Surgeons, Urologist


North Philadelphia East
3401 N Broad St
Suite 330
Philadelphia, PA 19140
215-707-3376
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American College of Surgeons

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Dr. Reyes is affiliated with 1 hospitals.

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  • Temple University Hospital
    3401 N Broad St, Philadelphia, PA 19140
    • Currently 2 of 4 crosses
  • Publications & Research

    Dr. Reyes has contributed to 42 publications.
    Title Delayed Proximal Ureteric Stricture Formation After Complex Partial Nephrectomy.
    Date March 2012
    Journal Bju International
    Excerpt

    •  To report and review our incidence of delayed ureteric stricture (US) after complex nephron-sparing surgery (NSS).

    Title [palliative Treatment for Locally Advanced or Metastatic Gallbladder Cancer: Conclusions of the Latin American Consensus Meeting for the Management of Gallbladder Cancer].
    Date January 2012
    Journal Revista Médica De Chile
    Excerpt

    Gallbladder cancer is a rare disease in Western developed countries, but it is a highly prevalent and lethal disease in Chile and other countries in Latin America. No randomized controlled trials have been performed in gallbladder cancer to establish standard treatments. We therefore performed the first Latin American consensus meeting for the management of gallbladder cancer. In this article we present the conclusions of the panel of experts for the palliative treatment of unresectable or metastatic gallbladder cancer based on a review of the literature, the discussion of the participating experts and the opinion of the assistants. The topics reviewed included: (1) Gallbladder cancer and cholangiocarcinoma--are they the same disease?; (2) Palliative chemotherapy: indications, drugs and schedules; (3) Palliative radiotherapy; (4) Palliative Surgery; (5) Management of malignant biliary obstruction.

    Title Variants in Dna Double-strand Break Repair Genes and Risk of Familial Breast Cancer in a South American Population.
    Date October 2010
    Journal Breast Cancer Research and Treatment
    Excerpt

    The double-strand break (DSB) DNA repair pathway has been implicated in breast cancer (BC). RAD51 and its paralogs XRCC3 and RAD51D play an important role in the repair of DSB through homologous recombination (HR). Some polymorphisms including XRCC3-Thr241Met, RAD51-135G>C, and RAD51D-E233G have been found to confer increased BC susceptibility. In order to detect novel mutations that may contribute to BC susceptibility, 150 patients belonging to 150 Chilean BRCA1/2-negative families were screened for mutations in XRCC3. No mutations were detected in the XRCC3 gene. In addition, using a case-control design we studied the XRCC3-Thr241Met, and RAD51D-E233G polymorphisms in 267 BC cases and 500 controls to evaluate their possible association with BC susceptibility. The XRCC3 Met/Met genotype was associated with an increased BC risk (P = 0.003, OR = 2.44 [95%CI 1.34-4.43]). We did not find an association between E233G polymorphism and BC risk. We also analyzed the effect of combined genotypes among RAD51-135G>C, Thr241Met, and E233G polymorphisms on BC risk. No interaction was observed between Thr241Met and 135G>C. The combined genotype Thr/Met-E/G was associated with an increased BC risk among women who (a) have a family history of BC, (b) are BRCA1/2-negative, and (c) were <50 years at onset (n = 195) (P = 0.037, OR = 10.5 [95%CI 1.16-94.5]). Our results suggested that the variability of the DNA HR repair genes XRCC3 and RAD51D may play a role in BC risk, but this role may be underlined by a mutual interaction between these genes. These findings should be confirmed in other populations.

    Title Association of Common Atm Variants with Familial Breast Cancer in a South American Population.
    Date October 2008
    Journal Bmc Cancer
    Excerpt

    The ATM gene has been frequently involved in hereditary breast cancer as a low-penetrance susceptibility gene but evidence regarding the role of ATM as a breast cancer susceptibility gene has been contradictory.

    Title Absence of Chek2 1100delc Mutation in Familial Breast Cancer Cases from a South American Population.
    Date September 2008
    Journal Breast Cancer Research and Treatment
    Title Demonstration by Redox Fluorometry That Sulforaphane Protects Retinal Pigment Epithelial Cells Against Oxidative Stress.
    Date July 2008
    Journal Investigative Ophthalmology & Visual Science
    Excerpt

    PURPOSE: To quantify the effects of oxidant challenge on the redox state of adult human retinal pigment epithelial cells using microscopic autofluorescence spectroscopy and to determine whether treatment with the isothiocyanate sulforaphane protects these cells against oxidative stress. METHODS: Oxidative stress was evoked in ARPE-19 cells by H2O2 and tert-butyl hydroperoxide. Reduced nicotinamide nucleotides NAD(P)H were assessed by excitation at 366 nm with measurement of fluorescence at 450 nm. Oxidized flavoproteins were assessed by excitation at 460 nm with measurement of fluorescence at 540 nm. The ratio of these measurements served as the index of cellular redox status. RESULTS: Redox ratio and cell viability decreased in a dose-dependent manner after oxidant exposure. ARPE-19 cells treated with sulforaphane maintained significantly higher redox ratio and cell viability. The ratio for sulforaphane-treated cells after exposure to 0.64 mM H2O2 was 2.64 +/- 0.19 compared with 1.77 +/- 0.16 in untreated cells (P = 0.001). At 1.2 mM H2O2, the redox ratio of sulforaphane-treated cells was 2.30 +/- 0.18 compared with 1.76 +/- 0.13 in untreated cells (P = 0.02). Similar results were observed after insult with tert-butyl hydroperoxide. CONCLUSIONS: Redox fluorometry provides quantitative information on the redox status of living cells. Sulforaphane protects ARPE-19 cells from oxidative injury by induction of antioxidant phase 2 genes. The findings in this study describe a useful method for assessing antioxidant effects in live cells and support phase 2 gene induction as a potential treatment strategy for macular degeneration and diseases in which oxidative injury plays a causative role.

    Title A Synthetic Peptide Derived from Alpha-fetoprotein Inhibits the Estradiol-induced Proliferation of Mammary Tumor Cells in Culture Through the Modulation of P21.
    Date July 2008
    Journal Advances in Experimental Medicine and Biology
    Excerpt

    A stable cyclized 9-mer peptide (cP) containing the active site of alpha-alpha fetoprotein (alphaFP) has been shown to be effective for prevention of estrogen-stimulated tumor cell proliferation in culture or of xenographt growth in immunodeficient mice. cP does not block 17beta-estradiol (E2) binding to its receptors, but rather appears to interfere with intracellular processing of the signal that supports growth. To obtain insight on that mechanism we studied the effect of cP on the proliferation of MCF-7 cells in culture. Proliferation in the presence of 2 microM E2 is decreased up to 40% upon addition of 2 microg ml(-1) cP to the medium; the presence of cP did not increase cell death, cP reduced also the proliferation of estrogen-dependent ZR75-1 cells but had no effect on autonomous MDA-MB-231 cells, cP did not modify the number of binding sites for labeled E2 or affected cell death. We detected increased nuclear p21Cip1 immunoreactivity after cP treatment. Our results suggest that cP acts via p21Cip1 to slow the process of MCF-7 cells through the cycle.

    Title A Peptide Derived from Alpha-fetoprotein Inhibits the Proliferation Induced by Estradiol in Mammary Tumor Cells in Culture.
    Date February 2008
    Journal Oncology Reports
    Excerpt

    This study was aimed to obtain additional information on the activity of a cyclized 9-amino acid peptide (cP) containing the active site of alpha fetoprotein, which inhibits the estrogen-stimulated proliferation of tumor cells in culture and of xenografts in immunodeficient mice. Breast cancer cells cultured in the presence of 2 nM estradiol were exposed to cP for different periods and their proliferation, estradiol binding parameters, clustering tendency and expression of E-cadherin and p21Cip1 were analyzed by biochemical and cell biology methods. The proliferation of MCF7 cells was significantly decreased by the addition of 2 microg/ml cP to the medium. cP did not increase cell death rate nor alter the number of binding sites for estradiol nor the endogenous aromatase activity of MCF7 cells. cP also decreased the proliferation of estrogen-dependent ZR75-1 cells but had no effect on estrogen-independent MDA-MB-231 cells. An increased nuclear p21Cip1 expression detected after cP treatment suggests that cP slows MCF7 cell proliferation via this regulator. We propose that cP could represent a novel breast cancer therapeutic agent whose mechanism of action is different from that of tamoxifen or of inhibitors of aromatase.

    Title Topical Corticosteroids As Adjunctive Therapy for Bacterial Keratitis.
    Date January 2008
    Journal Cochrane Database of Systematic Reviews (online)
    Excerpt

    BACKGROUND: Bacterial keratitis is a serious ocular infectious disease that can lead to severe visual disability. Risk factors for bacterial corneal infection include contact lens wear, ocular surface disease, corneal trauma and previous ocular or eyelid surgery. Topical antibiotics constitute the mainstay of treatment in cases of bacterial keratitis where as the use of topical corticosteroids remains controversial. Topical corticosteroids are usually used to control inflammation using the smallest amount of the drug. Their use requires optimal timing, concomitant antibiotics and careful follow up. OBJECTIVES: The objective of the review was to assess the clinical effectiveness and adverse effects of corticosteroids as adjunctive therapy for bacterial keratitis. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, EMBASE, and LILACS up to 15 January 2007. We also searched the Science Citation Index to identify additional studies that had cited the included trial, an online database of ongoing trials (www.clinicaltrials.gov), reference lists of included trials, earlier reviews and the American Academy of Ophthalmology guidelines. We also contacted experts to identify any unpublished and ongoing randomized trials. SELECTION CRITERIA: We included randomized controlled trials evaluating adjunctive therapy with topical corticosteroids in people with bacterial keratitis. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all the retrieved articles. Methodological quality of the one included trial was assessed using forms developed using pre-specified criteria by at least two review authors. We planned to extract data on outcomes using forms developed for the purpose. We planned to report risk ratios for dichotomous outcomes and mean differences for continuous outcomes. MAIN RESULTS: A single trial was eligible for inclusion in the review. Participants in the trial were randomized using a random numbers table. Allocation concealment was not attempted. Masking of participants, and care-providers was also not attempted. Outcome assessment was conducted independently by two physicians. Neither was masked to the treatment allocation. The trial reported the healing rate of epithelial defects and improvement in visual acuity. AUTHORS' CONCLUSIONS: There are no good quality randomized trials evaluating the effects of adjunct use of topical corticosteroids in bacterial keratitis. The only randomized trial we identified in the literature suffered from major methodological inadequacies.

    Title Rad51 135g>c Polymorphism and Risk of Familial Breast Cancer in a South American Population.
    Date November 2007
    Journal Cancer Genetics and Cytogenetics
    Excerpt

    Several studies have reported that mutations in genes involved in maintenance of genome integrity may be responsible for increased cancer risk. Human RAD51, known to function in DNA repair, interacts with a number of proteins implicated in breast cancer (BC), including BRCA1 and BRCA2. Few studies have investigated the role of RAD51 gene variations in familial BC. To detect potential novel gene defects that may contribute to hereditary BC susceptibility, 143 patients belonging to 143 Chilean families tested for BRCA1 and BRCA2 mutations were screened for mutations in RAD51, using conformational sensitive gel electrophoresis (CSGE) and DNA sequencing. No mutations were detected in the exon or splice-boundary regions of the RAD51 gene in these families. The RAD51 135G>C polymorphism (c.-98G>C, rs1801320) was studied in a case-control design, to evaluate its possible association with BC susceptibility. The frequency of the RAD51 135C allele was established in 143 cases and 247 controls, using restriction fragment length polymorphism-polymerase chain reaction. RAD51 135C genotypes (G/C and C/C) were associated with an increased BC risk only among women with (a) a family history of BC, (b) BRCA1/2 negative (n = 131), and (c) age at onset <50 years (P = 0.020; OR = 2.17, 95% CI = 1.11-4.24). Thus, we propose that RAD51 135G>C polymorphism presents an increased risk of familial BC in women with age < 50 years at diagnosis, and this polymorphism may be a BC risk variant. This finding should be confirmed in other populations.

    Title Metabolic Changes in Mesenchymal Stem Cells in Osteogenic Medium Measured by Autofluorescence Spectroscopy.
    Date January 2007
    Journal Stem Cells (dayton, Ohio)
    Excerpt

    The purpose of this study was to measure metabolic changes in mesenchymal stem cells (MSCs) placed in osteogenic medium by autofluorescence spectroscopy. MSCs were plated in stem cell-supporting or osteogenic medium and imaged. Shift from the basic growth environment to the inductive osteogenic environment was confirmed by reverse transcription-polymerase chain reaction. Reduced pyridine nucleotides were detected by exciting near 366 nm and measuring fluorescence at 450 nm, and oxidized flavoproteins were detected by exciting at 460 nm and measuring fluorescence at 540 nm. The ratio of these fluorescence measurements, reduction-oxidation (redox) fluorometry, is a noninvasive measure of the cellular metabolic state. The detected pyridine nucleotide to flavoprotein ratio decreased upon transitioning from the stem cell to the differentiated state, as well as with increasing cell density and cell-cell contact. MSC metabolism increased upon placement in differentiating medium and with increasing cell density and contact. Redox fluorometry is a feasible, noninvasive technique for distinguishing MSCs from further differentiated cells.

    Title Microkeratome Versus Femtosecond Laser Predissection of Corneal Grafts for Anterior and Posterior Lamellar Keratoplasty.
    Date December 2006
    Journal Cornea
    Excerpt

    PURPOSE: To compare 2 different techniques for predissection of human anterior and posterior lamellar corneal grafts for eye bank storage. METHODS: A mechanical microkeratome (group 1, N = 5) and a femtosecond laser (group 2, N = 5) were used to dissect intended 350-microm-deep lamellar planes in deepithelialized donor corneas mounted on an artificial anterior chamber. These corneas were replaced in Optisol GS at 4 degrees C postoperatively and examined 2 days later to simulate a clinical scenario. Ultrasonic pachymetry of corneal lamellar sections was measured before and after separation of the lamellar grafts. Group 1 sections were separated by the mechanical microkeratome, whereas group 2 sections were manually separated 2 days after laser dissection. Endothelial cell viability was evaluated in posterior grafts. RESULTS: Total corneal thicknesses immediately before dissection were 559 +/- 61 (group 1) and 578 +/- 79 microm (group 2; P = 0.46). Immediate postdissection anterior and posterior graft thicknesses were 361 +/- 68 and 203 +/- 74 microm (group 1), respectively. Achieved anterior and posterior graft thicknesses 2 days later were 282 +/- 44 and 413 +/- 35 microm (group 1) and 324 +/- 112 and 397 +/- 51 microm (group 2), respectively. Percentage of devitalized endothelial cells were 3.4% +/- 1.6% (group 1) and 1.6% +/- 1.2% (group 2; P = 0.35). CONCLUSIONS: Centralized predissection by both techniques, cold storage, and shipping by airmail results in viable grafts without significant endothelial cell loss 2 days later.

    Title Microkeratome Preparation of Lamellar Corneal Grafts.
    Date October 2006
    Journal Eye & Contact Lens
    Excerpt

    PURPOSE: To evaluate the thickness and viability of microkeratome-prepared lamellar corneal grafts in cold storage. METHODS: Ten human corneas were sectioned with a mechanical microkeratome with a 350-microm depth head and stored in Optisol GS at 4 degrees C for 2 days to simulate an eye bank scenario. Central corneal thickness before and after mechanical microkeratome sectioning was measured by ultrasonic pachymetry. Endothelial cell viability was evaluated by trypan blue and alizarin red staining. RESULTS: Total corneal thickness immediately before microkeratome dissection was 562 +/- 51 microm. Anterior and posterior graft thicknesses were 296 +/- 111 microm and 270 +/- 74 microm, respectively, immediately after dissection, and 282 +/- 38 microm and 429 +/- 31 microm, respectively, 2 days after storage. There was significant swelling in the posterior (P=0.005) but not the anterior grafts (P=0.386). The percentage of devitalized endothelial cells was 3.0% +/- 1.2%. CONCLUSIONS: Corneal lamellar grafts may possibly be precut in a centralized facility and stored cold before further distribution.

    Title Use of Topical Human Amniotic Fluid in the Treatment of Acute Ocular Alkali Injuries in Mice.
    Date August 2006
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To evaluate the efficacy of topical human amniotic fluid (HAF) in the treatment of ocular acute alkali burns in mice. DESIGN: Experimental study. METHODS: A chemical burn with 2 microl of sodium hydroxide 0.15 mol/l was created in one eye of 30 mice. The animals were divided into gender- and age-matched groups according to the topical treatment that was administered: group 1 was treated with preterm HAF (n = 10 mice); group 2 was treated with term HAF (n = 10 mice), and group 3 was treated with saline solution (n = 10 mice). Treatment consisted of one drop that was applied to the burned eye five times per day (week one), and three times per day (week two). The epithelial defect was photographed and measured on days two and four. Ocular burn damage was assessed at days two, seven, and 14 after a pre-established classification. On day 14, both eyes of each mouse were enucleated and assessed histopathologically. RESULTS: Median epithelial defect (interquartile range [IQR], 25th, 75th percentile) at day four was 9.93% (IQR, 8.57, 11.27) for group 1, 7.30% (IQR, 5.96, 8.97) for group 2, and 18.92% (IQR, 11.71, 27.64) for group 3 (P < .0076). The overall change (difference in slope) in ocular burn score between days 2 and 14 was -0.127 (P = .009) in group 1 vs 3, -0.134 (P = .012) in group 2 vs 3, and 0.007 (P = .88) in group 1 vs 2. On histologic examination saline solution-treated corneas had more inflammatory cells and blood vessels than HAF-treated corneas. CONCLUSION: Topical preterm/term HAF was an effective topical therapy for limiting the damage after acute alkali burns of the eye in this animal model.

    Title Noninvasive Mitochondrial Imaging in Live Cell Culture.
    Date June 2006
    Journal Photochemistry and Photobiology
    Excerpt

    The observed distribution of mitochondria in a cell can vary with environmental influence, degree of differentiation and disease. Differences in the distribution of mitochondrial autofluorescence may be used to distinguish these different cellular states.

    Title Brca1 and Brca2 Mutations in a South American Population.
    Date May 2006
    Journal Cancer Genetics and Cytogenetics
    Excerpt

    A sample of 64 high-risk breast and/or ovarian cancer families from Chile were screened for germline mutations in the coding sequences and exon-intron boundaries of BRCA1 (MIN no. 113705) and BRCA2 (MIN no. 600185) genes using conformation-sensitive gel electrophoresis, and the mutations found were confirmed with direct sequencing. Seven families (10.9%) were found to carry BRCA1 mutations and three families (4.7%) had BRCA2 mutations. Six different pathogenic mutations were detected in BRCA1, four that had been reported previously (c.187_188delAG; c.300T-->G, c.3450_3453delCAAG and IVS17-1G-->A) and two novel mutations (c.2605_2606delTT and c.4185_4188delCAAG). In BRCA2, we found three different pathogenic mutations, two previously described (c.6174delT and c.6503_6504delTT) and one novel mutation (c.5667delT). We also identified nine variants of unknown significance (five in BRCA1 and four in BRCA2). These findings indicate that the Chilean population has a heterogeneous spectrum of prevalent BRCA mutations. Given the results obtained in our study, the screening of the entire BRCA1 and BRCA2 coding regions is necessary for the molecular genetic testing of Chilean high-risk breast/ovarian cancer patients. To our knowledge, this is the first genetic study of BRCA gene mutations conducted in Chile. The Chilean population has a well-known admixed Amerindian-Caucasian ratio and, therefore, our findings are not only important per se, but they constitute the basis for improved and more specific genetic counselling, as well as to support for preventive campaigns geared toward the Chilean population.

    Title Phase Iii Study of Gemcitabine and Cisplatin with or Without Aprinocarsen, a Protein Kinase C-alpha Antisense Oligonucleotide, in Patients with Advanced-stage Non-small-cell Lung Cancer.
    Date April 2006
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    PURPOSE: To determine whether aprinocarsen, an antisense oligonucleotide directed against protein kinase C-alpha, when added to the chemotherapy regimen of gemcitabine and cisplatin improved survival in patients with advanced non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Patients with previously untreated stage IIIB/IV NSCLC and Eastern Cooperative Oncology Group performance status of 0 or 1, were randomly assigned to either a control arm of gemcitabine 1,250 mg/m2 on days 1 and 8 and cisplatin 80 mg/m2 on day 1, or experimental arms consisting of the identical chemotherapy plus aprinocarsen 2 mg/kg/d as continuous infusion for 14 days, starting on either day 1 or 3 days before chemotherapy. Cycles were repeated every 21 days. RESULTS: A total of 670 patients were randomly assigned between the control (n = 328) and experimental arms (n = 342). Due to the results from another phase III study of aprinocarsen in NSCLC, further enrollment was stopped, and the study was terminated early. The median number of cycles was four on the control arm and three on the combined experimental arms. Median overall survival was not different between the two groups (control, 10.4 months [95% CI, 8.6 to 12.2]; experimental, 10.0 months [95% CI, 8.4 to 10.8]; P = .613; hazard ratio = 1.05 [95% CI, 0.88 to 1.25]). Response rates (control arm, 35.0%; experimental arms, 28.9%; P = .124) and other time-to-event measures were not significantly different. Grade 3 and 4 toxicities were significantly increased for thrombocytopenia (P < .0001), epistaxis, and thrombosis/embolism in the experimental arms. CONCLUSION: Adding aprinocarsen to gemcitabine and cisplatin regimen did not enhance survival and other efficacy measures in patients with advanced NSCLC.

    Title Modified Microkeratome-assisted Posterior Lamellar Keratoplasty Using a Tissue Adhesive.
    Date February 2006
    Journal Archives of Ophthalmology
    Excerpt

    OBJECTIVE: To compare graft stability and astigmatic change using suture vs tissue adhesive in an experimental model of microkeratome-assisted posterior lamellar keratoplasty. METHODS: A 300-microm-thick partial flap keratectomy was performed in human donor corneoscleral rims using an artificial anterior chamber and a manual microkeratome. The flap stopped at the left central opening border, providing a wide hinge to add stability. After flap reflection, a 6.25-mm trephination was performed to obtain a disc of posterior stroma, Descemet membrane, and endothelium. The disc was positioned in a sutureless fashion, and the flap secured with either 5 interrupted sutures or a chondroitin-sulfate-aldehyde-based adhesive. Increasing intrachamber pressures were created to detect graft stability. Videokeratographic data were recorded to evaluate astigmatic change. RESULTS: The mean (SD) astigmatic change was 3.08 (0.84) diopters (D) in the sutured group and 1.13 (0.55) D in the glued group (P = .008). Mean (SD) resisted pressures were 95.68 (27.38) mm Hg and 82.45 (18.40) mm Hg in the sutured and glued groups, respectively (P = .97). CONCLUSION: This modified technique of microkeratome-assisted posterior lamellar keratoplasty showed excellent graft stability in both groups. Flaps sealed with the novel tissue adhesive had reduced astigmatic changes in our experimental model. CLINICAL RELEVANCE: Sutureless microkeratome-assisted posterior lamellar keratoplasty using tissue adhesive may become a new alternative in the surgical treatment of corneal endothelial disorders.

    Title Botulinum Toxin B-induced Mouse Model of Keratoconjunctivitis Sicca.
    Date February 2006
    Journal Investigative Ophthalmology & Visual Science
    Excerpt

    PURPOSE: To develop a mouse model of human chronic dry eye (keratoconjunctivitis sicca [KCS]). METHODS: Under direct visualization with an operating microscope, CBA/J mice received a transconjunctival injection of saline or 1.25, 5, or 20 milliunits (mU) of botulinum toxin B (BTX-B) into the lacrimal gland. The mice were either left unstressed or were subjected to an air blower for 5 h/d, 5 d/wk in fixed temperature and humidity conditions. Tear production and corneal fluorescein staining were evaluated in all groups before injection and at several time points after. Tear production was measured with phenol red-impregnated cotton threads. Corneal fluorescein staining was photographed under cobalt blue light with a digital camera fitted with a macro lens. RESULTS: BTX-B-injected mice displayed significantly decreased tear production until the 4-week time point. Throughout all time points, the addition of environmental blower stress did not appear to alter tear production significantly. Linear regression models, used to evaluate the effects of various doses of BTX-B on tear production, showed that doses higher than 1.25 mU did not provide significantly different outcomes. After 3 days, saline-injected mice showed no corneal staining, whereas BTX-B-injected mice displayed various amounts of staining. At the early time point (day 3), there did not appear to be an additional effect of the blower on corneal fluorescein staining. However, at 1, 2, and 4 weeks, the blower stress appeared to increase the amount of corneal fluorescein staining at each BTX-B dose, although not significantly. Furthermore, at 8 to 10 weeks, in the BTX B-injected groups, corneas had persistent staining, even though tear production had already returned to normal levels. Histopathologic analyses revealed no inflammatory cell infiltration of the stroma or acini of the lacrimal glands and conjunctivae of both saline-injected and BTX-B-injected animals. CONCLUSIONS: Intralacrimal gland injection of BTX-B resulted in persistent corneal fluorescein staining within 3 days, and a significant decrease in aqueous tear production that persisted for 1 month. Intralacrimal gland injection of BTX-B suppressed lacrimation, thereby establishing a dry eye state. This animal model could be a useful tool for investigating the pathogenesis of the chronic condition KCS in humans.

    Title Inflow of Ocular Surface Fluid into the Anterior Chamber After Phacoemulsification Through Sutureless Corneal Cataract Wounds.
    Date October 2005
    Journal American Journal of Ophthalmology
    Excerpt

    PURPOSE: To report inflow of extraocular fluid after phacoemulsification with use of sutureless corneal incisions. DESIGN: Interventional case series. METHODS: setting: Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland. patients: Eight patients (three women), aged 58 to 91 years, showing minimal bleeding from the limbal capillary bed during phacoemulsification. intervention: Surgery was performed through a 2.8-mm limbal incision. External pressure simulating patient manipulation was applied before and after wound hydrosealing with an irrigation cannula. main outcome measures: Inflow of blood-tinged tear fluid into the anterior chamber through the wound was monitored by using digital video. RESULTS: Inflow of extraocular fluid was observed in all eyes when the cannula was released, even after wound hydrosealing. Two patients showed spontaneous fluid inflow. CONCLUSIONS: Tested sutureless corneal incisions allow inflow of extraocular fluid into the anterior chamber after phacoemulsification. This may permit intraocular contamination leading to endophthalmitis.

    Title A New Donor Cornea Harvesting Technique for Posterior Lamellar Keratoplasty.
    Date October 2005
    Journal The British Journal of Ophthalmology
    Excerpt

    AIMS: To describe a technique for posterior lamellar keratoplasty donor preparation. METHODS: In an experimental study eight human donor research corneas were mounted onto an artificial anterior chamber and deep stromal pockets dissected. Four corneas were mounted in the standard endothelial side down orientation and dissected using standard instruments (group 1). Another four corneas were mounted endothelial side up and dissected using a flat spatula (group 2). Trephined lamellar graft thickness was assessed by ultrasound pachymetry. The grafts were also analysed using vital staining of the endothelium and standard histological preparation. RESULTS: Achieved posterior graft thickness was 118 (SD 32) microm (group 1) and 92 (23) microm (group 2) (p=0.324). Percentage of devitalised endothelial cells was 0.86% (1.48%) (group 1) and 3.9% (2.9%) (group 2) (p=0.185). The dissections using both harvesting techniques remained in plane and were smooth. CONCLUSIONS: A blunt spatula and endothelium side up orientation on an artificial anterior chamber can be used to create posterior lamellar dissections without compromising endothelial cell number or planarity when compared to standard endothelium side down harvest.

    Title A Modified Chondroitin Sulfate Aldehyde Adhesive for Sealing Corneal Incisions.
    Date May 2005
    Journal Investigative Ophthalmology & Visual Science
    Excerpt

    PURPOSE: To compare a modified chondroitin sulfate aldehyde adhesive with standard sutures for sealing corneal incisions. METHODS: A keratome knife was used to create non-self-sealing, uniplanar, 3-mm, clear corneal incisions in enucleated rabbit eyes (n = 18). The wounds were sealed with either a chondroitin sulfate-aldehyde adhesive (n = 8), three 10-0 nylon sutures (n = 5), or one 10-0 nylon suture (n = 5). Wound stability was tested by filling the globes with balanced salt solution through an anterior chamber port and slowly increasing the IOP. The pressure changes were monitored with a digital manometer connected to the anterior chamber, and leak pressure was recorded for each eye. Confocal microscopy was performed on the glued eyes, to document the glue distribution along the wound. RESULTS: The mean leak pressures in the single-suture and three-suture subgroups were 26.4 +/- 6.0 and 44.3 +/- 8.2 mm Hg (SD), respectively. The maximum IOP achieved in eyes that received the glue was 104.7 mm Hg with a mean of 101.4 +/- 3.2 mm Hg. None of the eyes in which glue was used showed leakage. At confocal microscopy, the glue was distributed inside the wound edges as a homogeneous thin layer of a less dense signal than that of the stroma. CONCLUSIONS: A novel chondroitin sulfate-aldehyde adhesive was shown to be effective ex vivo for sealing corneal incisions in rabbit eyes and was superior to sutures for this purpose.

    Title Comparison of Fibrin Glue and Sutures for Attaching Conjunctival Autografts After Pterygium Excision.
    Date April 2005
    Journal Ophthalmology
    Excerpt

    To compare the efficacy and safety of fibrin glue and suturing for attaching conjunctival autografts among patients undergoing pterygium excision.

    Title Molecular Analysis of the Eighteen Most Frequent Mutations in the Brca1 Gene in 63 Chilean Breast Cancer Families.
    Date April 2005
    Journal Biological Research
    Excerpt

    BRCA1 gene mutations account for nearly all families with multiple cases of both early onset breast and/or ovarian cancer and about 30% of hereditary breast cancer. Although to date more than 1,237 distinct mutations, polymorphisms, and variants have been described, several mutations have been found to be recurrent in this gene. We have analyzed 63 Chilean breast/ovarian cancer families for eighteen frequent BRCA1 mutations. The analysis of the five exons and two introns in which these mutations are located was made using mismatch PCR assay, ASO hybridization assay, restriction fragment analysis, allele specific PCR assay and direct sequentiation techniques. Two BRCA1 mutations (185delAG and C61G) and one variant of unknown significance (E1250K) were found in four of these families. Also, a new mutation (4185delCAAG) and one previously described polymorphism (E1038G) were found in two other families. The 185delAG was found in a 3.17% of the families and the others were present only in one of the families of this cohort. Therefore these mutations are not prominent in the Chilean population. The variant of unknown significance and the polymorphism detected could represent a founder effect of Spanish origin.

    Title Bile Duct Reconstruction After Iatrogenic Injury in the Elderly.
    Date February 2005
    Journal Annals of Hepatology
    Excerpt

    Bile duct injuries occur with a frequency of 1 to 5 per 1000 cases as a result of an increase in the number of procedures performed. Elderly patients have more severe lithiasis- related diseases than the younger population. This fact increases the likelihood of conversion from laparoscopic to open surgery, and the probability of injury. We report the results of bile duct reconstruction after injury in these patients.

    Title Phase Iii Randomized Pilot Study Comparing Interferon Alpha-2b in Combination with Radiation Therapy Versus Radiation Therapy Alone in Patients with Stage Iii-b Carcinoma of the Cervix.
    Date July 2003
    Journal International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society
    Excerpt

    This randomized pilot study was designed to determine whether the addition of interferon alpha-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon alpha-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (P = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (P = 0.424). We conclude that the addition of interferon alpha-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.

    Title [frequency of the 185delag Mutation in the Brca1 Gene in Chilean Healthy Women with Family History of Breast Cancer].
    Date March 2003
    Journal Revista Médica De Chile
    Excerpt

    Breast cancer is the most common malignancy among women, and is the second cause of cancer mortality among Chilean women. Female mortality due to breast cancer in Chile has shown a steady increase from 9.5 deaths per 100.000 women in 1985 to 12.8 deaths per 100.000 in 1995. A family history of breast cancer is one of the main risk factors for the development of the disease. BRCA1 and BRCA2 are two major hereditary breast cancer susceptibility genes. Mutations in these genes are associated to inherited breast cancer; 664 predisposing mutations have been described, but in specific populations only some of them, such as 185delAG have been found to be associated with susceptibility to breast cancer.

    Title [primary Gastric Lymphoma: Clinical and Histologic Aspects in 41 Cases].
    Date November 1989
    Journal Revista Médica De Chile
    Title [comparison of Computed Tomography and Ultrasonic Studies of the Brain in Newborns and Infants. Correlation in 40 Cases].
    Date June 1989
    Journal Boletín Médico Del Hospital Infantil De México
    Excerpt

    We correlate the cases of forty neonates and nursing infants whose brains were studied using ultrasound and CT scan. The indications for the aforementioned studies were: 15 cases of dysmorphism, 16 cases with significant neurological signs and 9 cases of preterm neonates with body weight less than 1,500 g. The results of the correlations were as follows: 24 cases demonstrated similar images (60%), 14 cases showed a better resolution of the images by ultrasound (35%), better resolution of the images by CT scan in 2.5% and non-coincidental images in one case (2.5%). We conclude that in the specialty of neonatology, using ultrasound has more advantages than the CT scan method.

    Title Phase Ii Study of Orally and Rectally Administered Tegafur in Liver Metastases from Gastric Carcinoma.
    Date May 1984
    Journal Japanese Journal of Clinical Oncology
    Excerpt

    Twenty-four eligible and evaluable patients with measurable liver metastases from gastric cancer were treated with oral or rectal Tegafur. Objective responses were seen in 8 of the patients (33.3%), lasting between 1.5 and 15 months. The median survival period was 10 months for the responders and 2.6 months for non-responders. No complete response was observed. The survival of responders was significantly longer than that of non-responders (p less than 0.01). Toxicity was mild and consisted principally of gastrointestinal and hematological side effects. No central nervous system toxicity was seen.

    Title The Cpr Experience over a One-year Period in a Rural Hospital.
    Date March 1983
    Journal Arizona Medicine
    Title Benign Chondrolipomatous Tumors of the Breast.
    Date December 1982
    Journal Archives of Pathology & Laboratory Medicine
    Title Specific Red Cell Adherence: Immunologic Evaluation of Random Mucosal Biopsies in Carcinoma of the Bladder.
    Date September 1981
    Journal The Journal of Urology
    Excerpt

    We studied 103 random biopsies from patients with overt transitional cell carcinoma of the bladder for specific red cell adherence. We evaluated 62 random biopsies from patients whose primary tumors were positive for specific red cell adherence and 100 per cent of the biopsies in these patients also were positive for specific red cell adherence regardless of the pathologic finding in the random biopsy. We evaluated 41 random biopsies from patients whose primary bladder tumors were negative for specific red cell adherence and only 27 per cent of all biopsies in this group of patients were positive for specific red cell adherence. Thus, we found that in 92 of the 103 random biopsies (89 per cent) and specific red cell adherence of the biopsy agreed with that of the primary tumor. The loss of red cell antigens in random biopsies that are histologically normal may prove to be the earliest measureable changes of the malignant potential of the urothelium.

    Title Specific Red Cell Adherence Testing and Benign Prostatic Hyperplasia.
    Date August 1981
    Journal The Journal of Urology
    Excerpt

    Specific red cell adherence testing has established itself as a valuable means of predicting the behavior of non-invasive bladder carcinoma. In an attempt to determine whether specific red cell adherence testing could have a similar role in low grade, low stage prostatic carcinoma we first attempted to detect its presence in benign prostatic diseases. We tested 36 consecutive prostatectomy specimens of benign disease for the presence of specific red cell adherence in the prostatic acini. We were able to detect the presence of specific red cell adherence in only 36 per cent of the cases with benign prostatic hyperplasia. Thus, we believe that specific red cell adherence testing is not present in a sufficient percentage of patients with benign disease to allow its usefulness in determining the aggressive behavior of prostatic cancer.

    Title Osteogenic Sarcoma of the Tongue.
    Date July 1981
    Journal Oral Surgery, Oral Medicine, and Oral Pathology
    Excerpt

    A 45-year-old woman had a mass in the left side of the tongue. Histologic examination of the tumor revealed it to be an extraskeletal osteogenic sarcoma. Pulmonary metastases were seen on admission. The patient had a rapid downhill course and died. Extraskeletal osteogenic sarcomas are well-recognized albeit rare neoplasms. In a search of the literature we were unable to find a single case arising in the tongue. The electron microscopic findings are also presented.

    Title Intracellular Spiral Inclusions in Cerebral Cell Processes in Creutzfeldt-jakob Disease.
    Date May 1981
    Journal Journal of Neuropathology and Experimental Neurology
    Excerpt

    Electron microscopic examination of brain biopsy specimens from two patients with Creutzfeldt-Jakob disease revealed the presence of intracellular membranous spiral inclusions in the processes of cortical cells. These inclusions, 375 nm to 660 nm in length and 50 nm to 88 nm in width, resemble similar structures reported in a patient with the same disease by Bastian and, more recently, in a second patient by Gray et al. These inclusions bear close morphologic resemblance to spiroplasma organisms, a wall-free prokaryote known to cause a "slow-virus"-like disorder in mice.

    Title Retroperitoneal Neurofibromatosis and Venous Anomalies.
    Date January 1981
    Journal Archives of Pathology & Laboratory Medicine
    Excerpt

    A 45-year-old woman had abdominal pain, azotemia, and hypertension. Intravenous pyelography revealed bilateral ureteral compression by extrinsic tumor masses that proved to be neurofibromata by histologic examination. After surgical removal of the tumors, she became normotensive and asymptomatic. In addition, severe medial hypertrophy of veins was seen in the tissue examined. We believe that the latter is most probably related to the neurofibromatosis and is analogous to the hypertrophic arterial changes known to occur in patients with von Recklinghausen's disease.

    Title Association of Pulmonary Alveolar Lipoproteinosis with Mycobacterial Infection.
    Date December 1980
    Journal American Journal of Clinical Pathology
    Excerpt

    A case of pulmonary alveolar proteinosis associated with tuberculosis of the lung is reported. The patient had fever, cough, and pulmonary cavities. Sputum cultures for Mycobacterium tuberculosis were positive on three occasions. Thirty-three months later, diffuse bilateral lower lobe infiltrates developed. An open lung biopsy revealed filling of the alveoli by a periodic-acid-Schiff-positive amorphous granular material. There is a significant association between this disease and various infectious and fungal agents, but its association with tuberculosis is rare. It has been reported only three times before in the English literature. This appears to be the fourth documented case with this association. A review of the literature with special emphasis on tuberculosis associated with alveolar lipoproteinosis is presented. The electron-microscopic findings are also described.

    Title [gynecological Hysterectomies].
    Date December 1966
    Journal Revista Chilena De Obstetricia Y Ginecología
    Title Spectrum of Brca1/2 Point Mutations and Genomic Rearrangements in High-risk Breast/ovarian Cancer Chilean Families.
    Date
    Journal Breast Cancer Research and Treatment
    Excerpt

    The distribution of BRCA1/2 germline mutations in breast/ovarian cancer (BC/OC) families varies among different populations. In the Chilean population, there are only two reports of mutation analysis of BRCA1/2, and these included a low number of BC and/or OC patients. Moreover, the prevalence of BRCA1/2 genomic rearrangements in Chilean and in other South American populations is unknown. In this article, we present the mutation-detection data corresponding to a set of 326 high-risk families analyzed by conformation-sensitive gel electrophoresis and heteroduplex analysis. To determine the contribution of BRCA1/2 LGRs in Chilean BC patients, we analyzed 56 high-risk subjects with no pathogenic BRCA1/2 point mutations. Germline BRCA1/2 point mutations were found in 23 (7.1%) of the 326 Chilean families. Families which had at least three BC and/or OC cases showed the highest frequency of mutations (15.9%). We identified 14 point pathogenic mutations. Three recurrent mutations in BRCA1 (c.187_188delAG, c.2605_2606delTT, and c.3450_3453delCAAG) and three in BRCA2 (c.4969_4970insTG, c.5374_5377delTATG, and c.6503_6504delTT) contributed to 63.6 and 66.7% of all the deleterious mutations of each gene, which may reflect the presence of region-specific founder effects. Taken together BRCA1/2 recurrent point mutations account for 65.2% (15/23) of the BRCA1/2 (+) families. No large deletions or duplications involving BRCA1/2 were identified in a subgroup of 56 index cases negative for BRCA1/2 point mutations. Our study, which is the largest conducted to date in a South American population, provides a comprehensive analysis on the type and distribution of BRCA1/2 mutations and allelic variants.

    Title Gunshot Wounds to the Scrotum: a Large Single-institutional 20-year Experience.
    Date
    Journal Bju International
    Excerpt

    Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Penetrating trauma to the scrotum often requires operative intervention, with testicular salvage only possible when enough testicular tissue can be re-approximated in the traumatic setting. The present report represents the largest series of gunshot wound trauma to the scrotum in the literature. Further, it validates recommendations of the European Association of Urology guidelines on urological trauma that advocate operative intervention due to minimal rates of patient morbidity and the inherent limitations of scrotal ultrasonography in discerning testicular compromise.


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