[Comparative study of the effect of two analgesic techniques in postoperative pain control in pediatric surgery]. / Estudio comparativo de dos técnicas analgésicas en el postoperatorio de Cirugía Pediátrica.

OBJECTIVE: The study purpose was to evaluate the analgesic efficacy of the association of paracetamol + metamizol versus tramadol in pediatric surgery. METHODS: A prospective, randomized and double-blinded study of 60 patients between 3 and 8 years, undergoing abdominal surgery in the ambulatory unit. Patients were divided into 2 groups who received paracetamol plus metamizol (Group I) or tramadol (Group II), prior to the end of the procedure. The anesthetic technique in all cases consisted of general anesthesia balanced. The study compared the pain intensity according to the Wong-Baker scale, the need of rescue analgesia, and the side effects every hour in the postoperative period. The statistical analysis was performed using the chi-square test and T-Student test. RESULTS: The analgesia time for Group I was 202 ± 25 minutes and 215 ± 17 minutes for Group II without statistical significance. There was no significant differences (p= 0.233) in the pain scores; only 3 children in the first group had more than 4 points on the Wong-Baker scale versus 5 children in the tramadol group. The overall side effects were significantly higher (p< 0.05) in Group II, 5 patients presented vomiting compared to no child in Group I. The average dose of morphine chloride was 0.6 ± 0.2 mg. CONCLUSIONS: Both techniques provide adequate pain control in the postoperative period of abdominal ambulatory surgery in pediatric patients. However, children treated with tramadol presented a greater number of side effects compared to the NSAIDs group.

OBJETIVO: Evaluar la eficacia analgésica de la asociación paracetamol + metamizol frente a tramadol en Cirugía Pediátrica. MATERIAL Y METODOS: Se realiza un estudio prospectivo, randomizado y a doble ciego, se seleccionaron 60 pacientes de entre 3 y 8 años programados para cirugía abdominal ambulatoria, divididos en 2 grupos, al grupo I se les administró paracetamol y metamizol intravenosos y al grupo II tramadol intravenoso, previos a la finalización de la intervención. La técnica anestésica consistió en anestesia general balanceada. Se valoró en el periodo postoperatorio la intensidad del dolor según la escala de Wong-Baker, la necesidad de analgesia de rescate y los efectos indeseables. El análisis estadístico se realizó mediante el test de Chi-cuadrado y la t-Student. RESULTADOS: El tiempo de analgesia para el grupo I fue de 202 ± 25 minutos y para el grupo II 215 ± 17 minutos sin significación estadística. Solo 3 niños en el grupo I presentaron valores superiores a 4 en la escala de Wong-Baker y 5 en el grupo II sin diferencias significativas (p= 0,233). En el grupo II presentaron vómitos 5 pacientes frente a ningún niño en el grupo I con diferencias estadísticamente significativas (p< 0,05). La dosis media de cloruro mórfico fue de 0,6 ± 0,2 mg. CONCLUSIONES: Ambas técnicas proporcionan una analgesia adecuada en el postoperatorio de la cirugía abdominal ambulatoria. Destaca un mayor número de efectos secundarios en el grupo del tramadol frente al grupo de los AINEs.

[Adherence to the treatment of pre surgical nasoalveolar molding in cleft lip and palate]. / Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina.

OBJECTIVES: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. MATERIALS AND METHODS: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher's exact correction. RESULTS: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. CONCLUSIONS: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater.

OBJETIVOS: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. MATERIAL Y METODOS: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. RESULTADOS: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. CONCLUSIONES: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor.

Development of a multilayered palate substitute in rabbits: a histochemical ex vivo and in vivo analysis.

Current tissue engineering technology focuses on developing simple tissues, whereas multilayered structures comprising several tissue types have rarely been described. We developed a highly biomimetic multilayered palate substitute with bone and oral mucosa tissues using rabbit cells and biomaterials subjected to nanotechnological techniques based on plastic compression. This novel palate substitute was autologously grafted in vivo, and histological and histochemical analyses were used to evaluate biointegration, cell function, and cell differentiation in the multilayered palate substitute. The three-dimensional structure of the multilayered palate substitute was histologically similar to control tissues, but the ex vivo level of cell and tissue differentiation were low as determined by the absence of epithelial differentiation although cytokeratins 4 and 13 were expressed. In vivo grafting was associated with greater cell differentiation, epithelial stratification, and maturation, but the expression of cytokeratins 4, 13, 5, and 19 at did not reach control tissue levels. Histochemical analysis of the oral mucosa stroma and bone detected weak signals for proteoglycans, elastic and collagen fibers, mineralization deposits and osteocalcin in the multilayered palate substitute cultured ex vivo. However, in vivo grafting was able to induce cell and tissue differentiation, although the expression levels of these components were always significantly lower than those found in controls, except for collagen in the bone layer. These results suggest that generation of a full-thickness multilayered palate substitute is achievable and that tissues become partially differentiated upon in vivo grafting.

[Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis]. / Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica?

OBJECTIVE: To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. METHODS: Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. RESULTS: During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). CONCLUSIONS: Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay.

OBJETIVO: Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. METODO: Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. RESULTADOS: En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). CONCLUSIONES: Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria.

[Analysis of the medical decision in abdominal pain suggestive of acute appendicitis]. / Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda.

OBJECTIVES: Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. METHODS: Retrospective cohort of 184 patients treated from January 2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendiceal disease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. RESULTS: The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3 points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant 94% and an increase in diagnostic certainty of 48 points. DISCUSSION: It is recommended to base the development of protocols and clinical guidelines in practice of test ultrasound as first, and joint determination of inflammatory markers, when that was questionable or negative. Further studies are proposed to increase the clinical certainty to reduce laparotomy white and diagnostic delays in this condition.

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

[Generation of a substitute for human oral mucosa and verification of its viability by tissue-engineering]. / Generación de un sustituto de mucosa oral humana y comprobación de su viabilidad mediante ingeniería tisular.

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues. This way, tissue ingineering techniques may provide a source of autologous tissues available for transplant in these patients. In this work, we have developed a new model for artificial oral mucosa generated by tissue engineering using a fibrin-agarosa scaffold. For that purpose, we have generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal mucosa oral using enzymatic treatments. Then, we have determined the viability of cultured cells by electron probe quantitative X-ray microanalysis, and we have demonstrated that most of the cells in the primary cultures were alive and hd high K/Na ratios. Once cell viability was determined, we used cultured fibroblasts and keratinocytes to develop an artificial oral mucosa construct by using a fibrin-agarosa extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral mucosa controls. The epithelium of the oral substitutes had several layers, with desmosomes and apical microvilli and microplicae. Both the controls and de oral mucosa substitutes showed high suprabasal expression of cytokeratin 13 and low expression of cytokeratin 10. All these results suggest that our model of oral mucosa using fibrin-agarose scaffolds show several similarities with native human oral mucosa.

Estudio comparativo de dos técnicas analgésicas en el postoperatorio de Cirugía Pediátrica / No disponible

Objetivo: Evaluar la eficacia analgésica de la asociación paracetamol + metamizol frente a tramadol en Cirugía Pediátrica. Material y métodos: Se realiza un estudio prospectivo, randomizado y a doble ciego, se seleccionaron 60 pacientes de entre 3 y 8 años programados para cirugía abdominal ambulatoria, divididos en 2 grupos, al grupo I se les administró paracetamol y metamizol intravenosos y al grupo II tramadol intravenoso, previos a la finalización de la intervención. La técnica anestésica consistió en anestesia general balanceada. Se valoró en el periodo postoperatorio la intensidad del dolor según la escala de Wong-Baker, la necesidad de analgesia de rescate y los efectos indeseables. El análisis estadístico se realizó mediante el test de Chi-cuadrado y la t-Student. Resultados: El tiempo de analgesia para el grupo I fue de 202 ± 25 minutos y para el grupo II 215 ± 17 minutos sin significación estadística. Solo 3 niños en el grupo I presentaron valores superiores a 4 en la escala de Wong-Baker y 5 en el grupo II sin diferencias significativas (p= 0,233). En el grupo II presentaron vómitos 5 pacientes frente a ningún niño en el grupo I con diferencias estadísticamente significativas (p< 0,05). La dosis media de cloruro mórfico fue de 0,6 ± 0,2 mg. Conclusiones: Ambas técnicas proporcionan una analgesia adecuada en el postoperatorio de la cirugía abdominal ambulatoria. Destaca un mayor número de efectos secundarios en el grupo del tramadol frente al grupo de los AINEs

Objective: The study purpose was to evaluate the analgesic efficacy of the association of paracetamol + metamizol versus tramadol in pediatric surgery. Methods: A prospective, randomized and double-blinded study of 60 patients between 3 and 8 years, undergoing abdominal surgery in the ambulatory unit. Patients were divided into 2 groups who received paracetamol plus metamizol (Group I) or tramadol (Group II), prior to the end of the procedure. The anesthetic technique in all cases consisted of general anesthesia balanced. The study compared the pain intensity according to the Wong-Baker scale, the need of rescue analgesia, and the side effects every hour in the postoperative period. The statistical analysis was performed using the chi-square test and T-Student test. Results: The analgesia time for Group I was 202 ± 25 minutes and 215 ± 17 minutes for Group II without statistical significance. There was no significant differences (p= 0.233) in the pain scores; only 3 children in the first group had more than 4 points on the Wong-Baker scale versus 5 children in the tramadol group. The overall side effects were significantly higher (p < 0.05) in Group II, 5 patients presented vomiting compared to no child in Group I. The average dose of morphine chloride was 0.6 ± 0.2 mg. Conclusions: Both techniques provide adequate pain control in the postoperative period of abdominal ambulatory surgery in pediatric patients. However, children treated with tramadol presented a greater number of side effects compared to the NSAIDs group

Adherencia al tratamiento de moldeado nasoalveolar en pacientes con fisura labiopalatina / No disponible

Objetivos: El dispositivo de moldeamiento nasoalveolar (NAM), diseñado para aproximar los segmentos fisurados y mejorar la asimetría nasal, facilita la intervención quirúrgica mejorando los resultados. Sin embargo, necesita gran colaboración por parte de la familia por ser largo, y a veces, tedioso. El objetivo de este trabajo es determinar la adherencia al tratamiento y las posibles variables que puedan determinar su rechazo. Material y métodos: Pacientes tratados con NAM en los últimos 6 años (64 pacientes). Recogida de datos retrospectiva (historias) y encuesta telefónica. Clasificación en 5 grupos según el seguimiento del tratamiento (rechazo del tratamiento hasta un cumplimiento correcto del tratamiento). Analizamos factores relacionados con el cuidador, el paciente y el contexto social (nivel de estudios, número de cuidadores, distancia al hospital, etc.). Mediante el programa SPSS se realizó un estudio descriptivo, analizando las variables mediante chi2 con corrección exacta de Fisher. Resultados: Se completaron las 46 encuestas (32 niños y 14 niñas), el 63% fueron unilaterales, el 91% con fisura palatina. El cumplimiento terapéutico fue bueno en el 80%, y solo el 7% rechazaron el tratamiento. La adherencia fue mayor, de forma significativa, si habían contactado con otras familias de pacientes (P< 0,01) y tendencia a mayor abandono en otras nacionalidades distinta a la española, aunque sin significación estadística. Conclusiones: El cumplimiento terapéutico de estos pacientes es bueno de forma general, y no podemos determinar de forma significativa las variables que pueden condicionar el rechazo al tratamiento, pero si, que el contacto con familiares de afectados o asociaciones de pacientes hacen que la adherencia sea mayor

Objectives: The nasoalveolar molding device (NAM) designed to decrease the size of the defect and improve nasal asymmetry, facilitates surgical intervention improving the results. However, family involvement is highly necessary due to the fact that the treatment herein referred is long and tedious. The aim of this study is to determine adherence to treatment and possible variables that can determine their rejection. Materials and methods: Patients treated with NAM over the last 6 years (64 patients). Retrospective data collection and telephone surveys. 5 groups established depending on its respective adherence to the treatment (from rejection of the treatment to good adherence to it). Several aspects are herein analyzed related to the caregiver, the patient and the social background (degree of education, number of caregivers, distance to the hospital, etc.). Through the SPSS program, a descriptive study was carried out, analyzing the variables using chi2 with Fisher’s exact correction. Results: 46 surveys were completed (32 boys and 14 girls), 63% were unilateral, 91% had a cleft palate. Adherence to the treatment was good by 80%, and only 6% rejected the treatment. The adherence was significantly higher, if they had contacted with other families of patients (P < 0.01) and a higher tendency of abandonment of treatment in other nationalities than the Spanish one, although without significant differences. Conclusions: Adherence to treatment is very good in general, and we can not significantly determine the variables that can condition the rejection of treatment, but contacting with family members of patients or associations of patients makes the adherence greater

Tratamiento de las oclusiones postoperatorias en niños: ¿adhesiolisis abierta o laparoscópica? / Treatment of the postoperative bowel obstructions in children: laparoscopic vs. open adhesiolysis

Objetivo. Comparar los resultados de la adhesiolisis laparoscópica frente a la técnica abierta en niños con oclusiones postoperatorias. Método. Estudio retrospectivo de los pacientes intervenidos por oclusiones postoperatorias en nuestro centro. Se recogieron variables demográficas, las características clínicas del paciente y del cuadro oclusivo y los resultados postoperatorios. Resultados. En los últimos 8 años, se han realizado 37 intervenciones por oclusiones intestinales postoperatorias: un 40,5% mediante laparoscopia y un 59,5% mediante laparotomía. La media de edad fue 6,31 y 4,32 años para la técnica laparoscópica y abierta, respectivamente. No encontramos diferencias en el tiempo de evolución del cuadro oclusivo, ni en los antecedentes quirúrgicos. Sin embargo, el grupo de adhesiolisis laparoscópica presentó mejores resultados que el de cirugía abierta en: necesidad de vía central (15% frente a 61,90% p= 0,012), uso parenteral (38,46% frente a 83,33% p= 0,005), reinicio de la nutrición enteral (4,04 días frente a 8,17 p= 0,004) y estancia postoperatoria (7,77 frente a 13,05 días p= 0,027). Conclusiones. Ambos abordajes son eficaces para la resolución de la oclusión. La adhesiolisis laparoscópica aporta ventajas frente a la cirugía abierta: menor necesidad de vía central y de nutrición parenteral, reinicio precoz de la nutrición enteral y menor estancia hospitalaria

Objective. To compare the results of laparoscopic versus open adhesiolysis in children affected by postoperative bowel obstruction. Methods. Retrospective study reviewing charts of all patients who were operated on due to postoperative adhesions in our Department. Demographic data, clinical characteristics and postoperative data were collected. Results. During the last 8 years, 37 patients were operated on for postoperative intestinal obstructions. 40.5% were operated by laparoscopy and 59.5% by laparotomy. Mean ages were 6.31 and 4.32 years in laparoscopic and open groups, respectively. There were no differences in days of evolution of the occlusion, neither in their medical history. Patients in laparoscopic group had better outcomes in the need of central lines (15% vs 61.90% p= 0.012), use of parenteral nutrition (38.46% vs 83.33% p= 0.005), beginning of the enteral nutrition (4.04 vs 8.17 days p= 0.004) and hospital stay (7.77 vs 13.05 days p= 0.027). Conclusions. Open and laparoscopic adhesiolysis are effective to treat adhesive cases. Laparoscopic adhesiolysis has some advantages over open surgery: less need of central lines and parenteral nutrition, earlier start of enteral nutrition, less rate of complications and shorter hospital stay

Angioqueratoma solitario de lengua en una niña de 7 años / Solitary angiokeratoma of the tongue in a girl 7 years old

Los angioqueratomas son malformaciones vasculares, caracterizadas por ectasias vasculares en la dermis papilar con hiperplasia epitelial e hiperqueratosis reactiva, que pueden aparecer de manera aislada o como forma sistémica generalizada asociados a enfermedades metabólicas. El angioqueratoma solitario de mucosa oral es una lesión poco frecuente, que hasta la comunicación de Sipponen, en 2006, se creía siempre típica de las formas sistémicas y muy rara en las localizadas. Su aparición en la infancia es, asimismo, poco frecuente, habiéndose descrito hasta la fecha sólo 5 casos en menores de 18 años, aunque algunos autores señalan que puede tratarse de una enfermedad infradiagnosticada de ahí la importancia de su adecuado estudio y diagnóstico. Presentamos el caso de una paciente de 7 años de edad, con una lesión rojiza en el dorso de la lengua, no dolorosa, sin antecedente traumático, en cuyo examen físico se observó una lesión de 14 mm de diámetro en el borde derecho de la lengua, con múltiples pápulas eritematosas, sin apreciarse otros cambios en la mucosa oral. Se realizó una extirpación bajo anestesia general, y el diagnóstico se verificó por examen histopatológico de la pieza extirpada (AU)

Angiokeratomas are vascular malformations characterized by vascular ectasia in the papillary dermis with reactive epithelial hyperplasia and hyperkeratosis, which can occur in isolation or as widespread systemic form associated with metabolic diseases. The solitary angiokeratoma of the oral mucosa is a rare injury, which to Sipponen communication in 2006, always believed typical of systemic forms and very rare in localized. Its occurrence in childhood is likewise rare, having been described to date only 5 cases in children under 18, although some authors suggest that this may be an underdiagnosed disease, hence the importance of adequate study and diagnosis. We report a 7 years with a reddish lesion on the dorsum of the tongue, no pain, no history of trauma, in which physical examination showed a lesion of 14 mm in diameter in right right edge of the tongue with multiple erythematous papules, showing no other changes in the oral mucosa. Excision was performed under general anesthesia and the diagnosis was verified by histopathological examination of the resected specimen (AU)

Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda / Analysis of the medical decision in abdominal pain suggestive of acute appendicitis

Objetivos. Aplicación del teorema de Bayes al estudio de la utilidad de las pruebas complementarias cuantitativas, y valoración cualitativa de la efi cacia del diagnóstico ecográfi co, con objeto de dotar al clínico de una herramienta para evaluar con exactitud la efectividad de dichas pruebas en el diagnóstico del dolor abdominal susceptible de cuadroapendicular. Método. Cohorte retrospectiva de 184 pacientes atendidos desde enero 2009 a junio 2010 por dolor abdominal sugestivo de abdomen agudo, de los que 145 fueron intervenidos. Se fijaron como variables predictoras de enfermedad apendicular la exploración abdominal, la ecografía y los valores plasmáticos de PCR y leucocitos. La metodología estadística se desarrolló según la sistemática bayesiana, previa determinación de curva ROC, y cálculo de momios y probabilidades postprueba, según la probabilidad preprueba basada en la exploración física. Resultados. El análisis ROC fi jó los puntos de corte de las pruebas cuantitativas en valores de leucocitos >12.800 y PCR >1,8 mg/dl. La aplicación del modelo al contaje leucocitario aumentó la certidumbre clínica de esta prueba en 11,3 puntos y de la PCR en 13,9. El uso combinado(..) (AU)

Objectives. Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. Methods. Retrospective cohort of 184 patients treated from January2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendice aldisease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. Results. The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant (..) (AU)

Moldeamiento nasoalveolar prequirúrgico en el niño con fi sura labiopalatina / Presurgical nasoalveolar molding a child with cleft lip and palate

Las fisuras labiopalatinas son una de las patologías que más se benefi cian de la creación de Unidades multidisciplinares (cirujanos pediátrico, maxilofacial y plástico, ortodoncista, otorrinolaringólogo, logopeda, psicólogo, etc.). Los objetivos del tratamiento ortodóncico y ortopédico prequirúrgico son: 1.- Alinear los segmentos alveolares y reducir la anchura de la fi sura para facilitar la queiloplastia. 2.- Guiar el crecimiento de los segmentos en que se halla dividido el maxilar. 3.- Mejorar la función lingual. 4.- Moldear los cartílagos nasales y la columela. Revisamos la evolución en los resultados en el tratamiento con moldeado nasoalveolar prequirúrgico (PNAM) en 15 pacientes tratados en la Unidad de Fisurados Labiopalatinos del Hospital Virgen de las Nieves (10 unilateral y 5 bilateral). Tres pacientes no completaron el tratamiento por falta de colaboración de los padres que lo abandonaron por el llanto del niño. En todos los pacientes que lo completaron se consiguió una importante mejoría en la alineación y separación de los segmentos alveolares así como en la forma del cartílago alar. La curva de aprendizaje en el moldeamiento hace que cada vez los resultados sean mejores y la comunicación entre los padres de los pacientes tratados hace que los abandonos sean prácticamente nulos (AU)

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.- Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.- To guide the growth of the segments in which the jaw is divided. 3.- Improve lingual function. 4.- Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby’s crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero (AU)

Generación de un sustituto de mucosa oral humana y comprobación de su viabilidad mediante ingeniería tisular / Generation of a substitute for human oral mucosa and verification of its viability by tissue-engineering

La reconstrucción de grandes defectos de mucosa oral a menudo es desafiante, por la escasez de mucosa oral sana para reemplazar tejidos dañados. De esta forma, las técnicas de ingeniería tisular pueden suponer una fuente de tejidos autólogos disponible para trasplantar a estos pacientes. En este trabajo hemos desarrollado un nuevo modelo de mucosa oral artificial generada mediante ingeniería tisular usando un soporte de fibrina-agarosa. Para ello, se han generado cultivos primarios de fibroblastos de la mucosa oral humana y queratinocitos a partir de pequeñas biopsias de mucosa oral normal y aplicándoles tratamiento senzimáticos. Después, se ha determinado la viabilidad de las células cultivadas mediante microanálisis por rayos-X, demostrando que la mayoría de las células de los cultivos primarios estaban vivas y tenían elevados K/Na ratios. Una vez que la viabilidad celular fue determinada, se usaron los fibroblastos y queratinocitos cultivados para desarrollar un constructo de mucosa oral sobre una matriz extracelular de (..) (AU)

Reconstruction of large oral mucosa defects is often challenging, since the shortage of healthy oral mucosa to replace the excised tissues. This way, tissue ingineering techniques may provide a source of autologoustissues available for transplant in these patients. In this work, wehave developed a new model for artificial oral mucosa generated by tissue engineering using a fibrin-agarosa scaffold. For that purpose, we have generated primary cultures of human oral mucosa fibroblasts and keratinocytes from small biopsies of normal mucosa oral using enzymatic treatments. Then, we have determined the viability of cultured cells by electron probe quantitative X-ray microanalysis, and we have demonstrated that most of the cells in the primary cultures were alive and hd high K/Na ratios. Once cell viability was determined, we used cultured fibroblasts and keratinocytes to develop an artificial oral mucosaconstruct by using a fibrin-agarosa extracellular matrix and a sequential culture technique using porous culture inserts. Histological analysis of the artificial tissues showed high similarities with normal oral (..) (AU)

Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales / Mandibular distraction osteogenesis in patients with craniofacial malformation

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular severa, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural; ende cúbito prono puede ser necesario monitorizar la saturación de oxígeno ,insertar un tubo nasofaríngeo e incluso endotraqueal. En casos más severos con pausas prolongadas y frecuentes de apnea la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y ocasional mente mortalidad. En los últimos dos años, en la Unidad Multidisciplinar de Labio y Fisura Palatina del Hospital Virgen de las Nieves, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular severa mediante distracción mandibular osteogénica, mostrándose este procedimiento eficaz en la resolución del problema. Ha evitado la traqueostomía, se ha elongado la mandíbula en el plazo de 2-3 semanas, en este tiempo han desaparecido los problemas respiratorios obstructivos y también de la deglución, siendo los resultados estéticos obtenidos excelentes y las complicaciones, por el momento, mínimas (AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy maybe necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, mínimum (AU)