[Must we change the surgical treatment of gallstones?]. / Hay que cambiar el planteamiento quirúrgico en las litiasis biliares?

UNLABELLED: The incidence of gallstones in childhood is 0.15%-0.22%. Frequency has increased in recent years due to a real increase or to a better diagnosis by ultrasound. The aim of our study is determinate the best treatment for every patient. MATERIALS AND METHODS: A retrospective study of 71 children with cholelithiasis admitted to our hospital in the last 20 years. RESULTS: The male to female ratio was 43:28. Seventeen patients present predisposing factors that might be related to the formation of gallstones. This disease was a casual event in half the cases. In 24 patients the diagnosis was made during a study for inspecific abdominal pain and 14 children showed typical symptoms. Only one patient suffer from acute cholecystitis. In 21 cases we find a single stone and in the other cases there were a lot of stones. The gallstones disappeared spontaneously in two patients. Nine children received treatment with ursodeoxycholic acid, but this treatment was ineffective in 8 of them. 27 patients were operated: Six laparoscopic cholecystectomy, 9 open cholecystectomy, 9 cholecystolithotomy and 3 cholecystectomy with splenectomy. CONCLUSIONS: We recommend periodic checks with ultrasound and conservative management is suggested in asymptomatic children. Operative intervention is recommended for symptomatic patients. The surgical treatment of choice in our centre for patients with solitary gallstones and without inflammatory changes in the gallbladder is cholecystolithotomy. We didn't find reappearence of gallbladder after cholecystolithotomy. Laparoscopic cholecystectomy is the best treatment for children with non working gallbladder, "porcelain gallbladder" and in patients with haematologic disease and gallstones.

[Megacystis-microcolon-intestinal hypoperistalsis syndrome: a case of prolonged survival]. / Síndrome de megavejiga-microcolon-hipoperistaltismo intestinal. A propósito de un caso de supervivencia prolongada.

Megacystis-microcolon-intestinal hypoperistalsis syndrome is a multisystemic disorder in which impaired intestinal motor activity causes recurrent symptoms of intestinal obstruction in the absence of mechanical occlusion, associated with bladder distention without distal obstruction of the urinary tract. It is an uncommon disorder with high morbidity and mortality, and long-term total parenteral nutrition may be required. We describe an 18-year-old girl with long-term survival, followed-up by our service since birth. With medical, surgical and nutritional management she currently presents a good oral tolerance and good quality of life, only requiring parenteral nutrition during periods of decompensation.

[Comparison of the determination of azotorrhea and steatorrhea in cystic fibrosis of the pancreas]. / Comparación de las determinaciones de azotorrea y esteatorrea en la fibrosis quística de páncreas.

Steatorrhea and azotorrhea are evaluated, by Van de Kamer and Kjendalh methods, in 24 patients affected by cystic fibrosis in the diagnosis and in their evolution. High values were obtained for steatorrhea in 87.5% of the cases and for azotorrhea in the 79.1% at the moment of diagnosis. Steatorrhea and azotorrhea have been correlated obtaining a high statistic significant for p less than 0.01 in the diagnosis and in patients who followed treatment with the same medication, not being significative for all patients during their evolution. With results obtained, determination of fecal nitrogen, is positively evaluated not only in the diagnosis but also in the evolution of these patients to obtain an optimum nutritious condition.

[Height alterations and calcium metabolism after prolongated phenobarbital treatment (author's transl)]. / Valoración del metabolismo Ca/P y del crecimiento lineal, en niños sometidos al tratamiento prolongado con fenobarbital.

In order to know if small children subjected to a long-term treatment with phenobarbital can suffer some alterations in their lineal growth or in their osseous maturity in the same way as those showed by epileptical mother's sons, 85 patients between six months and three years old, who had suffered fit convulsions during a fever process, 20 of them subjected to antithermic treatment, and the 65 left who received a phenobarbital treatment in doses of 5 mg./kg./day have been controlled. In each child, at the beginning of the control and after 12 months, their height, diaphysial diameter and cortical thickness of the metacarpal bones, and bone age is valued. At the same time a calcium, phosphorous and phosphatase-alcaline control was done. The group who had received anti-convulsivants drugs, showed a significant decrease in their lineal growth and in calcium concentration in blood. The control group didn't present any significant variation in any of the controls performed.