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Biomedical subjects

R Garcia-Rinaldi

Publications and source records attributed to R Garcia-Rinaldi.

At least 37 records · Page 2Linked to original sources
PubMed1984

Hiatal hernia with severe reflux esophagitis: treatment by superselective vagotomy and Nissen fundoplication.

Thirty-two patients had surgical treatment for severe reflux esophagitis due to sliding hiatal hernia. A superselective vagotomy was done as an adjunct to a Nissen fundoplication as the antireflux procedure. All patients had severe esophagitis; 16 patients (53%) had dysphagia, nine patients (28%) had esophageal stricture, and all had failed an intensive trial of medical treatment with antireflux measures, antacids, and histamine receptor blockers. Follow-up averaged 14.3 months (3 to 38). Three patients (9%) had significant postoperative esophagitis. The other 29 patients, including those with esophageal stricture, are now asymptomatic. We conclude that the combination of a superselective vagotomy and a Nissen fundoplication is a safe and effective operation for the treatment of severe reflux esophagitis.

Adult↗
PubMed1984

The Ionescu-Shiley valve: a solution for the small aortic root.

Valve replacement in patients with a small aortic anulus can cause difficult technical problems or leave the patient with a significant residual transvalvular gradient. Between August, 1977, and June, 1983, 35 patients with a small aortic root (21 mm or less) underwent aortic valve replacement with Ionescu-Shiley pericardial xenograft valves. They ranged in age from 29 to 76 years (mean 52.8 years) and in weight from 64 to 91 kg (mean 76.3 +/- 3.6 kg). Preoperatively, 26 patients were in New York Heart Association Functional Class III-IV. The valve sizes used were 17 mm in three cases, 19 mm in 16 cases, and 21 mm in 16 cases. There were four hospital deaths (11.4%) resulting from sepsis or low cardiac output. There were no late deaths. Cumulative duration of follow-up was 819.4 patient-months. Twenty-four (78%) of the 31 surviving patients are asymptomatic. Up to the time of review, there have been no episodes of thromboembolism, infective endocarditis, perivalvular leak, valve thrombosis, or primary tissue valve failure. Fifteen patients were hemodynamically evaluated 2 to 47 months (mean 14.3 months) after operation. The average resting transvalvular gradients for 19 and 21 mm valves were 15.1 and 10.8 mm Hg, respectively. Our experience suggests that the Ionescu-Shiley pericardial xenograft valve is a valid alternative in the surgical treatment of patients with a small aortic root.

Adult↗
PubMed1983

Simplified aortic cannulation.

Cannulation of the ascending aorta for cardiopulmonary bypass can be complicated by excessive bleeding or improper (too low) placement. A simple method of cannulation that avoids these problems is presented. This technique has been utilized in more than 1,000 patients without untoward complications.

Aorta↗
PubMed1979

The anatomic basis for the occasional failure of transfemoral balloon catheter thromboembolectomy.

A Fogarty balloon catheter was advanced from the common femoral artery through the popliteal artery and its branches in 15 cadavers. The catheter passed into the peroneal branch 89% of the time. In all 15 cadavers, the peroneal artery was the direct continuation of the popliteal artery and the arterior tibial and posterior tibial arteries branched off at varying angles from the popliteal. This provides an anatomic explanation for the occasional failure of transfemoral Fogarty catheter embolectomy of the leg. Our study suggests that if the patient's foot does not improve after Fogarty embolectomy, the popliteal artery should be exposed and the catheter directed into the shank arteries using vascular forceps.

Catheterization↗
PubMed1978

Intestinal obstruction due to phytobezoars. Observations in two patients with hypothyroidism and previous gastric surgery.

Two patients had small-bowel obstruction due to phytobezoars. Both patients were hypothyroid. One patient had undergone a previous pyloroplasty for pyloric stenosis and the other a truncal vagotomy and a pyloroplasty for a duodenal ulcer. Similarities and differences between the two cases and the possible predisposing factors in the formation of the phytobezoars are discussed. The recognition of high-risk patients, and their education to prevent phytobezoars are emphasized.

Aged↗
PubMed1978

Suspecting thoracic aortic transection.

Deceleration accidents produce a complex of potentially fatal thoracic injuries. Because early detection is the key to successful management of blunt trauma to the great vessels, emergency physicians must be knowledgeable of signs indicative of these complex injuries. Among more than 10,000 patients presenting to the Ben Taub Emergency Center over an 11-year period with thoracic injuries, 100 had clinical or radiographic clues suggestive of blunt trauma decelerative injury to the great vessels. Of these 100 patients, 23 had transection of the descending thoracic aorta and five had avulsion of the innominate artery. One patient had a double transection. Six patients died in the Emergency Center before proximal control could be achieved.

Adolescent↗
PubMed1977

Surgical management of penetrating injuries of the esophagus.

Although well protected and infrequently injured, penetration of the esophagus has a reported mortality of 10 to 30 per cent. The results of the management of seventy-seven patients with noniatrogenic penetrating injuries of the esophagus were reviewed. The region of esophageal injury was cervical in forty-five patients, intrathoracic in twenty-one patients, and intraabdominal in eleven patients. Gunshot wounds accounted for 75 per cent of the injuries. The overall mortality was 23 per cent. The highest morbidity and mortality was among patients with intrathoracic injuries, due to both difficulty in exposure and complexity of associated injuries. Because of the high incidence of late complications in intrathoracic injuries, cervical diversion and tube gastrostomy or complete esophageal exclusion must be considered early. Fundoplastic procedures were used in four patients with distal esophageal injuries. Although the overall mortality from truncal penetrating wounds has improved in recent years, the mortality from esophageal injuries remains high, reflecting a need for advancement in initial operative management.

Adolescent↗
PubMed1977

Myocardial revascularization prior to subsequent major surgery in patients with coronary artery disease.

Of our series of patients undergoing direct myocardial revascularization, we selected 60 patients who had subsequent major surgical and cardiovascular operative procedures. Thirteen of these patients had a second subsequent operative procedure, and four of the original 60 patients had a third subsequent operation. None of the patients died during the subsequent operation and none sustained a myocardial infarction. During the 77 subsequent procedures, there were eight different episodes of cardiac complications: seven patients had supraventricular arrhythmias and one patient had acute pulmonary edema. All patients responded to medical therapy. These results are suggestive that myocardial revascularization should be performed prior to other major indicated operative procedures in patients with documented coronary artery disease.

Adult↗