Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis. / Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada.

OBJECTIVE: The objective of this study was to assess the results of a clinical guideline for the treatment and early discharge of patients with complicated acute appendicitis in terms of infectious complications and hospital stay. MATERIALS AND METHODS: A guideline for appendicitis treatment according to severity was created. Complicated appendicitis cases were treated with ceftriaxone-metronidazole for 48h, with discharge being approved if certain clinical and blood test criteria were met. A retrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) in patients under 14 years of age to whom the new guideline was applied (Group A) vs. the historical cohort (Group B, treated with gentamicin-metronidazole for 5 days) was carried out. A prospective cohort study to assess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting early discharge criteria was also conducted. RESULTS: 205 patients under 14 years of age were included in Group A, whereas 109 patients were included in Group B. IAA was present in 14.3% of patients from Group A vs. 13.8% from Group B (p= 0.83), while SSI was present in 1.9% of patients from Group A vs. 8.25% from Group B (p= 0.008). Early discharge criteria were met by 62.7% of patients from Group A. Median hospital stay decreased from 6 to 3 days. At discharge, 57% of patients received amoxicillin-clavulanic acid, whereas 43% received cefuroxime-metronidazole, with no differences being found in terms of SSI (p= 0.24) or IAA (p= 0.12). CONCLUSIONS: Early discharge reduces hospital stay without increasing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.

OBJETIVO: El objetivo de este estudio es evaluar los resultados en términos de complicaciones infecciosas y estancia hospitalaria de la instauración de una guía clínica para el tratamiento y alta precoz en pacientes con apendicitis aguda complicada. MATERIAL Y METODOS: Se elaboró una guía para el tratamiento de las apendicitis en función de su grado de severidad. Las complicadas se trataron con ceftriaxona-metronidazol durante 48 h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analítico retrospectivo comparando la incidencia de abscesos intraabdominales postquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientes menores de 14 años sometidos a la nueva guía (Grupo A), respecto a una cohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortes prospectivas para evaluar qué antibioterapia (amocilina-clavulánico o cefuroxima-metronidazol) es más eficaz en los pacientes que cumplen criterios de alta precoz. RESULTADOS: Se incluyeron 205 pacientes menores de 14 años en el Grupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupo A, frente al 13,8% en el B (p=  0,83); e ISQ un 1,9% y un 8,25% respectivamente (p=  0,008). Cumplieron criterios de alta precoz el 62,7% de los pacientes del Grupo A. La mediana de estancia disminuyó a de 6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43% cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ (p=  0,24) ni de AIA (p=  0,12). CONCLUSIONES: El alta precoz disminuye la estancia hospitalaria sin aumentar el riesgo de complicaciones infecciosas postquirúrgicas. La amoxicilina-clavulánico es una opción segura para la antibioterapia oral domiciliaria.

Análisis de una guía clínica para el tratamiento y alta precoz en apendicitis aguda complicada / Analysis of a clinical guideline for treatment and early discharge in complicated acute appendicitis

Objetivo: El objetivo de este estudio es evaluar los resultados entérminos de complicaciones infecciosas y estancia hospitalaria de lainstauración de una guía clínica para el tratamiento y alta precoz enpacientes con apendicitis aguda complicada.Material y métodos: Se elaboró una guía para el tratamiento delas apendicitis en función de su grado de severidad. Las complicadas setrataron con ceftriaxona-metronidazol durante 48h, siendo alta si cumplen ciertos criterios clínicos y analíticos. Se realizó un estudio analíticoretrospectivo comparando la incidencia de abscesos intraabdominalespostquirúrgicos (AIA) e infección del sitio quirúrgico (ISQ) en pacientesmenores de 14 años sometidos a la nueva guía (Grupo A), respecto a unacohorte histórica (Grupo B), en la que la pauta de tratamiento era gentamicina-metronidazol 5 días. Además, se realizó un estudio de cohortesprospectivas para evaluar qué antibioterapia (amocilina-clavulánico ocefuroxima-metronidazol) es más eficaz en los pacientes que cumplencriterios de alta precoz. Resultados: Se incluyeron 205 pacientes menores de 14 años en elGrupo A y 109 en el Grupo B. Presentaron AIA un 14,3% en el grupoA, frente al 13,8% en el B (p= 0,83); e ISQ un 1,9% y un 8,25% respectivamente (p= 0,008). Cumplieron criterios de alta precoz el 62,7%de los pacientes del Grupo A. La mediana de estancia disminuyó a de6 a 3 días. Al alta, el 57% recibieron amoxicilina-clavulánico y el 43%cefuroxima-metronidazol, sin hallarse diferencias en términos de ISQ(p= 0,24) ni de AIA (p= 0,12).Conclusiones: El alta precoz disminuye la estancia hospitalariasin aumentar el riesgo de complicaciones infecciosas postquirúrgicas.La amoxicilina-clavulánico es una opción segura para la antibioterapiaoral domiciliaria.(AU)

Objective: The objective of this study was to assess the results of aclinical guideline for the treatment and early discharge of patients withcomplicated acute appendicitis in terms of infectious complicationsand hospital stay. Materials and methods: A guideline for appendicitis treatmentaccording to severity was created. Complicated appendicitis caseswere treated with ceftriaxone-metronidazole for 48h, with dischargebeing approved if certain clinical and blood test criteria were met. Aretrospective analytical study comparing the incidence of postoperative intra-abdominal abscess (IAA) and surgical site infection (SSI) inpatients under 14 years of age to whom the new guideline was applied(Group A) vs. the historical cohort (Group B, treated with gentamicinmetronidazole for 5 days) was carried out. A prospective cohort study toassess which antibiotic therapy (amoxicillin-clavulanic acid or cefuroxime-metronidazole) proved more effective in patients meeting earlydischarge criteria was also conducted.Results: 205 patients under 14 years of age were included in GroupA, whereas 109 patients were included in Group B. IAA was presentin 14.3% of patients from Group A vs. 13.8% from Group B (p=0.83),while SSI was present in 1.9% of patients from Group A vs. 8.25%from Group B (p=0.008). Early discharge criteria were met by 62.7%of patients from Group A. Median hospital stay decreased from 6 to 3days. At discharge, 57% of patients received amoxicillin-clavulanic acid,whereas 43% received cefuroxime-metronidazole, with no differencesbeing found in terms of SSI (p=0.24) or IAA (p=0.12). Conclusions: Early discharge reduces hospital stay without increas-ing the risk of postoperative infectious complications. Amoxicillin-clavulanic acid is a safe option for at-home oral antibiotic therapy.(AU)

Anomalías pulmonares congénitas y de la pared torácica / Congenital lung and chest wall malformations

El propósito de este artículo es evaluar las lesiones congénitas pulmonares y de la pared torácica que se pueden detectar desde la etapa fetal hasta alcanzar el desarrollo adulto. Nos hemos centrado en las patologías más prevalentes en ambos campos: malformaciones pulmonares congénitas aéreas (MPCA), secuestro broncopulmonar, enfisema lobar congénito, atresia bronquial y quiste broncogénico, en cuanto a las lesiones de parénquima pulmonar, y pectus excavatum, pectus carinatum, pectus arcuatum y síndrome de poland en el grupo de lesiones de pared torácica. Hemos evitado las descripciones casuísticas y las prolijas explicaciones quirúrgicas para centrarnos en la clínica y en el manejo inicial de estas malformaciones

The aim of this study was to evaluate congenital lung lesions and chest-wall deformities that can be diagnosed from the fetal period until the adulthood. We focused on the most prevalent lesions of each group: Congenital pulmonary airway Malformation (CpaM), Bronchopulmonary Sequestration, Congenital lobar emphysema, Bronchial atresia and Bronchogenic Cyst regarding to parenchymal lesions and pectus excavatum, Carinatum and poland's Syndrome in the group of wall defects. We tried to avoid series description or surgical details in order to highlight clinical issues and management decisions

Trastornos de la motilidad digestiva. Estreñimiento / Gastrointestinal motility disorders. Constipation

Bajo la denominación de trastornos de la motilidad digestiva, queremos englobar a todo proceso capaz de alterar, de forma aguda o crónica, el tránsito intestinal normal, cursando por ello con un síndrome aparentemente obstructivo, más o menos evidente. los trastornos de la motilidad digestiva son muy comunes en la población pediátrica, y su etiología puede ser muy variada, incluyendo multitud de patologías y trastornos funcionales. a lo largo de este capítulo nos centraremos en aquellas entidades en las que el cirujano pediátrico suele participar con mayor frecuencia. incluiremos también el estreñimiento crónico funcional, por ser causa frecuente de consulta en nuestro ámbito. excluiremos, por tanto, todos los trastornos de causa médica y de causa obstructiva mecánica, tanto congénitos como adquiridos, por considerar que deberían ser tratados en un tema aparte

Under the name of digestive motility disorders, we want to encompass any process capable of altering the normal intestinal transit, in an acute or chronic way, carrying on with an apparently obstructive syndrome, more or less evident. digestive motility disorders are very common in the pediatric population, and their etiology can be very varied, including a multitude of pathologies and functional disorders. throughout this chapter we will focus on those entities in which the pediatric surgeon usually participate. We will also include chronic functional constipation, as it is a frequent cause of consultation in our area. We will therefore exclude all medical cause disorders and mechanical obstructive causes, both congenital and acquired, considering that they should be treated in a separate topic

¿Estenosis hipertrófica de píloro o adenomioma pilórico? Diagnóstico diferencial de obstrucción gástrica en niños / Infantile hypertrofic pyloric stenosis or gastric adenomyoma? Differential diagnosis of gastric outlet obstruction in children

Introducción. El adenomioma gastrointestinal es una tumoración benigna rara cuya localización más frecuente es gástrica. Su diagnóstico diferencial es amplio debido a su gran espectro clínico y baja especificidad radiológica. La escisión quirúrgica es diagnóstico-terapeútica. Caso clínico. Niña de 49 días que presenta vómitos no biliosos de 48 horas de evolución. Ante sospecha de estenosis hipertrófica de píloro se solicita ecografía que muestra lesión nodular no obstructiva en pared anterior del píloro. Se realiza RM sugestiva de tumor miofibroblástico. Se procede a laparotomía y resección completa de tumoración pilórica, informada histológicamente como adenomioma gástrico. Comentarios. El adenomioma pilórico produce clínica obstructiva y se confunde con entidades comunes como la estenosis hipertrófica de píloro o la duplicación quística. En un niño con síntomas digestivos e imagen radiológica de invaginación o duplicación, debemos tener en cuenta esta patología. La resección quirúrgica es de elección para un diagnóstico certero y para evitar una posible degeneración maligna

Purpose. Gastrointestinal adenomyoma is a rare benign tumor most frequently located in the stomach. The differential diagnosis is wide because of its large clinical spectrum and unspecific radiological findings. Surgical excision is both diagnostic and therapeutic. Case report. A 49-days old girl presented with nonbilious vomiting of 48 hours of evolution. Infantile hypertrofic pyloric stenosis was suspected. Ultrasound showed a nonobstructive nodular lesion in the anterior pyloric wall. MRI suggested a myofibroblastic tumor. We proceeded to laparotomy and complete resection of the pyloric tumor. Histologic diagnosis was gastric adenomyoma. Conclusions. Pyloric adenomyoma causes obstructive symptoms similar to other common entities such as hypertrophic pyloric stenosis or cystic duplication. We have to consider this condition in children with digestive symptoms and radiological images of intussusceptions or duplication. Surgical excision is recommended to reach a definitive diagnosis and to avoid a possible malignant degeneration

[Infantile hypertrofic pyloric stenosis or gastric adenomyoma? Differential diagnosis of gastric outlet obstruction in children]. / ¿Estenosis hipertrófica de píloro o adenomioma pilórico? Diagnóstico diferencial de obstrucción gástrica en niños.

PURPOSE: Gastrointestinal adenomyoma is a rare benign tumor most frequently located in the stomach. The differential diagnosis is wide because of its large clinical spectrum and unspecific radiological findings. Surgical excision is both diagnostic and therapeutic. CASE REPORT: A 49-days old girl presented with nonbilious vomiting of 48 hours of evolution. Infantile hypertrofic pyloric stenosis was suspected. Ultrasound showed a nonobstructive nodular lesion in the anterior pyloric wall. MRI suggested a myofibroblastic tumor. We proceeded to laparotomy and complete resection of the pyloric tumor. Histologic diagnosis was gastric adenomyoma. CONCLUSIONS: Pyloric adenomyoma causes obstructive symptoms similar to other common entities such as hypertrophic pyloric stenosis or cystic duplication. We have to consider this condition in children with digestive symptoms and radiological images of intussusceptions or duplication. Surgical excision is recommended to reach a definitive diagnosis and to avoid a possible malignant degeneration.

INTRODUCCION: El adenomioma gastrointestinal es una tumoración benigna rara cuya localización más frecuente es gástrica. Su diagnóstico diferencial es amplio debido a su gran espectro clínico y baja especificidad radiológica. La escisión quirúrgica es diagnóstico-terapeútica. CASO CLINICO: Niña de 49 días que presenta vómitos no biliosos de 48 horas de evolución. Ante sospecha de estenosis hipertrófica de píloro se solicita ecografía que muestra lesión nodular no obstructiva en pared anterior del píloro. Se realiza RM sugestiva de tumor miofibroblástico. Se procede a laparotomía y resección completa de tumoración pilórica, informada histológicamente como adenomioma gástrico. COMENTARIOS: El adenomioma pilórico produce clínica obstructiva y se confunde con entidades comunes como la estenosis hipertrófica de píloro o la duplicación quística. En un niño con síntomas digestivos e imagen radiológica de invaginación o duplicación, debemos tener en cuenta esta patología. La resección quirúrgica es de elección para un diagnóstico certero y para evitar una posible degeneración maligna.

Acumulación de neonatos con malformación anorrectal en 2011. ¿Solo azar? / Increase of newborns with anorectal malformation in 2011. Is it just by chance?

Introducción. Durante 2011 hemos diagnosticado 9 pacientes con malformaciones anorrectales (MAR). Esto supone 13.3 casos/10.000 RN vivos, frente a la incidencia estimada de 2 casos/10.000 RN vivos. Esta acumulación de MAR puede no ser debida al azar, por lo que hemos decidido su investigación. Pacientes y Métodos. Incluimos en el estudio todos los pacientes con MAR nacidos en el 2011. En todos ellos analizamos: su área geográfica, edad y estado de salud de los padres, gestación, exposición ateratógenos (especialmente, ingesta de lorazepan), sexo, edad gestacional, peso al nacimiento, exploración abdominal y del periné, defectos congénitos asociados, estudios por imagen realizados, tratamiento y situación actual. Resultados. Todos los pacientes proceden de nuestra provincia, yla edad materna es menor de 20 años en 2, o mayor de 30 en 7; existe predominio de varones (8/1) y MAR de localización baja en 4 de los9 pacientes. El 100% de los RN presentan algún tipo de malformación asociada en los genitales, en el sistema urinario o costovertebrales. La valoración clínica y el estudio por imagen proporcionaron el diagnóstico correcto en todos los casos. Hay que destacar la ausencia de dificultades en el tratamiento quirúrgico y la evolución clínica satisfactoria en todos los niños. Conclusiones. A la acumulación de casos con MAR se suman el predominio en varones así como la alta incidencia de malformaciones asociadas y de MAR de localización alta. No hemos encontrado una explicación epidemiológica a esta concentración de pacientes con MAR. Esto nos obliga a continuar con nuestra investigación por si se detecta alguna causa, de momento no conocida (AU)

Objective. In 2011 we have diagnosed 9 anorectal malformations(MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not bedue to chance, so we have decided to focus on its research. Material and Methods. The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposureto teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. Results. All patients came from our province, and maternal age is under 20 years in (..) (AU)

[Increase of newborns with anorectal malformation in 2011. Is it just by chance?]. / Acumulación de neonatos con malformación anorrectal en 2011. Solo azar?

OBJECTIVE: In 2011 we have diagnosed 9 anorectal malformations (MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not be due to chance, so we have decided to focus on its research. MATERIAL AND METHODS: The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposure to teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. RESULTS: All patients came from our province, and maternal age is under 20 years in 2 patientes and older than 30 in 7; male-dominated (8/1); low forms in 4 of 9 patients. 100% of newborns have some type of associated malformation, in genitals, urinary system or costovertebral. Clinical assessment and imaging study provided the right diagnosis in all the cases. It must be noted the absence of difficulties in the surgery treatment and a favorable outcome in all children. CONCLUSIONS: To this accumulation of cases with anorrectal malformation cases it is added a male predominanced, and a high incidence of associatedmalformations and high defects. We have not found an epidemiological explanation for this concentration of patients with anorrectal malformations. This forces us to continue our investigation if detected for some reason, currently not known.

[Gastroesophageal reflux disease. Evaluation and indication for surgical treatment by esophageal phmetry]. / Enfermedad por reflujo gastroesofágico, Valoración e indicación de tratamiento quirúrgico mediante pHmetría esofágica.

INTRODUCTION: Oesophageal pH monitoring is considered the best procedure to assess the severity of gastroesophageal reflux disease (GERD), conditioning its treatment. The indication for surgery is becoming less common. We intend to meet this test to what extent it has influenced. MATERIAL AND METHODS: We recruit patients treated in our Centre since the introduction of pH monitoring. We compare the number of times before and after its use. We value clinical manifestations, usual pH metric values versus non-operated patients with pathological test, associated pathology. SAMPLE: 91 patients, 151 pH metric studies (98 preoperative). Number of interventions prior to introduction of pH monitoring: 20/year, post: 3.79/year. SYMPTOMS: gastrointestinal 60.2%, respiratory 10.2%, mixed 24.5%. 495 non-operated patients, 692 pathological studies. PH metric values operated/not operated: No. reflux 116.91 +/- 125.46/101.69 +/- 83.39 (p < 0.001), No. reflux >5 minutes 8.49 +/- 8.28/4.43 +/- 4.85 (p = 0.001), longest reflux 60.21 +/- 95.93/31.16 +/- 80.09 (p < 0.001), clearance 1.27 +/- 1.44/0.86 +/- 1.05 (p = 0.04), DeMeester 52.74 +/- 56.21/29.49 +/- 23.57 (p < 0.001). 14 of 98 preoperative pH monitoring were normal. Associated pathology operated/not operated: 13.26%/ 7.47%. CONCLUSIONS: The pH metric control of patients with GERD and the progress of medical treatment have led to a decrease in surgical procedures. In our experience, the intensity of GERD is a valuable parameter in deciding on the surgery. We attach particular value parameters measuring oesophageal clearance and indices that integrate several of them. However, in some patients without pathological pH monitoring, we have indicated the operation. The prevalence of associated pathology in the operated makes us value them more demanding.

Síndrome del colon izquierdo pequeño: Revisión de nuestra experiencia / No disponible

Objetivo. El objeto es presentar nuestra experiencia con el síndrome de colon izquierdo pequeño (SCIP) e investigar la utilidad de lamanometría anorrectal en el estudio de estos pacientes. Material y métodos. Se realiza una revisión de las historias clínicas de 10 pacientes tratados en nuestro Hospital por SCIP. Se valoran: sexo, antecedentes maternos, tipo de parto, edad gestacional, peso al nacimiento, manifestaciones clínicas, expulsión de meconio, enema con gastrografín, manometría anorrectal y tipo de tratamiento (Nursing, días de reposo digestivo, duración nutrición parenteral) y tiempo de hospitalización. Resultados. De los 10 pacientes, 5 son hombres; 2 son gemelos afectos y otro gemelo afecto presenta un hermano gemelo sano; 6 son hijos de madre diabética. Edad gestacional: 36,6 ± 2,11 semanas. Peso:3.001 ± 689,72 g. Anomalías asociadas en 2: fetopatía diabética, hemivértebrasD11-L2. Todos presentan distensión abdominal y vómitos a las48,73 ± 45,39 horas de vida. Sólo 2 expulsan meconio en las primeras 24horas. Los enemas con gastrografín muestran hallazgos típicos de este síndrome en todos los casos. La manometría anorrectal se realiza en 8 (..) (AU)

Objective. The object is to present our experience with the small lleft colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. Material and methods. This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografín, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition).Results. During the study period, 10 patient were identifi ed (5are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes (..) (AU)

Testículo no palpable: laparoscopia o inguinotomía / Nonpalpable testes: laparoscopy for inguinotomy

Introducción. El testículo no palpable hace referencia a la imposibilidad de objetivar el teste mediante maniobras exploratorias. Estos pacientes se han beneficiado del abordaje laparoscópico ya que anteriormente podían requerir incluso una laparotomía. El tratamiento definitivo del teste no palpable depende de los hallazgos laparoscópicos, estando en controversial a resolución en uno o en dos tiempos. El objetivo de este estudio es valorarla incidencia y los resultados tras la aplicación de la laparoscopia para el tratamiento del teste no palpable en nuestro Servicio. Pacientes y métodos. Se recogen los casos de testículo no palpable entre 2000-2009. Se analizan la edad de intervención, la lateralidad, los hallazgos operatorios, el tratamiento realizado y el tamaño de los (..) (AU)

Introduction. The nonpalpable testis refers to the inability to make objective the teste through exploratory maneuvers. These patients have benefited from the laparoscopic approach that previously they could require even a laparotomy. Definitive treatment of nonpalpable testis depends on the laparoscopic findings, being in dispute their resolution in one or two stages. The aim of this (..) (AU)

Enfermedad por reflujo gastroesofágico. Valoración e indicación de tratamiento quirúrgicomediante pHmetría esofágica / Gastroesophageal reflux disease. Evaluation and indication for surgical treatment by esophageal phmetry

Introducción. La pHmetría esofágica es considerada el mejor procedimiento para valorar la intensidad del reflujo gastroesofágico (RGE),condicionando su tratamiento. La indicación quirúrgica es cada vez menos frecuente. Nos proponemos conocer en qué medida esta prueba ha influido en ello. Material y métodos. Reclutamos los pacientes intervenidos en nuestro Centro desde la introducción de la pHmetría. Comparamos número de intervenciones antes y después de su utilización. Valoramos manifestaciones clínicas, valores pHmétricos habituales frente a no intervenidos patológicos, patología asociada. Resultados. Muestra: 91 pacientes, 151 estudios pHmétricos (98prequirúrgicos). Número de intervenciones previas a introducción de pHmetría: 20/año, posteriores: 3,79/año. Sintomatología: digestiva (..) (AU)

Introduction. Oesophageal pH monitoring is considered the best procedure to assess the severity of gastroesophageal reflux disease(GERD), conditioning its treatment. The indication for surgery is be comingless common. We intend to meet this test to what extent it has influenced. Material and methods. We recruit patients treated in our Centre since the introduction of pH monitoring. We compare the number oftimes before and after its use. We value clinical manifestations, usual (..) (AU)

[Small left colon syndrome: a review of our experience]. / Síndrome del colon izquierdo pequeño: revisión de nuestra experiencia.

OBJECTIVE: The object is to present our experience with the small left colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. MATERIAL AND METHODS: This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografin, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition). RESULTS: During the study period, 10 patient were identified (5 are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes was identified in 6 patients. The mean gestational age was 36.6 + 2.11 weeks, and the weight 3001 +/- 689.72 g. 2 patient presented anomalies associated: fetopatía diabetic, hemivértebras D11-L2. All 10 infants presented abdominal distention and vomiting at 48.73 +/- 45.39 hours of life. Only 2 presented meconium passage in the first 24 hours. The contrast enema with gastrografin performed show typical findings of this syndrome in all cases. The anorrectal manometry carries out in 8 patients and demonstrates presence of the recto-anal inhibitory reflex (RAIR) in 5 and absence in 3. In these 3 patients with no RAIR, the study was repeated weekly until the presence being observed (normally between 2a and 3a week of life). In 1 newborn was necessary colostomy; the suction rectal biopsy showed immaturity of ganglionars cells and the manometric control previously at the close of the colostomy (9 months) showed presence of the RAIR. Conservative treatment (nursing and digestive rest) was successful in all cases with a mean of duration the 6.40 +/- 5.10 days. 6 patient needed parenteral nutrition during 7.30 +/- 8.49 days. The mean of discharge was 17.78 +/- 13.28 days. The clinical development was favourable in all the cases. CONCLUSIONS: The contrast enema with gastrografin is diagnostic and therapeutic and together with the nursing, has allowed solve the distal intestinal obstruction in 9 cases (90%). In the newborns with absence of RIAR, the anomanometric controls have allowed to know the moment of the maturation of the anorectal function.

[Nonpalpable testes: laparoscopy for inguinotomy]. / Testículo no palpable: laparoscopia o inguinotomía.

INTRODUCTION: The nonpalpable testis refers to the inability to make objective the teste through exploratory maneuvers. These patients have benefited from the laparoscopic approach that previously they could require even a laparotomy. Definitive treatment of nonpalpable testis depends on the laparoscopic findings, being in dispute their resolution in one or two stages. The aim of this study is to assess the incidence and the results after the application of laparoscopy for the treatment of nonpalpable testis in our department. PATIENTS AND METHODS: All the cases of nonpalpable testis between 2000-2009 are selected. The age of intervention, laterality, operative findings, treatment performed and the size of the testes in cases operated in two stages are analized. RESULTS: Fifty-eight children are reviewed with a total of 60 testis. Thirty-one cases are left (53.4%), 25 are rights (43.1%) and 2 are bilateral (3.5%). In 32 children the testis is absent or atrophic, in 10 the Fowler-Stephens technique is developed, 8 gonads are next to the internal inguinal ring, 5 are in the inguinal canal and 2 is so high and so hipoplasic that orchiectomy is decided. Of those operated in 2 stages, 9 testes survive after the first time and 7 of them have a normal size 6 months after the second surgery. CONCLUSIONS: Laparoscopy is an effective method for diagnosis and treatment of non palpable testis, however, there is still no consensus, for certain locations, to descend the testicle in 1 or 2 stages and if the way is by laparoscopy or inguinotomy.

[The fetal ultrasonography in the second quarter: interest for the pediatric surgeon]. / La ecografía fetal en el segundo trimestre: interés para el cirujano pediatra.

INTRODUCTION: The paediatric surgeon should know the details of prenatal ultrasound diagnosis to participate in advising parents about the continuation of the pregnancy, and to plan the prenatal and postnatal treatment. Our objectives are: to determine the incidence of congenital anomalies detected with ultrasound in the 2nd trimester, the number of these diagnoses which is confirmed at birth and what is the usefulness of this test when advising parents. PATIENTS AND METHODS: We reviewed the prenatal ultrasound in 2nd trimester reports made from January 2005 to July 2009. We note the ultrasound findings, the maternal and gestational age. The evolution of anomalies of the fetuses and the number of spontaneous and volunteers abortions are noted. Finally, the diagnoses are checked in the newborns. RESULTS: 10,256 ultrasonographies are made in this period. 209 stories of pregnant women (2%), which present fetal pathology amenable to general surgical treatment, are accessible for study. These include: 182 urologic disorders (85.44%), 13 digestive disorders (6.1%), 6 thoracic disorders (2.8%), 6 multiple malformations (2.8%), 4 maxillofacial disorders (1.88%) a sacrococcygeal teratoma (0.47%), an umbilical cord cyst (0.47%), 7 pregnancies are spontaneous abortion and 7 are terminated voluntarily. 183 stories of newborns are reviewed, we can confirm 48 uropathies (26.37%), 4 digestive malformations (30.77%), 4 thoracic disorders (66.66%), 2 maxillofacial disorders (50%) and 1 teratoma. CONCLUSIONS: Ultrasonography in the 2nd trimester detects almost 2% of specific fetal malformations. False positives are common in all diagnostic groups. The number of abortions and the terminations of pregnancy is low, most of them are polymalformated fetuses. We believe that ultrasonography in the 20th week have low value to counsel the termination of pregnancy, because only 7 of the 160 terminations indicated in our hospital during the study period, correspond to fetuses with pathology detected in the 2nd trimester. We recognize the usefulness of this test but, the false positive and favorable developments in a high percentage of fetuses, make us to be cautious to advise the continuation of pregnancy and the indication of treatment.