Francisco Reed - Academia.edu (original) (raw)

Papers by Francisco Reed

Rev. chil. urol, 2013

Introduccion: El rabdomiosarcoma (RMS) es uno de los tumores solidos pediatricos mas frecuentes. ... more Introduccion: El rabdomiosarcoma (RMS) es uno de los tumores solidos pediatricos mas frecuentes. Se ha descrito que la braquiterapia es una herramienta prometedora para tratar esta patologia, presentando menos secuelas en los tejidos vecinos. Este estudio tiene como proposito objetivar las secuelas de la dinamica vesical, a traves de evaluacion con estudios urodinamicos (EUD) a pacientes pediatricos sometidos a cirugia conservadora mas braquiterapia por RMS de origen uroginecologico.P acientes y Metodos: Revision de casos de RMS uroginecologicos desde 2004 a 2011, manejados con braquiterapia pre y/o post operatoria, mas quimioterapia preoperatoria. Se realiza estudio urodinamico invasivo y/o no invasivo para evaluar secuelas en funcion miccional. Resultados: Serie de 4 casos de pacientes con RMS genitourinarios sometidos a braquiterapia sola o asociada a cirugia resectiva: 2 de prostata, 1 vaginal y 1 vesical. Los estudios urodinamicos muestran una capacidad vesical disminuida en 1 paciente, minima disminucion en otro y 2 presentan capacidad normal para la edad. La acomodacion del detrusor es adecuada en los 4 pacientes y no hay alteraciones en la funcion esfinteriana. Clinicamente todos los pacientes son continentes y no presentan sintomatologia de disfuncion miccional. Conclusiones: El RMS genitourinario es un tumor altamente invasivo y secuelante. La braquiterapia ha logrado un nivel de radiacion optimo que se enfoca en el area tumoral sin afectar mayormente tejidos vecinos. Esto implicaria menos probabilidades de producir efectos secundarios en la dinamica vesical. Hemos demostrado en esta serie, con evaluacion urodinamica, que estos pacientes con RMS presentan minimas alteraciones en la evaluacion urodinamica y no tienen repercusion clinica post tratamiento. Trabajos futuros estan orientados a evaluacion urodinamica pre y post braquiterapia.(AU) Introduction: Rhabdomyosarcoma (RMS) is one of the most common pediatric solid tumors. It has been described that brachytherapy is a promising tool to treat this pathology, presenting less sequelae in neighboring tissues. This study aims to objectify alterations in bladder function through evaluation with urodynamic studies (UDS) in pediatric patients undergoing conservative surgery plus brachytherapy due to urogynecological RMS. Patients and Methods: A review of cases of RMS urogynecological from 2004-2011, managed with pre and / or post-operative brachytherapy, and preoperative chemotherapy. Invasive and / or noninvasive Urodynamic Studies are performed to assess sequelae in voiding function. Results: A series of 4 cases of genitourinary RMS patients undergoing brachytherapy alone or combined with resection surgery: 2 prostate cases, 1 vaginal and 1 bladder case. Urodynamic studies show a decreased bladder in 1 patient, minimal decrease in another and 2 show normal capacity for the patients age. Detrusor compliance is adequate in the 4 patients and there are no alterations in sphincter function. Clinically all patients are continent and show no symptoms of voiding dysfunction. Conclusions: Genitourinary RMS are a highly invasive and invalidating tumor. Brachytherapy achieves optimal radiation level that focuses on the tumor area without greatly affecting neighboring tissues.This could imply less likelyhood to cause side effects in bladder dynamics. We have shown in this series, with urodynamic evaluation, that these patients with RMS have minimal alterations in urodynamic Studies and have no post-treatment clinical impact. Future work is aimed at evaluating urodynamics before and after brachytherapy.(AU)

Introduction: Laparoscopic surgical resolution for an ureteropelvic junction obstruction (UPJO) i... more Introduction: Laparoscopic surgical resolution for an ureteropelvic junction obstruction (UPJO) is being widely used around the world. It is considered as a hard and difficult procedure per-se, we considered for time, materials and effort optimization; to involve every single member of the surgical team. A surgical protocol was developed and revised, with some adjustments in the middle looking forward to reduce surgical time. Method: Prospective study including 12 patients <5kg weight with UPJO and difficult emptying MAG-3; to whom a surgical protocol for laparoscopic pyeloplasty was applied (surgical

Springer eBooks, Sep 30, 2013

Pediatric Surgery International

World Journal of Urology, 2022

Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches ha... more Since the development of minimally invasive surgery (MIS), laparoscopic and robotic approaches have been widely adopted. However, little has been published detailing the learning curve of MIS, especially in infants. To quantify the learning curve of laparoscopic (LP) and robot-assisted laparoscopic pyeloplasty (RAL-P) for treatment of uretero-pelvic junction obstruction (UPJO) in infants evidenced by number of cases, operative time, success and complications. Between 2009 and 2017, we retrospectively reviewed pyeloplasty cases for treatment of UPJO in infants at three academic institutions. The primary outcome was success. Secondary outcomes were UPJO recurrence, complications, and operative time as a surrogate of skill acquisition. Continuous variables were analyzed by t test, Welch-test, and one-way ANOVA. Non-continuous variables were analyzed by Chi-squared test or Fisher's exact test. Learning curves (LC) were studied by r-to-z transformation and CUSUM. Thirty-nine OP, 26 LP, and 39 RAL-P had mean operative times (OT) of 106, 121, and 151 min, respectively. LCs showed plateau in OT after 18 and 13 cases for LP and RAL-P, respectively. RAL-P showed a second phase of further improvements after 37 cases. At 16 months follow-up, there were similar rates of success and complications between the three groups. Despite different duration of learning phases, proficiency was achieved in both LP and RAL-P as evidenced by stabilization of operative time and similar success rates and complications to OP. Before and after achievement of proficiency, LP and RAL-P can be safely learned and implemented for treatment of UPJO in infants.

Journal of Pediatric Urology, Feb 1, 2018

Overall, 76 stomal and 77 subfascial revisions occurred. Risk of stomal revision was 9.3-12.0% at... more Overall, 76 stomal and 77 subfascial revisions occurred. Risk of stomal revision was 9.3-12.0% at 5 years of follow-up, and was similar between channel types or location (P=0.57). Risk of subfascial revision at 5 years was 7.4% for APV, 12.7% for all other Monti channels and 25.9% for SMU (P=0.001). On survival analysis, stomal and subfascial revision rates were similar between anterior and posterior channels for APV (P≥0.16), other Monti channels (P≥0.62) and SMU (P≥0.43) (Summary Fig.). On multivariate regression, channel configuration was not associated with stomal or subfascial revision for APV (P≥0.18) or other Monti channels (P≥0.64). Sex, age, diagnosis, country and stomal location were not associated with revision risk (P≥0.06). Discussion: Contrary to the hypothesis, subfascial revision rates were no different between anterior and posterior channels. Given that many reported outcomes related to genitourinary reconstruction occur rarely and require prolonged follow-up, collaborative research in this area should be encouraged. Conclusions: The study demonstrated durable long-term results with the APV and Monti techniques in an international cohort. Risks of stomal and subfascial complications were not significantly different between anteriorly and posteriorly implanted channels. As previously reported, Monti channels, particularly SMU, were more prone to undergoing subfascial revisions.

World Journal of Urology, Mar 22, 2023

Journal of Pediatric Urology

Objective: Placement of central venous catheters (CVC) for haemodialysis is part of the usual pra... more Objective: Placement of central venous catheters (CVC) for haemodialysis is part of the usual practice of the paediatric nephrourology services. However, there are few data in the literature documenting successful results with the catheters of haemodialysis (HD) in patients weighing less than 15 kg. Our aim is to report the survival and complications of CVCs inserted in children weighing less tan 15 kg and to asses whether their use is suitable and safe in low-wieght paediatric patients. Methods: Prospective follow-up of patients with end-stage renal disease (ESRD), weighing less than 15 kg, in whom a tunnelled haemodialysis CVC was inserted, between July 2006 and June 2011. The following data is gathered: gender, underlying cause of chronic kidney disease, age and weight at the beginning of haemodialysis, catheter location, duration of HD and reason for discontinuing it, number of catheters used per patient, reasons for removal, and catheter survival. Results: During a period of 60...

El rabdomiosarcoma (RMS) representa el 3° tumor solido extracraneal pediatrico. El uso de braquit... more El rabdomiosarcoma (RMS) representa el 3° tumor solido extracraneal pediatrico. El uso de braquiterapia nos ha dado una nueva herramienta en el tratamiento de esta patologia. En este trabajo queremos reportar la experiencia del uso de cirugia mas conservadora asociada a braquiterapia en pacientes con RMS urologicos. Metodo: Revision de todos los casos del ano 2004-2011 de RMS urologicos manejados con braquiterapia postoperatoria y/o intraoperatoria, asociado a quimioterapia (QMT) preoperatoria. Resultados: En los 8 anos de estudio hubo 6 RMS; se incluyen 5pacientes dado que uno fue RMS testicular que no requirio radioterapia. Caso 1: Masculino de 2 anos RMS embrionario Grupo IV Estadio 4 de prostata, con QMT segun protocolo y braquiterapia en la semana 24 de QMT. Lleva 76 meses libre de enfermedad. Caso 2: Masculino de 5 anos, RMS embrionario Grupo lll Estadio 2 en vejiga, con QMT preoperatoria (12 semanas), cirugia con reseccion de tumor en cara anterior de vejiga y braquiterapia; ...

Journal of Pediatric Urology, 2017

Journal of Pediatric Urology, 2012

Journal of Pediatric Urology, 2014

This study was designed to investigate whether postendoscopic treatment (ET) intraoperative cysto... more This study was designed to investigate whether postendoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome. Patients and methods: Patients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR. Results: Over a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months-11 years). Thirtytwo renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications. Conclusion: Of all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.

Journal of Pediatric Surgery, 2014

Purpose: Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. H... more Purpose: Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. However, there is paucity of information on the outcomes of CVCs when used for HD in very young patients. Our objective is to report the success, safety and complication rates of CVCs used for HD in children weighing less than 15 kg. Materials and methods: This is a single-center retrospective study of all patients with end-stage renal disease (ESRD) weighing b 15kg, who underwent a tunneled CVC placement for HD, between July 2006 and June 2012 at our institution. Analysed data included clinical background, age and weight at initiation of HD, outcome of HD, CVC vein insertion site, reason for removal, and catheter survival (in days). Results: Thirty-one CVC were placed in 11 patients weighing b 15 kg, 8 males and 3 females. The main causes of ESRD were renal dysplasia and congenital nephrotic syndrome. At the beginning of HD, mean age was 27.5 (range 5-60) months and mean weight was 10.4 kg (4.5-13 kg). The preferred insertion site was the right internal jugular vein (90%). Mean duration of HD was 312 days. Mechanical factors were the main reason for catheter removal (39%). Mean catheter survival was 110 days/catheter. Conclusions: We believe our study provides relevant information and encouraging data to support the use of CVC for HD in this cohort of infants; however, further improvement in prevention of catheter thrombosis and management of infections needs to be achieved.