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Biomedical subjects

E A Aguilar

Publications and source records attributed to E A Aguilar.

18 recordsLinked to original sources
PubMed2005

Breast cancer screening: another point of view.

The breast cancer screening programmes (BCSP) are very controversial at the present time. They are evaluated by different socio-economic sectors, each with its own particular point of view. Large numbers of breast cancer cases are concentrated in the Oncology Services, which are, therefore, sensitive to the changes that these programmes could bring about. All patients attending the medical oncology and radiotherapy services of the Reina Sofia University Hospital, Cordoba from January 1994 until January 2003 were reviewed. Of 1785 patients, 829 went to these services after the start of the BCSP introduced in March 1999 and 956 before it. The variables analysed were age, presentation form, stage and treatment received. In conclusion, the BCSP has produced favourable changes with respect to stage (increasing the percentage of early breast cancer) and therapeutic management (increasing conservative surgery and decreasing the number of adjuvant treatments (radiotherapy and chemotherapy)). These changes are more outstanding in the population group covered by the BCSP.

Adolescent↗
PubMed1996

Activity relationships of total hip arthroplasty in patients with osteonecrosis and osteoarthritis.

We compared the age adjusted results of all primary Osteonics total hip arthroplasties with osteonecrosis and osteoarthritis. The Harris index hip score was used for the analysis. Twenty-eight patients had osteoarthritis and 26 patients had osteonecrosis. The Harris hip score was used to compare the osteoarthritis and osteonecrosis gross. Patients with osteoarthritis gradually increased in Harris hip score, whereas osteonecrosis patients gradually decreased in Harris hip score over 60 months. However, after the patients were adjusted for age above and below 50 years, the trend for each group was similar despite the diagnosis. All patients below 50 years of age, regardless of diagnosis, gradually decreased in hip score over time. On the other hand, all patients over 50 had a gradual increase in hip score with time. The poor results seen in patients with osteonecrosis may be related more to age and activity level than to the primary diagnosis. We do not believe that the diagnosis of osteonecrosis plays as significant a role in the final outcome of a total hip arthroplasty as does the patient's age and, more importantly, activity level following hip arthroplasty.

Activities of Daily Living↗
PubMed1992

Grading system for the selection of patients with congenital aural atresia.

It is generally recognized that surgery for congenital aural atresia is difficult. In an effort to select those patients who have the greatest chance of success, we have developed a grading scheme based on the preoperative temporal bone CT scan and the appearance of the external ear. Patients are graded on a possible best score of 10. The stapes is assigned the highest rating (2 points), while all other entrees on the scale are 1 point. The grade assigned preoperatively has been shown to correlate well with the patient's chance of success, herein defined as a postoperative speech reception threshold of 15 to 25 dB. A patient with a preoperative grade of 8/10 would, therefore, have a 80 percent chance of achieving this threshold. Patients with scores of 5/10, or less, are not considered surgical candidates, because the risk of the operation would outweigh the potential benefits. We have found that the grading system allows us to avoid impossible surgical cases while allowing for a reasonable prediction of the hearing outcome.

Abnormalities, Multiple↗
PubMed1991

Integrating computers into orthopedic research.

The role of computers in orthopedic research and education is expanding rapidly. Its potential to manipulate large amounts of data and execute multiple complex assignments with great speed and accuracy indeed make the computer an awe-inspiring device. An important instrument in research is the computerized database, a collection of related data arranged so that useful information may be retrieved. Computer models derived from classical physics and fluid mechanics have been used to study motion of both extremities and spinal articulations. Computers also have found usefulness in clinical orthopedic research. The orthopedist of the future will use the computer directly in clinics and private practice for patient evaluation, computer-assisted preoperative planning, and financial recordkeeping.

Biomechanical Phenomena↗
PubMed1989

Treacher Collins syndrome: an otologic challenge.

Patients with Treacher Collins syndrome have severe middle ear malformations that render operation difficult. We have evaluated 43 patients with Treacher Collins syndrome, on whom only 11 were operated. Computed tomography, the single most important study done preoperatively, routinely showed an underdeveloped temporal bone with islands of bone marrow and absent mastoid pneumatization. The middle ear space was often underdeveloped. Ossicular dysjunction was often noted in which the fused malleus/incus remnant was found 3 to 4 mm distant to the stapes. A common finding was severe dysplasia of the stapes-facial nerve complex that often made the middle ear malformation uncorrectable. Hearing results were much less predictable than in patients with isolated atresia/stenosis of the ear.

Adolescent↗
PubMed1988

Sinusitis in the nasotracheally intubated patient.

Maxillary sinusitis as a complication of nasotracheal intubation has long been recognized as difficult to diagnose and equally difficult to treat. To better define this problem from a diagnostic and therapeutic standpoint, we studied patients admitted to the surgical intensive care unit at the University of Texas Health Science Center at Houston-Hermann Hospital over a six-month period. During this time, we identified 19 cases of maxillary sinusitis. Diagnostic criteria included fever, leukocytosis, purulent rhinorrhea, and maxillary sinus opacification or air fluid level noted on sinus roentgenograms. Patients who met these criteria underwent maxillary sinus aspiration. Sixteen patients were receiving antibiotic therapy when sinusitis was diagnosed. All patients had their endotracheal tubes replaced orally, had diseased maxillary antra lavaged, and underwent appropriate antibiotic therapy guided by culture and sensitivity studies. Four of 19 patients required more than one sinus lavage, but all patients had their sinus disease resolve. These data suggest an aggressive approach to diagnosing sinusitis in the nasotracheally intubated patient is needed. A maxillary sinus aspiration and lavage should be an integral part of the diagnosis and treatment of these patients.

Adolescent↗
PubMed1988

The surgical repair of congenital microtia and atresia.

Auricular reconstruction for congenital microtia is a complex multi-staged procedure. The repair of congenital atresia of the ear is one of the most difficult operations an otologic surgeon may attempt. In order to accomplish both procedures without endangering the integrity of either, there must be proper planning and close cooperation between the otologist and the facial plastic surgeon. In this article, we present our philosophy concerning the management and timing of these operations. The steps of each operation, and the impact of each on the other, are reviewed. Only through careful planning and coordination of these operations will patients realize the full benefit of their surgery.

Cartilage↗
PubMed1988

Cricothyroidotomy versus tracheotomy: an otolaryngologist's perspective.

A series of 655 elective cricothyroidotomies presented by Brantigan and Grow in 1975 has fueled a recent explosion in the number of cricothyroidotomies being performed for elective tracheal access. This article reviews Jackson's classic 1921 paper on cricothyroidotomy, Brantigan and Grow's series, seven recent clinical series of elective cricothyroidotomies, and our experience. Voice change is the most frequent complication of cricothyroidotomy occurring in up to 50% of cases. Chronic subglottic stenosis occurs in approximately 2% of cases. Contraindications to cricothyroidotomy include prolonged intubation, airway obstruction following extubation, and laryngeal pathology of any kind.

Cricoid Cartilage↗
PubMed1987

Primary oat cell carcinoma of the larynx.

The aggressiveness of small (oat) cell carcinoma of the larynx presents a therapeutic challenge to the oncologist. Since the first description of this type of carcinoma in 1972, 52 patients have been reported in the literature and a variety of treatment regimens have been used. The purpose of this study was to report two new cases and review all previous reports to determine the disease's biological behavior, clinical manifestations, and optimum treatment. Thirty-five percent of the tumors were transglottic, and 27% were supraglottic. Fifty-four percent of patients had regional metastases at initial presentation and 17.6% had distant metastases. The median survival was 10 months for all patients. Patients who were treated with chemotherapy with or without other modalities had the best 2-year survival rates (52.2%). Forty-one percent of patients had regional recurrence only, 12.5% had regional recurrence and distant metastases, and 2% developed distant metastases only. We conclude that patients with oat cell carcinoma of the larynx should be treated with combination chemotherapy and radiation therapy. Surgery is best reserved for persistent and recurrent disease at the primary site and neck.

Adult↗
PubMed1986

Neuro-otologic evaluation of the patient with acute, severe head injuries: correlations among physical findings, auditory evoked responses, and computerized tomography.

Long-term clinical neurologic and otologic sequelae of traumatic head injury are well recognized. In this article, we describe the relationship among neurophysiologic, neuro-otologic, and neuroradiologic findings in a series of fifty patients with acute, severe head injury. Seventy percent of the patients had one or more otologic abnormalities, of which hemotympanum was most common. Outcome of computerized tomography (CT), auditory brainstem response (ABR), and otologic examination findings were not mutually dependent. For example, otologic disease was found in 50% of the patients with normal ABR. All but one patient in the series showed brain damage by CT; yet only 14% of the series had evidence of temporal bone fracture and, unexpectedly, one third of this group yielded normal otologic findings and a normal ABR. We conclude that combined application of otologic examination, CT scanning, and auditory evoked response assessment provides complementary information on structural and functional neuro-otologic status in persons with acute, severe head injury.

Acute Disease↗
PubMed1984

Neuro-otologic applications of simultaneous multi-channel auditory evoked response recordings.

Multichannel auditory brain stem response (ABR) recordings were obtained in 75 acute, severely brain injured patients. The purpose of the study was to assess, in patients with varied neuro-otologic pathology, the clinical feasibility and value of measuring the ABR simultaneously with more than one electrode array. The use of alternative electrode arrays, in addition to the conventional (vertex to stimulus ipsilateral ear) array, augmented confident identification of wave components I through VI, and was particularly useful in patients with marked middle ear pathology which confounded ABR interpretation. The ABR recorded with an indifferent (noncephalic) reference electrode, e.g., was characterized by increased Wave V amplitude, and improved definition of Wave IV vs. V. Case studies are presented to illustrate neuro-otologic applications of the multichannel recording technique.

Adolescent↗
PubMedDate not supplied

High resolution CT scan of temporal bone fractures: association of facial nerve paralysis with temporal bone fractures.

This radiologic study analyzed high resolution computed tomographic (CT) scans of 22 patients with temporal bone fractures. There were 19 males and three females. Fifteen of 22 had clinical evidence of facial nerve injury ranging from mild paresis to complete paralysis. The high resolution CT scan analysis identified a characteristic fracture of the temporal bone in every patient with facial nerve injury. A high percentage of these fractures (68%) could be classified as mixed and did not fall into a longitudinal or transverse fracture category. The characteristic fracture extends from the petrotympanic fissure at the glenoid fossa to the anterior inferior aspect of the medial bony external auditory canal. It resumes at the superior aspect of the external auditory canal (scutum) extending laterally along the external canal wall. If the vector force of the fracture is projected medially, it will cross the facial nerve in its horizontal portion. Often, the evaluation of trauma patients with routine CT scans for central nervous system (CNS) (brain) evaluation is inadequate for evaluation of temporal bone fractures. A high resolution CT scan should be performed when clinical criteria warrant its use. It is recognized that the incidence of facial nerve injury may be higher in this select population.

Adolescent↗