[Congenital sternal cleft]. / Hendidura esternal congenita.

INTRODUCTION: Congenital sternal cleft is a rare malformation. Little more than one hundred cases have been published, and rarely more than two cases are published in a single publication. We present five new cases that show the entire spectrum of defects. METHODS: They were 3 males and 2 females. Age range between 1 day and 5 years of age. There were 2 supraxiphoid clefts (SC), 2 gladiolar defects and 1 xiphoid cleft. We evaluate the demographics, associated malformations, mode of treatments and results. RESULTS: The SC were not associated to congenital herat malformations, but with a many other malformative spectrum (anterior cervical web, hemangiomatosis, CNS malformations, coloboma and pectus excavatum). The two females had SC and were operated on the 24th and 30th days of age. The first one developed a superior vena cava síndrome for a few days after surgery and a moderate pectus excavatum that did not required surgery. A midline cervical web was also surgically repaired at 10 years of age. The second patient with SC was treated with interferon alfa-2a and local infiltration of corticosteroid for treatment of hemangiomatosis. Both patients had excellent final results (follow up 11 and 5 years respectively). Gladiolar clefts were observed durign surgical repair of congenital Herat malformations (ventricular septal defect and partial anomalous of pulmonary venous draninage). They were repaired by direct closure of the defect. The patient with the xiphoid cleft had associaed a Cantrell pentalogy. He died 4 days after operation because of extreme prematurity and pulmonary vascular hypertenion. CONCLUSIONS: 1) We have observed five new cases of sternal cleft. 2) Each anatomical variety had their own mode of presentation, a different malformative spectrum and clinical evolution that are based on a distinct embryonic origin. 3) Excluding the xiphoid clefts, the long term surviving is 100%, but they are associated with a great variety of other congenital defects.

[Prospective study of 288 cases of acute appendicitis during childhood: characteristics in preschool children]. / Estudio prospectivo de 288 apendicitis agudas en la infancia: Características en los niños menores de 5 años.

OBJECTIVE: The purpose of this study was to verify that preschool children with acute appendicitis show some clinical characteristics which, associated with the faster evolution of the infection at this age, result in a higher incidence of perforations, peritonitis and complications. PATIENTS AND METHODS: A group of 288 children between 9 months and 17 years of age with acute appendicitis was studied over a 17-month period, ending July 1993. They were divided into two age groups: Group I (< 5 years: n = 45) and Group II (5 or more years: n = 243). Comparisons between clinical, laboratory and radiological findings, appendiceal pathology, microbiology and complications were made. RESULTS: Children fro Group I showed a higher incidence of perforations (29% vs 7.8%), peritonitis (69% vs 36%), appendiceal masses (37% vs 10.2%), positive cultures (66% vs 18%) and complications (24% vs 9.8%) than those from Group II. All differences were found to be significant (p < 0.05). Children from Group I more frequently showed a set of clinical characteristics forming an atypical picture consisting of: 1) Diffuse abdominal pain (69% vs 30%); 2) Associated infections with non-specific symptoms (33% vs 11.5%); 3) Previous therapy with antimicrobial agents (40% vs 9.8%); 4) X-ray findings compatible with gastroenteritis (27% vs 7.4%); and 5) Inability of the child to specify the intensity and location of pain. CONCLUSIONS: All these factors justified the delay in the diagnosis and its significant relationship with the higher incidence of peritonitis in this age group.

[Neonatal suprarenal abscess: a diagnosis to be taken into account]. / Absceso suprarrenal neonatal. Un diagnóstico a tener en cuenta.

Neonatal adrenal abscess is a very rare condition. It might be suspected in those cases of newborns with fever, palpable abdominal mass and elevated WBC. A case recently treated in our hospital is reported.

[Prospective and comparative study of cefoxitin and ceftizoxime in appendicitis surgery]. / Estudio prospectivo y comparativo entre cefoxitina y ceftizoxima en cirugía apendicular.

OBJECTIVE: Acute appendicitis is the most common acute surgical disease in childhood and it still presents frequent septic complications. This prospective and randomized study compares the efficacy of two cephalosporins (cefoxitin and ceftizoxime) in terms of clinical response, in vitro activity and characteristics of use in clinical practice. PATIENTS AND METHODS: Of the 288 children with acute appendicitis admitted over a period of 15 months, 148 received cefoxitin (100 mg/kg/24 h; Group I) and 140 ceftizoxime (100 mg/kg/24 h; Group II) RESULTS: No significant differences were seen between these two groups in clinical response or infectious complication rates. In addition, activities of both antimicrobial agents against pathogens recovered from the peritoneal cultures of all patients were similar. The overall most common isolates were E. coli (75.5%), bacteroides species (33.7%) and Pseudomonas (32.4%). CONCLUSIONS: We conclude that ceftizoxime is as effective as cefoxitin and can be surely employed in the treatment of acute appendicitis in children. Its addition, its longer half-life simplifies its use in clinical practice.

[Laparoscopy in pediatric surgery]. / Laparoscopia en cirugía pediátrica.

The aim of this paper is to show our experience in Laparoscopic Surgery in the pediatric age. We make a review of 37 patients, in whom we carried out a laparoscopy. In 20 (54%) the laparoscopy was therapeutic: 15 appendectomies, 1 cholecystectomy, 1 ventriculo-peritoneal catheter extraction, 1 ovarian cyst, 1 bilateral oophorectomy and 1 adhesiolysis. In others 17 (46%) was diagnostic: 15 hepatic biopsies, 1 intussusception and 1 abdominal mass biopsy. Of 15 appendectomies, 8 were for acute appendicitis and 7 for chronic process. The age have ranged from 1 month to 18 years. The operative time from 2 h 30 min to 35 min. We had not complications and the average hospital stay was of 2 days. We can say that this is an useful technique in pediatric surgery.