[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)

[Cantrell's pentalogy: complete treatment, step by step]. / Pentalogía de Cantrell: tratamiento completo, paso a paso.

Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

[Volvulus of the small intestine. Contribution of abdominal echography to early diagnosis]. / Volvulo de intestino delgado. Contribucion de la ecografia abdominal al diagnostico precoz.

We report six cases of small intestine volvulus associated to malrotation, out of a whole of 11 volvulus managed by us in the last six years. None of them were diagnosed with the only help of clinical and conventional radiological explorations. In the other three cases the diagnosis was made through ultrasounds explorations: It showed the mesenteric vein on the left side of the mesenteric artery. Confirmation and resolution of the cases were reached with a laparotomy.

[Ectopic gastric mucosa in the proximal esophagus]. / Mucosa gástrica ectópica en esófago proximal.

Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.