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Unlabelled: The way used by physicians to obtain information from scientific research may have low-quality, with effects on assistance. Evidence-based medicine became necessary due to the exponential growing produced in the published research., Objectives: 1. To establish the scientific goodness of published papers on endoscopic treatment of vesicoureteral reflux. 2. To quantify the quality level of the papers by means of a series of explicit criteria., Material and Methods: Work type: Bibliometric revision. Databases: Revision of the electronic bases: Medline, ACP Journal Bandolier, Cochrane Collaboration and Pediatric Evidence Based Medicine., Inclusion Criteria: Papers on endoscopic treatment of primary reflux in children. Evaluation criteria: 1. Scientific level: Evidence classification proposed by Goodman, describing 10 levels from 1 (high) to 10 (low) and the Agency of Evaluation of Technology (AET) describing 9 levels. 2. Quality level: Dichotomic characters referred to the presence or absence of: experimental design, objectives, result measurement and concordance of methods and conclusion with the objectives., Results: 114 papers were found and analyzed 1. Evidence level: 86.9% of papers showed a low level of evidence by Goodman score (level 9) whereas 90.4% presented level 8 of AET. 79.5% of papers were consecutive series of clinical cases, 9% were non-critical bibliographic revisions, 1.7% were cohorts works, 5.3% non-randomized clinical trials and only 1 paper was a randomized clinical trial. 2. Quality level: 61.4% did not explicit the objectives and 57% did not expose the design. The population was not defined in 68.4% of papers and the way to appreciate the results in 73.7%. The experimental design, in 57.9% of works, and the conclusions, in 64.9%, did not concordate with the objectives., Conclusions: Endoscopic treatment of vesicoureteral reflux is becoming more popular. However, its effectiveness has to be proved by means of solid scientific bases, for works referring to it have low methodological level and low quality.

Background: The "burnout syndrome" is characterized by emotional exhaustion, despersonalization and decrease of the feeling of personal accomplishment, above all, in the field of professional achievement. It appears to be frequent in the helping professions and the human services workers, and in its origin labour factors seem to intervent., Hypothesis: The "burnout syndrome" can be affecting to the collective of spanish pediatric surgeons since the profession presents risk factors., Objectives: The purpose of this study was to evaluate the prevalence of "burnout" and level of work satisfaction among spanish pediatric surgeons, and related factors. METHODS., Design: [corrected] Crossover descriptive study., Subjects: Random sample of members of the Spanish Society of Pediatric Surgery., Measurements: A survey for self-administration with social and demographic variables, a spanish version of the Maslach Bournout Inventory (MBI), and the Font Roja questionnaire was used. The MBI consists of 22 items and the Font Roja of 24. Respectively, they explore the components of the syndrome and the factors of satisfaction with the work. It is considered "burnout" when it is scoring high in emotional exhaustion and despersonalization and low in personal achievement., Results: 85 people responded (response rate: 45.5%. Male: 81.2%. Mean age: 49.8 years. Burnout scores were in the average range (43.88 +/- 5.59). The emotional exhaustion subscale of the MBI averaged 19.16 +/- 5.35, with 75.3% in the moderate range. The despersonalization score averaged 11.79 +/- 3.68, with 45.9% of respondents scoring in the high range. The personal achievement subscore averaged 12.93 +/- 3.68, with 82.4% scoring in the low range. The overall mean satisfaction: 70.46 +/- 11.23. The factors that promote a greater satisfaction level are: intrinsic occupational satisfaction, social relationship in the work and appropriateness for the task., Conclusions: It exists a moderate level of "burnout syndrome" with a middle level of work satisfaction. Though contradictory this circumstance is possible, since it is considered professional satisfied with their profession (vocational election) that at the same time lives some difficult work conditions that generate a situation of high exhaustion professional.

The prevalence of ureteral ectopia is low and it is usually associated with pyeloureteral duplication. In these cases, incontinence is frequent. We present the cases of five female patients treated in our hospital for urinary incontinence due to ureteral ectopia and duplicity. The ectopic ureter reached the uterus in three patients and the vagina in the remaining two. The treatment chosen was heminephroureterectomy due to the presence of hypofunctional or dysplastic segments. Incontinence disappeared after surgery.

Background: The written information that is provided to the patient must gather a series of characteristics, quantitative and qualitative, so that fulfill the ethical criteria that govern the theory of the Informed Consent., Aims: To evaluated the degree of exhaustivity and readability of a series of Informed Consents forms in Pediatric Surgery units., Material and Methods: 1. Forms: We evaluated 118 consent forms submitted by 17 pediatric surgery units. 2. Exhaustivity: The studied variables have been: name of the hospital, name of the patient, name of the physician, date, description of the procedure, objectives, risks mention, personalized risks, possibility of recovery, benefits of the procedure, alternatives, possibility from withdrawing the assent, arrangement to widen the information, comprehension of the document, express assent and signatures. All the variables are dichotomics, being collected your presence or absence. 3. Readability: Each document has been introduced in the program "Corel Word Perfect". It was applied to the usefulness "Grammatik" and were collected: number of words, number of phrases, Flesch/Kincaid index, Orational Complexity index and LEGIN index., Results: 1. Exhaustivity: The paragraphs presence in the different forms by order of frequency were: physician signature (100%), express assent (100%), signatures (100%), date (98%), name of the patient (97%), comprehension of the forms (97%), name of the physician (94%), risks mention (92%), name of the hospital (85%), description of the procedure (78%), possibility from withdrawing the assent (70%), personalized risks (67%), arrangement to widen information (43%), to explain alternatives (41%), objectives of the procedure (36%), benefits (36%), and possibility of the recovery (16%). 2. Readability: 11.1% of the forms fulfills the Flesch index, 27.9% the Orational Complexity index, and 22.1% LEGIN index., Conclusions: Most of the documents offer sufficient quantity of information with respect to the formal aspect and the risks an less with respect to the benefits. This seems to indicate your defensive character. Equally, they are difficult to reading and by difficult to understanding.

Introduction: Testicular cancer in adult and young patients with cryptorchidism (operated or not operated on) has been reported previously, but its epidemiological impact (as concept to profile cancer and/or therapeutical result of cryptorchidism based on quantitative dates) is not defined actually., Objective: Determination by quantitative meta-analysis of the strength of relation (relative risk = RR) cancer and cryptorchidism and by qualitative meta-analysis of factors of cryptorchidism (anatomical position of teste, age of intervention, testicular biopsy) associated to cancer., Results: Case-control and cohort studies of medical literature have been included in this report. Relative risk of develop cancer in the patient with cryptorchidism is 7.75 more than poblational control without cryptorchidism (interval of confiance: 5.2-10.3). Qualitative meta-analysis of factors concluded that there is a significative relation cancer and abdominal position of teste, and also age of intervention after 10 and testicular biopsy., Conclusions: Significative relation between cancer and cryptorchidism with relative risk above control population is constated again, although with dates without epidemiological importance. But significative relation among cancer with abdominal testes and intervention after 10 years would recommend prospective studies, with strategy of multivariant analysis. Authors recommend not to make testicular biopsy, except if its indication is not questionable.

Unlabelled: Importance of the problem. Atypical or precocious presentation of acute appendicitis in children causes false diagnosis., Objectives: To determine internal and external validity of ultrasonography for confirmation diagnosis of acute appendicitis., Patients and Methods: Patients with suspicious acute appendicitis treated in 1998. They have been classified into two groups. Group 1: patients with appendicitis; Group 2: patients with non-specific abdominal pain., Material: Ultrasonography equipment (5 and 7.5 MHz)., Method: Ultrasonography has been considered as positive when 3 or more of the typical signs of appendicitis have been detected. Analysis unit: positivity of the test and presence or absence of illness confirmed by histologic analysis of the appendix obtained through laparotomy., Results: Number of patients selected for the work: 139. Middle age: 8 years-old (range: 2 to 14 years); 75% were males, 25% females. Patients included in group 1: 42; patients included in group 2:97. False positive rate was 12.23%, while false negative rate was 7.19%. Sensibility was 76%, specificity was 82%, positive predictive value was 65%, negative predictive value was 88% and precision was 80%. Odds-ratio pre-test: 0.43; Odds-ratio post-test: 0.64., Conclusions: Probability of accuracy diagnosis is duplicated by ultrasonography. Liability of the test is diminished by variability due to observer.

Background: Several studies have demonstrated that, between 30-60% of the cases, the urgent attention demand is considered inappropriate. This situation causes an increase in the sanitary costs and supposes for the patient a partial medical care. In the area of the Pediatric Surgery we have not found any work accomplished to such effect., Design: Transverse observational study., Setting: Emergency Service of a University Hospital., Patients: a sample random (alpha: 0.05; precision: 0.05) of the patients attended during 1998., Main Outcome Measures: Dependent: appropriateness. Independent: age, gender, proximity, diagnostic, studies of the parents, previous assistance, if attends by own initiative and motives that induce to demand. It was considered hospital emergency, continuing the criteria of the WHO, when it is considered vital emergency or when there is using of therapeutic or diagnostic means nor available in an primary level of health care. The statistic treatment consisted of a relative frequencies analysis, test x2 and t Student., Results: Of 2,226 cases attended in emergency service, they have 441 reviewed (age: 5.54 years; 63% male). The most frequent diagnoses have been: injuries and small traumatisms (39.7%), abdominal pain (22.2%), burns (3.6%), appendicitis (3.2%) and hernias (3.2%); 86.2% attended by own initiative. The proximity (19.9%), the alarm by the symptoms (13.1%) and the ignorance of the existence of other level of health care (10%) have been the causes by the parents for attention demand. The 63.9% of the visits were considered inappropriate. It has been found relationship between inappropriate use and age (p < 0.02), proximity (p < 0.003), to attend by own initiative (p < 0.001), and expectation of the parents (p < 0.02). It does not exist relationship to the gender or the studies level of the parents., Conclusions: These data suggest that in the Emergency Services exists a high appropriateness. The accessibility, the availability of means, the rapidity of the attention and who takes the decision of attending are variable associated to the appropriateness.

Chronic idiopathic intestinal pseudo-obstruction (CIPS) is a rare condition in which there is a defective motility of the gastrointestinal tract of unknown cause leading to repeated bouts of intestinal obstruction without organic explanation. This syndrome groups several ill-defined varieties of motor disorders that can sometimes be classified according to the presence of familial incidence and to the presence of muscular or nervous lesions. Nevertheless, a considerable proportion of cases cannot be ascribed to either type. CIPS is a very difficult challenge for pediatric surgeons because our role is never curative and because when we are involved in it is usually as a result of a false diagnosis. We present herein the experience of 2 Pediatric Surgery Departments in this entity. In the last 30 years we have been involved in the management of 16 children with CIPS. Male-to-female ratio was 5:11 and all but 3 patients had symptoms before 6 months of life. Thirteen had abdominal distension, 10 maldevelopment, 9 recurrent bouts of intestinal obstruction, 8 chronic diarrhea, 7 vomiting, 2 dysphagia and 2 constipation. Seven out of the 16 had urinary tract involvement and in three prenatal diagnosis of megacysts was made. The mean delayed time for diagnosis was 3.08 years. Esophageal or antroduodenal manometry was performed in 8 patients and it was abnormal in 7. Histologic and histochemical samples were available in 8 patients, but only in 4 was enough to make a diagnosis of myopathy. Twelve patients underwent 41 surgical procedures. Three are currently included in a program of home parenteral nutrition. Only three have died, and the mean age of the survivors is 13.9 years. In most of the patients with CIPS surgery is only useful for nutritional purposes, for diversion procedures or for intestinal transplantation in extreme cases. Every effort should be made to avoid unnecessary explorations, misdiagnosis and delay in the identification of the syndrome.

Background: There is wide-spread consensus that a part of the use of hospital resources is inadequate in the sense that the patients receive services that do not provide them with any significant benefits, or that could be more beneficial, or less costly, with a lower care standard., Objective: The main aim of this work is to determine the percentage of inadequate stays in a pediatric surgery service and to identify the causes that provoke them., Method: It was a concurrent study in pediatric patients entered, at least 24 hours, by different disease for surgery, observation or study. Revising trained applied the pediatric version of the Appropriateness Evaluation Protocol on the medical records of these patients. It has been measured if the stay was appropriated or not, and the cause., Results: The studied patients (279) caused a total of 1,001 stays of those which 373 (37.3%) were deemed to be unnecessary. The diseases with greater number of inappropriate stays were cryptorchidia (97.3%), hernia (88.9%), hypertrophic pyloric stenosis (50%), and soft tissues surgery (43.1%). A 68.2% of the unnecessary stays were responsibility of the hospital-service-surgeon, a 22.6% to the associated environment-familiar, and a 9.2% to the lack of alternative resources to the hospital., Conclusions: A meaningful proportion by day of hospital stay would be avoided. The unnecessary stays search facilitates the weak points identification on those which to develop improvement actions.

It's perform a descriptive study about a series of events with the purpose of discover the own characteristics of ovarian cysts and which characteristics determine its treatment. In the 41 patients (10 newborn, 14 prepubertal females and 17 post-menarchal females) we analyzed their symptoms, pathological findings, ecographics details, treatment, diagnostic and follow-up. The predominant symptom has been the abdominal pain (18 patients). In 8 newborn the cyst was find before born by prenatal sonography. The cyst was palped like abdominal mass in 22 patients and it was like a picture of acute abdomen in 11. It was found in the right ovary in 24 patients and bilaterally in 7. By pelvic ultrasonography was observed a superior size of 5 cm of diameter in 28 occasions, in 17 there were imagine of complex and in 3 there were hemorrhagic. In 16 patients the suspicion diagnostic was of torsion and in 5 of appendicitis. The torsion was confirmed in 11. In 16 patients it was a follicular cyst, in 9 was a dermoidal and in 9 hemorrhagic. Was realized a surgical treatment (cystectomy or ooforectomy in 36 girls, in 4 was realized a puncture and evacuation (bigger of 5 cm with clear liquid) and in 7 was hope the spontaneous evolution (clear liquid and infer size of 5 cm). There were not relapses. The clinic manifestations are presents with own characteristics depending of the cyst affected to newborn, premenarchal or menarchal females. The indications of surgery are: symptoms which are not resolved after a observation time (24-49 hours) and cysts of big volume associated a complications.(ABSTRACT TRUNCATED AT 250 WORDS)

By means of a retrospective study made of multiple centres, it was aimed to determine which variables could be influential at the moment of diagnosis in the prognostic of patients suffering neuroblastoma and medullary bone affection. Fifty four cases of patients belonging to a total of ten hospital centers have been revised in a period of five years. The ages under study spanned from three months to eight years of age (mean = 2.83 years). For the analysis of the patients, they were divided into two groups: one being composed of the deceased patients and the other of the surviving. The deceased patients were of a more advanced age, the delay in the diagnosis was greater, the primitive tumor was found to be more frequently located in the adrenal glands, the metastasis appeared more readily in multiples, and the effectiveness of the treatment was less, resulting in lower cases of remission and a less radical surgery. The only difference with respect to other publications is that in the case of surviving patients, the number of cases of enolase and ferritin is more frequently pathological.

A retrospective multicentric study of 23 patients with stage IV-S neuroblastoma treated in 10 national Pediatric Surgery Departments between January 1988 and December 1992, is presented. All cases were classified as stage IV-S following staging criteria proposed by Evans et al. The age diagnosis was an average of 3 months. An acute clinical course was seen in 7 patients. Primary sites of the tumor were: adrenal gland in 6 patients (30.5%), abdominal paravertebral in 3 (13%) and unknown in 2 (9%). Distant tumor sites were: liver in 20 patients, bone marrow in 9, and skin in 5. There were not systematic therapeutic approach, in 16 cases (69%) the primary tumor was resected, 18 (78%) received chemotherapy, the liver was irradiated in 3 (13%), and 1 case (4%) received no treatment at all. One children died. The overall disease-free survival is 95.6% at 43 months post-diagnosis. A common treatment protocol is proposed, with systematic determination of N-myc oncogene which will indicate the appropriate therapy.

With the aim of describe a typology that will result in a more precise diagnostic which in turn will permit the selection of the most direct method approach, an analysis was made of the clinical characteristics of patients we treated due to the presence of torsion of the testicular and epididymal appendages. A retrospective review was made of 91 patients, taking into account this age, time of appearance, time of evolution, symptoms, physical examination, histological study and effects. The average age was 9.47 years with a greater incidence occurring between the eight and twelve years old. No influence due to a seasonal phase was detected. The time span between the initial appearance of the symptoms and the time of admittance was 39.5 hours, being somewhat less in patients below the age of six. The common symptom was pain. In addition, 58.2% of the patients also suffered scrotal affectation. In 31 patients the hydatid was palpable and in 19 the "blue dot sign" rendered positive. In 83 cases, surgery was done via the scrotum, resulting in the confirmation of the initial diagnosis. The affectation of the left side was more frequent (62.5%). The hospital discharge was possible in less than 48 hours with no visible long-term effects. Thus, we believe that it is possible to almost always make a diagnosis based on the clinical data, and the type of treatment to be applied should be the extirpation of the hydatid to be carried out via the scrotum.

The following report is to appraise the utility of the Selective Committee of Works of the Pediatric Surgery Society as an assessing organ for the Directive Board to develop the scientific program for the annual congress. For this purpose, a revision was made of a four year period (1990-1993), compiling 738 summaries, which focused primarily on the capacity of the communicated message to widen our concept of disease or our diagnostic or therapeutic possibilities. The secondary topic focused on was the way in which the investigation was decided on planned and executed. The last point taken into consideration was the formal aspects of the summary, according to the regulations given to the authors. From the 738 summaries evaluated, 510 were remitted to be presented as oral communications and 228 as posters. From all these, a total of 311 articles were admitted (172 oral communications and 139 posters). The average pointage obtained was 8.22 (maximum: 20). The articles with the highest acceptance were those dealing with experimental surgery and/or clinical investigation (70%), transplantation (665), urology (50.7%), oncology (45.6%), cardiovascular surgery (45.5%) plastic surgery (40.5%), orthopedics (39.1%), digestive-abdominal (36.8%) and maxillofacial surgery (26.3%). In 77.5% of the articles, the study method followed is not specified, in 70.7% there is no description of the results obtained and in 85.4% there is no description of the conclusions. Deducing from the above information exposed, it is necessary to maintain a system of selection of the best communications, which in turn, will guarantee a greater scientific quality in the congresses.

Nutritional assessment was made in 134 pediatric patients before surgery in order to analyze the influence of age, sex anthropometric nutritional index and type of surgical operation (urgent vs elective). The anthropometrical index, hematology measurements and serum protein levels were compared by using a one-way ANOVA and a linear correlation was performed when appropriate. The type of surgery and age of the patient were the factors which influence nutritional status the most among the pre-operatively screened surgical pediatric patients. In addition, pre-albumin, retinol-binding protein and acute-phase proteins have been shown to be affected by stress and appear to be more sensitive indicators of nutritional state than comparison of the types of surgery.

It has been realized a study about energy and nitrogen balances in 23 patients with total parenteral nutrition in order to know how they get weight increase and nitrogen retention. The parameters analysed were nitrogen retention, nitrogen retention/100 g. of weight increase, efficacy in use of nitrogen, metabolized energy and metabolized energy expressed in percentage of intake energy. Positive correlation between intake energy and urinary eliminated energy (p < 0.05) as soon as between intake nitrogen and urinary eliminated nitrogen emphasize among the results. We have verified too that the percentage of metabolized energy over intake energy is upper in operated newborn than in other affected by necrotizing enterocolitis.

We report two cases of cerebral abscess secondary to esophageal dilations in children with caustic stenosis of the esophagus. High fever and neurological findings postdilation lead us to suspect this complication. Cranial C.T. confirmed the diagnosis. Clinical course was favourable in both patients, with antibioterapy on the first case and combined therapy with surgical drainage and parenteral antibiotics on the second patient. We remark the importance of suspect this complication on the basis of clinical and tomographic findings on the pediatric patients subjected to esophageal dilations. Pathogenic ways of bacterial dissemination from the esophagus to the brain are discussed and reviewed.

We report two cases of duodenal atresia associated with corporal symmetry changes. The one of them presented a "situs inversus total" and the other one a Ivermak syndrome. The association between duodenal atresia and Ivermak syndrome has a very low incidence. We have not found references with respect to the association between duodenal atresia and "situs inversus totalis". The embryo-genetic hypothesis that could relate both anomalies are discussed. Perhaps are not caused by chance.

Eighty patients to operated upon secondary hidronephrosis to pieloureteral or ureterovesical stenosis are studied. Diary diuresis and excretion of sodium of the operated kidney and the healthy kidney are valorated. We analyse the differences between age groups, grade of parenquima afectation or kind of pathology that cause the obstruction. Results show that the desobstruction of the urinary tract is accompanied by a increase of diuresis (p less than 0.001) and by a lost of sodium (p less than 0.001) in the operated kidney. Poliury is bigger in neonatal period than in other age groups.

22 patients, divided in 2 groups, are studied under-going intestinal resection as consequence of different pathological entities. Group I of 13 patients who had the ileocecal unión resected. Group II is made up of 9 patients who had small fragments of the small intestine enucleated. All the patients have, among other things, various anthropometrical, hematological and biochemical parameters, and their Ca/P metabolism analyzed, as well as the elimination of urinary nitrogen in its different forms. The patients who underwent resection of the ileocecal union present anthropometrical alterations, which can be consequence of a state of chronic malnutrition. The differences found in the alkaline phosphatase and in the elimination of amino acids in the urine can be a sign of a bacterial contamination of the small intestine by fecal flora or a sign of less availability of energetic contribution.

The case of a secreting adrenal tumor in a seven month old hemihypertrophic girl is described. Some features of hemihypertrophy and its relationships with the E.M.G. Syndrome and abdominal tumors are commented upon. The reported case is a typical association of malformation with tumor and recalls the close relationship between teratogenesis and oncogenesis.

Two cases of neonatal intestinal obstruction, with clinical, radiological and evolutive characteristics typical of the "neonatal small left colon syndrome", are described. Some etiological aspects are commented upon as well as differential diagnosis, which must be done with a certain number of diseases that produce intestinal obstruction in the newborn. Authors consider of great interest the high incidence of this syndrome in children born to diabetic mothers, diagnostic value of barium enema and the usually benign clinical course with very simple therapeutic procedures.

This is a description of a clinical case of a two-and-a-half year old male child who developed a urinary bladder stone seeded on chromic catgut used to suture of the bladder wall which was damaged in the course of the surgical repair of an inguinal hernia.

It has been done transluminal angioplastic with catheter balloon in 14 patients who are under 1 year of age and who are affected by aortic coarctation. For this study, they were divided in two groups. The first one was formed by newborn children whose transcoarctation gradient was 52 mm Hg in average. The second group was integrated by 9 newborn children whose transcoarctation gradient was 59 mm Hg. After this experience was done the gradient descended to 9 and 15 mm Hg respectively. Twenty four hours later, two months later and over two more months, there were follow-up of the clinical situation, the evolution of the pulse, differential arterial pressure and the need of surgery. Of the first group only one of the patients, who is now 2 years old, is in good clinical condition; the others needed to be surgically intervened. Of the second group 4 patients, all of whom were over 3 months old at the time of the angioplastic had positive results. The rest needed surgical intervention.