Biomedical subjects
Publications and source records attributed to J L Manzano.
We report a case of Pasteurella multocida pneumonia and its unusual clinical presentation. We also discuss the rarity of its diagnosis by TPC specimens and the delay in both an adequate diagnosis and treatment.
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In order to examine the prognostic value of pulmonary arterial hypertension (PAH) in patients with moderate and severe acute respiratory failure (ARF), 225 patients with ARF who had been treated with mechanical ventilation and admitted to our ICU during a 3-yr period (January, 1983 to January, 1986) were prospectively studied. All 70 (31%) patients with moderate and severe ARF also had some form of hemodynamic or pulmonary instability, and were monitored with a pulmonary artery catheter. Of these 70 patients, 38 (54%) had PAH (mean BP 29 +/- 6 mm Hg); their mortality was 79% (30/38). The rest of the patients (n = 32) did not have PAH (mean BP was 15 +/- 3 mm Hg) and their mortality was 44% (14/32) (p less than .01). Thirty patients met all the criteria for adult respiratory distress syndrome (ARDS), and their mortality was 70% (21/30); all of them were included among the 38 PAH patients. ARDS patients who died had a significantly higher pulmonary vascular resistance and a significantly lower cardiac index than patients who survived (p less than .001). We conclude that PAH (present in all our ARDS patients) is a good predictor of mortality in ARF of diverse causes.
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To solve the problem of data management, a digital computer was introduced in this ICU in 1977. Data are manually entered at the bedside alpha-numeric keyboards; two beds are directly connected to the computer. The system was especially designed to work in the 11-bed ICU; its functions are: (1) admission, discharge, and transfer data of patients; (2) management of doctors' and nurses' notes in a free text form; (3) management of the problem-oriented record; (4) management of physical and bio chemical variables, medical disorders, and fluid balance; and (5) diagnostic and therapeutic decision-making. Since 1977, the authors have computerized over 2600 patients and now conclude: (1) data management and communication have improved, thus, allowing nurses more time for direct patient care; (2) teaching of the residents and nurses has been facilitated and minimizes disparities from their diverse experience; (3) it has contributed to the development of protocols for many of the procedures; and (4) it has led to a more systematic approach to patient care. The assistance of a professional computer programmer and continuous maintenance of the software are essential.
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The technique of resuscitation of the asphyxiated newborn with one minute Apgar score of less than three and the results of the revision of 27 of the 55 resuscitated newborns are presented. Eighteen of the 55 patients (32%) needed to be transfused with blood, albumin, Ringer, due to hypotension but in eight of them this hypotension was only detected after the correction of the acidosis. In all the other patients ventilation and bicarbonate were only required for resuscitation and two of them received small doses of atropine, isoprenaline or adrenaline. Even though six of the 55 patients died, their death did not happen during resuscitation and so, the immediate results were 100% successful. Twenty seven patients were seen within six to 18 months after resuscitation and only 14% of them presented serious pathology. Therefore the organisation of a resuscitation team in each hospital not only would reduce neonatal mortality but morbidity also.
In the Intensive Care Unit of our General Hospital, where an important obstetric-pediatric unit exists, 392 infants have been treated from August 1974 to 1976. Although the results of all age groups are shown, the neonatal one is specially considered. All those patients who recovered and were discharged from the hospital were called for revision and the results of those whom attended are shown. The convinience of the regionalisation and hierarchisation of these intensive care units and the necessity of adequately organise the communication and transport of these patients from the peripheral small units to the regional one, is emphasized.
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BACKGROUND: Apoptosis is a programmed cell death, genetically controlled, that can be activated by physiological and pathophysiological events and by the administration of several drugs, including the exogenous administration of corticosteroids. The aim of this study was to develop a rat model of intestinal lymphocytic apoptosis induced by dexamethasone to determine if apoptosis could be prevented by enteral or parenteral nutrition. METHODS: Male Sprague-Dawley rats were used. On day 0, the right internal jugular vein was catheterized for parenteral nutrition, and a silicone tube was inserted into the duodenum for enteral feeding. Animals (n = 6/group) were randomly assigned to one of the following 3 feeding regimens: an immune-enhancing enteral diet; its placebo (the same formula without immunonutrients); and isocaloric isonitrogenous parenteral nutrition. On the seventh day, 200 microg of dexamethasone or vehicle were administered by i.v. bolus, and the diets were continued for 1 more day. Intestinal Peyer patches and thymic lymphocytic apoptosis were determined both by flow-cytometry and immunohistochemistry. RESULTS: A single dexamethasone dose (200 microg/rat) administered to surgically treated rats fasted for 18 hours, 24 hours later, caused massive intestinal and Peyer patches lymphocytic apoptosis (96 +/- 2% and 85 +/- 5%, respectively; p < .0001 versus vehicle in both kinds of tissue). Lymphocytic apoptosis was reduced to almost indetectable levels in intestinal and lamina propia lymphocytes (from 96 +/- 2% to <0.6%; p < .0001). Peyer patches lymphocytic apoptosis was reduced as well (from 85 +/- 5% to 15 +/- 7.1%; p < .001) in animals prefed the 2 enteral nutrition formulas. Those prefed parenteral nutrition only showed a partial decrease of lymphocytic apoptosis in the intestine (from 96 +/- 2% to 53 +/- 23%; p < .001). Nutrition had no effect on the dexamethasone-induced thymus involution. CONCLUSIONS: Enteral nutrition prevents intestinal intraepithelial and lamina propia lymphocytic apoptosis due to dexamethasone. These findings support the use of early enteral nutrition in critically ill patients treated with corticosteroids.
A complete understanding of the computer's capabilities and an exact identification and definition of the ICU problems/needs are essential for the complete control of patient records and the full utilization of the computer as a clinical tool.
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