A model for predicting court decisions on child custody.

Awarding joint or sole custody is of crucial importance for the lives of both the child and the parents. This paper first models the factors explaining a court's decision to grant child custody and later tests the predictive capacity of the proposed model. We conducted an empirical study using data from 1,884 court rulings, identifying and labeling factual elements, legal principles, and other relevant information. We developed a neural network model that includes eight factual findings, such as the relationship between the parents and their economic resources, the child's opinion, and the psychological report on the type of custody. We performed a temporal validation using cases later in time than those in the training sample for prediction. Our system predicted the court's decisions with an accuracy exceeding 85%. We obtained easy-to-apply decision rules with the decision tree technique. The paper contributes by identifying the factors that best predict joint custody, which is useful for parents, lawyers, and prosecutors. Parents would do well to know these findings before venturing into a courtroom.

Bronchoscopic sclerosis of post-resectional bronchial fistulas.

BACKGROUND: Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS: Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS: Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS: Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.

Neumotórax y hernia diafragmática congénita, una asociación infrecuente / Pneumothorax and Congenital Diaphragmatic Hernia: An Unusual Combination

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[Intrahepatic cholangiocarcinoma on a hydatidic cyst]. / Colangiocarcinoma intrahepático sobre quiste hidatídico.

Cholangiocarcinomas are malignant tumors arising from the bile ducts. One of the factors associated with the development of malignancy is parasitic infections by helminths trematodes that cause liver fluke infections. This association is very common in south-east Asia, but association with liver hydatidosis has not been reported in the scientific literature. We report a case in which these two diseases were associated and required non-radical surgical treatment, since radiological findings were not suspicious for these entities.

Colangiocarcinoma intrahepático sobre quiste hidatídico / Intrahepatic cholangiocarcinoma on a hydatidic cyst

Los colangiocarcinomas son tumores malignos que se originan en los conductos biliares. Uno de los factores asociados al desarrollo neoplásico es las infecciones parasitarias por helmintos trematodos que causan una inflamación crónica de esos conductos. Esta relación es muy común en el sudeste asiático, pero en la literatura científica no se los ha relacionado con la hidatidosis hepática. Nosotros presentamos un caso clínico en el que estas dos entidades se presentan juntas y motivaron un tratamiento quirúrgico no radical, dado que no se sospechó en el estudio radiológico (AU)

Cholangiocarcinomas are malignant tumors arising from the bile ducts. One of the factors associated with the development of malignancy is parasitic infections by helminths trematodes that cause liver fluke infections. This association is very common in south-east Asia, but association with liver hydatidosis has not been reported in the scientific literature. We report a case in which these two diseases were associated and required non-radical surgical treatment, since radiological findings were not suspicious for these entities (AU)

Quiste epidermoide esplénico gigante / Giant epidermoid splenic cyst

Los quistes epidermoides esplénicos son tumoraciones benignas muy poco frecuentes. El tratamiento de éstas ha evolucionado con el tiempo y tiende a ser cada vez menos agresivo y más conservador. Nosotros presentamos a través del caso clínico de una mujer joven con un quiste epidermoide gigante, que requirió la realización de una esplenectomía total vía abierta, una revisión de la bibliografía sobre las tumoraciones congénitas benignas de bazo (AU)

Giant epidermoid splenic cysts are rare benign tumors. Their treatment is becoming increasingly less aggressive and more conservative. We report the case of a young woman with a giant epidermoid cyst, which required open total splenectomy, and review the literature on benign congenital tumors of the spleen (AU)

[Giant epidermoid splenic cyst]. / Quiste epidermoide esplénico gigante.

Giant epidermoid splenic cysts are rare benign tumors. Their treatment is becoming increasingly less aggressive and more conservative. We report the case of a young woman with a giant epidermoid cyst, which required open total splenectomy, and review the literature on benign congenital tumors of the spleen.

Biopsia selectiva del ganglio centinela en el tratamiento del melanoma / Sentinel lymph node biopsy in the treatment of melanoma

Introducción. El objetivo del presente estudio es valorar los resultados obtenidos con la aplicación de la técnica de biopsia selectiva de ganglio centinela (BSGC) en el tratamiento del melanoma. Pacientes y método. Estudio clínico prospectivo. Se practicó BSGC a los melanomas primarios con espesor de Breslow mayor de 1 mm, o factores de mal pronóstico asociados. Desde marzo de 2000 a diciembre de 2001 se valoraron 53 melanomas. Resultados. Se realizó BSGC en 37 casos, el 69,8 por ciento de los melanomas. Se obtuvieron 36 mapas linfáticos (97,3 por ciento de las gammagrafías efectuadas) y se practicaron 45 biopsias ganglionares, debido a que en 9 casos (25 por ciento) se obtuvo drenaje a dos territorios. Se obtuvieron metástasis en el ganglio centinela en tres pacientes (8,3 por ciento). En estos casos se realizó linfadenectomía regional, en dos de ellos se halló afección en el resto de la cadena, y en el tercer caso el centinela era el único ganglio afectado. Conclusiones. El 8,3 por ciento de los pacientes a los que se detectó afección metastásica ganglionar se benefició del tratamiento complementario, lo que unido a la casi nula morbilidad hace que la BSGC sea una técnica que debería ser estandarizada en todos los centros donde sea realizable y que atiendan esta patología. (AU)

Volvulo gástrico: distintas formas de presentación / Gastric volvulus: different presentations

El vólvulo gástrico es una entidad poco frecuente y con múltiples formas de presentación que dificultan su diagnóstico. Presentamos distintas expresiones clínicas de vólvulo gástrico y diferentes opciones de tratamiento tanto en el cuadro crónico como en el agudo, también las dificultades que existen en el diagnóstico y como pueden condicionar la actuación terapéutica