Search PubMed⌕ Search

Biomedical subjects

J M Caffarena

Publications and source records attributed to J M Caffarena.

At least 19 recordsLinked to original sources
PubMed1992

Blunt chest injuries in 1696 patients.

We review 1696 patients with blunt chest trauma. Road traffic accidents were the main cause of injury followed by domestic falls and labour accidents. Outdoor falls and sport accidents accounted for a small number of injuries. For clinical evaluation, Stoddart's score was used. The injuries were considered as minor in 710 patients, intermediate in 740 and severe in 246. Global in-hospital mortality was low (5%) but increased to 37% when only patients with multiple severe injuries were considered. Thoracic wall fractures were present in 1419 patients. Flail chest was diagnosed in 140 patients and pulmonary contusion in 275. Diaphragmatic rupture was present in 40 patients and tracheobronchial injury in 6. Cardiovascular injuries occurred in 55 patients. Associated extrathoracic injuries were seen in 611 patients: 923 patients were clinically observed and/or medically treated. An intercostal tube was inserted in 638 patients. Thoracotomy was undertaken in 105 patients. Surgical fixation for flail chest was carried out in 29 patients. The results were generally good: 9 patients did not need any mechanical ventilation and 11 were ventilated for a short period. No deaths were due to the surgical procedure. The authors maintain that a selective attitude restricting, but not ignoring, surgical stabilization is the best policy.

Accidents↗
PubMed1992

Bronchial fistula to the mediastinum in a heart-lung transplant patient.

We present a case of heart-lung transplantation complicated by bronchial perforation as the cause or consequence of prolonged lung infection. Periodic bronchoscopic and radiological follow-up showed resolution of the condition following adequate antibiotic and physiotherapeutic treatment.

Adult↗
PubMed1992

[The use of cryopreserved homografts in reconstructing the right ventricular outflow tract in congenital cardiopathies].

In recent years the use of cryopreserved allograft valves has become very popular. Homograft valves have been used for aortic valve replacement and for reconstruction of the outflow tract of the right ventricle for more than 30 years with very good results. Recently the method of cryopreservation has made possible the creation of valve banks. The use of this cryopreserved valves has obtained very good short and medium term results. We present our experience with the use of cryopreserved allograft valves in the reconstruction of the right ventricular outflow tract in the treatment of complex cardiac malformations. We have operated 15 children. Six were diagnosed of different types of transpositions of the great arteries with ventricular septal defect and pulmonary atresia or stenosis. There were 2 deaths not related to the use of the allograft valves. Nine other patients were diagnosed of different types of complex cardiac malformations. One patient with a univentricular heart and pulmonary stenosis and a neonate presenting with a truncus arteriosus communis died after the operation; again the deaths were not related to the use of the homograft conduits. Our technique of cryopreservation consists in the procurement of aortic and pulmonary valves from multiorgan donor patients. The valves are sterilized in antibiotics for 48 hours. Then the process of freezing is began with a period of progressive cooling down to -40 degrees C and second phase of storage in liquid nitrogen to a temperature of -178 degrees C. The short and medium term results are very satisfactory. We have not seen late important complications.

Adolescent↗
PubMed1990

Management of non-tumoral tracheal stenosis in 112 patients.

From January 1973 to August 1989, 112 patients with non-tumoral tracheal strictures were treated in our unit. In 102 patients, the stenosis followed respiratory support. Eighty-one patients were treated surgically; the rest required only endoscopic therapy. In 28 patients, surgical treatment followed failure of endoscopic management. Of the patients submitted to surgery an isolated tracheal stenosis was present in 54 cases while a laryngotracheal stricture was the lesion in the other 27. Tracheal resection and end-to-end anastomosis was performed in the former group. Rethi, Pearson and Couraud procedures, respectively, were carried out in the latter. We emphasize the difference in the results achieved in the first 5 years and those obtained in the last 10 years. In the former period, 7 reoperations were needed. On the other hand, although the overall mortality of both series was 9%, it decreased to 2% during the last 10 years. Excellent or good ultimate results were achieved in 92% of survivors. Finally, we stress the differences in the proportion of reinterventions and definitive failures in the surgical treatment of isolated tracheal stenosis compared to laryngotracheal strictures.

Adolescent↗
PubMed1984

Pregnancy after heart valve replacement.

Thirty-two women, aged 21 to 44 years, who had undergone single (25) or multiple (7) heart valve replacement conceived 46 times and gave rise to 33 live-born infants. There were 12 abortions and one stillborn; a premature baby died 24 hr post-partum. Twenty-eight patients had mechanical prostheses and 4 had porcine xenografts, 29 patients being anticoagulated with acenocoumarol during the pregnancy. Cardiac status remained clinically satisfactory under medical treatment in all but one patient who developed heart failure. Fetal complications included cerebral hemorrhage in 1 premature infant, low birth weight in 3 newborns and 1 case of nasal hypoplasia. The incidence of abortion has decreased significantly during the latter part of our experience. It was significantly greater in patients with mitral prostheses. This review suggests that inadequate cardiac function, excessive anticoagulation and a history of primary infertility may increase the risk of abortion. Better control of anticoagulant therapy (accepting an elevation of the therapeutic limit) and improved prevention of pregnancy in high-risk patients are considered responsible for the improved results seen in recent years.

Abortion, Spontaneous↗
PubMed1982

Mitral valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura.

We report the management of a patient with chronic idiopathic thrombocytopenic purpura and mitral valve disease. Although a two-stage approach was planned (splenectomy followed by mitral valve replacement one month later), the patient developed medically-resistant heart failure, and splenectomy plus mitral valve replacement were performed during the same operation. The platelet count at operation was 20,000/mm3. Platelet transfusion, used at the end of cardiopulmonary bypass, was considered no longer necessary in the postoperative period, as the platelet count quickly increased after the first postoperative day. The postoperative course was uneventful. Though we believe the two-stage surgical approach is preferable, our case shows that open-heart operations and splenectomy can be successfully performed simultaneously in patients with idiopathic thrombocytopenic purpura.

Blood Transfusion↗
PubMed1980

Ebstein's anomaly of the left-sided atrioventricular (AV) valve in AV discordance.

Prosthetic valve replacement of the left-sided atrioventricular (AV) valve was performed in a patient with AV discordance and Ebstein's anomaly of the left-sided AV valve without other associated anomalies. An anatomical study of 22 specimens with AV discordance did not show a case with similar anatomy; 5 hearts had mild degrees of downward displacement of the attachment of the left-sided AV valve leaflets, with marked dysplastic changes and variable degrees of hypoplasia. The surgical implications are different according to the degree of downward displacement of the leaflets. This feature and the size of the annulus and the morphologically right ventricle should be considered in preoperative evaluation, along with the operative approach, possible presence of atrialization of the wall of the proximal chamber and the relation of the left AV valve to the conduction system. Preoperative diagnosis of the anomaly is possible by angiocardiography and other methods.

Adult↗
PubMed1980

Aorta--right atrial communication. Report of an unusual case.

An unusual aneurysmal aorta--right atrial communication was found in a 25-year-old man with a rounded mass in the right cardiophrenic angle. Differential diagnoses included ruptured aneurysm of the sinus of Valsalva, coronary arteriovenous fistula, rupture of a dissecting aneurysm of the ascending aorta into the right atrium, and pseudoaneurysm of the right coronary artery followed by formation of a fistula between the aneurysm and the right atrium. Closure of the communication was performed under cardiopulmonary bypass. Complete absence of the right superior vena cava with a large persistent left superior vena cava draining to the coronary sinus was an unexpected finding at operation. The origin of the communication is not known; possible anomalous coronary and noncoronary origins are considered.

Adult↗
PubMed1978

Aortic levopositions without ventricular inversion.

A multi-center series of aortic levoposition (aorta anterior and to the left of the pulmonary artery) without ventricular inversion is presented and analyzed from an anatomical viewpoint. All the cases are exceptions to the 'loop rule' and amount to 0.9% of the total number or cases reviewed. A combined study of our own cases and those reported in the literature is presented. There is a high incidence of anomalies (malrotations, juxtaposition of the atrial appendages, atrioventricular valve anomalies, ventricular septal defects, pulmonary outflow tract obstructions and abnormal conal types) which may be related to the primary cause of the aortic levoposition, suggesting that they may form part of a new syndrome of diagnostic and surgical importance. In some cases, absence of coronary sinus was noted without asplenia or left superior vena cava draining into the left atrium. The major coronary artery pattern in cases of antomically corrected malposition with two well-developed ventricles was similar to that seen with ventricular inversion. Most of these cases can be helped surgically provided accurate and detailed preoperative evaluation and operative assessment and treatment is carried out.

Aorta↗