Angioqueratoma solitario de lengua en una niña de 7 años / Solitary angiokeratoma of the tongue in a girl 7 years old

Los angioqueratomas son malformaciones vasculares, caracterizadas por ectasias vasculares en la dermis papilar con hiperplasia epitelial e hiperqueratosis reactiva, que pueden aparecer de manera aislada o como forma sistémica generalizada asociados a enfermedades metabólicas. El angioqueratoma solitario de mucosa oral es una lesión poco frecuente, que hasta la comunicación de Sipponen, en 2006, se creía siempre típica de las formas sistémicas y muy rara en las localizadas. Su aparición en la infancia es, asimismo, poco frecuente, habiéndose descrito hasta la fecha sólo 5 casos en menores de 18 años, aunque algunos autores señalan que puede tratarse de una enfermedad infradiagnosticada de ahí la importancia de su adecuado estudio y diagnóstico. Presentamos el caso de una paciente de 7 años de edad, con una lesión rojiza en el dorso de la lengua, no dolorosa, sin antecedente traumático, en cuyo examen físico se observó una lesión de 14 mm de diámetro en el borde derecho de la lengua, con múltiples pápulas eritematosas, sin apreciarse otros cambios en la mucosa oral. Se realizó una extirpación bajo anestesia general, y el diagnóstico se verificó por examen histopatológico de la pieza extirpada (AU)

Angiokeratomas are vascular malformations characterized by vascular ectasia in the papillary dermis with reactive epithelial hyperplasia and hyperkeratosis, which can occur in isolation or as widespread systemic form associated with metabolic diseases. The solitary angiokeratoma of the oral mucosa is a rare injury, which to Sipponen communication in 2006, always believed typical of systemic forms and very rare in localized. Its occurrence in childhood is likewise rare, having been described to date only 5 cases in children under 18, although some authors suggest that this may be an underdiagnosed disease, hence the importance of adequate study and diagnosis. We report a 7 years with a reddish lesion on the dorsum of the tongue, no pain, no history of trauma, in which physical examination showed a lesion of 14 mm in diameter in right right edge of the tongue with multiple erythematous papules, showing no other changes in the oral mucosa. Excision was performed under general anesthesia and the diagnosis was verified by histopathological examination of the resected specimen (AU)

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

[Analysis of the medical decision in abdominal pain suggestive of acute appendicitis]. / Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda.

OBJECTIVES: Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. METHODS: Retrospective cohort of 184 patients treated from January 2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendiceal disease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. RESULTS: The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3 points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant 94% and an increase in diagnostic certainty of 48 points. DISCUSSION: It is recommended to base the development of protocols and clinical guidelines in practice of test ultrasound as first, and joint determination of inflammatory markers, when that was questionable or negative. Further studies are proposed to increase the clinical certainty to reduce laparotomy white and diagnostic delays in this condition.

Moldeamiento nasoalveolar prequirúrgico en el niño con fi sura labiopalatina / Presurgical nasoalveolar molding a child with cleft lip and palate

Las fisuras labiopalatinas son una de las patologías que más se benefi cian de la creación de Unidades multidisciplinares (cirujanos pediátrico, maxilofacial y plástico, ortodoncista, otorrinolaringólogo, logopeda, psicólogo, etc.). Los objetivos del tratamiento ortodóncico y ortopédico prequirúrgico son: 1.- Alinear los segmentos alveolares y reducir la anchura de la fi sura para facilitar la queiloplastia. 2.- Guiar el crecimiento de los segmentos en que se halla dividido el maxilar. 3.- Mejorar la función lingual. 4.- Moldear los cartílagos nasales y la columela. Revisamos la evolución en los resultados en el tratamiento con moldeado nasoalveolar prequirúrgico (PNAM) en 15 pacientes tratados en la Unidad de Fisurados Labiopalatinos del Hospital Virgen de las Nieves (10 unilateral y 5 bilateral). Tres pacientes no completaron el tratamiento por falta de colaboración de los padres que lo abandonaron por el llanto del niño. En todos los pacientes que lo completaron se consiguió una importante mejoría en la alineación y separación de los segmentos alveolares así como en la forma del cartílago alar. La curva de aprendizaje en el moldeamiento hace que cada vez los resultados sean mejores y la comunicación entre los padres de los pacientes tratados hace que los abandonos sean prácticamente nulos (AU)

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.- Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.- To guide the growth of the segments in which the jaw is divided. 3.- Improve lingual function. 4.- Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby’s crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero (AU)

Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda / Analysis of the medical decision in abdominal pain suggestive of acute appendicitis

Objetivos. Aplicación del teorema de Bayes al estudio de la utilidad de las pruebas complementarias cuantitativas, y valoración cualitativa de la efi cacia del diagnóstico ecográfi co, con objeto de dotar al clínico de una herramienta para evaluar con exactitud la efectividad de dichas pruebas en el diagnóstico del dolor abdominal susceptible de cuadroapendicular. Método. Cohorte retrospectiva de 184 pacientes atendidos desde enero 2009 a junio 2010 por dolor abdominal sugestivo de abdomen agudo, de los que 145 fueron intervenidos. Se fijaron como variables predictoras de enfermedad apendicular la exploración abdominal, la ecografía y los valores plasmáticos de PCR y leucocitos. La metodología estadística se desarrolló según la sistemática bayesiana, previa determinación de curva ROC, y cálculo de momios y probabilidades postprueba, según la probabilidad preprueba basada en la exploración física. Resultados. El análisis ROC fi jó los puntos de corte de las pruebas cuantitativas en valores de leucocitos >12.800 y PCR >1,8 mg/dl. La aplicación del modelo al contaje leucocitario aumentó la certidumbre clínica de esta prueba en 11,3 puntos y de la PCR en 13,9. El uso combinado(..) (AU)

Objectives. Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. Methods. Retrospective cohort of 184 patients treated from January2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendice aldisease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. Results. The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant (..) (AU)