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La infección de la herida, tras la apendicectomía en la infancia, esun problema frecuente y que produce trastornos muy molestos. Revisamos prospectivamente a los niños operados por apendicitis aguda, con técnicas quirúrgicas convencionales, durante un período consecutivo de 9 meses (Grupo Control: 58 pacientes), y a los niños intervenidos durante los 9 meses siguientes, bajo las mismas circunstancias quirúrgicas excepto utilizar, de manera aleatoria, sutura recubierta de antiséptico (Vicryl Plus®, Ethicon Johnson & Johnson Medical), para el cierre de la pared abdominal en un Subgrupo o esponja de colágeno impregnada en gentamicina (Collatamp EG®, Acuña Fombona, S.A.;Schering-Plough, S.A.), introducida entre la musculatura de la incisión, en el otro Subgrupo (Grupo Estudio: 101 pacientes).Estudiamos en los dos grupos, fundamentalmente, la incidencia de abscesos de pared y la estancia media hospitalaria. La introducción de suturas recubiertas de antiséptico y/o esponja de colágeno impregnada en gentamicina, en el cierre de la herida quirúrgica postapendicectomía, ha contribuido a reducir de manera estadísticamente significativa la incidencia de abscesos de pared y de la estancia media hospitalaria de los niños incluidos en el Grupo Estudio, con respecto a los pertenecientes al Grupo Control (AU)

Postappendectomy wound infection is frequent in the pediatric age. It causes them important discomfort. We have conducted a prospective clinical study to evaluate this incidence under different surgical management. The subjects were children undergoing appendectomy for acute appendicitis. The patients belonging to the Control Group were operated, by standard surgical technique, along the first 9 months of the study period (n: 58).The Study Group was constituted by 101 children operated during the 9 consecutive months, identical on the basis of demographics and operations undergone, except for the use of, in an aleatory manner, sutures with antiseptic impregnation (Vicryl Plus®, Ethicon Johnson& Johnson Medical), to close the incision in children included in Study Sub-Group A, or gentamycin-containing collagen sponge (CollatampEG®, Acuña Fombona, S.A.; Schering-Plough, S.A.), placed within the muscles before wound closure,. In the children belonging to the Study Sub-Group B. We have analyzed in the two Groups the incidence of postoperative wound infection and the mean Hospital stay. The use of sutures with antiseptic impregnation and/or gentamycin containing collagen sponge, significantly reduced the wound infection rates in the children operated on for appendectomy included in the Study Group, compared with the ones in the Control Group, therefore contributing to decrease the Hospital length of stay (AU)

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Cuando resulta imposible restablecer la continuidad esofágica en las atresias de esófago (AE), el ascenso del estómago sólo y/otubulizado y la interposición de colon son las técnicas más realizadas, normalmente a partir de los 6 meses de edad, en varios tiempos y con alta morbilidad, larga estancia hospitalaria y alto coste social, familiar y económico. Hemos tratado a tres niños con AE, de un total de 34 AE diagnosticadas, en un período de 11 años, tubulizando el fundus gástrico, con suturas mecánicas, en continuidad con el cabo distal esofágico, en período neonatal. La técnica (basada en la técnica de Schärli) conlleva la tubulización desde la curvatura menor gástrica del fundus gástrico, mediante el uso de suturas mecánicas en continuidad con el cabo distal esofágico. De esta manera se efectúa una anastomosis esofago esofágica conservando el cardias y tubulizando el estómago en sentido isoperistáltico. Todos los pacientes han requerido dilataciones neumáticas de la anastomosis esofago esofágica. El control y seguimiento tras 11 años, 8 años y 8meses es satisfactorio en los tres pacientes, los cuales se encuentran bien, sin problemas de deglución y con un aceptable y adecuado desarrollo pondoestatural. Creemos que este tipo de intervención y realización de un neoesófago es útil para tratar las AE de segmento largo en neonatos, al emplazar un tubo esofagogástrico ortotópicamente de calibre homogéneo en continuidad isoperistáltica en período neonatal y en un solo tiempo, prescindiendo de la gastrostomía realizada a las pocas horas de vida, consiguiendo una importante reducción de la morbilidad y estancia hospitalaria (AU)

When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulized or complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay When is impossible to restore the oesophageal continuity in oesophageal atresia (EA), the stomach elevation (whether tubulizedor complete) and colon interposition are the most accomplished techniques, usually from the age of six month, in different steps and with the result of a high mortality, prolonged hospitalizations and high familial and economical cost. From a total of 34 EA diagnosed in an eleven years period, we had treated three children, tubulizing the gastric fundus with mechanical sutures in continuity with the distal oesophageal end in neonatal period. The procedure is done with preservation of the distal esophageal end in continuity with the tubuliced gastric fundus with mecanichal staplers. All the patients had needed pneumatic dilatations of the anastomosis After eleven years, eight years and six months follow-up respectively, the clinical behaviour of those patients is suitable, without swallowing problems and with weight and height development in predictable limits. We think that this kind of neoesophagus is useful to treat the long segment EA in newborns as it sets an esophago-gastric tube orthotopically, with homogeneous diameter in a isoperistaltic continuity, in neonatal period and in one step, putting aside the gastrostomy performed at the firsts hours of life and obtaining an important decreasing of mobility and hospitalisation stay (AU)

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Las quemaduras en la infancia constituyen un accidente que reviste un alto grado de dramatismo, fundamentalmente por la aparatosidad de las mismas y sus consecuencias inmediatas, y por otro lado por lo doloroso y elevado número de las curas, prolongada hospitalización y las secuelas estéticas e incluso funcionales que suelen dejar de por vida. Presentamos nuestra experiencia con el uso de Biobrane©, entre 1995 y 2000, en el tratamiento de 196 pacientes (edades: 4 meses a 14 años): 141 pacientes con lesiones por quemaduras de primer y segundo grado, 45 recubrimientos de zonas dadoras, 4 protecciones de injertos mallados, 3 dermoabrasiones traumáticas, 2 exéresis de tatuaje cutáneo post-traumático y 1 necrolisis epidérmica tóxica. Ventajas apreciadas al finall del tratamiento: • Cicatrización excelente.• Ausencia de dolor durante los cambios de apósitos. • Menor necesidad de autoinjertos.• Muy útil para el recubrimiento de zonas dadoras e injertos mallados. • Disminución considerable de la estancia hospitalaria e ingresos. • Mayor nivel de satisfacción en pacientes, en sus padres y en el personal sanitario.• Posibilidad de tratamiento ambulante en Consultas externas y en Centros de Atención Primaria.• Disminución de los costos hospitalarios en general. (AU)

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Burns in the pediatric age are accidents which cause a lot of trauma, on the one hand because of their immediate consequences and on the other hand because of the severity of the pain, the amount of times the dressings need to be change, the lengthy hospital stay and the scars that remain for life. Between 1995 and 2000 we have treated 196 children, (4 months to 14 years old), with Biobrane: 141 patients affected of first and second degree burn injuries, 45 skin donor sites covering, 4 reinforcing of meshed autografts, 3 traumatic dermoabrasions, 2 extirpation of post-traumatic cutaneous tattoo and 1 Toxic epidermic necrolisis. Advantages noticed at the end of the treatment: Excellent skin healing. No pain while changing dressings. Reduction the need to use skin grafts. It is very useful to cover the skin donor sites and meshed autografts. Shorter Hospital stay and less need to be kept in hospital. A higher level of satisfaction is shown by children, their parents and sanitary workers. It offers the possibility of outpatients treatment in First Aid Health Centers. It reduces hospital costs.

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Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical interventions is very rare. When a surgical exploration is mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prosteses. We present our experience over the 4 years with 9 severe splenic injuries. Six of this patients were treated operatively with a reabsorvable mesh, while the other 3 were managed percutaneosly by selective embolization of the splenic artery under fluoroscopic control. We describe our experience in the treatment of the splenic injuries in the last four years.

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The definitive surgical treatment in the first months of life without colostomy are essential principles at present in the management of Hirschsprung's disease. The appearing of little size stapling devices like EndoGIA, from the development of laparoscopic surgery, make possible the application of the classical surgicall procedures on early age patients. The experience in five patients operated under two months of life with the Duhamel-Martin procedure is reported. Only in one case previous colostomy was performed for one episode of enterocolitis at age of fifthteen days. The stapling of both pouches was performed with EndoGIA. The agartglionic pouch was closed with TA Roticulator. That provides a reduction in the high of the aganglionic pouch at minimum. Follow-up varied from 3 months to 2 years, without any complication.

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Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

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We report six cases of small intestine volvulus associated to malrotation, out of a whole of 11 volvulus managed by us in the last six years. None of them were diagnosed with the only help of clinical and conventional radiological explorations. In the other three cases the diagnosis was made through ultrasounds explorations: It showed the mesenteric vein on the left side of the mesenteric artery. Confirmation and resolution of the cases were reached with a laparotomy.

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Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.

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