ABSTRACT
OBJECTIVE: The Haller index (HI) is widely used to indicate surgical intervention in patients with pectus excavatum (PE). However, in patients with an atypical thoracic morphology, the severity of the defect can be incorrectly estimated. We propose comparing this index with the correction index (CI). MATERIAL AND METHODS: We analyzed clinical data and CT scans of 50 patients who consulted for PE in our center between 2010 and 2017. Haller index (HI), Correction index (CI) and ideal thoracic index (ITI) were calculated for each patient. The ITI allowed dividing the sample into two groups based on the thoracic morphology by excluding the PE component, therefore separating those with thorax too wide or too narrow from the standard patients. A standard group (36 patients) and a non-standard group (14 patients) were generated, among which the HI and the CI were correlated. RESULTS: The mean HI and CI of all patients were 3.99 and 27%, respectively. 31 of the 50 patients (62%) underwent intervention, 8 of them with an HI below 3.25. When comparing both groups, there was a moderate correlation between HI and CI in the standard group (Spearman r 0.799, p <0.01) and a greater correlation in the non-standard group (Spearman r 0.858, p <0.01).ween the scale and the presence of foreign body, except for SCORE 1, which was 57% what we attribute to an information bias. If the foreign body were not nuts, inorganic or bone, its aspiration was very unlikely, that is why we included it in the SCORE with -1. CONCLUSION: In our cohort, correlation of HI and CI was not different between both groups of patients. The CI did not prove its superiority when compared to HI in the surgical indication of patients with PE.
OBJETIVO: El índice de Haller (IH) se utiliza ampliamente para indicar la intervención quirúrgica en pacientes con pectus excavatum (PE). Sin embargo, en pacientes con una morfología torácica atípica, puede estimarse erróneamente la severidad del defecto. Planteamos comparar este índice con el índice de corrección (IC). MATERIAL Y METODOS: Analizamos datos clínicos y TC torácicos de 50 pacientes que consultan por PE en nuestro centro entre 2010 y 2017. Para cada paciente, se recalcula el índice de Haller (IH), el índice de corrección (IC) y el índice torácico ideal (ITI). El ITI permite formar dos grupos en base a la morfología torácica excluyendo el componente del PE, separando aquellos con tórax demasiado anchos o estrechos, de los pacientes estándar. Se genera un grupo estándar (36 pacientes) y un grupo no-estándar (14 pacientes), entre los que se correlacionan el IH y el IC. RESULTADOS: El IH y el IC medio de todos los pacientes fue de 3,99 y 27%, respectivamente. Se intervinieron 31 de los 50 pacientes (62%), 8 de ellos con un IH inferior a 3,25. Al comparar ambos grupos, existe una correlación moderada entre IH e IC en el grupo estándar (r Spearman 0,789; p<0,01) y una correlación mayor en el grupo no-estándar (r Spearman 0,858; p<0,01). CONCLUSION: En nuestra cohorte, no se ha probado que la correlación del IH y el IC sea diferente entre ambos grupos de pacientes. El IC no ha demostrado tener mayor validez que el IH en la indicación quirúrgica del PE.
Subject(s)
Funnel Chest/pathology , Tomography, X-Ray Computed/methods , Adolescent , Child , Female , Funnel Chest/diagnostic imaging , Funnel Chest/surgery , Humans , Male , Reproducibility of Results , Retrospective Studies , Severity of Illness IndexABSTRACT
Classic treatment for pyriform sinus fistula (PSF) has been surgical excision; however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air flow through the flexible endoscope was used to distend the pyriform sinus and facilitate recognition of the fistula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, performing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very effective; hence we consider it might become a first line therapy for PSF.
Subject(s)
Diathermy/methods , Endoscopy/methods , Fistula/surgery , Pyriform Sinus/abnormalities , Abscess , Child , Child, Preschool , Dilatation/methods , Electrocoagulation/methods , Female , Fistula/pathology , Humans , Infant , Male , Minimally Invasive Surgical Procedures/methods , Recurrence , Reproducibility of ResultsABSTRACT
No disponible
Subject(s)
Female , Humans , Infant, Newborn , Hemangiopericytoma , Hip , Soft Tissue NeoplasmsABSTRACT
Con el objetivo de investigar la relación entre alimentación y apendicitis aguda (AA) hemos realizado un estudio prospectivo de casos y controles durante 18 meses en niños entre 4 y 14 años, analizando la alimentación de 147 niños intervenidos de AA y comparándola con la de 161 niños-control, mediante la utilización de un cuestionario de frecuencia alimentaria. Hemos analizado la ingesta total de 93 alimentos y 30 nutrientes mediante el programa informático Food Procesor Plus, categorizando los grupos atendiendo a los tertiles de consumo diario. Hemos calculado el riesgo relativo de AA mediante la odd ratio y su intervalo de confianza. No hemos encontrado diferencias significativas para la talla, peso y edad entre ambos grupos. Las niñas presentaron un mayor riesgo (OR =1,60) de AA. El mayor consumo de carnes (OR = 0,56), pescados (OR = 0,51) y hortalizas (OR = 0,53) se asoció a un menor riesgo de AA. El alto consumo de alimentos grasos conlleva un mayor riesgo de AA (OR = 2,53). No hemos encontrado diferencias significativas entre los casos y controles en el consumo de fibra y cereales. En cuanto a los nutrientes, el mayor consumo de proteínas (OR = 0,56), niacina (OR = 0,55) y selenio (OR = 0,56) se ha relacionado con una menor incidencia de AA. Por el contrario el cobre (OR = 1,57), colesterol (OR = 1,73) e hidratos de carbono (OR = 1,74), se han asociado de forma positiva con la AA (AU)
Subject(s)
Female , Male , Child , Humans , Appendicitis/etiology , Diet/adverse effects , Prospective Studies , Feeding Behavior , Risk Factors , Case-Control StudiesABSTRACT
Wandering spleen is a clinical condition in which an absence of ligaments and a long vascular pedicle allows the spleen to move freely in the abdomen. It is a rare entity in children but the exactly incidence is unknown because most of them are asymptomatic. The most common form of presentation is acute, chronic or intermittent abdominal pain caused by spleen torsion. Ultrasonography is the elective diagnostic method, but frequently diagnosis is made after surgery. We report two cases with acute splenic torsion in children and we discuss the clinical presentation, etiology, diagnostic procedures and management. We conclude that splenopexy--if possible--is the treatment of choice in children.
Subject(s)
Spleen/physiopathology , Child , Child, Preschool , Female , Humans , Spleen/diagnostic imaging , Spleen/surgery , Syndrome , Torsion Abnormality , UltrasonographyABSTRACT
The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.
Subject(s)
Airway Obstruction/etiology , Bronchi , Bronchoscopy , Foreign Bodies/therapy , Airway Obstruction/diagnostic imaging , Bronchography , Child , Child, Preschool , Diagnosis, Differential , Female , Foreign Bodies/diagnostic imaging , Humans , Infant , Male , Retrospective StudiesABSTRACT
Twenty four patients diagnosed and operated of hypertrophic pyloric stenosis were examined by ultrasonography at diagnostic and sequential after pyloromyotomy. We measured pyloric diameter, thickness and length of the muscle and we calculated the pyloric volume. The overall configuration of the pylorus is more important than specific pyloric dimensions for diagnosis. The pyloric volume is the most discriminating criterion. Sequential sonograms at one and four months showed that all measurements fell to normal levels within four weeks, except pyloric volume.
Subject(s)
Pyloric Stenosis/surgery , Pylorus/surgery , Female , Follow-Up Studies , Humans , Hypertrophy , Infant , Infant, Newborn , Male , Pyloric Stenosis/diagnostic imaging , Pylorus/diagnostic imaging , Time Factors , UltrasonographyABSTRACT
Our experience in 12 cases of pediatric patients with scimitar syndrome is reported. Except for one, all of them presented cardiac or respiratory manifestations. The symptomatology was related to associated defects (3 atrial septal defects and 1 multiple peripheric pulmonary stenosis), degree of pulmonary hypoplasia, size of the right to left shunt and pulmonary hypertension. 3 patients underwent surgical treatment. One of them died during operation and the other two have had a good evolution. Nine patients with later respiratory manifestations have improved their condition progressively without surgical intervention. Therapeutic approach for patients with scimitar syndrome, respiratory manifestations and onset beyond the neonatal period, should be conservative.
Subject(s)
Scimitar Syndrome , Adolescent , Angiography , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Scimitar Syndrome/diagnostic imaging , Scimitar Syndrome/surgeryABSTRACT
Contribution of 14 patients with Unilateral Total Multicystic Renal Dysplasia treated with conservative criteria, with particular emphasis in the absence of clinical complications, as well as the natural tendency to involution of the affected organs. Five dysplastic kidneys disappeared in the ultrasound, 4 decreased in size, 3 remained the same and 2 have been removed. Review of the literature and discussion of all the reasons why nephrectomy was traditionally indicated, explaining the reasons why we support an expecting attitude.
Subject(s)
Kidney/abnormalities , Polycystic Kidney Diseases/therapy , Female , Humans , Infant , Infant, Newborn , Male , Polycystic Kidney Diseases/diagnosisABSTRACT
The hydroelectric and pH alterations that produce the digestive irrigation previous to the surgery, have justified the fulfillment of this study, addressed to design a kind of solution to be used at pediatric patients. It has been used two solutions: one of them proposed by Davis (S_I), and the other (S_II), is Davis' solution modification, in which it is decreased the quantity of polyethylene glycol (PEG-4000) and it is increased the concentration of bicarbonate. The analysis of the results demonstrated the superiority of the second solution avoiding the tendency to the acidosis that show the Davis' solution.
