Resolución por videolaparoscopia del síndrome de ligamento arcuato en pediatría / Videolaparoscopic management of arcuate ligament syndrome in pediatric patients

El síndrome de ligamento arcuato medio caracterizado por dolor posprandial se debe a la compresión del tronco celíaco por dicho ligamento. En pediatría su presentación es infrecuente. Niña de 14 años con dolor abdominal recurrente. Se diagnosticó por ecografía un aumento de la velocidad del flujo del tronco celíaco con inversión de flujo. La angiotomografía evidenció la compresión. Su resolución fue quirúrgica mediante la sección del ligamento arcuato por videolaparoscopia. Los síntomas desaparecieron inmediatamente luego de la cirugía y no recurrieron en 24 meses de seguimiento. El ligamento arcuato es una banda fibrosa en la crura diafragmática. El nacimiento del tronco celíaco en la aorta supradiafragmática conlleva que este ligamento comprima durante la espiración con isquemia distal transitoria. El diagnóstico se realiza con ecografía Doppler del tronco celíaco o angiotomografía, entre otros. La resolución quirúrgica consiste en la sección del ligamento arcuato. Este síndrome debe tenerse en cuenta ante un caso de dolor abdominal recurrente. La vía laparoscópica es sugerida para el tratamiento

Median arcuate ligament syndrome, which is characterized by post-prandial pain, occurs as a result of the compression of the celiac trunk by the ligament. It is a rare pathology in pediatric patients. We present the case of a 14-year-old girl with recurrent abdominal pain. Ultrasound examination showed an increase in celiac trunk flow rate with flow reversal, while CT angiography demonstrated compression. It was surgically managed by dividing the arcuate ligament through videolaparoscopy. Symptoms disappeared right after surgery and did not reappear in the 24-month follow-up. The arcuate ligament is a fibrous band located at the level of the diaphragmatic crus. The fact that the celiac trunk originates at the supradiaphragmatic aorta makes the ligament exert compression during expiration, with transitory distal ischemia. Diagnosis is achieved through Doppler ultrasonography of the celiac trunk or CT angiography, among others. Surgical management involves dividing the arcuate ligament. This syndrome should be considered in the presence of recurrent abdominal pain. The laparoscopic route is the treatment approach suggested

Changes over time in the prevalence of asthma, rhinitis and atopic eczema in adolescents from Taubaté, São Paulo, Brazil (2005-2012): Relationship with living near a heavily travelled highway

BACKGROUND: The prevalence of allergic diseases is increasing. We evaluated temporal trends in the prevalence of asthma, rhinitis and eczema in adolescents (13-14 years) living in Taubaté, SP, Brazil (2005-2012) and assessed the relationship between these prevalences and the residential proximity to Presidente Dutra Highway (PDH, a heavily travelled highway). METHODS: This cross-sectional study of adolescents (N=1039) from public and private schools was evaluated using the standard questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) plus a question about their place of residence in relation to PDH. The data obtained were compared to the 2005 data using a chi-square test or Fisher's exact test. An analysis by groups consisting of two phases (two-step cluster) was used to evaluate the effect of living near PDH. RESULTS: There was a lifetime increase in the prevalence of active asthma (15.3% vs. 20.4%, p = 0.005) and physician-diagnosed asthma (6.8% vs. 9.2%, p = 0.06) and a decrease in the symptoms of active rhinitis (36.6% vs. 18.5%) between 2005 and 2012. A high frequency of asthma and rhinitis (18.1% vs. 23.2%, respectively) was observed among adolescents living close or very close to PDH; furthermore, 85.6% of the adolescents without symptoms of asthma or rhinitis lived far from PDH. CONCLUSION: An increase in the prevalence of asthma and a decrease in the prevalence of rhinitis were observed during the studied period. Living near PDH was associated with higher rates of asthma, rhinitis, and eczema

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