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Biomedical subjects

J Mesa

Publications and source records attributed to J Mesa.

At least 55 records · Page 3Linked to original sources
PubMed1996

Primary cementless hip arthroplasty with a titanium plasma sprayed prosthesis.

One hundred two patients underwent 105 primary uncemented total hip arthroplasties and were reviewed at a minimum of 5 years after operation (mean, 6.1 years). The components were titanium alloy with a titanium plasma spray coating. The acetabular revision rate was 11.4%. Acetabular cavitary lytic lesions were identified in 25.5% at 5 years. All acetabular revisions were performed for a combination of wear and osteolysis. One femoral revision was performed to facilitate an acetabular revision, but the femoral revision rate for aseptic loosening was 0%. In addition, no femoral components had subsided or were thought to be loose radiographically. Thigh pain was present in 4% at 5 years. Despite the 25.5% incidence of acetabular osteolysis, distal femoral lysis was not seen and only 5% showed focal osteolysis in the trochanteric region proximal to the circumferential porous coating of the femoral component. Component design features were thought to be critical to the excellent performance of the femoral component and to the poor performance of the acetabular component.

Adult↗
PubMed1995

Health outcome assessment before and after adult deformity surgery. A prospective study.

STUDY DESIGN: Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status using a generic health outcome instrument before surgery and at an average of 2 years after surgery. OBJECTIVE: To assess whether adult spinal deformity surgery is a useful intervention when patients evaluate their own perception of health. The Medical Outcomes Survey Short Form-36, a validated generic health outcome assessment form, was used to measure patient's health status. SUMMARY OF BACKGROUND DATA: Surgery for adult scoliosis is technically demanding. No study that we are aware of uses a generic health outcome instrument in a prospective manner to compare patients' perception of their health after adult scoliosis surgery. The Medical Outcomes Survey Short Form-36 has been validated in multiple studies assessing other medical conditions and was found to be reliable, comprehensive, brief, and generic. METHODS: Sixty-eight adult patients undergoing surgery for adult spinal deformity were prospectively enrolled. Fifty-five patients were available to complete the Medical Outcomes Surgery Short Form-36 after surgery. The scores of the health profile were compared before and after surgery. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients fused to more caudal end vertebral levels ((L4, L5)5) were compared with those who were fused to more cranial end vertebral levels. The results of patients without complications after surgery were compared with those of patients with complications after surgery. RESULTS: Average follow-up period was 22.5 months (minimum 12 months) in 82% of 68 patients. Statistically significant improvements were seen in postoperative scores for physical function, social function, bodily pain, and perceived health change. We found no significant differences in self-reported health function parameters related to age ( > 40 vs. < 40), end vertebral level of fusion, or presence of complications after surgery. CONCLUSIONS: Applying a generic health outcome instrument to adult spinal deformity surgery shows that adult scoliosis surgery significantly improves patient self-reported health assessment and function. Beneficial results do not appear to deteriorate with age or more caudal end vertebral levels of fusion. Future studies combining disease-specific outcomes analysis and generic health surveys to assess end results of adult spinal deformity surgery will be useful.

Adult↗
PubMed1995

Differentiated thyroid carcinoma as a cause of cervical spinal injury.

Cervical cord compression due to local extension of differentiated thyroid carcinoma (DTC) is an extremely rare condition and, to our knowledge, only one case has been reported in the literature. Among 256 patients with DTC treated at our hospital, we have observed 3 cases of spinal injury due to local extension of DTC. A Brown-Séquard syndrome was detected at physical examination in 2 cases. In both patients, cervical cord compression precipitated a fatal event. In the remaining patient, a radiculopathy C5-C7 was observed. Magnetic resonance imaging was very successful in outlining the mass, clearly differentiating the extrinsic invasion from a metastasis, and allowing the surgical possibilities to be evaluated. Poor cervical uptake of 131I was observed on scans performed in two cases, suggesting a certain degree of cell dedifferentiation. We suggest that cervical spinal injury due to local extension of DTC may be an underreported complication of DTC that seems to condition the patient's outcome. Careful neurological examination is warranted in patients with DTC at stages III-IV and magnetic resonance imaging must be performed when spinal injury is suspected.

Adenocarcinoma, Follicular↗
PubMed1993

[Clinical usefulness of adrenal gland computed tomography in the etiologic diagnosis of Addison's disease].

BACKGROUND: The aim of this study was to evaluate adrenal gland morphology by computerized tomography (CT) in the etiologic diagnosis of Addison's disease. METHODS: Twenty-two patients were grouped according to their etiology based on the study of antiadrenal antibodies at diagnosis of the disease: 7 were positive (autoimmune etiology or EAA), 11 were negative (tuberculous etiology or EAT) and in four serologic study was not available (undetermined etiology or EAI). Adrenal gland CT was performed with contiguous sections every 5 mm. In eight cases the examination was carried out upon diagnosis of the disease (initial stage) and in 14 between 2 and 17 years following diagnosis (evolutive stage). RESULTS: In all the patients of the EAA group, examined in either the initial or evolutive stages, the adrenal glands appeared atrophic without calcifications. In the patients of the EAT group adrenal masses of proven tuberculous origin were found in five who were studied in the initial stage and with atrophic glands with calcifications in the remaining patients examined in the evolutive stage, with the exception of two cases with atrophic adrenal glands without calcifications which could serologically be considered as false negatives having autoimmune etiology. The patients in the EAI groups were studied in the evolutive stage with three having atrophic glands with calcifications and one atrophic adrenal glands without calcifications. CONCLUSIONS: Adrenal gland computerized tomography is an useful examination to differentiate between autoimmune or tuberculous origin in Addison's disease. Clinical application may be justified in all patients of recent diagnosis when the study of the antiadrenal antibodies is negative or not possible.

Addison Disease↗
PubMed1993

[Platelet hyperactivity in diabetic retinopathy: etiologic factor or epiphenomenon of microangiopathy?].

In order to analyze the etiologic and pathogenic meaning of platelet activity in diabetic retinopathy, Plasmatic Beta-Thromboglobulin (BTG) has been determined in 42 diabetics without retinopathy, 14 diabetics with non proliferative retinopathy and in 29 health controls. BTG showed higher values in diabetic patients with retinopathy in comparison with diabetics with no retinopathy (46.4 +/- 10.7 versus 37.6 +/- 13.4 ng/ml; p < 0.05 and with controls (31 +/- 18.8; p < 0.005). There were no differences between diabetics with no retinopathy and controls. No relation was found between BTG and the glycemic control grade, neither with lipoproteic profile. In resume, platelet hyperactivity found in patients with retinopathy seems to be an epiphenomenon of the microangiopathic lesion and not an etiologic factor, however this not precludes that it can play a role in the progression on retinal lesions.

Adult↗
PubMed1992

[Subtraction scintigraphy with thallium-201 chloride and technetium-99m pertechnetate versus high resolution ultrasonography in the localization of the parathyroid glands in primary hyperparathyroidism].

BACKGROUND: The aim of this study was to evaluate the use of scintigraphy with thallium-201 chloride (201 Tl) and technetium-99m pertechnetate (99mTc) in the diagnosis of the localization of the pathological parathyroid glands in primary hyperparathyroidism and compare the results with those of high resolution ultrasonography. METHODS: Twelve patients of 56.1 +/- 7.8 years of age diagnosed with primary hyperparathyroidism were studied between March 1987 and June 1990. High resolution ultrasonography with a 7.5 MHz transducer and scintigraphy of digital subtraction with 201Tl-99mTc were carried out preoperatively in all the patients. None of the patients had had previous cervical surgery and diagnosis was proven following surgery by histopathologic study. RESULTS: Ultrasonography detected 9 out of 11 adenomas and 3 out of 4 hyperplastic glands. Scintigraphy identified 9 adenomas and only 2 of the hyperplastic glands. With this latter technique there was one false positive. The sensitivity of ultrasonography was 80% and that of scintigraphy was 73% with specificity being 100% vs 96.9%, respectively. CONCLUSIONS: Subtraction 201 Tl-99mTc scintigraphy is useful in the diagnosis of the localization of pathologic parathyroid glands in patients with no previous cervical surgery although in this series this technique did not surpass that of high resolution ultrasonography.

Adenoma↗
PubMed1992

Intracoronary thrombus: chronic urokinase infusion and evaluation with intravascular ultrasound.

Percutaneous revascularization of coronary arteries with intraluminal thrombi is a clinical problem. We report a patient in whom we administered prolonged infusion of intracoronary urokinase and then assessed the stenosis with intravascular ultrasound before and after atherectomy. We found both angiography and intravascular ultrasound to be misleading in determining the presence of residual thrombus after thrombolysis.

Adult↗
PubMed1991

[Pheochromocytoma: clinical review of 21 cases].

BACKGROUND: To review the series of patients with pheochromocytoma diagnosed in this institution from 1976 to 1990. METHODS: The main clinical features and presentation of 21 patients (13 women and 8 males) with mean age 40 +/- 13 years were reviewed. Urinary excretion of vanillylmandelic acid (VMA) and total catecholamines had been measured. Abdominal echography, computed tomography (CT), adrenal scintigraphy and magnetic resonance (MR) had been used as localizing techniques. RESULTS: The main clinical feature was hypertension (86%), which was paroxysmal in 57% of patients. 9% were totally asymptomatic at the time of diagnosis. The following diseases were associated: thyroid medullary carcinoma (TMC) in one case, diabetes mellitus (5), cholelithiasis (3), contralateral nonfunctioning adrenal adenoma (2), and renal artery stenosis (1). The values of urinary catecholamines were high in all cases, while that of VMA was falsely negative in 33%. Echography localized the tumor in 10 of the 13 cases where it was carried out, and so did CT in 15 out of 15, scintigraphy in 6 out of 9 and MR in 5 out of 5. CONCLUSIONS: Hypertension, either paroxysmal or not, and increased perspiration were the most remarkable clinical features. VMA measurement has a small diagnostic value. Among the localizing techniques that were used, CT and MR had the highest yield.

Adrenal Gland Neoplasms↗