Opciones terapéuticas para la retirada de “superpegamentos” de la piel / Therapeutic options for removing superglues from the skin

El cianocrilato es un compuesto adhesivo que se utiliza en la fabricación de “superpegamentos”. En contacto con tejidos de algodón o lana puede producir quemaduras térmicas. Por el contrario, en contacto sobre piel sana se han descrito dermatitis de contacto o alérgica pero no quemaduras. Caso clínico. Niña de 8 años que acude a urgencias tras haber derramado de manera accidental un “superpegamento” directamente sobre una mano y ambas extremidades inferiores, permaneciendo con el pegamento en contacto con la piel durante 3 horas sin poder retirarlo en domicilio. En la exploración destacaba gran eritema en varias regiones subyacentes al pegamento, sin ampollas, heridas ni sangrado. El pegamento se retiró bajo sedoanalgesia con lavavajillas líquido diluido en agua tibia, sin apreciarse solución de continuidad ni quemadura. Conclusiones. Existen numerosas medidas para la retirada de adhesivos de la piel. Escoger la opción terapéutica viene determinado, entre otros factores, por la presencia de lesiones cutáneas bajo el adhesivo. La aplicación de acetona está contraindicada en pieles con lesiones debido a que puede empeorar la irritación de las mismas. La demora hasta la retirada del adhesivo puede influir en el éxito del tratamiento; así como en la aparición de posibles secuelas (AU)

Cyanoacrylate is an adhesive used as a component in most of “super glues”. It can cause thermal burns if in contact with wool or cotton fabric. Nevertheless, in contact with intact skin it can cause contact or allergic dermatitis, but no thermal burns have been described.Clinical case: 8-year-old girl who had suffered an accidental fall of one of these glues directly on one of her hands and both lower extremities, and who had remained with the glue in contact with the skin for 3 hours. On examination we observed erythema on several regions underlying the glue, without blisters, wounds or bleeding. The glue was removed with warm water and detergent. No open wounds or burns were noticed.Conclusions: There are different ways to remove adhesives from the skin. Choosing the correct therapeutic option is determined, among other factors, by the presence of skin lesions under the adhesive. The use of acetone is contraindicated in injured skin because it can worsen the irritation. The delay in the removal of the adhesive can influence the success of the treatment and the type of treatment to be applied. (AU)

The effects of tobacco consumption on paternity rates of adults with a history of cryptorchidism.

OBJECTIVE: To determine the effect of tobacco consumption on paternity rates in men with a history of cryptorchidism. To compare the paternity rates between formerly unilateral, bilateral cryptorchid smokers, and nonsmokers. METHODS: A retrospective cohort study of 153 men who had undergone orchiopexy between 1961 and 1985 at the Miguel Servet University Hospital (116 unilateral and 37 bilateral) and a control group of 100 men were evaluated by review of medical records and a questionnaire. RESULTS: A total of 197 men filled the questionnaire (76.7%). There was no difference in paternity rates between smokers compared to nonsmokers (P = 0.21). In the unilateral cryptorchid men (ULC) group, there is no difference in paternity rates when compared with the controls (P = 0.079) or when comparing ULC smokers to ULC nonsmokers (P = 0.35). In the bilateral cryptorchid men (BLC) group, there is no difference in paternity rates when compared to controls (P = 0.075) or when comparing BLC smokers to BLC nonsmokers (P = 0.36). When comparing according to consumption, there is no difference between mild, moderate or heavy smoker cases and controls. CONCLUSION: There is no difference in paternity rates between men with a history of cryptorchidism that consume tobacco compared to nonsmokers or controls. More studies are needed to determine the impact of tobacco consumption in formerly cryptorchid men.

Hendidura cervical media: una enfermedad poco frecuente / Midline cervical cleft: A rare anomaly

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Impacto de la aplicación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño / Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Objetivo: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. Población y métodos: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). Resultados: Se incluyeron 297 pacientes (49, 8% de niños, 50, 2% de niñas), edad media al momento del diagnóstico de 21, 71 meses. El grado de RVU fue: RVU I-III 45, 1%, RVU IV-V 54, 9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124, 32 meses. El tratamiento conservador fue la terapia de inicio en el 70, 3% de los pacientes del grupo 1 y en el 67, 9% del grupo 2. El número de cirugías se mantuvo constante (31, 45% vs. 31, 79%), con un incremento en el número de procedimientos endoscópicos (p < 0, 005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82, 32% vs. 59, 9%, p= 0, 000) y daño renal al momento del diagnóstico (49, 4% vs. 9, 8%, p= 0, 000). Conclusiones: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54, 9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidence-based approach that reduces the performance of unnecessary invasive procedures.

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children. / Impacto de la apación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño.

OBJETIVE: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. POPULATION AND METHODS: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. RESULTS: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). CONCLUSIONS: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

OBJETIVO: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. POBLACIÓN Y MÉTODOS: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). RESULTADOS: Se incluyeron 297 pacientes (49,8% de niños, 50,2% de niñas), edad media al momento del diagnóstico de 21,71 meses. El grado de RVU fue: RVU I-III 45,1%, RVU IV-V 54,9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124,32 meses. El tratamiento conservador fue la terapia de inicio en el 70,3% de los pacientes del grupo 1 y en el 67,9% del grupo 2. El número de cirugías se mantuvo constante (31,45% vs. 31,79%), con un incremento en el número de procedimientos endoscópicos (p < 0,005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82,32% vs. 59,9%, p= 0,000) y daño renal al momento del diagnóstico (49,4% vs. 9,8%, p= 0,000). CONCLUSIONES: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

Adenosquamous Cell Carcinoma of the Rectum in a Girl: First Case Reported and Review of the Literature.

Adenosquamous carcinoma is a rare colorectal tumor with few cases described in the literature; no children have been reported. A 12-year-old-girl presented tenesmus, diarrhea, and iron deficiency anemia. Intestinal bowel disease was suspected, colonoscopy and biopsy were performed and the diagnosis was a squamous cell carcinoma. Chemoradiation therapy based on last colorectal cancer guidelines was started. Complete regression of the primary tumor was observed with lymph node progression. The pathology report of the lymphadenectomy revealed metastasis of adenosquamous carcinoma, although there was not any adenomatous component in the first biopsy. The patient presented progression with liver metastases, despite stable local disease due to response to first-line treatment of the squamous component.