Luis Guerra - Academia.edu (original) (raw)

Papers by Luis Guerra

Research paper thumbnail of Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

Archives of Dermatology, 2003

To induce complete and reproducible repigmentation of large &... more To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure. Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital. Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders. The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm2 repigmented/2315.8 cm2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm2 repigmented/1953.4 cm2 transplanted). Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.

Research paper thumbnail of The course of pregnancy in patients with artificial heart valves

American Journal of Medicine, 1976

Twenty-five women, aged 20 to 38 years, were managed during 28 pregnancies ; 24 had Starr-Edwards... more Twenty-five women, aged 20 to 38 years, were managed during 28 pregnancies ; 24 had Starr-Edwards PHV and one a Cooley-Bloodwell-Cutter, all of which were implanted for rheumatic heart disease: none was cloth covered. Eight women had spontaneous abortions before undergoing surgery for heart disease and one had a premature delivery. After surgery, and before coming to our care, three had had abortions (Cases 3, 7 and 21) and one a premature delivery (Case 4); five patients (Cases 3, 7, 9, 16 and 24) had had a cerebral embolism: two patients (Cases 18 and 19) had associated mild to moderate aortic lesions: and 12 women were in atrial fibrillation. One patient (Case 11) had diffuse neurofibromatosis. A prothrombin time determination (Quick) or thrombotest (Owren) was performed every two to eight weeks during the postoperative period. 504 October IQ76 The American Journal of Medicine Volume 61 PREGNANCY IN PATIENTS WITH ARTIFICIAL HEART VALVES-IBARRA-PEREZ ET AL.

Research paper thumbnail of Healing Patterns in Anogenital Injuries: A Longitudinal Study of Injuries Associated With Sexual Abuse, Accidental Injuries, or Genital Surgery in the Preadolescent Child

Pediatrics, 2003

To study healing patterns of anogenital trauma in prepubescent children. A prospective 10-year st... more To study healing patterns of anogenital trauma in prepubescent children. A prospective 10-year study was conducted of 94 children who had anogenital trauma and were followed to healing and documented using a colposcope with 35-mm camera attachment. The 13 boys and 81 girls were referred with injuries as a result of sexual assault or anogenital trauma. Hymenal injuries occurred in 37 cases; 2 transections healed after surgery, and 15 persisted unchanged. Partial tears, hymenal abrasions, or hematomas healed completely or with minor nonspecific changes. Of the 47 injuries to the posterior fourchette, 22 abrasions, hematomas, or tears healed completely; 12 tears healed with vascular changes; 2 developed labial fusions; 10 lacerations required surgery; and 6 scarred and 4 healed with vascular changes. Only 2 of 39 cases of perihymenal trauma healed with vascular changes. All 17 cases of labial trauma healed completely. Anal trauma healed completely in 29 of 31 with scarring occurring in only 2 cases that required surgery. Anogenital trauma heals quickly, often without residua. Of the 94 cases, there were diagnostic anatomic changes in the 15 cases of hymenal transections (2 other cases healed completely with surgical reconstruction), 6 cases after surgical repair of posterior fourchette, and 2 cases of anal scarring after surgery.

Research paper thumbnail of Erbium:YAG Laser and Cultured Epidermis in the Surgical Therapy of Stable Vitiligo

Archives of Dermatology, 2003

To induce complete and reproducible repigmentation of large &... more To induce complete and reproducible repigmentation of large "stable" vitiligo lesions by means of autologous cultured epidermal grafts using a rapid, simple, and minimally invasive surgical procedure. Achromic epidermis was removed by means of appropriately settled erbium:YAG laser, and autologous epidermal grafts were applied onto the recipient bed. Melanocyte content was evaluated by dopa reaction. The percentage of repigmentation was calculated using a semiautomatic image analysis system. A biosafety level 3-type cell culture facility, a surgical ambulatory department, and a dermatological department in a hospital. Twenty-one patients with different types of vitiligo were admitted to the study and treated with autologous cultured epidermal grafts. Inclusion criteria were failure of at least 2 standard medical approaches; no therapy for at least 12 months; no progression of old lesions or appearance of new lesions; no Koebner phenomenon within the past 18 months; and no autoimmune disorders. The average percentage of repigmentation in 21 patients was 75.9% (1759.7 cm2 repigmented/2315.8 cm2 transplanted). Three patients showed a reactivation of their vitiligo and did not show repigmentation. The remaining 18 patients, with 43 distinct lesions, showed an average percentage of repigmentation of 90% (1759.7 cm2 repigmented/1953.4 cm2 transplanted). Under appropriate conditions, cultured epidermal grafts induce complete repigmentation of stable vitiligo lesions. Erbium:YAG laser surgery can supply a fast and precise tool for disepithelialization, hence allowing treatment of large vitiligo lesions during a single surgical operation.

Research paper thumbnail of The course of pregnancy in patients with artificial heart valves

American Journal of Medicine, 1976

Twenty-five women, aged 20 to 38 years, were managed during 28 pregnancies ; 24 had Starr-Edwards... more Twenty-five women, aged 20 to 38 years, were managed during 28 pregnancies ; 24 had Starr-Edwards PHV and one a Cooley-Bloodwell-Cutter, all of which were implanted for rheumatic heart disease: none was cloth covered. Eight women had spontaneous abortions before undergoing surgery for heart disease and one had a premature delivery. After surgery, and before coming to our care, three had had abortions (Cases 3, 7 and 21) and one a premature delivery (Case 4); five patients (Cases 3, 7, 9, 16 and 24) had had a cerebral embolism: two patients (Cases 18 and 19) had associated mild to moderate aortic lesions: and 12 women were in atrial fibrillation. One patient (Case 11) had diffuse neurofibromatosis. A prothrombin time determination (Quick) or thrombotest (Owren) was performed every two to eight weeks during the postoperative period. 504 October IQ76 The American Journal of Medicine Volume 61 PREGNANCY IN PATIENTS WITH ARTIFICIAL HEART VALVES-IBARRA-PEREZ ET AL.

Research paper thumbnail of Healing Patterns in Anogenital Injuries: A Longitudinal Study of Injuries Associated With Sexual Abuse, Accidental Injuries, or Genital Surgery in the Preadolescent Child

Pediatrics, 2003

To study healing patterns of anogenital trauma in prepubescent children. A prospective 10-year st... more To study healing patterns of anogenital trauma in prepubescent children. A prospective 10-year study was conducted of 94 children who had anogenital trauma and were followed to healing and documented using a colposcope with 35-mm camera attachment. The 13 boys and 81 girls were referred with injuries as a result of sexual assault or anogenital trauma. Hymenal injuries occurred in 37 cases; 2 transections healed after surgery, and 15 persisted unchanged. Partial tears, hymenal abrasions, or hematomas healed completely or with minor nonspecific changes. Of the 47 injuries to the posterior fourchette, 22 abrasions, hematomas, or tears healed completely; 12 tears healed with vascular changes; 2 developed labial fusions; 10 lacerations required surgery; and 6 scarred and 4 healed with vascular changes. Only 2 of 39 cases of perihymenal trauma healed with vascular changes. All 17 cases of labial trauma healed completely. Anal trauma healed completely in 29 of 31 with scarring occurring in only 2 cases that required surgery. Anogenital trauma heals quickly, often without residua. Of the 94 cases, there were diagnostic anatomic changes in the 15 cases of hymenal transections (2 other cases healed completely with surgical reconstruction), 6 cases after surgical repair of posterior fourchette, and 2 cases of anal scarring after surgery.