Biomedical subjects
Publications and source records attributed to J A Matute.
During an 9-month period (March to November 1992), six children underwent an intestinal anastomosis by means of a biofragmentable ring (BAR). Patients ages ranged from 5 to 16 years old. There were no mayor complications at surgery. The main technical problems was the difference of size between BAR and intestinal lumen. No patients in which BAR was used have presented fistulae, dehiscence or anastomotical stenosis.
Intraluminal masses within the upper urinary tracts are rare, are almost always benign, and most commonly take the form of fibroepithelial polyps within the ureters. Only exceptionally are these lesions found within the renal pelvis and for that reason may cause diagnostic difficulty. We present a new case of fibroepithelial polyp of the renal pelvis treated successfully in our hospital.
Esophageal stenosis secondary to lye ingestion and surgical repair of esophageal atresia have been treated traditionally with bougienage. More recently, it has been described a new technique to treat them, based in the works of GRUNTZIG which employs balloon catheters for vascular stenosis. We present a series of 11 patients treated by these method, with a total of 17 stenosis. Ten patients had ingested lye and one had an esophageal atresia. We describe the method employed. 91% of the cases had a satisfactory evolution.
Distal hypospadias are the most frequent form of all. Many surgical procedures have been described. We present a series of 84 patients treated using a modification of the technique described in 1967 by Saint Aubert, known as preputioplasty. We described the technique employed. Our esthetics and functional results are excellent. There was a very low complication rate: 1.1 percent of fistulas and 2.3 percent of preputial dehiscence. In 4.7 percent of the patients there was a redundant prepuce. The final result is a non-circumcised appearance which is quite important in our sociocultural ambience.
The clinical features of a new patient with dysplasia epiphysialis multiplex are reported. Similar symptoms are present in four members of the family. This disease seems to be inherited as a simple dominant Mendelian trait. The disease mainly affects the epiphyses of the long bone and nearly always begins with pain in the hip-joint. Our patient presented radiological features of osteoporosis with calciotropic hormones within normal range and with a low trabecular bone volume. This histomorphometric bone study shows a low bone turnover osteoporosis, which suggests an altered trabecular development with a greater clinical expression in the epiphyses.
Two cases of late hypophosphatemic osteomalacia are described: a male aged 30 who had the disease since he was 22 and a woman of 23 who had the disease since she was 14. Both presented with myopathy and bone pain, and showed hypophosphatemia, hyperglycinuria, reduced tubular phosphate reabsorption (TPR), increased hydroxyprolinuria and normal iPTH and iCT values. Radiologically the male had no Looser's zones and the woman did. Bone biopsy confirmed hypophosphatemic osteomalacia. Both cases were treated with vitamin D and oral phosphate and no improvement was observed. When treatment with 25(OH)D3 was initiated, no improvement was seen and afterwards this was combined with treatment using 1.25(OH)2D3 and from this time on a clinical improvement of the myopathy became evident in both patients. In the woman, healing of the bone lesions occurred at the same time as that of the myopathy, whereas in the male the bone lesions became worse. Healing of the myopathy was only obtained when treatment with 1.25(OH)2D3 was begun. Both patients had reduced values of 2.3 erythrocytic DPG and low level of serum phosphorus when the myopathy was cured, which suggests a lack of effect of 2.3 DPG or serum phosphorus as a cause of the myopathy. Although this had been attributed to a deficiency in the function of 25(OH)D3, the response to 1.25(OH)2D3 and due to the effects of this metabolite on calcium transport in muscle, suggests that the myopathy which occurs in late hypophosphatemic osteomalacia is a result of deficiency or resistance to the muscular effect of this metabolite. We cannot explain the lack of bone healing in the man and further therapeutic studies are required.
Although aseptic necrosis of the femoral head secondary to alcoholism is a very frequent entity, its etiology remains unknown. The same pathogenic mechanism is thought to be shared both by aseptic necrosis secondary to alcoholism and steroid therapy. Since alcohol stimulates adrenal steroid secretion, we have studied serum cortisol and urinary free-cortisol levels in 8 patients with aseptic necrosis of the femoral head due to alcoholism and compared them with those found in 8 age-matched patients with aseptic necrosis of idiopathic origin. Serum cortisol levels and urinary free-cortisol levels were significantly higher in the alcoholic than in the idiopathic group: serum 227 +/- 21.7 vs 154 +/- 22.1 ng/ml, P less than 0.001; urine 0.20 +/- 0.002 vs 0.13 +/- 0.04 micrograms/mg Cr/day, P less than 0.001. The data indicate that alcohol-induced aseptic necrosis of the femoral head results, at least in part, from increased circulating cortisol.