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Biomedical subjects

H Castellanos

Publications and source records attributed to H Castellanos.

16 recordsLinked to original sources
PubMed1996

Successfully establishing laparoscopic surgery programs in developing countries. Clinical results and lessons learned.

BACKGROUND: Laparoscopic surgery has not been widely established in developing countries due to the lack of access to training and lack of money. We describe our experience using on-site training programs to efficiently teach and propagate laparoscopic surgery in Leon, Nicaragua; La Paz, Bolivia; and Santa Cruz, Bolivia. METHODS: A group of well-trained and motivated local surgeons was identified in each country as the initial target for teaching. Participants were taught basic and advanced laparoscopic surgery during on-site didactics, animal laboratories, and proctoring sessions. Follow-up courses were held until the target group of surgeons was capable of independently teaching and supervising laparoscopic surgery among other surgeons in each country. RESULTS: Multiple technical and logistic difficulties were encountered. In Leon, Nicaragua, and La Paz, Bolivia, a total of eight surgeons were fully trained and proctored in laparoscopic cholecystectomy. In La Paz and Santa Cruz, Bolivia, a total of seven surgeons were instructed in advanced laparoscopic procedures. To date, over 180 patients have undergone laparoscopic cholecystectomy or advanced procedures with a morbidity similar to that reported in literature series in the United States. CONCLUSIONS: Our experience demonstrates that in spite of numerous limitations, basic and laparoscopic surgery can be efficiently and safely taught in developing countries. Many lessons were learned in how to safely and efficiently use laparoscopic equipment and instruments within strict financial constraints.

Clinical Competence↗
PubMed1995

Operative enteroscopy. A useful tool in the evaluation and intervention of bilioenteric anastomoses.

Roux-en-Y hepaticojejunostomy is the procedure of choice in the management of patients with major bile duct injuries. In instances of anastomotic stricture, this anastomosis is inaccessible to conventional endoscopy. A technique is described for assessment and intervention of bilioenteric anastomoses that escape the reach of conventional endoscopy. Three cases are presented illustrating the feasibility of open and laparoscopic-assisted small-bowel endoscopy. All patients presented with recurrent cholangitis and had multiple interventions in their biliary tree prior to referral. At operation, the limb of jejunum going to the bilioenteric anastomosis was identified, an enterotomy was made, and a flexible endoscope was passed to evaluate the anastomosis. In two cases the anastomosis was revised by endoscopically excising scar tissue. In the third case the anastomosis was patent and unnecessary intervention was avoided. There was no morbidity or mortality and the patients had complete resolution of their symptoms. Operative endoscopy appears to be useful in the evaluation and intervention of bilioenteric anastomoses that cannot be evaluated by conventional endoscopy.

Adult↗
PubMed1992

Sigmoid volvulus in the high altitude of the Andes. Review of 230 cases.

Sigmoid volvulus (SV) is uncommon in the United States. Little has been published in the English literature about the high incidence of SV among rural areas of the Bolivian and Peruvian Andes at 13,000 feet above sea level. A review of 230 cases of SV in a Bolivian hospital is presented. SV accounted for 79 percent of all intestinal obstructions. Nonoperative reduction was attempted in all patients except those with peritonitis. Nonoperative reduction alone was performed in 31 percent of the patients, and 69 percent underwent surgical intervention, 66 percent as an emergency and 3 percent electively. Surgical treatment consisted of sigmoidectomy and primary anastomosis (50 percent), Hartmann's procedure (12 percent), and operative detorsion with sigmoid plication (38 percent). Overall mortality was 13.5 percent. Fifty-seven of the surgically treated patients developed significant complications. The etiology of SV is unclear. High altitude, along with other etiologic factors, may play an important role in SV. To our knowledge, this series represents the highest incidence of SV in bowel obstruction.

Adolescent↗
PubMed1983

Heparin effect on plasma fibrinogen in the thrombophilic syndrome.

The effects of heparin were studied in a group of 42 patients with preinfarction angina (PA) and acute myocardial infarction (AMI) whose plasma fibrinogen was increased. Plasma fibrinogen was measured by the turbidimetric method in timol turbidimetric units. Statistically significant results proved that heparin reduces the plasma fibrinogen progressively over a treatment period of 6 weeks. During the first three weeks a dose of 1 cc (50 mg or 5000 IU) was given by intravenous injection at 6-h intervals, this was followed by a dose of 2 cc (100 mg or 10,000 IU) given by subcutaneous injection at 12-h intervals for a further three weeks. Hyperfibrinogenemia is perhaps one of the most important factors in the thrombophilic syndrome, and at the same time it is one of the fundamental physiopathological alterations observed in AMI and PA. Because heparin reduces hyperfibrinogenemia it has a beneficial effect in these diseases.

Adult↗
PubMed1983

Use of flecainide acetate in the treatment of premature ventricular contractions.

Flecainide acetate, a new benzamide antiarrhythmic agent, was studied after single-dose intravenous administration to 35 male and female patients with nonlife-threatening premature ventricular contractions (PVCs). Prior Holter monitoring established that each patient had "stable" PVCs of at least 600/12 hr. PCV in 80% of the patients was attributed to underlying coronary heart disease and/or Chagas' disease. After bolus injections of flecainide acetate, cardiac rhythm was again monitored by Holter ECG recording for 24 hours. All patients had 100% suppression of PVCs, ranging from 60 to 1440 minutes in duration. The average duration of suppression for all patients was more than 8 hours (498 minutes). Follow-up at 6, 12, 18, and 24 hours showed statistically significant PVC reductions (p less than 0.01) when compared with control rates. Side effects were trivial. The extended half-life of this new agent (about 20 hours in cardiac patients) may allow a convenient twice-daily dosage schedule.

Adult↗
PubMed1982

Heparin effect on blood viscosity.

The effect of heparin on blood viscosity was investigated in a group of patients with acute myocardial infarction (AMI) and preinfarction angina (PA), whose blood viscosity was elevated. Viscosity was measured with Cannon, Fenske, and Routine viscometers. Kinematic viscosity, bath and whole blood, plasma, and serum viscosity were determined as well as dependent parameters (fibrinogen, serum proteins, number of platelets, and hematocrit). All of them were found to increase, and it was significantly proved that intravenous heparin immediately decreased plasma viscosity, but has a lesser effect on serum and whole blood viscosity. A dose of 1 cc = 50 mg = 5000 IU intravenous heparin, will maintain this decrease for a month. In our four-week-study, 1 cc i.v. heparin was administered at 6-hour intervals for the first 2 weeks, and 2 cc heparin subcutaneous injections were administered at 12-hour intervals for the next 2 weeks. We found that heparin also decreased fibrinogen, hematocrit, serum alpha 2 globulin, and number of platelets. Hyperviscosity, hypercoagulability, and the increase of platelet adhesiveness arae some of the most important physiopathological alterations of AMI and PA. The decrease of blood viscosity due to heparin is one of the most important and beneficial effects of it in this pathology.

Adult↗