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Biomedical subjects

Z Ros

Publications and source records attributed to Z Ros.

17 recordsLinked to original sources
PubMed2003

[Arterial trauma in the first year of life].

Traumatic vascular lesions in neonates are usually due to preoperative iatrogeny. In the last ten years, we attended 11 patients aged less than one year with arterial lesions due to deliberate puncture. All required endovascular, surgical or combined treatment. The intra- and postoperative follow-up of severe congenital malformations necessitates appropriate arterial access. This should be achieved following strict protocols, with a limited number of punctures carried out by experienced staff and only in large arteries. When a vascular lesion occurs, first an endovascular and then a surgical approach is required in the shortest time period possible. In conclusion, care of arterial routes of access and their maintenance is the best preventive therapy. Appropriate and early treatment in fistulas, pseudoaneurysms and thrombosis must be provided to prevent serious complications, especially in underweight patients.

Angiography↗
PubMed2003

[Giant congenital nevus: past, present and future].

INTRODUCTION: The suitable cutaneous covering for big defects secondary to the removal of giant pigmented lesions has not been obtained yet. Nevus that affect a corporal surface bigger than 75%, have no curative treatment and in the cases of smaller nevus therapeutical possibilities are complex, take too much time and provide unfavourable aesthetic results. MATERIAL AND METHODS: Nineteen patients suffering giant congenital nevus (GCN) have been treated in the last eight years. The GCN affected back (8), scalp (3), face and neck (3), extremities (2), thorax and abdomen (2) and buttocks (1). RESULTS: There has been no melanoma case and all the cases showed a congenital melanocitic nevus as histological result, with plexiforme underlying plexiform neurofibroma in two of them. The treatment was: removal using expansors (6), removal and skin graft (5), multiple sequential removals (7), and removals using a covering of cultured keratinocites (1). CONCLUSION: To sum up, it is essential to choose the technique depending on the individual, taking into account the location, measurement, age and social conditions. In addition to that, the treatment shouldd be the earliest, the most effective, the fastest and the most secure. Moreover, it is very important to know every surgical technique well.

Adolescent↗
PubMed2003

[Severe complications in the treatment of vascular anomalies].

BACKGROUND: Success in the treatment of vascular anomalies during infancy depends on an accurate early diagnosis and a correct therapeutic management. Current available resources can be divided into pharmacologic, endovascular, surgical, and laser. Results are variable, and complications should always be kept in mind. METHODS: We reviewed all patients with vascular anomalies who suffered from major complications directly due to the treatment during the past five years. RESULTS: 1. A patient with an upper lip hemangioma following treatment with interferon after no response to steroids. A long-term severe neutropoenia forced to an early surgical excision of the lesion. 2. A patient suffering from an orbitary hemangioma with severe exoftalmus was treated with interferon because of a steroid-resistance. A spastic diplegia due to interferon reverted after treatment was discontinued. 3. In a patient with a Blue-Rubber Bleb Nevus syndrome, extended percutaneous sclerosis was performed. She developed skin necrosis of the left leg and a permanent sciatic nerve paralysis. 4. In a patient with an arteriovenous malformation on the right leg and gluteous, a femoral artery endoprosthesis was placed because of a massive bleeding. She underwent a total excision of the malformation and developed a recurrent ischemia related to a femoral thrombosis. Finally a foot amputation was needed. 5. A patient with a Kaposi-like hemangio-endothelioma who was following a high-dose prolonged steroid therapy died because of a meningoencephalitis related to a severe immunosuppression. CONCLUSIONS: Treatment of vascular anomalies during childhood need an early accurate diagnosis. If a right therapeutic sequence is not performed, useful drugs can turn into inefficient or dangerous. Most treatment complications in these patients can be avoided.

Blood Vessels↗
PubMed2002

[High flow vascular malformations in children].

Unlike hemangiomas and low-flow vascular malformations which are very common in children, arterial anomalies have small incidence. Differential diagnosis is difficult, and needs a physician familiarized with vascular anomalies. Appropriate treatment must be planned by multidisciplinary team considering the patient's age, and anatomical location. Twenty-eight children with high flow vascular malformations have been treated since 1990 at La Paz Children's Hospital Vascular Anomalies Program. We excluded of the study group patients with central nervous system lesions. 85% of the patients had malformation in stage I or II (according the ISSVA accepted Schöbinger stating) and most of them were erroneously diagnosed as hemangioms with a variety of inappropriate treatments previously performed. Doppler Ultrasound and Magnetic Resonance confirmed malformation flow and extension. Angiography and selective embolization was only considered as therapeutic approach in candidates to surgical resection. 16 patients underwent complete resection of the malformation including one foot and two fingers amputation and five more incomplete resection of the ulcerate area. In conclusion, we did not find age at onset, sex and symptoms relationship. Laser, radiotherapy, surgical ligation or partial resection must be considered inappropriate therapies which may stimulate AVM exacerbation. Only radical surgical procedure after selective endovascular embolization will be successful but then reconstructive surgery should be performed to achieve good aesthetic and functional results.

Adolescent↗
PubMed2002

[Integra Artificial dermis in pediatric reconstructive surgery].

UNLABELLED: The recent release of artificial dermis for general use, has open wide a new field in pediatric reconstructive surgery. The aim of this paper is to analyze the results of Integra artificial dermis in our Plastic Surgery Department. MATERIALS AND METHODS: The records of the patients treated with Integra between february 1999 and january 2001 were analyzed, focusing on the indications, the complications and the final results. RESULTS: Fourteen Integra implantation procedures in 11 patients aged 16 months to 12 years (mean +/- SD: 80.9 +/- 48.5 months) were performed. Indications were: acute burns in 5 cases, burns sequelae in 5, and partial extirpation of a congenital giant nevus in the last one. Integra was used to replace between 2 and 30% of total body surface area. The percentage of "take" of skin grafts was 85%. The most frequent early complication was the development of infection under the Integra; it occurred in 2 cases and artificial dermis had to be partially removed. Hypertrophic scars developed in 2 patients; both had refused pressure garments. Cosmetic results in the remaining 9 patients are considered excellent. CONCLUSIONS: The use of artificial dermis has settled as a new procedure in plastic pediatric surgery. In spite of possible complications, the easy manipulation and the good results make Integra a perfect skin substitute in several cutaneous disorders.

Biocompatible Materials↗
PubMed2002

[Decrease in bacterial translocation in burned children treated with controlled nutritional support].

INTRODUCTION: Alteration in epithelial enteric cells are the main cause of bacteria translocation and local and systemic infections. Our aim is to evaluate these infections in burned children treated with enteral nutrition and compare the results with our previous observations. Material and methods. We designed a prospective study including 50 patients (0-14 years) with TBSA > 10% (total body surface area). Bacteriological cultures were performed at their admittance and weekly until the discharge. Nutritional necessities were evaluated using calorimetry. Nutritional support was supplied by nasoduodenal tube at continuous rates. RESULTS: Three (6%) patients with enteral nutrition (Group 1) showed positive blood cultures (two of them by enteric bacteriae). 14 patients (28%) showed local infections (five by enterococci). We performed a retrospective study in a homogenous group of 44 patients (Group 2), previously treated in our Department without controlling nutrition. We found five (11.3%) positive blood cultures (four by enteric bacteriae) and 22 (50%) local infections (eleven by enteric bacteriae). The improvement of systemic and local infection rates and the decrease in infections caused by enteric bacteriae were statistically significative (p < 0.05). CONCLUSIONS: A controlled nutritional support is a main cause of the improvement in infection rates and decrease in bacterial translocation in pediatric burned patients.

Adolescent↗
PubMed2000

[Congenital fibrosarcoma. Diagnostic-therapeutic implications].

Most of the soft tissue sarcomas of childhood other than rabdomyosarcoma, have as final diagnosis fibrosarcoma, specially in the first months of life. Overlapping features between infantile myofibromatosis and congenital fibrosarcoma, hemangiopericytoma and fibrohistiocytoma have seen noted. Five patients with congenital fibrosarcoma were operated since 1991. Anatomical sites included lower limb, hand and forearm, and three of them had previous diagnoses of hemangiopericytoma, fibrohistiocytoma and myofibromatosis, with provocated non radical surgery and reoperation. The postoperative course was satisfactory and all are live one to eight years later. In our experience accurate histological diagnosis must be achieved to perform radical surgery on these cases.

Fibrosarcoma↗
PubMed2000

[Complex and complicated syndactylia. Review and treatment progress].

Complex syndactyly is generally defined as abnormal digital interconnection by bone, but sometimes simple syndactyly with complicated cutaneous, musculotendinous or neurovascular interconnections should be considered complex as well. Additionally, complex syndactyly involving anomalous bones (delta phalanx, brachiphalangism...) falls in different category called "complicated". 35 patients with complex or complicated congenital syndactyly are studied and 58 children with cutaneous syndactyly due to burns and epidermolysis bullosa are analyzed as well.

Child↗
PubMed1998

Venous graft repair following brachial artery thrombosis in a neonate.

A case of venous graft repair to recover blood flow of a newborn's upper extremity, is described. Even though this complication remains uncommon, we emphasize on to avoid brachial artery for vascular monitorization and to perform microsurgical revision as elective procedure if conservative therapy is unsuccessful.

Arm↗
PubMed1997

[Hemangiomas and vascular malformations. Review and update].

In 1982, Mulliken and Glowacki classificated congenital vascular lesions in two biological groups with different treatment, evolution and prognosis: Haemangiomas and Vascular malformations. We have seen 230 patients, 145 with haemangiomas and 85 with vascular malformations (74 with low flow and 11 with high flow). We have reviewed clinical, evolutive and ecographic findings. Depending on the type and localization of the lesion, we completed the study with CT, MRI and angiography. Among all the patients with haemangiomas; 45 were treated with local or systemic steroids because of bleeding, ulceration or affection in functional areas. In two more, we used interferon alfa 2a because of Kassabach-Merritt Syndrome. 23 were operated on with good aesthetic results. Patients with vascular malformations were managed with embolization, sclerotherapy, surgical approach or conservatively. Capillary malformations were treated with lasertherapy. We emphasize in correct classification of vascular lesions prior to start diagnosis, treatment or parents information.

Arteriovenous Malformations↗
PubMed1995

Cultured epidermal autograft in the management of critical pediatric burn patients.

We treated 4 patients with CEA at "La Paz" Children's Hospital between July 1992 and September 1993. All of them had acute flame burns. The total body surface area (TBSA) of burn injury ranged from 75% to 85% with an age range of two to five years. Before placement of CEA homografts and biosynthetic materials were used to prepare the wound bed. CEA take ranged from 40% to 90%. One of the children died after polyethylene glycol intoxication when the exposed areas were nearly totally covered. Two more have started rehabilitation therapy and the last patient was grafted just two months ago.

Burns↗
PubMed1991

[Histopathology of biliary atresia: correlation with biliary flow].

The objective of KASAI's operation is to obtain a postoperative bile excretion and to maintain an internal biliary fistula. The purpose of this report is to study the relationship between the liver histopathology and the postoperative bile flow and survival. From july 1976 to january 1990, 66 patients underwent a corrective operation for biliary atresia. In 24 patients we performed a KASAI's operation with internalization of the biliary conduit, 36 with externalization, four gall-bladder KASAI and two liver biopsy. The mean age at operation was 66 days and postoperative bile excretion was obtained in 43 of them (66 per 100). The survival rate was 70 per 100. The liver histopathology shown: minimum portal fibrosis (7.8 per 100), moderate (49 per 100) and severe (43 per 100). We found bile ducts in 30 patients (46 per 100), in three bile ducts were less than 50 mu, in 15 between 50 and 100 mu and more than 100 mu in 12. We did not found statistic correlation between grade of liver fibrosis size of bile duct and postoperative flow. We found a statistic correlation between the presence of bile ducts and postoperative flow (p less than 0.05).

Anastomosis, Surgical↗
PubMed1989

[Incidence and management of surgical pathology in children with cystic fibrosis of the pancreas].

This report reviews 110 children of ages ranging from 2 months to 17 years, with a diagnosis of cystic fibrosis, and analyzes the surgical treatments they have undergone. In our series, meconium ileus shows an higher occurrence (20%) than the reported by the literature. No direct relationship could be established between the existence of meconium ileus and a more severe affectation of cystic fibrosis. Rectal prolapse occurred in 10% of the patients, and only 4% underwent surgical treatment. Three children with appendicitis developed a periappendiceal abscess due to delayed diagnosis and 2 other were operated upon for meconium ileus equivalent. From 7 patients with gastroesophageal reflux, 5 were treated non-operatively and 2 required corrective surgery. Fifty five patients out of the 110 (45%) underwent different surgical procedures.

Adolescent↗
PubMed1989

[Reoperation in biliary atresia].

From July 1976 to February 1988 52 cases of extrahepatic biliary atresia were treated at our institution and 16 patients underwent reoperation. The original procedure were portojejunostomy in 11 cases (68 for 100), portocholecystostomy in four (25 for 100) and omento-duodenopexy in one (6 for 100). Age average at operation was 61 days; twelve had bile excretion. The reoperation was performed due to absence of bile drainage in three cases, cholangitis in 9 and bile peritonitis in four. Surgical procedures used at reoperation were: excision of scar tissue at the porta hepatis (12 patients) and portojejunostomy (five patients). Age average at reoperation was 105 days. Seven cases excreted bile. Liver pathology studies showed fibrosis in 12 cases and precirrhosis in four. The porta hepatis showed biliary ducts less than 100 mu in 10 cases, between 100mu-200mu in two, and absence of bile ducts in four. Currently four children are doing well with a mean long-term follow-up of 48 months, five are awaiting liver transplantation and one patient is doing well sixteen months post-transplant. Six patients (38 for 100) died. The best results were observed in those cases with early bile flow excretion after the first operation.

Age Factors↗
PubMed1980

[Tolazoline in postoperative period of diaphragmatic hernia (author's transl)].

During the last ten year period, 78 newborns with congenital diaphragmatic hernia were seen at the Clinica Infantil "La Paz", Madrid. Twenty seven cases died immediately after delivery and 51 were operated. Necropsy findings showed pulmonary hypoplasia and patent ductus arteriosus. Mortality rate in operated cases was 29%. It seems that pulmonary hypoplasia increases pulmonary vascular resistance resulting in a state of fetal circulation with right-to-left shunting through ductus arteriosus. In these cases right to left shunt with umbilical and temporal artery catheters measuring pre and postductal pO2 must be demonstrated. Authors show their experience with two cases of newborns with Bockdalek hernia treated with tolazoline in postoperative period. Both survived.

Hernia, Diaphragmatic↗