[Prognostic value of the ultrasound and diuretic renogram in the evolution of ureteropelvic junction obstruction]. / Valor pronóstico de la ecografía y el renograma diurético en la evolución de la estenosis pieloureteral.

INTRODUCTION: The congenital obstruction of the pieloureteral junction (UPJ) is the most frequent cause of hydronephrosis in children. Sometimes, establishing the convenience of a surgical procedure is difficult, mainly if we consider the literature published on the spontaneous resolution of the slight, moderate and even severe hydronephrosis in newborns. OBJECTIVE: To determine the prognostic value of ultrasound in the evolution of the unilateral hydronephrosis, by assesing the size of the contralateral kidney. To verify if the "supranormal" renal function (SRF) is real or an artefact. PATIENTS AND METHODS: We have performed a descriptive observational study over a 10 years period (1995-2005). The study included all patients with the only diagnosis of obstructive unilateral hydronephrosis that underwent pieloplasty, and were controlled for 1 year period after the surgical treatment. RESULTS: Of the 66 patients in the study, 42 were boys (63.6%) and 24 girls (36.4%). After the first diuretic renogram (DR), in 57 of the patients (86.4%) the clearance half-time (T1/2) was over 20 minutes, in 6 cases (9.1%) it was 10-20 minutes and only in 3 cases it was shorter than 10 minutes. A similar differential renal function (FRD) was observed in the moderate and severe hydronephrosis. Supranormal function (FRD > 52%) was detected on DR in 11 patients, predominating in left hidronefrosis, and in more than 50% of the cases this value it did not agree with the renal function measured by dimercapto-succinic acid (DMSA), Pearson's correlation coefficient: 0.19. These kidneys experienced a greater reduction of the postoperative renal function. CONCLUSIONS: In the unilateral obstructive hydronephrosis, the healthy contralateral kidney experiences hypertrophy detectable by ultrasound, but these ecographic diameters are within the band of individual confidence of the healthy children of reference. The supranormal function exists, but in most cases it is an artefact.

Valor pronóstico de la ecografía y el renograma diurético en la evolución de la estenosis pieloureteral / Prognostic value of the ultrasound and diuretic renogram in the evolution of ureteropelvic junction obstruction

Introducción. La obstrucción congénita de la unión pieloureteral(EPU) es la causa más frecuente de hidronefrosis en el niño. A veces, establecer la indicación quirúrgica es difícil, sobre todo si tenemos en cuenta la literatura publicada sobre la resolución espontánea de la hidronefrosis leve, moderada e incluso grave en el periodo neonatal. Objetivo. Determinar el valor pronóstico de la ecografía en la evolución de la hidronefrosis unilateral, monitorizando el tamaño del riñón contralateral. Comprobar si la función renal “supranormal” (FRS) es real o un artefacto. Pacientes y métodos. Realizamos un estudio observacional descriptivo que abarca 10 años (1995-2005). Se han considerado a efectos del estudio a todos los pacientes pediátricos con diagnóstico de hidronefrosis obstructiva que fueron sometidos a una pieloplastia, y controlados durante un período mínimo de 1 año tras el tratamiento quirúrgico. Resultados. De los 66 pacientes revisados 42 eran niños (63,6%)y 24 niñas (36,4%). Tras el primer renograma diurético (RD), en 57pacientes (86,4%) el tiempo medio de eliminación (T1/2) estaba por encima de los 20 minutos, en 6 casos (9,1%) estaba entre 10-20 minutos y sólo en 3 casos era menor de 10 minutos. Se observó una función renal diferencial (FRD) similar en las hidronefrosis moderadas y graves. En 11 pacientes encontramos una FRS (FRD>52%) renográfica, predominando en las hidronefrosis izquierdas, y en más del 50% de los casos este valor no coincidía con la FRD gammagráfica con ácido dimercaptosuccínico (DMSA), coeficiente de correlación de Pearson: 0,19. Estos riñones con FRS preoperatoria experimentaron un mayor descenso de la función renal postoperatoria. Conclusiones. En las hidronefrosis obstructivas el riñón contralateral sano experimenta una hipertrofia apreciable en la ecografía, pero estos diámetros ecográficos están dentro de la banda de confianza individual de la población sana de referencia. La función supranormal existe, pero en la mayoría de los casos es un artefacto (AU)

Introduction. The congenital obstruction of the pieloureteral junction(UPJ) is the most frequent cause of hydronephrosis in children. Sometimes, establishing the convenience of a surgical procedure is difficult, mainly if we consider the literature published on the spontaneous resolution of the slight, moderate and even severe hydronephrosis in newborns. Objective. To determine the prognostic value of ultrasound in the evolution of the unilateral hydronephrosis, by assessing the size of the contralateral kidney. To verify if the “supranormal” renal function(SRF) is a real or an artefact. Patients and methods. We have performed a descriptive observational study over a 10 years period (1995-2005). The study included all patients with the only diagnosis of obstructive unilateral hydronephrosis that underwent pieloplasty, and were controlled for 1 year period after the surgical treatment. Results. Of the 66 patients in the study, 42 were boys (63.6%) and24 girls (36.4%). After the first diuretic renogram (DR), in 57 of the patients (86.4%) the clearance half-time (T1/2) was over 20 minutes, in6 cases (9.1%) it was 10-20 minutes and only in 3 cases it was shorter than 10 minutes. A similar differential renal function (FRD) was observed in the moderate and severe hydronephrosis. Supranormal function (FRD>52%)was detected on DR in 11 patients, predominating in left hidronefrosis, and in more than 50% of the cases this value it did not agree with the renal function measured by dimercapto-succinic acid (DMSA), Pearson’s correlation coefficient: 0.19. These kidneys experienced a greater reduction of the postoperative renal function. Conclusions. In the unilateral obstructive hydronephrosis, the healthy contralateral kidney experiences hypertrophy detectable by ultrasound, but these ecographic diameters are within the band of individual confidence of the healthy children of reference. The supranormal function exists, but in most cases it is an artefact (AU)

Gas venoso hepatoportal secundario a diverticulitis aguda / Hepatoportal venous gas secondary to acute diverticulitis

La presencia de gas en el sistema venoso hepatoportal es una entidad muy infrecuente que se asocia a cuadros abdominales catastróficos, con una mortalidad del 75 por ciento. Se origina por la presencia de gérmenes productores de gas y/o comunicación directa del gas intraluminal con el espacio portal en casos de lesión mucosa -asociada o no a necrosis intestinal- u obstrucción intestinal. El tratamiento ha de ser combinado e intensivo, con reanimación, antibioterapia y cirugía. Se presenta un cuadro secundario a una etiología excepcionalmente citada, como es la diverticulitis aguda perforada, que inicialmente respondió al tratamiento agresivo médico y quirúrgico, aunque la evolución final fue el fallecimiento del paciente (AU)