PubMed Health⌕ Search

Biomedical subjects

J Sarmiento

Publications and source records attributed to J Sarmiento.

15 recordsLinked to original sources
PubMed1991

Statistical modeling of prognostic indices for evaluation of critically ill patients.

OBJECTIVE: To identify the most predictive association of variables from the usual indices of severity of illness by statistical objective analysis. DESIGN: Logistic regression analysis of the different variables of the most important indices. SETTING: A general critical care medicine group practice in a university hospital. PATIENTS: A total of 630 critical care patients age 12 to 87 yrs were evaluated. The most important indices of severity of illness and the corresponding variables were recorded and the patient's course was followed for 3 months after ICU admission. MEASUREMENTS AND MAIN RESULTS: One of our hypotheses was that the inclusion of an excessive number of variables to obtain the most common prognostic indices of mortality in critical care patients results in an underestimation of mortality and a redundancy of prognostic information. We performed a logistic regression analysis using the variables of the currently used indices of critical care prognosis: Acute Physiology Score, Simplified Acute Physiology Score, Acute Physiology Score-II, and Mortality Prediction Model. This mathematical approach resulted in a model of five variables: organ system failure, blood glucose, serum calcium, serum prothrombin activity, and serum osmolality. The score obtained from this model gave accurate prognostic criteria:sensitivity 91.2% and specificity 90%, using a cutoff point of 0.7; sensitivity 86% and, specificity 94%, using a cutoff point of 0.5. CONCLUSIONS: Our results show that suitable statistical management of the discriminant prognostic variables allows reduction of the number of variables of the severity indices currently used, obtaining five more predictive variables.

Adolescent↗
PubMed1987

Hepatocellular carcinoma presenting with bleeding due to duodenal perforation by the tumor.

A 70-year-old man was admitted with upper GI bleeding. Endoscopy showed a large duodenal bleeding mass. The aspect of the tumor was macroscopically similar to the liver surface. The diagnosis of hepatocellular carcinoma was made by aspiration cytology guided by abdominal computed tomographic scan. The postmortem examination revealed an extensive primary hepatic tumor which caused an ulcer in the first part of the duodenum and protruded into the lumen. This unusual presentation of a hepatocellular carcinoma has not been previously reported.

Aged↗
PubMed1981

[Hepatic cirrhosis and primary pulmonary hypertension. A case report (author's transl)].

The present report deals with the clinical history and autopsy findings of a 41 year-old male patient with hepatic cirrhosis, surgical splenorenal shunt and severe pulmonary hypertension. Since the original description of Mantz and Craige several series have been reported, both in children and in adults, of the association between pulmonary hypertension and liver disease and/or portal hypertension. However, the type of hepatic alteration associated to pulmonary hypertension and the mechanisms responsible for this association remain unclarified. In the present case prominent plexiform and/or angiomatoid lesions of the pulmonary vasculature were observed, prompting the authors to speculate on the possibility that non-identified vasoconstrictor substances might contribute to the production of morphological lesions in the arterio-venous pulmonary shunts.

Adult↗
PubMed1981

Acquired zinc deficiency syndrome during total parenteral alimentation. Clinical and histopathological findings.

An acute zinc deficiency state developed in 6 patients on total parenteral alimentation, which allegedly included zinc 37 mumol/l. The actual concentration of this trace element when measured by us, was 3 mumol/l. The clinical picture consisted of an acrodermatitis enteropathica-like syndrome, with subsequent development of distinctive nail lesions, which consisted of white transverse bands in all finger- and toenails. Histopathological examination of several of these cutaneous lesions revealed distinctive changes, which we consider rather specific of zinc deficiency states. They consisted in parakeratosis, cleavage and detachment of the superficial layers of the epidermis, mainly intracellular and also extracellular edema of the epidermal cells, development of microvesicles at different epidermal levels, and severe vacuolar alteration of the dermoepidermal junction. These changes also affected the outer root sheath of the hair follicles.

Adult↗
PubMed1981

Lipid inclusions in the telencephalic neuroglia of the developing rat.

The presence of lipid vacuoles is a common fact in neuroglial cells and their precursors in the developing rat brain. Simple lipid vacuoles are present in ependymal cells, subependymal cells, spongioblasts and astrocytes. Polymorphic inclusions are observed in subependymal cells, spongioblasts, astrocytes and oligodendrocytes. Great numbers of dense inclusions are found in "premyelinic" oligodendrocytes, while smaller numbers of simple lipid vacuoles are found in the astrocytes of the telencephalic mantle. These results are discussed and related to the better known changes present in the human developing brain.

Animals↗
PubMed1980

Nascent microglia in the developing brain.

Nascent microglia cells in the developing brain were studied by morphological, cytochemical, and autoradiographic methods. These cells are a well differentiated population, characterized by the presence of an activated nucleus, numerous ribosomes, a well developed Golgi system and associated structures including clear vesicles, dense granules, and membrane-bound polymorphous structures. Big clear vacuoles in the cytoplasm are a constant feature; filaments and microtubules are found in variable numbers. Finger-like projections and invaginations of the plasma membrane are usually found. The identification of these cells with the classical microglial cells stained by Rio Hortega's method was made by reconstruction of 20 cells using serial sections. These cells show strong NADPH dehydrogenase, ATPase, and acid phosphatase activities, in addition to nonspecific esterase activity which is inhibited by sodium fluoride. Transfusion of labeled bone marrow cells from a donor showed labeled cells only in those areas in which nascent microglia cells are more abundant. Taken together, these data suggest an exogenous, most probably monocytic, origin of nascent microglia. New studies with membrane markers are, however, needed for providing better characterization of these cells.

Animals↗
PubMed1980

Reactive microglia in the developing brain.

Reactive microglia in the developing brain after stab wound was studied by morphological, cytochemical, and autoradiographic methods. Morphologically, early reactive cells are of the "M" cell type (Matthews 1974). They show an activated nucleus, cytoplasm rich in ribosomes with wide Golgi complex and variable numbers of lipid inclusions. Big clear vacuoles are found in many of these cells. Microtubules not associated with centrioles and filaments may or may not be present. Junctional complexes of the zonula or puncta adherentia types are occasionally found. Strong NADPH dehydrogenase, weak NADH dehydrogenase, strong ATPase, and strong acid phosphatase, in addition to nonspecific esterase activities were demonstrated in many reactive cells. Intravenous infusion of labelled bone marrow cells from a donor showed labelled macrophages and labelled perivascular cells at the site of injury. Intracerebral injection of a small dose of tritiated thymidine at the time of injury resulted in the appearance of labelled macrophages in the following days. These data suggest that many of the reactive cells have an exogenous, more probably monocytic, origin; but a certain amount of endogenous cells also act as macrophages in brain injuries.

Animals↗
PubMed1979

Cerebral mixed tumour: osteo-condrosarcoma--glioblastoma multiforme.

A 49-year-old woman had a left frontal expanding mass with calcified areas. A craniotomy and resection of the mass were performed. Histological sections showed a mixed tumour: osteochondrosarcoma-glioblastoma multiforme. The absence of previous irradiation and its location, deep in the frontal lobe and apparently unattached to the meninges, add to the rarity of this association. A brief discussion concerning the presence of osseous or cartilaginous areas in brain tumours and the problem of cerebral mixed tumours follows the description of the case.

Brain Neoplasms↗
PubMedDate not supplied

[Use of a double-lumen tube with intermittent positive ventilation in a case of distal tracheal laceration].

We discuss the management of anesthesia in a patient brought to hospital following a traffic accident in which she suffered distal laceration of the trachea and unstable vertebral fracture that met surgical criteria. Our main objectives were to avoid placing positive pressure on the damaged trachea and to extubate immediately after surgery. Using a left double-lumen endotracheal tube guided by flexible bronchoscope, we administered general anesthesia with mechanical ventilation and positive pressure, with no air leakage through the damaged area. Anesthesia was maintained by continuous perfusion of propofol, allowing good hemodynamic stability and rapid extubation. We conclude that this will be a useful procedure in similar cases when no other form of mechanical ventilation is available.

Adult↗