Giant urethral calculus in a 6-year-old girl.

Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. Primary urethral calculi are extremely infrequent in females. We describe a case of a giant urethral stone impacted in a 6-year-old girl.

[Pneumopathy in patients surgically treated for type III esophageal atresia]. / Neumopatía en pacientes intervenidos de atresia de esófago tipo III.

UNLABELLED: Patients following esophageal atresia with tracheoesophageal fistula (EA-TEF) treatment have several long-term respiratory complications during infancy. They are associated with esophageal dismotility and gastroesophageal reflux (GER) as well as lung dysplasia. MATERIAL AND METHODS: Ten patients were evaluated as follow: 1. Review of medical record. 2. An annual interview was performed concerning respiratory and digestive symptoms. 3. Phmetric score and radiologic studies of the digestive tract. 4. Functional respiratory test. 5. Update symptoms. RESULTS: Mean follow-up was 7.3 +/- 4.45 years (8 months-15 years). Seven cases (70%) had respiratory distress during the first postoperative year. Two of them had middle GER, performing a Nissen procedure in another patient with severe GER. Spirometry was underwent in 6 cases, showing a restrictive pattern in three. CONCLUSION: Respiratory distress were common during the first postoperative year (70% of cases in our serie) but only 25% were GER related. Pulmonary function test can be performed in long-term evolution of patients following operation for EA-TEF in order to have early treatment for respiratory complications.

Testicular size following embolization therapy for paediatric left varicocele.

Optimal management of varicocele testis in children and adolescents is controversial, but testicular hypotrophy has been suggested as an indication for treatment in adolescents. This report concerns the diagnosis and management of left varicocele in 30 patients aged 6-15 years and the influence of treatment on testicular size. The left testicle was significantly smaller than the right in 14 patients at enrollment in the study. All patients were treated in local anaesthesia with percutaneous transfemoral spermatic venography and embolization of that vein with spring coil, followed by 24-hour observation. There were no major complications. At follow-up 9 to 12 months after the treatment, the size of the left testis had increased in 12 patients. Spring-coil embolization of the spermatic vein proved to be a safe and effective technique for treatment of varicocele.

Percutaneous venography and embolization of the internal spermatic vein by spring coil for treatment of the left varicocele in children.

The treatment of varicocele is controversial in boys and it is a contributing factor to male infertility. Recently it has been proposed that early therapy of a varicocele during childhood or adolescence may improve the prognosis of fertility. The authors review their experience with the diagnosis and management of left varicocele in 20 pediatric patients 6 to 15 years old. All were managed under local anesthesia by spermatic venography and percutaneous transcatheter embolization of the internal spermatic vein with spring coils. All achieved satisfactory occlusion, and during the follow-up, from 13 years to 9 months, there was only one recurrence, noted in a patient 6 months after the procedure. Complications were phlebitis of the pampiniform plexus, leading to swelling and erythema of the left scrotum, and mild flank pain; these symptoms resolved without sequelae. This is a safe and effective nonsurgical method of obliterating varicoceles in children, with a low morbidity rate and a short hospital stay.

Cystadenoma of the epididymis, another cause of scrotal mass in infancy.

We describe a case of cystadenoma of epididymis in a boy, 12-year-old. This condition should be emphasized in the differential diagnosis of a scrotal mass in the infancy.

Meconium ileus equivalent and Kawasaki syndrome. Case report.

Kawasaki syndrome appeared after operation for meconium ileus equivalent in a 4-year-old child with cystic fibrosis. The course and management are described.

Role of presynaptic purinoceptors and cyclic AMP on the noradrenaline release in cat cerebral arteries.

Field electrical stimulation (ES), K+ (50 mM) or ionophore X-537A (0.01 mM) induced tritium release from cat cerebral arteries preincubated with [3H]noradrenaline (NA). Adenosine and AMP (0.5 mM) did not modify tritium release caused by ionophore X-537A, but these agents and ATP (0.5 mM) significantly reduced that elicited by ES and K+; this reduction was antagonized by 1-methyl-3-isobutylxanthine (MIX; 0.05 mM). Inosine (0.5 mM) and the agonist of purinergic A2-receptors, 5'N-ethyl-carboxamide adenosine (NECA; 0.5 mM) had no effect, but the agonist of purinergic A2-receptors L-N6-phenylisopropyl adenosine (L-PIA; 0.1 mM) diminished tritium efflux caused by ES and K+. The adenosine inhibition of ES-induced radioactivity release was not affected by indomethacin (0.05 mM). MIX (0.05 mM) increased tritium release evoked by ES and K+. Agents that increase intracellular cyclic (c)AMP levels, such as dibutyryl cAMP (0.5 mM), the phosphodiesterase inhibitor Ro 20-1724 (0.1 mM), and the activators of adenylate cyclase, forskolin (0.005 mM) and NaF (2 mM) reduced tritium secretion elicited by ES and K+. However, the intracellular increase of cyclic GMP (cGMP) caused by 8-Br-cGMP did not affect this secretion. Dipyridamole (0.05 mM) and the adenosine deaminase inhibitor erythro-9-2-hydroxy-3 nonyl adenosine (EHNA; 0.1 mM) also produced inhibition of tritium secretion elicited by ES and K+. Dipyridamole reduced both the uptake of [3H]NA and [3H]adenosine.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pneumothorax in neonates and infants]. / Der Pneumothorax bei Neugeborenen und Säuglingen.

Pneumothorax in newborns and infants can have different etiologies: alveolar disruption following mechanic ventilation or reanimation, surgery for congenital diaphragmatic hernia or esophagus atresia, staphylococcal pneumonia, or thoracic traumas. We studied 105 cases of pneumothorax (96 newborns) treated in our hospital during the last 15 years. Pleural puncture with drainage and antimicrobial therapy were the treatments of choice. Due to early diagnosis and treatment of the pneumothorax and concomitant anomalies mortality was reduced to 17.4%.

Purinergic and cyclic AMP modulation of noradrenaline release in cat femoral arteries.

1. Adenosine, AMP, ATP (5 x 10(-4) M), 5'-N-ethylcarboxamide adenosine (NECA) and N6-L-phenylisopropyl adenosine (L-PIA) (10(-4) M) decreased tritium release elicited by electrical stimulation (ES) or 50 mM K+ in cat femoral arteries preincubated with [3H]noradrenaline (NA). 2. This effect was antagonized by 1-methyl-3-isobutylxanthine (MIX, 5 x 10(-5) M). 3. The release induced by ionophore X-537A (10(-5) M) was unaffected by adenosine and AMP. 4. The increase of intracellular cAMP levels caused by dibutyryl cAMP (5 x 10(-4) M), Ro-20 1724 (10(-4) M), forskolin (5 x 10(-6) M), NaF (2 x 10(-3) M) reduced, but MIX (5 x 10(-5) M) increased tritium release elicited by ES and K+. 5. Dipyridamole (5 x 10(-5) M) and erythro-9-2-hydroxy-3 nonyl adenosine (EHNA) (10(-4) M) also reduced tritium release. 6. Dipyridamole decreased both the uptake of [3H]NA and [3H]adenosine. 7. These data indicate: (a) the existence of A1 and A2 subtypes of purinoceptors situated presynaptically, which modulates NA release, (b) the intracellular increase of cAMP negatively modulates this secretion, and (c) these arteries possess an active system for incorporating and degrading adenosine.

Papillary cystic tumor of the pancreas.

A 10-year-old girl had fever, abdominal pain and a palpable mass at the left hypochondrium. She was found to have a pancreatic cystic tumour that was biopsied and removed by coeliotomy. The pathologic diagnosis was papillary cystic tumour of the pancreas with chronic pancreatitis. No pathological lesion was found elsewhere. 2 years later she is asymptomatic and without recurrence.

Surgical Management and follow-up of vascular rings.

Thirty patients with aortic arch anomalies resulting in tracheo-oesophageal compression were treated during the period 1966 through 1987. These anomalies are important causes of upper respiratory and oesophageal obstruction in babies and small children. Although symptoms started within the first months of life in most cases, only 15 underwent surgery before six months and a delay of more than one year occurred in 5. Diagnosis was established by chest roentgenogram, barium oesophagogram and angiography. Thirteen (43%) patients had a double aortic arch, 9 (30%) cases had aberrant right subclavian artery and 6 (20%) patients had right aortic arch with ductus or ligamentum arteriosum. One (3.5%) patient had pulmonary artery sling and 1 (3.5%) case had right aortic arch and ductus arteriosum and aberrant right subclavian artery. Associated malformations were seen in 8 (27%) cases, (4 ventricular septal defects, 1 atrial septal defect, 1 coarctation of the aorta, 1 hypoplasia of left pulmonary artery, 1 left diaphragmatic eventration). Basic surgical procedure includes exposure through a left thoracotomy, complete identification of the anomaly and division of the constricting ring. 85% of the patients are asymptomatic and minimal to moderate stridor persists among the remainder. Severe tracheomalacia was responsible for the only two deaths in the series.

[Reoperation in biliary atresia]. / La reoperacion en la atresia biliar.

From July 1976 to February 1988 52 cases of extrahepatic biliary atresia were treated at our institution and 16 patients underwent reoperation. The original procedure were portojejunostomy in 11 cases (68 for 100), portocholecystostomy in four (25 for 100) and omento-duodenopexy in one (6 for 100). Age average at operation was 61 days; twelve had bile excretion. The reoperation was performed due to absence of bile drainage in three cases, cholangitis in 9 and bile peritonitis in four. Surgical procedures used at reoperation were: excision of scar tissue at the porta hepatis (12 patients) and portojejunostomy (five patients). Age average at reoperation was 105 days. Seven cases excreted bile. Liver pathology studies showed fibrosis in 12 cases and precirrhosis in four. The porta hepatis showed biliary ducts less than 100 mu in 10 cases, between 100mu-200mu in two, and absence of bile ducts in four. Currently four children are doing well with a mean long-term follow-up of 48 months, five are awaiting liver transplantation and one patient is doing well sixteen months post-transplant. Six patients (38 for 100) died. The best results were observed in those cases with early bile flow excretion after the first operation.