A New Surgical Model of Skeletal Muscle Injuries in Rats Reproduces Human Sports Lesions.

Skeletal muscle injuries are the most common sports-related injuries in sports medicine. In this work, we have generated a new surgically-induced skeletal muscle injury in rats, by using a biopsy needle, which could be easily reproduced and highly mimics skeletal muscle lesions detected in human athletes. By means of histology, immunofluorescence and MRI imaging, we corroborated that our model reproduced the necrosis, inflammation and regeneration processes observed in dystrophic mdx-mice, a model of spontaneous muscle injury, and realistically mimicked the muscle lesions observed in professional athletes. Surgically-injured rat skeletal muscles demonstrated the longitudinal process of muscle regeneration and fibrogenesis as stated by Myosin Heavy Chain developmental (MHCd) and collagen-I protein expression. MRI imaging analysis demonstrated that our muscle injury model reproduces the grade I-II type lesions detected in professional soccer players, including edema around the central tendon and the typically high signal feather shape along muscle fibers. A significant reduction of 30% in maximum tetanus force was also registered after 2 weeks of muscle injury. This new model represents an excellent approach to the study of the mechanisms of muscle injury and repair, and could open new avenues for developing innovative therapeutic approaches to skeletal muscle regeneration in sports medicine.

[Robotic surgery: first pediatric series in Spain]. / Cirugía robótica: primera serie pediátrica en España.

OBJECTIVES: Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to robotic laparoscopy. METHODS: Retrospective review of all the pediatric laparoscopic surgery assisted by the da Vinci robot (Intuitive Surgical), in our center, between April 2009 and February 2010. RESULTS: 8 patients were operated (7-15 years), with an average weight of 42 Kg (18 to 83 Kg). 11 procedures were performed: bilateral salpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4), splenectomy (2), resection of pancreatic mass (1), fundoplication (1), adrenalectomy (1). All proceedings, except two, were completed with the robot. As complications, there was one intraoperative bleeding that required blood transfusion, and in the postoperative period, there was a surgical wound infection. There were no conversions to open surgery. The average time of preparation before surgery was 130 minutes. The three-dimensional vision and lack of tremor are the main advantages cited by all surgeons. CONCLUSIONS: The learning curve of Robotic Surgery is shorter than that of conventional laparoscopy. Trained surgeons can perform complex procedures laparoscopically from the outset. The main difficulty in children is the proper planning of trocar placement, due to the smaller size of the surgical field. The organization of surgery is complex and success depends on close collaboration of all stakeholders.

Cirugía robótica: primera serie pediátrica en España / Robotic surgery: First pediatric series in Spain

Objetivos. A pesar de que funcionan varios robots quirúrgicos en España, la experiencia en patología pediátrica es escasa, por lo que creemos interesante revisar la primera serie íntegramente pediátrica del país. Queremos también transmitir nuestras impresiones sobre el paso de la laparoscopia convencional a la robótica. Métodos. Revisión retrospectiva de los casos pediátricos intervenidos mediante laparoscopia asistida por el robot da Vinci (Intuitive Surgical) entre abril de 2009 y febrero de 2010.Resultados. Se intervinieron 8 pacientes (7 a 15 años), con un pesomedio de 42 kg (18 a 83 kg). Se realizaron 11 procedimientos: salpingo-ooforectomía bilateral (1), herniorrafia inguinal (1), colecistectomía(4), esplenectomía (2), exéresis de masa pancreática (1), fundoplicatura(1), suprarrenalectomía (1). Todos los procedimientos, salvo 2, se (..) (AU)

Objectives. Despite several surgical robots operating in Spain, the experience in pediatric pathology is limited. We found interesting to review the first full pediatric series in our country. We would like to share as well our views on the transition from conventional to roboticlaparoscopy. Methods. Retrospective review of all the pediatric laparoscopicsurgery assisted by the da Vinci robot (Intuitive Surgical), in our center, etween April 2009 and February 2010.Results. 8 patients were operated (7-15 years), with an average weight of 42Kg (18 to 83Kg). 11 procedures were performed: bilateralsalpingo-oophorectomy (1), inguinal hernia (1), cholecystectomy (4),splenectomy (2), resection of pancreatic mass (1), fundoplication (1),adrenalectomy (1). All proceedings, except two, were completed with (..) (AU)

Logistics and strategy of multiorgan procurement involving total face allograft.

The face is the latest body structure to be added to the field of transplantation and the learning curve is ongoing. In the scenario of multiorgan recovery, the face is a nonvital 'organ' structure compared with other life-saving organs. To date, the face has been the first 'organ' to be procured in a multiorgan procurement. A technique for simultaneous recovery of the whole face, heart, lungs, liver, pancreas and kidneys is described. Thirty professionals participated in the procedure, of whom 13 were surgeons. No tracheotomy was performed. A mask of the donor's face was made from a mold impression. Duration of the procedure from skin incision to the end of surgery was 7.3 h. The face was perfused with Wisconsin solution through a cannula inserted into the aortic arch between the origin of the brachiocephalic arterial trunk and the left subclavian artery. Blood requirements consisted of 4 units of packed red blood cells. After the procedure, the mask was placed on the donor's face. All recovered grafts functioned immediately. In summary, simultaneous multiorgan procurement including the whole face is feasible, effective and saves time without jeopardizing life-saving organs and without the need for tracheotomy.

No-touch hepatic hilum technique to treat early portal vein thrombosis after pediatric liver transplantation.

A 'no-touch' hilum technique used to treat early portal vein complications post-liver transplantation in five children with body weight <10 kg is described. Four patients developed thrombosis and one portal flow absence secondary to collateral steal flow. A vascular sheath was placed through the previous laparotomy in the ileocolic vein (n = 2), inferior mesenteric vein (n = 1) or graft umbilical vein (n = 1). Portal clots were mechanically fragmented with balloon angioplasty. In addition, coil embolization of competitive collaterals (n = 3) and stent placement (n = 1) were performed. The catheter was left in place and exteriorized through the wound (n = 2) or a different transabdominal wall puncture (n = 3). A continuous transcatheter perfusion of heparin was subsequently administered. One patient developed recurrent thrombosis 24 h later which was resolved with the same technique. Catheters were removed surgically after a mean of 10.6 days. All patients presented portal vein patency at the end of follow-up. Three patients are alive after 5 months, 1.5 and 3.5 years, respectively; one patient required retransplantation 18 days postprocedure and the remaining patient died of adenovirus infection 2 months postprocedure. In conclusion, treatment of early portal vein complications following pediatric liver transplantation with this novel technique is feasible and effective.

Linfangioma quístico cervical: todavía un reto / Cervical cystic lymphangioma: still a challenge

Introducción. Los linfangiomas cervicales de gran tamaño pueden no solo asociarse a graves secuelas estéticas, fonatorias o deglutorias, sino amenazar la supervivencia del paciente por compresión de la vía aérea o sangrados masivos. El objetivo de este trabajo es evaluar nuestros resultados quirúrgicos, el valor del diagnóstico prenatal y la aplicación de técnicas como el EXIT (Ex-Utero Intrapartum Treatment)para el control de la vía aérea en casos graves. Pacientes y métodos. Revisión retrospectiva de los linfangiomas cervicales tratados en nuestro centro entre 1986 y 2009, según el registro de Documentación Clínica. Se han analizado datos referentes al diagnóstico prenatal, manejo intraparto de la vía aérea, tratamiento quirúrgico y sus complicaciones, uso de esclerosantes y secuelas a (..) (AU)

Introduction. Cervical lymphangiomas can not only cause severes equelae (aesthetic, phonatory or deglutory) but can also be life the reatening due to airway compresion or massive bleeding. This paper analyzes our surgical results, the value of prenatal diagnosis and the use of new techniques such as the EXIT procedure for airway control in sereve cases .Patients and methods. We retrospectively reviewed the medical record of patients with cervical lymphangiomas treated in our center between 1986 and 2009, according to our Clinical Documentation Database. Data referred to prenatal diagnosis, intrapartum airway management, surgical procedures and morbidity, sclerosing substance infiltration and long term sequelae was analyzed. Results. Thirteen cases were identified. 53.8% of the patients were (..) (AU)

[Long term follow-up of bile duct stenosis treated with interventional radiology in pediatric liver transplantation]. / Seguimiento a largo plazo de las estenosis de la vía biliar tratadas con radiología intervencionista en el trasplante hepático pediátrico.

The reported incidence of biliary strictures following pediatric liver transplantation has ranged between 5-34%, with a higher incidence in segmental grafts. Currently, percutaneous transhepatic balloon dilatation of biliary strictures is considered as the first line treatment owing to its minimal invasiveness. Between 1995-2006, 20 children who underwent liver transplantation developed biliary complications treated with interventional radiology. 16/20 developed biliary stricture, of whom 10 were treated with percutaneous transhepatic balloon dilatation. The mean age at the procedure was 6.6 years (range 8 m--14 years). The allograft types included whole (n=4), split (n=3), and reduced (n=3) livers. The procedure was performed at a mean time post-transplantation of 2.6 years. All patients are alive with a mean follow-up post-procedure of 24 months (range: 4 months-11 years). Currently, only 4 have a normal appearing biliary tree by imaging techniques and 6 developed stricture recurrence; of whom 3 developed biliary cirrhosis (2 splits, 1 reduced), one patient underwent successful rescue surgery, one was treated again percutaneously, and the remaining was lost to followup. In conclusion, treatment of percutaneous transhepatic balloon dilatation of biliary strictures is effective avoiding surgical correction. However, stricture recurrence in the medium- long term follow-up is frequent, particularly in segmental grafts. [corrected]

Seguimiento a largo plazo de las estenosis de la vía biliar tratadas con radiología intervencionista en el trasplante hepático pediátrico / No disponible

La incidencia de estenosis de la vía biliar en el trasplante hepático infantil varía entre un 5-34%, y es más acusada en los injertos segmentarios que en los completos. El tratamiento de estas complicaciones mediante radiología intervencionista evita en algunos casos la cirugía. Entre 1995-2006 se han tratado 20 niños con trasplante hepático y complicaciones de la vía biliar con radiología intervencionista. Dieciséis de ellos presentaron estenosis de la vía biliar, de los cuales en 10se corrigió con dilatación percutánea transparietohepática. La edad media de los niños fue de 6,6 años (rango 8 meses-14 años). Los tipos de injerto incluyen 4 completos y 6 parciales (3 splits, 3 reducidos). Las dilataciones se realizaron a una media de 2,6 años postrasplante. Todos los pacientes están vivos, con un seguimiento medio desde la dilatación de 24 meses (rango 4 meses-11 años). Actualmente, solo4 (40%) presentan una vía biliar de características normales por pruebas de imagen y en 6 (60%) ocurrió una recidiva de la estenosis. De estos 6, 3 han desarrollado cirrosis biliar (2 splits, 1 segmentario), un paciente ha requerido corrección quirúrgica, otro se ha vuelto ha dilatar y el paciente restante se le ha perdido el seguimiento. Las dilataciones percutáneas transparietohepáticas en el tratamiento de las estenosis de la vía biliar, inicialmente son efectivas y evitan la corrección quirúrgica. Sin embargo, las reestenosis a medio-largo plazo son frecuentes, en especial en los injertos parciales (AU)

Incidence of bile duct strictures in the paediatric liver transplant ranges from 5-34%, and is most pronounced in segmental grafts that complete. The treatment of these complications avoided in most cases surgery. Between 1995-2006 have been treated 20 children with liver transplantation and bile duct complication with interventional radiology. Sixteen of them were suffering from bile duct strictures of which 10 were corrected with percutaneous dilation. The average age of children was6.6 years (range 8 months-14 years). The types of graft include 4 complete and 4 partial (3 splits, reduced 3). The dilatation was made at an average of 2.6 years after transplant. All patients are alive, with a mean follow-up from the dilation of24 months (range 4 months-11 years). Currently, only 4 (40%) have a normal bile duct by imaging techniques and 6 (60%) have had a recurrence of biliary strictures. Of these, 3 have developed biliary cirrhosis(2 splits, segmental 1), two patient have required surgical correction, another has been delayed again and the remaining patient has been lost monitoring. The percutaneous dilation in the treatment of strictures of the bileduct is initially effective avoiding surgical correction. However there strictures medium-long term are frequent (AU)

[Cervical cystic lymphangioma: still a challenge]. / Linfangioma quístico cervical: todavía un reto.

INTRODUCTION: Cervical lymphangiomas can not only cause severe sequelae (aesthetic, phonatory or deglutory) but can also be life thereatening due to airway compresion or massive bleeding. This paper analyzes our surgical results, the value of prenatal diagnosis and the use of new techniques such as the EXIT procedure for airway control in sereve cases. PATIENTS AND METHODS: We retrospectively reviewed the medical record of patients with cervical lymphangiomas treated in our center between 1986 and 2009, according to our Clinical Documentation Database. Data referred to prenatal diagnosis, intrapartum airway management, surgical procedures and morbidity, sclerosing substance infiltration and long term sequelae was analyzed. RESULTS: Thirteen cases were identified. 53.8% of the patients were diagnosed by prenatal ultrasound, and MRI was performed in 46.1%. The tongue was affected in 30.7%, parotid glands in 38.4% and airway in 38.4%. Four EXIT procedures were carried out (nasotracheal intubation) and one emergency tracheotomy was needed. Five patients required more than one surgical prodedures, including partial glossectomy, with severe intraoperatory complications in 23% (bleeding, pharyngeal damage). In eight patients primary or adyuvant sclerotherapy was used. Three children with giant masses died, two due to intracystic bleeding and one from sepsis. Among the survivors, 50% have no sequelae. CONCLUSIONS: Cervical lymphangiomas are a very sereve condition, not only due to possible airway compresion or massive bleeding but also becose of the severe secualaes they may cause. Tongue or parotid gland infiltration are difficult to treat. In severe cases diagnosed prenatally a close follow up in selected centers, with multidisciplinary teams consisting of obstetricians and pediatric surgeons, trained in the EXIT procedure is warranted. Despite therapeutic efforts the prognosis of large masses is still poor.

Tratamiento actual de los traumatismos penetrantes pediátricos / Current treatment of pediatric penetrating traumas

Introducción. Tradicionalmente, el tratamiento del trauma penetrante consistía en la revisión quirúrgica amplia de la zona anatómica afecta. Sin embargo, cada vez es más frecuente realizar un tratamiento menos invasivo gracias a la precisión diagnóstica que aportan pruebas de imagen como la tomografía computerizada (TC). El objetivo de este trabajo es revisar la experiencia de nuestro centro en los últimos8 años con la aplicación de criterios más conservadores. Pacientes y métodos. Tradicionalmente el tratamiento del trauma penetrante consistía en la revisión quirúrgica amplia de la zona anatómica afecta. Sin embargo, cada vez es más frecuente realizar un tratamiento menos invasivo gracias a la precisión diagnóstica que aportan pruebas de imagen como la tomografía computerizada (TC). El objetivo de este trabajo es revisar la experiencia de nuestro centro en los últimos 8 años con la aplicación de criterios más conservadores. Resultados. Identificamos 16 pacientes (mediana 8,5 años, rango 4-15) víctimas de traumatismos penetrantes. Según su localización se clasificaron en: cervicales (12,5%), torácicos (25%), abdominales (18,8%)y de extremidades (43,8%). Los tipos de lesión más frecuentes fueron (..) (AU)

Introduction. The traditional management of pediatric penetrating trauma has been wide surgical examination. However, the selective non operative management is increasing thanks to the precise diagnosis obtained from radiologic studies as CT scan. The purpose of this study is reviewing our experience in the last eight years with a less invasive management. Patients and methods. We retrospectively reviewed (2000-2007)the patients with penetrating injuries of different parts of the body(excluding cranioencephalic traumatism) treated in our center and registered by the Clinical Documentation Unit. The variables collected and evaluated included age, mechanism of injury, kind of injury, diagnostic and therapeutic modalities and outcome. Results. There were 17 patients (median 9,5 years, range 4-17) with penetrating trauma. According the localization of injury the patients were divided into 4 groups: abdominal (17,6%), thoracic (23,5%), cervical (17,6%) and extremities (41,2%). The most frequent kind of injuries (..) (AU)

Fetoscopic release of umbilical cord amniotic band in a human fetus.

Umbilical cord amniotic bands occur in approximately 10% of cases of amniotic band syndrome and are a well-known cause of fetal death. An unexpected amniotic band encircling the umbilical cord was diagnosed during a fetoscopic procedure to release a leg constriction. Both bands were released fetoscopically using a YAG laser. We report the first case of an amniotic band involving the umbilical cord diagnosed and released prenatally.

[Current treatment of pediatric penetrating traumas]. / Tratamiento actual de los traumatismos penetrantes pediátricos.

INTRODUCTION: The traditional management of pediatric penetrating trauma has been wide surgical examination. However, the selective nonoperative management is increasing thanks to the precise diagnosis obtained from radiologic studies as CT scan. The purpose of this study is reviewing our experience in the last eight years with a less invasive management. PATIENTS AND METHODS: We retrospectively reviewed (2000-2007) the patients with penetrating injuries of different parts of the body (excluding cranioencephalic traumatism) treated in our center and registered by the Clinical Documentation Unit. The variables collected and evaluated included age, mechanism of injury, kind of injury, diagnostic and therapeutic modalities and outcome. RESULTS: There were 17 patients (median 9.5 years, range 4-17) with penetrating trauma. According the localization of injury the patients were divided into 4 groups: abdominal (17.6%), thoracic (23.5%), cervical (17.6%) and extremities (41.2%). The most frequent kind of injuries were: skin and muscle (with or without penetrating peritoneal or chest cavity, 52.9%) vascular or neurological structures (29.4%). We would like to highlight one case of cardiac perforation and taponade, one traqueal lesion and one case of external iliac vein injury. The injuries caused by glass (35.3%) and sharp arms (29,4%) were the most frequent mechanism. Simple suture and observation was treatment enough in 47.1%. Three patients required neural and vascular micro suture. One patient followed a thoracotomy procedure and other one, a sternotomy. It wasn't necessary any laparotomy. No patient died and 88% of the patients have no sequelae. CONCLUSIONS: Most of the penetrating child traumas have good prognosis and are associated with few sequelae. Low energy thoracic and abdominal penetrating traumas can be managed conservatively when the patient is hemodiynamically stable and CT scan shows no organ injury, avoiding unnecessary surgical examinations.

[Conservative treatment of pneumatosis intestinalis and pneumoperitoneum after bone marrow transplantation]. / Tratamiento conservador de la neumatosis intestinal y el neumoperitoneo postrasplante de médula osea.

OBJECTIVE: Pneumatosis intestinalis (PI) is a radiological sign that can be accompanied by pneumoperitoneum. It is not exclusive of neonatal necrotizing enterocolitis. It can also appear after bone marrow transplantation. We describe our experience with 6 patients diagnosed of PI after bone marrow transplantation (BMT) who were treated conservatively without surgery in any case and good outcome. PATIENTS AND METHOD: We have reviewed the patients diagnosed of PI from 2000 to 2007 after BMT in our center. RESULTS: Six patients have had 7 episodes of PI with pneumoperitoneum in 3. All cases previously developed intestinal graft-versus-host disease. PI was diagnosed from 1 to 4 months after transplantation. At diagnosis, any patient presented peritoneal signs. Computed tomography was used for PI diagnosis with colonic predominance (5), pneumomediastinum (1) and retropneumoperitoneum (2). The treatment was conservative with intestinal rest, antibiotics and total parenteral nutrition. Enteral feeding was initiated progressively between 1 and 2 months after diagnosis but in one case PI reappeared and it required to start again the conservative treatment. In the other cases, outcome was very satisfactory, improving the pneumatosis and with a correct oral feeding without needing of surgery in any case. COMMENTS: PI with or without pneumoperitoneum is an condition to have in mind in bone marrow transplantation patients. Pneumoperitoneum with good general condition and no sign of peritonitis is not indicative of surgery in these patients. Conservative treatment with antibiotics and parenteral nutrition allows resolution spontaneously

Tratamiento conservador de la neumatosis intestinal y el neumoperitoneo postrasplante de médula ósea / Conservative treatment of pneumatosis intestinalis and pneumoperitoneum after bone marrow transplantation

Objetivo. La neumatosis intestinal (NI) es un signo radiológico que puede ir asociado o no a neumoperitoneo. Su presencia no es exclusiva de los neonatos con enterocolitis necrotizante. También puede aparecer en pacientes sometidos a trasplante de médula ósea alogénico. Presentamos nuestra experiencia con 6 pacientes con NI postrasplante de médula ósea (MO) tratados de forma conservadora sin necesidadde cirugía en ningún caso y con muy buena evolución. Material y métodos. Se han revisado los pacientes con el diagnóstico de NI desde el año 2000 al 2007 postrasplante de MO alogénica en nuestro centro. Resultados. Seis pacientes han presentado 7 episodios de NI con neumoperitoneo en 3 de ellos. Todos los casos desarrollaron previamente enfermedad de injerto contra huésped intestinal. La NI fue diagnosticada entre 1 y 4 meses postrasplante. Al diagnóstico, ningún paciente presentó signos de peritonitis ni afectación del estado general. La TAC fue utilizada para el diagnóstico, hallándose NI de predominiocolónico (5), neumomediastino (1) y retroneumoperitoneo (2). El tratamiento fue conservador con dieta absoluta, antibióticos y nutrición parenteral total. Se reinició la alimentación enteral progresivamente entre 1 y 2 meses después del diagnóstico, apareciendo en un caso una recidiva de la NI que requirió reiniciar el tratamiento conservador. En el resto de casos, la evolución posterior fue muy satisfactoria, con mejoría de la neumatosis y correcta tolerancia oral sin necesidad de cirugía en ningún caso. Comentarios. La NI con o sin neumoperitoneo es una entidad a tener en cuenta en los pacientes trasplantados de MO. La presencia de neumoperitoneo sin afectación del estado general ni aparición de signos de peritonitis no es indicativo de cirugía en estos pacientes. El tratamiento conservador con antibióticos y nutrición parenteral permite la resolución del cuadro espontáneamente (AU)

Objective. Pneumatosis intestinalis (PI) is a radiological sign thatcan be accompanied by pneumoperitoneum. It is not exclusive of neonatalnecrotizing enterocolitis. It can also appear after bone marrow transplantation. We describe our experience with 6 patients diagnosed of PI after bone marrow transplantation (BMT) who were treated conservatively without surgery in any case and good outcome. Patients and method. We have reviewed the patients diagnosed of PI from 2000 to 2007 after BMT in our center. Results. Six patients have had 7 episodes of PI with pneumoperitoneumin 3. All cases previously developed intestinal graft-versus-hostdisease. PI was diagnosed from 1 to 4 months after transplantation. At diagnosis, any patient presented peritoneal signs. Computed tomography was used for PI diagnosis with colonic predominance (5), pneumomediastinum(1) and retropneumoperitoneum (2). The treatment was conservative with intestinal rest, antibiotics and total parenteral nutrition. Enteral feeding was initiated progressively between 1 and 2 months after diagnosis but in one case PI reappeared and it required to start again the conservative treatment. In the other cases, outcome was very satisfactory, improving the pneumatosis and with a correct oral feeding without needing of surgery in any case. Comments. PI with or without pneumoperitoneum is an condition to have in mind in bone marrow transplantation patients. Pneumoperitoneum with good general condition and no sign of peritonitis is not indicative of surgery in these patients. Conservative treatment with antibiotics and parenteral nutrition allows resolution spontaneously (AU)

Asistencia inicial al traumatismo pediátrico y reanimación cardiopulmonar / Initial pediatric trauma care and cardiopulmonary resuscitation

Los accidentes son la causa más frecuente de muerte en niños por encima del año de edad. Las causas más importantes de muerte por accidente son los accidentes de tráfico, el ahogamiento, las lesiones intencionadas, las quemaduras y las caídas. La reanimación cardiopulmonar es una parte más del conjunto de acciones de estabilización inicial en un niño con traumatismo. La parada cardiorrespiratoria en los primeros minutos después del accidente, ocurre generalmente por obstrucción de la vía aérea o mala ventilación, pérdida masiva de sangre o lesión cerebral grave, y tiene muy mal pronóstico. La parada en las horas siguientes al traumatismo está generalmente producida por hipoxia, hipovolemia, hipotermia, hipertensión intracraneal o alteraciones hidroelectrolíticas. La primera respuesta ante el traumatismo, tiene tres componentes: proteger (valoración del escenario y establecimiento de medidas de seguridad), alarmar (activación del sistema de emergencias) y socorrer (atención inicial al traumatismo). La atención inicial al traumatismo se divide en reconocimiento primario y secundario. El reconocimiento primario incluye los siguientes pasos secuenciales: A. control cervical, alerta y vía aérea; B: respiración; C: circulación y control de la hemorragia; D: disfunción neurológica, y E: exposición. El reconocimiento secundario consiste en la evaluación del accidentado mediante la anamnesis, exploración física ordenada desde la cabeza a las extremidades y práctica de exámenes complementarios. Durante la atención al traumatismo se pueden precisar algunas maniobras específicas que no suelen ser necesarias en otras situaciones de emergencia como son maniobras de extracción y movilización, control cervical mediante inmovilización cervical bimanual y colocación del collarín cervical y retirada del casco. Si durante la asistencia inicial al traumatismo ocurre una parada cardiorrespiratoria las maniobras de reanimación cardiopulmonar se realizarán de forma inmediata adaptándose a las características específicas del niño traumatizado

Accidents are a frequent cause of death in children older than 1 year. The most frequent causes of death by accident are traffic accidents, drowning, intentional injuries, burns, and falls. Cardiopulmonary resuscitation is one component of the set of actions needed to obtain initial stabilization of a child with serious trauma. In the first few minutes after the accident, cardiorespiratory arrest can occur due to airway obstruction or inadequate ventilation, massive blood loss or severe brain damage; cardiorespiratory arrest in this setting has a dismal outcome. When arrest occurs hours after trauma, it is usually caused by hypoxia, hypovolemia, hypothermia, intracranial hypertension, or electrolyte disturbances. The first response to trauma should include three objectives: to protect (scenario assessment and implementation of safety measures), to alert (activation of the emergency medical system) and to help (initial trauma care). Initial trauma care includes primary and secondary surveys. The primary survey involves several consecutive steps: A. airway and cervical spine stabilization, B. breathing, C. circulation and hemorrhage control, D. neurological dysfunction, and E. exposure. The secondary survey consists of assessment of the victim by means of anamnesis, sequential physical examination (from head to limbs) and complementary investigations. During emergency trauma care, specific procedures such as extrication and mobilization maneuvers, cervical spine control by means of bimanual immobilization, and cervical collar placement or helmet removal. If a cardiorespiratory arrest occurs during initial trauma care, resuscitation maneuvers must be immediately started with the specific adaptations indicated in children with trauma

Extremity amniotic band syndrome in fetal lamb. I: An experimental model of limb amputation.

OBJECTIVE: The objective of the study was to reproduce severe forms of extremity amniotic bands, which result in amputation or severe lesions. STUDY DESIGN: Right limbs of 5 60-day gestational age pregnant sheep were ligated with silk suture at the infracondylar level. Left limbs were used for paired comparison. The limbs obtained from term fetuses were analyzed morphologically, radiologically, and histologically. RESULTS: The ligated limbs showed an amputation or quasiamputation. Four extremities showed a necrotic pattern and 4 an edema pattern. CONCLUSION: A model of severe extremity amniotic bands that reproduces the effect of the extremity amniotic bands in the human fetus was developed. Future applications of this new model could be an experimental study of in utero salvage of limbs affected with severe extremity amniotic bands in the ovine fetus.

Crecimiento pulmonar fetal tras oclusión traqueal en el feto humano con hernia diafragmática congénita / Fetal pulmonary growth after tracheal occlusion in the human fetus with congenital diaphragmatic hernia

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