Revisión de casos publicados de coristoma hepático. Diagnóstico diferencial de masas de cordón umbilical / Review of published cases of hepatic choristoma. Differential diagnosis of umbilical cord masses

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Lesión intestinal secundaria a traumatismo abdominal cerrado. Indicación quirúrgica basada en el diagnóstico por la imagen / Intestinal injury due to blunt abdominal trauma. Surgical indication based on diagnostic imaging

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[What can we do to improve our management of intestinal atresia?]. / ¿Qué podemos mejorar en el tratamiento de las atresias intestinales?

OBJECTIVE: To review our management of intestinal atresia (AI). MATERIAL AND METHODS: A retrospective review of patientes with AI, from 1995 to 2011. RESULTS: AI was identified in 41 patients, 29,2% had maternal polyhydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduodenostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunostomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel. CONCLUSIONS: Prenatal diagnosis of AI is difficult, especially AYI, which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It's important to keep in mind colorectal atresias, which can not be identified.

Ginecomastia puberal: comparación entre el abordaje periareolar inferior y el de doble anillo cutáneo / Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique

OBJETIVOS: El principal motivo de consulta e indicación de trata-miento quirúrgico en la ginecomastia puberal es la afectación psicológica que produce en el adolescente. El objetivo de este trabajo es describir nuestra experiencia en el tratamiento de esta patología, comparando los resultados obtenidos según el tipo de abordaje utilizado. MATERIAL Y MÉTODOS: En nuestro Servicio, el abordaje empleado para la mastectomía subtotal depende del grado de ginecomastia, utili-zándose la incisión periareolar inferior en los grados I-II y el doble anillo cutáneo en el tipo III según la clasificación de Simon. Hemos estudiado de forma descriptiva retrospectiva a los pacientes intervenidos de gine-comastia entre el 2007 y 2012. Comparamos los resultados obtenidos en cada grupo mediante tests estadísticos paramétricos. RESULTADOS: Se realizaron un total de 29 mastectomías en 15 pacientes. La edad media de intervención fue de 13,75 ± 1,06 años ([11-15] años). La forma de presentación en todos los casos fue el aumento progresivo de la glándula, sin síntomas asociados. En la mitad de los casos existía antecedente de obesidad o sobrepeso. Se realizó la técnica del doble anillo cutáneo en 5 casos (grupo-DAC) e incisión periareolar inferior en 10 (grupo-PIC). Se encontró una mayor incidencia de cicatrización patológica en el grupo-DAC, siendo esta diferencia estadísticamente significativa (p = 0,007). No se observa-ron recidivas tras un tiempo medio de seguimiento de 15,86 ± 19,47 meses ([3- 60] meses). CONCLUSIONES: Las dos técnicas estudiadas proporcionan resulta-dos satisfactorios a largo plazo. A pesar de haber detectado cicatrices hipertróficas y queloideas con la técnica del doble anillo, sigue siendo estéticamente ventajosa en las ginecomastias con exceso cutáneo

BACKGROUND/PURPOSE: The main reason to indicate the surgical treatment in pubertal gynecomastia is the psychological effect on the adolescent. The aim of this paper is to describe our experience in the surgical treatment of this condition, comparing the results obtained depending on the type of approach used. MATERIAL AND METHODS: In our department, the approach for the subtotal mastectomy depends mainly on the gynecomastia grade. We use an inferior periareolar incision in grades I and II, and a concentric circle technique in grade III of Simon's classification. A retrospective review was conducted to identify all adolescent patients that underwent to gynecomastia surgical treatment between 2007 and 2012. We compared the results obtained in each incision group by parametric statistical tests. RESULTS: A total of 29 mastectomies were performed in 15 patients. The mean age of surgery was 13.75 ± 1.06 years ([11-15] years). The presentation in all cases consisted in a progressive increase in size of the mammary gland, without associated symptoms. In half of patients there was a history of obesity or overweight. We performed the concentric circle technique in 5 patients (CCT-group) and inferior periareolar incision in 10 (IPI-group). There was a higher incidence of pathologic scarring in the CCT-group, and this difference was statistically significant (p = 0.007). No recurrences were observed after a mean follow-up of 15.86 ± 19.47 months ([3-60] months).Conclusions. Long term results were satisfactory in both groups. Despite of the higher incidence of hypertrophic and keloid scars observed in concentric circle technique, it remains aesthetically advantageous in cases of gynecomastia with extra skin

¿Qué podemos mejorar en el tratamiento de las atresias intestinales? / ¿What can we do to improve our management of intestinal atresia?

OBJETIVO: Aportar nuestra experiencia en el manejo de las atresias intestinales (AI). MATERIAL Y MÉTODOS: Revisión retrospectiva de pacientes con AI atendidos en nuestro centro entre 1995 y 2011. RESULTADOS: Se intervinieron 41 AI, de las cuales el 29,2% pre-sentaron polihidramnios y el 48,7% se diagnosticaron prenatalmente. Cuatro pacientes estaban afectos de síndrome de Down y 18 presentaban cardiopatía. Se halló atresia-estenosis duodenal (AD) en 21 casos, en los que se realizaron 19 duodenoduodenostomías, 1 duodenoyeyunostomia y 1 duodenotomía con resección de membrana duodenal. Se halló atresia yeyuno-ileal (AYI) en 20 casos, en los que se realizaron 15 anastomosis termino-terminales, 1 anastomosis íleo-cólica, 1 ileostomía, 2 yeyu-nostomías y 1 anastomosis término-terminal con yeyunostomía. Fue necesario reoperar a 9 pacientes con AYI: 6 por oclusión intestinal, 1 por evisceración y 2 por atresias colo-rectales inadvertidas. El tiempo medio con nutrición parenteral fue 29 días y la estancia media 37,3 días. Un paciente con AD falleció por cardiopatía y 2 con AYI fueron traslados por síndrome de intestino corto. CONCLUSIONES: El diagnóstico prenatal de atresias intestinales es complejo, sobre todo en las AYI, de las cuales sólo el 35% se diagnos-ticó prenatalmente. Las AD responden mejor al tratamiento quirúrgico y no precisan habitualmente reintervenciones, aunque presentan mayor mortalidad debida a otras malformaciones asociadas. En las AYI son más frecuentes las reoperaciones (45% de nuestros casos) por obstrucción, cierre de ostomías y problemas derivados de resecciones extensas. Es importante tener presentes las atresias colo-rectales, sobre todo mem-branosas, que pueden pasar desapercibidas

OBJECTIVE: To review our management of intestinal atresia (AI). MATERIAL AND METHODS: A retrospective review of patientes with AI, from1995 to 2011. RESULTS: AI was identified in 41 patients, 29,2% had maternal poly-hydramnios and 48,7% were diagnosed prenatally. Four of them had Down Syndrome and 18 had cardiopathy. Duodenal atresia-stenosis (AD) was present in 21 patients, that were treated by 19 duodenoduo-denostomy, 1 duodenojejunostomy and 1 duodenotomy with duodenal membrane resection. Jejunoileal atresia (AYI) was present in 20 patients and we performed 15 end to end anastomosis, 1 íleo-colic anastomosis, 1 ileostomy, 2 jejunostomies and 1 end to end anastomosis with jejunos-tomy. Nine AYI were reoperated: 6 bowel obstructions, 1 evisceration and 2 colo-rectal atresia. The average time on parenteral nutrition was 29 days and average hospital stay was 37,3 days. One AD died due to heart disease. In AYI, 2 required transfer to another center due to short bowel. CONCLUSIONS: Prenatal diagnosis of AI is difficult, especially AYI , which is only prenatally diagnosed in 35% of cases. AD respond better to surgery and rarely require reoperation, but mortality is higher than AYI because 57% suffer from heart disease. Reoperations are frecuent in AYI (45% of our patients), usually due to obstruction, ostomy closure and problems resulting from extensive bowel resections. It ́s important to keep in mind colorectal atresias, which can not be identified

[Puberal gynecomastia: a comparison between the inferior periareolar approach and the concentric circle technique]. / Ginecomastia puberal: comparación entre el abordaje periareolar inferior y el de doble anillo cutáneo.

BACKGROUND/PURPOSE: The main reason to indicate the surgical treatment in pubertal gynecomastia is the psychological effect on the adolescent. The aim of this paper is to describe our experience in the surgical treatment of this condition, comparing the results obtained depending on the type of approach used. MATERIAL AND METHODS: In our department, the approach for the subtotal mastectomy depends mainly on the gynecomastia grade. We use an inferior periareolar incision in grades I and II, and a concentric circle technique in grade III of Simon's classification. A retrospective review was conducted to identify all adolescent patients that underwent to gynecomastia surgical treatment between 2007 and 2012. We compared the results obtained in each incision group by parametric statistical tests, RESULTS: A total of 29 mastectomies were performed in 15 patients. The mean age of surgery was 13.75 +/- 1.06 years ([11-15] years). The presentation in all cases consisted in a progressive increase in size of the mammary gland, without associated symptoms. In half of patients there was a history of obesity or overweight. We performed the concentric circle technique in 5 patients (CCT-group) and inferior periareolar incision in 10 (IPI-group). There was a higher incidence of pathologic scarring in the CCT-group, and this difference was statistically significant (p = 0.007). No recurrences were observed after a mean follow-up of 15.86 +/- 19.47 months ([3-60) months). CONCLUSIONS: Long term results were satisfactory in both groups. Despite of the higher incidence of hypertrophic and keloid scars observed in concentric circle technique, it remains aesthetically advantageous in cases of gynecomastia with extra skin.

[Fertility survey of patients operated on of cryptorchidism in the pediatric age]. / Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica.

OBJECTIVES: To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. METHODS: A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. RESULTS: A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no significant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. CONCLUSIONS: There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw significant conclusions in regards to fertility and other clinical situations.

Encuesta de fertilidad en pacientes operados de criptorquidia en edad pediátrica / Fertility survey of patients opened on of cryptorchidism in the pediatric ag

Objetivos. Analizar la encuesta de fertilidad realizada en una cohorte de adultos, operados de criptorquidia en edad pediátrica, de los que disponemos datos clínicos y quirúrgicos y que fueron estudiados hace 10 años, realizando un espermiograma y un estudio del eje hipofisario. Métodos. Se envió una encuesta de fertilidad, incluyendo datos de estilo de vida y condiciones de trabajo al domicilio de 278 pacientes adultos operados de criptorquidia. Las 94 encuestas recibidas (33,8% de las enviadas) han sido analizadas con SPSS 15.0, realizando un estudio descriptivo y analítico. Consideramos que tienen fertilidad normal aquellas personas que consiguen el embarazo en un máximo de 12 meses con actividad sexual regular sin uso de anticonceptivos. Resultados. Han intentado tener hijos 53 casos de los encuestados (56,4%) y lo han conseguido 44 (83,1%). Han sido considerados fértiles 34 pacientes (64,2%) con una media de tiempo para embarazarse de 4,15 meses. Diecinueve pacientes (35,8%) han intentado ser padres durante más de 12 meses y lo han conseguido sólo 10 (18,9%), 5 de forma natural, 2 con tratamiento ovulatorio y 3 por FIV, con una media de 26,8 meses. No han conseguido ser padres 9 casos (16,9%). No existen diferencias significativas entre fertilidad y localización y lateralidad del testículo, edad de cirugía y densidad del espermiograma. Existen diferencias significativas entre paternidad natural y la uni o bilateralidad de la criptorquidia. Conclusiones. Existe mayor proporción de criptórquidos unilaterales en el grupo que ha llegado a ser padres. Necesitamos ampliar el número de encuestados para poder sacar conclusiones significativas en cuanto a la fertilidad en otras situaciones clínicas (AU)

Objectives. To analyze the fertility survey made in a cohort of adults operated on as children for cryptorchidism and for whom clinical and surgical data is available and who were studied 10 years ago by spermiogram and hypophyseal axis. Methods. A fertility survey including data on style of life and work conditions was sent to the homes of 278 adult patients operated on for cryptorchidism. The 94 surveys received (33.8% of those sent) were analyzed using the SPSS 15.0, carrying out a descriptive and analytic study. We consider persons who achieve pregnancy within a maximum of 12 months with regular sexual activity without the use of contraceptives as having normal fertility. Results. A total of 53 cases of those surveyed (56.4%) attempted to have children, 44 (83.1%) being successful. A total of 34 patients (64.2%) were considered fertile with a mean time of 4.15 months to become pregnant. Nineteen patients (35.8%) had attempted to become parents for more than 12 months and only 10 achieved it (18.9%), 5% in a natural way, 2 with ovulation treatment and 3 by in vitro fertilization, with a mean of 26.8 months. There was no success in becoming parents in 9 cases (16.9%). There are no signifi cant differences between fertilization and localization in laterality of the testicle, age at time of surgery and density on spermiogram. There are significant differences between natural paternity and unilateral or bilateral cryptorchidia. Conclusions. There is a greater proportion of unilateral cryptorchidias in the group that was successful in having children. We need to increase the number of those surveyed in order to draw signifi cant conclusions in regards to fertility and other clinical situation (AU)

[The PEG: why wait?]. / La PEG: ¿Por qué esperar?

UNLABELLED: The swallowing disorder is an impediment to feed the patient. The percutaneous endoscopic gastrostomy (PEG) offers importants advantages over nasogastric tube feeding in patients who need long-term enteral nutrition with difficulty to swallow and to failure to thrive. METHODS: We have achieved 40 PEG in our department over the past 10 years. We registered date of the age, weight, indications, types of PEG, the time to first change, evolution of weight and percentiles and the complications. RESULTS: The average age of our patients was 5 years, 30% under 1 year. We used mostly tubes between 9 and 15 Fr and increasing the size according to nutritional needs. The average weight at the time of PEG placement was 13 kg. The main indications were the impossibility to swallow and failure to thrive and the principal diagnosis was the encephalopathy in 45% of cases. The surgical technique was successful in 100%. Of the complications, only two patients required surgery, a gastrocolic fistula and a laparotomy about broken tube of gastrostomy that has been caught in the cecum. In our series we reported 11 cases of mortality from causes unrelated to the gastrotmy. CONCLUSIONS: The PEG is a good alternative to nasogastric tube in patients with swallowing disorders or failure to thrive in chronic diseases, even in children under one year. The early placement of the PEG support the growth development in these patients with chronic disease who require enteral nutrition for long periods. Probably, the time of placement should be more precocious in chronic patients as well tolerated and may have a long life with a good care.

[Differential diagnosis of the interlabial masses in girls under 5-years-old]. / Diagnóstico diferencial de las masas interlabiales en niñas menores de 5 años.

UNLABELLED: The masses that we can be found at interlabial in a girl are a extensive spectrum of heterogenous lesions and often there is a confusion in diagnosis, management and prognosis. METHODS: We present 5 cases of interlabial masses, prolapsed urethra, two paraurethral Skene cysts, botryoid sarcoma and fibroepithelial polyp, and its clinical of debut. RESULTS: A prolapsed urethra is presented in a 4-year-old black girl with vaginal bleeding from edamatous periurethral mass. The paraurethral cyst is a yellowish cystic mass displacing the urethral meatus in two newborn girls. The fibroepithelial polyp is presented in a newborn girl as polipoid and wartlike tumor and not bleeding injury in the introitus. The botryoid sarcoma appears in a 1-year-old girl with ulcerated polypoid mass of 2 cm from vagina. All cases were treated with surgery except the paraurethral cyst that drained spontaneously and the rhabdomyosarcoma was also treated with chemotherapy. CONCLUSIONS: There must be a good clinical examinations about interlabial masses distinguishing genital or urological origin. The surgery is indicated mainly to reject malignancy because the presentation of sarcoma and polyp could be similar. The prognosis of rhabdomyosarcoma vaginal is good with surgery and chemotherapy. The prolapsed urethra is more common in prepubertal black girls and it is important to exclude sexual abuse. The management of paraurethral cyst is controversial but some authors are advised first observation because they may regress.

Nuestra experiencia en el paciente politraumatizado pediátrico con criterios de ingreso en UCI / Our experience in the poly-traumatized pediatric patient with criteria for admission to the ICU

Objetivo. Presentar nuestra experiencia en el politraumatizado grave con ingreso en UCI pediátrica. Material y método. Se ha realizado un estudio retrospectivo de 78pacientes pediátricos ingresados en UCI por politraumatismo entre 2000y 2008 recogiendo variables de edad, sexo, época del año, lugar, mecanismo, Glasgow e ITP, tipo de lesiones, complicaciones, días de ingreso y fallecimientos. Se lleva a cabo el estudio descriptivo y analítico utilizando el SPSS 15.0 aplicando Chi cuadrado y Correlación de Pearson. Resultados. La edad media de los pacientes es de 8,5 ± 4,2 años siendo el 70% varones. Ocurren más accidentes en verano (37%), el lugar más frecuente es la carretera (47%) y el mecanismo el accidente de tráfico (45%). Ha habido un 15% de éxitus, de los cuales el 75% ocurre en las primeras 24 horas. Existe relación entre trauma abdominal y tipo de mecanismo (p<0,05), siendo el más frecuente el accidente de (..) (AU)

Objective. To present our experience with severe pediatric trauma. The pediatric trauma is the leading cause of death in children under2 years. Methods. We achieved a retrospective study from 78 pediatric patients admitted to the Intensive Care Unit (UCI) for multiple trauma between 2000 and 2008. Age, sex, season, location, mechanism, Glasgow and ITP, type of injuries, complications, days of hospitalization and deaths were reviewed. It was performed descriptive and analytical study using the SPSS 15.0 and chi square and Pearson correlation were applied. Outcomes. The mean age of patients was of 8.5 ± 4.2 years with (..) (AU)

La PEG: ¿Por qué esperar? / The peg: why wait?

La alteración en la deglución constituye un impedimento para la alimentación del paciente. La gastrostomía endoscópica percutánea(PEG) es una buena alternativa a la sonda nasogástrica (SNG) en pacientes que precisan nutrición enteral prolongada debido a problemas enla deglución o falta de medro. Material y métodos. Hemos realizado 40 PEG en nuestro Servicio en los últimos 10 años. Se han recogido datos de edad, peso, indicación, tipos de PEG, tiempo transcurrido hasta el primer cambio, pesoevolutivo y percentiles y complicaciones. Resultados. La edad media de nuestros pacientes fue de 5 años, delos cuales el 30% son menores de 1 año. Se utilizaron en su mayoría (..) (AU)

The swallowing disorder is an impediment to feed the patient. The percutaneous endoscopic gastrostomy (PEG) offers importants advantages over nasogastric tube feeding in patients who need long-term enteral nutrition with difficulty to swallow and to failure to thrive. Methods. We have achieved 40 PEG in our department over the past 10 years. We registered date of the age, weight, indications, types of PEG, the time to first change, evolution of weight and percentiles and the complications. Results. The average age of our patients was 5 years, 30% under1 year. We used mostly tubes between 9 and 15 Fr and increasing the (..) (AU)

Diagnóstico diferencial de las masas interlabiales en niñas menores de 5 años / Differential diagnosis of the interlabial masses in girls under 5 years old

Las masas que podemos encontrar a nivel interlabial en una niña representan un amplio espectro de lesiones heterogéneas y a menudo existe confusión en su diagnóstico, manejo y pronóstico. Material y métodos. Se presentan 5 casos de masas interlabiales, prolapso uretral, dos quistes parauretrales de Skene, sarcoma botrioidevaginal y pólipo fibroepitelial de vagina, y su clínica de debut. Resultados. El prolapso uretral se presenta en una niña de 4 años (..) (AU)

We present 5 cases of interlabial masses, prolapsed urethra, two paraurethral Skene cysts, botryoid sarcoma and fibroepithelial polyp, and its clinical of debut. Results. A prolapsed urethra is presented in a 4 year old black girl with vaginal bleeding from edamatous periurethral mass. The paraurethral cyst is a yellowish cystic mass displacing the urethral meatus in two newborn girls. The fibroepithelial polyp is presented in a newborn girl as polipoid and wart like tumor and not bleeding injury in the introitus. The botryoid sarcoma appears in a 1 year old girl with ulcerated polypoid mass of 2 cm from vagina. All cases were treated with (..) (AU)

[Our experience in the poly-traumatized pediatric patient with criteria for admission to the ICU]. / Nuestra experiencia en el paciente politraumatizado pediátrico con criterios de ingreso en UCI.

OBJECTIVE: To present our experience with severe pediatric trauma. The pediatric trauma is the leading cause of death in children under 2 years. METHODS: We achieved a retrospective study from 78 pediatric patients admitted to the Intensive Care Unit (UCI) for multiple trauma between 2000 and 2008. Age, sex, season, location, mechanism, Glasgow and ITP, type of injuries, complications, days of hospitalization and deaths were reviewed. It was performed descriptive and analytical study using the SPSS 15.0 and chi square and Pearson correlation were applied. OUTCOMES: The mean age of patients was of 8.5 +/- 4.2 years with 70% boys. Most accidents occurred in summer (37%) and the most common site was the road (47%). There was 15% of mortality, which the 75% occurred in the first 24 hours. There is an association between abdominal trauma and type of mechanism (p < 0.05). The most common mechanism was the traffic accident (45%) followed by a direct hit. Both ITP as Glasgow score were associated significantly with mortality and complications and with the hospital stay in the UCI there was a weak association but significant and negative (p < 0.05). CONCLUSIONS: Mortality is higher than other series but it may be because that these series include minor injuries. The fall down is the most frequent in pediatric emergencies but it was the mechanism that involves less admission to the UCI. Both ITP as Glasgow score are good indicators of severity and if their values decrease, the hospital stay in UCI and the mortality increase.