Biomedical subjects

C García-Sala

Publications and source records attributed to C García-Sala.

10 recordsLinked to original sources

PubMed2001

Urgent distal splenorenal shunt in low-body weight patients.

The authors report two patients with extrahepatic portal hypertension and repeated massive bleeding from esophageal varices who underwent urgent distal splenorenal shunting (DSRS) after having proved refractory to medical treatment, endoscopic sclerotherapy, and ligation of esophageal varices. Their ages and weights were 18 months/10 kg, and 11 months/6.4 kg, respectively. The splenic veins were 6 and 4 mm in diameter. During follow-up of 4 and 3 years, respectively, the shunts have remained patent in both patients as demonstrated by Doppler Ultrasound. Gastrointestinal hemorrhage has not recurred, splenomegaly regressed, and platelet and white blood cell counts increased gradually. Neither patient developed a significant encephalopathy, and liver function tests showed no significant changes throughout the observed period. The authors considered the shunting feasible despite the relatively narrow splenic veins. In both patients the anatomic position of the splenic vein--more caudal to the posterior wall of the pancreas--facilitated its isolation. In the smaller infant, the inferior mesenteric vein was sutured to gain a satisfactory segment of splenic vein. The successful use of a DSRS to control actively bleeding varices in a child weighing 6.4 kg has not been previously reported.

Angiography, Digital Subtraction↗

PubMed1999

Spontaneous biliary perforation and necrotizing enterocolitis.

A case of spontaneous bile-duct perforation in a 5-month-old boy with a history of necrotizing enterocolitis in his 1st week of life is reported. To our knowledge, this is the second case reported with such an antecedent, supporting a vascular etiology for some cases of spontaneous biliary perforation.

Ascites↗

PubMed1999

[Laparoscopic transsection of Ladd's bands: a new indication for therapeutic laparoscopy in neonates].

Within the last ten years and by the introduction of some new instruments, laparoscopy is a safe and effective method that has been further extended in children. We report our experience in the treatment of laparoscopy on a seven day old newborn affected by malrotation with an intermittent duodenal obstruction. The treatment consisted of a duodenal liberation after the section was easily performed in congenital Ladd's bands. The spiral twists of the small intestine found in the upper gastrointestinal series, disappeared in a new study done after surgery. We consider this operation as a new indication for an operative laparoscopy. It allows a good visualization of this congenital abnormality, and it is easy to perform with a significantly reduced operative trauma.

Duodenal Obstruction↗

PubMed1998

Long-gap esophageal atresia: reconstruction preserving all portions of the esophagus by Schärli's technique.

For distances of over 4-5 cm, esophageal replacement is almost always necessary in esophageal atresias. We present the technical details and describe our experience with esophageal reconstruction by elongation of the lesser curvature (Schärli's technique) in four cases of very long atresias. A retrosternal transposition was made without a thoracotomy in two children, and an orthotopic mediastinal route through a right thoracotomy was done in two others. There were two main complications: anastomotic leaks in three patients that closed spontaneously, and too-rapid gastric emptying, resulting in dumping symptoms that improved with time and diet. One patient developed an anastomotic stricture that responded to bouginage, while another had temporary feeding problems. Esophageal reconstruction by elongation of the lesser curvature provides a relatively simple method of esophageal replacement in children in that all portions of the esophagus are preserved. We propose this technique for early establishment of esophageal continuity in neonates.

Child, Preschool↗

PubMed1997

[The prolapse of the rectum. Treatment with fibrin adhesive].

Injection of sclerosing solutions into the rectal submucosa or into the perirectal space is one of the many therapies designed to correct rectal prolapse. Since 1994, four patients affected with this condition have been treated with fibrin adhesive percutaneous injection. Up to now, this product had not been used to this aim. Age range was from 1 month to 8 years. The medium duration of prolapse prior to therapy was 19 months and three of them had an associated pathology (myelomeningocele, cystic fibrosis and severe psychomotor retardation). There were no post-injection complications. In one patient with an irreducible prolapse an anus encirclement with a rectal tube was associated. Except for this patient, the whole process take less than 24 hours. With a medium follow up of 11 months this therapy has resulted effective in three of our four patients. It has failed in a girl with severe psychomotor retardation.

Child↗

PubMed1997

[Hepatoporto-appendicostomy. Our experience in 3 cases of biliary cystic disease].

This report details our preliminary experience with hepaticoporto-appendicostomy in three patients with biliary cystic disease. The surgical procedure was total resection of choledochal cyst and vascularized appendix interposition between biliary tree and duodenum. The children have been followed by clinical, ultrasonography and endoscopic (ECPR) during a period between 1-4 years. There was no episodes of ascending colangitis. All the patients remain free of jaundice and the biochemical abnormalities have become normal three months after interposition. Our results suggest that this procedure is more physiologic than the standard bilioenteric derivation Roux-in-Y, because allow bile to enter freely to duodenum and prevent reflux, stasis and ascending cholangitis. This procedure allows postoperative endoscopic valoration, not possible in another kind of bilioenteric derivations.

Appendix↗

PubMed1997

[Our experience in portal cavernomatosis in childhood: cross-sectional study and analysis of results].

A retrospective and transversal study of our patients with portal cavernomatosis is developed, with the aim of comparing the evolution and the present status of the patients that have undergone different therapeutical approaches. Between 1975 and 1995, 15 patients with portal cavernomatosis have been treated. Personal history, signs and symptoms at the moment of diagnosis, and treatment were analyzed. Now, the controls have been made by physical examination and ECO-Doppler of the espleno-portal system. In 6 cases the absence of bleeding made surgery unnecessary. In the 9 patients with digestive haemorrhage, it could be controlled pharmacologically, with a later surgical approach. Now, all non-operated and 6 operated patients show splenomegaly, without bleeding. The ECO-Doppler shows colateral flow, the splenomegaly in the non-operated and the surgical shunts and the hepatofugal circulation in the operated patients. Looking at our results, we believe that prophylactic surgery is not indicated. In those cases of digestive bleeding, surgery after the complete resolution of the acute disease shows good results at a short and long term.

Child, Preschool↗

PubMed1996

[Prenatal diagnosis of biliary atresia associated with choledochal cyst].

We report a case of biliary atresia promptly detected by its association with a choledochal cyst, prenatally diagnosed at 20 weeks' gestation. The baby was operated at 14 days of life. A choledochal cyst was found and fibrosis of the extrahepatic bile ducts was also noted. So, excision of the choledochal cyst and a Roux-en-Y porto-jejunostomy was done. Nine months later, despite an appropriate biliary drainage, echographic and histological changes compatible with liver cirrhosis have been detected. Including this one, six cases have been reported.

Biliary Atresia↗

PubMed1992

[Whole gut irrigation in pediatric patients: a comparative study].

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.

Adolescent↗

PubMed1987

[Laparoscopy in pediatrics].

Laparoscopy has been performed in 68 infants and children. In 50 cases of non-palpable testis; 7 cases of liver diseases; 4 cases of abdominal trauma; 7 cases for various other indications. In our experience, laparoscopy was a considerable advantage in the diagnosis and management of a number of pediatrics disorders.

Child↗