An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms?

INTRODUCTION AND OBJECTIVES: Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective is this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules. MATERIAL AND METHODS: We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis. RESULTS: We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study. CONCLUSIONS: The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy associate with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence do not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

Un intento de reducir intervenciones quirúrgicas innecesarias... ¿Pueden ayudar las características ecográficas a diferenciar el adenoma del carcinoma en las neoplasias tiroideas foliculares? / An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms?

Introducción y objetivosLos nódulos tiroideos requieren con frecuencia evaluación mediante ecografía y biopsia por aspiración con aguja fina (BAAF). No obstante, la BAAF no permite la diferenciación entre adenoma y carcinoma folicular en lesiones de tipo IV según la clasificación de Bethesda. Esto provoca numerosas intervenciones quirúrgicas innecesarias porque no es posible garantizar el carácter benigno de las lesiones, ni siquiera cuando la mayoría de las muestras corresponden a adenomas o incluso a otras lesiones benignas. El objetivo de este estudio es establecer si hay características ecográficas que nos ayudarían a pronosticar el riesgo de malignidad de los nódulos con un diagnóstico anatomopatológico de neoplasia folicular para conseguir un abordaje más conservador de los nódulos sin sospecha de malignidad.Material y métodosEstudiamos 61 nódulos en 61 pacientes (51 mujeres y 10 varones) que se habían sometido a intervención quirúrgica de la glándula tiroides y tenían resultados histopatológicos de adenoma o carcinoma folicular. Se analizaron diversas características ecográficas de los nódulos (composición, ecogenicidad, borde, estado de calcificación, presencia de halo y sospecha general de malignidad según el observador) y se estableció su correlación con el análisis histopatológico.ResultadosObservamos una relación estadísticamente significativa entre el carcinoma folicular y la presencia de calcificaciones, bordes mal definidos y la sospecha o impresión general del observador (definida por sospecha clara de signos ecográficos de malignidad, como calcificación, borde mal definido y un nódulo sólido marcadamente hipoecoico; y signos ecográficos de benignidad, como composición ecogénica predominantemente quística y presencia de halo hipoecogénico perinodular). Sin embargo, todas estas características han mostrado una sensibilidad baja en el estudio que nos ocupa (30%, 30% y 50%, respectivamente)...(AU)

Introduction and objectivesThyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions.The objective is this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules.Material and methodsWe studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma.Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis.ResultsWe have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study... (AU)

Salt marsh vegetation change during a half-century of experimental nutrient addition and climate-driven controls in Great Sippewissett Marsh.

Vegetative cover was mapped annually, 1976-2022, in experimental plots in Great Sippewissett Marsh, Cape Cod, USA, chronically fertilized at different doses, and subject to changes in sea level and other climate-related variables. Dominant species within areas of higher elevation in the plots followed different decadal trajectories: rise in sea level diminished cover of Spartina patens; higher N supplies increased cover of Distichlis spicata. The opportunistic growth response of D. spicata to high N supplies unexpectedly fostered increased platform accretion, a feature that persisted for succeeding decades and led to further changes in vegetation: D. spicata functioned as an effective ecosystem engineer with long-term ecological consequences. Shrubs usually found in upper marsh margins expanded into areas where D. spicata had stimulated accretion, then shaded and excluded D. spicata, but subsequently lost cover as sea level rise continued. Increased N supply converted stands of Spartina alterniflora, the dominant low marsh species, from short to taller ecophenotypes; sea level rise had minor effects on S. alterniflora, but during 2019-2022 appeared to reach a tipping point that fostered taller S. alterniflora and bare space even in un-fertilized control plots, and in Great Sippewissett Marsh in general. Model results anticipate that-in spite of potential accretion enhanced by vegetation and ecosystem engineer effects-there will be loss of high marsh, transient increases of low marsh, followed by loss of low marsh, and eventual conversion to shallow open water by the end of the century. Dire local projections match those of the plurality of recent reports from salt marshes around the world. Proposed management strategies may only delay unfortunate outcomes rather than maintain wetlands. Concerted reductions of warming from greenhouse gases, and lower N loads seem necessary to address the coming crises in wetlands-and many other environmental threats.

An attempt to reduce unnecessary surgical procedures... Can ultrasound characteristics help in differentiating adenoma vs carcinoma in follicular thyroid neoplasms? / Un intento de reducir intervenciones quirúrgicas innecesarias... ¿Pueden ayudar las características ecográficas a diferenciar el adenoma del carcinoma en las neoplasias tiroideas foliculares?

INTRODUCTION AND OBJECTIVES: Thyroid nodules frequently require ultrasound and Fine Needle Aspiration Cytology (FNAC) evaluation. However, FNA cytology does not allow differentiation between follicular adenoma and carcinoma on Bethesda type IV lesions. This situation leads to many unnecessary surgical procedures because it is not possible to assure the benignity of the lesions, even when most of the specimens correspond to adenomas or even other benign lesions. The objective in this study is to establish if there are any US characteristics that would help us to predict the risk of malignancy of nodules with a pathological diagnosis of follicular neoplasm in order to achieve a more conservative management for non-suspicious nodules. MATERIAL AND METHODS: We studied 61 nodules in 61 patients (51 women and 10 men) that underwent thyroid surgery and had histopathological results of either follicular adenoma or carcinoma. Different US characteristics of the nodules were analysed (composition, echogenicity, margin, calcification status, the presence of halo and overall observer suspicion of malignancy) and were correlated with the histopathological analysis. RESULTS: We have found a statistically significant association between the presence of calcifications, ill-defined borders and overall observer suspicion or impression (defined by well-known suspicious for malignancy ultrasonographic features, such as calcification, poorly defined margin, and a markedly hypoechoic solid nodule; and benign ultrasonographic features, such as predominantly cystic echogenic composition and the presence of a perinodular hypoechogenic halo) with follicular carcinoma. However all those features have shown low sensitivities in the present study (30%, 30% and 50%, respectively). On the other hand, the absence of halo sign has shown a sensitivity of 100% and a negative predictive value (NPV) of 100% in our study. CONCLUSIONS: The presence of calcifications, ill-defined borders and the overall impression or suspicion of malignancy are associated with a higher risk for follicular carcinoma in Bethesda type IV thyroid nodules but their absence does not allow to predict benignity in these nodules. Inversely, when a halo sign lesion is observed, benign follicular neoplasm should be considered.

[Endovascular embolization in the treatment of the pulmonary intralobar sequestration]. / Embolización endovascular en el tratamiento del secuestro pulmonar intralobar.

INTRODUCTION: Up to date the classical therapeutic approach for intralobar sequestrations (IS) has been surgical excision. However, systemic arteries embolization is presented as an alternative, and even constitutes the first line of treatment in some centers. We summarize our experience in selected cases with the aim of preserving the maximum lung parenchyma. MATERIAL AND METHODS: Retrospective study of IS who underwent endovascular embolization at our institution between 2013 and 2014. RESULTS: Three patients of 12, 14 and 21 months old were treated. Two patients had unilateral IS, one in the left lower lobe (LLL) and the other in the right lower lobe (RLL); the third one had bilateral lesions (a CAM-S complex in the RLL and a IS in the LII). The embolization of the four lesions was performed via right femoral artery. The case with bilateral lesions underwent thoracoscopic lobectomy of the CAM-S 7 months after embolization, finding adherences to the diaphragm. None of the patients had immediate complications and were discharged within 48 hours after embolization. In successive ultrasound and plain radiographs controls, with a follow-up of 6, 18 and 30 months, no complications were found. CONCLUSIONS: Systemic vessels embolization is a treatment option for the treatment of IS that avoids surgery, preserves lung parenchyma and does not preclude surgical resection in case of treatment failure or presence of parenchymal lesions. Longer follow-up is needed to determine long-term effectiveness.

INTRODUCCION: El tratamiento de elección de los secuestros intralobares (SI) es la lobectomía pulmonar. La mayoría de complicaciones se asocian a la vascularización sistémica pulmonar anómala. La embolización de las arterias sistémicas se presenta como una alternativa terapéutica, que incluso constituye la primera línea de tratamiento en algunos centros. Resumimos nuestra experiencia al aplicar esta técnica en casos seleccionados. MATERIAL Y METODOS: Estudio retrospectivo de los casos con SI tratados en nuestro centro mediante embolización entre 2013 y 2014, centrado en las indicaciones, resultados, complicaciones y seguimiento. Siendo la lobectomía la primera línea de tratamiento la embolización se reservó para casos seleccionados: bilaterales, con el objetivo de preservar parénquima pulmonar o ante el rechazo familiar a la intervención quirúrgica. RESULTADOS: Se trataron tres pacientes de 12, 14 y 21 meses. Dos presentaban un SI unilateral, uno en lóbulo inferior izquierdo (LII) y otro en el lóbulo inferior derecho (LID); el tercero lesiones bilaterales (un SI en LID y un complejo MAQ-secuestro en LII). Se embolizaron las cuatro lesiones por punción de arteria femoral derecha. El caso con lesiones bilaterales fue intervenido a los 7 meses tras la embolización, realizándose una lobectomía toracoscópica del complejo MAQ-secuestro, hallando adherencias al diafragma. Ninguno presentó complicaciones inmediatas y fueron dados de alta a las 48 horas. En los controles realizados con ecografía y radiografías simples, con seguimientos de 31, 47 y 56 meses, no se han observado complicaciones clínicas ni radiológicas. CONCLUSIONES: La embolización de los vasos sistémicos es una opción en el tratamiento del SI que permite evitar una cirugía, conservar parénquima pulmonar y no impide la exéresis quirúrgica en caso de fallo del tratamiento o lesión parenquimatosa. Es preciso un mayor seguimiento para determinar la efectividad a largo plazo.

Embolización endovascular en el tratamiento del secuestro pulmonar intralobar / Endovascular embolization in the treatment of the pulmonary intralobar sequestration

Introducción. El tratamiento de elección de los secuestros intralobares (SI) es la lobectomía pulmonar. La mayoría de complicaciones se asocian a la vascularización sistémica pulmonar anómala. La embolización de las arterias sistémicas se presenta como una alternativa terapéutica, que incluso constituye la primera línea de tratamiento en algunos centros. Resumimos nuestra experiencia al aplicar esta técnica en casos seleccionados. Material y métodos. Estudio retrospectivo de los casos con SI tratados en nuestro centro mediante embolización entre 2013 y 2014, centrado en las indicaciones, resultados, complicaciones y seguimiento. Siendo la lobectomía la primera línea de tratamiento la embolización se reservó para casos seleccionados: bilaterales, con el objetivo de preservar parénquima pulmonar o ante el rechazo familiar a la intervención quirúrgica. Resultados. Se trataron tres pacientes de 12, 14 y 21 meses. Dos presentaban un SI unilateral, uno en lóbulo inferior izquierdo (LII) y otro en el lóbulo inferior derecho (LID); el tercero lesiones bilaterales (un SI en LID y un complejo MAQ-secuestro en LII). Se embolizaron las cuatro lesiones por punción de arteria femoral derecha. El caso con lesiones bilaterales fue intervenido a los 7 meses tras la embolización, realizándose una lobectomía toracoscópica del complejo MAQ-secuestro, hallando moderadas adherencias al diafragma. Ninguno presentó complicaciones inmediatas y fueron dados de alta a las 48 horas. En los controles realizados con ecografía y radiografías simples, con seguimientos de 31, 47 y 56 meses, no se han observado complicaciones clínicas ni radiológicas. Conclusiones. La embolización de los vasos sistémicos es una opción en el tratamiento del SI que permite evitar una cirugía, conservar parénquima pulmonar y no impide la exéresis quirúrgica en caso de fallo del tratamiento o lesión parenquimatosa. Es preciso un mayor seguimiento para determinar la efectividad a largo plazo (AU)

Introduction. Up to date the classical therapeutic approach for intralobar sequestrations (IS) has been surgical excision. However, systemic arteries embolization is presented as an alternative, and even constitutes the first line of treatment in some centers. We summarize our experience in selected cases with the aim of preserving the maximum lung parenchyma. Material and methods. Retrospective study of IS cases treated with endovascular embolization at our institution between 2013 and 2014. Results. Three patients of 12, 14 and 21 months old were treated. Two patients had unilateral IS, one in the left lower lobe (LLL) and the other in the right lower lobe (RLL); the third one had bilateral lesions (a CAM-S complex in the RLL and a IS in the LII). The embolization of the four lesions was performed via right femoral artery. The case with bilateral lesions underwent thoracoscopic lobectomy of the CAM-S 7 months after embolization, finding moderate adherences to the diaphragm. None of the patients had immediate complications and were discharged within 48 hours after embolization. In successive ultrasound and plain radiography controls, with a follow-up of 31, 47 and 56 months, no complications were found. Conclusions. Systemic vessels embolization is an option for the treatment of IS that avoids surgery, preserves lung parenchyma and does not preclude surgical resection in case of treatment failure or presence of parenchymal lesions. Longer follow-up is needed to determine longterm effectiveness (AU)

CD4+ Th2 cells are directly regulated by IL-10 during allergic airway inflammation.

Interleukin-10 (IL-10) is an important regulatory cytokine required to control allergy and asthma. IL-10-mediated regulation of T cell-mediated responses was previously thought to occur indirectly via antigen-presenting cells. However, IL-10 can act directly on regulatory T cells and T helper type 17 (Th17) cells. In the context of allergy, it is therefore unclear whether IL-10 can directly regulate T helper type 2 (Th2) cells and whether this is an important regulatory axis during allergic responses. We sought to determine whether IL-10 signaling in CD4+ Th2 cells was an important mechanism of immune regulation during airway allergy. We demonstrate that IL-10 directly limits Th2 cell differentiation and survival in vitro and in vivo. Ablation of IL-10 signaling in Th2 cells led to enhanced Th2 cell survival and exacerbated pulmonary inflammation in a murine model of house dust mite allergy. Mechanistically, IL-10R signaling regulated the expression of several genes in Th2 cells, including granzyme B. Indeed, IL-10 increased granzyme B expression in Th2 cells and led to increased Th2 cell death, identifying an IL-10-regulated granzyme B axis in Th2 cells controlling Th2 cell survival. This study provides clear evidence that IL-10 exerts direct effects on Th2 cells, regulating the survival of Th2 cells and severity of Th2-mediated allergic airway inflammation.

Thoracic wall reconstruction with bioabsorbable plates in pediatric malignant thoracic wall tumors.

AIM: Childhood malignant chest wall tumors may require extensive surgical resection and reconstruction with musculoskeletal flaps or non-resorbable prosthetic materials. Implant-related complications and scoliosis often occur. This study analyzes the outcomes of chest wall reconstruction using resorbable plates as an alternative approach. METHODS: Retrospective review (2007-2015) of patients who underwent resection of malignant primary chest wall tumors in 2 tertiary pediatric centers. Reconstruction was performed using copolymer (l-lactic and glycolic acid) plates, fixed to the ribs and surrounding structures with copolymer screws and/or polyglactin sutures. RESULTS: Eight patients aged 10.6+2.6years were treated. There were no operative complications, and implant removal was not required in any case. Six patients received postoperative radiotherapy. Over follow-up (39.6months, range 9.4-78), chest wall shape was maintained in all, and there were no radiological artifacts. Three patients developed scoliosis (Cobb 17°-33°), but treatment was needed only in one, who had undergone hemivertebrectomy. There were no cases of local tumor relapse. One patient died because of metastatic spread. CONCLUSIONS: Implantation of bioabsorbable l-lactic and glycolic acid copolymer plates with a relatively simple technique provided a rigid, stable reconstruction with only mild mid-/long-term complications. Resorbable plates may be a good alternative for pediatric chest wall reconstruction. LEVEL OF EVIDENCE: IV.

[Conservative management of liver trauma and its complications: current gold-standard]. / Tratamiento conservador de los traumatismos hepáticos y sus complicaciones: gold-standard actual.

INTRODUCTION: The liver is the second most frequently involved organ in abdominal trauma in children. The aim of this study was to review the characteristics of liver traumas (LT) in children, its treatment and complications. MATERIAL AND METHODS: Retrospective study of patients with LT treated between 2010-2014. We analyzed data regarding diagnosis, conservative management (CM), complications and treatment. RESULTS: Twenty-four patients of LT with a mean age of 9.8 years (SD: 3.4) were treated at our center. Liver injury degrees according to the Organ Injury Scale of American Association for Surgery of Trauma (AAST) were: grade I (4), grade II (6), grade III (8), grade IV (5) and grade V (1). CT angiography was performed in 23 patients. Four of the six patients with initial hemodynamic instability required blood transfusion; of those, two required angioembolization for active bleeding in extrahepatic locations and a third required damage control surgery. Three patients presented late-onset complications: 2 large size bilomas which underwent spontaneous resolution and a third patient with a right biloma and section of the left bile duct who required a multidisciplinary approach. Median hospital stay was 6 days (r 1-92). With a mean follow-up of 17.75 months (SD: 16.35) (r: 2-57) long-term survival was 96%. The patient who received surgery died due to a post-traumatic brain injury. CONCLUSION: CM seems to be the treatment of choice in LT regardless of injury degree. Surgery should be reserved for cases refractory to CM due to the associated high mortality.

INTRODUCCION: El hígado es el segundo órgano más afectado en traumatismos abdominales en edad pediátrica. El objetivo de este trabajo es revisar las características de los traumatismos hepáticos (TH), su tratamiento y complicaciones. MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TH atendidos entre 2010 -2014. Analizamos datos referentes al diagnóstico, tratamiento conservador (TC), complicaciones y tratamiento de las mismas. RESULTADOS: Se trataron 24 casos de TH con una edad media de 9,8 años (DS: 3,4). Los grados de lesiones hepáticas según la Organ Injury Scale of American Association for Surgery of Trauma (AAST) fueron: grado I (4), grado II (6), grado III (8), grado IV (5) y grado V (1). Se realizó angio-TC en 23 pacientes. Cuatro de los 6 pacientes que presentaron inestabilidad hemodinámica inicial requirieron transfusión de hemoderivados; de éstos, 2 requirieron angioembolización por sangrado activo extrahepático y un tercero se intervino de forma urgente. Tres pacientes presentaron complicaciones tardías: 2 bilomas de gran tamaño que se resolvieron espontáneamente y un biloma derecho con sección de vía biliar izquierda que requirió un abordaje multidisciplinar. En los 3 casos se trataba de traumatismos de alto grado (2 grado IV, 1 grado V). La mediana de estancia hospitalaria fue de 6 días (r: 1-92). Con una media de seguimiento de 17,75 meses (DS: 16,35) (r: 2-57) la supervivencia global fue del 96%. El paciente que requirió cirugía falleció por el traumatismo craneoencefálico asociado. CONCLUSIONES: El TC parece ser de primera elección en los TH independientemente del grado aunque no está exento de complicaciones. La cirugía debe reservarse para los casos refractarios al TC dada la alta mortalidad que conlleva.

[Vascular interventional radiology: a fundamental procedure for the management of paediatric trauma]. / Radiología vascular intervencionista: un arma para el tratamiento del niño politraumatizado. Experiencia en un centro de Trauma Pediátrico.

INTRODUCTION: The management of active bleeding with haemodinamic lability in the paediatric trauma patient is difficult and generally leads to damage control surgery. Vascular Interventional Radiology (VIR) techniques are useful for the diagnosis as for the definitive treatment. AIM: The aim of our study was to describe our experience and evaluate effectiveness of VIR in the management of the paediatric trauma patient with active bleeding signs. METHODS: Retrospective analysis (2003-2014) of politraumatic patients who showed contrast blush on computed tomography and then treated by VIR techniques. RESULTS: In the reported study period 16 patients underwent VIR procedures. Medium age was 13 years (5-17). The most frequent lesion mechanism was traffic accident (8 out of 17) and 93,75% were blunt traumas. Findings on initial Computed Tomography were 12 contrast blushes and 2 absences of arterial flow. In 2 cases the contrast blush appeared 48 hours after the accident. Arteriography allowed us to localize the bleeding vessels in all the cases, performing selective or supraselective renal (7), pelvic (5), hepatic (3), splenic (1) and intercostal (1) embolization. One patient required an endoprothesis for renal revascularization. Two cases needed additional surgical procedures (2 nephrectomies) because of complete section of the renal artery (1) and disruption of the ureteropelvic junction (1). One case required hemofiltration in relation to rhabdomyolysis. CONCLUSION: In our experience VIR is a valuable diagnostic and therapeutic procedure for the management of paediatric trauma patients, with high effectiveness and a low complication rate.

INTRODUCCION: El tratamiento del sangrado activo en niños politraumatizados con labilidad hemodinámica es difícil y generalmente obliga a realizar una cirugía de control de daños. La aplicación de técnicas de Radiología Vascular Intervencionista (RVI) ayuda al diagnóstico y tratamiento definitivo. OBJETIVO: Describir nuestra experiencia y valorar la eficacia de la RVI en el tratamiento del paciente traumático pediátrico con signos de sangrado activo. MATERIAL Y METODO: Análisis retrospectivo (2003-2014) de los pacientes politraumatizados tratados mediante RVI en los cuales la AngioTC mostraba fuga de contraste o ausencia de captación. RESULTADOS: En el periodo de estudio se trataron 16 pacientes, con una media de edad de 13 años (5-17). El mecanismo lesional más frecuente fue el accidente de tráfico. El 93,75% fueron traumatismos cerrados. Los hallazgos de la angioTC inicial fueron 12 sangrados activos, 2 ausencias de flujo arterial. Dos sangrados se produjeron a las 48 horas del trauma. La arteriografía permitió localizar los vasos sangrantes, realizándose embolización selectiva o supraselectiva a nivel renal (7), pélvico (5), hepático (3), esplénico (1) e intercostal (1). Un paciente preciso revascularización renal con endoprótesis. Un paciente requirió nefrectomía urgente tras la angiografía por avulsión arterial completa y en 1 caso se realizó nefrectomía a las 48 horas por fuga de contraste y disrupción de la unión pieloureteral. En un caso se observó rabdomiólisis como complicación que requirió hemofiltración. CONCLUSION: La RVI constituye un procedimiento diagnóstico y terapéutico en el abordaje del paciente pediátrico traumático, con alta efectividad y escasas complicaciones, siendo una herramienta fundamental en un centro de trauma pediátrico.

Riesgo anestésico actual de las masas mediastínicas anteriores / Current anesthesia risk of anterior mediastinal masses

Objetivo. Analizar el riesgo actual de eventos anestésicos durante intervenciones quirúrgicas en pacientes con masas mediastínicas anteriores (MMA) en un centro terciario, utilizando los factores de riesgo publicados en la literatura para planificar el procedimiento. Materiales y métodos. Estudio retrospectivo (2009-2015) de los pacientes pediátricos con MMA sometidos a procedimientos quirúrgicos al debut. Se registraron: factores de riesgo publicados (clínicos, radiológicos), particularmente los estadísticamente significativos, diagnóstico, procedimiento quirúrgico y anestésico, medidas especiales y eventos anestésicos. Los pacientes se clasificaron como alto o bajo riesgo según presentasen compresión en vía aérea o vascular o síntomas de gravedad. Resultados. Registramos a 38 pacientes (media de edad 11,9 años ± 4,2). El 94,7% presentaban trastornos linfoproliferativos. El 50% tenían síntomas respiratorios y el 76,3% fueron considerados como de alto riesgo, al presentar uno o más factores ES. Solo 4 casos recibieron neoadyuvancia. Se realizaron 29 biopsias (3 toracoscópicas), 11 colocaciones de catéteres centrales, 2 drenajes torácicos y 3 resecciones. La técnica anestésica consistió en sedoanalgesia (60,5%) y diversas técnicas de anestesia general (41,4% de los casos de alto riesgo). Solo registramos 2 eventos (5,3%) consistentes en dificultad para la ventilación, respondiendo ambos a medidas básicas. Todas las intervenciones se finalizaron satisfactoriamente. Conclusiones. La evaluación preoperatoria del riesgo en MMA mediante historia clínica y TAC/RMN junto a la planificación anestésicoquirúrgica conduce a unos resultados excelentes. Deben favorecerse los procedimientos menos invasivos, pero si son precisos, la anestesia general planificada y en manos expertas es segura incluso en pacientes de riesgo

Aim. To analyze the current risk of an anesthetic event during surgical acts in pediatric patients with anterior mediastinal masses (AMM) in a tertiary oncology center, using the previously published risk factors to plan the procedure. Materials and methods. Retrospective study (2009-2015) of pediatric patients with AMM who underwent surgical procedures at debut. Published risk factors (symptoms, radiological findings), with special focus on the statistically significant ones, diagnosis, surgical and anesthetic procedure, special measures, and anesthetic events were recorded. Patients were classified as high or low-risk when airway or vascular compression or severe symptoms were present. Main results. 38 patients (average age 11.9 years, 1.4-17.3) were included. Diagnosis was lymphoproliferative disorder in 94.7%. 50% showed respiratory symptoms and 76.3% were considered as ‘high-risk’ patients, presenting one or more SS risk factors. Only 4 patients received neoadjuvant treatment. The procedures were: 29 biopsies (3 thoracoscopically), 11 placement of central venous catheters, 2 chest drains and 3 mass resections. Anesthetic management consisted on sedoanalgesia (60.5%) and different general anesthesia techniques (41.4% of the high-risk cases). Only 2 events (5.3%) happened, consisting on difficult ventilation, and both responded to basic rescue measures. All procedures could be satisfactorily finished. Conclusions. Preoperative evaluation of risk in AMM through clinical history and CT/MRI and surgical/anesthetic planning leads to excellent outcomes. The least aggressive procedures should be favored, but if needed, planned general anesthesia under experienced hands is safe even in risk patients

Tratamiento conservador de los traumatismos hepáticos y sus complicaciones: gold-standard actual / Conservative management of liver trauma and its complications: current gold-standard

Introducción. El hígado es el segundo órgano más afectado en traumatismos abdominales en edad pediátrica. El objetivo de este trabajo es revisar las características de los traumatismos hepáticos (TH), su tratamiento y complicaciones. Material y métodos. Estudio retrospectivo de pacientes con TH atendidos entre 2010 -2014. Analizamos datos referentes al diagnóstico, tratamiento conservador (TC), complicaciones y tratamiento de las mismas. Resultados. Se trataron 24 casos de TH con una edad media de 9,8 años (DS: 3,4). Los grados de lesiones hepáticas según la Organ Injury Scale of American Association for Surgery of Trauma (AAST) fueron: grado I (4), grado II (6), grado III (8), grado IV (5) y grado V (1). Se realizó angio-TC en 23 pacientes. Cuatro de los 6 pacientes que presentaron inestabilidad hemodinámica inicial requirieron transfusión de hemoderivados; de éstos, 2 requirieron angioembolización por sangrado activo extrahepático y un tercero se intervino de forma urgente. Tres pacientes presentaron complicaciones tardías: 2 bilomas de gran tamaño que se resolvieron espontáneamente y un biloma derecho con sección de vía biliar izquierda que requirió un abordaje multidisciplinar. En los 3 casos se trataba de traumatismos de alto grado (2 grado IV, 1 grado V). La mediana de estancia hospitalaria fue de 6 días (r: 1-92). Con una media de seguimiento de 17,75 meses (DS: 16,35) (r: 2-57) la supervivencia global fue del 96%. El paciente que requirió cirugía falleció por el traumatismo craneoencefálico asociado. Conclusiones. El TC parece ser de primera elección en los TH independientemente del grado aunque no está exento de complicaciones. La cirugía debe reservarse para los casos refractarios al TC dada la alta mortalidad que conlleva

Introduction. The liver is the second most frequently involved organ in abdominal trauma in children. The aim of this study was to review the characteristics of liver traumas (LT) in children, its treatment and complications. Material and methods. Retrospective study of patients with LT treated between 2010-2014. We analyzed data regarding diagnosis, conservative management (CM), complications and treatment. Results. Twenty-four patients of LT with a mean age of 9.8 years (SD: 3.4) were treated at our center. Liver injury degrees according to the Organ Injury Scale of American Association for Surgery of Trauma (AAST) were: grade I (4), grade II (6), grade III (8), grade IV (5) and grade V (1). CT angiography was performed in 23 patients. Four of the six patients with initial hemodynamic instability required blood transfusion; of those, two required angioembolization for active bleeding in extrahepatic locations and a third required damage control surgery. Three patients presented late-onset complications: 2 large size bilomas which underwent spontaneous resolution and a third patient with a right biloma and section of the left bile duct who required a multidisciplinary approach. Median hospital stay was 6 days (r 1-92). With a mean follow-up of 17.75 months (SD: 16.35) (r: 2-57) long-term survival was 96%. The patient who received surgery died due to a post-traumatic brain injury. Conclusion. CM seems to be the treatment of choice in LT regardless of injury degree. Surgery should be reserved for cases refractory to CM due to the associated high mortality

Radiología vascular intervencionista: un arma para el tratamiento del niño politraumatizado. Experiencia en un centro de Trauma Pediátrico / Vascular interventional radiology: a fundamental procedure for the management of paediatric trauma

Introducción. El tratamiento del sangrado activo en niños politraumatizados con labilidad hemodinámica es difícil y generalmente obliga a realizar una cirugía de control de daños. La aplicación de técnicas de Radiología Vascular Intervencionista (RVI) ayuda al diagnóstico y tratamiento definitivo. Objetivo. Describir nuestra experiencia y valorar la eficacia de la RVI en el tratamiento del paciente traumático pediátrico con signos de sangrado activo. Material y método. Análisis retrospectivo (2003-2014) de los pacientes politraumatizados tratados mediante RVI en los cuales la AngioTC mostraba fuga de contraste o ausencia de captación. Resultados. En el periodo de estudio se trataron 16 pacientes, con una media de edad de 13 años (5-17). El mecanismo lesional más frecuente fue el accidente de tráfico. El 93,75% fueron traumatismos cerrados. Los hallazgos de la angioTC inicial fueron 12 sangrados activos, 2 ausencias de flujo arterial. Dos sangrados se produjeron a las 48 horas del trauma. La arteriografía permitió localizar los vasos sangrantes, realizándose embolización selectiva o supraselectiva a nivel renal (7), pélvico (5), hepático (3), esplénico (1) e intercostal (1). Un paciente preciso revascularización renal con endoprótesis. Un paciente requirió nefrectomía urgente tras la angiografía por avulsión arterial completa y en 1 caso se realizó nefrectomía a las 48 horas por fuga de contraste y disrupción de la unión pieloureteral. En un caso se observó rabdomiólisis como complicación que requirió hemofiltración. Conclusión. La RVI constituye un procedimiento diagnóstico y terapéutico en el abordaje del paciente pediátrico traumático, con alta efectividad y escasas complicaciones, siendo una herramienta fundamental en un centro de trauma pediátrico

Introduction. The management of active bleeding with haemodinamic lability in the paediatric trauma patient is difficult and generally leads to damage control surgery. Vascular Interventional Radiology (VIR) techniques are useful for the diagnosis as for the definitive treatment. Aim. The aim of our study was to describe our experience and evaluate effectiveness of VIR in the management of the paediatric trauma patient with active bleeding signs. Methods. Retrospective analysis (2003-2014) of politraumatic patients who showed contrast blush on computed tomography and then treated by VIR techniques. Results. In the reported study period 16 patients underwent VIR procedures. Medium age was 13 years (5-17). The most frequent lesion mechanism was traffic accident (8 out of 17) and 93,75% were blunt traumas. Findings on initial Computed Tomography were 12 contrast blushes and 2 absences of arterial flow. In 2 cases the contrast blush appeared 48 hours after the accident. Arteriography allowed us to localize the bleeding vessels in all the cases, performing selective or supraselective renal (7), pelvic (5), hepatic (3), splenic (1) and intercostal (1) embolization. One patient required an endoprothesis for renal revascularization. Two cases needed additional surgical procedures (2 nephrectomies) because of complete section of the renal artery (1) and disruption of the ureteropelvic junction (1). One case required hemofiltration in relation to rhabdomyolysis. Conclusion. In our experience VIR is a valuable diagnostic and therapeutic procedure for the management of paediatric trauma patients, with high effectiveness and a low complication rate

[Current anesthesia risk of anterior mediastinal masses]. / Riesgo anestésico actual de las masas mediastínicas anteriores.

AIM: To analyze the current risk of an anesthetic event during surgical acts in pediatric patients with anterior mediastinal masses (AMM) in a tertiary oncology center, using the previously published risk factors to plan the procedure. MATERIALS AND METHODS: Retrospective study (2009-2015) of pediatric patients with AMM who underwent surgical procedures at debut. Published risk factors (symptoms, radiological findings), with special focus on the statistically significant ones, diagnosis, surgical and anesthetic procedure, special measures, and anesthetic events were recorded. Patients were classified as high or low-risk when airway or vascular compression or severe symptoms were present. MAIN RESULTS: Retrospective study (2009-2015) of pediatric patients with AMM who underwent surgical procedures at debut. Published risk factors (symptoms, radiological findings), with special focus on the statistically significant ones, diagnosis, surgical and anesthetic procedure, special measures, and anesthetic events were recorded. Patients were classified as high or low-risk when airway or vascular compression or severe symptoms were present. CONCLUSIONS: Preoperative evaluation of risk in AMM through clinical history and CT/MRI and surgical/anesthetic planning leads to excellent outcomes. The least aggressive procedures should be favored, but if needed, planned general anesthesia under experienced hands is safe even in risk patients.

OBJETIVO: Analizar el riesgo actual de eventos anestésicos durante intervenciones quirúrgicas en pacientes con masas mediastínicas anteriores (MMA) en un centro terciario, utilizando los factores de riesgo publicados en la literatura para planificar el procedimiento. MATERIALES Y METODOS: Estudio retrospectivo (2009-2015) de los pacientes pediátricos con MMA sometidos a procedimientos quirúrgicos al debut. Se registraron: factores de riesgo publicados (clínicos, radiológicos), particularmente los estadísticamente significativos, diagnóstico, procedimiento quirúrgico y anestésico, medidas especiales y eventos anestésicos. Los pacientes se clasificaron como alto o bajo riesgo según presentasen compresión en vía aérea o vascular o síntomas de gravedad. RESULTADOS: Registramos a 38 pacientes (media de edad 11,9 años ± 4,2). El 94,7% presentaban trastornos linfoproliferativos. El 50% tenían síntomas respiratorios y el 76,3% fueron considerados como de alto riesgo, al presentar uno o más factores ES. Solo 4 casos recibieron neoadyuvancia. Se realizaron 29 biopsias (3 toracoscópicas), 11 colocaciones de catéteres centrales, 2 drenajes torácicos y 3 resecciones. La técnica anestésica consistió en sedoanalgesia (60,5%) y diversas técnicas de anestesia general (41,4% de los casos de alto riesgo). Solo registramos 2 eventos (5,3%) consistentes en dificultad para la ventilación, respondiendo ambos a medidas básicas. Todas las intervenciones se finalizaron satisfactoriamente. CONCLUSIONES: La evaluación preoperatoria del riesgo en MMA mediante historia clínica y TAC/RMN junto a la planificación anestésico-quirúrgica conduce a unos resultados excelentes. Deben favorecerse los procedimientos menos invasivos, pero si son precisos, la anestesia general planificada y en manos expertas es segura incluso en pacientes de riesgo.

Lesiones laringotraqueales traumáticas en niños: ¿cuándo operar? / Laryngotracheal traumatic injuries (LTI) in children: when to operate?

Introducción. Las lesiones laringotraqueales traumáticas pediátricas están asociadas a una importante morb-imortalidad. Aunque históricamente el tratamiento ha sido quirúrgico, en la actualidad el enfoque conservador ha adquirido una mayor importancia. Valoramos el tratamiento y las indicaciones quirúrgicas de los traumatismos laringotraqueales tratados en nuestro centro. Material y métodos. Análisis retrospectivo de pacientes con traumatismos laringotraqueales del 2007 al 2014. Resultados. Siete pacientes, mediana de edad 4 años (r: 2-15), 6 traumatismos cerrados y 1 abierto. El 71,4% presentaban dificultad respiratoria, dolor y enfisema subcutáneo. Cinco fueron intubados (3 en prehospitalaria y 2 en hospital). En todos ellos se realizó fibrobroncoscopia determinando la localización, la extensión de la lesión y la posibilidad de extubación. En dos de ellos se asoció esofagoscopia. Dos casos no presentaban clínica respiratoria y el enfisema no progresó por lo que se tomó una actitud expectante y no precisaron broncoscopia. El 71,4% se trataron conservadoramente, siendo el criterio de tratamiento conservador la no progresión del enfisema ni empeoramiento del estado respiratorio, independientemente del grado y localización de la lesión, con una tasa de éxito del 100%. Dos pacientes se intervinieron: una fístula tráqueo-esofágica producida por una quemadura (pila de botón) que requirió resección traqueal; y una sección traqueal abierta asociada a lesión vascular, ambas con correcta evolución posterior. Conclusiones. En caso de no progresión de la clínica respiratoria o del enfisema, e independientemente del grado y localización, las lesiones laringotraqueales pueden tratarse de manera conservadora con o sin intubación. Lesiones esofágicas asociadas y lesiones abiertas obligan a un abordaje quirúrgico. Un diagnóstico precoz minimiza la morbimortalidad

Introduction. Paediatric LTI is associated with significant morbidmortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution. Material and methods. Retrospective study of patients with LTI treated between 2007 and 2014. Results. Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma. Respiratory distress, pain and subcutaneous emphysema were presented in 71.4% of the patients. Five children were intubated (3 pre-hospital care and 2 after reaching the hospital), all of them underwent fibrobronchoscopy, determining the location, the extention, and assessing the possibility of extubation. Esophagoscopy was made in 2 cases. The remaining 2 cases were bounded to observation as they did not have respiratory symptoms or progressive emphysema, precluding bronchoscopy. Conservative management was followed in 71.4% of the patients, with a 100% success rate. Conservative management criteria were no progression of emphysema or respiratory distress, regardless the degree and location of the lesions. Two patients needed surgery: one tracheoesophageal fistula caused by a button battery, and the other was a tracheal open section associated with vascular injury. Both of them recovered uneventfully. Conclusions. If the respiratory symptoms or the emphysema do not progress, patients with LTI can be managed conservatively, regardless of size or location of the injury. Associated esophageal lesions and open injuries require surgical management. An early diagnosis is mandatory in order to minimize morbidity and mortality

Rotura de un aneurisma de arteria mesentérica superior en edad pediátrica: caso clínico y revisión de la literatura / Rupture of a superior mesenteric artery aneurysm in pediatric age: case report and literature review

Introducción. Los aneurismas esplácnicos son excepcionales en la edad pediátrica. La elevada mortalidad por rotura justifica su tratamiento, existiendo diversas opciones terapéuticas entre las que destacan la cirugía y, recientemente, el tratamiento endovascular. Caso clínico. Paciente de 11 años que presentó dolor abdominal súbito y caída del hematocrito. La angio-TC abdominal urgente mostró un aneurisma sacular de la arteria mesentérica superior (AMS) a 4 cm del ostium con disección de la luz y signos de sangrado activo. Se realizó una angiografía que confirmó el aneurisma. Se colocó un stent autoexpandible en el tronco principal de la arteria mesentérica superior con repleción del aneurisma con microcoils y Onyx, sin evidenciar perfusión residual de la falsa luz y comprobando una adecuada vascularización tanto distal como de las ramas yeyuno-ileales. Se instauró doble antiagregación con AAS y dipiridamol. Tras 24 meses de seguimiento se encuentra asintomática. Comentarios. El tratamiento endovascular es efectivo en el paciente pediátrico, incluso en situaciones de emergencia

Introduction. Splanchnic artery aneurysms are rare in children. High mortality from rupture justifies its treatment, with various therapeutic options among which stand out surgery and recently, endovascular treatment. Case report. A 11 year old girl presented with abdominal pain and sudden drop in hematocrit. The urgent abdominal CT angiography showed a saccular aneurysm of the superior mesenteric artery (SMA) at 4 cm from the ostium with dissection and active bleeding. A selective angiography was performed which confirmed the dissection. A self-expanding stent was placed in the main trunk of the SMA and a transcatheter coil and onyx embolization of the aneurysm was performed. The control angiogram showed no evidence of residual perfusion of the false lumen and demonstrated proper vascularization of the distal jejunumileal branches. Dual antiplatelet therapy with aspirin and dipyridamole was begun. After 24 months of follow-up the patient is asymptomatic. Comments. Endovascular treatment of a SMA aneurysm is effective in the pediatric patient, even in emergency situations

[Rupture of a superior mesenteric artery aneurysm in pediatric age: case report and literature review]. / Rotura de un aneurisma de arteria mesentérica superior en edad pediátrica: caso clínico y revisión de la literatura.

INTRODUCTION: Splanchnic artery aneurysms are rare in children. High mortality from rupture justifies its treatment, with various therapeutic options among which stand out surgery and recently, endovascular treatment. CASE REPORT: A 11 year old girl presented with abdominal pain and sudden drop in hematocrit. The urgent abdominal CT angiography showed a saccular aneurysm of the superior mesenteric artery (SMA) at 4 cm from the ostium with dissection and active bleeding. A selective angiography was performed which confirmed the dissection. A self-expanding stent was placed in the main trunk of the SMA and a transcatheter coil and onyx embolization of the aneurysm was performed. The control angiogram showed no evidence of residual perfusion of the false lumen and demonstrated proper vascularization of the distal jejunum-ileal branches. Dual antiplatelet therapy with aspirin and dipyridamole was begun. After 24 months of follow-up the patient is asymptomatic. COMMENTS: Endovascular treatment of a SMA aneurysm is effective in the pediatric patient, even in emergency situations.

INTRODUCCION: Los aneurismas esplácnicos son excepcionales en la edad pediátrica. La elevada mortalidad por rotura justifica su tratamiento, existiendo diversas opciones terapéuticas entre las que destacan la cirugía y, recientemente, el tratamiento endovascular. CASO CLINICO: Paciente de 11 años que presentó dolor abdominal súbito y caída del hematocrito. La angio-TC abdominal urgente mostró un aneurisma sacular de la arteria mesentérica superior (AMS) a 4 cm del ostium con disección de la luz y signos de sangrado activo. Se realizó una angiografía que confirmó el aneurisma. Se colocó un stent autoexpandible en el tronco principal de la arteria mesentérica superior con repleción del aneurisma con microcoils y Onyx, sin evidenciar perfusión residual de la falsa luz y comprobando una adecuada vascularización tanto distal como de las ramas yeyuno-ileales. Se instauró doble antiagregación con AAS y dipiridamol. Tras 24 meses de seguimiento se encuentra asintomática.. COMENTARIOS: El tratamiento endovascular es efectivo en el paciente pediátrico, incluso en situaciones de emergencia.

[Laryngotracheal traumatic injuries (LTI) in children: when to operate?] / Lesiones laringotraqueales traumáticas en niños ¿cuándo operar?

INTRODUCTION: Paediatric LTI is associated with significant morbid-mortality. Although historically first line treatment was surgical, conservative management is making headway. The purpose of this study was to analyze the management and surgical indications of LTI treated at our institution. MATERIAL AND METHODS: Retrospective study of patients with LTI treated between 2007 and 2014. RESULTS: Six out of seven patients, with a median age of 4 years (2-15), had blunt traumas and one had an open trauma. Respiratory distress, pain and subcutaneous emphysema were presented in 71.4% of the patients. Five children were intubated (3 pre-hospital care and 2 after reaching the hospital), all of them underwent fibrobronchoscopy, determining the location, the extention, and assessing the possibility of extubation. Esophagoscopy was made in 2 cases. The remaining 2 cases were bounded to observation as they did not have respiratory symptoms or progressive emphysema, precluding bronchoscopy. Conservative management was followed in 71.4% of the patients, with a 100% success rate. Conservative management criteria were no progression of emphysema or respiratory distress, regardless the degree and location of the lesions. Two patients needed surgery: one tracheoesophageal fistula caused by a button battery, and the other was a tracheal open section associated with vascular injury. Both of them recovered uneventfully. CONCLUSIONS: If the respiratory symptoms or the emphysema do not progress, patients with LTI can be managed conservatively, regardless of size or location of the injury. Associated esophageal lesions and open injuries require surgical management. An early diagnosis is mandatory in order to minimize morbidity and mortality.

INTRODUCCION: Las lesiones laringotraqueales traumáticas pediátricas están asociadas a una importante morb-imortalidad. Aunque históricamente el tratamiento ha sido quirúrgico, en la actualidad el enfoque conservador ha adquirido una mayor importancia. Valoramos el tratamiento y las indicaciones quirúrgicas de los traumatismos laringotraqueales tratados en nuestro centro. MATERIAL Y METODOS: Análisis retrospectivo de pacientes con traumatismos laringotraqueales del 2007 al 2014. RESULTADOS: Siete pacientes, mediana de edad 4 años (r: 2-15), 6 traumatismos cerrados y 1 abierto. El 71,4% presentaban dificultad respiratoria, dolor y enfisema subcutáneo. Cinco fueron intubados (3 en prehospitalaria y 2 en hospital). En todos ellos se realizó fibrobroncoscopia determinando la localización, la extensión de la lesión y la posibilidad de extubación. En dos de ellos se asoció esofagoscopia. Dos casos no presentaban clínica respiratoria y el enfisema no progresó por lo que se tomó una actitud expectante y no precisaron broncoscopia. El 71,4% se trataron conservadoramente, siendo el criterio de tratamiento conservador la no progresión del enfisema ni empeoramiento del estado respiratorio, independientemente del grado y localización de la lesión, con una tasa de éxito del 100%. Dos pacientes se intervinieron: una fístula tráqueo-esofágica producida por una quemadura (pila de botón) que requirió resección traqueal; y una sección traqueal abierta asociada a lesión vascular, ambas con correcta evolución posterior. CONCLUSIONES: En caso de no progresión de la clínica respiratoria o del enfisema, e independientemente del grado y localización, las lesiones laringotraqueales pueden tratarse de manera conservadora con o sin intubación. Lesiones esofágicas asociadas y lesiones abiertas obligan a un abordaje quirúrgico. Un diagnóstico precoz minimiza la morbimortalidad.

[Salivaly gland tumors in childhood: importance of an early diagnosis and treatment]. / Tumores de glándulas salivales en la infancia. Importancia de un diagnóstico y tratamiento precoz.

OBJECTIVE: Review of our series of salivaly gland tumors at pediatric age, given its low frequency and their higher rate of malignancy compared with the adult population. MATERIAL AND METHODS: Retrospective study of the medical records of all pediatric patients with salivaly gland tumors treated in our center between 1998 and 2013. RESULTS: We identified 12 patients. The most common site of tumor location was the parotid gland in 11 patients followed by the sublingual gland in 1 patient. Three patients had previous cancer and radiotherapy history. The diagnosis (histological or radiological) were: 4 hemangiomas, 2 pleomorphic adenomas, 4 mucoepidermoid carcinomas, one acinar cell carcinoma and 1 primitive neuroectodermal tumor (PNET). No patient had metastasis at diagnosis. Preoperative fine needle aspiration (FNA) was performed in 6 patients with solid masses, being diagnostic in all cases. Eight patients underwent surgery. In two cases of total parotidectomy initial neuroapraxia appeared but none had permanent facial paralysis. There were no cases of Frey syndrome. The aesthetic results were good. There was only one tumor recurrence and all patients, except one who died of leukemia relapse, survive today. CONCLUSIONS: Salivaly gland tumors are uncommon in pediatric age but their high rate of malignancy makes it necessary to establish a rapid diagnosis. In our experience, FNA showed a high sensitivity. For malignant tumors, definitive treatment is surgical excision, preserving the facial nerve whenever possible. For vascular tumors, surgery is reserved for cases refractory to medical treatment.

OBJETIVO: Revisión de nuestra serie de neoplasias de glándulas salivales en pediatría, dada su baja frecuencia y mayor tasa de malignidad en comparación con la población adulta. MATERIAL Y METODOS: Estudio retrospectivo de las historias clínicas de los casos pediátricos de tumores de glándulas salivales tratados en nuestro centro entre los años 1998 y 2013. RESULTADOS: Se estudian 12 pacientes. Los tumores afectaban a la glándula parótida en 11 casos y en uno a la glándula sublingual. Tres pacientes presentaban historia oncológica previa y antecedentes de radioterapia. El diagnóstico (histológico o radiológico) fue de: 4 hemangiomas, 2 adenomas pleomorfos, 4 carcinomas mucoepidermoides, 1 carcinoma de células acinares y 1 tumor primitivo neuroectodérmico (PNET). Ningún paciente presentaba metástasis al diagnóstico. Se realizó PAAF preoperatoria en 6 pacientes que presentaban masas sólidas, siendo diagnóstica en todos ellos. Ocho pacientes fueron intervenidos. En dos casos de parotidectomía total apareció neuroapraxia inicial pero ninguno tuvo parálisis facial definitiva. No hubo ningún caso de síndrome de Frey. Los resultados estéticos fueron buenos. Un solo caso presentó recidiva tumoral y todos los pacientes, excepto uno que falleció por recaída de leucemia, sobreviven en la actualidad. CONCLUSIONES: Los tumores de glándula salival son raros en pediatría pero su alta tasa de malignidad hace necesario establecer un diagnóstico rápido. En nuestra experiencia, la PAAF presentó elevada sensibilidad. En los tumores malignos el tratamiento es la exéresis, preservando el nervio facial siempre que sea posible. En los tumores vasculares la cirugía se reserva para casos refractarios al tratamiento médico.