Abdominal Drainage After Laparoscopic Appendectomy in Children: An Endless Controversy?

BACKGROUND: Routine prophylactic abdominal drains after laparoscopic appendectomy for perforated appendicitis in children are still controversial. Throughout the history of surgery, potential benefits of the abdominal drains have been described. However, in recent studies, no benefits were observed and serious complications have been reported. METHODS: From January 2000 to December 2013, all charts of the pediatric patients who underwent laparoscopic appendectomy in our tertiary center were revised. The data from 1736 appendectomies were analyzed. We only included those patients with perforated appendicitis treated with early appendectomy (n = 192). Prophylactic drains were established according to the surgeon's preference. The sample was divided into two groups, those with drain (n = 117) and those without drain (n = 75). Demographics, operative findings, and postoperative outcomes were analyzed in both groups. RESULTS: Of all patients, 121 were male and 71 were female with a mean age of 7.77 ± 3.4 years. There were not statistically significant differences between the groups in gender (p = 0.82) and mean age (p = 0.31). There were no statistically significant differences between the two groups in the rate of intra-abdominal abscess, wound infection, and bowel obstruction. However, the drainage group has been statistically associated with an increased requirement of antibiotic and analgesic medication, fasting time, operative time, and length of hospital stay. CONCLUSION: The prophylactic use of abdominal drainage after laparoscopic appendectomy for perforated appendicitis in children does not prevent postoperative complications and may be associated with negative outcomes. Prospective randomized studies will be necessary to verify this question.

[Pyogenic granuloma following Smart Plug insertion]. / Granuloma piógeno en tapones lagrimales Smart Plug.

CASE REPORT: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. DISCUSSION: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug.

Granuloma piógeno en tapones lagrimales Smart Plug / Pyogenic granuloma following smart plug insertion

Caso clínico: Mujer de 65 años, diagnosticada de ojo seco, acude por aparición de tumoración en canto interno con sensación de cuerpo extraño. Tres años antes se le habían implantado tapones lagrimales SmartPlug en ambos puntos lagrimales inferiores. Se apreció un granuloma en el punto lagrimal inferior izquierdo que se extirpó. Dos semanas después presentó una recidiva lo que obligó a extraer el implante quedándose desde entonces asintomática. Discusión: Estamos ante un granuloma piógeno en un implante punctal SMART PLUG, complicación descrita clásicamente con los implantes de silicona, debido posiblemente a la irritación crónica de los detritus acumulados. Esta complicación obliga a extraer los tapones

Case report: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. Discussion: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug

Papilomatosis juvenil de la mama. Enfermedad del "queso suizo" / Juvenile papilomatosis of the breast

Presentamos un caso de papilomatosis juvenil de la mama, describimos la epidemiología, características clínicas y anatomopatológicas, así como los métodos diagnósticos, tipos de tratamiento y el significado pronóstico de una patología relativamente infrecuente (AU)

We present a case of juvenile papillomatosis of the breast, and describe the epidemiology, clinical and anatomopathological characteristics; also diagnostic methods, types of treatment and the prognostic significance of a relatively infrequent pathology (AU)

Pathologic intrathyroidal parathyroid glands.

BACKGROUND: Parathyroid glands originate from the third and fourth branchial pouches and migrate caudally to their final positions. Aberrations during migration result in anomalous locations. Intrathyroidal location is not common. METHODS: We reviewed cervical explorations performed from 1974 to 1993 in hyperparathyroidism patients. RESULTS: We found pathological intrathyroidal glands in six patients. Three patients had adenomas (left superior, left inferior and right inferior glands). The hyperplastic glands were left inferior in one patient and right inferior in the remaining two. Intraoperative diagnosis was made in three cases in which palpation of the thyroid gland showed a nodule that was suspected to be the parathyroid missing gland. In three patients it was a finding in thyroidectomy or hemithyroidectomy specimens, two of them with associated thyroid nodular disease. CONCLUSIONS: Ipsilateral thyroidotomy on the side of a palpable thyroid mass or blind hemithyroidectomy are justified if a presumably pathological intrathyroidal gland is suspected, when all other sites in the neck have been excluded.

The effect of proanthocyanidin-rich hulls and proanthocyanidin extracts from bean (Vicia faba L.) hulls on nutrient digestibility and digestive enzyme activities in young chicks.

Proanthocyanidins were prepared from three bean (Vicia faba L.) varieties by extracting hulls in aqueous acetone. The amounts of freeze-dried extracts recovered were 74, 89 and 97 g/kg hull for the varieties Brunette, Statissa and Minica respectively. Chicks (3 weeks old) were fed on a maize-soya-bean control diet or the same control diet substituted with either 30 g proanthocyanidin extracts/kg or 300 g proanthocyanidin-rich hulls/kg. Chicks were tube-fed diets twice daily for 4 d. Nutrient digestibilities were calculated from amounts present in diets and freeze-dried excreta with the aid of titanium dioxide as a marker. Enzyme activities were measured in digesta removed from the jejunum. Extracts of proanthocyanidins depressed the digestibility of protein by 34%, starch by 3% and had no effect on the digestibility of lipid. Proanthocyanidin-rich hulls depressed the digestibility of protein by 62%, starch by 6% and lipid by 4%. Digestive enzyme activities were depressed to the same extent by extracts and hulls, trypsin (EC 3.4.21.4) by 55 and 62%, alpha-amylase (EC 3.2.1.1) by 75 and 78% and lipase (EC 3.1.1.3) by 31 and 32% for proanthocyanidin-extract and proanthocyanidin-rich-hull diets respectively. The susceptibility of substrates as well as enzymes to the effects of proanthocyanidins is discussed.

[A simplified method for estimating mitral valve area by Doppler]. / Método simplificado para la estimación del área valvular mitral por Doppler.

Based upon geometrical considerations we have developed a new method for estimation of valve area in patients with mitral stenosis. A special ruler enables us to read the valve area from the Doppler record. We prove that our new method is more precise and rapid than original Hatle's procedure. In 35 patients, we found a good correlation between the result of our method and the valve area obtained by 2D-Echo. Thus the new method is very useful for Doppler evaluation of mitral stenosis patients.

Influence of peas (Pisum sativum) as a dietary ingredient and flavomycin supplementation on the performance and intestinal microflora of broiler chicks.

1. Two experiments were carried out to study the effects of diets containing various concentrations of pea meal (Pisum sativum L.), with or without flavomycin supplementation, on the performance and intestinal microflora of broiler chicks. 2. During the 7 to 28-d period, chicks fed on diets containing 300, 600 and 800 g pea meal/kg consumed more food and gained more weight than chicks receiving a maize-isolated soyabean protein control diet. The addition of flavomycin to the diets had similar effects on the performance of both the control and the pea groups. 3. Pea diets, with and without supplemental flavomycin, had little influence on the composition of intestinal microflora. The counts of enterococci in the small intestine and Clostridium perfringens and coliforms in the caeca of pea-fed chicks exceeded those of control chicks.

Conservative and bronchoplastic resection for bronchial carcinoid tumours.

From January 1974 to December 1987, 45 cases of bronchial carcinoid were surgically managed at our Unit, 44 of which were evaluated. All patients but 2 were submitted to fiberoptic bronchoscopy prior to surgery. A standard resection was performed in 19 cases (13 lobectomies, 4 bilobectomies and 2 pneumonectomies). In 11 cases, pulmonary resection was complemented with a bronchoplastic technique (6 lobectomies, 2 bilobectomies, 2 pneumonectomies, 1 segmentectomy). Four cases were managed by minimal resections (2 segmental, 1 wedge, 1 enucleation) and 8 others by bronchotomy and local resection without the sacrifice of lung tissue. There were two major postoperative complications and no operative mortality. Mean follow-up has been 53 months and no local bronchial recurrence has been observed although 2 patients have developed distant metastases, with 1 death. The absence of local recurrence in a series in which more than 50% of patients were treated with some form of conservative surgery seems to indicate that resection of lung tissue should be avoided whenever possible.

[Color-coded cardiac Doppler]. / Doppler cardíaco codificado en color.

Color flow mapping with Doppler technique was reviewed. We describe the advantages and technical was reviewed. We describe the advantages and technical limitations of the technique. The usefulness of color flow mapping in acquired and congenital disease was studied. We conclude that new information was added, concerning complex intracardiac flow, in order to the traditional study with classic continuous and pulsed Doppler examination.

[Limitation in articular movement in diabetic children]. / Limitación de la movilidad articular en niños diabéticos.

The presence of limited movement articular (LMA) was examined in 58 insulin-dependent diabetic children 38 boys and 20 girls in a range of 1 to 18 years. The children were ill during a mean of 4 years and 7 months +/- 3 years and nine months. The MAL was present in 36.2% of diabetic children versus 2.08% in the control group (96 healthy children). The presence of MAL has a statistically significant correlation with: age (9 years or more) (p less than 0.01); poor metabolic control (specially in severe forms) (p less than 0.001) and retinopathy (p less than 0.02). The examination of LMA is very useful for the early diagnosis of retinopathy in high risk patients because of the very frequent association of both complications of diabetes.

[Echocardiographic aspects of false intraventricular tendons]. / Aspetti ecocardiografici dei falsi tendini intraventricolari.

A series of 4260 consecutive echocardiographic examinations, performed in 5 Cardiological Centers was examined, identifying 125 intraventricular false tendons (FTs) in 100 cases (55 normals and 45 with heart disease) of whom 31 were female and 69 male, aged 3 to 82 years. An anatomo-morphological study was possible in 9 cases, dead for stroke or heart failure, on autopsy, and in 7, on heart surgery. A phonocardiogram was performed in all normals and in 20 patients. On echocardiography, FTs appeared as an echo-producing string-like structure, straight between the septum and the ventricular free wall, mobile during the cardiac cycle, without systolic thickening and any relation with the atrioventricular valvular apparatus. The prevalence of FTs was 2.3%; it was 3.2% to 5.3% in younger people. FTs were located in the right ventricle (4 cases), left ventricle (95 cases) or in both (1 case). Their site was left apical (45 FTs), right apical (2 FTs), right (3 FTs) and left (20 FTs), upper septum-to-free wall (55 cases). In 1 case hypertrophy of trabeculae of the left ventricle was detected. FTs were single (79 cases), double (19 cases), multiple (2 cases), short (42 cases), long (58 cases), thick (45 cases) and thin (55 cases). They showed a membrane-like motion (thick FTs-45 cases) and a valve-like motion (thin FTs-55 cases). Innocent murmur was detected in 50 of 55 normals and related to thin FTs. Of 16 cases examined anatomically and histologically, FTs were fibrous in their distal portion and fibro-muscular in the proximal one in 12 cases, whereas they were entirely fibrous-muscular in 4 cases. The site and location of FTs detected by echo were confirmed by anatomy in all cases. In 4 cases other 9 FTs, not detected on echocardiography, were found. These data suggest that echocardiography is a useful tool to detect intraventricular FTs and differentiate them from other echo-producing structures. Although a relationship between FTs and heart disease has not been found, their presence could be responsible of innocent murmur in many normal subjects.

[Persistent left superior vena cava and rheumatic mitral valve stenosis studied with echocardiography]. / Vena cava superior izquierda persistente y estenosis mitral reumática estudiadas con ecocardiografía.

A case of persistent left superior vena cava associated with rheumatic mitral stenosis in a 27 year old woman is described. Comments are made of the echocardiographic findings of a space free of echos located at a level behind the back wall of the left ventricle, at a level of the mitral valve. Echocardiographic Mode and two-dimensional technics were used in the observation of this image. Other pathologies, in which is possible to obtain similar images are also discussed, as well as the value of using echocardiographic contrast studies in the differential diagnosis.