[Preoperatory sonography efficiency in paediatric patients with cholelithiasis undergoing laparoscopic cholecystectomy]. / Eficacia de la ecografía preoperatoria en la colelitiasis en pacientes pediátricos sometidos a colecistectomía laparoscópica.

INTRODUCTION: Biliary lithiasis is not much frequent in paediatric patients. The manegement of cholelithiasis in patients undergoing laparoscopic cholecystectomy is still controversial. We propose the preoperatory echographic study of the biliary tree 24-48 h before surgery, as the first choice, instead of the intraoperatory cholangiography. MATERIAL AND METHODS: We made a retrospective study of 42 patients undergoing laparoscopic cholecystectomy due to symptomatic biliary lithiasis during the last 15 years, with ages between 18 months and 17-years-old (mean age 9,6-years-old) and weight between 11 and 70 kg (mean weight 42 kg) at the moment of surgery. Six of them had haematological illnesses, 17 came to the hospital because of acute abdominal pain, 10 had been studied because of recurrent abdominal pain and 9 had casual diagnoses. Abdominal sonography was performed in all patients 24-48 hours before surgery. RESULTS: Four children were diagnosed of biliary duct lithiasis: two choledocolithiasis and two stones in the cystic duct. One of the cystic stones was extracted in the operating room and the rest resolved spontaneously. One patient presented dilatation of choledocal duct after surgery, without any stones' evidence. Also this patient resolved spontaneously. We had no complications. CONCLUSIONS: Biliary lithiasis is not frequent in children, even if it seems to be increasing. A few of these patients will suffer of choledocolithiasis. The intraoperatory exploration of the biliary tree during laparoscopic surgery is technically difficult due the small size of paediatric patients. Cholangiography is not always successful and can produce some important complications as pancreatitis. Preoperative sonography 24-48 hours before surgery is a safe and efficient method for the diagnosis and follow-up of paediatric patients with biliary lithiasis undergoing laparoscopic cholecystectomy. It is safe enough to be performed without intraoperatory cholangiography.

[Intestinal atresia and bile duct atresia in a new born infant]. / Atresia intestinal y atresia de vías biliares en un recién nacido.

We report a recent case of small bowel atresia and biliary atresia in a newborn. We describe the management of the patient and we make a revision of the literature. Only 13 cases have been found, that confirms that this association is extraordinary rare.

[Thyroid carcinoma with lung metastasis]. / Carcinoma de tiroides con metástasis pulmonares.

Thyroid carcinoma is a rare disease in children. Much rare its presentation with pulmonary metastases is. We here report a recent case in 12 years-old girl. We make a review of recommended treatment and the prognosis.

[Pulmonary cystic adenomatoid malformation with anomalous vascularization with systemic origin]. / Malformación adenomatoidea quística pulmonar con vascularización anómala de origen sistémico.

We report an infant with the diagnosis of Congenital Cystic Adenomatoid Malformation. He was operated and we found an abnormal systemic blood supply associated in that lobe. We make a review of the literature, and we make a distinction between this rare combination and others like pseudo pulmonary sequestration, or Congenital Cystic Adenomatoid Malformation associated to pulmonary sequestration.

Barrett's esophagus and chemotherapy, a case report.

There have been few reports of Barrett's esophagus associated with chemotherapy in children. We report the case of a 3-year-old patient diagnosed with acute lymphoblastic leukemia who developed Barrett's esophagus after BMF-90 chemotherapeutic regimen. A stricture appeared as a complication of Barrett's metaplasia and Nissen fundoplication was performed. Symptoms improved shortly after surgery and regression of Barrett's esophagus was observed 2 years later. Children treated with antileukemic chemotherapy may develop Barrett's esophagus without previous clinical apparent gastroesophageal reflux. Endoscopic surveillance has been advised in these patients. Barrett's esophagus may regress after antireflux surgery.

Rhabdomyosarcoma of the biliary tree

Rhabdomyosarcoma (RMS) of the biliary tree is a rare tumor in children that has a very poor prognosis. Preoperatively, it is often mistaken for a choledochal cyst. We report a case of RMS of the biliary tree in a 4-year-old girl who presented with abdominal pain and obstructive jaundice. The RMS was diagnosed at laparotomy; excision was not possible due to its size and localization. Chemotherapy achieved complete regression of the tumor observed at second-look surgery. Preoperative chemotherapy can now avoid mutilating surgical procedures and improve survival.

Rhabdomyosarcoma of the biliary tree.

Rhabdomyosarcoma (RMS) of the biliary tree is a rare tumor in children that has a very poor prognosis. Preoperatively, it is often mistaken for a choledochal cyst. We report a case of RMS of the biliary tree in a 4-year-old girl who presented with abdominal pain and obstructive jaundice. The RMS was diagnosed at laparotomy; excision was not possible due to its size and localization. Chemotherapy achieved complete regression of the tumor observed at second-look surgery. Preoperative chemotherapy can now avoid mutilating surgical procedures and improve survival.

[Intestinal pseudo-obstruction secondary to systemic neuropathies and myopathies]. / Pseudoobstrucción intestinal secundaria a neuropatías y miopatías sistémicas.

The term intestinal pseudo-obstruction, is applied to a group of clinical disorders in which there are obstructive symptoms, in the absence of a mechanical agent, secondary to a disorder of intestinal motility. In this report, we show manometric studies done in four patients, with acute intestinal pseudo-obstructions, secondary to von Recklinghausen's neurofibromatosis (VRNF), in two patients, and in one patient with Duchenne's muscular dystrophy (DMD) and in another with Werdnig-Hoffmann's disease (WHD). We studied 24 hours antroduodenal motility, specially during phase 3 of the migratory motor complex (CMM), which showed a neuropathic disorder in one case of von Recklinghausen's disease and a myopathic disorder in patients with Duchenne's muscular dystrophy and Werdnig-Hoffmann's disease. We analysed results and conclusions and specially the kinetic action of erythromycin.

[Acute abdomen of unusual cause in children]. / Abdomen agudo de causa excepcional en el niño.

The acute abdomen in childhood is in most cases caused by an acute appendicitis and rarely it is secondary to other diseases. It is for that reason, that we present two cases extremely rare of acute abdomen: the first one was an abdominal Actinomycosis secondary to acute appendicitis that looked like a tumor and the second that was an acute omentitis due to pinworms.

[Asplenia syndrome with duodenal stenosis]. / Sindrome de asplenia con estenosis duodenal.

We report a patient with asplenia syndrome. To our knowledge this is the first case described of asplenia syndrome with duodenal stenosis and no heart anomalies. An other important finding has been the absence of vomiting in her symptomatology.

[Tumors in the newborn infant: development and surgical treatment]. / Tumores neonatales: evolución y tratamiento quirúrgico.

From 1970-1982, 70 newborns with different kinds of tumors were studied at "La Paz" Children's Hospital in Madrid. Our review was directed to study sex, site, kind and malignity. This type of neonatal work is uncommon in pediatric literature. We make special emphasis in the follow-up of malignant. tumors. 63% of these tumors were benign ant the remaining were malignant. The overall mortality was 28%.