[Surgical treatment of cholelithiasis in children. Role of cholecystotomy]. / Tratamiento quirúrgico de la colelitiasis en el niño. El papel de la colecistotomía.

Cholelithiasis is a rare pathology in children and with a different etiology, composition and clinic than adult. Cholecystectomy is the standardized treatment. The cholecystectomy is an alternative treatment in childhood. We studied 30 patients, aged between 8 months and 13 years, 15 of them with cholecystectomy and 15 with removal of pigment gallstones. The patients were followed up for 3 months-11 years. Recurrent stone formation was noted in one patient. 14 of the patients were non-symptomatic with normal ecography controls.

[Post-surgical paediatric pain: Nursing- PCA vs continuous I.V. infusion of tramadol ]. / Dolor postoperatorio en lactantes y niños pequeños: nursing-PCA vs perfusión i.v. de tramadol.

AIM: To evaluate the efficiency in the control of the post-surgical paediatric pain of the combination of a weak opioid [tramadol (T)] and an NSAID (paracetamol), comparing its administration through "Nursing-PCA" (NCA) techniques or through continuous i.v. infusion. METHODS: The investigation has been carried out in 30 patients (mean 9.5 months) selected according to their foreseeable degree of moderate-hard pain. All of them consumed in the postoperative period: rectal paracetamol (20 mg/Kg) every 8 hours and tramadol in two groups. Group I: PCA pump with tramadol that was handled by the nurse. Initial dose: 0.5 mg/Kg NCA, bolus injection 0.3 mg/Kg with an interval of 10 minutes for security and a highest dose of 1.2 mg/Kg/4 h every 4 hours. Group II: continuous infusion i.v. of tramadol (6 mg/Kg/24 h). The pain was evaluated, as well as the sedative action, saturation oxygen, respiratory and hemodynamics parameters, adverse effects, and efficiency during the first 24 hours, as well as the number of total dose of drugs asked in the Nursing PCA group. RESULTS: Pain decreased in both groups. There were more sedative effects in group II and the total dose of tramadol was higher. There were no cases of respiratory depression. CONCLUSIONS: The combination of tramadol and paracetamol through "Nursing PCA" has turned out to be an efficient method in the treatment of the post-surgical pain in little children and those whose are in their lacteal period. It is a possible alternative of the continuous infusion of Morphine in these patients.

[Adherence formation following different forms of treatment of peritoneal lesions]. / Respuesta adherencial de las diferentes formas de tratamiento de una lesión peritoneal.

The authors analyse the adhesion forming capacity of various forms of treating a peritoneal lesion. There were four groups each of 10 rats, all receiving the same peritoneal lesion. The control group did not receive any treatment for this injury; in the remaining three, the peritoneal lesion was treated with electrocoagulation, mechanical suture or manual suture. The animals were killed after 30 days, and adhesions quantified using an original method of the authors, which evaluates number, thickness, tenacity, vascularisation and site. Electrocoagulation significantly generated the smallest number of adhesions. The application of suture stimulated the formation of adhesions to a larger extent, manual suture more so than the mechanical method.

[Neuroblastoma in childhood. Review of clinical aspects and of 2 forms of treatment]. / Neuroblastoma en la infancia. Revisión clínica y de dos pautas de tratamiento.

The optimum time for a surgical resection of the primary lesion in the advanced neuroblastoma has not been defined properly. Recently the therapeutic results of the advanced neuroblastoma have improved through the use of preoperative chemotherapy. We check on our patients who were affected by this disease in the last 15 years. From 185 malignant tumours diagnosed in our department, 52 belonged to neuroblastomas with more than 12 months of evolution. Most of them were diagnosed during the year after their birth and it was not observed a difference of sexes. The location was the habitual one, except 2 cases of thoracoabdominal tumour and 1 of stesioneuroblastoma the most common manifestation was the metastatic disease. Catecholamines in 24 hours urine were positive in 74% of our patients, and enolase in 100% of the same ones. The longest percentage of patients is distributed in the advanced stages of Evans.

[Idiopathic perforation of the colon with simultaneous acute appendicitis in a newborn. Presentation of a case]. / Perforación idiopática del colon con apendicitis aguda simultánea en un recién nacido. Presentación de un caso.

We report a case of a three days old male newborn who suffered several apnea crisis. Radiologic studies revealed a pneumoperitoneum. Laparotomy proved it was caused by two intestinal perforations in the ascending colon. Histologic study showed a concomitant suppurated acute appendicitis. We discuss the case features, its possible etiopathogeny and the most frequent clinical aspects and treatment of intestinal perforation at this age.

[Segmentary agenesis of the intestinal muscle layer: a rare cause of intestinal obstruction. A case report]. / Agenesia segmentaria de la capa muscular intestinal: una causa rara de obstrucción intestinal. Presentación de un caso.

A very rare case of intestinal obstruction due to segmental agenesis of musculature of the small intestine is presented. In reviewing the literature, only nine cases of this entity has been published. Generally, the clinical evolution make necessary to perform several laparotomies, but the diagnosis is made by pathological findings. The prognosis is very poor.

[Wilms' tumor in patients with different abnormalities]. / Tumor de Wilms en pacientes con diversas malformaciones.

We present three cases of patients with Wilms' tumour. The first case showed a bilateral tumour with hemihypertrophy and Beckwith-Wiedemann syndrome. The second one had hemihypertrophy and double left pyelocalyceal system with double renal tumour. The last case had a horse-shoe kidney with a tumour on the right and a left hydronephrosis. The second and third cases had a good evolution.

[Azygo-portal disconnection with mechanical transection of the esophagus]. / Desconexión ácigo-portal con transección mecánica del esófago.

Many procedures are described to solve the problem of the massive hemorrhages due to esophageal varices in children with Portal Hypertension in which it's not possible to do a porto-systemic shunt by cause of the age. It's possible to treat them by sclerotherapy but in case of massive hemorrhages in which the patient life is at risk we have used the azygo-portal disconnection following the SUGIURA technique making the esophageal transection with autosuture instrument. We believe that this technical simplification account for more instances in which it's indicated. And it could be preferred to other procedures used with the same objective. We have done it in two male patients which came to our Center in several occasions due to massive hemorrhages. In both cases the Portal Hypertension is of extrahepatic cause. Follow up it is been satisfactory in both cases. Being one of them more than 3 1/2 years without hemorrhagic episodes, remaining under clinical and endoscopic controls. We have used in this cases the Proximate ILS of 21 mm. of Ethicon.

[Infrequent digestive pathology associated with a preduodenal portal vein]. / Patología digestivå infrecuente asociada a vena porta preduodenal.

We report two cases of preduodenal portal vein (PDPV) has with two different clinical pictures. The first case has an intestinal obstruction in infancy caused by PDPV. In the second child, the PDPV was only an operative finding in the newborn. We report for the first time PDPV associated with Hirschsprung disease.

[Hyperinsulinism. Two case reports and management (author's transl)]. / Sistemática de diagnóstico de los hiperinsulinismos en la infancia. A propósito de dos casos.

Two cases of hyperinsulinism are presented, one nesidioblastosis and one focal adenomatose hyperplasia, in 17 and three months-old males, respectively. Several techniques and diagnostic methods are revised, making a brief resume of its' difficulties. An approach to diagnostic of hyperinsulinisms in particular and of hypoglycemias in general is presented.

[Congenital posterolateral diaphragmatic hernia with delayed clinical manifestations (author's transl)]. / Hernia diafragmática posterolateral congénita de aparición tardía.

Two cases of late-appearing congenital posterolateral diaphragmatic hernia are described. Chest X-rays performed a few hours after birth were normal. The diagnosis was made 45 days and 18 months after birth. Authors call attention about this unusual presentation of Bochdalek hernia. A review of the literature is made.

[Gonadal tumors in children (author's transl)]. / Tumoraciones gonadales en la infancia.

Four cases of gonadal tumors in infancy were treated in the Service of Pediatric Surgery of the Hospital Infantil "Virgen de la Arrixaca", Murcia, during the first two years of surgical work. One of them is a Leydig cells testicular tumor, the second is a ovary tumor of the granulosa and the last two cases were ovarian cysts, one of them associated with precocious puberty. The clinical features, diagnostic and therapeutic problems of these tumors are reviewed.