Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

[Initial study of an experimental model for bladder augmentation]. / Estudio inicial de un modelo experimental para la ampliación vesical.

Since Coffey described in 1910 the Uretero-sigmoidostomy, the first auto-continent urinary derivation, many techniques have been developed and used for bladder augmentation, although none of them has been considered fully satisfactory. The availability of a product made of a bovine collagen and glycosaminoglycan base, used for regenerating dermis and oral mucosa induced us to start this study on rabbit bladder in order to verify if muscular fibers might grow in its interior. For that purpose we used 6 New Zealand rabbits, to which we implanted a fragment of artificial dermis inside the detrusor after dissecting it. We present our results after 3 and 6 weeks postoperatively.

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

[Analysis of 34 cases of distal hypospadias treated by modified Koff's technique]. / Análisis de 34 casos de hipospadias distal intervenidos mediante la técnica de Koff modificada.

Koff's procedure in the treatment of distal hypospadias consist in a large mobilization of the distal urethra. The association to a transglandular funelization and minimal urethroplasty is useful for the treatment in the majority of patients with distal hypospadias. In the last two years 34 patients with distal types of hypospadias were operated with a Koff's modified procedure. The technique consists in a urethral advancement without glanduloplasty and distal cutaneous tubulization. The primitive meatal localization was subcoronal (n = 22), glandular (n = 6), and on the distal shaft (n = 6). In 10 cases urethral catheters was not necessary. A patient develops a proximal fistula successfully treated with 14 days catheterization. Cosmetic and functional results were good in all cases. Extensive urethral mobilization can be done in cases of distal hypospadias and is evidence of the preserved vascularity and viability of the mobilized urethra.

[Intrahepatic biloma. Conservative management with external drainage]. / Bilioma intrahepático. Tratamiento conservador mediante drenaje externo.

A seven year old boy, one week after surgical intervention for blunt liver trauma, presents an intrahepatic bilioma. Under ultrasonografic guidance, an external drainage is inserted. Contrast injection shows billiary fistula. Three weeks later, after a new contrast injection, billiary fistula resolution is proved, and dranaige tube is withdrawn. Ultrasonografic and CT Scan studies showed total resolution of intrahepatic collection. Intrahepatic billiary collections are a rare complication of the hepatic traumatism. Conservative management with external drainage, should be keept in mind like a first choice terapeutic option.

[Surgical treatment of laryngotracheal stenosis in childhood]. / Tratamiento quirúrgico de las estenosis laringotraqueales en la infancia.

Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.

[Surgical options in the treatment of short bowel syndrome with loss of the ileocecal valve. Intestinal valve, intestinal duplication]. / Opciones quirúrgicas en el tratamiento del síndrome de intestino corto con pérdida de la válvula ileocecal. Válvula intestinal, desdoblamiento intestinal.

Morbidity and mortality are especially increased in pediatric patients affected of short bowel syndrome in whom ileocecal valve was resected. This report concerns 13 infants and children with short gut syndrome with ileocecal valve resected treated in the last 4 years. In two of them we performed intestinal duplication and in seven an antireflux intestinal valve with a segment of bowel. With that procedure we achieved a significant shortening of the hospital stay as well as reduction in time and quantity of total parenteral nutrition. The rest of the patients were treated with conservative management.

[Acute abdomen of unusual cause in children]. / Abdomen agudo de causa excepcional en el niño.

The acute abdomen in childhood is in most cases caused by an acute appendicitis and rarely it is secondary to other diseases. It is for that reason, that we present two cases extremely rare of acute abdomen: the first one was an abdominal Actinomycosis secondary to acute appendicitis that looked like a tumor and the second that was an acute omentitis due to pinworms.