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Biomedical subjects

F García-Ibarra

Publications and source records attributed to F García-Ibarra.

At least 19 recordsLinked to original sources
PubMed2000

Latex sensitization in children with spina bifida: follow-up comparative study after two years.

BACKGROUND: Previous findings suggest that sensitization to latex in children with spina bifida is a dynamic process. OBJECTIVE: To study if changes appear in the sensitization status after withdrawal of latex. METHODS: We studied a consecutive sample of 68 children with spina bifida, by means of latex skin prick tests and quantification of serum latex-specific IgE on two separate occasions two years apart. RESULTS: Forty-four (65%) were classified as nonsensitized, 6 (9%) showed indeterminate results, and 18 (26%) were sensitized to latex, six of whom had clinical reactions to latex. They were instructed to avoid latex. In a second evaluation, 2 years later, 38 (56%) were classified as nonsensitized, 3 (4%) as indeterminate, and 27 (40%) as sensitized to latex, 11 of whom had presented latex symptoms. This meant 22% of spina bifida children demonstrated progressive sensitization, in spite of having adopted a latex-free environment at our hospital. It illustrates the progressive character of latex sensitization in these patients. CONCLUSION: Latex avoidance measures both in the medical and home settings must be stressed. We recommend that children with spina bifida should be periodically evaluated regarding latex sensitization.

Adolescent↗
PubMed2000

The search of latex sensitization in spina bifida: diagnostic approach.

BACKGROUND: Sensitization to latex has become a major problem in children with spina bifida. Life-threatening reactions may occur in these patients, therefore the search of latex sensitization must be an active task in all of these children. OBJECTIVE: To design an approach for the diagnosis of latex sensitization in children with spina bifida. METHODS: We studied 100 consecutive unselected patients. Skin prick tests with a commercial latex extract were performed, latex-specific serum immunoglobulin (Ig) E was determined by CAP test, and risk factors were studied. Originally, patients with an area of latex skin test > 50% of the area of histamine and/or CAP class > or = 3 were considered sensitized to latex. Diagnostic tests were also performed in a control group of 51 atopic and nonatopic children. RESULTS: After performing a receiver-operating characteristics curve for both tests we recommend skin tests > 25% of the area of histamine (sensitivity - SEN = 79%, specificity - SPE = 100%, positive predictive value - PPV = 100%, negative predictive value - NPV = 90%), or CAP class > or = 2 (SEN = 88%, SPE = 100%, PPV = 100%, NPV = 94%) as diagnostic cut-off points. The anamnesis had a SEN of 44% for diagnosis, and a SPE of 100%. Latex sensitization was associated with more than 5 operations (OR = 8, 95% CI = 3-21.3), a personal history of atopy (OR = 11.5, 95% CI = 2.3-57.1), and serum total IgE > or = 2 z-units (OR = 4, 95% CI = 1. 6-10). CONCLUSION: For the routine evaluation of children with spina bifida, we propose a diagnostic algorithm with skin prick tests as a first step and CAP second.

Child↗
PubMed1999

Transitional cell carcinoma of the bladder in children.

We present a case of transitional cell tumor of the urinary bladder in an 8-year-old boy and discuss certain aspects of the epidemiology, aetiology, prognosis, treatment and follow-up. We review the published cases in the literature since 1992, and compare them with the classic series.

Carcinoma, Transitional Cell↗
PubMed1999

[Single-system ectopic ureters. A review of 19 cases].

Single system ectopic ureters are usually associated with multiple congenital abnormalities and the corresponding renal units is frequently abnormal. 19 cases of single system ectopic ureters were diagnosed and treated in our hospital during the last 20 years. The patients were less than 11 years old. The abnormality was bilateral in two cases and the 63% of all had associated malformations, being the anorectal abnormalities the most frequent. The incidence of reflux into the ectopic ureter was 57%, and the association to unilateral or contralateral renal agenesis, 26.3%. Thirteen ectopic ureters were reimplanted successfully into the bladder, and the cases of nonfunctioning kidneys were removed (nephroureterectomy). The follow-up period was 10 months to 14 years, developing the 68% of the cases without any complication and a good renal function. Two patients were transplanted due to a kidney failure. Diagnosis is often extremely difficult and requires a high degree of suspicion. This diagnosis may be incidental, and it may be made during investigation of patients with other malformations. An early diagnosis and treatment must be made in order to avoid a disturbance of renal function. We wish to point up the high incidence of reflux into the ectopic ureter and the high association to renal agenesis in the single system ectopic ureters in comparison with ectopic ureter of duplex system.

Abnormalities, Multiple↗
PubMed1997

Factors that influence the presence of symptoms caused by latex allergy in children with spina bifida.

BACKGROUND: Some children with spina bifida who are sensitized to latex can have severe reactions, whereas others remain free of symptoms. OBJECTIVE: Our aim was to study the differences between these two groups of patients. MATERIAL AND METHODS: In 110 consecutive children with spina bifida, we identified by means of skin prick tests and serum latex-specific IgE 32 patients sensitized to latex. In these 32 patients, data were collected for sex, age, personal and familial history of atopy, number of cystourethrograms and number of operations, history of intermittent bladder catheterization, serum levels of total IgE in units per milliliter and in z units, levels of latex-specific IgE, and results of skin prick tests. RESULTS: Sixteen patients (50%) had clinical symptoms related to latex. These patients had significantly higher levels of serum specific IgE (32.8 +/- 30.7 U/ml vs. 12.8 +/- 16.5 U/ml), were more likely to have positive responses on skin tests (100% vs. 75%), had a higher number of operations (10.5 +/- 6.9 vs. 5.8 +/- 2.7), and were more likely to have a personal history of atopy (44% vs. 6%) in comparison with findings for patients who did not have symptoms (p < 0.05 in all cases). A multivariate logistic regression analysis identified the latter two factors as independent synergistic variables to predict symptoms. CONCLUSIONS: The number of operations is the main risk factor for latex-related symptoms in sensitized children. Atopy seems to lower the threshold both for sensitization and for the presentation of clinical reactions.

Adolescent↗
PubMed1997

[The use of color doppler sonography of the acute scrotum in children].

The differential diagnosis of the causes of acute scrotum only by clinical means, is often very difficult and supposes the risk of making mistakes, which leaves to several unnecessary surgical explorations. By Colour Doppler Sonography we get some information about testicular flow that helps us in the diagnosis. During the last two years 72 consecutive cases of acute scrotum in children younger than 13 years old, were seen in our hospital emergency department. They all underwent testicular bilateral sonography with color flow imaging using a 7.5 MHz linear array transducer (Model Sonolayer Toshiba SSH-140 A). The sonographical diagnosis were: 45 epididymo-orchitis (62.5%), 8 testicular torsions (11%), 7 torsions of the appendix of testis (9.7%), 7 normal explorations (9.7%), 4 acute idiopathic scrotal oedema (5.5%) and a Henoch-Schönlein purpura (1.38%). Doppler examination showed a 97.2% sensibility and 72.2% specificity in the diagnosis of epididymo-orchitis and 88.88% sensibility and 100% specificity in the diagnosis of testicular torsion. The Colour Doppler Sonography should not minimize importance to the clinical explorations, but is very useful for the diagnosis of acute scrotal process, overcoat in inflammatory diseases.

Acute Disease↗
PubMed1997

[Latex allergy in children with myelomeningocele. Incidence and associated factors].

RATIONALE: The purpose of our work is to know the prevalence of allergies to latex in patients with myelomeningocele (MMC) and to evaluate any potential factors influencing its development. METHODS: The study included 100 children with mean age 7.5 +/- 4.8 years, diagnosed with MMC by skin tests and total and latex-specific IgE determination. The results were compared to those obtained in three "control" groups: atopic patients, patients undergoing their first operation and multi-operated patients. The relationship between the different variables analyzed was assessed using univariant and multivariant statistical studies. RESULTS: 29 were sensitized (15 symptomatic and 14 asymptomatic) and 8 doubtful. Results showed statistically significant (p < 0.05) differences for atopic and first operation groups and non significant differences for the multi-operation group. The multivariant study selected the followed as the most relevant variables: number of surgical interventions, total IgE levels in z units, ventricle-peritoneal by-pass carriers and atopy background. Also in the multivariant study, the following showed statistically significant results: age, Cums' number, inclusion in intermittent catheterism program and total IgE levels. Neither sex or familial background of atopy showed statistical significance. CONCLUSIONS: Allergy to latex in MMC patients is related to multiple antigen contacts, the numerous manipulations and operations undertaken throughout the patient's life plus a personal propensity to allergies. It is essential that this group should adopt certain standards to minimize contact with the antigen and undergo an allergological study so as to detect those who are sensitized, which in nearly half our series has not yet exhibited symptomatology in contact with latex utensils. All diagnostic and therapeutical procedures should be conducted in latex-free environments.

Adolescent↗
PubMed1996

Allergy to latex in spina bifida: a multivariate study of associated factors in 100 consecutive patients.

BACKGROUND: Latex allergy is quite frequent in patients who have undergone multiple operations, such as children with spina bifida. OBJECTIVE: This investigation was carried to study the prevalence and risk factors associated with latex allergy in patients with spina bifida. METHODS: We studied 100 consecutive patients by skin prick tests and quantified specific IgE to latex with commercial antigens. RESULTS: Twenty-nine patients were sensitized to latex, although 14 (49%) did not report symptoms. There was a statistical association (p < 0.05) between sensitization and age, number of operations, number of cystourethrograms, antecedents of intermittent bladder catheterization, personal antecedents of atopy, the presence of a ventricular-peritoneal shunt, and levels of serum total IgE, the latter both in absolute units per milliliter and relative z-units. Through a forward stepwise multiple logistic regression analysis, the number of operations, serum total IgE in z-units, the presence of a ventricular-peritoneal shunt, and personal antecedents of atopy were selected as the synergistic variables that most contributed to identification of sensitized patients. The mathematical model so developed had an area under the receiver operating characteristic curve of 0.95. Alternative models always retained two variables, the number of operations and levels of IgE. CONCLUSION: Allergy to latex is mainly related to the number of operations and to the atopic diathesis of patients.

Adolescent↗
PubMed1996

[Neonatal intravaginal testicular torsion in an undescended testis].

We report a case of intravaginal testicular torsion with an unusual debut in a 30 day old patient which had undescended testis. We emphasize the need of a complete physical exploration of the child that go to the emergency service with inspecific symptoms of abdominal pain, and supposing the hemiscrotum was empty, is essential to reject a torsion of a cryptorchidic testicle. An immediate surgery is necessary in order to diagnose and treat this disturbance.

Cryptorchidism↗
PubMed1994

Histological study in contralateral testis of prepubertal children following unilateral testicular torsion.

Histological changes in the contralateral testis in 8 prepubertal children whose ages ranged from 3 to 7.5 years with a history of testicular torsion and subsequent atrophy were studied. The following histological parameters were evaluated: fertility tubular index (FTI), Sertoli cell index (SCI) and minimum tubular diameter (MTD). According to our findings and following Nistal and Paniagua's classification (1984) for tubular alterations, we found 5 cases (62.5%) who present the following alterations. Type 1 (case 2): FTI was decreased above 50% corresponding to slight germinal hypoplasia with normal MTD and SCI. Type 2 (cases 3 and 5): testis with remarkable germinal hypoplasia; FTI was between 30 and 50% while MTD was below normal values. Type 3 (case 8): testis with diffuse tubular hypoplasia; FTI was below 30%, whereas MTD showed 33% decrease regarding normal values. Type 4 (case 6): testes with hyperplasia of Sertoli cells; SCI was increased one third with regard to that corresponding to his age; FTI showed severe hypoplasia of germ cells. No relationship between alterations in either the age of the patients or the time elapsed since the torsion was observed. Because of all these facts and the young age of our patients, we believe that the alterations found in the contralateral testis were due to congenital dysgenesia.

Atrophy↗
PubMed1992

[Pyeloureteral junction syndrome. Associated vesicoureteral reflux].

We reviewed our series comprised of 106 children that had undergone surgery for congenital hydronephrosis from ureteropelvic junction obstruction. Following our protocol, all patients were evaluated by serial micturition cystourethrography. The only anomaly that had been detected was vesicoureteral reflux in 11.32% of the cases. This incidence is reduced to 8.25% if only the renoureteral systems with both congenital anomalies are considered. This finding is not statistically significant (p less than 0.05) relative to patient age, sex or clinical symptoms. The results of the present study show that children with ureteropelvic junction obstruction are not at risk of developing vesicoureteral reflux. Thus, routine serial micturition cystourethrography appears to be unwarranted.

Adolescent↗
PubMed1983

[Diagnostic errors in nephroblastoma].

We review 37 patients diagnosed of Wilms' tumor at the Clinica Infantil "La Fe", in the last ten years, looking at the misdiagnosed cases. In two children, histological study showed a multilocular renal cyst. We also report a case previously diagnosed as being a multicystic kidney; the histological study revealed, however, a cystic partially differentiated nephroblastoma. No case of extrarenal tumors was present in the misdiagnosed patients. We comment the difficulties to make a correct diagnosis when confronted with the above mentioned entities and before histological data are available.

Diagnostic Errors↗
PubMed1983

[Wilms' tumor. Clinico-prognostic correlates].

A series of 42 children with Wilms' tumor collected in 11 years is reported. The female-to-male ratio was 1,5:1 and 85 per cent of the patients were under 5 years at diagnosis. The majority of the tumors were Stage I (38 per cent) followed by Stages III and IV. Pathological findings following Belkwith's criteria are commented upon. The 5 year survival was 72 per cent, and tumor-free survival was 62 per cent. There was a clear relationship between survival and Stage, age and the presence or absence of intra-abdominal lymph-node spread. Efficacity of preoperative chemotherapy and its' influence on the stage of tumor at operation is discussed.

Child↗
PubMedDate not supplied

[Neonatal urinary ascites. Considerations on its diagnosis and treatment].

Seven cases with neonatal urinary ascites are described. In all of the cases the underlying cause was an anatomical or functional obstructive uropathy of the lower urinary tract, the most common pathology being neurogenic bladder secondary to lumbosacral dysphagia. The techniques utilized for patient evaluation (ultrasound, serial micturition cystourethrography and IVP) are described and the findings afforded by each diagnostic technique are presented. The value of serial micturition cystourethrography is underscored. In our view, it is convenient to perform initial diversion by percutaneous nephrostomy, suprapubic punction or placement of a urethral catheter, according to the level of the etiologic process. The definitive surgical approach will depend on the results of subsequent radiologic controls and the existing uropathy.

Ascites↗
PubMedDate not supplied

[Congenital hydronephrosis: pyeloureteral junction syndrome. Surgical treatment].

This paper reviews the surgical procedure performed in 119 kidneys (114 children), diagnosed with congenital hydronephrosis due to pyeloureteral juncture stenosis (PUJS). Approaches used for diagnosis and choice of surgical techniques are commented. Puncture/nephrostomy with functional kidney assessment has been the method selected in extreme cases. Nephrectomy was the chosen option in 8 cases (6.7%) while conservative surgery was indicated in the others. Anderson-Hynes dismembered pyeloureteral plasty was the technique used in 110 cases with a 97.28% rate of success. Post-operative occurrences are commented and are related to the presence of pre- and post-operative derivation.

Adolescent↗