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Biomedical subjects

R M Flores

Publications and source records attributed to R M Flores.

13 recordsLinked to original sources
PubMed2001

Contralateral pulmonary artery stenosis after left pneumonectomy.

Contralateral pulmonary artery stenosis is a rare complication following pneumonectomy. When extensive intrapericardial dissection is warranted, one must be wary of this potential complication and take measures to avoid it. Postoperatively, a high index of suspicion must be maintained in a patient with a new onset of right-sided heart failure after intrapericardial pneumonectomy. We discuss intraoperative risk factors, postoperative clinical findings, and our strategy for repair.

Arterial Occlusive Diseases↗
PubMed2000

High-risk bronchoscopy.

Fiberoptic bronchoscopy may be performed in patients with acute respiratory distress after thoracic surgical procedures as a measure to avoid intubation and subsequent positive-pressure ventilation in a patient with mucous impaction or as a method of intubating in a patient with a difficult airway. We describe the indications, the technique, and the potential complications.

Bronchoscopy↗
PubMed2000

Diabetogenic role of insulin's counterregulatory hormones in the isletectomized, diabetic goby.

In an experimental model of insulin-dependent diabetes mellitus (IDDM) in the teleost fish, the goby Gillichthys mirabilis, an isletectomy procedure completely removes the pancreatic endocrine tissue without affecting the exocrine acini or other essential tissues. Interestingly, isletectomized (Ix) gobies do not exhibit a significant hyperglycemia until 10-15 d after this procedure, suggesting a lack of initial diabetogenic actions of a pancreatic factor(s). Administering exogenous glucagon in otherwise nonsymptomatic 7-d Ix gobies, however, induces a hyperglycemic state comparable to that in severely diabetic rats or gobies (after 20 d post-Ix). The spontaneously arising hyperglycemia observed between 10 and 15d post-Ix, on the other hand, is significantly correlated with increasing serum cortisol concentrations, with both exhibiting sustained elevated levels (approx 23 mmol/L and >100 ng/mL, respectively) at 20- and 25-d post-Ix. Exogenous cortisol treatment also significantly induced hyperglycemia in nonsymptomatic, 7-d Ix gobies. By contrast, growth hormone (GH) had no detectable diabetogenic effect in 7-d Ix gobies. Serum levels of ammonia, the principal nitrogenous waste in this species, were not affected by glucagon treatment but were reduced slightly by GH treatment (30% reduction; p < 0.05). Cortisol treatment, on the other hand, increased ammonia levels twofold, suggesting that the glucocorticoid induces a negative nitrogen balance. These results indicate that the counterregulatory hormones--glucagon and cortisol--are effective diabetogenic factors in the Ix goby, capable of driving metabolic imbalance in this model of IDDM.

Ammonia↗
PubMed1999

A simple visual immunoassay (VIA) for the semiquantitative determination of plasma elastase levels.

Elastase levels are an important marker of the extent and severity of inflammatory processes. We describe a visual immunoassay based on two monoclonal antibodies for the semi-quantitative determination of plasma elastase levels. The method is rapid, reliable, easy to perform, and does not require special laboratory equipment. There is coincidence of our results with those obtained by quantitative methods. The assay is suitable to obtain information for the management of patients in most intensive care units.

Animals↗
PubMed1999

Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients.

OBJECTIVES: Our aim was to identify prognostic variables for long-term postoperative survival in trimodality management of malignant pleural mesothelioma. METHODS: From 1980 to 1997, 183 patients underwent extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy. RESULTS: Forty-three women and 140 men (age range 31-76 years) had a median follow-up of 13 months. The perioperative mortality rate was 3.8% (7 deaths) and the morbidity, 50%. Survival in the 176 remaining patients was 38% at 2 years and 15% at 5 years (median 19 months). Univariate analysis identified 3 prognostic variables associated with improved survival: epithelial cell type (52% 2-year survival, 21% 5-year survival, 26-month median survival; P =.0001), negative resection margins (44% at 2 years, 25% at 5 years, median 23 months; P =.02), and extrapleural nodes without metastases (42% at 2 years, 17% at 5 years, median 21 months; P =.004). Using the Cox proportional hazards, the relative risk of death was calculated for nonepithelial cell type (OR 3.0, CI 2.0-4.5; P <.0001), positive resection margins (OR 1.7, CI 1.2-2.6; P =.0082), and metastatic extrapleural nodes (OR 2.0, CI 1.3-3.2; P =.0026). Thirty-one patients with 3 positive variables had the best survival (68% 2-year survival, 46% 5-year survival, median 51 months; P =.013). A previously published staging system using these variables stratified survival (P <.05). CONCLUSIONS: (1) Multimodality therapy including extrapleural pneumonectomy is feasible in selected patients with malignant pleural mesotheliomas, (2) pre-resectional evaluation of extrapleural nodes may select patients for radical therapy, (3) microscopic resection margins affect long-term survival, highlighting the need for further investigation of locoregional control, and (4) patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.

Adult↗
PubMed1999

Spontaneous popliteal artery dissection: a case report and review of the literature.

Spontaneous arterial dissection of a peripheral artery involving an extremity is a rare event. We report a case of atraumatic, nonaneurysmal dissection of the popliteal artery that occurred in a 62-year-old man who was admitted with progressive right lower-extremity claudication. Preoperative arteriography was suggestive of arterial dissection, and surgical treatment was undertaken before irreversible ischemia developed. Intraoperatively, a dissection of the popliteal artery was observed, and the patient underwent femoral-popliteal bypass grafting with the ipsilateral, greater saphenous vein and the popliteal artery was ligated distal to the dissection. Spontaneous dissection limited to the popliteal artery has not previously been reported in the literature. Successful management depends on consideration of the diagnosis, particularly when other, more common diseases have been excluded.

Humans↗
PubMed1998

Transthoracic, transdiaphragmatic excision of simultaneous lung and adrenal lesions.

Simultaneous adrenal and pulmonary lesions frequently present a therapeutic challenge to the thoracic surgeon. We describe 2 cases in which a transthoracic, transdiaphragmatic approach was used to establish tissue diagnosis and complete removal of gross tumor. In 1 case an intraoperative decision to perform a pneumonectomy was dictated by the tissue diagnosis of the adrenal mass, which was obtained with relative ease via this method. In both cases the morbidity of traditional approaches for adrenal operation was avoided.

Adrenal Gland Neoplasms↗
PubMed1998

Video-assisted thoracic surgery pericardial resection for effusive disease.

In patients who can tolerate single-lung ventilation and who have a long life expectancy, VATS offers definitive and durable treatment without the morbidity of an open thoracotomy. The patients who may benefit most from this technique include those with benign effusive disease, patients with malignant pericardial effusions with a good prognosis, and patients with concurrent pulmonary pathology.

Drainage↗
PubMed1997

Rupture of a nonaneurysmal atherosclerotic infrarenal aorta.

We report a case of spontaneous rupture of a nonaneurysmal infrarenal aorta through an area of atherosclerotic thinning. Close follow-up, aggressive antihypertensive therapy, and serial imaging of asymptomatic patients with documented aortic ulceration is warranted. In symptomatic patients, surgical intervention should be undertaken so that transmural aortic rupture can be averted.

Aged↗
PubMedDate not supplied

Endovascular management of an aortobronchial fistula arising after resection of a primary aortic sarcoma: a case report.

The experience with the use of endovascular covered stents for aortic lesions has been growing. The early results of using endovascular covered stents for the exclusion of thoracic and infrarenal abdominal aortic aneurysms have been promising and are being investigated in multiple ongoing trials. Their usage for other aortic lesions has been reported sporadically, often as resourceful options in unusual and difficult clinical situations. The authors report a patient who had previously undergone resection of a thoracic aortic sarcoma and subsequently presented in extremis from an aortobronchial fistula. The evaluation and treatment of an aortic sarcoma and the successful urgent exclusion of an aortobronchial fistula through use of an endovascular covered stent are discussed.

Aorta, Thoracic↗