Biomedical subjects

M Rull

Publications and source records attributed to M Rull.

42 records · Page 3Linked to original sources

PubMedDate not supplied

[Severe obesity: its surgical treatment in 120 patients. The results and a prospective focus].

Severe or morbid obesity (M.O.) is a pathological state which is very difficult to treat by non-surgical means. It is defined internationally on the basis of anthropometric measurements when a body mass index (BMI) of 40 kg/m2 is exceeded. In such cases, the pathological increase in body fat influences patient mortality and morbidity. The present state of bariatric surgery is reviewed in the series presented. The guidelines are submitted which are currently used as an approach to surgery, and the reasons are set out used by the authors, on the base of 5 years' experience and more than 110 patients operated on (ringed vertical gastroplasty-RVG, inflatable silicone gastric band, Salmon's technique) in a prospective approach to new surgical projects. The series presented is divided into two groups. It is shown that not all the severely obese (SMO) (BMI > 50 kg/m2) respond adequately to a simple restrictive technique (RVG) notwithstanding very considerable weight loss. Other techniques are currently under consideration for this group. It is concluded that bariatric surgery demonstrates effective and permanent results if the right technique is used on the patient selected.

Anesthesia↗

PubMedDate not supplied

[Omeprazole in the prophylaxis of Mendelson syndrome in elective surgery].

AIMS: To study the efficacy of different doses of omeprazole and the influence of premedication in the prophylaxis of the acid aspiration syndrome. METHODS: A double blind prospective study was carried out ASA I-III on 103 patients (mean age 51.08 yr) undergoing either general, gynecological or orthopedic surgery, allocated into 4 groups. Group NP: 24 non premedicated patients; group P: 29 patients premedicated with 1 mg of lorazepam the previous night and 50 mg of meperidine 1 hour before surgery and haloperidol or dipotassic chlorazepate according to age; group 020: 25 patients premedicated with the same drugs and doses as in group P plus 20 mg or oral omeprazole the night prior to surgery; group 040: 25 patients premedicated as in group P 40 mg of oral omeprazol the night prior to surgery. Following induction of anesthesia a nasogastric tube was placed and gastric juice withdrawn to determine the pH; were excluded patients with an aspiration volume of less than 8 ml. RESULTS: No significant differences were found in regard to pH among the non premedicated and premedicated groups, however a change between the latter two groups having received omeprazole was observed. The results of the pH were significantly higher in the group treated with 40 mg of omeprazole (mean 4.87 +/- SD 2.35) with respect to the group treated with 20 mg of omeprazole (mean 3.78 SD +/- 2.35). In the group treated with 40 mg of omeprazole, the incidence of pH < 1.5 was 4% vs 24% of cases in the group treated with 20 mg of omeprazole. CONCLUSIONS: Premedication with 40 mg of oral omeprazol the night prior to surgery increases pH up to safe values for the prophylaxis of the acid aspiration syndrome.

Adult↗

PubMedDate not supplied

[Morbid obesity. Reflections on a surgical protocol (I). A clinical and peroperative protocol].

UNLABELLED: Obesity as a condition, and morbid obesity as a disease, have at present reached epidemic proportions. Bariatric surgery is the most effective treatment in those patients in whom medical, dietary, and/or behavioral treatments have failed. What is more, it is the initial treatment of choice in morbid superobese patients (> 50 kg/m2). The present study summarizes and criticizes the main surgical techniques used at present, and purposes an action protocol for anesthesia, as well as some norms and advice on control, action, and pulmonary and dietary rehabilitation, in the peri- and post operative period, based on more than 7 years' experience with a series of more than 150 operated and controlled patients. CONCLUSION: A restrictive bariatric technique is a model which allows the multidisciplinary obesity treatment team to achieve a definite and permanent modification of the eating habits of all patients who meet the criteria for inclusion in a surgical protocol.

Anesthesia↗

PubMedDate not supplied

[Morbid obesity. Reflections on a surgical protocol (II). The experience accumulated over 5 years].

Bariatric surgery is done on a selected, ill patient (morbid obesity), with a surgical risk which is intrinsic to his condition and morbidity. The results on any program are more a function of the adequate selection, information and control, than of the surgical model itself. The first 125 patients of the present surgical series have been reviewed, with a minimum of 18 months of follow up, and the complications are detailed, with emphasis on the compulsory and necessary radiological evaluation in the immediate post-operative period, during the follow up, and in the face of any complication. The effectiveness criteria of the technique and the real value of the weight loss are reevaluated, as well as defining the criteria of failure of surgical treatment. Finally, we end with an up dating of the psychological results observed, as well justifying the need for a bariatric surgery protocol, with its ethical-legal implications. The final conclusion is that bariatric surgery shall only be clinically and ethically accepted if it complies with the principles for which it was designed.

Anthropometry↗

PubMedDate not supplied

[Deep venous thrombosis of the upper limb. A prospective study of the central venous catheter as an etiologic factor and clinical and subclinical incidence of pulmonary thromboembolism].

The thrombogenicity presented in different types of endovenous catheters and their anomalies are the cause of the development of pulmonary thromboembolism (PTE) in some patients, secondary to deep venous thrombosis (DVT) of the upper limbs. Presentation of a study made on the incidence of PTE in patients with prior history of DVT of the upper limbs. Of the 30 cases of DVT of the upper limbs studied, 20 were directly attributed to catheters. 18 were attached to a central catheter and the other 2 one or two peripheral catheters. 0,32% of DVT of the upper limbs secondary to a central catheter was calculated. Five of the 20 DVT patients (25%) had symptomatic or sub-clinical DVT. Emphasis was placed on the importance of DVT and its intrinsically serious nature and the need for studies on this condition, since it is possible for the patient not to develop the complete symptoms of DVT at the onset, which led to death in one patient. We recommend the establishing of strict norms with regard to the indications for inserting the central catheter and the choice of the correct material, aseptic and non-traumatic insertion, radiological control (essential) of the position of the catheter and its tip, establishing of a protocol for the correct maintenance and a device for controlling thrombotic complications in upper limbs, to ensure rapid treatment and a rapid check of the possibility of DVT by pulmonary gammagraphy during the first 24-48 hours.

Adult↗

PubMedDate not supplied

[Utility of thoracic teleradiography in hospitalized patients].

AIM: To assess the utility of the chest roentgenogram (CR) in hospitalized patients in terms of its diagnostic and therapeutic influence on the clinician. DESIGN: A survey in a group of residents of internal medicine at a tertiary care teaching hospital was carried out. Two questionnaires were applied: one when a follow-up CR was ordered (inquiring about reasons for ordering the film, the likelihood that the CR would show changes and physician's therapeutic plan); the second questionnaire was applied after the CR was obtained (inquiring about how unexpected the CR finding was and its degree of influence on therapy). Both questionnaires were analyzed in regard to the CR interpretation by a radiologist. RESULTS: One hundred surveys were analyzed. CR ruled out the suspicion of a new pulmonary event (55% of cases) or of the worsening of a known lung disease (50%) as predicted by the physician. In turn, CR confirmed the absence of a new pulmonary event (92%), or the improvement/stabilization of the course of a known lung disease (92%), as predicted by the physician. Sixty-one percent of these CR had a definite influence on patients' treatment. CONCLUSION: CR in hospitalized patients is of practical benefit to physicians, mainly in avoiding overdiagnosis and unnecesary treatment to their patients.

Academies and Institutes↗