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Biomedical subjects

J Cerdá

Publications and source records attributed to J Cerdá.

18 recordsLinked to original sources
PubMed2002

[Treatment of vestibular fistulas in older girls].

The vestibular fistula is the anorectal malformation more frequent in females. In this congenital anomaly the anus is located in the vaginal vestibule, having the rectum a common wall with the vagina. With the posterior sagittal approach described by Alberto Peña it changes the treatment of this anorectal malformation, contributing to the possibility of an aesthetic and functional improvement. From 1996 we have operated on 6 girls with ages included between 6 and 22 years (mean of 11 years) that presented a vestibular fistula. Five cases had been operated on in the neonatal period of vestibular fistula carrying out "cut-back", and a case had been operated on for cloaca syndrome. It was carried out in all of them, posterior sagittal approach disecting the rectum, separating it from the vagina and placing it in the sphincter. In a case a colostomy was carried out and in the other five were carried out intestinal cleaning, maintaining absolute diet and postoperative total parenteral nutrition. The evolution has been favorable in all the cases. the functionality of the neo-anus in terms of continence is absolutely normal, presenting an excellent aesthetic aspect. We believe that the posterior sagittal approach is suitable as surgical treatment of the vestibular fistula. The aesthetic improvement and the satisfaction of our patients motivates us to the realization of this technique that also allows us to correct in only one surgical act associated vaginal malformations.

Abnormalities, Multiple↗
PubMed2000

[Obstetric trauma. A current problem?].

Advances in obstetric practice have decreased birth traumas in the last years, although they are still an important chapter in neonatal age. Between 1993-1998 a total of 21,375 stillborns were registered with a total of 309 birth injuries in 303 neonates (1.44%). The diagnoses were: 2 liver subcapsular hematomas, 105 cephalohematomas, 16 parietal fractures, 11 subdural hemorrhages, 107 clavicular fractures, 10 miscellaneous fractures, 8 soft tissue injuries, 25 facial nerve injuries and 25 braquial palsy. About relation between type of labor and birth trauma was found that clavicular fracture and cephalic vaginal delivery were associated in 50% of the cases, cephalohematoma and forceps in 51%, braquial palsy and vaginal delivery in 44% and forceps in 36%. High weight at birth was another risk factor for entities such as clavicular fracture and braquial palsy. We conclude that birth trauma is a pathology with a relevant incidence and their epidemiology factor had to be known.

Birth Injuries↗
PubMed2000

[New approach in the surgical treatment of the urogenital sinus].

The urogenital sinus is an embriological anomaly which consists on a common channel from the urethra and vagina. The major incidence is produced in the congenital adrenal hyperplasia's context. In certain occasions it can be associated to an imperforate anus, then the malformation is called a cloacal defect. There are multiple surgical techniques to correct this malformation and different therapeutical approaches (without surgery, surgery at one or various times, early or delayed surgery) being the newest one the total urogenital mobilization. The purpose of this work is to reflect our experience with this technique. We present seven girls with urogenital sinus (3 with congenital adrenal hyperplasia, 2 with a cloacal defect, and the other 2 associated to ambiguous genitalia). Five patients were operated in the first year of life. The outcome has been favorable, and the cosmetic and functional results have been very good. The surgical technique consists on posterior sagittal incision, it can be done transanorectal if necessary, the urethrovaginal union is achieved and both structures are mobilized together, connecting them to the perineum, as a single unit. We believe that the total urogenital mobilization is actually the surgical technique to be chosen in every of urogenital sinus, for being easier, allowing early realization (girls under 1 year old), correcting simultaneously other anomalies, reducing the complications (urethrovaginal fistula, vaginal structure, or acquired vaginal atresia); and the result is excellent.

Abnormalities, Multiple↗
PubMed1999

[Hemodynamic changes during laparoscopic surgery. Preliminary study].

The haemodynamic changes produced by laparoscopic surgery in children have been evaluated. A transesophageal echocardiographic study on 13 patients (7 males and 6 females, 10.8 +/- 2.7 years old) has been performed before, during and after peritoneal CO2 gas insufflation. A change on the Doppler waves pattern of the infradiaphragmatic veins along with an increase in blood flow velocity were observed. Pulmonary veins suffered minimal changes showing an increase on either the systolic pressure and on atrial contraction. Diastolic retrograde flow in aorta reflected an increase in peripheral vascular resistance. Cardiac output increased minimally. All haemodynamic changes returned to basal after gas peritoneal desufflation. These data show that laparoscopic surgery could produce important cardiac derangements in children with ventricular dysfunction or in patients presenting left ventricular outlet obstruction. In these patients laparoscopic surgery might be precluded.

Abdominal Pain↗
PubMed1999

[Thyroid tumors in childhood].

The thyroid pathology in the paediatric population represents 5% of the total and 1.2% only thyroid pathology correspond to the infantile solitary thyroid nodules. Most of them are asymptomatic and as only sign an increase of volume is observed in the neck. Always we have to ask about the family history because the possibility of medullary carcinoma related with multiple endocrine neoplasias should be investigated (a patient of our series). The thyroid tumor represents 0.5% of all the tumors and of these 10% is in younger than 21 years old. We present 13 patients with thyroid pathology that have required surgical treatment, since 1983 to 1997. Five papillary carcinomas (ages: 7 to 14 years old) that started with a cervical nodule, normal thyroid function and a case of medullary carcinoma, in a multiple endocrine neoplasia (MEN II 2A). In the 5 cases of carcinoma papillary we were carried out total thyroidectomy and later on, postoperative ablative dose of 131I was administered. In the case of the girl with medullary carcinoma was carried out a total tumorectomy and lymph node excision. Finally, seven patients with nodule thyroid were thyroid benign tumors (benign 6 adenomas and 1 cyst colloid, ages: 8 to 15 years old). In all of them we were carried out total surgical excision of the thyroid nodules. Our protocol of study of nodule thyroid includes: 1) thyroid gammagraphy to know the intensity of reception of the isotope; 2) cervical ultrasound; and 3) biopsy or cytopathology of fine needle aspiration of the thyroid gland in children that it dissuades to base the surgical strategy on this test.

Adenoma↗
PubMed1999

[Sigmoid neovagina: apropos of 2 cases].

The presence of ambiguous external genitals can be related with a number of nosologic entities. We can find the female form with hypertrophic clitoris and vaginal hypoplasia in a wide variety of phenotype presentations. We have two young girls with ambiguous external genitals, where we notice hypertrophic clitoris and vaginal hypoplasia, with the diagnosis of mixed gonadal dysgenesis and androgen insensitivity syndrome (Morri's Syndrome). They have been operated several times: gonadectomy, genitoplasty, vaginoplasty and mammoplasty. We have made a neovagina, using a segment of sigma and preserving the walls of the former vagina. The surgical technique we used, consisted in the abdominoperineal descent of the segment of sigmoid colon and anastomosis with the back wall of the former vagina and the perineum; after that, we split the intervaginal septum, linking these two structures and reaching a lonely introitus vaginae. The hormonal treatment for the girl with mixed gonadal dysgenesis with estrogen and progestogen induces normal menstruations; we only use estrogen for the patient with Morri's Syndrome. The histology showed that there were dysgenetic gonads in one of the patients and testicular tissue without gonadal elements. Both girls have had a good evolution, with no problems and an excellent aesthetic and functional result.

Adolescent↗
PubMed1999

[Extracorporeal respiratory assistance (ECRA): initial experiences in Spain].

UNLABELLED: The attendance respiratory extracorporeal (AREC) is an oxygenation form for membrane extracorporeal with flow tidal and veno-venous cannula described by Chevalier et al. in 1990. We present our clinical experience so much with AREC in system veno-venous flow tidal as veno-arterial. From october of 1997 until the present time we have treated three patients by means AREC, in two patients with veno-venous system and in one veno-arterial. In all the cases bomb Collin-Cardio has been used with bladder for flow tidal and membrane of oxygenation of 0.8 m2, being inserted a system of alternative clamp of the branches of the circuit. The system AREC has been used in two patients with congenial diaphragmatic hernia, right in a case and left in the other one. The gestational age was of 38 and 36 weeks with a weight of 3,200 and 2,900 grams. Both patients were remitted from other centers by failure of the conventional treatment. In both cases the indication of AREC was the sharp deterioration of the general state with failure of the conservative treatment, being the previous oxygenation index of 109 and 112. The third patient precised veno-arterial AREC for ventricular failure during the correction of the congenital heart disease, this patient was 5 month old and the weight was 5,000 grams. The duration of AREC in the cases of congenital diaphragmatic hernia was of 14 and 10 days. In a patient the diaphragmatic hernia was corrected at the 55 hours of being in AREC. In the second case the hernia had been surgical corrected in another center. The exit of AREC in both cases carries out after a discreet improvement of the lung function. Both patients died at the 24 and 48 hours of the decannulation for cerebral hemorrhage and respiratory failure. The third patient stayed stable in veno-arterial AREC during 4 days, with hemodynamic support of 130 ml/kg/min, retiring the support to present absence of cerebral activity. CONCLUSIONS: With the derived limitations of the extreme severity of the treated cases and the current phase of beginning of the AREC team, we think that it is a useful and available technique in our country, for the handling of patient with cardiorespiratory failure while waiting for improvement of their base pathology.

Age Factors↗
PubMed1996

Pattern of vitellogenesis and follicle maturational competence during the ovarian follicular cycle of Fundulus heteroclitus.

The patterns of vitellogenesis and follicle maturational competence were examined across the semilunar spawning cycle of Fundulus heteroclitus. Daily egg collection showed spawning cyclicity in six experimental groups, with a mean period between spawnings of 14.9 +/- 0.3 days, indicated by the nonlinear regression sine-curve matching analysis. Each cycle was then dated from Day -7 to Day 7, with Day 0 as the peak egg-collection day. Females from each group were sampled on selected days during two to three consecutive spawning cycles, and these days were each chronologically given a temporal relation to Day 0 to pool the data into a composite. The analysis of the size-frequency distribution of ovarian follicles > or = 0.5-mm diameter across the composite revealed a constant recruitment of small follicles (0.5- to 0.7-mm diameter) into vitellogenesis, which was supported by the continuous presence of vitellogenin (Vtg) I mRNA in the liver of the females. The plasma levels of Vtg were also essentially constant across the cycle, except for a progressive decrease from Day -7 through Day 3 that could be related to a more active Vtg uptake by a dominant population of follicles up to 1.7 mm in diameter. A second and more selective recruitment of full-grown follicles (1.3- to 1.4-mm diameter) toward maturation was noted at Days -5, -4, which appeared associated with high plasma levels of estradiol-17 beta. However, the responsiveness of those follicles undergoing oocyte maturation in vitro after gonadotropin and maturation-inducing steroid (MIS), 17, 20 beta-dihydroxy-4-pregnen-3-one, stimulation dramatically declined from Days -1, 0, 1 to Days 4, 5, concomitantly with an increase of the population of the largest follicles (1.8- to 2.1-mm diameter) in the ovary. These findings extend previous observations on the process of follicular recruitment in F. heteroclitus and indicate that full-grown follicles may be recruited into maturation by a mechanism that modulates the oocyte sensitivity to the MIS.

Animals↗
PubMed1996

Neuropeptide Y in the forebrain and retina of the killifish, Fundulus heteroclitus.

The organization of the neuropeptide Y (NPY)-immunoreactive system in the forebrain, pineal organ and retina of a biweekly spawning fish (Fundulus heteroclitus) was investigated. Immunoreactivity was encountered in neurons of the nucleus olfactoretinalis, in the large population of neurons in the floor of the telencephalon, and in the nucleus entopeduncularis. Isolated somata were encountered in the hypophysiotropic hypothalamic nuclei, viz., the nucleus preopticus periventricularis, nucleus preopticus, and nucleus lateralis tuberis. Immunoreactive somata were also seen in the nucleus dorsomedialis thalami. The olfactory bulb was abundantly innervated by NPY fibers. The telencephalon showed thick radiating processes basally and terminal fields with modest to high densities in the dorsal and lateral regions. NPY-immunoreactive fibers were also conspicuous in the preoptic area, suprachiasmatic nucleus, tuberal hypothalamus, pituitary gland, and paraventricular thalamic regions; discrete CSF-contacting sites were also encountered. Of special interest was the occurrence of NPY immunoreactivity in fibers of the pineal stalk and organ. In the retina, some amacrine cells displayed immunoreactivity, while the inner plexiform layer revealed a well-developed pattern of NPY fibers different from that previously described for the goldfish.

Animals↗
PubMed1995

[Second tumors in childhood].

More aggressiveness in treatment of childhood malignancies has had an evident impact on survival and rate of cure but, it has also allowed us to discover long-term effects of these treatments, and second malignant tumors of them. Between 1970 and 1993, 472 cases of malignant tumors in childhood were diagnosed in our department. Six of them (1.27%) developed a second tumor (five malignant and one benign). Relationship between first and second tumors are: seven years old boy, cervical lymphosarcoma-thyroid carcinoma; eleven years old boy, osteogenic sarcoma-vesical carcinoma: two years and six months old boy, cerebellar astrocytoma-soft tissue osteogenic sarcoma; five years old girl. Wilm's tumor-scapular osteogenic chondroma; one year and a half old girl, abdominal neuroblastoma-granulocytic sarcoma (chloroma); twelve years old boy. Hodgkin's disease-acute myeloblastic leukemia. All of them were clearly related to concogenic effect of radiation or chemotherapy.

Abdominal Neoplasms↗
PubMed1995

[Use of the laryngeal mask in pediatric surgery].

The laryngeal mask is a new method in the control of the airway. In this study we assess the haemodynamic response during the insertion of the laryngeal mask, incidence of complications and recovery from anaesthesia after its use. We also check if the laryngeal mask is easy to place into the patient airway and its versatility in pediatric patients. We have obtain that the use of the laryngeal mask airway is a safe technique, with few complications, easy to learn and with a short recovery time.

Adolescent↗
PubMed1994

Segmentary splenectomy of the lower tip because of spontaneous rupture of a splenic hemangioendothelioma in a new-born child--a case report.

We present the first exceptional case of splenic hemangioendothelioma, an infrequent and generally asymptomatic benign vascular tumor, here triggering hypovolemic shock through spontaneous rupture of the spleen without prior injury. Conservative treatment of the spleen led us to perform a segmentary splenectomy of the lower tip with total extirpation of the vascular tumour and the acute splenic bleeding was controlled. One year later, splenic functions are normal.

Hemangioendothelioma↗
PubMed1989

[Intraoperative radiotherapy in the multidisciplinary treatment of malignant tumors in children. Preliminary results].

From September 1984 to March 1989, 57 children received intraoperative radiotherapy as part of a multidisciplinary tumor treatment. Their age ranged from 2 to 18 years. Tumor types: osteosarcoma, 21; Ewing's sarcoma, 19; soft tissue sarcomas, 6; neuroblastoma, 5; Wilm's tumor, 3; Hodgkin, 1; glioma, 1, and malignant pheochromocytoma, 1. In 44 patients the disease was localized while 13 had distant metastases. Intraoperative radiotherapy was used in 48 previously untreated patients as part of a radical treatment program and in 9 cases as an effort to rescue local failures (5 in previously irradiated areas). The intraoperative radiation field included the surgically exposed tumor or tumor bed, and the single doses ranged from 10 to 20 Gy, with 6-20 MeV electrons. With a median follow up time of 25 months (4 to 51 + months) 44 out of 57 patients are alive without local recurrence and 13 have died from tumor (6 with local progression). Intraoperative radiotherapy seems to be a feasible treatment which might promote local control in pediatric tumors.

Adolescent↗
PubMedDate not supplied

[A study of mortality in patients with acute cerebrovascular pathology in the Castellon General Hospital].

OBJECTIVE: To analyse the hospital death rate caused by acute cardiovascular disorder and their factors conducted. METHODS: We made a retrospective review of all patients suffering from this pathology who had gone into the Casualty Ward of the Castellón General Hospital in the course of 1991: we also looked for all patients with acute cardiovascular disorder who had died in the hospital. We studied the risk factors for the patients referred using a univariant analysis, comparing those still living with those who had died. RESULTS: We find 514 patients diagnosed as having acute cardiovascular disorder, with an stroke/TIA incidence rate of 188 cases per 100,000 inhabitants. The proportion of referred patients was 52%. Among these, the death rate was 27.8%. Factors affecting the death rate were the age of the patients, the reduction in the level of consciousness, and lateral gaze at the start of the stroke. CONCLUSIONS: We believe that the high death rate in our selection was due to the severity of the strokes and the advanced age of the patients, as was in accordance with the methodology used in the gathering of data, which made it possible to include patients who died early.

Acute Disease↗
PubMedDate not supplied

[The management of acute cerebrovascular disorders at the Emergency Services at the Castellon General Hospital].

OBJECTIVE: To analyse the policy for hospital admission in the case of the patients who come to the Emergency Ward with acute cerebrovascular disorders. METHOD: The study was based on a retrospective analysis of the release reports from the Emergency Ward of Castellón General Hospital in the course of 1991, in which stroke, or transitory ischemic attack (TIA) were diagnosed. RESULTS: 514 patients were attended to who went to the Emergency Ward because of cerebrovascular disorder. Of these, 57.2% were referred to hospital, with 42% being sent home. It was observed that 10.65% (n = 23) they did not accomplish the criteria for stroke. There was an overwhelming number of cases of TIA diagnosed (50.2%) in patients who were not admitted, contrasting with only 7.5% being selected for admission. We considered possible explanations for this. CONCLUSIONS: We observed that as far as making the decision to admit a patient with acute cerebrovascular disorder, priority for admission was given in those cases which showed the worst neurological deficiencies, and had a worse prognosis as a consequence. Similarly, the older age (average 76.5 years old) was a prominent factor as far as those who were not admitted.

Acute Disease↗
PubMedDate not supplied

[Urinary retention in a child secondary to urethral uric lithiasis].

Urinary lithiasis in children is less frequent than in adults. The incidence of uric acid lithiasis in adult population is between 5 to 39% of all lithiasis. Only a third part of the urinary calculi in infancy are compound of uric acid. The most frequent uric lithiasis is that so called endemic. Usually appears in the lower urinary tract and it is not related to metabolic disturbances. We present the exceptional case of an Arabian boy 4 years old who came to the Hospital because he suffered urinary retention secondary to the fixation of uric acid stone in bulbous urethra. The treatment performed was the external urethrotomy and we could removed the stone. We emphasize that the postoperative control was done by uroflowmetry. After one year, the result is satisfactory.

Child, Preschool↗