Negative pressure device used in pediatric patients with Hostile abdomen. Case series. / Dispositivo de presión negativa empleado en pacientes pediátricos con abdomen hostil: serie de casos.

INTRODUCTION: Hostile abdomen is a surgical condition characterized by loss of space between organs and structures in the abdomen. Negative pressure therapy use has been widely described in adults; the case is not the same for pediatric patients. The goal of this study is to present short-term results of negative pressure therapy use in pediatric patients with hostile abdomen due to different etiologies. MATERIAL AND METHODS: Pediatric hostile abdomen patients (< 18 years) who were treated Negative pressure therapy using ABTHERA were identified and retrospectively reviewed. RESULTS: 7 patients were included in this study. Median age was 16 (range: 9-17 yo). 5 (71.4%) were male and 2 (28.6%) females. 3 (43%) had significant past medical/surgical history (Systemic Lupus Erythematosus, complicated appendectomy and ventriculoperitoneal-shunt). The device was set at a continuous pressure ranging from -50 to -125 mmHg. Pre and post-surgical findings were reported using Bjork's classification. Devices were replaced every 4-7 days (median 5 days). Total amount of replacements was 1-4 (median 3). 5 (71.4%) patients required invasive mechanical ventilation during use of Negative pressure therapy based on clinical status. 4 (57%) patients received enteral nutrition. 1 (14%) patient required re-intervention posterior to definitive closure due to retroperitoneal abscess development. Outcome, evaluated by (oral tolerance, bowel movement and absence of pain), was favorable in all patients. CONCLUSION: Negative pressure therapy devices generate favorable results in hostile abdomen in pediatric population but further information is needed to assess pressure settings and device replacement frequency.

INTRODUCCION: El abdomen hostil es una patología quirúrgica caracterizada por una pérdida de espacio entre los órganos y estructuras del abdomen. La terapia de presión negativa se ha descrito de manera extensa en adultos, pero no así en pacientes pediátricos. El objetivo de este estudio es presentar los resultados a corto plazo de la terapia de presión negativa en pacientes pediátricos con abdomen hostil debido a distintas etiologías. MATERIAL Y METODOS: Identificación y análisis retrospectivo de los pacientes pediátricos con abdomen hostil (< 18 años) tratados con terapia de presión negativa ABTHERA. RESULTADOS: Se incluyó a 7 pacientes. La mediana de edad fue de 16 años (rango: 9-17). 5 (71,4%) eran niños y 2 (28,6%) niñas. 3 (43%) presentaban antecedentes médico-quirúrgicos de interés (lupus eritematoso sistémico, apendicectomía complicada y derivación ventriculoperitoneal). El dispositivo se empleó a presión constante, entre ­50 y ­125 mmHg. Los hallazgos preoperatorios y postoperatorios se notificaron mediante la clasificación de Bjork. Los dispositivos se sustituyeron cada 4-7 días (mediana de 5 días). La cantidad total de reemplazos fue de 1-4 (mediana de 3). 5 (71,4%) pacientes precisaron ventilación mecánica invasiva durante la terapia de presión negativa debido al estado clínico. 4 (57%) pacientes recibieron nutrición enteral. 1 (14%) paciente requirió reintervención posterior al cierre definitivo por el desarrollo de un absceso retroperitoneal. El resultado, evaluado en base a la tolerancia oral, el movimiento intestinal y la ausencia de dolor, fue favorable en todos los pacientes. CONCLUSION: Los dispositivos de terapia de presión negativa aportan resultados favorables en los pacientes pediátricos con abdomen hostil, aunque se necesita más información para evaluar los ajustes de presión y la frecuencia de reemplazo del dispositivo.

Splenogonadal fusion associated with Moebius and Poland syndromes: first case reported. / Fusión esplenogonadal asociada a síndrome de Moebius y Poland: primer caso reportado.

INTRODUCTION: Splenogonadal fusion is a rare congenital anomaly of unknown etiology caused by an abnormal fusion of the splenic tissue and the gonadal tissue. CASE REPORT: 2-year-old patient with paralysis of the 6th, 7th, and 9th cranial nerves, tent-shaped mouth, cleft palate, right pectoralis major hypoplasia, disruptive defect of the right upper limb, and a mass located at the left inguinal region. At inguinal hernia repair surgery, a processus vaginalis with non-reducible content was observed. When opening the hernia sac, a descending segment of splenic tissue merging with the upper pole of the left testis was found. The patient was diagnosed with splenogonadal fusion. The splenic tissue merging with the testis upper pole was resected, and the remaining splenic tissue was reduced towards the abdominal cavity. DISCUSSION: Splenogonadal fusion is difficult to diagnose. Being familiar with it allows unnecessary orchiectomies to be prevented.

INTRODUCCION: La fusión esplenogonadal es una anomalía congénita rara, de etiología desconocida, causada por la fusión anormal entre el tejido esplénico y gonadal. CASO CLINICO: Paciente de dos años, con parálisis del 6°, 7° y 9° nervio craneal, boca en tienda, paladar hendido, hipoplasia del músculo pectoral mayor derecho y defecto disruptivo de la extremidad superior derecha, masa visible en región inguinal izquierda. Al realizar la herniorrafia inguinal encontramos un conducto peritoneo vaginal con contenido no reductible y a la apertura del saco herniario observamos un segmento de tejido esplénico que desciende y se fusiona con el polo superior del testículo izquierdo. El paciente fue diagnosticado con fusión esplenogonadal. El tejido esplénico fusionado al polo superior del testículo es resecado y el resto del tejido esplénico se reduce hacia la cavidad abdominal. COMENTARIOS: La fusión esplenogonadal es una patología de difícil diagnóstico y su conocimiento puede evitar orquiectomías innecesarias.

[Supernumerary clavicle: a case report]. / Clavicula supernumeraria: reporte de un caso.

We report a case of left sided supernumerary clavicle in a male child, 3 years old with impossibility to the flexion and extension of the neck and lateralization since birth, in the 3D CAT SCAN we could appreciate the presence of bone tissue with italic S shape that was articulated with the jaw and the left sternun clavicle region. Previous evaluation from the rehabilitation service the patient underwent the removal of the lesion. The pathology study confirmed that this piece was osseous tissue with distal joints surfaces and central bone marrow.

[Treatment of proximal hypospadias: the onlay technique]. / [Tratamiento de los hipospadias proximales: técnica de "onlay"]

UNLABELLED: In 1987 Elder and Duckett published a modification of the Duckett technique for hypospadias repair, substituting the transverse preputial island flap for the onlay island. This modification preserves the urethral plate and has no circular anastomoses, the most common cause of fistulas and stenosis. MATERIAL AND METHODS: We present our experience in 67 cases with hypospadias (60 with chordee). The meatus was in the superior third of the penis in 15 cases, in the middle third in 29, at the base of the penis in 11, and interscrotal in 12 patients. Preoperative hormonal substitution was administer in 12 patients, correction of the chordee was possible in 66 cases, the urethral plate was dissected in 18 cases, and the Nesbit procedure in 16 cases. RESULTS: A good result was obtained in 59 cases a straight penis, meatus at the tip of the penis, good calibre of the urinary stream and a satisfactory esthetic result. Our rate of complication was of 12%, five fistulas, two partial deshicences of the preputioplasty and in one case a discrete chordee. CONCLUSIONS: We believe this is an surgical technique for one stage procedure in severe cases of proximal hypospadias with chordee with a good functional and esthetic result and few complications.

[Severe epispadias: the Mitchell's technique]. / Epispadias severos: técnica de Mitchell.

UNLABELLED: Epispadias associated or not to bladder extrophy is a congenital malformation with a difficult surgical correction. Mitchell published his technique in 1996, and it's based in the complete dissection of the uretheral band, ventral peneal skin and both corporas including their proximal insertion, that in next steps will be separated in all the length. These manoeuvres permit to: 1) Correct the dorsal incurvation; 2) Locate the urethra in a ventral position; 3) Locate the meatus at the tip of the penis with a vertical orientation. MATERIAL AND METHODS: We have performed these surgical procedure in 6 patients, 4 of them were epispadias (a 23 years old patient who had there surgical procedure, with persistent incurvation), the others two were associated with bladder extrophy, 3 had hormonal treatment previous surgery, due to a hypoplastic penis. In the two patients with bladder extrophy we used a labial mucosa graft sutured to the tubularized urethral plate to relocate the meatus at the tip of the penis. RESULTS: The esthetic results were good in all cases, 2 had a fistula that was corrected surgically.

[Auricular alloplastic reconstruction with osteointegrated implants: a new therapy option in microtia]. / Reconstrucción aloplástica auricular mediante implantes osteointegrados: una nueva opción terapéutica en la microtia.

Microtia has been treated over the years with autogenous tissues, although the results continue to improve, it is technically a very demanding procedure, even in the hands of a well trained surgeon. Osseointegrated implant-supported ear prosthesis, is less demanding, more straightforward, and offers a better cosmetic result. Since 1996 we have treated 8 patients with microtia types III and IV, with titanium osseointegrated implant-supported ear prosthesis in the bone of the mastoid process. The surgical procedure consists in two stages. First stage: when the three titanium screws are drill in the mastoid process of the temporal bone, with a previous CT scan of the area, that is used to measured the bone thickness. Second stage is done 3 to 6 months later. Ear remnants are removed at the beginning of the procedure, three titanium couplings are then secured to the integrated fixtures, a plastic cap is attached to each of the abutments, until healing takes place; three to four weeks later the auricular prosthesis made out of silicone over a metallic structure, will we plug in the titanium screws. Cosmetic results and patients acceptability have been good in all 8 cases, with few postoperative complications. This procedure has become and option for the patients with ear malformations.

[Esophageal dilatation by Savary-Guillard bougies in children]. / Dilataciones esofágicas con sondas de Savary-Guilliard en la infancia.

Dilatations are considered the election treatment for esophageal stenosis of different etiologies. Different methods of dilatation have been used through the years. Security and effectiveness are the main subjects when we choose a dilatation method. We present the results of the last 3 years that Savary-Guilliard have been used, with a guide wire probe, under endoscopic control. Six patients with postsurgical stenosis and 10 with post lye ingestion stenosis were treated with the above mentioned method. The site of stenosis is localized under flexible endoscopy, and a special guide wire probe is introduced to the stomach. Once the wire is in place, different diameter bougies are introduced until a firm resistance is felt or the desired diameter is reach. In complicated cases the progression of the wire was controlled by X-rays. A total of 208 dilatations have done in 16 patients over the last three years. Six patients with postsurgical stenosis needed from two to six dilatations for their cure. Of the 10 patients who ingest lye, none of them had needed a gastrostomy. Three of them have no dysphagia after 9, 13 and 13 dilatations. The other 7 are under dilatations every 6 weeks in 6 cases and every 4 weeks in one case, been all of them in the second year of treatment. All the dilatations have been performed under general anesthesia, as outpatients. We have not had any complication under this treatment. We have found that the Savary-Guilliard method is adequate for esophageal dilatations in pediatric population. Security and effectiveness are the main points of this procedure, there is no need for a gastrostomy, and the child will have a better quality of life. This procedure is less aggressive, and this will give a shorter postop period, with no complications and the child will have a longer period of normal life between dilatations.

Imperforate anus, delayed presentation in a 7-year-old girl.

Most of the cases of imperforate anus should be discovered at birth, during the initial physical examination. This case represents the status of Third World rural perinatal care, wherein delivery of an infant by a midwife in poverty stricken area of mountainous Jipijapa, Ecuador, failed to reveal the anomaly during the cursory examination. Moreover, the cultural taboos of the Jipijapan agricultural community further delayed the diagnosis. A 7-year-old girl with imperforate anus presenting with a rectovaginal fistula is reported. Specific findings in the case, therapy, and an approach to the diagnosis are discussed.