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Biomedical subjects

Rafael Golpe

Publications and source records attributed to Rafael Golpe.

8 recordsLinked to original sources
PubMed2005

Effect of body position on gas exchange after bronchoalveolar lavage.

OBJECTIVE: To assess the possible influence of body position on oxygen saturation after bronchoscopy (BC) with bronchoalveolar lavage (BAL). DESIGN: Prospective, open, randomized study. SETTING: The respiratory unit of a first level, community hospital. PATIENTS: Forty-one consecutive patients in which BC with BAL, using at least 150 mL of BAL fluid, was performed. METHOD: We randomly assigned 21 patients to lie in lateral decubitus (LD) with the lung where BAL was performed uppermost after BC, and 20 to lie in supine position (SP). Oxygen saturation (SO2) was measured for all patients from 10 min before to 30 min after the end of the BC. Saturation parameters were compared for both groups. RESULTS: Mean SO2 was significantly lower after than before the BC, both for LD and SP groups (LD: 91.4+/-3% vs. 94.9+/-2%, respectively; P=0.0001) (SP: 91.6+/-3 vs. 95.8+/-3%, respectively; P=0.0003). We did not find significant differences between LD and SP groups, after BC, regarding mean SO2 (91.4+/-3% vs. 91.6+/-3%), minimum SO2 (86.2+/-4.5% vs. 86.6+/-5.4%, respectively) or percentages of registry time at saturations below 90% (26.3+/-35.9% vs. 27.6+/-38.2%, respectively) (P:NS for all values). CONCLUSION: BC with BAL caused significant oxygen desaturation in our patients. We have not been able to demonstrate a significant influence of body position on SO2 after BAL.

Aged↗
PubMed2005

Short-term and long-term effects of nasal intermittent positive pressure ventilation in patients with obesity-hypoventilation syndrome.

OBJECTIVE: To assess the outcome of 54 patients with obesity-hypoventilation syndrome (OHS) who were treated with nasal intermittent positive-pressure ventilation (NIPPV). DESIGN: Descriptive analysis of retrospectively collected clinical data. MATERIALS AND METHODS: From March 1995 to December 2002, OHS (defined as a body mass index [BMI] of > 30 kg/m2, a daytime Pa(CO2) of > or = 50 mm Hg, and a Pa(O2) of < 60 mm Hg in the absence of COPD) was diagnosed in 69 cases. Fifteen patients (21.7%) refused to be treated with NIPPV, and 20 patients were started on NIPPV therapy electively and 34 following an acute exacerbation. We employed daytime arterial blood gas values and overnight pulse oximetry to determine the initial NIPPV modes and settings. The outcome measures were survival, clinical status, and arterial blood gas levels. RESULTS: Among the 54 study patients (18 women), the mean (+/- SD) age was 56 +/- 13 years. The mean BMI was 44 +/- 8.8 kg/m2. Sleep apnea syndrome (apnea-hypopnea index, > 5) was present in 87% of the patients. At presentation, 22 of the 54 patients had experienced an acute hypercapnic respiratory failure (pH < 7.34). None of these patients required orotracheal intubation after NIPPV treatment. Initially, 2 patients were treated with volume-preset ventilation, 49 patients used pressure-preset equipment, and 3 patients employed continuous positive airway pressure (CPAP). Forty-seven patients required supplemental oxygen. At the end of the follow-up period (mean duration, 50 months), Pa(O2) had increased by 24 mm Hg from baseline (95% confidence interval [CI], 21 to 28 mm Hg; p < 0.0001) and Pa(CO2) had decreased by 17 mm Hg (95% CI, 13 to 20 mm Hg; p < 0.0001). NIPPV therapy improved subjective sleepiness (mean Epworth sleepiness scale score decrease, 16 +/- 5 to 6 +/- 2; p < 0.001), and dyspnea decreased in all but four patients. During follow-up, three patients died (one of them due to the progression of respiratory failure). NIPPV therapy could be withdrawn in 5 patients who had achieved a sufficient weight loss, and the conditions of 16 patients could be maintained without respiratory failure by the use of simple therapy with CPAP. CONCLUSIONS: NIPPV therapy is effective in the treatment of patients with OHS, providing a significant improvement in clinical status and gas exchange.

Female↗
PubMed2002

Home sleep studies in the assessment of sleep apnea/hypopnea syndrome.

OBJECTIVE: To determine the clinical utility of a limited sleep-recording device used unsupervised in the patient's home, compared with in-laboratory, fully supervised polysomnography for the diagnosis of sleep apnea/hypopnea syndrome (SAHS), and to assess its impact on costs. DESIGN: Prospective case study. SETTING: The sleep-disorders unit of a tertiary referral university hospital. PATIENTS: Fifty-five patients suspected of having SAHS and living within 30 km of our laboratory. METHODS: Patients were studied first in their homes with the limited sleep-recording device. Polysomnography was performed within 30 days of the first study. Both studies were read by independent investigators blinded to the results of the other study. Diagnoses and therapeutic decisions regarding the use of continuous positive airway pressure obtained from the home and laboratory studies were compared. Agreement between the home and laboratory study recordings was also assessed using receiver operating characteristic (ROC) curves and Bland-Altman analysis. One half of the home studies were randomly assigned to be performed with a sleep technician's set up of the equipment in the patient's home (group 1), and the other half with the patient's own setup of the sleep-recording device (group 2), after an instruction period in the hospital. An economic analysis was performed, considering the cost of repeating studies in cases with faulty or inconclusive home studies (these patients should undergo polysomnography as a second step). RESULTS: Seven percent of the home studies in group 1, and 33% in group 2 produced no interpretable data because of artifacts (p < 0.05). Sixteen percent of the home study findings were inconclusive. The diagnosis obtained from the limited sleep-recording device and polysomnography agreed in 75% of the interpretable home studies (89%, if inconclusive home studies were excluded). The area under the ROC curve for the home study-derived parameters was between 0.84 and 0.89, compared with polysomnography. There was no bias between home and polysomnography studies in the Bland-Altman plot. The cost per study of home study recordings was less expensive than that of polysomnography (143.86 euros), either with (93.08 euros) or without (129.97 euros) intervention of the technician in the patient's home. CONCLUSION: Home sleep studies are a viable form of diagnosing SAHS, and are less expensive than polysomnography. Intervention of a sleep technician in the patient's home was the least expensive strategy, because of the high percentages of faulty studies with the patient's own setup of the equipment, when using the limited sleep-recording device.

Adult↗
PubMedDate not supplied

Multiple pulmonary nodules in a patient with Crohn's disease.

Crohn's disease (CD) can be associated with respiratory involvement. Multiple pulmonary nodules are an infrequent finding in patients with CD. When they are found, histology usually shows sterile necrobiotic nodules, which are spherical aggregates of neutrophils, which frequently cavitate. We report a patient with inactive CD treated with mesalazine, who presented with multiple pulmonary nodules. Transthoracic biopsy of one of the nodules disclosed a benign, nongranulomatous inflammatory lymphoid infiltration. The radiographic abnormalities responded well to oral prednisone. Focal, nongranulomatous lymphoid infiltration thus must be considered in the differential diagnosis of multiple pulmonary nodules in patients with CD.

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