PubMed Health⌕ Search

Biomedical subjects

J M Guitart

Publications and source records attributed to J M Guitart.

9 recordsLinked to original sources
PubMed1992

[Predictive factors of mortality in severe craniocerebral trauma].

BACKGROUND: The prediction of mortality in severe head injury is of interest for the evaluation of patient prognosis and to also permit therapeutic measures to be considered and improve knowledge of this problem. METHODS: A multiple logistic regression model was developed and validated from the data obtained from a series of 231 patients hospitalized for the above mentioned condition. Seventy-five percent of the patients were used to define the model with the remaining 25% validating the same. RESULTS: The variables included in the model were: intraventricular hemorrhage, odds ratio = 20.4 (confidence interval 95%: 3.56-116); compression of basal cistern and/or of the III ventricle, odds ratio = 11.5 (4.43-29.8); mydriatic pupils in both eyes, odds ratio = 5.71 (1.32-24.6); age, odds ratio = 1.03 (1.01-1.05) and Glasgow scale upon admission, odds ratio = 0.57 (0.43-0.75). The maximum global value of the model (84.9%) corresponded to a sensitivity of 84.5% and specificity of 85.2%. The cut-off point of probability of death was found to be 0.475. In the validation of the model the highest global value (84.2%) was also observed at the cut-off point of 0.475 with a sensitivity of 84.2% and specificity of 84.4%. CONCLUSIONS: The predictive factors of mortality in severe head injury are the evidence of hemorrhage in the cerebral ventricles, mydriasis and a low score on the Glasgow scale. The model presented is useful and valid for carrying out the prediction of mortality at the time of admission and is also easy to apply since the variables used are obtained in the initial examination of the patients with severe head injury.

Adult↗
PubMed1992

[Decrease in the incidence of epidural hematomas surgically treated during coma after a lucid interval. Is this an index of quality of care?].

The level of consciousness prior to surgery has been analyzed in a series of 64 patients suffering epidural hematoma (EDH) who underwent surgery during the period from July 1987 to June 1989. The percentage of cases which underwent surgery in coma after a lucid interval have been compared in different periods of time (1978-80, 1981-82, 1983-84 and July 1987 to June 1989). During the period from July 1987 to June 1989 surgery was performed on: 15 patients (23.5%) in coma from the moment of accident, 8 patients (12.5%) underwent surgery in coma but after a lucid interval and 41 patients (64.1%) were conscious. During the different periods of time the number of patients undergoing surgery in coma after a lucid interval were the following: 1979-80, 9 cases (26.5%); 1981-82, 17 cases (43.6%); 1983-84, 8 cases (20%) and during the last period, 1987-89, 7 cases (15.2%). The difference between the percentage of patients intervened in coma after a lucid interval in the previously referred periods of time was statistically significant (p 0.05).

Coma↗
PubMed1991

Intraspinal baclofen in the treatment of severe spasticity and spasms.

Ten patients with severe spasticity were evaluated according to a standardized protocol in order to be treated by intraspinal baclofen. Entry criteria in the protocol were the following: 1) Stable central nervous system lesion, 2) Severe spasticity and/or flexo-extensor spasms not controllable by oral treatment, 3) Normal CSF circulation and 4) Informed consent. All patients received a test dose of twenty-five micrograms of baclofen injected intrathecally. At intervals of at least one day, doses were increased in 10-25 microgram steps until total abolition of spontaneous spasms was achieved in complete spinal cord lesions. In patients with residual motor function, doses were titrated until the optimal dose was found that reduced spasms and enabled performance of maximum daily life activities according to the patient's neurological level. In nine patients a multidose reservoir was implanted to deliver intrathecal baclofen. Effective dosage was 60 +/- 31 micrograms in the entire group. Ashworth score was reduced from 4.6 +/- 0.7 to 1.2 +/- 0.4 (mean +/- SD) (p less than 0.0001) and spasms from 3.2 +/- 0.8 to 0.2 +/- 0.4 (p less than 0.0001). Follow-up of the nine patients in whom a reservoir was implanted has been 18 +/- 9 months. Initial dosage requirements and tolerance were significantly different in complete (Frankel's A grade) or incomplete lesions (Frankel's B, C and D grades). Complete spinal cord lesions required a greater initial dose (156 +/- 43) than incomplete lesions (44 +/- 24), these differences being statistically significant (Student's t-test, p less than 0.05). Tolerance was observed only in patients with complete motor and complete sensory lesions. In incomplete lesions, dose increase was insignificant.

Adolescent↗
PubMed1991

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called "normal pressure hydrocephalus" syndrome.

Fifty-four shunt-responsive patients were selected from a prospective protocol directed to study patients with suspected normal pressure hydrocephalus (NPH). Patients with gait disturbances, dementia, non-responsive L-Dopa Parkinsonism, urinary or faecal incontinence and an Evans ratio greater or equal to 0.30 on the CT scan were included in the study. As a part of their work-up all patients underwent intracranial pressure monitoring and hydrodynamic studies using Marmarou's bolus test. According to mean intracranial pressure (ICP) and the percentage of high amplitude B-waves, patients were subdivided in the following categories: 1) Active hydrocephalus (mean ICP above 15 mmHg), which is in fact no tone normal pressure hydrocephalus; 2) Compensated unstable hydrocephalus, when mean ICP was below 15 mmHg and B-waves were present in more than 25% of the total recording time and 3) Compensated stable hydrocephalus when ICP was lower or equal to 15 mmHg and beta waves were present in less than 25% of the total recording time. The majority of the patients in this study (70%) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group). Mean resistance to outflow of CSF (Rout) was 38.8 mm Hg/ml/min in active hydrocephalus and 23.5 mm Hg/ml/min in the compensated group (Students t-test, p less than 0.05). Higher resistance to outflow was found in patients with obliterated cortical sulci and obliterated Sylvian cisterns in the CT scan. No statistically significant correlation was found when plotting the percentage of beta waves against pressure volume index (PVI), compliance or Rout. An exponential correlation was found when plotting beta waves against the sum of conductance to outflow and compliance calculated by PVI method (r = 0.79). Patients with the so-called normal pressure hydrocephalus syndrome have different ICP and CSF dynamic profiles. Additional studies taking into consideration these differences are necessary before defining the sensitivity, specificity and predictive value of ICP monitoring and CSF studies in selecting appropriate candidates for shunting.

Adult↗
PubMed1991

[Symptomatic chronic subdural hematoma. Analysis of 68 cases treated surgically with small craniotomy and placement of a closed drainage system].

Sixty eight cases of chronic subdural hematoma (CSDH) surgically treated (December 1984-December 1988) with twist drill craniostomy (3-4 mm) and application of a closed drainage system (CDS) are reviewed. The patients were distributed in four groups depending on the density of the hematoma: hypodense (36 cases), isodense (6 cases), of mixed density (22 cases) and hyperdense (4 cases). In about one third of patients (25 cases) the duration of symptoms was shorter than one week, in 21 cases it was between one week and one month, and in 22 patients it was longer than one month. 77.95% of cases had a preceding head injury. Headache and motor deficits were the leading symptoms, being present in 43 (63.2%) and 42 (61.7%) cases, respectively. Twelve patients (17.6%) were comatose on admission. Twelve patients required reoperation. Six patients died (8.8%). The preoperative neurological status and associated systemic diseases influenced the outcome. We think that limited craniostomy with CDS is the therapy of choice for symptomatic CSDH.

Aged↗
PubMed1988

[Spontaneous cerebellar hematoma. Analysis of 23 cases].

A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of consciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69.5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsatisfactory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.

Adult↗
PubMedDate not supplied

[Reduction of the mortality from acute subdural hematoma. Comparison of 2 series (1979-1982 and 1987-1989) of patients operated on at the Hospital de la Vall d'Hebron].

Several clinical variables from a series of 101 patients with acute subdural hematoma (ASDH) operated on during the period 1979-1989 were compared with those from another group of 43 patients who were operated on during the period 1987-1989. Twenty-seven patients (26.7%) in the earlier period and 15 (34.8%) in the later one were younger than 40 years. The difference was not significant. There was a higher proportion of patients, 41 (40.5%), in the earlier period (1979-1982) who had traffic accidents than in the 1987-1989 period, where trauma was the mechanism in 15 patients (38.8%). However, the difference was not significant. Seven patients (6.9%) from the earlier group and 18 (41.9%) from the later group had a lucid interval. This difference was significant (p less than 0.001). During the 1979-1982 period 80 patients (79.2%) were comatose on admission as compared with 27 (62.7%) during 1987-1989. The difference was significant (p less than 0.05). A small group of 11 patients (10.8%) from the earlier series were operated on by means of craniotomy or trephine; by contrast, this approach was used in 35 (81.3%) patients from the later series. The difference was significant (p less than 0.001). Seventy-nine (78.2%) and 26 (60.4%) patients died in the periods 1979-1982 and 1987-1989, respectively. The difference between the mortality rates of both groups were significant (p less than 0.05). Our data suggest that the earlier diagnosis and the use of wider surgical procedures have contributed to the reduction in mortality.

Accidents, Traffic↗