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Biomedical subjects

P Guerrero

Publications and source records attributed to P Guerrero.

At least 19 recordsLinked to original sources
PubMed2003

[Ethical issues of diagnostic tests in neurology].

The presence of ethical issues in the diagnostic testing process is a common experience in Neurology. Pacient Ls consent has often some difficulties because of the limited capacity of neurological patients due to cognitive impairment, neurological deficits or emotional disturbances. An explicit assessment of capacity should be performed, including the analysis of patient Ls ability to make complex decisions and its operational components. The consent must also include other ethical and legal considerations. When neurologists make the election of diagnostic tests, they have two obligations: being beneficent with their patients and using health resources properly because of distributive justice. Diagnostic necessities and knowledge of efficiency of tests must be defined in order to make beneficent and just diagnostic decisions.

Bioethics↗
PubMed2000

The effect of hypertension on the response to blood loss in a rodent model.

OBJECTIVE: Hypertensive patients having higher baseline peripheral resistance and sympathetic tone than normotensive patients may have aberrant responses to hemorrhage. In an attempt to further characterize this clinical observation, the authors compared the hemodynamic and metabolic responses to hemorrhage between spontaneously hypertensive rats (SHR) and normotensive rats (NTR). METHODS: Twenty adult rats (10 NTR and 10 SHR) were anesthetized with althesin via the intraperitoneal route. Femoral arteries were cannulated by cutdown. Twelve (6 SHR and 6 NTR) rats underwent controlled catheter hemorrhage of 25% of their total blood volumes. Eight rats (4 SHR and 4 NTR) served as nonhemorrhage controls. Mean arterial pressure (MAP) and base excess (BE) were measured prehemorrhage and then every 15 minutes for the next 120 minutes. Data were reported as mean +/- standard error of the mean (SEM). Group comparisons were analyzed by ANOVA with repeated values post-hoc by Bonferroni. Statistical significance was defined by an alpha = 0.05. RESULTS: Immediately after hemorrhage, the SHR group experienced a significantly (p < 0.001) greater drop in MAP of 70 +/- 4% in the SHR vs 40 +/- 6% in the NTR. Blood pressure in the NTR returned to control values 15 minutes after hemorrhage, but the SHR remained relatively hypotensive for the entire length of the experiment. Base excess in the SHR decreased significantly (p < 0.004) by 8.2 +/- 2 mmol/L from control values, as compared with no changes in BE for the NTR. CONCLUSIONS: The authors observed significant differences in the response to hemorrhage between hypertensive and normotensive rats. Hypertensive rats experienced a more profound hemorrhagic shock insult than normotensives for the same degree of blood loss.

Animals↗
PubMed1998

Sarcoidosis, sclerosing cholangitis, and chronic atrophic autoimmune gastritis: a case of infiltrative sclerosing cholangitis.

We report a patient in whom sarcoidosis coexisted with sclerosing cholangitis and chronic atrophic autoimmune gastritis. There are some autoimmune diseases associated with primary sclerosing cholangitis; the difference between sarcoidosis and all other autoimmune diseases associated with primary sclerosing cholangitis is the ability of the former to damage the biliary tree. Moreover, when sarcoidosis behaves like cholestasis it can damage the biliary tree, mimicking primary sclerosing cholangitis, with high immunoglobulin M but without inflammatory bowel disease and p-ANCAs negative. We believe that it should be regarded as a single disease "infiltrative sclerosing cholangitis" because this is not a primary disease and sarcoidosis would be responsible for a beaded biliary tree.

Adult↗
PubMed1995

Evaluating and improving the cost-effectiveness of the implantable cardioverter-defibrillator.

The implantable cardioverter defibrillator (ICD) is an expensive, widely used device for severe ventricular arrhythmias. Marginal cost-effectiveness analysis is a technique to examine the incremental cost of treatment strategy in relation to its effectiveness. In this study, we used this technique to analyze the cost-effectiveness of the ICD compared with that of electrophysiology (EP)-guided drug therapy and examined ways in which it may be improved. We analyzed Michigan Medicare discharge abstracts (1989 to 1992) and local physician visit, test, and ICD charges. Effectiveness was from 218 previously described patients with ICDs in whom the time of first event (first appropriate shock or death) was determined and presumed to represent "control" (EP-guided drug therapy) mortality. We assumed a 4-year life cycle for the ICD generator and 3.4% operative mortality and used a 5% discount to prevent value. Data were analyzed in a 1-month cycle Markov decision model over a 6-year horizon, and results were updated to 1993 dollars. ICD effectiveness was an increase in discounted mean life expectancy of 1.72 years. Cost-effectiveness was $31,100/year of life saved (YLS). Results were minimally or modestly sensitive to variations in preoperative mortality; resource use; consideration only of patients with ICDs who were receiving any antiarrhythmic drug or specifically amiodarone; and to a decrease in the percentage of first shocks that would equal death without the ICD until the assumed percentage decreased to < 38%. At ejection fraction of < 0.25 and > or = 0.25, cost-effectiveness was $44,000/YLS and $27,200/YLS, respectively, and without preimplant EP study was $18,100/ YLS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Hepatic and blood lead levels in patients with chronic liver disease.

OBJECTIVE: To investigate the relationship between lead levels in the liver and blood, liver function indices and other biological variables in patients with liver disease. DESIGN: Prospective study. METHOD: The levels of lead in blood and hepatic tissue was measured in 92 patients with different liver diseases and in a control group (n = 100). Lead levels were analysed by electrothermic atomic absorption spectrophotometry. RESULTS: For controls, the mean lead level in blood was 175 +/- 87 micrograms/l. Blood lead levels were significantly linked with alcohol intake. They were raised in patients with alcoholic liver disease, including both those with cirrhosis (230 +/- 65 micrograms/l) and those with chronic non-cirrhotic liver disease (247 +/- 82 micrograms/l). The differences between these subgroups, the control group, and the patients with non-alcoholic liver disease were statistically significant. The mean hepatic lead level for patients was 2.30 +/- 1.40 micrograms/g dry weight (d.w.), and 2.15 +/- 1.71 micrograms/g d.w. for controls (not significant). Patients with alcoholic cirrhosis had higher hepatic lead levels than non-alcoholic patients (2.62 +/- 1.48 micrograms/g d.w. versus 2.07 +/- 1.14 micrograms/g d.w., respectively), although the difference was not statistically significant. There was no relationship between blood and hepatic lead levels (r = 0.27; not significant). Blood lead levels correlated with phosphorus (r = -0.36; P < 0.001), and alcohol intake (g/day; r = 0.32; P < 0.001). Blood and hepatic lead levels in patients with cirrhosis were similar for patients with Child-Pugh class A, B and C disease. CONCLUSIONS: Increased levels of lead were found in the blood of patients who consumed alcohol and those with alcoholic liver disease. Our data suggest that both blood and hepatic lead levels are not influenced by changes in liver function.

Adolescent↗
PubMed1993

Correlation of the local and systemic cytokine response with clinical outcome following thermal injury.

Eighty-eight patients with acute thermal injury were evaluated. Forty-eight hours after injury, TNF, IL-6, and IL-8 were significantly present in the systemic circulation, lung, normal skin, and thermally injured skin. The presence of TNF, IL-6, and IL-8 proteins in the lung, normal skin, and thermally injured skin were associated with TNF, IL-6, and IL-8 mRNA upregulation. Logistic regression analysis controlling for the Abbreviated Burn Severity Index demonstrated that the presence of IL-8 in the lung was associated with early pulmonary physiologic dysfunction (p = 0.006) and nosocomial pulmonary infection (p = 0.040). We conclude that acute thermal injury initiates an early systemic, lung, and skin response involving TNF, IL-6, and IL-8. The TNF, IL-6, and IL-8 protein present in the lung and skin in response to acute thermal injury are generated locally and do not originate from the systemic cytokine pool. The lung cytokine response to acute thermal injury may initiate local organ failure.

Adult↗
PubMed1991

[Primary segmental sclerosing cholangitis associated with Sjögren's syndrome].

We report the case of a patient with primary sclerosing cholangitis associated with Sjögren's syndrome and Raynaud's phenomenon, an uncommon association. The presence of periportal lymph nodes with features similar to those described in autoimmune diseases suggests an immune pathogenesis of the disease. The localized and segmentary involvement of the common duct is also an uncommon finding. The pathogenetic and therapeutic aspects are discussed.

Aged↗
PubMed1989

[Malabsorption syndrome caused by Giardia lamblia in gastrectomized patients].

We report three adult patients with gastrectomy who had malabsorption caused by Giardia lamblia. Type II gastrectomy had been carried out in the three patients several years before, and the clinical presentation was similar: chronic diarrhea with malabsorption. A remarkable fact was that the search for parasites in feces was repeatedly negative in two patients, the protozoon being identified in the intestinal biopsy samples. In the third case, the diagnosis was made by the visualization of Giardia cysts in the feces.

Animals↗
PubMedDate not supplied

[Side effects of antithrombotic treatment in the secondary prevention of cerebrovascular disease].

OBJECTIVE: To determine the incidence of adverse effects of antithrombotic drugs (platelet anti-aggregants and anticoagulants) in patients with transient ischemic attacks (TIA) and mild ischemic strokes (IL). PATIENTS AND METHODS: Clinical follow-up data on the patients with TIA and IL included in a community-based observational study undertaken in the province of Segovia. Adverse effects which led to suspension of treatment or were a potential danger for the patient's life were recorded. RESULTS: The groups studied included 235 patients and the average initial age was 70.8 years. The average follow-up time was 3.6 years. The treatment initially given included: aspirin (75.7%), ticlopidine (12.8%) and acenocumarol (9.4%). Adverse effects led to suspension of treatment in 6% (5% with aspirin and acenocumarol, 17% with ticlopidine). The adverse effects of ticlopidine were mild and patients did not need admission to hospital (cutaneous exanthema, diarrhoea and reversible leucopenia). Aspirin was associated with digestive tract bleeding (2.8%) and cerebral hemorrhage (1.7%) which required hospital admission in most cases. One patient treated with acenocumarol presented with a retroperitoneal hematoma. CONCLUSIONS: In general antithrombotic drugs are well-tolerated by patients with TIA and LI. Hemorrhagic complications, particularly of the digestive tract, associated with aspirin limit tolerance to it.

Acenocoumarol↗