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Biomedical subjects

R Garcia-Rinaldi

Publications and source records attributed to R Garcia-Rinaldi.

At least 37 records · Page 2Linked to original sources
PubMed1979

The anatomic basis for the occasional failure of transfemoral balloon catheter thromboembolectomy.

A Fogarty balloon catheter was advanced from the common femoral artery through the popliteal artery and its branches in 15 cadavers. The catheter passed into the peroneal branch 89% of the time. In all 15 cadavers, the peroneal artery was the direct continuation of the popliteal artery and the arterior tibial and posterior tibial arteries branched off at varying angles from the popliteal. This provides an anatomic explanation for the occasional failure of transfemoral Fogarty catheter embolectomy of the leg. Our study suggests that if the patient's foot does not improve after Fogarty embolectomy, the popliteal artery should be exposed and the catheter directed into the shank arteries using vascular forceps.

Catheterization↗
PubMed1978

Intestinal obstruction due to phytobezoars. Observations in two patients with hypothyroidism and previous gastric surgery.

Two patients had small-bowel obstruction due to phytobezoars. Both patients were hypothyroid. One patient had undergone a previous pyloroplasty for pyloric stenosis and the other a truncal vagotomy and a pyloroplasty for a duodenal ulcer. Similarities and differences between the two cases and the possible predisposing factors in the formation of the phytobezoars are discussed. The recognition of high-risk patients, and their education to prevent phytobezoars are emphasized.

Aged↗
PubMed1978

Suspecting thoracic aortic transection.

Deceleration accidents produce a complex of potentially fatal thoracic injuries. Because early detection is the key to successful management of blunt trauma to the great vessels, emergency physicians must be knowledgeable of signs indicative of these complex injuries. Among more than 10,000 patients presenting to the Ben Taub Emergency Center over an 11-year period with thoracic injuries, 100 had clinical or radiographic clues suggestive of blunt trauma decelerative injury to the great vessels. Of these 100 patients, 23 had transection of the descending thoracic aorta and five had avulsion of the innominate artery. One patient had a double transection. Six patients died in the Emergency Center before proximal control could be achieved.

Adolescent↗
PubMed1977

Surgical management of penetrating injuries of the esophagus.

Although well protected and infrequently injured, penetration of the esophagus has a reported mortality of 10 to 30 per cent. The results of the management of seventy-seven patients with noniatrogenic penetrating injuries of the esophagus were reviewed. The region of esophageal injury was cervical in forty-five patients, intrathoracic in twenty-one patients, and intraabdominal in eleven patients. Gunshot wounds accounted for 75 per cent of the injuries. The overall mortality was 23 per cent. The highest morbidity and mortality was among patients with intrathoracic injuries, due to both difficulty in exposure and complexity of associated injuries. Because of the high incidence of late complications in intrathoracic injuries, cervical diversion and tube gastrostomy or complete esophageal exclusion must be considered early. Fundoplastic procedures were used in four patients with distal esophageal injuries. Although the overall mortality from truncal penetrating wounds has improved in recent years, the mortality from esophageal injuries remains high, reflecting a need for advancement in initial operative management.

Adolescent↗
PubMed1977

Myocardial revascularization prior to subsequent major surgery in patients with coronary artery disease.

Of our series of patients undergoing direct myocardial revascularization, we selected 60 patients who had subsequent major surgical and cardiovascular operative procedures. Thirteen of these patients had a second subsequent operative procedure, and four of the original 60 patients had a third subsequent operation. None of the patients died during the subsequent operation and none sustained a myocardial infarction. During the 77 subsequent procedures, there were eight different episodes of cardiac complications: seven patients had supraventricular arrhythmias and one patient had acute pulmonary edema. All patients responded to medical therapy. These results are suggestive that myocardial revascularization should be performed prior to other major indicated operative procedures in patients with documented coronary artery disease.

Adult↗
PubMed1976

Specific in vitro binding of radiolabeled antibodies to cell surface antigens: interaction of antihuman thymocyte globulin with human target cells.

We have developed a highly sensitive and reproducible in vitro method to measure the rate and amount of binding of radiolabeled antibodies to target cells. We reduced non-specific binding of the antibodies to the target cells approx. 92% by removing protein aggregates from the antibody solutions. Using a specially designed cup that simultaneously allows washing and collection of target cells, cell loss was eliminated. This method was used to study the in vitro binding properties of the IgG fraction of anti-human thymocyte globulin (ATG) to nucleated human cells and to cells of other species. We found the initial rapid uptake of labeled ATG-IgG slowed with prolonged incubation. Incubation temperature and ATG concentration increased the rate of uptake. Sequential absorption studies indicated that initial uptake was due to rapidly binding antibodies. After these antibodies were removed, the rate of binding for antibodies that remained was several fold less than that of the antibodies removed by the initial absorption. Since temperature and the concentration of antibody and target cells can be rigidly controlled, this in vitro model system is ideally suited to quantify optimal conditions and kinetics of antibody binding to cell membrane antigens. Furthermore, the binding properties of antibody subpopulations in an antiserum may be determined by this technique. The maximum antibody binding capacity of various cell types can also be measured using the technique with a precision of +/- 14% on replicate determinations.

Animals↗
PubMed1976

Aneurysm of the main pulmonary artery: long-term survival after aneurysmorrhaphy and closure of a ventricular septal defect.

Pulmonary artery aneurysm (PAA) usually carries an ominous prognosis due to the associated pulmonary hypertension. Six years ago a patient with a PAA secondary to cystic medial necrosis and pulmonary hypertension due to a ventricular septal defect (VSD) was treated by aneurysmorrhaphy and closure of the VSD. Although the patient had early postoperative cardiac failure, his cardiopulmonary status stabilized, and he has done well without recurrence of his aneurysm or cardiac failure. This report summarizes the patient's clinical course, operative treatment, and long-term follow-up.

Adult↗
PubMed1976

Aneurysm of the sinus of Valsalva producing obstruction of the left main coronary artery.

An aneurysm of the left sinus of Valsalva compressed the left main coronary artery and the patient experienced anginal pain. Surgical correction consisted of obliteration of the orifice of the aneurysm, aortic valve replacement, and a saphenous vein bypass from the ascending aorta to the distal left anterior descending coronary artery. Postoperative studies revealed excellent function of the prosthetic valve, no recurrence of the aneurysm and retrograde filling of the left anterior descending and circumflex coronary arteries. Three years after the operation, the patient is asymptomatic.

Angiocardiography↗
PubMed1976

Unimpaired renal, myocardial and neurologic function after cross clamping of the thoracic aorta.

Twelve patients who had sustained trauma presented at the emergency department with either asystole or profound hypotension. All underwent thoracotomy and temporary cross clamping of the descending thoracic aorta as part of the resuscitative measures; all received massive amounts of fluids and cold blood and underwent prompt surgical intervention. In none of these patients was there evidence of myocardial, peripheral nerve, neurologic or renal damage. One patient had residual cortical blindness. Measures were taken to preserve renal function before, during and after aortic cross clamping. These included the avoidance of nephrotoxic antibiotics, limit of clamping time to the minimum effective period, intermittent release of the aortic clamp, and intraoperative administration of osmotic diuretics or furosemide, or both. Other factors which may have contributed to these results were the youth of these patients, the absence of cardiac, renal or metabolic diseases and the hypothermia resulting from the administration of large amounts of cold blood. We concluded that temporary cross clamping of the descending thoracic aorta should be performed only for patients with massive exsanguine trauma who have cardiac arrest or who do not respond to other intensive resuscitative measures.

Adolescent↗
PubMed1976

Surgical management of colon atresia.

Colon atresia is a rare cause of intestinal obstruction in the neonate and requires early diagnosis and prompt surgical treatment. It is impossible in the neonate to differentiate colon atresia from other forms of obstruction at the time of initial presentation. The diagnosis is confirmed roentgenographically, including views of the abdomen and contrast barium enema series. Lesions proximal to the splenic flexure are treated with initial resection of the atretic segment and a primary anastomosis. Those lesions distal to the splentic flexure are managed initally with a diverting loop colostomy with subsequent staged resection and anastomosis.

Colon↗