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M Castañón

Publications and source records attributed to M Castañón.

At least 19 recordsLinked to original sources
PubMed2006

[Lessons we've learned in the treatment of long gap esophageal atresias].

BACKGROUND: A gap greater than 3 cm between both esophageal pouches is observed in 1 of 20 cases of esophageal atresia. Our goal was to critically review our experience in the management of these patients. MATERIAL AND METHODS: During 1995-2004, 15 patients were treated for a long gap esophageal atresia (LEA). Gaps ranged from 3 to 8 cm. Ten patients presented a pure esophageal atresia. They were managed with a gastrostomy and delayed repair: 8 Schärli interventions and 2 esophageal flaps. The other 5 patients had an esophageal atresia with distal fistula (LEA-DF), and primary repair was attempted: 3 end-to-end esophageal anastomosis were achieved under a strong tension; 1 a Schärli procedure; 1 ligation of the fistula, feeding gastrostomy and delayed esophageal flap. The use of esophageal flaps is a late event in our series. since its introduction we've performed 5 esophageal atresia repairs using 3 flaps (2 pure atresias and 1 LEA-DF). RESULTS: From 9 Schärli we have to practice 2 reinterventions for anastomotic leak; there was 1 parahiatal hernia that needed surgery after 8 years. From 3 flaps 2 patients presented a persistent stricture that needed reintervention. All of the 3 E-E anastomosis had reintervention for persistent stricture and also anti-reflux procedures (Nissen). Eight patients showed a normal growth and development (4/9 Schärli, 3/3 flaps and 1/3 E-E). Seven patients are growth retarded (4/7 with associated malformations, 1/7 who developed an eosinophilic esophagitis and 2/7 preterm babies). CONCLUSIONS: The esophageal flap is our first choice, because the own esophagic tissue fills in the gap. In LEA-DF, we prefer fistula ligation, gastrostomy and delayed rise of a flap (as we did in our last patient) better than a very tense primary anastomosis. As a second option, a Schärli procedure offers satisfying mid-term results. Keeping the patient paralyzed and mechanically ventilated for 5-7 days after surgery helps to avoid disrupting forces on the anastomosis.

Esophageal Atresia↗
PubMed2005

Comparative study between isolated intestinal perforation and necrotizing enterocolitis.

INTRODUCTION: Intestinal perforations in the neonatal period are usually related to necrotizing enterocolitis (NEC) or intestinal occlusion. Intestinal perforation in the absence of these conditions is called isolated perforation (IP). Several risk factors and pathogenic mechanisms have been suggested, and most of them are common to those classically attributed to NEC. AIM: To identify and compare the clinical and pathological features of IP and NEC. MATERIAL AND METHODS: We reviewed all cases of neonatal intestinal perforation and NEC in the last five years. Thirty-three patients were retrospectively classified into Group NEC: 24 cases, and Group IP: 9 cases. We collected multiple data as study variables: 1) General features; 2) Obstetric history; 3) Neonatal treatment; 4) Comorbidity; 5) Perforation features; 6) Treatment and outcome. RESULTS: Comparing the groups, we found statistical significant differences in isolated perforation cases with these risk factors: extreme prematurity, very low birth weight, abruptio placenta, intubation and neonatal mechanical ventilation, umbilical catheterization, precocious sepsis, and indomethacin therapy. A more precocious operation and a good prognosis also reached statistical significance. In the other hand, we found statistically significant differences in NEC with congenital cardiopathy (excluding isolated patent ductus arteriosus), with intestinal pneumatosis, with diffuse bowel involvement and a worse prognosis. Risk factors and pathologic findings seem to support an ischaemic pathogenesis in both diseases.

Enterocolitis, Necrotizing↗
PubMed2004

[Thoracoscopic thymectomy].

BACKGROUND/PURPOSE: The use of videothoracoscopy in thoracic pediatric pathology has been progressively accepted in different diagnostic and therapeutic procedures along last decade. The aim of this work is to analyze our initial experience in thymectomy through this approach. PATIENTS AND METHODS: We have used the thoracoscopic approach in the last two cases of thymus pathology with surgical indication. Case 1: 9 year-old patient recently diagnosed on myasthenia gravis and several hospital admissions because of clinical worsening. Case 2: 9 year-old patient with a 7x8x3.5 cm. cervico-mediastinal tumour. FINAL DIAGNOSIS: Multilocular cystic thymoma. In both cases we used right approach in lateral decubitus, and the harmonic scalpel. RESULTS: Mean operating time was 125 minutes. No procedure-related complications. They were discharged on the 6th and 4th postoperative day. After 6 and 7 month follow-up, no incidences have been found, and case 1 has shown a sympthomatic improvement and a decrease in drug dosage. CONCLUSIONS: Thoracoscopy is a good alternative in thymus approach. Its cosmetic and recovery advantages upon transcervical and transsternal are obvious. Despite our very initial experience, we believe that this approach at least equals classic ones in the ability to resect the whole thymus.

Child↗
PubMed2004

[Transanal endorectal pull-through alone as treatment of Hirschsprung's disease].

UNLABELLED: The aim of this work is to present our experience in the treatment of Hirschsprung's disease (HD) with the technique described by De la Torre. MATERIALS AND METHODS: Seven children diagnosed with recto-sigmoid aganglionism have been treated with this surgical technique, to which a few modifications have been done. RESULTS: There were no intra- nor early postoperative complications. Surgical time ranged 150 to 240 minutes (average 198). All children began oral feedings 2 or 3 days postoperatively (average 2.4). Hospital stay averaged 5.2 days. Follow-up ranges from 6 months to 3 years (average 16 months). Two late complications were seen--one anastomotic stricture and one constipation--and successfully treated as out patients. CONCLUSIONS: The transanal only approach carries a rapid recovery. Family satisfaction is high because of the lack of scars. We believe this is the treatment of choice when confronting rectosigmoid aganglionism.

Anal Canal↗
PubMed2004

[Congenital solid tumors. A thirteen-year review].

UNLABELLED: Tumors diagnosed during the first month of life are infrequent: 0.5 to 2% of all childhood neoplasms. This is an interesting group of tumors because their type, relative incidence, natural history and response to treatment differ from those seen in older children. AIM: To contribute the experience of our institution in congenital tumors the last 13 years. MATERIAL AND METHODS: The records of all neonates (< 31 days old) diagnosed with solid tumors since January 1990 to December 2002 have been retrospectively reviewed. RESULTS: Twenty-seven neonates have been diagnosed with tumors in the last 13 years. Thirteen patients (48%) were prenatally diagnosed. Nine babies were diagnosed at the initial neonatal exam (40% of those diagnosedd after birth). Neuroblastoma was the commonest tumor (10 cases, 37%), of which 4 were stage I, 4 stage IV-S and 2 stage III. There were 8 teratomas (3 sacrocoxigeal, 1 retroperitoneal, 1 in the CNS, 1 orbitary and two oronasal), two hepatic tumors (1 hepatoblastoma, 1 hemangioendothelioma, two CNS tumors, two giant nevus (one on a hamartoma), and one each Wilms tumor, infantile fibrosarcoma and myofibroblastic tumor. Treatment was surgical resection alone in 17 cases (68%) and surgery + chemotherapy in 8 (32%) (5 neuroblastomas, one CNS tumor, one Wilms tumor and one presacral teratoma who developed a yolk sac tumor); 3 patients died (11%): one at surgery, one of tumoural airway obstruction at birth and one with craniopharyngioma. Among the 14 tumors that were initially not malignant, two can be locally agressive, one was an immature teratoma, the giant nevus with hamartoma developed in situ melanoma, the other nevus had meningeal melanosis with hydrocephalus, and one mature presacral teratoma developed a yolk sac tumor. CONCLUSIONS: Diagnosis of congenital tumors is performed earlier in recent years due to the wide use of prenatal ultrasound. Their natural history is more benign than in other age groups, except for CNS tumors and very large or obstructing tumors. The histological patern is not determinant of the outcome. Complete surgical excision is the treatment of choice, most cases not need adjuvant chemotherapy. We ought to pass this message on to our colleagues in prenatal diagnosis, so parents get reliable information.

Central Nervous System Neoplasms↗
PubMed2003

[Predictive value of prenatal MRI in the diagnosis of thoracic congenital malformations].

INTRODUCTION: Magnetic imaging (MI) has an increasing value in the prenatal diagnosis of thoracic malformations. MATERIAL AND METHOUS: We compare in this work the prenatal diagnoses with the prenatal sonographic diagnoses and postnatal imaging, surgical or postmortem findings. RESULTS: Prenatal sonography diagnosed 5 diaphragmatic hernias (CDH) and 3 cystic adenomatoid malformations (CAM). MI confirmed left side CDH in 4 cases, in two of them showing also herniation of the left hepatic lobe and the spleen. In the 5th case, MI suggested diaphragmatic eventration with partial occupation of the right hemithorax by the liver. Two of three CAM appeared to have lung sequestration at MI. At birth, four CDH and one diaphragmatic eventration were confirmed by simple x-ray, and by surgery in all but one, a CDH case who went into ECMO and died without surgery. Pulmonary sequestration was postnatally confirmed by CT scan and arteriography. Treatment was coil embolization of the systemic artery. CAM was confirmed postnatally through plain chest film and CT scan. Surgical resection of the lesion was performed and the pathology exam demonstrated the presumed lesion. CONCLUSIONS: When prenatal sonography suggest a fetal thoracic malformation, MI is the way to accurate diagnosis, follow-up, prognostic evaluation and therapeutic strategy.

Congenital Abnormalities↗
PubMed2002

[Intestinal duplications. A survey of 18 cases].

OBJECTIVE: The present study analyses the experience of two centers in the management of intestinal duplications in children. MATERIAL AND METHODS: We retrospectively reviewed the medical records of a series of 18 children with intestinal duplication (January 1993 to December 1999). The median age was 11 months (range: 9 days to 12 years). The variables analysed were: clinical presentation, diagnosis, localization, anatomic type, treatment, and complications. The relationship between age and clinical presentation was also analysed. RESULTS: Most cases were located in the ileum (n 14; 78 %) and presented with rectal bleeding (36 %) or intussusception (36 %). Most symptomatic cases in the first year of life presented with intussusception (n 5/6). All duplications, except one located in the ascending colon, were cystic. 99mTc-pertechnate abdominal scan was positive in three out of five patients. One case was diagnosed by prenatal ultrasonography. Diagnosis was confirmed by laparoscopy in three patients and by laparotomy in the remaining patients. In one patient, cystic esophageal duplication presented in the neonatal period as respiratory distress. Diagnosis as well as excision was performed by thoracoscopy. Of the two gastric duplications, one was diagnosed by prenatal ultrasonography and the other by laparotomy. Treatment consisted of segmental enterectomy (n 14) or excision of the lesion without enterectomy (n 4). No complications were found during a mean follow-up of 3 years. CONCLUSIONS: The onset of intestinal duplication may be late. The lesions were most commonly located in the ileum and were cystic. Clinical presentation was related to age. Minimally invasive surgery plays an important role in the management of these lesions.

Child↗
PubMed2000

Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: a comparative study.

BACKGROUND/PURPOSE: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. METHODS: Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Ducketttechnique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures. RESULTS: Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P > .05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P < .05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra. CONCLUSIONS: The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee.

Child, Preschool↗
PubMed2000

[Post-traumatic aneurysm of humeral artery].

Aneurysms are uncommon in the pediatric age-group. Unlike adults, in which aneurysms appear after alteration of the arterial wall due to systemic diseases, in children the traumatic etiology has to be considered: blunt trauma may disrupt the arterial wall and cause false aneurysm (pseudoaneurysm). Most aneurysms are asymptomatic, or they present as a pulsatile mass on an arterial traject. Diagnosis is confirmed with Doppler ultrasound and angiography. We present the case of a girl who, after blunt trauma of the right upper limb developed a pulsatile mass on the traject of the right humeral artery. Doppler ultrasound and angiography confirmed aneurysm of the humeral artery. She was successfully treated with surgical resection of the aneurysm and reconstruction of the arterial wall.

Aneurysm↗
PubMed1999

Long-term follow-up of nineteen cystic lymphangiomas treated with fibrin sealant.

BACKGROUND: Surgical exeresis is regarded as the first choice treatment for cystic lymphangioma. Surgery may be extremely complex, giving rise to complications. Several therapeutic methods have been described to avoid the complications derived from the conventional surgical approach. The idea of treating lymphangioma by means of suction and injection of fibrin sealant (Tissucol), is an alternative to surgery. METHODS: The authors present 19 cases of cystic lymphangioma, treated with fibrin sealant injected into the lesion, during the 1991 to 1997 period. Two of the patients had been treated surgically and experienced recurrence of the tumor previous to treatment. In the other 17 cases, puncture was the only therapy applied. One patient required 3 punctures, another 6 patients required 2 punctures, and only 1 of them, after 2 unsuccessful punctures, was treated with surgical resection. The rest of the 10 cases subsided after the first puncture. Follow-up ranged between 3 and 72 months, with a mean of 40 months. RESULTS: The ultrasonographic (US) follow-up showed a complete remission in 17 patients treated with puncture. One patient remained with a small intermittent tumor, the appearance of which is related to catarrhal processes, and another patient rejected further puncture after the second one. No complications appeared. CONCLUSION: These results support the fact that the puncture, aspiration, followed by injection of Tissucol, is a choice in the surgical treatment of cystic lymphangioma.

Child, Preschool↗
PubMed1999

[Interferon treatment of giant hemangioma].

As many as 10% to 20% of patients with disseminated hemangiomas involving vital organs fail to respond to conventional treatment with steroids, radiotherapy, laser or cyclophosphamide. For the last years, interferon-alpha-2 has been successfully used to treat complicated giant hemangiomas, because of its ability to inhibit endothelial cell proliferation. We report the case of a 3-months-old infant presenting with a giant cervicofacial hemangioma with extension to the chest wall and larynx, causing episodes of severe respiratory distress. CT scan and MRI revealed a second vascular lesion measuring 24 x 16 mm in the liver. Initial treatment with corticosteroids (prednisolone at a dose of 1-3 mg/kg/daily) and endoscopic laser barely improved the symptoms and the patient presented more episodes of shortness of breath requiring admission to the ICU. Interferon therapy was started at a dose of 3 million units/m2/every other day and was continued for 9 months. At the completion of the therapy, there was complete regression of the hemangioma. Four months later, the patient is asymptomatic. No side-effects were presented for hyperthermia when the treatment was started resolved with antithermics. Blood tests were always within the normal range.

Facial Neoplasms↗
PubMed1999

[Treatment of severe scrotal hypospadias with onlay-type urethroplasty using mouth mucosa].

Failure in repairing severe hypospadias complicated with fistula and cutaneous retraction is often associated with lack of subcutaneous tissue and skin providing protection to the neourethra. We report the results of treatment in 6 patients with scrotal hypospadias with severe deviation and scarce dorsal prepuce. A neourethra was created by the onlay technique applying an oral mucosa graft and preserving in all cases the dorsal preputial skin for the island cutaneous flap. All patients had hypospadias without previous repairs excepting one of them, who had had one first time hypospadias repair in other hospital. Patients age ranged between 2 years and 3 months, and 4 years (mean: 2 years and 9 months). In all cases, hypospadias was scrotal type with severe deviation and scarce dorsal prepuce. All patients had prior hormone stimulation with dehydrotestosterone 3%. Surgical repair was performed in one-stage. Urethroplasty included preservation of the urethral plate, oral mucosa graft to provide ventral coverage, and island cutaneous flap with the dorsal preputial skin. In all cases, the chord was dissected behind the urethral plate. In 3 patients a dorsal Nesbit plication was necessary to obtain a complete straighten penis. Results in all 6 cases were satisfactory. Only one patient had a small leakage at the previous neomeatus. The other five patients are asymptomatic. Follow-up ranges from 6 months to 2 years. We conclude that urethroplasty in association with a well vascularized island flap of dorsal preputial skin decrease the incidence of fistulae. In patients with severe hypospadias with scarce dorsal prepuce urethroplasty should be completed with oral mucosa grafts preserving dorsal preputial skin for the ventral cutaneous plasty.

Child, Preschool↗
PubMed1999

[Chronic granulomatous disease: the surgical aspects].

Chronic granulomatous disease is characterized by recurrent infections that have an aggressive course in spite of medical treatment. Surgery is necessary, starting early in life, to treat the infections episodes. We present four patients affected by recurrent infections episodes needing a variety of treatments, who were finally diagnosed with chronic granulomatous disease. Our aim is to emphasize the importance of clinical suspicion in order to make an early accurate diagnosis, and to underline the role of surgery in the resolution of the infection spells that occur along the file of the pediatric patients affected by this disease.

Abscess↗
PubMed1998

Effects of propentofylline on adenosine receptor activity in Chinese hamster ovary cell lines transfected with human A1, A2A, or A2B receptors and a luciferase reporter gene.

Propentofylline is neuroprotective in vivo, but its mechanism of action is not completely understood. Previously, propentofylline was shown to block adenosine transport processes, to inhibit three adenosine receptor subtypes, and to inhibit cAMP phosphodiesterase. We tested the effect of propentofylline on adenosine receptor function in Chinese hamster ovary (CHO) cells transfected with human adenosine A1, A2A, or A2B receptors and a luciferase reporter gene under control of a promoter sequence containing several copies of the cAMP response element. We investigated the concentration-dependent inhibitory effects of propentofylline on cAMP phosphodiesterase, adenosine transport processes, and adenosine A1, A2A, and A2B receptors. At concentrations > or = 1 mM, propentofylline increased luciferase activity probably as a result of inhibition of cAMP phosphodiesterase. Inhibition of [3H]adenosine uptake by propentofylline was concentration dependent, with IC50 values of 37-39 microM for the three cell types. Agonist-activated adenosine A1 receptors were antagonized by 100 microM propentofylline, but inhibition of agonist-stimulated A2A or A2B receptors was not observed. In contrast, A1 and A2A receptor mediated effects of adenosine were enhanced by propentofylline at concentrations of 1 and 100 microM, respectively. These data indicate that the net effects of propentofylline in vivo will be dependent on the concentrations of propentofylline and adenosine available and on the subtypes of adenosine receptors, phosphodiesterases, and nucleoside transporters present.

Adenosine↗