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1.
Laryngoscope ; 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31090942

RESUMO

OBJECTIVE: Primary tracheobronchial tumors (PTTs) are rare heterogeneous lesions arising from any part of the tracheobronchial tree. Nonspecific symptoms may lead to delayed diagnosis that requires more aggressive surgical treatment. An analysis of cases collected by the International Network of Pediatric Airway Team was undertaken to ensure proper insight into the behavior and management of PTTs. METHODS: Patients < 18 years of age with a histological confirmation of PTT diagnosed from 2000 to 2015 were included in this multicenter international retrospective study. Medical records, treatment modalities, and outcomes were analyzed. The patient presentation, tumor management, and clinical course were compared between malignant and benign histotypes. Clinical and surgical variables that might influence event-free survival were considered. RESULTS: Among the 78 children identified, PTTs were more likely to be malignant than benign; bronchial carcinoid tumor (n = 31; 40%) was the most common histological subtype, followed by inflammatory myofibroblastic tumor (n = 19; 25%) and mucoepidermoid carcinoma (n = 15; 19%). Regarding symptoms at presentation, wheezing (P = 0.001) and dyspnea (P = 0.03) were more often associated with benign growth, whereas hemoptysis was more frequently associated with malignancy (P = 0.042). Factors that significantly worsened event-free survival were age at diagnosis earlier than 112 months (P = 0.0035) and duration of symptoms lasting more than 2 months (P = 0.0029). CONCLUSION: The results of this international study provide important information regarding the clinical presentation, diagnostic workup, and treatment of PTTs in children, casting new light on the biological behavior of PTTs to ensure appropriate treatments. LEVEL OF EVIDENCE: NA Laryngoscope, 2019.

2.
Pediatr Transplant ; 23(1): e13311, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30362299

RESUMO

Cancer is a major adverse outcome of solid organ transplantation, and risks are especially high for malignancies caused by viral infections. HHV-8 is the etiologic agent of Kaposi´s sarcoma (KS). We report a case of visceral KS occurring in a 15-year-old patient after lung transplantation. The evolution was dramatically fast and interestingly, KS lesions were diffusely observed, but not in the skin. The autopsy showed the presence of numerous tumoral lesions in many organs. Microscopically, they all had very similar features, regardless of the organ affected. KS presented without cutaneous involvement. The girl was not tested for HHV-8 prior to transplantation as it was not part of our protocol. The donor was negative. The aim of the report is to alert other teams, especially those working in pediatrics, about this rare but potential complication in the setting of solid organ transplantation.


Assuntos
Transplante de Pulmão , Complicações Pós-Operatórias/diagnóstico , Sarcoma de Kaposi/diagnóstico , Adolescente , Evolução Fatal , Feminino , Humanos , Sarcoma de Kaposi/etiologia
3.
Pediatr Surg Int ; 32(5): 451-7, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26971789

RESUMO

PURPOSE: Primary lung tumors are rare during childhood and encompass a wide variety of histological types. Each has a different biology and a different therapeutic approach. The aim of this article is to review the experience of a pediatric referral center with this kind of tumors during the last 24 years. METHODS: A retrospective chart review was performed for patients with diagnosis of primary lung tumor between the years 1990-2014. The variables analyzed were age, sex, course of the disease, symptoms, localization, surgery, histology and outcome. RESULTS: Between 1990 and 2014, 38 patients with primary lung tumors were treated at our institution. Age at presentation was 6.6 ± 5.2 years (r 0.91-16.58) and the female:male relationship was 1.37. Inflammatory myofibroblastic lung tumor (n = 13), carcinoid tumor (n = 6) and pleuropulmonary blastoma (n = 6) were the most frequent histological types. Persistent radiographic abnormality was the most frequent presenting sign (34 %). Global mortality was 15.8 % varying according to histology. CONCLUSION: Although the diagnosis of primary lung tumor is rare, the persistence of a radiographic abnormality in spite of adequate treatment for inflammatory processes forces us to evaluate further. The age of the patient is an important factor in the decision of the diagnostic work-up.


Assuntos
Neoplasias Pulmonares/diagnóstico , Adolescente , Tumor Carcinoide/diagnóstico , Tumor Carcinoide/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/cirurgia , Masculino , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias de Tecido Muscular/cirurgia , Blastoma Pulmonar/diagnóstico , Blastoma Pulmonar/cirurgia , Encaminhamento e Consulta , Estudos Retrospectivos
4.
Arch Argent Pediatr ; 114(1): e29-31, 2016 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-26914087

RESUMO

Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico , Diagnóstico Tardio , Humanos , Lactente , Masculino
5.
Arch. argent. pediatr ; 114(1): e29-e31, feb. 2016. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-838172

RESUMO

La hernia diafragmática congénita (HDC) es una malformación rara, habitualmente unilateral y más frecuente del lado izquierdo. La HDC bilateral representa el 1% de todas las HDC. La mortalidad es mayor en las HDC derechas y en las bilaterales. Reportamos el caso de un paciente con HDC bilateral, cuya malformación inicialmente se diagnosticó y trató como una HDC derecha. Luego se encontró la presencia de HDC izquierda durante la cirugía de Ladd laparoscópica a los 8 meses de edad.


Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.


Assuntos
Humanos , Masculino , Recém-Nascido , Diagnóstico Tardio , Hérnias Diafragmáticas Congênitas/diagnóstico
8.
J Neonatal Surg ; 2(3): 35, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-26023455

RESUMO

We describe the case of a neonate with an umbilical hernia and persistent wet umbilicus. Examination revealed a pulsatile umbilical cord with palpable thrill. Doppler ultrasound suspected umbilical arteriovenous malformation and contrast-enhanced computed tomography was performed leading to a definitive diagnosis. Surgery was successfully performed on day 27.

9.
Arch Argent Pediatr ; 108(2): 148-52, 2010 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-20467711

RESUMO

Twenty patients with tracheal stenosis were surgically treated between July 2005 and May 2008; ten patients had a congenital stenosis and ten an acquired one. Global survival was 85%. Three patients died: 1 with acquired stenosis and 2 with congenital stenosis. From 17 alive patients, 15 remain asymptomatic; 2 patients operated on due to congenital stenosis, are under continuous follow-up (both with stents placed in the trachea). Surgical treatment of acquired stenosis presents less severe complications, requires less ventilatory support and hospital stay. Conversely, congenital stenosis often requires more than one procedure to control the disease, and presents a higher mortality rate.


Assuntos
Estenose Traqueal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino
10.
Arch. argent. pediatr ; 108(2): 148-152, abr. 2010.
Artigo em Espanhol | LILACS | ID: lil-548758

RESUMO

Veinte pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005y mayo de 2008, diez con estenosis congénita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congénita.De los diecisiete sobrevivientes, quince se encuentran asintomáticos; dos pacientes operados por estenosis congénita requieren controlesperiódicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadía hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongénita necesitan, generalmente, másde un procedimiento terapéutico y presentan mayor mortalidad.


Assuntos
Humanos , Masculino , Adolescente , Feminino , Lactente , Pré-Escolar , Criança , Constrição Patológica/complicações , Estenose Traqueal/cirurgia , Estenose Traqueal/congênito , Estenose Traqueal/terapia , Toracotomia
11.
Arch. argent. pediatr ; 108(2): 148-152, abr. 2010.
Artigo em Espanhol | BINACIS | ID: bin-125783

RESUMO

Veinte pacientes con estenosis de tráquea fueron intervenidos quirúrgicamente entre julio de 2005y mayo de 2008, diez con estenosis congénita y diez de origen adquirido.La sobrevida global fue de 85 por ciento. Fallecieron tres pacientes, uno con estenosis adquirida y dos conestenosis congénita.De los diecisiete sobrevivientes, quince se encuentran asintomáticos; dos pacientes operados por estenosis congénita requieren controlesperiódicos (ambos con tutores endoluminales [stents] colocados).La estenosis traqueal adquirida presenta menos complicaciones, requiere menos asistencia respiratoria y menor estadía hospitalaria en el posoperatorio. Los pacientes con estenosis traquealcongénita necesitan, generalmente, másde un procedimiento terapéutico y presentan mayor mortalidad.(AU)


Assuntos
Humanos , Masculino , Adolescente , Feminino , Lactente , Pré-Escolar , Criança , Estenose Traqueal/cirurgia , Estenose Traqueal/terapia , Estenose Traqueal/congênito , Constrição Patológica/complicações
12.
J Pediatr Surg ; 44(12): 2420-5, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20006042

RESUMO

AIM: The aim of this study was to evaluate the outcome of all patients who underwent an extrathoracic esophageal elongation (EEE) (Kimura's technique) and determine its role, among other surgical options, for the treatment of patients with complex esophageal atresia (EA) who have a previously created esophagostomy. METHODS: Between March 1997 and September 2008, we performed 20 EEEs. Twelve patients were males and 8 were females. The diagnoses were type C EA (n = 12), type A EA (n = 5), type B EA (n = 2), and type D EA (n = 1). Mean age at the initiation of the EEE was 10 months (range, 3-25 months). RESULTS: At the time of this report, 15 of the 20 patients have finished the treatment, 4 patients are still in the process of elongation, and one patient (premature, with a birth weight of 685 g) died before the final esophageal reconstruction. Of the 15 patients who finished the treatment, 12 (80%) completed it satisfactorily and 3 (20%) had to be prematurely interrupted. (In 2 patients, despite multiple attempts, the upper pouch could not be adequately elongated, and in one patient, an early perforation of the upper pouch precluded further elongations.) Of the 12 patients who completed the treatment satisfactorily, 10 (83%) are asymptomatic and exclusively on oral alimentation, whereas 2 (17%) have a pseudodiverticulum and esophageal dysmotility (requiring supplemental alimentation through a gastrostomy). Five of the 12 patients have gastroesophageal reflux (2 required a Nissen fundoplication and 3 are being treated medically). CONCLUSIONS: We believe that the EEE is a useful surgical option for a selected group of patients with complex long-gap EA who required a primary esophagostomy and also for patients with any type of EA who developed severe complications after a primary repair and required a secondary esophagostomy. With this technique, we avoided an esophageal replacement in 80% of cases, and given that the EEE does not invalidate a later esophageal replacement, we believe that the EEE is a feasible initial option for these patients.


Assuntos
Atresia Esofágica/cirurgia , Esofagoplastia/métodos , Esôfago/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , Transtornos da Motilidade Esofágica/etiologia , Esofagostomia , Estudos de Viabilidade , Feminino , Refluxo Gastroesofágico/etiologia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Resultado do Tratamento
16.
Buenos Aires; s.n; 2000. 13 p. tab. (83580).
Monografia em Espanhol | BINACIS | ID: bin-83580

RESUMO

El objetivo de este estudio es comparar distintos métodos de preservación traqueal en un modelo isogénico heterotópico de transplante inmediato y con 24 horas de preservación. Ochenta ratas Sprague-Dawley endocriadas, con un peso de 300-340 gramos fueron utilizadas como donantes y receptores divididas en 8 grupos: A: trasplante inmediato, no Euro-Collins, no criopreservación, B: trasplante inmediato, si Euro-Collins, no crioperservación, C: trasplante 24 horas, no Euro-Collins, no criopreservación, D: trasplante 24 horas, si Euro-Collins, no criopresenrvación, E: criopreservación luego de 24 horas a 4ºC, no Euro-Collins, F: criopreservación inmediata, no Euro-Collins, G: criopreservación luego de 24 horas a 4ºC, si Euro-Collins, H: criopreservación inmediata, si Euro-Collins. Todos los injertos fueron implantados en epiplón. Tres muestras para estudio microscópico fueron tomadas de cada espécimen: inmediatamente después de la ablación, inmediatamente antes del implante (al finalizar el período de preservación) y en el momento del sacrificio. No hubo muertes antes del tiempo establecido. Los escores de daño histológico del material obtenido en el momento del sacrificio fueron: grupo A: 3.1; grupo B: 1.7; grupo C: 3; grupo D: 1.1; grupo E: 3.2; grupo F: 3.7; grupo G: 1.3 y grupo H: 1. Todos los injertos presentaban la luz ocupadas por granulomas. La preservación con Euro Collins es superior a la preservación sin Euro Collins tanto en tráqueas criopreservadas como no criopreservadas. La criopreservación es una estrategia válida para la obtención de injertos traqueales. Los injertos criopreservados presentan lesiones leves aunque más severas que aquellos no criopreservados. La irrigación de Euro-Collins permite preservar tráqueas hasta 24 horas a 4ºC. (AU)


Assuntos
Traqueia/cirurgia , Traqueia/irrigação sanguínea , Traqueia/transplante , Preservação de Órgãos/métodos , Transplante Isogênico , Ratos Sprague-Dawley , Criopreservação , Soluções para Preservação de Órgãos , Bioensaio
17.
Buenos Aires; s.n; 1998. [40] p. (83549).
Monografia em Espanhol | BINACIS | ID: bin-83549

RESUMO

Introducción: la escasez de pulmones aptos para trasplante hace que el concepto de donante a corazón no batiente (DCNB), esto es, ablacionar órganos luego del cese de la función cardíaca, deba ser considerado como una estrategia alternativa para incrementar el número de órganos disponibles. El tratamiento con surfactante ha demostrado ser efectivo para mejorar la función pulmonar en varios modelos animales de injuria pulmonar aguda y también en el síndrome de distrés respiratorio agudo en humanos. El objetivo de este estudio es investigar si el tratamiento con surfactante antes de la reperfusión mejora la función del pulmón implantado en un modelo de trasplante de pulmón en ratas a partir de DCNB con sobrevida de 24 horas. Material y Métodos: 50 ratas Fischer endocriadas, con un peso de 300-340 gr. fueron utilizadas como donantes y receptores en un modelo isogénico de trasplante de pulmón izquierdo. Fueron conformados 5 grupos (n=5). El tiempo de isquemia fría fue de 4 horas en todos los grupos. las ratas del grupo I (contro) fueron trasplantadas en condiciones de donante a corazón batiente (sin tiempo de isquemia caliente). En las ratas de los restantes grupos se provocó el paro cardíaco y luego fueron dejadas a temperatura ambiente por 30, 120 y 240 minutos: grupos II (DCNB 30 n=5), III (DCNB 120 n=5), IV (DCNB 240 n=5) y V (DCNB 240+SURF n=5). En el grupo V se instiló por vía intratraqueal surfactante a una dosis de 100 mg/kg de peso momentos antes de reperfundir el órgano implantado. Se llevó a cabo el sacrificio de todos los animales 24 hs. luego del procedimento y se analizaron parámetros hemodinámicos (gases arteriales, presión arteria pulmonar, compliancia) y anatómicos (Rx tórax, histología). El análisis estadístico se efectuó con prueba T asumiendo varianzas desiguales. Resultados: los animales tratados con surfactante (grupo V) tuvieron valores más altos de oxigenación (PaO2) que aquellos con igual tiempo de isquemia caliente (grupo IV)(p<0.05), aunque sin igualar la función de los grupos con menor tiempo de isquemia (I,II y III)(p<0.01). La presión parcial de dióxido de carbono en sangre arterial (PCO2) se mantuvo estable en los grupos I,II y III (p=0.15 NS) pero fue significativamente más alta en los grupos IV (p<0.01) y V (p<0.05)...(TRUNCADO)(AU)


Assuntos
Animais , Ratos , Transplante de Pulmão , Transplante Isogênico/métodos , Doadores de Tecidos , Doadores Vivos , Cadáver , Intubação Intratraqueal , Surfactantes Pulmonares/administração & dosagem , Oxigênio/administração & dosagem , Isquemia/complicações , Pulmão/fisiologia , Reperfusão , Ratos Endogâmicos F344
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