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J Pinus

Publications and source records attributed to J Pinus.

17 recordsLinked to original sources
PubMed1998

Gastric-tube esophagoplasty in children.

From 1979 to 1996, 19 patients underwent gastric-tube esophagoplasty. There were 10 boys and 9 girls, aged between 1 year 4 months and 4 years 11 months at the time of surgery. In 1 patient the esophagoplasty was performed due to a long stenosis secondary to reflux; 3 others had caustic stenoses; and the remaining patients had esophageal atresia. In 17 cases an isoperistaltic gastric tube was brought up to the neck through the retrosternal space; in 2 an anisoperistaltic gastric tube was used, cervical mobilization being via the posterior mediastinum without a thoracotomy in 1 case and by the left transpleural route in the other. The cervical anastomosis was carried out in one surgical stage in 12 patients and in two stages in 7. In 1 patient the tube was resected due to necrosis of its proximal third; the child later underwent an esophagocoloplasty. Necrosis of the colic graft, mediastinitis, and septicemia occurred, leading to the only death in the series. There were 12 fistulas of the cervical anastomosis (63.3%) and 8 stenoses (42.1%). All fistulas, with 1 exception, closed spontaneously after 8 days to 2 months, and all stenoses were treated by endoscopic dilatation. Another patient developed a fistula of the gastric tube with chronic evolution to a stenosis of the distal third of the tube and communication with the right lower pulmonary lobe. A lobectomy and closure of the fistula were necessary. All patients were followed for a period of 1 to 16 years. At present, all of them swallow solid food normally. The evolution of the nutritional status was normal (eutrophic) in 14 of the 18 patients (77.7%) who survived the operation; 4 showed variable degrees of malnutrition. In 2 of these 4 cases the malnutrition was due to poor socioeconomic conditions, but was not related to the surgery. Redundancy, a problem associated with esophagocoloplasty, was not observed in any of the gastric tubes, which was attributed to the thickness of the gastric wall. The authors prefer the use of an isoperistaltic gastric tube (with proximal base) for esophageal replacement in children and recommend that the operation should be carried out when the child is able to swallow solid foods and walk. As in any other major surgical procedure, a good nutritional state is essential prior to operation.

Child, Preschool↗
PubMed1983

Caroli's disease in childhood: report of two new cases.

Caroli's disease is a rare congenital disorder characterized by segmentary saccular dilatation of the intrahepatic bile ducts, which manifests itself clinically by cholangitis and bile stones. We report two cases of Caroli's disease in schoolgirls with clinical signs of recurrent abdominal pain associated with intermittent crises of cholestatic jaundice. Diagnosis was made by retrograde cholangiography in one patient and by intravenous cholangiography in the other.

Abdomen↗
PubMedDate not supplied

Crossed testicular ectopia.

Crossed testicular ectopia (CTE) is a rare anomaly, characterized by migration of one testis towards the opposite inguinal canal. Presented here is a case of crossed ectopia of the right testis, treated by extraperitoneal transposition of the gonad and right orchiopexy. Embriology and surgical findings suggest that CTE is a common consequence of many unclear ethiologic factors, specially mechanical ones, and can be associated with Muller duct persistence. Review of literature suggests a classification of CTE into 3 types: I--associated with inguinal hernia alone; II--associated with persistent mullerian remnants; III--associated with other anomalies without mullerian remnants. Treatment includes transeptal orchiopexy or extraperitoneal transposition of the testis, research for mullerian remnants and other anomalies, and long term postoperative follow-up, due to the risk of becoming malignant.

Child, Preschool↗
PubMedDate not supplied

Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations.

PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.

Child↗
PubMedDate not supplied

Use of biofeedback (BFB) in the treatment of fecal incontinence after surgical correction of anorectal malformations by posterior sagittal anorectoplasty (PSARP).

OBJECTIVE: To evaluate biofeedback (BFB) responses to rehabilitation techniques and physical exercises in incontinent or partially continent anorectal malformations patients after posterior sagital anorectoplasty (PSARP). DESIGN: Prospective study. SETTING: Pediatric Surgery-Department of Surgery-UNIFESP-EPM. PATIENTS: The authors report on 14 patients with anorectal malformations (4 with partial fecal incontinence after primary PSARP; 6 with fecal incontinence after primary PSARP; 3 with partial fecal incontinence after secondary PSARP; and 1 with fecal incontinence after secondary PSARP). All patients were rehabilitated via a BFB program of exercises in order to improve the function of the anal sphincteric muscular complex for a period of 1-3 years. MAIN OUTCOME MEASURE: Clinical and manometric control. RESULTS: After BFB, of 4 partially continent patients after primary PSARP, 3 became continent; of 6 incontinent patients after primary PSARP, 4 became continent; of 3 partially continent patients after secondary PSARP, 1 became continent, 1 showed no improvement and 1 became incontinent (infection + abscess + fibrosis + important anorectal stenosis). The incontinent patient after secondary PSARP showed no improvement. CONCLUSION: The authors concluded that BFB, used at the appropriate time with patient collaboration, is an important complement to the anatomical reconstruction of anorectal malformations in order to achieve good development and contractile functioning of the sphincteric muscular complex.

Adolescent↗
PubMedDate not supplied

Clinical and radiological postoperative evaluation of posterior sagittal anorectoplasty in patients with upper and intermediate anorectal malformations.

The PSARP is today the most-used surgical technique for correction of high and intermediary anorectal malformations. There is much controversy in the literature about the post-operative evaluation of these cases. We studied 27 cases of anorectal malformations from clinical and radiological aspects, in order to analyse: 1. Fecal continence 2. Relationship between post-operative fecal continence and the associated sacral anomalies 3. Relationship between the radiological evaluation by defecogram and fecal continence From the analysis of the cases, we concluded: 1. Fecal continence was achieved in 48.14% of the cases; partial continence in 25.92%; and fecal incontinence in 25.92% of the cases. 2. The presence of fecal incontinence was directly related to the associated sacral anomalies.

Child↗
PubMedDate not supplied

The rebound effect in the treatment of complex hemangioma with interferon alpha 2A.

The authors report the case of an infant with an extensive face hemangioma with subglottic airway obstruction which had been successfully treated with interferon alpha 2A but then reoccurred with the same dimensions and airway blockage after treatment was abruptly interrupted. The authors suggest the implementation of a standard procedure for the interruption of interferon alpha 2A treatment in order to avoid this rebound effect and advise on the need for further studies to properly evaluate dosage and administration parameters for interferon alpha 2A in the treatment of difficult hemangioma.

Airway Obstruction↗
PubMedDate not supplied

[Anatomo-radiological study of the origin of the left gastroepiploic artery].

In an effort to aid the surgical procedures of the gastric-esophageal region, the authors tried to establish the most frequent anatomo-radiological patterns of the left gastroepiploic artery origin. The search consisted of thirty cases and it was possible to distinguish three fundamental types of vascular source. The absence of literature using the radiological method made this contribution very important to complete the anatomical studies.

Angiography↗