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Biomedical subjects

A Franco

Publications and source records attributed to A Franco.

At least 145 records · Page 8Linked to original sources
PubMed1995

Laparoscopic Nissen fundoplication is less expensive than open Belsey Mark IV.

Laparoscopic Nissen fundoplication is a relatively new technique used to treat gastroesophageal reflux disease (GERD). The purpose of this study was to compare the cost to the patient and insurer of a laparoscopic Nissen fundoplication (LN) to an open Belsey Mark IV (B4), the previous standard operation for GERD at Emory University Hospital. A retrospective review of 20 consecutive patients undergoing LN or B4 for GERD was performed. Patients were well matched for age, severity of disease, and comorbid illness. The data were analyzed using an unpaired Student's t-test or Wilcoxon signed rank analysis. The results are as follows (mean +/- SD): [table: see text] We conclude that the charges for laparoscopic Nissen fundoplication are significantly less than the charges for Belsey Mark IV. The majority of the savings resulted from a shortened hospital stay.

Adult↗
PubMed1995

Intraradicular and intradural lumbar disc herniation: experiences with nine cases.

BACKGROUND: Intraradicular or intradural disc herniation is a very rare complication of spinal degenerative processes. The aim of our study is to analyze the clinical spectrum, the mechanism, and the treatment of this acute spinal pathology. METHODS: Retrospective clinical examination was performed in nine personal cases of intradural disc herniation: among these, six were associated with lateral perforation, the remaining three with intradural herniation and ventral perforation. A review of the literature concerning mainly the frequency pathogenesis and diagnosis of intradural disc herniation has also been done. RESULTS: Nine cases of intradural herniations comprise 1.51% of the 593 cases of ruptured lumbar disc that underwent surgery from 1980 to 1992. The site most frequently involved is at level L4-L5, and 30% of patients have previously undergone surgery for lumbar disc herniation. Most patients reported in literature and in our present series have been complaining of a chronic history of sciatica, complicated later by bilateral neurologic signs. In the present series, diagnosis was obtained by means of myelography and computerized tomography; magnetic resonance imaging was performed in one case. All patients underwent surgery, reporting excellent results in five cases and good results in the other four. Surgery was performed either with an interlaminar approach or with a bilateral laminectomy in cases of ventral perforation. CONCLUSIONS: There is no typical neuroradiologic picture of intraradicular herniation, while a total or subtotal block is frequently observed in intradural ventral perforations. Dural perforation is often an unexpected intraoperative finding. Surgical treatment is always necessary. Favorable results are obtained if surgical treatment is carried out before the neurologic deficit becomes too pronounced.

Aged↗
PubMed1995

Viral mutations, TCR antagonism and escape from the immune response.

Persistent viruses use several mechanisms to evade the immune response, including the generation of mutations that affect TCR recognition. It has recently been reported that spontaneous mutations at TCR contact sites within individual viral epitopes in certain persistent human viruses can abrogate or antagonize the recognition of the corresponding wild-type epitope, and it has been suggested that such mutations may contribute to viral persistence.

Humans↗
PubMed1995

Immunological aspects of a case of posttransplant lymphoproliferative disorder.

We describe a female renal transplant recipient with cytomegalovirus and Epstein-Barr virus (EBV) infections who developed aggressive polymorphous polyclonal B cell proliferation. She received two courses of OKT3. We found a majority of transformed B cells bearing EBV membrane receptor CR2 and EBV nuclear antigen. Posttransplant lymphoproliferative disorders may be associated with a significant immunological activation, detected in this case by the sudden increase of beta 2-microglobulin and immunoglobulin levels, including immunoglobulin D. These raised levels persisted throughout the short and rapid course of the disease.

Adult↗
PubMed1995

[Partial interruption of the inferior vena cava using a Greenfield titanium percutaneous filter. Present indications and evaluation].

We report a prospective study of 39 patients who presented thromboembolic disease (TED) treated by partial interruption of inferior vena cava (PIIVC) with Greenfield Titanium filter. We observed 2 recurrent pulmonary embolisms, 1 symptomatic deep venous thrombosis and 2 asymptomatic filter thrombosis. With 1 year follow up, the survival probability is of 85%. Concerning the 12 last years evolution in our hospital, we note that the approach of TED diagnosis and treatment by a central, specialised team within the hospital care structure has lead to a reduction in the number of severe cases of TED, and consequently of PIIVC. So the use of percutaneous filters has not lead to an increase in the real rate of PIIVC performed but to a decrease (21% of patients with TED in 1982 vs 8% in 1993).

Adult↗
PubMed1995

Partial interruption of the inferior vena cava: ten-year evolution in protocols at Grenoble University Hospital. Study of 621 patients.

An evolution in protocols regarding indications and modalities for Partial Interruption of the Inferior Vena Cava (PIIVC) on 621 patients at Grenoble University Hospital is reported and the influence of new methods in diagnosis (vascular sonography) and therapy (percutaneous filters) is assessed. This comparative study covers the intervals from 1982-1984 (Period A - 333 patients), and 1989-1991 (Period B - 288 patients). The percentage of patients with venous thromboembolic disease who underwent PIIVC clearly decreased (21.8% in period A vs. 13% in period B, p < 0.01). The incidence of what are currently miscalled "prophylactic", but are in fact adjunctive indications also diminished (115 patients in period A, or 34.5% of the PIIVC cases vs. 60 patients in period B, or 20.8% of the PIIVC cases, p < 0.05). There was a reduction in the use of Miles caval clips (59 patients or 17.7% for period A vs. 34 patients or 11.8% for period B, p < 0.05). Although there has been an increase in the use of percutaneous caval filters, the use of percutaneous filters has not lead to an increase in the real rate of PIIVC performed by an Angiology Unit with a large experience in the diagnosis and follow-up of patients with venous thromboembolic disease.

Combined Modality Therapy↗
PubMed1995

Lesions in lambs experimentally infected with bovine respiratory syncytial virus.

An experimental model was designed to characterize lesions in the lung of lambs inoculated with bovine respiratory syncytial virus (BRSV). 25 Merino lambs of both sexes, with a live weight of 17 +/- 3 Kg, received an intratracheal inoculation of 20 ml saline solution containing 1.26 x 10(6) TCID50 BRSV (strain NMK-7) per ml. Lambs were slaughtered 1, 3, 7, 11 and 15 postinoculation days (PID), and histopathological, immunohistochemical and electron microscopic studies were performed. Results reflected a series of lesions, the most noteworthy of which were bronchiolitis obliterants with destruction of the mucociliary apparatus, the presence of syncytial cells in alveoli and a progressive interstitial reaction. BRSV antigen was detected in lung samples. These changes might be expected to decrease the efficiency of respiratory tract defence mechanisms, rendering the lung parenchyma susceptible to opportunist bacterial infection.

Animals↗
PubMed1995

[Obstetric anesthesia-analgesia in Spain. A review of its historic evolution during the second half of the past century].

To examine the historical development of obstetric anesthesia in Spain during the second half of the nineteenth century. Research was based on in-depth analysis of accounts of anesthesia during the period covered, mainly from original sources, using established methods for studying the history of medicine. We collected a great deal of documentary evidence, much of it unpublished and of clear historical value for tracing the history of obstetric anesthesia in Spain and identifying the main factors that have influenced it. We emphasize that controversy limited to a large extent the use of anesthesia in obstetrics. The controversy seems to have been fed by physicians' uneasiness with anesthesia as well as by certain prejudices of a religious or moral nature that are deeply rooted in Spanish society.

Analgesia, Obstetrical↗
PubMed1995

[Introduction and development of local anesthesia in Spain].

This study was carried out to identify key events in the history of the introduction and evolution of techniques for local anesthesia in Spain. We searched Spanish archives, finding a large number of documentary evidence, most of which is unpublished or has not been cited by other authors. Analyzing these documents with methods usually applied by medical historians, we found that techniques of local anesthesia were put into practice rapidly and widely and that they were an important factor in the development of Spanish surgery, as anesthesia made both the undertaking and the success of many procedures a real possibility.

Anesthesia, Local↗
PubMed1995

[Manual fragmentation of deep vein thrombosis].

To preserve the venous function after deep vein thrombosis, physical treatment combines elastic stockings, active exercises, lower limbs elevation, ventilatory exercises and manual lymph drainage. When this traditional treatment is not sufficient, we use a new technique. It aims at fragmenting thrombus by compressing it between the physiotherapist's fingers and the patient's bone. In order to define the fragmentation sites we use the Triplex ultrasonography. This technique has been tested on ten patients with serious thrombosis, whom the thromboembolic risk was first controlled. The evaluation was performed by the clinical examination, echography and occlusive impedance plethysmography rheography. The improvement of the subjective and objective signs leads to use our technique. It has to be validated on a larger scale to extend its use.

Female↗
PubMed1995

[Leg ulcer and Klinefelter syndrome].

We report a case of 47 years old patient who was admitted to hospital because of bilateral leg ulcers for 6 years. Chromosome analysis revealed XXY karyotype, confirming the clinical diagnosis of Klinefelter's syndrome. Testosterone level was low and Plasminogen Activator Inhibitor (PAI-1) was elevated. The patient was given androgen therapy which resulted in a normalization of the PAI-1 activity. The frequency of leg ulcers in patients with Klinefelter syndrome is between 6 and 12% according to studies. Different causes would explain the tendency towards leg ulcers in Klinefelter's syndrome: conjunctive tissues abnormalities were revealed in some studies. A higher frequency of venous insufficiency is reported in patients with Klinefelter's syndrome, either due to the particular morphology (obesity, taller size) or due to an androgen deficiency. A few arterial dysplasias cases of arteries's legs were described in patients with leg ulcers and Klinefelter syndrome. Haemostasis disorders presented in this case and normalized after androgen therapy will contribute to the physiopathologic discussion.

Adult↗