Search PubMed⌕ Search

Biomedical subjects

M A Jorge

Publications and source records attributed to M A Jorge.

14 recordsLinked to original sources
PubMed2001

Respiratory effects of halothane in a patient with refractory status asthmaticus.

We describe the case of a 36 year old patient who was admitted to the intensive care unit (ICU) for an acute asthma attack that failed to respond to conventional treatment and required mechanical ventilation. The patient's condition improved after halothane was administered; treatment with this inhalational anaesthetic lasted 7 h, and the beneficial effect was obtained by employing concentrations between 0.5 and 2%. Under constant mechanical ventilator settings, a highly significant linear correlation between peak airway pressure and arterial pCO(2)(r: 0.98 P<0.001) was observed. The decrease in p(a)CO(2)induced by halothane may be explained by the diminished dead space that results from the drop in peak airway pressure. Arterial hypotension, which improved with inotropic agents, was the only complication that seemed related to the inhaled anaesthetic. The patient was extubated 24 h after her arrival to the ICU and discharged 72 h later. A causal relationship between the administration of halothane and clinical improvement is suggested.

Administration, Inhalation↗
PubMed2001

Effect of isotretinoin on tooth germ and palate development in mouse embryos.

Vitamin A and its derivatives, retinoic acid, tretinoin and isotretinoin, are currently used in dermatological treatments. The administration of high doses of this vitamin provokes congenital malformations in mice: cleft palate, maxillary and mandibular hypoplasia and total or partial fusion of the maxillary incisors. This study compares the tooth germs of the first maxillary and mandibular molars of fetal mice submitted to isotretinoin during organogenesis. Twelve 60-day-old female Mus musculus were divided into two groups on the 7th day of pregnancy: treated group--1 mg isotretinoin per kg body weight, dissolved in vegetable oil, was administered from the 7th to the 13th day of pregnancy; control group--vegetable oil in equivalent volume was administered orally for the same period. On the 16th day of pregnancy, the females were sacrificed, the fetuses were removed and their heads amputated. After standard laboratory procedures, 6-micron thick serial slices were stained with hematoxylin and eosin for optical microscopy examination. The results showed that both groups had closed palates with no reminiscence of epithelial cells; however, the first molar germs of the isotretinoin-treated animals showed delayed development compared to the control animals.

Animals↗
PubMed2001

Intrauterine dentistry: an integrated model of prevention.

Intrauterine Dentistry is a highly relevant subject of our time. The use of preventive measures in the intrauterine stage can avoid several diseases, among these, dental caries. The WHO advises that from the 4th month of pregnancy, women should avoid the intake of sugar, so that the fetus, future child, does not develop an exaggerated attraction for these types of foods, thus being susceptible to caries. Through questionnaires sent to gynecologist-obstetricians and dentists, this research investigated the information they have about this subject and how they instruct their patients. Questionnaires were also sent to pregnant women requesting information about the instructions they had received for the prevention of oral diseases of their fetus. Seventy-one percent of the dentists and 80% of the gynecologist-obstetricians reported having instructed the pregnant women to reduce the intake of sugar. However, only 13.6% of the dentists and no gynecologist-obstetrician instructed the reduction of sugar intake between the 12th and 18th week of pregnancy. A total of 42.2% of the pregnant women referred to these instructions, but none received instruction as to the specific period of the 12th and 18th week. An ideal model of treatment for pregnant women must include integrated and multiprofessional treatment, in which general dentists and gynecologist-obstetricians work together with the participation of the patient.

Adolescent↗
PubMed2000

[Fluid overload in critically ill patients. Hemodynamic effect vs hydrosaline balance].

The administration of high volumes of fluids during resuscitation of critically ill patients follows the recommendations of experts' committees that postulate volume expansion to correct deficits that may be associated with certain conditions (sepsis, trauma, surgery, etc), not primarily characterized by hypovolemia. These recommendations suggest that optimizing cardiac output may avoid occult deficit in tissue oxygen delivery and consumption that could lead to multisystem organic failure and death. The lack of benefit in the morbidity and mortality rates of patients with treatments directed to reach supranormal values of oxygen delivery, attempts against this hypothesis, since it fails to correct the primary hemodynamic dysfunction (arterial vasodilatación) and generates fluid overload. The probable mechanisms linked with the avidity to retain water and sodium by critically ill patients are reviewed and the use of restricted protocols that preserve fluid balance is encouraged to potentially improve outcome.

Colloids↗
PubMed1999

Argentine Jewish community institution bomb explosion.

BACKGROUND: Descriptive study of physical injuries and implemented organization from a nearby, unwarned university hospital after the July 18, 1994, bombing of the seven-story Argentine Israeli Mutual Association (AMIA) building in Buenos Aires. Data were obtained from hospital medical records. RESULTS: A total of 86 victims arrived at the emergency department, 2 victims were dead on arrival, 41 victims were admitted, and 43 victims with minor injuries were assisted and allowed to go home. The explosion caused a total of 86 deaths and left more than 200 people injured. Mortality rate among hospitalized survivors was 8.3% and among critically injured victims was 28.6%. CONCLUSION: The total collapse of a multiple-story building immediately kills most of its occupants. In the present study, the few surviving victims were located at the lower floors. The majority of hospitalized victims were outside the building at the moment of the blast. Rapid overcrowding of the emergency department with minor and moderate injuries that do not require hospitalization should be anticipated by disaster management plans. Centralization of severely injured patients in critical areas seems appropriate, because this method keeps major cases from spreading through different wards.

Adolescent↗
PubMed1993

Active core rewarming in neurologic, hypothermic patients: effects on oxygen-related variables.

OBJECTIVES: To determine in hypothermic patients if a) the decrease in oxygen consumption (VO2) is exclusively dependent on the decrease in metabolic rate, or b) as a consequence of the greater hemoglobin affinity for oxygen, hypothermic tissues have impaired oxygen extraction. DESIGN: Clinical, prospective study; sequential measurements of oxygen-related variables during active core rewarming. SETTING: Intensive care unit of a university hospital. PATIENTS: Twelve patients (44 +/- 16 yrs of age) admitted to the intensive care unit with a core temperature of < 34 degrees C due to severe neurologic damage. INTERVENTIONS: Rewarming (with heated enemas, gastric infusions, and heated blankets) to increase body temperature at a rate of approximately 1 degree C/hr. Measurements of oxygen-related variables were performed at a baseline of 31.0 +/- 1.1 degrees C, and repeated at each 1 degree C increase to reach a core temperature of approximately 35 degrees C. MEASUREMENTS AND MAIN RESULTS: Oxygen-related variables of rewarmed patients were allocated into two groups, above or below the observed mean core temperature of 33.1 degrees C recorded for all measurements (n = 45). Comparison of the low core temperature group (31.1 +/- 1.4 degrees C; n = 20) with the high core temperature group (34.7 +/- 0.9 degrees C; n = 25) showed that the group with the lower core temperatures had a significant increase in VO2 index (67 +/- 22 vs. 103 +/- 38 mL/min/m2 [p < .001]), oxygen delivery index (183 +/- 73 vs. 290 +/- 123 mL/min/m2 [p < .001]), and the PO2 value at which hemoglobin was half-saturated with oxygen ([P50] 23 +/- 5.7 vs. 27.7 +/- 5.7 torr [3.0 +/- 0.7 vs. 3.6 +/- 0.7 kPa] [p < .02]). An increase in metabolic acidosis could be observed in the lower temperature group: arterial pH 7.47 +/- 0.15 vs. 7.34 +/- 0.13 (p < .01); base deficit -3.7 +/- 6.7 vs. -8.2 +/- 4.9 mEq/L (p < .02). The oxygen extraction ratio remained unchanged: 0.39 +/- 0.10 vs. 0.38 +/- 0.10 (NS). CONCLUSIONS: These data show that VO2 was reduced to half of normal values during hypothermia. Active core rewarming produced an average 4.5% increase in VO2 per 1 degree C that was characterized by the wide variation observed in this metabolic response between different patients and for individual cases. Despite the rightward shift of P50 observed during rewarming (mainly due to the Bohr effect), no change was reflected on the oxygen extraction ratio.

Acidosis, Lactic↗
PubMed1988

Comparison between measured and fick-derived values of hemodynamic and oxymetric variables in patients with acute myocardial infarction.

PURPOSE: Previous studies have compared the relationship between directly measured values for cardiac output, systemic oxygen consumption (VO2), and arteriovenous oxygen difference (D(A-v)O2) with those calculated by the Fick principle. However, the validity of Fick's principle in critically ill patients undergoing physiologic changes and pharmacologic interventions is unknown. The purpose of our study was to compare directly measured values for hemodynamic and oxymetric variables with those calculated by the Fick equation in patients with acute myocardial infarction, at baseline and after the hemodynamic changes produced by pharmacologic interventions. PATIENTS AND METHODS: Cardiac output, (VO2), and (D(A-v)O2) were measured in 33 patients with acute myocardial infarction, at baseline (50 +/- 30 hours after the onset of symptoms) and after pharmacologic intervention to relieve pulmonary congestion. These values were then compared with indirect values derived from the Fick equation. RESULTS: High and significant correlations were found between thermodilution and Fick-derived cardiac output at baseline (r = 0.91, p less than 0.001) and post-intervention (r = 0.92, p less than 0.001). Similarly, VO2 values measured by expired gas analysis showed a significant correlation with VO2 calculated by the Fick principle, at baseline (r = 0.85, p less than 0.001) and post-intervention (r = 0.84, p less than 0.001). Lastly, when D(A-v)O2 of arterial and mixed venous samples was measured by spectrophotometry and compared with calculated values, there was a significant correlation at baseline (r = 0.85, p less than 0.001) and after intervention (r = 0.85, p less than 0.001). Analysis of variance revealed no difference between measured and calculated values for the three variables under those two conditions. CONCLUSION: In patients with acute myocardial infarction, cardiac output, VO2, and D(A-v)O2 indirectly calculated by the Fick principle are equivalent to directly measured values, despite the various degrees of hemodynamic dysfunction and the currently used therapeutic interventions.

Aged↗
PubMed1985

Early physiologic changes in canine fecal peritonitis.

Oxygen delivery (DO2) and related variables were studied in eight dogs during severe untreated peritonitis induced by cecal ligation and perforation. The development of peritonitis was accompanied by abdominal fluid sequestration and significant increases in hemoglobin (Hgb), arterial oxygen content (CaO2), and P50. Changes in mixed venous PO2 (P-vO2), mixed venous saturation (S-vO2), DO2, oxygen uptake (VO2), cardiac index (CI), and arteriovenous O2 difference (C[a--v]O2) were not significant. When blood volume was returned to normal levels with dextran, CI rose and C(a--v)O2 decreased; P-vO2 increased and Hgb returned to baseline levels. In this animal model, sepsis and fluid sequestration produced an increase in blood O2 capacity and CaO2, which sustained DO2 and VO2. No changes were observed in P-vO2 or S-vO2. The hyperdynamic state of severe sepsis became evident only after reversing hemoconcentration by colloid infusion. The increase in P-vO2 and S-vO2 after volume loading is possibly related to primary septic mechanisms and/or to changes in DO2.

Animals↗