RESUMO
This is a prospective and randomized study of 100 patients with acute appendicitis who were less than 10 years old, in which four different antibiotic regimens commonly in use against gram-negative and anaerobic bacteria were compared in terms of postoperative septic complications. The antibiotics were begun immediately preoperatively and continued for five days. Ten percent of the patients developed infection complications, with 4% requiring further surgery. The best results were obtained with cefoxitin (4% of infection), metronidazole plus amikacin and latamoxef (8%), while the regimen of clindamycin plus amikacin was associated with the greatest number of complications (20%). On analyzing the main microbiologic findings of the study, we conclude that some sort of antibiotic treatment is indicated in all types of appendicitis, due to the occult presence of bacteria in the peritoneal cavity, even without clinical evidence of gangrene or perforation. Further, we emphasize the significance of Streptococcus faecalis as being responsible, along with Escherichia coli and Bacteroides fragilis, for serious postoperative complications.
Assuntos
Antibacterianos/uso terapêutico , Apendicite/cirurgia , Pré-Medicação , Infecção da Ferida Cirúrgica/tratamento farmacológico , Antibacterianos/administração & dosagem , Líquido Ascítico/microbiologia , Técnicas Bacteriológicas , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Masculino , Peritonite/tratamento farmacológico , Estudos Prospectivos , Distribuição AleatóriaRESUMO
Recurrent tracheoesophageal fistula (RTF) after repair of esophageal atresia with tracheoesophageal fistula is a serious complication, with the need for a second operation. The mortality rate is high. The authors report on the eradication of RTF using fibrin glue.
Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Fístula Traqueoesofágica/terapia , Broncoscopia , Atresia Esofágica/cirurgia , Adesivo Tecidual de Fibrina/administração & dosagem , Humanos , Recém-Nascido , Masculino , Complicações Pós-Operatórias/terapia , RecidivaRESUMO
The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.
RESUMO
Four patients underwent pneumatic endoscopic dilatation of achalasia at the La Fe Children's Hospital have been studied. Endoscopic pneumatic dilatation has been performed in only one session with four dilatation maneuvers. In the absence of complications, the patients were only hospitalized for twenty-four hours. The effectiveness of endoscopic pneumatic dilatation and the safety of this method, its ease of application and possibility of repetition make it a useful method in the treatment of achalasia in children.
Assuntos
Acalasia Esofágica/terapia , Esofagoscopia/métodos , Criança , Dilatação/instrumentação , Dilatação/métodos , Acalasia Esofágica/diagnóstico , Esofagoscópios , Humanos , ManometriaRESUMO
The observation of hydroelectric and pH changes, as well as the diminishing incidence of postoperative infections in pediatric patients, subjected to digestive irrigation (D.I.) before surgery, was the reason for carrying out this paper, fundamentally directed at two objectives: Firstly, to determine the hydro-ionic and clinical repercussions by means of a comparative study of the two most used irrigations solutions and secondly, to analyze the modifications that the D.I., itself and with the addition of antibiotics, is capable of producing on the fecal flora and the intestinal mucous membrane. To realize our aim, a prospective and double blinded study was designed on 124 patients irrigated with a saline solution (S-I), or with the Golytely solution (S-II). The analysis of the results showed that exist a marked predisposition to metabolic acidosis and dehydration after irrigation with S-II, compared with a tendency towards hyperhydration and alkalosis after irrigation with S-I. The effect of flushing with D.I. is capable of producing a significant lowering in the number of germs/ml found in the contents of the colon; a reduction which increases for the anaerobic group (p less than 0.001), when the antibiotics are added to the irrigation solution. Neither of the studied cases gave evidence of histomorphologic alterations in the colonic mucosa after irrigation with erythromycin and neomycin base.
Assuntos
Colo/cirurgia , Colonoscopia , Intestinos , Cuidados Pré-Operatórios , Irrigação Terapêutica , Adolescente , Fatores Etários , Criança , Pré-Escolar , Método Duplo-Cego , Eletrólitos , Eritromicina/administração & dosagem , Humanos , Lactente , Intestinos/microbiologia , Neomicina/administração & dosagem , Polietilenoglicóis , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Cloreto de Sódio , SoluçõesRESUMO
Twenty four patients diagnosed and operated of hypertrophic pyloric stenosis were examined by ultrasonography at diagnostic and sequential after pyloromyotomy. We measured pyloric diameter, thickness and length of the muscle and we calculated the pyloric volume. The overall configuration of the pylorus is more important than specific pyloric dimensions for diagnosis. The pyloric volume is the most discriminating criterion. Sequential sonograms at one and four months showed that all measurements fell to normal levels within four weeks, except pyloric volume.
Assuntos
Estenose Pilórica/cirurgia , Piloro/cirurgia , Feminino , Seguimentos , Humanos , Hipertrofia , Lactente , Recém-Nascido , Masculino , Estenose Pilórica/diagnóstico por imagem , Piloro/diagnóstico por imagem , Fatores de Tempo , UltrassonografiaRESUMO
Lymphangioma and venous angioma are a group of pathological entities which have required surgical treatment since years. Extension, localization and poor delimitation of some lesions have resulted in technical difficulties and serious complications. Our group began the sclerosing therapy with an injection of fibrin adhesive and, due to the lack of response in the first patient, a program with Ethibloc as an alternative substance was developed. We present 10 cases, 4 lymphangiomas and 6 venous angiomas. In 50% of our patients one single session of sclerotherapy was made, in 25% two sessions, and in the rest 25% three. From 10 cases, 4 are still on treatment, complete remission in 5 cases, and good evolution in one case (mixed lymphangioma). As a long-term complication, we have noticed fistulization in 3 cases, and expulsion of the sclerosing agent. In our experience, percutaneous sclerosis with Ethibloc should be the first therapeutic alternative.
Assuntos
Hemangioma/terapia , Linfangioma/terapia , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Criança , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Linfangioma/diagnóstico por imagem , Linfangioma/patologia , Masculino , Radiografia , Escleroterapia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/terapia , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Neoplasias Torácicas/terapia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia , Neoplasias Vasculares/terapiaRESUMO
Three cases of Morris Syndrome were detected among 103 girls admitted to the hospital for inguinal hernia. Diagnosis was made possible by routine sexual chromatine study in oral mucosa smear, but it can also be suspected when familial antecedents of amenorrhea exist. An early diagnosis of this condition is imperative in order to provide the patient with an adequate medical and surgical management, including the conservation of the gonads until pubertal age.
Assuntos
Síndrome de Resistência a Andrógenos/diagnóstico , Hérnia Inguinal/diagnóstico , Cromatina Sexual/análise , Síndrome de Resistência a Andrógenos/genética , Síndrome de Resistência a Andrógenos/cirurgia , Pré-Escolar , Diagnóstico Diferencial , Hérnia Inguinal/genética , Hérnia Inguinal/cirurgia , Humanos , Lactente , Masculino , Mucosa Bucal/análise , Fenótipo , Saliva/análiseRESUMO
Authors report the case of a newborn with a sudden picture of abdominal distension, bilious vomiting and blood stools due to a twisted ovarian cyst with ileal volvulus. Patient cured after surgical excision of both ovary and necrotic bowel. A high perinatal gonadotrophic activity could be at the origin of neonatal ovarian cycts. Association with ileal volvulus seems to have been reported only in three other instances.
Assuntos
Íleo/patologia , Doenças do Recém-Nascido/complicações , Doenças do Recém-Nascido/patologia , Obstrução Intestinal/patologia , Cistos Ovarianos/patologia , Diagnóstico Diferencial , Feminino , Humanos , Recém-NascidoRESUMO
The authors report a new aspect of NEC which can be at the origin of symptoms appearing late in the clinical course. These sequelae, consisting of colic strictures, can be observed in all patients both medically and surgically treated. The five cases presented were observed among the 21 medically managed of which they represent 23.8%. None of the ten operated patients presented sequelae. All strictures were located in the colon, always in coincidence with the original topography of pneumatosis. Multiple strictures were observed in one patient.
Assuntos
Enterocolite Pseudomembranosa/diagnóstico por imagem , Doenças do Recém-Nascido/diagnóstico por imagem , Doenças do Colo/etiologia , Enterocolite Pseudomembranosa/complicações , Enterocolite Pseudomembranosa/terapia , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/terapia , Necrose/etiologia , RadiografiaRESUMO
The authors report a study on the associated malformations found among 143 cases of digestive atresia at various levels. They are classified as single, multiple, single with trisomy and multiple with trisomy. Malformations are analysed in quality and quantity depending on the organ affected and the digestive level bearing the atresia.
Assuntos
Anormalidades Múltiplas/classificação , Doenças do Recém-Nascido/genética , Atresia Intestinal/classificação , Trissomia , Anormalidades Múltiplas/genética , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/genética , MasculinoRESUMO
Recuperation of pulmonary function after surgical repair of Bochdaleck's hernia is considered. Gasometric and radiologic features as well as scintigraphy are related in order of prognosis. Of 16 cases, seven had sudden fatal outcome. Survivals achieved total pulmonary recuperation, but some in two to three years.
Assuntos
Hérnia Diafragmática/cirurgia , Pneumopatias/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Hérnias Diafragmáticas Congênitas , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/cirurgia , Cintilografia , TecnécioRESUMO
Authors present analysis of 31 cases of necrotizing enterocolitis, which where treated medically as well surgically. Etiology is discussed and perinatal accidents are considered. An analysis of symptomatology and radiological study is made, both being deciding factors as to whether a surgical intervention is necessary. Medical treatment is commented as well as surgical and technical aspects. Mortality is sensibly diminished due to a better knowledge of the illness and to a closer cooperation between neonatologist and surgeon. It is important to point out sequelae which appeared in patients treated medically with intestinal stenosis localized in the colon.
Assuntos
Enterocolite Pseudomembranosa/diagnóstico por imagem , Doenças do Recém-Nascido/diagnóstico por imagem , Doenças Funcionais do Colo/diagnóstico por imagem , Doenças Funcionais do Colo/cirurgia , Diagnóstico Diferencial , Enterocolite Pseudomembranosa/complicações , Enterocolite Pseudomembranosa/cirurgia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Necrose , RadiografiaRESUMO
The angiomas studied at the Clinica Infantil "La Fe" in a four and a half years period are reviewed. The different therapeutic approaches are considered. Thirteen cases selected at random have been treated with local injections of steroids, with a 84% satisfactory results. The technique seems to be simple and without complications. It is recommended in the management of the parotideal, small size, subcutaneous and those angiomas in which the therapy could be followed by sequelae and in those where other therapy has failed.
Assuntos
Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Hemangioma/tratamento farmacológico , Triancinolona Acetonida/uso terapêutico , Criança , Pré-Escolar , Avaliação de Medicamentos , Neoplasias Faciais/tratamento farmacológico , Humanos , Lactente , Neoplasias Labiais/tratamento farmacológico , Neoplasias Parotídeas/tratamento farmacológicoRESUMO
Authors review fourteen cases of duodenal stenosis. A close observation can disclose early signs and enable an early diagnosis. A comment of the surgical technique is made.
Assuntos
Obstrução Duodenal , Doenças do Recém-Nascido , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/cirurgia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/cirurgiaRESUMO
Esophageal transection by means of an anastomotic clip or button is a simple and useful approach to the management of haemorrhage due to esophageal varices. We have used this technique in four cases (three Prioton clips, and one autosuture) and completed the procedure with periesophageal, left gastric and fundal veins ligation. The patients have been followed up for periods ranging between five months and six years. No one has rebled. Splenoportographic controls showed good results of disconnection, and endoscopic follow up revealed variceal cure. There was no GER and in one single case we had to dilate for mild stenosis. This is a simple and effective procedure for the control of variceal haemorrhage in the short and middle ranges, and can induce cure directing portal flow through other alternative ways.
Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hipertensão Portal/complicações , Criança , Pré-Escolar , Hemorragia Gastrointestinal/cirurgia , Humanos , Grampeadores CirúrgicosRESUMO
In the pediatric surgical Department of the "Le Fe" Hospital, from January 1971 to December 1982 2,350 laparotomies were performed in neonates, infants and children. In 67 patients abdominal surgery was complicated by bowel obstruction for which a second laparotomy had to be performed. In 86.56%, of patients with obstruction (58 cases) this became obvious during the first three months after the previous operation. In 54 out of the 67 patients reviewed (80.59%), adhesions were the cause for obstruction and only twelve was this caused by an abscess.