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Biomedical subjects

B Togores

Publications and source records attributed to B Togores.

12 recordsLinked to original sources
PubMed1999

Exhaled nitric oxide in patients with sleep apnea.

Cardiovascular diseases are frequent in patients with obstructive sleep apnea syndrome (OSAS), but the mechanisms underlying this association are largely unknown. Nitric oxide (NO) is a key regulatory element of vascular physiology. The concentration of NO in the exhaled air ([NOexh]) appears to be reduced in patients with systemic and pulmonary hypertension. This study sought to investigate whether [NOexh] is abnormal in patients with OSAS, and to explore potential relationships between [NOexh] and the severity of OSAS. We measured [NOexh] in 24 patients with OSAS (apnea-hypopnea index (AHI), 55 +/- 4 hour-1) (x +/- SEM), and in 7 healthy volunteers in whom OSAS was excluded clinically. [NOexh] was measured on line by a chemiluminescence analyzer (Dasibi Environmental Corporation, Glendale, Calif). Seven patients with OSAS (29%) had a positive history of cardiovascular disease. Mean [NOexh] was 19.7 +/- 3.2 ppb in healthy subjects, and 22.2 +/- 3.0 ppb in patients with OSAS (p = ns). [Noexh] was not significantly different in those patients with or without cardiovascular disease. [NOexh] was not significantly related to the AHI, the body mass index, or the arterial O2 saturation at night. These results show that [NOexh] is not abnormal in patients with OSAS, and that it does not relate to the presence of cardiovascular disease or to any of various common indices of disease severity.

Adult↗
PubMed1999

[The results of the operation of a monitoring unit for home oxygen therapy].

OBJECTIVE: This study aims to a) analyze the prevalence of domiciliary oxygen therapy (DOT) in Mallorca, b) evaluate the cost effectiveness of the DOT monitoring unit, and c) determine the survival of patients with chronic obstructive pulmonary disease who are presently receiving DOT. METHOD: When the DOT unit was created in April 1994, the situation of all patients receiving DOT in Mallorca was assessed in a transversal study. Over the next three years, these patients were reassessed regularly and all new prescriptions were evaluated (longitudinal study). RESULTS: Before the unit began work, DOT was prescribed for 71 out of 100,000 inhabitants. DOT was withdrawn from 31% of patients assessed in the transversal study. By the end of the longitudinal study, DOT was being prescribed at a rate of 56 times per 10,000 inhabitants. The activities of the DOT unit brought about annual savings of approximately 38 million pesetas. The number of patients with liquid oxygen and concentrators increased such that the latter has become the main delivery system. The survival of COPD patients with DOT in this study seems to be longer than report. CONCLUSIONS: a) The prevalence of DOT use in Mallorca before the DOT unit began operating was too high. b) The cost effectiveness of DOT monitoring is positive because DOT use has been optimized and significant savings have ensued (= 38 millions pesetas/year). c) The survival of COPD patients receiving DOT at present appears better than that reported in the literature, possibly related to the greater efficacy of modern treatment.

Aged↗
PubMed1997

A new bronchoscopic technique for the diagnosis of bacterial pneumonia in HIV-positive patients.

The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL). Fifty-eight HIV-positive patients with respiratory infection were included in the study. Samples from TPC and mpBAL were cultured quantitatively. Standard bronchoalveolar lavage was performed to rule out opportunistic infections. According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia). Sensitivity of TPC was 56% [95% confidence intervals (CI) 37-75%] and its specificity was 100%; these figures were 56% (CI, 37-75%) and 94% (CI, 86-100%) for mpBAL. When both techniques were assessed together, sensitivity increased to 70% (CI, 53-87%). The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50%. The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost.

Adult↗
PubMed1997

Effects of N-acetylcysteine on tissue oxygenation in patients with multiple organ failure and evidence of tissue hypoxia.

Covert tissue hypoxia, particularly of the splanchnic region, appears important in the pathogenesis of multiple organ failure (MOF). This investigation evaluates the effects of N-acetylcysteine (NAC) upon several measures of tissue oxygenation in 10 patients with severe MOF and evidence of splanchnic hypoxia (as suggested by a pathologically low value (< 7.32) of the pH of the gastric mucosa (pHi)). Patients were studied following a prospective, randomized, placebo-controlled, cross-over design. Measurements included pulmonary and systemic haemodynamics, cardiac output by thermodilution, arterial and mixed venous blood gas values, blood lactate concentration, whole-body oxygen uptake by analysis of the expired gases, and pHi by tonometry. A complete set of measurements was obtained before and 45 min after the infusion of NAC (150 mg.kg-1 in 250 mL of saline) and, also, before and 45 min after the infusion of an equivalent volume of saline. NAC increased the cardiac index and vasodilated the systemic circulation (p < 0.01). However, O2 delivery to the tissues did not increase because the arterial oxygen content fell after NAC (p < 0.01). Mean O2 extraction or lactate concentration did not change after NAC, and pHi fell slightly (from 7.11 +/- 0.21 to 7.07 +/- 0.21; p < 0.05). The infusion of saline did not modify any variable significantly. The O2 extraction fraction increased exponentially in those patients with reduced O2 transport to the tissues. These results argue against a beneficial effect of N-acetylcysteine upon tissue oxygenation in patients with severe multiple organ failure and evidence of splanchnic hypoxia. Furthermore, they suggest that the mechanisms controlling the extraction of oxygen by the peripheral tissues in these patients were not impaired.

Acetylcysteine↗
PubMed1997

Noninvasive ventilatory support after lung resectional surgery.

STUDY OBJECTIVES: To investigate the short-term effects of noninvasive ventilatory support (NIVS) on pulmonary gas exchange, ventilatory pattern, systemic hemodynamics, and pleural air leaks in patients submitted to elective lung resection. DESIGN: Prospective, randomized, parallel, and controlled investigation. SETTING: Thoracic Surgery Unit, Hospital Universitari Son Dureta, Palma Mallorca, Spain. PATIENTS: Nineteen patients electively submitted to lung resection because of varied clinical reasons. INTERVENTIONS: Medical therapy was standardized for all patients. Ten subjects received NIVS with a nasal ventilatory support system (BiPAP) during 1 h (study group). The remaining nine individuals constituted the control group. MEASUREMENTS AND RESULTS: Arterial blood gases, ventilatory pattern, systemic hemodynamics, and pleural air leaks were measured. Before surgery, there were no significant clinical or functional differences between groups. After surgery, and compared with preoperative measures, PaO2 decreased significantly (p<0.01) and to the same extent both in the study group (85.7+/-2.8 to 68.0+/-2.7 mm Hg) and the control group (83.6+/-2.5 to 67.3+/-2.6 mm Hg). In the study group, NIVS increased PaO2 (to 76.7+/-3.0 mm Hg; p<0.05) and decreased alveolar to arterial oxygen pressure gradient (P[A-a]O2) (27.2+/-2.7 to 17.6+/-2.3 mm Hg; p<0.05). This latter effect was still present 1 h after withdrawing NIVS. By contrast, PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study. PaCO2, the ventilatory pattern, and systemic hemodynamics did not change significantly throughout the study in any group. Importantly, NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks. CONCLUSIONS: Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients submitted to lung resectional surgery.

Female↗
PubMed1996

Continuous positive airway pressure is effective in treating upper airway oedema.

The case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) and upper airway oedema, is described. The patient presented with alveolar hypoventilation and obstructive apnoeas during sleep. Intravenous steroids (methylprednisolone, 160 mg.day-1) for 5 days did not reduce the oedema. However, it was rapidly reversed by the use of nasal continuous positive airway pressure (nCPAP). In addition, daytime pulmonary gas exchange was improved and sleep apnoea abolished. This beneficial effect made tracheostomy unnecessary. This case report suggests that CPAP can be a potentially useful therapeutic alternative to tracheostomy in the clinical management of upper airway oedema.

Aged↗
PubMed1996

Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease.

This investigation evaluates, in a prospective, randomized and controlled manner, whether noninvasive ventilatory support (NIVS) with bilevel positive airway pressure (BiPAP) facilitates recovery from acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD). Twenty four patients (mean age (+/-SEM) 68 +/- 2 yrs) with COPD (forced expiratory volume in one second (FEV1) at discharge 33 +/- 2% predicted), who attended the emergency room because of ARF (pH 7.33 +/- 0.01; arterial oxygen tension (Pa,O2) 6.0 +/- 0.2 kPa; arterial carbon dioxide tension (Pa,CO2) 7.9 +/- 0.3 kPa), were initially randomized. Four out of the 14 patients (29%) allocated to received NIVS did not tolerate it. Of the remaining 20 patients, 10 received NIVS with BiPAP in a conventional hospital ward during the first 3 days of hospitalization (two daytime sessions of 3 h duration each). All 20 subjects were treated with oxygen, bronchodilators and steroids. On the first and third hospitalization days, before and 30 min after withdrawing oxygen therapy and/or BiPAP ventilatory support, we measured peak expiratory flow, arterial blood gas values, ventilatory pattern, occlusion pressure (P0.1), and maximal inspiratory (MIP) and maximal expiratory (MEP) pressures. All patients were discharged without requiring tracheal intubation and mechanical ventilation. Hospitalization time was similar in both groups (11.3 +/- 1.3 vs 10.6 +/- 0.9 days, control vs BiPAP, respectively). Arterial oxygenation, respiratory acidosis and airflow obstruction improved significantly throughout hospitalization in both groups. By contrast, the ventilatory pattern, P0.1, MIP and MEP did not change. NIVS with BiPAP did not cause any significant difference between groups. We conclude that noninvasive ventilatory support with bilevel positive airway pressure does not facilitate recovery from acute respiratory failure in patients with chronic obstructive pulmonary disease. Furthermore, a substantial proportion of patients (29%) do not tolerate noninvasive ventilatory support under these circumstances. From these results, we cannot recommend the use of noninvasive ventilatory support with bilevel positive airway pressure in the routine management of chronic obstructive pulmonary disease patients recovering from acute respiratory failure.

Aged↗
PubMed1996

[Chronic eosinophilic pneumonia and difficult to control asthma].

We report a case of typical chronic eosinophilic pneumonia (CEP), in a female of 27 years-old suffering bronchial asthma light. Although the initial answer to the treatment with steroids was satisfactory, the patient develop difficult to control asthma (DCA). DCA is a clinical situation which requires careful investigation of several potential factors which can be solved. We suggest a protocol of treatment for patients affected with DCA.

Administration, Topical↗
PubMed1993

[Bronchiolitis obliterans with organizing pneumonia].

We present a typical case of Obliterant Bonchilitis with Organizative Pneumonia in a 73-years-old man. The diagnosis was established through minithoracotomy. Treated with high dosage of methylprednisolone, the clinical-radiological evolution was satisfactory. It is very important to know and correctly diagnose this entity, given its excellent therapeutical response.

Aged↗
PubMedDate not supplied

[Comparative evaluation of 3 types of syringes routinely used for arterial gas analysis].

This prospective study evaluates the practical utility of a special plastic syringe for collecting arterial blood samples for gasometry, comparing it to a glass syringe and a conventional plastic one, in 120 patients who came to our hospital for arterial blood analysis for a variety of reasons. The patients were randomly assigned to one of three groups according to type of syringe assigned. Technicians with experience in the technique prepared the syringes and collected the arterial blood samples after providing local anesthesia. The results showed that the special plastic syringe took less time (p < 0.05) to prepare than did the glass or conventional plastic ones. The differences were quite small, however, in absolute terms, with the special syringe requiring 17 seconds less than the glass syringe and 6 seconds less than the plastic one; the practical importance is therefore slight. No other advantages of the special syringe were observed. No patient required more than one puncture to obtain a valid arterial blood sample, the extraction times (time between arterial puncture until end of process) were similar in the three groups of patients, and the presence of post-puncture hematoma was rare in all groups. There were no differences in level of pain reported (on an analog scale) and the subjective quality of the radial pulse wave was good and similar in all three groups. In conclusion, these results show that use of the special syringe offers no important practical advantages for experienced technicians that would justify the higher price. In fact, as the conventional plastic syringes are cheaper, disposable and similarly effective in expert hands, our results suggest that their routine use for collecting arterial blood gas samples can help improve the cost-benefit ratio for a common procedure in pulmonary function units.

Blood Gas Analysis↗