Diagnóstico diferencial de la masa interlabial en la recién nacida: quiste parauretral / Differencial diagnosis of an interlabial mass in a newborn : paraurethral cyst

El quiste parauretral es una rara anomalía congénita que se produce por la obstrucción de los conductos de las glándulas parauretrales o de Skene. Presentamos un caso de quiste parauretral de las glándulas de Skene en una recién nacida a término que, a diferencia de los pocos casos publicados hasta la actualidad, presentaba otra anomalía genitourinaria asociada consistente en un himen imperforado. Se trata de una anomalía benigna que forma parte del diagnóstico diferencial de la masa interlabial en la recién nacida y su tratamiento consiste en la marsupialización o el drenaje simple del quiste, ya que la resolución espontánea es rara (AU)

[Predictive value of stress leak bladder pressure in urinary incontinence in children]. / Valor predictivo de la presión vesical de escape en estrés en la incontinencia urinaria en el niño.

UNLABELLED: The stress leak point pressure is the lowest bladder pressure at which leakage occurs during increases in intra-abdominal pressure. Our goal was the study of the stress leak point pressure in children to determine if it is a useful method of evaluation of incontinence and how it can be applied to pediatric clinical practice. We prospectively studied 68 consecutive incontinent children: Group 1 included 50 children neurologically normal. Group 2 included 18 children with myelodysplasia. RESULTS: 1) No correlation was found between stress leak point pressure and leak point pressure values. 2) The difference between the volumes at which the stress and rest leak were obtained was not statistically significant. 3) Study of stress leak point pressure: Group 1; Leakage during stress only occurs in 16%. Stress leak point pressure was greater than 100 cm of H2O in these children. Group 2; Leakage during stress occurs in all children (positive test in 100%). Stress leak point pressure was less than 100 cm of H2O, indicating intrinsic sphincter deficiency. These results suggest the stress leak point pressure is a diagnostic test that provide information about the function of proximal urethra and bladder neck in pediatric population, and an useful tool to despite of intrinsic sphincter deficiency.

Niña de 19 meses con neumonías de repetición / Recurrent pneumonia in a 19-month-old girl

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Alternativa a la aortopexia en el tratamiento de la traqueomalacia grave / An alternative to aortopexy in the treatment of severe tracheomalacia

El tratamiento clásico de la forma severa es la aortopexia. En la década de los ochenta comenzó a utilizarse para el tratamiento de la traqueomalacia recidivante o residual la implantación de prótesis intraluminales expandibles tipo Palmaz, diseñadas inicialmente para su uso en estenosis vasculares. Presentamos el caso clínico de un paciente con traqueomalacia grave, intervenido previamente de atresia de esófago con fístula traqueoesofágica distal, en el que debido a una cardiopatía congénita compleja acompañante se contraindicó la aortopexia, por lo que fue tratado de su malacia traqueal mediante la implantación de una prótesis tipo Palmaz. El empleo de este tipo de prótesis supone una alternativa eficaz a la cirugía convencional, debiendo hacer siempre una valoración individualizada en cada caso (AU)

First Spanish Trauma Registry: analysis of 1500 cases.

OBJECTIVES: To develop the first Spanish Pediatric Trauma Registry to collect and evaluate infomation concerning aspects of injuries in our pediatric population. METHODS: From January 1995 to August 1998, 35,946 children younger than 16 years were treated in our hospital for acute injury: 1500 were admitted and included in our database. Our file registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment morbidity and mortality. RESULTS: Accidents were more frequent in males (68%) than in females. The predominant age group was 12-15 years of age (34%). Accidents were more frequent in the street (35.1%) than at home (18.9%) or school (13%). Falls and traffic-related accidents were the leading cause of injury (39% and 21.2%, respectively). Two hundred and thirty-five (15.7%) had a Pediatric Trauma Score < or = 8. Fifty of these sustained multiple trauma (33%) (Injury Severity Score > or = 15). Musculoskeletal and head trauma were the most frequent injuries (48.5% and 42.0%, respectively). Surgical or orthopedic procedures were performed in 906 patients (56.5%). The average length of stay was 4.5 days (range 1-93 days). Functional impairment in children older than 4 years of age was found in 413 children (33.3%). We encountered 7 deaths in the 1500 patients, or an overall mortality of 0.5%. These 7 deaths were only seen in the I.S.S. > or = 15 group (50 patients) with 14% mortality. CONCLUSIONS: The goals of this Registry are to establish the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so that potential deficiencies can be corrected.

[Pediatric trauma registry: analysis of 1200 cases]. / Registro de trauma pediátrico: análisis de 1.200 casos.

OBJECTIVES: We developed the first Spanish Pediatric Trauma Registry in order to collect and evaluate information concerning aspects of injuries in our pediatric population. METHODS: From January'95 to September'97, 28,713 children younger than 16 years were treated in our Hospital for acute injury: 1,200 were admitted and included in our database. Our file-registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatments and morbidity-mortality. RESULTS: Accidents were more frequent in males (69%) than in females. The age-group predominantly was 12-15 years old (34%). Accidents were more frequent in the street (35.3%) than at home (18.7%) or school (14%). Falls and traffic-related accidents were the leading cause of injury (38 and 21.1%, respectively). The 16.7% of cases had Pediatric Trauma Score < or = 8 (n = 201). The 3.6% of this sustained multiple trauma (43 cases with Injury Severity Score > or = 15). Musculoskeletal and head trauma was the most frequent (62 and 42.3%, respectively). Surgical or orthopedic procedures were performed in 678 patients (56.5%). Average length of stay were 4.8 days (range 1-93 days), and functional impairments at discharge were found in 33.9% of patients older than 3 years (n = 338). Mortality rate in our series was 0.5% (n = 6), and 13.9% in children with ISS > or = 15. CONCLUSIONS: The utility of this Registry is to know the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so potential deficiencies can be identified and corrected.

[Results of the conservative treatment of severe renal trauma in childhood]. / Resultados del tratamiento conservador del traumatismo renal grave en la infancia.

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.

[Retroperitoneal laparoscopic nephrectomy in children]. / Nefrectomía laparoscópica retroperitoneal en la infancia.

We present two cases of obstructive uropathy nefrectomy through a retroperitoneal approach was performed. Renal differential function by means of a 2,3 dimercapto-succinic acid renal scan showed less than 10% on the ipsilateral kidney to the diagnosis pathology. The size of the kidneys meant no hindrance during its nefrectomy. Morcellation within the organ bag was required for its removal without needing to broaden the 10 mm port opening. The patients were discharged home 48 hours after surgery and they returned to school within the first postoperative week.

[Epidemiologic study of injuries in childhood: the first pediatric trauma registry]. / Estudio epidemiológico de los accidentes en la infancia: Primer Registro de Trauma Pediátrico.

OBJECTIVE: In order to collect and evaluate information concerning aspects of injuries in our pediatric population, we developed the first Spanish Pediatric Trauma Registry. PATIENTS AND METHODS: During 1995, 11,307 patients were seen at our hospital for acute injuries: 521 were admitted to the hospital and are included in our database. Each patient's protocol consists of 103 data points including: patient identification, type, place and mechanism of injury, prehospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment and morbidity-mortality. RESULTS: We found that accidents were more frequent in males (69) than in females. The predominant age group was 12-15 years (36%). Falls were the leading cause of injury (37%). A pediatric trauma score of 8 or less was seen in 13.4% of the cases. Twenty-nine patients were hospitalized in the Intensive Care Unit and 214 needed some surgical treatment. CONCLUSIONS: The utility of this registry is: 1) The knowledge of the epidemiology of our pediatric population. 2) To know and correct prehospital care deficiencies. 3) To improve hospital assistance and to recognize early prognosis factors.