Uso de prótesis autoexpandibles en estenosisesofágicas en niños / Use of self-expandable prosthesis in esophageal stenosis in children

Objetivos. Las estenosis esofágicas de origen péptico o cáustico en niños precisan múltiples dilataciones, que implican un importante riesgo anestésico y de traumatismo esofágico. La colocación de prótesis esofágicas puede suponer un avance en el tratamiento de estos pacientes. El objetivo de nuestro trabajo es analizar la eficacia de las prótesis autoexpandibles para el tratamiento de estenosis esofágicas en niños. Material y métodos. Presentamos 3 casos clínicos de pacientes que han sufrido estenosis esofágicas, una secundaria a ingesta de cáusticos y dos a reflujo gastroesofágico, en los que se han colocado prótesis, en el primer caso metálica recubierta de nitinol y en los otros dos casos de material reabsorbible. Resultados. Al paciente con estenosis cáustica, tras un año de dilataciones, se le colocaron 2 prótesis metálicas consecutivas. Tras su retirada, ha precisado nuevas dilataciones con mayores periodos asintomáticos. A los dos pacientes afectos de estenosis pépticas, tras varios meses de dilataciones, les fueron colocadas prótesis (..) (AU)

Objective. Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. Material and methods. Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. Results. After a year of serial (..) (AU)

[Use of self-expandable prosthesis in esophageal stenosis in children]. / Uso de prótesis autoexpandibles en estenosis esofágicas en niños.

OBJECTIVE: Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. MATERIAL AND METHODS: Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. RESULTS: After a year of serial dilations, we placed two consecutive metal stents in one patient with caustic stricture. After its withdrawal, new dilations have been needed, but with longer asymptomatic period. The other two patients had peptic strictures; biodegradable stents were placed after months of serial dilations, before performing antireflux surgery. None of them needed further dilation. CONCLUSIONS: Esophageal stent placement has solved the problem without further dilation in peptic esophageal strictures. Asymptomatic period was significantly increased in caustic stricture. The results obtained with self-expanding stents are promising.

[Expression of receptors of estrogens and androgens in the testicular appendices]. / Expresión de receptores de estrógenos y andrógenos en los apéndices testiculares.

INTRODUCTION: The appendices or hidátides of the testicle are structures that are considered an embryonic rest. In testicular hidátide estrogen receivers have been demonstrated but in the epididimys the results vary. Has been theorized that the elevation of the estrogen levels in the puberty can produce an inflammation and torsion of hidátide, nevertheless, in the epididimys in which the estrogen expression is not clear (and also they are twisted) the theory is put in doubt. This controversy takes us to the accomplishment of this work. MATERIAL AND METHOD: A prospective study is made in 20 testicular appendices, of which 7 from the epididimys are extirpated of patients to whom an escrotal exploration is made in the development of surgery of processes of the inguino-escrotal channel (hidroceles, hernias). Optical microscopy and inmunohistoquímical study are analyzed by means of using prediluted monoclonales antibodies, for receivers of estrogens, androgens and proliferative index. The results were proceed and analyzed by means of SPSS statistical program. RESULTS: All hidátides, testicular and from the epididimarys expressed receivers for estrogens without significant difference among them, not existing differences as far as the location of receiving sayings within the three compartments of hidátide. The number of estrogen receivers was in relation to the age of the patient. Only hidátides from the epididimys fundamentally expressed receivers of located androgens and at level of ductus. We have not found significant relation between the proliferative index and the expression of estrogen receivers. The proliferative index was more elevated at level of ductus. CONCLUSIONS: 1) As much the testicular appendices as those from the epididimays expressed receivers of estrogens at level of the three compartments. It makes think about a same embryonic origin, although only the epididimal ones expressed androgen receivers. 2) the observation of estrogen receivers in both types of hidátides, as well as the relation of the number of such with the age of the patient, makes think that the increase of estrogens in the puberty can participate in patogénia of the torsion of these appendices.

[Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy]. / Efecto de la anestesia local en la respuesta al dolor. Estudio en la herniotomía inguinal.

INTRODUCTION: The inguinal hemiotomy is a surgical procedure common in pediatric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgical pain. MATERIAL AND METHOD: A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hidrocele, under general anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1 and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency... 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second 60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was considered significant. RESULTS: 1) Conductual measurements: the differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type: in groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: in groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. CONCLUSIONS: 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the postoperating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anesthetics but the age of the patient.

Expresión de receptores de estrógenos y andrógenos en los apéndices testiculares / Expression of receivers of estrogens and androgens in the testicular appendices

Introducción. Los apéndices o hidátides del testículo son estructuras que se consideran restos embrionarios. En la hidátide testicular se han demostrado receptores estrogénicos pero en la epididimaria los resultados varían. Se ha teorizado que la elevación de los niveles de estrógenos en la pubertad puede producir una inflamación y torsión de la hidátide, sin embargo, en las epididimarias en las que no está clara la expresión de estrógenos (y también se torsionan) la teoría se pone en duda. Esta controversia nos lleva a la realización de este trabajo. Material y método. Se realiza un estudio prospectivo en 20 apéndices testiculares, de los cuales 7 son epididimarios extirpados de pacientes a los que se realiza una exploración escrotal en el desarrollo de cirugía de procesos del canal inguino-escrotal (hidroceles, criptorquídias).Se analizan mediante microscopía óptica y estudio inmunohistoquímico empleando anticuerpos monoclonales prediluidos, para receptores de estrógenos, androgenos e indice proliferativo. Los resultados fueron procesados y analizados mediante el programa estadístico SPSS. Resultados. Todas la hidátides, testiculares y epididimarias expresaron receptores para estrógenos sin diferencia significativa entre ellas, no existiendo diferencia en cuanto a la localización de dichos receptores dentro de los tres compartimentos de la hidátide. El número de receptores de estrógenos estaba en relación con la edad del paciente. Sólo las hidátides epididimarias expresaron receptores de andrógenos y localizados fundamentalmente a nivel de los ductus. No hemos encontrado relación significativa entre el índice proliferativo y la expresión de receptores de estrógenos. El índice proliferativo fue más elevado a nivel delos ductus. Conclusiones. 1) Tanto los apéndices testiculares como epididimarios expresaron receptores de estrógenos a nivel de los tres compartimentos. Ello hace pensar en un mismo origen embrionario, si bien sólo los epididimarios expresaron receptores de andrógenos. 2) La observación de receptores de estrógenos en ambos tipos de hidátides, así como la relación del número de los mismos con la edad del paciente, hace pensar que el aumento de estrógenos en la pubertad puede participar en la patogenia de la torsión de estos apéndices (AU)

Introduction. The appendices or hidátides of the testicle are structures that are considered an embryonic rest. In testicular hidátide estrogen receivers have been demonstrated but in the epididimys the results vary. Has been theorized that the elevation of the estrogen levels in the puberty can produce an inflammation and torsion of hidátide, nevertheless, in the epididimys in which the estrogen expression is not clear (and also they are twisted) the theory is put in doubt. This controversy takes us to the accomplishment of this work. Material and method. A prospective study is made in 20 testicular appendices, of which 7 from the epididimys are extirpated of patients to whom an escrotal exploration is made in the development of surgery of processes of the inguino-escrotal channel (hidroceles, hernias). Opticalmicroscopy and inmunohistoquímical study are analyzed by means of using prediluted monoclonales antibodies, for receivers of estrogens, androgens and proliferative index. The results were proceed and analyzed by means of SPSS statistical program. Results. All hidátides, testicular and from the epididimarys expressed receivers for estrogens without significant difference among them, not existing differences as far as the location of receiving sayings within the three compartments of hidátide. The number of estrogen receivers was in relation to the age of the patient. Only hidátides from the epididimys fundamentally expressed receivers of located androgens and at level of ductus. We have not found significant relation between the proliferative index and the expression of estrogen receivers. The proliferative index was more elevated at level of ductus. Conclusions. 1) As much the testicular appendices as those from the epididimays expressed receivers of estrogens at level of the three compartments. It makes think about a same embryonic origin, although only the epididimal ones expressed androgen receivers. 2) the observation of estrogen receivers in both types of hidátides, as well as the relation of the number of such with the age of the patient, makes think that the increase of estrogens in the puberty can participate in patogénia of the torsion of these appendices (AU)

Efecto de la anestesia local en la respuesta al dolor. Estudio en la herniotomía inguinal / Effect of the local anesthesia in the response to the pain. Study in the inguinal herniotomy

Introducción. La herniotomía inguinal es un procedimiento quirúrgico común en cirugía pediátrica y como en cualquier intervención quirúrgica es fundamental el control del dolor. El objetivo de este estudio es comprobar el efecto de la anestesia local junto a la anestesia general, en el control del dolor postquirúrgico. Material y método. Se realiza un estudio prospectivo en 60 pacientes sometidos a reparación de hernia inguinal e hidrocele unilateral, bajo anestesia general. Los pacientes fueron designados al azar en tres grupos iguales después de la inducción anestésica. En el grupo I se realiza bloqueo ilio-inguinal, antes de la incisión quirúrgica. En el grupo IIse realiza infiltración local tras el cierre de la aponeurosis y en el grupo III no se infiltra anestésico local. La edad de los pacientes estuvo comprendida entre 1 y 13 años. Para la valoración del dolor y comparación entre los tres grupos utilizamos: 1) Mediciones de tipo conductuales.2) Mediciones de tipo biológico antes y después de la intervención: Tensión arterial, frecuencia cardiaca, frecuencia respiratoria… 3)Mediciones de laboratorio: niveles de cortisol, prolactina, insulina y glucosa. Se realizan dos extracciones, la primera después de la inducción anestésica y la segunda 60 minutos después de la intervención. Los resultados fueron analizados empleando el programa informático-estadístico SPSS. Un valor de probabilidad < 0,05 fue considerado significativo. Resultados. 1) Mediciones de tipo conductuales: Las diferencias entre los grupos I y II en relación con el III fueron significativas. Esta diferencia conductual también estuvo relacionada con la edad de los pacientes. 2) Mediciones de tipo biológico. En los grupos I y II la tensión arterial media postoperatoria fue menor, pero solo en el grupo Il a diferencia fue significativa. La frecuencia cardiaca disminuyó en los tres grupos, pero significativa solo en el grupo I, al igual que la frecuencia respiratoria. 3) Mediciones de laboratorio: En los grupos I y II los niveles de cortisol y glucosa disminuyeron en el postoperatorio, pero sólo en el grupo I la diferencia fue significativa. Los valores de prolactina sólo disminuyeron en el postoperatorio en el grupo I pero no fue significativo. La insulina experimentó un aumento en los tres grupos, aunque menor en el grupo I. Conclusiones. 1) Los resultados del estudio demuestran que la infiltración local de anestésico disminuye la respuesta metabólica y reduce la intensidad del dolor postoperatorio, especialmente cuando se realiza antes del comienzo de la cirugía. 2) En la respuesta conductual al dolor no solo influye la utilización de anestésico local si no también la edad del paciente (AU)

Introduction. The inguinal herniotomy is a surgical procedure common in pediátric surgery and as in any operation the control of the pain is fundamental. The aim of this study is to verify the effect of the local anesthesia next to the general anesthesia, in the control of postsurgicalpain. Material and method. A prospective study is made in 60 patients submitted for unilateral repair of hernia inguinal and hydrocele, undergeneral anesthesia. The patients were designated at random in three equal groups after the anesthetic induction. In group I ilio-inguinal blockade is made, before the surgical incision. In group II local infiltration is made after the closing of the aponeurosis and in group III the anesthetic is not infiltrate. The age of the patients included was between 1and 13 years. For the valuation of the pain and comparison between the three groups we used: 1) Measurements of conductual type. 2) Measurements of biological type before and after the intervention: Arterial tension, cardiac frequency, respiratory frequency… 3) Laboratory measurements: cortisol levels, prolactose, insulin and glucose. Two extractions are made, first after the anesthetic induction and second60 minutes after the intervention. The results were analyzed using computer statistical program SPSS. A probability value of < 0,05 was consideredsignificant. Results. 1) Conductual measurements: The differences between groups I and II in relation to the III were significant. This conductual difference also was related to the age of the patients. 2) Measurements of biological type. In groups I and II the postoperative arterial tension average was smaller, but only in group I the difference was significant. The heart rate decreased in the three groups, but was significant only in group I, like the respiratory frequency. 3) Laboratory measurements: In groups I and II the levels of cortisol and glucose diminished in the postoperative period, but only in group I the difference was significant. The values of prolactose diminished in the postoperative period in group I but was not significant. Insulin experienced an increase in the three groups, although smaller in group I. Conclusions. 1) The results of the study demonstrate specially that the local infiltration of anesthetic diminishes the metabolic answer and reduces the intensity of the post operating pain, when is made before the beginning of the surgery. 2) In the conductual answer to the pain not only influences the use of the anaesthetics but the age of the patient (AU)

[Role of the Helicobacter pylori in the aetiology of acute appendicitis. Preliminary studies]. / Implicación del Helicobacter pylori en la etiopatogenia de la apendicitis aguda. Estudios preliminares.

Helicobacter pylori (H. pylori) has been found in the upper gastrointestinal tract. It is incriminated as aetiological factor in various pathological conditions. This study was designed to determine whether H. pylori plays a role in the pathogenesis of acute appendicitis. H.pylori was investigated in 40 patients divided in 2 groups. A: patients with abdominal pain and B: patients with acute appendicitis, confirmed by pathology studies. The Ag H.pylori was investigated in the faeces of both groups. In the group B, besides, appendix samples were tested for culture for H. pylori. Confirmation was made by PCR (Polymerase Chain Reaction) analysis. Statistical analysis was made. The positivity for H. pylori infection in the faeces was found in Group A in 15% of the patients and in the group B in 35%. In the group B, besides, the culture of the appendix cecal was positive in 71.4%. Though was observed difference between both groups, this one was not significant. It seems that H. pylori colonizes the appendix in small proportion and is unlikely to be associated in direct correlation with acute appendicitis. However, seropositive patients with acute inflammation are likely to suffer from purulent o gangrenous form.

Implicación del helicobacter pylori en la etiopatogenia de la apendicitis aguda. Estudios preliminares / Role of the helicobacter pylori in the aetiology of acute appendicitis. Preliminary studies

El Helicobacter pylori (HP) es el patógeno más común del tracto gastrointestinal en los seres humanos y se ha implicado en la etipatogénesis de muchas enfermedades digestivas. El objetivo de este trabajo es determinar si el Helicobacter pylori juega un papel en la patogénesis de la apendicitis aguda. Realizamos un estudio prospectivo en 40 pacientes divididos en 2 grupos, A: pacientes con dolor abdominal y B: pacientes intervenidos por apendicitis aguda, confirmada por anatomía patológica. En ambos grupos se investiga la presencia de HP. La detección del antígeno HP se realiza en las heces de los pacientes de ambos grupos y en el grupo B, además, en el apéndice cecal tras apendicectomía, mediante cultivo. En el grupo de pacientes con apendicitis aguda la detección del antigeno en heces (35%) fue superior a la del grupo A (15%), siendo positivo, además, el cultivo del apéndice cecal en el 71,4%. Aunque se observó diferencia entre ambos grupos, ésta no fue significativa. Nuestros resultados demuestran, por lo tanto, que aunque dicho bacilo puede colonizar el apéndice, no existe una relación significativa entre la apendicitis aguda y el HP. Sin embargo en los pacientes con cultivo positivo se ha observado mayor incidencia de apendicitis complicadas (purulentas o gangrenosas (AU)

Helicobacter pylori (H. pylori) has been found in the upper gastrointestinal tract. It is incriminated as aetiological factor in various pathological conditions.This study was designed to determine whether H. pylori plays a role in the pathogenesis of acute appendicitis. H.pylori was investigated in 40 patients divided in 2 groups. A: patients with abdominal pain and B: patients with acute appendicitis, confirmed by pathology studies. The Ag H.pylori was investigated in the faeces of both groups. In the group B, besides, appendix samples were tested for culture for H. pylori. Confirmation was made by PCR (Polymerase Chain Reaction) analysis. Statistical analysis was made. The positivity for H. pylori infection in the faeces was found in Group A in 15% of the patients and in the group B in 35%. In the group B, besides, the culture of the appendix cecal was positive in 71,4%. Though was observed difference between both groups, this one was not significant. It seems that H. pylori colonizes the appendix in small proportion and is unlikely to be associated in direct correlation with acute appendicitis. However, seropositive patients with acute inflammation are likely to suffer from purulent o gangrenous form (AU)

Alteraciones histológicas del músculo cremáster en determinados procesos del canal inguinal / Histological alterations of the muscle cremaster in certain inguinal-scrotal anomalies

La alteración en el músculo cremáster se ha implicado en la patogenia de determinados procesos inguinoescrotales, sin que en la actualidad existan estudios concluyentes. El objetivo de nuestro trabajo es determinar si existen alteraciones en el músculo cremáster (MC) que ayuden a explicar la etiopatogenia de distintos procesos como la hernia inguinal, el hidrocele o el mal descenso testicular. Realizamos el estudio en 42 pacientes afectos de: hernia inguinal (n = 14), criptorquidia (n = 14) e hidrocele (n = 14). Se toman muestras del músculo cremáster en el momento de la intervención quirúrgica. Las piezas quirúrgicas fueron repartidas por un lado para inclusión en formol y glutaraldehído y por otro, en suero fisiológico y congelación para estudio histoquímico. Se tiñeron con hematoxilina-eosina, Pas y hematoxilina fosfotúgstica. En el estudio histoquímico se empleó NADH, fosforilasas y el tricrómicro de Engel. Se valoran parámetros indicativos de cambios miopáticos. Todos las muestras de MC de los tres grupos presentaron cambios miopáticos de tipo primario en distinto grado: primer, segundo y tercer estadio. Dichas muestras producen alteraciones en la contractilidad del músculo, lo que podría colaborar en la patogenia de las mismas. Le existencia de cambios miopáticos primarios nos podría hacer pensar en una miopatía primaria, si bien existen datos que apuntan a una participación neurológica en la misma (AU)

The alteration in the cremaster muscle has been involved in the pathogeny of certain inguinal-scrotal anomalies, even though there are no conclusive studies up to date. The target of our paper is to determine the eventual existence of alterations in the cremaster muscle (CM) that helps to explain the etiopathogeny of different anomalies such as inguinal hernia, hydrocele or undescended testicle. We carried out a study on 42 patients with: inguinal hernia (n = 14), cryptorchidism (n = 14) and hydrocele (n = 14). Samples of the cremaster muscle were taken during the surgical intervention. Surgical samples were introduced or into formol and glutaraldehyde or into physiological serum and freezing for histological study. They were dyed with hematoxilin-eosin, PAS and phosphotungstic acid haematoxilin. In the histochemical study NADH, phosphoric hydrolases and Engel´s trichromic were used. Parameters indicative of myopathic changes were evaluated. All CM samples from all three groups showed myopathic changes of primary type in different levels: first, second and third stages. This changes that produce alterations in the muscle´s contractility, changes might make us think in a primary myopathy even though there are data pointing to a neurological influence on it (AU)

Valoración de las lesiones en el testículo criptorquídico: estudio anatomopatológico y ultrastructural / Assessment of the lesions in the cryptorchid testis: pathological and ultrastructural studies

Numerosos estudios han llegado a la conclusión de que el testículo criptorquídico es anormal con alteración de la espermatogénesis primaria. El mecanismo que produce las lesiones está sujeto a controversia. Se realizó biopsia en 20 pacientes con criptorquidia unilateral tomada durante el descenso testicular, y se llevó a cabo estudio ultrastructural con microscopia electrónica, valorando las lesiones que ocurren en el testículo no descendido. La degeneración tubular y celular fue focalizada dentro de un mismo testículo y túbulo, respectivamente. Las lesiones degenerativas fueron, fundamentalmente, vacuolización (índice de degeneración metabólica), edema y apoptosis celular o muerte celular programada. Esta fue la lesión más constante y llamativa. Al participar la apoptosis en procesos mediados inmunológicamente, hizo que nos planteáramos si la lesión en el testículo criptorquídico está mediada por un mecanismo inmune (AU)

[Apoptosis in the cryptorchidism. Role of the FAS protein in it's modulation]. / Apoptosis en el testículo criptorquídico. Implicación de la molécula FAS en su modulación.

The cellular degeneration, present at the criptorchidism leads to a malfunction in the spermatogenosis and it's due to cellular apoptosis (programed cellular death). This process is turned on and modulated by different ways. One of then is mediated by Ag-Ac reactions and a protein called FAS seems to have an important role in it's modulation. We studied the relation between FAS an the increased apoptosis in undescended testics. Testicular biopsies were done in criptorchid patients during orchidopexy and FAS was measured by immune-techniques. Our results seem to dismiss FAS as a modulation apoptosis factor in the cryptorchidism.

Apoptosis en el testículo criptorquídico. Implicación de la molécula FAS en su modulación / Apoptosis in the cryptorchidism. Role of the fas protein in it's modulation

La degeneración celular que ocurre en la criptorquidia con alteración de la espermatogénesis normal se produce por un mecanismo de «apoptosis» o muerte celular programada. Son varias las vías que activan o modulan dicha apoptosis y entre ellas la vía mediada inmunológicamente por reacción antígeno-anticuerpo. Cuando la muerte por apoptosis se produce por vía inmnológica, una molécula «FAS» es la implicada en la modulación de dicha apoptosis. En este trabajo investigamos el papel que la molécula FAS tiene en el incremento de apoptosis en el artículo criptorquídico. El estudio se realiza en biopsias testiculares de pacientes criptorquídicos tomadas durante la orquidopexia, y la determinación de FAS se realiza por técnicas de inmunohistoquímica. Los resultados obtenidos indican que la molécula FAS no parece tener una clara implicación en la modulación de la apoptosis en el testículo criptorquídico (AU)

[Modifications of gastric distensibility as a function of the type of fundoplication. Experimental model in rats]. / Modificaciones de la distensibilidad gástrica en función del tipo de funduplicatura. Modelo experimental en ratas.

UNLABELLED: Gastric fundoplication to create an antireflux valve reduces gastric volume. The most widely used technique is Nissen's fundoplication (NF), but an anterior (AF) and posterior (PF) partial fundoplication are also used. This study examines the changes caused by these three techniques on the volume and the compliance of the stomach in vitro. MATERIAL AND METHODS: We used 4 groups of 10 rats Wistar each, weighing approximately 250-300 grams. One group was not manipulated (Control) whereas the other groups had NF, AF or PF respectively. The fresh stomachs were removed and progressively filled with saline by means of an infusion pump and the intragastric pressure was continuously measured with a pressure monitor. The volume of saline infusion required necessary to achieve pressure increments of 1 unit from 0 to 30 mmHg were measured and the results were compared with ANOVA. RESULTS: The three modalities of fundoplication reduced significantly gastric compliance since rats from the control group required 21.7 +/- 3.3 mL to reach intragastric pressure of 30 mmHg whereas 9.5 +/- 2.4 mL, 11.75 +/- 1.8 mL and 13.4 +/- 2.2 mL were required for the groups NF, AF and PF respectively. According to these results, the type of fundoplication which reduced the least the compliance was the posterior one. CONCLUSIONS: The use of fundus of the stomach to create an antireflux valve always implies a significant reduction of gastric compliance, which can favour gastric emptying and thus dumping syndrome. Even though important, this reduction was slightly less relevant after posterior fundoplication in this model. This evidence must be taken into account when choosing an antireflux technique.

[Treatment of psoas abscess. Report of a case and review of the literature]. / Tratamiento del absceso de psoas. Aportación de un caso y revisión de la literatura.

Psoas abscess is an infrequent disease. We present a right psoas abscess diagnosed in a thirteen-year-old child. There wasn't a history of known trauma nor immunodeficiency. We didn't find another infection focus so the abscess was described as primary one. This is the most commonly presentation in children. Staphylococcus aureus was the bacteria identified in blood culture. The presenting symptoms were bottom and hip pain, limp and fever. The differential diagnosis was established with suppurative arthritis of the hip. Diagnosis was confirmed by Magnetic Resonance. In regard to treatment the patient was exclusively treated with systemic antibiotics, high spectrum of activity. The patient didn't require percutaneous-drainage. Though surgical drainage wasn't made, evolution was favourable and recurrence wasn't observed.

Modificaciones de la distensibilidad gástrica en función del tipo de funduplicatura. Modelo experimental en ratas / Modifications in the gastric compliance depending on the type of fundoplication. Experimental model with rats

El uso del fondo gástrico para confeccionar una válvula antirreflujo reduce la capacidad gástrica. La técnica más usada es la funduplicatura de Nissen (FN) pero también se usan funduplicaturas parciales anterior (FA) y posterior (FP). Este estudio investiga los cambios en el volumen y la distensibilidad del estómago in vitro causados por estas tres técnicas. Material y métodos. Usamos cuatro grupos de 10 ratas Wistar de 250-300 gramos, no manipuladas (Control) o que habían sufrido antes FN, FA y FP. Los estómagos frescos fueron llenados progresivamente con suero usando una bomba de infusión y registrando la presión intraluminal con un manómetro adecuado. Se midieron las cantidades de suero necesarios para elevar cada unidad de presión desde 0 hasta 30 mmHg comparando los resultados con ANOVA. Resultados. Las tres modalidades de funduplicatura disminuyeron significativamente la capacidad de acomodación gástrica, pues en las ratas del grupo control se requirieron 21,7 ñ 3,3 mL para alcanzar la presión de 30 mmHg; mientras que bastaron 9,5 ñ 2,4 mL, 11,75ñ 1,8 mL y 13,4 ñ 2,2 mL en los grupos FN, FA y FP, respectivamente. Entre las tres formas de funduplicatura la que menos redujo la acomodación fue la posterior. Conclusiones. El uso el fondo gástrico para confeccionar una válvula antirreflujo implica siempre una reducción significativa de la capacidad de acomodación que puede favorecer el vaciamiento gástrico y por ende el 'dumping'. Esta reducción, aun siendo considerable, es ligeramente menor tras funduplicatura posterior en este modelo. Este efecto debe tenerse en cuenta a la hora de elegir la técnica antirreflujo (AU)

Tratamiento del absceso de psoas. Aportación de un caso y revisión de la literatura / Treatment of psoas abscess. Case report and review of the literature

El absceso de psoas es una enfermedad diagnosticada con poca frecuencia. Presentamos el caso de un niño de 13 años diagnosticado en nuestro centro de absceso de psoas derecho. El paciente no presentaba antecedentes traumáticos, ni de inmunodeficiencia y tampoco se encontró foco de infección, por lo que se calificó de absceso primario, que es la forma más frecuente en pediatría. El germen aislado en el hemocultivo fue el Staphylococcus aureus. En la clínica destacaba dolor en la zona glútea y cadera derecha que dificultaba la deambulación, así como fiebre elevada, lo que hizo plantearse en un principio el diagnóstico diferencial con una artritis séptica de cadera. El diagnóstico definitivo se realizó con resonancia magnética. En cuanto al tratamiento, hemos obtenido la total resolución del absceso con el empleo de antibióticos de amplio espectro por vía intravenosa, no precisando, como en la mayoría de los casos encontrados en la bibliografía, la realización de drenaje percutáneo. Pese a no haber sido realizado drenaje quirúrgico la evolución ha sido favorable y sin complicaciones, no observándose recidivas (AU)

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Linfangioma adquirido progresivo: Presentación de un caso y revisión de la literatura / Lympuangioma acquired progressive: Present a patient and a literature review

Describimos una paciente de 2 años de edad con una lesión alopécica en cuero cabelludo y diagnóstico clínico de aplasia cutis. El estudio anatomopatológico de la lesión fue compatible con LAP. Se trata de un tumor vascular recientemente descrito que afecta a vasos linfáticos con tendencia a aparecer en la infancia y a progresar lentamente con los años. Se presenta como una placa-mácula eritematosa y la extirpación es generalmente curativa. Nuestro paciente es el más joven publicado (AU)

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[Progressive acquired lymphangioma: report of a case and review of the literature]. / Linfangioma adquirido progresivo: presentación de un caso y revisión de la literatura.

We present 2-year-old patient with a allopecia lesions in scalp, and clinique diagnostic of Cutis Aplasia. The anatomopathologic study have diagnosed the lesions as Acquired Progressive Lymphangioma (APL). Is a rare vascular tumour that has a tendency to appear in childhood an to progress slowly over the years. It could present as a solitary erythematous macule or plaque and a simple excision is usually curative. Our patient is the youngest reported in the literature.

[Neutropenic enterocolitis in children with cancer]. / La enterocolitis neutropénica en el niño con cáncer.

OBJECTIVES: Neuropenic enterocolitis (NEC) is a destructive lesion of the ileocecal region occurring in cancer patients treated with chemotherapy. Its clinical picture is one of febrile acute abdominal extension with bloody diarrhea and low neutrophil counts. Our aim was to determine the incidence of NEC in children with cancer and to review the indications of surgery in these cases. MATERIAL AND METHODS: The records of children with cancer treated with chemotherapy in the last 6 years at Hospital Infantile La Paz were reviewed. We selected those patients who had abdominal pain and neutropenia and whose physical examination and radiological findings were consistent with NEC. RESULTS: Twelve cases of NEC were diagnosed during this period among 432 malignancies. The symptoms most frequently seen were abdominal pain and distension, nausea and vomiting. The neutrophil count was consistently below 500/ml. All patients were receiving chemotherapy before the onset of the clinical picture. Five children were operated upon. In three of these we found various ileocecal perforations, in one a gastric perforation and in the remaining one a diffuse inflammation of the ileocecal area. Two non-operated patients died from NEC. The remaining children recovered without problems with medical therapy. CONCLUSION: Pediatric surgeons treating neutropenic cancer patients should be familiar with this condition, that must be suspected early in granulocytopenic patients with acute abdominal extension. Aggressive surgical management is indicated in cases with severe peritonitis, bowel perforation or massive lower gastrointestinal bleeding, irrespective of the degree of neutropenia. Medical support should aim at reestablishing normal neutrophil counts.