In the latter, a molecular basis has frequently been identified. Between 80-90% of CH cases remain unsolved in terms of molecular genetics. Pathogenesis: Several transcription factors and signaling molecules are involved in the development of the pituitary gland. Mutations in any of these genes may result in CH including HESX1, PROP1, POU1F1, LHX3, LHX4, SOX2, SOX3, OTX2, PAX6, FGFR1, GLI2, and FGF8. Over the last 5 years, several novel genes have been identified in association with CH, but it is likely that many genes remain to be identified, as the majority of patients with CH do not have an identified mutation. Clinical manifestations: Genotype-phenotype correlations are difficult to establish. There is a high phenotypic variability associated with different genetic mutations. The clinical spectrum includes severe midline developmental disorders, hypopituitarism (in isolation or combined with other congenital abnormalities), and isolated hormone deficiencies. Diagnosis and treatment: Key investigations include MRI and baseline and dynamic pituitary function tests. However, dynamic tests of GH secretion cannot be performed in the neonatal period, and a diagnosis of GH deficiency may be based on auxology, MRI findings, and low growth factor concentrations. Once a hormone deficit is confirmed, hormone replacement should be started. If onset is acute with hypoglycaemia, cortisol deficiency should be excluded, and if identified this should be rapidly treated, as should TSH deficiency. This review aims to give an overview of CH including management of this complex condition.

Airborne non-contact and contact broadband ultrasounds for frequency attenuation profile estimation of cementitious materials.

In this paper, the study of frequency-dependent ultrasonic attenuation in strongly heterogeneous cementitious materials is addressed. To accurately determine the attenuation over a wide frequency range, it is necessary to have suitable excitation techniques. We have analysed two kinds of ultrasound techniques: contact ultrasound and airborne non-contact ultrasound. The mathematical formulation for frequency-dependent attenuation has been established and it has been revealed that each technique may achieve similar results but requires specific different calibration processes. In particular, the airborne non-contact technique suffers high attenuation due to energy losses at the air-material interfaces. Thus, its bandwidth is limited to low frequencies but it does not require physical contact between transducer and specimen. In contrast, the classical contact technique can manage higher frequencies but the measurement depends on the pressure between the transducer and the specimen. Cement specimens have been tested with both techniques and frequency attenuation dependence has been estimated. Similar results were achieved at overlapping bandwidth and it has been demonstrated that the airborne non-contact ultrasound technique could be a viable alternative to the classical contact technique.

Angiomas en penacho en la infancia. Serie de 9 casos y revisión de la literatura / Tufted angiomas in childhood: A series of 9 cases and a literature review

INTRODUCCIÓN: El angioma en penacho o tufted angioma (TA) es una tumoración vascular benigna poco frecuente, que suele aparecer en la infancia, aunque existen casos de aparición en la edad adulta. Su presentación clínica es muy variable. Se manifiesta típicamente como una mácula, pápula o nódulo eritematovioláceo en el tronco o el cuello. Histológicamente, se caracteriza por agregados de lóbulos angiomatosos en la dermis formando pequeños penachos de capilares. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional de los casos diagnosticados de TA en los últimos 20 años en nuestro centro. RESULTADOS: Presentamos un total de 9 casos de angiomas en penacho en la infancia. El 77,7% de los casos fueron congénitos, lo que representa una frecuencia superior a la descrita previamente. Nuestros pacientes presentaron regresión espontánea en el 55,5% de los casos, siendo más frecuente en el grupo de TA congénitos. A diferencia de las otras series descritas en la literatura, observamos un mayor porcentaje de pacientes con regresión espontánea, un predominio femenino (6 de los 9 niños) y una localización más frecuente en miembros los superiores. Ninguno de nuestros pacientes presentó fenómeno de Kasabach-Merritt. CONCLUSIONES: Dada la alta tasa de involución espontánea en TA congénitos o tempranos, en ausencia de otras complicaciones, la vigilancia sería una buena opción de manejo, monitorizando estrechamente al paciente

INTRODUCTION: Tufted angioma (TA) is a rare benign vascular tumor that mostly appears during infancy or early childhood, although there are cases reported in adults. Clinical presentation and evolution of TA can vary. Histologically, it takes on a classic appearance of vascular tufts ('cannon ball' like appearance). PATIENTS AND METHODS: A retrospective observational study was conducted that included all patients diagnosed with TA at our center in the last 20 years. Results A series of 9 cases of tufted angioma in childhood are presented, 77.7% of which were congenital. This represents a frequency higher than previously described. Spontaneous regression was observed in 55.5% of the cases, and was more frequent in the congenital TA group. Unlike other TA series reported in the literature, a higher proportion of patients with spontaneous regression was observed in this series, with a higher prevalence in females (6 out of 9 children) and predominantly located in the upper limbs. None of our patients had Kasabach-Merritt phenomenon. CONCLUSIONS: There are many ways of treating TA, but none are uniformly effective. Given the high rate of spontaneous regression in congenital or early TA, we suggest that, in the absence of other complications, monitoring would be a good option for management

Learning to (dis)like: The effect of evaluative conditioning with tastes and faces on odor valence assessed by implicit and explicit measurements.

Evaluative conditioning may be an important mechanism for learning food preferences and aversions; however, in both real life and experimental settings it has not been consistently successful. The current study aimed to gain more insight into which underlying factors may contribute to a successful outcome of olfactory evaluative conditioning. Two groups of 18 participants came in on three consecutive days, and were repeatedly exposed to four novel, neutral odors (CS) coupled to varying disliked, neutral, liked, or no stimuli (taste and/or pictures, US), following a 50% reinforcement schedule, leading to 40 odor presentations per session. Liking ratings, as well as changes in the autonomic nervous system were assessed before, during and after conditioning. We were able to induce negative, but not positive, affective changes by pairing neutral odors with tastes and pictures differing in valence. Negative as well as multimodal stimuli appear to be more potent US, since they may be considered more salient. Lastly, results of the current study imply that heart rate is responsive to changes in valence of olfactory stimuli, and perhaps even more sensitive than explicit ratings of liking.

[Tufted angiomas in childhood: A series of 9 cases and a literature review]. / Angiomas en penacho en la infancia. Serie de 9 casos y revisión de la literatura.

INTRODUCTION: Tufted angioma (TA) is a rare benign vascular tumor that mostly appears during infancy or early childhood, although there are cases reported in adults. Clinical presentation and evolution of TA can vary. Histologically, it takes on a classic appearance of vascular tufts ("cannon ball" like appearance). PATIENTS AND METHODS: A retrospective observational study was conducted that included all patients diagnosed with TA at our center in the last 20 years. RESULTS: A series of 9 cases of tufted angioma in childhood are presented, 77.7% of which were congenital. This represents a frequency higher than previously described. Spontaneous regression was observed in 55.5% of the cases, and was more frequent in the congenital TA group. Unlike other TA series reported in the literature, a higher proportion of patients with spontaneous regression was observed in this series, with a higher prevalence in females (6 out of 9 children) and predominantly located in the upper limbs. None of our patients had Kasabach-Merritt phenomenon. CONCLUSIONS: There are many ways of treating TA, but none are uniformly effective. Given the high rate of spontaneous regression in congenital or early TA, we suggest that, in the absence of other complications, monitoring would be a good option for management.