[Treatment of adolescent varicocele: is percutaneous embolization better?]. / Tratamiento del varicocele del adolescente. Es mejor la embolización percutánea?

UNLABELLED: There are still doubts as to the most suitable criteria when considering surgery as the indication and optimal treatment for adolescent varicocele. MATERIAL AND PATIENTS: We reviewed the hospital and primary health care histories of patients diagnosed by ultrasound for varicocele over the last 7 years. The data was taken from computerised clinical histories and hard copy back-up material stored and processed in computer format. RESULTS: We studied 135 cases (mean age 12.8 years). These patients (125) were referred for scrotal swelling or as a result of chance detection, except for 10 patients who reported pain or scrotal asymmetry. Seventy-three underwent surgery and 62 continued as controls over the study period. The surgical indication was significant progressive asymmetry in testicular volume (28 children), high grade varicocele (41) as well as other reasons (4). We undertook percutaneous embolization in 44 patients (with a 66% relapse rate) and laparoscopic section of the spermatic cord with no arterial preservation in 29 (no relapses but 7 post-surgery hydroceles). No testicles were lost. At the end of the study 10 children continued as controls, 34 were discharged after recovery, 56 were referred to urology due to their age group, and 35 were lost to the study. DISCUSSION: In the controversy over the treatment of varicocele our experience shows a high degree of relapses after embolization. Section of the spermatic vessels (including the artery) with no lymphatic preservation is highly effective but involves 27% post-op hydroceles, usually self-limiting (only one had later to undergo surgery), with no testicular atrophy or other complications. CONCLUSIONS: We prefer complete laparoscopic section of the spermatic pedicle to embolization but it would be advisable to introduce modifications to avoid post-surgical hydrocele. Embolization must be reserved for patients with one testicle or with bilateral disease. Efforts must be made to communicate more effectively, in order to reduce the high drop-out rate.

Tumor miofibroblástico en la edad pediátrica. A propósito de 3 casos / Paediatric myofibroblastic tumours. A presentation of three cases

El tumor miofibroblástico inflamatorio es una enfermedad poco frecuente en la edad pediátrica, en general benigna, aunque con posible evolución a malignidad. Se presentan 3 pacientes con tumor miofibroblástico en edad pediátrica, en diferentes localizaciones: pulmonar, gástrica e intestinal. Las características clínicas dependen del lugar en el que esté ubicado el tumor. Generalmente, hay fiebre prolongada en todos, sin gran afectación del estado general. En el primer caso, la hematemesis era su primer síntoma, mientras que en el segundo la anemia y la fiebre obligaron a la realización de una imagen abdominal. En el tercer caso fueron la fiebre, la tos y los síntomas respiratorios los que alertaban acerca de una posible tumoración pulmonar. En este caso se obtuvo un cultivo positivo para una micobacteria atípica: Mycobacterium avium. Todos los casos cursan con aumento de proteína C reactiva, velocidad de sedimentación globular, anemia, trombocitosis y aumento de gammaglobulinas. La evolución es favorable; la cirugía es curativa siempre y cuando la resección sea total; el diagnóstico es anatomopatológico. Los autores quieren destacar la precocidad en el diagnóstico de uno de los pacientes (3 meses), dato no hallado en la literatura médica (AU)

There cases of paediatric inflammatory myofibroblastic tumours in different locations are presented. This a rare benign disease, that can develop into malignant forms. Clinical features are associated with the location. Fever was the main symptom in all our cases. The symptoms that indicated the location of the tumour were, haematemesis in the first case, and respiratory disease in the third. ,In the third case our patient was diagnosed with tuberculosis due to mycobacterium avium. All cases had increased CRP, ESR, thrombocytosis and high levels of gamma globulins. Surgery is curative if total resection is possible, and the diagnosis is made by histopathology. We would like to emphasise the early development in the second case as this was a 3 months-old infant (AU)

Tratamiento del varicocele del adolescente. ¿Es mejor la embolización percutánea? / Treatment of adolescent varicocele: Is percutaneous embolization better?

Siguen existiendo dudas sobre los criterios adecuados en la indicación quirúrgica y el tratamiento óptimo del varicocele en el adolescente. Material y pacientes. Revisamos las historias hospitalarias y de Atención Primaria de enfermos diagnosticados ecográficamente de varicocele en los últimos 7 años. Los datos fueron extraídos de la historiaclínica informatizada y soporte papel, almacenados y procesados mediante programas informáticos. Resultados. Estudiamos 135 casos (edad media 12,8 años). De ellos, 125 fueron remitidos por tumefacción escrotal o tras hallazgo casual y 10 pacientes consultaron por dolor o asimetría escrotal. 73 fueron tratados y 62 siguieron controles durante el periodo de estudio. La indicación quirúrgica fue asimetría progresiva significativa del volumen testicular (28 niños), varicocele de alto grado (41) y otros motivos(4). Realizamos embolización percutánea en 44 enfermos (con un 66%de recidivas), sección laparoscópica del cordón espermático sin preservación arterial en 29 (ninguna recidiva pero 7 hidroceles postquirúrgicos). No se perdió ningún testículo. Al final del estudio 10 niños seguían controles, 34 eran alta por curación, 56 pasaron a urología por su edad (..) (AU)

There are still doubts as to the most suitable criteria when considering surgery as the indication and optimal treatment for adolescen tvaricocele. Material and patients. We reviewed the hospital and primary healthcare histories of patients diagnosed by ultrasound for varicocele over the last 7 years. The data was taken from computerised clinical histories and hard copy back-up material stored and processed in computer format. Results. We studied 135 cases (mean age 12.8 years). These patients(125) were referred for scrotal swelling or as a result of chance detection, except for 10 patients who reported pain or scrotal asymmetry. Seventy-three underwent surgery and 62 continued as controls over the study period. The surgical indication was significant progressive asymmetry in testicular volume (28 children), high grade varicocele (41) as wellas other reasons (4). We undertook percutaneous embolization in 44 (..) (AU)