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Laresgoiti-Servitje E.,American British Cowdray Medical Center | Laresgoiti-Servitje E.,Panamerican University of Mexico
Journal of Leukocyte Biology | Year: 2013

Preeclampsia syndrome is characterized by inadequate placentation, because of deficient trophoblastic invasion of the uterine spiral arteries, leading to placental hypoxia, secretion of proinflammatory cytokines, the release of angiogenic and antiangiogenic factors and miRNAs. Although immune-system alterations are associated with the origin of preeclampsia, other factors, including proinflammatory cytokines, neutrophil activation, and endothelial dysfunction, are also related to the pathophysiology of this syndrome. The pathophysiology of preeclampsia may involve several factors, including persistent hypoxia at the placental level and the release of high amounts of STBMs. DAMP molecules released under hypoxic conditions and STBMs, which bind TLRs, may activate monocytes, DCs, NK cells, and neutrophils, promoting persistent inflammatory conditions in this syndrome. The development of hypertension in preeclamptic women is also associated with endothelial dysfunction, which may be mediated by various mechanisms, including neutrophil activation and NET formation. Furthermore, preeclamptic women have higher levels of nonclassic and intermediate monocytes and lower levels of lymphoid BDCA-2+ DCs. The cytokines secreted by these cells may contribute to the inflammatory process and to changes in adaptive-immune system cells, which are also modulated in preeclampsia. The changes in T cell subsets that may be seen in preeclampsia include low Treg activity, a shift toward Th1 responses, and the presence of Th17 lymphocytes. B cells can participate in the pathophysiology of preeclampsia by producing autoantibodies against adrenoreceptors and au-toantibodies that bind the AT1-R. © Society for Leukocyte Biology.


Villaroel-Salinas J.,American British Cowdray Medical Center | Campos-Martinez J.,Instituto Mexicano Del Seguro Social | Ortiz-Hidalgo C.,American British Cowdray Medical Center | Ortiz-Hidalgo C.,Panamerican University of Mexico
International Journal of Surgical Pathology | Year: 2012

Involvement of the tongue by a synovial sarcoma (SS) is an extremely rare event; there have only been 13 cases previously reported. The authors present herein a case of monophasic SS arising in the tongue in a 32-year-old woman. The neoplasm expressed cytokeratins AE1-3, OSCAR, and EMA as well as Bcl-2 and TLE1. Molecular analysis indicated that the patient tested positive for the SYT/SS2 fusion transcript. © The Author(s) 2012.


Padilla-Rodriguez A.L.,American British Cowdray Medical Center | Padilla-Rodriguez A.L.,Panamerican University of Mexico
Annals of Diagnostic Pathology | Year: 2012

Hibernomas are rare benign tumors composed of cells reminiscent of brown adipose tissue. In the mammary gland, hibernomas are extraordinary rare, with only 4 cases reported previously. We report the fifth case in a 37-year-old woman who presented with a slowly growing mobile mass in her right breast. A 2.2 cm well-circumscribed lobulated mass was completely removed. The histopathologic analysis showed the full characteristics of the hibernoma. A review of the clinicopathologic features of hibernomas, its relation to brown adipose tissue in humans, and considerations about its histogenesis are made. © 2012 Elsevier Inc. All rights reserved.


Jasqui-Remba S.,American British Cowdray Medical Center | Rodriguez-Corlay R.E.,Medical Center
BMJ Case Reports | Year: 2016

In this case report, we present an acute rupture in the muscular tendinous junction of a posterior tibialis muscle in a bimalleolar closed ankle fracture after a high-energy trauma in a 30-year-old patient with no significant medical history. Fracture was confirmed by simple X-rays, and was treated with an open reduction in which both of the fractures were treated with osteosynthesis material and reparation of the syndesmosis. If left untreated, this uncommon finding can result in a bad postsurgical outcome; we believe this injury is more common but under-reported in the literature. The surgeon should be aware and look specifically for this type of lesion during the procedure. Finding and treating this injury requires special postoperative care, non-weight-bearing instructions and balanced physiotherapy.


Chousleb E.,Cleveland Clinic | Shuchleib S.,American British Cowdray Medical Center | Chousleb A.,American British Cowdray Medical Center
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques | Year: 2010

Laparoscopic adhesiolysis is a valuable tool for the surgeon performing complex minimally invasive procedures. It can be used for the management of intestinal obstruction and chronic abdominal pain syndromes. It is also an essential skill when performing laparoscopic surgery on patients who had prior abdominal operations. The use of laparoscopy for patients with an intestinal obstruction was once considered an absolute contraindication. With the advancement in optics and increasing experience, more and more surgeons are turning to laparoscopy as a useful diagnostic and therapeutic tool in more complex situations. Copyright © 2010 by Lippincott Williams & Wilkins.


Rodriguez A.,American British Cowdray Medical Center | Mosti M.,American British Cowdray Medical Center | Sierra M.,American British Cowdray Medical Center | Perez-Johnson R.,American British Cowdray Medical Center | And 6 more authors.
Obesity Surgery | Year: 2010

Background: Small bowel obstruction (SBO) after laparoscopic Roux-en-Y gastric bypass (LRYGB) may be related to the surgical technique used. The frequency and characteristics of postoperative SBO were studied in two cohorts of patients after LRYGB. Methods: In a 4-year period, 359 patients underwent LRYGB as an initial bariatric operation at our clinic. Patients were divided into two groups. In Group 1 (n=187), the mesentery of the jejunum was widely divided, the mesenteric defect was closed, and Petersen's space was not sutured. In Group 2 (n=172), the mesentery was not divided, and both the mesenteric folds and Petersen's space were closed. Episodes of SBO, etiology, treatment, and outcome were analyzed and compared. Results: There were 141 males and 218 females, with mean age of 41±11 years. Preoperative BMI was 43.2±7 kg/m2. In Group 1, 29/187 patients (15.5%) developed SBO at a mean follow-up of 15±6.4 months. In Group 2, 2/172 patients (1.1%) developed SBO at 12.3±6.7 months. Internal hernia was responsible for the SBO in 29 patients (19 through the adjacent mesenteric defect and 10 through Petersen's space). Mean EWL at the time of SBO was 82.2±22.7%. SBO was successfully resolved by laparoscopy in 25 patients, conversion was necessary in three, and one was treated by open surgery. One patient presented intestinal perforation after revision. Conclusions: Surgical details such as leaving the jejunal mesentery intact and closing all created defects significantly decreased the incidence of SBO due to internal hernias in antecolic antegastric LRYGB. © 2010 Springer Science + Business Media, LLC.


Namendys-Silva S.A.,Instituto Nacional Of Cancerologia | Hernandez-Garay M.,American British Cowdray Medical Center | Herrera-Gomez A.,Deparment of Oncology Surgery
American Journal of Hospice and Palliative Medicine | Year: 2010

In immunosuppressed patients (ISP) with acute respiratory failure (ARF), invasive mechanical ventilation (IMV) is associated with high mortality rate. Noninvasive ventilation (NIV) is a type of mechanical ventilation that does not require an artificial airway. It has seen increasing use in critically ill patients to avoid endotracheal intubation. Acute respiratory failure due to pulmonary infections is an important cause of illness in ISP and their treatment. Immunosuppressive treatments have showed an increase not only in the survival but also in the susceptibility to infection. Several authors have underlined the worst prognosis for neutropenic patients with ARF requiring endotracheal intubation and IMV. The NIV seems to be an interesting alternative in ISP because of the lower risk of complications; it prevents endotracheal intubation and its associated complications with survival benefits in this population. © The Author(s) 2010.


Yanez C.,American British Cowdray Medical Center
Otolaryngology - Head and Neck Surgery (United States) | Year: 2010

OBJECTIVE: To evaluate laser-assisted cross-hatching technique for treatment of patients with Eustachian tube dysfunction. STUDY DESIGN: Prospective, institutional review boardapproved surgical trial. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: A total of 25 patients with Eustachian tube dysfunction underwent laser Eustachian tuboplasty with cross-hatching technique (CHT). Surgery involved use of the argon laser to cross-hatch the posterior cushion to modify the curvature of the cartilage of the posterior cushion and to alter the spring of the cartilage to make it wider and larger, thereby alleviating the obstructive dysfunction of the tube. None of the patients had any concurrent disease or surgical procedure. RESULTS: There were no surgical complications. Following CHT, subjective symptoms of an ear blockage improved in 23 of 25 (92%) patients. Posterior cushion curvature became softer and wider, and the valve appeared more open postoperatively on simple endoscopy (SE) and slow motion video endoscopic analysis (SMVEA). Mean pure-tone average improved by 10 dB (30 dB preoperatively vs 20 dB postoperatively; P = 0.015). Abnormal tympanogram improved in 24 of 25 (96%) patients. Failure of the procedure correlated with severity of cartilage deformation and valve obstruction as measured by both SE and SMVEA. Mean follow-up was 15 months (range 3-37 months). CONCLUSION: Cross-hatching technique for Eustachian tuboplasty appears to be a safe and useful technique for treatment of Eustachian tube dysfunction. © 2010 American Academy of Otolaryngology-Head and Neck-Surgery Foundation. All rights reserved.


Marhofer P.,Medical University of Vienna | Ivani G.,Regina Margherita Childrens Hospital | Suresh S.,Northwestern University | Melman E.,American British Cowdray Medical Center | And 2 more authors.
Paediatric Anaesthesia | Year: 2012

Summary Regional anesthesia in children is an evolving technique with many advantages in perioperative management. Although most regional anesthesia techniques are sufficiently described in the literature, the implementation of these techniques into daily clinical practice is still lacking. The main problems associated with pediatric regional anesthesia (PRA) include the appropriate selection of blockade, the management around the block, and how to teach these techniques in an optimal manner. This review article provides an overview of these 'hot' topics in PRA. © 2012 Blackwell Publishing Ltd.


Yanez C.,American British Cowdray Medical Center | Pirron J.A.,American British Cowdray Medical Center | Mora N.,American British Cowdray Medical Center
Otolaryngology - Head and Neck Surgery | Year: 2011

Objective. To assess the laser-assisted curvature inversion technique for the treatment of patients with patulous Eustachian tube (PET). Study Design. Case series with planned data collection. Setting. Tertiary care medical center. Subjects and Methods. Eleven patients with Eustachian tube dysfunction underwent laser-assisted curvature inversion technique (CIT) of the medial and lateral lamina of the Eustachian tube. A KTP laser is used to cross-hatch the medial and lateral lamina of the tube to modify the curvature and to alter the spring of the posterior cushion. A change in the direction of the cartilaginous structure curvature is created to promote full closure of the patulous gap without interfering with the tube's muscular activity. None of the patients had any concurrent disease or additional surgical procedure. Results. There were no surgical complications. Following CIT, subjective symptoms of autophony on nasal breathing improved in 9 of 11 patients (81.8%), while voice autophony improved in 8 patients (72.7%); posterior cushion curvature became inverted and less wide, and the valve was seen more closed postoperatively on simple endoscopy and slow-motion video-endoscopic analysis. On otoscopy, abnormal tympanic membrane excursions disappeared in 10 of 11 patients (90.9%). Mean immittance changes in tympanometric measurements for the forced respiration conditions improved postoperatively at least 0.05 mmhos in 9 of 11 patients (81.1%; P = .015). The follow-up period was 24 months. Conclusion. CIT appears to be a promising and relatively feasible technique for the treatment of PET. © American Academy of Otolaryngology - Head and Neck Surgery Foundation 2011.

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