Manejo de las urgencias quirúrgicas en el hospital / No disponible

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Certificación, recertificación y validación periódica / No disponible

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[Prenatal detection of primary non-refluxing megaureter. Review of our casuistics]. / Megauréter primario no refluyente detectado prenatalmente.

BACKGROUND: Most primary non-refluxing megaureters resolve spontaneously and the indications for surgery are not sufficiently well established. OBJECTIVES: To analyze the clinical features, treatment and outcome of asymptomatic primary non-refluxing megaureter. PATIENTS AND METHODS: We retrospectively studied 58 infants with primary non-refluxing megaureter. The diagnostic methods used were renal ultrasound, renal isotopic renogram, DMSA scan, and evaluation of renal function. RESULTS: The mean age at postnatal diagnosis was 24 days. The mean follow-up was 4 years. Sixty-nine percent of the patients were male. Fifty-seven percent were left megaureters and 22% were bilateral (71 affected renal units). Eleven percent of megaureters were grade I, 48% were grade II, and 41% were grade III. Only nine patients (15%) received surgical treatment. The indications for surgical treatment were severe megaureter (3/9 patients; 33%), prolonged T1/2 (3/9 patients; 33%), reduced function (1/9 patients; 11%), prolonged T1/2 plus reduced function (1/9 patients; 11%) and increased dilation (1/9 patients; 11%). The mean age at surgery was 7 months. Outcomes in the non-surgical group (85% of the patients; 60 renal units) were as follows: 90% of megaureters were corrected or improved on ultrasound scan and 10% showed no change. In the first renogram, function was low in 4/60 kidneys (7%) and T1/2 was prolonged in 3/60 (5%). Finally, all kidneys in the non-surgical group had normal function, except one, which was injured from the beginning. T1/2 was normal in all kidneys. Outcomes in the surgical group (10 megaureters) were as follows: 80% of megaureters were corrected or improved after surgical intervention and 20% showed no change. At diagnosis, 4/10 kidneys (40%) had reduced function. In the post-surgical renogram 2/10 kidneys (20%) continued to show reduced function, 1/10 kidney (10%) showed restored renal function, and 1/10 kidney (10%) was nephrectomized. Initial T1/2 was prolonged in 4/10 patients (40%), and after surgery T1/2 was normal in all patients. The final DMSA scan showed 5/71 kidneys (7%) with irreversible damage (one slightly injured, two moderately injured, and three severely injured). The remaining 66 kidneys were normal. Overall renal function and blood pressure were normal in all patients. CONCLUSIONS: Primary non-refluxing megaureter is usually a functional and benign congenital malformation that resolves during the first months of life. Although the malformation can persist, only a few patients require surgical treatment. Most authors agree that initial treatment should not be surgical and that surgery should be reserved for patients who develop ureteral dilation, a decrease in differential renal function, and/or severe symptoms during follow-up. In a few patients (7% of our series), the renal unit belonging to the megaureter shows irreversible congenital injury. In these patients, surgery is not useful.

Megauréter primario no refluyente detectado prenatalmente / Prenatal detection of primary non-refluxing megaureter

Antecedentes Aunque la mayoría de los megauréteres primarios no refluyentes se solucionan espontáneamente, las indicaciones de cirugía no están bien establecidas. Objetivos Analizar las características clínicas, el tratamiento y la evolución del megauréter primario no refluyente asintomático. Pacientes y métodos Estudio retrospectivo de 58 lactantes con megauréter primario no refluyente. Técnicas diagnósticas utilizadas: la ecografía, el renograma, el 99Tc-ácido dimercaptosuccínico (DMSA) y la función renal. Resultados La edad media al diagnóstico posnatal era de 24 días y tiempo medio (T1/2) de seguimiento de 4 años. El 69 % de los pacientes eran varones. El 57 % de los megauréteres eran izquierdos y el 22 % bilaterales (71 unidades renales afectadas). El 11 % de los megauréteres eran grado I, el 48 % grado II y el 41 % grado III. El 15 % (9 pacientes) recibieron tratamiento quirúrgico y el 85 % restante (49 pacientes) no precisaron intervención. Las indicaciones quirúrgicas fueron: megauréter muy severo (3/9 pacientes; 33 %), T1/2 alargado (3/9 pacientes; 33 %), función disminuida (1/9 pacientes; 11 %), T1/2 alargado 1 función disminuida (1/9 pacientes; 11 %) y aumento dilatación (1/9 pacientes; 11 %). La edad media a la intervención fue de 7 meses. La evolución de los megauréteres del grupo no quirúrgico (60 unidades renales) fue la siguiente: 90 % se corrigieron-mejoraron en la ecografía y 10 % no sufrieron cambios. La función en el renograma inicial estaba disminuida en 4/60 riñones (7 %) y el T1/2 alargado en 3/60 (5 %). Al final todos los riñones del grupo no quirúrgico tenían una función normal salvo un caso lesionado desde el principio y el T1/2 se normalizó en todos. La evolución de los megauréteres del grupo quirúrgico (10 megauréteres) fue la siguiente: 80 % se corrigieron-mejoraron tras la intervención y el 20 % se mantuvieron sin cambios. Antes de la intervención había 4/10 riñones (40 %) con función disminuida. En el renograma postintervención, 2/10 (20 %) mantuvieron la función disminuida, 1/10 (10 %) la normalizó y 1/10 (10 %) fue nefrectomizado y no tenía renograma. El T1/2 inicial estaba alargado en 4/10 casos (40 %). Tras la intervención se normalizó en todos. El DMSA final mostró 5/71 riñones (7 %) con lesión irreversible (1 leve, 2 moderadas y 2 casos con lesión grave). Los 66 riñones restantes eran normales. La función renal global y presión arterial eran normales en todos los casos. Conclusiones El megauréter primario no refluyente es casi siempre funcional y benigno, normalizándose en los primeros meses de la vida. Aunque en algunos casos puede persistir, son muy pocos los pacientes que necesitan ser intervenidos. La mayoría de los autores consideran que el tratamiento inicial debe ser no quirúrgico, reservando la intervención para aquellos casos en los que durante el seguimiento se produzca un aumento de la dilatación ureteral, un deterioro de la función renal diferencial y/o aparezca sintomatología importante. En un grupo muy reducido de pacientes (7 % de nuestra serie) la unidad renal perteneciente al megauréter, puede presentar una lesión renal irreversible que la mayoría de las veces tiene un origen congénito y que por tanto no se beneficia de una intervención quirúrgica

Background Most primary non-refluxing megaureters resolve spontaneously and the indications for surgery are not sufficiently well established. Objectives To analyze the clinical features, treatment and outcome of asymptomatic primary non-refluxing megaureter. Patients and methods We retrospectively studied 58 infants with primary non-refluxing megaureter. The diagnostic methods used were renal ultrasound, renal isotopic renogram, DMSA scan, and evaluation of renal function. Results The mean age at postnatal diagnosis was 24 days. The mean follow-up was 4 years. Sixty-nine percent of the patients were male. Fifty-seven percent were left megaureters and 22 % were bilateral (71 affected renal units). Eleven percent of megaureters were grade I, 48 % were grade II, and 41 % were grade III. Only nine patients (15 %) received surgical treatment. The indications for surgical treatment were severe megaureter (3/9 patients; 33 %), prolonged T1/2 (3/9 patients; 33 %), reduced function (1/9 patients; 11 %), prolonged T1/2 plus reduced function (1/9 patients; 11 %) and increased dilation (1/9 patients; 11 %). The mean age at surgery was 7 months. Outcomes in the non-surgical group (85 % of the patients; 60 renal units) were as follows: 90 % of megaureters were corrected or improved on ultrasound scan and 10 % showed no change. In the first renogram, function was low in 4/60 kidneys (7 %) and T1/2 was prolonged in 3/60 (5 %). Finally, all kidneys in the non-surgical group had normal function, except one, which was injured from the beginning. T1/2 was normal in all kidneys. Outcomes in the surgical group (10 megaureters) were as follows: 80 % of megaureters were corrected or improved after surgical intervention and 20 % showed no change. At diagnosis, 4/10 kidneys (40 %) had reduced function. In the post-surgical renogram 2/10 kidneys (20 %) continued to show reduced function, 1/10 kidney (10 %) showed restored renal function, and 1/10 kidney (10 %) was nephrectomized. Initial T1/2 was prolonged in 4/10 patients (40 %), and after surgery T1/2 was normal in all patients. The final DMSA scan showed 5/71 kidneys (7 %) with irreversible damage (one slightly injured, two moderately injured, and three severely injured). The remaining 66 kidneys were normal. Overall renal function and blood pressure were normal in all patients. Conclusions Primary non-refluxing megaureter is usually a functional and benign congenital malformation that resolves during the first months of life. Although the malformation can persist, only a few patients require surgical treatment. Most authors agree that initial treatment should not be surgical and that surgery should be reserved for patients who develop ureteral dilation, a decrease in differential renal function, and/or severe symptoms during follow-up. In a few patients (7 % of our series), the renal unit belonging to the megaureter shows irreversible congenital injury. In these patients, surgery is not useful

[Severe primary congenital unilateral hydronephrosis. A review of 98 cases]. / Hidronefrosis congénita primaria unilateral grave en lactantes asintomáticos. Revisión de 98 casos.

INTRODUCTION: Currently, consensus is lacking on the indications for surgery in primary congenital unilateral hydronephrosis. OBJECTIVES: To analyze the clinical characteristics, treatment and outcome of severe asymptomatic primary congenital unilateral hydronephrosis (grades 3 and 4). PATIENTS AND METHODS: We performed a retrospective study of 98 neonates with severe primary congenital unilateral hydronephrosis. Diagnostic techniques consisted of ultrasound, renogram, and DMSA scan. RESULTS: The mean age at diagnosis was 24 days. The mean length of follow-up was 4 years. Forty-eight percent of cases were grade 3 and the remaining cases were grade 4. Fifty-six percent of the patients received conservative treatment. Forty-four percent underwent surgery. Surgical indications consisted of prolonged T1/2, reduced differential renal function and/or very severe hydronephrosis. The mean age at surgery was 5.5 months. In 94 % of the patients who received conservative treatment, hydronephrosis resolved spontaneously. In this group, renal parenchyma and renal function were normal in all patients except two. In 97 % of the patients who received surgical treatment, hydronephrosis was corrected or improved after pyeloplasty. At diagnosis, 19 kidneys had reduced function. In the postsurgical renogram, although T1/2 had markedly improved, 8 kidneys showed reduced function. DMSA performed in 63 patients belonging to both groups, outside the active phase of hydronephrosis, revealed 8 atrophic kidneys, 4 with moderately reduced renal size and function and 4 with scarring and normal renal size and function. During the study period, overall function was maintained in all patients and none developed hypertension. CONCLUSIONS: Severe congenital unilateral hydronephrosis resolves spontaneously in most patients. Consequently, clinicians increasingly adopt a conservative approach. The available diagnostic techniques cannot identify patients who will benefit from pyeloplasty. In general, accepted surgical indications are an increase in hydronephrosis and/or worsening of renal function. In our series, 15 % of the patients with hydronephrosis had an irreversible lesion of variable severity, which in some patients seemed to have developed during embryogenesis. Kidneys at risk of presenting a lesion were those that had grade 4 hydronephrosis.

Hidronefrosis congénita primaria unilateral grave en lactantes asintomáticos. Revisión de 98 casos / Severe primary congenital unilateral hydronephrosis. A review of 98 cases

Introducción Actualmente no existe consenso sobre las indicaciones de la intervención quirúrgica en la hidronefrosis congénita primaria unilateral. Objetivos Analizar las características clínicas, el tratamiento y la evolución de la hidronefrosis congénita primaria unilateral grave (grados 3 y 4) asintomática. Pacientes y métodos Estudio retrospectivo de 98 lactantes con dicha patología. Como técnicas diagnósticas se utilizaron la ecografía, el renograma y el 99mTc-ácido dimercaptosuccínico (DMSA). Resultados La edad media al diagnóstico es de 24 días y el tiempo medio de seguimiento, de 4 años. El 48 % eran hidronefrosis grado 3 y el resto grado 4. El 56 % recibieron tratamiento conservador. El 44 % fueron intervenidos. Las indicaciones quirúrgicas fueron: tiempo medio alargado, función renal diferencial disminuida y/o hidronefrosis muy grave. La edad media de intervención fue de 5,5 meses. El 94 % de los casos tratados de manera conservadora se resolvieron espontáneamente. En este grupo el parénquima y la función renales fueron normales en todos los casos menos en dos. En el 97 % de los tratados quirúrgicamente, la hidronefrosis se corrigió o mejoró tras la pieloplastia. Al diagnóstico, 19 riñones tenían una función disminuida. En el renograma postintervención, aunque el tiempo medio había mejorado llamativamente, había todavía 8 riñones con función disminuida. En un DMSA realizado en 63 pacientes pertenecientes a ambos grupos, fuera de la fase activa de la hidronefrosis, se detectó: 8 riñones atróficos, cuatro con tamaño y función renal disminuida de forma moderada y cuatro con cicatrices pero con tamaño y función normales. Durante el tiempo que duró el estudio todos los pacientes mantuvieron la función global y ninguno desarrolló hipertensión arterial. Conclusiones La hidronefrosis congénita unilateral grave es un proceso que cede espontáneamente en la mayoría de los casos, por lo que cada día son más los clínicos que adoptan una actitud conservadora en estos pacientes. Las técnicas diagnósticas disponibles no permiten predecir quiénes son los que se van a beneficiar de una pieloplastia. En general se acepta como indicaciones quirúrgicas el aumento de la hidronefrosis y/o el deterioro de la función renal. En nuestra serie el 16 % de las hidronefrosis tenían una lesión irreversible de mayor o menor intensidad que en algunos pacientes parecía haberse originado durante la embriogénesis. Las unidades renales en riesgo de presentar lesión renal son las que tienen una hidronefrosis de grado 4

Introduction Currently, consensus is lacking on the indications for surgery in primary congenital unilateral hydronephrosis. Objectives To analyze the clinical characteristics, treatment and outcome of severe asymptomatic primary congenital unilateral hydronephrosis (grades 3 and 4). Patients and methods We performed a retrospective study of 98 neonates with severe primary congenital unilateral hydronephrosis. Diagnostic techniques consisted of ultrasound, renogram, and DMSA scan. Results The mean age at diagnosis was 24 days. The mean length of follow-up was 4 years. Forty-eight percent of cases were grade 3 and the remaining cases were grade 4. Fifty-six percent of the patients received conservative treatment. Forty-four percent underwent surgery. Surgical indications consisted of prolonged T1/2, reduced differential renal function and/or very severe hydronephrosis. The mean age at surgery was 5.5 months. In 94 % of the patients who received conservative treatment, hydronephrosis resolved spontaneously. In this group, renal parenchyma and renal function were normal in all patients except two. In 97 % of the patients who received surgical treatment, hydronephrosis was corrected or improved after pyeloplasty. At diagnosis, 19 kidneys had reduced function. In the postsurgical renogram, although T1/2 had markedly improved, 8 kidneys showed reduced function. DMSA performed in 63 patients belonging to both groups, outside the active phase of hydronephrosis, revealed 8 atrophic kidneys, 4 with moderately reduced renal size and function and 4 with scarring and normal renal size and function. During the study period, overall function was maintained in all patients and none developed hypertension. Conclusions Severe congenital unilateral hydronephrosis resolves spontaneously in most patients. Consequently, clinicians increasingly adopt a conservative approach. The available diagnostic techniques cannot identify patients who will benefit from pyeloplasty. In general, accepted surgical indications are an increase in hydronephrosis and/or worsening of renal function. In our series, 15 % of the patients with hydronephrosis had an irreversible lesion of variable severity, which in some patients seemed to have developed during embryogenesis. Kidneys at risk of presenting a lesion were those that had grade 4 hydronephrosis

Valor de la ecografía abdominal en el diagnóstico de apendicitis aguda / Value of abdominal ultrasonography in the diagnosis of acute appendicitis

No disponible

[Current indications of esophageal pH-monitoring]. / Indicaciones actuales de la monitorización de la pHmetría esofágica.

Regurgitation is a common manifestation in infants below the age of 1 year and a frequent cause of visits to general practitioners and pediatricians. Accurate diagnosis of this condition requires a good choice of pH monitoring equipment and optimal technique when performing this procedure. The present article is a consensus statement of the Working Group on Gastroesophageal Reflux of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SSPGHN) and reflects the conclusions reached in the VII Congress of the SSPGHN (Vigo, 2000). In general, esophageal pH monitoring is indicated in the following situations: (i) when symptoms of gastroesophageal reflux are present and evolution is not favorable, despite appropriate treatment; (ii) when trying to determine the relationship between gastroesophageal reflux and non-digestive symptoms and (iii) when evaluating the results of treatment, whether medical or surgical.

Indicaciones actuales de la monitorización de la phmetría esofágica / Esophageal pH- monitoring. Current indications

La regurgitación es una manifestación clínica común en niños menores de un año, y una frecuente causa de consulta en la práctica diaria pediátrica. Su diagnóstico preciso requiere la elección de un buen equipo de monitorización de pH esofágico y de una técnica de ejecución óptima. Este artículo es un consenso del Grupo de Trabajo de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP) discutido en el VII Congreso de la SEGHNP (Vigo, 2000). En general, las recomendaciones para indicar una monitorización de pHmetría esofágica se reducen a las siguientes situaciones: a) ante la existencia de síntomas sugestivos de reflujo gastroesofágico (RGE), cuya evolución no es favorable a pesar de instaurar un tratamiento correcto; b) cuando quiera establecerse la relación entre RGE y síntomas extradigestivos, y c) como control de la eficacia del tratamiento, ya sea médico o quirúrgico (AU)

Utilización del óxido nítrico en un neonato con una malformación adenomatoidea quística pulmonar / Nitric oxide inhalation therapy for persistent pulmonary hypertension in congenital cystic adenomatoid malformation of the lung

El óxido nítrico (NO) es un vasodilatador que, utilizado de forma inhalatoria, incrementa el 02 en la sangre y mejora los trastornos de ventilación-perfusión a nivel pulmonar, sin causar hipotensión sistémica. Su uso en patologías del neonato, tanto médicas (distress respiratorio, hipertensión pulmonar), como quirúrgicas (cardiopatías congénitas, hernia diafragmática) se ha demostrado eficaz. Hasta ahora no hay referencias de haber sido empleado en la malformación adenomatoidea quística pulmonar (MAQ).Presentamos el caso de un recién nacido de 33 semanas de gestación, intervenido a las 22 horas de vida por una MAQ que requirió lobectomía total del lóbulo medio. En el postoperatorio inmediato con Fi02 del 100 por ciento presentaba acidosis y severa hipoxemia. Ante la sospecha de hipertensión pulmonar persistente (HPP) se instauró tratamiento con NO inhalado durante 16 horas, disminuyéndose las necesidades de 02 y mejorándose los datos gasométricos. En la MAQ, cuando es de gran tamaño, el parénquima pulmonar sano ipsilateral puede estar comprimido e hipoplásico, y en el postoperatorio ocasionar un cuadro de HPP, lo mismo que sucede en la hernia diafragmática. Estos cuadros son susceptibles de ser tratados con NO inhalado (AU)

[Use of nitric oxide in a newborn child with pulmonary cystic adenomatoid malformation]. / Utilización del óxido nítrico en un neonato con una malformación adenomatoidea quística pulmonar.

Nitric oxide (NO) inhalation therapy relaxes preconstricted pulmonary blood vessels without causing concomitant systemic hypotension and increases oxygen uptake into the blood. NO inhalation is a new treatment for various disorders of neonates (respiratory distress syndrome, persistent pulmonary hypertension, congenital heart disease and congenital diaphragmatic hernia). There is no references of its use in congenital cystic adenomatoid malformation (CCAM). We report a case of a newborn of 33 week's gestation. The infant underwent resection of the CCAM that had occupied the right middle lobe. At the end of the operation, arterial blood gases at a fractional inspired oxygen concentration (FiO2) of 1.0 reveled acidosis and severe hypoxemia probably due to persistent pulmonary hypertension. NO therapy was used for 16 hours with decreased oxygen need and increase of arterial blood oxygen data. According to the extent of the adenomatoid lesion, likely due to the compression of the surrounding tissue, these patients at times postoperatively develop difficulty in oxygenation and ventilation and the changes are similar to those patients with congenital diaphragmatic hernia. The use of NO in these disorders are successfull.

[Xanthogranulomatous pyelonephritis: possibilities of diagnostic imaging]. / Pielonefritis xantogranulomatosa: posibilidades de diagnóstico por la imagen.

We report on two cases of xanthogranulomatous pyelonephritis (XGP) in children. In one patient preoperative diagnosis could be made on the basis of computerized tomography. Although XGP is a pathology diagnosis, new imagine techniques should allow its suspicion in a growing number of cases. This unusual disease should be suspected in from of a IVP showing non-functioning kidney specially when associated with urinary infection and/or lithiasis. Nephrectomy should be performed in all cases.