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Biomedical subjects

J García García

Publications and source records attributed to J García García.

At least 19 recordsLinked to original sources
PubMed2003

[External ear melanoma].

Cutaneous melanomas are the tumours that have increased more their incidence in the last fifty years. Melanomas arising from the external auditory canal are extraordinariously unfrequent. These tumours show an aggressive and silent behaviour, and due to this the diagnosis is frequently made in an advanced stage. A male with a malignant melanoma arising from his left external auditory canal was attended in our department, suspecting an epidermoid carcinoma. The clinical findings and the extension of the lesion required a lateral temporal bone resection, parotidectomy and neck dissection to achieve a total resection. We present a review of the literature about this entity and an analysis of the incidence, significance of the lymph node metastases and value of the elective neck dissection.

Ear Neoplasms↗
PubMed2001

[Triage criteria in a emergency department].

OBJECTIVE: Accurate patient triage for the early identification of potentially seriously ill or high-risk children is needed due to the increasing demands made on paediatric emergency departments. MATERIAL AND METHODS: A set of triage criteria for patient selection was established. Between October 1998 and April 1999 we selected 20 days with maximum patient flow in our emergency department (average 225 children/day). Patients who satisfied the triage criteria were selected. The following variables were studied: age, sex, triage criteria, waiting time, visit time and final diagnosis. RESULTS: Five hundred and thirteen patients satisfied our triage criteria (11% of patients admitted to the emergency department). Median age was 3.4 years. The most frequent complaints (criteria) were dyspnea (36.4%), referral to the emergency department by another physician (29%), fever and rash (11.7%) and age under 1 month (5.8%). The most common causes of patient referral to hospital were acute abdominal pain and fever (31% each). Waiting and visit times were 29 and 55 minutes, respectively. CONCLUSION: Definition of selection criteria seems effective and equivalent to other triage systems and allows optimization of human resources.

Adolescent↗
PubMed2001

[Causes of adolescent visits to the emergency department].

OBJECTIVE: To determine the complaints leading adolescents to a third level emergency department, as well as the distinguishing features between the different groups of complaints. MATERIAL AND METHODS: Retrospective study of the emergency department reports of 170 adolescents selected from the 1,172 adolescents who visited the Hospital Sant Joan de Déu pediatric emergency department in May 1997. We excluded 517 patients with trauma. Statistical analysis was carried out with the chi-square test for qualitative variables and analysis of variance for quantitative variables; differences were accepted as significant at p,0.05. RESULTS: Eighty-nine patients were female and 81 were male. Median age was 13.8 years. The most frequent discharge diagnoses were abdomen pain in 26 patients, viral illness in 15 and depression-anxiety in 14. Complementary investigations were carried out in 60 patients. One hundred forty-one patients were discharged. Of the 26 patients with psychiatric disorders, 18 were girls and 8 were boys. The proportion of girls was also higher among patients with abdominal and neurological symptoms, although not among patients with organic disorders (p50.03). Most of the patients with psychiatric antecedents were diagnosed with a psychiatric disorder. Ten (11.8%) of the 85 patients with organic complaints were admitted to hospital compared with 13(50%) of the 26 patients with psychiatric disorders (p,0.001). CONCLUSIONS: Adolescents visit emergency departments for a variety of complains. The proportion of psychiatric disorders and non-specific symptoms is high.

Adolescent↗
PubMed2000

[Predictors of sudden death in coronary artery disease].

Although advances in the management of acute myocardial infarction have resulted in a decline in long-term risk of sudden death, it continues to be high in certain subsets of patients. Thus, it is important to identify and treat these patients. Left ventricular ejection fraction less than 0.40, frequent premature ventricular ectopy on Holter monitoring, late potentials on signal-averaged electrocardiogram, impaired heart rate variability, abnormal baroreflex sensitivity and inducible sustained monomorphic ventricular tachycardia during electrophysiological study are predictors of sudden death and arrhythmic events. Although the negative predictive value of each factor is high, the positive predictive accuracy is low. Several tests can be combined to obtain higher positive predictive values. In fact, in some studies combined noninvasive tests have been used to select patients for ventricular stimulation study. Some preventive treatment can be applied in these patients. Available data do not justify prophylactic therapy with amiodarone in high-risk survivors of acute myocardial infarction. Sudden death and total mortality have been significantly reduced in postinfarction patients by long-term beta blockade. Hence, beta blockers should be given to all patients with acute myocardial infarction who do not have contraindications to their use. The MADIT study has shown the beneficial effect of implantable cardioverter defibrillator in reducing mortality in patients with prior myocardial infarction, an ejection fraction less than 0.36, asymptomatic nonsustained ventricular tachycardia, and inducible sustained ventricular tachycardia, unsuppressable by procainamide. Besides, several studies are under way to evaluate the prophylactic use of implantable defibrillator for improving survival in high-risk patients.

Coronary Disease↗
PubMed1999

[Internal cardioversion with low-energy shocks in atrial fibrillation resistant to external electric cardioversion].

BACKGROUND AND OBJECTIVE: Although external electrical cardioversion is effective in most patients with atrial fibrillation, there are cases refractory to external cardioversion. This study is aimed at showing our initial experience with an internal cardioversion system in patients with previous unsuccessful external cardioversion. PATIENTS AND METHODS: Between February, 1997 and September, 1998 nine consecutive patients with spontaneous chronic or persistent atrial fibrillation that failed external cardioversion, were included. Internal cardioversion was performed under sedation with two electrodes that had a 5.5 cm coil placed in the lateral right atrium and coronary sinus. Both electrodes were connected to an external defibrillator capable of delivering R-wave synchronized low-energy biphasic shocks following a minimum RR interval of 500 ms. Energy between 2 J and 10 J was applied until the restoration of sinus rhythm or a maximum of 2 shocks of 10 J. RESULTS: Sinus rhythm was achieved in the nine patients, but in two of them atrial fibrillation recurred after a few beats. Both had underlying structural heart disease. The other 7 patients, 5 of them without structural heart disease, were in sinus rhythm at discharge. No mechanic complications or ventricular arrhythmias were observed. Six patients are in sinus rhythm after 4 +/- 3 months of follow-up. CONCLUSIONS: Low-energy intracardiac cardioversion is useful in some patients with atrial fibrillation that had failed external cardioversion and can be performed without general anesthesia.

Adult↗
PubMed1999

[Adrenal oncocytoma].

OBJECTIVE: To describe an additional case of adrenocortical oncocytoma that had been incidentally discovered. METHODS/RESULTS: A case of adrenocortical oncocytoma in a 30-year-old male is presented. Patient evaluation by US, CT and arteriography revealed a well-defined mass between the upper pole of the left kidney, spleen and stomach, that appeared to be of adrenal origin. Histopathological and ultrastructural studies revealed a benign adrenocortical oncocytoma with moderate cell atypia but with no signs of infiltration. CONCLUSION: Adrenocortical oncocytoma must be included in the differential diagnosis of solid adrenal tumors.

Adenoma, Oxyphilic↗
PubMed1999

[Pregnancy and HIV infection: the need for routine serological evaluation].

OBJECTIVES: To determine the frequency of pregnancies among HIV-infected women in a sanitary area. To evaluate the proportion of women not receiving anti-retroviral treatment to decrease vertical transmission and the reasons why this treatment was not administered. PATIENTS AND METHODS: Point prevalence study performed on all women followed for 1997 at the HIV Infection Unit in a 360-bed hospital. The following variables were obtained: social class, civil status and place of residence, risk factors for HIV infection, obstetric antecedents (pregnancies, number of term pregnancies, living newborns) as well as prescription or not of anti-retroviral therapy during pregnancy. RESULTS: Out of 85 women included in the study, 51 (60%) reported to have had a pregnancy and 17 of these (33%) had interrupted the pregnancy at some time. No significant differences were found between pregnancy or abortion and the analyzed socio-demographic variables or risk factors for HIV infection. Only 12% of women with a full length pregnancy received anti-retroviral therapy. Of women with term pregnancy who were not treated, most (63%) did not know they were infected before delivery and an additional 10% refused therapy. Forty-four percent of women with children continued with pregnancy despite knowing they were infected. Vertical transmission occurred in a 13% of cases in which no therapy was instituted and in no case in which zidovudine was administered during pregnancy. CONCLUSIONS: The frequency of pregnancies among HIV-infected women is high in our area and a substantial number of women do not know they are infected. These data support the serological study to HIV in all pregnant women and the necessity of a higher level of information in order that the seropositive women be aware of the responsibility she takes when she decides to go on with her pregnancy.

AIDS Serodiagnosis↗
PubMed1997

[Tuberculosis en pediatric patients in the island of Gran Canaria].

OBJECTIVE: Tuberculosis is still an important sanitary problem in our country, which has a high rate of endemia. The pediatric population is highly susceptible to being exposed and has a high risk of developing the disease, as well as of suffering serious forms of it. The aim of this study was to analyze the clinical aspects and characteristics of pediatric patients who were diagnosed with tuberculosis in Gran Canaria during a nine years period. PATIENTS AND METHODS: The clinical charts of 49 children between 0 and 14 years of age who were diagnosed of having tuberculosis between 1986 and 1994 were revised. Tuberculosis was diagnosed when M. tuberculosis was isolated from at least one clinical sample. RESULTS: Of the children diagnosed, 69.4% were less than 5 years of age. Only one child had antibodies against HIV. Clinical forms were; pulmonary (33 cases), disseminated (13 cases), genitourinary (1 case), osteoarticular (1 case), and lymphatic (1 case). No association was found between any clinical form and any age group. The disseminated form presented more frequently with a negative Mantoux test (p < 0.01). In all cases lung disease was present and three patients also suffered meningitis. In most of the cases (77.8%), it was necessary to wait for the result of the culture to reach the diagnosis. Two children (4.1%) died and six (12.2%) had sequeale. CONCLUSIONS: Disseminated tuberculosis is relatively frequent (26.5%) in this population and is usually associated with a negative Mantoux test. Therefore, it appears that in this serious form of the disease, a high degree of clinical suspicion is needed and mycobacteria cultures must be done in clinical samples of different origins.

Adolescent↗
PubMed1995

[The return to work after coronary revascularization].

INTRODUCTION: Work resumption after a therapeutical intervention has been considered as a sensitive indicator of its success. There are some reports analyzing working status after coronary artery revascularization in western countries. However, to our knowledge, similar studies have not been published in Spain. PATIENTS AND METHODS: We studied 210 patients after coronary artery revascularization surgery or percutaneous transluminal coronary angioplasty. Exclusion criteria were age of 65 or more years and female sex gender (n = 64). RESULTS: Working patient rate before and after coronary revascularization was respectively 63.2% and 28.9% for surgery, and 57.1% and 41.4% for percutaneous angioplasty (p = 0.11). None of the former inactive patients, with the exception of one in the surgery group, went back to work after the revascularization procedure. Asymptomatic patients after percutaneous angioplasty had a higher postprocedure working rate than symptomatic ones (58.1% vs 11.1%, p < 0.0001). Patients in the surgery group did not show this relation (30% vs 25%, p = 0.69). CONCLUSIONS: Surprisingly, coronary artery revascularization interventions, mainly coronary surgery, seems to behave in our environment as important determinants of working cessation.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Echocardiography during transesophageal atrial pacing. Its applicability and diagnostic value].

INTRODUCTION AND OBJECTIVES: Atrial pacing has been proposed as an alternative method to the isotonic exercise, to induce ischemia, and, joined to two-dimensional echocardiography, as one of the main modalities in stress echo. In order to analyse its applicability and diagnostic value in assessing coronary artery disease this study was undertaken. PATIENTS AND METHODS: 52 patients referred to coronarography for suspicion or evaluation of ischemic disease, were submitted to this technique. RESULTS: The study was completed in 44 patients (applicability rate of 84,7%). The results obtained showed a sensitivity, specificity and diagnostic accuracy for the regional wall motion abnormalities echocardiographically detected, of 88%, 68% and 79%, respectively. When electrocardiographic changes or presence of angina during atrial pacing were added to echocardiographic data, sensitivity increased to 96%. In 41 patients in which a conventional stress test was available, sensitivity was 55% electrocardiographically, 33% clinically and 68% globally. CONCLUSIONS: It is concluded that transthoracic two-dimensional echocardiography during atrial pacing is a safe, highly sensitive method for coronary artery disease detection. The limitations of the method for its routine clinical application are also analysed.

Adult↗
PubMed1994

[Critical study of the Kennedy-LAD procedure].

The authors report their experience with ligament repair, using the Kennedy-LAD technique in 19 cases of chronic anteromedial and anterolateral instability. The postoperative follow-up was 3 to 4 years. They conclude that this repair provides excellent stability, but that the results are jeopardized by serious problems of biocompatibility; in 63% there was recurrent synovitis. According to the "Arpège" criteria, there was a mean of 58% poor results and 42% good or excellent results. Twenty-one percent of the patients were satisfied with the operation, and 25% were seriously dissatisfied. Stability, as evaluated by the postoperative radiological active Lachman test, was normal in 84% of the patients (0-6 mm anterior tibial deplacement).

Adolescent↗
PubMed1993

[Malignant vasovagal syncope: its diagnosis and therapeutic trial based on the orthostatism test (the tilt-table test)].

Seventy consecutive patients with recurrent unexplained syncope were evaluated by use of an up-right tilt-table test for 45 minutes (with or without an infusion of isoproterenol) in an attempt to reproduce symptoms. There were 42 males and 28 females with a mean age of 49 +/- 20 years (range 7-86), and with a mean symptoms duration of 35.2 +/- 16 months. All the patients underwent clinical examination which includes cardiological and neurological evaluation. Some tilt positive patients received therapy with either transdermal scopolamine, metoprolol or clonidine, the efficacy of which was evaluated by another tilt-table test. Syncope occurred in sixteen patients (22.9%), during the baseline tilt associated with hypotension (2 patients), bradycardia-asystolia (3 patients), or both (11 patients). In 11 patients with normal baseline tilt test, isoproterenol infusion was used appearing 4 new cases of abnormal response. Some patients who had positive test results, eventually became tilt-table negative by therapy (5 out of 8 patients treated with scopolamine, 5 out of 6 patients with metoprolol, and 3 out of 5 patients with clonidine). Time before syncope during tilt-test was increased with therapy, being of 45 min in normalized cases, and increasing from 11.9 +/- 16 basal to 34.4 +/- 17 min with scopolamine (p < 0.05), to 40 +/- 12 min with metoprolol (p < 0.05) and to 33.7 +/- 16.7 min with clonidine (p = NS). We conclude that upright tilt-table alone or combined with isoproterenol infusion is an useful test in the diagnosis of vasovagal syncope and in the evaluation of therapy.

Adolescent↗
PubMed1991

[Hypertrophic myocardiopathy (I). The clinical and echocardiographic characteristics of a population of 72 patients].

The results of the echocardiographic evaluation of 72 patients with hypertrophic cardiomyopathy are presented. We have measured left ventricular wall thickness in 8 different segments and classified our patients in 6 types according to the hypertrophy extent. Moreover, we have evaluated by Doppler ultrasound the presence and severity of mitral regurgitation and the left ventricular inflow and outflow. The hypertrophy cardiomyopathy pattern was symmetric in 8 patients, apical in five, and asymmetric in 31. According to Maron classification, asymmetric cardiomyopathy was I type: 4 patients, II type: 16, III type: 11, and IV type: 0 patients. There were left ventricular outflow obstruction (greater than 25 mmHg) in 26 patients (36.1%). This obstruction was more frequent in II and III type hypertrophic cardiomyopathy and we found significative relationship between septal posterior segment hypertrophy and left ventricular outflow obstruction. Ventricular inflow showed bad distensibility pattern in 45 patients (62.5%). Mitral regurgitation was mild, moderate and severe in 25, 15, and 4 patients. Left ventricular outflow obstruction, bad distensibility pattern and mitral regurgitation were independent each other.

Adolescent↗