Interventional Radiology-Guided Procedures in the Treatment of Pediatric Solid Tumors: A Systematic Review and Meta-Analysis.

INTRODUCTION: The use of interventional radiology (IR) in the treatment of pediatric solid tumors has markedly increased over the last three decades. However, data on effectiveness of IR-techniques, such as embolization/ablation, are scarce. In this systematic review and meta-analysis, we examined the outcomes of IR-procedures in the treatment of solid tumors in children. MATERIALS AND METHODS: Using a defined search strategy, we searched for studies reporting the use of IR-techniques for pediatric solid tumors from 1980 to 2017. Reports with less than three patients, review, and opinion articles were excluded. The study was conducted under preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We analyzed dichotomous and continuous variables by appropriate statistical methods. RESULTS: Of 567 articles screened, 21 papers met the inclusion criteria (12 retrospective, 7 prospective, and 2 randomized-control trials). Many of the analyzed papers described relatively small cohorts of patients. IR-guided procedures were mainly rescue procedures to treat primarily unresectable tumors, local recurrences, or metastases. Inclusion/exclusion criteria and success definition were not specified in most reports. Major side effects were documented in 17/286 (6%) infants, while minor side effects were self-limiting in most patients. Six studies had a comparison between tumor embolization (127 infants) to surgery or chemotherapy without IR-procedures (113 controls). The meta-analysis showed lower mortality (16 vs. 47%) and surgical time for resection (206 vs. 250 m), higher 2-year tumor-free survival (82 vs. 36%), and favorable histology in IR group (p < 0.001 for all). CONCLUSION: IR-guided techniques are promising in the treatment of pediatric solid tumors. Further prospective (randomized) trials are needed to clarify efficacy.

The effects of tobacco consumption on paternity rates of adults with a history of cryptorchidism.

OBJECTIVE: To determine the effect of tobacco consumption on paternity rates in men with a history of cryptorchidism. To compare the paternity rates between formerly unilateral, bilateral cryptorchid smokers, and nonsmokers. METHODS: A retrospective cohort study of 153 men who had undergone orchiopexy between 1961 and 1985 at the Miguel Servet University Hospital (116 unilateral and 37 bilateral) and a control group of 100 men were evaluated by review of medical records and a questionnaire. RESULTS: A total of 197 men filled the questionnaire (76.7%). There was no difference in paternity rates between smokers compared to nonsmokers (P = 0.21). In the unilateral cryptorchid men (ULC) group, there is no difference in paternity rates when compared with the controls (P = 0.079) or when comparing ULC smokers to ULC nonsmokers (P = 0.35). In the bilateral cryptorchid men (BLC) group, there is no difference in paternity rates when compared to controls (P = 0.075) or when comparing BLC smokers to BLC nonsmokers (P = 0.36). When comparing according to consumption, there is no difference between mild, moderate or heavy smoker cases and controls. CONCLUSION: There is no difference in paternity rates between men with a history of cryptorchidism that consume tobacco compared to nonsmokers or controls. More studies are needed to determine the impact of tobacco consumption in formerly cryptorchid men.

Hendidura cervical media: una enfermedad poco frecuente / Midline cervical cleft: A rare anomaly

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Diagnóstico prepuberal del síndrome de OHVIRA: ¿es posible? / Diagnosis of OHVIRA syndrome in prepuberty: Is it possible?

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Impacto de la aplicación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño / Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children

Objetivo: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. Población y métodos: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). Resultados: Se incluyeron 297 pacientes (49, 8% de niños, 50, 2% de niñas), edad media al momento del diagnóstico de 21, 71 meses. El grado de RVU fue: RVU I-III 45, 1%, RVU IV-V 54, 9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124, 32 meses. El tratamiento conservador fue la terapia de inicio en el 70, 3% de los pacientes del grupo 1 y en el 67, 9% del grupo 2. El número de cirugías se mantuvo constante (31, 45% vs. 31, 79%), con un incremento en el número de procedimientos endoscópicos (p < 0, 005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82, 32% vs. 59, 9%, p= 0, 000) y daño renal al momento del diagnóstico (49, 4% vs. 9, 8%, p= 0, 000). Conclusiones: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.

Objective: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. Population and methods: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. Results: A total of297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54, 9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). Conclusions: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidence-based approach that reduces the performance of unnecessary invasive procedures.

Impact of using an evidence-based clinical guideline for the management of primary vesicoureteral reflux in children. / Impacto de la apación de una guía clínica basada en la evidencia en el tratamiento del reflujo vesicoureteral primario en el niño.

OBJETIVE: To analyze changes in the therapeutic approach at a tertiary care hospital following the implementation of a clinical guideline for the treatment of primary vesicoureteral reflux (VUR) in children. POPULATION AND METHODS: Retrospective study conducted in a cohort of patients with primary VUR (1989-2015) aged 0-15 years at a tertiary care hospital. The therapeutic approach before and after the development of the clinical guideline (2008) was compared. RESULTS: A total of 297 patients (49.8% boys, 50.2% girls) were included; their mean age at the time of diagnosis was 21.71 months. VUR grading was: VUR I-III 45.1%, VUR IV-V 54,9%; 124 were treated after the implementation of the clinical guideline (group 1), and 173, before (group 2). The mean follow-up period was 124.32 months. A conservative approach was the initial treatment in 70.3% of group 1 patients and 67.9% of group 2 patients. The number of surgeries remains constant (31.45% versus 31.79%), with an increase in the number of endoscopic surgeries (p < 0.005). The profile of patients has changed based on the application of the algorithm proposed by the guideline. Fewer surgeries were done in patients with VUR IV-V (82.32% versus 59.9%, p= 0.000) and there were fewer cases of kidney damage at diagnosis (49.4% versus 9.8%, p= 0.000). CONCLUSIONS: The implementation of the clinical guideline has favored an initially conservative approach in patients with severe grade VUR and nephropathy, for whom surgery was traditionally indicated initially. Using clinical guidelines favors a unanimous, evidencebased approach that reduces the performance of unnecessary invasive procedures.

OBJETIVO: Analizar en qué manera se ha modificado la actitud terapéutica en un hospital de tercer nivel tras la implementación de la guía clínica para el tratamiento del reflujo vesicoureteral (RVU) primario en niños. POBLACIÓN Y MÉTODOS: Estudio retrospectivo sobre una cohorte de pacientes con RVU primario (1989-2015), de entre 0 y 15 años, en un hospital terciario. Se comparó la conducta terapéutica antes y después de la aparición de la guía clínica (2008). RESULTADOS: Se incluyeron 297 pacientes (49,8% de niños, 50,2% de niñas), edad media al momento del diagnóstico de 21,71 meses. El grado de RVU fue: RVU I-III 45,1%, RVU IV-V 54,9%; 124 fueron tratados tras la implementación de la guía clínica (grupo 1), 173, con anterioridad (grupo 2). El período medio de seguimiento fue de 124,32 meses. El tratamiento conservador fue la terapia de inicio en el 70,3% de los pacientes del grupo 1 y en el 67,9% del grupo 2. El número de cirugías se mantuvo constante (31,45% vs. 31,79%), con un incremento en el número de procedimientos endoscópicos (p < 0,005). El perfil de paciente se ha modificado a raíz de la aplicación del algoritmo propuesto por dicha guía. Hubo menos intervenciones en pacientes con RVU IV-V (82,32% vs. 59,9%, p= 0,000) y daño renal al momento del diagnóstico (49,4% vs. 9,8%, p= 0,000). CONCLUSIONES: La aplicación de la guía clínica ha favorecido una conducta conservadora inicial en pacientes con RVU de alto grado y nefropatía, en los que, tradicionalmente, se indicaba la cirugía desde el inicio. La utilización de las guías clínicas favorece una conducta unánime basada en la evidencia, que disminuye los procedimientos invasivos innecesarios.