Seguridad en procedimientos dermatológicos: sección de grandes vasos sanguíneos y estructuras nerviosas / Safety in Dermatologic Procedures: Accidental Injury to Major Blood Vessels and Nerve Structures

En el presente artículo de la serie «Seguridad en procedimientos dermatológicos» se aborda la sección quirúrgica accidental de grandes vasos sanguíneos y estructuras nerviosas. Se aborda, en primer lugar, la localización anatómica y recorrido de las distintas estructuras vasculares y nerviosas de más riesgo. A continuación, se explican las consecuencias de dicha lesión. Por último, se emiten algunas recomendaciones para evitar el daño accidental de las estructuras en dichas áreas de riesgo y se plantean algunas maniobras terapéuticas de reparación ante un eventual daño (AU)

This article in the series «Safety in Dermatologic Procedures» deals with the accidental laceration of major blood vessels and nerve structures during surgery. We first look at the anatomic location and course of the blood vessels and nerve structures that are most at risk of injury and then describe the possible outcomes in each case. We finally offer some recommendations on how to avoid damage to structures in danger zones and how to repair them if they are accidentally compromised (AU)

[Translated article] Safety in Dermatologic Procedures: Accidental Injury to Major Blood Vessels and Nerve Structures / Seguridad en procedimientos dermatológicos: sección de grandes vasos sanguíneos y estructuras nerviosas

This article in the series «Safety in Dermatologic Procedures» deals with the accidental laceration of major blood vessels and nerve structures during surgery. We first look at the anatomic location and course of the blood vessels and nerve structures that are most at risk of injury and then describe the possible outcomes in each case. We finally offer some recommendations on how to avoid damage to structures in danger zones and how to repair them if they are accidentally compromised (AU)

En el presente artículo de la serie «Seguridad en procedimientos dermatológicos» se aborda la sección quirúrgica accidental de grandes vasos sanguíneos y estructuras nerviosas. Se aborda, en primer lugar, la localización anatómica y recorrido de las distintas estructuras vasculares y nerviosas de más riesgo. A continuación, se explican las consecuencias de dicha lesión. Por último, se emiten algunas recomendaciones para evitar el daño accidental de las estructuras en dichas áreas de riesgo y se plantean algunas maniobras terapéuticas de reparación ante un eventual daño (AU)

Safety in Dermatologic Procedures: Accidental Injury to Major Blood Vessels and Nerve Structures. / Seguridad en procedimientos dermatológicos: sección de grandes vasos sanguíneos y estructuras nerviosas.

This article in the series «Safety in Dermatologic Procedures¼ deals with the accidental laceration of major blood vessels and nerve structures during surgery. We first look at the anatomic location and course of the blood vessels and nerve structures that are most at risk of injury and then describe the possible outcomes in each case. We finally offer some recommendations on how to avoid damage to structures in danger zones and how to repair them if they are accidentally compromised.

Percepciones del paciente en realimentación tras cirugía colorrectal. Un estudio cualitativo

Introducción: El conocimiento obtenido a partir de las experiencias de los pacientes favorece una atención de calidad. El objetivo de este estudio cualitativo es conocer la percepción de los pacientes sobre su realimentación tras una cirugía colorrectal, y los factores condicionantes en relación con dicho proceso. Material y Método: En base a la directriz de Standards for Reporting Qualitative Research, se realiza un estudio cualitativo a partir de una entrevista de 8 preguntas de término abierto realizada a 20 pacientes seleccionados por un método de variación máxima de muestreo. Se realizó análisis temático. Resultados: Se identificaron cuatro dimensiones principales (con subtemas respectivos) que condicionan la alimentación en el postoperatorio: 1. propósitos del paciente tras la alimentación (búsqueda de alta, hidratación, búsqueda de salud, finalizar ayuno, deambulación); 2. propiedades y características de los alimentos (sazón, presentación, temperatura, porciones, consistencia, favoritos); 3. factores del paciente (físicos, psicológicos); y 4. relación equipo de salud-paciente (confianza, complacencia, información, agradecimiento). Conclusión: El proceso de ingesta de alimentos en este contexto está condicionado por las cuatro dimensiones mencionadas. Sería importante considerarlas al momento de crear y ejecutar pautas y guías de alimentación adaptadas a los pacientes.

Introduction: Knowledge obtained from the experiences of patients favors quality care. The aim of this study is to know the perception of patients regarding refeeding after colorectal surgery, and particular factors that condition postoperative intake from their perspective. Materials and Method: Based on the guideline of Standards for reporting qualitative Research, a qualitative study was constructed from an interview with 8 open-ended questions to 20 patients selected by a maximum sampling variation method. Thematic analysis was carried out. Results: Four main dimensions were identified that determine feeding in the postoperative period: 1. patient's goals after feeding (search for discharge, hydration, search for health, end fasting, ambulation); 2. properties and characteristics of food (seasoning, presentation, temperature, portions, consistency, favorites); 3 patient factors (physical, psychological); and 4. health team-patient relationship (trust, complacency, information, gratitude). Conclusion: The process of food intake in this context is conditioned by the four dimensions mentioned. It would be important to consider them when creating and executing feeding guidelines adapted to patients.

Impacto del sitio de extracción en la incidencia de hernias incisionales en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal

Introducción: El objetivo de este estudio fue comparar la tasa de hernia incisional (HI) tras la extracción de piezas operatorias por mini-laparatomia media periumbilical (MM) versus mini-laparotomía transversa suprapúbica (MTS) en pacientes sometidos a cirugía laparoscópica por cáncer colorrectal (CLCC), y evaluar los factores asociados a su ocurrencia. Material y Método: Estudio de cohorte no concurrente. Se incluyen todos los pacientes consecutivos sometidos a CLCC en nuestro centro entre septiembre 2006 y diciembre 2017, cuya pieza operatoria fuese extraída por una MM o MTS y que contaran con un control tomográfico en el seguimiento. El diagnóstico de HI se realizó mediante tomografía computada, evaluada por dos radiólogos de forma independiente. Se agruparon los pacientes en MM y MTS, y se evaluaron las tasas de HI según sitio de extracción. Además, se realizó una regresión logística para identificar factores asociados a HI. Resultados: Se identificaron 1090 pacientes que tuvieron resecciones colorrectales lapa-roscópicas durante el período estudiado. De estos, 254 cumplieron con los criterios de inclusión. La edad media de la serie fue de 63 años (53,5% son hombres) con un IMC de 26,4 kg/m2. El sitio de extracción fue una MTS en un 53,1% y una MM en un 46,9%. Se identificó un total de 41 (34,5%) HI en el grupo de MM versus 17 (12,6%) en MTS (p = 0,001) en la TC de seguimiento realizado en una mediana de 18 meses (RIC 12-32) postoperatorios. En la regresión logística, el sitio de extracción (OR = 3,33, IC 95% 1,72-7,14, p < 0,001) y la presencia de patología bronquial obstructiva se asociaron de manera independiente con HI (OR = 3,45, IC 95% 1,11-11,11, p = 0,03). Conclusión: La MTS se asocia a una menor tasa de HI que la MM en pacientes sometidos a CLCC. Esto se debe tener en consideración al momento de elegir el sitio de extracción de pieza operatoria en CLCC.

Aim: To compare the rate of incisional hernia (IH) according to the extraction site in patients undergoing laparoscopic colorectal cancer surgery (LCCS), and to evalúate the risk factors associated with its occurrence. Material and Method: Cohort study including all consecutive patients undergoing LCCS in our center between September 2006 and December 2017, where the specimen was extracted through a median mini-laparotomy (MM) or transverse suprapubic mini-laparotomy (TSM) and have a tomographic control during follow-up. The diagnosis of IH was made by computed tomography evaluated by two radiologists, independently. The rate of IH was calculated for both groups and a regression analysis were performed to identify factors associated with IH. Results: Some 1090 patients undergoing laparoscopic colorectal resections were identified during the study period; of these, 254 met the inclusion criteria. The mean age of the series was 63 years (53.5% are men) with a BMI of 26.4 kg/m2. The extraction site was a TSM in 53.1% and a MM in 46.9%. A total of 41 (34.5%) IH were identified in the MM group versus 17 (12.6%) in TSM (p = 0.001) in the follow-up CT performed at a median of18 months (IQR 12-32) postoperative. In logistic regression, the extraction site (OR = 3.33, 95% CI 1.72-7.14, p < 0.001) and the presence of obstructive bronchial pathology were independently associated with IH (OR = 3, 45, 95% CI 1.11-11.11, p = 0.03). Conclusión: A TSM is associated with a lower rate of IH compared to a MM as extraction site in patients undergoing LCCS. This must be taken into account when choosing the extraction site in patients having LCCS.

Presencia de las distintas áreas quirúrgicas en el Congreso Nacional de Cirugía. Análisis de los últimos 12 años

Introducción: Los trabajos científicos permiten divulgar, compartir y contrastar resultados a terceros. Una de las formas de ver la actividad investigativa de cada especialidad es a través de las presentaciones que realizan en reuniones científicas. Objetivo: Describir el número de presentaciones de las distintas especialidades o áreas quirúrgicas en Chile en el principal congreso realizado a nivel nacional y evaluar si el comportamiento fue distinto durante los años de pandemia por coronavirus. Material y Método: Estudio bibliométrico del Congreso Chileno de Cirugía entre los años 2010 y 2021 evaluando el número total de presentaciones por área quirúrgica, año de presentación y período categorizado en 2010 a 2019 y 2020 a 2021. Se realiza estadística descriptiva y análisis de asociación de medias de publicaciones por área y período. Resultados: Se identificaron 4.462 presentaciones, incluyendo resúmenes orales, póster, videos y jornada de residentes. La media total fue 371,8 trabajos anuales. Coloproctología y Cirugía Gastroesofágica aportaron un total de 616 (13,8%) y 598 (13,4%) respectivamente. La media de presentaciones anuales previo a la pandemia por coronavirus fue de 414, en contraste a los 160 trabajos anuales durante ella, existiendo una disminución significativa de medias de presentaciones por área de 27,6 (± 18,8) a 10,7 (± 8,69) (p < 0,001), sin diferencias sus porcentajes de participación respecto del total (p = 0,776). Conclusión: Coloproctología y Cirugía Gastroesofágica son las áreas quirúrgicas más representadas. Si bien en el período contemporáneo a la pandemia por coronavirus significó una disminución en las presentaciones, no se observó una modificación en el porcentaje de participación de algún área en particular.

Introduction: Scientific studies allow the disclosure, sharing and comparison of results with third parties. One of the ways to see the investigative activity of each medical specialty is through the presentations they make at scientific meetings. Aim: To describe the number of presentations of the different surgical specialties or areas in Chile in the main congress held at a national level and to assess whether the behavior was different during the years of the coronavirus pandemic. Material and Method: Bibliometric study of the Chilean Congress of Surgery between 2010 and 2021, evaluating the total number of presentations by surgical area, year of presentation and two categorized periods (2010 to 2019 and 2020 to 2021). Descriptive statistics and association analysis of publication means by area and period are performed. Results: 4,462 presentations were identified, including oral summaries, posters, videos, and residents' sessions, with a mean of 371.8 per year. Coloproctology and Gastroesophageal Surgery contributed a total of 616 (13.8%) and 598 (13.4%) respectively. The mean number of annual presentations prior to the coronavirus pandemic was 414, in contrast to the 160 annual works during it, with a significant decrease in the mean number of presentations per area from 27.6 (± 18.8) to 10.7 (± 8.69) (p < 0.001), without differences in their percentages of participation with respect to the total (p = 0.776). Conclusion: Coloproctology and Gastroesophageal Surgery are the most represented surgical areas. Although the contemporary period of the coronavirus pandemic meant a decrease in presentations, no change was observed in the percentage of participation in any particular area.

Resultados quirúrgicos a corto y mediano plazo por enfermedad de Crohn ileocecal / Short and medium term results of the surgical management of ileocecal Crohn's disease

BACKGROUND: The treatment of Crohn's disease (CD) is based on medical therapy and surgery is reserved for failure of medical management or complications. AIM: To evaluate endoscopic, clinical, and surgical recurrence of CD after surgery. MATERIAL AND METHODS: In a prospectively maintained database, consecutive patients older than 15 years subjected to an ileocecal resection for ileocolic disease from January 2011 to April 2021, were identified. The diagnosis of CD was confirmed with the pathologic report. Patients with less than one year of follow-up were excluded. Information was obtained retrospectively from the database and clinical records. RESULTS: Fourteen patients were identified. The mean age at the time of surgery was 38 years. Surgery was performed at a median of 41.5 months (0-300) after the diagnosis of CD, nine elective and five emergency procedures. In five patients there were four major and two minor postoperative complications, with no anastomotic leakage. Six patients had endoscopic recurrence and seven had clinical recurrence (50%) at a mean of 15 months, one of whom required a second operation. There was no mortality. CONCLUSIONS: After the surgical treatment of CD, the clinical and endoscopic recurrence rate continues to be high.

Mucormicosis periostomal posoperatoria, a propósito de un caso / Mucormycosis periostomal: case report

Resumen Introducción: La mucormicosis en una enfermedad infrecuente y oportunista que afecta, principalmente, a pacientes inmunocomprometidos. Pocas veces se han reportado casos de afectación periostomal. Clínicamente puede ser confundida con otras patologías, pudiendo tener una evolución fulminante, por lo que un adecuado y pronto diagnóstico son necesarios para una instauración precoz del tratamiento. Caso Clínico: Se presenta el caso de una paciente de 62 años inmunocomprometida, que tras complicaciones quirúrgicas evoluciona con mucormicosis periostomal de la pared abdominal. A pesar de un tratamiento quirúrgico con múltiples resecciones de tejido asociado a antifúngico local y sistémico, la paciente fallece, concordante a la letalidad expresada en la literatura.

Introduction: Mucormycosis is a rare and opportunistic disease that mainly affects immunocompromised patients. Few cases of peristomal involvement have been reported. Clinically it can be confused with other pathologies and may have a fulminant evolution, so an adequate and prompt diagnosis is necessary for an early establishment of treatment. Clinical Case: We present the case of a 62-year-old immunocompromised patient who, after surgical complications, evolves with periostomal mucormycosis of the abdominal wall. Despite surgical treatment with multiple tissue resections, associated with local and systemic antifungal agents, the patient died, consistent with the lethality expressed in the literature.

Colgajo de Martius como tratamiento de una fístula rectovaginal recidivada: revisión de la técnica quirúrgica a propósito de un caso clínico / Martius Flap for recurrent Rectovaginal Fístula: clinical Case and surgical approach

Resumen Introducción: La fístula rectovaginal es una patología quirúrgica compleja de tratar. El trauma perineal obstétrico y las enfermedades inflamatorias intestinales, especialmente la Enfermedad de Crohn son las causas más frecuentes. La reparación quirúrgica con un Colgajo de Martius en manos experimentadas ha mostrado buenos resultados con mínima morbilidad en pacientes seleccionados. Material y Método: Presentamos un caso clínico de una paciente que cursó con una fístula rectovaginal posparto tardía, la cual tuvo una recurrencia precoz, luego de intentar tratamiento quirúrgico consistente en un colgajo de avance, siendo necesaria la desfuncionalización del tránsito con una colostomía en asa. Posteriormente se realizó un Colgajo de Martius con resultado exitoso. Resultados: Evolución satisfactoria. Cursó con dehiscencia de la herida perineal la cual requirió solo curaciones ambulatorias. Luego de 8 meses posterior a la confección del Colgajo de Martius, se realizó el cierre de colostomía. A los 30 meses poscolgajo, la paciente se encuentra en buenas condiciones, sin evidencia de recidiva y tránsito intestinal normal. Conclusión: En este caso clínico, el colgajo de Martius fue una alternativa segura y efectiva en el tratamiento de una fístula rectovaginal recidivada.

Introduction: The rectovaginal fistula is a complex surgical pathology to treat. Obstetric perineal trauma and inflammatory bowel diseases, especially Crohn's disease, are the most frequent causes. Surgical repair with a Martius flap in experienced hands has shown good results with minimal morbidity in selected patients. Material and Methods: We present a clinical case of a patient who had a late postpartum rectovaginal fistula, which recurred early after attempting surgical treatment consisting of an advancement flap, requiring defunctionalization of the transit with a loop colostomy. Subsequently, a Martius flap was performed with a successful result. Results: Satisfactory evolution. The patient presented a dehiscence of the perineal wound which required only ambulatory dressings. At 8 months from the Martius flap was made, the colostomy was closed. At 30 months post-flap, the patient is in good condition, with no evidence of recurrence and normal intestinal transit. Conclusión: In this clinical case, the Martius flap was a safe and effective alternative in the treatment of a recurrent rectovaginal fistula.

Antimicrobial efficacy of in vitro and ex vivo photodynamic therapy using porphyrins against Moraxella spp. isolated from bovine keratoconjunctivitis.

Infectious bovine keratoconjunctivitis (IBK) is an ocular disease affecting bovine herds worldwide, and it causes significant economic loss. The etiologic agent of IBK is considered to be Moraxella bovis, but M. ovis and M. bovoculi are frequently recovered of animals presenting clinical signs of IBK. The therapeutic measures available for its control have limited efficacy. Antimicrobial photodynamic therapy (aPDT) using porphyrins as photosensitizing molecules is an alternative method that can be used to reduce microbial growth. We evaluated the antibacterial activity of aPDT using two water-soluble tetra-cationic porphyrins (H2TMeP and ZnTMeP) against 22 clinical isolates and standard strains of Moraxella spp. in vitro and in an ex vivo model. For the in vitro assay, 4.0 µM of porphyrin was incubated with approximately 1.0 × 104 CFU/mL of each Moraxella sp. isolate and exposed to artificial light for 0, 2.5, 5, and 7.5 min. Next, 50 µL of this solution was plated and incubated for 24 h until CFU measurement. For the ex vivo assay, corneas excised from the eyeballs of slaughtered cattle were irrigated with Moraxella spp. culture, followed by the addition of zinc(II) porphyrin ZnTMeP (4.0 µM). The corneal samples were irradiated for 0, 7.5, and 30 min, followed by swab collection, plating, and CFU count. The results demonstrated the in vitro inactivation of the strains and clinical isolates of Moraxella spp. after 2.5 min of irradiation using ZnTMeP, reaching complete inactivation until 7.5 min. In the ex vivo experiment, the use of ZnTMeP resulted in the most significant reduction in bacterial concentration after 30 min of irradiation. These results encourage future in vivo experiments to investigate the role of metalloporphyrin ZnTMeP in the inactivation of Moraxella spp. isolates causing IBK.

[Short and medium term results of the surgical management of ileocecal Crohn's disease]. / Resultados quirúrgicos a corto y mediano plazo por enfermedad de Crohn ileocecal.

BACKGROUND: The treatment of Crohn's disease (CD) is based on medical therapy and surgery is reserved for failure of medical management or complications. AIM: To evaluate endoscopic, clinical, and surgical recurrence of CD after surgery. MATERIAL AND METHODS: In a prospectively maintained database, consecutive patients older than 15 years subjected to an ileocecal resection for ileocolic disease from January 2011 to April 2021, were identified. The diagnosis of CD was confirmed with the pathologic report. Patients with less than one year of follow-up were excluded. Information was obtained retrospectively from the database and clinical records. RESULTS: Fourteen patients were identified. The mean age at the time of surgery was 38 years. Surgery was performed at a median of 41.5 months (0-300) after the diagnosis of CD, nine elective and five emergency procedures. In five patients there were four major and two minor postoperative complications, with no anastomotic leakage. Six patients had endoscopic recurrence and seven had clinical recurrence (50%) at a mean of 15 months, one of whom required a second operation. There was no mortality. CONCLUSIONS: After the surgical treatment of CD, the clinical and endoscopic recurrence rate continues to be high.

Photodynamic control of Aedes aegypti larvae with environmentally-friendly tetra-platinated porphyrin.

This work evaluated the photosensitizing activity of isomeric tetra-cationic porphyrins with peripheral [Pt(bpy)Cl]+ to control the larval population of Aedes aegypti by photodynamic action. The photolarvicidal activity of the tetra-platinated porphyrins at meta and para position (3-PtTPyP and 4-PtTPyP) was evaluated under blue (450 nm), green (525 nm), and red (625 nm) light illumination at 55.0 J cm-2. The meta isomer presented an efficient photolarvicidal activity even at a low concentration (1.2 ppm) in the presence of light, while the para counterpart was inactive regardless of the concentration and illumination. The different responses were related to the improved optical features and higher water solubility of 3-PtTPyP compared to 4-PtTPyP. Additionally, the potential environmental toxicity of 3-PtTPyP was tested in a plant model (Allium cepa test), with no toxicity detected for all used concentrations (1.2 to 12 ppm). Hence, this work reveals that 3-PtTPyP has a great potential to be employed to photodynamically control the insect vector population in an environmentally safe way.

In vitro antimicrobial photodynamic therapy using tetra-cationic porphyrins against multidrug-resistant bacteria isolated from canine otitis.

Antimicrobial-resistant bacteria have been frequently isolated from canine otitis. Photodynamic therapy using porphyrins as photosensitizing molecules is an alternative therapy against microorganisms in localized infections. Therefore, we evaluated the antibacterial activity of two tetra-cationic porphyrins (H2TMeP and ZnTMeP) against gram-positive and -negative bacteria isolated from canine otitis, as well as its putative action mechanism. For this, two gram-positive and two gram-negative bacteria frequently detected in cases of canine otitis (coagulase-positive and -negative staphylococci [CPS and CNS], Pseudomonas aeruginosa, and Proteus mirabilis) were used in antibacterial activity assays. Each porphyrin at a non-cytotoxic dose was incubated with a fixed concentration of each bacterium and exposed to white-light irradiation for 0, 30, 60, and 90 min. Clinical isolates of CPS and CNS were photo-inactivated after 30 min of white-light exposure by both porphyrins (p < 0.05). Gram-negative bacteria were also photo-inactivated after 30 min (p < 0.05), reaching complete inactivation after 60 and 90 min of white-light irradiation by H2TMeP and ZnTMeP, respectively. Antibacterial assays using standard bacterial strains (ATCCs) demonstrated similar results to those obtained with clinical isolates, except for P. aeruginosa, which was completely inactivated by ZnTMeP at 60 min, and the absence of a significant reduction in P. mirabilis concentration when irradiated for 30 min. Similar assays were conducted using reactive oxygen species scavengers showing that the putative mechanism for bacterial inactivation is through the production of singlet oxygen species. These results indicated that H2TMeP and ZnTMeP tetra-cationic porphyrins were effective against bacteria isolated from canine otitis.

Influence of the meso-substituents on the spectral features of free-base porphyrin.

The role of meso-substituents on the spectral features of free-base porphyrins is explored. Meso-tetra(4-pyridyl)porphyrin is compared with meso-tetra(2-thienyl)porphyrin and meso-tetra(pentafluorophenyl)porphyrin. Our results indicate that some of the asymmetric Q-bands in the free-base porphyrin tend to become symmetric relative to the adopted meso-substituent. The results show that the outlying perturbations lead the free-base quasi-degenerated Qx1, Qx2, Qy1, and Qy2 bands to be closer in energy. Combined, absorption, fluorescence and Raman spectroscopies endorse our conclusions showing that both the frequencies and the Huang-Rhys factors associated with every vibronic progression are noticeably affected by the investigated meso-substituents. Our results confirm that the B-band is also multi-featured in agreement with what is found for the Q-bands.

Mixed Adenoneuroendocrine Carcinoma of the Esophagus: A Case Report and Review of the Literature.

The most frequent presentation of esophageal cancer is adenocarcinoma and squamous cell carcinoma. In recent years, the latter has decreased its incidence increasing the adenocarcinoma. Currently, another type of tumor with a much lower incidence has been described, which has a neuroendocrine component along with another exocrine glandular component and has been classified since 2010 as mixed adenoneuroendocrine carcinoma (MANEC). We present the case of a 68-year-old male with a history of dyspepsia and epigastric pain who after performing a gastroscopy, was diagnosed with a malignant neoplasm of the esophagus. The patient underwent a total esophagectomy with reconstruction by tubular gastroplasty with cervical anastomosis. The final result of the piece after immunohistochemistry revealed that the tumor was composed of one component of adenocarcinoma in 60% together with another component compatible with neuroendocrine in 40%. With these findings and according to the World Health Organization classification of 2010 was diagnosed as esophageal MANEC. MANECs are rare tumors, described in other locations of the digestive tract, the esophagus being an infrequent location. Its preoperative diagnosis is difficult, and it is not until the final analysis of the complete piece by means of specific immunohistochemical techniques when its diagnosis can be established. Its treatment is fundamentally surgical, whereas the adjuvant therapeutic schemes with chemotherapy are not well defined at present because of their low incidence.

Successful exchange transfusion in extremely preterm infant after symptomatic lipid overdose.

BACKGROUND: Complications of intravenous lipid administration are relatively uncommon. However, inadvertent rapid infusion of intravenous fat emulsion (IVFE) is an inherent risk when fats are infused separately from the dextrose-amino acid solution. CASE REPORT: Extremely preterm infant, born at 25 weeks and 6 days of gestational age weighing 920 g, who inadvertently received a massive overdose of IVFE due to a device failure. He developed lethargy, apnea, metabolic acidosis and hemodynamic instability requiring mechanical ventilation and inotropic support. Despite discontinuation of IVFE and supportive care, clinical course and metabolic acidosis worsened, so a double-volume exchange transfusion was performed. The procedure was well tolerated, without complications. Serum triglyceride concentration as well as other laboratory data normalized immediately after the exchange transfusion. The patient was extubated to continuous positive airway pressure and inotropic support was discontinued 24 hours after the procedure. He was discharged home at 40 weeks of corrected age with normal magnetic resonance imaging and neurological examination. CONCLUSION: In cases of profound, symptomatic hypertriglyceridemia due to lipid overdose, double-volume exchange transfusion should be considered, even in extremely preterm infants.

Drought responses, phenotypic plasticity and survival of Mediterranean species in two different microclimatic sites.

Climate models predict a further drying of the Mediterranean summer. One way for plant species to persist during such climate changes is through acclimation. Here, we determine the extent to which trait plasticity in response to drought differs between species and between sites, and address the question whether there is a trade-off between drought survival and phenotypic plasticity. Throughout the summer we measured physiological traits (photosynthesis - Amax , stomatal conductance - gs , transpiration - E, leaf water potential - ψl) and structural traits (specific leaf area - SLA, leaf density - LD, leaf dry matter content - LDMC, leaf relative water content - LRWC) of leaves of eight woody species in two sites with slightly different microclimate (north- versus south-facing slopes) in southern Spain. Plant recovery and survival was estimated after the summer drought period. We found high trait variability between species. In most variables, phenotypic plasticity was lower in the drier site. Phenotypic plasticity of SLA and LDMC correlated negatively with drought survival, which suggests a trade-off between them. On the other hand, high phenotypic plasticity of SLA and LDMC was positively related to traits associated with rapid recovery and growth after the drought period. Although phenotypic plasticity is generally seen as favourable during stress conditions, here it seemed beneficial for favourable conditions. We propose that in environments with fluctuating drought periods there can be a trade-off between drought survival and growth during favourable conditions. When climate become drier, species with high drought survival but low phenotypic plasticity might be selected for.