[Surgical and nutritional evaluation of children with percutaneous endoscopic gastrostomy]. / Evaluación quirúrgica y nutricional de los niños con gastrostomía endoscópica percutánea.

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) has suppoused an improvement in the nutritional management of patients with deglution difficulty. Surgical and nutritional aspects have been evaluated in our patients with PEG. MATERIAL AND METHODS: A descriptive retrospective study with individual analysis of surgical, nutritional and satisfaction items has been developed. RESULTS: 83 PEG (1994-08) have been implanted in neurological patients (63.8%) followed by cystic fibrosis; Mean age 7 years (4 months-25 years). Two patients have a ventriculo-peritoneal shunt (VPS) and 3 a peritoneal dialysis catheter (PDC). 12% had a mild complication and 3 patients a severe one, with 2 reinterventions performed. 40 patients have the dispositive, 25 were removed after a mean follow-up of 2,5 years and 17 patients dies. Nutrition was done with initial, continuation or specials formulas. Weight evaluation was satisfactory in 96% of patients and biochemical indicators were normalized in 97% of them. Satisfaction is very high among the majority of parents. CONCLUSIONS: PEG is a technique that allows nutritional recuperation with few surgical complications. VPS and PDC are not contraindications for the percutaneous gastrostomy. PEG improves children and relatives life quality.

[Fast track antibiotic protocol in acute appendicitis]. / Protocolo antibiótico "fast-track" en la apendicitis aguda.

INTRODUCTION: The increase of antimicrobial resistances, has affected the efficacy of antimicrobial triple therapy, increasing appendicitis morbidity. We decided to change to a fast-track protocol of 72 hours of Cefuroxime-Metronidazol or Ertapenem. AIM: to know if our infectious morbidity rate has improved and if early dischargement is possible. MATERIAL AND METHODS: Analytic historic cohort study: Historical cohort (HC): patients intervened of appendicitis between October 2005 and October 2006. Current cohort (CC): started in June 2007. A data collection protocol is designed for both groups. Homogeneity among cohorts is proved and data are analysed (a=0,05). Statistics are analyzed by SPSS 15.0. RESULTS: 226 patients were controlled, being 110 complicated appendicitis (HC: 61/135; AC: 49/91). There are no differences among cohorts about evolution time, temperature and leukocytes rate at admission, interval to intervention, use of laparoscopy, drainage or antimicrobial prophylaxis. There is difference about the use of pre-surgical ultrasound. Admission rate has been reduced in 2.82 days, from 8.41 days in HC to 5.58 with the new antimicrobial protocol (median 7 to 4). The relative risk of developing intraabdominal abscess is 0.366 (HC: 15.7%; CC: 6.4%) (p=0.145) and readmission rate has been reduced from 9.8% to 0% (p=0.028). In 33% of cultures we have found different levels of antimicrobial resistance. No Enterococcus has been isolated. CONCLUSIONS: 1) Infectious morbidity rate has decreased with the new therapy. 2) Antimicrobial resistance and new antibiotics have exceeded Triple antimicrobial therapy. 3) It is possible an early dischargement in perforated appendicitis without an increasing of readmission rate. 4) We must know the bacterial flora in order to adapt our antibiotic therapy.

[Neonatal diagnostic protocol of the Hirschsprung's disease]. / Fiabilidad de la manometría anorrectal para el diagnóstico de la enfermedad de Hirschsprung en neonatos: experiencia de 25 años.

UNLABELLED: Suction rectal biopsy (SRB) is the gold-standard for the diagnosis of Hirschsprung's disease (HD), but may not be applied before the first month of age. We propose a diagnostic protocol that allows the management of these patients. MATERIAL AND METHODS: A retrospective analytic study is done, analysing the results of our protocol. A rectal manometry (RM) is done to any patient with clinical symptoms of HD. When first test is positive (no reflex), we practice a weekly RM till the end of the neonatal period when we propose the SRB for the confirmation of the diagnosis. RESULTS: From 1980 to 2006 we have performed 503 tests in 391 HD's suspected neonates. Mean age in the first study was 15.19 days. In 54 cases, final diagnosis was EH. Rate of false-negative was 0.9%, sensibility 99%. Rate of non-usefull studies without sedation was 8%, being minor (2.97%) with sedation (OR = 2.853; p = 0.008). CONCLUSIONS: The protocol with a weekly RM allows the management of these patients because of a reliable diagnosis. Sedation has two positives effects: the reduction of the time of the study and the improvement of the results.

[Intraluminal impedance technique in the diagnosis of apparent life-threatening events (ALTE)]. / Importancia de la impedanciometría esofágica en el diagnóstico de los episodios aparentemente letales.

BACKGROUND: Apparent life threatening events (ALTE) affect children younger than one year. This syndrome is characterized by several symptoms: apnoea, change in colour or muscle tone, coughing or gagging. Approximately 50 percent of these children are diagnosed of an underlying pathology that explains the ALTEs, being gastroesophageal reflux one of the most important conditions to investigate. AIM: To demonstrate the effectiveness of intraluminal impedance technique for the diagnosis of the gastroesophageal reflux associated to ALTEs in infants. MATERIALS AND METHODS: Stationary esophageal manometric is used to define the low esophageal sphincter, a pH and impedance 24 hours was recorded. We determinate association between gastroesophageal reflux-ALTEs and characterisation of the reflux that occurs. RESULTS: Intraluminal esophageal impedance has been made to 16 children with the diagnosis of ALTEs between 1 and 6 months of age (mean of age 3.04 months). 23.4 episodes of reflux (9,500-31,275, P25 and P75 respectively) have been diagnosed by pHmetry whereas with impedance the number of reflux obtained were 70.88 (60.25 - 80.00), 36.21% acid and 63.78% weakly acidic. We have found 4 episodes of apnoea in one patient that seems to be connected with gastroesophageal reflux (3 nonacid and one acid event) in a statistically positive relation (SI > or = 50%; SSI > or = 10%). CONCLUSIONS: Intraluminal gastroesophageal impedance is a useful method for the diagnosis of gastroesophageal reflux in infants who present a gastric alkaline content most of time, allowing in addition, to differentiate between acid and nonacid reflux. According to our sample, the patients with the diagnosis of ALTEs do not present greater rate of gastroesophageal reflux than the healthy population of the same age. Only in one patient we have found a statistically significant relation between reflux and apnoea.