Background: There are several surgical and radiologic treatment options for varicocele repair. At two institutions we perform the Palomo technique with laparoscopic approach without sparing the testicular artery. Our purpose is to review our experience in the treatment of varicocele assessing recurrence and secondary hydrocele rate, comparing them with other techniques in the literature.
Material and methods: Observational retrospective review of patients under 16 years old treated with laparoscopic not selective ligation of spermatic vessels between 2009 and 2013 at our institutions.
Results: Ninety-eight patients were included in this study (mean age 13.4 years). Every case was unilateral left varicocele and the indications were testicular hypotrophy (39.8%), high degree (46.9%) and pain (4.1%). All patients underwent laparoscopic not selective ligation of spermatic vessels. The mean operating time was 45 minutes and the mean postoperative hospital stay was 16 hours. There was no conversion. Ten patients (10.2%) required a second surgical procedure because of secondary hydrocele. Two patients (2%) suffered a residual varicocele, one of them without clinical relevance and the other one required another surgery.
Conclusions: 1) High grade should be reconsidered as a surgical indication; 2) our results are similar to those published in the literature regarding laparoscopic Palomo and are superior to inguinal approaches, and 3) the laparoscopic Palomo technique offers the best treatment option for varicoceles, due to the good outcome and the acceptable percentage of secondary hydrocele.

I. Simal. Servicio de Cirugía Pediátrica. Hospital Álvaro Cunqueiro. Estrada de Clara Campoamor, 341. 36312 Vigo (Pontevedra). Correo electrónico: isabelsimal@gmail.com

Congenital patellar dislocation is a rare condition in which the patella is permanently dislocated and cannot be reduced manually. It usually manifests after birth, although in some rare cases, the diagnosis may be delayed until adolescence or adulthood. Early diagnosis is important, thereby allowing surgical correction and avoiding late sequelae, including early degenerative changes in the knee. A case of permanent dislocation of the patella is presented here, in a male aged twelve years, healthy and footballer.

Pelvic apophyseal avulsion fractures have a low incidence in childhood. These fractures occur during the adolescence in the interval between the appearence of ossific nuclei an their fusion at pelvic tuberosities. The pelvic apophyseal avulsion fractures occur during explosive exercises. We report a case of an adolescence how after a typical production presents an avulsion fracture of anterosuperior spine.

Herpes simplex virus esophagitis has been widely reported in immunocompromised patients, but has rarely been decribed in the immunocompetent pediatric patient. The vast majority of infections are related to herpes simplex type 1, although herpes simplex type 2 has occasionally been reported. Its occurrence may be due to reactivation of a previous infection, or less often, it’s a primary infection. The most common clinical features are fever, odynophagia and retroesternal pain. In immunocompetent patients, it occurs as an acute onset process and it’s self-limited in time. Upper endoscopy can lead to a suspicion diagnosis of herpetic esophagitis. Endoscopic findings typically show erythema and ulcers of the oesophageal mucosa and histopathologic examination includes multinucleated giant cells, with ground glass nuclei and eosinophilic inclusions (Cowdry type A inclusion bodies). Tissue viral culture or polymerase chain reaction on histologic samples is required to confirm the diagnosis. Treatment with Acyclovir in healthy patients is controversial as it is a self-limited process. We report a case of acute herpetic esophagitis in an immunocompetent host that debuted with severe acute upper gastrointestinal tract symptoms. It’s important to keep in mind this entity when facing an acute case of odynophagia.

Background: Choking phobia is characterized by a fear and avoidance of swallowing solid food and, on occasion, even liquids or pills. These characteristics, when added to the weight loss and the frequent association of obsessive-compulsive symptoms, are suggestive of an eating disorder.

Methods: The records of 6 children and adolescents (4 boys and 2 girls) who had been diagnosed as having choking phobia over the preceding five years were reviewed for inclusion in a longitudinal, descriptive study. The data are presented as the mean and standard deviation (SD).

Results: The mean age at the time of the first visit was 9.9 years (range 5 to 16 y). The mean time between the first symptoms and diagnosis was 1.7 months (SD: 1.0 mo). On average, the patients lost 13% of their initial weight. The Z score for weight was –1.19 (SD: 0.72). All of them received cognitive-behavioural therapy and, except in one case, they also received drugs. Four children had their diet supplemented with a hypercaloric enteral formula (300-900 kcal/day) for 2 months. Complete remission was achieved in every case, weight restoration took a mean period of 5.6 months (SD: 2.5 mo).

Conclusions: Although the differential diagnosis should include early onset anorexia nervosa, there is no body image distortion or fear of gaining weight. The episode started after a stressful situation, generally related to food. It was accompanied by a weight loss of 7% to 20% of initial weight. The combination of cognitive-behavioural therapy plus drugs and nutritional assessment obtained good results in this young popu¬lation.

The way our youngsters and adolescents spend their leisure time has undergone wide variations over the last few decades. Television viewing occupies more than three hours a day. More recently, part of this time has shifted towards the use of videogames and consoles and the Internet. On the other hand, personal music players (CD players, MP3, MP4, iPod) have become a constant among our adolescents.

What are the metabolic consequences of these changes in our lifestyle? There is an increase in overweight and obesity as a consequence of less time spent in physical activity and play. There is also an increase in deafness –mainly from hearing high-pitched sounds. But there are also worse outcomes related to communication and social skills. These difficulties in communication or social interaction and the development of restricted patterns of behavior, activities and interests are, in some way, very similar to those present in autistic spectrum disorders.

The pediatrician has a key role in addressing how our children and adolescents use the new technologies, as well as in the early detection of anomalous patterns of behavior.

Adolescence is a critical stage in the establishment of bone health, providing an opportunity to influence those factors that determine the amount of bone acquired. There are a series of important environmental factors that have to be taken in consideration, including calcium intake and regular physical activity, which have been found to interact with each other. It seems that the skeleton responds better to calcium supplements in the early stages of life, prior to puberty; after puberty, the effects are less important. Different authors also stress that providing calcium supplements without habitual physical activity and/or physical exercise has no significant effects on bone mass in adolescence.

Sleep is a basic physiological need for our health. Childhood is a relevant period because the child spends most of the day sleeping. Sleep, as a human behaviour, can be adjusted in order to learn to sleep well. And this process must be adaptive, because sleep in children is exposed to a slow maturation. And, therefore, it is essential that parents have a thorough knowledge of child and adolescents' sleep patterns. In children, parents must establish bedtime routines, usually providing "transitional objects" to facilitate sleep and environment association, and promote capability to initiate and maintain sleep independently. In teenagers, keeping sleep disciplines, restricting the use of computers and mobile phones at bedtime, are useful recommendations to improve sleep.

Introduction: Promoting sports in childhood is important as a means of instilling healthy habits and prevent future illnesses. Nutrition is an important factor to consider in order of being successful in sports.

Objectives: To do a nutritional assessment in a group comparing children who do sports of high competition and controls.

Patients and Methods: Twenty eight cyclists have been included and twelve appropriate controls where done in children between the ages of 10 and 15. The Z-scores of weight, height, brachial perimeter (BP), subscapular and triceps skinfold thickness and body mass index were calculated. In the group of athletic children, these measures were collected twice, at the beginning and at the end of the season. A survey about nutritional knowledge and a dietary evaluation were performed, focusing on total energy intake, macronutrient distribution and intake of vitamin A, D, E and C, iron, calcium, zinc and dietary fiber.

Results: Both groups had normal nutritional status according to the anthropometric analysis, with statistically differences in BMI between the beginning and end of the season in the group of cyclist (p

Conclusions: Athletic children's nutritional habits require special supervision in order to be able to train without compromising their growth and development. Nutritional education should be promoted at school and in competition sports.