[Diagnosis and management of testicular torsion in children]. / Diagnostic et prise en charge de la torsion testiculaire chez l'enfant.

Testicular torsion is a true urologic emergency with a bimodal age presentation : the perinatal testicular torsion presenting with a hard, tender or non-tender scrotal mass usually with underlying dark discoloration of the skin and the peripubertal testicular torsion presenting with severe acute testicular pain, vomiting and frequently pain irradiation in the inguinal area, a high riding-horizontally positioned testis and absence of the cremasteric reflex. Obtaining a US Doppler must not add unnecessary delay to the urgent surgical treatment which entails detorsion and bilateral orchidopexy. We do not recommend manual detorsion as around 30 % of testis rotate externally. Up to 50 % of patients presenting with a testicular torsion suffered beforehand from intermittent testicular pain episodes.

La torsion testiculaire est une urgence urologique avec deux âges de présentation. La période périnatale, avec un « scrotum aigu ¼ (bourse bleuâtre ou rouge, tuméfiée, avec ou sans douleurs), présent à la naissance ou dans les jours qui suivent et les torsions plus tardives, se manifestant par des douleurs testiculaires aiguës avec irradiation abdominale, une perte du réflexe crémastérien, une position ascensionnée et horizontalisée du testicule et parfois des vomissements. Le diagnostic est clinique et l'examen radiologique ne doit pas retarder l'exploration chirurgicale urgente avec détorsion et fixation testiculaire bilatérale. La détorsion manuelle externe est déconseillée, le sens de rotation du testicule étant aléatoire. 50 % des torsions testiculaires sont précédées d'épisodes de douleurs testiculaires intermittentes.

Evaluation of an antireflux procedure for colonic interposition in pediatric esophageal replacements.

BACKGROUND: In 1989, we introduced a 1-stage procedure with orthotopic colonic transplants for esophageal stenosis. A pitfall of this procedure is frequent reflux and/or stasis in the transplants from the cologastric anastomosis. Since 1993, we have used a new antireflux wrap (ARW) using an anterior wrap technique similar to the Dor procedure but fixed to the right crus of the diaphragm. PURPOSE: The purpose of the study was to evaluate ARWs. METHOD: From 1993 to 2008, the records of 67 patients with an ARW were compared with 27 without ARW (either operated on before 1993 or ARW was not appropriate) after colonic transplant for caustic esophageal stenosis. Both groups otherwise underwent the same surgical procedure. Postoperative esophagograms done on postoperative day 10 were reviewed for the presence of gastrocolonic reflux and stasis in the transplant. RESULTS: The reflux rate on the initial esophagogram was reduced from 48.1% to 7.5% using ARW. The incidence of reflux on later esophagograms was 40.0% with no ARW and 21.4% with ARW. The 25% long-term rate of stasis in the colonic transplant was not increased with ARW. CONCLUSIONS: A loose ARW in patients with colonic esophageal replacements reduces gastrocolic reflux without increasing the rate of stasis. In the long term, children adapt better to stasis than to reflux and are thus protected from occult inflammation.

Variación estacional de la preeclampsia. Hospital Nacional Arzobispo Loayza / Seasonal variation of pre-eclampsia. Arzobispo Loayza National Hospital

INTRODUCCION: Estudios recientes describen una variación estacional en la prevalencia de preeclampsia. La mayoría encuentra un aumento de la prevalencia en invierno. OBJETIVO: Determinar si en nuestro medio existe variación estacional o mensual en la prevalencia de la preeclampsia. DISEÑO: Estudio de tipo transversal descriptivo retrospectivo. MATERIAL Y MÉTODOS: Se revisó información de 7923 gestantes cuyo parto ocurrió entre el 1 de diciembre de 1999 y el 30 de noviembre de 2002, en el Hospital Arzobispo Loayza de Lima. Se identificó a las pacientes con preeclampsia leve y severa y se determinó mediante un análisis de regresión logística múltiple, la variación de la prevalencia de la enfermedad, en relación con el mes y la estación de parto. RESULTADOS: La prevalencia de preeclampsia fue 14,2 por ciento, siendo 28 por ciento de éstas severas. La prevalencia en septiembre (17,8 por ciento) y junio (17,3 por ciento) fue mayor respecto a febrero (11,1 por ciento) y diciembre (11,5 por ciento); por lo tanto, que hubo mayor prevalencia en invierno (16,6 por ciento) respecto al verano (12,7 por ciento) (p menor que 0,05; Para preeclampsia severa se encontró menor prevalencia en primavera (2,8 por ciento) respecto al verano (4,8 por ciento) (p menor que 0,05), por lo que la proporción de preeclampsia severa fue menor en primavera (21,4 por ciento) que en verano (38 por ciento) (p menor que 0,05). CONCLUSIONES: En nuestro medio, la prevalencia de la preeclampsia fue mayor en los meses fríos de primavera e invierno; la forma severa de la preeclampsia se presentó en menor proporción en estos meses.

BACKGROUND: Recent studies describe a seasonal variation on the prevalence of preeclampsia. Most of them find an increase in the prevalence in winter months. OBJETIVE: To determinate seasonal or monthly variations of preeclampsia prevalence in our settings. DESIGN: Transversal descriptive retrospective study. MATERIAL AND METHOS: We reviewed data from 7923 pregnant women who delivered at Arzobispo Loayza Hospital in Lima, between December 1, 1999, and November 30, 2002. We identified patients with mild severe preeclampsia and determined by multiple logistic regression analysis prevalence variation in relation to season and month of delivery. RESULTS: preeclampsia prevalence was 14,2 per cent, 28 per cent of cases severe preeclampsia. Prevalence was higher in September (17,8 per cent) and June (17,3 per cent) than in February (11,1 per cent) and December (11,5 per cent) (P less than 0,05); therefore prevalence was higher in winter (16,6 per cent) than in summer (12,7 per cent). Severe preeclampsia prevalence was longer in spring (2,8 per cent) compared to summer (4,8 per cent); as such, rate of severe preeclampsia was lower in spring (21,4 per cent) than in summer (38 per cent) (P less than 0,05). CONCLUSIONS: Season and month of birth influence preeclampsia prevalence; it is higher in the cold months of spring and winter. But the rate of severe forms of the disease is lower during these months.