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J A Matute

Publications and source records attributed to J A Matute.

At least 19 recordsLinked to original sources
PubMed2005

[Role of peritoneal drainage in very low birth weight with enterocolitis].

UNLABELLED: Peritoneal drainage (PD) has been proposed as a temporizing procedure for perforated necrotizing enterocolitis (NEC) in very low birth weight neonates. This operation was designed for patients considered too unstable to undergo laparotomy (LAP). Since the introduction of PD some investigators have suggested that it may serve as a definitive therapy. The aim of our study is to determine the efficacy of PD for the stabilization of patients with complicated NEC and its utility as a definitive surgical treatment. METHODS: We review the clinical records from all the patients treated in our unit because of NEC that required surgical therapy. We analyze the mean blood pressure, cardiac and respiratory rate, inspired oxygen concentration, mean airway pressure, diuresis, and arterial blood gases measured 6 and 12 hours after the initial surgical treatment. We divide patients in two different groups according to the initial surgical procedure, peritoneal drainage (PD) or laparotomy group (LAP). Data is shown as media +/- standard deviation, statistical analyses were performed using analysis of variance (ANOVA) for repeated measures and Mann-Withney test. RESULTS: From January 1997 to January 2001 we treated 13 patients with necrotizing enterocolitis that required surgical treatment. Among this group 6 patients were managed initially with PD and 7 with LAP. The gestational age media was 29.07 +/- 3.81 weeks and the birth weight mean 1199.76 +/- 521 gr., without any significant differences between the two groups DP and LAP. All patients improved haemodynamically and respiratory 6 and 12 hours after the surgical treatment. Nevertheless, the mean blood pressure improved even more in the DP group (p<0.005). The DP group showed an improvement in all parameters 6 hours after the drainage was placed, but this effect wasn't maintained for the next 12 hours onwards. From the 12 hours after PD all patients suffered a steady worsening that required further surgical procedures. The overall mortality was 3 patients (23%), without differences between the two groups. The surgical techniques performed (bowel resection, diversion) were similar for both groups. DISCUSSION: DP allows the stabilization for very critically ill patients with complicated NEC. However, this stabilization is temporary. This improvement lasts for a few hours providing a better status for the definitive surgical treatment for the perforated NEC. In our experience DP could not be considered as a definitive surgical treatment.

Child, Preschool↗
PubMed2005

[Spinal cord and vertebral column injuries in children].

AIMS: Analysis of main factors of spinal cord and vertebral column injuries in our environment. METHODS: We reviewed the data collected from the patients (n = 2640) admitted to our hospital because of trauma and included in our Registry from January 1995 to April 2002. Among this group, 86 patients (3.3%) had spinal cord and vertebral column injuries and were included in the study. RESULTS: Group gender distribution was 45 males and 41 females. In our group, 71 patients suffered vertebral fractures, 3 of them with spinal cord injuries (4.2%), 13 patients with vertebral subluxation, 11 of them between C1-C2, and 2 patients with spinal cord injury without radiographic abnormality. Only 71 patients, 4.9% of the total of the patients who were admitted with any type of fracture (n=1457), suffered vertebral fractures. These patients suffered 130 vertebral fractures, 35 of them (49.3%) suffered multiple fractures. Thoracic vertebrae were the most frequently affected (n=82, 63%). The most frequent localization was T4 toT8 (n=50, 38.5% and T11 to L2 (n=41, 31.5%). Age ranged between 12 and 15 years (n=35, 49.3%), with only 5 patients under 6 years. 90.9% of the patients with lumbar fractures were older than 8 years and 76.9% of the patients with cervical fractures were over 8 years. Motor vehicle accident was the most common cause in our series (n=20, 23.3%). 81% of these patients did not use safety belt. Ten children with cervical injuries were seen by medical staff at the prehospital stage, and only 4 of them arrived to Hospital with cervical collar. There were thirty five patients with thoracic or lumbar injuries but only 27 of them were transferred to our Institution by ambulance. Surgery was required in 2 patients, both of them with unstable fractures. Mean hospital stay was 17,1 days (range 2-37 days). CONCLUSIONS: Group gender distribution is similar between males and females and the incidence in our series is higher than other series of the literature. Thoracic injuries are the most frequent. It is necessary to improve prehospital management of these patients and to increase the use of safety belt. Spine injury incidence increased with age.

Adolescent↗
PubMed2004

[Diagnosis and management of necrotizing tracheobronchitis].

OBJECTIVE: Necrotizing tracheobronchitis has been described as a complication of mechanical ventilation of newborns with respiratory failure. Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction that causes 45% of mortality. The objective of our study is to analyze our experience in the management of these patients. MATERIAL AND METHODS: In the last three years we have treated eight patients with necrotizing tracheobronchitis The mean age was 0.84 +/- 0.95 months, gestational age of 37.43 +/- 2.3 weeks. The mean weight was 3.07 +/- 1.04 kg. Five patients had a congenital heat disease (62.5%) and three have a respiratory failure (37.5%). We have analyzed the contributing factors, symptoms, diagnosis, treatment and results. RESULTS: All patients presented episodes of shock with treatment of drugs. Five patients have conventional ventilation (62.5%) while three have high frequency oscillatory ventilation (37.5%). There were not significant differences in the ventilator parameters of both groups (PMA, PIP, PEEP). Three patients were supported by ECMO when they developed necrotizing tracheobronchitis. The treatment was bronchoscopic removal of necrotic tissue. There was not any complication after the procedure. A patient suffered a stenosis in the left main bronchus. Three patients have died during follow-up for different causes. The time of pursuit is of 10.33 +/- 7.61 months. CONCLUSIONS: Necrotizing tracheobronchitis may be increasing in the Neonatal Intensive Care Units, due to a bigger survival of patient with serious respiratory failure and shock. Hypotension and shock seems to be a major contributing factor in the development of this lesion. Bronchoscopy is necessary for treatment and survival of the patients.

Bronchitis↗
PubMed2004

[Management of infantile subglottic hemangioma].

INTRODUCTION: Subglottic hemangioma is an unusual lesion which can be treated in various ways. Multiple therapeutic attitudes with variable clinical results have been described. We present our experience in the management of these patients. PATIENTS AND METHODS: During last the three years we have treated four patients with subglottic hemangioma. The mean age was of 4.5 +/- 2.8 months and the mean weight of 6.9 +/- 2.04 kg. We present its presenting symptoms, location and size of the lesion, grade of obstruction (according to the classification of subglottic stenosis of Cotton), the treatment applied, complications and results in the long term. RESULTS: The lesions produced a mean obstruction of 83.75% of the airway (range 75-90%), being located in the right posterolateral region (2), left posterolateral region (1) and the last was completely to circulate. All the patients have been treated initially with steroids, but recurrence of symptoms when steroid dosage was decreased. All angiomas were removed surgically by submucous resection. No tracheotomy was performed. One patients developed a grade III subglottic stenosis that required an open surgery (laryngotracheoplasty with anterior a posterior graft). One patien suffered an overwhelming sepsis probably secondary to medical treatment. All patients had not had further respiratory difficulties. Postoperative follow-up is 18 months (range from 6 months to 3 years). CONCLUSIONS: Treatment of subglottic hemangioma is difficult to standarize. Treatment with steroids have many adverse effects in children. The surgical treatment offer a good option in the treatment of the angiomas of great size. Traqueostomy as must be avoided in the management of these patients.

Adrenal Cortex Hormones↗
PubMed2003

[Fiberoptic bronchoscopy, 3-D reconstruction of the airway and virtual bronchoscopy in patients with airway malformations. Preliminary report].

UNLABELLED: Bronchoscopy is the diagnostic gold standard in patients with airway malformations. Helical CT scan has produced studies such as virtual bronchoscopy or 3-D reconstruction of the airway. The purpose of this study is to analyze the correlation between fiberoptic bronchoscopy, virtual bronchoscopy and 3-D reconstruction of the airway in patients with airway malformations. METHODS: From January 2001 to March 2002 we evaluated the airway of 17 patients with airway malformations by means of a diagnostic protocol consisting on fiberoptic bronchoscopy, and Helical CT scan with 3-D reconstruction of the airway and virtual bronchoscopy. The radiologist had no access to bronchoscopic information. Age at study, associated cardiovascular anomalies, indications, localization, degree of diagnostic concordance, etiology and influence in treatment were analyzed. RESULTS: 20 studies were done to 17 patients whose mean age was 1.64 +/- 0.48 years (7 days-7 years). Twelve patients had associated anomalies of the aorta, pulmonary arteries or supraortic vessels. Excellent concordance was obtained in 13 cases (65%), good in 6 (30%) and poor in one (5%). 3-D reconstruction of the airway and adjacent vascular structures provided additional information in 14 cases (70%): in 3 exact length of the tracheal lesion and in 11 defined the cause of the compression. In all the cases, absolute concordance in localization was obtained. CT scan information modified treatment in 6 patients (35%). In 7 patients with associated vascular anomalies, no further image studies were done, confirming the anatomy concordance during surgery. CONCLUSIONS: 3-D reconstruction of the airway and virtual bronchoscopy are excellent diagnostic tools in patients with airway malformations, and contribute to define the etiology, length and diameter of the lesion. Excellent diagnostic correlation was obtained between analogic and virtual bronchoscopies, although further multicentric studies should be conducted.

Bronchi↗
PubMed2002

[Bronchoscopies in neonatal intensive care units: safety and efficiency].

The aim of our study is to asses the risks and complications in bronchoscopies at Neonatal Intensive Care Units (NICU). Between 1991 and 1999, we performed 142 bronchoscopies at the NICU. The mean age was 1.6 +/- 1.4 months (2 days-6 months) and mean weight was 2.5 +/- 1 kg (530 g-4.7 kg). We analysed the complications, arterial oxygen saturation and inspired oxygen fraction (FiO2) during bronchoscopy and we compared them related to weight, type of anesthesia and type of bronchoscope used. Mean basal saturation was 92 +/- 8.9% and end saturation was 92.8 +/- 10%. The basal FiO2 was 0.5 +/- 0.3 (0.21-1). There were more complications in patients weighting less than 1500 g and in those procedures made with rigid bronchoscopy (p < 0.05). There were no differences according to the anesthesia. Children who weight fewer than 1500 g and those who underwent rigid bronchoscopy suffered a descent in arterial oxygen saturation and needed higher FiO2 (p < 0.05). Bronchoscopy is a very useful technique and it is well tolerated in neonatal patients. We conclude that flexible fiberoptic bronchoscopy is safer than the rigid bronchoscopy, specially in children fewer under 1500 g.

Bronchoscopy↗
PubMed2002

[Respiratory deadspace and compliance measurements in neonates with congenital diaphragmatic hernia].

The mortality rate of infants with congenital diaphragmatic hernia (CDH) remains high, despite clinical improvements. Many attempts have been made to find accurate and reliable predictors of outcome. Deadspace (Vd/Vt) and dynamic compliance (DC) measured by single breath CO2 analysis may be useful to evaluate pulmonary function and perfusion. In the present study we analyse both parameters in patients with CDH. Nine patients with CDH were included for Vd/Vt and DC study. Measurements of arterial blood gases (pH, PO2, pCO2) were obtained, oxygenation index and alveolo-arterial difference calculated at diagnosis, preoperatively and postoperatively. Vd/Vt and DC were measured at the same moments by analysis of the CO2 espirogram. Statistical analysis was performed using Fisher exact test, ANOVA and Mann Whitney and Chi-square. The Vd/Vt was significant lower for the group of patients who survived (0.39 +/- 0.07 vs 0.64 +/- 0.14, p = 0.038). DC was significantly higher in the survivors group (1.39 +/- 0.30 vs 0.5 +/- 0.07, p = 0.011). The analysis of the evolutive Vd/Vt and DC (initial and preoperative) showed significant differences within both groups. Respiratory deadspace can be easily quantified in neonates with congenital diaphragmatic hernia providing an important insight regarding the efficiency of the airway-alveolus and its relationship to pulmonary blood flow. Vd/Vt and DC measurement constitute a reliable method to predict outcome in patients with CDH.

Hernia, Diaphragmatic↗
PubMed2000

Results of the Azizkhan procedure for long-term suprastomal tracheomalacia.

One of the reasons of failure to decannulate patients after airway surgery or long-term tracheostomy is suprastomal tracheomalacia. We present 7 cases with long-term tracheostomies treated by an anterior cricoid suspension described by Azizkhan in 1993. Prior to surgery, other causes of airway obstruction, as well as the presence of gastroesophageal reflux disease should be ruled out. All of them are decannulated. This procedure is a safe surgical technique, easily reproducible and with low costs.

Child↗
PubMed2000

Surgery of subglottic stenosis in neonates and children.

The excellent management of patients in the different Intensive Care Units has decreased mortality but, as a side effect, we have to treat an increasing number of patients with airway problems secondary to prolonged intubation. The clinical records of patients diagnosed of acquired or congenital subglottic stenosis (SE) between 1990 and 1995 were retrospectively reviewed. Types of treatment included conservative, endoscopic, and open surgery: anterior cricoid split (ACS), anterior laryngotracheoplasty (ALTP) and anteroposterior laryngotracheoplasty (APLTP). 46 patients had SE: 7 congenital and 39 acquired. According to Cotton's classification 13 had grade I, 16 grade II, 12 grade III and none grade IV. Eleven of twelve cases treated conservatively did well (92%); one out of six patients managed endoscopically required further surgery (7%); good results were obtained in 5 of 7 cases treated by ACS (71 %); 8 out of 9 patients treated by ALTP did well (89%) and 7 out of 8 managed by APLTP had good results (87.5%). One iatrogenic suture dehiscence required further surgery. There is no statistical difference in the complication rate between patients treated conservatively and those treated by open surgery, while the mean hospital stay was higher in the latter (p < 0.05). An appropriate surgical technique should be offered to those patients with SE who do not do well with conservative management, since these techniques have yielded good results with a low rate of complications. Long-term follow-up shows the absence of recurrence.

Bronchoscopy↗
PubMed2000

[Treatment of suprastomal tracheomalacia by anterior cricoid suspension].

BACKGROUND: One of the reasons of failure to decannulate patients after airway surgery or long-term tracheostomy is suprastomal tracheomalacia. OBJECTIVES: Evaluate the results obtained in the treatment of suprastomal tracheomalacia by anterior cricoid suspension. MATERIAL AND METHODS: We present 8 patients with suprastomal tracheomalacia associated to long-term tracheostomy corrected by this technique. Prior to surgery, other causes of airway obstruction, as well as the presence of gastroesophageal reflux disease should be ruled out. Results 5 females and 3 males wer treated by this technique. Mean age at surgery was 4,1 +/-0,97 years (range, 1,5-8,8 years). anteroposterior suprastomal collapse occluding 75% of the trachea was observed in 5 cases, and 75-90% in other three. All the patients were extubated successfully, although in one case stridor recurred because of residual suprastomal malacia that required a new surgical procedure. After a follow-up of 38,7+/-7,39 months (range, 1 month-4,6 years), the patients are decannulated and going well. Conclusions It is an safe surgical technique, easily reproducible and with low costs.

Child↗
PubMed2000

[Analysis of treatment failure in pediatric subglottic stenosis].

BACKGROUND: The good results obtained until nowadays in the surgery of subglottic stenosis is followed by an analysis of the failures. METHODS: We study retrospectively 48 cases treated in the last eight years in two institutions. Study variables were: age, previous diagnosis, grade os the stenosis, surgical treatment, complications and evolution. RESULTS: Mean age was 2.8 +/- 0.43 years (newborn-17 years). In 13 cases (27%) the result obtained was considered a failure. Failure indexes were: treatment selection (7,7%), surgical technique selection (23%), due to the technique itself (23%), iatrogenia (15,4%), associated diseases (30,7%). Mortality of the series was 8.3%. CONCLUSIONS: The learning curve of these techniques is difficult although once the necessary experience is achieved the results are excellent.

Adolescent↗
PubMed2000

[Surgery of lung metastasis].

INTRODUCTION: The 30-40% of the oncologic patients have pulmonary metastases. Lung can be the only organ affected. In selected patients, exeresis of the pulmonary nodules can mean their healing. MATERIAL AND METHODS: Between 1982-1997, twenty two patients presented metastases, 13 could be operated and 16 thoracotomies were done. There were 53% boys and 47% girls whose ages ranged from 3 to 15 years. We have considered: pulmonary tumour location, disease free interval, number of metastases, surgical technique and incomplete pulmonary tumour resection. RESULTS: Primary tumours were: Wilms tumours 23%, bone tumours 67% (Ewing and osteosarcoma). Disease free interval was < 2 years in 8 patients (61%) and > 2 years in 39%. X-Ray and CT were performed in every case and 66% presented a solitary nodule. Surgical techniques were: metastasectomy in two cases (12%), wedge resection in 8 (50%) and lobectomy in six cases (38%). We made thoracoscopy in two patients. There weren't postoperatory mortality but the patients with tumorectomy had an incomplete surgical resection. The overall survival is 54 percent and the 5 years survival is 23 percent (3 patients). CONCLUSIONS: The patients with a DFI < 2 years have a survival of 25% compared with 100% for patients who have a DFI > 2 years. The pulmonary resection in selected patients can offer better survival. We can use the thoracoscopy in same selected patients.

Adolescent↗
PubMed1997

Primary neuroblastoma presenting as a paratesticular tumor.

A 3-month-old boy was operated on for an inguinal tumor. Histological diagnosis was neuroblastoma. This is the second known case of primary paratesticular neuroblastoma reported in the literature. The treatment of choice for Evan's stage I is surgery.

Diagnosis, Differential↗
PubMed1997

[The treatment of the tracheobronchomalacia in pediatric age].

OBJECTIVE: Aortopexy is the more extended treatment for severe tracheomalacia, when it fails, reintervention and other procedures are necessary. We present our experience in the treatment of this pathology. MATERIAL AND METHODS: Tracheomalacia, bronchomalacia and tracheobroncomalacia cases during a twelve year period (1983-1995) were reviewed (type, age, symptoms, surgical procedures and results were collected). RESULTS: Nineteen patients (9 males, 10 females) presented tracheobronchomalacia in our Hospital. Diagnosis was made by bronchoscopy in all of them: nine cases of tracheomalacia, five bronchomalacias and five suprastomal malacias were found. Mean diagnosis age was twenty four months (newborn-twelve years). Ten patients were managed nonoperatively, five with anterior cricoideal suspension and two cases were treated by aortopexy; one of them, after 2 months of respiratory stridor and recurrent respiratory arrest, needed an endoscopically placed intraluminal expandable Palmaz Prothesis. This prothesis was removed two years later. In this moment, the patient is doing well without stridor or respiratory symptoms.

Bronchial Diseases↗
PubMed1995

[Rectocolonic plasty using mechanical stapler as a surgical solution in complications of megacolon].

Hirschsprung's disease surgically treated with Duhamel's technique in which no mechanical suture has been used, usually presents, as main complication, cronic constipation, due to fecalomas in the rectal pouch. In our experience (30 cases plus four patients sent to our hospital for reintervention), this complication is not present when mechanical suture is introduced to the Duhamel's Technique. This allows us to assure that perineal rectocoloplasty, with auto-suture material is a precise optional treatment, with excellent results and allows the chance of not going through laparotomy in those cases that require reintervention.

Anastomosis, Surgical↗
PubMed1994

[Surgical alternatives in congenital tracheal stenosis].

Congenital tracheal stenosis is a rare condition with a high mortality. In a 12-year period, 5 cases (ages 5 days to 4 years) with this anomaly were treated. 4 were corrected, the operative repair consisted of segmental resection and anastomosis in one patient, and rib-cartilage tracheoplasty in the other three. The other patient died 12 days after bronchoscopy without attempt of surgical correction. Two patients died during or just after surgery, both of them presenting a similar clinical course consisting on severe air trapping, mechanical pulmonary hypertension and low cardiac output. Long-term follow-up of the survivors is satisfactory.

Child, Preschool↗
PubMed1994

[Surgery of the structural lesions of the respiratory tract].

22 clinical files of patients treated in our institution since 1983 for structural lesion of the airway are reviewed. 3 cases presented congenital tracheal stenosis, 15 congenital or acquired subglottic stenosis, 1 severe tracheomalacia, 1 subglottic membrane, 1 congenital subglottic cyst and 1 subglottic granuloma. A conservative or surgical approach (endoscopic, anterior cricoid split, Fearon's laryngotracheoplasty, modified Rethi's procedure, Kimura's tracheoplasty and aortopex) was used. Good results were obtained in 55.5 percent of the conservative cases, 100 percent of the endoscopic procedures, 50 percent of the splits and 75 percent of the laryngotracheoplasties. The Kimura and aortopexy procedures gave also good results. 4 patients are waiting for surgery: 1 anterior laryngotracheoplasty for iatrogenic failure, 2 conservative cases for persistence of the symptoms and 1 congenitaltracheal stenosis. A case of difuse congenital tracheal stenosis died before surgery. There are no significant differences in the complication rates of the surgical and conservative groups, but mean hospital stay was shorter in the former (p < 0.05).

Child↗