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J Boix-Ochoa

Publications and source records attributed to J Boix-Ochoa.

At least 19 recordsLinked to original sources
PubMed1992

Paediatric liver transplantation: life after portoenterostomy in biliary atresia.

Seventy-five percent to 80% of patients with biliary atresia (BA) will be candidates for paediatric liver transplantation (PLTx) throughout the first 14 years of life. They form the main group of recipients in our Paediatric Liver Transplant Unit. Of 48 children transplanted, 21 (44%) had BA. These patients present particular features, average weight of 12 kg, mean age of 3 years, and severe malnutrition prior to PLTx, which distinguish them from other paediatric candidates. With the advent of PLTx, portoenterostomy (PE) has ceased to be the only recourse for treating the majority of patients with BA. Different factors converge in these patients: some, including haemorrhage and adhesions, may present technical difficulties, and others, such as infections (19% in this series) due to severe malnutrition and malabsorption and consequent chronic rejection (14% in this series), often lead to death in the postoperative period (33% in this series). BA is treated by all paediatric surgeons, but the overall success rate now depends not only on PE but also on PLTx. In an attempt to facilitate possible later PLTx in pts with BA, the authors as paediatric surgeons performing PE or PLTx present surgical modifications and emphasize the most important medical aspects conducive to the improved general status of these pts. Our aim was to establish guidelines for taking full advantage of PE while preventing posterior problems and facilitating future transplant surgery.

Biliary Atresia↗
PubMed1992

[Piriform sinus fistula, a new disease].

Pyriform sinus fistula has recently been described as a new, rare and little known pathology. The process develops as latero-cervical suppurative adenitis or acute suppurative thyroiditis, usually on the left side. Radical surgery is mandatory to avoid recurrence. This congenital malformation must be present in the differential diagnosis of recurrent infectious cervical processes, especially in acute thyroiditis. The only curative treatment is complete exeresis of the fistula after meticulous dissection of the fistulous tract. We present three cases of this pathology. The diagnostic approach and surgical treatment are discussed. The recent literature on this topic is reviewed.

Branchial Region↗
PubMed1992

[The surgical treatment of gastroesophageal reflux (GER)].

From 1960 to 1990, a total of 2,476 instances of cardio-hiatal abnormalities were treated. The cause of the abnormality was achalasia (cardio-esophageal dilatation) in 2.244 instances, sliding hernias in 167 and hiatal hernias in 65. Only 213 patients underwent operations, 8,%. Gastroesophageal reflux in children has characteristics different from those of gastroesophageal reflux in adults. Knowledge of the forces that influence the closing mechanisms of the lower esophageal sphincter (LES) is the cornerstone for rational and logical intervention. The philosophy in pediatrics is that a child is a being in evolution and that the anomaly in children originates from a displaced healthy LES that has not had the opportunity to demonstrate its function because it is not in its proper place. An operation that helps to provide essential anatomic conditions immediately leads the LES to normal physiology. The A.A. discussed and presented in which cases the surgical procedure has to be taken.

Child↗
PubMed1990

[Our experience in the treatment of cervico-facial adenitis caused by non-tuberculous mycobacteria (atypical mycobacteria)].

The authors believe that the greater part of chronic cervicofacial adenitis actually observed in our hospitals, are not caused by M. tuberculosis or M. bovis but by scrofulaceum mycobacterium, M. avium, M. fortuitum and M. Kansasii, and above all, by the first two of these. They present their experience with 16 cases of cervico-facial adenitis due to atypical mycobacterium (CAAM) treated in our centre during the last years, in which period no case of cervical tuberculosis (CT) was observed. It is important to establish an early differential diagnosis between both etiologies, seeing as treatment is different. Whilst tuberculostatics can solve the phymic infection, surgical extirpation is the only solution for CAAM. The diagnosis of these types of infection is achieved by means of a very characteristic clinical procedure and by cutaneous tests specific for each bacteria. Faced with the clinical suspicion, the total extirpation should be effected of the adenopathic block affected. The exact diagnosis can only be made by the culture of the operatory mass.

Child↗
PubMed1990

[Follow-up and evolution of 10 cases operated on for total colonic aganglionosis].

One hundred sixty-one cases of HIRSCHSPRUNG's disease have been operated on by us between 1966 and 1988. Of these, 19 were total colonic aganglionosis. Of eleven that underwent surgery before 1982, five are still alive. The eight that were operated on after 1982 have a good evolution. This report is a retrospective study of the clinical evolution in ten of the thirteen survivors. The ages are comprised between 21 and 2 1/2 years. We have reviewed their general condition, weight, height, tolerance to oral intake, stool frequency, general laboratory determinations, circulating iron, transferrin, transferrin saturation, absorption of vitamin B12 and folic acid, hydrogen test and stool examination. Except for one case, the others are in a perfect nutritional and growth condition. DUHAMEL's technique was employed in eight cases and REHBEIN's technique, in two. Given our good results, we think that LESTER-MARTIN's technique is unnecessary, except for that cases with extensive small bowel involvement due to the serious problems of absorption that this represents.

Colon↗
PubMed1990

[Meconial peritonitis: conclusions based on 53 cases].

The study of 53 patients with neonatal meconium peritonitis (MP) over a twenty-two year-period, the largest surgically-treated series at a single centre, is presented. Three different types of MP were established: Generalized, Localized and Cystic. Prognosis and surgical techniques to be used were determined by each MP type. The following survival rates achieved: for Generalized MP, 70% with "one stage" and 89% with "two stage"; for Localized MP, 80% with "one stage" and 100% with "two stage" and for Cystic MP, 57% with "two stage". The overall survival rate was 77%, rising to 85% in the last fifteen years, probably due to the advent of parenteral nutrition and advances in neonatal intensive care.

Cystic Fibrosis↗
PubMed1989

[Surgical approach in persistent neonatal pneumothorax].

837 neonates required mechanical ventilation at the Neonatal Intensive Unit in the last five years. 136 of them developed tension pneumothorax. Authors report our experience in these patients, who underwent next protocol: 1. Early diagnosis. 2. Underwater-seal drainage. 3. Suction drainage. 4. Selective intubation of contralateral bronchus. 5. Surgical closure. We explain step to step the protocol, specially in the 15 neonates who needed surgery. In such cases, surgical survival was 100%, in the postoperative phase 93% and total survival reached 78.5%. Therefore, we recommend surgery closure in patients who maintain pulmonary fistula in spite of an aggressive conservative treatment.

Female↗
PubMed1989

[Treatment of esophageal stenosis in children].

Esophageal stenoses, both congenital and acquired, represent a serious problem in childhood due to the deleterious effects, of these anomalies in the patients nutritional state and lifestyle. Choosing the best way to the solution of such problems is of primary importance, paying special attention to the techniques that may not compromise irreversibly the continuity of the alimentary tract. The authors experience on the treatment of 77 esophageal stenoses, 8 of which were congenital and 69 acquire, is reported. Of this group, 24 are sequelae of esophageal atresias, 33 are of caustic origin and 12 of peptic nature. In 3 congenital stenoses with a cartilaginous matrix, surgical repair was undertaken. In the remaining cases forward and retrograde dilatation guided by a thread, through the gastrostomy orifice were performed, in accordance to the length and severity of the stenoses. Duration of the treatment varied broadly, ranging from 3-5 anterograde sessions, in the cases of esophageal atresia sequelae, to several years with an average monthly periodicity of one session in cases of total pharyngoesophageal caustic burn. As for complications, there were three cases of mediastinitis and two of subcutaneous infiltrations at the cervical level that were solved with antibiotics. The authors believe, on the basis of their experience, the absence of mortality and the scarce morbidity that, in the pediatric patients the treatment of choice of esophageal stenoses consists of dilatations on their different modalities. A yearly follow-up must be strictly maintained until the patients have completed their growth. We reject esophageal coloplasties in the pediatric age because of their complications rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1989

[New perspectives in liver-based metabolic errors: liver transplantation].

Liver transplantation offers an actual alternative to patients end-stage liver disease. The aim of this study is to show our results of liver transplantation in paediatric patients with hepatic-based metabolic disorders. Survival rates in these indications can be high and these good results may enlarge the indications. Liver might transplantation therefore be offered earlier to patients with this kind of metabolic disease.

Amino Acid Metabolism, Inborn Errors↗
PubMed1989

[Fistula of the pyriform sinus. Report of 2 cases].

The authors present two patients of 8 and 11 years of age that presented a left sided piriform sinus fistula diagnosed by esophagram and surgically treated in our centre. One had been operated previously with a diagnosis of relapsing thyroglossal quist on five occasions. The piriform sinus fistula is a recently recognised entity as cause of thyroiditis and suppurative cervical infections in the pediatric age. Communicated for the first time in the literature in 1957 by Japanese authors, it was not until 1973 that Tucker published for the first time in English a case of recurrent cervical abscess caused by a fistula initiated in the piriform sinus. Until now very few cases have been published. The majority of authors consider it to be an embryological residue of the third or fourth pharyngeal pouch. The key to diagnosis is to bear it in mind whenever a patient presents suppurative thyroiditis or repetitive cervical infections, principally of the left side. An esophagram is necessary to demonstrate the course of the fistula. In cases of thyroiditis a thyroidal gammagraphy will allow vision of a cold zone in the upper third of the affected lobe. Treatment consists of total extirpation of the fistula and affected portion of the thyroidal lobe, once the infection has been solutioned. Before intervention it is important to collocate a tube in the fistula's course by means of a direct microlaryngoscopy which will serve as guide and allow the injection of methylene blue.

Abscess↗
PubMed1989

[Bolande's tumor: significance of its early diagnosis and treatment].

Four patients diagnosed of having a tumor of Bolande and treated at our institution in the past ten years are presented. In two of them, early diagnosis was aided by prenatal echographic techniques; the other two diagnoses were suspected ar three and ten days of age because of an abdominal mass. The four of them underwent a complete study which included: a plain abdominal film, an ultrasound scan and an intravenous urogram; the last three patients were also surveyed by a CT scan of the abdomen. Surgery was undertaken early on all the patients, the time of operation being in every instance within the first month of life. A laparotomy was performed and, once the contralateral kidney had been carefully examined, a nephroureterectomy was implemented, having been able to preserve in all the cases the suprarenal gland in view of the benign nature of the tumor. A histologic study confirmed the diagnosis and revealed the complete delimitation of the tumor by the renal capsule. The authors underscore the importance of this tumor's suspicion in the face of any solid renal mass detected by prenatal echography or in the neonatal period, since early diagnosis and treatment are imperative in order to prevent the ensuing complications in the rare and unfortunate cases that show a malignant tumoral trend.

Female↗