[Multicystic Kidney: is there any new scientific evidence to recommend nephrectomy?]. / Riñón multiquístico: existe alguna nueva evidencia científica que recomienda la nefrectomía?

With the aim to create a scientific evidence of the convenience or not of removing the Multicystic Kidney (MK), a systematic review has been done over the last 20 years, selecting those articles with determinant criterions. Our experience has been also evaluated. We have obtained an evidence table of 1082 MK, with a follow-up from 2 to 7 years. No case degenerated. The complications were: urinary tract infection (UTI) in 5% and hipertensión (HTA) in 0.7%. In our serie (68 cases): nephrectomy was done in 10 cases. 82% completely involved (66.6% before 5 years and 15.6% from 5 to 15 years of follow-up). 18% involved partially. No case degenerated. The complications were UTI (6 cases) and HTA in one. Periodical ultrasound follow-up is our recommendation for MK due to the results of our serie and from the systematic review of the literature.

Exercise-induced cerebral deoxygenation among untrained trekkers at moderate altitudes.

The pathophysiology of altitude-related disorders in untrained trekkers has not been clarified. In the present study, the effects of workload on cardiovascular parameters and regional cerebral oxygenation were studied in untrained trekkers at altitudes of 2700 m and 3700 m above sea level. We studied 6 males and 4 females at each altitude, and their average ages were 31.3+/-7.1 y at 2700 m and 31.2+/-6.8 y at 3700 m, respectively. The resting values of heart rate and mean blood pressure were not significantly different at 2700 m and 3700 m than at sea level. However, increases in these values after exercise were more prominent at high altitudes (heart rate increase = 51.6% at 2700 m and 70.4% at 3700 m; mean blood pressure increase: 19.0% at 2700 m and 17.2% at 3700 m). In addition, post-exercise blood lactate concentration was significantly higher at 3700 m than at sea level or at 2700 m (i.e., 7.6 mM at 3700 m, 3.8 mM at 2700 m, and 4.17 mM at 0 m, respectively). Exercise induced an acute reduction in the arterial oxygen saturation value (SpO2) at 2700 m and 3700 m (i.e., 11.2% reduction at 2700 m and 9.4% at 3700 m), whereas no changes were observed at sea level. The resting values of regional oxygen saturation (rSO2)--measured by a near infra-red spectrophotometer at sea level, 2700 m, and 3700 m-were nearly identical. Exercise at sea level did not reduce this value. In contrast, we observed a decrease in rSO2 after subjects exercised at 2700 m and 3700 m (i.e., 26.9% at 2700 m and 48.1% at 3700 m, respectively). The rSO2 measured 2 min and 3 min after exercise at 3700 m was significantly higher than the preexercise value. From these observations, we concluded that alterations in cardiovascular parameters were apparent only after an exercise load occurred at approximately 3000 m altitude. Acute reduction in cerebral regional oxygen saturation might be a primary cause of headache and acute mountain sickness among unacclimatized trekkers.

[Primary bladder diverticula. Study of 47 cases]. / Divertículos vesicales primarios. Estudio de 47 casos.

We report on 47 patients, surveyed and treated by us, diagnosed of primary vesical diverticula, having thus excluded all those secondary to lower obstructive anomalies, such as urethral valves and neurogenic bladder. Only seven out of the 47 patients were females: two of them had a iatrogenic cause and the remainder were of small size and associated with vesicoureteral reflux. All the cases have been documented by means of an intravenous pyelography (IVP), an excretory cystogram and a voiding cystourethrogram (VCUG). Many diverticula may go unnoticed when screened by IVP, whereas the cystogram and preferentially the VCUG are a 100 for 100 diagnostic. A 45 for 100 of these children (22 cases) had an attendant reflux and 23 for 100 (11 cases) had some other concomitant renal disease. Three further cases were iatrogenic, as a result of the methods employed for antireflux ureteral reimplantation. A 77 for 100 of the patients had urinary tract infection demonstrated by a urinary sediment and a positive culture. Surgery was performed on 34 patients, the indication being made on the basis of the big size of the diverticulum, its clinical repercussion, or because of its association with vesicoureteral reflux or any other kidney malformation. We employ an intravesical approach for the small diverticula with attendant reflux, but for resection of the sizeable ones, irrespective of the existence of reflux, we prefer the combined extra and intravesical approach, which allows a most accurate extravesical dissection, as well as the recognition and control of the ureter and the deferes duct, structures both that are usually anatomically distorted.

[Is it necessary to remove polycystic kidneys?]. / Es necesario extirpar los riñones multiquísticos?

The Multicystic Dysplastic Kidney is the most frequent renal congenital anomaly and the second most common cause of an abdominal mass in the newborn. Traditionally, since this pathological entity was described as such by Spene in 1955, early resection has been deemed its best treatment. In the last decade, a conservative approach has been advocated by some authors, except for the patients presenting with concomitant abdominal pain or infection. In our hospital, relying on the support afforded by the echographic assessment of these patients, we have proposed an expectant behaviour in the management of this entity. So far, we have had the opportunity to follow the course of the disease in 15 patients with the diagnosis of Multicystic Dysplastic Kidney, with the result that in no one of them the size of the cystic mass increased, but instead the mass disappeared completely in one case, diminished greatly in three cases, had a moderate decrease in size in eight cases and in just three patients it has not varied in size. No patient has complained of abdominal pain or has become infected. In the face of such findings, we believe that early resection of the multicystic kidney is not warranted if no complications develop.

Choanal atresia. Report of seventeen cases.

Seventeen cases of choanal atresia are presented, of which 13 were female and 4 male. In 11 patients the malformation was bilateral, being unilateral in the remaining 6; 8 patients also presented other malformations amongst which esophageal atresia and congenital heart disease were the most common. Treatment is surgical, and the prognosis depends largely on the presence or absence of associated malformations.

Mastocytosis with skeletal and gastrointestinal involvement in infancy. Two case reports and a review of the literature.

Two cases of mastocytosis with skeletal involvement in children three and six months old are reported. Bone lesions, either sclerotic or lytic, were encountered in their skeletal surveys. Gastrointestinal lesions in children with mastocytosis are exceedingly rare; in addition to skeletal lesions, one of our patients had a large duodenal ulcer. The diagnosis of mastocytosis was established by skin biopsy in both patients. A review of the literature is also presented.

Sonographic diagnosis of adrenal hemorrhage in patients with fulminant meningococcal septicemia.

We report two patients with fulminant meningococcal septicemia, in whom massive bilateral adrenal hemorrhages were diagnosed by ultrasound. Low plasma cortisol levels were found in one patient who eventually died. The other patient survived and has remained asymptomatic for the last three years. His adrenal function is normal. We suggest that routine ultrasound examination should be performed in patients with meningococcal sepsis and shock in order to clarify the prevalence of a renal hemorrhage. Determination of plasma cortisol levels in patients with adrenal hemorrhage, would allow identification of those with adrenal insufficiency who may benefit from steroid replacement.

Experimental use of a transportable hyperbaric chamber durable for 15 psi at 3700 meters above sea level.

A transportable hyperbaric chamber durable for 15 psi of pressure was used to treat a patient suffering from moderate acute mountain sickness at 3700 m above sea level. The symptoms were ameliorated a few minutes after pressurization in the chamber. After a 20-minute stay in the chamber, the patient was completely free of symptoms. Since the chamber can be inflated by using compressed air from a cylinder, no strenuous work was required of the operators. This transportable chamber seems to be useful for the treatment of high-altitude disorders at around 3000 m above sea level.

US, CT, and MR imaging of neck lesions in children.

Neck lesions are common findings in pediatric patients and can be classified as congenital, vascular, inflammatory, or tumoral. They can be evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging, either alone or in combination. US should be considered first for studying suspected congenital, vascular, and inflammatory lesions, although CT and MR imaging are best for demonstrating the extent of benign and malignant tumors and the presence or absence of bone erosion, vascular encasement, and airway compromise. MR imaging is also preferred for ruling out intracranial and intraspinal extension (eg, as occurs in rhabdomyosarcoma and neuroblastoma, respectively). In the authors' experience, thyroglossal duct cysts and lymphangioma are the most common congenital anomalies; jugular vein aneurysms are the most common vascular lesion; lymphadenitis is the most common inflammatory lesion; fibromatosis colli is the most common benign tumor or tumorlike condition; and lymphoma is the most common malignant neoplasm.

Pediatric pancreas: an overview.

Pancreatic disorders are not rare in children. Modern imaging equipment allows recognition of many pancreatic diseases that were difficult to identify in the past and therefore were considered to be unusual. Within the scope of this article we include information on imaging modalities for studying the pancreas and a description of the radiologic manifestations of the most common congenital, inflammatory, tumoral, traumatic and systemic disorders.

Idiopathic infantile arterial calcification: unusual features.

Idiopathic infantile arterial calcification (IIAC) is a rare disease of unknown etiology, which causes widespread arterial calcification and usually leads to early death from coronary arterial occlusion. Periarticular calcification has been reported in some cases. Two new cases are reported. In addition to the usual features of the disease, one was found to have ear-lobe calcification and the other an aortic aneurysm and coarctation of the aorta. Therapy with diphosphonate was apparently successful in one patient.