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Biomedical subjects

L Morales

Publications and source records attributed to L Morales.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Retroperitoneoscopy: minimally invasive renal surgery].

OBJECTIVE: Retroperitoneal laparoscopy is well known as a surgical technique in adult patients. Its use in pediatric surgery is still-recent but, because of the good results, retroperitoncoscopy indications are getting more acceptance and widening indications. The aim of this work is to analyze our initial experience in retroperitoneal laparoscopy procedures in urological diseases at our centre. PATIENTS AND METHODS: From July 2001 to February 2002 retroperitoneal laparoscopy has been used in 6 patients aged 6 months to 14 years. Surgical indications were: pyelolithotomy (lithiasis non-subsidiary to extracorporeal shock wave lithotripsy (n = 1); nephrectomy ofmulticystic dysplastic kidney (n = 4); and nephrectomy of atrophicpelvic kidney (n = 1). RESULTS: Mean operative time in nephrectomy has been 102 minutes, and 230 minutes in conservative surgery. All 5 patients nephrectomized were discharged 24 hours after operation with no postoperatory incidences. The patient operated on for pyelolithiasis (in which a external drainageand a pyelouretheral stent (pig-tail) was placed) remained one week until he could be discharged without drainage. The pig-tail stent was thrown out spontaneously three weeks later through the urethra. Follow up demonstrated no stenosis in this case and no complications in nephrectomy patients. CONCLUSION: Retroperitoneal laparoscopy is effective and safe in renal surgery and surpasses transperitoneal laparoscopy because its safety in reconstructive surgery avoiding urine leakage risk into the abdomen.

Atrophy↗
PubMed2002

Congenital prepubic sinus.

Prepubic sinuses are rare congenital anomalies of the urinary tract. There have been few case reports in the literature. The authors describe 2 clinical cases of this entity. A review of the 20 cases previously reported, to clarify the anatomic features and the embryology of this infrequent congenital anomaly, also is reported. Furthermore, the authors propose to classify these lesions not as dorsal urethral duplications but as fistulas of the primitive urogenital sinus, with 3 anatomic types: high, toward the urachal remnant; middle, to the bladder; and low, reaching the urethra.

Cutaneous Fistula↗
PubMed2002

Upper lip fistulas: three new cases.

OBJECTIVE: We present three new cases of congenital upper lip fistula. Two of them were located in the philtrum midline, one of which was associated to a double maxillary frenulum, a medial lip cleft, and a medial cleft of the primitive palate. The other was located in the left side of the vermilion. All three patients had clear fluid discharge through the fistulous orifice without pain. Two of them had a history of recurrent swelling of the philtrum area. CONCLUSIONS: A simple surgical excision is the treatment of choice in these cases, in which the anatomy is preserved; this fact is more consistent with a completed but aberrant development than with focal dysgenesis.

Child↗
PubMed2002

[Mammaplasty in adolescent girls].

The aim of this work is to analyze the experience in our pediatric center on the surgical management of mammary malformation in teenagers. We have reviewed or mammaplasty cases until 1999 (n = 24). We have divided them in two groups: augmentation (A) and reduction (R) mammaplasty. The analyzed parameters were: ethiology, associated pathology, surgical approach, aesthetic results and complications. Group A (n = 14; 17 implants). The surgical indication was moderate-severe mammary hypoplasia with psychological repercussion. Associated pathology: thoracic malformation (n = 13) and psychiatric pathology (n = 2). The surgical approach was submammary in 6 cases, videoassisted transaxillary in 4 and iterative on thoracic scar in 3. All the implants were located at the subglandular space. No major complications were found and the cosmetic results were good, with only one reoperation because of asymmetry. Group R (n = 10). Surgery was indicated because of bilateral puberal mammary hipertrophy in all cases. Associated pathology: obesity (n = 3), psychiatric and behaviour disorders (n = 3), scoliosis (n = 2), and one case of isosexual precocious puberty. In all cases but one the Strömbeck mammaplasty was performed. We used the Lejour technique in this single case. The cosmetic results were good, except for 2 cases of hypertrophic scar. The only complication was a wound infection that healed well.

Adolescent↗
PubMed2002

[Intestinal duplications. A survey of 18 cases].

OBJECTIVE: The present study analyses the experience of two centers in the management of intestinal duplications in children. MATERIAL AND METHODS: We retrospectively reviewed the medical records of a series of 18 children with intestinal duplication (January 1993 to December 1999). The median age was 11 months (range: 9 days to 12 years). The variables analysed were: clinical presentation, diagnosis, localization, anatomic type, treatment, and complications. The relationship between age and clinical presentation was also analysed. RESULTS: Most cases were located in the ileum (n 14; 78 %) and presented with rectal bleeding (36 %) or intussusception (36 %). Most symptomatic cases in the first year of life presented with intussusception (n 5/6). All duplications, except one located in the ascending colon, were cystic. 99mTc-pertechnate abdominal scan was positive in three out of five patients. One case was diagnosed by prenatal ultrasonography. Diagnosis was confirmed by laparoscopy in three patients and by laparotomy in the remaining patients. In one patient, cystic esophageal duplication presented in the neonatal period as respiratory distress. Diagnosis as well as excision was performed by thoracoscopy. Of the two gastric duplications, one was diagnosed by prenatal ultrasonography and the other by laparotomy. Treatment consisted of segmental enterectomy (n 14) or excision of the lesion without enterectomy (n 4). No complications were found during a mean follow-up of 3 years. CONCLUSIONS: The onset of intestinal duplication may be late. The lesions were most commonly located in the ileum and were cystic. Clinical presentation was related to age. Minimally invasive surgery plays an important role in the management of these lesions.

Child↗
PubMed2002

[Morphologic study of the intestine in an experimental model of amnioinfusion in fetal rabbits with gastroschisis].

An experimental model of serial amnioinfusion has been developed in fetal rabbits with gastroschisis, using an intraamniotic catheter connected to a subcutaneous port. Fetuses of 4 groups were compared 7 days after surgery: group A: gastroschisis and daily amnioinfusion through an implanted catheter; group C: gastroschisis and blind amniotic catheter; group G: gastroschisis without catheter; group O: nonoperated fetuses. Survival rate, fetal body weight, lung weight, intestinal weight and length were determined. Computer aided morphometric analysis was performed, in which intestinal diameter, thickness and villi length were measured. Amniotic fluid samples were recovered along the experimental period. Intestinal length was significantly shorter and had a significantly thicker wall than nonoperated fetuses; we found no other morphometric differences between gastroschisis treated with amnioinfusion (group A) and the other gastroschisis groups (C and G). Amnioinfusion did not affect fetal survival rate; the amniotic catheter alone did not cause pulmonary hypoplasia due to significant amniotic leak. The physiological decrease in amniotic volume towards the end of gestation has not been modified by this regime of amnioinfusion.

Amniotic Fluid↗
PubMed2002

[Creation of a model for myelomeningocele in rabbit embryos].

UNLABELLED: Spinal dysraphism causes paraplegia, fecal incontinence, neurogenic bladder, sexual dysfunction, hydrocephalus and skeletal abnormalities in newborns. Its ethiology and pathogenesis are still not known, and probably multifactorial. AIM: To determine whether spinal cord exposition to the amniotic space causes a functional (impairment) and anatomic lesion similar to that of human myelomeningocele. MATERIAL AND METHODS: Forty-eight fetal rabbits underwent to create spina bifida on the 23rd gestational day (term is 31 days). The procedure consisted of lumbosacral skin excision and posterior laminectomy. The fetuses are allowed to continue their gestation. On the 30th gestational by the operated fetuses were harvested, together with a group of nonoperated littermates for control. A clinical and neurologic evaluation was done, as well a study of somato-sensorial evoked potentials in the upper and lower limb and histologic study of the affected vertebral and cordial segment. RESULTS: The 26 surviving animals had deformity and lack of movement of the lower limbs. Evoked potentials showed absent response to stimuli in the lower limbs of animals with spina bifida, whereas upper limbs and control animals did respond. Histologically the spinal cord of the operated rabbits was uncovered and flattened. CONCLUSION: This model of myelomeningocele in fetal rabbit reproduces a variety of features similar to human spinal dysraphism, and hence can be used to study the pathophysiology of spina bifida.

Animals↗
PubMed2001

Intestinal damage in gastroschisis is independent of the size of the abdominal defect.

The intestinal damage in gastroschisis (GS) has been attributed to a narrow abdominal wall defect (AWD), among other causes, but this causal effect is difficult to prove in humans. The present experimental study was done to ascertain the damaging effect of clinically extrapolable mild and moderate constriction at the AWD on the intestine of fetuses with GS. AWDs of two different sizes were carried out in the fetal rabbit model: small-ring GS (1.5x bowel diameter, SRG) and large-ring GS (3x bowel diameter, LRG); a group of unoperated littermates served as controls. Fetal body weight, intestinal length and weight, bowel diameter and wall thickness, and histology were checked 7 days later. No statistical difference was found in body weight and bowel diameter among the groups. Intestinal length, weight, and wall thickness were significantly different in the GS groups compared to the controls, but no difference was found between the GS groups. Histology did not show venous stasis, ischemic lesions, or differences in the degree of edema between groups SRG and LRG. Mesothelial hyperplasia was seen in both GS groups. The intestinal changes in length, weight, diameter, wall thickness, and histology in GS should thus not be attributed to the diameter of the AWD.

Abdominal Muscles↗
PubMed2001

Effects of yohimbine on the antinociceptive and place conditioning effects of opioid agonists in rodents.

1. The pharmacological modulation of opioid actions by drugs acting on heterologous mechanisms could be useful to overcome some of the main problems associated with the use of opiate agonists. Based on previous findings on the interactions between yohimbine and opioid drugs, we have further studied the effects of yohimbine on the antinociceptive and positive-negative reinforcing effects of morphine (mu opioid receptor-preferring agonist), U-50,488 (kappa agonist) and SNC80 (delta agonist). 2. Pretreatment with yohimbine completely blocked the antinociception provided by the three opioid agonists in the mouse tail-immersion test. 3. A similar blockade of SNC80 and U-50,488-induced antinociception was observed with yohimbine in the mouse hot plate test at the same doses. In this paradigm, the effect of the kappa agonist was very slight and the actions of yohimbine rather variable. 4. In place conditioning experiments with SD (Sprague -- Dawley) male rats, yohimbine alone was inactive but it limited the preference induced by morphine and SNC80 and the aversive effect of U-50,488. Impaired novelty preference was also observed with the combination of yohimbine and U-50,488. 5. It is concluded that yohimbine tends to limit opioid antinociception and the addictive potential of mu and delta opioid agonists. More selective drugs could help to understand the mechanisms involved in these actions.

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed2001

Antireflux role of free muscle transplantation. Experimental study in a reflux esophagitis rat model.

PURPOSE: Experimental work on free muscle transplantation has resulted in some successful clinical applications. After a previous experimental study that established the viability of this procedure on the distal esophagus of the rat, we investigated the antireflux efficacy of free muscle transplantation on the distal esophagus in a reflux esophagitis rat model. METHODS: Two groups of Sprague-Dawley rats were submitted to a reflux-inducing operation. Thirteen animals underwent esophagojejunostomy only (EJ) and fourteen were submitted to esophagojejunostomy plus free muscle transplantation of plantaris on the distal esophagus (ETx). Eight weeks later, the esophagi of survivors were removed after sacrifice (EJ, n = 10; ETx, n = 10) and the macroscopic longitudinal extension (mm) and the histological grade (1-4) of esophagitis evaluated. RESULTS: All esophageal specimens of both groups had esophagitis. However, the extent of esophagitis (median: ETx: 23 vs EJ: 32) and the frequency of high grades of esophagitis (ETx: 30 % vs. EJ: 100 %) were significantly lower in the ETx group (p = 0.005 and p = 0.001, respectively). All except one ETx subject presented with an extent and/or a grade of esophagitis which was less than the EJ subjects' lowest values. CONCLUSIONS: Experimental free muscle transplantation on the distal esophagus seems to have antireflux function, thus its therapeutic implications deserve further investigation. The incomplete efficacy of the procedure may suggest that a putative anatomic sphincter per se is not enough to promote an effective antireflux mechanism.

Animals↗
PubMed2001

[Intraabdominal metastasis of cerebellar medulloblastoma through ventriculoperitoneal shunt].

We present a 6-year-old girl with cerebellar medulloblastoma causing obstructive hydrocephalus that was treated by ventriculoperitoneal shunting. The patient subsequently underwent surgical excision of the tumor followed by adjuvant craniospinal radiotherapy. Nine months after shunting, multiple intraabdominal metastatic lesions were found. Although the risk is low, ventriculoperitoneal shunting may facilitate the spread of malignant cells.

Abdominal Neoplasms↗
PubMed2001

[Bilateral cleft lip and palate: experience from a center with a multidisciplinary approach].

The aim of this work is to analyse the global experience of a center where a pluridisciplinar approach of the child affected with a cleft lip and palate is regularly done. Since january 1980 until january 2000, a total of 36 children (8 F, 28 M) with bilateral cleft lip and palate were treated. Only 5 children were born at this hospital. The others (n = 31) were referred soon after birth (24/31) or later for treat sequels. A multidisciplinary team evaluated every case. The parameters analysed were: surgical protocol, aesthetic and speech outcome, hearing disturbance, complications and the number of secondary lip surgeries. Surgical approach consisted on a soft palate closure before 3 months follow by a bilateral cheiloplasty (6 months) and a hard palate closure before 4 years of age, in the majority of cases (24/36). The esthetical result was evaluated in 25 children and was acceptable in the great majority (22/25). 16 children were submitted to tympanic draining in order to treat their secretory otitis. Speech outcome was analysed in 27 children and was good in 23. With a follow-up of 8.4 years, 15 children (8 treated soon on this center and 7 that came for their sequels) were treated for complications. There was a media of 4.5 surgeries per children.

Child, Preschool↗
PubMed2000

Tecoma sambucifolia: anti-inflammatory and antinociceptive activities, and 'in vitro' toxicity of extracts of the 'huarumo' of peruvian incas.

Aqueous and alcoholic extracts of pods and flowers of Tecoma sambucifolia H.B.K. (Bignoniaceae) ('huarumo') were analysed to determine their anti-inflammatory activity (carrageenan-induced edema test), antinociceptive activity (acetic acid writhing test) and 'in vitro' toxicity in Chinese hamster ovary cells, human hepatome cells and human larynx epidermal carcinoma cells. The cytotoxic effects of both extracts were evaluated by two endpoint systems: neutral red uptake assay and tetrazolium assay. The results showed that all extracts have anti-inflammatory and antinociceptive activity, but the highest potency is that of the alcoholic extracts. There were significant differences in cytotoxicity between extracts and among the response of cells to them. The highest cytotoxicity was noted with the alcoholic extract, and the human hepatome cell line was the most sensitive, especially to the alcoholic extract of flowers. The aqueous pod extract appeared to have the best pharmaco-toxicological profile, since it provided a significant reduction of both pain and inflammation together with the lowest cytotoxicity.

Animals↗
PubMed2000

Treatment of proximal hypospadias with a tubularized island flap urethroplasty and the onlay technique: a comparative study.

BACKGROUND/PURPOSE: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. METHODS: Between April 1994 and December 1998, 80 patients underwent surgical treatment for hypospadias. A tubularized island flap (Ducketttechnique) was performed in 42 cases, and the onlay island flap technique was used in 38 patients. The authors retrospectively compared the complication rate and type of these 2 procedures. RESULTS: Altogether, fistula was the most frequent complication without any significant difference between the 2 groups (21.4% for Duckett technique and 18.4% for onlay repair; P > .05). However, the anastomotic stricture was much more common in the tubularized flap group (7.14% v 2.63%; P < .05). Moreover, a megaurethra was found only in the Duckett technique group (4.7%). There was no case of chordee recurrence, but 6 patients (15.7%) treated with the onlay technique required urethrolysis including dissection of the chord behind the urethral plate, and in the other 3 patients of the same group (7.9%), a dorsal Nesbit plication also was necessary. In all these cases, the urethroplasty included an island cutaneous flap to provide ventral coverage to the neourethra. CONCLUSIONS: The authors conclude that both techniques present similar complications. However, proximal strictures and megaurethra are more common after the Duckett technique. This procedure is of choice in patients with scrotal hypospadias. Conversely, the onlay repair should be completed with other procedures (urethrolysis, dorsal Nesbit plication) to obtain good results in patients with severe degree of chordee.

Child, Preschool↗
PubMed2000

An English and Spanish Pediatric Asthma Symptom Scale.

BACKGROUND: Pediatric asthma survey measures have not been adequately tested in non-English-speaking populations. OBJECTIVES: To test the reliability and validity of an English and Spanish symptom scale to measure asthma control in children. SUBJECTS: Parents (54% Spanish-speaking; 61% not high school graduates) of 234 children seen in the emergency department for an asthma exacerbation. MEASURES: Parent report of frequency and perceived severity of child asthma symptoms during the beginning and after resolution of the exacerbation. RESULTS: An 8-item scale composed of reports of cough, wheezing, shortness of breath, asthma attacks, chest pain, night symptoms, and overall perceived severity had very good psychometric properties in both English and Spanish. The reliability (Cronbach's alpha) of the scale ranged from 0.81 to 0.87 for both languages and time frames. In both languages, the validity of the scale was supported by responsiveness to changes in clinical status (lower symptom score after resolution of the exacerbation, P < 0.001) and by moderate to strong correlations (P < 0.001) with other asthma morbidity measures (parent report of child bother: r = 0.59-0.65; school days lost: r = 0.38-0.67; and activity days lost: r = 0.41-0.59). There were no statistically significant differences in the reliability or construct validity of the summary symptom scale by language, although Spanish speakers reported a lower frequency of some symptoms than did English speakers. CONCLUSIONS: A reliable and valid 8-item scale can be used to measure control of asthma symptoms in Spanish-speaking populations of low literacy. Additional research to evaluate language equivalency of asthma measures is necessary.

Absenteeism↗