Bronchogenic Cyst: Lessons Learned in 20 Years of Experience at a Tertiary Pediatric Center.

BACKGROUND: Bronchogenic cysts are benign congenital malformations of the primitive ventral foregut. The aim of this study is to analyze and report 20 years of experience in the diagnosis and treatment of bronchogenic cysts at a tertiary pediatric center. METHODS: A retrospective review was conducted of all patients diagnosed with a bronchogenic cyst between 2000-2020. Presence of symptoms, cyst location, surgical technique, postoperative complications, need for pleural drainage, and recurrence were reviewed. RESULTS: Forty-five children were included in the study. In 37 patients a partial resection of the cyst was done, followed by cauterization or chemical obliterateration with iodopovidone of the mucosa of the remaining cyst wall that was adherent to the airway. A lobectomy was done in patients who had intrapulmonary cysts (n = 8). Cyst location was subcarinal in 23 (51.1%), paratracheal in 14 (31.1%), and intrapulmonary in eight patients (17.8%). The majority of subcarinal and paratracheal cysts (90%) were approached by thoracoscopy. Complications occurred in seven patients (15%): subcutaneous emphysema after pleural drain removal in one, extubation failure in two, reoperation due to bleeding in one, surgical site infection in one, bronchopleural fistula in one, and pneumothorax in one. Reoperation due to cyst recurrence was necessary in two patients (4.4%). Mean follow-up was 56 months (range, 0-115). CONCLUSION: A minimally invasive approach is a safe option for the management of paratracheal and subcarinal bronchogenic cysts with no history of infection in specialized pediatric surgery center. Thoracoscopic partial resection is a feasible option in most patients with subcarinal and paratracheal bronchogenic cysts with a low complication and reoperation rate. LEVEL OF EVIDENCE: IV.

Surgical treatment of thoracic outlet syndrome in pediatrics.

AIM: Thoracic outlet syndrome (TOS) is a condition that occurs when the cervical neuro-vascular bundle becomes compressed at one of the three narrow areas of the thoraco-cervico-axillary region. Conservative management is the first line of treatment. Patients who do not respond to conservative management should be treated surgically. The aim of this review is to present our experience with the surgical management of TOS in pediatric patients. METHODS: We retrospectively reviewed the outcomes of all patients with TOS operated at our Hospital between 2001 and 2020. We collected all demographic data, clinical features, imaging data, type of operation performed, intraoperative findings, complications and recurrence. RESULTS: We operated 9 patients within the study period. The median age at surgery was 14 (7 to 17) years. A transaxillary approach was used in 7 patients and a supraclavicular approach in 2. There was only one minor intraoperative complication (violation of the pleural space). There were no postoperative complications. The median length of stay was 3 (2 to 4) days. All patients were extubated in the operating room. Two patients developed symptoms on the contralateral side. One of these underwent a successful contralateral transaxillary Roos operation. The follow-up was 4 months to 20 years. All patients are asymptomatic. CONCLUSION: We believe that the Roos operation is a safe and effective treatment with excellent long-term outcomes for children with TOS that fail conservative management.

Cáncer de piel no melanoma: de la patología a la tutela / Nonmelanoma skin cancer: pathology guardianship

El manuscrito hace una revisión sobre cáncer de piel no melanoma desde diferentes aristas del problema: iniciando en aspectos de conceptualización de la patología, pasando por la descripción de los trámites y costos que debe afrontar un paciente que requiere atención al presentar un diagnóstico presuntivo de cáncer de piel no melanoma en el actual Sistema General de Seguridad Social en Salud colombiano. Adicionalmente, se describien las barreras de acceso y negaciones de servicios, acotando el caso con resultados de una Empresa Promotora de Salud con sede en Bogotá y finalizando en la tutela como tabla de salvación para exigir un derecho fundamental, el derecho a la salud. En Colombia un paciente con cáncer de piel no melanoma diariamente batalla no solo contra su enfermedad sino contra una estructura compleja que supera el resorte del sistema de salud y trasciende a los componentes político, social y económico del país. Lo anterior constituye un círculo vicioso que requiere con urgencia de una intervención profunda a diferentes escalas y que supera el alcance de la reforma del sistema de salud colombiano. Para superar las dificultades documentadas en el acceso real, efectivo y de calidad de los colombianos que sufren de cáncer de piel no melanoma a los servicios de salud se requiere de un compromiso decidido y de acciones concretas.

The manuscript is a review of non-melanoma skin cancer (NSC) from different angles of the problem: starting in conceptualizing aspects of the disease through the description of the procedures and the cost that a patient who requires attention when presenting presumptive NSC diagnosis must face in the current General System of Social Security in Colombian Health. Additionally, barriers to access and denial of services are explained by mentioning the results of a case-based EPS in Bogotá which ending in guardianship as a lifeline to demand the fundamental right to health. In Colombia, a patient with NSC daily struggles not only against the disease but also with a complex structure that overcomes the rein of the health system and transcends political, social and economic components of the country. This is considered as a vicious circle which urgently requires a deep intervention at different scales and which exceeds the scope of the reform of the Colombian health . A strong commitment and concrete actions are required to overcome the difficulties documented in the real, effective and quality access of the Colombians who are suffering from NSC to health services.