Barrett's oesophagus in young individuals is a rare pathology. The purpose of this study was to identify those risk factors involved in Barrett's oesophagus (BO) development in children.
We performed ...a case-control study between years 2000 and 2010. Cases had endoscopic BO with histological confirmation of gastric or intestinal metaplasia. For each case, three to four controls were selected from our ph-monitoring database. They were matched by age, + 2 years, or by associated features (oesophageal atresia or Down's syndrome) when appropriate. An analysis of the demographic variables, symptoms and endoscopic data was performed: sex, digestive or respiratory symptoms, exposition time to gastroesophageal reflux (GER) without treatment with proton-pump inhibitors (PPI) and Helicobacter pylori (HP) presence.
Six patients were diagnosed with BO (age range: 8 months-14 years) and a 21 control samples were included. Both groups were comparable in sex and age parameters. There were no differences in clinical presentation, neither in presence of hiatal hernia nor HP colonisation. The ph-monitoring register did not differ between groups, median Reflux Index or Boix Ochoa Index. The only risk factor found in this study is the exposition time to GER: OR = 1.046; CI95% (1.007-1.086); p = 0.021.
Our results suggest that exposition time to GER without treatment with PPI is related to Barrett's oesophagus development in childhood.
Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders.
Patients ...with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank.
From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid.
OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.
In recent years we have observed in our country an increase in complications associated with bacterial pneumonia, such as pleural effusion and empyema. The initial treatment is an association of ...antibiotics, covering the potential germ involved, and the placement of a pleural drainage tube, in order to accelerate the resolution process. Formation of septa within the pleural cavity requires additional therapy (antifibrinolytic treatment, videothorascopy), but no one of these two alternatives is been demonstrated better than the other. We present a review that covers last 15 years (1990-2006), related to management of empyema. The management strategy with initial instillation of antifibrinolytic intrapleural makes our series the longest in our country using such treatment (30 of 50 patients reviewed (60) were treated with this technique). Initial success was 96% with this modality, without rescuing surgery. There is also a descriptive analysis of several clinical, laboratory and radiological parameters. In comparative analysis, length of stay in intensive care unit decreases in those patients treated with antifibrinolytics. This result is a prove of the efficacy of this treatment, and quite encourageing.
To gain further insight into the natural history of patients with biliary atresia.
We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia ...attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included.
Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5%) and the most common biochemical finding was raised gamma-glutamyltransferase (3-4 times its standard value), which appeared in 100 % of the patients. Abdominal ultrasonography was diagnostic in 85.7% of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100%. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life.
Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome.
Obtener un mejor conocimiento del comportamiento deuna población de pacientes con diagnóstico de atresia de vías biliares en las distintas fases de la enfermedad
Estudio retrospectivo, transversal y ...descriptivo, tipo serie de casos clínicos. Pacientes con diagnóstico de atresia de vías biliares atendidos en la Unidad de Gastroenterología del Hospital Infantil La Fe de Valencia desde enero de 1990 a diciembre del 2000
De los 16 niños controlados, en el momento actual permanecen estables ocho, han precisado trasplante hepático seis y han fallecido dos. La edad media al diagnóstico es de 47,5 días de vida. La manifestación clínica más frecuente es la ictericia (87,5 %), y el hallazgo analítico más importante el aumento de la gammaglutamiltranspeptidasa (GGT) (3–4 veces su valor de referencia) en el 100 % de los casos
Las imágenes ecográficas son diagnósticas en el 85,7 %. El Hepato-Hida ofrece una sensibilidad del 100 %. El tratamiento quirúrgico mediante portoenterostomía se realizó en todos los pacientes, con biopsia hepática en el mismo acto. La precocidad en la intervención se refleja en un mejor pronóstico a largo plazo, siendo mejor si ésta se realiza antes de los 65 días de vida
Un alto índice de sospecha permite el tratamiento quirúrgico precoz, única medida terapéutica que puede condicionar un pronóstico menos desfavorable
To gain further insight into the natural history of patients with biliary atresia
We performed a retrospective, cross-sectional, descriptive, case series study. All patients with biliary atresia attended at the Pediatric Gastrointestinal and Hepatology Unit of La Fe Children's Hospital in Valencia (Spain) from January 1990 to December 2000 were included
Of 16 children followed-up, eight are currently stable, six have undergone liver transplantation and two died. The mean age at diagnosis was 47.5 days. The most frequent clinical manifestation was jaundice (87.5 %) and the most common biochemical finding was raised γ-glutamyltransferase (3–4 times its standard value), which appeared in 100 % of the patients
Abdominal ultrasonography was diagnostic in 85.7 % of the patients. Nuclear scintiscan (DISIDA) showed a sensitivity of 100 %. Portoenterostomy with intraoperative liver biopsy was performed in all patients. Patient age at surgery was a predictor of long-term outcome, with more favorable results in patients aged less than 65 days of life
Biliary atresia should be suspected as soon as possible, since early surgical treatment is the only therapeutic measure that can improve outcome
The hydroelectric and pH alterations that produce the digestive irrigation previous to the surgery, have justified the fulfillment of this study, addressed to design a kind of solution to be used at ...pediatric patients. It has been used two solutions: one of them proposed by Davis (S_I), and the other (S_II), is Davis' solution modification, in which it is decreased the quantity of polyethylene glycol (PEG-4000) and it is increased the concentration of bicarbonate. The analysis of the results demonstrated the superiority of the second solution avoiding the tendency to the acidosis that show the Davis' solution.
The esophageal length in the study of patients with Gastroesophageal Reflux (G.E.R.) has the importance of assuring us of the correct position of the probe/sound of the esophageal ph-metering. We ...carried out a prospective study which correlated the size with the location of the Lower Esophageal Sphincter (L.E.S.), and we tried an approximation, greater than the one, obtained by other methods, in the measurement of the esophageal length, to obviate the manometric study, when our only aim was to insert correctly the probe/sound of the esophageal ph-metering.
Four patients underwent pneumatic endoscopic dilatation of achalasia at the La Fe Children's Hospital have been studied. Endoscopic pneumatic dilatation has been performed in only one session with ...four dilatation maneuvers. In the absence of complications, the patients were only hospitalized for twenty-four hours. The effectiveness of endoscopic pneumatic dilatation and the safety of this method, its ease of application and possibility of repetition make it a useful method in the treatment of achalasia in children.
