Biomedical subjects
Publications and source records attributed to J M Soler.
Clinical configuration of borderline period of awakening is described based on the triangular relation (Patient, Family, Care Team) beginning during coma. The possible suffering before awakening (regressive attitude, downfall of immune defences, and so on ...) evokes a sort of reply of trauma and the hypothesis that mechanisms of "negative hallucination" play a part in post-traumatic amnesia.
The question of head trauma reasons, and the shock of traditional family and therapeutic references, make the authors examine clinic coma evolution till awakening. From signs of libidinal values collected by care-team, another way during coma and till life recovery, is rebuilt.
We assessed the buprenorphine use in a sample of studied 184 patients with DSM III-R diagnostic criteria for opioid dependence who attended the Sta. Eulalia's CAS (outpatients facility) during 18 months period The lifetime prevalence of buprenorphine was 79% (43.5% of them were occasional users and 35.5% habitual; whereas the point prevalence was 16.8% (6.5% occasional users and 10.3% habitual). We compared the clinical characteristics of this patients, those who use the drug habitually and those who take it occasionally. The first group showed a longer time of opioid abuse (p less than 0.05) and they were more involved in drug traffic (p less than 0.001), mostly buprenorphine. These patients may present higher levels of clinical severity and social conflicts. Anyway they are usually polydrug users who consume more frequently flurnitracempan, cocaine, heroine, alcohol and cannabis (p less than 0.001). The usual ways of obtaining the buprenorphine are illegal traffic and GP's prescription in the Public health care facilities often by menace and intimidation. For consuming buprenorphine the abusers crush the pill, dilute it and them inject the solution i.v. The subgroup of patients who use buprenorphine occasionally only take in when don't have heroine and clinically they are not so deteriorated.
We studied 184 patients with DSM III-R diagnostic criteria for opioid dependence who attended the Sta. Eulalia's CAS (outpatients facility) during 18 months in order to measure the buprenorphine use. We collected the data from the patient's reports on the present buprenorphine use. The period prevalence was 79% (43.5% of them were occasional users and 35.5% habitual; whereas the point prevalence was 16.8% (6.5% occasional users and 10.3% habitual). The average of buprenorphine use was 6.1 +/- 9.9 months. Main method of consume is crushing the pill then dilute it and then injecting the solution e.v. The usual way of getting the substance is from illegal market (about 65% of patients get it in this way). About the third of our patients have been involved in the illegal traffic of in this drug anytime. From the data presented above we conclude that a more strict control of buprenorphine in highly recommended.
We report two cases of cardiac amyloidosis. The echocardiographic features of this infrequent disease, and the doppler study of the ventricular diastolic function in these patients, together with its possible prognostic significance, is revised.
Because many surgical alternatives exist, and because full invasion of the entire eyelid is rare, we described a new way of surgery: we performed transposition of the whole eyelid, including the part of the elevator muscle of the eyelid, through the rotation of a part of frontal skin. The lacrimal lubrication of the eye was kept intact.
Malpractice is a recognized and growing problem for physicians and hospitals, but it is difficult to ascertain the risk of malpractice in the prehospital arena. Dade County, Florida (greater Miami), with a population of 1.7 million, currently is served by 339 certified paramedics. During the decade of 1972 to 1982, Dade County Fire Rescue handled 265,060 incidents; 16 claims were filed with the Risk Management Division of Dade County. The claims were produced by 11 incidents, which yields a rate of one per 24,096 incidents. The two greatest problems identified were inadequate record keeping and "gray zone" patients who do not fit any particular protocol.
A hundred patients with multiple sclerosis and urinary disorders were examined clinically and by gas or water cystometry. Particular attention was paid to abnormalities in the voiding need sensation. These abnormalities can best be studied by cystometry combined with urethral striated sphincter electromyography. When the sequence of the three degrees of need (usual need, pressing need and urgent need) is respected, there is a good correlation between the progression of the voiding need during the filling phase of the cystometry and during the detrusor action. When there is interference with the sequence of these three degrees of the voiding need, especially the absence of the sensation normally contemporaneous with the detrusor action or immediately preceding it, there is exaggeration of either the hyperactivity or the hypoactivity of the bladder, and this aggravates vesical sensitivity: premature contraction of the detrusor muscle eliminates the first two degrees (usual need and pressing need), while progressive distension of the detrusor muscle eliminates all three stages. As the multiple sclerosis evolves a stage is reached at which there are functional mictional disorders exclusively connected with the interference with the degrees of voiding need pollakiuria and urgency.
Explore the source record for details and available documents.
Aneurysms should be suspected in patients with a mass in the hand following either open or closed trauma. Posttraumatic aneurysms are classified as true or false. False aneurysms usually result from penetrating trauma and can occur in any disrupted vessel. In contrast, true aneurysms usually occur in either the thenar or hypothenar eminence a few weeks following closed hand injuries. Pulsations may be evident. Symptoms are coolness or paresthesia of the digits and dull pain aggravated by exercise. A positive Allen's test is a helpful confirmatory sign in diagnosis. Treatment is surgical with resection of the aneurysm and primary anastomosis or vein graft when possible.
In an unusually severe case of multiple toxin ingestion, a 48-year-old man ingested approximately 300 cc of Hoppe's Gunpower Solvent #9, which contains kerosene, denatured ethyl alcohol, oil and nitrobenzene. The major manifestation was nitrobenzene-induced methemoglobinemia of rapid onset. Treatment involves the judicious use of 1% methylene blue plus, in severe cases, hemodynamic and ventilatory support. The patient recovered after 48 hours and was transferred to the psychiatric service with continued follow-up for a mild poison-induced hemolytic anemia.
Explore the source record for details and available documents.
Sympathetic skin responses (SSRs) were recorded in six spinal cord injured patients. These SSRs were obtained at hands and feet, after electrical stimulation of the median or the posterior tibial nerves. Below the level of the lesion, SSRs had similar latencies than normal subjects, but were more inconstant, with a lesser amplitude and elicited after stronger stimulus intensity. The origin of these somatosympathetic reflexes are discussed. SSRs recordings seem to be a simple and suitable technique for investigation of the autonomic nervous system of the spinal cord injured patients.
We studied 184 patients with DSM III-R diagnostic criteria for opiate dependence and classified them in order of their buprenorphine use: those who never used it (21%), others who used it from time to time (43.5%), and those who use it habitually (35.5%). The patients who use buprenorphine habitually have a poorer social functioning and are more disturbed clinically. They present too: more unemployment (p less than 0.05), longer time of opioid dependence (p less than 0.05), they offend usually (p less than 0.001), they traffic in drugs more than the other patients (p less than 0.001), mostly buprenorphine (p less than 0.001) and they are usually polydrug-addicts (p less than 0.001).
Cisapride (Prepulsid) is a new prokinetic drug of the gastrointestinal tract. It has indirect muscarinic parasympathicomimetic effects on the neuromuscular junction of smooth muscle that we also observed on the vesical function by four of the six patients presented in this study.
We present a 71-year-old man with primary amyloidosis characterized by several outstanding clinical features, namely hip involvement of a pseudotumoral appearance, periarticular osteolytic lesions and a pathological fracture. Kappa light chains in the synovial fluid were observed. The patient survived for 90 months without developing plasma cell dyscrasia, and with preservation of vital functions despite parenchymal involvement of multiple organs.