Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

Consenso AITP español: Una lista de verificación AITP / Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist

Introducción: El curso de Asistencia Inicial al Trauma Pediátricose imparte en España desde 1997, existiendo en la actualidad 9 centrosformadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al errorpor olvido, por lo que las listas de verificación, como herramientasmnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas deverificación para la asistencia al traumatismo pediátrico, ninguna se hadesarrollado en el entorno de nuestro curso. Material y métodos: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con lacomisión científica de politrauma de la Sociedad Española de CirugíaPediátrica. Los ítems para formar la lista de verificación se obtuvierona partir de una revisión bibliográfica y de la consulta a los expertosseleccionados, empleando un método Delphi. Resultados. Se seleccionaron 10 expertos que representan los 9grupos o centros formadores en Asistencia Inicial al Trauma Pediátri-co y se elaboró una lista de verificación con 28 ítems, siguiendo susrecomendaciones de diseño. Conclusiones: Se diseñó una lista de verificación para el manejodel paciente pediátrico politraumatizado, con el consenso de todos losgrupos empleando un método Delphi, requisito fundamental para facilitarla difusión de esta lista. Sería preciso adaptar y validar dicha lista parasu uso en cada centro asistencial.(AU)

Introduction: The course in Primary Care in Pediatric Trauma(ATIP in Spanish) has been taught in Spain since 1997, and there arecurrently 9 accredited training centers. Care of polytraumatized pedi-atric patients often takes place in an environment conducive to errorsresulting from forgetfulness, which is why checklists –mnemonic toolswidely used in industry and medicine– are particularly useful to avoidsuch errors. Although several checklists exist for pediatric trauma care,none have been developed within the setting of our course. Materials and methods: The criteria for being selected as an expertin Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society.The items that make up the checklist were obtained from a review ofthe literature and consultation with selected experts, using the DelphiTechnique. Results: 10 experts representing the 9 groups or training centers inPrimary Care in Pediatric Trauma were selected, and a 28-item checklistwas drawn up in accordance with their design recommendations.Conclusions: With the consensus of all the groups, a checklist forthe treatment of polytraumatized pediatric patients was drawn up usingthe Delphi Technique, an essential requirement for the disseminationof this checklist, which should be adapted and validated for use in eachhealthcare center.(AU)

Intraoperative injection of (99mm)Tc- nanocolloid for localization of nonpalpable intratesticular tumours in organ-sparing surgery.

OBJECTIVE: Radical orchidectomy is the standard treatment for malignant testis tumours. Radical orchidectomy results in androgen deprivation, infertility and impaired psychological well-being, especially in synchronous bilateral tumours, metachronous contralateral tumours or tumour in a solitary testis. According to the European Association of Urology Guidelines, if pre-operative testosterone level is normal and the tumour volume is less than 30% of the testicular volume, organ preserving surgery can be performed. For nonpalpable tumours, organ-sparing surgery needs a precise intraoperative localization with high-frequency ultrasound, especially for nonpalpable tumours. MATHERIAL AND METHODS: We report two cases of nonpalpable intratesticular tumours successfully localised using (99mm)Tc nanocolloid injected with intraoperative US and detected with a γ-ray detection probe. CONCLUSIONS: This method is easily reproducible and safe for the patient. This technique could guarantee complete excision of the tumour, especially if the mass is poorly delimited.

[Cystic lymphangioma. Our experience]. / Linfangioma quístico. Nuestra experiencia.

OBJECTIVE: To comment on the most relevant aspects and to review the literature on this unusual pathology. MATERIAL AND METHODS: We present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum. DISCUSSION: Cystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed. CONCLUSIONS: There are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma.

Linfangioma quístico. Nuestra experiencia / Cystic lymphangioma. Our experience

Objetivo: Comentar los aspectos más relevantes y revisar la literatura de esta patología tan poco frecuente. Material y métodos: Presentamos dos casos de linfangioma o higroma quístico, comentando la clínica, diagnóstico, tratamiento y la evolución de éstos y, revisando la literatura actual. El primer caso es el de un joven diagnosticado de linfangioma pélvico y escrotal. El segundo es el de un paciente con linfangioma quístico retroperitoneal. Discusión: El linfangioma quístico es una malformación congénita hamartomatosa del sistema linfático que suele aparecer en la infancia a modo de grandes masas a nivel de partes blandas, con tendencia a crecer, a no ser que se extirpen de forma completa. Conclusión: Son pocos los casos descritos de higroma quístico escrotal, muchas veces diagnosticados erróneamente, como otras patologías quísticas escrotales, lo que comporta indicaciones quirúrgicas erróneas y cirugías incompletas que predisponen a la recidiva posterior. El higroma quístico retroperitoneal aislado es una patología infrecuente diagnosticada a menudo de forma incidental

Objective: To comment on the most relevant aspects and to review the literature on this unusual pathology. Material and Methods: We present two cases of cystic lymphangioma, their clinical, diagnosis, therapy and development, and we review the actual literature. The first case is a young man with the diagnosis of cystic lymphangioma of the scrotum and pelvis. The second case is one patient with a cystic lymphangioma of the retroperitoneum. Discussion: Cystic lymphangioma is a congenital lymphatic hamartoma of the lymphatic system that usually appears at childhood like a big mass at soft tissues that has a tendency to grow unless a completed excision is performed. Conclusions: There are few cases of scrotal cystic lymphangioma in the literature; they are often misdiagnosed as other common cystic scrotal conditions leading to an improper surgical approach and an incomplete surgery that predisposes later recurrence. Cystic lymphangioma of the retroperitoneum is a rare entity diagnosis in most cases as an incidentaloma

Síndrome de Guillain-Barré después de trasplante hepático pediátrico / Guillain-Barré syndrome after pediatric liver transplantation

La presentación de un síndrome de Guillain-Barré en el postoperatorio inmediato de un trasplante de órganos sólidos en niños es un hecho infrecuente. La patogenia de estos casos se ha explicado generalmente por la presencia de infección por alguno de los agentes tradicionalmente implicados en la aparición del síndrome (citomegalovirus, Campylobacter jejuni).Presentamos un caso de síndrome de Guillain-Barré en un receptor de trasplante hepático, en el que no se encontró ninguno de los factores descritos habitualmente como inductores del mismo, y revisamos los aspectos etiopatogénicos y clinicoterapéuticos de este síndrome (AU)

[Familial fatal insomnia: a human prion disease which opens the door to a greater understanding of the thalamus]. / Insomnio familiar fatal: una enfermedad priónica humana que abre las puertas a un mayor conocimiento del tálamo.

In 1986, Lugaresi [1] described fatal familial insomnia (FFI), an inherited prion disease, characterised by untreatable insomnia and dysautonomia. The most severe neuropathological changes have been found in the mediodorsal (MD) and anterior (A) thalamic nuclei. The data lead to think that the thalamus could play an important role in the wake-sleep cycle and other vegetative and endocrine circadian activities, specially MD and A.

[Acute focal bacterial nephritis. Pathology mimicking renal masses]. / Nefritis aguda bacteriana focal. Patología mimetizante de masas renales.

Focal acute bacterial nephritis is an uncommon form of renal acute infection with a clinical presentation that, although similar to other acute infections of the renal parenchyma, must be taken into account in order to reach a correct differential diagnosis with other processes which have very similar radiological images but highly different management approaches, such as the renal carcinoma. This paper present one case in which the sings and symptoms were crucial to establish the diagnosis.

[Unilateral ureteral hernia. Report of a case]. / Hernia ureteral unilateral. A propósito de un caso.

Hernia of the ureter is an uncommon condition and may classified into two types in relation to the peritoneum: extraperitoneal (without hernial sac) and paraperitoneal (with permeable peritoneum and redundant sac). This condition is generally asymptomatic and may be detected incidentally during urography or herniorrhaphy. We report on a case that had been detected during radiologic control evaluation of a left percutaneous nephrostomy prior to treatment with ESWL of a calculus in the ipsilateral lumbar ureter.

[An arteriovenous fistula as a complication of percutaneous nephrostomy]. / Fístula arteriovenosa como complicación de la nefrostomía percutánea.

Percutaneous nephrostomy has emerged as a substitute for surgical nephrostomy. The complication rate is low, hematuria being one of the most common. Treatment should be conservative while possible since the clot plays an important role in the tamponade of hemorrhage. Arteriovenous fistulas following percutaneous nephrostomy are rare. Diagnosis is by arteriography and treatment is by selective embolization.

[Local anesthesia in the surgical management of hydrocele and cysts of the spermatic cord]. / La anestesia local en el tratamiento quirúrgico del hidrocele y quiste de cordón espermático.

Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.

[Dermatomyositis as paraneoplastic syndrome of bladder tumor]. / Dermatomiositis como síndrome paraneoplásico de tumor vesical.

The dermatomyositis is a connective tissue disease characterized by changes affecting both the skin and the muscle, appearing most frequently around the fifth and sixth decades and which association to a vesical tumour is very rare. This paper contributes one case of paraneoplastic dermatomyositis associated to infiltrant vesical tumour, presenting erythematous damage in face, nape of the neck and upper thorax, as well as periorbital heliotrope erythema and fingernails base and sides telangiectasia, all of which are typical signs of dermatomyositis.

[Hereditary transmission of a familial chromosome marker (author's transl)]. / Transmisión hereditaria de un marcador familiar y trisomía 22.

Banding patterns allow identification of chromosome 22 admitting today trisomy 22 without doubt. A case of this chromosomic aberration is presented. Particular characteristic of the case is the existence of Gp+ chromosome in the mother, two of her brothers and two later brothers of the "probandus". This variation is not discussed as origin of the trisomy.