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Biomedical subjects

L Morales

Publications and source records attributed to L Morales.

At least 19 recordsLinked to original sources
PubMed2006

Endometrial safety of third generation aromatase inhibitors versus tamoxifen in breast cancer patients.

The estrogenic activity of tamoxifen on the uterus increases the risk of developing benign and malignant uterine pathologies in breast cancer patients receiving this drug. This has led to gynecological interventions specifically in symptomatic women to exclude malignant disease. Given this known side effect associated with tamoxifen therapy, newer endocrine therapies such as the third-generation aromatase inhibitors have been compared to tamoxifen also in terms of their uterine effects. To date, studies that have directly compared the uterine effects of tamoxifen with that of aromatase inhibitors generally show that aromatase inhibitors such as anastrozole, letrozole, and exemestane are associated with less uterine pathologies compared to tamoxifen. Furthermore, aromatase inhibitors may even reverse uterine abnormalities induced by tamoxifen. This implies that the absence of a stimulatory effect on the uterus would be one of the benefits gained with aromatase inhibitor therapy and may decrease or even obviate the need for gynecological interventions.

Antineoplastic Agents, Hormonal↗
PubMed2006

[Lessons we've learned in the treatment of long gap esophageal atresias].

BACKGROUND: A gap greater than 3 cm between both esophageal pouches is observed in 1 of 20 cases of esophageal atresia. Our goal was to critically review our experience in the management of these patients. MATERIAL AND METHODS: During 1995-2004, 15 patients were treated for a long gap esophageal atresia (LEA). Gaps ranged from 3 to 8 cm. Ten patients presented a pure esophageal atresia. They were managed with a gastrostomy and delayed repair: 8 Schärli interventions and 2 esophageal flaps. The other 5 patients had an esophageal atresia with distal fistula (LEA-DF), and primary repair was attempted: 3 end-to-end esophageal anastomosis were achieved under a strong tension; 1 a Schärli procedure; 1 ligation of the fistula, feeding gastrostomy and delayed esophageal flap. The use of esophageal flaps is a late event in our series. since its introduction we've performed 5 esophageal atresia repairs using 3 flaps (2 pure atresias and 1 LEA-DF). RESULTS: From 9 Schärli we have to practice 2 reinterventions for anastomotic leak; there was 1 parahiatal hernia that needed surgery after 8 years. From 3 flaps 2 patients presented a persistent stricture that needed reintervention. All of the 3 E-E anastomosis had reintervention for persistent stricture and also anti-reflux procedures (Nissen). Eight patients showed a normal growth and development (4/9 Schärli, 3/3 flaps and 1/3 E-E). Seven patients are growth retarded (4/7 with associated malformations, 1/7 who developed an eosinophilic esophagitis and 2/7 preterm babies). CONCLUSIONS: The esophageal flap is our first choice, because the own esophagic tissue fills in the gap. In LEA-DF, we prefer fistula ligation, gastrostomy and delayed rise of a flap (as we did in our last patient) better than a very tense primary anastomosis. As a second option, a Schärli procedure offers satisfying mid-term results. Keeping the patient paralyzed and mechanically ventilated for 5-7 days after surgery helps to avoid disrupting forces on the anastomosis.

Esophageal Atresia↗
PubMed2005

HPLC-DAD determination of opioids, cocaine and their metabolites in plasma.

High performance liquid chromatography with diode array detection (HPLC-DAD) was used to develop a method for the simultaneous determination of morphine, codeine, 6-acetylmorphine (6AM), cocaine, benzoylecgonine (BEG), cocaethylene, methadone and its metabolite, 2-ethylidene-1,5-dimethyldiphenylpyrrolidine (EDDP), in plasma. Following solid-phase extraction with Bond Elut Certify cartridges, chromatography was performed on an X-Terra RP8 column (250 mm x 4.6 mm i.d., 5 microm particle size), using acetonitrile-phosphate buffer pH 6.53 as mobile phase and elution in the gradient mode. The detector response was linear at concentrations over the range 0.1-10 microg/mL in plasma, and the correlation coefficients for the eight drugs studied were all higher than 0.99. The average extraction recoveries from plasma ranged from 60% for BEG to 95% for methadone. The precision was acceptable, with coefficients of variation oscillating between 2.55% and 6.45%. The accuracy was found to be within satisfactory limits (+/- 8.1%). Finally, the method was applied to 21 plasma samples from fatal overdoses, obtaining positive results for two or more drugs.

Analgesics, Opioid↗
PubMed2005

Comparative study between isolated intestinal perforation and necrotizing enterocolitis.

INTRODUCTION: Intestinal perforations in the neonatal period are usually related to necrotizing enterocolitis (NEC) or intestinal occlusion. Intestinal perforation in the absence of these conditions is called isolated perforation (IP). Several risk factors and pathogenic mechanisms have been suggested, and most of them are common to those classically attributed to NEC. AIM: To identify and compare the clinical and pathological features of IP and NEC. MATERIAL AND METHODS: We reviewed all cases of neonatal intestinal perforation and NEC in the last five years. Thirty-three patients were retrospectively classified into Group NEC: 24 cases, and Group IP: 9 cases. We collected multiple data as study variables: 1) General features; 2) Obstetric history; 3) Neonatal treatment; 4) Comorbidity; 5) Perforation features; 6) Treatment and outcome. RESULTS: Comparing the groups, we found statistical significant differences in isolated perforation cases with these risk factors: extreme prematurity, very low birth weight, abruptio placenta, intubation and neonatal mechanical ventilation, umbilical catheterization, precocious sepsis, and indomethacin therapy. A more precocious operation and a good prognosis also reached statistical significance. In the other hand, we found statistically significant differences in NEC with congenital cardiopathy (excluding isolated patent ductus arteriosus), with intestinal pneumatosis, with diffuse bowel involvement and a worse prognosis. Risk factors and pathologic findings seem to support an ischaemic pathogenesis in both diseases.

Enterocolitis, Necrotizing↗
PubMed2005

Third generation aromatase inhibitors may prevent endometrial growth and reverse tamoxifen-induced uterine changes in postmenopausal breast cancer patients.

BACKGROUND: Tamoxifen may induce uterine abnormalities of clinical concern. Our aim was to compare early uterine changes occurring in postmenopausal breast cancer patients treated in first-line with tamoxifen or third generation aromatase inhibitors. We also assessed the effect of aromatase inhibitors on tamoxifen-induced uterine changes. PATIENTS AND METHODS: Seventy-seven consecutive postmenopausal breast cancer patients scheduled to start endocrine treatment were included in this prospective study. Transvaginal ultrasonography (TVUS) was carried out before and after 3 months of therapy. No interventions were done on pre-existing asymptomatic uterine abnormalities seen on baseline sonography. RESULTS: After 3 months of therapy, tamoxifen significantly increased endometrial thickness and uterine volume. Additionally, tamoxifen induced endometrial cysts and polyps, and increased the size of pre-existing fibroids. In contrast, aromatase inhibitors did not stimulate endometrial growth and were not associated with endometrial pathologies seen under tamoxifen. Furthermore, aromatase inhibitors decreased endometrial thickness and uterine volume in patients previously treated with tamoxifen. CONCLUSIONS: Our study demonstrates that tamoxifen induces uterine abnormalities from as early as 3 months of therapy. In contrast, these abnormalities are not seen in patients on aromatase inhibitors. Furthermore, our data indicate that tamoxifen therapy followed by an aromatase inhibitor may lead to a reduction in endometrial pathologies associated with tamoxifen.

Antineoplastic Agents, Hormonal↗
PubMed2005

[Continent urinary diversion: the Mitrofanoff principle].

INTRODUCTION: Continent urinary diversion (based on Mitrofanoff's principle), despite its complexity, is the gold standard in the treatment of those vesicourethral disfunctions that need clean intermittent catheterization (CIC) to achieve complete vesical voiding, in patients with non easily catheterizable native urethra. AIM: To analize our experience in continent urinary diversion at our centre. PATIENTS AND METHODS: We have reviewed the records of the 14 cases of continent urinary diversion in the last 8 years. They were grouped in order to the underliying condition: 1-Bladder exstrophy group (n=5): Mean age at diversion time was 5.5 years (range 3-7). In all patients the original Mitrofanoff s technique was performed (continent cutaneous appendicovesicostomy). Associated procedures were: ureterovesical reimplantation in all 5 cases; bladder neck reconstruction also in all 5 (3 of them needed vesicourethral transection); and bladder augmentation in two cases, using ileum and sigmoid respectively. 2- Myelomeningocele group (n=9, 10 procedures): Mean age was 11.5 years (range 6-16). Appendicovesicostomy was performed in 7 cases and a reconfigured ileum with the Casale technique was used in 3 cases (primarily in 2 and as an alternative in one). Associated procedures were: ureterovesical reimplantetion in 5 cases and bladder augmentation in 7 (using sigmoid in 4, ileum in 2 and urether in one case). RESULTS: In all patients complete continence was achieved. Complications found were: one appendicostomy prolapse, one appendix necrosis (that was then diverted with Casale's technique), one appendicular conduit stenosis and one case with catheterization difficulties that needed a tappering of the ileum conduit. Nowadays, 13 out of 14 pacients follow the CIC program each 3-4 hours without complication. CONCLUSION: Continent urinary diversion improves autonomy and life quality in those patients that need a definitive urinary diversion and have a long life expectancy. We have used these procedure with good results in patients with severe vesicourethral disfunction (of an intrinsic or neuropathic origin) in which clean intermittent catheterization was not possible through native urethra, or in patients with refractary incontinence in which vesicourethral transection was the only effective treatment.

Adolescent↗
PubMed2005

[Retroperitoneoscopic nephrectomy: our experience in short-term hospital stay].

OBJECTIVE: To prove that the nephrectomy, in spite of being a major surgery, requires less than 48 hours stay hospital if it is performed by retro peritoneal approach. Consequently this procedure can be carry out in a short hospital stay. MATERIAL AND METHODS: From 1995, we have treat 40 patients by retroperitoneoscopic nephrectomy, 46 nephrectomies in total, being bilateral in 6 patients because of terminal renal failure (TRF), who do not take part in that study. The average age was 4.8 years range old (with a rank between 6 months and 13 years old), in relation with sex, male (n=16) and female (n=18). As for the side of the nephrectomy, it was the right in 20 cases and left in 14. Those pathologies, which indicated the nephrectomy because of kidney's functional annulations, were: obstructive hydronephrosis (n=2); obstructive megaureter (n=1); kidney destroyed by reflux (n=8); multicystic displasia (n=11); involution multicystic diyplasia (n=12). RESULTS: In all the cases, the nephrectomy was pure retroperitoneal approach. The average time of surgical duration was of 92 minutes (with a range between 60-240 minutes). It was reconversion in 1 case (4.5%) by peritoneal micro perforation (n=1). We underline absence of inherent complications to retroperitoneoscopy, intraoperative and postoperative procedures. As secondary complications to the access surgical procedure were 2 wall relaxations because of incisional injury and one serum collection of the first port site. The bleeding during the operative act was imperceptible, less than 20 cc. Drainages were not left in the operative bed. The average stay has been reduced to 27 hours, without being counted the 6 cases of TRF. In the last 18 cases the hospitality discharge was made in the first 24 h postoperative. The analgesic established by protocol was analgesic of infiltration of ports site with 1% bupivacaine and one dose of paracetamol/ibuprofen, given 12h after the intervention and repeated after hospitality discharge. Essumpcion of their day home-life and school- was earlier in 100% of cases. We underline the absence of secondary complications to pain (breathing) neither to immobilization. CONCLUSIONS: The retroperitoneoscopic nephectomy is a clearly established indication and of required fulfilment in paediatric age. It is the suitable surgical boarding to perform a nephrectomy because of its reliability, reproductibile and safety. Media hospital stayis lesser when the nephrectomy was performed by retro peritoneal approach than conventional surgery. Consequently this procedure can be carry out in a short hospital stay.

Adolescent↗
PubMed2004

[Laparoscopic adrenalectomy].

BACKGROUND/PURPOSE: Laparoscopic adrenalectomy is a standard procedure in adult patients. In the pediatric patient the same advantages with regard to traditional surgery have been demonstrated in the treatment of localized adrenal tumours. The aim of this work is to analyze our initial experience in this technique. MATERIAL AND METHODS: We have reviewed our last three adrenalectomy cases. They were two girl and a boy aged 4, 15 and 17 year-old. The etiology was pheochromocytoma in two cases and one ganglioneuroblastoma. In two cases the tumour was right-sided and the other one was in the left adrenal gland. All cases were studied with ultrasound, TC and MRI. Patients with pheochromocytoma were also studied with MIBG-scintigraphy and genetics, hormone and endocrine MEN screening. One patient with pheochromocytoma had von Hippel-Lindau disease. Main size tumour was 40 mm. Preoperative alpha-blockade in pheochromocytoma was done with prazosín and intraoperative with nitroprusside. In lateral decubitus position, through four 10 and 5 mm ports, in two cases adrenalectomy was performed and tumorectomy in one. RESULTS: Main operating time was 120 minutes. There was no operative-related complication. Blood pressure in pheochromocytoma patients was controlled without drugs 36h after surgery. They were discharged between the 2nd and 4th postoperative day. No incidences on follow-up. CONCLUSIONS: Adrenalectomy joins other pediatric procedures affordable with the laparoscopic approach. It minimizes surgical trauma, gland exposure is better, allows a safe and quick resection in adrenal tumours, with a short and suitable postoperative course.

Adolescent↗
PubMed2004

[Thoracoscopic thymectomy].

BACKGROUND/PURPOSE: The use of videothoracoscopy in thoracic pediatric pathology has been progressively accepted in different diagnostic and therapeutic procedures along last decade. The aim of this work is to analyze our initial experience in thymectomy through this approach. PATIENTS AND METHODS: We have used the thoracoscopic approach in the last two cases of thymus pathology with surgical indication. Case 1: 9 year-old patient recently diagnosed on myasthenia gravis and several hospital admissions because of clinical worsening. Case 2: 9 year-old patient with a 7x8x3.5 cm. cervico-mediastinal tumour. FINAL DIAGNOSIS: Multilocular cystic thymoma. In both cases we used right approach in lateral decubitus, and the harmonic scalpel. RESULTS: Mean operating time was 125 minutes. No procedure-related complications. They were discharged on the 6th and 4th postoperative day. After 6 and 7 month follow-up, no incidences have been found, and case 1 has shown a sympthomatic improvement and a decrease in drug dosage. CONCLUSIONS: Thoracoscopy is a good alternative in thymus approach. Its cosmetic and recovery advantages upon transcervical and transsternal are obvious. Despite our very initial experience, we believe that this approach at least equals classic ones in the ability to resect the whole thymus.

Child↗
PubMed2004

[Transanal endorectal pull-through alone as treatment of Hirschsprung's disease].

UNLABELLED: The aim of this work is to present our experience in the treatment of Hirschsprung's disease (HD) with the technique described by De la Torre. MATERIALS AND METHODS: Seven children diagnosed with recto-sigmoid aganglionism have been treated with this surgical technique, to which a few modifications have been done. RESULTS: There were no intra- nor early postoperative complications. Surgical time ranged 150 to 240 minutes (average 198). All children began oral feedings 2 or 3 days postoperatively (average 2.4). Hospital stay averaged 5.2 days. Follow-up ranges from 6 months to 3 years (average 16 months). Two late complications were seen--one anastomotic stricture and one constipation--and successfully treated as out patients. CONCLUSIONS: The transanal only approach carries a rapid recovery. Family satisfaction is high because of the lack of scars. We believe this is the treatment of choice when confronting rectosigmoid aganglionism.

Anal Canal↗
PubMed2004

[Congenital solid tumors. A thirteen-year review].

UNLABELLED: Tumors diagnosed during the first month of life are infrequent: 0.5 to 2% of all childhood neoplasms. This is an interesting group of tumors because their type, relative incidence, natural history and response to treatment differ from those seen in older children. AIM: To contribute the experience of our institution in congenital tumors the last 13 years. MATERIAL AND METHODS: The records of all neonates (< 31 days old) diagnosed with solid tumors since January 1990 to December 2002 have been retrospectively reviewed. RESULTS: Twenty-seven neonates have been diagnosed with tumors in the last 13 years. Thirteen patients (48%) were prenatally diagnosed. Nine babies were diagnosed at the initial neonatal exam (40% of those diagnosedd after birth). Neuroblastoma was the commonest tumor (10 cases, 37%), of which 4 were stage I, 4 stage IV-S and 2 stage III. There were 8 teratomas (3 sacrocoxigeal, 1 retroperitoneal, 1 in the CNS, 1 orbitary and two oronasal), two hepatic tumors (1 hepatoblastoma, 1 hemangioendothelioma, two CNS tumors, two giant nevus (one on a hamartoma), and one each Wilms tumor, infantile fibrosarcoma and myofibroblastic tumor. Treatment was surgical resection alone in 17 cases (68%) and surgery + chemotherapy in 8 (32%) (5 neuroblastomas, one CNS tumor, one Wilms tumor and one presacral teratoma who developed a yolk sac tumor); 3 patients died (11%): one at surgery, one of tumoural airway obstruction at birth and one with craniopharyngioma. Among the 14 tumors that were initially not malignant, two can be locally agressive, one was an immature teratoma, the giant nevus with hamartoma developed in situ melanoma, the other nevus had meningeal melanosis with hydrocephalus, and one mature presacral teratoma developed a yolk sac tumor. CONCLUSIONS: Diagnosis of congenital tumors is performed earlier in recent years due to the wide use of prenatal ultrasound. Their natural history is more benign than in other age groups, except for CNS tumors and very large or obstructing tumors. The histological patern is not determinant of the outcome. Complete surgical excision is the treatment of choice, most cases not need adjuvant chemotherapy. We ought to pass this message on to our colleagues in prenatal diagnosis, so parents get reliable information.

Central Nervous System Neoplasms↗
PubMed2004

[Evolution of pre and postoperative renographic parameters in pyeloreteral juntion obstruction syndrome].

With the objective of observing the modifications that the postoperative Diuretic Renography (DR) curve shows and determining how the quantitative parameters of this exploration (Differential Renal Function (DRF), Peak Time (PT), Half Time (HT), descent of maximum activity at 10 min (DMA10)) can be modified, the records of 50 patients affected by unilateral pyeloureteral junction obstruction and without any other associated pathology treated between 1991 and 2001, were revised. The age of the patients was between 1 month and 12 years (average 2 years 7 months). Of the 50 patients, 31 were male and in 28 of the cases were affected on the left side. Patient selection was random. The preoperative evaluation was made using ultrasound (US), intravenous urography (IU), voiding cystourethrography (VCU), and RD. The RD technique and surgical intervention were standardized and the latter were performed by the same surgeon. Postoperative control was made with US and/or IU and RD between 6 and 18 months following surgery, even though total follow up ranged from 6 months to 10 years (average 38.24 months). In all of the cases the follow up US and/or IU results were satisfactory, even though there was residual pyelic ectasia and absence of tension. The morphology of the preoperative curves was mostly obstructive or partially obstructive without lasix response, the curves became normal in 9 cases and partially obstructive with a good response to lasix in 38. The 3 remaining cases that corresponded to the hypofunctional kidney curve did not change. The DRF did not present major variations. The postoperative PT decreased in 62% of the cases. The HT and DMA10 improved in very few cases. In conclusion, it can be said that in spite of a good surgical outcome, the patterns of the postoperative renographic curve often do not completely normalize, major variations in the postoperative DRF are not expected, and with a diminshed postoperative PT a favorable pyeloplasty outcome can be appreciated. HT and DMA10 indicate improvement when they decrease, but do not indicate that the disease has reappeared when they do not change or increase.

Child↗
PubMed2003

Differences of mu-opioid receptors between Lewis and F344 rats.

F344 and Lewis rats show different responses to opioids in several experimental paradigms. In this study we have used the specific mu-opioid agonist DAMGO to find out if these differences could be attributed to heterogeneity of mu-opioid receptors. The density of [H3]DAMGO binding sites was similar in the brain cortex and spinal cord of both strains, but DAMGO affinity for mu-opioid receptors was higher in F344 tissues. Moreover, a parallel study of the effects of DAMGO on electrically-evoked twitches of isolated vasa deferentia revealed that this drug was also more effective in F344 preparations. These results suggest that mu-opioid receptors of F344 rats are more sensitive to pharmacological stimulation in vitro, which could be related to a higher drug affinity.

Analgesics, Opioid↗
PubMed2003

Biological activity of extracts from Catalpa bignonioides Walt. (Bignoniaceae).

Catalpa bignonioides Walt. (Bignoniaceae) is a species that belongs to a tropical family but has been introduced in many countries as ornamental. Although this plant is consumed by indigenous cultures of South America for medical uses, experimental studies of the biological properties of Catalpa bignonioides are lacking. The aim of this work was to study the biological activity of crude extracts from either pods, seeds or leaves of Catalpa bignonioides which were collected in Spain. Ethyl ether, butanolic and aqueous fractions of the pod extract were also prepared and studied. We have examined the antimicrobial activity against five bacteria and one yeast, the cytotoxic activity against HepG2 cells and the anti-inflammatory and antinociceptive effects in rodents. A preliminary phytochemical analysis of the extracts and fractions was also conducted. Results showed no antimicrobial or antitumoral effects, but prominent anti-inflammatory and antinociceptive actions of the extracts. These last activities may be a result of the presence of either of saponins, sterols or phenols, mainly found in the leaves and pods of the plants.

Acetic Acid↗
PubMed2003

[Fetal skin allografts on newborn excisional wounds].

There is clinical and experimental evidence that skin allografts improve secondary intention wound healing, however the grafts do not take. Because of the special characteristics of the healing process in the fetal period, fetal skin allografts could be presumed to be a good alternative to adult skin allografts, and even to autografts in particular cases. In order to explore the behavior of fetal skin grafts on newborn animals, skin has been grafted to laboratory rabbits of two different ages: 26 fetal skin allografts to fetuses and newborns and 21 neonatal skin allografts to newborns. Macroscopic and microscopic features of the grafted area have been compared at the 7th, 14th and 21st postoperative days. The newborn response to a fetal skin graft was somewhat different from that to a newborn skin allograft, the first showing an earlier increase in graft bed vascularization, less edema and less foreign body reaction.

Animals↗
PubMed2003

[Is laparoscopic surgery the technique of choice in nephrectomy?].

Laparoscopic is performed in adults for the treatment of benign renal diseases. It is widely accepted that laparoscopic surgery has more advantages than open surgery in many procedures such as nephrectomy, but there is no further experience in this technique. In pediatric urology laparoscopy has become an accepted approach for varicocele, non palpable testis, bladder augmentation, adrenalectomy and urinary diversion. We report our experience with 25 laparoscopic nephrectomies in children.

Adolescent↗
PubMed2003

[Predictive value of prenatal MRI in the diagnosis of thoracic congenital malformations].

INTRODUCTION: Magnetic imaging (MI) has an increasing value in the prenatal diagnosis of thoracic malformations. MATERIAL AND METHOUS: We compare in this work the prenatal diagnoses with the prenatal sonographic diagnoses and postnatal imaging, surgical or postmortem findings. RESULTS: Prenatal sonography diagnosed 5 diaphragmatic hernias (CDH) and 3 cystic adenomatoid malformations (CAM). MI confirmed left side CDH in 4 cases, in two of them showing also herniation of the left hepatic lobe and the spleen. In the 5th case, MI suggested diaphragmatic eventration with partial occupation of the right hemithorax by the liver. Two of three CAM appeared to have lung sequestration at MI. At birth, four CDH and one diaphragmatic eventration were confirmed by simple x-ray, and by surgery in all but one, a CDH case who went into ECMO and died without surgery. Pulmonary sequestration was postnatally confirmed by CT scan and arteriography. Treatment was coil embolization of the systemic artery. CAM was confirmed postnatally through plain chest film and CT scan. Surgical resection of the lesion was performed and the pathology exam demonstrated the presumed lesion. CONCLUSIONS: When prenatal sonography suggest a fetal thoracic malformation, MI is the way to accurate diagnosis, follow-up, prognostic evaluation and therapeutic strategy.

Congenital Abnormalities↗