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Biomedical subjects

F García Ibarra

Publications and source records attributed to F García Ibarra.

At least 19 recordsLinked to original sources
PubMed2006

[Vesicoureteric reflux endoscopic treatment complications in childhood].

INTRODUCTION: Nowadays, around 1% of children suffer from vesicoureteral reflux (VUR), which represents a risk factor for long-term kidney damage. In the last decade, development in this field has shown that subureteric endoscopic injection of bulking agents for childhood VUR is an acceptable alternative unlike long-term antibiotic prophylaxis and open surgery. OBJECTIVE: To establish the complications of childhood VUR endoscopic treatment. MATERIAL AND METHODS: A retrospective analysis was carried out for every patient treated endoscopically in our department from January 1999 to September 2003, with a total amount of 516 implants of submucous bulking agents. All patients were assessed with an ultrasound as a first diagnostic technique so as to establish the complications associated with it, especially ureteral obstruction and injected agent migration. RESULTS: Out of 516 cases, Macroplastique was used in 455, Deflux in 44 and Polytef in 17. 10 patients (1.9%) (5 girls/ 5 boys), with ages ranging from 15 months to 11,4 years, presented some kind of complications (Macroplastique was used in 8cases and Deflux in 2). Among them, 5 were remarkable due to an ureterohydronefrosis, 2 of which needed a nephrostomy. 3 patients presented an implant migration, 1 epididymitis and 1 bladder edema. CONCLUSIONS: Endoscopic bulking agent injection has become a safe alternative to open surgery in childhood VUR management.

Adolescent↗
PubMed2006

[Ultrasound role in assessment of vesicoureteral reflux endoscopic treatment results].

INTRODUCTION: Since the beginning of the application of the RVU treatment, the use of the ultrasound was used taking into account two main indications/symptoms: a) identification of the complications; b) assessment of the result (visualization of the implanted material and the presence of the "uretheral jet" by means or through/of ecodoppler-color). OBJECTIVE: To determine the value of the ultrasound in the assessment of the result of the endoscopic treatment of the RVU and in the detection of its complications. MATERIAL AND METHOD: From 2001-2002 we have carried out the endoscopic treatment to an overall of 261 ureteral units of all degree and etiology. 246 were assessed post-operation with an ultrasound per month and all of them were evaluated with a cistography after 3 months. In a random sample of 92 units, the result of the isotopic cistography has been compared with the visualization of the implanted material in the bladder; and in a random sample of 56 units, the result of the isotopic cistography has been compared with the presence of ureteral jet in the study with ecodoppler-color after moisturizing of the patient. In order to do, we have done two corresponding comparative charts 2 x 2 and we have calculated the Sensibility and Specificity of the tests, as well as their predictive positive and negative values, the degree of similarity of both tests with the Kappa index, and the degree of statistical relevance with Chi squared. RESULTS: The ultrasound did not show significant changes if compared to previous studies in 213 units (86,58 %) although in 5 patients an ectasia has been identified as attributed to the treatment. 3 of this patients have developed renoureteral pain, and in 2 pain has spontaneously disappeared as shown in later tests. The S and the E of the presence of implanted material is 94% and 10%respectively and its VPP and VPN of 80% and 10% and estadistical. The S and E of the jet visualization is 82% and 30%, with a VPP of 84% and a VPN of 27%, a level of statistical relevance of 0.836 and a degree of correlation of 0.121. CONCLUSIONS: Ultrasound is not a useful technique in the assessment of the result of the endoscopic treatment of the RVU. The role it plays in the assessment of complications is a small one and its use is only indicated to confirm the suspicion of ectasia in those patients that present renoureteral pain.

Adolescent↗
PubMed2005

Renal transplantation in children with severe bladder dysfunction.

PURPOSE: Renal transplantation in children with bladder dysfunction carries a risk for the renal graft. We report our experience with transplantation in 15 patients 6 to 18 years old with severe abnormalities of the lower urinary tract. MATERIALS AND METHODS: A total of 18 renal transplants were performed in 15 children with bladder dysfunction secondary to myelomeningocele (3), occult spina bifida (1), malformation/agenesis of the sacrum (5), posterior urethral valves (4), female hypospadias (1) and bladder exstrophy (1) between 1979 and 2003. Urological surgery was performed before transplantation in 14 cases-7 bladder augmentations, 5 incontinent urinary conduits/reservoirs and 2 vesicostomies. Voiding was maintained by intermittent catheterization in 9 cases and incontinent ostomies in 6. Graft implantation was performed by extraperitoneal route with ureteral anastomosis to the native bladder in cases of bladder augmentation. Immunosuppression consisted of triple therapy with polyclonal/monoclonal antibodies. RESULTS: Urological complications consisted of urethral obstruction due to mucus hypersecretion (1), urinary fistula (1), ureterovesical obstruction (1), stone formation (3), urinary tract incrustation by Corynebacterium urealyticum (1) and pyelonephritis (2). Graft survival rates at 1 and 5 years were 77% and 62%, respectively, with a median of 79 months (95% CI 51 to 107). Three graft losses were related to urological disease. CONCLUSIONS: Renal transplantation in children with severe bladder dysfunction can achieve similar results to those obtained in the general population. Meticulous selection of patients and surgical reparative techniques ensuring voiding and adequate control of urinary infections are mandatory. Augmentation cystoplasty and intermittent catheterization are appropriate techniques currently used for achieving this outcome.

Adolescent↗
PubMed2004

[Pyeloureteral duplicity and intrathoracic kidney].

Intrathoracic ectopia is an unusual ectopia that represents less than 5% of renal ectopia. The association of a duplex system and an intrathoracic renal ectopia is very rare. We report a case of a girl affected from these two anormalities, being the first case published in the literature reviewed. Presentation, diagnosis and therapeutic aspects are discussed.

Abnormalities, Multiple↗
PubMed2003

[Vesicostomy in children. Our experience with 43 patients].

INTRODUCTION AND OBJECTIVES: Cutaneous vesicostomy (CV) is a choice temporary urinary diversion technique for patients with upper urinary tract (URT) dilation, secondary to vesical o infravesical disease. The objective of this study is to share our experience in children undergoing such diversion, analysing its efficacy to prevent urinary infections, improve or resolve the ureterectasia, and stabilise or improve renal function; in short the functional and morphological recovery of URT. MATERIAL AND METHODS: 43 children, mean age 2.5 years (range: 1 month-14 years) with ureterohydronephrosis grade IV-V, persistent urinary infection and/or renal function impairment underwent cutaneous vesicostomy (Blocksom's technique in 36 and Lapides' procedure in the rest). Thirty subjects had neuropathic bladder (26 with secondary vesicoureteral reflux), 7 massive primary vesicoureteral reflux, and 6 posterior urethral valve. RESULTS: All children (100%) with neurogenic bladder (30 cases), showed improvement of ureteral-pyelic-calyceal ectasia after the diversion, and 90% improved renal function with disappearance of vesiculoureteral reflux in 65%. Augmentation cystoplasty with gut was performed in 12 patients during vesicostomy closure, using Mitrofanoff's type diversion in 5 of them. The same continent diversion with cecal appendix was used in another 7 children as the only procedure. The remaining 11 children still retain their vesicostomy. In 5 of the 7 children with primary vesicoureteral reflux, the reflux disappeared and so the vesicostomy was closed. Reflux correction during the same surgical procedure was required for the other 2 children. Of the 6 children with posterior urethral valves, 2 received a renal transplant, one is in waiting list and the rest (50%) maintain an acceptable renal function. In the first year of follow-up, 4 patients developed symptomatic urinary infection that later disappeared. The rest had occasional asymptomatic bacteriuria that required no treatment. Complications included vesical prolapse due to ostomy in 4 patients, lithiasis in 3 and stomal stenosis in 2. CONCLUSIONS: We consider vesicostomy to be the choice urinary diversion technique in cases of common section obstruction and/or non-obstructive ureterohydronephrosis in new-borns who do not improve with conservative treatment.

Adolescent↗
PubMed2003

[Bilateral testicular epidermoid cyst in a pediatric patient with Klinefelter syndrome].

Epidermoid cysts of the testis are rare in children (3% of all the testicular tumors). Bilateral appearance has only been described in the pediatric age in 2 cases and none associated to Klinefelter's syndrome. We present, for our knowledge, the first case of bilateral epidermoid testicular cyst associated to klinefelter's syndrome in a boy, highlighting its management and therapeutic approach. We analyze the different kinds of treatment.

Child, Preschool↗
PubMed2000

[Acute lobar nephronia. Report of a pediatric case].

OBJECTIVE: A case of lobar nephronia in a child is presented. METHODS: Herein we describe a case of acute lobar nephronia in a 10-year-old boy. The clinical, diagnostic and therapeutic aspects are discussed. RESULTS/CONCLUSIONS: Acute lobar nephronia or acute focal bacterial nephritis is an uncommon form of pyelonephritis that can affect both adults and children, although few cases have been reported in children. Imaging techniques are necessary for diagnosis and to distinguish it from other conditions, such as abscess or renal masses that require a different treatment. Ultrasound is the imaging technique of choice in the diagnosis and follow-up of lobar nephronia.

Acute Disease↗
PubMed1999

[Diagnostic attitude in a patient with kidney trauma].

OBJECTIVE: Our aim was to assess our results in the management of renal trauma patients. PATIENTS AND METHODS: A retrospective review of medical charts from 1989 to 1997 was carried out. RESULTS: Twenty-seven cases involving 27 kidneys were treated during the study period, with 16 grade II injuries, 8 grade II and 3 grade III. Ultrasound was the most used diagnostic tool, followed by computerized tomography (CT) and intravenous pyelography (IVP). Falls and traffic accidents were the main etiologic agents (48 and 41%, respectively). Eight out of 11 patients with grade II/III injuries received surgical treatment. Three cases required early surgery immediately after arrival and 5 cases had planned surgery. After a mean follow-up period of 16 months, renal function has remained above 40% in all patients, excluding 3 cases treated with partial nephrectomy. CONCLUSIONS: A conservative attitude is of choice in children with renal trauma. CT is the main diagnostic tool except in patients suspected of isolated grade I injury. Ultrasound followed by IVP is a valid choice for these cases and especially helpful for preschool patients which require general anesthesia for CT exploration.

Accidental Falls↗
PubMed1998

[Renal adenocarcinoma in children].

Contribution of two cases of renal adenocarcinoma in pediatric patients. Comments on the most updated and relevant aspects of epidemiology, clinical manifestations, diagnosis, treatment, prognosis and follow-up. Comparison to nephroblastoma and renal adenocarcinoma of the adult.

Carcinoma, Renal Cell↗
PubMed1997

[Ureteral ectopia in pediatric age: treatment and evolution in 55 cases].

In the last twenty years 55 children with ureteral ectopia were diagnosed and treated in our Hospital. Thirty seven of them were female (67.3%) and they presented the urinary tract infection like the most frequent symptomatology. Seven children were diagnosed during the first days after being born because the detection of hydronephrosis in the antenatal ultrasound; 36 were associated with complete ureteric duplication (65.4%) and the other 19 with single system (34.6%). Congenital abnormalities associated were seen in 14 patients with more frequency in those which presented single-system ectopic ureter (12/14), being the imperforate anus and the kidney agenesia those the most incidence. The most frequent points of opening were the bladder neck and posterior uretra. Diagnostic work-up included some radiological studies (abdominal ultrasound, intravenous urography, sequence mictional cystourethrography and vaginogram), isotopical tests, meticulous genital exploration, cystoscopy and vaginoscopy. 49.1% underwent conservative surgical treatment (7 ipsilateral ureteroureterostomy and 20 ureteral reimplantation) and 50.9% underwent total or partial nephroureterectomy, being the type of treatment depended on functionality of renal units. After treatment, 74.5% had not any incident; among all postsurgical complications, reflux reappearance was the most frequent (3 cases).

Anus, Imperforate↗
PubMed1995

[Tumor of the testicular vitelline sac in children: clinical course and treatment].

Presentation of a review of 10 paediatric patients with tumour of the testis vitelline sack, to report our experience in the management of this pathology. Mean age was 20 months (14-32), and the interval of the study was from 1970 to 1994. After orchiectomy, 7 children were included in stage I, 1 in stage II, and 2 in stage III. Four underwent Retroperitoneal Lymphadenectomy. All patients in stage I are currently free of disease, with a mean follow-up of 132 months, regardless the type of treatment employed (vigilance in 2 cases, chemotherapy in 2, and chemotherapy plus Retroperitoneal Lymphadenectomy in 3). On the contrary, the 3 children with extratesticular disease died 15, 18 and 15 months after orchiectomy. In conclusion, we believe that patients included in stage I should undergo only a strict vigilance, based on the excellent prognosis of this group and the lack of differences between the survival time obtained with the various therapeutical approaches followed. On the other hand, patients with stage II or stage III disease should receive from the beginning chemotherapy, thus saving the Retroperitoneal Lymphadenectomy for the residual disease.

Child, Preschool↗
PubMed1995

[Vesicostomy in children].

OBJECTIVES: To evaluate the upper urinary tract morphology and function in children undergoing vesicostomy for different causes. METHODS: We report on 27 children aged 1 month to 12 years who had undergone a Blocksom vesicostomy procedure. Twenty had a neuropathic bladder and 3 had posterior urethral valves. RESULTS: In the 20 children with neuropathic bladder, renal function improved in 95% and the associated vesicoureteral reflux improved in 56%. The morphology of the upper urinary tract returned to normal prior to the definitive operation in all cases. Only one of the patients with posterior urethral valves has preserved satisfactory renal function two years following vesicostomy. The most common complication was prolapse (14.8%). CONCLUSIONS: In our view, vesicostomy is the best urinary diversion procedure in the cases described herein. Vesicostomy closure must be performed following definitive treatment of the underlying condition, except in those cases with neuropathic bladder who require augmentation cystoplasty to keep upper urinary tract pressures low.

Child↗
PubMed1994

[Paratesticular rhabdomyosarcoma in children. Is retroperitoneal lymphadenectomy necessary in disease limited to the scrotum?].

Between 1970 and 1993, five children with paratesticular rhabdomyosarcoma (PR) and age ranging from 3 to 10 years were treated by our group. Following radical orchidectomy and clinical staging, 4 were rates as Group I-IRS (completely resected local disease) and 1 in Group IV-IRS (distant metastasis). All patients in Group I underwent intensive chemotherapy with vincristine, actynomicin D and cyclophosphamide (VAC) for 18 months, while no case of retroperitoneal lymphadenectomy was performed. Currently, all patients are disease free with a mean follow-up of 8 years and 5 months. The single patient included in Group IV received radiotherapy (800 rads in abdominal field) and chemotherapy with VAC + prednisone (PDR), and retroperitoneal lymphadenectomy of residual masses was performed. The patient developed liver metastasis and died 20 months later. The purpose of this paper is to convey the reader our experience in the treatment of PR in children, making a special reference to the excellent prognosis when the disease is limited to the scrotum and recommending in such cases the use of intensive chemotherapy with VAC after performing radical orchidectomy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Male complete urethral duplication: report of 3 new cases.

Urethral duplication (UD) is a very rare congenital malformation, either in its complete or incomplete presentation. Its different types of appearance as well as the usually associated malformations (genitourinary, gastrointestinal, musculo-skeletal, and others) make it a complex disorder which requires an individualized treatment. Three new cases of complete UD are now reported. One of them is associated with diphallus, and another with severe renal failure due to obstructive uropathy which needed renal transplantation 3 years after diagnosis. We describe and analyze the diagnostical and therapeutical approach used for each case.

Humans↗
PubMed1990

[Ten years of renal transplantation in children].

One hundred and fourteen kidney transplants (87 first and 27 second and thirds) were performed in 90 children aged 1 to 15 years during the period 1979-1988; 44% were under 10 years, 14% under 5 and 8% under 3 years of age. The renal grafts were from living related donor (LD) in 30 cases and from cadaveric donor (CD) in 84; 91 were from adult donors and 23 from pediatric ones. The actuarial survival rate of the patients at one and two years was 100% in the LD and 92 and 90% respectively in the CD group. The actuarial survival rate of the first graft at one two years was 98% and 78% in the LD and 83% and 68% in the CD group. When gathered for the receptor age the actuarial survival rate of the first graft was 78 and 67% in the 1-5 years group (n = 19) and 86 and 71% in the 6-15 years one (n = 68). Serum creatinine level was 0.9 +/- 0.4 mg/dl three months, 1.2 +/- 0.7 mg/dl at one year, an 1.8 +/- 1.2 mg/dl at two years among the 50 transplants with a follow-up over two years.

Age Factors↗