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Biomedical subjects

J Almirall

Publications and source records attributed to J Almirall.

At least 55 records · Page 3Linked to original sources
PubMed1993

Incidence of community-acquired pneumonia and Chlamydia pneumoniae infection: a prospective multicentre study.

This one year prospective multicentre study was designed to determine the incidence of community-acquired pneumonia in adults. It was carried out in primary health care centres and three reference hospitals, located in the 'Maresme' region (Barcelona, Spain) serving a population of 39,733 subjects over 13 years of age. Patients suspected of having contracted community-acquired pneumonia were visited by their family doctors and referred to the three reference hospitals for confirmation of the diagnosis. Patients attending the emergency services of these hospitals were also included. Urine and blood samples were obtained for culture, antigen detection, blood count, serological tests, blood gases and biochemical profile. The diagnosis of community-acquired pneumonia was made in 105 patients. Forty-six patients had an identifiable microbial etiology. Chlamydia pneumoniae was the most common pathogen (16 cases) followed by Streptococcus pneumoniae (13 cases) and Mycoplasma pneumoniae (8 cases). In conclusion; the annual incidence rate of community-acquired pneumonia in adults in this area was 2.6 cases per 1,000 inhabitants and Chlamydia pneumoniae was the most frequent causative pathogen.

Adolescent↗
PubMed1993

Cytomegalovirus colitis in chronic renal failure.

Cytomegalovirus (CMV) is an ubiquitous agent and is recognized as a pathogen in all age groups. Although symptomatic infection by CMV (CMV disease) in normal adults is generally mild, the virus is known to produce severe symptoms, mostly in immunocompromised patients. In this group of patients, the primary involvement of the colon by CMV is reported to be rare. However, chronic renal failure patients are prone to CMV infection. Nevertheless, despite the high incidence of infection in these patients and the recognition of a defective immune response in some of them, clinical manifestations are an exception. Two chronic renal failure patients who developed acute colitis due to CMV infection are presented. Of interest are the rarity of the association, the favorable clinical course and the differential diagnosis with other gastrointestinal disorders which are more common in these patients.

Aged↗
PubMed1992

[Nephropathy in human immunodeficiency virus infection].

BACKGROUND: Patients with the human immunodeficiency virus (HIV) infection may present different types of nephropathy with focal segmentary glomerulosclerosis (FSGS) being the most specific lesion associated to HIV (HIVN). The prevalence of this entity varies between 1 to 23%. These differences have been attributed to ethnic factors and/or intravenous drug addiction (IVDA). The renal alterations presented in these patients with HIV infection were analyzed. METHODS: Two groups of patients were studied: Group I with 300 consecutive patients with advanced HIV infection (complex related with AIDS) treated with zidovudine without initial kidney infection followed for a mean of 19 +/- 11 months (99% caucasian, 65% IVDA, 66% AIDS); and group II with 11 patients with HIV infection remitted for kidney involvement (4 on hemodialysis). RESULTS: Group I: 26 cases (9%) presented acute reversible kidney failure (12 prerenal, 9 nephrotoxicity and 5 mixed). No patient presented HIVN criteria. Group II: one black patient developed HIVN and had no known risk factors. The remaining patients presented glomerular changes different from those of HIVN. CONCLUSIONS: The scarce prevalence of human immunodeficiency virus nephropathy in the present series is of note despite the high number of intravenous drug addicts included suggesting that ethnic factors determine the differences observed in different series. The most frequent kidney disturbances seen are those related with infectious complications associated to the acquired immunodeficiency syndrome and the treatment of the same.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Calciphylaxis in a hemodialysis patient: appearance after parathyroidectomy during a psoriatic flare.

Chronic renal failure patients are prone to soft tissue calcifications. A phenomenon of acute ischemic skin necrosis and dermohypodermic arteriolar medial calcification has been described recently in patients with chronic renal failure and secondary hyperparathyroidism (HPT). This phenomenon, termed calciphylaxis, occurs in response to certain factors, the most important of which appears to be an elevated blood calcium-phosphate product. Accordingly, parathyroidectomy in addition to normalization of calcium-phosphate product has been proposed as the only effective therapeutic approach for this condition. We describe a case of chronic renal failure with severe secondary HPT in which the patient developed calciphylaxis 4 days after the appearance of a psoriatic flare. Four months before, a subtotal parathyroidectomy was performed for severe HPT and at the time the ulcerations appeared, blood calcium-phosphate product was correct. Etiological and physiopathological aspects of calciphylaxis are discussed.

Calciphylaxis↗
PubMed1992

Acquired renal cystic disease in HD: a study of 82 nephrectomies in young patients.

In order to study the development of acquired renal cystic disease (ARCD) and its potential complications, we studied, macro- and microscopically, 82 surgical specimens of nephrectomy carried out on young patients with chronic renal failure previous to renal transplantation. Statistical correlation of pathological findings with age, sex and time on hemodialysis (HD) have been done. There were 72 cases of ARCD (87.8%). It was statistically correlated with male sex (p less than 0.02) and prolonged time on HD (p less than 0.001) as has been previously reported. Hyperplasia of the cystic epithelium was found in 42 cases (52%), with 18 (22%) showing marked papillary proliferation. Also, there were 22 cases (27%) with renal adenomas. This incidence of hyperplastic and neoplastic proliferations, more than would be common in such a young population (males: 33.5 +/- 9.3 years; females: 35.4 +/- 11.7 years), suggests the potential of patients affected by ARCD to develop neoplasms. Thus, we consider that these patients must be checked periodically to detect possible malignant neoplasms.

Adenoma↗
PubMed1991

[Aspiration cytology in the diagnosis of renal transplant rejection].

BACKGROUND: The use of fine needle aspiration for the diagnosis of renal transplant rejection is advantageous for its innocuousness, thereby making it an acceptable method for monitoring. However, the clinical use reported among several groups has been variable and indeed, the influence it may have on the results of the use of different lines of immunosuppressors is little known. METHODS: Thirty-six consecutive renal transplanted patients were studied prospectively over the 2 months following the transplantation of the organ. The basal immunosuppressor treatment consisted in the administration of prednisone and antilymphocytic serum in patients presenting acute post-transplant tubular necrosis with the remaining patients receiving cyclosporin in monotherapy. One hundred seventy-three double punction were carried out. RESULTS: No complications were observed as a consequence of the punction. The material obtained was insufficient for evaluation on 18 occasions. The use of the method for diagnosis of rejection obtained a sensitivity and specificity of 73% and 81% respectively. Furthermore, in the group of patients with stable renal function, higher immunoactivation indexes were observed in those treated with cyclosporin in monotherapy (1.7 +/- 1.7) with respect to those who received triple treatment (0.5 +/- 0.4). CONCLUSIONS: The use of fine needle aspiration cytology is safe and clinically useful in the monitoring of the post renal transplantation period. The results should be interpreted in terms of different immunosuppressive lines.

Adolescent↗
PubMed1991

[Prospective study of community-acquired pneumonias seen in a general hospital. Diagnostic errors].

BACKGROUND: The patients with community acquired pneumonias seen in an emergency service of a basic general hospital during one year were evaluated to assess their etiological, clinical and radiological features, and also to investigate the initial and final diagnosis of the disease, its evolution and the parameters associated with each microbiological type. METHODS: A medical team investigated daily the clinical records. For etiologic diagnosis, blood cultures, serological studies, urine counterimmunoelectrophoresis (CIE) and, in individualized patients, pleural fluid culture, bronchoaspirate and bronchoalveolar lavage were performed. The discordance between the initial clinical and radiological diagnosis and the microbiological results, and also the initial and final diagnostic errors were analyzed. RESULTS: 311 cases of pneumonia (150 adults and 161 children) were diagnosed. 95 (30%) had microbiological confirmation. Streptococcus pneumoniae was the most commonly isolated organism. Serologic studies were the diagnostic method with the highest yield. Complications developed in 28% of the patients and the mortality rate was 2%. There was a relationship between mortality and a high respiratory rate on admission. The initial-final diagnostic discrepancy was 43% in atypical pneumonias and 40% in bacterial pneumonias. CONCLUSIONS: Clinical parameters permitting the differentiation between atypical and bacterial pneumonia were not found. The initial diagnostic error was 12%, consisting of false positives in all instances, and the final diagnostic error included 15% false positives and 10% false negatives. Underlying diseases have a influence on the evolution of pneumonia. The mean respiratory rate on admission should be measured as a prognostic indicator. In the present study, urine CIE was a poorly sensitive method.

Adolescent↗
PubMed1991

[Diagnosis of renal carcinoma in acquired cystic renal disease. Usefulness of echography in detection during subclinical phase].

BACKGROUND: The patients with end-stage renal disease on periodic hemodialysis often develop acquired cystic renal disease, and they have renal tumours more commonly than the normal population. METHODS: To evaluate the usefulness of echography for the evaluation of these lesions and the prevalence of acquired cystic renal disease and occult renal tumours in patients treated with hemodialysis during years, a prospective ultrasonographic study was carried out. To this end, renal echographic studies were performed in 43 asymptomatic patients treated with periodic hemodialysis during 5 years or more. Patients with renal polycystic disease were excluded from the study. RESULTS: The overall prevalence of acquired cystic renal disease was 86%. It was higher in males (96%) than in females (70%). Two patients (4.6%) had malignant renal tumours. CONCLUSIONS: In view of the high prevalence of tumours in acquired cystic renal disease, it is suggested that periodic echographic studies should be carried out in patients with end-stage renal disease treated with hemodialysis during years to detect renal carcinoma in subclinical stage.

Adolescent↗
PubMed1991

Tobacco prevention in hospitals: long-term follow-up of a smoking control programme.

This paper presents the results of a smoking control programme carried out in Sant Jaume i Santa Magdalena Hospital in Mataró (Barcelona, Spain) involving the entire hospital staff. The general objectives of the programme were: (1) to reduce tobacco consumption among hospital staff and (2) to create an awareness of their exemplary role as health professionals. In order to achieve these aims, different activities were carried out: lectures on the consequences of smoking; restrictions on smoking in hospital areas; and smoking cessation help for those who wished to give up smoking. To measure the effectiveness of the intervention, a survey of smoking habits and attitudes among the hospital staff was conducted before the start of the programme in 1986 and repeated two and a half years later in 1989. The population studied in both surveys (n = 298 and n = 304) was similar by sex, age, and professional status. Regarding tobacco consumption there was the same proportion of never smokers, while the percentage of current smokers was reduced by 11 between the two surveys (51 to 40%), and the ex-smokers group showed an increase (16 to 23%). These differences were significant. There was also a remarkable change in attitudes among the health professionals, especially with regard to their disposition to give advice to stop smoking. The results show a reduction of the prevalence of smoking among the hospital staff and a positive change in their attitudes towards smoking.

Adult↗
PubMed1991

[Disseminated mucormycosis in a hemodialyzed female patient treated with deferoxamine].

A case is presented of a patient affected of chronic renal failure caused by multiple myeloma who was under a chelating treatment with Depreroxamine as a consequence of iron intoxication and suffered a disseminated mucormycosis. We performed a literature search of previous cases and discuss the probable relation between this opportunistic infection and depheroxamine treatment.

Deferoxamine↗