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P Ros

Publications and source records attributed to P Ros.

15 recordsLinked to original sources
PubMed2003

[Techniques and complementary techniques. Complementary treatments: nitric oxide, prone positioning and surfactant].

The management of hypoxic respiratory failure is based on oxygen delivery and ventilatory support with lung-protective ventilation strategies. Better understanding of acute lung injury have led to new therapeutic approaches that can modify the outcome of these patients. These adjunctive oxygenation strategies include inhaled nitric oxide and surfactant delivery, and the use of prone positioning. Nitric oxide is a selective pulmonary vasodilator that when inhaled, improves oxygenation in clinical situations such as persistent pulmonary hypertension of the newborn, pulmonary hypertension associated with congenital heart disease, and acute respiratory distress syndrome (ARDS). When applied early in ARDS, prone positioning improves distribution of ventilation and reduces the intrapulmonary shunt. The surfactant has dramatically decreased mortality caused by hyaline membrane disease in premature newborns, although the results have been less successful in ARDS. Greater experience is required to determine whether the combination of these treatments will improve the prognosis of these patients.

Adult↗
PubMed2000

Radiology quality and performance metrics on the Web: a management information and communications tool.

RATIONALE AND OBJECTIVES: The purpose of this study was to demonstrate the feasibility of using the World Wide Web to communicate critical radiology quality and performance metrics to departmental and hospital management staff. MATERIALS AND METHODS: Data on report turnaround, appointment access, patient and physician satisfaction, and financial performance were harvested from a variety of sources. These were then standardized and condensed so they could be displayed electronically in a concise, information-dense fashion. RESULTS: The final product was a series of graphic materials on a single Web site. The most informative was a summary "spiderweb chart" that indicated the percentage of specified performance goals achieved for 12 operational parameters. These graphic materials were distributed to management staff monthly by means of e-mail. CONCLUSION: The use of simple Web-based technology facilitates the collection of key departmental performance data and the dissemination of these data to a wide audience.

Humans↗
PubMed2000

Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection.

An observational study was undertaken to describe a nosocomial outbreak caused by multiresistant Klebsiella pneumoniae (MRKP). Ten patients in the pediatric intensive care unit (ICU) at a hospital in Madrid were colonized by or infected with MRKP from October 1997 to April 1998. Thirty-two patients with MRKP-negative surveillance cultures who were admitted to the ICU during the outbreak period were selected as control patients. Random amplified polymorphic DNA analysis of MRKP isolates revealed patterns that were indistinguishable from each other. After identification of colonized patients by surveillance cultures and implementation of standard and contact precautions, the outbreak was controlled. An age <12 weeks (odds ratio [OR], 13.1) and previous treatment with third-generation cephalosporins and aminoglycosides (OR, 31.2) were independently associated with MRKP colonization and/or infection. Individual exposure to antibiotics, irrespective of other clinical determinants, is a risk factor for MRKP acquisition. Screening high-risk patients during outbreaks and reducing the use of third-generation cephalosporins and aminoglycosides contribute to the control of these epidemics.

Anti-Bacterial Agents↗
PubMed1999

Thyroid-specific gene expression in the multi-step process of thyroid carcinogenesis.

Thyroid-specific transcription factors TTF-1 and Pax-8 play a decisive role in the determination and maintenance of cellular phenotype activating thyroglobulin (Tg), thyroperoxidase (TPO), thyrotropin receptor (TSH-R) and the sodium/iodide symporter (NIS) gene transcription. In the present work, we have studied the expression of TTF-1 and Pax-8 and their target genes in samples derived from thyroid neoplasms of follicular origin, as well as in medullary carcinoma (MTC), obtained from surgery or from fine needle aspiration (FNA) biopsies. The results show that TTF-1 and Pax-8 are expressed in well differentiated adenomas and that their expression decreases in less differentiated papillary and follicular carcinomas and is lost in undifferentiated anaplastic carcinomas. Parallel levels of Tg, TPO and TSH-R expression were found in the same neoplasm samples. Interestingly TSH-R and TTF-1 gene expression was found in MTC samples. Furthermore, the expression of the thyroid-specific genes and their transcription factors is lost in thyroid cells derived from follicular, papillary and anaplastic human carcinomas. In these cells, Tg, TPO and TSH-R promoter activities were absent. Cotransfection with expression vectors for TTF-1 and Pax-8 resulted in the stimulation of transcription to a different extent for each promoter. These results may be clinically relevant for the evaluation and prognosis of thyroid cancer since the loss of specific markers correlates with the degree of tumor differentiation.

Carcinoma, Medullary↗
PubMed1998

[Postoperative management following single-stage laryngotracheoplasty in acquired subglottic stenosis in children].

Acquired laryngotracheal stenosis (ALTS) in children is a more and more common disease, following the widespread adoption of prolonged endotracheal intubation for respiratory support, specially among newborn and premature infants with respiratory distress syndrome. Several treatment procedures have been described in order to solve this problem; some authors have recently reported encouraging results with single-stage laryngotracheoplasty, making open reconstruction with airway division, cartilage grafts when appropriate, and closure of the tracheotomy tract at the same operation, followed by a short period of endotracheal intubation, avoiding the need for prolonged laryngeal stenting with its associated risks of granulation tissue formation, restenosis and airway obstruction, and with no need of new surgical procedures. Two patients of 9 and 16 months of age underwent successfully the surgical technique described above, with no need of laryngeal stent; postoperative management required several issues in order to prevent an accidental extubation during the time of scarring of the laryngotracheoplasty. No complications occurred. Follow-up at 6 and 12 months after operation was normal, both ventilation and voice quality.

Female↗
PubMed1997

Pituitary-thyroid function in patients with septic shock and its relation with outcome.

OBJECTIVE: To study the time course of thyroid function abnormalities and their relation to outcome in patients with septic shock. DESIGN: Prospective study in a cohort of consecutive patients. SETTING: Intensive Care Unit in a University Hospital. PATIENTS AND METHODS: We studied 27 patients (mean age 50 +/- 19 years, Apache II score 18.4 +/- 5.2, 15 survivors) diagnosed of septic shock. Total T4 (T4) and total T3 (T3) (RIA) were determined on days 1 and 5 after admission. We also measured TSH (ultrasensitive RIA) at 08.00, 20.00 and 01.00 hours (on days 1 and 5), and the TSH response to TRH (400 microg intravenous) on days 2 and 6. Data are mean +/- SD. RESULTS: Whereas low thyroid hormones concentrations were present on day 1 in all patients, only survivors presented a significant increase in T3 and T4 on day 5. Basal TSH levels and the area under the curve of the TSH response to TRH on day 2 were significantly higher in survivors than in non survivors (0.89 +/- 0.63 vs. 0.34 +/- 0.42 microIU/ml, and 229 + 157 vs. 101 + 101). The normal nocturnal (01.00 hr) surge of TSH (the difference between TSH concentrations at 8 am and at 1 am) was abolished in both survivors and non survivors on day 1 but it was recovered on day 5 only in survivors. CONCLUSIONS: Our data indicate that patients with septic shock present an altered hypothalamic-pituitary-thyroid axis, and that survivors thyroid function differs from that of non survivors shortly after diagnosis. Survivors are characterised by a greater TSH response to TRH, indicating a less deranged hypothalamic-pituitary-thyroid axis. Thyroid function improves in survivors, but not in non survivors, during the course of their illness.

Adult↗
PubMed1995

Male gonadal function after chemotherapy in survivors of childhood malignancy.

Investigations of adult patients have shown that chemotherapy causes gonadal damage, but much less information is available about the impact of chemotherapy on gonadal function in children with malignant disease. At one time, being prepubertal during therapy was thought to confer some protection against chemotherapy induced gonadal damage. However, recent studies have indicated otherwise. We designed this study to assess gonadal function in 15 postpubertal males who had received polychemotherapy for a malignant disease during childhood and we compared them with 13 control adults males. The mean age of the patients at the time of the study was 18.2 +/- 3.6 years (range 13.8-29.0), and when given chemotherapy treatment was 10.2 +/- 3.0 years (range 6-16). At that time 12 were prepubertal and at the time of the study all were Tanner V. The mean interval from the completion of treatment until the study was 6.42 years (range 2.0-16.5). All patients had received polychemotherapy. We evaluated testicular size, sperm counts, LH and FSH after GnRH test, and testosterone levels. Puberty had progressed normally in all patients. We found no significant differences in testosterone and basal LH levels between patients and controls. However, we detected an appreciable difference in peak LH levels (P < 0.05) and in basal and peak FSH levels (P < 0.001). Seven patients had exaggerated LH response to GnRH, indicating dysfunction of the Leydig cells. The results of semen analyses were: 8 patients had azoospermia, 3 oligospermia, and 1 patient had a normal semen analysis. All patients with semen abnormalities presented a basal and peak FSH higher than the mean +2 SD of the control group. In summary, we found no evidence of gonadal protection in prepubertal patients. We found a high incidence of germinal cell damage, whereas Leydig cell abnormalities were found less often. An endocrine study of patients that have received chemotherapy is warranted.

Adolescent↗
PubMed1991

Effect of thiopentone, etomidate and propofol on systemic vascular resistance during cardiopulmonary bypass.

We have studied the effect of thiopentone, etomidate and propofol on systemic vascular resistance (SVR) during cardiopulmonary bypass with constant pump flow in 30 patients undergoing elective coronary artery bypass surgery. SVR decreased to 78% of control values after thiopentone 4 mg kg-1, to 72% of control after etomidate 0.3 mg kg-1, and to 68% of control after propofol 2 mg kg-1; it returned to control values 10 min after administration of thiopentone and propofol and 7 min after administration of etomidate. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups.

Adult↗
PubMed1990

Effect of propofol on peripheral vascular resistance during cardiopulmonary bypass.

Twenty-eight patients undergoing elective coronary artery bypass surgery were allocated randomly to receive either propofol 2 mg kg-1 or an equivalent volume of its vehicle during cardiopulmonary bypass with constant pump flow. Peripheral vascular resistance (PVR) was calculated from perfusion pressure and pump flow. After propofol, PVR decreased from 1767 (SD 415) dyn s cm-5 to a minimum of 1263 (283) dyn s cm-5 at 2 min, and remained significantly less than the control value until 12.5 min after administration of propofol. In the group given the vehicle, PVR did not change significantly. In a second study in 10 patients, venous blood samples were withdrawn before and 2, 4, 6, 8, 10, 20 and 30 min after injection of propofol 2 mg kg-1 during cardiopulmonary bypass, for measurement of blood concentrations of propofol. Concentrations were greater than predicted by a computer simulation based on published pharmacokinetic data. The decrease in PVR may be an important factor in the hypotension caused by propofol during induction of anaesthesia.

Aged↗
PubMed1985

Sensitivity of MRI in metastatic neoplasia: a case report.

Serial magnetic resonance imaging (MRI) and computed tomography (CT) were performed on a patient with metastatic lung cancer to brain. Magnetic resonance (MR) visualized two foci of intracerebral metastasis six weeks prior to CT.

Adenocarcinoma↗
PubMedDate not supplied

CT findings of retroperitoneal malignant mesenchymoma.

Malignant mesenchymoma (MM) is a rare mesenchymal neoplasm which, by definition, demonstrates at least two distinct types of malignant mesenchymal differentiation. We present the computed tomographic (CT) findings of a 42-year-old female with a pathologically proven retroperitoneal MM consisting of osteoid production combined with foci of liposarcoma and Kaposi sarcoma. MM should be considered along with extraosseous osteosarcoma and teratoma in the differential diagnosis for unusual large heterogeneous retroperitoneal masses with massive calcification.

Adult↗