[Gastroschisis. Preterm elective cesarean and immediate primary closure: our experience]. / Gastrosquisis. Cesárea electiva pretérmino y cierre primario inmediato; nuestra experiencia.

PURPOSE: Our experience en treatment of gastroschisis using a protocol with elective preterm delivery by caesarean section at 34-35 weeks and immediate primary abdominal wall closure. METHODS: During a period of 18 month we treated 5 patients with gastroschisis using the following management pathway: Starting at 30th week of gestation, weekly ultrasound evaluation of fetal gut and pulmonary maturation with corticosteroids. Delivery by elective caesarean section between 34-35 weeks or earlier if evidence of bowel compromise was reported en ultrasound study. Immediate surgical correction after birth with primary closure was preformed under control of abdominal pressure. RESULTS: Mean gestational age of our patient was 33,94 weeks, and mean birth weight was 2154 gr. None of the cases present inflammatory peel and we found no difficulties for reduction of the gut at time of surgery. Two patients presented an intestinal malrotation. Extubation was preformed 36-48 hours after surgery. We started a trofic diet at 3,6 days and parental nutrition was retired after a mean period of 15,8 days. The mean time of hospital stay was 33,4 days. One patient with intestinal obstruction had a consideriously increased length of hospital stay of 74 days. CONCLUSIONS: A management pathway for gastroschisis with selective preterm delivery by caesarean section and immediate surgical treatment probably reduces the experience of inflammatory peel. This pathway permits a early initiation of oral feeding, reduces times of parenteral nutrition and need of central catheters, and shortens length of hospital stay.

[Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis]. / Valor de la cistogammagrafía directa en el diagnóstico del reflujo vesicoureteral en pacientes con hidronefrosis prenatal.

OBJECTIVE: As the radiation received in conventional cystography is about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral reflux, we consider the use of radionuclide cystography in early detection of reflux in patients with prenatally detected hydronephrosis. MATERIALS AND METHODS: Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide scintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed severe dilatation, or in general in cases with parenchymatous atrophy or if a duplex system was suspected. RESULTS: In 13 (20%) of the 65 cases (18 kidneys) reflux was detected (3 minor, 8 moderate and 7 severe). In most cases, follow up was performed with radionuclide cystography. None of the patients with reflux placed on prophylactic antibiotics developed a febrile urinary tract infection during the first year of life. CONCLUSIONS: Direct radionuclide cystography is a useful diagnostic method in early detection of vesicoureteral reflux in patients with prenatal hydronephrosis with higher sensitivity than conventional cystography, and with an important advantage concerning radiation of the patient. Patients screened and placed on prophylactic antibiotics are probably going to present less episodes of pielonephrytis.

Gastrosquisis. Cesárea electiva pretérmino y cierre primario inmediato; nuestra experiencia / Gastroschisis. preterm elective cesarean and immediate primary closure: our experience

Objetivos. Presentar nuestra experiencia de 5 casos de gastrosquisis con un protocolo de parto por cesárea electiva entre las 34-35 semanas de gestación y cierre primario inmediato en una nota clínica. Material y métodos. En un periodo de 18 meses se han tratado 5pacientes con gastrosquisis con el siguiente protocolo: monitorización ecográfica semanal a partir de los 30 semanas y maduración pulmonar fetal; cesárea electiva entre las 34 y 35 semanas o ante la presencia de signos ecográficos de sufrimiento intestinal; corrección quirúrgica inmediata postparto con cierre primario de la pared bajo control de la presión abdominal. Resultados. La edad gestacional media de los pacientes ha sido de33,94 semanas, el peso medio fue de 2.154 g. No observamos engrosamiento de las asas (peel) en ninguno de los casos y no objetivamos dificultad para la reducción de las asas en la cavidad abdominal. Dos pacientes presentaron una mal rotación intestinal asociada. Se logró la extubación entre las 36 y 48 horas. Instauramos una dieta trófica a los3,6 días de media. La retirada de la nutrición parenteral fue posible a los15,8 días de media y el alta hospitalaria, a los 33,4 días de media. Un caso de oclusión intestinal pre-alta alargó considerablemente la estancia hospitalaria de este paciente (74 días).Conclusiones. Nuestra experiencia apoya el manejo terapéutico de las gastrosquisis mediante cesárea electiva pretérmino y tratamiento quirúrgico inmediato, probablemente sirve para evitar la aparición del temido peel. Este protocolo permite iniciar una dieta oral precozmente ,reduce el tiempo de nutrición parenteral, la necesidad de vías centrales con el riesgo de sepsis y acorta la estancia hospitalaria (AU)

Purpose. Our experience en treatment of gastroschisis using a protocol with elective preterm delivery by caesarean section at 34-35 weeks and immediate primary abdominal wall closure. Methods. During a period of 18 month we treated 5 patients with gastroschisis using the following management pathway: Starting at 30thweek of gestation, weekly ultrasound evaluation of fetal gut and pulmonary maturation with corticosteroids. Delivery by elective caesarean section between 34-35 weeks or earlier if evidence of bowel compromise was reported en ultrasound study. Immediate surgical correction afterbirth with primary closure was preformed under control of abdominal pressure. Results. Mean gestational age of our patient was 33,94 weeks, and mean birth weight was 2154 gr. None of the cases present inflamatory peel and we found no difficulties for reduction of the gut at time of surgery. Two patients presented an intestinal malrotation. Extubation was preformed 36-48 hours after surgery. We started atrophic diet at 3,6 days and parental nutrition was retired after a mean period of 15,8 days. The mean time of hospital stay was 33,4 days. One patient with intestinal obstruction had a consideriously increased length of hospital stay of 74 days. Conclusions. A management pathway for gastroschisis with selective preterm delivery by caesarean section and immediate surgical treatment probably reduces the experience of infl ammatory peel. This pathway permits a early initiation of oral feeding, reduces times of parenteral nutrition and need of central catheters, and shortens lengthof hospital stay (AU)

Valor de la cistogammagrafía directa en el diagnóstico del reflujo vesicoureteral en pacientes con hidronefrosis prenatal / Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis

Objetivo. Dado que la radiación recibida en una cistografía convencional, es del orden de 20 veces superior a la de una cistografía isotópica y que la sensibilidad de ésta última, es más alta en el diagnóstico del reflujo vésicoureteral, nos planteamos su utilización en el despistaje de este, en pacientes con hidronefrosis congénita. Material y métodos. En el periodo 2003-2009, se ha aplicado el siguiente protocolo a los neonatos con antecedentes de hidronefrosis prenatal con la finalidad de descartar reflujo. Profilaxis antibiótica si se confirma en ecografía a la semana de vida la dilatación de la vía excretora, a las 6 semanas de vida, se realiza nuevo control ecográfico, en el cual si la ectasia es superior a 8 mm, se practica cistogammagrafía directa. Si se trata de un niño de sexo masculino con dilatación o afectación parenquimatosa severa, o en casos en que se sospeche duplicidad, se practica cistografía convencional. Resultados. De los 65 casos estudiados, se ha detectado reflujo en 13 pacientes (20%) en 18 unidades renales (3 leve, 8 moderado y7 severo). El seguimiento se ha realizado en la mayoría de casos concistografía isotópica. Ninguno de los 13 pacientes con refl ujo a los que (..) (AU)

Objective. As the radiation received in conventional cystographyis about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral refl ux, we consider the use of radionuclide cystography in early detection of refluxin patients with prenatally detected hydronephrosis. Materials and methods. Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide escintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed (..) (AU)