[When is it best to perform enterostomy closure in premature infants with necrotizing enterocolitis?]. / ¿Cuándo es mejor cerrar la enterostomía en prematuros con enterocolitis necrosante?

UNLABELLED: INTRODUCION AND AIM: The enterostomy used in the treatment of Necrotizing Enterocolitis (NEC) causes many complications before and after its closure. The aim of this study was to examine the complications of closure aiming at determining the best timing for this operation. PATIENTS AND METHOD: Retrospective review patients (p) below 1500 g with NEC in whom the enterostomy was closed in the last seven years. P were divided into two groups: PC (planned closure after uncomplicated postoperative period) and CC (advanced closure due to stomal--excessive looses--or to parenteral nutrition complications--septicemia, liver dysfunction-). We compared the age at closure, time of enterostomy, weight gain and complications. RESULTS: Out of a total of 25 p requiring surgical treatment for NEC, 16 from the PC group and 9 from the CC group were included. The mean age at the moment of the closure were, respectively, 129 + 65 vs. 204 +/- 121 days (p < 0.05). Weight at closure was 2665 +/- 841 vs. 4665 +/- 2076 g (p < 0.05); the mean time with the enterostomy was 105 +/- 64 vs. 187 +/- 116 d (p < 0.05), and the weight gain was 1779 +/- 859 vs. 3693 +/- 2155 g (p < 0.05). After stomal closure, 7/16 p of the CC group (43%) and 2/9 of the PC group (22%) required reoperation due to severe complications (ns). In 4 of them, three of the CC group and one of the PC group, a new enterostomy was performed. CONCLUSIONS: In p with enterostomy-related complications, closure has often to be advanced and it is performed in deficient nutritional conditions. Severe complications after enterostomy closure required reoperation in 43% of the CC group and in 22% of the PC group. Although there was no statistically significant difference, the trend indicates an augmented risk in CC group. The timing for enterostomy closure should be chosen individually. At the time of indicating the closure, the high risk of complications, should be taken into account particularly in preterms with enterostomy-related problems.

[The treatment of the tracheobronchial stenosis by extracorporeal circulation]. / Tratamiento de las estenosis traqueo-bronquiales mediante circulación extracorpórea.

Six children with tracheobronchial stenosis secondary to cardiovascular ring were operated with extracorporeal surgery. Three of them with pulmonary sling had a tracheobroncoplasty with costal cartilage, one with xiphoides appendix and another with pericardio. One girl 2 years old was operated resecting three tracheal rings and anastomosis end to end. The child that was operated with pericardio died with infection and sepsis three months after the operation. The other five are well five, four and two years after plasty.

[Fibroadenoma of the breast in a 17 month old girl]. / Fibroadenoma de mama en una niña de 17 meses.

Breast pathology is uncommon in infancy and adolescence. Fibroadenoma is the most frequent lesion. The juvenile variant is rare, occurring in only 2-7% of all the fibroadenomas. We report a case of juvenile breast fibroadenoma in a patient of 17 months of age.

[Bilateral diaphragmatic hernia]. / Hernia diafragmática bilateral.

Six cases of bilateral diaphragmatic hernia are described between 145 congenital diaphragmatic hernia in Department of Pediatric Surgery, "La Paz" Children's Hospital of Madrid since 1966 to 1986. All patients showed symptoms early after birth. Death occurred almost immediately in five cases, for the severe bilateral pulmonary hypoplasia and the malformations associated in the most them (cardiac, genitourinary, digestive system and metabolic). One patient was alive for 22 days. We study the obstetrical history and the evolution of our patients.

[Achalasia of the cricopharyngeal muscle in the infant]. / Achalasia del músculo cricofaríngeo en el lactante.

Two patients with Cricopharyngeal achalasia have been treated at the Clínica Infantil "La Paz" (Madrid) in the last 20 years. They were one and a half, and four and a half months old at the time of operation. The postoperative period and follow-up has been satisfactory. Clinical symptoms in both of them were cough, cyanosis, regurgitation and aspirative pneumonia. One of them came with the diagnosis of congenital esophageal stenosis, and the other one with the diagnosis of tracheoesophageal fistula. The diagnosis was confirmed by endoscopy and barium-X-ray. Section of the Cricopharyngeus muscle was curative and recovery of the normal function has been complete.

[Neonatal appendicitis. Presentation of three cases (author's transl)]. / Apendicitis neonatal. Aportación de tres casos.

Authors present three patients with acute appendicitis developed during the first month of life. Up to 1975 they found only 106 cases described in the Spanish, French and English literature. The rarity of this pathology together with extreme difficulty in clinical and radiological diagnosis, usually produces a delay of treatment with logical increase of mortality. Their three patients were operated through laparotomy and one through right herniography. None of them had intestinal aganglionosis.

[Congenital diaphragmatic hernia: an analysis of the results and prognostic factors prior to the development of an ECMO program]. / Hernia diafragmática congénita: análisis de resultados y factores pronósticos previos al desarrollo de un programa de ECMO.

BACKGROUND: Some neonates with congenital diaphragmatic hernia (CDH) and persistent pulmonary hypertension are not adequately oxygenated with conventional treatment. The extracorporeal membrane oxygenation (ECMO) has been successful in some of them as an alternative in their management. PATIENTS AND METHODS: We studied the charts of 47 neonates with CDH, symptomatic within 24 hours of birth, treated in our institution during the last seven years (1987-1994). In all of them, conventional ventilation and hemodynamic support was used. In 12 patients high frequency ventilation (HFV) was used and two survived. In all patients we analyzed the following ventilatory and gasometric parameters: Oxygenation index (OI)*, ventilatory index (VI)** and postductal PCO2. In 15 neonates who did not survive, a necropsy was performed and a morphometric parameter, pulmonary index (PI)*** was studied. RESULTS: The overall survival was 60%. VI and OI showed significant differences (p < 0.001) between survivors and non-survivors with values of 460.9 +/- 303 vs 1532 +/- 500.6, respectively for VI and 10.3 +/- 5.7 vs 46.2 +/- 37.8, respectively for IO. There were no significant differences in postductal PCO2. Mean PI in the 15 non-survivors was 0.0072 +/- 0.002 (normal > 0.015). Regression coefficients of PI with OI or VI were not significant. Neonates with VI < 1000 and OI < 40 survived. All patients with VI > 1000 and OI > 40 died. Some babies with VI > 1000 and OI < 40 (21.6%) survived. CONCLUSIONS: In our experience, the use of HFV did not improve the prognosis of these patients, but we believe that the use of ECMO in those patients with VI > 1000, and overall, patients with VI > 1000 and OI < 40 would improve the survival rates of this congenital malformation. *QI = FiO2 x MAP/PO2 postductal x 100. (MAP = Median airway pressure). **VI = VR x MAP (VR = Ventilatory rate). ***PI = Pulmonary weight/Body weight.

¿Cuándo es mejor cerrar la enterostomíaen prematuros con enterocolitis necrosante? / When is it best to perform enterostomy closure in premature infants with necrotizing enterocolitis?

Introducción y objetivos. Revisar las complicaciones del cierre de enterostomía usada en el tratamiento de la enterocolitis necrosante(ECN) con el fin de precisar el momento más oportuno para esta operación. Pacientes y métodos. Estudio retrospectivo de los pacientes (p)< 1.500 g con ECN y en quienes se cerró la ostomía en los últimos 7años. Dividimos a los pacientes en dos grupos: CP (cierre programado por evolución sin incidentes) y CC (cierre adelantado por complicaciones del estoma o de la nutrición parenteral). Comparamos edad en el momento del cierre, tiempo de enterostomía, ganancia ponderal y complicaciones. Resultados. De un total de 37 p, 16 (64%) se incluyeron en el grupoCC y 9 (36%) en el CP. La edad al cierre fue respectivamente de 129± 65 vs. 204 ± 121 días (p < 0,05). El peso en el momento del cierre fuede 2.665 ± 841 vs. 4.665 ± 2.076 g (p < 0,05), el tiempo medio con el (..) (AU)

Introduction and aim. The enterostomy used in the treatment of Necrotizing Enterocolitis (NEC) causes many complications before and after its closure. The aim of this study was to examine the complications of closure aiming at determining the best timing for this operation. Patients and method. Retrospective review patients (p) below1,500 g with NEC in whom the enterostomy was closed in the last seven years. P were divided into two groups: PC (planned closure after uncomplicated postoperative period) and CC (advanced closure dueto stomal –excessive looses– or to parenteral nutrition complications–septicemia, liver dysfunction–). We compared the age at closure, time (..) (AU)

Presente y futuro de la cirugía neonatal / Neonatal surgery: the present and the future

La Cirugía Neonatal debe considerarse como una parte de la Cirugía Perinatal que se ocupa de los procedimientos quirúrgicos que se realizan en el feto y en el neonato antes y después del parto. Su desarrollo ha sido espectacular en las últimas décadas gracias sobre todo al desarrollo de la Ecografía, la creación de Unidades de Cuidado intensivo neonatal , la cirugía fetal y la Anestesia Pediátrica. Por otro lado la legalización del aborto y la disminución de la natalidad han influido negativamente en su desarrollo. El futuro de nuestra especialidad se adivina con avances espectaculares en el área de los procedimientos quirúrgicos, trasplantes de órganos, ingeniería tisular, terapia génica etc (AU)