[Hydrostatic enema outcome in patients with long history of ileocolic intussusception]. / Resultados del enema hidrostático en pacientes con clínica prolongada de invaginación ileocólica.

PURPOSE: Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. MATERIAL AND METHODS: Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. RESULTS: In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of history <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when comparing both groups (p=0.588). No complications were seen after enema reduction. CONCLUSIONS: The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms.

OBJETIVOS: El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. RESULTADOS: En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. CONCLUSIONES: El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución.

[Probabilistic algorithm for management of suspected foreign body aspiration in children]. / Protocolo probabilístico para el manejo del cuerpo extraño en la vía aérea.

INTRODUCTION: The aim is to create a protocol for the managing of foreign body aspiration in children based on a probability scale. MATERIAL AND METHODS: Retrospective observational study, including patients admitted with suspected foreign body aspiration (FBA) in the last 15 years. The parameters were assessed with a SCORE that included witnessed choking, stridor and wheezing during choking, unilateral reduced air entry and abnormal X-Ray. This scale relates them to a probability of FBA, where a score ≤ 1 is associated with less than 10% and ≥ 4 with more than 50% of FBA. According to the probability, we propose: observation, chest Computed Tomography (CT) or bronchoscopy. Then, we tried to adapt it to our casuistry. RESULTS: A total of 109 children admitted between 2002-2017 were included. The median age was 25 months, a foreign body was found in 88 patients, the most frequent being organic (seeds and nuts). Significant predictors of FBA were unilateral reduced air entry and abnormal X-Ray. In our study, we found the same ascending probability between the scale and the presence of foreign body, except for SCORE 1, which was 57% what we attribute to an information bias. If the foreign body were not nuts, inorganic or bone, its aspiration was very unlikely, that is why we included it in the SCORE with -1. CONCLUSION: The use of the algorithm would imply the performance of 7% more of CT in patients without a FBA, but avoiding an 8.5% of bronchoscopy. Our results present an information bias, characteristic of a retrospective study.

OBJETIVOS: Creación de un protocolo de manejo del cuerpo extraño (CE) en vía aérea (VA) basado en una escala de probabilidad. MATERIAL Y METODOS: Estudio retrospectivo observacional de pacientes con sospecha de aspiración de CE en 15 años. Los parámetros fueron valorados con un SCORE que contempla atragantamiento presenciado, estridor y sibilancias durante el atragantamiento, hipoventilación unilateral y radiografía alterada. Dicha escala los relaciona con una probabilidad de presencia de CE en VA, donde una puntuación ≤ 1 se asocia a menos de un 10% y ≥ 4 a > 50%. Según la probabilidad se plantea: observación, TAC o instrumentación de VA. A continuación se intentó optimizar en función de nuestra casuística. RESULTADOS: Se analizaron 109 pacientes (mediana 25 meses), identificándose CE en 88, principalmente frutos secos. De las variables predictoras solo fueron significativas: la hipoventilación unilateral y la radiografía alterada. En nuestra serie se observó la misma probabilidad ascendente entre la escala y la presencia de CE, excepto en la puntuación de 1 que fue del 57%, lo que atribuimos a un sesgo de información. Si el CE no era fruto seco, material inorgánico o hueso, era muy improbable su aspiración (p= 0) por lo que lo incluimos en el SCORE con un -1. CONCLUSIONES: La aplicación de la escala implicaría la realización de un 7,5% más de TAC en pacientes sin CE pero evitando un 8,5% de instrumentaciones de la VA. Nuestros resultados presentan un sesgo de información, propio de un estudio retrospectivo. Actualmente hemos iniciado la implementación prospectiva.

Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas / Seromuscular colocystoplasty lined by urothelium. Experimental study in rats

Objetivo. Determinar qué técnica de ampliación vesical en ratas puede ofrecer los mejores resultados funcionales e histológicos. Diseño. Estudio experimental comparativo entre parámetros pre y postoperatorios de 60 ratas Wistar hembra divididas en cinco grupos según la técnica de ampliación vesical utilizada: sham, colocistoplastia (CC), colocistoplastia desmucosada (DCC), colocistoplastia seremuscular cubierta de urotelio (AADCC) y autoaumento vesical (AA). Instrumentalización. Cistometría preoperatoria.Ampliación vesical usando diversas técnicas. Cistomanometría al mes postoperatorio, previa al sacrificio del animal y extracción de la vejiga para su estudio histológico. Medición del volumen y presión de ruptura. Resultados. La técnica de enterocistoplastia seromuscular presenta una alta mortalidad en la rata (63,6 por ciento). El aumento del volumen vesical producido en los dos grupos que portaban injerto seromuscular fue escaso (0,22 +/- 0,5 y 0,47 +/- 0,3 ml) frente al grupo de control (0,11 +/- 0,4ml). Sólo la colocistoplastia estándar y el autoaumento vesical produjeron aumentos significativos tanto del volumen vesica (0,78+/-0,5 y 0,69+/-0,6 ml, respectivamente) como del volumen de ruptura. No se observaron diferencias significativas en cuanto a la presión de ruptura vesical (AU)

[Seromuscular colocystoplasty lined by urothelium. Experimental study in rats]. / Colocistoplastia seromuscular recubierta de urotelio. Un estudio experimental en ratas.

OBJECTIVE: To determine what technical of vesical extension in rat can offer the best functional and histological results. DESIGN: Comparative experimental study between pre and postoperative parameters of 60 female Wistar rats. The animals were divided in 5 groups using different techniques of vesical augmentation. Sham, colocystoplasty (CC), demucosalised colocystoplasty (DCC), demucosalised colocystoplasty lined by urothelium (AADCC), autoaugmentation (AA). INTERVENTIONS: Preoperative cystometrical study. Microsurgery for vesical augmentation. New cystometric study at the month, previous to the sacrifice of the animal and extraction of bladder for its histological study. Measurement of the volume and pressure of rupture. RESULTS: The technique of seromuscular enterocistoplasty presents the high mortality in the rat (63.6%). The increase of the vesical volume in both groups that carried seromuscular grafts was little (0.22 +/- 0.5 and 0.47 +/- 0.3 ml) in front of the control group (0.11 +/- 0.4 ml). Only standard colocystoplasty and bladder autoaugmentation produced significant increases on vesical volume (0.78 +/- 0.5 and 0.69 +/- 0.6 ml, respectively) and rupture volume. There were not observed significant differences on vesical rupture pressure.

[Surgical treatment of hypospadias. Our experience and follow up in 1993-1998]. / Tratamiento quirúrgico del hipospadias. Nuestra experiencia y seguimiento durante el período 1993-1998.

OBJECTIVE: To review our series of hypospadias. The incidence of the different types of hypospadias and the complication rates according to the different surgical techniques and materials utilized are analyzed. METHODS: We reviewed our series of 130 patients with hypospadias who underwent surgical correction at the Department of Pediatric Urology from 1993-1998. RESULTS: The patients presented the following types of hypospadias: glandular (13 cases), balano-preputial (56), distal penile (42), mid-penile (9), proximal penile (2) and penoscrotal hypospadias (8). The surgical techniques utilized were the Mickulitz meatotomy procedure (6 cases), MAGPI (24), Mathieu (77), Crawford (5), onlay (7), Duckett (3), Retik (4), Duplay (1), Denis-Brown (2) and penoscrotal transposition (1). The complications commonly observed were fistula (20 cases), hematoma (4), stricture of urethral meatus (4), infection (3), megaurethra (3), skin necrosis (1). CONCLUSIONS: Surgical repair of this developmental anomaly is performed when the patient is approximately 18 months old. In our series 15% of the patients developed fistula, which is similar to the complication rate reported in the literature. However, since we started using monofilament resorbable material, the incidence of fistula has dropped from 20% to approximately 5%. Although other factors are involved, the lower incidence of fistula formation may be largely due to a reduced tissue reaction to foreign body.

[Hypertension secondary to intrarenal aneurysms in childhood]. / Hipertensión secundaria a aneurismas intrarrenales en la infancia.

OBJECTIVES: Arterial hypertension due to renovascular dysfunction is uncommon in children. The most common cause is stenosis of the renal artery and, rarely, aneurysm of secondary arteries. The present case underscores the therapeutic difficulties. Treatment must be based on the clinical symptoms, location, size, number and etiology of these vascular malformations. METHOD/RESULTS: We describe a 4-year-old patient with secondary arterial hypertension arising from several aneurysms in the primary and secondary arterial branches of the right kidney that had been diagnosed by arteriography. After medical treatment had failed, the patient underwent a right nephrectomy since local or conservative procedures could not be done. CONCLUSIONS: It is widely advocated in the literature that patients with medically refractory arterial hypertension warrant surgical treatment. The type of surgery will depend on the location and the characteristics of the lesion.

[Intravesical foreign body caused arising from ureterostomy protective resin-gum]. / Cuerpo extraño intravesical producido por resina-goma protectora de ureterostomía.

OBJECTIVES: Bladder foreign bodies can arise from many factors and are iatrogenic in a high percentage. A case of intravesical foreign body from accumulated fragments of synthetic gum utilized to protect the ureterostomy is described. These problems can be avoided by correct management of the osteotomy and must therefore be emphasized to those responsible for the patient's care. METHODS/RESULTS: A case of a 7-year-old patient with chronic nephropathy and a bilateral high-loop ureterostomy is described. The migration and subsequent condensation of small fragments of the material protecting the ureterostomy led to the formation of a foreign body which took the shape of the bladder. Treatment was by vesicostomy. CONCLUSION: The possible complications arising from the passage of objects from outside into the urinary tract should always be taken into account in patients with an external urinary diversion.

Nefropatías atípicas como causa de nefrectomías en la edad pediátrica / Atypical nephropaties leading to nephrectomy in children

El porcentaje de unidades renales que deben ser extirpadas en la edad pediátrica ha disminuido, gracias al desarrollo de técnicas de diagnóstico precoz y a la aparición de tratamientos quirúrgicos alternativos como la cirugía de banco, las embolizaciones selectivas y el gran avance de la edoscopía renal.Sin embargo un cierto número de patologías nefrourológicas no tienen otra alternativa que la nefrectomía para eliminar el riesgo vital que suponen para el enfermo.Se presentan tres nefropatías, atípicas en la edad pediátrica,cuya evolución obligó a la extirpación del riñón patológico.Se trataba de una pielonefritis xantogranulomatosa que afectaba todo el riñón derecho una hematuria esencial de evolución maligna cuyo diagnóstico etiológico no pudo ser establecido,incluso en el estudio histopatológico y una hipertención secundaria a múltiples anuerismas intrarenales localizados exclusivamente en el riñón derecho

Nefropatías atípicas como causa de nefrectomías en la edad pediátrica / Atypical nephropaties leading to nephrectomy in children

El porcentaje de unidades renales que deben ser extirpadas en la edad pediátrica ha disminuido, gracias al desarrollo de técnicas de diagnóstico precoz y a la aparición de tratamientos quirúrgicos alternativos como la cirugía de banco, las embolizaciones selectivas y el gran avance de la edoscopía renal.Sin embargo un cierto número de patologías nefrourológicas no tienen otra alternativa que la nefrectomía para eliminar el riesgo vital que suponen para el enfermo.Se presentan tres nefropatías, atípicas en la edad pediátrica,cuya evolución obligó a la extirpación del riñón patológico.Se trataba de una pielonefritis xantogranulomatosa que afectaba todo el riñón derecho una hematuria esencial de evolución maligna cuyo diagnóstico etiológico no pudo ser establecido,incluso en el estudio histopatológico y una hipertención secundaria a múltiples anuerismas intrarenales localizados exclusivamente en el riñón derecho

[Latex allergy in children with spina bifida]. / Alergia al látex en niños con espina bífida.

Latex allergy is a frequent happening in children with spina bifida or congenital urologic abnormalities. These patients have multiples exposures to derivatives of latex as part of the management increasing the risk of allergic reactions. We present three children who developed general anaphylactic reaction during urodynamic exploration with a rectal latex catheter. All patients showed positive skin test and positive latex specific IgE test (RAST). A prospective survey of 17 patients with spina bifida at the time of cystometry showed positive RAST levels in 7 (41%). Recommendations for prophylaxis are included, suggesting the avoidance of latex products in children with spina bifida since birth.

[Poisoning by viper bites in children]. / Intoxicación por mordedura de víbora en niños.

Our experience with 36 cases of adder bites, collected during 13 years (1976-1989), is presented. The severity of the clinical picture was minimal to moderate in most of the cases, with mainly local symptomatology noted. Only 4 of the cases had symptoms such as vomiting and abdominal pain. Good results wee obtain in all cases with the prescribed medical treatment, except in one case which had partial necrosis of the skin on one finger on the side of viper bite. Antibiotics were used in all cases except three and anti-tetanus therapy was used in those cases where needed. Corticosteroids and antihistamines were used on selected occasions. We recommend the use of antiofidic serum, although the possibilities of anaphylactic reaction must be noted. We do not recommended local incisions and suction for this type of bites.

[Urologic obstructions due to fungal balls]. / Obstrucciones urológicas por tapones fúngicos.

Fungal urologic infections are unusual in children. They are associated with chronic uropathies, citostatics and antibiotic treatments and depressed immunity which allow the pathologic growth of a saprofitie organism. This infection must present special forms when the mycotic development is realized in cavities and special advantageous conditions. Then it adopt the form of fungal bezoars, and it can mobilize itself and provoke obstructions in the urinary tract. We present two cases of urinary obstructions secondary to fugal bezoars. The obstruction was localized in the uretero-vesical junction. In both of them the infection was associated with long antibiotic treatment, and with severe immunodeficiency only in one. The diagnosis was possible by echography and direct determination of candida albicans in urine. We proved also temporary ureterovesical stenosis we found before a reflux. The treatment included intravenous and local anfotericine B with dissolution of the bezoar in three and four days respectively.

[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.

[Neonatal hypothyroidism secondary to the use of povidone-iodine]. / Hipotiroidismo neonatal secundario a la utilización de povidona yodada

The skin absorption of iodine products in neonates with inhibition of thyroid function has been documented in the past. The use of Povidone-Iodine is the most frequent cause of this type of intoxication. Three neonates in which Povidone-Iodine was used during and after surgery had hypothyroidism secondary to glandular inhibition. They were discovered during the routine Programme for Neonatal Metabolic Diseases and were treated as deficits persists on retesting at 14 days of age. Treatment was maintained during one year, and the follow up controls of TSH-T4 were normal. During the neonatal period the use of Iodine containing antiseptics should be avoided because the potential risk of intoxication and glandular inhibition.

[Simultaneous bilateral Wilms tumor]. / Tumor de Wilms bilateral sincrónico.

Bilaterality is uncommon in Wilms' tumor, being present in 4% to 8% of the cases. Definite progress has been made in the treatment with marked improvement in prognosis. The recent trend toward more conservative sugery, preoperative chemotherapy an avoidance of high-dose radiation therapy has yielded good results. This is confirmed in our two cases with synchronous tumors.

[Cystic lymphangioma of the scrotum]. / Linfangioma quistico de escroto.

The authors present a case of cystic lymphangioma of the scrotum. They stress the rarity of this location. They also comment upon the embriology, clinical picture and treatment of these benign tumours.

[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.