Analyzing complications and implementing solutions in a pediatric inguinal hernia cooperation program in Equatorial Guinea: a prospective cohort study.

Background: Few studies have evaluated the efficacy of short-term medical missions. This study was aimed to evaluate complication rates and determine the effects of protocol changes in a pediatric inguinal hernia campaign in Equatorial Guinea and analyze post-operative follow-up capacity. Methods: In this prospective observational cohort study, we evaluated two patient cohorts (group A, 2017-2018; group B, 2019) treated during campaigns in Equatorial Guinea for congenital inguinal pathology (hernia, hydrocele, and cryptorchidism). Patients aged < 18 years treated in referral campaigns were included. Complications occurring up to 6 months post-operatively were evaluated. Two stages were defined: Stage 1, wherein, complication rate in group A was compared to that in a control group from a tertiary hospital in Spain (with a case-control ratio of 1:2, paired according to age, sex and diagnosis); stage 2, wherein, complication rates between groups A and B were compared. Group B received a single dose of prophylactic amoxicillin-clavulanic acid. Follow-up capacity was assessed through follow-up appointments. Results: In stage 1, complication and surgical site infection (SSI) rates were 21.3% and 7.4% in group A (n = 94), and 5.8% (p < 0.001) and 0.5% (p = 0.012) in the control group, respectively. Group A had 20.2% loss-to-follow-up. In group B (n = 62), 6-month postoperative follow-up could not be assessed owing to restrictions due to the COVID-19 pandemic, so only early complications were considered in stage 2, were complication and surgical site infection rates were 18.1% and 7.4% in group A and 11.3% (p = 0.350) and 1.6% (p = 0.150) in group B. Conclusion: Our results showed higher than expected complication rates. Pre-operative prophylactic antibiotic could not show to reduce SSI. Further studies are needed to reduce complication rates in these campaigns. Patient loss-to-follow-up ratio warrants considering new strategies.

Point-of-care manufacturing: a single university hospital's initial experience.

BACKGROUND: The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital. METHODS: Observational, descriptive, retrospective, and monocentric study of 907 instances of 3D printing from November 2015 to March 2020. Variables such as product type, utility, time, or manufacturing materials were analyzed. RESULTS: Orthopedic Surgery and Traumatology, Oral and Maxillofacial Surgery, and Gynecology and Obstetrics are the medical specialties that have manufactured the largest number of processes. Working and printing time, as well as the amount of printing material, is different for different types of products and input data. The most common printing material was polylactic acid, although biocompatible resin was introduced to produce surgical guides. In addition, the hospital has worked on the co-design of custom-made implants with manufacturing companies and has also participated in tissue bio-printing projects. CONCLUSIONS: The integration of 3D printing in a university hospital allows identifying the conceptual evolution to "point-of-care manufacturing."

Ingesta de cuerpos extraños magnéticos en la edad pediátrica. Caso clínico de localización y extracción endoscópica con ayuda de un imán / Ingestion of magnetic foreign bodies during the paediatric age. Case report, location and endoscopic extraction aided by a magnet

La ingesta accidental de más de un imán puede producir complicaciones graves. Los protocolos actuales recomiendan la extracción endoscópica de ser posible. El objetivo de este trabajo es presentar un caso clínico de una ingesta de dos imanes y la técnica endoscópica de extracción. Niño de 11 años que acudió a Urgencias tras la ingesta de dos imanes, asintomático. En la radiografía de abdomen, se identificaron dos cuerpos extraños radiopacos, aparentemente unidos, en la cámara gástrica. Se realizó una endoscopía bajo anestesia general en quirófano. Para facilitar la extracción, se colocó, encima de la pared abdominal, a nivel gástrico, un imán de neodimio. En la endoscopía, se observaron dos pequeños imanes localizados y fijados en la cara anterior del estómago. Una vez localizados, se retiró el imán externo y se procedió a su extracción con cesta

The ingestion of more than one magnet can cause multiple complications. Current protocols recommend endoscopic extraction if possible. We report a patient who swallowed two magnets and the endoscopic extraction technique. An 11-yearold boy presented at the Emergency Room after ingesting two small magnets, being asymptomatic. In the abdominal x-ray two radiopaque bodies were identified at the gastric chamber, apparently together. A gastroscopy was done in the operating room under general anaesthesia. To enable the extraction, a neodymium magnet was placed externally at the abdominal wall. In the endoscopic image, the two magnets were fixed to the anterior gastric wall. Once located, the neodymium magnet was removed and the two magnets were retrieved with an endoscopic basket.

[Ingestion of magnetic foreign bodies during the paediatric age. Case report, location and endoscopic extraction aided by a magnet]. / Ingesta de cuerpos extraños magnéticos en la edad pediátrica. Caso clínico de localización y extracción endoscópica con ayuda de un imán.

The ingestion of more than one magnet can cause multiple complications. Current protocols recommend endoscopic extraction if possible. We report a patient who swallowed two magnets and the endoscopic extraction technique. An 11-yearold boy presented at the Emergency Room after ingesting two small magnets, being asymptomatic. In the abdominal x-ray two radiopaque bodies were identified at the gastric chamber, apparently together. A gastroscopy was done in the operating room under general anaesthesia. To enable the extraction, a neodymium magnet was placed externally at the abdominal wall. In the endoscopic image, the two magnets were fixed to the anterior gastric wall. Once located, the neodymium magnet was removed and the two magnets were retrieved with an endoscopic basket.

La ingesta accidental de más de un imán puede producir complicaciones graves. Los protocolos actuales recomiendan la extracción endoscópica de ser posible. El objetivo de este trabajo es presentar un caso clínico de una ingesta de dos imanes y la técnica endoscópica de extracción. Niño de 11 años que acudió a Urgencias tras la ingesta de dos imanes, asintomático. En la radiografía de abdomen, se identificaron dos cuerpos extraños radiopacos, aparentemente unidos, en la cámara gástrica. Se realizó una endoscopía bajo anestesia general en quirófano. Para facilitar la extracción, se colocó, encima de la pared abdominal, a nivel gástrico, un imán de neodimio. En la endoscopía, se observaron dos pequeños imanes localizados y fijados en la cara anterior del estómago. Una vez localizados, se retiró el imán externo y se procedió a su extracción con cesta.

Situación de la circuncisión por motivos religiosos en España / Situation of religious circumcision in Spain

Introducción: la realización de la circuncisión por motivos culturales o religiosos es una práctica cuya indicación no está bien definida dentro de nuestra práctica médica. El objetivo de nuestro trabajo es mostrar la diversidad de su práctica en España a fin de establecer un protocolo de actuación general con respecto a este tema. Material y métodos: se ha realizado una encuesta nacional en 49 centros públicos con disponibilidad de servicio de cirugía pediátrica, en la que se recogen datos epidemiológicos, descriptivos y de opinión tanto colectiva como del personal médico sobre las derivaciones recibidas para hacer circuncisión. Resultados: se enviaron 200 encuestas, de las que se obtuvieron un total de 142 respuestas, el 76,6% de los facultativos no realizan circuncisiones por motivo religioso en el ámbito público. El 89% de los pacientes vistos en consulta son derivados por su pediatra. Hasta el 65% de los médicos afirman que han tenido algún conflicto con la familia del paciente cuando rechazan la indicación de la circuncisión por esta razón. De los profesionales que aceptan la intervención, el 39% lo hace para evitar la cirugía en peores condiciones fuera del hospital. El 57% de los cirujanos desconoce si esta indicación está incluida en la cartera de servicios del Sistema Nacional de Salud. Conclusiones: en base a nuestra encuesta, la mayoría de los profesionales desconoce si esta indicación está dentro de la cartera de servicios y coinciden en la necesidad de tener un consenso de actuación. Es importante tener una actitud conjunta, conocer todas las opiniones, y crear un protocolo de manejo de esta situación

Introduction: the performance circumcision for cultural or religious reasons is a practice whose indication is not well defined within the scope of medical practice in Spain. The objective of this study was to illustrate the variability in its practice in Spain with the purpose of eventually establishing a general protocol on the subject. Material and methods: we conducted a nationwide survey of public hospitals with a paediatric surgery department to collect epidemiological and descriptive data and opinions, both general and from individual medical providers, on the referrals received for performance of circumcision. Results: we submitted 200 questionnaires and received 142 responses, and 76.6% of the responding physicians reported not performing circumcisions for religious reasons in their practice in the public health system. Of all patients seen for a consultation, 89% had been referred by their paediatricians. Up to 65% of doctors reported having conflict with families when they refused to perform circumcision for this indication. Of the professionals who agreed on religious reasons as an indication, 39% performed the surgery to prevent its being performed under poorer conditions outside a hospital. Of all paediatric surgeons, 57% did not know whether this indication is included among the services covered by the National Health System. Conclusions: based on our survey, most professionals do not know whether this indication is included in the services covered by the public health system and agree on the need of establishing a consensus guideline. We believe that it is important to have a homogeneous approach, to explore the opinions of the professional collective as a whole and to develop a general protocol for approaching this situation

Abdomen agut en lactant de 23 mesos / No disponible

No disponible

[Medium-term results of the endourological management with balloon dilatation of the ureteropelvic junction stenosis in infants]. / Resultados a medio plazo del tratamiento endourológico retrógrado con balón de la estenosis pieloureteral en niños menores de 1 año.

AIM: In the last years it has spread minimally invasive therapeutic for the treatment of pyeloureteral junction obstruction in children. Some of them have got poor outcomes in 4-year-old minor children. We show our experience in the retrograde dilatation with balloon of high pressure in infants. METHODS: It's a retrospective study of 16 infants treated in our hospital. The average follow-up after the intervention is 27.4 +/- 10.0 months. The diagnostic protocol included abdominal ultrasound, cystogram and diuretic renography. The treatment was realized by endourology retrograde balloon dilatation under fluoroscopy. The balloons were in all the cases semicompliant, with a profile of 5 mm, 6 mm 6 7 mm. After the expansion there was placed stents type double J with profile and length depending on the weight of the patient. To obtain the results, we do ultrasound scans and diuretic renography at least 1 year after the intervention. RESULTS: The mean duration of the intervention was 36.4 +/- 15.5 minutes. During the intervention, in 2 patients the placement of the stent was not possible. The time of revenue was 48 hours in all the patients except in 1 of them. The analgesic needs were exclusively non steroid antiinflammatorys. The double J stent was withdrawn with cystoscopy. In 3 patients there were postoperatory complications: a migration of the stent, a urinary infection and an urinoma. In 1 patient with worsening of hydronephrosis was needed of pyeloplasty. In the controls the disappearance of the hydronephrosis was observed in all the cases, eliminating likewise the expansion of the renal calyces. The diuretic renography improved in all babies, being the boss of the curve normal in 14 cases and semi obstructively in 2. The mean time of elimination was 9.8 +/- 2.8 minutes. CONCLUSIONS: We think that the balloon dilatation of pyeloureteral junction obstruction is a minimally aggressive technique that is possible to realize in infants with good results and scanty complications.

Resultados a medio plazo del tratamiento endourológico retrógrado con balón de la estenosis pieloureteral en niños menores de 1 año / Medium-term results of the endourological management with balloon dilatation of the ureteropelvic junction stenosis in infants

Introducción: En los últimos años se han extendido terapéuticas mínimamente invasivas para el tratamiento de la estenosis pieloureteral en niños. Algunas de ellas con pobres resultados en niños menores de 4 años. Presentamos nuestra experiencia en el tratamiento mediante dilatación endourológica retrógrada con balón de alta presión en lactantes. Material y métodos: Presentamos un estudio retrospectivo de 16 pacientes menores de 1 año tratados en nuestra unidad. El seguimiento medio tras la intervención es de 27,4±10,0 meses. El protocolo diagnóstico incluyó ecografía abdominal, gammagrafía renal, cistouretrografía miccional y renograma diurético. El tratamiento se realizó mediante dilatación endoscópica retrógrada bajo control radioscópico. Los balones utilizados eran en todos los casos semicompliantes, con un perfil de 5 mm, 6 mm ó 7 mm. Tras la dilatación se colocó stents tipo doble J de calibre y longitud en función del peso del paciente. Para obtener los resultados se analizan las ecografías y los renogramas diuréticos por lo menos 1 año después de la intervención. Resultados: La duración media de la intervención fue de 36,4±15,5 minutos. Durante la intervención, en 2 pacientes no fue posible la colocación del stent, El tiempo de ingreso fue de 48 horas en todos los pacientes excepto en 1 de ellos. Las necesidades analgésicas fueron exclusivamente AINES. El stent tipo doble J fue retirado mediante cistoscopia de manera ambulatoria. En 3 pacientes hubo complicaciones postoperatorias: una migración del stent, una ITU y un urinoma. La técnica fracasó en 1 paciente que necesitó de pieloplastia desmembrada. En los controles se observó la desaparición de la hidronefrosis en todos los casos, desapareciendo así mismo la dilatación de los cálices renales. El renograma diurético MAG-3 mejoró en todos los lactantes, siendo el patrón de la curva normal en 14 casos y semiobstructivo en 2. El tiempo medio de eliminación fue de 9,8±2,8 minutos. Conclusiones: Pensamos que la dilatación con balón es una técnica mínimamente agresiva que es posible realizar en pacientes menores de 1 año con buenos resultados y escasas complicaciones (AU)

Aim: In the last years it has spread minimally invasive therapeutic for the treatment of pyeloureteral junction obstruction in children. Some of them have got poor outcomes in 4-year-old minor children. We show our experience in the retrograde dilatation with balloon of high pressure in infants. Methods: It´s a retrospective study of 16 infants treated in our hospital. The average follow-up after the intervention is 27.4±10.0months. The diagnostic protocol included abdominal ultrasound, cystogram and diuretic renography. The treatment was realized by endourology retrograde balloon dilatation under fluoroscopy. The balloons were in all the cases semicompliant, with a profile of5 mm, 6 mm ó 7 mm. After the expansion there was placed stents type double J with profile and length depending on the weight of the patient. To obtain the results, we do ultrasound scans and diuretic renography at least 1 year after the intervention. Results: The mean duration of the intervention was 36.4±15.5 minutes. During the intervention, in 2 patients the placement of thestent was not possible. The time of revenue was 48 hours in all the patients except in 1 of them. The analgesic needs were exclusively non steroid antiinflammatorys. The double J stent was withdrawn with cystoscopy. In 3 patients there were postoperatory complications: a migration of the stent, a urinary infection and an urinoma. In 1 patient with worsening of hydronephrosis was needed of pyeloplasty. In the controls the disappearance of the hydronephrosis was observed in all the cases, eliminating likewise the expansion of the renal calyces. The diuretic renography improved in all babies, being the boss of the curve normal in 14 cases and semi obstructively in 2. The mean time of elimination was 9.8±2.8 minutes. Conclusions: We think that the balloon dilatation of pyeloureteral junction obstruction is a minimally aggressive technique that is possible to realize in infants with good results and scanty complications (AU)