Pleural effusion in a child with a correctly placed ventricle-peritoneal shunt.

Pleural effusions in children (PE) due to ventricle-peritoneal shunt (VPS) is very rare, with few cases reported. We present a new case of an infant with VPS who had a massive hydrothorax not associated with misplacement or migration of the distal catheter or with ascites. After the evacuation of the PE we managed the patient by adjusting the pressure of the adjustable valve (AV). Sequential thoracic ultrasounds showed a satisfactory outcome. We review the literature thoroughly and describe the possible pathophysiological mechanisms.

[The effect of age on the prognosis of patients with traumatic brain injury who undergo a craniotomy: analysis of a surgical series]. / Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.

INTRODUCTION: In our setting, the ageing of the population has led to management of traumatic brain injury (TBI) in the later stages of life becoming an increasingly frequent problem. AIM: To evaluate the association between age and the functional and survival prognosis of patients who have undergone surgery due to TBI. PATIENTS AND METHODS: We performed a retrospective analysis of a series of 404 patients submitted to surgery between the years 2000 and 2015: 144 youngsters (12-44 years), 77 adults (45-64 years), 148 geriatric patients (65-79 years) and 26 'super geriatric' patients (> 80 years). We reviewed the demographic and nosological characteristics of the population, the survival and functional prognosis (Glasgow Outcome Scale, GOS) on discharge and at six months. RESULTS: Age presents a positive linear association with both intra-hospital mortality and the proportion of patients with an unfavourable prognosis (GOS 1-3) on hospital discharge and at six months (p < 0.001). Taking the population of youngsters as a reference, the relative risk for an unfavourable prognosis at six months was 1.5 (95% CI: 1.04-2.19) for adults; 2.37 (95% CI: 1.77-3.17) for the geriatric patients; and 3.5 (95% CI: 2.63-4.7) for the 'super geriatric' patients. These latter present a mortality rate while in hospital of 77.78% and a percentage of poor functional prognosis at six months of 94.44%. CONCLUSION: Increased age is a major negative determining factor in the prognosis of patients who undergo a craniotomy due to TBI. More precise knowledge of these outcomes and an adequate pre-operative discussion with the family will be an invaluable aid in the decision-making process.

TITLE: Efecto de la edad en el pronostico de pacientes con traumatismo craneoencefalico sometidos a craneotomia: analisis de una serie quirurgica.Introduccion. En nuestro entorno, el envejecimiento poblacional ha convertido el manejo del traumatismo craneoencefalico (TCE) en etapas avanzadas de la vida en un problema de frecuencia creciente. Objetivo. Valorar la asociacion entre la edad y el pronostico vital y funcional de pacientes intervenidos por TCE. Pacientes y metodos. Analizamos retrospectivamente una serie de 404 pacientes intervenidos en nuestro centro entre los años 2000 y 2015: 144 jovenes (12-44 años), 77 adultos (45-64 años), 148 pacientes geriatricos (65-79 años) y 26 supergeriatricos (> 80 años). Revisamos las caracteristicas demograficas y nosologicas de la poblacion, y el pronostico vital y funcional (escala pronostica de Glasgow, GOS) en el momento del alta y a los seis meses. Resultados. La edad presenta asociacion lineal positiva tanto con la mortalidad intrahospitalaria como con la proporcion de pacientes con pronostico desfavorable (GOS 1-3) en el alta y a los seis meses (p < 0,001). Tomando como referencia la poblacion de jovenes, el riesgo relativo para pronostico desfavorable a los seis meses fue de 1,5 (IC 95%: 1,04-2,19) para los adultos, 2,37 (IC 95%: 1,77-3,17) para los geriatricos y 3,5 (IC 95%: 2,63-4,70) para los supergeriatricos. Estos ultimos presentan una mortalidad durante el ingreso del 77,78% y un porcentaje de mal pronostico funcional a los seis meses del 94,44%. Conclusion. El aumento de la edad es un factor determinante negativo mayor en el pronostico de pacientes sometidos a craneotomia por TCE. Un conocimiento preciso de estos resultados y una adecuada discusion preoperatoria con la familia resultaran de gran ayuda en el proceso de toma de decisiones.

Completeness of T, N, M and stage grouping for all cancers in the Mallorca Cancer Registry.

BACKGROUND: TNM staging of cancer is used to establish the treatment and prognosis for cancer patients, and also allows the assessment of screening programmes and hospital performance. Collection of staging data is becoming a cornerstone for cancer registries. The objective of the study was to assess the completeness of T, N, M and stage grouping registration for all cancers in the Mallorca Cancer Registry in 2006-2008 and to explore differences in T, N, M and stage grouping completeness by site, gender, age and type of hospital. METHODS: All invasive cancer cases during the period 2006-2008 were selected. DCO, as well as children's cancers, CNS, unknown primary tumours and some haematological cases were excluded. T, N, M and stage grouping were collected separately and followed UICC (International Union Against Cancer) 7th edition guidelines. For T and N, we registered whether they were pathological or clinical. RESULTS: Ten thousand two hundred fifty-seven cases were registered. After exclusions, the study was performed with 9283 cases; 39.4 % of whom were women and 60.6 % were men. T was obtained in 48.6 % cases, N in 36.5 %, M in 40 % and stage in 37.9 %. T and N were pathological in 71 % of cases. Stage completeness exceeded 50 % in lung, colon, ovary and oesophagus, although T also exceeded 50 % at other sites, including rectum, larynx, colon, breast, bladder and melanoma. No differences were found in TNM or stage completeness by gender. Completeness was lower in younger and older patients, and in cases diagnosed in private clinics. CONCLUSIONS: T, N, M and stage grouping data collection in population-based cancer registries is feasible and desirable.

Valores de referencia del antígeno prostático específico (PSA) en 63.926 trabajadores sin síntomas prostáticos que participaron en el cribado de cáncer de próstata desarrollado por la Sociedad de Prevención de Ibermutuamur durante el año 2006 / Reference values of prostate specific antigen (PSA) in 63926 workers without prostatic symptoms who participated in prostate screening cancer developed by the Ibermutuamur Prevention Society in 2006

Objetivo: Determinar los valores de referencia de PSA en trabajadores españoles sin antecedentes de problemas prostáticos y compararlos con otras latitudes geográficas. Métodos: Estudio observacional, retrospectivo, multicéntrico y con base poblacional realizado entre 01 de enero y 31 de diciembre de 2006. De los 65.303 trabajadores que participaron en el Programa de cribado del cáncer de próstata realizada por la Sociedad de Prevención de Ibermutuamur en diferentes regiones españolas. De ellos, fueron seleccionados para este informe, 63926: 149 fueron excluidos por historia personal de problemas prostáticos y 1.328 por ser mayores de 64 años. Las determinaciones de PSA se realizaron mediante la prueba de Abbott. Se especificaron los valores de PSA para cada edad y para los rangos de edad: menores de 40 años, 40–49 años, 50–59 años y 60–64 años. También se calcularon las medias de los valores de PSA por Comunidades Autónomas. Los datos fueron expresados como media (±DE), los intervalos de confianza al 95%, error estándar de la media (SEM) y en los percentiles 5, 25, 50, 75 y 95. Los resultados obtenidos fueron comparados con los de otras zonas del mundo. Todos los datos fueron analizados utilizando el programa estadístico GraphPad Quick Calculs. Resultados: Valor medio de PSA: para todos los casos fue de 1,06ng/ml (95% IC: ±1,18); por grupos de edades: menores de 40 años, 0,67ng/ml (95% IC: ±0,49), 40–49 años, 0,77ng/ml (95% IC: ±0,66), 50–59 años, 1,11ng/ml (95% IC: ±1,22) y 60–64 años, 1,57ng/ml (95% IC: ±1,72). Según la edad, osciló entre 0,67ng/ml menores de 40 años y 1,70 en los 64 años. Por Comunidades Autónomas, el valor más bajo se registró en el País Vasco con 0,98ng/ml (95% CI: 1,02) y mayor en Asturias con 1,28ng/ml (95% CI: 1,32). Valores del PSA según percentil: el límite superior (percentil 95) fue de 1,40ng/ml en aquellos menores de 40 años, 1,70ng/ml en 40–49 años, 3,30ng/ml en 50–59 años y 5,18ng/ml en el grupo de 60–64 años. Conclusiones: Los valores de PSA recogidos en este estudio podrían servir de referencia para población española en edad, utilizando el rango descrito por décadas, o mejor aún, los correspondientes a cada edad (AU)

Objective: To determine the values of PSA in Spanish workers without history of prostate problems and compare them with other geographical latitudes. Methods: Observational, retrospective, multicenter and population-based study, conducted between January 1 and December 31, 2006. A total of 65303 workers participated in the Programme of prostate cancer screening conducted by the Ibermutuamur Prevention Society in different Spanish regions. Of these, were selected for this report, 63926: 149 were excluded by personal history of prostate problems and 1328 for being over 64 years. PSA determinations were performed using the Abbott test. Were specified PSA values for each age and for the following age ranges: younger than 40 years, 40–49 years, 50–59 years and 60–64 years. Also calculated the mean PSA values by Autonomous Communities. The data were expressed as mean (±SD), confidence intervals 95%, standard error of the mean (SEM) and in the percentiles 5, 25, 50, 75 and 95. The results obtained were compared with those in other areas of the world. All data were analysed using the statistical software GraphPad Quick Calcs. Results: Mean PSA value: for all cases was 1.06ng/ml (95% CI: ±1,18) and age groups: under 40 years, 0.67ng/ml (95% CI: ±0.49), 40–49 years, 0, 77ng/ml (95% CI: ±0.66), 50–59 years, 1.11ng/ml (95% CI: ±1.22) and 60–64 years, 1.57ng/ml (95% CI: ±1.72). Depending on the age ranged between 0.67ng/ml under age 40 and 1.70 in the 64 years. According to region, the lowest value was recorded in the País Vasco with 0.98ng/ml (95% CI: 1.02) and higher in Asturias with 1.28ng/ml (95% CI: 1.32). Percentile value PSA: the upper normal limit (95th percentile) was 1.40ng/ml in those younger than 40 years, 1.70ng/ml in 40–49 years, 3.30ng/ml in 50–59 years and 5.18ng/ml in the group 60–64 years. Conclusions: PSA values collected in this study may serve as a reference for the Spanish working population, using the range described for decades, or even better, those relating to each age (AU)

[Fluorescence-guided resection with 5-aminolevulinic acid of an intramedullary tumor]. / Resección de tumor intramedular guiada por fluorescencia con ácido aminolevulínico.

Fluorescence-guided resection with 5-aminolevulinic acid (5-ALA) has demonstrated its usefulness in the resection of malignant cerebral gliomas. It also seems useful for the treatment of other types of cerebral and intramedullary neoplasms. We present the case of a patient with an intramedullary tumor in who fluorescence- guided resection was useful for intraoperative localization, definition of small tumor nodules and in order to achieve a complete resection of the tumor.

[Reference values of prostate specific antigen (PSA) in 63926 workers without prostatic symptoms who participated in prostate screening cancer developed by the Ibermutuamur Prevention Society in 2006]. / Valores de referencia del antígeno prostático específico (PSA) en 63.926 trabajadores sin síntomas prostáticos que participaron en el cribado de cáncer de próstata desarrollado por la Sociedad de Prevención de Ibermutuamur durante el año 2006.

OBJECTIVE: To determine the values of PSA in Spanish workers without history of prostate problems and compare them with other geographical latitudes. METHODS: Observational, retrospective, multicenter and population-based study, conducted between January 1 and December 31, 2006. A total of 65303 workers participated in the Programme of prostate cancer screening conducted by the Ibermutuamur Prevention Society in different Spanish regions. Of these, were selected for this report, 63926: 149 were excluded by personal history of prostate problems and 1328 for being over 64 years. PSA determinations were performed using the Abbott test. Were specified PSA values for each age and for the following age ranges: younger than 40 years, 40-49 years, 50-59 years and 60-64 years. Also calculated the mean PSA values by Autonomous Communities. The data were expressed as mean (+/-SD), confidence intervals 95%, standard error of the mean (SEM) and in the percentiles 5, 25, 50, 75 and 95. The results obtained were compared with those in other areas of the world. All data were analysed using the statistical software GraphPad Quick Calcs. RESULTS: Mean PSA value: for all cases was 1.06 ng/ml (95% CI: +/-1,18) and age groups: under 40 years, 0.67 ng/ml (95% CI: +/-0.49), 40-49 years, 0, 77 ng/ml (95% CI: +/-0.66), 50-59 years, 1.11 ng/ml (95% CI: +/-1.22) and 60-64 years, 1.57 ng/ml (95% CI: +/-1.72). Depending on the age ranged between 0.67 ng/ml under age 40 and 1.70 in the 64 years. According to region, the lowest value was recorded in the País Vasco with 0.98 ng/ml (95% CI: 1.02) and higher in Asturias with 1.28 ng/ml (95% CI: 1.32). Percentile value PSA: the upper normal limit (95th percentile) was 1.40 ng/ml in those younger than 40 years, 1.70 ng/ml in 40-49 years, 3.30 ng/ml in 50-59 years and 5.18 ng/ml in the group 60-64 years. CONCLUSIONS: PSA values collected in this study may serve as a reference for the Spanish working population, using the range described for decades, or even better, those relating to each age.

[Intramedullary schwannomas. Report of two cases]. / Neurinomas intramedulares. Presentación de dos casos de un tumor infrecuente.

Intramedullary schwannomas are benign tumors that arise from clusters of Schwann cells embedded in the medullary parenchyma. They are very rare and account for 0.3 to 1.5 % of all spinal schwannomas. It is not known for certain why this happens, and several theories have been put forward. They do not exhibit any characteristic clinical picture, being pain the most frequent symptom. Imaging is also not specific and the correct diagnosis is attained most of the times after pathological examination. The goal of treatment must be complete removal, which is curative. We are presenting two patients in whom an intramedullary tumor was removed. The true nature of the lesions was suspected during the operation, but only after pathological examination was confirmed. A review of the literature has been undertaken, with special attention to the theories about the origin of these uncommon tumors.

Investigation of gammaE-crystallin target protein binding to bovine lens alpha-crystallin by small-angle neutron scattering.

alpha-Crystallin, one of the main constituent proteins in the crystalline lens, is an important molecular chaperone both within and outside the lens. Presently, the structural relationship between alpha-crystallin and its target proteins during chaperone action is poorly understood. It has been hypothesised that target proteins bind within a central cavity. Small-angle neutron-scattering (SANS) experiments in conjunction with isotopic substitution were undertaken to investigate the interaction of a target lens protein (gammaE-crystallin) with alpha-crystallin (alpha(H)) and to measure the radius of gyration (Rg) of the proteins and their binary complexes in solution under thermal stress. The size of the alpha(H) in D(2)O incubated at 65 degrees C increased from 69+/-3 to 81+/-5 A over 40 min, in good agreement with previously published small-angle X-ray scattering (SAXS) and SANS measurements. Deuterated gammaE-crystallin in H(2)O buffer (gammaE(D)/H(2)O) and hydrogenous gammaE-crystallin in D(2)O buffer (gammaE(H)/D(2)O) free in solution were of insufficient size and/or too dilute to provide any measurable scattering over the angular range used, which was selected primarily to investigate gammaE:alpha(H) complexes. The evolution of the aggregation size/shape as an indicator of alpha(H) chaperone action was monitored by recording the neutron scattering in different H:D solvent contrasts under thermally stressed conditions (65 degrees C) for binary mixtures of alpha(H), gammaE(H), and gammaE(D). It was found that Rg(alpha(H):gammaE(D)/D(2)O)>Rg(alpha(H):gammaE(H)/D(2)O)>Rg(alpha(H)/D(2)O) and that Rg(alpha(H):gammaE(H)/D(2)O) approximately Rg(alpha(H)/D(2)O). The relative sizes observed for the complexes weighted by the respective scattering powers of the various components imply that gammaE-crystallin binds in a central cavity of the alpha-crystallin oligomer, during chaperone action.

[Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst]. / Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide.

Dermoids cysts are embrionary benign lesions that comprise approximately 0.04-0.25% of all intracranial tumors. Occasionally they break and spread their content into subarachnoid space and/or lateral ventricles causing several acute or delayed symptoms. Debut of this type of tumor as acute stroke is poorly reflected in literature. We present a 26-year-old woman with a isolated mesencephalic infarct secondary to spontaneous rupture of a dermoid cyst. We discuss the possible pathophysiological mechanisms for this condition and review the literature.

Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide / Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst

Los quistes dermoides son lesiones benignas deorigen embrionario que representan del 0.04 a 0,25%de todos los tumores intracraneales. Estos quistesocasionalmente pueden romperse diseminándose elcontenido graso intraquístico al espacio subaracnoideoy/o los ventrículos laterales. En este caso puede provocardiversas manifestaciones clínicas de forma agudao retardada. El debut de este tipo de tumor con unictus agudo está escasamente reflejado en la literatura.Presentamos el caso de una mujer de 26 años con uninfarto mesencefálico aislado secundario a la rupturade un quiste dermoide. Discutimos el mecanismofisiopatológico supuesto y realizamos una revisión delos casos recogidos en la literatura (AU)

Dermoids cysts are embrionary benign lesions thatcomprise approximately 0.04-0.25% of all intracranialtumors. Occasionally they break and spread their contentinto subarachnoid space and/or lateral ventriclescausing several acute or delayed symptoms. Debut ofthis type of tumor as acute stroke is poorly reflected inliterature. We present a 26-year-old woman with a isolatedmesencephalic infarct secondary to spontaneousrupture of a dermoid cyst. We discuss the possiblepathophysiological mechanisms for this condition andreview the literature (AU)

[Remote cerebellar hemorrhage after lumbar spinal fluid drainage. Report of two cases and literature review]. / Hematomas de cerebelo como complicación de drenaje lumbar. Presentación de dos casos y revisión de la literatura.

Remote cerebellar hematoma, a cerebellar hematoma occurring after performing a surgical procedure in an anatomical distant area from the cerebellum, is a rare complication. It has been reported after supratentorial surgery and, less often, after spinal surgery with dural opening with important loss of cerebrospinal fluid. We report the occurrence of remote cerebellar hemorrhage after lumbar spinal fluid drainage in two patients with suspected normal pressure hydrocephalus. They were managed conservatively with good outcome. We review the pathologic mechanism, diagnostic procedures, management and prognosis of remote cerebellar hemorrhage.

Diffuse leptomeningeal seeding from benign choroid plexus papilloma.

Choroid plexus papillomas (CPP) are rare intracranial tumours with a favourable long-term outcome after surgical excision. Although they are histologically benign, local recurrences may occasionally occur, but leptomeningeal dissemination is exceptional. We report an unusual example of a fourth ventricle choroid plexus papilloma with diffuse leptomeningeal seeding. Neither the initial tumour nor the recurrence showed malignant histological features. Treatment with systemic and intrathecal chemotherapy was ineffective in this patient. We review the literature concerning leptomeningeal dissemination of benign choroid plexus papillomas.

Fracaso renal anúrico en paciente con estenosis de arteria renal por displasia fibromuscular / Anuric renal failure in a patient with fibromuscular dysplasia renal artery stenosis

La displasia fibromuscular es una entidad que predomina en mujeres jóvenes. Su manifestación clínica más frecuente es la hipertensión arterial. El diagnóstico de estenosis de arteria renal continúa siendo mediante las técnicas de imagen, y la repermeabilización de arteria renal conlleva una mejora significativa del control tensional y la función renal. Presentamos un caso clínico de estenosis de arteria renal por displasia fibromuscular en un hombre joven al que se diagnostica tras presentar episodios de poliuria-anuria con insuficiencia renal, forma infrecuente de presentación de esta entidad

Fibromuscular dysplasia is an entity that predominates in young women. The most common clinical presentation is hypertension. The diagnosis of renal artery stenosis is based on images and revascularisation of renal artery leads to an improvement in renal function and blood pressure control. A clinical case of renal artery stenosis due to fibromuscular dysplasia in a young male patient is exposed, which first appears as polyuria-anuria and renal failure, a rare way of presentation of this pathologyFibromuscular dysplasia is an entity that predominates in young women. The most common clinical presentation is hypertension. The diagnosis of renal artery stenosis is based on images and revascularisation of renal artery leads to an improvement in renal function and blood pressure control. A clinical case of renal artery stenosis due to fibromuscular dysplasia in a young male patient is exposed, which first appears as polyuria-anuria and renal failure, a rare way of presentation of this pathology

[Hemifacial spasm as clinical presentation of intracranial meningiomas. Report of three cases and review of the literature]. / Espasmo hemifacial como presentación clínica de meningiomas intracraneales. Presentación de 3 casos y revisión de la literatura.

Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is exceptional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal deficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association.

[Cocaine abuse as precipitating factor of tumoral bleeding in an oligoastrocitoma]. / Consumo de cocaína como desencadenante de hemorragia en un oligoastrociloma.

Cocaine abuse has been associated with a variety of intracranial haemorrhagic disorders, such as intracerebral, subdural or subarachnoidal haemorrhage. Frequently, these patients harbour underlying vascular malformations, like cerebral aneurysms or arteriovenous malformations (AVM). To the best of our knowledge only two cases of tumoral haemorrhage induced by cocaine abuse have been previously reported. We describe a new case of intracerebral haemorrhage after cocaine inhalation, in which both the preoperative imaging studies and the pathological examination showed a brain tumour as the origin of the haemorrhage. We think that cocaine abuse may be considered as a new precipitating factor in intratumoral haemorrhage.

Espasmo hemifacial como presentación clínica de meningiomas intracraneales. Presentación de 3 casos y revisión de la literatura / Hemifacial spasm as clinical presentation of intracranial meningiomas. Report of three cases and review of the literature

El espasmo hemifacial (EH) constituye una entidad clínica caracterizada por contracciones tónico-clónicas de carácter involuntario de la musculatura inervada por el nervio facial. Como forma de presentación de meningiomas intracraneales es excepcional. Presentamos tres casos de pacientes con meningiomas cuya presentación clínica fue en forma de EH, bien de forma aislada o asociado a sintomatología de hipertensión intracraneal o déficit neurológico focal. Se revisa la literatura y se discuten los posibles mecanismos fisiopatológicos que puedan intervenir en esta asociación

Hemifacial spasm (HFS) is a clinical entity consisting of brief clonic jerking movements of the facial musculature, beginning in the orbicularis oculi with downward spreading to other facial muscles. Apart from vascular loop compression at the root exit zone of the facial nerve, other causes of HFS are rare. It is excepcional as a form of presentation of intracranial meningiomas We report three cases of patients with meningiomas who presented with HFS, either as an isolated sign or associated with symptoms of rise intracranial pressure or focal déficit. We review the literature and discuss the possible physiopathological mechanisms responsible for this association

[Contralateral mesencephalic injury due to tentorial uncal herniation. Magnetic resonance imaging of the Kernohan's notch]. / Lesión mesencefálica contralateral por hernia cerebral. Imagen en resonancia magnética de la hendidura de Kernohan (Kernohan's notch).

We report a case of a traumatic epidural hematoma with ipsilateral hemiparesis, due to the so-called Kernohan's notch. We document the injury with axial and coronal magnetic resonance imaging.

Migración del marcapasos como manifestación electrocardiográfica del feocromocitoma / Pacemaker migration as electrocardiographic manifestation of pheochromocytoma

Se describe un caso de feocromocitoma en una paciente remitida a nuestro servicio por cuadro de hipertensión arterial de 3 meses de evolución acompañada de sudoración, cefalea, palpitaciones, pérdida de agudeza visual y alteraciones en el electrocardiograma en forma de alternancia de ondas P positivas con ondas P negativas. Se realiza la anamnesis y la exploración física sospechándose un feocromocitoma, que se confirma con los exámenes complementarios y la intervención quirúrgica, después de la cual desaparece la sintomatología, mejorando las cifras de presión arterial y desapareciendo las alteraciones electrocardiográficas. Este artículo remarca la utilidad del electrocardiograma ante la sospecha clínica de feocromocitoma para orientar nuestras investigaciones diagnósticas hacia la búsqueda del mismo (AU)

[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)