Occupational exposure to endocrine-disrupting chemicals and other parental risk factors in hypospadias and cryptorchidism development: a case-control study.

AIM OF THE STUDY: Endocrine-disrupting chemicals (EDCs) are exogenous agents that are capable of altering the endocrine system functions, including the regulation of developmental processes. The aim of this study was to investigate the association between EDC exposure and other parental factors in the etiology of hypospadias and cryptorchidism. METHODS: A case-control study was conducted. Cases (n = 210) were infants aged between 6 months and 14 years diagnosed with hypospadias or cryptorchidism who attended the authors' hospital over a period of 18 months, and controls (n = 210) were infants within the same range of age and without any urological disorders who attended the outpatient clinic of the same hospital during the same time period. Their selection was independent of exposures. Data on parental occupational exposure to EDCs and other sociodemographic variables were collected through face-to-face interviews and systematically for both cases and controls. Crude and adjusted odds ratios (ORs) were estimated to control for confounding with their 95% confidence interval (CI) by means of logistic regressions. Specifically, three final models of a dichotomous outcome were constructed: one for cryptorchidism, one for hypospadias, and the third considering both malformations together. The Hosmer-Lemeshow test was used to assess the goodness of fit of the models. Their discriminatory accuracy (DA) was ascertained by estimating their areas under the receiver operating characteristic curves area under the curve (AUC) along with their 95% CI. RESULTS: Associations were found between advanced maternal age (OR adjusted = 1.82; 95% CI: 1.14-2.92), mother's consumption of anti-abortives (OR = 5.40; 95% CI: 1.40-38.5) and other drugs (OR = 2.02; 95% CI: 1.31-3.16) during pregnancy, maternal and paternal occupational exposure to EDCs (OR = 4.08; 95% CI: 2.03-8.96 and OR = 3.90; 95% CI: 2.41-6.48, respectively), fathers smoking (OR = 2.0; 95% CI: 1.33-2.99), and fathers with urological disorders (OR = 2.31; 95% CI: 1.15-4.90). Maternal and paternal high educational level could be protective of cryptorchidism (OR = 0.47; 95% CI: 0.28-0.76 and OR = 0.63; 95% CI: 0.42-0.93, respectively). The DA of the models for the whole sample (AUC = 0.75; 95% CI: 0.70-0.79) for cryptorchidism (AUC = 0.76; 95% CI: 0.71-0.82) and for hypospadias (AUC = 0.75; 95% CI: 0.69-0.81) was moderately high. CONCLUSIONS: Advanced age, some parental occupational exposure to EDCs, some drug consumption, smoking, and the father's history of urological disorders may increase risk and predict the developments of these malformations. Studies with higher samples sizes are needed to assess associations between individual EDC occupational exposures and drugs and these malformations.

Exposición a disruptores endocrinos y otros factores paternos en la etiología del hipospadias y la criptorquidia / Endocrine disrupting chemicals exposure and other parental factors in hypospadias and cryptorchidism etiology

Objetivos. Investigar la asociación entre la exposición a disruptores endocrinos (DE) y otros factores en el desarrollo del hipospadias y la criptorquidia. Material y métodos. Estudio de casos y controles. Consideramos como casos a los niños de entre 6 meses y 6 años de edad diagnosticados de hipospadias y/o criptorquidia que acudieron a las consultas de Urología/Cirugía durante un período de estudio de 6 meses y como controles, a los niños con mismo rango de edad que acudieron a las mismas consultas con otros diagnósticos. Recogimos las variables de interés mediante una encuesta epidemiológica y comparamos los resultados obtenidos en cada grupo mediante tests estadísticos paramétricos. Resultados. Estudiamos 180 pacientes, 90 casos (45 hipospadias/45 criptorquidias) y 90 controles, con edad media de 2,60 ± 1,72 años [rango 0,5-6]. Las medias de edad gestacional y peso al nacer fueron menores en el grupo-caso sin objetivarse diferencias significativas. La edad media materna fue significativamente mayor en el grupo-caso (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Encontramos asociación significativa entre la exposición ocupacional materna a DE (ftalatos principalmente) y el grupo-caso siendo la Odds ratio (OR) de 3,67 (IC 95%: 1,28-10,51; p= 0,018) y también en la paterna (principalmente a pesticidas/herbicidas) con OR= 6,65 (IC 95%: 2,60-17,02; p= 0,001). Encontramos asociación significativa entre el consumo de tabaco y alcohol paternos y el grupo-caso: OR= 2,08 (IC 95%: 1,11-3,87; p= 0,029) y OR= 2,50 (IC 95%: 1,36-4,57; p= 0,003) respectivamente. Conclusiones. Este estudio supone una pequeña aportación respecto a los posibles factores etiológicos del hipospadias y la criptorquidia, y demuestra la necesidad de estudios ulteriores con mayor potencia estadística para aumentar la evidencia científica de nuestros hallazgos

Aim of the study. To investigate the association between endocrine disrupting chemicals (EDC) exposure and other paternal factors in the etiology of hipospadias and cryptorchidism. Methods. A case-control study. Cases were infants between 0 and 6 years of age diagnosed with hypospadias or cryptorchidism in our pediatric urology and general pediatric surgery services during a period of 6 months, and controls were infants with the same range of age attending the same services without any urological problem. Several variables were collected by face-to-face interviews with both parents. After data abstraction, we compared the characteristics of both groups using parametric statistical tests. Main results. A total of 180 patients were studied, 90 cases (45 hypospadias/45 cryptorchidism) and 90 controls with a mean age of 2,37 ± 1.50 years [range 0,5-6]. Median of mother´s age was significantly greater in case group (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Significant differences were observed between cases and controls in regard to maternal occupational exposure to EDC (mainly phthalates), adjusted Odds ratio (OR) was 3.67 [95% confidence interval (CI): 1.28- 10.51; p= 0,018] and regarding the paternal occupational exposure to EDC (mainly pesticides and herbicides), adjusted OR was 6.65 [95% CI: 2.60-17.02; p= 0,001]. Increased risk was also observed in smoking fathers and fathers who drink alcohol, adjusted Odds ratio were 2.36 [95% CI: 1.11-3.87; p= 0,029] and 2.50 [95% CI: 1.36-4.57; p= 0,003] respectively. Conclusions. This study represents a little contribution to the possible etiologic factors of hypospadias and cryptorchidism, further studies with higher statistical power would be needed to prove it

Eficacia de la pieloplastia asistida por retroperitoneoscopia versus a la realizada por minilumbotomía posterior / Efficacy of the retroperitoneal-assisted laparoscopic pyeloplasty versus the mini posterior lumbotomy approach

Objetivo. Evaluar la pieloplastia asistida por retroperitoneoscopia, exteriorizando la unión pieloureteral (PAR) versus la pieloplastia por minilumbotomía posterior en ángulo costovertebral (PMLP). Material y Métodos. Estudio retrospectivo de 77 pacientes diagnosticados de estenosis pieloureteral (2007-2013), se analizaron técnica, complicaciones y resultados, mediante la valoración del diámetro anteroposterior de la pelvis renal, grosor del parénquima renal, función renal y morfología de la curva del renograma. Resultados. Realizamos 50 PAR y 21 PMLP. Edad mediana de intervención: 10,85 meses [rango intercuartílico (IC) 86,8] en PAR y 23,3 meses (rango IC 54,7) en PMLP. No hubo diferencias significativas en tiempo quirúrgico. Se dejó doble J en 90% de las PAR y en 52,4% de las PMLP. La incisión fue 1,5 cm en la PAR y 3,0 cm de mediana (rango IC 1,0) en la PMLP (p0,05). El seguimiento mediante ecografía en una media de 68,04 meses de edad (rango 7,5-186,5) y renograma diurético en una media de 50,25 meses de edad (rango 6,6-173,8), evidenciaron mejora en los parámetros arriba señalados en ambos grupos de pacientes, sin diferencias significativas. Conclusiones. En nuestra serie, la PAR es un abordaje con un índice de complicaciones mayor al esperado. Por otra parte, la PMLP es un abordaje seguro y con resultados estéticos y funcionales adecuados

Objective. To evaluate the results of the retroperitoneal-assisted laparoscopic pyeloplasty (RALP) versus the mini posterior lumbotomy pyeloplasty (MPLP). Material and Methods. A retrospective study of 77 patients diagnosed with ureteropelvic junction obstruction between 2007 and 2013 was made, analyzing the surgical technique, complications and results. The anteroposterior pelvic diameter of the kidney, the thickness of the renal parenchyma, the renal function and the morphology of the renogram curve were also evaluated and compared. Results. We performed 50 RALP and 21 MPLP. Median age of intervention: 10.85 moths (ICR 86.8) in RALP and 23.30 moths (ICR 54.7) in MPLP. No significant differences were found in surgical time (p>0.05). Double J was left in 90% of the RALP and 52.4% of the MPLP. Median length of incision was 1.5 cm of the RALP and 3.0 cm in MPLP (p>0,05). The follow-up was performed using ultrasound in an average of 68,04 months of age (range 7.5-186.5) and diuretic renogram in an average of 50,25 months of age (range 6,6-173,8). The above parameters showed improvements in both groups of patients without significant differences. Conclusions. In our experience, the RALP is a technique with a greater rate of complications than the expected. Moreover, the MPLP, is a technique we consider safe and with adequate aesthetic and functional results

Valoración clínica de la incontinencia fecal en pacientes intervenidos de malformación anorrectal / Clinical assessment of fecal incontinence in patients with anorectal malformation surgery

Objetivos. Aportar nuestra experiencia en el manejo de las malformaciones anorrectales (MAR) y comparar dos escalas cuantitativas para la valoración clínica de la incontinencia fecal. Material y métodos. Revisamos los pacientes intervenidos de MAR con edades comprendidas entre los 3 y 15 años. Recogimos una serie de variables y evaluamos la incontinencia fecal mediante dos escalas: la de Holschneider y una utilizada previamente en nuestro Servicio, cuyos ítems se completaron mediante entrevista clínica. Resultados. Estudiamos 48 pacientes, 29 niños y 19 niñas. El 81% presentaba factores de buen pronóstico (grupo A) y el 19% de mal pronóstico (grupo B) según la clasificación de Peña. El tratamiento realizado fue la anorrectoplastia sagital posterior (ARPSP) en 32 pacientes, ARPSP más descenso vía abdominal en 3, descenso abdominal en 2 y anoplastia tipo "Cut-Back" en 14. No existieron diferencias significativas en la edad media de continencia (3,41 ± 1,80 años en grupo A vs 3,92 ± 1,07 en grupo B; p= 0,35). No encontramos diferencias significativas en la media de puntuación de incontinencia utilizando nuestra escala (17,57/20 en grupo A vs 14/20 en grupo B; p= 0,05), pero fue significativamente menor en el grupo B utilizando la de Holschneider (12,39/14 en grupo A vs 10,43/14 en grupo B; p= 0,04). En 16 pacientes se detectó estreñimiento; de ellos, la mitad presentó pérdidas por rebosamiento. Conclusiones. Nuestra escala penaliza el estreñimiento, por este motivo la puntuación media del grupo A fue menor y no se encontraron diferencias respecto al grupo B, contrariamente a lo ocurrido con la escala de Holschneider, por lo que podría resultar más precisa para valorar la incontinencia fecal de estos pacientes

Background/purpose. To review our management of anorectal malformations (ARM) and to compare two quantitative scales for clinical assessment of fecal incontinence. Material and methods. We reviewed all patients with ARM surgery who are currently 3 to 15 years old. Several variables were collected and fecal incontinence was evaluated using two scales: the Holschneider scale and one used previously in our Service, both were filled out through clinical interview. Results. 48 patients were studied, 29 males and 19 females. According to the Peña’s classification, 81% had good prognosis indicators (group A) and 19% had bad prognosis indicators (group B). Posterior sagittal anorectoplasty (PSARP) was performed in 32 patients, PSARP and abdominal approach in 3, abdomino-perineal pullthrough in 2, and a "Cut-back" anoplasty in 14 patients. There were not statistical significative differences in average age of continence between both groups. We found no significative differences on the average score of fecal incontinence between both groups using our scale (17.57/20 in group A vs 14/20 in group B; p= 0.05) but it was significantly lower in group B using the Holschneider scale (12.39/14 in group A vs 10.43/14; p= 0.04). Constipation was detected in 16 patients, half of whom had overflow pseudoincontinence. Conclusions. Our scale penalizes constipation, for this reason the average score of group A was lower and we didn’t find differences with respect to group B, contrary to what it happened using Holschneider’s scale, so we believe our scale could be more precise to evaluate fecal incontinence of these patients

[Clinical assessment of fecal incontinence in patients with anorectal malformation surgery]. / Valoración clínica de la incontinencia fecal en pacientes intervenidos de malformación anorrectal.

BACKGROUND/PURPOSE: To review our management of anorectal malformations (ARM) and to compare two quantitative scales for clinical assessment of fecal incontinence. MATERIAL AND METHODS: We reviewed all patients with ARM surgery who are currently 3 to 15 years old. Several variables were collected and fecal incontinence was evaluated using two scales: the Holschneider scale and one used previously in our Service, both were filled out through clinical interview. RESULTS: 48 patients were studied, 29 males and 19 females. According to the Peña's classification, 81% had good prognosis indicators (group A) and 19% had bad prognosis indicators (group B). Posterior sagittal anorectoplasty (PSARP) was performed in 32 patients, PSARP and abdominal approach in 3, abdomino-perineal pullthrough in 2, and a "Cut-back" anoplasty in 14 patients. There were not statistical significative differences in average age of continence between both groups. We found no significative differences on the average score of fecal incontinence between both groups using our scale (17.57/20 in group A vs 14/20 in group B; p= 0.05) but it was significantly lower in group B using the Holschneider scale (12.39/14 in group A vs 10.43/14; p= 0.04). Constipation was detected in 16 patients, half of whom had overflow pseudoincontinence. CONCLUSIONS: Our scale penalizes constipation, for this reason the average score of group A was lower and we didn't find differences with respect to group B, contrary to what it happened using Holschneider's scale, so we believe our scale could be more precise to evaluate fecal incontinence of these patients.

OBJETIVOS: Aportar nuestra experiencia en el manejo de las malformaciones anorrectales (MAR) y comparar dos escalas cuantitativas para la valoración clínica de la incontinencia fecal. MATERIAL Y METODOS: Revisamos los pacientes intervenidos de MAR con edades comprendidas entre los 3 y 15 años. Recogimos una serie de variables y evaluamos la incontinencia fecal mediante dos escalas: la de Holschneider y una utilizada previamente en nuestro Servicio, cuyos ítems se completaron mediante entrevista clínica. RESULTADOS: Estudiamos 48 pacientes, 29 niños y 19 niñas. El 81% presentaba factores de buen pronóstico (grupo A) y el 19% de mal pronóstico (grupo B) según la clasificación de Peña. El tratamiento realizado fue la anorrectoplastia sagital posterior (ARPSP) en 32 pacientes, ARPSP más descenso vía abdominal en 3, descenso abdominal en 2 y anoplastia tipo "Cut-Back" en 14. No existieron diferencias significativas en la edad media de continencia (3,41 ± 1,80 años en grupo A vs 3,92 ± 1,07 en grupo B; p= 0,35). No encontramos diferencias significativas en la media de puntuación de incontinencia utilizando nuestra escala (17,57/20 en grupo A vs 14/20 en grupo B; p= 0,05), pero fue significativamente menor en el grupo B utilizando la de Holschneider (12,39/14 en grupo A vs 10,43/14 en grupo B; p= 0,04). En 16 pacientes se detectó estreñimiento; de ellos, la mitad presentó pérdidas por rebosamiento. CONCLUSIONES: Nuestra escala penaliza el estreñimiento, por este motivo la puntuación media del grupo A fue menor y no se encontraron diferencias respecto al grupo B, contrariamente a lo ocurrido con la escala de Holschneider, por lo que podría resultar más precisa para valorar la incontinencia fecal de estos pacientes.

[Endocrine disrupting chemicals exposure and other parental factors in hypospadias and cryptorchidism etiology]. / Exposición a disruptores endocrinos y otros factores paternos en la etiología del hipospadias y la criptorquidia.

AIM OF THE STUDY: To investigate the association between endocrine disrupting chemicals (EDC) exposure and other paternal factors in the etiology of hipospadias and cryptorchidism. METHODS: A case-control study. Cases were infants between 0 and 6 years of age diagnosed with hypospadias or cryptorchidism in our pediatric urology and general pediatric surgery services during a period of 6 months, and controls were infants with the same range of age attending the same services without any urological problem. Several variables were collected by face-to-face interviews with both parents. After data abstraction, we compared the characteristics of both groups using parametric statistical tests. MAIN RESULTS: A total of 180 patients were studied, 90 cases (45 hypospadias/45 cryptorchidism) and 90 controls with a mean age of 2,37 ± 1.50 years [range 0,5-6]. Median of mother´s age was significantly greater in case group (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Significant differences were observed between cases and controls in regard to maternal occupational exposure to EDC (mainly phthalates), adjusted Odds ratio (OR) was 3.67 [95% confidence interval (CI): 1.28-10.51; p= 0,018] and regarding the paternal occupational exposure to EDC (mainly pesticides and herbicides), adjusted OR was 6.65 [95% CI: 2.60-17.02; p= 0,001]. Increased risk was also observed in smoking fathers and fathers who drink alcohol, adjusted Odds ratio were 2.36 [95% CI: 1.11. CONCLUSIONS: This study represents a little contribution to the possible etiologic factors of hypospadias and cryptorchidism, further studies with higher statistical power would be needed to prove it.

OBJETIVOS: Investigar la asociación entre la exposición a disruptores endocrinos (DE) y otros factores en el desarrollo del hipospadias y la criptorquidia. MATERIAL Y METODS: Estudio de casos y controles. Consideramos como casos a los niños de entre 6 meses y 6 años de edad diagnosticados de hipospadias y/o criptorquidia que acudieron a las consultas de Urología/Cirugía durante un período de estudio de 6 meses y como controles, a los niños con mismo rango de edad que acudieron a las mismas consultas con otros diagnósticos. Recogimos las variables de interés mediante una encuesta epidemiológica y comparamos los resultados obtenidos en cada grupo mediante tests estadísticos paramétricos. RESULTADOS: Estudiamos 180 pacientes, 90 casos (45 hipospadias/45 criptorquidias) y 90 controles, con edad media de 2,60 ± 1,72 años [rango 0,5-6]. Las medias de edad gestacional y peso al nacer fueron menores en el grupo-caso sin objetivarse diferencias significativas. La edad media materna fue significativamente mayor en el grupo-caso (34,40 ± 5,64 versus 31,74 ± 5,05; p= 0,001). Encontramos asociación significativa entre la exposición ocupacional materna a DE (ftalatos principalmente) y el grupo-caso siendo la Odds ratio (OR) de 3,67 (IC 95%: 1,28-10,51; p= 0,018) y también en la paterna (principalmente a pesticidas/herbicidas) con OR= 6,65 (IC 95%: 2,60-17,02; p= 0,001). Encontramos asociación significativa entre el consumo de tabaco y alcohol paternos y el grupo-caso: OR= 2,08 (IC 95%: 1,11-3,87; p= 0,029) y OR= 2,50 (IC 95%: 1,36-4,57; p= 0,003) respectivamente. CONCLUSIONES: Este estudio supone una pequeña aportación respecto a los posibles factores etiológicos del hipospadias y la criptorquidia, y demuestra la necesidad de estudios ulteriores con mayor potencia estadística para aumentar la evidencia científica de nuestros hallazgos.

Absceso del músculo obturador interno: presentación de 2 casos / Internus obturator muscle abscess: Presentation of 2 cases

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Tumor testicular neonatal / Neonatal testicular tumour

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[What can we do to improve our management of intestinal atresia?]. / ¿Qué podemos mejorar en el tratamiento de las atresias intestinales?

OBJECTIVE: To review our management of intestinal atresia (AI). MATERIAL AND METHODS: A retrospective review of patientes with AI, from 1995 to 2011. RESULTS: AI was identified in 41 patients, 29,2% had maternal polyhydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduodenostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunostomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel. CONCLUSIONS: Prenatal diagnosis of AI is difficult, especially AYI, which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It's important to keep in mind colorectal atresias, which can not be identified.

Sinus pericranii. Serie de 5 casos / Sinus pericranii. A series of 5 cases

El sinus pericranii es una malformación vascular rara en la cual existe una comunicación anormal entre el sistema venoso extracraneal y los senos venosos durales. La historia natural, en la mayoría de casos, es la de una anomalía vascular en línea media craneal desde la nariz hasta el occipucio, que aumenta progresivamente de tamaño. Las opciones terapéuticas son diversas: desde la observación de la lesión hasta la embolización del componente intracerebral o la exéresis completa tanto del componente extra como intracraneal. En todas estas circunstancias pueden producirse complicaciones potencialmente letales, como son la trombosis y la hemorragia cerebrales. Describimos nuestra experiencia en el manejo del sinus pericranii, destacando la importancia del abordaje terapéutico multidisciplinar de esta infrecuente entidad (AU)

Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the dural venous sinuses. The natural history in most cases consists of a purplish nodule in the frontal region that may gradually increase in size. Different treatment options can be chosen: from observation of the lesion, to endovascular embolization of intracerebral component or a complete resection of both anomalous components (extra- and intra-cranial) by surgery. In this context, potential life-threatening complications including thrombosis and cerebral hemorrhage can occur. Here we present our experience in management of sinus pericranii, and emphasize the importance of a multidisciplinary therapeutic approach of this uncommon entity (AU)

Ginecomastia puberal: comparación entre el abordaje periareolar inferior y el de doble anillo cutáneo / Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique

OBJETIVOS: El principal motivo de consulta e indicación de trata-miento quirúrgico en la ginecomastia puberal es la afectación psicológica que produce en el adolescente. El objetivo de este trabajo es describir nuestra experiencia en el tratamiento de esta patología, comparando los resultados obtenidos según el tipo de abordaje utilizado. MATERIAL Y MÉTODOS: En nuestro Servicio, el abordaje empleado para la mastectomía subtotal depende del grado de ginecomastia, utili-zándose la incisión periareolar inferior en los grados I-II y el doble anillo cutáneo en el tipo III según la clasificación de Simon. Hemos estudiado de forma descriptiva retrospectiva a los pacientes intervenidos de gine-comastia entre el 2007 y 2012. Comparamos los resultados obtenidos en cada grupo mediante tests estadísticos paramétricos. RESULTADOS: Se realizaron un total de 29 mastectomías en 15 pacientes. La edad media de intervención fue de 13,75 ± 1,06 años ([11-15] años). La forma de presentación en todos los casos fue el aumento progresivo de la glándula, sin síntomas asociados. En la mitad de los casos existía antecedente de obesidad o sobrepeso. Se realizó la técnica del doble anillo cutáneo en 5 casos (grupo-DAC) e incisión periareolar inferior en 10 (grupo-PIC). Se encontró una mayor incidencia de cicatrización patológica en el grupo-DAC, siendo esta diferencia estadísticamente significativa (p = 0,007). No se observa-ron recidivas tras un tiempo medio de seguimiento de 15,86 ± 19,47 meses ([3- 60] meses). CONCLUSIONES: Las dos técnicas estudiadas proporcionan resulta-dos satisfactorios a largo plazo. A pesar de haber detectado cicatrices hipertróficas y queloideas con la técnica del doble anillo, sigue siendo estéticamente ventajosa en las ginecomastias con exceso cutáneo

BACKGROUND/PURPOSE: The main reason to indicate the surgical treatment in pubertal gynecomastia is the psychological effect on the adolescent. The aim of this paper is to describe our experience in the surgical treatment of this condition, comparing the results obtained depending on the type of approach used. MATERIAL AND METHODS: In our department, the approach for the subtotal mastectomy depends mainly on the gynecomastia grade. We use an inferior periareolar incision in grades I and II, and a concentric circle technique in grade III of Simon's classification. A retrospective review was conducted to identify all adolescent patients that underwent to gynecomastia surgical treatment between 2007 and 2012. We compared the results obtained in each incision group by parametric statistical tests. RESULTS: A total of 29 mastectomies were performed in 15 patients. The mean age of surgery was 13.75 ± 1.06 years ([11-15] years). The presentation in all cases consisted in a progressive increase in size of the mammary gland, without associated symptoms. In half of patients there was a history of obesity or overweight. We performed the concentric circle technique in 5 patients (CCT-group) and inferior periareolar incision in 10 (IPI-group). There was a higher incidence of pathologic scarring in the CCT-group, and this difference was statistically significant (p = 0.007). No recurrences were observed after a mean follow-up of 15.86 ± 19.47 months ([3-60] months).Conclusions. Long term results were satisfactory in both groups. Despite of the higher incidence of hypertrophic and keloid scars observed in concentric circle technique, it remains aesthetically advantageous in cases of gynecomastia with extra skin

[Sinus pericranii. A series of 5 cases]. / Sinus pericranii. Serie de 5 casos.

Sinus pericranii is a rare vascular anomaly in which an abnormal communication exists between the extracranial venous system and the dural venous sinuses. The natural history in most cases consists of a purplish nodule in the frontal region that may gradually increase in size. Different treatment options can be chosen: from observation of the lesion, to endovascular embolization of intracerebral component or a complete resection of both anomalous components (extra- and intra-cranial) by surgery. In this context, potential life-threatening complications including thrombosis and cerebral hemorrhage can occur. Here we present our experience in management of sinus pericranii, and emphasize the importance of a multidisciplinary therapeutic approach of this uncommon entity.

¿Qué podemos mejorar en el tratamiento de las atresias intestinales? / ¿What can we do to improve our management of intestinal atresia?

OBJETIVO: Aportar nuestra experiencia en el manejo de las atresias intestinales (AI). MATERIAL Y MÉTODOS: Revisión retrospectiva de pacientes con AI atendidos en nuestro centro entre 1995 y 2011. RESULTADOS: Se intervinieron 41 AI, de las cuales el 29,2% pre-sentaron polihidramnios y el 48,7% se diagnosticaron prenatalmente. Cuatro pacientes estaban afectos de síndrome de Down y 18 presentaban cardiopatía. Se halló atresia-estenosis duodenal (AD) en 21 casos, en los que se realizaron 19 duodenoduodenostomías, 1 duodenoyeyunostomia y 1 duodenotomía con resección de membrana duodenal. Se halló atresia yeyuno-ileal (AYI) en 20 casos, en los que se realizaron 15 anastomosis termino-terminales, 1 anastomosis íleo-cólica, 1 ileostomía, 2 yeyu-nostomías y 1 anastomosis término-terminal con yeyunostomía. Fue necesario reoperar a 9 pacientes con AYI: 6 por oclusión intestinal, 1 por evisceración y 2 por atresias colo-rectales inadvertidas. El tiempo medio con nutrición parenteral fue 29 días y la estancia media 37,3 días. Un paciente con AD falleció por cardiopatía y 2 con AYI fueron traslados por síndrome de intestino corto. CONCLUSIONES: El diagnóstico prenatal de atresias intestinales es complejo, sobre todo en las AYI, de las cuales sólo el 35% se diagnos-ticó prenatalmente. Las AD responden mejor al tratamiento quirúrgico y no precisan habitualmente reintervenciones, aunque presentan mayor mortalidad debida a otras malformaciones asociadas. En las AYI son más frecuentes las reoperaciones (45% de nuestros casos) por obstrucción, cierre de ostomías y problemas derivados de resecciones extensas. Es importante tener presentes las atresias colo-rectales, sobre todo mem-branosas, que pueden pasar desapercibidas

OBJECTIVE: To review our management of intestinal atresia (AI). MATERIAL AND METHODS: A retrospective review of patientes with AI, from1995 to 2011. RESULTS: AI was identified in 41 patients, 29,2% had maternal poly-hydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduo-denostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunos-tomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel. CONCLUSIONS: Prenatal diagnosis of AI is difficult, especially AYI , which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It ́s important to keep in mind colorectal atresias, which can not be identified

[Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique]. / Ginecomastia puberal: comparación entre el abordaje periareolar inferior y el de doble anillo cutáneo.

BACKGROUND/PURPOSE: The main reason to indicate the surgical treatment in pubertal gynecomastia is the psychological effect on the adolescent. The aim of this paper is to describe our experience in the surgical treatment of this condition, comparing the results obtained depending on the type of approach used. MATERIAL AND METHODS: In our department, the approach for the subtotal mastectomy depends mainly on the gynecomastia grade. We use an inferior periareolar incision in grades I and II, and a concentric circle technique in grade III of Simon's classification. A retrospective review was conducted to identify all adolescent patients that underwent to gynecomastia surgical treatment between 2007 and 2012. We compared the results obtained in each incision group by parametric statistical tests, RESULTS: A total of 29 mastectomies were performed in 15 patients. The mean age of surgery was 13.75 +/- 1.06 years ([11-15] years). The presentation in all cases consisted in a progressive increase in size of the mammary gland, without associated symptoms. In half of patients there was a history of obesity or overweight. We performed the concentric circle technique in 5 patients (CCT-group) and inferior periareolar incision in 10 (IPI-group). There was a higher incidence of pathologic scarring in the CCT-group, and this difference was statistically significant (p = 0.007). No recurrences were observed after a mean follow-up of 15.86 +/- 19.47 months ([3-60) months). CONCLUSIONS: Long term results were satisfactory in both groups. Despite of the higher incidence of hypertrophic and keloid scars observed in concentric circle technique, it remains aesthetically advantageous in cases of gynecomastia with extra skin.

[Fertility survey of patients operated on of cryptorchidism in the pediatric age]. / Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica.

OBJECTIVES: To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. METHODS: A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. RESULTS: A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no significant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. CONCLUSIONS: There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw significant conclusions in regards to fertility and other clinical situations.

Triada de Currarino: sus diferentes formas de presentación / Currarino triad: Different forms of presentation

Objetivos. Presentar nuestra experiencia en casos diagnosticados de síndrome de Currarino y sus diferentes formas de presentación. material y métodos. Caso 1: neoanata con diagnóstico prenatal por RM de mielomeningocele confirmado al nacimiento como lipomielomeningocele asociado a atresia ano-rectal alta con vascularización anómala del colon, agenesia parcial sacra y riñón en herradura. Caso 2: varón de 14 meses con clínica de estreñimiento y diagnóstico de estenosis anal, lipomeningocele presacro más teratoma y agenesia parcial sacra. Caso 3: varón de 8 meses con clínica de meningitis de repetición y diagnosticado de estenosis anal, meningocele anterior con fístula rectal y agenesia parcial sacra. Resultados. El caso 1 tras un descenso abdomino-perineal fallido por vascularización anómala es portadora actual de cecostomía y a los 3 años de vida presenta un buen control urinario y de la deambulación. El caso 2, con dos años de vida, evoluciona favorablemente con hábito intestinal normal tras extirpación del teratoma y meningocele más dilatación anal. El caso 3 precisó una colostomía tras extirpación del meningocele con fístula rectal por fístula recto-cutánea en el postoperatorio inmediato y derivación ventriculoperitoneal por hidrocefalia postmeningitis. Conclusiones. Según la bibliografía, la forma de presentación del síndrome de Currarino (SC) puede ser muy variada, siendo lo más frecuente el estreñimiento. La presentación más compleja y con alto índice de mortalidad (56%) es la meningitis de repetición debido a fístulas recto-meníngeas. La malformación ano-rectal más frecuente es la estenosis anal y malformaciones más complejas tienen un alto índice de incontinencia. Es un síndrome que precisa de manejo y seguimiento multidisciplinar (AU)

Background. We describe our experience in Currarino syndrome (CS) and our clinical findings. methods. Case 1: Newborn female with prenatal diagnosis of myelomeningocele which was confirmed at birth as a lipomyelomeningocele, associated with partial sacral agenesis, horseshoe kidney and complex anorectal malformation with colonic vascular anomaly. Case 2: A 14-month-old male with constipation. The physical examination detected an anal stricture and radiological findings of a presacral lipomeningocele plus teratoma and a partial sacral agenesis. Case 3:An 8-month-old male with recurrent meningitis associated with anterior sacral meningocele and rectal fistula. An anal stricture and hemisacrum were also demonstrated. Results. In case 1, an abdomino-perineal pull-through was performed but it failed because of her colonic vascular anomaly. Nowadays she is 3 years old and has a cecostomy, controls her micturition and is able to walk. Case 2 is two years old with satisfactory flow-up-after the teratoma and meningocele removal plus anal dilation. In case 3 a colostomy was necessary because after mass excision a recto-cutaneous fistula appeared during postoperative period. A ventriculoperitoneal valve implantation due to his hydrocephaly was also performed. Conclusions. The constipation is the most common symptom in the CS. Recurrent meningitis has a high mortality rate (56%) due to rectomeningeal fistula. The most common anorectal malformation is the anal stricture, and the more complex the malformation is, higher will the risk of incontinence be. The success of the management and follow-up is a multidisciplinary responsability (AU)

Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica / Fertility survey of patients opened on of cryptorchidism in the pediatric ag

Objetivos. Analizar la encuesta de fertilidad realizada en una cohorte de adultos, operados de criptorquidia en edad pediátrica, de los que disponemos datos clínicos y quirúrgicos y que fueron estudiados hace 10 años, realizando un espermiograma y un estudio del eje hipofisario. Métodos. Se envió una encuesta de fertilidad, incluyendo datos de estilo de vida y condiciones de trabajo al domicilio de 278 pacientes adultos operados de criptorquidia. Las 94 encuestas recibidas (33,8% de las enviadas) han sido analizadas con SPSS 15.0, realizando un estudio descriptivo y analítico. Consideramos que tienen fertilidad normal aquellas personas que consiguen el embarazo en un máximo de 12 meses con actividad sexual regular sin uso de anticonceptivos. Resultados. Han intentado tener hijos 53 casos de los encuestados (56,4%) y lo han conseguido 44 (83,1%). Han sido considerados fértiles 34 pacientes (64,2%) con una media de tiempo para embarazarse de 4,15 meses. Diecinueve pacientes (35,8%) han intentado ser padres durante más de 12 meses y lo han conseguido sólo 10 (18,9%), 5 de forma natural, 2 con tratamiento ovulatorio y 3 por FIV, con una media de 26,8 meses. No han conseguido ser padres 9 casos (16,9%). No existen diferencias significativas entre fertilidad y localización y lateralidad del testículo, edad de cirugía y densidad del espermiograma. Existen diferencias significativas entre paternidad natural y la uni o bilateralidad de la criptorquidia. Conclusiones. Existe mayor proporción de criptórquidos unilaterales en el grupo que ha llegado a ser padres. Necesitamos ampliar el número de encuestados para poder sacar conclusiones significativas en cuanto a la fertilidad en otras situaciones clínicas (AU)

Objectives. To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. Methods. A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. Results. A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no signifi cant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. Conclusions. There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw signifi cant conclusions in regards to fertility and other clinical situation (AU)

[Currarino triad: different forms of presentation]. / Triada de Currarino: sus diferentes formas de presentación.

BACKGROUND: We describe our experience in Currarino syndrome (CS) and our clinical findings. METHODS: Case 1: Newborn female with prenatal diagnosis of myelomeningocele which was confirmed at birth as a lipomyelomeningocele, associated with partial sacral agenesis, horseshoe kidney and complex anorectal malformation with colonic vascular anomaly. Case 2: A 14-month-old male with constipation. The physical examination detected an anal stricture and radiological findings of a presacral lipomeningocele plus teratoma and a partial sacral agenesis. Case 3: An 8-month-old male with recurrent meningitis associated with anterior sacral meningocele and rectal fistula. An anal stricture and hemisacrum were also demonstrated. RESULTS: In case 1, an abdomino-perineal pull-through was performed but it failed because of her colonic vascular anomaly. Nowadays she is 3 years old and has a cecostomy, controls her micturition and is able to walk. Case 2 is two years old with satisfactory flow-up-after the teratoma and meningocele removal plus anal dilation. In case 3 a colostomy was necessary because after mass excision a recto-cutaneous fistula appeared during postoperative period. A ventriculoperitoneal valve implantation due to his hydrocephaly was also performed. CONCLUSIONS: The constipation is the most common symptom in the CS. Recurrent meningitis has a high mortality rate (56%) due to rectomeningeal fistula. The most common anorectal malformation is the anal stricture, and the more complex the malformation is, higher will the risk of incontinence be. The success of the management and follow-up is a multidisciplinary responsability.