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Biomedical subjects

E Blesa Sánchez

Publications and source records attributed to E Blesa Sánchez.

At least 19 recordsLinked to original sources
PubMed2004

[Utility of anorectal manometry in the diagnosis and treatment of encopresis].

BACKGROUND: Biofeedback based on anomanometric techniques has been shown to be effective in the treatment of children with encopresis. The long-term efficacy of biofeedback and which variables of anorectal manometry (anorectal manometry) could help to establish biofeedback indications are currently the subject of debate. OBJECTIVES: To identify which variables of anorectal manometry, in addition to symptoms, could be useful in deciding which patients could benefit from biofeedback therapy and to assess the outcome of this treatment. PATIENTS AND METHODS: Anorectal manometry was performed in 88 patients, who were referred to our service complaining of soiling at least once a month for a minimum of 6 months after a period of normal continence of 1 year or more. The chronological and mental age of the patients was 4 years. All patients were otherwise in good health and had shown no response to medical treatment. The following variables were studied: anal canal profile, rectoanal inhibitory reflex (RAIR), continence reflex, rectal sensitivity, external anal sphincter (EAS) activity and defecatory maneuver. The patients were divided into two groups, according to clinical and anomanometric impairment, and the most affected patients (n = 41) underwent biofeedback therapy. The indications and outcome of biofeedback were assessed through clinical course and anorectal manometry. In the statistical analysis, the mean and standard deviation were calculated. The chi-squared test with Yates' correction was used to compare clinical and manometric qualitative parameters; Student's t-test was used to compare quantitative parameters; nonparametric tests consisted of the Mann-Whitney test and the Wilcoxon test was used for paired data. RESULTS: Patients treated with biofeedback therapy presented shorter anal canal, greater pressure in the rectal ampulla (P < 0.001), decreased pressure in the anal canal (P < 0.05), lesser distension of the EAS on provoking RAIR, lower presence of the continence reflex (P < 0.01), lower rectal sensitivity, and a worse response of the striated sphincteric muscle and of the defecatory maneuver (P < 0.001). Seventy-eight percent of the patients had a good response to biofeedback therapy. Pressure in the anal canal and rectal sensitivity improved (P < 0.001) with normality on straining in 11 out of 15 patients. These good results persisted in a long-term follow-up of 10 patients. Eight of 10 patients who did not undergo biofeedback therapy showed persistent encopresis (P < 0.001). CONCLUSIONS: Anorectal manometry detected disturbances, chiefly in the activity of the EAS, which are useful in indicating biofeedback therapy in children with secondary encopresis. Biofeedback therapy seems to produce favorable long-term results in the majority of the most severely affected patients.

Biofeedback, Psychology↗
PubMed2002

[Re-education of the anal sphincter in patients with myelomeningocele].

OBJECTIVE: The aim of this study was to analyze the usefulness of biofeedback techniques based on manometrical procedures in the treatment of defecation disorders in patients with myelomeningocele. PATIENTS AND METHODS: We studied 24 patients with myelomeningocele, aged 13 days to 15 years, who were referred to our Instrumental Diagnosis Unit for evaluation of anorectal function, or constipation and/or fecal incontinence study. Biofeedback was given to 12 patients who fulfilled the following criteria: age more than 5 years, existence of anorectal sensitivity with a perceptual threshold of less than 60 ml of rectal expansion, ability to contract and relax the gluteus muscles and thus be able to exercise pressure on the anal margin, and collaboration on the part of child and the family. As a complement defecatory maneuvers were performed. RESULTS: Between 4 and 65 sessions took place (35.14 19.97) after which rectal perceptual volume decreased from 24.66 14.13 to 3.33 2.95 ml and pressure on the anal margin increased from 45.62 17.82 to 114.37 13.99 mmHg. These differences were statistically significant (p < 0.001). Clear clinical improvement was produced in 10 of 12 patients who achieved good fecal continence with spontaneous depositions. Partial improvement was produced in 2 patients. CONCLUSIONS: We consider that biofeedback based on manometrical procedures is more useful than other conservative therapies in the treatment of defecatory problems in patients with myelomeningocele. In most patients this technique produces clinical improvement with satisfactory continence and without the drawbacks of other procedures.

Adolescent↗
PubMed2000

[Comparative study of different methods of pleural drainage in an experimental model of pneumothorax].

OBJECTIVE: To observe the usefulness of several procedures for draining pneumothorax in an animal model and to identify the best pleural drainage system with minimal impairment of respiratory function. METHOD: Thirty-four New Zealand white rabbits weighting 1687 +/- 78 g and aged a mean 59 days were randomly placed in groups as follows. Unilateral pneumothorax was induced in the first problem group (P1) rabbits (n = 10) by thoracostomy, with pleural drainage. In the second problem group (P2) of rabbits (n = 10), bilateral pneumothorax was similarly induced by thoracostomy with pleural drainage. The control groups underwent unilateral (C1; n = 7) and bilateral (C2; n = 7) thoracostomy and drainage. Every 7 minutes the chest tube was connected successfully in each animal to an underwater seal with a dead-space volume of 35.58 ml (neonatal Bülau unit) or to a 3,940 ml system (chest drainage unit) and to pleural aspirations of -5 and -20 cmH2O. We analyzed mortality, fluctuations of the hydrostatic column of the underwater seal, heart rate (HR), respiratory rate (RR), PaCO2, SaO2, pH and arterial blood gas measures. RESULTS: Intraoperative mortality was significantly higher (particularly in the P2 group) when connection was to a large volume system without aspiration. Recovery after pneumothorax was more satisfactory with aspiration of -5 and -20 cmH2O. CONCLUSIONS: The results suggest that a pleural drainage unit with a large dead space between the pleural cavity and the underwater seal is a frequent cause of respiratory failure or insufficiency. We believe that when an underwater seal without pleural suction is applied, the Bülau unit should be used with the smallest possible volume.

Animals↗
PubMed1999

[Malignant head-neck fibrous histiocytoma in an infant].

We describe one case of malignant fibrous histiocytoma variant myxoid in an eight month old infant. A review of the etiology of this tumor is made. Its unusual presentation in the cervical-cranial region may induce to misdiagnosis with lymphangioma in this location.

Diagnosis, Differential↗
PubMed1998

[Renal hydatid disease in childhood. Report of two cases].

Hydatid disease of the kidney is rare and is responsible for only 1-5% of all hydatid disease. Primary hepatorrenal association with hydatid disease is a 3%. A pre-operative diagnosis is often not considered because of the rarity of the disease and the infrequent occurrence of an isolated disease lesion of the kidney. These diagnosis may be mistaken for hepatic hydatid cyst. The accepted treatment is often the partial or total nephrectomy. We report two patients 4 years-old, of both sexes. On admission, a palpable mass in the right upper quadrant of the abdomen is the only clinical sign. In the first case, the pre-operative diagnosis was renal hydatid cyst and hepatorrenal hydatid disease in the second case. A patient who underwent at cyst enucleation only and total pericystectomy was performed in the other patient. The post-operatives courses were excellent in both patients. Total excision of the cyst and its adventitia with conservation of the renal parenchyma is the most desirable treatment, but it's not always feasible.

Animals↗
PubMed1996

[The hair-thread tourniquet syndrome of the toes and penis].

We present eight cases of the hair-thread tourniquet syndrome which affected the toes in 6 cases and presented strangulation of the penis in two. All patients were infants and the mechanism of injury was the strangulation by hair or thread wrapped around an appendage. Neither lesions were promptly recognized by their physicians and the patients were seen in the emergency room with swelling, erythema and a circumferential scar with the typical distal edema. The lesions had ischemic signs, but without tissue necrosis. All patients were treated by immediate removal of the constricting fibers and sometimes a simple vertical, short and deep incision over the area of strangulation, avoiding injury to tendons and digital nerves and vessels, was performed. The potential risk of amputation and the need for a premature diagnosis and treatment are stressed.

Child, Preschool↗
PubMed1996

[Third and fourth cervical pouches remnants and branchial clefts].

We present our experience with nine patients who were operated on for having cervical cysts lesions with the purpose of providing more information about this type of pathology. Five patients presented a left low-jaw cervical mass, diagnosed in the neonatal period. All of them presented with respiratory distress and in four of them quick local inflammatory manifestations appeared. A plain radiograph demonstrated liquid and air in the lesion and we proceeded to the operation. We made four drainages with marsupialization and in another patient complete excision of the lesion was made. Two marsupializations closed spontaneously and the other two had to be reoperated for excision of a pharyngo-cutaneous fistula. In the wall of the cyst there were thyroid-follicles, considering them remnants from the fourth branchial pouch. Three patients were diagnosed at one, two and five years of age respectively with a cervical mass and were operated on with complete excision. Due to its anatomic situation and lack of relation with other structures, we thought as probably deriving from the cervical sinus. In one patient who presented a mass in the inner side of the sternocleidomastoid muscle, complete excision of the lesion was made which had a tract joining the piriform sinus area, and thymic and thyroid tissue, being diagnosed as a cervical thymic cyst. All the patients cured with the complete excision. The anatomic situation ot these lesions and their connexions with next structures provide the best data to know their probable embrionary origin.

Branchial Region↗
PubMed1995

[Ovarian cysts in childhood].

It's perform a descriptive study about a series of events with the purpose of discover the own characteristics of ovarian cysts and which characteristics determine its treatment. In the 41 patients (10 newborn, 14 prepubertal females and 17 post-menarchal females) we analyzed their symptoms, pathological findings, ecographics details, treatment, diagnostic and follow-up. The predominant symptom has been the abdominal pain (18 patients). In 8 newborn the cyst was find before born by prenatal sonography. The cyst was palped like abdominal mass in 22 patients and it was like a picture of acute abdomen in 11. It was found in the right ovary in 24 patients and bilaterally in 7. By pelvic ultrasonography was observed a superior size of 5 cm of diameter in 28 occasions, in 17 there were imagine of complex and in 3 there were hemorrhagic. In 16 patients the suspicion diagnostic was of torsion and in 5 of appendicitis. The torsion was confirmed in 11. In 16 patients it was a follicular cyst, in 9 was a dermoidal and in 9 hemorrhagic. Was realized a surgical treatment (cystectomy or ooforectomy in 36 girls, in 4 was realized a puncture and evacuation (bigger of 5 cm with clear liquid) and in 7 was hope the spontaneous evolution (clear liquid and infer size of 5 cm). There were not relapses. The clinic manifestations are presents with own characteristics depending of the cyst affected to newborn, premenarchal or menarchal females. The indications of surgery are: symptoms which are not resolved after a observation time (24-49 hours) and cysts of big volume associated a complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

[The clinical characteristics of patients with torsion of the testicular and epididymal appendages].

With the aim of describe a typology that will result in a more precise diagnostic which in turn will permit the selection of the most direct method approach, an analysis was made of the clinical characteristics of patients we treated due to the presence of torsion of the testicular and epididymal appendages. A retrospective review was made of 91 patients, taking into account this age, time of appearance, time of evolution, symptoms, physical examination, histological study and effects. The average age was 9.47 years with a greater incidence occurring between the eight and twelve years old. No influence due to a seasonal phase was detected. The time span between the initial appearance of the symptoms and the time of admittance was 39.5 hours, being somewhat less in patients below the age of six. The common symptom was pain. In addition, 58.2% of the patients also suffered scrotal affectation. In 31 patients the hydatid was palpable and in 19 the "blue dot sign" rendered positive. In 83 cases, surgery was done via the scrotum, resulting in the confirmation of the initial diagnosis. The affectation of the left side was more frequent (62.5%). The hospital discharge was possible in less than 48 hours with no visible long-term effects. Thus, we believe that it is possible to almost always make a diagnosis based on the clinical data, and the type of treatment to be applied should be the extirpation of the hydatid to be carried out via the scrotum.

Adolescent↗
PubMed1993

[Metabolic balance in newborns receiving parenteral nutrition].

It has been realized a study about energy and nitrogen balances in 23 patients with total parenteral nutrition in order to know how they get weight increase and nitrogen retention. The parameters analysed were nitrogen retention, nitrogen retention/100 g. of weight increase, efficacy in use of nitrogen, metabolized energy and metabolized energy expressed in percentage of intake energy. Positive correlation between intake energy and urinary eliminated energy (p < 0.05) as soon as between intake nitrogen and urinary eliminated nitrogen emphasize among the results. We have verified too that the percentage of metabolized energy over intake energy is upper in operated newborn than in other affected by necrotizing enterocolitis.

Energy Metabolism↗
PubMed1992

[Favorable effect of orchiectomy in unilateral testicular torsion on the exocrine function of the contralateral testis in rats].

The unilateral testicular torsion reflects in a negative manner on the contralateral testis. With the objective of proving if these alterations can be avoided, we used two groups of rats. The problem group was subjected to torsion with posterior orchiectomy. The control of spermatozoon we found significant differences for the spermatozoon with bigger motility. These results are from different from those obtained in animals submitted to testicular torsion with posterior distortion leaving the testis twisted. We think the orchiectomy has a prophylactic value upon the perturbation in the contralateral testis.

Animals↗