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Biomedical subjects

J Canet

Publications and source records attributed to J Canet.

At least 37 records · Page 2Linked to original sources
PubMed1997

An epidural abscess due to resistant Staphylococcus aureus following epidural catheterisation.

We report a case of abscess formation after epidural analgesia, a rare complication that developed in our patient 13 days after placement of a thoracic epidural catheter for patient controlled analgesia. Culture of the pus grew methicillin-resistant Staphylococcus aureus. Although early diagnosis and rapid management have been reported to yield a satisfactory outcome, the case we describe ended in severe sequelae.

Abscess↗
PubMed1995

Costs and offset effect in panic disorders.

BACKGROUND: The study is aimed at assessing the costs before and after the diagnosis and the provision of effective treatment for panic disorder (PD), and the offset effect related to the psychiatric encounter. METHOD: A 24-month prepost design was used to collect data on clinical status and health care services utilisation in a natural environment. The 61 PD patients' assessment included the SCID-UP, ratings on general functioning, improvement, severity of symptoms and level of disability. All health care services used and lost workdays were recorded. RESULTS: Both sociodemographic characteristics and the outcome show that this was a standard group of PD patients, who received effective treatment for their condition. The total direct costs of health care use during the previous year and the year after the diagnosis were, respectively, US$ 29,158 and US$ 46,256. The indirect costs of lost productivity were US$ 65,643 in period I and US$ 13,883 in period II. CONCLUSIONS: A strong offset effect (94%) has been found in this study, significantly greater than the one described for psychiatric disorders as a whole. The costs of nondiagnosis are usually overlooked when estimating the global costs of PD. Methods for improving early detection of PD may substantially reduce the costs incurred before diagnosis.

Absenteeism↗
PubMed1994

[The use of services, the effect of compensation and the costs of a panic disorder].

BACKGROUND: The use of general health care services by psychiatric patients has decreased drastically following correct diagnosis. This phenomenon, called offset effect, allows the use of inefficient health care services to be evaluated and contributes to the estimation of the relative impact of the disorder in addition to the estimation of the benefits of the training campaigns and/or the implementation of services. The aim of this study was to evaluate the offset effect and the costs of the panic disorder (PD) in a natural environment. METHODS: The clinical data and the use of health care services over 12 months prior to diagnosis and 12 months following diagnosis were collected. Clinical evaluation of 61 patients with PD included a standard interview (SCID-UP), scales of general functioning, improvement, severity of the symptoms and the level of disability. The number of work days missed was also reported. RESULTS: The sociodemographic features, clinical evolution and the rate of response to treatment were comparable to those referred in other studies performed in a natural medium. The direct costs of treatment of AP were 1,795,000 pesetas (1,547,000-1,889,000) higher during the year following the first psychiatric consultation, mainly due to the costs of the visits to the psychiatrist and the medication. On the contrary, the indirect costs were 5,435,000 pesetas less during this period. CONCLUSIONS: In this study on the treatment of patients with the panic disorder a strong offset effect (94%) was found being much greater than that described for general psychiatric disorders. Adequate psychiatric treatment induces in the next 12 months an increase in the cost due psychiatric consultation and medication, however reduces the total costs when absenteeism is taken into account.

Adolescent↗
PubMed1994

Effects of halothane and isoflurane on ventilation and occlusion pressure.

BACKGROUND: Isoflurane has been said to be more ventilatory depressant than halothane. However, data for comparing the respiratory effects of halothane and isoflurane in humans are insufficient at this time. The aim of this study was to extend our understanding of the nature of the central, as opposed to peripheral, ventilatory effect of halothane and isoflurane by comparing them at two concentrations. METHODS: Twenty patients were randomly assigned to receive halothane (n = 10) or isoflurane (n = 10). The patients were studied the day before surgery and during anesthesia immediately before surgery. Ventilatory effects were analyzed in terms of breathing pattern, end-tidal carbon dioxide pressure (PETCO2) and inspiratory occlusion pressure. After anesthetic induction and orotracheal intubation with thiopental and succinylcholine patients were allowed to breathe halothane or isoflurane in oxygen spontaneously at 1.2 (low) and 2.0 (high) minimum alveolar concentration (MAC) applied in random order. Inspiratory active impedance during anesthesia was also measured. RESULTS: Significant reduction of minute ventilation between awake and low MAC states was observed for isoflurane (-34.4%; P < 0.001) but not for halothane. Inspiratory occlusion pressure at 100 ms increased significantly between awake and low MAC states, from 1.43 +/- 0.89 to 2.67 +/- 1.05 cmH2O (P < 0.05) for halothane, representing an 87% increase, whereas a nonsignificant increase (16%) was observed for isoflurane. Both anesthetics showed a dose-related ventilatory depressant effect, not attributable to changes in mechanical properties, reflected by significant reductions in minute ventilation (P < 0.001), tidal volume (P < 0.001), and inspiratory occlusion pressure at 100 ms (P < 0.05) and increases in respiratory rate (P < 0.001) and end-tidal carbon dioxide pressure (P < 0.01) when concentration was increased. However, at the higher concentration a significantly greater reduction of minute ventilation (P < 0.01) was observed for isoflurane (-25.6%) than for halothane (-9.4%). We did not observe differences in respiratory rate between the two anesthetics. Significant differences in inspiratory occlusion pressure wave were observed, characterized by a concave-upward tendency for isoflurane and for high concentration. CONCLUSIONS: Our study confirms the stronger ventilatory depression induced by isoflurane compared with that induced by halothane and indicates that halothane at 1.2 MAC induces significantly less ventilatory depression than expected.

Adult↗
PubMed1994

A prospective randomized trial comparing somatostatin and sclerotherapy in the treatment of acute variceal bleeding.

Somatostatin and endoscopic sclerotherapy are widely used in the treatment of acute variceal bleeding. Although objective evidence does exist about the advantages of either treatment, data comparing both procedures are scarce. In order to compare the effectiveness and safety of somatostatin and sclerotherapy in the treatment of acute variceal bleeding, 70 consecutive cirrhotic patients suffering from esophageal variceal hemorrhage and meeting the inclusion criteria were randomly assigned to treatment with somatostatin (35 patients) or sclerotherapy (35 patients). No differences in age, sex, alcohol intake, etiology of cirrhosis and severity of liver failure were found between groups. Failure of treatment (defined as persistence of bleeding despite therapy or subsequent rebleeding within the 48-hr trial period) occurred in seven patients (20%) in the somatostatin group and in six (17.1%) in the sclerotherapy group (NS). Early rebleeding occurred in seven of 28 patients (25%) in the somatostatin group and in five of 29 (17.2%) in the sclerotherapy group (NS). Mortality within the first 6 wk was no different between both groups: 10 (28.5%) and eight (22.8%) in the somatostatin and sclerotherapy groups, respectively. Sclerotherapy, but not somatostatin, was associated with major complications in five cases (14.2%) (p = 0.026), two of which resulted in patient's death. These results suggest that somatostatin is safer, and as effective as sclerotherapy, in controlling acute variceal bleeding until an elective treatment can be established.

Acute Disease↗
PubMed1991

Acid aspiration prophylaxis in morbidly obese patients: famotidine vs. ranitidine.

Famotidine and ranitidine were compared as agents for the prevention of acid aspiration syndrome in 32 morbidly obese patients undergoing vertical banded gastroplasty. Single-dose oral famotidine or double-dose oral ranitidine were administered on a random basis before surgery. Gastric contents were aspirated through a gastric tube, manually aided by the surgeon with the abdomen open. Mean (SD) gastric volumes were 13.8 ml (6.7) and 12.1 ml (13.0) for the famotidine and ranitidine groups, respectively. Mean (SD) gastric pH values were 6.2 (1.5) and 6.8 (1.5), respectively. There were no significant differences between the groups and no patient was considered 'at risk' (pH less than 2.5 and gastric volume greater than 25 ml). We conclude that single-dose oral famotidine and double-dose oral ranitidine are equally effective for preventing acid aspiration syndrome in morbidly obese patients.

Adult↗
PubMed1991

Active inspiratory impedance and neuromuscular respiratory output during halothane anaesthesia in humans.

The aim of this study was to measure, in 11 patients with healthy lungs, active inspiratory impedance during anaesthesia. In addition, we recorded changes in inspiratory occlusion pressure at 100 ms (P0.1) and ventilatory pattern while awake and during anaesthesia with a mean inspiratory fraction (FI) of 0.017 halothane in O2. The total active inspiratory resistance and elastance values were 5.4 +/- 3.3 hPa.l.1.s and 29.9 +/- 6.2 hPa.l.1, respectively. P0.1 and the ratio between P0.1 and mean inspiratory flow (P0.1/(VT/TI)) increased 124% (p less than 0.001) and 68% (p less than 0.001), respectively, during anaesthesia. Respiratory frequency rose significantly from 12.2 +/- 1.5 (mean +/- SD) to 24.6 +/- 4.6 cycles.min-1, while tidal volume and inspiratory duty cycle lowered significantly from 0.599 +/- 0.195 l and 0.44 +/- 0.04 to 0.372 +/- 0.088 l (p less than 0.001) and 0.40 +/- 0.04 (p less than 0.05), respectively. Minute ventilation (VE) and VT/TI did not change significantly. During halothane anaesthesia with an FI:0.017, the increase in neuromuscular respiratory output appears to compensate for the increased mechanical load, thus resulting in maintenance of VE at levels similar to those of an awake state.

Adult↗
PubMed1990

Respiratory input impedance in anesthetized paralyzed patients.

Respiratory impedance (Zrs) was measured between 0.25 and 32 Hz in seven anesthetized and paralyzed patients by applying forced oscillation of low amplitude at the inlet of the endotracheal tube. Effective respiratory resistance (Rrs; in cmH2O.l-1.s) fell sharply from 6.2 +/- 2.1 (SD) at 0.25 Hz to 2.3 +/- 0.6 at 2 Hz. From then on, Rrs decreased slightly with frequency down to 1.5 +/- 0.5 at 32 Hz. Respiratory reactance (Xrs; in cmH2O.l-1.s) was -22.2 +/- 5.9 at 0.25 Hz and reached zero at approximately 14 Hz and 2.3 +/- 0.8 at 32 Hz. Effective respiratory elastance (Ers = -2pi x frequency x Xrs; in cmH2O/1) was 34.8 +/- 9.2 at 0.25 Hz and increased markedly with frequency up to 44.2 +/- 8.6 at 2 Hz. We interpreted Zrs data in terms of a T network mechanical model. We represented the proximal branch by central airway resistance and inertance. The shunt pathway accounted for bronchial distensibility and alveolar gas compressibility. The distal branch included a Newtonian resistance component for tissues and peripheral airways and a viscoelastic component for tissues. When the viscoelastic component was represented by a Kelvin body as in the model of Bates et al. (J. Appl. Physiol. 61: 873-880, 1986), a good fit was obtained over the entire frequency range, and reasonable values of parameters were estimated. The strong frequency dependence of Rrs and Ers observed below 2 Hz in our anesthetized paralyzed patients could be mainly interpreted in terms of tissue viscoelasticity. Nevertheless, the high Ers we found with low volume excursions suggests that tissues also exhibit plasticlike properties.

Adult↗
PubMed1990

[Brucellosis in a 3 month-old infant].

During the course of a bronchiolitis in a 3 month-old child, one blood culture yielded Brucella melitensis. The diagnosis of brucellosis is difficult in infancy because the symptoms are nonspecific and the disease may be mild and self-limited. The child received only breast milk and dietetic preparations. So, the detection in the maternal serum of a significant titer of Brucella agglutinin enabled us to consider the very rare human-to-human transmission from mother to child. Because the efficacy of ceftriaxone assessed by a favorable initial response, and in order to avoid complications due to the use of tetracyclines and cotrimoxazole in infant, our patient was successfully treated with ceftriaxone plus rifampin.

Breast Feeding↗
PubMed1989

Recording pressure at the distal end of the endotracheal tube to measure respiratory impedance.

To minimize the flow-dependent effects caused by an endotracheal tube during impedance measurements, we recorded pressure inside the tube at its distal end. We used a commercial endotracheal tube with a lumen built into its wall with the opening located near the outlet of the tube. We characterized the effect of the tube by means of an effective transfer function (H). We measured H from 0.25-32 Hz on a mechanical analogue by using pseudorandom excitation with different peak-to-peak flow amplitudes (Vpp). For an 8 mm internal diameter (ID) endotracheal tube the modulus of H measured with Vpp 0.2 l.s-1 was 1.00 at 0.25 Hz and increased with the frequency to 1.40 at 32 Hz. The phase factor was close to zero (less than 5 degrees) over the whole frequency band. The modulus of H changed less than 5% and the phase factor less than 3 degrees when Vpp was increased from 0.2 to 0.8 l.s-1. We evaluated the method on five mechanical analogues with increased resistance or elastance and with a different tracheal area. The mean normalized distance in the complex plane over the whole frequency band (dz) between the analogue impedance and the estimated value from intubation was always less than 5%. Finally, the method was tested on an active analogue which superimposed a high-amplitude (up to 1.4 l.s-1 peak-to-peak) low-frequency (0.25 or 0.33 Hz) sinusoidal flow onto excitation: dz was always less than 4.3%.

Airway Resistance↗
PubMed1989

[Collodion baby. Apropos of a case with eye manifestations].

We report a case of a male collodion baby, born at term of a consanguineous couple of Afghan origin. The new-born baby displayed a pseudo-dysmorphic syndrome predominant of the face, with a marked ectropion of the upper and lower eye-lids and chemosis, without corneal involvement. The condition improved with time but complete regression was not obtained. Collodion baby syndrome is a pathologic skin condition observable during the neonatal period. Long term evolution is towards ichthyosis in 90% of cases, and resolution in 10%.

Ectropion↗