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Primary spinal cord tumors are relatively rare, comprising approximately 4%-16% of all tumors originating from the central nervous system. These tumors are anatomically separable into 2 broad categories: intradural intramedullary and intradural extramedullary. Intramedullary tumors are composed predominantly of gliomas (infiltrative astrocytoma) and ependymomas.1-4 The primary treatment approach for these tumors is surgical resection, aiming to preserve neurologic function.5-9 In Video 1, the authors showcase a step-by-step approach for microsurgical resection of a primary spinal ependymoma, with emphasis on microsurgical technique and utility of adjunct equipment, such as intraoperative ultrasound and neuromonitoring.10,11 The patient consented to the procedure.

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STUDY DESIGN: Retrospective population-based database analysis from the Physician/Supplier Procedure Summary Medicare/Medicaid Dataset. OBJECTIVE: To provide a comprehensive analysis of trends in spinal orthosis utilization over a 12-year period. SUMMARY OF BACKGROUND DATA: Widespread prescription of spinal orthosis persists, despite evidence suggesting equivocal efficacy in many spinal conditions. The utilization of spinal orthosis on a national level, including prescribing specialty data, has not been previously analyzed. METHODS: Healthcare common procedure coding system (HCPCS) codes for cervical (CO), thoracic-lumbar-sacral (TLSO), lumbar (LO), lumbar-sacral (LSO), and cervical-thoracic-lumbar-sacral (CTLSO) orthosis were used to determine spinal orthosis utilization from 2010 to 2021. Provider specialty codes were utilized to compare trends between select specialties. Additionally, a neurosurgical CO analysis, based on subclassifications of cervical bracing, was performed. Linear trendlines were implemented to elucidate and present trends by slope (ß). RESULTS: Among 332,241 claims, decreases in CO (ß=-0.3387), TLSO (ß=-0.0942), LO (ß=-0.3485), and LSO (ß=-0.1545) per 100,000 Medicare Part B enrollees and CTLSO (ß=-0.052) per 1,000,000 Medicare Part B enrollees were observed. Decreases among neurosurgery (ß=-7.9208), family medicine (ß=-1.0097), emergency medicine (ß=-2.1958), internal medicine (ß=-1.1151), interventional pain management (ß=-5.0945), and chiropractic medicine (ß=-49.012), and increases among orthopedic surgery (ß=5.5891), pain management (ß=30.416), physical medicine and rehabilitation (ß=4.6524), general practice (ß=79.111), and osteopathic manipulative medicine (ß=45.303) in total spinal orthosis use per 100,000 specialty claims were observed. Analysis on subclassifications of cervical orthosis among neurosurgeons revealed decreases in flexible (ß=-1.7641), semi-rigid (ß=-0.6157), and collar bracing (ß=-2.7603), and an increase in multi-post collar bracing (ß=2.2032) per 100 neurosurgical cervical orthosis claims. CONCLUSIONS: While utilization of spinal orthosis decreased between 2010-2021, increased utilization was observed among a subset of specialties. Identifying these specialties allows for focused research and educational efforts to minimize unnecessary durable medical equipment use for effective healthcare spending.

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Solubility is one of the most important physicochemical properties due to its involvement in physiological (bioavailability), industrial (design) and environmental (biotoxicity) processes, and in this regard, cosolvency is one of the best strategies to increase the solubility of poorly soluble drugs in aqueous systems. Thus, the aim of this research is to thermodynamically evaluate the dissolution process of triclocarban (TCC) in cosolvent mixtures of {N-methyl-2-pyrrolidone (NMP) + water (W)} at seven temperatures (288.15, 293.15, 298.15, 303.15, 308.15, 313.15 and 318.15 K). Solubility is determined by UV/vis spectrophotometry using the flask-shaking method. The dissolution process of the TCC is endothermic and strongly dependent on the cosolvent composition, achieving the minimum solubility in pure water and the maximum solubility in NMP. The activity coefficient decreases from pure water to NMP, reaching values less than one, demonstrating the excellent positive cosolvent effect of NMP, which is corroborated by the negative values of the Gibbs energy of transfer. In general terms, the dissolution process is endothermic, and the increase in TCC solubility may be due to the affinity of TCC with NMP, in addition to the water de-structuring capacity of NMP generating a higher number of free water molecules.

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The middle fossa, cavernous sinus, and paraclival triangles consist of ten triangles. Their use in a surgical approach is vast; most are used as landmarks to access and identify other structures of surgical interest. Multiple labels, borders, and contents mentioned by different authors make understanding and reproduction challenging and confusing. This study aims to organize and clarify recent or most relevant publications and disclose our portrayal of the ten triangles using cadaveric dissection and simple and practical figures. Four middle fossa triangles, four cavernous sinus triangles, and two paraclival triangles were dissected and delineated in a cadaveric specimen. Drawings were simplified to eliminate confusion and evaluate the triangles effortlessly. Similarities and differences in triangle names, border limits, and contents are described in a precise form. The recognition of triangle landmarks allows for treating pathologies in a frequently distorted anatomy or challenging to access structure. That is why an accurate knowledge of the surgical anatomy should be mastered, and a safe approach should be accomplished.

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Introducción. El angiosarcoma primario de la mama es una neoplasia maligna derivada de las células endoteliales de los vasos sanguíneos, potencialmente agresiva independientemente de su grado histológico, por lo que su pronóstico es malo. Su diagnóstico prequirúrgico es difícil, ya que las características clínicas e imagenológicas son inespecíficas, y el diagnóstico definitivo únicamente se realiza por estudios de patología. Para su tratamiento generalmente se requiere de resección quirúrgica, radioterapia y, ocasionalmente, quimioterapia.Caso clínico. Paciente de 49 años sin antecedentes, que consultó por cuadro clínico de 5 meses de evolución de aparición y rápido crecimiento de masa en mama izquierda. Se realizaron estudios imagenológicos que reportaron lesión BIRADS 4a y diagnóstico histológico de lesión vascular con atipía, por lo cual fue llevada a mastectomía simple, con informe final de patología de angiosarcoma primario de mama; tuvo que ser reintervenida por márgenes positivos. Completó 33 ciclos de radioterapia y dos años después de la cirugía presentó cambios inflamatorios en la cicatriz quirúrgica, de la cual se tomó biopsia con reporte de lesión vascular atípica, por lo que fue operada nuevamente, con reporte histológico negativo para angiosarcoma residual. Actualmente la paciente está en seguimiento imagenológico, sin evidencia de recaída tumoral. Conclusión. Los angiosarcomas primarios de la mama son neoplasias raras y muy agresivas, independientemente de su grado histológico, por lo cual es importante hacer un diagnóstico histológico y tratamiento oncológico oportunos.

Introduction. Primary breast angiosarcoma is a malignant pathology derived from the endothelial cells of the blood vessels of the breast. They are potentially aggressive regardless of histological grade, reason why its prognosis is poor and treatment requires surgical resection plus radiation therapy and occasionally chemotherapy depending on the degree. Its pre-surgical diagnosis is difficult since the clinical and imaging characteristics are nonspecific, and the definitive diagnosis is only made by means of pathology studies. Clinical case. A 49-year-old patient was admitted to the breast surgery outpatient clinic due to clinical symptoms of 5 months of evolution consisting of the appearance of a painful mass in the left breast. Imaging of the lesion with ultrasound report BIRADS 4a and a tricot biopsy was taken with histological diagnosis of vascular lesion with atypia. It was decided to take the patient to a simple mastectomy, with a final report of breast angiosarcoma but with a margin compromised by a tumor for which she was reoperated. She received 33 cycles of radiotherapy and continued in follow-up for two years. During this period, the patient presented inflammatory changes in the surgical scar for which a punch biopsy was done with histological report of vascular atypical lesion. Surgical resection was performed with final report of negative pathology for residual angiosarcoma. Nowadays the patient continues imaging follow-up without evidence of a tumour relapse. Conclusion. Primary breast angiosarcomas are a rare malignant pathology, very aggressive regardless of its histological grade, for which it is important to perform a timely histological diagnosis and oncological treatment

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Development of Internal Carotid Artery pseudoaneurysms (ICAp) after transsphenoidal surgery is extremely rare, occurring only in 0.4% of cases. Surgical treatment of ICAp poses a real challenge to the neurosurgeon as treatment may require parent vessel sacrifice or artery reconstruction with bypass grafting. Furthermore, surgical resolution of these lesions is rarely reported in the literature. The internal carotid artery is prone to iatrogenic injury in transsphenoidal surgery due to its frequent involvement in pituitary adenomas. Intracranial pseudoaneurysms may be at high risk for rupture and increased morbidity and mortality. Here we present a case of a patient with an ICAp rupture two months after transsphenoidal surgery for a pituitary adenoma.

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Neoadjuvant chemotherapy (NAT) in breast cancer (BC) has been used to reduce tumor burden prior to surgery. However, the impact on prognosis depends on the establishment of Pathological Complete Response (pCR), which is influenced by tumor-infiltrating lymphocyte levels and the activation of the antitumor immune response. Nonetheless, NAT can affect immune infiltration and the quality of the response. Here, we showed that NAT induces dynamic changes in the tumor microenvironment (TME). After NAT, an increase of regulatory T cells and a decrease of CD8+ T cells was found in tumor, correlated with the presence of metastatic cells in lymph nodes. In addition, an increase of polymorphonuclear myeloid-derived suppressor like cells was found in luminal patients post-NAT. pCR patients showed a balance between the immune populations, while non-pCR patients presented an inverse relationship in the frequency of CD68+ versus CD3+, CD8+, and CD20+ cells. Moreover, activated T cells were found in peripheral blood, as well as an increase in T cell clonality with a lower diversity post-NAT. Overall, these results shown that NAT induces an activation of immune response, however, a balance in the TME seems to be related to a better antigenic presentation and therefore a better response to treatment.

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BACKGROUND: Orthotopic liver transplantation (OLT) is the accepted treatment in patients with unresectable, early-stage hepatocellular carcinoma (HCC) in the setting of cirrhosis. Due to increasing waitlist demand for OLT, determining optimal groups for transplant is critical. Elderly patients are known to have poorer postoperative outcomes. Considering the effectiveness of liver-directed therapies for HCC, we sought to determine whether elderly patients received survival benefit from OLT over liver-directed therapy alone. STUDY DESIGN: The National Cancer Database participant use file was used to analyze data between 2004 and 2017. Only patients ≥70 years of age who received OLT or liver-directed therapy alone were included. Patients with alpha-fetoprotein >500 ng/mL or missing alpha-fetoprotein values were excluded. Baseline demographic variables, model for end-stage liver disease score, and overall survival from time of diagnosis were collected. Descriptive statistics, Kaplan-Meier survival, Cox proportional hazards model, and propensity score matching were used. RESULTS: A total of 2,377 patients received ablative therapy alone, and 214 patients received OLT. Multivariable analysis and Kaplan-Meier showed that OLT conferred a significant survival benefit compared to liver-directed therapy alone. Age was also associated with a yearly 3% increase in risk of mortality. Propensity-matched analysis adjusting also demonstrated a significant survival benefit for elderly patients receiving OLT compared to liver-directed therapy alone. CONCLUSION: Despite increased age and associated comorbidities being factors associated with poor outcomes, OLT confers a survival advantage compared to liver-directed ablative therapies alone in selected elderly patients with HCC. OLT should be offered in medically appropriate elderly patients with HCC.

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The breeding of medically important snakes is of great value, not only for the production of serums, but also for scientific studies aimed at the maintenance and well-being of animals in captivity. The present study aimed to establish the correlation between body size, sex and age in the venom production of Bothrops leucurus snakes, when manually milked under intensive captivity conditions, for one year. Were used 31 specimens kept in the Herpetology laboratory of Instituto Butantan, grouped by sex and age (young, adult and old). Biometric data (weight and length) and solid and liquid weight of venoms extracted from each fang were recorded, totaling 106 extractions in the period. We evaluated the electrophoretic profile (SDS-PAGE) under reducing conditions, the 50% lethal dose (LD50) and the minimum coagulant dose (DMC) of the extracted venoms. The body size was positively correlated with venom production in B. leucurus snakes. Regardless of sex and age, the venom showed no differences between liquid and solid composition or between right and left fang, however, the production of venom in females was twice the one found in males and more lethal. The clotting ability was lost as the animals aged, indicating that older snakes are not the best choice for venom pools in the production of antivenoms. These results are important to choose of serum production animals, and to understand the composition of snake venoms under captive conditions.

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OBJECTIVE: Primary leiomyosarcoma of bone (PLB) is a rare type of malignant bone tumor considered as a variant of the spindle cell sarcomas (SCS). The objective of this study was to analyze the clinicopathologic and the prognostic factors of patients with PLB treated at a single institution. METHODS: We retrospectively reviewed the records of 22 patients with pathologically confirmed PLB. The data collected were: age, sex, tumor size and location, grade and stage of the disease and histopathologic features. Mean age was 45.5 years (range, 17 to 73 y). Location was: upper limb (27.3%), lower limb (68.2%) and pelvis (4.5%). Patients had high grade in 90.9% of the reports. Margins were negative in 77.3% of the cases. Histological reports describe spindly sarcomatous cells arranged in fascicles with increased vascular formation without osteoid or chondroid matrix production. On immunohistochemistry, smooth muscle actin and desmin where positive in all cases. RESULTS: Mean follow-up time was 73.5 months (range, 5.3 to 331.1 m). We found 22.7% of local recurrence (LR). Distant metastasis (DM) was reported in 9 (40.9%) patients. Lung metastasis was the only DM affected site. Overall survival (OS) rate in 5 years was 59.1%. Predictors of OS were LR and DM. CONCLUSIONS: PLB is an extremely rare malignant bone tumor that has a higher rate of DM and similar OS prognosis compared with other bone sarcomas. Level of Evidence IV, Case Series.

OBJETIVOS: O leiomiossarcoma primário do osso (LPO) é um tumor ósseo maligno raro, considerado uma variante do sarcoma de células fusiformes (SCF). O objetivo deste estudo foi fazer uma análise clínico-patológica e dos fatores de prognóstico dos pacientes diagnosticados com LPO tratados em uma instituição única. MÉTODOS: Foram analisados retrospectivamente os prontuários de 22 pacientes com diagnóstico confirmado de LPO. Os dados coletados foram: idade, sexo, tamanho e localização do tumor, grau histológico, estádio da doença e as características histopatológicas. A média de idade foi 45,5 anos (de 17 a 73 a). A localização foi: membro superior (27,3%), membro inferior (68,2%) e pelve (4,5%). Os pacientes apresentaram alto grau em 90,9% dos relatos. As margens foram livres em 77,3% dos casos. Os relatos histológicos descrevem células sarcomatosas finas e compridas, arranjadas em fascículos, com aumento da vascularização e sem produção de matriz osteoide ou condral. No estudo imuno-histoquímico, a actina do músculo liso e a desmina foram positivas em todos os casos. RESULTADOS: O tempo médio de seguimento foi 73,5 meses (de 5,3 a 331,1 m). Dos pacientes, 22,7% apresentaram recorrência local (RL). Metástase à distância (MD) foi reportada em 9 (40,9%) pacientes. O único local de MD foi o pulmão. O tempo médio de sobrevida em 5 anos foi de 59,1%. Os fatores preditivos de sobrevida global foram: RL e MD. CONCLUSÃO: O LPO é um tumor ósseo maligno extremamente raro que tem uma taxa maior de MD, com uma sobrevida global similar aos outros sarcomas ósseos. Nível de Evidencia IV, Série de Casos.

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Introducción: La infección del sitio quirúrgico (SSI) es una de las principales complicaciones quirúrgicas, con una incidencia del 10-20% en cirugía colorrectal. Las terapias basadas en presión negativa (NPWT) han mostrado su eficacia en el tratamiento de heridas crónicas, traumáticas, en las dehiscencias de piel, en el uso de colgajos o injertos. El objetivo principal del estudio es valorar la eficacia de NPWT en la prevención de SSI en cirugía colorrectal. Los objetivos secundarios son valorar la reducción del ingreso hospitalario y analizar los factores de riesgo de SSI. Métodos: Estudio casos y controles prospectivo. Ochenta pacientes intervenidos tras diagnóstico de enfermedad colorrectal, de forma programada o urgente durante el año 2017. Cuarenta pacientes fueron tratados con NPWT preventivo durante una semana. Cuarenta pacientes fueron tratados según protocolo habitual postoperatorio de cuidado de herida quirúrgica. Resultados: No se encontraron diferencias entre NPWT y grupo control en variables demográficas, comorbilidades, abordaje quirúrgico, indicación urgente o programada, preparación colónica o procedimiento quirúrgico. Se objetivó SSI con el empleo de NPWT en 3 (8%) pacientes (IC del 95%, 0-17,5). SSI en 10 (25%) pacientes (IC del 95%, 12,5-37,5) (p = 0,034); OR 0,7 (IC del 95% 0,006-0,964). La estancia hospitalaria en el grupo NPWT fue de 8 días vs. 12 días en el grupo control (0 p= 0,22). En el análisis multivariante se encontró como único factor relacionado con SSI la preparación colónica (p = 0,047; OR: 0,8, IC 0,45-0,93). Conclusiones: El uso de dispositivos NPWT para la cobertura de incisiones cerradas tras cirugía colorrectal puede disminuir la incidencia de SSI

Background: Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. Methods: We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. Results: No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p = 0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p = 0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p = 0.047; OR: 0.8, CI 0.45-0.93). Conclusions: NPWT is a useful SSI prevention treatment in colorectal surgery

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BACKGROUND: Surgical site infection (SSI) is one of the most frequent complications in colorectal surgery. It is diagnosed in 10 - 20% of colorectal procedures. Negative Pressure Wound Therapy (NPWT) has shown efficacy in the treatment of chronic and traumatic wounds, wound dehiscence, flaps and grafts. The main objective of this study is to assess NPWT in the prevention of SSI in colorectal surgery. Hospital stay reduction and SSI risk factors are secondary objectives. METHODS: We present a prospective case-control study including 80 patients after a colorectal diagnosis and surgical procedure (elective and non-elective) in 2017. Forty patients were treated with prevention NPWT for one week. Forty patients were treated according to the standard postoperative surgical wound care protocol. RESULTS: No significant differences were found in demographic variables, comorbidities, surgical approach, elective or non-elective surgery, mechanical bowel preparation and surgical procedure. Three patients has SSI in the NPWT group (8%) (95%CI 0 - 17.5). Ten patients presented SSI in the control group (25%) (95%CI 12.5 - 37.5) (p=0.034); OR 0.7 (95%CI 0.006-0.964). Hospital stay in the NPWT group was 8 days versus 12 days in the non-NPWT group (p=0.22). In the multivariate analysis, mechanical bowel preparation was found to be the only risk factor for SSI (p=0.047; OR: 0.8, CI 0.45-0.93). CONCLUSIONS: NPWT is a useful SSI prevention treatment in colorectal surgery.

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The thermodynamic properties of the 3-chloro-N-phenyl-phthalimide in acetone + methanol cosolvent mixtures were obtained from solubility data report in literature. The solubility was higher in near acetone and lower in pure methanol at all temperatures studied. A non-linear plot of ∆solnH° vs. ∆solnG° shows a negative slope from pure acetone up to x1 = 0.691. Beyond this composition, a variable positive slope is obtained with the exception of mixtures with x1 = 0.121, x1 = 0.272 and x1 = 0.356 which is a not common trend in these systems. The preferential solvation of 3-chloro-N-phenyl-phthalimide by the components of the solvents was estimated by means of the inverse Kirkwood-Buff integral method, showing the 3-chloro-Nphenyl-phthalimide is preferential solvated by methanol in more polar mixtures and by acetone in less polar ones.

Las propiedades termodinámicas de 3-cloro-N-fenil-ftalimida en mezclas cosolventes acetona + metanol fueron obtenidas a partir de los datos de solubilidad reportados en la literatura. La mayor solubilidad se presentó en acetona y la menor en metanol puro en todas las temperaturas estudiadas. La grafica ΔsolnH° vs. ΔsolnG° presenta una tendencia no lineal, con una pendiente negativa desde la acetona pura hasta x1 = 0,691 a partir de esta composición hasta el metanol puro se obtiene una pendiente positiva variable con la excepción de las mezclas con x1 = 0,121, x1 = 0,272 y x1 = 0,356, la cual es una tendencia poco común en estos sistemas. La solvatación preferencial de 3-cloro-N-fenil-ftalimida por cada uno de los solventes de la mezcla se estimó por medio del método de las integrales inversas de Kirkwood-Buff mostrando que la 3-cloro-N-fenil-ftalimida se solvata preferencialmente por metanol en las mezclas más polares y por acetona en las menos polares.

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Los parámetros de solvatación preferencial, es decir, las diferencias entre la fracción molar local y de la solución de los solventes en solución de naringina se derivan de su solubilidad en mezclas cosolventes mediante el método de las integrales inversas de Kirkwood-Buff. Según el método IKBI, la naringina es sensible a los efectos específicos de solvatación según la composición cosolvente, por lo que el parámetro de solvatación preferencial por δx1,3, es negativo en mezclas ricas en agua y en mezclas ricas en etanol, pero positivo en composiciones entre 0,24 y 0,40 en fracción molar de etanol. Esto podría demostrar el papel relevante de hidratación hidrofóbica alrededor de los grupos no polares en la solvatación de fármacos en mezclas ricas en agua. Por otro lado, en mezclas de composiciones cosolventes intermedias, el fármaco es solvatado principalmente por etanol, posiblemente debido al comportamiento básico de la mezcla cosolvente; mientras que en mezclas ricas en etanol, la solvatación preferencial por el agua podría deberse al carácter ácido del agua.

The preferential solvation parameters, i.e., the differences between the local and bulk mole fractions of the solvents in solutions of naringin is derived from their solubility in binary solvent mixtures by means of the inverse Kirkwood-Buff integral (IKBI) method. According to IKBI method it is found that naringin is sensitive to solvation effects, so the preferential solvation parameter by ethanol δx1,3, is negative in waterrich and ethanol-rich mixtures but positive in compositions from 0.24 to 0.40 in mole fraction of ethanol. This could demonstrate the relevant role of hydrophobic hydration around the non-polar groups in the drug solvation in water-rich mixtures. Otherwise, in mixtures of intermediate co-solvent compositions, the drug is mainly solvated by ethanol, probably due to the basic behavior of the co-solvents; whereas, in ethanol-rich mixtures, the preferential solvation by water could be due to the acidic behavior of water.

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El nevus sebáceo de Jadassohn es una lesión congénita sobre la cual se pueden desarrollar de manera infrecuente, diversos tumores, en su mayoría benignos. Se presenta el caso de una mujer de 63 años con un nevus sebáceo sobre el cual se desarrolló un adenocarcinoma apocrino primario.

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El adenocarcinoma fetal bien diferenciado de pulmón es un tumor raro compuesto por glándulas neoplásicas ricas en glucógeno y túbulos que se parecen al pulmón fetal entre la semana 10 y 16 de gestación[1]. Se presenta el caso de una mujer de 26 años, con antecedentes de bronquitis aguda y tabaquismo, cuyos hallazgos clínicos, imaginológicos, macroscópicos y microscópicos fueron indicativos de esta neoplasia. Se le practicó lobectomía inferior izquierda.

Well differentiated fetal adenocarcinoma is a rare lung tumour that is composed of glycogenrich neoplasic glands and tubules that resemble fetal lung at 10 to 16 weeks of gestation. In this report, we present a case of a 26 year old woman with a history of acute bronchitis and smoking, on which the clinical, imaging, macroscopic and microscopic features were compatible with this neoplasm. Lobectomy was performed of the left lower lobe.

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INTRODUCTION: Spigelian hernias in childhood are extremely uncommon. The aim of this study was to analyse the pathogenetic factors of paediatric Spigelian hernias. PATIENTS AND METHOD: A retrospective review of worldwide literature for infants who had undergone surgical repair of a Spigelian hernia from 1950 to 2006. Descriptive statistical techniques were applied and percentages and means were calculated. RESULTS: There were 33 patients in whom 40 Spigelian hernias were repaired, 26 males and 7 females, with a sex ratio of 3.7/1. The mean age was 2.7 years. 7 hernias are bilateral. RISK FACTORS: anal stenosis (n = 1). Associated defects: cryptorchidism (n = 22), inguinal hernia (n = 5), umbilical hernia (n = 2). The most common hernia contents are testicle (40%), small intestine ( 27.5%) and omentum (15%). CONCLUSIONS: The mean age of Spigelian hernia in children was 2.7 years, which would suggest a congenital cause. Spigelian hernias in infants are more common in males. There were 21.2% bilateral hernias. No risk factors were detected. Combined hernias accounted for 15.1% of the total. The most frequent hernia content is the testicle (40%). Interestingly, 48.4% of those infants with Spigelian hernias had ipsilateral cryptorchidism, which may suggest a new syndrome.

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Introducción. La hernia de Spiegel es muy poco frecuente en la infancia. El objetivo de este trabajo es analizar los aspectos etiopatogénicos de estas hernias. Material y método. Analizamos retrospectivamente a los pacientes pediátricos con reparación quirúrgica recogidos en la literatura entre 1950 y 2006. Se aplicó estadística descriptiva con cálculo de porcentajes y medias. Resultados. Se analiza a 33 pacientes menores de16 años tratados quirúrgicamente de 40 hernias de Spiegel. La media de edad fue 2,7 años. Había 26 varones y 7 mujeres, en proporción de 3,71:1. Había 15hernias derechas, 11 izquierdas y 7 bilaterales. Factores predisponentes: estenosis de ano (n = 1). Anomalías asociadas: criptorquidia (n = 22) (10 ipsolateralesy 6 bilaterales), hernia inguinal (n = 5), hernia umbilical(n = 2). El contenido del saco más frecuente fue el testículo (el 40% de todas las hernias), seguido de intestino delgado (27,5%) y epiplón (15%).Conclusiones. La media de edad de los pacientes pediátricos con hernias de Spiegel es de 2,7 años, lo que indica una causa congénita. Las hernias de Spiegel pediátricas son más frecuentes en varones. Estas hernias son bilaterales en el 21,2% de los pacientes. Hay pocos factores predisponentes. Aparecen hernias asociadas en el 15,1%. El contenido del saco más frecuente es el testículo (40%). La asociación entre hernia de Spiegel y criptorquidia ipsolateral ocurre en el 48,4% de los pacientes, lo que puede significar un nuevo síndrome (AU)

Introduction. Spigelian hernias in childhood are extremely uncommon. The aim of this study was to analyse the pathogenetic factors of paediatric Spigelianhernias. Patients and method. A retrospective review of worldwide literature for infants who had undergone surgical repair of a Spigelian hernia from 1950 to2006. Descriptive statistical techniques were applied and percentages and means were calculated. Results. There were 33 patients in whom 40 Spigelian hernias were repaired, 26 males and 7 females, with a sex ratio of 3.7/1. The mean age was 2.7 years.7 hernias are bilateral. Risk factors: anal stenosis (n =1). Associated defects: cryptorchidism (n = 22), inguinal hernia (n = 5), umbilical hernia (n = 2). The most common hernia contents are testicle (40%), small intestine( 27.5%) and omentum (15%).Conclusions. The mean age of Spigelian hernia in children was 2.7 years, which would suggest a congenital cause. Spigelian hernias in infants are more common in males. There were 21.2% bilateral hernias. No risk factors were detected. Combined hernias accounted for 15.1% of the total. The most frequent hernia content is the testicle (40%). Interestingly, 48.4%of those infants with Spigelian hernias had ipsilateral cryptorchidism, which may suggest a new syndrome (AU)

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