Comparación de dos técnicas de sección vascular en lavaricocelectomía laparoscópica. Estudio prospectivo / Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study

Introducción: El varicocele es la dilatación anormal del plexopampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducirhipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones,incluyendo la recurrencia del varicocele, dependiendo de la técnica deoclusión vascular utilizada: clip y sección o sellador vascular, en latécnica de Palomo laparoscópico en nuestro centro.Material y métodos: Estudio longitudinal prospectivo que se realizade 2017 a 2021. Se crean dos grupos terapéuticos según el método deoclusión vascular utilizada durante la varicocelectomía laparoscópica:clip y sección o sellador vascular. Los pacientes son incluidos en ungrupo mediante asignación sistemática consecutiva alternante. Se realizael análisis de las variables: edad, grado de varicocele según la clasifica-ción de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento yrecurrencia del varicocele, según el método empleado.Resultados: Se intervinieron un total de 37 niños, con edad mediade 12 años (10-15 años) y una media de seguimiento de 12 meses. En20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes(45,9%), sellador vascular. El 24,3% presentaba varicocele Grado IIsintomático y el 75,7%, Grado III. El 32,4% de los niños presentó algunacomplicación postquirúrgica durante el seguimiento. El 29,7% de lospacientes presentó hidrocele tras la intervención, perteneciendo 8 niñosal grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisóreintervención por este motivo. Ningún paciente presentó recurrenciadel varicocele. Conclusiones: La técnica de Palomo laparoscópica es una técnicasegura y efectiva que presenta buenos resultados en pacientes pediátricos...(AU)

Introduction: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males.Varicocele diagnosis is important since it can induce testicular hyper-trophy and fertility issues in adulthood. The objective of this studywas to assess whether complications, including varicocele recurrence,depend on the vascular occlusion technique used –clipping + divisionvs. vascular sealer–in the laparoscopic Palomo technique used inour institution. Materials and methods: A longitudinal, prospective study wascarried out from 2017 to 2021. Two therapeutic groups were createdaccording to the vascular occlusion method used during laparoscopicvaricocelectomy –clipping + division vs. vascular sealer. Patients wererandomly allocated to the groups in a systematic alternating consecutivemanner. Variables –age, varicocele grade according to the Dubin-Amelarclassification, postoperative complications, follow-up, and varicocelerecurrence– were analyzed according to the method employed.Results: A total of 37 boys, with a mean age of 12 years (10-15years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17(45.9%), the vascular sealer was employed. 24.3% had symptomaticGrade II varicocele and 75.7% had Grade III varicocele. 32.4% of thechildren had postoperative complications during follow-up. 29.7% ofthe patients had hydrocele following surgery –8 boys from the seal-ing group and 3 boys from the clipping group–, with 13.5% requiringre-intervention as a result of this. None of the patients had varicocelerecurrence. Conclusions: The laparoscopic Palomo technique is safe and ef-fective, with good results in pediatric patients and few postoperativecomplications, regardless of the vascular occlusion device used...(AU)

Comparing two vascular division techniques in laparoscopic varicocelectomy. A prospective study. / Comparación de dos técnicas de sección vascular en la varicocelectomía laparoscópica. Estudio prospectivo.

INTRODUCTION: Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution. MATERIALS AND METHODS: A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence- were analyzed according to the method employed. RESULTS: A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence. CONCLUSIONS: The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences.

INTRODUCCION: El varicocele es la dilatación anormal del plexo pampiniforme. Puede afectar al 15-20% de los varones preadolescentes-adultos. La importancia de su diagnóstico radica en que puede inducir hipotrofia testicular y problemas de fertilidad en la etapa adulta. El objetivo de este estudio es evaluar si existe mayor índice de complicaciones, incluyendo la recurrencia del varicocele, dependiendo de la técnica de oclusión vascular utilizada: clip y sección o sellador vascular, en la técnica de Palomo laparoscópico en nuestro centro. MATERIAL Y METODOS: Estudio longitudinal prospectivo que se realiza de 2017 a 2021. Se crean dos grupos terapéuticos según el método de oclusión vascular utilizada durante la varicocelectomía laparoscópica: clip y sección o sellador vascular. Los pacientes son incluidos en un grupo mediante asignación sistemática consecutiva alternante. Se realiza el análisis de las variables: edad, grado de varicocele según la clasificación de Dubin-Amelar, complicaciones postquirúrgicas, seguimiento y recurrencia del varicocele, según el método empleado. RESULTADOS: Se intervinieron un total de 37 niños, con edad media de 12 años (10-15 años) y una media de seguimiento de 12 meses. En 20 pacientes (54,1%), se utilizó clip y sección, y en los 17 restantes (45,9%), sellador vascular. El 24,3% presentaba varicocele Grado II sintomático y el 75,7%, Grado III. El 32,4% de los niños presentó alguna complicación postquirúrgica durante el seguimiento. El 29,7% de los pacientes presentó hidrocele tras la intervención, perteneciendo 8 niños al grupo de sellado y 3 niños al de clipaje. El 13,5% de estos precisó reintervención por este motivo. Ningún paciente presentó recurrencia del varicocele. CONCLUSIONES: La técnica de Palomo laparoscópica es una técnica segura y efectiva que presenta buenos resultados en pacientes pediátricos, ya que presenta pocas complicaciones postquirúrgicas, independientemente del dispositivo de oclusión vascular que se utilice. En nuestro estudio, no se ha demostrado que existan diferencias estadísticamente significativas en cuanto al uso de clip o sellador vascular en esta técnica laparoscópica. No obstante, es preciso realizar más estudios con mayor tamaño muestral para hallar posibles diferencias.

Assessment of quality indicators in pediatric major outpatient surgery. Influence of the COVID-19 pandemic. / Evaluación de los indicadores de calidad en cirugía mayor ambulatoria pediátrica. Influencia de la pandemia por COVID-19.

INTRODUCTION: Major Outpatient Surgery (MOS) is an organizational and management model for surgical care that allows selected patients to be treated efficiently and safely. Our objective was to evaluate the quality of the different activities through standardized quality indicators, analyzing whether they have been modified during the COVID-19 pandemic. MATERIALS AND METHODS: An observational and comparative descriptive study of the quality indicators (QI) of MOS in our Pediatric Surgery Department from 2019 to 2020 was carried out. In accordance with the International Association for Ambulatory Surgery (IAAS) and the recommendations of the Spanish Ministry of Health and Consumer Affairs, we assessed the basic quality and the degree of family satisfaction of patients undergoing MOS. RESULTS: A total of 848 and 652 interventions were performed in 2019 and 2020, respectively, with a mean age of 6 and 7 years. 539 (ambulatory rate (AR) 63.6%) and 465 (AR 71.3%) MOS surgeries were conducted in 2019 and 2020. In 2019, the overall substitution rate (SR) was 96.8%, hospitalization rate (HR) was 1.67%, suspension rate was 5.94%, and readmission rate was 1.48%. In 2020, the overall IS was 98.3%, HR was 0.86%, suspension rate was 4.73%, and readmission rate was 1.72%. No differences were found in terms of satisfaction between 2020 and 2019. CONCLUSIONS: QI allow us to know and analyze the performance and results of the different management units. In our department, the COVID-19 pandemic has not reduced the quality of CMA care.

INTRODUCCION: La cirugía mayor ambulatoria (CMA) es un modelo de gestión de asistencia quirúrgica que permite tratar de forma eficiente y segura a pacientes seleccionados. Nuestro objetivo es evaluar la calidad de esta actividad a través de indicadores de calidad estandarizados, analizando si se han visto modificados durante la pandemia por COVID-19. MATERIAL Y METODOS: Estudio descriptivo observacional y comparativo entre 2019 y 2020 de los indicadores de calidad (IC) de CMA de nuestra unidad de Cirugía Pediátrica. De acuerdo con la International Association for Ambulatory Surgery (IAAS) y las recomendaciones del Ministerio de Sanidad y Consumo, valoramos los indicadores de calidad básicos para CMA, así como el grado de satisfacción de las familias de pacientes intervenidos en este régimen. RESULTADOS: En total 848 y 652 intervenciones realizadas en 2019 y 2020, respectivamente, con edad media de 6 y 7 años. 539 (índice de ambulatorización (IA) 63,6%) y 465 (IA 71,3%) cirugías en régimen de CMA en 2019 y 2020. En 2019, índice de sustitución (IS) global 96,8%, índice de hospitalización (IH) 1,67%, índice de suspensión 5,94% e índice de reingreso 1,48%. En el año 2020, IS global 98,3%, IH 0,86%, índice de suspensión 4,73% e índice de reingreso 1,72%. No hemos encontrado diferencias en el grado de satisfacción entre ambos años. CONCLUSIONES: Los IC permiten conocer y analizar el funcionamiento y los resultados de las distintas unidades de gestión. En nuestra Unidad, la pandemia por COVID-19 no ha reducido la calidad de la asistencia en régimen de CMA.

Evaluación de los indicadores de calidad en cirugía mayor ambulatoria pediátrica. Influencia de la pandemia por COVID-19 / Assessment of quality indicators in pediatric major outpatient surgery. Influence of the COVID-19 pandemic

Introducción. La cirugía mayor ambulatoria (CMA) es un modelo de gestión de asistencia quirúrgica que permite tratar de forma eficiente y segura a pacientes seleccionados. Nuestro objetivo es evaluar la calidad de esta actividad a través de indicadores de calidad estandarizados, analizando si se han visto modificados durante la pandemia por COVID-19. Material y métodos. Estudio descriptivo observacional y comparativo entre 2019 y 2020 de los indicadores de calidad (IC) de CMA de nuestra unidad de Cirugía Pediátrica. De acuerdo con la International Association for Ambulatory Surgery (IAAS) y las recomendaciones del Ministerio de Sanidad y Consumo, valoramos los indicadores de calidad básicos para CMA, así como el grado de satisfacción de las familias depacientes intervenidos en este régimen. Resultados. En total 848 y 652 intervenciones realizadas en 2019 y 2020, respectivamente, con edad media de 6 y 7 años. 539 (índice de ambulatorización (IA) 63,6%) y 465 (IA 71,3%) cirugías en régimen de CMA en 2019 y 2020. En 2019, índice de sustitución (IS) global 96,8%, índice de hospitalización (IH) 1,67%, índice de suspensión 5,94% e índice de reingreso 1,48%. En el año 2020, IS global 98,3%, IH 0,86%, índice de suspensión 4,73% e índice de reingreso 1,72%. No hemos encontrado diferencias en el grado de satisfacción entre ambos años. Conclusiones. Los IC permiten conocer y analizar el funcionamiento y los resultados de las distintas unidades de gestión. En nuestra Unidad, la pandemia por COVID-19 no ha reducido la calidad de la asistencia en régimen de CMA.(AU)

Introduction: ajor Outpatient Surgery (MOS) is an organizational and management model for surgical care that allows selected patients to be treated efficiently and safely. Our objective was to evaluate the quality of the different activities through standardized quality indicators, analyzing whether they have been modified during the COVID-19 pandemic. Materials and methods: An observational and comparative descriptive study of the quality indicators (QI) of MOS in our Pediatric Surgery Department from 2019 to 2020 was carried out. In accordance with the International Association for Ambulatory Surgery (IAAS) and the recommendations of the Spanish Ministry of Health and Consumer Affairs, we assessed the basic quality and the degree of family satisfaction of patients undergoing MOS. Results: A total of 848 and 652 interventions were performed in 2019 and 2020, respectively, with a mean age of 6 and 7 years. 539 (ambulatory rate (AR) 63.6%) and 465 (AR 71.3%) MOS surgeries were conducted in 2019 and 2020. In 2019, the overall substitution rate (SR) was 96.8%, hospitalization rate (HR) was 1.67%, suspension rate was 5.94%, and readmission rate was 1.48%. In 2020, the overall IS was 98.3%, HR was 0.86%, suspension rate was 4.73%, and readmission rate was 1.72%. No differences were found in terms of satisfaction between 2020 and 2019. Conclusions: QI allow us to know and analyze the performance and results of the different management units. In our department, the COVID-19 pandemic has not reduced the quality of CMA care.(AU)

Congenital malformations of the urinary tract: progression to chronic renal disease. / Malformaciones congénitas del tracto urinario (CAKUT): evolución a enfermedad renal crónica.

INTRODUCTION: Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage. MATERIALS AND METHODS: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for. RESULTS: The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD. CONCLUSIONS: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

INTRODUCCION: Las anomalías nefrourológicas congénitas (CAKUT), constituyen un grupo de enfermedades de gran relevancia por su alta prevalencia y por ser la principal causa de enfermedad renal crónica (ERC) en la población pediátrica. Nuestro objetivo es conocer las características y la prevalencia de CAKUT en nuestro medio, identificando los factores asociados a la aparición de daño renal. MATERIAL Y METODOS: Estudio retrospectivo, descriptivo, analítico y transversal, que incluyó los pacientes atendidos en la consulta de Nefrología Pediátrica de un hospital de tercer nivel desde el 1 de enero al 31 de diciembre de 2018. Se analizaron variables epidemiológicas, clínicas y analíticas, y se buscaron posibles factores de riesgo asociados a ERC. RESULTADOS: Se incluyeron 685 pacientes con 827 unidades renales con CAKUT con una edad media de 9,98 ± 5,12 años. El 62,2% fueron varones y el seguimiento medio desde el diagnóstico fue de 9,95 ± 5,09 años. El 58,8% fueron dilataciones no obstructivas, seguido por displasia renal, dilataciones obstructivas y anomalías de número y posición. La malformación más frecuente fue el reflujo vesicoureteral (RVU). El lado más afectado fue el izquierdo (47,5%). El 55% de los diagnósticos fueron prenatales. Fueron intervenidos 172 pacientes. El tratamiento inicial de elección en el RVU fue endourológico. La tasa de reintervención global alcanzó el 20%. Del total de pacientes, se pudo analizar el filtrado glomerular en 383 pacientes, de los cuales 95 (24,8%) tenían ERC (86% en estadio 2). El sexo masculino, la bilateralidad y la proteinuria fueron factores de riesgo asociados a la ERC. CONCLUSIONES: El conocimiento de las características epidemiológicas y clínicas de los niños con CAKUT y de los factores asociados a la ERC ayuda a individualizar el seguimiento clínico de estos pacientes adecuando las pruebas diagnósticas y los recursos sanitarios.

Malformaciones congénitas del tracto urinario(CAKUT): evolución a enfermedad renal crónica / Congenital malformations of the urinary tract: progression to chronic renal disease

Introducción: Las anomalías nefrourológicas congénitas (CAKUT),constituyen un grupo de enfermedades de gran relevancia por su altaprevalencia y por ser la principal causa de enfermedad renal crónica(ERC) en la población pediátrica. Nuestro objetivo es conocer las ca-racterísticas y la prevalencia de CAKUT en nuestro medio, identificandolos factores asociados a la aparición de daño renal. Material y métodos: Estudio retrospectivo, descriptivo, analíticoy transversal, que incluyó los pacientes atendidos en la consulta deNefrología Pediátrica de un hospital de tercer nivel desde el 1 de eneroal 31 de diciembre de 2018. Se analizaron variables epidemiológicas,clínicas y analíticas, y se buscaron posibles factores de riesgo aso-ciados a ERC.Resultados: Se incluyeron 685 pacientes con 827 unidades rena-les con CAKUT con una edad media de 9,98 ± 5,12 años. El 62,2%fueron varones y el seguimiento medio desde el diagnóstico fue de9,95 ± 5,09 años. El 58,8% fueron dilataciones no obstructivas, se-guido por displasia renal, dilataciones obstructivas y anomalías denúmero y posición. La malformación más frecuente fue el reflujovesicoureteral (RVU). El lado más afectado fue el izquierdo (47,5%).El 55% de los diagnósticos fueron prenatales. Fueron intervenidos172 pacientes. El tratamiento inicial de elección en el RVU fue en-dourológico. La tasa de reintervención global alcanzó el 20%. Deltotal de pacientes, se pudo analizar el filtrado glomerular en 383pacientes, de los cuales 95 (24,8%) tenían ERC (86% en estadio 2).El sexo masculino, la bilateralidad y la proteinuria fueron factoresde riesgo asociados a la ERC. Conclusiones: El conocimiento de las características epidemioló-gicas y clínicas de los niños con CAKUT y de los factores asociados ala ERC ayuda a individualizar el seguimiento clínico de estos pacientesadecuando las pruebas diagnósticas y los recursos sanitarios.(AU)

Introduction: Congenital nephrourological abnormalities (CAKUT)are a particularly relevant group of diseases due to their high prevalenceand the fact they are the main cause of chronic renal disease (CRD) in thepediatric population. Our objective was to determine the characteristicsand prevalence of CAKUT in our setting, while identifying the factorsassociated with the occurrence of renal damage. Materials and methods: A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric NephrologyDepartment of a third-level hospital from January 1 to December 31,2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRDwere searched for.Results: The study involved 685 patients with 827 kidney unitsaffected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% weremale, and the mean follow-up period after diagnosis was 9.95 ± 5.09years. 58.8% were non-obstructive dilations, followed by renal dysplasia,obstructive dilations, and number and position abnormalities. The mostfrequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses wereprenatal. 172 patients underwent surgery. The initially chosen treatmentfor VUR was endourological. Overall re-intervention rate was 20%. Ofthe total number of patients, glomerular filtration rate was analyzed in383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilateral ity, and proteinuria were risk factors associated with CRD. Conclusions: Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated withCRD helps to individualize the clinical follow-up of these patients, thuscustomizing diagnostic tests and healthcare resources.(AU)

Clavien-Dindo classification: a tool to assess complications following surgical treatment in children with acute appendicitis. / Clasificación de Clavien-Dindo. Herramienta para evaluar las complicaciones tras el tratamiento quirúrgico en niños con apendicitis aguda.

INTRODUCTION: In pediatrics, there are few standard criteria to classify and consolidate postoperative complications, particularly in appendectomy, where according to the literature, complications range from 5% to 30%. METHODS: A cross-sectional, observational, retrospective study of patients undergoing surgery as a result of suspected acute appendicitis (AA) from December 2018 to January 2020 was carried out. Complications were grouped and consolidated according to the Clavien-Dindo (CD) classification. Postoperative complications and factors involved were analyzed by conducting a bivariate and multivariate statistical study using SPSS statistical software, version 25. RESULTS: A total of 124 patients were studied. Mean age was 9 years (3-14 years). 62% were boys, and 38% were girls. All patients underwent appendectomy - 80.6% through laparotomy, and 19.4% through laparoscopy. 20% of patients had postoperative complications, which were grouped according to the CD classification (p = 0.002). Most complications were included in the CD I group (64%). Collections treated with antibiotic therapy were included in the CD II group (28%). Intra-abdominal collections requiring re-intervention for drainage purposes were included in the CD IIIb group (8%). The main factors driving complications were complicated AA (81% gangrenous and perforated) (p < 0.001) and progression time (80% > 24 h of progression) (p = 0.036), which increased mean hospital stay by 7 ± 4 days (p = 0.016). 137 ± 37 CRP levels were associated with plastron identification (p < 0.001), whereas 109 ± 19 CRP levels were associated with peritonitis (p < 0.001). CONCLUSIONS: The Clavien-Dindo classification allows post-appendectomy complications in pediatric surgery to be classified using a common language, by associating complication grade with treatment complexity.

INTRODUCCION: En pediatría hay pocos criterios estándares para clasificar y unificar las complicaciones postquirúrgicas y en particular en la apendicectomía, donde, según la literatura, las complicaciones varían de un 5-30%. METODOS: Realizamos un estudio retrospectivo, observacional tipo transversal de los pacientes intervenidos por sospecha de apendicitis aguda (AA) durante diciembre 2018 a enero 2020. Las complicaciones fueron agrupadas y unificadas según la clasificación de Clavien-Dindo (CD). Se analizan las complicaciones postoperatorias y factores implicados, aplicando estudio estadístico bivariante y multivariante según el programa estadístico SPSS versión 25. RESULTADOS: Un total de 124 pacientes incluidos. Edad media 9 años (3-14 años). 62% niños, 38% niñas. A todos se les realizó apendicectomía, el 80,6% apendicectomía abierta, 19,4% por laparoscopia. El 20% presentó algún tipo de complicación en el postoperatorio y fueron agrupadas según la clasificación de CD (p = 0,002). En CD I (64%) se incluyen la mayoría de las complicaciones, En el grupo CD II (28%) colecciones tratadas con antibioticoterapia. En el grupo CD IIIb (8%), colección intraabdominal que requirió reintervención para su drenaje. Los principales factores implicados en la aparición de complicaciones fueron: AA complicadas (81% gangrenosas y perforadas) (p < 0,001), tiempo de evolución (80% > 24 h de evolución) (p = 0,036) que incrementó la estancia media 7 ± 4 días (p = 0,016). El valor de proteína C reactiva (PCR) (137 ± 37) se relacionó con la identificación de plastrón (p < 0,001), y el valor de PCR (109 ± 19) con peritonitis (p < 0,001). CONCLUSIONES: La clasificación de Clavien-Dindo permite utilizar un lenguaje común para clasificar las complicaciones postapendicectomía en cirugía pediátrica, expresando el grado de estas según complejidad del tratamiento utilizado para su resolución.

Clasificación de Clavien-Dindo. Herramienta para evaluar las complicaciones tras el tratamiento quirúrgico en niños con apendicitis aguda / Clavien-Dindo classification: a tool to assess complications following surgical treatment in children with acute appendicitis

Introducción: En pediatría hay pocos criterios estándares para clasificar y unificar las complicaciones postquirúrgicas y en particular en la apendicectomía, donde, según la literatura, las complicaciones varían de un 5-30%.Métodos: Realizamos un estudio retrospectivo, observacional tipo transversal de los pacientes intervenidos por sospecha de apendicitis aguda (AA) durante diciembre de 2018 a enero de 2020. Las complicaciones fueron agrupadas y unificadas según la clasificación de Clavien-Dindo (CD). Se analizan las complicaciones postoperatorias y factores impli- cados, aplicando estudio estadístico bivariante y multivariante según el programa estadístico SPSS versión 25.Resultados: Un total de 124 pacientes incluidos. Edad media, 9 años (3-14 años). 62% niños, 38% niñas. A todos se les realizó apendicectomía, el 80,6% apendicectomía abierta, 19,4% por laparoscopia. El 20% presentó algún tipo de complicación en el postoperatorio y fueron agrupadas según la clasificación de CD (p = 0,002). En CD I (64%) se incluyen la mayoría de las complicaciones. En el grupo CD II (28%) colecciones tratadas con antibioticoterapia. En el grupo CD IIIb (8%), colección intraabdominal que requirió reintervención para su drenaje.Los principales factores implicados en la aparición de complicaciones fueron: AA complicadas (81% gangrenosas y perforadas) (p < 0,001), tiempo de evolución (80% >24 h de evolución) (p = 0,036) que incrementó la estancia media 7 ± 4 días (p = 0,016). El valor de proteína C reactiva (PCR) (137 ± 37) se relacionó con la identificación de plastrón (p < 0,001), y el valor de PCR (109 ± 19) con peritonitis (p < 0,001). Conclusiones: La clasificación de Clavien-Dindo permite utilizar un lenguaje común para clasificar las complicaciones postapendicectomía en cirugía pediátrica, expresando el grado de estas según complejidad del tratamiento utilizado para su resolución.

Introduction: In pediatrics, there are few standard criteria to classify and consolidate postoperative complications, particularly in appendectomy, where according to the literature, complications range from 5% to 30%. Methods. A cross-sectional, observational, retrospective study of patients undergoing surgery as a result of suspected acute appendicitis (AA) from December 2018 to January 2020 was carried out. Complications were grouped and consolidated according to the Clavien-Dindo (CD) classification. Postoperative complications and factors involved were analyzed by conducting a bivariate and multivariate statistical study using SPSS statistical software, version 25.Results: A total of 124 patients were studied. Mean age was 9 years (3-14 years). 62% were boys, and 38% were girls. All patients underwent appendectomy – 80.6% through laparotomy, and 19.4% through laparoscopy. 20% of patients had postoperative complications, which were grouped according to the CD classification (p = 0.002). Most complications were included in the CD I group (64%). Collections treated with antibiotic therapy were included in the CD II group (28%). Intraabdominal collections requiring reintervention for drainage purposes were included in the CD IIIb group (8%). The main factors driving complications were complicated AA (81% gangrenous and perforated) (p < 0.001) and progression time (80% >24 h of progression) (p = 0.036), which increased mean hospital stay by 7 ± 4 days (p = 0.016). 137 ±37 CRP levels were associated with plastron identification (p < 0.001), whereas 109 ± 19 CRP levels were associated with peritonitis (p < 0.001).Conclusions: The Clavien-Dindo classification allows post-appendec tomy complications in pediatric surgery to be classified using a common language, by associating complication grade with treatment complexity.

Transanal endoscopic surgery with a 3D printed device.

BACKGROUND: The aim of this study was to investigate the effectiveness of devices manufactured with 3D printing for performing transanal endoscopic procedures without pneumorectum. METHODS: Functional devices were designed in the Polytechnic School of Engineering of Gijón from 2016 to 2018 using three-dimensional (3D) solid modelling software (Solid-Works®), that allows customization of the device (diameter and length). The devices were made in acrylonitrile butadiene styrene (ABS) by additive manufacturing using an HP Designjet 3D Printer, with fused deposition modelling (FDM) technology. Tests were carried out on mixed simulators (with viscera) and cadavers with a prototype in the form of an open cylindrical base ellipsoid spindle with two bars. In this paper, we present the information of the first series of patients in which this device has been used to perform a full-thikness endoscopic resection of the rectal wall without pneumorectum. The characteristics of the patients, size, and location of the lesion, the type of anesthesia used, the duration of the procedure, hospital stay, complications, and pathology were analyzed. An endoscopic follow-up was also carried out for at least 2 years. RESULTS: Seven interventions were carried out in six patients. The lesions were located at a mean distance of 5 cm from the anal verge and an average area of 11.8 cm2. Four of the procedures were performed with general anesthesia and 3 with spinal anesthesia. Histopathology examination identified 3 adenomas, 3 pT1 and 1 pT2 adenocarcinomas. All excisions were full thickness. En bloc excision was possible in all cases. In only one case of a benign polyp there was a positive lateral margin. As regards complications, there was one case of postoperative rectal bleeding without the need for transfusions. There were no readmissions and no postoperative mortality. CONCLUSIONS: An innovative device made with a 3D printer can be used successfully in transanal endoscopic resections of the rectal wall, with spinal anaesthesia and avoiding the need for pneumorectum.

Conservative parenchymal surgery in testicular tumors. / Cirugía conservadora de parénquima en tumores testiculares.

OBJECTIVES: Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery. MATERIAL AND METHODS: A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients. RESULTS: Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence. CONCLUSIONS: Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved.

OBJETIVOS: La orquiectomía ha sido la técnica quirúrgica clásicamente más empleada en tumores testiculares (TT). Sin embargo, en función del tamaño del tumor, marcadores tumorales e histología, se puede considerar la tumorectomía como técnica de elección, ya que en su mayoría se trata de tumores benignos. Presentamos nuestra experiencia en cirugía conservadora. MATERIAL Y METODOS: Estudio retrospectivo de 21 casos de TT en 19 pacientes menores de 14 años, tratados en nuestro centro entre 1998-2018. Analizamos las siguientes variables: edad, lateralidad, tipo histológico, evolución, existencia o no de recidivas, seguimiento ecográfico y analítico. Revisamos la actitud terapéutica empleada, con énfasis en la posibilidad de preservación testicular en pacientes seleccionados. RESULTADOS: Se realizó cirugía conservadora en nueve casos de TT tratados que correspondían a siete pacientes (dos bilaterales). La edad media de presentación fue de seis años (0-13 años). El 86% de los casos debutaron como masa escrotal asintomática. No existieron diferencias significativas en cuanto a lateralidad. Los marcadores tumorales fueron negativos antes y después de la intervención, salvo en un lactante con alfafetoproteína elevada, normalizada en el posoperatorio. El estudio histológico diagnostica 7TT estromales (tres de células de Leydig y uno bilateral de células de Sertoli, un hamartoma y un fibroma) y 2TT de células germinales (quiste epidermoide bilateral). Evolución favorable en todos ellos, sin recidivas clínicas ni ecográficas. CONCLUSIONES: La cirugía conservadora del parénquima testicular, mediante tumorectomía, puede ser la primera opción terapéutica en tumores benignos y en pacientes seleccionados con tumores bilaterales, con el objetivo de preservar la función hormonal y reproductora futura.

Suitability of therapeutic effort in paediatric intensive care units: Opinion and attitude of professionals. / Adecuación del esfuerzo terapéutico en unidades de cuidados intensivos pediátricos: opinión y actitud de los profesionales.

OBJECTIVE: To determine the opinion and describe the attitude of different health professionals on suitability of therapeutic effort. METHOD: Multi-centre, cross-sectional observational study carried out with nurses and doctors who work in the paediatric intensive care units of four hospitals in the Madrid region. A self-administered questionnaire, previously piloted to assess its viability, was used and a sealed box was set up at the nursing station to hand it in. The analysis was performed using SPSS 21.0 software. RESULTS: The 98.9% of the respondents were in favour of suitability of therapeutic effort. Doctors consider that the decision is made with the agreement of the multidisciplinary staff and the child's parents (48.8%). Of the nurses, 51.1% believe that the decision is made by agreement with the doctors and parents. Of the nurses, 65.5% state that they are never asked about decision-making for their patients. Of the doctors, 75% are always or almost always asked. Fifty-seven percent of the nurses and 83% of the doctors feel capable of making decisions about suitability of therapeutic effort. Of the professionals, 77.2% believe that suitability is used less often than required. CONCLUSIONS: There are differences between doctors and nurses both in the perception of the decision-making model and in the way to proceed. Professionals seem not to follow any protocols or circuits in the decision-making process.

Allergy management in primary care across European countries -- actual status.

The standard of care for allergies within a primary care (PC) setting has a strong influence on disease prevention and control, quality of life, and patient satisfaction. The level of knowledge of allergic diseases and the accessibility to regular follow-up are essential. EAACI and IPCRG conducted a survey to evaluate the actual status of care for allergic diseases in PC. Access to allergy and asthma specialist treatment was identified as the greatest 'unmet need'. The average waiting time between a referral and being seen in a public health service is usually >6 weeks. Referring the patients to an 'organ' specialist is much easier compared with referral to an allergist. Most PCPs have access to blood tests for total and specific IgE. Skin prick testing is available in only half of the cases, while provocation tests, allergen quantification in homes, and a dietician service are even less available. 20.6% of practices do not have access to allergy tests at all. Other issues raised were low political or general public awareness, lack of understanding by the patients of their allergic disease, the need to invest in PC, and to achieve sufficient competence at the appropriate level of care.

Analysis of the variability in the number of viable bacteria after mild heat treatment of food.

Variability in the numbers of bacteria remaining in saline solution and whole milk following mild heat treatment has been studied with Listeria innocua, Enterococcus faecalis, Salmonella enterica serovar Enteritidis, and Pseudomonas fluorescens. As expected, the most heat-resistant bacterium was E. faecalis, while P. fluorescens was the least heat resistant, and all bacteria showed greater thermal resistance in whole milk than in saline solution. Despite the differences in the inactivation kinetics of these bacteria in different media, the variability in the final number of bacteria was affected neither by the species nor by the heating substrate, but it did depend on the intensity of the heat treatment. The more severe the heat treatment was, the lower the average number of surviving bacteria but the greater the variability. Our results indicated that the inactivation times for the cells within a population are not identically distributed random variables and that, therefore, the population includes subpopulations of cells with different distributions for the heat resistance parameters. A linear relationship between the variability of the log of the final bacterial concentration and the logarithmic reduction in the size of the bacterial population was found.

Prevalencia de síntomas urinarios e incontinencia de orina en una muestra de mujeres militares del Ejército del Aire / Prevalence of urinary symptoms and urinary incontinence in a sample of Air Force military women

Objetivo: determinar por primera vez la prevalencia de síntomas urinarios e incontinencia urinaria y su repercusión sobre la calidad de vida y la actividad profesional de una muestra de mujeres militares. Material y Métodos: Se administró a una muestra de 50 mujeres militares profesionales, de edad media: 25,9 años, (intervalo entre 18 y 33 años), destinadas en la BA de Torrejón, la versión española del cuestionario de puntuación por síntomas urinarios «King Health Questionnaire». Resultados: El síntoma urinario más frecuente fue la frecuencia miccional aumentada (o polaquiuria), referido por el 60% de las encuestadas, seguido de la nicturia, presente en un 48% de las mujeres de la muestra. Un 30% de las encuestadas no refirieron ningún tipo de alteración urinaria, y un 28% infecciones urinarias. La incontinencia urinaria en sus diversos tipos, presente en un 28% de los casos. La incontinencia de esfuerzo estuvo presente en el 24% y la urgencia incontinencia en el 20%. Un 23 % de las encuestadas refirieron que los síntomas urinarios afectaban a su vida general y un 11% a su actividad física. La frecuencia miccional fue la que mostró más diferencias significativas respecto a la repercusión sobre la calidad de vida, seguida de la incontinencia de esfuerzo, urgencia-incontinencia e infección urinaria. Conclusiones: a pesar de la baja repercusión sobre su calidad de vida y desarrollo de sus actividades profesionales de los síntomas urinarios, se observa una alta prevalencia de síntomas urinarios e incontinencia urinaria en la muestra de mujeres estudiada, a pesar de tratarse de una población joven y con buen estado de salud (AU)

Objective: to determine for the first time the prevalence of urinary symptoms and urinary incontinence and their impact on the quality of life and professional activity of a sample of military women. Material and Methods: the Spanish version of the “King’s Health Questionnaire” for urinary symptoms was administered to a sample of 50 military women, average age 25.9 years (interval between 18 and 33 years) in the Torrejón Air Force Base. Results: the most common urinary symptom was the increased urinary frequency, indicated by 60 % of the interviewed subjects, followed by nocturia, present in 48 % of the sample. No urinary alteration was reported by 30 % of the subjects and 28 % reported urinary infections. Urinary incontinence in its different presentations was present in 28 % of the cases. Effort related incontinence was present in 24 % and urge incontinence in 20%. Among the interviewed personnel 23 % reported that the urinary symptoms had an impact on their life quality and 11 % on their physical activity. Urinary frequency was the parameter that showed the most significant differences on the quality of life, followed by the effort-related incontinence, urge incontinence and urinary infection. Conclusions: In spite of the low repercussion of the urinary symptoms on their life quality and professional activities, a high prevalence of urinary symptoms and incontinence is observed in the studied sample of military women, even though this is a young and healthy population (AU)

[Scrotal leiomyosarcoma with bone metastasis]. / Leiomiosarcoma escrotal con metástasis óseas.

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metastasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization.

Leiomiosarcoma escrotal con metástasis óseas / Scrotal leiomyosarcoma with bone metastasis

Se presenta un caso de leiomiosarcoma de escroto en un paciente de 87 años que debuta como una lesión en hemiescroto izquierdo indolora, y de un año de evolución. En el momento del diagnóstico se observa la presencia de metástasis óseas. Se realiza una revisión de la literatura comprobándose la rareza de este tipo de lesión (sólo se han descrito 27 casos), y que a diferencia de otro tipo de leiomiosarcomas, su evolución agresiva no es habitual en esta localización

A case of scrotum leiomyosarcoma is presented in a 87 year-old patient. It debuts as a painless lesion in left hemiescrotum, of one year of evolution. Bony metástasis were observed in the moment of the diagnosis. We carried out a literature revision proving the rarity of this lesion type (only 27 cases have been described), and that, contrary to another leiomiosarcomas type, their aggressive evolution is not habitual in this localization

El transporte de heridos por vía aérea durante la campaña del norte de África / Air evacuation of casualties during the North African campaign 1921-1927

La Gran Guerra cambió por completo los conceptos de asistencia médico-quirúrgica de urgencia en la campaña del norte de África, aconsejando que se practicara lo más cercana posible al frente. Se idearon formaciones quirúrgicas móviles que acompañaban a las tropas como el hospital quirúrgico de montaña inspirado en la ambulancia quirúrgica automóvil de Marcille, el auto Chir de Prousts y Gosset o el hospital quirúrgico móvil de Plisson usados por belgas y franceses en la I Guerra Mundial. La idea hasta entonces en nuestros territorios del norte de África era instalar hospitales fijos en las grandes ciudades, hasta donde los heridos debían ser transportados en lentos convoyes que circulaban por malas carreteras y bajo el acoso del enemigo. Esto hacía que los heridos llegasen en muy malas condiciones y que por tanto los resultados fueran funestos. Esta modificación de la doctrina sanitaria fue vital en el comienzo del uso de los aviones sanitarios para el transporte de los heridos graves a los hospitales de retaguardia con urgencia y rapidez. En este trabajo se realiza una descripción de la ubicación de los primeros aeródromos de nuestras posesiones norteafricanas, un estudio de los primeros aparatos, personal encargado de su pilotaje y cuidados así como un relato en cifras de las primeras aeroevacuaciones (AU)

The Great War completely changed the concepts of emergency medical care in the North African campaign, with the recommendation to provide the medical care as near as posible to the front line. Mobile surgical formations were designed which followed the units, as the mountain surgical hospital, inspired in the Marcille´s automobile surgical ambulance, Proust and Gosset´s or Plisson´s mobile surgical hospital used by Belgians and French in the World War I. Until then the concept in our North African territories was to establish fixed hospitals in the big cities, to which the wounded had to be transported in slow convoys that travelled on bad roads and under the harassment of the enemy. This usually caused the wounded to arrive in seriuly deteriorated conditions and therefore the outcome was often disastrous. This modification of the medical support doctrine was vital in the beginning of the use of the medical planes for the evacuation of the severly wounded to the rear hospitals with urgency and rapidity. In this article a description of the location of the first aerodromes in our North African possessions is made, as well as a study of the first aircrafts, flying and maintenance personnel and an account in numbers of the first air evacuations (AU)

Rotura uterina postparto en gestante con útero sano / Postpartum rupture of a healthy uterus

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