Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis. / Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada.

OBJECTIVE: The objective of this study was to assess the results of a clinical guideline for the treatment and early discharge of patients with complicated acute appendicitis in terms of infectious complications and hospital stay. MATERIALS AND METHODS: A guideline for appendicitis treatment according to severity was created. Complicated appendicitis cases were treated with ceftriaxone-metronidazole for 48h, with discharge being approved if certain clinical and blood test criteria were met. A retrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) in patients under 14 years of age to whom the new guideline was applied (Group A) vs. the historical cohort (Group B, treated with gentamicin-metronidazole for 5 days) was carried out. A prospective cohort study to assess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting early discharge criteria was also conducted. RESULTS: 205 patients under 14 years of age were included in Group A, whereas 109 patients were included in Group B. IAA was present in 14.3% of patients from Group A vs. 13.8% from Group B (p= 0.83), while SSI was present in 1.9% of patients from Group A vs. 8.25% from Group B (p= 0.008). Early discharge criteria were met by 62.7% of patients from Group A. Median hospital stay decreased from 6 to 3 days. At discharge, 57% of patients received amoxicillin-clavulanic acid, whereas 43% received cefuroxime-metronidazole, with no differences being found in terms of SSI (p= 0.24) or IAA (p= 0.12). CONCLUSIONS: Early discharge reduces hospital stay without increasing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.

OBJETIVO: El objetivo de este estudio es evaluar los resultados en términos de complicaciones infecciosas y estancia hospitalaria de la instauración de una guía clínica para el tratamiento y alta precoz en pacientes con apendicitis aguda complicada. MATERIAL Y METODOS: Se elaboró una guía para el tratamiento de las apendicitis en función de su grado de severidad. Las complicadas se trataron con ceftriaxona-metronidazol durante 48 h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analítico retrospectivo comparando la incidencia de abscesos intraabdominales postquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientes menores de 14 años sometidos a la nueva guía (Grupo A), respecto a una cohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortes prospectivas para evaluar qué antibioterapia (amocilina-clavulánico o cefuroxima-metronidazol) es más eficaz en los pacientes que cumplen criterios de alta precoz. RESULTADOS: Se incluyeron 205 pacientes menores de 14 años en el Grupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupo A, frente al 13,8% en el B (p=  0,83); e ISQ un 1,9% y un 8,25% respectivamente (p=  0,008). Cumplieron criterios de alta precoz el 62,7% de los pacientes del Grupo A. La mediana de estancia disminuyó a de 6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43% cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ (p=  0,24) ni de AIA (p=  0,12). CONCLUSIONES: El alta precoz disminuye la estancia hospitalaria sin aumentar el riesgo de complicaciones infecciosas postquirúrgicas. La amoxicilina-clavulánico es una opción segura para la antibioterapia oral domiciliaria.

Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada / Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis

Objetivo: El objetivo de este estudio es evaluar los resultados entérminos de complicaciones infecciosas y estancia hospitalaria de lainstauración de una guía clínica para el tratamiento y alta precoz enpacientes con apendicitis aguda complicada.Material y métodos: Se elaboró una guía para el tratamiento delas apendicitis en función de su grado de severidad. Las complicadas setrataron con ceftriaxona-metronidazol durante 48h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analíticoretrospectivo comparando la incidencia de abscesos intraabdominalespostquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientesmenores de 14 años sometidos a la nueva guía (Grupo A), respecto a unacohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortesprospectivas para evaluar qué antibioterapia (amocilina-clavulánico ocefuroxima-metronidazol) es más eficaz en los pacientes que cumplencriterios de alta precoz. Resultados: Se incluyeron 205 pacientes menores de 14 años en elGrupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupoA, frente al 13,8% en el B (p= 0,83); e ISQ un 1,9% y un 8,25% respectivamente (p= 0,008). Cumplieron criterios de alta precoz el 62,7%de los pacientes del Grupo A. La mediana de estancia disminuyó a de6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43%cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ(p= 0,24) ni de AIA (p= 0,12).Conclusiones: El alta precoz disminuye la estancia hospitalariasin aumentar el riesgo de complicaciones infecciosas postquirúrgicas.La amoxicilina-clavulánico es una opción segura para la antibioterapiaoral domiciliaria.(AU)

Objective: The objective of this study was to assess the results of aclinical guideline for the treatment and early discharge of patients withcomplicated acute appendicitis in terms of infectious complicationsand hospital stay. Materials and methods: A guideline for appendicitis treatmentaccording to severity was created. Complicated appendicitis caseswere treated with ceftriaxone-metronidazole for 48h, with dischargebeing approved if certain clinical and blood test criteria were met. Aretrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) inpatients under 14 years of age to whom the new guideline was applied(Group A) vs. the historical cohort (Group B, treated with gentamicinmetronidazole for 5 days) was carried out. A prospective cohort study toassess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting earlydischarge criteria was also conducted.Results: 205 patients under 14 years of age were included in GroupA, whereas 109 patients were included in Group B. IAA was presentin 14.3% of patients from Group A vs. 13.8% from Group B (p=0.83),while SSI was present in 1.9% of patients from Group A vs. 8.25%from Group B (p=0.008). Early discharge criteria were met by 62.7%of patients from Group A. Median hospital stay decreased from 6 to 3days. At discharge, 57% of patients received amoxicillin-clavulanic acid,whereas 43% received cefuroxime-metronidazole, with no differencesbeing found in terms of SSI (p=0.24) or IAA (p=0.12). Conclusions: Early discharge reduces hospital stay without increas-ing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.(AU)

La ecografía fetal en el segundo trimestre: interés para el cirujano pediatra / The fetal ultrasonography in the second quarter: Interest for the pediatric surgeon

Introducción. El cirujano pediatra debe conocer los detalles del diagnóstico ecográfico prenatal para participar en el asesoramiento a los padres a efectos de continuar o no el embarazo, y planificar el tratamiento pre y postnatal. Los objetivos de nuestro estudio son: conocer la incidencia de las malformaciones congénitas detectadas con la ecografía del2º trimestre, cuántos de estos diagnósticos se confirman al nacimiento y cuál es la utilidad de esta prueba a la hora de informar a los padres. Pacientes y métodos. Se revisan los informes ecográficos prenatales del 2º trimestre realizados entre enero de 2005 y julio de 2009,recogiendo los hallazgos ecográficos y la edad materna y gestacional. A continuación, se anotan la evolución de las alteraciones de los fetos y el número de abortos espontáneos y voluntarios. Por último, se comprueba el diagnóstico en (..) (AU)

Introduction. The paediatric surgeon should know the details of prenatal ultrasound diagnosis to participate in advising parents about the continuation of the pregnancy, and to plan the prenatal and postnatal treatment. Our objectives are: to determine the incidence of congenital anomalies detected with ultrasound in the 2 nd trimester, the number of these diagnoses which is confirmed at birth and what is the usefulness of this test when advising parents. Patients and methods. We reviewed the prenatal ultrasound in 2ndtrimester reports made from January 2005 to July 2009. We note the ultrasound findings, the maternal and gestational age. The evolution of anomalies of the fetuses and the number of spontaneous and volunteers abortions are noted. Finally, the diagnoses are checked in the newborns. Results. 10,256 ultrasonographies are made in this period. 209 stories of pregnant women (2%), which present fetal pathology amenable (..) (AU)

[The fetal ultrasonography in the second quarter: interest for the pediatric surgeon]. / La ecografía fetal en el segundo trimestre: interés para el cirujano pediatra.

INTRODUCTION: The paediatric surgeon should know the details of prenatal ultrasound diagnosis to participate in advising parents about the continuation of the pregnancy, and to plan the prenatal and postnatal treatment. Our objectives are: to determine the incidence of congenital anomalies detected with ultrasound in the 2nd trimester, the number of these diagnoses which is confirmed at birth and what is the usefulness of this test when advising parents. PATIENTS AND METHODS: We reviewed the prenatal ultrasound in 2nd trimester reports made from January 2005 to July 2009. We note the ultrasound findings, the maternal and gestational age. The evolution of anomalies of the fetuses and the number of spontaneous and volunteers abortions are noted. Finally, the diagnoses are checked in the newborns. RESULTS: 10,256 ultrasonographies are made in this period. 209 stories of pregnant women (2%), which present fetal pathology amenable to general surgical treatment, are accessible for study. These include: 182 urologic disorders (85.44%), 13 digestive disorders (6.1%), 6 thoracic disorders (2.8%), 6 multiple malformations (2.8%), 4 maxillofacial disorders (1.88%) a sacrococcygeal teratoma (0.47%), an umbilical cord cyst (0.47%), 7 pregnancies are spontaneous abortion and 7 are terminated voluntarily. 183 stories of newborns are reviewed, we can confirm 48 uropathies (26.37%), 4 digestive malformations (30.77%), 4 thoracic disorders (66.66%), 2 maxillofacial disorders (50%) and 1 teratoma. CONCLUSIONS: Ultrasonography in the 2nd trimester detects almost 2% of specific fetal malformations. False positives are common in all diagnostic groups. The number of abortions and the terminations of pregnancy is low, most of them are polymalformated fetuses. We believe that ultrasonography in the 20th week have low value to counsel the termination of pregnancy, because only 7 of the 160 terminations indicated in our hospital during the study period, correspond to fetuses with pathology detected in the 2nd trimester. We recognize the usefulness of this test but, the false positive and favorable developments in a high percentage of fetuses, make us to be cautious to advise the continuation of pregnancy and the indication of treatment.

[Nonparasitic splenic cyst]. / Quistes no parasitarios de bazo.

Nonparasitic splenic cysts are a disease of very low incidence, although the availability of ecography and the indication of the preservative treatment of the splenic traumas are becoming it less infrequent. We report our experience with 6 patients, 4 girls and 2 boys, between 9- and 14-years-old. The reason was attended: 4 had abdominal pain, one of them underwent a traumatism and the other one was an accidental finding. The ultrasound gave us the diagnosis in all patients. The CT (computer tomography) and MR (magnetic resonance) added a few interesting details. All of them were operated, 4 with laparotomy and 2 with laparoscopy that we turned to laparotomy, one of them by suspicion of large hidatidic cyst and the other one by external aspect of solid tumour. The histological results were 4 epidermoid cysts, a simple cyst and a lymphangioma. After our experience we considered that ecography is a sufficient diagnosis method, like surgical treatment, the access and the technique vary according to the location of the cyst, the amount of splenic parenchyma around it and their macroscopic characteristics. The more superficial cysts, less wall thickness and location polar have the indication of laparoscopic partial decapsulation.

Quistes no parasitarios de bazo / Nonparasitic splenic cyst

Los quistes esplénicos no parasitarios constituyen una patología de muy escasa incidencia, aunque la disponibilidad de la ecografía y la mayor indicación del tratamiento conservador de los traumatismos esplénicos están haciéndola cada vez menos infrecuente. Aportamos nuestra experiencia con 6 pacientes, 4 niñas y 2 niños, de entre 9 y 14 años. El motivo por el que acudieron fue: 4 por dolor abdominal, uno tras un traumatismo y el otro fue un hallazgo casual. El diagnóstico fue ecográfico en todos los pacientes. La TAC y la RMN añadieron pocos datos de interés. Se intervino a los 6, 4 por laparotomía y 2 por laparoscopia que convertimos a laparotomía, en uno por sospecha de gran quiste hidatídico y el otro por aspecto externo de tumor sólido. El diagnóstico histológico fue de 4 quistes epidermoides, un quiste simple y un linfangioma. Tras nuestra experiencia consideramos suficiente la ecografía como método diagnóstico y como tratamiento quirúrgico, el acceso y la técnica varían según la localización del quiste, la cantidad de parénquima esplénico que lo rodea y sus características macroscópicas. Cuanto más superficial, menor grosor de pared y localización polar, mayor indicación de laparoscopia y destechado o puesta a plano (AU)

Nonparasitic splenic cysts are a disease of very low incidence, although the availability of ecography and the indication of the preservative treatment of the splenic traumas are becoming it less infrequent. We report our experience with 6 patients, 4 girls and 2 boys, between 9 and 14 years old. The reason was attended: 4 had abdominal pain, one of them underwent a traumatism and the other one was an accidental finding. The ultrasound gave us the diagnosis in all patients. The CT (computer tomography) and MR (magnetic resonance) added a few interesting details. All of them were operated, 4 with laparotomy and 2 with laparoscopy that we turned to laparotomy, one of them by suspicion of large hidatidic cyst and the other one by external aspect of solid tumour. The histological results were 4 epidermoid cysts, a simple cyst and a lymphangioma. After our experience we considered that ecography is a sufficient diagnosis method, like surgical treatment, the access and the technique vary according to the location of the cyst,the amount of splenic parenchyma around it and their macroscopic characteristics. The more superficial cysts, less wall thickness and location polar have(..) (AU)