PubMed Health⌕ Search

Biomedical subjects

J Muñoz

Publications and source records attributed to J Muñoz.

239 records · Page 14Linked to original sources
PubMedDate not supplied

Cerebrotendinous xanthomatosis diagnosed after traumatic subdural haematoma.

We report the case of a 34-year old man, who, after presenting with subacute traumatic subdural haematoma, was diagnosed as CTX. He presented a ten year history of progressive deterioration of cognitive functions, unsteadiness of gait and surgery for bilateral cataracts at age 21. Cholestanol level in serum was 120.7 mmol/liter, and cholestanol/cholesterol ratio 2.52%. Bile alcohols in urine were 23, 25-pentol: 2.2665 mg/mmol creatinine, 24, 25-pentol: 1.3226 mg/mmol creatinine, and 27-nor-24, 25-pentol: 0.7363 mg/mmol creatinine. Electrophysiological study was consistent with a mixed demyelinating and axonal neuropathy. The assessment of autonomic nervous system (ANS) showed a postganglionic cholinergic failure accompanying somatic peripheral neuropathy. Brain-stem auditory evoked potentials (BAEPs) demonstrated markedly low amplitude and poorly defined waves, and almost symmetrical peak V and I to V interpeak latency (IPL) slight delays. Two nodular, bilateral, symmetrical lesions, strongly suggestive of calcifications, in the cerebellar white matter on CT and MRI were noted. On T2-weighted images diffuse high signal lesions were found in the cerebellar white matter, and multiple, hyperintense cerebral foci of demyelination or gliosis. MRI study of the Achilles tendon showed neither enlargement of the tendon, nor areas of lipid deposits. After ten months of treatment with chenodeoxycholic acid (CDCA) (750 mg/d) the clinical course was unaffected and the neurophysiological measures, CT and MRI remained unchanged.

Adult↗
PubMedDate not supplied

[Bacterial pneumonia as a risk marker for new bacterial diseases in patients with HIV infection].

BACKGROUND: Bacterial pneumonias are a main cause of morbidity and mortality among patients infected by the HIV. Furthermore, recent data suggest that, under certain circumstances, they can be prognostic markers. METHODS: The evolution of a cohort of HIV-infected patients, prospectively defined by having suffered a pneumonia, was studied with regards to the occurrence of a new pneumonia or death from a bacterial disease; the evolution of a control cohort of patients matched according to sex, CD4-cell count, previous HIV-disease and zidovudine-treatment was compared to the former cohort by means of survival-analysis techniques. RESULTS: Forty-nine patients in each group were followed up for a total of 1389 and 1893 patient-months respectively. In the first group, 17 new first pneumonia episodes were diagnosed, as compared to 7 in the second group (relative-risk: 3.23, 95% confidence interval: 1.34 to 7.79, p = 0.005). Eight of the 31 deaths that occurred in the first group were attributed to a bacterial disease, as compared to none of the 24 deaths in the second group (p = 0.007, Fisher's exact test) (in five of those cases, a bacteria was isolated which was thought to be directly related to the death). CONCLUSIONS: HIV-infected patients who suffer a bacterial pneumonia have an increased risk of suffering new severe bacterial diseases (pneumonia or fatal diseases) as compared to HIV-infected patients with similar prognostic features but no previous episodes of pneumonia.

Adolescent↗
PubMedDate not supplied

[Tracheostomy in the intensive care unit].

During the last 22 months, a total number of 85 tracheostomies have been performed in our ICU, 40 of which have been surgical, and 45 percutaneous to patients under mechanical ventilation. This period has coincided with the learning process of the technique of percutaneous tracheostomy by our staff. The choice of the type of tracheostomy was not taken at random, but guided by clinical criteria. Our results confirm a lower rate of infection of the estoma in percutaneous tracheostomies than in surgical ones (5 percutaneous and 29 surgical, p < 0.001). The most serious complication was a tracheal perforation in a percutaneous tracheostomy. 17 of the 85 patients died in ICU, and 33 of the 68 patients who were discharged, survived the hospital, 27 of whom left with a closed tracheostomy. The other 6 permanent tracheostomies had been performed surgically and corresponded to 4 patients with worsening EPOC, one neurological patient and another patient suffering from anoxic encephalopathy. No percutaneous tracheostomy was left as permanent. The patients who benefitted especially from the tracheostomy presented the following characteristics: acute respiratory insufficiency with prolonged intubation, neurological patients, and worsening EPOC. The tracheostomy in persistent vegetative status allowed their moving to more suitable areas. Our study proves the existence of a learning curve in the practice of percutaneous tracheostomy. This aspect should be taken into account by other groups who are interested in including this technique in their services.

Adult↗
PubMedDate not supplied

The muscle inhibitory period by transcranial magnetic stimulation. Study in stroke patients.

Motor evoked potentials (MEPs) elicited over hand muscles by transcranial magnetic stimulation (TMS) were studied in healthy individuals and, bilaterally, in patients with cerebral infarction. Conduction time of the central motor pathways (CMCT), threshold intensity, and amplitude of the MEPs were correlated with recovery motor hand function after stroke. Following MEPs by TMS during tonic muscle contraction, there is a transient suppression of muscle action. This inhibitory period (IP) was significantly shorter in the upper paretic limb of stroke patients with spasticity than in normal limb of the patients and healthy individuals. Shortening of the IP duration was correlated to degree of upper limb spasticity (Ashworth scale) and may be due to supraspinal level reduction of the inhibitory function. The IP study contributes to a better quantification of the hand function in stroke patients.

Adult↗