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Introduction: Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele., Materials and Methods: 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years)., Results: Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord's plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh., Conclusion: Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum.

Objectives: The groin is a complex anatomic region that has traditionally been ignored by radiologists because most lesions can be diagnosed from clinical data and physical examination. Nevertheless, ultrasound examinations of the groin are increasingly being requested to confirm injury or to resolve diagnostic uncertainty. On the other hand, some conditions involving the groin are found only in pediatric patients. This article describes the key imaging findings in pediatric groin injuries, placing special emphasis on the ultrasound appearance., Conclusions: Knowledge about conditions that can affect the groin in pediatric patients and the key imaging findings associated with them helps improve the diagnostic performance of ultrasound., (Copyright © 2020 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: In the last few years, numerous studies have focused on the genetics of the renal system. Betchel et al in 2010 demonstrated that methylation, as a epigenetic phenomenon, would be involved in the perpetuation of fibrosis. In our study, we want to demonstrate whether epigenetics is related to pyeloureteral stenosis and, if that is the case, if it could be used as prognostic and diagnostic biomarker., Methods: This is a descriptive observational and cross-sectional study that analyzed the methylation in DNA extracted from pyeloureteral junction samples obtained from surgery in pediatric patients in the period from 1999 to 2015, resulting in a total of 20 patients. Clinical data were analyzed using correlation tests and they were grouped with a free access software statistical phylogenetic package called PHYLIP. The selected genes for methylation-specific PCR (MSP) were the following: p16, RASSF1A, MGMT, Cyclin D-2, HIN-1, E-Cadherin and RASAL-1., Results: The clinical-radiological data analyzed phylogenetically by the PHYLIP program established 7 groups of patients. The results of methylation showed a considerable proportion of aberrant methylation in the promotor region of the genes p16 (25%), MGMT (15%), E-Cadherin (25%), HIN-1 (25%) and RASAL-1 (35%). The association of the clinical-radiological groups with methylation/non-methylation states of each gene was also analyzed., Conclusions: This study demonstrates that methylation does have a role in fibrosis developed in pyeloureteral stenosis. Two clinical patterns of poor prognosis associated with two epigenetic methylation cluster. RASAL- 1, E-Cadherin, HIN-1 and p16 would be candidates for future studies on their prognostic implications in pyeloureteral stenosis.

Angiopoietin-like protein 4 (ANGPTL-4) regulates lipidic metabolism and affects energy homeostasis. However, its function in children with obesity remains unknown. We investigated plasma ANGPTL-4 levels in children and its relationship with body mass index (BMI) and different lipidic parameters such as free fatty acids (FFA). Plasma ANGPTL-4 levels were analyzed in two different cohorts. In the first cohort (n = 150, age 3-17 years), which included children with normal weight or obesity, we performed a cross-sectional study. In the second cohort, which included only children with obesity (n = 20, age 5-18 years) followed up for two years after an intervention for weight loss, in which we performed a longitudinal study measuring ANGPTL-4 before and after BMI-loss. In the cross-sectional study, circulating ANGPTL-4 levels were lower in children with obesity than in those with normal weight. Moreover, ANGPTL-4 presented a negative correlation with BMI, waist circumference, weight, insulin, homeostasis model assessment of insulin resistance index (HOMA index), triglycerides, and leptin, and a positive correlation with FFA and vitamin-D. In the longitudinal study, the percent change in plasma ANGPTL-4 was correlated with the percent change in FFA, total-cholesterol and high-density lipoprotein cholesterol. This study reveals a significant association of ANGPTL-4 with pediatric obesity and plasma lipid profile.

The gastrointestinal-brain axis is a key mediator of the body weight and energy homeostasis regulation. Uroguanylin (UGN) has been recently proposed to be a part of this gut-brain axis regulating food intake, body weight and energy expenditure. Expression of UGN is regulated by the nutritional status and dependent on leptin levels. However, the exact molecular mechanisms underlying this UGN-leptin metabolic regulation at a hypothalamic level still remains unclear. Using leptin resistant diet-induced obese (DIO) mice, we aimed to determine whether UGN could improve hypothalamic leptin sensitivity. The present work demonstrates that the central co-administration of UGN and leptin potentiates leptin's ability to decrease the food intake and body weight in DIO mice, and that UGN activates the hypothalamic signal transducer and activator of transcription 3 (STAT3) and phosphatidylinositide 3-kinases (PI3K) pathways. At a functional level, the blockade of PI3K, but not STAT3, blunted UGN-mediated leptin responsiveness in DIO mice. Overall, these findings indicate that UGN improves leptin sensitivity in DIO mice.

Though context has yet to receive an unequivocal definition, it is a concept that frequently appears in research in children's knowledge and its construction. This article examines the scope and meaning of context in genetic psychology and social anthropology in order to better understand the relationship between children's construction of knowledge and the context in which it occurs. Meta-theoretical, theoretical and methodological complexities arise when the concept is analyzed in the two disciplines, and these will also be addressed herein. The fields of anthropology and constructive psychology are both affected by the relationship between the building of knowledge and the social practices surrounding this process. Finally, based on these empirical examinations, the article explores how research methodologies could incorporate the notion of context in research focused on the construction of knowledge.

One of the most controversial aspects of hypospadias surgery is the election of an appropriate wound dressing. In fact, there may be as many different types of dressing as there are types of surgical repair. Here, we describe a new, simple method for hypospadias dressing in children that minimizes painful removal.

We analyze different methodological and conceptual contributions of anthropology and psychogenetic theory to the research of children's religious knowledge. We argue that for the study of children's points of view it is possible to build an approach that links aspects studied by both disciplinary fields. With this aim, we revise some of their basic theoretical assumptions and recent reviews as well as their methodological proposals. Then we review the core characteristics of ethnography and the clinical-critical method-proposed by Piaget's psychogenetic theory-with the goal of stressing their potentialities as well as their limitations in research. We argue that within an ethnographic approach, we must establish certain restrictions on the clinical-critical method following basic premises of social anthropology. This approach lets us demonstrate the importance of understanding children's constructions by placing them within social relations that children produce and update in everyday interactions.

The omental infarction is a pathology that occurs more and more in children due to the increased use of imaging studies and the increment in overweigth and obesity. Clinical presentation is characterized by abdominal pain and can be confused with appendicitis, ileitis, adenitis, among other abdominal conditions. Definitive diagnosis requires the performance of radiologic investigations and its treatment may be conservative. We report three cases of omental infarction with different form of clinical presentation, successfully managed conservatively.

Prolapse of a cecoureterocele through the urethra presenting as a prenatal vulval mass is an extremely uncommon entity. We present a case of a newborn girl with a cecoureterocele extending through the urethra (diagnosed at 29 weeks' gestation) and we present its postnatal findings and outcomes.

Diabetes education has proved to be an essential tool in the care of patients with type 1 diabetes mellitus. To perform this educational task, the VII Area Murcia East Diabetes Unit, incorporated nurses in advanced diabetes education in the Hospital General Universitario Reina Sofía of Murcia. We carried out a retrospective study, which assessed the performance of these nurses by evaluating the type 1 diabetic patients attending inquiries between 2007 and 2011. We analyzed a total of 179 medical records, of patients with type 1 diabetes mellitus over 11 years, with 103 (52.3%) males and 94 (47.7%) women. Patients had a mean age 38.25 ± 14.02 years and a mean duration of diabetes of 16.22 ± 11.73 years. The initial mean value of HbA1c was 8.49 ± 2.04%. Only 37 (16.2%) of the 197 patients were under 25 at the start of the study. The results showed that the decrease in HbA1c (-0.57 ± 1.80%) was significant after 6 months (p = 0.002) from the first query, reaching values of 7.86 ± 1.39% and remained from that time. Insulin doses were stable throughout the study., (Copyright AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Incomplete polyorchidism (also called bilobed testicle) is an extremely uncommon congenital anomaly. Only 3 cases of bilobed testicle were previously reported in the available literature. We describe a case of a 4-year-old boy who presented with a 6-month history of an asymptomatic scrotal mass located in the upper pole of the left testicle mimicking testicular tumour. After partial orchiectomy, macroscopic and pathological examination of the lesion confirmed the diagnosis of normal testicular tissue., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Many surgical procedures performed in pediatric surgery have a slow learning curve, the volume of patients and the existence of complex diseases that require extensive training and surgical skill, have taken our service to create a global training program of experimental surgery. This program based on the simulation and training invasive procedures in real anatomical models, aims to educate our residents in a global and efficiently way in order to obtain an improvement of technical training, and increased patient safety result of experience and expertise wined in the experimental animal. This paper presents the main features, objectives and results obtained with this training program and seeks to promote the incorporation of simulation programs in live animal as an essential part of the training of pediatric surgery resident.

Introduction: Most of specialists involved in giant congenital nevi (GCN) care, agree that the risk of melanoma is probably not significant enough to warrant the prophylactic removal of all those lesions. However, many patients benefit from very early surgical procedures., Material and Methods: In the last 15 years 41 children undergwent surgical removal of their large or giant melanocityc lesions in the first year of life at our institution. Indications for such an early excision were as follows: painful ulceration or bleeding, alarming dermatoscopic changes, location in the scalp being removable with primary closure, concomitant surgical procedures, multiple expected interventions and severe parental psychosocial distress., Results: All patients had a good cosmetic result. All nevus in the scalp between 3 and 5 cms were removed with a primary closure in order to avoid future need of scalp expansion. Familial psychological distress improved significantly and disturbances related to scholar activities were not noticed., Conclusions: Despite the lack of international consensus regarding the appropriate timing for large or giant congenital nevi excision, a selection of patients and their families can benefit from early surgical removal.

Introduction: Enuresis affects 15% of the children under 5. Possible etiopatogeny explaining the mechanism of production of nocturnal enuresis has been described, resulting in different terapeutical approaches; however, we cannot speak up to now of general guidelines for its treatment., Materials and Methods: On the basis of 544 children who were treated in our hospital in the last 12 years, we analysed a sample of 124 patients corresponding to the last two years. We now present the therapeutical protocol used and analyse the results. In the initial therapeutical approach a distinction is made between monosymptomatic enuresis and eneuretic syndrome., Results: We studied a total of 120 patients (89 boys and 31 girls). 63% of them showed monosymptomatic enuresis while 37% suffered from enuretic syndrome. In the case of 15% of them, this was associated with heavy sleep and difficulties to wake up. 92% was the general percentage of recovery. In the patients suffering from nonosymptomatic eneuresis, the problem was solved with desmopressin in 87% of them (demospressin on its own in 65% or in combination with oxibutine in the remaining 35%). In the group of enereutic symdrome, the problem was solved with oxibutine in 71% (on its own in 40% or in combination with desmopressin in 54%., Conclusions: The treatment and solution of enuresis improve the child's self-esteem and the anxiety caused in the family. A good medical history with a clear distinction between enuretic syndrome and monosyntomatic enuresis leads us to a suitable therapeutical approach for every patient, allowing us to find earlier the right treatment for every individual.

Introduction: Twenty per cent of the operated patients suffering from cryptorchidisim show no palpable testis in the physical check-up. The use of a non-palpable testis in the initial stages is considered to be controversial when deciding between a laparascopic or an inguinal approach. Our aim is to compare the results obtained with these two approaches and evaluate which one of them would be the most relevant as an initial option., Materials and Methods: We examined the patients who have been subjected to surgical intervention for non-palpable testis in the last three years. We had a sample of 53 patients. Bilateral non-palpable testes were disregarded. In the case of 35 patients the initial approach was through the groins while in 18 of them the approach was laparascopic. Relevant data were recorded, such as the age of the patient, right or left side, surgical findings, need for a laparascopic or groin approach and associated hernia., Results: The average age of the patients at the time of the surgical treatment was 3.7 years R (1-13 years). 42% of the testes were on the right side and 58% on the left. In an initial stage the inguinal approach was used with 35 patients, 2 of these requiring laparascopic exploration due to a non-concluding check-up; it was concluded that they were 2 cases of anorchia. An initial laparoscopic approach was used with 18 patients. Internal vessels in the canal were found which required an inguinal approach. In 12 patients normal or atrophic testes were observed. Testicular descent was achieved through the groin in 10 of them while in the remaining 2 a combined approach was adopted., Conclusions: 80% of the patients subjected to a first laparoscopic approach needed a groin approach later on. 11% of the patients subjected to a first inguinal approach required laparascopic examination. In view of the results obtained, we conclude that inguinal exploration diminishes the need for second procedures.