[Focal nodular hyperplasia of the liver]. / Hiperplasia nodular focal del hígado.

Focal nodular hyperplasia (FNH) of the liver is an uncommon benign lesion that usually occurs in young or middle-aged women. Although it has been associated with oral contraceptive use, no evidence supports this hypothesis. Most patients with this lesion are asymptomatic. We report the case of a 10-year-old boy with a history of transient epigastric abdominal pain over several days. Physical examination revealed a tender mass in the upper left quadrant. Abdominal ultrasonography revealed an 85 3 45 mm mass located in the left lobe of the liver. Computed tomography-guided biopsy showed histological changes consistent with FNH. Left hepatectomy was performed and the diagnosis was confirmed by histological study. FNH of the liver is extremely rare in children, especially in boys. Unlike adenoma, malignant transformation of FNH has not been described and consequently patients can be periodically followed-up with imaging tests, without need of surgery. The differential diagnosis includes other benign hepatic lesions such as hemangioma and hepatocellular adenoma. Surgical resection is indicated in symptomatic patients, usually with abdominal pain, cholestasis or palpable abdominal mass, and when the differential diagnosis, especially with hepatic adenoma, is unclear.

Hiperplasia nodular focal del hígado / Focal nodular hyperplasia of the liver

La hiperplasia nodular focal es un tumor hepático benigno muy poco frecuente que afecta a mujeres jóvenes o de mediana edad. Se ha sugerido su asociación con el uso de anticonceptivos orales, pero este hecho no ha sido demostrado. En la mayoría de los casos la lesión es asintomática. Se presenta el caso de un niño de 10 años de edad, que consultó por un cuadro de dolor epigástrico intermitente de varios días de evolución. La palpación abdominal mostró una tumoración dolorosa y dura localizada en el hipocondrio izquierdo. La ecografía abdominal reveló la existencia de una masa de 85X45 mm situada en el lóbulo hepático izquierdo, de la cual se practicó una biopsia por punción dirigida mediante tomografía computarizada (TC). El estudio histopatológico mostró un tejido hepático con alteraciones indicativas de hiperplasia nodular focal. El paciente fue intervenido realizándose una hepatectomía izquierda. El estudio histológico definitivo confirmó el diagnóstico. La hiperplasia nodular focal del hígado en la edad pediátrica es rara y aún más en niños varones. A diferencia del adenoma, no se ha descrito la transformación maligna, por lo que los pacientes pueden ser seguidos de forma periódica mediante pruebas de imagen sin necesidad de tratamiento quirúrgico. El diagnóstico diferencial debe establecerse con otros tumores benignos como los hemangiomas y el adenoma hepatocelular. El tratamiento quirúrgico está indicado en pacientes con síntomas como dolor recurrente, colestasis por compresión o la presencia de una masa abdominal palpable, así como siempre que existan dudas en el diagnóstico diferencial, en particular con el adenoma hepático (AU)

[Evolution of hypospadias surgery. Comparative study of the various techniques used for 20 years]. / Evolución en la cirugía del hipospadias. Estudio comparativo de las diferentes técnicas empleadas a lo largo de 20 años.

With the purpose of studying the long-term results of the different surgical techniques used for the treatment of hypospadias, we have examined 1186 patients treated in our centre over the last 20 years. To facilitate the comparative study, three well-defined periods have been established: 1974-1981 (165 pts.). Treatment was done in several operative times. Denis Browne and Mathieu's urethroplasties were the techniques more frequently used. Their long-term evolution show keratosis and hairiness of the neourethra, which in 17 patients required a new urethroplasty with vesicle mucosa, as the most serious complication. 1982-1986 (281 pts.). Restoration was done in one single operative time. Magpi, Mathieu and Duckett's techniques were the most frequently used during this period. 1987-1993 (624 pts.). An island flap is added as cutaneous plasty after urethroplasty has been performed. Fistulae were the most frequent complications in all the above time-periods (18, 10 and 7.3%, respectively), followed by stenosis (12, 6.5 and 4.4%) and megaurethra (6.8, 6.7 and 2.9%). The remarkable decrease both in number and seriousness of the complications is due to the island cutaneous flap, hormonal stimulation, use of slow reabsorption materials , silicone probes, silastic foam dressings, caudal anaesthetics and, above all, a better indication for the surgical technique in each case.