Evidence of melatonin synthesis in the ram reproductive tract.

Melatonin is a ubiquitous molecule found in a wide range of fluids, one of them being ram seminal plasma, in which it can reach higher concentrations than those found in blood, suggesting an extrapineal secretion by the reproductive tract. In order to identify the source of the melatonin found in ram seminal plasma, we first tried to determine whether the melatonin levels were maintained during the day. For this purpose, melatonin concentrations were measured in seminal plasma obtained from first ejaculates of six rams at 6:00 a.m. in total darkness, at 10:00 a.m. and at 14:00 p.m. The melatonin concentration was higher (p < 0.05) in ejaculates collected at 6:00 a.m. than at 10:00 and 14:00. There was no statistical difference between the latter. To further corroborate an extrapineal secretion of melatonin, the presence of the two key enzymes involved in melatonin synthesis, arylalkylamine-N-acetyltransferase (AANAT) and N-acetylserotonin-O-methyltransferase (ASMT) was analyzed by RT-PCR, q-PCR and Western-blot in ram testes, epididymis, and accessory glands. The RT-PCR showed the presence of the m-RNA codifying both AANAT and ASTM in all the tissues under study, but the q-PCR and Western-blot revealed that gene expression of these enzymes was significantly higher in the testis (p < 0.05). Immunohistochemistry confirmed the presence of AANAT and ASMT in the testis and revealed that they were found in the Leydig cells, spermatocytes, and spermatids. Also, measurable levels of melatonin were found in testicular tissue and the tail of the epididymis. In conclusion, our study indicates that the testes are one of the likely sources of the high levels of melatonin found in ram seminal plasma, at least during the day.

Influence of sodium replacement on physicochemical properties of dry-cured loin.

The consumption of cured meat products is not recommended to hypertensive consumers due to its high sodium content. This constitutes an important restriction for this industry, which is becoming more and more important due to the current trends in consumption. The partial replacement of sodium chloride by potassium chloride has been proposed as a possible strategy to reduce the sodium content of this type of products. The aim of this study was to evaluate the effect brought about by partial replacement of sodium chloride with potassium chloride (up to 70%) on physicochemical and microbiological parameters of dry-cured pork loin after the curing and drying process. The results showed that it is possible to obtain low sodium dry-cured loin, up to a 50% replacement of sodium by potassium, with similar physicochemical characteristics to the commercial product with usual amounts of sodium.

Microbiology and physico-chemical changes of dry-cured ham during the post-salting stage as affected by partial replacement of NaCl by other salts.

Dry-cured ham consumption is restricted by hypertensive consumers due to its high sodium content. This constitutes an important matter for this industry, being relevant due to the current trends in consumption. In order to prevent the problems related to the high sodium intake, one of the possibilities is the total or partial replacement of sodium by other ions, such as potassium, calcium and magnesium. The aim of this study was to characterise the post-salting stage in Spanish cured ham production with the results obtained after salting with low sodium salt content. The results showed that lower sodium hams needed more time of post-salting to reach similar water activity values than those achieved by hams salted with 100% NaCl. Nevertheless, no differences in microbial counts were observed among the studied batches, although a sharp decrease in microbiota was observed when the, post-salting time was prolonged in the lower sodium hams.

[Testicular and epididymal appendages. Contribution about it's embryology and pathogenesis]. / Apéndices testiculares y epididimarios. Contribución a la embriología y a la patogénesis.

OBJECTIVE: The testicular appendages are structures with biologic activity and with the possibility to become ischaemic or to degenerate before determined stimulus. Laterly, we have seen an apparent increase in our cases of torsion of testicular appendages. The said, together with the questions about embriology and pathogenesis of this structures, encourage us to do this work. PATIENTS AND METHODS: 1- Retrospective clinical study of patients operated of torsion of testicular appendages, from January 1984 to December 2001. We asses age, year of operation and clinical features. 2- Prospective clinical study of patients operated of torsion of testicular appendages, between March 1999 and March 2000. We asses age, time of evolution, degree of ischaemia, nutritional status, sexual maturity stage and testicular volume. 3- Inmunocytochemical study of testicular and epididymal appendages. We identified the oestrogen receptors. RESULTS: There is a meaningful increase in the yearly incidence of ischaemia of testicular appendages. The mean age of the patients was 9.3 +/- 2.5 years, similar alone of the study. In the patients of group 2, the mean time of evolution was 49.2 +/- 46.6 hours. The appendages showed oedema and several degrees of ischaemia in the absence of torsion (14/21). The body mass index was 19.5 +/- 3.7, and 90% of patients had stages I and II of Tanner. The mean of testicular volume was 2.1 +/- 1.6 ml. By means of inmunocytochemical study we identified oestrogen receptors in 7 of all testicular appendages studied and absence of oestrogen receptors in all epididymal appendages. CONCLUSIONS: The clinical syndrome of the acute scrotum in the majority of cases is due to oedema and ischemia of the appendages, in absence of torsion, probably related to its enlargement in response to hormonal stimulation, at least in some grade, in prepubertal boys. The difference found, related to oestrogen receptors, suggest a different origin for testicular and epididymal appendages.

Apéndices testiculares y epididimarios. Contribución a la embriología y a la patogénesis / Testicular and epididymal appendages. Contribution about itsembriology and pathogenesis

Objeto: Los apéndices testiculares son estructuras con actividad biológica y capacidad de isquemia o degeneración ante determinados estímulos. Hemos observado un aparente incremento en nuestro ámbito de torsión de apéndices testiculares. Ello, junto con dudas relacionadas con la embriogénesis y patogenicidad de estas estructuras nos induce a la realización del presente trabajo. Pacientes y Métodos: 1.Estudio clínico retrospectivo de pacientes intervenidos por torsión de apéndices testiculares desde Enero de 1984a Diciembre de 2001. Valoramos edad, año de intervención y características clínicas. 2. Estudio clínico prospectivo de pacientes intervenidos desde Marzo de 1999 a Marzo de 2000 por torsión de apéndices. Valoramos edad, tiempo de evolución, grado de isquemia, estado nutricional, estadio de maduración sexual y volumen testicular. 3. Estudio inmunohistoquímico de apéndices testiculares y epididimarios. Se identifican los receptores estrogénicos. Resultados: Existe un incremento evidente en la incidencia anual de isquemia de apéndices testiculares, siendo la edad media, de 9,3±2,5años, similar a lo largo de todo el estudio. En los pacientes del grupo 2,el tiempo medio de evolución fue de 49,2±46,6 horas. Los apéndices de estos pacientes mostraban edema y diferentes grados de isquemia, en ausencia de torsión en 14 de 21 pacientes. Su índice de masa corporal fue (..) (AU)

Actuación de los equipos de emergencias extrahospitalarias en el lugar del accidente

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Los marcapasos cardíacos

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[Colonic aganglionosis with ileal involvement. Ileocolic plasty]. / Aganglionismo cólico con afectación ileal. Plastia ileocólica.

During 1994 through 1999, we have treated five patients (3 boys, 2 girls) with total colonic aganglionosis (TCA) and ileal involvement. In three of them we performed a diverting ileostomy in the neonatal period and at the age of four and five months respectively in the remaining two patients, due to intestinal obstruction. In these two last patients a diagnosis of Hirschsprung's disease was made by anorectal manometry and rectal biopsies in the neonatal period. During laparotomy, a cutaneous ileostomy was created in all patients at the distal end of normal ileum, which was 30 to 110 cm (mean = 71 +/- 37 cm) from the ileocecal valve. After operation, a short bowel syndrome developed in three patients causing fluid and nutritional problems that required prolonged total parenteral nutrition (TPN). The definitive operative repair is performed at 4.5 to 14 months (mean = 8 +/- 3.7 months) by a 12 to 20 cm side-to-side ileocolostomy created between the ileum and aganglionic ascending color (Boley procedure) and ileorectal primary anastomosis (Rehbein procedure) using a circular stapler. Rectal dilatation, irrigation of the colon with saline, loperamide hydrochloride and resincholestyramine were begun in all patients postoperatively. Oral antibiotic prophylaxis, was given to the three patients who suffered from SBS. Oral feedings with semielemental diet were tolerated once stools were semiformed and TPN was discontinued at 8 to 34 days (mean = 21 +/- 1.7 days). postoperatively. After the definitive operation, enterocolitis developed in two patients, requiring one of them a short hospitalization during the episode. A possible explanation for the low incidence of enterocolitis in this series is the systematic postoperative use of irrigations of the colon with saline in all patients. These five patients have been followed-up for growth, development, bowel habit and continence. Follow-up has ranged from 15 to 62 months (mean = 32.2 +/- 19.2 months). Presently, all patients in this series have full enteral feeding and one to three bowel movements per day, with formed or semiformed stools. No patients is incontinent of stool. The patient's body weights (74 to 93%) and heights (89 to 92%) for their age were below average (four patients) or within normal range (one patient). Hemoglobin levels are within normal range in all patients. One patient has iron deficiency and another one has serum ferritin concentration below normal. Three patients have folic acid deficiency. Vitamin B12 absorption is normal in all patients. Although we can not conclude this is a better procedure than others, with is use we have obtained satisfactory results, with an excellent survival, scanty morbidity, a rapid return of bowel function and continence, and an acceptable physical development. During long-term follow-up, patients mus be evaluated for iron and folic acid deficiency.

[Severe caustic injuries of the esophagus: when to replace the esophagus]. / Causticaciones esofágicas graves: cuándo decidir prescindir del esófago.

From June 1985 to May 1998, 20 patients have been treated in our hospital by esophageal dilatations due to serious esophageal caustic stenosis. A retrospective analysis of these 20 patients was performed, evaluating age, sex, causative agent, number and time of dilatations, iatrogenic esophageal perforations, gastroesophageal reflux (GER) and psychological and social consequences. Follow-up has ranged from 1.5 to 14.5 years (mean = 8.07 years). The mean age at the time of accidental swallow was 42.2 months. The causative agent was dishwashing detergent in 11 patients and caustic soda in 9 patients. The mean of dilatations needed was 19.1 and the average duration of dilatations was 24.7 months. Seven patients had esophageal perforation during dilatation and none of them required surgical treatment. All patients had improvement of swallowing and an easier esophageal dilatation afterwards. Oral contrast studies demonstrated distortion of the esophago-gastric junction in the majority of patients. Ten patients were screened for GER with 24-hour esophageal pH monitoring in the first year postburn and it was pathological in 5. Antireflux surgery was carried out in 4 patients with a conspicuous improvement following surgery. Dilatations proved successful in 16 patients in less than two years, and in more than two years in 3 patients. The authors conclude that the majority of children with esophageal caustic stenosis can be managed successfully by esophageal dilatations, even with dilatation periods longer than two years or when an esophageal perforation occur during the procedure. The paramount importance of early diagnosis and treatment of GER is stressed.

Aganglionismo cólico con afectación ileal. Plastia ileocólica / Total colonic aganglionosis with ileal involvement. Ileocolic plasty

Entre los años 1994 y 1999 hemos tratado a cinco pacientes (H/M: 3/2) afectos de aganglionismo eólico total con extensión ileal. En tres de ellos se realiza ileostomía en los primeros 4 días de vida por obstrucción intestinal y en los otros 2, a los 4 y 5 meses por la misma causa. En estos últimos, el diagnóstico de agangfionismo se efectúa en los primeros días de vida mediante anomanometría y hiopsia rectal. En todos los pacientes la enfermedad de Hirschsprung se confirma al efectuar la derivación digestiva. La longitud del segmento ileal afectado oscila en los 5 niños entre 30 y 110 cm (71 ñ 37 cm). Tres pacientes presentan un síndrome de intestino corto post-ileostomía requiriendo un período prolongado de alimentación parenteral. La intervención definitiva se realiza entre los 5 y 14 meses (8 ñ 3.7) mediante una plastia coloileal, según Técnica de Boley, utilizando de 12 a 20 cm de colon derecho y descenso ileorrectal tipo Rehbein con sutura mecánica. En el postoperatorio se instauran dilataciones anales, irrigaciones rectales, loperamida y resincolesteramina. En los tres pacientes con síndrome de intestino corto se utiliza descontaminacián digestiva. La alimentación parenteral se ha mantenido en el postoperatorio de 8 a 34 días (21 ñ 1,7 días), continuando con alimentación central con dietas semielementales a baja osmolaridad. Dos pacientes presentan un episodio de enterocolitis precisando solo uno de ellos hospitalización. Creemos que la irrigación rectal ha contribuido a la baja incidencia de esta temida complicación. En el seguimiento se valora la duración de la alimentación parenteral, introducción de alimentación normal, peso y talla relativos, incidencia de enterocolitis, número de deposiciones, continencia fecal, así como los niveles sanguíneos de Hgb, hierro, ferritina, ácido fólico y vitamina B 12. En la actualidad, con un seguimiento de 15 a 62 meses (33,3 ñ 19.2 meses) todos los pacientes reciben una alimentación normal para su edad, con 1 a 3 deposiciones al día continencia fecal normal. El desarrollo ponderal se sitúa en Iímites bajos o próximos a la normalidad, con un preso en el último control entre el 74 por ciento y el 93 por ciento, del P50. La altura, con tallas relativas entre el 89 por ciento y el 92 por ciento es normal. Los valores del Hto y Hgb se encuentran dentro de la normalidad en todos los niños. Un paciente presenta cifras bajas de hierro y otro de ferritina. Asimismo, en tres niños el perfil sérico del ácido fólico está disminuido. Los niveles séricos de vitamina B 12 son normales. Finalmente, si bien no podemos concluir de forma categórica que esta técnica sea superior a otras, ha permitido la supervivencia de todos los pacientes con escasa morbilidad, con una recuperación rápida de la función y control intestinal y un crecimiento aceptable. Las deficiencias en la absorción de hierro y ácido fólico obligan a controles periódicos y un seguimiento a largo plazo de estos niños (AU)

Causticaciones esofágicas graves: Cuándo decidir prescindir del esófago / Severe aesophageal caustications: when to replace the esophagus

El tratamiento de las estenosis cáusticas (EC)graves incluye la posible sustitución del esófago par otro fragmento del tubo digestivo, cuando se considera que no se podrá conseguir su recuperación. En nuestra experiencia, todos los esófagos causticados pudieron ser recuperados.Entre junio de 1985 y mayo de 1998 hemos sometido a dilataciones esofágicas, por EC, a 20 pacientes. En todos el los hemos valorado distintas variables epidemiológicas y relacionadas con las dilataciones, reflujo gastroesofágico (RGE) y evolución.La edad media de los pacientes en el momento de la ingestión del caustico ha sido de 42,2 meses. El producto ingerido por f f fue lavavajillas industrial y sosa cáustica por 9, La media de dilataciones necesarias fue de 19,1 y la de su duración de 24,7 meses. fin -7 pacientes se produjo una perforación esofágica seguida en todos los casos de una mejoría llamativa de la disfagia y una mayor facilidad para las dilataciones posteriores. Los tránsitos esofágicas mostraron 'morfología refluyente, de la unión esófago gástrica en la mayoría de los pacientes. En 10 realizamos pHmetría esofágica durante el primer año de fa causticación, siendo patológica en seis. Sometimos a plastia antirreflujo a cuatro pacientes, con mejoría llamativamente rápida tras ella. Trece pacientes curaron tras menos de 2 años de dilataciones y tres tras 4 años y 2 meses, 6 años y 9 años, respectivamente.El límite de 1 a 2 años post-causticación, aceptado de forma amplia como tope para continuar los intentos de recuperación del esófago causticado, nos parece insuficiente, siempre que la luz esofágica mantenga algo de permeabilidad. Preferimos en el momento de mayor dificultad para dilatar, correr cl riesgo de perforar el esófago a dar lo por irrecuperable. El diagnóstico y tratamiento del RGE en estos pacientes nos parece fundamental para su buena evolución (AU)

Utilidad de la manometría anorrectal para el diagnóstico neonatal de la enfermedad de Hirschsprung / Usefulness of anorectal manometry in the neonatal diagnosis of the Hirschsprung's disease

Entre 1992 y 1998 se han realizado estudios anomanométricos a 32 recién nacidos con edades comprendidas entre 48 horas y 28 días de vida y peso entre 1.400-4.200 gramos. La prueba se ha indicado por retraso meconial en 32 pacientes, presentando 13 de éstos, además, cuadro de suboclusión u obstrucción intestinal. La manometría anorrectal se realizó con una sonda diseñada por nosotros para neonatos y polígrafo Hellige. Se valoran, fundamentalmente, la presencia o ausencia del RIA. El estudio se repite a la semana y a las tres semanas de la primera manometría, en los pacientes con ausencia del RIA. En los enfermos con ausencia del RIA se realiza enema con contraste. De los 32 recién nacidos, el RI.A estuvo presente en 20, en el primer estudio, lo que permitió la exclusión de la EH en estos niños. De los 12 pacientes restantes, en 11 se demostró la ausencia del RIA en el primer estudio manométrico, haciendo posible el diagnóstico precoz de EH en 9 pacientes y en 2 neonatos el de obstrucción transitoria del colon, corroborado éste por los hallazgos del enema que mostraban un colon izquierdo pequeño y la aparición del RIA en un control manométrico posterior. Hubo un resultado dudoso en el primer estudio, demostrándose posteriormente la ausencia de RIA. El primer enema de contraste de los 11 recién nacidos con ausencia del RIA fue considerado normal en tres pacientes, con zona de transición en cuatro neonatos y microcolon en un paciente. El diagnóstico final ha sido en 10 pacientes de EH y en dos, de obstrucción funcional transitoria de colon (AU)

[Usefulness of anorectal manometry in the neonatal diagnosis of Hirschsprung disease]. / Utilidad de la manometría anorrectal para el diagnóstico neonatal de la enfermedad de Hirschsprung.

During 1992 through 1998 anorectal manometry studies have been carried out on 32 newborn, with age between 48 hours and 28 days and weight range of 1,400 and 4,200 g at the test moment. The test has been prescribed due to a retard in meconial evacuation in the 32 patients, moreover, 13 out of them also presented an intestinal obstruction or subobstruction. The anorectal manometry is carried out with a probe especially designed by us for newborn and a Hellige polygraph. Presence or absence or rectoanal inhibitory reflex (RAIR) is assessed. The test is repeated after one and three weeks from the first study in the cases of RAIR absence. A barium enema was carried out in case of RAIR absence. The RAIR was present in 20 out of the 32 newborn, which allowed the exclusion of Hirschsprung's disease (HD) in these patients. Of the remaining 12 patients, in 11 it was shown the absence of RIAR in the first anorectal manometry study, making it possible the early diagnosis of HD in 9 patients and transient functional obstruction of the colon in 2 newborns. This former diagnosis was corroborated by the findings of the enema, which showed a small left colon and by the presence of RAIR in a later anorectal manometry control. There was a doubtful case in the first study, showing later the absence of RAIR. The first enema in 10 newborn with HD was considered normal in 3 cases and with transitional zone in 4 newborns and microcolon in 1 case.

[Pancreatic pseudocyst. Review of 22 cases]. / Pseudoquiste de páncreas (Revisión de 22 casos).

The management of 22 children with pseudocyst of the pancreas presenting over a 15-year period at three pediatric Hospitals is reviewed. The mean age of patients was 7 years being more common in boys (17:5). Ninety one per cent were due to trauma, while in 9% the cause was unknown. Vomiting (81.8%), abdominal pain (77.2%), a mass (72.7%), fever (31.8%) and anorexia (31.8%) were the most frequent findings. The diagnosis was confirmed by finding hyperamylasemia (elevated in 72.7% of cases), by barium meal and ultrasound. Operative treatment included external drainage in 4 children, cystgastrostomy in 9, cystjejunostomy in 6, and excision in 1. One patient was successfully managed nonoperatively and another had spontaneous gastric drainage. There were no deaths or significative complications in this series.

[Multicystic renal dysplasia and Wilms tumor]. / Displasia renal multiquística y tumor de Wilms.

We review a case of multicystic right dysplasia containing nodular renal blastema in a 3-year-old girl with left Wilms tumor. In relation to this finding the management of the asymptomatic multicystic dysplastic kidney in discussed.

[Effects of several methods of thoracic drainage on respiratory function]. / Repercusión de distintas formas de drenaje torácico sobre la función respiratoria.

UNLABELLED: The object of this study was to verify the influence on the pulmonary function of the pleural space ampliation with pleural drainage tube underwater seal, with several volumes or with variables negative pressures. We performed 42 New Zealand white rabbits of both sexes with an average age of 57 +/- 9.31 days and an average weight of 1720 +/- 181 g. The experimental protocol consisted of study group: P1 (n = 14) was performed a unilateral thoracostomy at the 5th. Intercostal space and P2 (n = 14) with bilateral pleural drainage. The pleural drainage tube (drain trocart ORX Vygon number 8) connected at small bottle (Fp), with 35 ml of extrapleural volume and at big bottle (FG) with 3940 ml of extrapleural volume and vacuum suction of various negative pressures (-5, -10, -15 and -20 cm H2O). CONTROL GROUP: C1 (n = 7) with unilateral pleural drainage clamped and C2 (n = 7) with bilateral pleural drainage clamped. Anesthesia was induced with ketamine hydrochloride (7.5 ml/Kg) and propionilpromazyne (1.5 ml/Kg) intramuscular cocktail and after maintained with bolus injection of 1/4 induction dose. We studied the mortality, the the fluctuations of drain hydrostatic column, heart rate (FC), respiratory rate (FR) and blood gas tensions, after cannulation of right jugular vein and during the different phases of experimental design. Venous blood samples were obtained for pO2, pCO2 and pH measurements were repeated at 5' in both groups. The 50% of animals died in the P2 group during the drainage pleural of FG. The fluctuation of column of Fp was similar in both groups: P1 = 6.39 +/- 1.0, with a decrease of 0.64 +/- 0.23 and P2 = 6.37 +/- 1.29, with a decrease of 0.63 +/- 0.28, respectively. The vacuum suction of pleural cavity may produce a FR fall which recovery fast. The bilateral pleural drainage with negative pressures produced decreases of pCO2 and pO2. There is not modifications of Acid Base Balance in the experimental groups. We concluded that during bilateral pleural underwater seal connected a FG, because the increase of extrapleural space may produce a high mortality and a fall of respiratory rate with fast recovery. Also the pleural suction improved the CO2 diffusion into the alveolus. There is not modifications of pO2 in P1 group or decrease in the P2 group.

Incomplete diphallus: correction in one stage.

We report a patient with an anorectal malformation and an abnormal penis with an isolated prepuce, double glans, and two corpora cavernosa. A right main urethra opened into the bladder neck; the right meatus was hypospadiac. The proximal end of the left accessory urethra opened into the right prostatic urethra and the left meatus was orthotopic. Severe chordee and normal urinary flow through both meatuses were present. At the age of 4 years, the diphallus was corrected. Both corpora cavernosa were dissected and the urethra was reconstructed, lengthening the right urethra with a 2.5-cm fragment of left urethra as a free graft excised from the emergence point and joined to the main urethra pasteriorly. The right urethra, whose meatus was hypospadiac and lateral, was dissected until a medial course was obtained. The glans was reconstructed using the lateral aspect of each glans; both medial aspects were extirpated. To correct the urethral trajectory, the urethra was fixed to the tip of the glans. A penis with two corpora cavernosa, a single glans, and a complete urethra with a meatus at the tip of the glans was obtained. The prepuce was reconstructed from the dorsal redundant aspect. The postoperative course was satisfactory.

[Epidermoid cysts of the spermatic cord]. / Quistes epidermoides de cordón espermático.

We report two cases of epidermoid cyst of the spermatic cord in infants 14 months and 2 1/2 years old, respectively. The initial diagnosis in one patient was funicular hydrocele and paratesticular mass no transilluminable in the other case. The treatment was the local excision of tumor and the diagnostic was histological in both patients. Postoperative course was excellent in both, the first after fistullization and surgical treatment. Must be explored the transillumination of the mass which would have led us to think other of the diagnoses different from that of the cord hydrocele before the operation, since it would have given negative. During the operation, must be assured that the cystic anomaly is limited to spermatic cord, to evite fistulization in the postoperative course.

[Transitional cell papilloma of the ureter causing uretero-hydronephrosis in a child]. / Papiloma de células transicionales del uréter como causa de uretero-hidronefrosis en un niño.

A case of transitional cell papilloma of the ureter is reported in a seven-year-old boy who had a history of left flank pain, involuntary voiding and nocturnal enuresis, and was found to have ureterohydronephrosis of a solitary left kidney and renal insufficiency. Renal function and morphology were restored by cutaneous loop ureterostomy, neoureterocystostomy and ureterostomy closure in a staged repair.

Congenital diaphragmatic hernia and intrathoracic intestinal volvulus.

The main symptom of the congenital diaphragmatic hernia (CDH) is the respiratory distress due to the pulmonary hypoplasia and the persistence of foetal pulmonary circulation. Sometimes the CDH appears outside of the neonatal period with respiratory symptoms, abdominal pain and seldom with intestinal obstruction. A case of CDH presenting with intrathoracic volvulus is reported. This case shows that tendency of delayed repair until the newborn has been recovered, require more attention because the good condition of the patient can be changed not only by the pulmonary hypoplasia and the persistence of the foetal pulmonary circulation but also by the symptoms of the intrathoracic gut complications.