Peritonitis primària per N. meningitidis serogrup B / Peritonitis primaria por N. Meningitidis serogrupo B / Primary peritonitis by serogroup B N. Meningitidis

INTRODUCCIÓ: Neisseria meningitidis és un dels principals causants de sèpsia I meningitis adquirida a la comunitat en pacients pediàtrics. Se'n descriuen presentacions atípiques, com la peritonitis primària. Presentem aquest cas per la seva excepcionalitat: una patologia infreqüent en edat pediàtrica causada per un germen poc habitual. CAS CLÍNIC: Es presenta un lactant de 4 mesos que acut al servei d'Urgències amb els seus pares per febre I lesions cutànies disseminades de 24 hores d'evolució, amb vòmits I diarrea. Davant la sospita de sèpsia, s'inicien maniobres de reanimació inicial, amb càrrega de volum I antibioteràpia, prèvia extracció d'hemocultiu. Tot I la millora clínica inicial, persisteix la palpació dolorosa a l'hipogastri. Es valora juntament amb Cirurgia I es fa una tomografia computada abdominal que mostra hipercaptació de nanses d'intestí prim I líquid intraabdominal compatible amb procés inflamatori peritoneal. Es fa una laparoscòpia exploradora I s'obté abundant líquid purulent; es revisen íntegrament budell I colon sense observar lesions. Es manté a dieta absoluta durant 48 hores després de la cirurgia, amb progressió alimentària posterior sense incidències. S'obtenen resultats microbiològics: hemocultiu positiu per N. meningitidis B I reacció en cadena de la polimerasa N. meningitidis positiva en sang I en líquids cefalorraquidi I peritoneal. COMENTARIS: La peritonitis primària en pacients pediàtrics sans és una entitat de baixa incidència. Entre els gèrmens descrits en la literatura és molt poc freqüent trobar N. meningitidis. És necessari pensar en aquesta entitat davant d'un pacient amb malaltia invasiva per N. meningitidis I exploració abdominal patològica. La base del tractament són la cirurgia I l'antibioteràpia endovenosa

INTRODUCCIÓN: Neisseria meningitidis es una de las principales causas de sepsis y meningitis adquirida en la comunidad en pacientes pediátricos. Se describen presentaciones atípicas entre las cuales consta de forma excepcional la peritonitis primaria. Este caso ha sido seleccionado por su excepcionalidad, pues se trata de una patología poco frecuente en edad pediátrica y causada por un germen poco habitual. CASO CLÍNICO: Se presenta a un lactante de 4 meses que acude al servicio de Urgencias con sus padres por fiebre y lesiones cutáneas diseminadas de 24 horas de evolución, junto con vómitos y diarrea. Ante la sospecha de sepsis se realizan maniobras de reanimación inicial con carga de volumen y antibioterapia, con previa toma de hemocultivo. A pesar de la mejoría clínica inicial, persiste palpación dolorosa en hipogastrio. Se valora junto con Cirugía y se realiza tomografía computarizada abdominal que muestra hipercaptación de asas de intestino delgado, asociado a líquido intra-abdominal compatible con proceso inflamatorio peritoneal. Se realiza laparoscopia exploradora y se obtiene abundante líquido purulento y esfacelos; se revisan de forma íntegra intestino y colon sin observar lesiones. Se mantiene a dieta absoluta durante 48 horas tras la cirugía, con progresión alimentaria posterior y sin incidencias. Se obtienen resultados microbiológicos: hemocultivo positivo para N. meningitidis B sensible y reacción en cadena de la polimerasa N. meningitidis B positiva en sangre y en líquidos cefalorraquídeo y peritoneal. COMENTARIOS: La peritonitis primaria en pacientes pediátricos sanos es una entidad de baja incidencia. Entre los gérmenes descritos en la literatura es muy poco frecuente encontrar N. meningitidis. Es necesario pensar en esta entidad ante un paciente con infección invasiva por N. meningitidis con exploración abdominal patológica. La base de su tratamiento son la cirugía y la antibioterapia endovenosa

INTRODUCTION: Neisseria meningitidis is one of the main causes of community acquired sepsis and meningitis in children. Atypical presentations have been described, one of them is primary peritonitis. CASE REPORT: We present a 4-month-old infant admitted to the emergency department with fever and disseminated petechia of 24 hours of evolution along with vomiting and diarrhea. With the diagnosis of sepsis, resuscitation maneuvers were started with intravenous fluids and antibiotics after a blood culture was obtained. In spite of the initial clinical improvement, painful palpation persisted in hypogastrium. The patient was assessed together with surgery and an abdominal computed tomography was performed, which showed a small intestine loop enlargement, associated with intraabdominal fluid that suggested peritonitis. Exploratory laparoscopy was performed, obtaining abundant purulent fluid and necrotic and inflammatory tissue. The entire bowel and colon were inspected and no lesions were found. The patient remained fasting for 48 hours after surgery. Enteral nutrition was started afterwards with no complications. N. menigitidis B was isolated in blood culture and polymerase chain reaction positive for N. meningitidis B was positive in blood and in cerebrospinal and peritoneal fluids. COMMENTS: Primary peritonitis in healthy pediatric patients is rare. N. meningitidis is very rare causative pathogen. Primary peritonitis should be considered when having a patient with invasive infection by N. meningitidis with abnormal abdominal examination. Treatment includes surgery and intravenous antibiotics

Extra-axial sacral soft tissue giant cell ependymoma affecting a child: Case report and review of the literature.

An otherwise healthy eight-year-old girl presented with a mass in the soft tissue of the sacral region. The lesion was diagnosed as a vascular malformation on imaging studies, for which percutaneous sclerotherapy was attempted. The mass continued to grow and a complete resection was performed after four years. The pathological diagnosis was giant cell ependymoma (GCE). GCE is a term used to describe a rare histologic variant of ependymoma characterized by malignancy-like morphologic phenotype and indolent behavior. To the best of our knowledge, this is the first case of extra-axial soft tissue sacral GCE reported in a child.

Midline Cervical Cleft: An Anatomical Finding and a Proposal for a New Approach.

Congenital midline cervical cleft is a rare malformation. Typical case shows an area of hypotrophic skin, a cranial nipple-like structure, and a caudal blind sinus. Cervical extension is limited. Relapse of the retraction is common following cutaneous z-plasty. The aim of this study is to describe the radiological, surgical, and histological findings of the 4 cases treated in our center in the last 8 years and communicate the finding of a contractile structure, anterior to the platysma, composed by striated muscle, figure not previously described. This distinct muscular band is responsible for neck retraction. Removal of this releases cervical tension and is essential to avoid the relapse.

Registry of Valvular and Vascular Allograft Transplants in the Autonomous Community of Catalonia, Spain (ReVAC): Design of the Registry.

BACKGROUND: In recent years, there have been significant changes in the perception of valvular and vascular allograft transplants. Despite the constant evolution of the field of transplant and the involvement of multiple surgical specialties, there is not an official registry for administrative and clinical control. This study aims to design a registry of vascular and valvular allograft transplantation in Catalonia, Spain (ReVAC). MATERIALS AND METHODS: Three consecutive focal groups were designed. Focal groups established administrative, technical, and clinical requirements of ReVAC. ReVAC included patients with a transplanted cryopreserved vascular segment or cardiac valves that were distributed by Catalan tissue banks to public and private hospitals in Catalonia. Ten hospitals were involved in this study. Data were collected on 380 patients between January 1995 and November 2015. RESULTS: The project resulted in the completion of a growing platform available online. ReVAC was divided into the following 3 levels: patient-related, surgery-related, and transplant-related data. Online access is available through the website of applications of the "Generalitat de Catalunya." CONCLUSION: ReVAC has been useful for administrative and clinical control of transplants in Catalonia. Currently, data related to outcomes of arterial allografts are available, reinforcing the current guideline-supported indications, as well as opening a window for further analysis and guideline creation.

Auricular Reconstructive Surgery Improvement to the Firmin Technique for Placing an Earring.

Microtia has an incidence of 1 in 7000 to 8000 births. Ear reconstruction has 2 main aims: reconstructive and aesthetic, and a considerable number of patients ask for an earring at the end of their treatment. Herein, we explain our team's modification to the Firmin technique, perforating the lowest part of the autologous cartilage framework (Parri's modification). The orifice is cartilaginous and the skin covering both sides is easily perforable without contacting the rest of the framework. In conclusion, our modification for placing an earring is simple; it does not increase the surgical time and contributes to approach the perfection of auricular reconstructive surgery.

Rendimiento de futbolistas sometidos a reconstrucción del ligamento cruzado anterior con técnica Hueso Tendón Hueso / Evaluate soccer player´s performance in anterior cruciate ligament reconstruction with bone-tendon-bone technique

Objetivo: Evaluar el rendimiento en términos de fuerza, confianza, potencia y estabilidad en futbolistas sometidos a reconstrucción del ligamento cruzado anterior (LCA) con técnica hueso tendón hueso (HTH) y en comparación de futbolistas sanos. Material y métodos: Estudio analítico de cohortes de futbolistas de alto rendimiento con lesión de LCA intervenidos con técnica HTH entre los años 2006 al 2013, y el grupo control estuvo conformado por futbolistas de alto rendimiento sin lesión del LCA. Se incluyeron nueve deportistas en cada grupo, y los mismos fueron sometidos a seis pruebas de salto en una única sesión que abarcó saltos horizontales y verticales monopodales, salto en caída más doble salto, salto al cuadrado y salto lateral. Resultados: No se encontraron diferencias en el rendimiento entre los futbolistas operados y no operados. Pero si se encontraron en el salto vertical entre la rodilla operada y no operada de los deportistas con lesión de LCA (No operada: 25,7 ± 3,6, Operada: 23,4 ± 3,9, p=0,041). Conclusión: Los futbolistas de alto rendimiento con lesión de LCA sometidos a reconstrucción del LCA con técnica HTH, después de un promedio de 40 meses de recuperación, mostraron resultados de rendimiento similar a los futbolistas sanos de alto rendimiento sin lesión de LCA.

Purpose: Evaluate soccer player’s performance in terms of strength, power, confidence and stability that were subjected to reconstruction of anterior cruciate ligament (ACL) with bone-tendon-bone technique compared to healthy soccer players. Methods: Analytical cohort study of high performance soccer players with LCA injuries treated with the HTH technique between the years 2006 to 2013, the study control group was made up of high performance soccer players without LCA injury. In each group, nine athletes were included and all of them were put through a six trial jump in one session which included horizontal, vertical jumps, freefall jump plus a double jump, squared jump and lateral jump. Results: There were no differences in high performance between the surgically intervened soccer players and the non-surgically intervened players. There were differences found in the vertical jump performance between the operated knee and the not operated in players with LCA injuries. Conclusion: High performance soccer players with LCA injury submitted to a LCA reconstruction with HTH technique after a 40 month average of recuperation, showed similar performance results in comparison with healthy high performance soccer players without LCA injury.

Micronucleated erythrocytes in newborns rats exposed to three different types of ultraviolet-A (UVA) lamps from commonly uses devices.

Exposure to ultraviolet-A (UVA) light can accidentally cause adverse effects in the skin and eyes. UVA induces DNA damage directly by creating pyrimidine dimers or by the formation of reactive oxygen species that can indirectly affect DNA integrity. UVA radiation is emitted by lamps from everyday devices. In adult rats, micronucleated erythrocytes (MNE) are removed from the circulation by the spleen. However, in newborn rats, MNE have been observed in peripheral blood erythrocytes. The objective of this study was to use micronucleus tests to evaluate the DNA damage caused in newborn rats exposed to UVA light from three different types of UVA lamps obtained from commonly used devices: counterfeit detectors, insecticide devices, and equipment used to harden resins for artificial nails. Rat neonates were exposed to UVA lamps for 20min daily for 6days. The neonates were sampled every third day, and the numbers of MNE and micronucleated polychromatic erythrocytes (MNPCE) in the peripheral blood were determined. The rat neonates exposed to the three types of UVA lamps showed increased numbers of MNE and MNPCE from 48h to 144h (P<0.05 and P<0.001 respectively). However, no relationship was observed between the number of MNE and the wattage of the lamps. In conclusion, under these conditions, UVA light exposure induced an increase in MNE without causing any apparent damage to the skin.

Postoperative vesicoureteral reflux after high-pressure balloon dilation of the ureterovesical junction in primary obstructive megaureter. Incidence, management and predisposing factors.

OBJECTIVE: To describe the incidence, predisposing factors and management of postoperative vesicoureteral reflux (VUR) after high-pressure balloon dilation to treat primary obstructive megaureter (POM). MATERIALS AND METHODS: We have reviewed patients that underwent endoscopic treatment for POM from May 2008 to November 2013. All patients were evaluated with renal ultrasound, voiding cystourethrography and diuretic renogram. Endoscopic treatment was done with high-pressure balloon dilation of the ureterovesical junction under general anesthesia; a double-J stenting was done in all patients. Follow-up was performed with ultrasonography, voiding cystourethrography and a diuretic renogram in all patients. RESULTS: Fifteen boys and five girls with a mean age of 14.18 months (3-103) were reviewed. A total of 22 ureters underwent HPBD to treat POM. Ureterohydronephrosis improves in 19 ureters. After endoscopic treatment, six ureters developed VUR. Four ureters were managed surgically, and in the other two, VUR disappeared in a second cystogram. The presence of parameatal diverticulum in the preoperative cystography and those patients with bilateral POM are factors related to postoperative VUR (p < 0.05). Urinary tract infection after HPBD was observed in four patients, but only one of them was affected with VUR.

Thoracoscopic segmentectomy of methylene blue dyed intralobar sequestrations.

Surgical resection of congenital lung lesions has evolved with minimally invasive and parenchyma-preserving techniques. Although these lesions are usually small and their limits can be suspected by direct vision or palpation, there are no clear anatomic landmarks to enable a precise resection. This report presents a new technique that helps to define the limits of intralobar sequestrations, leading to a safe and anatomic thoracoscopic segmentectomy.

Anderson-hynes pyeloplasty in patients less than 12 months old. Is the laparoscopic approach safe and feasible?

PURPOSE: The aim of our study is to compare the outcomes of open and laparoscopic pyeloplasty in children less than 12 months of age. PATIENTS AND METHODS: We reviewed all medical charts of patients less than 12 months old who underwent pyeloplasty from January 2007 to February 2013. We divided them in two groups: Open pyeloplasty (OP) and laparoscopic pyeloplasty (LP). The following data were analyzed: age, sex, weight, US measurements, operative time, hospital stay, complications, and success rate. Quantitative data were analyzed with the Student t test or Mann-Whitney U test, and chi-square test or Fisher test for qualitative data. RESULTS: Fifty-eight patients (46 boys and 12 girls) with a mean age of 4.66 months (±3.05) were included. Mean age was 4.25 months and 5.15 months in OP and LP group respectively. Mean weight was 6.78 kg and 7.02 kg in OP and LP groups. There were no statistical differences in age, weight, and sex between OP and LP groups. There were no statistical differences in preoperative ultrasonography measurements. Mean posterior-anterior (PA) pelvis diameter was 28.57 mm and 23.94 mm in OP and LP groups, respectively. Mean calices diameter were 10.86 mm and 10.96 mm in OP and LP groups, respectively. Mean operative time was 129.53 minutes in the OP group and 151.92 minutes in the LP group with statistical differences (P=0.018). Mean hospital stay was 6.34 days in the OP group and 3.46 in the LP group with statistical differences (P<0.05). No intraoperative and postoperative complications were found in either group. Hydronephrosis improved in all patients, and no patient needed a repeated pyeloplasty. CONCLUSION: The laparoscopic approach of Anderson-Hynes pyeloplasty in patients less than 12 months old is a safe procedure with the same outcomes as the open approach.