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Biomedical subjects

R M Vazquez

Publications and source records attributed to R M Vazquez.

11 recordsLinked to original sources
PubMed2002

Balloon-assisted endoscopic retroperitoneal gasless (BERG) technique for anterior lumbar interbody fusion (ALIF).

BACKGROUND: The objective of this study was to determine the utility of balloon-assisted endoscopic retroperitoneal gasless (BERG) exposure for anterior lumbar interbody fusion (ALIF) with a variety of interbody fusion devices. METHODS: Between January 1998 and February 2002, 46 individuals underwent (ALIF) with a variety of devices, including cylindrical cages, femoral ring allografts, and Synmesh (Synthes, Philadelphia, PA, USA) cages. There were 34 men and 12 women in the group. The average age was 40 years. The average hospital stay was 3 days. The operations were performed for severe back and leg pains in individuals who did not obtain relief of their pain with nonsurgical treatments for a period of >or=1 one year. The surgical conditions for fusion were degenerative disc disease with back and leg pain, grade 1 spondylolisthesis, retrospondylolisthesis, and disc space infection with and without neurological deficit. Lumbar discs L5, L4, and L3 were approached 30, 21, and three times, respectively. The procedures were performed with the patients positioned supine on a radiolucent table. Access to the retroperitoneal space was gained in a manner similar to a totally extraperitoneal (TEP) hernia repair. The rest of the procedure was performed in a gasless fashion using standard orthopedic and laparoscopic instruments. A Harmonic Scalpel (Ethicon Endosurgery, USA) was used to coagulate and divide the ascending lumbar vein to mobilize the left common iliac vein for access to the L4 disc. The segmental arteries were dealt with in a similar fashion to permit retraction of the great vessels. RESULTS: Complications included a left common iliac vein injury not requiring operative repair and a far lateral placement of a BAK (Bagby and Kuslich) cage at the L5 level that required removal 2 days later. One patient reported retrograde ejaculation after two-level ALIF at L3 and L5. CONCLUSION: BERG/ALIF is a viable alternative to the conventional open procedure and gas laparoscopy for ALIF. BERG permits the use of most open orthopedic instruments and any implant. The anterior approach preserves the musculo-skeletal spine anatomy. Postsurgical scarring in and around the spinal canal and nerve roots is avoided, and average blood loss is less than 223 cc.

Adult↗
PubMed1986

An analysis of the advantages of Stamm and percutaneous endoscopic gastrostomy.

The results of 221 Stamm gastrostomies were analyzed in order to compare this technique to the recently reported percutaneous endoscopic technique (PEG). Cited advantages of the PEG technique, including avoidance of general anesthesia, shorter procedure time, safety, bedside convenience and cost savings, are addressed. Several disadvantages and possible hazards of the PEG are identified.

Adolescent↗
PubMed1985

Thromboembolic complications associated with L-asparaginase therapy. Etiologic role of low antithrombin III and plasminogen levels and therapeutic correction by fresh frozen plasma.

A case of an 18-year-old woman with acute lymphoblastic leukemia who developed L-asparaginase-associated stroke and subclavian vein thrombosis is presented. The latter was also associated with a Hickman central venous catheter. Thrombotic complications occurred when plasma levels of plasminogen and antithrombin III were still markedly reduced as a result of L-asparaginase therapy, although the fibrinogen had recovered from its lower levels. The stroke was treated with fresh frozen plasma and the subclavian vein thrombosis was treated with streptokinase and fresh frozen plasma. L-asparaginase and Hickman-associated coagulopathy is reviewed and the treatment is discussed.

Adolescent↗
PubMed1985

Nutrition and somatomedin. XIII. Usefulness of somatomedin-C in nutritional assessment.

Malnutrition is common in hospitalized patients, but current measures of nutritional status are limited. Because levels of somatomedins are regulated by nutrition, the utility of somatomedin-C measurement in nutritional assessment was studied. Thirty-seven malnourished patients had measurement of somatomedin-C and conventional nutritional indexes. In 28 patients seen before therapy, the somatomedin-C level was reduced (38 percent of normal) and was lower than the albumin level (66 percent, p less than 0.01), transferrin level (59 percent, p less than 0.05), and lymphocyte count (43 percent, p = NS). Somatomedin-C level was lowest with combined "kwashiorkor-marasmus" (25 percent of normal) and also reduced with "kwashiorkor" (51 percent) or "marasmus" (57 percent) alone. Somatomedin-C was correlated with albumin, transferrin, and lymphocyte count (p less than 0.02 for each). In six patients given nutritional therapy, somatomedin-C levels rose by more than 70 percent in each (mean increase 181 percent), whereas lymphocyte counts rose in four (increase 78 percent for all patients), transferrin levels rose in four (increase 33 percent), and albumin levels rose in one (-6 percent). In 20 patients with detailed dietary analysis, only somatomedin-C was correlated with intake of protein and calories (p less than 0.005 for each). Somatomedin-C may be a sensitive marker of malnutrition and the response to nutritional therapy.

Adult↗
PubMed1985

Primary and secondary malposition of silicone central venous catheters.

We reviewed our experience with the percutaneous insertion of 459 silicone central venous catheters from 1979 to 1984. Special attention was given to the complication of malposition of these catheters. From 1981-1984, 116 consecutive percutaneous silicone central venous catheters (CVC) were inserted using the peel away sheath introducer. There were no primary catheter malpositions using this technique; however, secondary malposition occurred with 6% of the catheters. In addition to the use of this technique, patient response to movement of the guidewire during the catheterization procedure is described. The details of catheter insertion technique which permit operative assessment of the correctness of catheter location are presented. Symptoms and signs of secondary catheter malposition, as well as management required for this problem, are discussed.

Adult↗
PubMed1981

Subclavian catheterization using the peel away sheath.

The placement of percutaneous central venous catheters has become commonplace. Refinement of the technical details of the procedure should be directed toward the goals of increasing safety for the patient and facilitating the accurate positioning of the intravenous catheters. The method described achieves these therapeutic goals and may be used to insert several of the devices which are commercially available. With this method of catheter placement, the Seldinger technique of achieving vascular access is used. A medium bore needle is used to locate the desired vein and to position an intravascular guide wire. Tissue trauma is minimized, and finally, the introducer sheath may be removed prior to dressing placement. We have used the method for the placement of subclavian catheters in 50 patients. Catheter malposition occurred once. No patient had a technical complication of catheter insertion or catheter sepsis.

Catheterization↗
PubMedDate not supplied

Care of the central venous catheterization site: the use of a transparent polyurethane film.

Studies of care of patients with central venous catheters report a 3-7% incidence of catheter-induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self-adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. This dressing was used for the care of 100 consecutive patients with central venous catheters. Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers.

Bacterial Infections↗
PubMedDate not supplied

A method to prevent unintentional removal of a Hickman catheter.

Many patients benefit from the use of tunneled Dacron-cuffed central venous catheters. Operative insertion with the aid of fluoroscopy is required for the proper placement of these devices. Perioperative unintentional removal of the catheter is a reported complication. The outward migration of the device occurs before adequate tissue ingrowth into the Dacron cuff has taken place. The frequency with which this unfavorable outcome occurs can be reduced by placement of a subcutaneous absorbable restraining suture distal to the Dacron cuff during the insertion procedure. The authors advocate the routine use of this adjunctive measure for the insertion of all Dacron-cuffed caval catheters.

Catheterization, Central Venous↗