[Recto-sacral fixation in the treatment of rectal prolapse refractory to conservative treatment]. / La pexia recto-sacra en el tratamiento del prolapso rectal refractario a tratamiento conservador.

INTRODUCTION: The clinical cases of 20 patients submitted to Reifferscheid intervention (fixation of rectum to promontorium) between 1967 and 1997 are presented. PATIENTS AND METHODS: Twenty patients have been treated by means of the operation of Reifferscheid. They were divided in two groups: from 1967 to 1972, ten patients were submitted to this technique (group A). From 1974 to 1997, other ten patients (group B). In each case, the following items were registered: sex, eventual secondary diagnosis, incision, complications, middle-term evolution. RESULTS: Group A: Middle age: 2.15 years old. Sex: 7 girls (5 of them presented mielomeningocele) and 3 males; pararectal incision for babies, Pfannenstiel incision for children over 1 year-old. FOLLOW-UP: 2 years without recidives. Group B: Middle age: 2.5 years-old, 9 males (2 of them were diagnosed of mielomeningocele) and 1 girl. No recidives were detected. DISCUSSION: These excellent results obtained with Reifferscheid operation contrast with the poor results referred by other authors for other therapeutical approaches. That is why, in patients affected of serious rectal prolapse, especially when associated to other pathologies, rectal fixation to promontorium is an useful and long-term sure approach.

[Macrostomia secondary to transverse facial cleft of Tessier No.4]. / Macrostomía secundaria a hendidura facial transversa de Tessier n-0 4.

A case of bilateral macrostomia type transverse facial cleft of Tessier n. 4 is reported, which was operated on with good results when had ten months of age, repaired using suture of three planes of three embryonic folds. A treatment plain precocious is recommended and pathogenic theories about this uncommon entity are exposed.

[The usefulness of ultrasonography in the diagnosis of acute appendicitis in children]. / Utilidad de la ultrasonografía para el diagnóstico de apendicitis aguda en la infancia.

The main objective of the present report was the evaluation of the utility of echography as a diagnostic method in abdominal pain suspicious of acute appendicitis. A control-case study was performed in 165 children hospitalized for abdominal pain. Appendicitis histologically confirmed were considered cases (n = 110) while control (n = 55) were the not-operated patients (46 children) or the not-confirmed appendicitis after laparotomy (n = 9). The variables considered here were: the results of echography (Eco+ when echography showed signs of acute appendicitis: Eco- when not), the age of the patient (randomized at three groups; < 6, 6-9, > 9 years), and the conclusions of fisical exploration (conclusive or not as acute appendicitis). The results were analyzed statistically with the SPSS program, calculating the following predictive values; sensibility, specificity, positive predictive value, negative predictive value. Odds Radio before and after test and the global value of echography. Authors conclude that ultrasonography as method of support to abdominal exploration for diagnostic in acute appendicitis is manifest and present a global value of 70.90%.

[Gonadal, hormonal and spermatic function in patients treated for cryptorchidism]. / Función gonadal hormonal y espermática en pacientes tratados por criptorquidia.

This paper studies the gonadal-hormonal and spermatic function of 48 adults (over 18 years old) who were treated in childhood for cryptorchidism by medical, surgical or both treatments. We measure plasmatic levels of FSH, LH, testosterone and prolactin of 34 patients and sperm samples of 31 patients. The testicular hormonal function was not disturbed except in four patients with high levels of prolactin (> 20 ng/ml) without symptoms. The spermatic function was disturbed in bilateral cryptorchidism mainly. The better sperm quality and testicular volume were at patients treated with hormonal treatment before surgical treatment.

[Deferred appendectomy in a case of appendiceal mass]. / Apendicectomía diferida en caso de plastrón apendicular.

The treatment of acute appendicitis when appendix is technically impossible to remove, remains controversial. The clinical case of a 12-years-old child diagnosed of acute appendicitis in which appendectomy was not initially performable is presently described. After treatment with antibiotics, he was submitted to appendectomy five months later. Operative and pathologic findings in this second laparotomy prove the predisposition of the patient to a second acute appendicitis, and uphold the preventive attitude, the interval appendectomy.

[Determining factors of nutritional status in a pediatric surgical unit]. / Factores determinantes del estado nutricional en una población pediátrica médico-quirúrgica.

Nutritional assessment was made in 134 pediatric patients before surgery in order to analyze the influence of age, sex anthropometric nutritional index and type of surgical operation (urgent vs elective). The anthropometrical index, hematology measurements and serum protein levels were compared by using a one-way ANOVA and a linear correlation was performed when appropriate. The type of surgery and age of the patient were the factors which influence nutritional status the most among the pre-operatively screened surgical pediatric patients. In addition, pre-albumin, retinol-binding protein and acute-phase proteins have been shown to be affected by stress and appear to be more sensitive indicators of nutritional state than comparison of the types of surgery.

[Cerebral abscess secondary to esophageal dilatations]. / Absceso cerebral secundario a dilataciones esofágicas.

We report two cases of cerebral abscess secondary to esophageal dilations in children with caustic stenosis of the esophagus. High fever and neurological findings postdilation lead us to suspect this complication. Cranial C.T. confirmed the diagnosis. Clinical course was favourable in both patients, with antibioterapy on the first case and combined therapy with surgical drainage and parenteral antibiotics on the second patient. We remark the importance of suspect this complication on the basis of clinical and tomographic findings on the pediatric patients subjected to esophageal dilations. Pathogenic ways of bacterial dissemination from the esophagus to the brain are discussed and reviewed.

[Helicobacter pylori: a new pathogen to be considered in infancy]. / Helicobacter pylori: un nuevo patógeno a considerar en la infancia.

A prospective study in 11 consecutive children with gastroduodenal disease is presented. Endoscopic study and gastric biopsies were performed for histologic and bacteriologic research of H. pylori. Endoscopic studies in 7 of the patients showed lesions of antritis that were assessed by histopathologic study. H. pylori was isolated in 4 of them. The presence of H. pylori in the stomach of children with chronic gastritis is confirmed. It is remarked the importance of gastric biopsy, at least when the endoscopic study shows the presence of antral gastritis.

[High risk congenital diaphragmatic hernia. Factors predicting mortality]. / Hernia diafragmática congénita de alto riesgo. Factores predictores de mortalidad.

A retrospective study of patients with high-risk congenital diaphragmatic hernia operated on in our hospital the last 15 years is made in order to establish some predictors involved in the final evolution of the patients. The best prognostic correlation has been demonstrated by preoperatory roentgenogram, Apgar-test and gasometric values 24 hours after surgical repair. A delayed surgical operation is also correlated with a better prognosis in accordance with the suitability of respiratory stabilization of the patient before the stress of surgery or because of a lesser respiratory insufficiency in patients operated on later.