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Biomedical subjects

P A Rubio

Publications and source records attributed to P A Rubio.

At least 19 recordsLinked to original sources
PubMed1995

Importance of accurate preoperative diagnosis and role of advanced laparoscopic cholecystectomy in relieving chronic acalculous cholecystitis.

Between April 1, 1989, and January 1, 1994, 38 patients with chronic acalculous cholecystitis underwent an advanced (3-puncture) laparoscopic cholecystectomy at our institution. The 30 women and 8 men had a mean age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease produced typical biliary colic, but no gallstones were visualized on ultrasound examination; cholecystokinin-stimulated cholescintigraphy revealed a dysfunctional gallbladder, as evidenced by an ejection fraction of < or = 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relief of symptoms. Although an increasing number of physicians are recommending this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objective criteria confirming the need for surgical intervention should be obtained by means of appropriate preoperative testing, including cholecystokinin-stimulated cholescintigraphy.

Adult↗
PubMed1994

Laparoscopic resection of a solitary cecal diverticulum.

Cecal diverticulitis is an uncommon disorder that, unlike sigmoid diverticular disease, usually involves a solitary true diverticulum. The resulting pain is hard to distinguish from that of appendicitis or perforating carcinoma. The typical patient is male, Asian, and in the fourth decade of life. The following case is unusual in that the patient was a 50-year-old Caucasian woman, and the diverticulum was excised laparoscopically. To the author's knowledge, this is the first case in which laparoscopy has been used for this purpose.

Appendectomy↗
PubMed1994

Laparoscopic colorectal surgery: a challenge for ET nurses.

A growing number of colorectal procedures are being performed either partially or totally by laparoscope. Because of the lack of a major incision, this approach offers numerous advantages, including reduced postoperative pain and shorter recovery time. To familiarize ET nurses with the laparoscopic technique, this article reports a case of laparoscopic abdominoperineal resection and discusses some of the special considerations involved in patient care.

Colostomy↗
PubMed1991

Endoscopic cholecystectomy with the holmium:YAG laser: preliminary report.

In the first clinical trial of its kind, the author used a pulsed holmium:YAG laser to perform endoscopic gallbladder removal in 10 patients. Compared to other endoscopic laser systems, the holmium:YAG produced relatively shallow tissue penetration. As a cutting instrument, it allowed faster dissection than other lasers. As a coagulating instrument, it provided such satisfactory hemostasis that no other hemostatic method was needed. This preliminary trial left no doubt that the holmium:YAG is a excellent laser for laparoscopic surgery, particularly removal of the gallbladder.

Adult↗
PubMed1991

Pacemaker-lead puncture of the tricuspid valve. Successful diagnosis and treatment.

During insertion, a transvenous pacing lead pierced the tricuspid valve in a 66-year-old man, causing progressive tricuspid insufficiency and congestive heart failure. The defect remained undiagnosed for ten years and was then repaired. To our knowledge, this is the first case in which this problem has been successfully treated rather than being diagnosed at autopsy.

Aged↗
PubMed1990

Percutaneous endoscopic treatment of cholelithiasis.

Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

Chenodeoxycholic Acid↗
PubMed1990

Endoscopic laser cholecystectomy: initial report.

With the recent advent of endoscopic laser cholecystectomy, gallbladder removal has been transformed into a minimally invasive operative procedure. To date, we have performed this technique in 12 patients (nine women and three men, aged 24 to 66 years). Early in our experience, one procedure was converted from the endoscopic technique to a standard open cholecystectomy after the gallbladder was accidentally punctured by the grasping forceps. The remaining 11 cases were completed endoscopically. Eight days postoperatively, one patient underwent reexploration because of bile leakage secondary to a fallen cystic duct (which was thickened from chronic inflammation). Compared with traditional methods, the endoscopic technique resulted in decreased morbidity and discomfort, a shorter hospital stay, minimal scarring, and a faster return to work.

Adult↗
PubMed1990

Unusual cause of traumatic diaphragmatic hernia in a 12-year-old boy.

A 12-year-old boy with a short history of dyspnea and occasional left-sided chest pain was discovered to have a diaphragmatic hernia that apparently resulted from minor chest trauma two years earlier. A large portion of the small bowel, part of the transverse colon, and the entire omentum were found in the left side of the chest. The patient recovered uneventfully after primary repair of the diaphragm. Although such lesions are usually associated with relatively severe injuries, this case shows that they may result from any type of chest trauma.

Accidents↗
PubMed1990

Complete jejunoileal necrosis due to torsion of the superior mesenteric artery.

We have reported a case of small-bowel volvulus in which complete jejunoileal necrosis resulted from torsion of the superior mesenteric artery. This case was unusual not only because of the extent of necrosis but also because primary small-bowel volvulus is rare in adults. Despite nearly total small-bowel resection, the patient continues to do well 6 months postoperatively.

Gangrene↗
PubMed1990

Thoracic outlet syndrome caused by a latissimus dorsi flap for breast reconstruction.

After undergoing bilateral breast reconstruction with latissimus dorsi flaps, a 34-year-old woman developed right-sided thoracic outlet syndrome. At operation, the latissimus dorsi flap was found to have formed a constrictive muscle sling that compressed the thoracic outlet. To the author's knowledge, thoracic outlet syndrome has not previously occurred under these circumstances.

Adult↗
PubMed1989

Mycotic thoracic aortic aneurysm producing vertebral body destruction and paraplegia: case report.

In the surgical treatment of an aortic aneurysm, disruption of the blood supply to the spinal cord, resulting in paraplegia and anaesthesia below the level of involvement, is a dreaded complication. Occasionally, when an aortic aneurysm compresses a major vessel that supplies the anterior spinal artery, spinal cord ischaemia and paraplegia can occur before surgery. In the case presented here, however, preoperative paraplegia appears to have resulted from direct spinal destruction by an infected aortic aneurysm that was originally diagnosed as a spinal abscess. The patient underwent operative repair, but her aorta was so friable that the sutures would not hold. Despite repeat surgery, her condition rapidly proved fatal. This case shows that, in patients with a suspected spinal abscess, computer tomographic scanning and angiography should be performed to confirm the diagnosis and to rule out other pathological conditions. An accurate pre-operative diagnosis will permit adequate operative planning and prevent catastrophic results.

Aortic Aneurysm↗
PubMed1988

Ventral hernia in a massively obese patient: diagnosis by computerized tomography.

Although ventral hernias can usually be diagnosed by palpation, this method is imprecise in massively obese patients. In the case we have described, computerized tomography was used to confirm the presence of a ventral hernia in a morbidly obese woman. We recommend the use of this technique when a suspected ventral hernia cannot be diagnosed by routine methods.

Female↗
PubMed1988

Double valve replacement and coronary artery bypass in a patient with chronic osteomyelitis.

Implantation of a prosthetic heart valve is generally contra-indicated in the presence of infection. A 68-year-old man with chronic osteomyelitis underwent successful double valve replacement, combined with coronary artery bypass, after his draining osteomyelitic fistula was controlled with antibiotics. During the 39 months since surgery, he has shown no sign of paravalvular leakage or infectious complications.

Aged↗