Aganglionose total do cólon: aspectos radiológicos / Total aganglionosis of the colon: radiological findings

A partir da observação de três pacientes com aganglionose total do cólon e de revisão da literatura, os autores salientam as particularidades diagnósticas desta entidade que justificam uma análise separada da forma típica da doença de Hirschsprung. Não há sinais radiológicos patognomônicos e o diagnóstico definitivo somente pode ser obtido pelo estudo histopatológico. Considerando sua alta incidência de complicações e mortalidade, a aganglionose total do cólon deve ser considerada em todo recém-nascido ou criança maior com evidências radiológicas de obstrução intestinal, quaisquer que sejam os achados de enema opaco.

The role of videolaparoscopy in the diagnostic and therapeutic approach of nonpalpable testis

OBJECTIVE: Evaluate the results from the first 5 years of experience with laparoscopy for diagnosis and treatment of nonpalpable testes. MATERIALS AND METHODS: Medical records of 51 patients submitted to laparoscopic testicular exploration, during a 5-year period, were retrospectively analyzed. Patients' mean age was 65.7 months (median = 48) on the first procedure. The youngest patient was 10 months and the oldest was 14 years old on the first surgery. Twenty-four (47 percent) patients presented nonpalpable testes bilaterally, 7 (14 percent) only at the right side and 20 (39 percent) at the left, totaling 75 testicular units assessed. Patients who had their testes palpated after anesthetic induction were excluded from the study, and in all other cases, surgical management was based on the testicular position and viability. During the post-operative follow-up, surgical success was classified as palpable testis in scrotal sac, with adequate consistency and volume. RESULTS: Nine (12 percent) testes were not localized, but their vessels and deferent duct were atrophic. Two (3 percent) testes were intra-abdominal and atrophic, and 2 (3 percent) gonads, in the same patient, had a dysmorphic aspect. Nineteen (25 percent) testicular units were located close to the internal inguinal ring (peeping testes) and, in 22 (29 percent) units, the spermatic vessels and deferent duct penetrated the internal inguinal ring. Eight (10 percent) testes were located at a distance of less than 2 cm from the internal inguinal ring and 13 (17 percent) at a distance greater than 2 cm. The 2 intra-abdominal atrophic testes were removed. Inguinotomy was performed in a total of 41 (54 percent) cases, reaching a surgical success of 89 percent. Laparoscopic orchiopexy in one stage, without vascular ligation, was performed in 9 (12 percent) testes, which presented a distance of less than 2 cm from the internal inguinal ring, also with a surgical success index of 89 percent. Orchiopexy in 2 stages, with ligation of the spermatic vessels, was performed in 13 (17 percent) testicular units located at a distance greater than 2 cm from the internal inguinal ring, reaching 77 percent of good results. CONCLUSION: Videolaparoscopy is a safe and effective method for diagnosis and treatment of nonpalpable testis.

Colonizaçäo bacteriana em cateter implantado através de flebotomia em crianças de uma enfermaria geral de pediatria / Bacterial contamination in catheter implanted through the phlebotomy in children of a general ward of pediatrics

Foi estudada prospectivamente a incidência de contaminaçäo bacteriana e de septicemia em cateter endovenoso, colocado por flebotomia, em crianças de uma enfermaria de Pediatria de um hospital-escola. Foram analisados dados obtidos em dois períodos de tempo. A porcentagem de culturas positivas foi maior em pacientes com diarréia e no segundo período. Näo houve correlaçäo com o local da flebotomia nem com a manipulaçäo do cateter para o uso de antibióticos. A incidência de septicemia foi de 6,3% das cateterizaçöes

Apendicite aguda na criança: experiência e estudo comparativo em apendicite supurada / Acute appendicitis in children: experience and comparative study in suppurative appendicitis

Analisam-se 93 casos de apendicite aguda em crianças com idade compreendida entre 3 a 13 anos, com ênfase especial na técnica cirúrgica empregada, tempo de íleo pparalítico e período de internaçäo. Compara-se a eficácia de dois esquemas antibióticos na profilaxia das complicaçöes infecciosas pós-apendicectomia. O uso de metronidazol e gentamicina, no lugar de cloranfenicol, reduziu significativamente a incidência de complicaçöes infecciosas no pós-operatório de apendicite supurada (de 31% para 5%)