Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

Treatment of pectus excavatum with vacuum bell during puberty. / Tratamiento del pectus excavatum con campana de succión durante la pubertad.

OBJECTIVE: To assess the efficacy of the vacuum bell during puberty, according to the daily hours of use and treatment duration. MATERIALS AND METHODS: A retrospective analysis of patients treated with vacuum bell during puberty in the 2010-2021 period was carried out. Several variables were collected, including baseline and final sinking, repaired sinking expressed in cm and as a percentage from baseline sinking, daily hours of use, treatment duration, and complications. Patients were categorized into groups according to the daily hours of use (≤ 3 hours; 4-5 hours; ≥ 6 hours) and treatment duration (6-12 months; 13-24 months; 25-36 months; > 36 months), and they were statistically analyzed. RESULTS: A total of 50 patients -41 male and 9 female- were studied, with a mean age of 12.5 years (range: 10-14 years). No significant differences among groups were observed in terms of baseline sinking, thoracic index, and final sinking. Repaired sinking did increase with the daily hours of use, with significant differences. Complications were mild. 3 patients withdrew from follow-up, and 5 out of the 25 patients who completed treatment achieved a good repair. CONCLUSIONS: To increase treatment efficacy, the vacuum bell should be used for 6 hours/day during puberty. This method is well-tolerated, causes mild complications, and may be an alternative to surgery in some cases.

OBJETIVO: Evaluar la eficacia de la campana de succión durante la pubertad, según las horas diarias de uso y la duración del tratamiento. MATERIAL Y METODOS: Se evaluaron retrospectivamente los pacientes tratados con campana de succión durante la pubertad en el periodo 2010-2021. Se recogieron diferentes variables, incluyendo el hundimiento inicial y final, el hundimiento corregido expresado en centímetros y en porcentaje con respecto al hundimiento inicial, las horas diarias de uso, la duración del tratamiento y las complicaciones. Se categorizaron los pacientes en grupos según las horas diarias de uso (≤ 3 horas; 4-5 horas; ≥ 6 horas) y la duración del tratamiento (6-12 meses; 13-24 meses; 25-36 meses; > 36 meses), y se analizaron estadísticamente. RESULTADOS: Se estudiaron un total de 50 pacientes; 41 varones y 9 mujeres, con una edad media de 12,5 años (rango 10-14 años). No se observaron diferencias significativas entre los diferentes grupos en relación con el hundimiento inicial, el índice torácico y el hundimiento final. El hundimiento corregido aumentó en relación con las horas diarias de uso, con diferencias significativas. Las complicaciones fueron leves, 3 pacientes abandonaron el seguimiento y 5 pacientes de los 25 que finalizaron el tratamiento, alcanzaron una buena corrección. CONCLUSIONES: Para aumentar la eficacia del tratamiento, el tiempo de uso de la campana de succión durante la pubertad debería alcanzar las 6 horas diarias. Este método es bien tolerado, presenta leves complicaciones y puede ser una alternativa a la cirugía en algunos casos.

Tratamiento del pectus excavatum con campana de succión durante la pubertad / Treatment of pectus excavatum with vacuum bell during puberty

Objetivo: Evaluar la eficacia de la campana de succión durante lapubertad, según las horas diarias de uso y la duración del tratamiento. Material y métodos: Se evaluaron retrospectivamente los pacientestratados con campana de succión durante la pubertad en el periodo 2010-2021. Se recogieron diferentes variables, incluyendo el hundimientoinicial y final, el hundimiento corregido expresado en centímetros y enporcentaje con respecto al hundimiento inicial, las horas diarias de uso,la duración del tratamiento y las complicaciones. Se categorizaron lospacientes en grupos según las horas diarias de uso (≤ 3 horas; 4-5 horas;≥ 6 horas) y la duración del tratamiento (6-12 meses; 13-24 meses; 25-36meses; > 36 meses), y se analizaron estadísticamente. Resultados: Se estudiaron un total de 50 pacientes; 41 varones y9 mujeres, con una edad media de 12,5 años (rango 10-14 años). Nose observaron diferencias significativas entre los diferentes grupos enrelación con el hundimiento inicial, el índice torácico y el hundimientofinal. El hundimiento corregido aumentó en relación con las horas diariasde uso, con diferencias significativas. Las complicaciones fueron leves,3 pacientes abandonaron el seguimiento y 5 pacientes de los 25 quefinalizaron el tratamiento, alcanzaron una buena corrección. Conclusiones: Para aumentar la eficacia del tratamiento, el tiempode uso de la campana de succión durante la pubertad debería alcanzarlas 6 horas diarias. Este método es bien tolerado, presenta leves com-plicaciones y puede ser una alternativa a la cirugía en algunos casos.(AU)

Objective: To assess the efficacy of the vacuum bell during puberty,according to the daily hours of use and treatment duration.Materials and methods: A retrospective analysis of patients treatedwith vacuum bell during puberty in the 2010-2021 period was carried out. Several variables were collected, including baseline and finalsinking, repaired sinking expressed in cm and as a percentage frombaseline sinking, daily hours of use, treatment duration, and complications. Patients were categorized into groups according to the daily hoursof use (≤ 3 hours; 4-5 hours; ≥ 6 hours) and treatment duration (6-12months; 13-24 months; 25-36 months; > 36 months), and they werestatistically analyzed.Results: A total of 50 patients – 41 male and 9 female – were studied, with a mean age of 12.5 years (range: 10-14 years). No significantdifferences among groups were observed in terms of baseline sinking,thoracic index, and final sinking. Repaired sinking did increase withthe daily hours of use, with significant differences. Complications weremild. 3 patients withdrew from follow-up, and 5 out of the 25 patientswho completed treatment achieved a good repair. Conclusions: To increase treatment efficacy, the vacuum bell shouldbe used for 6 hours/day during puberty. This method is well-tolerated,causes mild complications, and may be an alternative to surgery insome cases.(AU)

Postoperative hyperlipasemia in perforated appendicitis in children. / Hiperlipasemia posoperatoria en apendicitis perforada en niños.

OBJECTIVE: The objective of this study was to assess the hyperlipasemia cases detected in the postoperative period of perforated appendicitis. MATERIALS AND METHODS: A retrospective analysis of the perforated appendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperative serum lipase levels were available were included. The variables collected were statistically assessed by means of a descriptive, univariate analysis. RESULTS: A total of 88 patients were studied. They were divided into 3 groups according to postoperative lipase levels - 57 were allocated to Group 1 (lipase: 70-194.0 U/L, normal range), 20 were allocated to Group 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (lipase: > 582 U/L, which triples normal levels). Statistically significant differences were found in the following variables: sex, postoperative abscess, postoperative subocclusion/intestinal occlusion, preoperative lipase levels, days of parenteral nutrition, days of ICU stay, and days of hospital stay. Postoperative lipase had a moderate correlation with preoperative lipase, and none of the cases met acute pancreatitis diagnostic criteria. CONCLUSIONS: Hyperlipasemia in the postoperative period of perforated appendicitis is not associated with developing clinical pancreatitis, but it is associated with worse progression in terms of increased complications, such as subocclusion/intestinal occlusion and intra-abdominal abscess, and longer ICU stay, hospital stay, and parenteral nutrition. There is a moderate correlation between preoperative and postoperative lipase, which means they could both prove useful as prognostic markers.

OBJETIVO: El objetivo del estudio es evaluar los casos de hiperlipasemia detectados en el posoperatorio de la apendicitis perforada. MATERIAL Y METODO: Se evaluaron retrospectivamente los casos de apendicitis perforada en nuestro centro durante 7 años (2013-2019), seleccionando aquellos con mediciones preoperatorias y posoperatorias de lipasa sérica. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva y univariante. RESULTADOS: Se estudiaron un total de 88 pacientes que se dividieron en tres grupos según el valor de la lipasa posoperatoria: 57 corresponden al grupo 1 (lipasa 70-194 U/L, rango normal), 20 al grupo 2 (lipasa 195-582 U/L) y 11 al grupo 3 (lipasa > 582 U/L, valor tres veces por encima del normal). Las variables que mostraron diferencias estadísticamente significativas fueron el sexo, el absceso posoperatorio, la suboclusión/oclusión intestinal posoperatoria, la lipasa preoperatoria, los días de nutrición parenteral, los días de ingreso en UCI y los días de estancia hospitalaria. La lipasa posoperatoria mostró una correlación moderada con la lipasa preoperatoria y ningún caso cumplió criterios diagnósticos de pancreatitis aguda. CONCLUSIONES: La hiperlipasemia en el posoperatorio de la apendicitis perforada no se asocia al desarrollo de pancreatitis clínica, pero sí se asocia a una peor evolución en relación con un aumento de complicaciones, como la suboclusión/oclusión intestinal y el absceso intraabdominal, y un mayor número de días de ingreso en UCI, de días de nutrición parenteral y de estancia hospitalaria. Existe una moderada correlación entre la lipasa preoperatoria y posoperatoria, de modo que ambas podrían ser útiles como marcadores pronósticos.

Hiperlipasemia posoperatoria en apendicitis perforada en niños / Postoperative hyperlipasemia in perforated appendicitis in children

Objetivo: El objetivo del estudio es evaluar los casos de hiper-lipasemia detectados en el posoperatorio de la apendicitis perforada.Material y método: Se evaluaron retrospectivamente los casos deapendicitis perforada en nuestro centro durante 7 años (2013-2019),seleccionando aquellos con mediciones preoperatorias y posoperatorias de lipasa sérica. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva y univariante. Resultados: Se estudiaron un total de 88 pacientes que se dividieron en tres grupos según el valor de la lipasa posoperatoria: 57 correspondenal grupo 1 (lipasa 70-194 U/L, rango normal), 20 al grupo 2 (lipasa 195-582 U/L) y 11 al grupo 3 (lipasa > 582 U/L, valor tres veces por encimadel normal). Las variables que mostraron diferencias estadísticamentesignificativas fueron el sexo, el absceso posoperatorio, la suboclusión/oclusión intestinal posoperatoria, la lipasa preoperatoria, los días denutrición parenteral, los días de ingreso en UCI y los días de estanciahospitalaria. La lipasa posoperatoria mostró una correlación moderadacon la lipasa preoperatoria y ningún caso cumplió criterios diagnósticosde pancreatitis aguda. Conclusiones: La hiperlipasemia en el posoperatorio de la apendicitis perforada no se asocia al desarrollo de pancreatitis clínica, perosí se asocia a una peor evolución en relación con un aumento de complicaciones, como la suboclusión/oclusión intestinal y el absceso intraabdominal, y un mayor número de días de ingreso en UCI, de díasde nutrición parenteral y de estancia hospitalaria. Existe una moderadacorrelación entre la lipasa preoperatoria y posoperatoria, de modo queambas podrían ser útiles como marcadores pronósticos.(AU)

Objective: The objective of this study was to assess the hyperli-pasemia cases detected in the postoperative period of perforated ap-pendicitis. Materials and methods: A retrospective analysis of the perforatedappendicitis cases occurred in our institution over a 7-year period (2013-2019) was carried out. Only cases where preoperative and postoperativeserum lipase levels were available were included. The variables collectedwere statistically assessed by means of a descriptive, univariate analysis.Results: A total of 88 patients were studied. They were divided into3 groups according to postoperative lipase levels – 57 were allocatedto Group 1 (lipase: 70-194 U/L, normal range), 20 were allocated toGroup 2 (lipase: 195-582 U/L), and 11 were allocated to Group 3 (li-pase: > 582 U/L, which triples normal levels). Statistically significantdifferences were found in the following variables: sex, postoperativeabscess, postoperative subocclusion/intestinal occlusion, preoperativelipase levels, days of parenteral nutrition, days of ICU stay, and daysof hospital stay. Postoperative lipase had a moderate correlation withpreoperative lipase, and none of the cases met acute pancreatitis di-agnostic criteria. Conclusions: Hyperlipasemia in the postoperative period of perfo-rated appendicitis is not associated with developing clinical pancreatitis,but it is associated with worse progression in terms of increased compli-cations, such as subocclusion/intestinal occlusion and intra-abdominalabscess, and longer ICU stay, hospital stay, and parenteral nutrition.There is a moderate correlation between preoperative and postoperativelipase, which means they could both prove useful as prognostic markers.(AU)

[Appendicitis versus nonspecific acute abdominal pain: diagnostic accuracy of ultrasound]. / Apendicitis versus dolor abdominal agudo inespecífico: rendimiento diagnóstico de la ecografía.

PURPOUSE: The aim of this study is to assess the diagnostic accuracy of ultrasound to differentiate appendicitis from nonspecific acute abdominal pain, that is the most common process requiring differential diagnosis in clinical practice. MATERIAL AND METHODS: Patients admitted for suspicion of appendicitis were prospectively evaluated in our hospital during two years (2013-2014). Cases of nonspecific acute abdominal pain and appendicitis assessed by ultrasound were enrolled in the study. The different variables collected were statistically analyzed by descriptive, univariate and diagnostic accuracy studies. RESULTS: A total of 275 patients were studied, 143 cases of nonspecific acute abdominal pain and 132 cases of appendicitis. Ultrasound sensitivity and specificity to differentiate appendicitis were 94.7% and 87.4% respectively, with a 12.6% rate of false positives and a 5.3% rate of false negatives. The rate of false negatives in perforated group was 17.4% and analysis according to Pediatric Appendicitis Score risk groups showed a 12.2% rate of false positives in low-risk group and a 6.3% rate of false negatives in high-risk group. CONCLUSIONS: The use of ultrasound in low clinical probability cases of appendicitis could rise unnecessary surgery rate, due to the significant number of false positives in this group of patients. In high probability clinical cases, ultrasound does not contribute too much to diagnosis and it could be a confusion factor by the significant number of false negative associated to perforated appendicitis.

OBJETIVO: El objetivo del estudio es evaluar el rendimiento diagnóstico de la ecografía para diferenciar la apendicitis del dolor abdominal agudo inespecífico, principal proceso con el que requiere diagnóstico diferencial en la práctica clínica. MATERIAL Y METODOS: Se evaluaron los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años (2013-2014), incorporando al estudio los casos de dolor abdominal agudo inespecífico y apendicitis en los que se realizó ecografía. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva, univariante y con estudios de rendimiento diagnóstico. RESULTADOS: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La sensibilidad y especificidad de la ecografía para diferenciar apendicitis fue del 94,7% y 87,4%, respectivamente, con un porcentaje de falsos positivos del 12,6% y de falsos negativos del 5,3%. El porcentaje de falsos negativos en el grupo de apendicitis perforada alcanzó el 17,4% y el análisis según los grupos de riesgo establecidos por el Pediatric Appendicitis Score mostró un porcentaje de falsos positivos del 12,2% en el grupo de bajo riesgo y de falsos negativos del 6,3% en el grupo de alto riesgo. CONCLUSIONES: El uso de la ecografía en casos de baja probabilidad clínica de apendicitis podría incrementar la tasa de cirugía innecesaria, debido al significativo número de falsos positivos en este grupo de pacientes. En casos de alta probabilidad clínica de apendicitis, la ecografía aporta poco al diagnóstico, e incluso podría ser un factor de confusión por el significativo número de falsos negativos asociados a la apendicitis perforada.

Apendicitis versus dolor abdominal agudo inespecífico: rendimiento diagnóstico de la ecografía / Appendicitis versus nonspecific acute abdominal pain: diagnostic accuracy of ultrasound

Objetivo. El objetivo del estudio es evaluar el rendimiento diagnóstico de la ecografía para diferenciar la apendicitis del dolor abdominal agudo inespecífico, principal proceso con el que requiere diagnóstico diferencial en la práctica clínica. Material y métodos. Se evaluaron los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años (2013-2014), incorporando al estudio los casos de dolor abdominal agudo inespecífico y apendicitis en los que se realizó ecografía. Las diferentes variables recogidas se analizaron estadísticamente de manera descriptiva, univariante y con estudios de rendimiento diagnóstico. Resultados. Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La sensibilidad y especificidad de la ecografía para diferenciar apendicitis fue del 94,7% y 87,4%, respectivamente, con un porcentaje de falsos positivos del 12,6% y de falsos negativos del 5,3%. El porcentaje de falsos negativos en el grupo de apendicitis perforada alcanzó el 17,4% y el análisis según los grupos de riesgo establecidos por el Pediatric Appendicitis Score mostró un porcentaje de falsos positivos del 12,2% en el grupo de bajo riesgo y de falsos negativos del 6,3% en el grupo de alto riesgo. Conclusiones. El uso de la ecografía en casos de baja probabilidad clínica de apendicitis podría incrementar la tasa de cirugía innecesaria, debido al significativo número de falsos positivos en este grupo de pacientes. En casos de alta probabilidad clínica de apendicitis, la ecografía aporta poco al diagnóstico, e incluso podría ser un factor de confusión por el significativo número de falsos negativos asociados a la apendicitis perforada (AU)

Purpose. The aim of this study is to assess the diagnostic accuracy of ultrasound to differentiate appendicitis from nonspecific acute abdominal pain, that is the most common process requiring differential diagnosis in clinical practice. Material and methods. Patients admitted for suspicion of appendicitis were prospectively evaluated in our hospital during two years (2013-2014). Cases of nonspecific acute abdominal pain and appendicitis assessed by ultrasound were enrolled in the study. The different variables collected were statistically analyzed by descriptive, univariate and diagnostic accuracy studies. Results. A total of 275 patients were studied, 143 cases of nonspecific acute abdominal pain and 132 cases of appendicitis. Ultrasound sensitivity and specificity to differentiate appendicitis were 94.7% and 87.4% respectively, with a 12.6% rate of false positives and a 5.3% rate of false negatives. The rate of false negatives in perforated group was 17.4% and analysis according to Pediatric Appendicitis Score risk groups showed a 12.2% rate of false positives in low-risk group and a 6.3% rate of false negatives in high-risk group. Conclusions. The use of ultrasound in low clinical probability cases of appendicitis could rise unnecessary surgery rate, due to the significant number of false positives in this group of patients. In high probability clinical cases, ultrasound does not contribute too much to diagnosis and it could be a confusion factor by the significant number of false negative associated to perforated appendicitis (AU)

Diagnóstico prenatal de masa suprarrenal: secuestro pulmonar intraabdominal, una entidad a tener en cuenta / Prenatal diagnosis of an adrenal mass: Intra-abdominal pulmonary sequestration, an entity to consider in diagnosis

Los secuestros pulmonares son anomalías congénitas infrecuentes pero bien reconocidas. En los últimos años han mostrado un aumento de su incidencia en relación a los controles ecográficos rutinarios a los que son sometidas las gestantes. Por ello y a pesar de que representan tan solo entre el 0,15-6,45% de todas las malformaciones congénitas pulmonares constituyen entre el 8 y el 23% de los diagnósticos prenatales de anomalías pulmonares. El secuestro pulmonar extralobar infradiafragmático es una anomalía congénita extremadamente rara. La mayoría de estas lesiones se localizan en el hemiabdomen izquierdo siendo importante el diagnóstico diferencial con masas suprarrenales. El secuestro pulmonar debería ser considerado en todo neonato con masa abdominal superior o suprarrenal, sobre todo en casos de diagnóstico prenatal (AU)

Congenital lung sequestrations are uncommon but are well recognized. Recently, the incidence of these anomalies has increased due to routine ultrasound scans in pregnant women. Although these anomalies represent only 0,15% to 6,45% of all pulmonary malformations, they constitute between 8% and 23% of the prenatal diagnosis of lung abnormalities. Extralobar pulmonary sequestration is an extremely rare congenital infradiaphragmatic anomaly. Most of these lesions are located in the left abdomen and differential diagnosis with adrenal masses is essential. Pulmonary sequestration should be considered in any infant with an upper abdominal or adrenal mass, especially when diagnosis is prenatal (AU)

¿Es necesaria o imprescindible la cirugía experimental en el programa formativo de un cirujano pediátrico? / Is experimental surgery necessary or essential in the training program of a pediatric surgeon?

Muchas técnicas quirúrgicas realizadas en la cirugía pediátrica presentan una curva de aprendizaje lenta(1), el volumen de pacientes objeto de nuestra especialidad y la existencia de patologías complejas, que requieren gran entrenamiento y habilidad quirúrgica, han llevado a nuestro servicio a poner en marcha un programa formativo integral de cirugía experimental. Este programa, basado en la simulación y en la realización de procedimientos invasivos y mínimamente invasivos en modelos anatómicos reales, tiene como objetivo principal instruir de manera eficaz y global a los residentes, para así conseguir una mejoría de la formación técnica, y un aumento de la seguridad de los pacientes fruto de la experiencia y competencia adquirida en el campo de experimentación. Este trabajo presenta las características principales, objetivos y resultados obtenidos con este programa formativo e intenta promoverla incorporación de programas de simulación y experimentación en animales vivos como una parte esencial de la formación del residente de cirugía pediátrica (AU)

Many surgical procedures performed in pediatric surgery have a slow learning curve(1), the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident (AU)

[Is experimental surgery necessary or essential in the training program of a pediatric surgeon?]. / ¿Es necesaria o imprescindible la cirugía experimental en el programa formativo de un cirujano pediátrico?

Many surgical procedures performed in pediatric surgery have a slow learning curve, the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident.

Accidentes de circulación: impacto en un registro de trauma infantil en la Comunidad Autónoma de Galicia / Traffic accidents: impact on a child trauma registry in the Autonomous Community of Galicia

Objetivo: Estudiar el impacto de los accidentes de circulación en un registro autonómico de trauma pediátrico (RTP). Material y método: Recogida de datos prospectiva, sistemática y multicéntrica durante el año 2009, de pacientes pediátricos con ingreso hospitalario en Galicia. Se analizaron 398 pacientes, 66% varones, con edad media de 7 años y peso medio 30 kg. El 34% fueron accidentes de tráfico. Recibieron asistencia prehospitalaria un 53%, y por personal médico un 38,5%. Resultados: Traslados en ambulancia no medicalizada un 30,8%, medicalizada el 13,8%, medio particular el 53,8%, por propio pie el 1,5%. En ambulancia medicalizada un 38,5% no llevaban vía intravenosa, y un 77,6 % no portaban collarín cervical. De los trasladados en coche un 6,4% llegaron con un Índice de Trauma Pediátrico (ITP)<8. En accidentes de automóvil viajaban sin sistema de retención el 62,5% de los casos, y en los de moto el 30% sin casco. Los sistemas más afectados fueron el aparato locomotor (61,5%), y el área craneofacial (58%). El 73% de los accidentes ocurrió en ciudad y la mayoría entre las 17 y las 20 horas. Conclusiones: Mayor riesgo en varones, mayor frecuencia de accidentes en ciudad y en horario de tarde, afectación mayoritaria del aparato locomotor. La incidencia de ingresos aumenta según disminuye el ITP (AU)

Objetive: To assess the impact of traffic accidents in a regional pediatric trauma registry (PTR). Methods: During 2009 we collected data prospectively, systematic, multi-hospital, in a secure Web database from 398 patients, 66% male, mean age 7 years, and mean weight 30 kg. Of this group received 53% prehospital care and by medical personnel only 38,5%. Inclusion criteria: pediatric patient admited at hospital by accident. Results: Transfer in non medicalised ambulance in 30,8%, medicalized in 13,8%, passenger car in a 53,8% or even walking at 1,5%. Those who were taken by ambulances to a 38,5% had no intravenous and 77,6% did not bring a cervical collar. Of the car moved, 6,4% came with ITP <8 (Pediatric Trauma Index). In car accidents, children had no restraint in 62.5%, and the motorcycle, 30% not wearing a helmet. Most affected systems, highlights the locomotor 61,5% and the craniofacial area with 58%. In the study of the site highlights the city, 73%, and the highway, 20% of the total. For slots, the majority of accidents occurred between 17 and 20 hours. Conclusions: The RTP shows a bleak picture in terms of initial support to pediatric trauma is concerned, and specifically in road accidents (AU)

[Quality of life in children operated on for anal atresia]. / Calidad de vida en los pacientes intervenidos de atresia de ano.

INTRODUCTION: Most children with anorectal malformations have some type of intestinal dysfunction. A correct follow up in this aspect after surgery affects their quality of life. MATERIAL AND METHODS: We gathered a sample of 20 children that were lost in their follow up after posterior sagittal anorectoplasty (PSARP). We got contact with them and they were interviewed and examined in our department. RESULTS: We collected 12 girls and 8 boys. Age range was between 3 and 14 years. 70% had good prognosis for continence (low fistula) and 30% poor prognosis (high fistula). 35% suffered from postoperative complications being the most frequent prolapse especially in high atresias. 85% had good rectal sensitivity, 15% had poor sensitivity that was directly related to incontinence. Anal tone was decreased in our exploration in 35% of patients which was not directly related to their continence. 65% suffered constipation with or without fecaloma. 5% of cases had intestinal hipermotility. The total incidence of fecal loose was 40%. More than a half (62,5%) kept on loosing stool despite treating their constipation or hipermotility, so we consider them true incontinents (no voluntary bowel movements). 67% of children with high fistula were true incontinents, just 7% of those with low fistula. Subjective quality of life in patients with soling was 6.4. In clean patients it was 9.3. Objective quality of life (Score/13) in dirty patients was 6.6. In Clean patients: 11.9. After our bowel management protocol we got 100% of patients clean during school time, thereby improving their quality of life. CONCLUSIONS: Incontinence determines the long-term quality of life in our patients in addition to the psycho-social consequences. They are clearly more frequent in patients with high fistula. Much assume incontinence as an unavoidable part of their disease so do not always demand treatment if they are not followed by a surgeon.

Calidad de vida en los pacientes intervenidos de atresia de ano / Quality of life in children operated on for anal atresia

Introducción. El utrículo prostático consiste en una regresión incompleta de las estructuras Müllerianas. Puede presentar varios signos y síntomas, como incontinencia e infecciones del tracto urinario. Presentamos nuestra experiencia personal en la extirpación laparoscópica de lutrículo prostático en pacientes con sintomatología de ITU e incontinencia. Material y Métodos. La cirugía consiste en una cistouretroscopia y canalización del utrículo con colocación de sonda de Fogarty nº4 o del cistoscopio en el interior, si este atraviesa el orificio. Esta maniobra ayuda a la localización. La laparoscopia se lleva a cabo con un trocar de 10 mm y dos de 5 mm. Gracias a la tras iluminación, la localización es más sencilla. La resección se realiza con electrocoagulación y extirpación tras puntos transfixivos. Resultados. Se operaron cinco varones con una media de edad de7 (2-11) años. En todos la laparoscopia fue satisfactoria excepto en uno, que necesitó la reconversión a cirugía abierta. La media de duración fue de 110 (90-210) min. Conclusión. La exéresis laparoscópica del utrículo prostático es una vía segura y sencilla de tratamiento. La iluminación directa con el cistoscopio ayuda a la visualización y disección del mismo (AU)

Introduction. The prostatic utricle is an embryological remnantfrom Müllerian duct tissue. Most prostatic utricles are asympomatic, but they may manifest as a urinary tract infection or an incontinence. Material and method. Surgery consists in a cysto-urethroscopy and cannulation of the prostatic utricle with a ureteral catheter (Fogarty ner 4) and the cystoscopy left in situ to facilitate identification and mobilization. A 10 mm port through a umbilical incision and two more5 mm working ports were inserted. After mobilization, the ureteral defect was closed by an absorbable suture and ultrasonic coagulation. Results. Five boys with symptomatic prostatic utricles underwent surgery at a mean (range) age of 7 (2-11) years. The laparoscopic escisión was successful in all but one due to a bleeding. The mean (range) operative duration was 165 (120-240) min. Conclusion. Laparoscopic escision under cystoscopic guidance offers a good surgical view and allowing easy dissection (AU)

[Role of alpha antagonists in uncoordinated micturition syndrome in childhood]. / Papel de los alfa-antagonistas en el síndrome de micción no coordinada en la infancia.

INTRODUCTION: Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. OBJECTIVE: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. MATERIAL AND METHODS: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. RESULTS: There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness. CONCLUSIONS: Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.

[Non-palpable testes: laparoscopic or inguinal approach?]. / Testes no palpables: abordaje laparoscópico o inguinal?

INTRODUCTION: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option. MATERIALS AND METHODS: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35 patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for a laparascopic or groin approach and associated hernia. RESULTS: The average age of the patients at the time of the surgical treatment was 3.7 years R (1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach was used with 18 patients. Internal vessels in the canal were found which required an inguinal approach. In 12 patients normal or atrophic testes were observed. Testicular descent was achieved through the groin in 10 of them while in the remaining 2 a combined approach was adopted. CONCLUSIONS: 80% of the patients subjected to a first laparoscopic approach needed a groin approach later on. 11% of the patients subjected to a first inguinal approach required laparascopic examination. In view of the results obtained, we conclude that inguinal exploration diminishes the need for second procedures.

[Therapeutic approach of enuresis based on the differentiation of the enuretic syndrome and monosymptomatic enuresis]. / Enfoque terapéutico de la enuresis basándose en la diferenciación del síndrome enurético y la enuresis monosintomática.

INTRODUCTION: Enuresis affects 15% of the children under 5. Possible etiopatogeny explaining the mechanism of production of nocturnal enuresis has been described, resulting in different terapeutical approaches; however, we cannot speak up to now of general guidelines for its treatment. MATERIALS AND METHODS: On the basis of 544 children who were treated in our hospital in the last 12 years, we analysed a sample of 124 patients corresponding to the last two years. We now present the therapeutical protocol used and analyse the results. In the initial therapeutical approach a distinction is made between monosymptomatic enuresis and eneuretic syndrome. RESULTS: We studied a total of 120 patients (89 boys and 31 girls). 63% of them showed monosymptomatic enuresis while 37% suffered from enuretic syndrome. In the case of 15% of them, this was associated with heavy sleep and difficulties to wake up. 92% was the general percentage of recovery. In the patients suffering from nonosymptomatic eneuresis, the problem was solved with desmopressin in 87% of them (demospressin on its own in 65% or in combination with oxibutine in the remaining 35%). In the group of enereutic symdrome, the problem was solved with oxibutine in 71% (on its own in 40% or in combination with desmopressin in 54%. CONCLUSIONS: The treatment and solution of enuresis improve the child's self-esteem and the anxiety caused in the family. A good medical history with a clear distinction between enuretic syndrome and monosyntomatic enuresis leads us to a suitable therapeutical approach for every patient, allowing us to find earlier the right treatment for every individual.

Corrección de las orejas procidentes mediante un abordaje mínimamente invasivo / Correction of lop ear using minimally invasive approach

Introducción. El hélix valgus u orejas procidentes es un problema común que afecta a un 5% de la población. Las alteraciones anatómicas del pabellón que más frecuentemente se encuentran son el defecto en el desarrollo de los pliegues de antehélix y el sobre desarrollo dela concha. Esta patología en los niños suele causar ansiedad y un trauma emocional que puede interferir en su desarrollo. Material y métodos. Existen múltiples técnicas descritas para la corrección del hélix valgus. Describimos la técnica realizada en nuestro servicio durante los últimos siete años analizando los resultados. Realizamos la otoplastia mediante un abordaje anterior puntiforme que nos permite realizar de una manera poco agresiva varios cortes parciales del cartílago por vía anterior. Por vía posterior realizamos la (..) (AU)

Introduction. Helix valgus or procident ears is a common problem that affects about 5% of the population. The folds of the antehelix and the overdevelopment of the concha are the most commonly found anatomic alterations of the ear pavilion. In children this pathology usually causes anxiety and an emotional trauma that may interfere in their normal development. Materials and methods. There are a few tipes of techniques to correct helix valgus. We present the application of the technique in our (..) (AU)

Testes no palpables: ¿abordaje laparoscópico o inguinal? / Non-Palpable testes: Laparoscopic or inguinal approach?

Introducción: El 20% de los pacientes intervenidos por criptorquidia presentan teste no palpable en la exploración física. El manejo inicial de estos pacientes sigue siendo controvertido. Nuestro objetivo es comparar el abordaje inguinal y el laparoscópico y valorar cuál de ellos es el más resolutivo como opción inicial. Material y métodos: Revisamos los pacientes intervenidos por teste no palpable unilateral en los últimos tres años en nuestro servicio. Tras descartar los testes no palpables bilaterales entramos en el estudio53 pacientes. En 35 el abordaje inicial realizado fue por vía inguinal y en 18 laparoscópico. Los datos recogidos para el estudio son la edad del paciente en el momento de la intervención, lado del teste no palpable, hallazgos quirúrgicos, necesidad de abordaje combinado laparoscópico o inguinaly presencia o no de hernia asociada. Resultados: La edad media de los pacientes en el momento de la intervención quirúrgica fue de 3,7 años (R: 1-13 años). El 42% de los testes no palpables correspondían al lado derecho y el 58% al izquierdo. El 65 % de los pacientes se abordaron inicialmente por vía inquinal. En tan sólo el 11% debido a una exploración no concluyente se necesitó realizar una exploración laparoscópica que concluyó en todos los casos anorquia. En el 33% el abordaje inicial fue laparoscópico. En (..) (AU)

Introduction: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option. Materials and methods: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for alaparascopic or groin approach and associated hernia. Results: The average age of the patients at the time of the surgical treatment was 3.7 years R ( 1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach (..) (AU)