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Biomedical subjects

J Cobo

Publications and source records attributed to J Cobo.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Infection of sternal wound in heart surgery: analysis of 1000 operations].

BACKGROUND: Sternal wound infection (SWI) is the most important complication in cardiac surgery. The aim of this study was to describe the frequency and clinical and microbiological features of this complication. METHODS: All the cases of SWI which were observed in the authors' hospital in the first 1,000 cardiac surgery operations performed with extracorporeal circulation were retrospectively reviewed. The cases were identified through the Infectious Diseases and Cardiac Surgery Department files and were classified according to the depth of the infection. During the study period neither the prophylaxis against infection nor the surgical techniques were modified. RESULTS: Forty-three patients (4.3%) presented SWI. Fourteen were superficial infections and 29 were deep infections of which 9 were classified as osteomyelitis and 20 as mediastinitis. A progressive decrease was observed in the proportion of SWI over time parallel to an increase in the number of operations performed. Staphylococcus aureus was the agent most frequently isolated (60.4%). Gram-positive aerobic cocci were found in 66.7% of the total number of isolations, being most frequent in the deep infections (83.3% of the isolations). The gram-negative aerobic bacilli were isolated more frequently in the superficial infections than in the deep infections (57.8% v.s. 16.7% of the isolations, respectively p < 0.01). In patients with SWI the predictive value of the positive blood cultures for the diagnosis of mediastinitis was 83.3%, with a sensitivity of 50% and specificity of 91.3%. Three patients with deep infection developed chronic complications and another three died (mortality by mediastinitis 15.0%). The mean postoperative stay was 52 days for the patients with deep infection and 39 days for those with superficial infection (p = NS). CONCLUSIONS: The percentage of surgical wound infection during the study period showed a trend to a decrease parallel with an increase in the number of operations. The gram-positive bacteria were responsible for most of the SWI. Although the depth of SWI is difficult to clinically predict, the presence of bacteremia suggests the existence of mediastinitis. Despite their lesser clinical importance, the superficial infections carry a long postoperative stay.

Blood↗
PubMed1996

Identification of AIDS-related tuberculosis with concordant gallium-67 and three-hour delayed thallium-201 scintigraphy.

Concordant gallium-67 and thallium-201 uptake has been described in malignant lesions. More recently, 201Tl accumulation has been described in some benign conditions. The authors report three HIV-positive patients who underwent 67Ga and 201Tl scintigraphy. These studies revealed concordant 67Ga and 201Tl uptake and tumour was erroneously diagnosed. All three patients were finally diagnosed as having tuberculosis.

AIDS-Related Opportunistic Infections↗
PubMed1996

Dentoalveolar stress from bodily tooth movement at different levels of bone loss.

This study was undertaken to determine the stress that appears in the tooth, the periodontal ligament, and the alveolar bone, when a couple and horizontal forces were applied to obtain the bodily movement of a lower digitalized canine and its changes depending on the degree of loss of the supporting bone. The analysis of tensions was carried out by means of the finite element method (FEM) with no bone loss and after reducing the support bone 2, 4, 6, and 8 mm. False color three-dimensional images indicating intensity of stress (tensile and compressive) and extension are generated. After the application of the forces in the model without bone loss, a rather uniform distribution of stress is observed. When the bone loss is 2 mm, an increased stress in the levels next to the alveolar crest is already apparent. After 4, 6, and 8 mm of bone support reduction, a change of the sign and an increment of the magnitude of stress in the lowest levels occurs.

Alveolar Bone Loss↗
PubMed1996

[Invasive pulmonary aspergillosis associated with influenza virus].

Invasive pulmonary aspergillosis can occur after viral influenza infection. It is described a previously healthy 58-year-old man with influenza virus infection who later suffered pulmonary aspergillosis. His response to amphotericin B was successful. The seven similar cases reported in the literature are revised and some common features established. Early antifungal therapy should be administered to any patient with previous flu illness presenting bilateral pulmonary infiltrates without response to antibiotics, if Aspergillus is isolated from the respiratory secretions.

Adult↗
PubMed1996

[Tuberculous hepatosplenic abscess, human immunodeficiency virus infection and multiresistant tuberculosis].

BACKGROUND: Tuberculosis (TB) with liver and/or spleen abscess (HSA) formation in HIV-positive patients is uncommon. PATIENTS AND METHODS: One hundred and thirty-seven HIV positive patients with TB were studied from January 93 to June 95. Patients with tuberculous HSA were enrolled in the study. Diagnosis was obtained by recovery of Mycobacterium tuberculosis in clinical specimens and the presence of hypoechogenic lesions in liver and/or spleen. RESULTS: M. tuberculosis isolates were resistant to some of the usual drugs in 51 patients. Twenty of these patients had HSA (39%) and in 18 patients the antibiotic sensitivity testing showed resistance to isoniazid, rifampin, ethambutol, and streptomycin. The remaining 86 patients had episodes of TB with drug-susceptible microorganism and only three patients had HSA (3%) (p < 0.001). The 23 patients with tuberculous HSA had a mean CD4+ lymphocyte count of 33 x 10(6) cells/L (2-111) and 7 had a previous episode of TB. The abdominal echography showed hepatosplenomegaly in all cases. Abscesses were located at the liver in 12 patients (52%), spleen in 18 (78%) and both organs in 7 (30%). In 16 cases a corticosteroid therapy was indicated. In the 3 patients with susceptible TB and HSA the clinical course was good. The 20 patients with resistant TB died. CONCLUSION: Abdominal TB in HIV-positive patients and HSA formation appears to be more common in severely immunosuppressed patients, with resistant TB and its mortality rate is high. The response to therapy with antituberculous drugs is slow and sometimes the administration of corticosteroids is necessary for the resolution of symptoms.

Abdominal Abscess↗
PubMed1995

[Invasive pulmonary aspergillosis. Necropsy series].

Invasive pulmonary aspergillosis (IPA) is a severe infection which is usually diagnosed at postmortem examination. This infection occurs mainly in immunosuppressed patients, although it has also been reported in immunocompetent patients. Clinical records from patients diagnosed with IPA in our institution from 1983 to 1992 were retrospectively studied to analyse clinical and therapeutical characteristics of IPA. Sixteen episodes of IPA were recorded, all of them but one from necrotic specimens. A total of 18.7% of patients were immunocompetent, one patient had the acquired immunodeficiency syndrome (AIDS), and the remaining patients had a classical immunosuppression. Fever and dyspnea were noted in all patients; hemoptysis was recorded in 12.5% of patients. The predominant radiological pattern was a bilateral alveolar infiltrate (75%). Diagnosis was made at postmortem examination in 15 cases (93.7%), and a clinical premortem suspicion was obtained only in 25% of patients. IPA can occur in immunocompetent patients more frequently than considered until now. The suspicion index for IPA is low, even in immunosuppressed patients.

Adult↗
PubMed1995

Abnormal gallium-67 skull uptake: a sign of peripheral marrow activation in HIV-positive patients with disseminated mycobacterioses.

UNLABELLED: The purpose of this study was to investigate the significance of abnormal 67Ga-citrate skull uptake in AIDS patients with mycobacterioses. METHODS: Gallium-67 scans of 39 HIV-positive patients who have been diagnosed with mycobacterioses were analyzed; the scans of 15 consecutive HIV-positive patients without mycobacterioses were also reviewed as a control group. The skull was chosen to assess bone marrow uptake because of the absence of overlapping structures. RESULTS: Twenty-nine of 39 (74%) patients with mycobacterial infections had disseminated disease. Gallium-67 uptake in the skull was visualized in 24 of these 29 patients (82%). One of the patients without disseminated disease and one patient in the control group (n = 15) showed skull uptake. CONCLUSION: Abnormal 67Ga skull uptake appears to be a sensitive (82%) and specific (82%) indicator of disseminated mycobacterial infection in HIV-positive patients.

AIDS-Related Opportunistic Infections↗
PubMed1995

Changes in the upper airway of patients who wear a modified functional appliance to treat obstructive sleep apnea.

This study was designed to investigate changes that occur in the upper airway of patients with obstructive sleep apnea who use a modified functional appliance. The experimental group included 10 men, all diagnosed with obstructive sleep apnea. Nuclear magnetic resonance imaging was carried out on each patient. One image was taken when the patient was in maximum habitual occlusion and another was taken while the patient wore the appliance. From the images gained, a three-dimensional reconstruction of the upper airway from the palatal plane was achieved. The images revealed statistically significant increases in the volume of the upper airway with the use of a modified functional appliance. Three-dimensional studies of the upper airway show greater detail and therefore seem likely to have more validity than two-dimensional studies.

Adult↗
PubMed1993

Faster isolation of Brucella spp. from blood by isolator compared with BACTEC NR.

Brucella spp. was isolated from blood cultures in a mean time of 3.1 days (range, 2-5) in seven cases of human brucellosis processed with the Isolator lysis-centrifugation system. Simultaneous BACTEC NR blood cultures in the same patients were positive in six, with a mean detection time of 20.6 days (range, 17-29). These data suggest a higher speed of recovery of Brucella spp. from blood specimens with the lysis-centrifugation procedure compared with the BACTEC NR system.

Bacteriological Techniques↗
PubMed1993

Initial stress induced in periodontal tissue with diverse degrees of bone loss by an orthodontic force: tridimensional analysis by means of the finite element method.

This study was undertaken to determine the stress that appears in tooth, periodontal ligament and alveolar bone, when a labiolingual force of 100 gm is applied in a labiolingual direction in a midpoint of the crown of an inferior digitalized canine, and its changes depending on the degree of loss of the supporting bone. The analysis of tensions was carried out by means of the finite element method (FEM) for a normal case and after reducing the periodontal support bone 2, 4, 6, and 8 mm. Three-dimensional images in false color in which intensity of tensions and its areas of extension are generated. Special attention was paid to changes at level D (apical transversal section) to which maximum, mean, minimum, and Von Mises tensions are calculated. After applying the labiolingual force in the canine, a progressive increase of the stress in the labial and lingual zones of the tooth, periodontal membrane and alveolar bone was observed when the alveolar bone was reducing. In the mesial and distal zones, no compensating forces appear, which could provoke a tooth rotation during the tipping movements.

Alveolar Bone Loss↗
PubMed1993

Transcranial oblique lateral radiography to verify the position of the mandibular condyles with the use of functional appliances.

By means of standardized transcranial oblique lateral (TOL) radiographs, the position of the mandibular condyles in the glenoid fossae of 14 patients with Class II division 1 malocclusion was studied at the beginning of treatment with or without functional appliances placed in position, and also at the end of treatment. A significant increase in the distance between the upper point of the condyle and the glenoid fossa was found when the appliance was worn for the first time. This displacement was found to disappear at the end of the treatment even when the appliance was placed in position.

Activator Appliances↗