Bilateral and multilobar cystic adenomatoid malformation of the lung.

We report a case of bilateral and multilobar congenital cystic adenomatoid malformation (CCAM) in a four-months-old child with good clinical results after resections of the lesions. This is a relatively rare form of pulmonary disease. The final prognosis in these patients depends on the type of malformation, the presence or absence of fetal hydrops and on the extent of affected lung. Few cases of multiple involvement have been reported. We will consider the physiopathological aspects of the case, late clinical presentation and treatment and the positive surgical response based on the findings of the functional and anatomic imaging studies.

Torsion of vermiform appendix: value of ultrasonographic findings.

A case of torsion of the vermiform appendix is described in a five-year-old boy with a two-day history of right-sided abdominal pain. No associated abdominal tenderness was reported, no vomiting nor fever. The pain was localized in the same place for 24 hours and became more severe and constant. Blood film showed a normal white cell count. After two ultrasonographic examinations in the course of 24 hours, the sign of a distended intestinal loop became constant. With the diagnosis of mucous-producing appendicular lesions or appendicular torsion, a laparotomy was performed. The appendix was severely congested and gangrenous; there was a 360-degree anticlockwise twist in its base. The related literature is reviewed and the value of the ultrasound scanner images and the possible mechanism involved is discussed.

[Alternatives to splenectomy in the surgical treatment of splenic injuries]. / Alternativas a la esplenectomía en el tratamiento quirúrgico de los traumatismos esplénicos.

Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical interventions is very rare. When a surgical exploration is mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prosteses. We present our experience over the 4 years with 9 severe splenic injuries. Six of this patients were treated operatively with a reabsorvable mesh, while the other 3 were managed percutaneosly by selective embolization of the splenic artery under fluoroscopic control. We describe our experience in the treatment of the splenic injuries in the last four years.

[Rapunzel syndrome: a report of a new case]. / Síndrome de Rapunzel. Aportación de un nuevo caso.

The Rapunzel Syndrome is a rare form of gastric trichobezoar extending throughout the bowel. A 8-year-old girl was admitted to our institution with a six months history of vomiting and astenia. Upper gastrointestinal contrast study showed a lot of filling defects in stomach and the first bowel loops. At laparotomy a large intraluminal mass is observed. Gastrotomy revealed a large tricobezoar with intestinal extension to jejunum, that were extracted. In rare instances, this syndrome presents with a confusing clinical picture. A detailed medical history is an essential point in the diagnosis.

[Surgical treatment of laryngotracheal stenosis in childhood]. / Tratamiento quirúrgico de las estenosis laringotraqueales en la infancia.

Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.

[Surgical options in the treatment of short bowel syndrome with loss of the ileocecal valve. Intestinal valve, intestinal duplication]. / Opciones quirúrgicas en el tratamiento del síndrome de intestino corto con pérdida de la válvula ileocecal. Válvula intestinal, desdoblamiento intestinal.

Morbidity and mortality are especially increased in pediatric patients affected of short bowel syndrome in whom ileocecal valve was resected. This report concerns 13 infants and children with short gut syndrome with ileocecal valve resected treated in the last 4 years. In two of them we performed intestinal duplication and in seven an antireflux intestinal valve with a segment of bowel. With that procedure we achieved a significant shortening of the hospital stay as well as reduction in time and quantity of total parenteral nutrition. The rest of the patients were treated with conservative management.