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)

Invaginación atípica por tumor miofibroblástico inflamatorio / Atypical intussusception caused by inflammatory myofibroblastic tumor

No disponible

Utilización de dermis artificial en el manejo de heridas traumáticas con exposición ósea y/o tendinosa en niños / Use of artificial dermal matrix in the management of traumatic wounds with exposed bone and/or tendon in children

En los últimos años ha aumentado el uso de dermis artificial (Integra®) en niños, siendo su principal indicación la reconstrucción cutánea tras una quemadura o una extirpación de lesiones congénitas. Su uso en heridas traumáticas en niños es todavía poco frecuente, con escasas referencias en la bibliografía. Recientemente hemos utilizado dermis artificial en tres pacientes de 7, 9 y 13 años de edad, que presentaban heridas traumáticas en el miembro inferior izquierdo, el miembro inferior derecho y la región frontal, respectivamente. En todos los casos existía una importante pérdida de sustancia con exposición ósea y/o tendinosa. La dermis artificial se colocó entre los días 7 y 10 de evolución, siguiendo el protocolo habitual, tras el desbridamiento quirúrgico de las lesiones. En los tres casos la evolución ha sido satisfactoria, sin complicaciones y con unos buenos resultados estéticos y funcionales. El uso de dermis artificial en el caso de heridas traumáticas, con una importante pérdida de sustancia y exposición ósea y/o tendinosa, debe considerarse como una alternativa a los injertos de piel parcial o total, a los expansores tisulares e incluso a las transferencias de tejidos. En este tipo de heridas recomendamos la aplicación diferida de la dermis artificial (AU)

In recent years, the use of artificial dermal matrix (Integra®) in children has increased, being its main indication skin reconstruction after burn or removal of congenital lesions. Its use in traumatic wounds in children is rare, with few references in the literature. Recently, we have used artificial dermal matrix in 3 patients of 7, 9 and 13 years of age that presented traumatic wounds in left lower limb, right lower limb and frontal region respectively. In all cases there were important tissue defects with exposed bone and/or tendon. The artificial dermal matrix was applied between the 7th and 10th day of evolution, following the usual protocol, after surgical debridement of the wounds. In all 3 cases the evolution has been satisfactory, without complications and with good aesthetic and functional results. The use of artificial dermal matrix (Integra®) in cases of traumatic wounds, with important tissue subsastances and exposed bone and/or tendon, must be considered as an alternative to split or full thickness skin grafting, skin expansion and even skin flaps. We recommend in these wounds the deferred application of artificial dermal matrix (AU)

[Initial study of an experimental model for bladder augmentation]. / Estudio inicial de un modelo experimental para la ampliación vesical.

Since Coffey described in 1910 the Uretero-sigmoidostomy, the first auto-continent urinary derivation, many techniques have been developed and used for bladder augmentation, although none of them has been considered fully satisfactory. The availability of a product made of a bovine collagen and glycosaminoglycan base, used for regenerating dermis and oral mucosa induced us to start this study on rabbit bladder in order to verify if muscular fibers might grow in its interior. For that purpose we used 6 New Zealand rabbits, to which we implanted a fragment of artificial dermis inside the detrusor after dissecting it. We present our results after 3 and 6 weeks postoperatively.

Estudio inicial de un modelo experimental para la ampliación vesical / Initial study of an experimental model for bladder augmentation

Desde la descripción de Coffey en 1910 de la uretero-sigmoidostomía, primera derivación urinaria continente, se han utilizado multitud de técnicas para ampliar la vejiga, pero ninguna plenamente satisfactoria. La aparición de un producto compuesto por una matriz de colágeno bovino y glicosaminoglicano, utilizado en regeneración de dermis y mucosa oral, nos indujo a realizar este estudio sobre vejiga de conejo con el fin de comprobar si podrían crecer fibras musculares en su interior. Para ello utilizamos 6 conejos New Zealand, a los que tras dislacerar una porción de detrusor les implantamos un fragmento de dermis artificial. Posteriormente, se realizó estudio anatomopatológico a las tres yseis semanas, con los resultados que posteriormente se detallan (AU)

Since Coffey described in 1910 the Uretero-sigmoidostomy, the first auto-continent urinary derivation, many techniques have been developed and used for bladder augmentation, although none of them has been considered fully satisfactory. The availability of a product made of a bovine collagen and glycosaminoglycan base, used for regenerating dermis and oral mucosa induced us to start this study on rabbit bladder in order to verify if muscular fibers might grow in its interior. For that purpose we used 6 New Zealand rabbits, to which we implanted a fragment of artificial dermis inside the detrusor after dissecting it. We present our results after 3 and 6 weeks postoperatively (AU)

Torsión intraútero de un quiste ovárico. Presentación neonatal atípica / Intrauterine torsion of ovarian cyst. Atypical neonatal presentation

La ecografía prenatal y posnatal nos ha permitido conocer realmente los datos sobre la frecuencia y la evolución de los quistes ováricos fetales. Aunque la mayoría de estos quistes involucionan en el transcurso de los primeros meses de vida, pueden presentar complicaciones durante el periodo fetal o posnatal, entre las cuales la torsión ovárica es la más frecuente. Presentamos el caso de una niña de 5 meses de edad, remitida a nuestro servicio de cirugía pediátrica por una tumoración intraabdominal, que resultó ser una autoamputación ovárica, complicación derivada de un quiste ovárico fetal que provocó una torsión ovárica intraútero. Revisamos los conocimientos actuales sobre los quistes ováricos fetales, haciendo especial hincapié en su manejo médico y quirúrgico posnatal (AU)

Pre- and postnatal echographies have allowed us to know reliable data about frequency and evolution of fetal ovarian cysts. Though most of these cysts involute during the first months of life, sometimes complications may appear during fetal or neonatal periods, being the ovarian torsion the most frequent. We present a case report of a 5 months-old female patient referred to our Pediatric Surgery Service with an intraabdominal tumoration. This tumoration resulted to be an ovarian autoamputation, which is a complication derived from a fetal ovarian cyst which caused an intrauterine ovarian torsion. We revise the current knowledge about fetal ovarian cysts emphasizing its postnatal surgical and clinical management (AU)

Estudio comparativo de la incidencia de abscesos de pared abdominal en niños intervenidos quirúrgicamente por apendicitis aguda: tratamiento convencional vs con suturas recubiertas de antiséptico o con apósitos impregnados de antibiótico / Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial suture or gentamicin impregnated collagen fleeces

La infección de la herida, tras la apendicectomía en la infancia, esun problema frecuente y que produce trastornos muy molestos. Revisamos prospectivamente a los niños operados por apendicitis aguda, con técnicas quirúrgicas convencionales, durante un período consecutivo de 9 meses (Grupo Control: 58 pacientes), y a los niños intervenidos durante los 9 meses siguientes, bajo las mismas circunstancias quirúrgicas excepto utilizar, de manera aleatoria, sutura recubierta de antiséptico (Vicryl Plus®, Ethicon Johnson & Johnson Medical), para el cierre de la pared abdominal en un Subgrupo o esponja de colágeno impregnada en gentamicina (Collatamp EG®, Acuña Fombona, S.A.;Schering-Plough, S.A.), introducida entre la musculatura de la incisión, en el otro Subgrupo (Grupo Estudio: 101 pacientes).Estudiamos en los dos grupos, fundamentalmente, la incidencia de abscesos de pared y la estancia media hospitalaria. La introducción de suturas recubiertas de antiséptico y/o esponja de colágeno impregnada en gentamicina, en el cierre de la herida quirúrgica postapendicectomía, ha contribuido a reducir de manera estadísticamente significativa la incidencia de abscesos de pared y de la estancia media hospitalaria de los niños incluidos en el Grupo Estudio, con respecto a los pertenecientes al Grupo Control (AU)

Postappendectomy wound infection is frequent in the pediatric age. It causes them important discomfort. We have conducted a prospective clinical study to evaluate this incidence under different surgical management. The subjects were children undergoing appendectomy for acute appendicitis. The patients belonging to the Control Group were operated, by standard surgical technique, along the first 9 months of the study period (n: 58).The Study Group was constituted by 101 children operated during the 9 consecutive months, identical on the basis of demographics and operations undergone, except for the use of, in an aleatory manner, sutures with antiseptic impregnation (Vicryl Plus®, Ethicon Johnson& Johnson Medical), to close the incision in children included in Study Sub-Group A, or gentamycin-containing collagen sponge (CollatampEG®, Acuña Fombona, S.A.; Schering-Plough, S.A.), placed within the muscles before wound closure,. In the children belonging to the Study Sub-Group B. We have analyzed in the two Groups the incidence of postoperative wound infection and the mean Hospital stay. The use of sutures with antiseptic impregnation and/or gentamycin containing collagen sponge, significantly reduced the wound infection rates in the children operated on for appendectomy included in the Study Group, compared with the ones in the Control Group, therefore contributing to decrease the Hospital length of stay (AU)

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

[Analysis of 34 cases of distal hypospadias treated by modified Koff's technique]. / Análisis de 34 casos de hipospadias distal intervenidos mediante la técnica de Koff modificada.

Koff's procedure in the treatment of distal hypospadias consist in a large mobilization of the distal urethra. The association to a transglandular funelization and minimal urethroplasty is useful for the treatment in the majority of patients with distal hypospadias. In the last two years 34 patients with distal types of hypospadias were operated with a Koff's modified procedure. The technique consists in a urethral advancement without glanduloplasty and distal cutaneous tubulization. The primitive meatal localization was subcoronal (n = 22), glandular (n = 6), and on the distal shaft (n = 6). In 10 cases urethral catheters was not necessary. A patient develops a proximal fistula successfully treated with 14 days catheterization. Cosmetic and functional results were good in all cases. Extensive urethral mobilization can be done in cases of distal hypospadias and is evidence of the preserved vascularity and viability of the mobilized urethra.

[Intrahepatic biloma. Conservative management with external drainage]. / Bilioma intrahepático. Tratamiento conservador mediante drenaje externo.

A seven year old boy, one week after surgical intervention for blunt liver trauma, presents an intrahepatic bilioma. Under ultrasonografic guidance, an external drainage is inserted. Contrast injection shows billiary fistula. Three weeks later, after a new contrast injection, billiary fistula resolution is proved, and dranaige tube is withdrawn. Ultrasonografic and CT Scan studies showed total resolution of intrahepatic collection. Intrahepatic billiary collections are a rare complication of the hepatic traumatism. Conservative management with external drainage, should be keept in mind like a first choice terapeutic option.

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

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

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

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

[Acute abdomen of unusual cause in children]. / Abdomen agudo de causa excepcional en el niño.

The acute abdomen in childhood is in most cases caused by an acute appendicitis and rarely it is secondary to other diseases. It is for that reason, that we present two cases extremely rare of acute abdomen: the first one was an abdominal Actinomycosis secondary to acute appendicitis that looked like a tumor and the second that was an acute omentitis due to pinworms.