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Biomedical subjects

G Gomez

Publications and source records attributed to G Gomez.

At least 109 records · Page 6Linked to original sources
PubMed1986

Diagnosis-related groups and the salvagable trauma patient in the intensive care unit.

We reviewed 59 patients with trauma treated in the surgical intensive care unit (SICU) in 1983 comparing hospital charges with payments calculated from diagnosis-related groups (DRG). There were 37 male and 22 female patients with a mean age of 38.3 years. The mechanism of injury was blunt trauma in 42 and penetrating injury in 17 patients. The mean injury severity score (ISS) was 30.7 +/- 13.8 (mean plus or minus standard deviation). The duration of SICU care was 5.4 +/- 6.1 days. Over-all, 18 patients died. For the entire group, payment based upon a DRG system would have resulted in an over-all loss of $1,468,094.00 or $24,883.00 dollars per patient. Calculated DRG payments would have accounted for only 32.3 per cent of the total hospital charges. Calculated losses for 41 survivors would have been $1,098,431.00 dollars. Length of stay had a significant relationship to the calculated DRG payment (r = 0.69, p less than 0.001) but account for only 48 per cent of the variance. DRG only accounted for 26 per cent of the variance in charges despite a statistically significant relationship (r = 0.51, p less than 0.001). No statistically significant relationship was found between ISS and hospital charge by linear regression (r = 0.20, p greater than 0.01) or between ISS and DRG payment (r = 0.14, p less than 0.4). DRG as presently formulated would only pay one-third of total hospital charges for patients with trauma requiring SICU care. Present DRG payment schedules reflect neither the elements of care currently expended nor the modifiers necessary to adjust for acuity and severity. The ISS score would not be a useful modifier to correct DRG payment in this high cost group.

Adolescent↗
PubMed1986

Preventable trauma deaths: Dade County, Florida.

We reviewed 1,201 trauma deaths that occurred in Dade County, Florida, in 1982 in order to evaluate the need for an organized trauma network. There were 715 deaths (59.5%) at the scene. Of the remaining 486 patients who were transported to hospitals for treatment there were 240 central nervous system (CNS) deaths and 246 non-CNS deaths. Fifty-two (21.1%) preventable non-CNS trauma deaths were identified out of the 246 non-CNS deaths. The lack of an appropriate surgical procedure or a delay to surgery accounted for 82.7% of the preventable deaths. The preventable non-CNS death rate was 12.1% at the then functional Level I hospital and 26.4% at the other 22 hospitals (p less than 0.01). The ISS scores were similar for both the functional Level I hospital and the other hospitals. A trauma network involving seven hospitals is currently being established in Dade County, Florida. Applying the 1982 data to these hospitals reveals a preventable non-CNS death rate of 12.1% for the Level I hospital, 21.5% for the six planned Level II hospitals, and 30.0% for the other 16 hospitals. We conclude that: the severely injured should be triaged directly to trauma centers, and there is a need in Dade County, Florida, for an organized trauma system.

Adolescent↗
PubMed1986

Bile inhibits release of cholecystokinin and neurotensin.

We have investigated the effect of bile on fat-stimulated release and basal plasma levels of cholecystokinin-33/39 (CCK) and neurotensin in six awake dogs prepared with chronic gastric and duodenal cannulas. Experimental bile diversion was achieved by catheterization of the common bile duct through the duodenal cannula; the gallbladder was undisturbed. Bile diversion significantly enhanced the release of both CCK and neurotensin that was stimulated by intraduodenal (ID) infusion of a triglyceride suspension (corn oil) (0.5 gm/kg-hr). The integrated release with ID triglyceride (ng [0 to 90 min]/ml) for CCK was control 5.58 +/- 0.83, bile diversion 14.47 +/- 2.81, bile excess 1.68 +/- 0.56, and for neurotensin was control 0.35 +/- 0.19, bile diversion 1.26 +/- 0.35, and bile excess 0.45 +/- 0.31. ID infusion of excessive bile (bile collected during bile diversion) significantly inhibited both the release and basal levels of CCK. Bile diversion alone did not modify plasma levels of CCK or neurotensin. We conclude that: endogenous bile exerts a negative feedback effect on release of CCK and neurotensin induced by triglyceride and on basal plasma levels of CCK; bile is unnecessary for the stimulation of endocrine cells in the intestinal mucosa by dietary fat; and measured basal levels of CCK and neurotensin represent a real amount of circulating peptide in the fasting state, that is, the basal levels are real and not artifactual.

Animals↗
PubMed1985

Dysphagia and lower esophageal sphincter abnormalities after proximal gastric vagotomy.

We studied 96 patients subjected to elective proximal gastric vagotomy for intractable duodenal ulceration. Dysphagia was a frequent finding and occurred in 32 percent. It appeared in the immediate postoperative period and usually lasted for 1 to 2 months without any abnormalities in lower esophageal sphincter function. In five patients, dysphagia was severe and, although transient, was associated with changes in lower esophageal function simulating those observed in achalasia. The mechanism of these motor abnormalities is probably due to a reversible neuromuscular dysfunction of the lower esophageal sphincter.

Adult↗
PubMed1981

An open comparison of dosage frequencies of beclomethasone dipropionate in seasonal allergic rhinitis.

In an open group-comparative study, 123 adult patients with seasonal allergic rhinitis were allocated at random to one of three treatment groups; each of which received a daily dose of 400 micrograms beclomethasone dipropionate as (1) one puff in each nostril four times daily, (2) two puffs in each nostril twice daily and (3) four puffs in each nostril once per day. The result of treatment was assessed on daily symptom scores and the use of antihistamine tablets. There were no statistically significant differences between the three groups. The results indicate that it is unnecessary to give beclomethasone dipropionate nasal spray four times daily, and treatment in the morning and in the evening is recommended.

Adolescent↗
PubMed1981

Dysphoric response to neuroleptics as a predictor of treatment outcome with schizophrenics. A comparative study of haloperidol versus mesoridazine.

In a double-blind comparison of haloperidol and mesoridazine in the treatment of 39 recently hospitalized schizophrenic patients, the two drug treatment groups showed comparable antipsychotic effects, though they did differ in side effects in expected manners. Analysis of the Brief Psychiatric Rating Scale to calculate an index of dysphoric response previously found predictive of poor ultimate outcome failed to predict outcome in this 4-week trial though patients with a dysphoric response to neuroleptics did prove to include a higher proportion of process schizophrenics, who might ultimately show poorer outcome, than did nondysphoric responders.

Adult↗
PubMed1981

Effect of methisoprinol on E-rosette formation by trypsin-treated lymphocytes.

Human lymphocytes lose the capacity to form E rosettes after trypsin treatment. This ability is partially restored, in normal conditions, by a prolonged incubation in fresh medium supplemented with FCS. By adding methisoprinol to trypsin-treated lymphocytes, it has been observed a significant recovery after 2 hours of incubation, without further enhancement up to 24 hours, when compared to the controls. These results imply that the drug effect is time-dependent and that methisoprinol acts likely by a metabolic pathway in the early resynthesis of E receptors on trypsin-treated lymphocytes.

Humans↗
PubMed1981

MER immunotherapy and combination chemotherapy for advanced, recurrent Hodgkin's disease. Cancer and Leukemia Group B study.

The effects of chemotherapy and chemoimmunotherapy in previously treated advanced Hodgkin's disease were evaluated in a randomized study of 167 patients by CALGB. Combination chemotherapy consisted of treatment with one of three regimens with further randomization of MER (methanol extraction residue BCG) immunotherapy or no MER during chemotherapy. CVPP (CCNU, vinblastine, procarbazine, prednisone) was compared to a new combination, BAVS (bleomycin, Adriamycin, vincristine, streptozotocin), and to a third regimen consisting of alternating cycles of CVPP and BAVS. At the current analysis there is no significant difference in complete responses among the chemotherapy regimens. MER did not improve complete response frequency and was associated with significantly poorer survival for patients previously treated with chemotherapy. There was also no benefit with MER for patients with at least one pretreatment positive skin test. Because of the documented lack of therapeutic benefit and the morbidity of painful ulcers, MER treatment has been discontinued.

Adult↗
PubMed1980

Labetalol ('trandate') in hypertension: a multicentre study in general practice.

A study was carried out in 1286 hypertensive patients seen in general practice to evaluate the effectiveness of labetalol given for periods of up to 24 months. Initial dosage was 300 mg per day. The results showed that blood pressure was readily controlled and maintained by labetalol alone in the majority of patients. Pulse rate, vision and fundi were unchanged. There was little difference between the supine and upright blood pressures, confirming the clinical finding that postural hypotension was not a problem. The incidence of side-effects leading to withdrawal was small (7.2%), most side-effects being minor and transient. No drug interactions with concomitant therapy were apparent and the incidence of bronchospasm was very low. The incidence of myocardial infarction and cerebrovascular accident in the population studied was lower than expected.

Adult↗
PubMed1980

The design of cancer chemotherapy: metabolic modulation and cellular de novo versus salvage metabolism.

Attempts were made to evaluate the degree of utilization of 'salvage' and de novo purine and pyrimidine metabolites by normal and tumor cells. The significance of unique ribonucleotide pools and their ratios were also investigated. The results indicate that while normal bone marrow cells appear to depend almost exclusively on salvage pathways for their nucleic acid synthesis, tumor cells appear to utilize both the de novo and salvage pathways. The degree of dependence of tumor cells on these pathways appears to vary considerably. Utilizing this unique difference between tumor and normal cells, attempts were made to utilize the salvage precursors with the hope of modifying selectively the effects of antimetabolites against tumor cells in vivo. Results indicate that thymidine can potentiate the in vivo toxicity of 1-beta-D-arabinofuranosylcytosine and fluorouracil. The degree of modulation by normal metabolites appears to correlate with the level of circulating salvage metabolites.

Animals↗
PubMed1979

The treatment of hypertension with propranolol and bendrofluazide.

In 101 hypertensive patients, the effects of a combination of propranolol and bendrofluazide were compared with those of each drug alone. After an introductory period with a placebo, the patients received, in a double-blind randomized trial, propranolol 80 mg twice a day, bendrofluazide 2.5 mg twice a day, or both drugs together twice daily. The combination produced significantly greater reductions in lying, standing, and post-exercise systolic and diastolic blood pressure than either drug separately. Side-effects were minimal and the combination was well accepted by patients.

Adult↗
PubMed1976

Immunotherapy of chronic myelocytic leukemia: effects of different vaccination schedules.

In a clinical trial of immunotherapy in chronic myelocytic leukemia, 62 patients received repeated intradermal injections of BCG-cultured cell mixtures, while 16 were vaccinated with BCG alone. The lymphoblastoid cell lines used for vaccination were established from blood of patients with advanced myeloid leukemia and were reactive with "specific" primate antisera against myeloid leukemic cells. Both sensitization to target cell antigens and substantial general increases in delayed hypersensitivity responses were recorded among immunized patients. Major immunologic complications (hypersensitivity and "autoimmune" phenomena) were observed in 10 patients. These complications were attributable to the BCG content of vaccines, and their incidence correlated with intensity of immunologic stimulation. Data from cases in which intermittent busulfan therapy was used provided suggestive evidence that immunotherapy (either with BCG-cell mixtures or with BCG alone) prolonged unmaintained remissions in one-third of the patients. Among 48 "good-risk" patients, there was an inverse correlation between intensity of immunologic stimulation and survival. The survival of 18 patients who received the most intensive vaccination schedule was identical to that of controls. Survival of the other 30 patients was significantly better (p = 0.03), with an increase of 2 years in median survival. Survival of 30 poor-risk patients (24, most intensive vaccination schedule) was identical to that of controls. We conclude that immunologic stimulation may produce worthwhile prolongation of life in CML but that overly aggressive schedules of immunotherapy abrogate this effect. Our experience raises the question whether results in other clinical trials of immunotherapy may have been adversely affected by excessive frequency or dosage of immunologic stimulants.

Abscess↗