[Management of penile trauma from compressed air gun in a child]

We report on a 6-year old child with a penile injury resulting in the inclusion of a pellet in the cavernous body, by a fortuitous shot. Conservative approach with elective extraction of the bullet and cavernous body repair led to a satisfactory result, in better anatomic conditions. The patient did not have any perioperative complication. Accidents by air weapons are particularly important in children, because these weapons are erroneously considered as toys. Air gun injuries to head, neck and thorax have been often published, but these injuries are rare in the chidren genitourinary area.

[Cholecystolithotomy: first middle-long term results of our series]

Cholelithiasis in children is an infrequent disease whose incidence has increased over the last few decades. It has its own typical characteristics, different from those present in adults. Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cases, still its connection with right-sided colon cancer and other diseases associated with the procedure has led to recommend it with some reservation. Though several authors adopted cholecystotomy as a therapeutic option in recent years, its use remains controversial. Our indication criteria for this technique are presented herewith, as well as long- and medium-term results (mean follow-up of 10 years) of our series, previously reported in 2003, and a new case added later in 2006.

MATERIALS AND METHODS

Since 2003, a prospective study of 15 patients from our previous series and a new patient added afterwards is being carried out, including: 1) Medical history checking for symptoms connected with biliary conditions. 2) DIAGNOSTIC TESTS: laboratory tests and ultrasonography.

RESULTS

Out of our 16 patients: A girl relapsed a few months later and underwent cholecystectomy, but whether it was a true relapse or a missed gallstone was not established. A patient with a history of recurrent abdominal pain has shown no improvement in his symptoms even though his tests are normal. Two patients have been lost for our study, but showed normal tests for 5 and 7 years respectively. Our 11 remaining patients show no symptoms as well as normal laboratory and imaging tests. A new patient joined our study in 2006, showing normal tests to date and no postsurgical complications.

CONCLUSIONS

Based on our experience, cholecystotomy has proved to be a complication-free, safe and easy procedure with a virtually nonexistent relapse rate in the long and medium term for patients in the pediatric age group presenting with single or double cholelithiasis, unchanged for 1-2 years with no size increase, no apparent etiology, no complications and a normal bile duct.

[Complete lower urinary tract duplication with true diphallia associated to anorrectal and neural malformations]

We report a case of complete urinary tract duplication with true diphallia associated to intestinal and neural anomalies. Complete penile duplication with hypospadias and bifidum scrotum were showed. Moreover, he had got anorrectal disease (anterior anus) and neural tube defects (myelomeningocele). Radiological and functional studies were performed and complete duplication lower urinary tract with coordinate miction were found. Combined surgical approach were used: perineal to remove lateralized and hypospadic penile and abdominal for cystoplasty. We report a case due to the extremely low prevalence. Only 15 cases have been described in the literature.

[Nonsurgical correction of congenital auricular deformities a new method of neonatal molding and splinting]

INTRODUCTION

The utility of the nonsurgical correction of congenital auricular deformities by ear molding and splinting has been previously established. Occasionally, its application cannot be easy, and the later collaboration of the parents is necessary. We report a new method of splinting that simplifies the procedure.

DESIGN

prospective, case series.

PATIENTS AND METHODS

Twenty ears in 15 patients between 7 and 60 days of age (average 22 days) were treated. They were 12 prominent ears, 4 Stahl's ears, 2 lop ears, 1 Crinkled ear, and 1 case of increase of antihelix folder. Cotton impregnated with 2-Octyl-Cyanoacrylate is placed as splint for 6 weeks.

RESULTS

The bilateral application lasted less than 5 minutes, end there were no spills to the external auditory canal. The splint was given off to the 2 weeks, and a second procedure was necessary in all the cases. There were no dermatitis or skin ulcers. The treatment was successful in 11 cases, partial improvement in 3, poor correction in 4, and recurrence in 2.

CONCLUSIONS

The splint therapy is an easy nonsurgical method for the treatment of congenital auricular deformities that applied during the first weeks of life provides good aesthetic results in more than 50% of the patients.

[Anterior approach otoplasty for treatment of prominent ears in children. A minimally invasive technique]

INTRODUCTION

In adult patients, it has been reported that prominent ears can be treated by mattress sutures placed through the anterior aspect of the ear, with a minimally invasive technique. In order to verify the utility of this method in children, we used this technique in our patients.

MATERIAL AND METHODS

Twenty-two prominent ears were treated in 12 patients between 8 and 11 years of ages. All were operated under general anesthesia. The anterior surface of the auricular cartilage is scored with a rasp. The antihelix shape is obtained, and mattress sutures are placed through the anterior surface of the ear.

RESULTS

A good aesthetic result was obtained in all the cases. Superficial skin necrosis happened in three. Partial loss of correction in the superior pole was noted in four ears. In 6, some knots were visible through the skin.

CONCLUSIONS

This repair is a simple technique for the treatment of the prominent ears in children, of good aesthetic results, that it avoids the necessity of dorsal skin resection and produces folds of antihelix more naturally curved. In children, to avoid the exteriorization of the suture material, the knots must be placed in the posterior surface of de auricular cartilage.

Ventriculopleural shunting with new technology valves

Ventriculoperitoneal shunting constitutes the standard procedure for draining cerebrospinal fluid (CSF) in children with hydrocephalus. Ventriculoatrial and ventriculopleural shunting are alternative methods of CSF drainage, which have gained less acceptance. Ventriculopleural shunts are seldom used owing to justified fears of pneumothorax and symptomatic effusions of CSF. The addition of an antisiphon device to standard shunt systems seems to have prevented CSF pleural effusion. From 1988 to 1998, we treated each of six hydrocephalic children with a ventriculopleural shunt. In five cases we used new-technology valves designed to prevent the effects of siphoning with current differential pressure valves. Peritoneal adhesions, recent peritonitis, ascites, and obstruction of a previous ventriculoatrial shunt were the indications for pleural shunting. After a mean follow-up period of 2.5 years all shunts were functioning adequately. Only one patient showed transient symptoms of CSF overdrainage, which were corrected by up-grading the valve setting with the magnet. A late death was unrelated to the pleural shunting procedure. The use of valves of a new design designed to prevent overdrainage seems to account for the satisfactory outcomes observed in this series. We suggest that ventriculopleural shunting should be considered as the preferred alternative to peritoneal drainage in children with intra-abdominal adhesions or with a history of recent peritoneal infection.

Influence of abdominal incision on the formation of postoperative peritoneal adhesions: an experimental study in rats

OBJECTIVE

To see if the three most commonly used abdominal incisions were associated with the development of postoperative peritoneal adhesions.

DESIGN

Prospective experimental study.

SETTING

University hospital, Spain.

SUBJECTS

30 Wistar rats.

INTERVENTIONS

Three groups each of 10 rats underwent suprainfraumbilical midline laparotomy, right subcostal laparotomy or infraumbilical right transrectal laparotomy.

MAIN OUTCOME MEASURES

The animals were killed after 30 days and adhesions quantified according to a special designed score which assessed the number of adhesions, their site, vascularisation, thickness, and strength.

RESULTS

The transrectal incision was associated with most adhesions (median: 9.3, interquartile 7-10), followed by subcostal laparotomy (5.5, 4-6.7), and midline laparotomy (2.0, 0-7).

CONCLUSIONS

Infraumbilical incisions away from the midline are more traumatic, damage more of the peritoneum, and are more likely to come into contact with the omentum, peritoneal fat, bowel loops, and pelvic contents, thereby predisposing to the formation of peritoneal adhesions.

[Solitary hepatic cyst. Presentation of a case diagnosed in neonatal period]

We reported one case of hepatic solitary cyst, in an infant seven days old. The precocious diagnostic was supported by the presence of an abdominal cyst mass in prenatal period. Different diagnostic and therapeutic consideration are made.