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1.
Rev Chil Pediatr ; 91(2): 251-254, 2020 Apr.
Article in English, Spanish | MEDLINE | ID: mdl-32730545

ABSTRACT

INTRODUCTION: Upper gastrointestinal bleeding (UGIB) secondary to portal hypertension (PHT), without endoscopic or surgical treatment options due to an ectopic or unidentified bleeding site or the patient's anatomic characteristics, is challenging in pediatric hepatology. The usual treatment in these cases includes intravenous Octreotide. Recently, the availability of long-acting release Octreo tide (OCT-LAR) for monthly intramuscular administration has become an interesting therapeutic alternative. OBJECTIVE: To report the case of an infant with UGIB due to PHT who was successfully treated with OCT-LAR. CLINICAL CASE: Eight-month-old patient with repeated episodes of UGIB due to extrahepatic portal vein malformation, requiring blood transfusions, and intravenous octreotide infusions. As neither endoscopic nor surgical treatment were feasible, we decided to start IM OCT- LAR monthly. After ten months of treatment, the patient did not present bleeding episodes. No medication-related events were observed. CONCLUSION: We consider that this report could help in the management of similar pediatric patients with UGIB due to PHT without conventional therapeutic possibilities.


Subject(s)
Duodenal Diseases/drug therapy , Gastrointestinal Agents/administration & dosage , Gastrointestinal Hemorrhage/drug therapy , Hypertension, Portal/complications , Octreotide/administration & dosage , Delayed-Action Preparations , Duodenal Diseases/etiology , Gastrointestinal Agents/therapeutic use , Gastrointestinal Hemorrhage/etiology , Humans , Infant , Injections, Intramuscular , Male , Octreotide/therapeutic use
2.
Rev. chil. pediatr ; 91(2): 251-254, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1098899

ABSTRACT

Resumen: Introducción: La hemorragia digestiva por hipertensión portal, sin alternativa de tratamiento endos- cópico o quirúrgico por localizaciones ectópicas, no identificadas del sitio de sangrado o caracterís ticas anatómicas, constituye un desafío terapéutico en Pediatría. El tratamiento habitual incluye la infusión de octreótido endovenoso. En los últimos años, la presentación de octreótido de liberación prolongada (OCT-LAR) para administración mensual intramuscular, resulta una alternativa tera péutica atractiva. Objetivo: Reportar el caso de un lactante con hemorragia digestiva por hiperten sión portal que recibió tratamiento exitoso con OCT-LAR. Caso Clínico: Paciente de 8 meses de vida, con malformación de vena porta extrahepática y episodios reiterados de sangrados digestivos con re querimientos transfusionales e infusiones de octréotido, sin posibilidad de tratamiento endoscópico o quirúrgico. Indicamos OCT-LAR intramuscular mensualmente. Después de diez meses de iniciado el tratamiento, el paciente no repitió sangrados digestivos y no presentó efectos adversos relacionados a la medicación. Conclusión: Consideramos que el reporte de este caso puede resultar de utilidad al presentar una nueva alternativa para el tratamiento de pacientes pediátricos con sangrado digestivo por hipertensión portal sin posibilidades terapéuticas convencionales.


Abstract: Introduction: Upper gastrointestinal bleeding (UGIB) secondary to portal hypertension (PHT), without endoscopic or surgical treatment options due to an ectopic or unidentified bleeding site or the patient's anatomic characteristics, is challenging in pediatric hepatology. The usual treatment in these cases includes intravenous Octreotide. Recently, the availability of long-acting release Octreo tide (OCT-LAR) for monthly intramuscular administration has become an interesting therapeutic alternative. Objective: To report the case of an infant with UGIB due to PHT who was successfully treated with OCT-LAR. Clinical Case: Eight-month-old patient with repeated episodes of UGIB due to extrahepatic portal vein malformation, requiring blood transfusions, and intravenous octreotide infusions. As neither endoscopic nor surgical treatment were feasible, we decided to start IM OCT- LAR monthly. After ten months of treatment, the patient did not present bleeding episodes. No medication-related events were observed. Conclusion: We consider that this report could help in the management of similar pediatric patients with UGIB due to PHT without conventional therapeutic possibilities.


Subject(s)
Humans , Male , Infant , Gastrointestinal Agents/administration & dosage , Octreotide/administration & dosage , Duodenal Diseases/drug therapy , Gastrointestinal Hemorrhage/drug therapy , Hypertension, Portal/complications , Gastrointestinal Agents/therapeutic use , Octreotide/therapeutic use , Delayed-Action Preparations , Duodenal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Injections, Intramuscular
9.
Med. infant ; 13(2): 100-103, jun. 2006. ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: lil-494288

ABSTRACT

Propósito: Reportar nuestra experiencia con la Cecostomía Percutánea en el manejo de pacientes pediátricos con incontinencia fecal. Pacientes Método: Entre marzo 2002 y agosto 2005, se efectuaron 20 cecostomías percútáneas. La edad promedio fue de 8.9 años. Las causas de incontinencia fueron: malformación anorectal en 18 casos, mielomeningocele en 1 caso y constipación crónica en el restante. Todos los procedimientos se realizaron bajo anestesia general y control radioscópico. En todos los casos se utilicó un catéter Dawson Mueller de 8.5 F, que se reemplazó luego de 45 días, por un botón ad-hoc (trapdoor catheter). Resultados: Todos los procedimientos fueron satisfactorios. No se registraron complicaciones mayores. Conclusión: La Cecostomia Pecutánea es un procedimiento seguro y efizaz para el manejo de pacientes con incontinencia fecal de cualquier origen. El objetivo de este procedimiento es permitir el lavado anterógrado de todo el colon. Con ello se evita la necesidad de repetidos enemas evacuantes, lo que contribuye significtivamente a la mejor calidad de vida de estos pacientes.


Subject(s)
Child , Catheterization , Cecostomy/methods , Colon/abnormalities , Fecal Incontinence/therapy
10.
Med. infant ; 13(2): 121-127, jun. 2006. ilus, tab
Article in Spanish | LILACS | ID: lil-494292

ABSTRACT

Las malformaciones vasculares (MV) son errores difusos o localizados del desarrollo embriológico del sistema vascular. se originan entre la cuarta y décima semana de vida intrauterina, encontrándose por lo tanto presentes desde el nacimiento, aunque pueden no ser evidentes hasta semanas, meses o años después. El objetivo de este trabajo es mostrar nuestra experiencia en el diagnóstico y tratamiento percutáneo en 48 pacientes con MV de bajo flujo: 21 con malformaciones venosas infiltradas con absoluto (n 18), ( n 3 con ethibloc) y 27 con malformaciones linfáticas infiltradas con Ethibloc. Los resultados funcionales y estéticos de los tratamientos fueron correlativos. El resultado se consideró como excelente y moderado en el 71 por ciento de las venosas y en el 96 por ciento de las linfáticas. Se registraron complicaciones en 3 pacientes (6.3 por ciento).


Subject(s)
Infant , Child, Preschool , Administration, Cutaneous , Lymphatic Abnormalities/complications , Lymphatic Abnormalities/diagnosis , Lymphatic Abnormalities/therapy , Arteriovenous Malformations/classification , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/therapy , Retrospective Studies
11.
Medicina (B.Aires) ; 65(5): 402-408, 2005. graf, tab
Article in Spanish | LILACS | ID: lil-445765

ABSTRACT

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.


Subject(s)
Liver Transplantation , Postoperative Complications , Argentina/epidemiology , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Epidemiologic Methods , Graft Survival , Immunosuppression Therapy , Reoperation , Graft Rejection/etiology , Time Factors , Treatment Outcome , Liver Transplantation/mortality
12.
Medicina (B.Aires) ; 65(5): 402-408, 2005. graf, tab
Article in Spanish | BINACIS | ID: bin-123240

ABSTRACT

Orthotopic liver transplantation is the only definitive mode of therapy for children with end-stage liver disease. However, it remains challenging because of the necessity to prevent long-term complications. The aim of this study was to analyze the evolution of transplanted patients with more than one year of follow up. Between November 1992 and November 2001, 238 patients underwent 264 liver transplantations. A total of 143 patients with more than one year of follow up were included. The median age of patients +/- SD was 5.41 years +/- 5.26 (r: 0.58-21.7 years). All children received primary immunosuppression with cyclosporine. The indications for liver replacement were: fulminant hepatic failure (n: 50), biliary atresia (n: 38), cirrhosis (n: 37), chronic cholestasis (n: 13) and miscellaneous (n: 5). The indications for liver re-transplantation were: biliary cirrhosis (n: 7), hepatic artery thrombosis (n: 4) and chronic rejection (n: 3). Reduced-size liver allografts were used in 73/157 liver transplants, 14 of them were from living-related donors and 11 were split-livers. Patient and graft survival rates were 93% and 86% respectively. Death risk was statistically higher in retransplanted and reduced-size grafted patients. Growth retardation and low bone density were recovered before the first 3 years post-transplant. The incidence of lymphoproliferative disease was 7.69%. De novo hepatitis B was diagnosed in 7 patients (4.8%). Social risk did not affect the outcome of our population. The prevention, detection and early treatment of complications in the long-term follow up contributed to improve the outcome.(AU)


Subject(s)
Liver Transplantation , Postoperative Complications , Argentina/epidemiology , Epidemiologic Methods , Graft Rejection/etiology , Graft Survival , Immunosuppression Therapy , Liver Transplantation/mortality , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Reoperation , Time Factors , Treatment Outcome
15.
Med. infant ; 9(2): 109-117, jun. 2002. graf, tab
Article in Spanish | LILACS | ID: lil-517347

ABSTRACT

El trasplante hepático (TH) constituye la única alternativa terapéutica para numerosas enfermedades hepáticas avanzadas. Los adelantos en la técnica quirúrgica y en la inmunosupresión desarrollados en los últimos años permitieron mejorar la sobrevida. En la evolución a largo plazo de los pacientes trasplantados pueden presentarse complicaciones de diversa severidad. Objetivo: analizar la evolución a largo plazo de los pacientes trasplantados con un seguimiento mayor de 1 año post-TH. Material y Métodos: Durante el período 11/92-11/01 se realizaron 264 TH en 238 pacientes. De estos pacientes 143 (157 TH) fueron seguidos más allá de un año post-TH. La mediana de edad (m.a más menos DS) fue de 5,41 años más menos 5,26 (r:0.58 - 21.7 años); 76 pertenecían al sexo femenino. Catorce (9.79 por ciento) recibieron un re-TH. Fueron excluidos los pacientes que no habían cumplido todavía un años post- TH o los que fallecieron antes de ese lapso de seguimiento. Las indicaciones de TH fueron: falla hepática fulminante (FHF) (n:50); atresia de vías biliares (AVB) (n:38); cirrosis (n: 37); colestasis crónica (n: 13) y otras (n: 5). Las indicaciones de Re-TH fueron: cirrosis biliar (n: 7); trombosis de la arteria hepática (n: 4) y rechazo crónico (n: 3). En 73/157 TH se utilizaron injertos reducidos: 14 donantes vivos relacionados (DVR) y 11 biparticiones hepáticas. Se sometieron a análisis estadístico variables potenciales de morbimortalidad. Resultados: La sobrevida global fue: pacientes 93 por ciento: injerto: 86 por ciento. El re-TH y el injerto reducido fueron las variables de mayor significación para aumento del riesgo de muerte en nuestra población. El déficit de talla y masa ósea se recuperó anes de los 3 años post-TH. La incidencia del síndrome linfoproliferativo (SLP) fue del 7.69 por ciento, su diagnóstico y tratamiento temprano permitió una evolución favorable en la mayoria de los casos.


Subject(s)
Child , Adolescent , Follow-Up Studies , Indicators of Morbidity and Mortality , Liver Transplantation/adverse effects , Data Interpretation, Statistical
18.
Pediatr Radiol ; 24(8): 564-8, 1994.
Article in English | MEDLINE | ID: mdl-7724277

ABSTRACT

Diaphragmatic paralysis, a difficult diagnosis in the pediatric age group, has classically been made by fluoroscopy or B-mode ultrasound. We report our experience with TM-mode exploration. Twenty-seven patients suspected to have diaphragmatic paralysis were examined by means of inspiratory and expiratory chest radiography, fluoroscopy and B-mode ultrasound. The diaphragmatic echo was recorded on TM-tracing during spontaneous breathing using coronal oblique scans. Direction, excursion and the pattern of the transition between inspiration and expiration were analysed. In 7 patients examination was normal and TM mode demonstrated movement of normal direction and excursion with a sharp aspect of the transition zone. Diaphragmatic paralysis was present in 11 patients: unilateral in 9 and bilateral in 2 cases. TM mode demonstrated paradoxical movement, reduced excursion and a smooth transition zone. In 9 patients with diaphragmatic dysfunction TM mode demonstrated movement in the normal direction but with reduced excursion and a smooth transition zone. Compared to other imaging modalities, TM-mode records diaphragmatic movements more objectively. It can identify direction of the movement even if they are fast and of weak amplitude and in the case of bilateral paralysis. TM can differentiate paralysis from dysfunction. Moreover, this low-cost, non-irradiating made of imaging can be performed at the bedside and is available on all basic devices.


Subject(s)
Respiratory Paralysis/diagnostic imaging , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Methods , Radiography , Ultrasonography
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