Dilation with rigid dilators as primary treatment of subglottic stenosis in pediatrics.

INTRODUCTION: Acquired subglottic stenosis (SGS) occurs in 1-2% of children with a history of intubation. An alternative treatment is endoscopic dilation with rigid dilators. MATERIAL AND METHODS: Seventy-four patients with SGS grade I to III were treated between 2003 and 2017. Dilations were performed with Hegar-type rigid dilators every 2-3 weeks. RESULTS: Eighty-two percentage of patients responded to the treatment. 10% presented SGS grade I, 35% grade II and 55% grade III. Previous intubation time in successful cases was 12.4 days and it was 32 days in those that failed (p=0.02). The average number of dilations was 3.23 in the group that responded and 2.98 for those that did not respond (p=0.51). The presence of tracheostomy reduced the effectiveness of the treatment (p=0.002). The average follow-up was 43.5 months. CONCLUSION: The use of rigid dilators under endoscopic control is an effective minimally invasive method for treating patients with SGS grades I to III. Previous intubation time and the presence of tracheostomy were identified as poor prognostic factors.

Videolaparoscopic management of arcuate ligament syndrome in pediatric patients. / Resolución por videolaparoscopia del síndrome de ligamento arcuato en pediatría.

Median arcuate ligament syndrome, which is characterized by postprandial pain, occurs as a result of the compression of the celiac trunk by the ligament. It is a rare pathology in pediatric patients. We present the case of a 14-year-old girl with recurrent abdominal pain. Ultrasound examination showed an increase in celiac trunk flow rate with flow reversal, while CT angiography demonstrated compression. It was surgically managed by dividing the arcuate ligament through videolaparoscopy. Symptoms disappeared right after surgery and did not reappear in the 24-month follow-up. The arcuate ligament is a fibrous band located at the level of the diaphragmatic crus. The fact that the celiac trunk originates at the supradiaphragmatic aorta makes the ligament exert compression during expiration, with transitory distal ischemia. Diagnosis is achieved through Doppler ultrasonography of the celiac trunk or CT angiography, among others. Surgical management involves dividing the arcuate ligament. This syndrome should be considered in the presence of recurrent abdominal pain. The laparoscopic route is the treatment approach suggested.

El síndrome de ligamento arcuato medio caracterizado por dolor posprandial se debe a la compresión del tronco celíaco por dicho ligamento. En pediatría su presentación es infrecuente. Niña de 14 años con dolor abdominal recurrente. Se diagnosticó por ecografía un aumento de la velocidad del flujo del tronco celíaco con inversión de flujo. La angiotomografía evidenció la compresión. Su resolución fue quirúrgica mediante la sección del ligamento arcuato por videolaparoscopia. Los síntomas desaparecieron inmediatamente luego de la cirugía y no recurrieron en 24 meses de seguimiento. El ligamento arcuato es una banda fibrosa en la crura diafragmática. El nacimiento del tronco celíaco en la aorta supradiafragmática conlleva que este ligamento comprima durante la espiración con isquemia distal transitoria. El diagnóstico se realiza con ecografía Doppler del tronco celíaco o angiotomografía, entre otros. La resolución quirúrgica consiste en la sección del ligamento arcuato. Este síndrome debe tenerse en cuenta ante un caso de dolor abdominal recurrente. La vía laparoscópica es sugerida para el tratamiento.

Resolución por videolaparoscopia del síndrome de ligamento arcuato en pediatría / Videolaparoscopic management of arcuate ligament syndrome in pediatric patients

El síndrome de ligamento arcuato medio caracterizado por dolor posprandial se debe a la compresión del tronco celíaco por dicho ligamento. En pediatría su presentación es infrecuente. Niña de 14 años con dolor abdominal recurrente. Se diagnosticó por ecografía un aumento de la velocidad del flujo del tronco celíaco con inversión de flujo. La angiotomografía evidenció la compresión. Su resolución fue quirúrgica mediante la sección del ligamento arcuato por videolaparoscopia. Los síntomas desaparecieron inmediatamente luego de la cirugía y no recurrieron en 24 meses de seguimiento. El ligamento arcuato es una banda fibrosa en la crura diafragmática. El nacimiento del tronco celíaco en la aorta supradiafragmática conlleva que este ligamento comprima durante la espiración con isquemia distal transitoria. El diagnóstico se realiza con ecografía Doppler del tronco celíaco o angiotomografía, entre otros. La resolución quirúrgica consiste en la sección del ligamento arcuato. Este síndrome debe tenerse en cuenta ante un caso de dolor abdominal recurrente. La vía laparoscópica es sugerida para el tratamiento

Median arcuate ligament syndrome, which is characterized by post-prandial pain, occurs as a result of the compression of the celiac trunk by the ligament. It is a rare pathology in pediatric patients. We present the case of a 14-year-old girl with recurrent abdominal pain. Ultrasound examination showed an increase in celiac trunk flow rate with flow reversal, while CT angiography demonstrated compression. It was surgically managed by dividing the arcuate ligament through videolaparoscopy. Symptoms disappeared right after surgery and did not reappear in the 24-month follow-up. The arcuate ligament is a fibrous band located at the level of the diaphragmatic crus. The fact that the celiac trunk originates at the supradiaphragmatic aorta makes the ligament exert compression during expiration, with transitory distal ischemia. Diagnosis is achieved through Doppler ultrasonography of the celiac trunk or CT angiography, among others. Surgical management involves dividing the arcuate ligament. This syndrome should be considered in the presence of recurrent abdominal pain. The laparoscopic route is the treatment approach suggested

Neuroblastoma neonatal estadio IV y IVs: Tratamiento quirúrgico con silo y reducción hepática / Neonatal Stage IV and IVs neuroblastoma: surgical treatment with silo and liver reduction

Las metástasis hepáticas del neuroblastoma neonatal pueden causar fallo multiorgánico debido al crecimiento rápido y hepatomegalia masiva. El objetivo de este trabajo es presentar dos neonatos con Neuroblastoma estadio IV y IVs en situación crítica que necesitaron un silo abdominal descompresivo y reducción hepática para lograr el cierre abdominal definitivo. Actualmente los dos niños tienen 6 años de edad y están libres de enfermedad. Conclusión. La colocación de un silo abdominal descompresivo continúa siendo una opción de rescate. La reducción hepática quirúrgica podría ser una alternativa para el cierre precoz del abdomen

Hepatic metastases of neonatal neuroblastoma can cause multiple organ failure due to rapid growth and severe hepatomegaly. The objective of this work is to present two infants with neuroblastoma stage IV and IVs in a critical situation that needed a decompressive abdominal silo and surgical liver reduction for definitive abdominal closure. Currently both children are 6 years old and they are free from disease. Conclusion. The placement of a silo for abdominal decompression is still an indication for salvage. Surgical hepatic reduction is an alternative for the early closure of the abdomen avoiding complications due to infection or dehiscence of the silo

[Neonatal stage IV and IVs neuroblastoma: surgical treatment with silo and liver reduction]. / Neuroblastoma neonatal estadio IV y IVs: Tratamiento quirúrgico con silo y reducción hepática.

UNLABELLED: Hepatic metastases of neonatal neuroblastoma can cause multiple organ failure due to rapid growth and severe hepatomegaly. The objective of this work is to present two infants with neuroblastoma stage IV and IVs in a critical situation that needed a decompressive abdominal silo and surgical liver reduction for definitive abdominal closure. Currently both children are 6 years old and they are free from disease. CONCLUSION: The placement of a silo for abdominal decompression is still an indication for salvage. Surgical hepatic reduction is an alternative for the early closure of the abdomen avoiding complications due to infection or dehiscence of the silo.