Anesthetic management with laryngeal mask in a child with Brachmann-de Lange syndrome.
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Anesthesia, Inhalation↗
Biomedical subjects
A López García
Publications and source records attributed to A López García.
[Lung transplantation in rats: a viable experimental model].
OBJECTIVES: To incorporate a new fast, safe, and reversible anesthetic procedure into the experimental model of lung transplantation (LT) using a cuff technique originally described by Mizuta. MATERIAL AND METHOD: Eighty-eight Sprague-Dawley rats were used in the experimental model. Thirty left LTs were performed, using 60 rats. The donor heart-lung block was excised by median sternotomy with dissection of the left lung and cuffs (intravenous catheters cut into 3-mm sections) were put in place. The left lung was implanted in the recipient by lateral thoracotomy using the cuffs for anastomoses. The duration of surgery and postoperative complications were recorded. Also noted were signs of ischemia-reperfusion injury, and acute rejection of the transplanted lung. RESULTS: We discarded lungs excised from 8 animals when developing the experimental model. Transplants could not be completed in 10 rats due to technical problems, despite satisfactory excision. Of the rats who received a transplant, 4 died in the first 24 hours and 26 survived to 48 hours. They were then killed and examined. The state of the anastomoses was good and signs of ischemia-reperfusion injury, as well as acute rejection were observed in the parenchyma of the transplanted lung. CONCLUSIONS: LT with cuffs in rats is a valid, reliable, reproducible, and cheap model for studying ischemia-reperfusion injury and rejection in LT. The surgical technique is complex, requiring experienced surgeons and a long learning process. Modification of the technique to more closely resemble the surgical procedure in humans is possible, thus facilitating interpretation and allowing more reliable extrapolation to humans.
Animal Experimentation↗
[Malnutrition prevalence in institutionalized elderly people in Valencia Community, Spain].
BACKGROUND: The goal of this study was to know the prevalence of malnutrition in an institutionalized elderly population according to age and sex. PATIENTS AND METHOD: We studied 615 institutionalized patients, with a mean age (SD) of 79.33 (9.07) years. Anthropometric parameters included weight, height, knee-heel length, tricipital and subescapular skin folds, arm perimeter and fat mass. Biochemical parameters included: total cholesterol, triglycerides, albumin, prealbumin, transferrin,retinol-binding protein, C3 and lymphocyte count. Malnutrition prevalence was 26.87% (CI 95%, 23.15-30.86), 29.08% (CI 95%, 22.82-35.97) in men and 25.59% (CI 95%, 25.01-30.61) in women. Anthropometric parameters were found to be decreased in all malnourished patients. Significant decreases in albumin and retinol-binding protein concentrations were observed in some age groups of malnourished patients. We also found a decrease in the total cholesterol level in parallel to an age increase in both sexes, regardless of the nutritional status. Triglyceride levels were significantly decreased in both males and females with malnutrition. CONCLUSIONS: We detected a high prevalence of malnutrition, yet lower than reported in other studies with similar age groups.
Aged↗
[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia].
OBJECTIVE: Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization. MATERIAL AND METHOD: One hundred epidural catheters were studied in two groups (A and B) of 50. Group A catheters contained stylettes and the distal ends were open (Vygon). Group B catheters contained no stylettes and had closed distal ends and three side openings (Becton Dickinson). Continuous epidural anesthesia was simulated with half the catheters in each group (25) by touching the distal end of each line with the gloves and later inserting the catheter through a Tuohy needle. All catheters--those used in the simulation as well as the untouched ones--were then examined under a scanning electron microscope. The particles on the internal and external surfaces of the gloves had previously been identified under a microscope and analyzed by X-ray diffraction. RESULTS: Gloves: external glove surfaces carried particles measuring between 3 and 4 mu; their morphology was consistent with calcium carbonate. On internal surfaces we found larger particles, between 11 and 14 mu in diameter, shaped differently and of smooth appearance. Analysis of the latter showed them to contain traces of magnesium and to have characteristics consistent with organic molecules. The particles of one surface were never observed on the other. Catheters: the non-manipulated catheters in both groups contained no free particles matching those described above, whereas the outside surfaces of the catheters in contact with gloves contained particles consistent with those of external glove surfaces. The number of particles per square millimeter of surface was 2,598 (95% CI 2,200 to 2,900) in group A catheters and 2,340 (95% CI 2,000 to 2,600) in the group B catheters (p = NS). The differences in the number of particles adhering to catheters touched by gloves and those that had not been manipulated were statistically significant (p < 0.001). CONCLUSIONS: Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.
Anesthesia, Epidural↗
[Thickness variation of the dural sac].
OBJECTIVE: To measure carefully the thickness of the dural sac and evaluate possible variation in recently removed human specimens that had not yet undergone postmortem change. The thickness of the dural membrane is of interest because of its function as a barrier during diffusion processes and during closure of spinal lesions. MATERIAL AND METHODS: After receiving the consent of our hospital's ethics committee and the family of the deceased, and immediately after extraction of organs for transplantation, we removed the dural sac and nerves contained therein from the cadaver of 56-year-old patient diagnosed of brain death. The membrane was dissected and 240 measurements of thickness were made over the entire surface of the sample. A micrometer was used, controlled through a surgical microscope. To analyze variations in thickness, the specimen was divided into 48 zones. RESULTS: The dural sac open on its anterior side was treated as a rectangular membrane measuring 130 x 54 mm. Mean thickness of the sample was 0.322 mm. Mean thickness of anterior zones was 0.353 mm, with no significant differences among them. Posterior zones measured a mean 0.295 mm with significant differences among them (p < 0.001). Up to the second lumbar root, anterior and posterior zone thicknesses presented no significant differences. However, after the space between the second and third lumbar roots, the posterior side was significantly thinner. Where the first, second and third lumbar roots emerged, we measured thicknesses of 0.315, 0.361 and 0.322 mm, with no significant differences among anterior, posterior and side zones on any level. At the fourth lumbar root and in the spaces of the dura mater between the emergence of the first and second, the second and third, the third and fourth and fourth and fifth lumbar roots, we observed significant differences. The measurements were 0.298 mm (p < 0.01); 0.348 mm (p < 0.01); 0.337 mm (p < 0.001), 0.306 mm (p < 0.01); 0.289 mm (p < 0.001), respectively. CONCLUSION: Possible inter- or intra-individual variation in dural sac thickness is an unpredictable variable affecting the management of dural lesions. The data we report on thickness allow for future objective assessment of the maximum sizes recommended for the lateral orifices of bevelled, pencil-point needles in order to avoid straddling the membrane when subarachnoid anesthesia is given. The data also contributes to the study of substance diffusion through this membrane.
Dura Mater↗
[New results in the visualization of the spinal dura mater with scanning electron microscopy].
UNLABELLED: Although there are various published descriptions of the dura mater spinalis [4, 7, 9, 11, 16], some points relating to the texture of the collagen fibres in the dura have still not been adequately explained. In this study the orientation of the collagen fibril bundles was revealed with the aid of scanning electron microscopy, and our observations have yielded new insights into the three-dimensional structure of the human dura mater spinalis. MATERIALS AND METHODS: The preparations used were taken from the bodies of four persons who had died of acute cardiac infarct at the ages of 70-78 years. The histories of these patients gave no indications of earlier neurological, endocrine or septic illnesses. The tissue examined was taken 8-12 h after death in all cases; it was immediately fixed in glutaraldehyde and then processed for scanning electron microscopy in the usual way. RESULTS: In the outermost (epidural) layer of the dura mater spinalis the collagen fibres are bunched together in bands that run in all directions. Elastic fibres 2 mm thick are woven into this three-dimensional network of collagen systems. On the inside (the arachnoid side) thin collagen fibres are fused into layers in such a way that the innermost layer resting on the arachnoid has a smooth, shiny appearance comparable to that of a serosa. It is attached to the actual dura with a supporting band of connective tissue. Rests of the subdural neuroepithelium could contribute to the smooth appearance of the superficial aspect. CONCLUSIONS: The outermost layer of the dura is made up mainly of collagen fibres, which run in all three directions--longitudinal, horizontal and transverse--both singly and in groups. These findings are at odds with "classic" descriptions, according to which the fibres in the dura mater spinalis all have a parallel course with a longitudinal orientation in tangential sections.
Aged↗
[Anatomical description of a natural perforation present in the human lumbar pia mater].
OBJECTIVE: The pia mater has always been considered more permeable than other meningeal membranes. Natural pia mater perforations found in some animals at-test to this membrane's permeability. Such perforations, however, have never been demonstrated in human tissue. Our objective was to study human pia mater from the dorsal lumbar region, looking for perforations that facilitate the diffusion of substances to the spinal cord following subarachnoid administration. MATERIAL AND METHOD: The specimens were removed from four human cadavers aged 70, 72, 77 and 78 years between 8 and 12 hours after death. The specimens were fixed in a phosphate glutaraldehyde buffer solution, followed by desiccation in acetone and critical point elimination of acetone, treatment with carbon and metallization with gold. RESULTS: The pia mater was composed of a smooth surfaced, thin layer of cells and underlying connective tissue formed mainly of collagen fibers and fundamental amorphous matter. The collagen fibers were oriented in various directions. Throughout the surface of the pia mater, natural circular, elliptical and ovoid perforations were distributed irregularly. Size varied. Most measured over 10 to 15 micrometers in diameter or less than 5 to 8 micrometers. Inside the openings, fibers similar to collagen fibers could be seen at the point where they would normally be found beneath the cell layer. CONCLUSION: The total thickness of the pia mater varies in different zones of the spine, as a result of variations in the thickness of the cell layer and in the underlying extracellular layer. The existence of natural fenestrations in all the analyzed specimens of human dorsal lumbar pia mater accounts for the high permeability of this membrane, which permits substances administered in spinal fluid to reach the spinal cord. These natural fenestrations are areas where the cell surface in absent, with underlying collagen fibers usually visible. The pia mater is generally believed to be composed of a complete cell layer that forms a barrier between the central nervous system and the subarachnoid space; however, the presence of fenestrations would indicate that such a barrier does not exist, the base membrane being placed under the connective fibers, the only intact structure prior to medullary glial cells.
Aged↗
[Does the subdural space exist?].
A potential space between the dura mater and the arachnoides is thought to exist, occupied by a serous fluid and called the subdural space. Recent studies may change this classical concept, however. The dura-arachnoid complex from the epidural to the arachnoid space is formed by morphologically distinct layers: the dura mater, the subdural compartment and the arachnoid mater, which are made up of different cell types. The dura mater consists of greater and lesser laminae formed mainly of collagen fibers aligned differently. The subdural compartment is formed by a number of so-called "neurothelial cells", which are in close contact with the inner dural layers. These cells are flat and have long interlaced branches. The arachnoides are made of cells grouped in three different layers. The outer layer is the "barrier arachnoid layer". Located just inside the anterior cell plane, this layer is made of less flattened cells that form an epithelial-type tissue, with complex cell-cell junctures surrounded by collagen fibers. The middle layer is the reticular arachnoid, composed of irregularly interlaced cells alternating with collagen fibers and intercellular gaps of varying sizes. The innermost layer, the trabecular arachnoid, is in direct contact with the subarachnoid space. The cells of this layer form strands that contribute to the weblike pattern found in the subarachnoid space. Recently, special techniques for fixing and preparing samples, preserving in situ the anatomical relations between the arachnoides and the dura mater, have allowed us to examine the normal configuration of the subdural space. All samples examined revealed the presence of a cellular plane between the dura mater and the arachnoides, with no evidence of the classically described space. The zone of least resistance in the dura-arachnoid complex was the subdural compartment, which could be torn mainly along intercellular spaces, though cell rupture was also observed, affecting the cytoplasmic membranes of adjacent cells. The subdural space is opened by tearing the subdural compartment between neurothelial cells alongside the collagen fibers of the dura mater. Such a tear can be caused mechanically by injecting air or contrast media, which exert pressure on a laminar structure that tends to separate because it is weaker than neighboring ones.
Animals↗
High performance liquid chromatography methods for studying protein binding of aluminium in human serum in the absence and in the presence of desferrioxamine.
Ion-exchange high performance liquid chromatography of serum proteins was combined with aluminium determination by electrothermal-atomisation-atomic-absorption spectroscopy and fluorimetry for studying the distribution of aluminium in human serum in the absence and in the presence of desferrioxamine. Aluminium was eluted as a single peak in the same fraction as transferrin. However, following the addition of desferrioxamine most of the aluminium was liberated from transferrin and become attached to the chelator.
Aluminum↗
[Expansive intraorbital processes].
The authors report thirteen orbital tumors seen in their service, describing incidence, exophthalmos, sex, visual and papillar changes, alteration of the extrinsic and intrinsic eye muscles, radiology, surgical treatment and evolution.
Adult↗
[Partial defect in hypoxanthine-guanine phosphorisbosiltransferase in Berger's disease in a young gout patient].
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Adult↗
[Commentary on the letter: "Azathioprine and cavum carcinoma in a male patient with autoimmune hepatitis and Crohn's disease"].
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Azathioprine↗
[Correlation between Blatella germanica and Periplaneta americana in allergic patients].
BACKGROUND: It has been identified shared allergens from whole body between Blatella germanica and Periplaneta americana. It has been reported high correlation between both cockroaches. OBJECTIVE: To estimate correlation between skin test for two major species of intradomiciliary cockroaches. METHODS: It was included patients with clinical diagnostic of allergy pathology whom attended to external consult of Allergy and Clinical Immunology Service of the Hospital Universitario de Puebla in a period of six months, prick skin tests with standardized antigens of Blatella germanica and Periplaneta americana were made. RESULTS: One hundred twenty patients were enrolled in the study, 54.2% were women and 45.8% were men, with a mean age of 15.7 years old. The correlation coefficient between Germany cockroach and American cockroach to erythema was 0.49 and to papule was 0.40. CONCLUSION: The outcomes showed a moderate correlation or a considerable relation between both cockroaches whether erythema or papule. Based on the results presented, we suggest to evaluate both antigens in order to improve diagnostic accuracy.
Adolescent↗
[Efficacy and safety of fexofenadine and cetirizine in the treatment of allergic rhinitis].
BACKGROUND: Allergic rhinitis affects 20 million of people in United States and a higher figure all around the world. OBJECTIVE: To evaluate the efficacy and safety of fexofenadine compared with certirizine in the treatment of allergic rhinitis. MATERIAL AND METHOD: It was carried out a prospective, double blind, comparative, randomized and multicentric study in patients with allergic rhinitis, with ages between 12 and 65 years. In the first phase, placebo was administered during three days to all the patients; and then, they were randomly allocated to receive fexofenadine 120 mg or cetirizine 10 mg in one dose a day during 14 days. Laboratory and cabinet tests at the beginning and at the end were performed to value security, as well as a global evaluation of the researcher to estimate effectiveness. RESULTS: 176 patients were included, 63.6% were women, average age was 27 years (+/- 12), 47.7% received fexofenadine and 52.2%, cetirizine. There was not significant difference in parameters of effectiveness nor of security in the studied group. CONCLUSION: The results of the present study confirm the efficacy and safety of the antihistaminic fexofenadine in the treatment of allergic rhinitis.
Adolescent↗
[Reference values of T-lymphocyte subsets in umbilical cord blood].
In order to determine reference values of T lymphocyte subpopulations in cord blood in the metropolitan area of Puebla city we randomly selected 80 from a total of 400 term, eutrofic and without pathology newborn. The percentage of CD3, CD4 and CD8 T lymphocyte subpopulations in cord blood were determined by flow cytometry. Reference values were gotten from the 25 and 75 percentile in parameters without gaussian distribution. Reference values are CD3 (45.5 to 91.3%), CD4 (26.2 to 69.4%), CD8 (16.2 to 24.1%) and NK (2.0 to 8.5%). The presented data represent valuable normal ranges of T lymphocyte subsets to compare with values observed in sick or in risk of developing immunoallergic pathology children.
Cross-Sectional Studies↗
[Anesthesia of a patient with morbid obesity: anesthetic and logistic management].
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Adult↗
[Incidence of adverse reactions to immunotherapy in allergic patients at Puebla University Hospital].
MATERIAL AND METHOD: In order to know adverse reaction incidence to, immunotherapy, it realized a longitudinal, prospective and descriptive study in patients of outward consultation of Allergy Immunology Clinic Service of Hospital Universitario de Puebla in a period of 10 months. It determined age, sex, diagnostic, reaction adverse kind and presentation time of them. Initial immunotherapy dose was 0.05 ml administered subcutaneously with treatment antigens 1:100 weight/volume without premedication. It included 170 patients with average age of 22.6 years (SID 15.4), 56.5% female sex and 43.5% male. RESULTS: Most frequent pathologics were asthma and rhinitis. Adverse reactions incidence at specific immunotherapy were 2.4%, all of them were of immediate and local kind. CONCLUSION: These results are influence by the concentration and dose of antigens utilized and may differ of another studies.
Adult↗