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Biomedical subjects

M Fuster

Publications and source records attributed to M Fuster.

At least 19 recordsLinked to original sources
PubMed2005

Visceral leishmaniasis: diagnosis by ultrasound-guided fine needle aspiration of an axillary node.

A 77-year-old woman presented with fever up to 39 degrees C and acute pain in the left upper quadrant and renal fossa. Full blood count and biochemical screen revealed a haemoglobin (Hb) of 9.8 g dl(-1), an increased erythrocyte sedimentation rate and an elevated lactate dehydrogenase, all other parameters were normal. Thoracic and abdominal CT demonstrated two enlarged lymph nodes in the left axilla, and splenic infarcts. Ultrasound-guided fine needle aspiration of one of the axillary lymph nodes revealed macrophages filled with leishmanias.

Aged↗
PubMed2001

Usefulness of the head-upright tilt test for distinguishing syncope and epilepsy in children.

PURPOSE: Episodic loss of consciousness in children, whether or not associated with hypertonia or short-duration clonic movements, presents a diagnostic challenge to the pediatrician and child neurologist. We provide some evidence of the usefulness of the head-upright tilt test for investigating the causes of transient loss of consciousness in children, and for distinguishing between syncope, convulsive syncope, and epilepsy. METHODS: We studied nine children previously diagnosed as epileptic on the basis of compatible clinical events and epileptiform findings in routine EEGs who were treated over the long term with antiepileptic drugs, but whose clinical records suggested syncope or convulsive syncope rather than epilepsy on reevaluation. All subjects underwent head-upright tilt testing. RESULTS: The tilt-test result was positive in all nine cases, with the patients reporting the same symptoms as in the previously considered epileptic attacks. CONCLUSIONS: Inadequate histories and misuse/overinterpretation of EEG results often lead to misdiagnosis of epilepsy in children. The head-upright tilt test is a useful and reliable diagnostic technique, allowing syncopal events to be induced and evaluated under controlled conditions. In a subset of patients, it may help to distinguish epilepsy from simple or convulsive syncope.

Adolescent↗
PubMed1999

Prospective study of new-onset seizures in patients with human immunodeficiency virus infection: etiologic and clinical aspects.

OBJECTIVE: To determine the frequency and etiologic and clinical aspects of new-onset seizures in patients with human immunodeficiency virus (HIV) infection. DESIGN: A prospective survey of an HIV-infected patient cohort. SETTING: Outpatients and inpatients in a university hospital in Barcelona, Spain. PATIENTS: Five hundred fifty HIV-infected patients recruited over 1 year. MAIN OUTCOME MEASURE: Analysis of new-onset seizures, with detailed medical history and appropriate workup. RESULTS: Seventeen HIV-infected patients (3%) had a new-onset seizure during the study period. Fourteen (82%) of 17 patients had acquired immunodeficiency syndrome diagnosed according to the 1993 CDC Expanded AIDS Definition. Mean latency (+/-SD) between diagnosis of HIV infection and the first seizure was 60.7+/-37.6 months. Seizure cause was drug toxicity in 8 patients (47%) and intracranial lesion in 6 patients (35.3%). Two patients had seizures related to metabolic derangements. No cause was found in 1 case. The first seizure was generalized in 12 patients (70.6%), simple partial motor seizure in 2 (11.8%), and simple partial seizure evolving to generalized seizure in 3 (17.6%). We found partial seizures in 66.6% of patients who had intracranial lesions. Most patients were treated with phenytoin, which was well tolerated and effective in controlling seizures. CONCLUSIONS: New-onset seizures are infrequent in patients with HIV. In most cases a definite or probable cause is identified, which is usually related to toxic and/or metabolic factors. Most seizures are generalized, and partial seizures suggest a focal cerebral lesion.

Adult↗
PubMed1999

Beta 2-microglobulin and immunoglobulins are more useful markers of disease progression in HIV than neopterin and adenosine deaminase.

Reference change values of six biochemical quantities (beta 2-microglobulin, neopterin, adenosine deaminase and immunoglobulins IgA, IgG and IgM) have been established in asymptomatic human immunodeficiency virus (HIV)-infected patients following the method described by Harris and Yasaka in 1983. Patients included in the evaluation were classified as A1, A2 or A3 according to the classification of the Centers for Disease Control (CDC) (January 1993). All patients were followed-up quarterly, with a minimum of four samples each available for statistical analysis. The main objective of this paper was to study whether differences found to be greater than calculated reference change values could predict clinical or immunological worsening in patients' status. Retrospective analysis was made in asymptomatic patients (n = 256) included in an HIV infection protocol carried out in our hospital. Of these patients, 179 showed clinical or immunological worsening during the study period and 77 maintained their clinical and immunological status. Changes in beta 2-microglobulin showed the greatest sensitivity to detect clinical or immunological worsening (43.0%), whereas changes in adenosine deaminase showed the lowest (21.8%). Clinical or immunological worsening in 169 of the 179 patients was detected by one of the six biochemical quantities evaluated. Ten patients showed clinical or immunological worsening, although differences between measurements were lower than the reference change values calculated. Of 77 patients whose clinical state did not deteriorate, there was a change in biochemical analytes greater than the reference value calculated in 29 patients (a period of 12 months had elapsed since detection). In 48 patients, no increases greater than calculated reference change values were detected. The sensitivity obtained using the six analytes was 94.4% and the specificity was 62.3%.

Adenosine Deaminase↗
PubMed1996

[Cerebral toxoplasmosis in patients with human immunodeficiency virus (HIV) infection. Clinico-radiological and therapeutic aspects in 63 patients].

We have retrospectively reviewed 63 cases of encephalic toxoplasmosis (ET) in HIV-infected patients in order to determine clinical and radiological characteristics, the diagnostic value of serologic determinations, and the response to antioxoplasmic therapy. ET was the AIDS-defining condition in 44% of the patients. Eighty of the patients had a CD4 cell count < 100/microliters when ET was diagnosed. Only 4.8% of the patients had been taking anti-Pneumocytis carinii prophylaxis with cotrimoxazol. The most frequent clinical presentation was focal neurologic signs in 80.9% of the patients, with headache and fever in 53.3% and 42.4%, respectively. The most frequent cerebral CT finding was hipodense lesions (92%) with ring enhancement (68.9%). They were most frequently had a hemisferic location. Seroconversion was detected in two patients (6%), whereas 55 patients had serologic evidence of latent infection by Toxoplasma gondii (87.3%). Ninety eight percent of the patients were treated with sulphadiazine plus pyrimethamine. However, such therapy should be discontinued in 22% of them and switched to clindamycin plus pyrimethamine. The overall mortality rate during the acute phase of the disease was 7.9%, but 41.4% of the survivors exhibited neurologic sequelae. Relapsing ET was detected in 33.3% of the patients, and it was usually due to discontinuation of treatment. The mean survival time after the diagnosis of ET was 11.5 months. ET is the most common opportunistic infection of the central nervous system among our AIDS patients. Primary prophylaxis for toxoplasmic infection seems advisable in our epidemiologic environment, when CD4 cell count is less than 200/microliters and there is serologic evidence of latent infection. Acute ET usually has a good response to therapy, and the acute mortality rate is low. However, most of the survivors will remain with neurologic sequelae. The high frequency of adverse effects to sulphamide therapy with clindamycin make the need of alternative treatment strategies urgent.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Thrombocytopenia associated with human immunodeficiency virus infection. Immunologic study of 60 patients addicted to parenteral drugs].

BACKGROUND: The immunologic study of 60 intravenous drug addict patients who were seropositive for the human immunodeficiency virus (HIV) and who developed thrombocytopenia (TP) is reported with the aim of establishing the relation of possible pathogenic factors which may trigger this complication. METHODS: In all the patients the presence of antiplatelet antibodies was studied by direct and indirect immunofluorescence together with crypto-antibodies, immune complexes, lymphocytotoxic antibodies, antiphospholipid antibodies, immunoglobulins, lymphocytic populations and subpopulations and serology against different infectious agents. RESULTS: Antiplatelet antibodies were detected in 71% of the patients of which 50% corresponded to immunoglobulins of IgG class, 12% to IgM, 21% to IgG plus IgM, 7% IgM plus IgA, 5% to IgG plus IgA and 5% IgG plus IgM plus IgA. In these patients a characteristic membrane fluorescence pattern was observed in which the fluorescein is distributed forming a thick, hard point. In 3 patients EDTA dependent crypto-antibodies were detected which in one case determined pseudothrombocytopenia. The immune complexes were demonstrated in 50% of the cases. Other findings were: hypergammaglobulinemia (86%), decrease in the CD4 population (47%), CD4/CD8 ratio < 1 (71%), lymphocytotoxic antibodies (70%), antiphospholipid antibodies (60%), and seropositivity for cytomegalovirus (62%), Epstein-Barr virus (10%) and hepatitis B virus (anti-HBc 75%, HBsAg 33%). CONCLUSIONS: Thrombocytopenia associated to infection by the human immunodeficiency virus in intravenous drug addict patients is due to the concurrence of multiple factors. The relevance of each may vary according to the risk practice of the collective analysed and even within the same group of some individuals or others. The numerous serologic findings in these patients fundamentally express the existence of a chronic polyclonal stimulation of B cells which may be initiated by the action of the drug itself and which becomes aggravated during the course of the multiple acquired infections among which that due to the human immunodeficiency virus is of note.

Adult↗
PubMed1992

Findings on Doppler echocardiography in asymptomatic intravenous heroin users.

To detect potential cardiac abnormalities induced by intravenous heroin use, 68 persons without a previous episode of infective endocarditis were studied by Doppler echocardiography. A control group of 41 normal subjects was studied for comparison. The following measurements were considered: (1) diameter of heart chambers, (2) systolic left ventricular function, (3) morphologic valvular abnormalities, (4) presence of valve regurgitations, (5) Doppler indexes of diastolic function, and (6) estimation of pulmonary arterial resistances. Results showed no significant differences regarding the size of the heart chambers or systolic left ventricular function. A significantly higher incidence of valvular abnormalities (focal thickening or valve prolapse) was found in drug addicts (p = 0.0009) at the mitral and tricuspid valves, as was valvular regurgitation detected by Doppler (p = 0.04). Also, a significantly prolonged deceleration time of mitral and tricuspid early diastolic Doppler flow was found in the study group (p = 0.0001 and 0.027, respectively) although a different hemodynamic condition in the study group (pharmacologically reduced preload) precluded these findings to be attributable to an actual diastolic dysfunction. No differences were observed in pulmonary arterial resistances. It is concluded that mitral and tricuspid valve abnormalities can be detected by echocardiography in asymptomatic intravenous heroin users, whereas no apparent effects are observed in morphologic or functional parameters of cardiac structures other than the valves.

Adolescent↗
PubMed1991

[Alagille's syndrome: a family case and its association with hepatocellular carcinoma].

Two cases of Alagille syndrome are reported, father and son. This, a 6-year-old boy, presented with neonatal cholestasis but thereafter evolved with progressively decreasing jaundice and persisting pruritus. A liver biopsy confirmed the absence of intrahepatic bile ducts with preservation of hepatic architecture and no fibrosis. The patient had a characteristic phenotype: short stature, triangular face, deep eyes with hypertelorism, partial embryotoxon and data of peripheral pulmonary artery stenosis. His father died 43-year-old by a hepatocarcinoma. His liver biopsy showed also absence of intrahepatic bile ducts. In addition to the association Alagille's syndrome hepatocarcinoma (previously reported in six cases, three into the same family), it should be stressed in this case the long survival and the fact he had many children: the case with Alagille's syndrome, five children in good health, and one who died shortly after birth.

Abnormalities, Multiple↗
PubMed1982

[Determination of the mean dose of oral theophylline in asthmatic children (author's transl)].

The oral dosage of theophylline was adjusted in order to maintain a serum level between 10 and 20 micrograms/ml. in a group of 53 children whose ages were less tha nine years. A plan of regular increments with a maximal dosage reduced to 18.5 mg./kg./day was followed, with advantageous results. The necessary medium dosage was 18.4 +/- 2.7 mg./kg./day. This dosage didn't have statistically significant difference with that obtained previously by us (18.4 +/- 4.0) in a group of 46 children of comparable age but, by contrast, it had a statistically significant difference when compared with the dosage (24.1 +/- 5.5) obtained by another medical teams working with american children of similar age. After a fruitless search of known causes that could explain these differences, we think in the possibility of genetical and/or unknown environmental influences.

Administration, Oral↗
PubMed1981

[Individualization of the dosage of oral theophylline with regular increase method and serum level control in 55 asthmatic children (author's transl)].

Authors have adjusted oral theophylline requirements in 55 asthmatic children, whose ages ranged from 19 months to 14 years, following a preconceived plan. The procedure is practical and useful. It's easily understood by parents and realizable in an ambulatory way. The average necessities of oral theophylline in children under nine years in their group have been lower than those signaled by other authors. This and the fact that oral requirements of theophylline in two pair of univitelin twins were identical, make the authors think that it is necessary probably to modificate protocols previously proposed for the different groups of population.

Administration, Oral↗
PubMed1980

[Allopurinol in progressive muscular dystrophy (author's transl)].

Authors have treated with allopurinol ten children with progressive muscular dystrophy, whose ages were between 15 months to eleven years. An initial and monthly clinical evaluation of muscular strength, Gowers's sign and pseudohypertrophy was performed. Monthly determinations of CPK, LDH, aldolase, GOT and serum urate; every two months electromyography was also made. In three patients a complete recovery of strength, Gowers's sign was found and at the same time pseudohypertrophy diminished; the age average was three years and four months. In four patients a partial recovery was found; the age average was nine years and four months. In three patients there was no answer to treatment, they were contracted and had deformities, being age average ten years. No variations on monthly controls of CPK, LDH, aldolase and GOT were observed. On these facts their opinion is that allopurinol is an effective drug in the treatment of progressive muscular dystrophy and that its' effectivity is better when treatment is initiated early and, of course, before patients present deformities and contractures.

Allopurinol↗