Author Correction: Salt concentration and charging velocity determine ion charge storage mechanism in nanoporous supercapacitors.

The original version of this Article contained an error in the Acknowledgements, which incorrectly omitted from the end the following: 'The research leading to these results has received funding from the European Community's Horizon 2020 Framework Programme under grant agreement nº 730872.' This has been corrected in both the PDF and HTML versions of the Article.

Salt concentration and charging velocity determine ion charge storage mechanism in nanoporous supercapacitors.

A fundamental understanding of ion charge storage in nanoporous electrodes is essential to improve the performance of supercapacitors or devices for capacitive desalination. Here, we employ in situ X-ray transmission measurements on activated carbon supercapacitors to study ion concentration changes during electrochemical operation. Whereas counter-ion adsorption was found to dominate at small electrolyte salt concentrations and slow cycling speed, ion replacement prevails for high molar concentrations and/or fast cycling. Chronoamperometry measurements reveal two distinct time regimes of ion concentration changes. In the first regime the supercapacitor is charged, and counter- and co-ion concentration changes align with ion replacement and partially co-ion expulsion. In the second regime, the electrode charge remains constant, but the total ion concentration increases. We conclude that the initial fast charge neutralization in nanoporous supercapacitor electrodes leads to a non-equilibrium ion configuration. The subsequent, charge-neutral equilibration slowly increases the total ion concentration towards counter-ion adsorption.

Towards in situ determination of 3D strain and reorientation in the interpenetrating nanofibre networks of cuticle.

Determining the in situ 3D nano- and microscale strain and reorientation fields in hierarchical nanocomposite materials is technically very challenging. Such a determination is important to understand the mechanisms enabling their functional optimization. An example of functional specialization to high dynamic mechanical resistance is the crustacean stomatopod cuticle. Here we develop a new 3D X-ray nanostrain reconstruction method combining analytical modelling of the diffraction signal, fibre-composite theory and in situ deformation, to determine the hitherto unknown nano- and microscale deformation mechanisms in stomatopod tergite cuticle. Stomatopod cuticle at the nanoscale consists of mineralized chitin fibres and calcified protein matrix, which form (at the microscale) plywood (Bouligand) layers with interpenetrating pore-canal fibres. We uncover anisotropic deformation patterns inside Bouligand lamellae, accompanied by load-induced fibre reorientation and pore-canal fibre compression. Lamination theory was used to decouple in-plane fibre reorientation from diffraction intensity changes induced by 3D lamellae tilting. Our method enables separation of deformation dynamics at multiple hierarchical levels, a critical consideration in the cooperative mechanics characteristic of biological and bioinspired materials. The nanostrain reconstruction technique is general, depending only on molecular-level fibre symmetry and can be applied to the in situ dynamics of advanced nanostructured materials with 3D hierarchical design.

A carbon nanopore model to quantify structure and kinetics of ion electrosorption with in situ small-angle X-ray scattering.

A new carbon model derived from in situ small-angle X-ray scattering (SAXS) enables a quantitative description of the voltage-dependent arrangement and transport of ions within the nanopores of carbon-based electric double-layer capacitors. In the first step, ex situ SAXS data for nanoporous carbon-based electrodes are used to generate a three-dimensional real-space model of the nanopore structure using the concept of Gaussian random fields. This pore model is used to derive important pore size characteristics, which are cross-validated against the corresponding values from gas sorption analysis. In the second step, simulated in situ SAXS patterns are generated after filling the model pore structure with an aqueous electrolyte and rearranging the ions via a Monte Carlo simulation for different applied electrical potentials. These simulated SAXS patterns are compared with in situ SAXS patterns recorded during voltage cycling. Experiments with different cyclic voltammetry scan rates revealed a systematic time lag between ion transport processes and the applied voltage signal. Global transport into and out of nanopores was found to be faster than the accommodation of the local equilibrium arrangement in favor of sites with a high degree of confinement.

Uncovering three-dimensional gradients in fibrillar orientation in an impact-resistant biological armour.

The complex hierarchical structure in biological and synthetic fibrous nanocomposites entails considerable difficulties in the interpretation of the crystallographic texture from diffraction data. Here, we present a novel reconstruction method to obtain the 3D distribution of fibres in such systems. An analytical expression is derived for the diffraction intensity from fibres, explaining the azimuthal intensity distribution in terms of the angles of the three dimensional fibre orientation distributions. The telson of stomatopod (mantis shrimp) serves as an example of natural biological armour whose high impact resistance property is believed to arise from the hierarchical organization of alpha chitin nanofibrils into fibres and twisted plywood (Bouligand) structures at the sub-micron and micron scale. Synchrotron microfocus scanning X-ray diffraction data on stomatopod telson were used as a test case to map the 3D fibre orientation across the entire tissue section. The method is applicable to a range of biological and biomimetic structures with graded 3D fibre texture at the sub-micron and micron length scales.

Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica? / Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis

Objetivo. Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. Método. Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. Resultados. En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). Conclusiones. Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria

Objective. To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. Methods. Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. Results. During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). Conclusions. Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay

[Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis]. / Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica?

OBJECTIVE: To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. METHODS: Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. RESULTS: During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). CONCLUSIONS: Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay.

OBJETIVO: Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. METODO: Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. RESULTADOS: En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). CONCLUSIONES: Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria.

[Conservative management of retained central venous catheters]. / Manejo conservador de los catéteres venosos centrales retenidos.

BACKGROUND: Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed. MATERIAL AND METHODS: We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs. RESULTS: An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-. CONCLUSIONS: The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients.

Repeated sorption of water in SBA-15 investigated by means of in situ small-angle x-ray scattering.

The effect of repeated cycles of water adsorption/desorption on the structural stability of ordered mesoporous silica SBA-15 is studied by small-angle x-ray scattering (SAXS). In situ sorption measurements are conducted using a custom-built sorption apparatus in connection with a laboratory SAXS setup. Two striking irreversible changes are observed in the sorption isotherms as derived from the integrated SAXS intensity. First, the capillary condensation pressure shifts progressively to lower relative pressure values with increasing number of sorption cycles. This effect is attributed to chemisorption of water at the silica walls, resulting in a change of the fluid-wall interaction. Second, the sorption cycles do not close completely at vanishing vapour pressure, suggesting that progressively more water remains trapped within the porous material after each cycle. This effect is interpreted to be the result of an irreversible collapse of parts of mesopores, originating from pore wall deformation due to the large Laplace pressure of water acting on the pore walls at capillary condensation and capillary evaporation.

Manejo conservador de los catéteres venosos centrales retenidos / Conservative management of retained central venous catheters

Introducción. La retirada de los catéteres venosos centrales (CVCs) suele ser un procedimiento quirúrgico sencillo. Sin embargo, en algunos casos el catéter se encuentra englobado en la pared del vaso y su extracción no es posible si no se realizan intervenciones más invasivas. Material y métodos. Se ha realizado un estudio retrospectivo desde 2003 a 2011 de los pacientes a los que se les ha retirado un CVC y de los factores que podrían haber intervenido en la imposibilidad de retirada. Se han comparado los tipos de catéter, la zona de inserción, el tiempo transcurrido desde la inserción a la retirada, el diagnóstico principal y el tipo de medicación. Además, se ha realizado un seguimiento clínico y mediante pruebas de imagen en los pacientes con CVCs retenidos. Resultados. Se realizaron 174 intervenciones. En 5 casos no se pudo extraer el CVC. Estos 5 casos fueron pacientes diagnosticados de LLA B y llevaron tratamiento quimioterápico idéntico. Además, en el momento de su retirada, todos llevaban el CVC por un periodo mayor a 2 años (de 29 a 84 meses). En los pacientes con fragmentos retenidos no se produjo ninguna complicación derivada de esta condición. El periodo medio de seguimiento fue de 36 meses (máximo de 48 meses).Conclusiones. Las posibles complicaciones derivadas de la presencia de fragmentos de los CVCs retenidos son la infección, la trombosis venosa y la migración del catéter. En base a nuestros resultados, planteamos que se podría considerar en estos pacientes una actitud expectante y un manejo conservador (AU)

Background. Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed. Material and methods. We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs. Results. An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-.Conclusions. The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients (AU)

Density minimum of confined water at low temperatures: a combined study by small-angle scattering of X-rays and neutrons.

A simple explanation is given for the low-temperature density minimum of water confined within cylindrical pores of ordered nanoporous materials of different pore size. The experimental evidence is based on combined data from in-situ small-angle scattering of X-rays (SAXS) and neutrons (SANS), corroborated by additional wide-angle X-ray scattering (WAXS). The combined scattering data cannot be described by a homogeneous density distribution of water within the pores, as was originally suggested from SANS data alone. A two-step density model reveals a wall layer covering approximately two layers of water molecules with higher density than the residual core water in the central part of the pores. The temperature-induced changes of the scattering signal from both X-rays and neutrons are consistent with a minimum of the average water density. We show that the temperature at which this minimum occurs depends monotonically on the pore size. Therefore we attribute this minimum to a liquid-solid transition of water influenced by confinement. For water confined in the smallest pores of only 2 nm in diameter, the density minimum is explained in terms of a structural transition of the surface water layer closest to the hydrophilic pore walls.

Direct regulation of microRNA biogenesis and expression by estrogen receptor beta in hormone-responsive breast cancer.

Estrogen effects on mammary epithelial and breast cancer (BC) cells are mediated by the nuclear receptors ERα and ERß, transcription factors that display functional antagonism with each other, with ERß acting as oncosuppressor and interfering with the effects of ERα on cell proliferation, tumor promotion and progression. Indeed, hormone-responsive, ERα+ BC cells often lack ERß, which when present associates with a less aggressive clinical phenotype of the disease. Recent evidences point to a significant role of microRNAs (miRNAs) in BC, where specific miRNA expression profiles associate with distinct clinical and biological phenotypes of the lesion. Considering the possibility that ERß might influence BC cell behavior via miRNAs, we compared miRNome expression in ERß+ vs ERß- hormone-responsive BC cells and found a widespread effect of this ER subtype on the expression pattern of these non-coding RNAs. More importantly, the expression pattern of 67 miRNAs, including 10 regulated by ERß in BC cells, clearly distinguishes ERß+, node-negative, from ERß-, metastatic, mammary tumors. Molecular dissection of miRNA biogenesis revealed multiple mechanisms for direct regulation of this process by ERß+ in BC cell nuclei. In particular, ERß downregulates miR-30a by binding to two specific sites proximal to the gene and thereby inhibiting pri-miR synthesis. On the other hand, the receptor promotes miR-23b, -27b and 24-1 accumulation in the cell by binding in close proximity of the corresponding gene cluster and preventing in situ the inhibitory effects of ERα on pri-miR maturation by the p68/DDX5-Drosha microprocessor complex. These results indicate that cell autonomous regulation of miRNA expression is part of the mechanism of action of ERß in BC cells and could contribute to establishment or maintenance of a less aggressive tumor phenotype mediated by this nuclear receptor.

Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome dedumping tras cirugía de Nissen laparoscópico / Modifications of the glucose curves and gastric voiding of children with dumping syndrome after laparoscopic nissen surgery

Introducción. Se ha asistido a una importante evolución del tratamiento quirúrgico en los últimos años por la generalización progresiva de la cirugía laparoscópica. Todas las técnicas disponibles pueden hacerse laparoscópicamente con similares resultados a los de la cirugía abierta. En 1978, Villet et al. describieron el síndrome de Dumping (SD) como una complicación frecuente de la fundoplicatura de Nissen. EL SD es un complejo de signos y síntomas que aparecen poco después de la cirugía, incluyendo dolor abdominal, palidez, sudoración, diarrea, náuseas, palidez, incluso pérdida de peso. Los síntomas se pueden diferenciar en dumping precoz, que ocurre entre 30 y 60 minutos después de la comida, y tardío, que ocurre entre 90-240 min. del período postprandial. Material y métodos. Se han estudiado 8 pacientes (3 niños y 5niñas) de edades comprendidas entre 3 y 12 años (media de 9 años) diagnosticados de síndrome de dumping tras la realización de Nissen-Rosseti laparoscópico. A todos ellos se les realizó un estudio de vaciadogástrico por gammagrafía tras administración de un volumen de leche adecuado a su peso marcado con Tc99 DTPA y Test de sobrecarga ora (..) (AU)

Introduction. There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet etal. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period (..) (AU)

Moisture changes in the plant cell wall force cellulose crystallites to deform.

Nano-crystallite deformation of cellulose microfibrils in the secondary cell wall layer of spruce wood tracheids was observed during de- and rehydration experiments below the fibre saturation point. A quantitative analysis of the (004), (200) and the (110)/(11 0) doublet X-ray diffraction peaks revealed longitudinal contraction, lateral expansion and changes in the monoclinic angle of the cellulose unit cell during drying of wood fibres. Experiments on unfixed samples as well as the simultaneous application of mechanical tensile and dehydration stress to samples hold at constant length showed two deformation mechanisms of different nature and magnitude. The first mechanism depends on the relative wood moisture content and the second one on the macroscopic tensile stress. These findings imply a new perspective on the role of water adsorption perceiving a hydration-induced structural change of cellulose crystal structure as a major driving force for deformation.

[Modifications of the glucose curves and gastric voiding of children with Dumping syndrome after laparoscopic Nissen surgery]. / Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome de dumping tras cirugía de nissen laparoscópico.

INTRODUCTION: There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet et al. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period. MATERIAL AND METHODS: A total of 8 patients (3 boys and 5 girls) have been studied. Their ages ranged from 3 to 12 years (mean 9 years), and they were diagnosed of dumping syndrome after performing the laparoscopic Nissen-Rossetti. All underwent a gastric voiding study by scintigraphy after administration of a volume of milk adjusted to their weight labeled with 99Tc-DTPA and oral glucose overload test with 1.75 g/kg of glucose, determining the baseline glycemia and every 30 minutes post-intake, at 0, 30 and 90 minutes. Insulin was also measured to obtain the glucose/insulin ratio. This study was conducted for all patient diagnosed of dumping syndrome before and after laparoscopic Nissen-Rossetti surgery. RESULTS: The following results were obtained: Glucose Curve: 1. Maximum glycemia. PreNissen. The mean of the maximum glycemia values before surgery was 133.9+/-32.11 mg/dl. Post-Nissen. Mean maximum glycemias after surgery was 208.5 +/- 45.07 mg/dl with a range of 147-276 mg/dl. These differences of maximum glycemia were clearly significant with a p <0.002. Minimum glycemia. The mean value of the minimum glycemias after the surgery, compared with the previous value, did not show significant differences: 62.6+/- 11.51 mg/dl versus 71.8 +/- 28.04 mg/dl. Glucose/insulin ratio. The hyperinsulinism values after the intervention studied by means of the glucose/insulin ratio were abnormal in 70.5% (defined as ratio under 3). The mean value was also characteristic of hyperinsulinism (2.3 +/- 1.62). The mean value of the coefficient prior to the surgery was 4.6 with a deviation of 3.04, the differences not being statistically significant with a p= 0.097. Measurement of gastric voiding: The T1/2 (decay) value in post-Nissen patients was significantly lower than in pre-Nissen patients. The postsurgical mean and standard deviation was 29.74 +/- 7.92 min, while in the presurgical group, the mean and standard deviation was 73.75 +/- 28.34 min with p< 0.011; statistically significant. CONCLUSIONS: From the values obtained, we can state that a significant increase in maximum glycemia has been found in all children after surgery who were diagnosed of dumping syndrome and a significant decrease in the mean time of gastric voiding and therefore an increase in the acceleration of gastric voiding after the performance of the Nissen regarding the previous values. The dumping syndrome is a frequent side effect that we must keep in mind in patients who have been previously operated for anti-reflex surgery, the symptoms being greater in most of the transitory cases. Furthermore, it is important to keep in mind because it has an easy treatment that reverts the symptoms in a short time

Duplicaciones duodenales infectadas como causa de abdomen agudo / Acute abdomen caused by infected duodenal duplication

Las duplicaciones quísticas duodenales infectadas son lesiones congénitas muy raras. Presentamos dos casos clínicos de duplicaciones duodenales complicadas por infección que motivaron dolor abdominal agudo. Revisamos la literatura y discutimos las posibilidades diagnósticas y modalidades de tratamiento propuestas para esta inusual patología (AU)

Infected cystic duplications of the duodenum are unusual lesions. We report two cases of duodenal duplications complicated by infection. The literature is reviewed, and the diagnostic modalities and management options for this unusual pathology are discussed (AU)

[Parotid gland's tumors in children]. / Tumores de parótida en niños.

The tumors of the salivary glands are infrequent in children, and parotid gland is involved in 80% of them. When a salivary gland tumor is present, the chance of malignancy is greater in the child than in the adult. We reviewed 8 cases identified in patients aged 14 years and younger in our hospital, analyzing its antecedents, signs and symptoms, histological features, diagnosis, treatment and evolution. All the patients displayed preauricular painless, non-inflammatory and slow-growing masses to an age between 10 months and 14 years. Four or them were pleomorphic adenomas, two haemangiomas, one epidermal cysts and one myoepithelial carcinoma. We emphasize the exceptional nature of the carcinoma for its rareness and for the high degree of malignancy expressed. We made a fine needle aspiration biopsy in four cases but they were conclusive only in three. All were treated by surgical resection of the tumour except for the myoepithelial carcinoma and the recurrent pleomorphic adenoma that were treated by total parotidectomy. The malignant tumours of the parotid gland are clinically indistinguishable of the benign ones, thus when any palpable mass appears in the zone of the parotid gland, an accurate diagnosis should be made without delay. The treatment of choice is the surgical excision with wide margins, being other adjuvant treatments less useful to this age than in the adult age.

Tumores de parótida en niños / Parotid gland´s tumors in children

Los tumores de glándulas salivares son infrecuentes en niños, afectando el 80% a la parótida y presentando una mayor proporción de malignidad que en adultos. Revisamos 8 casos en menores de 15 años tratados en nuestro hospital, atendiendo a sus antecedentes, expresividad clínica, tipo tumoral, diagnóstico, tratamiento empleado y seguimiento. Todos debutaron con masa parotídea asintomática y de crecimiento lento a una edad entre 10 meses y 14 años. Cuatro fueron adenomas pleomorfos, dos angiomas capilares, un quiste epidérmico y un carcinomamioepitelial. Destacamos la excepcionalidad del carcinoma por su rareza y por el alto grado de malignidad expresado. Se realizó punción-aspiración con aguja fina en cuatro pacientes, siendo concluyente sólo en tres. En todos se practicó tumorectomía, excepto en el carcinoma mioepitelialy en uno de los adenomas pleomorfos recidivado, en los que se realizó parotidectomía total. Los tumores malignos de la parótida son clínicamente indistinguibles de los benignos, por lo que ante toda masa palpable en la zona parotídea deberíamos establecer un diagnóstico sin demora. El tratamiento de elección es la exéresis quirúrgica con márgenes amplios, siendo otros tratamientos coadyuvantes poco útiles en niños (AU)

The tumors of the salivary glands are infrequent in children, and parotid gland is involved in 80% of them. When a salivary gland tumor is present, the chance of malignancy is greater in the child than in the adult. We reviewed 8 cases identified in patients aged 14 years and younger in our hospital, analyzing its antecedents, signs and symptoms, histological features, diagnosis, treatment and evolution. All the patients displayed preauricular painless, non-inflammatory and slow-growing masses to an age between 10 months and 14 years. Four of them were pleomorphic adenomas, two haemangiomas, one epidermal cysts and onemyoepithelial carcinoma. We emphasize the exceptional nature of the carcinoma for its rareness and for the high degree of malignancy expressed. We made a fine needle aspiration biopsy in four cases but they were conclusive only in three. All were treated by surgical resection of the tumour except for the myoepithelial carcinoma and the recurrent pleomorphic adenoma that were treated by total parotidectomy. The malignant tumours of the parotid gland are clinically indistinguishable of the benign ones, thus when any palpable mass appears in the zone of the parotid gland, an accurate diagnosis should be made without delay. The treatment of choice is the surgical excision with wide margins, being other adjuvant treatments less useful to this age that in the adult age (AU)

[Effectiveness of high pressure balloon dilatation in the treatment of postsurgical strictures of urinary tract in children]. / Efectividad de la dilatación retrógrada con balón de alta presi6ón de estenosis posquirúrgicas de la vía urinaria en la edad pediátrica.

INTRODUCTION: Endoscopic dilatation using a high pressure balloon is a widely used technique for the treatment of strictures of the urinary tract secondary to surgery in adult patient. Several studies have evaluated its usage in the treatment of primary and secondary strictures of the urinary tract of child with a disparity of results. GOAL: Evaluate Effectiveness and Safetiness of high pressure balloon dilatation and double "J" implantation in the treatment of postsurgical strictures of urinary tract in children. PATIENTS AND METHODS: Retrospective study of endoscopic dilatation of secondary to surgery strictures performed in our unit during the last past 18 months. Demographical data, surgical records, symptoms, renal function, dilatation technique, postsurgery complications and ultrasonography and isotopic data (pre and post dilatation) were evaluated. RESULTS: Six children, aged 13 months-9 years (media = 4.3 years) were treated in our unit. Four presented ureteropelvic junction obstruction (UPO) after Anderson-Hynes pyeloplasty and 2 vesico-ureteral junction stenosis (VUO) in 3 reimplants units, (one with Cohen tecnique and two with Politano tecnique). All 6 patients showed dilatation of urinary tract and isotopic diuretic renogram prior to dilatation that showed for all cases an obstructed pattern with T1/2 > 20 minutes. Two of the children presented lumbar pain and one of them had suffered an urine infection. Time interval between surgery and dilatation varied between 23 and 118 months. Surgical technique used for all cases was high pressure retrograde balloon dilatation and placement of double "J" before retrograde pielography. In all patients a double J catheter was implanted and left in place for 4 to 9 weeks. Technical inability to place the catheter after the expansion forced to the accomplishment of a percutaneus nephrostomy echo guided in one case. One of the children showed hematuria up to 7 days after dilatation procedure. Hospilatization varied between 24 hours to 10 days being (moda = 3 days). The patient that needed nephrostomy underwent ulterior sucessful dilatation 4 months after first procedure. The 2 children presenting vesico-ureteral junction stricture underwent calibration 10 and 12 months after dilatation, showing both good caliber. Diuretic renogram curve Improvement was confirmed for all patients but one of the VUO children that showed renal function deterioration after dilatation procedure. Lumbar pain disappear for both 2 children that had referred it. CONCLUSIONS: Endoscopic dilatation of strictures of urinary tract using balloon in children that were previously sommeted to surgical interventions is technically available and shows good results in the short-medium term with low index of post procedural complications, so, it should be considered as initial treatment for these patients.

Efectividad de la dilatación retrógrada con balón de alta presión de estenosis postquirúrgicas de la vía urinaria en la edad pediátrica / Effectiveness of high pressure balloon dilatation in the treatment of postsurgical strictures of urinary tract in children

Introducción. La dilatación endoscópica con balón de alta presión es una técnica comúnmente utilizada en el tratamiento de estenosis de la vía urinaria secundarias a cirugía en el paciente adulto. Diversos autores han evaluado su uso en el tratamiento de estenosis primarias y secundarias de la vía urinaria en el niño, comunicando resultados dispares. Objetivos. Evaluar la efectividad y seguridad de la dilatación con balón de alta presión y colocación de doble “J” en el manejo de niños con estenosis postquirúrgica de la vía urinaria. Pacientes y Métodos. Se realizó un estudio retrospectivo de las dilataciones endoscópicas de estenosis postquirúrgicas realizadas en nuestra unidad en los últimos 18 meses. Se evaluaron datos demográficos, antecedentes quirúrgicos, presencia de síntomas, función renal, procedimiento utilizado en la dilatación, complicaciones tras el procedimiento, y datos ecográficos e isotópicos pre y post dilatación. Resultados. Se trataron 6 niños con edades comprendidas entre los 13 meses y los 9 años (media 4.3 años), 4 presentaban estenosis de la unión pieloureteral (EPU) tras pieloplastia de Anderson-Hynes y 2 estenosis a nivel de la unión vesicoureteral (EUV) en 3 unidades reimplantadas, un reimplante tipo Cohen y dos según técnica de Politano. Los pacientes presentaban dilatación de la vía urinaria y fueron sometidos a un renograma diurético previo a la dilatación que demostró en todos un patrón obstructivo con T1/2 mayor de 20 minutos. Dos de los niños referían dolor lumbar y uno había tenido una infección de orina. El intervalo entre la cirugía y la dilatación endoscópica osciló entre los 23 y los 118 meses. La técnica quirúrgica fue en todos los casos dilatación retrógrada con balón tras pielografía retrógrada intraoperatoria. En todos los pacientes se colocó un catéter doble “J” que se mantuvo entre 4 y 9 semanas, salvo en un niño donde la imposibilidad técnica de colocar el catéter tras la dilatación obligó a la realización de una nefrostomía percutánea eco-guiada. Una de las niñas sometida a dilatación de la unión pieloureteral presentó hematuria moderada hasta 7 días después del procedimiento. La estancia postdilatación osciló entre las 24 horas y los 10 días con una moda de 3 días. El paciente que precisó colocación de nefrostomía se sometió a una segunda dilatación con éxito a los 4 meses de la primera. Los dos niños con EUV fueron sometidos a calibración de la zona a los 10 y 12 meses de la dilatación comprobándose en ambos buen calibre. Se produjeron cambios en el diámetro AP de la pelvis en uno de los pacientes tratados de EPU y en el diámetro del uréter retrovesical en uno de los pacientes tratados de EUV. Se constató mejoría de la curva de eliminación en todos los pacientes salvo en uno de los niños con EUV que presentó un empeoramiento de la función renal diferencial del riñón afecto tras la dilatación. El dolor lumbar desapareció en los dos niños que lo padecían. Conclusiones. La dilatación endoscópica con balón de estenosis en la vía urinaria en niños operados previamente es técnicamente accesible y ofrece buenos resultados a corto-medio plazo con un bajo índice de complicaciones por lo que debe ser considerada como una forma inicial de tratamiento en este grupo de pacientes (AU)

Introduction. Endoscopic dilatation using a high pressure balloon is a widely used technique for the treatment of strictures of the urinary tract secondary to surgery in adult patient. Several studies have evaluated its usage in the treatment of primary and secondary strictures of the urinary tract of child with a disparity of results. Goal. Evaluate Effectiveness and Safetiness of high pressure balloon dilatation and double "J” implantation in the treatment of postsurgical strictures of urinary tract in children. Patients and methods. Retrospective study of endoscopic dilatation of secondary to surgery strictures performed in our unit during the last past 18 months. Demographical data, surgical records, symptoms, renal function, dilatation technique, postsurgery complications and ultrasonography and isotopic data (pre and post dilatation) were evaluated. Results. Six children, aged 13 months-9 years (media=4.3 years) were treated in our unit. Four presented ureteropelvic junction obstruction (UPO) after Anderson- Hynes pyeloplasty and 2 vesico-ureteral junction stenosis (VUO) in 3 reimplants units, (one with Cohen tecnique and two with Politano tecnique). All 6 patients showed dilatation of urinary tract and isotopic diuretic renogram prior to dilatation that showed for all cases an obstructed pattern with T1/2 > 20 minutes. Two of the children presented lumbar pain and one of them had suffered an urine infection. Time interval between surgery and dilatation varied between 23 and 118 months. Surgical technique used for all cases was high pressure retrograde balloon dilatation and placement of double "J" before retrograde pielography. In all patients a double J catheter was implanted and left in place for 4 to 9 weeks. Technical inability to place the catheter after the expansion forced to the accomplishment of a percutaneus nephrostomy echo guided in one case. One of the children showed hematuria up to 7 days after dilatation procedure. Hospilatization varied between 24 hours to 10 days being (moda=3 days). The patient that needed nephrostomy underwent ulterior sucessful dilatation 4 months after first procedure. The 2 children presenting vesico-ureteral junction stricture underwent calibration 10 and 12 months after dilatation, showing both good caliber. Diuretic renogram curve Improvement was confirmed for all patients but one of the VUO children that showed renal function deterioration after dilatation procedure. Lumbar pain disappear for both 2 children that had referred it. Conclusions. Endoscopic dilatation of strictures of urinary tract using balloon in children that were previously sommeted to surgical interventions is technically available and shows good results in the short-medium term with low index of post procedural complications, so, it should be considered as initial treatment for these patients (AU)