Biomedical subjects

E Criado

Publications and source records attributed to E Criado.

11 recordsLinked to original sources

PubMed1992

Heterotopic hindgut duplication: a cloacal remnant associated with exstrophy of the bladder.

Lower hindgut duplications, although very rare, usually present as a cystic mass located posterior to the rectum and confined to the pelvis. Hindgut duplications are often associated with genitourinary or spinal anomalies. We describe a neonate with a previously unreported heterotopic colonic duplication presenting as an exophytic perineal mass associated with classic bladder exstrophy. The embryonic significance of these anomalies is discussed.

Abdominal Neoplasms↗

PubMed1992

Descending thoracic aorta-to-iliofemoral artery bypass as an alternative to aortoiliac reconstruction.

During the last 3 decades subcutaneous extraanatomic bypass, despite its limited durability, has been the favored alternative to infrarenal aortofemoral bypass. Meanwhile, the descending thoracic aorta has been scarcely used as an inflow source for aortoiliac reconstruction. Over the past 8 years we performed 16 bypasses from the descending thoracic aorta to the iliofemoral vessels for occlusive disease. Our experience combined with that found in the English-language literature totaled 141 patients. In 79 patients (56%) the indication for surgery was failure or infection of an abdominal aortofemoral graft. Previous abdominal operations, sepsis, radiation therapy, the presence of abdominal stomas, or an unsuitable infrarenal aorta were the indications in the remaining cases. The combined operative mortality rate was 6.4%. The life-table primary graft patency was 98% at 1 year, 88% at 2 years, and 70.4% at 5 years. Bypass from the descending thoracic aorta to the iliofemoral artery uses an inflow source superior to other extraanatomic reconstructions, does not require aortic cross-clamping, avoids the abdominal cavity, and places the graft remote to the skin and intestine. The operative mortality and patency rates compare favorably to those of other extraanatomic or remedial aortic reconstructions. Descending thoracic aorta to iliofemoral artery bypass is a superb alternative to abdominal aortofemoral bypass, carries a low mortality rate, has an excellent short-term patency, and features unique characteristics for long-term durability.

Adult↗

PubMed1992

Long term results of percutaneous catheter drainage of pancreatic pseudocysts.

Percutaneous catheter drainage (PCD) has become an established and often preferred alternative to surgical treatment in the management of pancreatic pseudocysts. However, the long term results of percutaneous drainage of pancreatic pseudocysts remain uncertain. In an effort to determine the long term outcome of this therapy, 42 patients undergoing PCD of a pancreatic pseudocyst were analyzed retrospectively. Forty-two pancreatic pseudocysts were drained percutaneously in 42 patients. Sixty-seven percutaneous drainage procedures were performed--22 patients underwent one, 15 had two and five patients required three procedures. Percutaneous drainage was considered not to be effective when the pseudocyst persisted or when it recurred after initial resolution. Twenty-three pseudocysts were infected at the time of drainage and 19 were not infected. In 30 patients, the cause of the pseudocyst was alcoholic pancreatitis. There were no deaths related to the procedures and seven complications occurred, including hemorrhage, pancreatic fistula and empyema. Mean follow-up evaluation time of the patients was ten months. In nine patients, the pseudocyst was successfully drained and resolved. There were 33 treatment failures, among which 26 pseudocysts failed to resolve and seven recurred after initial resolution. Eventually, 25 patients underwent a surgical procedure, 20 for persistent pseudocyst and five for recurrence. Using contingency table analysis, the size of the pseudocyst, amount of fluid drained, amylase concentration in the aspirate, presence of infection, number of drainage procedures performed and duration of catheter drainage had no influence on the likelihood of success in long term pseudocyst resolution after PCD. Pseudocysts not related to alcoholic pancreatitis seemed to be less likely (p < 0.05) to resolve with percutaneous drainage than those caused by alcohol. PCD is a safe and valuable procedure in the acute management of patients with pancreatic pseudocyst. However, the current data suggest that despite early success with percutaneous drainage, the lack of resolution and recurrence rate of pancreatic pseudocyst is high. Therefore, it should not be considered as the definitive form of therapy in most patients. Close surveillance of patients undergoing percutaneous drainage and communication between surgeons and radiologists are critical in the management of pancreatic pseudocysts.

Adult↗

PubMed1992

The course of severe foot infection in patients with diabetes.

Infection of the foot is a limb threatening condition for patients with diabetes mellitus. Identification of patients with diabetes and severe infection of the foot most likely to benefit from early revascularization or major amputation would improve the results of a treatment policy to prevent limb loss and avoid futile delays in amputation. During a nine year period, 79 diabetic patients underwent emergency procedures for severe infection of the foot during the initial hospitalization period. None of the patients underwent arterial reconstruction. Eventually, 21 of the patients required a major amputation, eight during the initial hospitalization and 13 on a subsequent admission. Stepwise discriminant analysis of clinical independent variables revealed that the patients most likely to require a major amputation during the initial hospitalization were those with an absent dorsalis pedis pulse and a polymicrobial infection (p = 0.018). The overall amputation rate (immediate or subsequent amputation) was higher for patients of either sex with nonpalpable pedal pulses when compared with those with at least one palpable pulse (p less than 0.05). Males who were not dependent on insulin had the highest risk of overall limb loss (p = 0.01). Patients undergoing delayed amputation required a significantly higher number (p = 0.01) of readmissions to the hospital for recurrent infection of the foot than those who did not undergo amputation. Data in the current study suggest that early major amputation in a subset of patients would prevent delay in the rehabilitation process of the amputee, decrease long term morbidity and reduce health care cost. An aggressive policy of early revascularization in patients with a pulse deficit may reduce the amputation rate in those with diabetes with severe infection of the foot.

Amputation, Surgical↗

PubMed1991

Venous disease.

Explore the source record for details and available documents.

Humans↗

PubMed1991

Surgery for chronic vein insufficiency.

1. Although varicose veins are the most prevalent form of venous insufficiency, obstruction or valvular incompetence of the deep system produces the most severe forms of lower extremity venous insufficiency and is responsible for most cases of leg ulceration of venous etiology. 2. With careful patient selection, surgery for varicose veins can be successful. Deep venous surgery, however, has limited indications and still carries a high failure rate; it should only be indicated in selected patients after conservative therapy has failed. 3. The main causes for failure of deep venous surgery are the low pressure and low velocity flow characteristics of the venous system that favor thrombosis.

Chronic Disease↗

PubMed1991

Intermittent claudication.

The natural history of intermittent claudication is generally benign. Clear indications for revascularization in patients with intermittent claudication are rest pain and necrotic tissue. Disabling claudication in patients who are at low operative risk is another acceptable indication for surgical treatment. Young patients with intermittent claudication from aortoiliac occlusion constitute a subset of patients in whom a more aggressive approach is justified. Nevertheless, in most patients, the management of intermittent claudication should be conservative.

Female↗

PubMed1990

Delayed diagnosis of a foreign body in the spinal canal.

The absence of neurologic deficit does not preclude the diagnosis of stab wound injury of the spinal cord. Adequate radiologic examination is fundamental in detecting retained foreign bodies. Surgical extraction of foreign bodies is indicated to avoid infection and myelopathy.

Adult↗

PubMed1988

Trachea-innominate artery fistula: retrospective comparison of treatment methods.

A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. Bronchoscopy and angiography are often nondiagnostic. Control of hemorrhage and a patent airway are the initial goals of treatment. Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise.

Adult↗

PubMed1987

Continuous measurement of pulmonary blood flow using a retractable pulsed Doppler probe.

The feasibility of measuring pulmonary blood flow (PAQ) continuously using a removable, extraluminal 20 MHz pulsed Doppler probe, which has been used successfully to measure aortic blood flow, was assessed in seven anesthetized mongrel dogs. Simultaneous recordings were made from the Doppler probe (range-gated 5-6 mm from the anterior wall of the main pulmonary artery) and an electromagnetic flow probe (encircling the aorta) over cardiac outputs (CO) ranging from 0.2 to 5.5 L/min. Assuming a flat velocity profile and a fixed cross-sectional area, PAQ was initially calculated as the product of area and mean velocity. Regression analyses (PAQ = a + b X CO) indicated good intraanimal linear correlations in six animals (r greater than or equal to 0.84) and no correlation in one animal (r = 0.003); however, PAQ was consistently higher than CO and interanimal variability was marked, as suggested by large deviations in mean intercept and slope values (a = 1.67 +/- 1.09 L/min and b = 0.70 +/- 0.33). Results improved (r greater than or equal to 0.79 in all animals, a = 0.47 +/- 0.52 L/min, and b = 0.77 +/- 0.21) when the method to estimate PAQ was altered to assume that the starting cross-sectional area was the area that would make baseline PAQ and CO agree, and that the area during each subsequent CO level changed as a function of pulmonary artery pressure and an estimate of pulmonary artery compliance. Results of this study imply that it will be more difficult to use this Doppler probe to monitor CO from the pulmonary artery than it was from the aorta due to the elliptical, more compliant pulmonary vessel walls and the irregular pulmonary artery velocity profile.

Animals↗

PubMedDate not supplied

Infarcted appendiceal carcinoid. CT appearance mimicking appendiceal abscess.

A unique case of an infarcted carcinoid of the appendix is presented in which the computed tomography (CT) and clinical findings mimicked an appendiceal abscess. Though unusual, this possibility and appearance should be familiar to the radiologist particularly if percutaneous drainage is considered.

Abscess↗