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Biomedical subjects

D Pérez

Publications and source records attributed to D Pérez.

At least 19 recordsLinked to original sources
PubMed2006

[Complications in cochlear implantation].

OBJECTIVE: The objective [corrected] of this paper is to present the surgical complications in cochlear implant, in a serie of 346 patients, submitted to surgery by the same surgical team with the subsequent control and follow-up for a long period of time. We show the description and the handling of each complication. MATERIAL AND METHODS: A follow-up was carried out on 346 cochlear implant patients by the same surgical team, from February 1993 to March 2004. The complications were assessed and their handling and follow-up is reported. The series includes 211 children and 135 adults. RESULTS: The complication rate was 9.8% (n = 34). The complications found were: Intraoperatory Complications: Cerebrospinal Fluid Leaks (CSF), 7; Facial nerve injury, 1; excessive thinning of the posterior wall, 2; inmediate post operatory complications: infection of the surgical wound, 4; post operatory persistent pain, 1; Tinnitus, 2; late complications: Mastoiditis, 2; extrusion of the stimulating receptor, 1; facial nerve stimulation, 5; late infections of the stimulation receptor, 2; technical failure of the implanted system, 7. Neither alteration or migration was found in the receptor placing. CONCLUSIONS: The cochlear implant surgery has a low morbility. We found no cases of meningitis due to this procedure.

Adult↗
PubMed2005

Pulmonary tuberculosis in lung and heart-lung transplantation: fifteen years of experience in a single center in Spain.

The increase in the number of solid organ transplants has resulted in an increased incidence of opportunistic infections, including infection by typical and atypical mycobacteria, with risk of developing tuberculosis. Pretransplant chemoprophylaxis with isoniazid has become increasingly common in an attempt to prevent the disease. The source of infection in tuberculosis (TB) may be difficult to identify. Infection may be caused by reactivation of a primary infection in the recipient, reactivation of a lesion from the donor lung, or primary infection. There are few reports on TB in lung transplantation. Incidence in the reported series ranges from 6.5% to 10%. Our series of 7 patients out of a total 271 patients (2.58%) represents a rate higher than reported for the general Spanish population, 26.7/10(5) inhabitants and for lung transplant candidates (0.18%). Our aim was to evaluate the incidence, clinical signs, and outcome of TB in our series of patients undergoing lung transplantation in the 15 years since inception of the program (February 1990 to December 2004). Morbidity and mortality was high (42.8%), but limited to patients in whom treatment was not administered or could not be successfully completed. However, early detection and treatment are essential.

Adult↗
PubMed2005

[Cochlear implant in congenital malformations].

OBJECTIVE: The main objective is to evaluate the complications and problems encountered in a population with inner ear congenital malformation undergoing cochlear implantation. MATERIALS AND METHODS: The present study includes 33 patients with congenital inner ear malformation, from a total population of 346 cochlear implant patients, implanted from February 1993 to March 2004. Radiological evaluation and neurological exams were performed to all these patients in order to evaluate all the preoperative conditions. RESULTS: The most common cochlear anomalies we found were: cochlear hypoplasia, Incomplete partition and Common cavity (n=15). In 4 cases an enlarge aqueduct was also associated to the cochlear anomaly. We also found 6 cases with labyrinthine anomalies. The surgical procedure was performed in 23 cases, and in 18 of them we obtained an electrical stimulation of the neural elements. CONCLUSIONS: There are no differences between patients with Incomplete Partition of the cochlea and mild Cochlea hypoplasia, if compared with those with normal cochlea. Severe malformations as Common Cavity or severe hypoplasia may have a higher rate of surgical complications and the outcome cannot be predicted.

Adult↗
PubMed2004

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.

BACKGROUND: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

Adolescent↗
PubMed2003

Non-invasive management of an acute chest infection for a patient with ALS.

We describe a man diagnosed with non-bulbar amyotrophic lateral sclerosis (ALS) who uses 24-h non-invasive ventilator at home, and assisted cough through the use of the mechanical insufflation-exsufflation (MAC) device (CoughAssist, J.H. Emerson). This was essential for the removal of bronchial secretions in order to provide successful non-invasive management (and indeed less suffering for the patient) during an acute respiratory tract infection with hypoxemia and failure of manually assisted cough.

Acute Disease↗
PubMed2003

National prevalence of larval echinococcosis in sheep in slaughtering plants Ovis aries as an indicator in control programmes in Uruguay.

Diagnostic surveys carried out on ovine larval echinococcosis in slaughtering plants at a national level in 1998 made it possible to meet several objectives, i.e. to estimate the existing levels of prevalence, to evaluate the effectiveness of the control actions applied by the Programme against Hydatidosis and to contribute to the improvement of the health information systems for epidemiological surveillance. The work included sheep (Ovis aries), both lambs (2-4 teeth) and adults (6-8 teeth). A random sample was performed among sheep from the plants that slaughter the majority of animals in the country. The sample included 22 animals per herd, and it involved removing their offal (liver, lungs and heart) and processing serial sections at the laboratory. The histopathological studies were performed on the lesions that could not be adequately identified at gross examination, and those that were so small that had to be submitted for confirmation of the diagnosis. Of the 2035 animals that were examined, 1019 were lambs (2-4 teeth) and 1016 were adults (6-8 teeth). The prevalence of larval echinococcosis was 7.7% in lambs and 18.0% in adults. The overall prevalence in the liver was 8.5 and 8.0% in the lungs. As to the characteristics of the morphologic structures of the larvae, in younger animals 29% of the lesions were calcified, and 71.0% were hyaline, while in older animals the proportions were 34.4% calcified versus 65.6% hyaline. Other conditions found in the liver parenchyma included: white stain (0.8%), caseous lymphadenitis (3.0%), abscess (0.4%), larvae of Taenia hydatigena (5.1%), Fasciola hepatica (3.9%). And 1.7% of the animals presented larvae of Taenia ovis in the cardiac muscle. Previous surveys carried out in 1994 using the same methodology showed a prevalence of 15.2% in 2-4 teethed animals and 33.9% in 6-8 teethed animals, thus confirming that rates have decreased by 49.6 and 47.0%, respectively. The data obtained reflect the reduction of areas contaminated with eggs of Echinococcus granulosus, which would cause a loss in immunity against this parasite after a certain time. Prevalence of larvae T. hydatigena and T. ovis could change if more sites were considered, a fact that was confirmed in studies carried out in our country. The species O. aries must be used as an indicator in the control programmes, especially in the category of 2-4 teethed lambs. The fact they are not as frequent in our market must be considered; in 1998 they accounted for only 3.0% of the total numbers of animals.

Abattoirs↗
PubMed2003

Can we expand the indications for liver transplantation among hepatocellular carcinoma patients with increased tumor size?

INTRODUCTION: Due to the scarcity of donors and the fact that size is the main prognostic factor, Milan criteria have been used since 1996 to select hepatocellular carcinoma (HCC) patients for liver transplantation. In 2001 UCSF criteria showed that including layer tumors did not reduce the survival results. The objective of this paper was to evaluate whether HCC tumor sizes exceeding the Milan criteria adversely influence survival rates. PATIENTS AND METHODS: Between May 1988 and July 2001, 53 patients were transplanted due to HCC and cirrhosis. The etiology of cirrhosis was HCV in 23 cases and HBV in 6. In 11 cases the HCC were incidental by discovered namely, a mean/ diameter of 1.8 cm (versus 2.6 cm in nonincidental HCC). Sixty-two percent of tumors met the Milan criteria, and 68% the USCF criteria. RESULTS: The actuarial survival was 79% at 1 year and 62% at 5 years. The survival of patients with incidental HCC was 82% at 1 year and 82% at 5 years, which is better than the survival of those with nonincidental HCC (78% at 1 year and 57% at 5 years, P<.05). According to Milan criteria, the survival patients with early tumors was 82% at 1 year and 68% at 5 years, and for advanced tumors (NS), 75% and 54%, respectively. Comparison of early versus advanced tumors according to UCSF criteria showed survivals of 84% versus 64% at 1 year (P<.05) and 67% versus 48% at 5 years (P<.05), respectively. CONCLUSION: Increasing the HCC size among LT according to the California criteria did not reduce survival rates compared with the Milan criteria.

Alcoholism↗
PubMed2001

Factors that affect recurrence after incisional herniorrhaphy with prosthetic material.

OBJECTIVE: To evaluate the risk factors for recurrence after prosthetic incisional herniorrhaphy. DESIGN: Retrospective study. SETTING: Tertiary referral centre, Spain. PATIENTS: 246 patients who had incisional herniorrhaphy with a prosthetic material (polypropylene) between 1990 and 1997 INTERVENTIONS: A reinforcement mesh was inserted when the hernia was more than 5 cm. In incisional hernias less than 5 cm the reinforcement mesh was inserted when the repair was under tension or when tissues were noted to be weak during the operation. MAIN OUTCOME MEASURES: Age, sex, obesity, the presence of bronchial disease, previous repair of the incisional hernia, type of surgery, size and site of hernia and presence of local complications during the immediate postoperative period. RESULTS: Mean (SD) follow-up was 77 (6) months (minimum follow up two years). The hernia recurred in 43 cases (17%) (mean time of recurrence 10 (8) months). Age over 60 years, previous herniorrhaphy, size of hernia, and postoperative local complications were significant risk factors (p < 0.01) in both the univariate and multivariate analyses. CONCLUSIONS: Patients at the greater risk of recurrence are those aged over 60 years, with large, recurrent hernias and who develop local complications during the postoperative period.

Age Factors↗
PubMed2001

Recurrent papillary thyroid cancer: analysis of prognostic factors including the histological variant.

OBJECTIVE: To analyse the factors that influence the development of recurrent papillary thyroid carcinoma, including the histological variant. DESIGN: Retrospective study. SETTING: Teaching hospital, Spain. SUBJECTS: 200 patients who had papillary thyroid cancers resected between 1970 and 1995. MAIN OUTCOME MEASURES: Prognostic factors and disease-free interval assessed by univariate and multivariate analysis. RESULTS: All patients were followed up for a mean of 9 years (range 4-29). 54 patients presented with recurrent disease (27%) of whom 19 (35%) died of their disease. 5-year, 10-year, and 15-year survival for those with recurrent disease were 75%, 68%, and 60%, respectively. The corresponding figures for the whole series were 93%, 90%, and 84%. The significant variables on multivariate analysis were completeness of resection (p = 0.002), extrathyroid involvement (p < 0.002), presence of lymph node metastases (p = 0.002), and histological variant of the carcinoma (P < 0.001). CONCLUSION: Using these risk factors it is possible to draw up a prognostic index and classify patients as being at low, medium, or high risk of recurrence.

Adolescent↗
PubMed2000

Spermine is neuroprotective against anoxia and N-methyl-D-aspartate in hippocampal slices.

Polyamines were implicated as either neurotoxic or neuroprotective in several models of stroke. Spermine augments the excitotoxicity mediated by the N-methyl-D-aspartate (NMDA) receptor because this receptor is activated at micromolar spermine concentrations. However, at higher concentrations, spermine could be neuroprotective because it blocks the NMDA receptor and voltage-activated Ca(2+) channels. In this work, acute hippocampal slices were exposed to 1 mM spermine and either 10 min of anoxia or 0.5 mM NMDA. The percent recovery of population spikes was the measure of neuroprotection. One millimolar spermine was robustly neuroprotective; however, 0.1 mM spermine and 1 mM putrescine were not. The neuroprotective concentration of spermine was higher than the physiological concentration of free spermine. However, during an excitotoxic episode, extracellular Ca(2+) is decreased, enabling the inhibitory activity of lower spermine concentration. In addition, several noxious stimuli trigger the release of intracellular spermine and could raise local levels of spermine. Therefore, it is possible that spermine has a neuroprotective role in vivo.

Animals↗
PubMed2000

DNA ploidy status and proliferative activity as markers of malignant potential in Barrett's esophagus: flow cytometric study using routinely paraffin-embedded tissue.

Regular endoscopic surveillance is recommended for patients with Barrett's esophagus to detect dysplasia and to diagnose carcinoma while it is in an early and possibly treatable stage. However, there are numerous unknown aspects regarding the natural history of dysplasia in this disease, and there is still a need for more accurate markers of risk of a malignant change. The aim of this study was to investigate the usefulness of DNA flow cytometry in Barrett's esophagus to define subgroups of patients showing similar histologic findings but with a different malignancy potential. Routinely formalin-fixed and paraffin-embedded tissues of 43 patients with Barrett's esophagus were processed for flow cytometric measurements (ploidy, proliferative index) and the results were compared with the histologic evolution observed in these patients. Only in the group of patients with "indefinite" dysplasia did we find statistically significant differences between the samples from patients with and without progression to more severe lesions (mean proliferative index of stable patients: 5.2% versus 8.3% in patients with progression, p = 0.001, Student's t-test). The presence in the flow cytometric analysis of a DNA aneuploid cell line is closely related to the presence of severe histologic alterations (i.e., high-grade dysplasia: p < 0.001, Fisher's exact test). Our results suggest that this procedure is at least capable of distinguishing between a real, although incipient, neoplastic process and morphologic changes of a reactive or reparative type. The increment in the tissue proliferative index could be an indicator of an early genomic instability which, with time, will develop into lesions with a more altered DNA content: aneuploidy.

Adenocarcinoma↗
PubMed2000

[Pneumothorax as the clinical presentation of bronchogenic carcinoma. A report of 3 cases].

The association of pneumothorax and lung cancer is rare and diagnosis is complex in such cases. Clinical suspicion of cancer must be based on radiological findings and the existence of risk factors. We discuss the mechanisms involved in the development of pneumothorax in patients with lung cancer, the clinical significance of the association, and the recommended diagnostic approach and therapeutic guidelines.

Adenocarcinoma↗
PubMed2000

A statistical analysis of the seasonality in pulmonary tuberculosis.

The present study examines whether pulmonary tuberculosis (PTB) has an annual seasonal pattern. A mathematical model is also obtained to forecast the pattern of incidence. The data for the study are the cases of PTB reported throughout Spain, published in the Epidemiology Bulletin by the Carlos III Health Center of the Spanish Ministry of Health in a 26-year period, 1971-1996. The analytical results show that the low rates in tuberculosis notifications over the period 1971-1981 have changed, halting in 1982 and reversing with high incidence from 1983 onwards. An annual seasonal pattern was also shown with higher incidence during summer and autumn. With the mathematical model we predicted the disease behaviour in 1997 and the results were compared to the reported cases. In Spain, as in several industrialised countries, the reason for this recent increase in the number of reported cases is, mainly, the human immunodeficiency virus (HIV) infection. The seasonal trend, with higher incidence in winter, can be attributed to the increase in indoor activities, much more common than in a warm climate. The tubercle bacilli expelled from infected persons in a room with closed windows may remain infectious for a long time, increasing the risk of exposure of healthy persons to the bacilli. As the preclinical period, from exposure to clinical onset, may be of several weeks, the high incidence in spring would be explained. Moreover, in winter and spring the infections of viral aetiology, like flu, are more frequent and cause immunological deficiency which is another reason for the seasonal trend observed. An incidence greater than that foreseen by the mathematical model would express a failure in epidemiologic surveillance, and thus the results of this study may be used to assess a quality of the preventive measures.

Cohort Studies↗
PubMed2000

Wheels within wheels: creating a circle of knowledge through communication.

For end-stage renal disease patients, patient education is a critical aspect of treatment and wellness. A successful patient education program depends on knowing the target audience and choosing materials and media according to what they already know and what they want and need to learn. Understanding how people learn and selecting an educational model to guide the creation of an educational program provide the underpinnings for an effective presentation. Selection of materials and medium and determining who, when, where, and how the program is conducted optimize the potential for learning. This article presents and illustrates part of The Renal Network's (ESRD Networks 9/10) outreach, communication, and programming efforts to bring all of these elements together in educational activities suitable for a diverse and significantly older population of patients across a 4-state area. It highlights The Renal Network's use and support of the Patient Advisory Council Representative as a patient leader undertaking activities on the facility level to provide patient-to-patient assistance, information sharing, and educational opportunities for fellow patients at their facility. This article shows how the Network initiated a consistent flow of information to facilitate the identification, assessment, selection, media, and means for its patient education activities.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

[Arterial hypertension in Cuba. General overview of the past 25 years].

A general overview of hypertension as a major health problem in Cuba in the last 25 years are presented. In the first period, 1974-1990 was created a National Hypertension High Commission by the Minister of Public and the First national program for prevention and Control of Hypertension in Cuba was launched. To define high blood pressure in adults 15 years and older the cut-off point was set at 160/95 mmHg. The prevalence found was 15% in urban areas and 7-8% in rural areas. The second period, 1991-1998 the original National program was re-evaluated in 1990 and 1995. The new blood pressure cut-off point was set at 140/90 mmHg. The prevalence increased to 30.6% in urban areas and 15% in rural areas and incidence of 2.5% annual. A total of 862,303 hypertensive patients were registry at the end of 1997 which represents less than 40% of the total number of possible hypertensive patients. A National Campaign was launched in 1998. In 9 months the preliminary reports were: 25% increase in prevalence, registry and follow-up of hypertensive patients 15 years old and older (8.5% to 12.5%); 92.9% of primary care doctors and 89.5% of primary care nurses received training; improvement in public education and social support; improvement in risk factor awareness in general public and improvement of hypotensive drugs availability and splygmomanometers supplies.

Cuba↗