Alejandro Zavala B

Litiasis biliar en niños: un estudio clínico-morfológico

Background: The use of ultrasonography increased the frequency of diagnosis of cholelithiasis in childhood. Aim: To determine the clinical and laboratory features and follow up of children with biliary stones. Patients and methods: Twenty six children (13 male, aged 1 month to 14 years) were prospectively enrolled. Results: Nine children had a past medical history of factors potentially predisposing to stones. A clinical presentation with vomiting (50%), abdominal pain (46%) and jaundice (23%) was the most common indication for surgery. The diagnosis was based on abdominal ultrasound in all children. Cholecystectomy was performed in 15 children (laparoscopy in 13 and open surgery in 2). Children who underwent surgery were older than those who did not undergo surgery (p <0.001), but they did not have differences in liver function tests. Eight children had pigmented stones and seven had cholesterol stones. Conclusions: In our patients, neither family history nor laboratory tests were useful in the diagnosis as well as in the clinical decision of surgery, which was based on symptoms. The presence of cholesterol stones in a high proportion of these children may be a unique situation in Chile, considering the high prevalence of this disease in the adult population (Rev Med Chile 2003; 131: 37-45)

Enfrentamiento médico quirúrgico de la invaginación intestinal: Experiencia de una institución universitaria

Background: Management of intestinal intussusception in children has evolved from exclusively surgical treatments to nonoperative reduction under fluoroscopic monitoring. Aim: To report a 10 year experience in a University Hospital in the management of intestinal intussusception. Patients and methods: Seventy two patients, aged 2 to 72 months of age, with an uncomplicated intussusception, that were treated by barium or air enema, were studied. Results: The success rate was 73% with barium reductions, and 100% with air reductions. In 17 patients (24%), enema reduction was unsuccessful and were subjected to a surgical reduction. Conclusions: Nonsurgical reduction is safe and effective as the initial treatment of uncomplicated intussusception in children

Gemelos onfalópagos con síndrome de transfusión Gemelo-gemelar. Preparación y técnica para una separación exitosa en Chile

. Se los clasifica en ocho tipos segun el sitio de union (Figura 1 y Tabla 1). Su infrecuencia y la variabilidad entre ellos, determinan que su separacion constituya uno de los mayores desafios medico-quirurgicos, ya que existen pocos casos comparables entre si y ademas escasos profesionales con experiencia acumulada en el tema. Se trata de la primera separacion quirurgica de gemelos siameses onfalopagos con un Sindrome de Transfusion Gemelo-Gemelar (STGG) realizada en nuestro pais.Presentamos la preparacion, estudio y aspectos de la tecnica quirurgica de una separacion quirur-gica electiva de dos hermanos gemelos siameses onfalopagos con un sindrome de transfusion gemelo-

EPIGNATHUS: REPORTE DE UN CASO Y REVISIÓN DE LA LITERATURA

SUMMARY Epignahtus is an uncommon form of teratoma, located in the oropharynge, which protrudes through the mouth and that is associated with a high mortality during the neonatal period. The key to a successful outcome in managing of the airway obstruction is early prenatal diagnosis and the controlled execution of the EXIT (ex-utero intrapartum treatment) to secure the fetal airway. We report a case of a giant epignathus and the application of EXIT procedure, in which time to secure an airway is provided while preserving uteroplacental gas exchange.

Atresia Esofágica y Fístula Traqueoesofágica: Evolución y Complicaciones Postquirúrgicas

ABSTRACT Esophageal Atresia and Tracheoesophagic Fistula. Evolution and Postsurgical Complications Esophageal atresia (EA) and tracheoesophageal fi stula are congenital anomalies associated with respiratory and gastrointestinal morbidity. Objective: The aim of this study was to describe clinical characteristics of patients with EA and TEF during childhood, specially focused on respiratory and gastrointestinal complica-tions. Methods: We reviewed the clinical charts from fi fteen patients admitted to our hospital and who were followed locally between 1995 and 2007. Results: Gross classifi cation distribution was: A: 0, B: 0, C: 12, D: 2, E: 1. Waterston distribution was A1: 6, B1: 1, B2: 4 y C2: 4. Associated malformations to EA and TEF were 7/15. Main morbidity during the follow up period were: Recurrent pneumonia: 6/15, recurrent wheezing 12/15, tracheomalacia in 9/15 and apnea in one patient. Fistula re-opening in 3/15, Gastroesophageal refl ux in 15/15 esophagic stenosis in 7/15. All patients were admitted to the hospital at least once during the follow up and in 12/15 of this were due to respiratory causes.

Evaluación clínica del uso de nutrición enteral domiciliaria en pacientes pediátricos

Resumen en: Enteral nutrition (EN) is the delivery of nutrients to the gastrointestinal tract by nasogastric (SNG), nasojejunal (SNY) or gastrostomy (GTT), being the...

Causa infrecuente de hipertensión arterial en lactantes: neuroblastoma congénito quístico suprarrenal. Caso clínico

La frecuencia de hipertension arterial (HTA) en ninos ha aumentado significativamente en la ultima decada. A menor edad del paciente mayor es la probabilidad de que la HTA sea secundaria. Asi, las principales causas de HTA en recien nacidos son de origen renovascular o parenquimatoso. objetivo: Presentar el caso de un lactante hipertenso por neuroblastoma (NB) congenito quistico. Caso Clinico: Recien nacido con diagnostico prenatal de quiste suprarrenal, quien evoluciono con HTA por sobre el percentil 99 para edad, sexo y talla, sin respuesta a terapia farmacologica. La resonancia magnetica permitio realizar el diagnostico presuntivo de neuroblastoma congenito y la reseccion de la lesion permitio resolver la HTA y confirmar el diagnostico. Conclusion: La HTA en recien nacidos generalmente se debe a causas secundarias. El NB es el tumor maligno neonatal mas frecuente que se puede presentar como una masa abdominal de diagnostico antenatal, siendo la HTA una forma infrecuente de presentacion.

Litiasis biliar en ni??os: un estudio cl??nico-morfol??gico

Background: The use of ultrasonography increased the frequency of diagnosis of cholelithiasis in childhood. Aim: To determine the clinical and laboratory features and follow up of children with biliary stones. Patients and methods: Twenty six children (13 male, aged 1 month to 14 years) were prospectively enrolled. Results: Nine children had a past medical history of factors potentially predisposing to stones. A clinical presentation with vomiting (50%), abdominal pain (46%) and jaundice (23%) was the most common indication for surgery. The diagnosis was based on abdominal ultrasound in all children. Cholecystectomy was performed in 15 children (laparoscopy in 13 and open surgery in 2). Children who underwent surgery were older than those who did not undergo surgery (p <0.001), but they did not have differences in liver function tests. Eight children had pigmented stones and seven had cholesterol stones. Conclusions: In our patients, neither family history nor laboratory tests were useful in the diagnosis as well as in the clinical decision of surgery, which was based on symptoms. The presence of cholesterol stones in a high proportion of these children may be a unique situation in Chile, considering the high prevalence of this disease in the adult population (Rev Med Chile 2003; 131: 37-45)

Clinical and morphological features of cholelithiasis in children

Background: The use of ultrasonography increased the frequency of diagnosis of cholelithiasis in childhood. Aim: To determine the clinical and laboratory features and follow up of children with biliary stones. Patients and methods: Twenty six children (13 male, aged 1 month to 14 years) were prospectively enrolled. Results: Nine children had a past medical history of factors potentially predisposing to stones. A clinical presentation with vomiting (50%), abdominal pain (46%) and jaundice (23%) was the most common indication for surgery. The diagnosis was based on abdominal ultrasound in all children. Cholecystectomy was performed in 15 children (laparoscopy in 13 and open surgery in 2). Children who underwent surgery were older than those who did not undergo surgery (p <0.001), but they did not have differences in liver function tests. Eight children had pigmented stones and seven had cholesterol stones. Conclusions: In our patients, neither family history nor laboratory tests were useful in the diagnosis as well as in the clinical decision of surgery, which was based on symptoms. The presence of cholesterol stones in a high proportion of these children may be a unique situation in Chile, considering the high prevalence of this disease in the adult population (Rev Med Chile 2003; 131: 37-45)