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R Salas

Publications and source records attributed to R Salas.

47 records · Page 3Linked to original sources
PubMed1977

The role of surgery in the management of pulmonary monosporosis. A collective review.

Nine cases of pulmonary monosporosis treated in the Missouri State Chest Hospital over a period of 19 years (1956 to 1975) were reviewed. Nine other cases from the literature are summarized. Ten of these 18 patients underwent resectional operations with two operative deaths, one from respiratory insufficiency and the other from a bronchopleural fistula and massive hemorrhage. The rest of the patients had an uneventful recovery. The indications for resectional surgery are re-established for suitable cases. The underlying disease is the major determinant of the outcome of the surgery. Other modes of treatment are also discussed. Based on the analysis of these 18 cases, a guideline for the management of pulmonary monosporosis is proposed.

Aged↗
PubMed1976

Surgical treatment of atypical pulmonary tuberculosis.

During a 12 year period from January 1962 to December 1973, 48 patients with atypical mycobacterial infection of the lung were treated surgically with excellent results. There were no deaths, and sputum conversion was achieved in all of them. The considerable drug resistance of the atypical mycobacteria and the possible ill effects of prolonged conservative treatment in cases with active disease and drug resistant organisms are pointed out. Early surgical treatment is recommended in such circumstances. Some bacterioligical and biological characteristics of atypical mycobacteria are also discussed.

Adult↗
PubMedDate not supplied

[A model for evaluating internal accuracy].

OBJECTIVE: To provide an evaluation model of internal accuracy illustrating its use in a quality control program of clinical chemistry. METHODS: The model uses data transformed to percentage of assigned value (%AV) that allows the pooling of different controls. Precision is evaluated by the mean of the intracontrol coefficients of variation, and accuracy by the mean of means of the %VAs and its standard deviation. The model was used in 17,280 measurements of 23 analytes assayed in seven pairs of controls (medium and high concentration) during four years in two automated clinical chemistry analyzers. RESULTS: The model established inaccuracy of 5% to 25% in seven analytes, five of them enzymes. It also detected interanalyzer differences in accuracy of five analytes (22%) and an erroneous assigned value in 19 of 304 controls (6%). CONCLUSIONS: The model showed its capacity to dissect the sources of variation of accuracy. There was inaccuracy in 30% of the analytes but further studies are needed to validate these inaccuracies with controls of other sources. The model can be useful for control programs of any quantitative assay system. A summary description of the model's operation is given.

Chemistry, Clinical↗
PubMedDate not supplied

[Evaluation of pipetting systems. II. Precision and accuracy of precision dispensers].

OBJECTIVE: To evaluate the precision and accuracy of the liquid dispensers being used in our institution. MATERIAL: A total of 15 dispensers (8 micro and 7 macro) of automatic, semiautomatic or manual types were evaluated. They had been in use from 0.5 to 7 years. METHODS: The volume dispensed was established by gravimetry using an analytical balance (Chio JP-160) and deionized distilled water as previously described. The microdispensers were evaluated using volumes of 20 and 100 microL, and the macrodispensers with 1 and 5 mL. Each dispenser was evaluated using 10 replicates: the mean and the CV (coefficient of variation) were calculated with the 10 replicates. The mean was transformed to per cent of the theoretical volume. Thus a 100% ratio of accuracy corresponds to a perfect accuracy. An important methodological aspect was that the 10 dispensing replicates were performed personally by the habitual user of the dispenser. RESULTS: The mean and CV are shown in table 2 for the microdispensers, and in table 3 for the macrodispenser. In the total 25 evaluation in tables 2 and 3 there were 8 instances in which precision was poor (CV above 3%) and also 8 cases of sizable inaccuracy (ratio outside of 100 +/- 5%). In 4 (2 micro and 2 macro) of these 8 inaccuracies, the error ranged from 10% to 22%. A minority was within the specifications of precision and accuracy claimed by the manufacturers of the dispensers with the exception of the manual microdispensers which were within specifications in most instances. We attribute the latter to the lack of a mechanical device in the manual dispensers. CONCLUSIONS: As in a previous evaluation of automatic micropipettes, we detected a high proportion of pipetting systems out of specifications in both precision and accuracy. The magnitude of error in the accuracy of 4 dispensers (10 to 22%) would be catastrophic in methods demanding good pipetting.

Calibration↗
PubMedDate not supplied

[Patient data for evaluating reference values].

OBJECTIVE: To explore the use of data in patients as a way to evaluate the values of reference in clinical assays. Serum calcium (Ca) and phosphorus (P) were selected for this purpose. MATERIAL: A total of 836 consecutive admissions in a 10 week period were revised. Seventy percent (580 cases) had data of Ca and P in the first week following admission. A total of 424 were excluded by anyone of the following criteria: a) serum urea greater than 50 mg/dL, b) serum creatinine greater than 1.5 mg/dL; c) serum albumin less than 4 g/dL; d) lack of data of either urea, creatinine or albumin. These cutoff values were selected on the basis of a significant difference (t test) in the mean of Ca and/or P in patients grouped according to levels of the available data. The remainder of 156 cases is the selected population of study, and the 580 with Ca and P is the total population. METHODS: Ca and P were assayed in an analyzer (Coulter Chemistry) using the DAM and the Jaffé methods respectively. The precision during the period of study was adequate (CVs of 2.6% for Ca and 2.9% for P). RESULTS: Table 1 compares the mean, SD and CV of Ca and P in the selected versus the total population. There are significant reductions (F test) in the variability of Ca and P in the selected population (from a CV 9 to 5% in Ca and from 35 to 13% in P). Table 2 compares the age and sex distributions of the selected versus the total population. There are no significant differences (chi square test) although there is a lower proportion of people above 80 years of age in the selected population. The reference intervals of Ca and P in the selected population were obtained with the mean +/- 2 SD as both showed Gaussian distributions. These limits are compared in table 3 versus the values of the institution and of the manufacturer of the analyzer used. The P limits of this study fall intermediate to the other two, but in Ca they are the lowest of the three. Shortly after the completion of this study, the institutional values of Ca were changed to 8.5-10.5 mg/dL on the basis of the one year results in a WHO quality assessment scheme. The modification made the Ca limits of this study also intermediate to the other two series. The small differences in the limits have clinical and economic repercussions. Table 4 shows there is a 20% reduction in the number of abnormal tests (206 vs 259) and in the number of abnormal individuals (165 vs 203) using the limits of this study versus the institutional limits before modification. CONCLUSIONS: The data of Ca and P in a selected but representative population of patients proved to be a reliable way of evaluating its reference intervals. The reference intervals of this study were intermediate to those of the manufacturers of the analyzer and the laboratory (after modification). This finding suggests the strategy may be as good as more conventional approaches to establish reference values.

Adolescent↗
PubMedDate not supplied

[The management of acute cerebrovascular disorders at the Emergency Services at the Castellon General Hospital].

OBJECTIVE: To analyse the policy for hospital admission in the case of the patients who come to the Emergency Ward with acute cerebrovascular disorders. METHOD: The study was based on a retrospective analysis of the release reports from the Emergency Ward of Castellón General Hospital in the course of 1991, in which stroke, or transitory ischemic attack (TIA) were diagnosed. RESULTS: 514 patients were attended to who went to the Emergency Ward because of cerebrovascular disorder. Of these, 57.2% were referred to hospital, with 42% being sent home. It was observed that 10.65% (n = 23) they did not accomplish the criteria for stroke. There was an overwhelming number of cases of TIA diagnosed (50.2%) in patients who were not admitted, contrasting with only 7.5% being selected for admission. We considered possible explanations for this. CONCLUSIONS: We observed that as far as making the decision to admit a patient with acute cerebrovascular disorder, priority for admission was given in those cases which showed the worst neurological deficiencies, and had a worse prognosis as a consequence. Similarly, the older age (average 76.5 years old) was a prominent factor as far as those who were not admitted.

Acute Disease↗
PubMedDate not supplied

Epidemiology and inmunogenetics in recently diagnosed Venezuelan children with insulin-dependent diabetes mellitus.

Genetic and immunological markers in children with Type I diabetes have not been studied previously in Venezuela. We evaluated 91 newly diagnosed IDDM children mean age 7.8 +/- 4.5 (range 0.8-20.8 years), 51 females and 40 males. Eleven percent of first degree relatives had a family history of Type I IDDM; 56.7% had had upper respiratory infection prior to diagnosis and 12.7% had had either mumps or varicella. Peak incidence of disease was found in February and March and August to October. Eighty seven percent had HLA-DR3 and/or DR4 vs 36% of the Venezuelan general population; 81.6% were HLA-DQW2 and/or HLA-DQW8. We found 55.9% to have positive islet cell antibodies (ICA) with 4 of these having a positive complement fixation test. Three patients (7.9%) were found to have positive insulin autoantibodies. Only 3 out of 11 HLA-identical siblings had positive ICAs, while none had positive insulin autoantibodies. One of them also had a positive complement fixation test; this subject developed IDDM. No positive serotypes for enterovirus (Coxsackie-B) were found in our patients, but we detected 11 cases with elevated titers for cytomegalovirus antibodies and positive antibodies for measles, mumps, herpes and varicella were found in some children. These data confirm that most of our Type I diabetics carry HLA-DR3 or DR4 and that the heterozygous DR3/DR4 phenotype is markedly increased in this population; they also indicate that DR3QW2 and DR4QW8 are associated with increased risk in our population.

Adolescent↗
PubMedDate not supplied

[Evaluation of pipetting systems. III. Micropipette precision in a routine task].

OBJECTIVE: To establish a norm of the precision achievable with a micropipette in an IRMA assay under routine conditions. MATERIAL AND METHODS: A micropipette (Gilson) adjusted to dispense 100 microL was used by a single analyst with experience in its use. In each assay, ten aliquots of radioactive antiprolactin were pipetted in clean tubes (PRE-batch tubes), followed by pipetting of the tubes being processed in the assay, and at the end, a second pipetting of 10 aliquots in clean tubes (POST-batch tubes). The study includes the data of 15 consecutive batches during a seven month period with an overall mean of 283 tubes per batch. The PRE- and POST-tubes were read in a gamma counter (Crystal plus). The mean, SD and CV for PRE, POST and global (PRE+POST) tubes were calculated for each batch. RESULTS: The global CV of the 15 batches ranged from 1.6 to 6.9%, mean of 3.1%. We found no evidence of increased imprecision due to fatigue of the analyst, but surprisingly, we observed that in nine of the 15 batches there was a significant difference in the means of the PRE-tubes vs the POST-tubes (t test) without differences in precision. Thus, part of the global variability is due to what we have called pseudoimprecision (i.e. an increase in CV due to differences in means). In addition, the POST-tubes had higher values in the first 7 batches but the opposite occurred in the last 8 batches (table 2). This shift in the sign of the PRE-POST differences suggests the presence of opposite factors operating in time, i.e. one or more factors increased the volume of pipetting after using the pipette more than 150 times (batches 1-7) whereas other/others decreased it (batches 8-15). CONCLUSIONS: 1. Our first approximation to a norm of micropipetting precision in batches of 200-300 tubes was a CV of 3.1%. 2. This norm was influenced by a problem of pseudoimprecision detected ex-post-facto. 3. Our findings justify continuation studies to detect the pseudoimprecision and evaluate its causes prospectively.

Antibodies↗