Biomedical subjects

Raúl Sánchez-Lozada

Publications and source records attributed to Raúl Sánchez-Lozada.

10 recordsLinked to original sources

PubMedDate not supplied

[Traumatic subarachnoid-pleural fistula secondary to non-penetrating thoracic gunshot wound].

INTRODUCTION: Traumatic subarachnoid-pleural fistula (TSPF) is very unusual and is due to the anomalous communication between the pleural and subarachnoid space. We report a TSPF by Bullet wound that was not penetrating to the thoracic cavity. CLINICAL CASE: Masculine of 34 years-old that receives wounded by bullet in the posterior face of thorax. A pleural effusion was identified and medullar wound with fracture of the fifth thoracic vertebra. The effusion is persist and also added headache appear. TSPF was diagnosed for myelography. The patient die before carrying out the surgical treatment. A massive tromboemboly of lug was the cause. The autopsy confirmed the diagnosis. DISCUSSION: The TSPF should be suspected by the association of medullar lesion with a persistent pleural effusion. The diagnosis should be confirmed by radiology. The treatment can be medical or surgical.

Adult↗

PubMedDate not supplied

[Superior mesenteric artery syndrome as a cause of chronic partial intolerance to oral feeding. Report of a case and review of the subject].

INTRODUCTION: Superior mesenteric artery syndrome (SMAS) is the obstruction of the duodenum in the third portion due to this artery. We present a case of chronic oral feeding intolerance due to this problem. CLINICAL CASE: A 24 year-old woman, with a time of evolution of 1 year and a half of postprandial epigastric pain with nausea, vomiting, and loss of 30 kg managed as acid-peptic disease. The patient was studied with gastrointestinal contrast study and endoscopy without conclusive results. The patient was admitted for unstoppable vomiting, malnutrition, and severe dehydration. A laparotomy was performed and SMAS was identified. We performed Treitz's ligament section and gastrojejunoanastomosis. Her clinical outcome was satisfactory and the patient was discharged without complications. DISCUSSION: SMAS is also called Wilkie's syndrome. SMAS is more frequent in women between the 10 and 39 years. The disease due to the decrease of the angle between the superior mesenteric artery and the aorta, to the anomalous origin of this artery, or to the shortening of Treitz's ligament. SMAS may appear as a sudden weight loss. Food intolerance is a predominant symptom. Diagnosis can be made with x-ray studies. Treatment is medical or surgical, with Treitz's ligament section, duodenojejunoanastomosis, and in some cases gastrojejunoanastomosis. CONCLUSIONS: SMAS should be considered as no the differential diagnosis of chronic oral feeding intolerance.

Adult↗

PubMedDate not supplied

[Etiology on determining the severity of acute pancreatitis].

INTRODUCTION: There exist contradictory results regarding the role of etiology in severity and mortality of acute pancreatitis. In the population of "Hospital General de México" we stablished their importance. MATERIAL AND METHODS: We carried out a retrospective, comparative, longitudinal, and observational study. We determined sex, age, time of evolution, and subjective nutritional state of patients with diagnosis of acute pancreatitis from January 1, of 1996 to December 31, 2000. We compared days of hospitalization, severity, and mortality according to etiology. RESULTS: Ninety five patients were studied, 54% with biliarY and 41% with alcoholic etiology. Differences did not exist in ages and times of symptom evolution, but did in distribution by sex and nutritional state. There were no differences in days of hospitalization but there were differences in severity and mortality when comparing groups of different etiologies. DISCUSSION: In acute pancreatitis, etiology is the decisive factor of severity and mortality, although this can be conditioned by sex of patient and nutritional state.

Acute Disease↗

PubMedDate not supplied

[Use of base deficit as a prognosis factor for acute pancreatitis].

INTRODUCTION: Acute pancreatitis (AP) severe is accompanied by important morbidity and mortality. Tissular hypoperfusion has been suggested as a severity determinant. Base deficit (BD) demonstrated to be a good indicator of hypo-perfusion. We established predictive value in AP. MATERIAL AND METHODS: A retrospective, longitudinal, descriptive, and observational study was carried out. We included hospitalized patients from January 1996 to December 2000 with confirmed diagnosis of AP for laboratory, tomography and/or surgery; and with determination of BD on admission. Patients were divided into groups with or without BD and were compared with certain severity and mortality. RESULTS: We study 104 patients, 40(38%) without BD and 64 (62%) with BD. The mortality belonged to 22 patients (21.2%), all of the group with BD. The BD had a sensibility of 71.4% to predict severity and of 100% for the motility DISCUSSION: BD allows predicting severity and mortality in AP. These points out the role that carried out tissular hip perfusion; in addition, it can serve as guide for appropriate treatment.

Acute Disease↗

PubMedDate not supplied

[Efficacy of decompression treatment of abdominal compartment syndrome].

INTRODUCTION: Abdominal compartment syndrome (ACS) is an entity that represents a latent problem in the patient subjected to laparotomy. OBJECTIVE: To evaluate the effectiveness of decompressive treatment of ACS. MATERIAL AND METHODS: We studied patients subjected to decompressive treatment for diagnosis of SCA from May 1 to November 30, 2001 prospectively. We evaluated intraabdominal pressure (IAP), peak pressure of air way (J)PVA), oxygen available index (OAi), ventilation-perfussion index and uresis, before, after, and at 48 h of decompressive surgery. The data were treated statistically with paired student t test taking as significant p < 0.05 using percentages for qualitative variables and average with standard deviation for quantitative variables. RESULTS: We included 10 patients; three died (30%). Alone it VP & it descended significantly after compression (1 > < 0.05). Uresis, PPVA, OlA and VPI were carried out 48 h of decompressive surgery. CONCLUSIONS: Decompressive treatment is effective in ACS, showing immediate decreased of IAP and improvement of the hemodynamic variables after 48 h post-surgery.

Abdomen↗

PubMedDate not supplied

[Open vs. closed abdomen in acute peritonitis. A comparative study].

INTRODUCTION: Open abdomen is a management alternative that, however, is not exempt from complications. We evaluated, in a comparative manner, the handling with open abdomen (OA) against closed abdomen (CA) in treatment of patients with severe peritonitis for traumatic lesion. MATERIAL AND METHODS: We carried out an observational, retrospective, longitudinal, and comparative study. It included patients managed with diagnosis severe peritonitis due to abdominal trauma between 1998 and 2000. They were divided into two groups, according to management with OA or CA. We compared age, sex, trauma type, severity of lesion, morbility and mortality. RESULTS: 12 patients were managed with OA, which presented longer hospitalization and 24 with CA who in turn presented a greater lesion severity. There were statistical differences in other parameters, including complications and mortality. However, patients managed with OA frequently presented more complications. DISCUSSION: OA does not improve morbility and mortality of patients, although they presented less severe lesions that those managed with CA.

Abdominal Injuries↗

PubMedDate not supplied

[Acute pancreatitis, diabetes, and sacoidosis. Case report and review of the literature].

INTRODUCTION: Sarcoidosis is a systemic, chronic, granulomatous disease of unknown cause. Pancreatic affection is rare and even more rare is the association among sarcoidosis, acute pancreatitis and diabetes mellitus. This is the first case reported in Mexico. CASE REPORT: Male 29 years. Sarcoidosis is diagnosed from the patient age of 20 years, with intermittent episodes affecting articulate, ophthalmic, cutaneous, lung and central nervous system. At 22 years of age the patient was diagnostic with diabetes mellitus. He was admitted with severe acute pancreatitis, that causes him to die. DISCUSSION: Diabetes mellitus is due to sarcoidotic infiltration of pancreas. Acute pancreatitis has been related with inflammatory or secondary process to frequent presence of hypercalcemia in the sarcoidosis. Diagnosis is not easy. This type of pancreatitis responds to treatment with steroids.

Acute Disease↗

PubMedDate not supplied

[Acute pancreatitis: five year experience at the Hospital General de Mexico].

INTRODUCTION: In Mexico acute pancreatitis is an important cause of morbility and mortality. We here describe the characteristics of patients managed with that diagnosis at the Hospital General de Mexico. MATERIAL AND METHODS: Retrospective, descriptive and observational study. Patients with acute panrcreatitis were seen between January 1996 to December 2000. RESULTS: The acute pancreatitis prevalence found in the hospital setting was 5%. We identified 104 patients, 62% men, with mean age 37 yrs. In 74% ofcases seen, we made a correct early diagnosis upon admission. The biliary (49%) and the alcoholic (37%) were the most frequent causes. Abdominal pain was the most common symptom at onset (94%). High leukocyte count (78%), followed by serum lipase (74%) was the most sensitive laboratory test. Only 34% of patients studied had an adequate nutritional status. 54% of' patients presented severe pancreatitis. The mean number of hospital days was 17 and 44% required ICU management. Thirty five percent required surgery where necrosectomy was performed and a mortality of 67% was found. The total mortality rate was 21%. CONCLUSIONS: The correct clinical diagnosis of acute pancreatitis is frequent. It is a more common finding than severe pancreatitis, but it does not increase the morbility and mortality in our patient population.

Acute Disease↗

PubMedDate not supplied

[Frequency of organic failure in acute necrotic pancreatitis].

INTRODUCTION: Theacute pancreatitis is classified as severe by the presence of glandular necrosis or organic failure. However both conditions are not simultaneous. We determine the frequency of organic failure in patients with pancreatic necrosis for acute pancreatitis. MATERIAL AND METHODS: A study retrospective, traverse, descriptive and observational is carried. Were included the cases of pancreatic necrosis by acute pancreatitis presented of January 1 from 1996 to December 31 2000. The presence of organic failure was determined, as well as ages, sex, etiology, nutritional state, Ranson's criteria, surgeries carried and mortality. RESULTS: 45% of the patients with necrosis pancreatic development organic failure. The masculine sex and the realization of some surgery predominated in them. 92% of the patients with organic failure presents it to the admission, the system circulatory was the more frequently affected, continued by the respiratory, and the renal. The patients with organic failure had a mortality of 88% against 0% of those that didn't present it. The SIRPA and irreversible shock were the causes of death. DISCUSSION: Not is clear the relationship between necrosis and organic failure. The death of pancreatic tissue for apoptosis, that limits the damage and the necrosis, that it favors, is factors to consider. The hypoperfusion tissular can be the determinant among these two lesion forms.

Adult↗

PubMedDate not supplied

[Intestinal trichobezoar as a cause of small bowel obstruction. Case report and review of the literature].

BACKGROUND: The trichobezoars are conglomerates of hair ingested by a person. They are located in the stomach, although they can extend also to the small bowel. They are common in children and adolescents, and 90% of the patients are women. An occasional complication is mechanical obstruction, usually at the gastric level or in the small bowel. It is extremely rare to find trichobezoars in the small bowel without a gastric component. CASE REPORT: A 18 year-old female patient was admitted for small bowel obstruction. Three weeks before she had underwent appendectomy. Laparotomy was performed identifying three trichobezoars occluding the jejune, without evidence of gastric bezoars. The bezoars were extracted by enterotomy. No post-operatory complications were presented. CONCLUSIONS: Trichobezoars are a rare entity that may be complicated by bowel obstruction. The discovery of trichobezoars in the bowel may be due to primary formation, which is improbable, or to fragmentation in the stomach followed by migration of the fragments, which in the case presented could be favored by the patient's previous operation.

Adolescent↗