Biomedical subjects
Publications and source records attributed to A Muñoz.
A prospective study was carried out in 6 patients with cancer of larynx operated between 1986 and 1988. Technical aspects for supracricoid partial laryngectomy with cricohyoidopexy are described. Indications, follow-up and complications are discussed.
AIM: To report on the results of the Registry on Home-based Parenteral Nutrition (HPN) of the NADYA-SENPE working group, corresponding to the year 2002. MATERIALS AND METHOD: Compilation of the registry data loaded by the Units in charge of HPN patients care. It consists of an on-line registry available to the registered users of the group's web page (www.nadya-senpe.com). Epidemiological, diagnostic, access route, complications, hospital admissions, degree of disability, and course until December 31st of 2002. RESULTS: Data from 74 patients were gathered (56.8% women and 43.2% men), from 18 hospital centers. Mean age of adult patients was 49.4 +/- 15.5 years and 2.3-1.1 years for patients younger than 14 years (n=3 patients). Diseases that prompted the use of HPN were mesenteric ischemia (29.7%), followed by neoplasms (16.2%), radiation enteritis (12.2%), motility impairments (8.1%), and Crohn's disease (5.4%). Tunneled catheters were used in 52.7% of cases, as compared to 36.5% of subcutaneous reservoirs. Mean treatment duration was 8.7 +/- 4.4 months; 68.9% of patients remained on HPN for a duration longer than 6 months, and in 41.9% longer than one year. Patients' follow-up was mainly done from the reference hospital (87.8%), and the remaining patients (12.5%) by the home care team. In no case patients were followed by the primary care team or other specialists than the ones that prescribed nutritional support. In 94 cases there were complications related to nutritional therapy. The more frequent complications presented were infectious. These complications represented 1.84 admissions per patient. The mean number of visits was 12.9 per patient (10.2 routinary visits and 2.7 emergency visits). At the end of the year, we observed that 74.3% patients stayed in the program, whereas in the remaining 23.6% HPN had been discontinued. The main causes for discontinuation were death (52.9%), and switch to oral diet (23.5%) or enteral nutrition (11.8%). With regards to disability degree, 16.1% were confined to a wheelchair or bed, and 17.6% had no disability at all or only a mild social disability. CONCLUSIONS: We observed a sustained HPN prevalence rate in Spain (1.8 patient pmp). The main cause for its use was short bowel syndrome secondary to vascular disease, followed by cancer. Complications associated to nutritional therapy were common, especially of infectious origin.
GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2002. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3967 patients that belong to twenty-one hospitals. Mean age from those adults 69.2 +/- 19.2 years, and from those younger than 14, 5.6 +/- 4.1 years. Neurological and neoplasic diseases were the diagnostics more frequents (39.2% and 34.6%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (53.6%) followed by naso-enteral tube (30.6%), and only in 15.8% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (81.5%). The mean time on HEN was 5.8 +/- 4.4 months; the 35.7% of patients stayed in the treatment for less than 3 months, 22.4% between 3 and 6 months, and 41.6% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (75.3%). While the reference hospital supplies the material (65.7%), reference hospital pharmacy (43%) and public pharmacies (37.3%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (29.7%), mechanical complications (22.9%), gastrointestinal complications (22.9%), and the metabolic one (9.2%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 49.3% of patients were in the HEN programme, and in 41.5% HEN was finish due to accept oral conventional alimentation (47.3%) or by deceased of patients. While 31.8% of the patients were confined to bed o armchair, 17.8% no o light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country (96.5 patients/million inhabitants. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.
OBJECTIVE: To report the results of the Home-based Parenteral Nutrition (HBPN) registry of the NADYA-SENPE working group, for the year 2003. MATERIAL AND METHODS: Gathering of registry data introduced by all units responsible of HBPN patient care. This an on-line registry available for authorized users of the working group web page (www.nadya-senpe.com). Epidemiological data, diagnosis, access route, complications, hospital admissions, disability degree, and course at December 31st, 2003 RESULTS: Data from 86 patients (62% female and 38% male) from 17 hospitals were gathered. Mean age of adult patients was 50.7 +/- 15.0 years, whereas for patients younger than 14 years was 2.4 +/- 1.5 years (n = 5 patients). Diseases that prone HBPN were neoplasm (21%), followed by mesenteric ischemia (20%), radiation enteritis (16.3%), motility impairments (10.5%), and Crohn's disease (4.6%). Tunneled catheters were used in 66.3% of the cases versus 29.1% of subcutaneous reservoirs. Mean treatment duration has been 8.5 +/- 4.6 months; 67.4% of patients had been on HBPN for a period of time longer than 6 months. Patient follow-up was mostly done from the reference area hospital (88.4%). In no case patient follow-up was done by the primary care team or by specialists other than those prescribing nutritional support. Nutritional support-related complications were seen in 98 occasions. The most frequent complications were infectious ones. They represented 1.60 hospital admissions per patient. The mean number of visits was 7.9 per patient (6.4 for scheduled visits and 1.5 for emergency visits). By the end of the year, we observed that 73.3% of the patients were still on the program, whereas in 23.3% HBPN had been withdrawn. The main reasons for withdrawal were decease (11 patients), and advancing to oral diet (9 patients). As for the disability degree, 13% were confined to a wheelchair or bed, and only 28% had no disability degree or only mild social disability. CONCLUSIONS: We observed a mild increase in HBPN prevalence rate in Spain (2.15 patients pmp). The main indication was cancer followed by short-bowel syndrome secondary to vascular pathology. Nutritional support-related complications were common, especially those of an infectious origin.
The purpose of this study was to evaluate the effectiveness of a Nutritional Support Team (NST) in the control and follow-up of enteral nutrition (EN) in patients subjected to laryngectomy as a result of neoplasia. The study was performed on two groups of patients (A and B) who had been admitted into the Otorhinolaryngological Department, and who required EN by nasogastric tube during the postoperative period. Group A consisted of 20 patients in whom EN was based on standard guidelines, with a daily intake of 11.1 g of Nitrogen and 2.000 kcals. Group B included 23 patients who received EN individually, using NST with a daily intake of Nitrogen of between 8 and 21 g, and energy intake of between 2.000 and 3.000 kcals. The total cost of nutrition was calculated using the following partial costs: diet, administration, laboratory analysis and NST head responsible for follow-up of Group B. Individualized EN was more effective in nutritional terms than a standard diet in all patients. Using this form of treatment, positive Nitrogen balance were achieved, levels of seric albumin were maintained as well as weight, and complications were reduced. The average cost of nutrition per patient in Group B was 46.258 pesetas and in Group A, 43.963 pesetas. However, in the latter Group, there was an average additional weight loss of 4 kg per patient, and an increase in cost effectiveness ratio of 573 pesetas in weight gained in Group B compared to Group A.
As a result of a case report, a bibliographic review was made about false aneurysms on the popliteal arteries accidentally produced following a meniscectomy by arthroscopy. Such type of aneurysms can be defined by its false wall, its sack-shape and extensive haematoma and its clinical presentation as an acute ischemia of an extremity. It should be noted that, in all cases, an important delete in the diagnosis time was registered. It is also remarkable that an early treatment reduced the sequels of this pathology.
We have studied 37 patients with advanced head and neck cancer. A combination of Cis-Platinum and 5-Fluorouracil, both administered four days continuously as infusion, was assessed. There were 15 complete responses (40.5%), 15 partial responses (40.5%) and the number of objective responses was 30 (81.5%). Survival is 79.1% at 22 months and none of the patients in complete responses has relapsed during this period.
67 patients were included in two different protocols with cisplatin and 5-fluorouracil as induction chemotherapy. Group A (30 patients), received cisplatin in bolus and 5-FU in continuous infusion for 120 hours, and Group B (37 patients), were treated with cisplatin and 5-FU both in continuous infusion for 96 hours. All patients received surgery and/or radiotherapy after chemotherapy. Overall response in Group A was 73% with 27% Complete Clinic Response (CCR), and in Group B 81% with 40.5% (CCR). Overall survival at 24 months was 58% and 63%, respectively.
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The demonstration of the tumoral invasion of the cartilaginous structure of the larynx is a fact that contraindicates any conservative treatment, either surgical or radiotherapeutic. The usual methods of clinical exploration, such as direct or indirect laryngoscopy or fiberoptic laryngoscopy are not very useful, as well as conventional radiology which presents little sensitivity to defect tumoral invasion. It has been communicated previously that computerised tomography (CT) is more sensitive. In our evaluation of these different diagnostic methods, we present a series of 51 patients with laryngeal cancer at different stages in a hom studies prior to surgery using computerised tomography (CT) have been realised. We evaluate the efficacy of his diagnostic method in the tumoral invasion of the laryngeal backbone. Results have been analysed, demonstrating that this method is superior to other techniques used.
A randomized, double-blind clinical trial of plasma-derived and DNA recombinant hepatitis B virus vaccines was conducted in 186 homosexual men. Nine months after the immunization series (three doses) began, the seroconversion rate in the plasma vaccine group was 88% (68/77); this was significantly higher than the 74% (60/81) response rate of the recombinant vaccine group. Men positive for antibody to the human immunodeficiency virus (HIV) had a considerably higher nonresponse rate to either vaccine than expected in non-HIV-infected homosexual men. The odds ratios of nonresponse to hepatitis B virus vaccine for HIV-seropositive vs HIV-seronegative subjects were 12.0 (95% confidence interval, 1.7 to 89.3) and 13.6 (95% confidence interval, 2.3 to 148.3) for the plasma and DNA recombinant vaccines, respectively.
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An autoregressive model for the analysis of longitudinal data was applied in the context of investigating the effect of bronchial responsiveness on the growth of pulmonary function in children. In the model used, the correlation between pulmonary function values within an individual decreases exponentially as the time between visits increases. The model incorporates both fixed and time-dependent covariates in a unified fashion and does not require complete data in all visits for each individual. Furthermore, the change in pulmonary function is not assumed to be linear over time. Using response to cold air data as a measure of bronchial responsiveness, we found that children who responded to cold air have a slower rate of growth in pulmonary function. In addition, the data suggested that the effect of cigarette smoking may be greater as the response to cold air increases. Extensions of the autoregressive approach to other correlation structures and to the case of unequidistant observations are discussed.
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