Tutor externo de ePTFE en estenosis traqueal. Aplicación clínica / External stent of ePTFE prosthesis in tracheal stenosis. Clinical application

Las estenosis traqueales adquiridas en el niño son secundarias bien a traumatismo directo cérvico-torácico o a secuelas postintubación. La resección y anastomosis término-terminal sigue siendo el tratamiento de elección. La tasa elevada de reestenosis está directamente relacionada con la tensión anastomótica en lesiones de más de 2 cm de longitud. Presentamos el caso clínico de un niño de 7 años que sufre politraumatismo severo por accidente de tráfico e intubación traumática en el lugar del accidente, con desarrollo subsecuente de estenosis traqueal cervical que precisa tratamiento endoscópico con láser y dilataciones con balón en tres ocasiones, sin éxito. Se practica resección del segmento traqueal estenótico, aplicando un tutor externo de ePTFE. El postoperatorio cursó sin complicaciones y fue posible una extubación precoz del niño. La evolución posterior ha sido satisfactoria; los estudios endoscópicos y de RNM postoperatorios muestran un diámetro anastomótico normal, sin estenosis. El niño se halla asintomático en la actualidad, 3 años después de la intervención y practica deporte de competición. Podemos concluir que el modelo descrito de tutor externo de ePTFE ha sido efectivo clínicamente en la prevención de la estenosis traqueal postanastomótica en el niño (AU)

[External tutor of ePTFE in tracheal stenosis. Clinical application]. / Tutor externo de ePTFE en estenosis traqueal. Aplicación clínica.

Acquired tracheal stenosis in children can be either to direct cervicothoracic trauma or to post-intubation. Resection and end-to-end anastomosis continues to be the treatment of choice. The high rate of restenosis is directly related to anastomotic tension in resections of more than 2 cm. We report a case of a 7 year old child who suffered severe injury caused by car crash and intubation at the scene of the accident, with subsequent development of a cervical tracheal stenosis which required preoperative iterative laser sessions and balloon dilatation on 3 occasions, without result. Resection and primary anastomosis with an external stent of ePTFE was performed. The patient was treated successfully and was extubated promptly. Post-operative endoscopic studies and magnetic resonance imaging showed widely patent tracheal lumina with no stenosis. Three years post-operatively, the child is asymptomatic and participates in competitive sport activities. We can conclude that the model described above was clinically effective in the prevention of post-anastomotic tracheal stenosis in the child.

[Acute intestinal invagination: hydrostatic reduction vs. pneumatic reduction]. / Invaginación intestinal aguda: reducción hidrostática versus reducción neumática.

We report the results of 100 cases of acute intussusception treated by inflation of the colon with air under controlled pressure. We compare this method with the traditional one and we analyse the advantages of each method. Successful reduction was achieved in 76% of the cases of intussusception treated with a barium enema and in 88% of the cases treated with an air enema. Pneumocolon in the treatment of acute intestinal intussusception is an alternative method that is very effective and with additional advantages such as: less radiation, less cost and less morbidity in case of perforation.

[Transanastomosis in pyeloplasty of the pyeloureteral junction syndrome: comparative study of 72 cases]. / El tutor transanastomótico en la pieloplastia en el síndrome de la unión pieloureteral: estudio comparativo en 72 casos.

The role of the urinary by-pass and the indications of its utilisation in the treatment of the pyelourethral union syndrome a been a matter of continual controversy. As a results, there have been no objective data for their preference on the part of surgeons. We present an analysis of 72 pyeloplasties carried out by the surgery team of our hospital over a period of 8 years, in order to determine the influence in the postoperative process and the long term effects of its use or nonuse in patients of pediatric age.

[Nephropathy caused by ventriculo-atrial derivation (shunt nephritis)]. / Nefropatía por derivación ventrículo-atrial ("nefritis por shunt").

We report three patients (one, nine and ten year old) who suffered from secondary nephritis caused by an infection of a ventriculo-atrial shunt. In all three cases diagnosis was made based on persistent hematuria accompanied by prolonged fever of unclear origin and was subsequently confirmed by the presence of staphylococcus in the blood. LCR and prosthesis cultures and in the renal biopsy. The period of time elapsed between the insertion of the shunt, the beginning of the illness and the diagnosis, was variable. In the three cases, the treatment consisted of removal of the infected shunt and insertion of a new one in the peritoneum together with antibiotic treatment. The outcome was successful in only two cases, the third died. The hystological study showed the presence of: membranoproliferative, proliferative and intra and extra capillary glomerulonephritis with diffuse semilunae in each case. We point out the importance of the prosthesis infection by low virulence germs, the continuous dissemination of these into the circulatory system and the production and depositing of antibodies at the renal level.

[Late presentation of pleuroperitoneal diaphragmatic hernias with intrathoracic gastric strangulation]. / Presentación tardía de hernias diafragmáticas pleuroperitoneales con estrangulación gástrica intratorácica.

Four cases of pleuroperitoneals diaphragmatic hernia are described. The onset in the four infants was intensive respiratory distress. In all patients the only herniated viscera was the stomach, that was found strangulated and dilated into the thoracic cavity. The foramen herniarium was located on the diaphragmatic cupula with a size between 2-3 cm.

[New technique of renal plication for the treatment of severe hydronephrosis]. / Nueva técnica de nefroplicatura en el tratamiento de las hidronefrosis graves.

We present the case of an eleven-year old boy affected of giant hydronephrosis on a unique right pelvic kidney, treated according to an original technique consisting in the use of a free peritoneal flap for the completion of a renal banding to complement Mollard's (1973) and Stewart Hamilton's (1957) nephroplasty procedures.

[Thyroid cancer in childhood (author's transl)]. / Cáncer de tiroides en el niño

The authors present three cases of thyroid cancer in the child with comments on the etiologic, clinical and therapeutic aspects of this rare disease. The authors insist on the danger of local radiotherapy and on the need to suspect thyroid cancer in cases of persistent laterocervical adenopathies whose diagnosis can only be confirmed by means of a biopsy. It is of note that the illness took a favourable course and various therapeutic criteria are discussed.