ABSTRACT
Existen múltiples patologías del tracto urinario, ya sea congénitas o adquiridas, que requieren de tratamiento quirúrgico de Nefrectomía total o parcial. En el siguiente estudio longitudinal prospectivo se incluyen 21 nefroureterectomías en pacientes pediátricos con patología del tracto urinario con o sin enfermedad renal crónica y algún tipo de terapia de reemplazo renal, realizados con la técnica de Cirugía Minimamente Invasiva (CMI) abordaje retroperitoneal o retroperitoneoscopía. (AU)
There are several urinary tract diseases, such as congenital or adquired, that require total or partial nephrectomy. This prospective longitudinal study included 21 total nephrectomies in pediatric patients with or without end stage renal disease and some kind of renal replacement therapy. All surgeries were done with retroperitoneal approach using minimally invasive surgery (MIS), retroperitoneoscopy. (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Renal Insufficiency, Chronic/surgery , Kidney Diseases/surgery , Nephrectomy/methods , Retroperitoneal Space , Urogenital Abnormalities/surgery , Prospective Studies , Longitudinal Studies , Minimally Invasive Surgical Procedures/methodsABSTRACT
OBJECTIVE: The Guatemalan Foundation for Children with Kidney Diseases was established in 2003 as the first and only comprehensive pediatric nephrology program and hemodialysis unit in Guatemala. Bridge of Life (BOL) is a not-for-profit charitable organization focused on chronic kidney disease and supplied equipment, training and support during formation of the hemodialysis unit. Pediatric permanent vascular access (VA) expertise had not been established and noncuffed dialysis catheters provided almost all VA, many through subclavian vein access sites. BOL assistance was requested for establishing a VA surgical program, resulting in recurring BOL surgical missions to create arteriovenous fistulas (AVF) in these children. This study analyzes the BOL pediatric VA missions to Guatemala. METHODS: Three surgical pediatric VA missions were conducted in Guatemala from 2015 to 2017. Each mission was led by two or three surgeons. All supplies and equipment (including ultrasound units) were taken as part of each mission. The BOL surgical VA mission teams work with local pediatric surgeons, pediatric nephrologists, and dialysis nurses to establish collegial relationships and foster teaching interactions. We retrospectively reviewed the patient demographic data, procedures, and outcomes for these missions. RESULTS: AVFs were created in 54 new pediatric patients. Ages were 8 to 19 years (13.4 ± 2.8 years) and 29 patients (54%) were male. Patient weights were 28 to 50 kg (30.8 ± 8.3 kg) with body mass indexes of 12 to 25 kg/m2 (17.9 ± 2.9 kg/m2). Radiocephalic AVFs were created in 21 children (39%), proximal radial artery AVFs in 12 (22%). and brachial artery inflow AVFs in 5 (9%). Sixteen patients (30%) required transpositions and one a translocation; two of these were femoral procedures. Primary and cumulative patency rates were 83% and 85% at 12 months and 62% and 85% at 36 months, respectively. The median follow-up was 17 months. Interventions with fistulagram and balloon angioplasty options were not available for AVF dysfunction or access salvage during the study period. However, six patients underwent an AVF revision and salvage during subsequent missions or by one of the Guatemalan surgeons (R.S.). Four individuals underwent successful transplantation during the study period. There were no operative deaths or major complications. CONCLUSIONS: Pediatric VA missions to Guatemala created safe and functional AVFs in concert with local pediatric surgeons and pediatric nephrologists. Three surgical missions included access operations in 54 new patients. Cumulative AVF patency was 85% at 36 months.
Subject(s)
Arteriovenous Shunt, Surgical/statistics & numerical data , Graft Occlusion, Vascular/epidemiology , Hemodialysis Units, Hospital/statistics & numerical data , Medical Missions/statistics & numerical data , Renal Dialysis/methods , Adolescent , Arteriovenous Shunt, Surgical/adverse effects , Child , Female , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Guatemala , Hemodialysis Units, Hospital/organization & administration , Humans , Male , Medical Missions/organization & administration , Renal Dialysis/statistics & numerical data , Retrospective Studies , Treatment Outcome , Vascular PatencyABSTRACT
Se reportan 2 casos de quiste de colédoco neonatal sintomáticos, uno de ellos con diagnóstico prenatal, que fueron llevados a tratamiento quirúrgico, realizando la resección de quiste del colédoco, derivación bilioentérica tipo hepático-yeyuno anastomosis en Y de Roux y colocación de drenaje de Penrose. En seguimiento de 20 meses en promedio con adecuada evolución.
We report two cases of symptomatc neonatal choledochal cysts, one of them prenatally diagnosed, who had surgical treatment with choledochal cyst resecton and Roux en Y hepato-jejunal anastomosis and Penrose drain. Follow up at 20 months (average) with good outcomes.
Subject(s)
Humans , Male , Female , Infant, Newborn , Choledochal Cyst/surgery , Choledochal Cyst/diagnosis , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , Common Bile Duct/diagnostic imagingABSTRACT
Paciente Femenina de 11 años con el síndrome de Herlyn-Werner-Wunderlich, manejado multdisciplinariamente y resuelto endoscópicamente con una septotomía y dilataciones vaginales.
This case is about a female patent, 11 years old, with Herlyn-Werner-Wunderlich Syndrome, who received multdisciplinary approach and was endoscopically resolved with septotomy and vaginal dilatatons.
Subject(s)
Humans , Female , Child , Urogenital Abnormalities/diagnosis , Vagina/abnormalities , Genitalia, Female/surgery , Kidney/abnormalities , Mullerian Ducts/abnormalities , Uterus/abnormalities , Hematocolpos/diagnosisABSTRACT
Preescolar, Masculino, 3 años 9 meses con antecedente quirúrgico de corrección de hipospadias 1er tiempo hace 2 años y que durante el 2do tiempo de corrección de hipospadias se encuentra incidentalmente una duplicación uretral tipo IB. Se confirma por medio de instilación de azul de metileno por uretra ventral y luego por medio de uretrocistoscopia. Se realiza la resección y cierre de uretra dorsal. Requiere de una dilatación uretral y está pendiente la corrección quirúrgica de una fistula uretrocútanea.
We report the case of a 3 year 9 month old boy who had a failed hypospadia correction two years prior to his second surgery when a IB urethral duplication was incidentally found. There are only 300 case reports of this published. The diagnosis was confirmed by instilling methylene blue through the ventral urethra, by urethero-cystoscopy. Resection and closure of the dorsourethra was performed. He required a urethral dilatation and developed aurethero-cutaneous fistula, which is pending surgical correction.
