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Biomedical subjects

J Muñoz

Publications and source records attributed to J Muñoz.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Incidence of lymphoid neoplasms in patients with HIV infection].

BACKGROUND: The incidence, histologic type and clinical characteristics of the lymphoid neoplasms found in patients with HIV infection may be influenced by environmental factors. These characteristics were herewith investigated in the authors medium. METHODS: The medical records of the patients in whom lymphoma was diagnosed were reviewed studying the usual clinical, epidemiological, histological and biological variables. RESULTS: Fourteen patients: 10 with non Hodgkin lymphomas and four with Hodgkin disease were studied. The prevalence was 5% of the total number of patients with AIDS. Seven patients of the former and none of the latter had previously uncomplicated HIV infection. The following histologic types were observed: two Burkitt lymphoma, 4 undifferentiated lymphomas and 4 immunoblastic lymphomas among the non Hodgkin cases and two with mixed cellularity, one lymphocytic depletion and one undetermined among the Hodgkin's cases. Eighty percent of the patients with non Hodgkin lymphoma and 50% of the patients with Hodgkin disease presented a IV-B stage. The median of survival was 2.5 months (limits 1-8) for non Hodgkin cases and 11 months (limits 1-36) for the patients with Hodgkin disease. CONCLUSIONS: The prevalence of lymphoma in patients with AIDS in the authors' medium is similar to that referred in other studies although a high proportion of Hodgkin's disease may be found.

Adult↗
PubMed1994

[Hepatic disease associated with human immunodeficiency virus infection: anatomo-clinical study].

OBJECTIVE: To study the spectrum of liver disease in the infection by the human immunodeficiency virus (HIV) and to assess the usefulness and indications of liver biopsy. PATIENTS: Fifty eight HIV seropositive patients (48 intravenous drugs users) were prospectively studied by means percutaneous liver biopsy, because of hepatic biological alterations, hepatomegaly or fever of unknown origin. RESULTS: Chronic hepatitis was the most common diagnosis, which was found in up to 20 patients (34%) (12 had chronic active hepatitis). Most of them were caused by hepatitis C virus (90%). Hepatic granulomatosis was diagnosed in nine patients (15%), all of them among the subgroup of 19 patients (47%) studied because of fever of unknown origin. Granulomas were thought to be caused by mycobacteria in eight cases (seven tuberculosis, one Mycobacterium avium-intracellulare. Mycobacteria were isolated in culture in four patients whose histologic findings were inspecific. Other representative diagnosis were liver cirrhosis in eight patients, lymphoma in two, alcoholic hepatitis in one and candidiasic hepatitis in one. The diagnostic yield of liver biopsy was 79%. CONCLUSIONS: Liver biopsy is a useful method in the diagnosis of these patients, specially if they present with fever of unknown origin or hepatic biological alterations. In this study chronic active hepatitis was the most common finding, while hepatic granulomatosis was so in patients with fever of unknown origin.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Bacteremia caused by Haemophilus influenzae with special reference to its relation to HIV infection].

BACKGROUND: The association between infection by Haemophilus influenzae and infection by the human immunodeficiency virus (HIV) has been clearly demonstrated. However, some characteristics of this association still remain poorly defined. METHODS: The medical records of all adult patients admitted to a general hospital over a period of four years with blood cultures positive for Haemophilus influenzae were reviewed. Patients were grouped according to whether HIV infection or no evidence of HIV infection existed. Clinical and epidemiologic data were collected and compared. The main features of data corresponding to seropositive patients are reported. RESULTS: Of a total of 29 cases of bacteremia by Haemophilus influenzae, 19 were diagnosed in adults: 5 in patients with HIV infection and 14 in patients without HIV infection. Over the following 18 months one additional case was reported. The incidence (calculated in cases per 100,000 people/year) was 1.9 in the general population, 1.5 in adults, 70 in adults with HIV infection and 360 in AIDS patients. All the cases diagnosed in adults below the age of 30 years were reported in HIV carriers. Five of the 16 (31%) H. influenzae strains tested were resistant to ampicillin, with a significant difference being found between those isolated from HIV positive patients (4/5) and from HIV negative patients (1/11). No patient with HIV infection died during the episode. But five of the HIV negative adults died. CONCLUSIONS: HIV infection seems to be frequent risk factor for bacteremia by Haemophilus influenzae. It should always be considered on diagnosis in adults under the age of 30. Likewise, the high probability of resistance to ampicillin should also be taken into account for the empiric treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[The incidence and significance of late potentials in patients with aborted sudden death].

BACKGROUND: Reentrant ventricular tachycardia and fibrillation probably have different electrophysiological bases. Regional conduction delay during sinus rhythm seems to be greatest in patients with spontaneous sustained ventricular tachycardia than in patients with spontaneous sustained ventricular fibrillation. We investigated the prevalence and significance of late potentials in patients with documented VT or VF in the setting of coronary diseases and other organic heart diseases. PATIENTS AND METHODS: Nineteen patients with a history of spontaneous sustained ventricular tachycardia (11 patients) or fibrillation (8 patients) were studied with signal-averaged ECG. All patients had been resuscitated of sudden cardiac death. All recordings were made in sinus rhythm in an antiarrhythmic free state following the recommendations of the Committee of the European Society of Cardiology for data acquisition and analysis of ventricular late potentials using Signal Averaged Electrocardiography. The relationship between this late potentials and tachyarrhythmia inducibility during electrophysiologic study were established. RESULTS: Abnormal late potentials were found in 79% of patients with sudden cardiac death. Patients with spontaneous ventricular tachycardia had a longer ventricular activation time in sinus rhythm than did patients with spontaneous ventricular fibrillation, but this difference did not reach statistic significance. The only analysis of late potentials could not discern the mechanism of sudden cardiac death. However when sudden cardiac death was caused by a spontaneous ventricular tachycardia, a good correlation between abnormal late potentials and induced ventricular tachycardia by programmed stimulation was found. Quantitative indices of late potentials did not correlate with ventricular tachycardia cycle length. CONCLUSIONS: 1) We have found and elevated incidence of abnormal late potentials in patients with sudden cardiac death, and 2) only when the mechanism of sudden cardiac death was a spontaneous VT, we were able to correlate abnormal late potential with provoked ventricular tachycardia during electrophysiologic study.

Aged↗
PubMed1993

[Mitral endocarditis caused by Staphylococcus aureus resistant to methicillin, aminoglucosides and rifampicin: description of 2 cases with fatal course].

Two patients with infectious endocarditis (IE) by Staphylococcus aureus resistant to methicillin, aminoglucosides and rifampicin (SARMAR) acquired in hospital during the course of an epidemic outbreak of this microorganism in the Hospital Clínic i Provincial of Barcelona. Both patients had undergone surgery of the lower limbs. The entrance of the microorganism was the infection of the surgical wound, with bacteriemia, followed by mitral IE after a short time interval (20 days). Despite adequate treatment with vancomycin both patients died. The culture of mitral vegetation was positive for SARMAR in one. Analysis of the chromosomic DNA of all the isolations from the patients was identical and coincided with that of the SARMAR strains isolated in the epidemic outbreak of the hospital. The current situation of IE by SARMAR is reviewed and the therapeutic implications commented upon suggesting that treatment of this entity should simultaneously include the administration of vancomycin and phosphomycin or cotrimoxazole, with surgery being considered if infection persists.

Aged↗
PubMed1993

[Bacillary (epithelioid) angiomatosis with a nodular presentation and self-limited evolution].

Bacillary angiomatosis (epithelioid) is a recently described clinicopathologic syndrome, principally associated to infection by the human immunodeficiency virus. The case of a patient who was seen for fever and the appearance of four painful, erythematous and indurated subcutaneous nodules on the anteroexternal face of the right lower extremity 15 days previously is presented. No microorganisms were observed by microbiologic and histologic techniques however the latter showed a vascular proliferation with prominent endothelium of epithelioid morphology and notable interstitial inflammatory reaction according to the pattern described as characteristic of epithelioid angiomatosis. The fever and the nodules disappeared spontaneously. The clinical and histopathologic characteristics of this disease as well as the recent contributions with respect to the identification of the possible causative bacillus are discussed.

AIDS-Related Opportunistic Infections↗
PubMed1993

Computer assisted CT-guided stereotactic transplantation of foetal ventral mesencephalon to the caudate nucleus and putamen in Parkinson's disease.

We report our preliminary results related to CT-guided stereotactic transplantation of foetal ventral mesencephalic cell suspension into the striatum of five patients with idiopathic Parkinson's disease. The mean age was 51 years, the evolution time of the disease ranged from 7 to 14 years, and all of them had motor complications associated with chronic L-dopa therapy. The patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) for one year before and three months after surgery. The postoperative clinical assessment demonstrated significant improvement of neurological symptoms and reduction of daily L-dopa dosage.

Caudate Nucleus↗
PubMed1993

Interaction between intrinsic positive end-expiratory pressure and externally applied positive end-expiratory pressure during controlled mechanical ventilation.

OBJECTIVE: To assess the interaction between intrinsic and externally applied positive end-expiratory pressure (intrinsic PEEP and administered PEEP) in mechanically ventilated patients. DESIGN: Prospective study. SETTING: Intensive care unit of a university hospital. PATIENTS: Twelve consecutive critically ill patients. INTERVENTIONS: Application of an external PEEP of the same value as the intrinsic PEEP. MEASUREMENTS AND MAIN RESULTS: We found that when the administered PEEP was increased from 0 to the baseline value of intrinsic PEEP, mean intrinsic PEEP decreased from 6.5 +/- 4.2 (SD) to 1.3 +/- 0.7 cm H2O (p = .001). The mean end-inspiratory pressure was increased from 20.3 +/- 4.6 to 23.1 +/- 6.1 cm H2O (p < .05). The difference between the modification of intrinsic PEEP and the change in the end-inspiratory pressure was not significantly > 0 cm H2O. Thus, the increase in end-inspiratory pressure may be directly attributable to the increase in total PEEP (administered PEEP plus intrinsic PEEP). None of the other measurements of pulmonary mechanics changed (peak pressure, inspiratory resistance, compliance, and trapped-gas volume). CONCLUSIONS: The administration of positive end-expiratory pressure equal to the intrinsic positive end-expiratory pressure causes the almost total disappearance of the intrinsic positive end-expiratory pressure. When the administered positive end-expiratory pressure does not exceed the intrinsic positive end-expiratory pressure, the former is applied almost in its entirety to the patient's external circuit. The administration of positive end-expiratory pressure without prior quantification of the intrinsic positive end-expiratory pressure results in an overestimation of the beneficial effects of the administered positive end-expiratory pressure on the quasi-static compliance.

Adult↗
PubMed1993

Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow.

OBJECTIVE: To ascertain whether pressure-controlled ventilation offers any advantage with respect to conventional controlled mechanical ventilation with decelerating flow. DESIGN: Prospective, comparative study. SETTING: Intensive care unit. PATIENTS: Eleven consecutive critically ill adult patients. MEASUREMENTS AND MAIN RESULTS: Study of respiratory mechanics and arterial blood gases after 30 mins of pressure-controlled ventilation. Repetition of the same measurements after 30 mins of controlled mechanical ventilation with decelerating flow waveform, with equal tidal volumes, using a commercially available mechanical ventilator. Student's t-test for paired comparisons. A lesser maximum inspiratory flow rate was required for pressure-controlled ventilation (55.7 +/- 16 L/sec) than for controlled mechanical ventilation (72 +/- 2 L/sec) (p < .001). Nevertheless, the peak pressures measured in the orotracheal tubes of the patients were higher in pressure-controlled ventilation (20.4 +/- 3.5 cm H2O) than in controlled mechanical ventilation (18.4 +/- 4.8 cm H2O) (p < .05). This model measured pressure in the inspiratory line, providing erroneous information regarding the behavior of pressures in the airway. The peak pressure measured by the ventilator was significantly higher in controlled mechanical ventilation than in pressure-controlled ventilation and was, in addition, reached at initiation of inspiration in ten of 11 patients with controlled mechanical ventilation, while peak pressure measured in the orotracheal tube was invariably reached at the end of the inspiration, both in pressure-controlled ventilation and controlled mechanical ventilation. The rest of the parameters analyzed, including end-inspiratory pressure, mean pressure, intrinsic positive end-expiratory pressure, and arterial blood gases, showed no differences. The difference between quasi-static compliances almost reached statistical significance (72 +/- 25.4 mL/cm H2O in pressure-controlled ventilation vs. 68.8 +/- 24.3 mL/cm H2O in controlled mechanical ventilation; p = .052). CONCLUSIONS: Our study failed to demonstrate any important difference between pressure-controlled ventilation and controlled mechanical ventilation with decelerating inspiratory flow waveform. The differences in the airway pressures detected by the ventilator are spurious and are due to the place (inspiratory line) where these pressures were measured. The difference between the peak pressure measured in the orotracheal tube has statistical, but not clinical, value and is lower in controlled mechanical ventilation. Based on the limited number of variables we studied and unless the tendency indicated in the quasi-static compliance is demonstrated in the future, we do not believe that pressure-controlled ventilation contributes any uniqueness to the theory or practice of mechanical ventilation.

Adolescent↗
PubMed1993

[A single bone metastasis as the initial manifestation of an undifferentiated bladder carcinoma].

The spread of Vesical Neoplasia occurs frequently through local or regional extension. Its systemic dissemination happens frequently in advanced phases but it is exceptional as initial manifestation. The case of an undifferentiated vesical carcinoma is described, its presentation was as a big size osteolytic lesion on the sacrum. Local manifestations of the tumor appeared later. The study performed both in bones as well as in the vesical mucosa showed an undifferentiated adenocarcinoma. The great resemblance and histological and immunohistochemical concordances of both biopsies confirmed that it was a primary vesical neoplasia with a metastasis in sacrum. The specific clinical evolution of this tumor is discussed which is probably related with the fact that it is an undifferentiated carcinoma.

Aged↗
PubMed1993

[Elevated negative predictive value of angiotensin converting enzyme in the diagnosis of active sarcoidosis].

OBJECTIVE: To evaluate the usefulness of angiotensin converting enzyme (ACE) in the differential diagnosis of active sarcoidosis in action with other interstitial and granulomatous processes. METHODS: The study involved 30 patients with a histological diagnosis of sarcoidosis, 38 subjects with anatomopathologically and/or microbiologically confirmed pleuropulmonary tuberculosis, and 12 subjects with idiopathic pulmonary fibrosis confirmed by histological studies. Following the technique developed by Rohatgi and Ryan, a radioenzymatic system was used to determine the activity of serum ACE. In patients with sarcoidosis, levels of ACE were measured in active cases as well as those in remission. Our laboratory reference values for those over 20 years of age are 39.84 +/- 9.19 mumol/min/l. RESULTS: Levels of ACE were significantly higher (p < 0.001) in active sarcoidosis (67.71 +/- 17.73 mumol/min/l) than during inactivity (41.18 +/- 16.00 mumol/min/l), tuberculosis (46.99 +/- 13.65 mumol/min/l), or fibrosis (35.87 +/- 11.36 mumol/mol/l). A cut-off point of 59 mumol/min/l shows a significant association with the diagnosis of active sarcoidosis (p < 0.001) and reaches a negative predictive value of 90.90%. CONCLUSION: The usefulness of serum ACE in the differential diagnosis of sarcoidosis should be reconsidered.

Adult↗
PubMed1993

[Left ventricular outflow obstruction due to accessory mitral tissue].

An asymptomatic 31-year-old woman was studied because she presented a systolic ejection cardiac murmur. The echocardiogram showed a mobile, sac-like mass attached to the ventricular surface of the anterior mitral leaflet and its chordae tendineae and papillary muscle. This structure moved to the left ventricular outflow tract during every systole occupying the subaortic area. Conventional and color-coded Doppler examination revealed left ventricular outflow obstruction caused by the accessory mitral valve tissue that produced a high-velocity turbulent flow pattern in the subaortic area where the sac-like structure approximated to the outflow tract walls.

Adult↗
PubMed1992

Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors.

This paper examines sex differences in psychiatric morbidity, using data from a community sample. The PSE-CATEGO-ID system was used to evaluate psychopathology. Six sociodemographic factors and physical illness were taken as independent variables. Females exhibit both a significantly higher psychiatric morbidity than males and a predominance of syndromes closely related to depression (SD; OD syndromes) and anxiety (GA; SA; TE; IT syndromes). Logistic modelling analysis, carried out separately for each sex, yielded different models. Psychiatric illness in men was best predicted by physical illness, unemployment and the interaction between the two. In contrast, physical illness emerged, in women, as the only factor exerting significant effects on psychiatric morbidity.

Adolescent↗
PubMed1992

Sodium fluoride prevents bone loss in primary biliary cirrhosis.

Low-bone-turnover osteoporosis is a common complication of primary biliary cirrhosis (PBC). Since sodium fluoride stimulates bone formation we assessed the effect of this drug on bone mass in a 2-year, prospective, double-blind trial including 22 women with PBC who were randomly assigned to receive sodium fluoride (50 mg/day) or placebo. All received calcium supplements and low doses of vitamin D. Bone mineral density of the lumbar spine was measured by dual-photon absorptiometry initially and every 6 months. Vertebral fractures were evaluated in thoracic and lumbar spine initially, and after 1 and 2 years. Seven patients in the fluoride group and eight in the placebo group completed the trial. In the fluoride group, bone mineral density did not change after 2 years (initial 1.05 +/- 0.07, final 1.07 +/- 0.06 g/cm2; p = n.s.). In the placebo group, however, bone mineral density decreased significantly (initial 1.00 +/- 0.07, final 0.93 +/- 0.06 g/cm2; p = 0.03). Moreover, in the fluoride group bone mineral density increased by 2.9 +/- 3.6%, and in the placebo group decreased by 6.6 +/- 2.6% (p = 0.04). None of the patients developed new vertebral or non-vertebral fractures. Treatment with sodium fluoride did not impair liver function or cholestasis in PBC. These results indicate that sodium fluoride prevents bone loss in PBC and therefore might be considered as a possible therapeutic agent for osteoporosis associated with this liver disease. Since a small number of patients completed the trial, further studies are required.

Absorptiometry, Photon↗
PubMed1992

HIV-1 sequence variation between isolates from mother-infant transmission pairs.

To examine the sequence diversity of human immunodeficiency virus type 1 (HIV-1) between known transmission sets, sequences from the V3 and V4-V5 region of the envelope gene from four mother-infant pairs were analyzed. The mean interpatient sequence variation between isolates from linked mother-infant pairs was comparable to the sequence diversity found between isolates from other close contacts. The mean intrapatient variation was significantly less in the infants' isolates then the isolates from both their mothers and other characterized intrapatient sequence sets. In addition, a distinct and characteristic difference in the glycosylation pattern preceding the V3 loop was found between each linked transmission pair. These findings indicate that selection of specific genotypic variants, which may play a role in some direct transmission sets, and the duration of infection are important factors in the degree of diversity seen between the sequence sets.

Adult↗
PubMed1992

Right ventricular systolic time intervals determined by means of a pulmonary artery catheter.

OBJECTIVES: To evaluate the right ventricular systolic time interval as an index of right ventricular function and also to ascertain whether the right ventricular ejection fraction may be determined by means of a conventional pulmonary artery catheter. DESIGN: Prospective study. SETTING: Intensive care unit. PATIENTS: Eight, consecutive critically ill adult patients. METHODS: Simultaneous blind measurements, performed by two investigators, of the right ventricular systolic time interval and right ventricular ejection fraction, determined by means of a pulmonary artery catheter. Two studies, separated by an interval of 24 hrs, per patient. Linear regression analysis. Multiple regression test. RESULTS: Of the 16 studies performed, two determinations of right ventricular systolic time intervals were technically inadequate. In the remaining 14 valid studies, we found one close linear correlation between the right ventricular ejection fraction and the preejection period/ejection time quotient measured using the simultaneous display of the electrocardiogram (EKG) and pulmonary arterial pressure curve (r2 = .90, p < .001, right ventricular ejection fraction = 68.96-60.59 x [right ventricular preejection period/right ventricular ejection time]). The method proved to be simple, very accurate, with little interobserver variation (8.09 +/- 10.6% interobserver variation for right ventricular preejection period/right ventricular ejection time) and provided adequate information regarding situations in which the performance of the right ventricle is modified in a given patient. The right ventricular preejection period/right ventricular ejection time quotient was the only variable that displayed a significant relationship with the right ventricular ejection fraction in the multivariate analysis (p < .001). CONCLUSIONS: Right ventricular systolic time intervals, measured using the simultaneous display of the pulmonary artery catheter curve and EKG, provide adequate information regarding right ventricle performance in critically ill patients. The close linear correlation between the right ventricular preejection period/right ventricular ejection time quotient and the right ventricular ejection fraction enables the investigator to estimate, with a high degree of accuracy, the right ventricular ejection fraction and the values derived from the preload of the right ventricle, without the need for a modified pulmonary artery catheter.

Aged↗