[Indications of transduodenal papillotomy for choledochal cyst]. / Indicaciones de la papilotomía transduodenal en el tratamiento del quiste de colédoco.

UNLABELLED: The Choledochal Cyst is a dilatation of the biliary tract whose etiology is still under debate. OBJECTIVE: This paper analyzes the cases of our group an contributes on the indications of transduodenal papilotomy in the surgical treatment of this process. MATERIAL AND METHODS: Seven cases diagnosed as choledochal cysts are presented with mean age between 3 and 10 years (5 females and 2 males). Six cases were presented with abdominal pain, four with jaundice, three presented with biliary stones and one cases was a casual discovery during an US examination. In all cases US and magnetic resonance cholangiopancreatography (MRCP) were performed as preoperative work-up. In one case an endoscopic retrograde cholangiopancreatography (ERCP) was made. In all cases intraoperative cholangiography was carried out. The surgical treatment was quistectomy and hepatico yeyunostomy Roux-Y in four cases; in one of them a transduodenal papilotomy was added. Cholecystectomy and transduodenal papilotomy was made in three cases, two of them presented choledocholithiasys. RESULTS: All patients are symptoms free after a mean follow up period of 2 years and 3 months (range: 1 year and 6 months to 4 years and 10 months). In one case persists dilated choledochal distal stump on MRCP.

Indicaciones de la papilotomía transduodenal en el tratamiento del quiste de colédoco / Indications of transduodenal papilotomy for choledochal cyst

El Quiste de Colédoco es una dilatación de la vía biliar cuya etiología sigue sujeta a debate. Objetivos: Análisis de la casuística del Servicio y aportación de las indicaciones de la papilotomía transduodenal en el tratamiento quirúrgica de esta patología. Material y métodos: Se presentan siete casos diagnosticados de quiste de colédoco con una edad entre 3 y 10 años ( 5 hembras y 2 varones). Seis casos presentaron dolor abdominal, cuatro ictericia, tres eran portadores de litiasis biliar y un caso fue un hallazgo casual en el curso de una exploración ecográfica. En todos ellos se realizó ecografia y colangio-pancreato-resonancia magnética (CPRM) preoperatorias. En un caso se realizó una colangio-pancreatografía retrógrada endoscópica (CPRE). En todos se realizó colangiografía intraoperatoria. El tratamiento quirúrgico realizado fue Quistectomia y hepático- yeyunostomía en Y de Roux en cuatro casos. En uno de ellos se añadió una papilotomía transduodenal. En tres casos se efectuó colecistectomía y papilotomía transduodenal. Dos de estos pacientes presentaban coledocolitiasis. Resultados: Todos los pacientes están asintomáticos tras un periodo de seguimiento medio de 2 años y 3 meses (rango: laño y 6 meses a 4 años y 10 meses). En un caso se aprecia en la CPRM postoperatoria la existencia de un muñón residual del colédoco distal con ectasia. (AU)

Diagnostic and therapeutic laparoscopy for nonpalpable testis.

BACKGROUND: We evaluated the use of laparoscopy in the management of impalpable testis to determine what advantages it might offer over the open approach. METHODS: Over a 5.5-year period, a total of 46 patients with 53 nonpalpable testes underwent a laparoscopic procedure at our hospital. There were 28 cases of intraabdominal testis (52.83%), 18 cases of the vas and vessels entering the internal ring (33.96%), and seven cases of intraabdominally absent testis (13.20%). We performed a laparoscopic orchiopexy for 24 testes (scrotal in 21 cases and partial to the inguinal canal in three cases) and an orchiectomy for three testes. We encountered inguinal hernia in 14 cases (26.41%). RESULTS: At follow-up, all testes were the same size as at the time of operation and were well positioned in the scrotum, except for four testes that required reoperation due to partial migration at the superficial inguinal ring. The operating time was <1 h in unilateral cases and <2 h for the bilateral cases. All procedures were completed successfully without conversion or complications. CONCLUSIONS: Laparoscopy is the only exploratory procedure that is accurate enough to enable the diagnosis of nonpalpable testis and also allow the surgical treatment to be done in the same setting.

[Metastatic Crohn's disease in childhood]. / Enfermedad de Crohn metastásica.

Crohn's disease (CD) is an intestinal inflammatory disease of unknown origin that is sometimes associated with cutaneous manifestations. These skin lesions are usually nonspecific (erythema nodosum, erythema multiforme and pyoderma gangrenosum) and should be differentiated from the cutaneous lesions corresponding to the typical histological pattern of CD; most of these extend directly from the involved bowel. Noncaseating granulomatous infiltration in skin anatomically distant from areas of gastrointestinal CD and separated by normal skin is extremely rare. This entity, known as metastatic Crohn's disease, can be the first symptom of CD or even more unusually can appear during the course of the disease.We report the case of a 9-year-old boy, previously diagnosed with ileocolic and perianal CD, who had been receiving treatment with mesalazine, prednisone and 6-mercaptopurine for 3 years. He presented with swelling of the penis and scrotum of 2 weeks' evolution, without any other symptoms. Testicular ultrasound showed thickening of the scrotal wall and increased flux at this site. Skin biopsy showed noncaseating granulomas. Results of special staining techniques were negative for the presence of microorganisms. The prednisone dose was increased and metronidazole was added, with noticeable improvement in the lesions. Due to reappearance of cutaneous lesions when the prednisone dose was reduced, the patient currently receives maintenance treatment.

[Tendon and/or nerve lesions of the hand in childhood]. / Lesiones tendinosas y/o nerviosas de la mano en la infancia.

We have reviewed 50 consecutive children treated during the last five years of injuries of nerves and tendons of the hand, wrist and forearm. Seventy six per cent of these injuries affected the hand and/or fingers. The rest were located in the wrist or forearm.

Hepatic artery aneurysm in a child.

The present report refers to a child hospitalized because of nonspecific symptomatology, who was found to have aneurysms of both hepatic arteries. A year after simple proximal ligature of both hepatic arteries, the child remains symptom-free and developing normally. Proximal ligation appears to be a simple and effective technique for treating hepatic artery aneurysm in children in preference to direct approach of the vascular pathology.

Bilateral multifocal Wilms' tumor.

A three-year-old boy who presented with symptoms of peritonitis was found to have four Wilms' tumors affecting both kidneys. Individual enucleation of three tumors in the right kidney plus left lower nephrectomy were performed. Chemotherapy was administered for one year. The diagnosis of Wilms' tumor was confirmed on each specimen by the histologic studies. The child remains asymptomatic and developing normally six years after the initial surgical treatment. Bilateral partial nephrectomies is the most conservative of the surgical treatments available for bilateral Wilms' tumor.

[Contralateral reflux after unilateral antireflux surgery]. / Reflujo contralateral después de la cirugía antirreflujo unilateral.

108 unilateral antireflux surgical procedures are analysed over a period of seven years. All the cases were operated upon for essential or primary renal reflux, using ureteral advancement techniques crossing the bladder midline. There were 10 patients who developed contralateral renal reflux (CRR) in the postoperative evolution (9,2%). The CRR disappeared in all cases, but three of them needed surgical treatment because of urinary tract deterioration (Reflux nephropathy, bladder lithiasis, and shift of reflux grade from I to III). Two different surgical antireflux techniques were utilised. Using the Glenn-Anderson's technique the incidence of CRR was 9/68 (13,2%) whereas this incidence was 1/40 (2,5%) using the Cohen's technique, which does not disrupt the trigonal area. The authors do not believe that systematic bilateral antireflux surgery for unilateral reflux is necessary. When CRR occurs an initially conservative management is recommended.

[Renal injuries in children]. / Traumatismos renales en la infancia.

16 children admitted to the hospital for blunt renal trauma were studied. Following Mandour's classification 10 cases were minor, five mayor and one was critical. No vascular or ureteral problems were seen. The treatment was initially conservative in all cases, without explorative lumbotomy or perirenal drainage. Only one patient was operated on for an arteriovenous fistula in the renal parenchyma; an exeresis of that portion was done. The follow-up (for one year) with clinical, IVP, echography and blood pressure controls was normal in all cases. The present authors prefer a conservative management, whenever possible, and surgical treatment only for complications and vascular or pyeloureteral disruption.