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.

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.

[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.

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.

[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.

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.