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Eyer de Jesus L. Comments to the paper postnatal surgical treatment and complications following intrauterine vesicoamniotic shunting with the SOMATEX_ intrauterine shunt. A single-center experience. J Pediatr Urol 2024; 20:350-351. [PMID: 38135587 DOI: 10.1016/j.jpurol.2023.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Surgery/Urology Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
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Eyer de Jesus L, Paz de Oliveira AP, Porto LC, Dekermacher S. Testicular adrenal rest tumors - Epidemiology, diagnosis and treatment. J Pediatr Urol 2024; 20:77-87. [PMID: 37845103 DOI: 10.1016/j.jpurol.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/08/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Testicular adrenal rest tumors (TART) are common in males suffering from congenital adrenal hyperplasia (CAH). Correct and timely diagnosis is important for differential diagnosis with malignant testis tumors, related infertility and as TART may worsen in time, especially in the absence of adequate and continuous hormonal control. The rarity of the disease, predominance of small cohorts and case reports and research heterogeneity (concerning type of CAH, patients' age and specific focus of the paper) complicate the understanding of this condition. OBJECTIVES To review epidemiological and clinical aspects of TART, including treatment and prognosis. METHODS Non-systematic review of CAH-related TART research. RESULTS TART's prevalence grows progressively over time, predominating after puberty, affecting a mean of 20-40 % of CAH males. There is no proof of more frequent proportional affection of specific CAH phenotypes or types of enzyme deficiency, but cases of TART among non-classic CAH patients have been rarely reported. Chronic undertreated are more frequently affected and present larger tumors. Systematic ultrasound screening of CAH males is the state-of-the art for diagnosis, but TART are still often diagnosed in CAH adults seeking infertility treatment. TART are usually asymptomatic and present normal testicular volume. Biopsies are not recommended, except when the differential diagnosis between TART and testicular tumors cannot be guaranteed. Abnormal semen analysis is common. Leydig cell tumors are the main differential diagnosis, due to histological similarities to TART. Misdiagnosis may lead to unnecessary orchiectomies. Preservation of gonadal functions is inversely proportional to the total tumor volume. Tumors tend to regress under adequate adrenal suppression with steroids. Surgery in not indicated to treat TART. DISCUSSION The reported prevalence of TART depends on age, usage of systematic follow-up ultrasound, and adequate CAH control. Timely detection of the disease is important to avoid irreversible gonadal dysfunction (not clinically apparent, due to high serum levels of androgen) and infertility. The relationship between TART and specific CAH phenotypes/genotypes has not been proved, and some cases do not present abnormal serum ACTH levels. Knowledge about TART should be disseminated among non-experts, to avoid unnecessary orchiectomies and false diagnosis of malignant testis tumors. Infertility is frequent, but has not been not satisfactorily addressed by physicians, even among experts. Sperm cryopreservation should be early offered to CAH adult males, but there are offer problems related to high cost.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil.
| | - Ana Paula Paz de Oliveira
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Luiza Coutinho Porto
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Samuel Dekermacher
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
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Jesus LED. Non-invasive erections induced by perineal compression may be reflex. J Pediatr Urol 2024:S1477-5131(24)00063-9. [PMID: 38326168 DOI: 10.1016/j.jpurol.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Surgery/Urology Department, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brazil.
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Jesus LED, Rosina AG, Rabeca ACG, Pereira LMBM, Dekermacher S. [How much does a specialized medical consultation cost for families of pediatric patients in the Brazilian Unified National Health System?]. CAD SAUDE PUBLICA 2023; 39:e00137322. [PMID: 36651381 DOI: 10.1590/0102-311xpt137322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
In this study, we investigated the costs of transportation for each outpatient consultation in patients referred to specialized surgical evaluation in a tertiary hospital in Rio de Janeiro, Brazil. Descriptive study with guardians of pediatric patients scheduled for pediatric surgery, questioning transportation cost, and opportunity costs (loss of remuneration, food, payment of caregivers for other children, expenses for other companions). About half patients were aged up to five years; about two thirds had diseases of simple and definitive surgical resolution; and 181 families (89.17%) presented monthly family income up to BRL 1,999.00. The proportion of families that benefited from free transportation ranged from 4.26% to 15.56% for patients living up to 100 km away from the hospital (45.83% for patients living more than 100 km away from the institution). A total of 176 (87.13%) guardians reported expenses buying food, 12 (5.94%) paid caregivers to the other children on the day of the consultation, and 80 (39.6%) reported loss of remuneration for the working day. Among the high complexity cases, 9.33% of the mothers have given up their regular paid employment. Transportation expenses for a pediatric surgery consultation at a reference hospital in Rio de Janeiro cost about 4.42% of the current minimum wage, spending around 217.32 minutes of displacement/consultation. Expenses with food and loss of remuneration due to absence at work also entail significant financial charges or loss of remuneration for the patient at each consultation.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Brasil
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Jesus LED, Dekermacher S, Resende GC, Justiniano RR. Testicular involvement in pediatric acute lymphocytic leukemia: what to do about it? Int Braz J Urol 2022; 48:981-987. [DOI: 10.1590/s1677-5538.ibju.2022.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Brasil; Hospital federal dos Servidores do Estado, Brasil
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de Jesus LE, Rondon A. Editorial Comment: Anterior component separation technique for abdominal closure in bladder exstrophy repair: Primary results. Int Braz J Urol 2022; 48:867-869. [PMID: 35838513 PMCID: PMC9388184 DOI: 10.1590/s1677-5538.ibju.2022.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói, RJ, Brasil.,Hospital dos Servidores do Estado, Ministério da Saúde; Rio de Janeiro, RJ, Brasil
| | - Atila Rondon
- Hospital Universitário Pedro Ernesto. Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brasil.,Hospital Federal Cardoso Fontes, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
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Aziz Filho AM, de Azevedo LMS, Rochael MC, de Jesus LE. Frequency of lichen sclerosus in children presenting with phimosis: A systematic histological study. J Pediatr Urol 2022; 18:529.e1-529.e6. [PMID: 35864046 DOI: 10.1016/j.jpurol.2022.06.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of preputial lichen sclerosus (PLS) among children presenting with phimosis varies from 10 to 95%, depending on the age, the protocol for the treatment of pediatric phimosis, the method of diagnosis (clinical versus histological), and case mix (congenital versus acquired phimosis). OBJECTIVE PLS may not be clinically obvious. Our aim is to show that a systematic histological examination of the prepuce may diagnose PLS in clinically unsuspected cases. METHODS Prospective observational study of the histology of all prepuces resected from boys undergoing circumcision for phimosis but not clinically suspected to have PLS. RESULTS PLS was diagnosed histologically in 22 boys (32%). Boys with PLS were significantly older (mean 8.4 versus 4.7 years old). Diagnosis of PLS was not related to the degree of phimosis (summary figure). In three patients (grade 4 phimosis) glans discoloration was observed during surgery, and all had PLS. Follow up for boys found to have PLS ranged from 1 to 10 years. One patient developed recurrent phimosis, attributed to inappropriate conservative resection, and required further surgery. There were no cases of meatal stenosis. DISCUSSION Subtle cases of PLS may be difficult to detect clinically. Children are frequently asymptomatic, except for being unable to retract the prepuce. Physical examination has a low negative predictive value for the diagnosis of PLS. Complete removal of the prepuce with permanent glans exposure is regarded as essential to cure PLS and to avoid recurrent phimosis, but our patients were treated with partial circumcisions for cultural reasons. Only one needed reoperation for recurrent phimosis. CONCLUSION Histological PLS was present in approximately 1/3 of boys with phimosis, frequently without typical manifestations. Those patients may be cured with partial circumcisions.
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Affiliation(s)
| | | | | | - Lisieux Eyer de Jesus
- Antônio Pedro University Hospital, UFF, Niterói, Rio de Janeiro, Brazil; Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
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de Jesus LE. Comments on the paper Surgical approach to prune belly syndrome: A review of our series and novel surgical technique. J Pediatr Urol 2022; 18:250-251. [PMID: 35183452 DOI: 10.1016/j.jpurol.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil.
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Abstract
INTRODUCTION Bladder exstrophy (BE) affects continence and sexual function, impacting on social life and mental health. Long-term data from the patients' point of view are needed to get a real-life perspective on the problem. STUDY DESIGN A self-developed questionnaire concerning sexual, psychosexual and psychosocial outcomes was sent to the adult members of the Brazilian Exstrophy Group. RESULTS Fifty out of 67 adults from the group (74.5%) responded to the questionnaire. Failure of initial bladder closure attained 62%. Almost ¾ of the patients had augmentation cystoplasty. Bladder lithiasis was common. Esthetic procedures were frequently done. Repetitive UTI (n = 32, 64%) and kidney scars/disease (n = 20, 40%) were frequent. Most (88%) patients either depend on CIC or remain incontinent. Sexual problems predominated in males. Surgery for continence often failed, requiring re-operations, but the prognosis without these procedures was comparatively worse. Continent patients underwent more surgeries (mean 18, 13 and 9 procedures in continent, imperfectly continent and incontinent patients, respectively). Augmented patients more frequently achieved dryness (p = 0.0035). Two-thirds of the women underwent vaginoplasties, but dyspareunia/feeling of "tight" vagina still affected a quarter of them. Four women (15.4%) delivered healthy children. 91.7% of the males reported "normal" erections, but sexual inhibition was common due to feeling of having a small penis (n = 18, 75%). Persistent dorsal curvature and abnormal ejaculation were common (58.3% and 77.1%, respectively). Patients' comments related mainly to mental health issues/need for specialized care, limitations of medicine to cure/treat their disease, unavailability of experts, especially adult specialists, embarrassment over deformities and insufficient information about disease/treatment/prognosis. DISCUSSION Most BE patients are well-integrated into society, but feelings of sadness and low self-esteem are common. Most welcome procedures to become dry, despite self-catheterization. The results of bladder neck reconstruction are far from perfect, despite multiple attempts and bladder augmentation was often necessary. Volitional voiding is uncommon. Sexual problems are worse for males, and sexual avoidance is common. Sexual function and self-image are inter-related. It seems reasonable to offer selective esthetic procedures to improve social/sexual interaction. Obstetric complications are common, especially UTI, need for ureteral and/or conduit stenting, abnormal fetal positioning, uterine prolapse, technical problems during surgical deliveries and prematurity. CONCLUSION Continence/dryness in BE was mostly eventually achieved, usually depending on multiple interventions, bladder augmentation and self-catheterization. Despite multiple surgeries many adults remain incontinent. Sexual problems and avoidance are the rule in males, due to the feelings of penile inadequacy. Pregnant females deserve expert obstetric care.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Surgery and Urology Department, Hospital Federal Dos Servidores Do Estado, Rio de Janeiro, Brazil.
| | - Samuel Dekermacher
- Pediatric Surgery and Urology Department, Hospital Federal Dos Servidores Do Estado, Rio de Janeiro, Brazil
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de Jesus LE. Bladder dysfunction depends on many variables in children with posterior urethral valves. Int Braz J Urol 2021; 48:87-88. [PMID: 34735084 PMCID: PMC8691246 DOI: 10.1590/s1677-5538.ibju.2021.0046.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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Jesus LED, Silva EWGMD, Balieiro M, Feldman K, Dekermacher S. Post-tracheostomy tracheoinnominate fistula: endovascular treatment. ACTA ACUST UNITED AC 2021; 40:e2020229. [PMID: 34259783 PMCID: PMC8280763 DOI: 10.1590/1984-0462/2022/40/2020229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022]
Abstract
Objective: Tracheoinnominate fistula (TIF) is a rare and frequently lethal complication of tracheostomies. Immediate bleeding control and surgical treatment are essential to avoid death. This report describes the successful endovascular treatment of TIF in a preschooler and reviews the literature concerning epidemiology, diagnosis, prophylaxis, and treatment of TIF in pediatric patients. Case description: A tracheostomized neurologically impaired bed-ridden three-year-old girl was admitted to treat an episode of tracheitis. Tracheostomy had been performed two years before. The child used a plastic cuffed tube continually inflated at low pressure. The patient presented two self-limited bleeding episodes through the tracheostomy in a 48h interval. A new episode was suggestive of arterial bleeding, immediately leading to a provisional diagnosis of TIF, which was confirmed by angiotomography, affecting the bifurcation of the innominate artery and the right tracheal wall. The patient was immediately treated by the endovascular placement of polytetrafluoroethylene (PTFE)/nitinol stents in Y configuration. No recurrent TIF, neurological problems, or right arm ischemia have been detected in the follow-up. Comments: TIF must be suspected after any significant bleeding from the tracheostoma. Endovascular techniques may provide rapid bleeding control with low morbidity, but they are limited to a few case reports in pediatric patients, all of them addressing adolescents. Long-term follow-up is needed to detect whether stent-related vascular complications will occur with growth.
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Affiliation(s)
- Lisieux Eyer de Jesus
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Marcos Balieiro
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
| | | | - Samuel Dekermacher
- aHospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, RJ, Brazil
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de Jesus LE, Fulgencio C, Leve TC, Dekermacher S. Nephroblastomatosis and wilms tumor: dangerous liaisons. Int Braz J Urol 2021; 48:157-164. [PMID: 33650837 PMCID: PMC8691244 DOI: 10.1590/s1677-5538.ibju.2020.0694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Celine Fulgencio
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Thais Cardoso Leve
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Samuel Dekermacher
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
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de Jesus LE. Editorial Comment: Quality of life in enuretic children. Int Braz J Urol 2021; 47:542-543. [PMID: 33621000 PMCID: PMC7993964 DOI: 10.1590/s1677-5538.ibju.2020.0308.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Serviço de Urologia Pediátrica, Hospital Universitário Antônio Pedro - Universidade Federal Fluminense - UFF, Niterói, RJ, Brasil
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Eyer de Jesus L. Comment to: Deepithelialized glans reconfiguration (DeGRe) for distal hypospadias repair. J Pediatr Urol 2021; 17:60. [PMID: 33144074 DOI: 10.1016/j.jpurol.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery and Urology, Servidores do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil.
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de Jesus LE, Leve TC, Fulgencio C, Dekermacher S. Botulinum toxin abdominal wall injection and post-omphalocele ventral hernia repair: database and proposal of a protocol. Ann Pediatr Surg 2020. [DOI: 10.1186/s43159-020-00058-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Post-omphalocele ventral hernias (POVH) are common after giant omphaloceles. Abdominal wall botulinum toxin injections (BTI) are useful to treat complex incisional hernias (CIH) in adults, which may also apply to POVH. We review BTI data in the treatment of CIH and POVH and propose an algorithm applicable to POVH.
Results
Sixteen papers which described the treatment of CIH on the treatment of POVH in adults (n = 15) and children (n = 1) were reviewed. BTI elongates the lateral abdominal wall and reduces the hernia defect, with a lower incidence of compartment syndrome and respiratory complications. Doses and injection volumes vary. Effects start after 3 days, peak after 10–15 days, stabilize for 2–3 months, and decline after 4–6 months, disappearing after 6–9 months. Patients should be operated on 3–4 weeks after injection. Post-operative complications are uncommon. BTI may be associated with pre-operative pneumoperitoneum (PPP). Children presenting POVH differ from adults presenting CIH. Associated congenital cardiac malformations, genetically determined syndromes, pulmonary hypoplasia, abdominal wall hypoplasia, and thoracic dysmorphism, are common; children need sedation for any procedures; non-absorbable reinforcing meshes are not indicated; and POVH limits are frequently near to the costal margin.
Conclusion
BTI to induce preoperative muscular relaxation in preparation of CIH repair in adults is effective and safe. Experience with the method in children with POVH is limited, but the proposal is logical and probably safe. POVH differs from CIH in some aspects, especially abdominal wall hypoplasia, proximity to the rib cage, and diaphragmatic biomechanics.
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Eyer de Jesus L, Fazecas T, Anderson KM, Dekermacher S. Idiopathic hemorrhagic urethritis of childhood. J Pediatr Urol 2020; 16:690-699. [PMID: 32762951 DOI: 10.1016/j.jpurol.2020.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/25/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION idiopathic hemorrhagic urethritis of childhood (IHU) is uncommon. Data about the disease are limited. There are no available protocols for diagnosis, treatment, or follow-up and prognostic factors are unknown. OBJECTIVE We aim to review the available data about IHU, to organize and to synthesize information, to facilitate clinical choices and the establishment of future research protocols. STUDY DESIGN Descriptive review of the literature. RESULTS The disease typically affects peri-pubertal boys. A third evolve to chronic disease and circa 15% develop urethral stenoses. Voiding dysfunction is frequent. Acute scrotum secondary to orchiepididymitis may occur. Meatal stenosis and hypospadias are more frequent than in the general population. Diagnosis is clinical (urethrorrhagia ± dysuria). Complementary exams are mostly used for differential diagnosis. Indications for cystoscopy are controversial. Bulbar urethral inflammation with fibrinous "membranes" are typical. Treatment is controversial and mostly expectant. Topical steroids and indwelling catheterization are the most successful for severe or recalcitrant cases (summary table). CONCLUSION IHU turns into a chronic condition in a significant proportion of the cases and associates to a low quality of life. Urethral stenosis is the most common complication. Indications for diagnostic cystoscopy, prolonged catheterization, and steroid prescription need to be better defined. Clinical protocols are deeply needed.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil; Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil.
| | | | | | - Samuel Dekermacher
- Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
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de Jesus LE. Posterior urethral valves and hypospadias: What about voiding dysfunction? J Pediatr Urol 2020; 16:738. [PMID: 32798108 DOI: 10.1016/j.jpurol.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Antônio Pedro University Hospital, School of Medicine, Federal Fluminense University, RJ, Brazil; Servidores Do Estado Federal Hospital, Health Ministry, RJ, Brazil.
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Araújo J, Bacelar S, Jesus LED. Family planning among female medical students: are their plans comparable to other professionals? ACTA ACUST UNITED AC 2020; 66:485-490. [PMID: 32578783 DOI: 10.1590/1806-9282.66.4.485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Late pregnancy is a problem among physicians, especially surgeons. This paper studies family planning among Medical Students (MS) and Law students (LS). METHODS A questionnaire was sent to all female MS and LS attending the two last years of University in the first semester of 2019. Data on age, family income, marital status, and family planning (age, planning for future pregnancies, timing, professional relationship or other issues, the ideal moment for a pregnancy, attitude towards eventual pregnancies, or maternity leave) were researched. RESULTS MS were significantly older than LS. A minority of women did not plan future pregnancies (10.6% of MS and 16.4% of LS), for markedly different reasons: 40% of the MS mentioned career plans, while for 70% of LS motherhood was not a personal project. The ages chosen for pregnancy also differed: MS tended to choose older ages. The most important priorities were financial planning and professional career for both groups, but specialization/post-graduation were only cited among MS. Both groups considered that the ideal moment for pregnancy was after professional consolidation in the job market. There were differences between MS that chose a surgical specialty and other MS. DISCUSSION MS tend to go through pregnancy late, especially students planning a surgical career. Professional issues are more influential over MS than LS. Medical educators and health managers must recognize there is a need to reconcile the medical career and motherhood as females represent > 50% of MS in Brasil.
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Affiliation(s)
- Juliana Araújo
- . Estudante de Medicina (residência), Faculdade de Medicina , Universidade Federal Fluminense , Rio de Janeiro , RJ , Brasil
| | - Sthan Bacelar
- . Estudante de Medicina (residência), Faculdade de Medicina , Universidade Federal Fluminense , Rio de Janeiro , RJ , Brasil
| | - Lisieux Eyer de Jesus
- . Cirurgião Pediátrico, Diretor do Departamento, Cirurgia Pediátrica, Univerdidade Federal Fluminense , Rio de Janeiro , RJ , Brasil
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de Jesus LE. Editorial comment on the paper practice patterns in classic bladder exstrophy: A global perspective. J Pediatr Urol 2020; 16:512. [PMID: 32340882 DOI: 10.1016/j.jpurol.2020.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Universidade Federal Fluminense, Pediatric Surgery, Av Marquês de Paraná 616, 24210-270 Niterói, Rio de Janeiro, Brazil.
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de Jesus LE. Editorial Comment: The outcomes of mini-laparoscopic pyeloplasty in children - brazilian experience. Int Braz J Urol 2020; 46:260-261. [PMID: 32022516 PMCID: PMC7025840 DOI: 10.1590/s1677-5538.ibju.2019.0381.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Associação Brasileira de Cirurgia Pediátrica, Rio de Janeiro, RJ, Brasil.,Universidade Federal Fluminense - UFF, Niterói, RJ, Brasil.,Hospital Federal Servidores do Estado, Rio de Janeiro, RJ, Brasil
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de Jesus LE, Costa EC, Dekermacher S. Gender dysphoria and XX congenital adrenal hyperplasia: how frequent is it? Is male-sex rearing a good idea? J Pediatr Surg 2019; 54:2421-2427. [PMID: 30905417 DOI: 10.1016/j.jpedsurg.2019.01.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/26/2019] [Accepted: 01/30/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The frequency of gender dysphoria (GD) among 46,XX congenital adrenal hyperplasia (CAH) patients is unknown. These data are needed to put into perspective the debate about the timing of reconstructive surgery and possible male-raising of the most severely virilized children. OBJECTIVE To analyze the frequency of female to male GD between 46,XX individuals raised as females; to identify subgroups with higher chances of showing GD; to describe the results of male-raising among 46,XX CAH patients. MATERIALS AND METHODS Analytic/descriptive literature review (January 1988 to April 2018). RESULTS Female-raised patients frequently report the desire to be male, adopt male-typical behavior and are frequently homosexual/bisexual as adults, but this does not correspond to GD. Declared GD among 46,XX CAH patients attained 9% of the reported cohorts, generally in late adolescence/adulthood. We could not prove a relationship between inadequate treatment, null-genotype, late diagnoses, a higher degree of virilization, type of CAH or higher levels of androgens and female to male GD, but this may be due to statistical limitations. Male gender raised patients (MGR) were 10.1% of CAH cohorts included in this review, mostly from underdeveloped countries, with a high proportion of late diagnoses (76.3%) and familial choices. GD was more common in this group than among female-raised patients. Opting for male gender relates to a short final height, the need for multiple surgeries, surgical castration before puberty and infertility. CONCLUSION Both male to female and female to male GD may present in 46,XX CAH patients in a contemporaneous cohort. The proportion of GD is higher among patients raised as males. DSD patients sexual maladjustments are complex and not comparable to the transgender population. Many 46,XX CAH patients with GD define themselves as gender-fluid and do not seek for legal/formal transition. Male-raising Prader 4/5 46,XX CAH patients imply infertility and multiple surgeries. There is no proof that any subgroup of CAH is more prone to GD, despite null genotypes, salt wasting phenotypes and Prader 4/5 cases being related to male-typical behavior and female homosexuality. TYPE OF STUDY Descriptive/analytic non-systematic REVIEW. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Urology and Surgery Department, Servidores do Estado Federal Hospital, UFF, Rio de Janeiro, Brazil; Pediatric Surgery and Urology Department, Antonio Pedro University Hospital, UFF, Rio de Janeiro, Brazil.
| | - Eduardo Corrêa Costa
- Pediatric Surgery and Urology Department, Porto Alegre Clinics Hospital, UFRS, Porto Alegre, Brazil
| | - Samuel Dekermacher
- Pediatric Urology and Surgery Department, Servidores do Estado Federal Hospital, UFF, Rio de Janeiro, Brazil
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de Jesus LE, Fulgêncio C, Leve T, Dekermacher S. Thyroid-like follicular carcinoma of the kidney presenting on a 10 year-old prepubertal girl. Int Braz J Urol 2019; 45:834-842. [PMID: 31063281 PMCID: PMC6837619 DOI: 10.1590/s1677-5538.ibju.2018.0471] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/17/2019] [Indexed: 12/18/2022] Open
Abstract
The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin - TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Celine Fulgêncio
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Thais Leve
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Samuel Dekermacher
- Departamento de Cirurgia e Urologia Pediátrica, Hospital Estadual dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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de Jesus LE, Carvalho AC, Stulzer G, Barreto MD. Gastroschisis may be good, bad, not so ugly, and falsely beautiful. J Pediatr Surg 2019; 54:1510-1511. [PMID: 30954229 DOI: 10.1016/j.jpedsurg.2019.02.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Disciplines of Pediatric Surgery and Pathology, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil.
| | - Angela Cristina Carvalho
- Disciplines of Pediatric Surgery and Pathology, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Gilmar Stulzer
- Disciplines of Pediatric Surgery and Pathology, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Monique Dm Barreto
- Disciplines of Pediatric Surgery and Pathology, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
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de Jesus LE. Re: Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management. Int Braz J Urol 2017; 43:1004. [PMID: 28792189 PMCID: PMC5678543 DOI: 10.1590/s1677-5538.ibju.2017.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 12/04/2022] Open
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de Jesus LE, Fazecas T, Ribeiro BG, Dekermacher S. Transperineal Ultrasound as a Tool to Plan Surgical Strategies in Pediatric Urology: Back to the Future? Urology 2017; 104:175-178. [PMID: 28257917 DOI: 10.1016/j.urology.2017.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/13/2017] [Accepted: 02/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To demonstrate the usefulness and advantages of transperineal ultrasound (TPUS) on planning the surgical tactics to treat childhood pelviperineal disease (CPPD). METHODS A cohort of CPPD is reviewed to provide a pictorial review of TPUS as imaging method variety of CPPD. Other imaging methods are compared with TPUS. RESULTS TPUS studies of patients showing different conditions on the spectrum of pelviperineal malformation are shown in detail (pictorial review, graphically shown-see figures in the article and as supplementary material), highlighting the advantages of the method and comparing TPUS findings with other imaging techniques. CONCLUSION Magnetic resonance imaging, contrast genitograms, voiding cystourethrography, and genital or urologic endoscopy have some important disadvantages, especially radiation exposure, high cost, not easily available equipment, and the need of general anesthesia or deep sedation in children. TPUS is easily available, including in impoverished environments, portable, painless, reproducible, inexpensive, and capable of providing detailed and specific information about pelviperineal malformation with accuracy. Data provided by TPUS are comparable with other imaging techniques (Table 1). Its main disadvantage is the dependency on the expertise of the operator to obtain high-quality, well-interpreted images.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Surgery and Urology Department, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil; Pediatric Surgery and Urology Department, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
| | - Tatiana Fazecas
- CDPI Criança, Rio de Janeiro, Brazil; Radiology Department, Jesus Municipal Hospital, Rio de Janeiro, Brazil
| | - Bianca G Ribeiro
- CDPI Criança, Rio de Janeiro, Brazil; Radiology Department, Jesus Municipal Hospital, Rio de Janeiro, Brazil
| | - Samuel Dekermacher
- Pediatric Surgery and Urology Department, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
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de Jesus LE. About the paper "Prevalence of nocturnal enuresis and its influence in the quality of life in school-aged children". J Pediatr Urol 2017; 13:111-112. [PMID: 28288775 DOI: 10.1016/j.jpurol.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery/Urology, Hospital Universitário Antonio Pedro, Federal Fluminense University, Rio de Janeiro, Brazil; Department of Pediatric Surgery/Urology, Hospital Federal dos Servidores do Estado, Ministry of Health, Rio de Janeiro, Brazil.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery/Urology, Hospital Universitário Antônio Pedro e Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil.
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Jesus LED, Teixeira L, Bertelli A. Recurring priapism may be a symptom of voiding dysfunction – case report and literature review. Int Braz J Urol 2016; 42:389-91. [PMID: 27256196 PMCID: PMC4871403 DOI: 10.1590/s1677-5538.ibju.2015.0435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/05/2015] [Indexed: 12/02/2022] Open
Abstract
Recurring priapism is rare in pre-pubertal children and may be attributed to multiple causes. We propose that voiding dysfunction (VD) may also justify this symptom and detail a clinical case of recurring stuttering priapism associated to overactive bladder that completely resolved after usage of anticholinergics and urotherapy. Sacral parasympathetic activity is responsible for detrusor contraction and for spontaneous erections and a relationship between erections and bladder status has been proved in healthy subjects (morning erections) and models of medullar trauma. High bladder pressures and/or volumes, voiding incoordination and posterior urethritis can potentially trigger reflex erections.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Brasil; Hospital Federal dos Servidores do Estado, Brasil
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de Jesus LE, Tomé A, Cobe D, Camelier P. Psychosocial and respiratory disease related to severe bladder dysfunction and non-monosymptomatic enuresis. J Pediatr Urol 2016; 12:126.e1-6. [PMID: 26762535 DOI: 10.1016/j.jpurol.2015.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/19/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Complicated bladder dysfunctions (BD) (associated with infections/urological complications or irresponsive to treatment) are a small proportion of all cases, but are highly morbid, clinically and psychosocially. Our aim is to describe a cohort of complicated pediatric BD, using subgroup analysis to compare presentations and responses to treatment among genders, age groups, and patients with or without non-monosymptomatic enuresis (NME). We also relate severe BD to other health conditions or to social/behavioral problems and report treatment results. METHOD Thirty-five cases of complicated BD were reviewed. Neurogenic bladders and anatomical urological problems were excluded. Justifications for referral, comorbidities, and social aspects/familial dynamics were studied. Overactive bladders were primarily treated with oxybutynin. Transcutaneous parasacral neuromodulation was used in case of insufficient response or unbearable side effects. For infrequent voiders, timed voiding and transcutaneous neuromodulation were counseled. RESULTS Incontinence/enuresis were the motives for referral in only a third of the cases. UTI (42.9%) was the main reason for referral. Hydronephrosis was observed in 8.6% of the children. Respiratory/ENT problems, obesity, and precocious puberty were highly prevalent. Schooling problems and neuropsychiatric disease were common. Social problems were common. Five patients presented urological problems secondary to BD (hydroureteronephrosis, VUR, trabeculated bladder). Twenty percent of cases required high anticholinergic doses and 37.1% transcutaneous electrostimulation. Eight (22.9%) patients abandoned but later resumed therapy, and 14.6% did not follow treatment. Boys tended to be older than girls and presented NME, respiratory, and behavioral problems more often, with a significant difference for asthma and anxiety/depression. Associated health problems and neuropsychiatric treatment tended to be more frequent among those presenting NME. Non-enuretic children tended to show better results from treatment (see Table). CONCLUSION The social characteristics of our population (severe cases, socially deprived, very poor, not well educated, and with limited access to health care) determine a very specific sampling. Our research demonstrated that even severe cases of BD affecting socially deprived children may be treated, with adhesion to treatment and results comparable with other cohorts of BD, although the children need multidisciplinary attention and close follow-up. Boys, older children, and NME are more difficult to treat and often have other associated health and behavioral problems. Stress-related conditions were common in severe BD. A relatively high occurrence of precocious puberty was an unexpected finding in our research.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Urology and Pediatric Surgery Departments, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil.
| | - Alberto Tomé
- Urology and Pediatric Surgery Departments, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Diego Cobe
- Urology and Pediatric Surgery Departments, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Pedro Camelier
- Urology and Pediatric Surgery Departments, Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil
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Abstract
Introduction: Concealed penis (CP) may vary in severity and includes megaprepuce (MP) as a variant. Many different surgical strategies have been described in order to maximize penile exposure and to deal with skin deficiency. We describe the strategies that we use to overcome technical problems in severe cases of CP. Materials and Methods: Six consecutive cases of severe CP (including 3 with MP) were treated in a 2-year period between January 2011 and April 2013. These patients were treated using extensive degloving, removal of dysplastic dartos, Alexander's preputial flap, scrotal flaps and skin grafts. Three patients had been previously circumcised. Cases associated with hypospadias, obesity, disorders of sexual differentiation and micropenises were excluded. Results: All six patients attained good results, with good exposure of the penis, ability to void standing with a well-directed flow and reasonable esthetic results. A technical algorithm for the treatment of primary or recurring cases of CP is proposed. Conclusion: Alexander’ s distally based ventral preputial flap is a useful technical resource to treat MP cases. Free skin grafts and/or laterally based scrotal flaps may be used to cover the penis after release in severe cases of CP.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Surgery/Pediatric Surgery and Urology, Antonio Pedro University Hospital Fluminense Federal University, Rio de Janeiro, Brazil ; Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Samuel Dekermacher
- Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Kleber M Anderson
- Department of Pediatric Surgery and Urology, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil
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Barcellos BM, Camelier PDS, de Jesus LE. Electrocardiographic Monitoring in Patients with Epidermolysis Bullosa: A New Proposal. Pediatr Dermatol 2015. [PMID: 26205369 DOI: 10.1111/pde.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Epidermolysis bullosa causes serious blistering of the skin even with minor trauma. The use of standard electrodes, tapes, and adhesives is restricted in these patients because it exposes the skin to stretching and shearing forces that cause traumatic blister formation. We propose herein an alternative electrocardiographic monitoring technique to minimize cutaneous trauma.
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Affiliation(s)
- Bruno M Barcellos
- Department of Anesthesiology, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | | | - Lisieux Eyer de Jesus
- Department of Pediatric Surgery, Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Rio de Janeiro, Brazil
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de Jesus LE. About the article: Prevalence of lower urinary tract symptoms in individuals with Down syndrome. J Pediatr Urol 2015; 11:102-3. [PMID: 25779539 DOI: 10.1016/j.jpurol.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Lisieux Eyer de Jesus
- Pediatric Surgery and Urology Department, Servidores do Estado Federal Hospital and Antonio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil.
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Jesus LED, Rangel M, Moura-Filho RS, Novaes G, Quattrino A, Aguas AF. Urological surgery in epidermolysis bullosa: tactical planning for surgery and anesthesia. Int Braz J Urol 2014; 40:702-7. [PMID: 25498283 DOI: 10.1590/s1677-5538.ibju.2014.05.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 11/09/2013] [Indexed: 11/22/2022] Open
Abstract
Epidermolysis bullosa (EB) is characterized by extreme fragility of the skin and mucosae. Anesthetic and surgical techniques have to be adapted to those children and routine practice may not be adequate. Urological problems are relatively common, but surgical techniques adapted to those children have not been well debated and only low evidence is available to this moment. Herein we discuss the specifics of anesthetic and surgical techniques chosen to treat a six year old EB male presenting with symptomatic phimosis.
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Affiliation(s)
| | - Maira Rangel
- Department of Pediatric Surgery, Hospital Universitário Antônio Pedro, RJ, Brazil
| | | | - Glória Novaes
- Department of Anesthesiology, Hospital Universitário Antônio Pedro, RJ, Brazil
| | - Ada Quattrino
- Department of Dermatology, Hospital Universitário Antônio Pedro, RJ, Brazil
| | - Angelica F Aguas
- Department of Pediatrics, Hospital Universitário Antônio Pedro, RJ, Brazil
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Jesus LED. Is the transition possible? Rev Col Bras Cir 2014; 41:384-5. [DOI: 10.1590/0100-69912014006001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
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Jesus LED, Maciel F, Monnerat ALC, Fernandes MA, Dekermache S. Testis tumor associated to microlithiasis. Rev Paul Pediatr 2014; 31:554-8. [PMID: 24473964 PMCID: PMC4183048 DOI: 10.1590/s0103-05822013000400021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/24/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in
children and to consider the chances of testis preserving surgery in specific
cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis,
corresponding to a cystic testicular tumor. The tumor was excised, with
ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill
defined in children. Pediatric urologists need to develop specific follow-up
protocols for pre-pubertal children.
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Affiliation(s)
| | - Felipe Maciel
- Hospital Universitário Antonio Pedro, UFF, Rio de JaneiroRJ, Brasil
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de Jesus LE. Resolution of UTIs post deflux injections for VUR may be due to the cure of BBD. J Korean Med Sci 2013; 28:1410. [PMID: 24015054 PMCID: PMC3763123 DOI: 10.3346/jkms.2013.28.9.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery/Urology, Hospital Universitário Antônio Pedro e Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
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de Jesus LE, Helman L, Dekermacher S, Bernardo RL, Martinez CDM. Anterior sagittal transrectal approach (ASTRA) for vaginoplasty after complications of posterior sagittal anorectoplasty. Rev Col Bras Cir 2013; 40:234-6. [PMID: 23912372 DOI: 10.1590/s0100-69912013000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 08/10/2012] [Indexed: 11/22/2022] Open
Abstract
Transperineal exposure of the high portion of the vagina is limited. These limitations can be circumvented using ASTRA (anterior sagittal transrectal approach). We report the use of this surgical strategy for the treatment of a case of acquired vaginal atresia after posterior anorectoplasty due to anorectal malformation.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Surgery and Pediatric Urology, State Servers Federal Hospital, Rio de Janeiro, Rio de JANEIRO State - RJ, Brazil.
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de Jesus LE, Dekermacher S, Manhães CR, Faria LM, Barros ML. Acquired Labial Sinechiae and Hydrocolpos Secondary to Stevens-Johnson Syndrome. Urology 2012; 80:919-21. [DOI: 10.1016/j.urology.2012.06.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022]
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de Jesus LE, Fernandes A, Sias SMA, de Mello CMG, de Carvalho AM, Junior NC. Neonatal osteomyelitis and complex nephro-ureteral duplication. Surg Infect (Larchmt) 2010; 12:73-5. [PMID: 21091200 DOI: 10.1089/sur.2009.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This report presents a case of femoral osteomyelitis secondary to urinary tract infection in a female neonate with bilateral urinary duplication and right ectopic ureterocele. METHODS A female neonate with a history of late perinatal sepsis presented to the emergency department and was found to have left distal femoral osteomyelitis. A complex urological malformation was diagnosed (bilateral renal duplication with right ectopic ureterocele associated with nonfunctional superior pole of the ipsilateral kidney). The baby was submitted to prolonged antibiotic therapy and upper pole nephrectomy of the right kidney. RESULTS The pathology report confirmed chronic pyelonephritis and dysplasia in the resected specimen. After 1.5 years the patient is asymptomatic and developing normally, with no apparent deformity, but manifests asymptomatic vesicoureteral reflux. CONCLUSIONS Urinary tract infections must always be excluded as the primary infection focus in neonates with sepsis. Perinatal osteomyelitis is almost always a complication of neonatal sepsis and is associated with orthopedic sequelae. This is the first report in literature of a case of osteomyelitis complicating complex urinary duplication and urinary tract infection.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Departments of Surgery and Pediatrics, Disciplines of Pediatric Surgery, Pediatrics and Orthopedics, Antônio Pedro University Hospital, Federal Fluminense University, Rio de Janeiro, Brazil.
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Abstract
This paper proposes to discuss the training methodologies for young surgeons, considering the modern needs, by discussing their expectations and the reality of the surgeons' job market nowadays. Scientific and technological novelties, the huge amount of information imposed daily, managerial interventions and cost issues modified radically the activities of the surgeons, especially if compared to classical conceptions. Recent re-readings of the classical ethical postulates demand a new behavior of the doctors concerning the patients and the society per se. Contemporaneous social culture bring about individual expectations concerning quality of life and professional perspective issues. It becomes necessary to modify the training methods for surgeons to make them adequate to the need of continuous learning and adaptation to new technological instruments. They also should adapt to social interactions with the patients and the other health professionals that fit nowadays expectations. Those structural adaptations are fundamental to maintain the interest of the new professionals in the area of surgery.
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Jesus LED, Aguiar AS, Campos MDSMD, Baratella JRDS, Ketzer JC, Mastroti RA, Amarante ACM. Formação e demanda do cirurgião pediátrico no Brasil. Rev Col Bras Cir 2009; 36:356-61. [DOI: 10.1590/s0100-69912009000400016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/05/2009] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Definir o perfil epidemiológico dos especialistas em cirurgia pediátrica no Brasil. Definir as relações mercado-oferta de trabalho em cirurgia pediátrica no Brasil. Comparar o perfil profissional do cirurgião pediátrico brasileiro ao perfil deste especialista em outros países. MÉTODOS: Utilizando informações estatísticas fornecidas pelo IBGE, Conselho Federal de Medicina e Associação Brasileira de Cirurgia Pediátrica, definir o perfil de trabalho dos médicos especializados em cirurgia pediátrica no Brasil. RESULTADOS: A demanda de cirurgiões pediátricos trabalhando no Brasil em horário integral é de 850 cirurgiões, caso se considere apenas o atendimento de lactentes e neonatos. Há uma centralização excessiva de cirurgiões pediátricos no sul e sudeste e falta de mão de obra nas regiões norte e nordeste. Os dados quanto ao número de cirurgiões pediátricos atuando no Brasil são conflitantes (dados de pesquisa epidemiológica da FIOCRUZ diferem de dados do CFM e da CIPE). A rotina de trabalho do cirurgião pediátrico no Brasil não é comparável com aquela dos profissionais norte-americanos e europeus, fontes da maior parte dos dados de referência em literatura. CONCLUSÃO: A demanda de cirurgiões pediátricos trabalhando no Brasil em horário integral apenas para atendimento de lactentes e neonatos é de 850 cirurgiões. Existe um desequilíbrio entre oferta e ocupação de postos de trabalho nas diversas regiões do país. O sudeste é um centro de formação de especialistas que exporta profissionais para as demais regiões do país. Os dados quanto ao número de cirurgiões pediátricos atuando no Brasil são conflitantes.
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Abstract
OBJECTIVE Priapism may cause serious sequelae concerning the future sex life of the patient, as it can determine impotence, erectile dysfunction or psychogenic sexual aversion. It is a common symptom of sickle cell disease in children and adolescents. There are few good quality evidence manuscripts about the problem in current medical literature. SOURCES Literature review on the databases MEDLINE and LILACS covering the period from 1966 to 2008. SUMMARY OF THE FINDINGS The basis for the treatment of low flow priapism includes treating sickle cell disease and the usage of intracavernous adrenergic agents as necessary. Surgery is indicated in a minority of cases. The treatment of pediatric cases demands dose adjustments, adequate drug choice and sedoanalgesia to cover procedures involving pain or trauma. CONCLUSIONS A new physiopathologic theory concerning sickle cell disease, which questions the traditional vascular blockage mechanisms by deformed red cells and proposes that endothelial inflammatory activation is the main cause of clinical problems, allows to propose new therapeutic maneuvers to solve sickle cell priapism. The absence of good quality evidence to treat sickle cell priapism suggests the necessity to conduct good prospective multicenter protocols to investigate the condition.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Departamento de Cirurgia Pediátrica, Hospital Universitário Antônio Pedro, Niterói, RJ, Brazil.
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Jesus LED, Sias SMA, Vieira AA, Gonçalves IT, Villalba RDC, André MRF. Ascaridíase hepatobiliar complicada por pneumonia lipoídica. Rev paul pediatr 2008. [DOI: 10.1590/s0103-05822008000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Apresentar um caso de ascaridíase hepatobiliar complicado por pneumonia lipoídica e discutir as implicações anestésicas envolvidas. DESCRIÇÃO DO CASO: Menina de dois anos de idade com ascaridíase hepatobiliar complicada por pneumonia lipoídica por aspiração e desnutrição grave, advinda de família em condições sociais precárias em zona rural, com quatro irmãos. Foi tratada com sucesso por uma combinação de lavados broncopulmonares sucessivos e cirurgia. COMENTÁRIOS: Ascaridíase biliar corresponde a cerca de 10% dos casos de complicações de ascaridíase. Apenas uma minoria precisa de tratamento cirúrgico. O uso de óleo mineral por via oral é um tratamento tradicional para a suboclusão intestinal pelo Ascaris lumbricoides, mas a broncoaspiração do óleo e a conseqüente pneumonia lipoídica representam um risco alto para o seu uso. Anestesia geral para laparotomia exploradora em pré-escolar desnutrido com pneumonia lipóide e ascaridíase biliar é uma situação pouco contemplada na literatura médica, o que exigiu um planejamento terapêutico específico.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Colégio Brasileiro de Cirurgiões do Rio de Janeiro; Sociedade Brasileira de Cirurgia Pediátrica; Universidade Federal Fluminense, Brasil
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Abstract
O autor discute a crise atual de formação de médicos e de cirurgiões fazendo uma revisão de dados de literatura atual, referentes ao quantitativo de médicos e discussão de referências éticas e filosóficas da profissão. Há uma diminuição crescente na formação de médicos e cirurgiões, com uma crescente participação de mulheres. Os médicos jovens buscam qualidade de vida e autonomia profissional como principais requisitos profissionais. As síndromes de burn-out são comuns entre os médicos em atividade, e a perda de autonomia profissional tem papel preponderante na determinação da doença. A crise que atinge a profissão médica e as especialidades cirúrgicas tem bases éticas, sociais e financeiras. É necessário e fundamental discutir novos paradigmas de educação e atuação profissional na sociedade moderna.
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Abstract
OBJETIVO: Apresentar a experiência clínica com o uso de neuromodulação através de eletroestimulação transcutânea no tratamento das disfunções de eliminação. MÉTODOS: Foram analisados retrospectivamente seis pacientes com disfunções de eliminação submetidos à neuromodulação através de eletroestimulação percutânea peri-sacral. Todos os pacientes incluídos eram refratários ao tratamento clínico convencional e a eletroestimulação foi utilizada como terapia de resgate. As sessões terapêuticas eram semanais e o seguimento mínimo foi de seis meses. RESULTADOS: Todos os pacientes obtiveram melhora clínica. Quatro pacientes não necessitaram de mais medicação. Todos aceitaram bem o tratamento e referiram melhora da qualidade de vida. CONCLUSÃO: A eletroestimulação percutânea mostrou-se útil no tratamento das disfunções do assoalho pélvico e da musculatura vesical.
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Jesus LED, Gameiro VS, Novelli RJ, Girotto Jr GB, Penha M. Hamartoma fibroso infantil: lesão volumosa com envolvimento de plexo braquil. Acta ortop bras 2006. [DOI: 10.1590/s1413-78522006000400011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Apresentar um caso de hamartoma fibroso da infância em lactente ressecado tardiamente e se apresentando como lesão extensa, com envolvimento de elementos vasculares e neurais do plexo braquial. MÉTODOS: Estudo de caso clínico e revisão de literatura pertinente. RESULTADOS: Criança do sexo masculino, com massa tumoral axilar direita, irregular surgida aos 2 meses de idade e relacionada à administração da vacina BCG, sendo tratada com agentes anti-tuberculosos, sem resposta. Mediante biópsia a lesão foi diagnosticada como hamartoma fibroso infantil, e, após sofrer período de crescimento rápido, foi submetida à exérese cirúrgica completa. CONCLUSÃO: O hamartoma fibroso juvenil é um tumor benigno raro, tipicamente se apresentando no primeiro ano de vida em meninos, com localização mais comum no oco axilar. O diagnóstico diferencial se faz com tumores de partes moles em geral e, em casos de apresentação na axila direita, com adenopatias axilares causadas por reação à BCG. O tratamento é exerese completa da lesão e o prognóstico é favorável.
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Abstract
The authors present a case of intestinal tuberculosis affecting exclusively the left colon causing severe undernourishment, abdominal pain, and bowel obstruction with a sealed colonic fistula in a 10-year-old child. These clinical characteristics and difficulties led to a diagnosis of intestinal tuberculosis in childhood. Intestinal tuberculosis affecting exclusively the colon is very rare, and differential diagnosis with Crohn's disease is difficult. Surgical complications are frequent, especially intestinal obstruction, and can be treated in most cases by resection of the affected segment and primary anastomosis.
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