[Resolutive fibrinolysis in a case of acute mesenteric ischaemia] [In Process Citation]
Explore the source record for details and available documents.
Journal Article↗
Biomedical subjects
J Larrea
Publications and source records attributed to J Larrea.
[Brief fibrinolysis in a case of acute mesenteric ischemia].
Explore the source record for details and available documents.
Acute Disease↗
Insulin therapy for a non-diabetic patient with severe hypertriglyceridemia.
OBJECTIVE: To compare the short and long term effectiveness of fish oil, insulin, and gemfibrozil in a non-diabetic patient with severe hypertriglyceridemia. METHOD: An adolescent male with hypertriglyceridemia (triglyceride level 4575 mg/dl) and abdominal pain was treated with the goal of immediate reduction and maintenance of triglyceride (TG) level below 1000 mg/dl. Fish oil, insulin and gemfibrozil were administered sequentially, in separate time blocks, for a duration of 3, 6, and 6 months, respectively. RESULTS: Fish oil took several weeks to lower TG level, and patient compliance during 3 months of therapy was inadequate. Insulin was effective in immediately lowering the TG level, but was unable to maintain the level below 1000 mg/dl. Gemfibrozil was ineffective in achieving the immediate reduction of TG level; however, it was adequate in maintaining the desired level in the long-term and patient compliance was better than with the fish oil. CONCLUSION: In patients with risk of pancreatitis due to severe hypertriglyceridemia, immediate reduction of the triglyceride level is achievable by using a single dose of regular insulin (0.1 unit/kg, subcutaneous) while long-term maintenance therapy can be provided by gemfibrozil.
Abdominal Pain↗
Abnormal thyroid function tests in infants with congenital hypothyroidism: the influence of soy-based formula.
OBJECTIVE: To assess the etiology of hyperthyroxinemia or hyperthyrotropinemia in infants with congenital hypothyroidism who are on replacement therapy with L-thyroxine. METHODS: These infants were treated with recommended doses of L-thyroxine following the diagnosis of congenital hypothyroidism. Because of hyperthyroxinemia (2 patients) and hyperthyrotropinemia (1 patient), medication compliance and dietary practice (formula type, age of introduction, and discontinuation or change of the formula) were assessed. Clinical evaluation was also performed. RESULTS: Elevated thyroxine level in 2 infants was associated with discontinuation of soy formula 4 weeks previously; reduction of L-thyroxine dose normalized serum levels in both of these infants. In the third infant, who received soy formula from 1 week of age, TSH remained elevated despite incremental L-thyroxine doses of 19 micrograms/kg/day; discontinuation of soy formula was followed by normalization of the TSH in 3 weeks and helped attain a subsequent decrement of L-thyroxine dose to 8.6 micrograms/kg/day. Neither the hyperthyroxinemia nor hyperthyrotropinemia in these infants was associated with any adverse behavioral-developmental consequence. CONCLUSION: When initiating soy-formula feeding in infants with congenital hypothyroidism, the L-thyroxine dose should be increased because of significant reduction in intestinal absorption: conversely, when soy feeding is discontinued, the L-thyroxine dose should be decreased.
Congenital Hypothyroidism↗
[Modification of nutritional septic risk in perioperative transfusion].
Explore the source record for details and available documents.
Humans↗
[Preoperative nutritional assessment: a 1-year experience].
A study was made of 443 surgical patients using a standard protocol for nutritional evaluation based on anthropometrical, analytical and immunological tests. The main criteria used for considering the presence of malnutrition was a weight loss of 10% and/or seric albumin level of less than 3.5 g/dl., by which method four nutritional groups were established. The average age of the sample was 56 +/- 15 years and 35% of patients had neoplasias, 9.25% of patients were classified as belonging to Group A (weight loss and low albumin levels), 10.15% as group B (low albumin levels), 14.44% as group C (weight loss), and 66.16% as group D (normal), so that the global malnutrition percentage was 33.84%. The Body Mass Index (BMI) and Ideal Weight Percentage (% IWP) were of similar importance, and there was a significant alteration in the Triceps Skin Fold (% TSF) and Muscular Area Percentage of the arm (% MAP) when malnutrition was in evidence. In the study of the Delayed Hypersensitivity Skin Tests (DSST) 21.4% showed anergia, 15.8% hypoergia and 62.8% were reactive, with a reduction in reactivity in the case of malnutrition. This was the parameter that most affected the albumen level.
Adult↗
[The nutritional status and immunological situation of cancer patients].
A study was performed on the nutritional state of a sample of 138 patients with digestive and extradigestive neoplasias. The study protocol was based on anthropometric, analytical and immunological tests. The main criteria for malnutrition were as follows: loss of 10% or more in normal weight and/or albumen levels of less than 3.5 gr/dl. A global malnutrition percentage of 56.5% was obtained. The highest malnutrition percentages were found among patients with neoplasia of the oesophagus (78.9%) and the lowest in neoplasias of the breast (9.1%). From the nutritional standpoint, neoplasias of the rectum showed an extradigestive behaviour, with a low malnutrition percentage (40%) compared to digestive tumors. The global malnutrition level for the sample studied was 56.6%. The muscular compartment was the most affected in cases of malnutrition. In the PCHR results, no evidence of the effect of the nutritional state on the alteration of these was recorded (Chi 2 = 6.42, p = 0.207).
Aged↗
[Immunologic consequences of malnutrition: assessment with multitest].
Presentation of a clinical study of 256 patients eligible for elective surgery, with the purpose of evaluating the immunological consequences of malnutrition. With this aim, retarded hypersensitivity skin tests were performed. The malnutrition criteria used included 10% normal weight loss and/or seric albumin levels of less than 3.5 g/dl. There were 99 patients in total (38.67%) with malnutrition criteria. Within this group 21.79% showed positive responses compared to 38.88% of control group (p less than 0.001). The "average papule" in the group suffering from malnutrition was 4.18 +/- 2.06 and in the control group, 3.64 +/- 2.20 (p less than 0.001), with a significant increase in tuberculine papule in the group with malnutrition.
Adult↗
[Liaison psychiatry: a new perspective on mental health in Latin America].
The situation of Mental Health in Latin America is analyzed. Urgently creating a system able at handling the psychiatric disease increase in the years to come is a conclusion this paper strongly aims at. The beginning of Psychiatry is reviewed, and the importance of Psychiatry at the General Hospital is outlined as well as its rapprochement toward the community, which led to a better control and prevention in the field of Mental Health. A definition of Psychiatry is proposed, as a branch of Medicine which stands in between mental hospitals and communities. Active teamwork, coupled with the physician's work and the tasks other members of the health personnel are engaged in, has led to a more integrated approach onto the ill thus benefiting not only patients but also the whole community.
Delivery of Health Care↗
[Peroperative transfusion and postoperative infections in patients with benign pathology of the digestive tract].
A prospective study of 136 patients submitted to elective surgery for benign digestive tract pathology, submitted to elective surgery, has been done to evaluate the influences of the nutritional state and the perioperative transfusions on the development of postoperative infections. All patients were given a nutritional evaluation protocol based on anthropometric parameters, analytical data and delayed-type hypersensitivity skin tests (DHST). The criteria for undernourishment were a standard weight percentage lower than 90% and/or an albumin level lower than 3.5 g/dl. Transfusion indication was established at hemoglobin levels lower than 10 g/dl and/or hematocrit values below 30% with perioperative transfusion being considered as that which took place within three weeks prior to the surgery, that taking place during the surgery, and that which took place within the first 48 postoperative hours. The infections were qualitatively evaluated as wound infection, intraabdominal infection and respiratory infection, and quantitatively by means of the Elebeute and Stoner index. 32 of the patients (23.5%) presented undernourishment, and 18 of the patients (13.2%) were transfused. A total of 20 patients (14.7%) presented a postoperative infection. A significant association between under nourishment and infection has been shown (p =), as between transfusion and undernourishment (p < 0.001). Finally, we confirm that the combination of the factors undernourishment and transfusion leads a significance increase (f = 28,462, p < 0.001) of infectious complications.
Adult↗
[The role of multiparameter indices in preoperative nutritional assessment].
The consequence of malnutrition in surgical patients is an increase in post-operative complications. Detection of alteration in the nutritional state is a target in surgery theatres, using a variety of methods, notably anthropometry, analytic protein calculation, and delayed hypersensitivity cutaneous trials, which provide and objective assessment of the different body behaviors. A drawback is the large number of calculations required per patient, so that there is a limited number of patients with all the normal tests. To improve results in predicting complications in surgical patients based on nutritional parameters, the use is proposed of Multiparametric Nutritional Indices, obtained from the joint valuation of those parameters, by using multivariable statistical calculation techniques. The main indices in the literature are described. Multiparametric Indices are useful and easily calculated for the nutritional screening of surgical populations.
Humans↗
[The prediction of postoperative septic complications by means of nutritional parameters. II. The verification of the predictive formula].
An assessment was made of the predictive capacity of the following predictive formulation named Nutritional Sepsis Risk: NSR = 14.26 - 1.76 (albumin) - 1.47 (risk area) This was done in a sample of 65 surgery patients with digestive pathology who were candidates for selective surgery. All had undergone a pre-operative nutritional evaluation program, based on anthropometric and analytical data and Retarded Hypersensitivity Cutaneous Tests (RHCT). NSR was calculated pre-operatively. Infections were assessed qualitatively and quantitatively using Elebeute and Stoner's sepsis index. There were a total of five post-operative infections (7.69%). The NSR intersection point was calculated with an ROC curve, situated in a score of 3. The NSR detected the five infections, so is 100% sensitive, with 70% specificity and, in the detection of the septic risk population, surpassed the other nutritional parameters, whether anthropometric or analytical, and the RHCTs, when they were studied individually.
Aged↗
[The prediction of postoperative septic complications via nutritional parameters. I. The prognostic formulation].
A study has been made of the influence of the nutritional situation on post-operative infections in a sample of 217 patients. A nutritional evaluation file was prepared for each of them, based on anthropometric and analytical tests and delayed hypersensitivity skin tests (PCHR) during the first 24 hours of hospital admission. The criteria whereby a post-operative infection was considered to be present were surgical wound infection, intra-abdominal infection, pneumonia and post-operative fever of 38.5 degrees C or more without a demonstrable septic focus. They were also evaluated quantitatively using Elebeute and Stoner's sepsis index. In the study of the anthropometric parameters, the relation was noted between the body mass index (BMI) and usual weight Percentage (HW%), and septic risk areas (RA) were defined, as a new anthropometric data. A total of 33 patients (15.2%) showed some type of post-surgical infection, manifested in this group by an alteration of the nutritional state revealed by a lower BMI, increased weight loss, a lower albumin rate than in the control group. The septic prognostic value of the RAS is confirmed: no relation was found between septic complications and the PCHR. Finally a multiple regression procedure was prepared between the Elebeute and Stoner sepsis index and all the nutritional parameters studied, to give the following nutritional sepsis risk prognosis index (RSN): NSR = 14,265 - 1,764 x Albumin - 1,427 x Risk Area.
Adult↗
[Variability of anthropometric parameters].
Presentation of a comparative study of four ideal weight tables applied to the same population, in order to evaluate the differences or similarities between the same. Significant differences (p<0.001) were found between the four tables studied (WHO, USA, Barcelona, Tenerife) when classifying a patient into one of the three groups defined (malnutrition, normal and obese). The maximum differences found were between the Barcelona and Tenerife tables, which classified 13,7% and 24.05% respectively as cases of malnutrition and 35.9% and 16.89% respectively as obese.
Adult↗
[Incidence of malnutrition in a surgery department].
Presentation of a description of the initial results obtained in nutritional evaluation of patients admitted for elective surgery during a 6-month period. A total of 212 patients were studied, recording malnutrition in 25%. This was severe in half of the cases. As a result of the malnutrition, a significant reduction was observed in the number of positive responses to the Multitest and the total count of lymphocytes.
Adult↗
[Modification of the nutritional septicemic risk (RSN) by means of perioperative transfusion].
A prospective study was carried out in 207 patients with benign and neoplastic diseases of the digestive tract who were candidates for elective surgery, in order to evaluate the influence of the nutritional status and perioperative transfusions on the appearance of postoperative infections. All patients were subjected to a nutritional assessment study based on anthropometric parameters, analytical data, and cutaneous delayed hypersensitivity tests. With the aim of establishing a risk potential for postoperative infection based on the nutritional status of the patients, a multi-parametric index called Nutritional Septicemic Risk (NSR) was applied to all. NSR = 14.265 - 1.764 + Albumin - 1.472 x risk area The criteria that were considered to indicate Proteic Caloric Malnutrition (PCM) were the presence of a Usual Weight Percentage (UW%) lower than 90% and an albumin level lower than 3.5 g/dl. Transfusions were indicated at Hemoglobin levels lower than 10 g/dl and/or a Hematocrit lower than 30%. The perioperative transfusion was defined as that which took place within three weeks prior to the surgery, during the surgery itself, and that which took place during the first 48 hours postoperatively. The postoperative infections have qualitatively been evaluated as: infection of the surgical wound, intraabdominal abscess, and respiratory infection. A total of 80 patients (38.6%) showed some degree of malnutrition. With regard to the transfusions, 55 patients (26.6%) underwent a transfusion. The univariable study has identified the nutritional status as classified according to the NSR multi-parametric index, neoplastic disease, perioperative transfusion and a surgical intervention time greater than two hours, as being risk factors of infection. By means of the logistic regression study, the nutritional status (NSR score) and the perioperative transfusions have been identified as independent risk factors.
Blood Transfusion↗