[Risk factors for the development of severe gastroesophageal reflux in neonates with congenital diaphragmatic hernia surgery]. / Riesgo para desarrollar reflujo gastroesofágico severo en neonatos operados de hernia diafragmática congénita.

BACKGROUND: Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to 89 % of patients, out of which 20 to 30 % will require surgical management. Identification of risk factors for the development of this complication might allow for a Nissen fundoplication to be performed at the sime surgical time in those requiring it. The purpose of this research was to identify those factors in children with diaphragmatic hernia surgery. METHODS: A case-control study was conducted, where patients with diaphragmatic hernia surgery treated between 2006 and 2011 were included. Patients with severe gastroesophageal reflux were regarded as the cases, whereas those who did not develop it over the 1-year follow up were the controls. RESULTS: Nine patients developed severe gastroesophageal reflux after the diaphragmatic hernia surgery. A large size of the hernia, it containing 4 or more organs, 10 days or more of ventilatory support requirement after the surgery or high mechanical ventilation variables significantly increased the risk for the development of severe gastroesophageal reflux. CONCLUSIONS: Presurgical risk factors such as large hernias or hernias containing more than 4 organs might suggest the convenience of conducting a fundoplication at the same time of the diaphramatic hernia surgical correction.

INTRODUCCIÓN: el reflujo gastroesofágico posterior a la reparación de la hernia diafragmática congénita se presenta hasta en 89 % de los pacientes; de ellos, 20 a 30 % requerirá manejo quirúrgico. Conocer los factores de riesgo para desarrollar esta complicación podría permitir realizar funduplicatura Nissen en el mismo tiempo quirúrgico en quienes sea necesaria. El objetivo de esta investigación fue identificar esos factores en niños operados de hernia diafragmática. MÉTODOS: se realizó un estudio de casos y controles en el que se incluyeron neonatos operados de hernia diafragmática que fueron atendidos entre 2006 y 2011. Se consideró como casos a los pacientes con reflujo gastroesofágico severo y como controles a quienes no lo presentaron en el seguimiento de un año. RESULTADOS: se incluyeron 24 pacientes posoperados de hernia diafragmática; nueve de ellos presentaron reflujo gastroesofágico severo después de la cirugía de la hernia diafragmática. Se identificaron como factores que incrementaron significativamente el riesgo para desarrollar reflujo gastroesofágico severo, el tamaño amplio de la hernia, que esta contuviera cuatro o más órganos, la necesidad de 10 días o más de asistencia ventilatoria después de la cirugía y los valores altos de las variables de ventilación mecánica. CONCLUSIONES: los factores de riesgo prequirúrgicos como hernias amplias o con cuatro o más órganos podrían sugerir al cirujano realizar funduplicatura en el mismo tiempo quirúrgico de la corrección de la hernia diafragmática.

[Age of onset of different malignant tumors in childhood]. / Edad de aparición de los diferentes tumores malignos en la infancia.

OBJECTIVE: To identify the main age of onset of different malignant tumors in childhood and to describe the distribution of the different tumors in each pediatric age group. MATERIAL AND METHODS: Descriptive survey was used. We reviewed the files of six Mexico City hospitals from 1980 to 1992. We included 4595 cases divided into 13 types of cancer. Peak age was defined when in that year we encountered a frequency equal to or below 10 % of the cases. RESULTS: Peak ages for hepatic, sympathetic nervous system, germ cell tumors, retinoblastoma and rhabdomyosarcoma were between 2 and 3 years of age. Wilms' tumor appeared between the first and fourth years; central nervous system tumors between 4 and 5 years; acute lymphoblastic leukemia between 2 and 4 years; non-Hodgkin's lymphomas between 3 and 6 years; Hodgkin's disease between 4 and 8 years; bone tumors between 10 and 14 years. In acute myeloid leukemia and carcinomas no age peak was found. CONCLUSIONS: Lymphomas present an age peak different from that reported in developed countries. In neonates and infants, the most frequent tumor was retinoblastoma.

[Neuroblastoma: prognostic factors and survival. Experience in Hospital de Pediatria del Centro Medico Nacional del Siglo XXI and review of the literature]. / Neuroblastoma: factores pronósticos y sobrevida. Experiencia en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI y revisión de la literatura.

Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period, respectively. According to histology there was 91% survival for differentiated and 23% for undifferentiated tumors. The chemotherapeutic regimen reported is effective but not better than that reported by other authors, in which some benefits are seen with use of transplant and immunotherapy. The most important prognostic factors are still considered to be age, stage and histology.

[Trends in the incidence of hepatic tumors in childhood]. / Tendencia de la incidencia de los tumores hepáticos en la infancia.

OBJECTIVE: To evaluate the incidence trends of hepatic tumors among children living in Mexico City. MATERIAL AND METHODS: A cross-sectional hospital survey was conducted to yield two databases. The first database contains the registry of all the cases of hepatic tumors occurring during the period 1982-1991, in public hospitals of Mexico City. The second database contains all hepatic tumor cases found between 1996 and 1999 in Hospital de Pediatría del Centro Médico Nacional "Siglo XXI" and in Hospital General del Centro Médico La Raza, both hospitals pertaining to Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). The average annual incidence rates (AAIR) were calculated for each type of hepatic tumor. The rates were standardized with the direct method, using as standard the world population under 15 years of age. The trends were evaluated with the annual incidence rates and the average rate of change assuming a Poisson distribution. RESULTS: The AAIR for hepatoblastoma during the period 1982-1991 was three times higher for men than for women, with a value of 0.6 x 10(6). The group of 1-4 years of age was the most affected. For hepatocarcinomas the AAIR was two-fold for women (0.14) as compared to men. Between 1996-1999 the AAIR for hepatoblastoma was 5.11 in women and 1.85 in men. The age group with the highest rate was women under one year of age. The AAIR for hepatocarcinoma was 0.64 for males and 1.23 for females. The most affected age group was males aged 10 to 14 years. No significant upward or downward trend was found in the incidence of hepatoblastomas. A non-significant change rate of 10% was found for hepatocarcinoma. CONCLUSIONS: No significant trends were observed in the incidence of hepatic tumors in children of Mexico City aged under 15 years, during the periods 1982-1991 and 1996-1999. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Tendencia de la incidencia de los tumores hepáticos en la infancia / Trends in the incidence of hepatic tumors in childhood

OBJECTIVE: To evaluate the incidence trends of hepatic tumors among children living in Mexico City. MATERIAL AND METHODS: A cross-sectional hospital survey was conducted to yield two databases. The first database contains the registry of all the cases of hepatic tumors occurring during the period 1982-1991, in public hospitals of Mexico City. The second database contains all hepatic tumor cases found between 1996 and 1999 in Hospital de PediatrÝa del Centro MÚdico Nacional "Siglo XXI" and in Hospital General del Centro MÚdico La Raza, both hospitals pertaining to Instituto Mexicano del Seguro Social (Mexican Institute of Social Security). The average annual incidence rates (AAIR) were calculated for each type of hepatic tumor. The rates were standardized with the direct method, using as standard the world population under 15 years of age. The trends were evaluated with the annual incidence rates and the average rate of change assuming a Poisson distribution. RESULTS: The AAIR for hepatoblastoma during the period 1982-1991 was three times higher for men than for women, with a value of 0.6 x 10(6). The group of 1-4 years of age was the most affected. For hepatocarcinomas the AAIR was two-fold for women (0.14) as compared to men. Between 1996-1999 the AAIR for hepatoblastoma was 5.11 in women and 1.85 in men. The age group with the highest rate was women under one year of age. The AAIR for hepatocarcinoma was 0.64 for males and 1.23 for females. The most affected age group was males aged 10 to 14 years. No significant upward or downward trend was found in the incidence of hepatoblastomas. A non-significant change rate of 10 was found for hepatocarcinoma. CONCLUSIONS: No significant trends were observed in the incidence of hepatic tumors in children of Mexico City aged under 15 years, during the periods 1982-1991 and 1996-1999. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Eficacia del levamisol en el tratamiento de niños con papilomatosis recurrente y refractaria a los tratamientos convencionales / Efectiveness of levamisole in the treatment of children with recurrent and refractory papillomatosis to conventional therapeutic measures

La finalidad de este estudio fue demostrar la utilidad del levamisol en el tratamiento de niños con papilomatosis recurrente o refractaria a los tratamientos convencionales. El diseño del estudio fue de ensayo terapéutico. Se incluyeron en el mismo ocho niños con edad promeio de 6.8 años con papilomatosis bucal, genital o perianal. Todos se habían sometido a tratamiento previo. Los ocho pacientes recibieron levamisol a dosis diarias de 2.5 mg por kilogramo de peso cuatro días a la semana, con duración total del tratamiento de dos a 22 meses. El control previo al tratamiento y subsecuente al mismo fue fotográfico y con citología hemática. Se considera que, de los ocho pacientes, seis tuvieron una reacción adecuada. En 33 por ciento de los pacientes las lesiones desaparecieron totalmente, en 50 por ciento la regresión fue de 75 por ciento, y en 16 por ciento la regresión de las lesiones fue de 50 por ciento al momento del corte. Se concluye que en niños el levamisol es útil para el tratamiento de la papilomatosis, y que se puede utilizar con seguridad