Matrix Cauterization With Silver Nitrate in the Treatment of Ingrown Toenails in Children: Pilot Study. / [Artículo traducido] Cauterización de la matriz con nitrato de plata para el tratamiento de las uñas encarnadas en los dedos de los pies en niños: estudio piloto.

BACKGROUND: Although partial onychectomy with chemical matricectomy has been described asthe treatment of choice, there is sparse evidence in the literature regarding the use of silvernitrate for matricectomy. Our aim is to describe the effectiveness of silver nitrate for matrixcauterization after partial onychectomy. METHODS: A prospective observational study was performed on patients with ingrown toenailsstage 2-3 who underwent partial onychectomy with silver nitrate chemical matricectomy during 2018-2019 in our institution. All patients were evaluated in the outpatient clinic on the 7th and 30th post-operative day and a telephone evaluation was performed every 6 months afterthe surgical procedure to date. RESULTS: One hundred and twenty-three patients, who underwent 231 partial onychectomies with silver nitrate chemical matricectomy were included, with a median follow-up of 21 months (interquartile range, 12-29). The procedure had an effectiveness of 95.3%, with only 11 recur-rences (4.7%) reported so far on follow-up. Postoperative infections were observed in 4 patients (1.7%). Adverse effects, such as pain and postoperative drainage, were irrelevant in mostpatients. CONCLUSIONS: Silver nitrate matricectomy after partial onychectomy is an effective and safealternative for the treatment of ingrown toenail in children, with scarce postoperative morbidityand low recurrence rate.

Matrix Cauterization With Silver Nitrate in the Treatment of Ingrown Toenails in Children: Pilot Study.

BACKGROUND: Although partial onychectomy with chemical matricectomy has been described as the treatment of choice, there is sparse evidence in the literature regarding the use of silver nitrate for matricectomy. Our aim is to describe the effectiveness of silver nitrate for matrix cauterization after partial onychectomy. METHODS: A prospective observational study was performed on patients with ingrown toenails stage 2-3 who underwent partial onychectomy with silver nitrate chemical matricectomy during 2018-2019 in our institution. All patients were evaluated in the outpatient clinic on the 7th and 30th post-operative day and a telephone evaluation was performed every 6 months after the surgical procedure to date. RESULTS: One hundred and twenty-three patients, who underwent 231 partial onychectomies with silver nitrate chemical matricectomy were included, with a median follow-up of 21 months (interquartile range, 12-29). The procedure had an effectiveness of 95.3%, with only 11 recurrences (4.7%) reported so far on follow-up. Postoperative infections were observed in 4 patients (1.7%). Adverse effects, such as pain and postoperative drainage, were irrelevant in most patients. CONCLUSIONS: Silver nitrate matricectomy after partial onychectomy is an effective and safe alternative for the treatment of ingrown toenail in children, with scarce postoperative morbidity and low recurrence rate.

Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform? / Apendicectomía incidental en el tratamiento quirúrgico de la intususcepción ileocólica en niños. ¿Es segura?

BACKGROUND: Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection. MATERIALS AND METHODS: A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed. RESULTS: A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not. CONCLUSIONS: Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.

OBJETIVO: El tratamiento quirúrgico de la intususcepción ileocólica (IIC) es la segunda causa más frecuente de laparotomía de urgencia en niños. La realización de una apendicectomía incidental tras la reducción quirúrgica sigue siendo motivo de controversia. El objetivo de este trabajo es analizar los resultados obtenidos al llevar a cabo una apendicectomía incidental tras la reducción quirúrgica de una IIC con o sin resección intestinal asociada. MATERIAL Y METODO: Se realizó un estudio retrospectivo en pacientes con episodios de IIC sometidos a tratamiento quirúrgico en nuestro centro entre 2005 y 2019. Los pacientes se dividieron en dos grupos según se llevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad de practicar resección intestinal en ambos grupos. Se analizaron las variables demográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias y las recidivas. RESULTADOS: Se incluyeron un total de 101 pacientes (77 en el grupo AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron un total de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupo NA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AA frente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospitalaria (mediana de 5 días en ambos grupos). Tampoco se registraron diferencias en términos de complicaciones posoperatorias o recidivas entre los dos grupos. El análisis estratificado mostró que la resección intestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a cabo apendicectomía asociada o no. CONCLUSION: La apendicectomía incidental durante el tratamiento quirúrgico de la IIC en niños es un procedimiento seguro que no aumenta el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias ni las posibilidades de recidiva.

Impact of the COVID-19 pandemic on acute appendicitis in children.

BACKGROUND AND OBJECTIVES: Since the COVID-19 pandemic confinement was established in Spain on March 9, 2020, the number of visits to the pediatric Emergency Department (ED) has decreased dramatically, probably due to the fear of parents becoming infected in the hospital environment. The aim of this work was to analyze the medium-term consequences during the first 9 months after the onset of the COVID-19 pandemic in children with acute appendicitis (AA). MATERIAL AND METHODS: A retrospective study was performed on children operated on for AA in our institution between 2017 and 2020, who were distributed in two groups according to the date of surgery: COVID-19 group (after March 9, 2020) and control group (before March 9, 2020). Demographic variables, associated symptoms, time from symptoms onset, hospital stay, rate of complicated AA and postoperative complications were analyzed. RESULTS: A total of 1274 patients were included (288 COVID group; 986 control group), without demographic differences. Time from symptom onset was significantly longer in COVID-19 group (34.5 vs. 24.2h; p=0.021), although no differences in associated symptoms were observed between both groups. COVID-19 group presented a higher rate of complicated AA (20.1% vs. 14%; OR: 1.55; CI 95% [1.10-2.18]; p=0.008), a longer hospital stay (3.5 vs. 2.8 days; p=0.042) as well as a higher rate of postoperative complications (21.5% vs. 15.7%; OR: 1.47; CI 95% [(1.06-2.04)]; p=0.008). CONCLUSION: In our experience there was a negative medium-term effects of the COVID-19 pandemic on children with acute appendicitis: delayed ED visits, increased rate of complicated AA, increased hospital stay and increased postoperative complications.

Aberrant muscular hyperplasia of the hand and PIK3CA related overgrowth spectrum disorders. A case series study. / Hiperplasia muscular aberrante de la mano y síndromes de sobrecrecimiento relacionados con el PIK3CA. Serie de casos.

INTRODUCTION: Congenital muscular hyperplasia of the hand is a rarely described entity, characterized by the presence of aberrant or accessory muscles in the hypothenar eminence, which has been always reported as sporadic anomaly in the medical literature. The aim of this paper is to report a series of cases with a phenotype of aberrant muscle hyperplasia associated with PIK3CA mutations. MATERIAL AND METHODS: We describe a retrospective series of cases followed at our institution between 2008 and 2020, with a unique phenotypein the context of PIK3CA mutations. RESULTS: A total of 6 patients were included (4 males and 2 females), who presented with an enlargement of the hypothenar eminence of the hand and peculiar wrinkling of the overlying skin, associated with ulnar deviation of the metacarpo-phalangeal joints. In all cases, variable degrees of congenital overgrowth of the ipsilateral limb were observed. Skin punch biopsy (5 mm diameter and 3-5 mm depth) was performed on 4 patients, where striated muscle hyperplasia and the presence of striated muscular fibers in the dermis and hypodermis were observed in all of them. Genetic studies revealed PIK3CA mutation in 3 of the 4 patients whose affected tissue was analyzed, in a mosaic state ranging from 3 to 8% (His1047Arg, Glu542Lys, and Cys420Arg, 1 case each). CONCLUSION: Aberrant muscular hyperplasia of the hand is a well-recognized entity scarcely described in association with PIK3CA spectrum disorder in the pediatric population. The role of PIK3CA in muscle overgrowth is not yet well understood.

INTRODUCCION: La hiperplasia muscular congénita de la mano es una entidad rara, caracterizada por la presencia de músculos aberrantes o accesorios en la eminencia hipotenar, que siempre se ha descrito en la literatura médica como una anomalía esporádica. El objetivo de este artículo es informar de una serie de casos con fenotipo de hiperplasia muscular aberrante asociada a mutaciones del PIK3CA. MATERIAL Y METODOS: Serie retrospectiva de casos atendidos en nuestro centro entre 2008 y 2020, con un fenotipo único en el contexto de las mutaciones del PIK3CA. RESULTADOS: Se incluyeron un total de 6 pacientes (4 masculinos y 2 femeninos) con ensanchamiento de la eminencia hipotenar de la mano y arrugamiento peculiar de la piel suprayacente, asociado a desviación ulnar de las articulaciones metacarpofalángicas. En todos los casos se observaron grados variables de sobrecrecimiento congénito del miembro ipsilateral. Se realizó biopsia cutánea por punch (5 mm de diámetro y 3-5 mm de profundidad) en 4 pacientes con hiperplasia muscular y presencia de fibras musculares estriadas en dermis e hipodermis. Los estudios genéticos revelaron mutación del PIK3CA en 3 de los 4 pacientes, cuyo tejido afectado fue enviado a analizar, con mosaicismo de entre el 3 y el 8% (His1047Arg, Glu542Lys y Cys420Arg respectivamente). CONCLUSION: La hiperplasia muscular aberrante de la mano es una entidad reconocida pero escasamente descrita en asociación con síndromes relacionados con el PIK3CA en la población pediátrica. A día de hoy sigue desconociéndose el papel del PIK3CA en el sobrecrecimiento muscular.

Does time to antibiotic initiation and surgery have an impact on acute appendicitis results? / ¿Influye el tiempo hasta el inicio de la antibioterapia y la intervención en los resultados de la apendicitis aguda?

OBJECTIVE: Time to treatment initiation is a key element to be considered in infectious pathologies such as acute appendicitis (AA). There are few articles in the literature analyzing the relationship between early pre-surgical antibiotic treatment initiation and complication occurrence in AA. Our objective is to analyze such influence and the effects of late treatment initiation. MATERIALS AND METHODS: A retrospective, observational study was carried out in children undergoing surgery for AA between 2017 and 2018. Demographic variables, time to antibiotic treatment initiation, time to surgery, and postoperative complications were analyzed. RESULTS: 592 patients with a median 12-month follow-up were included in the study. Antibiotic treatment initiation in the first 8 hours following diagnosis prevents complications [OR 0.24 (95% CI: 0.07-0.80)] and dramatically reduces the occurrence of intra-abdominal abscess from 25.0% to 5.5% (p=0.03). Antibiotic treatment initiation in the first 4 hours following diagnosis significantly reduced wound infection rate in non-overweight patients [2.9% vs. 13.6%; OR 0.19 (95% CI: 0.045-0.793); p=0.042]. Surgery within the first 24 hours following diagnosis reduced the proportion of advanced AA (gangrenous appendicitis and peritonitis) from 100% to 38.6% (p=0.023). CONCLUSIONS: Antibiotic treatment initiation in the first 4 hours following AA prevented the occurrence of post-surgical complications, especially in non-overweight patients. An adequate clinical approach and an early assessment by the pediatric surgeon are key to reduce the morbidity associated with AA.

OBJETIVO: El tiempo hasta el inicio del tratamiento es un elemento fundamental a considerar en patologías infecciosas como la apendicitis aguda (AA). Existen escasos artículos en la literatura que analicen la relación entre el inicio precoz de la antibioterapia prequirúrgica y el desarrollo de complicaciones en la AA. Nuestro objetivo es analizar dicha influencia y el efecto de su retraso. MATERIAL Y METODOS: Se realizó un estudio observacional retrospectivo en niños intervenidos de AA entre 2017-2018. Se analizaron variables demográficas, tiempo transcurrido hasta el inicio de la antibioterapia, tiempo hasta la cirugía y complicaciones postoperatorias. RESULTADOS: Se incluyeron 592 pacientes con mediana de seguimiento de 12 meses. El inicio de la antibioterapia en las primeras 8 horas tras el diagnóstico previene la aparición de complicaciones [OR 0,24 (IC95% 0,07-0,80)], disminuyendo significativamente el porcentaje de aparición de abscesos intraabdominales del 25,0 al 5,5% (p= 0,03). El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico disminuyó significativamente la tasa de infección de herida en pacientes sin sobrepeso [2,9 vs. 13,6%; OR 0,19 (IC95% 0,045-0,793); p= 0,042]. La intervención quirúrgica en las primeras 24 horas tras el diagnóstico disminuyó la proporción de AA evolucionada (gangrenada y peritonitis) del 100 al 38,6% (p= 0,023). CONCLUSIONES: El inicio de la antibioterapia en las primeras 4 horas tras el diagnóstico de AA previno el desarrollo de complicaciones postquirúrgicas, sobre todo en pacientes sin sobrepeso. Una orientación clínica adecuada y valoración precoz por el cirujano pediátrico son un elemento clave para disminuir la morbilidad asociada a la AA.