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IntroductionObesity is a pathological state that involves the dysregulation of different metabolic pathways and adipose tissue cells, constituting a risk factor for the development of other diseases. Bariatric surgery is the most effective treatment. The study of the behavior of pollutants in situations of extreme weight loss can provide biomonitoring information and tools to manage diseases of environmental etiology.AimTo determine the prevalence of serum persistent and non-persistent pollutants in obese patients subjected to bariatric surgery and analyze the impact of sociodemographic variables on these changes.MethodsGC-MS/MS and UHPLC-MS/MS were utilized to determine the detection rates and concentrations of 353 compounds, including persistent organic pollutants (POPs), pesticides, pharmaceuticals, and rodenticide, in serum samples of 59 obese patients before and after undergoing bariatric surgery.ResultsDetection rates of p,p’-DDE, HCB, β-HCH, naphthalene, phenanthrene and PCB congeners 138, 153 and 180 significantly increased due to surgery-induced weight loss. Serum levels of p,p’-DDE, PCB-138, PCB-153 and PCB-180 also increased after surgery. Correlations between naphthalene levels, weight loss, variation of total lipids and time after surgery were found. Additionally, correlations were observed between concentrations of PCB-138 and weight loss, and between phenanthrene levels and reduction of total lipids. No statistically significant differences were observed for other groups of contaminants, pharmaceuticals and other chemicals included in the quantification methods.ConclusionsIncrement of POPs was observed after bariatric surgery. Serum concentrations of POPs after surgery were influenced by adiposity-related variables. Although biomonitoring studies show a decreasing tendency of exposure, rapid weight loss leads to an increase of circulating POPs. Further research on the interplay between adipose tissue, POPs and peripheral organs is required.

Abstract Background The objective of this study was to analyze the characteristics of patients diagnosed with metaplastic carcinoma of the breast with squamous differentiation and to identify the particular clinical and histological characteristics that need to be taken into account in this type of tumors. Case presentation Retrospective observational study of two patients managed at our hospital between 2014 and 2020 (15 months mean follow-up), plus all cases published in the last 7 years (8 patients). Thus, a total of 10 cases were analyzed, all with less than 2 years mean global survival. Studied variables were: age, medical background, tumor size, axillary involvement, radiological characteristics, surgical approach, complementary treatments, histologic characteristics, and progression of the disease. In 50% of cases, the disease appeared as a palpable mass of rapid growth, associated with axillary infiltration; 80% of the tumors were triple negative; 30% of them progressed to distant metastatic disease in 30%. Conclusions This unusual carcinoma requires a complex multidisciplinary treatment. Its prognosis is unfavorable due to its high local aggressiveness, with rapid progression and appearance of metastatic disease. The predominance of different histological components may determine the response to medical treatments.

Summary: Background: Assessment of local relapse in patients treated with surgery for breast cancer. Materials and methods: This observational study included 673 patients treated with surgery for breast cancer between 2005 and 2010, who were monitored for a 7-year minimum follow-up period. The study was concluded on 2017 and yielded a total of 31 cases of local relapse. Results: 4.6% of patients presented local relapse, most of them during the first 3 years of follow-up; 45% of patients with local relapse subsequently presented the disease at distant points. The association between the occurrence of local relapse and later onset of the disease at distant points was significant. The Kaplan–Meier survival analysis revealed that negative results for the presence of progesterone receptors, the use of neoadjuvant chemotherapy and the presence of the disease at distant points were factors that significantly influenced patient survival. Conclusions: Almost half of the patients suffering relapse subsequently present the disease at distant points. Certain factors increase the aggressiveness of the disease, predict higher risk of relapse and determine its prognosis. Keywords: Breast cancer, Local recurrence, Survival, Predictive factor

Introducción: El objetivo del estudio fue conocer los efectos físicos y psicológicos de un programa de biodanza en niños de Educación Primaria. Metodología: La muestra estuvo compuesta por 53 niños y niñas de un colegio público de la provincia de Huelva a los que se dividió en un grupo cuasi-control y otro cuasi-experimental. A todos los participantes se les aplicaron cuestionarios, al comienzo y al final del curso, para medir las variables psicológicas (autoestima, inteligencia emocional y satisfacción con la vida); y test físicos para medir el consumo máximo de oxígeno y la agilidad. Resultados: Los resultados muestran mejoras significas en las variables autoestima (t(53)=4.599; p< .001), inteligencia emocional (t(52)=2.160; p= .035) y agilidad (U=-3.763; p< .001). Para las variables consumo máximo de oxígeno y satisfacción con la vida se han encontrado mejoras, pero no suficiente como para considerarse significativas. Conclusiones: Estos resultados sugieren que un programa de biodanza en jóvenes escolares puede ser una buena herramienta para mejorar las variables físicas y psicológicas mencionadas anteriormente. Abstract Introduction: The aim of the study was to know the physical and psychological effects of a biodanza program in primary school children. Methods: Fifty-three students (boys and girls) from a public school located in the province of Huelva were selected for the sample. The students were divided into two different groups: a quasi-control group and a quasi-experimental one. Questionnaires were applied to all the participants at the beginning and at the end of the course in order to measure the psychological variables (self-esteem, emotional inteligence and life satisfaction). Several physical test was also applied to measure maximum consumption of oxygen and agility. Results: Results show significant improvement in self-esteem (t(53)=4.599; p< .001), emotional inteligence (t(52)=2.160; p= .035) and agility (U=-3.763; p< .001). For maximum consumption of oxygen and life satisfaction variables some improvements have been found, but they are not enough to be considered significant. Conclusions: These results suggest that a biodanza program in school children can be a good tool to improve the physical and psychological variables previously cited.

Introduction: The aim of the study was to know the physical and psychological effects of a biodanza program in primary school children. Methods: Fifty-three students (boys and girls) from a public school located in the province of Huelva were selected for the sample. The students were divided into two different groups: a quasi-control group and a quasi-experimental one. Questionnaires were applied to all the participants at the beginning and at the end of the course in order to measure the psychological variables (self-esteem, emotional inteligence and life satisfaction). Several physical test was also applied to measure maximum consumption of oxygen and agility. Results: Results show significant improvement in self-esteem (t(53)=4.599; p< .001), emotional inteligence (t(52)=2.160; p= .035) and agility (U=-3.763; p< .001). For maximum consumption of oxygen and life satisfaction variables some improvements have been found, but they are not enough to be considered significant. Conclusions: These results suggest that a biodanza program in school children can be a good tool to improve the physical and psychological variables previously cited.

This paper reports a case of Petersen's space hernia after mini gastric bypass. This is an anecdotal post-operative complication in the mini gastric bypass technique, with an estimated rate of 1/5000 cases. Similar cases described in the literature were treated by the surgical hernia reduction and the closure of the mesenteric defect. Our patient had a unique management, performing a conversion to Roux-en-Y gastric bypass with dissection of the biliopancreatic limb at the anastomosis and creation of a variable foot-point anastomosis with excellent mid-term post-operative results. This should provide better long-term results as compared to simple mesenteric closure, avoiding the complications of mini gastric bypass technique.

La malrotación intestinal y el situs inversus pueden tener re - percusiones importantes si se presenta dolor abdominal agu - do. La posición de las estructuras intraabdominales puede ser invertida y eso puede confundir fácilmente al cirujano durante el examen físico. Afortunadamente, los exámenes radiológicos han mejorado el diagnóstico preoperatorio de estos pacientes. Sin embargo, en aquellos casos difíciles donde se sospecha una enfermedad quirúrgica subyacente, la laparos - copía sigue siendo el procedimiento óptimo para diagnosticar y tratar, si es posible, el trastorno sospechado. Presentamos un caso de apendicitis aguda del lado izquierdo en un niño con malrotación intestinal congénita desconocida. Además, este caso puso en evidencia el valor de la laparoscopía en la práctica diaria con el fin de evaluar a los pacientes con dolor abdominal atípico.

Background: hypercalcemia in patients with diagnosed carcinoma has predominantly a humoral basis mediated by parathyroid hormone-related protein (PTH-rP). Among the reported cases, hypercalcemia associated with the majority of abdominal malignancies indicates an advanced stage of disease. Case report: we present a case of a 78-year-old patient with an adenosquamous pancreatic carcinoma associated with humoral hypercalcemia mediated by PTH-rP. Conclusion: in this case, demonstration of unexpectantly rapid increase in calcium serum correlated with aggressive tumor growth led us to raise the hypothesis that PTH-rP could be a mediator of invasion and dissemination secreted by some tumors, and probably indicates the appropriate time to initiate palliative treatment.

Laparoscopic sleeve gastrectomy is currently used for the management of morbid obesity. Gastric fistula is the primary life-threatening complication, and its resolution continues to be a strong challenge for surgeons. Multiple treatment options are available, ranging from conservative therapy to endoscopic use of clips or stents, and even surgical reoperation involving total gastrectomy or conversion to a different bariatric technique. The applicability of each individual option will depend on the type of fistula and the patient clinical status. A clinical case is reported of a 29-year-old male patient with a body mass index at 49% who following laparoscopic sleeve gastrectomy had a delayed gastric fistula that failed to respond to conservative management but was successfully treated using the over-the-scope clip (Ovesco®) system.

Background: Gastric duplication is an uncommon condition in adults representing only 4-8% of all gastrointestinal duplications. It develops as a cystic growth within the thick gastric wall that is surrounded by a layer of smooth muscle and lined with gastric mucosa. It is usually asymptomatic but may present with nonspecific abdominal symptoms as well as cyst-related complications such as gastrointestinal (GI) bleeding, ulceration and even pancreatitis. They are difficult to distinguish from other gastric submucosal lesions and may also mimic a gastrointestinal tumor (GIST) or mucinous cyst of the pancreas. Endoscopic ultrasound (EUS) is the most widely used diagnostic procedure and histology provides a definitive diagnosis. Case report: We report the case of a 36-year-old female patient with a history of a "contained" perforated gastric ulcer that was managed conservatively. The patient was diagnosed with a gastric GIST which prompted a laparoscopic subtotal gastrectomy and Roux-en-Y reconstruction with a good postoperative outcome. Discussion: The definitive histological diagnosis was gastric duplication. Thus, the previous diagnosis of a "contained" perforated gastric ulcer was in fact a complication of the gastric duplication itself.