Biomedical subjects
Publications and source records attributed to J Utrilla.
A female newborn presented a mass in the left upper abdominal quadrant. It was removed by surgery and contained two independent fetuses. Dissection and radiological study of the fetuses showed an axial skeleton and long bones. It corresponds to the generally recognized diagnostic criteria of fetus in fetu.
Four patients with portal hypertension, oesophageal varices and severe hypersplenism were treated by partial splenic embolization. All showed improvement of blood and platelet counts early in the postoperative period. Three months after embolization IgA and C3 levels increased significantly. All patients had a decrease in the incidence of variceal bleeding and this procedure provides an acceptable alternative to splenectomy.
Intestinal malrotation has received, so far, little attention in the Spanish medical literature. This is probably due to the fact that is variable forms of clinical presentation may be overlooked during infancy and childhood and be present or not later in adult life. This is a report on 33 patients between 1 week and 8 years old operated upon, from 1965 to 1985, at the Clinica Infantil "La Paz", Madrid, with pre or postoperative diagnoses of intestinal malrotation (patients with Bochdalek's hernia, omphalocele and gastrosschisis are excluded). Midgut volvulus has been the most frequent preoperative complication and has occurred in 50% of patients. Intestinal obstruction was the most frequent clinical presentation, specially in patients under one week of age. There was a 30% figure of associated malformations, mostly of the duodenojejunal area (atresia, diaphragm, anular pancreas). All 5 deceased patients had other associated malformations. Long term survival was 85%.
Sixty newborn infants with necrotizing enterocolitis (NEC) were retrospectively studied in 1979. The incidence was 0,49/1.000 living newborns: 81% were under 2,500 g and 30% under 1.500 g. We found a very low incidence of the so-called pathogenic factors. Feeding started in this group on the 24 h of life, with adapted formulas; 28% underwent surgery with a postoperative mortality of 62% and an overall mortality of 28%. Ten out of the 17 deceased were under 1.500 g. From 1979 with a similar medical treatment we introduced a prospective study consisting of a protocol of 10 different parameters including clinical, radiological and analytical values, the aim being a more objective way of indicating when to operate the patient. Special meticulous care of the nutrition of the low-weight babies was taken; 22 patients were treated til 1982, only 4,5% were under 1.500 g. The initial feeding time in all high risk babies under 1.250 g being 7 days with gastric gavage and elementary diets. All the infants with more than 60% values in the protocol underwent surgery (38%). The postoperative mortality was 37% with an overall mortality of 19%. A look back to our series suggests a clear usefulness of the protocol and the suspicion that the delay on feeding with intragastric continuous perfusion in low weight babies reduces NEC.
Authors present a case of a Leydig cell testicular tumor in a boy aged three years with a six-month follow-up. This type of tumor which is usually hormone-producing has in children a virilizing effect giving signs of pseudoprecocious puberty. Hormonal tests before and after surgery are described as well as the histological study. The various possibilities of differential diagnosis, treatment and prognosis in the presence of a unilateral testis enlargement in a boy are commented.