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Biomedical subjects

A Herrera

Publications and source records attributed to A Herrera.

142 records · Page 8Linked to original sources
PubMedDate not supplied

Marchetti-Vicenzi nailing of humeral shaft fractures.

Between 1995 and 1999, 46 acute nonpathological humeral shaft fractures were treated with retrograde Marchetti-Vicenzi humeral nailing. The mean healing time of all fractures was 10.8 weeks. Forty-five fractures (97.9%) united primarily, and one needed bone grafting (2.1%). Function of the shoulder was excellent in 35 patients (76.1%) and moderate in 11 (23.9%). Elbow function was also excellent in 35 patients and moderate in 11. Global functional results were excellent in 16 patients (34.8%), good in 22 (47.8%) and fair in 8 (17.4%). There were 4 cases of 10 degrees varus malunion (8.6%), one case of 15 degrees varus malunion (2.1%), and one case of 15 degrees anterior angulation malunion (2.1%). These malunions were clinically well tolerated. Four patients required removal of the nail because of posterior elbow pain. Retrograde Marchetti-Vicenzi nailing is an acceptable alternative for the treatment of acute humeral shaft fractures with a low complication rate.

Adolescent↗
PubMedDate not supplied

[Comparative analysis of the criteria for surveillance and monitoring in anesthesia, resuscitation and pain therapy. Recommendation of the Sociedad Española de Anestesia y Reanimación].

INTRODUCTION: One part of morbidity and mortality associated with anesthesia is due to accidents. It is thought that an additional monitoring can prevent and avoid most of anesthetic accidents. OBJECTIVES: In order to improve patient's safety and quality of anesthesia, Harvard University hospital approved in 1985 the rules for intraoperative monitoring. These were adopted by the American Society of Anesthesiologists (ASA) in 1986. In line with this procedure, professional associations of several countries pronounced their own rules. SEDAR did it in 1989. The purpose of this study was to compare spanish rules with those of America (Harvard and ASA), Australia, England and France. RESULTS: Comparative analysis revealed that the spanish norms are more extensive since they include not only the intraoperative anesthetic activities, but also those related to recovery, pain, and obstetric anesthesia. However, it has some deficiencies such as the lack of a periodical revision, and of an adaptative period and assistance to the anesthesiologist provided by auxiliary personnel. Successful points were the recognition that pulse oximetry is essential, the preoperative verification of all material, and, more importantly, is the only one that considers essential capnography in the assessment of ventilation and pulse oximetry during regional anesthesia and postoperative phase. CONCLUSION: Spanish norm is comparable to that of the other countries considered in this study. It shows important successful points and at the same time some significant deficiencies.

Analgesia↗
PubMedDate not supplied

[Topiramate in comorbid disorders: epilepsy and migraine].

INTRODUCTION: With relative frequency epilepsy and migraine are associated in a same patient. Some times it is difficult to distinguish an attack of others. Reason why it would be of utility to have a treatment effective in both pathologies. It is tried to study in patients with this comorbidity, how of effective it is a drug indicated in the two pathologies, as it is topiramate. PATIENTS AND METHODS: An observational, longitudinal and prospective study is made, where 15 patients are recruited with this association, and which they were treated with topiramate. They are revaluated at three and six months of treatment. RESULTS: Significant differences are obtained (p < 0.05) in all the studied variables (severity and duration of the migraine attacks and frequency of the migraine and epileptic attacks), with a medium dose of 100 mg/day of topiramate, at the end of the study. Not serious adverse effects were observed. CONCLUSIONS: Topiramate in monotherapy seems to be a suitable treatment in patients who undergo epileptic and migrainous attacks jointly.

Adolescent↗
PubMedDate not supplied

[Correlation of clinical, radiologic and pathologic aspects of the thymus in newborn infants].

The thymus of 30 autopsied neonates who died from different causes (hyaline membrane disease: 13 cases; severe infections: 11 cases; congenital malformations: 4 cases; severe asphyxia: 2 cases) were prospectively examined in order to look for the most frequent macroscopic and microscopic morphological changes in this organ. Findings were correlated with clinical and radiological data. In hyaline membrane disease patients moderate decrease of thymic weight and slight depletion of cortical lymphocytes as to reference values were observed; such changes were likewise seen in cases with malformations and severe asphyxia. Newborns who died from severe infections exhibited early and pronounced decrease of thymic weight as well as severe depletion of cortical lymphocytes, more noticeable at all times than in the remaining groups. It is concluded that the predominant finding in examined patients is thymic involution secondary to stress, whose intensity would depend upon the type and duration of the main disease, being most severe the longer the evolutionary time. The variability observed in thymic size of individuals with similar physical features and the lack of an accurate correlation between radiology and post mortem findings with respect to thymic size are remarkable.

Abnormalities, Multiple↗
PubMedDate not supplied

[Comparison of oxygen saturations in mixed venous and central blood during thoracic anesthesia with selective single-lung ventilation].

OBJECTIVES: To establish the ratio of oxygen saturation in mixed venous to that of central venous blood in patients undergoing thoracic surgery, in order to rationalize use of the pulmonary arterial catheter. MATERIAL AND METHODS: We compared simultaneous spectrophotometric in vivo measurements for SvO2 [Abbott Oximetrix 3/SvO2 (O)] and in vitro analysis of blood taken from the distal opening of the catheter (co-oximeter/SvO2 [CO]), with in vitro analysis of central venous blood from the superior vena cava (co-oximetry/SvcO2 [CO]) for 23 patients scheduled for lung resection by thoracotomy in lateral decubitus with single lung ventilation and the same type of monitoring and anesthesia. Measurements were taken 15 min after induction (M1), after 15 minutes in lateral decubitus (M2), 5 minutes after pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6) and after 5 min supine (M7). RESULTS: SvO2(O) was higher than SvcO2 (CO) at M1, M3, M6 and M7 and the mean difference between the two concentrations was always less than 0.9%. SvcO2 (CO) was always higher than SvO2 (CO) (M1 to M7) and the mean difference was less than 1.3%. Simple linear correlation was significant (p < 0.001) for each of the measurements as well as for the whole sample. Both bias (0.2 and 0.7%) and its standard deviation (2.7 and 2.5%) between the two techniques were small and the differences between all measurements were less than 5% in 97 and 95.6%. CONCLUSION: For thoracic anesthesia in patients who are not good candidates for catheterization of the pulmonary artery, continuous measurement of SvO2 may be substituted for that of SvcO2 in order to monitor the balance of supply/demand.

Adult↗
PubMedDate not supplied

[Continuous monitoring of hemoglobin oxygen saturation in mixed venous blood during thoracic anesthesia with selective single-lung ventilation].

OBJECTIVES: The lateral decubitus position, the thoracotomy and selective single-lung ventilation all cause serious changes in oxygenation. The aim of this study is to examine the usefulness of continuous monitoring of mixed venous saturation (SvO2) under these conditions. MATERIAL AND METHODS: Twenty-three patients scheduled for pulmonary resection by thoracotomy in lateral decubitus position with single-lung ventilation were monitored continuously for SvO2 by reflection oximetry and a fiber-optic catheter in the pulmonary artery (Abbot Oximetrix 3). Cardiorespiratory profiles were obtained 15 minutes after induction (M1), after 15 minutes in lateral decubitus position (M2), 5 min after start of pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6), and after 5 min in supine decubitus position (M7). RESULTS: The decrease in SvO2 was not statistically significant. It reached its lowest level at M5 and rose significantly in M6 (p < 0.05). For all SvO2 measurements there was a significant correlation between Oximetrix 3 and Co-oximeter readings. C(a-v)O2 and O2 uptake correlated significantly at all measurements, as did those of PvO2 and Qva/Qt except at M6. VO2I correlated inversely from M1 to M5, and CI an DO2I only at M6 and M7. PaO2 and SaO2 were significantly correlated during single-lung ventilation (M4 and M5) and later (M6). The combined changes in SaO2(a-v) and CI explain the changes in SvO2 only during and after selective ventilation, and the changes are more likely to be reflected by SaO2 than by CI. CONCLUSIONS: Under the conditions studied, continuous monitoring of SvO2 is a reliable method, indicating primarily oxygenation, and cardiac output secondarily, particularly during single-lung ventilation, and also reflecting the balance of oxygen supply and demand in tissues. Given the lack of specificity, however, hemodynamic and gas measurements must be taken to diagnose the cause of any change in the supply/demand balance whenever there is a sudden drop in SvO2.

Anesthesia↗
PubMedDate not supplied

Generation of memory CD4+, CD8+, CD45RO+ and CD16- lymphocytes activated with IL-2, INF-gamma, and TNF-alpha with specific cytotoxicity against autologous cervical cancer cells in a mixed leukocyte-tumour cell culture.

Cytotoxic T lymphocytes (CTL) specific against autologous human cervical cancer cells were generated in vitro from peripheral blood leukocytes (PBL) from four patients with non-keratinized epidermoid carcinoma. For this purpose, these patients' PBL were co-cultured for 28 days either with IL-2 or a mixture of IL-2, IFN-gamma and TNF-alpha in the presence of autologous tumour cells (ATC). Our results showed that these CTL were highly cytotoxic for ATC, weakly cytotoxic for heterologous cervical cancer tumour cells, and not cytotoxic for carcinoma cell lines, normal cervix cells nor autologous PBL. Proliferation and cytotoxicity against ATC were greater when the PBL were activated with the three cytokines. These CTL had a CD4:CD8 ratio of 1:1, were CD16- and CD45RO+ and their killing activity was inhibited by antibodies against CD3, CD8 and MHC-class I but not by antibodies against CD4, CD16 or HLA-class II. The possibility of generating specific CTL in long term cultures for cervical cancer therapy is also discussed.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Postoperative mortality in a general hospital].

OBJECTIVES: To compare the postoperative mortality of our hospital to that of others. PATIENTS AND METHOD: Retrospectively, we studied patients who died after surgery in 1994, defining postoperative mortality as death occurring in the hospital after surgery. The variables studied were age, sex, preoperative disease, ASA, type of surgery, anesthetic technique, intraoperative complications and place, cause and time of death. RESULTS: One hundred six (1.63%) of the 6,485 surgical patients died. The highest proportion were cardiovascular surgery patients (3.36%) and the smallest proportion (0%) had undergone eye surgery. Of patients receiving general anesthesia 2.16% died, while 0.59% of those receiving local-regional anesthesia did so. Most of those who died were male (55.66%); were over 55 years of age (87.73%); were ASA IV (67.03%); had associated medical disease (79.24%), mainly arterial hypertension; or had undergone emergency surgery (54.71%). Most who died had received general anesthesia (87.73%). Half of all deaths occurred in patients who presented some type of complication during surgery; this was the case with all who received intradural anesthesia, in 47.89% of those who had received general anesthesia and 20% of those receiving local anesthesia. The most common intraoperative complication in all anesthetic techniques was post-induction arterial hypotension. Over half of deaths occurred on the ward, after the first postoperative week, and the most frequent cause of death was sepsis (19.81%). We considered a death occurring on the hospital ward within the first 24 hours after surgery as possibly being associated with anesthesia (1.54/10,000). CONCLUSIONS: Risk factors for postoperative mortality established in other studies (advanced age, male sex, emergency surgery and ASA IV-V) were relevant in most of the deaths studied. Our mortality rate is similar to that reported by other authors for the first 24 to 48 hours after surgery, but is higher 30 days after surgery and later. Some of the 13 patients who died on the hospital ward in the first 48 hours after surgery probably did not receive the care that would have been provided in the postoperative intensive care unit.

Adult↗
PubMedDate not supplied

[Usefulness of abdominal echography in the diagnosis of active Crohn's disease].

OBJECTIVE: The aim of this study was to evaluate the relevance of the ultrasonography in assessing activity in a series of patients with Crohn's disease. PATIENTS AND METHODS: A series of 24 patients with active (Crohn's disease activity index > 150) ileal or ileocolonic Crohn disease underwent abdominal ultrasonography. RESULTS: There was a significant correlation between bowel wall thickening and the Crohn's disease activity index: the higher the bowel wall thickening was the higher were the values of Crohn's disease activity index. Two or more ultrasound studies were performed in 10 patients with bowel wall > 4 mm during treatment, and a progressive normalization of bowel wall size was observed with new thickening when recurrence occurred. CONCLUSIONS: A bowel wall thickening (> or = 4 mm) was found in patients with active Crohn's disease. A patient with bowel wall thickness > 6 mm should make us suspect the presence of stenosis. Abdominal ultrasonography is an accurate method in the first assessment of Crohn's disease because its high correlation with the Crohn's disease activity index.

Abdomen↗