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Biomedical subjects

H Durán

Publications and source records attributed to H Durán.

At least 19 recordsLinked to original sources
PubMed2000

[Esophageal perforations. Presentation of 23 cases].

AIM: Esophageal perforations are the most serious perforations of the digestive tract and their treatment remains controversial. The aim of this study was to analyse the outcome of patients with esophageal perforations given surgical and conservative treatment. PATIENTS AND METHODS: Retrospective study of 23 patients with esophageal perforations, 8 cervical (35%) and 15 thoracic (65%). Medical treatment was indicated in patients who fulfilled Cameron's criteria (minimal signs of clinical sepsis; disruption contained in the mediastinum; drainage of the cavity back into the esophagus; minimal symptoms). The remaining patients underwent surgery. RESULTS: Two patients with cervical perforations (25%) met Cameron's criteria. Evolution after conservative treatment was favourable. The remaining patients (75%) were surgically treated: simple closure of the perforation was performed in four and drainage of the cervical abscess in two. Two of the patients who underwent surgery presented pleural hemorrhage, one of which was associated with pneumonia. Four patients with thoracic perforation (27%) met the criteria for conservative treatment. One presented respiratory distress syndrome during treatment and required intensive care. Evolution was favorable in all. The remaining 11 patients (73%) received surgical treatment: in five (46%) simple closure of the perforation was performed, in three (27%) bipolar exclusion was performed and in the remaining patients, other techniques were used. Morbidity was 82% (nine patients) mainly due to pneumonia and mortality was 46% (five patients). CONCLUSIONS: Treatment of esophageal perforation should be individualized. Conservative treatment should be considered in patients meeting Cameron's criteria as their evolution is favorable, with low morbidity and mortality and surgery is not necessary.

Abscess↗
PubMed1995

[Diabetes and ignored disorders of glucose tolerance in primary care. Evidence from opportunistic detection. Group for the Study of Diabetes in Tarragona].

OBJECTIVE: To investigate the level of attendance for care of people with glucose tolerance disorders, both known and not, and to discuss their real impact on Primary Care. DESIGN: Simple prospective randomised sampling. Opportunist detection among spontaneous users over 40, excluding pregnant women. SETTING: Primary Health Care. PATIENTS AND OTHER PARTICIPANTS: Data was recorded using a pre-designed survey, which included the recognised Diabetes (DM) risk factors. MEASUREMENTS AND MAIN RESULTS: Of the 183 cases evaluated, DM was already known in 13 (7.1%). 15 (8.2%) with unknown DM and 27 (14.7%) with GIT. A strong link was demonstrated with the average age and a marked tendency to overweight and obesity only significant when comparing DM with the rest. As to the risk factors researched, there was a significant association with antecedents of prior tolerance abnormality, DM in pregnancy, hyperglucaemiant medicines and ischaemic disease, in cases where family antecedents of definite diabetes were not found. CONCLUSIONS: The frequency of attendance of users with diabetes and unknown glucose tolerance disorders is very high in spontaneous primary care consultations. These results suggest that opportunist detection should be encouraged in primary health care centres.

Adult↗
PubMed1990

Heterotopic auxiliary liver transplantation with portal flow. Gradual development of the collateral circulation.

One of the causes of auxiliary liver transplantation failure is the inter-liver competition between the host liver and the graft for the hepatotrophic factors of the portal blood. We have developed an experimental model of heterotopic partial (30%) liver isotransplant using Wistar rats so as to study this competition. Splenoportography and dissection demonstrate the existence of collateral circulation. The collaterals at 90 days post-transplant (PT) consisted of veins from the portal vein to the host liver (PR), paraesophageal veins (PE) and splenorenal veins (SR). At 60 days P.T., PR and SR veins but not PE ones appeared, and at 30 days P.T., there were only PR veins. Graft atrophy at 90 days P.T. was associated with a severe degree of bile duct proliferation. The gradual development of portal hypertension causes porto-systemic collateral circulation and the graft loses the portal hepatotrophic factors. The late development of the portal hypertension and the biliary proliferation could be caused by the hepatic arterial ischemia in this experimental model. Thus, as has been described in the orthotopic liver transplantation, the heterotopic one might require a double vascularization, both portal and arterial.

Animals↗
PubMed1990

[Critical Care Surgery Unit in general and digestive system surgery].

In a 5-bed Critical Care Surgery Unit (UQCC) where surgeons are in charge of care, 126 patients admitted over 5 consecutive months were divided into 4 groups according to the treatment given: Group I (n = 49): elective gastrointestinal surgery; Group II (n = 52): emergency gastrointestinal surgery; Group III (n = 15): non-gastrointestinal surgery; Group IV (n = 10): medical treatment. The mean stay of all patients in the Surgical Critical Care Unit was 6 +/- 7.7 days and the global mortality was 7.9% (n = 10). The mean age of the patients who died was 71.5 +/- 7.3 years and 70% of the deaths corresponded to Group II. Forty percent of the patients who died had systemic candidiasis. Among the factors implicated in the mortality acute gastrointestinal pathology per se, the coexistence of chronic systemic disease and advanced age were prominent. We discuss the need for typifying the role of Surgical Critical Care Units in General and Gastrointestinal Surgery.

Adolescent↗
PubMed1989

[Immunosuppression with cyclosporin after orthoptic liver transplant in pigs].

The immunosuppressive effect of cyclosporine A (CsA) was studied in six pigs that underwent orthotopic liver transplant (OLT). The drug was administered i.v. in low doses (1.5-4 mg/Kg-1/12 h-1) and associated with wide spectrum antibiotics. The mean survival of the animals was 23.4 +/- 11.2 days. All animals had fever, jaundice and hypertrichosis, and the preoperative corporal weight remained constant. Liver abscesses by E. coli were common autopsy findings. Livers also presented biliary regeneration and cholestasis with a slight lymphocytic infiltration. OLT in pigs without immunosuppressive treatment causes and elevation in serum gamma-GTP, GOT, LDH, alkaline phosphatase and bilirubin. In the post-mortem findings, the livers did not present abscesses but evidenced intense atrophy with hepatocellular necrosis and abundant lymphocytic infiltration.

Animals↗
PubMedDate not supplied

Washout of the pig liver with Haemaccel after hypothermic preservation.

In hepatic preservation by simple perfusion and hypothermic storage, a portal and hepatic washout before revascularization would avoid receptor hyperkaliema. In this report we study the effectiveness of this washout with Haemaccel at room temperature. Large-White pigs were used and eight livers were perfused "in situ" via the portal wein with Hartmann's solution containing 10,000 IU of heparin at 4 degrees C, and afterwards, via portal and arterial routes with C2 solution at 4 degrees C. After a cold ischemia time of less than 31/2 hours a liver washout via the portal vein and hepatic artery with Haemaccel before portal revascularization was done. The high concentrations of glucose, K+, GOT, GPT and LDH in the effluents obtained during the washout are attributed to Haemaccel hyperosmolarity. A portal and arterial hepatic washout associated with free drainage of the first 50-100 ml of portal venous blood after hepatic portal revascularization through the infrahepatic inferior vena cava (IH-IVC), prevents hyperkaliemia from occurring after a portal and arterial revascularization in the orthotopic liver transplant (OLT) in pigs.

Animals↗