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J Cortina

Publications and source records attributed to J Cortina.

At least 19 recordsLinked to original sources
PubMed2001

[Surgical reconstruction of intervalvular fibrous body in active infective endocarditis].

INTRODUCTION AND OBJECTIVES: Surgery for infective endocarditis with paravalvular abscesses and fibrous body destruction has the highest mortality and morbidity rates in this disease with high surgical risk. We report a new approach of radical resection of the abscess and affected tissues and reconstruction of the heart with pericardium as an alternative to conventional surgery. METHODS: In the last two years six patients with infective endocarditis, paravalvular abscesses and fibrous body destruction underwent surgery (five prostheses with infective endocarditis). The main indication for surgery was persistent sepsis despite adequate antibiotic treatment in five patients and congestive heart failure in one. After wide resection of the abscesses and fibrous body the heart was reconstructed with glutaraldehyde-fixed bovine pericardium. RESULTS: There was no hospital mortality. The median bypass and clamp times were 198 and 174 minutes, respectively. One patient presented complete AV block and a permanent transvenous pacemaker was implanted. Doppler echocardiographic studies performed in all the patients prior to discharge indicated that no patient had patch dehiscence or paravalvular leaks. Patients were followed a mean of 15 months with no deaths or other complications being reported. CONCLUSIONS: Resection of the abscesses and fibrous body, and reconstruction of the heart with glutaraldehyde-fixed bovine pericardial patch is a radical, feasible technique with all infected tissues being resected to thereby prevent reinfection or paravalvular leaks.

Abscess↗
PubMed2000

Coronary surgery in Europe: comparison of the national subsets of the European system for cardiac operative risk evaluation database.

OBJECTIVE: To compare the national samples of patients who underwent isolated coronary artery bypass grafting (CABG) during the European System for Cardiac Operative Risk Evaluation (EuroSCORE) trial in order to evaluate national differences in epidemiology, patient risk profile and surgical methods. METHODS: From September to November 1995, 11731 patients had CABG in the six largest contributing nations to the EuroSCORE project: Germany, UK, Spain, Finland, France and Italy. The Chi-square and Kruskal-Wallis tests were applied to obtain an international comparison of patient general status, including pre-operative risk factors, cardiac status, critical pre-operative states, rare conditions, urgency of surgery, angina status, coronary lesions, procedures and EuroSCORE risk assessment. RESULTS: Large national samples (from 984 patients in Finland to 3138 in Germany) identified significant differences in epidemiology, risk profile and surgical practice. Regarding epidemiology, CABG accounted for 62.8% of adult cardiac surgery, with a range of 46.2 in Spain to 77.7% in Finland (P<0.001). The mean age was 62.9 years (61.4 in Britain to 64.4 in France, P<0.001). The mean body mass index was 26.8 (26 in France to 27.5 in Finland, P<0.001). With regard to risk profile, diabetes was present in 20.3% of patients (11.8% in Britain to 27.7% in Spain, P<0.001). Chronic renal failure was present in 8.3% (6.8% in Germany to 10.6% in Spain, P<0.001). Chronic airway disease affected 3.8% (1.9% in Italy to 5. 1% in Germany, P<0.001). The mean ejection fraction was 0.56 (0.48 in Britain to 0.58 in Finland, P<0.001). The mean predicted mortality (according to EuroSCORE) was 3.3% (2.8% in Finland to 3.6% in France, P<0.001). The prevalence of chronic congestive heart failure, unstable angina and recent myocardial infarction also showed statistically significant differences. No differences were found for some critical preoperative states (such as immediate preoperative cardiac massage and pre-operative intubation), or for surgery for catheter laboratory complication. Regarding surgical practice, major differences were noted in preoperative intra-aortic balloon use (mean 1%, Finland 0%, Spain 2.3%, P<0.001), the number of mammary artery conduits used (mean 0.9, Spain 0.7, France 1.1, P=0.0001) and the number of distal anastomoses (mean 3, France 2.7, Finland 3.8, P=0.001). CONCLUSION: There are important epidemiological differences in the national cohorts of CABG patients in the EuroSCORE database. Any international comparison of European surgical results must therefore take into account the risk profile of patients by using a compatible risk stratification system.

Aged↗
PubMed2000

Race, age, and back pain as factors in completion of residential substance abuse treatment by veterans.

OBJECTIVE: Variables associated with successful completion of residential substance abuse treatment were identified. METHODS: The records of 340 veterans admitted to a 120-day substance abuse treatment program were retrospectively analyzed. The likelihood of successful treatment completion was calculated as a function of race, age, gender, psychiatric diagnosis, past suicide attempts, homelessness, legal history, childhood physical or sexual abuse, parental history of addiction, multiple substance dependence, medical problems, and the race of the therapist. Univariate analysis and logistic regression analysis were used to identify variables that were significant predictors of treatment completion. RESULTS: Overall, 66 percent of veterans completed the program. Eighty-two percent of the veterans admitted to the program were black, and 16 percent were white. The completion rate of black veterans (71 percent) was significantly higher than that of white veterans (49 percent). Veterans completing treatment were significantly more likely to be older, by an average of two years, than those who did not complete treatment. The association between younger age and failure to complete the program was largely accounted for by younger black veterans. Veterans with back pain were significantly less likely to complete treatment than those without back pain. Completion rates did not vary by the other variables examined. In the regression analysis that included age, race, and back pain, each variable, when adjusted by the other variables, was a significant predictor of completion. CONCLUSIONS: White patients were less likely to complete residential substance abuse treatment in a program in which the majority of both therapists and patients were black. Younger black veterans and those with back pain were also less likely to complete treatment.

Adult↗
PubMed1999

Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients.

OBJECTIVE: To assess risk factors for mortality in cardiac surgical adult patients as part of a study to develop a European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS: From September to November 1995, information on risk factors and mortality was collected for 19030 consecutive adult patients undergoing cardiac surgery under cardiopulmonary bypass in 128 surgical centres in eight European states. Data were collected for 68 preoperative and 29 operative risk factors proven or believed to influence hospital mortality. The relationship between risk factors and outcome was assessed by univariate and logistic regression analysis. RESULTS: Mean age (+/- standard deviation) was 62.5+/-10.7 (range 17-94 years) and 28% were female. Mean body mass index was 26.3+/-3.9. The incidence of common risk factors was as follows: hypertension 43.6%, diabetes 16.7%, extracardiac arteriopathy 2.9%, chronic renal failure 3.5%, chronic pulmonary disease 3.9%, previous cardiac surgery 7.3% and impaired left ventricular function 31.4%. Isolated coronary surgery accounted for 63.6% of all procedures, and 29.8% of patients had valve operations. Overall hospital mortality was 4.8%. Coronary surgery mortality was 3.4% In the absence of any identifiable risk factors, mortality was 0.4% for coronary surgery, 1% for mitral valve surgery, 1.1% for aortic valve surgery and 0% for atrial septal defect repair. The following risk factors were associated with increased mortality: age (P = 0.001), female gender (P = 0.001), serum creatinine (P = 0.001), extracardiac arteriopathy (P = 0.001), chronic airway disease (P = 0.006), severe neurological dysfunction (P = 0.001), previous cardiac surgery (P = 0.001), recent myocardial infarction (P = 0.001), left ventricular ejection fraction (P = 0.001), chronic congestive cardiac failure (P = 0.001), pulmonary hypertension (P = 0.001), active endocarditis (P = 0.001), unstable angina (P = 0.001), procedure urgency (P = 0.001), critical preoperative condition (P = 0.001) ventricular septal rupture (P = 0.002), noncoronary surgery (P = 0.001), thoracic aortic surgery (P = 0.001). CONCLUSION: A number of risk factors contribute to cardiac surgical mortality in Europe. This information can be used to develop a risk stratification system for the prediction of hospital mortality and the assessment of quality of care.

Adolescent↗
PubMed1998

A new approach to cardiac valve replacement through a small midline incision and inverted L shape partial sternotomy.

OBJECTIVE: Minimally invasive cardiac surgery is becoming more popular as an alternative technique in some cardiac operations. We report our experience with an inverted 'L' ministernotomy in 25 patients and describe the technical details of this new approach. METHODS: From June 1996 to February 1997 we performed 25 ministernotomy approaches for cardiac surgery, 17 aortic and 7 mitral valve replacements and 1 atrial septal defect closure. A comparison group included all patients (n = 126) operated on for mitral or aortic valve replacement through a median sternotomy since June 1996. RESULTS: Ventilatory support, Intensive Care Unit stay and hospital stay were 8.3 h (SD = 4 h), 25 h (SD = 8 h) and 5.5 days (SD = 3 days) in the L ministernotomy group and 11.5 h (SD = 5), 53 h (SD = 11) and 9.1 days (SD = 4 days) in the median sternotomy group (P < 0 05). Mortality and morbidity are similar to conventional sternotomy (hospital mortality 4% vs. 5.5%; P not significant). CONCLUSIONS: We conclude that inverted L ministernotomy for cardiac surgery is a safe approach and can offer some advantages over the conventional approach.

Aortic Valve↗
PubMed1997

Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure.

OBJECTIVE: The authors examined the refusal of antipsychotic medications and associated outcomes prospectively in a group of 348 psychiatric patients admitted to three acute inpatient units in a state-operated mental health facility in Virginia where psychiatrists have the discretionary power to administer treatment over patients' objections. METHODS: Newly admitted patients were administered both a questionnaire to ascertain their attitudes toward admission and the Brief Psychiatric Rating Scale (BPRS). Patients who refused antipsychotic medication were identified, and data were collected on the length of refusal and whether the refusal episode was terminated voluntarily or involuntarily. A group of patients compliant with antipsychotic medication was selected for comparison on outcome measures, including the rate of seclusion and restraint and length of hospitalization. RESULTS: Patients who refused treatment were found to have significantly higher BPRS scores than were patients who complied with antipsychotic treatment and more negative attitudes toward hospitalization and past, present, and future treatment. Refusal episodes were brief, on average 2.8 days, and all patients, who refused treatment were treated. When compared with the compliant patients, patients who refused treatment were more likely to be assaultive, were more likely to require seclusion and restraint, and had longer hospitalizations. CONCLUSIONS: Psychiatrists exercised their discretion to promptly treat all patients who refused treatment. Nonetheless, these patients suffered more morbidity than compliant patients. This study suggests that the negative sequelae of in-hospital treatment refusal cannot be eliminated by rapid treatment. The policy implications are discussed.

Adult↗
PubMed1996

[Infection of sternal wound in heart surgery: analysis of 1000 operations].

BACKGROUND: Sternal wound infection (SWI) is the most important complication in cardiac surgery. The aim of this study was to describe the frequency and clinical and microbiological features of this complication. METHODS: All the cases of SWI which were observed in the authors' hospital in the first 1,000 cardiac surgery operations performed with extracorporeal circulation were retrospectively reviewed. The cases were identified through the Infectious Diseases and Cardiac Surgery Department files and were classified according to the depth of the infection. During the study period neither the prophylaxis against infection nor the surgical techniques were modified. RESULTS: Forty-three patients (4.3%) presented SWI. Fourteen were superficial infections and 29 were deep infections of which 9 were classified as osteomyelitis and 20 as mediastinitis. A progressive decrease was observed in the proportion of SWI over time parallel to an increase in the number of operations performed. Staphylococcus aureus was the agent most frequently isolated (60.4%). Gram-positive aerobic cocci were found in 66.7% of the total number of isolations, being most frequent in the deep infections (83.3% of the isolations). The gram-negative aerobic bacilli were isolated more frequently in the superficial infections than in the deep infections (57.8% v.s. 16.7% of the isolations, respectively p < 0.01). In patients with SWI the predictive value of the positive blood cultures for the diagnosis of mediastinitis was 83.3%, with a sensitivity of 50% and specificity of 91.3%. Three patients with deep infection developed chronic complications and another three died (mortality by mediastinitis 15.0%). The mean postoperative stay was 52 days for the patients with deep infection and 39 days for those with superficial infection (p = NS). CONCLUSIONS: The percentage of surgical wound infection during the study period showed a trend to a decrease parallel with an increase in the number of operations. The gram-positive bacteria were responsible for most of the SWI. Although the depth of SWI is difficult to clinically predict, the presence of bacteremia suggests the existence of mediastinitis. Despite their lesser clinical importance, the superficial infections carry a long postoperative stay.

Blood↗
PubMed1996

Modifications in the evolution of the dominant frequency in ventricular fibrillation induced by amiodarone, diltiazem, and flecainide. An experimental study.

In 22 anesthetized mongrel dogs, spectral methods were used to analyze the surface electrocardiogram (ECG) for the time course of the dominant frequency in ventricular fibrillation and its modifications under the influence of amiodarone, diltiazem, and flecainide. The ECG was recorded over 5 minutes after triggering ventricular fibrillation. Following A/D conversion and by applying the Fourier fast transform, the frequency spectrum of the signals was obtained. In group 1 (5 dogs), the ECGs were obtained without prior drug administration; group 2 (5 dogs) first received amiodarone, 5 mg/kg; group 3 (7 dogs) received diltiazem, 0.2 mg/kg; and group 4 (5 dogs) received flecainide, 2 mg/kg. All drugs were administered intravenously. An initial increase in the dominant frequency of ventricular fibrillation was found in the control group and also in the groups that received amiodarone, diltiazem, or flecainide. Diltiazem significantly increased the dominant frequency and diminished the arrhythmia-slowing process. Amiodarone and flecainide tended to diminish the dominant frequency.

Amiodarone↗
PubMed1996

[Survival in patients with sick sinus syndrome and artificial pacemaker. Determining clinical factors].

INTRODUCTION AND OBJECTIVE: The hypothesis that ventricular pacing is the most important factor in the survival of patients with Sick Sinus Syndrome remains controversial. The aim of this report was to determine independent clinical variables to predict survival in paced SSS patients. METHODS: Retrospective, nonrandomized study of 153 patients with a mean age of 69 +/- 11 years, who received an initial pacemaker for Sick Sinus Syndrome between 1980 and 1994: 65 physiologic pacing (32 dual chamber, 33 atrial) and 88 ventricular pacing mode. After a maximum follow up of 177 months (median 57 months) the end point was total mortality. RESULTS: Total mortality was 21%. Using univariate analysis, single chamber ventricular pacing, age > or = 70 years and NYHA > or = 2, was associated with a higher risk for total mortality (4 times increased risk for ventricular pacing compared to other pacing modalities). Independent predictors using multivariate analysis were: 1) NYHA > or = 2 (p < 0.05). 2) Coronary artery disease (p < 0.01). 3) Chronic obstructive pulmonary disease (p < 0.05) and 4) Gender (p < 0.05). CONCLUSIONS: Mortality in patients with the Sick Sinus Syndrome is strongly predicted by preimplant baseline clinical variables. Our data indicate that the role of ventricular pacing mode remains inconclusive. A large, randomized study is necessary to confirm these results.

Age Factors↗
PubMed1996

[Thromboendarterectomy as a treatment for chronic pulmonary hypertension].

Chronic pulmonary hypertension is an extremely difficult disease to diagnose and is usually identified by the exclusion of other more recognized causes of enlargement in mean pulmonary arterial resistance. Up to now, treatments proposed for this disease, have not been very successful. Medical procedures are not a long term proper solution which leads the process to an irreversible point whose only solution should be a pulmonary transplantation. In recent years, study groups have established a surgical method, alternative to transplantation, which has been able to increase, with a decrease in mortality rates, a longer and a better quality of life for the patients affected by this disease: we are talking about pulmonary thromboendarterectomy.

Chronic Disease↗
PubMed1996

[Aortic valve replacement via ministernotomy].

Minimally invasive cardiac surgery is arising as an alternative technique in some cardiac operations. We present the first aortic valve replacement via ministernotomy. We describe in detail the technique of ministernotomy and the limitations that this new approach would have. We conclude with the advantages of minimally invasive cardiac surgery over conventional approach and review other techniques described in the literature.

Aortic Valve↗
PubMed1996

[Cardiovascular surgery in Spain in 1994. Registry of Interventions of the Spanish Society of Cardiovascular Surgery (SECCV)].

The Spanish Society of Cardiovascular Surgery Registry of 1994 includes data from 44 hospitals. Within this year a total of 25,385 patients were operated on, with an average of 577 operations/ center. Fourteen thousand one hundred and fifteen of these were cardiac operations under extracorporeal circulation, with an average of 320 cases/hospital. The number of coronary surgeries was greater to that of valvular procedures (6,660 vs 5,386). The average of coronary graft/patient was 2.67. The 67.6% of these were arterial grafts. The hospital mortality was 7.8%, 5.9%, 6.6%, 7.0% and 4.1% for 1, 2, 3, 4 and 5 or more grafts, respectively. The number of valvular prothesis implanted was 6,243 and 80.7% of these were mechanical. There were 2,274 (58.2%) patients operated on aortic valvular surgery and 1,582 by mitral surgery, with a mortality of 5.9 and 8.6%, respectively. The number of patients operated on for congenital cardiac defects was 1,993 (1,367 open heart surgeries and 626 closed). There were 5,023 operations by peripheral vascular surgery. The number of aneurysms operated on during this year was 506.

Cardiac Surgical Procedures↗
PubMed1995

[A method for the predictive estimation of the surgical risk in adult cardiac pathology].

INTRODUCTION: In order to test the efficiency of statistical predictive models, we compare the results of a standard method (Parsonnet) with the model created through the data of our population. MATERIAL AND METHODS: We used the chi 2 univariate model, lineal and logistic regression with the data of the whole population receiving cardiac surgical procedure from January 1, 1990 to December 31, 1993 (total 1626 patients). The population was divided into a control group (1100 cases, 68%) and a study group (526 cases, 32%). The coefficients of the control group were used to estimate the results in the study group. RESULTS: Univariate model p value. Significant (p < 0.001) for emergency, age, pulmonary hypertension, left ventricular failure, preoperative use of intra-aortic balloon pump; p < 0.05 mitral valve disease, aortic aneurysm and reoperation. No significance (p < 0.01) was found for gender, aortic or tricuspid disease, percutaneous transluminal coronary angioplasty, unstable or postinfarction angina, transplant, left main or vessel disease number, and mitral, tricuspid or aortic procedure. MULTIVARIATE MODEL: Emergency, pulmonary hypertension, age, left ventricular dysfunction and aortic aneurysm. We estimated a 5.2%, 5.2% and 11.4% mortality with linear, logistic and Parsonnet method respectively with a real group mortality of 6.5%. The average error of the observed and predicted mortality after risk stratification was 5.7%, 6% and 12%. CONCLUSION: A model for risk prediction based on the data of the own institution is more accurate for that population than a model created for comparison between institutions, because the former takes account of the center and population peculiarities.

Adult↗
PubMed1995

[The emergency heart transplant].

From the International Registry on Cardiac Transplantation we can not infer a higher mortality in urgent or emergent Cardiac Transplantation. The data in the Spanish Registry and in the literature show that the risk is higher in these patients compared to non urgent transplantation, implying ethical considerations which are discussed in the article. A different approach to urgent transplantation could be based on previous circulatory support, or heart assist systems as a bridge to transplantation.

Assisted Circulation↗
PubMed1994

The influence of different electrode configurations on the inhibitory effect of subthreshold high-frequency stimuli.

Subthreshold stimuli trains may inhibit the response to a subsequent suprathreshold stimulus; the inhibitory effect decreases or even disappears when the subthreshold stimuli are delivered apart from the suprathreshold stimulus. The purpose of this study is to analyse, in atrial epicardium, the influence of different electrode configurations upon the inhibitory effect of subthreshold stimuli trains delivered at a short distance from the explored zone. In 18 anaesthetized dogs, the basal atrial effective refractory period was determined using an epicardial unipolar cathodal electrode. A second determination was performed when a subthreshold stimuli train (1 ms cathodal pulses, 800 Hz, and intensity 10% less than the diastolic threshold of the train) was delivered prior to the extrastimulus through: (a) 8 electrodes equidistant (4.5 mm) from the central test electrode (Group 1, n = 5); (b) a 1 mm wide ring electrode, 2.5 mm from the central test electrode (Group 2, n = 7); and (c) a 3.5 mm wide ring electrode, 2.5 mm from the central test electrode (Group 3, n = 6). A third determination was performed in all experiments delivering both the subthreshold stimuli train and the extrastimulus through the same central test electrode. Atrial effective refractory period did not vary significantly with respect to the basal values in Group 1 (141 +/- 22 vs 142 +/- 25 ms; ns) though it increased in Group 2 (168 +/- 27 vs 142 +/- 18 ms; P < 0.01) and in Group 3 (160 +/- 20 vs 133 +/- 25 ms; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Effect of site, summation and asynchronism of inputs on atrioventricular nodal conduction and refractoriness.

The impulses coming from the sinus node synchronically penetrate the AV node via the crista terminalis and inter-atrial septum. Studies in superfused rabbit AV preparations suggest that the crista terminalis is a more effective input than the inter-atrial septum, and that the summation of both inputs facilitates AV nodal conduction. The aim of this study was to verify the hypothesis in a more physiological model, such as the whole rabbit heart perfused by a Langendorff system. Fifteen rabbit hearts were studied in a Langendorff perfusion system with six bipolar extracellular electrodes: two for stimulating (crista terminalis and inter-atrial septum) and four for recording (crista terminalis, inter-atrial septum, His bundle electrogram and right ventricle). Seven hearts (Group I) were consecutively paced at the crista terminalis, inter-atrial septum and both sites simultaneously, to determine the AV nodal Wenckebach cycle length and effective refractory period under basal conditions and after acetylcholine (0.75 x 10(-6) M). In eight hearts under 0.75 x 10(-6) M acetylcholine (Group II), the crista terminalis and inter-atrial septum were simultaneously (delay = 0 ms) or sequentially (delay = 2, 4, 6, 8, 10, 12, 14, and 16 ms) stimulated to calculate the AV nodal effective refractory period and the AH interval at an atrial coupling interval 5 ms longer than the AV nodal effective refractory period, for each delay tested.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗