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.

Nefrectomías en riñón no funcionante, ¿estamos haciendo lo correcto? / Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?

Objetivos. Presentar nuestra experiencia en el manejo quirúrgico del riñón poco o no funcionante, revisando las indicaciones de nefrectomía y sus resultados a largo plazo. Material y métodos. Estudio retrospectivo de los pacientes intervenidos de nefrectomía en nuestro centro entre los años 2010 y 2014. Se revisaron sus historias clínicas y se recogieron una serie de variables sociodemográficas y clínicas, prestando especial atención a la resolución o no de la sintomatología que motivó la cirugía. Resultados. Realizamos un total de 18 nefrectomías. La edad media fue de 6,5 años (11 meses - 15 años). La indicación de cirugía se realizó por infecciones del tracto urinario (ITUS) de repetición en 7 casos, hipertensión arterial renovascular (HTAR) en 5, dolor en 2, aumento de tamaño en 2 y dificultad para el seguimiento en otros 2 pacientes. La nefrectomía se realizó vía laparoscópica en 16 casos y abierta en 2. La mediana de la estancia hospitalaria fue de 48 horas. La tasa de complicaciones fue del 5,55% tanto intraoperatoriamente (1 caso de sangrado) como postoperatoriamente (1 caso de enfisema subcutáneo). En todos los casos se objetivó resolución de la sintomatología salvo en 3, 2 pacientes presentaron ITUS y 1 HTA persistente. Conclusiones. La nefrectomía es un procedimiento seguro en niños con una tasa baja de complicaciones. La selección adecuada de los casos y un correcto estudio multidisciplinar previo son aspectos fundamentales para obtener buenos resultados clínicos y evitar complicaciones postoperatorias

Aim of the study. To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys. Methods. Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery. Main results. A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents’ preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT. Conclusions. Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications

[Nephrectomies in poor or non-functioning kidneys. Is it the right thing to do?] / Nefrectomías en riñón no funcionante, ¿estamos haciendo lo correcto?

AIM OF THE STUDY: To review our management and outcomes of nephrectomies performed in patients with non-functioning kidneys. METHODS: Retrospective analysis of the patients who underwent nephrectomy surgery in our hospital between 2010 and 2014. Data was collected from the patient charts paying special attention to the clinical resolution of the symptoms that motivated surgery. MAIN RESULTS: A total of 18 nephrectomies were performed. Median age was of 6,5 years (range: 11 months to 15 years). Surgery was indicated by recurrent urinary tract infections (UTI) in 7 cases, renovascular hypertension (RHT) in 5, pain in 2, increasing size in 2 and parents' preference due to poor compliance with follow up in 2 patients. 16 nephrectomies were performed laparoscopically and 2 were open procedures. Median hospital length of stay was 48 hours. Complication rate was 5.55% both for the intraoperatively (1 case of bleeding) and post operatively (1 case of subcutaneous emphysema). Signs and symptoms were successfully resolved in all cases except for 3, 2 patients had an UTI and 1 persistent RHT. CONCLUSIONS: Nephrectomy is a safe surgical procedure in children with a low rate of complications. An appropriate selection of the cases and a thorough preoperative multidisciplinary assessment are essential aspects to obtain good clinical results and to avoid post-operative complications.

OBJETIVOS: Presentar nuestra experiencia en el manejo quirúrgico del riñón poco o no funcionante, revisando las indicaciones de nefrectomía y sus resultados a largo plazo. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes intervenidos de nefrectomía en nuestro centro entre los años 2010 y 2014. Se revisaron sus historias clínicas y se recogieron una serie de variables sociodemográficas y clínicas, prestando especial atención a la resolución o no de la sintomatología que motivó la cirugía. RESULTADOS: Realizamos un total de 18 nefrectomías. La edad media fue de 6,5 años (11 meses - 15 años). La indicación de cirugía se realizó por infecciones del tracto urinario (ITUS) de repetición en 7 casos, hipertensión arterial renovascular (HTAR) en 5, dolor en 2, aumento de tamaño en 2 y dificultad para el seguimiento en otros 2 pacientes. La nefrectomía se realizó vía laparoscópica en 16 casos y abierta en 2. La mediana de la estancia hospitalaria fue de 48 horas. La tasa de complicaciones fue del 5,55% tanto intraoperatoriamente (1 caso de sangrado) como postoperatoriamente (1 caso de enfisema subcutáneo). En todos los casos se objetivó resolución de la sintomatología salvo en 3, 2 pacientes presentaron ITUS y 1 HTA persistente. CONCLUSIONES: La nefrectomía es un procedimiento seguro en niños con una tasa baja de complicaciones. La selección adecuada de los casos y un correcto estudio multidisciplinar previo son aspectos fundamentales para obtener buenos resultados clínicos y evitar complicaciones postoperatorias.

[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.

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

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 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

[Robotic surgery: first pediatric series in Spain]. / Cirugía robótica: primera serie pediátrica en España.

OBJECTIVES: Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to robotic laparoscopy. METHODS: Retrospective review of all the pediatric laparoscopic surgery assisted by the da Vinci robot (Intuitive Surgical), in our center, between April 2009 and February 2010. RESULTS: 8 patients were operated (7-15 years), with an average weight of 42 Kg (18 to 83 Kg). 11 procedures were performed: bilateral salpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4), splenectomy (2), resection of pancreatic mass (1), fundoplication (1), adrenalectomy (1). All proceedings, except two, were completed with the robot. As complications, there was one intraoperative bleeding that required blood transfusion, and in the postoperative period, there was a surgical wound infection. There were no conversions to open surgery. The average time of preparation before surgery was 130 minutes. The three-dimensional vision and lack of tremor are the main advantages cited by all surgeons. CONCLUSIONS: The learning curve of Robotic Surgery is shorter than that of conventional laparoscopy. Trained surgeons can perform complex procedures laparoscopically from the outset. The main difficulty in children is the proper planning of trocar placement, due to the smaller size of the surgical field. The organization of surgery is complex and success depends on close collaboration of all stakeholders.

Tratamiento del empiema paraneumónico tabicado: ¿videotoracoscopia o fibrinolíticos? / Treatment of loculated parapneumonic empyema. Video assisted thoracoscopy or fibrinolytics?

Objetivo: El tratamiento ideal del empiema paraneumónico no está determinado. El objetivo del estudio es comparar la evolución del derrame paraneumónico tabicado según el tratamiento inicial, videotoracoscopia (VATS) o drenaje con fibrinolíticos (DF). Material y métodos: Revisión retrospectiva. Pacientes ingresados con el diagnóstico de derrame paraneumónico entre enero de 2001 y julio de 2008. Los derrames complicados (según la ecografía) fueron tratados con drenaje y uroquinasa (DF) o con videotoracoscopia (VATS), dependiendo del cirujano responsable. Las variables analizadas fueron: el número de días hospitalizado tras la intervención, número de días totales de hospitalización, días con drenaje, días de fiebre tras la intervención y fracasos del tratamiento. Resultados: Se atendieron 121 pacientes. Diecisiete pacientes fueron excluídos del análisis por tratarse de derrames paraneumónicos simples. De los 104 analizados, 47 fueron tratados con drenaje y uroquinasa y 57, con videotoracoscopia. No hubo diferencias significativas entre ambos grupos en la estancia hospitalaria (mediana 12 vs 12 días) ni estancia post-operatoria (mediana 10 vs 9 días). Se encontraron diferencias en los días de drenaje (mediana grupo DF 5 días, VATS, 4 días, p<0,05) y en los días de fiebre post-operatoria (mediana 3 vs 2 días, p<0,05). El 22% de los pacientes precisó de una reintervención (14 del grupo DF y 9 del grupo VATS, p=0,09). Conclusiones: Los resultados de la VATS frente al DF como tratamiento inicial del empiema tabicado son muy similares. Parece existir una mayor tasa de fracasos con necesidad de reintervención en aquellos casos tratados con inicialmente con uroquinasa, aunque no ocasionan un aumento significativo de la estancia hospitalaria de los pacientes (AU)

Objective: There is no consensus regarding the ideal treatment of loculated parapneumonic empyema (PPE).The aim of this study is to compare the effectiveness of drainage plus urokinase (DF) with video-assisted thoracoscopy (VATS). Material and methods: Retrospective review. Patients admitted with a PPE between January 2001 and July 2008. Loculated empyema was diagnosed by chest ultrasound and patients were treated with DF or VATS depending on the attending surgeon. Compared variables were: post-operative stay, total hospital stay, days of tube thoracostomy, post-operative fever and treatment failure. Results: One hundred and twenty one patients were admitted with the diagnosis of PPE. Seventeen patients were excluded from analysis because of simple parapneumonic effusions. Of the 104 patients included in the study, 47 were treated with urokinase and 57 with videothoracoscopy. No statistically significant differences (P>.05) were found between the median values in the DF and VATS groups for hospital stay (median 12 vs 12 days) or post-operative stay (median 9 vs 9 days). There were differences in duration of tube thoracostomy (median DF group 5 days, VATS, 4 days, P<0.05) and in the post-operative fever (median 3 vs 2 days, p<0,05).Twenty two per cent of children needed a second procedure (14 patients of DF and 9 of VATS group, P=0.09). Conclusions: According to our experience, the results of DF and VATS for the treatment of loculated parapneumonic empyema are similar. Although there are no statistical differences, there seems to be a higher rate of failure, with the need of more procedures in the DF group. This difference does not affect the average total hospital stay (AU)

[Treatment of loculated parapneumonic empyema. Video assisted thoracoscopy or fibrinolytics?]. / Tratamiento del empiema paraneumónico tabicado: ¿videotoracoscopia o fibrinolíticos?

OBJECTIVE: There is no consensus regarding the ideal treatment of loculated parapneumonic empyema (PPE). The aim of this study is to compare the effectiveness of drainage plus urokinase (DF) with video-assisted thoracoscopy (VATS). MATERIAL AND METHODS: Retrospective review. Patients admitted with a PPE between January 2001 and July 2008. Loculated empyema was diagnosed by chest ultrasound and patients were treated with DF or VATS depending on the attending surgeon. Compared variables were: post-operative stay, total hospital stay, days of tube thoracostomy, post-operative fever and treatment failure. RESULTS: One hundred and twenty one patients were admitted with the diagnosis of PPE. Seventeen patients were excluded from analysis because of simple parapneumonic effusions. Of the 104 patients included in the study, 47 were treated with urokinase and 57 with videothoracoscopy. No statistically significant differences (P>.05) were found between the median values in the DF and VATS groups for hospital stay (median 12 vs 12 days) or post-operative stay (median 9 vs 9 days). There were differences in duration of tube thoracostomy (median DF group 5 days, VATS, 4 days, P<.05) and in the post-operative fever (median 3 vs 2 days, p<0,05).Twenty two per cent of children needed a second procedure (14 patients of DF and 9 of VATS group, P=.09). CONCLUSIONS: According to our experience, the results of DF and VATS for the treatment of loculated parapneumonic empyema are similar. Although there are no statistical differences, there seems to be a higher rate of failure, with the need of more procedures in the DF group. This difference does not affect the average total hospital stay.

Cirugía robótica: primera serie pediátrica en España / Robotic surgery: First pediatric series in Spain

Objetivos. A pesar de que funcionan varios robots quirúrgicos en España, la experiencia en patología pediátrica es escasa, por lo que creemos interesante revisar la primera serie íntegramente pediátrica del país. Queremos también transmitir nuestras impresiones sobre el paso de la laparoscopia convencional a la robótica. Métodos. Revisión retrospectiva de los casos pediátricos intervenidos mediante laparoscopia asistida por el robot da Vinci (Intuitive Surgical) entre abril de 2009 y febrero de 2010.Resultados. Se intervinieron 8 pacientes (7 a 15 años), con un pesomedio de 42 kg (18 a 83 kg). Se realizaron 11 procedimientos: salpingo-ooforectomía bilateral (1), herniorrafia inguinal (1), colecistectomía(4), esplenectomía (2), exéresis de masa pancreática (1), fundoplicatura(1), suprarrenalectomía (1). Todos los procedimientos, salvo 2, se (..) (AU)

Objectives. Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to roboticlaparoscopy. Methods. Retrospective review of all the pediatric laparoscopicsurgery assisted by the da Vinci robot (Intuitive Surgical), in our center, etween April 2009 and February 2010.Results. 8 patients were operated (7-15 years), with an average weight of 42Kg (18 to 83Kg). 11 procedures were performed: bilateralsalpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4),splenectomy (2), resection of pancreatic mass (1), fundoplication (1),adrenalectomy (1). All proceedings, except two, were completed with (..) (AU)

Linfangioma quístico cervical: todavía un reto / Cervical cystic lymphangioma: still a challenge

Introducción. Los linfangiomas cervicales de gran tamaño pueden no solo asociarse a graves secuelas estéticas, fonatorias o deglutorias, sino amenazar la supervivencia del paciente por compresión de la vía aérea o sangrados masivos. El objetivo de este trabajo es evaluar nuestros resultados quirúrgicos, el valor del diagnóstico prenatal y la aplicación de técnicas como el EXIT (Ex-Utero Intrapartum Treatment)para el control de la vía aérea en casos graves. Pacientes y métodos. Revisión retrospectiva de los linfangiomas cervicales tratados en nuestro centro entre 1986 y 2009, según el registro de Documentación Clínica. Se han analizado datos referentes al diagnóstico prenatal, manejo intraparto de la vía aérea, tratamiento quirúrgico y sus complicaciones, uso de esclerosantes y secuelas a (..) (AU)

Introduction. Cervical lymphangiomas can not only cause severes equelae (aesthetic, phonatory or deglutory) but can also be life the reatening due to airway compresion or massive bleeding. This paper analyzes our surgical results, the value of prenatal diagnosis and the use of new techniques such as the EXIT procedure for airway control in sereve cases .Patients and methods. We retrospectively reviewed the medical record of patients with cervical lymphangiomas treated in our center between 1986 and 2009, according to our Clinical Documentation Database. Data referred to prenatal diagnosis, intrapartum airway management, surgical procedures and morbidity, sclerosing substance infiltration and long term sequelae was analyzed. Results. Thirteen cases were identified. 53.8% of the patients were (..) (AU)

Hamartoma condromesenquimal endobronquial / Endobronchial chondromesenchymal hamartoma

Los tumores pulmonares primarios son poco frecuentes en la infancia. Dentro de estos, los endobronquiales son todavía menos frecuentes y entre los benignos, los pseudotumores inflamatorios y los hamartomas son los de mayor incidencia. Se presenta el caso de una niña de 2 años y medio de edad afecta de un hamartoma condromesenquimal endobronquial izquierdo con obstrucción del 90% de la luz bronquial. Se realizó resección completa de la masa endobronquial mediante broncoscopio rígido y aplicación de mitomicina C tópica. Desde la resección del tumor y tras un periodo de seguimiento de 12 meses, la paciente ha presentado una evolución favorable con desaparición inmediata de la clínica respiratoria y con fibrobroncoscopias sucesivas sin objetivar tumor residual (AU)

Primary lung tumours are uncommon in childhood. Among these tumours, endobronchial masses are even less common and, among benign tumours, inflammatory pseudotumours and hamartomas have the highest incidence in children. We present the case of a 2.5-year-old girl with a left endobronchial chondromesenchymal hamartoma with obstruction of 90% of the bronchial lumen. Complete resection of the endobronchial mass was performed by rigid bronchoscopy and application of topical mitomycin C. After tumour resection and a 12-month follow-up, the patient has shown a favourable outcome with immediate disappearance of respiratory symptoms. Successive fibreoptic bronchoscopies have shown no residual tumour (AU)

[Endobronchial chondromesenchymal hamartoma]. / Hamartoma condromesenquimal endobronquial.

Primary lung tumours are uncommon in childhood. Among these tumours, endobronchial masses are even less common and, among benign tumours, inflammatory pseudotumours and hamartomas have the highest incidence in children. We present the case of a 2.5-year-old girl with a left endobronchial chondromesenchymal hamartoma with obstruction of 90% of the bronchial lumen. Complete resection of the endobronchial mass was performed by rigid bronchoscopy and application of topical mitomycin C. After tumour resection and a 12-month follow-up, the patient has shown a favourable outcome with immediate disappearance of respiratory symptoms. Successive fibreoptic bronchoscopies have shown no residual tumour.

[Cervical cystic lymphangioma: still a challenge]. / Linfangioma quístico cervical: todavía un reto.

INTRODUCTION: Cervical lymphangiomas can not only cause severe sequelae (aesthetic, phonatory or deglutory) but can also be life thereatening due to airway compresion or massive bleeding. This paper analyzes our surgical results, the value of prenatal diagnosis and the use of new techniques such as the EXIT procedure for airway control in sereve cases. PATIENTS AND METHODS: We retrospectively reviewed the medical record of patients with cervical lymphangiomas treated in our center between 1986 and 2009, according to our Clinical Documentation Database. Data referred to prenatal diagnosis, intrapartum airway management, surgical procedures and morbidity, sclerosing substance infiltration and long term sequelae was analyzed. RESULTS: Thirteen cases were identified. 53.8% of the patients were diagnosed by prenatal ultrasound, and MRI was performed in 46.1%. The tongue was affected in 30.7%, parotid glands in 38.4% and airway in 38.4%. Four EXIT procedures were carried out (nasotracheal intubation) and one emergency tracheotomy was needed. Five patients required more than one surgical prodedures, including partial glossectomy, with severe intraoperatory complications in 23% (bleeding, pharyngeal damage). In eight patients primary or adyuvant sclerotherapy was used. Three children with giant masses died, two due to intracystic bleeding and one from sepsis. Among the survivors, 50% have no sequelae. CONCLUSIONS: Cervical lymphangiomas are a very sereve condition, not only due to possible airway compresion or massive bleeding but also becose of the severe secualaes they may cause. Tongue or parotid gland infiltration are difficult to treat. In severe cases diagnosed prenatally a close follow up in selected centers, with multidisciplinary teams consisting of obstetricians and pediatric surgeons, trained in the EXIT procedure is warranted. Despite therapeutic efforts the prognosis of large masses is still poor.

Tratamiento actual de los traumatismos penetrantes pediátricos / Current treatment of pediatric penetrating traumas

Introducción. Tradicionalmente, el tratamiento del trauma penetrante consistía en la revisión quirúrgica amplia de la zona anatómica afecta. Sin embargo, cada vez es más frecuente realizar un tratamiento menos invasivo gracias a la precisión diagnóstica que aportan pruebas de imagen como la tomografía computerizada (TC). El objetivo de este trabajo es revisar la experiencia de nuestro centro en los últimos8 años con la aplicación de criterios más conservadores. Pacientes y métodos. Tradicionalmente el tratamiento del trauma penetrante consistía en la revisión quirúrgica amplia de la zona anatómica afecta. Sin embargo, cada vez es más frecuente realizar un tratamiento menos invasivo gracias a la precisión diagnóstica que aportan pruebas de imagen como la tomografía computerizada (TC). El objetivo de este trabajo es revisar la experiencia de nuestro centro en los últimos 8 años con la aplicación de criterios más conservadores. Resultados. Identificamos 16 pacientes (mediana 8,5 años, rango 4-15) víctimas de traumatismos penetrantes. Según su localización se clasificaron en: cervicales (12,5%), torácicos (25%), abdominales (18,8%)y de extremidades (43,8%). Los tipos de lesión más frecuentes fueron (..) (AU)

Introduction. The traditional management of pediatric penetrating trauma has been wide surgical examination. However, the selective non operative management is increasing thanks to the precise diagnosis obtained from radiologic studies as CT scan. The purpose of this study is reviewing our experience in the last eight years with a less invasive management. Patients and methods. We retrospectively reviewed (2000-2007)the patients with penetrating injuries of different parts of the body(excluding cranioencephalic traumatism) treated in our center and registered by the Clinical Documentation Unit. The variables collected and evaluated included age, mechanism of injury, kind of injury, diagnostic and therapeutic modalities and outcome. Results. There were 17 patients (median 9,5 years, range 4-17) with penetrating trauma. According the localization of injury the patients were divided into 4 groups: abdominal (17,6%), thoracic (23,5%), cervical (17,6%) and extremities (41,2%). The most frequent kind of injuries (..) (AU)

Cirugía bariátrica en adolescentes / No disponible

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[Current treatment of pediatric penetrating traumas]. / Tratamiento actual de los traumatismos penetrantes pediátricos.

INTRODUCTION: The traditional management of pediatric penetrating trauma has been wide surgical examination. However, the selective nonoperative management is increasing thanks to the precise diagnosis obtained from radiologic studies as CT scan. The purpose of this study is reviewing our experience in the last eight years with a less invasive management. PATIENTS AND METHODS: We retrospectively reviewed (2000-2007) the patients with penetrating injuries of different parts of the body (excluding cranioencephalic traumatism) treated in our center and registered by the Clinical Documentation Unit. The variables collected and evaluated included age, mechanism of injury, kind of injury, diagnostic and therapeutic modalities and outcome. RESULTS: There were 17 patients (median 9.5 years, range 4-17) with penetrating trauma. According the localization of injury the patients were divided into 4 groups: abdominal (17.6%), thoracic (23.5%), cervical (17.6%) and extremities (41.2%). The most frequent kind of injuries were: skin and muscle (with or without penetrating peritoneal or chest cavity, 52.9%) vascular or neurological structures (29.4%). We would like to highlight one case of cardiac perforation and taponade, one traqueal lesion and one case of external iliac vein injury. The injuries caused by glass (35.3%) and sharp arms (29,4%) were the most frequent mechanism. Simple suture and observation was treatment enough in 47.1%. Three patients required neural and vascular micro suture. One patient followed a thoracotomy procedure and other one, a sternotomy. It wasn't necessary any laparotomy. No patient died and 88% of the patients have no sequelae. CONCLUSIONS: Most of the penetrating child traumas have good prognosis and are associated with few sequelae. Low energy thoracic and abdominal penetrating traumas can be managed conservatively when the patient is hemodiynamically stable and CT scan shows no organ injury, avoiding unnecessary surgical examinations.

Nueva estrategia quirúrgica en la gastrosquisis: simplificación del tratamiento atendiendo a su fisiopatología / New surgical strategy in gastroschisis: treatment simplification according to its physiopathology

Introducción. La gastrosquisis (GQS) es un defecto congénito de la pared abdominal que se caracteriza por la exposición de las asas intestinales al líquido amniótico a través de un orificio paraumbilical derecho. Tras el nacimiento a término, observamos gran edema e inflamación del intestino expuesto. En la corrección quirúrgica, éste ofrece una difícil reubicación abdominal, precisando en ocasiones un silo y cierre diferido. En el postoperatorio observamos un período prolongado de hipomotilidad intestinal que obliga a una nutrición parenteral (NPT) y a una larga estancia hospitalaria. Objetivo. El objetivo de este estudio es evaluar los beneficios de adelantar el parto para evitar la inflamación de las asas y evitar sus consecuencias neonatales. Pacientes y métodos. Desde Julio 2002 hemos tratado 6 casos de GQS con diagnóstico prenatal, siguiendo una nueva estrategia que consiste en adelantar el parto por cesárea programada a las 34-35 semanas de edad gestacional (EG) y realizar una reducción intestinal en la propia incubadora bajo anestesia general. Hemos comparado este grupo pretérmino (PT) con los 6 casos previos, operados desde Enero 1999, en que se dejó la gestación a término (AT). Se analizan el aspecto de las asas, la técnica quirúrgica, necesidad de silo, existencia de atresias, evolución postoperatoria, necesidad de NPT y estancia hospitalaria. Resultados. Todos los casos AT (EG media: 36,3 semanas) presentaron importante edema intestinal con engrosamiento de la pared. Se practicó cierre primario mediante laparotomía en 2 casos y cierre diferido con silo de silástic en 4 casos. En un caso existía atresia intestinal, un caso falleció por sepsis de origen intestinal. Necesitaron NPT durante una media de 41,2 días y la estancia hospitalaria fue de 69,8 días. El grupo PT se controló mediante ecografía prenatal. Tras el parto por cesárea electiva (EG media: 34,8 semanas), se observaron asas intestinales herniadas de aspecto normal, sin signos inflamatorios ni edema, excepto en un caso, que mostraba sonoluscencia intestinal en la ecografía antes de las 34 semanas. Ningún caso presentó dificultad respiratoria. Se realizó reducción intestinal sin dificultad en todos los casos. Un caso requirió revisión por una adherencia oclusiva, que alargó su estancia. La NPT se precisó en una media de 13,4 días y la alimentación enteral se inició a los 6 días. La estancia hospitalaria media fue de 28,6 días, si incluimos el caso que mostraba asas edematizadas. Conclusiones. Esta nueva estrategia de tratamiento de la GQS, adelantando el parto, evita la inflamación de las asas intestinales, facilitando su reducción a la cavidad abdominal, minimiza la aparición de atresias, reduce el período de hipoperistalsis intestinal, con introducción precoz de la alimentación oral y reducción de los días de NPT y estancia hospitalaria. Requiere una buena cooperación multidisciplinar entre los equipos de obstetricia, neonatología y cirugía pediátrica (AU)

Introduction. Gastroschisis (GS) is a congenital abdominal wall defect that permits bowel exposure to amniotic fluid (AF). Intestinal damage is related to the chemical action of AF and constriction. After birth at term, a thickened intestinal wall with inflammation and, in some cases, intestinal atresias were observed. Surgical repair and intestinal reubication may be difficult, and thus staged silo repair could be necessary. These patients require a long hospital stay owing to bowel damage causing severe intestinal hypoperistalsis and poor absorptive capacity. Total parenteral nutrition (TPN) is required for a long period. Objective. The aim of this prospective study is to evaluate the benefits of a preterm delivery to avoid bowel damage and its post-natal consequences. Patients and methods. Six cases of prenatally-diagnosed GS have been treated following a new strategy since July 2002. A preterm Cesarean section (c-section) delivery was programmed at 34-35 weeks of gestational age (GA). Some hours after birth, at bedside in the NICU, bowel reduction through the defect hole was performed under general anesthesia. This preterm group (PT) was compared the past 6 cases at term (AT) from January 1998 to July 2002. Macroscopic appearance, atresia existence, surgical technique, silo requirement, neonatal outcome, TPN and hospital stay were analyzed. Results. All six cases AT (mean GA: 36.3 weeks) presented bowel inflammation and thickened wall. Only 2/6 cases allowed the intestine to be housed in a primary closure after laparotomy. 4/6 cases required staged silo repair. 1 patient presented intestinal atresia and other had perforations who died at 17 days of life from intestinal sepsis. Mean postoperative intubation period was 16.2 days. Mean TPN was 41.2 days and mean hospital stay 69.8 days. PT group was monitored by prenatal sonography seeking bowel sonolucency. After programmed PT c-section delivery (mean GA: 34.8 weeks) in all 6 cases, bowel loops presented normal appearance and intestinal thickening was absent, except in one case. No prematurity-related respiratory complications were observed. Easy bowel reduction without abdominal compression was performed in all cases. 1/6 cases required surgical release of occlusive intestinal adherence. Mean postoperative intubation period was 0.4 days (9.6 hours). Oral feeding was started at 6 days. Mean TPN was 13.4 days and mean hospital stay 28.6 days. Conclusions. The third trimester is a critical period for fetal bowel development. Intestinal damage rises with increasing exposure time to amniotic fluid. This strategy of preterm delivery for the treatment of GS avoids intestinal damage, prevents «peel» and intestinal atresia, renders surgical reduction easier, reduces the hypoperistalsis, need for TPN and hospital stay. Multidisciplinary coordination between obstetricians, neonatologists and pediatric surgeons is required (AU)

[New surgical strategy in gastroschisis: treatment simplification according to its physiopathology]. / Nueva estrategia quirúrgica en la gastrosquisis: simplificación del tratamiento atendiendo a su fisiopatología.

INTRODUCTION: Gastroschisis (GS) is a congenital abdominal wall defect that permits bowel exposure to amniotic fluid (AF). Intestinal damage is related to the chemical action of AF and constriction. After birth at term, a thickened intestinal wall with inflammation and, in some cases, intestinal atresias were observed. Surgical repair and intestinal reubication may be difficult, and thus staged silo repair could be necessary. These patients require a long hospital stay owing to bowel damage causing severe intestinal hypoperistalsis and poor absorptive capacity. Total parenteral nutrition (TPN) is required for a long period. OBJECTIVE: The aim of this prospective study is to evaluate the benefits of a preterm delivery to avoid bowel damage and its post-natal consequences. PATIENTS AND METHODS: Six cases of prenatally-diagnosed GS have been treated following a new strategy since July 2002. A preterm Cesarean section (c-section) delivery was programmed at 34-35 weeks of gestational age (GA). Some hours after birth, at bedside in the NICU, bowel reduction through the defect hole was performed under general anesthesia. This preterm group (PT) was compared the past 6 cases at term (AT) from January 1998 to July 2002. Macroscopic appearance, atresia existence, surgical technique, silo requirement, neonatal outcome, TPN and hospital stay were analyzed. RESULTS: All six cases AT (mean GA: 36.3 weeks) presented bowel inflammation and thickened wall. Only 2/6 cases allowed the intestine to be housed in a primary closure after laparotomy. 4/6 cases required staged silo repair. 1 patient presented intestinal atresia and other had perforations who died at 17 days of life from intestinal sepsis. Mean postoperative intubation period was 16.2 days. Mean TPN was 41.2 days and mean hospital stay 69.8 days. PT group was monitored by prenatal sonography seeking bowel sonolucency. After programmed PT c-section delivery (mean GA: 34.8 weeks) in all 6 cases, bowel loops presented normal appearance and intestinal thickening was absent, except in one case. No prematurity-related respiratory complications were observed. Easy bowel reduction without abdominal compression was performed in all cases. 1/6 cases required surgical release of occlusive intestinal adherence. Mean postoperative intubation period was 0.4 days (9.6 hours). Oral feeding was started at 6 days. Mean TPN was 13.4 days and mean hospital stay 28.6 days. CONCLUSIONS: The third trimester is a critical period for fetal bowel development. Intestinal damage rises with increasing exposure time to amniotic fluid. This strategy of preterm delivery for the treatment of GS avoids intestinal damage, prevents "peel" and intestinal atresia, renders surgical reduction easier, reduces the hypoperistalsis, need for TPN and hospital stay. Multidisciplinary coordination between obstetricians, neonatologists and pediatric surgeons is required.

Lung transplantation in young infants with interstitial pneumonia.

OBJECTIVES: We describe our experience with infants suffering from interstitial pneumonia referred for lung transplantation. METHODS: From April 1998 to December 2000, three infants were admitted to our lung transplantation program: a 9-month-old girl (patient 1) suffering from surfactant protein C deficiency who had high oxygen requirements (fraction of inspired oxygen: 70% to 90%), and two boys, ages 2 (patient 2) and 9 months (patient 3), who were ventilator-dependent due to chronic pneumonitis of infancy. RESULTS: Patients were transplanted at the age of 5 months (patient 2) and 13 months (patients 1 and 3) at 87 to 105 days after being accepted for lung transplantation. All cases underwent a sequential double lung transplant on cardiopulmonary bypass. The immunosuppressive regime included tacrolimus, prednisone, and azathioprine. Patients 2 and 3 also received basiliximab. Two cases suffered a mild rejection episode that responded to high-dose steroids. Patient 2 was ventilator-dependent for 8 months after transplant, owing to severe bronchomalacia and left main bronchus stenosis. Bronchial stenosis resolved after pneumatic dilatation and endobronchial stenting. This patient also presented with a pulmonary artery anastomosis stricture that required percutaneous balloon dilatation. All three patients are at home, carrying out normal activities for their age, with no respiratory symptoms after a period of 8 to 29 months of follow-up. CONCLUSIONS: Interstitial pneumonia of infancy is a rare disease with a bad prognosis and no specific treatment; therefore, lung transplantation represents a good therapeutic option for these infants.

[Nineteen years experience with posterior sagittal anorectoplasty as a treatment of anorectal malformation]. / Diecinueve años de anorrectoplastia sagital posterior como tratamiento de la malformación anorrectal.

UNLABELLED: Posterior sagittal anorectoplasty (PSARP) is considered today the best surgical technique for the treatment of the anorectal malformations. With the aim of evaluating the results of the PSARP in our patients, the charts of 39 children (27 male, 12 female) were reviewed. Mean age was 11 years (3 to 20 years) and the mean follow-up period from the closure of the colostomy was 9.4 years (1 to 18 years). Patients with any alteration of the extrinsic innervation or those with rare malformations were excluded of the study. According to the Wingspread classification, 14 patients had a high defect, 13 had an intermediate type and 12 had a low one. One patient had a PSARP in the newborn period whereas the rest of them had a descending loop colostomy. Definitive repair consisted in PSARP in low and intermediate forms and in six of the high type patients. The rest (8) of the high type patients had a Rehbein abdominoperineal pull-through (DA) plus a PSARP. Evaluation for the surgical results was made by means of an anorectal manometry (existence or not of anal inhibitory reflex [RIA], the symmetry and pressure of the canal anal, and the existence of extrinsic innervation) and a clinical questionnaire. Patients or parents were asked for fecal continence, age at which the continence was achieved and the existence of severe constipation. RESULTS: Low defects: Eleven patients were continent between 3 and 5 years old. Seven patients had RIA. Intermediate defects: Seven patients were continent. Five (all with RIA) achieved continence between 2 and 8 years old; the other 2 were continent at the age of 10. The six incontinent patients had absence of RIA and/or low-pressure anal canal. High defects: Five patients were continent, between 11 and 16 years old. All had an DA plus PSARP. None of them had RIA. All the incontinent patients had an anomalous anal canal. CONCLUSIONS: The lowest the type of an anorectal malformation, the better the prognoses. In these patients, there is a relationship between the achievement of continence, the presence of RIA and the symmetry and high pressures at the anal canal. Among the patients with high defects, the results are better when they had an abdominoperineal pull-through plus PSARP.