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Biomedical subjects

A Alarcon

Publications and source records attributed to A Alarcon.

14 recordsLinked to original sources
PubMed2005

Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study.

INTRODUCTION: The prevalence of diabetes mellitus (DM) is greater among patients with solid organ transplants than in the general population, although the factors associated with posttransplant DM (PTDM) are unknown. OBJECTIVES: The objective of this study was to estimate the prevalence of and assess the risk factors for PTDM. PATIENTS AND METHODS: We included outpatients with functioning isolated solid organ allografts (kidney, liver, heart, and lung). We collected demographic and posttransplant clinical data that included DM diagnostic ADA criteria, DM treatment, DM family history, presence of hepatitis C virus (HCV), immunosuppression treatment, hypertension, and dyslipidemia. RESULTS: A total of 2178 patients included, 1410 kidney recipients, 489 liver transplants, 207 heart transplants, and 72 lung recipients. Seventeen and four-tenths percent of the patients who did not have DM prior to transplantation, developed PTDM (median time: 79 days). A greater prevalence was observed among patients with a family history, HCV, and tacrolimus treatment (with or without steroids P < .05). By logistic regression analyses, OR for these factors were 1.51, 1.65, and 1.38, respectively. Of those patients who did not suffer PTDM, 55.2% showed basal blood glucose values under 100 mg/dL; only 68% presented with a hemoglobin Alc under 6. CONCLUSIONS: The prevalence of PTDM among kidney recipients was higher than that in the general population. DM family history, HCV positive, and tacrolimus were risk factors associated with this entity.

Adult↗
PubMed1997

A comparison of surgeons' posture during laparoscopic and open surgical procedures.

BACKGROUND: There is increasing recognition of surgeons' physical fatigue in the new ergonomic environment of laparoscopic surgery. The purpose of this study was to determine what the differences are in the movement of the surgeon's axial skeleton between laparoscopic and open operations. METHODS: Surgeons' body positions were recorded on videotape during four laparoscopic (LAP) and six open (OP) operations. The percent of time the head and back were in a normal, bent, or twisted position as well as the number of changes in head and back position were tabulated using a computer program. A separate laboratory study was performed on four surgeons "walking" a 0.5-inch polyethylene tubing forward and backward using laparoscopic and open techniques. The movements of the surgeons' head, trunk, and pelvis were measured using a three-camera kinematic system (Kin). The center of pressure was recorded using a floor-mounted forceplate (Fp). RESULTS: In the operating room surgeons' head and back positions were more often straight in laparoscopic procedures and more often bent in open operations. The number of changes in back position per minute were significantly decreased when the laparoscopic-only part of surgery was analyzed. In the laboratory the subjects' head position was significantly (p = 0.02) more upright and the anteroposterior (AP) and rotational range of motion of the head was significantly reduced during laparoscopy. Subjects' CP was more anterior and there was a significant reduction in the AP range of motion of the CP during laparoscopy. CONCLUSIONS: Our study suggests that surgeons exhibit decreased mobility of the head and back and less anteroposterior weight shifting during laparoscopic manipulations despite a more upright posture. This more restricted posture during laparoscopic surgery may induce fatigue by limiting the natural changes in body posture that occur during open surgery.

Ergonomics↗
PubMed1997

Laparoscopic cecal ligation and puncture in the rat. Surgical technique and preliminary results.

BACKGROUND: We describe a technique of laparoscopic cecal ligation and puncture (CLP) in the rat analogous to open CLP which may facilitate the study of minimally invasive surgery (MIS) and peritonitis. METHODS: Forty-four rats were randomized to either laparoscopic or open CLP and their 3-day mortality was recorded. Autopsies were performed for peritoneal fluid cultures, measurement of the length of ligated cecum, and scoring of the degree of cecal necrosis. RESULTS: Laparoscopic CLP required slightly longer operating times compared to open CLP (average 15.6 vs 13.1 min, p = 0.002). Three-day postoperative mortality was 36.4% and 22.7% for open and laparoscopic CLP, respectively (p = NS). There were no differences in the length of ligated cecum or the cecal necrosis score between the open and laparoscopic CLP groups. CONCLUSION: Laparoscopic CLP is feasible and produces a fecal peritonitis with similar characteristics to those of traditional open CLP.

Animals↗
PubMed1996

A comparison of operating room crowding between open and laparoscopic operations.

BACKGROUND: The clutter of equipment and lines in today's operating room (O.R.) is increasing. Endoscopic surgical procedures are particularly afflicted by this problem because they require additional equipment. Increasing O.R. crowding may present unnecessary hazards to traffic and adversely affect the performance of the surgical team. The purpose of this study is to provide a quantitative summary of the furniture, equipment, cables, and tubes present during open and laparoscopic operations. METHODS: We prospectively studied an unselected series of general surgical open (OP, n = 10) and laparoscopic (LAP, n = 10) operations performed at a major university teaching hospital. We recorded the location of all furniture and equipment as well as the source, course, and destination of all cables and tubes in the O.R. Cables and tubes touching the surgeon or the assistant were particularly noted. Results are expressed as median values for each group. RESULTS: The percent of O.R. space occupied increased from OP = 36% to LAP = 41% (p < 0.002). The median number of cables and tubes present increased from OP = 27 to LAP = 34 (p < 0.0002), with the number of these lines touching a member of the surgical team increasing from OP = 2 to LAP = 6 (p < 0.0003). CONCLUSIONS: We conclude that there is a significant trend toward increasing O.R. crowding during laparoscopic surgery. Innovative designs will be needed to reduce clutter in the O.R. of the future.

Crowding↗
PubMed1996

Clinical manifestations and molecular epidemiology of five cases of diarrhoea in children associated with Vibrio metschnikovii in Arequipa, Peru.

In April 1994, Vibrio metschnikovii was isolated from five infants with watery diarrhoea in Arequipa, Peru, as part of a passive cholera surveillance system. The children ranged in age from 11 to 20 months and had acute diarrhoea, with two cases showing moderate dehydration. Two children also had traces of blood in liquid stool. The children were seen at two different hospitals, and no evidence of a common source of infection was found. No additional V. metschnikovii isolates were identified in the remaining surveillance period that covered the rest of 1994 and 1995. However, stool samples were not screened for enteric pathogens other than vibrios. V. metschnikovii strains isolated from stool samples produced opaque and translucent colonies on agar plates, suggesting capsular material. All isolates were resistant to ampicillin, erythromycin and streptomycin. Plasmid analysis revealed a common 200-kb plasmid in isolates from all cases and an additional 2.7-kb plasmid in three of the isolates. Ribotyping of each isolate after restriction with BglI and HindIII endonucleases demonstrated identical ribotyping patterns. The cases reported suggest that V. metschnikovii may be associated with diarrhoea in man by mechanisms so far unknown.

Acute Disease↗
PubMed1991

Effect of negative pressure ventilation on arterial blood gas pressures and inspiratory muscle strength during an exacerbation of chronic obstructive lung disease.

The effects of intermittent negative pressure ventilation have been studied in 20 patients with chronic obstructive pulmonary disease during an exacerbation of their disease. Measurements of arterial blood gas tensions and maximal inspiratory pressure (MIP) were performed before and after six hours of negative pressure ventilation or standard treatment (control day) given in random order on two consecutive days. After negative pressure ventilation the mean (SD) value of MIP increased from 68.1 (21.5) to 74.8 (20) cm H2O;* arterial oxygen tension (PaCO2) fell from 60.6 (12.2) to 50.9 (8.9) mm Hg* but PaO2 changed little (from 48.4 (7.4) to 47.6 (8.2) mm Hg). There were no significant changes on the control day in arterial blood gas tensions (PaO2 47.8 (8.1) and 48.9 (9.4) and Paco2 59.8 (10.9) and 57.5 (8.06) mm Hg) or in MIP (69.4 (22.4) and 70.9 (22.9) cm H2O). Six patients tolerated negative pressure ventilation poorly and these patients showed less improvement after negative pressure ventilation. Our results suggest that intermittent negative pressure ventilation can increase alveolar ventilation in patients with an exacerbation of chronic obstructive lung disease, particularly in those who tolerate the procedure well. Most subjects showed a fall in PaCO2 and an increase in MIP. The fact that PaO2 was unchanged despite the fall in PaCO2 suggests that gas exchange may deteriorate with negative pressure ventilation in these patients.

Aged↗
PubMed1990

Curve of perceptive intellectual deterioration in hemodialysis patients.

In order to optimize the results of kidney transplant, i.e. patient's acceptance and speedy recovery, the available organ resources must be combined with appropriate "preparation" of the patient's mental state. In order to plot the "mental deterioration curve" of patients on a hemodialysis program, the present study was made on 62 patients in a general hospital in Spain. The possible repercussions of treatment of kidney disease on intellectual (Weschler's Adult Intelligence Scale-WAIS test) and perceptive (Benton test) capacity were investigated. Samples were grouped according to whether they had been on dialysis for up to four years (less than 4) or more than four years (greater than 4). The WAIS test for the greater than 4 group indicated a lower I.Q. These results indicated that it was after four years on dialysis that greater negative effects began to be seen in perceptive-intellectual capacity. The Benton test indicated that time on hemodialysis adversely affected the patient's capacities. A sharp decline was seen particularly between two and four years in the less than 4 group, suggesting that patients' mental conditions vary with time on dialysis but that their resources and capacities are still fairly untroubled by the treatment in the first two years. In the light of these findings, the deterioration curve should be taken into account when planning kidney transplant, in order to take advantage of the initial period if possible.

Adult↗
PubMed1988

Surgical treatment of the incontinent female patient with myelomeningocele.

Surgical therapy was required for 42 incontinent female patients with myelomeningocele who had urodynamically documented high pressure bladders. Conservative treatment consisting of cholinolytic and alpha-adrenergic agents, and intermittent self-catheterization had failed. The surgical approach consisted of perivesical denervation (for hyperreflexia), Burch bladder neck suspension, enlargement cystoplasty and ureteral reimplantation when required. Among 33 patients (79 per cent) there was no incontinence on intermittent self-catheterization and 6 (14 per cent) had improvement with rare urgency or stress incontinence. In 3 patients (7 per cent) sphincteric incompetence required a transvaginal sling procedure.

Adolescent↗
PubMed1988

Fascial sling to correct male neurogenic sphincter incompetence: the McGuire/Raz approach.

We report the surgical approach used in 4 male myelomeningocele patients suffering from severe urinary incontinence owing to poor bladder compliance and sphincter incompetence. While bladder compliance was corrected by enlargement cystoplasty the sphincteric incompetence was treated by an autologous fascial sling around the bladder neck with excellent results. We consider this operation as an alternative to the artificial urinary sphincter in cases of male neurogenic sphincter incontinence.

Adolescent↗
PubMed1987

Urodynamic use of fiberoptic microtipped catheter.

Solid state microtransducers are used widely in urodynamics to record bladder and intraluminal urethral pressures. They are sensitive and capable of giving high quality, reproducible pressure recordings. They do not require the determination of a reference point but they are expensive and fragile, and calibration may be difficult to perform. We describe our experience with a new catheter for pressure recording based on fiberoptic technology. In addition to the advantages of the conventional microtipped catheters, the new catheter is thinner (4F), easier to calibrate and less expensive. Controlled testing of the new catheter was performed in an experimental setting and in clinical trials during urodynamic evaluation. The catheter provides reliable pressure recordings compared to standard microtipped catheters.

Animals↗
PubMed1982

Serum ferritin in haemodialysis.

A rapid assay for serum ferritin was performed in old and new patients undergoing regular dialysis treatment. The mean values were higher in the patients, especially the older patients, than in the controls. The normal differences in serum ferritin with age and sex were absent in the patients. We attribute these changes to iron loss and multiple transfusions received. Tissue iron was well reflected by serum ferritin concentration even during iron treatment, unless the intravenous route was used. Although an acceptable rise of serum ferritin was obtained, results of the iron administration have been poor.

Anemia, Hypochromic↗