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Biomedical subjects

J Quero

Publications and source records attributed to J Quero.

At least 37 records · Page 2Linked to original sources
PubMed1996

Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study.

HYPOTHESIS: The study was undertaken to characterize acute myocardial infarction (AMI) in young patients. METHODS: In all 108 consecutive Mediterranean patients with AMI (102 men and 6 women), aged < or = 40 years, were prospectively included in this study over a period of 6.5 years. Coronary angiography was carried out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and in-hospital and late morbidity and mortality were evaluated. RESULTS: Young patients with AMI represent 4.1% of the 2,644 patients admitted because of definite AMI during this period. The most common risk factors were cigarette smoking (94.5%) and hypercholesterolemia (48%). Location of the AMI was anterior in 37%, inferior in 57.5%, and non-Q in 5.5%. A history of previous angina was present in 42.5% of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started in the week prior to the AMI. In-hospital mortality and mortality during a mean follow-up of 41 +/- 23 months were 3.7 and 3.8%, respectively. The Kaplan-Meier actuarial curve assessed on 97 of 104 survivors was 100 and 94% at 1 and 5 years, respectively. Coronary arteries were angiographically normal in 17 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p < 0.05), and late angina (p < 0.01), but development of congestive heart failure and survival were similar in both groups. CONCLUSION: These data suggest that young patients with AMI are very frequently heavy smokers, have a high incidence of angiographically normal coronary arteries, and that the short- and long-term prognosis is excellent.

Adult↗
PubMed1996

Central nervous system vasculopathy in neonatal lupus erythematosus.

Central nervous system involvement in neonatal lupus erythematosus (NLE) has not been previously reported. We report four patients with NLE, all with complete congenital heart block and three with cerebral ultrasound and color Doppler flow imaging (CDFI) studies demonstrating evidence of associated vasculopathy in the gangliothalamic vasculature. CDFI confirmed blood flow through the affected vessels, indicating that blood flow was not compromised at this early stage. Short-term follow-up revealed no signs of progression of the vasculopathy, focal ischemia, gangliothalamic atrophy, or neurological impairment. Nevertheless, the implications of this finding with respect to the natural history of NLE remain to be defined, particularly in cases in which the disease develops into systemic lupus erythematosus later in life. Besides specific diagnostic studies for NLE, cerebral ultrasound, and CDFI studies are mandatory in all cases of complete congenital heart block, regardless of whether mothers are diagnosed as having connective-tissue disease or not. Neonates with signs of vasculopathy in the gangliothalamic region should be examined for NLE.

Autoantibodies↗
PubMed1996

Effects of the cyclooxygenase inhibitor ibuprofen on retinal and choroidal blood flow during hyperoxia in newborn piglets.

PURPOSE: The effect of the cyclooxygenase inhibitor ibuprofen (IB) on choroidal (ChBF) and retinal (RBF) blood flow during hyperoxia was examined in 21 spontaneously breathing newborn piglets. METHODS: ChBF and RBF were measured using radiolabelled microspheres before and 30 min after either saline or IB (30 mg/kg, i.v.) infusion in room air and subsequently, after 90 min of hyperoxia (O2). RESULTS: The basal RBF and ChBF did not change after IB infusion. However, during hyperoxia a significant decrease in RBF was observed in the IB group (54 +/- 5 to 37 +/- 3 ml/min/100 g, p < 0.02) and in the control group (54 +/- 3 to 37 +/- 5 ml/min/100 g, p < 0.02). Also, ChBF decreased in the IB group (2,635 +/- 446 to 1,670 +/- 199 ml/min/100 g, p < 0.02) and in the control group, (2,997 +/- 346 to 2,014 +/- 246 ml/min/100 g,p < 0.02) during hyperoxia. CONCLUSIONS: Despite cyclooxygenase inhibition with IB, RBF and ChBF decreased to the same extent as in the control group following exposure to O2. These data suggest that hyperoxia decrease RBF and ChBF through mechanisms and/or mediators other than the cyclooxygenase by-products of arachidonic acid metabolism.

Animals↗
PubMed1996

Effects of dexamethasone on retinal and choroidal blood flow during normoxia and hyperoxia in newborn piglets.

Our purpose was to study the effect of dexamethasone (DEX) on choroidal (ChBF) and retinal blood flow (RBF) during normoxia and hyperoxia. Eighteen spontaneously breathing newborn piglets were examined. ChBF and RBF were measured using radiolabeled microspheres while the piglets were in normoxia before (RA1) and 45 min after either saline or DEX (2 mg/kg) infusion (RA2), and after 90 min of hyperoxia (O2) (Pao2 40-60 kPa). Vitreous prostanoids (prostaglandins F1 alpha and E2 and thromboxane B2) and leukotrienes (leukotriene B4) measurements were obtained during normoxia after either placebo or DEX infusion in an additional 22 piglets. Vitreous prostanoids were also studied after 90 min of hyperoxia. We found that RBF increased significantly after DEX infusion (p < 0.02). There was no change in RBF from RA1 to RA2, before and after saline infusion. RBF decreased significantly during hyperoxia in both groups (p < 0.03). ChBF did not change significantly between RA1 and RA2 in any of the groups. ChBF decreased significantly during hyperoxia in both groups (p < 0.03). Vitreous prostanoids and leukotrienes were reduced significantly after DEX infusion (p < 0.05). Prostanoids were similar in the two groups during hyperoxia. We concluded that DEX increases RBF significantly, but not ChBF. RBF and ChBF decreased in both groups during hyperoxia. Therefore, the metabolites of arachidonic acid do not seem to be involved as mediators of hyperoxic vasoconstriction.

Animals↗
PubMed1996

[Congenital diaphragmatic hernia: an analysis of the results and prognostic factors prior to the development of an ECMO program].

BACKGROUND: Some neonates with congenital diaphragmatic hernia (CDH) and persistent pulmonary hypertension are not adequately oxygenated with conventional treatment. The extracorporeal membrane oxygenation (ECMO) has been successful in some of them as an alternative in their management. PATIENTS AND METHODS: We studied the charts of 47 neonates with CDH, symptomatic within 24 hours of birth, treated in our institution during the last seven years (1987-1994). In all of them, conventional ventilation and hemodynamic support was used. In 12 patients high frequency ventilation (HFV) was used and two survived. In all patients we analyzed the following ventilatory and gasometric parameters: Oxygenation index (OI)*, ventilatory index (VI)** and postductal PCO2. In 15 neonates who did not survive, a necropsy was performed and a morphometric parameter, pulmonary index (PI)*** was studied. RESULTS: The overall survival was 60%. VI and OI showed significant differences (p < 0.001) between survivors and non-survivors with values of 460.9 +/- 303 vs 1532 +/- 500.6, respectively for VI and 10.3 +/- 5.7 vs 46.2 +/- 37.8, respectively for IO. There were no significant differences in postductal PCO2. Mean PI in the 15 non-survivors was 0.0072 +/- 0.002 (normal > 0.015). Regression coefficients of PI with OI or VI were not significant. Neonates with VI < 1000 and OI < 40 survived. All patients with VI > 1000 and OI > 40 died. Some babies with VI > 1000 and OI < 40 (21.6%) survived. CONCLUSIONS: In our experience, the use of HFV did not improve the prognosis of these patients, but we believe that the use of ECMO in those patients with VI > 1000, and overall, patients with VI > 1000 and OI < 40 would improve the survival rates of this congenital malformation. *QI = FiO2 x MAP/PO2 postductal x 100. (MAP = Median airway pressure). **VI = VR x MAP (VR = Ventilatory rate). ***PI = Pulmonary weight/Body weight.

Blood Gas Analysis↗
PubMed1995

Multiple organ involvement in perinatal asphyxia.

OBJECTIVES: (1) To evaluate the frequency and spectrum of severity of multisystem dysfunction after perinatal asphyxia and (2) to analyze the relationship between the clinical and biochemical markers of perinatal asphyxia and multiorgan involvement. STUDY DESIGN: Seventy-two consecutive term newborn infants with perinatal asphyxia were studied prospectively. Systematic neurologic, renal, pulmonary, cardiac, and gastrointestinal evaluations were performed. Involvement of each organ was classified as moderate or severe. RESULTS: Involvement of one or more organs occurred in 82% of the infants; the central nervous system (CNS) was most frequently involved (72%). Severe CNS injury (7 infants) always occurred with involvement of other organs, although moderate CNS involvement was isolated in 14 infants. Renal involvement occurred in 42%, pulmonary in 26%, cardiac in 29%, and gastrointestinal in 29% of the infants; 15% neonates had renal failure and 19% had respiratory failure. The Apgar scores at 1 and 5 minutes were the only perinatal factors related to the number of organs involved and the severity of involvement; the Apgar score at 5 minutes had the stronger independent association. No relationship or organ dysfunction was found with the umbilical cord arterial blood pH, meconium-stained amniotic fluid, umbilical cord abnormalities, presentation, or type of delivery. CONCLUSIONS: Our findings indicate that the Apgar score at 5 minutes, in infants who have other criteria for asphyxia, is the perinatal marker that may best identify infants at risk of organ dysfunction.

Apgar Score↗
PubMed1995

Thyroid gland volume as measured by ultrasonography in preterm infants.

The volume of the thyroid gland was determined by ultrasonography in 30 preterm infants (27-36 weeks' gestation) born in Madrid. Thyroid gland volume significantly increased (p < 0.01) with postnatal and postmenstrual age and was very well correlated with body weight, height and surface area (p < 0.01). Serum thyroid hormones 3,5,3'-triiodothyronine (T3) and free thyroxine (FT4) were linearly correlated with postnatal and postmenstrual age, thus T3 and FT4 levels were also correlated with thyroid gland volume (p < 0.05). We report measurements of the thyroid gland volume obtained by ultrasonography in this group of preterm infants. Quantitative determination of thyroid gland volume is more accurate for the diagnosis of goitre than clinical criteria. It is also interesting to determine the thyroid gland volume in the neonatal period when the thyroid is particularly hypersensitive to the effects of iodine deficiency and excess.

Female↗
PubMed1995

Neural migration disorders studied by cerebral ultrasound and colour Doppler flow imaging.

Cerebral ultrasound and colour Doppler flow imaging (CDFI) were used to diagnose a wide spectrum of anomalies of cell migration (17 patients): presumed lissencephaly (n = 12); schizencephaly of both fused (n = 2) and open lips (n = 2); hemimegalencephaly (n = 1); and subependymal type grey matter heterotopia (n = 12). The patients with grey matter heterotopia had irregular ventricular margins (n = 10), periventricular hyperechogenic bands (n = 12), and/or periventricular hyperechogenic nodules (n = 7). Some patients had more than one type of migration disorder as well as other central nervous system malformations. Cerebral ultrasound diagnoses were confirmed by magnetic resonance imaging (MRI) or necropsy. It is concluded that colour Doppler flow imaging is a worthwhile addition to the assessment of brain surface anomalies.

Autopsy↗
PubMed1995

Cerebrospinal fluid beta 2-microglobulin in neonates with central nervous system infections.

Beta 2-microglobulin (beta 2m) determination in CSF of 72 neonates who underwent a spinal tap as part of a sepsis or meningo-encephalitis workup was performed to evaluate the usefulness of this test in the diagnosis of CNS infections. Beta 2m was measured by enzyme immunoassay. Sixty neonates had sterile culture and normal neurological status at discharge. Twelve infants had CNS infections: 8 bacterial meningitis, 3 TORCH infections (T = toxoplasmosis, O = others, R = rubella, C = cytomegalovirus and H = herpes simplex) and 1 viral meningitis. Neonates with CNS infection exhibited significantly higher CSF beta 2m levels compared to neonates with sterile culture (6.24 +/- 2.66 vs 1.74 +/- 0.5 mg/l; P < 0.0001). CSF beta 2m levels did not correlate with the white cell count, total protein concentration or glucose level in CSF. When serum and CSF levels were measured simultaneously, the CSF beta 2m level was significantly higher than the corresponding serum level in patients with CNS infection (6.98 +/- 2.5 vs 3.2 +/- 0.25 mg/l; P < 0.01). Sensitivity, specificity, and predictive values were estimated for different cut-off points. The best operational diagnostic cut-off value was 2.25 mg/l. Receiver operating characteristic curve analysis showed an appropriate trade-off between specificity and sensitivity and indicated that CSF beta 2m was accurate in distinguishing between neonates with and without CNS infection. Conclusion. CSF beta 2m may be a useful ancillary tool in neonates when CNS infection is suspected.

Female↗
PubMed1994

New pattern of hyperechogenicity in thalamus and basal ganglia studied by color Doppler flow imaging.

Thirty-seven infants whose cerebral real-time B-mode ultrasound (CUS) documented hyperechogenic areas in the thalamus and basal ganglia (HTBG) either of linear or fine punctate pattern, were studied prospectively by color Doppler imaging (CDI). This study aimed to establish a relationship between these areas and the regional vasculature, to analyze associated disorders to establish pathogenesis, and to determine clinical significance. HTBG were diagnosed in the first 4 days of life in all but 7 infants. Different patterns of HTBG were observed: punctate in 11 infants, linear in 12, and mixed in 14. The basal ganglia were affected in all patients, 9 also had involvement of the thalamus. CDI confirmed that HTBG were allocated along the gangliothalamic vessels. Blood flow velocity waves were obtained at this level in all patients. Real-time spectral analyses were performed in 35 patients and compared with a control group of 20 healthy neonates. Differences were not significant. Computed tomography and magnetic resonance imaging failed to indicate this abnormality. Necropsy revealed basophilic deposits in the walls of involved arteries. Congenital infections manifested in 5 patients, chromosomal abnormality in 1, dysmorphic syndromes in 9 (3 unidentified), isolated congenital defects in 5, and diverse congenital disorders in 3. In the remaining 14, no congenital disorders nor infections were found. This CDI study demonstrates the vascular location of these HTBG. Supported by early CUS diagnosis, it is speculated that vascular injury in that region has a prenatal origin. This abnormality does not appear to alter regional blood flow. HTBG are associated with very heterogeneous disorders and in most patients the etiology and pathogenesis remain unclear.

Arteries↗
PubMed1994

Iodine content of infant formulas and iodine intake of premature babies: high risk of iodine deficiency.

As part of a study of thyroid function in premature babies, the iodine content of their mothers' breast milk, that of 32 formulas from different brands used in Spain, and that of 127 formulas used in other countries was determined. Breast milk contained more iodine--mean (SEM) 10 (1) microgram/dl--than most of the formulas, especially those for premature babies. Iodine intakes were therefore below the recommended daily amount (RDA) for newborns: babies of 27-30 weeks' gestational age took 3.1 (1.1) micrograms/day at 5 days of age and 29.8 (2.7) micrograms by 2 months of age. This problem is not exclusive to Spanish premature babies as the iodine content of many of the formulas on sale in other countries was also inadequate. It is concluded that preterm infants who are formula fed are at high risk of iodine deficiency.

Bottle Feeding↗
PubMed1994

Neuron-specific enolase and myelin basic protein: relationship of cerebrospinal fluid concentrations to the neurologic condition of asphyxiated full-term infants.

OBJECTIVE: We questioned whether neuron-specific enolase (NSE) and myelin basic protein (MBP) concentrations in cerebrospinal fluid (CSF) in the first 72 hours of life are correlated with the neurologic condition of asphyxiated full-term infants in the neonatal period and at 1 year of age. PATIENTS AND METHODS: Sixty-nine asphyxiated infants were studied with serial neurologic examination, cranial ultrasonography, and neurologic follow-up. CSF samples were obtained by lumbar puncture at 12 and 72 hours of life. NSE was measured by enzyme immunoassay, and MBP was measured by radioimmunoassay. RESULTS: Twenty infants had no neonatal encephalopathy and 49 exhibited different stages of encephalopathy. NSE and MBP concentrations in CSF at 12 and 72 hours of life were related to the degree of neonatal encephalopathy. Neither NSE nor MBP levels were correlated with any perinatal factors. Infants with documented brain injury had the highest concentrations of both NSE and MBP. The concentrations of these two biochemical markers at both 12 and 72 hours correlated with adverse outcome (death or cerebral palsy at 1 year). Based on a receiver operating characteristics curve analysis for any given specificity, NSE at 12 hours was a more accurate marker than MBP at either 12 or 72 hours for distinguishing infants with motor impairment at age 1 year from infants with normal outcome at the same age. CONCLUSIONS: Our findings suggest that NSE and MBP are reliable biochemical markers for early estimates of hypoxic-ischemic brain damage in asphyctic full-term newborns, NSE being superior to MBP.

Asphyxia Neonatorum↗
PubMed1993

[Prolonged asystole requiring resuscitation techniques during head-tilt table test].

We describe a case of a patient with recurrent syncope without cardiac disease and with a normal electrophysiological study. The patient underwent a head-up tilt table test as a diagnostic method. During the test the individual suffered a twenty-nine seconds cardiac asystole. He recovered the cardiac rhythm nineteen seconds after having adopted the supine position and with resuscitation maneuvers. In the consulted bibliography, there is no evidence of such a long asystole induced during a head-up tilt table test, where the patient required a chest thumping. Commonly the spontaneous recuperation of the cardiac rhythm takes place immediately after the patient adopts a horizontal position. This case supports the hypothesis that the asystole provoked by a cardioinhibitor reflex in patients suffering from a vasovagal syncope, can become potentially lethal and therefore lead to sudden cardiac death.

Aged↗
PubMed1992

Early neurological manifestations and brain anomalies in Marden-Walker syndrome.

We report on an infant with the Marden-Walker syndrome. In addition to the consistent neurological abnormalities described previously in this syndrome, the infant had a striking neurological constellation, absence of primitive reflexes, jerky eye movements, failure to habituate to repeated stimuli, inadequate behavior development, and absence of orientation responses to visual or auditory stimuli. Muscle biopsy showed a similar pattern to the congenital fiber-type disproportion. Ultrasonograms and magnetic resonance imaging of his brain demonstrated absence of corpus callosum, colpocephaly, hypoplastic brainstem, hypoplasia of the inferior vermis and of the cerebellar hemispheres. These findings further delineate this syndrome and suggest that prenatal central nervous system (CNS) dysfunction, mainly of the cerebellum and brainstem, may play a significant role in the pathogenesis of the Marden-Walker syndrome.

Abnormalities, Multiple↗
PubMed1992

Stroke in neonates with cardiac right-to-left shunt.

Neonatal focal cerebral arterial infarction has been rarely reported in the literature, in contrast to the watershed infarctions, which are common entities among asphyxiated infants. In neonatal postmortem series, thromboembolism was the commonest cause of cerebral arterial occlusion; the source of emboli was associated to different risk factors. Our four cases are the first alive patients reported with congenital heart disease and right-to-left shunt, who suffered a cerebral infarct with its clinical neurological correlates in the neonatal period. We assume that the most probable mechanism was paradoxical embolism, once pulmonary filter is obviated as a result of the altered hemodynamics in these patients. Our data demonstrate the value of ultrasound scanning for assessment of focal cerebral ischemic lesions. Thus, although abnormal neurological signs in this particular group of infants could be attributed to hypoxemia or specific treatments as prostaglandins, we suggest routine cerebral ultrasounds in neonates with congenital heart disease and neurological disabilities, as early complications could be not so infrequent.

Cerebrovascular Disorders↗
PubMed1991

Congenital cutaneous candidiasis: report of four cases and review of the literature.

Congenital cutaneous candidiasis (CCC) is a rare disease acquired by an ascending route, liable to affect the offspring of pregnant women suffering from vulvovaginitis. The cutaneous lesions are present at birth or within the first hours of life. Some infants may present with respiratory distress or clinical signs of sepsis during the first 2 days of life. We report four new cases of CCC, three of which presented transient respiratory distress and clinical signs of sepsis with hepatosplenomegaly. The evolution was favourable in all three cases with topical and oral therapy. We emphasize the self-limited character of this disease, although preterm infants may be at risk of systemic spread. Only one infant presented paronychia as a late complication.

Candidiasis↗