[Antiparasitic medication in a Spanish hospital: the needs of the year 2000].
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Health Services Needs and Demand↗
Biomedical subjects
J Garay
Publications and source records attributed to J Garay.
[Giant subserous pendulous liquefied uterine myoma].
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Female↗
[Reflux esophagitis: histologic clinical and functional study].
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Adolescent↗
[The average duration of nocturnal reflux in the prognosis of respiratory problems associated with gastroesophageal reflux].
Choice of therapeutic approach remains difficult in patients with gastro-oesophageal reflux and respiratory symptoms. Except in children in whom microaspiration has been demonstrated it is very difficult to predict which ones are going to be relieved from their respiratory disease after GER treatment. In 1981 Jolley and coll. found that the mean duration of nocturnal episodes of reflux (MDNR) in extended pH-metering excluding post-cibal hours could differentiate not only patients with and without respiratory manifestations, but also those in whom respiratory tract disease will disappear after GER treatment from those in whom this will be useless. Only some references on this topic have been published ever since. We have reviewed the charts and pH tracings of the 70 patients with respiratory disease and GER treated in our service aiming at assessing the real value of this parameter in our hands. Fifty-two cases could be evaluated: 41/52 were either improved or completely relieved from their respiratory manifestations (79%) where has the remaining 21% were unchanged by GER treatment. In the first group MDNR was 13.1 +/- 9.7 min and in the second one it was 6.3 +/- 4.6 (p less than 0.05). Our results confirm that MDNR is a valid parameter in order to make prognosis in this particular group of patients.
Child↗
[Results of surgical treatment of gastroesophageal reflux with respiratory manifestations].
Respiratory tract disease was the main indication for surgery in 45 out of the 102 children operated upon for GER in the last 7 years: twenty-four had recurrent bronchitis and pneumonia, 18 had bronchitis with constriction (true asthma in 10), 2 had unbearable cough and 1 apnoeic crises. All had been medically treated before without success. The diagnosis of GER has been accepted only in patients with abnormal results in three or more of the following tests: barium swallow, extended pH-metering, manometry, endoscopy-biopsy and gastro-oesophageal scintigraphy. Nissen fundoplication cured GER in all cases, and its effect on respiratory tract disease after an average follow-up of 17 months (range 6 to 48) was rather encouraging: twenty-six children cured (57%), 9 improved (21%) and 10 remained unchanged (22%). Failures were more frequent in children with bronchoconstriction (45%) and in those without prior digestive symptoms (36%). Surgery is probably indicated more often in the treatment of respiratory tract diseases associated with GER in children than it was previously thought, but indications remain difficult and the results are uncertain in children with either asthma or bronchoconstriction.
Child↗
[Indications for the surgery of gastroesophageal reflux in children].
A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.
Age Factors↗
Abnormal preoperative and postoperative esophageal peristalsis in gastroesophageal reflux.
Extended 24-hour pH monitoring and esophageal manometry before and 6 months after Nissen fundoplication in a group of 14 children with symptomatic gastroesophageal reflux (GER), of whom 12 had esophagitis, have shown that all patients were clinically cured and their initially abnormal pH-monitoring parameters significantly decreased to normal values after operation. Whereas lower esophageal sphincter pressure (LESP) was not modified by surgery, lower esophageal sphincter length (LESL) was significantly increased. The percentage of tertiary, nonpropulsive esophageal waves, that was very high in basal conditions (74.9 +/- 34.5%) and following instillation of acid into the esophagus (79.8 +/- 20.2%) remained high (58 +/- 23.2% and 72.1 +/- 18.2% respectively) several months postoperatively. The persistence of abnormal peristalsis after surgical cure of GER suggests that severe symptoms in this group of patients resulted from the simultaneous failure of both components of the antireflux mechanism (LES and esophageal peristaltic "pump"), which led to increased acid exposure. The good results of surgical establishment of an effective valve-like barrier alone illustrate the possibility of compensation by only one of the components when the other fails. According to this interpretation, whereas patients with good peristalsis would tolerate GER fairly well, those with GER and bad peristalsis would have increased acid exposure and, consequently, esophageal damage.
Child↗
[Gastroesophageal reflux in neurologic patients].
Sixteen among the 129 children operated upon for GER in the last 9 years had neurologic diseases with psychomotor retardation. Average age at diagnosis was advanced (90 months) although most patients vomited since infancy and more than 50% had haemorrhage as a sign of oesophagitis which was endoscopically confirmed in 10 cases. Prolonged acid exposure as proven by extended pH-metry was due to motor failure with incompetence of the LES and abnormal peristalsis (aside with other minor factors) as we could demonstrate manometrically. Surgical treatment achieved good results in almost all cases and we think that there is no reason not to offer its benefits to this group of patients. GER is more frequent and severe in brain damaged patients than it can be judged by the scarce number of them operated upon in our country. It must be looked after in them and treated appropriately whenever complications make it advisable.
Adolescent↗
[Functional study of gastroesophageal reflux in children with brain diseases].
Aiming to evaluate the participation of oesophageal motor troubles in the pathogeny of gastro-oesophageal reflux in brain-damaged children, we have studied 16 of these patients. Most of them had a more or less severe esophagitis due to excessive acid exposure. We have found a decreased LESP as compared to normal subjects (8.84 +/- 6.20 vs. 18.33 +/- 6.55 mmHg (p less than 0.001)), and high percentages of non-propulsive waves in basal conditions (70 +/- 29.66 vs. 6.25 +/- 9.16 (p less than 0.001)) as well as after serum (66.33 +/- 28.06 vs. 16.66 +/- 13.66 (p less than 0.001) and acid instillation (58.33 +/- 28.91 vs. 26.41 +/- 12.04 (p less than 0.05)). These results demonstrate that motor disturbances are responsible for the severity of GER in this group of patients.
Adolescent↗
Cricopharyngeal dysphagia and gastro-oesophageal reflux.
Nasal regurgitation of milk and choking after feeding were observed in a 1,450 g newborn boy. A nasogastric tube was inserted and several episodes of aspiration pneumonia occurred after every interruption of gavage. Weight gain was very slow. At the age of 7 months, cineradiographic studies depicted cricopharyngeal spasm and passage of the barium into the nasopharynx and larynx. Pharyngo-oesophageal manometry showed incoordination, high cricopharyngeal pressure and incomplete relaxation of the muscle. Extended lower oesophageal pH-metering revealed severe gastro-oesophageal reflux. After cricopharyngeal myotomy and fundoplication the patient recovered, x-ray findings improved, and so did manometry except for a persistent incoordination. Functional studies are mandatory for diagnosis of this complex clinical pattern. The need for ruling out gastrooesophageal reflux before myotomy in order to prevent subsequent severe aspiration, is pointed out.
Deglutition Disorders↗
[Esophageal peristalsis and acid clearance. A study method].
Peristaltic waves account for clearance of acid refluxed into the oesophagus, acting as a second anti-reflux barrier. We have developed a system combining oesophageal motor and pH studies. We use a three-lumen, constantly perfused, manometry probe attached to a pH microelectrode. Primary and secondary oesophageal waves are able to clear injected acid from the oesophagus, whilst non-propulsive tertiary waves do not raise pH back to normal levels. Children with severe GER have a high proportion of tertiary waves, and it is tempting to incriminate these motor disturbances as an important for their bad tolerance to GER.
Acids↗
Appendiceal perforation and shigellosis.
Appendiceal perforation and shigella enteritis were concomitantly observed in a 5-year-old boy. S. Sonnei was recovered from peritoneal exudate and faeces. This association must be kept in mind when treating patients with abdominal pain and gastroenteritis.
Appendicitis↗
[Surgical repair of the spleen in children].
Splenectomy is the easiest solution, and a still widespread surgical approach for the management of traumatic spleen rupture. Nevertheless, the evidence of an increased risk of overwhelming sepsis in splenectomy patients has encouraged the development of techniques for organ repair and conservation. We report on four patients with spleen rupture repaired surgically in our institution. In two of them we performed a splenorrhaphy alone and in the remaining two this was completed with a partial splenectomy. There were no immediate or late postoperative complications. The patients have been followed-up for periods ranging from 1 to 2 1/2 years and all show isotopic evidence of spleen activity in amount related to the remaining organ. We feel that splenic repair and conservation is possible in most cases and must always be given a trial.
Child↗
[Pancreatic resection in the treatment of infantile hypoglycaemia].
Authors report four patients with hyperinsulinemic unremitting hypoglycaemia due to pancreatic nesidioblastosis. Onset was neonatal in three of them and at the end of the first year in the remaining one. After variable periods of only partially successful medical therapy, the four patients were operated and subtotal pancreatectomy was carried out. This alone was sufficient in one case, and in another one diazoxide made control possible. The other two children had a total pancreatectomy, and one of them has needed insulin ever since. Hypoglycaemia is under control in all children and only one has mental impairment. Diagnostic work-up and surgical techniques are described, and the need for a prompt operation when medical control is incomplete is stressed. Although apparently a blind and major undertaking, surgery is still the only way of preserving neuronal function in some selected cases.
Adenoma, Islet Cell↗
[Gastroesophageal reflux with respiratory manifestations. Manometric and pH-metric study].
Gastroesophageal reflux can be found in patients with respiratory tract disease even in the absence of vomiting. A manometric and pH-metric study carried out in 69 children with radiologic reflux (of whom 49 had respiratory symptoms) and 10 normal controls has shown: 1. lower esophageal sphincter pressure was lower in refluxing patients than in controls, but values were significant only for those with vomiting; 2. all parameters of prolonged esophageal pH-metry indicating reflux were very significantly abnormal in the group of respiratory patients who were by this respect very similar to vomiting refluxers; 3. nevertheless, one fourth to one third of these patients were manometrically and pH-metrically normal. These data confirm that there is a relationship between gastroesophageal reflux and bronchopulmonary disease. A widening of the field of antireflux therapy can be predicted for the near future, although a further definition of the indications is necessary.
Asthma↗
[Analysis of germ cultures in 57 cases of appendicular peritonitis and 16 postoperative septic complications].
Reliable bacteriological data were obtained from 53 and 16 out of 64 pediatric appendiceal peritonitis an 17 of their suppurative complications. Studies for aerobic and anaerobic flora ws performed in all. Each primitive peritoneal exudate contained a mixed flora with an average of 1.3 aerobic and 2.27 anaerobic species. E. coli and B. fragilis were almost constantly found among other enteric bacteria. Exudates from wound or intraabdominal complicative infections contained an average of 1.3 aerobic and 3 anaerobic species, and again E. coli and B. fragilis were constantly present. In eleven patients, there were exudates available from both the peritonitis and the complications, and the flora was coincident for, at least, one gram in all, and for two or more in eight. These facts enable us to point out the importance of anaerobes in peritoneal infections and their complications. At the same time, we recall that antibiotic treatment of peritonitis must be prescribed with this evidence in mind.
Abscess↗
[Internal hernia through Treves' avascular field defect (author's transl)].
Authors report two cases of internal hernia through Treves avascular field defects, at the ileal level and another case in which this mesenteric mishape was incidentally found during operation for intestinal obstruction due to adhesions. In this particular case it can be speculated that the defect could have been the cause of a former neonatal obstruction for which operation did not offer an explanation. This type of internal hernia is one of the rarest in pediatric surgical practice. The clinical picture is that of an intestinal strangulation and therefore diagnosis can hardly be made preoperatively. The ileal terminal location of the strangulated loop can, in their opinion, justify a resection extending to the caecum in order to avoid vascular risks on the anastomosis in spite of the sacrifice of the ileo-cecal valve. The three patients survived. Literature on this topic is briefly reviewed.
Cecum↗
[Mesenteric cystic lymphangiomas (report of three cases) (author's transl)].
Three cases of mesenteric cystic lymphangiomas in children are reported. All of them were found during laparotomies for acute abdomen, and their pathology was rather similar, except for the contents which was chylous in the two cases located in the jejunum and serous in the remaining ileal case. One of these tumours contained calcified material, a fact which makes diagnostic suspicion possible. The literature on this topic is up-dated.
Abdomen, Acute↗