Working status of Spanish pediatric surgeons. / Situación de los profesionales de cirugía pediátrica en España.

OBJECTIVE: To analyze work, demographic, and social parameters in order to learn about the working status of pediatric surgeons in Spain. MATERIAL AND METHODS: A survey inspired in job satisfaction models and designed by the authors was performed. It was an observational, descriptive, cross-border online survey intended for pediatric surgeons from the Spanish Society of Pediatric Surgery (SECIPE). RESULTS: Of the 290 SECIPE pediatric surgeons, 133 responded to the survey (45.8% response rate), of whom 49.6% were 30-39 years old. The number of male and female respondents was virtually the same. 69% of respondents devoted 75-100% of their working hours to healthcare, 89.4% devoted 0-25% to research, and 80% devoted 0-25% to teaching. The survey demonstrated job satisfaction in terms of colleagues, healthcare role, professional development expectations, and social consideration. However, respondents showed disconformity with their pay, the time devoted to research and teaching, and their relationship with the executive board. CONCLUSION: This study sheds light on the Spanish professionals' working status, which can help identify measures for improvement. The survey shows widespread disconformity with the short time devoted to research, and little satisfaction with teaching. Most of the working hours are devoted to clinical practice, with poor pay satisfaction, which can contribute to dissatisfaction in the development of healthcare activity.

OBJETIVO: Analizar parámetros sociolaborales y sociodemográficos para conocer la situación de los cirujanos pediátricos en España. MATERIAL Y METODOS: Se realizó una encuesta de elaboración propia inspirada en modelos de satisfacción laboral. Es un estudio observacional, descriptivo y transversal, realizado online a los cirujanos pediátricos pertenecientes a la Sociedad Española de Cirugía Pediátrica (SECIPE). RESULTADOS: De los 290 cirujanos pediátricos de la SECIPE, 133 contestaron a la encuesta (tasa de respuesta de 45,8%). De estos, el 49,6% tienen entre 30-39 años, habiendo casi igualdad entre hombres y mujeres. El 69% de los encuestados dedican entre el 75 y el 100% de su tiempo de trabajo a la asistencia, el 89,4% dedica entre 0-25% a la investigación y el 80% entre 0 y 25 % a la docencia. Los resultados mostraron satisfacción laboral tanto en relación con el equipo de trabajo como con la calidad asistencial, las posibilidades de desarrollo profesional o la consideración social. Sin embargo los encuestados mostraron su disconformidad con respecto al sueldo, al tiempo dedicado a la investigación y a la docencia, y a la relación con la dirección. CONCLUSION: Este estudio permite conocer la situación laboral de los profesionales en España, lo que puede ayudar a identificar medidas de mejora. La encuesta señala un descontento generalizado con el escaso tiempo dedicado a la investigación y poca satisfacción en el trabajo docente. La mayor parte del tiempo se dedica a la práctica clínica, existiendo baja satisfacción salarial, circunstancias que pueden contribuir a la insatisfacción en el desarrollo de la actividad asistencial.

Situación de los profesionales de cirugía pediátrica en España / Working status of Spanish pediatric surgeons

OBJETIVO: Analizar parámetros sociolaborales y sociodemográficos para conocer la situación de los cirujanos pediátricos en España. MATERIAL Y MÉTODOS: Se realizó una encuesta de elaboración propia inspirada en modelos de satisfacción laboral. Es un estudio observacional, descriptivo y transversal, realizado online a los cirujanos pediátricos pertenecientes a la Sociedad Española de Cirugía Pediátrica (SECIPE). RESULTADOS: De los 290 cirujanos pediátricos de la SECIPE, 133 contestaron a la encuesta (tasa de respuesta del 45,8%). De estos, el 49,6% tienen entre 30-39 años, habiendo casi igualdad entre hombres y mujeres. El 69% de los encuestados dedican entre el 75 y el 100% de su tiempo de trabajo a la asistencia, el 89,4% dedica entre 0-25% a la investigación y el 80% entre 0 y 25 % a la docencia. Los resultados mostraron satisfacción laboral, tanto en relación con el equipo de trabajo como con la calidad asistencial, las posibilidades de desarrollo profesional o la consideración social. Sin embargo, los encuestados mostraron su disconformidad con respecto al sueldo, al tiempo dedicado a la investigación y a la docencia, y a la relación con la dirección. CONCLUSIÓN: Este estudio permite conocer la situación laboral de los profesionales en España, lo que puede ayudar a identificar medidas de mejora. La encuesta señala un descontento generalizado con el escaso tiempo dedicado a la investigación y poca satisfacción en el trabajo docente. La mayor parte del tiempo se dedica a la práctica clínica, existiendo baja satisfacción salarial, circunstancias que pueden contribuir a la insatisfacción en el desarrollo de la actividad asistencial

OBJECTIVE: To analyze work, demographic, and social parameters in order to learn about the working status of pediatric surgeons in Spain. MATERIALS AND METHODS: A survey inspired in job satisfaction models and designed by the authors was performed. It was an observational, descriptive, cross-border online survey intended for pediatric surgeons from the Spanish Society of Pediatric Surgery (SECIPE). RESULTS: Of the 290 SECIPE pediatric surgeons, 133 responded to the survey (45.8% response rate), of whom 49.6% were 30-39 years old. The number of male and female respondents was virtually the same. 69% of respondents devoted 75-100% of their working hours to healthcare, 89.4% devoted 0-25% to research, and 80% devoted 0-25% to teaching. The survey demonstrated job satisfaction in terms of colleagues, healthcare role, professional development expectations, and social consideration. However, respondents showed disconformity with their pay, the time devoted to research and teaching, and their relationship with the executive board. CONCLUSION: This study sheds light on the Spanish professionals' working status, which can help identify measures for improvement. The survey shows widespread disconformity with the short time devoted to research, and little satisfaction with teaching. Most of the working hours are devoted to clinical practice, with poor pay satisfaction, which can contribute to dissatisfaction in the development of healthcare activity

Esofagitis eosinofílica: una patología infravalorada. Nuestra experiencia / Eosinophilic esophagitis: an underevaluated condition. Our experience

Objetivos. El objetivo de esta revisión es presentar nuestra experiencia en esta patología emergente y, principalmente, ayudar a mejorar su sospecha diagnostica. Material y métodos. Realizamos una revisión de la literatura para analizar la epidemiologia, fisiopatología, diagnostico y manejo de la esofagitis eosinofílica (EE), a propósito de 4 casos diagnosticados en nuestro centro durante el año 2011, en los que se ha llegado al (..) (AU)(

Objectives. The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. Material and methods. We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagi is (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction .Results. The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of (..) (AU)

[Eosinophilic esophagitis: an underevaluated condition. Our experience]. / Esofagitis eosinofílica: una patología infravalorada. Nuestra experiencia.

OBJECTIVES: The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. MATERIAL AND METHODS: We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagitis (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction. RESULTS: The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of dysphagia. In esophagoscopy we observed nonspecific macroscopic findings. The results of biopsies showed the presence of an infiltration of eosinophils in the mucosa over 15 per high power field. All patients were referred to the gastroenterology section of our hospital. DISCUSSION: Eosinophilic esophagitis is a primary disease of esophagus, defined as the presence of symptoms of esophageal dysfunction (mainly dysphagia and food impaction), associated to at least one esophageal biopsy with more than 15 eosinophils in high-power field and the exclusion of gastroesophageal reflux. The diagnosis is clinical, endoscopic and pathologic. It requires an upper endoscopy to evaluate characteristic findings and biopsies for histology. Current treatments include diet therapy based on avoiding exposure to certain food allergens.

[Spontaneous urinary bladder perforation after pediatric cystoplasty]. / Perforación vesical espontánea tras cistoplastia en la infancia.

OBJECTIVE: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. MATERIAL AND METHODS: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. RESULTS: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. CONCLUSIONS: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis.

Perforación vesical espontánea tras cistoplastia en la infancia / Spontaneous urinary bladder perforation after pediatric cystoplasty

Objetivos: La perforación espontánea de una cistoplastia es un problema grave y potencialmente fatal, si no se diagnostica y se trata a tiempo. Se pretende: 1) buscar una prevención analizando los factores de riesgo, 2) identificarlos principales datos de sospecha diagnóstica y 3) valorar el resultado de los tratamientos realizados. Material y Método: De 30 pacientes pediátricos con cistoplastia, 5 presentaron 8 perforaciones (16,6%). Se revisan los diversos factores influyentes, la clínica, los tratamientos y la evolución. Resultados: El tiempo medio transcurrido entre la cistoplastia y la perforación fue 8,2 años. Los principales factores de riesgo han sido una resistencia uretral que permitía continencia, y una insuficiente realización temporal del sondaje intermitente (SI). En los 8 episodios hubo dolor y distensión abdominal. La ecografía mostró líquido libre intraperitoneal en 5, múltiples quistes peritoneales en 1, e imagen sugestiva de plastrón apendicular en otro. La cistografía sólo mostró paso de contraste a la cavidad peritoneal en 3. El tratamiento inicial fue conservador, sin cirugía, en los 7 episodios diagnosticados preoperatoriamente, siendo la evolución favorable en 3(42,8%); los otros 4 necesitaron tratamiento quirúrgico, con buena evolución en todos. De los 5 pacientes, 2 (40%) presentaron 3 recidivas en un tiempo medio de 5 años. La supervivencia es del 100 %.Conclusiones: El 16,6% de los pacientes con cistoplastia de esta serie, ha tenido uno o más episodios de perforación vesical espontánea. Los factores de riesgo más significativos son una resistencia uretral alta y la inadecuada realización del SI. Los pacientes con cistoplastia y sus familias deben conocer esta complicación, sus factores de riesgo y sus síntomas, para prevenirla o facilitar un diagnóstico precoz (AU)

Objective: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. Material and Methods: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. Results: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. Conclusions: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis (AU)

[The treatment of the primary intrarenal reflux. Is the surgery always necessary?]. / Tratamiento del reflujo intrarrenal primario. Es imprescindible la cirugía?

UNLABELLED: THE AIMS OF THIS STUDY was to evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.) in order to know the results of surgical and non surgical treatment. Fifty one children with 64 kidneys with primary I.R.R. were studied. 53% of them were less than one year of age. Initial examination were: urography, ultrasounds, cystography and DMSA scan; the follow up was done with ultrasounds, DMSA scan and cystography. When no R.N. was present, grade of reflux was < IV, and age < 12 years, a non surgical treatment was indicated. RESULTS: During first examination R.N. was demonstrated in 47% of kidneys; the main difference was the grade of reflux: 16/44 II-III (36%) and 14/20 IV-V (70%). Surgical treatment was performed in 42 (82%) children and non surgical in 9 (18%). Reflux stopped in 98% and 100%, respectively. Only one child, without R.N., developed a new renal scar, and a previous R.N. progressed in two. I.R.R. can be treated successfully without surgery in selected cases.

[Postnatal differential diagnosis of fetal ureteropelvic dilatation]. / Diagnóstico diferencial postnatal de la dilatación pielocalicial fetal.

UNLABELLED: A clinical study of 51 children with prenatal diagnosis of pielocaliceal dilatation with 65 kidney affected is done. The objective was to assess the accuracy of the postnatal diagnostic studies practiced in order to an early differentiation between obstructive and non obstructive dilatation. MATERIAL AND METHODS: There were evaluated ultrasonography (US), intravenous pielography and diuretic isotopic renogram. The data were statistically analyzed with SPSS program. A regression logistic analysis was carried out between all the significant variables in order to identify the obstruction risk factors. Also the probabilities calculated index and the sensibility and specificity were studied. RESULTS: The obstruction risk factors were: grade III dilatation or greater in the US, differential renal function less of 40%, and half time more than 21 minutes. The probabilities calculated index showed that the probabilties of obstruction are different according to the number of obstruction risk factors presented in every patient. Risk factors have a high sensibility and specificity as diagnostic test.