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Biomedical subjects

R Martín-Crespo

Publications and source records attributed to R Martín-Crespo.

8 recordsLinked to original sources
PubMed2005

[Use of oral anticholinergic therapy in children under 1 years of age with high risk bladder].

THE AIM: To assess the effectiveness and safety of the treatment with oral anticholinergic agents (Oxybutin clorure) in patients under 1 year old, and who aree carriers of high risk bladder secondary to neurological illness as well as no neurological one. MATERIAL AND METHODS: Since 1989, we have indicated treatment with anticholinergic agents to 16 patients: 9 patients had neurogenic bladder secondary to: myelomeningocele (n=7) and sacrocoxigeal teratoma (n=2). Others 7 patients had non neurogenic bladder secondary to: posterior urethral valvulas (n=1), valvula-like syndrome (n=4), post-surgery of neonatal giant bladder diverticulum (n=1) and Prune-Belly syndrome (n=1). The urodinamic study was performed during the first six months of life, being "high risk bladder" defined according to the parameters of compliance vesical and pressure of leak at point (PER). Five of the patients showed neonatal cronic renal failure (CRF), who were treated by cutaneus temporary derivation. All patients at treatment with anticholinergic agents at a 0.2 mg/kg/day dose was established; other early adjunctive treatment prior to the closure of the urinary derivation in children with CRF(n=5); or as a part of the conservative treatment (n=3), alone or associate to intermittent bladder catheterization (IBC) (n=8). During the treatment with anticholinergic agents, the cardiac frequency was controlled by EKG registration in 6 patients, being the rest of the children clinicaly controled (skin colour, mouth dryness, cardiac frequency and intestinal function). RESULTS: In all the cases, the minimum duration of the treatment was one year, until the functional stabilization of the urinary tract. It is to underline the absence of secondary complications which would have caused the suspension or the reduction of the treatment at long term. Conventional studies of urologicals image and urodinamic studies, showed the stabilization of the urinary tract and also the preservation of kidney function and not only was demonstrated in those patients with oral anticholinergic agent as their unique treatment, but also in those patients who had previously been derivated. The previous vesical stabilization allowed the optimum result of subsequent corrective surgeries in five patients (ureteroneocystostomy and vesiscotomy clousure. In cases with previous derivation, the treatment with oral anticholinergic agents made easier vesicostomic clousure in the forth quarter of the first year old wih the maintenance of the vesical stability. CONCLUSIONS: The use of oral anticholinergic agents at a dose of 0.2 mg/kg/day, has resulted to be safe as well as effective in the treatment of high risk bladder in infancy those with less than one year of life. In those patients with serious dysplasia by reflux, it contributes to the preservation of kidney function, it makes easier the early desderivation and it also stabilizes in a functional way the bladder as a previous step to subsequent reconstructive surgeries.

Child↗
PubMed2005

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay].

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Adolescent↗
PubMed2003

[In which patients is the oxybutynin-desmopressin combination therapy indicated?].

PURPOSE: We assume that desmopressin decreases nocturnal urine output of the enuretic child. The aim of this study is to evaluate the efficacy of desmopressin plus oxybutynin and to define urodynamic pattern in children with bladder hyperactivity partially-responders to oxybutynin alone (in which nocturnal enuresis persists in spite of bladder stability). METHODS: 48 enuretic patients with urodynamically confirmed bladder hyperactivity were enrolled in the prospective study. All patients were treated with oxybutynin, 0.3-05 mg/Kg/day orally, and bladder therapy, for six months. At the end of this period, patients with excellent response (cessation of nocturnal and diurnal symptoms) was designed as group I (28 children, 58%); patients with partial response (persistence of nocturnal enuresis) as group II (19 children, 40%); and patients non-responders as group III (1 patient, excluded because of no completion of treatment). After six months patients were assessed by standardized urodynamic study. Group II patients were treated with combined therapy, desmopressin-20 mcg/day-plus oxybutynin, for six months. Group I patients served as controls. RESULTS: The differences between mean bladder accommodation and mean voiding pressure in patients with excellent response and partially response to oxybutynin were statistically significant. After combined therapy 18 of 19 patients (95%) of group II became group I. CONCLUSIONS: The efficacy of desmopressin plus oxybutynin is confirmed in patients with low final accommodation (< 3 ml/cm H2O) and high voiding pressure (> 70 cm H2O). Combined therapy can be a good choice of treatment in children with bladder hyperactivity with partial response to oxybutynin alone.

Adolescent↗
PubMed1999

[Indications from the laparoscopic approach in pediatric urological surgery: our experience in 49 patients].

OBJECTIVES: To analyse the diagnostic and therapeutic potential of video-assisted laparoscopy in the urology paediatric pathology. We had analysed its indications and results, to measure in disminution of morbidity and hospital stay. PATIENTS AND METHODS: We are treated in our section of Paediatric Urology 49 patients during the period of June 1995 and December 1998, performing 51 laparoscopics procedures. The mean age was 8 years (2-16 years ago). The laparoscopic indications were diagnostic in 33 patients: intra-abdominal testes (n = 16), renal biopsy (n = 17), and terapeuthics in 16 patients (17 laparoscopics procedures): varicoceltomy (n = 7), orchiectomy (n = 1), closure peritoneal-vaginal duct (n = 2), retroperitoneal nephrectomy (n = 6), marsupilazation and omentoplastic in giant lymphocel renal post-transplantation (n = 2). RESULTS: The laparoscopic approach were effective in 100% of diagnostic procedures and 93.4% of therapeuticm procedures. Conversion in 2 cases were necessary to make renal biopsy (n = 1). We hadn't have postoperatives complications and the indices of intraoperative morbidity was of 2.4%. The mean hospital stay was 1.4 days. CONCLUSIONS: We believe that exist indications clinically stabilised of laparoscopic approach--diagnostic and therapeutic--in paediatric urology. There are others indications that its are consider anecdotal in the present but in immediately future these indications will be valid.

Adolescent↗
PubMed1998

Histomorphometric changes after small bowel transplantation.

AIM: Rejection results in destruction of the intestinal mucosa. This is the major cause of morbidity and morbility in human allografts. The aim of this study was to investigate histomorphometric changes in both the graft and recipient intestinal mucosa after experimental orthotopic small bowel transplantation. EXPERIMENTAL DESIGN: Using the pig model, 21 large-white pigs underwent: laparotomy (n = 7) (control group); orthotopic small bowel transplantation without immunosuppression (n = 7); and orthotopic small bowel transplantation with cyclosporine A (n = 7). RESULTS: 1) Significant reduction of total mucosal thickness (villi plus crypt) (p < 0.05) in both the graft and recipient mucosa; 2) Attenuation of this effect by administration of cyclosporine A, which reduced the loss of mucosal thickness mainly at the expense of crypt hipertrophy. CONCLUSIONS: These findings suggest that villi and crypt length measurements may be a reliable method for monitoring rejection after small bowel transplantation.

Animals↗
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↗
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↗