Fibrinolysis versus thoracoscopy: Comparison of results in empyema management in the child.

OBJECTIVE: The objective of this study is to compare the outcome of treatment with drainage and urokinase (UK) versus thoracoscopy (TS) in pleural empyema secondary to complicated pneumonia. METHODS: This was a retrospective study of patients with complicated parapneumonic effusions between 2008 and 2019 treated with UK or TS. Epidemiological and evolutionary data compared days of fever, antibiotic, pre- and postprocedure stay, time to radiological resolution, and complications. The results were expressed as medians and the comparisons were made by the Mann-Whitney U-test. RESULTS: Of 143 patients with NC, 46 were empyemas (26 men), 25 were treated with TS, and 10 were treated with UK. The remaining 11 received combined treatment, being excluded from the study. There were no significant differences between TS versus UK in age (median 4 vs. 3 years), days of fever before the procedure (4 vs. 2) and after (2 vs. 2), days of antibiotic treatment before the procedure (4 vs. 4), overall hospital stay (15 vs. 13 days), and months until radiological normalization (2 vs. 2). The complications related to the therapy were scarce in both groups and had no impact on evolution. Patients with TS had a longer preprocedural stay (4 vs. 1; P < 0.001) and required fewer days of subsequent antibiotic after procedure (8 vs. 11; P = 0.03), and a shorter overall antibiotic treatment time (11 vs. 16; P = 0.03). They also had a shorter post-TS stay (9 vs. 12 days), although this difference did not become significant (P = 0.09). CONCLUSIONS: In our experience, the results obtained with both procedures are quite similar, although patients undergoing TS had a better evolution (fewer days of antibiotic and a tendency to less hospitalization), despite having been performed a priori in more evolved patients.

Análisis de los tumores sólidos ováricos pediátricos en nuestra población / Analysis of solid ovarian tumours in a Spanish paediatric population

INTRODUCCIÓN Y OBJETIVOS: Los tumores ováricos son raros en la infancia y representan entre el 1 y el 5% de todos los tumores sólidos. Nuestro objetivo es conocer las características epidemiológicas, los subtipos histológicos y el manejo terapéutico de los tumores sólidos ováricos de la población pediátrica de la provincia de Córdoba. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, descriptivo, observacional, en el que se han revisado las historias clínicas de pacientes ≤ 14 años diagnosticadas de tumores sólidos ováricos en un hospital de tercer nivel entre los años 1994 y 2017, excluyéndose los tumores secundarios. Se revisó la edad, la presentación clínica, la lateralidad, la metodología diagnóstica, el tratamiento, la anatomía patológica y la evolución. RESULTADOS: Se revisaron 37 tumores ováricos en 31 pacientes, siendo 6 bilaterales. La edad media fue de 10,3 años (0-14). El 58% debutaron como masa palpable. No existe predominio de lateralidad. Los marcadores tumorales fueron negativos. Se practicó cirugía conservadora en el 29,7% y anexectomía en el 70,3%. Solo un teratoma inmaduro estadio I con gliomatosis peritoneal precisó tratamiento quimioterápico adyuvante postoperatorio. El estudio histológico demuestra un predominio de tumores de células germinales (65%) frente a los de estirpe epitelial (22%). Destacan 3 tumores estromales que corresponden a fibromas (síndrome de Gorlin) y un gonadoblastoma bilateral asociado a síndrome de Frasier. El tipo de tumor más frecuente fue el teratoma quístico maduro (35,1%). Evolución favorable en todos los casos. CONCLUSIONES: Dada la alta tasa de benignidad de los tumores ováricos en la infancia, la cirugía conservadora debe ser de primera elección, sobre todo en los bilaterales. Si existen antecedentes hereditarios, es imprescindible realizar estudios genéticos moleculares para descartar síndromes asociados

INTRODUCTION AND OBJECTIVES: Ovarian tumours are rare in childhood, and account for 1-5% of all tumours. The aim of this study is to determine the epidemiological features, histological subtypes, and therapeutic management of ovarian solid ovarian tumours of the paediatric population of the province of Cordoba, in Spain. MATERIAL AND METHODS: A retrospective, descriptive, observational and institutional study was conducted in which a review was made of the clinical histories of patients younger than 14years-old diagnosed with ovarian tumours, excluding secondary tumours in a University Hospital between 1994 and 2017. A review was carried out on the age, clinical presentation, laterality, diagnostic methodology, treatment, histopathology, and evolution of these tumours. RESULTS: A total of 37 ovarian tumours were reviewed in 31 patients, 6 of them being bilateral. The mean age was 10.3 (0-14) years, with 58% presenting as a palpable mass. There was no predominance of laterality. The tumour markers were negative. Conservative surgery was performed in 29.7% and adnexectomy in 70.3%. Only one case required post-operative adjuvant chemotherapy treatment (stage I immature teratoma with peritoneal gliomatosis). The histological study shows a predominance of germ cell tumours (65%) against those of epithelial lineage (22%). There were 3 stromal tumours that corresponded to fibroma (Gorlin syndrome), and bilateral gonadoblastoma associated with Frasier syndrome. The most frequent type of tumour was mature cystic teratoma (35.1%). There were no complications in the follow-up. CONCLUSIONS: Given that most childhood ovarian tumours are benign, conservative surgery is considered as the first choice, being even more important in bilateral tumours. If there is a family history, it is essential to carry out molecular genetic studies, to rule out associated syndromes

[Analysis of solid ovarian tumours in a Spanish paediatric population]. / Análisis de los tumores sólidos ováricos pediátricos en nuestra población.

INTRODUCTION AND OBJECTIVES: Ovarian tumours are rare in childhood, and account for 1-5% of all tumours. The aim of this study is to determine the epidemiological features, histological subtypes, and therapeutic management of ovarian solid ovarian tumours of the paediatric population of the province of Cordoba, in Spain. MATERIAL AND METHODS: A retrospective, descriptive, observational and institutional study was conducted in which a review was made of the clinical histories of patients younger than 14years-old diagnosed with ovarian tumours, excluding secondary tumours in a University Hospital between 1994 and 2017. A review was carried out on the age, clinical presentation, laterality, diagnostic methodology, treatment, histopathology, and evolution of these tumours. RESULTS: A total of 37 ovarian tumours were reviewed in 31 patients, 6 of them being bilateral. The mean age was 10.3 (0-14) years, with 58% presenting as a palpable mass. There was no predominance of laterality. The tumour markers were negative. Conservative surgery was performed in 29.7% and adnexectomy in 70.3%. Only one case required post-operative adjuvant chemotherapy treatment (stageI immature teratoma with peritoneal gliomatosis). The histological study shows a predominance of germ cell tumours (65%) against those of epithelial lineage (22%). There were 3 stromal tumours that corresponded to fibroma (Gorlin syndrome), and bilateral gonadoblastoma associated with Frasier syndrome. The most frequent type of tumour was mature cystic teratoma (35.1%). There were no complications in the follow-up. CONCLUSIONS: Given that most childhood ovarian tumours are benign, conservative surgery is considered as the first choice, being even more important in bilateral tumours. If there is a family history, it is essential to carry out molecular genetic studies, to rule out associated syndromes.

Manejo del reflujo gastroesofágico en niños. Funduplicatura de Nissen convencional y por laparoscopia en los últimos 15 años en un centro especializado / Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years

INTRODUCCIÓN: La funduplicatura de Nissen (FN) es la técnica más utilizada y con mejores resultados para tratar el reflujo gastroesofágico en niños. El abordaje laparoscópico (FNL) es seguro, con baja morbilidad y alta tasa de éxito, aunque algunos casos precisan abordaje convencional (FNC) o abierto. Nuestro objetivo es comparar los resultados entre la FNC y la FNL en nuestro centro. MATERIAL Y MÉTODOS: Estudio retrospectivo de los pacientes < 14 años sometidos a FN entre 2000 y 2015. Comparamos ambos abordajes: complicaciones, estancia hospitalaria y seguimiento. RESULTADOS: Se realizaron 75 FN; 49 (65,3%) FNL, 23 (30,7%) FNC y 3 (4,0%) reconversiones. Se asoció gastrostomía por laparoscopia en el 10,7% y abierta en el 5,3%. El 10,7% portaban gastrostomía previamente a la FN. La edad media fue de 4 a˜nos, y el 68,7% fueron varones. El 36% presentaron algún grado de encefalopatía, el 14,7% hernia hiatal, el 5,4% antecedente de atresia esofágica intervenida y el 5,4% al menos un episodio aparentemente letal. No encontramos diferencias significativas en la duración de la intervención entre ambos abordajes. El 36% presentaron complicaciones, más frecuente en la FNC: OR = 3,30 (IC 95%: 1,1-9,6). La estancia disminuyó en 9 días en la FNL (IC 95%: 5,5-13,5). El seguimiento medio fue de 26 meses (IC 95%: 20,9-31,6), con 10,7% fallecimientos (5 insuficiencias respiratorias, una muerte súbita y 2 por su encefalopatía); el 4,2% precisaron nueva funduplicatura, el 15,8% mostraron mejoría sintomática y el 64,0%, ausencia de síntomas. CONCLUSIONES: La FNL es una técnica adecuada para el tratamiento del reflujo gastroesofágico, con menor morbilidad y menor estancia que la FNC, por lo que se recomienda como primera opción terapéutica

INTRODUCTION: Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre. MATERIAL AND METHODS: A retrospective review was performed on patients < 14 years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and followup for both approaches. RESULTS: Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR = 3.30, 95% CI: 1.1-9.6). The hospital-stay decreased by 9 days in the LNF (95% CI: 5.5-13.5). Mean follow-up was 26 months (95% CI: 20.9-31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms. CONCLUSIONS: The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option

[Management of gastroesophageal reflux in children. Single centre experience in conventional and laparoscopic Nissen fundoplication in the last 15 years]. / Manejo del reflujo gastroesofágico en niños. Funduplicatura de Nissen convencional y por laparoscopia en los últimos 15 años en un centro especializado.

INTRODUCTION: Nissen fundoplication (NF) is the most used and effective technique for the treatment of gastroesophageal reflux in children. The laparoscopic approach (LNF) is safe, with low morbidity and high success rate, although some cases require a conventional approach (CNF). The aim of the study is to compare the results between LNF and CNF in our centre. MATERIAL AND METHODS: A retrospective review was performed on patients <14years after NF between 2000 and 2015. A comparison was made of the complications, hospital stay, and follow-up for both approaches. RESULTS: Of the total 75 NF performed, 49 (65.3%) were LNF, 23 (30.7%) CNF, and 3 (4.0%) reconversions. Concomitant laparoscopic gastrostomy was performed in 10.7%, and open gastrostomy in 5.3% of cases. Prior to NF, 10.7% had a gastrostomy. The mean age was 4 years and 68.7% were male. Of the diagnoses, 36% had encephalopathy, 14.7% hiatal hernia, 5.4% oesophageal atresia, and 5.4% an acute life-threatening event. No differences were found in operation time. More than two-thirds (36%) had complications, which were more frequent in the CNF (OR=3.30, 95%CI: 1.1-9.6). The hospital-stay decreased by 9 days in the LNF (95%CI: 5.5-13.5). Mean follow-up was 26 months (95%CI: 20.9-31.6). Mortality during follow-up was of 5.3% (5 respiratory failure, 1 sudden cardiac death, and 2 due to complications of the encephalopathy), 4.2% required re-fundoplication, 15.8% had symptomatic improvement, and 64.0% had absence of symptoms. CONCLUSIONS: The LNF is an effective technique for the treatment of gastroesophageal reflux, with lower morbidity and shorter hospital stay than CNF. It is recommended as the first surgical option.

Abdomen agudo como presentación de absceso tubo-ovárico en adolescente sexualmente inactiva / Acute abdomen as the form of presentation of tubo-ovarian abscess in a sexually inactive adolescent

El absceso tubo-ovárico es una complicación de la enfermedad inflamatoria pélvica (EPI), entidad poco frecuente en mujeres sin actividad sexual previa. Presentamos el caso de una paciente de 13 años, sin relaciones sexuales, que consultó por cuadro de dolor abdominal, fiebre y diarrea. Fue diagnosticada de absceso tubo-ovárico bilateral que se resolvió mediante antibioterapia por vía intravenosa y drenaje laparoscópico. El diagnóstico del absceso tubo-ovárico y su tratamiento precoz son esenciales para prevenir posibles secuelas (infertilidad, embarazo ectópico o dolor abdominal crónico) y debe ser sospechado aun en ausencia de relaciones sexuales. Actualmente, la laparoscopia es el tratamiento quirúrgico de elección porque genera menos morbilidad postoperatoria (AU)

Tubo-ovarian abscess (TOA) is a complication of pelvic inflammatory disease (PID) rarely found in sexually inactive girls. We report the case of a 13-year-old sexually inactive adolescent who presented with abdominal pain, fever and diarrhea. The patient was diagnosed with bilateral tubo-ovarian abscess, which was resolved by laparoscopic drainage of the abscess and antibiotic therapy. Early diagnosis and treatment are essential to prevent further sequelae including infertility, ectopic pregnancy and chronic pelvic pain. TOA should be included in the broad differential diagnosis of abdominal pain with fever in adolescent girls regardless of sexual history. Currently, laparoscopy is the surgical treatment of choice because it produces less postoperative morbidity (AU)

Quiste paratubárico en la infancia. Manejo laparoscópico / Paratubal Cyst in Childhood. Laparoscopic Management

Los quistes paratubáricos son de diagnóstico excepcional en la edad pediátrica. Presentamos el caso de una niña de 12 años con dolor abdominal intermitente de 2 años de evolución a la que se le detectó por pruebas de imagen una masa quística y homogénea en pelvis compatible con quiste paratubárico. Tras completar el estudio diagnóstico se llevó a cabo la quistectomía laparoscópica con bisturí armónico. La resección quirúrgica es el tratamiento de elección, siendo el abordaje laparoscópico la primera opción en la actualidad (AU)

Diagnosis of paratubal cysts in children is exceptional. We present the case of a 12-year-old girl with a 2-year history of intermittent abdominal pain. Imaging studies revealed a homogeneous cystic mass in the pelvis compatible with a paratubal cyst. After completing the diagnostic workup, laparoscopic cystectomy was performed by harmonic scalpel. Surgical resection is the treatment of choice in this entity, the laparoscopic approach currently being the first option (AU)