Biomedical subjects
O I Morales
Publications and source records attributed to O I Morales.
[Intraoperative autotransfusion in massive hemorrhage following thoracic-abdominal trauma].
In the University Hospital of Granada (Spain), 359 surgical trauma patients underwent intraoperative autotransfusion. The patients were divided into 2 groups, according to their blood loss: group I (blood loss less than or equal to 2000 ml) and group II (blood loss greater than 2000 ml). Patients from group I did not require homologous blood transfusion. So the high risk involved in this type of transfusion was avoided. Macroscopic haemoglobinuria was only found in those patients where the Solcotrans, Viavae type of autotransfusion system was used; with the Bentley ATS system, no macroscopic haemoglobinuria was registered. With patients from group II, however, that is, those with a blood loss of more than 2000 ml, we had to fall back on homologous transfusion in addition to retransfusing autologous blood. When the transfusion exceeds 4000 ml there is increasing bleeding, which requires treatment with fresh frozen plasma, platelets and/or fibrinogen. The mortality rate of patients in group II was very high but the patients died from the severity of their injuries or from postoperative complications which were not due to autotransfusion in itself with the exception of 3 patients who underwent massive autotransfusion (12,000 to 25,000 ml) and died from acute renal failure. The main indication for intraoperative autotransfusion is without doubt abdominal and thoracic trauma which lead to high blood loss.
[Intraoperative autotransfusion in massive hemorrhage after thoracic-abdominal trauma].
In the University Hospital of Granada (Spain), 359 trauma surgical patients underwent intraoperative autotransfusion. Patients from group I (blood loss less than 2000 ml) did not requiere homologous blood transfusion. So the high risk involved in the type of transfusion was avoided. With patients from group II, however, that is, those with a blood loss of more than 2000 ml, we had to fall back on homologous transfusion in addition to retransfusing autologous blood. The main indication for intraoperative autotransfusion is without doubt abdominal and thoracic trauma which lead to high blood loss.
Benign osteoblastoma of vertebral column and skull. Report of two cases.
Osteoblastoma of the spine is a rare but important cause of back pain and the sciatica syndrome in young adults. Osteoblastoma of the skull is rare and the involvement of the orbital roof is very unusual. Clinical complaints and physical examination are not specific enough to provide a lead to the diagnosis. Bone scans and computerized tomography scans should be performed in all cases, to show the extent of vertebrae or calvarium infiltration by the tumor. To prevent recurrence and malignant transformation, the tumor should be completely removed whenever possible. If tumor excision is incomplete, a continuous follow-up is necessary to detect any recurrence or malignant transformation, which normally appears 5-10 years after the first operation (in one of our cases 7 years later).
Evaluation of toupet antireflux operation, by means of gastroesophageal scintiscan.
The Toupet operation (270 degrees posterior fundoplication) has been performed in 99 patients suffering from symptoms of gastro-oesophageal reflux secondary to a hiatal hernia. To assess the effects of the Toupet antireflux procedure, we performed in 20 cases oesophageal manometry, intraoperatively and gastro-oesophageal scintiscan in the early postoperative period (3 months: 98 cases) and also later (5 years). For us gastro-oesophageal scintiscan is the ideal method of detecting reflux because it is a noninvasive technique as sensitive as the intra-oesophageal pH, is easy to perform and well-tolerated by the patient. Our long-term follow-up, with only 6% of poor results show that the Toupet operation like the Nissen fundoplication is the most effective surgical technique that can be used to correct gastro-oesophageal reflux and has an added advantage: the side effects, particularly the postfundoplication or gas-bloat syndrome are minimal. Additional follow-up after 10 years will be needed to establish the final outcome of the operation.
[Complications in bland struma surgery. A retrospective study based on 2,035 personal cases].
In the present retrospective study we examine the complications arising from simple goiter operations based on the analysis of 2,035 cases. The mortality rate is extremely low (0.3%). The most typical intraoperative complications - such as unilateral vocal cord paralysis (1.6%) and permanent parathyroprival hypocalcemia (0.4%) were observed to occur much more frequently in cases of subtotal thyroidectomy than in those of partial resection. - As a result of the introduction of synthetic reabsorbent sewing materials, healing problems have been drastically reduced (0.4%). Hypothyreosis and goiter recurrence can be avoided in cases of subtotal thyroidectomy by life-long and individually adjusted administration of thyroid hormones (rate of incidence in our study 3.1%). - In our view a subtotal thyroidectomy is indicate in cases where malignity is suspected (one or more cold nodules).
Posterior mediastinal goiter.
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[Echinococcosis of the liver. Its surgical treatment based on 178 personal cases].
Reported in this paper are 178 patients who had received surgical treatment for echinococciasis of the liver, among them 144 at the Surgical Hospital of Madrid University, between 1962 and 1970, and another 34 at the Surgical Hospital of Granada University, between 1971 and 1982. All of them had been carriers of Echinococcus cysticus. Echinococciasis of the liver usually is not diagnosed until the hydatid cyst begins to cause conspicuous symptoms or complications on account of its own growth. Diagnostic clues are obtainable from laboratory findings (eosinophilia in excess of four per cent), immune reaction, complement fixation reaction according to Weinberg, and intracutaneous test according to Casoni. Diagnosis of the authors' cases had been preceded by scintiscanning. Surgical removal of echinococcus cysts from the liver calls for an undogmatic approach. From among all surgical methods applicable to cyst removal the authors have most frequently used closed marsupialisation, according to Posadas-Dew (65.8 per cent of all cases). Drainage marsupialisation was applied to 25.8 per cent of all cases. The postoperative lethality amounted to 2.3 per cent. Morbidity was low.
[Congenital arteriovenous fistulas of the lung. Report of 5 personal cases].
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[Preoperative hemodilution as prophylaxis of deep vein thrombosis].
In a clinical study the effectiveness of aggregation limiters (Dextran and acetyl-salicylic acid) and preoperational normovolaemic haemodilution as prophylaxis for deep vein thrombosis (D.V.T.) was assessed on the basis of experimental work in 404 surgical patients. Our patients were monitored by means of the fibrinogen test and ascending phlebography. Our results show that haemodilution is a very effective preventive for D.V.T. Therefore, moderate normovolaemic haemodilution can be applied as an effective prophylactic measure for postoperative deep vein thrombosis.