Priapismo y leucemia mieloide crónica en adolescente. Debut poco frecuente. Reporte de caso / Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report

El priapismo es una erección dolorosa y persistente acompañada o no de estímulo sexual. Una causa poco frecuente de esta anormalidad es la leucemia mieloide crónica. Se han reportado pocos casos de priapismo como manifestación inicial de una leucemia de este tipo en pacientes adolescentes. A continuación, se informa el caso de un paciente de 16 años de edad que presentó priapismo como manifestación inicial de una leucemia mieloide crónica. Durante su evolución, no se realizó aspiración de los cuerpos cavernosos. Se inició tratamiento hematológico específico y, ante la persistencia del priapismo, fue necesario realizar un shunt de cuerpos cavernosos en dos ocasiones, tratamiento a pesar del cual existen altas probabilidades de secuelas.

Priapism is a painful and persistent erection, with or without sexual stimulation. A rare cause of such abnormality is chronic myeloid leukemia. Few cases of priapism as an initial manifestation of this type of leukemia have been reported in adolescent patients. Here we describe the case of a 16-year-old patient who presented with priapism as the initial manifestation of chronic myeloid leukemia. No cavernosal aspiration was performed. A specific hematological treatment was started and, given the persistence of priapism, the patient required 2 corpora cavernosa shunt procedures; despite this treatment, there is a high probability of sequelae.

Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report. / Priapismo y leucemia mieloide crónica en adolescente. Debut poco frecuente. Reporte de caso.

Priapism is a painful and persistent erection, with or without sexual stimulation. A rare cause of such abnormality is chronic myeloid leukemia. Few cases of priapism as an initial manifestation of this type of leukemia have been reported in adolescent patients. Here we describe the case of a 16-year-old patient who presented with priapism as the initial manifestation of chronic myeloid leukemia. No cavernosal aspiration was performed. A specific hematological treatment was started and, given the persistence of priapism, the patient required 2 corpora cavernosa shunt procedures; despite this treatment, there is a high probability of sequelae.

El priapismo es una erección dolorosa y persistente acompañada o no de estímulo sexual. Una causa poco frecuente de esta anormalidad es la leucemia mieloide crónica. Se han reportado pocos casos de priapismo como manifestación inicial de una leucemia de este tipo en pacientes adolescentes. A continuación, se informa el caso de un paciente de 16 años de edad que presentó priapismo como manifestación inicial de una leucemia mieloide crónica. Durante su evolución, no se realizó aspiración de los cuerpos cavernosos. Se inició tratamiento hematológico específico y, ante la persistencia del priapismo, fue necesario realizar un shunt de cuerpos cavernosos en dos ocasiones, tratamiento a pesar del cual existen altas probabilidades de secuelas.

Roux-en-Y partial volvulus in biliary-digestive reconstruction in children.

Various complications occur after a biliary-digestive reconstruction. Volvulus of a segment of the biliodigestive loop has not been described. Two patients who underwent biliodigestive bypass, years later, began with sudden and intense abdominal pain, associated with a volvulus with necrosis of a segment of this biliodigestive loop. This complication occurred many years after the initial correction, and manifested with sudden abdominal pain without impaired liver function, as occurred in these patients.

Diversas complicaciones pueden ocurrir después de una reconstrucción biliodigestiva. El vólvulo de un segmento del asa biliodigestiva no ha sido descrito. Dos pacientes operados de derivación biliodigestiva, años después iniciaron con dolor abdominal súbito e intenso, asociado a un vólvulo con necrosis de un segmento de la asa interpuesta. Se ha descrito el vólvulo de toda el asa interpuesta, pero no el de solo una pequeña porción de esta. La complicación ocurrió muchos años después de la corrección inicial y se manifiesto con dolor abdominal súbito sin deterioro de la función hepática, como sucedió en estos pacientes.

Botulinum toxin A (IncobotulinumtoxinA) and pneumoperitoneum image-guided for hernia repair with loss of dominance.

Post-incisional ventral hernia is estimated at 5-30%, when the content of the abdominal cavity migrates to the hernial sac (HSV), with a HSV/abdominal cavity volume ratio > 25%, conditioning systemic changes defined as "loss of domain". A 27-year-old male presented with ventral hernia with loss of domain that required pre-operative preparation techniques, using application of botulinum toxin A (IncobotulinumtoxinA) and pneumoperitoneum, both guided by image. A ventral plasty was performed with adequate return of the viscera to the abdominal cavity. The combination of both techniques seems to be a safe procedure to carry out a tension-free repair.

La hernia ventral postincisional se estima en 5 al 30%, cuando el contenido de la cavidad abdominal migra al saco herniario, con una relación VSH/VCA > 25% condicionando cambios sistémicos se define como "pérdida de dominio". Masculino de 27 años con hernia ventral con pérdida de dominio que ameritó técnicas de preparación preoperatoria, utilizando toxina botulínica A (IncobotulinumtoxinA) y neumoperitoneo, ambos guíados por imagen. Se realizó una plastia ventral con adecuado regreso de las vísceras a la cavidad abdominal. La combinación de ambas técnicas es un procedimiento seguro para realizar una reparación libre de tensión.

Laparoscopic vs Open Extravesical Ureteral Reimplantation in Pediatric Population: A Single-Center Experience.

PURPOSE: To evaluate the safety and efficacy of conventional laparoscopic vs open Lich-Gregoir ureteral reimplantation in pediatric vesicoureteral reflux. MATERIAL AND METHODS: A retrospective study was conducted in a tertiary care hospital. Patients with vesicoureteral reflux who underwent open or laparoscopic Lich-Gregoir ureteral reimplantation from 2013-2020 were included.  The primary outcome was resolution of reflux. Complications and perioperative characteristics were evaluated. The outcomes between open and laparoscopic surgery were analyzed. RESULTS: A total of 110 patients and 150 ureters were included. The mean age was 4.5 years ± 3.4 and 73.6% were females. A total of 125 ureters (83.3%) underwent laparoscopic and 25 (16.6%) open Lich-Gregoir vesicoureteral reimplantation (5:1 Ratio). Resolution was reported in 112 (89.6%) for laparoscopy and 21 (84%) for open surgery (P = .42). Mean surgical time for laparoscopy and open surgery were 142.4 min ± 64.4 and 153 min ± 40, respectively (P =.29). Mean bleeding (9.5 mL ± 11.2 vs 29.6 mL ± 22.8) and length of hospital stay (2.4 days ± 2.3 vs 5.05 ± 3.1) were significantly higher with open surgery (P < .001). No significant difference in complications was reported between open surgery (32%) and laparoscopic approach (22.4%) (P = .305). CONCLUSION: Conventional laparoscopic vesicoureteral reimplantation with the Lich-Gregoir technique has an acceptable success rate comparable with open surgery, with shorter hospital stay, less bleeding, and less need of transfusion.

Ocurrencia y factores asociados con la violencia física y psicológica a mujeres embarazadas atendidas en un hospital materno infantil / Occurrence and associated factors with physical and psychological violence on pregnant women users of a motherhood and children hospital

Resumen OBJETIVO: Estimar la ocurrencia y los factores asociados con la violencia física y psicológica ejercida a las embarazadas por parte de sus parejas. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo y transversal efectuado en las pacientes atendidas entre los meses de junio a noviembre de 2019 en el Hospital de la Madre y el Niño Guerrerense, México. Mediante un cuestionario electrónico (Abuse Assessment Screen), autoadministrado, se indagaron los datos sociodemográficos, de violencia física y psicológica y los antecedentes ginecoobstétricos. La estimación de factores asociados se hizo mediante razón de momios y análisis multivariado. RESULTADOS: Se reunieron 463 registros útiles para el análisis; 125 (27%) reportaron violencia psicológica y 7% (n = 32) violencia física. Los factores asociados con la violencia psicológica fueron: antecedente de este tipo de violencia en la infancia (razón de momios ajustada [RMa] 2.5; IC95%: 1.3-4.8) y antes del embarazo (RMa: 33.9; IC95%: 18.9-60.6). Los factores asociados con la violencia física fueron: antecedente de este tipo de violencia antes del embarazo (RMa: 24.6; IC95%: 10.4- 58.6) y en la infancia (RMa: 3.6; IC95%: 1.5-8.5) además, consumo de alcohol durante el embarazo (RMa: 5.5; IC95%: 1.3-24.4). Estar casada o en unión libre fue un factor protector en contra de la violencia psicológica (RMa: 0.33; IC95%: 0.11-0.97) y física (RMa: 0.29; IC95%: 0.08-0.99). CONCLUSIONES: La violencia psicológica fue mayor que la reportada para la física. Ambas se experimentaron durante los años de infancia o antes del embarazo e incrementaron el riesgo de sufrirla durante el proceso reproductivo. Las embarazadas casadas o en unión libre tuvieron menor riesgo de sufrir violencia física y psicológica.

Abstract OBJECTIVE: To estimate the occurrence and factors associated with physical and psychological violence exerted on pregnant women by their partners. MATERIALS AND METHODS: Cohort, retrospective and cross-sectional study carried out in patients attended from June to November 2019 at the Hospital de la Madre y el Niño Guerrerense, Mexico. An electronic questionnaire (Abuse Assessment Screen), self-administered, was used to inquire about sociodemographic data, physical and psychological violence and gynecological and obstetric history. The associated factors were estimated by odds ratio and multivariate analysis. RESULTS: We collected 463 records useful for analysis; 125 (27%) reported psychological violence and 7% (n = 32) physical violence. Factors associated with psychological violence were history of such violence in childhood (adjusted odds ratio [aOR] 2.5; 95%CI: 1.3-4.8) and before pregnancy (aOR: 33.9; 95%CI: 18.9-60.6). The factors associated with physical violence were history of this type of violence before pregnancy (aRI: 24.6; 95%CI: 10.4-58.6) and in childhood (aRI: 3.6; 95%CI: 1.5-8.5) and alcohol consumption during pregnancy (aRI: 5.5; 95%CI: 1.3-24.4). Being married or in union was a protective factor against psychological (RMa: 0.33; 95%CI: 0.11-0.97) and physical violence (RMa: 0.29; 95%CI: 0.08-0.99). CONCLUSIONS: Psychological violence was higher than that reported for physical violence. Both were experienced during the childhood years or before pregnancy and increased the risk of suffering it during the reproductive process. Pregnant women who were married or in union had a lower risk of suffering physical and psychological violence.

Intraoperative Endoscopy as an Adjuvant to Minimally Invasive Surgery in Pediatrics.

Background: Minimally invasive surgery has a different visual and tactile perception compared with conventional surgery, which could lead to complications, especially in complex procedures. In these cases, flexible endoscopy can facilitate and prevent complications in minimally invasive procedures in children. The study aimed to clarify the utility of intraoperative endoscopy as an adjuvant to minimally invasive surgery in children. Materials and Methods: This retrospective study reviewed the medical records of pediatric patients who had undergone endoscopy during a minimally invasive surgery to treat an upper digestive pathology between January 2000 and December 2020. Results: The study included 83 patients who underwent a laparoscopic procedure with simultaneous endoscopy. The diagnosis was peptic stenosis in 9 patients, achalasia in 23, congenital embryonic tracheobronchial remnants in 4, re-fundoplication in 42, esophageal duplication in 2, superior mesenteric artery syndrome in 2, and giant gastric hemangioma in 1 patient. With adjuvant endoscopy, 7 digestive perforations were noted, 11 cases of short esophagus were diagnosed, and the permeability of the anastomosis was confirmed in 6 cases. No complications were related with the endoscopy procedures. Discussion: Minimally invasive surgery has a few special and tactile limitations that can lead to complications in certain procedures. Simultaneous digestive endoscopy in the upper gastrointestinal tract facilitates organ identification and dissection. Conclusion: Digestive endoscopy is an excellent adjunct to minimally invasive surgery in children because it facilitates and identifies complications and ensures safer minimally invasive surgeries. Future prospective studies are required to assess this conclusion.

Case Report: Fibroglial Retinal Tissue in Contractile Morning Glory Disc Anomaly.

The purpose of the present case is to describe a patient with tractional retinal detachment (RD) associated with contractile morning glory: a 17-year-old female, with a history of failed surgery for RD when she was 2 years old in her right eye (OD), nystagmus, and a limited visual acuity in the left eye (OS). The slit lamp examination showed phthisis bulbi in OD and the anterior segment was unremarkable in OS. Dilated fundus examination revealed a tractional RD in the posterior pole and peripapillary and preretinal fibrosis without evidence of intravitreal dispersion of retinal pigment epithelial cells. After surgery treatment, the RD resolved and the posterior segment showed a staphylomatous excavation around the optic disc anomaly with irregular contractions that folded the macular area. This were unrelated to light, breathing, or eye movements. Although morning glory disc anomaly is associated with RD, the early diagnosis can reverse structural changes. In this case, the rare association with contractile movements was found posterior to the pars plana vitrectomy after all the fibroglial epiretinal tissue was removed.

Caries en primeros molares permanentes y factores asociados a esta en escolares de Acapulco / Caries in permanent first molars and associated factors with its in schoolchildren from Acapulco

Introducción: La caries es una de las enfermedades bucodentales más frecuentes y, por ser las primeras en emerger, los primeros molares permanentes son las piezas más susceptibles a esta afección. Objetivo: Estimar la prevalencia de caries y factores asociados a esta en los primeros molares permanentes en escolares de segundo grado de primaria. Métodos: Estudio transversal, en estudiantes de segundo grado en 17 de 67 escuelas públicas de Acapulco, Guerrero. Un cuestionario autoadministrado se utilizó para obtener datos sociodemográficos y hábitos de higiene dental. La caries y la presencia de placa dentobacteriana se midieron a través de índices epidemiológicos, el CPOD (diente cariado, obturado y perdido) y el O'Leary. Se estimó la razón de momios e intervalo de confianza de 95 por ciento, ajustada por conglomerado, como medida de la fuerza de asociación mediante análisis multivariado. Resultados: Se revisaron 3332 primeros molares permanentes, el 21 por ciento tuvo caries, el 6 por ciento tuvo obturaciones y el 1 por ciento ya se había extraído. El índice CPOD de caries grupal fue 0,27. Cinco factores estuvieron asociados a la caries de los primeros molares permanentes: higiene dental deficiente (RMa = 2,87), técnica de cepillado dental inadecuada (RMa = 1,70), tomar alguna bebida dulce antes de ir a dormir (RMa = 1,68), visitar al dentista (RMa = 0,67) y aplicación de flúor (RMa = 0,61). Conclusiones: La prevalencia de caries en los primeros molares permanentes fue 21 por ciento dentro del rango reportado en otros estudios. Fueron identificados cinco factores asociados a la caries: higiene dental deficiente, técnica de cepillado inadecuado, consumo de azúcares antes de dormir, visitas al dentista y aplicación de flúor. Estos factores orientan sobre qué medidas preventivas se deben promover en los escolares para la preservación de sus piezas dentales(AU)

Introduction: Caries is the most frequent oral disease and the first permanent molars are very susceptible to this condition because they are the first teeth to emerge. Objective: To estimate the prevalence of caries its associated factors in the first permanent molars in second grade primary school children. Methods: A cross-sectional study was carried out in second grade students in 17 out of 67primary public schools in Acapulco, Guerrero. We applied a self-administered questionnaire to obtain sociodemographic data and dental hygiene habits. Caries and the presence of dentobacterial plaque were measured through epidemiological indices, CPOD (decayed, blocked and lost tooth) and O'Leary index. The odds ratio and 95 percent confidence interval, adjusted by cluster, were estimated as a measure of strength of association through multivariate analysis. Results: We reviewed 3 332 permanent first molars, 21 percent had cavities, 6 percent had seals and 1 percent had already been removed. The CPOD index of group caries was 0,27. We found five factors associated with caries of the first permanent molars: deficient dental hygiene (RMa=2,87), inadequate tooth brushing technique (RMa=1,70), drinking a sweet drink before bedtime (RMa=1,68), visiting the dentist (RMa=0,67) and fluoride application (RMa=0,61). Conclusions: Prevalence of caries in the first permanent molars was 21 percent, within the range reported in other studies. Five factors associated with caries were identified: poor dental hygiene, inadequate brushing technique, consumption of sugars before going to sleep, visits to the dentist and application of fluoride. These factors guide what preventive measures should be promoted in schoolchildren for the preservation of their teeth(AU)

Treatment of chronic pancreatitis by laparoscopic DuVal procedure: report of a pediatric case.

ANTECEDENTES: La pancreatitis es una enfermedad rara. La obstrucción es común y se puede corregir con endoscopia; si fracasa, necesitará cirugía. CASO CLÍNICO: Reportamos un paciente con pancreatitis secundaria a páncreas divisum. Se realizó derivación tipo DuVal laparoscópica. Varón de 12 años, con múltiples cuadros de pancreatitis y fallidos intentos de esfinteroplastias. La colangiorresonancia mostró páncreas divisum. Se realizó una derivación tipo DuVal por laparoscopia. Seguimiento de 5 años. No ha habido recurrencia del dolor y la lipasa se normalizó a los 6 meses. El conducto pancreático no estaba dilatado. Ante la dificultad para hacer una anastomosis lateral se utilizó la técnica laparoscópica propuesta por DuVal. BACKGROUND: Pancreatitis is rare. Obstruction is common. They can be corrected with endoscopy, if they fail they need surgery. CASE REPORT: We reported a patient with pancreatitis secondary to pancreas divisum, laparoscopic DuVal shunt was performed. Male 12 years, multiple pancreatitis pictures and failed sphinteroplasty attempts. Colangio resonance showed pancreas divisum. A DuVal-type shunt was built for laparoscopy. Follow-up 5 years. There has been no recurrence of pain and lipase was normalized at 6 months. The pancreatic duct was not dilated, in the face of difficulty making a lateral anastomosis was used the technique proposed by DuVal by laparoscopic approach.

Prevalencia de depresión posparto y factores asociados en usuarias de un hospital público de Acapulco, Guerrero, México / Prevalence of postpartum depression and its associated factors in users of a public hospital at Acapulco, Guerrero, Mexico

Resumen OBJETIVO: Estimar la prevalencia de depresión posparto y los factores asociados en usuarias del Hospital General Progreso, Acapulco, Guerrero, México. MATERIALES Y MÉTODOS: Estudio prospectivo, observacional y transversal de serie de casos. El instrumento para medir la depresión fue un cuestionario que incluyó la Escala de Depresión Posnatal de Edimburgo (EPDS por sus siglas en inglés). Además, a las pacientes se les preguntaron sus datos sociodemográficos, antecedentes de control prenatal, historial obstétrico, atención del parto y otros datos relacionados con su pareja. Mediante análisis bivariado y multivariado se estimaron los factores asociados con la depresión posparto. RESULTADOS: Se analizaron 485 pacientes con media de edad de 24.6 años y límites de 14 y 43 años. La prevalencia de depresión posparto fue de 16%. En el modelo final del análisis multivariado los factores asociados con la depresión posparto fueron: complicaciones en el parto (IC95%:1.61-6.54), antecedente de alcoholismo antes del embarazo (IC95%:1.17- 3.30) y recibir apoyo emocional del esposo durante el embarazo (IC95%: 0.17-0.68). CONCLUSIONES: El antecedente de consumo de bebidas alcohólicas, previo al embarazo, y tener alguna complicación del parto, fueron indicios de posible aparición de depresión posparto. Quienes la padecieron tuvieron la referencia temprana a los servicios de Psicología. La pareja debe estar informada que su apoyo emocional ayuda a reducir el riesgo de depresión posparto en la paciente.

Abstract OBJECTIVE: To estimate the prevalence of postpartum depression and associated factors in users of the Hospital General Progreso, Acapulco, Guerrero, Mexico. MATERIALS AND METHODS: Prospective, observational, cross-sectional case series study. The instrument to measure depression was a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS). In addition, patients were asked about their sociodemographic data, prenatal control history, obstetric history, delivery care and other data related to their partner. Factors associated with postpartum depression were estimated by bivariate and multivariate analyses. RESULTS: We analyzed 485 patients with a mean age of 24.6 years and cut-offs of 14 and 43 years. The prevalence of postpartum depression was 16%. In the final multivariate analysis model, the factors associated with postpartum depression were: delivery complications (CI95%:1.61-6.54), history of alcoholism before pregnancy (CI95%:1.17- 3.30) and receiving emotional support from husband during pregnancy (CI95%: 0.17-0.68). CONCLUSIONS: A history of alcoholic beverage consumption prior to pregnancy and having some complication of childbirth were indicative of possible occurrence of postpartum depression. Those who suffered from it had early referral to psychology services. The couple should be informed that their emotional support helps to reduce the risk of postpartum depression in the patient.

Autologous full-thickness retinal transplant for refractory large macular holes.

BACKGROUND: Despite the constant refinement of techniques and surgical aids, extremely large and refractory macular holes continue to have poor surgical outcomes with the current standard of care. The objective of the present study is to assess the anatomical and functional outcomes, as well as the structural change through time, of the optical coherence tomography of patients with refractory macular holes treated with a full-thickness autologous retinal transplant. METHODS: Prospective, case series. We include patients with a clinical diagnosis of refractory macular holes with a minimum diameter of at least 500 µm. All the patients had a comprehensive ophthalmological examination, which included a best-corrected visual acuity assessment, fundus examination, and optical coherence analysis. All the patients underwent a 23-gauge pars plana vitrectomy with a full-thickness retinal transplant and silicone oil tamponade (5000 cs<). Follow-up was done at 1, 3, 6, and 12 months. Statistical analysis was done with a test for repeated measurements and Bonferroni correction, with an alpha value of 0.05 for statistical significance and a Mann-Whitney U test for nonparametric continuous variables. RESULTS: We enrolled 13 eyes from 13 patients (mean age: 67.15 years) with refractory macular holes, with a mean base diameter of 1615.38 ± 689.19 µm and a minimum diameter of 964.08 ± 709.77 µm. The closure rate after 12 months of follow-up was 76.92%. Six patients with a closed macular hole at the end of the follow-up had complete recovery of the myoid/ellipsoid layer. The remaining showed a 44.9% reduction of the initial gap. Most patients formed a pseudofovea and normalization of the internal retinal layers. Despite a positive trend toward visual recovery (p = 0.034), after the correction of the alpha value, the change lost its statistical significance. During follow-up, one patient developed mild proliferative vitreoretinopathy and epiretinal membrane without anatomical or functional consequences. CONCLUSIONS: An autologous full-thickness retinal transplant may improve the anatomical and structural outcome of patients with refractory macular holes. The full safety profile of this new technique is still unknown. More studies are needed in order to assess functional changes through time.

Femoral hernia in children: diagnostic and therapeutic challenge. Case report.

INTRODUCCIÓN: Las hernias femorales son raras en la infancia. El defecto está abajo del ligamento inguinal. La frecuencia de un diagnóstico erróneo es de hasta el 75%. Pueden ser resueltas mediante cirugía abierta o laparoscópica. OBJETIVO: Comunicar el caso de un niño con hernia femoral resuelto mediante laparoscopía. CASO CLÍNICO: Varón de 5 años, con antecedente de criptorquidia bilateral resuelta a los 2 años de edad. Padecimiento actual con 1 mes de evolución, con aumento de volumen en el tercio externo de la ingle. El ultrasonido reportó un defecto aponeurótico junto a los vasos femorales derechos. Abordaje laparoscópico, con hallazgos de defecto por abajo del ligamento inguinal. Sin recidiva a los 12 meses de seguimiento. DISCUSIÓN: Las hernias femorales son raras en los niños y su diagnóstico es difícil. La exploración laparoscópica permitió identificarla al encontrar un defecto por abajo del ligamento inguinal y junto a los vasos femorales independiente del anillo inguinal profundo y de la fascia transversal. INTRODUCTION: Femoral hernias are rare in children. The defect is below the inguinal ligament. The frequency of a misdiagnosis is up to 75%. They can be resolved by open or laparoscopic surgery. OBJECTIVE: To report the case of a child with femoral hernia, resolved by laparoscopy. CASE REPORT: Male, 5 years old, with a history of bilateral cryptorchidism resolved at 2 years of age. Current condition with a month of evolution with an increase in volume in the outer third of the groin. Ultrasound reported aponeurotic defect along with the right femoral vessels. Laparoscopic approach, with defect findings below the inguinal ligament. No recurrence at 12 months follow-up. DISCUSSION: Femoral hernias are rare in children, their diagnosis is difficult. Laparoscopic examination allowed its identification, finding a defect below the inguinal ligament and adjacent to the femoral vessels independent of the deep inguinal ring and the transversalis fascia.

Simultaneous mechanical ventilation of several patients with a single ventilator.

INTRODUCTION: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. OBJECTIVE: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. RESULTS: No statistically significant differences were observed between programmed, recorded and measured positive end-expiratory pressure, mean airway pressure and peak pressure, except when simultaneously ventilating four lung simulators. CONCLUSIONS: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

INTRODUCCIÓN: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. OBJETIVO: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro. RESULTADOS: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. CONCLUSIONES: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Ventilación mecánica simultánea con un solo ventilador a varios pacientes / Simultaneous mechanical ventilation of several patients with a single ventilator

Resumen Introducción: La ventilación mecánica simultánea a varios pacientes con un solo ventilador podría disminuir el déficit de esos dispositivos para atender a los enfermos con insuficiencia respiratoria aguda por Covid-19. Objetivo: Comunicar los resultados de un ejercicio de ventilación mecánica con un ventilador en un simulador de pulmón, y simultáneamente en dos y cuatro simuladores. Resultados: No se observaron diferencias estadísticamente significativas entre la presión positiva al final de la espiración, presión media de la vía aérea y presión pico programadas, registradas y medidas, excepto al ventilar simultáneamente cuatro simuladores de pulmón. Conclusiones: La ventilación mecánica simultánea debe ser instaurada por personal médico con experiencia en el procedimiento, restringirse a dos pacientes y ser realizada en la unidad de cuidados intensivos.

Abstract Introduction: Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. Objective: To communicate the results of a mechanical ventilation exercise with a ventilator in a lung simulator, and simultaneously in two and four. Results: No statistically significant differences were observed between positive end-expiratory pressure, mean airway pressure, and programmed, recorded and measured peak pressure, except when simultaneously ventilating four lung simulators. Conclusions: Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.

Laparoscopic Collis-Nissen approach for shortened esophagus treatment in children.

BACKGROUND: Short esophagus is a disability to obtain a proper portion of abdominal esophagus, thus a lengthening technique is required. Collis approach is the best option. OBJECTIVE: To demonstrate effectiveness of laparoscopic Collis-Nissen approach in children. METHOD: Retrospective and descriptive case series performed in children with reflux and short esophagus, Collis esophagoplasty was carried out with stapler, together with fundoplication. Age, symptomatology, surgical background, oral nutrition beginning, hospital stay, complications and reflux control were recorded. RESULTS: Eight children, 4-15 years old were treated from 2005 to 2017. Three of them with slipped fundoplication background and two with esophageal atresia. The rest of the children had no background, two of them with stenosis. Symptoms; cough 8/8, abdominal pain 5/8, dysphagia 3/8. Without complications. Oral nutrition beginning at the 5th day. Up to 10 years follow-up, with complete remission of the symptomatology in 6 years. DISCUSSION: Since a true short esophagus diagnosis depends on transurgical findings, pediatric surgeons should notice this entity when practicing any antireflux procedure. Laparoscopic Collis-Nissen approach is safe and efficient in these patients.

ANTECEDENTES: El esófago corto es la imposibilidad de obtener una porción adecuada de esófago abdominal, por lo que se requiere alguna técnica de alargamiento. La mejor opción es el procedimiento de Collis. OBJETIVO: Demostrar la eficacia del procedimiento de Collis-Nissen por laparoscopía en niños. MÉTODO: Estudio retrospectivo, descriptivo, serie de casos, niños con reflujo y esófago corto, esofagoplastía de Collis con engrapadora y funduplicatura. Se analizaron edad, sintomatología, antecedentes quirúrgicos, tiempo quirúrgico, inicio de vía oral, tiempo de hospitalización, complicaciones y control del reflujo. RESULTADOS: De 2005 a 2017 se trataron ocho niños de 4 a 15 años. De ellos, tres con antecedente de funduplicatura deslizada y dos con antecedente de atresia esofágica. El resto sin antecedentes, dos con estenosis. Síntomas; tos 8/8, dolor abdominal 5/8, disfagia 3/8. Sin complicaciones. Inició de vía oral al quinto día. Seguimiento de hasta 10 años, con remisión total de la sintomatología en seis casos. DISCUSIÓN: Debido a que el diagnóstico de esófago corto verdadero depende de los hallazgos transoperatorios, los cirujanos pediatras deben reconocer esta condición al momento de practicar cualquier procedimiento antirreflujo. El procedimiento de Collis-Nissen laparoscópico es una opción segura y eficaz en estos pacientes.

Laparoscopic Approach of the Obstruction of the Lower Third of the Esophagus in Children.

Objective: To review the diagnostic methodology in pediatric patients with obstruction of the lower third of the esophagus as well as minimally invasive therapeutic options. Materials and Methods: Retrospective study carried out reviewing records of children with esophageal obstruction diagnostic, from 2000 to 2018. They were divided into Group I stenosis secondary to reflux; Group II achalasia; and Group III embryonic remnants. Results: Thirty-three patients. Group I: 7; esophageal barium swallow irregular stenosis of the distal third and endoscopy irregular stenosis in 7. Treated with laparoscopic fundoplication 2, Collis Nissen 5. Group II: 22 patients, age X = 11.55 years. All with dysphagia and symmetrical stenosis of esophagogastric junction. Fifteen underwent manometry and all underwent intraoperative endoscopy. All had laparoscopic myotomy, with 2 perforations and no conversions, 2 patients had subsequent dysphagia to solids, and they did not need esophageal dilatation. Group III: 4 patients, stenosis was above esophagogastric junction. On endoscopy, inflammation was present in all 3 with irregular esophagogastric junction and difficulty passing endoscope. Three patients underwent laparoscopic resection and anastomosis. One patient leaked and developed a fistula. One patient has not been operated upon as yet. Conclusions: In those patients, the best surgical option depends upon the diagnosis. Esophageal barium studies and endoscopy allow discerning among them.

Management of Pediatric Urolithiasis Using a Combination of Laparoscopic Lithotomy and Pyeloscopy.

BACKGROUND: Minimally invasive procedures have become the standard option for treatment of urinary stones; the use of more invasive techniques is not a common practice currently. This emergent technology is not always available and laparoscopy is the alternative option. There are few reports of laparoscopic management for urinary lithiasis in pediatric patients. This study is about the use of laparoscopic surgery combined with pyeloscopy as a feasible first-line treatment for pediatric urolithiasis in renal and proximal ureteral locations. PATIENTS AND METHODS: We reviewed the records of 14 patients with renal and proximal ureteral stones who underwent laparoscopic pyelolithotomy and pyeloscopy in a period from January 2011 to July 2016. The outcome measures were needed for auxiliary procedures, treatment success, and complication rates. RESULTS: A total of 16 procedures were carried out in 14 patients, 15 transperitoneal and 1 retroperitoneal laparoscopic pyelolithotomies were done. It was necessary to perform upper ureterolithotomies to remove ureteral stones in 2 cases. The holmium laser and/or pneumatic lithotripter were used to fragment staghorn calculi. Some of the complications were blood transfusion in 12.5% and self-limited urinary leak in 18.7% of the patients. The success rate after undergoing one procedure was 92.8%. CONCLUSIONS: Transperitoneal or retroperitoneal laparoscopic lithotomy is a safe and feasible procedure for the treatment of pediatric urolithiasis. It can be an alternative to shock-wave lithotripsy and percutaneous nephrolithotomy when these are not feasible or possible.