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1.
Cir Pediatr ; 35(4): 165-171, 2022 Oct 01.
Article in English, Spanish | MEDLINE | ID: mdl-36217786

ABSTRACT

BACKGROUND: Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection. MATERIALS AND METHODS: A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed. RESULTS: A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not. CONCLUSIONS: Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.


OBJETIVO: El tratamiento quirúrgico de la intususcepción ileocólica (IIC) es la segunda causa más frecuente de laparotomía de urgencia en niños. La realización de una apendicectomía incidental tras la reducción quirúrgica sigue siendo motivo de controversia. El objetivo de este trabajo es analizar los resultados obtenidos al llevar a cabo una apendicectomía incidental tras la reducción quirúrgica de una IIC con o sin resección intestinal asociada. MATERIAL Y METODO: Se realizó un estudio retrospectivo en pacientes con episodios de IIC sometidos a tratamiento quirúrgico en nuestro centro entre 2005 y 2019. Los pacientes se dividieron en dos grupos según se llevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad de practicar resección intestinal en ambos grupos. Se analizaron las variables demográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias y las recidivas. RESULTADOS: Se incluyeron un total de 101 pacientes (77 en el grupo AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron un total de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupo NA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AA frente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospitalaria (mediana de 5 días en ambos grupos). Tampoco se registraron diferencias en términos de complicaciones posoperatorias o recidivas entre los dos grupos. El análisis estratificado mostró que la resección intestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a cabo apendicectomía asociada o no. CONCLUSION: La apendicectomía incidental durante el tratamiento quirúrgico de la IIC en niños es un procedimiento seguro que no aumenta el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias ni las posibilidades de recidiva.


Subject(s)
Appendicitis , Digestive System Surgical Procedures , Intussusception , Laparoscopy , Appendectomy/methods , Appendicitis/surgery , Child , Digestive System Surgical Procedures/methods , Humans , Intussusception/surgery , Laparoscopy/methods , Length of Stay , Postoperative Complications/surgery , Retrospective Studies , Treatment Outcome
2.
Cir. pediátr ; 35(4): 165-171, Oct. 2022. ilus, tab
Article in Spanish | IBECS | ID: ibc-210858

ABSTRACT

Objetivo: El tratamiento quirúrgico de la intususcepción ileocólica(IIC) es la segunda causa más frecuente de laparotomía de urgencia enniños. La realización de una apendicectomía incidental tras la reduc-ción quirúrgica sigue siendo motivo de controversia. El objetivo deeste trabajo es analizar los resultados obtenidos al llevar a cabo unaapendicectomía incidental tras la reducción quirúrgica de una IIC cono sin resección intestinal asociada. Material y método: Se realizó un estudio retrospectivo en pacientescon episodios de IIC sometidos a tratamiento quirúrgico en nuestro centroentre 2005 y 2019. Los pacientes se dividieron en dos grupos según sellevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad depracticar resección intestinal en ambos grupos. Se analizaron las variablesdemográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, laestancia hospitalaria, las complicaciones posoperatorias y las recidivas. Resultados: Se incluyeron un total de 101 pacientes (77 en el gru-po AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron untotal de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupoNA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AAfrente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospi-talaria (mediana de 5 días en ambos grupos). Tampoco se registrarondiferencias en términos de complicaciones posoperatorias o recidivasentre los dos grupos. El análisis estratificado mostró que la resecciónintestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a caboapendicectomía asociada o no.(AU)


Background: Surgical treatment of ileo-colic intussusception (ICI)has been reported as the second cause of emergency laparotomy inchildren. The performance of incidental appendectomy after surgicalreduction is currently controversial. The aim is to analyse the outcomesof performing incidental appendectomy after surgical ICI reduction withor without associated bowel resection. Materials and methods: A retrospective study was performed inpatients with ICI episodes, who underwent surgical treatment in ourinstitution between 2005-2019. Patients were divided in two groupsaccording to the performance of associated appendectomy (AA group)or not (NA group). Subsequently, a stratified analysis was performedaccording to the need for bowel resection in both groups. Demographicvariables, intraoperative findings, surgical time, hospital stay, postopera-tive complications and recurrences were analysed.Results. A total of 101 patients (77 AA group; 24 NA group) wereincluded, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 groupNA), with no differences in surgical time (55.7 min in group AA vs.61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in bothgroups). There were also no differences in postoperative complicationsor recurrences between the two groups. Stratified analysis showed thatbowel resection increases operative time, hospital stay and postopera-tive complications, regardless of whether associated appendectomy wasperformed or not.(AU)


Subject(s)
Humans , Male , Female , Child , Appendectomy , Intussusception , Digestive System Surgical Procedures , Treatment Outcome , Child Health , Pediatrics , General Surgery , Retrospective Studies
3.
Cir. pediátr ; 24(4): 224-227, oct. 2011.
Article in Spanish | IBECS | ID: ibc-107359

ABSTRACT

Todavía hay un desconocimiento en general de cómo funciona el robot, de las ventajas y aplicaciones que se pueden obtener con su uso en cirugía pediátrica. Los beneficios son controvertidos. La maniobrabilidad de los instrumentos y la mejor visualización del campo quirúrgico favorecen su uso. En contra, el coste y la falta de instrumental diseñado para los pacientes más pequeños. El objetivo de este trabajo es actualizar en detalle los pros y contras del uso de robótica en un paciente pediátrico (AU)


Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery (AU)


Subject(s)
Humans , Male , Female , Child , Robotics/methods , Child Health Services/methods , /trends , Cost-Benefit Analysis , Surgical Instruments/standards
4.
Cir Pediatr ; 24(4): 224-7, 2011 Oct.
Article in Spanish | MEDLINE | ID: mdl-23155636

ABSTRACT

Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.


Subject(s)
Robotics , Surgical Procedures, Operative/methods , Child , Humans
5.
Bol Asoc Med P R ; 90(4-6): 79-81, 1998.
Article in English | MEDLINE | ID: mdl-9866272

ABSTRACT

Primitive neuroectodermal or neuroepithelial tumors are names used to describe neoplasias composed of undifferentiated cells resembling germinal cells of the embryonic neural tube. These tumors are small round cell malignancies of the neural crest origin arising outside the central and sympathetic nervous system. They are described as peripheral and central neuroectodermal tumors related to the original malignant cell. A great number of tumors are described under this classification in spite of the fact that there is no an universal acceptance that these small-cell neoplasms, regardless of their primary site, are derived from immature neuroectoderm tissue. Because one tumor resembles others in terms of its phenotypic expression, multiple specific studies such as clinical profile, ultrastructural, immunocytochemical, and cytogenetic features should be studied, since no single clinical or laboratory marker is by itself diagnostic. However, there is a chromosomal reciprocal translocation, t(11;22)(q24;q12), which is unique to Primitive Neuroectodermal Tumor (PNET).


Subject(s)
Neuroectodermal Tumors, Primitive/epidemiology , Adolescent , Adult , Bone Neoplasms/epidemiology , Bone Neoplasms/pathology , Bone Neoplasms/therapy , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Neuroblastoma/epidemiology , Neuroblastoma/pathology , Neuroblastoma/therapy , Neuroectodermal Tumors, Primitive/pathology , Neuroectodermal Tumors, Primitive/therapy , Prognosis , Puerto Rico/epidemiology , Retroperitoneal Neoplasms/epidemiology , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/therapy , Retrospective Studies , Sarcoma, Ewing/epidemiology , Sarcoma, Ewing/pathology , Sarcoma, Ewing/therapy
6.
Bol Asoc Med P R ; 90(4-6): 82-4, 1998.
Article in English | MEDLINE | ID: mdl-9866273

ABSTRACT

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report.


Subject(s)
Aorta, Abdominal/pathology , Aortic Diseases/pathology , Postoperative Complications/pathology , Ureteral Diseases/pathology , Urinary Fistula/pathology , Vascular Fistula/pathology , Aged , Aorta, Abdominal/diagnostic imaging , Aorta, Abdominal/surgery , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgery , Humans , Intraoperative Complications , Male , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Postoperative Complications/surgery , Radiography , Ureter/injuries , Ureter/surgery , Ureteral Diseases/diagnostic imaging , Ureteral Diseases/etiology , Ureteral Diseases/surgery , Urinary Fistula/diagnostic imaging , Urinary Fistula/etiology , Urinary Fistula/surgery , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology , Vascular Fistula/surgery
7.
Bol Asoc Med P R ; 90(1-3): 34-6, 1998.
Article in English | MEDLINE | ID: mdl-9734156

ABSTRACT

This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN.


Subject(s)
Appendicitis/complications , Glomerulonephritis, IGA/etiology , Acute Disease , Adolescent , Anti-Bacterial Agents/therapeutic use , Appendectomy , Appendicitis/drug therapy , Appendicitis/surgery , Child , Glomerulonephritis, IGA/surgery , Humans , Male
8.
Bol Asoc Med P R ; 90(1-3): 37-9, 1998.
Article in English | MEDLINE | ID: mdl-9734157

ABSTRACT

This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms.


Subject(s)
Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/complications , Adolescent , Humans , Ileal Neoplasms/complications , Ileal Neoplasms/surgery , Leiomyoma/complications , Leiomyoma/surgery , Male , Meckel Diverticulum/surgery , Rectum
9.
J Pediatr Surg ; 33(8): 1302-5, 1998 Aug.
Article in English | MEDLINE | ID: mdl-9722010

ABSTRACT

BACKGROUND/PURPOSE: Thyroid nodules are rare in children. The need to uncover malignancy is the most challenging dilemma in management. The aim of this report was to determine whether management of pediatric thyroid nodules has changed in the era of fine-needle aspiration (FNA) cytology. METHODS: Twenty-four children with thyroid nodules comprised the study group. Demographic characteristics, clinical manifestations, imaging results, FNA cytology results, surgical therapy, complications, and pathological reports were reviewed retrospectively. FNA cytology results were categorized as either benign, malignant, suspicious, or insufficient. RESULTS: Girls outnumbered boys (five to one) with a mean age of 14.9 years. Nineteen nodules were benign and five malignant. Malignancy was characterized by localized tenderness, multiglandular appearance, and fixation to adjacent tissues. Ultrasound scans and nuclear scans gave no clue toward management because cystic, hot, and warm nodules figured among malignant cases. FNA in 18 children achieved 80% accuracy, 60% sensitivity, 90% specificity, 75% positive, and 81% negative predictive value. Physical examination findings, persistence of the nodule, and progressive growth decided for surgery in most children. CONCLUSIONS: FNA is a safe adjunctive test that plays a minor role in the decision to withhold surgery. Its greatest strength is to resolve, in case of suspicious or malignant cytology, that a more radical procedure will be needed. Clinical judgement as determined by serial physical findings continues to be the most important factor in the management of thyroid nodules in children.


Subject(s)
Adenocarcinoma, Follicular/pathology , Carcinoma, Papillary/pathology , Thyroid Neoplasms/pathology , Thyroid Nodule/pathology , Adenocarcinoma, Follicular/surgery , Adolescent , Biopsy, Needle , Carcinoma, Papillary/surgery , Child , Diagnosis, Differential , Female , Humans , Incidence , Male , Prognosis , Puerto Rico/epidemiology , Risk Factors , Thyroid Neoplasms/surgery , Thyroid Nodule/surgery , Thyroidectomy , Treatment Outcome
10.
Bol. Asoc. Méd. P. R ; 90(4/6): 82-84, Apr.-Jun. 1998.
Article in English | LILACS | ID: lil-411395

ABSTRACT

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report


Subject(s)
Humans , Male , Aged , Aorta, Abdominal/pathology , Aortic Diseases/pathology , Postoperative Complications/pathology , Ureteral Diseases/pathology , Urinary Fistula/pathology , Vascular Fistula/pathology , Aorta, Abdominal , Aorta, Abdominal/surgery , Aortic Diseases/etiology , Aortic Diseases , Aortic Diseases/surgery , Postoperative Complications/etiology , Postoperative Complications , Postoperative Complications/surgery , Ureteral Diseases/etiology , Ureteral Diseases , Ureteral Diseases/surgery , Urinary Fistula/etiology , Urinary Fistula , Urinary Fistula/surgery , Vascular Fistula , Vascular Fistula/surgery , Intraoperative Complications , Ureter/injuries , Ureter/surgery
11.
Bol. Asoc. Méd. P. R ; 90(4/6): 79-81, Apr.-Jun. 1998.
Article in English | LILACS | ID: lil-411396

ABSTRACT

Primitive neuroectodermal or neuroepithelial tumors are names used to describe neoplasias composed of undifferentiated cells resembling germinal cells of the embryonic neural tube. These tumors are small round cell malignancies of the neural crest origin arising outside the central and sympathetic nervous system. They are described as peripheral and central neuroectodermal tumors related to the original malignant cell. A great number of tumors are described under this classification in spite of the fact that there is no an universal acceptance that these small-cell neoplasms, regardless of their primary site, are derived from immature neuroectoderm tissue. Because one tumor resembles others in terms of its phenotypic expression, multiple specific studies such as clinical profile, ultrastructural, immunocytochemical, and cytogenetic features should be studied, since no single clinical or laboratory marker is by itself diagnostic. However, there is a chromosomal reciprocal translocation, t(11;22)(q24;q12), which is unique to Primitive Neuroectodermal Tumor (PNET)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Neuroectodermal Tumors, Primitive/epidemiology , Bone Neoplasms/epidemiology , Bone Neoplasms/pathology , Bone Neoplasms/therapy , Retroperitoneal Neoplasms/epidemiology , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/therapy , Neuroblastoma/epidemiology , Neuroblastoma/pathology , Neuroblastoma/therapy , Prognosis , Puerto Rico/epidemiology , Retrospective Studies , Sarcoma, Ewing/epidemiology , Sarcoma, Ewing/pathology , Sarcoma, Ewing/therapy , Neuroectodermal Tumors, Primitive/pathology , Neuroectodermal Tumors, Primitive/therapy
12.
Bol. Asoc. Méd. P. R ; 90(1/3): 37-39, Jan.-Mar. 1998.
Article in English | LILACS | ID: lil-411406

ABSTRACT

This is a review of a child who developed symptomatic anemia secondary to a huge Meckel's Diverticulum (MD). The patient presented with multiple complications, such as: neoplasia, occult chronic bleeding, giant size MD, partial intestinal obstruction and severe symptomatic anemia. There was complete resolution of the condition after resection and ileo-ileal anastomosis. After revision of the literature, this case is the first report of MD occurring concomitantly with such a myriad of signs and symptoms


Subject(s)
Humans , Male , Adolescent , Meckel Diverticulum/complications , Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/surgery , Leiomyoma/complications , Leiomyoma/surgery , Ileal Neoplasms/complications , Ileal Neoplasms/surgery , Rectum
13.
Bol. Asoc. Méd. P. R ; 90(1/3): 34-36, Jan.-Mar. 1998.
Article in English | LILACS | ID: lil-411407

ABSTRACT

This is a review of two children who developed acute glomerulonephritis (AGN) following acute gangrenous appendicitis (AGA) with periappendicular collections. The first patient presented with AGN during the course of appendicitis. The second patient developed AGN after appendectomy. Both patients did not have any other predisposing factors. AGN resolved in both patients after massive intravenous antibiotics. This is the first report of acute appendicitis as a predisposing factor for AGN


Subject(s)
Humans , Male , Child , Adolescent , Appendicitis/complications , Glomerulonephritis, IGA/etiology , Acute Disease , Appendectomy , Anti-Bacterial Agents/therapeutic use , Appendicitis/drug therapy , Appendicitis/surgery , Glomerulonephritis, IGA/surgery
14.
Bol Asoc Med P R ; 86(7-9): 53-5, 1994.
Article in English | MEDLINE | ID: mdl-7945653

ABSTRACT

This is a case report of a male patient admitted with a huge rectosigmoid mass that had eroded into the lumen, causing persistent rectal bleeding. Special procedures such as double contrast Barium Enema, abdomino-pelvic CT-Scan and proctosigmoidoscopy addressed us to identify it as an intramural lipoma. Rectosigmoid lipoma with its differential diagnosis and surgical approach is reviewed together with the most pertinent literature.


Subject(s)
Lipoma/diagnosis , Rectal Neoplasms/diagnosis , Sigmoid Neoplasms/diagnosis , Diagnosis, Differential , Endoscopy , Humans , Lipoma/diagnostic imaging , Lipoma/surgery , Male , Middle Aged , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/surgery , Sigmoid Neoplasms/diagnostic imaging , Sigmoid Neoplasms/surgery , Tomography, X-Ray Computed
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