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Biomedical subjects

J R Fraile

Publications and source records attributed to J R Fraile.

16 recordsLinked to original sources
PubMed1996

[Glomus jugulare tumor: perioperative management].

Surgical treatment of glomus jugulare tumors yields high rates of perioperative morbidity and mortality for several reasons, among them neuroendocrine secretory activity, a high degree of vascularization, intracranial extension, duration of surgery and cranial nerve lesion. Secretory activity (e.g. catecholamines and serotonin) should be investigated before surgery and treated appropriately. Carotid arteriography (and ball occlusion) are useful to assess vascularization of the tumor and determine the need to clamp the carotid artery during the procedure. Potential complications such as hemodynamic alterations (bleeding or endocrine response), pulmonary embolism (air or thrombotic), hypothermia, facial nerve lesion, should be monitored for during surgery. After surgery cranial nerve involvement, which can lead to dysphagia and bronchoaspiration, must be looked for; the risk of cerebro-spinal fluid fistula is also high. We report the case of a woman who underwent surgery for a non secreting glomus jugulare tumor with extradural intracranial invasion. The main complications during surgery were bleeding with hemodynamic repercussions, pulmonary embolism, lesions in the VII, VIII and X cranial nerves, and opening of the dura mater (which required insertion of an intradural drain to prevent formation of a fistula). After surgery oral intake was delayed until intestinal function was established and glottic sphincter competence was verified by fiberoptic laryngoscopy. The only complication presenting at this time was cephalea, which disappeared upon removal of the drain on day 4. The patient was released on day 10.

Catheterization↗
PubMed1995

[Electromyographic response to precurarization with vecuronium bromide].

OBJECTIVE: To analyze electromyographic response and clinical effects after precurarization with vecuronium bromide (0.01 mg/Kg), also noting intubation conditions and the presence or not of fasciculations after administration of succinylcholine (1.5 mg/Kg). PATIENTS AND METHODS: A single precurarization dose of vecuronium was administered to 20 patients 5 minutes before anesthetic induction for general surgery. During this period we monitored neuromuscular transmission of the cubital nerve in the wrist by electromyography with a series of 4 stimuli, expressing each as the percentage of the first response and of the ratio T4/T1. We also recorded clinical repercussions. General anesthesia was then induced; after administration of succinylcholine, the presence or not of fasciculations was noted and intubation conditions were evaluated. RESULTS: The electromyographic response after precurarization was highly variable, as 4 different responses were recorded. We found potentiation phenomena in 20% of our patients, diminished response in 60%, fatigue phenomena in 15% and no change in 5%. Clinical signs noted were blurred vision and heavy eyelids. Fasciculations disappeared in 95% of the patients and intubation conditions were excellent. CONCLUSIONS: Vecuronium at a precurarization dose produces highly varied but well-tolerated electromyographic responses. The drug is effective in eliminating fasciculations produced by succinylcholine and does not affect intubation conditions.

Adult↗
PubMedDate not supplied

[Acute pain in "Don Quixote"].

OBJECTIVE: A descriptive analysis of references to pain symptoms in Don Quixote based on linguistic, literary, clinical, and mannerist features. METHODS AND MATERIAL: Don Quixote was read and an entry was created for each description of an injury or illness (group I/I). A second group of entries was created for each medical commentary (group C). This information was complemented using a computer search for the roots of words referring to pain symptoms, with an asterisk placed after each root to locate all word forms used. Data entries with pain references were analyzed in group I/I by examining patient, location, characteristics, causes, associated disorders, remedies, caregivers, and recovery times and in group C by examining the full text. RESULTS: Ninety-one entries were made (64 in group I/I, 27 in group c). References to pain were found in 37 entries (29 in group I/I, 8 in group C). The most commonly used words came from the roots dol (the Spanish root for dolor, or pain, among other related words) (52) and moli (for forms related to Spanish idiomatic uses of molido, suggesting severe injury) (19). All pains were due to injuries. Forty-two occasions of injury (Don Quixote 14, Sancho 9, others 19) and 51 lesions (ribs 5, back 5, other 15, unspecified 26) were mentioned. Known remedies and caregivers of the period were described, but other invented ones were also present. Associated disorders were insomnia, anxiety, rage, melancholy, functional impotence and other sexual dysfunctions. Recovery times ranged from 0 to 8 days. CONCLUSION: Pain references are subject to literary considerations. The style is simple and the descriptions are credible for the period depicted but do not meet clinical standards. Issues of current interest are treated: pain threshold and sensitivity, social influences, the placebo effect, and affective disorders.

Acute Disease↗
PubMedDate not supplied

[Dual atrioventricular nodal conduction and arrhythmia with severe hemodynamic alterations during liver retransplantation].

We report the case of a man who developed tachycardia caused by atrioventricular reentry related to dual nodal conduction during liver retransplantation. The hemodynamic alterations were severe. Arrhythmia and altered cardiac conduction are potential complications of liver transplantation. The development of tachyarrhythmias--atrial fibrillation as well as episodes of supraventricular and ventricular tachycardia and bradycardia--have been described. Such arrhythmias tend to occur particularly during reperfusion of the graft. Risk factors implicated are the severe ion imbalances, acid-base imbalance, and hypothermia that accompany the reperfusion of a new organ. A review of the possible pathogenic and etiological mechanisms that lead to arrhythmia in patients with end-stage liver disease is provided.

Acid-Base Imbalance↗
PubMedDate not supplied

[Anesthesia in heart transplantation. Experience at the Clínica Puerto de Hierro].

The anaesthetic management of 41 patients who underwent cardiac transplantation during a 40 month period at Clínica Puerta de Hierro is reviewed. The study includes the preoperative assessment, anaesthetic agents used and intraoperative incidences. The anaesthesia was induced with etomidate whereas a high-dose fentanyl, supplemented with diazepam, was the most commonly anaesthetic technique used. There was no intraoperative mortality in this series. Several interesting concerns related to the physiology of the denervated heart and the effects of vasoactive agents after extracorporeal circulation are reviewed.

Adolescent↗
PubMedDate not supplied

[Artificial heart. Management and clinical utilization].

The improved results of heart transplantation and the need to support hemodynamically those patients with cardiac failure while waiting for a suitable donor has heralded the development of mechanical ventricular assist pumps and the total artificial heart (TAH) as a bridge to transplantation. There are nowadays several TAH in use. The aim of this paper is to describe the current clinical model of the Utah University (model Jarvik-7) and its present or potential clinical applications and indications for use. The world experience up to August 1988 is reviewed.

Equipment Design↗
PubMedDate not supplied

[Peroperative management of the orthotopic implant of a Jarvik-7 total cardiac prosthesis].

A 31 years old woman with a terminal phase dilated cardiomyopathy and a ventricular ejection fraction of 0.12 was admitted to our hospital to be included in the cardiac transplantation program. When entering the hospital her condition worsened and she suffered an electromechanical dissociation that needed cardiopulmonary resuscitation. Few hours later, energetic medical treatment could not improve her haemodynamic situation. Having no adequate organ available for emergency transplantation, a total orthotopic prosthesis (Jarvik-7-70) implantation was decided. Anesthesia was maintained with fentanyl (50 micrograms/kg), droperidol (0.23 mg/kg) and diazepam (0.25 mg/kg). There were no incidents during or after extracorporeal circulation bypass; despite the use of furosemide (100 mg) and mannitol (1 g/kg) diuresis was less than 40 ml/h. After by-pass, pulmonary hypertension was observed and treated with sodium nitroprusside (1 microgram/kg/min) and isoproterenol (5 micrograms/kg/min), as well as increasing the right ventricle working pressure of the device from 40 to 70 mmHg, obtaining haemodynamic stabilization and good tissular perfusion. After operation, the patient arrived to the Recovery Unit in a steady situation, with a cardiac index of 2.87 l/min/m2 and a diuresis of 150 ml/h. Some other aspects of the anaesthetic management are also discussed in this paper.

Adult↗