Dislocación testicular postraumática / Post-traumatic testicular dislocation

Objetivo: Hacer una revisión de la literatura, así como aportar 2 nuevos casos de dislocación testicular postraumática, una patología poco frecuente en las urgencias pediátricas. Para ello, se realizó un estudio de las publicaciones en revistas de impacto en castellano e inglés, con la finalidad de acercarnos a un diagnóstico y un manejo lo más rápido y eficaz posible. Casos clínicos: Se presentan los casos clínicos de 2 niños que acudieron al Servicio de Urgencias Pediátricas del Hospital Torrecárdenas durante los años 2010-2012 tras sufrir sendos accidentes. Ambos fueron diagnosticados de dislocación testicular mediante exploración física, con posterior confirmación ecográfica. El tratamiento en los 2 casos fue quirúrgico (orquidopexia). Resultados: En ambos casos la evolución posquirúrgica fue favorable y no presentaron secuelas posteriores. Conclusión: La dislocación testicular es una rara entidad, de aproximadamente 1 caso/año en nuestro medio, que debe tenerse en cuenta en los traumatismos abdominopélvicos, ya que su diagnóstico y tratamiento precoz (generalmente quirúrgico) cobra especial importancia (AU)

Objective: Making a review of the literature and presenting two new cases of traumatic dislocation of the testicle, a rare pathology in the pediatric emergency department. For this reason a study is performed on the publications in journals in spanish and english, with the purpose of bringing us closer to a diagnosis and a management as quickly and efficiently as possible. Clinical cases: We present 2 clinical cases in young children who went to the Pediatric Emergency Department of the Hospital Torrecárdenas during the years 2010-2012 after suffering two separate accidents. Both of them were diagnosed with dislocation testicular through physical examination with ultrasound confirmation later. Treatment in the 2 cases was surgical (orchidopexy). Results: In both cases the postoperative evolution was well and subsequent without sequelae. Conclusion: Testicular dislocation is a rare entity, approximately 1 case/year in our environment, that must be taken into account in the trauma abdomino-pelvic since its early diagnosis and treatment (usually surgical) is of special importance (AU)

Hormonal response to surgical stress in schoolchildren.

PURPOSE: To determine hormone concentrations (ACTH, cortisol, beta-endorphin) in children before and after surgery, to assess the correlation between any hormonal changes and to study the influence exercised on them by the severity of surgical stress and the elective/emergency nature of the surgery. PATIENTS AND METHODS: Prospective cohort of 78 children (age= 10+/-2.6 years, range 6-13 years) undergoing elective or emergency surgery. Preoperative and postoperative (1 and 24 hours postoperation) plasma concentrations of ACTH, cortisol and beta-endorphin were determined in all children. The severity of surgical stress was evaluated as low (< 6) or high (> 6) according to the Oxford scale. Student's t-test was used to analyse hormonal changes and the influence of degree of surgical stress and elective/emergency character of the surgery, and Pearson's coefficient for correlations between hormonal values. p < 0.05 was regarded as significant. RESULTS: We observed a significant increase in hormonal concentrations one hour after surgery. ACTH and cortisol values normalised 24 hours after surgery, but beta-endorphin concentrations remained increased. There was a correlation between ACTH and beta-endorphin values both before surgery and one hour after. Operations with high surgical stress significantly increased cortisol concentrations one hour after surgery and beta-endorphin concentrations 24 hours after surgery. Patients selected for emergency surgery showed significantly higher concentrations of cortisol and ACTH both before and after surgery. CONCLUSIONS: Postoperative hormonal response among children of school age is characterised by increases in ACTH, cortisol and beta-endorphin one hour after surgery, and by high concentrations of beta-endorphin 24 hours after surgery. Cortisol is an index of surgical stress. Emergency surgery is associated with significant increases in ACTH and cortisol.

[Massive vesicoinguinal hernia and acute renal failure. An infrequent association]. / Hernia vesicoinguinal masiva y fracaso renal agudo. Una asociación poco frecuente.

OBJECTIVE: To report a rare complication of acute renal failure secondary to massive vesicoinguinal hernia. To our knowledge, only 4 cases have been previously reported in the literature. METHODS: Herein we describe a case of massive vesicoinguinal hernia in a patient that had presented at the emergency services with symptoms of acute renal failure. The diagnostic and therapeutic aspects of this rare complication are discussed. RESULTS: Patient evaluation showed a left inguinal hernia and benign hyperplasia of the prostate. Blood analytical findings were compatible with acute renal failure. A left massive vesicoinguinal hernia was detected on ultrasound evaluation and confirmed by retrograde cystography. Treatment was by surgical repair of the inguinal hernia, bladder repositioning and cervicoprostatotomy plus TUR of the excrescent bladder lesions to resolve the obstruction. CONCLUSIONS: Massive vesicoinguinal hernia may go undetected if the symptoms are unremarkable and may mimick those of acute renal failure.

[Median raphe cysts of the perineum in childhood]. / Quistes del rafe medio perineal en la infancia.

Median raphe cysts of the perineum are uncommon congenital lesions. Congenital lesions rarely encountered in daily clinical practice. Their diagnosis in childhood is particularly rare. We report two children with these cysts requiring surgical removal. We review the embryological, diagnostic and therapeutic aspects of these cysts, which could be of interest to pediatricians and pediatric surgeons when faced with this pathology in children.

Absceso pulmonar en la infancia sobre malformación congénita subyacente / Childhood lung abscess associated with an underlying congenital malformation

En la actualidad el absceso pulmonar en la infancia constituye una entidad de baja frecuencia, debido a los avances producidos en el campo de la antibioticoterapia y a un tratamiento más precoz de sus factores predisponentes. El presente trabajo describe 3 casos diagnosticados en un periodo de 15 años, tratados con éxito mediante intervención quirúrgica (lobectomía de la zona afectada). Todos y cada uno de los casos asentaban sobre una patología malformativa congénita de base, como puso de manifiesto el examen histopatológico de la pieza resecada. Se pone énfasis en la necesidad de sospechar y tratar quirúrgicamente dicha patología malformativa pulmonar ante todo caso de absceso pulmonar recidivante y resistente a tratamiento médico (AU)

Duplicación quística de yeyuno asociada a malrotación intestinal: presentación como abdomen agudo neonatal / Jejunal duplication cyst associated with intestinal malrotation: presentation as neonatal acute abdomen

La malrotación intestinal es una eventualidad frecuente que constituye una causa predominante de obstrucción intestinal alta en el recién nacido. Por otro lado, las duplicaciones digestivas son malformaciones congénitas infrecuentes cuyo diagnóstico clínico es dificultoso. La asociación de duplicación intestinal y malrotación es extremadamente rara, habiéndose descrito tan sólo 12 casos previos. Presentamos el caso de una recién nacida que debutó con obstrucción intestinal alta por vólvulo de intestino medio asociado a duplicación yeyunal quística, que evolucionó satisfactoriamente tras la intervención quirúrgica (AU)

Quistes del rafe medio perineal en la infancia / Median raphe cysts of the perineum in childhood

Los quistes del rafe medio perineal son lesiones congénitas poco habituales en la práctica clínica diaria, siendo particularmente infrecuentes en la infancia. Se presentan dos casos pediátricos afectados de dicha lesión, en los que se requirió escisión quirúrgica. Revisamos aspectos embriológicos, diagnósticos y opciones terapéuticas que pueden ser de utilidad al pediatra o cirujano pediátrico ante la presencia de un caso afectado de dicha enfermedad (AU)

Despertar intraoperatorio: Presentación de un caso en cirugía pediátrica / Awareness: Report of a case in pediatric surgery

El despertar intraoperatorio (DIO) o 'Awareness' se define como la recuperación de la consciencia durante una anestesia general. Se presenta el caso de un paciente de 11 años intervenido de hipospadias, que tras la educción anestésica, relató hechos que denotaban claramente consciencia intraoperatoria, sin acompañarse de dolor, ansiedad, síntomas displacenteros ni alteración psicoconductal a largo plazo. Resaltamos aspectos fisiopatológicos, diagnósticos y preventivos de esta rara complicación en cirugía pediátrica (AU)

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[Intraoperative awakening: report of a case in pediatric surgery]. / Despertar intraoperatorio: presentación de un caso en cirugía pediátrica.

Intraoperatory awakening or awareness can be defined as recovering of conscience during general anesthesia. We report such a case happened in a 11 year-old boy during a hypospadias repair. After anesthetic education he related intraoperatory conscience without pain, anxiety, displeasing symptoms or long-term psychoconductal distress. We remark fisiopathology, diagnostic and preventive aspects of this rare event in pediatric surgery.

[Macrostomia secondary to transverse facial cleft of Tessier No.4]. / Macrostomía secundaria a hendidura facial transversa de Tessier n-0 4.

A case of bilateral macrostomia type transverse facial cleft of Tessier n. 4 is reported, which was operated on with good results when had ten months of age, repaired using suture of three planes of three embryonic folds. A treatment plain precocious is recommended and pathogenic theories about this uncommon entity are exposed.

[Is the predischarge exercise test valid in patients younger than 40 years old after myocardial infarct for determination of multivascular disease?]. / Es válida la prueba de esfuerzo precoz en pacientes jóvenes menores de 40 años tras infarto de miocardio para la determinación de enfermedad multivaso?

BACKGROUND AND OBJECTIVES: Conventional exercise testing before hospital discharge is the most useful procedure in order to estimate postinfarction prognosis and in detecting multivessel coronary disease which is associated with a poor long-term prognosis. There are no bibliographic reports about it in younger myocardial infarction survivors. The aim of the study was to evaluate sensitivity, specificity and predictive value of symptoms limited maximal exercise testing for multivessel disease diagnosis in young patients after myocardial infarction. METHODS: Myocardial infarction survivors until the age of 40 performed symptoms limited maximal exercise testing and had a coronary arteriography before hospital discharge. RESULTS: A total of 100 consecutive patients were included, although in only 83 of them exercise tests and coronariographic studies were done. In this group, multivessel disease was confirmed in 27 patients (15 with positive tests and 12 with normal exercise testing). In the remaining 56 young adults without multivessel involvement, positive tests were only observed in 15 patients and normal tests in 45. Thus, a sensitivity of 56%, specificity of 73%, positive predictive value of 50% and negative predictive value of 77% were found. When patients showed high risk exercise test criteria, the exercise test positive predictive value increased to 80%. CONCLUSIONS: Due to the lower sensitivity of this test in young myocardial infarction survivors for detecting multivessel artery disease, we remark on the need for predischarge complementary tests such as isotopic, stress echocardiography or coronariography testing.

[The anomalous origin of the left common coronary trunk in the right sinus of Valsalva with an interarterial path. Apropos a case]. / Origen anómalo del tronco coronario común izquierdo en el seno de Valsalva derecho con trayecto interarterial. A propósito de un caso.

We present the case of an old patient with coronary artery disease and two previous myocardial infarctions, admitted to the hospital by syncopal episodes, in which the coronariographic study showed the ectopic origin of the left main coronary artery in the right sinus of Valsalva with anomalous course between the aortic and pulmonary arteries. In this case the initial coronariographic diagnosis and the therapeutical attitude (initially aggressive only in cases of interarterial course) was confirmed by mean of transesophageal echocardiography, showing a better topographical definition of the ectopic vessel aberrant course, although due to the high degree of left ventricular disfunction and the diffuse disease of distal vessels in this patient, CABG surgery was avoided. The angiographic feature is described and the transesophageal approach is remarked as a complementary diagnostic tool in the correct definition of the anomalous course.

[Cerebral abscess secondary to esophageal dilatations]. / Absceso cerebral secundario a dilataciones esofágicas.

We report two cases of cerebral abscess secondary to esophageal dilations in children with caustic stenosis of the esophagus. High fever and neurological findings postdilation lead us to suspect this complication. Cranial C.T. confirmed the diagnosis. Clinical course was favourable in both patients, with antibioterapy on the first case and combined therapy with surgical drainage and parenteral antibiotics on the second patient. We remark the importance of suspect this complication on the basis of clinical and tomographic findings on the pediatric patients subjected to esophageal dilations. Pathogenic ways of bacterial dissemination from the esophagus to the brain are discussed and reviewed.

[Morgagni hernia in childhood]. / Hernias de Morgagni en la infancia.

We report six cases of Morgagni hernia diagnosed and operated on in our pediatric surgical unit during a 14-year period. Four children were younger than 1 year and two between 1 and 2 years. Predominance in males was found. Associated congenital pathology was present in 3 children (Down's syndrome, diaphragmatic relaxation, criptorquidia and pyelo-ureteral stenosis). Predominant clinical features were respiratory infections and vomiting. In only one patient clinical onset was with respiratory distress. Plain chest x-ray was the most used diagnostic procedure. In all cases barium enema was performed to confirm the clinical diagnosis. Most frequent surgical approach was a midline supra-umbilical laparotomy. Diaphragmatic defect was left sided in 3 children and right-sided in the other 3. Transverse colon and liver were the most frequent herniated viscera. Postoperative follow-up showed no complications or recidives.

[Duodenal atresia and heterotaxia]. / Atresia duodenal y heterotaxia.

We report two cases of duodenal atresia associated with corporal symmetry changes. The one of them presented a "situs inversus total" and the other one a Ivermak syndrome. The association between duodenal atresia and Ivermak syndrome has a very low incidence. We have not found references with respect to the association between duodenal atresia and "situs inversus totalis". The embryo-genetic hypothesis that could relate both anomalies are discussed. Perhaps are not caused by chance.