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Biomedical subjects

J A Salva

Publications and source records attributed to J A Salva.

At least 19 recordsLinked to original sources
PubMed1991

Nonoperative management of splenic injuries.

The traditional management of splenic trauma has undergone major revision in recent years. Given the physiological importance of the spleen, certain controversy has arisen regarding the most appropriate method of managing this type of trauma. Nonoperative therapy in children has proven to be successful not only in the case of kidney lesions but also for splenic lesions. Nonoperative management carried out in the authors' hospital on a group of 56 patients (49 adults and seven children over the age of 7 years) has proved successful in 37 cases. The success of this technique requires a well-formulated protocol, diagnostic methods (ultrasound and computed tomography), rigorous patient control in the emergency room during the initial phase (first 48 hours), the availability of a medical team if surgical intervention becomes necessary (persistent or recurrent hemorrhage), and complementary measures which facilitate the cicatrization of the splenic injury (bed rest, antibiotic therapy).

Adolescent↗
PubMed1990

Surgery of atrioventricular septal defects. Review of the first 100 cases.

From 1972 to 1985, the first 100 children suffering from some form of atrio-ventricular septal defect underwent surgical correction. In all cases, corrective surgery was carried out primarily except in 3 children who presented with a total defect and first underwent palliative surgery. In 48 children, a complete form was present, in 5 an intermediate form, and in 47 a partial form. There were 43 males and 57 females. Thirty-eight percent of patients suffered from Down's syndrome. The mean age at operation was 42 (range 2-143) months. A prosthesis was implanted in the left atrio-ventricular valve at primary correction in 9 patients. Up to 1980, the overall mortality was 20% and from 1981 to 1985 it was 3.3%. There was late mortality in 3 children (2 with a complete form and 1 partial). In 32 cases, postoperative cardiac catheterization was performed. Nine patients were reoperated upon (9%), 2 due to a residual shunt, 4 due to serious mitral incompetence (in all cases a prosthesis was used), and 3 due to valvular thrombosis. In this series, only 2 patients remained in complete atrio-ventricular block (1 affected by the complete form and the other partial). Long term survival is related to the severity of left valvular insufficiency. In this series with a mean follow-up of 3.83 +/- 2.78 years, we had an a cumulative survival of 86.7% +/- 3.43%. At the last control, most of the survivors had a good quality of life: 91% were in class I and 9% in class II according to the NYHA scale.

Cardiac Catheterization↗
PubMed1989

Diffuse axonal injury after severe head trauma. A clinico-pathological study.

Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude. In this paper we present a group of 24 patients with a severe head injury in whom the postmortem examination demonstrated unequivocal signs of DAI. Widespread axonal retraction balls, located preferentially in the centrum semiovale and internal capsule were the most constant histological finding. We divided the entire series into two subgroups. One group (15 cases), included all the patients in whom the CT scan did not demonstrate mass lesions. In the second group (9 patients) we considered patients with a diffuse axonal injury in whom the CT scan additionally demonstrated a mass lesion (6 acute subdural haematomas, 2 intracerebral and 1 extradural haematoma). The mean age of the entire group was 26 years. Twenty two patients were injured in a road traffic accident, the remaining two fell from a considerable height. All were rendered immediately unconscious on impact. Diffuse brain damage is a common finding in patients with a severe head injury and immediate coma in whom the CT scan does not show mass lesions. Diffuse axonal injury can also appear in connection with a wide spectrum of focal lesions (acute subdural haematoma, basal ganglia haematoma etc.).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Correlation of etiology and severity in a series of 506 cases of acute pancreatitis].

We present a retrospective study on 506 patients with acute pancreatitis (AP), admitted in our hospital in the last five years (1984-1988). The goal of the paper is to establish a possible correlation between the severity and the etiology of the AP. Depending on the severity of the acute attack, and according to the Ranson's prognostic signs and the findings of the abdominal CAT, we have classified AP in three grades: mild, moderate and severe. 52% of AP were of biliary etiology, 25.7% alcoholic, and in 17.0% of the cases the responsible agent was not demonstrated. In relation with severity, the distribution was as follows: mild, 184 (36.4%), moderate, 254 (50.2%) and severe, 68 (13.4%). Among the cases of biliary and alcoholic etiology, 14.7% and 9.2%, respectively, were severe. Postoperative AP were severe in 71.4% of the cases. Systemic complications were more frequent in the severe forms, particularly of biliary etiology. Pancreatic abscesses and fistulas were also more frequent in biliary pancreatitis; on the other hand, pseudocysts and ascites were more common in alcoholic pancreatitis. Overall mortality was 2.8% (14 patients). Mortality was 19.1% in the severe forms. In relation to etiology the mortality was as follows: 3.7% in biliary AP; 0.8% in alcoholic AP; 14.3% in postoperative AP; and 2.3% in the idiopathic AP.

Acute Disease↗
PubMed1975

Shortened small bowel syndrome. Mackby's operation.

Intestinal infarction is a condition with a high rate of mortality. Progress in the fields of anesthesia, maintenance of electrolyte balance, and intensive postoperative care has made survival possible in a number of patients subjected to extensive resection of the small intestine. Many of these patients, however, later succumb to the effects of malabsorption. In this paper we report on a patient who has undergone massive intestinal resection, because of venous intestinal infarction, and Mackby's operation, with favorable results twelve months postoperatively.

Adult↗