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PURPOSE: The management of overriding distal forearm fractures is still controversial. This study aimed to evaluate the efficacy of immediate closed reduction and cast immobilization (CRCI) at the emergency department (ED) using equimolar nitrous oxide (eN2O2) as conscious sedation, and without the use fluoroscopic assistance. METHODS: Sixty patients with overriding distal forearm fracture were included in the study. All procedures were performed in the ED without fluoroscopic assistance. Antero-posterior and lateral wrist radiographs were taken after CRCI. Follow-up radiographs were taken 7 and 15 days post-reduction, and at cast removal to evaluate callus formation. Depending on the radiological outcome, two groups of patients could be identified: Group 1 (satisfactory reduction and maintenance of alignment) and Group 2 (poor reduction or secondary displacement requiring further manipulation and surgical fixation). Group 2 was additionally divided into Group 2A (poor reduction) and Group 2B (secondary displacement). Pain was assessed using Numeric Pain Intensity (NPI) score, while functional outcome was measured according to Quick DASH questionnaire. RESULTS: Mean age at the time of injury was 9.2 ± 2.4 years (range, 5-14). Twenty-three (38%) patients were aged between 4 and 9 years old, 20 (33%) patients between 9 and 11, 11 (18%) patients between 11 and 13, and 6 (10%) patients between 13 and 14. The mean follow-up time was 45.6 ± 12 months (range, 24-63). Satisfactory reduction with maintenance of alignment was achieved in 30 (50%) patients (Group 1). Re-reduction was performed in the remaining 30 (50%) patients (Group 2) due to poor reduction (Group 2A) or secondary displacement (Group 2B). No complications related to the administration of eN2O were recorded. No statistically significant difference could be identified between the three groups for any clinical variable (Quick DASH and NPI). CONCLUSION: Overriding distal forearm fractures may be safely treated with CRCI at ED using eN2O2 as conscious sedation. However, fluoroscopic assistance during CRCI might significantly improve the quality of reduction thus avoiding further treatment as the lack of relaxed muscle can restrain reduction.
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Fracturas del Radio , Fracturas de la Muñeca , Humanos , Preescolar , Niño , Adolescente , Fracturas del Radio/terapia , Fracturas del Radio/cirugía , Óxido Nitroso , Muñeca , Sedación Consciente , Moldes Quirúrgicos , Resultado del TratamientoRESUMEN
PURPOSE: To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age. METHODS: 270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL). RESULTS: From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively. CONCLUSION: We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.
Asunto(s)
Clavos Ortopédicos , Cráneo , Adolescente , Niño , Preescolar , Servicio de Urgencia en Hospital , Humanos , Lactante , Recién Nacido , Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Unfortunately, the author group has been incorrectly listed by the first name instead of the family name in the original publication. The complete correct author group should read as follows.
RESUMEN
PURPOSE: The purpose of this study was to explore whether increasing the hip abduction angle would increase the incidence of avascular necrosis (AVN) in patients with late- detected developmental dysplasia of the hip (DDH) treated by closed reduction (CR) and spica cast immobilization. METHODS: A total of 55 patients (59 hips) with late-detected DDH underwent MRI after CR. Hip abduction angle and hip joint distance were measured on postoperative MRI transverse sections. The acetabular index and centre-edge angle were measured on plain radiographs at the last follow-up. The presence of AVN according to Kalamchi and McEwen's classification was assessed. We retrospectively analyzed the associations among abduction angles, hip joint distances, radiographic parameters, AVN and final outcomes, exploring the relationship between hip joint abduction angle and AVN rate. RESULTS: The mean age at the time of CR was 14.4 months SD 5.5 (6 to 28), and the mean follow-up was 26.2 months SD 8.1 (12.4 to 41.7). The mean hip abduction angle was 70.2° SD 7.2° (53° to 85°) on the dislocated side and 63.7° SD 8.8° (40° to 82°) on the normal side; the mean hip joint distance was 5.1 mm SD 1.9 (1.3 to 9.1) on the dislocated side and 2.2 mm SD 0.6 on the normal side (1.3 to 3.3). Eight of 59 hips (13.6%) developed AVN. Neither the amount of abduction nor hip joint distance increased the AVN rate (p = 0.97 and p = 0.65, respectively) or the dislocation rate (p = 0.38 and p = 0.14, respectively). CONCLUSION: Abduction angle up to 70.2° following CR did not increase the AVN rate in children aged six to 28 months with late-detected DDH treated by CR. LEVEL OF EVIDENCE: III.
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PURPOSE: To quantitatively evaluate the upper extremity and elbow function with the Mayo Elbow Performance Score (MEPS) in children with transphyseal fracture of the distal humerus (TFDH) treated surgically. METHODS: During the period between 2005 and 2015, a total of 16 patients (ten male, six female) met the inclusion criteria. Mean age at the time of injury was 18 months (11 to 37) and mean follow-up was 42.3 months (6 to 98). Based on a modified version of Delee's classification (Group A to C), the clinical and radiographic outcome of TFDH in toddlers treated surgically were retrospectively evaluated. RESULTS: Mean humeral-ulnar (HU) angle of the injured and non-injured side was 1.2° (-18° to 14°) and 8.8° (2° to 19°), respectively (p = 0.001). Closed and open reduction showed similar HU angle values (p = 0.682). Mean MEPS score of the injured and non-injured side was 85.5 points (70 to 95) and 95 points (90 to 100), respectively (p = 0.002). No significant association was identified between MEPS score and gender, side, age at trauma, direction of displacement, time from trauma to surgery, presence of ossified capitellum, type of surgery and type of fracture. CONCLUSION: Functional outcome was generally good regardless of surgical procedure performed, closed or open and type of fracture according to modified Delee's classification. However, a residual cubitus varus was commonly observed among toddlers with transphyseal fractures of the distal humerus. LEVEL OF EVIDENCE: Level IV - Therapeutic study.
RESUMEN
The main objective of this paper is to review the current literature on treatment of tibial and femur fractures in children and adolescents guided by body weight in patients weighing 50 kg (110 lb) or more. A secondary aim of this mini-review was to determine, as per literature review, whether weight > 50 kg (110 lb) is an identifiable factor associated with increased complication rate. A search of the PubMed/MEDLINE, EMBASE and Cochrane Database of Systematic Reviews databases from 1954 to September 2017 was performed to identify papers related to pediatric tibia and femur fractures in children weighing more than 50 kg (110 lb). Abstracts were screened, and relevant full-text articles were retrieved for further review. Reference sections of identified papers were also screened to identify further literature. All levels of evidence were included. Overall, seven full-text articles dealing with pediatric tibia or femur fractures in patients weighing more than 50 kg (110 lb), and one article reporting on both femur and tibia fractures in this patients' population, have been identified (n = 8 full-text article included). The articles reviewed a total of 679 children. In particular, 48/438 femur shaft fractures (mean weight: 51.7 kg or 113.9 lb) and 91/241 tibia fractures (mean weight: 53.3 kg or 117.5 lb) met the inclusion criteria. The overall rate of complications was 27.9%. In particular, the rate of complication was 51.7 and 29.6% in children with femur and tibia fracture weighing more than 50 kg (110 lb), respectively (p < 0.05). Elastic stable intramedullary nailing (ESIN) has become the treatment of choice for displaced tibia and femur shaft fractures in children between six and 12-15 years of age. Unstable fracture pattern, higher age and higher weight have been reported as potential risk factors associated with poor outcomes in children and adolescents treated with ESIN for displaced long bone fractures of the lower extremity, in particular femur shaft fractures. Despite these findings, data reporting exclusively on ESIN-treated long bone fractures in children weighing 50 kg (110 lb) or more remain scant.
Asunto(s)
Peso Corporal , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adolescente , Niño , Fracturas del Fémur/complicaciones , Humanos , Obesidad/complicaciones , Fracturas de la Tibia/complicaciones , Resultado del TratamientoRESUMEN
PURPOSE: The main objective of this study was to retrospectively evaluate the clinical and radiological outcomes of acute (AMF) and chronic Monteggia fractures (CMF) in children treated by closed or open reduction and external fixation (EF). METHODS: This is a retrospective review of 26 patients with Monteggia fracture. Patients with AMF (time between trauma and surgery less than two weeks) were treated by closed reduction and EF of the ulna (Group A; 15 patients) while those with CMF (time between trauma and surgery more than three weeks) were managed by closed or open reduction and EF of the ulna (Group B; 11 patients). Clinical outcome was evaluated with radiography and the short version of the Disabilities of the Arm, Shoulder and Hand outcome questionnaire (Quick DASH). Complications were recorded in both groups. RESULTS: No secondary displacement, wire migration, consolidation delays, nonunion, malunion or re-fracture was noted. However, one patient in Group A (6.7%) developed heterotopic ossification of the ulna; the final functional outcome was good (Quick DASH score: 18.2). One case of postoperative redislocation of the radial head was detected in Group B (9.1%). Two patients (7.6%) developed transient pin tract infection. Despite the fact that 16 out of 26 patients (six in Group A and ten in Group B) complained of the clinical appearance and/or had intermittent residual pain on the injured side, the results were essentially the same between the two groups of patients (p > 0.05). CONCLUSION: EF is an alternative for the management of acute and chronic paediatric Monteggia fractures. It provides satisfactory radiological and clinical outcomes with relatively low rates of complications. LEVEL OF EVIDENCE: IV.
RESUMEN
A fracture is defined as pathological when it arises in a bone tissue that has been modified and reshaped by a local or systemic pathological process. In children, pathological fractures can be secondary to several conditions, ranging from metabolic diseases to tumors, infections or neuromuscular pathologies. History, clinical examination and radiologic assessment are essential to making a diagnosis, to identifying the underlying cause and to planning the right treatment of a pathological fracture. Treatment must be tailored to both the fracture and the underlying cause. The objective of this work is to present the diagnostic approach and the course to follow when a child presents with a pathological fracture. The most common causes of pathological fractures, as well as their characteristics, will be described. Pathological fractures occurring in osteogenesis imperfecta and in abused children as well as stress fractures will not be discussed.
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Quistes Óseos/diagnóstico , Neoplasias Óseas/diagnóstico , Fracturas Espontáneas/diagnóstico , Osteomielitis/diagnóstico , Seudoartrosis/congénito , Adolescente , Quistes Óseos/complicaciones , Quistes Óseos/cirugía , Neoplasias Óseas/complicaciones , Neoplasias Óseas/cirugía , Niño , Preescolar , Fracturas Espontáneas/etiología , Fracturas Espontáneas/cirugía , Humanos , Lactante , Recién Nacido , Osteomielitis/complicaciones , Osteomielitis/cirugía , Seudoartrosis/complicaciones , Seudoartrosis/diagnóstico , Seudoartrosis/cirugíaRESUMEN
BACKGROUND: Dysplasia epiphysealis hemimelica (DEH) is a rare developmental bone disorder with hemimelic involvement of one or more epiphysis. We report on nine new cases and discuss the clinical manifestations, the value of MRI, and the results of complete and early surgical resection of these lesions. MATERIALS AND METHODS: In this retrospective study, nine patients with a diagnosis of DEH were evaluated. Age at presentation ranged from 1 year to 12 years. The main complaint at diagnosis was a swelling bony mass. Angular deformities were recorded in two patients. All patients were surgically treated and followed up clinically and by imaging. Eight patients underwent excision only. RESULTS: The average follow-up was 5.6 years (range, 2-10.5 years). All patients had a good outcome without related symptoms. No epiphysiodesis, angular deformity or recurrence was observed. One patient with femoral lesion involving the distal medial part of the epiphysis developed, four months after surgical excision, a calcification outside the area of total excision. This calcification did not increase in size at two years follow-up. Another patient with lateral involvement of the proximal tibial epiphysis presented a postoperative nervous complication. Spontaneous nervous recovery occurred three months after surgery. DISCUSSION: MRI was useful to find a potential plane of cleavage between the epiphysis and the pathological tissue. We recommend early removing ossifications when a cleavage plane is identified. Waiting a possible complication or increasing of size does not seem logical. Of course, the treatment will be not the same if no cleavage plane is found on MRI. LEVEL OF EVIDENCE: IV.
Asunto(s)
Enfermedades del Desarrollo Óseo/diagnóstico , Fémur/anomalías , Tibia/anomalías , Enfermedades del Desarrollo Óseo/diagnóstico por imagen , Enfermedades del Desarrollo Óseo/patología , Enfermedades del Desarrollo Óseo/cirugía , Niño , Preescolar , Diagnóstico Diferencial , Diagnóstico por Imagen , Femenino , Fémur/diagnóstico por imagen , Fémur/patología , Fémur/cirugía , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Complicaciones Posoperatorias , Radiografía , Procedimientos de Cirugía Plástica , Recurrencia , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/patología , Tibia/cirugíaRESUMEN
Assessment of skeletal age is important in children's orthopaedics. We compared two simplified methods used in the assessment of skeletal age. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We also investigated the influence of assessor experience on applying these two methods. Our investigation was based on the anteroposterior left hand and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1 ) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal growth spurt. A total of nine observers examined the radiographs with the observers assigned to three groups based on their experience (experienced, intermediate and novice). These raters were required to determined skeletal ages twice at six-week intervals. The correlation between the two methods was determined per assessment and per observer groups. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods. The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. There was no significant (p < 0.05) difference between the levels of experience. The two methods are equally reliable in assessing skeletal maturity. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified.
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Determinación de la Edad por el Esqueleto/métodos , Articulación del Codo/crecimiento & desarrollo , Epífisis/crecimiento & desarrollo , Olécranon/crecimiento & desarrollo , Pubertad , Articulación de la Muñeca/crecimiento & desarrollo , Adolescente , Niño , Articulación del Codo/diagnóstico por imagen , Epífisis/diagnóstico por imagen , Femenino , Humanos , Masculino , Olécranon/diagnóstico por imagen , Reproducibilidad de los Resultados , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
The aim of this study was to describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. Forty non-ambulatory children and adolescents (47 hips) were consecutively treated with percutaneous pelvic osteotomy. The mean preoperative Reimers' migration percentage improved from 66.2% to 4.9% at the final follow-up. The mean preoperative acetabular angle (AA) improved from 32.4° to 13.2° at last follow-up. Percutaneous pelvic osteotomy is a less invasive surgical approach and appears to be a valid option with similar outcomes to standard techniques.This method results in less muscle stripping and blood loss and a shorter operating time.
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Parálisis Cerebral/complicaciones , Luxación de la Cadera/cirugía , Osteotomía/métodos , Huesos Pélvicos/cirugía , Adolescente , Niño , Femenino , Estudios de Seguimiento , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/etiología , Humanos , Masculino , Huesos Pélvicos/diagnóstico por imagen , RadiografíaRESUMEN
The ideal treatment for traumatic anterior dislocation of the shoulder in the skeletally immature patient is controversial. The aim of this study is to evaluate the outcomes after either conservative and/or surgical treatment using the Latarjet technique. A retrospective series of 49 out of 80 patients were reviewed. We found no significant differences between either treatment method regarding functional scores and pain levels. Although not statistically significant, post-surgical patients showed better signs of shoulder stability than others who have a higher rate of recurrence. Further, 92% of the post-surgical group had returned to the same level of activity versus 52% in the non-surgically treated group. We found no contraindications to operate on a skeletally immature patient.
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Inestabilidad de la Articulación/terapia , Luxación del Hombro/terapia , Adolescente , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Masculino , Dimensión del Dolor , Rango del Movimiento Articular , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Luxación del Hombro/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: Displaced proximal humerus fractures within the pediatric population can be treated by elastic stable intramedullary nailing (ESIN). The main objective of our study is to evaluate functional outcome of the displaced proximal humeral fractures treated by ESIN within the pediatric group using a standardized evaluation scale. The secondary goal is to compare functional outcome of epiphyseal and metaphyseal injuries and functional outcome of children younger and older than 10 years of age. MATERIALS AND METHODS: From March 2010 to December 2011, 27 children had been treated surgically using ESIN for displaced fractures at the proximal extremity of the humerus. These fractures were displaced and closed without neurovascular insult. Patients were followed radiographically and clinically on a regular basis. After hardware removal, the functional outcomes had been homogeneously assessed by using the French edition of the QuickDash(®) evaluation scale. The descriptive statistics including mean, standard deviation, and confidence interval have been realized. RESULTS: We included 27 children who were operated on consecutively (10 boys, 17 girls). The mean age at the time of operation is 11.2 ± 2.7 years (range 7.1-15.9). The mean angulation is 55.9° ± 20.3° (range 20-90). The mean apposition is 52.8 % ± 33.1 (range 10-100). The mean follow-up period is 15.2 ± 5.6 months (range 6.1-28.5). Results were considered good for children between 7.1 and 15.9 years old with epiphyseal and meataphyseal fractures. The mean QuickDash(®) score is 2.0 (range 0-6.5), with 14 cases showing a score of 0 (58.3 %), 2 cases with 4.3 (8.3 %), 4 cases with 4.5 (16.7 %), and 4 cases with a score of 6.5 (16.7 %). Ranges of movement were preserved. The patients regained their daily and sportive activity over the time without pain or discomfort. CONCLUSION: Our study showed a good outcome of functional results within a pediatric population who had a sustained displaced proximal humeral fracture and treated by ESIN. Using a standardized evaluation scale is recommended in order to be able to evaluate the patients in a homogeneous manner.
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Epífisis/cirugía , Fijación Intramedular de Fracturas/métodos , Fracturas del Hombro/cirugía , Adolescente , Clavos Ortopédicos , Niño , Epífisis/fisiopatología , Femenino , Curación de Fractura , Humanos , Masculino , Rango del Movimiento Articular/fisiología , Recuperación de la Función/fisiología , Fracturas del Hombro/fisiopatología , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Laparoscopic appendectomy is a feasible and safe alternative to open appendectomy for uncomplicated appendicitis. In the past decade several laparoscopic procedures have been described using one or more ports. We report our experience in treating acute appendicitis with one-port transumbilical laparoscopic-assisted appendectomy (TULAA). PATIENTS AND METHODS: We performed 231 TULAA on patients in the period from November 2001 to September 2007. We introduced an 11 mm Hasson's port using open technique; an operative channel with 10 mm telescope and an atraumatic grasper were used. After intra-abdominal laparoscopic dissection, the appendix was exteriorised through the umbilical access. The appendectomy was performed outside the abdomen as in the open procedure; the operation was completed using only one port in 227 patients (98%), two and three ports in two patients (1%) while conversion to open surgery was needed in two patients (1%). RESULTS: The average operating time was 38 minutes and the median time to discharge was three days. Four (1, 7%) early postoperative complications (two suppuration of the umbilical wound) with no major complications were observed. CONCLUSIONS: Our results demonstrate that TULAA, which combines the advantages of both open and laparoscopic procedures, is a valid alternative form of treating uncomplicated appendicitis. If appendectomy cannot be completed with only one port, insertion of one or more ports may be necessary to safely conclude the procedure.
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Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía/métodos , Adolescente , Apendicitis/diagnóstico , Niño , Preescolar , Femenino , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Ombligo/cirugíaRESUMEN
AIM: The best treatment of non-palpable testes is currently argument of debate. The aim of present study was to describe authors' experience in surgical treatment with inguinal standard orchidopexy of non-palpable testes. METHODS: In the last 17 years we have treated 2002 cryptorchid testes, among these 327 (16.33%) were non palpable. Age and distribution of cryptorchid testes was: 0-1 y (165 NPT), 1-2 y (84 NPT), 2-5 y (43 NPT), 5-10 y (16 NPT) and >10 y (19 NPT). RESULTS: Non-palpable testes were diagnosed and treated earlier (76.14% in the first two years). At surgical examination 204 (62.38%) were intrabdominal, 80 (24.46%) were atrophic and 43 (13.14%) vanishing. Among atrophic testes 54 (67.5%) were intracanicular, 21 (26.5%) were at the external inguinal ring, 4 (5%) were intrabdominal and 1 (1.25%) ectopic; among vanishing testes 22 (51.16%) were intrabdominal, 14 (32.55%) intracanicular and 7 (16.27%) at the external ring of inguinal canal. CONCLUSION: Atrophic and vanishing testes were in intrabdominal location in 26 cases: only in these cases (7.95% of all non palpable testes) laparoscopy should have avoided inguinal surgery. Inguinal standard orchiopexy performed as day-surgery with general anaesthesia associated to caudal analgesia should be considered effective and less invasive than laparoscopic approach.
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Criptorquidismo/cirugía , Niño , Preescolar , Humanos , Lactante , Conducto Inguinal , Masculino , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodosAsunto(s)
Adrenalectomía/métodos , Hiperfunción de las Glándulas Suprarrenales/cirugía , Hiperpigmentación/complicaciones , Laparoscopía/métodos , Adolescente , Hiperfunción de las Glándulas Suprarrenales/complicaciones , Hiperfunción de las Glándulas Suprarrenales/diagnóstico , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XRESUMEN
AIM: A retrospective analysis was made to evaluate our experience in the management of tracheobronchial foreign bodies (TFB) in children (age Asunto(s)
Bronquios
, Cuerpos Extraños
, Pulmón/diagnóstico por imagen
, Tráquea
, Adolescente
, Algoritmos
, Anestesia General
, Broncoscopios
, Broncoscopía
, Preescolar
, Femenino
, Cuerpos Extraños/diagnóstico
, Cuerpos Extraños/diagnóstico por imagen
, Cuerpos Extraños/terapia
, Humanos
, Lactante
, Masculino
, Radiografía
, Cintigrafía
, Estudios Retrospectivos
, Factores de Tiempo
, Resultado del Tratamiento
RESUMEN
INTRODUCTION: Recent data has indicated the usefulness of performing orchiopexy in the first years of life. In this study, we evaluated testicular function in young men operated on for cryptorchidism in the first year of life. To our knowledge, this is the first report on the effects of such an early treatment. MATERIALS AND METHODS: Testicular function was assessed in a group of young men operated for cryptorchidism during the first year of life (Group A, n=13) and during the second year of life (Group B, n=16). RESULTS: Total sperm counts were clearly higher in Group A (52.3+/-14.3 million/ml vs. 30.4+/-23.5 million/ml, p=0.005) as was sperm motility (36.2+/-8.7 vs. 23.1+/-15.7%, p=0.009). A clear inverse relationship was found between age at orchiopexy and total sperm count (r=-0.394, p=0.034) and sperm motility (r=-0.382, p=0.041). The relationship between volume of testes, position at surgery, uni/bilaterality of cryptorchidism, evidence of Ad spermatogonia at biopsy performed during surgery and treatment with LHRH and hCG performed before surgery and fertility was not significant. The latter findings may be partially explained by the low number of patients participating in the study and need further investigation. CONCLUSIONS: We obtained, for the first time, results showing the benefit of treating cryptorchidism during the first year of life rather than in the second year or even later.
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Criptorquidismo/cirugía , Infertilidad Masculina/prevención & control , Orquidopexia , Recuento de Espermatozoides , Factores de Edad , Biopsia , Preescolar , Humanos , Lactante , Masculino , Medición de Riesgo , Factores de Riesgo , Motilidad Espermática , EspermatogoniasRESUMEN
Joint contractures, subluxation and dislocation are common problem in children with neuromuscular disorders. Medical, surgical and rehabilitative approaches can be used to maintain patient function and comfort. Contracture release, hip dysplasia correction and procedures to address or prevent hip subluxation or dislocation, are not always necessary since patients can be asymptomatic and surgical treatment will not always be successful in maintaining a reduced hip. In fact, controversy surrounds the management of hip disorder in children with Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, Charcot-Marie-Tooth Disease and Arthrogryposis Multiplex Congenita. Patients with neuromuscular disorders also frequently develop a progressive scoliosis with pelvic obliquity which may affect sitting balance and become painful. Most subluxations and dislocations have the tendency to occur on the high side of a tilted pelvis. Spinal stabilisation is sometimes necessary to improve the pelvic tilt and to prevent further increase. The present article provides an overview of the current strategies of hip management in neuromuscular disorders.
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Artrogriposis/terapia , Enfermedad de Charcot-Marie-Tooth/terapia , Contractura de la Cadera/terapia , Luxación de la Cadera/terapia , Distrofia Muscular de Duchenne/terapia , Atrofias Musculares Espinales de la Infancia/terapia , Adolescente , Artrogriposis/complicaciones , Enfermedad de Charcot-Marie-Tooth/complicaciones , Niño , Preescolar , Contractura de la Cadera/etiología , Luxación de la Cadera/etiología , Articulación de la Cadera/fisiopatología , Humanos , Lactante , Distrofia Muscular de Duchenne/complicaciones , Terapia Ocupacional , Modalidades de Fisioterapia , Rango del Movimiento Articular , Atrofias Musculares Espinales de la Infancia/complicacionesRESUMEN
An extremely rare case of type A esophageal atresia is reported. The baby girl patient born spontaneously after a 38-week pregnancy, was diagnosed prenatally with suspected type A esophageal atresia. Diagnosis was confirmed at birth by chest and abdominal X-ray. As per protocol, a naso-esophageal tube was positioned in aspiration and a Stamm gastrostomy made for nutritional purposes. Evaluation of the distance between blind pouches at one month of life showed they were overlapping. At intervention the pouches were found to be united by a fibrous bridge about 1.5 cm long. Anastomosis was carried out with ease. The postoperative course was trouble-free. On the X day the baby girl was being fed completely per os. Histolo-gical examination of the fibrous residue excluded the presence of a mucosa-lined lumen. X-ray examination of the esophageal-gastric passage, one month after the operation, showed the smooth transit of the contrast medium and an adequate anastomotic lumen. At follow-up, at the age of 9 months, the baby was growing normally and being fed per os with a diet appropriate for her age; no oesophageal dilatation was necessary. Type A oesophageal atresias are long-gap forms: they are treated with direct anastomosis after the blind pouches come together spontaneously in the first four months of life. Stress is laid on the rarity of the case. According to Kluth's classification of 1976, this form was described by Mason in 1855 and Jlott in 1905 on the basis of autopsy findings. A review of the literature did not show any similar clinical cases.