[Benefits of pyeloplasty in children with pyeloureteral stenosis: study of somatic development and differential renal function]. / Beneficios de la pieloplastia en niños con estenosis pieloureteral: estudio evolutivo del desarrollo somático y la función renal diferencial.

INTRODUCTION: Under the actual controversy about the management of hydronephrosis for ureteropelvic junction obstruction, our objective has been to evaluate the indications and the effects of pyeloplasty as therapeutic option. MATERIAL AND METHODS: We have reviewed the charts of patients who underwent pyeloplasty, in special concerns at the preoperatory study and the postoperatory control by means of differential renal function (DRF) and half-time drainage (T1/2) on curves of Tc99m MAG3 diuretic renogram, and the effects in the body growth. RESULTS: Between 1995-1999 a total of 16 patients (17 kidneys) underwent pyeloplasty (range: 2 months to 12 years), selecting for the surgical treatment the symptomatic cases and the asymptomatics with alteration of renographic curve and/or DRF. The left side was involved in 12 cases, the right side in 3, and one case was bilateral. The malformation was detected by prenatual ultrasonography on 56.25% of cases and by several symptoms (abdominal pain, infection) in remaIns. The preoperatory DRF was normal (> or = 45%) in 53.3% and deteriorated in 46.7%. Postoperatively, global differential renal function improved significantly, with normal values in 66.7% of kidneys at first control and 75% at the second one. All the cases presented before surgery an obstructed renographic curve, with a half-time superior to 20 minutes; after pyeloplasty the excretory pattern in the diuresis renogram improved significantly, with a normal pattern (T1/2 < 10') in 54%, indeterminate (T1/2 between 11 and 20') in 26.7% and obstructive (T1/2 > 20') in 20% of cases. At the age of surgery, 29.4% of children was below the 50th percentile in weight; postoperatively, only 5.9% was, demonstrating a significant increment in all the cases. CONCLUSIONS: Pyeloplasty is an effective technique for the treatment of ureteropelvic junction obstruction in the selected cases, demonstrating a significant of differential renal function and body growth.

Beneficios de la pieloplastia en niños con estenosis pieloureteral: estudio evolutivo del desarrollo somático y la función renal diferencial / Useful pyeloplasty in children with ureteropelvic junction obstruction: evolutive study of somatic growth and differential renal function

Introducción. Ante la actual controversia con respecto al manejo de la hidronefrosis por estenosis de la unión pieloureteral, nuestro objetivo ha sido la evaluación de las indicaciones y posibles efectos beneficios de la pieloplastia como opción terapéutica. Material y métodos. Hemos registrado los datos epidemiológicos, clínicos y diagnósticos de las pieloplastias realizadas, incidiendo en el estudio preoperatorio y el control evolutivo postoperatorio mediante valores de función renal diferencial (FRD) y tiempo de eliminación TI/2 del renograma isotópico MAG3 Tc99, así como el desarrollo ponderal. Resultados. Durante los años 1995-1999 se han practicado 17 pieloplastias en 16 pacientes de edades comprendidas entre los 2 meses y 12 años, seleccionando los casos quirúrgicos en función de la sintomatología y de la morfología de la curva renográfica excretora y la FRD en los casos asintomáticos. El lado afecto fue el izquierdo en 12 casos, el derecho en tres y bilateral en uno. La malformación se detectó con ecografía prenatal en el 56,25 por ciento de los casos, mientras que en el resto el diagnóstico fue consecuencia de un cuadro clínico sintomático. La FRD preoperatoria fue normal (>= 45 por ciento) en el 53,3 por ciento y disminuida ( 20') en el 20 por ciento de los casos. En el momento de la intervencion el 29,4°' de los casos se encontraban por debajo del percentil 50 de peso, pasando al 5,9 por ciento tras la misma, apreciando un incremento global significativo del desarrollo ponderal. Conclusiones. La pieloplastia es una técnica beneficiosa en el tratamiento de la estenosis pieloureteral en los casos seleccionados, demostrando influir positivamente en la mejora evolutiva del desarrollo ponderal y de la función renal del riñón afecto (AU)

[Cystic dilation of the bile duct in childhood]. / Dilatación quística de la vía biliar en la infancia.

OBJECTIVES: Common bile duct dilatation (CBDD) represents part of a wide spectrum of pancreaticobiliary disorders, with different etiopathogenic mechanisms. The objective of this study was to compile the cases treated in our service during the last five years. PATIENTS AND METHODS: Four cases of CBDD (17 months to 10 years of age) are reported. All of them presented abdominal pain and bilious vomiting. One patient previously had pancreatitis. Cholestatic jaundice was associated in only one patient. The diagnosis was made by ultrasound, being confirmed by endoscopic retrograde cholangiopancreatography (ERCP) in three cases and by computed tomography scan (CT) in one case. RESULTS: Three patients had a single fusiform dilation of the extrahepatic bile duct (type I cyst, Alonso Lej-Todani classification), which were treated by cyst excision and hepaticojejunostomy by using a Roux-en-Y limb. In one patient, the ERCP detected a combined dilatation of the intra- and extrahepatic bile duct (type IV cyst), associated with an anomalous choledochopancreticoductal junction with a distal obstruction of the common bile duct. In the case, the treatment consisted of a transduodenal esfintherotomy. CONCLUSIONS: Based on our experience and a literature review, an increasing incidence of this pathology is deduce. Therefore, the relevance of ultrasounds and ERCP in the diagnosis and visualization of pancreatobiliary ducts and the choice of treatment, depending on the CBDD, are discussed.

[Thyroglossal duct cysts. Do prior inflammatory episodes influence the number of recurrences?]. / Quistes del conducto tirogloso. Influyen los episodios inflamatorios previos en el número de recidivas?

INTRODUCTION: The most common complication in the treatment of thyroglossal duct cysts (TDC) is the high index of relapses. An analysis of this index and the influence of previous inflammatory episodes are presented. PATIENTS AND METHODS: A retrospective study of 120 consecutive TDC cases operated on during a period of 23 years, from 1972 to 1994, is presented. The statistical study was done using the Chi square test and the contrast of hypothesis for two proportions. RESULTS: The mean age of the patients was 4.9 years, with 93 cases (77%) being operated before 7 years of age. An inflammatory episode before surgery occurred in 57 cases (47%). Treatment was the Sistrunk technique in 112 cases (93%) and a simple excision of the cyst in 8 cases, with a relapse occurring in 4 of the latter cases (50%). Those cases where the Sistrunk technique was performed were divided into two groups: Group I (56 cases) those patients which had suffered an inflammatory episode before surgery and group II (56 cases) those that had not. Five relapses (8.9%) were found in group I and 2 (3.5%) in group II. CONCLUSIONS: TDC are fore frequent during early childhood, occurring most frequently before 7 years of age. The number of relapses are dramatically reduced when the Sistrunk technique is used, but no significant differences were found in those that had suffered previously an inflammatory episode.

[Which is the role of laparoscopic surgery in the treatment of cryptorchism?]. / Cúal es el lugar de la cirugía laparoscópica en el tratamiento de la criptorquidia?

OBJECTIVES: The present study analyzed the indications for laparoscopic surgery in cryptorchidism. METHODS: The clinical, surgical and anatomopathological data of 2000 cryptorchid testes submitted to surgery from 1972 to 1993 were reviewed. RESULTS: 17.75% (355 testes) were not palpable at physical examination; of these, 3.45% (69 cases) were anorchid and only 5.4% (108 testes) of the remaining 14.3% were true intra-abdominal testes. The other 8.9% were localized elsewhere. Scrotal descent was achieved only by funiculolysis in 68% of the cases. The remaining 28% (30 testes, since the technique used was not reported in 5) were brought to the scrotum using two-stage procedures, Stephen-Fowler and autotransplantation (one case), which could have been replaced or preceded by laparoscopy. Of the 30 testes, 10 were removed. CONCLUSIONS: Since only 5% (20 testes) can benefit from laparoscopic techniques and, moreover, 68% have a very low tubular fertility index and there is an increased possibility of progressing to malignancy, if other than standard surgical techniques are warranted in cases with unilateral cryptorchidism, testis removal is preferable, which further reduces the application of laparoscopy in cryptorchidism.