[Paratesticular dermoid cyst. Report of a case and review of the literature]. / Quiste dermoide paratesticular. Aportación de un caso y revisión de la literatura.

It is discussed a dermoid cyst case that depends on paratesticular structures, clinical entity which has low frequency of presentation. It is analyzed the controversial terminology of this tumours and are established anatomopathological criteria for this disease.

Quiste dermoide paratesticular. Aportación de un caso y revisión de la literatura / Paratesticular dermoid cyst. Presentation of one case and bibliographic revision

Se presenta un caso de un quiste dermoide que depende de las estructuras paratesticulares, entidad clínica de baja frecuencia de presentación. Se analiza la controvertida terminología de estos tumores y se establecen los criterios anatomopatológicos de esta enfermedad que preside el diagnóstico (AU)

It is discussed a dermoid cyst case thath depends on paratesticular structures, clinical entity which has low frecuency of presentation. It is analyced the controversial terminology of this tumours and are established anatomopathological criteria for this disease (AU)

Brugada syndrome in a patient with accessory pathway.

Brugada syndrome in a patient with Wolff-Parkinson-White syndrome. We report a 32-year-old man with orthodromic atrioventricular (AV) reciprocating tachycardia using a right posterior accessory pathway. However, his ECG showed ST segment elevation in leads V1 to V3. After successful radiofrequency ablation of his accessory pathway a cardioverter defibrillator was implanted.

Bronquiolitis en la infancia. Revisión de 90 casos / Bronchiolitis in childhood: a review of 90 cases

La bronquiolitis aguda es la infección respiratoria aguda más frecuente en lactantes; su causa fundamental, en la mayoría de los casos, es el virus respiratorio sincitial (VRS). Presentamos una revisión epidemiológica de 90 pacientes ingresados en el Hospital General Universitario 'Gregorio Marañón', en los que se estudiaron diversos factores, como sexo, edad de presentación, gravedad clínica, morbimortalidad, transmisión nosocomial y tratamiento. Este estudio retrospectivo permitió obtener conclusiones de aplicación en la práctica clínica diaria (AU)

[Primary stent implantation in aortic coarctation: mid-term follow-up]. / Implantación primaria de stent en la coartación de aorta: seguimiento a medio plazo.

BACKGROUND: The use of balloon-expandable stents provides an effective alternative therapy in patients with stenotic lesions in congenital heart disease. Stents implantation has served to improve the results and to reduce complications of balloon angioplasty for coarctation and recoarctation of the aorta. OBJECTIVE: We report our results after primary stents implantation for coarctation and recoarctation of the aorta. PATIENTS AND METHODS: Balloon-expandable stents were implanted in 14 patients (mean age 20 +/- 12 years) with coarctation of the aorta (11 native and 3 postoperative); 2 patients had associated malformations. The morphology varied: 10 resembled a located-diaphragm (one of them with moderate arch hypoplasia); 2 had distorted coarctation and 2 had a complete aortal obstruction. Five patients were hypertensive and 1 had cardiogenic shock and severe arrhythmias which did not respond to intensive medical therapy. In all cases 14 Palmaz stents (7 P308 and 7 P4014) were implanted with the primary technique through a Mullin's sheath. The balloon-to-descending aorta diameter ratio, measured at the level of the diaphragm, was 1. A special technique was carried out in the 2 cases with complete aortal obstruction. RESULTS: The procedure was effective in all 14 cases. The coarctation diameter increased from 4 +/- 2 to 15 +/- 2 mm (p < 0.0001) and transcoarctation systolic pressure gradient decreased from 43 +/- 19 to 2 +/- 2 mmHg (p < 0.0001). The ratio of the coarctation to descending aorta diameter measured at the level of the diaphragma increased from 0.3 +/- 0.1 to 0.95 +/- 0.05 (p < 0.001). At 19 +/- 8 months follow up, all patients showed sustained clinical improvement. The patient with complete aortal obstruction experienced a dramatic improvement, but she died from a sudden cardiac event 22 months after the procedure. At angiographic follow up in 7 patients, 1 year after implantation, no recoarctation was observed with secondary vessels patent, and absence of restenosis. CONCLUSIONS: a) Percutaneous endovascular stents implantation in coarctation and recoarctation of the aorta may become an effective treatment modality in the older child, adolescent and adults; b) stents are particularly attractive in those patients with a more complex anatomy and higher surgical risk; c) primary stenting is expected to have a lower rate of complications, and d) we describe a special technique with a right femoral-left humeral arterial circuit that is successfully applied to patients with complete aortal obstruction.

[Experience with Palmaz stent in pulmonary branch stenosis]. / Experiencia con el stent de Palmaz en la estenosis de rama pulmonar.

INTRODUCTION AND OBJECTIVES: Since 1989, the balloon expandable Palmaz stent (Johnson & Johnson Interventional Systems) has been used for the treatment of congenital heart disease. This study reports the results and the technique used for its implantation in native and post surgical retraction pulmonary branch stenosis. MATERIALS AND METHODS: From february 1995 to june 1996, we have performed this technique in 11 symptomatic children/adolescents with pulmonary branch stenosis, the mean age was 11 +/- 2 years. Fourteen procedures were made and 16 stents were implanted. The mean condition of the patients was: 7 with tetralogy of Fallot after a previous complete correction, 1 with Noonan syndrome and a surgically corrected atrial septal defect, 1 with pulmonary trunk aneurysm and a previous surgical correction for pulmonary valve and branch stenosis, 1 with pulmonary atresia and an intact septum who underwent a surgical valvotomy and posterior percutaneous valvuloplasty with a good ventricular development, and final was a tricuspid atresia with a previous Waterston anastomosis which produced a stenosis at the right pulmonary branch who underwent a modified Fontan operation with the result of a severe stenosis at the medial and inferior right pulmonary artery. The branch ostium was affected in five cases, and in one case with diffuse hypoplasia of the right branch, the stenosis was at both sites. The stenosis was native in nine cases and post surgery in the other five (2 Waterston, 1 Blalock-Taussig, 1 Fontan). We used the right and/or left femoral vein in all cases except two, in which we used the internal jugular vein. We followed the technique reported by the Boston-Houston experience, with an extra stiff guide and Mullins sheath towards the site of the stenosis. RESULTS: The procedure was effective in all cases except one. The mean pulmonary branch and balloon diameter was 11 +/- 3 mm and 14 +/- 2 mm, respectively, rate 1.2. The stenosis diameter rose from 4.8 +/- 1 to 11 +/- 2 mm (p < 0.001) with a percentage fall from 63 +/- 5 to 2 +/- 1% (p < 0.001). The pressure gradient fell from 30 +/- 5 to 5 +/- 1 mmHg (p < 0.001) and the right ventricle systolic pressure fell from 77 +/- 6 to 48 +/- 3 mmHg (p < 0.01). The mean followup was 10 +/- 3 months, a symptomatic and pulmonary perfusion improvement was seen. After 8 +/- 4 months, we evaluated six patients/nine stents with angiography, and we excluded thrombosis, aneurysms and occlusion of lobar or segmental branches. One case had a proximal stent re-stenosis as it did not cover the whole stenosis, so a new stent was implanted. Three patients/four stents underwent redilatation getting a slightly higher diameter than previously. COMPLICATIONS: One patient had a stent migration and he underwent surgical stent retrieval. CONCLUSIONS: Implantation of the Palmaz stent is a useful procedure for the treatment of native or post-operative pulmonary stenosis. It is possible to apply it to hypoplastic and ostial pulmonary stenosis. We confirm the effectiveness of redilatation at mid term.

[Acute right ventricular insufficiency reversible following anthracycline treatment]. / Insuficiencia ventricular derecha aguda reversible tras tratamiento con antraciclinas.

Anthracyclines are very effective antineoplastic agents for the treatment of acute leukemia. Early and late dose-related cardiotoxicity can occur. We present a 33 year old women who developed a reversible right heart failure fifteen days after receiving a treatment with doxorubicine. Severe regional wall motion abnormalities were appreciated through two-dimensional and Doppler-flow echocardiography, there was no evidence of impaired systolic or diastolic left ventricle function. Two weeks later, remission of acute right ventricle failure was obtained, echocardiographic assessment was normal at this time. Incidence of right ventricle abnormalities after treatment is discussed.

[Angioplasty of the stenotic Blalock-Taussig]. / Angioplastia del Blalock-Taussig estenótico.

BACKGROUND: Balloon angioplasty is a useful therapeutic method in some congenital heart diseases. We show our experience of stenotic Blalock-Taussig angioplasty, which was effective in six cases. PATIENTS AND METHODS: Six symptomatic patients with different congenital heart diseases, reduced pulmonary blood flow and a previous Blalock-Taussig shunt (it was classic in three patients and modified in another three) underwent the procedure. Conventional angioplasty was performed in four cases and coronary angioplasty technique, under monorail system, was applied in the other two. RESULTS: After angioplasty, we observed an increase in the minimum luminal diameter from 1 +/- 0.7 to 4 +/- 0.5 mm (p < 0.01), a reduction in the percentage of the stenosis from 77 +/- 15 to 13 +/- 13 (p < 0.01) and an increase in oxygen saturation from 63 +/- 10% to 82 +/- 5% (p < 0.05). The effectiveness of the technique in an extreme case of a thrombosed Blalock-Taussig, hours later the surgery, is reported. In the follow-up, we observed a symptomatic improvement, stable oxygenation levels, and a tendency in the hematocrit reduction. CONCLUSION: We consider that angioplasty of Blalock-Taussig shunt is indicated in those symptomatic patients, in whom a complete surgical correction is contraindicated. We demonstrate the effectiveness of the procedure, the coronary angioplasty, under monorail system is very useful for the stenotic modified Blalock-Taussig. It can be an effective technique when there is a postoperative thrombosis of the fistula.

[Cystic ureteritis. Presentation of a new case and review of the most recent national literature]. / Ureteritis quística. Presentación de un nuevo caso y revisión de la literatura nacional más reciente.

We report on a patient with this uncommon condition that presented without hematuria and in association with a rare abdominal and thoracic malformation known as situs inversus. A review of the literature focussing on recently reported cases in the Spanish literature revealed it to be a disease of unknown etiology whose pathogenesis is not well-established, clinical features unspecific, without treatment for the underlying cause, and is a radiologic diagnostic difficulty requiring a differential diagnosis from other filling defects in the urothelium.

[Enuresis. Results of a new therapeutic approach]. / Enuresis. Resultados de un nuevo enfoque terapéutico.

We present the results of the pharmacological treatment of a syndromic entity particularly common in childhood with a new Oybutinine Chloride drug. We point out that we have achieved positive results in more than 75% from the standpoint of improvement or clinical cure and more than 50% from the urodynamic viewpoint, in the sense of disappearance or improvement of vesical stability. We underline the perfect tolerance of the drug with very few side effects. We conclude that this drug represents a valid alternative in the treatment of this syndrome, although it would be desirable for its effects not to call for such prolonged treatment, which would result in better compliance with the dosages on the part of the patients or heir relatives in the case of small children.

[Seminal vesicular agenesis, non-invasive diagnosis. Presentation of a case and review of the literature]. / Agenesia de vesícula seminal, diagnóstico no invasivo. Presentación de un caso y revisión de la literatura.

We report on a case of unilateral agenesia, a rare disorder, in a patient with children who consulted for unspecific discomfort. The patient had previously undergone vasectomy. During the procedure however, the ipsilateral deferent duct could not be localized. The foregoing led us to suspect this disorder. A review of the scant literature available on this condition reflect how uncommon it is, particularly in fertile subjects. Moreover, the literature shows that invasive diagnostic methods (deferent-vesiculography, puncture, etc.) have been replaced by ultrasound and computerized axial tomography.

[Psoriasis and chronic vitamin A poisoning]. / Psoriasis e intoxicación crónica por vitamina A.

A case of a five year old girl who during a treatment with high doses of A and D vitamins prescribed for a long time because "psoriasis" is showed. Clinical, radiologic and biochemical symptomatology of chronic poisoning by vitamin A is proved. Authors want to draw attention to dangers of long use of vitamin A.

[Incidence, clinical, forms and complications of meningococcal infections (author's transl)]. / Incidencia, formas clínicas, complicaciones y secuelas de la infección meningocócica.

Eighty four cases of meningococcal infections are reviewed. Fifty seven cases presented themselfs as meningococcal meningitis, twelve cases as sepsis with moderate hypotension and 15 cases were sepsis with septic shock. A brief course of the disease, shock, echymosis, absence of meningeal signs, leucopenia and intravascular coagulation were findings more frequent in the group of patients with hiperacute sepsis, whereas other signs as fever, headaches, vomiting and petechiae were present with equal frequency in the three groups. N. meningitis was isolated in 73% of the cases. Shock (18.85%) and intravascular coagulation (12%) were the complications more frequently found, followed by convulsions (4.81%), arthritis (4.81%), skin necrosis (4.81%), subdural efusion (3.57%), cerebral palsy (3.40%), thrombophlebitis (1.20%), recurrence (1.20%), inapropiate antidiuretic hormone secretion (1.20%) and subaracnoideal hemorrage (1.20%). The overall mortality was 10.70% and 60% of the patients which initially presented with shock and intravascular coagulation died. Autopsy findings included wide spred hemorragic lesions and intravascular thrombi in skin, mucous membranes and viscera. Adrenal hemorrhage was present in five of the six cases studied.