We describe a five-week-old boy who had seizures and extreme hypernatraemia secondary to ingesting an improper home-made formula. Initial sodium concentration was 211 mmol.l-1. Other clinical and biological features were moderate dehydration and renal insufficiency with generous urine output and high urinary sodium concentration. Fluid therapy with hypotonic dextrose solution corrected the volume deficit in 48 h and progressively decreased the serum sodium concentration. During ICU stay the patient developed recurrent episodes of seizures and pulmonary oedema requiring mechanical ventilation for five days. Recovery was complete with no abnormal sequelae after a ten-month follow-up. Salt poisoning is in unusual cause of extreme hypernatraemia. It can be safely managed with fluid therapy alone if urine output is preserved, with progressive decrease of serum sodium as target. If this condition is recognized, outcome should be favourable.

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La falta de pérdida de peso o la re-ganancia de peso postoperatoria, en el by pass gastrico, es un fenomeno que ocurre en un porcentaje significativo de los pacientes, que puede indicar el desarrollo de una dilatación en la anastomosis gastro-yeyunal, que no restringe adecuadamente la ingesta de alimentos. Hay evidencia que muestra que el diametro de la anastomosis gastro-yeyunal se correlaciona positivamente con la reganancia de peso.La recalibración endoscópica de la gastro-yeyuno anastomosis es un procedimiento efectivo que constituye una alternativa a la cirugía de revisión.

Total wall resection by full-thickness resection device post-hybrid endoscopic submucosal dissection of a laterally spreading tumor in the colon Non-lifting lesions can occur owing to fibrosis caused by multiple biopsies, submucosal tumor involvement, and lesions resulting from incomplete resections, among others. These lesions can be successfully resected using the full-thickness resection device (FTRD) [1 -5]. Here we report the case of a patient who, after undergoing endoscopic submucosal dissection, presented with lesion recurrence. In light of this, the decision was taken to perform resection with the FTRD. A colonoscope with a conical cup was advanced to the hepatic flexure of the colon, where a flat, granular-type, laterally spreading tumor of approximately 4 × 6 cm, covering 40 % of the perimeter and a complete haustral fold longitudinally, was identified (▶ Fig. 1 a). The margins of the lesion were clearly identified. ▶ Fig. 1 Endoscopic views showing: a a flat lesion with agranular lateral extension of about 4 x 6 cm, occupying 40 % of the total perimeter and an entire haustral fold; b endoscopic submucosal dissection (ESD) being performed; c scar folds from the previous ESD with residual adenomatous tissue on colonoscopy 6 months later; d complete wall resection of the segment that contained the residual lesion using the full-thickness resection device (FTRD); e evidence of a flat scar but no residual adenomatous tissue on the final follow-up colonoscopy.Video 1 A laterally spreading tumor in the colon is treated by hybrid endoscopic mucosal resection; recurrent adenomatous tissue is treated with a full-thickness resection device (FTRD); the final follow-up colonoscopy shows only the scar from the total wall resection with no adenomatous tissue present.

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