Biomedical subjects
Publications and source records attributed to G Rodríguez.
Acute colonic dilation due to anastomotic edema is rare and is not always solved with conservative treatment. Endoscopic colonic decompression was carried out in 3 patients completing the procedure with a transrectal drainage. No complications resulted from the procedure and all 3 patients did well, once motility was re-established.
Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.
We present our experiences in fifteen high-risk surgical patients, with large bile duct stones, treated with endoscopic home-made biliary stents. We observed good immediate and mediate results in all patients, with a 19.9 months follow-up. In one case, acute cholangitis developed after 25 months and the patient died. Other three died of unrelated causes. None of the patients required surgery. We conclude that endoscopic stenting is a useful procedure in the treatment of large bile duct stones in poor-risk surgical patients.
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Eight babies with severe bronchopulmonary dysplasia (BPD) were discharged from a private hospital at Santiago, Chile, on a program that provided oxygen therapy at home. Mean gestational age was 27 +/- 2 weeks and mean birth weight was 1,181 +/- 353 g. Discharge was decided after stabilization of arterial PO2 or O2 Sat, PCO2 less than 50 mmHg and adequate weight gain. Prior to discharge parents were trained in O2 administration and cardiopulmonary resuscitation. Oxygen was given at home for a mean of 71 days (range 7 to 339). There were no complications secondary to oxygen therapy. At follow up in only two cases additional hospitalizations were needed, in both instances because of intercurrent respiratory infections. Weight gain between 3d and 50th percentile were seen in all cases. Oxygen therapy at home appears to be a good alternative in the treatment of infants with BPD, and it reduces significantly hospital stay and costs. Both optimal family conditions and adequate support at home are needed.
Since 1981 to 1989 we have performed percutaneous endoscopic gastrostomy (PEG) in 285 patients with age range of 6 months to 97 years old; the main indication was enteral feeding in 278 cases, drainage of gastric secretion in 5 cases and in 2 patients for bile replacement of external biliary drainage. The procedure was successful in 98.2% of the cases, with major complications in 1.8% and minor complications in 12.7% mortality of 0.7% PEG is an efficient, rapid, worldwide accepted method because it is a bedside technique with minimal morbidity, low cost and insignificant mortality.
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Analysis of World Fertility Survey data from five countries--Colombia, Costa Rica, Korea, Malaysia and Nepal--shows that the availability of contraceptive services and supplies is a major determinant of use. In Nepal, where few women know where to obtain supplies, only two percent are contracepting. In Costa Rica, where almost all married women know an outlet nearby, 53 percent use effective methods.
In order to face the current economical problems of the country, our Institute has intensified its efforts to replace the imports of medical goods by developing its own medical technology. This article summarizes what we have achieved in this field and describes the rules to be followed in the future. We describe the program on the designing and development of heart valve prosthesis together with an hydraulic-electrical system to test them. In the field of computed instruments, we have developed a system of "synchronos color pictures" to be applied in nuclear medicine. In the field of electrocardiography; an EKG paste, a computed program for automatic EKG interpretation and a "filter" of the 60 cycle interference. The Institute is engaged in the designing of a sophisticated EKG machine at low cost, and EKG tracing simulator for teaching purposes. These programs have been shared with others institutions of the country.
We analyzed 33 cases of Acquired Systemic Arteriovenous Fistulas (FAVSA) seen in the INC-ICH between 1945 and 1981. The most frequent causes were traumatic (gunshot and knife wounds) and iatrogenic (surgery). The most affected vessels were femoral, carotid, axillary and subclavian. The FAVSA produced a hyperkinetic hemodynamic syndrome of high output that frequently resulted in fistular cardiopathy. Fistular cardiopathy and heart failure became evident from 4 days to 31 years after the initial insult and was related to the magnitude of the arteriovenous shunt. The latter depended on the distensibility of the communicating ring (the development of perifistular fibrosis did not allow dilatation of the fistular opening). Heart failure was a result of the magnitude of the shunt, even when the patient was young with a healthy heart. A detailed traumatic or surgical history was extremely important in the diagnosis. Relevant physical signs included: bounding pulses, a wide pulse pressure, the presence of a continuous murmur and thrill, a positive Nicoladoni-Branham's sign with a decrease in the heart rate and an increase in systemic blood pressure when the FAVSA was compressed. The existence of the condition became suspicious when heart failure appeared otherwise unexplained by an obvious cardiac lesion. Other important signs included the development of distal venous insufficiency and the presence of a palpable pulsatile mass. Fistular cardiopathy was observed in 60% of the cases studied, although the ECG was normal in 33%; 73% had cardiomegaly which improved with correction of the FAVSA. The treatment is necessarily surgical and required the appropriate technique.
In any infant admitted with diagnosis of "clinical sepsis", a chest radiograph is commonly obtained as a routine work-up. The purpose of this study was to establish the relationship between an abnormal chest radiograph and "clinical sepsis" in a population of infants. The clinical records and chest radiographs of 81 infants, (less than 3 month old) were reviewed. The temperature, white blood cell count, respiratory signs, symptoms, and chief complaints were recorded and compared with positive or negative chest radiographs. A statistically significant correlation with abnormality in the chest radiograph was not established. Four patients, (31%), with any respiratory signs had abnormal chest radiographs, whereas only 13, (19%) asymptomatic patients did. It was concluded that chest radiographs do not add useful information to the evaluation of a febrile infant who does not have clinical findings of pulmonary diseases. However, due to the limited population studied, it seems appropriate to continue the current recommended practice of ordering chest radiographs in febrile infants 3 months old or less.
We present a 52-year-old patient who came to the emergency room with non-specific symptoms and whose clinical profile after 24 hours included acute abdomen and paresthesia in both lower extremities. A chest film revealed mediastinic enlargement; embolism was suspected. During surgery intestinal ischemia was found in the superior mesenteric artery; this was resected and termino-terminal anastomosis was accomplished with the remaining jejunum and the descending colon. At the same time, some flaccid vesicles were removed along with embolis in the femoral arteries, leading to suspicion of hydatid embolism. Transthoracic and transesophageal echocardiography showed multivessicular masses with internal blood flow in the posterior-inferior mediastinum, suggestive a ruptured hydatid cyst in the thoracic aorta. This was confirmed by thoracic-abdominal computed tomography. The patient's condition worsened, with acute renal failure, ischemia, necrosis of both legs and multiorgan failure leading to death. We discuss the rarity of this case, the use of imaging tools for diagnosis, and the inexorability of the disease in spite of treatment.
Four experiences in health education in communities located in the state of Lara in Venezuela were analyzed from a sociopsychological perspective. Under a qualitative approach, the information was obtained from three sources: documentary analysis of didactic material; participant observation in workshops, and interviews to leaders and participants.
A survey of 245 adolescents visiting different San Juan area beaches was conducted to determine the frequency with which they used sunscreens lotions. Seventy-two percent of the teenager in the survey stated that they spent most weekends in the sun; however, only 68% always used sunscreen, while 31% never did. Prevalence factors found to be associated with the sunscreen use included male sex (odd ratio = 1.01 P < 0.01), having a friend who routinely used the lotion (odds ratio = 0.06, P < 0.05), and having parents who strongly recommend the sunscreen use, (odds ratio = o.g, P > 0.05). This survey substantiates poor compliance with sunscreen lotion use by teenagers despite increasing evidence of the dangers of sun exposure.
Coronary heart disease is the leading cause of death in Puerto Rico. Enough evidence exists to believe that coronary heart disease begins during the pediatric age. There has been and increased interest in recent years about the rationale for detection and treatment of hypercholesterolemia in children. Blood samples of 506 patients ages 3 to 17 were analyzed for plasma cholesterol level using the method RA-1000 Technicon. Measurement of cholesterol, blood pressure and Quetelex index were obtained during the sampling. Family history, and past history were also determined to compare the relationship between positive family history for coronary heart disease and cholesterol value. Based on these samples we concluded that 30% of the sampled population had high cholesterol values for age.
This article describes the first case in Mexico of an implantable pacer-cardioverter-defibrillator in a 44-year-old man with coronary artery disease and recurrent ventricular tachycardia without the need for a thoracotomy and epicardial electrodes. The patient underwent electrophysiological evaluation that revealed drug-refractory ventricular tachycardia. Endocardial catheter ablation with radiofrequency was considered and rejected due to an unstable hemodynamic state during the tachycardia. A triple electrode system using two transvenous catheter electrodes and a subcutaneous chest patch were employed. Two monophasic unsynchronized shocks were delivered with a 18 J sequential pulse technique over two distinct current pathways. The automatic pacer-cardioverter-defibrillator was implanted in the abdominal wall and demonstrated reproducible termination of ventricular fibrillation.
Administration of hGH during the acute phase of experimental myocardial infarctions in pigs showed several aspects which clearly distinguished the treated group from the control one. In the first case the necrotic segment appeared considerably smaller than in the control group but also exhibit a qualitative different necrotic pattern in the histologic aspect, i.e. the infarcted area is shown itself reduced to isolated cells; scarce clusters of them interspersed where found within larger areas of preserved tissue. Affected cells have been defined as "injured fibres" according to their particular aspect which notably differs to the classic expected picture of a 25th day infarction and exhibits itself as an "arrested necrosis". A remarkable preservation of capillary vessels has also been found in the treated cases by a contrasting disappearance of the capillary bed in the control group. Ventricular contractility was also explored with ECHO B which showed significant differences between both groups: wall thinning of the ventricular wall in the affected area did not appear in treated cases and normal contractility in the same area reappeared a few hours after the infarction. Contractility was never restored in the control group. hGH main action is directed towards the preservation of the myocardial collagen matrix, helping to maintain the structural integrity of ventricular wall. There are, however, other possible effects on immunological aspects of the macrophages partially noticed, and to be disclosed in the future.
The involvement of the central nervous system by histoplasma is an infrequent complication. The clinical diagnosis is difficult because the microscopic examination and the culture of the spinal fluid are frequently negative. In this article we report two cases of meningitis by Histoplasma capsulatum in patients with acquired immunodeficiency syndrome. The first case is a meningitis without evidence of disseminated histoplasmosis in a patient who had been treated with amphotericin B. The histologic appearance was that of a granulomatous inflammation of the meninges and the underlying nervous tissue. The second case is a disseminated histoplasmosis with involvement of the central nervous system. This consists of macrophages filled with histoplasma invading the meninges and underlying nervous tissue without associated inflammation.