15 results on '"Alejandra Aguado del Hoyo"'
Search Results
2. Adams-Oliver syndrome with unusual central nervous system findings and an extrahepatic portosystemic shunt
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Carlos Pérez-García, Yolanda Ruíz Martín, Alejandra Aguado del Hoyo, Carlos Marín Rodríguez, and Minia Campos Domínguez
- Subjects
Adams-Oliver Syndrome ,Periventricular calcifications ,Portosystemic-shunt ,Pediatric Neuroradiology ,Medicine ,Pediatrics ,RJ1-570 - Abstract
We report a case of a premature neonate girl with scalp and skull defects and brachydactyly of the feet consistent with an Adams-Oliver syndrome (AOS). The patient had central nervous system abnormalities, such as periventricular calcifications, hypoplastic corpus callosum, and bilateral hemispheric corticosubcortical hemorrhagic lesions. A muscular ventricular septal defect and a portosystemic shunt were diagnosed. To our knowledge, this is the first report of congenital supratentorial grey-white matter junction lesions without dural sinus thrombosis in association with AOS. Some of these lesions may be secondary to birth trauma (given the skull defect) whilst others have a watershed location, perhaps as further evidence of vascular disruption and decreased perfusion during critical periods of fetal brain development as the previously proposed pathogenesis of this syndrome.
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- 2017
- Full Text
- View/download PDF
3. Fetal MRI by Robust Deep Generative Prior Reconstruction and Diffeomorphic Registration.
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Lucilio Cordero-Grande, Juan Enrique Ortuño Fisac, Alejandra Aguado del Hoyo, Alena Uus, Maria Deprez, Andrés Santos, Joseph V. Hajnal, and María J. Ledesma-Carbayo
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- 2023
- Full Text
- View/download PDF
4. Coste efectividad de la estrategia de cribado de citomegalovirus en recién nacidos mayores de 34 semanas de bajo peso para la edad gestacional
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Amaia Merino-Hernández, Laura Sánchez-Barriopedro, Sonia Villar-Castro, Alejandra Aguado-Del Hoyo, Itziar Marsinyach-Ros, and Manuel Sánchez-Luna
- Subjects
Pediatrics, Perinatology and Child Health - Published
- 2023
5. Cost-effectiveness of a cytomegalovirus screening strategy in neonates born after 34 weeks small for gestational age
- Author
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Amaia Merino-Hernández, Laura Sánchez-Barriopedro, Sonia Villar-Castro, Alejandra Aguado-Del Hoyo, Itziar Marsinyach-Ros, and Manuel Sánchez-Luna
- Subjects
Management of Technology and Innovation - Abstract
Infection by cytomegalovirus (CMV) is one of the most common congenital infections, with a global prevalence of 0.3%-2.4%. In Spain, CMV screening is not performed during pregnancy, but rather in neonates with risk factors, and, in many hospitals, in those born small for gestational age (SGA). Screening is usually performed by measurement of the viral load in urine by polymerase chain reaction (PCR) and/or head ultrasound in search of compatible features. The aim of the study was to assess the yield of the CMV PCR test in urine and head ultrasound examination in asymptomatic neonates born SGA after 34 weeks' gestation. The secondary objective was to assess the cost-effectiveness of this strategy.We conducted an observational and retrospective study between January and December 2019 in a tertiary care hospital. It included neonates delivered after 34 weeks, SGA and without additional risk factors assessed with a CMV PCR test in urine and/or head ultrasound.The sample included 259 patients. It was divided in 2 groups: group 1, patients with a head circumference, weight and length below the 10th percentile (53 patients; 20.5%), and group 2, patients in whom only the weight was below the 10th percentile (206 patients; 79.5%). The incidence of late preterm birth, twin pregnancy, neonatal admission and exposure to illicit drugs during gestation was higher in group 1. A total of 186 urine PCR tests and 223 head ultrasounds were performed overall, and both tests were performed more frequently in group 1 (P=.002). There was only 1 positive CMV PCR test result in the sample (0.54%), corresponding to a patient in group 2 with no abnormal sonographic findings who remained asymptomatic throughout the follow-up. Two head ultrasound examinations yielded abnormal findings, in both cases unrelated to congenital CMV infection. We performed a cost-effectiveness analysis and determined that the cumulative cost of head ultrasound examinations and urine CMV PCR tests in our sample amounted to Є17 000 for the detection of a single asymptomatic positive case.In our population, screening for congenital CMV infection in asymptomatic late preterm and term newborns whose only risk factor is SGA does not seem to be cost effective. It would be necessary to expand the sample to other populations.
- Published
- 2023
6. Esclerosis tuberosa diagnosticada por ecografía torácica POCUS
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Rebeca Gregorio-Hernández, Paz Chimenti-Camacho, Alejandra Aguado del Hoyo, and Manuel Sánchez-Luna
- Subjects
Pediatrics, Perinatology and Child Health - Published
- 2023
7. Fetal MRI by robust deep generative prior reconstruction and diffeomorphic registration
- Author
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Lucilio Cordero-Grande, Juan Enrique Ortuno-Fisac, Alejandra Aguado del Hoyo, Alena Uus, Maria Deprez, Andres Santos, Joseph V. Hajnal, and Maria J. Ledesma-Carbayo
- Subjects
Radiological and Ultrasound Technology ,Electrical and Electronic Engineering ,Software ,Computer Science Applications - Abstract
Magnetic resonance imaging of whole fetal body and placenta is limited by different sources of motion affecting the womb. Usual scanning techniques employ single-shot multi-slice sequences where anatomical information in different slices may be subject to different deformations, contrast variations or artifacts. Volumetric reconstruction formulations have been proposed to correct for these factors, but they must accommodate a non-homogeneous and non-isotropic sampling, so regularization becomes necessary. Thus, in this paper we propose a deep generative prior for robust volumetric reconstructions integrated with a diffeomorphic volume to slice registration method. Experiments are performed to validate our contributions and compare with methods in the literature in a cohort of 72 fetal datasets in the range of 20-36 weeks gestational age. Quantitative as well as radiological assessment suggest improved image quality and more accurate prediction of gestational age at scan is obtained when comparing to state of the art reconstruction methods. In addition, gestational age prediction results from our volumetric reconstructions are competitive with existing brain-based approaches, with boosted accuracy when integrating information of organs other than the brain. Namely, a mean absolute error of 0.618 weeks (R
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- 2022
8. Effects of Sex, Age and Height on Symphysis–Ischial Spine Distance Measured on a Pelvic CT
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Daniel Sánchez García, Alejandra Aguado del Hoyo, María Sánchez Pérez, Santiago García-Tizón Larroca, Yolanda Ruiz Martín, Isabel Gordillo Gutiérrez, Coral Bravo Arribas, Melchor Alvarez-Mon, Miguel A. Ortega, and Juan De Leon-Luis
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Medicina ,Ginecología y obstetricia ,Diagnóstico por imagen y medicina nuclear ,General Medicine ,symphysis–ischial spine distance ,pelvic CT images ,reproducibility ,Anatomía - Abstract
Objective: To examine the influence of age, sex and height on the symphysis–ischial spine distance (SID) measured on pelvic Computed tomography (CT)images in subjects of reproductive age, and to determine the interobserver reproducibility. This measurement (SID) is of great importance because the use of intrapartum ultrasound is based on the assumption of a specific value (30 mm) of such a measurement. Methods: This was a cross-sectional descriptive study in which SID was measured in subjects aged 20 to 44 years who had been scheduled for pelvic CT at our centre from January 2018 to May 2021 for different reasons. Radiographic measurements of the pelvis were obtained through the multiplanar reconstruction of the CT image. The images obtained from all of the participants were independently assessed by three senior radiologists, and the SID measurements made by each one were blinded from those of the remaining observers. Correlations between the SID and patient age, height and sex were analyzed by univariate and multivariate linear regression. Results: The mean SID for 87 of the enrolled participants (45 women, 42 men) was 28.2 ± 6.25 mm. Among the observers, the mean difference in this distance was 1 to 2 mm, and was scarcely related to measurement size, with agreement being greater than 70%. The mean SID was significantly related to sex and height (SID = −24.9 − 6.51 × sex (0 or 1) + 0.34 × height (cm); p = 0.01; sex equals 1 for a man and 0 for a woman), such that it was a mean of 2.5 mm greater in women than men (29.50 mm vs. 26.99 mm). Conclusion: Measurements of SID on CT images show good interobserver reproducibility, and are related to sex and height.
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- 2022
- Full Text
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9. A Rare Complex Case of Congenital Umbilical Arteriovenous Malformation and Review of Literature
- Author
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Rebeca Gregorio-Hernández, Ester Sanz-López, Alejandra Aguado-Del Hoyo, Gema Manrique-Martín, Juan Carlos De-Agustín, and Manuel Sánchez-Luna
- Subjects
arteriovenous malformation ,congenital ,high-output cardiac failure ,newborn ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Introduction Congenital umbilical arteriovenous malformations (AVMs) are extremely rare. We present the first case of congenital umbilical AVM with feeding arteries originating not only from abdominal but also from the mammary arteries. Case Report A 34-week gestational age newborn was transferred to our hospital with a supraumbilical murmur. Abdominal Doppler ultrasound (US) showed a large vascular AVM, with multiple feeding arteries and several venous drainage structures to the umbilical vein and also a persistent ductus venosus. She developed signs of heart failure on the 12th day of life. Computed tomography angiogram revealed an umbilical congenital AVM with feeding arteries originating from the external iliac, hypogastric, epigastric, and mammary arteries and a dilated umbilical vein draining the cluster. Also, a patent ductus venosus was observed. At 14 days of life, laparotomy was performed but due to the complexity of the feeding arteries of the AVM, complete exeresis was not performed, but only ligation of these arteries was made, to reduce the surgical risk. Conclusion To our knowledge, this is the first time that no complete excision was made but only ligation of the arteries. The infant was discharged home on postoperative day 14 being asymptomatic. Follow-up Doppler US showed thrombosed vascular structures.
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- 2016
- Full Text
- View/download PDF
10. Prognostic value of somatosensory-evoked potentials in the newborn with hypoxic-ischemic encephalopathy after the introduction of therapeutic hypothermia
- Author
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María Arriaga-Redondo, Dorotea Blanco Bravo, Alejandra Aguado del Hoyo, Ana Polo Arrondo, Yolanda Ruiz Martín, and Manuel Sánchez-Luna
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Hypothermia, Induced ,Evoked Potentials, Somatosensory ,Pediatrics, Perinatology and Child Health ,Hypoxia-Ischemia, Brain ,Infant, Newborn ,Humans ,Prognosis ,Retrospective Studies - Abstract
To establish the ability of somatosensory-evoked potentials (SEPs) to detect neurological damage in neonatal patients with hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). Retrospective study including 84 neonates ≥ 36 weeks of gestational age with HIE and TH with SEPs performed in the first 14 days of life. SEPs from the median nerve were performed after completion of TH. Either unilateral or bilateral absence of N20, or unilateral or bilateral latency ≥ 36 ms, was considered pathological. All newborns underwent a cerebral resonance imaging (MRI) at between days 7 and 14 of life and a neurodevelopmental evaluation using the Brunet-Lezine test at two years of age; a global Brunet-Lezine test score 70 was considered unfavorable. The risk of moderate-to-severe alteration on basal ganglia-thalamic (BGT) and/or white matter areas on MRI for pathological SEPs was as follows: odds ratio 95% IC: 23.1 (6.9-76.9), sensitivity 78.6%, specificity 86.3%, positive predictive value 75.9%, and negative predictive value 88%. The BGT and internal capsule were the areas with the greatest risk of lesion with an altered SEPs: odds ratio 95% IC 93.1 (11.1-777.8). The risk of neurodevelopmental impairment for pathological SEPs was odds ratio 95% IC: 38.5 (4.4-335.3), sensitivity 91.7%, specificity 77.8% positive predictive value 52.4%, and negative predictive value 97.2%.The present study demonstrates the good predictive capacity of SEPs performed in the first two weeks of life in newborns with HIE and TH to detect an increased risk of neuroimaging lesions and neurodevelopmental impairment at two years of age.• Bilateral absence of the N20 cortical component of somatosensory evoked potentials has been associated with poor neurological outcome in neonates with hypoxic-ischemic encephalopathy.• This work confirms the predictive capacity of SEPs by adding two important aspects: the value of latency when interpreting SEPs results and the absence of effect of the hypothermia method used on the results of SEPs.
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- 2021
11. [Herlyn-Werner-Wünderlich syndrome of neonatal diagnosis]
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Julio Alberto, Vázquez Gómez, Ester, Sanz López, Sara, Vigil Vázquez, and Alejandra, Aguado Del Hoyo
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Pregnancy ,Prenatal Diagnosis ,Urogenital Abnormalities ,Uterus ,Humans ,Female ,Syndrome - Published
- 2020
12. Trasplante de médula ósea en pacientes con anemia falciforme. Experiencia en un centro
- Author
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Alejandra Aguado del Hoyo, Marina García Morin, Ana Pérez-Corral, Elena Cela, Cristina Beléndez, Cristina Pascual, Eduardo J. Bardón Cancho, and Carmen Garrido
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03 medical and health sciences ,0302 clinical medicine ,Allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling ,Sickle cell disease ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Pediatrics ,RJ1-570 ,030215 immunology - Abstract
Resumen: Introducción: La enfermedad de células falciformes (ECF), pese a la mejora en el manejo médico, persiste asociada a morbilidad y a menor supervivencia. El alotrasplante de progenitores hematopoyéticos (alo-TPH) es actualmente la única opción curativa. Describir la evolución clínico-analítica de los pacientes trasplantados en nuestro centro. Material y método: Estudio unicéntrico descriptivo, incluye a pacientes con ECF en los que se realiza alo-TPH de médula ósea de hermano HLA-idéntico desde enero del 2010 hasta diciembre del 2014. Se recogen datos epidemiológicos, clínicos y analíticos con tiempo de seguimiento hasta diciembre del 2015. Los datos se presentan como frecuencias, porcentajes y medianas (rango). Resultados: Se recluta a 11 pacientes (8 varones), mediana de edad: 7 años (2-13), todos ellos con comorbilidad previa al TPH. Se consigue injerto estable en 10/11 pacientes, quimerismo completo en 9/11 y quimerismo mixto estable tras un año del TPH en 1/11. Un paciente presenta fallo secundario de injerto con reaparición de clínica el día +180. Complicaciones post-TPH: complicaciones neurológicas 4/11 pacientes (hemorragia subaracnoidea, crisis), HTA 7/11, fallo renal agudo 3/11, reactivación CMV 9/11, EICHa cutáneo 6/11, uno de ellos desarrolla EICH intestinal grado iv causando su fallecimiento (día +51). Ningún paciente desarrolla EICH crónico. Supervivencia global y libre de eventos a los 3,1 años de seguimiento: 90,9 y 81,9%, respectivamente. Conclusiones: El alo-TPH, única opción curativa, no está exento de morbimortalidad, encontramos un riesgo de muerte similar a otras series (1/11), siendo su primera causa el EICH agudo. Otros problemas son fallo de injerto (1/11) y complicaciones neurológicas (4/11), aunque las secuelas permanentes son leves. Abstract: Introduction: Sickle cell disease (SCD), despite the improvement in the medical management, is still associated with severe morbidity and decreased survival. Allogenic hematopoietic stem cell transplantation (Allo-HSCT) currently provides the only curative therapy. A report is presented on our experience in children with SCD, who underwent Allo-HSCT in a single centre. Material and method: A single centre descriptive study was conducted on patients with SCD who underwent a bone marrow transplant from an HLA-identical sibling donor between January 2010 and December 2014. Epidemiological, clinical and analytical parameters were collected with a follow-up to December 2015. Data are presented as frequencies, percentages, and medians (range). Results: Allo-HCST was performed in 11 patients (8 males) with a median age of 7 years (2-13), all of them with comorbidity prior to the HCST. A stable graft was achieved in 10 out of 11 patients, 9 of them with complete donor chimerism, and one patient with stable mixed chimerism after 1 year of allo-HSCT. One patient has secondary graft failure with re-appearance of symptoms associated with SCD on day 180. Complications of Allo-HSCT are: arterial hypertension 7/11, acute renal failure 3/11, CMV reactivation 9/11, neurological complications 4/11 (subarachnoid haemorrhage, seizure), and acute graft versus host disease (aGVHD) of the skin 6/11, one of whom developed grade iv intestinal aGVHD, causing his death (day 51). None of the patients developed chronic GVHD. The overall survival and event-free survival was 90.9% and 81.9%, respectively, with a median follow-up of 3.1 (1-5.7) years. Conclusions: Allo-HSCT, the only curative therapy, remains associated with morbidity. There was a transplant related mortality in our study, consistent with multicentre studies (1/11), and with aGVHD being the main cause. Other problems still include graft failure (1/11), and neurological complications (4/11), although the permanent sequelae are mild.
- Published
- 2017
13. Bone marrow transplant in patients with sickle cell anaemia. Experience in one centre
- Author
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Cristina Beléndez, Cristina Pascual, Marina García Morin, Ana Pérez-Corral, Eduardo J. Bardón Cancho, Carmen Garrido, Elena Cela, and Alejandra Aguado del Hoyo
- Subjects
Male ,medicine.medical_specialty ,Bone marrow transplant ,Adolescent ,medicine.medical_treatment ,Anemia de células falciformes ,Anemia, Sickle Cell ,Disease ,Hematopoietic stem cell transplantation ,Pediatrics ,RJ1-570 ,03 medical and health sciences ,0302 clinical medicine ,Management of Technology and Innovation ,Alo-trasplante de médula ósea de hermano HLA idéntico ,Epidemiology ,Humans ,Medicine ,In patient ,Sibling ,Child ,Bone Marrow Transplantation ,Retrospective Studies ,business.industry ,Transplant-Related Mortality ,medicine.disease ,Comorbidity ,Surgery ,surgical procedures, operative ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,business ,030215 immunology - Abstract
Introduction: Sickle cell disease (SCD), despite the improvement in the medical management, is still associated with severe morbidity and decreased survival. Allogenic hematopoietic stem cell transplantation (Allo-HSCT) currently provides the only curative therapy. A report is presented on our experience in children with SCD, who underwent Allo-HSCT in a single centre. Material and method: A single centre descriptive study was conducted on patients with SCD who underwent a bone marrow transplant from an HLA-identical sibling donor between January 2010 and December 2014. Epidemiological, clinical and analytical parameters were collected with a follow-up to December 2015. Data are presented as frequencies, percentages, and medians (range). Results: Allo-HCST was performed in 11 patients (8 males) with a median age of 7 years (2–13), all of them with comorbidity prior to the HCST. A stable graft was achieved in 10 out of 11 patients, 9 of them with complete donor chimerism, and one patient with stable mixed chimerism after 1 year of allo-HSCT. One patient has secondary graft failure with re-appearance of symptoms associated with SCD on day 180. Complications of Allo-HSCT are: arterial hypertension 7/11, acute renal failure 3/11, CMV reactivation 9/11, neurological complications 4/11 (subarachnoid haemorrhage, seizure), and acute graft versus host disease (aGVHD) of the skin 6/11, one of whom developed grade IV intestinal aGVHD, causing his death (day 51). None of the patients developed chronic GVHD. The overall survival and event-free survival was 90.9% and 81.9%, respectively, with a median follow-up of 3.1 (1–5.7) years. Conclusions: Allo-HSCT, the only curative therapy, remains associated with morbidity. There was a transplant related mortality in our study, consistent with multicentre studies (1/11), and with aGVHD being the main cause. Other problems still include graft failure (1/11), and neurological complications (4/11), although the permanent sequelae are mild. Resumen: Introducción: La enfermedad de células falciformes (ECF), pese a la mejora en el manejo médico, persiste asociada a morbilidad y a menor supervivencia. El alotrasplante de progenitores hematopoyéticos (alo-TPH) es actualmente la única opción curativa. Describir la evolución clínico-analítica de los pacientes trasplantados en nuestro centro. Material y método: Estudio unicéntrico descriptivo, incluye a pacientes con ECF en los que se realizó alo-TPH de médula ósea de hermano HLA-idéntico desde enero del 2010 hasta diciembre del 2014. Se recogen datos epidemiológicos, clínicos y analíticos con tiempo de seguimiento hasta diciembre del 2015. Los datos se presentan como frecuencias, porcentajes y medianas (rango). Resultados: Se recluta a 11 pacientes (8 varones), mediana de edad: 7 años (2–13), todos ellos con comorbilidad previa al TPH. Se consigue injerto estable en 10/11 pacientes, quimerismo completo en 9/11 y quimerismo mixto estable tras un año del TPH en 1/11. Un paciente presenta fallo secundario de injerto con reaparición de clínica el día +180. Complicaciones post-TPH: complicaciones neurológicas 4/11 pacientes (hemorragia subaracnoidea, crisis), HTA 7/11, fallo renal agudo 3/11, reactivación CMV 9/11, EICHa cutáneo 6/11, uno de ellos desarrolla EICH intestinal grado IV causando su fallecimiento (día +51). Ningún paciente desarrolla EICH crónico. Supervivencia global y libre de eventos a los 3,1 años de seguimiento: 90,9 y 81,9%, respectivamente. Conclusiones: El alo-TPH, única opción curativa, no está exento de morbimortalidad, encontramos un riesgo de muerte similar a otras series (1/11), siendo su primera causa el EICH agudo. Otros problemas son fallo de injerto (1/11) y complicaciones neurológicas (4/11), aunque las secuelas permanentes son leves.
- Published
- 2017
14. A Rare Complex Case of Congenital Umbilical Arteriovenous Malformation and Review of Literature
- Author
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Alejandra Aguado-Del Hoyo, Rebeca Gregorio-Hernández, Manuel Sánchez-Luna, Ester Sanz-López, Gema Manrique-Martín, and Juan Carlos De-Agustín
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,arteriovenous malformation ,Case Report ,030204 cardiovascular system & hematology ,Asymptomatic ,lcsh:Gynecology and obstetrics ,Umbilical vein ,03 medical and health sciences ,0302 clinical medicine ,high-output cardiac failure ,newborn ,030225 pediatrics ,Laparotomy ,medicine ,lcsh:RG1-991 ,business.industry ,congenital ,Obstetrics and Gynecology ,Gestational age ,Arteriovenous malformation ,medicine.disease ,Surgery ,Heart failure ,Pediatrics, Perinatology and Child Health ,cardiovascular system ,medicine.symptom ,Ligation ,business ,Ductus venosus - Abstract
Introduction Congenital umbilical arteriovenous malformations (AVMs) are extremely rare. We present the first case of congenital umbilical AVM with feeding arteries originating not only from abdominal but also from the mammary arteries. Case Report A 34-week gestational age newborn was transferred to our hospital with a supraumbilical murmur. Abdominal Doppler ultrasound (US) showed a large vascular AVM, with multiple feeding arteries and several venous drainage structures to the umbilical vein and also a persistent ductus venosus. She developed signs of heart failure on the 12th day of life. Computed tomography angiogram revealed an umbilical congenital AVM with feeding arteries originating from the external iliac, hypogastric, epigastric, and mammary arteries and a dilated umbilical vein draining the cluster. Also, a patent ductus venosus was observed. At 14 days of life, laparotomy was performed but due to the complexity of the feeding arteries of the AVM, complete exeresis was not performed, but only ligation of these arteries was made, to reduce the surgical risk. Conclusion To our knowledge, this is the first time that no complete excision was made but only ligation of the arteries. The infant was discharged home on postoperative day 14 being asymptomatic. Follow-up Doppler US showed thrombosed vascular structures.
- Published
- 2016
15. Neurological complications after gamma-knife radiosurgery for hypothalamic hamartoma
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Niki Oikonomopoulou, Alejandra Aguado del Hoyo, Rosa M. Meiriño, Estíbaliz Barredo Valderrama, María Vázquez López, Ana Jiménez de Domingo, Roberto García-Leal, María Concepción Miranda Herrero, and Laura Butragueño Laiseca
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Hamartoma ,Radiosurgery ,Hypothalamic disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Hypothalamic hamartoma ,Seizures ,Gelastic seizure ,Edema ,medicine ,Humans ,Child ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Pediatrics, Perinatology and Child Health ,Consciousness Disorders ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Hypothalamic Diseases - Abstract
Background The Gamma-knife technique is a safe and effective option for the treatment of hypothalamic hamartomas that produce epileptic seizures refractory to medical treatment and/or serious behavioral disorders. After this type of radiosurgery, an adequate symptomatic control is normally achieved, with notable decrease or even disappearance of the seizures. Radiological changes, such as a decrease in the size of the tumor or adjacent edema secondary to non-necrotizing radioinduced inflammatory reaction are unusual consequences. Side effects and neurological complications are also rare events. Case presentation This report describes an unusual case of complete radiological resolution of a hypothalamic hamartoma as well as neurological complications after Gamma-knife surgery (receiving 13 Gy to the 85% isodose line, 1 cm3 of tumor volume) in a 8-year-old boy who suffered from severe refractory seizures. After radiosurgery, the patient experienced a notable improvement in his symptoms, achieving seizure cessation within 3 months. However, 4 months after the procedure he presented drowsiness, fever and decreased level of consciousness due to a direct effect on the hypothalamus with local and regional edema secondary to the radiosurgery that was performed. He was successfully treated with corticosteroids (with a total duration of 11 months), and twelve months after the surgery, complete disappearance of both the nodular lesion and the secondary edema was observed. The patient remains seizure-free in the last 16 months, with remarkable changes in his behavior. Conclusions The present case shows that complete radiological resolution of a hypothalamic hamartoma after Gamma-knife technique is unusual but possible, without long-term neurological consequences. Nevertheless, despite its low incidence, if a patient presents neurological symptoms, primarily during the first year after intervention, possible complications of this type of surgery must be taken into account.
- Published
- 2015
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