Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia. / Tiroidectomía transoral endoscópica con abordaje vestibular (TOETVA): una nueva opción para el tratamiento de pacientes pediátricos.

Pediatric pneumonectomies are exceptional nowadays, being reserved for cases with destroyed lungs with frequent exacerbations and reinfections and only two cases of thoracoscopic pneumonectomy have been previously published. We present the case of a 4-year-old patient with no relevant history who developed complete atelectasis of the left lung (LL) after influenza A pneumonia, followed by secondary recurrent infections. A year later a diagnostic bronchoscopy without alterations was performed. A complete loss of volume and hypoperfusion of the LL (right lung perfusion 95%, LL perfusion: 5%) with bronchiectasis and hyperinsufflation and herniation of the right lung into the left hemithorax was observed in a pulmonary perfusion SPECT-CT. After unsuccessful conservative management and recurrent infections a pneumonectomy was indicated. The pneumonectomy was performed through a five-port thoracoscopy. The dissection of the hilum was made using hook electrocautery and sealing device. The left main bronchus was sectioned with an endostapler. There were no intraoperative complications. An endothoracic drain was removed the first postoperative day. The patient was discharged on the fourth postoperative day. The patient has not presented any complications 10 months after surgery. Although pneumonectomy is an exceptional surgery in children, it can be performed by minimally invasive surgery with success and safety in centers with extensive experience in pediatric thoracoscopic surgery.

Hoy en día, las neumonectomías pediátricas son algo excepcional. El procedimiento se reserva para aquellos casos en los que los pulmones están destruidos y presentan exacerbaciones y reinfecciones frecuentes, con tan solo dos casos de neumonectomía toracoscópica publicados hasta la fecha. Presentamos el caso de un paciente de 4 años sin antecedentes de interés que desarrolló atelectasia completa del pulmón izquierdo (PI) tras neumonía por gripe A, seguido de infecciones secundarias recurrentes. Un año después, se le practicó broncoscopia diagnóstica, sin que esta mostrara alteraciones significativas. Tras realizársele un SPECT-CT de perfusión pulmonar, se evidenció pérdida completa de volumen e hipoperfusión del PI (perfusión del pulmón derecho: 95%; perfusión del pulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y herniación del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar el manejo conservador y registrarse infecciones recurrentes, se estableció la indicación de neumonectomía. La neumonectomía se llevó a cabo mediante toracoscopia por cinco puertos. La disección del hilio se realizó mediante gancho de electrocoagulación y dispositivo de sellado. El bronquio principal izquierdo se seccionó con endograpadora. No se registraron complicaciones intraoperatorias. El drenaje endotorácico se retiró al día siguiente de la intervención, mientras que el paciente fue dado de alta a los cuatro días, sin que haya presentado complicaciones transcurridos 10 meses desde la cirugía. Aunque la neumonectomía es una intervención excepcional en niños, puede llevarse a cabo de manera exitosa y segura por cirugía mínimamente invasiva en centros con amplia experiencia en cirugía toracoscópica pediátrica.

Neumonectomía toracoscópica en un niño de 4 años con el pulmón destruido tras neumonía vírica / Thoracoscopic pneumonectomy in a 4 year-old-child with destroyed lung following viral pneumonia

Hoy en día, las neumonectomías pediátricas son algo excepcional. Elprocedimiento se reserva para aquellos casos en los que los pulmones estándestruidos y presentan exacerbaciones y reinfecciones frecuentes, con tansolo dos casos de neumonectomía toracoscópica publicados hasta la fecha.Presentamos el caso de un paciente de 4 años sin antecedentes deinterés que desarrolló atelectasia completa del pulmón izquierdo (PI) trasneumonía por gripe A, seguido de infecciones secundarias recurrentes.Un año después, se le practicó broncoscopia diagnóstica, sin que estamostrara alteraciones significativas. Tras realizársele un SPECT-CT deperfusión pulmonar, se evidenció pérdida completa de volumen e hi-poperfusión del PI (perfusión del pulmón derecho: 95%; perfusión delpulmón izquierdo: 5%), con bronquiectasia e hiperinsuflación y hernia-ción del pulmón derecho hacia el hemitórax izquierdo. Tras fracasar elmanejo conservador y registrarse infecciones recurrentes, se establecióla indicación de neumonectomía.La neumonectomía se llevó a cabo mediante toracoscopia por cincopuertos. La disección del hilio se realizó mediante gancho de electro-coagulación y dispositivo de sellado. El bronquio principal izquierdose seccionó con endograpadora. No se registraron complicaciones in-traoperatorias.El drenaje endotorácico se retiró al día siguiente de la intervención,mientras que el paciente fue dado de alta a los cuatro días, sin que hayapresentado complicaciones transcurridos 10 meses desde la cirugía.Aunque la neumonectomía es una intervención excepcional enniños, puede llevarse a cabo de manera exitosa y segura por cirugíamínimamente invasiva en centros con amplia experiencia en cirugíatoracoscópica pediátrica.(AU)

Pediatric pneumonectomies are exceptional nowadays, being re-served for cases with destroyed lungs with frequent exacerbations and einfections and only two cases of thoracoscopic pneumonectomy havebeen previously published.We present the case of a 4-year-old patient with no relevant his-tory who developed complete atelectasis of the left lung (LL) afterinfluenza A pneumonia, followed by secondary recurrent infections.A year later a diagnostic bronchoscopy without alterations was per-formed. A complete loss of volume and hypoperfusion of the LL(right lung perfusion 95%, LL perfusion: 5%) with bronchiectasisand hyperinsufflation and herniation of the right lung into the lefthemithorax was observed in a pulmonary perfusion SPECT-CT. Afterunsuccessful conservative management and recurrent infections apneumonectomy was indicated.The pneumonectomy was performed through a five-port thoracos-copy. The dissection of the hilum was made using hook electrocauteryand sealing device. The left main bronchus was sectioned with an en-dostapler. There were no intraoperative complications.An endothoracic drain was removed the first postoperative day. Thepatient was discharged on the fourth postoperative day. The patient hasnot presented any complications 10 months after surgery.Although pneumonectomy is an exceptional surgery in children,it can be performed by minimally invasive surgery with success andsafety in centers with extensive experience in pediatric thoracoscopicsurgery.(UA)

Telorragia: revisión de la literatura a propósito de dos casos / Telorrhagia: literature review on two cases

La telorragia es infrecuente en la edad pediátrica y un signo de alarma en la edad adulta. Estos pacientes se remiten a la consulta de Cirugía para valorar intervenciones agresivas por la amenaza de la malignidad. Sin embargo, su principal etiología es la ectasia ductal mamaria, un proceso benigno y autorresolutivo. Se presentan dos pacientes varones de 4 y 5 meses con telorragia. Una vez realizadas la exploración, la ecografía y la citología, se descartó un proceso maligno y se resolvió con manejo conservador en un periodo de 12 meses. A continuación, se realiza una revisión de la literatura incluyendo los pacientes pediátricos (0-16 años) con telorragia monosintomática. Encontramos un total de 59 casos publicados. Es más frecuente en varones (1,5:1) y el 74% de los casos ocurren en el primer año de vida. En los estudios revisados se realizan diversas pruebas complementarias (cultivo, citología, analítica hormonal) pero solo parece aportar información de utilidad la ecografía, que se encuentra alterada en un 69,2% de los pacientes. El abordaje terapéutico clásico ha sido la resección quirúrgica de la glándula mamaria, pero en la literatura más reciente se ha demostrado que, ya que se trata de una patología limitada en el tiempo, el manejo conservador es el más adecuado. Se reserva la cirugía para los casos con diagnóstico dudoso o persistentes. La recidiva es infrecuente (9,8%). Conclusiones: pese a ser un síntoma alarmante, la telorragia en lactantes debe de manejarse de forma conservadora evitando las intervenciones quirúrgicas agresivas, que podrían condicionar secuelas posteriores (AU)

Nipple discharge in children is uncommon, whereas it is considered a warning sign in adulthood. Hence these patients are referred to the Paediatric Surgeon to assess whether it is necessary to perform aggressive procedures to avoid the risk of malignancy. However, the most common ethology is ductal ectasia, a benign and self-limited process.We present two cases of a 4 and 5-month-old male patients with bloody nipple discharge. Once malignancy was ruled out by physical examination, ultrasound and cytology, a conservative approach was adopted and the symptoms disappeared over a period of 12 months. Then we conducted a systematic review including pediatric patients (0-16 years) with monosymptomatic bloody nipple discharge.We found a total of 59 cases published. It is more prevalent in male patients (1,5:1) and 74% present before the age of 12 months. In the articles reviewed several tests are mentioned (secretion culture, cytology, hormonal blood test) but only ultrasound provided useful information, showing altered results in 69.2% of the patients. The classical therapeutic approach was breast surgical resection but in more recent reports ductal ectasia has been shown to be a self-limited pathology. Therefore, conservative treatment is now advocated while surgery is reserved for persistent symptoms or cases where there is a diagnostic doubt. Relapse is infrequent (9.8%).Conclusions: despite of being a disturbing sign, bloody nipple discharge in infants should be managed conservatively, avoiding aggressive surgical procedures that might cause permanent consequences. (AU)

[Utility of radioguided surgery in splenosis]. / Utilidad de la cirugía radioguiada en la esplenosis.

Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.

[Laparoscopic cholecystectomy: what we can learn about]. / Colecistectomía laparoscópica en niños y adultos: lo que podemos aprender.

BACKGROUND: Laparoscopic cholecystectomy (LC) is a very usual procedure within adult population, but not as frequent in childhood. The aim of this study was to assess the outcome of LC in children compared with those performed in adulthood. MATERIALS AND METHODS: We reviewed 39 consecutive patients who underwent LC between 2003 and 2013 at our Department and a similar sample of patients from 18 to 40 years of age from the General Surgery Department. RESULTS: 39 children and 40 adults fulfilled criteria to be included in the study. The most frequent indication was cholelithiasis in both groups. The mean operating time was significantly higher among children (127 min, adults 71 min, p < 0.01) but we didn't find differences neither in conversion nor in complication rates (children 5% and 7.7%, adults 2.5% and 15% respectively). In regard to preoperative factors, only male gender was correlated to a higher complication rate (p 0.037). On the other hand we found out that, in absence of complications, both the average length of stay (children 2.1 days, adults 0.5 days) and mean time to first feeding (children 21 hours, adults 8 hours) were significantly higher among children (p < 0.01). CONCLUSIONS: 1) LC in childhood is a safe procedure that does not imply more morbidity than the same intervention in adults, even though a more prolonged operating time. 2) We believe that our longer hospital stay is due to certain lack of confidence with the technique and, in the future, the trend should be bent on encouraging a shorter time to first feeding and an earlier discharge.

Papel de la laparoscopia en prematuros con sospecha de enterocolitis necrotizante / Role of laparoscopy in premature infants with suspicion of necrotizing enterocolitis

Introducción. La indicación quirúrgica en la enterocolitis necrotizante(ECN) puede ser difícil en ausencia de neumoperitoneo o peritonitis secundaria. Proponemos la laparoscopia para realizar un diagnóstico precoz de perforaciones o necrosis intestinal y evitar laparotomías “en blanco”. Material y métodos. Se planteó un protocolo diagnóstico terapéutico que incluyera la laparoscopia en los casos de ECN de indicación quirúrgica incierta. Posteriormente se realizó un estudio prospectivo de los 7 pacientes en los que se realizó laparoscopia, analizando efectos fisiopatológicos en el prematuro, dificultades técnicas del procedimiento, congruencia diagnóstica y evolución postoperatoria. Resultados. La edad gestacional media al nacimiento fue de 27semanas (rango 25 a 31) con un peso medio de 1,147 kg (rango 0,900 a1,600). Se colocaron dos trócares orientados según la focalidad de la exploración o la radiología, aplicando un neumoperitoneo de 6-10 mm Hg durante una media de 17 min. La laparoscopia evitó la laparotomía en un paciente, que evolucionó bien tras lavado y drenaje; y magnificólas lesiones en otro paciente que, tras la laparotomía, no precisó derivación intestinal. En el resto de los casos la laparoscopia permitió una minilaparotomía orientada a las lesiones y derivación intestinal. No se produjo ninguna complicación quirúrgica atribuible al procedimiento, que fue bien tolerado en todos los casos. Conclusiones. La laparoscopia puede ser una herramienta útil para valoración de las lesiones de ECN en los casos de indicación quirúrgica incierta. En nuestra experiencia es bien tolerada en el neonato de bajo peso, permitiendo orientar el tratamiento quirúrgico e, incluso, evitarla laparotomía (AU)

Introduction. The indication of surgery in necrotizing enterocolitis(NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies. Material and methods. A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency. Results. The mean gestational age at birth was 27 weeks (range 25 to31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases. Conclusions. Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience ,it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy (AU)

[Role of laparoscopy in premature infants with suspicion of necrotizing enterocolitis]. / Papel de la laparoscopia en prematuros con sospecha de enterocolitis necrotizante.

INTRODUCTION: The indication of surgery in necrotizing enterocolitis (NEC) can be difficult in the absence of pneumoperitoneum or peritonitis. We propose laparoscopy for early diagnosis of intestinal perforation or necrosis in order to avoid unneccessary laparotomies. MATERIAL AND METHODS: A new protocol was proposed which included diagnostic and therapeutic laparoscopy in cases of uncertain surgical ECN indication. Subsequently, a prospective study of the 7 patients who underwent laparoscopy was performed, analyzing pathophysiological effects in the premature, technical difficulties of the procedure, and postoperative diagnostic consistency. RESULTS: The mean gestational age at birth was 27 weeks (range 25 to 31) with an average weight of 1.147 kg (range 0.900 to 1.600) two trocars were placed as the focal oriented scanning or radiography, using a pneumoperitoneum 6-10 mmHg for an average of 17 min. Laparoscopy avoided laparotomy in a patient who did well after washing and drainage and magnified lesions in one patient who did not require laparotomy after intestinal bypass. In other cases, laparoscopy was followed by minilaparotomy oriented to the lesions and stoma formation. There were no surgical complications attributable to the procedure, which was well tolerated in all cases. CONCLUSIONS: Laparoscopy can be a useful tool for evaluation of lesions of NEC in cases of uncertain surgical indications. In our experience, it is well tolerated in neonates of low weight, allowing oriented minilaparotomies or even to avoid laparotomy.

Estrategia terapéutica en la extrofia de cloaca femenina / Therapeutic strategy in cloacal exstrophy

La extrofia de cloaca femenina enfrenta al cirujano pediá- trico con un reto en el que está implicada la reconstrucción del tracto genitourinario y digestivo así como su manejo funcional. El objetivo de nuestro trabajo es presentar nuestra experiencia en el manejo de las malformaciones genitales en niñas con extrofia de cloaca así como de la continencia urinaria y fecal. Revisamos las historias clínicas de las pacientes tratadas en nuestro centro en las que se ha llegado a una corrección definitiva del espectro malformativo de la extrofia de cloaca. En las tres pacientes se ha realizado un cierre del cuello vesical y un estoma cateterizable continente a través del cual llevan a cabo un programa de autocateterismo vesical intermitente, manteniéndose secas. Con respecto a la integración psicosexual, las tres pacientes están satisfechas con el resultado cosmético obtenido, aunque sólo una de ellas mantiene relaciones sexuales. El manejo de la extrofia de cloaca femenina debe tener en cuenta tanto los factores anatómicos como funcionales. La reconstrucción genital en niñas con extrofia de cloaca requiere un plan ajustado en cada paciente y en ocasiones realizar varias intervenciones hasta que la paciente esté satisfecha con el resultado tanto cosmético como funciona (AU)

Cloacal exstrophy is a complex multisistemic anomaly thatinvolves gastrointestinal and genitourinary issues. The aim of our paper is to report our experience in dealing with genital reconstruction and faecal and urinary continence in patients with female cloacal anomalies. We reviewed the clinical records from the three patients we have achieved a final reconstruction. We recorded the surgical management and both functional and anatomic results. The three of them required a bladder neck closure associated with a continent stoma, they are dry with intermittent catheterization and free of upper urinary complications. Genital reconstruction required a unique plan for each one, according to their anatomy and their cosmetic desires. One of the patients reported satisfactory sexual intercourse. Management of patients with cloacal exstrophy has major concerns about urinary and fecal continence and about genital reconstruction and function. Knowing the long-term results may help to develop management strategies and improve counselling for patients who have undergone reconstruction (AU)

[Therapeutic strategy in cloacal exstrophy]. / Estrategia terapéutica en la extrofia de cloaca femenina.

Cloacal exstrophy is a complex multisistemic anomaly that involves gastrointestinal and genitourinary issues. The aim of our paper is to report our experience in dealing with genital reconstruction and faecal and urinary continence in patients with female cloacal anomalies. We reviewed the clinical records from the three patients we have achieved a final reconstruction. We recorded the surgical management and both functional and anatomic results. The three of them required a bladder neck closure associated with a continent stoma, they are dry with intermittent catheterization and free of upper urinary complications. Genital reconstruction required a unique plan for each one, according to their anatomy and their cosmetic desires. One of the patients reported satisfactory sexual intercourse. Management of patients with cloacal exstrophy has major concerns about urinary and fecal continence and about genital reconstruction and function. Knowing the long-term results may help to develop management strategies and improve counselling for patients who have under-gone reconstruction.

First Spanish Trauma Registry: analysis of 1500 cases.

OBJECTIVES: To develop the first Spanish Pediatric Trauma Registry to collect and evaluate infomation concerning aspects of injuries in our pediatric population. METHODS: From January 1995 to August 1998, 35,946 children younger than 16 years were treated in our hospital for acute injury: 1500 were admitted and included in our database. Our file registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment morbidity and mortality. RESULTS: Accidents were more frequent in males (68%) than in females. The predominant age group was 12-15 years of age (34%). Accidents were more frequent in the street (35.1%) than at home (18.9%) or school (13%). Falls and traffic-related accidents were the leading cause of injury (39% and 21.2%, respectively). Two hundred and thirty-five (15.7%) had a Pediatric Trauma Score < or = 8. Fifty of these sustained multiple trauma (33%) (Injury Severity Score > or = 15). Musculoskeletal and head trauma were the most frequent injuries (48.5% and 42.0%, respectively). Surgical or orthopedic procedures were performed in 906 patients (56.5%). The average length of stay was 4.5 days (range 1-93 days). Functional impairment in children older than 4 years of age was found in 413 children (33.3%). We encountered 7 deaths in the 1500 patients, or an overall mortality of 0.5%. These 7 deaths were only seen in the I.S.S. > or = 15 group (50 patients) with 14% mortality. CONCLUSIONS: The goals of this Registry are to establish the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so that potential deficiencies can be corrected.

[Pediatric trauma registry: analysis of 1200 cases]. / Registro de trauma pediátrico: análisis de 1.200 casos.

OBJECTIVES: We developed the first Spanish Pediatric Trauma Registry in order to collect and evaluate information concerning aspects of injuries in our pediatric population. METHODS: From January'95 to September'97, 28,713 children younger than 16 years were treated in our Hospital for acute injury: 1,200 were admitted and included in our database. Our file-registry consists of 108 data points including: patient identification, type, place and mechanism of injury, pre-hospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatments and morbidity-mortality. RESULTS: Accidents were more frequent in males (69%) than in females. The age-group predominantly was 12-15 years old (34%). Accidents were more frequent in the street (35.3%) than at home (18.7%) or school (14%). Falls and traffic-related accidents were the leading cause of injury (38 and 21.1%, respectively). The 16.7% of cases had Pediatric Trauma Score < or = 8 (n = 201). The 3.6% of this sustained multiple trauma (43 cases with Injury Severity Score > or = 15). Musculoskeletal and head trauma was the most frequent (62 and 42.3%, respectively). Surgical or orthopedic procedures were performed in 678 patients (56.5%). Average length of stay were 4.8 days (range 1-93 days), and functional impairments at discharge were found in 33.9% of patients older than 3 years (n = 338). Mortality rate in our series was 0.5% (n = 6), and 13.9% in children with ISS > or = 15. CONCLUSIONS: The utility of this Registry is to know the epidemiology of our injured pediatric population, to review patient care, to develop prevention programs and to compare results with other centers so potential deficiencies can be identified and corrected.

[Results of the conservative treatment of severe renal trauma in childhood]. / Resultados del tratamiento conservador del traumatismo renal grave en la infancia.

Surgical treatment of severe renal trauma usually ends in loss of high percentage of kidneys. In consequence of this, in the last decade several authors prefer a conservative management of kidneys severely injured. There include stabilization in Intensive Care Unit, with the goal of preservation the most possible functioning renal tissue. The purpose of this paper is to present the results of conservative management of severe renal trauma in our Center in the last five years. We conclude that this type of management is accurate and effective.

[Epidemiologic study of injuries in childhood: the first pediatric trauma registry]. / Estudio epidemiológico de los accidentes en la infancia: Primer Registro de Trauma Pediátrico.

OBJECTIVE: In order to collect and evaluate information concerning aspects of injuries in our pediatric population, we developed the first Spanish Pediatric Trauma Registry. PATIENTS AND METHODS: During 1995, 11,307 patients were seen at our hospital for acute injuries: 521 were admitted to the hospital and are included in our database. Each patient's protocol consists of 103 data points including: patient identification, type, place and mechanism of injury, prehospital care, transport, assessment on admission, severity scores, diagnostic studies, injuries, treatment and morbidity-mortality. RESULTS: We found that accidents were more frequent in males (69) than in females. The predominant age group was 12-15 years (36%). Falls were the leading cause of injury (37%). A pediatric trauma score of 8 or less was seen in 13.4% of the cases. Twenty-nine patients were hospitalized in the Intensive Care Unit and 214 needed some surgical treatment. CONCLUSIONS: The utility of this registry is: 1) The knowledge of the epidemiology of our pediatric population. 2) To know and correct prehospital care deficiencies. 3) To improve hospital assistance and to recognize early prognosis factors.

[Multicystic renal dysplasia: changes in the contralateral urinary tract]. / Displasia renal multiquistica: alteraciones en el tracto urinario contralateral.

We have treated seven children with multicystic dysplastic kidney during the last 15 years. Three of then presented contralateral upper urinary tract anomalies. Four cases were diagnosed during prenatal period and three during the first term of life. We did analytic kidney function evaluation, ultrasound examination, voiding cystourethrography, radionuclide scan, gammagraphy, excretory urography and urinary cultures in all cases. We have found a vesicoureteral reflux with a bifid pelvis associated in the same child and two other cases with nonobstructive hydronephrosis. The child with vesicoureteral reflux presented also ipsilateral anomalies like a bladder diverticulum and an incomplete urethral duplication. One child with hydronephrosis opposite to the multicystic dysplastic kidney, also presented a bowel malrotation and a congenital cardiopathy, as extra-urologic associated anomalies.

[Therapeutic attitude in patients with multicystic dysplastic kidneys]. / Actitud terapéutica ante la displasia renal multiquística.

We presented seven multicystic dysplastic kidney cases treated in our Hospital during the last 15 years. Four children were diagnosed prenatally and three during the first term of life. Five were girls and two boys. We found three contralateral upper urinary tract anomalies. We did five nephrectomies. In two cases because compressive abdominal mass during the neonatal period, in two cases during the first year of life because symptomatic urinary tract infections and one case at the age of 13 months with persistent multicystic dysplastic kidney followed by ultrasound. Two cases were not operated. In one patient with partial regression of the multicystic kidney the family refused operation. We have lost follow-up in the last patient.

[Indications for urodynamic studies in childhood: our experience with 214 surgical patients]. / Indicaciones del estudio urodinámico en la infancia: nuestra experiencia en 214 pacientes quirúrgicos.

Between 1983 and 1994, 515 pediatric patients with medical and/or surgical problems underwent urodynamic evaluation. We present the urodynamic findings of 214 children with surgical pathology: 73 cases with vesicoureteral reflux, 26 with urethral stricture, 11 with posterior urethral valves and 104 cases with lipo- and myelomeningocele. We found a high incidence of urodynamic abnormalities associated to these pathologies: 46.5 in patients with vesicoureteral reflux, 88.4% in urethral strictures, 54.4% in posterior urethral valves and 100% in patients with spina bifida. In our opinion, the urodynamic assessment has a contributory role in the indication for corrective surgery; because the knowledge of the vesicourethral complex state will help to stabilize it through a correct individualized medical treatment before surgical treatment, delaying or even avoiding surgery in some cases.

[Femoral hernia in children]. / Hernia femoral en el niño.

Femoral hernia is rare in adults and even less common in children, to the point that expert surgeons have limited experience with it. Eleven patients with femoral hernia have been operated upon in our service during the past 15 years. Preoperative diagnosis was made in 6 cases (54.5%), and we underline that the ideal therapy began with this early diagnosis. We review the etiologies, clinical findings and treatment of femoral hernia in children.