[Hydrostatic enema outcome in patients with long history of ileocolic intussusception]. / Resultados del enema hidrostático en pacientes con clínica prolongada de invaginación ileocólica.

PURPOSE: Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. MATERIAL AND METHODS: Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. RESULTS: In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of history <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when comparing both groups (p=0.588). No complications were seen after enema reduction. CONCLUSIONS: The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms.

OBJETIVOS: El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. RESULTADOS: En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. CONCLUSIONES: El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución.

[Probabilistic algorithm for management of suspected foreign body aspiration in children]. / Protocolo probabilístico para el manejo del cuerpo extraño en la vía aérea.

INTRODUCTION: The aim is to create a protocol for the managing of foreign body aspiration in children based on a probability scale. MATERIAL AND METHODS: Retrospective observational study, including patients admitted with suspected foreign body aspiration (FBA) in the last 15 years. The parameters were assessed with a SCORE that included witnessed choking, stridor and wheezing during choking, unilateral reduced air entry and abnormal X-Ray. This scale relates them to a probability of FBA, where a score ≤ 1 is associated with less than 10% and ≥ 4 with more than 50% of FBA. According to the probability, we propose: observation, chest Computed Tomography (CT) or bronchoscopy. Then, we tried to adapt it to our casuistry. RESULTS: A total of 109 children admitted between 2002-2017 were included. The median age was 25 months, a foreign body was found in 88 patients, the most frequent being organic (seeds and nuts). Significant predictors of FBA were unilateral reduced air entry and abnormal X-Ray. In our study, we found the same ascending probability between the scale and the presence of foreign body, except for SCORE 1, which was 57% what we attribute to an information bias. If the foreign body were not nuts, inorganic or bone, its aspiration was very unlikely, that is why we included it in the SCORE with -1. CONCLUSION: The use of the algorithm would imply the performance of 7% more of CT in patients without a FBA, but avoiding an 8.5% of bronchoscopy. Our results present an information bias, characteristic of a retrospective study.

OBJETIVOS: Creación de un protocolo de manejo del cuerpo extraño (CE) en vía aérea (VA) basado en una escala de probabilidad. MATERIAL Y METODOS: Estudio retrospectivo observacional de pacientes con sospecha de aspiración de CE en 15 años. Los parámetros fueron valorados con un SCORE que contempla atragantamiento presenciado, estridor y sibilancias durante el atragantamiento, hipoventilación unilateral y radiografía alterada. Dicha escala los relaciona con una probabilidad de presencia de CE en VA, donde una puntuación ≤ 1 se asocia a menos de un 10% y ≥ 4 a > 50%. Según la probabilidad se plantea: observación, TAC o instrumentación de VA. A continuación se intentó optimizar en función de nuestra casuística. RESULTADOS: Se analizaron 109 pacientes (mediana 25 meses), identificándose CE en 88, principalmente frutos secos. De las variables predictoras solo fueron significativas: la hipoventilación unilateral y la radiografía alterada. En nuestra serie se observó la misma probabilidad ascendente entre la escala y la presencia de CE, excepto en la puntuación de 1 que fue del 57%, lo que atribuimos a un sesgo de información. Si el CE no era fruto seco, material inorgánico o hueso, era muy improbable su aspiración (p= 0) por lo que lo incluimos en el SCORE con un -1. CONCLUSIONES: La aplicación de la escala implicaría la realización de un 7,5% más de TAC en pacientes sin CE pero evitando un 8,5% de instrumentaciones de la VA. Nuestros resultados presentan un sesgo de información, propio de un estudio retrospectivo. Actualmente hemos iniciado la implementación prospectiva.

[Hypertension secondary to intrarenal aneurysms in childhood]. / Hipertensión secundaria a aneurismas intrarrenales en la infancia.

OBJECTIVES: Arterial hypertension due to renovascular dysfunction is uncommon in children. The most common cause is stenosis of the renal artery and, rarely, aneurysm of secondary arteries. The present case underscores the therapeutic difficulties. Treatment must be based on the clinical symptoms, location, size, number and etiology of these vascular malformations. METHOD/RESULTS: We describe a 4-year-old patient with secondary arterial hypertension arising from several aneurysms in the primary and secondary arterial branches of the right kidney that had been diagnosed by arteriography. After medical treatment had failed, the patient underwent a right nephrectomy since local or conservative procedures could not be done. CONCLUSIONS: It is widely advocated in the literature that patients with medically refractory arterial hypertension warrant surgical treatment. The type of surgery will depend on the location and the characteristics of the lesion.

[Intravesical foreign body caused arising from ureterostomy protective resin-gum]. / Cuerpo extraño intravesical producido por resina-goma protectora de ureterostomía.

OBJECTIVES: Bladder foreign bodies can arise from many factors and are iatrogenic in a high percentage. A case of intravesical foreign body from accumulated fragments of synthetic gum utilized to protect the ureterostomy is described. These problems can be avoided by correct management of the osteotomy and must therefore be emphasized to those responsible for the patient's care. METHODS/RESULTS: A case of a 7-year-old patient with chronic nephropathy and a bilateral high-loop ureterostomy is described. The migration and subsequent condensation of small fragments of the material protecting the ureterostomy led to the formation of a foreign body which took the shape of the bladder. Treatment was by vesicostomy. CONCLUSION: The possible complications arising from the passage of objects from outside into the urinary tract should always be taken into account in patients with an external urinary diversion.

[Latex allergy in children with spina bifida]. / Alergia al látex en niños con espina bífida.

Latex allergy is a frequent happening in children with spina bifida or congenital urologic abnormalities. These patients have multiples exposures to derivatives of latex as part of the management increasing the risk of allergic reactions. We present three children who developed general anaphylactic reaction during urodynamic exploration with a rectal latex catheter. All patients showed positive skin test and positive latex specific IgE test (RAST). A prospective survey of 17 patients with spina bifida at the time of cystometry showed positive RAST levels in 7 (41%). Recommendations for prophylaxis are included, suggesting the avoidance of latex products in children with spina bifida since birth.