RESUMO
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.
Assuntos
Criptorquidismo/complicações , Neoplasias Testiculares/etiologia , Criança , Humanos , Masculino , Risco , Neoplasias Testiculares/epidemiologiaRESUMO
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.
Assuntos
Apendicite/diagnóstico por imagem , Doença Aguda , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , UltrassonografiaRESUMO
INTRODUCTION: The study on the physiological alterations due to surgical aggression (surgical stress), widely investigated in adults, is less known in paediatric age. THE OBJECTIVE: Of this work is to quantify surgical stress (evaluated by means of Oxford Scale as high or low depending on its value bigger or lower than 6), after determining changes of plasmatic concentrations of ACTH, beta-endorphin and cortisol in operated children. PATIENTS AND METHODS: Observational analytic design of a prospective cohort with internal comparison of the groups. SAMPLE SIZE: 33 (age 10 +/- 2.6 years; range 5 to 14 years). DEPENDENT VARIABLES: plasmatic concentrations of ACTH, beta-endorphin and cortisol determined before and after the intervention (1 and 24 hours after surgery), by radio-immune-analysis. RESULTS: Significative increase of the three considered hormones one hour after surgery, with decrease of them until preoperative levels 24 hours later. Significative correlation between beta-endorphin (24 hours after surgery), cortisol (1 hour after surgery) and surgical stress levels. CONCLUSIONS: Surgery in children provokes the activation of hipophysal-suprarrenal system. These levels early came back to normal ones, 24 hours after surgery. There is a specific change in beta-endorphin, that is why it is possible to assure that beta-endorphin is a "stress-hormone", since it is affected by surgical aggression. Cortisol seems to be a good index of level of surgical stress.
Assuntos
Sistema Hipófise-Suprarrenal/fisiopatologia , Estresse Fisiológico/etiologia , Estresse Fisiológico/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: The clinical cases of 20 patients submitted to Reifferscheid intervention (fixation of rectum to promontorium) between 1967 and 1997 are presented. PATIENTS AND METHODS: Twenty patients have been treated by means of the operation of Reifferscheid. They were divided in two groups: from 1967 to 1972, ten patients were submitted to this technique (group A). From 1974 to 1997, other ten patients (group B). In each case, the following items were registered: sex, eventual secondary diagnosis, incision, complications, middle-term evolution. RESULTS: Group A: Middle age: 2.15 years old. Sex: 7 girls (5 of them presented mielomeningocele) and 3 males; pararectal incision for babies, Pfannenstiel incision for children over 1 year-old. FOLLOW-UP: 2 years without recidives. Group B: Middle age: 2.5 years-old, 9 males (2 of them were diagnosed of mielomeningocele) and 1 girl. No recidives were detected. DISCUSSION: These excellent results obtained with Reifferscheid operation contrast with the poor results referred by other authors for other therapeutical approaches. That is why, in patients affected of serious rectal prolapse, especially when associated to other pathologies, rectal fixation to promontorium is an useful and long-term sure approach.
Assuntos
Prolapso Retal/cirurgia , Pré-Escolar , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Lactente , Masculino , SacroRESUMO
A case of bilateral macrostomia type transverse facial cleft of Tessier n. 4 is reported, which was operated on with good results when had ten months of age, repaired using suture of three planes of three embryonic folds. A treatment plain precocious is recommended and pathogenic theories about this uncommon entity are exposed.
Assuntos
Anormalidades Craniofaciais/complicações , Macrostomia/etiologia , Anormalidades Craniofaciais/cirurgia , Humanos , Lactente , MasculinoRESUMO
The main objective of the present report was the evaluation of the utility of echography as a diagnostic method in abdominal pain suspicious of acute appendicitis. A control-case study was performed in 165 children hospitalized for abdominal pain. Appendicitis histologically confirmed were considered cases (n = 110) while control (n = 55) were the not-operated patients (46 children) or the not-confirmed appendicitis after laparotomy (n = 9). The variables considered here were: the results of echography (Eco+ when echography showed signs of acute appendicitis: Eco- when not), the age of the patient (randomized at three groups; < 6, 6-9, > 9 years), and the conclusions of fisical exploration (conclusive or not as acute appendicitis). The results were analyzed statistically with the SPSS program, calculating the following predictive values; sensibility, specificity, positive predictive value, negative predictive value. Odds Radio before and after test and the global value of echography. Authors conclude that ultrasonography as method of support to abdominal exploration for diagnostic in acute appendicitis is manifest and present a global value of 70.90%.
Assuntos
Apendicite/diagnóstico por imagem , Dor Abdominal/etiologia , Doença Aguda , Apendicite/complicações , Apendicite/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , UltrassonografiaRESUMO
This paper studies the gonadal-hormonal and spermatic function of 48 adults (over 18 years old) who were treated in childhood for cryptorchidism by medical, surgical or both treatments. We measure plasmatic levels of FSH, LH, testosterone and prolactin of 34 patients and sperm samples of 31 patients. The testicular hormonal function was not disturbed except in four patients with high levels of prolactin (> 20 ng/ml) without symptoms. The spermatic function was disturbed in bilateral cryptorchidism mainly. The better sperm quality and testicular volume were at patients treated with hormonal treatment before surgical treatment.
Assuntos
Criptorquidismo/cirurgia , Hormônio Foliculoestimulante/sangue , Hormônio Luteinizante/sangue , Prolactina/sangue , Espermatozoides , Testosterona/sangue , Adulto , Criança , Humanos , MasculinoRESUMO
The treatment of acute appendicitis when appendix is technically impossible to remove, remains controversial. The clinical case of a 12-years-old child diagnosed of acute appendicitis in which appendectomy was not initially performable is presently described. After treatment with antibiotics, he was submitted to appendectomy five months later. Operative and pathologic findings in this second laparotomy prove the predisposition of the patient to a second acute appendicitis, and uphold the preventive attitude, the interval appendectomy.