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Persistent sciatic vein is a rare anomaly of mesodermal development. When found, it is often associated with varicosities in abnormal distributions, pain, limb congestion, and hypertrophy. In this report, we describe a case of an isolated, complete persistent sciatic vein with an atypical anatomy and onset.

Objective To report our experience of laparoscopic heminephroureterectomy (Hnu) in pediatric patients with duplex anomalies, in comparison to open surgery. Patients and methods Retrospective review of data from patients who underwent Hnu from 2005 to 2008 was performed. The patients were divided into two groups: laparoscopic (LHnu) and open surgery (OHnu). Laparoscopic surgery was performed by transperitoneal approach in majority of cases. Open surgery was performed by retroperitoneal approach in all cases. Results Group LHnu: nine patients (8 females, 1 male) with median age of 14 months (range 3–205). Transperitoneal approach was performed in eight patients. Mean operative time was 182 min (CI 95% 146–217). No conversion to open surgery was necessary and there were no complications. Mean hospital stay was 2.44 days (CI 95% 1.37–3.52). Group OHnu: eight patients (3 females, 5 males) underwent nine heminephrectomies at median age of 6.9 months (range 1–12). Mean operating time was 152 min (CI 95% 121–183). There were no complications and mean hospital stay was 4.38 (CI 95% 2.59–6.16) days. Statistical analysis showed no statistically significant difference ( P > 0.05) in operating time between groups while mean hospital stay was significant ( P = 0.021). Conclusion The laparoscopic approach is feasible, safe, reduces hospital stay, does not increase operating time and has better cosmetic results. We believe this should be the first option for heminephrectomy.

Purpose To compare efficacy of Cohen's ureteral reimplantation and endoscopic treatment with Dx/HA in patients with primary VUR grades II, III and IV. Methods From April 2002 to June 2004, patients over 1 year old with VUR grade I, II, III or IV were included. Patients were randomized into two groups: endoscopic treatment (ET) or ureteral reimplantation (UR). In the ET group, an ultrasonography study was performed 24 h and 1 month after surgery, and two voiding cystourethrographies at 3 and 6 months post treatment. In the UR group, an ultrasonography study was done 7 days and 1 month after surgery and a micturial cystography 6 months post surgery. A postoperative nuclear direct cystogram was performed 5 years later in both groups. Results A total of 41 patients were included in this study: in ET 22 patients with 35 refluxing ureters and in UR 19 patients with 32 refluxing ureters. The VUR grades in ET were: 16 grade II, 16 grade III and 3 grade IV; and in UR: 15 grade II, 12 grade III and 5 grade IV. VUR was resolved in 91% (32/35) of ET (28% of ureters needed a second injection), and in 100% of UR group. Five years after the procedure, VUR was still resolved in 30/32 of ET and 32/32 of UR. Conclusion Short- and long-term follow up shows that multiple endoscopic treatment of VUR grades II, III and IV with Dx/HA is as effective as ureteral reimplantation.

Retroperitoneal laparoscopy is well known as a surgical technique in adult patients. Its use in pediatric surgery is still-recent but, because of the good results, retroperitoncoscopy indications are getting more acceptance and widening indications. The aim of this work is to analyze our initial experience in retroperitoneal laparoscopy procedures in urological diseases at our centre.From July 2001 to February 2002 retroperitoneal laparoscopy has been used in 6 patients aged 6 months to 14 years. Surgical indications were: pyelolithotomy (lithiasis non-subsidiary to extracorporeal shock wave lithotripsy (n = 1); nephrectomy ofmulticystic dysplastic kidney (n = 4); and nephrectomy of atrophicpelvic kidney (n = 1).Mean operative time in nephrectomy has been 102 minutes, and 230 minutes in conservative surgery. All 5 patients nephrectomized were discharged 24 hours after operation with no postoperatory incidences. The patient operated on for pyelolithiasis (in which a external drainageand a pyelouretheral stent (pig-tail) was placed) remained one week until he could be discharged without drainage. The pig-tail stent was thrown out spontaneously three weeks later through the urethra. Follow up demonstrated no stenosis in this case and no complications in nephrectomy patients.Retroperitoneal laparoscopy is effective and safe in renal surgery and surpasses transperitoneal laparoscopy because its safety in reconstructive surgery avoiding urine leakage risk into the abdomen.

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are formulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for successful implementation and acceptance by the needy. This paper presents the results of research undertaken in Mexico and Central America to test the hypothesis that population groups view health gain as only one among several benefits derived from health systems. The goal at this stage was two-fold: (a) to identify through qualitative methods the range of benefits that are significant for a wide cross-section of social groups and (b) to classify such benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. Fourteen focus groups were undertaken in Costa Rica, El Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and social conditions. Six major types of health system benefits were identified besides health gain: reassurance/uncertainty reduction, economic security, confidence in health system quality, financial benefits derived from the system, health care process utility and health system fairness. Benefits most often mentioned can be classed under health care process utility and confidence in system quality. They also have the most consensus across social groups. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benefits mentioned. Health systems and health sector reform proposals must emphasise those aspects of quality related to human resources to be in accord with population expectations.

To make and validate a data base that allows to collect information about clinical characteristics and use of health care services by HIV-infected patients. An additional purpose is to obtain some data about costs of health care services utilization.We have designed an informatic data base that includes: demographic data, clinical data and health care services utilization during the follow up. One hundred and nine patients were selected from 5 different hospitals in Spain and they were followed for 6 months (from January to June 1997). Analytic accounting of one hospital and official tariffs were used to calculate costs of the health care services.The informatic data base designed is useful and appropriate to collect the information of these patients. The annual average cost is 2.5 millions dollars, ranging from 1 million dollars for asymptomatic patients to 3.8 millions for AIDS patients. The comparison of our results with previous studies shows an increased cost of asymptomatic patients.These results give a preliminary information about health care services utilization by HIV-infected patients and confirm the possibility of using the designed instrument in the future. Since HIV-infection presents an uncertain evolution and a variable prognosis, to implant a tracking system is a necessary requirement in order to obtain a fast and accurate information system about the evolution of clinical variables and their economic repercussions.

Since it was defined, SOP has been related to surgery. Before clomifero was introduced, ovarian wedge resection was the only way to stimulate ovulation and gestation in women with this syndrome. Surgical techniques were derelict in favour of less aggressive medical treatments. However, surgery has reduced its side effects due to the incorporation of laparoscopic techniques and other advances. Because of this fact, surgery is being reintroduced in the treatment of polycystic ovarian disease.

In this article, the authors analyze the pathological alterations which women suffer in which menopause is assumed to be a risk factor leading to the outbreak of these pathologies. Taken together, all of these alterations present some clear nutritional considerations; therefore, adequate dietetical care, followed by women during this phase, could help in their prevention and control. These alterations are: osteoporosis, obesity, arterial hypertension, arteriosclerosis and cardiovascular diseases.

A 5-year-old girl with Stevens-Johnson syndrome developed progressive dysphagia secondary to esophageal stenosis. The authors resolved this by treating the patient with balloon dilatation. She has remained symptom-free for 10 months post-treatment.

Fertile-aged women are a population group at special risk for developing ferropenia. In the periodic health care examinations, hemogram, among other tests, are included to detect the most advanced state of iron deficity, ferropenic anemia. Likewise, preanemic ferropenia presents a certain morbidity. The aim of this study was to analyze the cost-effectiveness of screening serum ferritin determination in health care examinations of fertile-aged women.An observational transversal study was carried out in 322 women in whom hemogram and serum ferritin were determined. The effects of serum ferritin determination were simulated in a hypothetical cohort of 20-year old women annually examined up to the age of 50 years (mean age of menopause).The prevalence of preanemic ferropenia (serum ferritinor = ng/ml) was 44.1% and that of ferropenic anemica (Hb120 g/l and serum ferritinor = 25 ng/ml) was 3.4%. Hemogram sensitivity for detection of ferropenia was 7.2% (3.6-12.5). By means of the screening program with serum ferritin avoiding of one year with ferropenia costs 2,428 pesetas. Prolonging the program to longer than 35 years largely increases the marginal cost. Cost-effectiveness analysis is specially sensitive to the cost of the diagnostic tests and disease prevalence.Ferropenia in fertile-aged women is a frequent disorder. Avoiding ferropenia by early diagnosis may be performed at a relatively low cost.

The cost-effectiveness of hypolipemiant treatment with lovastatine (0.02, 0.04 and 0.08 g/day), cholestyramine (12 and 24 g/day), cholestipol (10 and 20 g/day) and gemfibrocyl (1.2 g/day) was estimated in individuals presenting hypercholesterolemia (200 mg/dl or 5.17 mmol/l) following dietetic treatment.The cost-effectiveness relationship was measured in terms of cost per year of life gained comparing the net cost of the program with its effectiveness for each treatment studied. The net cost of the program was calculated taking the costs associated with hypolipemiant treatment into account and subtracting the estimated reduction of the costs of coronary heart disease attributed to the prevention program. The Framingham equation and the information concerning to the prevalence of cardiovascular risk factors and life expectancy according to age and sex in the Catalonian (Spain) population were used to estimate the effectiveness.The lesser to greater cost per year of life gained is lovastatine-0.02, cholestyramine-12, cholestipol-12, lovastatine-0.04, gemfibrocyl, cholestyramine-24, cholestipol-10, lovastatine-0.08 and cholestipol-20. In males from 45-49 years of age with cholesterol concentration of 300 mg/dl (7.76 mmol/l) the costs per year of life gained were 3.4 millions for lovastatine-0.02, 4.6 for cholestyramine-12, 4.8 for lovastatine-0.04, 5.4 for gemfibrocyl, 6.5 for cholestyramine-24, 7.8 for cholestipol-10, 8.1 for lovastatine 0.08 and 11.6 for cholestipol-20. In women the cost-effectiveness were 11.6, 15.4, 17.7, 21.3, 25.4, 25.9 and 37.1, respectively. The cost-effectiveness for the most effective treatments was less than 5 million of pesetas per year of life gained in males presenting a cholesterol concentration higher than 300 mg/dl (7.76 mmol/l) and those under the age of 65 years. In women the cost-effectiveness was lower than 10 million of pesetas per year of life gained in those presenting more than 340 mg/dl (8.79 mmol/l) under the age of 65 years.The results of this study demonstrate that the administration of lovastatine at 0.02 g/day is the most effective hypolipemiant treatment in preventing coronary heart disease.

PURPOSE: To describe the clinical and radiologic manifestations of juvenile Huntington disease and to determine whether adult imaging criteria for Huntington disease are helpful for pediatric patients. METHODS: Six patients (3 to 18 years of age; mean age, 9.8 +/- 5.6 years; 3 female, 3 male) with juvenile Huntington disease were studied with CT (n = 6) and/or MR (n = 3). CT and MR studies were evaluated for frontal horn distance/intercaudate distance and bicaudate ratios, which were compared with those of 24 age-matched healthy children and 12 age-matched patients with Leigh (n = 9) or Wilson (n = 3) disease. RESULTS: Atrophy of the caudate nuclei was identified in all Huntington patients. The frontal horn distance/intercaudate distance (1.64 +/- 0.39) and bicaudate (0.205 +/- 0.060) ratios of the patients with juvenile Huntington disease were found to be significantly different from those of healthy children and that of those patients with Leigh/Wilson disease. The 3 patients with Huntington disease who underwent MR evaluation were noted to have increased proton density- and T2-weighted signal in the caudate nuclei and putamina. CONCLUSION: As in adult patients, the use of frontal horn distance/intercaudate distance and bicaudate ratios are helpful for the diagnosis of Huntington disease in pediatric patients. On MR, increased proton density- and T2-weighted signal in the atrophic caudate nuclei and putamina are additional features of juvenile Huntington disease.

We report a 12-year-old girl who at presentation had diffuse myxopapillary ependymomatosis of uncertain primary site. The MR appearance and mechanism of metastases of the tumor are discussed.

In a 13-year old girl, an ovarian tumor was suspected of being responsible for causing amenorrhea-galatorrhea. In the absence of any abnormality of the medial umbilical folds, hormonal assessment indicated a high level of prolactin, which was restored to normal after exeresis of the mass. This was an ovarian tumor of the sexual cords with annelated tubules (SCTAT de Scully).

Three cases of rectal carcinoma associated with pregnancy led the authors to review the general literature. The lesion is most often an adenocarcinoma, diagnosed late at an advanced stage of progression in young women. Results of treatment are poor and the outcome fatal.

High blood pressure has a high incidence and produces a high morbidity and mortality due to associated diseases: cerebrovascular disease, ischemic cardiopathy, and cardiac failure. The socioeconomic impact of high blood pressure in Spain was estimated during 1985 in primary, hospitalary and pharmaceutical health care, to provide a framework for decision making and to determine strategies for reducing the costs of this entity.The methodology of analysis of the cost of the disease was followed with the aim of quantifying the socioeconomic consequences of an entity, disease or risk factor with prevalence being the focus of the study.The socioeconomic impact estimated was situated between 95,000 and 124,000 millions of pesetas according to the different hypothesis adopted in the analysis of sensitivity. The direct health care costs represented between 2.6 and 3.9% of the global health care costs for Spain in 1985. Health care funding consumed by high blood pressure in primary health care was higher (between 4.5 and 6.7%) than hospital attendance (between 1.0 and 1.5%) and pharmaceutical care (between 2.3 and 3.5%), with respect to the total costs of each category.The reduction of the costs related with high blood pressure in Spain must be obtained from improvement of efficacy of interventions carried out in health care education and primary health care. The economic evaluation of the primary and secondary prevention programs may aid in determining more cost-effective strategies.

The short and thick bowel found in gastroschisis has been attributed to contact with amniotic fluid, among other factors. We designed an original animal model in order to isolate the effect of amniotic fluid on the fetal bowel. We created experimental gastroschisis in fetal rabbits. Extruded bowel was kept out of the amniotic sac in half of the operated fetuses. At term, seven days after surgery, 21 surviving fetuses--12 intra-amniotic (GIA) and nine extra-amniotic (GEA)--and 16 control littermates were harvested for study. Five parameters were measured in each animal: body weight, intestinal weight, intestinal length, bowel diameter and bowel wall thickness. We found no statistically significant difference in body weight, intestinal weight or bowel wall thickness. An enormous difference was found in intestinal length among the three groups. Bowel diameter was significantly different in the extreme groups (GIA and controls), with the intestine being more dilated in GIA than in GEA and controls. Gastroschisis in the absence of amniotic fluid has not been as damaging to the fetal intestine as "natural" intraamniotic gastroschisis.

Tympanometry and otoscopy has been carried out to determine the presence of middle ear disease on patients with cleft palate and the influence of corrective surgery. This explorations have been evaluated preoperatively and at one and six months postoperative follow-up. There is a high incidence of otitis media with effusion in patients with cleft palate, almost 60 per 100 in our study. The influence of cleft palate surgery repair has not revealed as a mayor factor on its resolution, although a visible benefit has been observed in the long term controls. We recommend a otorhinolaryngological follow-up in these patients.

In the last 10 years, four children with adrenocortical tumors were treated in our hospital. Three of them had symptoms of adrenogenital virilizing syndrome, and another, nonfunctional, was found during a routine examination. A diagnosis of adrenocortical tumor was established given the symptoms, hormonal tests, and radiologic studies. Two of the tumors were located in the left side, and the histologic diagnosis was pleomorphic cortical adenoma; the ones that affected the right side were adenocarcinomas. All the patients were treated by surgery and none received chemotherapy. At both presurgical and postsurgical stages, the patients were treated with cortisol. All four children have had a favorable course, with normal growth and the disappearance of public hair and hirsutism; however, macrogenitals still persist.

We describe a case of a solitary pelvic kidney coexisting with adrenal and pelvic neuroblastoma in a child with multiple malformations, including microcephaly, hypertelorism, aortic coarctation and a bifid uterus. The association of a solitary kidney and neuroblastoma has not been reported previously.

We report on 6 laparoschisis treated in the last 5 years. Five patients survived whereas one died at the age of 41 days. We review clinical aspects of this malformation and point out the need for a prompt operation and an adequate nutritional management.

Four cases of pleuroperitoneals diaphragmatic hernia are described. The onset in the four infants was intensive respiratory distress. In all patients the only herniated viscera was the stomach, that was found strangulated and dilated into the thoracic cavity. The foramen herniarium was located on the diaphragmatic cupula with a size between 2-3 cm.

The aim of this paper is to analyze our experience in different surgical techniques to perform a nephrectomy for benign renal diseases in children.From 1993 to 2005 we have performed 98 nephrectomies. We have three groups of patients depending on the surgical technique: open nephrectomy (ON), transperitoneal laparoscopic nephrectomy (TLN) and retroperitoneal laparoscopic nephrectomy (RLN). ON was performed in 36 patients. Mean age was 3.3 years. TLN was performed in 39 patients. Mean age was 4.7 years old. RLN was performed in 23 patients. Mean age was 3.6 years old. Criteria to nephrectomy was a renographic function under 19%. We have compared the three surgical techniques in relation with surgical time and mean hospital stay.Mean operative time was 126.2 minutes in ON, 132.3 minutes in TLN and 134.1 minutes in RLN. Mean stay was 5.02 days in ON, 2.35 days in TLN and 1.86 days in RLN. The median hospital stay of the ON group is significantly longer than that of NLT and NR groups (p0.05). However, there are no differences related to surgical time between all the groups.Nephrectomy may be performed for benign disease in children using less invasive surgical techniques. They are associated with minimal morbidity, minimal postoperative discomfort, improve cosmesis and a shorter hospital stay. However, we haven't found differences between TLN and RLN.