Résumé
Objectives:Describe the demographic variables, types of liver tumor, surgeries performed and survival children diagnosed with liver tumor undergoing surgical treatment.Method: A retrospective analysis was performed in patients with pediatric liver tumors undergoing surgical treatment, from January 2010 to December 2015 at the "General Oncology Hospital. Solon Espinoza Ayala”.Results:Data from our study reported a diagnosis of hepatoblastoma in 51.85% of all pediatric liver tumors; 50% are routine controls without evidence of disease, 14.28% have been completed clinical treatment, 21.42% died from a second primary diagnosis with metastasis, and another 14.28% (only surgery) who were not followed up because they were transfers from another health system; with respect to global survival it was 64%. The ages ranged from 0 to 15 years old with an average of 5.5.Conclusion: It is very important a timely detection and adequate treatment by a specialized center and trained professionals, liver surgery is a very important chapter for the treatment of liver tumors. The surgical approach with tumor-free resection along with multidisciplinary treatment is the goal for healing.
Résumé
La estenosis subaórtica es una lesión cardiaca poco frecuente, en el cual el tracto de salida del ventrículo izquierdo está estrechado por la presencia de un anillo fibroso o fibromuscular. Constituye 8 a 20% de todas las formas de obstrucción al tracto de salida del ventrículo izquierdo. La cirugía ha sido considerada el tratamiento de elección cuando el gradiente pico es mayor de 50 mmHg o en pacientes que, con gradientes menores, presentan progresión de la insuficiencia aórtica o dilatación de los diámetros ventriculares, disfunción ventricular o síntomas. Presentamos el caso de un paciente menor de edad, portador de estenosis subaórtica por membrana, con síntomas de insuficiencia cardiaca y función ventricular izquierda muy comprometida, en la que se realizó el tratamiento percutáneo, alternativo al quirúrgico, con resultado exitoso. Constituye el primer caso reportado en el país de tratamiento percutáneo con balón y con evolución favorable.
Discrete subaortic stenosis is a rare cardiac lesion with left ventricle outflow narrowed by the presence of a muscular or fibrous ring. It accounts for 8-20% of all forms of left ventricle outflow tract obstruction. Surgery is considered the treatment of choice when the peak gradient is over 50 mmHg or in patients with lower gradients and either progression of aortic regurgitation, dilated ventricular diameters, left ventricular dysfunction or symptoms. We report the case of a child with membrane subaortic stenosis and symptoms of heart failure and compromised left ventricular function, in whom percutaneous balloon dilatation was performed as an alternative to surgery. This is the first case reported in the country with successful outcome.
Résumé
Objetivo: relatar nossa experiência com a colocação e o uso do cateter venoso central de longa permanência(CVCLP), implantado através das veias do braço. Pacientes e Métodos: trata-se de um trabalho retrospectivo em que foram analisados 586 cateteres implantados em crianças com câncer, de janeiro de 1995 a dezembro de 1999, no HC I - INCA. Resultados: dos 586 CVCLP implantados em crianças com câncer, 91,5 % foram inseridos através das veias do braço (536), 45 (8 %) implantados no tórax e 5 (1 %) em outros sítios. As veias de escolha para o implante do cateter no braço foram as braquiais. Os resultados em relação às complicações (infecção, obstrução, exteriorização do anel fixador, ruptura do cateter, migração, entre outras), foram similares àqueles da literatura quando implantados no tórax. Conclusão: recomendamos a colocação do cateter no braço como primeira opção para colocação de cateteres venosos centrais de longa permanência para crianças com câncer, uma vez que mostrou-se mais seguro, confortável, esteticamente mais tolerável e permitiu maior mobilidade aos pacientes, quando em uso do cateter do que os implantados no tórax. Implicação clínica: propomos a opção da colocação do CVCLP no braço como a primeira escolha por acharmos ser mais segura, mais confortável e eficiente, do que os implantados no tórax, para as crianças com câncer, que necessitem de um acesso venoso por tempo prolongado.
Objective: To report our experience with insertion and use of LTCVC in the arm. Pacients and Methods: It is aretrospective study. We analyzed 586 LTCVC inserted on children with cancer, from January 1995 to December1999. Results: From a total of 586 inserted LTCVC; 536 (91,5%) were in the arm, 45 in the thorax and 5 wereinserted in other sites. The vein of choice for the arm was the brachial vein, on its proximal third. All LTCVC were inserted at operating rooms, under general anesthesia. The tip of the catheter was localized on superior cava vein under fluoroscopy. Our experience with the site of insertion on the arm had demonstrated that this site is safe,comfortable, esthetically better, and that it allows more mobility to the patients when it is activated. The resultsregarding infection rates for arm insertionare similar to those found on the literature for LTCVC thorax inserted.Conclusion: We indicate the arm (brachial vein) as the site of choice for inserting LTCVC for children with cancer. Clinical Implication: The insertion of LTCVC in the arm is a safe and efficient option for inserting LTCVC in children with cancer.