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Biomedical subjects

A Martorell

Publications and source records attributed to A Martorell.

At least 19 recordsLinked to original sources
PubMed1999

Vocal cord dysfunction in a child.

Vocal cord dysfunction (VCD) involves paradoxical adduction of the vocal cord during the respiratory cycle. This usually occurs during inspiration, but can also be seen in expiration. Vocal cord appositioning produces airflow obstruction sufficient to cause wheezing, shortness of breath, chest tightness, and coughing. These symptoms often imitate the respiratory alterations of asthma, thus leading to inappropriate treatment; intubation or tracheotomy may prove necessary. An 11-year-old girl was admitted with intractable dyspnea. She had been diagnosed with atopic asthma, although she failed to respond to an increase in antiasthma medication, including high-dose oral steroids. Flow-volume loops were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as a flat inspiratory loop. No structural abnormalities were seen with either computed tomography (CT) or magnetic resonance imaging (MRI). Fibroscopy revealed paradoxical adduction of the vocal cords during the respiratory cycle, no obstructive disorder being observed. After the diagnosis of VCD, the clinical manifestations resolved with psychiatric treatment. Adduction was not demonstrable at repeat fibroscopy after treatment. VCD may simulate bronchial asthma; it may also be associated with that disorder, thus masking the diagnosis. It should be suspected in patients with recurrent wheezing who fail to respond to usual asthma treatment. An early diagnosis avoids unnecessary aggressive management. Treatment should consist of respiratory and phonatory exercises; psychotherapy may be useful.

Asthma↗
PubMed1993

Venographic assessment of deep vein thrombosis and risk of developing post-thrombotic syndrome: a prospective study.

It is well known that patients with deep vein thrombosis (DVT) constitute a risk group for development of pulmonary embolism. However, the relation of DVT and the extent thereof with the subsequent sequelae (post-thrombotic syndrome) are insufficiently investigated. We have prospectively studied a series of consecutive patients admitted because of DVT on lower limbs, trying to correlate venographic findings during acute DVT with post-thrombotic (PTS) symptoms that develop later. Seventy-nine patients (84 limbs) with acute DVT were followed-up in our out-patient clinic at 4-monthly intervals for 3 years. At each visit patients were carefully examined regarding the appearance of PTS symptoms and/or signs from the DVT-affected leg. Three years after discharge, presence of PTS signs was assessed according to a simple scoring system. And then correlated to venographic findings during acute DVT. Patients were classified as having no (37 legs), mild (30 legs), or severe PTS signs (17 legs). Patients with popliteal vein involvement showed a significantly higher incidence of PTS 3 years later (P < 0.001). The risk of PTS also increased as DVT extent increased (P < 0.001). Nevertheless, the logistic regression analysis showed that DVT location explained all the differences (P < 0.001). In other words, DVT extent was overriden by the significance of DVT location, being popliteal the only location that showed a relevant contribution to the PTS incidence (95% confidence interval = 2.49-71.5).

Acute Disease↗
PubMed1991

Occult cancer in patients with deep venous thrombosis. A systematic approach.

The authors prospectively studied 113 consecutive patients with deep venous thrombosis of the lower extremities to determine the most appropriate workup study for searching for a hidden cancer. After a careful physical examination, the following routine tests were performed: erythrocyte sedimentation rate (ESR), whole blood counts, biochemistry, carcinoembryonic antigen (CEA) levels, chest radiograph, upper gastrointestinal endoscopy, abdominal ultrasound and computed tomography (CT) scan. If a malignant lesion was suspected, further appropriate studies were performed. After discharge, periodic follow-up was performed on all patients in the outpatient clinic. A malignant neoplasm was detected in 12 patients. Of these 12 patients, six were asymptomatic with the exception of experiencing thrombophlebitis. Cancer was found more commonly in patients with idiopathic deep vein thrombosis (DVT) (7 of 31 versus 5 of 82 patients with secondary DVT; P = 0.012), and in those patients with abnormal lactic dehydrogenase (LDH) levels (6 of 23 versus 6 of 90; P = 0.007). Abnormal CEA levels allowed diagnosis of two cases of colonic cancer (on colonoscopy). Both ultrasound and CT scan of the abdomen showed two cases of urinary bladder carcinoma at a very early stage. Furthermore, two cases of adenomatous polyps in colon were found, a condition considered by most authors to be a colorectal cancer precursor. In addition, there were five patients with large benign pelvic tumors, and two patients with absent inferior vena cava. The most striking finding was that some cases of cancer were at a very early stage. It was concluded that blood cell counts, LDH, CEA, chest radiograph, and abdominal ultrasonography (or CT scan) should be routinely performed on all patients with deep venous thrombosis (particularly those with idiopathic DVT). Malignancy would not have been recognized in some patients if these tests had not been performed.

Adult↗
PubMed1990

Peak expiratory flow measured with the Mini Wright Peak Flow Meter in children.

We established pediatric reference values for peak expiratory flow rate (PEFR), using the Mini Wright Peak Flow Meter. The study was based on 1,566 Mediterranean white children, aged 7 to 14 years from Valencia (Spain) schools. Height was the biometric variable with the greatest correlation to PEFR in both sexes; significant differences were noted between males and females. Prediction equations and percentile tables are presented for each sex. The performance of the Mini Wright Peak Flow Meter was compared with that of a spirometer.

Adolescent↗
PubMed1987

Predicting pulmonary embolism in postoperative patients with deep venous thrombosis of lower limbs.

Ventilation-perfusion lung scans were done in 70 patients admitted because of an iliofemoral deep vein thrombosis (DVT), and diagnosed by venography. Eighteen items of clinical and laboratory information were measured to predict the presence of lung scan abnormalities consistent with asymptomatic pulmonary embolism. Eighteen patients had perfusion defects in the lung scan that were classified as "high probability of pulmonary embolism", while the lung scan was normal in 32 patients. Patients with an idiopathic DVT were at high risk of pulmonary embolism, but those with a postoperative DVT had a low embolic risk. In patients with a postoperative DVT two factors predicted pulmonary embolism: those patients who developed symptomatic DVT after an operation but had a normal lung scan showed higher platelet counts than their preoperative levels. Conversely, it they developed a pulmonary embolism their platelet count dropped from their preoperative levels.

Adult↗
PubMedDate not supplied

[Round Table: urticaria with a physical cause].

Physical urticaria comprises a series of clinically differentiated conditions in which wheals develop as a result of physical stimuli: mechanical (friction, pressure), cold, heat, increased body temperature, exercise exposure to sunlight, vibration and contact with water. The present study reviews their clinical, diagnostic and treatment characteristics. Although the precise prevalence of physical urticaria is not know, it nevertheless represents the most common form of urticaria of known etiology in children. Symptomatic dermatographism is the most frequent presentation in children; it may be present from birth and persist indefinitely. In order to study the prevalence of dermatographism in our pediatric population, we randomly selected 238 children of both sexes (128 boys and 110 girls) aged 2 to 14 years, in the Paternal Health Care Center (Valencia, Spain). An evaluation was made of skin response 5 minutes after the application of pressure (3,200 g/cm2) along a 5-cm extent of skin on the back, using a dermatographometer. A positive response was considered when a wheal over 2 mm in diameter developed; in this context, the prevalence of dermatographism was 24%, with a significant predominance of females (33%) over males (16%). According to the data obtained from the anamnesis, 41% of the children with dermatographism referred exanthema in response to friction and pressure compatible with symptomatic dermatographism, versus only 5% of those who tested negatively. Lastly, 42% of the children with dermatographism referred intense local reaction (5 cm or more) in response to mosquito bites, versus only 16% of the children who tested negatively for dermatographism. The study of bronchial reactivity to metacholine in 17 children with dermatographism but no bronchial asthma (based on the Chatham method) proved positive in 13 cases (76%). Seven of these 17 children (41%) yielded positive skin tests (3 referred symptoms of rhinitis, with no manifestations of asthma in any case), and the metacholine challenge proved positive in 5 (71%). Ten of the children showed negative skin testing for aeroallergens - with positive metacholine testing in 8 (80%). These results indicate a high prevalence of bronchial hyper-responsiveness in children with dermatographism, suggesting the existence of an association between skin and bronchial hyper-reactivity. Skin tests with aeroallergens were made in 45 of the 58 children with positive dermatographism; 38% were found to be positive for at least one of the allergens studied, a figure that increased to 43% when only considering children over the age of 7 years. This points to a high prevalence of atopy among children with dermatographism. In order to evaluate the prevalence of dermatographism in the atopic population, we studied 100 patients in the 4-14 years age range suffering from respiratory pathology associated with sensitization to aeroallergens. A positive response to pressure (3,200 g/cm2) was observed in 47% of cases, this being significantly higher than the prevalence observed among the general pediatric population.

Acetylcholine↗
PubMedDate not supplied

Prevalence of dermographism in children.

The prevalence of dermographism in our pediatric population was studied in 238 children of both sexes (128 boys and 110 girls) aged 2-14 years, randomly selected from a health care center. Skin reaction was evaluated after 5 min pressure (3,200 g/cm2) applied with a dermatographometer on a 5-cm length of dorsal skin. The reaction was considered positive when a wheal of more than 2 mm was observed. The prevalence of dermographism was found to be 24%, with a significant female predominance (33%) over males (16%). Forty-one percent of the children with dermographism reported exanthema in response to friction and pressure, which was compatible with symptomatic dermographism, compared with only 5% of those who yielded negative reactions. In order to assess the prevalence of dermographism in the atopic population, 100 patients in the 4-14 age range with respiratory disease (perennial allergic rhinitis and/or bronchial asthma) involving sensitization to aeroallergens (house dust mites and/or Alternaria) were studied. A positive response to the application of pressure (3,200 g/cm2) was observed in 47% of cases, this figure being significantly higher than in the general pediatric population.

Adolescent↗
PubMedDate not supplied

Intolerance to sodium metabisulfite in children with steroid-dependent asthma.

Oral challenge tests were carried out with sodium metabisulfite solution doses of 5, 10, 25, 50 and 100 mg, dissolved in 20 ml of citric acid, and administered to 20 children aged 7-14 years with steroid-dependent bronchial asthma. A single-blind challenge protocol was performed initially and the positive responses were confirmed by double-blind challenge. Initially, 6 of 20 presented a positive reaction, confirmed in 4 of 20 by double-blind challenge. Only 1 child was clinically suspected of exhibiting intolerance to this agent. The prevalence of the challenge test using sodium metabisulfite in children with steroid-dependent bronchial asthma was 20%.

Adolescent↗
PubMedDate not supplied

[Arteriovenous fistulae of posttraumatic origin: apropos 7 cases].

We present our experience with arterio-venous traumatic fistulas. Seven cases, between 6 patients are reviewed. Respective etiologies were: 4 cases after an accidental traumatism, 2 cases produced by iatrogenicity and 1 case of idiopathic etiology. Respective localizations were: 6 cases at lower limbs (85.7%) and one case at cervical column (14.2%). All patients underwent surgical treatment. There was any case of mortality and treatment results were satisfactory in all cases. Patients were followed and, up to now, no recidives have been registered. follow-time ranged from 1.5 to more than 6 years.

Adolescent↗