[Endoscopic sclerosis with pneumatic distension for pyriform sinus fistula treatment]. / Esclerosis endoscópica con distensión neumática para el tratamiento de las fístulas del seno piriforme.

Classic treatment for pyriform sinus fistula (PSF) has been surgical excision; however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air flow through the flexible endoscope was used to distend the pyriform sinus and facilitate recognition of the fistula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, performing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very effective; hence we consider it might become a first line therapy for PSF.

Esclerosis endoscópica con distensión neumática para el tratamiento de las fístulas del seno piriforme / Endoscopic sclerosis with pneumatic distension for pyriform snus fistula treatment

El tratamiento clásico de la fístula seno piriforme (FSP) ha sido la exéresis quirúrigca del trayecto fistuloso, sin embargo posteriormente se han desarollado alternativas menos invasivas que tratan de obliterar el seno. Los autores presentan una modificación técnica de la esclerosis endoscópica con diatermia (ED): aplicar un flujo de aire fl ujo de aire continuo a través del endoscopio fl exible que favorece la distensión del seno piriforme y así la visualización del orifi cio de apertura de la fístula. Se utilizó una guía metálica y diatermia para obliterar el trayecto fi stuloso. En los últimos 15 años se diagnosticaron 9 pacientes de FSP en nuestro centro. El tra-tamiento inicial fue antibioterapia, en algunos casos asociada al drenaje del absceso cervical. Se procedió a la fi stulectomía en 4 casos y a la ED en otros 4. El noveno paciente recibió tratamiento mixto, realizando la electrocauterización tras una recidiva quirúrgica. Mientras que tres casos tratados quirúrgicamente recidivaron, ninguno tratado mediante ED lo hizo ni presentó complicaciones. En nuestra experiencia, la es-clerosis endoscópica con distensión neumática es una técnica sencilla, reproducible, poco agresiva y muy efectiva, por lo que creemos que podría convertirse en la terapia de primera elección para esta patología

Classis treatment for pyriform sinus fistula (PSF) has been surgical excision: however, less invasive therapeutic alternatives whose aim is the obliteration of the sinus have been described subsequently. The authors present a technical modification of endoscopic sclerosis with diathermy (ESD): continuous infusion of air fl ow through the fl exible endoscope was used to distend the pyriform sinus and facilitate recognition of the fi stula opening. The sinus obliteration was performed with a wire guide and diathermy. In the last 15 years, 9 patients were diagnosed of suffering from PSF in our institution. Initial treatment was antibiotics therapy associated in some cases to cervical abscess drainage. Fistulectomy was performed in 4 cases and ESD in 4. The ninth patient received both treatments, perform-ing electrocauterization after a surgical recurrence. Three of the patients who underwent surgery relapsed; none treated by ESD did, or had any complications. In our experience, endoscopic sclerosis with pneumatic distension is a simple technique, reproducible, not invasive and very ef-fective; hence we consider it might become a fi rst line therapy for PSF

[Risk factors for Barrett's oesophagus in children: a case-control study]. / Factores de riesgo del esófago de Barrett en niñios: estudio caso-control.

AIM OF THE STUDY: Barrett's oesophagus in young individuals is a rare pathology. The purpose of this study was to identify those risk factors involved in Barrett's oesophagus (BO) development in children. METHODS: We performed a case-control study between years 2000 and 2010. Cases had endoscopic BO with histological confirmation of gastric or intestinal metaplasia. For each case, three to four controls were selected from our ph-monitoring database. They were matched by age, + 2 years, or by associated features (oesophageal atresia or Down's syndrome) when appropriate. An analysis of the demographic variables, symptoms and endoscopic data was performed: sex, digestive or respiratory symptoms, exposition time to gastroesophageal reflux (GER) without treatment with proton-pump inhibitors (PPI) and Helicobacter pylori (HP) presence. MAIN RESULTS: Six patients were diagnosed with BO (age range: 8 months-14 years) and a 21 control samples were included. Both groups were comparable in sex and age parameters. There were no differences in clinical presentation, neither in presence of hiatal hernia nor HP colonisation. The ph-monitoring register did not differ between groups, median Reflux Index or Boix Ochoa Index. The only risk factor found in this study is the exposition time to GER: OR = 1.046; CI95% (1.007-1.086); p = 0.021. CONCLUSIONS: Our results suggest that exposition time to GER without treatment with PPI is related to Barrett's oesophagus development in childhood.

Factores de riesgo del esófago de Barrett en niños: estudio caso-control / Risk factors for Barrett’s oesophagus in children: A case-control study

Objetivo. El esófago de Barrett es una patología infrecuente en la población infantil. El objetivo del estudio es identificar los factores de riesgo que pueden favorecer el desarrollo de esófago de Barrett (EB) en niños. Material y métodos. Realizamos un estudio caso-control entre los años 2000 y 2010. Los casos presentaban EB endoscópico con confirmación histológica de metaplasia gástrica o intestinal. Para cada caso se seleccionaron tres o cuatro controles de nuestro registro de pH-metrías. Se emparejaron por edad, ± 2 años, o bien por patología asociada (atresia de esófago o síndrome de Down). Realizamos un análisis de las variables demográficas, clínicas y endoscópicas recogidas: el sexo, los síntomas digestivos y respiratorios, el tiempo de exposición al reflujo gastroesofágico (RGE) sin el tratamiento con inhibidores de la bomba de protones (IBP), los hallazgos endoscópicos y la presencia de Helicobacter pylori (HP).Resultados. Se diagnosticaron seis pacientes con EB (rango de edad: 8 meses-14 años) y 21 controles. Ambos grupos fueron comparables en edad y sexo. No encontramos diferencias significativas en la presentación clínica, en la presencia de hernia hiatal o HP. Los datos pH métricos, índice de reflujo e índice de Boix, tampoco difirieron entre los grupos. El único factor de riesgo que hallamos en el estudio fue el tiempo de exposición al RGE: OR = 1,046; IC 95%: 1,007-1,086; p = 0,021.Conclusiones. Los resultados sugieren que el tiempo de exposición al RGE sin tratamiento con IBP está relacionado con el desarrollo de esófago de Barrett en la infancia (AU)

Aim of the study. Barrett’s oesophagus in young individuals is a rare pathology. The purpose of this study was to identify those risk factors involved in Barrett’s oesophagus (BO) development in children. Methods. We performed a case-control study between years 2000 and 2010. Cases had endoscopic BO with histological confirmation of gastric or intestinal metaplasia. For each case, three to four controls were selected from our ph-monitoring database. They were matched by age, ± 2 years, or by associated features (oesophageal atresia or Down’s syndrome) when appropriate. An analysis of the demographic variables, symptoms and endoscopic data was performed: sex, digestive or respiratory symptoms, exposition time to gastroesophageal reflux (GER) without treatment with proton-pump inhibitors (PPI) and Helicobacter pylori (HP) presence. Main results. Six patients were diagnosed with BO (age range: 8 months-14 years) and a 21 control samples were included. Both groups were comparable in sex and age parameters. There were no differences in clinical presentation, neither in presence of hiatal hernia nor HP colonisation. The ph-monitoring register did not differ between groups, median Reflux Index or Boix Ochoa Index. The only risk factor found in this study is the exposition time to GER: OR = 1.046; CI 95% (1.007-1.086); p = 0.021.Conclusions. Our results suggest that exposition time to GER without treatment with PPI is related to Barrett’s oesophagus development in childhood (AU)

Criopreservación ovárica en niñas con cáncer: nuevos retos / Ovarian cryopreservation in girls with cancer: new challenges

Objetivos. La criopreservación de la corteza ovárica (CCO) para futuro autotrasplante permitirá hacer frente al fallo ovárico precoz y a las alteraciones de la capacidad reproductiva que afectan a algunas delas supervivientes de cáncer pediátrico. Material y métodos. En el Programa de Preservación de Fertilidad en Oncología Pediátrica se incluyen pacientes con alto riesgogonadotóxico: las que vayan a recibir radioterapia pélvica, trasplante de precursores hematopoyéticos, altas dosis de radioterapia craneal o agentes alquilantes, o aquéllas con patología ovárica bilateral. Antes del tratamiento oncológico y coincidiendo con otros procedimientos invasivos, se recoge el tejido ovárico por vía laparoscópica. Una vez descartada la malignidad en la muestra y confirmada la presencia de folículos primordiales, el equipo multidisciplinar de oncólogo, cirujano y especialista en fertilidad coordina la manipulación y envío de la corteza ovárica al Banco de Tejidos de la Comunidad Valenciana. Resultados. De julio de 2008 hasta mayo de 2010 se incluyeron en el programa a 8 pacientes, entre 8 y 18 años, con diagnóstico de: linfoma de Hodgkin (n= 2), leucemia aguda linfoide y mieloide (n= 2),sarcoma de Ewing pélvico, teratoma ovárico bilateral y meduloblastoma. Cinco pacientes recibieron quimioterapia no gonadotóxica previa a la CCO. De forma adicional, se practicaron 6 procedimientos en el mismo acto anestésico. Se realizó o oforectomía parcial en la mitad delos casos y total en el resto, asociando pexia ovárica en 1 ocasión. Todas las muestras fueron válidas. Conclusiones. La CCO de los casos seleccionados se realizó de forma segura, sin complicaciones ni demora del tratamiento oncológico. Podemos afi rmar que la primera experiencia nacional en este tipo de abordaje ha sido satisfactoria (AU)

Background. Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatriccancer survivors affected of ovarian failure and fertility disorders. Methods. Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad ValencianaTissue Bank. Results. From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin’s lymphoma (n= 2), Acute Myeloblastic and Lymphoblasticleukaemia (n= 2), pelvic Ewing’s sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxicchemo therapy before OCC. Six additional procedures were doneusing the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarianpexia was once associated. All taken samples were found to be valid. Conclusions. OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the fi rst national experience in this procedure has been satisfactorily achieved (AU)

[Ovarian cryopreservation in girls with cancer: new challenges]. / Criopreservación ovárica en niñas con cáncer: nuevos retos.

BACKGROUND: Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders. METHODS: Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank. RESULTS: From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid. CONCLUSIONS: OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.