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Biomedical subjects

E Medina

Publications and source records attributed to E Medina.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: a prospective study of 592 cases.

The development of gallbladder carcinoma has been correlated with the presence of a single large gallstone in two retrospective studies. The objective of the present study was to determine the number and size of gallstones in patients with gallbladder carcinoma compared to asymptomatic and symptomatic female patients with gallstones. The following three groups of patients were included in this prospective trial: (A) 78 asymptomatic patients with gallstones; (B) 365 symptomatic patients with gallstones; and (C) 149 patients with gallbladder carcinoma. At the end of the operation, the resected gallbladder was opened and the number of stones counted. The maximum size of the stones was determined using calipers. Patients with gallbladder carcinoma were significantly older than patients in the other two groups (P <0.001). In the group with asymptomatic gallstones, there were significantly more patients with one single stone, whereas in the group with gallbladder carcinoma there were significantly more patients with multiple stones (more than 11; P <0.01). Patients with gallbladder carcinoma had significantly larger stones, regardless of the number of stones present (P <0.001). We postulate that the increase in the number and size of the stones among patients with gallbladder carcinoma could simply be an effect of aging or it could be a reflection of the long-term presence of stones in the gallbladder rather than some particular chemical or physical influence.

Adult↗
PubMedDate not supplied

[Bilateral chylothorax after gastric surgery].

Chylothorax is a lymphatic effusion of chylous in the pleural space due to thoracic duct obstruction or injury. The most frequent aetiology is cancer; it is also related to chest trauma and iatrogenic. We describe the case of bilateral chylothorax in a 76-year-old woman, right predominant, during the post-operational phase of gastric surgery. This presented itself with respiratory insufficiency and tachycardia without initial haemodynamic compromise. It presented a favourable evolution after conservative treatment, cessation of oral intake and TPN and chest tube during 10 to 14 days.

Aged↗
PubMedDate not supplied

[Predictors of tobacco addiction in young adults].

To identify smoking dependence predictors, 150 active smokers were interviewed. To assess tobacco dependence Fagerström's test was used. The potential associations between smoking dependence and some variables related to life style were investigated. In a case-control study design an induction period > or = 2 months was assumed. After estimating crude odds ratios, a logistic regression model was fitted. The dependent variable was dependence to tobacco smoking. In the multivariate analysis independent predictors, in addition to age, were: a) an earlier hour for starting smoking (OR: 6.08; 95% CI: 2.29-16.2), b) thinking that smoking avoids getting fat (OR: 4.36; 95% CI: 1.50-12.7) and c) not knowing any person with smoking-related pathology (OR: 3.75; 95% CI: 1.36-10.3). Exercise appeared to protect against smoking addiction (OR: 0.36; 95% CI: 0.13-0.98). The knowledge of these factors could help to avoid the development of smoking addiction.

Adolescent↗
PubMedDate not supplied

[Non-aneurysmatic aortic dysphagia].

Esophageal compression by a vascular structure is a rare cause of dysphagia, the aberrant right subclavian artery being the most common congenital abnormality. Aortica dysphagia is usually observed in the elderly, especially in hypertensive women with cardiopathy and degenerative osteopathy. We report a 73-year-old woman with dysphagia, caused by a non-aneurysmatic aortic elongation, who presented progressive dysphagia, which ended in aphagia associated with heart failure. The diagnostic approach to these patients is discussed. The patient received cinitapride and, following treatment for heart failure, remains asymptomatic after a 3-year follow-up period, although manometric alterations persist.

Aged↗
PubMedDate not supplied

[Neurophysiological clinical study of 70 patients with type 2 spinocerebellar ataxia].

INTRODUCTION: The prevalence of hereditary ataxia in Holguín, Cuba, is 43 per 100,000 inhabitants, but in some regions reaches 503 per 100,000 inhabitants, a figure never previously recorded in the international literature. OBJECTIVES: To evaluate the part played by non-cerebellar structures and vias in causing some of the clinical signs of the disorder by means of clinico-electro physiological correlation. PATIENTS AND METHODS: A neurological examination, peripheral nerve conduction studies and somato-sensorial evoked potentials of the median and posterior tibial nerves were done in 70 patients with type 2 spinocerebellar ataxia. RESULTS: The commonest clinical signs were ataxia on walking, dysarthria, dysmetria and adiadochokinesia. Correlation analysis showed that the variable most significantly correlated with the degree of ataxia and Romberg's sign was latency of the P40 component, whilst tendon reflexes were best correlated with H reflex latency. However, the duration of the disease was not found to have statistical correlation. CONCLUSIONS: These results suggest that degeneration of long peripheral nerves and sensory paths contributes to the degree of ataxia and other clinical signs. At present no correlation has been found between the duration of the illness and increasing electrophysiological changes, and therefore seems not to have a major effect on neurodegenerative mechanisms.

Adolescent↗
PubMedDate not supplied

[Diagnosis and treatment of hepatic artery thrombosis after liver transplantation].

The aim of this study was to examine the clinical presentation and time of hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT), stressing the role of imaging modalities. Therapeutic options are described, such as retransplantation (Re-OLT), hepatic resections and revascularization procedures, focusing on complications and outcome in a consecutive series of 687 OLT. Over the period from 1986 to 1999, 687 OLT were carried out in 601 patients, 592 of whom were adults and 95 pediatric subjects. Of these operations 601 were primary OLT and 86 Re-OLT (71 I Re-OLT, 14 II Re-OLT and 1 III Re-OLT). In this retrospective study, we reviewed rejection episodes, time of HAT (early or late), possible cause of HAT, day of suspected diagnosis of HAT and day of confirmation of diagnosis. Clinical presentation, management, complications, outcome, survival rates and the need for Re-OLT were also recorded. The incidence of HAT was 2.47% (17/687). Early HAT (n = 9, < 30 days) was diagnosed 15.6 days after OLT (range: 3-25 days), whereas late HAT (n = 8, > 30 days) occurred 295.1 days after OLT (range: 38-1830 days). In two asymptomatic patients (2/17: 11.7%), HAT was discovered incidentally. Most of the patients (11/17: 64.7%) presented with increased liver function test values and fever. Relapsing bacteremia occurred in 7/17 cases (41.1%), whereas a biliary stricture and biliary leak were diagnosed in 3/17 (17.6%) and in 1/17 patients (5.8%), respectively. Fulminant hepatic failure was the clinical presentation in 2/17 cases (11.7%). In one case the clinical presentation was acute and chronic rejection (1/17: 5.8%). Intrahepatic abscesses were diagnosed in one case (1/17: 5.8%), as well as an intrahepatic haemorrhage (1/17: 5.8%). Doppler ultrasound (DUS) correctly revealed HAT in 9 of the 17 patients (52.9% sensitivity). In 8 of the 9 patients (88.8%) in whom HAT was diagnosed by DUS, angiography was also performed to confirm the diagnosis. Overall, angiography detected HAT in 14/17 patients (82.3% sensitivity). HAT management consisted of immediate Re-OLT in 6 patients 6.8 days (range: 3-12 days) after diagnosis. Delayed Re-OLT was performed in 6 patients 529.1 days (range: 68-1920 days) after diagnosis. The overall retransplantation rate was 70.5% (12/17). Two patients died despite undergoing intraarterial urokinase treatment. Three grafts were salvaged, but suffered biliary stricture due to ischemic cholangitis and underwent hepatico-jejunostomy. A II Re-OLT was carried out in 4 of 12 patients (33.3%). The overall mortality rate was 41.1% (7/17). One-year and 3-year overall survival rates were 58.8% (10/17) and 47.0% (8/17), respectively. Both 5- and 10-year overall survival rates were 11.7% (2/17). Although the results of OLT have improved dramatically over the past few years, HAT is still associated with substantial morbidity, a high incidence of graft failure and high mortality rates. The use of DUS to screen for HAT has permitted earlier diagnosis, but early angiographic evaluation of the hepatic arteries is still needed for accurate diagnosis of HAT and remains the gold standard. Retransplantation is the definitive solution for HAT in the majority of cases, though it is essentially the patient's clinical condition that dictates the form of management.

Adolescent↗
PubMedDate not supplied

[Is it possible to have a consensual terminology in disc diseases?].

The large variety of concepts and classifications for disc disease (anatomical, pathological, surgical and radiological) are reflected in the, often ambiguous, terminology of degenerative disc disease used on imaging study reports by neuroradiologists and radiologists. The attempts to standardize the nomenclature, made by some medical societies, lack general acceptance. This work reflects the conviction that morphological characterization of disc disease prevails over the anatomopathological due to the limitations of imaging study techniques, including magnetic resonance imaging.

Humans↗
PubMedDate not supplied

Combined effect of click rate and stimulus polarity on BAEP latencies.

Previous studies addressed themselves to the effect of different parameters on the brainstem auditory evoked potentials (BAEPs). Of special interest were the repetition rate and the click polarity, both able to influence significantly the results. While previous contributions studied these two parameters separately, the present investigation is concerned with their combined effect, non-parametric statistical analyses allowing simultaneous consideration. 37 patients, 21 females and 16 males, with an age range of 20 to 95, carrying different diagnoses, were studied using rarefaction as well as condensation polarities, 10/sec as well as 30/sec repetition rates. Abnormalities present with only one stimulus polarity and repetition rate but not with another combination were present in 24 cases for polarity dependent changes (64.9%) and in 25 (67.4%) cases for repetition rate dependent ones. Generally 30/sec repetition rate yielded longer latencies when repetition rates were kept constant. The combination of condensation clicks and high repetition rates revealed a strong correlation with higher latencies.

Adult↗
PubMedDate not supplied

[Semiologic considerations and clinical significance of magnetic resonance in 11 intracranial aneurysms].

The author's experience with high-field Magnetic Resonance (Signa, 1.5 T, G.E.) in 11 cases of intracranial aneurysms (6 presenting as space lesion and 5 with symptoms of rupture) is reported. Spin-echo, gradient-echo and GRASS (fast-scan or flip-angle) sequences have been used and results compared with those of CT-scan and angiography. Magnetic Resonance findings, relating to blood flow and oxidation of haemoglobin (within the lumen, in the wall and at the periphery of the aneurysm) were interpreted from the point of diagnosis and surgical planning. The authors concluded that Magnetic Resonance should be considered as a routine investigation for intracranial aneurysms particularly when it is suspected that they might be voluminous and/or thrombosed.

Adolescent↗