RESUMEN
BACKGROUND: Waterston's prognostic classification of esophageal atresia has been used in most hospitals throughout the world. A number of technical advances, mainly in neonatal intensive care units have contributed to a reduction in mortality. Although the Waterston classification continues to be widely used, increased survival in the highest risk groups in this classification has led to new classifications being described in the last few years. OBJECTIVE: To determine the influence of birth weight and cardiac anomaly on the outcome of patients with esophageal atresia. MATERIAL AND METHODS: The outcome of 100 infants with esophageal atresia was analyzed. The patients were divided chronologically into two groups according to advances in ICUs and surgical techniques: 45 patients treated in the first period (1971-1982) and 55 in the second (1983-2000). The influence of birth weight in the groups described by Waterston and Spitz and the association with cardiac malformation were compared between both periods. RESULTS: Mortality in the birth weight groups described by Waterston decreased significantly between periods but this decrease was lower when the birth weight groups at highest risk described by the Spitz (1,500 g) were compared. Survival in patients with esophageal atresia improved from the first period (57.8 %) to the second (80 %) but mortality was still high when an associated major cardiac anomaly was present (80 % vs 75 %). CONCLUSIONS: Although advances in the medical and surgical management of neonates have rendered birth weight less important to prognosis than previously, mortality continues to be high in patients with very low weight and major cardiac malformation.
Asunto(s)
Atresia Esofágica/mortalidad , Anomalías Múltiples , Peso al Nacer , Femenino , Cardiopatías Congénitas , Humanos , Lactante , Recién Nacido , Masculino , PronósticoRESUMEN
Antecedentes: La clasificación pronóstica de Waterston para la atresia de esófago ha sido utilizada por la mayoría de los hospitales del mundo. Una serie de avances técnicos, fundamentalmente en la unidad de cuidados intensivos (UCI) neonatal, han contribuido a reducir su mortalidad. Aunque la clasificación de Waterston continúa siendo empleada, se han descrito nuevas clasificaciones durante los últimos años, debido a la insatisfacción que ésta ha producido como consecuencia del aumento de la supervivencia en los grupos de Waterston de peor pronóstico. Objetivo: Determinar la influencia que tiene el peso al nacer y la malformación cardíaca sobre el pronóstico de los pacientes con atresia de esófago. Material y métodos: Se ha analizado el pronóstico de 100 niños con atresia de esófago. Los casos se dividieron cronológicamente en 2 grupos con relación a los avances en la UCI y en las técnicas quirúrgicas: 45 pacientes tratados en el primer período (1971-1982) y 55 en el segundo (1983-2000). Se comparó, entre ambos grupos, la influencia que tenían el peso, según los grupos descritos por Waterston y Spitz, y la asociación de malformación cardíaca. Resultados: La mortalidad de los grupos de peso descritos por Waterston disminuyó de manera significativa entre ambos períodos, pero no fue tan importante al comparar los grupos de peso de peor pronóstico de Spitz (< 1.500 g). Aunque la supervivencia de los pacientes con atresia de esófago mejoró desde el primer período (57,8%) al segundo (80%), persistió una mortalidad alta cuando el paciente asociaba una malformación cardíaca grave (80% frente a 75%). Conclusiones: Aunque los avances en el tratamiento médico y quirúrgico de la atresia de esófago han hecho que el peso de nacimiento sea menos importante para el pronóstico durante los últimos años sugerimos que los pacientes con muy bajo peso y los que asocian una malformación cardíaca grave continúan teniendo una mortalidad elevada (AU)
Asunto(s)
Masculino , Lactante , Recién Nacido , Femenino , Humanos , Pronóstico , Peso al Nacer , Anomalías Múltiples , Atresia Esofágica , Cardiopatías CongénitasRESUMEN
INTRODUCTION: Infantile hypertrophic pyloric stenosis (IHPS) consists of hypertrophy of the muscular layer of the pylorus. Its etiology is still unknown. In the last years only few jobs that studied the extracellular matrix (ECM) in the muscular layer in the IHPS have been reported. Our aim was to investigate the expression of two ECM molecules: chondroitin-sulfate proteoglycan (CSPG) and fibronectin (FN), and fibroblasts. MATERIAL AND METHODS: Full-thickness muscle biopsy specimens were obtained from 33 IHPS patients at pyloromyotomy and 12 controls. Indirect immunohistochemistry was performed using CSPG, FN and fibroblasts monoclonal antibodies. The results were showed by a semiquantitative scale as follows: strong (++), moderate (+), weak (+/-), and absent (-). RESULTS: We demonstrated that the CSPG immunoreactivity was localized in the connective tissue septa and the expression of FN molecules in the pericellular space. Both molecules were significantly the increased in the muscle layer of the pylorus with IHPS in relation to control pylorus. We also demonstrated a marked increased expression in the number of fibroblasts in the muscle layer of the pylorus with IHPS. Even-though the most striking increase was localized in the septa, we also observed great number of fibroblasts amongst the smooth muscle cells. CONCLUSIONS: We suggest that IHPS is characterized, not only by the muscle layer hypertrophy, but also by the increase of several ECM molecules, such as CSPG and FN. We also think that the increase of fibroblast could explain the higher expression of both ECM molecules in the muscle layer of pylorus in IHPS.
Asunto(s)
Proteínas de la Matriz Extracelular/metabolismo , Estenosis Pilórica/metabolismo , Estenosis Pilórica/patología , Condroitinasas y Condroitín Liasas/metabolismo , Femenino , Fibroblastos , Fibronectinas/metabolismo , Humanos , Hipertrofia , Lactante , Recién Nacido , MasculinoRESUMEN
Introducción. La estenosis hipertrófica de píloro (EHP) se caracteriza por la hipertrofia de la capa muscular del píloro. Su etiología permanece todavía desconocida. En los últimos años ha sido publicado algún trabajo que estudia la matriz extracelular (MEC) en la EHP. Nuestro objetivo fue investigar la expresión de dos moléculas de MEC: el proteoglicano condroitín-sulfato (PGCS) y la fibronectina (FN), así como la de los fibroplalstos. Material y métodos. Las biopsias delpíloro fueron obtenidas de 33 pacientes con EHP y 12 controles. Se utilizó inmunohistoquímica indirecta usando anticuerpos monoclonales dirigidos contra el PGCS, la FN y los fibroplastos. Los resultados fueron expresados mediante una escala semicuantitativa, como sigue: fuerte (++), moderada (+), débil (+/-) y ausente (-). Resultados. Se desmostró que la inmunorreactividad para el PGCS se localizaba en el tejido conjuntivo de los septos, y la de la FN en el espacio pericelular. Ambas moléculas estaban muy aumentadas en la capa muscular del píloro con EHP con relación a la capa muscular de los píloros control. También demostramos un marcado aumento en la expresión del número de fibroplastos en la capa muscular del píloro con EHP. Aunque la mayor expresión se localizó en los septos, también observamos gran número entre las células de músculo liso. Conclusiones: Sugerimos que la EHP, no sólo se caracteriza por la hipertrofia de la capa muscular, sino también por el aumento de varias moléculas de la MEC, como el PGCS y la FN. También sugerimos que el aumento de fibroplastos podría explicar la mayor expresión de estas moléculas de MEC en la capa muscular del píloro con EHP (AU)
Asunto(s)
Masculino , Lactante , Recién Nacido , Femenino , Humanos , Proteínas de la Matriz Extracelular , Estenosis Pilórica , Condroitinasas y Condroitín Liasas , Hipertrofia , Fibroblastos , FibronectinasRESUMEN
INTRODUCTION: The major advances in neonatal intensive care have made less useful the Waterston's criteria for esophageal atresia (EA) and/or tracheoesophageal fistula (TEF), and other prognostic classifications have been reported. The aim of this study was to determine the influence of various parameters on the outcome of EA-TEF. MATERIAL AND METHODS: We reviewed 97 cases admitted in our hospital for 29 years. We divided the cases in two groups in relation to the improvement of our neonatal unit care during the years: 1st. 1971-1982 (n = 46); 2nd. 1983-1999 (n = 51). chi 2 squared test and logistic regression analysis of the influence of several parameters before surgical treatment (Waterston's and Spitz's birth weight groups, pneumonia, ventilator dependence, severity of associated anomalies and cardiac malformations) on mortality was performed. RESULTS: The survival rate increased since 1983, reaching 86.2% in the last 10 years, although the number of neonates with birth weight < 1500 g has increased. Association with a major anomaly increased the mortality significantly in the 2nd. group only (45.5% major vs 7.1% minor and 8.3% none). The cardiac malformations were the most common, not only before 1983 (26.8%), but also since then (31.3%). When the neonate associated a major cardiac malformation the mortality was significantly higher in the 2nd. group (71.4%). The mortality, when pneumonia was present, was significantly higher before 1983 only (75% vs 32.4%), whereas the mortality was significantly increased by the need of ventilator in the 2nd. group only (85.7% vs 9.1%). Before 1983, the best prognostic parameters were the pneumonia and the severity of associated anomalies, whereas only the ventilator dependence was selected between 1983 and 1999. CONCLUSIONS: The EA-TEF mortality has decreased in the last years. The associated cardiac malformation is the most common. We think that the ventilator dependence is the most reliable prognostic risk factor, showing a poor physiologic status of the neonate.
Asunto(s)
Atresia Esofágica/mortalidad , Fístula Traqueoesofágica/mortalidad , Anomalías Múltiples/epidemiología , Atresia Esofágica/complicaciones , Femenino , Humanos , Recién Nacido , Modelos Logísticos , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Fístula Traqueoesofágica/complicacionesRESUMEN
We have operated on 2204 cryptorchid testis between 1972 and 1995. We took pathological specimens, not only in the undescended testis but also in the normally descended contralateral testis in 122 children. Clinical, surgical and anatomopathological records were reviewed. Moreover, we have studied the spermiograms in 10 young men. We found the Tubular Fertility Index (TFI) was abnormal in 37% of the contralateral testis. In 5 cases we didn't find germinal line. The Tubular Diameter was abnormal in 6.5% of the contralateral testicles only. When we compared the anatomopathological records in the contralateral testis depending on the surgical age and the surgical location of the undescended testis, we didn't find significant differences. When we studied the spermiograms in the 10 young men we obtained some cases where the TFI and the spermiogram were discordant. In conclusion, more than 1/3 of the children with unilateral undescended testis have an abnormal TFI in both testis. Moreover, neither the surgical age nor surgical location of the undescended testis have an influence on the contralateral TFI. Finally, according to the spermiogram results we should question TFI as a fertility index.
Asunto(s)
Criptorquidismo/cirugía , Testículo/patología , Adolescente , Niño , Preescolar , Coristoma , Fertilidad , Lateralidad Funcional , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Transporte Espermático , Cordón Espermático/anatomía & histología , Testículo/cirugíaRESUMEN
INTRODUCTION: The most common complication in the treatment of thyroglossal duct cysts (TDC) is the high index of relapses. An analysis of this index and the influence of previous inflammatory episodes are presented. PATIENTS AND METHODS: A retrospective study of 120 consecutive TDC cases operated on during a period of 23 years, from 1972 to 1994, is presented. The statistical study was done using the Chi square test and the contrast of hypothesis for two proportions. RESULTS: The mean age of the patients was 4.9 years, with 93 cases (77%) being operated before 7 years of age. An inflammatory episode before surgery occurred in 57 cases (47%). Treatment was the Sistrunk technique in 112 cases (93%) and a simple excision of the cyst in 8 cases, with a relapse occurring in 4 of the latter cases (50%). Those cases where the Sistrunk technique was performed were divided into two groups: Group I (56 cases) those patients which had suffered an inflammatory episode before surgery and group II (56 cases) those that had not. Five relapses (8.9%) were found in group I and 2 (3.5%) in group II. CONCLUSIONS: TDC are fore frequent during early childhood, occurring most frequently before 7 years of age. The number of relapses are dramatically reduced when the Sistrunk technique is used, but no significant differences were found in those that had suffered previously an inflammatory episode.
Asunto(s)
Quiste Tirogloso/epidemiología , Adolescente , Distribución por Edad , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Inflamación/epidemiología , Inflamación/cirugía , Masculino , Recurrencia , Reoperación , Estudios Retrospectivos , Distribución por Sexo , España/epidemiología , Quiste Tirogloso/cirugíaRESUMEN
OBJECTIVES: The present study analyzed the indications for laparoscopic surgery in cryptorchidism. METHODS: The clinical, surgical and anatomopathological data of 2000 cryptorchid testes submitted to surgery from 1972 to 1993 were reviewed. RESULTS: 17.75% (355 testes) were not palpable at physical examination; of these, 3.45% (69 cases) were anorchid and only 5.4% (108 testes) of the remaining 14.3% were true intra-abdominal testes. The other 8.9% were localized elsewhere. Scrotal descent was achieved only by funiculolysis in 68% of the cases. The remaining 28% (30 testes, since the technique used was not reported in 5) were brought to the scrotum using two-stage procedures, Stephen-Fowler and autotransplantation (one case), which could have been replaced or preceded by laparoscopy. Of the 30 testes, 10 were removed. CONCLUSIONS: Since only 5% (20 testes) can benefit from laparoscopic techniques and, moreover, 68% have a very low tubular fertility index and there is an increased possibility of progressing to malignancy, if other than standard surgical techniques are warranted in cases with unilateral cryptorchidism, testis removal is preferable, which further reduces the application of laparoscopy in cryptorchidism.