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Biomedical subjects

A Arroyo

Publications and source records attributed to A Arroyo.

At least 19 recordsLinked to original sources
PubMed2006

Is anal endosonography useful in the study of recurrent complex fistula-in-ano?

INTRODUCTION: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.

Anal Canal↗
PubMed2005

Cerebrospinal fluid: postmortem biochemical study.

UNLABELLED: Postmortem phenomena can change and alter biochemical components in body fluids such as blood and as cerebrospinal fluid (CSF). AIMS OF THE STUDY WERE: (a) to analyse urea, glucose, potassium, chloride, protein, creatinine, calcium, alkaline phosphatase and cortisol in CSF fluid and (b) to compare results between two age groups, between groups with or without mental or degenerative neurological illness and between a group reported as dying from natural causes and a group that had a violent death. MATERIALS AND METHODS: The study was carried out in Hospitalet de Llobregat (Barcelona) of 55 corpses. Samples were obtained following section of the corpus callosus, through the lateral ventricles and frozen to -80 degrees C until processed. RESULTS: Significant differences were found in urea levels between the two age groups, in protein between natural and violent death groups and in alkaline phosphatase between the two age groups and between the natural and violent death group. Cortisol levels revealed significant difference between the two age groups and is those supplying natural and violent death. CONCLUSIONS: The study indicates to the need for further studies designed to include groups with defined diagnose of mental or degenerative disorders as well as different age groups.

Age Factors↗
PubMed2005

Micronuclei assessment in buccal cells of people environmentally exposed to arsenic in northern Chile.

To determine the genotoxic risk associated to environmental arsenic exposure, the frequency of micronuclei in buccal cells (BCMN) of people drinking arsenic-contaminated water has been evaluated. A group of 105 individuals from the Antofagasta region (north Chile), and 102 individuals from the area of Concepcion, used as reference group, were included in the study. Arsenic concentration in drinking water was high (0.75 mg/L) in the Antofagasta area, 75-fold the maximum recommended level by WHO (0.01 mg/L), while the values obtained in Concepcion were significantly lower (0.002 mg/L). Individual measures of arsenic exposure were also determined in fingernails, which clearly confirm the existence of chronic exposure in the sampled populations from the Antofagasta region (10.15 microg/g versus 3.57 microg/g). The cytogenetic results indicate that, although the BCMN frequency is higher in exposed than in controls, this increase does not attain statistical significance. When the exposure biomarkers were related with the cytogenetic values, no correlations were observed between BCMN and arsenic content in water or in fingernails. In addition, the genotoxicity values do not seem to be related to the ethnic origin from people belonging to the exposed group. As a conclusion it appears that, in the studied population, the chronic ingestion of arsenic-contaminated water does not induce cytogenetic damage, measured as micronuclei, in the cells of the oral mucous in a significant extent.

Adult↗
PubMed2005

Multidrug resistance-associated protein (MRP1) gene is strongly expressed in gastric carcinomas. Analysis by immunohistochemistry and real-time quantitative RT-PCR.

AIMS: To assess MRP1 protein and MRP1 mRNA levels in gastric carcinomas and in non-neoplastic mucosa remote from the tumours. MRP1 gene expression may play a role in the complex pattern of chemoresistance present in gastric carcinomas. METHODS AND RESULTS: A total of 57 carcinomas and respective gastric tissues were included for immunohistochemical assessment with the anti-MRP1 monoclonal antibodies MRPr1 and QCRL-1. Of these, 35 tumour and gastric mucosa tissues were also assessed by real-time quantitative reverse transcriptase-polymerase chain reaction. Medium or high MRP1 protein expression was detected in 89% and 77% of carcinomas and in 96% and 93% of non-neoplastic gastric mucosa by MRPr1and QCRL-1, respectively. No difference in MRP1 mRNA levels was detected between carcinomas and non-neoplastic gastric mucosa tissues in 77% of the patients. A significant correlation was found between MRP1 mRNA level and protein expression detected in carcinomas related to non-neoplastic gastric mucosa, although they were non-concordant in 29% of the patients. CONCLUSIONS: MRP1 gene is usually expressed in most gastric carcinomas and does not differ substantially from that observed in non-neoplastic gastric mucosa remote from the tumour. However, a decrease in MRP1 gene expression is found in some carcinomas. For accurate assessment of changes in MRP1 expression between tumour and normal tissues both protein and mRNA detection are necessary.

Gastric Mucosa↗
PubMed2004

Evaluation of micronucleus induction in a Chilean population environmentally exposed to arsenic.

In the present study we have evaluated whether or not environmental exposure to arsenic in ground drinking-water results in a significant increase in the frequency of micronuclei (MN) in peripheral blood lymphocytes. Thus, 106 individuals from the Antofagasta region (North Chile), together with 111 individuals from the area of Concepción, were used in this investigation. In the Antofagasta area, arsenic levels in drinking-water as high as 0.750 mg/L were measured. In Concepción, located about 2500 km towards the south and used as reference area, arsenic levels in tap water were as low as 0.002 mg/L. The total content of arsenic in fingernails was determined as a biomarker of individual exposure. The cytogenetic results obtained in this study indicate that in the exposed group the overall frequency of binucleated micronucleated cells (BNMN) is higher than in the reference group, the difference being statistically significant. In addition, no differences were found between the exposed and the reference groups, regarding the cytokinesis-block proliferation index (CBPI). No association was observed between BNMN and arsenic content in water or arsenic in fingernails. On the other hand, when the exposed group was divided according to their Atacameno or Caucasian ethnicity, no significant differences were observed between them. In addition, as usually found in other human biomonitoring studies, sex and age are factors that modulate the frequency of MN in both exposed and reference populations.

Adult↗
PubMed2004

Long-term results of botulinum toxin for the treatment of chronic anal fissure: prospective clinical and manometric study.

BACKGROUND: The aim of this prospective trial was to analyse the effectiveness and morbidity of chemical sphincterotomy in the treatment of chronic anal fissure after a 3-year follow-up. METHODS: One hundred consecutive patients with chronic anal fissures were treated by chemical sphincterotomy with 25 U botulinum toxin injected into the internal sphincter. Clinical and manometric results were recorded. RESULTS: No major complications were found; initial incontinence at the 2-month review (6%) spontaneously reversed at 6 months. There was a tendency of progressive recurrence over time, with an overall healing after 3 years of 47%. We found a group of patients with clinical (symptoms longer than 12 months and presence of a sentinel pile before treatment) and manometric factors (persistently elevated mean resting pressure, percentage of time with slow waves, and number of patients or percentage of time with ultra slow waves after treatment) associated with a higher recurrence of anal fissures. CONCLUSION: Since it avoids the greater risk of incontinence associated with surgical sphincterotomy, we recommend the use of botulinum toxin as the first therapeutic approach for patients with chronic anal fissure and risk factors for incontinence; despite the higher rate of recurrence associated with this treatment. In patients with factors related to recurrence, re-injection with higher doses of botulinum toxin or complementary medical-surgical treatment should be considered.

Adult↗
PubMed2004

Open versus closed day-case haemorrhoidectomy: is there any difference? Results of a prospective randomised study.

BACKGROUND AND AIMS: Nowadays there is still controversy as to whether open or closed haemorrhoidectomy is the surgical treatment of choice for haemorrhoidal pathology. PATIENTS AND METHODS: We carried out a randomised prospective study in the Day Surgery Unit comparing 100 patients undergoing Milligan-Morgan haemorrhoidectomy (group A) versus 100 patients undergoing Ferguson haemorrhoidectomy (group B) for symptomatic haemorrhoids, in whom medical treatment or rubber band ligation had failed. RESULTS: Characteristics of the population were: mean age 43.5 years, with predominance of males, 123 vs. 77; 88% ASA I-II. CLINICAL PRESENTATION: 95% rectal bleeding; 87.5% third-fourth degree. The anaesthetic technique of choice was local anaesthesia plus sedation in 180 patients (90%). Length of surgery: 24 min (group A) and 30 min (group B) (p=n.s.). Resection of three haemorrhoidal cushions was done in 87.5% of cases. There were no re-operations or re-admissions after discharge. Symptomatic recurrence, stenosis and incontinence were not found during the follow-up of the first year. Postoperative pain during the first postoperative week was greater in the open haemorrhoidectomy group, but the difference was statistically significant (p<0.05) only during bowel movements. There was complete healing in 40% of the patients in group A and 90% of those in group B (p<0.05) after 1 month. After 1 year, the results and complications were similar in both groups (p=n.s.). CONCLUSIONS: Closed haemorrhoidectomy gives better results in terms of pain and healing than open haemorrhoidectomy, whereas recurrence and complications are similar after 1 year.

Adult↗
PubMed2003

Management and course of hydronephrosis secondary to inflammatory aneurysms of the abdominal aorta.

The objective of this study was to evaluate the management and course of obstructive uropathy secondary to inflammatory aneurysms. From January 1981 to December 2000 a total of 52 patients underwent surgical intervention for inflammatory aneurysms of the abdominal aorta. Eleven of these cases (21%) had obstructive uropathy, which was bilateral in five cases. Preoperative drainage of the urinary tract was done in five ureters in three patients with four double J catheters and one percutaneous nephrostomy; surgical ureterolysis was also carried out in one case. Endoaneurysmorraphy and placement of an aortic graft were performed in all 11 patients. Operative mortality was zero. There was no recurrence of hydronephrosis in seven patients during a mean follow-up of 55 months. Three patients were lost to follow-up and one died. When compared with 41 inflammatory aneurysms in which hydronephrosis did not develop, there were statistically significant differences with respect to lumbar pain and renal insufficiency. The ureter is a structure adjacent to the aorta that is trapped by fibrosis in 21% of patients with inflammatory abdominal aortic aneurysms. The natural tendency of the periaortic fibrosis is to remit following surgery to correct the aneurysm. This results in spontaneous remission of the hydronephrosis, making routine intraoperative manipulation of the ureter unnecessary.

Adult↗
PubMed2003

Treatment of pulmonary sequestration by video-assisted thoracic surgery (VATS).

Pulmonary sequestration is a rare malformation of the respiratory tract that accounts for 0.15-6.4% of all congenital lung anomalies. Treatment requires resection of the lesion, provided that there is no technical contraindication. The lesion should first be evaluated using video thoracoscopy and then resected whenever possible by video-assisted thoracic surgery (VATS). We report a case of extralobar pulmonary sequestration in a 48-year-old woman. She underwent lobectomy by VATS and achieved an excellent outcome.

Bronchopulmonary Sequestration↗
PubMed2003

Binding of fatty acids facilitates oxidation of cysteine-34 and converts copper-albumin complexes from antioxidants to prooxidants.

As a transition metal capable of undergoing one-electron oxidation-reduction conversions, copper (Cu) is essential for life and fulfills important catalytic functions. Paradoxically, the same redox properties of copper can make it extremely dangerous because it can catalyze production of free radical intermediates from molecular oxygen. Factors involved in regulation of redox activity of albumin-bound copper have not been well characterized. In the present study, effects of modification of the albumin cysteine-34 (Cys-34) and binding of nonesterified fatty acids on the redox-cycling activity of the complex of copper with human serum albumin (Cu/HSA) were studied. Because ascorbate is the most abundant natural reductant/scavenger of free radicals in blood plasma, the electron paramagnetic resonance assay of ascorbate radical formation was used as a method to monitor Cu/HSA redox-cycling activity. At Cu/HSA ratios below 1:1, the bound Cu was virtually redox inactive, as long as Cys-34 was in reduced state (Cu/HSA-SH). Alkylation, nitrosylation, or oxidation of Cu/HSA resulted in the appearance of redox-cycling activity. Experiments with ultrafiltration of Cu/HSA alkylated with N-ethylmaleimide (Cu/HSA-NEM) showed that at Cu/HSA-NEM ratios below 1:1, the ascorbate radicals were produced by Cu tightly bound to HSA rather than by Cu released in solution. The rate of ascorbate radical production in HSA-NEM and S-nitrosylated HSA (HSA-NO) was, however, more than one order of magnitude lower than that in a solution containing equivalent concentration of free copper ions. While Cu/HSA-SH was redox inactive, binding of oleic or linoleic acids induced Cu-dependent redox-cycling with maximal activity reached at a fatty acid to protein molar ratio of 3:1 for oleic acid and 2:1 for linoleic acid. Binding of fatty acids caused profound conformational changes and facilitated oxidation of the Cys-34 SH-group at essentially the same ratios as those that caused redox-cycling activity of Cu/HSA. We conclude that fatty acids regulate anti-/prooxidant properties of Cu-albumin via controlling redox status of Cys-34.

Antioxidants↗
PubMed2002

Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment.

BACKGROUND AND AIMS: Anal abscess is a frequent acute proctological disorder and whether the underlying fistula should be treated at the same time when the abscess is drained remains controversial. We examined indications for drainage alone versus drainage plus fistulotomy in terms of recurrence and continence. PATIENTS AND METHODS: We carried out a randomized prospective study of 200 consecutive patients with anal abscess. One group received drainage alone, while in the other group drainage plus fistulotomy was performed when a subcutaneous-mucosa, low transsphincteral, or intersphincteral fistula was found. Delayed progressive fistulotomy with suture threads was performed in cases of high transsphincteric or suprasphincteric fistula. RESULTS: The internal opening of the fistula track was found in 83% of the patients. The recurrence rate was related to the surgical technique employed: 29% in the group with drainage alone and 5% in the group for which treatment of the fistula track was attempted. The incontinence rate was also related to the surgical option. In those receiving drainage and treatment of the fistula track incontinence was restricted mostly to patients with delayed fistulotomy (36.7%), compared to 2.8% of patients when simple fistulotomy was performed. There was no incontinence in the drainage alone group. CONCLUSION: Drainage of anal abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteral, or low transsphincteral fistulae with a minimal recurrence rate. However, drainage alone and posterior treatment of the fistula track is recommended for high transsphincteral or suprasphincteral fistulae.

Abscess↗
PubMed2001

[Analysis of a programme of direct referral between primary and specialist care in potential surgery patients].

OBJECTIVE: To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study. SETTING: Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres. PARTICIPANTS: Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time. RESULTS: 86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation. CONCLUSIONS: This new programme is effective and economic, in that there is < > of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.

Adolescent↗
PubMed2001

Hernia surgery for the third millennium. Does classical herniorraphy still play a role?

The steadily increasing use of prosthetic grafts in hernia repairs can be said to play down the classical approach for repairing groin hernia. We retrospectively report on 894 patients operated on for groin hernia at our out-patient surgery clinic from June 1992 to May 1998. Herniorraphy was widely performed (96.3%). The recurrence rate was of 1.6% (overall). For patients younger than 45 yr with no systemic concurrent disease, as few as 0.1% relapsed after a 58-month average follow-up. According to our results, ambulatory herniorraphy can provide an excellent degree of efficiency in selected young patients suffering from indirect unilateral primary groin hernia. Likewise, we regard the prosthetic repair as the gold standard technique in those patients with a weakened posterior inguinal wall.

Journal Article↗
PubMed2001

Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults.

BACKGROUND: Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects. METHODS: The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I-II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent). RESULTS: There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0.0015). CONCLUSION: Prosthetic repair could become the standard treatment for primary umbilical hernia in adults.

Adolescent↗
PubMed2000

Quinolizin-coumarins as physical enhancers of chemiluminescence during lipid peroxidation in live HL-60 cells.

We investigated whether physical enhancers of low-level chemiluminescence-coumarin laser dyes C-314, C-334, and C-525--may be used to monitor interactions of lipid peroxyl radicals during lipid peroxidation in live cells. We present data demonstrating that two quinolizin-substituted coumarins--C-525 and C-334--can be integrated into HL-60 cells and successfully used as physical enhancers of chemiluminescence induced by the lipid soluble azo-initiator 2,2'-azobis(2,4-dimethyl-valeronitrile) (AMVN). Coumarins did not inhibit AMVN-induced peroxidation of membrane phospholipids in HL-60 cells, and no consumption of these coumarins occurred in the course of AMVN-induced oxidative stress. Redox status, evaluated by intracellular GSH content, remained unchanged after treatment with the coumarins. tert-Butyl hydroperoxide and cumene hydroperoxide (more hydrophilic oxidants) induced a lower chemiluminescence signal with both coumarins. Viability of HL-60 cells was not affected by coumarins both in the presence and in the absence of oxidants. Based on these results we conclude that quinolizin-substituted coumarins represent a promising class of physical enhancers of chemiluminescence for monitoring free radical peroxidation in live cells.

Azo Compounds↗