Cylindrical implosion platform for the study of highly magnetized plasmas at Laser MegaJoule.

Investigating the potential benefits of the use of magnetic fields in inertial confinement fusion experiments has given rise to experimental platforms like the Magnetized Liner Inertial Fusion approach at the Z-machine (Sandia National Laboratories) or its laser-driven equivalent at OMEGA (Laboratory for Laser Energetics). Implementing these platforms at MegaJoule-scale laser facilities, such as the Laser MegaJoule (LMJ) or the National Ignition Facility (NIF), is crucial to reaching self-sustained nuclear fusion and enlarges the level of magnetization that can be achieved through a higher compression. In this paper, we present a complete design of an experimental platform for magnetized implosions using cylindrical targets at LMJ. A seed magnetic field is generated along the axis of the cylinder using laser-driven coil targets, minimizing debris and increasing diagnostic access compared with pulsed power field generators. We present a comprehensive simulation study of the initial B field generated with these coil targets, as well as two-dimensional extended magnetohydrodynamics simulations showing that a 5 T initial B field is compressed up to 25 kT during the implosion. Under these circumstances, the electrons become magnetized, which severely modifies the plasma conditions at stagnation. In particular, in the hot spot the electron temperature is increased (from 1 keV to 5 keV) while the density is reduced (from 40g/cm^{3} to 7g/cm^{3}). We discuss how these changes can be diagnosed using x-ray imaging and spectroscopy, and particle diagnostics. We propose the simultaneous use of two dopants in the fuel (Ar and Kr) to act as spectroscopic tracers. We show that this introduces an effective spatial resolution in the plasma which permits an unambiguous observation of the B-field effects. Additionally, we present a plan for future experiments of this kind at LMJ.

Hepatoblastoma in a 14 month-old female.

Hepatoblastoma (HB) is the most common malignant liver tumor in children. Complete surgical resection is the best treatment choice with a good prognosis in most cases. We present the case of a 14 month-old female patient was admitted to the pediatric surgery unit due to an abdominal mass localized in the right upper quadrant. The diagnosis retained was hepatoblastoma, so the patient underwent preoperative chemotherapy. The final size of the tumor permitted a complete surgical resection through a right subcostal incision enlarged to the left. Hepatoblastoma is the most common malignant liver tumor in children, more frequent in male than in female and typically presenting before 3 years of age as an abdominal mass found accidentally. Recent treatment strategies, consisting of chemotherapy combined with extensive surgery and in extreme cases liver transplantation, have improved the prognosis during the last years although HB's etiology and management are still subjects of debate.

Pediatric blunt renal trauma with wide fragments dislocation: successful organ saving management by internal stenting and percutaneous perirenal drain.

Children have an high risk of renal damage as a result of blunt trauma. Conservative management is always recommended for lower grades (I to III) but is rather controversial whenever high grade injuries (grade IV and V) are concerned. We describe a case of successful conservative management in grade IV renal injury occurred in a 9-years-old girl with blunt trauma.

Neonatal adrenal masses: do we have reliable criteria for differential diagnosis and expectant management?

AIM: Differential diagnosis of neonatal adrenal masses (NAM) is often based on empirical criteria. Expectant management relies on spontaneous regression, described either for NB as for adrenal hemorrhage (AH). Histology was available for biopsied cases only. Aim of the study was to correlate clinical, laboratory and imaging data of a series of NAM, to final diagnosis. METHODS: Records of 23 NAM, diagnosed before or after birth, were reviewed, collecting data about: obstetrical history, clinical features, imaging, laboratory data, surgical findings, outcome. RESULTS: M/F ratio was 1.6/1. Size of the lesion ranged from 17 to 50 mm.. Doppler sonography (PD) showed no flow in 14/23. Urinary catecholamines (UCM) were elevated in 5/23. Reduction in a mean time of 3 months occurred in 14/23. MIBG and CT scans resulted positive in 8 and 9 cases among 16 NAM, unvaried or increased at one month. Three cases developed as IV S NB; diagnosis was confirmed by CT guided biopsy; regression occurred within 20 months. Surgery was decided for 6 unchanged/increasing NAM after 3-6 months; they were all NB. Predictive value for NB was high for MIBG and CT scan and was lower for high UCM level and positive PD findings. CONCLUSION: Clear criteria to differentiate AH from NB are still missing. Despite spontaneous regression is thought to indirectly confirm a non neoplastic lesion, benign evolution has also been documented for NB. As histology is available only in operated or biopsied cases, we still lack a reliable set of signs for early differentiation and to reduce repeated, invasive investigations.

Patients with a history of infection and voiding dysfunction are at risk for recurrence after successful endoscopic treatment of vesico ureteral reflux and deserve long-term follow up.

AIM OF THE STUDY: Subureteral endoscopic injection of a bulking agent is an attractive alternative to open surgery or antibiotic prophylaxis for vesico ureteral reflux (VUR). Little information is available about long-term risk of recurrence after an initially successful treatment. Aim of this paper was to review short- and long-term success rate of endoscopic treatment in a single Center series after risk stratification of individual patients. MATERIALS AND METHODS: The records of 126 patients who underwent Deflux injection for primary VUR were examined. Indications to treatment were an unvaried high grade VUR (IV-V) at 1 year from diagnosis and/or and recurrent urinary tract infection (UTI) on antibiotic prophylaxis even in the presence of mild grade VUR (III grade). Gender, age and mode of diagnosis, infections (UTI), voiding dysfunctions, VUR grade and side, renal function, number of treatments were correlated to outcome. Long-term evaluation was planned at a minimum of 1 year from the last negative post-injection cystogram (MCUG). A new MCUG and DMSA scan were also offered to those complaining new UTI episodes. Late recurrences were correlated to history and grade of reflux. Data were analyzed with Graph Pad Instat software; the Chi-square test was used for univariate comparisons, the Fisher's exact test for categorical variables.and multiple regression tests for factors influencing outcome. RESULTS: M/F ratio was 62 to 64; median age at diagnosis was 28 months. VUR affected 198 renal units. Preinjection VUR grade was I in 1, II in 27, III in 107, IV in 59, and V in 4 units. Reduced DMSA uptake was evidenced in 51 units and scarring in 24. Median age at treatment was 34.5 months, for persistent high grade VUR (IV-V) in 55 patients and recurrent IVU in 92. Two hundred sixty seven injections were performed on 198 ureters. Complete resolution was documented by MCUG at 3-5 months in 68%, low grading < II in 20%, persistence or unsignificant reduction in 11%. Preoperative recurrent UTI, higher grade VUR, and bilaterality were correlated to a poorer surgical outcome. Among 80 successfully treated cases, 12 complained of persistent UTI. Recurrence of VUR was demonstrated in 31% of them. Deteriorated uptake or additional scarring in 25% was independent from VUR recurrence. Preoperative recurrent UTI and voiding dysfunction correlated significantly to late outcome. CONCLUSIONS: Preoperative recurrent IVU, together with high-grade reflux, seem to correlate to lower success rate of Deflux injection for primary VUR. Even after successful endoscopic treatment, long-term surveillance may be needed among these cases, mainly if voiding dysfunction is also recorded. Late recurring VUR must be actively excluded in case of new IVU episodes.

Frequency-fluctuation model applied to Stark-Zeeman spectral line shapes in plasmas.

A very fast method for calculating line shapes in the presence of an external magnetic field accounting for charge particle dynamics is proposed. It is based on a reformulation of the frequency fluctuation model, which provides an expression of the dynamic line shape as a functional of the static distribution function of frequencies. In the presence of an external magnetic field, the distribution of intensity and polarization of the emission depends on the angle between the observation line and the magnetic field's direction. Comparisons with numerical simulations and experimental results for various plasma conditions show very good agreement. Results on hydrogen lines in the context of magnetic fusion and the Lyman-α line, accounting for fine structure, emitted by argon in the context of inertial fusion, are also presented.

An all-endo Approach to Complete Ureteral Duplications Complicated by Ureterocele and/or Vesicoureteral Reflux: Feasibility, Limitations, and Results.

Purpose. Totally endoscopic management (all-endo) of patients with a duplicated renal system (DS) associated with severe vesicoureteral reflux (VUR) or obstructive ureterocele (UC) is an attractive alternative to traditional open procedures. The authors discuss feasibility and results of an all-endo approach on a consecutive series of patients. Methods. From 1999 to 2009, all patients with a complete DS associated with UC and/or VUR were proposed for primary all-endo approach. UC puncture was performed using a 3 Fr Bugbee electrode. Deflux (dextranomer/hyaluronic acid copolymer) injection was administered for VUR. The need for secondary surgery was evaluated on followup. Results. Of the 62 patients recruited, 46 were treated using a primary all-endo approach and 16 patients received no treatment. Of the 46 treated patients with 56 affected renal units, 32 (97%) UCs collapsed following puncture and 29 (63%) VURs were resolved or downgraded. Secondary VUR occurred in 13 (39%) renal units. Secondary surgery was performed on 23 (41%) renal units. Conclusion. The all-endo approach for VUR in DS is an effective therapeutic option. UC collapse was achieved by puncture in most of the patients; secondary VUR was the main complication in a small group of extravesical UC.

Fourier-limited seeded soft x-ray laser pulse.

We present what we believe to be the first measurement of the spectral properties of a soft x-ray laser seeded by a high-order harmonic beam. Using an interferometric method, the spectral profile of a seeded Ni-like krypton soft x-ray laser (32.8 nm) generated by optical field ionization has been experimentally determined, and the shortest possible pulse duration has been deduced. The source exhibits a Voigt spectral profile with an FWHM of 3.1+/-0.3 mA, leading to a Fourier-transform pulse duration of 4.7 ps. This value is comparable with the upper limit of the soft x-ray pulse duration determined by experimentally investigating the gain dynamics, from which we conclude that the source has reached the Fourier limit. The measured bandwidth is in good agreement with the predictions of a radiative transfer code, including gain line narrowing and saturation rebroadening.

Dynamic Stark broadening as the Dicke narrowing effect.

A very fast method to account for charged particle dynamics effects in calculations of spectral line shape emitted by plasmas is presented. This method is based on a formulation of the frequency fluctuation model (FFM), which provides an expression of the dynamic line shape as a functional of the static distribution of frequencies. Thus, the main numerical work rests on the calculation of the quasistatic Stark profile. This method for taking into account ion dynamics allows a very fast and accurate calculation of Stark broadening of atomic hydrogen high- n series emission lines. It is not limited to hydrogen spectra. Results on helium- beta and Lyman- alpha lines emitted by argon in microballoon implosion experiment conditions compared with experimental data and simulation results are also presented. The present approach reduces the computer time by more than 2 orders of magnitude as compared with the original FFM with an improvement of the calculation precision, and it opens broad possibilities for its application in spectral line-shape codes.

Endoscopic subureteral injection for vesicoureteral reflux and the risk of overtreatment.

AIM: Risk of vesicoureteral reflux (VUR) overtreatment was anticipated following introduction of endoscopic treatment (ET). New tool reduces hospitalization and patients discom-fort, with good results and parental preferences may prevail on questions about benefits of treatment. The authors analyzed two series of patients to evaluate impact of ET on management. METHODS: Two hundred sixty-four patients were selected; group A (90 cases) were observed and treated before adoption of ET. Group B included 174 patients who benefited of ET (Deflux). Treatment started from grade III (infections or renal damage). Lower refluxes were treated only in association to an higher grade in the other kidney. 81 ureters were reinplanted in Group A (92% success rate); 67 ureters were reinplanted in group B (98% sr) and 115 had a ET (89% sr). Rate of treatment, time of follow up and age at operation were compared. RESULTS: No differences were found in order to reflux grade distribution, treatment rate and time spent waiting for spontaneous before reinplant or ET. ET was a first choice procedure, for grade III, in group B. Reinplant continued to have a role for grade IV cases, which responded to ET in 85%, and for grade V. Spontaneous resolution was observed respectively in 29% and 30% (grade III) and 13% and 7% (grade IV). CONCLUSIONS: Despite ET is accessible and effective, there are no evidences that extensive indications are of any benefit. Enthusiasm for new tools must be submitted to the need for long term, prospective studies to support our indications.

Relevance of combinatorial profiles of intermediate filaments and transcription factors for glioma histogenesis.

In order to define specific markers for histogenesis of three well-characterized subgroups of human gliomas (pilocytic astrocytomas, glioblastoma multiforme and oligodendrogliomas), we studied the expression of relevant markers that characterize gliomagenesis, by immunohistochemistry and in situ hybridization. They include the intermediate filament proteins glial fibrillary acidic protein (GFAP), vimentin and nestin, the transcription factors Olig2, Nkx2.2 and Sox10, and the proteolipid protein transcripts plp/dm20. We show that the three major categories of human gliomas express a combinatorial profile of markers that gives new insights to their histogenesis and may help diagnosis. Pilocytic astrocytomas strongly express GFAP, vimentin, Olig2, Nkx2.2 and Sox10 but not nestin. In contrast, glioblastomas strongly express GFAP, vimentin and nestin but these tumours are heterogeneous regarding the expression of the transcription factors studied. Finally, in oligodendrogliomas, intermediate filament proteins are generally not observed whereas Olig2 was found in almost all tumour cells nuclei while only a subpopulation of tumour cells expressed Nkx2.2 and Sox10.

Diagnostic workup of urinary tract infections within the first 24 months of life, in the era of prenatal diagnosis. The contribution of different imaging techniques to clinical management.

AIM: The aim of this study was to evaluate the role of different techniques in the diagnostic workup of children with negative prenatal ultrasonogram, referred for urinary tract infection (UTI) within the first 24 months. METHODS: One-hundred and forty-seven patients, 71 males/76 females were studied. All patients were submitted to renal ultrasonogram (RUS) and to micturating cystourethrogram (MCU) independently from the results of RUS. In a small group (48 children) DMSA scan was performed independently from the results of RUS and MCU. Sensitivity and predictive value of RUS for vesicoureteric reflux (VUR) were estimated. Multiple regression analysis was performed on a selected number of signs to evaluate their predictive value. The group investigated by DMSA scan was analysed to evaluate how the presence of VUR on MCU anticipated renal damage. RESULTS: Nineteen (21%) patients with normal RUS, had VUR. Predictive value of RUS (0.21) was influenced by the grade of the VUR but more than 30% of high grade refluxing renal units appeared normal at initial ultrasonography. DMSA scan was abnormal in 27% of 48 patients; its result was independent from the presence of VUR of whatever grade. CONCLUSIONS: The increasing number of renal abnormalities detected before birth reduces the possibility of late abnormal RUS findings. It makes RUS screening for abnormalities, after a first episode of UTI, scarcely useful. VUR may be easily missed when RUS resulted normal and MCU is omitted. Negative MCU cannot exclude renal damage in presence of UTI. Renal defects at DMSA scan may be unrelated to a demonstrable VUR and could have a different pathogenesis.

Surgical approach to neonatal intestinal perforation. An analysis on 85 cases (1991-2001).

AIM: Primary gastrointestinal perforations have an incidence of between 1% and 3% in NICU patients. The 3 Centers participating in this study cover nearly 40% of the NICU population of the Lazio Region--Italy. The aim of this study is to discuss factors affecting survival in patients affected by a primary intestinal perforation. METHODS: From 1991 to 2001, 67 cases of 85 with a neonatal gastrointestinal perforation, were related to primary bowel lesions. Necrotizing enterocolitis (NEC) was not always the cause of perforation and in many patients an isolated bowel lesion without signs of NEC was found. The aim of this study was to examine clinical and intraoperative findings of NEC and non NEC perforations and their impact on survival. A relevant number of these patients were extremely low-birth weight (ELBW). Controversies about treatment of this category of neonates are discussed. RESULTS: Patients were 37 males and 30 females (mean birth weight 1 274.8 g, mean gestational age 28.9 weeks, mean age at perforation 10 days). Overall survival was 56.8%. Patients were divided by intraoperative findings in 2 groups: NEC (n=48), or isolated intestinal perforation (IIP) without signs of NEC (n=19). Differences between these 2 groups with regard to birth weight, maturity, associated cardiac anomalies (patent ductus arteriosus, PDA) were significant. NEC and IIP behaved as 2 distinct entities, each with peculiar clinical (age at perforation, oral feeding, need of ventilatory support) and radiological aspects. At surgery, multiple lesion on necrotic bowel were typical of NEC versus single, isolated perforations on healthy bowel typical of IIP. Overall survival was almost identical in the 2 groups (59% vs 58%). ELBW patients (55% of the total neonatal intestinal perforations) were also studied. There were 21 patients with NEC and 16 with IIP. The 2 groups were different in age at perforation, previous oral feeding and associated cardiac anomalies (PDA). Overall survival was 62% for NEC and 50% for IIP. A laparotomy was always performed. Temporary peritoneal drainage was done in 4 cases only. Results were better when intestinal diversion was performed rather than resection and primary anastomosis. Almost all NEC patients had multiple perforations and extended bowel necrosis. CONCLUSION: NEC is the most frequent cause of neonatal intestinal perforation. This is a quite distinct entity from IIP, which must always be differentiated preoperatively and which is most frequently found among low birth weight newborns. As far as surgical treatment of perforation among ELBW neonates is concerned, peritoneal drainage might be reasonably performed when a single lesion on healthy bowel as in IIP is clearly diagnosed but it could be inadequate for NEC patients.

Hypospadias surgery: a 10-year review.

Hypospadias surgery is one of the most difficult areas in pediatric urology and has been characterized by constant evolution. Some of the surgical techniques proposed in the past are now considered inadequate because of an unacceptable complication rate or poor functional and aesthetic results. The key for assessing a surgical technique (or a particular aspect of it) is continuous evaluation through long-term patient follow-up. We present the medical records of 693 patients over 10 years, all operated on by the same surgeon (the first author), with a minimum of 12 months of follow-up. The overall complication rate was 6.49% (45 cases). The most frequent complication was urethral fistula, occurring in 28 patients (62%). Other complications were redo for penile deformity or meatal retraction (eight cases, 17%), megalourethra (five cases, 11%), meatal stenosis (two cases, 4%), and urethral stenosis (two cases, 4%). We have noticed an increased rate of complications in patients older than 12 months (18.7% vs. 3.4% in patients younger than 12 months) and in patients operated on at puberty or later (15%). We have seen no difference in the complication rate related to the type of hospitalisation (day surgery vs. traditional hospitalisation). Regarding the relationship between the type of complication and the type of defect, except for the constant presence of fistulae, a high incidence of megalourethra was seen in proximal defects treated with preputial graft. The sexual outcomes of 32 subjects are presented. Multiple factors influence the final result, but the most important factor is the surgeon's own experience. Knowledge of different techniques and delicate tissue handling are essential. Our experience shows that the ideal age for surgery is 8-12 months. Owing to a minimal emotional impact on the child and to a reasonable use of economical resources, we consider day surgery the ideal way to treat these patients whenever possible. Even in the absence of complications, follow-up must be continued at least until the end of puberty and, when possible, up to the patient's sexual debut. Adequate interviews with the patients (principally teenagers and young adults) are the best way to evaluate their need for psychological support.

[Natural history of prenatally diagnosed hydronephrosis: possible recurrence of dilatation after spontaneous reduction, in cases with pelvic diameter larger than 20 mms, recommends long term follow-up]. / Evoluzione naturale delle idronefrosi a diagnosi prenatale: rischio di ricomparsa, dopo riduzione spontanea, delle dilatazioni con DAP superiore a 20 mm ed indicazioni per un follow-up a lungo termine.

BACKGROUND: Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years of life. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the risk of recurrent hydronephrosis long time after reduction and to identify factors associated to recurrence. MATERIALS AND METHODS: In a seven years period (1992-99) 276 patients with hydronephrosis unrelated to reflux, duplex kidney, megaureter or vesical obstruction have been observed. Among them, 231 were referred after prenatal diagnosis. Hydronephrosis of grade III or more was recorded in 73/231 with a pelvic diameter > or = 15 mms at ultrasonography (US) and a normal counter-lateral kidney. Surgical treatment was elected in 39 cases on the basis of a separate function < 40%, deterioration during follow-up, or occurrence of clinical symptoms. Thirthy four cases were treated conservatively and four were lost at follow. Among the remaining 30 cases, 14 had a pelvic diameter lager than 20 mms. They were followed for a mean of 16.6 months (range 7-26) and spontaneous significant reduction of pelvic dilatation was recorded in all of them. RESULTS: Patients were recalled after a mean of 32.1 months from the last US. In 3 cases among 14 with a pelvic diameter larger than 20 mms a recurrent severe hydronephrosis was found respectively at 39, 56, and 68 months. In two of them, isotopic scans documented a reduced separate function. The third case reported recurrent symtpoms. A pyeloplasty was performed in all cases. CONCLUSIONS: Spontaneous reduction in most of the prenatally detected cases of neonatal hydronephrosis within the first two months of life make follow-up beyond this term controversial, whenever complete disappearance of pelvic dilatation has been documented. The Authors report three cases with severe hydronephrosis (pelvic diameter > 20 mms) among a group of patients treated conservatively. Long time after spontaneous reduction, recurrent hydronephrosis was documented in all by US, associated to deterioration of separate function and symptoms. Long term follow-up is recommendable in severe cases of prenatally detected hydronephrosis cases, even after reduction, to warrant from recurrence and renal damage.

[Congenital megacolon in neonates and infants: impact of early, one-stage repair on morbidity and surgical complications]. / Megacolon agangliare nel neonato e nel lattante: riflessi del trattamento precoce in tempo unico su morbilità e complicanze chirurgiche.

Hirschsprung's disease (HD) is a major cause of congenital bowel obstruction in children. Classical management includes stoma creation, a pull-through procedure, and restoration of bowel continuity. Colostomy may be also pulled through directly at second operation. Since the first report of a single stage (SS) primary pull-through without colostomy for HD, in 1980, several patients have been treated according to this procedure, even in neonatal period. All of them had a favourable outcome with better compliance of families and less hospital stay. The Authors reviewed the clinical records of 22 patients selected among 36 treated for HD between 1992 and 2000; in all, disease extended to rectum-sigma-descendent; all cases of "total aganglionosis" or "ultra short" cases were excluded. Fifteen patients underwent SS repair: 11 neonates were operated at mean age of 69 days (range 14-172). In four infants diagnosis was made later (mean age 15 +/- 9 months) and SS repair was performed 8 days after (range 4-14). Seven patients underwent multiple stage (MS) repairs for clinical reasons: pull-through of the previous colostomy was performed at mean age of 171 days (range 47-330). A Duhamel procedure with an Endo-GIA linear stapler was performed in all No differences in gestational age or birth weight were found in both groups. Complications were observed only in the MS group (2 related to colostomy, 1 to postoperative adhesions). The Authors conclude that primary SS treatment of HD is safe and effective even in newborn patient, reduce familiar stress and hospital stay. The lower morbidity and complication rates could be explained by the limited bowel manipulation. Accurate histological-hystochemical diagnosis and meticulous preoperative bowel management should be part of the management.

[Intramural esophageal bronchogenic cyst: an unusual cause of dysphagia in pediatric patients. Report of a case]. / Quiste broncogénico de la pared esofágica: un caso inusual de disfagia en un paciente pediátrico.

Bronchogenic cyst a bronchopulmonary foregut malformation. An intramural esophageal localization has rarely been reported in respect to more common esophageal duplications or leiomyoma. The authors describe a case of bronchogenic cyst of the esophageal wall in a 3 years old girl. It was an misdiagnosed cause of dysphagia and was revealed by endoscopy and CT scan after two uneffective antireflux procedures performed in different institutions, which caused a worsening of symptoms. Complete excision of the lesion through a thoractomic approach and a redo of the antireflux procedure were followed by complete recovery.

[Neonatal asymptomatic and childhood symptomatic hydronephrosis: Are they different nosological entities?]. / Hidronefrosis neonatal asintomática e infantil sintomática: dos entidades nosológicas diferentes?

The authors reviewed two groups of patients with ureteropelvic junction obstructión divided by age and mode of presentation: patients with neonatal asymptomatic hydronephrosis diagnosed by prenatal ultrasonography and patients with symptomatic hydronephrosis. It was assumed that in these patients we are observing a continuous spectrum of the same pathology; nevertheless, some relevant differences were found between the two groups. Diuretic renograms did not show any change in postoperative renal function among prenatally detected cases while a significative improvement followed surgery among most of symptomatic cases. A possible explanation could be found in the obstructive mechanism which was responsible of obstruction in a significative proportion of these patients. Lower polar vessels produce a progressive symptomatic hydronephrosis in an healthy kidney in respect to intrinsic obstruction which are mainly found among prenatally detected cases and which are frequently associated to congenital renal damage unresponsive to surgery.

Quiste broncogénico de la pared esofágica: un caso inusual de disfagia en un paciente pediátrico / Intramural esophageal bronchogenic cyst: an unusual cause of disphagia in pediatric patients. Case report

El quiste broncogénico es una malformación broncopulmonar del intestino anterior. Su localización en la pared del esófago es una rareza, respecto al hallazgo más común a ese nivel, que es la duplicación esofágica o el leiomioma. Los autores describen un caso de un quiste broncogénico de la paredes ofágica en una niña de 3 años de edad. Se trataba de un caso de disfagia de causa desconocida, en el cual se llegó al diagnóstico mediante endoscopia y una tomografía axial computerizada, después de que en otra institución fueron realizadas dos cirugías antirreflujo que no resultaron satisfactorias y que habían llevado a un empeoramiento de los síntomas, los cuales tampoco desaparecieron después de repetidas dilataciones esofágicas. Con la exéresis completa de la lesión a través de una toracotomía y la restauración de un procedimiento antirreflujo se obtuvo una curación completa con desaparición de los síntomas (AU)