[Retrocaval ureter in children: surgical approach based on the obstructive pattern in the diuretic renogram with 99mTc DTPA]. / Uréter retrocavo en edad pediátrica: actitud quirúrgica en base al patrón obstructivo en el renograma diuretico 99mTc DTPA.

Retrocaval ureter is a rare disease in childhood which is due to a abnormal development of the inferior cava vein. We report a new case of retrocaval ureter in a 9 year-old girl who had consulted for macrohematuria and right flank pain. Preoperative intravenous urography and DTPA diuretic renogram suggested this entity. CT scan was no necessary for the diagnosis. We consider the diuretic renogram the best diagnostic method in the surgical decision of this disease.

[Ureteral hydronephrosis secondary to appendicular abscess]. / Ureterohidronefrosis secundaria a absceso apendicular.

OBJECTIVE: To report a case of ureterohydronephrosis secondary to an undiagnosed appendiceal abscess. METHODS/RESULTS: Herein we describe a case of a 4-year-old girl with right ureterohydronephrosis arising from extrinsic compression of the right ureter due to an undiagnosed appendiceal abscess. The patient was treated with intravenous antibiotics and the abscess was drained. Regular isotope and US assessments showed both the residual retroperitoneal fibrosis and renoureteral dilation had decreased. CONCLUSIONS: Acute appendicitis is still the most common cause of emergency abdominal operations in children. Although the symptoms are easily recognizable and generally lead to the correct diagnosis in most cases, the peculiarities of childhood can lead to errors in the diagnosis resulting in the complications reported herein. We emphasize the usefulness of ultrasound in the diagnosis and conservative treatment is advocated.

[Benign gingival granular cell tumor in the newborn: congenital epulis]. / Tumor gingival benigno de células granulares en el recién nacido: epulis congénito.

Gingival granular cell tumor, or congenital epulis, was first described by Neumman in 1871 and subsequently 201 cases have been published in 173 patients. It is an uncommon benign tumor that is present like a pedunculated, smooth surfaced, isolated lesion on the alveolar mucosa of the maxillar of the newborn child. Its firm consistency and variable size can occasionally cause problems in the child's breathing or feeding. This tumor is easily diagnosed clinically and, although spontaneous regression of the tumor mass has occasionally been reported, the current treatment is surgical removal. Two new cases of congenital epulis are reported and a literature review is included.

[Blunt abdominal trauma. Nonoperative management]. / Traumatismos abdominales cerrados: un enfoque conservador.

During the 7 year period, 1987 to 1994, 48 patients with blunt abdominal trauma were treated in our Hospital. There were splenic injury in 50% cases, liver trauma in 25% and renal injury in 40%. Seven patients suffered injuries to multiple sites. The clinical findings were confirm with ultrasound (47 children) and Computed Tomography scanning (CT) (19 children). Intravenous pyelography were performed in nine cases with previously suspect of renal affection. The CT scan provided diagnosis in four patients with negative findings in the sonography. In the present serine, 42 cases were managed by nonoperative means with 100% survivals. One patient surgically treated died from associated severe head injury. The postoperative complications appeared in ten nonoperatively cases (recurrence of bleeding in four children). 14 of these non surgical patients required blood transfusion, and the mean volume of transfusion was 30 ml/kg. A follow-up abdominal sonography was obtained in all survivors, showing resolution of the injury in all of them. We conclude that non surgical managements must be the first choice in all blunt abdominal trauma in pediatrics. Laparotomy is mandatory in masive bleeding or hemodynamically inestable patients. Ultrasonography is a simple method without risks and fast available, well indicated for diagnosis and follow-up of this children.

[Necrotizing enterocolitis: a 10-year survey]. / Enterocolitis necrotizante: revisión de 10 años.

We reviewed the records of all infants with necrotizing enterocolitis (NEC) who had been diagnosed in "Teresa Herrera" Hospital in La Coruña between 1984 and 1994. We tried to determine the risk factors that could influence at the beginning of the disease, the clinic presentation, and the basic aspects of treatment. All cases of ECN with clinic-radiologic confirmation were examined (Bell stages II and III). With this approach, a general questionnaire containing records, clinical presentation, and treatment, was applied to all cases. In our revision, we found that neonate most at risk is that one with an average gestational age of 35 weeks, a mean weight of 2500 gr., with a laborious delivery and who was admitted in the neonatal intensive care unit for an important disease. The onset of NEC was more frequent in the first 15 days of life, and clinical and radiological features were used to confirm the disease. In 86% of the cases, oral feeding had begun. Surgery was needed in 36% of the cases, of which 86% suffered from gut perforation, terminal ileum being the most frequent localization. The general mortality was 12%. Only one of the operated patient died. We conclude that in the appearance of NEC there are a lot of influential factors, including perinatal stress, prematurity and a low birth weight. Clinical symptoms are haemodynamic instability, abdominal distension and bloody stools, obtaining confirmation through radiology in 87%. We consider the importance of early diagnosis and treatment and exhaustive observation by children's surgeon to indicate early surgery.

[Comparative sensitivity of intravenous urography, ultrasonography and DMSA scan in the diagnosis of vesicoureteral reflux nephropathy]. / Sensibilidad comparada de la urografía intravenosa, la ecografía y el DMSA scan en la detección de la nefropatía del reflujo vesicoureteral.

We compared the efficiency of the IVP, the ultrasound and the DMSA scan in the detection of pyelonephritic lesions during the evaluation of 165 kidneys in 83 children, aged up to 14 years, with vesicoureteric reflux. Our study showed an efficiency of 60.20% for the IVP, 29.60% for the ultrasound and 96.90% for the DMSA scan. These results clearly show that the best imaging method for detecting renal scars is the DMSA scan, followed by IVP and ultrasound.

[Our experience with aspiration of ectopic ureteroceles]. / Nuestra experiencia con la aspiracion de los ureteroceles ectopicos.

Since 1986 we have performed suction of the ectopic ureteroceles in seven cases. In four of these cases the obstruction caused by the ureteroceles affected the upper hemi-kidney. In the remaining three cases both hemi-kidneys of the same side were affected. One child suffered failure of both hemi-kidneys. All the ureteroceles corresponded to the upper hemi-kidney and were associated with ipsilateral duplicity. In four of the cases the treatment applied was the heminephrectomy of the upper hemi-kidney and the suction of the ureterocele. In one case, we did a nephrectomy and suction of the ureterocele. In the remaining two cases the suction of the ureterocele was done, as well as the ureteropyelostomy, since it was necessary to use the upper hemi-kidney in the renal TC99m dimercaptosuccinic acid scan-DMSA. In five of the children there was a collapse of the ureterocele giving good results in both kidneys. In two of the children there was no collapse, which provoked the need for removal of the ureterocele. In one of these two cases, the renal dilatation persisted later. In the last case it was necessary to perform nephrectomy due to the absence of recuperation of the renal function. Three of the children had associated reflux which disappeared in one of them, after the suction of the ureterocele. Vesical surgery might be avoided by means of the ureterocele's suction technique in 60 per 100 of the cases. However, it is essential to pursue the child's progress once every six months, in order to detect possible failures of ureterocele collapse.

[The use of technetium 99m with diethyleneamino pentaacetic acid (Tc 99-DTPA) in the pathology of the pyeloureteral junction]. / Aplicación del tecnecio 99m con ácido dietilenoaminopentacético (Tc 99-DTPA) en la patología de la unión pieloureteral.

By using diuretic renograms with technetium 99m-diethylenetriaminepentaacetic acid (Tc 99-DTPA) as a non-invasive procedure to evaluate paediatric patients with pelvicaliceal dilatation, we are able to make a clear differentiation between dilated, obstructed and non obstructed renal units. This procedure has given us a new insight into the management of these patients, permitting us to decide which patients would benefit from a surgical treatment and which patients would be reserved for clinical observation and follow up.

[Xanthogranulomathous pyelonephritis (and cystic dysplasia) in a newborn]. / Pielonefritis xantogranulomatosa (y displasia quística) en un recién nacido.

The authors present a case of diffuse xanthogranulomatous pyelonephritis in a new-born baby which, according to the literature reviewed, is the youngest case reported throughout the world. They stress the coexistence of two facts not mentioned in the cases reviewed: --Segmentary cystic dysplasia.--Xanthogranulomatous disorder in the suprarenal gland. It is also interesting due to the presence of chronic contralateral pyelonephritis. They comment upon the special features of the etiopathogeny, anatomopathology, clinical picture, diagnosis and treatment of this rare disorder.

[Vesicoureteral reflux. Surgical treatment]. / Reflujo vesicoureteral. Tratamiento quirúrgico.

We present the casuistry of vesico-ureteral refluxes operated upon in our centre, which total 45. We comment upon and describe the guidelines which we have followed in indicating the operation, assessing and comparing the results obtained with the different techniques used: Leadbetter-Politano, 62.5% of successes; Cohen, 90.9%; Glen-Anderson, 100%, and González Martin, 90.5%. Finally, we make some comments upon infection associated with reflux.

[Vesico-ureteral reflex. Medical treatment]. / Reflujo vesicoureteral. Tratamiento médico.

We have reviewed the problem of vesico-ureteral reflux in children and comment upon the selection guidelines followed for indicating medical treatment, on the basis of the clinical picture and the radiographic and analytical findings. We assess the results obtained (58.06% of cures) as a result of which we stress the need for conservative treatment in cases of moderate refluxes.

[Omphalopagus conjoined twins with successful surgical separation (author's transl)]. / Separación quirúrgica con supervivencia de dos gemelas siamesas onfalópagos.

The authors present an observation of omphalopagus conjoined twins with successful separation. They comment on the etiopathogenic factors, obstetrical problems, investigation of the extent of the union and operative timing.