Diagnóstico prenatal de masa abdominal. Revisión del fetus in fetu / Prenatal diagnosis of abdominal mass: Review of the foetus in foetu

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Atresia de esófago long-gap: repercusión del momento de la extubación en la evolución / Long-gap esophageal atresia: effect of the timing of extubation on outcome

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Utilidad del adhesivo tisular 2-octil cianoacrilato en cirugía pediátrica / Utility of octyl-2-cianocrylate in pediatric surgery

Objetivo: El objetivo de este trabajo es demostrar la utilidad y conveniencia del 2-octil cianoacrilato en la sutura cutánea de diversas enfermedades propias de la edad pediátrica. El 2-octil cianoacrilato es un adhesivo tisular tópico que puede utilizarse para la piel y que ya se ha probado en la práctica quirúrgica para el sellado de las suturas. Con este material se evita el empleo de la sutura convencional. Material y métodos: Hemos aplicado 2-octil cianoacrilato en heridas cutáneas menores de 5 cm en 100 pacientes distribuidos: servicio de urgencias; 20 pacientes con heridas incisas simples de la región facial y de las extremidades; bloque quirúrgico; herida cutánea quirúrgica de 80 pacientes con las siguientes patologías: hernias inguinales (20 pacientes), criptorquidias (20 pacientes), hernias umbilicales (10 pacientes), hipospadias (17 pacientes), fístulas posthipospadias (8 pacientes) y fisura labial (5 pacientes).Se han analizado los resultados valorando: eficacia, resultado estético, tiempo de sutura, material empleado y bienestar del paciente. Conclusiones: Mayor comodidad de aplicación que la sutura convencional en cada una de sus aplicaciones. Disminución del tiempo empleado en su utilización respecto al tratamiento convencional y en definitiva menor coste por procedimiento (AU)

[Utility of octyl 2-cyanoacrylate in pediatric surgery]. / Utilidad del adhesivo tisular 2-octil cianoacrilato en cirugía pediátrica.

OBJECTIVE: The aim this study was to demonstrate the utility and suitability of octyl-2-cianocrylate in cutaneus repair of different conditions in the pediatric population. Octyl-2-cianocrylate is a topical tissular adhesive which can be used on skin and which has been tested in surgical practice as a wound sealant, avoiding the use of conventional sutures. MATERIAL AND METHODS: We applied octyl-2-cianocrylate in 100 patients with skin wounds smaller than 5 cm. The patients were distributed as follows: Emergency department: simple sharp wounds in the face and extremities (20 patients); surgical block: surgical wounds in 80 patients with the following conditions: inguinal hernia (20 patients), cryptorchidism (20 patients), umbilical hernia (10 patients), hypospadias (17 patients), post-hypospadias fistula repair (8 patients) and cleft lip (5 patients). The results were analyzed in terms of efficacy, cosmetic result, procedure time, material used, and patient comfort. CONCLUSIONS: Octyl-2-cianocrylate was easier to use than conventional sutures in all its applications, requiring less time than conventional sutures and therefore lowering the cost per procedure.

[Focal nodular hyperplasia of the liver]. / Hiperplasia nodular focal del hígado.

Focal nodular hyperplasia (FNH) of the liver is an uncommon benign lesion that usually occurs in young or middle-aged women. Although it has been associated with oral contraceptive use, no evidence supports this hypothesis. Most patients with this lesion are asymptomatic. We report the case of a 10-year-old boy with a history of transient epigastric abdominal pain over several days. Physical examination revealed a tender mass in the upper left quadrant. Abdominal ultrasonography revealed an 85 3 45 mm mass located in the left lobe of the liver. Computed tomography-guided biopsy showed histological changes consistent with FNH. Left hepatectomy was performed and the diagnosis was confirmed by histological study. FNH of the liver is extremely rare in children, especially in boys. Unlike adenoma, malignant transformation of FNH has not been described and consequently patients can be periodically followed-up with imaging tests, without need of surgery. The differential diagnosis includes other benign hepatic lesions such as hemangioma and hepatocellular adenoma. Surgical resection is indicated in symptomatic patients, usually with abdominal pain, cholestasis or palpable abdominal mass, and when the differential diagnosis, especially with hepatic adenoma, is unclear.

Hiperplasia nodular focal del hígado / Focal nodular hyperplasia of the liver

La hiperplasia nodular focal es un tumor hepático benigno muy poco frecuente que afecta a mujeres jóvenes o de mediana edad. Se ha sugerido su asociación con el uso de anticonceptivos orales, pero este hecho no ha sido demostrado. En la mayoría de los casos la lesión es asintomática. Se presenta el caso de un niño de 10 años de edad, que consultó por un cuadro de dolor epigástrico intermitente de varios días de evolución. La palpación abdominal mostró una tumoración dolorosa y dura localizada en el hipocondrio izquierdo. La ecografía abdominal reveló la existencia de una masa de 85X45 mm situada en el lóbulo hepático izquierdo, de la cual se practicó una biopsia por punción dirigida mediante tomografía computarizada (TC). El estudio histopatológico mostró un tejido hepático con alteraciones indicativas de hiperplasia nodular focal. El paciente fue intervenido realizándose una hepatectomía izquierda. El estudio histológico definitivo confirmó el diagnóstico. La hiperplasia nodular focal del hígado en la edad pediátrica es rara y aún más en niños varones. A diferencia del adenoma, no se ha descrito la transformación maligna, por lo que los pacientes pueden ser seguidos de forma periódica mediante pruebas de imagen sin necesidad de tratamiento quirúrgico. El diagnóstico diferencial debe establecerse con otros tumores benignos como los hemangiomas y el adenoma hepatocelular. El tratamiento quirúrgico está indicado en pacientes con síntomas como dolor recurrente, colestasis por compresión o la presencia de una masa abdominal palpable, así como siempre que existan dudas en el diagnóstico diferencial, en particular con el adenoma hepático (AU)

Tratamiento con triamcinolona acetónido (trigon-depot) de las estenosis post-intervención de hipospadias graves / Triamcinolone cetonide (trigon-depot) for the treatment of stenosis secondary to surgery of severe hypospadias

La estenosis uretral, después de la fístula, es la complicación más frecuente que presentan los pacientes intervenidos de hipospadias. Su incidencia oscila entre un 4 por ciento-12 por ciento dependiendo de la técnica quirúrgica empleada. Su trata-miento en la mayoría de las ocasiones es sencillo, siendo suficiente la dilatación de la zona estenosada en una o varias sesiones. Sin embargo en otros casos, sobre todo en los pacientes con hipospadias graves en los que ha sido preciso la disección y resección amplia de los tejidos fibrosos para corregir la incurvación y en los multitratados, la dilatación de la zona estenosada es difícil. Presentamos 3 pacientes afectos de hipospadias graves (escrotales y perineales) multioperados, que presentaron como complicación en el post-operatorio estenosis uretral a distinto nivel. Sometidos a programa de dilataciones periódicas durante varios meses no se consiguió solucionar la estenosis. Se intervinieron para intentar ampliar la zona estenosada. En dos la ampliación se hizo con un injerto libre de mucosa oral y en el tercero se utilizó un colgajo local. Al poco tiempo de la ampliación, se estenosaron de nuevo, no respondiendo de nuevo al programa de dilataciones. Ante la persistencia de la sintomatología y la dureza de las cicatrices de la zona estenosada, se inyectó Triamcinolona D.C.I. acetónido (Trigon Depot) corticoesteroide de acción prolongada, sobre la zona de máxima fibrosis uretral, con la idea de reproducir el efecto reblandecedor que tiene sobre las cicatrices cutáneas hipertróficas y queloideas. Los tres pacientes fueron tratados con inyecciones repetidas de triamcinolona con un intervalo entre ellas de 2 a 3 meses. El periodo de seguimiento de estos pacientes oscila entre 5 y 20 meses, encontrándose todos libres de sintomatología y con un buen chorro miccional (AU)

[Treatment with triamcinolone cetonide (trigon-depot) for stenosis after surgery of severe hypospadias]. / Tratamiento con triamcinolona acetónido (trigon-depot) de las estenosis post-intervención de hipospadias graves.

Urethral stenosis is, after the fistula, the most frequent complication in patients undergoing hypospadias repair. Incidence ranges between 6% and 10% depending on the surgical technique. Treatment of this complication with simple dilation of the narrowed segment is enough in most cases. However, dilation of the stricture may be difficult in patients with severe hypospadias that required wide dissection and excision of fibrotic tissue to repair a large deviation and also in patients who had previously multiple operations. We report 3 patients with severe hypospadias (scrotal and perineal) with history of multiple operations for that condition and postoperative urethral stenosis at different sites. All patients had periodical dilations for several months without any improvement. Surgical treatment was indicated to enlarge the stenotic segment. Enlargement was performed using oral mucosa graft in two cases and a local flap in the third one. Urethral stricture recurred in all cases very soon after the plasty and repeated dilations did not improve the symptoms. In the presence of hard scar tissue it was decided to inject triamcinolone DCI acetoide (Trigon depot), a long acting steroid, into the segment where the fibrotic narrowing was more severe, in an effort to obtain the same results reported in the treatment of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections every 2-3 months. Follow-up ranges between 5 and 20 months and all of them are free of symptoms.

[Cystic lymphangioma: treatment with adhesive fibrin tissue. Follow-up study]. / Linfangioma quístico: Tratamiento con adhesivo de fibrina. Control evolutivo.

We present twelve cases of cystic lymphangioma in the neck and one in the leg, treated with fibrina adhesive injected into the lesion, during the periode 1991-1994. Two cases had been surgically treated and experimental recurrence of the tumor previous to our treatment. In the other ten the punction was the only therapy applied. Four cases needed two punctions and only one of then after two failed punctions, had be treated with surgical extripation. The follow up was between 3 and 42 months, with a mean of 26.5 months. No complications appeared. The ecografic follow up demonstrated a complete remission in the ten cases treated only with punction. We believe that our results support the fact that the punction-aspiration and posterior Tissucol infection is the first choice in the surgical treatment of the cystic lymphangioma.

[Changes in traditional techniques in anterior hypospadias]. / Modificaciones a las técnicas tradicionales en el hipospadias anterior.

After confirming that the Magpi and Mathieu techniques are not sufficient for the adequate treatment of 100% of the anterior forms of hypospadias and observing that they often cause defects in the appearance of the meatus, 23 patients were selected and treated with traditional urethroplasties modified by the pyramid technique (King), the Barcat technique, or both, with satisfactory results in all cases. These techniques which are easy to perform, effectively contribute to improving the final appearance of the penis, do not involve major operating time, and present a lower incidence of complications than the traditional techniques.

[Evolution of hypospadias surgery. Comparative study of the various techniques used for 20 years]. / Evolución en la cirugía del hipospadias. Estudio comparativo de las diferentes técnicas empleadas a lo largo de 20 años.

With the purpose of studying the long-term results of the different surgical techniques used for the treatment of hypospadias, we have examined 1186 patients treated in our centre over the last 20 years. To facilitate the comparative study, three well-defined periods have been established: 1974-1981 (165 pts.). Treatment was done in several operative times. Denis Browne and Mathieu's urethroplasties were the techniques more frequently used. Their long-term evolution show keratosis and hairiness of the neourethra, which in 17 patients required a new urethroplasty with vesicle mucosa, as the most serious complication. 1982-1986 (281 pts.). Restoration was done in one single operative time. Magpi, Mathieu and Duckett's techniques were the most frequently used during this period. 1987-1993 (624 pts.). An island flap is added as cutaneous plasty after urethroplasty has been performed. Fistulae were the most frequent complications in all the above time-periods (18, 10 and 7.3%, respectively), followed by stenosis (12, 6.5 and 4.4%) and megaurethra (6.8, 6.7 and 2.9%). The remarkable decrease both in number and seriousness of the complications is due to the island cutaneous flap, hormonal stimulation, use of slow reabsorption materials , silicone probes, silastic foam dressings, caudal anaesthetics and, above all, a better indication for the surgical technique in each case.

[Complications in hypospadias repair: 20 years of experience]. / Complicaciones de los hipospadias y su tratamiento: veinte años de experiencia.

We report a comparative study of the complications in hypospadias repair of 1185 patients treated in our hospital in the last 20 years. They are divided in three well-defined groups: from 1974 to 1981 (265 p.); from 1982 to 1986 (281 p.) and from 1987 to 1993 (624 p.). These were the more frequent complications seen: a) Early as cutaneous necrosis, a severe complication that had an incidence of 3% in the first period. In the second and third period this percentage diminished to 1.9% and 1.1%, respectively. Only one patient developed a total necrosis of the cutaneous island flap that required a new urethroplasty. b) Late: Persistent chordee. It was present in 10% of the children in the first period and it was secondary to an inadequate release of the chordee and cutaneous necrosis. The incidence of the second period was 3.5% and only 2% of patients of the third group suffered it because of a non appropriate selection of the surgical technique. Fistula. It was the most common complication and it was present in 18%, 10% and 7.3% of the patients of each period. We think that the introduction of the cutaneous island flap procedure helped to the improvement in the rate of fistulas. Urethral structure. The incidence was 12% in the first period, 6.5% in the second one and it fall down to 4.4% in the third group due to the triangular flap of the glans. Megaurethra. The incidence was of 6.8% in the first period, 6.5% in the second one and only the 2.9% in the last years.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hypospadias. Onlay technique]. / Hipospadias. Técnica en onlay.

The "onlay" urethroplasty is based technically on the following principles: movilization of the urethral plate without dividing it, complete exeresis of chordee beneath it and use of a double faced mucocutaneous vascularized flap from the dorsal aspect rotated to the ventral aspect of penis. Several advantages over other technical modalities make its applicability possible in almost all varieties of hypospadias even in those with severe incurvature. Up to date we have used this technique in 9 patients between 2 and 3 years of age with proximal and middle hypospadias and in one with a considerable middle third fistula, without complications.

[Fibrin adhesive: a new therapeutic alternative in the treatment of cystic lymphangioma]. / Adhesivo de fibrina: una nueva alternativa terapéutica en el tratamiento del linfangioma quístico.

We present three cases of cystic lymphangioma of the neck, treated with a new therapeutic method which consists of an injection of fibrin adhesive into the lesion following aspiration of the liquid contents of the lymphangioma. Two of the cases had been treated surgically and were faced with the recurrence of the tumor, the aforesaid treatment was applied. In the third case, it was the only therapy applied. We believe that the results obtained were excellent in all three cases.

[Neurofibromatosis as a cause of arterial hypertension in children]. / Neurofibromatosis como causa de hipertensión arterial en niños.

Hypertension can complicate the course of neurofibromatosis. When it appears in adulthood (after 18 years of age) it is usually due to pheochromocytoma, but in children the cause is a stenotic lesion of the renal arteries or the suprarenal aorta. Its treatment follows the general principles used in the treatment of the more common forms of renovascular hypertension. We report four patients that developed renovascular hypertension after being diagnosed of neurofibromatosis, they had different localizations of the stenotic lesion, and the diverse types of surgical treatment are analyzed.