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Biomedical subjects

J Cervantes

Publications and source records attributed to J Cervantes.

At least 19 recordsLinked to original sources

Unilateral polycystic (dysgenetic) disease of the parotid gland.

We report a case of unilateral polycystic disease of the parotid gland. Only eight cases of this disease have previously been published in the English language literature, and seven of them were bilateral. Thus, we are reporting the second case of unilateral involvement. The disease is apparently limited to the parotid gland and to women. Clinically, a fluctuating, long-standing, nontender parotid gland swelling is usually noticed in adulthood. Histologically, there are numerous epithelial-lined cysts, which appear to be derived from intercalated ducts. This disease probably represents a developmental condition.

Actins

Intrahepatic subcapsular biloma. A rare complication of laparoscopic cholecystectomy.

Bile leaks leading to bilomas in the subhepatic space are amongst the most common complications of laparoscopic cholecystectomy (LC). We describe the case of a large (1,100 cc) intrahepatic biloma that presented with pain and fever 14 days post LC. The diagnosis was suspected as a result of ultrasound and CT scan and the problem was solved by percutaneous catheter drainage. We believe this intrahepatic biloma was caused by a lesion of an abnormal bile duct near the bed of the gallbladder during a difficult dissection due to severe contraction and fibrosis.

Bile

An enhanced surveillance program for adult T-cell leukemia in central Brooklyn.

The Brooklyn Adult T-cell Leukemia/Lymphoma (ATL) study was developed to estimate the incidence of the human T-cell lymphotropic virus type I (HTLV-I)-associated ATL in the Crown Heights/Bedford Stuyvesant community. This central Brooklyn black community is an area which has already been shown in earlier reports to be endemic for HTLV-I-associated ATL. Surveillance has been conducted at seven area hospitals that serve this community, with surveillance already completed at five hospitals. Potential study subjects who are 20 years or older are identified by the review of admission records, discharge summaries, pathology and clinical chemistry reports, or physician referrals. Diagnoses of leukemia or lymphoma, or the presence of leukocytosis or hypercalcemia are used as criteria to identify the subjects. Participating subjects give a sample of blood for the determination of HTLV-I infection by serologic tests. At the time of enrollment, subjects provide demographic information including age, sex and birthplace. After one year of surveillance at five hospitals (39.5% of inpatient beds in the catchment), we have identified 12 cases of HTLV-I-associated ATL. The mean age of the ATL patients was 50 years, with patients being predominantly female (83.3%) and often Caribbean immigrants (83.3%). Interestingly, 42% of our cases were identified solely by findings of hypercalcemia from clinical chemistry reports. The remaining ATL cases were identified by physician referral. This enhanced surveillance program that uses both clinical and laboratory criteria for ATL case ascertainment can serve as a prototype for similar surveillance in other areas endemic for HTLV-I-associated ATL--an important effort because of the strong potential for disease prevention.

Adult

[Laparoscopic cholecystectomy in pediatrics. A report of the first case in the Mexican literature].

The authors present the case of a 9.8-year-old girl with 5 a month history of epigastric pain which was due to gallstones as demonstrated by ultrasound. After an extensive work-up failed to reveal associated hematologic problems, she was successfully treated by laparoscopic cholecystectomy, resulting in complete recovery, hospitalization of 22 hours and return to school three days after major surgery. We could not find references of laparoscopic cholecystectomy in the pediatric age group in the Mexican literature and only 3 in English language publications. In cases of cholelithiasis without associated diseases in children, the operation of choice should be laparoscopic cholecystectomy.

Child

Measurement of gastric emptying rate in humans by real-time ultrasound.

Simultaneous studies of gastric emptying by ultrasound and scintigraphy were performed in 14 subjects to assess the use of ultrasound for the measurement of gastric emptying rate. The presence of air in the stomach prevented the acquisition of gastric emptying data by ultrasound in 3 of the 14 subjects. In the remaining 11 subjects there was no significant difference between values for the half-time (t1/2) of gastric emptying obtained by scintigraphy [for anterior imaging, mean t1/2 = 20.9 +/- 9.9 min (+/- SD); for anterior and posterior imaging, geometric mean t1/2 = 21.1 +/- 10.5 min (+/- SD)] compared with those derived by ultrasound [mean t1/2 = 20.2 +/- 10.0 min (+/- SD), p greater than 0.05 for each comparison]. A significant correlation between the t1/2 of gastric emptying derived by scintigraphy (anterior scanning and geometric mean of counts obtained by anterior and posterior scanning) and the t1/2 measured by ultrasound was obtained (r2 = 0.7, 0.69, respectively). These results imply that ultrasound can be used for the valid assessment of the gastric emptying rate in humans.

Adult

Ultrasound diagnosis of rectus sheath hematoma.

The authors present three patients with rectus sheath hematoma who were diagnosed with ultrasound and successfully operated upon. The importance of a correct preoperative diagnosis is stressed to avoid an unnecessary laparotomy. Ultrasound helps to localize the presence of an extra-abdominal mass located between the aponeurotic sheaths of the rectus muscle. Surgery is the best treatment since it is possible to evacuate the large hematoma, and at the same time it affords an opportunity to ligate the bleeding vessels, usually the epigastrics. No advantage is seen using conservative treatment, as several weeks may be necessary before complete resolution, while the patient is suffering considerable pain and discomfort.

Abdominal Muscles

Fluphenazine decanoate and tardive dyskinesia: a possible association.

The authors examined the charts of 22 outpatients who had received intramuscular fluphenazine decanoate and oral fluphenazine hydrochloride to assess the incidence of tardive dyskinesia. The severity of tardive dyskinesia was assessed with the Abnormal Involuntary Movement Scale (AIMS). Both the total dose and average daily dose of fluphenazine decanoate correlated significantly with high AIMS scores. There were also significant correlations of AIMS scores with total dose of antiparkinsonian medication and total dose of other neuroleptics. Total dose of antiparkinsonian medication correlated with total dose of fluphenazine decanoate. The authors discuss the clinical and physiological implications of these correlations.

Adult

Health care delivery system. Effects on surgical education: the Mexican panorama.

Health care delivery in Mexico is divided in three groups: a social sector that covers approximately 53% of the population and is financed by the labor force, the state and the employer; a public, or open, sector that covers 33% of the population and is financed by federal and state funds; and a private sector that covers about 5% of the population and has two categories, the not-for-profit hospitals and the profit-oriented institutions. Most medical practitioners can work in any of the three groups or in several. Nine percent of Mexico's population, because of extreme ignorance, poverty, or isolation, have no or limited access to medical care. Mexico has 58 medical schools, which graduate about 7800 new physicians annually, awarding them the title Medico Cirujano (Physician Surgeon). There are more than 160,000 physicians in Mexico, 20,000 of whom are unemployed. Each year, approximately 12,000 physicians compete for the 4306 places in the official residency training programs for all specialties. Of those taking the examination, 2000 try to get one of the 625 slots available for training in general surgery. Most of the surgical training programs in Mexico have a 3-year duration. The Mexican Academy of Surgery, the Mexican Society of General Surgery, and the Mexican Board of Surgery, as well as private individuals and organizations, are working to improve the quality of medical education and trying to establish a 5-year training program in surgery. The rapid movement toward modernization that is sweeping the country must include the improvement of surgical education as well.

Delivery of Health Care

Acute thrombosis of abdominal aortic aneurysm. An uncommon entity.

Acute thrombosis of an abdominal aneurysm is a catastrophic complication which is little known. It presents as a sudden event, characteristically with lower abdominal pain, signs of profound lower extremity ischemia and pronounced bilateral lower extremity neuromuscular dysfunction. While the mechanism of thrombosis is not understood and is unpredictable, it is certain that the condition is rapidly fatal if uncorrected. The mortality of acute thrombosis is very high, similar to rupture, which is the most common complication of an abdominal aortic aneurysm. Diagnosis is not difficult, and must be followed by prompt surgical restoration of circulation of the lower half of the body, if death is to be prevented. This can be accomplished by aneurysm resection and graft replacement. Retrograde transfemoral thromboembolectomy should not be done. This report describes two successfully operated cases which dramatize the symptomatology of the condition and show the gratifying results of immediate surgical intervention. Only 30 cases (15 fatal) have been reported in the literature.

Acute Disease

[Fat embolism].

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Adolescent

[Ischemic colitis].

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Aged