[Risk factors for the development of severe gastroesophageal reflux in neonates with congenital diaphragmatic hernia surgery]. / Riesgo para desarrollar reflujo gastroesofágico severo en neonatos operados de hernia diafragmática congénita.

BACKGROUND: Gastroesophageal reflux after congenital diaphramatic hernia surgical correction occurs in up to 89 % of patients, out of which 20 to 30 % will require surgical management. Identification of risk factors for the development of this complication might allow for a Nissen fundoplication to be performed at the sime surgical time in those requiring it. The purpose of this research was to identify those factors in children with diaphragmatic hernia surgery. METHODS: A case-control study was conducted, where patients with diaphragmatic hernia surgery treated between 2006 and 2011 were included. Patients with severe gastroesophageal reflux were regarded as the cases, whereas those who did not develop it over the 1-year follow up were the controls. RESULTS: Nine patients developed severe gastroesophageal reflux after the diaphragmatic hernia surgery. A large size of the hernia, it containing 4 or more organs, 10 days or more of ventilatory support requirement after the surgery or high mechanical ventilation variables significantly increased the risk for the development of severe gastroesophageal reflux. CONCLUSIONS: Presurgical risk factors such as large hernias or hernias containing more than 4 organs might suggest the convenience of conducting a fundoplication at the same time of the diaphramatic hernia surgical correction.

INTRODUCCIÓN: el reflujo gastroesofágico posterior a la reparación de la hernia diafragmática congénita se presenta hasta en 89 % de los pacientes; de ellos, 20 a 30 % requerirá manejo quirúrgico. Conocer los factores de riesgo para desarrollar esta complicación podría permitir realizar funduplicatura Nissen en el mismo tiempo quirúrgico en quienes sea necesaria. El objetivo de esta investigación fue identificar esos factores en niños operados de hernia diafragmática. MÉTODOS: se realizó un estudio de casos y controles en el que se incluyeron neonatos operados de hernia diafragmática que fueron atendidos entre 2006 y 2011. Se consideró como casos a los pacientes con reflujo gastroesofágico severo y como controles a quienes no lo presentaron en el seguimiento de un año. RESULTADOS: se incluyeron 24 pacientes posoperados de hernia diafragmática; nueve de ellos presentaron reflujo gastroesofágico severo después de la cirugía de la hernia diafragmática. Se identificaron como factores que incrementaron significativamente el riesgo para desarrollar reflujo gastroesofágico severo, el tamaño amplio de la hernia, que esta contuviera cuatro o más órganos, la necesidad de 10 días o más de asistencia ventilatoria después de la cirugía y los valores altos de las variables de ventilación mecánica. CONCLUSIONES: los factores de riesgo prequirúrgicos como hernias amplias o con cuatro o más órganos podrían sugerir al cirujano realizar funduplicatura en el mismo tiempo quirúrgico de la corrección de la hernia diafragmática.

[Neuroblastoma: prognostic factors and survival. Experience in Hospital de Pediatria del Centro Medico Nacional del Siglo XXI and review of the literature]. / Neuroblastoma: factores pronósticos y sobrevida. Experiencia en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI y revisión de la literatura.

Neuroblastoma (NB) is the most frequent extracranial solid tumor in children according to the literature. In Mexico it is less frequent, fallen to 8th place. Our objective was to analyze our experience and compare it with the one reported in other countries. We included all patients admitted to our hospital during the previous five years and who had not received any treatment. Patients with stages I, II, and IV received cyclophosphamide and epirrubicin. Patients with stages were III and IV received the same chemotherapy alternating with cisplatinum., ifosfamide and etoposide during 12 months as well as massive doses of 131-MIBG and surgical ablation of the remaining tumor when possible. We included 30 patients, 25 with initial presentation in the abdomen. Five were in early stages and 20 (70%) were advanced with an overall survival of 100% and 27% at 5 years respectively. When analyzed by age, 40% were 12 months of age and 60% older, with survival of 100% and 27% in the same period, respectively. According to histology there was 91% survival for differentiated and 23% for undifferentiated tumors. The chemotherapeutic regimen reported is effective but not better than that reported by other authors, in which some benefits are seen with use of transplant and immunotherapy. The most important prognostic factors are still considered to be age, stage and histology.