IgE-Mediated Sensitization to Blo t 21 and Blo t 5 Is Associated With Asthma in the Tropics: A Case-Control Study.

BACKGROUND AND OBJECTIVE: Sensitization to Blomia tropicalis is associated with asthma in various tropical and subtropical countries; however, information about the specific molecular components associated with this disease is scarce. Using molecular diagnosis, we sought to identify B tropicalis allergens associated with asthma in Colombia. METHODS: Specific IgE (sIgE) to 8 B tropicalis recombinant allergens (Blo t 2, 5, 7, 8, 10, 12, 13, and 21) was determined using an in-house ELISA system in asthma patients (n=272) and controls (n=298) recruited in a national prevalence study performed in several Colombian cities (Barranquilla, Bogotá, Medellín, Cali, and San Andrés). The study sample included children and adults (mean [SD] age, 28 [17] years). Cross-reactivity between Blo t 5 and Blo t 21 was evaluated using ELISA-inhibition. RESULTS: Specific IgE (sIgE) to 8 B tropicalis recombinant allergens (Blo t 2, 5, 7, 8, 10, 12, 13, and 21) was determined using an in-house ELISA system in asthma patients (n=272) and controls (n=298) recruited in a national prevalence study performed in several Colombian cities (Barranquilla, Bogotá, Medellín, Cali, and San Andrés). The study sample included children and adults (mean [SD] age, 28 [17] years). Cross-reactivity between Blo t 5 and Blo t 21 was evaluated using ELISA-inhibition. CONCLUSION: Although Blo t 5 and Blo t 21 are considered common sensitizers, this is the first report of their association with asthma. Both components should be included in molecular panels for diagnosis of allergy in the tropics.

IgE sensitization to Blo t 21 and Blo t 5 is associated with asthma in the tropics: a case-control study.

BACKGROUND AND OBJECTIVES: Blomia tropicalis sensitization is associated with asthma in different tropical and sub-tropical countries; however, information about the specific molecular components associated with this disease is scarce. Using molecular diagnosis, we sought to identify B. tropicalis allergens associated with asthma in Colombia. METHODS: Specific IgE (sIgE) to eight B. tropicalis recombinant allergens (Blo t 2/5/7/8/10/12/13 and 21) was determined using an in-house developed ELISA system in asthmatic patients (n=272) and control subjects (n=298) recruited in a national prevalencestudy performed in Colombian cities (Barranquilla, Bogotá, Medellín, Cali and San Andrés). Sample study included children and adults (mean age: 28±SD 17 years old). Cross-reactivity between Blot 5 and Blo t 21 was evaluated by ELISA-inhibition. RESULTS: Sensitization to Blo t 21 (aOR: 1.9; 95% CI: 1.2 - 2.9) and Blo t 5 (aOR: 1.6; 95%CI: 1.1 - 2.5), but not Blo t 2, was associated with asthma. sIgE levels to Blo t 21 and to Blo t 5 were significantly higher in the disease group. Cross-reactivity between Blo t 21 and Blo t 5 is on average moderate; however, individual analysis indicates that may be high (>50%) in some cases. CONCLUSIONS: Although Blo t 5 and Blo t 21 has been described as common sensitizers, this is the first report of their association with asthma. Both components should be included in molecular panels for allergy diagnosis in the tropics.

Utilidad clínica de la medición del área máxima del trazado del detrusor en el estudio urodinámico en el paciente pediátrico con vejiga neuropática: estudio piloto / Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study

IntroducciónLa vejiga neuropática (VN) es una disfunción del tracto urinario inferior (DTUinf) con riesgo de deterioro de la función renal, siendo el estudio urodinámico (EUD) la prueba patrón para su diagnóstico y seguimiento. El parámetro urodinámico clásico para identificar el riesgo renal es la presión de fuga del detrusor>=40 cmH2O, aunque este valor aislado puede carecer de interés pronóstico. Recientemente se ha descrito el área bajo la curva (ABC) del trazado de la presión del detrusor como factor pronóstico.ObjetivoAnalizar la utilidad clínica del ABC del trazado de la presión del detrusor en edad pediátrica (< 15 años).MétodosEstudio retrospectivo de registros urodinámicos en población pediátrica con VN entre 2011-2020. Se registran: presión detrusor y de fuga ≥ 40 cmH2O, alteración de la acomodación, vaciado e hiperactividad detrusor. Se clasifica la muestra según evolución clínica-radiológica en el momento del EUD. Se calcula el ABC utilizando los métodos de Newton-Côtes (trapecios, Simpson compuesto) y se calculan sus índices según la capacidad vesical (índice trapecios [IT]; índice Simpson [IS]). Significación estadística: p<0,05.ResultadosSe analizan 55 registros. El 41,8% (n=23) tuvo una evolución clínica desfavorable. La alteración en el vaciado, la hipoacomodación y los índices se asociaron a una situación clínica desfavorable(p <0,05). El ABC del rendimiento diagnóstico de los nuevos índices fue: IT (0,736, p=0,0006); IS (0,755, p=0,0001). Los puntos de corte del valor de IT e IS fueron de 10,69 y 8 cmH2O×s/cc, respectivamente. No encontramos diferencias en el rendimiento diagnóstico entre ellos (p> 0,05).ConclusionesLos nuevos índices estudiados son útiles en el diagnóstico de pacientes con VN y situación clínica desfavorable (AU)

IntroductionNeuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP)>=40cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor.AimTo analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years).MethodsRetrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure>=40cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P<.05.ResultsFifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n=23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P<.05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P=.0006), SI (0.755, P=.0001) with a cut-off value of 10,69 and 8cmH2Os/cc, respectively. We did not find differences in the diagnostic performance between them (P>.05).ConclusionsThe analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition (AU)

Clinical utility of the maximum area of detrusor tracing measurement in the urodynamic studies in pediatric population diagnosed with neuropathic bladder: A pilot study.

INTRODUCTION: Neuropathic bladder (NB) is a lower urinary tract dysfunction (LUTD) that may lead to kidney failure. Urodynamic study is the gold standard for its diagnosis and follow-up. A classic prognostic parameter to predict the risk of upper urinary tract damage (UUTD) is the detrusor leak point pressure (DLPP) ≥  40 cmH2O, although this factor alone may lack prognostic value. The area under the curve (AUC) of the detrusor pressure tracing has been recently described as a prognostic factor. AIM: To analyze the clinical utility of the AUC of the detrusor pressure tracing in the pediatric population (<15 years). METHODS: Retrospective study of urodynamic recordings in pediatric population with NB from 2011 to 2020. The following variables were evaluated: detrusor leak point pressure ≥ 40 cmH2O, voiding dysfunction, bladder compliance and overactivity. The sample is classified according to clinical-radiological findings at the time of the UD. AUC is calculated using Newton-Cotes rules (trapezium, Simpson's rule) and its indexes are calculated according to bladder capacity (TI: Trapezium Index, SI: Simpson Index). Statistical significance: P < .05. RESULTS: Fifty-five recordings are analyzed. Unfavorable clinical condition was identified in 41.8% (n = 23) patients. Voiding dysfunction, low compliance and both indexes were associated with an unfavorable clinical condition (P < .05). ROC analysis showed the following AUC for the new indexes: TI (0.736, P = 0.0006), SI (0.755, P = .0001) with a cut-off value of 10,69 and 8 cmH2O·s/cc, respectively. We did not find differences in the diagnostic performance between them (P > .05). CONCLUSIONS: The analyzed indexes are useful in the diagnosis of patients with NB and unfavorable clinical condition.

High-flow priapism in pediatric population: Case series and review of the literature.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

High-flow Priapism in Pediatric Population: Case Series and Review of the Literature. / Priapismo de alto flujo en población pediátrica: serie de casos y revisión de la literatura.

INTRODUCTION: Priapism is a prolonged erection that lasts longer than four hours. It is a rare pathology in the pediatric population, with an estimation of 0.3-1.5 per 100,000 children per year. The diagnostic sequence includes clinical history, physical examination and penile Doppler ultrasound (PDUS). Puncture of corpora cavernosa is not always necessary to establish the differential diagnosis between high-flow and low-flow priapism. The treatment of choice in pediatric age is not well defined. PATIENTS AND METHODS: Multicentric, retrospective and descriptive study including patients under 14 years with high-flow priapism between 2010 and 2020. RESULTS: A total of seven patients were diagnosed with high-flow priapism. None of them required puncture of the corpora cavernosa. Patients were treated with a conservative management, two patients required superselective arterial embolization due to persistent symptoms. CONCLUSIONS: High-flow priapism is a very rare entity in pediatric age; therefore, knowing the proper diagnosis and management is crucial. Currently, penile doppler ultrasound is enough for diagnosis in most cases and allows obviating the use of blood gas analysis. Children should be initially treated with a conservative management, reserving embolization for refractory cases.

[Experience in the conservative treatment of renal trauma]. / Experiencia en el tratamiento conservador del traumatismo renal.

OBJECTIVE: The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution. MATERIAL AND METHODS: Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed. RESULTS: We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication. CONCLUSIONS: In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population.

OBJETIVO: El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución. MATERIAL Y METODOS: Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución. RESULTADOS: Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación. CONCLUSIONES: En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica.

Experiencia en el tratamiento conservador del traumatismo renal / Experience in the conservative treatment of renal trauma

Objetivo: El manejo del traumatismo renal ha ido variando en los últimos años de modo que en la actualidad, incluso en los grados altos, se aboga por un tratamiento inicial conservador. El objetivo de este trabajo es revisar la presentación, actitud inicial y evolución de los traumatismos renales atendidos en nuestra institución. Material y métodos: Revisión retrospectiva de pacientes con traumatismo renal atendidos en los últimos 10 años. Se analizaron las variables epidemiológicas, mecanismo de producción, índice de trauma pediátrico (ITP), tratamiento y evolución. Resultados: Se estudiaron 26 pacientes, 18 varones (69,23%). La causa más frecuente fue el golpe directo en 11 pacientes (42,31%). El lado más frecuentemente afectado fue el derecho en 14 pacientes (53,85%). El traumatismo grado III según la American Association for the Surgery of Trauma (AAST) fue el más común, 11 pacientes (42,31%). Nueve pacientes (44,55%) presentaron lesiones concomitantes en otros órganos sólidos. En 24 pacientes (92,30%) el tratamiento inicial fue conservador con medidas de soporte. Un paciente se presentó con inestabilidad hemodinámica y se intervino de forma urgente realizándose embolización supraselectiva con control inmediato del sangrado activo. En otro paciente se colocó un catéter doble J por disrupción de la vía excretora. De los pacientes tratados de manera conservadora inicialmente solo 1 paciente (4,1%) requirió maniobras quirúrgicas secundarias debido a una complicación. Conclusiones: En pacientes con traumatismo renal el tratamiento no quirúrgico es seguro y eficaz. En caso de inestabilidad hemodinámica o complicación, las técnicas radiológicas intervencionistas han demostrado ser seguras y efectivas en la edad pediátrica

Objective: The management of renal trauma has been changing in recent years so that nowadays, even in high grades, an initial conservative treatment is advocated. The aim of this work is to review the presentation, initial attitude and evolution of the renal traumas treated in our institution. Material and methods: Retrospective review of patients with renal trauma treated at our institution in the last 10 years. Epidemiological variables, production mechanism, pediatric trauma index (PTI), treatment and evolution were analyzed. Results: We studied 26 patients, 18 men (69.3%). The most frequent mechanism was the direct hit in 11 patients (42.31%). The most frequently side affected was the right one in 14 patients (53.85%). The grade III traumatism according to American Association for the surgery of Trauma (AAST) was the most repeated, 11 patients (42.31%). Nine patients (44.55%) presented concomitant injuries in other solid organs. In 24 patients (92.30%) the initial treatment was conservative with supportive measures. One patient presented with hemodynamic instability and an urgent intervention was conducted, performing a supraselective embolization with immediate control of the active bleeding. In another patient, a double J catheter was placed due to disruption of the excretory tract. Of the patients treated conservatively initially, only one patient (4.1%) required secondary surgical maneuvers due to a complication. Conclusions: In patients with renal trauma, non-surgical treatment is safe and effective. In case of hemodynamic instability or complication, interventional radiological techniques have been demonstrated to be safe and effective in the pediatric population

[Evaluation of redundancy of tests in acute appendicitis]. / Evaluación de la redundancia de pruebas en la apendicitis aguda.

AIM: Evaluation of the redundancy of abdominal ultrasound tests in the diagnosis of acute appendicitis in a third level hospital. MATERIAL AND METHODS: Retrospective study of patients treated for suspected acute appendicitis in 2011 at our center. The variables of the study were: age, origin of the patient, blood count, number of ultrasounds performed, surgery and final diagnosis based on surgical findings. We defined as redundant ultrasound the request for a new ultrasound in patients with a final diagnosis of appendicitis and previous positive ultrasound.nd total expressed as percentage of observed / expected lung volume (VPT o/e) and percentage of herniated liver (PHH). We studied: survival, ECMO and associated malformations. RESULTS: 340 patients with a mean age of 9.4 years (range 2-13) were analyzed, 278 of whom had appendicitis and 62 non-specific abdominal pain. 246 were derived from other centers of which 217 (88%) provided an ultrasound. Of the 198 patients referred with positive ultrasound, 76 cases were repeated, of which 78.9% can be considered as redundant. From the total of patients with appendicitis, 29.6% were operated on with 2 or more ultrasounds. Leukocytosis was not found to influence ultrasound redundancy (15,600 vs 15,100, p > 0.05). CONCLUSION: The 78.9% of the duplicate ultrasounds do not fit the definition of rational use of a diagnostic test. The greater request for ultrasound is not attributable to differences on the blood test results, nevertheless the origin of the patient seems to influence in that request.

OBJETIVO: Evaluación de la redundancia de la ecografía abdominal en el diagnóstico de la apendicitis aguda en un hospital de tercer nivel. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes atendidos por sospecha de apendicitis aguda en el año 2011 en nuestro centro. Las variables del estudio fueron: edad, origen del paciente, hemograma, número de ecografías realizadas, cirugía y diagnóstico final en función de los hallazgos quirúrgicos. Definimos como ecografía redundante la solicitud de una nueva ecografía en pacientes con diagnóstico final de apendicitis y ecografía previa positiva. RESULTADOS: 340 pacientes con una edad media de 9,4 años (rango 2-13) de los cuales 278 tuvieron apendicitis y 62 dolor abdominal inespecífico. 246 fueron derivados de otros centros de los que 217 (88%) aportaban una ecografía. De los 198 pacientes remitidos con ecografía positiva se repitió en 76 casos, de las cuales el 78,9% pueden considerarse redundantes. Del total de pacientes con apendicitis, el 29,6% se operó con 2 o más ecografías. No se halló que la leucocitosis influyera en la redundancia de pruebas (15.600 vs 15.100, p > 0,05). CONCLUSIONES: El 78,9% de las ecografías duplicadas no se ajusta a la definición de uso racional de una prueba diagnóstica. La mayor solicitud de ecografías no es atribuible a diferencias en los resultados analíticos, sin embargo, la procedencia del paciente podría influir en dicha solicitud.

[Nephroblastoma. Long-term experience in the multidisciplinary approach]. / Nefroblastoma. Experiencia a largo plazo en el abordaje multidisciplinario.

OBJECTIVES: Main objective: to perform a descriptive study of patients with nephroblastoma, diagnostic tests, medical and surgical treatment. Secondary objective: to evaluate the rate of relapse and 5-year survival and risk factors for relapse and death. MATERIALS AND METHODS: Retrospective study of patients with nephroblastoma treated according to the protocol of the SIOP-2001. Demographic variables, comorbidities and associated syndromes were collected. Other data were tumor location, size, extent and stage. The relapse rate and the development of other secondary tumors as well as the long-term survival were also studied. RESULTS: We collected 33 patients with nephroblastoma. A biopsy was performed in 7 patients (21.2%). The Kaplan-Meir curve for event-free survival (tumor recurrence) was 84% with a 95% CI = [0.73-0.98] and the Kaplan-Meier overall survival curve was 0.93 95% CI [0.85-1]. Recurrence occurred in all patients before the first year. CONCLUSIONS: Nephroblastoma is a tumor with a favorable prognosis. The unfavorable histology as well as advanced stages are factors of a poor prognosis. The follow-up must be exhaustive during the first year after the diagnosis.

OBJETIVOS: Objetivo principal: realizar un estudio descriptivo de los pacientes con nefroblastoma, las pruebas diagnósticas, el tratamiento médico y la actitud quirúrgica. Objetivo secundario: valorar la tasa de recidiva y de supervivencia a 5 años y los factores de riesgo para la recidiva y el fallecimiento. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con nefroblastoma tratados según el protocolo de la SIOP-2001. Se recogieron las variables demográficas, comorbilidades y síndromes asociados. Otros datos fueron la localización del tumor, el tamaño, la extensión y el estadio. Se estudió también la tasa de recidiva y/o el desarrollo de otros tumores secundarios así como la supervivencia a largo plazo. RESULTADOS: Se recogieron 33 pacientes con nefroblastoma. En 7 pacientes (21,2%) se realizó una biopsia. La curva de Kaplan-Meir para la supervivencia libre de evento (recidiva tumoral) fue del 84% con un IC 95%= [0,73-0,98] y la curva de Kaplan-Meier de supervivencia global fue de 0,93 IC 95% [0,85-1]. La recidiva se produjo en todos los pacientes antes del primer año. CONCLUSIONES: El nefroblastoma es un tumor con buen pronóstico. La histología desfavorable así como estadios avanzados son factores de mal pronóstico. El seguimiento debe ser exhaustivo durante el primer año tras el diagnóstico.

Evaluación de la redundancia de pruebas en la apendicitis aguda / Evaluation of redundancy of tests in acute appendicitis

Objetivo. Evaluación de la redundancia de la ecografía abdominal en el diagnóstico de la apendicitis aguda en un hospital de tercer nivel. Material y métodos. Estudio retrospectivo de los pacientes atendidos por sospecha de apendicitis aguda en el año 2011 en nuestro centro. Las variables del estudio fueron: edad, origen del paciente, hemograma, número de ecografías realizadas, cirugía y diagnóstico final en función de los hallazgos quirúrgicos. Definimos como ecografía redundante la solicitud de una nueva ecografía en pacientes con diagnóstico final de apendicitis y ecografía previa positiva. Resultados. Se analizaron 340 pacientes con una edad media de 9,4 años (rango 2-13) de los cuales 278 tuvieron apendicitis y 62 dolor abdominal inespecífico. 246 fueron derivados de otros centros de los que 217 (88%) aportaban una ecografía. De los 198 pacientes remitidos con ecografía positiva se repitió en 76 casos, de las cuales el 78,9% pueden considerarse redundantes. Del total de pacientes con apendicitis, el 29,6% se operó con 2 o más ecografías. No se halló que la leucocitosis influyera en la redundancia de pruebas (15.600 vs 15.100, p> 0,05). Conclusiones. El 78,9% de las ecografías duplicadas no se ajusta a la definición de uso racional de una prueba diagnóstica. La mayor solicitud de ecografías no es atribuible a diferencias en los resultados analíticos, sin embargo, la procedencia del paciente podría influir en dicha solicitud (AU)

Aim. Evaluation of the redundancy of abdominal ultrasound tests in the diagnosis of acute appendicitis in a third level hospital. Material and methods. Retrospective study of patients treated for suspected acute appendicitis in 2011 at our center. The variables of the study were: age, origin of the patient, blood count, number of ultrasounds performed, surgery and final diagnosis based on surgical findings. We defined as redundant ultrasound the request for a new ultrasound in patients with a final diagnosis of appendicitis and previous positive ultrasound. Results. 340 patients with a mean age of 9.4 years (range 2-13) were analyzed, 278 of whom had appendicitis and 62 non-specific abdominal pain. 246 were derived from other centers of which 217 (88%) provided an ultrasound. Of the 198 patients referred with positive ultrasound, 76 cases were repeated, of which 78.9% can be considered as redundant. From the total of patients with appendicitis, 29.6% were operated on with 2 or more ultrasounds. Leukocytosis was not found to influence ultrasound redundancy (15,600 vs 15,100, p> 0.05). Conclusion. The 78.9% of the duplicate ultrasounds do not fit the definition of rational use of a diagnostic test. The greater request for ultrasound is not attributable to differences on the blood test results, nevertheless the origin of the patient seems to influence in that request (AU)

Nefroblastoma. Experiencia a largo plazo en el abordaje multidisciplinario / Nephroblastoma. Long-term experience in the multidisciplinary approach

Objetivos. Objetivo principal: realizar un estudio descriptivo de los pacientes con nefroblastoma, las pruebas diagnósticas, el tratamiento médico y la actitud quirúrgica. Objetivo secundario: valorar la tasa de recidiva y de supervivencia a 5 años y los factores de riesgo para la recidiva y el fallecimiento. Material y métodos. Estudio retrospectivo de pacientes con nefroblastoma tratados según el protocolo de la SIOP-2001. Se recogieron las variables demográficas, comorbilidades y síndromes asociados. Otros datos fueron la localización del tumor, el tamaño, la extensión y el estadio. Se estudió también la tasa de recidiva y/o el desarrollo de otros tumores secundarios así como la supervivencia a largo plazo. Resultados. Se recogieron 33 pacientes con nefroblastoma. En 7 pacientes (21,2%) se realizó una biopsia. La curva de Kaplan-Meir para la supervivencia libre de evento (recidiva tumoral) fue del 84% con un IC 95%= [0,73-0,98] y la curva de Kaplan-Meier de supervivencia global fue de 0,93 IC 95% [0,85-1]. La recidiva se produjo en todos los pacientes antes del primer año. Conclusiones. El nefroblastoma es un tumor con buen pronóstico. La histología desfavorable así como estadios avanzados son factores de mal pronóstico. El seguimiento debe ser exhaustivo durante el primer año tras el diagnóstico (AU)

Material and methods. Retrospective study of patients with nephroblastoma treated according to the protocol of the SIOP-2001. Demographic variables, comorbidities and associated syndromes were collected. Other data were tumor location, size, extent and stage. The relapse rate and the development of other secondary tumors as well as the long-term survival were also studied. Results. We collected 33 patients with nephroblastoma. A biopsy was performed in 7 patients (21.2%). The Kaplan-Meir curve for eventfree survival (tumor recurrence) was 84% with a 95% CI = [0.73-0.98] and the Kaplan-Meier overall survival curve was 0.93 95% CI [0.85-1]. Recurrence occurred in all patients before the first year. Conclusions. Nephroblastoma is a tumor with a favorable prognosis. The unfavorable histology as well as advanced stages are factors of a poor prognosis. The follow-up must be exhaustive during the first year after the diagnosis (AU)

[Complications in the conservative managemennt of splenic rupture]. / Complicaciones en el tratamiento conservador del traumatismo esplénico.

INTRODUCTION: Management of splenic rupture in haemodynamically stable children is non-surgical treatment. However, complications can occur during follow-up. Objective: to study the frequency, evolution and treatment of complications of conservative treatment of splenic rupture. Secondary objective: to evaluate the results of the American Pediatric Surgical Association (APSA) clinical guideline in conservative treatment. MATERIAL AND METHODS: Retrospective study of patients with abdominal trauma between 2010-2016. We included children under 15 years of age with splenic injury after blunt abdominal trauma. Demographic variables, mechanism and degree of injury of American Association for the Surgery of Trauma were studied in the sample. The complications, the time of onset and their treatment were analyzed. The treatment was based on the recommendations of the APSA with the exception of ultrasound follow-up. In case of complications and according to the clinical and characteristics, embolization was indicated. RESULTS: Twenty-eight patients were attended, 21 males (75%). The median age was 8.35 years (6.28-11.35). Seven patients (25%) presented complications: two arteriovenous fistula (AVF), three pseudo-aneurysms and two hemorrhages. The median time to diagnosis of complications was 5.67 days (P25 4- P75 5.75). Embolization was performed in two patients with pseudo-aneurysm. Another patient underwent emergency splenectomy for rebleeding. The rest of the complications resolved spontaneously. CONCLUSIONS: In splenic rupture, unlike APSA, ultrasound monitoring is useful to rule out early complications.

INTRODUCCION: El manejo estándar de las lesiones esplénicas en pacientes hemodinámicamente estables es el tratamiento no quirúrgico. Sin embargo, durante el seguimiento pueden surgir complicaciones. Objetivo: estudiar la frecuencia, evolución y tratamiento de las complicaciones del tratamiento conservador del traumatismo esplénico. Objetivo secundario: evaluar los resultados de la guía clínica de la American Pediatric Surgical Association (APSA) en el tratamiento conservador. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con traumatismo abdominal entre 2010-2016. Se incluyeron menores de 15 años con lesión esplénica tras un traumatismo abdominal cerrado. En la muestra se estudiaron variables demográficas, mecanismo y grado de lesión según la American Association for the Surgery of Trauma. Se analizaron las complicaciones, el tiempo de aparición y su tratamiento. El tratamiento se fundamentó en las recomendaciones de la APSA a excepción del seguimiento ecográfico. En caso de aparición de complicaciones y en función de la clínica y de las características se indicó tratamiento con embolización. RESULTADOS: Se atendieron 28 pacientes, 21 varones (75%). La mediana de edad fue 8,35 años (6,28-11,35). Siete pacientes (25%) presentaron complicaciones: dos fístulas arteriovenosas (FAV), tres pseudoaneurismas y dos hemorragias. La media de tiempo para el diagnóstico de las complicaciones fue de 5,67 días. En dos pacientes con pseudoaneurisma se realizó embolización. Un paciente fue sometido a esplenectomía de urgencia por resangrado. El resto de complicaciones se resolvieron espontáneamente. CONCLUSIONES: En el traumatismo esplénico, a diferencia de la APSA, el seguimiento ecográfico en pacientes con lesiones de alto grado es útil para descartar complicaciones de forma precoz.

Complicaciones en el tratamiento conservador del traumatismo esplénico / Complications in the conservative managemennt of splenic rupture

Introducción. El manejo estándar de las lesiones esplénicas en pacientes hemodinámicamente estables es el tratamiento no quirúrgico. Sin embargo, durante el seguimiento pueden surgir complicaciones. Objetivo: estudiar la frecuencia, evolución y tratamiento de las complicaciones del tratamiento conservador del traumatismo esplénico. Objetivo secundario: evaluar los resultados de la guía clínica de la American Pediatric Surgical Association (APSA) en el tratamiento conservador. Material y métodos. Estudio retrospectivo de pacientes con traumatismo abdominal entre 2010-2016. Se incluyeron menores de 15 años con lesión esplénica tras un traumatismo abdominal cerrado. En la muestra se estudiaron variables demográficas, mecanismo y grado de lesión según la American Association for the Surgery of Trauma. Se analizaron las complicaciones, el tiempo de aparición y su tratamiento. El tratamiento se fundamentó en las recomendaciones de la APSA a excepción del seguimiento ecográfico. En caso de aparición de complicaciones y en función de la clínica y de las características se indicó tratamiento con embolización. Resultados. Se atendieron 28 pacientes, 21 varones (75%). La mediana de edad fue 8,35 años (6,28-11,35). Siete pacientes (25%) presentaron complicaciones: dos fístulas arteriovenosas (FAV), tres pseudoaneurismas y dos hemorragias. La media de tiempo para el diagnóstico de las complicaciones fue de 5,67 días. En dos pacientes con pseudoaneurisma se realizó embolización. Un paciente fue sometido a esplenectomía de urgencia por resangrado. El resto de complicaciones se resolvieron espontáneamente. Conclusiones. En el traumatismo esplénico, a diferencia de la APSA, el seguimiento ecográfico en pacientes con lesiones de alto grado es útil para descartar complicaciones de forma precoz (AU)

Introduction. Management of splenic rupture in haemodynamically stable children is non-surgical treatment. However, complications can occur during follow-up. Objective: to study the frequency, evolution and treatment of complications of conservative treatment of splenic rupture. Secondary objective: to evaluate the results of the American Pediatric Surgical Association (APSA) clinical guideline in conservative treatment. Material and methods. Retrospective study of patients with abdominal trauma between 2010-2016. We included children under 15 years of age with splenic injury after blunt abdominal trauma. Demographic variables, mechanism and degree of injury of American Association for the Surgery of Trauma were studied in the sample. The complications, the time of onset and their treatment were analyzed. The treatment was based on the recommendations of the APSA with the exception of ultrasound follow-up. In case of complications and according to the clinical and characteristics, embolization was indicated. Results. Twenty-eight patients were attended, 21 males (75%). The median age was 8.35 years (6.28-11.35). Seven patients (25%) presented complications: two arteriovenous fistula (AVF), three pseudo-aneurysms and two hemorrhages. The median time to diagnosis of complications was 5.67 days (P25 4- P75 5.75). Embolization was performed in two patients with pseudo-aneurysm. Another patient underwent emergency splenectomy for rebleeding. The rest of the complications resolved spontaneously. Conclusions. In splenic rupture, unlike APSA, ultrasound monitoring is useful to rule out early complications (AU)

[Prophylactic thyroidectomy in RET proto-oncogen mutation]. / Tiroidectomía profiláctica en mutación del protooncogén RET.

OBJECTIVE: Analysis of prophylactic thyroidectomy cases carried out in our Center in patients with RET gene mutations. MATERIAL AND METHODS: Retrospective study of 25 patients with RET proto-oncogene mutations subjected to prophylactic thyroidectomy between January 2000 and January 2016. Epidemiologic variables, surgical technique, histological results and follow-up were studied. RESULTS: Our sample consists of 25 patients, 15 males and 10 females. The range of age was from 7 months to 12 years old, with a median of 5 years old. We obtained 21 cases with NEM2A, from which 19 (76%) presented 634 mutation and 2 (8%) presented 611 mutation. Four cases were NEM2B, all with 918 mutation. Microscopical findings showed microcarcinoma, in situ carcinoma or medullary thyroid carcinoma in 16 patients (64%). Eight of them showed hyperplasia (32%) and 1 presented fibrosis (4%). The presence of elevated calcitonin was correlated with histologic alterations in 7 cases (43.7%), without significant differences (χ2 0.3; p 0.6). From 16 patients with carcinoma (13 NEM2A and 3 NEM2B), 10 were 5 years old or less at the moment of the surgery. A total thyroidectomy was performed in all patients. There were no intra or post-surgical complications. During the follow-up of the patients, levels of calcitonin, calcium, parathormone, catecholamines and metanephrines were normal, except from one case. CONCLUSIONS: The study of RET proto-oncogene allows the identification of patients susceptible of performing a prophylactic thyroidectomy, which have to be carried out early, in an experienced centers.

OBJETIVO: Analizar los casos de tiroidectomía profiláctica realizados en nuestro centro en pacientes con mutaciones del gen RET. MATERIAL Y METODOS: Estudio retrospectivo de 25 pacientes con mutación del protooncogén RET a los que se les realizó tiroidectomía profiláctica entre enero del 2000 y enero de 2016. Se estudiaron variables epidemiológicas, técnica quirúrgica, resultados anatomopatológicos y seguimiento. RESULTADOS: Nuestra serie consta de 25 pacientes, 15 varones y 10 mujeres. La mediana de la edad fue de 5 años con un rango de 7 meses a 12 años. Obtuvimos 21 casos con MEN2A de los que 19 (76%) presentaban la mutación 634 y 2 (8%) la mutación 611. Cuatro casos fueron MEN2B, todos con la mutación 918. Los hallazgos microscópicos revelaron microcarcimona, carcinoma in situ o carcinoma medular de tiroides en 16 casos (64%). 8 presentaron hiperplasia (32%) y 1 (4%) fibrosis. La presencia de calcitonina elevada se correlacionó con alteraciones anatomopatológicas en 7 casos (43,7%), pero no mostró diferencias significativas (χ² 0,3; p 0,6). De los 16 pacientes con carcinoma, (13 MEN2A, 3 MEN2B), 10 de ellos (62,5%) tenían 5 años o menos en el momento de la intervención. En todos los casos se realizó tiroidectomía total. No existieron complicaciones intra ni postoperatorias. Durante el seguimiento, los valores de calcitonina, calcio, paratohormona, catecolaminas y metanefrinas se han mantenido normales, excepto en 1 paciente. CONCLUSIONES: El estudio del protooncogén RET permite identificar pacientes susceptibles de realizar tiroidectomía profiláctica, la cual debe ser realizada de forma precoz, y en centros con experiencia.

¿Es posible el manejo ambulatorio de la invaginación intestinal? / Is it possible the outpatient management of intussusception?

Introducción: la invaginación intestinal es la causa más frecuente de obstrucción intestinal en menores de tres años. Habitualmente, tras la desinvaginación, los pacientes permanecen ingresados 24-48 horas. Recientemente se ha propuesto el manejo ambulatorio mediante observación clínica durante 12 horas. Nuestro objetivo es valorar la implementación de esta actitud terapéutica. Material y métodos: revisión retrospectiva de las invaginaciones intestinales atendidas en nuestro centro durante los últimos 12 años. Resultados: se incluye 458 pacientes, el 60,3% de ellos varones. Edad media de 24,1 meses, siendo la localización ileocólica la más frecuente (77,7%). El 2,4% presentó alguna causa secundaria. Se realizó neumoenema en 370 niños, requiriendo cirugía el 10,7%. Se registraron 78 recidivas en 56 pacientes (12,2%), 15 de ellos intrahospitalariamente. El tiempo medio para la reintroducción de la alimentación y la estancia media fueron de 28,6 y 64,4 horas respectivamente, sin diferencias significativas entre aquellos que recidivaron y los que no (60,8 frente a 69 horas; t = -0,4; p = 0,689). No se registraron diferencias entre el tiempo de evolución clínica y la tasa de éxito del neumoenema (t = 0,478; p = 0,634); aunque hubo diferencias en la necesidad de intervención quirúrgica (χ² = 5,604; p = 0,018), no hubo ninguna complicación. La reintroducción precoz de la alimentación no se relacionó con más recidivas ni diferencias entre los grupos (30,2% en el grupo que recidivó y 23,1% en el grupo sin recidiva, p = 0,608). Conclusiones: el ingreso hospitalario más allá de 12 horas no disminuye la tasa de complicaciones. Por tanto, consideramos que la observación en urgencias tras la desinvaginación durante 12 horas es una medida segura y coste-efectiva (AU)

Introduction: intussusception is the most frequent cause of bowel obstruction in children under three years. Usually, after reduction, patients remain admitted for 24-48 hours. Ambulatory management has recently been proposed, based on clinical experience of follow-up of the patient's evolution in the Emergency Department of the hospital during the following 12 hours. Our objective is to evaluate the implementation of this new therapeutic attitude. Material and methods: retrospective review of all the intussusceptions treated at our center during the last 12 years. Results: 458 patients were included, 60.3% ot them were male. Mean age was 24.1 months (SD 24.6), with the ileo-colic location being the most frequent (77.7%). 2.4% had secondary causes. A pneumoenema was performed in 370 children, requiring surgery 10.7%. There were 78 relapses in 56 patients (12.2%), 15 of them during admission. The mean time to reintroduce feeding and the mean hospital stay was 28.6 and 64.4 hours respectively, with no significant difference between those who relapsed and those who did not (60.8 vs 69 hours, t = -0.4, p = 0.689). There was no relationship between a longer clinical evolution and pneumoenema succeed rate (t = 0.478, p = 0.634). Although there were differences in the need for surgical intervention (χ² = 5.604, p = 0.018), there were no complications. Early reintroduction of feeding was not related to any recurrences or differences between groups (30.2% in the relapsed group and 23.1% in the non-recurrent group, p = 0.608). Conclusions: hospital admission beyond 12 hours does not decrease the rate of complications. Therefore, we consider that outpatient observation for 12 hours after reduction is a safe and economical measure (AU)

Tiroidectomía profiláctica en mutación del protooncogén RET / Prophylactic thyroidectomy in RET proto-oncogen mutation

Objetivo. Analizar los casos de tiroidectomía profiláctica realizados en nuestro centro en pacientes con mutaciones del gen RET. Material y métodos. Estudio retrospectivo de 25 pacientes con mutación del protooncogén RET a los que se les realizó tiroidectomía profiláctica entre enero del 2000 y enero de 2016. Se estudiaron variables epidemiológicas, técnica quirúrgica, resultados anatomopatológicos y seguimiento. Resultados. Nuestra serie consta de 25 pacientes, 15 varones y 10 mujeres. La mediana de la edad fue de 5 años con un rango de 7 meses a 12 años. Obtuvimos 21 casos con MEN2A de los que 19 (76%) presentaban la mutación 634 y 2 (8%) la mutación 611. Cuatro casos fueron MEN2B, todos con la mutación 918. Los hallazgos microscópicos revelaron microcarcimona, carcinoma in situ o carcinoma medular de tiroides en 16 casos (64%). 8 presentaron hiperplasia (32%) y 1 (4%) fibrosis. La presencia de calcitonina elevada se correlacionó con alteraciones anatomopatológicas en 7 casos (43,7%), pero no mostró diferencias significativas (χ² 0,3; p 0,6). De los 16 pacientes con carcinoma, (13 MEN2A, 3 MEN2B), 10 de ellos (62,5%) tenían 5 años o menos en el momento de la intervención. En todos los casos se realizó tiroidectomía total. No existieron complicaciones intra ni postoperatorias. Durante el seguimiento, los valores de calcitonina, calcio, paratohormona, catecolaminas y metanefrinas se han mantenido normales, excepto en 1 paciente. Conclusiones. El estudio del protooncogén RET permite identificar pacientes susceptibles de realizar tiroidectomía profiláctica, la cual debe ser realizada de forma precoz, y en centros con experiencia (AU)

Objetive. Analysis of prophylactic thyroidectomy cases carried out in our Center in patients with RET gene mutations. Material and methods. Retrospective study of 25 patients with RET proto-oncogene mutations subjected to prophylactic thyroidectomy between January 2000 and January 2016. Epidemiologic variables, surgical technique, histological results and follow-up were studied. Results. Our sample consists of 25 patients, 15 males and 10 females. The range of age was from 7 months to 12 years old, with a median of 5 years old. We obtained 21 cases with NEM2A, from which 19 (76%) presented 634 mutation and 2 (8%) presented 611 mutation. Four cases were NEM2B, all with 918 mutation. Microscopical findings showed microcarcinoma, in situ carcinoma or medullary thyroid carcinoma in 16 patients (64%). Eight of them showed hyperplasia (32%) and 1 presented fibrosis (4%). The presence of elevated calcitonin was correlated with histologic alterations in 7 cases (43.7%), without significant differences (χ2 0.3; p 0.6). From 16 patients with carcinoma (13 NEM2A and 3 NEM2B), 10 were 5 years old or less at the moment of the surgery. A total thyroidectomy was performed in all patients. There were no intra or post-surgical complications. During the follow-up of the patients, levels of calcitonin, calcium, parathormone, catecholamines and metanephrines were normal, except from one case. Conclusions. The study of RET proto-oncogene allows the identification of patients susceptible of performing a prophylactic thyroidectomy, which have to be carried out early, in an experienced centers (AU)

A recombinant cystatin from Ascaris lumbricoides attenuates inflammation of DSS-induced colitis.

Helminthiasis may ameliorate inflammatory diseases, such as inflammatory bowel disease and asthma. Information about immunomodulators from Ascaris lumbricoides is scarce, but could be important considering the co-evolutionary relationships between helminths and humans. We evaluated the immunomodulatory effects of a recombinant cystatin from A. lumbricoides on an acute model of dextran sodium sulphate (DSS)-induced colitis in mice. From an A. lumbricoides cDNA library, we obtained a recombinant cystatin (rAl-CPI). Protease activity inhibition was demonstrated on cathepsin B and papain. Immunomodulatory effects were evaluated at two intraperitoneal doses (0.5 and 0.25 µg/G) on mice with DSS-induced colitis. Body weight, colon length, Disease Activity Index (DAI), histological inflammation score, myeloperoxidase (MPO) activity, gene expression of cytokines and cytokines levels in colon tissue were analysed. Treatment with rAl-CPI significantly reduced DAI, MPO activity and inflammation score without toxic effects. Also, IL-10 and TGF-B gene overexpression was observed in rAl-CPI-treated group compared to DSS-exposed control and healthy mice. Furthermore, a reduction in IL-6 and TNF-A expression was found, and this was confirmed by the levels of these cytokines in colonic tissue. In conclusion, rAl-CPI reduces inflammation in a mouse model of DSS-induced colitis, probably by increasing the expression of anti-inflammatory cytokines and reducing pro-inflammatory ones.

Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA2LEN).

Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA2LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 µm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect the physician's considerations of disease features, phenotype, and response to previous therapy. This article is being co-published in Asthma Research and Practice and the World Allergy Organization Journal.

Adrenalectomía por vía laparoscópica: ventajas del abordaje mínimamente invasive / Laparoscopic adrenalectomy: advantages of the minimally invasive approach

Objetivo. Describir nuestra experiencia como centro terciario en el uso de la laparoscopia para la exéresis de lesiones adrenales en la edad pediátrica. Material y métodos. Estudio descriptivo y retrospectivo de pacientes con lesiones en la glándula suprarrenal intervenidos de suprarrenalectomía laparoscópica entre los años 2012 y 2015. Se estudiaron variables epidemiológicas, técnica quirúrgica, complicaciones y seguimiento. Resultados. Se estudiaron 9 pacientes con una mediana de 62 meses (5-184). Tres pacientes (33,33%) tenían un diagnóstico prenatal y tres pacientes debutaron con síntomas: hipertensión e insuficiencia renal, pubertad precoz y otro con un adenoflemón secundario a metástasis. En el resto, el hallazgo fue incidental. En cinco pacientes la lesión se situó en el lado derecho y en cuatro en el izquierdo. La intervención se realizó por vía laparoscópica. En un paciente se convirtió a cirugía abierta por mala visualización en el campo quirúrgico. No se produjeron complicaciones perioperatorias ni necesidad de trasfusión. La media de la estancia hospitalaria fue de 4 días (2-5). El dolor postoperatorio fue controlado durante las primeras 24 horas y con analgésicos de primer escalón. Los diagnósticos confirmados por histología fueron: seis neuroblastomas, dos ganglioneuromas y un adenoma. La media de seguimiento fue de 22 meses (1-53). Conclusiones. En nuestra serie esta vía de abordaje está asociada a una baja morbimortalidad con una recuperación precoz, corta estancia hospitalaria y resultados satisfactorios. Por tanto, proponemos la adrenalectomía laparoscópica como una buena alternativa para el abordaje de las lesiones suprarrenales en la población pediátrica

Objective. To describe our experience as a tertiary center on the use of laparoscopic adrenal surgery in children. Material and Methods. A descriptive, retrospective study of patients with pathologic adrenal masses undergoing laparoscopic adrenal surgery, between 2012 and 2015. Epidemiological variables, surgical technique, complications and follow-up were studied. Results. Nine patients were studied with a median age of 62 months (5-184). In 3 patients (33.33%) there was a prenatal diagnosis. Three patients had symptoms: hypertension and renal failure, precocious puberty, and an infected lymph node secondary to metastasis. In the rest, findings were incidental. In five patients the lesion was located on the right side and in four, on the left. The operation was performed laparoscopically. There was one conversion to open surgery because of poor visualization of the surgical field and no major intra- or postoperative complications were noted. The average hospital stay was 4 days (2-5). Postoperative pain was controlled during the first 24 hours with first step painkillers. Diagnoses were histologically confirmed: two ganglioneuroma, three neuroblastoma, bronchogenic cyst, pulmonary sequestration and adenoma. Mean follow-up was 22 months (1-53). Conclusions. In our series this surgical approach is associated with low morbidity and mortality, early recovery, shorter hospital stay and satisfactory results. We therefore propose laparoscopic adrenalectomy as a good alternative for approaching the pathologic adrenal masses in the pediatric population