Immunological studies in the postsplenectomy syndrome.

Variations in the serial immunoglobulins of 52 children splenectomized for a variety of indications were studied and compared with two groups of children, one postoperative and one without operation. The most significant finding was the constant decrease in Ig M in every instance. Our series of splenectomized children seems to confirm the facts noted by other authors. The incidence of serious infections has been clearly significant and is clearly postsplenectomy sepsis. The age of the patients has a great influence on the seriousness of the septic process, these being more severe on younger children. The influence has also been revealed of the cause which motivated the operation, this corresponding in the first place to thalassemia and in the second place through spherocytosis and pseudohormones. It is evident that the immunologic role of the spleen during early childhood, especially under the age of 5 yr is important. The greatest risk or postsplenectomy sepsis is in the first 2 yr of life. Splenectomy should be delayed until after the age of 5 if clinical circumstances permit. If not, prophylactic chemotherapy should be carried out during the first 18 mo after splenectomy.

Segmental dilatation of the duodenum.

In this article two cases of idiopathic duodenal dilation are described. These cases meet the present criteria for segmental dilations of the intestine. The onset of the clinical features was acute in one case and chronic in the other. However, the radiological images were similar in both cases and provided the diagnosis. Surgical treatment consisted of duodenal resection and tapering and was curative in one case. The other patient died shortly after surgery. The duodenal specimens showed normal three-layer duodenal architecture in the pathology study. The intramural nervous plexi were unimpaired. Angiodysplasia was found in one case. Vascular abnormalities were also found in 10 other segmentary intestinal dilatations reported in the literature. The surgical implications of this new localization of segmentary intestinal dilatation are analyzed.

[Thymus in posterior mediastinum]. / Timo en mediastino posterior.

It is presented the clinical case of a mass of posterior mediastinum with diagnostic by C.T.Scan, and ratified by Pathologic Anatomy, as posterior prolongation of thymus. Comments of the importance of the diagnostic by image and the rarity of this entity are made.

[Esophagocoloplasty in the treatment of total caustic stenosis of the esophagus]. / La esofagocoloplastia en el tratamiento de la estenosis cáustica total del esófago.

Since October 1986 until January 1988 we have treated 3 patients with corrosive strictures of the esophagus, by substitution of esophagus with vascularized colon. Two females (4 and 8 years) and one male (5 years) had been treated on others hospitals by means of gastrostomy and periodically retrogradual dilatations; in two of them for more than 24 months. The surgical treatment was indicated upon the evolution time, the degree of dysphagia and the size of the affected segment. The coloesophagoplasty by retrosternal approach with proximal anastomosis in the neck, has been the operative technique performed in the male case. On the others two cases, colon interposition by extrapleural thoracic approach, combined with laparotomy was carried out. We think that the coloesophagoplasty by retroesternal way should only be advised in cases were superior anastomosis in the neck is indicated, conditioned by the height of the stricture. On the other hand, colon interposition by extrapleural approach, is the elective way for the others cases.

[Role of somatostatin in the treatment of intestinal fistulas]. / Papel de la somatostatina en el tratamiento de las fistulas digestivas.

Somatostatin is a peptide hormone which inhibits the secretion of the growth hormone, and has proved to be a powerful inhibitor of exocrine pancreatic, gastric and intestinal secretion. It was therefore used as an adjuvant therapy in the conservative treatment of two children of eight and nine years old with fistulas of the small intestine. The first case was a colonic fistula for cecal defect, surgical intervention was carried out because treatment during 14 days with hormonal treatment after the third consecutive day of somatostatin application. In this study the authors present their experience with somatostatin, with particular emphasis on the indications contraindications, doses and lines for administration.

[Rib actynomycosis]. / Actinomicosis costal.

A unusual case of rib actynomycosis, observed several months after surgery for acute appendicitis in a 11 year boy is reported. Surgical excision of the affected segment of rib had to be implemented with lyncomycin in order to obtain the cure. Laboratory data are consistent with the above mentioned diagnosis.

[Neonatal functional intestinal obstruction of unknown etiology (author's transl)]. / Ileo funcional del recién nacido de etiología desconocida.

Three cases of newborn intestinal obstruction without obvious organic cause are reported. Narrow left colon (Davis's syndrome), small colon, megacystis and intestinal hypoperistaltism (Berdon's syndrome) and segmental bowel dilatation (Swenson's syndrome) were the diagnoses. Through a review of the literature a possible interrelationship among these three clinical entities at the level of an abnormal myenteric plexus neuronal function is discussed.

[Pediatric cystoscopy. Prospective study]. / Cistoscopia pediátrica. Estudio prospectivo.

Like other European departments, we have been using since 1982 report form on cystoscopic studies, containing a total of 56 data. In this paper we present a model of our cystoscopic report and the results obtained from 185 cystoscopic explorations performed on 153 patients, of both sexes, between the ages of 4 days and 15 years. Cystoscopy which is not routinely performed in all patient suffering from uropathy or reflux, has facilitated the establishment or confirmation of diagnosis in 35% when combined with radiology. It has been useful in postoperative control as well (23%), it has to decide therapeutic policies (15%) and has resolved all ureteral valve cases as well as some ureteral stenosis cases. We explain the technic used in our department for the transfixation and tearing of the valves by electrocoagulation and the absence of any complications using this method. The actual nomenclature of ureteral meatus, based on their location, grade of opening and the frequently associated grade of renal dysplasia, as well as the criteria followed in the endoscopic control of previous ureteral reimplants and the rising pyelography indications, are also explained.

[Rhabdomyosarcoma of the bile ducts]. / Rabdomiosarcoma de vías biliares.

Two children of two and three years old affected with biliary tract rhabdomyosarcoma are presented. In both cases the diagnostic was confirmed by anatomopathologic studies of the tumoural piece obtained by surgical extraction. Clinic evolution, surgical technic and cytostatic treatment are described been noticeable a favourable clinic development in both cases. Authors had made a bibliographic revision on the subject, pointing a minor incidence of the biliary tract in comparison with other tumour locations.