Biomedical subjects
Publications and source records attributed to R Salvador.
Villous adenomas of the vermiform appendix are uncommon. Their malignant potential is unknown and their treatment is controversial. Because of a reported association between adenomas of the appendix and other gastrointestinal neoplasms, long-term surveillance is recommended. A new case of appendicular villous adenoma is reported.
We report the case of a 26 year old female with low abdominal pain occurring post-partum. Ultrasonography revealed the existence of pelvic cysts. Laparotomy allowed the resection of the cysts interpreted at that time as hydatic cysts. Four months later the patient was readmitted because of a recurrence of the cysts. Pathological examination made the final diagnosis of multilocular peritoneal inclusion cysts. The literature on this rare condition, previously denominated cystic benign mesothelioma, is reviewed. Recurrence may be prevented by the use of sclerosing agents during the surgical intervention.
In this work we studied some of the main effects of the maxillary protraction orthopedic device. The initial dento-craniofacial reactions induced by maxillary protraction similar to that commonly employed in clinical practice are reported. The fringe counting holographic interferometry technique is used to measure displacements. The experiments were performed on a dried human skull; traction application points were situated over the permanent lateral incisors or over the first permanent molars. The results fundamentally reveal an anterior rotation of the dentomaxillary complex, more intense when traction is applied to the lateral incisors, as shown by a more marked extrusion of the molars in this case. Moreover, major deformation patterns could be observed in inner hard structures of the skull base when applying orthopaedic forces.
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We present 10 cases of early gastric carcinoma with lymph node invasion in a series of 40 cases early gastric cancer operated between 1974 and 1984 in our unit. Two tumours were mucosal and 8 were submucosal. One tumour was polypoid, 5 were superficiel and 4 were ulcerated. The mean number of invaded lymph nodes was 2.7. We performed a total gastrectomy in two patients and a distal gastrectomy in the other eight patients. Two patients died 26 and 27 months after the operation. The others are alive and tumour free. We believe that early gastric cancer must be treated aggressively by means of total or partial gastrectomy with resection of the N1 and N2 lymph node chains, when ever possible.
A prospective study has been made of the incidence of changes in transaminase levels, hyperkalaemia and thrombocytopenia in three groups of patients: 89 consecutive patients with venous thrombosis receiving therapeutic heparinization, 49 patients admitted because of hip fracture and receiving prophylactic low-dose conventional heparin, and 43 patients admitted because of hip fracture and randomly allocated to receive low molecular weight heparin. Laboratory measurements were made on admission and 8 days after commencing heparin. Only two patients on high-dose heparin developed thrombocytopenia. Increased transaminases were frequent with conventional heparin (18% and 32% of patients on high-dose heparin developed abnormal AsT and AlT values, respectively compared with 14% and 17% patients on low dose therapy). In contrast, only one patient on low molecular weight heparin developed abnormal AlT activity. Hyperkalaemia was uncommon in patients on any form of heparin therapy, and severe hyperkalaemia occurred in only one patient.
In a randomized, prospective, double-blind trial, the effect of conventional low-dose heparin (5,000 units every 8 hours) was compared with that of a low molecular weight fragment (2165 LMWH, Kabi Vitrum AB, starting 2,500 units 2 hr before surgery, and then 5,000 units subcutaneously every morning for 9 days). A total of 90 patients admitted because of hip fracture fulfilled the inclusion criteria and were analyzed for development of pulmonary embolism and deep vein thrombosis: 46 patients were included in the low molecular weight heparin (LMWH) group, and 44 in the conventional heparin group. Two and three, respectively, died before diagnostic tests were performed. In the remaining patients a ventilation-perfusion lung scan was performed 8 days after intervention. In the first 57 patients studied a bilateral ascending venography was performed on the ninth day only if clinical symptoms suggested a deep venous thrombosis. Because of the rate of venous thrombosis detected in those patients was unexpectedly low, venography was requested in the remaining 33 patients, even if the screening tests were negative. Pulmonary embolism occurred in six patients, all in the LMWH group. Deep vein thrombosis occurred in 14 patients in the LMWH group and in six patients in the conventional heparin group. Both differences are statistically significant. Mortality did not differ between the groups, nor did haemorrhagic complications. Our findings suggest that, in patients with hip fracture, LMWH is not useful at the dosage used.
This is a prospective study of 108 patients in two distinct groups undergoing real-time ultrasonography (US) and ascending conventional venography within the same day. The two patient groups consisted of the following: Those patients evaluated because of suspicion of deep venous thrombosis of lower limbs (69 patients) and those at high risk for venous thrombosis (19 patients with a recent hip fracture, 20 with a suspected pulmonary embolism). In the diagnosis group 48 patients had venographic evidence of thrombosis. The predictive value of abnormal findings from real-time US was 97%, and that of a negative study was 75%. Thus, real-time US may have a role as a diagnostic procedure, to be followed by x-ray venography in patients with negative US results. By contrast, real-time US is far less sensitive as a screening test in patients without clinical evidence of thrombosis. Only 3 of 9 patients with thrombosis were detected, with a 50% sensitivity for proximal vein thrombosis. Therefore, the use of real-time US for screening high-risk patients must be limited to very high risk patients in whom other tests are ineffective (as in hip surgery).
We have prospectively studied a series of 121 consecutive patients with venous thromboembolism (38 with pulmonary embolism, 83 with venous thrombosis of the lower extremities) searching for recurrences of pulmonary embolism despite adequate heparin therapy. A baseline ventilation-perfusion lung scan was obtained initially in every patient, whether the original diagnosis was pulmonary embolism or venous thrombosis. Repeat chest roentgenograms and lung scans were obtained routinely at eight days of heparin treatment. The primary trial endpoints were a finding of a clinically apparent recurrent pulmonary embolism, or laboratory evidence of subclinical pulmonary embolism. Eight items of clinical and laboratory information were recorded at admission and then correlated with the lung scan results. Recurrences were seen in seven of 38 patients with an original diagnosis of pulmonary embolism, and in five of 83 patients admitted because of venous thrombosis (p = 0.034). Recurrences were also more frequent in patients with a free-floating thrombus on venography (p = 0.014). The risk of new defects in patients with venous thrombosis and without free-floating thrombus was 3.05 percent, venous thrombosis with free-floating thrombus, 13.33 percent; patients with pulmonary embolism without free-floating thrombus, 11.42 percent; and with free-floating thrombus, 38.67 percent. Venography seems thus mandatory in patients with pulmonary embolism, as it recognizes a subgroup of patients at a high risk of recurrences.
Cystadenoma of the pancreas is a rare tumor. In the surgery unit of the Hospital de la "Santa Cruz y San Pablo", of 18 cases of cephalic duodeno-pancreatectomy in the last nine years, we have only observed one case of cystadenoma. The patient was a 70 year-old woman, hypertensive and very obese, who had few symptoms and was diagnosed as pancreatic tumor by echography. CAT, ERCP and abdominal arteriography confirmed the diagnosis. Needle biopsy guided by echography and CAT was negative for malignant cells. In the operation, needle and trucut biopsy revealed benign cystadenoma. Cephalic duodenopancreatectomy was performed. The postoperative period was difficult, and the patient required reoperation within hours for intraperitoneal hemorrhage and again, eight days later, for dehiscence of the pancreatic suture. Finally she recuperated and was released at 38 days. Of all the types of proliferative pancreatic cysts, microcystic or serous adenoma is benign, as compared to mucinous cyst, of clearly malignant potential. However, needle biopsy rarely provides differential diagnosis. In some cases of high surgical risk, the indication for resection can be dubious if the cyst lies in the region of the pancreatic head and its benign nature can be demonstrated.
A non-invasive method is proposed to determine human skin roughness. The technique is based on measurement of the correlation between two field distributions scattered by a metallised triafol (cellulose acetate foil) replica of the epidermal area to be analysed. The two speckle patterns are produced from the same rough surface illuminated by two coherent plane waves (He-Ne laser) under two slightly different angles. The accuracy of the method is highlighted by measurements made on a set of standard samples with roughnesses previously determined by mechanical profilometry. Analysis of the results indicates a precision of around 10%, and an applicability within the interest range of very rough surfaces in excess of 4-5 microns.
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Ventilation-perfusion lung scans were done in 70 patients admitted because of an iliofemoral deep vein thrombosis (DVT), and diagnosed by venography. Eighteen items of clinical and laboratory information were measured to predict the presence of lung scan abnormalities consistent with asymptomatic pulmonary embolism. Eighteen patients had perfusion defects in the lung scan that were classified as "high probability of pulmonary embolism", while the lung scan was normal in 32 patients. Patients with an idiopathic DVT were at high risk of pulmonary embolism, but those with a postoperative DVT had a low embolic risk. In patients with a postoperative DVT two factors predicted pulmonary embolism: those patients who developed symptomatic DVT after an operation but had a normal lung scan showed higher platelet counts than their preoperative levels. Conversely, it they developed a pulmonary embolism their platelet count dropped from their preoperative levels.
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