[Conservative management of retained central venous catheters]. / Manejo conservador de los catéteres venosos centrales retenidos.

BACKGROUND: Withdrawal of central venous catheters (CVCs) is usually a simple surgical procedure. However, in some cases, the catheter is stuck in the vessel wall and its removal is not possible if more invasive interventions are not performed. MATERIAL AND METHODS: We performed a retrospective study from 2003 to 2011 of patients who were clearing a CVC and the factors that could have intervened in the removal impossibility. We compared the type of catheter, the insertion site, the time between its insertion and removal, the primary diagnosis and the treatment. In addition, a monitoring by clinical and imaging tests has been made in patients with retained CVCs. RESULTS: An amount of 174 interventions were carried out. In 5 cases the CVC could not been removed. These 5 cases were patients diagnosed with ALL B and were treated with identical chemotherapy treatment. In addition, at the time of its retirement, all the patients had the CVC for a period longer than 2 years -29 to 84 months-. In patients with retained fragments, no complication arose from this condition. The mean follow-up period was 36 months -maximum 48 months-. CONCLUSIONS: The potential complications arising from the presence of the retained CVCs fragments include infection, venous thrombosis and catheter migration. Based on our results, we propose that a conservative management might be considered as an option in these patients.

Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome dedumping tras cirugía de Nissen laparoscópico / Modifications of the glucose curves and gastric voiding of children with dumping syndrome after laparoscopic nissen surgery

Introducción. Se ha asistido a una importante evolución del tratamiento quirúrgico en los últimos años por la generalización progresiva de la cirugía laparoscópica. Todas las técnicas disponibles pueden hacerse laparoscópicamente con similares resultados a los de la cirugía abierta. En 1978, Villet et al. describieron el síndrome de Dumping (SD) como una complicación frecuente de la fundoplicatura de Nissen. EL SD es un complejo de signos y síntomas que aparecen poco después de la cirugía, incluyendo dolor abdominal, palidez, sudoración, diarrea, náuseas, palidez, incluso pérdida de peso. Los síntomas se pueden diferenciar en dumping precoz, que ocurre entre 30 y 60 minutos después de la comida, y tardío, que ocurre entre 90-240 min. del período postprandial. Material y métodos. Se han estudiado 8 pacientes (3 niños y 5niñas) de edades comprendidas entre 3 y 12 años (media de 9 años) diagnosticados de síndrome de dumping tras la realización de Nissen-Rosseti laparoscópico. A todos ellos se les realizó un estudio de vaciadogástrico por gammagrafía tras administración de un volumen de leche adecuado a su peso marcado con Tc99 DTPA y Test de sobrecarga ora (..) (AU)

Introduction. There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet etal. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period (..) (AU)

[Modifications of the glucose curves and gastric voiding of children with Dumping syndrome after laparoscopic Nissen surgery]. / Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome de dumping tras cirugía de nissen laparoscópico.

INTRODUCTION: There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet et al. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period. MATERIAL AND METHODS: A total of 8 patients (3 boys and 5 girls) have been studied. Their ages ranged from 3 to 12 years (mean 9 years), and they were diagnosed of dumping syndrome after performing the laparoscopic Nissen-Rossetti. All underwent a gastric voiding study by scintigraphy after administration of a volume of milk adjusted to their weight labeled with 99Tc-DTPA and oral glucose overload test with 1.75 g/kg of glucose, determining the baseline glycemia and every 30 minutes post-intake, at 0, 30 and 90 minutes. Insulin was also measured to obtain the glucose/insulin ratio. This study was conducted for all patient diagnosed of dumping syndrome before and after laparoscopic Nissen-Rossetti surgery. RESULTS: The following results were obtained: Glucose Curve: 1. Maximum glycemia. PreNissen. The mean of the maximum glycemia values before surgery was 133.9+/-32.11 mg/dl. Post-Nissen. Mean maximum glycemias after surgery was 208.5 +/- 45.07 mg/dl with a range of 147-276 mg/dl. These differences of maximum glycemia were clearly significant with a p <0.002. Minimum glycemia. The mean value of the minimum glycemias after the surgery, compared with the previous value, did not show significant differences: 62.6+/- 11.51 mg/dl versus 71.8 +/- 28.04 mg/dl. Glucose/insulin ratio. The hyperinsulinism values after the intervention studied by means of the glucose/insulin ratio were abnormal in 70.5% (defined as ratio under 3). The mean value was also characteristic of hyperinsulinism (2.3 +/- 1.62). The mean value of the coefficient prior to the surgery was 4.6 with a deviation of 3.04, the differences not being statistically significant with a p= 0.097. Measurement of gastric voiding: The T1/2 (decay) value in post-Nissen patients was significantly lower than in pre-Nissen patients. The postsurgical mean and standard deviation was 29.74 +/- 7.92 min, while in the presurgical group, the mean and standard deviation was 73.75 +/- 28.34 min with p< 0.011; statistically significant. CONCLUSIONS: From the values obtained, we can state that a significant increase in maximum glycemia has been found in all children after surgery who were diagnosed of dumping syndrome and a significant decrease in the mean time of gastric voiding and therefore an increase in the acceleration of gastric voiding after the performance of the Nissen regarding the previous values. The dumping syndrome is a frequent side effect that we must keep in mind in patients who have been previously operated for anti-reflex surgery, the symptoms being greater in most of the transitory cases. Furthermore, it is important to keep in mind because it has an easy treatment that reverts the symptoms in a short time

[Mesenteric and omental cysts. Apropos of 2 cases]. / Quistes mesentéricos y omentales. A propósito de dos casos.

Two cases of abdominal lymphatic cysts are described, one had an omental origin , and the other arose from jejunal mesentery. Both patients presented with non-specific abdominal pain, and a vague clinical picture. Diagnosis was made through echography findings, which were unmistakable .

[Esophageal endoscopy and gastroesophageal reflux]. / La endoscopia esofágica como base para la clasificación y pauta a seguir en el reflujo gastroesofágico.

Authors expose the value of different tests performed in 166 patients diagnosed of gastroesophageal reflux (GER). In 24 patients, less than three months old, only radiological studies were performed. Another group of 142 patients had radiology, endoscopy and biopsy performed, with a total of 180 endoscopic procedures. From the results obtained patients were classified in four grades: Grade I, included 28 patients less than three months old, GER is due to the immaturity of antireflux system. Grade II, included 75 patients of all ages with radiology and/or positive scintigram, but endoscopy and biopsy within normal limits. Grade III, 46 patients, in whom endoscopy and biopsy revealed presence of edema, fibrinous exudates and other inflammatory changes. Grade IV, 17 patients, endoscopy revealed healing strictures or deep bleeding ulcers. Grades I, II and III should be treated with medical measures. Grade IV requires immediate surgical treatment. In 2.7% and 6.4% of grade II and grade III cases respectively, endoscopy revealed progressive disease and necessity of final surgical treatment. Authors believe that endoscopy and biopsy are not only valuable to detect complicating progression of disease, but are also an efficient method of grading and prognosis of GER disease.

[Exstrophy of the cloaca: report of two cases. Review of embryology and management (author's transl)]. / Extrofia de cloaca. Presentación de dos casos y revisión de la embriología y tratamiento.

Two cases of cloacal exstrophy in infants are reported as well as the treatment performed in one of them, which remains alive. The theories which enable us to understand the embryology of the malformation and treatment applied after Rickham are reviewed. Most successful surgical guidelines are described.