[Left cardiac sympathetic denervation in congenital ventricular arrythmias: initial experience]. / Denervación cardiaca simpática izquierda en las arritmias ventriculares congénitas: experiencia inicial.

BACKGROUND: Left cardiac sympathetic denervation (LCSD) has been proposed as a second-line therapy for potentially lethal ventricular arrythmia with no response to the gold standard treatment with beta-blockers. It has been used mainly in channelopathies such as long QT syndrome (LQTS) and polymorphic cathecolaminergic ventricular tachycardia (PCVT). AIM: Analizing our preliminary experience in the treatment of congenital ventricular arrythmia with thoracoscopic LCSD. MATERIAL AND METHODS: We have reviewed the first 5 LCSD performed in the last two years (2011-2013) to 5 female patients with a mean age of 8 years (1 month-15 years). The underlying disease was the LQTS in three and the PCVT in two. RESULTS: Selective contralateral bronchial intubation was used in two cases and double-lumen tube in three. We performed in all cases T1 sympathicolysis, denervation of T2 ganglion and sympathicolysis of T3 and T5 levels. No intraoperatory nor postoperatory complications were observed. In four cases ventricular tachycardia disappeared after the procedure and in one case, although they did not completely disappeared, they could be better controled on medical therapy. Ventricular extrasystoles reappeared 17 months after the procedure in one PCTV case, but disappeared completely after T1-T5 left sympathectomy completion. With a mean follow-up time of 20 months, all patients are sympthom-free and continue on betablocker oral therapy. CONCLUSIONS: Thoracoscopic DCSI is a safe and effective therapy for prevention of severe congenital ventricular arrythmias.

INTRODUCCION: La denervación cardiaca simpática izquierda (DCSI) se ha propuesto como tratamiento de segunda línea de las arritmias ventriculares con potencial riesgo de muerte que no responden al tratamiento farmacológico gold standard con beta bloqueantes. Fundamentalmente se ha utilizado en las canalopatías, que incluyen el síndrome de QT largo congénito (SQTL) y la taquicardia ventricular polimórfica catecolaminérgica (TVPC). OBJERIVO: Analizar nuestra experiencia inicial en el tratamiento de las arritmias ventriculares congénitas mediante DCSI toracoscópica. MATERIAL Y METODOS: Hemos revisado las primeras 5 DCSI realizadas en los últimos dos años (2011-2013) a 5 pacientes femeninas con una edad media de 8 años (1 mes-15 años). La patología de base fue el SQTL en tres casos y la TVPC en dos. Se utilizó una intubación selectiva contralateral en dos casos y una intubación con tubo de doble luz en tres. En todos los casos se realizó simpaticolisis T1, denervación del ganglio T2 y simpaticolisis de los niveles T3 y T5. RESULTADOS: No se registraron complicaciones intra ni postoperatorias. En 4 casos las taquicardias ventriculares desparecieron tras el procedimiento y en un caso, pese a no desaparecer completamente, se controlaron adecuadamente con tratamiento médico. Un caso de TVPC presentó nuevamente salvas de extrasístoles ventriculares (EV) 17 meses después de la simpaticolisis, realizando una simpatectomía T1-T5 con desaparición de las EV. Con un seguimiento medio de 20 meses, todas las pacientes permanecen asintomáticas y reciben tratamiento betabloqueante oral. CONCLUSIONES: La DCSI vía toracoscópica es un tratamiento efectivo y seguro para la prevención de las arritmias ventriculares congénitas graves.

Use of high-pressure balloon dilatation of the ureterovesical junction instead of ureteral reimplantation to treat primary obstructive megaureter: is it justified?

OBJECTIVE: To compare outcomes between high-pressure balloon dilatation of the ureterovesical junction (UVJ) and ureteral reimplantation with ureteral tapering to treat primary obstructive megaureter (POM). PATIENTS AND METHODS: Retrospective review of clinical data from patients who underwent surgical treatment of POM from 2005 to 2010. Patients were divided into two groups: endoscopic treatment (ET) with UVJ dilatation and ureteral reimplantation (UR) with Cohen's or Leadbetter-Politano neoureterocystostomy and Hendren's tapering. Preoperative studies included ultrasound scan (US), voiding cystourethrography, and diuretic isotopic renogram. Outcome parameters were US, differential renal function (DRF), presence of postoperative vesicoureteral reflux, need for secondary reimplantation and complications. RESULTS ET: 13 patients with a median age of 7 (4-24) months; UR: 12 patients with a median age of 14 (7-84) months, with no statistical differences in age and gender between groups. Preoperative US parameters were similar. ET: mean diameter of renal pelvis, calices and ureter was 23.5 mm, 13.46 mm and 15.77 mm respectively. UR: mean diameter of renal pelvis, calices and ureter was 22.25 mm, 11.75 mm, and 19.08 mm, respectively. Preoperative DRF was 45.62% and 39.33% for ET and UR, respectively (p > 0.05). Significant improvement of hydroureteronephrosis was observed in 11/13 patients of ET and 11/12 patients of UR (p > 0.05). Postoperative DRF was 42% and 48% for ET and UR, respectively (p > 0.05). Postoperative vesicoureteral reflux was observed in 2 patients of ET and 1 of UR (p > 0.05). Secondary ureteral reimplantation was needed in 3 patients of ET and 2 of UR (p > 0.05). CONCLUSION: Endoscopic treatment of POM is as effective as ureteral reimplantation but further randomized clinical trials are needed to support these results.

Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage.

OBJECTIVE: To present our cases of ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR) with dextranomer/hyaluronic acid (Dx/HA). PATIENTS AND METHODS: We collected data from patients who had suffered ureteral obstruction after endoscopic treatment of VUR with Dx/HA in our institution. RESULTS: From April 2002 to April 2011 we treated endoscopically 475 ureters with VUR, and detected 5 ureteral obstructions. Median age at reflux treatment was 39 months. Reflux grade before treatment was III in one patient and IV in four. Three ureterovesical junctions (UVJ) were blocked after a second endoscopic treatment. The median of Dx/HA injected was 1 ml (0.6-1.1). In two patients ureteral obstruction presented acutely and was treated with a ureteral stent. In the other three, the ureteral obstruction appeared gradually and was detected by ultrasound scans and MAG3 diuretic renogram; one underwent nephrectomy because of poor renal function, and the other two were treated with endoscopic dilatation of the UVJ. In all these patients both reflux and obstructions have resolved. CONCLUSIONS: On preoperative cystography, three of the patients had a narrowed distal ureter, and probably had a refluxing and obstructive megaureter. Other causes are not clear, except for those patients with acute presentation in whom edema of the UVJ was found. Ureteral obstruction after endoscopic treatment of VUR is rare. Endoscopic intervention such as ureteral stent placement or high-pressure balloon dilatation of the UVJ has good results as a treatment of acute and delayed obstruction.

Manejo del traumatismo rectal en la edad pediátrica / Management of rectal traumatism in the pediatric age

Objetivo. En pediatría, las heridas anorrectales son infrecuentes y su manejo ha incluido clásicamente la derivación intestinal. Actualmente, y si las condiciones son favorables, se tiende a realizar una reparación primaria de la lesión sin colostomía. Presentamos nuestra casuística y experiencia en el manejo de esta patología, revisando la literatura con el objetivo de crear unas pautas de actuación a seguir en estos casos. Material y métodos. Estudio retrospectivo, descriptivo, de pacientes con herida anorrectal en nuestro centro entre 2005-2011. Se analizan los datos demográficos de cada paciente, mecanismo de la lesión, malformaciones asociadas, tiempo de evolución lesión-cirugía, tratamiento, estancia hospitalaria y evolución. Resultados. Los 7 pacientes revisados se clasifican según el tipo de lesión en dos grupos; lesiones iatrogénicas (todas con malformaciones asociadas) y lesiones accidentales no iatrogénicas. En 4 de ellos se realizó una TC (tomografía computerizada). Ninguno se exploró mediante sigmoidoscopia. En los pacientes revisados, se realizó colostomía de (..) (AU)

Objective. In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We presentour experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. Patients and methods. Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. Results. 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with (..) (AU)

[Anderson-Hynes pyeloplasty in children under 2 years. Is the laparoscopy the technique of choice?]. / Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección?

OBJECTIVE: To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction in patients under 2 years of age. PATIENTS AND METHODS: Pyeloplasties performed in children under 2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. RESULTS: We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05). CONCLUSIONS: Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long.

High pressure balloon dilation of the ureterovesical junction--first line approach to treat primary obstructive megaureter?

PURPOSE: We describe the efficacy of dilation of the ureterovesical junction to treat primary obstructive megaureter. MATERIALS AND METHODS: A total of 13 patients with primary obstructive megaureter were treated from May 2008 to December 2010. Of these patients 8 were diagnosed prenatally and the others were diagnosed after a urinary tract infection. Preoperative studies included ultrasonography, voiding cystourethrography despite vesicoureteral reflux and diuretic isotopic renogram (mercaptoacetyltriglycine). With the patient under general anesthesia, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A Double-J(®) catheter was positioned, and 2 months later it was withdrawn and the ureterovesical junction was reviewed. A secondary treatment was performed in those in whom the ureterovesical junction was still narrow. Followup was performed with ultrasonography, cystourethrography and isotopic diuretic renography. RESULTS: A total of 18 procedures were performed in 13 patients (median age 7 months, range 4 to 24). Median diameter of the distal ureter was 14 mm (range 10 to 26), and median diameter of the renal pelvis and calyx was 27 mm (range 10 to 47) and 12 mm (range 9 to 26), respectively. Significant postoperative improvement of hydroureteronephrosis was observed in 11 of 13 patients and vesicoureteral reflux was found in 2. Only 3 patients needed ureteral reimplantation after endoscopic treatment due to hydroureteronephrosis in 2 and high grade vesicoureteral reflux in 1. CONCLUSIONS: High pressure balloon dilation of the ureterovesical junction is effective in treating primary obstructive megaureter, but long-term followup is needed.

Pieloplastia Anderson-Hynes en menores de 2 años. ¿Es la laparoscopia la técnica de elección? / Anderson hynes pyeloplasty in children under 2 years. is the laparoscopy the technique of choice?

Objetivo. Demostrar que la laparoscopia es tan eficaz como la cirugía abierta en el tratamiento de la estenosis pieloureteral en menores de 2 años. Material y métodos. Pieloplastias en menores de 2 años entre 2007y 2010. Dos grupos: pieloplastia abierta (PA) y pieloplastia laparoscópica(PLap). Se han analizado: peso, diámetro de la pelvis renal y delos cálices pre y postoperatorios, tiempos quirúrgicos, estancia media y complicaciones. Resultados. 35 PA y 13 PLap. No han existido diferencias significativas ni en el peso medio, ni en los diámetros de la pelvis renal y cálices pre ni postoperatorios, ni en las complicaciones. Sí hemos encontrado diferencias estadísticamente significativas en el tiempo quirúrgico medio y la estancia media (p<0,05).Conclusión. Este estudio sugiere que la pieloplastia laparoscópica en niños menores de 2 años es una buena técnica alternativa a la cirugía abierta. El único inconveniente es el mayor tiempo quirúrgico, que irá disminuyendo con la experiencia (AU)

Objective. To analyze if the laparoscopic pyeloplasty is as effective as the open procedure in the ureteropelvic junction obstruction inpatients under 2 years of age. Patients and methods. Pyeloplasties performed in children under2 years of age between 2007 and 2010. Weight, pre and postoperative renal pelvis and calices diameter, operating time, hospital stay and complications were analyzed. Results. We found no statistic differences in weight, complications, or pre and postoperative renal pelvis and calices diameter. However, we found differences in hospital stay and operating time (p<0.05).Conclusions. Laparoscopic pyeloplasty in children under 2 years of age is a good alternative technique for ureteropelvic junction obstruction, although operating time are still long (AU)

[Management of rectal traumatism in the pediatric age]. / Manejo del traumatismo rectal en la edad pediátrica.

OBJECTIVE: In pediatrics anorectal injuries are not very common and their management classically includes an intestinal derivation. In selected patients and with favourable conditions, there has been an increased interest in repair the injuries without derivation. We present our experience in the management of this pathology, looking through the literature. The aim of the study is to develop some guidelines to follow in these cases. PATIENTS AND METHODS: Retrospective and descriptive study of patients with anorectal injury admitted in our institution between 2005-2011. Data abstraction included patient demographic data, mechanism of injury, associated injuries, time between injury and treatment, methods of diagnosis, treatment, length of stay and resultant complications. RESULTS: 7 patients were reviewed and classified according to the type of the injury in two groups: iatrogenic injuries (all of them with associated malformations) and non-iatrogenic accidental injuries. A CT was performed in 4 cases. None of them was explored with sigmoidoscopy. We performed colostomy without primary repair in four patients, primary injury repair with colostomy in two patients, and one patient underwent primary repair without colostomy. All patients had a long evolution (mean hospital length of stay was 31,4 days) with many dressings and some of them required relaparotomy. Fecal continence and long term results have been, in all of them, satisfactories. CONCLUSIONS: An early and complete diagnosis of anorectal injuries is basic for an appropriate approach to the treatment. Primary repair of injuries without colostomy could be a safe procedure as a first treatment in selected patients: stables, with no contamination and no associated injuries. It is very important to individualize each patient to minimize the morbidity, reduce the hospital length of stay and reach a full continence.

Carcinoma de tiroides en Pediatría: seguimiento a 30 años / Thyroid carcinoma in pediatrics: a 30-year follow-up

Introducción. Los tumores tiroideos son neoplasias de presentación infrecuente en la población pediátrica. El objeto de este estudio fue valorar la evolución terapéutica y seguimiento (supervivencia) a lo largo de 30 años. Materiales. Se revisaron 28 casos con diagnóstico de carcinoma de tiroides desde 1978 a 2008. Las variables a estudiar fueron: epidemiológicas, métodos diagnósticos utilizados, tipo de histología, tratamiento y supervivencia a 300 meses posterior al tratamiento. Consideramos como significativo una p<0,05. Resultados. El 73,1% de los casos fueron de sexo femenino. La edad promedio fue 12,3 años (1,6-19). La ecografía fue la prueba más solicitada (78,5%). La mutación RET se presento en tres casos asociados a MEN. El tipo histológico papilar fue el más frecuente (50%). Latiroidectomía total (TT) fue la cirugía más practicada (67,9%). La radioiodoablación (RIA) se usó en el 46,4% de los casos. La terapia de sustitución hormonal se usó en 27 pacientes de la serie. El 89,29% de la serie al cabo de 300 meses se encontraron libres de enfermedad. Conclusiones. El tratamiento de la serie ha variado a lo largo de (..) (AU)

Introduction. The thyroid tumours are infrequent neoplasms of presentation in paediatric. The object of this study was to value therapeutic evolution and the survival throughout 30 years. Materials. 28 cases with diagnosis of thyroid carcinoma. Were reviewed from 1978 to 2008. Were the variables to study: epidemiologists, methods used diagnostic, type of histology, later treatment and survival to 300 months to the treatment. We like considered significant p <0.05. Results. 73.1% of the cases were of feminine sex. The average age was 12.3 years (1.6 to 19). The ultrasound was asked for the test more(78.5%). The RET mutation associated appear in three cases to MEN. The histology type to papillary was most frequent (50%). The total thyroidectomy (TT) was the (..) (AU)

Utilidad de la ECMO en pacientes con hernia diafragmática congénita / Utility of the ecmo in patients with congenital diaphragmatic hernia

Actualmente, la membrana de oxigenación extracorpórea (ECMO)constituye el último eslabón en la terapéutica del manejo del fallo respiratorio en pacientes con hernia diafragmática congénita (HDC). Presentamos nuestra experiencia. Desde enero de 2001 disponemos en UCI- neonatal de ECMO. De76 HDC, 13 (3 derechas y 10 izquierdas) han precisado ECMO (uno en dos ocasiones; en total 14 procedimientos). Criterios de inclusión: hipoxemia refractaria, índice de oxigenación > 40 y peso > de 2 kg. 5 niñas y 8 niños con edad gestacional entre 35 y 41 semanas (media:38) y peso al nacer entre 2.300 y 3.500 gramos (media 2.817). En 6casos (5 trasladados desde otros centros), el diagnóstico fue posnatal. De los 7 con diagnóstico prenatal, en 4 casos se había realizado terapiafetal mediante oclusión traqueal. Procedimiento veno-venoso en 8 y veno-arterial en 5. Rango de duración: 68-606 horas, media de 228,35. La cirugía se ha realizado antes de la ECMO en 9 casos, 2 durante y 1 después. En una ocasión (..) (AU)

At the moment the extracorporeal membrane oxygenation (ECMO)constitutes the last link in the therapeutic one of the handling of the respiratory failure in patients with Congenital Diaphragmatic Hernia (HDC).We presented our experience. From January 2001 we arrange the ECMO in neonative UCI. 76HDC, 13 (3 rights and 10 lefts) they have needed ECMO (one in two occasions; altogether 14 procedures). Criteria of inclusion: refractory hypoxaemia, oxigenaction index > 40 and weight > 2 kg. 5 girls and 8 boys with gestacional age between 35 and 41 weeks(average: 38) and weight when being born between 2,300 and 3,500grams (average 2,817). In 6 cases (5 transferred from other centers) the diagnosis was posnatal. Of the 7 with prenatal diagnosis, in 4 cases fetal therapy by means of traqueal occlusion had been made. Veno-venous in 8 and veno-arterial procedure in 5. Rank of duration: 68-606 hours, average of 228.35. The surgery has been made before the ECMO in 9 cases, 2 during and 1 later. In an occasion there was no (..) (AU)

[Laparoscopìc pyeloplasty in pediatric patients. Our initial cases and lessons learned]. / Pieloplastia laparoscópica en pacientes pediátricos. Nuestros primeros casos y lecciones aprendidas.

OBJECTIVE: To analyze the initial experience in our first patients with ureteropelvic junction obstruction (UPJO) treated by laparoscopic surgery. PATIENTS AND METHODS: All laparoscopic Anderson-Hynes pyeloplasties performed from July 2007 to April 2009 were analyzed. Before surgery, patients underwent a renal ultrasound and isotope renogram. A double J catheter was left in place and subsequently removed. Patients were followed up by ultrasound and renography. RESULTS: Fourteen patients with a median age of 8.6 years were analyzed. Preoperative ultrasound showed a median renal pelvis diameter of 34.5 mm. Median operating time was 235 min, and median hospital stay 5.5 days. Median renal pelvis diameter decreased in all patients (13.5 mm). CONCLUSIONS: Laparoscopy is an effective procedure for UPJO correction in children, although operating times are still long.

Pieloplastia laparoscópica en pacientes pediátricos. Nuestros primeros casos y lecciones aprendidas / Laparoscopìc pyeloplasty in pediatric patients. Our initial cases and lessons learned

Objetivo: Analizar la experiencia inicial en nuestros primeros pacientes afectos de estenosis pieloureteral tratados mediante cirugía laparoscópica. Pacientes y métodos: Se han incluido todas las pieloplastias laparoscópicas tipo Andereson Hynes realizadas entre julio de 2007 y abril de 2009. Los pacientes fueron estudiados preoperatoriamente mediante ecografía renal, renograma isotópico. Se les dejó un tutor doble «J» que se retiró posteriormente. El seguimiento ha sido ecográfico y renográfico. Resultados: Catorce pacientes con una media de edad de 8,6 años El estudio ecográfico prequirúrgico mostró una media del diámetro de la pelvis renal de 34,5mm. El tiempo quirúrgico media ha sido de 235min. La estancia media fue de 5,5 días. En todos los pacientes ha habido una disminución de la media del diámetro de la pelvis renal (13,5mm). Conclusiones: La laparoscopia es técnica eficaz para la corrección de la estenosis pieloureteral en la edad pediátrica; a pesar que los tiempos quirúrgicos aún son elevados (AU)

Objective: To analyze the initial experience in our first patients with ureteropelvic junction obstruction (UPJO) treated by laparoscopic surgery. Patients and methods: All laparoscopic Anderson-Hynes pyeloplasties performed from July 2007 to April 2009 were analyzed. Before surgery, patients underwent a renal ultrasound and isotope renogram. A double J catheter was left in place and subsequently removed. Patients were followed up by ultrasound and renography. Results: Fourteen patients with a median age of 8.6 years were analyzed. Preoperative ultrasound showed a median renal pelvis diameter of 34.5mm. Median operating time was 235min, and median hospital stay 5.5 days. Median renal pelvis diameter decreased in all patients (13.5mm). Conclusions: Laparoscopy is an effective procedure for UPJO correction in children, although operating times are still long (AU)

Lobectomía toracoscópica: Experiencia inicial / Thoracoscopic lobectomy: initial experience

Objetivo. Analizar nuestra experiencia inicial en el tratamiento de malformaciones pulmonares mediante lobectomía toracoscópica. Material y método. Hemos revisado nuestros primeros 6 casos del obectomía toracoscópica realizados en el último año (2008-09). Hemos realizado 6 lobectomías toracoscópicas en 6 pacientes varones con una edad media de 16 meses (6 m-4 años). Por localización se realizaron: 3lobectomías inferiores (2 derechas y una izquierda), 2 lobectomías superiores derechas y una lobectomía superior izquierda con preservación lingular. La patología de base fue la malformación adenomatoidea quística en 5 casos (dos de ellos asociados a secuestro intralobar) y un enfisema lobar por atresia bronquial. Resultados. Se utilizó una intubación selectiva en 4 casos y una intubación traqueal con bloqueador bronquial en dos casos. Ningun caso requirió reconversión a toracotomía. El tiempo operatorio medio fue de (..) (AU)

Aim. Analizing our preliminary experience in the treatment of pulmonary malformations with thoracoscopic lobectomy. Material and methods. We have reviewed our first cases of thoracoscopic lobectomy during last year (2008-09). We have performed6 thoracoscopic lobectomies in 6 male patients with a mean age of 16months (6 months-4 years). They were 3 lower lobectomies (2 right and one left), 2 right upper lobectomies and one lingular sparing left upper lobectomy. Lung lesion was a congenital cystic adenomatoid malformation in 5 (2 of them asociated with intralobar sequestration) and one lobar emphysema due to bronquial atresia. Results. Selective bronchial intubation was used in 4 cases and and tracheal intubation with bronchial blocker in 2. There were no conversions to open thoracotomy. Mean operative time was 202’ (155-250’). There were no intraoperative nor postoperative complications. None of these patients needed blood transfusion. Mean drainage time (..) (AU)

[Thoracoscopic lobectomy: initial experience]. / Lobectomía toracoscópica: experiencia inicial.

AIM: Analizing our preliminary experience in the treatment of pulmonary malformations with thoracoscopic lobectomy. MATERIAL AND METHODS: We have reviewed our first cases of thoracoscopic lobectomy during last year (2008-09). We have performed 6 thoracoscopic lobectomies in 6 male patients with a mean age of 16 months (6 months-4 years). They were 3 lower lobectomies (2 right and one left), 2 right upper lobectomies and one lingular sparing left upper lobectomy. Lung lesion was a congenital cystic adenomatoid malformation in 5 (2 of them asociated with intralobar sequestration) and one lobar emphysema due to bronquial atresia. RESULTS: Selective bronchial intubation was used in 4 cases and and tracheal intubation with bronchial blocker in 2. There were no conversions to open thoracotomy. Mean operative time was 202' (155-250'). There were no intraoperative nor postoperative complications. None of these patients needed blood transfusion. Mean drainage time was 3.5 days (3-4 d) and mean discharge time was 4.8 days (4-7 d). With a mean follow-up time of 5.3 months (2 m-12 m), all of the patients have no symptoms and X-ray are normal. CONCLUSIONS: Thoracoscopic lobectomy is a safe and efective approach to treat congenital pulmonary pathology. The keys to perform it safely are good anesthetic management, adequate instruments for children size, and careful disection of broncovascular structures. Advantages of the minimal access surgery and implementation and miniaturization of the instruments and sealing devices will favor its progressive use.

[Thyroid carcinoma in pediatrics: a 30-year follow-up]. / Carcinoma de tiroides en pediatría: seguimiento a 30 años.

INTRODUCTION: The thyroid tumours are infrequent neoplasms of presentation in paediatric. The object of this study was to value therapeutic evolution and the survival throughout 30 years. MATERIALS: 28 cases with diagnosis of thyroid carcinoma. Were reviewed from 1978 to 2008. Were the variables to study: epidemiologists, methods used diagnostic, type of histology, later treatment and survival to 300 months to the treatment. We like considered significant p <0.05. RESULTS: 73.1% of the cases were of feminine sex. The average age was 12.3 years (1.6 to 19). The ultrasound was asked for the test more (78.5%). The RET mutation associated appear in three cases to MEN. The histology type to papillary was most frequent (50%). The total thyroidectomy (TT) was the surgery practice more (67.9%). The radioiodine (RI) was used in 46.4% of the cases. The substitute hormonal therapy was used 27 patients. 89.29% of the were series after 300 months free of disease. CONCLUSIONS: The treatment of the series these are hundreds throughout 30 years, but when valuing our experience we include / understand that: 1) the TT with selective lymphatic dissection, 2) it in the RI cases with positive to the body tracking and/or of factors of risk and 3) the substitute hormonal therapy, is the at the moment best offer alternatives to than we can these paediatric patients and prolong the survival in adult its age.

[Utility of the ECMO in patients with congenital diaphragmatic hernia]. / Utilidad de la ECMO en pacientes con hernia diafragmática congénita.

At the moment the extracorporeal membrane oxygenation (ECMO) constitutes the last link in the therapeutic one of the handling of the respiratory failure in patients with Congenital Diaphragmatic Hernia (HDC). We presented our experience. From January 2001 we arrange the ECMO in neonative UCI. 76 HDC, 13 (3 rights and 10 lefts) they have needed ECMO (one in two occasions; altogether 14 procedures). Criteria of inclusion: refractory hypoxaemia, oxigenaction index > 40 and weight > 2 kg. 5 girls and 8 boys with gestacional age between 35 and 41 weeks (average: 38) and weight when being born between 2,300 and 3,500 grams (average 2,817). In 6 cases (5 transferred from other centers) the diagnosis was posnatal. Of the 7 with prenatal diagnosis, in 4 cases fetal therapy by means of traqueal occlusion had been made. Veno-venous in 8 and veno-arterial procedure in 5. Rank of duration: 68-606 hours, average of 228.35. The surgery has been made before the ECMO in 9 cases, 2 during and 1 later. In an occasion there was no surgery. The complications have been of hemorrágico type in one patient and infectious in three cases with sudden sepsis in one. Precocious mortality has been of 6 patients and delayed the 2 (total 61%). Although this procedure has the high morbi-mortality, it is necessary to consider that is patients very badly prognosis without another alternative (with mortality of the 100%). Multicentric studies are needed to establish indicators prognoses pre and postbirthdays.

[Our experience in the treatment of proximal hypospadias in a single surgical intervention]. / Nuestra experiencia en el tratamiento del hipospadias proximal en un solo tiempo quirúrgico.

BACKGROUND: The surgical correction of proximal severe hypospadias, especially those with penoscrotal transposition (penis buried in scrotum), represents a true challenge for paediatric surgeons. A sequential approach to their repair is widely accepted, to preserve the vascularization of the neourethra and to avoid injuries in penis covering. In our experience, we believe that all hypospadias, even those associated with penoscrotal transposition, can be repaired in one surgical time by using a vascularized flap from dorsal prepuce in one or two layers (mucosal portion for urethra and skin face for ventral island). MATERIALS AND METHODS: From 1997 until 2007, 88 patients with proximal severe hypospadias have been operated. 35 patients associated penoscrotal transposition. Since 2005, we introduced a modification consisting in drawing the incisions following the own cutaneous folds resulting from the fusion of the lateral folds in penis skin. RESULTS: We performed Duckett type urethroplasty in 10 patients, Onlay type flap in 74, Onlay with oral mucosa in 2 and vesical mucosa urethroplasty in 2 of them. The fistula rate needing surgical closure was 17% (15/88), urethral stenosis was present in 5 patients (5.7%, 1 vesical mucosa, 2 Duckett urethrolpasties and 2 Onlay flaps). Severe complications were represented by partial necrosis of the skin flap in 3 patients (3.4%) needing a reurethroplasty. 1 patient presented surgical wound infection without later problems. Before 2005, among the 22 patients with penoscrotal transposition, 5 needed a new cutaneoplasty, associated in 2 occasions to a dorsal Nesbitt plicature to obtain the complete penis alignment. From 2005 until now, None of the 13 patients presenting with penoscrotal transposition needed any posterior cutaneoplasty. The follow up goes from 1 month until 10 years (median 45 months). At present time, urine spurt shows a correct range in all cases and the penis is located out of scrotal bag except in one patient, waiting for a new plasty. DISCUSSION: In our experience, we believe that all of the hypospadias may be repaired in a unique surgical time, including those of them associated with buried penis. Modification on skin incisions design following penoscrotal lateral folds with mucocutaneous preputial flap is an excellent option both for urethroplasty and correcting penis transposition.

Nuestra experiencia en el tratamiento del hipospadias proximal en un solo tiempo quirúrgico / Our experience in the treatment of proximal hypospadias in a single surgical intervention

Introducción: La corrección en un solo tiempo quirúrgico de los hipospadias proximales graves es un verdadero desafío para los cirujanos. Una aproximación secuencial en la reparación está ampliamente aceptada, a fin de preservar la vascularización de la neouretra y evitar lesiones en el recubrimiento del defecto peneano. En nuestra experiencia todos los hipospadias, incluso los que asocian una transposición penoescrotal, pueden repararse en un solo tiempo quirúrgico con un colgajo en una sola faz o en doble faz procedente del prepucio dorsal (porción mucosa para la uretra y cutánea para el recubrimiento ventral). Material y Métodos: De 1997 al 2007 se han intervenido 88 pacientes con hipospadias proximal grave. De ellos, en 35 se asociaba enterramiento o transposición penoescrotal. Desde el 2005 hemos introducido una modificación en la plastia cutánea que consiste en incidir lapiel siguiendo los restos de fusión de los pliegues cutáneos laterales. Resultados: El tipo de uretroplastia ha sido Duckett en 10, Onlay en74, Onlay con mucosa oral en 2 y uretroplastia con mucosa vesical en2. El porcentaje de fístulas que han precisado cierre quirúrgico es del 17%(15/88); estenosis uretral en 5 pacientes (5,7%): 1 mucosa vesical, 2 Duckett y 2 Onlay; necrosis parcial del colgajo cutáneo en 3 pacientes (3,4%). (..) (AU)

Background: The surgical correction of proximal severe hypospadias, especially those with penoscrotal transposition (penis buried inscrotum), represents a true challenge for paediatric surgeons. A sequential approach to their repair is widely accepted, to preserve the vascularization of the neourethra and to avoid injuries in penis covering. In our experience, we believe that all hypospadias, even those associated with penoscrotal transposition, can be repaired in one surgical time by using a vascularized flap from dorsal prepuce in one or two layers(mucosal portion for urethra and skin face for ventral island). Materials and methods: From 1997 until 2007, 88 patients with proximal severe hypospadias have been operated. 35 patients associated penoscrotal transposition. Since 2005, we introduced a modification consisting in drawing the incisions following the own cutaneous folds resulting from the fusion of the lateral folds in penis skin. Results: We performed Duckett type urethroplasty in 10 patients, Onlay type flap in 74, Onlay with oral mucosa in 2 and vesical mucosaurethroplasty in 2 of them. The fistula rate needing surgical closure was17% (15/88), urethral stenosis was present in 5 patients (5.7%, 1 vesical mucosa, 2 Duckett urethrolpasties and 2 Onlay flaps). Severe complications were represented by partial necrosis of thesk in flap in 3 patients (3.4%) needing a reurethroplasty. 1 patient presented surgical wound infection without later problems. Before 2005, among the 22 patients with penoscrotal transposition,(..) (AU)

Hernia diafragmática congénita asociada a secuestro pulmonar, quiste dermoide y duplicación intestinal / Congenital diaphragmatic hernia associated with pulmonary sequestration, dermoid cyst and intestinal duplication

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