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J Pérez Frías

Publications and source records attributed to J Pérez Frías.

15 recordsLinked to original sources
PubMed2003

[Techniques and complementary techniques. Fiberoptic bronchoscopy in mechanically ventilated children].

Fiberoptic bronchoscopy can be performed at the patient's bedside. This technique allows direct visualization of the upper and lower airways up to the segmental and subsegmental bronchi. Its most frequent indications are airway examination ot evaluate damage produced by toxins or the endotracheal tube, patency of the endotracheal tube and extubation failure. It is also used to obtain microbiological samples, facilitate intubation when difficult, aspirate airway sections or mucus plugs, perform bronchoalveolar lavage and administer drugs. With prior preparation, adequate monitoring and sedation, material according to the size of the patient and correct techniques, there are few complications. However, the procedure can produce trauma and obstruction of the airway, bronchial hemorrhage, barotrauma, loss of alveolar recruitment, bronchospasm, hypoxemia, bradycardia, and bronchopulmonary infection.

Bronchi↗
PubMed2001

[Management of parapneumonic pleural effusions].

Pleural effusion in children is most often due to bacterial pneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40% of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism. Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100%, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100% of patients, also depending on the effusion stage.

Algorithms↗
PubMed2001

[Pleurodesis with tetracyclines after fontan operation].

Chemical pleurodesis consists of the fusion of both pleural layers after contact with certain substances, and is used in the treatment of prolonged or recurrent pleural effusions refractory to other therapeutic approaches. This procedure has been extensively used in adults with malignant pleural effusion but has rarely been used in children. The Fontan technique is used in the treatment of tricuspid atresia and other heart diseases that act as a single ventricle. This technique frequently presents complications due to fluid retention (edema, ascites, pleural and pericardial effusions and protein-losing enteropathy). With persistent or recurrent pleural effusion, chemical pleurodesis through the drainage tube might constitute a safe and reliable alternative treatment. We report the case of a female patient with tricuspid atresia, who presented recurrent pleural effusion after undergoing the Fontan procedure. The disorder was resolved by chemical pleurodesis with tetracycline.

Child↗
PubMed1999

[Usefulness of fiberoptic bronchoscopy in critical pediatric care].

UNLABELLED: Fiberoptic bronchoscopy (FB) is being applied increasingly in pediatrics as a therapeutic and diagnostic technique. OBJECTIVE: To analyze the contribution of FB to the diagnosis and treatment of respiratory disease in patients admitted to the pediatric intensive care unit (PICU). PATIENTS AND METHOD: We reviewed FB performed with 3.5 and 2.2 mm external diameter instruments between January 1989 and October 1998 in patients admitted to the PICU. Underlying disease and purpose of and indications for FB were analyzed. We also analyzed route of insertion, findings of airway inspection and bronco-alveolar lavage (BAL), complications and the contribution of FB to patient management. RESULTS: A total of 51 procedures in 47 patients aged between ten days and 12 years old were performed. Twenty-one children (41%) were under one year old. The initial indications for FB were diagnostic in 73% and therapeutic in 27%. Airway inspection showed abnormality in 65%. BAL was performed in 18 cases, with microbiological findings in 8 of the 18. The patients benefited directly from the technique in 75% of cases. CONCLUSIONS: FB is useful diagnostic and therapeutic procedure in PICU patients and is generally well tolerated.

Age Factors↗
PubMed1998

[Incidence and current clinical spectrum of tuberculosis in a metropolitan area in the south of Spain].

BACKGROUND: To study the incidence and clinical spectrum of tuberculosis in the metropolitan area of Málaga (Spain). METHODS: Prospective study which includes all patients who had a diagnosis of tuberculosis within the referral area of "Carlos Haya" Málaga Regional Hospital from March 1, 1993 to February 28, 1994. RESULTS: During the study period, there were 138 cases of tuberculosis, with an incidence of 43.7 cases/10(5) inhabitants. Ninety one cases (66%) were male, and the mean age (SD) was 33.2 (18.3), with 88% being less than 55 years old. Thirty six patients (26.1%) were HIV-infected. Extrapulmonary tuberculosis made up 27.5% of the cases, and was more frequent in HIV-infected patients (p < 0.01; odds ratio: 2.9; 95% CI: 1.2-7.1). The mean (SD) time to diagnosis was 54.3 (76) days. The diagnosis was microbiologically confirmed in 106 cases (76.8%), histologically in 14 cases (10.1%), and the remaining 18 cases (13.1%) were clinically diagnosed. The global rate of resistance was 10.8%. The rate of primary resistance was 4.6%, and the rate of multidrug-resistant tuberculosis was 3.1%. Eighty nine patients (77.4%) were cured, six patients (5.2%) stopped the treatment, 3 (2.6%) had relapses and 1 (0.9%) was considered a therapeutic failure; 16.7% of patients were lost for follow-up. Sixteen patients died and in nine of them (6.5%) the death was attributed to tuberculosis. CONCLUSIONS: The incidence of tuberculosis in Málaga urban area is high. It mainly affects young males of unfavored socio-economic classes. HIV-infected patients account for a high percentage of the cases. The high number of productive cases and the long time to diagnosis evidence the shortcomings of our sanitary system. These facts, together with the high rate of non-compliance, of treatment may explain the seriousness of the current situation in our country.

Adolescent↗
PubMed1998

[Pulmonary symptoms of primary immunodeficiency diseases].

OBJECTIVE: Patients who lack major components of the immune system carry an increased risk for severe and recurrent pulmonary infections at those respiratory sites were the deficient component would, in the normal state, have its greatest concentration. We report different pulmonary manifestations in pediatric patients with primary immunodeficiency disease (PID). PATIENTS AND METHODS: We studied 44 children younger than 14 years old, who were diagnosed of PID in our pediatric department between January 1990 and May 1996. RESULTS: Antibody deficiencies were the most frequent disorders (27/44; 61.3%) followed by PID associated with or secondary to other disorders (10/44; 22.7%) and defects of phagocyte function (5/44; 11.3%). Twenty-seven patients (61.3%) showed relevant pulmonary manifestations that required assistance in the division of pediatric pulmonology. Bronchial responsiveness was seen in 17/27, 11/27 had recurrent pneumonias with development of bronchiectasis in 7/27. Opportunistic or severe pneumonias leading to acute respiratory failure were diagnosed in 9/27. Necrotizing pneumonias leading to development of pneumatoceles, cavities or abscesses was seen in 3/27 with the same rate for lymphoid interstitial pneumonia. Respiratory symptoms were the first manifestations of PID in 19/27 (70.3%). CONCLUSIONS: The findings of the study emphasize the responsibility of the pediatric pulmonologists in avoiding the delayed diagnosis of PID since the prognosis depends on the precocity of diagnosis.

Child↗
PubMed1996

[Endoscopic evaluation of endobronchial tuberculosis in children].

The aim of this study was to determine the role of fiberoptic bronchoscopy (FB) in pulmonary tuberculosis in children. We assessed bronchoscopic findings of 36 procedures performed in 30 children who presented the following abnormalities on chest films: lobular or segmentary atelectasis (17), paratracheal or parahilar adenopathies (14), parenchymatous consolidation (9) and localized hyperinflation (5). Premedication for FB included intravenous atropine and diazepam plus ketamine for sedation, as well as lidocaine 2 and 5% in aerosol form for topical anesthesia. FB results showed that involvement was endobronchial in 29 patients. In the 18 patients with X-rays suggestive of endobronchial tuberculosis (EBT), the diagnosis was confirmed by FB. Significantly, EBT was found by FB in 11 (36.6%) patients with no clinical or radiological signs of such involvement. EBT was in the early stages in 3 (10%) patients and was advanced in 8 (26.6%). M. tuberculosis was isolated in 9 (30%) of the 30 patients. Culture was of bronchoalveolar lavage in three, of gastric lavage in four and of endobronchial biopsy in two. We conclude that FB is a safe, important tool for the confirmation of EBT in the management of pulmonary tuberculosis in children. It serves as a guide for the start of steroid treatment, especially in children with no radiological suggestion of EBT.

Age Factors↗