Satisfaction analysis of overground gait exoskeletons in people with neurological pathology. a systematic review.

BACKGROUND: People diagnosed with neurological pathology may experience gait disorders that affect their quality of life. In recent years, research has been carried out on a variety of exoskeletons in this population. However, the satisfaction perceived by the users of these devices is not known. Therefore, the objective of the present study is to evaluate the satisfaction perceived by users with neurological pathology (patients and professionals) after the use of overground exoskeletons. METHODS: A systematic search of five electronic databases was conducted. In order to be included in this review for further analysis, the studies had to meet the following criteria: [1] the study population was people diagnosed with neurological pathology; [2] the exoskeletons had to be overground and attachable to the lower limbs; and [3]: the studies were to include measures assessing either patient or therapist satisfaction with the exoskeletons. RESULTS: Twenty-three articles were selected, of which nineteen were considered clinical trials. Participants diagnosed with stroke (n = 165), spinal cord injury (SCI) (n = 102) and multiple sclerosis (MS) (n = 68). Fourteen different overground exoskeleton models were analysed. Fourteen different methods of assessing patient satisfaction with the devices were found, and three ways to evaluate it in therapists. CONCLUSION: Users' satisfaction with gait overground exoskeletons in stroke, SCI and MS seems to show positive results in safety, efficacy and comfort of the devices. However, the worst rated aspects and therefore those that should be optimized from the users' point of view are ease of adjustment, size and weight, and ease of use.

[Manual detorsion and elective orchiopexy as an alternative treatment for acute testicular torsion in children]. / Detorsión manual y cirugía diferida en la torsión testicular aguda.

AIM: To present our experience in pediatric patients with testicular torsion (TT) treated by manual detorsion (MD). PATIENTS AND METHODS: Retrospective analysis of patients treated by MD in a 10-year period in a single center. Description of symptoms, detorsion technique, follow-up and complications. RESULTS: 76 patients diagnosed with TT were studied in a 10-year period. 16 patients were treated by MD. Mean age was 12 years (Range: 10-13 years) and time from onset of pain was 5.25 hours (±4,2). Left testicle was affected in 75% (n=12). Detorsion maneuver was performed by a pediatric surgeon at the radiology room, in counter-clockwise direction in the right testicle and clockwise direction in the left testicle in all cases. The success was defined as the relief of pain, normal physical examination and was confirmed by Doppler ultrasound performed immediately after MD. MD was effective in 75% (n=12) and orchiopexy was performed under elective conditions at median time of 2 weeks (0-5 weeks). MD was unsuccessful in 3 patients and emergency orchiopexy was performed with no testicular loss. 1 patient had a second MD maneuver for incomplete detorsion. No short or long term complication nor testicular atrophy was observed. CONCLUSION: MD and elective orchiopexy seems to be an efficient and reliable procedure in the treatment of TT in children. Further studies may be necessary to establish its safety and indications.

OBJETIVO: Presentar nuestra experiencia, protocolo e indicaciones de la detorsión testicular manual (DM) como tratamiento en la torsión testicular (TT). MATERIAL Y METODOS: Estudio retrospectivo de pacientes con TT tratados mediante DM en los últimos 10 años. Analizamos tiempo de evolución, técnica de detorsión, evolución y complicaciones. RESULTADOS: 76 pacientes diagnosticados de TT en los últimos 10 años, de los cuales 21% (n=16) fueron tratados mediante DM. Edad media de 12 años (rango: 10-13 años) y duración del comienzo del dolor de 5,25 horas (± 4,2 horas), mayor frecuencia en el testículo izquierdo (75%, n=12). La técnica de DM se realizó ecoguiada, en dirección horaria y antihoraria en el lado derecho e izquierdo, respectivamente. El éxito se definió como el alivio inmediato de los síntomas, hallazgos normales en el examen físico y comprobación de la recuperación del flujo mediante ecografía tras la maniobra de detorsión. Fue efectiva en el 75% (n=12), siendo dados de alta a las 24 horas, tras realizar nueva ecografía de control y comprobar normalidad en el flujo. Orquidopexia vía escrotal diferida a las 2 semanas (rango: 0-5,4 semanas). En tres pacientes (18,8%) se realizó cirugía urgente por insuficiente recuperación del flujo y en otro paciente (6,2%) fue necesario realizar una segunda maniobra de detorsión. No hubo complicaciones tras DM a corto/largo plazo, ningún caso de atrofia testicular. CONCLUSIONES: La DM ecoguiada y orquidopexia diferida es una opción terapéutica en pacientes con TT de corta evolución. Es necesario series más amplias y realizar estudios prospectivos para establecer su seguridad y eficacia.

[Peritoneal drainage as definitive treatment in necrotizing enterocolitis of preterm infants with low weight]. / Drenaje peritoneal como tratamiento definitivo en la enterocolitis necrotizante de prematuros de bajo peso.

OBJECTIVES: The management of advanced necrotizing enterocolitis (NEC) in preterm birth with low weight remains controversial. The aim of this study consists in the analysis of the results of treatment in these patients, as well as the evaluation of the role of peritoneal drainage as a definitive therapeutic option. METHODS: Observational and descriptive study of 31 patients under 1,500 g of weight with advanced NEC, whom have had surgery in our center in the last 15 years. They were classified in two groups: G1 (n = 21) <1,000 g and G2 (n = 10) 1,000-1,500 g. RESULTS: Average weight in G1 patients was 791.7 ± 137.5 g and 1,280.7 ± 207.9 g in G2 patients (p <0.01). Average gestational age was 26 ± 1 weeks in G1 patients and 30 ± 2 weeks in G2 patients (p <0.01). Mean time to the start of the advanced NEC was 9,4 ± 4.4 days in G1 patients and 16.7 ± 13.5 days in G2 patients (p = 0.031). In group G1, 95.2% of the patients were treated throughout peritoneal drainage, and 4,8% (n = 1) with laparotomy. In G2, 60% (n = 6) of the patients were treated throughout peritoneal drainage, and 40% (n = 4) with laparotomy (p = 0.027). The peritoneal drainage was a definitive treatment in 84.2% (16/20) of the G1 patients, with a survival rate of 56.3% (n = 9); G2 patients had a definitive treatment in 50% of the patients (3/6), with a survival rate of 66.7% (n = 2) (p = 0.261). In G1 patients, 50% (2/4) of the drains which required subsequently laparotomy, died 0% (0/3) in G2 patients. CONCLUSIONS: Peritoneal drainage is primarily a valid therapeutic option in extremely premature infants and can be used as definitive treatment.

OBJETIVO: El manejo de la enterocolitis necrotizante (ECN) avanzada en prematuros de bajo peso continúa siendo controvertido. El objetivo de este estudio es analizar los resultados del tratamiento en estos pacientes, así como valorar el papel del drenaje peritoneal como opción terapéutica definitiva. MATERIAL Y METODOS: Estudio observacional y descriptivo de 31 pacientes menores de 1.500 g de peso, intervenidos en nuestro centro, con ECN avanzada en los últimos 15 años. Se clasificaron en dos grupos en función del peso: G1 <1.000 g (n = 21) y G2 1.000-1.500 g (n = 10). RESULTADOS: El peso medio en los pacientes del G1 fue de 791,7 ± 137,5 g y de 1.280,7 ± 207,9 g en el G2 (p <0,01). La edad gestacional media de 26 ± 1 semanas en el G1 y de 30 ± 2 semanas en el G2 (p <0,01). El tiempo medio hasta el comienzo del cuadro de ECN avanzada fue de 9,4 ± 4,4 días en el G1 y de 16,7 ± 13,5 días en el G2 (p = 0,031). En el G1 el 95,2% (n = 20) de los pacientes se trataron mediante drenaje peritoneal y el 4,8% (n = 1) mediante laparotomía; en el G2 el 60% (n = 6) se trataron con drenaje peritoneal y el 40% (n = 4) mediante laparotomía (p = 0,027). El drenaje peritoneal fue el tratamiento definitivo en el 84,2% (16/20) del G1, con una supervivencia del 56,3% (n = 9); en el G2 el 50% (3/6), con una supervivencia del 66,7% (n = 2) (p = 0,261). En el G1 fallecieron el 50% (2/4) de pacientes que tras el drenaje precisaron posteriormente laparotomía, mientras que en el G2 no falleció ningún paciente (0/3). CONCLUSION: El drenaje peritoneal es una opción terapéutica válida fundamentalmente en prematuros extremos y puede ser empleado como tratamiento definitivo.

[Retrospective analysis of morbidity and mortality of intestinal atresias in newborns]. / Análisis retrospectivo de la morbilidad y mortalidad de las atresias intestinales diagnosticadas en el periodo neonatal.

OBJECTIVE: Intestinal atresia (IA) is the most common obstructive congenital malformation in the gastrointestinal tract. The aim is to describe the morbidity and mortality of AI in our series. METHODS: Retrospective study in infants with AI who underwent surgery in our hospital in the past 15 years. Descriptive analysis was performed by collecting clinical and epidemiological variables. Qualitative and quantitative statistical analysis were performed. RESULTS: A total of 32 patients, 40.6% (13) women and 59.4% (19) males, maternal age 31 ± 5 years. Prenatal care in 96.8% (30) and prenatal diagnosis in 68.8% (22). Gestational age 35 ± 3 (SG 25-41), birth weight 2,506 ± 516 g (920-3,470 g). 53% (17/32) were localized in duodenum (65% extrinsic, 35% type I); 37.5% (12/32) jejunoileal (16.6% type I, 25% type II, 16.6% type IIIa, 16.6% type IIIb and 25% type IV); 6.5% (2/32) were colonic and 3% (1/32) pyloric. In 65.6% (21/32) it was associated with other congenital malformation. 81.3% (26) were operated within the first 48 hours of life. 15.6% (5/32) required enterostomy. 21.8% (7/32) had complications requiring reoperation in 71% (5/7) with 1 case of short bowel syndrome. Median time to enteral nutrition onset was 10 days (IQR 7-15), higher in patients with ileal atresia. Hospital stay was 33 days (interquartile range 23-66 days) and overall mortality of 9.3%. CONCLUSION: In our series the congenital malformations associated with intestinal atresia were determinant in the prognosis and mortality of these patients.

OBJETIVOS: La atresia intestinal es la malformación congénita obstructiva del tubo digestivo más frecuente. Nuestro objetivo es describir la morbilidad y mortalidad de las atresias intestinales en nuestro medio. MATERIAL Y METODOS: Estudio retrospectivo de neonatos con atresia intestinal intervenidos en nuestro centro en los últimos 15 años. Se realiza un análisis descriptivo de variables clínicas y epidemiológicas. RESULTADOS: Un total de 32 pacientes, 40,6% (13) mujeres y 59,4% (19) varones, edad materna de 31 ± 5 años, controles prenatales en el 96,8% (30) y diagnóstico prenatal en 68,8% (22). Edad gestacional de 35 ± 3 (25-41 SG), peso al nacer 2.506 ± 516 g (920-3.470 g). El 53% (17/32) de localización duodenal (65% extrínseca y 35% tipo I); el 37,5% (12/32) yeyunoileal (16,6% tipo I, 25% tipo II, 16,6% tipo IIIa, 16,6% tipo IIIb y 25% tipo IV); el 6,5% (2/32) colónica y 3% (1/32) pilórica. El 65,6% (21/32) asociaba otra malformación congénita. El 81,3% (26) fueron intervenidos en las primeras 48 horas de vida, precisando derivación intestinal un 15,6% (5/32). El 21,8% (7/32) presentaron complicaciones, de los cuales el 71% (5/7) requirieron reintervención, con un caso de intestino corto. El tiempo medio de inicio de nutrición enteral fue 10 días (RIQ 7-15), mayor en los pacientes con atresia ileal; la estancia hospitalaria fue de 33 días (RIQ 23-66 días) y la mortalidad general, del 9,3%. CONCLUSIONES: Las malformaciones congénitas asociadas en pacientes con atresia intestinal son un factor determinante en el pronóstico y mortalidad de los mismos.

[Management and description of neonatal tumours in a surgical oncology unit]. / Tumores neonatales: experiencia en una Unidad de Cirugía Oncológica.

AIM: Neonatal tumours represents less than 2% of all childhood cancers. The biological behaviour of this tumours will differ in older children. The tumours's biological differences and the immature physiological characteristics of newborns represent a great therapeutically challenge making newborns vulnerable. The aim of this study is to describe the clinical characteristics, associated malformations, diagnostic methods, treatment and the outcomes of neonatal tumours. METHODS: Retrospective review of patients ≤ 28 days-old with diagnosis of neonatal tumour between 2000-2016. Statistical analysis of clinical characteristics, histology, diagnostic methods, treatment and morbimortality. RESULTS: A total of 26 tumours were diagnosed in newborns with a mean age of 4.85 ± 8.9 days and 69.2% of boys. Prenatal diagnosis was achieved in 38.5% (n = 10) and 38.5% (n = 10) in the first week of age. Associated malformations were found in 30.6% (n = 8). The most frequent tumours were hepatic hemangioma 23.1% (n = 6), neuroblastoma 15.4% (n = 4) and sacrococcygeal teratoma 11.5% (n = 3). Medical treatment was indicated in 7.7% (n = 5), surgical 57.7% (n = 15) and observation 30.8% (n = 7). Global mortality was 19.23% (n = 5) of which 42.9% (n = 3/7) were perioperatively. CONCLUSIONS: The management of neonatal tumours require a multidisciplinary approach to minimize the consequences and assure the best outcome. Global mortality is low and depends primarily of the physiologic and association of other malformations of the newborn.

OBJETIVO: Los tumores neonatales representan menos del 2% de los tumores pediátricos, sin embargo, el comportamiento biológico difiere de los desarrollados en otros grupos de edad. Estas características, junto a la inmadurez neonatal, dificultan el tratamiento, convirtiéndolos en un grupo muy vulnerable. El objetivo de este estudio es describir las características clínicas, anomalías asociadas, diagnóstico y repercusión del tratamiento de los tumores neonatales. MATERIAL: Estudio retrospectivo de pacientes ≤ 28 días diagnosticados de tumor neonatal entre 2000-2016. Se realizó análisis estadístico de las principales características clínicas, histológicas, métodos diagnósticos, tratamientos establecidos y morbimortalidad. RESULTADOS: Se diagnosticaron 26 recién nacidos con tumores. El 69,2% varones, con edad media al diagnóstico de 4,85 ± 8,9 días. El diagnóstico fue prenatal en 38,5% (n = 10) y 38,5% (n = 10) en la primera semana de vida. El 30,6% (n = 8) asoció otra malformación. Los tumores más frecuentes fueron los hemangiomas hepáticos, 23,1% (n = 6), neuroblastoma, 15,4% (n = 4) y teratoma sacrococcígeo, 11,5% (n = 3). Se realizó tratamiento médico en 7,7% (n = 5), quirúrgico en 57,7% (n = 15) y conservador en 30,8% (n = 7). La mortalidad global fue del 19,23% (n = 5), de los cuales 42,9% (n = 3/7) casos ocurrieron durante el periodo perioperatorio. CONCLUSIONES: El manejo de los tumores neonatales requiere un equipo multidisciplinar para minimizar las secuelas y garantizar el mejor resultado. El manejo conservador es una opción terapéutica válida en determinados tipos de tumores. La mortalidad global es baja y depende principalmente de las características fisiológicas del neonato y de sus malformaciones asociadas.

Electroencephalography as a post-stroke assessment method: An updated review. / Electroencefalografía como método de evaluación tras un ictus. Una revisión actualizada.

Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels.

[Clinical and immunohistochemical correlation of balanitis xerotica obliterans]. / Correlación clínica e inmunohistoquímica de la balanitis xerotica obliterans.

AIM: Balanitis xerotica obliterans (BXO) is a disease of the skin and mucosa of male genitals of unknown etiology that may affect children of any age. It has a low incidence (9-19%) and in adults is considered a potential premalignant lesion. The aim of our study is to establish the incidence of BXO in our center and to determine its correlation between the clinical and immunohistochemical (IHC) findings. METHODS: Prospective cohort including all children < 14 years with foreskin pathology that required a circumcision between 2014-2016. Statistical analysis of the clinical characteristics, histological and IHC findings searching for inflammatory response, premalignant lesions and microbiological findings. RESULTS: A total of 176 boys with phimosis had circumcision with a mean age of 7 ± 3 years (Range 2-14). Presurgical diagnosis of BXO was suspected in 28.4% (n= 50) whereas the AP confirmed a total of 29.5% (n= 53) with a very good interobserver concordance (kappa= 0.81: p< 0.01). Previous treatment with corticoids in BXO was found in 63.5% (n= 33/52). Meatal stenosis was found in 7.69% (n= 4/52) requiring meatal/urethral dilations. Patients with BXO had a T-Lymphocytes CD3+ mediated inflammatory response with a positive correlation between tumor suppressing protein (p53) expression and chronic inflammation. CONCLUSIONS: BXO is a chronic inflammatory disease mediated by T-lymphocytes with an incidence greater than previously reported. Surgeons' criterion has a very good concordance with the AP findings. The elevation of p53 in children with BXO may indicate a plausible malignant potential that may require a surgical treatment (circumcision) and an adequate follow-up.

OBJETIVO: La balanitis xerotica obliterans (BXO) es una enfermedad de etiología incierta, que afecta a piel y mucosa de genitales masculinos de cualquier edad. La incidencia en niños es baja (9-19%) y en adultos se considera una lesión premaligna. El objetivo de este estudio es establecer la incidencia de BXO en nuestro centro y determinar la correlación entre las características clínicas y los hallazgos inmunohistoquímicos (IHQ). METODOS: Cohorte prospectiva de niños ≤14 años con fimosis circuncidados entre 2014-2016. Análisis estadístico de las características clínicas e histológicas e IHQ para valorar la respuesta inflamatoria, presencia de lesiones premalignas y asociaciones microbiológicas. RESULTADOS: Se incluyeron 176 pacientes circuncidados con una edad media de 7 ± 3 años (rango 2-14 años). La sospecha clínica de BXO, 28,4% (n= 50), se confirmó mediante anatomía patológica en 29,5% (n= 52) con muy buena fuerza de concordancia interobservador (kappa= 0,81: p< 0,01). El 63,5% (n= 33/52) recibieron corticoterapia como tratamiento inicial. El 7,69% (4/52) presentaron estenosis meatal requiriendo dilataciones meatales/uretrales. Los casos de BXO presentaron una respuesta mediada por linfocitos-T: CD3+ (p< 0,01) y correlación positiva con la sobreexpresión de proteína supresora de tumores (p53) (p< 0,01). CONCLUSIONES: BXO es una enfermedad inflamatoria crónica mediada por linfocitos-T con una incidencia mayor a la reportada. La concordancia interobservador entre la sospecha de BXO y la confirmación histológica es muy buena. La elevación de p53 en los pacientes con BXO indica un posible potencial maligno que requiere tratamiento quirúrgico (circuncisión) y un seguimiento adecuado.

[Correlation between prenatal ultrasound and postnatal diagnosis of birth defects]. / Correlación entre la ecografía prenatal y el diagnóstico postnatal de las malformaciones congénitas.

OBJECTIVES: To assess the accuracy of prenatal ultrasound diagnosis and to analyze the protocol applied for congenital defects (CD) in our environment. METHODS: Descriptive study of prenatally diagnosed CD in our area between 2004-2013. Includes: total births, fetal medicine referrals (number of consultations, ultrasound, invasive techniques) anatomical and chromosomal abnormalities, confirmed diagnoses, necropsies performed, false diagnoses, absence of prenatal diagnoses, and number and reasons for abortions (VIEs). RESULTS: Mean annual births were 3,646 ± 1,299, with a mean prenatal ultrasound of 2,144 ± 307 and 512 ± 74 invasive techniques per year. The annual average of prenatal chromosomopathies diagnosed were 26 ± 8 and 140 ± 14 anatomical abnormalities, which represents a 36.44% from all of the prenatal ultrasound performed. These include: neurological, cardiac and nephron-urological anatomic anomalies. Pre and post-natal correlation was observed in 95.6% of the DCs detected. Most common causes of abortion were chromosomal abnormalities, heart and neurological diseases. CONCLUSIONS: Due to the variety of CD that cause VIEs, a highly specialized multidisciplinary approach is recommended to ensure optimal information for parents.

OBJETIVOS: Valorar la precisión del diagnóstico ecográfico prenatal y analizar el protocolo de actuación frente a un determinado defecto congénito (DC) en nuestro medio. MATERIAL Y METODOS: Estudio descriptivo de los DC diagnosticados prenatalmente en nuestra área sanitaria entre los años 2004-2013. Como variables del estudio se incluyeron el número de nacimientos totales, derivaciones a medicina fetal (número de consultas, ecografías, técnicas invasivas) anomalías anatómicas por sistemas, cromosomopatías, diagnósticos confirmados, necropsias realizadas, falsos diagnósticos, ausencia de diagnóstico prenatal, número y motivo de interrupciones voluntarias del embarazo (IVEs). RESULTADOS: Durante el período estudiado, la media de nacimientos anuales fue de 3.646 ± 1.299, con una media de 2.144 ± 307 ecografías prenatales y 512 ± 74 técnicas invasivas anuales. La media anual de diagnóstico prenatal fue de 26 ± 8 cromosomopatías y 140 ± 14 anomalías anatómicas que suponen un 36,44% del total de las ecografías prenatales realizadas. Entre estas últimas se observaron malformaciones del sistema urinario, cardíacas y neurológicas, entre otras. Se observó correlación pre y postnatal en el 95,6% de los DC detectados. Las causas de interrupción del embarazo más frecuentes fueron las cromosomopatías, seguidas de las malformaciones congénitas (MC) cardíacas y neurológicas. CONCLUSIONES: Debido a la variedad de DC que originan IVE, es recomendable un abordaje multidisciplinar altamente especializado que garantice una información óptima a los padres.

[An unexpected complication: glans ischemia after circumcision. Review of the literature]. / Isquemia postcircuncisión: una complicación inesperada. Revisión de la literatura.

INTRODUCTION: Circumcision is a frequent and common surgical procedure in children; nevertheless it is not completely hassle-free. Post circumcision ischemic complications are even rare and they are generally due to administration of local vasoconstrictor anesthetics. There are few cases reported in the literature. We report the management and treatment of post- circumcision penile ischemia (PCI). CASE REPORT: A 10 years old patient who underwent circumcision and a dorsal penile nerve block DPNB presents signs of penile ischemia two hours after surgery without any other symptoms. Ultrasonography shows weak flow of the penile artery, with progressive worsening. 24 hours later we start treatment with pentoxifylline (PTX) that is maintained for 6 days, topical testosterone and a caudal blocking (for 48 hours). The patient evolved favorably within a few hours and there was complete resolution in 6 days. DISCUSSION: We analyze 9 cases of pediatric patients which were described in the literature. 7 cases (77.7 %) received DPNB. The PCI is an unusual complication of circumcision, and DPNB seems to be the most frequent cause. Several therapeutic options are available for its management, but none is protocolised.

INTRODUCCION: La circuncisión, aunque es el procedimiento quirúrgico más común en niños, no está totalmente libre de complicaciones. Las complicaciones isquémicas post-circuncisión, son muy raras, y generalmente debidas a la administración de anestésicos locales vasoconstrictores. Se presenta el manejo y tratamiento con éxito de una isquemia peneana post-circuncisión (IPC) en un niño y se realiza una revisión de los casos descritos en la literatura. CASO CLINICO: Paciente de 10 años de edad sometido a circuncisión y bloqueo del nervio dorsal peneano (BNDP), que presenta a los 2 horas de la intervención, signos de isquemia peneana, sin otra sintomatología. La ecografía objetiva flujo débil de la arteria peneana, con empeoramiento progresivo. A las 24 horas, se inicia tratamiento con pentoxifilina (PTX) durante 6 días, testosterona tópica y un bloqueo caudal que se mantuvo durante 48 horas. Se observa mejoría de la isquemia a las pocas horas de instaurado el tratamiento y resolución total a los 6 días. DISCUSION: Existen 9 casos de pacientes con edad pediátrica de IPC descritos en la literatura en los últimos 10 años, 7 de los cuales (77,7%) recibieron BNDP. La IPC es una complicación inusual y el BNDP parece ser la causa más frecuente. Se dispone de diferentes opciones terapéuticas para el manejo de la IPC, pero ninguna protocolizada.

[Intestinal duplication, a single experiencie center]. / Duplicaciones intestinales, nuestra experiencia.

PURPOUSE: Intestinal duplications (DI) are rare congenital anomalies (1/10.000 new born). We analyze the clinical characteristics, management and treatment of intestinal duplications in our center. MATERIALS AND METHODS: We perform a retrospectively descriptive analysis review by the DI confirmed by histological studies since 1993-2014 in our center. The variables analyzed are: age, sex, clinical presentation, localization, anatomical type, associated diseases, heterotopic tissue, treatment and complications. RESULTS: We found ten patients diagnosed with DI. 60% were male, the middle age was 2.72 years (12 days-7 years). In the clinical presentation 30% presents acute abdomen, another 30% gastrointestinal bleeding and 30% were prenatal diagnosed. Imaging studies were echography, gammagraphy, magnetic resonance imaging and intestinal transit contrast. The most frequent localization was the yeyuno-ileal (60%) with cystic predominance; the gastric, duodenal colic was 10% respectively; an ectopic localization was a suprarenal mass. The treatment was a complete resection by laparotomy in eight cases and laparoscopic in two In the duodenal duplication, we perform a partial resection and mucosectomy. In 60% was necessary the intestinal resection. In anatomy pathologic results, gastric tissue (heterotopic tissue) was present in 70% and pancreatic tissue in 10%. We report an intussusception postsurgical as a complication. CONCLUSIONS: The preoperative diagnosis is rare, although prenatal diagnosis is increasing. Clinical manifestations are associated with the location of the DI and the existence of heterotopic gastric mucosa. Laparoscopy is currently the treatment of choice in uncomplicated cases.

OBJETTIVO: Las duplicaciones intestinales (DI) son anomalías congénitas raras (1/10.000 recién nacidos vivos). Analizamos las características clínicas, manejo y tratamiento de DI en nuestro centro. MATERIAL Y METODOS: Análisis descriptivo retrospectivo de las DI confirmados por histología desde 1993-2014 en nuestro centro. Revisamos como variables: edad, sexo, presentación clínica, localización, tipo anatómico, enfermedades asociadas, presencia de tejido heterotópico, tratamiento y complicaciones. RESULTADOS: Se diagnosticaron 10 pacientes con DI, 6 fueron varones, la edad media fue de 2,72 años (12 días-7 años). 3 debutaron con abdomen agudo; otros 3 con hemorragia digestiva alta, 2 con masa abdominal; uno con obstrucción intestinal y uno con dolor crónico. De estos el 30% tuvo diagnóstico prenatal. Los estudios de imagen incluyeron ecografía, gammagrafía, resonancia magnética y tránsito intestinal. La localización anatómica más frecuente fue yeyuno-ileal (60%) de predominio quístico; la gástrica, duodenal, cólica fue de 10% respectivamente; y una localización ectópica con sospecha de masa suprarrenal. El tratamiento consistió en resección completa mediante laparotomía en 8 casos y laparoscopía en dos. En la DI duodenal que se practicó mucosectomía y resección parcial. En 6 casos se llegó a realizar resección intestinal. Se halló tejido gástrico heterotópico en 7 y pancreático en uno. Como complicaciones destaca un caso de invaginación intestinal postoperatoria. CONCLUSIONES: El diagnóstico preoperatorio es poco frecuente, aunque se está incrementando el diagnóstico prenatal. Las manifestaciones clínicas se relacionan con la localización de la DI y con la existencia de mucosa heterotópica gástrica. Actualmente la laparoscopia es el tratamiento de elección en casos no complicados.

Central versus peripheral arterial cannulation and neurological outcomes after thoracic aortic surgery: meta-analysis and meta-regression of 4459 patients.

BACKGROUND: Thoracic aortic surgeries remain with high mortality rates, often associated with postoperative neurological complications. The choice of the right cannulation site is extremely important for suitable blood supply and maintenance of vital functions, especially of the central nervous system. OBJECTIVES: To compare the influence of central versus peripheral arterial cannulation on neurological outcomes in patients undergoing thoracic aortic surgery through systematic review and meta-analysis. METHODS: MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS and reference lists of relevant articles were searched for clinical studies that reported in-hospital neurological outcomes after central or peripheral arterial cannulation during thoracic aortic surgery procedures until December 2013. The principal summary measures were Odds Ratio (OR) for central compared to peripheral arterial cannulation with 95% confidence interval (CI) and p-values considered statistically significant when <0.05. The ORs were combined across studies, using the DerSimonian-Laird random effects model and fixed effects model using the Mantel-Haenszel model--both models were weighted. The meta-analysis was completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, NJ). RESULTS: Six studies were identified and included a total of 4459 patients (1180 for central and 3279 for peripheral cannulation). There was no significant difference between the central and peripheral groups regarding neurological outcomes. The meta-regression evidenced no relationship between neurological outcomes and the variables age, sex, previous coronary event, previous neurological event, urgency surgery, cardiopulmonary bypass time, activated clotting time and esophageal temperature with p > 0,05. CONCLUSION: When it comes to neurological outcomes in patients undergoing thoracic aortic surgery, there was no evidence that argues in favor of any choice of arterial cannulation site, which makes us reject any superiority of one approach over the other in this regard.

Effectiveness of equine therapy in children with psychomotor impairment.

INTRODUCTION: Equine therapy, an intervention method that has been practiced for decades around the world, is used to treat patients susceptible to psychomotor delays. OBJECTIVES: We examine development of gross motor function compared to other psychomotor skills in patients undergoing this therapy, and analyse how this improvement affects general health status and quality of life. MATERIAL AND METHODS: The study includes 11 children with delayed psychomotor development (aged 8.82 ± 3.89; 6 boys, 5 girls). The main study variables were gross motor function (GMFM-88) and perceived quality of life (Pediatric Quality of Life Inventory, PedsQL). Three measurements were performed: before and after a period of inactivity, and once again 2 months after the second measurement, following completion of a sustained period of therapy. RESULTS: We observed significant differences in overall results on the GMFM-88 between the initial and final tests and between the intermediate and final tests. Regarding the PedsQL quality of life scale, no statistically significant results were recorded. CONCLUSIONS: Noticeable changes in motor control were recorded throughout the course of the intervention, which suggests that equine therapy may be appropriate treatment in cases of delayed psychomotor development.

Theories and control models and motor learning: clinical applications in neuro-rehabilitation.

INTRODUCTION: In recent decades there has been a special interest in theories that could explain the regulation of motor control, and their applications. These theories are often based on models of brain function, philosophically reflecting different criteria on how movement is controlled by the brain, each being emphasised in different neural components of the movement. The concept of motor learning, regarded as the set of internal processes associated with practice and experience that produce relatively permanent changes in the ability to produce motor activities through a specific skill, is also relevant in the context of neuroscience. Thus, both motor control and learning are seen as key fields of study for health professionals in the field of neuro-rehabilitation. DEVELOPMENT: The major theories of motor control are described, which include, motor programming theory, systems theory, the theory of dynamic action, and the theory of parallel distributed processing, as well as the factors that influence motor learning and its applications in neuro-rehabilitation. CONCLUSIONS: At present there is no consensus on which theory or model defines the regulations to explain motor control. Theories of motor learning should be the basis for motor rehabilitation. The new research should apply the knowledge generated in the fields of control and motor learning in neuro-rehabilitation.

[Conservative or early surgical management of appendiceal mass. Does it affect the appearance of complications?] / Tratamiento quirúrgico o conservador del plastrón apendicular. ¿Influye en la aparición de complicaciones?

OBJECTIVES: Currently the management of appendicular mass remains controversial. Many authors advocate conservative management followed by delayed appendectomy, whereas others favour inmediate appendectomy. The aim of our study is to compare both treatments. METHODS: A descriptive and observational study over 46 patients treated for appendiceal mass at our center in the last ten years was performed. Patients were categorized as group 1, early surgical intervention (54.3%) and group 2, conservative management and interval appendectomy (45.7%), with a mean interval of 5.3 ± 1.5 months. RESULTS: Mean age was 9.2 ± 3.8 years in group 1 and 3.7 ± 3 years in group 2 (p<0.001). Median delay between the first symptoms and diagnosis was 4 ± 2.2 days in group 1 and 7.9 ± 4.2 days in group 2 (p<0.001). Antibiotics were administered before diagnosis in 24% of patients in group 1 and 42.9% in group 2 (p = 0.297). Ultrasound was performed in all patients, while 19.6% of patients requiered TAC for definitive diagnosis. Median hospital stay was 7.9 ± 2.9 days in group 1 and 8.3 ± 2.2 days in group 2 (p = 0.441). Complicactions were found in 64% of patients (group 1) and 23% of patients (group 2) (p = 0.015). Three patients from group 2 requiered readmission because of recurrent abdominal pain, but just one requiered early surgery. CONCLUSION: Conservative management of appendicular mass has a lower complication rate compared to the initial surgical management.

OBJETIVO: Actualmente el manejo del plastrón apendicular sigue siendo controvertido. Muchos autores defienden el tratamiento conservador y posterior apendicectomía programada, frente a otros que defienden la intervención quirúrgica en fase aguda. Nuestro objetivo es comparar ambos tratamientos. MATERIAL Y METODOS: Estudio observacional descriptivo de 46 pacientes tratados por presentar plastrón apendicular en nuestro centro en los últimos diez años. El 54,3% de los pacientes (n = 25) (G1) fueron tratados quirúrgicamente en la presentación del cuadro agudo, mientras que el 45,7% (n = 21) (G2) se trataron de forma conservadora con posterior apendicectomía, con un intervalo medio de 5,3 ± 1,5 meses. RESULTADOS: La edad media de presentación fue de 9,2 ± 3,8 años en el G1 y de 3,7 ± 3 en el G2 (p<0,001). El tiempo medio hasta el diagnóstico fue de 4 ± 2,2 días en el G1 y de 7,9 ± 4,2 en el G2 (p<0,001). El 24% de los pacientes habían recibido tratamiento antibiótico previo al diagnóstico en el G1 y el 42.9% en el G2 (p = 0,297). La TAC fue necesaria para el diagnóstico en el 19.6% del total, en el resto, la ecografía fue suficiente. La estancia hospitalaria media fue de 7,9 ± 2,9 días en el G1, frente a 8,3 ± 2,2 días en el G2 (p = 0,441). El porcentaje de complicaciones en el G1 fue del 64% frente al 23,8% en el G2 (p = 0,015). Tres pacientes del G2 reingresaron de urgencias por dolor abdominal, precisando uno de ellos cirugía antes de la fecha programada. CONCLUSIONES: El manejo conservador del plastrón apendicular presenta una menor tasa de complicaciones respecto al manejo quirúrgico inicial.

[Implementation of a Plan of Patient Safety in Service of Pediatric Surgery. First results]. / Implementación de un Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica. Primeros resultados.

OBJECTIVES: In 2014 our department starts to apply the PatientSafety Strategic in Pediatric Surgery. Our aim is to describe the results obtained. METHODS: For the measurement of adverse events (AE) we used a modification of the Global Trigger Tool of the Institute for Healthcare Improvement. Population analysed: patients undergoing surgery with hospitalization. On a monthly basis, audits of the medical records of 12 patients discharged in the prior week of the assessment were performed. The evaluation team was composed by experienced pediatric surgeon, two staff nurses, and a doctor and nurse from the Quality Department. RESULTS: 95 clinical records and a total of 406 days of hospital stay were reviewed. 31 patients (32.6%) experienced one or more AE. Total AE: 43. The AE/1000 patients/day ratio: 105.9. The most common AE were: vomiting, itching and pain. 28 EA were considerd mild and 3 moderate in severity, according to the classification of the National Coordinating Council for Medication Error Reporting and Prevention. No EA were considered serious or critical. CONCLUSIONS: The analysis of prevalence through regular assessments of medical records is an easy method to obtain information about the frequency of occurrence, exact understanding of the AE types and the implementation of corrective measures. The main limitation of this method is that it can miss some of the serious EA and miss the records and analysis of sentinel events that may occur in the period between assessments.

OBJETIVOS: Durante el año 2014 se aplica el Plan de Seguridad del Paciente en un Servicio de Cirugía Pediátrica, elaborado previamente por nuestro Servicio. Se describen los resultados. MATERIAL Y METODOS: El método empleado para la medición de eventos adversos (EAs) es una modificación del Global Trigger Tool del Institute for Health care Improvement. Población analizada: pacientes intervenidos quirúrgicamente con hospitalización. Con una periodicidad mensual, se realizaron 12 auditorias de las historias clínicas correspondientes a los pacientes dados de alta en la semana anterior al día de la evaluación. El equipo evaluador estaba compuesto por: un cirujano pediátrico experto, dos enfermeras de planta más un médico y una enfermera del Servicio de Calidad. RESULTADOS: Se revisaron 95 historias y 406 días de estancia. 31 pacientes (32,6%) sufrieron uno o más eventos adversos. Total EAs: 43. Número EAs/1.000 pacientes/día: 105,9. Los 3 EA más frecuentes fueron: vómitos, prurito y dolor. 28 EAs fueron de gravedad leve y 3 moderada, según la clasificación del National Coordinating Council for Medication Error Reporting and Prevention. Ningún EA fue grave o crítico. CONCLUSIONES: La determinación de la prevalencia mediante evaluaciones regulares de historias clínicas es un método que permite obtener información de forma fácil sobre la frecuencia de aparición, el conocimiento exacto de los tipos de EAs y la aplicación de medidas correctoras. Este método tiene como limitación principal la posible falta de recogida EAs graves así como registro y análisis de eventos centinelas que pueden ocurrir en el periodo entre evaluaciones.

Effect of ankle-foot orthosis on postural control after stroke: a systematic review.

INTRODUCTION: Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. DEVELOPMENT: The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. CONCLUSIONS: Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution.

Use of virtual reality systems as proprioception method in cerebral palsy: clinical practice guideline.

INTRODUCTION: The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions. DEVELOPMENT: All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait. CONCLUSIONS: The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.

Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study. / Comparación de dos técnicas de sección vascular en la varicocelectomía laparoscópica. Estudio prospectivo.

INTRODUCTION: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution. MATERIALS AND METHODS: A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence- were analyzed according to the method employed. RESULTS: A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence. CONCLUSIONS: The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences.

INTRODUCCION: El varicocele es la dilatación anormal del plexo pampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducir hipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones, incluyendo la recurrencia del varicocele, dependiendo de la técnica de oclusión vascular utilizada: clip y sección o sellador vascular, en la técnica de Palomo laparoscópico en nuestro centro. MATERIAL Y METODOS: Estudio longitudinal prospectivo que se realiza de 2017 a 2021. Se crean dos grupos terapéuticos según el método de oclusión vascular utilizada durante la varicocelectomía laparoscópica: clip y sección o sellador vascular. Los pacientes son incluidos en un grupo mediante asignación sistemática consecutiva alternante. Se realiza el análisis de las variables: edad, grado de varicocele según la clasificación de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento y recurrencia del varicocele, según el método empleado. RESULTADOS: Se intervinieron un total de 37 niños, con edad media de 12 años (10-15 años) y una media de seguimiento de 12 meses. En 20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes (45,9%), sellador vascular. El 24,3% presentaba varicocele Grado II sintomático y el 75,7%, Grado III. El 32,4% de los niños presentó alguna complicación postquirúrgica durante el seguimiento. El 29,7% de los pacientes presentó hidrocele tras la intervención, perteneciendo 8 niños al grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisó reintervención por este motivo. Ningún paciente presentó recurrencia del varicocele. CONCLUSIONES: La técnica de Palomo laparoscópica es una técnica segura y efectiva que presenta buenos resultados en pacientes pediátricos, ya que presenta pocas complicaciones postquirúrgicas, independientemente del dispositivo de oclusión vascular que se utilice. En nuestro estudio, no se ha demostrado que existan diferencias estadísticamente significativas en cuanto al uso de clip o sellador vascular en esta técnica laparoscópica. No obstante, es preciso realizar más estudios con mayor tamaño muestral para hallar posibles diferencias.

Description of Intensive Care and Intermediate Care resources managed by Anaesthesiology Departments in Spain and their adaptation capacity during the COVID-19 pandemic.

INTRODUCTION: It is essential to understand the strategic importance of intensive care resources in the sustainable organisation of healthcare systems. Our objective has been to identify the intensive and intermediate care beds managed by Anaesthesiology and Resuscitation Services (A-ICU and A-IMCU) in Spain, their human and technical resources, and the changes made to these resources during the COVID-19 pandemic. MATERIAL AND METHODS: Prospective observational study performed between December 2020 and July 2021 to register the number and characteristics of A-ICU and A-IMCU beds in hospitals listed in the catalogue published by the Spanish Ministry of Health. RESULTS: Data were obtained from 313 hospitals (98% of all hospitals with more than 500 beds, 70% of all hospitals with more than 100 beds). One hundred and forty seven of these hospitals had an A-ICU with a total of 1702 beds. This capacity increased to 2107 (124%) during the COVID-19 pandemic. Three hundred and eight hospitals had an A-IMCU with a total of 3470 beds, 52.9% (2089) of which provided long-term care. The hospitals had 1900 ventilators, at a ratio of 1.07 respirators per A-ICU; 1559 anaesthesiologists dedicated more than 40% of their working time to intensive care. The nurse-to-bed ratio in A-ICUs was 2.8. DISCUSSION: A large proportion of fully-equipped ICU and IMCU beds in Spanish hospitals are managed by the anaesthesiology service. A-ICU and A-IMCUs have shown an extraordinary capacity to adapt their resources to meet the increased demand for intensive care during the COVID-19 pandemic.

[Implementation of "fast-track" treatment in paediatric complicated appendicitis]. / Aplicación de un modelo terapéuticofast-track en la apendicitis aguda complicada del paciente pediátrico.

OBJECTIVE: Acute appendicitis is the most common emergency surgical pathology in childhood and there is no consensus on its management. Fast-track treatment, based on optimizing perioperative care has reduced morbidity and mortality of surgical pathologies, including simple acute appendicitis. The aim of our study was to assess the effects of a fast-track protocol in complicated acute appendicitis. METHODS: Ambispective cohort study. Historical unexposed cohort: children with complicated appendicitis and appendectomy in our hospital during 2008-2009. Exposed cohort: children operated in 2010-2011 and who performed protocol. The protocol treatment was done after a literature review, adapting the principles of fast-track to a potentially severe urgent disease: early mobilization, limited drainage-tubes and short antibiotic regimens Taking hospital stay as the resulting variable, the calculated sample size for alpha = 0.05 and power = 90% was 54, being X1 = 7 +/- 3DS and X2=5. RESULTS: We included 151 patients, historical cohort 81 and current cohort 70, which excluded 31 children who did not meet protocol because of surgeon choice. Both groups showed homogeneity due to the absence of differences in sex, age, weight, type of appendicitis (gangrenous, perforated, generalized peritonitis) or surgical approach. The average stay decreased 2.71 days (p <0.001) due to the protocol, without any complication increase (abscess, postoperative ileus, readmission). CONCLUSIONS: Complicated appendicitis in children is common and potentially serious, and optimization of treatment should be a primary goal of our practice. Application of a fast-track protocol can provide clinical and economic benefits, although this requires an appropriate multidisciplinary management.