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Biomedical subjects

R Ronco

Publications and source records attributed to R Ronco.

5 recordsLinked to original sources
PubMed1999

[Multidisciplinary management of malignant hepatic tumors in children: a recent national experience].

BACKGROUND: Malignant hepatic tumors (Mht) are rare in children. Among them hepatoblastoma (HB) is the most common. AIM: To report the results of the multidisciplinary management in 6 consecutive children: five HB and one metastatic Wilms tumor (MWT). PATIENTS AND METHODS: The mean age of patients was 42 months. All HB patients had elevated serum alfafetoprotein (median 150,000 ng/ml). All patients received preoperative chemotherapy: HB patients received carboplatin/doxorubicin alternating with cisplatin, and the MWT patient, vincristine alone. Surgery included two formal right and two formal left hepatectomies, one extensive central resection with partial left segmentectomy, and one lateral segmentectomy. Extracorporeal circulation was used in the child with atrial involvement. All patients received postoperative chemotherapy. RESULTS: All tumors had variable regresion on preoperative chemotherapy. Complete resection with negative margins was achieved in all patients. The degree of tumor necrosis on histology ranged from 60% to 90%. Alfafetoprotein levels fell to under 10 ng/ml in all HB cases, one to three months after surgery. All patients survive free of disease at a median follow up of 19 months. CONCLUSION: A multidisciplinary approach including the well timed used of chemotherapy and surgery is highly effective in the management of pediatric malignant tumors.

Child↗
PubMed1995

Outcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest.

OBJECTIVE: To determine the outcome and cost for children resuscitated following out-of-hospital cardiopulmonary arrest. DESIGN: Retrospective case series. SETTING: An organized prehospital emergency medical system within Birmingham, Ala, in a county with 150,493 children under the age of 15 years. PATIENTS: Sixty-three pediatric victims of out-of-hospital cardiopulmonary arrest of any cause presenting to the emergency department of a children's hospital. INTERVENTION: Standard resuscitative techniques were performed for all patients until resuscitative efforts were discontinued in the hospital emergency department or successful resuscitation was achieved. MAIN OUTCOME MEASURES: Successful resuscitation, survival to hospital discharge, neurological outcome, final disposition, and cost of hospital care. RESULTS: Of 63 children with out-of-hospital cardiopulmonary arrest treated in the emergency department of a children's hospital, 60 were pulseless and apneic on arrival, 18 (28.6%) were successfully resuscitated and admitted to the intensive care unit, and six (9.5%) were discharged from the hospital. Five of the survivors had severe neurological deficits and one appeared normal. On follow-up, two patients had died (1 month and 7 months after discharge), three were in a vegetative state, and one was normal. The normal patient had successful defibrillation prior to arrival at the emergency department. The average inpatient charge was $10,667 per patient for those who died and $100,000 for those discharged. CONCLUSIONS: Aggressive treatment does not lead to intact survival for victims of out-of-hospital cardiopulmonary arrest who present to the pediatric emergency department with a preterminal rhythm and absence of spontaneous circulation. Resuscitation efforts in the emergency department are commonly successful but lead to death or severe neurological sequelae at discharge with extremely high cost of care.

Adolescent↗
PubMedDate not supplied

[Acute epiglottitis].

Acute epiglottitis caused by Haemophilus influenzae type B (Hib) is seldom described in Chile. To reinforce the need to take this severe entity into account in the differential diagnosis of acute upper respiratory tract obstructions, the case of a 9 month old girl is described, who's symptoms were initially attributed to acute laryngitis, but showed not response to racemic epinephrine and betamethasone therapy. The correct diagnosis of acute epiglottitis was suggested five hours after admission by lateral neck's radiographs and confirmed by direct laryngoscopic examination under general anesthesia. Appropriate treatment was soon instituted including tracheal intubation respiratory support and antibiotics. An uneventful clinical course proceeded from then on. Hemophilus influenzae B was isolated from blood cultures.

Acute Disease↗