[Recurrence of uncomplicated intestinal intussusception. Can it be treated as an outpatient?] / Recurrencia de la invaginación intestinal no complicada. ¿Es posible el manejo ambulatorio?

OBJECTIVES: To estimate the recurrence rate of intussusception after successful enema reduction and to analyze the costs of hospital admission with the current management of this pathology. MATERIAL AND METHODS: A retrospective study over 5 years of 97 patients with confirmed diagnosis of intussusception was undertaken. Medical records were evaluated for patient demographic, clinical and radiological data. Patients with enema-reduced intussusception were selected and data respecting to timing and outcome of recurrences, and length of stay were analyzed. Recurrence was defined as a new episode of intussusception within 72 hours of the initial presentation. Costs were calculated using hospital-specific data. RESULTS: During the study period there were 81/97 children with successful enema reduction. Mean length of stay was 35 hours in the conservative treatment group. There were 8 episodes of recurrence, 5 of them within the first 24 hours (6.17%), for an overall recurrence rate of 9.88%. 7 children were treated by repeated enema and only one patient needed surgery for persistent illness. Assuming the overall recurrence rate of 9.88%, it would require hospitalizing 16 patients to identify a single recurrence with a cost of 1,723.75 € per patient. CONCLUSIONS: Given the low recurrence rate for enema-reduced intussusception and the possibility of repeated enema for their treatment in most of recurrences, we strongly advocated for the outpatient management as a safe and cost-effective alternative.

OBJETIVOS: Estimar la tasa de recurrencia en la invaginación intestinal tras reducción con hidroenema. Analizar los costes de estancia hospitalaria según el manejo actual de esta patología. MATERIAL Y METODOS: Estudio retrospectivo de los 97 pacientes con diagnóstico ecográfico de invaginación intestinal en los últimos 5 años. Revisamos datos demográficos, clínicos y ecográficos. Seleccionamos los casos tratados de forma conservadora, analizando las recurrencias, su tratamiento y la estancia hospitalaria. Consideramos recurrencia a un nuevo episodio de invaginación intestinal en las siguientes 72 horas a la reducción. Los costes fueron calculados según los grupos relacionados por diagnóstico en base a datos específicos del centro. RESULTADOS: En los 81/97 (83,5%) pacientes con tratamiento conservador se diagnosticaron 8 episodios de recurrencia, 5 en las primeras 24 horas. En 7 casos se resolvió la recurrencia con hidroenema, mientras que 1 requirió tratamiento quirúrgico por recidivas persistentes. La media de estancia hospitalaria fue de 35 horas en el grupo de tratamiento conservador (81/97 pacientes). La tasa global de recurrencia fue del 9,88%, (6,17% antes de 24 horas), siendo necesario el ingreso de 16 pacientes para el diagnóstico de un caso de recurrencia en las primeras 24 horas. Según estos resultados, y los costes hospitalarios/24 horas, el manejo ambulatorio supondría un ahorro de 1.723,75 €/paciente. CONCLUSIONES: Dado que el riesgo de recurrencia en la invaginación intestinal no complicada es bajo y su tratamiento es conservador en la mayoría de los casos, estaría justificada la implantación de un protocolo de manejo ambulatorio como alternativa segura y costo-efectiva.

[Establishment of a preclinical neuroblastoma model in immunocompetent mice]. / Establecimiento de un modelo preclínico de neuroblastoma en ratones inmunocompetentes.

AIM: To develop a NB animal model which makes possible studies related to tumor immunity. MATERIALS AND METHODS: Two types of NB cells were used. Cell line 36769 was derived from TH-MYCN+ mouse in which overexpression of the MYCN gene is governed by rat tyrosine hydroxylase promotor. Cell line 4040 was derived from TH-MYCN/ALK mice, which in addition express an activating mutation of ALK gene. For each cell type, 1x106 neurospheres were implanted in 129/SVJ mice (with the same genetic background as donors, n=8), via orthotopic injection in the left suprarenal gland by intraperitoneal approach, through a transverse supraumbilical laparotomy. Daily postsurgical clinical follow-up of the animals was done until they were sacrificed at four weeks. The tumor presence was macroscopically confirmed. The tumoral sample was excised and was processed for cellular immunity and molecular tolerance mediator's studies. The existence of metastasis was investigated by flow cytometry in the spleen, bone marrow and peripheral blood. RESULTS: 1) Orthotopic Neuroblastoma was generated in all the transplanted mice. 2) The tumors were infiltrated by several immune subpopulations, with effector, regulatory and suppressor inmunophenotype. This was similar to the inmunophenotype described in human NB. Furthermore, the molecular mediators of the environment point to a state of protumoral tolerance. CONCLUSION: The orthotopic implantation of NB neurospheres in syngeneic mice has allowed us to generate a NB model in which it has been possible to study the tumor immunity.

OBJETTIVO: Desarrollar un modelo animal de neuroblastoma (NB) que posibilite estudios relacionados con la inmunidad tumoral. MATERIAL Y METODOS: Se utilizaron dos tipos de células NB. La línea 36769 procedía del ratón TH-MYCN+ en el que la sobreexpresión del gen MYCN está gobernada por el promotor de la tirosín hidroxilasa de rata. La línea 4040 procedía de ratones TH-MYCN+/ALK+, que además expresan una mutación activadora del gen ALK. De cada tipo celular se implantaron 1x106 neurosferas en ratones 129/SVJ (mismo fondo genetico que los donantes, n=8), mediante inyección ortotópica en glándula suprarrenal izquierda por abordaje intraperitoneal, a través de laparotomía transversa supraumbilical. Se realizó seguimiento clínico diario postquirúrgico de los animales hasta su sacrificio a las 4 semanas. La presencia de tumor se confirmó macroscópicamente. La pieza tumoral se extirpó y se procesó para estudios de inmunidad celular y mediadores moleculares de tolerancia. Se investigó la existencia de metástasis por citometría de flujo en bazo, médula ósea y sangre periférica. RESULTADOS: 1) En todos los ratones trasplantados se generó NB ortotópico. 2) La pieza tumoral se encontró infiltrada por diversas subpoblaciones inmunes, con inmunofenotipo efector, regulador y supresor, similar a la situación descrita en los NB humanos. Además, los mediadores moleculares del microambiente apuntan a un estado de tolerancia protumoral. CONCLUSIONES: La implantación ortotópica de neurosferas NB en ratones singénicos nos ha permitido generar un modelo de NB en el que ha sido posible estudiar la inmunidad tumoral.

[Experience in performance of percutaneous endoscopic gastrostomy in 60 children]. / Experiencia en la colocación de la gastrostomía endoscópica percutánea en 60 niños.

The Percutaneous endoscopic gastrostomy (PEG) has radically changed the handling of the children with nutritional problems that until then were forced to receive nutritionals contributions by parenteral or enteral way, by nasogastric tube, conventional surgical gastrostomy or by central venous access. The objective of this work was to evaluate our experience with 60 patients, with diverse pathologies, that needed a PEG so that they could receive a suitable nutritional contribution. Were registered data of age, sex, reason for the accomplishment of the PEG, used surgical time, days of hospital stay and we analyzed the complications derived from the technique. There were two important complications. In one case one was a patient who presented a gastrocolic fistula as a result of the perforation of the colon in the accomplishment of the PEG and in another case a necrotizing fascitis in a girl who presented a choanal bilateral atresia. The rest of the complications were minor and they were treated without problems. The complications have been comparable to the registered in other series. Although the technique is simple and fast, is not free of risks, reason why it is necessary to inform suitably to the parents of the possibility of complications. In general, the degree of satisfaction of the parents was high.

[ Pulmonary inflammatory pseudotumor in a child]. / Pseudotumor inflamatorio de pulmón en el niño.

The Inflammatory Pseudotumor is a no neoplastic process characterised by an irregular growth of inflammatory cells. A case of 10 years old male is described, he was asymptomatic, diagnosed by a casual chest XR, with a spheric mass in the inferior lobe of the right lung. An excisional biopsy was done with the result of "Inflammatory Pseudotumor". The Inflammatory Pseudotumor is a rare process that can be found in different regions of the human body, with most frequent localization, in the lung. The image tests are not specific for the diagnosis that only can be done by biopsy. The recommended treatment is the complete resection.

[Independent intestinal duplication]. / Duplicación intestinal independiente.

Some types of intestinal duplication are an infrequent clinical condition in the gastroenterology tract that do not meet all classic requisites for their definition. We present a case of independent intestinal duplication from small intestine that starts with acute abdomen; cystic, perforated and separated tumor from wall of normal intestine was founded during surgery. It was totally resected with preservation of normal intestine adjacent, because it was an independent vascular supply. We review a new vascular classification of intestinal duplication and their importance in surgical treatment of this matter.

Femoral hernia in childhood: review of 38 cases.

Femoral hernias rarely occur at any age, but are extremely rare in infancy. We present 38 cases of femoral hernia treated in our pediatric surgery department during the last 15 years. The number of patients who underwent surgery was high compared with other series reviewed. This might be due to the fact that these hernias were considered in the differential diagnosis of inguinal pathology in childhood. The preoperative diagnosis was correct in 22 cases (57. 8%). After surgical treatment no recurrence was reported.

[Post-traumatic cholelithiasis]. / Colelitiasis postraumática.

A 5 year old patient, without any lithogenic antecedent, suffered a trauma, resulting in a shrunken fracture of the left parietal bone, and a splenic parenchymal hematoma. A hemoperitoneum developed at the 3rd postoperation day, with an overall blood loss of 15% of the total blood volume. At the 6th day a well formed biliary calculi was detected in the gallbladder. As the patient remain asymptomatic related to his cholelithiasis, an ultrasound follow-up was instituted. At 3 month postinjury all biliary stones dissolved completely. In this report, the etiopathogenic factors responsible of stone formation in the biliary tree, and current therapeutic recommendations are reviewed.

[Laparoscopy in pediatric surgery]. / Laparoscopia en cirugía pediátrica.

The aim of this paper is to show our experience in Laparoscopic Surgery in the pediatric age. We make a review of 37 patients, in whom we carried out a laparoscopy. In 20 (54%) the laparoscopy was therapeutic: 15 appendectomies, 1 cholecystectomy, 1 ventriculo-peritoneal catheter extraction, 1 ovarian cyst, 1 bilateral oophorectomy and 1 adhesiolysis. In others 17 (46%) was diagnostic: 15 hepatic biopsies, 1 intussusception and 1 abdominal mass biopsy. Of 15 appendectomies, 8 were for acute appendicitis and 7 for chronic process. The age have ranged from 1 month to 18 years. The operative time from 2 h 30 min to 35 min. We had not complications and the average hospital stay was of 2 days. We can say that this is an useful technique in pediatric surgery.

[The histopathological diagnosis of Hirschsprung's disease. Our experience over 18 years]. / Diagnóstico histopatológico de la enfermedad de Hirschsprung. Nuestra experiencia en dieciocho años.

Having had several cases of difficult interpretation from the anatomopathological point of view, we make a review of all intestinal biopsies carried out in 54 patients for diagnosis of Hirschsprung's disease and above all of the suction rectal biopsies. The result has been seven cases with false diagnosis that represents 22 per 100 of the series. We analyse the possible causes that can lead to false positives and negatives results with the suction rectal biopsy, like the height where the biopsy has been taken, the age of the patients (71 per 100 of false results were in children under one month) and finally other diagnosis like hyperganglionisme.

[Pygopagus Siamese twins. Surgical treatment]. / Gemelas siamesas pygopagus. Tratamiento quirúrgico.

A case is presented wherein a set of black female pygopagus siamese twins were successfully separated by our department in their 45th day of life. Both twins had multiple malformations: cardiopulmonary, vertebral, anorectal, genitourinary, etc. The bilateral renal absence in one of them, originated her death on the 7th postoperative day. Only nine other cases have been referred successful during the last 35 years, in a bibliographic review conducted. The associated malformations and surgical skills for treatment and separation of them, are studied: previous colostomy and effective separation at life ages, comprised between one and thirteen months.

[Meckel's diverticulum in children. A series of cases over 16 years]. / Divertículo de Meckel en la infancia. Casuística de dieciseis años.

The authors review 45 cases of patients with Meckel's Diverticulum, 28 were symtomatics and 17 asymtomatics. DM symtomatics were more frequent in males 3:1 and usually the diagnosis was made between 0 and 4 years of age. 85% apared with rectal bleeding, diverticulitis and intestinal obstruction. Near all cases with rectal bleeding and diverticulitis were associated with heterotopic mucosa (90%). The best method of diagnosis is the Tc-99 pertechnetate scan although it has been used in small number of cases because of the emergency. The results have been goods except one death, two intestinal obstructions and two wound infections.