Perineal transsphincteric derivation of urine. Experimental study in rabbits.

AIM OF THE STUDY: We present the experimental results of a new technique that makes use of the anal sphincter to achieve urinary continence in individuals with major congenital defects of the urinary sphincter. METHODS: 50 New Zealand White rabbits were assigned to one of 6 groups and a different surgical procedure was carried out for each group under general anaesthesia with isoflurane alone or isoflurane and local anaesthesia. Variables of interest were: number, consistency and morphology of the faeces, number, shape and location of the stains of urine, histological changes and biochemical parameters in blood. RESULTS AND CONCLUSIONS: The best anaesthetic levels were obtained with 2 % isoflurane and local anaesthesia. The surgical procedure demonstrated its usefulness in achieving urinary continence in all rabbits, although an initial self-limited period of incontinence was common. No histologic alterations were detected, but a significant increase in the levels of urea and creatinine in blood was identified, most likely reflecting an obstructive uropathy.

Saccular aneurysm in arm secondary to accidental arterial puncture.

We present a rare case of saccular aneurysm localised in the arm of a breast-feeding baby, secondary to accidental arterial puncture. Colour Doppler echography showed a cystic lesion with turbulent arterial flow related to the humeral artery. Complete surgical resection of the aneurysm was achieved.

Hendidura superficial media de cuello / The midline cervical cleft

Teniendo en cuenta la anatomía e histología de los 4 casos tratados en niños de hendidura superficial media del cuello de este trabajo y revisando la literatura se establece una relación etiológica entre esta malformación congénita y los quistes broncógenos subcutáneos cervicales de la linea medía. Sus relaciones anatómicas e histológicas con presencia en ambas de epitelio cilíndrico ciliado seudoestratificado parece ser determinante. Las diferencias anatómicas con el quiste tirogloso, aún a pesar de su coincidencia en el contenido de epitelio ciliado, indican que sean procesos de embriología distinta. En un niño de 6 meses se practicó, por su pequeño tamaño, únicamente la extirpación del proceso sin Z plastia con buen resultado tres meses después. (AU)

[The superficial midline cervical cleft]. / Hendidura superficial media de cuello.

Given the anatomy and the histology of the 4 cases of children with a midline cervical cleft presented in this work, and after reviewing the specific literature, an etiologic relationship between: this congenital malformation and the subcutaneous midline cervical bronchogenic cyst can be established. The presence of pseudostratified ciliated columnar epithelium in both entities and their anatomic relationship are determinant. The anatomic differences with the thyroglossal duct cyst indicated that their embryological origins were different, in spite of the presence of ciliated epithelium. In a 6 months old infant, the extirpation of the lesion without practicing a Z-plasty was carried out due to the small size of the malformation with good result after 3 months.

[Alterations of nuclear maturity in spermatozoids of males with antecedents of cryptorchidism]. / Alteraciones de la madurez nuclear en espermatozoides de varones con antecedentes de criptorquidia.

The association between infertility and cryptorchidism is an accepted fact, usually attributed to the oligozoosperm, asthenozoosperm or teratozoosperm presented in ejaculation products of males with this antecedent. The nuclear maturity in a sample of men with antecedents of cryptorchidism have been studied and these results have been compared to those of a control group. The results of this work show the deficient transformation of nuclear proteins to protamines in males with antecedents of cryptorchidism compared to the control group, due to the remaining of immature histones. Alterations of nuclear maturity able to contribute to the subfertility of these men were found in spermatozoids of adult males with antecedents of cryptorchidism.

Alteraciones de la madurez nuclear en espermatozoides de varones con antecedentes de criptorquidia / Alterations of nuclear maturity in spermatozoids of males with antecedents of cryptorchidism

La asociación de infertilidad y criptorquidia es un hecho aceptado. Casi siempre se ha atribuido a la oligozoosperrmia, astenozoospermia o teratozoospermia que presentan los eyaculados de los varones con este antecedente. Hemos estudiado la madurez nuclear de los espermatozoides de un grupo de varones con antecedentes de criptorquidia y la hemos comparado con la de un grupo control. Los resultados de este estudio demuestran la deficiente transformación de las proteínas nucleares en protaminas en los varones con antecedentes de criptorquidia respecto al grupo control, permaneciendo en su estado inmaduro de historias. En los espermatozoides del eyaculado de varones adultos con antecedentes ele criptorquidia encontramos alteraciones de la madurez nuclear que pueden contribuir a la subfertilidad de los mismos (AU)

Absceso pulmonar en la infancia sobre malformación congénita subyacente / Childhood lung abscess associated with an underlying congenital malformation

En la actualidad el absceso pulmonar en la infancia constituye una entidad de baja frecuencia, debido a los avances producidos en el campo de la antibioticoterapia y a un tratamiento más precoz de sus factores predisponentes. El presente trabajo describe 3 casos diagnosticados en un periodo de 15 años, tratados con éxito mediante intervención quirúrgica (lobectomía de la zona afectada). Todos y cada uno de los casos asentaban sobre una patología malformativa congénita de base, como puso de manifiesto el examen histopatológico de la pieza resecada. Se pone énfasis en la necesidad de sospechar y tratar quirúrgicamente dicha patología malformativa pulmonar ante todo caso de absceso pulmonar recidivante y resistente a tratamiento médico (AU)

Duplicación quística de yeyuno asociada a malrotación intestinal: presentación como abdomen agudo neonatal / Jejunal duplication cyst associated with intestinal malrotation: presentation as neonatal acute abdomen

La malrotación intestinal es una eventualidad frecuente que constituye una causa predominante de obstrucción intestinal alta en el recién nacido. Por otro lado, las duplicaciones digestivas son malformaciones congénitas infrecuentes cuyo diagnóstico clínico es dificultoso. La asociación de duplicación intestinal y malrotación es extremadamente rara, habiéndose descrito tan sólo 12 casos previos. Presentamos el caso de una recién nacida que debutó con obstrucción intestinal alta por vólvulo de intestino medio asociado a duplicación yeyunal quística, que evolucionó satisfactoriamente tras la intervención quirúrgica (AU)

La pexia recto-sacra en el tratamiento del prolapso rectal refractario a tratamiento conservador / Rectal fixation to promontorium in the management of rectal prolapse non-responding to conservative treatment

Introducción. Presentamos los casos de 20 pacientes sometidos a la técnica de Reifferscheid (fijación de la cara posterior del recto a la anterior del sacro) desde 1967 hasta 1997. Pacientes y métodos. Un total de 20 pacientes han sido tratados mediante la técnica de Reifferscheid. Se establecieron dos grupos: de 1967 a 1972 se trataron 10 enfermos (grupo A) y de 1974 a 1997 otros 10 (grupo B). En todos los casos se registraron la edad en el momento de la intervención, el sexo, los posibles diagnósticos secundarios, la vía de abordaje, las eventuales complicaciones y el estado del paciente a medio plazo. Resultados. Grupo A: edad media: 2,15 años; sexo: 7 niñas (5 de ellas presentan mielomeningocele asociado) y 3 niños; incisión de Pfannenstiel o pararrectal izquierda (lactantes). Seguimiento: 2 años, sin recidives. Grupo B: edad media: 2,5 años, 9 varones (dos de ellos presentaban mielomeningocele) y una niña. No recidiva del prolapso en ningún caso. Discusión. Los excelentes resultados obtenidos en nuestra experiencia con la aplicación de esta técnica de fijación recto-sacra contrastan con los pobres resultados que muestran otras técnicas referidas en la literatura. Por ello, en pacientes que presentan prolapso rectal grave, en especial en aquellos asociados a otro tipo de patologías, la pexia recto-sacra se muestra como una técnica útil y segura a largo plazo (AU)

[Recto-sacral fixation in the treatment of rectal prolapse refractory to conservative treatment]. / La pexia recto-sacra en el tratamiento del prolapso rectal refractario a tratamiento conservador.

INTRODUCTION: The clinical cases of 20 patients submitted to Reifferscheid intervention (fixation of rectum to promontorium) between 1967 and 1997 are presented. PATIENTS AND METHODS: Twenty patients have been treated by means of the operation of Reifferscheid. They were divided in two groups: from 1967 to 1972, ten patients were submitted to this technique (group A). From 1974 to 1997, other ten patients (group B). In each case, the following items were registered: sex, eventual secondary diagnosis, incision, complications, middle-term evolution. RESULTS: Group A: Middle age: 2.15 years old. Sex: 7 girls (5 of them presented mielomeningocele) and 3 males; pararectal incision for babies, Pfannenstiel incision for children over 1 year-old. FOLLOW-UP: 2 years without recidives. Group B: Middle age: 2.5 years-old, 9 males (2 of them were diagnosed of mielomeningocele) and 1 girl. No recidives were detected. DISCUSSION: These excellent results obtained with Reifferscheid operation contrast with the poor results referred by other authors for other therapeutical approaches. That is why, in patients affected of serious rectal prolapse, especially when associated to other pathologies, rectal fixation to promontorium is an useful and long-term sure approach.

Cardiac injury from an air gun pellet: a case report.

Air guns are tools which each day become more powerful serious or even fatal accidents are caused by them. We report the clinical case of a 10-year old patient who received an accidental shot puncturing the right auricle, with generation of an important hemopericardium. A favorable evolution followed conservative treatment. However, we want to emphasize the potential gravity of injuries caused by this type of weapon.

[Macrostomia secondary to transverse facial cleft of Tessier No.4]. / Macrostomía secundaria a hendidura facial transversa de Tessier n-0 4.

A case of bilateral macrostomia type transverse facial cleft of Tessier n. 4 is reported, which was operated on with good results when had ten months of age, repaired using suture of three planes of three embryonic folds. A treatment plain precocious is recommended and pathogenic theories about this uncommon entity are exposed.

[The usefulness of ultrasonography in the diagnosis of acute appendicitis in children]. / Utilidad de la ultrasonografía para el diagnóstico de apendicitis aguda en la infancia.

The main objective of the present report was the evaluation of the utility of echography as a diagnostic method in abdominal pain suspicious of acute appendicitis. A control-case study was performed in 165 children hospitalized for abdominal pain. Appendicitis histologically confirmed were considered cases (n = 110) while control (n = 55) were the not-operated patients (46 children) or the not-confirmed appendicitis after laparotomy (n = 9). The variables considered here were: the results of echography (Eco+ when echography showed signs of acute appendicitis: Eco- when not), the age of the patient (randomized at three groups; < 6, 6-9, > 9 years), and the conclusions of fisical exploration (conclusive or not as acute appendicitis). The results were analyzed statistically with the SPSS program, calculating the following predictive values; sensibility, specificity, positive predictive value, negative predictive value. Odds Radio before and after test and the global value of echography. Authors conclude that ultrasonography as method of support to abdominal exploration for diagnostic in acute appendicitis is manifest and present a global value of 70.90%.

[Gonadal, hormonal and spermatic function in patients treated for cryptorchidism]. / Función gonadal hormonal y espermática en pacientes tratados por criptorquidia.

This paper studies the gonadal-hormonal and spermatic function of 48 adults (over 18 years old) who were treated in childhood for cryptorchidism by medical, surgical or both treatments. We measure plasmatic levels of FSH, LH, testosterone and prolactin of 34 patients and sperm samples of 31 patients. The testicular hormonal function was not disturbed except in four patients with high levels of prolactin (> 20 ng/ml) without symptoms. The spermatic function was disturbed in bilateral cryptorchidism mainly. The better sperm quality and testicular volume were at patients treated with hormonal treatment before surgical treatment.

Scrotal lymphangioma in children.

The intrascrotal localization of lymphangioma in children is uncommon, especially when the lymphangioma does not depend on testicular structures. We present the case of a 13-year-old male who started with a right intrascrotal mass unconnected with the testicle, clinically and ultrasonically compatible with cystic lymphangioma. The mass was excised because of progressive growth over the previous 5 months, and at surgery a scrotal lymphangioma was disclosed projecting towards the umbilical area through the subcutaneous cell tissue of the anterior abdominal wall. There have been no complications or recurrences to date, 6 months afterwards. Surgical removal is the only efficacious therapeutic approach and is the best way to achieve a definitive diagnosis in these patients.

[Deferred appendectomy in a case of appendiceal mass]. / Apendicectomía diferida en caso de plastrón apendicular.

The treatment of acute appendicitis when appendix is technically impossible to remove, remains controversial. The clinical case of a 12-years-old child diagnosed of acute appendicitis in which appendectomy was not initially performable is presently described. After treatment with antibiotics, he was submitted to appendectomy five months later. Operative and pathologic findings in this second laparotomy prove the predisposition of the patient to a second acute appendicitis, and uphold the preventive attitude, the interval appendectomy.

[Hormonal response and two special techniques of postoperative analgesia in pediatric surgery]. / Respuesta hormonal con dos técnicas distintas de analgesia postoperatoria en cirugía pediátrica.

AIMS: We studied neuroendocrine response in the postoperative pain relief in pediatric patients treated with two analgesic techniques (conventional intravenous analgesia and patient controlled analgesia). MATERIAL AND METHODS: A double blind study was made in 30 patients, 6-14 year-old children, under total intravenous anesthesia for programmed surgery. An intravenous analgesia dose of 0.5 mg/Kg was given 10 minutes before operation was finished. Postoperative analgesia was achieved by two techniques: A. Patient controlled analgesia (PCA), and B. Conventional intravenous analgesia every 6 hours. Hormones measurements were made (catecholamines, cortisol, ACTH and beta-endorphin), hemodynamic monitoring (blood pressure and heart rate), and pain measurement (Hannallah's score) in both pre and postoperative times (1, 6 and 24 hours after operation). RESULTS: Pain score was low and without significant differences in both groups (p > 0.05). beta-endorphin level decreased in both groups, and a cortisol and catecholamine level increase was noticed at 6 hours after operation; these changes were less significant in PCA group (p < 0.001). ACTH level did not change significantly in both groups. Hemodynamic monitoring measurements were not significantly different. CONCLUSIONS: Both analgesic techniques were appropriate to postoperative pain relief in pediatric patients. Low pain score shows better conditions to attend these patients. We suggest PCA technique is better to treat postoperative stress response following pediatric surgery.

[Determining factors of nutritional status in a pediatric surgical unit]. / Factores determinantes del estado nutricional en una población pediátrica médico-quirúrgica.

Nutritional assessment was made in 134 pediatric patients before surgery in order to analyze the influence of age, sex anthropometric nutritional index and type of surgical operation (urgent vs elective). The anthropometrical index, hematology measurements and serum protein levels were compared by using a one-way ANOVA and a linear correlation was performed when appropriate. The type of surgery and age of the patient were the factors which influence nutritional status the most among the pre-operatively screened surgical pediatric patients. In addition, pre-albumin, retinol-binding protein and acute-phase proteins have been shown to be affected by stress and appear to be more sensitive indicators of nutritional state than comparison of the types of surgery.