Frenillo lingual corto: resultados de una intervención para mejorar la continuidad asistencial / Short lingual frenulum: results of an intervention to improve continuity of care

Introducción: la discrepancia entre los criterios de derivación de pacientes con diagnóstico de frenillo lingual corto/anquiloglosia (FLC/A) a la consulta de cirugía plástica infantil desde Atención Primaria (AP) y los criterios propuestos por parte de los profesionales de la unidad para la realización de frenotomía lingual motivó la creación de un tríptico informativo sobre la patología para intentar homogeneizar la actuación entre niveles asistenciales. El objetivo principal del trabajo consiste en analizar el impacto de la intervención en las derivaciones de estos pacientes a atención especializada (AE). Material y métodos: redacción y divulgación de la información entre los profesionales de AP adscritos al área de salud de nuestro hospital. Análisis retrospectivo de las derivaciones a AE y de la actuación llevada a cabo en consulta en los 2 años previos al envío de la información. Análisis prospectivo de las consultas atendidas en el año posterior a la difusión del tríptico. Comparación de ambos periodos. Resultados: se analizaron 874 consultas; de ellas, el 59,6% se realizó previa difusión del tríptico. Las derivaciones se ajustaron a los criterios propuestos por la UCPI (Unidad de Cirugía Plástica Infantil) en un 61,9% de los casos, observándose una reducción significativa en los pacientes mal derivados entre ambos periodos de tiempo (41,8% vs. 32,6%). Se comprobó una disminución estadísticamente significativa en el número de pacientes derivados sin un problema funcional claro asociado al FLC (34,4% vs. 23,3%). Conclusiones: la difusión de un tríptico informativo sobre FLC/A ha demostrado ajustar las derivaciones hechas desde AP a los criterios propuestos para frenotomía lingual en la UCPI de nuestro hospital (AU)

Introduction: we created an informative triptych about short lingual frenulum/ ankyloglossia (SLF/A) to avoid discrepancy in the referral criteria of patients to the pediatric plastic surgery consultation from primary care (PC). The main objective is to analyze the impact of this intervention on the referrals to specialized care (SC).Material and methods: the information was sent to the primary care professionals attached to the health area of our hospital. We performed a retrospective analysis of the referrals to SC in the 2 years prior sending the information. We compared these results with the prospective analysis of the consultations attended in the year after sending the triptych.Results: we analyzed 874 consultations. 59.6% of them were attended prior sending the information. 61.9% of the referrals adjusted to the proposed criteria for lingual frenotomy, observing a significant reduction in the wrongly referred patients between the compared periods of time (41.8% vs 32.6%). We also found a significant reduction in the number of patients with no functional problem associated to the SLF (34.4% vs 23.3%).Conclusions: our informative triptych about SLF/ ankyloglossia has adjusted referrals from PC to the proposed criteria for lingual frenotomy in our hospital. (AU)

[Pyeloplasty and vascular crossing detection: Surgical approach influence on pieloureteral junction stricture.] / Pieloplastia y detección de cruces vasculares: análisis de la influencia del abordaje quirúrgico en la evolución de la estenosis de la unión pieloureteral.

OBJECTIVE: Polar vessels are related with pyelo-ureteral stenosis (PUE) in 5-10% of the patients. In the 24% of these cases an intrinsic cause of stenosis can also be found. An increased incidence of polar vessels is found in laparoscopic surgery, compare to open procedures. Our study analyses this difference in our hospital, studying its influence in the aetiology of the disease.MATERIAL AND METHODS: Descriptive and retrospective study of patients operated in our hospital of pyeloplasty, because of PUE between 2009 and 2017. Patients have been divided in two groups: operated by laparoscopy (PL), or operated by conventional surgery (PA). All cases in which polar vessels were seen in TC where excluded. Each group included 47 patients. RESULTS: We found no statistical differences in the age of surgery of the two groups (36,1±41,3 months PL/31,8±37,2 months PA; p=0.527). Overall, 18 polar vessels were found, 15 in PL and 3 in PA. 6 patients of the PA group presented recurrence of the obstruction, and in 2 of them, polar vessels were found in the second surgery. All the 18th cases presented anomalies in the histological study related with inflammation or fibrosis. CONCLUSIONS: The laparoscopic approach allows a better vision of crossing vessels in the cases of extrinsic PUE. Dismembered pyeloplasty might be the best treatment, as an intrinsic cause of obstruction cannot be ruled out according to the observed histological alterations.

OBJETIVO: La incidencia de vasos polares como causa de estenosis pielo-ureteral (EPU) es del 5-10%. En un 24% de los casos asocia, además, una estenosis intrínseca. La aplicación de la laparoscopia para la realización de la pieloplastia ha aumentado significativamente la detección de cruces vasculares respecto a la cirugía abierta. El objetivo del estudio es analizar esta diferencia en nuestro centro, valorando su repercusión en el cuadro de obstrucción.MATERIAL Y MÉTODOS: Estudio descriptivo y retrospectivo de pacientes intervenidos mediante pieloplastia por EPU entre 2009 y 2017. Los pacientes se han dividido en dos grupos: intervenidos por vía laparoscópica (PL) o por cirugía abierta (PA), excluyéndose los casos diagnosticados previamente de vaso polar. La muestra incluyó un total de 94 pacientes, 47 en cada grupo. RESULTADOS: No se han encontrado diferencias estadísticamente significativas en la edad de intervención de ambos grupos (36,1±41,3 meses PL/31,8±37,2 meses PA; p=0,527). Se detectaron 18 vasos polares en total, 15 en PL y 3 en PA. 6 pacientes del grupo PA presentaron recidiva de la obstrucción y 2 de ellos presentaron cruces vasculares no detectados en la primera cirugía. En los 18 casos se encontraron alteraciones histológicas de tipo inflamatorio/fibrosis. CONCLUSIONES: La laparoscopia ofrece una visión mas detallada de la vascularización del riñón, permitiendo una mayor detección de vasos polares frente a la PA. La pieloplastia desmembrada constituye el tratamiento con mejores tasas de éxito, pues no se puede descartar un componente intrínseco obstructivo, además de la compresión vascular.

Pieloplastia y detección de cruces vasculares: análisis de la influencia del abordaje quirúrgico en la evolución de la estenosis de la unión pieloureteral / Pyeloplasty and vascular crossing detection: Surgical approach influence on pieloureteral junction stricture

OBJETIVO: La incidencia de vasos polares como causa de estenosis pielo-ureteral (EPU) es del 5-10%. En un 24% de los casos asocia, además, una estenosis intrínseca. La aplicación de la laparoscopia para la realización de la pieloplastia ha aumentado significativamente la detección de cruces vasculares respecto a la cirugía abierta. El objetivo del estudio es analizar esta diferencia en nuestro centro, valorando su repercusión en el cuadro de obstrucción. MATERIAL Y MÉTODOS: Estudio descriptivo y retrospectivo de pacientes intervenidos mediante pieloplastia por EPU entre 2009 y 2017. Los pacientes se han dividido en dos grupos: intervenidos por vía laparoscópica (PL) o por cirugía abierta (PA), excluyéndose los casos diagnosticados previamente de vaso polar. La muestra incluyó un total de 94 pacientes, 47 en cada grupo. RESULTADOS: No se han encontrado diferencias estadísticamente significativas en la edad de intervención de ambos grupos (36,1±41,3 meses PL/31,8±37,2 meses PA; p = 0,527). Se detectaron 18 vasos polares en total, 15 en PL y 3 en PA. 6 pacientes del grupo PA presentaron recidiva de la obstrucción y 2 de ellos presentaron cruces vasculares no detectados en la primera cirugía. En los 18 casos se encontraron alteraciones histológicas de tipo inflamatorio/fibrosis. CONCLUSIONES: La laparoscopia ofrece una visión mas detallada de la vascularización del riñón, permitiendo una mayor detección de vasos polares frente a la PA. La pieloplastia desmembrada constituye el tratamiento con mejores tasas de éxito, pues no se puede descartar un componente intrínseco obstructivo, además de la compresión vascular

OBJECTIVE: Polar vessels are related with pyelo-ureteral stenosis (PUE) in 5-10% of the patients. In the 24% of these cases an intrinsic cause of stenosis can also be found. An increased incidence of polar vessels is found in laparoscopic surgery, compare to open procedures. Our study analyses this difference in our hospital, studying its influence in the aetiology of the disease. MATERIAL AND METHODS: Descriptive and retrospective study of patients operated in our hospital of pyeloplasty, because of PUE between 2009 and 2017. Patients have been divided in two groups: operated by laparoscopy (PL), or operated by conventional surgery (PA). All cases in which polar vessels were seen in TC where excluded. Each group included 47 patients. RESULTS: We found no statistical differences in the age of surgery of the two groups (36,1±41,3 months PL/31,8±37,2 months PA; p = 0.527). Overall, 18 polar vessels were found, 15 in PL and 3 in PA. 6 patients of the PA group presented recurrence of the obstruction, and in 2 of them, polar vessels were found in the second surgery. All the 18th cases presented anomalies in the histological study related with inflammation or fibrosis. CONCLUSIONS: The laparoscopic approach allows a better vision of crossing vessels in the cases of extrinsic PUE. Dismembered pyeloplasty might be the best treatment, as an intrinsic cause of obstruction cannot be ruled out according to the observed histological alterations

Malformación linfática mesentérica: una causa poco frecuente de abdomen agudo / Mesenteric lymphatic malformation: A rare cause of an acute abdomen

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Laryngeal stenosis in children: Types, grades and treatment strategies.

INTRODUCTION: Laryngeal stenosis is infrequent in children and usually secondary to endotracheal intubation. The aims of this study were to review the outcomes of the distinct endoscopic and surgical procedures and to suggest a technical modification for one of them. METHODS: Retrospective review of patients with the diagnosis of laryngeal stenosis treated in an academic tertiary care institution between 2000 and 2017. The following variables were analyzed: demographic data, endoscopic findings including anatomic type and severity of the lesion, associated anomalies, type of treatment, outcomes, and time of follow-up. RESULTS: Seventy-eight children were included in the study (39 boys) with a median age at diagnosis of 9 months, and 33 (42.3%) showed an associated anomaly. Lesions were acquired in 84.6% of cases and the subglottic region was most frequently involved (77%). Thirty patients (38.4%) had a severe stenosis (Myer-Cotton grades III and IV) and a tracheotomy was performed as an initial treatment in 38 patients (48.7%). Overall, 91% of endoscopically or surgically treated patients showed a good outcome and the decannulation rate in the series was 79.4%. Fourteen patients were managed conservatively. Median follow-up was 29 months (I.R. 10-60 m.) CONCLUSIONS: Laryngeal stenosis in children is usually acquired and exhibit a wide range of anatomic presentations. Endoscopic therapeutic procedures may be useful in the management of low grade immature stenosis. Reconstructive surgical techniques may provide a high success rate with an appropriate selection of candidates.

Laparoendoscopic single-site nephrectomy in children: Is it a good alternative to conventional laparoscopic approach?

BACKGROUND: Minimally invasive surgery is considered to be the gold standard treatment for nephrectomy in children. In recent decades it has been proposed that laparoendoscopic single-site (LESS) surgery is a feasible alternative to perform laparoscopic nephrectomies. OBJECTIVE: The aim of our study was to compare the safety and efficacy of LESS against conventional laparoscopic (CL) nephrectomy. STUDY DESIGN: From March 2010 to November 2012 charts of pediatric patients who underwent laparoscopic nephrectomy at our tertiary center were revised. The data from 23 nephrectomies performed by either LESS or conventional laparoscopic approach were analyzed retrospectively. A transperitoneal approach was selected for both modalities. Indications for surgery included multicystic dysplastic kidneys (MCDK), hydronephrosis, vesicoureteral reflux (VUR), and renal dysplasia. Malignancy and previous abdominal interventions were exclusion criteria. Differences with a p value less than 0.05 were considered to be statistically significant. RESULTS: Twenty-three laparoscopic nephrectomies were performed, 13 by CL (53.5%) and 10 by LESS (46.5%). The mean age of patients was 3.29 ± 3.5 years. There were no significant differences in age, gender, laterality of pathology, size of the kidneys, and surgical indications between the groups (p = 0.067, 0.431, 0.94, 0.644, and 0.078, respectively). The mean operative times were 120 min for LESS and 132.7 min for CL (p = 0.334). No procedures required conversion to open surgery or to standard laparoscopy. There was one intraoperative complication in each group (p = 0.845). The mean length of stay (LOS), narcotic usages, and postoperative complications were similar in both groups. DISCUSSION: To overcome technical difficulties of the LESS approach, articulated tools have been developed. However, they may be not suitable for use with younger children. Although we performed LESS nephrectomies with conventional laparoscopic instruments, in our study, LESS and CL approach were comparable in terms of operative time, analgesic therapy, LOS, and complications. CONCLUSIONS: LESS nephrectomy for benign kidney diseases performed by skilled laparoscopic surgeons is safe and comparable with CL technique in pediatric patients. However, although minimally invasive development pushes towards "a scar-free surgery" (see Figure), these approaches have been performed in only a few centers in the world. Prospective studies comparing both approaches are necessary to verify the advantages of LESS nephrectomy in children.

Tumores neuroendocrinos gastroenteropancreáticos: características clínicas, proceso diagnóstico y pronóstico en el Hospital Universitario Clínico San Carlos (Madrid) / Gastroenteropancreatic neuroendocrine tumors: Clinical characteristics, diagnosis and prognosis at Hospital Universitario Clínico San Carlos (Madrid)

INTRODUCCIÓN: Los tumores neuroendocrinos (TNE) representan un grupo de neoplasias originadas por células de la cresta neural y del endodermo con gran heterogenicidad en cuanto a localización, comportamiento clínico, agresividad y pronóstico. El páncreas y el tubo digestivo constituyen las localizaciones más frecuentes. MATERIAL Y MÉTODOS: Se ha realizado una revisión de casos diagnosticados de neoplasia neuroendocrina gastroenteropancreática (TNEGEP), tanto primaria como metastásica, en el Hospital Universitario Clínico San Carlos (HUCSC) entre enero de 2007 y mayo de 2012. Se han comparado los datos obtenidos con los aportados por el Registro del Grupo Español de Tumores Neuroendocrinos (RGETNE). RESULTADOS: El estudio constó de 78 pacientes. El tipo de tumor más común fue el gastroentérico no funcionante. Un 50,6% de los pacientes presentó metástasis al diagnóstico, siendo lo más prevalente la afectación ganglionar. Los TNEGEP localizados en el recto se acompañaron de un mayor porcentaje de metástasis. La supervivencia global a los 24 meses fue del 74,8%, estando en relación con el sexo, la expresión del Ki-67 y la presencia de enfermedad a distancia

INTRODUCTION: Neuroendocrine tumors are a group of neoplasms arising from the neural crest and endoderm and very heterogeneous as regards localization, clinical behavior, aggressiveness, and prognosis. Pancreas and gastrointestinal tract are the most common sites where neuroendocrine tumors can be found. MATERIAL AND METHODS: A review was made of all cases of neuroendocrine tumors diagnosed at Hospital Universitario Clínico San Carlos (HUCSC) from January 2007 to May 2012. Data were compared to the results provided by the Registry of the Spanish Group on Neuroendocrine Tumors (RGETNE). RESULTS: The study cohort comprised 78 patients. Gastroenteric nonfunctional tumors were the most common neoplasms. Metastases were found at diagnosis in 50.6% of patients, with nodal involvement being most prevalent. Tumors located in the rectum were associated to the highestrate of metastasis. Overall 2-year survival rate was 74.8% and was related to sex, Ki-67 expression, and presence of metastasis

[Gastroenteropancreatic neuroendocrine tumors: clinical characteristics, diagnosis and prognosis at Hospital Universitario Clínico San Carlos (Madrid)]. / Tumores neuroendocrinos gastroenteropancreáticos: características clínicas, proceso diagnóstico y pronóstico en el Hospital Universitario Clínico San Carlos (Madrid).

INTRODUCTION: Neuroendocrine tumors are a group of neoplasms arising from the neural crest and endoderm and very heterogeneous as regards localization, clinical behavior, aggressiveness, and prognosis. Pancreas and gastrointestinal tract are the most common sites where neuroendocrine tumors can be found. MATERIAL AND METHODS: A review was made of all cases of neuroendocrine tumors diagnosed at Hospital Universitario Clínico San Carlos (HUCSC) from January 2007 to May 2012. Data were compared to the results provided by the Registry of the Spanish Group on Neuroendocrine Tumors (RGETNE). RESULTS: The study cohort comprised 78 patients. Gastroenteric nonfunctional tumors were the most common neoplasms. Metastases were found at diagnosis in50.6% of patients, with nodal involvement being most prevalent. Tumors located in the rectum were associated to the highestrate of metastasis. Overall 2-year survival rate was 74.8% and was related to sex, Ki-67 expression, and presence of metastasis.