Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. / Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario.

INTRODUCTION: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE: To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS: A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS: 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION: Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.

INTRODUCCION: La exploración de vía aérea mediante broncoscopia flexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugía cardiaca. En nuestro hospital estas exploraciones son practicadas por un neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátrico del Comité de Vía Aérea Pediátrica, formado en 2014. OBJETIVO: Analizar las exploraciones de vía aérea practicadas a neonatos durante su estancia en Neonatología/Unidad de Cuidados Intensivos Neonatales desde la constitución del Comité de Vía Aérea. MATERIAL Y METODOS: Estudio retrospectivo de exploraciones de vía aérea practicadas a neonatos de 2015-2019. Se recogen datos clínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviación estándar. Se consideró un resultado estadísticamente significativo cuando p < 0,05. RESULTADOS: Se analizaron 92 exploraciones de vía aérea en 51 pacientes (género femenino: 54,9%). El 51% de los pacientes fueron prematuros. La extubación fallida y la persistencia de sintomatología respiratoria tras una extubación satisfactoria fueron las indicaciones más frecuentes (35,3%). La estratificación por edad gestacional o por peso al nacimiento no se asociaba a un mayor riesgo de presentar hallazgos patológicos en la exploración. El hallazgo más frecuente fue la parálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) no se encontraron hallazgos patológicos. CONCLUSION: La exploración de la vía aérea es útil en pacientes con estridor postextubación y para identificar parálisis de cuerda vocal tras extubación fallida. Además, permite el diagnóstico y tratamiento de patologías congénitas de la vía aérea.

Manejo de la patología congénita y adquirida de la vía aérea en el neonato por parte de un comité multidisciplinar en un centro terciario / Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital

Introducción: La exploración de vía aérea mediante broncoscopiaflexible/rígida en el neonato ha demostrado utilidad en el estridor persistente, extubaciones fallidas o para valorar complicaciones tras cirugíacardiaca. En nuestro hospital estas exploraciones son practicadas porun neumólogo, neonatólogo, otorrinolaringólogo y cirujano pediátricodel Comité de Vía Aérea Pediátrica, formado en 2014. Objetivo: Analizar las exploraciones de vía aérea practicadas aneonatos durante su estancia en Neonatología/Unidad de CuidadosIntensivos Neonatales desde la constitución del Comité de Vía Aérea.Materiales. Estudio retrospectivo de exploraciones de vía aéreapracticadas a neonatos en el periodo 2015-2019. Se recogen datosclínicos y demográficos, número de exploraciones, indicación, hallazgos y complicaciones. Se presentan las medias con su desviaciónestándar. Se consideró un resultado estadísticamente significativocuando p < 0,05. Resultados: Se analizaron 92 exploraciones de vía aérea en 51pacientes (género femenino: 54,9%). El 51% de los pacientes fueronprematuros. La extubación fallida y la persistencia de sintomatologíarespiratoria tras una extubación satisfactoria fueron las indicacionesmás frecuentes (35,3%). La estratificación por edad gestacional o porpeso al nacimiento no se asociaba a un mayor riesgo de presentar ha-llazgos patológicos en la exploración. El hallazgo más frecuente fue laparálisis de cuerda vocal (n = 14; 27,5%). En 10 pacientes (19,6%) nose encontraron hallazgos patológicos. Conclusión: La exploración de la vía aérea es útil en pacientes conestridor postextubación y para identificar parálisis de cuerda vocal trasextubación fallida. Además, permite el diagnóstico y tratamiento depatologías congénitas de la vía aérea.(AU)

Introduction: Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persis-tent stridor and extubation failure, as well as to assess complicationsfollowing cardiac surgery. At our institution, these examinations arecarried out by a pulmonologist, a neonatologist, an otorhinolaryngolo-gist, and a pediatric surgeon from the pediatric airway committee,established in 2014. Objective: To analyze the airway examinations performed in neo-nates during their stay at the neonatology/neonatal intensive care unitsince the airway committee was established.Materials and methods. A retrospective study of the airway ex-aminations conducted in neonates from 2015 to 2019 was carried out.Clinical and demographic data, number of examinations, indications,findings, and complications were collected. Results are presented asmean and standard deviation. Statistical significance was establishedat p < 0.05. Results: 92 airway examinations were analyzed in 51 patients(54.9% of whom were female). 51% of the patients were premature.Extubation failure and persistent respiratory symptoms followingsuccessful extubation were the most frequent indications for airwayexamination (35.3%). Stratification by gestational age or weight atbirth was not associated with an increased risk of pathological findingsat examination (p > 0.05). The most frequent finding was vocal cordparalysis (n = 14; 27.5%). In 10 patients (19.6%), no pathologicalfindings were observed. Conclusion: Airway examination is useful in patients with stridorto identify vocal cord paralysis following extubation failure. It alsoallows congenital airway pathologies to be diagnosed and treated. Thenumber of examinations with no pathological findings was similar tothat reported in international series.(AU)

Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. / Tratamiento con adhesivo de fibrina asociado o no a diatermia para las fístulas traqueoesofágicas recurrentes: resultados tras más de 20 años de experiencia.

INTRODUCTION: Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS: A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS: 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS: Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.

INTRODUCCION: La fístula traqueoesofágica recurrente (FTER) representa una complicación frecuente (5-10%) en los pacientes con atresia de esófago (AE). La cirugía abierta de FTER implica una alta morbimortalidad, por lo que los abordajes endoscópicos suponen una alternativa prometedora. Presentamos los resultados a largo plazo de la aplicación broncoscópica de adhesivo de fibrina (AF) en pacientes con FTER secundaria a AE, técnica utilizada por primera vez en 1994 por nuestro equipo. METODOS: Revisión retrospectiva de 1993 a 2019, incluyendo a todos los pacientes diagnosticados de FTER tras la reparación de AE, y tratados con aplicación broncoscópica de AF. En la mayoría de los casos se aplicó diatermia previamente al sellado con AF. El número máximo de sesiones endoscópicas se estableció en cinco; en caso de persistir FTER tras la quinta sesión, se procedió a cirugía abierta. RESULTADOS: 14 pacientes con FTER fueron tratados con AF; en todos salvo los primeros 3 casos (11 pacientes, 78,6%) se aplicó diatermia concomitante. El día promedio del primer tratamiento fue el día 85 de vida (14 a 770). Los pacientes recibieron una media de 2,1 (1-5) sesiones endoscópicas. El seguimiento medio fue de 12,1 (10-20) años. El éxito global fue del 71,4%, sin apenas variar con la aplicación o no de diatermia concomitante (72,7% vs. 66,6%). CONCLUSIONES: La aplicación broncoscópica de adhesivo de fibrina asociado o no a diatermia representa una excelente opción para el tratamiento de FTER en pacientes con AE. El abordaje endoscópico debe considerarse como tratamiento de primera elección para FTER.

[Multidisciplinary approach on subglottic pathology: a 5-year review]. / Manejo multidisciplinar de la patología subglótica: revisión a 5 años.

INTRODUCTION: Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. MATERIAL AND METHODS: Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. RESULTS: Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. CONCLUSIONS: Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results.

OBJETIVOS: La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. RESULTADOS: Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. CONCLUSIONES: El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos.

Optimisation of metabolic criteria in the prognostic assessment in patients with lymphoma. A multicentre study. / Optimización de los criterios metabólicos en la valoración pronóstica de los pacientes con linfoma. Estudio multicéntrico.

OBJECTIVE: To compare sensitivity, specificity and predictive value of Deauville score (DS) vs. ΔSUVmax in interim-treatment PET (iPET) and end-treatment PET (ePET), in patients with diffuse large B cell lymphoma (DLBCL), Hodgkin lymphoma (HL), and follicular lymphoma (FL). METHOD: Retrospective longitudinal multicentre study including 138 patients (46 DLBCL, 46 HL, 46 FL), on whom 3 18F-FDG PET/CT were performed: baseline, iPET, and ePET. Visual (DS) and semi-quantitative (ΔSUVmax) parameters were determined for iPET and ePET. Predictive value was determined in relation to disease-free interval. RESULTS: Statistical analysis. iPET for DLBCL, HL, and FL: 1) sensitivity of DS: 76.92/83.33/61.53%; specificity: 78.78/85/81.81%; 2) sensitivity of ΔSUVmax: 53.84/83.33/61.53%; specificity: 87.87/87.50/78.78%. ePET for DLBCL, HL and FL: 1) sensitivity of DS: 61.53/83.33/69.23%; specificity: 90.90/85/87.87%; 2) sensitivity of ΔSUVmax: 69.23/83.33/69.23%; specificity: 90.90/87.50/84.84%. Predictive assessment. iPET study: in DLBCL, DS resulted in 10.3% recurrence of negative iPET, and 17.1% in ΔSUVmax at disease-free interval; in HL, both parameters showed a 2.8% recurrence of negative iPET; in FL, DS resulted in 15.6% recurrence of negative iPET, and 16.1% in ΔSUVmax, with no statistical significance. ePET study: in DLBCL, DS resulted in 14.3% recurrence of negative ePET, and 11.8% in ΔSUVmax at disease-free interval; in HL and FL, both methods showed 2.8 and 12.5% recurrence in negative ePET, respectively. CONCLUSION: DS and ΔSUVmax did not show significant differences in DLBCL, HL and FL. Their predictive value also did not show significant differences in HL and FL. In DLBCL, DS was higher in iPET, and ΔSUVmax in ePET.

[Complicated omental cyst after a herniorrhaphy in an infant]. / Quiste epiploico complicado tras una herniorrafia en un lactante.

Omental cysts are uncommon benign masses localized in the abdomen. This article describes the case of a male infant who underwent surgery due to a left inguinal hernia. During the operation a small omental cyst was found inside the sac that was resected. The first postoperative days were uneventful but the infant came back to hospital seven days after. Subsequent imaging and operative findings revealed a complicated omental cyst. This cyst was removed and the histopathology report described an inflammatory pseudotumor. The postoperative evolution was satisfactory and the patient has remained asymptomatic since he was discharged from hospital. In conclusion, it is important to explore the contents of the hernial sac during inguinal hernia repair. The finding of a small omental cyst inside the sac should encourage to study other potential intraabdominal lesions.

[Long gap esophageal atresia: Schärli versus Foker]. / Atresia esofágica long-gap. Schärli versus Foker.

PURPOSE. To submit the short and long term results of long-gap esophageal atresia (EA) with two surgical techniques. METHODS. We carried out a retrospective study of long-gap type EA without fistula (n=8) and with fistula (n=2) over the last 18 years, comparing the outcome of the Schärli technique (1992) with that of the Foker technique (1997). RESULTS. We included 10 patients with long gap EA. Mean birth weight was 2,418 grams. 30% had associated diseases (VACTERL, Down Syndrome, DiGeorge Syndrome). Gastrostomy or jejunostomy was initially placed in 7 patients. Schärli technique was performed in 4 patients (mean age: 3.3 months), and Foker technique in 6 patients (median age: 23.5 days of life). Complications were: a) Schärli: dehiscence (25%), stenosis (75%), one patient died from his heart disease (25%), colonic herniation through diaphragmatic hiatus (25%). The mean number of stricture dilatations was 7 sessions (S.D. 9.2). a) Foker: dehiscence (83.3%), stenosis (83.3%), gastroesophageal reflux (GER) (83.3%), fistula (16.7%). Mean number of dilatations was 13.7 sessions (S.D. 12.8). All patients operated on with Schärli technique (6-18 years, median follow-up 12 years) were asymptomatic at the time of the study, although one of them had grade III esophagitis in the last biopsy. As for the Foker's, 5 had undergone antireflux surgery and only one was asymptomatic. The rest had complications that were still being treated (stenosis and development of fistulae). CONCLUSION. Treatment of long gap EA remains a surgical challenge. In our experience patients developed fewer complications with the Schärli technique. Nevertheless, it is difficult to make a comparison with such a limited number of patients.

[Short term evaluation of transanal pull-through with automatic suture]. / Valoración a corto plazo del descenso transanal con sutura automática.

For the last ten years many centres have adopted transanal pull-through (TP) as the first choice technique for the treatment of Hirschsprung's Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5-months-old to 5-years-old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly, a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place between the fourth and the tenth postoperative day. Oral feeding was started in the 2nd-7th postoperative day. Medium term outcomes show a single case of complications: a patient Developer a skin stricture due to the low suture, which has been treated conservatively with rectal dilatations. Patients older than three (42.8%) are continent, although one presents occasional fecal soiling. The rest of the children present normal stools for their age. Automatic suture involves several advantages such as celerity and safety. We ought to point out that this method should not be used in children under 5 months because the autosuture size does not allow to do so.

Valoración a corto plazo del descenso transanal con sutura automática / Short term evaluation of transanal pull-through with automatic suture

En los últimos 10 años el descenso transanal (DT) se ha popularizado en muchos centros como técnica de elección para el tratamiento de la enfermedad de Hirschsprung (EH). Presentamos nuestra experiencia de DT con autosutura, inédita en la literatura. En nuestro programa de tratamiento de la EH aplicamos el DT para las formas de afectación recto-sigmoidea de fácil manejo ambulatorio. Hemos practicado un estudio retrospectivo de la evolución de 7pacientes con edades comprendidas entre 5 meses y 5 años a los que se les ha realizado un descenso transanal con autosutura en los dos últimos años. Nuestra técnica se desarrolla en dos pasos. En un primer tiempo practicamos una biopsia laparoscópica, en el segundo tiempo se realiza un descenso endorrectal según la técnica de De La Torre, modificado con autosutura circular de 21mm. En ningún caso se han precisado reintervenciones. Nuestros pacientes empezaron a realizar deposiciones entre el 2º y 4º día postoperatorio (DPO). La complicación más frecuente fue distensión abdominal en (..)

For the last ten years many centres have adopted transanal pull-through(TP) as the first choice technique for the treatment of Hirschsprung’s Disease (HD) affected children. We present our experience, based on the endorectal pull-through with autosuture, which has not been reported up to now. According to our HD management programme, TP with autosuture should be performed in rectosigmoid forms of HD which are easily handled with outpatient care. Seven patients with HD whose ages ranged from 5 months old to 5 years old underwent EP with autosuture. We present the short term results of the evolution of our patients. Firstly,a laparoscopic procedure is carried out in order to obtain a biopsy from the transition zone. The second stage consists of the TP following the De La Torre technique, modified by the 21 mm circular autosuture. No new surgical operation was necessary. Passage of stools started between the second and fourth postoperative day. The most frequent complication was abdominal distention, found in an 85.7% of patients and resolved before being discharged. Hospital discharge took place (..) (AU)

[Endoscopic treatment of recurrent tracheoesophageal fistula]. / Tratamiento endoscópico de la fístula traqueoesofágica recurrente.

UNLABELLED: Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopic treatment with fibrin glue and diathermia. MATERIAL AND METHODS: A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to 4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-up time vary from 1 to 13 years and the number of sessions was limited to 3 per patient. RESULTS: Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no major complications. DISCUSSION: Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE.

Tratamiento endoscópico de la fístula traqueoesofágica recurrente / Endoscopic treatment of recurrent tracheoesophageal fistula

Una de las complicaciones más graves del tratamiento de la Atresia de Esófago (AE) con fístula traqueal, es la repermeabilización (RTE)de la misma. Presentamos los resultados a largo plazo de nuestra técnica de tratamiento broncoscópico con Adhesivo de Fibrina y Diatermia. Material y Métodos. Se presenta un estudio retrospectivo de 10pacientes con RTE tratados entre 1993 y 2006, en enfermos de 14 días a 2 años, cuatro de ellos de otros centros Un paciente asoció una fístula congénita superior, desapercibida en la intervención abierta. Se utilizó un procedimiento broncoscópico, utilizando instrumentación rígida. La fístula fue sellada con Adhesivo de Fibrina y en los últimos 7 se asoció al procedimiento Diatermia previa, con un catéter ureteral. En todos los casos se realizó seguimiento clínico y radiológico. Controlendoscópico en 6. El seguimiento incluye de 1 a 13 años y número de sesiones se limitó a 3 por paciente. Resultados. Es evidenció cierre de la fístula en 9 casos (90%), que precisaron un total de 15 sesiones (Media: 1,5). El grupo de asociación con Diatermia 70% necesitó 9 (Media: 1,2) No se presentaron complicacionesgraves. Conclusiones. La reparación quirúrgica de RTE comporta a menudo serias complicaciones, por lo algunos grupos han intentado desarrollar diferentes técnicas broncoscópicas, con diferentes materiales. La revisión de la literatura no aporta una opción concluyente, pues son pacientes aislados sin evolución a largo plazo. A la vista del presente estudio opinamos que la aplicación de Diatermia y Adhesivo de Fibrina debe considerarse en el tratamiento de la RTE, como opción de inicio (AU)

Repermeabilization of the tracheoesophageal fistula (RTE) is one of the major complications of the esophageal atresia with tracheal fistula. We present the long term results of our technique based on broncoscopictreatment with fibrin glue and diathermia. Material and methods: A retrospective study of 10 children with RTE treated from 1993 to 2006, their ages ranging from 14 days-old to4 years-old; there were 4 patients from other hospitals. One of the patients involved had a superior congenital fistula that had not been noticed during open surgery. Broncoscopic procedure was performed using rigid instrumentation. The fistula was sealed with fibrin glue ; the last seven patients in the series received previous diathermia with an uretheral catheter. Clinical and radiological follow up took place in all children. Endoscopic evaluation was performed in 6 of them. Follow-uptime vary from 1 to 13 years and the number of sessions was limited to3 per patient. Results: Closure of the fistula was confirmed in 9 cases (90%) who required a whole number of 15 sessions (Mean: 1.5). The group who received diathermia needed 9 sessions (Mean: 1.2). There were no majorcomplications. Discussion: Surgery reparation of RTE is often related to serious complications. Therefore, many groups have tried to develop several broncoscopic techniques using different materials. Scientific reviews have not pointed out a definitive option since they involve isolated patients with no long term evolution. Taking this report into account we believe that the application of diathermia and fibrin glue ought to be considered the first choice treatment for the RTE (AU)

Consecuencias del retraso diagnóstico de la aspiración de cuerpo extraño / Consequences of diagnostic delay in foreign body aspiration

Objetivos: Analizar las características clínicas de los niños con aspiración de cuerpo extraño, sus complicaciones y su correlación con el retraso diagnóstico. Material y métodos: Estudio retrospectivo realizado en 136 niños con sospecha de aspiración de cuerpo extraño; el diagnóstico se confirmó en 118 casos tras su extracción con el broncoscopio. Se calculó la especificidad, sensibilidad, valor predictivo positivo y negativo de cada uno de los datos diagnósticos utilizados: antecedente de crisis de sofocación, sintomatología sugestiva de aspiración (tos, estridor) en niños previamente sanos, hallazgos de auscultación positivos (hipoventilación, sibilancias) y atrapamiento respiratorio en la radiografía de tórax. Resultados: La aspiración se debe, fundamentalmente, a cuerpos extraños orgánicos (84,7%), sobre todo frutos secos, con predominio por el árbol bronquial derecho (56,8%). Se produce casi siempre en el domicilio familiar mientras el niño come o juega. La crisis de sofocación es la prueba de mayor sensibilidad (91 %) y de mayor valor predictivo positivo (95%), aunque su especificidad (66%) y valor predictivo negativo (27%) sean menores. Los hallazgos clínicos y la radiología tienen mucha menos sensibilidad o especificidad y su utilidad se basa en la localización del cuerpo extraño. El diagnóstico se demoró más de 48 horas en más de la mitad de los casos. Conclusiones: El antecedente de crisis de sofocación en niños obliga a efectuar una broncoscopia. Las complicaciones durante (episodios de broncospasmo, edema subglótico y hemorragia bronquial por laceración) y tras la broncoscopia (atelectasias, neumonías y bronquiectasias) fueron mayores en pacientes con diagnóstico tardío

Objective: We analyze the clinical features and complications associated with foreign body aspiration in children, correlating them with delayed diagnosis. Methods: The records of 136 children who were admitted for suspected foreign body aspiration were reviewed retrospectively. Bronchoscopic retrieval of foreign bodies was successful in 118 children. We evaluated the sensitivity, specificity and positive and negative predictive values of the following diagnostic tools: history of choking episodes, symptoms (cough and stridor) in previously healthy children, positive auscultatory findings (hypoventilation, wheezing) and unilateral air trapping in chest radiography. Results: The aspirated material was organic (dried fruits) in most patients(84.7%), and right main bronchus was most often involved (56.8%). The aspiration almost always occurred at home, while the children were eating or playing. A choking episode is the most sensitive diagnostic Clue (91 %), and has the highest positive predictive value (95%), although its specificity (66%) and negative predictive value (27%) were lower. Clinical signs and symptoms and radiology are much less sensitive and specific, and their utility is mainly confined to the localization of the foreign body. The diagnosis was delayed more than 48 hours in over half of our patients. Conclusions: Bronchoscopy should by performed in all children who have had a choking episode. The complications during bronchoscopy(bronchospasm, subglottic edema and bleeding due to tracheal laceration) and afterwards( atelectasis, pneumonia and bronchiectasis) were related to the diagnostic delay

[Multifocal biliary papillomatosis: an indication for liver transplantation]. / Papillomatose multifocale des voies biliaires: une indication de transplantation hépatique.

Biliary papillomatosis is a uncommon disease. Because of the high rate of recurrence and the possibility of malignant transformation, liver resection or transplantation was recommended. A case of diffuse bilobar biliary papillomatosis, in a 60 years old patient, responsible for cholangitis, cholestasis and for high portal pressure (esophageal varices grade I and II and hypersplenisme) is reported. The patient had had an external biliary drainage leading to an great loss of hydroelectrolytic component important. Opacification and biopsies under endoscopic control assert the right diagnosis. He was treated by a orthotopic liver transplantation. Post operative course was simple. In the 9th month, it was asymptomatic with a completely satisfactory evolution. The other therapeutic modalities was discussed, as well as the review of the literature.

[Laparoscopic transsection of Ladd's bands: a new indication for therapeutic laparoscopy in neonates]. / Sección laparoscópica de bandas de Ladd: una nueva indicación para la laparoscopia terapéutica en neonatos.

Within the last ten years and by the introduction of some new instruments, laparoscopy is a safe and effective method that has been further extended in children. We report our experience in the treatment of laparoscopy on a seven day old newborn affected by malrotation with an intermittent duodenal obstruction. The treatment consisted of a duodenal liberation after the section was easily performed in congenital Ladd's bands. The spiral twists of the small intestine found in the upper gastrointestinal series, disappeared in a new study done after surgery. We consider this operation as a new indication for an operative laparoscopy. It allows a good visualization of this congenital abnormality, and it is easy to perform with a significantly reduced operative trauma.

Rectal drainage: unusual evolution of a psoas abscess.

We report two cases of primary psoas abscess in two patients of 15 months and 4 years of age. As the first case showed the natural history of this process the second one was large enough to produce a huge ureterohydronephrosis and to drain through the rectal wall to the rectum spontaneously, although this natural way did not achieve complete drainage. Both were treated by open drainage and systemic antibiotics with good response. They were discharged at the 7th and 12th postoperative day. 5 months later no complication has come up. Etiological, clinical and therapeutic aspects of this unusual pathology are reviewed.

[Acute abdomen: other initial symptom of abdominal lymphangioma]. / Abdomen agudo: otra forma de debut del linfangioma abdominal.

Lymphangiomas are benign tumors, their growth are slow, customarily without symptoms, their location more frequent are in head or neck and they're diagnosed before the two first life years frequently. Their etiology continues uncertain, being accepted the congenital origin. We report on three cases of abdominal lymphangioma beginning as an acute abdomen. The importance of these cases is based mainly in the low frequency of presentation of these tumors in this location (2-5% of the lymphangiomas) and in their initial symptomatology.

Long-gap esophageal atresia: reconstruction preserving all portions of the esophagus by Schärli's technique.

For distances of over 4-5 cm, esophageal replacement is almost always necessary in esophageal atresias. We present the technical details and describe our experience with esophageal reconstruction by elongation of the lesser curvature (Schärli's technique) in four cases of very long atresias. A retrosternal transposition was made without a thoracotomy in two children, and an orthotopic mediastinal route through a right thoracotomy was done in two others. There were two main complications: anastomotic leaks in three patients that closed spontaneously, and too-rapid gastric emptying, resulting in dumping symptoms that improved with time and diet. One patient developed an anastomotic stricture that responded to bouginage, while another had temporary feeding problems. Esophageal reconstruction by elongation of the lesser curvature provides a relatively simple method of esophageal replacement in children in that all portions of the esophagus are preserved. We propose this technique for early establishment of esophageal continuity in neonates.

Congenital intrahepatic portocaval shunt associated with trimethylaminuria.

A case of congenital portal-systemic shunting due to an intrahepatic connection diagnosed by ultrasound scanning and color Doppler in an 8-month-old girl is reported. She began to manifest trimethylaminuria 3 years later. At 7 years of age, she is asymptomatic without therapeutic measures except for diet. This is the seventh reported case and the third in a child to our knowledge.

[The prolapse of the rectum. Treatment with fibrin adhesive]. / Prolapso rectal. Tratamiento con adhesivo de fibrina.

Injection of sclerosing solutions into the rectal submucosa or into the perirectal space is one of the many therapies designed to correct rectal prolapse. Since 1994, four patients affected with this condition have been treated with fibrin adhesive percutaneous injection. Up to now, this product had not been used to this aim. Age range was from 1 month to 8 years. The medium duration of prolapse prior to therapy was 19 months and three of them had an associated pathology (myelomeningocele, cystic fibrosis and severe psychomotor retardation). There were no post-injection complications. In one patient with an irreducible prolapse an anus encirclement with a rectal tube was associated. Except for this patient, the whole process take less than 24 hours. With a medium follow up of 11 months this therapy has resulted effective in three of our four patients. It has failed in a girl with severe psychomotor retardation.

[Prenatal diagnosis of biliary atresia associated with choledochal cyst]. / Diagnóstico prenatal de atresia biliar asociada a quiste de colédoco.

We report a case of biliary atresia promptly detected by its association with a choledochal cyst, prenatally diagnosed at 20 weeks' gestation. The baby was operated at 14 days of life. A choledochal cyst was found and fibrosis of the extrahepatic bile ducts was also noted. So, excision of the choledochal cyst and a Roux-en-Y porto-jejunostomy was done. Nine months later, despite an appropriate biliary drainage, echographic and histological changes compatible with liver cirrhosis have been detected. Including this one, six cases have been reported.