[Risk factors for Barrett's oesophagus in children: a case-control study]. / Factores de riesgo del esófago de Barrett en niñios: estudio caso-control.

AIM OF THE STUDY: Barrett's oesophagus in young individuals is a rare pathology. The purpose of this study was to identify those risk factors involved in Barrett's oesophagus (BO) development in children. METHODS: We performed a case-control study between years 2000 and 2010. Cases had endoscopic BO with histological confirmation of gastric or intestinal metaplasia. For each case, three to four controls were selected from our ph-monitoring database. They were matched by age, + 2 years, or by associated features (oesophageal atresia or Down's syndrome) when appropriate. An analysis of the demographic variables, symptoms and endoscopic data was performed: sex, digestive or respiratory symptoms, exposition time to gastroesophageal reflux (GER) without treatment with proton-pump inhibitors (PPI) and Helicobacter pylori (HP) presence. MAIN RESULTS: Six patients were diagnosed with BO (age range: 8 months-14 years) and a 21 control samples were included. Both groups were comparable in sex and age parameters. There were no differences in clinical presentation, neither in presence of hiatal hernia nor HP colonisation. The ph-monitoring register did not differ between groups, median Reflux Index or Boix Ochoa Index. The only risk factor found in this study is the exposition time to GER: OR = 1.046; CI95% (1.007-1.086); p = 0.021. CONCLUSIONS: Our results suggest that exposition time to GER without treatment with PPI is related to Barrett's oesophagus development in childhood.

Factores de riesgo del esófago de Barrett en niños: estudio caso-control / Risk factors for Barrett’s oesophagus in children: A case-control study

Objetivo. El esófago de Barrett es una patología infrecuente en la población infantil. El objetivo del estudio es identificar los factores de riesgo que pueden favorecer el desarrollo de esófago de Barrett (EB) en niños. Material y métodos. Realizamos un estudio caso-control entre los años 2000 y 2010. Los casos presentaban EB endoscópico con confirmación histológica de metaplasia gástrica o intestinal. Para cada caso se seleccionaron tres o cuatro controles de nuestro registro de pH-metrías. Se emparejaron por edad, ± 2 años, o bien por patología asociada (atresia de esófago o síndrome de Down). Realizamos un análisis de las variables demográficas, clínicas y endoscópicas recogidas: el sexo, los síntomas digestivos y respiratorios, el tiempo de exposición al reflujo gastroesofágico (RGE) sin el tratamiento con inhibidores de la bomba de protones (IBP), los hallazgos endoscópicos y la presencia de Helicobacter pylori (HP).Resultados. Se diagnosticaron seis pacientes con EB (rango de edad: 8 meses-14 años) y 21 controles. Ambos grupos fueron comparables en edad y sexo. No encontramos diferencias significativas en la presentación clínica, en la presencia de hernia hiatal o HP. Los datos pH métricos, índice de reflujo e índice de Boix, tampoco difirieron entre los grupos. El único factor de riesgo que hallamos en el estudio fue el tiempo de exposición al RGE: OR = 1,046; IC 95%: 1,007-1,086; p = 0,021.Conclusiones. Los resultados sugieren que el tiempo de exposición al RGE sin tratamiento con IBP está relacionado con el desarrollo de esófago de Barrett en la infancia (AU)

Aim of the study. Barrett’s oesophagus in young individuals is a rare pathology. The purpose of this study was to identify those risk factors involved in Barrett’s oesophagus (BO) development in children. Methods. We performed a case-control study between years 2000 and 2010. Cases had endoscopic BO with histological confirmation of gastric or intestinal metaplasia. For each case, three to four controls were selected from our ph-monitoring database. They were matched by age, ± 2 years, or by associated features (oesophageal atresia or Down’s syndrome) when appropriate. An analysis of the demographic variables, symptoms and endoscopic data was performed: sex, digestive or respiratory symptoms, exposition time to gastroesophageal reflux (GER) without treatment with proton-pump inhibitors (PPI) and Helicobacter pylori (HP) presence. Main results. Six patients were diagnosed with BO (age range: 8 months-14 years) and a 21 control samples were included. Both groups were comparable in sex and age parameters. There were no differences in clinical presentation, neither in presence of hiatal hernia nor HP colonisation. The ph-monitoring register did not differ between groups, median Reflux Index or Boix Ochoa Index. The only risk factor found in this study is the exposition time to GER: OR = 1.046; CI 95% (1.007-1.086); p = 0.021.Conclusions. Our results suggest that exposition time to GER without treatment with PPI is related to Barrett’s oesophagus development in childhood (AU)

Criopreservación ovárica en niñas con cáncer: nuevos retos / Ovarian cryopreservation in girls with cancer: new challenges

Objetivos. La criopreservación de la corteza ovárica (CCO) para futuro autotrasplante permitirá hacer frente al fallo ovárico precoz y a las alteraciones de la capacidad reproductiva que afectan a algunas delas supervivientes de cáncer pediátrico. Material y métodos. En el Programa de Preservación de Fertilidad en Oncología Pediátrica se incluyen pacientes con alto riesgogonadotóxico: las que vayan a recibir radioterapia pélvica, trasplante de precursores hematopoyéticos, altas dosis de radioterapia craneal o agentes alquilantes, o aquéllas con patología ovárica bilateral. Antes del tratamiento oncológico y coincidiendo con otros procedimientos invasivos, se recoge el tejido ovárico por vía laparoscópica. Una vez descartada la malignidad en la muestra y confirmada la presencia de folículos primordiales, el equipo multidisciplinar de oncólogo, cirujano y especialista en fertilidad coordina la manipulación y envío de la corteza ovárica al Banco de Tejidos de la Comunidad Valenciana. Resultados. De julio de 2008 hasta mayo de 2010 se incluyeron en el programa a 8 pacientes, entre 8 y 18 años, con diagnóstico de: linfoma de Hodgkin (n= 2), leucemia aguda linfoide y mieloide (n= 2),sarcoma de Ewing pélvico, teratoma ovárico bilateral y meduloblastoma. Cinco pacientes recibieron quimioterapia no gonadotóxica previa a la CCO. De forma adicional, se practicaron 6 procedimientos en el mismo acto anestésico. Se realizó o oforectomía parcial en la mitad delos casos y total en el resto, asociando pexia ovárica en 1 ocasión. Todas las muestras fueron válidas. Conclusiones. La CCO de los casos seleccionados se realizó de forma segura, sin complicaciones ni demora del tratamiento oncológico. Podemos afi rmar que la primera experiencia nacional en este tipo de abordaje ha sido satisfactoria (AU)

Background. Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatriccancer survivors affected of ovarian failure and fertility disorders. Methods. Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad ValencianaTissue Bank. Results. From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin’s lymphoma (n= 2), Acute Myeloblastic and Lymphoblasticleukaemia (n= 2), pelvic Ewing’s sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxicchemo therapy before OCC. Six additional procedures were doneusing the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarianpexia was once associated. All taken samples were found to be valid. Conclusions. OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the fi rst national experience in this procedure has been satisfactorily achieved (AU)

[Ovarian cryopreservation in girls with cancer: new challenges]. / Criopreservación ovárica en niñas con cáncer: nuevos retos.

BACKGROUND: Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders. METHODS: Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank. RESULTS: From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid. CONCLUSIONS: OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.

Tratamiento farmacológico con antifibrinolíticos del empiema secundario a derrame paraneumónicocomplicado / Drug treatment with antifibrinolytics of secondary empyema secondary to complicated parapneumonic effusion

En los últimos años se ha observado en nuestro país un incremento en las complicaciones asociadas a neumonía bacteriana, tales como derrame y empiema. El tratamiento inicial de este tipo de complicación es la asociación de antibióticos que cubran el posible germen implicado así como la colocación de un tubo de drenaje pleural para acelerarla resolución del proceso. La formación de septos dentro de la cavidad pleural requiere terapia adicional (tratamiento antifibrinolítico, videotoracoscopia), sin haberse demostrado cual de estas dos alternativas es mejor. Presentamos una revisión que abarca más de 15 años (1990-2006), del manejo del empiema en nuestro centro. La estrategia de manejo con instilación inicial de antifibrinolíticos intrapleurales, hace de nuestra serie la más larga de las revisadas en nuestro país en que se utiliza dicho tratamiento (30 pacientes de los 50 revisados (60%) fueron tratados con dicha técnica). El éxito inicial fue de 96% con esta modalidad, sin requerir cirugía de rescate. Se hace además un análisis descriptivo de varios parámetros clínicos, analíticos y radiológicos, destacando la estancia media hospitalaria y en unidad de cuidados intensivos. En el análisis comparativo se aprecia una disminución de la estancia en unidad de cuidados intensivos en aquellos pacientes a los que se administró antifibrinolíticos. Este resultado prueba la eficacia del tratamiento en ese aspecto, lo cual es bastante alentador (AU)

In recent years we have observed in our country an increase in complications associated with bacterial pneumonia, such as pleural effusion and empyema. The initial treatment is an association of antibiotics, covering the potential germ involved, and the placement of a pleural drainagetube, in order to accelerate the resolution process. Formation of septawith in the pleural cavity requires additional therapy (antifibrinolytictreatment, videothorascopy), but no one of these two alternatives is been demonstrated better than the other. We present a review that covers last15 years (1990-2006), related to management of empyema. The management strategy with initial instillation of antifibrinolytic intrapleural makes our series the longest in our country using such treatment(30 of 50 patients reviewed (60) were treated with this technique).Initial success was 96% with this modality, without rescuing surgery. There is also a descriptive analysis of several clinical, laboratory andradiological parameters. In comparative analysis, length of stay in intensive care unit decreases in those patients treated with antifibrinolytics. This result is a prove of the efficacy of this treatment, and quite encourageing (AU)

Traslado del niño politraumatizadoen misiones HEMS(helitransporte sanitario) / No disponible

Los instantes posteriores a un incidente van a determinarlas tasas de morbilidad y mortalidad del paciente implicado.Debido a ello uno de los objetivos de los servicios deemergencia extrahospitalarios es disminuir el tiempo quepasa desde que ocurre el incidente hasta la atención médicaespecializada. Numerosas publicaciones han demostradoque un traslado de calidad y con reducción de los tiemposdel mismo, ayuda a disminuir la morbilidad y mortalidadde los niños afectados por el incidente. Es preciso considerarque la tasa de mortalidad en niños politraumatizados essuperior a la de los adultos con lesiones equiparables. Loshelicópteros han demostrado su utilidad en la disminucióndel tiempo de intervención, pero sobre todo han acercado laatención de calidad a niños que sufren un incidente en cualquierlugar.Como conclusiones observamos que la edad y las patologíasde la edad pediátrica diferencian el traslado entreniños y adultos. Es necesaria una formación en transportesanitario pediátrico y es imprescindible que el personalsanitario reciba una formación específica sobre fisiopatologíadel transporte aéreo y que aprenda a desenvolverse enel lugar del incidente y en el medio de transporte, en estecaso el helicóptero, para afrontar con éxito las misionesHEMS en la asistencia al niño politraumatizado (AU)

The moments after an incident will determine the ratesof morbidity and mortality of the patient involved. As aresult one of the objectives of the prehospital emergencyservices is to reduce the amount of time since the incidentoccurs until the specialized medical care appears.Numerous publications have shown that a shipment ofquality and reduction in times, helping to reduce morbidityand mortality of children affected by the incident. We needto consider that the mortality rate in children trauma ishigher than that of adults with comparable injuries. Thehelicopters have proven helpful in decreasing the time ofintervention, but on the whole have brought quality care tochildren suffering from an incident anywhere.As conclusions, we have observed that the age and thediseases of the pediatric age difference between the transportof children from adults. There is a need for training inpediatric health and transport is essential that health personnelreceive specific training on pathophysiology of airtransport and learn to function in the place of the incidentand on the means of transport, in this case the helicopter, tosuccessfully HEMS missions in child care trauma (AU)

Atresia de vías biliares: estudio clínico retrospectivo / Biliary atresia: retrospective clinical study

Objetivo: Obtener un mejor conocimiento del comportamiento de una población de pacientes con diagnóstico de atresia de vías biliares en las distintas fases de la enfermedad. Pacientes y métodos: Estudio retrospectivo, transversal y descriptivo, tipo serie de casos clínicos. Pacientes con diagnóstico de atresia de vías biliares atendidas en la Unidad de Gastroenterología del Hospital Infantil La Fe de Valencia desde enero de 1990 a diciembre del 2000. Resultados: De los 16 niños controlados, en el momento actual permanecen estables ocho, han precisado trasplante hepático seis y han fallecido dos. La edad media al diagnóstico es de 47,5 días de vida. La manifestación clínica más frecuente es la ictericia (87,5 por ciento), y el hallazgo analítico más importante el aumento de la gamma glutamiltranspeptidasa (GGT) (3-4 veces su valor de referencia) en el 100 por ciento de los casos. Las imágenes ecográficas son diagnósticas en el 85,7 por ciento. El Hepato-Hida ofrece una sensibilidad del 100 por ciento. El tratamiento quirúrgico mediante portoenterostomía se realizó en todos los pacientes, con biopsia hepática en el mismo acto. La precocidad en la intervención se refleja en un mejor pronóstico a largo plazo, siendo mejor si ésta se realiza antes de los 65 días de vida. Conclusiones: Un alto índice de sospecha permite el tratamiento quirúrgico precoz, única medida terapéutica que puede condicionar un pronóstico menos desfavorable (AU)

[Biliary atresia: Retrospective clinical study]. / Atresia de vías biliares: estudio clínico retrospectivo.

OBJECTIVE: To gain further insight into the natural history of patients with biliary atresia. PATIENTS AND METHODS: We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included. RESULTS: Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5%) and the most common biochemical finding was raised gamma-glutamyltransferase (3-4 times its standard value), which appeared in 100 % of the patients. Abdominal ultrasonography was diagnostic in 85.7% of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100%. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life. CONCLUSIONS: Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome.

[Digestive irrigation, new perspectives]. / Irrigación digestiva, nuevas perspectivas.

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.

[A new method for the measurement of the anatomical development of the muscle complex of the anus in children with anorectal malformations]. / Nuevo método de cuantificación del desarrollo anatómico del complejo muscular del ano en los niños con malformación anorrectal.

We present a new method for the measurement of the anorectal muscle complex. We studied 40 children with anorectal malformation (14 low and 16 high). Taking the perineal TAC with a rectal probe and quotient called "C": [formula: see text] A "C" value less than 0.31 indicates little development of the anus muscle complex. In 10/26 patients with high malformation, "C" was less than 0.31. All of these patients had fecal incontinence.

[Neurologic changes or vertebral malformations in children with anorectal malformations]. / Alteración nerviosa vs malformación vertebral en niños con malformación anorrectal.

We present a prospective study of 40 patients with anorectal malformations. We have studied the correlation between neurological impairment and vertebral anomalies. We did not find a statistical correlation.

[Localization of the lower esophageal sphincter: a new formula]. / Localización del esfínter esofágico inferior: nueva fórmula.

The esophageal length in the study of patients with Gastroesophageal Reflux (G.E.R.) has the importance of assuring us of the correct position of the probe/sound of the esophageal ph-metering. We carried out a prospective study which correlated the size with the location of the Lower Esophageal Sphincter (L.E.S.), and we tried an approximation, greater than the one, obtained by other methods, in the measurement of the esophageal length, to obviate the manometric study, when our only aim was to insert correctly the probe/sound of the esophageal ph-metering.

[Conservative treatment of post-appendectomy abscesses]. / Tratamiento conservador de los abscesos postapendicectomía.

The standard form of treatment for an abscess in the abdominal cavity is surgical drainage. We present a prospective study of 626 patients under the age of ten who underwent appendectomy. The antibiotic prophylaxis consists of cefoxitin and ampicillin. Postoperative intra-abdominal abscess were found in 1.4% of the patients who were then treated with antibiotics (metronidazole plus amicacin). Following this course of treatment, of the nine abscess, 4 required no surgical drainage, and progressed favourably as shown by the clinical controls and ultrasonography (US). In 3 patients, percutaneous drainage was performed and controlled by US. This paper shows that antibiotic therapy is a useful alternative in the treatment of postappendectomy intraabdominal abscess.

[The treatment of esophageal achalasia in children by endoscopic pneumatic dilatation. A report on 4 cases]. / Tratamiento de la acalasia esofágica en niños mediante dilatación neumática endoscópica. A propósito de cuatro casos.

Four patients underwent pneumatic endoscopic dilatation of achalasia at the La Fe Children's Hospital have been studied. Endoscopic pneumatic dilatation has been performed in only one session with four dilatation maneuvers. In the absence of complications, the patients were only hospitalized for twenty-four hours. The effectiveness of endoscopic pneumatic dilatation and the safety of this method, its ease of application and possibility of repetition make it a useful method in the treatment of achalasia in children.

[Caustic burns of the stomach secondary to ingestion of acid in infants: importance of fibro-endoscopy]. / Causticaciones gástricas secundarias a la ingestión de ácido en la infancia: importancia de la fibroendoscopia.

Two cases of corrosive burns of the stomach after the ingestion of acid by children are presented. Both patients were the same sex and of a similar age (19 and 20 months). The chemical nature of the caustic substance ingested (hydrochloric acid) and the lack of initial symptoms were also similar. The clinical diagnosis however, was completely different due to the endoscopic finding of serious gastric lesions in one of the patients which were then treated accordingly. In children, the accidental ingestion of caustic acids is often accompanied by few clinical symptoms initially. This can lead to failure to diagnose correctly when symptoms are correlated with the existence and severity of digestive lesions. When a caustic substance has been ingested, in addition to symptoms, consideration of the acidity or alkalinity of the ingested product is also an important parametre in evaluating endoscopic findings.

[Gastric duplication. Presentation of 4 cases localized in the antropyloric region]. / Duplicación gástrica. Presentación de cuatro casos localizados en región antropilórica.

Gastric duplications are very rare, especially those located at the pyloric region. Four cases are reported with gastric duplication in patients of two days, eight months, two and a half and three and a half years old, a review is made including symtomatology, diagnostic, treatment and anatomopathological studies. In all four cases post-operative evolution was satisfactory.