[Total colonic aganglionism (author's transl)]. / Aganglionismo cólico total.

Total colonic is the most frequent form of extensive aganglionism. Diagnosis is difficult, but it must be taken in mind whenever either muscoviscidosis or ileal atresia are considered. Nine cases out of a series of 319 aganglionisms seen between 1957 and 1977 are reported. Ileostomy can be lifesaving but Duhamel-Lester Martin technique must be elected as a definitive treatment. The modification proposed by the authors, carried out in three cases, can be performed as a first-choice operation in the newborn. The long term results in these three cases are compared to those of other techniques. A general review of the problem is made.

[Ileocaecal valve incompetence. A new syndrome (author's transl)]. / Incompetencia de la válvula ileocecal.

Out of series of 237 colonic aganglionisms (1965--1977) 32 cases (13%) showed a clincial, radiological and manometric syndrome of "incompetent ileocaecal valve". Symptoms were vomiting, constipation with bouts of diarrhea, incomplete intestinal obstruction and failure to thrive. Sixteen cases were under P-3 weight percentiles. Initial diagnosis were aganglionism (10 cases), hiatal hernia (4 cases) and N.E.C. (1 case). Seventeen patients were explored through an iliac incision in the first three months of life. Ileocaecal continence was minimal (less than 25 cm. of water pressure). Ilocaecoplication was performed and completed with internal sphincterectomy (10 cases), colostomy (1 case) and caecostomy (3 cases). This new syndrome has been experimentally studied, but its etiology remains obscure. It introduces a bad prognostic component in aganglionism. Ileocaecoplication, a very simple operation, can be a lifesaving procedure.

[Choledochal cyst (author's transl)]. / Quistes de colédoco.

This paper reports six pediatric patients with congenital choledochal cyst. From the long-term follow-up results of the six patients authors conclude that primary excision of the choledochal cyst and Roux hepatic jejunostomy are the first choice treatment for this lesion. However, it may not be possible in all cases, and choledochocystoenterostomy would then be useful as a second choice.

[Hypertrophic pyloric stenosis. Review of 314 cases (author's transl)]. / Estenosis hipertrófica del píloro. Revisión de 314 casos.

Three hundred fourteen patients with hypertrophic pyloric stenosis have been operated from 1969 to 1976. The different etiologies are discussed. Clinical and analytical data are evaluated. Radiology is employed in 99 per 100 of the cases with no complications. Medical treatment used is exposed clearly as well as the surgical procedure (Monereo's modification of the classical Fredet-Ramstedt technique). Postoperative results and complications such as vomiting, wound infection (4.4 per 100), eventration (0.6 per 100) and fatal outcome (0.6 per 100) are thouroughly detailed as well as the associated pathology.

[Effects of parenteral nutrition solutions on the venous walls (an experimental study) (author's transl)]. / Efectos de las soluciones de alimentación parenteral sobre las paredes venosas periféricas. Estudio experimental.

Lesions (thrombosis, intimal damage, perivascular inflammation) of the marginal ear vein of domestic rabbits were studied 48 hours after infusions of parenteral feeding solutions administered through a butterfly-type 25 needles. Six-hour infusions with a rather diluted solution (12 g dextrose, 1.25 g. aminoacids, 1.5 mEq., Na, Cl, K and PO4 and 1.5 mEq. Ca and Mg per 100 ml.) with osmolality of 930 and pH of 6.9 were slightly harmful, while the lesions were considerable after 12-hours infusions. A more concentrated solution (15.83 g. dextrose, 2.08 g. aminoacids, 2.5 mEq. Na, Cl, K and PO4 0.2 MEq. Ca and Mg per 100 ml.) with osmolality of 1,600 and pH 6.7 produced severe lesions both after 6 and 12-hours infusions. Similar results were obtained with a mixture of this solution with intralipid at clinical doses (4 g. fat for 100 ml. of solution). This mixture had 1,280 mOsm/1. and pH of 6.7. Rather surprisingly the lesions were even more marked when intralipid alone was infused (osmolality 317, pH 7.5). These results lead to the conclusion that practically all fluids used for parenteral feeding purposes either centrally or peripherally, are considerably harmful for the venous wall after a few hours of infusion, probably due to their shifts from isoosmolality and chemical neutrality. Specially puzzling was the harmful local effect of the otherwise well tolerated intralipid.

[Hemihepatectomy with I.V.C. by-pass. Experience of 11 cases (author's transl)]. / Hemihepatectomía con "by-pass" de la vena cava inferior. Resumen de nuestra experiencia personal en 11 casos de tumores hepáticos en el niño

22 malignant tumors of the liver in children have been treated so far at the "La Paz" Childrens Hospital. 11 cases underwent hemihepatectomy with intracaval by-pass. This technique is described and its advantages underlined.

[Surgical approach of retroperitoneal neuroblastoma in infancy (author's transl)]. / Abordaje quirúrgico de los neuroblastomas retroperitoneales en la infancia

Rarely retroperitoneal neuroblastoma is a well localized, encapsulated tumor, like it my appear somewhere else, as in the pelvic floor or mediastinum. Even with the same histological findings they are different from de point of view of invasion. Therefore the surgical approach should be different in each case. This is our main conclusion after de study performed in 48 cases operated upon in the last 8 years. We have tried three kinds of operations. 1. The so called curative, total resections. Performing a surgical ablation of the tumor and the organs macroscopically involved, either prior or after radiotherapy or quimiotherapy. At any risk, even of life in the early postoperative period. This kind of surgery has been undertaken in 34 cases with an early mortality of 9. The main aim of this technique is to divide the tumor in two across the supraaortic line well below the renal vessels and up to the diaphragm. In 18 cases the homolateral kidney was resected with the suprarrenal gland. Spleen and pancreas in 5 cases, colon in 4, and the inferior vena cava in 3. The survivors over 2 years are 19 cases. 2. Paliative resection, taking out the main tumor only, has been achieved in 4 cases, with the highest mortality because postoperative hemorrhage. We believed is a dangerous procedure. None of these children survived more than one year. 3. Biopsy and surgical macroscopic diagnosis of invasion plus placing clips at their margin has been carried out in 12 occasions. This had naturally the best early postoperative but not in the long run, none survived more than 2 years. A second look up with resection was undertaken in 3 cases with mortality of one. Most surgeons are puzzled when dealing with retroperitoneal neuroblastoma and some how disappointed before undertaking a long, difficult and highly risk operation, but in many instances still is about the only hope they may have.

[Sacro-coccygeal dysplasia and megarrectum in children (author's transl)]. / Displasias sacrocoxígeas y megarrecto en la infancia

35 cases of megarrectum associated with lumbo-sacro-coccygeal dysplasis are reviewed. 32.7% of the dysplasia were sacral. Nine cases were ultrashort aganglionic segments. Symptoms were variable, of early onset (82.7% before one year) and mild (57.1% required medical advise after three). Medical management was useful in the non aganglionic group whereas it was ineffective in the aganglionic group. Sphincteric myotomy was the more common operation used. Physiopathology and modalities of treatment are discussed.

[Neonatal gastric perforation (author's transl)]. / Perforación gástrica neonatal (aportación de tres casos)

Three cases of neonatal gastric perforation of unknown etiology are presented. All three patients are female, one of them a second twin and two of them less than 2,000 g. in weight. All the patients were born under anoxic deliveries and needed resuscitative treatment. Digestive and respiratory symptoms started in all between the 2nd and the 4th days of life. Diagnosis, clinically suspected, is established radiologically. Perforations were surgically closed in all three patients. Two remain alive.

[Traumatic duodenal hematoma (author's transl)]. / Hematoma duodenal postraumático

Two cases of duodenal hematoma secondary to abdominal trauma in children are reported. The latent periods between trauma and the onset of symptoms were two and fifteen days. X-ray studies were conclusive for diagnosis. Pancreatic signs were mild in one case. Both cases were treated surgically, draining the fluid collection extramucosally. The authors advise surgical treatment whenever associated lesions need to be ruled out and when obstruction persists after the first days.