Congenital hydronephrosis: disease or condition?

The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition. Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task. Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years. On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51 .5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.

Minimally invasive treatment of 56 consecutive supracondylar fractures of the humerus in children.

OBJECTIVE: to present our results from the minimally invasive approach in the treatment of 56 consecutive Gartland types II and III supracondylar fractures of the humerus in school-age patients. METHOD: Including criteria were isolated supracondylar fractures Gartland types II and III, in the period from January 2011 to November 2011. We admitted 56 children aged four to 12 years (mean 6.9 y.). The most common mechanism of injury was fall with the elbow extended. The treatment procedure consisted of four steps: 1) Classification of the injury according to x-ray findings; 2) Under general anaesthesia, the injured child was placed in a prone position; 3) Closed reduction was obtained by placing the elbow on a special table with the elbow flexed at 90 degrees, using gravity to help reposition; 4) After x-ray verification of the reduction two Sommer pins were inserted to stabilize the fracture. The pins were placed percutaneously through the medial and lateral humeral condyles respectively. After the intervention all elbows were immobilized in a splint cast for 3 weeks. RESULTS: All patients were followed up for six months. Control radiographs were performed postoperatively, three weeks and two months after the injury. There were no malunions or nonunions. We estimated the elbow function using the Mayo elbow performance index. The functional results were excellent and very good according to the Mayo score. CONCLUSION: We recommend this one-day surgical approach for the treatment of Gartland type II and III supracondylar fractures.