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Biomedical subjects

J R Polo

Publications and source records attributed to J R Polo.

27 records · Page 2Linked to original sources
PubMed1990

Brachial-jugular polytetrafluoroethylene fistulas for hemodialysis.

A retrospective analysis was made of 16 patients who had received a brachial-jugular polytetrafluoroethylene (PTFE) graft for hemodialysis. In four patients, the procedure was used to treat malfunctioning brachio-axillary fistulas due to long venous stenosis in the axillary vein. In 12 other patients, the operation was chosen in cases of exhaustion of the veins in the upper extremity because of previous multiple failed fistulas. Two patients died with a functioning fistula 7 and 10 months after placement of the graft of causes unrelated to the vascular access. The other 14 patients retained functioning fistulas between 8 and 26 months after construction of the shunt. Three patients needed graft thrombectomy to treat occlusive episodes. No venous stenosis was found in a postoperative fistulography made in those patients. One patient needed substitution of a graft segment due to stenosis of the prosthesis crossing over the clavicle. We believe that the brachial-jugular graft is a procedure that can be considered as vascular access for hemodialysis in cases where the use of veins in the upper extremity and the axilla is not possible.

Adult↗
PubMed1989

Peritoneal mucormycosis in a patient receiving continuous ambulatory peritoneal dialysis.

A 48-year-old man receiving maintenance hemodialysis for 3 years and continuous ambulatory peritoneal dialysis for 1 year developed a clinical picture compatible with peritonitis. Three successive fluid cultures were negative, and only after filtration of a large volume of peritoneal fluid a fungus identified as a Rhizopus sp was isolated in cultures of the filtering devices. The same fungus was also isolated from the peritoneal catheter cuff. Intravenous amphotericin B was administered and both the abdominal and general conditions of the patient improved transiently. Twenty days after initiation of antifungal treatment, a clinical suspicion of intestinal perforation arose and an exploratory laparotomy was scheduled, but the patient died during the anesthetic induction. The patient never received deferoxamine; any conditions predisposing to mucormycosis, such as diabetes or immunosuppression, were also absent.

Amphotericin B↗
PubMed1988

Treatment of severe intra-abdominal sepsis and/or necrotic foci by an 'open-abdomen' approach. Zipper and zipper-mesh techniques.

Undrained necrotic tissue or septic foci contribute to continued "activation" of host processes that in turn lead to multiple organ failure and death. We hypothesized that if wide-open drainage of the abdominal cavity is provided, thus not allowing intra-abdominal collections to form, mortality in these patients can be reduced. Since 1982 we have treated 49 patients with necrotic pancreatitis and related infections and 15 patients with severe intra-abdominal sepsis from intestinal perforations. The surgical treatment was based on the provision for daily laparotomies in the intensive care unit with the patient under epidural anesthesia by using an "open-abdomen" technique (zipper alone or a zipper-mesh combination). The APACHE II score and the functional classification were used to derive expected mortalities. The patients with intraabdominal sepsis had a mean APACHE II score of 25 and an expected mortality of 45%, vs the 26.5% mortality that we observed. The lowest mortality in the necrotic pancreatitis group was associated with noninfected pancreatic necrosis (6%) and single abscess (9%) vs 22% mortality rate in the patients with infected pancreatic necrosis. The mean expected mortality in this group was 47%, vs the observed 22%. We attributed this result to the daily abdominal explorations that achieved a complete excision of infected or necrotic tissue.

Abdomen↗
PubMed1979

Congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease): report of a case and review of the literature.

A case of congenital cystic dilatation of the intrahepatic bile ducts (Caroli's disease) followed for more than 7 years is reported. This patient presented also with congenital hepatic fibrosis, gallstones, and biliary hypersecretion of more than 3,000 ml in 24 hours. An analysis of the literature relating to Caroli's disease disclosed 46 well-documented cases of both hepatic histopathology and biliary tree studies. Six cases (13%) were found to be isolated forms of intrahepatic cystic dilatations; 16 (34.7%) were associated with congenital hepatic fibrosis; 10 (21.7%) presented with either a choledochal cyst or nonobstructive extrahepatic biliary tree dilatation; and in 14 cases (30%) the three anomalies were found together in the same patient. After these findings, we think that congenital hepatic fibrosis, congenital cystic dilatations of the intrahepatic bile ducts (Caroli's disease), choledochal cyst and other nonobstructive dilatations of the extrahepatic biliary tree are possibly the same congenital disease with different levels of involvement.

Bile Ducts, Intrahepatic↗
PubMedDate not supplied

Surgical wound infection by Aspergillus fumigatus in liver transplant recipients.

Cutaneous aspergillosis is generally associated with immunosuppression, burns, and major trauma. Most cases are acquired by direct inoculation, although cutaneous involvement does occasionally occur with disseminated disease. Surgical wound infections caused by Aspergillus species are very unusual and to our knowledge have not been described in the setting of organ transplantation. We describe two liver transplant recipients who developed wound aspergillosis during a nosocomial outbreak of Aspergillus infection. Infection developed in the second and fourth postoperative week respectively, and in both cases wound appearance mimicked necrotizing fasciitis. Both patients died despite local debridement and antifungal therapy with amphotericin B. Aspergillus must be added to the list of potential pathogens of surgical wounds, especially in the setting of organ transplantation.

Amphotericin B↗
PubMedDate not supplied

BsmI vitamin D receptor polymorphism and pathogenesis of parathyroid adenoma.

INTRODUCTION: The role of vitamin D receptor (VDR) gene polymorphism in the pathogenesis of hyperparathyrodism is not clear yet. The aim of this study was to examine the role of BsmI VDR gene polymorphism in patients with primary hyperparathyrodism (PHP) secondary to adenomas. MATERIAL AND METHODS: Fifty-two postmenopausal women with PHP, mean age 64.5 years, were compared with a normal age-matched female population (n = 81). RESULTS: Distribution of BsmI polymorphism in PHP group was: Bb 54% (28/52); BB 21% (11/52); bb 25% (13/52). In the control group, the distribution in PHP group as follows: Bb 49% (40/81); BB 16% (13/81); bb 35% (28/81). No statistical differences were found between the two groups. In the PHP group, no statistical associations were found between different allelic distribution and age, creatinine, hematocrit, phosphorus, alkaline phosphatase (ALP), total calcium, serum parathyroid hormone (PTH), or gland weight. This data suggest that at least in this group, BsmI VDR gene polymorphism appears to be without relevance in clinical presentation and possibly tumorigenesis in PHP secondary to adenomas.

Adenoma↗
PubMedDate not supplied

Salvage of angioaccess after late thrombosis of radiocephalic fistulas for hemodialysis.

A retrospective study of 44 surgical procedures performed in 39 patients with late occlusions of radiocephalic fistulas for hemodialysis is reported. In 6 cases (13.6%) no apparent anatomical cause was found, and a simple thrombectomy was performed as a corrective procedure. Some sort of arterial and/or venous stenosis was present in the other 38 cases. In 11 cases with evidence of mild localized vascular stenosis we performed a thrombectomy and then an endoluminal angioplasty with a balloon catheter and Bakes dilators. In 26 cases, with more severe degrees of stenosis, we made a proximal new fistula in the distal portion of the forearm, bypassing the vascular stenosis, either end-to-end radiocephalic or with interposition of a short segment of PTFE graft. The best results were achieved with the creation of a proximal new fistula, which resulted in almost 50% cumulative patency rates at 2 years, with no immediate failures. We think that an attempt at angioaccess salvage should be made in every case of late thrombosis of radiocephalic fistulas.

Humans↗