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Biomedical subjects

J J Sancho

Publications and source records attributed to J J Sancho.

At least 19 recordsLinked to original sources
PubMed2002

Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis.

BACKGROUND: The prevalence of enterococcal isolation and factors associated with postoperative enterococcal infection remain ill defined. METHODS: A prospective longitudinal observational study was conducted of consecutive patients with a first episode of intra-abdominal infection and a positive microbiological culture who did or did not develop a postoperative septic complication involving enterococci. The prevalence of initial enterococcal isolation was determined for each focus of infection. Postoperative enterococcal infections were related to whether appropriate (piperacillin--tazobactam), suboptimal (carbapenems) or inappropriate (cefotaxime plus metronidazole) antienterococcal therapy had been administered empirically. RESULTS: Enterococci were isolated in 42 (21 per cent) of the 200 patients investigated. The isolation rates were 11 per cent for community-acquired peritonitis, 50 per cent for postoperative peritonitis and 23 per cent for intra-abdominal abscesses of both origins. No enterococci were isolated from 49 patients with perforated appendicitis. Independent factors for postoperative enterococcal infection were type of intra-abdominal infection (P = 0.006), Acute Physiology And Chronic Health Evaluation (APACHE) II score greater than 12 (P = 0.04) and inappropriate empirical antibiotic cover (P = 0.05). Postoperative enterococcal infections were associated with a high mortality rate (21 versus 4 per cent; P < 0.0007). CONCLUSION: Enterococci are frequently isolated from intra-abdominal infections of non-appendiceal origin and are often involved in postoperative infectious complications, particularly peritonitis. Empirical antibiotic therapy covering Enterococcus faecalis should be contemplated in some circumstances.

Abdominal Abscess↗
PubMed2001

Influence of parenteral nutrition on postoperative recovery in an experimental model of peritonitis.

BACKGROUND AND AIMS: There seems to be no clear-cut indications for routine TPN support after major elective surgery. The present study was designed to investigate whether TPN could improve the results of standard surgical care for acute peritonitis (laparotomy plus antibiotics). ANIMALS AND METHODS: Peritonitis was induced in 48 New Zealand rabbits (day -2). On day 0, appendectomy and peritoneal lavage were performed, ceftriaxone (250 mg, i.m./24 h.) was started and animals were randomly assigned to receive regular fluids (RF), glucose-based TPN (G-TPN) or isocaloric fat-based TPN (F-TPN) for 6 days. MAIN OUTCOME MEASURES: Balance studies (days 1-3), s-albumin, thyroid hormones and urinary catecholamines were determined at various points of the experiment. At postmortem, wound infection, residual intra-abdominal infection and laparotomy wound breaking strength were recorded. RESULTS: Peritonitis produced a fall in weight, s-albumin and T3. At day 6, weight-loss was more pronounced in RF than in G-TPN or F-TPN (-7 vs 1.5 vs -1.2%;P=0.0001) but s-albumin and T3 concentrations were similar. Diuresis (377 vs 268 vs 269 mL/3 days; P=0.01) was higher and water balance lower (373 vs 511 vs 480 mL/3 days; P=0.01) in Group RF. Although the differences were not statistically significant (P<0.2), persistent infection and wound breaking strength were slightly worse in the pooled TPN groups compared with the RF group (19 vs 6% and 542 vs 701 g, respectively). CONCLUSIONS: TPN failed to improve relevant biochemical markers and clinical outcome after laparotomy for peritonitis.

Acute Disease↗
PubMed2000

Controlling for chance agreement in the validation of medical expert systems with no gold standard: PNEUMON-IA and RENOIR revisited.

In the validation of medical expert systems, agreement among different human specialists on a random sample of cases may be taken as a substitute to a missing gold standard. Distance measures between pairs of experts, extensively described in previous studies, do not take into account the influence of chance-expected agreement. A weighted kappa index, with three different weighting schemes, is proposed as an alternative to be applied in the general situation of N cases assessed by E experts about K possible diagnoses, each of them qualified with one of G ordinal categories. A hierarchical cluster analysis, applied to the kappa matrices generated, allows for the classification of the expert system among clinical specialists, providing a relative assessment of its diagnostic ability. The above methodology is applied to the validation of two medical expert systems, PNEUMON-IA and RENOIR.

Cluster Analysis↗
PubMed2000

Learning just-in-time in medical informatics.

Just-in-time learning (JITL) methodology has been applied to many areas of knowledge acquisition and dissemination. The paradigm is a challenge to the traditional classroom course-oriented approach with the aim to shorten the learning time, increasing the efficiency of the learning process, improve availability and save money. The information technology tools and platforms have been heavily involved to develop and deliver JITL. This paper discusses the main characteristics of JITL with regard to its implementation to teaching Medical Informatics.

Audiovisual Aids↗
PubMed1999

European and Latin-American countries associated in a networked database of outstanding guidelines in unusual clinical cases (ELCANO).

The aim of ELCANO, an EU-funded project, is to build a virtual multilingual multimedia library of unusual clinical cases related to gastroenterology. Based on a standardisation of the format to report and the representation of clinical information on WWW, the multilingual multimedia case has been developed and till now 350 cases have been included. User satisfaction and user acceptance of ELCANO are under evaluation.

Databases as Topic↗
PubMed1998

Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation.

BACKGROUND: Emergency operation in the elderly carries a high risk of death. We investigated the incidence of euthyroid sick syndrome (ESS) and associated nutritional and endocrine abnormalities and their relationship to postoperative outcome in this population. METHODS: Sixty-six patients older than 70 years of age requiring emergency operations were assessed before any therapeutic intervention. Values for thyroid hormones, catecholamines, cortisol, interleukin-6, interleukin-1, C-reactive protein, and the Acute Physiology and Chronic Health Evaluation II score were determined. Nutritional assessment was carried out. Mortality rates and duration of hospital stay were related to ESS and albumin concentrations. RESULTS: ESS was diagnosed in 34 patients (51.50%) and was associated with worse Acute Physiology and Chronic Health Evaluation II scores (10.9 vs 8.6; p = 0.004), hypoalbuminemia (34.7 vs 40.8 gm/L; p = 0.0001), lower triceps skinfold (11.8 vs 14.6 mm; p = 0.03), and higher cortisol and norepinephrine levels (937 vs 741 nmol/L [p = 0.04] and 358 vs 250 pg/ml [p = 0.02], respectively), interleukin-6 plasma concentrations (347 vs 113 pg/ml; p = 0.01), death rate (20% vs 0%; p = 0.02), and length of hospital stay (17.2 vs 11.8 days; p = 0.03). A serum albumin level less than 35 gm/L was virtually always associated with ESS. CONCLUSIONS: ESS is highly prevalent in the elderly with acute surgical problems and is associated with poor nutrition, higher sympathetic response, and worse postoperative outcome. The serum albumin level at admission is a specific marker of ESS.

APACHE↗
PubMed1998

IMASIS. A multicenter hospital information system--experience in Barcelona.

The present study aimed to analyse physicians' attitudes towards IMASIS, and their potential influence on IMASIS medical record project. IMAS (Institut Municipal d'Assistència Sanitària) is the health care organisation of the City Council of Barcelona. IMAS hospital information system (IMASIS), which first applications were designed and implemented in 1984, is currently facing a new phase, focused on clinical information management. Our approach included a personal interview with representatives of every hospital unit, and a self-administered questionnaire distributed to every clinician. Both provided a worthy insight into the cultural patterns to be considered in the HIS implementation process. Moreover, the results helped to define the subsequent steps of IMASIS evolution. Our experience is proposed as a tool to assess clinical informations systems from a user point of view.

Adult↗
PubMed1995

[Informatics in medical schools and postgraduate education centers for health professionals. Survey on the situation in Spain].

BACKGROUND: Informatics is acquiring an increasing relevance in the medical profession. METHODS: During the year 1993, a survey was carried out at the medical schools (MS) and postgraduate education centres (PEC) in Epidemiology, Public Health and Health Administration of Spain, on the available computer infrastructure and the teaching activities. The percentages of respondents were 81 at the MS and 100 at the PEC. RESULTS: 81% of the MS and 100% of the PEC had a computer laboratory, mainly equipped with personal computers with MS-DOS operating system. The use of general purpose applications was predominant. The number of students using the computer laboratory was very variable (5-300 per day). 48% of the MS organized courses on microcomputer applications. 66% of the MS included subjects related with informatics in the new curricula. CONCLUSIONS: Use of computers in the Spanish MS is heterogeneous. Compared with the Nord-American MS, they do not usually use applications of computer-assisted-instruction. The use of the computers at the PEC is much more generalized.

Curriculum↗
PubMed1995

Inadequate levels of metronidazole in subcutaneous fat after standard prophylaxis.

The efficacy of antibiotic prophylaxis depends on appropriate tissue levels of the drug being present at the time of potential wound contamination. Metronidazole concentrations in serum, muscle and subcutaneous fat were measured after a single intravenous dose given at two different intervals before operation. Twenty-six patients undergoing abdominal wall procedures were divided into two groups. Patients in group 1 received metronidazole 500 mg intravenously 2 h before surgery, and those in group 2 were given the drug during induction of anaesthesia. Mean plasma levels of metronidazole at the beginning of the procedure were significantly lower (P = 0.01) in group 1 (7.3 (95 per cent confidence interval 5.7-8.9)) micrograms/ml than in group 2 (12.3 (8.9-15.7)) micrograms/ml although in both cases were above the minimum inhibitory concentration for 90 per cent of Bacteroides fragilis. Similar therapeutic concentrations of metronidazole were achieved in plasma and muscle in both groups at the end of the operation. However, patients in both groups had non-therapeutic concentrations of metronidazole in subcutaneous fat: group 1 0.9 (0.6-1.2) micrograms/mg, group 2 1.2 (0.7-1.7) micrograms/mg at the beginning of operation, and 1.2 (0.8-1.6) and 1.5 (0.9-2.1) micrograms/mg respectively at the end of the procedure. It is concluded that infusion of metronidazole 2 h before surgery or during induction of anaesthesia achieved adequate plasma and muscle levels but failed to achieve therapeutic levels in subcutaneous fat.

Adipose Tissue↗
PubMed1995

Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula.

Somatostatin and octreotide both enhance closure of gastrointestinal fistulas. The present trial was undertaken to test whether early combined treatment with parenteral nutrition and octreotide 100 micrograms every 8 h by subcutaneous injection had a beneficial effect compared with parenteral nutrition plus placebo. Thirty-one patients with post-operative gastrointestinal or pancreatic fistula were randomly assigned to receive parenteral nutrition plus octreotide (14 patients) or placebo (17) within 8 days of fistula onset. The percentage reduction in output and rate of spontaneous closure within 20 days were analysed. Mean(s.d.) reduction in output was similar after octreotide and placebo at 24 h (66(43) versus 68(47) per cent, P = 0.9), 48 h (60(46) versus 57(43) per cent, P = 0.8) and 72 h (62(50) versus 66(49) per cent, P = 0.9) after starting the combined treatment. Closure within 20 days was observed in eight of 14 fistulas in patients given octreotide and in six of 17 in those receiving placebo (P = 0.4). Administration of octreotide, within 8 days of fistula onset, associated with parenteral nutrition does not significantly increase the spontaneous fistula closure rate compared with parenteral nutrition plus placebo.

Aged↗
PubMed1995

Influence of nutrition, thyroid hormones, and rectal temperature on in-hospital mortality of elderly patients with acute illness.

The present study was undertaken to investigate the interrelation of nutrition, core temperature, and thyroid function and their influence on survival of patients aged > or = 70 y admitted to the hospital with acute conditions. Sixty-seven patients entered the study. Nutritional state, thyroid function, rectal temperature, and the APACHE II score were recorded at admission. The patients were followed until death or hospital discharge. Patients with a serum albumin concentration < 35 g/L showed a lower triiodothyronine (T3) concentration, a higher reverse triiodothyronine (rT3) concentration, and a higher death rate. Prior weight loss (> or = 10%) did not influence thyroid status but increased the mortality rate. Eleven patients were hypothermic (< 36.5 degrees C) and had a higher mortality, lower total T3 concentration, and higher rT3 concentration than the normothermic or hyperthermic subjects. Serum albumin, body weight, and total T3 concentration were higher in survivors (n = 51) than in nonsurvivors (n = 16). Ongoing weight loss and hypoalbuminemia at admission are highly prevalent in elderly people with acute disease, and influence their clinical outcome. Mild hypothermia was a good predictor of death. Hypoalbuminemia and hypothermia were associated with low T3 and high rT3 values.

APACHE↗
PubMed1994

Validation of the medical expert system RENOIR.

RENOIR is an expert system developed to assist the diagnosis of 37 diseases of connective tissue and inflammatory arthropathies. Precise diagnosis of rheumatic diseases implies great uncertainty and there is no gold standard with which to compare the expert system output. To overcome this problem a set of clinical cases was submitted to RENOIR and its diagnoses were compared with those of clinicians. Medical records of 81 patients with rheumatic diseases were interpreted by RENOIR and by 12 clinicians at three different expertise levels in rheumatology. Distances between the likelihoods of the 37 considered diseases provided by clinicians and RENOIR were computed as a disagreement measure. Mahalanobis distance was used to correct the collinearity between the possibilities of each pair of diseases. Using the resulting matrices of distances between experts, cluster analyses were carried out to classify RENOIR among human experts. Greater differences between RENOIR and clinicians than among clinicians themselves were not found.

Cluster Analysis↗
PubMed1994

Influence of calorie source on the physiological response to parenteral nutrition in malnourished rabbits.

The present study was designed to investigate whether calorie source influences sodium and water metabolism and sympathetic activity during parenteral nutrition (PN). 20 New Zealand rabbits were starved until a mean weight loss of 18% was achieved and then re-fed for 6 days with 2 formulae of PN with different glucose-fat proportions. In the Glucose group (n = 9), 70% of non-protein calories were given as glucose while in the Lipid group (n = 11), 70% of non-protein calories were administered as lipids. Rabbits with a high glucose intake showed significantly higher weight gain (151 +/- 87 vs. 52 +/- 7 g, P = 0.01), water cumulative balance (542 +/- 132 vs. 411 +/- 87 ml; P = 0.02) and urinary metanephrine excretion (0.42 +/- 0.12 vs. 0.30 +/- 0.1 mumol/d, P = .03). Only in this group, urinary metanephrines correlated positively with water and sodium balances (r2 = 0.6; P = 0.02 and r2 = 0.7; P = 0.009 respectively). The Glucose group showed 2 different responses and in a second experiment 10 additional rabbits were added to this group to allow a statistical analysis of the response pattern: half of the animals increased their extracellular water (ECW) compartment while the remaining animals did not. The former group had higher sodium balance (13.9 +/- 8 vs. 4.3 +/- 5; P = 0.004) and wet lung weight (8.9 +/- 0.9 vs. 7.9 +/- 0.8; P < 0.05) after re-feeding and, at the beginning of PN, their serum aldosterone concentration were also higher (221 +/- 11 vs. 130 +/- 47 pmol/l; P < 0.05). In conclusion, glucose based PN appears to increase sympathetic activity and induce spurious weight gain due to markedly positive wate and sodium balances. Plasma aldosterone concentration at the end of starvation period influences sodium retention and ECW expansion during high glucose re-feeding.

Journal Article↗
PubMed1993

Introducing medical students to medical informatics.

Medical informatics (MI) has been introduced to medical students in several countries. Before outlining a course plan it was necessary to conduct a survey on students' computer literacy. A questionnaire was designed for students, focusing on knowledge and previous computer experience. The questions reproduced a similar questionnaire submitted to medical students from North Carolina University in Chapel Hill (NCU). From the results it is clear that although almost 80% of students used computers, less than 30% used general purpose applications, and utilization of computer-aided search of databases or use in the laboratory was exceptional. Men reported more computer experience than women in each area investigated by our questionnaire but this did not appear to be related to academic performance, age or course. Our main objectives when planning an MI course were to give students a general overview of the medical applications of computers and instruct them in the use of computers in future medical practice. As our medical school uses both Apple Macintosh and IBM compatibles, we decided to provide students with basic knowledge of both. The programme was structured with a mix of theoretico-practical lectures and personalized practical sessions in the computer laboratory. As well as providing a basic overview of medical informatics, the course and computer laboratory were intended to encourage other areas of medicine to incorporate the computer into their teaching programmes.

Computer Literacy↗
PubMed1992

Validation of the medical expert system PNEUMON-IA.

The present study validates the expert system PNEUMON-IA. The aim of PNEUMON-IA is assessing the etiology of community-acquired pneumonias from clinical, radiological, and laboratory data obtained at the onset of the disease. Validation was performed using data from medical records of 76 patients with proven clinical diagnosis of pneumonia. The etiological diagnoses provided by PNEUMON-IA were compared to those established by five specialists unrelated to the development of the expert system. For each etiological possibility, both PNEUMON-IA and the experts provided a causal possibility, expressed as a linguistic label (i.e., "almost impossible"). Linguistic labels were then converted to numeric values. In the majority of cases, an etiological diagnosis was unavailable to be used as a gold standard. To overcome this limitation, distances between arrays of etiological possibilities given by specialists and by PNEUMON-IA were considered as an agreement measure between diagnoses. Cluster analysis based on those distances was used to classify PNEUMON-IA among experts. Results showed the same differences between specialists and PNEUMON-IA as among the specialists themselves. The method used to validate PNEUMON-IA could prove useful to assess the performance of expert systems in fields where no gold standard is available.

Adolescent↗
PubMed1989

Medullary thyroid carcinoma. The need for early diagnosis and total thyroidectomy.

Forty patients with medullary thyroid carcinoma and 3 patients with C-cell hyperplasia were studied. Seventeen (40%) cases were sporadic and 26 (60%) were hereditary. Eight patients had type lla multiple endocrine neoplasia, 7 patients had type llb multiple endocrine neoplasia, and 11 patients had familial nonmultiple endocrine neoplasia medullary thyroid carcinoma. Mean follow-up was 6.3 years, with actuarial survival of 88% and 78% at 5 and 10 years (22 and 13 patients), respectively. Seven patients died 1.5 to 10 years after the initial operation; all had advanced disease at presentation (6 with distant, 1 with lymph node metastasis). No deaths occurred in patients with familial nonmultiple endocrine neoplasia medullary thyroid carcinoma, C-cell hyperplasia, or medullary thyroid carcinoma limited to the thyroid gland. Nineteen (68%) of 28 patients diagnosed without screening had regional or distant metastases, whereas only 6 (40%) of 15 patients diagnosed by screening had metastases. Twenty-six patients treated initially with total thyroidectomy and central neck clearance required an average of one reoperation, whereas those with lesser initial procedures required an average of two reoperations. We concluded that (1) familial nonmultiple endocrine neoplasia medullary thyroid carcinoma, early medullary thyroid carcinoma or C-cell hyperplasia, and asymptomatic patients have a good prognosis; (2) screening for medullary thyroid carcinoma by measuring serum calcitonin levels results in earlier diagnosis; and (3) total thyroidectomy and central neck clearance is the procedure of choice for medullary thyroid carcinoma.

Adult↗
PubMed1989

Measurement of body water compartments after ligation of the common bile duct in the rabbit.

To elucidate the pathogenesis of renal insufficiency associated with obstructive jaundice we have studied spontaneous water intake and body water compartments in rabbits undergoing common bile duct ligation. Total body water, extracellular water and plasma volume were measured by multi-isotope dilution technique. During the initial 6 postoperative days spontaneous water intake was 898 ml in sham operated animals (SO) but only 280 ml in jaundiced rabbits (OJ6) (P less than 0.01). Creatinine clearance was almost unchanged in SO but fell to 60 per cent of the preoperative values both in OJ6 and in paired-drink sham operated animals (SO2). There was a 15 per cent decrease in total body water (P less than 0.01) and a 24 per cent decrease in extracellular water (P less than 0.01) 6 days after bile duct ligation. There was a further reduction of the extracellular water to 35 per cent and a 15 per cent reduction of plasma volume 12 days after ligation. Water restriction mimicked the alterations in body composition produced by bile duct ligation. We conclude that bile duct ligation is associated with hypodypsia and a depletion of extracellular water and plasma volume. These alterations could explain the tendency to develop hypotension and renal failure which are associated with obstructive jaundice.

Animals↗