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J Sauleda

Publications and source records attributed to J Sauleda.

36 records · Page 2Linked to original sources
PubMed1998

Expression of adhesion molecules and G proteins in circulating neutrophils in chronic obstructive pulmonary disease.

We investigated the expression of adhesion molecules in circulating neutrophils (lymphocyte function-associated antigen-1 [LFA-1], Mac-1, and L-selectin) and endothelial cells (soluble intercellular adhesion molecule-1[sICAM-1]) in 23 patients with stable chronic obstructive pulmonary disease (COPD), 18 subjects with exacerbated COPD, and 23 healthy volunteers. Also, in these circulating neutrophils, we assessed the expression of two G protein subunits (Galphas and Galphai1/2). Compared with control subjects, patients with stable COPD showed increased expression of Mac-1 (p < 0.001) and lower levels of sICAM-1 (p = 0.002); LFA-1 and L-selectin expression was similar in patients and control subjects. During exacerbations, compared with stable patients, the expression of Mac-1 and LFA-1 was reduced (p < 0.001). Finally, the expression of Galphas (but not Galphai1/2) was also reduced (p < 0.001) in circulating neutrophils of patients with COPD, irrespective of the clinical condition of the patient. These results indicate that in patients with COPD: (1) the expression of some neutrophil adhesion molecules (Mac-1) is abnormal, and that this pattern changes during exacerbations; (2) there may be a form of endothelial dysfunction, as suggested by the low sICAM-1 levels; (3) the expression of G protein subunit (Galphas) in circulating neutrophils is downregulated, irrespective of their clinical conditions. Overall, these results indicate the presence of significant systemic abnormalities in COPD.

Analysis of Variance↗
PubMed1998

Structure and function relationships of the respiratory muscles.

Potential relationships between the structure of the diaphragm and external intercostals and several indices of respiratory muscle function, lung function and nutrition in 27 patients (61+/-10 yrs of age) subjected to thoracotomy as a result of a lung neoplasm have been investigated. Prior to surgery the nutritional status of the patients was assessed and lung function (spirometry, lung volumes, transfer factor of the lungs for carbon monoxide, arterial blood gases) and respiratory muscle function (maximal inspiratory pressure (MIP) and diaphragmatic function were measured). Biopsies of the diaphragm (and external intercostals) were obtained during surgery. On average, patients showed mild airflow limitation (forced expiratory volume in one second (FEV1), 70+/-14% of predicted value, FEV1/forced vital capacity (FVC), 70+/-9%) with some air trapping (residual volume (RV), 139+/-50% pred) and normal gas exchange (arterial oxygen tension (Pa,O2), 11.3+/-1.33 kPa (85+/-10 mmHg)) and arterial carbon dioxide tension (Pa,CO2) 5.4+/-0.5 kPa (40.6+/-4 mmHg). MIP was 77+/-25% pred; maximal transdiaphragmatic pressure was 90+/-27 cmH2O. Most morphometric measurements of the diaphragm and external intercostals were within the range of values reported previously in other skeletal muscles. The size of the fibres of these two respiratory muscles was positively related (p<0.05) to MIP (% pred). There were no significant relationships between the structure of both muscles and nutritional status or any index of lung function. In conclusion, in the population studied, the fibre size of the diaphragm and external intercostals appears to relate to their ability to generate force.

Diaphragm↗
PubMed1997

A new bronchoscopic technique for the diagnosis of bacterial pneumonia in HIV-positive patients.

The aim of the present study was to evaluate in HIV-positive patients with bacterial pneumonia, the diagnostic value of a new endoscopic technique that uses a single catheter to perform a telescopic plugged catheter (TPC) followed by a modified protected bronchoalveolar lavage (mpBAL). Fifty-eight HIV-positive patients with respiratory infection were included in the study. Samples from TPC and mpBAL were cultured quantitatively. Standard bronchoalveolar lavage was performed to rule out opportunistic infections. According to the clinical and microbiological results, patients were classified in the study group (27 with bacterial pneumonia) or the control group (31 without bacterial pneumonia). Sensitivity of TPC was 56% [95% confidence intervals (CI) 37-75%] and its specificity was 100%; these figures were 56% (CI, 37-75%) and 94% (CI, 86-100%) for mpBAL. When both techniques were assessed together, sensitivity increased to 70% (CI, 53-87%). The use of a single catheter reduced the cost of the originally described pBAL procedure by approximately 50%. The use of a single catheter to perform a TPC followed by a mpBAL can improve the diagnostic yield in HIV-positive patients with bacterial pneumonia, and reduces its cost.

Adult↗
PubMed1996

Continuous positive airway pressure is effective in treating upper airway oedema.

The case of a patient with diffuse idiopathic skeletal hyperostosis (DISH) and upper airway oedema, is described. The patient presented with alveolar hypoventilation and obstructive apnoeas during sleep. Intravenous steroids (methylprednisolone, 160 mg.day-1) for 5 days did not reduce the oedema. However, it was rapidly reversed by the use of nasal continuous positive airway pressure (nCPAP). In addition, daytime pulmonary gas exchange was improved and sleep apnoea abolished. This beneficial effect made tracheostomy unnecessary. This case report suggests that CPAP can be a potentially useful therapeutic alternative to tracheostomy in the clinical management of upper airway oedema.

Aged↗
PubMed1995

Structure of the latissimus dorsi muscle and respiratory function.

The aim of this study was to evaluate whether respiratory function influences the structure of the latissimus dorsi muscle (LD). Twelve patients (58 +/- 10 yr) undergoing thoracotomy were studied. Lung and respiratory muscle function were evaluated before surgery. Patients showed a forced expired volume in 1 s (FEV1) of 67 +/- 16% of the reference value, an FEV1-forced vital capacity ratio of 69 +/- 9%, a maximal inspiratory pressure of 101 +/- 21% of the reference value, and a tension-time index of the diaphragm (TTdi) of 0.04 +/- 0.02. When patients were exposed to 8% CO2 breathing, TTdi increased to 0.06 +/- 0.03 (P < 0.05). The structural analysis of LD showed that 51 +/- 5% of the fibers were type I. The diameter was 56 +/- 9 microns for type I fibers and 61 +/- 9 microns for type II fibers, whereas the hypertrophy factor was 87 +/- 94 and 172 +/- 208 for type I and II fibers, respectively. Interestingly, the histogram distribution of the LD fibers was unimodal in two of the three individuals with normal lung function and bimodal (additional mode of hypertrophic fibers) in seven of the nine patients with chronic obstructive pulmonary disease. An inverse relationship was found between the %FEV1-forced vital capacity ratio and both the diameter of the fibers (type I: r = -0.773, P < 0.005; type II: r = -0.590, P < 0.05) and the hypertrophy factors (type I: r = -0.647, P < 0.05; type II: r = -0.575, P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

[Usefulness of respiratory endoscopy in patients with severe rhonchi and/or sleep apnea syndrome].

BACKGROUND: Obstruction of the upper respiratory tract is the most common cause of the sleep apnea syndrome (SAS). Different methods have been used to localize this obstruction and give the appropriate treatment. The aim of this study was to evaluate the usefulness of respiratory endoscopy performed during arousal to identify the site and cause of the obstruction in patients with severe rhoncopathy and/or SAS. METHODS: Sixty-eight patients with acute rhoncopathy were included in the study with 36 also fulfilling polysomnographic criteria of SAS (36%). The endoscopy was performed via the upper respiratory tract with inspiratory collapse at each level being evaluated in both easy respiration and during the Müller manoeuver. RESULTS: The site and cause of the obstruction was identified in 61 patients (90%, CI 95%, 79.9 +/- 95.8). In most cases the Müller manoeuver best demonstrated the collapse. The predominant obstruction was in the nasopharyngeal region (72%, mainly associated to changes in soft palate), followed by obstruction in the oropharyngeal region at the base of the tongue (29%). Multiple localization of the obstruction was observed in 19 patients. CONCLUSIONS: Endoscopy performed during arousal may allow the identification of the site and cause of obstruction in most of the patients with rhoncopathy and sleep apnea syndrome, thus aiding in the selecting the most adequate treatment for the patient.

Endoscopy↗
PubMed1994

Simplified exercise test for the initial differential diagnosis of Pneumocystis carinii pneumonia in HIV antibody positive patients.

BACKGROUND: This study was designed to evaluate the usefulness of a simplified exercise test in the differential diagnosis of Pneumocystis carinii pneumonia (PCP). METHODS: Forty five subjects with antibodies against the human immunodeficiency virus (HIV) and pneumonia were included and divided into two groups: those with PCP and those with "other pneumonias" (non-PCP). The test involved pedalling for two minutes on a stretcher bed and was considered positive if SaO2 decreased by at least 3%. RESULTS: During the exercise the mean(SE) SaO2 fell in patients with PCP from 88(4)% to 84(3)%, p < 0.01, whilst it improved slightly in subjects with non-PCP from 91(1)% to 93(3)%, p < 0.05. Sensitivity was 77% and specificity 91%. CONCLUSIONS: This simple test seems potentially useful for the initial investigation of HIV antibody positive patients with pneumonia.

Adult↗
PubMed1994

Probable pentamidine-induced acute pancreatitis.

OBJECTIVE: To report a case of probable pentamidine-induced acute pancreatitis. CASE SUMMARY: A patient was hospitalized because of fever, dyspnea, and productive cough. Chest X-ray revealed diffuse alveolar infiltrates, and the examination of bronchoalveolar lavage demonstrated the presence of Pneumocystis carinii. Intravenous cotrimoxazole was administered but the patient's condition did not improve. As secondary leukopenia appeared, the treatment was changed to pentamidine isethionate 4 mg/kg/d i.v. On day 5 of this new therapy, the patient experienced abdominal pain, and both blood and urine amylase concentrations raised to 330 U/L and 3960 U/L, respectively. The patient died 48 hours later, and signs of acute pancreatitis were observed in necropsy. DISCUSSION: With reference to a classical method for estimating the probability of adverse drug reactions, a probable relationship between pentamidine therapy and acute pancreatitis was found in this patient. Furthermore, no alternative causes of pancreatitis were present. CONCLUSIONS: It is likely that pentamidine administration in our patient resulted in an acute episode of pancreatitis. Serum and urine amylase concentrations should be monitored in patients receiving this drug.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Neutrophilia in the bronchoalveolar lavage of patients with AIDS and Pneumocystis carinii pneumonia. Reflections on its prognostic value in the Spanish setting].

The prognostic value of neutrophilia (> 5%) in bronchoalveolar lavage (BAL) in our context is studied in 21 patients with AIDS and Pneumocystis carinii pneumonia. Neutrophilia does not seem to be a good prognostic indicator in our context. We have found this condition, with a mean of 6 +/- 4%, in only 33% of our sample. The sensitivity of this parameter with respect to risk of death was very low (25%), while specificity was moderate (65%). In contrast with what has been reported in studies done with Anglo-Saxon populations, neutrophilia in BAL is probably of little prognostic use in our context. This may be due to various factors, among them the type of population (most being intravenous drug users) and the therapeutic protocol (early empirical treatment).

AIDS-Related Opportunistic Infections↗
PubMed1993

Pneumatoceles and pneumothorax after Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) is common in patients with AIDS. The usual chest X-ray pattern is a diffuse interstitial pulmonary infiltrate. Nevertheless, unusual roentgenographic forms can appear. A patient with PCP that resulted in pneumatoceles and a further pneumothorax is described.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Antigenic response against PPD and antigen 60 in tubercular patients: single antigen versus the combined test].

We analyze serum samples from 70 patients with pulmonary tuberculosis and 50 healthy individuals. The antigenic activity (IgG) against protein purified antigen (PPD) and antigen 60 (A60) from M. tuberculosis. Thirteen patients were also HIV infected, and three patients had AIDS defined by the presence of disseminated tuberculosis. The test using antigen alone showed a 77% sensitivity and 74% specificity when PPD is used. When A60 was used, both values improved (81% sensitivity, 94% specificity). The use of a combined test (PPD and A60) improves the sensitivity (89%) but reduces the specificity (82%). The HIV infected patients showed similar responses to those of other patients. The combined use of different antigens might be useful for diagnosing tuberculosis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Usefulness of CT scan in the diagnosis of pulmonary aspergilloma].

Early diagnosis and precise anatomical localization of aspergillomas are essential for an effective treatment of their complications. We have evaluated the usefulness of thorax CT scan in the fulfillment of these objectives. Nine consecutive patients were studied with a presumable diagnosis of pulmonary aspergilloma. A thorax CT scan was performed in all patients (sections every 5 to 10 mm) in lying position and with lateral mobilizations. This technique allowed to rule out as fibrotic lesions some of the images previously attributed to mycetomas by conventional X-ray. On the other hand it helped to identify small size aspergillomas, to precise their localization and to demonstrate the possible communication between the main cavity and bronchial tree. In three patients who died in the period immediately following the study an excellent correlation between CT scan and underlying pathological lesions was observed.

Adult↗
PubMed1990

[Dysphagia as the form of presentation of Forestier-Rotés disease].

We present the case of a 73-year-old patient suffering dysphagia secondary to cervical osteophytosis as the clinical presentation of Forestier-Rotés disease. Although this is a frequent disease, there are few cases of dysphagia secondary to this condition it being the initial symptom exceptional. The diagnostic methodology is commented emphasizing cervical CT scan as well as the therapeutic attitude, suggesting starting with a conservative treatment since surgery is not always successful.

Aged↗