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Biomedical subjects

A Mora

Publications and source records attributed to A Mora.

106 records · Page 6Linked to original sources
PubMedDate not supplied

[Anesthetic approach in 2 patients with pulmonary lymphangiomyomatosis].

Pulmonary lymphangiomyomatosis (PLM) is an idiopathic disease of females in fertile age. It results in respiratory failure characterized by obliteration of the small airways, emphysema, formation of bullae, hemoptysis, pneumothorax, pulmonary fibrosis, severe hypoxemia and reduced carbon monoxide diffusion capacity. The major lymphatic ducts are also involved, resulting in chylous pleural effusion and ascites. Pulmonary abnormalities improve objectively and subjectively after surgical therapy, which consists in bilateral oophorectomy. Its evolution results in death in no more than 10 years. We report the anesthetic approach to 2 patients with PLM. Patient 1 was a female who had already been diagnosed of PLM and had received medical and surgical therapy, requiring reoperation for the resection of cystic intestinal masses and abdominal eventration. Patient 2 had been scheduled for bilateral oophorectomy after a diagnosis of PLM. We discuss the clinical condition of both patients, the course of the disease, the previous treatments and the anesthetic technique in each case.

Adult↗
PubMedDate not supplied

[A rare complication of endotracheal intubation: posterior luxation of the left arytenoid cartilage].

The luxation of the arytenoid cartilage is a very uncommon complication of endotracheal intubation. Symptoms usually are aphonia, dysphonia, pain or discomfort in the throat, odynophagia and laryngeal stridor. It may be due to several factors: the pressure of the convex aspect of the tube on the arytenoid, traumatic or prolonged intubations, reintubations within a short period, or some systemic diseases. We report a case of posterior luxation of the left arytenoid in a patient who had been anesthetized for the radical cure of a left inguinal hernia. The clinical features developed when he recovered from anesthesia, with aphonia and discomfort in the throat. The diagnosis was made by indirect laryngoscopy. Treatment with nonsteroidal antiinflammatory agents was instituted. Aphonia disappeared after 2 weeks and dysphonia persisted. The patient became asymptomatic with corticosteroids on the fourth week after operation. Early diagnosis under laryngoscopic vision is recommended, with adequate therapy to prevent fibrosis of the cricoarytenoid joint with permanent sequelae.

Adult↗
PubMedDate not supplied

[Anesthesia in insulinoma surgery: report of 18 cases].

We reviewed 18 patients operated on insulinoma during the last 16 years (1974-1990). The previous symptoms, the clinical and biochemical diagnostic procedures, the localization before and during operation, and the medical and surgical treatment are reported. Constant and continuous glucose solution perfusion at the preoperative stage prevented the occurrence of hypoglicemia without interference with the rebound hyperglicemia that follows tumor exeresis. Neuroleptanalgesia with nitrogen protoxide and competitive muscular relaxant agents was satisfactory in all instances. Prevention and treatment of postoperative complications are also discussed in this study.

Adolescent↗
PubMedDate not supplied

[Myasthenia gravis].

The present review updates myasthenia gravis. Immunopathogenesis of this condition, the clinical picture and degrees of involvement according to Osserman's classification, diagnostic procedures currently available, medical treatment and repercussion on the patient who is going yo be thymectomized are discussed. We review the works of several authors as far as concern to the use of muscle relaxants in myasthenic patients, peroperative monitoring of neuromuscular blockade, anesthetic techniques to be used, analgesia and intensive care required during postoperative period.

Anesthesia↗
PubMedDate not supplied

[Myasthenia gravis: thymectomy. Muscle relaxation with atracurium besilate].

We have carried out a prospective study on the use of the muscle relaxant, atracurium besilate, in 10 patients with myasthenia gravis, seven had type IIB and three had type IIA, who were scheduled for thymectomy, using ED95 0.20 mg/kg, and ten non myasthenic patients undergoing cholecystectomy using ED95 0.50 mg/kg. After monitoring neuromuscular transmission, the time for establishing maximum blockade (EMB), clinical efficacy time (CET), recovery index (RI) and total duration time (TDT) were measured and evaluated comparatively. Results showed that in myasthenics patients, EMB was faster, CET an TDT were more prolonged and RI was higher than in non myasthenic patients. We conclude that atracurium at doses of 0.20 mg/kg is currently the non depolarizing muscle relaxant of choice in myasthenic patients because of the excellent muscle relaxation allowing extubation in the operating room without reverting muscle blockade and not needing ventilatory support during postoperative period.

Adult↗
PubMedDate not supplied

[Pheochromocytoma: review of the preoperative treatment and anesthesiologic technic in 14 patients].

Fourteen patients operated for pheochromocytoma from 1978 to 1988 are reviewed. The preoperative treatment with adrenergic blockers is analyzed: phenoxybenzamine with final doses of 10-140 mg/day (mean 55.4 mg/day) and propranolol with doses of 40-80 mg/day (mean 50 mg/day). The premedications and anesthetic techniques are compared, the use of droperidol being discouraged because of the development of hypertensive paroxysms both preoperatively and postoperatively. The new benzodiazepines are offered as an alternative. The treatment of hypertensive paroxysms with phentolamine with total doses of 2.5-35 mg and that of peroperative arrhythmias with propranolol with total doses of 1-6 mg are reported. The recently described therapeutic approaches are also discussed.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Verrucous carcinoma of the cervix uteri: report of a case.

A case of verrucous carcinoma of the cervix uteri is reported. The cytologic findings in a Papanicolaou smear of the cervical area that permitted a diagnosis of verrucous carcinoma as opposed to epidermoid carcinoma or hyperkeratotic severe dysplasia are described. The importance of a proper diagnosis of verrucous carcinoma in order to avoid its treatment by radiation is stressed since verrucous carcinoma can turn into a more aggressive malignancy after such treatment.

Aged↗
PubMedDate not supplied

[Adenosine triphosphate in the peroperative management of hypertensive crises and heart rate disorders in the surgical treatment of pheochromocytoma].

OBJECTIVE: To assess the hypotensive and antiarrhythmic effect of adenosine triphosphate (ATP) and its impact on hypertensive crises and heart rhythm abnormalities resulting from surgery to remove pheochromocytoma. PATIENTS AND METHODS: A prospective study of 7 patients with pheocromocytoma who were scheduled for unilateral (4) or bilateral (3) suprarenalectomy prior to treatment with phenoxybenzamine and propranolol. The anesthetic procedure was the same for all patients, as was monitoring: ECG, digital pulse oximetry, capnography, direct recording of arterial pressure by a catheter in the left radial artery and a Swan-Ganz fiber optic catheter in the pulmonary artery to measure pulmonary pressures and mixed venous oxygen saturation. Minute volume was measured by thermodilution. Blood glucose levels and urine excreted through a catheter were recorded hourly during surgery. During surgery, when arterial pressure had risen 20% above baseline level, i.v. infusion of ATP 0.5 mg/kg/min was begun and adjusted up or down depending on patient response. Infusion was stopped when the suprarenal vein had been tied. Hemodynamic analysis was performed during 4 phases: 1) start of surgery; 2) during manipulation of the tumor; 3) after excision, and 4) after surgery. Hemodynamic and metabolic variables were recorded, as were ATP doses and requirements for vasopressors and antiarrhythmic drugs. RESULTS: We found the following changes between phase 1 and phase 2, coinciding with ATP infusion: systemic arterial pressure increased 22.2%, heart rate increased 28.04% (with no cardiac arrhythmia observed in any patient), pulmonary artery pressure rose 25.35%, pulmonary capillary pressure rose 22.17%, cardiac index rose 108% while systemic vascular resistance decreased 55.82% and pulmonary vascular resistance decreased 33.96%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMedDate not supplied

[Comparative study between 10 and 20 mg of cetirizine in the symptomatic treatment of seasonal allergic rhinoconjunctivitis].

Our patients with seasonal allergic rhinoconjunctivitis usually present severe clinical symptoms. A single daily dose of cetirizine 10 mg might be insufficient for these patients. To investigate this hypothesis we compared clinical efficacy and adverse side effects between two daily doses of cetirizine, 10 and 20 mg. We designed a comparative open randomized study, including 38 patients, with hay fever sensitized to local pollens (grass, olive, parietaria judaica, chenopodium album, artemisia vulgaris and plantago lanceolata) diagnosed by clinical history and a positive skin prick test (wheal > 3 mm), 20 women and 18 men, aged 17 to 57 years (x: 31.32 +/- 9.73), living in the same geographic area. Randomly, after a week run in period, 21 subjects received a daily dose of cetirizine 10 mg during 2 weeks, and the other 17 received 10 mg twice a day. The symptomatic score used was based on: sneezes number, nasal itching, nasal secretion, nasal congestion, ocular itching, lacrimation, weight gain, sedation and additional methylprednisolone usage. All symptoms were scored on a 0-3 scale (0: absent; 1: mild; 2: moderate; 3: severe). A mean 8 points daily score during the previous week was required for recruitment. Nasal eosinophilia was determined at baseline and at the end of treatment. The study was conducted in may 1992. We did not find significant differences between the two groups, except in sneezes number and sedation. Both groups improved their symptoms, in comparison with the basal week (p < 0.01) and reduced their oral steroid use (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Comparative study] of beclomethasone and budesonide, with same posology (400 micrograms every 12 hours), in the control of cortico-dependent intrinsic asthma].

Inhaled steroids have rendered an undoubtful benefit in the control of airway inflammation of the asthmatic patients. Our objective was to compare clinical efficacy between budesonide (BUD) and beclomethasona depropionate (BDP), when administered at equal doses (800 micrograms/24 hours). A two ways crossed open clinical trial was designed. Thirty-three steroid dependent chronic asthmatic patients (18 females, 15 males) were included. Ages ranged from 29 to 73 years (mean = 52.5 +/- 11.7). All subjects suffered a severe asthma, with several years of activity (mean = 11.7 +/- 7.8), insufficiently controlled by inhaled steroids and bronchodilators, who required regular systemic steroids supply. The parameters compared were: the patients subjective symptoms punctuation (cough, expectoration, thoracic noises, exercise induce dyspnea and dyspnea at rest), salbutamol needs (number of inhalations/day), additional prednisone needs, sputum eosinophil counts, FEV1 measurement and inespecific bronchial reactivity control (PD20 methacoline). After a baseline week patients received one of the drugs for 6 weeks and, after a lavage week, the other drug was administered for another 6 weeks. All patients improved with both therapies. We got the following conclusions: 1) a significative decrease in salbutamol (p < 0.05-0.001) and prednisone needs (p < 0.05-0.001); 2) this decrease has been more important during BUD therapy, although without significative differences; 3) no significant variations in sputum eosinophils, FEV1 or bronchial reactivity were observed; 4) both drugs, when administered at equal doses, have probed to be equally effective in severe steroid dependent asthma control.

Adult↗
PubMedDate not supplied

[Prevalence of E. coli O157:H7 in a pediatric population in Bogotá, D.C. with acute gastroenteritis].

BACKGROUND: The aim of this study was to determine the prevalence of E. coli O157:H7 in pediatric patients with acute gastroenteritis (AGE). PATIENTS AND METHODS: A prospective epidemiologic study was performed in cases and controls to detect the germ in fecal samples of 300 children with AGE in Bogotá, D.C. The stools of the patients and 85 controls were seeded in MacConkey-sorbitol agar. The sorbitol negative colonies were biotyped and seroagglutinated with a latex test for E. coli O157:H7. Antimicrobial susceptibility was performed after using the Bauer & Kirby method. RESULTS: Of the 300 diarrhea specimens analyzed, 14 strains corresponded to E. coli O157:H7 with a prevalence rate of 4.7% in children with AGE. The prevalence was 1.14%, the excess of risk of presenting E. coli O157:H7 was 14% in children with AGE. One child developed SUH. In three of the 85 controls E. coli O157:H7 was isolated, with a prevalence rate of 3.53%. The mean age of the 14 patients was 21 months (range: 3 months to 7 years) and the mean length of diarrhea in the children was 2 days. All the isolations of E. coli O157:H7 were sorbitol negative and indol negative with only 2 strains being MUG negative. DISCUSSION: This epidemiologic study has, for the first time, demonstrated the strong prevalence of E. coli O157:H7 in Colombia. The clinical data do not show a common pattern. Whether the strains isolated in the study are verotoxin producers remains to be demonstrated.

Case-Control Studies↗