[Upper gastrointestinal endoscopy in pediatrics: experience of a high complexity center in Latin-America]. / Endoscopia digestiva superior en pediatría: experiencia de un centro de alta complejidad de Latinoamérica.

OBJECTIVE: To characterize pediatric patients undergoing esophagogastroduodenoscopy (EGD) in a high-complexity hospital. PATIENTS AND METHOD: Retrospective study in patients under 14 years of age who underwent EGD at the Hospital San Vicente Fundación de Medellín, between January 2019 and June 2020. The following sociodemographic characteristics were evaluated: age, sex, type of health insurance, place of origin, service where the procedure was indicated, indications for endoscopy, type of care, purpose of the procedure, endoscopic findings, endoscopic intervention, complications associated with the procedure or anesthesia, and relevance of the procedure. RESULTS: 466 patients who underwent 552 endoscopies were included. Fifty-seven percent of the patients were male. In diagnostic EGD, the main indications were abdominal pain (23%) and upper gastrointestinal bleeding (17%). In therapeutic EGD, the most frequently performed procedures were percutaneous endoscopic gastrostomy (41%), foreign body removal (27%), and esophageal dilation (24%). The complication rate related to the procedure was 0.5% and in relation to anesthesia was 0.7%. CONCLUSIONS: EGD in pediatric patients is an effective and safe tool if performed with an appropriate indication. One-third of therapeutic EGD could be avoided from primary prevention.

Stent for the management of Esophagic Stenosis by caustics in pediatry. / Stent para el manejo de las Estenosis Esofágicas por cáusticos en pediatría.

INTRODUCTION: Esophageal stricture is one of the most serious complications of caustic ingestion in children, and may occasionally recur or be refractory to management with repeated dilations. OBJECTIVE: To pre sent a case of the use of a silicone-coated metallic stent in a child with recurrent esophageal stricture secondary to caustic ingestion. CLINICAL CASE: A 6-year-old boy with accidental caustic ingestion, with evidence of Zargar grade IIIA esophagitis in all three portions of the esophagus and a 3 cm prepyloric gastric ulcer that received initial treatment with antibiotics and corticosteroids. After 21 days, the esophageal lumen diminished in relation to the healing process, which required serial di lations. Later, he developed a punctal stenosis, so it was decided to place two silicon-coated metallic esophageal stents, which were kept for 4 months, without new stenosis episodes. CONCLUSIONS: The silicone-coated metallic stent is an alternative for the treatment of recurrent esophageal stricture due to caustic ingestion in children.

Protocolo quirúrgico en la reconstrucción de la parálisis facial: nuestra experiencia tras 140 casos tratados / Protocol in surgical treatment of facial paralysis after 140 treated cases

El objetivo de este trabajo es presentar nuestro protocolo de actuación en el tratamiento quirúrgico de la parálisis facial tras 140 casos tratados entre los años 2000 y 2007. Este protocolo está basado en los resultado sobtenidos con un nuevo sistema de captura del movimiento facial en 3D denominado “Facial Clima”, que puede ser considerado como un método objetivo de medición de los resultados en la cirugía de reanimación facial. Así podría compararse en pacientes con parálisis facial, la efectividad de los tratamientos entre distintos centros. Exponemos los resultados obtenidos tanto a nivel de la reconstrucción de la sonrisa como a nivel palpebral (AU)

The aim of this study is to present our protocol in the surgical treatment of facial paralysis after 140treated cases since 2000 to 2007. The protocol is based on the results obtained with a new 3-D capture system of the facial movement called “Facial Clima”,that could be considered as the adequate tool to assess the outcome of the facial paralysis reanimation surgery. Thus, patients with facial paralysis could be compared among surgical centres such that effectiveness of facial reanimation operations could be evaluated. The results obtained are exposed for smile and lid reconstruction (AU)

Weekly docetaxel as second-line therapy for patients with advanced breast cancer resistant to previous anthracycline treatment.

This phase II trial evaluated the efficacy and toxicity of weekly docetaxel as treatment of advanced metastatic breast cancer patients resistant to prior anthracycline chemotherapy. After the first 18 patients, the initial dose (40 mg/m2, 30-min i.v. infusion for 6 consecutive weeks, followed by 2-week rest) was reduced to 36 mg/m2 in the remaining 17 patients due to the incidence of toxicity (28% grade 3-4 asthenia). Overall response rate was 34% (95% CI, 19-50): two complete (6%) and ten partial responses (28%) were found. The median duration of response was 6.8 months, the median time to disease progression was 8.4 months, and the median overall survival was 13.6 months (median follow-up of 11.4 months). Neutropenia was the only severe hematologic toxicity (17% of patients), whereas asthenia, nail, ocular and skin disorders were the most common nonhematologic toxicities. Only one death during further follow-up was related to toxicity (caused by pulmonary fibrosis). In conclusion, we found weekly docetaxel to be an active and safe chemotherapy regimen for patients with metastatic breast resistant to previous anthracyclines. This weekly regimen caused minimal myelosupression, while retaining significant activity against advanced breast cancer. Both factors provide attractive possibilities for the development of combination therapies incorporating weekly docetaxel. Nevertheless, the number of patients receiving either dose (40 and 36 mg/m2) which we studied is low and our results require confirmation on larger groups of patients.

Isolated progressive muscle weakness with tubular aggregates.

We report 2 isolated cases of slowly progressive muscle weakness in which tubular aggregates in muscle biopsy were found as the major pathological feature. Tubular aggregates were present in both types of fibers. Electron microscopy revealed the accumulation of double-walled tubular structures in dense subsarcolemmal locations or in smaller amounts within the myofibrils, close to cytoplasmic organelles. Myopathy with tubular aggregates is believed to form a distinct clinico-pathological entity with 3 well-distinguished clinical groups. The cases reported herein would fall into the group of sporadic isolated progressive muscle weakness of which only 3 other cases have been previously described.

[Plasma cell leukemia: our experience in 4 cases]. / Leucemia de células plasmáticas: nuestra experiencia de cuatro casos.

Clinical findings and response to treatment in four cases with plasma cell leukemia (PCL) out of 152 patients of multiple myeloma diagnosed at the Hospital La Paz from 1969 to 1988 are studied. Three of the four plasma cell leukemia cases presented a primary form, and one a secondary form. Our cases had a lower incidence of lymphadenopathy and splenomegaly than reported in previous series. The incidence of serum M band in PCL was similar to that found in multiple myeloma. The four patients received combination chemotherapy; one of them attained PR lasting for 2 months, and the remaining three failed to respond to similar therapy. The mean duration of survival was less than 8 months. Current treatments are reviewed.

[Collapsed ventricle syndrome (slit-ventricle). Apropos of 8 cases]. / Síndrome de ventrículos colapsados ("slit-ventricle"). A propósito de ocho observaciones.

Slit-ventricle syndrome (SVS) may appear in shunted hydrocephalic children as a complication by chronic overdrainage. SVS is defined by clinical features (headache, nausea and/or vomiting, disturbance of consciousness), slow valve refilling and slit or slit-like ventricles at computerized tomography. Authors report eight cases of SVS and review physiopathological, clinical and therapeutic aspects of this syndrome. It is concluded that SVS at present time may be considered an iatrogenic complication and the placement of high-pressure valves as a prophylactic measure can be a useful system to avoid SVS. It seems necessary to make more studies in order to evaluate efficacy of antisiphon devices.

Urinary fibrinogen degradation products (FDP) in bladder cancer.

The value of urinary fibrinogen degradation products (EPD) as a biological marker of bladder cancer has been studied. An increase in FDP was found in 75% of bladder cancer patients, independent of the fact that they had active tumours or that they were disease free. A high correlation between the amount of the increase and the grade, local invasiveness, and risk of recurrence of the tumour has been established. The assessment of urinary FDP is considered as a valuable screening and follow-up test in patients with bladder neoplasms.