[Meckel's diverticulum. Study of 61 cases]. / Divertículo de Meckel. Estudio de 61 casos.

BACKGROUND: Meckel's diverticulum is a well known disease in children. The main clinical presentations are rectal bleeding and intestinal occlusion. OBJECTIVE: To investigate the frequency, main clinical symptoms, signs, complications, localization, histology and diagnosis in a population of mexican children. METHOD: We studied 61 children who were seen at the Instituto Nacional de Pediatria, Mexico City, during a period of 10 years. The age, sex, symptoms, complications, hematocrit, 99mTc-Pertechnetate scanning, histology, and localization of Meckel's diverticulum were analyzed in all of them. RESULTS: 15 children were female and 46 male (1:3). In infants the main clinical finding was rectal bleeding. Intestinal occlusion was the most common clinical expression in older children. Gastric mucosa was a common finding in the diverticulum of children with rectal bleeding in contrast to ileal mucosa in children with intestinal occlusion. 99mTc-pertechnetate scanning with previous administration of H2 blocking agent was the best diagnostic procedure. CONCLUSIONS: Meckel's diverticulum must be considered an emergency in children. Meckel's diverticulum, has to be ruled cut as in infants with significant bleeding, as well as in children with intestinal occlusion. The best method for diagnosis is 99mTc-pertechnetate scanning.

Wilms' tumor with intracardiac extension.

Intracardiac tumor extension from nephroblastoma is a rare event. We report on two cases with this peculiar condition who presented with a different set of signs and symptoms. Both were diagnosed in life but only one could be properly managed on time. Emphasis is made upon the most reliable methodology for early detection and the surgical approach as the only plausible way to solve this particular complication.

[Bilio-enteric convergent diversion with an antireflux mechanism. An experimental study]. / Derivación bilioentérica convergente con mecanismo antirreflujo. Estudio experimental.

A new biliary-enteric derivation was used in one group of mongrel puppies to avoid reflux and its complications. A Y-en-Roux derivation in one pared group of puppies was used also. There was a substantial complications decrease in the first puppies, but do not stop at all contamination in the bile duct tree and liver.

Apnea en el prematuro. / Apnea in the premature

Se revisaron los expedientes de 1.444 ninos recien nacidos de alto riesgo ingresados al Servicio de Neonatologia de 1975 a 1979 del Instituto Nacional de Pediatria.De ellos 425 presentaron apneas mayores de 15 segundos. Se seleccionaron 104 por reunir las variables propuestas, tanto con "apneas centrales" (no asociadas a patologias demostrables) como "apneas perifericas" con patologia cardiaca (CIV, PCA y otros) pulmonar (membranas hialinas, neumonias), hemorragia central, anemia, hipoglicemia, septicemia, hipocalcemia, hipo o hipertermia, crisis convulsivas, etc. A treinta de ellos se les hizo registro poligrafico durante el sueno y en 20 se dosificaron niveles de teofilina a las 2, 8, 12, 24 h y cada 24 h despues de la administracion del farmaco durante 10 dias. Se detectaron y trataron las causas de apnea periferica y en caso de persistencia se administro teofilina oral a 4 mg/kg/dosis cada 6 h durante 48 h primero, seguido de 2 mg/kg/dosis cada 6 h por 6 dias como sosten, con lo cual se mantuvieron niveles terapeuticos sin signos de toxicidad. El 51% requirieron tratamiento por 8 dias y 49% entre 9 y 180 dias; se retiro el medicamento hasta corroborar la desaparicion de apneas con estudio poligrafico. El grupo que requirio tratamiento a largo plazo tuvo en su mayoria patologia severa

Radionuclide angiography: as diagnostic method for Wilms' tumor with direct extension into the heart.

Radioisotope angiography may be used as an initial study in Wilms' tumor. We report a patient who had a total nephrectomy but then had severe cardiovascular complications. These led to open heart surgery and removal of a tumor lodged in the right atrium. Radioisotope angiography, performed two weeks earlier, showed a "cold" image on the anterior wall of the right ventricle. This finding was later confirmed by other studies and finally at the time of a second operation. The purpose of this paper is to discuss the different methods employed in this case, to emphasize the risks attributed to each, and finally to suggest the use of non-invasive studies such as radioisotope angiography as a practical method of study in infancy.

[Gammagraphic diagnosis of diaphragmatic abnormalities in children]. / Diagnóstico gammagráfico de las deformaciones diafragmáticas en el niño.

Hepatic and lung scanning were evaluated as complement methods of congenital defects in the diaphragm, 14 cases were evaluated in which the scan showed alteration on the morphology and function of the liver or lung. On 13 cases correlation was found between the surgical diagnosis and the scan. In 4 cases with diaphragmatic hernia (2 Morgagni and 2 Bochdalek) the scan showed that one portion of the hepatic tissue was localized in the thoracic cavity and in one case of diaphragmatic agenesis in the scan the liver occupied the whole right hemithorax. In 9 cases of diaphragmatic eventration the scan showed alteration of the pulmonary perfussion in large or small areas and generally the hepatic image was displaced towards the thorax. These results showed that the scanning is a trustworthy method and of great help in the diagnosis of congenital diaphragmaic malformations.