[Initial study of an experimental model for bladder augmentation]. / Estudio inicial de un modelo experimental para la ampliación vesical.

Since Coffey described in 1910 the Uretero-sigmoidostomy, the first auto-continent urinary derivation, many techniques have been developed and used for bladder augmentation, although none of them has been considered fully satisfactory. The availability of a product made of a bovine collagen and glycosaminoglycan base, used for regenerating dermis and oral mucosa induced us to start this study on rabbit bladder in order to verify if muscular fibers might grow in its interior. For that purpose we used 6 New Zealand rabbits, to which we implanted a fragment of artificial dermis inside the detrusor after dissecting it. We present our results after 3 and 6 weeks postoperatively.

Estudio inicial de un modelo experimental para la ampliación vesical / Initial study of an experimental model for bladder augmentation

Desde la descripción de Coffey en 1910 de la uretero-sigmoidostomía, primera derivación urinaria continente, se han utilizado multitud de técnicas para ampliar la vejiga, pero ninguna plenamente satisfactoria. La aparición de un producto compuesto por una matriz de colágeno bovino y glicosaminoglicano, utilizado en regeneración de dermis y mucosa oral, nos indujo a realizar este estudio sobre vejiga de conejo con el fin de comprobar si podrían crecer fibras musculares en su interior. Para ello utilizamos 6 conejos New Zealand, a los que tras dislacerar una porción de detrusor les implantamos un fragmento de dermis artificial. Posteriormente, se realizó estudio anatomopatológico a las tres yseis semanas, con los resultados que posteriormente se detallan (AU)

Since Coffey described in 1910 the Uretero-sigmoidostomy, the first auto-continent urinary derivation, many techniques have been developed and used for bladder augmentation, although none of them has been considered fully satisfactory. The availability of a product made of a bovine collagen and glycosaminoglycan base, used for regenerating dermis and oral mucosa induced us to start this study on rabbit bladder in order to verify if muscular fibers might grow in its interior. For that purpose we used 6 New Zealand rabbits, to which we implanted a fragment of artificial dermis inside the detrusor after dissecting it. We present our results after 3 and 6 weeks postoperatively (AU)

Estudio comparativo de la incidencia de abscesos de pared abdominal en niños intervenidos quirúrgicamente por apendicitis aguda: tratamiento convencional vs con suturas recubiertas de antiséptico o con apósitos impregnados de antibiótico / Prospective study comparing the incidence of wound infection following appendectomy for acute appendicitis in children: conventional treatment versus using reabsorbable antibacterial suture or gentamicin impregnated collagen fleeces

La infección de la herida, tras la apendicectomía en la infancia, esun problema frecuente y que produce trastornos muy molestos. Revisamos prospectivamente a los niños operados por apendicitis aguda, con técnicas quirúrgicas convencionales, durante un período consecutivo de 9 meses (Grupo Control: 58 pacientes), y a los niños intervenidos durante los 9 meses siguientes, bajo las mismas circunstancias quirúrgicas excepto utilizar, de manera aleatoria, sutura recubierta de antiséptico (Vicryl Plus®, Ethicon Johnson & Johnson Medical), para el cierre de la pared abdominal en un Subgrupo o esponja de colágeno impregnada en gentamicina (Collatamp EG®, Acuña Fombona, S.A.;Schering-Plough, S.A.), introducida entre la musculatura de la incisión, en el otro Subgrupo (Grupo Estudio: 101 pacientes).Estudiamos en los dos grupos, fundamentalmente, la incidencia de abscesos de pared y la estancia media hospitalaria. La introducción de suturas recubiertas de antiséptico y/o esponja de colágeno impregnada en gentamicina, en el cierre de la herida quirúrgica postapendicectomía, ha contribuido a reducir de manera estadísticamente significativa la incidencia de abscesos de pared y de la estancia media hospitalaria de los niños incluidos en el Grupo Estudio, con respecto a los pertenecientes al Grupo Control (AU)

Postappendectomy wound infection is frequent in the pediatric age. It causes them important discomfort. We have conducted a prospective clinical study to evaluate this incidence under different surgical management. The subjects were children undergoing appendectomy for acute appendicitis. The patients belonging to the Control Group were operated, by standard surgical technique, along the first 9 months of the study period (n: 58).The Study Group was constituted by 101 children operated during the 9 consecutive months, identical on the basis of demographics and operations undergone, except for the use of, in an aleatory manner, sutures with antiseptic impregnation (Vicryl Plus®, Ethicon Johnson& Johnson Medical), to close the incision in children included in Study Sub-Group A, or gentamycin-containing collagen sponge (CollatampEG®, Acuña Fombona, S.A.; Schering-Plough, S.A.), placed within the muscles before wound closure,. In the children belonging to the Study Sub-Group B. We have analyzed in the two Groups the incidence of postoperative wound infection and the mean Hospital stay. The use of sutures with antiseptic impregnation and/or gentamycin containing collagen sponge, significantly reduced the wound infection rates in the children operated on for appendectomy included in the Study Group, compared with the ones in the Control Group, therefore contributing to decrease the Hospital length of stay (AU)

Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

Hemangiopericitoma congénito / Congenital hemangioparicytoma

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[Analysis of 34 cases of distal hypospadias treated by modified Koff's technique]. / Análisis de 34 casos de hipospadias distal intervenidos mediante la técnica de Koff modificada.

Koff's procedure in the treatment of distal hypospadias consist in a large mobilization of the distal urethra. The association to a transglandular funelization and minimal urethroplasty is useful for the treatment in the majority of patients with distal hypospadias. In the last two years 34 patients with distal types of hypospadias were operated with a Koff's modified procedure. The technique consists in a urethral advancement without glanduloplasty and distal cutaneous tubulization. The primitive meatal localization was subcoronal (n = 22), glandular (n = 6), and on the distal shaft (n = 6). In 10 cases urethral catheters was not necessary. A patient develops a proximal fistula successfully treated with 14 days catheterization. Cosmetic and functional results were good in all cases. Extensive urethral mobilization can be done in cases of distal hypospadias and is evidence of the preserved vascularity and viability of the mobilized urethra.

Selective splenic artery embolization or use of polyglycolic acid mesh in children with severe splenic trauma.

Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical intervention is very rare. When surgical exploration in mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prostheses. We present our experience over the past year with 5 severe splenic injuries. Three of these patients were treated operatively with a resorbable mesh, while the other two were managed percutaneously by selective embolization of the splenic artery under fluoroscopic control. We describe the embolization technique with its advantages, good outcome with low morbidity, and low economic and social cost.

[Surgical treatment of laryngotracheal stenosis in childhood]. / Tratamiento quirúrgico de las estenosis laringotraqueales en la infancia.

Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.

[Surgical options in the treatment of short bowel syndrome with loss of the ileocecal valve. Intestinal valve, intestinal duplication]. / Opciones quirúrgicas en el tratamiento del síndrome de intestino corto con pérdida de la válvula ileocecal. Válvula intestinal, desdoblamiento intestinal.

Morbidity and mortality are especially increased in pediatric patients affected of short bowel syndrome in whom ileocecal valve was resected. This report concerns 13 infants and children with short gut syndrome with ileocecal valve resected treated in the last 4 years. In two of them we performed intestinal duplication and in seven an antireflux intestinal valve with a segment of bowel. With that procedure we achieved a significant shortening of the hospital stay as well as reduction in time and quantity of total parenteral nutrition. The rest of the patients were treated with conservative management.

[Renal volumetric echography in the newborn infant with an agenetic, dysplastic or obstructive contralateral kidney]. / Volumetría ecográfica renal en el recién nacido con riñón contralateral agenésico, displásico u obstructivo.

In newborn babies with congenital renal pathology type agenesia, dysplasia or obstruction is very important to know if there is intrautero vicariant growing of the contralateral kidney. To find out that we have proceeded to be ultrasound volume measurement of the normal renal unit, as this is a valuable parameter related to compensatory mechanisms. We have studied by ultrasounds 28 renal units (16 right, 12 left) in newborns with contralateral pathology: pyeloureteral stenosis in 10 cases, multicystic kidney in 13 cases, renal agenesia in 3 cases, obstructive ureterocele in 1 case and another one with ureterovesical stenosis. We considered renal function, length of the larger renal axis width and depth of the kidney mass. Renal function was normal in all cases. Analysis of objectives results show a clear difference between the volume of normal Kidneys in children with contralateral pathology and the control group constituted by 42 renal unit in normal newborns without urological pathology. We conclude with the real evidence of compensatory growing of the normal contralateral kidney during intrautero periods.

[Intralobar pulmonary sequestration with multiple arterial blood supply]. / Secuestro pulmonar intralobar con irrigación arterial múltiple.

We report the case of a 4 years old boy, who presented at our institution with reiterative neumonia affecting left basal lobe. Anomalous vascular appearance was detected in the chest x-ray. With the suspicion of pulmonary sequestration we carried on Digital Intravenous Angiography by Substraction (DIVAS) and aortogram. The anomalous systemic arterial supply was formed by 6 vessels coming from the thoracic aorta and going into the left lower lobe basal segment. Lobectomy was performed and previous diagnosis was confirmed pathologically.

[Cantrell's pentalogy: complete treatment, step by step]. / Pentalogía de Cantrell: tratamiento completo, paso a paso.

Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

[Volvulus of the small intestine. Contribution of abdominal echography to early diagnosis]. / Volvulo de intestino delgado. Contribucion de la ecografia abdominal al diagnostico precoz.

We report six cases of small intestine volvulus associated to malrotation, out of a whole of 11 volvulus managed by us in the last six years. None of them were diagnosed with the only help of clinical and conventional radiological explorations. In the other three cases the diagnosis was made through ultrasounds explorations: It showed the mesenteric vein on the left side of the mesenteric artery. Confirmation and resolution of the cases were reached with a laparotomy.

[Ectopic gastric mucosa in the proximal esophagus]. / Mucosa gástrica ectópica en esófago proximal.

Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.