Consistency between POLARS and LARS scores regarding the incidence of low anterior resection syndrome in a Chilean population undergoing rectal surgery secondary to cancer in a high-volume hospital.

AIM: The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high-volume hospital. METHOD: The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland-Altman plot with Lin's concordance correlation coefficient. RESULTS: A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor. CONCLUSION: In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales.

Ileal pouch-anal anastomosis in ulcerative colitis: outcomes, functional results, and quality of life in patients with more than 10-year follow-up.

PURPOSE: Ileal pouch-anal anastomosis (IPAA) has become the surgical procedure of choice for patients with ulcerative colitis (UC). IPAA was incorporated into our institution in 1984, and thereafter, more than 200 procedures have been performed. The functional results and morbidity of this surgery have been reported previously. However, long-term functional outcomes and quality of life have not been evaluated. METHODS: As a cohort study, we identified all consecutive patients who underwent IPAA for UC between 1984 and 2017 and selected those with more than 10-year follow-up. Demographic data, morbidity, and pouch survival information were obtained. Long-term functional results and quality of life were evaluated through an e-mail survey using the Öresland score and the Cleveland Global Quality of Life scales, respectively. RESULTS: Of 201 patients, 116 met the inclusion criteria. Median follow-up was 20 (10-34) years. Early post-operative complications (30 days) were observed in 19 (16.4%) patients and 66 (56.9%) presented adverse events. The IPAA preservation rate at 10 and 20 years was 96.5% and 93.1%, respectively. Long-term functional scores presented a median of 6 (1-15) points. IPAA function was satisfactory in 11 (20.0%) patients, acceptable in 18 (32.7%), and deficient in 26 (47.3%). The median score for global quality of life was 0.8 (0.23-1.0) points. CONCLUSION: IPAA as treatment for UC meets the expectations of cure of the disease, maintaining adequate long-term intestinal functionality associated with a good quality of life in most patients.

New treatment for faecal incontinence using zinc-aluminium ointment: a double-blind randomized trial.

AIM: In a randomized double-blind study the therapeutic effect of a novel zinc-aluminium ointment was compared with placebo in patients with faecal incontinence. METHOD: A randomized double-blind trial was performed. Patients who met the inclusion criteria were randomized to receive the ointment or a placebo. All were evaluated prior to and 3 weeks after ointment application, using the Wexner incontinence score and the Fecal Incontinence Quality of Life (FIQL) score. RESULTS: Fifty patients were randomized and six were lost to follow-up, leaving 24 in the treatment and 20 in the placebo group. The average ages were 61.3 and 60.7 years. The respective Wexner scores prior to intervention were 16.6 and 16.7. They decreased significantly after treatment to 8.5 and 13.1 (P<0.001 and P=0.002 respectively). There was a significant difference in the final scores, favouring the treatment group (P=0.001). The FIQL scores for the treatment group were also significantly better in all parameters compared with those of the placebo group. CONCLUSION: The study shows that the zinc-aluminium based ointment decreases faecal incontinence significantly compared with placebo.

[Quality of life in children operated on for anal atresia]. / Calidad de vida en los pacientes intervenidos de atresia de ano.

INTRODUCTION: Most children with anorectal malformations have some type of intestinal dysfunction. A correct follow up in this aspect after surgery affects their quality of life. MATERIAL AND METHODS: We gathered a sample of 20 children that were lost in their follow up after posterior sagittal anorectoplasty (PSARP). We got contact with them and they were interviewed and examined in our department. RESULTS: We collected 12 girls and 8 boys. Age range was between 3 and 14 years. 70% had good prognosis for continence (low fistula) and 30% poor prognosis (high fistula). 35% suffered from postoperative complications being the most frequent prolapse especially in high atresias. 85% had good rectal sensitivity, 15% had poor sensitivity that was directly related to incontinence. Anal tone was decreased in our exploration in 35% of patients which was not directly related to their continence. 65% suffered constipation with or without fecaloma. 5% of cases had intestinal hipermotility. The total incidence of fecal loose was 40%. More than a half (62,5%) kept on loosing stool despite treating their constipation or hipermotility, so we consider them true incontinents (no voluntary bowel movements). 67% of children with high fistula were true incontinents, just 7% of those with low fistula. Subjective quality of life in patients with soling was 6.4. In clean patients it was 9.3. Objective quality of life (Score/13) in dirty patients was 6.6. In Clean patients: 11.9. After our bowel management protocol we got 100% of patients clean during school time, thereby improving their quality of life. CONCLUSIONS: Incontinence determines the long-term quality of life in our patients in addition to the psycho-social consequences. They are clearly more frequent in patients with high fistula. Much assume incontinence as an unavoidable part of their disease so do not always demand treatment if they are not followed by a surgeon.

Are topical oestrogens useful in faecal incontinence? Double-blind randomized trial.

BACKGROUND: Histopathological studies have shown the presence of oestrogenic receptors in the anal sphincter, which presumes a role in muscular trophism for circulating oestrogens. This could explain the increase in faecal incontinence (FI) in postmenopausal women. OBJECTIVE: To evaluate the effect of topical oestrogens (TE) in controlling symptoms of FI in postmenopausal women. Hypothesis The application of TE in postmenopausal women with FI improves continence. METHOD: We performed a prospective double-blind randomized trial applying TE to the anal mucosa in postmenopausal women with FI. STUDY PERIOD: 2005-2006. The patients were randomized into two groups: I--topical estriol, II--placebo. In both groups, the ointment was applied three times daily for a period of 6 weeks. We compared Wexner's FI score and the FI quality of life scale, before commencing and after 6 weeks of application. RESULTS: In this period we evaluated 36 patients. Average age: 67 years (48-84). Group I: 18 patients and group II: 18 patients, one patient was excluded. Wexner's FI score in group I was 11 (5-18) and 7 (0-19) with pre- and postapplication respectively (P = 0.002). Wexner's FI score in group II was 12 and 9 with pre- and postapplication respectively (P = 0.013). When we compared the results between both groups, this was not statistically significant (P = 0.521). CONCLUSION: There is improvement of continence in both groups that had the ointment applied; nonetheless this study could not show that TE improves FI more than a placebo does.

[Non-palpable testes: laparoscopic or inguinal approach?]. / Testes no palpables: abordaje laparoscópico o inguinal?

INTRODUCTION: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option. MATERIALS AND METHODS: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35 patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for a laparascopic or groin approach and associated hernia. RESULTS: The average age of the patients at the time of the surgical treatment was 3.7 years R (1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach was used with 18 patients. Internal vessels in the canal were found which required an inguinal approach. In 12 patients normal or atrophic testes were observed. Testicular descent was achieved through the groin in 10 of them while in the remaining 2 a combined approach was adopted. CONCLUSIONS: 80% of the patients subjected to a first laparoscopic approach needed a groin approach later on. 11% of the patients subjected to a first inguinal approach required laparascopic examination. In view of the results obtained, we conclude that inguinal exploration diminishes the need for second procedures.

[Therapeutic approach of enuresis based on the differentiation of the enuretic syndrome and monosymptomatic enuresis]. / Enfoque terapéutico de la enuresis basándose en la diferenciación del síndrome enurético y la enuresis monosintomática.

INTRODUCTION: Enuresis affects 15% of the children under 5. Possible etiopatogeny explaining the mechanism of production of nocturnal enuresis has been described, resulting in different terapeutical approaches; however, we cannot speak up to now of general guidelines for its treatment. MATERIALS AND METHODS: On the basis of 544 children who were treated in our hospital in the last 12 years, we analysed a sample of 124 patients corresponding to the last two years. We now present the therapeutical protocol used and analyse the results. In the initial therapeutical approach a distinction is made between monosymptomatic enuresis and eneuretic syndrome. RESULTS: We studied a total of 120 patients (89 boys and 31 girls). 63% of them showed monosymptomatic enuresis while 37% suffered from enuretic syndrome. In the case of 15% of them, this was associated with heavy sleep and difficulties to wake up. 92% was the general percentage of recovery. In the patients suffering from nonosymptomatic eneuresis, the problem was solved with desmopressin in 87% of them (demospressin on its own in 65% or in combination with oxibutine in the remaining 35%). In the group of enereutic symdrome, the problem was solved with oxibutine in 71% (on its own in 40% or in combination with desmopressin in 54%. CONCLUSIONS: The treatment and solution of enuresis improve the child's self-esteem and the anxiety caused in the family. A good medical history with a clear distinction between enuretic syndrome and monosyntomatic enuresis leads us to a suitable therapeutical approach for every patient, allowing us to find earlier the right treatment for every individual.

[Correction of lop ear using minimally invasive approach]. / Corrección de las orejas procidentes mediante un abordaje mínimamente invasivo.

INTRODUCTION: Helix valgus or procident ears is a common problem that affects about 5% of the population. The folds of the antehelix and the overdevelopment of the concha are the most commonly found anatomic alterations of the ear pavilion. In children this pathology usually causes anxiety and an emotional trauma that may interfere in their normal development. MATERIALS AND METHODS: There are a few tipes of techniques to correct helix valgus. We present the application of the technique in our service. We conduct the otoplastia with an outer puntiform technique which allows us to cut the cartilage partially from the outside. Next we fold from the rear the antehelix and hide the concha. RESULTS: We analysed 7 years of the application of this technique and we now present 87 otoplastias conducted to 44 children. The 97% of them were bilateral. No precocious complications have been observed after the surgery. All cases except for one of them have been bilateral. All the patients were satisfied with the aesthetic results. None of them showed relapse. In one case there was a hypertrophic scar that required cutting and in 2 of the cases there was a slight hypercorrection. CONCLUSIONS: Procident ears may occasion a psychological trauma in children. We believe that this technique, which is minimally invasive, provides very satisfactory aesthetic results, the puntiform scar being hardly noticed fifteen days before surgery. The patients need to stay in hospital for a short period, 24-48 hours, and complications are very rare, recidiva has not been described. We strongly recommend this technique for the correction of procident ears.

[25 years experience in cerebrospinal shunt. Are new systems better?]. / 25 años de experiencia en válvulas de derivación ventrículo-peritoneal. Son mejores los nuevos sistemas?

INTRODUCTION: Since the introduction of the first ventricular shunt in 1949, the cerebrospinal shunts are the most used choice for the management of hydrocephalus in children. With the technological advance, systems have been developing increasingly sophisticated. Our aim is to study the incidence of complications after the implantation of these shunts and the variables associated to it. MATERIAL AND METHODS: We perform a retrospective study between 1981 and 2006, gathering the patients between 0 and 15 years treated at our Hospital for the placement of a cerebrospinal shunt or as consequence of a problem of the device. We analyze the tipe of shunt (Hakim, Pudentz, Delta, Orbis-Sigma, Strata, Codman), etiology of hydrocephalus, age, immediate and late complications, permanence of the system, changes of the system and cerebrospinal fluid. The qualitative data were analyze by c2 test. We also estimate survival of shunts with Kaplan-Meier stimator and make a multivariant Cox regression analysis. RESULTS: A total of 75 patients. The main etiology for hydrocephalous was myelomeningocele, followed by congenital and posthemorrhagic. Most of the patients presented complications of the system in the follow-up. They were adjusted for age, sex, etiology, shunt and surgeon. The variable that had an independent effect for predicting the presence of a complication was the type of shunt, being the most ancient systems those with major survival. The most frequent complication in the immediate period (< 3 month) was the obstruction and infection of the proximal catheter or shunt. Distal catheter disconnection or break prevailed in the late one. We got few functional complications, these were not related with the type of shunt. CONCLUSIONS: In our experience, the shunts with the less short-term probability of complication (< 3 months) have been old simple systems like Hakim and Pudentz. The functional complications, that are those which presumably should be reduced by the new programmable systems, don,t seem do it, neither mean longer survival of the system.

Enhancing palatability traits in beef chuck muscles.

Thirty-six USDA Select complexus, latissimus dorsi, rhomboideus, serratus ventralis (SEV), splenius, subscapularis, supraspinatus (SUS), and triceps brachii (TRB) muscles were studied. Muscles were assigned to one of four treatments: control, marinated, needle-pumped, and vacuum-tumbled to reach 10% brine pick-up after treatment. The solution was formulated to have 0.5% of sodium chloride and 0.4% of sodium tripolyphosphate in the end product. Steaks from the SEV, SUS, and TRB muscles were cooked on a grill and the other five muscles were oven-roasted whole, all of them cooked to an internal temperature of 71°C. Sensory evaluations and Warner-Bratzler shear force (WBSF) determinations were conducted immediately after cooking (Day-1), and after being cooked and stored frozen for 60 days (Day-60). For the Day-60 evaluation, samples were reheated using a microwave oven. The needle-pumped treatment reduced WBSF values compared to the control in 3 out of 8 muscles (P<0.05). The marinated treatment appeared to have the greatest influence on juiciness and was different from the control in 7 of 8 muscles (P<0.05). Comparing treated muscles to the control, tenderness was increased in 4 out of 8 muscles when needle pumped (P<0.05). Brine treatment reduced sensory detected connective tissue only in 2 of 8 muscles. More off-flavors were detected by the panel for marinated samples from six of eight muscles. All muscles had lower values for WBSF, less connective tissue and off-flavors, and higher juiciness, overall tenderness, and beef flavor intensity on Day-1 than Day-60. The needle-pumped method was slightly superior to the marinated and vacuum-tumbled treatments even though the differences were not always consistent. But, regardless of the application method, palatability traits were generally enhanced by brine treatments.

Venous segmentation of the human spleen. A corrosion cast study.

Partial splenectomy is possible because of vascular segmentation of this organ. Although interest has focused upon arterial supply, this study shows similar venous segmentation. Emerging splenic veins in excess of 1.7 mm at the hilum of ten unembalmed spleens were injected with different colors of modified Batson's compound, and corrosion casts were made. In four additional spleens, alternate veins and arteries were injected. Ten spleens had two primary segments (lobes); four had three lobes. Half of these lobes were further subdivided into two segments. Lobes and segments extended through the full thickness of the spleen. Relatively avascular interlobar planes were always approximately perpendicular to the longitudinal axis of the spleen, whereas intersegmental planes were more variable. Both interlobar and intersegmental planes frequently corresponded to marginal notches. When arteries and veins were both injected, similar segmentation was noted. Venous drainage did not overlap arterial segments, indicating that veins are intrasegmental. These results indicate that the surgical unit of the spleen can be based upon surgically accessible vessels at the hilum of the spleen. Identification of segmental vessels could permit salvage of a larger amount of splenic tissue than would be possible if only lobar vessels were identified.

[Munchausen syndrome by proxy, an unusual presentation]. / Síndrome de Münchausen por poder, una presentación inusual.

We report a 12 year old girl that first consulted for fever with bilateral knee arthralgias. A neurological workout was started due to a progressive gait disturbance, but all results were incongruent with nerve or nerve root lesions, leading to the diagnosis of a functional paralysis. The patient worsened to the point of prostration. Due to the suspicion that the mother was inducing the symptoms, the patient was admitted to the hospital, where she improved notably. She was discharged walking. The improvement during hospital stay confirmed the diagnosis of a Münchausen by proxy syndrome, mimicking a disabling neurological condition.

Contaminated anterior cruciate ligament grafts: the efficacy of 3 sterilization agents.

PURPOSE: A study was undertaken to determine the incidence of positive cultures resulting from an anterior cruciate ligament (ACL) specimen dropped on the operating room floor and the efficacy of sterilizing the specimen by soaking in 1 of 3 antimicrobial solutions: an antibiotic solution of neomycin and polymyxin B, 10% providone-iodine solution, and standard chlorhexidine gluconate solution. TYPE OF STUDY: Randomized trial. MATERIALS AND METHODS: Fifty ACL specimens removed from patients undergoing total knee arthroplasty were used as the test group. The specimens were longitudinally sectioned into 4 equal pieces. The 4 pieces were dropped on the floor and left for a period of 15 seconds. Cultures were taken from each specimen after immersion in 1 of the 3 sterilization solutions for a period of 90 seconds. One of the 4 specimens was cultured without being exposed to any solution, thereby establishing these specimens as the control group. Cultures of a floor swab were taken at the same time and place that the ACL was dropped. RESULTS: The floor swab cultures were positive in 48 of the 50 specimens (96%). The ACL control group (untreated dropped grafts) had 29 of 50 specimens positive (58%). The grafts soaked in antibiotic solution had 3 of 50 specimens positive (6%). The grafts soaked in providone-iodine solution had 12 of 50 specimens positive (24%). The grafts soaked in chlorhexidine gluconate solution had 1 of 50 specimens positive (in broth only) (2%). CONCLUSION: This study shows that significant contamination occurs when dropping specimens on the floor, as 58% of the dropped grafts had positive cultures. Of the 3 sterilization techniques used, chlorhexidine gluconate seems to be the most efficient with only a single broth culture (2%) found to be positive. The antibiotic solution was second best (6%), although there is no statistically significant difference between these 2 groups. The 10% providone-iodine solution under these test conditions was the least effective of all the 3 sterilization agents with 24% cultures positive after immersion.

Menstrual cycle, pregnancies and offspring before and after MOPP therapy for Hodgkin's disease.

The menstrual cycle, pregnancies and offspring were studied before and after MOPP therapy (3 or 6 cycles) in women treated for Hodgkin's disease between 1972 and 1976. All were between 16 and 45 years of age at diagnosis; none received subdiaphragmatic irradiation. This study was carried out through a questionnaire. Before treatment, all patients had normal menses; 72 pregnancies occurred; 61 children were born, 2 with minor abnormalities. After therapy, oligo or amenorrhea occurred in 26.4% of the patients. This percentage was different according to the age at therapy: 4.8% before age 30, 61.5% after age 30 (P less than 0.001); 50 women (73.6%) continued to menstruate normally, 22 of whom had 30 pregnancies; 22 children were born, 1 with a minor abnormality. All have normal physical and intellectual development. For the 73.6% of women who continued to menstruate, MOPP therapy seems to have no impact on fertility, pregnancies, and offspring.

[Pregnancies and offspring after MOPP therapy]. / Grossesses et progéniture après chimiothérapie MOPP.

The influence of MOPP therapy on pregnancy and offspring was retrospectively studied by means of a questionnaire in 68 women who had been given 3 to 6 cycles of the drug combination for Hodgkin's disease between 1972 and 1976. All were aged from 16 to 45 years at the time of diagnosis; none had received abdominal irradiation. Before treatment, 72 pregnancies had occurred in 36 women; 31 children were born and 2 of these had minor congenital abnormalities. After treatment, 30 pregnancies were recorded in 22 of the 50 women who were still menstruating; 22 children were born, and only one had a minor congenital malformation; all children showed normal psychomotor development. It is concluded that MOPP does not seem to have any effect on fertility, pregnancy and offspring of those women (73,6%) who continue having menstruations after treatment.

[Relationship between maternal and neonatal iron stores]. / Relación entre las reservas de hierro maternas y del recién nacido.

OBJECTIVE: To establish the relationship of normal, low, and moderate blood iron values in mothers and their newborns. MATERIAL AND METHODS: A cross-sectional study was conducted among 163 pregnant women and their newborns, users of Hospital de Ginecología y Obstetricia número 15, Instituto Mexicano del Seguro Social, from Chihuahua, Mexico. The mothers' clinical histories were collected and analyzed; hemoglobin, hematocrit, and ferritin serum levels were measured in maternal and umbilical cord samples. Iron maternal stores were determined by ferritin (microgram/l) values as follows: low: < or = 11; moderate: 12-20; and normal: > or = 20.1. The Kruskal-Wallis test was used to establish differences among group; the chi-squared test to determine differences of proportions; and Pearson's correlation coefficient for assessing the association between maternal and newborn iron stores. RESULTS: A weak correlation between maternal and neonatal ferritin was found (r = 0.14, p = 0.07). Geometric means of neonatal ferritin for low, moderate, and normal maternal iron stores were 4.77, 4.85, and 5.02 respectively (p = 0.12). The maternal iron stores changed after iron supplementation (p = 0.01). CONCLUSIONS: Iron stores in mothers and their newborns are closely related. Women who take iron supplements during pregnancy have significantly higher iron stores at the end of pregnancy.

Tratamiento ortopédico de las malformaciones craneales posturales / Orthopedic treatment of the postural cranial malformations

Introducción: En 1992, la Academia Americana de Pediatría recomendó que los bebés durmieran boca arriba o de lado para reducir el riesgo de síndrome de muerte súbita del lactante. Desde entonces, la incidencia de las malformaciones craneales posturales ha aumentado de forma considerable y, con ello, sus consecuencias estéticas e incluso psicológicas. Gran parte de los niños afectados precisarán tratamiento ortopédico de su deformidad mediante ortesis craneal. Realizamos un estudio sobre la eficacia, las indicaciones y el resultado de dichas ortesis según la experiencia y el protocolo de tratamiento en la unidad de malformaciones craneales de nuestro hospital. Material y métodos: Analizamos los niños tratados por malformaciones craneales posturales durante 5 años. Recogemos los datos clínicos que nos han resultado más importantes para el diagnóstico diferencial con las sinostosis y la necesidad de pruebas complementarias. Valoramos la morfología de la lesión, su gravedad, los factores etiológicos asociados, la edad del niño en el momento del diagnóstico, la duración del tratamiento postural u ortésico y la eficacia de éste según nuestro registro fotográfico, así como la opinión subjetiva de los padres. Realizamos una revisión bibliográfica al respecto (AU)

Resultados: Hemos registrado un total de 105 niños con malformaciones craneales posturales, la gran mayoría con plagiocefalia. Entre los factores asociados podemos indicar que 12 pacientes estuvieron ingresados durante largo tiempo en la unidad de neonatos, 16 con una desproporción materno fetal, 8 niños padecían tortícolis congénita y, curiosamente, 12 niños eran de procedencia china por adopción, 8 con antecedente departo instrumental. La media de edad en el momento del diagnóstico en nuestra consulta fue de 6,3 meses, la misma media de edad en que se indicó una ortesis, ya que en general los pacientes acuden con un diagnóstico demasiado tardío como para poder instaurar el tratamiento postural, y sólo 16 niños acudieron o fueron diagnosticados antes de los 3 meses de edad. La ortesis se mantuvo durante una media de 4,5 meses. El porcentaje de malformación facial apreciable subjetivamente fue del 28%. El porcentaje de niños diagnosticados en nuestra consulta que no precisaron ortesis dentro del mismo tipo de deformidad fue nulo, dado el mencionado diagnóstico tardío. Ninguna malformación postural precisó cirugía. Se realizó una radiografía craneal al 20% de los niños, todas ellas solicitadas por médicos no especialistas. La cuantificación subjetiva de la mejoría fue mayor en los niños diagnosticados precozmente. El tiempo medio de resolución fue de 4,5 meses. Conclusiones: Las malformaciones craneales, dada su elevada incidencia actual, precisan un adecuado conocimiento, protocolo de tratamiento y diagnóstico precoz, ya que éste facilita la probabilidad de éxito con un tratamiento sencillo y corto; provocan una no despreciable incidencia de deformidad facial. El desconocimiento de esta patología conlleva la realización de pruebas complementarias innecesarias (AU)

Introduction: In 1992, the American Academy of Pediatrics (AAP) recommended for babies to sleep face up or sideways to reduce the risk of sudden infant death syndrome, since then, the incidence of cranial malformations has increased considerably and thus its esthetic and psychological consequences. Many affected children require orthopedic treatment of their cranial deformities through an orthosis helmet. We make a study of effectiveness, indications and results of these orthosis according to our experience and our treatment protocol in the unit of cranial malformations of our hospital. Material and methods: We studied children treated for postural cranial malformations during 5 years. We analyze the most important clinical data for differential diagnosis with synostosis and the need of additional studies. We appreciate themorphology of the lesion, severity, the associated etiological factors, child’s age at diagnosis, duration of conservative or orthotic treatment and their effectiveness in our photographic files and in the subjective opinion of the parents. We have made a bibliographic review on this matter (AU)

Results: We have registered a total of 105 children with positional cranial malformations, most of them with morphologically with plagiocephaly. The associated factors were: 12 patients stayed long time in our newborn unit, 16 had maternal fetal disproportion, 8 children suffered from congenital torticollis, oddly 12 children whom were adopted had a Chinese origin, 8 had history of instrumental delivery. The average age of diagnosis in our department was of 6.3 months, same mean age in which an orthosis was indicated, because they generally arrive with a late diagnosis to be able to establish the positional therapy, only 16 children attended or were diagnosed at ages younger than 3 months. The orthosis helmet was kept for an average of 4.5 months. The percentage of subjective facial malformation was of 28%. The number of children diagnosed in our department who did not require helmets within the same type of deformity was of zero because of such a late diagnosis. None of them needed surgery, skull radiography was performed in 20% of the children, all of them requested by a non-specialist doctors. The quantification of subjective improvement was greater in children with an early diagnosis. The mean time of resolution was of 4.5 months. Conclusions: Positional cranial malformations, because of their high incidence require a complete knowledge, treatment protocol and early diagnosis, as this provides higher probability of successful, simple a short treatment. They cause a non negligible incidence of facial deformity. The ignorance of this condition causes the consumption of unnecessary tests (AU)

Toracoscopia en niños con empiema pleural en fase II. ¿Lavado y desbridamiento de tabiques de fibrina o decorticación? / Thorascoscopy in children with pleural empyema in 2nd stage, breaking and washing fibrinous loculations or decortication?

Introducción: Ante el aumento de incidencia de derrames pleurales paraneumónicos complicados en niños, ha aumentado considerablemente el número de toracoscopias realizadas, ya sea para el lavado y el desbridamiento de los tabiques de fibrina para liberar el líquido acumulado, o completando la intervención con decorticación completa de la fibrina aún no organizada adherida a la pared pulmonar. Material y métodos: Estudiamos una muestra de 31 niños tratados toracoscópicamente por un derrame pleural complicado en fase II. Estudiamos diversas variables: edad, tiempo de clínica y de tratamiento antibiótico preoperatorios, composición del líquido pleural, germen, opción quirúrgica, tiempo operatorio, días con drenaje pleural mayor de 20 mL/día o fiebre y complicaciones. Resultados: De 31 toracoscopias, el 52% son descorticaciones pulmonares y el 48% desbridamientos y lavados. Mediante el test de la t de Student comprobamos que el tiempo de drenaje pleural en los pacientes con desbridamiento simple es estadísticamente superior, al igual que los días de fiebre (sin diferencias significativas), y se requieren más fibrinolíticos y reintervención. No observamos una mayor incidencia de fuga aérea en la decorticación, aunque sí de íleo paralítico posquirúrgico. Conclusiones: La decorticación pulmonar en los derrames pleurales complicados en fase II conlleva un menor tiempo de drenaje torácico y clínica febril. En manos entrenadas no aumenta el tiempo operatorio ni el número de complicaciones graves (AU)

Introduction: Before the increase of incidence of complicated pleural parapneumonic effusion in children, has increased the number of Video Assisted Thoracoscopy (VATS) considerably. Whether it is for the washing or breaking of the nasal bone fibrin to liberate the accumulated liquid, or complete the intervention with complete decortication of a non-organized fibrin wall attached to the lung. Material and methods: We study a sample of 31 children whounder went VATS for complicated pleural effusion in 2nd stage. We study: age, clinical time and pre-surgical symptoms and antibiotics, composition of the pleural liquid, infectious agent, surgical option, operative time, days with fever and pleural drainage more than 20 cc/day or fever and complications. Results: From 31 VATS, 52 % were pulmonary decortications and 48 % debridement and wash. Using the t-student we get statistically significative difference in time of pleural drainage, longer in patients with simple debridement, as in days with fever, not being this difference significant. There is more need of fibrinolysis and reintervention in this group. We do not see more incidence of air leak in the decortication group, but there is more post surgery paralytic ileus. Conclusions: Lung decortication in pleural complicated effusions2nd stage entails less time with thoracic drainage and fever. In trained hands it does not increase neither the operative time nor the number of serious complications (AU)