Uso de prótesis autoexpandibles en estenosisesofágicas en niños / Use of self-expandable prosthesis in esophageal stenosis in children

Objetivos. Las estenosis esofágicas de origen péptico o cáustico en niños precisan múltiples dilataciones, que implican un importante riesgo anestésico y de traumatismo esofágico. La colocación de prótesis esofágicas puede suponer un avance en el tratamiento de estos pacientes. El objetivo de nuestro trabajo es analizar la eficacia de las prótesis autoexpandibles para el tratamiento de estenosis esofágicas en niños. Material y métodos. Presentamos 3 casos clínicos de pacientes que han sufrido estenosis esofágicas, una secundaria a ingesta de cáusticos y dos a reflujo gastroesofágico, en los que se han colocado prótesis, en el primer caso metálica recubierta de nitinol y en los otros dos casos de material reabsorbible. Resultados. Al paciente con estenosis cáustica, tras un año de dilataciones, se le colocaron 2 prótesis metálicas consecutivas. Tras su retirada, ha precisado nuevas dilataciones con mayores periodos asintomáticos. A los dos pacientes afectos de estenosis pépticas, tras varios meses de dilataciones, les fueron colocadas prótesis (..) (AU)

Objective. Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. Material and methods. Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. Results. After a year of serial (..) (AU)

[Use of self-expandable prosthesis in esophageal stenosis in children]. / Uso de prótesis autoexpandibles en estenosis esofágicas en niños.

OBJECTIVE: Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. MATERIAL AND METHODS: Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. RESULTS: After a year of serial dilations, we placed two consecutive metal stents in one patient with caustic stricture. After its withdrawal, new dilations have been needed, but with longer asymptomatic period. The other two patients had peptic strictures; biodegradable stents were placed after months of serial dilations, before performing antireflux surgery. None of them needed further dilation. CONCLUSIONS: Esophageal stent placement has solved the problem without further dilation in peptic esophageal strictures. Asymptomatic period was significantly increased in caustic stricture. The results obtained with self-expanding stents are promising.

Diagnóstico prenatal en un caso de secuestro pulmonar intralobular asociado con malformación adenomatoidea quística / Prenatal diagnosis in a case of intralobar pulmonary sequestration associated with cystic adenomatoid malformation

Las malformaciones pulmonares congénitas constituyen una causa infrecuente de morbilidad neonatal. Muchas de ellas, como los quistes broncogénicos, los secuestros pulmonares y la malformación adenomatoidea quística pulmonar han sido clasificadas como “malformaciones del intestino anterior” ya que comparten un origen común. Su diagnóstico prenatal es infrecuente a no ser que las pruebas se realicen en centros especializados. La ultrasonografía prenatal permite el diagnóstico y el seguimiento de estas malformaciones, así como el asesoramiento a los padres. En este artículo aportamos un caso de secuestro pulmonar asociado con malformación adenomatoidea quística, diagnosticado y seguido prenatalmente. Esta afectación está poco descrita en la bibliografía en lengua española consultada. El conocimiento prenatal de esta enfermedad constituyó un factor decisivo para la planificación del parto y el tratamiento del paciente tras el nacimiento. Se decidió realizar cirugía electiva en un centro especializado. También se plantean en este artículo consideraciones respecto al diagnóstico diferencial, la evolución variable de estas anomalías durante su seguimiento ultrasonográfico, el pronóstico materno y fetal, la discusión sobre las alternativas de tratamiento y se ofrece una amplia revisión de la bibliografía (AU)

Congenital malformations of the lung are a rare cause of neonatal morbidity. Most of them-bronchogenic cyst, pulmonary sequestration and cystic adenomatoid malformation of the lung-have been clasiffied as bronchopulmonary foregut malformations since they share a common origin. Their prenatal diagnosis is uncommon unless carried out in specialized centers. Prenatal ultrasonography enables the obstetrician to diagnose and monitor theses malformations and to provide parental counseling. In this article, we report a case of pulmonary sequestration associated with cystic adenomatoid malformation that was diagnosed and monitored prenatally. This entity has rarely been described in the Spanish medical literature reviewed. The prenatal diagnosis of this anomaly was decisive in the planning of the delivery and the postnatal management of the infant. Elective surgery in a center staffed with a team of pediatric surgeons was considered the best alternative. We discuss the differential diagnosis, the different courses these malformations may present during their ultrasonographic follow-up, maternal and fetal outcomes and treatment options, and provide an extensive review of the literature (AU)

[Helicobacter pylori: a new pathogen to be considered in infancy]. / Helicobacter pylori: un nuevo patógeno a considerar en la infancia.

A prospective study in 11 consecutive children with gastroduodenal disease is presented. Endoscopic study and gastric biopsies were performed for histologic and bacteriologic research of H. pylori. Endoscopic studies in 7 of the patients showed lesions of antritis that were assessed by histopathologic study. H. pylori was isolated in 4 of them. The presence of H. pylori in the stomach of children with chronic gastritis is confirmed. It is remarked the importance of gastric biopsy, at least when the endoscopic study shows the presence of antral gastritis.

[High risk congenital diaphragmatic hernia. Factors predicting mortality]. / Hernia diafragmática congénita de alto riesgo. Factores predictores de mortalidad.

A retrospective study of patients with high-risk congenital diaphragmatic hernia operated on in our hospital the last 15 years is made in order to establish some predictors involved in the final evolution of the patients. The best prognostic correlation has been demonstrated by preoperatory roentgenogram, Apgar-test and gasometric values 24 hours after surgical repair. A delayed surgical operation is also correlated with a better prognosis in accordance with the suitability of respiratory stabilization of the patient before the stress of surgery or because of a lesser respiratory insufficiency in patients operated on later.