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Biomedical subjects

M Vallès

Publications and source records attributed to M Vallès.

10 recordsLinked to original sources
PubMed2005

Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient.

STUDY DESIGN: Case report. OBJECTIVE: To report an uncommon case of cerebral hemorrhage due to autonomic dysreflexia (AD) in a spinal cord injury (SCI) patient. SETTING: Institut Guttmann, Neurorehabilitation Hospital in Barcelona, Spain. CASE REPORT: An SCI patient developed AD due to urinary tract infection after surgery for a pressure sore. The hypertension was difficult to control and the case progressed to hypertensive encephalopathy. MRI of the brain was performed showing a hemorrhagic lesion on the left occipital area. The hypertension was finally controlled and the neurological status improved although with some cognitive deficits. CONCLUSION: This is an uncommon case of cerebral hemorrhage due to AD, showing the importance of an adequate diagnosis and treatment of AD to avoid this life-threatening complication.

Autonomic Dysreflexia↗
PubMed2004

[Evaluation of plasma volume variation during different hemodialysis maneuvers].

UNLABELLED: Intradialytic hypotension is closely linked to hypovolemia and ascribed to the degree of ultrafiltration. Among the maneuvers used to recovery hypotension, we have the Trendelenburg position, the infusion of isotonic saline serum or plasma extenders as well as shutting of the ultrafiltration. The objective of this study is to quantify the influence that the different maneuvers employed for recovery hypovolemia will have on blood volume, employing the Crit-Line system. We have studied 32 hemodialysis patients over 5 consecutive hemodialysis sessions. The different maneuvers evaluated were: administration of saline serum, plasma extenders, Trendelenburg position, shutting off the ultrafiltration and administration of hypertonic saline serum. RESULTS: The administration of saline serum causes an increase of 2.9% in blood volume at the end of the third hour, which is higher than the increase achieved in the first hour (2.6%) and second hour (2.4%). The Trendelenburg position achieves a minimal blood volume increase of 0.4%. The administration of plasma extenders achieves the most significant increase in blood volume of 3.1% and the longer lasting one as well (37 minutes). The cessation of ultrafiltration at the end of the first and third hours, achieves a blood volume increase of 2% and 2.3% respectively. Lastly, the administration of hypertonic saline serum causes a minimal blood volume increase of 0.7%. CONCLUSION: The infusion of isotonic saline serum and plasma extenders, are the quickest, most efficient and long lasting maneuvers for blood volume expansion, followed by the cessation of ultrafiltration. In concerning to quick plasma volume recovery, the Trendelenburg position and the administration of hypertonic saline serum are not very efficient maneuvers.

Adult↗
PubMed2003

[Immunonegative necrotizing glomerulonephritis: an atypical case of lupus nephropathy].

We report here a case of systemic lupus erythematosus with severe, active pauci-immune necrotizing and crescentic glomerulonephritis. This patient had been diagnosed of a lupus nephritis type III previously and treated with steroids and azathioprine. After a renal symptomless period of nine years, she developed heavy proteinuria and hypertension. A second kidney biopsy was then performed. The pathological study disclosed a pauci-immune necrotizing crescentic and segmental glomerulonephritis. The absence of subendothelial and mesangial deposits was confirmed by both immunofluorescent microscopy and electron microscopy. The simultaneous immunological study showed normal ANCA levels while complement, anti-dsDNA and ANA were altered. The patient was treated with steroids and cyclophosphamide eith good response. This case points out the possibility previously recognized by others of an association between lupus and an pauci-immune necrotizing glomerulonephritis.

Adult↗
PubMed2000

Post-traumatic syringomyelia following complete neurological recovery.

OBJECTIVE: To describe the later neurologic deterioration secondary to the appearance of a post-traumatic syringomyelic cavity, in a patient who, in the initial phase, had an incomplete spinal cord lesion (ASIA C), which improved to ASIA E. METHODS: A 52-year-old male patient who, at the age of 19 (1965), suffered a spinal cord injury. He presented with a fracture of the sixth and seventh cervical neurological segment at the time of the lesion, evolving to ASIA E. Nine years after the traumatism, he began to feel pain accompanied by a sensory and motor deficit. RESULTS: With the aid of myelography and MRI, the existence of a syringomyelic cavity was detected, which extended from the fourth to the seventh cervical segments. The patient was operated on, on various occasions, placing a syringo-subarachnoid shunt. The neurological status of the patient continued to deteriorate and, at present, he has a complete lesion below the fourth neurological cervical segment with a partially preserved sensitive area up to T1. CONCLUSION: The development of the syringomyelic cavity could be one of the causes of later neurologic deterioration in patients with traumatic spinal cord injury with neurological recovery 'ad integrum' in the initial phase of spinal cord injury.

Cervical Vertebrae↗
PubMed1998

[Mortality and risk factors in patients with acute renal failure and multiple organ dysfunction].

BACKGROUND: Acute renal failure (ARF) associated to multiple organ dysfunction (MOD) deserves currently a poor survival. The aim of this study was to analyze the risk factors for mortality in ARF-MOD patients treated by means of continuous renal replacements strategies. PATIENTS AND METHODS: All the ARF-MOD patients treated by means of continuous renal replacement techniques (CRRT) in a single center in the period 1989-1995 have been evaluated. MOD was defined by the 1992 American Conference criteria. Both demographic and the scored clinical data were analysed by means of descriptive and comparative statistics and by multiple logistic regression for the mortality risk factors. RESULTS: 103 patients have been evaluated. The median age was 62 years (range 20-80), 73.8% were males and the mean APACHE II score was 22.7 (SD 5.5). In the 17.4% the ARF-MOD condition corresponded to multiple trauma, the other medical and surgical pathologies represented the 82.6% of cases. At least two organic systems were involved in all patients. Both urea and creatinine values significantly decreased in all the patients and the fluid removal was of 8.9 (2.6) l/24 h. The mortality rate was 78.6%. The risk for death, as evaluated by logistic regression, was higher in patients older than 60 years (OR: 3.45; Cl 95%: 1.1-10.78; p = 0.03), and lower in those with remaining diuresis (OR: 0.65; Cl 95%: 0.48-0.9; p = 0.008). Survival was better among ARF-MOD traumatic patients. CONCLUSIONS: The mortality rates among ARF-MOD patients remains high. The CRRT were useful for removing uremic toxins and fluids. By logistic regression only advanced age and low urine output were the main risk factors for mortality.

APACHE↗
PubMed1997

[Prevalence of arterial hypertension and other cardiovascular risk factors among hospital workers].

BACKGROUND: The attitude of sanitary workers is essential for the control of arterial hypertension (HT). The aim of the study was to identify the prevalence of HT and some cardiovascular risk factors in both sanitary and non-sanitary hospital workers and the knowledge, therapeutic compliance and control of hypertense individuals. SUBJECTS AND METHODS: Two tensional measurements were obtained by using a manometer of mercury at the beginning and at the end of an epidemiological request. A logistic regression model was obtained to evaluate the association between HT and risk factors. RESULTS: One thousand and one individuals (762 females) with a median age of 37.2 years were studied. Prevalence of HT was 9.7%. Men showed a higher age-related prevalence than women (19.7 vs 6.6%, p < 0.001). Body mass index was higher in HT individuals. Thirty eight per cent of the hospital workers were smokers. HT prevalence increased with alcohol consumption. Sex, mass body index and age were significantly associated with HT. Knowledge, therapeutic compliance and control of HT were 73.2, 19.7 and 28%, respectively, in the total group and 61, 26.3 and 0%, respectively, in the group of physicians and nurses. CONCLUSIONS: Hospital workers showed a high prevalence of cardiovascular risk factors. Inadequate therapeutic and control measures were observed on both nurses and physicians with high blood pressure.

Adult↗
PubMed1997

Effects of recombinant interleukin-2 and revaccination for hepatitis B in previously vaccinated, non-responder, chronic uraemic patients. Collaborative Group of Girona.

BACKGROUND: Growing evidence suggests that it is possible to seroconvert chronic renal failure patients who are absolute non-responders to hepatitis B vaccine by means of either additional booster vaccine doses or associated IL-2 administration or both. We have studied the possibilities of hepatitis B seroconversion by revaccination and its dependence on vaccine dose, and the effects of a concurrent low-dose rHuIL-2 regime. METHODS: Forty known absolute non-responders with chronic renal failure were entered into a complete revaccination protocol. Patients were randomly assigned to two dosage groups of either 20 or 40 micrograms hepatitis B vaccine administered at 0, 1, 2 and 6 months. Further randomly selected patients from each dosage group were given 500,000 U of rHuIL-2 in the same deltoid area 4 h after vaccine administration. RESULTS: Sixty-seven per cent of patients revaccinated with 40 micrograms attained antibody protecting levels compared to only 20% of those receiving doses of 20 micrograms (P < 0.025). When compared with initial values, the ThCD4/CD25 cell count was significantly reduced immediately after HuR-IL2 administration (P < 0.003) and significantly increased 1 month after the last dose was given (P < 0.0003). A definite rHuIL-2 effect on HBV antibody synthesis could not be demonstrated, nor was erythropoietin found to enhance seroconversion. CONCLUSIONS: From these results we suggest that more intense and frequent antigenic stimulation as obtained by revaccination using four doses of 40 micrograms may effectively reduce the pool of hepatitis B vaccine nonresponders in chronic renal failure patients.

Clinical Protocols↗