[Indication of appendectomy in the recurrent abdominal pain]. / Indicación de la apendicectomía en el dolor abdominal recidivante.

INTRODUCTION: The frequency of the recurrent abdominal pain without demonstrable pathology is high and in occasions it takes to the surgeon to practice an appendectomy. In most of the cases the pain disappears. This performance although subjective, it doesn't base on objective data, what takes us to carry out this work. MATERIAL AND METHOD: The study is carried out in 47 patients with recurrent abdominal pain and subjected to appendectomy, 17 were excluded by diverse causes. The vermiform appendixes were studied by morphological and immunohistochemical methods, using the monoclonal antibodies, valuing morphologic sing of a chronic inflammation of the appendix. RESULTS: 100% of the samples studied presented microscopically chronic inflammatory changes microscopically. We observe fibrose in 100%, lympho-plasmocytic inflammatory infiltrate in 60% and a lymphocytes T prevalence has more than enough lymphocytes B. CONCLUSIONS: Our results support the existence of a clinical-pathological condition that can be defined as chronic appendicitis and therefore it justifies the appendectomy in recurrent abdominal pain when another disease has been excluded.

[Immunohistochemical study of hypertrophic pyloric stenosis]. / Estudio inmunohistoquímico en la estenosis hipertrófica del píloro.

INTRODUCTION: In spite of the clinical experience about infantil Hypertrophic Pyloric Stenosis (IHPS), its etiopathology remains unknown. Recent studies have been focussed in immunohistochemistry techniques for valuing the neuronal development in the pyloric muscle. MATERIAL AND METHODS: We took biopsy from 10 babies diagnosed of IHPS and 10 babies with similar age, died because of other causes. Immunohistochemical study was performed using monoclonal antibodies: S100 protein, GFAP, enolasa and neurofilaments NF. The results were showed semi-quantitativement as strong (++), moderate (+) and absent (-). Immunotinction of the myenteric plexus (ganglion cells and satellite) and nervous fibers of the muscle layer, were done. RESULTS: We observed a poor immunoreactivity in the muscle layer (longitudinal and circular) in the 60-70% of specimens of pyloric muscle in babies with IHPS. GFAP were absent in the 80% in the myenteric plexus. This poor innervation may be related to the etiopathogenesis of pyloric stenosis and hypertrophy.

[First results with Integra artificial skin in the management of severe tissue defects in children]. / Primeros avances en el tratamiento del niño gran traumatizado con piel artificial Integra.

In extreme cases of tissue defects, wound coverage after excision may be problematic because of the limited existence of donor sites. An option for temporary wound coverage used in the management after early scar release is a dermal substitute: Integral artificial skin. The biosinthetic material consists of un upper silicone film and a lower layer of porous cross-linked bovine collagen and chondroitin-6-sulfate as a template for dermal regeneration after staged tangencial necrectomy. In the third and fourth weeks following application the silicone layer was easily removed and the newly formed neodermis covered with widely unmeshed thin split thickness autograft. We report 6 patients with tissue defects with open fractures in three cases, one hemorrhagic necrosis of the skin by meningococcemia who requiring amputations of all four extremities and two traumatic necrosis. Other patient has a retractil scar. All were treated with Integral and epidermical autograft. The good results with Integral regarding recovery may affect initial treatment and reconstruction planning after extensive wound injuries with tissue defects to obtain immediate wound closure.

[Index finger pollicization for congenitally deficient first finger of the hand in children]. / Pulgarización en los déficits del primer rayo en la mano del niño.

Pollicization is a single-stage neurovascular pedicle transfer of the index digit to function as a thumb. The objective of this study is to investigate the results of index finger pollicization for correction of congenital deficiency of the first ray in pediatric hand. We have done 6 pollicizations of index fingers in 6 hands (there were 2 right hands, 2 left hands, and 1 bilaterally) in 5 patients (4 boys and 1 girl) who had absent or nonfunctioning thumbs (type III-V of Blauth's classification). Associated anomalies where numerous and included radial club hand, mirror hand and cardiovascular and urologic anomalies. The average time of Kirschner wire extraction was 32 days (30 to 36 days) and to beginning the hand rehabilitation at 5 degrees to 10 degrees day. The average age at pollicization was 5.5 years (range 2 to 8 years), and follow-up averaged 8 years (5 to 11 years). The cosmetic and functional results were excellent, with manual dexterity of prehension and opposition. Pollicization in children can be performed at least 2 years of age, to due of minor risk of neurovascular lesion but without delayed the cortical representation of the pollicized finger.

[Lymphangioma of the spermatic cord]. / Linfangioma de cordón espermático.

We report a new case of spermatic cord lymphangioma in a infant 2 years old. The initial diagnosis was funicular hydrocele. The treatment was the local excision of tumor and the diagnostic was histological. Postoperative course was excellent. Must be explored the transillumination of the mass which would have led us to think other the diagnosis different from that of the cord hydrocele before the operation since it would have given negative. During the operation, must the assured that the cystic anomaly is limited to spermatic cord, to evite recurrences in the postoperative course.

[Testicular teratoma and epididymal adrenal choristoma]. / Teratoma testicular y coristoma adrenal epididimario.

We report a case of mature testicular cystic teratoma in a 28-month old boy. Due to the characteristics of the palpation and its partial transillumination, it may be confused with a hydrocele. They emphasize on the rarity and benign nature of the peculiarities and refer to its prognosis, usually benign, when is diagnosed at about 2 years of age, providing that a very careful examination of the histological sections rules out the presence of anaplastic cells. A left inguinal orchiectomy was performed because it was not possible to establish a line of cleavage between the tumor and the normal tissue. The pathologic examination revealed a benign lesion. An adrenal choristoma in the caput epididymis was also observed. Postoperative course was satisfactory.

[Apoptosis of the contralateral testis after unilateral testicular injury. Experimental study]. / Apoptosis en el testículo contralateral tras lesión testicular unilateral. Estudio experimental.

INTRODUCTION: The results of both clinical and experimental studies suggest that some testicular unilateral lesions cause infertility due to disruption of spermatogenesis. The cellular mechanism responsible for the degenerative changes is still unclear. OBJECTIVE: Study of the cellular viability in the contralateral testis after unilateral testis injuries. MATERIAL AND METHOD: Six groups of 10 prepuberal Wistar rats subjected to unilateral testicular lesion. To identify the cellular death by "apoptosis" in situ, analysis of DNA fragmentation was performed in cytometric flow. RESULTS: The present study demonstrated an increase of the apoptosis in the contralateral testis after unilateral testicular lesion.

Síndrome de bandas de constricción congénitas / Congenital constriction band syndrome

Se presentan 7 pacientes pediátricos con bandas de constricción congénitas,tratadas en un solo tiempo quirúrgico mediante la escisión del surco de constricción anular,junto con plastias en Z múltiples.En todos los casos se obtuvieron excelentes resultados estéticos y funcionales,sin complicaciones ni lesiones vásculo-nerviosas

Síndrome de bandas de constricción congénitas / Congenital constriction band syndrome

Se presentan 7 pacientes pediátricos con bandas de constricción congénitas,tratadas en un solo tiempo quirúrgico mediante la escisión del surco de constricción anular,junto con plastias en Z múltiples.En todos los casos se obtuvieron excelentes resultados estéticos y funcionales,sin complicaciones ni lesiones vásculo-nerviosas

[Experimental testicular torsion: its effect on the contralateral testicle]. / Torsión testicular experimental: efecto en el testículo contralateral.

The purpose of this project is to determine the lesion in contralateral testis after unilateral testicular torsion. For that is reproduced the lesion in an experimental model animal using 35-45 days old Wistar rats. The study of the contralateral testis is performed 30-35 days after lesion, once orchiectomy with histopathological and ultrastructural analysis, was made. We observed zonal tubular atrophy, alteration of spermatogenesis, abnormal formation of spermatozoa and death cellular by apoptosis.

[Clinical and epidemiological analysis of 1,451 pediatric surgery consultations in a third level hospital referred from the primary health care sector]. / Analisis clínico-epidemiológico de 1.451 primeras consultas de cirugía pediátrica derivadas de la Atención Primaria a un hospital de tercer nivel.

OBJECTIVE: The aim of this study was to determine the pediatric surgery demands in a third level hospital due to referrals from the primary health care sector in order to better plan the work and continuing education programs. PATIENTS AND METHODS: The total number of patients (1,451) consulting a service of pediatric surgery for the first time and referred from the primary care sector during a twelve month period were studied. RESULTS: A total number of 1,451 children, with a maximum age of 14 years consulted. The assistential pressure was 22.01 consultations/pediatrician/day in one year. Consultations by children older than 7 years of age comprised 31.42% of the total. As for the distribution of these consultations, 61.26% were with a previous appointment, 38.74% were remitted to the second level. The most frequent reasons for consultations were inguinal hernia and hydrocele (30.46% of the cases), followed by phimosis (28.8%), undescended testis (8.2%) and skin neoplasms (5.78%). CONCLUSIONS: The demands of pediatric surgery consultations referred from the primary health care sector is very important. It is necessary to adapt the continuing education programs so that pediatric residents and primary medicine physicians are more aware of the surgical pathologies that are most frequently found in primary care centers and to decrease the assistential pressure of the pediatric surgery consultations in the hospital.

[Duplication of the colon: a case report]. / Duplicación de colon: presentación de un caso.

We report a new case of intestinal duplication in a child of two years old with acute abdomen. At the laparotomy was found to be due to tubular duplication ascending colon. A resection duplication joined a tract of normal colon where are was performed, with termino-terminal anastomosis. The postoperative course was excellent.

[Bone lengthening in children]. / Alargamientos óseos en niños.

Since June 1987, were realized 45 limb lengthening (40 lower and 5 upper) in 34 children with between 3-15 years old. A dynamic axial fixator (DAF) system with telescoping capabilities, permits a slow distraction through a osteotomy and callotasis in 36 bones, and chondrodiatasis in 5. Twenty-six unilateral lengthening were realized and 5 alineation-lengthening, 20 congenital and 11 acquired causes. 14 bilateral lengthening were done in 5 patients (4 achondroplastic and one Turner's syndrome). The average increase in length was 5.5 cm. for limb and ranged from 4.3 to 8.0 cm. The healing index was 32.1 days for each centimeter of length gained in the femurs and 5.2 cm. with 28.2 days/cm. in the tibias. The complications were superficial pin tract infection (73%), that were not generally treated with antibiotic, 2 knee valve, 2 knee subluxation and one patella subluxation with knee flexion contracture.

[Treatment of radial club hand with double articulated external fixators]. / Tratamiento de la mano zamba radial mediante doble montaje articulado con fijadores externos.

Congenital absence of the radius is a rare malformation, characterized by radial deviation of the hand to more than 90 degrees. Early treatment with plaster cast use to be enough to correct radial deviation, making easier surgical correction on several years later. We report a case of a newborn with radial club hand absence of the thumb of the right hand, bilateral hydronephrosis and bilateral cryptorchidism. Was treated with a new procedure, permitting wrist centralization, coupled with osteotomy and callostasis of the ulnar diaphysis using external fixation. We obtained an important success with this serial lengthening of the ulna.

[Solitary intestinal fibromatosis: an unusual cause of neonatal intestinal obstruction]. / Fibromatosis intestinal solitaria: una causa rara de obstrucción intestinal neonatal.

We report a new case of solitary intestinal fibromatosis (SIF) in a neonate with intestinal obstruction in the first day of life. At the laparotomy was found to be due to a solid mass in the jejunum. A segmental jejunal resection with anastomosis was performed. Histologic examination showed a SIF. The postoperative course was excellent in contrast to cases of congenital fibromatosis with multiples lesions, which carries a poor prognosis.

[Isolated congenital stenoses of the extrahepatic bile ducts]. / Estenosis congénitas aisladas de las vías biliares extrahepáticas.

Congenital isolated strictures of the extrahepatic bile ducts are very rare, with only eleven cases reported until 1990. We report two infants (3 and 2 months old, respectively) one of them with a choledocal stenosis and the other with a congenital stricture of the common hepatic duct and spontaneous perforation of the biliary tract. Dilatation of the distal stricture with insertion of T-tube was performed during surgical act. We get success with this technique in both cases.

[Protocol for the treatment of hypertrophic cicatrix with silastic gel. First results]. / Protocolo para el tratamiento de cicatrices hipertróficas con gel de silastic. Primeros resultados.

Functional limitation and scarring use to be common sequelaes of a burns injury in children. We report our initial experience with silicone gel (silastic gel shetting) in the treatment of 15 children with hypertrophic scars, without success to other alternatives therapies. Improvements in texture, colour and height of the lesion were noted in all cases.

[Appendicular carcinoid tumor in childhood]. / Tumor carcinoide apendicular en la infancia.

Apendicular Carcinoid tumors are very infrequent, being lower than 0.1% of the appendicectomies carried out. We report on the case of a 13 year-old girl, with Acute Appendicitis picture. The appendix was removed and the histological study revealed the presence of the carcinoid tumor with a diameter of a 6 mm. Where non-invasive treatment was decided on, and at present, after two years follow-up, there has been no recurrence.

[Delayed presentation of congenital diaphragmatic hernia]. / Hernias diafragmáticas congénitas de aparición tardía.

We report two cases of congenital diaphragmatic hernia in two infants (3 years and 11 months of age). Recurrent respiratory infections, growth and ponderal delay were the previous clinical findings. Clinical and radiological diagnostic procedures were used and surgery showed left Bochdalek hernia without sac in both cases and intestinal malrotation anomaly in one of them. Postoperative recovery was excellent.