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Andrés Moreno AM, Ramos Boluda E, Hernández Oliveros F. Pediatric intestinal failure: an update. Cir Pediatr 2023; 36:97-109. [PMID: 37417213 DOI: 10.54847/cp.2023.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- A M Andrés Moreno
- Pediatric Surgery Department. Hospital Universitario La Paz. Madrid (Spain)
| | - E Ramos Boluda
- Pediatric Gastroenterology Department. Hospital Universitario La Paz. Madrid (Spain)
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Pérez Costoya C, Gómez Farpón A, Hernández Oliveros F, Soto Verdugo V, Álvarez Muñoz V, García Bernardo CM. Conservative treatment of suprahepatic pseudoaneurysm in a pediatric patient. Cir Pediatr 2023; 36:93-96. [PMID: 37093120 DOI: 10.54847/cp.2023.02.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Suprahepatic and inferior vena cava (IVC) pseudoaneurysms are rare in children. Most cases in adults are treated surgically due to the high risk of rupture. CASE REPORT Seven-year-old girl referred for a thoracic-abdominal trauma of unknown origin. Hemodynamically stable, with a hemoglobin level of 9.1 g/dl. An emergency CT scan was performed, showing a pseudoaneurysm at the confluence of the IVC with the middle and left suprahepatic veins, with active bleeding contained by the hepatic capsule. Given the hemodynamic stability and surgical risk, conservative treatment was decided upon. CT-scan at 24 hours showed cessation of bleeding. A control CT-scan was performed one month, three months, one year, and one and a half years later, showing the lesion had disappeared. DISCUSSION Conservative treatment of suprahepatic vein pseudoaneurysm/ICV is feasible in the case of hemodynamic stability provided that strict clinical and radiological surveillance is maintained.
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Affiliation(s)
- C Pérez Costoya
- Pediatric Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
| | - A Gómez Farpón
- Pediatric Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
| | | | - V Soto Verdugo
- Radiodiagnosis Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
| | - V Álvarez Muñoz
- Pediatric Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
| | - C M García Bernardo
- General and Digestive Surgery Department. Hospital Universitario Central de Asturias. Oviedo (Spain)
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Hernández Oliveros F, Alcolea Sánchez A, Ramos Boluda E, Andrés Moreno A. Intestinal and multivisceral transplantation. Cir Pediatr 2023; 36:50-59. [PMID: 37093113 DOI: 10.54847/cp.2023.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
| | - A Alcolea Sánchez
- Intestinal Rehabilitation Unit. Hospital Universitario La Paz. Madrid (Spain)
| | - E Ramos Boluda
- Intestinal Rehabilitation Unit. Hospital Universitario La Paz. Madrid (Spain)
| | - A Andrés Moreno
- Intestinal Rehabilitation Unit. Hospital Universitario La Paz. Madrid (Spain)
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Jiménez Gómez J, Gómez Cervantes JM, Encinas Hernández JL, Hernández Oliveros F, Castro Parga L, De la Serna Blázquez OR, Alcolea Sánchez A, Martínez Martínez L, López Santamaría M, De la Torre Ramos CA. Efficacy of endoscopic removal in the treatment of subglottic ductal cysts. Cir Pediatr 2020; 33:43-46. [PMID: 32166923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Subglottic cyst is a rare cause of airway obstruction, and there is a lack of evidence about the best treatment in the literature. This report describes our experience with endoscopic removal. MATERIAL AND METHODS A retrospective study of all patients undergoing endoscopic removal of subglottic cyst at our healthcare facility between 2014 and 2019 was performed. Clinic and demographic data regarding gestational age, intubation, comorbidities, surgical procedures, first symptoms, endoscopic findings, treatment, and follow-up were collected. RESULTS Four patients were identified. Two out of four (50%) were preterm, and all patients were intubated during their neonatal period. Median age and weight at diagnosis were 6.5 months (6-8) and 5.9 kg (3.6-7). Median time between last intubation and diagnosis was 119.5 days (71-171). Biphasic stridor and progressive respiratory distress were the most common clinical symptoms. Airway obstruction of at least 50% was found during upper airway endoscopy in all patients. Endoscopic removal was performed as a first-line treatment in 3 patients, and as a second-line treatment in 1 patient. Median intubation time after treatment and hospital stay were 13.5 hours (0-48) and 7 days (6-9). All four patients are free of disease, with a median follow-up of 17.5 months (6-42). CONCLUSION Subglottic cyst is a rare cause of post-extubation stridor. Endoscopic removal seems to be a feasible and effective treatment with a low recurrence rate.
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Affiliation(s)
- J Jiménez Gómez
- Pediatric Surgery Department. Hospital Universitario La Paz. Madrid (Spain)
| | | | | | | | - L Castro Parga
- Pediatric Surgery Department. Hospital Universitario La Paz. Madrid (Spain)
| | | | - A Alcolea Sánchez
- Pediatric Surgery Department. Hospital Universitario La Paz. Madrid (Spain)
| | | | - M López Santamaría
- Pediatric Surgery Department. Hospital Universitario La Paz. Madrid (Spain)
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Gómez Cervantes M, de la Torre Ramos CA, Jiménez Gómez J, Encinas Hernández JL, Hernández Oliveros F, Dore Reyes M, Serradilla Rodríguez J, Núñez Cerezo V, López Santamaría M. [Management of suspected foreign body aspiration in children. 10-year experience in a single center]. Cir Pediatr 2018; 31:81-84. [PMID: 29978959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Foreign body aspiration (FBA) is a potentially life-threatening event, and is the leading cause of death in children after road traffic injuries. If suspected, a prompt exploration of the airway should be performed. We present our experience in FBA treatment in the last 10 years. MATERIAL AND METHODS A retrospective study of patients admitted in our center with suspected FBA between 2005 and 2015 was performed. Clinical history, physical findings, radiologic imaging, treatment and evolution were assessed. RESULTS A total of 115 children (70 M/45 F) with a median age of 2 years old (8 months-13 years), presented with a clinical history of FBA. All of them suffered a choking event and the most frequent symptoms were persistent cough (88.3%) and respiratory distress (46.8%). Pathologic physical examination was registered in 75% and an abnormal chest X-ray was seen in 72%. Rigid bronchoscopy (RB) was performed in 100% based on compatible history, regardless of physical and radiologic exams. A foreign body was found during RB in 78 patients (68.1%) and the most frequent were seeds and nuts (63.4%), located mainly in the right bronchus (46.8%). If the criteria for RB had been based on a compatible history along with clinical findings and abnormal chest X-ray, 21 foreign bodies (26.9%) would have been missed, with the subsequent risk of sudden death. All the foreign bodies were removed with success, without any immediate complication during the procedure. CONCLUSION FBA is a frequent accident among children. The history, clinical findings and imaging cannot always concur. In case of a positive history of FBA an examination of the tracheobronchial tree must be done.
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Affiliation(s)
- M Gómez Cervantes
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - J Jiménez Gómez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | | | - M Dore Reyes
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - V Núñez Cerezo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Triana Junco P, de la Torre C, Barrio MI, de la Serna O, Dore Reyes M, Núñez V, Jiménez J, Martínez Martínez L, Madero R, Encinas JL, Hernández Oliveros F, López Santamaría M. [Pulmonary lobectomy in children: the sooner the better?]. Cir Pediatr 2018; 31:71-75. [PMID: 29978957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM OF THE STUDY Recommendation of early pulmonary resection in asymptomatic congenital pulmonary airway malformations (CPAMs) is based on the presumed compensatory lung growth during the first months of life. Our aim is to analyze the long-term pulmonary function after lobectomy before and after one year of age using spirometry. METHODS We performed a retrospective review of children who underwent pulmonary lobectomy for CPAM between 2001 and 2016. Patients who were old enough (>5 years) to carry out a spirometry were included in the study and were divided into 2 groups (surgery before or after 12 months of age). Pulmonary function testing values were considered normal if they were >80% of predicted. MAIN RESULTS Forty-seven patients underwent pulmonary lobectomy for CPAM, 23 of them met the inclusion criteria and prospectively performed a spirometry. Among them, 7 had surgery before and 16 after one year of age (0.1 vs. 2); being both groups comparable in terms of sex, type of CPAM and surgical approach. Time from surgery until pulmonary function testing was longer in patients who had surgery before one year of age (9.1 vs. 4.6 years, p = 0.003). After correcting results by time from surgery until spirometry, a better FEV1/FVC was found in patients who had surgery after one year of age (90% vs. 77%, p = 0.043). CONCLUSION Although spirometry may be influenced by many other variables, these preliminary results do not support the current recommendation of performing early lobectomy in CPAMs. Further studies are required in order to resolve the best age to perform pulmonary lobectomy.
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Affiliation(s)
- P Triana Junco
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - C de la Torre
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M I Barrio
- Servicio de Neumología Infantil. Hospital Universitario La Paz. Madrid
| | - O de la Serna
- Servicio de Neumología Infantil. Hospital Universitario La Paz. Madrid
| | - M Dore Reyes
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - V Núñez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J Jiménez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - R Madero
- Bioestadística. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Vilanova A, De la Torre CA, Sánchez-Galán A, Hernández Oliveros F, Encinas JL, Ortiz R, Núñez Cerezo V, De la Serna O, Barrio MI, Castro L, Builes L, Verdú C, López Santamaría M. [Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]. Cir Pediatr 2018; 31:8-14. [PMID: 29419952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years. MATERIAL AND METHODS Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms. RESULTS 32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully. CONCLUSIONS Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.
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Affiliation(s)
- A Vilanova
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - C A De la Torre
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Sánchez-Galán
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - J L Encinas
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - R Ortiz
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - V Núñez Cerezo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - O De la Serna
- Servicio de Neumología Pediátrica. Hospital Universitario La Paz. Madrid
| | - M I Barrio
- Servicio de Neumología Pediátrica. Hospital Universitario La Paz. Madrid
| | - L Castro
- Servicio de Anestesia y Reanimación Pediátrica. Hospital Universitario La Paz. Madrid
| | - L Builes
- Servicio de Anestesia y Reanimación Pediátrica. Hospital Universitario La Paz. Madrid
| | - C Verdú
- Unidad de Cuidados Intensivos Pediátricos. Hospital Universitario La Paz. Madrid
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Dore Reyes M, De La Torre C, Bret Zurita M, Triana Junco P, Jiménez Gómez J, Romo Muñoz M, Vilanova Sánchez A, Parrón Pajares M, Pérez Vigara A, Encinas Hernández JL, Martínez Martínez L, Hernández Oliveros F, López-Santamaría M. [Benefits of magnetic resonance for the study of pectus excavatum in children: initial experience]. Cir Pediatr 2017; 30:71-76. [PMID: 28857528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION/AIM OF THE STUDY In patients with PE, cardiovascular alterations ensue as a result of the mediastinum compression caused by sternum impingement and is responsible of many of the symptoms. Anatomical and functional assessment is of the utmost importance for a comprehensive understanding of the disease and an adequate treatment plan. Our aim was to describe the use of magnetic resonance image (MRI) in the study of PE and whether it is comparable to imaging techniques. PATIENTS AND METHODS A retrospective study of the first 10 patients in which an MRI was performed as part of PE assessment within august 2015-2016. PE indexes were evaluated: Haller, correction, asymmetry, as well as sternal rotation. An analysis of right ventricular function was carried out comparing echocardiogram and MRI. RESULTS MRI scan on 10 patients showed the following findings: Haller index: inspiration: 3.75 (3.5-7.3) and expiration 4,9 (3.9-10.8), correction index of 24% (5-37%) and a sternal rotation of 12º (0-31º). The cardiovascular study showed a median ejection fraction of the right ventricle (EFRV) of 50% (38-64%), with 9 of the 10 patients under the normal value of 61% (54-71%). Echocardiographic findings underestimated functional alterations in all of the patients. CONCLUSION This initial study suggests that the use of MRI as a test of choice in the evaluation of PE subject to surgical correction is feasible. Absence of radiation offers the capacity of a complete and dynamic anatomical as well as cardiovascular study.
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Affiliation(s)
- M Dore Reyes
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - C De La Torre
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Bret Zurita
- Servicio de Radiología Pediátrica. Hospital Universitario La Paz. Madrid
| | - P Triana Junco
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J Jiménez Gómez
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo Muñoz
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - M Parrón Pajares
- Servicio de Radiología Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Pérez Vigara
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Hernández Oliveros F. [Pediatric Surgery in the European Reference Networks: look after, share, treat]. Cir Pediatr 2017; 30:1-2. [PMID: 28585782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- F Hernández Oliveros
- Jefe de Sección de Trasplante Pediátrico. Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid. Miembro del Comité Ejecutivo de TRANSPLANTCHILD
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Domínguez Amillo E, De la Torre Ramos C, Andrés Moreno A, Encinas Hernández JL, Hernández Oliveros F, López Santamaría M. [Results of the mesoportal bypass (Rex shunt) in the treatment of idiopathic extrahepatic portal vein obstruction in children]. Cir Pediatr 2017; 30:22-27. [PMID: 28585786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Extrahepatic portal vein obstruction (EPVO) is the principal cause of portal hypertension in children. The objective of this study was to analyze the capacity of the surgical technique that creates a mesoportal shunt to treat changes caused by EPVO. METHODS Retrospective review of patients with idiopathic EPVO who underwent a mesoportal shunt and analysis of the changes in the number of leucocytes, platelets, prothrombin time and spleen size one year after the surgery. RESULTS Twelve patients underwent surgery, out of which 10 had prior leukopenia, 11 thrombopenia, 9 longer prothrombin times and all had hypersplenism. One patient suffered a postoperative shunt thrombosis, was reoperated and underwent a change in the operative technique. The remaining patients (92%) have functioning shunts 4.3 ± 2.5 years after surgery, and none have suffered any episode of gastrointestinal bleeding. One year after surgery, there were significant changes in the number of platelets, prothrombin time and spleen size, with no significant changes in the number of leukocytes. However, the number of patients who went from a leukopenic to a normal state was significant, as happened with changes in prothrombin time. CONCLUSIONS Mesoportal Rex shunt improves some of the disorders caused by portal hypertension in children suffering EPVO, with a high rate of surgical success. This technique should be of first choice in these patients.
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Affiliation(s)
- E Domínguez Amillo
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | - A Andrés Moreno
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | | | - M López Santamaría
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Sánchez Galán A, Vilanova Sánchez A, Martínez Martínez L, Dore Reyes M, Romo Muñoz M, Núñez Cerezo V, Hernández Oliveros F, López Santamaría M. [Growth in children with choledochal cyst]. Cir Pediatr 2016; 29:105-109. [PMID: 28393504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM In patients with a choledochal cyst, the malformation and subsequent biliodigestive reconstruction lead to a non-physiological state in the digestive tract and biliary excretion that could affect the child's growth. The effect of this malformation and its surgical treatment are reviewed here in a large patient cohort. MATERIAL AND METHODS Retrospective review of patients undergoing surgery for choledochal cyst in the last 20 years. Nutrition and liver function parameters, weight and height data were collected from medical records. Patients presenting other serious diseases affecting growth were excluded. RESULTS From 1994-2014 forty-five patients were diagnosed for choledochal cyst (75% female). All underwent cyst resection followed by Roux-en-Y hepaticojejunostomy. Eight patients were excluded for comorbidities and 37 selected for the study, with a median age at diagnosis and surgery of 16 (0-120) and 24 (1-149) months, respectively. The median follow-up was 76 (1-215) months. At diagnosis, 10.8% of patients had low weight, which was entirely resolved within 6 months after surgery (p< 0.05). CONCLUSIONS The choledochal cyst induces a situation of moderate malnutrition in around 10% of the patients. Surgical correction quickly reverses this situation, despite the decreased absorption surface and deviation of biliary secretion to the jejunum instead of the duodenum.
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Affiliation(s)
- A Sánchez Galán
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | | | - M Dore Reyes
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo Muñoz
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - V Núñez Cerezo
- Servicio de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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Dore Reyes M, Triana Junco P, Barrena Delfa S, Encinas JL, Romo Muñoz M, Vilanova Sánchez A, Chocarro Amatriain G, Hernández Oliveros F, Martínez Martínez L, López-Santamaría M. [Primary versus secondary closure: ventilatory and nutritional differences in patients with gastrosquisis]. Cir Pediatr 2016; 29:49-53. [PMID: 28139102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM OF THE STUDY Optimal surgical treatment of patients with gastroschisis remains controversial. Recent studies suggest better outcomes with secondary closure techniques (surgical or preformed silo). The purpose of the study is to identify differences in outcome of infants treated with traditional primary closure (PC) versus surgical silo (SS). PATIENTS AND METHODS Retrospective study of patients primarily treated of gastroschisis between 2004 and 2014. Patients were divided in PC and SS according to abdominal wall closure. Non-parametric statistical analysis was used with p< 0.05 regarded as significant. RESULTS Twenty-seven patients were included (14M/13F). Primary closure was performed on 17 and 10 underwent surgical silo placement with a median of 6 (5-26) days till secondary closure. Prenatal diagnosis was available in most patients (74%) by the 20th week of gestation. There were no significant differences regarding sex, gestational age or birthweight between groups. Fewer ventilation days were required in PC group compared to SS (4 vs 13, p< 0,05), however, there was no difference in type of ventilation or oxygen needs. Sedation and parenteral nutrition requirements were also lower in PC patients 4 vs 10 and 12 vs 20 days respectively (p< 0,05). Post-operative complications (5vs6) and median length of stay (36vs43 days) were also similar in PC and SS patients. One patient ultimately died due to catheter-related sepsis. Mean length of stay in hospital was 42 days (20-195). CONCLUSION Patients with gastroschisis who underwent primary closure showed shorter ventilator support and PN dependency than those treated with surgical silo. However, SS is as safe and effective technique as PC and led to similar outcome regarding digestive autonomy and hospital length of stay.
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Affiliation(s)
- M Dore Reyes
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - P Triana Junco
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - S Barrena Delfa
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - J L Encinas
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - M Romo Muñoz
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | - A Vilanova Sánchez
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
| | | | | | | | - M López-Santamaría
- Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid
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13
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Aguilar Cuesta R, Barrena Delfa S, Hernández Oliveros F, Lassaletta Garbayo L, Tovar Larrucea JA. [When is it best to perform enterostomy closure in premature infants with necrotizing enterocolitis?]. Cir Pediatr 2011; 24:109-111. [PMID: 22097659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED INTRODUCION AND AIM: The enterostomy used in the treatment of Necrotizing Enterocolitis (NEC) causes many complications before and after its closure. The aim of this study was to examine the complications of closure aiming at determining the best timing for this operation. PATIENTS AND METHOD Retrospective review patients (p) below 1500 g with NEC in whom the enterostomy was closed in the last seven years. P were divided into two groups: PC (planned closure after uncomplicated postoperative period) and CC (advanced closure due to stomal--excessive looses--or to parenteral nutrition complications--septicemia, liver dysfunction-). We compared the age at closure, time of enterostomy, weight gain and complications. RESULTS Out of a total of 25 p requiring surgical treatment for NEC, 16 from the PC group and 9 from the CC group were included. The mean age at the moment of the closure were, respectively, 129 + 65 vs. 204 +/- 121 days (p < 0.05). Weight at closure was 2665 +/- 841 vs. 4665 +/- 2076 g (p < 0.05); the mean time with the enterostomy was 105 +/- 64 vs. 187 +/- 116 d (p < 0.05), and the weight gain was 1779 +/- 859 vs. 3693 +/- 2155 g (p < 0.05). After stomal closure, 7/16 p of the CC group (43%) and 2/9 of the PC group (22%) required reoperation due to severe complications (ns). In 4 of them, three of the CC group and one of the PC group, a new enterostomy was performed. CONCLUSIONS In p with enterostomy-related complications, closure has often to be advanced and it is performed in deficient nutritional conditions. Severe complications after enterostomy closure required reoperation in 43% of the CC group and in 22% of the PC group. Although there was no statistically significant difference, the trend indicates an augmented risk in CC group. The timing for enterostomy closure should be chosen individually. At the time of indicating the closure, the high risk of complications, should be taken into account particularly in preterms with enterostomy-related problems.
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Affiliation(s)
- R Aguilar Cuesta
- Hospital Universitario La Paz, Paseo de la Castellana, 261.28046, Madrid.
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López Santamaría M, Hernández Oliveros F. [Indications, techniques, and outcomes of small bowel transplant]. NUTR HOSP 2007; 22 Suppl 2:113-23. [PMID: 17679299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The most recent outcomes on bowel transplantation (BT), with a survival rate immediately after transplant higher than 80% and a great rate of survivors achieving complete digestive autonomy and able to carry out activities according to their age allow for considering BT as the first choice therapy in patients with irreversible intestinal failure in whom poor prognosis with parenteral nutrition is foreseen. Parenteral nutrition-associated liver damage is the most frequent indication for BT, especially in children that are more susceptible than adults to develop this complication. Other accepted indications for BT are irreversible intestinal failure in association with loss of deep venous accesses, life-threatening severe infections associated with the use of central catheters, and those cases of intestinal failure usually leading to early death, such as ultra-short bowel syndromes, refractory diarrheas, and intestinal failure associated to high morbidity and poor quality of life. BT is performed in human clinical practice under three technical modalities: isolated bowel transplant, combined liver-bowel transplant, and multi-visceral transplantation. Currently, refinements of original techniques including reduction of liver and/or intestinal grafts, grafts from living donors, etc., allow for overcoming the different needs as well as increasing the likelihood of having access to transplantation, which is a desirable goal specially in very young or very low-weighted children candidate to liver-bowel transplant. One of the most interesting issues in BT programs is having given access to the Intestinal Rehabilitation Units, which comprise the three therapeutic modalities by means of a multidisciplinary team: nutritional support, pharmacotherapy, and surgery. These Units optimize the outcomes, minimize costs, and allow for offering a management adapted to individual needs.
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Affiliation(s)
- M López Santamaría
- Hospital Universitario La Paz, Departamento de Cirugía Pediátrica, Madrid, España.
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Oliveros FH, Santamaría ML, Gámez M, Murcia J, Leal N, Frauca E, Hierro L, Camarena C, de la Vega A, Bortolo G, Díaz MC, Jara P. Comparative Study Between Living and Cadaveric Donors in Pediatric Liver Transplantation. Transplant Proc 2005; 37:3936-8. [PMID: 16386590 DOI: 10.1016/j.transproceed.2005.10.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED We examined whether the results in living-related hepatic transplantation (LRLT) are better than those from a cadaveric donor (CDLT). MATERIAL AND METHODS The last 27 consecutive LRLT, performed from 1998 to 2005, were compared with 27 CDLT matched for age, weight, date, and diagnosis. Grafts in LRLT group were left lateral segment (n = 22), left lobe (n = 3), and right lobe (n = 2). In the CDLT group, the grafts were split in situ (n = 10), hepatic reduction (n = 9) and whole liver (n = 8). We analyzed the actuarial survivals (grafts and children), retransplantation, primary nonfunction, initial graft malfunction (liver enzymes >2000 U/L), surgical complications, rejection, and resource consumption. RESULTS Patient survivals at 6 months, 1 year, and 5 years were 100%, 96%, and 96% in LRLT and 100%, 100%, and 100% in CDLT (P = NS). Graft survivals were 93%, 89%, and 89% versus 96%, 96%, and 96%, respectively (P = NS). Complications were biliary complications (LRLT, 25% vs CDLT, 3%; P = .021); portal vein thrombosis (LRLT, 7% vs CDLT, 3%; NS), and hepatic artery thrombosis (LRLT, 0% vs CDLT, 3%; NS). The overall incidence of acute rejection was slightly higher (NS) in LRLT (LRLT, 18% vs CDLT, 11%; NS). Liver enzyme levels were higher in the CDLT group, but initial malfunction rate was not statistically different. Regarding resource consumption: blood product needs were higher in LRLT (P < .05) and hospital stay and ICU stay were longer, although not significantly, among LRLT. CONCLUSIONS The results in LRLT among children are similar to those obtained in CDLT. We found a trend towards less initial graft malfunction in LRLT. Blood product needs were higher in LRLT. Hospital and ICU stay were longer, but not significantly different in LRLT. The benefits of LRLT are saving a scarce resource: a cadaveric donor liver graft.
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Abstract
The renal handling of Ca in response to Na intake was evaluated in 12 patients with hypercalciuria and active kidney stone disease. There was no depression of urinary Ca excretion in response to the hypocalciuric effect of metolazone. Patients were hospitalized and their Ca and Na excretions measured while on a 190-mEq Na, 800-mg Ca, 1200-mg PO4- diet. These measurements were then repeated after Na intake decreased to 35 mEq/day while other variables, including diuretic dose and Ca intake, were unchanged. Two distinct responses were elicited by patients after Na restriction. In group I or the "responders" (n = 4), Ca excretion was reduced from 255 +/- 31 to 62 +/- 6 mg/24 hr. In the control group (n = 4), Ca excretion decreased from 95 +/- 8 to 57 +/- 11 mg/24 hr at similar levels of Na excretion. In group II or the "nonresponders" (n = 8), Ca excretion fell from 317 +/- 31 to 154 +/- 17 mg/24 hr when Na excretion was less than 50 mEq/24 hr. Metolazone with Na restriction normalized urine Ca excretion to the same order as in control subjects in group I. This is indicative of a mild Ca leak or a salt-sensitive leak. Despite diuretic and Na restriction most of the patients with hypercalciuria (group II) did not reabsorb Ca in a normal manner. This is indicative of a severe reabsorptive defect for Ca despite normal Na handling.
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Abstract
Metolazone, a nonthiazide diuretic with the hypocalciuric effect of the thiazides, was evaluated in patients with idiopathic calcium nephrolithiasis. During the mean 3-yr treatment period, there was a 77% decrease in stone incidence in 38 male patients (from 2.10 to 0.49 stones/patient/year). Urine calcium decreased 51% (from 231 +/- 19 to 114 +/- 7 mg/24 hr after 13 mo therapy). The treatment response was the same when these patients were divided into normocalciuric (n = 23), borderline hypercalciuric (n = 10), and hypercalciuric groups (n = 5). In six other patients with high sodium intake there was no decrease in urine calcium on stone formers regardless of the initial level of urine calcium excretion. High sodium intake may blunt and low intake potentiate the hypocalciuric effect of metolazone.
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