Efficacy of 1-day vs. 2-day intestinal preparation using peg 3350 + Bisacodyl: A randomized clinical trial. / Eficacia de la preparación intestinal con un día de PEG 3350 + bisacodilo en comparación con dos días: ensayo clínico aleatorizado.

OBJECTIVE: The objective was to compare the efficacy of 1-day intestinal preparation for colonoscopy using PEG 3350 (polyethylene glycol) (4 g/kg/day) + bisacodyl vs. 2-day intestinal preparation using PEG 3350 (2 g/kg/day) + bisacodyl in pediatric patients. MATERIALS AND METHODS: A blind, randomized clinical trial was carried out with endoscopists who assessed colon cleansing. Patients aged 2-18 years old undergoing scheduled colonoscopy were included. They were randomized into 2 groups: 1-day preparation using PEG 3350 (4 g/kg/day) + bisacodyl, and 2-day preparation using PEG 3350 (2 g/kg/day) + bisacodyl. Endoscopic evaluation (Boston Scale) allowed the efficacy of both preparations to be assessed. Statistical analysis: T of Student for quantitative variables, and Chi square for qualitative variables. RESULTS: 72 patients with a mean age of 94 ± 49 months were included. No significant difference was found between groups regarding preparation difficulty and safety. Efficacy, assessed using the Boston Scale score and the proportion of excellent and good grades achieved, was higher in the 1-day group. Left colon score and total score were higher than in the 2-day group (left colon: 2.20 vs. 1.89, p=0.03; total score: 7.28 vs. 6.76, p=0.01) (left colon: 94.4% vs. 83.4%, p=0.034). CONCLUSIONS: Efficacy in the quality of intestinal preparation for colonoscopy was higher in the 1-day group using PEG 3350 + oral bisacodyl than in the 2-day group.

OBEJTIVO: Comparar la eficacia de la preparación intestinal para colonoscopia con 1 día de preparación con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo en comparación con 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo en pacientes pediátricos. MATERIAL Y METODOS: Se realizó un ensayo clínico, aleatorizado y cegado para los médicos endoscopistas que evaluaron la limpieza del colon. Se incluyeron pacientes de 2 a 18 años, que ameritaban colonoscopia en forma programada. Se aleatorizaron a los pacientes en dos grupos: 1 día de preparación con PEG 3350 (4 g/kg/día) + bisacodilo y 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo. Por medio de valoración endoscópica (escala de Boston) se determinó la eficacia de las dos preparaciones a evaluar. Análisis estadístico: T de student para cuantitativas y Chi2 para cualitativas. RESULTADOS: Se incluyeron 72 pacientes con edad promedio de 94 ± 49 meses. No hubo diferencia significativa entre los grupos con respecto a la dificultad y seguridad de la preparación. La eficacia, evaluada por el puntaje de la escala de Boston y la proporción de calificación excelente o buena, fue mejor en el grupo de un 1 día, el colon izquierdo y el puntaje total fue mejor en comparación al grupo de 2 días (colon izquierdo 2,20 vs. 1,89 p= 0,03 y total 7,28 vs. 6,76 p= 0,01) (colon izquierdo 94,4 vs. 83,4% p= 0,034). CONCLUSIONES: La eficacia de la calidad en la preparación intestinal para colonoscopia fue mejor entre el grupo de 1 día con PEG 3350 + bisacodilo vía oral en comparación a la preparación de 2 días.

Preoperative catheterization of H-type tracheoesophageal fistula to facilitate its localization and surgical correction.

PURPOSE: The aim of this study was to demonstrate that preoperative catheterization of H-type tracheoesophageal fistula facilitates its identification and surgical correction. METHODS: This is a case series of seven patients with H-type tracheoesophageal fistula. Diagnosis was established in three patients and suspected in two more by means of an esophagogram. Confirmation of fistula was performed by endoscopy in all patients. On the day of surgery, either a rigid bronchoscope or a nasolaryngoscope was introduced into the trachea to localize and catheterize the fistula. Because of the location of the fistula, the surgical correction was performed through the neck in five patients and through the thorax in two patients. The fistulas were easily identified surgically and the corrections were successfully performed in all cases. An extensive dissection was not required in any case. Refistulization, identified by bronchoscopic examination one week after surgery, occurred in one patient. Surgical repair was performed again using same procedure described above. All patients are currently asymptomatic and without any evidence of refistulization. CONCLUSIONS: Preoperative catheterization of H-type tracheoesophageal fistula is useful to facilitate its preoperative identification, to plan the surgical approach, and to decrease operating times and the extent of surgery.

A new endoscopic procedure for membranectomy of fenestrated duodenal membranes.

AIM OF THE STUDY: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes. METHODS: With the patients under general anesthesia and tracheally intubated, a flexible video-panendoscope was introduced into the second portion of the duodenum. The fenestrated membrane was visualized and a triple-lumen stone extraction balloon of 15 mm was inserted through the fenestration. After the balloon was insufflated, gentle traction was performed in order to expose the fenestrated membrane and differentiate it from the normal duodenal wall. The orifice was dilated in order to introduce the endoscope and localize the Vater's ampulla. A sphincterotome was used to carry out one or two incisions of 1.5 to 2 cm in the membrane in the opposite direction to the ampulla. RESULTS: The procedure was successfully performed in five patients with a mean surgical time of 50 minutes. None of the patients complained of postoperative pain. Peristalsis was not affected, and patients started intake of oral fluids at approximately 24 hours. On discharge patients were completely asymptomatic, and four patients were followed up for one year following the procedure and remained asymptomatic. One patient who was also asymptomatic did not continue follow-up longer than two weeks after the procedure. CONCLUSION: Endoscopic membranectomy of duodenal membranes is a safe and effective procedure that reduces surgical times, postoperative fasting times and the length of hospitalization, and probably has no postoperative complications.

Benefits of oral administration of an electrolyte solution interrupting a prolonged preoperatory fasting period in pediatric patients.

PURPOSE: The aim of this study was to evaluate the benefits of an oral isosmolar solution of electrolytes (ISE) administered to interrupt a prolonged fasting period in children undergoing an elective surgical procedure under general anesthesia. METHODS: Forty unpremedicated children aged 3 to 12 years, ASA I, undergoing a surgical procedure requiring general anesthesia were assigned randomly to 1 of 2 groups. Group 1 consisted of patients with an overnight fasting period for milk and solids of at least 8 hours. In group 2, patients under a similar fasting period received a volume of 4 mL/kg of an oral ISE 3 hours before completing the fasting period. After anesthetic induction, blood glucose level (BGL) was quantified, and patients underwent an endoscopic examination to obtain the gastric content to determine the residual gastric volume (RGV) and pH levels. RESULTS: In group 1, the RGV was 0.78 +/- 0.44 mL/kg, pH was 1.75 +/- 0.38, and BGL was 86.4 +/- 14.5. In group 2, the RGV was 0.40 +/- 0.29 mL/kg, pH was 3.18 +/- 0.61, and BGL was 85.1 +/- 12.6. Only RGV and pH were significantly different between groups. CONCLUSION: A prolonged fasting period interrupted with oral ISE administration resulted in an RGV of low risk, without counterbalancing a potential fasting-induced hypoglycemia.

[Congenital cystic adenomatoid malformation of the lung. A report of 12 cases]. / Malformación adenomatoidea quística pulmonar congénita. Presentación de 12 casos.

The congenital cystic adenomatoid malformation of the lung is uncommon. In the Hospital Infantil de México Federico Gómez, 12 cases have been seen over a period of 31 years, which points out how rare this malformation is. There was a male predominance, and 75% of the patients had symptoms by 8 months of age. The main complaints were progressive respiratory failure in the newborn period and recurrent lung infection in older children. Treatment was surgical in all cases. There was only one fatality due to cardiac failure.

[Diaphragmatic eventration. Our experience with 50 cases]. / Eventración diafragmática. Experiencia de 50 casos.

Diaphragmatic eventration is the abnormal elevation of the diaphragm as a result of paralysis, aplasia or atrophia of the muscular fibers. This is a diagnostic problem specially in the newborn. The objective of this report is present the clinical course and surgical management of 50 cases attended in the Hospital Infantil de México Federico Gómez. Of them, 56% were males; eight were newborns; five with previous surgery. The clinical course was variable; the landmark was the chest X-ray findings. There were operated 36 cases. The right diaphragm was the most frequent affected; the surgical management was with thoracotomy in the great majority of them. In 30 cases had good evolution two years after surgery.

[Congenital lobar emphysema]. / Enfisema lobar congénito.

This article includes the way cases of congenital lobe emphysema were treated at the Hospital Infantil de México "Federico Gómez" during 1971 to 1989. A total of 17 cases were gathered, 13 were males and 4 were females; admittance age varied from 13 days to 3 years. The children's main symptoms were respiratory failure and cyanosis. The diagnosis was enhanced by a chest X-ray where lobe hyperclarity was detected, as well as a deviation of the mediastinum and a collapsed lung. A lobectomy was performed in all cases. The upper left lobe was seen to be the most affected. Two of the children died. It is important to recognize this disease early on and conduct prompt surgical treatment.