Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas / Seromuscular colocystoplasty lined by urothelium. Experimental study in rats

Objetivo. Determinar qué técnica de ampliación vesical en ratas puede ofrecer los mejores resultados funcionales e histológicos. Diseño. Estudio experimental comparativo entre parámetros pre y postoperatorios de 60 ratas Wistar hembra divididas en cinco grupos según la técnica de ampliación vesical utilizada: sham, colocistoplastia (CC), colocistoplastia desmucosada (DCC), colocistoplastia seremuscular cubierta de urotelio (AADCC) y autoaumento vesical (AA). Instrumentalización. Cistometría preoperatoria.Ampliación vesical usando diversas técnicas. Cistomanometría al mes postoperatorio, previa al sacrificio del animal y extracción de la vejiga para su estudio histológico. Medición del volumen y presión de ruptura. Resultados. La técnica de enterocistoplastia seromuscular presenta una alta mortalidad en la rata (63,6 por ciento). El aumento del volumen vesical producido en los dos grupos que portaban injerto seromuscular fue escaso (0,22 +/- 0,5 y 0,47 +/- 0,3 ml) frente al grupo de control (0,11 +/- 0,4ml). Sólo la colocistoplastia estándar y el autoaumento vesical produjeron aumentos significativos tanto del volumen vesica (0,78+/-0,5 y 0,69+/-0,6 ml, respectivamente) como del volumen de ruptura. No se observaron diferencias significativas en cuanto a la presión de ruptura vesical (AU)

[Seromuscular colocystoplasty lined by urothelium. Experimental study in rats]. / Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas.

OBJECTIVE: To determine what technical of vesical extension in rat can offer the best functional and histological results. DESIGN: Comparative experimental study between pre and postoperative parameters of 60 female Wistar rats. The animals were divided in 5 groups using different techniques of vesical augmentation. Sham, colocystoplasty (CC), demucosalised colocystoplasty (DCC), demucosalised colocystoplasty lined by urothelium (AADCC), autoaugmentation (AA). INTERVENTIONS: Preoperative cystometrical study. Microsurgery for vesical augmentation. New cystometric study at the month, previous to the sacrifice of the animal and extraction of bladder for its histological study. Measurement of the volume and pressure of rupture. RESULTS: The technique of seromuscular enterocistoplasty presents the high mortality in the rat (63.6%). The increase of the vesical volume in both groups that carried seromuscular grafts was little (0.22 +/- 0.5 and 0.47 +/- 0.3 ml) in front of the control group (0.11 +/- 0.4 ml). Only standard colocystoplasty and bladder autoaugmentation produced significant increases on vesical volume (0.78 +/- 0.5 and 0.69 +/- 0.6 ml, respectively) and rupture volume. There were not observed significant differences on vesical rupture pressure.

Cirugía infantil ambulatoria: 25 años de experiencia / Anibulatory pediatric surgery, 25 years of experience

Los objetivos del estudio son: recoger la experiencia de 25 años de cirugía infantil ambulatoria en el Servicio de Cirugía Infantil del Hospital de Cruces, presentar los resultados de una encuesta de satisfacción de padres y mostrar el ahorro económico estimado en el último quinquenio. En el período 1973-1997 se han intervenido ambulatoriamente 19.934 niños (56 por ciento del total de cirugía programada) que han sido agrupados en cinco quinquenios, apreciándose un incremento constante del número de casos y del porcentaje de cirugía ambulatoria. Las especialidades que más utilizan esta modalidad son cirugía general y ORL (72,4 por ciento y 68,6 por ciento en el último decenio, respectivamente).En cirugía general, la hernia inguinal es el diagnóstico más frecuente, habiendo aumentado el porcentaje de orquidopexias en el último quinquenio; ORL realiza amigdalectomías en régimen ambulatorio en el último decenio. Las prolongaciones de estancia y los ingresos no anticipados se han debido en su gran mayoría a vómitos postoperatorios. La encuesta de satisfacción muestra un elevado grado de aceptación por los padres, si bien un 13 por ciento hubieran preferido una corta estancia postoperatoria. El ahorro económico estimado en el último quinquenio ha sido importante (AU)

Estudio clínico y nasométrico de la función velofaríngea en dos tiempos / Clinico-nasometric study of the velopharyngeal function in the two-stage palatoplasty

En 1976 iniciamos un régimen de estafilorrafia en dos tiempos en pacientes con fisura labio-palatina completa, con veloplastia al año de edad y palatoplastia del paladar óseo entre 3-12 años de edad. El objetivo es presentar la valoración clínica e instrumental del habla y de la función velofaríngea de 41 pacientes, edad media 8,2 años, 28 fisurados unilaterales y 13 bilaterales; 7 casos presentaban fístula palatina > 5 mm2. Los resultados muestran hipernasalidad moderada-severa en 20 por ciento de los casos, errores articulatorios persistentes con posteriorización en 43 por ciento de los casos, golpe de glotis en 2 por ciento, la inteligibilidad era deficiente en 7 por ciento. La evaluación de la resonancia oro-nasal con el Nasometer muestra valores de sospecha o Insuficiencia velofaríngea (IVF) en 14 y 20 por ciento de los casos respectivamente. Por Nasofibroscopia el 35 por ciento mostró algún grado de IVF. El 17 por ciento requirió repalatoplastia o cierre de fístula y un 12 por ciento colgajo faríngeo. La gran incidencia de errores articulatorios nos ha obligado a discontinuar esta técnica (AU)

Since 1976 children born with complete cleft lip and palate have been treated according to two stage cleft palate repair regime, soft palate at one year of age and hard palate between 3-12 years of age. The objective of this paper is to present the clinical and instrumental speech evaluation and the velopharyngeal function of 41 patients, mean age 8.2 years, 28 unilaterals and 13 bilateral clefts; 7 cases had palatal fistulae larger than 5 mm2. The results showed moderate-severe hypernasality in 20% of cases, persisting articulatory errors with backing in 43% of cases, glotal stops in 2%, the intelligibility was deficient in 7%. The evaluation of the oro-nasal resonance with Nasometry showed suspicious or VPI values in 14 and 20% of cases respectively. Nasendoscopy findings showed same degree of VPI in 35% of cases. Repalatoplasty or fistula closure was needed in 17% and pharyngeal flap in 12% of cases. The great incidence of articulatory errors have promoted us to discontinue this technique (AU)

[Clinical and nasometric study of velopharyngeal function in two-stage palatoplasty]. / Estudio clínico y nasométrico de la función velofaríngea en la palatoplastia en dos tiempos.

Since 1976 children born with complete cleft lip and palate have been treated according to two stage cleft palate repair regime, soft palate at one year of age and hard palate between 3-12 years of age. The objective of this paper is to present the clinical and instrumental speech evaluation and the velopharyngeal function of 41 patients, mean age 8.2 years, 28 unilaterals and 13 bilateral clefts; 7 cases had palatal fistulae larger than 5 mm2. The results showed moderate-severe hypernasality in 20% of cases, persisting articulatory errors with backing in 43% of cases, glotal stops in 2%, the intelligibility was deficient in 7%. The evaluation of the oro-nasal resonance with Nasometry showed suspicious or VPI values in 14 and 20% of cases respectively. Nasendoscopy findings showed same degree of VPI in 35% of cases. Repalatoplasty or fistula closure was needed in 17% and pharyngeal flap in 12% of cases. The great incidence of articulatory errors have promoted us to discontinue this technique.

[Ambulatory pediatric surgery: 25 years of experience]. / Cirugía infantil ambulatoria: 25 años de experiencia.

The objectives of this study are: collect 25 years of experience with ambulatory pediatric surgery in The Pediatric Surgery Service of Hospital de Cruces, present the results of a parents-patient satisfaction survey and show the estimated money savings in the last five years. In the period 1973-1997, 19,934 children (56% of the total surgical cases) were operated with ambulatory surgery, and have been grouped in five quinquenia, showing a constant increase of the percentage of ambulatory surgery. General surgery and ENT are the specialities that more frequently uses this type of surgery (72.4% and 68.6% of the surgical cases of each speciality, respectively, in the last ten years). In general surgery inguinal hernia is the most frequent diagnosis with an increase of orchidopexy in the last five years. ENT is doing ambulatory tonsilectomies in the last ten years. The prolonged recovery stay and unanticipated admissions are rare, usually due to vomiting. The parents satisfaction survey shows great acceptancy, although 13% preferred an overnight postoperative stay. The estimated money saved in the last quinquenia has been important.

[Results of a questionnaire on the treatment of cleft lip and palate in Spain]. / Resultado de la encuesta sobre el tratamiento del fisurado labio-palatino en España.

OBJECTIVE: To present the results of a questionnaire done to evaluate the status of the multidisciplinary team treatment of cleft lip and palate in Spain, directed to know the experience and organization of each center. METHOD: A questionnaire was sent to 34 hospitals asking about the following: existence of multidisciplinary team, number of primary surgical cleft operation in 1997, specialty of the primary surgeon/s, the presence in the hospital staff of: ENT, speech therapist, orthodontist, maxillofacial surgeon; if evaluation of the velopharyngeal function is done, if orthodontist meets with other members of the team, where the speech therapy is performed, how the financial burden of these treatments are covered and if there is a parent group. RESULTS: Nineteen centers (55.8%) have responded. Only seven centers admit to have a multidisciplinary team, primary surgery is done by pediatric, plastic and maxillofacial surgeons, 36% of the surgeons operate less then 10 cases/year, the absence of a speech therapist and orthodontist in staff was 42% and 84% respectively, instrumental diagnosis of VPI is not performed in 60% of teams, scanty and not uniform cost coverage of these treatments, only 12% of centers admit to have a parent group. CONCLUSIONS: Deficiencies of organization and staff are present in many centers, there is not a team culture. Centralization of primary surgery is needed. The need of a Spanish Cleft Palate Association is pointed. Eurocleft treatment guidelines are presented.

[Integrated treatment of cleft lip and palate. Organization of a treatment team]. / Tratamiento integral de las fisuras labio palatinas. Organización de un equipo de tratamiento.

OBJECTIVE: Collect the team experience in the treatment of children with cleft lip and palate, indicating the evolution of the team composition, advantages and improvement aspects, trying to transmit the need of team treatment. METHOD: The Bilbao cleft palate team was created in 1983, since then a cleft palate clinic, a parents group and a unit of velopharyngeal function has been developed. At present the team is composed by: pediatric reconstructor surgeon, speech therapist, orthodontist, dentist, pediatrician, ENT, maxillofacial surgeon, dismorphologyst, geneticist, nursing. RESULTS: One of the achievements has been the data unification, obtaining speech cephalometrics, photographic dental casts and video images with prospective view. At this time 403 cleft lip and palate children have been intervened, being essential the transdisciplinar team approach between surgeon, speech therapist and orthodontist. The importance of the team coordinator is pointed. The results of an audit of the two stage cleft palate closure in complete unilateral cleft lip and palate have obligated us to vary our surgical policy. The unresolved aspects are the lack of multidisciplinary team recognition at official level and the non existence of orthodontist in staff, without cost coverage of this treatment by public health system. CONCLUSIONS: In our experience the team treatment of cleft lip and palate has resulted in improvement of the clinic results, treatment protocols and training.

[Section of the sublingual frenulum. Are the indications correct?]. / Sección del frenillo sublingual. Son las indicaciones correctas?

OBJECTIVE: To see the relationship of the lingual frenum with speech and other oral functions, evaluating the surgical indications and the results of frenectomy. MATERIAL AND METHODS: In 1997 we operated 72 children with sublingual frenulum, a telephone questionnaire to the mothers of these patients was done, obtaining data about: age at surgery, professional reasons for referral, preoperative findings, pre-post operative speech therapy, place of surgery and type of anesthesia and mother's impression about the final result. RESULTS: Fifty valid questionnaires were obtained, the mean age at frenectomy was 3.03 years, 38% of children were sent due to speech problems, 60% due to some degree of tongue-tie and 2% due to dentofacial developmental anomalies. In 70% the patients were sent by a pediatrician and in 14% by a speech therapist. In 20% preoperative speech therapy was done and postoperatively in 30%. In 48% of cases, aged less than 2 years, speech was not possible to be evaluated. In the 11 cases with questionable results, a multidisciplinary reevaluation showed 7 cases with lingual dysfunction and poor tongue control, 4 cases with deglutitory anomalies and 3 cases with orofacial occlusal problems secondary to lingual dysfunction or altered oral habits. CONCLUSIONS: The presence of a nondisturbing lingual frenulum does not justify its surgical section, the frenectomy is indicated only in presence of altered oro-lingual functions caused by the tongue-tie such as: speech problems, errors of bite and deglutition, lingual dysfunction and anomalous oral habits.

[Cancellations in pediatric surgery]. / Cancelaciones en cirugía pediátrica.

UNLABELLED: Cancellations have an important role in the effectiveness of the surgical schedule. OBJECTIVE: Analyze the evolution of the cancellations during the years 1994-1997, after institution of several corrective measures. MATERIAL AND METHOD: We started in 1994 together with the Quality Unit of the Hospital, a program to reduce surgical cancellations. It consisted in improvement of parents information, surgical schedule centralization, and increasing the awareness of the importance of constant improvement. Cancellations have been divided in: inevitables and inevitables, and analyzed for the entire Service and for each speciality. RESULTS: A significant reduction of cancellations have been obtain (from 12.38% in 1992 to 3.35% in 1997). The inevitable causes (no presentation, inadequate preparation and lack of time in the surgical room) have shown the most improvement. Although the inevitable causes (intercurrent disease) were also significantly improved, after obtaining prior information of the health of the child, by telephone call or parents advise. ENT is the speciality with greatest improvement by significant reduction of the non presentation and intercurrent disease. CONCLUSION: After corrective measures conjointly with a realistic surgical schedule, prior telephone call and improvement quality concept, have permitted a significant reduction of cancellations.

Pleomorphic adenoma of the palate in children: report of a case.

Salivary gland tumors are rare in infancy, and almost all of them are found in the parotid gland. Minor salivary gland tumors are even more rare, pleomorphic adenoma being the most frequently involved tumor. Only six well-described cases of pleomorphic adenoma arising in the palate have been reported in children. A case occurring in a 16-year-old boy is presented.

[Latex allergy in children with spina bifida]. / Alergia al látex en niños con espina bífida.

Latex allergy is a frequent happening in children with spina bifida or congenital urologic abnormalities. These patients have multiples exposures to derivatives of latex as part of the management increasing the risk of allergic reactions. We present three children who developed general anaphylactic reaction during urodynamic exploration with a rectal latex catheter. All patients showed positive skin test and positive latex specific IgE test (RAST). A prospective survey of 17 patients with spina bifida at the time of cystometry showed positive RAST levels in 7 (41%). Recommendations for prophylaxis are included, suggesting the avoidance of latex products in children with spina bifida since birth.

Nasometric sensitivity and specificity: a cross-dialect and cross-culture study.

A series of 514 patients seen at three clinics in the United States and Spain were evaluated using clinical judgments of hypernasality, and nasometric assessment of oral-nasal resonance balance. Data from the nasometer were obtained while patients read a passage devoid of nasal consonants. Across all subjects, the Pearson correlation coefficient between the clinical and instrumental measures was 0.78. Prediction analyses revealed that maximum efficiency was obtained using a somewhat different threshold nasalance value for each of the three patient samples. When all 514 subjects were investigated as a single group, a threshold nasalance score of 28 was found to optimize identification of patients with and without clinically significant hypernasality. In that analysis, a sensitivity of 0.87, a specificity of 0.86 and an overall efficiency of 0.87 was obtained. The clinical relevance of these findings is discussed.

[Poisoning by viper bites in children]. / Intoxicación por mordedura de víbora en niños.

Our experience with 36 cases of adder bites, collected during 13 years (1976-1989), is presented. The severity of the clinical picture was minimal to moderate in most of the cases, with mainly local symptomatology noted. Only 4 of the cases had symptoms such as vomiting and abdominal pain. Good results wee obtain in all cases with the prescribed medical treatment, except in one case which had partial necrosis of the skin on one finger on the side of viper bite. Antibiotics were used in all cases except three and anti-tetanus therapy was used in those cases where needed. Corticosteroids and antihistamines were used on selected occasions. We recommend the use of antiofidic serum, although the possibilities of anaphylactic reaction must be noted. We do not recommended local incisions and suction for this type of bites.

[Post-adenoidectomy velopharyngeal insufficiency in children with velopalatine clefts]. / Insuficiencia velofaríngea postadenoidectomía en niños con fisuras velopalatinas.

The influence of adenoidectomy on speech has been well documented, essentially in cleft palate children. A revision of the speech outcome in 7 adenoidectomized cleft palate children reveals 4 cases of deteriorated speech. The need of a preoperative evaluation to look for risk factors is outlined, specially in cases of submucous cleft palate. The evolution of cases with permanent postadenoidectomy velar insufficiency with nasometry, shows increasing severity of nasality .

[Complete duplication of the urethra]. / Duplicación completa de uretra.

A case of complete urethral duplication in a child is presented. The malformation consisted of a normal urethra and another epispadial dorsal urethra ending at the dome of the bladder. This is a rare variant of this type of malformation. Incontinence was the surgical indication. The classification, embryology, diagnosis, indications for surgery and treatment of this anomaly are presented.

[Prevention of bicycle accidents in children]. / Prevención de los accidentes de bicicleta en el niño.

The preventive measures of bicycle accidents in children, depends on the knowledge of the risk of use of the bicycle by children. In our study, over 50% of severe bicycle accidents had CNS trauma, pointing the need of brain protection. In view of our experience we recommend the teaching of the rules of circulation to children and the necessity of periodic bicycle revisions.

[Penoscrotal inversion]. / Inversión penoescrotal.

A case of a child with complete penoscrotal transposition is presented. Surgical correction was performed in two stages. First, we performed penile elongation with scrotoplasty and partial perineal urethroplasty with the Thiersch Duplay technique, followed by Byars urethroplasty. The surgical techniques commonly used to correct this anomaly and their indications are reviewed. Currently, we recommend correction of hypospadias and transposition in a single stage procedure whenever possible.

[Neonatal hypothyroidism secondary to the use of povidone-iodine]. / Hipotiroidismo neonatal secundario a la utilización de povidona yodada

The skin absorption of iodine products in neonates with inhibition of thyroid function has been documented in the past. The use of Povidone-Iodine is the most frequent cause of this type of intoxication. Three neonates in which Povidone-Iodine was used during and after surgery had hypothyroidism secondary to glandular inhibition. They were discovered during the routine Programme for Neonatal Metabolic Diseases and were treated as deficits persists on retesting at 14 days of age. Treatment was maintained during one year, and the follow up controls of TSH-T4 were normal. During the neonatal period the use of Iodine containing antiseptics should be avoided because the potential risk of intoxication and glandular inhibition.