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Biomedical subjects

L Morales

Publications and source records attributed to L Morales.

At least 19 recordsLinked to original sources
PubMed1994

Streptomycin and alternative agents for the treatment of tularemia: review of the literature.

Because of the recent lack of availability of streptomycin--currently considered the drug of choice for the treatment of tularemia--we reviewed the literature on alternative drugs that have been used for this purpose. In addition, we reviewed data on the in vitro susceptibility of Francisella tularensis to a wide variety of agents. The rate of cure for streptomycin was 97%, with no relapses. For gentamicin and tetracycline, respectively, the rates of cure were 86% and 88%, the rates of relapse were 6% and 12%, and the rates of failure were 8% and 0. The duration of therapy with gentamicin and a delay in its initiation may have affected outcome in severe cases. For chloramphenicol and tobramycin, cure rates were 77% and 50%, respectively; relapse rates were 21% and 0; and failure rates were 2% and 33%, respectively. Treatment with imipenem/cilastatin was successful in one case, and that with ciprofloxacin or norfloxacin was successful in six cases; in contrast, therapy with ceftriaxone was ineffective in eight cases. On the basis of this review, we conclude that gentamicin is an acceptable alternative to streptomycin for the treatment of tularemia.

Francisella tularensis↗
PubMed1994

Congenital hypertrophy of the retinal pigment epithelium associated with familial adenomatous polyposis.

PURPOSE: Multiple, bilateral areas of congenital hypertrophy of the retinal pigment epithelium (CHRPE) have been described in association with familial adenomatous polyposis (FAP). Histopathologic findings have suggested a generalized effect of the FAP gene on the RPE, which could impair the functional integrity of the RPE. The clinical, psychophysical, electrophysiologic, and fluorescein angiographic findings in CHRPE in subjects with FAP were assessed. METHODS: RPE function was assessed in 7 subjects with CHRPE and a family history of FAP. Four had documented FAP (mean age = 22.25 years) and the other three were siblings of affected subjects, with a 50% risk of developing FAP (mean age = 6.33 years). All subjects underwent comprehensive ophthalmologic examination. RESULTS: All subjects showed mild hyperopia (mean, +1.13 D; best corrected visual acuity, 20/20 or better). On perimetry, there were scotomas corresponding to some lesions. ERG showed normal rod, maximal, single-flash cone, and flicker responses. Light-dark ratio was within the normal range on EOG. Fluorescein angiography demonstrated normal retinal vasculature overlying the CHRPE lesions, which blocked background choroidal fluorescence. A normal choriocapillaris was observed through some hypopigmented lacuna. CONCLUSION: CHRPE has been related to generalized expression of an abnormal gene in RPE, but its functional abnormalities tend to be localized.

Adenomatous Polyposis Coli↗
PubMed1994

Presurgical orthopedic premaxillary alignment in cleft lip and palate reconstruction.

Premaxillary malposition is a difficult problem in cleft lip and palate repair. Orthopedic palatal devices are excellent in positioning the premaxilla, though they are somewhat cumbersome and require complex techniques in adjusting precisely the position of the premaxilla prior to repair. A new technique has been developed for premaxillary repositioning in conjunction with palatal shelf expansion and obturation. The procedure implements microplate fixation anterior to the premaxillary segment and linked to a palatal splint by adjustable elastics. The microplate is inserted through a nasal floor incision and secured by a tight submucosal tunnel through minimal dissection between the prolabium and premaxilla. The last hole of each microplate protrudes through the mucosa and is attached to a pin-retained palatal splint by an elastic chain. Differential tension is applied to the chains to allow gradual repositioning of the protruding maxilla while the splint expands and maintains positioning of the lateral palatal segments. These elastic retractors can be adjusted by staff in the outpatient office. During the past 2 years, this technique has been used successfully in 21 consecutive patients with unilateral or bilateral cleft lip and palate. Its technical ease and design allows simple adjustments to control premaxillary positioning and growth before definitive surgical closure.

Bone Plates↗
PubMed1994

[Experimental alkaline reflux esophagitis. Role of the refluxed material].

Alkaline reflux is new recognised to play an important place in gastroesophageal reflux disease. In order to investigate the role of refluxate in the development of esophagitis we have performed an experimental study in laboratory animals submitted to alkaline reflux inducing operations. We produced esophagitis in two experimental groups of Sprague-Dawley rats: group I, end-to-side esophagojejunostomy (EY) and group II, esophagojejunostomy with partial derivation of afferent loop by an omega-like conduit (EO) designed to attain lesser reflux. Group III consisted of sham laparotomized animals (L). RESULTS. At day 14, all the animals of experimental groups have developed esophagitis, but the macroscopic extent and histological grade in group EO (med: 27 mm; grade 2) were significantly lower than in group EY (med: 35 mm; grade 3). Biochemical measurements (med) in esophageal washout revealed: a) pH were alkaline in all groups with a decrease in experimental groups that was only significant in group EY; b) Amylase, lipase and bile acids in groups EY (8090; 498; 32) and EO (12840; 449; 50) were similar, but significantly more higher than in group L (920; 24; 0). The analysis of correlation between esophagitis parameters and biochemical measurements revealed no significant ones except for pH (r = -.437 and -.417). CONCLUSIONS. 1- The alternative model (EO) presents lesser grade and extent of esophagitis. 2) The refluxate was rich in bile acids and pancreatic enzymes what is proof of the actual occurrence of reflux and supports its determinant contribute to the development of esophagitis. 3) Esophagitis has developed at alkaline pH but with no alkalinity increase in the experimental groups what indicate that "alkaline reflux esophagitis" is not an appropriate denomination. 4) The discrepancy between the biochemical analysis in esophageal washout and the extent and grade of esophagitis suggests that others than the nature and amount of refluxate (e.g. mucosal resistance) could play a role in reflux esophagitis.

Amylases↗
PubMed1994

[Obstructive candidiasis: a process with surgical solution].

We describe three severe clinic cases due to fungus balls of Candida albicans in hospitalized risky patients which presented a quickly clinical evolution. Because of their different local presentations medical and surgical management was needed. In the first case a intestinal fungus ball was found whereas in the other two cases were localized in the urinary tract. Here we present their clinical findings rather than their evolution after a medical and surgical management.

Adolescent↗
PubMed1993

[Reflux esophagitis in an experimental model. Are the systemic consequences attributable to the esophagitis?].

The esophagojejunostomy model of reflux esophagitis has been shown to cause nutritional deterioration and alterations of hematologic parameters. However, these disturbances have been assumed rather than proved to be the consequence of esophagitis. Little attention has been paid to the anatomical and physiological alterations related to the reflux-inducing operation. We produced reflux esophagitis by an end-to-side esophagojejunostomy (EJ) in Sprague-Dawley rats. These rats were compared to a second group with a similar operation not leading to reflux esophagitis (Roux-en-Y esophagojejunostomy, R-Y). Sham operated animals were used as controls. Erosive esophagitis was produced in all but one of the EJ subjects at day 14, and in none of the R-Y animals. Significant weight loss (-21.7%), anemia (HCT, -17.3%) and hypoproteinemia (-14.2%) were seen in EJ model with respect to sham group. However, a similar variation of weight (-28.7%) and hematocrit (-26.2%) were also found in Y-R group; therefore, these parameters seemed to correlate more with the surgical challenge itself than with the esophagitis.

Anastomosis, Roux-en-Y↗
PubMed1992

[Characteristics of cicatrization of wounds during the fetal period].

Recent clinical experience on open prenatal surgery in human beings, although scarce, suggests that skin wound healing in the fetus differs from that in adult life. This fact is supported by several experimental studies. Three types of skin wounds have been practiced in a group of thirty 23rd-gestational-day rabbit fetuses: sutured incision, non-sutured incision, and electrocautery burn. Seven days later, the resulting scars were assessed by mechanical and hystological studies. The results obtained were compared with those seen in 30 newborn rabbits and 30 adult rabbits in which the same wounds were carried out. In the fetuses, rupture tension of the sutured wound was 20% of that of the normal skin. A similar relationship was found in the group of adult rabbits. The sutured wounds in the fetuses showed a better macroscopic repair than in older rabbits. However, the non-sutured wounds and burns did not heal in the fetuses, on the contrary, their opening increased from the time of the lesion. These results seem to suggest that wound repair in the fetus is more like a remodeling process than in older ages.

Animals↗
PubMed1992

[Role of the amniotic fluid in gastroschisis. An experimental study].

The short and thick bowel found in gastroschisis has been attributed to contact with amniotic fluid, among other factors. We designed an original animal model in order to isolate the effect of amniotic fluid on the fetal bowel. We created experimental gastroschisis in fetal rabbits. Extruded bowel was kept out of the amniotic sac in half of the operated fetuses. At term, seven days after surgery, 21 surviving fetuses--12 intra-amniotic (GIA) and nine extra-amniotic (GEA)--and 16 control littermates were harvested for study. Five parameters were measured in each animal: body weight, intestinal weight, intestinal length, bowel diameter and bowel wall thickness. We found no statistically significant difference in body weight, intestinal weight or bowel wall thickness. An enormous difference was found in intestinal length among the three groups. Bowel diameter was significantly different in the extreme groups (GIA and controls), with the intestine being more dilated in GIA than in GEA and controls. Gastroschisis in the absence of amniotic fluid has not been as damaging to the fetal intestine as "natural" intraamniotic gastroschisis.

Abdominal Muscles↗
PubMed1991

[Otological assessment in patients operated on for cleft palate].

Tympanometry and otoscopy has been carried out to determine the presence of middle ear disease on patients with cleft palate and the influence of corrective surgery. This explorations have been evaluated preoperatively and at one and six months postoperative follow-up. There is a high incidence of otitis media with effusion in patients with cleft palate, almost 60 per 100 in our study. The influence of cleft palate surgery repair has not revealed as a mayor factor on its resolution, although a visible benefit has been observed in the long term controls. We recommend a otorhinolaryngological follow-up in these patients.

Acoustic Impedance Tests↗
PubMed1991

Nurses' practice of breast cancer screening and early detection: results of a pilot survey.

Nursing has a professional responsibility to participate in cancer screening and early detection. Nurses represent the largest professional group in the health care workforce and are presently an underutilized potential resource for implementing breast cancer screening and early detection. Development of a reliable and valid instrument which could be used to evaluate the effectiveness of mechanisms designed to increase nursing's role in breast cancer screening and early detection is needed. The questionnaire tested in this pilot study represents an initial attempt at fulfilling this need. This questionnaire in its present form may be used to evaluate the results of intervention studies aimed at increasing nurses' practice of breast cancer screening and early detection. For example, the questionnaire could be used as an evaluation tool to examine the effectiveness of educational programs regarding breast cancer screening and early detection. It may also be used as an outcome measure to evaluate change in practice activities such as the effect on nursing practice of including questions on the nursing history and assessment form related to BSE, clinical breast exam and mammography. Results of nursing action in breast cancer screening and early detection could have a significant impact on the achievement of the NCI's year 2000 goal of a 30% reduction in breast cancer mortality.

Adult↗
PubMed1991

[An experimental models in the evaluation of the effect of the amniotic fluid].

Fetal life develops in a fluid environment. Amniotic fluid is not inert. It contains proteins, hormones, fetal urine and electrolytes, known to interact with a variety of fetal processes such as wound healing, intestinal growth, etc. Interest in its study has been increasing recently. In order to determine the effect of amniotic fluid, intra-amniotic and extra-amniotic fetuses should be compared. We describe a model that allows isolation of a fetal portion from amniotic fluid. Sixty 23-day pregnant rabbits were operated on. Surgery was performed in two fetuses of each mother. One fetus was replaced into the amniotic sac; the other was sutured along its waist to the histerotomy orifice, leaving the caudal half of the fetus in an extra-amniotic position. The mothers continued their pregnancy and were sacrificed on day 30. Maternal survivance rate was 82 per 100. Twelve intra-amniotic fetuses (FIA) and nine extra-amniotic fetuses (FEA) were obtained, as well as 16 nonoperated littermates that served as controls. The average weight of FIA fetuses was 31 g, FEA fetuses weighed 37 g and controls 36 g. The difference was not statistically significant between any of the groups. This model allows the study of a variety of fetal conditions in the absence of amniotic fluid. The survivance rate of this technique of extrauterine fixation has been 75 per 100.

Amniotic Fluid↗
PubMed1990

Effects of neonatal androgenization on the chromatofocusing pattern of anterior pituitary FSH in the female rat.

Anterior pituitary glands were removed from neonatally androgenized (100 micrograms testosterone propionate) female rats and normal controls at 5, 10, 18, 21, 30, 60 and 90 days of age, and the multiple forms of FSH present within them were separated by chromatofocusing (pH range 7.5-4.0). Additional pituitary glands from intact adult males (90 days old) were also studied for comparative purposes. All animal groups exhibited multiple forms of immunoactive FSH within a pH range of 7.5-4.0, as well as an additional FSH form obtained after the addition of 1.0 mol NaCl/l to the chromatofocusing column (salt peak). In animals 5-30 days old (controls and androgenized) the majority of FSH applied to the chromatofocusing columns was recovered within the salt peak (45-85% of total FSH immunoactivity recovered). However, as the animals aged, more FSH immunoactivity focused within less acidic regions (isoelectric point (pI) 5.9-5.0); pituitaries from animals 60 days old contained the greatest proportion of FSH focused within this pH range (controls, 39.2 +/- 0.6%; androgenized, 23.1 +/- 0.9% of total immunoactivity recovered; P less than 0.03 vs animals 30 days old for both experimental groups). This shift towards less acidic FSH was attenuated in androgenized animals compared with the controls (P less than 0.01). In control adult rats, the chromatofocusing distribution pattern of pituitary FSH varied according to the day of the oestrous cycle. Pituitary extracts from control rats decapitated during the morning of pro-oestrus, oestrus and day 1 of dioestrus exhibited the highest proportion of immunoactive FSH (23.2-28.8% of total) focused within a pH range of 5.9-5.0, whilst only 10.4-11.6% of FSH from androgenized rats and those on day 1 of dioestrus was recovered within this pH range (P less than 0.05). In control animals decapitated during the morning of pro-oestrus and oestrus, 10-26% of FSH focused within the most alkaline region (pI 7.5-6.0); the chromatofocusing pattern of pituitary FSH from the neonatally androgenized animals was characteristic, in that no more than one peak (1.5 +/- 0.5% of total) was detected in this alkaline region. In the adult male rats, the majority of pituitary FSH eluted from the chromatofocusing columns within a pH of 4.9-4.0 (52.4 +/- 1.2% of total FSH immunoactivity) and the salt peak (pH less than 4.0) (33.1 +/- 2.4 of total). All FSH isoforms obtained after chromatofocusing represented alpha and beta dimers as disclosed by size exclusion chromatography.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1990

[Fiber colonoscopy in children under 18. Our experience with 112 patients studied in the digestive endoscopy section of a general hospital].

The aim of the study was to evaluate the indications of colonoscopy, diagnostic accuracy and efficacy treatment of procedure in young patients aged less than eighteen years using standard forward colonoscopes Olympus CF LB2, CF LBw and CF HL20. Among 5,400 procedures done along eleven years, 112 (2.07 per 100) were performed in patients aged less than eighteen years, 37.6 per 100 of which were performed in children under ten years. In this group general anaesthesia was employed without complications. The most frequent indication of colonoscopy in young patients was rectal bleeding (62.5 per 100). Related to the frequency, in this series, the control of graft versus host disease in patients submitted to bone marrow transplantation was the second indication (11 per 100), followed by the study of chronic anaemia (4.2 per 100) and control of the chronic inflammatory bowel disease (4.2 per 100). Diagnostic accuracy reached 93.75 per 100. In 6 per 100 of the cases the exploration were considered unsatisfactory because inadequate cleaning of the colon. The most frequent diagnostic was "normal colon" (29.6 per 100 of the cases). Polyp was found in 21.2 per 100 of the cases. Polypectomy was performed in all indicated cases. One patient with multiple polyposis were submitted to surgery. Colonoscopy reached the right colon in 25.4 per 100 of the cases. In 54 per 100 of the procedures reached splenic angle and in 83.8 per 100 of the cases, all sigmoid colon was explored. From this experience we suggests that colonoscopy, using standard endoscopes, is a very useful diagnostic and therapeutic technique in child and in young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Lacrimal gland prolapse in craniosynostosis syndromes and poor function congenital ptosis.

Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.

Blepharoptosis↗
PubMed1989

[Biochemical profile of primary hyperparathyroidism. Comparative study with hypercalciuric renal lithiasis].

Primary hyperparathyroidism (PH) is now considered a common condition. Its frequency and the deleterious long-term effects of hypercalcemia make a correct diagnosis mandatory. We attempted to evaluate the usefulness of the indexes of parathyroid function and hormone measurements more commonly used in the diagnosis of PH. To this end we studied 64 patients, distributed in three groups: group with PH, group with hypercalciuric renal lithiasis (HRL) and control group (CG). The results were evaluated with a test of comparison of means and a stepwise discriminating regression analysis. The 8 most useful measurements to differentiate PH from HRL and CG were serum calcium, corrected serum calcium, serum phosphorus, fasting calcium excretion (FCE), maximal tubular calcium reabsorption (MTCR), maximal tubular phosphate reabsorption (MTPR), osteocalcin, PTH half molecule (PTH-HM) and 1,25-dihydroxyvitamin D. The 3-variable and 4-variable groups with a highest discriminating ability were: serum calcium, FCE and PTH-HM, and serum calcium, FCE, PTH-HM and MTPR. We think that the measurement of these four variables is the most adequate strategy for the diagnosis of PH.

Adult↗