Carcinoid syndrome at the Puerto Rico Medical Center: 1976-1983.
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Biomedical subjects
J Ríos
Publications and source records attributed to J Ríos.
[Digestive changes in cholecystectomized patients].
An important number of cholecystectomized patients after some years of complete well-being, begin complaining of symptoms such as periodic diarrhea or constipation, abdominal pain, regurgitation, vomiting, etc. The purpose of this study is to try to identify an alteration or lesion in the stomach or colon in cholecystectomized patients of more than five years standing, which may be causing the aforementioned condition. The forty patients under observation, free of biliary tract post-operative lesions, were subjected to: hemogram, amylasemia, either infusion cholangiograph or ERCP, fecal parasitological-tests, upper digestive and colon X Ray series, esophagus, stomach and duodenal endoscopy with biopsies. Additionally, ten underwent a colonoscopy which also included biopsy. The result of the radiological, amylasemia and hemogram studies was normal in all cases. The parasitological tests were negative. In every case, a moderate to severe superficial, chronic gastritis was found as well as minor histopathological alterations in the colon mucosa. The presence of bile in both duodenum and colon in interdigestive periods, alterations in the enterohepatic circulation as well as in the biliary composition itself, are suggested as the possible causes of the patients symptoms.
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[Increase in costs attributable to surgical infection after appendicectomy and colectomy].
OBJECTIVE: To determine the costs, with the help of direct case to case measurement, of the surgical site infection in apendicectomy and colectomy. METHODS DESIGN: cases and controls study, population-based, in which the cases were all the patients diagnosed of surgical site infection after apendicectomy or colectomy in SCIAS- Hospital de Barcelona, and the controls were a random sample of noninfected patients that presented common characteristics for matching purposes. STUDY PERIOD: from January 1, 1998, to December 31, 1999. Types of matching: a) individual, patients grouped according to main diagnosis, main surgical procedure, age and gender, and b) patients grouped according to main diagnosis, main surgical procedure, age and gender using in addition, as controls criteria, the number of secondary diagnoses. DATA SOURCES: computer system with all the registries and clinical histories in electronic support, including the costs registered in real time. ANALYTICAL ACCOUNTING: ADS plus program that calculated the real costs (patient to patient) extracted from real data, such as drugs consumption, medical supplies, additional diagnosis tests and generated stays. The structural costs were imputed in the matrix of costs from the countable calculation and its impact on the direct costs. The cost attributable to the infection was calculated as the additional cost resultant from the difference between cases and controls. STATISTICAL ANALYSIS: the statistical calculations were made by means of the statistical package SPSS, version 9.0. Nonparametric tests were used considering the sample size. The test of Wilcoxon for continuous variables, with the purpose of comparing age, operations length, hospital stay and costs, was applied. The results were expressed as arithmetic mean. A level of statistical meaning of p < 0.01 was considered. RESULTS: The first matching included 23 cases and 23 controls for patients operated on apendicectomy and 20 cases and 20 controls for those operated on colectomy. In matching 2, the sample consisted on 17 pairs of cases and controls on apendicectomy and 14 pairs of cases and controls on colectomy. The infection increased the average length of stay between 7.7 days (matching 1) and 7.3 days (matching 2) in cases of infected apendicectomy and between 17.6 days (matching 1) and 15.4 days (matching 2) in cases of infected colectomy. The patients with apendicectomy infection presented an average cost three times higher than the ones not infected, both in matching 1 (2,998.60 versus 941.89;, respectively; p < 0.0001) and in matching 2 (2,751.70 versus 870.81;, respectively; p < 0.0001). Similar findings were observed in colectomy both in matching 1 (10,705.34 versus 2,600.55;, respectively; p < 0.0001) and in matching 2 (9,081.12 versus 2,621.39;, respectively; p < 0.0001). The average cost of surgical site infection oscillated between 2,056.71; (matching 1) and 1,880.89; (matching 2) in apendicectomy and between 8,140.79; (matching 1) and 6,405.65; (matching 2) in colectomy. CONCLUSIONS: Under the study conditions, the infection of surgical site determines the prolongation of the hospital stay in more than one week in apendicectomy and in more than two in colectomy, with an increase higher than 300% in the total direct cost.
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[Anatomoclinical study of pulmonary embolism in patients with or without pulmonary infarction].
The autopsy protocols of 560 patients were studied in order to detect the incidence of pulmonary embolism, 83 cases were found (15%). The clinical data was analyzed to establish the existence of differentiating points between subjects with pulmonary infarcts and those with embolism but without infarction. The necropsy findings were further scrutinized to determine the effect of the anatomic localization of the embolus upon the production of infarction. Pulmonary infarctions were present in 60% of the cases with pulmonary embolus. The presence of cardiac failure, valvular heart disease and left ventricular hypertrophy was significantly more frequent in patients with pulmonary infarcts. In subjects with or without infarction the age, sex and the presence of medical debilitating diseases, recent trauma, surgical interventions or postpartum, cardiac diseases, arteriosclerotic heart disease, clinical evidence of thrombophlebitis, prolonged bed rest and atrial fibriliation preceding the pulmonary embolism, did not evidenciate any significant difference. In the cases with infarction the pulmonary embolus was significantly more frequently located in the small and sublobar pulmonary artery branches, while when pulmonary infarction was not found the embolic process was more frequently located in the main, right or left pulmonary arteries; occlusion of the lobar arteries had approximately the same incidence in the two groups. The most common clinical signs of pulmonary thromboembolism were dyspnea, tachycardia, cough and shock. The presence of hyperthermia, cough, jaundice, bloody sputum, pleuritic pain, pleural friction rub and pleural effusion was significantly more frequent in those cases with pulmonary infarction; the last five features were present only in the presence of infarction. The electrocardiogram was strongly suggestive of pulmonary embolism in the 6% of all cases, while the chest X-ray in 30% of those with pulmonary infarct. The diagnosis was established antemortem in 40% of the cases with infarction and in 20% of the cases with embolus but without pulmonary infarction. In 23% adequate anticoagulant therapy was established.
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