Éxito del tratamiento conservador de la fimosis, ¿la pauta de aplicación de corticoide tópico influye? / Success of conservative treatment of phimosis, does the topical corticosteroid application regime influence this?

Introducción. Actualmente no existe una pauta de aplicación única establecida para el tratamiento tópico corticoideo de la fimosis. Nos planteamos comparar la efectividad de dos de las pautas más utilizadas, así como la importancia de otros factores en el éxito del tratamiento conservador. Material y métodos. Estudio analítico de tipo cohortes retrospectivas, incluyendo niños con fimosis no complicada a los que se instauró dos pautas distintas de aplicación de corticoide tópico (con periodo de descanso y con dosis descendente). Se estudió el resultado final circuncisión o curación en base a la pauta y a otros factores epidemiológicos. Resultados. Se incluyeron 159 niños con edad media de 6 años. La pauta con descanso se aplicó en el 57,9% de los pacientes con una adherencia del 93,4% y una tasa de curación del 83,7%, frente al 79,1% de grupo con pauta descendente (diferencia no significativa). Se observó un mayor riesgo de circuncisión en pacientes con tratamiento tópico previo y con prepucio cicatricial y un papel protector de la adherencia al tratamiento. La presencia de balanitis previa o el grado de fimosis no se asocian con mayor fracaso del tratamiento. Conclusiones. Las pautas de aplicación estudiadas no presentan diferencias significativas en la tasa de curación. No obstante, la adherencia es mayor con la pauta con descanso por lo que parece recomendable. Las balanitis y el grado alto de fimosis no serían contraindicación inicial del tratamiento conservador (AU)

Introduction. Currently there is no single application guideline established for the topical corticosteroid treatment of phimosis. We set out to compare the effectiveness of two of the most widely used guidelines, as well as the importance of other factors in the success of conservative treatment. Material and methods. Retrospective cohort-type analytical study, including children with uncomplicated phimosis who received two different regimens of topical corticosteroid application (with a rest period and a descending dose). The final result of circumcision or cure was studied based on the guideline and other epidemiological factors. Results. 159 children with a mean age of 6 years were included. The regimen with rest was applied in 57.9% of the patients with an adherence of 93.4% and a cure rate of 83.7%, compared to 79.1% in the group with a descending regimen (non-significant difference). An increased risk of circumcision was observed in patients with previous topical treatment and with scarred foreskin and a protective role of adherence to treatment. The presence of previous balanitis or the degree of phimosis is not associated with greater treatment failure. Conclusions. The application guidelines studied do not show significant differences in the cure rate. However, adherence is greater with the rest pattern, so it seems advisable. Balanitis and a high degree of phimosis would not be an initial contraindication to conservative treatment (AU)

[Conservative treatment for omental infarction]. / Tratamiento conservador del infarto omental.

The omental infarction is a pathology that occurs more and more in children due to the increased use of imaging studies and the increment in overweigth and obesity. Clinical presentation is characterized by abdominal pain and can be confused with appendicitis, ileitis, adenitis, among other abdominal conditions. Definitive diagnosis requires the performance of radiologic investigations and its treatment may be conservative. We report three cases of omental infarction with different form of clinical presentation, successfully managed conservatively.

[Surgical treatment of perinatal ovarian cysts]. / Tratamiento quirürgico de los quistes ováricos perinatales.

INTRODUCTION: Actually, the perinatal ovarian cysts are increasingly being diagnosed by prenatal and neonatal ultrasound. OBJECTIVE: We reported our experience in the surgical management of perinatal ovarian cysts. Patients and methods. We have reviewed the clinical charts of 10 female newborns diagnosed of ovarian cysts who underwent surgical management in our hospital from 1989 to 2009. RESULTS: The ovarian cysts were diagnosed antenatally in 8 cases and period neonatal in 2 cases. The clinical presentation was asymptomatic abdominal mass in 7 cases. Ultrasound confirmed the ovarian mass in 8 patients. CT scan and MRI were necessary for confirm suspected diagnosis in two patients. Ultrasonography showed 7 complex cysts and 3 simple cysts. Surgery of the complicated cysts revealed ovarian torsion in 5 cases and 1 hemorragic cyst. At surgery, 5 patients underwent salpingooophorectomy, 2 patients needed oophorectomy and in 3 cases only cystectomy were necessary. CONCLUSION: The ovarian torsion is the most common complication and the cause of loss of the ovary. The neonatal ovarian cysts greater than 5 centimetres, symptomatic cysts, complex cysts and cysts persisting for more than 6 months need surgical intervention.

[Infantile Amyand's hernia presenting as acute scrotum]. / Hernia de amyand infantil presentándose como escroto agudo.

Amyand's hernia is a condition of exceptional presentation in children and is defined by the presence of inflamed appendix inside a inguinal hernia. It may manifest clinically as acute scrotum, inguinal lymphadenitis or strangulated hernia. The treatment is surgical and although several approaches are described, appendectomy with herniotomy by inguinal approach is considered of choice.