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Biomedical subjects

C Brotons

Publications and source records attributed to C Brotons.

At least 19 recordsLinked to original sources
PubMed1999

Attenuated severity of new acute ischemic events in patients with previous coronary heart disease receiving long-acting nitrates.

BACKGROUND: Platelet aggregation and secondary vasoconstriction are key events in the genesis of acute coronary syndromes. HYPOTHESIS: Since nitrates have vasodilatory and antiaggregant effects, treatment with long-acting nitrates at the time of onset of acute coronary syndromes could be associated with attenuation of their severity. METHODS: A consecutive series of 533 patients with acute coronary syndrome and past history of coronary artery disease admitted to the Cardiology Service of a general hospital was studied. A specific questionnaire assessed the use of nitrates and other relevant drugs, as well as other clinical variables. The diagnosis of unstable angina or acute myocardial infarction (MI) was established according to clinical, electrocardiographic, and enzymatic criteria. RESULTS: In the whole cohort, 169 patients had MI and 364 had unstable angina. Previous use of long-acting nitrates was significantly more common in patients with unstable angina (56%) than in those with MI (37%) (p < 0.0001). Multivariate analysis identified being a nonsmoker [odds ratio: 95%, confidence limits (CL) 0.37, 0.23-0.59], previous unstable angina (CL 0.62, 0.41-0.92), use of aspirin (CL 0.58, 0.41-0.92), and use of long-acting nitrates (CL 0.61, 0.40-0.93) as the independent predictors of the development of unstable angina rather than MI; of these the combination of nitrates and aspirin was the strongest predictor. CONCLUSIONS: Long-acting nitrates as well as aspirin are suggested to have a protective or modifying effect on the development of acute coronary syndromes, favoring unstable angina rather than acute MI.

Adrenergic beta-Antagonists↗
PubMed1998

Worldwide distribution of blood lipids and lipoproteins in childhood and adolescence: a review study.

Review and pooled analysis of the relevant worldwide literature was investigated from 1975 to 1996. Eighteen surveys out of 54 were suitable for analysis according to the selection criteria. This represents a total of 60494 observations from 26 countries all over the world. Data suggests differences as great as 76 mg/dl when comparing northern European countries to black African children. The overall curve of cholesterol with age observed in the pooled population indicates a pre-adolescent peak and then a slightly inverse change is observed for both boys and girls, from 3 to 12 years old being almost coincident absolute values. Beyond age 12, values for boys continue to slightly decrease to age 16, while for girls values tend to increase through this age-range. The curve in the late teens (16-18 years) tends to reach pre-teen levels for both sexes, although girls have consistently higher absolute values than boys. There is a great variation in the specific age-sex and race levels of cholesterol among different populations or even in the same populations over a period of time. However, an apparently universal pattern of an early rise, a fall, and a subsequent rise in mean values of total cholesterol by age from the preadolescence to late teens is observed. More data are needed on total cholesterol and lipid fractions between late school age and mid-adulthood.

Adolescent↗
PubMed1998

[Trends of morbidity and mortality in chronic heart failure in Catalonia].

INTRODUCTION: The epidemiology of chronic heart failure, specifically its morbidity and mortality, is insufficiently known, despite the fact that it has an important economic impact because of the pharmacological treatment and the high hospitalization rate. OBJECTIVE: To analyze the trends of mortality and morbidity of chronic heart failure in Catalonia during the periods 1975-1994 and 1989-1994 respectively. PATIENTS AND METHODS: Specific mortality and morbidity rates (ages 45-65, and older than 65) were calculated for both sexes. Standardised mortality rates were also calculated for mortality rates using the European population as the reference. RESULTS: The trend of mortality of chronic heart failure in the population of 45-65 is stable, the rates being higher for men than for women. The trend in the age group older than 65 shows an important increase from 1983 on, higher in women than in men. Morbidity (hospitalization discharge rates) increases slightly in the population of 45-65 years, especially in men; in the population older than 65 an important increase is observed for both sexes. CONCLUSIONS: Trend of mortality is increasing specifically in women older than 65, while trends of morbidity are clearly increasing for both age groups.

Age Factors↗
PubMed1998

Is prophylactic treatment after myocardial infarction evidence-based?

OBJECTIVE: We aimed to evaluate the use of evidence-based prophylactic treatment after myocardial infarction on hospital discharge and in primary care after 1 year of hospitalization. METHODS AND RESULTS: We conducted a 1-year prospective study of all the patients discharged from a tertiary hospital who had been treated for myocardial infarction from January 1 to December 31 1995. Three hundred and eighty surviving patients were consecutively discharged from the hospital. Seventy per cent of patients were treated with aspirin, 45% with beta-blockers, 27% with calcium channel blockers, 26% with ACE inhibitors, 40% with nitrates and 8% with cholesterol-lowering drugs after discharge from the hospital. In primary care, prescription of lipid-lowering drugs increased to 17%, while prescription of beta-blockers decreased to 34%. ACE inhibitor prescriptions at discharge were clearly more common in patients with impaired ventricular function or heart failure (57%). CONCLUSION: According to the evidence, there is still potential for reducing the risk of a further ischaemic event or death in patients with MI, especially by increasing the use of beta-blockers and lipid-lowering drugs.

Adrenergic beta-Antagonists↗
PubMed1998

[Patients with acute coronary syndrome: therapeutic approach (management patterns) and 1-year prognosis in a tertiary general hospital].

BACKGROUND: To assess the determinants of short-term and one-year prognosis of all patients with suspected acute coronary syndrome seen by the cardiologist on duty in the Emergency Service of a tertiary hospital during a six month period. PATIENTS AND METHODS: 153 consecutive patients with a diagnosis of acute myocardial infarction, 225 with a diagnosis of unstable angina and 89 with a diagnosis of atypical chest pain were identified and their in-hospital characteristics and one-year prognosis were prospectively assessed. RESULTS: Age was higher than 65 years in 53% of acute myocardial infarction and in 54% of unstable angina patients. Only 3 patients were lost to follow-up. 35% of acute myocardial infarction patients had died or had reinfarction after one year and 16% of unstable angina patients had died or had suffered acute myocardial infarction. Baseline features, management patterns and prognosis of patients admitted with acute myocardial infarction to the Cardiology Service, to other hospital areas or to other hospitals were markedly different, and admission in areas other than the Cardiology Service was an independent mortality predictor. In unstable angina, complications happened in patients older than 75 years, those with previous revascularization procedures, those undergoing revascularization or those with lesions not deemed revascularizeable. CONCLUSIONS: a) In the study population there was a predominance of elderly patients; the proportion of patients with poor prognosis was considerably high; b) a sizeable proportion of patients with severe complications was scarcely represented in the major clinical trials; c) the possibility arises of a distribution of care resources tending to concentrate the greater therapeutic efforts in the patients with good prognosis.

Acute Disease↗
PubMed1997

[Preventive treatment of nonrheumatic atrial fibrillation: from the efficacy of clinical trials to the effectiveness of clinical practice].

OBJECTIVES: To know the percentage of patients with nonrheumatic atrial fibrillation treated with anticoagulants as an approach to the effectiveness of the prophylactic treatment of stroke. DESIGN: Multicenter observational study. SETTING: Six primary health centers from Barcelona. PARTICIPANTS: 465 patients with the diagnosed of AF were selected during the second semester of 1996. Patients that had suffered a hemorrhagic stroke, or with mitral stenosis, or with a prosthetic valve, or had hyperthyroidism, or receiving anticoagulant therapy were excluded. MEASUREMENTS AND MAIN RESULTS: 299 patients (64%) were finally included for the analysis. 15.8% of the patients were treated with acenocoumarin, and 35.4% were treated with aspirin. The percentage of patients treated improved for high risk patients (higher than 50%). CONCLUSIONS: The percentage of patients with nonrheumatic AF treated with acenocoumarin or aspirin is low, and physicians might be reluctant to use them because of bleeding complications, compliance with the treatment, or problems of accessibility.

Acenocoumarol↗
PubMed1997

[Assessment of quality of life related to health 2 years after coronary surgery].

BACKGROUND: The determinants of quality of life after coronary artery surgery in well defined health care populations are still incompletely understood. The aim of the present study was to assess the health related quality of life associated with coronary artery bypass surgery as performed in a tertiary public hospital, and also to investigate its association with clinical variables. PATIENTS AND METHODS: All survivors of a first coronary artery bypass grafting operation performed during a calendar year in a single center (100 patients) were included for assessment two years after surgery. Assessment included a review of the clinical records, a structured clinical interview and the administration of three questionnaires of perceived health (Nottingham Health Profile, Duke Activity Status Index and SF-36 Health Survey). RESULTS: The mean scores of the administered questionnaires corresponded to a moderate overall impairment of perceived health, with wide individual variations. Chronic stable postoperative angina pectoris (28% of patients), worse clinical functional grade (either due to angina or to others causes), comorbidity (51% of patients) and female sex were significantly associated with worse scores. CONCLUSIONS: In the study population, postoperative angina, impairment of the clinical functional grade (due to angina or to other conditions), and female gender were the major determinants of impaired health related quality of life after coronary artery bypass surgery. As such determinants are associated with anatomoclinical variables in the population undergoing coronary bypass surgery and also with perioperative variables, appropriate effectively studies appear to be indicated for the assessment of this surgical procedure.

Aged↗
PubMed1997

[Impact of consensus conferences of hypercholesterolemia and hypertension in Spain].

BACKGROUND: In May 1989 and June 1990, consensus conferences of treatment of hypertension and hypercholesterolemia respectively were held in Spain, at the General Division of Health Planning from the Ministry of Health. The objective of this article is to assess the effect of such conferences of physicians' knowledge, attitudes and practices. SUBJECTS AND METHODS: Cross-sectional telephone survey was carried out in physicians of general medicine, family practice, internal medicine and cardiology specialties. 807 physicians were selected, 347 family physicians, 177 general practitioners, 156 cardiologists and 128 internists. A questionnaire of 30 items was designed to obtain information about demographic and professional characteristics, knowledge of the consensus conferences and attitudes related to a case of an otherwise healthy asymptomatic 48-years-old man. RESULTS: The response rate was 57% (463 physicians), and 60% of physicians had knowledge about the conferences, being general practitioners the ones who had less knowledge of the conferences. The items about recommendations of diet and pharmacological treatment were property answered (about 50% of the physicians answered correctly). The mean of serum cholesterol when diet and drugs are recommended was 232 mg/dl (SD 23) (6.01 mmol/l) and 260 mg/dl (SD 25) (6.7 mmol/l) respectively. The first-choice cholesterol lowering drugs were statines. A patient was considered as hypertensive it the mean of systolic blood pressure was 149 mmHg (9.4) and the mean for diastolic blood pressure was 92 mmHg (3.8). The mean of diastolic blood pressure considered for drug treatment was 96.7 mmHg (SD 4.6). The first-choice antihypertensive drugs were angiotensin conversive enzyme inhibitors. CONCLUSIONS: Diffusion of the conferences has been unequal, being general practitioners less knowledgeable about the content of the conferences. Although physicians know reasonably well the recommendations about diet and drug treatments, the attitude in practice is more aggressive than recommended. Globally, the knowledge of the contents of the conferences was acceptable, although there were differences between specialties; however the effect on clinical practice is still low.

Consensus Statements as Topic↗
PubMed1997

Measuring functional status of chronic coronary patients. Reliability, validity and responsiveness to clinical change of the reduced version of the Duke Activity Status Index (DASI).

AIMS: Health-related quality of life assessment may be useful for understanding the variability in functioning of patients with a similar level of clinical impairment. We assessed the reliability, validity and responsiveness to clinical change of a reduced version of the Duke Activity Status Index (DASI) in chronic coronary patients. METHODS AND RESULTS: The reduced version of the DASI, a measure of self-reported functional capacity, was administered twice to two groups of patients: 46 stable coronary heart disease outpatients were tested and re-tested 2 weeks after their initial visit; and 44 patients undergoing elective angioplasty for angina pectoris were evaluated the day before and one month after the procedure. The Canadian Cardiovascular Society (CCS) functional grade was assessed in all patients, and a treadmill exercise test was performed sequentially (before and after the procedure) in angioplasty patients. Cronbach's alpha reliability coefficients for reduced DASI scores were high (between 0.81 and 0.89). Correlations of the reduced DASI scores with CCS grade and exercise test duration were moderately high (r = -0.51 and r = 0.45, respectively). Improvement after angioplasty as assessed by the reduced DASI scores was important (effect size = 0.75, P < 0.001). CONCLUSION: The reduced DASI is reliable, valid and responsive to clinical changes. Health-related quality of life measures may be useful in monitoring coronary patients.

Activities of Daily Living↗
PubMed1996

Predisposing factors and prognostic value of sustained monomorphic ventricular tachycardia in the early phase of acute myocardial infarction.

OBJECTIVES: The purpose of the study was to analyze the factors that favor the occurrence of sustained monomorphic ventricular tachycardia in the early phase (< 48 h) of acute myocardial infarction and to establish its prognostic implications. BACKGROUND: Sustained monomorphic ventricular tachycardia early in the course of an acute myocardial infarction is an uncommon arrhythmia, and its significance has not been specifically studied. METHODS: The clinical characteristics and prognosis of sustained monomorphic ventricular tachycardia were studied in 21 (1.9%) of 1,120 consecutive patients admitted to the coronary care unit with a diagnosis of myocardial infarction. RESULTS: Patients with sustained monomorphic ventricular tachycardia had a larger infarct on the basis of peak creatine kinase, MB fraction (CK-MB) isoenzyme activity (435 +/- 253 IU/liter vs. 168 +/- 145 IU/liter, p < 0.001) and higher mortality rate (43% vs. 11%, p < 0.001). By logistic regression analysis, independent predictors of sustained monomorphic ventricular tachycardia were CK-MB (odds ratio [OR] 11.8), Killip class (OR 4.0) and bifascicular bundle branch block (OR 3.1). Moreover, sustained monomorphic ventricular tachycardia was itself an independent predictor of mortality (OR 5.0). Compared with patients with ventricular fibrillation, those with sustained monomorphic ventricular tachycardia had a worse Killip class (Killip class > I: 63% vs. 30%, p < 0.05), higher CK-MB activity (430 +/- 260 IU/liter vs. 242 +/- 176 IU/liter, p < 0.01) and higher arrhythmia recurrence rate (31% vs. 4%, p < 0.01). During the follow-up period, 5 (42%) of 12 survivors in the sustained monomorphic ventricular tachycardia group died of cardiac-related causes. Recurrence of ventricular tachycardia was seen in two patients (17%). CONCLUSIONS: Sustained monomorphic ventricular tachycardia during the first 48 h of myocardial infarction is a sign of extensive myocardial damage and an independent predictor of in-hospital mortality.

Adult↗
PubMed1996

Evaluation of preventive and health promotion activities in 166 primary care practices in Spain. The Coordinating Group For Prevention and Health Promotion in Primary Care in Spain.

BACKGROUND: Since January 1989 the Spanish Society of Family and Community Medicine has supported the Program of Prevention and Health Promotion (PAPPS) with the following objectives: to detect possible difficulties in the implementation of recommendations especially among asymptomatic low-risk adults and children in Spain, to disseminate those recommendations, and to encourage research in prevention and health promotion in primary care. OBJECTIVE: We wished to evaluate the implementation of PAPPS in primary care practices. METHODS: A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21,631 patients were selected using systematic sampling. RESULTS: Age was positively associated with correct performance in the adult population, while in the paediatric population it was negatively associated. Females had higher probability than males of having blood pressure measurement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the preventive chart had a lower probability than user practices of correctly performing blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcohol counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probability than teaching centres of correct performance of blood pressure measurement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counseling (OR 1.39, 95% CI 1.29 to 1.51). CONCLUSIONS: There is an unequal level of performance depending on the procedure and on the target population. A preventive chart might be useful in improving implementation of periodic health maintenance. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.

Adolescent↗
PubMed1996

[Normal values of valvular flow velocities determined by Doppler echocardiography: relations with heart rate and age].

INTRODUCTION AND OBJECTIVES: The velocity-time integral (VTI) and the mean velocity of valvular flow are widely-used variables in Doppler-echocardiography. The aim of the present work was to determine normal VTI and mean velocity values of valvular flow and their relation to age, sex, heart rate and body surface area. METHODS: One hundred and fifty-six patients (84 men, 72 women; age range: 6-86 y; mean: 37 +/- 20) without cardiovascular disease were studied by Doppler echocardiography. VTI and the mean velocity of left and right ventricular outflow tract, and mitral and tricuspid valvular flow were determined by pulsed-wave Doppler. Aortic and pulmonary valvular flow were assessed by continuous wave Doppler. RESULTS: Mean value of aortic valvular flow VTI (22 +/- 4 cm) was slightly higher than that of pulmonary valvular flow (20 +/- 4 cm). Mean VTI values of left and right ventricular outflow tract and mitral valvular flow were similar (16 +/- 3, 15 +/- 3 and 15 +/- 3 cm, respectively) with an acceptable correlation (r = 0.76-0.83). VTI of tricuspid valvular flow was clearly lower than the rest (10 +/- 3 cm; p < 0.001). Linear regression analysis showed the VTI to be inversely related to heart rate and age, and mean velocity positively related to heart rate and inversely to age. While VTI remained relatively stable up to the age of 60 and decreased sharply thereafter, mean velocity decreased progressively with age. VTI values were identical for both sexes; however, mean velocity was higher in women up to the age of 60. CONCLUSIONS: VTI is a Doppler parameter independent of body surface area, inversely related to heart rate, not sex-related and remains stable up to the age of 60. Normal mean velocity values should be defined in relation to heart rate and age. Normal values of these Doppler parameters should be borne in mind for non-invasive assessment of cardiovascular function.

Adolescent↗
PubMed1995

[Winter epidemic of carbon monoxide poisoning in Badia].

OBJECTIVE: To find the incidence, morbidity and possible causes of the acute carbon monoxide poisonings (ACMP) which occurred in Badia between january 1992 and june 1993. DESIGN: A longitudinal, retrospective study. PATIENTS: Every Badia resident discharged from the Hospital Consortium of Parc Taulí, Sabadell with a diagnosis of ACMP and/or from Barcelona's Red Cross Hospital (RCH) after hyperbaric treatment was considered. MEASUREMENTS AND RESULTS: Cases were identified using the hospital discharge records from Parc Taulí and the RCH. A systematic review of the primary care clinical records was undertaken. The causes of the poisoning were investigated by a technical committee and through the gas company carrying out inspections of dwellings in 1993. The incidence of ACMP was 76.5 per 100,000 inhabitants in 1992 and 109.4 per 100,000 in the first half of 1993. 94% of the 34 cases occurred in December, January, February and March. 50% of those affected were under 17. The number of cases per household varied between 2 and 5 people. The most common underlying cause was the existence of defects in the conduits taking fumes away from gas heaters. The gas review detected defects in installation in 54% of dwellings. CONCLUSIONS: ACMP is a common and serious problem in our environment. The underlying causes and the high number of dwellings at risk have suggested a need for information campaigns in the community.

Adolescent↗
PubMed1995

Topical pharyngeal anesthesia improves tolerance of upper gastrointestinal endoscopy: a randomized double-blind study.

BACKGROUND AND STUDY AIMS: The usefulness of topical pharyngeal anesthesia is not well established. The aim of the present study was to determine its benefits in relation to patient tolerance and facilitation of the procedure in unsedated patients undergoing upper gastrointestinal endoscopy. PATIENTS AND METHODS: A randomized double-blind study comparing Topicaina spray - a mixture of benzocaine butyl aminobenzoate (butoforme), amethocaine, and butacaine - and a placebo was carried out on 256 outpatients referred for diagnostic endoscopy. No additional premedication was used. After the examination, both the tolerance to and difficulty of the intubation and examination were evaluated by patients and endoscopists respectively, using visual analogue scales and a questionnaire. RESULTS: Three patients (1.2%) did not tolerate the endoscopy. One patient was excluded for unexpected therapeutic endoscopy. One hundred twenty-five patients received the active spray and 127 received the placebo. The two groups were similar with respect to patient characteristics. Both intubation and examination, assessed with visual analogue scales, were better tolerated (both p = 0.0001) and more easily performed (p = 0.02 and p = 0.0001 respectively) in the active treatment group. Patients receiving the active spray had a better tolerance for the procedure, according to questionnaire replies. CONCLUSIONS: Topical pharyngeal anesthesia in unsedated patients undergoing diagnostic upper gastrointestinal endoscopy improves tolerance and makes examination easier.

4-Aminobenzoic Acid↗
PubMed1995

Value of routine preoperative tests: a multicentre study in four general hospitals.

We have assessed the value of routine preoperative tests in asymptomatic patients and their influence on anaesthetic and surgical decisions. We studied 3131 ASA I and II patients from four general hospitals undergoing elective surgical procedures. A retrospective review of the medical records revealed that 853 (27%) patients had some abnormal test result, of which 465 (15%) were previously unknown and not suspected at the preanaesthetic visit; these comprised 8.6% chest radiographs, 5.6% electrocardiograms and biochemical tests, and 2.9% haematological tests. Perioperative management was altered in only 0.56-0.26% of patients, depending on the particular test. The present study confirms the need for selective and rational ordering of preoperative tests, the basis of which should be the clinical assessment during the preanaesthetic visit.

Anesthesia, General↗
PubMed1993

[Tendencies of mortality from cardiovascular diseases in Catalonia: 1975-1992].

BACKGROUND: There is an uncertainty of which is going to be the trend of cardiovascular disease in Spain. In the present study cardiovascular disease mortality is described from 1975 to 1992 in Catalonia, and a prediction until 1997 is made, assuming the same trend. Possible causes of this trend are analyzed. METHODS: Deaths from cardiovascular disease, ischaemic heart disease and stroke have been identified from 1975 to 1992. It has been used the direct method for standardization by age and sex, using the European population as the standard population. Logarithmic transformations of the standardized rates were used for each cause of death and for both sexes. Linear regression analysis was used to adjust the evolution of the rates in the time period. RESULTS: There is a reduction of 2.6% and 2.7% by year in rates for cardiovascular diseases mortality for both males and females respectively, a reduction of 1.2% by year in rates for ischaemic heart disease in males and a reduction of 1.8% in females, and a reduction of 4.0% and 4.2% for stroke in males and females respectively. CONCLUSIONS: Trends in cardiovascular disease mortality reveal a decline for both males and females, mostly due to a reduction in stroke mortality; ischaemic heart disease mortality slightly decreased specifically during the period 1983-1992.

Adult↗