Puesta al día en el manejo del hipospadias / Update on the management of hypospadias

El hipospadias es la malformación congénita más frecuente del pene. el diagnóstico se realiza al nacimiento y es primordial explicar a los padres las características de la malformación, su repercusión funcional y el plan terapéutico a seguir. el tratamiento es quirúrgico y se recomienda llevarlo a cabo antes de la edad escolar. los objetivos de la cirugía son funcionales además de estéticos. puesto que hay una gran variabilidad en cuanto a presentación clínica y severidad, existen múltiples técnicas quirúrgicas

Hypospadias is the most common congenital malformation of the penis. the diagnosis is made at birth and it is essential to explain to the parents the characteristics of the malformation, its functional repercussion and the therapeutic objectives. Surgical treatment is recommended before school age. the objectives of the surgery are functional as well as aesthetic. Because there is great variability in clinical presentation and severity, there are multiple surgical techniques

Calendario quirúrgico en Pediatría / Surgical schedule in Pediatrics

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Resultados de la miectomía anorrectal posterior en el tratamiento del estreñimiento crónico idiopático / Outcome of posterior anorectal myectomy for the treatment of idiopathic chronic constipation

Objetivo. Evaluar los resultados clínicos del tratamiento quirúrgico de pacientes con estreñimiento crónico incontrolable con tratamiento médico. Material y métodos. Estudio descriptivo de pacientes con estreñimiento crónico severo tratados mediante miectomía anorrectal posterior (técnica de Lynn). Se recogen los resultados de los últimos 15 años, con periodo de seguimiento postoperatorio mínimo de 1 año. Se incluyen pacientes con larga historia de estreñimiento, refractarios a tratamiento médico. Pruebas complementarias: enema opaco, manometría anorrectal y biopsias rectales. El resultado clínico de la técnica se clasifica según los siguientes criterios: Curación: >3 movimientos intestinales por semana, sin incontinencia/encopresis y sin necesidad de tratamiento médico. Mejoría: >3 movimientos intestinales por semana, sin incontinencia/ encopresis y con necesidad de laxante. Resultados. Se realizaron 19 miectomías (edad media de 8,47 años). Tiempo medio de estreñimiento previo de 7,89 años. Los hallazgos en la anatomía patológica fueron: presencia de células ganglionares en 10, ausencia de células ganglionares en 4 y otras alteraciones en 5. Manometría en 6 pacientes, 4 presentaron reflejo inhibitorio anal. Cuatro pacientes se diagnosticaron de enfermedad de Hirschsprung (uno se curó con la miectomía, dos precisaron cirugía correctora y uno no acudió a revisiones). En los 15 restantes, cumplieron criterios de curación 8 pacientes (53,3%), 4 mejoraron (26,6%), 1 sin mejoría sigue tratamiento fisioterápico. Dos pacientes no continuaron las revisiones. No se registró incontinencia fecal ni otras complicaciones. Conclusiones. La miectomía de Lynn es un procedimiento eficaz y seguro para los pacientes con estreñimiento crónico severo refractario al tratamiento médico. También resulta el tratamiento definitivo en la enfermedad de Hirschsprung de segmento ultracorto

Objectives. The aim of this study is to assess the outcome of surgery (Lynn’s myectomy) in patients with chronic persistent constipation and failure of medical treatment. Material and methods. Descriptive study of patients with severe chronic constipation treated by posterior anorectal myectomy (Lynn’s technique). We report data from the last 15 years, with a minimum postoperative follow-up of one year. Patients included in the study suffered from a long-term constipation refractory to medical management. Data regarding contrast enema, anorectal manometry and rectal biopsy were recorded. The procedure’s outcome is classified following clinical criteria: Asymptomatic: >3 bowel movements per week, with no soiling/ incontinence and with no medical treatment. Improvement: >3 bowel movements per week, with no soiling/ incontinence but using laxatives occasionally. Results. Nineteen myectomies were performed (median age of 8.47 years). Median time of constipation before surgery was 7.89 years. Rectal biopsy findings: 10 with ganglion cells, 4 without ganglion cells and other abnormalities in 5. Anorectal manometry was performed in 6 patients, 4 presented rectoanal inhibitory reflex. Four patients were diagnosed of Hirschsprung’s disease (1 was asymptomatic after myectomy, 2 needed further surgery and 1 was lost in follow-up). Of the remaining 15 patients, 8 were asymptomatic (53.3%), 4 experienced improvement (26.6%) and 1 without clinical changes is on pelvic floor physiotherapy. Two were lost in follow-up. There were no other postoperative complications after long term follow-up. Conclusions. Lynn’s myectomy is an effective and safe procedure in patients suffering from persistent chronic constipation despite of medical treatment. It is also the definitive treatment for patients with ultrashort-segment Hirschsprung’s disease

[Outcome of posterior anorectal myectomy for the treatment of idiopathic chronic constipation]. / Resultados de la miectomía anorrectal posterior en el tratamiento del estreñimiento crónico idiopático.

OBJECIVES: The aim of this study is to assess the outcome of surgery (Lynn's myectomy) in patients with chronic persistent constipation and failure of medical treatment. MATERIAL AND METHODS: Descriptive study of patients with severe chronic constipation treated by posterior anorectal myectomy (Lynn's technique). We report data from the last 15 years, with a minimum postoperative follow-up of one year. Patients included in the study suffered from a long-term constipation refractory to medical management. Data regarding contrast enema, anorectal manometry and rectal biopsy were recorded. The procedure's outcome is classified following clinical criteria: Asymptomatic: >3 bowel movements per week, with no soiling/incontinence and with no medical treatment; Improvement: >3 bowel movements per week, with no soiling/incontinence but using laxatives occasionally. RESULTS: Nineteen myectomies were performed (median age of 8.47 years). Median time of constipation before surgery was 7.89 years. Rectal biopsy findings: 10 with ganglion cells, 4 without ganglion cells and other abnormalities in 5. Anorectal manometry was performed in 6 patients, 4 presented rectoanal inhibitory reflex. Four patients were diagnosed of Hirschsprung's disease (1 was asymptomatic after myectomy, 2 needed further surgery and 1 was lost in follow-up). Of the remaining 15 patients, 8 were asymptomatic (53.3%), 4 experienced improvement (26.6%) and 1 without clinical changes is on pelvic floor physiotherapy. Two were lost in follow-up. There were no other postoperative complications after long term follow-up. CONCLUSIONS: Lynn's myectomy is an effective and safe procedure in patients suffering from persistent chronic constipation despite of medical treatment. It is also the definitive treatment for patients with ultrashort-segment Hirschsprung's disease.

OBJETIVO: Evaluar los resultados clínicos del tratamiento quirúrgico de pacientes con estreñimiento crónico incontrolable con tratamiento médico. MATERIAL Y METODOS: Estudio descriptivo de pacientes con estreñimiento crónico severo tratados mediante miectomía anorrectal posterior (técnica de Lynn). Se recogen los resultados de los últimos 15 años, con periodo de seguimiento postoperatorio mínimo de 1 año. Se incluyen pacientes con larga historia de estreñimiento, refractarios a tratamiento médico. Pruebas complementarias: enema opaco, manometría anorrectal y biopsias rectales. El resultado clínico de la técnica se clasifica según los siguientes criterios: Curación: >3 movimientos intestinales por semana, sin incontinencia/encopresis y sin necesidad de tratamiento médico; Mejoría: >3 movimientos intestinales por semana, sin incontinencia/encopresis y con necesidad de laxante. RESULTADOS: Se realizaron 19 miectomías (edad media de 8,47 años). Tiempo medio de estreñimiento previo de 7,89 años. Los hallazgos en la anatomía patológica fueron: presencia de células ganglionares en 10, ausencia de células ganglionares en 4 y otras alteraciones en 5. Manometría en 6 pacientes, 4 presentaron reflejo inhibitorio anal. Cuatro pacientes se diagnosticaron de enfermedad de Hirschsprung (uno se curó con la miectomía, dos precisaron cirugía correctora y uno no acudió a revisiones). En los 15 restantes, cumplieron criterios de curación 8 pacientes (53,3%), 4 mejoraron (26,6%), 1 sin mejoría sigue tratamiento fisioterápico. Dos pacientes no continuaron las revisiones. No se registró incontinencia fecal ni otras complicaciones. CONCLUSIONES: La miectomía de Lynn es un procedimiento eficaz y seguro para los pacientes con estreñimiento crónico severo refractario al tratamiento médico. También resulta el tratamiento definitivo en la enfermedad de Hirschsprung de segmento ultracorto.

[Implementation of "fast-track" treatment in paediatric complicated appendicitis]. / Aplicación de un modelo terapéuticofast-track en la apendicitis aguda complicada del paciente pediátrico.

OBJECTIVE: Acute appendicitis is the most common emergency surgical pathology in childhood and there is no consensus on its management. Fast-track treatment, based on optimizing perioperative care has reduced morbidity and mortality of surgical pathologies, including simple acute appendicitis. The aim of our study was to assess the effects of a fast-track protocol in complicated acute appendicitis. METHODS: Ambispective cohort study. Historical unexposed cohort: children with complicated appendicitis and appendectomy in our hospital during 2008-2009. Exposed cohort: children operated in 2010-2011 and who performed protocol. The protocol treatment was done after a literature review, adapting the principles of fast-track to a potentially severe urgent disease: early mobilization, limited drainage-tubes and short antibiotic regimens Taking hospital stay as the resulting variable, the calculated sample size for alpha = 0.05 and power = 90% was 54, being X1 = 7 +/- 3DS and X2=5. RESULTS: We included 151 patients, historical cohort 81 and current cohort 70, which excluded 31 children who did not meet protocol because of surgeon choice. Both groups showed homogeneity due to the absence of differences in sex, age, weight, type of appendicitis (gangrenous, perforated, generalized peritonitis) or surgical approach. The average stay decreased 2.71 days (p <0.001) due to the protocol, without any complication increase (abscess, postoperative ileus, readmission). CONCLUSIONS: Complicated appendicitis in children is common and potentially serious, and optimization of treatment should be a primary goal of our practice. Application of a fast-track protocol can provide clinical and economic benefits, although this requires an appropriate multidisciplinary management.

[Testicular cancer and cryptorchidism: myth or reality]. / Cáncer testicular y criptorquidia. Mito o realidad.

OBJECTIVE: To evaluate the previous history of cryptorchidism in patients with testicular cancer. MATERIALS AND METHODS: We carried out a study using 175 patients diagnosed with testicular cancer, in our hospital, from 1999 to 2010. We analyzed the previous history of cryptorchidism and its characteristics, testicular placing, histology and intervention age. RESULTS: 5 out of the 175 patients (2,8%) with testicular neoplasm presented a history of cryptorchidism, The average age was 31 years old, an orchidopexy was only carried out in 2 patients. The histology was different depending on the treatment chosen to battle cryptorchidism and in 2 cases it developed in the adjoining testicle. The average ratio was of 1,9. CONCLUSIONS: Our results reflect that the association of cryptorchidism with testicular neoplasm is in fact lower than in the past. A good and proper handling of cryptorchidism can prevent it from turning malignant, presenting these patients similar incidences to the rest of the population.

[Appendectomy and Crohn's disease]. / Apendicectomía y enfermedad de Crohn.

UNLABELLED: We analyzed the relationship between Crohn's disease and appendectomy in paediatric age. METHOD AND MATERIAL: We studied the patients diagnosed with Crohn's disease and appendectomy (under 20) between 1999 and 2011. We retrieved their previous medical histories and carried out an histological re evaluation of those appendix. RESULTS: 11 patients out of 137 (8,02%) had an appendectomy before the development of Crohn's disease. An average age in which the appendectomy took place and the development of Crohn's disease was diagnosed 14 (5-20 years), having 90% of the patients diagnosed in the early post-surgical stages. A patient did not develop any symptoms until a year later. There were no more appendectomies carried out in comparison with the adult population. The initial anatomopathologic diagnosis and the histological re evaluation agreed in just one case, compatible with Crohn's disease. CONCLUSION: The majority of appendectomies carried out in paediatric patients that later develop Crohn's disease are realized by a bias diagnosis of acute appendicitis and the relation between the two of them can be explained as the not yet developed Crohn's disease at the moment of the appendectomy. Appendectomies at a paediatric age are not associated with a potential development of Crohn's disease. There is no evidence of histological changes compatible with Crohn's disease in the first episode.

Aplicación de un modelo terapéutico fast-track en la apendicitis aguda complicada del paciente pediátrico / Implementation of “fast-track” treatment in paediatric complicated appendicitis

OBJETIVOS: La apendicitis aguda es la patología quirúrgica urgente más frecuente en la infancia y no existe consenso sobre su manejo. El tratamiento fast-track, basado en optimizar los cuidados perioperatorios, ha permitido disminuir la morbi-mortalidad de las patologías quirúrgicas, incluyendo la apendicitis aguda simple. El objetivo de nuestro trabajo es valorar los efectos de un protocolo fast-track en la apendicitis aguda complicada. MATERIAL Y MÉTODOS: Estudio de cohortes ambispectivo. Cohorte no expuesta histórica: niños con apendicitis complicada apendicectomizados en nuestro servicio durante 2008-2009. Cohorte expuesta: niños intervenidos en 2010-2011 que cumplieron el protocolo. La vía terapéutica fue elaborada tras revisión bibliográfica, adecuando los principios del fast-track a una patología urgente potencialmente grave: movilización precoz, limitación de drenajes-sondas y pautas antibióticas cortas. Tomando como variable principal la estancia hospitalaria, se calculó un tamaño muestral para α= 0,05 y potencia= 90% de 54, siendo x1 = 7 ± 3DS y x2= 5. RESULTADOS: Se incluyeron 151 pacientes, cohorte histórica 81 y cohorte actual 70, de la que se excluyeron 31 niños que no cumplieron protocolo por elección del cirujano. Ambas muestras demostraron homogeneidad al no existir diferencias en el sexo, edad, peso, tipo de apendicitis (gangrenosa, perforada, peritonitis generalizada) o vía de abordaje. La estancia media disminuyó 2,71 días (p < 0,001) con la aplicación del protocolo, sin aumento de complicaciones (absceso, íleo postoperatorio, reingreso). CONCLUSIONES: La apendicitis complicada en pediatría es frecuente y potencialmente grave, y la optimización de su tratamiento debe ser un objetivo primordial de nuestra práctica. La aplicación de un protocolo fast-track puede aportar beneficios clínicos y económicos, aunque para ello es necesario un manejo multidisciplinar adecuado

OBJECTIVE: Acute appendicitis is the most common emergency surgical pathology in childhood and there is no consensus on its management. Fast-track treatment, based on optimizing perioperative care has reduced morbidity and mortality of surgical pathologies, including simple acute appendicitis. The aim of our study was to assess the effects of a fast-track protocol in complicated acute appendicitis. METHODS: Ambispective cohort study. Historical unexposed cohort: children with complicated appendicitis and appendectomy in our hospital during 2008-2009. Exposed cohort: children operated in 2010-2011 and who performed protocol. The protocol treatment was done after a literature review, adapting the principles of fast-track to a potentially severe urgent disease: early mobilization, limited drainage-tubes and short antibiotic regimens Taking hospital stay as the resulting variable, the calculated sample size for α = 0.05 and power = 90% was 54, being x1 = 7 ± 3DS and x2 = 5. RESULTS: We included 151 patients, historical cohort 81 and cur-rent cohort 70, which excluded 31 children who did not meet protocol because of surgeon choice. Both groups showed homogeneity due to the absence of differences in sex, age, weight, type of appendicitis (gangrenous, perforated, generalized peritonitis) or surgical approach. The average stay decreased 2.71 days (p < 0.001) due to the protocol, without any complication increase (abscess, postoperative ileus, readmission). CONCLUSIONS: Complicated appendicitis in children is common and potentially serious, and optimization of treatment should be a primary goal of our practice. Application of a fast-track protocol can provide clinical and economic benefits, although this requires an appropriate multidisciplinary management

Cáncer testicular y criptorquidia. Mito o realidad / Testicular cancer and cryptorchidism: myth or reality

OBJETIVO: Valorar el antecedente de criptorquidia en pacientes con cáncer testicular. MATERIAL Y MÉTODO: Realizamos un estudio retrospectivo de 175 pacientes diagnosticados de tumoraciones malignas, en nuestro hospi-tal, desde 1999 a 2010. Analizamos el antecedente de criptorquidia y características de la misma, localización testicular, histología y edad de intervención. RESULTADOS: De los 175 pacientes con cáncer testicular, 5 pacientes presentaron antecedente de criptorquidia (2,8%). Sólo en 2 pacientes se había efectuado una orquidopexia. La edad media de presentación del tumor fue de 31 años y el tipo histológico fue diferente según el tratamiento aplicado a la criptorquidia. En 2 pacientes el tumor se de-sarrolló en el testículo contralateral. La odds ratio de presentación de degeneración maligna es de 1,9. CONCLUSIONES: Nuestros resultados reflejan que la asociación criptorquidia-cáncer testicular es menor que la descrita en el pasado. Un manejo adecuado y protocolizado de la criptorquidia previene la malignización, presentando estos pacientes una incidencia casi similar al resto de la población

OBJECTIVE: To evaluate the previous history of cryptorchidism in patients with testicular cancer. MATERIALS AND METHODS: We carried out a study using 175 patients diagnosed with testicular cancer, in our hospital, from 1999 to 2010. We analyzed the previous history of cryptorchidism and its characteristics, testicular placing, histology and intervention age. RESULTS: 5 out of the 175 patients (2,8%) with testicular neoplasm presented a history of cryptorchidism, The average age was 31 years old, an orchidopexy was only carried out in 2 patients. The histology was different depending on the treatment chosen to battle cryptorchi-dism and in 2 cases it developed in the adjoining testicle. The average ratio was of 1,9. CONCLUSIONS: Our results reflect that the association of cryptor-chidism with testicular neoplasm is in fact lower than in the past. A good and proper handling of cryptorchidism can prevent it from turning malignant, presenting these patients similar incidences to the rest of the population

Focal nodular hyperplasia on accessory lobe of the liver: preoperative diagnosis and management.

We report the case of a 13 year-old girl transferred to our department with a one month history of vomiting, weight loss, and abdominal mass that was diagnosed as Focal Nodular Hyperplasia in an accessory lobe of the liver. Accessory liver lobe is a rare congenital anomaly whose preoperative diagnosis is difficult and usually presents as an incidental finding intraoperatively. Depending on their location and size, they can present as acute abdomen or abdominopelvic mass. In the literature reviewed, we found no association of focal nodular hyperplasia and accessory liver lobe in children.

Apendicectomía y enfermedad de Crohn / Appendectomy and Crohn´s disease

Objetivo. El objetivo de nuestro estudio es valorar el efecto de la apendicectomía en el posterior desarrollo de la EC en la edad pediátrica. Material y método. Estudiamos retrospectivamente los pacientes menores de 20 años diagnosticados de EC y sometidos a apendicectomía entre 1999 y 2011 en nuestro centro, seleccionando a aquellos que fueron apendicectomizados previo al diagnóstico de Crohn. Se llevó a cabo una reevaluación histológica de dichos apéndices. Resultados. 11 pacientes de un total de 137 (8,02%) fueron apendicectomizados antes de desarrollar la EC. La edad media de los pacientes en el momento de la intervención y del diagnóstico de la enfermedad fue de 14 años (5-20 años), siendo el 90% diagnosticados en el postoperatorio temprano. No se evidenció una incidencia mayor de apendicectomía respecto a la población general a diferencia de lo que sucede en la edad adulta. El diagnóstico anatomopatológico inicial del apéndice y la reevaluación histológica coincidieron siendo tan solo un caso compatible con enfermedad Crohn. Conclusiones. Las mayoría de las apendicectomías realizadas en pacientes pediátricos que desarrollan posteriormente una EC son realizadas por un sesgo diagnóstico de apendicitis aguda y la relación entre ambas puede limitarse a la falta de diagnóstico de la EC en el momento de la intervención. La apendicectomía en la edad pediátrica no parece estar asociada a un peor pronóstico de la enfermedad. No se evidencian cambios histológicos compatibles con EC en el primer episodio (AU)

We analyzed the relationship between Crohn’s disease and appendectomy in paediatric age. Method and material. We studied the patients diagnosed with Crohn’s disease and appendectomy (under 20) between 1999 and 2011. We retrieved their previous medical histories and carried out an histological reevaluation of those appendix. Results. 11 patients out of 137 (8,02%) had an appendectomy before the development of Crohn’s disease. An average age in which the appendectomy took place and the development of Crohn’s disease was diagnosed 14 (5-20 years), having 90% of the patients diagnosed in the early post-surgical stages. A patient did not develop any symptoms until a year later. There were no more appendectomies carried out in comparison with the adult population. The initial anatomopathologic diagnosis and the histological reevaluation agreed in just one case, compatible with Crohn´s disease. Conclusion. The majority of appendectomies carried out in paediatric patients that later develop Crohn’s disease are realized by a bias diagnosis of acute appendicitis and the relation between the two of them can be explained as the not yet developed Crohn´s disease at the moment of the appendectomy. Appendectomies at a paediatric age are not associated with a potential development of Crohn´s disease. There is no evidence of histological changes compatible with Crohn’s disease in the first episode (AU)

[Evaluation of quality of life in patients operated on for gastroesophageal reflux in the pediatric age]. / Valoración de la calidad de vida en los pacientes intervenidos por reflujo gastroesofágico en la edad pediátrica.

AIM: To assess the quality of life and symptoms of GER patients who underwent laparoscopy in our hospital before and after surgery. MATERIAL AND METHODS: We collect data from patients operated laparoscopically for gastroesophageal reflux disease (GER) in our center before and after surgery in 3 items: nutritional studies, diagnostic methods, interviews with the families of patients about symptoms (preferably differing in digestive or respiratory symptoms) and quality of life; also, determined the age, gender, personal history and surgical technique of patients. RESULTS: 30 patients have been operated for GER, 22 men and 8 women, 11 months to 14 years (median age 5 years) of whom 12 (40%) had some degree of encephalopathy. The most common surgical technique used is Nissen (73% cases). Most patients had significant alterations in their daily activities before surgery. The most common symptom was gastrointestinal (70% cases), although all showed improvement, families of children with respiratory symptoms related predominantly greater reduction in the clinic after surgical correction. All improved in its growth curve. CONCLUSIONS: Surgery for GER patients have a significant improvement in their quality of life, not only by the reduction of their symptoms but also in enhancing from the nutritional status. Patients with respiratory symptoms have a higher satisfaction with surgical treatment than those with gastrointestinal clinical.

Valoración de la calidad de vida en los pacientes intervenidos por refl ujo gastroesofágico en la edad pediátrica / Evaluation of quality of life in patients operated on for gastroesophageal reflux in the pediatric age

Objetivo. Valorar la calidad de vida y sintomatología de los pacientes intervenidos por RGE mediante laparoscopia en nuestro centro, antes y después de la cirugía. Material y métodos. Recogemos los datos de los pacientes intervenidos laparoscópicamente por reflujo gastroesofágico (RGE) en nuestro centro, pre y postcirugía, agrupados en 3 ítems: estudio nutricional, pruebas diagnósticas, encuesta realizada a las familias de los pacientes sobre sintomatología (diferenciando en síntomas preferentemente digestivos o respiratorios) y calidad de vida; además, determinamos la edad y sexo de los pacientes, antecedentes personales y la técnica quirúrgica utilizada. Resultados. Hemos intervenido a 30 pacientes por RGE, 22 varones y 8 mujeres, de 11 meses a 14 años (mediana 5 años) de los cuales 12 (40%) presentaban algún grado de encefalopatía. La técnica quirúrgica más utilizada es la de Nissen (73% de los casos). La mayoría de los pacientes presentaban alteración importante en sus actividades diarias previamente a la cirugía. La sintomatología más frecuente fue la digestiva (70% casos) y, aunque todos presentaron mejoría, las familias de los niños con clínica predominantemente respiratoria referían mayor satisfacción tras la corrección quirúrgica. Todos mejoraron en su curva de crecimiento. Conclusiones. Los pacientes intervenidos por RGE tienen una mejora importante en su calidad de vida, no solo por la reducción de su sintomatología, sino también por la recuperación nutricional. Los pacientes con sintomatología respiratoria presentan una mayor satisfacción con el tratamiento quirúrgico que aquellos que presentan clínica principalmente digestiva (AU)

Aim. To assess the quality of life and symptoms of GER patients who underwent laparoscopy in our hospital before and after surgery. Material and methods. We collect data from patients operated laparoscopically for gastroesophageal reflux disease (GER) in our center before and after surgery in 3 items: nutritional studies, diagnostic methods, interviews with the families of patients about symptoms (preferably differing in digestive or respiratory symptoms) and quality of life; also, determined the age, gender, personal history and surgical technique of patients. Results. 30 patients have been operated for GER, 22 men and 8 women, 11 months to 14 years (median age 5 years) of whom 12 (40%) had some degree of encephalopathy The most common surgical technique used is Nissen (73% cases). Most patients had significant alterations in their daily activities before surgery. The most common symptom was gastrointestinal (70% cases), although all showed improvement, families of children with respiratory symptoms related predominantly greater reduction in the clinic after surgical correction. All improved in its growth curve. Conclusions. Surgery for GER patients have a signifi cant improvement in their quality of life, not only by the reduction of their symptoms but also in enhancing from the nutritional status. Patients with respiratory symptoms have a higher satisfaction with surgical treatment than those with gastrointestinal clinica (AU)

Torsión aislada de la trompa de Falopio en una adolescente premenárquica de 11 años de edad / Isolated torsion of the Fallopian tube in a 11 years premenarcheal adolescent girl

La torsión aislada de la trompa de Falopio es una causa muy rara de dolor abdominal agudo en adolescentes. Debemos tener en cuenta esta patología en el diagnóstico diferencial del dolor abdominal agudo, ya que el tratamiento quirúrgico precoz es fundamental para la conservación de la trompa. Presentamos un caso unilateral de esta patología en una adolescente de 11 años de edad, cuyo diagnóstico se realizó intraoperatoriamente(AU)

The isolated Fallopian tube torsion is an infrequent cause abdominal pain among premenarcheal adolescent girls. This entity produces symptoms of non-specific abdominal pain and consequently should be included in the differential diagnosis, because the early diagnosis and surgery mainstay for keeping the Fallopian tube. This case is about an 11 years adolescent girl with isolated torsion of left Fallopian tube, whose diagnosis was made during surgery(AU)

Miofibroma infantil solitario congé nito. Presentación de dos casos / Congenital solitary infantile myofibroma: Report of two cases

La miofibromatosis infantil es una patología rara que suele afectar a niños menores de 2 años. Más de la mitad son congénitos, localizándose en cabeza-cuello (..) (AU)

The infantile myofibromatosis is a rare pathology usually affecting children under 2 years. More than half are congenital, located in head and neck in a 30% of the (..) (AU)

[Congenital solitary infantile myofibroma: report of two cases]. / Miofibroma infantil solitario congénito. Presentación de dos casos.

UNLABELLED: The infantile myofibromatosis is a rare pathology usually affecting children under 2 years. More than half are congenital, located in head and neck in a 30% of the cases. Myofibroma is a benign mesenchymal tumor that appear an isolated lesion or multiple, with or without visceral involvement. Case 1: A newborn girl that presents lump in scalp suspected of encefalocele. Ultrasound and RM: solid and heterogeneous mass 4 x 2 cm with increased peripheral vascularisation. Case 2: A 7-month-old baby boy with lump in right occipital zone detected at 4 months. Ultrasound and RM: injury 1 x 1.5 cm in head esplenio muscle suggestive of hemangioma. RESULTS: After surgical total resection, the histological study and immunohistochemical identified the lesion as myofibroma. The evaluation of disease dissemination was normal and the recovery of the patients was favorable. The differential diagnosis of myofibroma must be carried out with other mesenchymal tumors and with non neoplastic injuries characteristics of the region affects. The visceral location and multiple forms worsen the prognosis, so is important do an exhaustive study. Treatment is conservative surgery, but if there is no risk to the child, the possibility of spontaneous regression makes the abstention therapeutic a correct alternative.

Alteraciones estructurales del músculo liso y de la expresión de EGFR y C-kit en la estenosispieloureteral congénita. Relación con su patogénesis / Structural alterations of the smooth muscle and of the egfr expression and c-kit in congenital pyelouretheral stenosis. relationship with its pathogenesis

Objetivos. Evaluar el papel que la displasia muscular, el factor de crecimiento epidérmico (EGFR) y las células intersticiales de Cajal(CIC) C-kit+ pueden tener en la fisiopatología de la estenosis pieloureteral (EPU).Material y Método. Se estudian 30 muestras de UPU (unión pieloureteral), 25 con EPU y 5 controles. Se realizan tinciones con Tricrómico de Masson y técnicas de inmunohistoquímica para Actina de músculo liso, EGFR (factor de crecimiento epidérmico) y CD117(C-kit)(Dako). Comparamos los resultados estadísticamente Resultados. El grupo control expresó positividad difusa de EGFR en la capa muscular; en las muestras de EPU fue positiva en el 4%, débil en el 16% y negativa en el 80%. Los controles muestran CIC C-kit+entre las células musculares, evidenciándose una densidad disminuida en las muestras de obstrucción. El tricrómico de Masson resaltó aumento del colágeno inter e intramuscular y fibras musculares atenuadas, más finas e individualizadas, en la capa muscular interna de los casos de (..) (AU)

Purpose. To assess the role that the muscular dysplasia, epidermal growth factor (EGFR) and interstitial cells of Cajal (ICC) C-kit +, may have in the pathophysiology of pyeloureteral stenosis (EPU).Materials and Methods. 30 samples were studied UPJ (ureteropelvic junction), with 25 UPJ obstruction and 5 controls. Performed with Masson’s trichrome staining and immunohistochemical techniques for smooth muscle actin, EGFR (epidermal growth factor) and CD117(C-kit) (Dako). We compared the results statistically. Results. The control group was diffuse positivity of EGFR in the muscle layer in samples of EPU was positive in 4%, weak in 16% and negative in 80%. The controls are C-kit + ICC between the muscle cells showed a decreased density in the samples of obstruction. Masson’strichrome highlighted the increase of inter-and intramuscular collagen and attenuated muscle fibers, thinner and individualized, in the inner (..) (AU)

[Structural alterations of the smooth muscle and of the EGFR expression and C-kit in congenital pyeloureteral stenosis. Relationship with its pathogenesis]. / Alteraciones estructurales del músculo liso y de la expresión de EGFR y C-kit en la estenosis pieloureteral congénita. Relación con su patogénesis.

PURPOSE: To assess the role that the muscular dysplasia, epidermal growth factor (EGFR) and interstitial cells of Cajal (ICC) C-kit +, may have in the pathophysiology of pyeloureteral stenosis (EPU). MATERIALS AND METHODS: 30 samples were studied UPJ (ureteropelvic junction), with 25 UPJ obstruction and 5 controls. Performed with Masson's trichrome staining and immunohistochemical techniques for smooth muscle actin, EGFR (epidermal growth factor) and CD117 (C-kit) (Dako). We compared the results statistically. RESULTS: The control group was diffuse positivity of EGFR in the muscle layer in samples of EPU was positive in 4%, weak in 16% and negative in 80%. The controls are C-kit + ICC between the muscle cells showed a decreased density in the samples of obstruction. Masson's trichrome highlighted the increase of inter-and intramuscular collagen and attenuated muscle fibers, thinner and individualized, in the inner muscular layer of the cases of EPU also evident with the actin. Differences between groups were statistically significant (p < 0.001). CONCLUSIONS: Our results suggest that dysplastic changes in the muscle layer, the low expression of EGFR and the decrease or absence of C-kit + ICC, may participate in the pathophysiology of UPJ obstruction.