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Biomedical subjects

J M Ramos

Publications and source records attributed to J M Ramos.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Serologic diagnosis of severe non-bacterial pneumonia and acquired in the community].

BACKGROUND: The aim of this study was to evaluate the profitability of the serology, especially against Streptococcus pneumoniae and Chlamydia sp., in the community pneumonia with hospital admission. METHOD: Descriptive and retrospective study. One hundred fifty-five pair of sera of 129 patients adults and 26 patients with less of 15 years with pneumonia were analysed. Antibody against respiratory virus, Coxiella burnetii, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia sp. and S. pneumoniae were investigated. RESULTS: The serology diagnosis was obtained in 58 patients (37.4%) (42 [32.6%] adults and 16 [61.5%] children; p = 0.006). The pneumonia most frequently detected was caused by M. pneumoniae (21 cases; 13.5%), followed by Chlamydia spp. (13, 8.4%), S. pneumoniae (8, 5.2%) and mixed infection in other 7 cases. Detection of antibodies against pneumococcus and Chlamydia sp. improved as a whole in 8.4% (from 29% to 37.4%), a 10.9% (from 22.5 to 32.6%) in adults and none case in children. Moreover, a major proportion of mixed infection and by syncytial respiratory virus in children (19.5 and 11.5%, respectively) versus adults (1.6 and 0%, respectively; p < 0.1) was observed. CONCLUSION: With the detection of antibodies against Chlamydia spp. by indirect immunofluorescence and capsular polysaccharide pneumococcal by enzyme-immunoanalysis increased the etiologic diagnosis of the community pneumonia.

Adolescent↗
PubMed1995

Role of laparoscopy in colorectal surgery. A prospective evaluation of 200 cases.

PURPOSE: The aim of this study was to prospectively evaluate the role of laparoscopic-assisted surgery in patients presenting for routine colorectal surgical procedures. METHODS: Two hundred consecutive patients were assessed for the possible use of laparoscopic surgery. The decision regarding suitability of the patient for the procedure was made by the operator. For the purpose of analysis, patients were assigned to open, converted, and laparoscopic groups. RESULTS: Ninety-five of 200 patients were considered appropriate for laparoscopic surgery, 62 (65.3 percent) being successfully completed. These completed operations included right colectomy (24/30), sigmoid colectomy (22/36), appendectomy (9/10), anterior resection (3/8), abdominoperineal resection (3/5), and left colectomy (1/2). Complications attributable to laparoscopy were infrequent (6.3 percent) and were not responsible for any deaths. Patients in the laparoscopic group required less analgesia, tolerated oral intake earlier, and were discharged from the hospital earlier than those who were converted or who had open procedures. CONCLUSIONS: Laparoscopic-assisted surgery is safe, effective, and applicable to many of the standard colorectal procedures. Observed benefits include less postoperative pain and shorter hospital stay.

Adolescent↗
PubMed1995

Surgical wound infections due to Propionibacterium acnes: a study of 10 cases.

Ten cases of surgical wound infection in which Propionibacterium acnes was probably the aetiologic agent were reviewed; in five the organism was isolated in pure culture. Six patients underwent a neurosurgical procedure. The average time for development of infection was 17.5 days (range 1-30 days). All patients were cured by surgical drainage and, in nine cases, with appropriate antimicrobial therapy. In conclusion, P. acnes must be considered as a cause of surgical wound infections especially after neurosurgery.

Adult↗
PubMed1995

Isolation of Propionibacterium acnes from central nervous system infections.

Propionibacterium acnes is a common skin colonizer and its involvement in central nervous system (CNS) infections may be related with previous neurosurgical procedures. P. acnes was isolated in pure or mixed cultures from ten patients with CNS infections during a 5-year period. The clinical presentation, treatment and outcome were retrospectively reviewed. Nine out of 11 patients had CNS infections after a neurosurgical procedure. The clinical presentation was: brain abscess (five patients), subdural or epidural empyema (four patients) and shunt meningitis (one patient). Three patients had also secondary meningitis. All patients received antibiotic therapy and all abscesses and empyemas were drained. The patient with shunt meningitis cured without catheter removal. Only one patient with a brain abscess by P. acnes died, but several months thereafter and as a consequence of a Gram-negative superinfection. P. acnes is a pathogen for the CNS and infections must be surgically managed under adequate antibiotic treatment.

Journal Article↗
PubMed1995

[Bacteremia caused by group A and B beta-hemolytic Streptococcus in adults].

In order to know the epidemiological, clinical and evolutive characteristics of bacteriemia caused by beta-hemolytic streptococci groups A and B, a retrospective investigation was undertaken of 48 bacteremic episodes observed in adult patients for 10 years (1985-1994). Twenty-two episodes were caused by Group A beta-hemolytic streptococci (GAS) and 26 by Group B beta-hemolytic streptococci (GBS). Patients with GAS bacteremia (GASB) had a lower mean age than patients with GBS bacteremia (GBSB) (p = 0.03). Infection with immunodeficiency virus was more common in patients with GASB than in patients with GBSBA (27 and 4%, respectively; p = 0.04); in contrast, diabetes mellitus was more common in patients with GBSB than in patients with GASB (27 and 5%, respectively) (p = 0.04). Nine (41%) patients with GBSB were i.v. drug abusers; nevertheless, none of the subjects with GBSB were i.v. drug abusers (p < 0.001). The proportion of bacteremia without demonstrable source due to GBS (41%) was significantly higher than that due to GAS (9%) (p = 0.02). Five (23%) patients with GASB and other five (20%) patients with GBSB had fatal outcomes, but only in two (9%) and three (12%) cases, respectively, was death directly attributed to bacteremia. In conclusion, bacteremias caused by GAS and GBS have different epidemiological characteristics but similar prognosis.

Adult↗
PubMed1995

[Extrapulmonary tuberculosis. Experience at a general hospital (1980-1993)].

In order to know extrapulmonary tuberculosis in our environment the results of all samples submitted for culture of mycobacteria to the Microbiology Department, Fundación Jiménez Díaz, from 1980 to 1993 were analyzed. During this period 290 cases of extrapulmonary cases were diagnosed, 101 from 1980 to 1985 and 189 from 1986 to 1993. The most common site of infection before 1985 was in genitourinary tract (42.6%); in contrast, from 1986 onwards the more common sites of infection were pleural (22.8%), genitourinary tract and lymphatic glands (22.2% in both sites). When EPT was compared in the two periods of time the observations made were a relative decrease of genitourinary infections (p = 0.00004) and increase in disseminated (p = 0.015) and pleural tuberculosis (p = 0.011) from 1986 compared with previous years. From 1986 a greater proportion of disseminated form was observed (p < 0.0001) in positive-HIV patients and of genitourinary (p = 0.011) and pleural (p = 0.076) forms in negative HIV-patients. In conclusion, extrapulmonary tuberculosis has increased in our environment during the period 1980-1993, and this increase is not attributable only to positive-HIV patients. The distribution of clinical forms of this disease was different in the two studied periods and among positive and negative HIV patients.

HIV Infections↗
PubMed1995

[Abnormal origin of left coronary artery from pulmonary artery].

OBJECTIVE: To assess the frequency and severity of the anomalous origin of the left coronary artery (ALCA) from the pulmonary artery (PA). DESIGN OF THE STUDY: Prospective study of case series between March 1991 and December 1994. SETTING: Referral-based Paediatric Cardiology Department of a Tertiary Care Center. PATIENTS AND METHODS: Five consecutive patients (pts) with anomalous origin of the LCA from the PA; there were three infants aged 4 months and two children one 8 year and one 9 year old. There were three girls and two boys. All pts had clinical and 2D-echo and Doppler investigation prior to cardiac catheterization (CC). Indication for CC was based in the association of symptoms and signs of myocarditis or dilated cardiomyopathy of acute or subacute onset and electrocardiographic (ECG) signs of ischemia in infants. In older patients (pts) diagnosis was suspected mainly from ECG. During CC in all pts, aortograms and when necessary selective coronary angiograms were performed. Surgical correction was performed in all children. In two pts stress exercise ECG and stress Thallium studies before and after surgery were performed. RESULTS: two pts had "adult" an three had "infantile" type of ALCA from the PA. CC was performed and diagnosis was confirmed at surgery in all cases. In one child, correct diagnosis was made by ECO prior to CC and in one case LCA to PA fistula was suspected on Colour-Doppler study. No complications were attributed to CC. Several types of surgery were performed: reimplantation of the ALCA from the PA to the aorta (three pts); tunnel connection of the aorta to the ALCA via the PA (one pt) and left internal mammary to LCA anastomosis (one pt). Two infants died intraoperatively due to extensive myocardial infarction and poor left ventricular function. All the three survivors are asymptomatic after a mean follow up of 34 months. Two oldest pts are currently in New York Heart Association functional class I with normal ECG and improved myocardial perfusion on Thallium scan despite almost total occlusion of LCA at the site of implantation in the aorta as diagnosed on coronary angiogram. CONCLUSIONS: ALCA from PA is associated with major morbidity and mortality. Diagnosis should be suspected in pts with unexplained myocardial ischemia on ECG and even more if it is associated to clinical signs of dilated cardiomyopathy or myocarditis. Careful assessment on ECO and pulsed Doppler and colour flow mapping should make the diagnosis in most cases. Although surgery can be performed based only on ECO diagnosis, we strongly advise for angiography in all cases as in our experience there are false negative diagnosis by ECO. Preoperative Thallium studies can be useful for the selection of the type of surgery as pts with very little viable myocardium will not survive the establishment of a direct systemic to coronary blood flow and may be candidates for heart transplantation.

Abnormalities, Multiple↗
PubMed1995

[Emergency catheterization in a coronary intensive care unit. The diagnostic and therapeutic implications].

OBJECTIVE: to evaluate the diagnostic and therapeutic role of emergency hemodynamic studies, in the coronary intensive care (UCI). STUDY DESIGN: Retrospective study of--patients (P) submitted to emergency catheterization. PATIENTS: 183 P (152 M and 31 F), mean age 56 +/- 11.5 years, admitted to UCI of Hospital Santa Marta and who had cardiac catheterization performed, between October 88 and November 92. METHODS: Patient clinical files were reviewed. We considered the reasons for emergency cardiac catheterization; final diagnosis; complications in the first 24 hours; catheterization role in the therapeutic orientation. RESULTS: Reasons for hemodynamic study were: coronary artery disease (CAD) in 127 P (69%); aortic dissection in 33 P (18%); valvular disease in 19 P (10%) and other in 4 P (3%). Clinical diagnosis was confirmed in 92% and changed in 8% by hemodynamic study results. Left main coronary artery disease was diagnosed in 6.5% of CAD patients. Coronary artery disease was excluded in 5 P with previous CAD diagnosis, in 19 P with aortic dissection and in 11 valvular patients. 32% of P were sent to emergent surgery: 93% ascending aortic dissection and 20% of CAD, 76% of valvular disease. The hemodynamic study was decisive in the therapeutic option of myocardial revascularization in 77% of P with CAD: 39 emergent PTCA (31%), 13 primary (33%) and 14 P oriented to elective PTCA (11%); 26 emergent surgery and 19 P oriented to elective surgery (15%). The emergency cardiac catheterization mortality rate was 0.5%, and the morbidity 2.7%. CONCLUSIONS: The contribution of Hemodynamic Department to UCI was decisive in the diagnostic and therapeutic orientation of critical patients.

Adult↗
PubMed1995

[Tuberculous meningitis: prognostic aspects of 22 microbiologically confirmed cases].

BACKGROUND: Tuberculous meningitis continues to be a severe disease difficult to diagnose within a reasonable time carrying a high morbimortality. METHODS: A retrospective review of cases of microbiologically confirmed tuberculous meningitis diagnosed and treated in the authors' institution is presented. RESULTS: From 1974-1993, 22 patients (12 males and 10 females, mean age of 31.5 years; range: 4 months and 77 years) were studied. Eighteen patients (81%) presented extrameningeal tuberculosis. Seven (31.8%) died and 6 (27.3%) presented severe neurologic sequelae. The worst prognosis was observed in patients older than the mean (p = 0.03), worse neurologic situation on admittance (p = 0.03) and hydrocephaly diagnosed by imaging techniques (p = 0.04). Corticoids were administered in 15 patients (68%) without contributing comparatively to better disease prognosis. CONCLUSIONS: The authors consider that the initiation of specific early treatment in justified while awaiting microbiologic confirmation of the disease.

Adolescent↗
PubMed1995

[Soft-tissue infection caused by Aeromonas hydrophila].

BACKGROUND: Two cases of soft tissue infection by Aeromonas hydrophila are presented with review of the literature. PATIENTS AND METHODS: Two cases of soft tissue infection by Aeromonas hydrophila diagnosed from 1992-1993 are reported. RESULTS: Most soft tissue infection produced by Aeromonas organisms are caused by Aeromonas hydrophila. These infections predominantly affect the lower limbs of middle-aged males with previous history of injury favoring infection. The most common clinical presentation is cellulitis with a good prognosis if bacteremia is not produced. Antibiotics, such as mainly third generation cephalosporins, imipenem, aztreonam, cotrimoxazole, tetracycline, chloramphenicol, quinolones and aminoglucosides (except streptomycin) are usually very active in vitro against these organisms. Surgery is often necessary to cure the process. CONCLUSIONS: Cellulitis by Aeromonas hydrophila is a very infrequent entity in Spain and is usually associated to previous injury and probable contamination by environmental bacteria.

Adult↗