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Biomedical subjects

R Valls

Publications and source records attributed to R Valls.

29 records · Page 2Linked to original sources
PubMed1985

Must patients over 65 be haemodialysed?

This manuscript consists of a study of the results of 26 end stage renal failure (ESRF) patients, who commenced regular haemodialysis treatment (RHDT) from the age of 65 onwards (65-85) and who have been undergoing this treatment for periods ranging from 7 years to 3 months. These results are to be compared with those obtained from another group of 26 patients whose age ranged between 40 and 55 and who were treated with the same policy. The following parameters are compared: mortality, morbidity, life-style, cardiovascular situation, hypotension in haemodialysis, vascular access, anaemia, osteoarticular and peripheral nervous disorders, hypertension. We have not found any significant differences between both groups, besides a higher morbidity for patients over 65. Therefore, we recommend the inclusion of the older patients into RHDT programmes.

Adult↗
PubMedDate not supplied

[Assessment of long-term bone metabolism in patients with relative hypoparathyroidism after changing the calcium concentration of the dialyzate to 3mEq/L].

The existence of a low-bone turnover, non-aluminium related, has been more prevalent in recent years. Factors involved include the increasing number of older and diabetic patients initiating dialysis. Also higher intake of calcium salts and the widespread use of vitamin D derivates may play a role. Demonstration of low PTH secretion allows the recognition of the group of patients with special risk of adynamic bone disease. Little can be done to improve bone remodelling apart from correct management of risk factors previously mentioned. A decrease in dialysate calcium concentration can act in this way, but the long term effect of this procedure on bone mineral density has scarcely been established. The aim of this study was to evaluate the long term effect of lowering the dialysate calcium concentration from 3.5 to 3 mEq/L on bone mass and PTH activity in patients with hypoparathyroidism. We studied 19 patients with PTH < 120 pg/ml and calcemia between 8.5 and 10.5 mg/dl, without aluminium intoxication. Blood levels of Ca, P, alkaline phosphatase, aluminium, iPTH and dialysis doses were measured every 4 months during the two years of follow-up. Phosphate binders were closely monitored. Also calcium dietary feeding was measured by a 5-day dietetic registry at the beginning and 6 and 12 months later. Bone mineral density was assessed by quantitative computed tomography of the distal radius initially and after 18 months. PTH values had significantly increased from the first measurement (from 46 +/- 33 to 97 +/- 68 four months later). At the end of follow up, 8 patients (42%) had reached the objective of maintaining a PTHi above 120 pg/ml, while 11 had not reached it (3 were previously parathyroidectomized and two were diabetic). Only one patient has developed an exaggerated PTH response that has been controlled with oral vitamin D. No bone mineral loss was observed during the follow up. In conclusion, the use of a 3 mEq/l dialysate calcium may improve hypoparathyroidism in a substantial number of patients, avoiding the untoward effect that lower calcium concentration has on bone mineralization.

Aged↗
PubMedDate not supplied

[Multilocular cystic nephroma. A diagnostic problem].

A multilocular cystic nephroma is described in a female patient diagnosed as having a mucinous cystadenocarcinoma of the left ovary, treated by surgery. It is presented as a mixed mass in the left kidney; image findings were specified with the new image diagnostic methods currently available, ultrasonography and computerized tomography. In the ultrasonographic study the mass is presented as an heterogenous image, with multiple anecogenic areas, separated by more ecogenic bands, situated mainly in the lower pole affecting all the cortical area and occasionally invading renal sinus. In the computerized tomography study a cystic mass is observed, with cysts of a different size that, after administering intravenous iodine, show a density increase in intercystical fibrous tracts. In cases with more complex image presentations, fine needle puncture is recommended, preferably in different areas in the mass in order to rule out the presence of malignant cells.

Aged↗
PubMedDate not supplied

Topography of peribulbar anesthesia.

BACKGROUND AND OBJECTIVES: Peribulbar anesthesia has fewer complications than retrobulbar anesthesia, but ocular perforation has also been described in peribulbar anesthesia. This study aims to verify by computed tomography that the recommended points for performing peribulbar anesthesia are safe. METHODS: Three human corpses were used. The puncture points were position A (superior internal orbital angle and inferior external orbital angle), position B (superior and inferior orbital median line), and position C (superior external and inferior internal orbital angle). Contrast diffusion was studied in each position at 3, 4, 5, and 10 minutes after contrast injection. RESULTS: Among upper eyelid punctures, the only one anatomically safe is the internal angle puncture, given that either in the median line or the external angle there is a chance of eye globe perforation. Lower eyelid positions are a safe distance from the optic nerve and ocular globe. Contrast diffusion was satisfactory in positions A and B. There was little diffusion in position C. CONCLUSIONS: The median or external superior angle eyelid puncture may cause eye globe perforation.

Anesthesia, Local↗