A prospective comparison of four antihypertensive agents in daily clinical practice.
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Adult↗
Biomedical subjects
J Segura
Publications and source records attributed to J Segura.
Reducing time delay in the thrombolysis of myocardial infarction: an internal quality improvement project. ARIAM Project Group. Analisis del Retraso en Infarto Agudo de Miocardio.
The objectives of this study were to improve thrombolytic therapy in acute myocardial infarction by reducing the "door-to-needle" time in a 285-bed university hospital in Spain. A quality management approach was used involving all the relevant staff. Target standard was set at 35 minutes. Baseline data, intervention effect, and continuous monitoring were analyzed using x control charts. Analysis of baseline data showed a wide out-of-control variation and 72 minutes' average delay. Cause analysis revealed organizational and clinical problems that were subjected to intervention. Postintervention data showed a stable process, with an average of 30 minutes. Continuous monitoring showed further improvement in average time and predictable variation. The template of the current control chart has an average of 26 minutes. Quality management methods, particularly staff involvement in problem analysis and intervention design, and the use of control charts were useful to understand, solve, and continuously monitor an important clinical problem whose existence was evident only after it was measured.
Emergency Service, Hospital↗
[Listeria monocytogenes endocarditis in a patient with mitral prosthesis, left auricular thrombus and adenocarcinoma of the colon].
A case of Listeria monocytogenes endocarditis in a patient with mitral prosthetic valve, left atrial thrombus and colonic adenocarcinoma is reported. Vegetations were not demonstrated by transesophageal echocardiography and the clinical course was benign and without complications. Cure was achieved with antibiotic therapy, and surgery was not required. These features suggest that atrial thrombus could be the source of infection.
Adenocarcinoma↗
[The incidence of cerebrovascular accidents in the town of Rivera, Uruguay].
INTRODUCTION: Knowledge about the epidemiology of cerebrovascular accidents (CVA), or stroke, in the town of Rivera, Uruguay, would be useful as the basis on which to apply health care strategies both in the prevention of risk factors and in early diagnosis and treatment. AIMS: To determine the incidence of CVA in the town of Rivera and to study the association between certain risk factors and the pathological type of CVA. PATIENTS AND METHODS: The study, which spanned the period between 1st March 2000 and 28th February 2001, was conducted in the town of Rivera, which has a population of 62,859 and is located in the north of the Eastern Republic of Uruguay. The sample consisted of 114 patients with CVA, of whom 79 had no previous history of CVA -first CVA in lifetime (FCVAL)-. RESULTS AND CONCLUSIONS: The incidence of CVA was 181.3 cases per 100,000 inhabitants per year. The incidence of FCVAL was 125.7 cases per 100,000 inhabitants per year. 73.4% of the FCVAL were ischaemic and 26.6% were haemorrhagic. A high percentage of arterial hypertension was found in patients with CVA (84%) and with FCVAL (80.7%), and a statistically significant association was observed between congestive heart failure and ischaemic CVA.
Adult↗
[Ischemic heart disease (VII). Determinants of functional recovery after thrombolytic treatment].
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Fibrinolytic Agents↗
In vivo metabolism of clebopride in three animal species and in man.
Clebopride is extensively metabolized in the rat, rabbit, dog, and man. By use of chromatographic methods, up to 25 metabolites in hydrolyzed and nonhydrolyzed urine have been detected. All four species produced the same main metabolites, as indicated by thin-layer chromatography. These, isolated from urine of the three animal species, were identified as N-(4'-piperidyl)-2-methoxy-4-amino-5-chlorobenzamide, N-(4'-piperidyl-2'-one)-2-methoxy-4-amino-5-chlorobenzamide, and N-(1'-alpha-hydroxybenzyl-4'-piperidyl)-2-methoxy-4-amino-5-chlorobenzamide (tentative structure of a carbinolamine more stable than expected). In the dog, 2-methoxy-4-amino-5-chlorobenzoic acid was also detected. N4-glucuronidation of clebopride and some of its metabolites has been shown to occur in the three animal species. The rabbit produced large amounts of these conjugates. Clebopride N4-sulfonate was not present in the urine of any of the species investigated.
Animals↗
[Hypothermia as the only method of preservation of swine liver in hepatic transplants (proceedings)].
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Animals↗
[Insulin-like growth factor I as a marker of nutritional status in patients on enteral nutrition].
In order to appraise type 1 insulin growth factor (IGF-1) as nutritional state marker in comparison with other known markers, seric IGF-1 (RIA), albumin, prealbumin, transferrin and retinol-bound protein were determined weekly in 15 patients with oropharyngeal neoplasm and 7 in the burns unit, all being administered enteral nutrition. At the beginning of the study, IGF-1 seric levels were significantly lower in the burns group compared with the neoplasm group (82.28 +/- 23.36 vs 137.58 +/- 66.2 ng/ml, p < 0.01). IGF-1 values in the first group were initially significantly lower in comparison with those for the same group at the end of the study (82.28-23.36 vs 177.11 +/- 53.87 ng/ml, p < 0.01 for paired data). No significant change was demonstrated in IGF-1 seric levels in the neoplasm group. IGF-1 seric levels showed a significant multiple correlation with albumin, prealbumin, transferrin and retinol-bound protein in both the group with burns (r = 0.696, p < 0.001) and that with neoplasms (r = 0.615, p < 0.001). The nitrogen balance revealed a univariant and significant linear correlation with IGF-1 (r = 0.373, p < 0.05) and with prealbumin (r = 0.377, p < 0.05). According to the data obtained, seric IGF-1 has a significant correlation with other well-known nutritional markers. In the burns group, the hypercatabolism was accompanied by a significant increase in seric IGF-1 levels.
Adolescent↗
A randomized study comparing deflazacort and prednisone in heart transplant patients.
Prednisone is widely used by most heart transplantation units despite its frequent side effects. Deflazacort, an oral synthetic steroid with fewer side effects, has been successfully used in patients after heart transplantation, but a prospective study comparing deflazacort and prednisone in transplant patients is lacking. We have carried out, in the last year, a prospective trial of deflazacort versus prednisone involving 35 consecutive heart transplant patients. Two of these patients died perioperatively (surgical mortality, 5.7%), and another two were excluded from the protocol because of diabetes mellitus in one patient and active infection before transplantation in the other patient. Thus 31 patients were enrolled in the 3-month study. All of them were treated with antithymocyte globulin, 10 mg/kg/day for 3 days after transplantation, azathioprine, and cyclosporine; patients were randomly assigned groups: 15 patients to receive deflazacort therapy, 1.5 mg/kg/day, and 16 patients to receive prednisone therapy, 1 mg/kg/day, starting the first day after transplantation. Steroids were rapidly tapered, reaching the maintenance dose at 2 to 3 weeks after transplantation (prednisone, 0.15 mg/kg/day; deflazacort, 0.25 mg/kg/day). Both groups were similar in terms of age, gender, ABO identity, serum cyclosporine levels, azathioprine dosage, and pretransplantation serum glucose and lipids levels. Seven endomyocardial biopsies were performed on each patient, at 1, 2, 3, 5, 7, 10, and 13 weeks after transplantation. Incidence of acute rejection was similar between prednisone and deflazacort groups; 33% of patients receiving prednisone therapy and 42% of patients receiving deflazacort therapy had one episode of 3A or higher rejection (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Late recurrence and endocranial metastasis caused by giant cell tumor.
A case of giant cell tumor localized in the proximal end of the right tibia, initially treated by simple curettage is described. After 11 years there was local recurrence, confirmed anatomopathologically, observed during wide resection and reconstruction by arthroplasty plus homoplastic grafting. After a few months there were metastatic lesions in the left parietooccipital and right retroorbitary area. Biopsy of the parietooccipital lesion showed giant cells in a sarcomatous stroma. The patient died after several attempts at chemotherapy. Even if only sporadic cases have been described of late recurrences and of extrapulmonary metastases for giant cell tumors, the case presented here is exceptionally rare. The factors that influence recurrence of these tumors and their ability to metastasize is discussed.
Adult↗
Baker's pseudocyst in the prosthetic knee affected with aggressive granulomatosis caused by polyethylene wear.
It is our belief that this is the first histologically documented case of popliteal cyst secondary to early failure of a cementless knee prosthesis, that occurred after 4 years. The walls of the cyst presented with granulomatous reaction to polyethylene particles. In prosthetic reimplantation successive to excision of the cyst we observed a recurrence of cysts and osteointegration of the prosthetic components, that made reimplantation difficult. Histological assessment of the synovial tissue, periprosthetic tissue and underlying bone showed granulomatous reaction to polyethylene debris. A "tumor" in a patient that has a knee prosthesis can be caused by implant failure. In cases of early failure wear forms large particles and their migration at the bone-prosthesis interface may be obstructed and thus cause a different biological response. If reimplantation is necessary osteointegration of the implants may make surgery difficult.
Female↗
The treatment of giant cell tumors by curettage and filling with acrylic cement. Long-term functional results.
Curettage and filling with acrylic cement in the treatment of para-articular giant cell tumor (GCT) has multiple advantages as compared to other methods; nonetheless, the possibility of progression in arthrosis is still a drawback. The literature does not report long-term functional results when this method was used. Four cases are presented with a mean long-term follow-up of 13.5 years (minimum 11, maximum 18). Clinical results, evaluated by the Enneking system (18), were excellent, and there were no radiological modifications, so that we believe that this is the method to choose for Campanacci stage I and II GCT (1), and in some stage III cases, as joint function is not compromised in time.
Acrylates↗