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Biomedical subjects

A Rosales

Publications and source records attributed to A Rosales.

At least 19 recordsLinked to original sources
PubMed2006

External venous valve plasty (EVVP) in patients with primary chronic venous insufficiency (PCVI).

OBJECTIVES: To evaluate the patency of EVVP and its effect in symptom relief, ulcer healing and ulcer-free period in patients with PCVI. METHODS: Between 1993 and 2004, 1800 patients with CVI were evaluated and seventeen with PCVI were selected for EVVP. They were all investigated with ambulatory venous pressure measurement (AVP), colour duplex ultrasound (CDU), ascending venography and descending video venography. The CEAP classification was used to group the patients. Six patients were C4, four C5 and seven C6. All had deep reflux and high levels of AVP. RESULTS: All procedures were technically successful. The ulcer healing rate was 4/7 (57%) within 3 months. All C4 patients experienced symptom improvement postoperatively and had a median recurrence free period of 72 (range 60-122) months. The C5 group had an median ulcer free period of 61 months (12-72) and the C6 of median 48 (12-72) months. Single valve plasties (4) reached a median competence period of 48 months (12-72), 12 multiple valve plasties at the same level show a median 78 months (63-122) and 10 multilevel repairs median 54 months (12-96). Multiple valve plasties at the same level (multi-station plasties) performed on the C4 group seemed to yield the longest durability with a median of 103 months (84-122). CONCLUSION: EVVP with an ulcer healing rate of 57% and satisfactory symptom improvement seems to be an alternative of surgical treatment for selected patients with PCVI. The durability of this technique seems to be related to clinical severity and the multiplicity of repairs.

Adult↗
PubMed2006

Assessment of the arteries in living kidney donors: correlation of magnetic resonance angiography with intraoperative findings.

Comprehensive imaging evaluation of kidney donor anatomy is crucial for selecting candidates for living kidney transplantation and for determining the surgical technique to procure the renal graft. In 76 living renal donors we compared the results of preoperative magnetic resonance angiography (MRA) with the intraoperative findings of arterial anatomy. Donors were evaluated for the number of main renal arteries and the presence of any polar arteries. A total of 80 main renal arteries and five polar arteries were observed at MRA. At surgery, 90 main renal arteries and eight polar arteries were identified. MRA demonstrated a sensitivity, specificity, and overall accuracy of 18%, 98%, and 87%, respectively, for main arteries and 25%, 96%, and 88% for polar arteries. Eleven (14.5%) kidneys displayed more than one main artery and MRA only detected two cases. Eight kidneys had polar arteries and MRA only detected two cases. MRA is a reliable method for presurgical evaluation of renal arteries in potential donors, providing valuable information required by the surgeon. But, as the technique misses small-diameter vessels, it cannot be recommended as the sole diagnostic tool in unclear cases.

Adult↗
PubMed2005

Clamping of the renal artery in laparoscopic partial nephrectomy: an old device for a new technique.

OBJECTIVE: We describe our experience with the transient clamping of the renal artery during laparoscopic partial nephrectomy for renal cancer with a double loop clamping device, inspired by the Rumel tourniquet. The silastic rubber loop is positioned around the renal artery and clinched, thus achieving arterial occlusion. METHODS: From November 2002 until July 2004, fourteen consecutive patients (mean age of 58 +/- 11.6 years) underwent laparoscopic transperitoneal partial nephrectomy using the silastic rubber clamping device, eight of them on the right side and six on the left side. Hemorrhage of the renal defect was controlled with bipolar electrocoagulation, argon beam coagulation, laparoscopic sutures, surgical and fibrin glue. RESULTS: : The mean surgical time was 198.92 +/- 39.95 min for a mean tumour size of 2.9 +/- 2.32 cm and a mean blood loss of 104.57 +/- 77.69 ml. The clamping device was easily and successfully positioned around the renal artery in 2.05 +/- 0.45 min and the mean warm ischemic time was 25.21 +/- 6.07 min. CONCLUSIONS: The clamping device procures successful atraumatic occlusion of the renal artery during laparoscopic partial nephrectomy without the need for an additional port. As such, it could be considered as an alternative for the laparoscopic bulldog and Satinsky clamp.

Constriction↗
PubMed2005

Results and complications of 50 laparoscopic nephrectomies for live donor renal transplantation.

Living donors represent 30% of kidneys for renal transplantation. Laparoscopic nephrectomy is the best surgical procedure due to its clear advantages: low morbidity, less blood transfusion requirements, and shorter donor hospitalization. From March 2002 to August 2004, we performed 50 laparoscopic nephrectomies for transplantation to recipients who were prescribed tacrolimus (0.1 mg/kg bid), mycophenolate mofetil (1 gr bid), and prednisone (0.5-1 mg/kg per day PO from 48 hours before transplantation). Mean surgery time was 170 minutes (120-260); warm ischemia time, 3.1 minutes (1.5-10); and cold ischemia time, 1.27 hours (0.85-4). Mean bleeding was 270 cc (100-900), and mean donor hospitalization was 5.5 days (3-9). Four cases required conversion of the laparoscopic procedure to open surgery because of bleeding. Seventy-two hours posttransplantation, the mean plasma creatinine was 170 micromol/L. None of the patients suffered delayed graft function. Eighteen percent experienced acute rejection episodes. Donor and recipient survivals were 100% at 1 year, and graft survival, 94% (kidney losses were due to acute rejection, severe acute pancreatitis, and surgical complications).

Employment↗
PubMed2005

[The living kidney donor: laparoscopy versus open surgery].

INTRODUCTION: Living renal donors are an important source of transplanted kidneys due to the number of patients on waiting list is progressively increasing. On the other side, they allow the pre-emptive kidney transplantation. With the aim of reducing donor obstacles such as pain, hospital stay or cosmetic results and in creasing the number of living donors, in 1995 Ratner performed the first laparoscopic nephrectomy (LLDN). By now, LLDN is a routine procedure in more than 200 centres worldwide. METHODS: Literature databases are searched. We have reviewed the data from our experience after performing 50 laparoscopic nephrectomies. RESULTS: Preoperative living donor assessment and contraindications to LLDN do not differ from the open approach. Results are very influenced by the surgeon's situation in the learnig curve. Operating times use to be longer in laparoscopic procedures. The overall complication rate and mortality of LLDN are the same for both of the approaches. Conversion to open-donor nephrectomy has been reported in 0-13% of cases (8% in our data). Postoperative pain and donor estimated blood loss are lower for LLDN, as well as the convalescence period. To avoid the possible negative effects of the laparoscopic technique on kidney graft function a lot of method's variations have been proposed for gaining access and harvesting the kidney, including the hand-assistance techniques, with the aim of minimizing operative time, pneumoperitoneus negative effect on graft function and warm ischemia time (WIT). The higher WIT is not related to delayed graft function or acute rejections when it is less than ten minutes. Delayed graft function does not differ in both approaches and creatinine values from the first month until the third year after transplantation show no differences in randomized studies. CONCLUSIONS: The laparoscopic approach to harvest the allograft from the living donor is a save and effective technique and has the advantage of being less invasive and allowing the donor a shorter convalescence. It has no negative effects on allograft function in the short term follow-up. Further studies are required to evaluate long term donor complications and allograft function and survival.

Age Factors↗
PubMed2005

[Outcomes of transplantation from living renal donor].

Living donors represent 30% of our kidneys for renal transplantation. Laparoscopic nephrectomy is the best surgical procedure to obtain them due to its clear advantages such as low morbidity, less blood supply and donor time in hospital. From March 2002 to August 2004 we performed 50 laparoscopic nephrectomies for renal transplantation. Kidneys were transplanted to recipients receiving tacrolimus 0.1 mg/kg/bid, mycophenolate mofetil 1 g/bid and prednisone 0.5-1 mg/kg/day p.o 48 hours before transplantation. Mean time for surgery was 170 minutes (120-260), warm ischaemia time 3.1 minutes (1.5-10) and cold ischaemia time 1.27 hours (0.85-4). Mean bleeding was 270 cc (100-900) and donor time in hospital 5.5 days (3-9). Four cases required conversion of the laparoscopic procedure to open surgery because of bleeding. 72 hours post-transplant mean plasmatic creatinine was 170 micromol/l. None of the patients suffered delayed graft function. 18% presented acute rejection. Survival of donor and recipient was 100% at 1 year and graft survival was 94% at 1 year (kidney losses were due to acute rejection, severe acute pancreatitis and surgical problem).

Anti-Inflammatory Agents↗
PubMed2004

[Living donor nephrectomy for kidney transplantation. Experience in the first two years].

OBJECTIVES: Laparoscopic surgery offers potential advantages in terms of diminishment of postoperative pain, shorter hospital stay, faster convalescence, and better cosmetic results. These advantages may increase kidney donation, making donation be accepted by more candidates. We report our first 2 years' experience with laparoscopic donor nephrectomy METHODS: Between March 2002 and February 2004 we performed 38 laparoscopic living donor nephrectomies for kidney transplantation. The technique of choice was the transperitoneal laparoscopic approach with four trocars, usually three of them from the start of the procedure--two 10-12 mm and one 5 mm--, and a 6.5 cm perumbilical midline incision for kidney retrieval at the end of the procedure. RESULTS: Receptor and donor survivals were 100%. Graft survival was 97.6%. There was not any case of delayed graft function. Donor: Mean operative time was 161 minutes (115-260). Mean estimated blood loss was 270 ml (100-1200). Three patients required blood transfusions, 2 units of packed red blood cells each. Mean hospital stay was 5.1 days (3-11). Mean warm ischemia time was 3.2 min. (2-10). Conversion to open surgery was necessary in four cases. Receptor: there have been three significant complications requiring surgical repair: one case of low arterial flow, one vesico ureteral leak, and one midurethra stenosis. Initial renal function: mean serum creatinine at one month was 147mmol/l, with a trend to improve to 126 mmol/l at one year, which is considered optimum. First postoperative day mean serum creatinine was 192mmol/l and the nadir was on second postoperative day with a value of 152mmol/l. CONCLUSIONS: We believe laparoscopic living donor nephrectomy is a real alternative to open surgery because it offers better recovery to the donor with the same capacity to preserve renal function in the receptor.

Humans↗
PubMed2003

Management and prognosis of transitional cell carcinoma superficial recurrence in muscle-invasive bladder cancer after bladder preservation.

PURPOSE: To assess the bladder preservation rate and cancer-specific survival after conservative treatment of superficial relapses in invasive tumors after bladder preservation. MATERIAL AND METHODS: Fifty-one patients with invasive bladder tumor (T2) were treated using transurethral resection (TUR) followed by three cycles of systemic chemotherapy (carboplatin-vinblastine). After three weeks, an endoscopic reappraisal was made including deep TUR of the site of the original tumor and multiple cold cup biopsies. Forty-two patients retained their bladder (33 complete responses and 9 partial responses). RESULTS: With a median follow-up of 63 months, 18 patients recurred as superficial TCC tumor (43%). Fourteen patients with high grade superficial recurrence were treated with TUR and Bacillus Calmette-Guerin (BCG) instillations; two patients (G2-3 T1) with TUR as well as endovesical mytomicine, and two patients with low grade recurrence with only TUR. With a median follow-up of 44 months after TUR of first superficial relapse, there was only one case with progression of the disease without any evidence of bladder tumor. Two cystectomies were made due to carcinoma in situ (Cis) persistence and high grade superficial recurrence. Eighty-three percent of the patients who had superficial recurrence retained their bladders, with 94% cancer-specific survival. CONCLUSIONS: A very strict follow-up is mandatory due to the high rate of superficial relapses (43%). Cis is the most frequent type of superficial recurrence. Superficial recurrences in bladder preservation may be treated with TUR and BCG instillations when they are high grade and and/or associated with Cis. Superficial recurrences do not imply a worse prognosis for bladder preservation or cancer-specific survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

Endoscopic approach of the overinfected urachal cyst.

The overinfected urachus cyst presents itself in quite different forms. In spite of the accuracy of ultrasound and abdominal CT scan, sometimes the diagnosis of this urachal abnormality is imprecise and even misleading. This article describes the transvesical endoscopic drainage of an infected urachal cyst with optimum result upon the treatment of this condition.

Adult↗
PubMed2001

Evaluation of human exposure to ambient PM10 in the metropolitan area of Mexico City using a GIS-based methodology.

The main goal of this study was to evaluate the magnitude of outdoor exposure to fine particulate matter (PM10) potentially experienced by the population of metropolitan Mexico City. With the use of a geographic information system (GIS), spatially resolved PM10 distributions were generated and linked to the local population. The PM10 concentration exceeded the 24-hr air quality standard of 150 microg/m3 on 16% of the days, and the annual air quality standard of 50 microg/m3 was exceeded by almost twice its value in some places. The basic methodology described in this paper integrates spatial demographic and air quality databases, allowing the evaluation of various air pollution reduction scenarios. Achieving the annual air quality standard would represent a reduction in the annual arithmetic average concentration of 14 microg/m3 for the typical inhabitant. Human exposure to particulate matter (PM) has been associated with mortality and morbidity in Mexico City; reducing the concentration levels of this pollutant would represent a reduction in mortality and morbidity and the associated cost of such impacts. This methodology is critical to assessing the potential benefits of the current initiative to improve air quality implemented by the Environmental Metropolitan Commission of Mexico City.

Air Pollutants↗
PubMed2000

Evaluation of the hygienic performances of the processes for cleaning, dressing and cooling pig carcasses at eight packing plants.

The hygienic performances of the processes for the production of cooled carcasses at eight pork packing plants were assessed from small sets of microbiological data. At each plant, a single sample was obtained from a randomly selected site on each of 25 randomly selected carcasses at each of three stages of processing, which were after polishing, after washing at the end of the dressing process, and after cooling. The aerobic bacteria, coliforms and Escherichia coli recovered from each sample were enumerated. When bacteria of one type were recovered from > or = 20 of 25 samples, the log mean number of those bacteria on the population of carcasses undergoing processing was estimated on the assumption that the set of counts was normally distributed. The log of the total number recovered from 25 samples was calculated for each set of counts. The log mean numbers of total aerobic bacteria recovered from the polished carcasses at different plants ranged from about 1.9 to 3.8 log cfu cm(-2). At six of the plants, the log mean numbers of total aerobes on the cooled carcasses did not differ substantially from the log mean numbers on the polished carcasses, but the log mean numbers on the cooled carcasses were substantially higher at one plant and substantially lower at another than on the polished carcasses. Coliforms and E. coli were recovered from too few samples in most sets from cooled carcasses for estimation of their log mean numbers. However, the log total numbers of coliforms and E. coli recovered indicated that substantial numbers of those organisms were added to carcasses during the dressing processes at four of the plants, and that the numbers on the carcasses were substantially reduced by the processes for cooling without spraying at two of the plants. At seven of the plants, the total numbers of coliforms and E. coli recovered from cooled carcasses were <3.1 and <2.2 log cfu 2500 cm(-2), respectively. The findings indicate that production processes for pig carcasses can be operated to give cooled carcasses with log mean numbers of total aerobes < 2 cm(-2), and log total numbers of coliforms and E. coli each < 1 2500 cm(-2).

Animals↗
PubMed1999

[Catheter-directed thrombolytic therapy--a current alternative to proximal deep venous thrombosis].

Deep venous thrombosis extending into the iliac veins is associated with significant acute and late morbidity despite adequate conventional treatment with heparin and oral anticoagulants. The purpose of this paper is to focus on a multidisciplinary, aggressive approach with catheter-directed thrombolysis, in which a catheter with many side-holes is placed within the thrombus and thrombolytics infused. The aim is to eliminate the thrombus, to provide unobstructed venous drainage from the affected limb, and to prevent recurrent thrombosis. Total recanalisation of the iliofemoral segment was achieved in three of four treated patients, while partial lysis was obtained in one patient with symptoms for four weeks. Two weeks after discharge, two patients had no symptoms, while two had a moderate leg oedema. All of the three women used oral contraceptives at the time of thrombus formation; two had hereditary thrombophilia. Most probably, successful catheter-directed thrombolysis will reduce the incidence of post-thrombotic syndrome, but there are no long-term follow-up studies after such treatment.

Adult↗
PubMed1999

Intravesical bacille Calmette-Guérin in the treatment of carcinoma in situ or high-grade superficial bladder carcinoma after radiotherapy for bladder carcinoma.

OBJECTIVE: To evaluate the effectiveness and tolerance of endovesical bacille Calmette-Guérin (BCG) after pelvic radiation therapy for bladder cancer in patients with recurrence as carcinoma in situ (CIS) and/or high-grade superficial bladder cancer. PATIENTS AND METHODS: In a prospective study, 13 patients were treated with weekly instillations of 81 mg BCG Connaught for 6 weeks. for CIS and/or high-grade superficial bladder carcinoma. All had been treated previously with radical radiation therapy for bladder carcinoma. RESULTS: Five patients had no recurrences and six patients retained their bladders, within a median follow-up of 74.5 months. Five patients progressed; two underwent radical surgery and are alive after 75 months of follow-up, and three died from the disease (two were high-risk surgical patients and one had metastatic disease). Another two patients died from intercurrent disease without bladder cancer. Eight patients were alive at a mean (SD range) follow-up of 85 (12, 65-97) months. CONCLUSION: Intravesical BCG is useful for controlling CIS and/or high-grade superficial bladder carcinoma in irradiated bladders and has an acceptable local tolerance: more than a third of patients were free of disease and preserved their bladders. This proportion is acceptable in patients currently scheduled for cystectomy.

Adjuvants, Immunologic↗
PubMed1998

Balloon dilatation in the treatment of ureteral stenosis in kidney transplant recipients.

OBJECTIVE: To assess the usefulness of balloon percutaneous dilatation as a starting treatment technique of ureteral stenosis in kidney transplant recipients. PATIENTS AND METHODS: A total of 472 kidney transplants have been performed at our center between August 1981 and January 1997. The coexistence of high creatinine values and urinary tract dilatation in the postoperative period, after discarding concomitant causes, was managed with a percutaneous nephrostomy. Once renal function had recovered, antegrade pyelography was performed to confirm ureteral stenosis and to determine its location. The dilatations are performed by means of 5-french balloon-fitted angioplasty catheters. RESULTS: Thirty patients were diagnosed with ureteral stenosis during follow-up, i.e. an incidence of 6.3%. Transluminal balloon dilatation was made as a first therapeutic option in 18 cases. No immediate complications were observed following dilatation. Disappearance of the stenosis as well as maintenance of the improvement in creatinine levels were verified in 39% of cases (7 patients). CONCLUSIONS: Ureteral stenosis in kidney transplant recipients should be included as part of the differential diagnosis when there is a deterioration in renal function. Balloon dilatation is the technique chosen as initial treatment of juxtavesical ureteral stenosis because of its good reproducibility and its low morbidity.

Adult↗
PubMed1995

Increase in cardiac output and PEEP as mechanism of pulmonary optimization.

The influence of cardiac output (CO) and PEEP on pulmonary shunt (Qs/Qt) has been the subjects of considerable investigation but findings are controversial. The role of CO and PEEP on 19 isolated rabbit lung preparations perfused with hypoxic mixture (6% CO2, 10% O2, and 84% N2), which resulted in a constant oxygen venous pressure (64 +/- 5.6 mmHg) has been studied. The first group of 11 preparations were used to study the influence of CO modifications with room air ventilation on the Qs/Qt when the CO rises in 48%; in the second group simultaneous modifications in CO and PEEP (0.5 and 10 cm H2O) were performed. A positive correlation (p < 0.01) in Qs/Qt (0.048 +/- 0.04 to 0.12933 +/- 0.09) was found when the CO increased in the first experimental group, the fluid filtration rate (FFR) also increased and the pulmonary vascular resistance (PVR) remained stable. In the second group an increase of 5 and 10 cm H2O of PEEP at constant CO reduced the Qs/Qt (0.0361 +/- 0.02 to 0.0184 +/- 0.006) while it increased the arterio-venous oxygen difference, PVR and FFR. During high CO conditions increase of 5 and 10 cm H2O of PEEP reduced the Qs/Qt (0.099 +/- 0.03 to 0.027 +/- 0.02) and FFR. These data suggest that when the Qs/Qt is increased, the use of PEEP can compensate the ventilation/perfusion alterations and restore pulmonary gas exchange.

Animals↗