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Biomedical subjects

Carlos Baeza-Herrera

Publications and source records attributed to Carlos Baeza-Herrera.

At least 19 recordsLinked to original sources
PubMedDate not supplied

[Renal trauma in childhood. Second-level hospital experience].

UNLABELLED: The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Accidents↗
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[Hirschsprung in children over 6 years of age].

INTRODUCTION: Hirschsprung's disease or colonic agangliosis is a rare condition in schoolchildren and adolescents. It is common in infants and chronic constipation is the usual symptom. MATERIALS, METHODS, AND RESULTS: In a period of 5 years, 11-years-old patients were diagnosed and treated for Hirschsprung's disease. We studied six male patients; mean age was 8.6 years. All patients had classic disease and nine, severe chronic constipation, and two were admitted with encopresis. One had 10 kg of feces in 40 cm of colon. Diagnosis was established with barium enema and tissue biopsy. All patients had colostomy. In eight patients, Duhamel procedure was performed with good results. CONCLUSIONS: This disease is a rare condition in older patients and Duhamel procedure is a good surgical option.

Adolescent↗
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[Testicular necrosis resulting from torsion in children. Perspective of a second level hospital].

INTRODUCTION: The disaster of a testicular torsion leading to the possible loss of a gonad within a few hours is a well known occurrence and it is discouraging. Clinical examples emphasizing torsion of the testis as the most important differential diagnosis in children with acute scrotal pain and swelling, as well as the need for early exploration, have been reported with increasing frequency. MATERIAL AND METHODS: Seventy cases of clinically diagnosed unilateral torsion of the testis have been admitted to our pediatric surgical unit over a period of 8 years. There were 46 cases between 13 and 15 years of age; 34 were admitted after 24 ho and 25 after 3 days of multilating disease. Left side was involved in 46 cases and 61 testicles were removed. CONCLUSIONS: In order to avoid initiation procedures, early diagnosis is very important.

Adolescent↗
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[Intestinal ischemia resulting from previous laparotomy].

INTRODUCTION: Acute adhesive obstruction of the small intestine is a surgical emergency in which there is a risk of intestinal ischemia. By delaying diagnosis and institution of appropriate treatment for ischemic obstruction, morbidity and mortality increase. MATERIAL, METHOD AND RESULTS: The hospital records of 63 patients with diagnosis of intestinal obstruction and regional ischemia due to fibroadhesive peritonitis were reviewed in an attempt to identify criteria that could be used to separate patients who would require an emergency operation; 39 (61.9%) were male and three (4.7%) newborn. This complication was seen after 3 years of age in 39 patients (69.1%). Appendicitis was first cause with 26 cases (41.2%). Range of time of appearance after operation was from 1 week to 15 years (median 10 months). In 87% of patients the operation was a second procedure. All had gangrene and an enterostomy was constructed. General morbidity rate was 80%. Four children died. CONCLUSION: It is mandatory to identify which patients require non conservative management.

Child↗
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[Retroperitoneal hematoma in children].

INTRODUCTION: Retroperitoneal hematoma is frequently due lo blunt trauma and is a challenging problem. Incidence of this complication in adults is high, but in childhood is uncommon. MATERIALS AND METHODS: Analysis of 30 cases is presented. PTS was found between 10 and 12 points, zone II, 12, zone III, 17, and zone I, only one. We observed 33 associated injuries: 17 were pelvic fractures and nine, ureteral rupture. Three patients underwent hepatic or splenic laceration. Seventy-three percent of patients had exploratory laparotomy, but did not have exploration of retroperitoneum. CONCLUSIONS: Retroperitoneal hematoma in infancy should be treated conservatively.

Adolescent↗
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[Battered child syndrome. Surgical implications].

INTRODUCTION: Major trauma, specially abdominal and thoracic trauma due to child abuse is a serious, but fortunately infrequent problem which carries unacceptably high mortality. MATERIAL AND METHODS: We reviewed our experience with childhood trauma due to battered child syndrome in our hospital to learn the extent, circumstances, presentations, and consequences of this kind of events. Our hospital is the most important center for traumatized child care in Mexico. RESULTS: After our study, mild trauma due to child abuse accounted for 35 and major trauma accounted for 50 cases. In the former group, 10 patients with fractures were observed; 21 were male patients. Children were abused by father or stepfather in the 21 cases, and by the mother in six. There was delay in seeking immediate medical attention treatment in all patients. In the second group, there were ruptures of small bowel in 27, of the colon in four patients, pancreas in three, and esophagus in two. Lung, pleura, bladder, spleen and other anatomic structures also were affected. Five patients died. Similarity between the two patient groups studied indicates both the widespread nature of child abuse and the need to suspect this diagnosis whenever a child is present with unexplained shock or peritonitis, specially if there is anemia or bilious emesis. Delay in diagnosis contributed to mortality.

Battered Child Syndrome↗
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[Acute pancreatitis in childhood. Is it the same disease in adults?].

BACKGROUND: Acute pancreatitis in children is an uncommon, little known, poorly defined disease and thus is rarely considered in diagnosis of pediatric abdominal pain. It is rare but is being recognized more frequently, and differs from the disease in the adult both in etiology and therapeutic approach. CLINICAL MATERIAL: Fifty children with acute pancreatitis were managed. Their history and postoperative course were analyzed in a retrospective study. RESULTS: The clinical presentation was unremarkable; all patients had abdominal pain, specially in epigastrium, and vomiting was the only other clinical sign exhibited by > 80%. More than 40 biliary diseases were the cause of pancreatitis; trauma was the cause in 30%. Diagnosis could be difficult and unnecessary laparotomy was performed in 16 cases (32.0%) instances of suspected acute abdomen. Morbidity included sepsis, diabetic cetoacidosis, and pancreatic pseudocyst. Biliary disease is a frequent cause of both pediatric and adult pancreatitis. They are differences in clinical course and prognosis. In children, pancreatitis is usually confused with appendicitis.

Acute Disease↗
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[Inguinal symptoms of acute abdomen].

INTRODUCTION: We describe a syndrome in which empty hernial sac, in its role of peritoneal recess, becomes distended with pus during or after general peritonitis, usually caused by acute appendicitis. Until 1998, only 14 pediatric cases were described in the literature. MATERIALS, METHODS, AND RESULTS: We presented here eight cases of patients who experienced inguinal symptoms. In four, appendectomy was performed; in four, this was secondary to necrotizing enterocolitis. Inguinal complaints, pain, and flogosis were present in first group, while pneumoperitoneum and visible duct vaginalis were present in second group. CONCLUSIONS: These cases demonstrated that persistent patent processus vaginalis may predispose to inguinal pathology secondary to intraabdominal sepsis and represent a unique complication.

Abdomen, Acute↗
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[Congenital transmesenteric hernia].

INTRODUCTION: Acute intestinal obstruction due to congenital defects in the mesentery of the small bowel are quite uncommon. The most frequent location of the defect is the mesentery of the terminal ileum. MATERIAL AND METHODS: Five cases of small bowel obstruction caused by congenital transmesenteric hernia was reviewed. RESULTS: Four were male and all patients had an intestinal obstructive disease, small bowel gangrene and peritonitis. Two patients died. DISCUSSION AND CONCLUSIONS: Diagnosis is difficult and most cases recorded until today are incidental findings on laparotomy and surgical treatment is mandatory.

Adolescent↗
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[Calcified renal artery aneurism and high blood pressure. A case report and review of the literature].

Renal artery aneurysm is a rare disease in children and usually is due to fibromuscular dysplasia. Clinical symptoms are frequently high blood pressure, abdominal pain, and hematuria. Diagnosis is carried out by means of angiography. We report the case of a 13-year-old male patient who had renovascular hypertension due to calcification and aneurysm of fibromuscular dysplasia-associated renal artery. We carried out total nephrectomy to resolve high blood pressure. We suggested that presence of discreet calcification in region of renal artery in a boy with renovascular high blood pressure should guide us toward diagnosis of fibromuscular dysplasia-related renal artery aneurysm.

Adolescent↗
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[Intrauterine necrosis in closed gastroschisis].

INTRODUCTION: Strangulation of the intestine as the result of compression of its blood supply in a tightly closed gastroschisis defect is a very rare occurrence. CLINICAL CASES: We present the cases of two newborn patients who had extra-abdominal infarcted bowel and intra-abdominal jejunal atresia due to vascular compression for gastroschisis defect. One was associated with colonic, probably acquired aganglionosis. Both had similar clinical courses. CONCLUSIONS: This association is very uncommon. Prognosis of this complex is very poor.

Colon↗
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[Cost analysis: metronidazole-amikacin vs. preoperative monodose of ceftriaxone in appendicitis. Preliminary report].

INTRODUCTION: Postoperative management of acute appendicitis in our country has been supported by results from studies overseas. Ampicillin, clindamycin and gentamicin is the classic association of antimicrobial drugs. However, it is expensive, unnecessary and risky. We believe that a single dose can be useful. MATERIAL AND METHODS: We studied two groups comprised of 82 patients each in whom an appendectomy was performed. In group A an intravenous (i.v.) dose of ceftriaxone was given 30-240 minutes before skin incision. Group B or control group was comprised by the same number of patients previously operated and managed under traditional method (amikacin-metronidazole). RESULTS: In group A, three wound infections and an intraperitoneal abscess were identified, while in group B only one wound infection was seen. Average cost for patients in group A was 2,108.91 pesos (approx. 200 US dollars). In group B, the average cost was 9,407.48 pesos (approx. 900 US dollars). CONCLUSIONS: One dose of preoperative ceftriaxone proved to be most financially economical.

Adolescent↗
PubMedDate not supplied

Surgical aspects of intussusception secondary to Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a familial condition characterized by the presence of pigmented mucocutaneous spots and intestinal polyposis. Intussusception is the most frequent abdominal complication, but it is very rare. In our country, this is the second known report. In this article we present four cases of PJS associated with intussusception. All the patients were female and all underwent a surgical procedure. The intussusception was located in the ileum and colon. There are no more than 20 reported cases in the world where these two entities are associated. Children with PJS have a high risk of suffering from ileo-ileal or jejuno-ileal intussusception that will frequently require a special surgical procedure.

Adolescent↗
PubMedDate not supplied

[Esophageal atresia: a second-level hospital experience].

INTRODUCTION: In recent years, surgical correction of esophageal atresia with distal tracheoesophageal fistula has become increasingly successful. However, there is still a group of high-risk patients with specific factors in whom the mortality remains appreciable. These associated factors include weight, gestational age, associated malformations and respiratory distress. MATERIAL AND METHODS: This report analyzes the mortality in 80 newborn infants with variants of esophageal atresia with or without tracheoesophageal fistula who were treated from 1999 to 2003. Data were collected restrospectively from hospital and office records. RESULTS: We observed 42 male patients, 69 patients were C variety, all had more than 12 h of postnatal life, 34 were preterm newborn, 41 were classified A or B according to Waterston, and 41 died. A logistic regression analysis and chi2 of the influence of each risk factor on mortality was performed. Relevant statistical significance was found in the studied variables. CONCLUSIONS: Morbidity and mortality of esophageal atresia was higher due to identified risk factors.

Cross-Sectional Studies↗
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[Henoch-Schönlein purpura and intestinal perforation].

Schönlein-Henoch purpura is one of the most common forms of vasculitis in childhood, and intestinal perforation, necrosis and intussusception constitute the major surgical conditions. We present one recent case of spontaneous small bowel perforation without intussusception. An intestinal resection and ileostomy were performed. Perforation, usually ileal, frequently is accompanied by intussusception. We believe the the perforation is secondary to deep ischemic phenomenon of the bowel.

Child↗
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[Appendicitis in a two-months old infant with a peritoneovaginal duct].

Acute appendicitis in infants is a very unusual disease, but associated to structural defects like patent peritoneovaginal duct, Meckel's diverticulum, clubfeet, and Moebius syndrome is extremely rare. Case report. A male of two months-old with this association is presented. Left inguinal swelling and acute abdomen syndrome were identified. In laparotomy, iguinal defect and a gangrenous appendicitis were observed. Appendectomy was performed and postoperative recovery was unevenful.

Appendicitis↗