Value of Fibrinogen to Discriminate Appendicitis from Nonspecific Abdominal Pain in Preschool Children.

INTRODUCTION: The aim of this study was to assess the diagnostic value of the biomarker fibrinogen (FB), along with the markers white blood cell (WBC) count, absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in preschool children. MATERIALS AND METHODS: We prospectively evaluated all children aged <5 years admitted for suspected appendicitis at an academic pediatric emergency department during 5 years. Diagnostic accuracy of FB (prothrombin time-derived method), WBC, ANC, and CRP were assessed by the area under the curve (AUC) of the receiver-operating characteristic curve. RESULTS: A total of 82 patients were enrolled in the study (27 NSAP, 17 uncomplicated, and 38 complicated appendicitides). WBC and ANC had moderate diagnostic accuracy for appendicitis versus NSAP (WBC: AUC 0.66, ANC: AUC 0.67). CRP and FB had good diagnostic accuracy for appendicitis versus NSAP (CRP: AUC 0.78, FB: AUC 0.77). WBC and ANC are not useful to discriminate complicated versus uncomplicated appendicitis (WBC: AUC 0.43, ANC: AUC 0.45). CPR and FB had good diagnostic accuracy for complicated versus uncomplicated appendicitis (CRP: AUC 0.80, FB: AUC 0.73). CONCLUSION: CRP and FB are more useful than WBC and ANC to discriminate appendicitis from NSAP in preschool children. CRP and FB are especially useful to discriminate complicated from uncomplicated appendicitis and NSAP. In a child with suspected appendicitis, a plasma FB level (prothrombin time-derived method) >540 mg/dL is associated with an increased likelihood of complicated appendicitis.

Appendicitis or non-specific abdominal pain in pre-school children: When to request abdominal ultrasound?

AIM: The aim of this study is to determine the most useful diagnostic tools to differentiate appendicitis from non-specific abdominal pain (NSAP) in pre-school children. METHODS: We prospectively evaluated all children aged 5 years or younger admitted for suspected appendicitis at a paediatric emergency department during 5 years. Cases of NSAP and appendicitis were enrolled according to inclusion and exclusion criteria. The different variables collected were assessed by statistic and diagnostic accuracy studies. RESULTS: A total of 82 patients were studied: 27 cases of NSAP and 55 cases of appendicitis. We found no symptoms or signs with a high power of discrimination between both processes. Complicated cases of appendicitis begin to appear when the duration of symptoms exceeds 12 h. Among laboratory tests, C-reactive protein (CRP) value >34 mg/L was the variable with a greater association to appendicitis (odds ratio 9.8). Abdominal ultrasound (US) had high sensitivity and specificity to differentiate appendicitis, significantly improving its diagnostic accuracy when the duration of symptoms exceeds 12 h. CONCLUSIONS: A good history and physical examination are important in the diagnostic process, but reliable physical signs can be difficult to elicit in pre-school children. CRP and abdominal US are useful investigations that can improve diagnostic accuracy. According to our results, abdominal pain duration longer than 12 h or CRP value >34 mg/L should be an indication to perform an abdominal US in pre-school children with right lower quadrant tenderness.

Caracterización clínicoepidemiológica, demográfica e histológica de los enfermos de cáncer pancreático avanzado diagnosticados mediante biopsia por tru-cut / Epidemiological, demographic and histological characterization of advanced pancreatic cancer patients diagnosed by tru-cut biopsy

Introducción: el cáncer pancreático tiene el peor pronóstico entre los tumores malignos con solo 5 por ciento de supervivencia a los cinco años de diagnosticados los pacientes. Su diagnóstico, generalmente tardío, se hace cuando la enfermedad está avanzada o cuando hay metástasis.Objetivo: caracterizar los enfermos con diagnóstico histológico de cáncer de páncreas estadios III y IV, en los que se aplicó como técnica para toma de la muestra la biopsia por tru-cut.Método: se realizó un estudio descriptivo a 11 enfermos con cáncer pancreático estadios III y IV cuya confirmación histológica se logró mediante la biopsia por tru-cut en el Hospital General Provincial Docente de Ciego de Ávila en el período enero-diciembre de 2017. Las variables estudiadas fueron: edad, sexo, localización topográfica, factores de riesgo, histología, complicaciones y supervivencia.Resultados: predominaron el grupo de edades de 66-81 años (45,45 por ciento), el sexo masculino (63,64 por ciento), la localización en la cabeza (54,55 por ciento), y el tabaquismo (21,74 por ciento) como factor de riesgo. El adenocarcinoma bien diferenciado (36,36 por ciento) fue la neoplasia dominante. La supervivencia después de siete meses fue elevada (90,90 por ciento), y su rango mayor fue 10-12 meses. Las complicaciones fueron mínimas y no graves.Conclusiones: se caracterizó a los en enfermos diagnosticados de cáncer pancreático estadios III y IV según las variables a estudiar. En el curso de la investigación se mostró la sobrevida alcanzada en ellos dado a las posibilidades terapéuticas oncoespecíficas propiciadas por el estudio histológico, logrado mediante la biopsia por tru-cut(AU)

Introduction: pancreatic cancer has the worst prognosis among malignant tumors with only 5 percent survival after five years of diagnosed patients. The diagnosis, usually late, is carried out when the disease is advanced or when there is metastasis.Objective: to characterize the patients with histological diagnosis of stages III and IV pancreatic cancer, in which the tru-cut biopsy was applied as a technique for taking the sample.Method: a descriptive study was carried out on 11 patients with stages III and IV pancreatic cancer whose histological confirmation was achieved by means of the tru-cut biopsy in the General Provincial Teaching Hospital of Ciego de Ávila in the period January-December 2017. The variables studied were: age, sex, topographic location, risk factors, histology, complications and survival.Results: the age group of 66-81 years (45,45 percent), the male sex (63,64 percent), the location in the head (54,55 percent), and smoking (21,74 percent) as a risk factor prevailed. Survival after seven months was high (90,90 percent), and its highest range was 10-12 months. The complications were minimal and not serious. Conclusions: patients diagnosed with pancreatic cancer stages III and IV were characterized according to the variables to be studied. In the course of the investigation, the survival achieved in them was shown given the onco-specific therapeutic possibilities fostered by the histological study, achieved by means of a tru-cut biopsy(AU)

Determinant factors for chronic kidney disease after partial nephrectomy.

The objective of this review is to evaluate the factors that determine the development or deterioration of Chronic Kidney Disease (CKD) after partial nephrectomy (PN). When current literature is reviewed, it is found that factors that influence renal function after partial nephrectomy, are multifactorial. Those are divided into pre-surgical factors, such as hypertension, diabetes mellitus, urolithiasis, obesity, metabolic syndrome among others; intra-surgical factors, like the surgical technique used, the remaining healthy tissue, the experience of the surgeon, the time and type of ischemia among others. Lastly, post-surgical factors, also impose some influence on the post-surgical renal performance. It was also found that minimally invasive surgery, in addition to its known advantages, seems to offer a greater field of action in the future that will allow more nephrons preservation in any future surgical scenario. Finally, the current trend is to perform PN on all patients, in whom surgery is technically feasible regardless of the approach used, without risking oncological outcomes, patient safety, and without being exposed to any additional complications.

Utilidad del dermatoscopio en el diagnóstico del carcinoma basocelular / Use of dermatoscopy in the diagnosis of basocelular carcinoma

Introducción: la dermatoscopia es una herramienta no invasiva que aumenta la especificidad del diagnóstico de las lesiones más frecuentes de la piel, de ahí la importancia de su uso en el diagnóstico del carcinoma basoceluar.Objetivo: evaluar la utilidad de la dermatoscopia en el diagnóstico del carcinoma basocelular.Método: se realizó una investigación observacional descriptiva transversal que desde el punto de vista espacial se circunscribió a los cuatro municipios del territorio sur de la provincia de Ciego de Ávila: Majagua, Ciego de Ávila, Venezuela y Baraguá. Desde el punto de vista temporal se limitó al período: julio de 2014 a junio de 2015. El universo de estudio estuvo integrado por los 68 enfermos mayores de 30 años con diagnóstico clínico de carcinoma basocelular.Resultados: el grupo de edad de 60 años y más, el sexo masculino y los fototipos de piel I, II y III fueron las características observadas con mayor frecuencia en los pacientes con diagnóstico del carcinoma basocelular. Según el patrón clínico predominó el carcinoma basocelular pigmentado y el patrón histopatológico sólido quístico. Las características dermatoscópicas más identificadas fueron: la ausencia de retículo pigmentado y telangiectasias ramificadas. Existió alta correspondencia entre los diagnósticos clínico, dermatoscópico e histológico.Conclusiones: la alta correspondencia del diagnóstico dermatoscópico con el histológico permite recomendar el empleo de esta técnica para el diagnóstico eficaz y temprano del carcinoma basocelular(AU)

Introduction: dermatoscopy is a non-invasive tool that increases the specificity of the diagnosis of the most frequent lesions of the skin, hence the importance of its use in the diagnosis of basocellular carcinoma.Objective: to evaluate the usefulness of dermatoscopy in the diagnosis of basal cell carcinoma.Method: a descriptive cross-sectional observational research was carried out that from the spatial point of view was limited to the four municipalities of the southern territory of Ciego de Ávila: Majagua, Ciego de Ávila, Venezuela and Baraguá. From the temporary point of view it was limited to the period: July 2014 to June 2015. The universe of study was composed of 68 patients over 30 years of age with a clinical diagnosis of basal cell carcinoma.Results: the age group of 60 years and over, the male sex and skin phototypes I, II and III were the most frequent characteristics observed in patients diagnosed with basal cell carcinoma. According to the clinical pattern, pigmented basal cell carcinoma and solid cystic histopathological pattern predominated. The most identified dermatoscopic characteristics were: absence of pigmented reticulum and branched telangiectasias. There was high correspondence between the clinical, dermatoscopic and histological diagnoses.Conclusions: the high correspondence of the dermatoscopic diagnosis with the histological one makes it possible to recommend the use of this technique for the efficient and early diagnosis of basal cell carcinoma(AU)

Apendicitis versus dolor abdominal agudo inespecífico: evaluación del Pediatric Appendicitis Score / Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation

Introducción: El dolor abdominal agudo inespecífico es el principal proceso que requiere diagnóstico diferencial con la apendicitis en la práctica clínica. El objetivo de este estudio es evaluar la utilidad del Pediatric Appendicitis Score (Regla de predicción clínica de apendicitis pediátrica) para diferenciar estas 2 entidades. Material y métodos: Se evaluó prospectivamente a los pacientes atendidos por sospecha de apendicitis en nuestro centro durante 2 años, incorporando al estudio casos de dolor abdominal agudo inespecífico y apendicitis. Se recogieron diferentes variables, incluyendo las que conforman el Score y la proteína C reactiva, que se analizaron estadísticamente de manera descriptiva, univariante y multivariante, y mediante pruebas de rendimiento diagnóstico (curvas ROC). Resultados: Se estudiaron 275 casos; 143 casos de dolor abdominal agudo inespecífico y 132 casos de apendicitis. La temperatura y el dolor a palpación en fosa iliaca derecha fueron las únicas variables que no mostraron diferencias significativas entre los grupos, careciendo de poder de discriminación. El dolor con la tos, el salto y/o la percusión fue la variable con mayor asociación a apendicitis. El Score estratificó correctamente a los pacientes en grupos de riesgo. La sustitución de la temperatura por la proteína C reactiva en el Score aumentaba su rendimiento diagnóstico, aunque sin diferencias significativas. Conclusiones: El Pediatric Appendicitis Score ayuda en el diagnóstico diferencial entre apendicitis y dolor abdominal agudo inespecífico. Sería recomendable la sustitución de la temperatura en el Score, pues carece de poder de discriminación entre estos grupos. La proteína C reactiva, categorizada en el valor 25,5 mg/L, podría ser utilizada en su lugar (AU)

Introduction: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. Material and methods: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. Results: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. Conclusions: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5 mg/L value could be used instead (AU)

[Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation]. / Apendicitis versus dolor abdominal agudo inespecífico: evaluación del Pediatric Appendicitis Score.

INTRODUCTION: Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. MATERIAL AND METHODS: All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. RESULTS: A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. CONCLUSIONS: The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead.

Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children.

AIM: The aim of this study was to assess the diagnostic accuracy of the biomarker fibrinogen (FB), along with the more traditional markers white blood cell count (WBC), absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in children. METHODS: We prospectively evaluated all children aged 5 to 15 years admitted for suspected appendicitis at an academic pediatric emergency department during 2 years. Diagnostic accuracy of FB (prothrombin time-derived method), WBC, ANC, and CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: A total of 275 patients were enrolled in the study (143 NSAP, 100 uncomplicated appendicitis, and 32 complicated appendicitis). WBC and ANC had a moderate diagnostic accuracy for appendicitis vs NSAP (WBC: AUC 0.79, ANC: AUC 0.79). FB and CPR had a poor diagnostic accuracy for appendicitis vs NSAP (FB: AUC 0.63, CRP: AUC 0.64) and a good diagnostic accuracy for complicated vs uncomplicated appendicitis (FB: AUC 0.86, CRP: AUC 0.90). All inflammatory markers had a good diagnostic accuracy for complicated appendicitis vs NSAP. CONCLUSIONS: WBC and ANC are useful inflammatory markers to discriminate appendicitis from NSAP. FB and CRP are not very useful to discriminate appendicitis from NSAP, but they discriminate properly complicated from uncomplicated appendicitis and NSAP, with a similar diagnostic accuracy. In a child with suspected appendicitis, a plasma FB level (prothrombin time-derived method) >520 mg/dL is associated to an increased likelihood of complicated appendicitis.

Dermoid cyst of the spermatic cord in children.

Most of inguinal masses in children correspond to inguinal indirect hernias, but other pathologic entities may be found. Dermoid cysts of the spermatic cord are very rare, with only 9 clear cases reported in the literature to date, all of them in adults. We present a case of dermoid cyst of the spermatic cord in a 2-year-old boy, the youngest patient reported so far. Dermoid cysts of the spermatic cord should be considered as part of the differential diagnosis of inguinal masses in children, especially in cases of long-standing, nontender, and irreducible inguinal mass.

Schwannoma del nervio vestibular / Vestibular nerve Schwannoma

Se hace una revisión bibliográfica del Schwannoma del nervio vestibular, analizando fundamentalmente los aspectos epidemiológicos, etiológico, anatomopatológico y clínico. Se esboza detalladamente la clasificación de House–Brackmann para la valoración de la función del nervio facial, así como llegar al diagnóstico de dicha patología. Se hace énfasis en el diagnóstico diferencial. Finalmente se concluye con el tratamiento, el cuál depende de la clasificación de KOOS basada en el tamaño del tumor. El pronóstico depende de la extensión de la enfermedad, la cual puede provocar varias complicaciones (AU)

There has been done a bibliographic revision of the vestibular nerve schwannoma, analysing mainly its epidemiological, ethiological and clinical aspects. It´s outlined in details House-Brackmann´s classification to the valuation of facial nerve´s function, as well as to arrive to the diagnosis of this pathology. There has been emphasized the differential diagnosis. Finally it´s concluded by the treatment, which depends on Koos´s classification based on the tumor´s size. The prognosis depends on the illness´s extension which can cause various complications (AU)

Fístula faringo cutánea / Pharyngo cutaneous fistula

Se realiza un análisis y revisión bibliográfica de la fístula faringo cutánea, enfocando específicamente los aspectos etiopatogénicos, diagnóstico y las diferentes clasificaciones desde la más histórica hasta la más moderna que es la de Funk. Finalmente se exponen los factores que intervienen en la reparación de la fístula faringo cutánea, así como los diferentes tipos de reparación en dependencia del tamaño del orificio cutáneo. Concluimos con las posibles complicaciones que se pueden presentar en el cierre del faringostoma (AU)

An analysis and a bibliographic revision is accomplished on the pharingho cutanoeus fistula, focusing especifically on the etiopathogenetic aspects, diagnosis and the different classifications from the most historical until most modern which is Funk´s. Finally there are expound factors that work on the repair of the pahringho cutaneous fistula as well as the different types of repair depending on the size of the cutaneous hole. We finish our work with the possible complications that can be presented in the pharynx fistula closure (AU)

Hipotiroidismo: sus efectos sobre la salud / Thyroid failure: its effects in health

Se realiza una revisión de las disímiles manifestaciones clínicas que produce en los diferentes órganos y sistemas del organismo humano el hipotiroidismo que se caracteriza por un déficit en la secreción de hormonas tiroideas, lo cual limita considerablemente la calidad de vida de estos pacientes. Consecuentemente se señalan los signos y síntomas que produce esta enfermedad, poniendo a disposición de forma específica las más evidentes manifestaciones de este proceso por aparato para una mejor comprensión en su análisis. Como conclusiones de esta revisión sugerimos la importancia de un diagnóstico precoz y fundamentalmente en las edades extremas de la vida; lo indiscutible de la necesidad de un abordaje clínico integral e interdisciplinario y la necesidad de realizar una reflexión preventiva para asumir de forma integradora esta enfermedad a medida que ganamos en conocimiento y experiencia (AU)

t has been done a revision of different clinical manifestations that cause in the different organs and systems of the body the thyroid failure which is characterized by a deficit in thyroid hormones which considerably limits the quality of life of these patients. Consistently they point out the signs and symptoms that cause this illness, trying to facilitate the more evident manifestations of this process to a better comprehension in its analysis. As a conclusion for this revision we suggest the importance of an early diagnosis and especially in extreme ages of life; what has no discussion here is the need of a clinical, integral and interdisciplinary, approach and the need to do a preventive reflection to assume, in an inclusive way, this illness as we gain in knowledge and experience (AU)

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

A new case of male Y-type urethral duplication and review of literature.

Urethral duplication is a rare congenital anomaly, affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. The embryology of this pathology is still controversial. In the English medical literature, approximately 175 cases have been reported. We report here a new case of urethral duplication type II A2 "Y" in a 14-year-old boy and review the current literature of this rare entity.