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Biomedical subjects

R Rivera

Publications and source records attributed to R Rivera.

204 records · Page 12Linked to original sources
PubMedDate not supplied

Double outlet left ventricle (report of a case with intraventricular surgical repair).

A case of successful surgical treatment of double outlet left ventricle is reported. In a 7 year-old patient with this rare congenital cardiac malformation, situs solitus of the viscera and atria and concordant connexion of atria and ventricles, d-malformation of the great arteries with the aorta to the right and slightly posterior to the pulmonary artery, large doubly committed ventricular septal defect and neither a subpulmonary nor subaortic infundibulum, the repair was achieved performing intraventricular rerouting of the blood from the right ventricle to the pulmonary artery and closing the interventricular communication with a synthetic patch.

Angiocardiography↗
PubMedDate not supplied

[Septicemia in patients with cancer].

Twenty nine patients with the histological diagnosis of cancer and with positive blood cultures are presented. The majority of this group presented tumor activity at the time of developing septicemia. Some of these patients presented a history of recurrent infections. Only 20% of this population had no history of infection preceeding septicemia. The majority of the patients presented leucopenia and thrombocytopenia. All of the patients admitted to the Oncology Unit showed fever but no clinical evidence of the site of the infection. Several cultures were made but the patients were started at once on systemic antibiotics. The antibiotic combination used in every case was freely selected according with the physician's criteria; however, six patients were not treated with antibiotics and died. There was a definitive predominance of gram-negative blood cultures. The mortality in this group was 68% and was secondary to three main factors: those patients which were not treated with any antibiotic; granulocitopenia and inadequate selection of the antibiotic used in some of the patients. Pertinent literature regarding infection and cancer was reviewed, including the cause/effect of chemotherapy, radiotherapy and surgery, as well as other factors, such as the immunosuppression produced by the malignant disease. Emphasis is placed on the usage of prophylactic antibiotics in patients with cancer, neutropenia and fever of unknown origin.

Adolescent↗
PubMedDate not supplied

[Trends in thyroid surgery at the Instituto Nacional de la Nutrición Salvador Zubirán].

The diagnosis and treatment of thyroid disease has significantly changed with time. With the aim of analysing changes in thyroid surgery in our institution, a representative sample of patients from the first three years in four decades (1960-1992) were comparatively analysed. In the sixties, the diagnosis of thyroid cancer was made during surgery; by contrast, this diagnosis was correctly done by fine needle aspiration (FNA) in most patients of the last decade. Thyroid lobectomy, infrequently used in the treatment of differentiated thyroid carcinoma in earlier times, has now been abandoned and currently most patients undergo total or near-total thyroidectomy. Complications such as hypoparathyroidism and recurrent laryngeal nerve paralysis have importantly decreased with time and were not seen in the last decade. A trend toward an earlier diagnosis of thyroid carcinoma was also observed. In summary, the number of thyroidectomies for benign diseases has been importantly reduced by the use of FNA with the proportional increment of surgery for malignant disease.

Adenoma↗
PubMedDate not supplied

[Surgical treatment of multinodular goiter at the Instituto Nacional de la Nutrición Salvador Zubirán].

BACKGROUND: Surgical treatment is the first option for patients with obstructive multinodular goiter. The extent of the resection and the use of postoperative hormonal therapy are, on the other hand, still under debate. OBJECTIVE: To analyze the results of surgical treatment in 101 patient with multinodular goiter seen from 1980 to 1995. MATERIALS AND METHODS: The clinical/pathologic charts of all patients were reviewed with emphasis to the clinical diagnosis, extent of resection, final histology, type and number of complications, and long-term follow-up. The mean follow-up was three years (range 0.5-12). RESULTS: Ten males and 91 females with a mean age of 46 years were included. Surgery was recommended for a nodule suspicious of malignancy in 60 patients, for airway compression in 33, and for cosmetic reasons in eight. Unilateral lobectomy was performed in 30, bilateral subtotal thyroidectomy in 55 and total thyroidectomy in 16. Postoperative hormone therapy was administrated to 83 patients. Surgical complications occurred in six patients. Four developed permanent hypoparathyroidism and two vocal cord paralysis. There was no operative mortality. A final diagnosis of multinodular goiter was established in 89 whereas 12 had cancer. There were three asymptomatic recurrences in the group with benign lesions (they had undergone unilateral lobectomy followed by hormonal therapy). CONCLUSION: Bilateral subtotal thyroidectomy was the best treatment for multinodular goiter in our series. This procedure had few complications and there was no recurrence of the disease.

Adolescent↗
PubMedDate not supplied

[Anaplastic carcinoma of the thyroid at the Instituto Nacional de la Nutrición Salvador Zubirán].

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is a highly aggressive tumor with a median survival rate of 6 months. AIM: To analyze presentation, treatment, morphology, immunohistochemistry, and nuclear DNA analysis of a cohort of patients with ATC. PATIENTS AND METHODS: Twelve patients with ATC (11 female) with a mean age of 65 years were seen at our hospital from 1970-1995. The data were obtained from the clinical records and the morphology, immunohistochemic studies and DNA pattern were performed in slides obtained from archival specimens. RESULTS: Previous or coexisting thyroide disease was documented in 10 patients (9 multinodular goiters and one Grave's). The most frequent presentation was a rapidly growing tumor associated with dysphagia, cervical pain, hoarseness and dyspnea. A cold thyroid nodule was detected by thyroid scan in 10 patients. The most frequent subtype was the spindle cell variety. Papillary thyroid carcinoma coexisted in eight cases, two of them corresponded to the tall cell variant. Reactivity for S-100 protein and vimentin was studied in six patients: all were positive for S-100 protein and vimentin, 5/6 for epithelial membrane antigen, half for carcinoembriogenic antigen, 2/6 for thyroglobulin and calcitonin, and one for neuronal specific enolase. These six tumors showed a diploid DNA pattern. Tumor resection was achieved in 2/11 and none survived six years after diagnosis. CONCLUSIONS: ATC is a highly aggressive tumor coexisting with thyroid pathologies. Spindle cell variant is the most frequent with positive reactivity for S-100 protein, vimentin and epithelial membrane antigen. Most tumors have a diploid DNA content.

Aged↗