Biomedical subjects
Publications and source records attributed to A Gómez Fraile.
The megalourethra is an uncommon congenital anomally. It is a consecuence of the abnormal development of the corpus spongiosum and, occasionally, also the abnormal development of the corpora cavernosum. It is specially common in association with the Prune-Belly syndrome, and with upper tract abnormalities. We present a bizarre case because of its association with a VACTER syndrome.
INTRODUCTION: The endoscopic treatment of vesicoureteral reflux constitutes an easy and simple option at the moment for its resolution in all degrees and ages. It is necessary to carry out an ECO and VCUG (vesical cystouretrography) during voiding to verify their resolution. The ultrasongraphy can detect the wheal of injected material (Teflon or Macroplastic), but it is ignored if its visualization implies its disappearance or not. OBJECTIVE: To see the correspondence or not between the sonographic presence of injected material wheal and disappearance of reflux in the VCUG. MATERIAL AND METHODS: It has been statistically selected a sample of convenience to calculate the sensibility and specificity of the sonographic visualization of the endoscopic injected material wheal. We have studied 115 ureters with all the reflux degrees and ages, chosen randomly among patients treated endoscopically of vesicoureteral reflux, independently of the injected material, polytetrafluoroethylene (Teflon) or polydimethylsiloxane (Macroplastic). Refluxes due to duplex systems and those in which there were doubts of their correct installation during endoscopy were rejected. Cases with two or more injections were rejected too. The ECO and corresponding cystographies were revised in the first control after treatment (three months later). With this data, a chart of 2X2 was built comparing the presence or not of wheal in the ECO with the presence or not of reflux in the VCUG. We calculate sensibility, specificity, PPV (positive predictive value) and NPV (negative predictive value) as well as the degree of agreement of both tests with the kappa index. RESULTS: In 115 ureteral units we visualized with ECO the wheal of injected material in 97 and not in 18 (16%). In those cases with visualized wheal, reflux disappeared in 59 (61%), and in 38 not (39%). In those cases where the wheal was not visualized, reflux disappeared in 13 and persisted in other 5 (28%). The degree of sensibility was 12%, the specificity 82%, the PPV 22% and the NPV 61%. CONCLUSIONS: Attending to the low specificity and predictive values, the sonographic presence of material wheal doesn't indicate that the reflux has been corrected, as well as its absence doesn't reflect the presence of the same one, being always necessary to carry out a cystography for its diagnosis.
UNLABELLED: A Hydronephrosis operation represents a relatively frequent surgery in childhood. There is not agreement about the necessity of using drainage neither on the type to use, decisions that rebound in the patient's hospital stay. The objective of the study is to show the reduction of the days of stay according to the type of drainage used. MATERIAL AND METHODS: We present 14 children diagnosed of hydronephrosis operated on by Anderson-Hynes technique with an internal drainage double J type no 3 or 4. There were left side predominance (10 kidneys). Age of diagnosis varied from 0 to 11 years. We analysed the decrease of the stay with regard to the system that we used previously, nephrostomy drainage and stent, as well as the presence of complications related with the drainage. A cystoscopy was performed fifteen days later, in ambulatory way, to remove the catheter. A questionnaire of satisfaction was requested to the parents. RESULTS: Thirteen patients abandoned the hospital 2 days postoperatively and 2 three days postoperatively. There were 3 complications, being 2 minor and 1 mayor (double J ascension removed by ureteroscopy and an additional one day stay hospital). The reduction of the stay with regard to the traditional method varied between 7 and 8 days what represents an important saving of costs. In the questionnaire, the methods has appealed to the parents. CONCLUSION: We believe that the placement of a double J catheter represents an improvement that saves time and diminishes nuisances to patients, although a cystoscopy procedure is necessary for its removal. The double J catheters with a straight prolonged end, like a nephrostomy tube, recently in the market can avoid this last procedure.
PURPOSE: The increasing number of ultrasonographically detected asymptomatic, renal dilations have caused a lot of explorations to be performed in these patients. The Society of Fetal Urology proposed a four grades classification of echographic renal dilations and renographic studies are recommended in grades II to IV. However we have observed that grade II dilations don't evolve to obstruction. The aim of this work is to evaluate the obstruction rate in this group of patients, and the necessity or not of practising diuretic renography. MATERIAL AND METHODS: We studied 42 children diagnosed of grade II renal dilation during a 1.5 year period. Left side was more frequently affected, 23 cases, 7 cases were bilateral what means 49 affected renal units. There was a male predominance (69%). Mean age at diagnosis was 2 months (0 to 36 months). Seventy nine per cent were prenatally diagnosed. RESULTS: The MAG-3 renal scan showed 48 unobstructed renal units and 1 obstructed. The F-15 variant was made in 15 cases by a doubtful curve or retarded elimination. The patient with obstructive curve presented an 15 mm renal pelvic diameter echographically measured and the intravenous urography showed a higher dilation being operating on. The mean time follow up was 23.5 months (13 to 53 months) without any change. CONCLUSION: Grade II pielocalicial dilations with renal pelvis lesser than 15 mm can be echographically controlled without renal scan. It should be performed only if renal dilation increases.
UNLABELLED: Due to the high frequency of asymptomatic pyelocaliceal dilatations, most of them with prenatal diagnosis, the diagnosis of obstruction remains a major chance. Isotopic diuretic renogram (IDR) remains the basic diagnostic tool, although it has some pitfalls and undetermined diagnosis. To obviate them, several others tests have been used, such as diuretic Doppler ultrasound (DDU). The object of this paper is to determine its validity. METHODS: All the patients with hydronephrosis and with grade II dilatation or bigger were studied wit DDU. The results were compared with those obtained by IDR, obtaining 2 x 2 tables to analyze specificity and sensibility. RESULTS: 37 patients were studied, 9 of them bilateral, with a total of 46 dilated kidneys. There were 22 males and 15 females. 59 percent had prenatal diagnosis and 57 percent were asymptomatic. 22 percent had grade IV dilatation, 37 percent grade III and 41 percent grade II. 2 cases had contralateral vesicoureteral reflux. IDR showed 15 obstructed kidneys, 7 of them with a regular renal function. 16 were operated, one more due to abdominal pain despite a non-obstructed IDR. Only 7 of the 15 kidneys presented an obstructive pattern in the DDU. Comparing both tests, DDU had a 46 percent of sensibility and 100 percent of specificity and a negative predictive value of 79% for a 95% interval. Kramer index was 0.54 representing a very low association. CONCLUSIONS: In our institution, DDU is not better than IDR to diagnose obstruction. We consider its use as a second line test in cases of doubtful IDR.
Explore the source record for details and available documents.
Testicular and paratesticular tumors are rare in childhood, representing 1-2 percent of the solid tumors in the pediatric age. In patients under 14 years, the incidence is 0.5-2/100,000. The evolution differs from that of the adult. Since 1981 to 1994 we have treated 14 cases of testicular and paratesticular tumors. Mean age was 2.54 years, the younger patients presenting germinal tumors. The most frequent tumor was the yolk sac tumor (36%), followed by teratoma mature (29%), and Leydig cell tumor, epidermoid cyst, paratesticular fibrous hamartoma, paratesticular neuroblastoma and paratesticular rabdomyosarcoma (7% each). A testicular mass was present in all cases (100%). Testicular ultrasound was used in 100%. In all the patients with malignant tumors a thoraco-abdominal CT scans was done to rule out extension or the tumor, being negative in all cases. Alphafetoprotein were high in all the cases of yolk sac tumor, being within normal range one month after surgery except in one case. In 11 patients an orquiectomy was done through an inguinal approach, and in three cases a simple tumorectomy without orquiectomy. No lymphadenectomy was done. All the malignants neoplasms were stage I tumors, except one yolk sac tumor stage III. Postop chemotherapy was applied in this one and in the embrionary rabdomyosarcoma. There were no recurrences after a follow-up mean time of 3.98.
From 1981 to 1993, we have treated 31 pediatric patients with ectopic ureterocele (associated to duplex system, intra and extravesicals). Diagnostic work-up included abdominal ultrasound, intravenous urography (IVU), sequence mictional cystouretrography (SM-CU) and diuresis renography (DTPA-DMSA o MAG-3). Patients were divided in two groups: 1. Good renal function in the affected system (5 cases) with 2 endoscopic incision of the ureterocele and 3 without surgical treatment (all intravesical). 2. Almost non-existent ipsilateral renal function (26 cases), treated by heminephrectomy and ureterocelic aspiration, and in the remaining a nephrectomy was done for ipsilateral non-existent renal function. 2 cases treated by endoscopic incision presented vesicoureteral reflux, and 4 cases treated by nephrectomy had a low grade reflux. There is no a definite treatment established. The choice should by made based on renal function. Endoscopic incision is a good choice in obstructed cases with good renal function. In those with no function at all, heminephrectomy with aspiration of the ureterocele will be the best treatment if we consider that almost 50 percent of the patients will need a second surgical procedure.
Fournier's Gangrene (FG) is a rapidly progressive necrotizing fasciitis affecting the male scrotum and perineum, highly uncommon in paediatric patients. Initially considered as an idiopathic disease, it is frequently found associated to debilitating diseases or in immunocompromised patients. Prognosis is more favourable in children than in adults and is dependent of an early diagnosis and a rapid institution of the appropriate medical and surgical therapy.
Intraluminal masses within the upper urinary tracts are rare, are almost always benign, and most commonly take the form of fibroepithelial polyps within the ureters. Only exceptionally are these lesions found within the renal pelvis and for that reason may cause diagnostic difficulty. We present a new case of fibroepithelial polyp of the renal pelvis treated successfully in our hospital.
Explore the source record for details and available documents.
Due to the widespread use of obstetrical ultrasonography with concomitant fetal screening, congenital uropathies are usually diagnosed in asymptomatic neonates. The main issue is to distinguish those cases of dilatation which are clearly obstructive and need surgical treatment from those which are within the normal anatomical range. Out of 47 patients with primary megaureter, 23 were nonobstructive, these are the aim of our study. There were 16 males and 7 females; 13 were located on the left side, 7 on the right side and 3 were bilateral, adding up to 26 reno-ureteral units. Prenatal diagnosis was performed in 16 cases, the eldest patient diagnosed was nine. All infants were evaluated with ultrasonography, voiding cystourethrography, excretory urography and diuresis renography. The latter has been the most important test inducing us to adopt a conservative attitude. Differential renal function was more than 40% in 24 units and in 2 was more than 35%. Diuretic renograms were type IIIa (Dilated non obstructed) in 19 cases and IIIb (Dilated partially obstructed) in 7. There were 2 cases with vesicoureteral reflux in the contralateral system. We have performed ultrasonography and diuresis renography during the follow-up. There were 8 cases with type I (Normal) renograms and 17 cases with type IIIa. Only one patient developed an obstruction and was operated on. In every case differential renal function did not deteriorate. In 9 cases urography was performed in order to see the anatomical changes. They have remained asymptomatic during the follow-up except for two cases which presented urinary tract infection. BUN, creatinine and other biochemical figures remained within normal ranges.(ABSTRACT TRUNCATED AT 250 WORDS)
Treatment of choice of ovarian cysts diagnosed in the neonatal period has been until nowadays mainly surgical. Another possibility is a conservative approach, since these cysts have a natural tendency to spontaneous regression. We present 9 cases treated in our hospital in the last 8 years. 6 of them were treated surgically, while in 3 a conservative attitude was used, with sera ultrasound follow-up and disappearance of the cysts in 2 months in 2 cases and in 12 in the other. In cysts smaller than 5 cm we adopt a conservative management, leaving surgery only for those bigger or complicated.
Instrumental esophageal perforation is a serious complication that demands immediate therapy. In a retrospective study we have evaluated the results in seven patients treated for esophageal perforation by means of a conservative treatment without mortality. Instrumental dilatation of corrosive strictures were the most frequent cause of iatrogenic endoscopy. We have observed an esophageal injury associated with a Sengstaken-Blackemore tube placement. Clinical symptoms associated with chest roentgenograms guided to early diagnosis in all cases. Conservative treatment usually consist of a course of antibiotics, pleural drainage, and total parenteral nutrition. Clinical follow-up has been good in the seven patients treated.
Total colectomy in the neonatal period, after a necrotizing enterocolitis is not infrequent and implies a series of complex attitudes towards a good adaptation of the remaining small bowel. We present 9 cases of total colectomy in children with necrotizing enterocolitis of 11 cases surgically treated out of 57 cases. We describe the different types of surgical procedures used as well as the evolution of each patient.
Explore the source record for details and available documents.
Gastric duplications are very rare, especially those located at the pyloric region. Four cases are reported with gastric duplication in patients of two days, eight months, two and a half and three and a half years old, a review is made including symtomatology, diagnostic, treatment and anatomopathological studies. In all four cases post-operative evolution was satisfactory.
Primitive bening spleen tumors are very rare in pediatrics. They can be solid or cystic. Authors report two cases of spleen tumors: one hamartoma of red pulp in a 4 1/2 year old male, with symptoms of an enlarged spleen and immunological deficit; and the other case a simple cyst, that developed as an enlarged spleen, lined by mesotelium. Based on this experience, they comment on frequency, clinical and radiologic diagnosis, pathology and treatment of these tumors.