Bilateral Lung Injury with Delayed Pneumothorax following Preoperative Cryoanalgesia for Pectus Excavatum Repair in a 13-year-old Boy.

A 13-year-old male patient with marfanoid features and pectus excavatum with Haller index 4 and correction index of 38% underwent the Nuss procedure with cryoanalgesia 9 days prior, which transpired uneventfully. Preoperative spirometry was normal, and echocardiogram showed light aortic valve dilation. A month later, during a routine outpatient checkup, he referred middle abdominal pain, denying respiratory symptoms nor thoracic pain. He presented bilateral apical and right basal hypophonesis. Chest X-ray revealed bilateral pneumothorax and right pleural effusion. Consequently, the patient was admitted to the emergency room, and a chest computed tomography was ordered, reporting right apical blebs. Bilateral thoracoscopy was performed, and apexes were checked for pulmonary blebs to rule out primary pneumothorax. In the right chest, a wedge resection of a distorted area on the apex and pleuroabrasion were done. Four air leaking eschars were found when performing lung expansion under water as leaking test, corresponding to cryoanalgesia intercostal eschars, and subsequently closed by primary suture. In the left chest, there were no blebs. However, another four pleural lesions with intact pleura in the left lower lobe were also found. Postoperative course was uneventful and chest drains were removed 48 hours after surgery. He remains asymptomatic 21 months after discharge. Cryoanalgesia in pectus excavatum is spreading due to the improvement in postoperative pain control. However, some complications may occur.

Bilateral hydrosalpinx in patients with Hirschsprung's disease.

PURPOSE: Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. AIM: to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD. METHODS: The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed. RESULTS: Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p=0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p=0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program. CONCLUSION: An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Parental presence during invasive procedures in a Spanish pediatric emergency department: incidence, perspectives, and related anxiety.

BACKGROUND: Family presence during invasive procedures (IPs) is infrequent in Spanish pediatric emergency departments (PEDs), despite the benefits of family presence. OBJECTIVES: To investigate the proportion of relatives who wish to be present during IP, to determine the percentage of relatives who stayed during IP in our PED, and to evaluate parental anxiety. METHODS: A prospective observational study was carried out in a PED of an urban, tertiary-care university-affiliated hospital in Barcelona (Spain). A written survey was given to the relatives of children who were admitted to the PED during the month of November 2009. RESULTS: Of the 365 given questionnaires, 213 (58.4%) were completed. Ninety-nine percent of surveys were answered by the parents. Mean age of respondents was 37 years (74.6% were women). IPs were performed on 73.3% of patients, and 97.4% of IPs were performed in the presence of relatives. Parents were present during blood sampling (98%), urethral catheterizations (97%), lumbar punctures (LP; 72%), simple wound repair (62%), and fracture reductions (37%). Parents wanted to stay during blood sampling (98%), urethral catheterization (89.9%), LP (82.4%), simple wound repair (88.6%), and fracture reduction (86.5%). Respondents (51.6%) believed that parents should decide on their own whether their presence was desirable. Parents were least anxious during blood sampling and were most nervous during LP. CONCLUSION: Most of the parents wish to stay beside their children during IPs. In our PED, parents were present for more than 95% of IPs. The more invasive the procedure is, the more anxious parents feel.