Biomedical subjects
Publications and source records attributed to R Muñoz.
Propofol was used for the induction and maintenance of anesthesia in a patient undergoing a laparoscopic tubal ligation. This new anesthetic has not been associated with postoperative ventricular arrhythmias. This report demonstrates the occurrence of supraventricular tachycardia deteriorating to ventricular tachycardia in a patient who received propofol. Included is a discussion of the possible causes of this event.
STUDY OBJECTIVE: To examine the safety and efficacy of intravenous fenoldopam as compared to placebo for the treatment of postoperative hypertension. DESIGN: Randomized, placebo-controlled, double-blind study. SETTING: Community hospital. PATIENTS: 16 ASA I-III hypertensive patients scheduled for noncardiac surgical procedures. INTERVENTIONS: Treatment with fenoldopam or placebo was initiated immediately after other causes of hypertension had been ruled out. Hypertension was defined as a supine systolic blood pressure (SBP) or diastolic blood pressure (DBP) greater than 20% over the patient's preoperative baseline, which was obtained 6 hours prior to the procedure with the patient lying quietly. The baseline consisted of 3 consecutive blood pressure (BP) measurements obtained at 5-minute intervals and not varying by more than 10%. Fenoldopam or placebo infusion was initiated at 0.1 microgram/kg/min and increased and decreased as necessary until the therapeutic goal BP was reached or treatment failure had occurred. The therapeutic goal BP was a decrease to at least 10% above the preoperative baseline, and failure of treatment was defined as inability to reach this BP level after 15 minutes at 1.5 micrograms/kg/min. MEASUREMENTS AND MAIN RESULTS: BP and heart rate (HR) data were collected consistently throughout the study and 1 hour after termination of infusion. Laboratory studies and 12-lead electrocardiographic results were obtained at the start of the study and repeated 24 hours after termination of infusion. Blood samples were obtained for the measurement of epinephrine, norepinephrine, and dopamine levels and were analyzed using high-performance liquid chromatography with electrochemical detection. Pretreatment BP measurements were significantly elevated from baseline in both groups. Fenoldopam treatment significantly reduced BP to the therapeutic goal in 8 of 8 patients; placebo reduced BP to this goal in only 4 of 8 patients (p < 0.05). At the end of the titration period, the therapeutic goal BP was not significantly different from baseline in the fenoldopam group. HR was significantly elevated (p < 0.05) at goal in the fenoldopam group as compared with the placebo group. Fenoldopam administration lowered SBP and DBP to goal in a mean time of 28 minutes versus 42.5 minutes in the placebo group. There were no significant differences in catecholamine levels at any of the measurement periods. CONCLUSION: Fenoldopam is an effective drug for reducing BP following hypertensive episodes in the postoperative setting. Fenoldopam use is associated with an increase in HR versus placebo.
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AIM: To assess the feasibility and results of application of Ambulatory Patient Groups (APG) patient's classification system to the case-mix of patients seen at the Emergency Departments (ED) of 6 Barcelona metropolitan area hospitals. METHODS: Development of a minimum discharge data set specific for the Emergency Departments (CMBDAU). Gathering of relevant variables from a random sample of patients seen at the ED using the ED discharge reports. Use of the APG classification system to those episodes. RESULTS: A total of 11.188 episodes were codified and grouped with the APG system. Fifteen diagnostics identified 25% of all episodes. Nearly 50% of all procedures performed at the ED were common and simple procedures. Fifteen APG's grouped 50% of all cases seen at the ED. CONCLUSIONS: The ED Uniform Discharge Data Set (CMBDAU) developed is a valid instrument for describing the case-mix seen at the ED, and its grouping by means of the APG system provides consistent and meaningful results. The widespread use of systems like APG in the ED requires a former validation of relative weights assigned in the US system. The availability of human and technical resources must also be assessed, in order to guarantee the quality and sustainability of such a system.
Previous research suggests higher rates of smoking, and smoking cessation failure, in alcohol- and drug-abusing populations. The present study examined the relationship of alcohol/drug treatment history and current alcohol and marijuana consumption with success in smoking cessation treatment in a smoking clinic population. Participants were 199 smokers; 23% reported a history of alcohol/drug problems, 12.6% reported a history of drug treatment, 78.7% reported alcohol use, and 21.3% reported marijuana use during treatment. Results indicate no significant differences in abstinence rates based on history of alcohol/drug problem or treatment. Differences were found for any current alcohol use but not for marijuana use. Both alcohol use at baseline and any alcohol use during treatment predicted smoking at all follow-up points. Alcohol users had significantly lower quit rates than did participants reporting no use. Neither use of marijuana at baseline nor during treatment predicted outcome. These findings suggest that even low to moderate levels of alcohol consumption during smoking cessation may decrease treatment success.
The capsular gene cluster (cap/cps) of 13 out of the 90 known pneumococcal types has been sequenced. The cap/cps operon, located between dexB and aliA in the Streptococcus pneumoniae chromosome, contains some of the genes responsible for the synthesis of the type-specific polysaccharide flanked by four conserved open reading frames. The biochemical function of only a few capsular genes has been established, whereas the role of the flanking regions is controversial. Remarkably, only one gene (tts) located outside the cap locus is required for the synthesis of type 37 capsule. Moreover, other genes not linked to the cap gene cluster are also needed for capsule synthesis in pneumococcus.
This study examines the effectiveness of an intervention for minor depression in primary care patients. One hundred fifty public care medical patients were randomly assigned to either an 8-week cognitive-behavioral course intended to help them use pleasant activities, constructive thinking, and interpersonal relationships to improve mood or a control condition. Assessments were completed at postintervention, 6 months, and 1 year. The results support the effectiveness of the intervention. Persons with minor depression assigned to the intervention experienced reductions in depressive symptomatology, which persisted through the 1-year follow-up. In addition, the intervention lowered the somatic symptomatology that was associated with minor depression. Finally, those with minor depression who received the intervention missed fewer appointments with their primary care provider during the following year than did those with minor depression who received no intervention. The results from this preliminary evaluation suggest that interventions addressing minor depression in medical patients are feasible and are effective in reducing both depressive symptomatology and associated problems.
The aim of this study was to assess serum zinc levels in a cohort of healthy subjects and cirrhotic patients from Mexico City. A total of 153 healthy subjects and 100 cirrhotic patients, males and females aged 18-65, were studied. Inclusion criteria for healthy subjects were (1) Mexican-born with first and second generation relatives born in Mexico, and (2) somatometric (body mass index under 30) and clinical evaluation establishing that they had no underlying disease. Entry criteria for cirrhotic patients were (1) clinical and histological proven cirrhosis, (2) compensated liver disease (absence of coma, bleeding hemorrhage or refractory ascitis), and (3) cirrhosis of any cause. Zinc serum levels were measured with atomic absorption spectrophotometry. In healthy subjects, mean serum levels were 77.4 +/- 4.2 micrograms/dl (range 42.9-105.2 micrograms/dl). In cirrhotic patients zinc serum levels (58.9 +/- 16.1 micrograms/dl, range 22-88 micrograms/dl) were significantly lower than in healthy subjects (p < 0.05). A stepwise decline in serum zinc with worsening Child class (A, 73.4 +/- 13; B, 64.4 +/- 12; C, 55.8 +/- 15.6; p < 0.05 by ANOVA test) was found. In conclusion, this study confirms that zinc serum levels are significantly lower in cirrhotic patients and shows that zinc serum levels in a cohort of 153 healthy subjects from Mexico City were unexpectedly lower compared to those found in other countries. This last finding might be explained by different dietetic patterns and deserves further investigation.
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Thromboembolism problem is a grave complication which occurs with great frequency in patients hospitalized in a critical state. The association between periferical venous thrombosis and the thromboembolic accident is plainly demonstrated, although the accurate establishment of the clinical diagnosis of phlebothrombosis is only feasible in 50% of the cases. In the present work, we describe the methodology and the experience which we have acquired with the use of radioisotops in the diagnosis of these problems. We studied 64 patients to whom in the supine position we injected into a vein in both heels, from 3 to 5 millicuries of 99m-Tecnecio, practicing three stages: dynamic venography, a static study, and a pulmonary gammagram. In the normal cases, we clearly identified the tracts of the principal femural, iliac, and the inferior third of the inferior vena cava veins. In the abnormal studies, we observed the obstructive process manifested by the absence of radioactivity in the affected venous tract, with appearence of collateral circulation, definitive data which establishes with certainty the diagnosis. It can be concluded that the method is rapid and easily carried out, meaning that it could be a routine practice in all of those patients who are suspected of having this problem.
In this work we present our experience with a seven-day protocol of i.v. dihydroergotamine (DHE) in the treatment of 6 patients (7 treatments) suffering from intractable transformed migraine. All of them were admitted to hospital and treated for one week with a protocol which included DHE doses between 0.5-1 mg/8 h. One patient did not respond. The remaining 6 became free of pain in under 48 hours after the beginning of treatment. This positive effect remained for between 15 days and 3 months. All patients experienced adverse events; however, these were slight and ceased when the DHE dose was reduced. DHE is an effective and quick option for the short-term treatment of patients with severe transformed migraine resistant to other medications.
BACKGROUND/AIMS: We compared the response to interferon-alpha 2a in 35 patients with antibody to HBeAg (anti-HBe) and 20 patients with HBeAg in serum, and histological features of chronic hepatitis B. METHODOLOGY: Patients were treated with 4.5-6 MU of interferon-alpha 2a, three times a week for 12 months, and followed for 30.8 +/- 13.5 additional months. RESULTS: All of them had elevated serum levels of aminotransferases and positive test for hepatitis B virus-DNA in serum. Patients with anti-HBe-positive chronic hepatitis were older and had higher serum aminotransferase levels than HBeAg-positive patients, but no differences were seen between both groups with respect to sex, history of acute hepatitis, mode of transmission of the infection or histological appearance before interferon therapy. Serum levels of alanine transaminase became normal and hepatitis B virus-DNA undetectable by PCR at the end of therapy in 25 (71%) of anti-HBe-positive patients and in 10 (50%) of HBeAg-positive patients (P > 0.05). Although 10 (29%) of the anti-HBe-positive and none of the HBeAg-positive patients relapsed, no significant difference was seen in the rate of sustained response (43% vs. 50%, respectively). The histological improvement was similar in both groups. CONCLUSIONS: The results of this study indicated that biochemical, virological and histological response to 12-month interferon-alpha 2a therapy was similar in patients with anti-HBe antibody than in patients with the classical HBeAg-positive of chronic hepatitis B.
To assess the anatomy of the left atrium and mitral plane after heart transplantation, we performed a transesophageal echocardiographic study to 37 consecutive transplant patients. After heart transplantation no patient was under anticoagulant treatment and no case of atrial fibrillation was documented. The transesophageal approach allowed us to measure the left atrial free wall suture which was: less than 15 mm in 14 patients, between 15 and 25 mm in 16 patients, and more than 25 mm in 7 patients. In those patients with a left atrial free wall suture greater than 15 mm, blood flow turbulences within the "niche" underneath the protruding suture as well as blood flow acceleration at the rim of that suture were noted. In 4 patients a "pseudoaneurysm" of the interatrial septum was observed. Two patients had mitral valve prolapse. Mitral regurgitation was noted in 17 patients (46%) by color Doppler transesophageal echocardiography and graded as mild in 15 patients and moderate in 2 cases. In 16 patients (43%) spontaneous echo contrast within the left atrium was detected by transesophageal echocardiography. Both major and minor axis as well as left atrial area in patients with and without dynamic echoes were, respectively: 72.5 +/- 12.2 mm vs 56.9 +/- 5.9 mm (p < 0.001), 48.3 +/- 7.1 mm vs 39 +/- 7.9 mm (p < 0.001), and 35.4 +/- 7.1 cm2 vs 24.4 +/- 5.2 cm2 (p < 0.001). Atrial thrombi were not detected. After a mean follow-up of 15 +/- 10.7 months there was no arterial thromboembolism in patients with spontaneous contrast.(ABSTRACT TRUNCATED AT 250 WORDS)
According to the heterogenous nature of hemolytic uremic syndrome in relation to the etiology, pathophysiology, treatment and diagnosis, we wish to draw attention to the main characteristics about its epidemiological clinical and immunopathological aspects. The HUS's distributes through all the world, but in Argentina, North of Europe, South Africa and west of USA the incidence is higher than the rest of the countries. The immunopathological studies shows thrombotic angiopathic lesion, consisting in generalized alteration of the capillary and arteriolar epithelium. Decreased levels of PGI2, Von Willebrand's factor and bacterial toxins are apparently involved among mechanism that are able to produce HUS. Dialysis is one of the main helps in the treatment of HUS, and in spite of our continued advances in knowledge about this disease, still further developments are needed in pathophysiology and therapeutics to enlight its intimate mechanisms.
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