[Fetal pulmonary growth after tracheal occlusion in the human fetus with congenital diaphragmatic hernia].
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Fetal Development↗
Biomedical subjects
J Lloret
Publications and source records attributed to J Lloret.
[New surgical strategy in gastroschisis: treatment simplification according to its physiopathology].
INTRODUCTION: Gastroschisis (GS) is a congenital abdominal wall defect that permits bowel exposure to amniotic fluid (AF). Intestinal damage is related to the chemical action of AF and constriction. After birth at term, a thickened intestinal wall with inflammation and, in some cases, intestinal atresias were observed. Surgical repair and intestinal reubication may be difficult, and thus staged silo repair could be necessary. These patients require a long hospital stay owing to bowel damage causing severe intestinal hypoperistalsis and poor absorptive capacity. Total parenteral nutrition (TPN) is required for a long period. OBJECTIVE: The aim of this prospective study is to evaluate the benefits of a preterm delivery to avoid bowel damage and its post-natal consequences. PATIENTS AND METHODS: Six cases of prenatally-diagnosed GS have been treated following a new strategy since July 2002. A preterm Cesarean section (c-section) delivery was programmed at 34-35 weeks of gestational age (GA). Some hours after birth, at bedside in the NICU, bowel reduction through the defect hole was performed under general anesthesia. This preterm group (PT) was compared the past 6 cases at term (AT) from January 1998 to July 2002. Macroscopic appearance, atresia existence, surgical technique, silo requirement, neonatal outcome, TPN and hospital stay were analyzed. RESULTS: All six cases AT (mean GA: 36.3 weeks) presented bowel inflammation and thickened wall. Only 2/6 cases allowed the intestine to be housed in a primary closure after laparotomy. 4/6 cases required staged silo repair. 1 patient presented intestinal atresia and other had perforations who died at 17 days of life from intestinal sepsis. Mean postoperative intubation period was 16.2 days. Mean TPN was 41.2 days and mean hospital stay 69.8 days. PT group was monitored by prenatal sonography seeking bowel sonolucency. After programmed PT c-section delivery (mean GA: 34.8 weeks) in all 6 cases, bowel loops presented normal appearance and intestinal thickening was absent, except in one case. No prematurity-related respiratory complications were observed. Easy bowel reduction without abdominal compression was performed in all cases. 1/6 cases required surgical release of occlusive intestinal adherence. Mean postoperative intubation period was 0.4 days (9.6 hours). Oral feeding was started at 6 days. Mean TPN was 13.4 days and mean hospital stay 28.6 days. CONCLUSIONS: The third trimester is a critical period for fetal bowel development. Intestinal damage rises with increasing exposure time to amniotic fluid. This strategy of preterm delivery for the treatment of GS avoids intestinal damage, prevents "peel" and intestinal atresia, renders surgical reduction easier, reduces the hypoperistalsis, need for TPN and hospital stay. Multidisciplinary coordination between obstetricians, neonatologists and pediatric surgeons is required.
Digestive System Surgical Procedures↗
[Intrauterine treatment of severe congenital diaphragmatic hernia. European Collaboration Protocol].
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Clinical Protocols↗
[Pancreatectomy level in the persistent hyperinsulinic hypoglycemia].
INTRODUCTION: Persistent neonatal and infantile hyperinsulinemic hypoglycemia (PNHH) is a rare entity which remains to be elucidated but associated with severe lesions in pediatric patients. The aim of this study is to present our current surgical strategy face to this disease, based on our pathology findings and clinical experience. MATERIAL AND METHODS: It is a retrospective study of 29 patients treated at our centre, medically and surgically. In 15 surgical patients, morphologic, morphometric and immunohistochemical studies for insulin, somatostatin and glucagon were performed and consequently it has been possible to establish a focal and different forms of a diffuse type. RESULTS: Out of 29 patients studied, 25 were diagnosed before their first year old and 4 patients between the first and second infancy. Of the 25 first patients, one died at 7 hours postpartum. Twelve patients only received medical treatment, one of them died at 45 days of life and the remaining 11 patients had good outcome. Another 12 patients received in addition surgical treatment. In 2 of them we observed adenoma which was removed and patients cured. In the remaining 10 patients a subtotal pancreatectomy was performed. (One case was informed as normal and cured and the other 9 had the diffuse type). Of these 9 patients with diffuse type, 4 died, 3 cured and 2 underwent second surgery. Out of the 4 patients diagnosed in infancy, 3 underwent surgery (2 adenomas and 1 diffuse type) and the other one received only medical treatment. CONCLUSIONS: Currently, we give medical treatment in all types and forms of PNHH. If the patient is resistant, we dismiss adenoma. If this is diagnosis we remove it. If the type is diffuse, near-total pancreatectomy is performed with a peroperatory biopsy. In cases of hyperplasia or mixed form we recommend a total pancreatectomy and in case of nesidioblastosis we recommend a partial pancreatectomy.
Child↗
[Thyroid carcinoma:Experience 57 cases. Is there a different bio-development in pediatric age?].
UNLABELLED: It has been suggested a different biodevelopment in the differentiated thyroid cancer in pediatric age. General and pediatric surgeons from different centres has coincided to operate this kind of pediatric pathology that finally conclude the treatment in the nuclear medicine department from the reference hospital. The objectives of this revision is, to confirm de difference in thyroid cancer in pediatric age and to know few factors implicated. MATERIALS AND METHODS: A review of 57 patients with differentiated thyroid cancer, medullary and anaplastic were excluded, treated in the nuclear medicine department during the last 20 years. 28% were < 10 years old (16 cases) and 72% > 10 years old (41 cases). This 57 young patients were operated in 22 hospitals and 79% by a general surgeon and 21% by pediatric surgeon. The analysis was performed with SPSS MS Windows 6.0 (chi cuadrado, t-Student-Fisher). RESULTS: There are more reinterventions in patients operated by a general surgeon. There aren't differences between the number of total neck dissections between both groups of surgeons, but when is performed, the incidence of complications is significantly high. In patients < 10 years old, there are more metastasis and more surgical complications. In spite of, all patients still alive. CONCLUSIONS: Children < 10 years old, the illness is more local aggressive and the recurrence and lung metastasis is high, more surgical complications. We recommend to concentrate this pathology in a few hospitals to achieve more experience and to avoid complications.
Adolescent↗
Retro-esophageal subclavian artery: a case report.
This case report presents the finding of an aberrant right subclavian artery during the routine dissection of 230 human adults specimens. The case which we describe appeared in an 82-year-old male donor, in whom the right retro-esophageal subclavian artery was observed as the last branch of the aortic arch. The rate of occurrence of this variation is stated to be less than 1%. This variation is described in detail; embryology and anatomy are reviewed and we discuss it in relation to other cases. The aortic arch was dissected, and its branches were described as regards their relations, length and diameter.
Aged↗
Spinal anaesthesia for inguinal herniotomy in preterm infants sedated with nitrous oxide: a comparison of lumbar puncture in the lateral or sitting position.
This study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L4-5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg-1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median [range] maximum block height was T5[T4-T7] in the lateral group and T5[T4-T5] in the sitting group. The median [range] duration of motor blockade was 67 [50-85] min in the lateral group and 63 [50-80] min in the sitting group. Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg-1 in the lateral or sitting position is equally effective and is associated with minimal side effects.
Anesthesia, Spinal↗
Pancreatectomy extension in persistent hyperinsulinaemic hypoglycaemia: a new strategy.
INTRODUCTION: Persistent neonatal and infantile hyperinsulinaemic hypoglycaemia (PNHH) is a rare entity which remains to be elucidated but is associated with severe lesions in paediatric patients. The aim of this study was to present our current surgical strategy with this disease, based on our pathologic findings and clinical experience. MATERIALS AND METHODS: This is a retrospective study of 29 patients treated, medically and surgically, at our centre. In 15 surgical patients, morphologic, morphometric and immunohistochemical studies for insulin, somatostatin and glucagon were performed and consequently it was possible to establish a focal and different forms of a diffuse type. RESULTS: Of 29 patients studied, 25 were diagnosed before one year of age and 4 between the first and second year of infancy. Of the first 25 patients, one died 7 hours post partum. Twelve patients received medical treatment alone: one died at 45 days of life and the remaining 11 had a good outcome. Another 12 patients additionally received surgical treatment. In 2 of these, adenoma were observed and removed and the patients cured. Subtotal pancreatectomy was performed in the remaining 10. (One case was normal and cured and the other 9 had the diffuse type.) Of these 9 patients with diffuse type, 4 died, 3 were cured and 2 underwent repeat surgery. Of the 4 patients diagnosed later, 3 underwent surgery (2 with adenomas and 1 diffuse type) and the other received medical treatment alone. CONCLUSIONS: We currently give medical treatment for all types and forms of PNHH. If the patient is resistant to therapy, adenoma is ruled out. If adenoma is diagnosed, it is removed. If the type is diffuse, near-total pancreatectomy is performed with a perioperative biopsy. In cases of hyperplasia or mixed forms we recommend total pancreatectomy and in cases of nesidioblastosis, partial pancreatectomy.
Adenoma, Islet Cell↗
[Diaphragmatic paralysis: pathology at the reach of the pediatric surgeon].
The phrenic nerve is the only motor nerve in the diaphragm. The injury will lead to a diaphragmatic paralysis or eventration with paradoxical movements during breathing. The aim of this review is to analyze the diagnostic criteria, surgical indications, and the patients that are not treated by surgery. We review 53 cases with diaphragmatic pathology in the last 5 years; 19 females and 20 males. One was a diaphragmatic rupture, 13 were diaphragmatic hernias, and 39 had diaphragmatic paralysis. Diaphragmatic paralysis was diagnosed by fluoroscopy in 97%, electromiography 5.1% or ultrasounds. The ethiology was 64% after cardiac surgery and 10% after thoracic oncologic surgery. The age at diagnosis was less than 1 month in 41% cases. In 29 patients the paralysis was well tolerated and were extubated between 24 h and 4 days after the diagnosis, frequently was in the first 48 h. 4 patients need a traqueostomy and 2 went to another hospital. In 5 we performed a diaphragmatic plication because the inability to be extubated or the persistence of respiratory distress. The paralysis was demonstrated by fluoroscopy. 2 patients are asymptomatic, 2 are in mechanical ventilation and 1 died (sepsis). The most frequent cause of diaphragmatic paralysis was related to cardiac or thoracic surgery. In general, is well tolerated, almost asymptomatic, the patients were extubated between 24 or 48 h. In pediatric population they are few cases that need surgical treatment. The patients that we operated on were less than 2 months old, because is at that age were the repercussion is more important. We must follow strict criteria, without precipìtation for the surgical indications.
Child, Preschool↗
[Laparoscopic splenectomy in pediatric hematologic diseases].
INTRODUCTION: Surgical acceptance of the laparoscopic splenectomy in the pediatric hematological disorders has improved due to safety, to relif postoperative pain, and to reduce the hospital stay. The aim of this study is present our surgical laparoscopic technique performed. MATERIAL AND METHODS: Eight patients, 6 spherocytosis (age ranged: 6-14 years, average age: 9.5 years; 5 girls and 1 boy) and 2 cases of autoimmune hemolytic anemia (both boys of 18 months and 4 years) underwent laparoscopic splenectomy. The Trias-Targarona technique has been performed placing the patient at the right lateral-decubitus position. Four trocars are placed, two of 5 mm in the posterior axillary line and epigastrium and other 2 trocars of 12 mm, in the middle of them. RESULTS: In all these 8 patients a laparoscopic splenectomy was completely performed. We had 2 cases with problems with the sac introduction. Cosmetic results have been excellent and we changed the 7-day antibiotic protocol for 2-day protocol. The surgical time has changed from 3 to 2 hours. CONCLUSIONS: With laparoscopic splenectomy we can give an adequate response to hematological disorders in children with a acceptable surgical time, an excellent cosmetic result with a minimum postoperative time and a very short hospital stay.
Adolescent↗
[Partial nephrectomy in unilateral Wilms tumor. New draft for a protocol of the SIOP].
Unilateral Wilms' tumor has been treated according to 9301 SIOP protocol, with good results. The new pre protocol that SIOP is developing has a high inclusion rate. From 1993 to 1999, 11 patients with unilateral Wilms' tumor were treated in our center; in 6 cases preop chemotherapy was done, in the other 5 cases pre and postoperative chemotherapy were used. Nine of the 11 patients could be included in the pre protocol this was due to a thrombosis of the vena cava in one case, and in the other the middle renal in area was widely affected. Wilms' tumor has a good prognosis with the actual protocol, SIOP. New pre protocol could give a better quality of life due to the amount of functional renal parenchyma, without decreasing the actual high cure rate.
Adolescent↗
Stimulus frequency affects c-fos expression in the rat visual system.
We have characterised the c-fos expression patterns in various centers of the visual pathway of adult rats monocularly stimulated either by continuous or flickering light at different frequencies. Results show different immunocytochemical patterns in all centers studied, the geniculate lateral complex (LGC), superior colliculus (SC) and primary visual cortex (Oc1), depending on the physical characteristics of the stimulus (blinking frequency and light wavelength). After stimulation of the left eye, the ipsilateral pathway presents a substantial density of immunoresponsive cells, which is greater than expected with respect to the number of fibers that project ipsilaterally from the retina to the LGC and the superficial layers of the SC. A surprisingly high positive immunoresponsiveness is obtained in all cases with coherent light stimulation in the red spectrum (634 nm).
Animals↗
MucR is necessary for galactoglucan production in Sinorhizobium meliloti EFB1.
Sinorhizobium meliloti can produce two types of acidic exopolysaccharides, succinoglycan and galactoglucan, that are interchangeable for infection of alfalfa nodules. Strain SU47 and derivatives produce only succinoglycan, unless it grows under phosphate limitation or carries a mutation in either of two regulatory loci, mucR or expR. It has been proposed that MucR acts as a transcriptional repressor that blocks the expression of the exp genes responsible for galactoglucan production. Strain EFB1 simultaneously produces both exopolysaccharides. Heterologous expression of lacZ transcriptional fusions of the expE promoters has shown that genetic background is more important that promoter sequence for exp gene expression, since expE promoters from both strains are expressed at high level in EFB1 and not in SU47. We have found that mucR is present in mucoid and nonmucoid strains, and in EFB1 differs from SU47 in only one conservative amino acid change. MucR proteins from both strains are interchangeable. An mucR mutant of EFB1 cannot produce galactoglucan and does not express mucS.
Bacterial Proteins↗
PCR use of highly conserved DNA regions for identification of Sinorhizobium meliloti.
A PCR identification method in which four primers that recognize homologous conserved regions in the Sinorhizobium meliloti genome are used was developed and tested. The regions used for identification were the nodbox 4 locus, which is located in one of the symbiotic megaplasmids, and the mucR gene, which is located in the chromosome. The new method was used to establish a collection of S. meliloti strains from polluted soils.
Bacterial Proteins↗
[False positives in the detection of Meckel's diverticulum].
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Barium↗
[Burns in childhood. Social implications in the eve of the year 2000].
INTRODUCTION: The thermic wounds in childhood are the third cause of morbility at hospital in our ambiance. The knowledge about incidence, the causal agents more frequent, and the detailed analysis of different variants about the subject are the unique manner to try to establish precautions against. The aim of this project is to analyse the factors and situations associated with thermic wound, through the retrospective study about the patients admitted. MATERIALS AND METHODS: During three years, 362 patients were admitted at hospital, between 0 and 14 years old, following the criterion: barge burn size more than 10%, critical location (hands, face, neck), causal agent (electricity, chemical) or social situation. Different facts were analyzed about provenance, place, causal agent, burned part of the body, degree of lesion and the average stay at hospital. RESULTS: There were 59.6% males, and 40.3% females. Children between 1 and 5 years old, represented the largest group of patients, 205 cases. The 66% were from other hospital were they receive the first aid. The 98.7% were burned at home, and the place more frequent was kitchen, 51%. The causal agent was liquid in 65.4%, specially scald with water about 104 cases. The zones more affected were the face (39.2%), and the superior extremities, about 81% second degree superficial or deep. The size was 10 to 20% in 19% of patients, and more than 40% in 0.2% of children. The average stay was 17.47 days at hospital.
Adolescent↗
Changes in growth, growth hormone, and insulin-like growth factor-I (IGF-I) after orthotopic liver transplantation.
Growth failure is an important consequence of chronic liver disease in childhood. Insulin-like growth factor-I (IGF-I), which is synthesized and released by the liver, plays an important role as a growth regulator in humans. We examined the growth hormone (GH)/IGF-I axis before and after orthotopic liver transplantation (LT) in 14 children aged between 2 and 11 years (mean 5.6 +/- 1.1 years). Pre-transplantation serum GH levels (7.5 +/- 1.2 ng/ml) were significantly higher (P < 0.001) compared with controls (5 +/- 0.5 ng/ml). However, post-transplantation levels (1.8 +/- 0.8 ng/ml) did not differ from those in the control group. Serum IGF-I levels showed a statistically significant increase after LT (20.1 +/- 9.4 vs 190 +/- 66.2 ng/ml; P < 0.001) and became indistinguishable from the levels in the control group (180 +/- 96 ng/ml). In comparison with pre-transplantation data (z - 2.70), there was an increase in height 4 years postoperatively (z - 1.68). Catch-up growth was highly significant, in particular during the 1st year after LT (z -1. 58 +/- 1.63 vs 2.59 +/- 5.29; P < 0.01). We conclude that a GH resistance state found in patients with severe chronic liver disease reverted following LT. Given that IGF-1 depends upon liver function, this could be one of the main factors in the significant catch-up growth in pediatric LT recipients.
Child↗
Exopolysaccharide II production is regulated by salt in the halotolerant strain Rhizobium meliloti EFB1.
The halotolerant strain Rhizobium meliloti EFB1 modifies the production of extracellular polysaccharides in response to salt. EFB1 colonies grown in the presence of 0.3 M NaCl show a decrease in mucoidy, and in salt-supplemented liquid medium this organism produces 40% less exopolysaccharides. We isolated transposon-induced mutant that, when grown in the absence of salt, had a colony morphology (nonmucoid) similar to the colony morphology of the wild type grown in the presence of salt. Calcofluor fluorescence, proton nuclear magnetic resonance spectroscopy, and genetic analysis of the mutant indicated that galactoglucan, which is not produced under normal conditions by other R. meliloti strains, is produced by strain EFB1 and that production of this compound decreases when the organism is grown in the presence of salt. The mutant was found to be affected in a genetic region highly homologous to genes for galactoglucan production in R. meliloti Rm2011 (expE genes). However, sequence divergence occurs in a putative expE promoter region. A transcriptional fusion of the promoter with lacZ demonstrated that, unlike R. meliloti Rm2011, galactoglucan is produced constitutively by EFB1 and that its expression is reduced 10-fold during exponential growth in the presence of salt.
Base Sequence↗