Biomedical subjects

J Estevão-Costa

Publications and source records attributed to J Estevão-Costa.

22 records · Page 2Linked to original sources

PubMed1998

[Evolution in the management of splenic trauma. Retrospective study in children].

BACKGROUND/PURPOSE: The treatment of blunt splenic lesions had changed in the last years with an increasing trend to conservative management. In the absence of national surveys, this paper is aimed to evaluate the results of this therapeutic approach in a group of Portuguese children. MATERIALS AND METHODS: Patients with blunt splenic lesions, admitted over a period of 7 years, (n = 54) were retrospectively analysed. A group submitted to surgical treatment 'ab initio' (group A, from 1990 to 1992 incl.) was compared with a group managed by a conservative approach (group B, from 1993 to 1996 inclusive). Age, sex, associated lesions, treatment, need of a blood transfusion and length of hospital stay were studied. RESULTS: The frequency of splenic lesions was relatively stable (6 to 10 years) in both periods. Group A (n = 24) was similar to group B (n = 30) regarding gender and age. In group A, 23 (97%) splenectomies were performed. In group B, only six (20%) children underwent laparotomy and 4 (13%) of them were submitted to splenectomy (A vs. B, p < 0.001). The need of a blood transfusion was similar in the two groups and so were the associated lesions. The great majority of transfused children presented associated lesions (10/11, 91%). In group B, associated lesions did not significantly alter the effectiveness of the conservative treatment. Hospital stay was significantly longer in group B (B vs. A: 12.5 +/- 2.5 vs. 9.8 +/- 1.8, p = 0.017). CONCLUSIONS: The conservative approach was viable in the great majority of patients with blunt splenic lesions, resulting in a drastic reduction in splenectomies. The need for transfusions did not increase, but the length of hospital stay increased. These results are concordant with other series from major centres, justifying this approach and constituting the challenge of its application in adults.

Child↗

PubMedDate not supplied

[Cobb's collar. Unusual cause of hematuria].

The Cobb's collar is a congenital narrowing of the bulbar urethra with variable clinical presentation and obstruction grade. Herein we report a clinical case of a 13-year-old boy presenting terminal macroscopic haematuria and post-mictional urethral bleeding. At cystoscopy a membrane on the bulbar urethra distal to the external sphincter and prominent vessels in the prostatic urethra were found. Transurethral endoscopic incision was carried out with no complications or recurrence at 9-month follow-up. The authors briefly review the embryopathogenesis, clinical features and treatment of this uncommon anomaly.

Adolescent↗

PubMedDate not supplied

[Intestinal invagination in children. Reduction with pneumo-enema].

UNLABELLED: Pneumatic reduction of intussusception in children is an effective and safe procedure, although controversy persists concerning contraindications. The shown by this procedure when compared to barium reduction have led to its implementation in our Service. AIM: To evaluate the usefulness of a 'handicraft method' of pneumatic reduction of intussusception with very restricted contraindications (peritonitis or shock). MATERIAL AND METHODS: The prospective study included 50 attempts at pneumatic reduction in 48 children (age range: 1.5-24 months). After confirmation of the diagnosis by ultrasonography. Then, air insufflation of the colon was performed under manometric and fluoroscopic control. After confirmation of diagnosis by ultrasonography, air insufflation of the colon was performed under manometric and fluoroscopic control in an operative room. Evolution longer than 24 hours was considered diagnostic delay, leukocytosis if WBC > 15 x 10(9)/l and distal localisation after splenic angle. Immediate laparotomy was undertaken in case of unsuccessful or doubtful reduction. RESULTS: Thirty-five reduction procedures (70%) were effective ab initio. In the 15 children submitted to laparotomy, seven were completely reduced (14%), five were manually reduced (10%), two presented intestinal necrosis (4%) and one (recurrence) had an ileal duplication (2%). The "real" efficacy (84%) was lower, even though significantly affected by diagnostic delay (81% vs 83%), rectal bleeding (81% vs 100%) or leukocytosis (71% vs 81%); efficacy was significantly lower only in distal localised cases (67% vs 97%, p = 0.02). There was one more recurrence (4%) and no other complications. CONCLUSIONS: The adopted method of pneumatic reduction was highly effective with low morbidity. Restricted contraindications were appropriate.

Child, Preschool↗

PubMedDate not supplied

[Intestinal duplication. A diagnostic and therapeutic challenge].

Duplications of the alimentary tract are rare congenital anomalies. The symptoms often mimic other surgical diseases and the diagnostic workup presents low accuracy. The charts of twelve children with intestinal duplications were reviewed. Their ages ranged from 13 days to 12 years (median: 12 months). The majority of the cases were located at ileum (n = 9). These children presented: rectal bleeding (n = 4), intussusception (n = 3), intestinal obstruction (n = 1) and hemoperitoneum (n = 1). All that were symptomatic before 1 year of age presented with intussusception (n = 3/3). All, except one colonic case was cystic. 99mTc abdominal scan was positive in 3 cases presenting rectal bleeding. One child with gastric duplication was diagnosed prenatally. Treatment consisted of enterectomy in all but one case, with no complications. Experience in the diagnostic workup and management is important to achieve a low morbidity rate in this congenital anomaly, which may present delayed manifestations.

Adolescent↗