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J Torcal

Publications and source records attributed to J Torcal.

11 recordsLinked to original sources
PubMed2003

[Protocol for the multi-centre evaluation of the Experimental Programme Promotion of Physical Activity (PEPAF)].

OBJECTIVE: To evaluate the effectiveness of an innovative programme to promote physical activity (PEPAF) introduced into the daily consultations of the family doctor. DESIGN: Clinical trial with control, randomised for groups of 100 patients seen by one of the 70 doctors taking part, allocated to two parallel groups and monitored for 24 months.Setting. 13 primary care centres coordinated through the Network of Research into Preventive and Health Promotion Activities conducted in primary care. PARTICIPANTS: Sample with probability of 7000 sedentary patients, selected from among those who consulted for any reason their family doctor during the third quarter of 2003. Patients with cardiovascular disease or other problems meaning that exercise could cause adverse effects will be excluded. INTERVENTIONS: The doctors allocated to the PEPAF will design a plan of physical activity with those patients prepared to make the change. Those not prepared to will be briefly counselled and given material to help them. All will be monitored at random. The control group doctors will postpone any systematic intervention on exercise until after 2005, excepting those patients whose health problem is directly related to a sedentary life-style. MEASUREMENTS: The main measurement of results will be the increase in the level of physical activity from the base measurement to those at 3, 6, 12 and 24 months, using 7-day physical activity recall. Health-related quality of life (SF 36) and physical fitness will also be measured. Variables that might be predictive or confusing, such as sex, age, comorbidity, social class, etc., will be considered. Analysis. The average changes observed in the two groups will be compared, on the basis of intention to treat, through analysis of covariance. We will use mixed-effect models able to cover the intra-patient, intra-doctor and intra-centre correlation.

Exercise↗
PubMed2001

Prevention in routine general practice: activity patterns and potential promoting factors.

BACKGROUND: Primary care physicians have a unique opportunity to deliver preventive services, but a desired level of involvement is not always attained. METHODS: We analyzed self-reported preventive activity in a stratified random sample of 635 primary care physicians to determine how often they deliver effective interventions for the prevention of cardiovascular diseases, cancer, and acquired immunodeficiency syndrome as well as to assess factors associated with a greater implementation of preventive activity in routine practice. RESULTS: More than 63% reported to ask about tobacco use or alcohol consumption or to check blood pressure to most of their new patients. On the other hand, only 33% asked about intravenous drug use, 14% about sexually transmitted diseases, and 6% about the number of sexual partners and less than 33% reported to have an appropriate criterion for any periodic preventive activity in routine daily practice. Correlates of high preventive activity included group practice, specific register of preventive activities, participation in the Program of Preventive Activities of the Spanish Society of Community and Family Medicine, and specific nursing consultation. CONCLUSIONS: Organizational factors could be used to improve preventive activity which is far from being an adequate component of routine general practice especially with regard to human immunodeficiency virus infection and periodic preventive activity for chronic diseases.

Adult↗
PubMed2001

Determination of the immunoglobulin E postoperative variation as a measure of surgical injury.

The aim of this study was to ascertain postoperative changes in immunoglobulin E (IgE) in patients undergoing different types of surgery and the possible correlation with the duration and type of surgery. Evidence suggests that surgery induces a predominant activation pattern through the T-helper-2 (Th2) cell pathway, increasing interleukins (IL-4, IL-5, IL-10, IL-13), inhibiting Th1 cell activation, and promoting B and Th2 cell activation. IgE production may indicate predominant Th2 pathway activation and may be a more persistent and easily measurable postoperative marker than IL-6 for measuring surgical trauma. Altogether, 180 patients undergoing different types of surgery for nonneoplastic and nonparasitic diseases were studied. All patients received the same type of anesthesia. Before surgery and on the first (1PO) and 7th (7PO) postoperative days we determined in peripheral blood the CD3, CD4, CD8, CD16, and CD19 cell percentages; IL-1, IL-2, IL-4, IL-6, and tumor necrosis factor (TNF) levels; and the IgA, IgG, IgM, total IgE, C3, C4, and CIC levels. On 1PO, all variables decreased except IgE, IL-1, IL-2, IL-4, IL-6, CIC, and CD19. Only IgE, IL-6, and CD19 increases showed a significantly statistical (ss) difference regarding preoperative values (0.01, 0.05, 0.001, respectively). Relations between the IL-4 and IgE increases (p < 0.01) and between the IgG decrease and IgE increase (p < 0.001) were found. On 7PO, only IgE was increased (p < 0.001). The IgE increase correlated with surgical trauma intensity (p < 0.05). We concluded that IgE increases during the early postoperative period, correlating with surgical injury intensity. The increase in the IgE level may be detected 24 hours after surgery and during the first 7 postoperative days depending on the type of surgery.

Adult↗
PubMed2001

Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma.

OBJECTIVE: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. METHODS: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's T test, and logistic regression analysis. RESULTS: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p < 0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p < 0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). CONCLUSION: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

Adolescent↗
PubMed2000

Autologous blood transfusion as an immunomodulator in experimental sepsis.

BACKGROUND: Homologous blood transfusion is associated with immunosuppressive consequences. Some clinical and experimental studies have suggested an immunostimulating action of autologous blood transfusion. The aim of this paper is to ascertain the effects of either homologous blood transfusion or autologous blood transfusion on the lymphocyte subsets and cytokines in a model of intra-abdominal sepsis. MATERIALS AND METHODS: There were three study groups. Group A: 10 Wistar-Furth (WF) rats underwent cecal ligation and puncture (CLP) aimed at causing an intra-abdomial sepsis; Group B: 10 WF rats underwent CLP plus 1 ml homologous blood perioperative transfusion obtained from Fisher-344 rat while Group C: 10 WF rats underwent CLP plus 1 ml autologous blood perioperative transfusion. Changes of peripheral lymphocyte subsets, percentages of total T-lymphocytes (CD3), Helper T-lymphocytes (CD4), supressor/cytotoxic T-lymphocytes (CD8), CD4/CD8 ratio, Interleukin-2 receptor expression (IL-2R) and cytokines IL-1 and TNF-alpha were measured in peripheral blood on the preoperative, 1st, 3rd and 7th postsepsis (PO) days. RESULTS: Rats in homologous transfused group showed a decrease of %CD4 on the 3rd PO (from preoperative to 3rd PO;p < 0.01; and from 1st to 3rd PO; p < 0.05) and on the 7th PO (from preoperative to 7th PO; p < 0.05); %CD8 increased from preoperative to 3rd PO (p < 0.05), from 1st to 3rd PO (p < 0.01) and from 1st to 7th PO (p < 0.05). An initial decrease on day 1 (p < 0.01) followed by an increase on the 3rd PO (p < 0.01) with regard to IL-2R and a significant increase of IL-1 levels within the first 24h (p < 0.01). Rats in autologous transfused group showed an increase of %CD3 from preoperative to 7th PO (p < 0.05), and from 3rd to 7th PO (p < 0.01). CONCLUSIONS: We observed that homologous blood transfusions induce a greater alteration in the cellular immune response and of the cascade of cytokines than autologous transfusions. This modulates the variations of the immune response induced by sepsis.

Animals↗
PubMed1999

Primary hydatid disease in lumbar muscles.

The authors report a case of primary hydatid disease in the lumbar muscles of a 40-year-old male patient. The rarity of this disease in our regions and the low incidence of this location make primary diagnosis difficult. The tumor had been treated elsewhere five years previously by means of simple excision. Recurrence of the lesion was diagnosed five years after the first surgery. Wide excision of the cyst and pericyst with a 3.5-cm security margin was performed. Six years after the last surgery, no recurrence has been detected.

Adult↗
PubMed1998

Immune response and cytokines in septic rats undergoing blood transfusion.

BACKGROUND: Intrabdominal sepsis and allogeneic blood transfusion have been associated with a depression of the immune response in patients undergoing surgery. Some authors have considered that an already immunocompromised host is probably primed for a potential detrimental effect of allogeneic blood. The aim of this paper is to ascertain the effects of allogeneic blood transfusion on the lymphocyte subsets and cytokines in septic rats. MATERIALS AND METHODS: Thirty rats were allotted into three groups: Sham-CLP, anesthesia and laparotomy; CLP, cecal ligation and puncture; CLP+BT, CLP and allogeneic blood transfusion. Preoperatively and on the 1st, 3rd, and 7th postoperative days, the cell percentages of lymphocyte subpopulations, the IL-2 receptor expression, and the IL-1, IL-2, TNF-alpha and IFN-gamma were measured in blood by flow cytometry and ELISA: RESULTS: CLP+BT rats showed on Day 3 a decrease of the CD4+%, an increase of the IL-2R expression directly correlated to the increase of the CD8+% phenotype, a steady increase of IL-1 levels, a decrease of the TNF-alpha levels on the 1st and 3rd days, and a decrease of the IL-2 and IFN-gamma on Day 1. CONCLUSIONS: An accumulative effect of the immunodepression induced by sepsis was observed when allogeneic blood transfusion is added. Blood transfusion + sepsis induces an extensive impairment on cellular immune response and an initial cytokine downregulation, except for IL-1.

Animals↗
PubMed1996

Immune response and in vivo production of cytokines in patients with liver hydatidosis.

Cytokines play an important role in the human immunological response, but the exact role of cytokines in the human immune response against parasites, especially against Echinococcus granulosus, remains unclear. IL-1, IL-2, IL-4 and tumour necrosis factor (TNF) levels in peripheral blood of 21 patients with liver hydatidosis were evaluated before surgical treatment, and the levels of IgA, IgM, IgG, IgE, specific IgE against E. granulosus, C3, C4 and DF complement fractions and CD20, CD3, CD4, CD8 and CD16 cell percentages were also determined, as was the relationship between these variables and cytokine levels. Data from hydatid patients were compared with data obtained from 21 healthy volunteers. Hydatid patients showed increases of IgG, IgE, IgEs and IL-2 (P < 0.01), and decreases of IL-1 and TNF levels (P < 0.001), but these variables (respectively) increased in patients showing cysts in the central area of the liver or with a wide opening of cysts in the biliary tract. The increase of IL-1, IL-2 and IL-4 showed a close relationship with the number, characteristics and above all the location of cysts within the liver itself. IgG and IL-4 levels and also IgG and IgE levels showed a significant correlation (P < 0.05).

Adolescent↗
PubMedDate not supplied

Intracystic infection of liver hydatidosis.

BACKGROUNDS/AIMS: The aim of this study was to review the clinical presentation and management of patients with intracystic bacterial infection in liver hydatidosis. METHODOLOGY: The records of 480 patients suffering from liver hydatid disease treated at our institution were reviewed. Only 42 patients fulfilled intracystic bacterial infection criteria. We assessed the incidence, clinical and laboratory findings, diagnostic procedures and surgical approach in these cases. RESULTS: The incidence of intracystic bacterial infection was steady throughout the study period. Clinical and laboratory data are non-specific. Diagnostic procedures for intracystic bacterial infection, including liver computed tomography scan, are of limited value. Although both, radical and non-radical surgical approaches, were used in these patients, mortality was associated with non-radical surgery. The morbidity rate was high regardless of the procedure used. CONCLUSIONS: Our current goal in the management of intracystic bacterial infection, if overall condition of the patient is good, is to carry out a total or subtotal cystectomy in order to avoid mortality and hydatid disease relapses.

Adult↗