[Surgical management and recurrence of congenital preauricular fistula]. / Manejo quirúrgico y recurrencia de la fístula preauricular congénita.

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients's charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery.

Manejo quirúrgico y recurrencia de la fístula preauricular congénita / Surgical management and recurrence of congenital preauricular fistula

El artículo describe el manejo quirúrgico y recurrencia postoperatoria de la fístula preauricular (FPA) ya que el tratamiento quirúrgico se caracteriza por elevada recurrencia. Los antecedentes clínicos, operatorios y postoperatorios fueron recogidos retrospectivamente de expedientes de pacientes que fueron sometidos a manejo quirúrgico primario de la FPA en cinco hospitales en Guadalajara, Jalisco, durante el periodo de enero 2001 a diciembre 2006. Un total de 44 escisiones de FPA se realizaron en 38 pacientes (15 hombres, 23 mujeres).Infección recurrente y secreción fueron los síntomas más comunes. El manejo quirúrgico incluyó 25 intervenciones con técnica estándar(sinectomía) y 19 abordajes supra-auriculares. La recurrencia global ocurrió en el 59% de las FPA y difirió ampliamente entre las técnicas utilizadas. Con la técnica estándar, la recurrencia fue significativamente elevada 52,2 vs 6,8% resultante mediante el abordaje supraauricular (p= 0,01). También, los pacientes en quienes no se realizó escisión de la raíz del hélix, 84,6% recurrieron vs 15,3% cuando el cartílago fue extirpado (p=0,01). Los resultados muestran que, independientemente de la presentación clínica de la FPA, la técnica estándar y la falta de escisión de la raíz del hélix contribuyeron a recurrencia. Recomendamos el abordaje supra-auricular, en particular en casos con historia de abscesos (AU)

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients’s charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery (AU)

[Severe hemorrhage intestinal in a child with ileal duplication and brief entity review]. / Hemorragia intestinal severa en una niña con duplicación ileal y breve reseña de la entidad.

Intestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularly in the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adulthood. The wide spectrum of symptoms and unspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most noteworthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndrome and intense abdominal pain over 15 months. In this patient, hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Using a laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding of the digestive tube is discussed.

Hemorragia intestinal severa en una niña con duplicación ileal y breve reseña de la entidad / Severe hemorrhage intestinal in a child with ileal duplication and brief entity review

Las duplicaciones intestinales son malformaciones congénitas poco comunes localizadas en el borde mesentérico del intestino delgado, particularmente en el íleon. Más del 60% de los casos son sintomáticas durante el primer año de vida y el resto en escolares y adultos. El amplio espectro de síntomas y signos inespecíficos que presentan, frecuentemente simulan otras enfermedades. Entre las complicaciones destaca la hemorragia gastrointestinal que llega, ocasionar anemia severa y shock, como el caso que describimos de una niña de 11 años de edad, que presentó durante 15 meses severas evacuaciones sanguinolentas intermitentemente acompañadas de dolor abdominal intenso y anemia. Los niveles de hemoglobina llegaron hasta 6 g/dL requiriendo en varias ocasiones hemotransfusión. Múltiples diagnósticos y exámenes fueron realizados y finalmente la gammagrafía con Tc99m mostró mucosa gástrica ectópica; mediante laparotomía se encontró una duplicación intestinal en el íleon terminal. Se analiza esta entidad y su importancia de considerarla en el diagnóstico diferencial en cualquier tipo de sangrado del tubo digestivo (AU)

Intestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularly in the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adulthood. The wide spectrum of symptoms and unspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most noteworthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndrome and intense abdominal pain over 15 months. In this patient, hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Using a laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding of the digestive tube is discussedIntestinal duplications are very uncommon congenital malformations located in the mesenteric edge of the small bowel, particularlyin the ileum. Over 60% of the patients become symptomatic during the first year of life whereas the remainder demonstrates symptoms at school age or adult hood. The wide spectrum of symptoms andunspecific signs frequently simulate other diseases. Gastrointestinal hemorrhage is the most note worthy complication, which can cause severe anemia and shock. In the case we describe an 11-year-old girl experienced massive intermittent intestinal hemorrhage, anemic syndromeand intense abdominal pain over 15 months. In this patient,hemoglobin levels rose up to 6 g/dL necessitating several hemotransfusion. Multiple diagnosis and examinations were carried out until finally the gammagram with Tc99m disclosed an ectopic gastric mucosa. Usinga laparotomy an intestinal duplication was found in the terminal ileum. In this paper the intestinal duplication is analyzed and the importance of considering it as a differential diagnosis in any kind of bleeding ofthe digestive tube is discussed (AU)

Facial nerve regeneration through progesterone-loaded chitosan prosthesis. A preliminary report.

Biodegradable nerve guides have represented new treatment alternatives for nerve repairing. They are gradually biodegradable, exert biological effects directly to the injured nerve, and act as drug- or cell-delivery devices. Furthermore, progesterone (PROG) has been demonstrated to promote injured peripheral nerve regeneration. In this study, it was hypothesized that PROG delivered from chitosan prostheses provides better facial nerve regenerative response than chitosan prostheses with no PROG. As there are no reports on the use of the former as nerve-guide material in the regeneration of injured nerves, this is the main objective of the present work. Chitosan prostheses containing PROG were used to bridge 10-mm gaps in rabbit facial nerves. The regenerated nerves were evaluated 45 days after implantation in animals with the use of light microscopy and morphometric analysis. Gas chromatography was used in order to quantify PROG content in prosthesis prior to and after implantation in subcutaneous tissue at different periods of up to 60 days. In addition, the prosthesis walls were evaluated with histological techniques in order to assess their integrity and the surrounding tissue reaction. Chitosan prostheses allowed PROG release during the time needed for nerve regeneration. At 45 days myelinated nerve fibers were observed in both the proximal and distal stumps. This parameter and the N ratio were higher in the progesterone-treated group when compared to that of the vehicle control. Findings indicate that chitosan prostheses were useful in nerve regeneration, acting as a long-lasting PROG delivery device a faster nerve regeneration.