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Biomedical subjects

J Canet

Publications and source records attributed to J Canet.

At least 19 recordsLinked to original sources
PubMed1999

Differential clinical features of early-onset panic disorder.

BACKGROUND: Although panic disorder (PD) begins typically in adulthood, an earlier onset is not uncommon. Recent studies on early-onset PD indicate that this subgroup of patients may display distinct clinical characteristics. OBJECTIVE: To compare a subgroup of early-onset PD patients with the rest of the sample. METHOD: A consecutive series of 442 patients with PD were included. Family histories were investigated, and clinical assessment employed the following instruments: Hamilton's scales, Global Functioning Scale, Marks-Mathews' Fears and Phobia Scale, and Panic-Associated Symptom Scale. The age threshold for 'early-onset' was considered at 18 years. RESULTS: A total of 45 patients (10.2%) exhibited early-onset PD, with a mean age at onset of 14.6. They were younger and had a longer duration of illness than later-onset patients. No differences were found in severity of panic symptoms, anxiety or depressive symptoms, and social functioning. They had more comorbidity with simple phobia, social phobia, and substance dependence. Rates of PD among first-degree relatives were higher in the early-onset group. CONCLUSION: Early-onset PD patients displayed a greater familial loading, but clinical severity of their panic-agoraphobia symptoms was not higher. Comorbidity was greater with phobic and substance-related disorders.

Adult↗
PubMed1999

Ventilatory compensation for inspiratory resistive loads during anaesthesia with halothane or isoflurane.

We have analysed the ventilatory response to sustained inspiratory resistive loads in 14 patients, while awake and during halothane (n = 7) or isoflurane (n = 7) anaesthesia. Patients breathed halothane or isoflurane in oxygen at 1.2 minimum alveolar concentration (MAC). Inspiratory resistances of 0, 12 and 37 cm H2O litre-1 s were applied. Tidal volume (VT) was maintained with the greater loads. At the greatest resistance, a significant reduction in minute ventilation occurred in both awake (-18.9%) and anaesthetized states, with both halothane (-10.4%) and isoflurane (-14.5%). Ventilatory frequency decreased significantly from mean 14.6 (SD 4.7) to 12.5 (4.3) bpm in the awake state and during anaesthesia, with increasing inspiratory resistance (29.5 (3.6) to 23.7 (7.2) bpm and 25.8 (3.3) to 23.4 (4.0) bpm, respectively, for halothane and isoflurane) because inspiratory time (TI) was significantly longer (P < 0.01). End-tidal PCO2 increased by 0.3 kPa, on average, from baseline to the highest level of resistance (P < 0.01). Inspiratory occlusion pressure at 100 ms increased significantly with increased loading in all situations (P < 0.001). We found a similar pattern of ventilatory adaptation to sustained inspiratory flow resistive loads both in awake and anaesthetized states. VT was maintained at increased loads because of an increase in inspiratory neuromuscular output and inspiratory duration.

Adolescent↗
PubMed1998

[Subtyping panic disorders according to their symptoms].

BACKGROUND: Panic disorder (PD) is a common illness associated with high levels of disability and with a high utilisation of non-psychiatric health services which is inefficient in most cases. A better understanding of the clinical subtyping of PD may improve diagnosis both in psychiatric and medical settings. The present study is aimed at assessing the frequency, factorial grouping and comorbidity of PD symptoms in a naturalistic sample of patients. PATIENTS AND METHODS: All consecutive cases of PD (n = 442) who contacted with two outpatient clinics in Barcelona (Spain) were assessed by two experienced interviewers. Assessment instrument included SCID-UP-R interview and inventory of panic symptoms based on DSM-III-R. RESULTS: Palpitations (86.7%), shortness of breath (76.5%), fear of dying (69.9%) and dizziness (63.6%) were the most frequent and intense symptoms reported by the PD patients. The principal component analysis revealed four factors which explained the 56% of the variancel "cardiorespiratory" (23.2%), "depersonalization-derealization" (15.8%), "vestibular" (10%) and "mixed" (7%). CONCLUSIONS: The frequency of presentation of symptoms was similar to other studies. However some disimilarities appeared that may be attributed to transcultural differences as well as terminological problems and the range of symptoms assessed. Factors found in the present study support the clinical subtyping of PD in 3 groups characterised by cardiorespiratory symptoms and fear of dying, cognitive symptoms (depersonalization-derealization) and vestibular symptoms such as dizziness and faintness.

Adult↗
PubMed1998

Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction.

BACKGROUND: Long-term postoperative cognitive dysfunction may occur in the elderly. Age may be a risk factor and hypoxaemia and arterial hypotension causative factors. We investigated these hypotheses in an international multicentre study. METHODS: 1218 patients aged at least 60 years completed neuropsychological tests before and 1 week and 3 months after major non-cardiac surgery. We measured oxygen saturation by continuous pulse oximetry before surgery and throughout the day of and the first 3 nights after surgery. We recorded blood pressure every 3 min by oscillometry during the operation and every 15-30 min for the rest of that day and night. We identified postoperative cognitive dysfunction with neuropsychological tests compared with controls recruited from the UK (n=176) and the same countries as study centres (n=145). FINDINGS: Postoperative cognitive dysfunction was present in 266 (25.8% [95% CI 23.1-28.5]) of patients 1 week after surgery and in 94 (9.9% [8.1-12.0]) 3 months after surgery, compared with 3.4% and 2.8%, respectively, of UK controls (p<0.0001 and p=0.0037, respectively). Increasing age and duration of anaesthesia, little education, a second operation, postoperative infections, and respiratory complications were risk factors for early postoperative cognitive dysfunction, but only age was a risk factor for late postoperative cognitive dysfunction. Hypoxaemia and hypotension were not significant risk factors at any time. INTERPRETATION: Our findings have implications for studies of the causes of cognitive decline and, in clinical practice, for the information given to patients before surgery.

Abdomen↗
PubMed1998

Semiology and subtyping of panic disorders.

To date, the quantitative psychopathology of panic disorder (PD) has been less well studied than that of other psychiatric conditions such as schizophrenia or major depression. The aim of the present study was to assess the frequency and factorial grouping of symptoms in a naturalistic sample of PD patients. A total of 274 consecutive cases of PD who contacted an out-patient clinic in Barcelona, Spain were assessed by two experienced interviewers. The assessment instruments included the Structured Clinical Interview for DSM-III-R Upjohn version (SCID-UP-R) and an inventory of panic attack symptoms based on DSM-III-R. Of the patients who presented at the unit during the assessment period, 8.5% presented with PD. Palpitations, shortness of breath, fear of dying and dizziness were the most frequent and intense symptoms reported by the PD patients. Principal-component analysis revealed four factors which accounted for 57% of the variance, including 'cardiorespiratory' (26.1%) and 'vestibular' (15.1%) factors, and two additional factors with mixed symptoms. The frequency of presentation of symptoms was similar to that reported in other studies. However, some discrepancies were observed that may be attributed to transcultural differences as well as to terminological problems and the range of symptoms assessed. These factors may also explain some of the differences found in factor analysis groupings in previous studies. Our findings support the symptom subtyping of PD.

Adolescent↗
PubMed1997

An epidural abscess due to resistant Staphylococcus aureus following epidural catheterisation.

We report a case of abscess formation after epidural analgesia, a rare complication that developed in our patient 13 days after placement of a thoracic epidural catheter for patient controlled analgesia. Culture of the pus grew methicillin-resistant Staphylococcus aureus. Although early diagnosis and rapid management have been reported to yield a satisfactory outcome, the case we describe ended in severe sequelae.

Abscess↗
PubMed1995

Costs and offset effect in panic disorders.

BACKGROUND: The study is aimed at assessing the costs before and after the diagnosis and the provision of effective treatment for panic disorder (PD), and the offset effect related to the psychiatric encounter. METHOD: A 24-month prepost design was used to collect data on clinical status and health care services utilisation in a natural environment. The 61 PD patients' assessment included the SCID-UP, ratings on general functioning, improvement, severity of symptoms and level of disability. All health care services used and lost workdays were recorded. RESULTS: Both sociodemographic characteristics and the outcome show that this was a standard group of PD patients, who received effective treatment for their condition. The total direct costs of health care use during the previous year and the year after the diagnosis were, respectively, US$ 29,158 and US$ 46,256. The indirect costs of lost productivity were US$ 65,643 in period I and US$ 13,883 in period II. CONCLUSIONS: A strong offset effect (94%) has been found in this study, significantly greater than the one described for psychiatric disorders as a whole. The costs of nondiagnosis are usually overlooked when estimating the global costs of PD. Methods for improving early detection of PD may substantially reduce the costs incurred before diagnosis.

Absenteeism↗
PubMed1994

[The use of services, the effect of compensation and the costs of a panic disorder].

BACKGROUND: The use of general health care services by psychiatric patients has decreased drastically following correct diagnosis. This phenomenon, called offset effect, allows the use of inefficient health care services to be evaluated and contributes to the estimation of the relative impact of the disorder in addition to the estimation of the benefits of the training campaigns and/or the implementation of services. The aim of this study was to evaluate the offset effect and the costs of the panic disorder (PD) in a natural environment. METHODS: The clinical data and the use of health care services over 12 months prior to diagnosis and 12 months following diagnosis were collected. Clinical evaluation of 61 patients with PD included a standard interview (SCID-UP), scales of general functioning, improvement, severity of the symptoms and the level of disability. The number of work days missed was also reported. RESULTS: The sociodemographic features, clinical evolution and the rate of response to treatment were comparable to those referred in other studies performed in a natural medium. The direct costs of treatment of AP were 1,795,000 pesetas (1,547,000-1,889,000) higher during the year following the first psychiatric consultation, mainly due to the costs of the visits to the psychiatrist and the medication. On the contrary, the indirect costs were 5,435,000 pesetas less during this period. CONCLUSIONS: In this study on the treatment of patients with the panic disorder a strong offset effect (94%) was found being much greater than that described for general psychiatric disorders. Adequate psychiatric treatment induces in the next 12 months an increase in the cost due psychiatric consultation and medication, however reduces the total costs when absenteeism is taken into account.

Adolescent↗
PubMed1994

Effects of halothane and isoflurane on ventilation and occlusion pressure.

BACKGROUND: Isoflurane has been said to be more ventilatory depressant than halothane. However, data for comparing the respiratory effects of halothane and isoflurane in humans are insufficient at this time. The aim of this study was to extend our understanding of the nature of the central, as opposed to peripheral, ventilatory effect of halothane and isoflurane by comparing them at two concentrations. METHODS: Twenty patients were randomly assigned to receive halothane (n = 10) or isoflurane (n = 10). The patients were studied the day before surgery and during anesthesia immediately before surgery. Ventilatory effects were analyzed in terms of breathing pattern, end-tidal carbon dioxide pressure (PETCO2) and inspiratory occlusion pressure. After anesthetic induction and orotracheal intubation with thiopental and succinylcholine patients were allowed to breathe halothane or isoflurane in oxygen spontaneously at 1.2 (low) and 2.0 (high) minimum alveolar concentration (MAC) applied in random order. Inspiratory active impedance during anesthesia was also measured. RESULTS: Significant reduction of minute ventilation between awake and low MAC states was observed for isoflurane (-34.4%; P < 0.001) but not for halothane. Inspiratory occlusion pressure at 100 ms increased significantly between awake and low MAC states, from 1.43 +/- 0.89 to 2.67 +/- 1.05 cmH2O (P < 0.05) for halothane, representing an 87% increase, whereas a nonsignificant increase (16%) was observed for isoflurane. Both anesthetics showed a dose-related ventilatory depressant effect, not attributable to changes in mechanical properties, reflected by significant reductions in minute ventilation (P < 0.001), tidal volume (P < 0.001), and inspiratory occlusion pressure at 100 ms (P < 0.05) and increases in respiratory rate (P < 0.001) and end-tidal carbon dioxide pressure (P < 0.01) when concentration was increased. However, at the higher concentration a significantly greater reduction of minute ventilation (P < 0.01) was observed for isoflurane (-25.6%) than for halothane (-9.4%). We did not observe differences in respiratory rate between the two anesthetics. Significant differences in inspiratory occlusion pressure wave were observed, characterized by a concave-upward tendency for isoflurane and for high concentration. CONCLUSIONS: Our study confirms the stronger ventilatory depression induced by isoflurane compared with that induced by halothane and indicates that halothane at 1.2 MAC induces significantly less ventilatory depression than expected.

Adult↗
PubMed1994

A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding.

Somatostatin and endoscopic sclerotherapy are widely used in the treatment of acute variceal bleeding. Although objective evidence does exist about the advantages of either treatment, data comparing both procedures are scarce. In order to compare the effectiveness and safety of somatostatin and sclerotherapy in the treatment of acute variceal bleeding, 70 consecutive cirrhotic patients suffering from esophageal variceal hemorrhage and meeting the inclusion criteria were randomly assigned to treatment with somatostatin (35 patients) or sclerotherapy (35 patients). No differences in age, sex, alcohol intake, etiology of cirrhosis and severity of liver failure were found between groups. Failure of treatment (defined as persistence of bleeding despite therapy or subsequent rebleeding within the 48-hr trial period) occurred in seven patients (20%) in the somatostatin group and in six (17.1%) in the sclerotherapy group (NS). Early rebleeding occurred in seven of 28 patients (25%) in the somatostatin group and in five of 29 (17.2%) in the sclerotherapy group (NS). Mortality within the first 6 wk was no different between both groups: 10 (28.5%) and eight (22.8%) in the somatostatin and sclerotherapy groups, respectively. Sclerotherapy, but not somatostatin, was associated with major complications in five cases (14.2%) (p = 0.026), two of which resulted in patient's death. These results suggest that somatostatin is safer, and as effective as sclerotherapy, in controlling acute variceal bleeding until an elective treatment can be established.

Acute Disease↗