Biomedical subjects
Publications and source records attributed to J A Matute de Cárdenas.
The number of patients with laryngotracheal disorders is small but they have great importance because they produce anxiety in parents and they have a considerable morbi-mortality rate. We present the state of the art in three groups of patients: subglottic stenosis, tracheobroncomalacia and tracheal stenosis.
We present the results obtained in our center with laryngo-tracheoplasty for the management of laryngeal stenosis in infants and children. Nineteen patients were treated between 1989 and 1995. Their weights ranged from 1,200 g to 36 kg. Twenty-five operations were performed, not including endoscopic maneuvers. Fifteen patients have been decannulated (79%). Complications were infrequent and resolved satisfactorily. We consider that these surgical procedures should occupy a prominent place in the management of pediatric patients with laryngeal stenosis.
Testicular and paratesticular tumors are rare in childhood, representing 1-2 percent of the solid tumors in the pediatric age. In patients under 14 years, the incidence is 0.5-2/100,000. The evolution differs from that of the adult. Since 1981 to 1994 we have treated 14 cases of testicular and paratesticular tumors. Mean age was 2.54 years, the younger patients presenting germinal tumors. The most frequent tumor was the yolk sac tumor (36%), followed by teratoma mature (29%), and Leydig cell tumor, epidermoid cyst, paratesticular fibrous hamartoma, paratesticular neuroblastoma and paratesticular rabdomyosarcoma (7% each). A testicular mass was present in all cases (100%). Testicular ultrasound was used in 100%. In all the patients with malignant tumors a thoraco-abdominal CT scans was done to rule out extension or the tumor, being negative in all cases. Alphafetoprotein were high in all the cases of yolk sac tumor, being within normal range one month after surgery except in one case. In 11 patients an orquiectomy was done through an inguinal approach, and in three cases a simple tumorectomy without orquiectomy. No lymphadenectomy was done. All the malignants neoplasms were stage I tumors, except one yolk sac tumor stage III. Postop chemotherapy was applied in this one and in the embrionary rabdomyosarcoma. There were no recurrences after a follow-up mean time of 3.98.
From 1981 to 1993, we have treated 31 pediatric patients with ectopic ureterocele (associated to duplex system, intra and extravesicals). Diagnostic work-up included abdominal ultrasound, intravenous urography (IVU), sequence mictional cystouretrography (SM-CU) and diuresis renography (DTPA-DMSA o MAG-3). Patients were divided in two groups: 1. Good renal function in the affected system (5 cases) with 2 endoscopic incision of the ureterocele and 3 without surgical treatment (all intravesical). 2. Almost non-existent ipsilateral renal function (26 cases), treated by heminephrectomy and ureterocelic aspiration, and in the remaining a nephrectomy was done for ipsilateral non-existent renal function. 2 cases treated by endoscopic incision presented vesicoureteral reflux, and 4 cases treated by nephrectomy had a low grade reflux. There is no a definite treatment established. The choice should by made based on renal function. Endoscopic incision is a good choice in obstructed cases with good renal function. In those with no function at all, heminephrectomy with aspiration of the ureterocele will be the best treatment if we consider that almost 50 percent of the patients will need a second surgical procedure.
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The original Duhamel procedure for the treatment of Hirschsprung's disease (HD) has undergone several important modifications over the years. The use of mechanical suture in recent years has added significant advantages to this surgical procedure. Sixteen patients with HD were operated on according to this surgical technique, from 1985 to 1990. We analyse clinical, radiological and surgical aspects. We concentrate on early and late postoperative complications and the results achieved after a maximum follow-up of 4.5 years.
One case of congenital esophageal stenosis due to tracheobronchial remnants and associated with microphthalmos and corneosclera is reported. Diagnostic and therapeutic methods employed are discussed.
Instrumental esophageal perforation is a serious complication that demands immediate therapy. In a retrospective study we have evaluated the results in seven patients treated for esophageal perforation by means of a conservative treatment without mortality. Instrumental dilatation of corrosive strictures were the most frequent cause of iatrogenic endoscopy. We have observed an esophageal injury associated with a Sengstaken-Blackemore tube placement. Clinical symptoms associated with chest roentgenograms guided to early diagnosis in all cases. Conservative treatment usually consist of a course of antibiotics, pleural drainage, and total parenteral nutrition. Clinical follow-up has been good in the seven patients treated.
The DUHAMEL operation is widely used for the treatment of HIRSCHSPRUNG disease. Recently, technical modifications using stapled instruments have been introduced. The results of 12 patients treated between 1985 and 1989, performing the DUHAMEL procedure are reviewed. We perform with mechanical sutures, both surgical stages, e.g. abdominal and perineal. The technique for the procedure is described. Since we introduce the technique, we have observed several advantages consisting in a shorter surgical time, earlier normal life pattern, less postoperative complications and better results in clinical evolution.
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Total colectomy in the neonatal period, after a necrotizing enterocolitis is not infrequent and implies a series of complex attitudes towards a good adaptation of the remaining small bowel. We present 9 cases of total colectomy in children with necrotizing enterocolitis of 11 cases surgically treated out of 57 cases. We describe the different types of surgical procedures used as well as the evolution of each patient.
Anterior cricoid split was described in 1980 by COTTON and SEID as an alternative to tracheotomy for managing neonatal laryngeal stenosis. Seven patients managed in our unit using this technique since 1989 were reviewed. Five evolved favorably. Two patients in whom the technique failed underwent successful laryngotracheal reconstruction. Complications were minimal, the most important being persistent tracheocutaneous fistula. The most common complication was accidental postoperative extubation. The success of the technique depends on the availability of a pediatric intensive care unit staffed by experienced personnel and with suitable equipment.