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Biomedical subjects

E Delgado

Publications and source records attributed to E Delgado.

At least 55 records · Page 3Linked to original sources
PubMed1997

Tracheal gas insufflation during pressure-control ventilation: effect of using a pressure relief valve.

OBJECTIVES: Pressure-control ventilation minimizes alveolar overdistention by limiting peak airway pressure, but a consequence of this pressure limitation may be a reduction in tidal volume with subsequent hypercarbia. Tracheal gas insufflation (TGI) can be used in combination with pressure-control ventilation to augment CO2 elimination. During pressure-control ventilation with continuous TGI, we observed that peak airway pressure increased above the set inspiratory pressure. Based on this observation, we investigated the ability of the pressure-control ventilator circuit to compensate for continuous TGI and the effect of insertion of a pressure relief valve to eliminate over-pressurization. SETTING: University research laboratory. DESIGN: Using an artificial lung model, we studied the effects of continuous TGI with varying catheter flows (0, 2, 6, and 10 L/ min); ventilator frequencies (10 and 20 breaths/min); inspiratory duty cycles (0.33, 0.50, and 0.67); lung compliance (0.01, 0.02, and 0.04 L/cm H2O); and airway resistance (5, 20, and 50 cm H2O/L/sec) on: a) peak airway pressure; b) total inspiratory tidal volume; c) ventilator-derived tidal volume; and d) intrapulmonary pressure at end-exhalation (auto-PEEP). Tests were performed with and without a pressure relief valve whose threshold "pop-off" pressure was adjusted to match the set inspiratory pressure (35 cm H2O) for a total of 432 experimental conditions. MEASUREMENTS AND MAIN RESULTS: Our data demonstrate that pressure-control ventilation augmented with continuous TGI can increase peak airway pressure above set inspiratory pressure due to delivery of a higher than intended tidal volume. Predisposing conditions include catheter flow rates of 6 and 10 L/min, long inspiratory time, low compliance, and low resistance. With the pressure relief valve, peak airway pressure was maintained at the set inspiratory pressure and total inspiratory tidal volume remained constant. CONCLUSION: A pressure relief valve is a necessary adjunct to maintain peak airway pressure at set inspiratory pressure and keep total inspiratory tidal volume constant when continuous TGI is administered in conjunction with pressure-control ventilation.

Airway Resistance↗
PubMed1997

Low levels of nitric oxide as contaminant in hospital compressed air: physiologic significance?

OBJECTIVES: To determine whether the levels of nitric oxide found in hospital compressed air have a clinically relevant effect on oxygenation in intubated patients with normal lungs. DESIGN: Prospective study. SETTING: Cardiothoracic and surgical intensive care unit in a university hospital. PATIENTS: Twelve postoperative patients receiving mechanical ventilation. INTERVENTIONS: Pure nitrogen and oxygen were substituted for hospital compressed air as a source of blending for correct FIO2. MEASUREMENTS AND MAIN RESULTS: Hemodynamics and PaO2 were measured in nitrogen and oxygen used for blending oxygen during stable FIO2 levels. Inhaled nitric oxide was measured with a nitric oxide-chemiluminescence detector. There was no clinically relevant change in systemic hemodynamics. However, the PaO2 decreased significantly when nitrogen was used for blending. Inhaled nitric oxide levels varied from 2 to 550 parts per billion during use of hospital compressed air; no nitric oxide was detectable during use of nitrogen. CONCLUSIONS: The low concentration of nitric oxide in hospital compressed air improves oxygenation in patients with normal lungs receiving mechanical ventilation.

Blood Gas Analysis↗
PubMed1997

Contamination of hospital compressed air with nitric oxide: unwitting replacement therapy.

BACKGROUND: Inhaled nitric oxide (NO) at levels between 5 and 80 ppm has been used experimentally to treat a variety of conditions. NO also is a common environmental air pollutant in industrial regions. As compressed hospital air is drawn from the local environment, we speculated that it may contain NO contamination, which, if present, would provide unwitting inhaled NO therapy to all subjects respiring this compressed gas. METHODS: NO levels were measured twice daily from ambient hospital air and compressed gas sources driving positive pressure ventilation from two adjacent hospitals and compared with NO levels reported daily by local Environmental Protection Agency sources. An NO chemiluminescence analyzer (Sievers 270B; Boulder, Colo) sensitive to > or =2 parts per billion was used to measure NO levels in ambient air and compressed gas. RESULTS: NO levels in ambient air and hospital compressed air covaried from day to day, and absolute levels of NO differed between hospitals with the difference never exceeding 1.4 ppm (range, 0 to 1.4 ppm; median, 0.07 ppm). The hospital with the highest usage level of compressed air had the highest levels of NO, which approximated ambient levels of NO. NO levels were lowest on weekends in both hospitals. We also documented inadvertent NO contamination in one hospital occurring over 5 days, which corresponded to welding activity near the intake port for fresh gas. This contamination resulted in system-wide NO levels of 5 to 8 ppm. CONCLUSION: Hospital compressed air contains highly variable levels of NO that tend to covary with ambient NO levels and to be highest when the rate of usage is high enough to preclude natural degradation of NO in 21% oxygen. Assuming that inhaled NO may alter gas exchange, pulmonary hemodynamics, and outcome from acute lung injury, the role of unwitting variable NO of hospital compressed air needs to be evaluated.

Air↗
PubMed1996

Pressure controlled-inverse ratio ventilation.

One of the many challenges in the management of the patient with adult respiratory distress syndrome is optimal application of mechanical ventilation. Pressure controlled-inverse ratio ventilation has surfaced as a possible alternative to conventional ventilation for patients affected by this condition. In pressure controlled-inverse ratio ventilation, the conventional inspiratory-to-expiratory ratio is reversed, allowing the inspiratory phase to lengthen with an accompanying increase in mean airway pressure. When carefully applied, mean airway pressure adjustments can be manipulated without increases in positive end-expiratory pressure and peak airway pressure, thus minimizing the risk of alveolar rupture and worsening of lung injury.

Adult↗
PubMed1996

Pulseless arm in association with totally displaced supracondylar fracture.

Seven children (3-10 years of age) were treated for a type III supracondylar fracture of the humerus. All fractures were reduced and pinned. Closed reduction was performed in four patients; three required open reduction. Before reduction six of the seven patients did not have a distal palpable pulse in the involved forearm. After reduction of the fractures all patients had a pulseless arm and a seemingly viable hand. Doppler pulses were absent or greatly diminished compared with the normal side in all involved extremities. Six patients underwent immediate antecubital fossa exploration of the brachial artery without arteriogram; one patient, referred to us from another facility, underwent angiography followed by immediate exploration. In three patients the brachial artery was directly damaged or transected and was repaired via saphenous vein graft, with reestablishment of distal pulses in each case. In the other four patients the brachial artery was kinked or entrapped at the fracture site, necessitating microdissection to mobilize the vessel and reestablish pulses in each case. At an average follow-up of 30 months, all seven patients had normal circulatory status, including a radial pulse. All fractures had healed, and all extremities had a normal carrying angle and normal elbow motion. Immediate exploration of the antecubital fossa should be considered if an extremity remains pulseless (to palpation and Doppler) after reduction and stabilization of significantly displaced supracondylar fractures of the humerus.

Algorithms↗
PubMed1996

Health seeking behaviour for child illness in rural Guatemala.

Considerable efforts were made in Guatemala to cover rural areas with health centres, and health programmes have been launched to treat and prevent the most important childhood diseases. Despite this, the utilization rate of public health services has reportedly been low throughout the past two decades. How, and how effectively, do mothers resolve the health problems of their children? To gain better insight into health care behaviour, we conducted a health services utilization survey in two highland communities in the department of Sacatepequez in 1992-1993. We asked 324 mothers in two villages whether, and where, they had sought help the last time their children under 5 years of age had suffered from diarrhoea, fever, cough symptoms or worms. Mothers relied on home care in 63-83% of reported episodes and the use of health services-Western or traditional-was consistently low. Although Western health care was easily accessible, it was used in only 8-15% of cases. The only identifiable significant independent determinants of utilization were occupational status of the mother (RR = 1.5 if employed) and overall level of socioeconomic development of the community (RR = 1.7). Inquiry into treatments used revealed that except for worms, which were frequently treated with herbs (31%) or external remedies (20%) alone, modern pharmaceuticals predominated. Antibiotics were the remedy of choice against diarrhoea (63%), antipyretics in case of fever (83%) and cough syrups with expectorants or antitussives against cough (65%). One hundred and twenty-one of the children born after 1975 died; in only 64 cases (53%) was a Western health service consulted between onset of disease and death. No relation was found between attendance and socioeconomic characteristics of the parents, but a positive linear association between duration of the fatal illness episode and age of the child could be identified. Independent sources report a drop in infant mortality of 53 and 35% respectively in the two communities between 1977 and 1991. Our findings seem to indicate that this reduction was achieved despite under-utilization of Western health services.

Adult↗
PubMed1996

Aerosolized cyclosporine in lung recipients with refractory chronic rejection.

This study evaluated aerosolized cyclosporine as rescue therapy for lung transplant recipients with unremitting chronic rejection. Nine patients with histologic active obliterative bronchiolitis and progressively worsening airway obstruction refractory to conventional immune suppression received aerosolized cyclosporine. Improvement in rejection histology was seen in seven of nine patients. We compared the changes in the FVC and FEV1 over time using linear regression analysis in these seven histologic responders and nine historical control patients. During the pretreatment period for both the experimental and control groups, the FVC and FEV1 declined at comparable rates. After aerosolized cyclosporine there was stabilization of pulmonary function, whereas in the controls there was continued decline. Cyclosporine blood levels were less than 50 ng/ml 24 h after an aerosolized dose of 300 mg in five patients receiving oral tacrolimus. Nephrotoxicity, hepatotoxicity, and a greater than expected rate of infection was not observed. This study suggests that aerosolized cyclosporine is safe and may be effective therapy for refractory chronic rejection in lung transplant recipients.

Adult↗
PubMed1995

[10 Year follow up of chemotherapy and surgery on the second laparotomy in advanced ovarian cancer].

BACKGROUND: Advanced ovarian neoplasm has bad prognosis. There is little knowledge as to the effect of surgical and chemotherapy treatments on long-term survival. METHODS: Seventy-two patients with advanced epithelial ovary carcinoma (53 stage III and 19 stage IV) were treated according to a treatment regimen with reduction surgery, five cycles of chemotherapy with cyclophosphamide, adriamycin and cisplatin (CAP) followed by second revision laparotomy. RESULTS: The rate of response for the CAP schedule was 80%, of which 16 patients (23%) showed complete response (CR), 7 (10%) partial microscopic response (PMiR) and 33 (47%) partial macroscopic response (PMR). Complete resection of residual masses was performed on the second laparotomy in 14 of the 33 patients with parital response. The median survival for all the group was 36 months with overall actuarial survival of 27% at 10 years. The survival of the group of patients with CR was significantly longer than that of PMiR and other groups. Significant differences favorable for the group of partial response with second attempt radical surgery were found versus the group in which te second surgical resection was not radical. FIGO III stage and prechemotherapy tumor size less than 5 cm were found to have favorable effect in the rate of response and survival. CONCLUSIONS: The use of CAP chemotherapy achieved complete response in 23% of the patients studied. This group of patients showed to have a greater probability of longer survival. Second attempt surgery on the second laparotomy offers therapeutic benefits when radical.

Adult↗
PubMed1995

Glucagon-like peptide-1 binding to rat skeletal muscle.

We have found [125I]glucagon-like peptide-1(7-36)-amide-specific binding activity in rat skeletal muscle plasma membranes, with an estimated M(r) of 63,000 by cross-linking and SDS-PAGE. The specific binding was time and membrane protein concentration dependent, and displaceable by unlabeled GLP-1(7-36)-amide with an ID50 of 3 x 10(-9) M of the peptide; GLP-1(1-36)-amide also competed, whereas glucagon and insulin did not. GLP-1(7-36)-amide did not modify the basal adenylate cyclase activity in skeletal muscle plasma membranes. These data, together with our previous finding of a potent glycogenic effect of GLP-1(7-36)-amide in rat soleus muscle, and also in isolated hepatocytes, which was not accompanied by a rise in the cell cyclic AMP content, lead use to believe that the insulin-like effects of this peptide on glucose metabolism in the muscle could be mediated by a type of receptor somehow different to that described for GLP-1 in pancreatic B cells, where GLP-1 action is mediated by the cyclic AMP-adenylate cyclase system.

Adenylyl Cyclases↗
PubMed1995

Changes in mandibular rotation after muscular resection. Experimental study in rats.

The purpose of this study was to evaluate the effect of bilateral muscular resection on the rotational pattern of the rat mandible. The specific aim of the study was to seek possible changes in "articular growth" in the posterior (ramus and condyle of the mandible), and in the anterior part of the face (upper viscerocranium, and maxillary and mandibular dentoalveolar processes). The masseter, temporal, and suprahyoid muscles were bilaterally resected in three experimental groups of 21-day-old female Wistar rats. Another group of rats served as control. The results were evaluated at 42 (prepubertal) and 60 days after birth (pubertal rats). The craniofacial growth pattern, ramus dimension, condylar growth direction, histologic evaluation of condylar cartilage, and dentoalveolar processes height changes were studied. Two mandibular rotational patterns were found: one inferior after masseter muscles resection (MR), and the other superior after temporal muscles resection (TR). A less intense superior rotational pattern, after suprahyoid muscles resection (SR), was found also. Morphologic changes were more intense in older rats. On the contrary, more intense condylar histologic changes were found in younger rats. Changes in "articular growth" primarily take place at maxillary and mandibular dentoalveolar processes. Condylar growth amount could be modified to a limited extent. More important were the changes in condylar growth direction. An upward rotational pattern of the upper viscerocranium was detected when the inferior mandibular rotation pattern was produced.

Age Factors↗
PubMed1995

Active microbreak effects on musculoskeletal comfort ratings in meatpacking plants.

This study was conducted to examine whether a system of active microbreaks can reduce the discomfort perceived by employees in a meatpacking plant. Moreover, the relationship between the discomfort perceived on the job and musculoskeletal capability was investigated. Twenty-eight men employed in a local meatpacking plant participated in a study conducted over a period of four weeks. Results indicated that active microbreaks significantly reduced the level of discomfort perceived by employees during the course of the working day. The subjective ratings of perceived discomfort correlated significantly with anthropometric, strength and background information (R2 = 0.66). The physical characteristics of Caucasian employees were higher than those of their Hispanic counterparts. Moreover, the physical characteristics of meatpacking employees were significantly lower than those reported in the literature for employees engaged in manual handling tasks.

Absenteeism↗
PubMed1995

Acetabulum pedis. Part II: Talocalcaneonavicular joint socket in clubfoot.

Many pathoanatomic studies of clubfeet have been made. Bone changes and ligament and tendon alterations are among the different deformities reported in the literature. The socket of the talocalcaneonavicular joint is termed the acetabulum pedis (AP), and alterations of the joint have been reported previously as malformations associated with clubfoot. We report pathoanatomic observations of AP in three human clubfoot specimens. Anomalies in AP were observed and compared with those in normal feet. In such cases, AP volume is restricted. Surface area is reduced on the acetabular floor and medial wall. Changes occur in the osseous components as well as in the ligaments of the AP.

Cadaver↗
PubMed1995

Glucagon-like peptide-1 binding to rat hepatic membranes.

We have found [125I]glucagon-like peptide (GLP)-1(7-36)amide specific binding activity in rat liver and isolated hepatocyte plasma membranes, with an M(r) of approximately 63,000, estimated by cross-linking and SDS-PAGE. The specific binding was time- and membrane protein concentration-dependent, and equally displaced by unlabelled GLP-1(7-36)amide and by GLP-1(1-36)amide, achieving its ID50 at 3 x 10(-9) M of the peptides. GLP-1(7-36)amide did not modify the basal or the glucagon (10(-8) M)-stimulated adenylate cyclase in the hepatocyte plasma membranes. These data, together with our previous findings of a potent glycogenic effect of GLP-1(7-36)amide in isolated rat hepatocytes, led us to postulate that the insulin-like effects of this peptide on glucose liver metabolism could be mediated by a type of receptor probably different from that described for GLP-1 in pancreatic B-cells or, alternatively, by the same receptor which, in this tissue as well as in muscle, uses a different transduction system.

Animals↗
PubMed1995

Chemotherapy and radiotherapy in locally advanced cervical cancer.

Radiotherapy has been standard therapy for locally advanced squamous cell cervical cancer. Neoadjuvant chemotherapy is being studied to improve responses and survival. We report a phase II study in locally advanced squamous cell cervical cancer (FIGO stages III and IVA) using chemotherapy with bleomycin, methotrexate and cisplatin (BMP) followed by radical radiotherapy. Of the 35 patients, 31 in stage III and 4 in stage IVA, 3 complete responses (CR) and 22 partial responses (PR) were achieved after chemotherapy treatment. Thirty-one patients completed radiotherapy; 19 achieved CR and 4 PR. Five-year actuarial survival for the entire group was 45% (95% confidence interval, 37-53%) with a median survival of 56 months. Patients with CR had a significantly better survival: the 5-year actuarial survival was 74% (95% CI, 59-89%). Recurrence developed in 4 of 19 patients. The most frequent side-effects were nausea and vomiting. Myelosuppression and impaired renal function also occurred. There was no evidence of radiotherapy toxicity enhancement. The stage and Karnofsky index were significant prognostic factors. It is concluded that BMP chemotherapy in advanced cervical cancer is effective and, followed by radiotherapy, allows a good control of this tumor. The group of patients with complete response have a low rate of recurrences and a long survival chance.

Adult↗
PubMed1995

Acetabulum pedis. Part I: Talocalcaneonavicular joint socket in normal foot.

The socket of the talocalcaneonavicular ball and socket joint in the foot is termed acetabulum pedis (AP). Observations of 72 feet from necropsies of stillborns or deceased newborns are the basis of our architectural description of AP. It has five walls: the roof or superior wall, the floor or inferior wall, the bottom or anterior wall, the medial wall, and the lateral wall. Variations in the tridimensional situation of the anterior and middle articular facets of the calcaneus modify the acetabular floor area. The same is true of the variations in position of the ligaments in both the acetabular floor and the medial wall. These modifications of the acetabular floor and medial wall areas can change the shape of the foot.

Cadaver↗
PubMed1995

Endometrial cancer stages I and II. Analysis of survival and prognostic factors.

BACKGROUND: Endometrial cancer is the most frequent gynaecologic neoplasia in women. Stages I and II account for 75% of endometrial cancers. METHODS: Diagnostic features, treatment and outcome based on therapy with surgery and/or irradiation of 185 endometrial cancer patients in Stage I and II were analysed retrospectively. RESULTS: There were 148 patients (80%) in Stage I and 37 (20%) in Stage II. Twenty-nine patients (16%) relapsed and 18 have died of cancer. The 5 and 10 year specific actuarial survival was 89% and 81% respectively. The 5 and 10 years disease free survival was 82% and 78% respectively. In our analysis of prognostic factors we observed a significantly worse survival for postmenopausal and Stage II patients, high grade tumors (grade III) and greater myometrial penetration (outer 2/3). CONCLUSIONS: Endometrial cancer has a relatively good prognosis partly because of its early diagnosis. There is general consensus that surgery is the optimal treatment in Stages I and II. While it is well documented that complementary irradiation improves survival in Stage II, there is no general agreement regarding the value of complementary irradiation in Stage I. Further studies are needed to delimit Stage I patients who would benefit from complementary irradiation.

Adult↗