SCir.P - Serviço de Cirurgia Pediátrica
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- Dysgenetic male pseudohermaphroditismPublication . Proença, E.; Freitas, S.; Fonseca, M.; Figueiredo, S.; Rodrigues, C.Acta Med Port. 2001 Sep-Dec;14(5-6):511-4. [Dysgenetic male pseudohermaphroditism] [Article in Portuguese] Proença E, Freitas S, Fonseca M, Figueiredo S, Rodrigues C. Serviço de Cirurgia Pediátrica, Hospital Maria Pia, Porto. Abstract Dysgenetic male pseudohermaphroditism is the result of a defect of testis development that encompasses a large clinical heterogeneity. It is characterized by bilateral dysgenetic testis, absence of mullerian regression, ambiguous genitalia and/or stigmata of Turner's syndrome in the majority of the cases. Typically, these individuals have either a 46,XY or 45,X/46,XY karyotype. The authors present four cases of dysgenetic male psudohermaphroditism, with ages of diagnosis between 1 month and 17 years old. The first had a male phenotype with stigmata of Turner's syndrome and the others ambiguous genitalia. Two patients were 45,X/46,XY and 45X/47,XYY mosaics and the other two were 46,XY. Gonadal karyotyping showed mosaicism (45,X/46,XY) in all four cases. In the first case was programed orquidectomy; all the others assigned a male gender, with regular follow-up until the puberty. PMID: 11878163 [PubMed - indexed for MEDLINE]
- Comparative study of the degree of patient satisfaction in intermittent catheterization with Lofric and polyvinyl chloride cathetersPublication . Pereira, P.; Urrutia, M.; Lobato, L.; Rivas, S.; Monereo, E.Actas Urol Esp. 2001 Nov-Dec;25(10):725-30. [Comparative study of the degree of patient satisfaction in intermittent catheterization with Lofric and polyvinyl chloride catheters]. [Article in Spanish] López Pereira P, Martínez Urrutia MJ, Lobato L, Rivas S, Jaureguizar Monereo E. SourceUnidad de Urología Infantil, Hospital Universitario La Paz, Madrid. Abstract PURPOSE: To assess the grade of satisfaction in children on intermittent catheterization with the use of LoFric and PVC conventional catheters. MATERIAL AND METHODS: A total of 40 p with experience in CIC were included in this study. An anonymous questionnaire was sent to all patients after 2-months using the LoFric catheter. Patients were divided in 3 groups (bladder augmentation, artificial sphincter, Mitrofanoff) because of major differences in CIC discomfort between these groups. RESULTS: The questionnaire was completed by 87.5% of the patients (35 p). In 86% (30 p) LoFric catheter training was easy or very easy but in 14% (5 p) it was difficult. Four patients had some difficulty during conventional catheter insertion, in 3 (75%) the difficulty disappeared with the use of LoFric catheter. Of the 51% (18 p) who reported some discomfort during the insertion of conventional catheter, 72% said it was eliminated when the LoFric catheter was used. Of 6 p with some discomfort when removing the conventional catheter, 5 (83%) said it disappeared with the new catheter. Th LoFric catheter was favored by 70% of patients because it reduced the discomfort caused by conventional catheters, bladder insertion was easier and smoother, and gel lubrication was not needed. The 17% of patients reported some difficulty dealing with this slippery catheter. CONCLUSIONS: The use of the LoFric catheter could be justified in patients who report with conventional catheters have some discomfort. It can also be recommended in patients with artificial sphincter, bladder augmentation and Mitrofanoff procedure, in whom any complication related to CIC would have serious consequences.
- Minimal invasive surgical of intersex abnormalities: our experiencePublication . Recamán, M.; Bonet, B.; Enes, C.; Cidade-Rodrígues, J.
- Reconstruction of velopharyngeal sphincter in secondary Cleft Palate: surgical alternativePublication . Recamán, M.; Bonet, B.; Leitão, J.; Mesquita, A.Cir Pediatr. 2006 Apr;19(2):106-10. [Reconstruction of velopharyngeal sphincter in secondary Cleft Palate: surgical alternative] [Article in Spanish] Recamán M, Bonet B, Leitão J, Mesquita A. Hospital Central e Especializado de Crianças Maria Pia, Serviço de Cirurgía Plástica. monicarec@iol.pt Abstract There are numerous surgical procedures for the repair of Cleft Palate (CP). Since 1998, in children with CP we use a modified Wardill-Kilner technique, with a large section of the nasal mucous layer at the level of the muscular insertion on the hard palate and lateral nasopharingeal wall, obtaining a push-back and reorientation of the muscular fibres without dissection, diminishing this way the risks of haemorrhages and fibrosis, simplifying the intervention. It allows a lower operative time and a short internment. The aim of our study was to evaluate the results of this operative procedure specially in the development of the speech in 73 children operated on from 1998 until 2000 in our hospital. We verify a competence of the velopharingeal sphincter with ideal results in speech in 88,8% of the cases. PMID: 16846134 [PubMed - indexed for MEDLINE
- Testículos no palpables: experiencia del Hospital Central Especializado de Crianças Maria PiaPublication . Bonet, B.; Recaman, M.; Ferreira-Sousa, J.; Carvalho, F.; Enes, C.; Cidade-Rodrigues, J.La incidencia de criptorquidia es del 1% en niños de 1 año de edad, siendo en el 20% de los casos el testículo no palpable. El objetivo de este trabajo fue estudiar la contribución de la cirugía mínimamente invasiva en el diagnóstico y tratamiento de estos pacientes. Los autores realizaron un estudio prospectivo, analítico y longitudinal durante el período de enero de 2001 a diciembre de 2004, englobando 89 niños portadores de 98 testículos no palpables sometidos a laparoscopia. Los autores analizaron los siguientes parámetros: localización del testículo no palpable, examen objetivo bajo anestesia general ecografía inguinoescrotal, edad de la intervención, hallazgos laparoscópicos, tratamiento efectuado, resultados anatomopatológicos de las piezas extirpadas y seguimiento después de la cirugía.
- In utero topographic analysis of astrocytes and neuronal cells in the spinal cord of mutant mice with myelomeningocele.Publication . Reis, J.L.; Correia-Pinto, J.; Monteiro, M.P.; Hutchins, G.M.Abstract OBJECT: Myelomeningocele (MMC) is the most severe form of spina bifida causing severe neurological deficits. Injury to the placode has been attributed to in utero aggression. In this study, glial and neuronal cell changes in both number and topography in mice with MMC were investigated during gestation. METHODS: The curly tail/loop-tail mice model of MMC was used, and fetuses were harvested using caesarean surgery at Days 14.5, 16.5, and 18.5 (full gestation at 19 days). Immunohistochemical analyses of the MMC placodes and the normal spinal cords from the control group were performed using anti-glial fibrillary acidic protein (astrocytes) and mouse anti-neuronal nuclear (neurons) antibodies. Light microscopy was used along with computer-assisted morphometric evaluation. Progressive increases in astrocytes in the spinal cord of all mouse fetuses were found between Days 14.5 and 18.5 of gestation. This increase was significantly higher in the placodes of mice with MMC than in those of normal mice, particularly in the posterior region. Neuronal labeling at Day 14.5 of gestation was similar between mice with MMC and control mice. At Day 16.5 of gestation there was a deterioration of neural tissue in MMC fetuses, mainly in the posterior region, progressing until the end of gestation with a marked loss of neurons in the entire MMC placode. CONCLUSIONS: This study delineated the quantitative changes in astrocytes and neurons associated with MMC development during the late stages of gestation. The detailed topographic analysis of the MMC defines the timing of the intrauterine insult and how the placode lesions progress. This study supports the current concept of placode protection through in utero surgery for fetuses with MMC. PMID: 17566405 [PubMed - indexed for MEDLINE]
- Vascular and apoptotic changes in the placode of myelomeningocele mice during the final stages of in utero developmentPublication . Reis, J.L.; Correia-Pinto, J.; Monteiro, M.P.; Costa, M.; Hutchins, G.M.JOAQUIM L. REIS, M.D., PH.D.,1,2 JORGE CORREIA-PINTO, M.D., PH.D.,3,4 MARIANA P. MONTEIRO, M.D., PH.D.,1 MADALENA COSTA, B.SC.,1 AND GROVER M. HUTCHINS, M.D.5 1Department of Anatomy, Abel Salazar Institute for the Biomedical Sciences and Unit for Multidisciplinary Biomedical Research, University of Porto; 2Department of Neurosurgery, Santo António General Hospital; 4Department of Pediatric Surgery, São João Hospital, Porto; 3Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; and 5Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland Object. Myelomeningocele (MMC) is a primary neurulation defect that is associated with devastating neurological disabilities in affected newborns. To better characterize the in utero neurodegenerative process of MMC, the authors investigated the changes in vascular organization, apoptosis, and the presence of inflammatory cells during gestation by using a mutant mouse model of MMC. Methods. The curly tail/loop tail (ct/lp) mutant mouse model of MMC was chosen to obtain fetuses at different stages of gestation. Mouse fetuses harboring MMC were harvested by caesarean section at embryonic Days 14.5, 16.5, and 18.5 (complete mouse gestation at 19 days, 6 mice/group); littermate fetuses with the same gestational age but without an MMC were used as controls. Samples of the MMC placode or normal spinal cord were stained for immunocytochemical labeling with caveolin antibody (endothelium marker) and activated caspase-3 antibody (apoptosis marker). Samples were morphometrically analyzed with a computer-assisted image analyzer. Results. The MMC mice presented with an increase in vascular density from embryonic Days 16.5–18.5 and an enhanced number of apoptotic cells at embryonic Day 18.5, compared with controls. There were scarce signals of an inflammatory reaction in the MMC placode, as a few infiltrating neutrophils were seen only at embryonic Day 18.5. Conclusions. Fetal placodes in MMC mice showed evidence of increased vascular density since embryonic Day 16.5 and increased apoptosis at embryonic Day 18.5. These new data support the view that in utero changes of the MMC placode, occurring during the last stages of gestation, contribute to the neuropathological manifestations in fullterm newborns with MMC. (DOI: 10.3171/PED/2008/2/8/150)
- A experência da criança no perioperatório de cirurgia programadaPublication . Teixeira, E.; Figueiredo, M.A experiência da criança submetida a cirurgia programada é sempre uma vivência individual, não descorando o binómio criança/família. A ansiedade, o medo, o choro, e outras reacções são conhecidas da nossa prática como manifestações à separação familiar e ao ambiente hospitalar. Numa tentativa de compreender a experiência da criança, em idade escolar, no perioperatório de cirurgia programada, levamos a cabo um estudo qualitativo de intervenção. A amostra incluiu 30 crianças admitidas no Serviço de Cirurgia da Instituição. O primeiro grupo (A), seguiu os procedimentos habituais da instituição. O segundo grupo (B), foi submetido a uma intervenção de enfermagem no pré-operatório, realizada na véspera do acto cirúrgico. Após análise das entrevistas, constatou-se a existência de oito categorias: experiência hospitalar, experiência cirúrgica, experiência de aprendizagem, experiência no bloco operatório, sensações, resultados da experiência, papel do enfermeiro e hospital pediátrico. Estas categorias foram alvo de análise de conteúdo para compreensão das mensagens das crianças. As conclusões deste estudo, revelam-nos que as crianças submetidas a intervenção de enfermagem pré-operatória, quando comparadas com as crianças que seguiram o procedimento habitual da instituição, expressam maior entendimento, aceitação e reconhecimento dos procedimentos cirúrgicos; estabelecem, com maior facilidade, uma relação terapêutica com a equipa de enfermagem; relatam menos medo e encaram a experiência como fonte de aprendizagem, e a presença do familiar como o garante tranquilizador.
- Varicocoelectomy in adolescents: laparoscopic versus open high ligation techniquePublication . Moreira-Pinto, J.; Osorio, A.; Carvalho, F.; Castro, J.; Enes, C.; Reis, A.; Cidade-Rodrigues, J.Background: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. Materials and Methods: We retrospectively evaluated 33 adolescents who underwent varicocoelectomy at our paediatric hospital, between May 2004 and September 2008. Patients were divided into two groups depending on the technique: those who had an LV and those submitted to an open varicocoelectomy (OV). We analysed side, age of surgery, follow-up period and the incidence of recurrence/persistence, hydrocoele formation and wound complication. Results: There were 24 patients in the LV group and 9 in the OV group. All varicocoeles were in the left side. Mean age was 12 years in both groups. Mean follow-up time was 32 months for the LV group and 38 months for the OV group (P = 0.49). There was no significant difference in the incidence of hydrocoele in both the groups (25% versus 22%, P = 0.626). There was no recurrence/persistence on the LV group, while in the OV group there were three cases (P = 0.015). Conclusion: LV seems more efficient than open high ligation technique in the treatment of adolescents«SQ» varicocoeles. Larger series are necessary to draw more reliable conclusions.
- Nefrectomia laparoscópica retroperitoneal em crianças com idade inferior a nove anos: Estado da ArtePublication . Moreira-Pinto, J.; Osório, A.; Pereira, J.; Enes, C.; Ribeiro-Castro, J.; Reis, A.Introdução e Objectivos: Em Portugal, a experiência em retroperitoneoscopia pediátrica é escassa. Os autores apresentam a primeira série portuguesa de nefrectomias realizadas por esta via, em crianças com idade inferior a nove anos, e uma revisão da literatura sobre o tema. Material e Métodos: Análise retrospectiva dos processos das crianças submetidas a nefrectomia laparoscópica retroperitoneal (NLR), de Janeiro de 2009 e Dezembro de 2009, num Departamento de Cirurgia Pediátrica. A revisão da literatura foi realizada através de uma pesquisa na base de dados Medline. Resultados: Foram realizadas oito NLR. A média de idades dos doentes operados foi 4,5 anos (mínimo = 11 meses, máximo = 8,6 anos). As indicações cirúrgicas encontradas foram: quatro rins multiquísticos, três nefropatias de refluxo, uma nefropatia obstructiva. Quatro NLR foram realizadas à esquerda. O tempo cirúrgico médio foi 99 minutos (mínimo = 50 minutos, máximo 180 minutos), notando-se um encurtamento do mesmo à medida que aumenta a experiência da equipa. Não houve nenhuma conversão para lombotomia. A média de tempo de internamento foi 1,5 dias (mínimo = 1 dia, máximo = 2 dias). Não se registaram complicações intra-operatórias nem pós-operatórias. Conclusão: A NLR é exequível em crianças de idade inferior a nove anos e deve ser considerado tratamento de eleição na idade pediátrica.