Tumoración abdominal intermitente secundaria a ectopia renal cruzada sin fusión / Intermittent abdominal tumor secondary to crossed nonfused renal ectopia

La ectopia renal cruzada, sin fusión, es excepcional. Ensus diferentes formas clínicas de presentación, la aparición como una masa abdominal intermitente no la hemos observado en la revisión bibliográfica realizada. Presentamos a un varón con historia de dolor y tumoración intermitente de repetición, en hipogastrio, que en diferentes pruebas se observó que correspondía a una ectopia al derecha, cruzada, sin fusión, debida a una hidronefrosis secundaria, intermitente, por una posición anómala de la unión pieloureteral. Se practicó una plastia tipo Anderson-Hynes, no habiendo complicaciones en el postoperatorio. El estudio de la función renal fue normal. Debido a que se suele acompañar de múltiples anomalías, es preciso realizar un estudio exhaustivo. Como conclusión, consideramos que en el diagnóstico diferencial de las masas abdominales intermitentes se debe incluir la posibilidad de la hidronefrosis intermitente debida a ectopia renal con anomalía en la unión pieloureteral. Asimismo, existen complicaciones a largo plazo, por lo que estos pacientes se deben controlar de por vida (AU)

Crossed renal ectopia without fusion is a rare form. Among its different variations in clinical presentation, the appearance as an intermittent abdominal mass have not been ascertained reviewing literature. In this case, we present a male patient with a history of a hypogastric periodic repetitive pain and mass, which is later observed corresponding to a right crossed renal ectopia, without fusion, and due to secondary intermittent hydronephrosis by an abnormal ureteropelvic junctional position. A pyeloplasty of Anderson—Hynes type was performed without any postoperative complications. Renal functional study was normal. A thorough study is required due to it commonly being accompanied by multiple abnormalities. In conclusion, we believe that the differential diagnosis of intermittent abdominal masses should include the possibility of intermittent hydronephrosis due to renal ectopia with ureteropelvic junction abnormality. Furthermore, these patients should be monitored throughout their lives due to lifelong complications (AU)

Vejiga neurógena no neurogénica congénita (VNNN C): estudio evolutivo / Congenital non-neurogenic neurogenic bladder: evolutionary study

Introducción. Dentro de los trastornos funcionales vesicales de vaciado o disfunciones miccionales, uno de los más conocidos es el síndrome de Allen-Hinman, considerado como un proceso adquirido. Recientemente, se han descrito varios casos de aparición congénita, por lo que es una patología muy poco conocida, originando graves errores diagnósticos y terapéuticos. Caso clínico. Niña de 15 años de edad, controlada desde el nacimiento por presentar una gran distensión abdominal, evacuando 400 ml de orina; siendo los estudios realizados compatibles con vejiga neurógena no neurogénica congénita mediante el tratamiento médico y sondajes vesicales intermitentes, se ha conseguido que no exista afectación renal. Conclusiones. Consideramos que la VNNN congénita es excepcional. Gracias al tratamiento seguido, se ha logrado que no exista afectación renal, y ninguna complicación. Desde hace unos 5 años, a veces, presenta deseos de micción, que no se acompaña de la misma, por lo que debemos seguir realizando un control evolutivo preciso (AU)

Introduction. The Allen-Hinman syndrome, considered being a adquired process, is one of the best known within functional disorders of emptying, or voiding dysfunctions. Recently, several cases describing a congenital appearance has been seen. It is a very little-known pathology, resulting in serious diagnostical and therapeutical errors. Clinical case. A 15 year old girl, known since birth to present a great abdominal distension, removing 400 ml of urine; realizing through studies a compatibility with congenital non-neurogenic neurogenic bladder. Medical treatment and intermittent catheterization has come to show no renal involvement or any complications with the treatment. Conclusions. We consider that congenital VNNN is exceptional. Thanks to continued treatment, We have come to conclude there being no renal involvement as well as any complications with the treatment. During the last five years she has occasionally presented the desire to urinate, both by day time and night time, without urination following. Not knowing if it can be a future-related bladder, we have to secure a evolutionary control (AU)

[Ureteral triplication]. / Triplicidad ureteral.

INTRODUCTION: Ureteral triplication is considered a rare anomaly and its association with ectopic ureterocele, is unusual. CLINICAL CASE: We report a male with a history of recurrent urinary tract infections, who showed left vesicoureteral reflux associated with apparent ureteral duplication in multiple test performed, and only during the vesicostomy was discovered a third ureter ending in a ectopic ureterocele corresponding with the upper pole ectopic kidney. CONCLUSIONS: Being a very unusual and complex pathology, and despite all the tests made, it is very difficult to make an accurate presurgical diagnosis, therefore the diagnosis sometimes is only performed during the surgical treatment, which must be individualized according to fthe unctional stage of each renal portion and the termination of each ureter.

Triplicidad ureteral / Ureteral triplication

Introducción. La triplicidad ureteral se considera una anomalía muy poco frecuente y su asociación a ureterocele ectópico, no es habitual. Caso clínico. Presentamos a un varón con historia de infecciones urnarias de repetición, a quien en las múltiples pruebas realizas se observa un reflujo vesicoureteral izquierdo asociado a una aparente duplicidad ureteral, y sólo durante la vesicostomía se descubrió un tercer uréter que terminaba en un ureterocele ectópico correspondiente al riñón del pielon superior. Conclusiones. Al ser una patología tan poco frecuente y compleja y a pesar de todas las pruebas realizadas, es muy difícil efectuar un diagnóstico exacto previo a la intervención, por lo que el diagnóstico, a veces, sólo se realiza durante el tratamiento quirúrgico, el cual debe ser individualizado, según el grado de función de cada porción renal y la terminación de cada uréter

Introduction. Ureteral triplication is considered a rare anomaly and its association with ectopic ureterocele, is unusual. Clinical case. We report a male with a history of recurrent urinary tract infections, who showed left vesicoureteral reflux associated with apparent ureteral duplication in multiple test performed, and only during the vesicostomy was discovered a third ureter ending in a ectopic ureterocele corresponding with the upper pole ectopic kidney. Conclusions. Being a very unusual and complex pathology, and despite all the tests made, it is very difficult to make an accurate presurgical diagnosis, therefore the diagnosis sometimes is only performed during the surgical treatment, which must be individualized according to the unctional stage of each renal portion and the termination of each ureter

Acumulación de neonatos con malformación anorrectal en 2011. ¿Solo azar? / Increase of newborns with anorectal malformation in 2011. Is it just by chance?

Introducción. Durante 2011 hemos diagnosticado 9 pacientes con malformaciones anorrectales (MAR). Esto supone 13.3 casos/10.000 RN vivos, frente a la incidencia estimada de 2 casos/10.000 RN vivos. Esta acumulación de MAR puede no ser debida al azar, por lo que hemos decidido su investigación. Pacientes y Métodos. Incluimos en el estudio todos los pacientes con MAR nacidos en el 2011. En todos ellos analizamos: su área geográfica, edad y estado de salud de los padres, gestación, exposición ateratógenos (especialmente, ingesta de lorazepan), sexo, edad gestacional, peso al nacimiento, exploración abdominal y del periné, defectos congénitos asociados, estudios por imagen realizados, tratamiento y situación actual. Resultados. Todos los pacientes proceden de nuestra provincia, yla edad materna es menor de 20 años en 2, o mayor de 30 en 7; existe predominio de varones (8/1) y MAR de localización baja en 4 de los9 pacientes. El 100% de los RN presentan algún tipo de malformación asociada en los genitales, en el sistema urinario o costovertebrales. La valoración clínica y el estudio por imagen proporcionaron el diagnóstico correcto en todos los casos. Hay que destacar la ausencia de dificultades en el tratamiento quirúrgico y la evolución clínica satisfactoria en todos los niños. Conclusiones. A la acumulación de casos con MAR se suman el predominio en varones así como la alta incidencia de malformaciones asociadas y de MAR de localización alta. No hemos encontrado una explicación epidemiológica a esta concentración de pacientes con MAR. Esto nos obliga a continuar con nuestra investigación por si se detecta alguna causa, de momento no conocida (AU)

Objective. In 2011 we have diagnosed 9 anorectal malformations(MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not bedue to chance, so we have decided to focus on its research. Material and Methods. The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposureto teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. Results. All patients came from our province, and maternal age is under 20 years in (..) (AU)

Parénquima testicular ectópico en la túnica albugínea / Ectopic testicular parenchyma in albugineal tunic

Presentamos un varón, operado de criptorquidia bilateral, en el que macroscópicamente ambos testículos presentaban máculas y que en el estudio histológico se observaron grupos de túbulos seminíferos, con estroma y células de Leydig, rodeados por la albugínea, aislados del resto del parénquima testicular, siendo el diagnóstico histopatológico de "ectopia del parénquima testicular". Esta anomalía puede inducir a error y realizar laparotomías innecesarias, debido a que los túbulos seminíferos están rodeados por la albugínea, sin conexión aparente con el resto del parénquima testicular, siendo necesaria su valoración a largo plazo tanto durante la pubertad como en la edad adulta (AU)

We introduce a male patient with bilateral chryptorchidism submitted to surgery; during the intervention, macroscopically round macules were seen in the outer surface of both testes. In the round macules histological study, groups of seminiferous tubules were observed, including stroma and Leydig’s intestitial cells surrounded of tunica albuginea, isolated from the rest of testicular parenchymal tissue; the diagnosis "Ectopic testicular parenchyma tissue" was confirmed by histopathological study. Due to the seminiferous tubules are surrounded by the tunica albuginea, with no apparent connection to the rest of the testicular parenchyma, a long-term assessment is required, both during puberty aswell as in adulthood; owing to that can mislead and make unnecessary laparotomies and orchiectomies in the future (AU)

[Increase of newborns with anorectal malformation in 2011. Is it just by chance?]. / Acumulación de neonatos con malformación anorrectal en 2011. Solo azar?

OBJECTIVE: In 2011 we have diagnosed 9 anorectal malformations (MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not be due to chance, so we have decided to focus on its research. MATERIAL AND METHODS: The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposure to teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. RESULTS: All patients came from our province, and maternal age is under 20 years in 2 patientes and older than 30 in 7; male-dominated (8/1); low forms in 4 of 9 patients. 100% of newborns have some type of associated malformation, in genitals, urinary system or costovertebral. Clinical assessment and imaging study provided the right diagnosis in all the cases. It must be noted the absence of difficulties in the surgery treatment and a favorable outcome in all children. CONCLUSIONS: To this accumulation of cases with anorrectal malformation cases it is added a male predominanced, and a high incidence of associatedmalformations and high defects. We have not found an epidemiological explanation for this concentration of patients with anorrectal malformations. This forces us to continue our investigation if detected for some reason, currently not known.

[Ectopic testicular parenchyma in albugineal tunic]. / Parénquima testicular ectópico en la túnica albugínea.

We introduce a male patient with bilateral chryptorchidism submitted to surgery; during the intervention, macroscopically round macules were seen in the outer surface of both testes. In the round macules histological study, groups of seminiferous tubules were observed, including stroma and Leydig's intestitial cells surrounded of tunica albuginea, isolated from the rest of testicular parenchymal tissue; the diagnosis "Ectopic testicular parenchyma tissue" was confirmed by histopathological study. Due to the seminiferous tubules are surrounded by the tunica albuginea, with no apparent connection to the rest of the testicular parenchyma, a long-term assessment is required, both during puberty as well as in adulthood; owing to that can mislead and make unnecessary laparotomies and orchiectomies in the future.

[Gastroesophageal reflux disease. Evaluation and indication for surgical treatment by esophageal phmetry]. / Enfermedad por reflujo gastroesofágico, Valoración e indicación de tratamiento quirúrgico mediante pHmetría esofágica.

INTRODUCTION: Oesophageal pH monitoring is considered the best procedure to assess the severity of gastroesophageal reflux disease (GERD), conditioning its treatment. The indication for surgery is becoming less common. We intend to meet this test to what extent it has influenced. MATERIAL AND METHODS: We recruit patients treated in our Centre since the introduction of pH monitoring. We compare the number of times before and after its use. We value clinical manifestations, usual pH metric values versus non-operated patients with pathological test, associated pathology. SAMPLE: 91 patients, 151 pH metric studies (98 preoperative). Number of interventions prior to introduction of pH monitoring: 20/year, post: 3.79/year. SYMPTOMS: gastrointestinal 60.2%, respiratory 10.2%, mixed 24.5%. 495 non-operated patients, 692 pathological studies. PH metric values operated/not operated: No. reflux 116.91 +/- 125.46/101.69 +/- 83.39 (p < 0.001), No. reflux >5 minutes 8.49 +/- 8.28/4.43 +/- 4.85 (p = 0.001), longest reflux 60.21 +/- 95.93/31.16 +/- 80.09 (p < 0.001), clearance 1.27 +/- 1.44/0.86 +/- 1.05 (p = 0.04), DeMeester 52.74 +/- 56.21/29.49 +/- 23.57 (p < 0.001). 14 of 98 preoperative pH monitoring were normal. Associated pathology operated/not operated: 13.26%/ 7.47%. CONCLUSIONS: The pH metric control of patients with GERD and the progress of medical treatment have led to a decrease in surgical procedures. In our experience, the intensity of GERD is a valuable parameter in deciding on the surgery. We attach particular value parameters measuring oesophageal clearance and indices that integrate several of them. However, in some patients without pathological pH monitoring, we have indicated the operation. The prevalence of associated pathology in the operated makes us value them more demanding.

Síndrome del colon izquierdo pequeño: Revisión de nuestra experiencia / No disponible

Objetivo. El objeto es presentar nuestra experiencia con el síndrome de colon izquierdo pequeño (SCIP) e investigar la utilidad de lamanometría anorrectal en el estudio de estos pacientes. Material y métodos. Se realiza una revisión de las historias clínicas de 10 pacientes tratados en nuestro Hospital por SCIP. Se valoran: sexo, antecedentes maternos, tipo de parto, edad gestacional, peso al nacimiento, manifestaciones clínicas, expulsión de meconio, enema con gastrografín, manometría anorrectal y tipo de tratamiento (Nursing, días de reposo digestivo, duración nutrición parenteral) y tiempo de hospitalización. Resultados. De los 10 pacientes, 5 son hombres; 2 son gemelos afectos y otro gemelo afecto presenta un hermano gemelo sano; 6 son hijos de madre diabética. Edad gestacional: 36,6 ± 2,11 semanas. Peso:3.001 ± 689,72 g. Anomalías asociadas en 2: fetopatía diabética, hemivértebrasD11-L2. Todos presentan distensión abdominal y vómitos a las48,73 ± 45,39 horas de vida. Sólo 2 expulsan meconio en las primeras 24horas. Los enemas con gastrografín muestran hallazgos típicos de este síndrome en todos los casos. La manometría anorrectal se realiza en 8 (..) (AU)

Objective. The object is to present our experience with the small lleft colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. Material and methods. This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografín, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition).Results. During the study period, 10 patient were identifi ed (5are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes (..) (AU)

Enfermedad por reflujo gastroesofágico. Valoración e indicación de tratamiento quirúrgicomediante pHmetría esofágica / Gastroesophageal reflux disease. Evaluation and indication for surgical treatment by esophageal phmetry

Introducción. La pHmetría esofágica es considerada el mejor procedimiento para valorar la intensidad del reflujo gastroesofágico (RGE),condicionando su tratamiento. La indicación quirúrgica es cada vez menos frecuente. Nos proponemos conocer en qué medida esta prueba ha influido en ello. Material y métodos. Reclutamos los pacientes intervenidos en nuestro Centro desde la introducción de la pHmetría. Comparamos número de intervenciones antes y después de su utilización. Valoramos manifestaciones clínicas, valores pHmétricos habituales frente a no intervenidos patológicos, patología asociada. Resultados. Muestra: 91 pacientes, 151 estudios pHmétricos (98prequirúrgicos). Número de intervenciones previas a introducción de pHmetría: 20/año, posteriores: 3,79/año. Sintomatología: digestiva (..) (AU)

Introduction. Oesophageal pH monitoring is considered the best procedure to assess the severity of gastroesophageal reflux disease(GERD), conditioning its treatment. The indication for surgery is be comingless common. We intend to meet this test to what extent it has influenced. Material and methods. We recruit patients treated in our Centre since the introduction of pH monitoring. We compare the number oftimes before and after its use. We value clinical manifestations, usual (..) (AU)

[Small left colon syndrome: a review of our experience]. / Síndrome del colon izquierdo pequeño: revisión de nuestra experiencia.

OBJECTIVE: The object is to present our experience with the small left colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. MATERIAL AND METHODS: This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografin, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition). RESULTS: During the study period, 10 patient were identified (5 are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes was identified in 6 patients. The mean gestational age was 36.6 + 2.11 weeks, and the weight 3001 +/- 689.72 g. 2 patient presented anomalies associated: fetopatía diabetic, hemivértebras D11-L2. All 10 infants presented abdominal distention and vomiting at 48.73 +/- 45.39 hours of life. Only 2 presented meconium passage in the first 24 hours. The contrast enema with gastrografin performed show typical findings of this syndrome in all cases. The anorrectal manometry carries out in 8 patients and demonstrates presence of the recto-anal inhibitory reflex (RAIR) in 5 and absence in 3. In these 3 patients with no RAIR, the study was repeated weekly until the presence being observed (normally between 2a and 3a week of life). In 1 newborn was necessary colostomy; the suction rectal biopsy showed immaturity of ganglionars cells and the manometric control previously at the close of the colostomy (9 months) showed presence of the RAIR. Conservative treatment (nursing and digestive rest) was successful in all cases with a mean of duration the 6.40 +/- 5.10 days. 6 patient needed parenteral nutrition during 7.30 +/- 8.49 days. The mean of discharge was 17.78 +/- 13.28 days. The clinical development was favourable in all the cases. CONCLUSIONS: The contrast enema with gastrografin is diagnostic and therapeutic and together with the nursing, has allowed solve the distal intestinal obstruction in 9 cases (90%). In the newborns with absence of RIAR, the anomanometric controls have allowed to know the moment of the maturation of the anorectal function.

Cierre quirúrgico del conducto arterioso en el pretérmino extremo o muy extremo / Surgical closure of ductus arteriosus in the extreme or very extreme preterm infant

Objetivos. El cierre quirúrgico del conducto arterioso en pretérminos extremos o muy extremos presenta dificultades, tanto por su anestesia e intervención como por las circunstancias clínicas que suelen acompañarle. Revisamos nuestra experiencia con el objeto de conocerlos factores que más han contribuido a los resultados obtenidos. Métodos. En todos los pacientes revisados, valoramos: edad gestacional; peso al nacimiento; tratamiento farmacológico; cierre quirúrgico; incidencia de displasia broncopulmonar, insuficiencia renal y enterocolitis necrosante; tiempo de ingreso; mortalidad y sus causas. Resultados. Constituyen la muestra 26 prematuros de edad gestacional media de 26,24 semanas y peso medio de 885 g. Se trataron con Indometacina 22, a una edad media de 7 días y mediante ligadura (..) (AU)

Objectives. The surgical close of patent ductus arteriosus in the extreme or very extreme premature presents difficulties, because of its anaesthesia, surgical intervention and the clinical circumstances that usually accompany this pathology. We reviewed our experience in order to understand the factors that have contributed to the obtained results. Methods. In all the reviewed patients we evalue: gestational age, birth weight, drug treatment, surgical close, incidence of broncho pulmonary dysplasia, necrotizing enterocolitis and renal failure, time of (..) (AU)

[Familial adenomatous polyposis: a follow-up of the extracolonic manifestations]. / Poliposis adenomatosa familiar: seguimiento de las manifestaciones extracolónicas.

INTRODUCTION: Total colectomy is the only effective treatment for prophylaxis against colon cancer in patients with familial adenomatous polyposis (FAP). We present our experience with 4 children colectomized for FAP, with a particular focus on the long-term surveillance to detect extracolonic manifestations. PATIENTS AND METHODS: We review the clinical histories of 4 patients from 10 to 16-years-old, with family histories of FAP. Performed for each patient were: genetic testing, colonoscopy, double contrast enema, gastro-oesophageal duodenoscopy, thyroid and abdominal ultrasound, fundus oculi, and tumour markers (CEA, CA 19.9). They underwent total colectomy with ileoanal anastomosis and anorectal mucosectomy with an ileal J-pouch. During follow-up, they were monitored regularly with imaging techniques (including a video capsule in one patient) and endoscopy. Also evaluated were faecal continence, food intake, and height-weight development. RESULTS: All had multiple polyps in the colon, and mutation of the APC gene. Hypertrophy of the retinal pigment epithelium was observed in three. Immediately postoperative, there were abundant diarrhoeic stools, two presented an episode of "pouchitis", and one moderate undernourishment. One patient had an intraperitoneal haemorrhage that was resolved by blood transfusion. All 4 have normal faecal continence. During the first months postoperative, two patients showed considerable weight loss. In the follow-up (> 3 years), moderate undernourishment was observed in one patient. Duodenal polyps were found in two patients--in one by duodenoscopy, and in the other with the video capsule. CONCLUSIONS: After colectomy, FAP patients may develop extracolonic clinical manifestations, some of which may be malignant such as thyroid and periampullary cancer. Careful surveillance of these patients is therefore very important, with annual checks using gastroduodenoscopy and thyroid and abdominal ultrasound.

Poliposis adenomatosa familiar: seguimiento de las manifestaciones extracolónicas / Familial adenomatous polyposis: a follow-up of the extracolonic manifestations

Introducción. La colectomía total es el único tratamiento eficaz para prevenir el cáncer de colon en pacientes con Poliposis Adenomatosa Familiar (PAF). El objetivo es exponer nuestra experiencia con 4niños colectomizados por PAF con especial atención al seguimiento a largo plazo para la detección de manifestaciones extracolónicas. Pacientes y métodos. Revisamos las historias clínicas de 4 pacientes de entre 10 y 16 años, con antecedentes familiares de PAF. En cada paciente se realiza: estudio genético, colonoscopia, enema de doble contraste, esófago-gastro-duodenoscopia, ecografías abdominal y tiroidea, fondo de ojo y marcadores tumorales (CEA, Ca 19.9). Se les practica (..) (AU)

Introduction. Total colectomy is the only effective treatment for prophylaxis against colon cancer in patients with familial adenomatous polyposis (FAP). We present our experience with 4 children colectomized for FAP, with a particular focus on the long-term surveillance to detect extracolonic manifestations. Patients and methods. We review the clinical histories of 4 patients from 10 to 16 years old, with family histories of FAP. Performed for each patient were: genetic testing, colonoscopy, double contrast enema, gastro-œsophageal duodenoscopy, thyroid and abdominal ultrasound, fundus oculi, and tumour markers (CEA, CA 19.9). They underwent total colectomy with ileoanal anastomosis and anorectal mucosectomy with an ileal J-pouch. During follow-up, they were monitored regularly with imaging techniques (including a video capsule in one patient)and endoscopy. Also evaluated were (..) (AU)

[Surgical closure of ductus arteriosus in the extreme or very extreme preterm infant]. / Cierre quirúrgico del conducto arterioso en el pretérmino extremo o muy extremo.

OBJECTIVES: The surgical close of patent ductus arteriosus in the extreme or very extreme premature presents difficulties, because of its anaesthesia, surgical intervention and the clinical circumstances that usually accompany this pathology. We reviewed our experience in order to understand the factors that have contributed to the obtained results. METHODS: In all the reviewed patients we evalue: gestational age, birth weight, drug treatment, surgical close, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis and renal failure, time of hospitalization, mortality and its causes. RESULTS: The sample is constituted of 26 prematures whose average gestational age is 26.24 weeks and average weight 885 g. 22 were treated with indomethacin, at an average age of 7 days, and all of them underwent surgical close, at an average age of 19 days (0-50). 10 patients suffered bronchopulmonary dysplasia, operated when they were 28 days of life. 7 suffered renal failure, 5 of them after drug treatment. 6 suffered necrotizing enterocolitis. 7 died (27%), 3 of them because of prematurity and preoperative severe pathology, 2 because of heart disease, and 2 because of severe necrotizing enterocolitis. CONCLUSIONS: Surgical ligation of patent ductus arteriosus in these patients is well tolerated, especially if the attention to prevent bronchopulmonary dysplasia, necrotizing enterocolitis and renal failure is optimized. Mortality in our series is not very different from that provided for the total of prematures with similar gestational age and birth weight, regardless of their pathology.

[Intrakidney-catheter. Post pyelo-plasty complication]. / Catéter intrarrenal. Complicación post-pieloplastia.

One of the more severe urology complications are the forgetfulness of surgical instruments or materials (compress, gauzes...), with different types of complications. We present a male, operated of left hydronephosis. The post surgical catheter was retired five days after the anterograde urography, being all normal. But, in the new urography, practised six month after, a little fragment of catheter was discover, being necessary to do a new lobotomy and extraction. After revised the paediatric-urology bibliography, we note the very few articles about surgical complications, which is not the case of the adult's urologist. And this is very negative to the resident training, and also to our patients.

Catéter intrarrenal. Complicación post-pieloplastia / Intrakydney-catheter. post pielo-plasty complication

Las complicaciones urológicas yatrogénicas son excepcionales, siendo una de las más frecuentes el olvido de material dentro del campo quirúrgico, principalmente las gasas y compresas, que son el material más frecuente, el cual puede ser asintomático u originar diferentes complicaciones. Presentamos a un varón operado de una hidronefrosis izda, al que se le colocó una sonda de nefrostomía y un catéter transanastomótico retirado al 5º día. En la urografia descendente inmediata a la intervención y enla ecografía realizada al mes, no se observa ningún cuerpo extraño, pero en la urografía realizada al 6º mes de la intervención se comprueba un fragmento de catéter dentro de la pelvis renal que precisó nueva lumbotomía. Se realiza una revisión bibliográfica de las complicaciones urológicas y atrogénicas y se llama la atención sobre las pocas publicaciones existentes de yatrogenia urológica pediátrica, al contrario que los urólogos de adultos, que sí las publican. Esta falta de publicaciones repercute negativamente en la formación de los cirujanos pediátricos, especialmente, de los residentes (AU)

One of the more severe urology complications are the forgetfulness of surgical instruments or materials (compress, gauzes…), with different types of complications. We present a male, operated of left hydronephosis. The post surgical catheter was retired five days after the anterograde urography, being all normal. But, in the new urography, practised six month after, a little fragment of catheter was discover, being necessary to do a new lumbotomy and extraction. After revised the paediatric-urology bibliography, we note the very few articles about surgical complications, which is not the case of the adult’s urologist. And this is very negative to the resident training, and also to our patients (AU)

Angioma de células litorales y enfermedad de Von Willebrand / Littoral cell angioma and Von Willebrand’s disease

No disponible