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Biomedical subjects

M García Mérida

Publications and source records attributed to M García Mérida.

At least 19 recordsLinked to original sources
PubMed2005

[Spontaneous urinary bladder perforation after pediatric cystoplasty].

OBJECTIVE: The spontaneous cystoplasty perforation is a serious and potentially fatal problem if a delay in diagnosis and treatment occurs. We pretend: 1) to look for prevention analyzing the risk factors, 2) to identify the main data of diagnostic suspicion and 3) to evaluate the result of the treatments done. MATERIAL AND METHODS: Out of 30 children with cystoplasty 5 of them have presented 8 perforations (16,6%). Several influential factors, the symptoms, the treatments and the evolution are reviewed. RESULTS: The average time between cystoplasty and the perforation was 8,2 years. A urethral resistance that allows continence, and an insufficient intermittent catheterization, have been the main risk factors. In the 8 episodes there were abdominal pain and distension. The ultrasonography showed intraperitoneal extravasation in 5 episodes, multiple peritoneal cysts in one, and suggestive image of appendicular plastron in another one. The cystography showed intraperitoneal extravasation only in 3 cases. The initial management was conservative in the 7 episodes diagnosed before surgery, and 3 had a good evolution (42,8%); the other 4 needed surgery with good evolution in all cases. Two of 5 patients (40%) presented 3 relapses in an average time of 5 years. The survival is 100%. CONCLUSIONS: 16,6% of patients with cystoplasty of this series had one or more episodes of spontaneous bladder perforation. The more significant risk factors are a high urethral resistance and an inadequate intermittent catheterization. The patients with cystoplasty, and their families, must know this complication, their risk factors and symptoms to prevent it, or to facilitate an early diagnosis.

Adolescent↗
PubMed1999

[Long-term follow-up of children with neurogenic bladder and artificial urinary sphincter].

MATERIALS AND METHODS: Since 1986 an artificial urinary sphincter was implanted in 16 children (13 males and 3 females) 4 to 12 years old (median age 9) in order to solve their urinary incontinence. Mean age at implantation was 9 years. In 10 children (63%) only the implant procedure of artificial sphincter was performed without any other procedure associated (Group A), while in 6 children an augmentation cystoplasty simultaneously was performed (Group B). The results were analysed in both groups separately: 1. Group A: 10 patients. Two are functioning excellently after 10 and 11 years of follow up. Eight developed some type of troublesome: Five developed a deterioration of urinary tract and all of five were treated by augmentation cystoplasty; one of them is in a good condition after 11 years, another presented a fail of the device after 10 years, it has been changed, and in the others three the apparatus was removed by diverse causes. Two developed a mechanical fail of device: one was removed due familiar decision and the other has received another device. One urinary fistula developed 6 months later. The device was removed. 2. Group B: 6 patients (artificial sphincter and augmentation cystoplasty simultaneously). Five are functioning without trouble some. One persistent urinary fistula. The device was removed. Actually, of 16 cases (both groups) 8 cases (50%) are good functioning, 6 devices have been removed and 2 are waiting a new implant. CONCLUSIONS: The artificial urinary sphincter is a good solution for children with urinary incontinence in selected cases, but is mandatory a correct follow up because longterm complications can be developed. Results seem better when an augmentation cystoplasty is associated.

Child↗
PubMed1997

[Laparoscopy in the non-palpable testicles. Is it always necessary?].

In order to know the role of diagnostic laparoscopy with non palpable testicles (NPT), 15 children with 16 NPT were studied. Middle age was 7 years (R: 2-12). The surgical procedure was: laparoscopy initially and open inguinal surgery (OIS) after that. Six NPT were discovered with laparoscopy (37.5%). With OIS inguinal hernia was present in 4 cases, with testicle into the inguinal sac in 3 cases; 12 cases had not inguinal hernia, and 6 of them showed spermatic vessel and vas deferent without testicle. Orquidopexy of the 6 located testicles and testicular prothesis implantation in the other 10 cases, were performed. Finding of laparoscopy and OIS were perfectly correlated. Laparoscopy made the diagnosis in 7 cases, which the OIS would have been unable to do it (43.7%). In the other 9 cases, the OIS would have been diagnostic enough (56.2%) without laparoscopy. For those results, the authors prefer to begin the surgical procedure with OIS and if the spermatic vessels are no located, then the laparoscopy is done under the same anesthesia.

Child↗
PubMed1997

[The treatment of the primary intrarenal reflux. Is the surgery always necessary?].

UNLABELLED: THE AIMS OF THIS STUDY was to evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.) in order to know the results of surgical and non surgical treatment. Fifty one children with 64 kidneys with primary I.R.R. were studied. 53% of them were less than one year of age. Initial examination were: urography, ultrasounds, cystography and DMSA scan; the follow up was done with ultrasounds, DMSA scan and cystography. When no R.N. was present, grade of reflux was < IV, and age < 12 years, a non surgical treatment was indicated. RESULTS: During first examination R.N. was demonstrated in 47% of kidneys; the main difference was the grade of reflux: 16/44 II-III (36%) and 14/20 IV-V (70%). Surgical treatment was performed in 42 (82%) children and non surgical in 9 (18%). Reflux stopped in 98% and 100%, respectively. Only one child, without R.N., developed a new renal scar, and a previous R.N. progressed in two. I.R.R. can be treated successfully without surgery in selected cases.

Child↗
PubMed1996

[Newborn infants diagnosed prenatally with uropathies].

UNLABELLED: A clinical study of 111 newborns (NB) with prenatal diagnosis (PD) of urinary tract pathology was performed. The weight and size at birth, physical examination, incidence of uropathies, associated malformations and postnatal diagnostic studies were analyzed. MATERIAL AND METHODS: All data corresponding to 111 neonates with PD of urinary tract pathology were submitted to the Student's t and Chi square tests and contingency tables. RESULTS: Uropathies were more frequent in male NB (69%) and on the left side (2/1). Pyelocaliceal dilatation (PCD) was present in 46% of the patients. The mean weight and size was normal. However, NB with PCD had a mean weight of 249 grams below that observed in the remaining group (p = 0.016). Thirteen newborns (12%) had associated anomalies. An abdominal mass was present in 17 neonates with obstructive uropathies (15%). Serum urea and creatinine were normal in 101 neonates (91%). SUMMARY: 1) PCD is the most frequent uropathy diagnosed prenatally. 2) The incidence of fetal uropathies, diagnosed prenatally, is higher in males. 3) The left side is more frequently involved. 4) The mean weight and size of NB with uropathies is normal. 5) The mean weight of NB with DCP is 249 grams lower than the rest of the group. 6) Serum urea and creatinine were found elevated only in severe bilateral obstructive uropathies.

Female↗
PubMed1996

[The first year of life of children with myelodysplasia: a multicenter study of 393 cases].

A multicentric study about the first year of life of myelodisplastic children, was done. Family, pregnancy, delivery, newborn somatometry, and anatomical-pathological and terapeuthical aspects were review in 393 patients born before july 1992. Annual prevalence vary from 6 (1973) to 28 (1984). The families clinical history was not significant. There were 9 (2,3%) gemelar pregnancies, but both children were affected only in one case. Prenatal ultrasound was not diagnostic in 61%-84% of patients are meningomyeloceles, the anatomical level of myelodisplasia was lumbar and or sacral in 98%. There was hydrocephalus in 59%, hip dislocation in 24%, feet deformities in 50%, upper urinary tract dilatation in 12%, vesicoureteral reflux in 15%. In total 825 surgical procedures were performed (M = 2); the neurosurgery was 94% of them.

Adolescent↗
PubMed1996

[Enterocystoplasties: results in 22 children].

A study of paediatric enterocystoplasty in 22 children of 1 to 14 years of age (M = 8) during 5 years is presented. The diagnoses were: neurogenic bladder 16 (73%), extrophic bladder 3, urethral valves 1, and complex uropathies 2. The intestinal segments used were: ileum 12 cases, sigmoid 8, and ileocaecal region 2 (non myelodisplastic). During the last years sigmoid have been preferred due to its bigger size. The middle follow up is 3.5 years (R 1-6). The results have been good in: renal function 86%, and upper urinary tract 95%. Bladder capacity was 278% higher, bladder pressure was 82% less, and residual urine was 217% more, than preoperatively. Five children developed 6 complications (23%), and 4 reinterventions were performed (18%). When it is indicated, paediatric enterocystoplasty is a good alternative to urinary diversion, and it is useful to prevent the upper urinary tract deterioration; but a frequent and, all the life long follow up is necessary, due to its possible complications.

Adolescent↗
PubMed1996

[Postnatal differential diagnosis of fetal ureteropelvic dilatation].

UNLABELLED: A clinical study of 51 children with prenatal diagnosis of pielocaliceal dilatation with 65 kidney affected is done. The objective was to assess the accuracy of the postnatal diagnostic studies practiced in order to an early differentiation between obstructive and non obstructive dilatation. MATERIAL AND METHODS: There were evaluated ultrasonography (US), intravenous pielography and diuretic isotopic renogram. The data were statistically analyzed with SPSS program. A regression logistic analysis was carried out between all the significant variables in order to identify the obstruction risk factors. Also the probabilities calculated index and the sensibility and specificity were studied. RESULTS: The obstruction risk factors were: grade III dilatation or greater in the US, differential renal function less of 40%, and half time more than 21 minutes. The probabilities calculated index showed that the probabilties of obstruction are different according to the number of obstruction risk factors presented in every patient. Risk factors have a high sensibility and specificity as diagnostic test.

Diagnosis, Differential↗
PubMed1990

[Enuresis and urinary pathology].

The incidence of urinary pathology is studied in 71 pediatric cases of primary nocturnal enuresis. These incidences have been 18.3 per cent, but there are two different groups. After a negative urological anamnesis, incidence goes down to 5.4 for 100 (3 patients of 55). When anamnesis shows suspicious of uropathy, incidence growth to 62.5 for 100 (10 patients of 16). Urological study with ultra sound and XR is recommended in nocturnal enuretic children only when there are suspicions of uropathy after a detailed clinical exploration and anamnesis.

Adolescent↗
PubMed1984

[A technic to avoid postoperative intestinal hypodynamia].

The hypodynamic postoperative ileus in children, has as main cause the circle gastric distension-reflex intestinal ileus, produced by the swallowed air. The gastric emptying system-through a Levin tube from the stomach is not usually sufficient to get off all the swallowed air. Nevertheless, a continuous suction from the lower third of oesophagus, through a double lumen sump tube is twelve times more effective in the getting off de air before it comes into the stomach, without need of a nasogastric tube.

Abdomen↗
PubMed1984

[Contralateral reflux after unilateral antireflux surgery].

108 unilateral antireflux surgical procedures are analysed over a period of seven years. All the cases were operated upon for essential or primary renal reflux, using ureteral advancement techniques crossing the bladder midline. There were 10 patients who developed contralateral renal reflux (CRR) in the postoperative evolution (9,2%). The CRR disappeared in all cases, but three of them needed surgical treatment because of urinary tract deterioration (Reflux nephropathy, bladder lithiasis, and shift of reflux grade from I to III). Two different surgical antireflux techniques were utilised. Using the Glenn-Anderson's technique the incidence of CRR was 9/68 (13,2%) whereas this incidence was 1/40 (2,5%) using the Cohen's technique, which does not disrupt the trigonal area. The authors do not believe that systematic bilateral antireflux surgery for unilateral reflux is necessary. When CRR occurs an initially conservative management is recommended.

Child, Preschool↗
PubMed1984

[Renal injuries in children].

16 children admitted to the hospital for blunt renal trauma were studied. Following Mandour's classification 10 cases were minor, five mayor and one was critical. No vascular or ureteral problems were seen. The treatment was initially conservative in all cases, without explorative lumbotomy or perirenal drainage. Only one patient was operated on for an arteriovenous fistula in the renal parenchyma; an exeresis of that portion was done. The follow-up (for one year) with clinical, IVP, echography and blood pressure controls was normal in all cases. The present authors prefer a conservative management, whenever possible, and surgical treatment only for complications and vascular or pyeloureteral disruption.

Child↗
PubMed1984

[Pheochromocytomas in children].

Three cases of pheochromocytoma in children are presented. Diagnosis was made by selective adrenal arteriography, ultrasound examination and catecholamines urinary levels. The surgical treatment consisted in exeresis of the tumor in all cases. In one case familial incidence was found. The postoperative course has been normal in all cases.

Adrenal Gland Neoplasms↗
PubMed1981

[Treatment of peritoneal hydatidosis with mebendazole. Preliminary study (author's transl)].

Authors present three cases of peritoneal hydatidosis, two of which are due to spontaneous rupture of hepatic hydatid cysts and the other due to operative rupture of ovarian hydatid cyst. A dose of 1 g./day of mebendazole was administered for 11 months with 30 day break periods every three months. Mebendazole has proved effective in the treatment of secondary echinococcosis. In authors judgement this may be an effective treatment for peritoneal spreading if mebendazole is used at an early stage since they have verified the absence of dissemination in one of the cases and an inactive dissemination in other one. If treatment is applied later, regression is achieved too, but more slowly. Immunological and ecographical results are reported in detail as well as surgical and pathologic findings. A cautious interpretation of these preliminary results is advised since data on long-term results are lacking.

Benzimidazoles↗
PubMed1978

[Respiratory distress syndrome and pulmonary congenital malformations (author's transl)].

The present report is based on three infants with respiratory distress syndrome due to congenital lobar emphysema in two and cystic adenomatoid malformation of the lung in the third. The serious worsening of the respiratory distress in two children prompted a partial pulmonary resection within the first 24 hours of life. A brief description of the clinical, radiological and pathological characteristics of this anomalies is included. Our three patients remain asymptomatic showing a normal development, after a follow-up period of five months in one child and just over two years for the other two. Any neonate showing progressive respiratory distress should have a chest X-ray taken to rule out a lobar emphysema or a severe malformation of the lung leading to abnormal ventilation. The management in this cases should be the immediate resection of the affected pulmonary lobes.

Female↗
PubMedDate not supplied

[Spontaneous autoembolization in a child with high-flow post-traumatic priapism].

There are two sort of priapism: the venous or low flow priapism, that is usually painful, and the arterial or high flow one, painless and rare, especially in childhood. We present a case of a boy 5 years old, who 6 days after to suffer a perineal closed traumatism, had a painless and arterial priapism, with aneurism and fistula of the dorsal penile arteria, that was resolute spontaneously through self-embolization, 11 days after. We review the bibliography of 14 cases of arterial posttraumatic priapism in childhood, without find any case resolute by spontaneous self-embolization.

Blood Flow Velocity↗
PubMedDate not supplied

[Pyeloureteral stenosis secondary to Schoenlein-Henoch purpura].

We present an 8-year-old male suffering from Schönlein-Henoch purpura with multisystemic clinical manifestations, which developed as a complication a pyeloureteral stenosis secondary to vasculitis. He was operated on and a ureteropyeloanastomosis was carried out according to the Anderson-Hynes technique with good results. We discuss the etiology, diagnostic methods and therapeutic possibilities. It is the eighth case in the literature requiring surgical correction as a result of this exceptional complication.

Child↗