Browsing by Author "Pascoal, J"
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- Dilatação Endoscópica de Balão para Tratamento de Megaureter Obstrutivo Primário: Experiência de um CentroPublication . Morão, S; Pratas Vital, V; Cardoso, D; Alves, F; Catela Mota, F; Pascoal, JIntroduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Methods: All patients with diagnosis of primary obstructive megaureter treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of primary obstructive megaureter was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG-3 diuretic renogram and absence of vesicoureteral reflux. After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of hydroureteronephrosis (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7.6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis. No patients were lost to follow-up (average 46.7 months). They all had hydroureteronephrosis greater than grade 3 and preoperative MAG-3 diuretic renogram was obstructive in all cases. Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive hydroureteronephrosis. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the hydroureteronephrosis in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Conclusion: Endoscopic balloon dilatation is a useful option in the management of primary obstructive megaureter requiring surgical intervention and may be considered first line treatment in small children.
- Lesões Ósseas Fibrosas Benignas na CriançaPublication . Lucas, AP; Marques, M; Pascoal, J; Antunes, JAProcedeu-se à revisão dos Tumores Ósseos e Lesões Pseudotumorais Benignos diagnosticados na Consulta de Ortopedia do Hospital de Dona Estefânia no período de Janeiro de 1988 e Janeiro de 1995. Seleccionaram-se 130 crianças com esse diagnóstico. Cinquenta e quatro desses (42%) doentes apresentavam Tumores Fibrosos Benignos. Fez-se seguidamente uma revisão clínica, radiológica, histológica e de abordagem terapêutica dos Tumores Fibrosos Benignos encontrados na população estudada.
- MURCS Association and Anorectal Malformation: Case Report of a Female NewbornPublication . Morão, S; Chaves, F; Virella, D; Alves, F; Alves, R; Pascoal, JMURCS association is rare, first described by Duncan et al. in 1979, including Müllerian duct aplasia, renal aplasia and cervicothoracic somite dysplasia. Levitt and Pe~na described in 2007 a classification of syndromic anorectal malformation (ARM) that associates these two entities. The reported case is the first one described in neonatal period. We describe a case of a female newborn with suspected diagnosis of anorectal and renal malformations. Physical and radiologic investigation revealed agenesis of sacrum and coccyx, tethered cord, left multicystic renal dysplasia, absence of vaginal orifice and hymen, normally placed urethral orifice and abnormal anal opening at the vaginal introitus as a rectovestibular type fistula. Also, she had right uterine, tube and ovary agenesis with a normal 46, XX female karyotype. A left diversing colostomy was done in first day of life and four months later, was performed a posterior sagittal anorectoplasty (PSARP), with intra-operative identification of a duplication of the distal rectum (related with caudal regression syndrome type 2). There were no complications in postoperative period. A staged management strategy is a viable option avoiding further complications in an already poor prognosis situation.
- Pieloplastia Laparoscópica em Idade PediátricaPublication . Morão, S; Pratas Vital, V; Vaz Silva, A; Cardoso, D; Alves, F; Catela Mota, F; Pascoal, JIntrodução: A obstrução da junção pielo-ureteral (OJPU) é a causa congénita mais comum de uropatia obstrutiva na criança. O objectivo deste trabalho é documentar a experiência desta Unidade de Urologia Pediátrica relativamente às primeiras 20 pieloplastias realizadas por via laparoscópica. Material e Métodos: Estudo retrospectivo em que foram incluídos vinte doentes com o diagnóstico de OJPU submetidas a pieloplastia por via laparoscópica, por um único cirurgião, no nosso Hospital, no período compreendido entre Novembro de 2010 e Dezembro 2014, tendo completado pelo menos um ano de seguimento. O sucesso do procedimento foi definido como ausência de conversão, resolução dos sintomas e melhoria dos critérios imagiológicos. Resultados: A mediana da idade à data da cirurgia foi de 9,5 anos (variando entre os 10 meses e os 17 anos). Constatou-se a existência de obstrução intrínseca em sete casos, obstrução extrínseca em 12 casos, sendo que num caso se verificaram as duas situações. O tempo operatório mediano foi de 235 minutos (variando entre 165 e 275 minutos), tendo havido necessidade de conversão para abordagem laparotómica em dois casos (10%). O tempo mediano de internamento foi de dois dias (variando entre 2 e 5 dias). Em quatro casos (20%) registaram-se complicações pós-operatórias precoces e houve necessidade de re-intervenção em dois casos (10%) durante o seguimento. O tempo mediano de seguimento foi de 33 meses (variando entre 12 e 60 meses). No seguimento, todos excepto dois doentes estavam assintomáticos. Constatou-se melhoria imagiológica da hidronefrose em todos os doentes excepto em um, apesar de não apresentar padrão obstrutivo no renograma. Conclusão: Os nossos resultados são consistentes com os da literatura publicada, com taxas de sucesso comparáveis com a abordagem por via laparotómica e com as vantagens da cirurgia minimamente invasiva.
- Torsion and Inflammation of Meckel's Diverticulum: Rare Cause of Acute Abdominal PainPublication . Morão, S; Knoblich, M; Alves, F; Alves, R; Pascoal, JMeckel's diverticulum is a remnant of the embryologic vitelline duct. It was named after its anatomical and embryological description, in the early 19th century, by Johann Meckel. It is known as a true diverticulum of the small bowel and is typically estimated to be present in 2% of the general population, with only a very small percentage being symptomatic. In this report, we present a 14-year-old boy with complaints of abdominal pain, fever, nausea, vomiting and diarrhea. During physical examination we observed peritoneal irritation and raised inflammatory markers. Surgical exploration revealed torsion and inflammation of a large Meckel's diverticulum with a gangrenous area. In order to ensure the removal of etopic tissue, if present, segmental bowel resection with primary anastomosis was performed. Histopathological analysis did not find ectopic tissue. The operative and postoperative courses were uneventful. Meckel's diverticulum is an important differential diagnosis in acute abdominal pain in children.
- Transferência Sanitária de Crianças do Países Africanos de Língua Oficial PortuguesaPublication . Lucas, AP; Alves, F; Pascoal, J; Leal, MJOs autores analisaram retrospectivamente os processos das crianças enviadas dos Países Africanos de Língua Oficial Portuguesa (PALOP's) para o Departamento de Cirurgia do Hospital de Dona Esteffinia (H.D.E.), ao abrigo dos Acordos de Cooperação na área da Saúde, durante o período de Janeiro de 1989 a Janeiro de 1997. Foram efectuadas 108 transferências: 17 de Angola, 49 de Cabo Verde, 26 da Guiné-Bissau e 16 de S. Tomé e Príncipe, nenhuma da República Popular de Moçambique; a que corresponderam 185 internamentos. A reflexão sobre os resultados e o percurso destes doentes, leva os Autores a propor modificações àcerca do desiderato do processo, nomeadamente na selecção e celeridade nas transferências, assim como no processo assistencia1 hospitaiar, substituindo os internamentos prolongados por tratamento em ambulatório apoiado, sempre que possível, e/ou deslocação paritária de equipas cirúrgicas, em que os custos financeiros e humanos sejam mais rentáveis e os resultados obtidos optimizados.
- Vascular Trauma in Children-Review from a Major Paediatric CenterPublication . Morão, S; Ferreira, RS; Camacho, N; Vital, VP; Pascoal, J; Ferreira, ME; Mota Capitão, L; Gonçalves, FBBACKGROUND: Traumatic noniatrogenic vascular injuries in children are rare and rarely discussed in literature. Pediatric vascular injuries pose a set of challenges mainly because of continued growth and development in a child or adolescent. The purpose of the study is to characterize management strategies and outcomes in these cases. METHODS: This is a single-center retrospective review of patients less than age 18 years (pediatric age) with acute, noniatrogenic traumatic vascular injuries between January 2009 and December 2015. Patient's demographics, injury characteristics, surgical management, complications, and follow-up were analyzed. RESULTS: From 2009 to 2015, 3277 children with traumatic injuries were treated, of which 21 (0.6%) had 23 significant vascular injuries: 17 arterial and 6 venous injuries. The majority were males (n = 16), and the median age was 14 years (range 1 to 16 years). Penetrating injuries were the predominant mechanism (n = 21), mainly by glass (n = 13). At presentation, 4 patients were hemodynamically unstable, 3 of them in hypovolemic shock. All patients were managed operatively. Operations for arterial injuries included 5 primary arterial repairs, 4 repairs using vein grafts and 8 ligations. The following adjunct procedures were necessary: one 4-compartment leg fasciotomy due to associated soft tissue trauma, 8 tendon repairs, and 11 nerve repairs. Operations for venous injuries included 4 ligations and 2 primary repairs. There were no intraoperative or postoperative deaths, major complications, or limb loss. The median length of stay in the hospital was 6 days (range: 2-23 days). The median time of follow-up was 52 months (range: 20-94 months). Ten patients did not have any sequelae, and 11 patients reported impaired mobility and/or decreased sensation, which was transitory in most cases and related to associated neurological or muscle tendon injuries. All reconstructions remained patent over the course of follow-up. No limb asymmetry was observed. CONCLUSIONS: Noniatrogenic pediatric vascular trauma is uncommon. Penetrating mechanism is more common than blunt and extremities are more frequently affected. Overall complications come from associated injuries to tendons and nerves.