Temporoparietal fascia flap for auricular reconstruction. / Colgajo de fascia temporoparietal para reconstrucción auricular.

INTRODUCTION: Microtia is a congenital malformation of the auricle. The most common complication of microtia surgical repair is costal cartilage exposure. We describe the case of a patient with costal cartilage exposure and the use of temporoparietal fascia flap (TPFF) for covering purposes. CLINICAL CASE: 12-year-old male patient with right microtia undergoing two auricle reconstruction surgeries. One month following the second surgery, costal cartilage exposure was noted, with loss of grafted skin. A TPFF and a scalp skin graft were performed to cover the exposed cartilage. COMMENTS: An adequate and critical management of costal cartilage exposure is required to avoid cartilage reabsorption. TPFF represents a useful tool in ear reconstruction surgeries and should be considered in potential face reconstruction surgeries.

INTRODUCCION: La microtia es una malformación congénita del pabellón auricular. Dentro de las complicaciones de la reparación quirúrgica, la más frecuente es la exposición del cartílago costal. Describimos el caso de un paciente con exposición del cartílago costal y la utilización del colgajo de fascia temporoparietal (CFTP) para su cobertura. CASO CLINICO: Paciente varón de 12 años con microtia derecha intervenido de primer y segundo tiempo de reconstrucción del pabellón auricular. Al mes de la segunda cirugía se evidencia exposición del cartílago costal, con pérdida de la piel injertada. Se realiza un CFTP e injerto de piel de cuero cabelludo para cubrir el cartílago expuesto. COMENTARIOS: Un manejo adecuado y crítico de la exposición del cartílago costal es necesario para evitar la reabsorción de dicho cartílago. El CFTP representa una herramienta para cirugías reconstructivas de la oreja y se ha de conocer para eventuales cirugías de reconstrucción facial.

Colgajo de fascia temporoparietal para reconstrucción auricular / Temporoparietal fascia flap for auricular reconstruction

INTRODUCCIÓN: La microtia es una malformación congénita del pabellón auricular. Dentro de las complicaciones de la reparación quirúrgica, la más frecuente es la exposición del cartílago costal. Describimos el caso de un paciente con exposición del cartílago costal y la utilización del colgajo de fascia temporoparietal (CFTP) para su cobertura. CASO CLÍNICO: Paciente varón de 12 años con microtia derecha intervenido de primer y segundo tiempo de reconstrucción del pabellón auricular. Al mes de la segunda cirugía se evidencia exposición del cartílago costal, con pérdida de la piel injertada. Se realiza un CFTP e injerto de piel de cuero cabelludo para cubrir el cartílago expuesto. COMENTARIOS: Un manejo adecuado y crítico de la exposición del cartílago costal es necesario para evitar la reabsorción de dicho cartílago. El CFTP representa una herramienta para cirugías reconstructivas de la oreja y se ha de conocer para eventuales cirugías de reconstrucción facial

INTRODUCTION: Microtia is a congenital malformation of the auricle. The most common complication of microtia surgical repair is costal cartilage exposure. We describe the case of a patient with costal cartilage exposure and the use of temporoparietal fascia flap (TPFF) for covering purposes. CLINICAL CASE: 12-year-old male patient with right microtia undergoing two auricle reconstruction surgeries. One month following the second surgery, costal cartilage exposure was noted, with loss of grafted skin. A TPFF and a scalp skin graft were performed to cover the exposed cartilage. COMMENTS: An adequate and critical management of costal cartilage exposure is required to avoid cartilage reabsorption. TPFF represents a useful tool in ear reconstruction surgeries and should be considered in potential face reconstruction surgeries

[Pediatric surgery 2.0]. / Cirugía pediátrica 2.0.

New tools from the web are a complete breakthrough in management of information. The aim of this paper is to present different resources in a friendly way, with apps and examples in the different phases of the knowledge management for the paediatric surgeon: search, filter, reception, classification, sharing, collaborative work and publication. We are assisting to a real revolution on how to manage knowledge and information. The main charateristics are: immediateness, social component, growing interaction, and easiness. Every physician has clinical questions and the Internet gives us more and more resources to make searchs easier. Along with them we need electronic resources to filter information of quality and to make easier transfer of knowledge to clinical practice. Cloud computing is on continuous development and makes possible sharing information with differents users and computers. The main feature of the apps from the Intenet is the social component, that makes possible interaction, sharing and collaborative work.

Cirugía pediátrica 2.0 / Pediatric surgery 2.0

Las nuevas herramientas que ofrece la web suponen una auténtica revolución en la forma de gestionar la información. El objetivo de este artículo es presentar los diferentes recursos de forma sencilla, proponiendo aplicaciones y ejemplificando con casos concretos su uso en las diferentes etapas de la gestión de la información para el profesional de la cirugía pediátrica: búsqueda, filtro, recepción, clasificación y almacenamiento, compartir, trabajo colaborativo y publicación. Hemos llegado a una auténtica revolución en la forma de gestionar la información y el conocimiento. Las principales características son: inmediatez, componente social, posibilidad creciente de interacción web-usuario, gratuidad y sencillez de manejo. Cualquier médico presenta dudas clínicas con frecuencia. Internet ofrece cada vez más recursos que facilitan las búsquedas. Junto a los buscadores, son necesarios recursos electrónicos que ayuden a fi ltrar información de calidad y faciliten la traslación del conocimiento a la práctica. El almacenamiento de la información en "la nube" está en continuo desarrollo y mejora la posibilidad de compartir información entre diferentes ordenadores y usuarios. Una característica nuclear de las diferentes aplicaciones que ofrecen los nuevos recursos de Internet es el componente social, que permite interactuar, compartir y trabajar de forma colaborativa (AU)

New tools from the web are a complete breakthrough in management of information. The aim of this paper is to present different resources in a friendly way, with apps and examples in the different phases of the knowledge management for the paediatric surgeon: search, fi ter, reception, classification, sharing, collaborative work and publication.We are assisting to a real revolution on how to manage knowledge and information. The main charateristics are: immediateness, social component, growing interaction, and easiness. Every physician has clinical questions and the Internet gives us more and more resources to make searchs easier. Along with them we need electronic resources to filter information of quality and to make easier transfer of knowledge to clinical practice. Cloud computing is on continuous development and makes possible sharing information with differents users and computers. The main feature of the apps from the Intenet is the social component, that makes possible interaction, sharing and collaborative work (AU)

[Cystic adenomatoid malformation pulmonary: are we able to foresee its evolution?]. / Malformación adenomatoidea quística: somos capaces de prever su evolución?

The congenital pulmonary malformation are a rare entity in pediatric age. Between of them, the cystic adenomatoid malformation (MAQ) is the most ferquent entity, followed by pulmonary sequestration (SP) and the most rare broncogenic cyst. As a consequence of ultrasound and fetal magnetic resonance we are abble to diagnose earlier this patology. To know the clinical findings, the diagnosis, and the evolution, we have done a retrospective study of underwented MAQ at our hospital during the last 17 years, including such with late diagnosis as with prenatal diagnosis, and describing those presenting impredictable evolution or a different difficul diagnosis. We report four MAQ's cases. Three of them, about late diagnose: the first one evolutioned till malignant tumor, the second one with a supplementary lobe and third one with a wrong MAQ diagnose. The fourth one associated MAQ with a SP.

[Retrospective evaluation of carcinoid tumors of the appendix in children]. / Estudio retrospectivo del tumor carcinoide apendicular en niños.

Carcinoids of the appendix are rare in children. Usually diagnosed incidentally on histologic investigation following appendectomy for acute apendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid tumors in children, we conducted a retrospective study in our institution. Between 1990 and 2007 a total of 1158 appendectomy were done. In four patients the diagnosis was appendiceal carcinoid. We studied treatment, follow-up and prognosis of this patients. Indicacion for appendectomy was acute pain in lower right quadrant. The median tumor diameter was lower than 1 cm and the appropriate treatment was appendectomy. The prognosis was excellent in all the patients.

Malformación adenomatoidea quística: ¿somos capaces de prever su evolución? / Cystic adenomatoid malformation pulmonary: Are we abble to foresee its evolution?

Las malformaciones congénitas pulmonares son una entidad rara en pediatría. Entre ellas, la malformación adenomatoidea quística(MAQP) es la entidad más frecuente, seguida del secuestro pulmonar(SP) y más raro del quiste broncogénico. Debido a la ecografía de alta definición y a la resonancia magnética fetal, somos capaces de diagnósticar estas entidades de forma más precoz. Para conocer la clínica, el diagnóstico y la evolución hemos realizado un estudio retrospectivo de las MAQ intervenidas en nuestro Centro durante 17 años tanto de diagnóstico tardío como prenatal, describiendo los que presentaron una evolución no previsible o un dificil diagnóstico diferencial. Presentamos cuatro casos de MAQ. Tres de ellos de diagnóstico tardío: el primero con evolución a tumor maligno, el segundo con un SP accesorio extralobar y el tercero con diagnóstico erróneo de MAQ. El cuarto caso asoció la MAQ con un SP (AU)

The congenital pulmonary malformation are a rare entity in pediatric age. Between of them, the cystic adenomatoid malformation (MAQ)is the most ferquent entity, followed by pulmonary sequestration (SP)and the most rare broncogenic cyst. As a consequence of ultrasound and fetal magnetic resonance we are abble to diagnose earlier this patology. To know the clinical findings, the diagnosis, and the evolution, we have done a retrospective study of underwented MAQ at our hospital during the last 17 years, including such with late diagnosis as with prenatla diagnosis, and describing those presenting impredictable evolution or a different difficult diagnosis. We report four MAQ’s cases. Three of them, about late diagnose: the first one evolutioned till malignant tumor, the second one with a suplementary lobe and third one with a wrong MAQ diagnose. The fourth one associated MAQ with a SP(AU)

Estudio retrospectivo del tumor carcinoide apendicular en niños / Retrospective evaluation of carcinoid tumors of the appendix in children

Los tumores carcinoides del apéndice son raros en la infancia. Habitualmente se diagnostican al realizar el estudio histológico del apéndice extirpado por un cuadro de apendicitis aguda. Para analizar la trascendencia clínica se ha realizado un estudio retrospectivo de niños diagnosticados de tumor carcinoide histológicamente confirmado tras realizar una apendicectomía. Entre 1990 y 2007se han realizado 1.158 apendicectomías con un total de 4 pacientes diagnosticados de carcinoide apendicular. Hemos estudiado el tratamiento, seguimiento y pronóstico de estos pacientes. La indicación de apendicectomía fue por dolor en el cuadrante inferior derecho del abdomen. La medida del tumor en todos ellos fue inferior a 1cm y el tratamiento definitivo fue la apendicectomía. El pronóstico ha sido excelente en todos los casos (AU)

Carcinoids of the appendix are rare in children. Usually diagnosed incidentally on histologic investigation following appendicectomy for acute apendicitis. To investigate the significance of the diagnosis of appendiceal carcinoid tumors in children, we conducted a retrospective study in our institution. Between 1990 and 2007 a total of 1158 apendicectomy were done. In four patients the diagnosis was appendiceal carcinoid. We studied treatment, follow-up and prognosis of this patients. Indicacion for appendicectomy was acute pain in lower right quadrant. The median tumordiameter was lower than 1cm and the appropiate tractament was appendicectomy. The prognosis was excellent in all the pacients (AU)

[Malformations of the anterior thoracic wall]. / Anomalías de la pared torácica anterior.

The different anomalies of the anterior Chest Wall are exposed. We emphasize the deformities of the sternum--Depression and Protusion Deformities--because they are the most common and the most difficult ones to treat. Based in the results of 73 patients operated upon by the author, and in the review of the bibliography, we also comment on some aspects of the surgical indication, assessment methods, surgical technique, complications and results.

[Boix Ochoa's antireflux procedure returns patients to normalcy: 24 hour esophageal pH monitoring of 21 cases]. / La plastia de Boix Ochoa reconvierte al enfermo a la normalidad. Estudio pHmétrico de 21 casos.

A great controversy exist concerning the surgical management of gastroesophageal reflux (GER). It is well known that Nissen procedure produces a hypercorrection of the gastroesophageal competency and often a "gas bloat syndrome". On the other hand, the Boix Ochoa's technique is more physiological but corrects GER allowing the persistence of a "radiological" reflux. The aim of the study was to demonstrate the accuracy of this procedure. 287 pediatric patients were studied because of GER and abnormal barium upper gastrointestinal series. 24 hours esophageal pH monitoring was performed in all this patients and in 21 the results were clearly pathological. They were operated on and six months later were new evaluated with upper GI series and continuous 24 hours esophageal pH monitoring. The results were compared with those previous to operation and also with a control group. Statistical great significance was found between presurgical and postsurgical data, what determine the efficacy of the procedure. No statistical significance was found between postsurgical data and the control group, what means that Boix Ochoa's procedure resolve GER without hipercorrection.

Branchio-oto-renal syndrome: incidence in three generations of a family.

It is well known that the persistence of alterations in the normal embryological development of branchial arches can lead to preauricular and cervical fistulas within a family. However, until 1970, there were no reports of dysplasia affecting the branchial, otic, and renal systems (BOR syndrome) with dominant autosomic inheritance. The authors report on a family with BOR syndrome of different expressivity in three generations, and describe an unusual case of bilateral fistulas of the first and second branchial arches in a newborn.

[Study of the esophageal function by prolonged intraluminal pH-metry in patients with gastroesophageal reflux and respiratory manifestations]. / Estudio de la funcion esofagica mediante pH-metrica intraluminar prolongada en pacientes afectos de reflujo gastroesofagico y manifestaciones respiratorias.

Gastroesophageal reflux (GER) can be found in a high number of patients with respiratory tract disease (RTD). In the present study a 24 hours esophageal pH monitoring was performed in 55 children. 15 of them were normal controls, 16 patients with GER but normal score, 14 patients with GER and RTD and 9 patients with GER and only digestive symptoms. The number of reflux episodes of more than 5 minutes, the duration of the longest single reflux episode, the percentage of time the esophageal pH was less than 4, the reflux/hour index and the clearance index were measured. Comparing the results of the different groups we found that normal controls and normal vomiting patients were significatively different. Refluxers and refluxers with RTD also were different of asymptomatic controls. The main significative differences founded comparing refluxers and refluxers with RTD were the duration of the longest single reflux, the percentage of time the esophageal pH was less than 4 and the clearance index. All these parameters were longer in the refluxers with RTD. Our conclusion is that esophageal clearance is slower in the group of refluxers with RTD and that this index is helpful to distinguish them from the single refluxers.

[Mesothelial cysts of the peritoneum in children]. / Quistes mesoteliales del peritoneo en la edad pediatrica.

The authors emphasize the existence of these cystic formations on the peritoneal surface. They point out that the exact diagnosis of the mesothelial cyst and the diagnostic workup with the cystic lymphangioma can only be done with an exhaustive histological examination.

[Congenital segmental dilatation of the colon]. / Dilatación segmentaria congénita del colon.

Segmental dilatation of the colon is a rare congenital entity that cause chronic constipation in children. A new case is presented and another 9 former cases described in the literature are reviewed. We think that this entity may be diagnosed before the operation, if it is kept in mind. So, the barium enema and rectal biopsy are of paramount importance. The resection of the dilated ++ segment is the treatment of choice.