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Biomedical subjects

R Gutierrez

Publications and source records attributed to R Gutierrez.

At least 73 records · Page 4Linked to original sources
PubMed1985

Renal allograft rupture: surgical treatment by renal corsetage with lyophilized human dura.

We report 5 cases of renal allograft rupture in which diagnosis was established early through clinical data, laboratory tests and echography. Immediate surgery confirmed the suspicion in all cases. Acute rejection was present in 4 patients and in 1 the previous surgical puncture from the perirenal collection demonstrated serohematic fluid with a biological character similar to that of lymph. This latter case seemed to confirm the suspicion that any process associated with edema in a kidney with obstructed lymphatic tracts (meticulous lymphatic ligatures during donor extraction) is capable of causing a rupture. Conventional surgical treatment is dangerous and insecure on an edematous and friable kidney, resulting in a nephrectomy rate of 55.7 per cent and a postoperative death rate of 8 per cent. Hematoma evacuation, hemostasis by local compression and tridimensional containment of the ruptured areas should be the principles of this operation. By means of renal corsetage with lyophilized human dura these principles can be achieved. This surgical technique, which is simple and secure, its variations and future possibilities are described. In 3 of our 5 patients corsetage with lyophilized human dura was applied. All 5 grafts have taken. Renal function is good in 3 cases and acceptable in 2 at followup between 2 and 15 months.

Adult↗
PubMed1985

Renal artery stenosis in transplanted kidney: management and results in six patients.

Severe hypertension and a decrease of renal function, with or without oliguria, suggest renal artery stenosis in the transplanted kidney. 6 renal artery stenoses were observed in 100 transplanted kidneys followed up for more than 3 months. In 4 patients, percutaneous transluminal angioplasty was performed. 1 patient required a new percutaneous transluminal angioplasty 3 months later and a 2nd patient was submitted to surgery after 14 months. Surgery was performed in 2 more cases, with failure in 1. It seems that the endoarteric lesion during cold perfusion could be the main etiopathological factor, when associated with rejection episodes. Percutaneous transluminal angioplasty is the treatment of choice in the management of renal artery stenosis in transplanted kidneys. Surgery must be reserved when it fails.

Adult↗
PubMed1985

Verrucous carcinoma, hyperplasia and leukoplakia of the oral mucosa: a clinico-histopathological and histometric study.

Thirteen cases of verrucous leucoplakia (VL), 3 of verrucous hyperplasia (VH) and 19 of verrucous carcinoma (VC) were evaluated by means of 4 clinical features, 12 microscopic parameters and 6 epithelial histometric measurements. No significant clinical differences were detected, but histologic data showed that orthokeratinization was more frequent in VL and VH, while parakeratinization proved more common in VC. Sharp epithelial projections predominated in all three lesion types, though lymphoplasmatic infiltration and Russell bodies were more frequent in VH. Histometrically, there were statistical differences between VL or VH vs VC in three parameters, namely connective tissue-epithelial interface (Ice), epithelial height (He) and connective tissue-epithelial interface plus verrucous epithelial surface (Ice + Sve). To conclude, in this series, VH failed to exhibit significant clinical or histologic differences vs VL or VC, but histometric analysis was able to detect epithelial differences between both premalignant lesions and VC.

Aged↗
PubMed1979

Healing of enterotomies with preexisting peritonitis. An experimental study in guinea pigs.

The question of whether the presence of peritonitis has any influence upon the process of healing and the load capacity of a standard enterotomy was studied in guinea pigs. Laparotomy was performed 4 h after induction of peritonitis by a standardized method. Fecal peritonitis could be confirmed clinically, histologically and bacteriogically in all cases. A standardized enterotomy was carried out. The animals were killed 3 or 5 days later, anastomoses inspected, and the intraluminal pressures for anastomotic rupture measured. Comparison with a control group showed: (1) there can be normal healing of an enterotomy even with coexisting peritonitis; (2) anastomotic breakdown takes place at the same pressure as in the control group (p less than 0.01), and (3) primary lethality is significantly higher in cases operated in the presence of peritonitis (33 vs. 20%).

Animals↗
PubMed1976

Intermittent bundle-branch block in patients with accessory atrio-His or atrio-AV nodal pathways. Variants of the Lown-Ganong-Levine syndrome.

Intracardiac electrophysiological studies were performed in two patients with a documented history of repetitive supraventricular tachyarrhythmias. Case 1, with short PR interval and narrow QRS complexes had a short AH interval and intermittent right bundle-branch block. Thus the short PR wide QRS syndrome is not always a result of the Wolff-Parkinson-White syndrome but can also be seen in the Lown-Ganong-Levine syndrome coexisting with bundle-branch block. Case 2, with normal PR and AH at the lower limits of normal, showed the dual pathway response to atrial pacing that can occur in patients with Lown-Ganong-Levine syndrome. He also had tachycardia-dependent right bundle-branch block and left posterior hemiblock. Therefore, neither the short PR interval nor the narrow QRS complexes characterized these forms of pre-excitation. The constant features were, from the clinical viewpoint, the occurrence of repetitive supraventricular tachyarrhythmias, and electrophysiologically the abnormal response to atrial stimulation.

Arrhythmias, Cardiac↗
PubMed1976

Effects of pacing site on QRS morphology in Wolff-Parkinson-White syndrome, with special reference to 'pseudo-tachycardia-dependent block in accessory pathway and 'atrial gap'.

In a patient with a Wolff-Parkinson-White (WPW) syndrome type A mid-right atrial stimulation at a rate of 73/min produced a lesser degree of ventricular pre-excitation than when a slower sinus rhythm was present. This paradoxical effect was not related to tachycardia-dependent block in the accessory pathway because pre-excitation again increased at faster pacing rates. It was partly the result of a (proportionally) greater prolongation of intra-atrial conduction time to the accessory pathway than to the atrioventricular node and partly of a faster atrioventricular nodal conduction time. The latter, in turn, could be attributed either to later-than-normal arrival of excitation at the atrioventricular node, at a time when this structure was more recovered, or to a change in the site or mode of entry into the atrioventricular node. A gap in the atria was present because at a St1-St2 interval shorter than that which A2 had been blocked in the accessory pathway conduction was again possible, but with longer A1-A2 intervals. Finally, at similar, short, coupling intervals the impulse penetrated the atrioventricular node from the mid-right atrium but not from the coronary sinus. The unusual findings in this case support a recent assumption that in patients with WPW type A atrial stimulation should be performed from the coronary sinus to minimize the potential sources of error which can be produced by intra-atrial delay.

Atrioventricular Node↗
PubMedDate not supplied

The effect of levodopa on vocal function in Parkinson's disease.

Phonatory and articulatory dysfunctions are frequent observations in Parkinson's disease. We have investigated, using acoustic measures, the effects of levodopa treatment on vocal function in 20 patients with Parkinson's disease before and after levodopa. These patients were also compared with a matched control group. The mean age was 63.5 +/- 9.66 years, Hoehn-Yahr stage was 2.38 +/- 0.45, and onset mean age was 56.5 +/- 10.36 years. Paired Wilcoxon tests were performed to compare measurements before and after levodopa. The acoustic analysis using Computerized Speech Lab and MultiDimensional Voice Program software programs (Kay Elemetrics, Lincoln Park, NJ, USA) showed that measurements of fundamental frequency (p < 0.017) were significantly increased after medication, whereas short-term frequency perturbation jitter (p < 0.033), soft phonation index (noise parameter) (p < 0.015 ), and frequency tremor intensity index (p < 0.018) were significantly decreased after medication. The objective measurements of acoustic analysis are useful in evaluating the dopaminergic pharmacologic response in Parkinson's disease. The improvement in fundamental frequency and other vocal parameters may be a result of decrease in laryngeal hypokinesia and rigidity.

Aged↗
PubMedDate not supplied

Contemporary medical management of left ventricular dysfunction and congestive heart failure.

OBJECTIVE: The primary purpose of this review was to address the following question: based on the best available evidence, what should be the current medical management of congestive heart failure (CHF)? DATA SOURCES: The major sources for this review were from searches of the English language literature, including computer and bibliography reviews, of all randomized, controlled clinical trials and overview analyses of positive inotropic agents, preload/afterload reduction agents and beta-blocker medications in CHF. STUDY SELECTION: The number of studies reviewed was approximately 40. The major criterion for selection was that the studies be of CHF patients in randomized controlled clinical trials, particularly with a mortality/survival endpoint. Additional clinical trials of nonmortality endpoints in CHF patients and mortality trials in non-CHF patients were also selected to support possible pathophysiological insights for future CHF trials. DATA EXTRACTION: The data, particularly for the accompanying tables, were initially extracted by a single reviewer using common qualitative guidelines as far as was possible within the different temporal, etiological and geographic frameworks of the original component studies. Conclusions are drawn from this data synthesis and from published overviews. DATA SYNTHESIS: Angiotensin converting enzyme (ACE) inhibition therapy is effective in reducing mortality and morbidity in severe left ventricular dysfunction and CHF. Other systemic vasodilators may also be beneficial. The effects of digitalis on survival and morbidity in CHF are presently uncertain, but should be resolved in the near future. Other inotropic agents, at least in the long term, are clinically detrimental. Diuretics decrease morbidity, but their effect on mortality in CHF remains unknown. Beta-blocker and magnesium therapy offer promise in CHF, but await definitive clinical trials evaluation. CONCLUSIONS: The current medical therapy of CHF should definitely include ACE inhibitors, probably diuretics and possibly other vasodilators. Further viable trials of promising new, and older heretofore under-evaluated, CHF therapies are needed. Additionally, innovative strategies are needed to deal with this disease which has an increasing prevalence. Two strategies, primary prevention of CHF and a 'Heart Function Clinic', are discussed.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Serum sulfate concentration and the anion gap in hemodialysis patients.

First-of-the-month predialysis serum sulfate (SO4) and other blood chemistry values were measured prospectively for 5 to 7 months in 14 patients undergoing single pass chronic tri-weekly maintenance hemodialysis with bicarbonate dialysate. Blood was also obtained predialysis and again immediately postdialysis from seven patients (five of whom also participated in the chronic study). As expected, the patients manifested a high anion gap (AG) metabolic acidosis. Serum SO4 was only moderately stable from month to month (the average coefficient of variation was 0.30; correlation between the serum SO4 value of month one and months two and five were r = 0.59, p = 0.026; and r = 0.38, p = 0.182, respectively). The ratio of mean serum SO4 to mean AG (5.0 +/- 0.4 [SE] mEq/L divided by 19.1 +/- 0.5 mEq/L) was 0.26. Although there was a statistically significant correlation between the serum SO4 and the blood urea nitrogen (BUN), there was no such correlation between SO4 and AG. A single hemodialysis reduced serum SO4 by 54% (from 3.5 +/- 0.5 mEq/L to 1.6 +/- 0.1 mEq/L), but there was no correlation between the change in SO4 and the change in AG. The authors concluded that SO4 contributes importantly to the elevated AG in patients receiving chronic hemodialysis. Single pass bicarbonate hemodialysis temporarily reduces, but does not normalize, both the serum SO4 and the AG of such patients.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Enterovesical fistula caused by a prosthesis made of synthetic material].

Enterovesical fistulas affect mainly male patients, due to the interposition of the uterus in women. They can be caused by neoplastic, inflammatory or traumatic processes. A case of ilovesical fistula due to migration of a silastic plate used to repair an epigastric infissional hernia is presented. This case has two distinctive features: first, the cause is extraurological, causing a fistula between both systems due to an inflammatory process. Secondly, we report the long distance travelled by the synthetic mesh, causing a peculiar clinical picture five years after its implantation.

Female↗
PubMedDate not supplied

The anion gap of patients receiving bicarbonate maintenance hemodialysis.

To compare the effect of maintenance bicarbonate hemodialysis on the serum anion gap (AG) and the serum HCO3, the authors retrospectively evaluated the data of 28 patients using the first-of-the-month blood chemistries. Data were available for at least 9 of the previous 12 months in each case. For the entire group, the average AG was 15.8 +/- 0.1 mEq/L and the HCO3 21.7 +/- 0.2 mEq/L. Comparing these values with the data compiled recently by three different groups of investigators in undialyzed patients with severe chronic renal failure indicates that the AG of the dialyzed patients was similar to that of untreated patients, but the HCO3 levels of dialyzed patients averaged 2 to 3 mEq/L higher. Separate prospective evaluation of the acute effect of two consecutive bicarbonate dialyses in 31 patients revealed that the average acute (immediate postdialysis) decrease (from predialysis values) in AG was only about 40% of that of the increase in HCO3. The authors conclude that bicarbonate dialysis is more effective in improving serum HCO3 than AG.

Acid-Base Equilibrium↗