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Biomedical subjects

R Naranjo

Publications and source records attributed to R Naranjo.

At least 19 recordsLinked to original sources
PubMed2001

Telemedicine: Strabismus e-consultation.

BACKGROUND: Volunteer ophthalmologists can achieve success with teaching and service programs working with high intensity over a short term. Continuation of initially successful programs may be limited by lack of timely, effective communication and follow-up. In an attempt to overcome these limitations, a total of 6 telemedicine programs were established after a successful trial program at the Ramon Pando Ferrer Hospital in Havana, Cuba. METHODS: Two pediatric ophthalmology-strabismus clinics, one in Cuba and one in Romania, were provided a digital camera and a computer in order to obtain and then transmit by e-mail patient images obtained according to a prescribed format. Ophthalmologists in both of these programs were instructed personally during an orientation period in their clinics. Training included use of a digital camera and computer, patient examination, and surgical technique in the operating room. Four additional programs referred patients via digital images after receiving only written and oral instruction. RESULTS: The diagnosis and treatment plan determined by one of us (E.M.H.) for each of the first 15 Cuban patients after study of digital images sent by e-mail was the same as the diagnosis and treatment plan determined by the same observer after in-person examination of the patients. On the basis of the level of confidence attained in these patients, 35 additional patients from a total of 6 clinics were seen by digital consultation only. CONCLUSION: A store-and-forward telemedicine consultation technique that uses digital images and e-mail holds promise to be an effective means for carrying out consultation for patients with strabismus.

Child↗
PubMed2000

Acute angle-closure glaucoma after hyperopic laser in situ keratomileusis.

We report a case of acute angle-closure glaucoma 1 year after hyperopic laser in situ keratomileusis (LASIK). The glaucoma was resolved with laser iridotomy, and a prophylactic iridotomy was performed in the fellow eye. Corneal topography was performed 2, 5, and 18 weeks after the acute episode. A myopic shift occurred after the episode and resolved within 3 months. Hyperopic patients with narrow angles are at risk for angle closure and should be carefully monitored.

Acute Disease↗
PubMed1999

Oculocardiac reflex in sedated patients having laser in situ keratomileusis.

PURPOSE: To eliminate stress as a variable in assessing the frequency of the oculocardiac reflex during laser in situ keratomileusis (LASIK). SETTING: Merida Ophthalmological Hospital and Oftalmedica, Mexico City, Mexico. METHODS: A pulse oximeter registered the heart rate of 30 sedated patients having LASIK. Sedation was accomplished with a combination of midazolam and fentanyl. The heart rate was noted before and during suction. The results in 1 eye of each patient were recorded. Oculocardiac reflex was defined as a decrease of 10% or more of the basal heart rate. RESULTS: Fourteen patients (46.7%) had a 10% or more decrease in heart rate when suction was applied. Ten of the 14 had a decrease in heart rate between 10% and 19%, 3 between 20% and 29%, and 1 of more than 30%. Two patients (6.6%) had an increase in the basal heart rate of more than 10%. CONCLUSIONS: The findings suggest that the oculocardiac reflex occurs more frequently in sedated patients than in nonsedated patients.

Adult↗
PubMed1998

Oculocardiac reflex during laser in situ keratomileusis.

PURPOSE: To evaluate the occurrence of oculocardiac reflex during laser in situ keratomileusis (LASIK). SETTING: Merida Ophthalmological Hospital, Mexico City, Mexico. METHODS: This study included 20 patients who were given an electrocardiogram prior to, during, and after LASIK. Heart rate was noted before the procedure and during the preparation, placement of the patient under the microscope light, blepharostat application, and suction and laser treatment. The results in 1 eye of each patient were recorded. RESULTS: In 4 of the 20 patients (20%), the heart rate decreased during suction. In 2 of the 4, the decrease was 30% of baseline. In an additional 4 patients (20%), the heart rate increased more than 20% of baseline. This increase was detected prior to application of the suction ring. In the remaining 12 patients (60%), the heart rate did not change. CONCLUSIONS: Electrocardiographic changes compatible with oculocardiac reflex occurred in 20% of patients in this study. The same percentage showed an increase in heart rate attributable to surgical stress.

Adult↗
PubMed1997

[Changes in the concentrations of catecholamines and cortisol in balanced anesthesia and total intravenous anesthesia].

OBJECTIVE: To compare hormone response to stress caused by surgery performed under balanced general anesthesia and total intravenous anesthesia. PATIENTS AND METHOD: Two randomly formed groups of 24 patients each were studied. All patients were scheduled for lumbar laminectomy to correct disc hernias, with one group receiving balanced anesthesia with isoflurane (expiratory fraction between 0.5% and 0.6%), and the second group receiving total intravenous anesthesia (TIVA) (propofol infusion changed every 10 min from 12 to 6 mg/kg/h). Analgesics and relaxants were given by continuous infusion at preestablished doses (fentanyl 2 micrograms/kg/h; vecuronium 0.05 mg/kg/h). Cortisol and catecholamine (adrenalin, noradrenaline and dopamine) levels were determined at the following times: the morning of surgery (baseline), 5 min after intubation, 5 min after incision, 30 and 60 min after intubation; 5 min after tube removal and upon admission to the recovery unit. RESULTS: Cortisol levels decreased from baseline (14 +/- 3 pg/ml) until 30 min after intubation (4 +/- 2 pg/ml; p < 0.05) in the balanced anesthesia group. Adrenaline levels followed the same pattern (baseline 77 +/- 7 versus 57 +/- 10 pg/ml 30 min after intubation). Dopamine levels were statistically different (p < 0.05) at baseline (42 +/- 3 pg/ml), after intubation (38 +/- 2 pg/ml) and after incision (35 +/- 3 pg/ml), but the difference disappeared 30 minutes after intubation (38 +/- 8 pg/ml). Noradrenaline levels after incision (425 +/- 116 pg/ml) were significantly different from those at baseline (671 +/- 124 pg/ml), and the difference was evident until 60 min after incision. In the TIVA group we found significantly higher cortisol levels after intubation (21 +/- 0 pg/ml) than after baseline (14 +/- 2 pg/ml); this level decreased after extubation (7 +/- 0 pg/ml; p < 0.05). Adrenaline levels were significantly higher than at baseline (64 +/- 11 pg/ml) at times corresponding to intubation (76 +/- 5 pg/ml) and extubation (48 +/- 5 pg/ml). Noradrenaline increased significantly over baseline (497 +/- 99 pg/ml) after incision (597 +/- 90 pg/ml) and decreased significantly after 30 min. The increases in cortisol were significantly greater in the TIVA group than in the control group after intubation (21 +/- 0 versus 8 +/- 3 pg/ml, respectively) after intubation, after incision (18 +/- 2 versus 6 +/- 3 pg/ml) and 30 minutes after intubation (15 +/- 2 versus 4 +/- 2 pg/ml). Similar differences were found for dopamine after intubation (49 +/- 2 versus 38 +/- 2 pg/ml) and after incision (45 +/- 5 versus 35 +/- 3 pg/ml). CONCLUSIONS: Hormone levels are significantly higher during intravenous anesthesia than during balanced anesthesia, and the difference is evident from the earliest measurement performed.

Adult↗
PubMed1993

Muir-Torre syndrome associated with a family history of hyperlipidemia.

The Muir-Torre syndrome is a rare disorder characterized by sebaceous neoplasms of the skin and multiple visceral malignancies. The syndrome appears to be a familial, autosomal dominant condition. We diagnosed this syndrome in a previously unreported patient and found a personal and family history of malignancies and hyperlipidemia. The association of Muir-Torre syndrome with a family history of hyperlipidemia, another autosomal dominant condition, has not been previously reported. The possible genetic relationship between the two disorders is discussed.

Aged↗
PubMed1993

Myxoid change in decidualized scar endometriosis mimicking malignancy.

A case of cesarean scar endometriosis with massive decidualization is presented. The 25-year-old patient had an extensive, ulcerated lesion that mimicked malignancy microscopically due to myxoid change with alveolar patterns reminiscent of some soft tissue sarcomas, signet ring-like cells similar to mucin-producing carcinoma, and pseudoinfiltration of the fascia. The myxoid tissue was positive for acid mucopolysaccharides but negative with PAS. Decidual cells were vimentin positive and keratin negative. No atypia or mitoses were seen. The pseudoinfiltrative aspect was due to abundant extracellular matrix that separated the fascicles of the fascial tissue. There was a metaplastic decidual "proximity effect" in the surrounding, unaffected dermis, which may be responsible for the expansile features of the lesion. This case exemplifies the differential diagnosis of myxoid endometriosis with malignant conditions of the skin.

Abdomen↗
PubMed1984

[Mastocytosis].

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Humans↗
PubMed1980

Electrical burns.

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Burns, Electric↗