[Crossed testicular ectopia. Report of a case]. / Ectopia testicular cruzada. Presentación de un caso.

Crossed testicular ectopia is a rare congenital malformation in which both testis are located in the same hemiscrotum, and is related to an anomaly in normal testicular descent. This entity was first described by Lenhossek in 1886 and posteriorly by Halstead in 1907. Since then, there have been described less than a hundred of cases of this rare congenital malformation. Several ethiopathogenic theories have been proposed, including testicular adherence to mullerian structures, fusion of the wolffian ducts or defective gubemacular development, although none of them has been widely accepted. Usually, clinical sign is an inguinal hernia with empty contralateral hemiscrotum, and sometimes both testis in ipsilateral hemiscrotum. A new case of this pathology is presented.

[Congenital lumbar hernia]. / Hernia lumbar congénita.

Hernias in the lumbar region are abdominal wall defects that appear in two possible locations: the superior lumbar triangle of Grynfelt-Lesshaft and the inferior lumbar triangle of Petit. There are 40 cases reported in the pediatric literature, and only 16 are considered congenital, associated with the lumbocostovertebral syndrome and/or meningomyelocele. A new case is presented. A premature newborn with a mass in the left flank that increases when the patient cries and reduces easily. The complementary studies confirm the diagnosis of lumbar hernia and reveal the presence of lumbocostovertebral syndrome associated. At the time of operation a well defined fascial defect at the superior lumbar triangle of Grynfelt-Lesshaft is primarily closed. The diagnosis of lumbar hernia is not difficult to establish but it is necessary the screening of the lumbocostovertebral syndrome. We recommend the surgical treatment before 12 months of age; the objective is to close the defect primarily or to use prosthetic material if necessary.

Neurogenic bladder in children: urodynamic studies and results with medical conservative treatment.

We present the urodynamic findings and therapeutic results in 25 children with neurogenic bladder, ranging in age from 2 months to 14 years. We observed a significant reduction of urinary infections and vesicoureteral refluxes following medical treatment based on the urodynamic findings. Furthermore, we observed a worse evolution in patients with pre-voiding bladder pressure in excess of 50 cm H2O, incontinence being more difficult to treat in children with urethral closure pressure profile below 47 cm H2O. In our series, anticholinergic treatment improved hypertonia and hyperreflexia which disappeared in 66.6% of cases. Total continence was achieved in 37.5% and improved in 29.1% of children.

[Primary varicocele in children. The surgical indications]. / Varicocele primario en el niño. Indicaciones quirurgicas.

Varicocele is an abnormal dilatation of the veins of the pampiniform plexus. It is a commonly diagnosed finding due to the augmentation of pediatric age in our institutions and to the better routine physical examinations. The influence of varicocele on infertility is very well known, because of oligospermia and low motility of the sperm. There are controversy on surgical indications in children, because the absence of semen analysis. Do we have to operate all patients with varicocele or only those with symptoms? We review 16 cases with varicocele, 9 of those underwent surgery. The surgical indications were those patients with scrotal pain, stage II and III of varicocele classification and patients with lesser size of ipsilateral testis. Surgical procedures were high ligation of spermatic veins in all cases. Clinical evolution hsa been excellent, up to date.

[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%.

[Cheilo-maxillo-palatine clefts and associated malformations]. / Fisuras queilo-maxilo-palatinas y malformaciones asociadas.

Based on the experience in this service during the preceding 6 years, authors have carried out an statistical study of cleft lip palates, and at the same time, given the high frequency that these are seen to be associated with congenital malformation, classify them within a syndromic group or family.

[Removal of foreign bodies from the upper airways and the bronchial tree of small children]. / Entfernung von Fremdkörpern aus den oberen Luftwegen und dem Bronchialbaum bei Kleinkindern.

Food remnants are the foreign bodies most frequently aspirated by young children. Larger foreign objects are nearly always rejected spontaneously. In many cases, however, aspiration of foreign bodies lead to death by suffocation. From March 1975 to August 1979, 27 endoscopies removing 22 foreign bodies have been carried out by us. All children were less than 7 years old. The foreign bodies most commonly found were peanuts. Endoscopy was not only carried out when diagnosis was clear, but also if there was suspicion of foreign body aspiration. It is nowadays a treatment without risk when the following conditions are met: 1. Careful medical preparation leading to bronchial dilatation. 2. Effective collaboration with a paediatric anaesthetist. 3. Exact knowledge of the bronchial tree of children.

[Gastroesophageal reflux in infancy. The physiological basis of management (author's transl)]. / Reflujo gastroesofágico en la primera infancia. Bases fisiológicas de su tratamiento.

Gastrin has a regulating effect on the complicated closing mechanism of the lower oesophageal sphincter. This hormone produced in G-cells of the pyloric antrum and carried by the blood stream has its greatest effect on the anterior fundus wall, cardias and the lower oesophageal sphincter. Thus, when there is a failure in the closing mechanism of the lower oesophageal sphincter produced by lacking maturity of the oesophageal fibers and the cardias zone, only those surgical procedures using the gastric fundus in order to correct the failure can guarantee a good result, if medical treatment has not been successful. The authors comment on the physiological basis of the treatment, the medical as well as the surgical one, of the gastro-oesophageal reflux.

[Burns in children. Experience of 53 cases (author's transl)]. / Quemaduras cutáneas infantiles. A propósito de 53 casos.

A series of 53 children admitted during a 20-month period to the Hospital for burns due to hot liquids is reported 88.6% were under three. 34 children were seen during spring and fall months. Most patients were recently burnt and in the majority of cases (27) burned surface was under 20%. l.v. fluids were used in 17 cases and management protocol included: Closed local care after the 3rd or 4th day with nitrofurazone cream and antibiotics only in selected cases. Mortality was 5.5% (three cases) due to acute renal failure at the 3rd, 5th and 10th days. 24.5% had a local infection in the first two weeks, gram negative bacteria being present in 75% of these cases. 33.2% (18 cases) required grafting. This was more frequently needed in boiling oil burns. In seven cases, grafting was necessary before the 30th day (average 23.2 days), and in the remaining patients after this time (average 42.1 days). Authors advise a strict prevention of acute rend failure and early grafting.