Lesiones neonatales perinatales: desgarro rectovaginal / Perinatal neonatal lesions: retrovaginal tears

Las lesiones neonatales producidas durante el parto o en las maniobras de reanimación tienen una alta morbilidad y suponen la 8ª causa de mortalidad en recién nacidos. El objetivo de este artículo es revisar nuestra casuística en los últimos 10 años y presentar un caso clínico de desgarro rectovaginal, revisando las posibles opciones terapéuticas publicadas en la literatura .Se recogieron un total de 8 lesiones neonatales perinatales, siendo la mayoría de ellas heridas inciso-contusas (5) en cuero cabelludo, pabellón auricular y tórax. Los demás casos afectaban al periné: un desgarro anal y dos desgarros rectovaginales. En el caso clínico presentado, el periné fue reparado de forma primaria, realizándose posteriormente una colostomía y perineo plastia por dehiscencia. Solo un pequeño porcentaje de las lesiones neonatales perinatales son valoradas por el cirujano pediátrico. Algunas de ellas son graves y pueden tener importantes consecuencias. La colostomía y cierre primario o secundario es una opción terapéutica segura en desgarros rectovaginales (AU)

Neonatal injuries produced during the childbirth or in the maneuvers of resuscitation they have a high morbidity and suppose the 8th reason of mortality in newborns. The aim of this article is to check our casuistry in the last 10 years and to present a case report of rectovaginal tear with the possible therapeutic options published in the literature. There were gathered a total of 8 perinatal neonatal injuries, being the majority of them clause-contused (5) in hairy leather, pinna and thorax. Other cases were affecting the perine: an anal tear and two rectovaginal tears; one of these patients needed colostomy and surgical repair of the perine. Only a small percentage of the perinatal neonatal injuries are valued by the paediatric surgeon. Some of them are serious and can have important consequences. The colostomy and primary or secondary closing is a therapeutic sure option in rectovaginal tears (AU)

[Perinatal neonatal lesions: retrovaginal tears]. / Lesiones neonatales perinatales: desgarro rectovaginal.

Neonatal injuries produced during the childbirth or in the maneuvers of resuscitation they have a high morbidity and suppose the 8th reason of mortality in newborns. The aim of this article is to check our casuistry in the last 10 years and to present a case report of rectovaginal tear with the possible therapeutic options published in the literature. There were gathered a total of 8 perinatal neonatal injuries, being the majority of them clause-contused (5) in hairy leather, pinna and thorax. Other cases were affecting the perine: an anal tear and two rectovaginal tears; one of these patients needed colostomy and surgical repair of the perine. Only a small percentage of the perinatal neonatal injuries are valued by the paediatric surgeon. Some of them are serious and can have important consequences. The colostomy and primary or secondary closing is a therapeutic sure option in rectovaginal tears.

[Abdominal lesions associated to safety belt mark]. / Lesiones abdominales asociadas a marca por cinturón de seguridad.

INTRODUCTION: Motor vehicle crashes cause 28% of morbidity and mortality in children. A proper medical evaluation of the polytraumatized patient is essential to reduce these numbers. The aim of our study is to correlate clinical and radiological signs in patients with seat belt mark, to establish an early diagnosis of internal injuries. MATERIALS AND METHODS: From 1998 to 2007 we treated 8 cases of polytraumatized patients (5 boys and 3 girls) with abdominal bruises (seat belt mark) after suffering a traffic accident. The mean age was 8.37 years (range: 4-11). 100% of the patients suffered a frontal collision of their vehicle. In 2 cases the position of the lap belt was inadequate. The trauma team made the initial attention of all patients in the Emergency room, with a complete physical examination and they requested: abdominal X-ray, ultrasound and computed tomography (CT-scan). RESULTS: The main clinical signs found in our patients were: one case of hemodynamic instability, hypovolemic shock and abdominal distension; 2 cases of diffuse abdominal pain and signs of peritoneal irritation; 4 cases of non-specific diffuse abdominal pain and one patient in coma with Glasgow 8. The radiological signs found were: abdominal free fluid (detected in 100% of the CT-scan and only in 75% of ultrasound studies), thickening and enhancement of small bowel (62.5%), mesenteric infiltration (87.5 %) and pneumoperitoneum (37.5%). The surgical findings were: seven cases (87.5%) of an intestinal bursting perforation and one case of vascular injury of the medium colic vein. The diagnosis of intestinal perforation was late established in five patients, and they underwent treatment between 5 and 19 days after the accident. CONCLUSIONS: All our patients (100%) with a seat belt mark presented abdominal injuries. The treatment is frequently delayed due to the difficulty in establishing the diagnosis. The finding of cutaneous ecchymosis caused by the lap belt must be a warning sign to suspect abdominal injuries. The CT scan is the most effective imaging technique to study patients with seat belt mark.

Lesiones abdominales asociadas a marca por cinturón de seguridad / Abdominal lesions associated to safety belt mark

Introducción. Los accidentes de tráfico son causa del 28% de morbimortalidad en la edad pediátrica. Una correcta evaluación médica del politraumatizado es imprescindible para la reducción de estas cifras. El objetivo de nuestro trabajo es correlacionar en pacientes con lesiones cutáneas postraumáticas por cinturón de seguridad, los signos clínicos y radiológicos para establecer un diagnóstico precoz de lesiones internas. Material y métodos. Desde 1998 hasta 2007 hemos tratado a 8pacientes (5 niños y 3 niñas) politraumatizados con marca por cinturón de seguridad tras accidente de tráfico. La edad media fue de 8,37 años(rango: 4-11). El 100% de los pacientes sufrieron una colisión frontal de su vehículo. Se constató que en 2 casos la posición del cinturón era inadecuada. A todos los pacientes se les realizó la atención inicial al politraumatizado, con una exploración física completa y se solicitaron exploraciones complementarias: radiografía simple, ecografía y tomografía computarizada (TC) abdominal. Resultados. La clínica principal que presentaron los pacientes fue: un caso de inestabilidad hemodinámica, shock hipovolémico y distensión abdominal; 2 casos con dolor abdominal difuso y signos de (..) (AU)

Introduction. Motor vehicle crashes cause 28% of morbidity and mortality in children. A proper medical evaluation of the polytraumatized patient is essential to reduce these numbers. The aim of our study is to correlate clinical and radiological signs in patients with seat beltmark, to establish an early diagnosis of internal injuries. Materials and methods. From 1998 to 2007 we treated 8 cases of polytraumatized patients (5 boys and 3 girls) with abdominal bruises(seat belt mark) after suffering a traffic accident. The mean age was 8.37years (range: 4-11). 100% of the patients suffered a frontal collision of their vehicle. In 2 cases the position of the lap belt was inadequate. The trauma team made the initial attention of all patients in the Emergency room, with a complete physical examination and they requested: abdominal X- ray, ultrasound and computed tomography (CT-scan). Results. The main clinical signs found in our patients were: one case of hemodynamic instability, hypovolemic shock and abdominal distension; 2 cases of diffuse abdominal pain and signs of peritoneal irritation; 4 cases of non-specific diffuse abdominal pain and one patient (..) (AU)

Catalytic effects of different redox mediators on the reductive decolorization of azo dyes.

The catalytic effects of redox mediators, with distinct standard redox potentials (E'0), were evaluated on the first-order rate constant of decolorization (Kd) of recalcitrant azo dyes by an anaerobic granular sludge. The dyes studied included mono-azo (Reactive Orange 14, RO14), di-azo (Direct Blue 53, DB53), and tri-azo (Direct Blue 71, DB71) compounds. Toxicity and auto-catalytic aspects seemed to play a role in determining the rate of decolorization. Addition of riboflavin, anthraquinone-2,6-disulphonate (AQDS) or lawsone as a redox mediator, increased the Kd value for all dyes studied, although their impact varied in every case. Kd values were increased from 1.1-fold up to 3.8-fold depending on the redox mediator applied. Moreover, catalysts with moderately similar E'0 value caused distinct stimulation on the rate of decolorization. These results should be considered for selecting the proper redox mediator to be applied during the anaerobic treatment of textile wastewaters and effluents containing electron-withdrawing pollutants, such as nitro-aromatic and polychlorinated compounds.

Controversias en el manejo terapéutico de la hernia diafragmática congénita: actualización a través de la medicina basada en pruebas / Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine

Introducción. La hernia diafragmática congénita (HDC) es una enfermedad de alto riesgo en cirugía neonatal. El objetivo de este artículo es realizar una actualización sobre las controversias terapéuticas (momento de la cirugía y estabilización médica) de la HDC, por medio de una revisión sistemática y crítica de las mejores pruebas científicas de la literatura. Métodos. Revisión sistemática y estructurada de los artículos relacionados con el manejo terapéutico de la HDC (cirugía, ventilación mecánica, óxido nítrico inhalado, oxigenación por membrana extracorpórea, surfactante, etc.) publicados en fuentes de información secundaria (TRIPdatabase, revisiones sistemáticas de la Colaboración Cochrane, guías de práctica clínica, informes de evaluación de tecnología sanitaria, etc.) y primaria (bases de datos, revistas biomédicas, libros de texto, etc.) y valoración crítica por medio de la metodología del Evidence- Based Medicine Working Group. Seleccionamos las publicacionescon la mejor evidencia científica en artículos sobre tratamiento (ensayo clínico, revisión sistemática, metaanálisis y guías de práctica clínica). Resultados. La principal información secundaria se detecta en The Cochrane Library: 3 revisiones sistemáticas en Neonatal Group (una en relación con el momento de la cirugía, y dos relacionadas con el uso de óxido nítrico y oxigenación por membrana extracorpórea en el fracaso respiratorio grave del recién nacido). Pero la mayoría de los artículos relevantes se detectan en la base de datos Pubmed, principalmente publicados en Journal Pediatric Surgery y con determinados grupos de investigación (Congenital Diaphragmatic Hernia Study Group en la Universidad de Texas y Buffalo Institute of Fetal Therapy en la Universidad de New York). Conclusiones. A partir del análisis de la medicina basada en pruebas, los resultados sobre el manejo de la HDC no fueron claros entre la cirugía precoz y tardía, pero la cirugía diferida (con estabilización preoperatoria) se ha convertido en el manejo preferido en la mayoría de los centros, así como que la cirugía fetal in utero no ofrece ventajas sobre la cirugía neonatal. La opinión respecto al tiempo adecuado de la cirugía ha cambiado gradualmente desde la intervención precoz a la estabilización inicial con posterior cirugía. Debido a la hipertensión pulmonar persistente y/o hipoplasia pulmonar en la HDC, el tratamiento médico se ha focalizado hacia la optimización de la oxigenación evitando el barotrauma, utilizando ventilación «suave» e hipercapnia permisiva. La ventilación de alta frecuencia oscilatoria, óxido nítrico inhalado y oxigenación con membrana extracorpórea, se utilizarán en casos graves, pero estos tratamientos no mejoran claramente el pronóstico en recién nacidos con HDC. La utilidad de surfactante y ventilación líquida parcial se fundamentan en estudios de experimentación animal, debido a que los ensayos clínicos en neonatos son escasos y no concluyentes. Los cambios de futuro en esta área de estudio incluyen la necesidad de mayores y mejores ensayos clínicos, que incluyan efectos a largo plazo entre los niños supervivientes (AU)

Introduction. Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in neonatal surgery. The aim of this article is to make an update of the controversies about the therapeutic management (time of surgery and modalities of medical stabilization) of CDH, by means of a systematic and critical review of the best scientific evidence in bibliography. Methods. Systematic and structured review of the articles about therapeutic management of CDH (surgery, mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation, surfactant, etc) published in secondary (TRIPdatabase, systematic review in Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). Results. The main secondary information is found in The Cochrane Library: 3 systematic review in the Neonatal Group (one specific about the time of surgery, and two related to the use of nitric oxide and extracorporeal membrane oxygenation in neonatal severe respiratory failu-re). But we found the main relevant articles in Pubmed database, mainly published in Journal Pediatric Surgery and with some clusters of investigation (Congenital Diaphragmatic Hernia Study Group in Texas University and Buffalo Institute of Fetal Therapy in New York University). Conclusions. From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear, but delayed surgical (with pre-operative stabilization) has become preferred approach in many centers, and foetal surgery is not better than neonatal one. Opinion regarding the time of surgery has gradually shifted from early repair to a policy of stabilization and delayed repair. Because of associated persistent pulmonary hypertension and/or pulmonary hypoplasia in CDH, medical therapy is focused toward optimizing oxygenation while avoiding barotrauma, using gentle ventilation and permissive hypercarbia. High frequency oscillatory ventilation, inhaled nitric oxide and extracorporeal membrane oxygenation are used in severe cases, but these treatments do not clearly improve the outcome in neonates with CDH. The usefulness of surfactant and partial liquid ventilation are based in animal model experimentation, because the clinical trials in newborns are little and non-conclusive. Challenges for the future in this thematic area include the need for bigger and better trials of therapy in this field, with long-term outcomes among surviving children (AU)

[Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine]. / Controversias en el manejo terapéutico de la hernia diafragmática congenita: actualización a través de la medicina basada en pruebas.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in neonatal surgery. The aim of this article is to make an update of the controversies about the therapeutic management (time of surgery and modalities of medical stabilization) of CDH, by means of a systematic and critical review of the best scientific evidence in bibliography. METHODS: Systematic and structured review of the articles about therapeutic management of CDH (surgery, mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation, surfactant, etc) published in secondary (TRIPdatabase, systematic review in Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). RESULTS: The main secondary information is found in The Cochrane Library: 3 systematic review in the Neonatal Group (one specific about the time of surgery, and two related to the use of nitric oxide and extracorporeal membrane oxygenation in neonatal severe respiratory failure). But we found the main relevant articles in Pubmed database, mainly published in Journal Pediatric Surgery and with some clusters of investigation (Congenital Diaphragmatic Hernia Study Group in Texas University and Buffalo Institute of Fetal Therapy in New York University). CONCLUSIONS: From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear, but delayed surgical (with pre-operative stabilization) has become preferred approach in many centers, and foetal surgery is not better than neonatal one. Opinion regarding the time of surgery has gradually shifted from early repair to a policy of stabilization and delayed repair. Because of associated persistent pulmonary hypertension and/or pulmonary hypoplasia in CDH, medical therapy is focused toward optimizing oxygenation while avoiding barotrauma, using gentle ventilation and permissive hypercarbia. High frequency oscillatory ventilation, inhaled nitric oxide and extracorporeal membrane oxygenation are used in severe cases, but these treatments do not clearly improve the outcome in neonates with CDH. The usefulness of surfactant and partial liquid ventilation are based in animal model experimentation, because the clinical trials in newborns are little and non-conclusive. Challenges for the future in this thematic area include the need for bigger and better trials of therapy in this field, with long-term outcomes among surviving children.

[Rectosigmoidectomy and end to end coloanal anastomosis with mechanical stapler for treatement of Hirschsprung disease]. / Rectosigomoidectomía y anastomosis término-terminal coloanal con sutura mecánica para el tratamiento de la enfermedad de Hirschsprung.

UNLABELLED: The experience of the Pediatric Surgical Service of the Materno Infantil University Hospital from Málaga on surgical treatment of the Hirschsprung disease by means of a modified technique of Swenson and Rehbein operations is presented. MATERIAL AND METHODS: Between 1992 and 2001 25 patients were operated of a rectosigmoidectomy. Of them, 23 were diagnosed of Hirschsprung's disease, one suffered a rectal angiodisplasia and the other one presented with a rectal stenosis secondary to a previous rectosigmoidectomy. In all of them a transabdominal rectosigmoidectomy with coloanal end to end anastomosis by means of a circular intraluminal stapler was performed. In 10 of them (group A), a modified Rehbein operation with intraabdominal anastomosis was performed. In the remaining 15 patients (group B), a modified Swenson operation with exteriorization of the aganglionic colon through the anus and extrabdominal anastomosis was performed. RESULTS: The postoperative course was evaluated by measuring the postoperative fasting time and the first spontaneous deposition. The medium hospital stay was of 9 days, nevertheless in 16 patients (64%) was lower than 7 days. The postoperative complications are presented. It consists in 1 anastomotic leakage (4%), postoperative enterocolitis 1 case (4%) and transient anastomotic stenosis in 4 patients (16%). All of them were treated with conservative treatment except one case of stenosis which needed a sphincterotomy. CONCLUSIONS: The rectosigmoidectomy and coloanal end to end anastomosis with endoluminal stapler is a safe and easy to do technique to treat the Hirschsprung's disease allowing a deep rectal resection which is very difficult to achieve by manual suture. The anastomosis is located in and extraperitoneal position, with a minimum risk of peritoneal involvement in case of anastomotic leakage. The patients presented a fast recovery, a minimum of complications and good functional result.

[Complete sternal fissure. Use of autogenic grafts in modified surgery]. / Fissure sternale complète. Utilisation de greffons autogènes en chirurgie différée.

A patient with complete sternal cleft, was referred to us over the neonatal period. For this reason, she was treated with a modified technic consisting of breaching the sternal defect with free rib grafts covered by prosthetic material made of silastic and teflon. Late results were excellent.

Ureteral triplication and duplicated opposite kidney with refluxing ureterocele.

A case is reported of ureteral triplication with ectopia of two of the ureters and contralateral duplication with a ureterocele. This patient is the youngest that we have found reported with this type of anomaly and the only one presenting with abdominal distention and an intact but refluxing ureterocele.