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Biomedical subjects

J Cruz

Publications and source records attributed to J Cruz.

At least 163 records · Page 9Linked to original sources
PubMed1978

Effects of gravitational stresses on mitral valve prolapse. I. Changes in auscultatory findings produced by progressive passive head-up tilt.

The effects of passive head-up tilt on systolic time intervals were assessed in 18 patients with mitral valve prolapse. In addition to causing prolongation of the pre-ejection period and shortening of left ventricular ejection time, this circulatory stress led to progressive shortening of the Q to click interval. In 1 patient, a systolic click became audible which had not been heard in the supine posture. In 7 patients the click disappeared during head-up tilt, usually at 60 degrees or 90 degrees. In 2 patients without a murmur while supine, a mid-late systolic murmur appeared with tilt; 1 of these 2 as well as another patient who had a soft late systolic murmur while supine developed loud systolic whoops at greater angles of tile. The correlations between Q to click interval and aortic valve opening to click interval, and both the angle and the sine of the angle of tilt were highly significant.

Adolescent↗
PubMed1978

The mitral knock with atrial fibrillation. A possible source of auscultatory confusion.

A 29-year-old woman with atrial fibrillation and severe rheumatic mitral regurgitation initially had a very loud third heart sound with high-frequency components (mitral knock), as well as with a first heart sound of widely varying intensity. After long diastoles a faint first heart sound was heard, with distinct separation from the third heart sound of the preceding cycle; however, on short cycles the loud and high-pitched third heart sound combined with a loud first heart sound to simulate the combination of a first heart sound with an ejection click. Phonoechocardiographic studies clarified the identity of the transients.

Adult↗
PubMed1976

Persistence of the third heart sound after resection of the native mitral and tricuspid valves. Evidence against the valvular theory of third sound origin.

A patient is described with severe rheumatic mitral and tricuspid insufficiency in whom both atrioventricular valves with their chordae tendineae and papillary muscles were resected and replaced with Hancock porcine grafts. This would appear to be the second such patient reported and the first described in detail in whom the third heart sound persisted postoperation. This occurrence documents the fact that a third heart sound can occur in the absence of native atrioventricular valve leaflets and the major portions of the subvalvular supporting apparatus, and argues against the theory that the third heart sound is generated by either the valvular leaflets of the subvalvular apparatus.

Adult↗
PubMed1975

Mechanisms of O2 transport in Andean dogs.

Using previously inserted catheters, 11 dogs native to high altitude (7.5-23 kg bwt) were studied standing and unsedated in Cerro de Pasco, Peru at 4350 meters. Hemoglobin (Hb), hematocrit (Hct), O2 and CO2 contents, PO2, PCO2 and pH were measured in simultaneously obtained arterial and mixed venous blood samples. Blood pressures were measured in the pulmonary artery and the left ventricle and cardiac output (Q) was determined by dye dilution. Moderately higher values for Hb and Hct were found in these dogs. Hb-O2 affinity was no different than that found in sea level dogs: the P50 in the Andean dogs was 31.6 mm Hg at 38 degrees C and pH of 7.4. Because of the low barometric pressure at 4350 m (458 mmHg) the partial pressures of oxygen in inspired and in alveolar air were lower than at sea level: 84.3 and 56.4 mm Hg, respectively. PAO2 and PVO2, were 55.5 and 32.9 mm Hg while the SAO2 and SVO2 were 79.5 and 50.7%, respectively. Marked hyperventilation was observed (PACO2, 25.6 mm Hg) however, pH was normal. Cardiac output was normal (average 162 plus or minus 39 ml/min/kg). Moderate pulmonary arterial hypertension was observed in the presence of normal left ventricular end diastolic pressure suggesting increased pulmonary vascular resistance.

Acclimatization↗
PubMedDate not supplied

Reducing distress in cancer patients with an orientation program.

The purpose of this study was to test a brief orientation program for reducing anxiety, depressive symptoms, and overall distress in cancer patients at their initial clinic visit. One hundred and fifty consecutively referred patients seen in an oncology outpatient clinic were randomly assigned to an intervention or usual care control group. The intervention group received a clinic tour, general information about clinic operations, and a question and answer session with an oncology counselor. Outcome measures included the State-Trait Anxiety Inventory (STAI), the Brief Profile of Mood States (POMS), the Center for Epidemiologic Studies-Depression (CES-D) Scale, and an oncology clinic questionnaire which were administered at the initial clinic visit and follow-up. There were no statistically significant clinical or demographic differences between groups at initial assessment. At follow-up, the intervention group had lower state anxiety, lower overall distress, and fewer patients reporting depressive symptoms. Patients in the intervention group demonstrated significantly more knowledge about clinic operations and greater satisfaction with care. These data provide evidence that anxiety, distress and depressive symptoms can be reduced with an orientation program. This finding has particular relevance in the early stages of diagnosis where patients may suffer symptoms of anxiety and depression.

Adaptation, Psychological↗
PubMedDate not supplied

Trends in mechanical ventilation and immediate extubation after liver transplantation in a single center in Chile.

INTRODUCTION: Some groups have reported early extubation post-liver transplantation in patients with previously defined criteria, in an attempt to shorten the ICU stay and decrease costs. We review our experience with trends in mechanical ventilation and resource utilization. METHODS: We retrospectively reviewed the length of mechanical ventilation, ICU stay, hospital stay, transfusions, and costs of liver transplants performed since the program's inception in 1993 and 2002 including 82 OLT in 71 patients. We also report our experience with immediate postoperative extubation, which we have done from October to December of 2002. We compare different periods: the early days (1993 to 1997), namely, fewer than 10 OLT per year, with the subsequent years assessed individually. RESULTS: There has been a progressive decrease over time in the length of mechanical ventilation, ICU stay, hospital stay, and costs. Since the program's inception actuarial adult patient 1- and 5-year survival rates were 88.7% and 78%, respectively. The 1-year survival rate increased to 97% during the period of 2000 to 2002 (n = 30). From October to the present, we extubated four of seven adult patients who met criteria with none of them requiring reintubation. CONCLUSIONS: We demonstrate improved results, decreased length of mechanical ventilation, ICU, and hospital stay, and costs. The immediate postoperative extubation may be feasible for patients who meet previously defined criteria.

Blood Transfusion↗
PubMedDate not supplied

Antibody to c antigen consequent to renal transplantation.

A case of apparent red cell (RBC) autoimmunity due to anti-c is described in the recipient of a cadaveric renal transplant. Although the patient suffered little hemolysis as a result, a strong direct anti-c agglutinin was detectable on the patient's RBCs 8 days after transplantation and in his serum only 4 days after transplantation. We believe that the antibody was produced by passively transferred B lymphocytes in the donor kidney, and that the recipient may have been protected from more serious hemolysis by immunosuppressive agents administered at the time of transplantation. The donor received multiple transfusions before transplantation, but his serum lacked anti-c in a screen performed shortly before his death. This case raises the possibility that donor alloantibodies to other Rh antigens on recipient RBCs can arise after transplantation, if the donor has been transfused.

Adolescent↗
PubMedDate not supplied

[Sevoflurane in airway management using fibrobronchoscopy: apropos of 2 difficult orotracheal intubation cases].

We report two cases of difficult orotracheal intubation in which intubation with a fiberoptic bronchoscope was performed after induction with an inhalational anesthetic. Mild inhalational anesthesia with sevoflurane was started fairly rapidly, with no respiratory incidences. The tubes were then inserted through a fiberoptic bronchoscope, with no airway management problems.

Anesthetics, Inhalation↗