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Pediatric patients with sickle cell disease and thalassemia major present clinical characteristics that could lead to a higher incidence of central venous access devices-associated complications (CVAD-C). With the objective of analyzing the safety of the use of CVAD in these patients, a retrospective review including all pediatric patients with these pathologies who required the implantation of a CVAD between 2004 and 2019 was performed. In all, 54 patients with 100 CVAD (65 totally implantable venous access port with subcutaneous reservoir, 35 single-lumen or double-lumen partially tunneled catheter) were included. During 60,410 days at risk of suffering a CVAD-C, 55 complications (complication rate [CR]/1000 catheter-days at risk=0.91) were reported in 46 CVAD: 19 mechanicals (CR=0.32), 32 infectious (CR=0.53), and 4 thrombotic complications (CR=0.066). Incidence of mechanical and infectious complications was significantly higher in double-lumen partially tunneled catheter than in totally implantable venous access port with subcutaneous reservoir (P

Este artículo investiga la relación entre las fricciones en los mercados financieros y la actividad económica en México, para lo cual se construye y descompone un diferencial de tasas para los bonos emitidos por empresas privadas no financieras en el mercado interno, basado en Gilchrist y Zakrajsek (2012). Se muestra que el diferencial contiene información significativa sobre la evolución de la actividad económica y de los agregados crediticios. Además, se encuentra que la prima excedente de los bonos (PEB), cuya dinámica describe la relación entre la probabilidad de impago de las empresas y su diferencial de tasas, es el componente con mayor poder predictivo. Se muestra que choques negativos en las condiciones financieras, identificados como innovaciones en PEB, generan una desaceleración en la actividad económica y en el financiamiento. Finalmente, se encuentra evidencia de efectos no lineales en la respuesta de la actividad económica ante este choque.

Laparoscopic learning curves are slow, and there are no uniform surgical skill acquisition models. Therefore, our objective was to assess a laparoscopic skill learning program in individuals without any surgical experience, analyzing the learning curve by means of a certified custom-made simulator, and evaluating whether previous surgical experience had an impact on the learning curve.A certified custom-made simulator and laparoscopic instruments were used to assess 20 university students who performed 10 repetitions of 3 exercises of growing difficulty (eye-hand coordination, hand-hand coordination, and cutting). Three parameters were analyzed: total time with each hand, total mistakes with each hand, and three items of the OSATS technical skill scale. The two first exercises were compared with a group of 14 experienced surgeons. Statistical analysis using repeated-measures Anova and Student's t-test was carried out (p0.05).Significant time improvement with each repetition was demonstrated in the three exercises. Curve stabilization was faster in surgeons (2-4 repetitions) than in students (8-9). Time reduction was noted in the first and second exercises in both groups, with 44.08% and 33.1% shorter times, respectively.Individuals without surgical experience acquired basic laparoscopic skills using a custom-made simulator, which allows simple surgical techniques to be carried out in an inexpensive, accessible fashion. Previous surgical experience was associated with a shorter learning curve. The custom-made simulator allowed individuals with and without surgical experience to be distinguished from each other.La curva de aprendizaje en cirugía laparoscópica es lenta y no existen modelos uniformes de adquisición de habilidades quirúrgicas. Tratamos de establecer la idoneidad de un programa de aprendizaje de habilidades laparoscópicas en sujetos sin experiencia quirúrgica, analizando la curva de aprendizaje utilizando un simulador artesanal homologado. Comprobar si la experiencia quirúrgica previa modifica la curva de aprendizaje.Se empleó un simulador artesanal validado e instrumental laparoscópico para evaluar a 20 estudiantes universitarios que realizaron 10 repeticiones de tres ejercicios de dificultad creciente (coordinación ojo-mano, coordinación mano-mano y corte). Se evaluaron tres parámetros: tiempo total y con cada mano, errores totales y con cada mano y tres ítems de habilidad técnica OSATS. Comparación de los dos primeros ejercicios con un grupo de 14 cirujanos con experiencia. Análisis estadístico mediante Anova para medidas repetidas y t de Student (p0,05).Se demostró la mejoría significativa del tiempo con cada repetición en los tres ejercicios. La estabilización de la curva fue más precoz entre los cirujanos (2-4 repeticiones) que los estudiantes (8-9). Se comprobó la reducción del tiempo invertido para el primer y segundo ejercicio en ambos grupos, que en los estudiantes fue del 44,08% y 33,1% respectivamente.Individuos sin experiencia quirúrgica desarrollan habilidades laparoscópicas básicas utilizando un simulador artesanal, que permite practicar técnicas quirúrgicas sencillas de forma barata y accesible. La experiencia quirúrgica previa se asocia con el acortamiento de la curva de aprendizaje. El simulador artesanal permite discriminar entre sujetos con y sin experiencia quirúrgica.

Even though thyroid surgery is rare in pediatric patients, frequency has increased in the last years. The objective of this study was to analyze the causes and results of these procedures in a pediatric surgical facility.Retrospective study including all patients requiring thyroid surgery in our department from 2000 to 2019. Demographic data, diagnostic data, associated pathology, type of surgical procedure, pathological results, and intraoperative and postoperative complications were recorded.47 patients with a mean age of 8.9 ± 3.9 years at surgery were included. The most frequent diagnosis was MEN syndrome (n = 30, 29 MEN 2A and 1 MEN 2B), followed by thyroid papillary carcinoma (n = 5), follicular adenoma (n = 5), multinodular goiter (n = 4), follicular carcinoma (n = 1), thyroglossal duct papillary carcinoma (n = 1), and Graves-Basedow syndrome (n = 1). 38 total thyroidectomies (73.7% of which were prophylactic), 3 double hemithyroidectomies, 5 hemithyroidectomies, and 5 lymphadenectomies were performed. No intraoperative complications or recurrent laryngeal nerve lesions were noted. Mean postoperative hospital stay was 1.3 ± 0.6 days. 7 patients had transitory asymptomatic hypoparathyroidism, and 1 patient had persistent symptomatic hypoparathyroidism. Pathological results of prophylactic thyroidectomies were: 18 C cell hyperplasias, 7 microcarcinomas, and 3 cases without histopathological disorders.Thyroid surgery in pediatric patients is safe if performed by specialized personnel. Even though it remains rare, frequency has increased in the last years.La cirugía tiroidea es poco frecuente en la edad pediátrica, aunque ha aumentado su frecuencia en los últimos años. El objetivo de este estudio es analizar las causas y los resultados de estos procedimientos en un centro quirúrgico pediátrico.Estudio retrospectivo que incluyó a todos los pacientes que necesitaron cirugía tiroidea en nuestro servicio entre 2000-2019. Se recogieron datos demográficos, diagnóstico, patología asociada, tipo de procedimiento quirúrgico realizado, resultados anatomopatológicos y complicaciones intra y posoperatorias.Se incluyeron 47 pacientes con una edad media en el momento de la intervención de 8,9 ± 3,9 años. El diagnóstico más frecuente fue síndrome MEN2 (n = 30, 29 MEN2A y 1 MEN2B), seguido de carcinoma papilar de tiroides (n = 5), adenoma folicular (n = 5), bocio multinodular (n = 4), carcinoma folicular (n = 1), carcinoma papilar del conducto tirogloso (n = 1) y síndrome de Graves-Basedow (n = 1). Se realizaron 38 tiroidectomías totales (el 73,7% fueron profilácticas), tres dobles hemitiroidectomías, cinco hemitiroidectomías y en cinco casos fue necesario realizar una linfadenectomía. No se presentaron complicaciones intraoperatorias ni lesiones de nervio laríngeo recurrente. La estancia media posoperatoria fue de 1,3 ± 0,6 días. Siete pacientes presentaron hipoparatiroidismo transitorio asintomático y en un caso, persistente sintomático. Los resultados anatomopatológicos de las tiroidectomías profilácticas fueron: 18 hiperplasias de células C, 7 microcarcinomas y 3 sin alteraciones histopatológicas.La cirugía tiroidea en la edad pediátrica es segura en manos de equipos especializados. Aunque sigue siendo un procedimiento poco habitual, su frecuencia está aumentando en los últimos años.

Aim of the study To evaluate the outcome of prophylactic thyroidectomies (PT) in patients with MEN 2 syndrome in a tertiary center. Methods A retrospective study was designed, including all patients with MEN 2 syndrome who underwent PT between 2000 and 2019. Demographics, gene mutation, postoperative complications and histopathological findings were registered. Main results 30 patients were included (29 MEN 2A and 1 MEN 2B) with a median age at surgery time of 7.0 ± 3.2 years. Familiar history was present in all but 3 patients. A therapeutic thyroidectomy was performed in 2 patients due to evidence of medullary thyroid carcinoma (MTC, both were late diagnosis), and in the other 28 cases, a PT was performed. 8 patients had a RET mutation ranked as Moderate Risk (American Thyroid Association): median age at surgery was 7.2 ± 4.2 years, and histological findings were C-cell hyperplasia (n = 6) and no alterations (n = 2). 16 patients had a high risk mutation; median age at surgery time was 6.9 ± 2.8 years and histological findings were normal thyroid gland (n = 1), C Cell Hyperplasia (n = 8), microcarcinoma (n = 6), and MTC (n = 1). The mean hospital stay was 1.4 ± 0.68 days. No intraoperative complications or recurrent laryngeal nerve injuries were registered. 7 patients presented a transient hypoparathyroidism and 1 patient had permanent hypoparathyroidism. Conclusions Early PT in patients with MEN 2 syndrome is a safe procedure when performed by an experienced team of Pediatric Surgeons and with a multidisciplinary approach. Early genetic analysis and familial counselling is essential to prevent the development of a MTC.

Anastomotic stricture is the most common complication following esophageal atresia (EA) surgical repair. The objective of this study was to evaluate Anastomotic Stricture Index (ASI: relationship between pouch and stricture diameters in the postoperative esophagram) as a predictor of the need for esophageal dilatation.A retrospective review of all patients undergoing EA repair in our healthcare facility from 2009 to 2017 was designed. Proximal pouch ASI (proximal ASI) and distal pouch ASI (distal ASI) in the first and second postoperative esophagram were calculated, and correlation with the number of esophageal dilatations required was studied. For statistical analysis purposes, Spearman's correlation test and ROC curves were used.Of the 31 patients included, 21 (67.7%) required esophageal dilatation, and 11 (35.5%) required 3 or more dilatations. The relationship between ASIs in the first esophagram and the need for esophageal dilatation was not statistically significant (p0.05). The relationship between proximal ASI (RHO = 0.84, p0.05) and the number of dilatations in the second esophagram was statistically significant. None of the patients with0.55 proximal ASI required dilatation; patients with 0.55-0.79 proximal ASI required less than 3 dilatations; and patients with0.79 proximal ASI had a high risk of requiring 3 or more dilatations.According to our study, measuring ASI in the second esophagram proves useful in predicting EA patients' postoperative management, especially when it comes to identifying patients with lower risk of undergoing multiple dilatations.La estenosis esofágica es la complicación más frecuente tras la corrección de la atresia esofágica (AE). El objetivo de este estudio es el análisis de los Índices de estenosis de la anastomosis (IEA: relación entre los diámetros de los bolsones y de la estenosis en el esofagograma postoperatorio) como predictores de la necesidad de dilatación esofágica.Se diseña un estudio retrospectivo incluyendo los pacientes con AE y anastomosis esofágica en nuestro centro entre 2009-2017, calculando los IEA del bolsón proximal (IEA-proximal) y distal (IEA-distal) en el primer y segundo esofagograma postoperatorio, analizando su correlación con el número de dilataciones esofágicas que necesitaron. Para el análisis estadístico, se ha empleado el test de correlación de Spearman y las curvas ROC.Se incluyeron 31 pacientes: 21 precisaron dilatación esofágica (67%), y 11 de ellos (35%) 3 o más dilataciones. No se demostró relación estadísticamente significativa entre los IEA del primer esofagograma con la necesidad de dilatación esofágica (p0,05). Se observó una relación entre el IEA-proximal (rho = 0,84, p0,05) y el número de dilataciones en el segundo esofagograma. Ningún paciente con ASI-proximal0,55 necesitó dilatación; los pacientes con ASI-proximal entre 0,55-0,79 precisaron menos de 3 dilataciones y los pacientes con ASI-proximal0,79 presentaron alto riesgo de necesitar 3 o más dilataciones.Según los resultados de nuestro estudio, la medición de IEA en el segundo esofagograma constituye una herramienta útil para predecir el manejo postoperatorio en pacientes con AE, especialmente en la identificación de aquellos con menor riesgo de someterse a múltiples dilataciones.

Multiple approaches to the treatment of simple and complicated (gangrenous or perforated) appendicitis in children have been promoted. Our goal is to develop a new protocol for these patients that allows shorter hospital stays without increasing complications rates.Prospective collected data of patients undergoing appendicitis treated according to the new protocol for a period of 7 months were reviewed. This protocol consists on antibiotic prophylaxis in all cases continued with triple antibiotic regimen in complicated appendicitis. Antibiotics were stopped when specific clinical and laboratory criteria were met. Outcomes are compared to a historical group of patients treated under standard protocol (antibiotic prophylaxis followed by 48 hours of dual antibiotic therapy in simple appendicitis or 5 day-course of triple antibiotic therapy in complicated as postooperative antibiotic regimen).A total of 196 patients (96 current group and 100 historical group) were reviewed. In simple appendicitis average length of postoperative hospitalization was significantly lower in the current group (no statistical difference). 52.9% of complicated appendicitis in the current group were discharged home before 5th day without increasing the complication rate. When a wound infection or intraabdominal abscess occurs thrombocytosis (52%) and prolonged vomiting are the most frequent symptoms.No further postoperative treatment is needed in simple appendicitis. In complicated appendictis a short course of antibiotics according to clinical and laboratory criteria allows early discharge without major morbidity. Prolonged postoperative vomiting and thrombocytosis suggest infectious complications.Existen múltiples modalidades de tratamiento antibioterápico tras una apendicectomía en niños. Nuestro objetivo es desarrollar un nuevo protocolo para el tratamiento de las apendicitis que permita acortar la estancia hospitalaria sin aumentar las complicaciones.Estudio prospectivo que analiza a los pacientes intervenidos de apendicitis tratados según el nuevo protocolo de antibioterapia durante un periodo de 7 meses. Dicho protocolo consiste en profilaxis quirúrgica en todos los casos y continuar con triple antibioterapia en las evolucionadas, con una duración variable según criterios clínico-analíticos establecidos previamente. Se comparan los resultados con los de un grupo histórico de pacientes tratados con el protocolo clásico (profilaxis y 48 horas de doble antibioterapia en las flemonosas y 5 días de triple en las evolucionadas).Se estudian un total de 196 pacientes (96 grupo actual y 100 grupo histórico). En las apendicitis flemonosas la estancia hospitalaria postquirúrgica media es significativamente menor en el grupo actual sin encontrar diferencias estadísticas en la tasa de complicaciones. El 52,9% de las apendicitis evolucionadas del grupo actual fueron dadas de alta antes del 5º día sin aumentar la tasa de complicaciones. De los pacientes que presentaron una complicación infecciosa el 52% asociaban trombocitosis y la clínica más frecuente fue de vómitos prolongados.No es necesario tratamiento antibioterápico postoperatorio en apendicitis simples. En las evolucionadas un tratamiento corto de antibióticos según criterios clínico-analíticos permite un alta precoz sin mayor morbilidad asociada. Los vómitos prolongados y la trombocitosis son indicadores de complicaciones infecciosas postoperatorias.

Laparoscopic cholecystectomy (LC) is a very usual procedure within adult population, but not as frequent in childhood. The aim of this study was to assess the outcome of LC in children compared with those performed in adulthood.We reviewed 39 consecutive patients who underwent LC between 2003 and 2013 at our Department and a similar sample of patients from 18 to 40 years of age from the General Surgery Department.39 children and 40 adults fulfilled criteria to be included in the study. The most frequent indication was cholelithiasis in both groups. The mean operating time was significantly higher among children (127 min, adults 71 min, p0.01) but we didn't find differences neither in conversion nor in complication rates (children 5% and 7.7%, adults 2.5% and 15% respectively). In regard to preoperative factors, only male gender was correlated to a higher complication rate (p 0.037). On the other hand we found out that, in absence of complications, both the average length of stay (children 2.1 days, adults 0.5 days) and mean time to first feeding (children 21 hours, adults 8 hours) were significantly higher among children (p0.01).1) LC in childhood is a safe procedure that does not imply more morbidity than the same intervention in adults, even though a more prolonged operating time. 2) We believe that our longer hospital stay is due to certain lack of confidence with the technique and, in the future, the trend should be bent on encouraging a shorter time to first feeding and an earlier discharge.

Objetivos: La aspiración de cuerpos extraños es uno de los accidentes de mayor incidencia y morbimortalidad en la infancia, favorecido entre otros motivos por la curiosidad propia de esta edad y la inmadurez de los mecanismos de-glutorios. Con el objetivo de evaluar los signos y síntomas más comunes que conducen al diagnóstico de broncoaspi-ración, y para demostrar el valor diagnóstico de la anamnesis, analizamos los casos de aspiración de cuerpo extraño tratados en nuestro centro durante los años 1975-1997. Pacientes y método: Se presenta un estudio retrospectivo que evalúa distintos parámetros en un total de 210 pacientes, de los cuales se realizó broncoscopia en 208 casos, hallándose evidencia de cuerpo extraño en el 90%. Resultados y conclusiones: Destacamos el valor de una detallada historia clínica, presentando el antecedente de atragantamiento y las crisis de tos persistente una sensibilidad del 80%, respectivamente. En cuanto a la exploración clínica, la auscultación se revela como una prueba de gran sensibilidad (90%), aunque con baja especificidad (16%). Las pruebas radiológicas presentan menor sensibilidad, con un 16% de falsos negativos. Un elevado porcentaje se trataba de cuerpos extraños vegetales (82%), con una tasa de complicaciones del 5,7% y una mortalidad del 0,9%, si bien en los últimos 8 años no ha fallecido ningún niño. : Objective: Foreign body aspiration is one of the accidents with highest incidence, morbidity and mortality in childhood. It is favoured by curiosity and the immature swallowing mechanisms of this age group. To determine the most common signs and symptoms leading to the diagnosis of foreign body aspiration and to demonstrate the diagnostic value of a detailed anamnesis, we analyzed the cases of foreign body aspiration treated in our hospital between 1975 and 1997. Patients and method: Retrospective study of 210 patients with suspected foreign body aspiration. In 208 patients rigid bronchos-copy was performed. Evidence of a foreign body was found in 90%. Results and conclusions: We emphasize the clinical value of thorough anamnesis which showed high sensitivity (80%) in choking crises and persistent cough. Physical examination and respiratory auscultation showed high sensitivity (90%) but low specificity (16%). Chest X-ray showed the lowest sensitivity with 16% of false negatives. Most foreign bodies were vegetable fragments (82%), with a complication rate of 5.7%. Mortality was 0.9%, with no deaths occurring in the last 8 years.

Minimally Invasive Surgery (MIS) is getting more and more important in our specialty. However, the formation of the residents on MIS is, in many cases, irregular. The purpose of this study is to assess the state of training in MIS among the residents of Pediatric Surgery and their potential weaknesses.An electronic survey was distributed among 71 residents of Pediatric Surgery from 17 national hospitals.The response rate was 70.2%.100% of the residents are interested in a broadening of training activities in MIS. The main areas of interest are gastrointestinal (92%) and thoracic (47%) surgery. Only 57% have access to training facilities and less than half of them attend to courses and conferences. 80% believe that they are not given adequate attention from specialized associations. 52% think they should do rotations at referral centers, 86% that courses and seminars should be enhanced, and 44% that the responsibility of the resident in surgery should be increased. The main defects encountered in their training are scarce volume of patients, lack of financial support and overcoming the learning curve of surgeons in their services.Despite the advance of the MIS, resident's training in this discipline still has shortcomings, as expressed in their views. Knowledge of the current state of training should be the starting point for designing a training strategy that ensures adequate skills.

Anal prolapse is a common postoperative complication related to anorectal malformations (MAR) surgery, which is sometimes considered to be insignificant and/or not worthy of further intervention. We analysed the causes of this complication and our current surgical protocols.Since 1995, 26 patients with anal prolapse have been operated secondary to surgical correction of an anorectal pathology. The most common MAR in girls (12) was cloaca (10), and in boys (14) was anorectal atresia with prostate fistula (8). The symptoms were anal pain and bleeding associated with alterations in bowel control alterations. The diagnosis in most patients was made in the first months after surgery, during the period of anal dilatations period. The surgical procedure involves prolapse resection of the prolapse and a new anoplasty. In 18 patients (69%) the prolapse was corrected before the colostomy closure on an outpatient basis. The other 8 patients (31%) underwent prolapse surgery after colostomy closure, requiring hospitalisation.There were no immediate postoperative complications, improving continence and aesthetic anus appearance. In 4 patients the prolapse recurred, requiring further surgical correction.Anal prolapse is a possible minor complication after anorectal correction. MAR type, the quality of the perineal musculature and defects in surgical technique are the main factors determining ia prolapse will appearance. The anal prolapse surgery indication has been recently increased (including small unilateral prolapses) as long as they are done before the colostomy closure, due to good aesthetic and functional results, requiring only outpatient surgery.

Long-term indwelling central venous access devices are frequently used in pediatric patients. Their main complication is infection, that can even mean their removal. We try to identify the risk factors really involved in this complication and in their removal. We have made a retrospective review of 120 oncologic pediatric patients who received a central venous device between 2003 and 2009. We searched for epidemiologic, clinic, microbiologic and surgical risk factors. We made a comparative data analysis among: GROUP A, children who suffered device infection, GROUP B the others. Group A was divided into early infection (first month after implantation)/late infection, removed/not removed. Data were analized with statistical program SPSS. 29 suffered from leukemia, 19 from lymphoma and the main part, 72, from solid tumour. 31% experienced infection (GROUP A), being early in the 36% of them. 16% had to be withdrawn. Data analysis revealed statistical association with the age (p=0.015) and with the reception of chemiotherapic treatment the week before the surgical insertion. The rest of the studied factors did not revealed a real association, but could be guess a relationship among infection and leukemia, subclavian catheters, those patients whose deviced was introduced using a guide over a previous catheter and also transplanted. Related to early infection the only associateon founded was with the subclavian access (p=0.018). In conclusion, in our serie long-term central venous access infection was more frequent in the younger patients and also in those who had received chemotherapy the week before the catheter implantation. The tendency towards infection in leukemia, transplanted and subclavian carriers has to be studied in a prospective way with a larger number of oncologic children.

Peritoneal drainage is one of the options for treatment in necrotizing enterocolitis (NEC). Currently its role is controversial as an alternative to laparotomy in low birthweight and mortality associated with both procedures is high (35-55%).We reviewed 30 low-weight premature (1000 g) with NEC treated surgically. We evaluate the hemodynamic, respiratory and metabolic status of the patients, as well as multi-organ involvement and the need for inotropic drugs. These data were analyzed previos to surgery and at 6 and 12 hours. We divided the sample into two groups: those who underwent peritoneal drainage (PD) input or laparotomy (LAP).In the series the average birth weight was 754 +/- 156 g and gestational age was 26.1 +/- 2.1 weeks. We carry on 10 peritoneal drainage and 20 laparotomies. The DP group before the intervention showed increased heart rate, FiO2 and acidosis (p0.05). The needs of dopamine were similar in both groups. Following the peritoneal drainage, we found breathing improvement (adequate ventilation and oxygenation, decreased FiO2) and hemodynamic improvement (blood pressure maintained, reduced heart rate, reduced requirements for dopamine) at 6 and 12 h. DP was not the definitive treatment in any of the patiens, and all survivors (80%) of this group required further laparotomy. 62% of them died. Overall mortality was 47% (70% DP and 35% LAP, p = 0.07).Peritoneal drainage allowed the stabilization of low-weight premature in critical condition. The hemodynamic and respiratory stabilization was transient and did not prevent the definitive surgical treatment, although it improved the conditions for doing so. In our series, the peritoneal drainage did not improve long-term survival, questioning its role as an alternative to surgery for NEC.

The indication of surgery in necrotizing enterocolitis (NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies.A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency.The mean gestational age at birth was 27 weeks (range 25 to 31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum 6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases.Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience, it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy.

Se presenta un caso de angiomatosis quística en un paciente que debutó con una tumoración inguinoescrotal debida a una malformación linfangiomatosa retroperitoneal y que presentó así mismo lesiones viscerales esplénicas y lesions esqueléticas difusas. Se discute esta rara entidad haciendo una revisión de la bibliografía. : A case of cystic angiomatosis is presented in a patient whose clinical sign were the presence of an inguinoescrotal mass due to a retroperitoneal lymphangioma, visceral splenic lesions and diffuse skeletal lesions. This rare entity is discussed and a brief review of the literature is made.

We have evaluated 465 patients diagnosed as having vesicoureteral reflux between 1975 and 2000 in our Department. Three hundred cases were treated surgically and 165 received submucosal injection of Teflon as endoscopic procedure. Since 1991, when we introduced the endoscopic technique in our Department, 31 patients required open surgery. The work includes the study of the diagnostic procedures performed in the patients, such as ultrasonography, voiding cystouretrography and renal isotopic gammagraphy. We focused on these patients treated endoscopically. The overall success rate was 97.6% with surgical techniques. Reflux was resolved using the endoscopic procedure in 76% after first injection, 93% after second and 96% after third. We conclude that the submucosal injection of Teflon is an appropriate treatment for most cases of vesicoureteral reflux. The non-invasive procedure requirement, lack of adverse effects and minimal morbidity make it an alternative to medical treatment and open surgery. The future is the search for new biocompatible materials with tissue-augmenting properties as Teflon.

Abdominal wall closure is not possible in large congenital defects, even after extensively stretching in to enlarge its capacity. The skin coverage is usually adequate but the aponeurotic defect has to be closed temporally using synthetic patches. The use of these materials leads to increase complication such as infection, fistula formation and extrusion. In addition a second operation is required to remove the material and to perform a definitive closure. The role of fascia lata in reconstruction of abdominal wall is well established as free grafts, pedicled flaps or free flaps. Bank cadaveric fascia lata is used extensively in neurosurgical, ophtalmological, orthopaedic and urogynecological procedures. This is the first description of the use of cadaveric fascia lata for the closure of large abdominal wall defects.We present two cases of congenital diaphragmatic hernia. The first patient was a newborn who presented the impossibility to close the fascia, that was salvaged by a teflón patch. Five months later the wound opened, leaving the mesh exposed that had to be removed. A cadaveric fascia lata patch was used to cover the defect, closing the skin satisfactorily. The second case was a two days newborn. We performed the diaphragmatic closure, and the aponeurotic defect was closed using cadaveric fascia lata.Cosmetic and functional appearance are satisfactory in both cases and no complications have been seen.Fascia lata patches are revascularized in the abdominal wall and incorporates into receptor tissue. They have the following advantages with respect to synthetic materials: First, the risk of complications is lower. Second, their removal is not necessary. Finally, no intraperitoneal adhesions occur. The risks of disease transmission and rejection are minimized by the Centro Comunitario de Transfusiones donor selection and processing of the cadaveric fascia lata.

Foreign body aspiration is one of the accidents with highest incidence, morbidity and mortality in childhood. It is favoured by curiosity and the immature swallowing mechanisms of this age group. To determine the most common signs and symptoms leading to the diagnosis of foreign body aspiration and to demonstrate the diagnostic value of a detailed anamnesis, we analyzed the cases of foreign body aspiration treated in our hospital between 1975 and 1997.Retrospective study of 210 patients with suspected foreign body aspiration. In 208 patients rigid bronchoscopy was performed. Evidence of a foreign body was found in 90%.We emphasize the clinical value of thorough anamnesis which showed high sensitivity (80%) in choking crises and persistent cough. Physical examination and respiratory auscultation showed high sensitivity (90%) but low specificity (16%). Chest X-ray showed the lowest sensitivity with 16% of false negatives. Most foreign bodies were vegetable fragments (82%), with a complication rate of 5.7%. Mortality was 0.9%, with no deaths occurring in the last 8 years.

A case of hepatic capillariasis in a 54-year-old woman confined to a mental institution is reported. The patient was transferred to the Hospital General de México for terminal care of a breast cancer; she died 12 days after admission. Hepatomegaly was observed clinically and numerous Capillaria hepatica eggs were found at autopsy. The laboratory examinations did not show eosinophilia or other abnormalities. Twenty-six cases of human hepatic capillariasis have been recorded in the world literature. This is the third case reported in Mexico: the previous two in children. Since the patient had a psychiatric condition she may have had aberrant alimentary habits. The features of C hepatica eggs stained with Jone's silver methenamine, which allows the demonstration of an internal multilayered sheath and an external layer endowed with multiple radiated canaliculi, are described in this patient.

CASO CLINICO Varon de 12 anos, remitido por su medico al hospital por presentar astenia, anorexia y adelgazamiento de 13 kg (de 71 a 58 kg), de 2 meses de evolucion. El cuadro se acompana de fiebre moderada (38,5-39 oC) diaria, sin predominio horario. La historia familiar y personal solo revelaba un episodio de gastroenteritis aguda los dias previos al inicio de los otros sintomas, que se resolvio en pocos dias y que curso con fiebre elevada y hemograma infeccioso con desviacion izquierda. En la actualidad las deposiciones son normales y solo vomita ocasionalmente. El examen fisico al ingreso mostraba fiebre de 38o C, mal aspecto general, palidez y abdomen discretamente doloroso de forma generalizada, sin adenopatias, nivel de conciencia y resto de exploracion normales. En la analitica realizada al ingreso destacaba: hemograma con 15.500 leucocitos (61% segmentados y 8% cayados). Hemoglobina 9,2 g/dl y hematocrito del 29,7%. VSG 105 mm a la primera hora y proteina C reactiva 174 mg/dl. El Coombs directo fue negativo. No presentaba reticulocitosis. El proteinograma era compatible con proceso subagudo. El tiempo de coagulacion demostro una discreta disminucion de la tasa de protrombina (67%) y el C3 y C4 ligeramente elevados. La analitica sistematica y el sedimento de orina, las hormonas tiroideas, el cortisol y los cultivos de heces, orina y sangre resultaron normales. Los anticuerpos antivirus, marcadores de hepatitis B y C y de VIH fueron negativos. La radiologia simple de torax evidencio atelectasias laminares en hemitorax izquierdo con elevacion de ambos hemidiafragmas. A las 24 h del ingreso se realizo una ecografia abdominal que puso de manifiesto un aumento del bazo con una imagen hipoecogenica, en su interior, de contorno irregular pero bien definida (fig. 1). La TC con contraste yodado confirmo la presencia de una imagen de baja densidad, sin captacion de contraste en el bazo, siendo el resto de estructuras abdominales normales (fig. 2).

Percutaneus gastrostomy placement is a procedure widely performed in children with failure to thrive or intolerance to oral feeding. At the moment of making the indication, the need of an antir-reflux surgery in the same procedure comes to question. The aim of this study was to analyse which preoperative factors are associated with a higher risk of a posterior fundoplication.We realized a retrospective review of 67 patients divided in 2 groups (cases and controls) in which a percutaneus gastrostomy (PEG) had been made by our service in the period of 1997 to 2008. We compared these two groups: Group A (n=11) - patients with severe gastroesophageal reflux who required a Nissen procedure afterwards; Group B (n=56) - patients who kept without reflux after PEG. We analyzed the different preoperative factors that could have been in association to severe reflux after gastrostomy.Mean age at the moment of undergoing PEG was 15 months. Mean time of follow up was 3,5 years. Only neurological impairment and documented reflux pregastrostomy were associated with the need of an antirreflux surgery after PEG.Neurological impairment and documented pregastrosotmy GER could be an indication of concurrent antirreflux surgery at the time of gastrostomy.

One hundred patients with acute lumbo sciatica symptoms probably due to disc hernia, have been studied. A CT scan and a myelography was performed in all patients. The clinical and radiologic (myelography and CT scan) findings have been evaluated in three categories based on their intensity and a correlation between these three parameters has been performed. Our results show a positivity of 94% in the clinical signs, 87% in the myelography findings and 88% in CT scan findings. The correlation results show that in very severe lumbo sciatica syndromes there is a greater positivity in the myelography than in CT scan findings and that there could be big radiologic changes without a clear clinical repercussion.