Showing papers by "Hospital General Universitario Gregorio Marañón published in 1992"

Tuberculous Meningitis in Patients Infected with the Human Immunodeficiency Virus

Abstract: Background and Methods. Tuberculosis is a frequent complication of human immunodeficiency virus (HIV) infection. We describe the clinical manifestations and outcomes of tuberculous meningitis in patients with HIV infection, and compare them with those in non—HIV-infected patients. We reviewed the records from 1985 through 1990 at two large referral hospitals in Madrid for patients who had Mycobacterium tuberculosis isolated from cerebrospinal fluid. Results. Of 2205 patients with tuberculosis, 455 (21 percent) also had HIV infection, of whom 45 had M. tuberculosis isolated from the cerebrospinal fluid. Of the 37 HIV-infected patients with tuberculous meningitis for whom records were available, 24 (65 percent) had clinical or radiologic evidence of extrameningeal tuberculosis at the time of admission. In 18 of 26 patients (69 percent), a CT scan of the head was abnormal. In most patients, analysis of cerebrospinal fluid showed pleocytosis (median white-cell count, 0.234×109 per liter) and hypoglyc...

Purification and characterization of major inhalant allergens from soybean hulls.

Abstract: Proteins responsible for respiratory allergy to soybean have been purified from an extract of soybean hulls. The purification procedure combined size exclusion and reverse-phase HPLC. Two pure glycoproteins (S1 and S2) exhibiting IgE-binding ability, as demonstrated by immunoblotting and ELISA techniques, were obtained. Both proteins displayed low molecular weight values on SDS-PAGE (S1, 7.0 kD; S2 7.5 kD). Protein S1 showed charge microheterogeneity, rendering two bands at pH 6.1-6.2 on IEF, whereas S2 showed a single band at pH 6.8. Amino acid composition analyses revealed a strong homology between S1 and S2 and, as a characteristic feature, a high percentage of hydrophobic residues, mainly leucine and isoleucine. Concerning the allergenic activity, both proteins were recognized by the specific IgE from 95% of patients who suffered asthma attacks during the asthma outbreaks of 1987 and 1988 in Cartagena (Spain), caused by soybean dust. Besides, proteins S1 and S2 were able to, separately, inhibit up to 75% the binding of specific IgE to the whole extract. Moreover, purified proteins totally crossreacted, even though protein S2 seemed to be slightly more active in all the immunochemical techniques employed. Results presented allow us to conclude that both proteins are isoallergens and to name them as Gly m IA (protein S2) and Gly m IB (protein S1), according to the IUIS-allergen nomenclature system.

Cross-sectional epidemiology of phlebitis and catheter-related infections

Abstract: Objectives To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections. Design Cross-sectional, including the entire hospitalized population. Setting A university-affiliated hospital. Results Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intra-arterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-11) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1-130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR] = 8.7, CI = 4.13-18.3, p less than .0001), inappropriate catheter care (OR = 5.3, CI = 2.5-11.2, p less than .0001), inappropriate length of catheter use (OR = 3.5, CI = 1.4-9.02, p less than .01), and duration of hospitalization exceeding 14 days (OR = 2.6, CI = 0.9-7.83, p = .07). Conclusion The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.

Septic arthritis in patients with acquired immunodeficiency syndrome with human immunodeficiency virus infection.

Abstract: We have evaluated the presence and characteristics of septic arthritis in intravenous (iv) drug users with human immunodeficiency virus (HIV) infection. Sixteen patients with both HIV infection and septic arthritis were studied and compared with 5 patients with septic arthritis but no HIV infection. Clinical profile, laboratory findings at the time of onset, localization, causative organisms, mean hospitalization time and presence of complications were the same in HIV positive and HIV negative patients. Staphylococcus aureus was the most commonly isolated organism in both groups. We conclude that septic arthritis in HIV infected iv drug users is not uncommon, it is produced by the same organisms and presents similar characteristics to the ones found in iv drug users without HIV infection. Therefore, the presence of HIV infection does not appear to modify the characteristics of septic arthritis.

A seroepidemiologic study of hepatitis A in Spanish children. Relationship of prevalence to age and socio-environmental factors.

Abstract: Three child population groups from the Madrid area were studied for anti-HAV antibodies. Analysis was carried out with respect to age and socio-environmental factors. The population under study was composed of 156 children, with ages ranging from 1 to 14 years; they were stratified in three socio-environmental groups (white-family unit, gypsy-family unit and orphanage), and also divided into subgroups according to age. As a whole, an age-related increase in prevalence was found. The overall seroprevalence by socio-environmental groups was: gypsy-family unit 63%, orphanage 46%, and white-family unit 23%. Significant differences between groups appeared from seven years on, being more marked among the eldest subgroups. Among the factors evaluated, hygienic-sanitary conditions and overcrowding influenced the high prevalence rate found in the gypsy-family unit subjects, whereas overcrowding appeared to be responsible for the higher prevalence in orphanage residents, as compared to white-family unit children.

Treatment of the femoral and tibial fractures with Grosse and Kempf locking nails.

Abstract: In a series of 104 femoral and 50 tibioendomedullary nailings using Grosse-Kempf (G-F) locking nails, 24% of femoral fractures and 12% of tibial fractures were comminuted; 48% of the patients had multiple injuries. The nail was locked at proximal and distal levels in 54% of the cases for the femur. Dynamization of the nail was carried out at an average of 12 weeks. Nonweight-bearing was imposed for both series from three weeks to three months. Bone healing was achieved before six months in 100% of tibial fractures. Following Thoressen criteria, the results of femoral cases were all excellent and good; the percentage reached 96% for tibial cases. The G-F nail is suitable for high-energy, comminuted fractures.

[Arnold-Chiari malformation with multiple paroxysmal manifestations induced by coughing].

Abstract: We present a 66-year old woman suffering from a chronic disorder characterized by multiple paroxysmal symptoms precipitated by coughing. These included cephalalgia, syncope, binocular photopsia phenomena with blurred vision, and an "electric-like" paroxysmal tingling of the hands. In addition to a central spinal cord cavity and hindbrain herniation, magnetic resonance imaging showed multiple skeletal anomalies and the craniospinal junction which included a narrow clivo-axial angle, basilar impression of the skull and a tight foramen magnum. Resonance magnetic imaging showed a high-signal intensity lesion on T2-weighted images at the posterior medullo-spinal junction suggesting focal demyelination. We propose that paroxysmal symptoms induced by coughing in patients bearing hindbrain ectopia and skeletal anomalies at the foramen magnum region may involve different pathogenetic mechanisms, including ectopic axonal activity and ephaptic transmission at the sensory pathways. This caused a Lhermitte-like phenomenon precipitated by coughing, rather than by forward flexion of the neck. However, increased pressure at the posterior fossa presumably underlies all these phenomena, and may therefore be potentially relieved by suboccipital decompressive craniotomy.

[Prognostic value of anti-RNP/Sm and anti-Ro/La antibodies in lupus nephropathy].

Abstract: With the aim to analyze the prognostic value of anti-RNP/Sm and anti-Ro/La antibodies (Ab) in lupus nephropathy, we have studied through Contraimmunoelectrophoresis (CIE) and Immunoblotting (IB) the serum of 63 patients diagnosed of systemic lupus erythematosus. Mean age was 36.5 years (15-71) and 90% were females. We have classified the patients into three subgroups: I, 25 patients without nephropathy; II, 26 patients with evidence of nephropathy (persistent proteinuria and/or microhematuria) and normal renal function; and III, 12 patients with renal failure (servu creatinine > 1.5 mg/dl). 21 patients had kidney biopsy. IB allows to identify a higher number of positive serum, specially in the case of anti-RNP (7.9% CIE vs 28.5% IB) and anti-Sm antibodies (6.3% vs 30.1%). Prevalence of anti-RNP Ab is lower in subgroup III (32% I vs 34% II vs 8% III) (p > 0.05). Anti-Sm Ab are more frequent in group II and are not associated with renal failure (16% vs 54% vs 8%) (p > 0.05). Anti-Ro Ab are related with the absence of nephropathy (52% vs 15% vs 0%) (p < 0.05). We conclude that IB is more sensitive than CIE in the detection of these Ab and its use in Systemic Lupus Erythematosus permits to identify patient subgroups with lesser risk to develop renal failure. Even though our data are preliminary, we suggest that the detection of anti-RNP/Sm and/or anti-Ro/La antibodies are a good prognostic factor in lupus nephropathy.

Urethral sonography in the diagnosis and preoperative evaluation of urethral stenosis

Abstract: An area of spongiofibrosis can be found proximal and distal to all stenosis of the urethra. The severity of such spongiofibrosis as well as its length are in many instances decisive when choosing an adequate surgical approach. Conventional radiological diagnosis of stenosis of the urethra only shows the area of urethral stricture but is unable to inform on the fibrosis of the spongy body. Sonourethrography or urethral echography affords a dynamic tridimensional examination of the anterior urethra which provides accurate data on the length of the stenosis, as well as the extend and severity of the spongiofribosis. Sixteen patients diagnosed with stenosis of the urethra through sonourethrography were evaluated. This easy-to-perform investigation, allowed the identification of 4 patients with peristenotic intense spongiofibrosis, hypercongenital urethra, who underwent open urethroplastia. The urethra of another 3 patients showed normal echogenicity, but diminished elasticity, and were diagnosed as of moderate spongiofibrosis requiring extensive internal urethrotomy. We believe sonourethrography should become a procedure to be included as part of the routine pre-surgical investigation of the stenosis of the urethra due to its non-invasive nature, easiness to perform, and because it provides highly useful information which would allow a decreased number of re-stenosis following surgery of the urethral stenosis.

Determining factors of acceleration in sustained monomorphic ventricular tachycardias in response to bursts of stimuli

Abstract: To analyse the determinants of acceleration of sustained monomorphic ventricular tachycardias in response to bursts of rapid ventricular pacing, we studied 46 consecutive patients with 90 distinct ventricular tachycardias during which one or more burst of rapid pacing were delivered. Tachycardia acceleration was observed in 11 tachycardias in 8 patients. The highest incidence of acceleration was observed in patients with left ventricular dysfunction of non coronary origin. There was a non significant trend towards lower values of left ventricular ejection fraction in patients with acceleration. There were no significant differences between ventricular tachycardias with of without acceleration in respect to: clinical presentation, QRS morphology, tachycardia cycle length and treatment with antiarrhythmic drugs. The shortest cycle of bursts of rapid pacing, was lower in tachycardias with acceleration than in those without it (229 +/- 57 ms vs 283 +/- 67 ms; p = 0.006) and tachycardias with acceleration showed a lower relation between burst cycle length and tachycardia cycle length (69 +/- 9% vs 84 +/- 8%; p or = 250 ms, and 96% for values of the relation between the burst cycle length and the tachycardia cycle length > or = 70%. This parameter show a very high discriminating value with of without antiarrhythmic drugs effect. Acceleration of sustained monomorphic ventricular tachycardias in response to bursts of rapid pacing depends on, the pacing rate and the relation between pacing rate and tachycardia rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Subacute paraneoplastic cerebellar degeneration in microcytic carcinoma of the lung. Presentation of 2 cases

Abstract: Subacute paraneoplastic cerebellous degeneration is a rare syndrome which is found in less than 1% of patients with cancer. Small cell cancer of the lung and of the ovary are the two neoplasms most frequently associated to this entity. Two patients with small cell lung cancer who initially had a cerebellous syndrome in which no sign of macroscopic cerebellous lesion could be demonstrated by either computerized tomography or nuclear magnetic resonance of the head are presented. One of the patients was evaluated at autopsy. Both patients were treated with polychemotherapy with which partial response was obtained. Neurologic symptomatology was not alleviated in the first patient with death due to bronchopneumonia at 5.5 months of initiation of the disease, while improvement of the cerebellous paraneoplastic syndrome was achieved in the second patient. The different evolution of subacute paraneoplastic cerebellous degeneration in two patients in whom antibodies were not demonstrated and in whom initial response of the tumor to chemotherapy was achieved may be explained by the second patient having undergone prolonged treatment of 6 cycles suggesting a strict relation ship between the tumor and subacute cerebellous degeneration which, to date, remains unknown.

A right kidney autotransplant after inferior cavectomy

Abstract: We investigated the feasibility of diverting blood supply from the right kidney after resection of the vena cava by autotransplantation to the right iliac fossa. The experiment was conducted in 10 mini-pigs that had previously undergone partial ligation of the vena cava to produce collateral circulation. Although a good collateral circulation had developed, it was not sufficient to drain the complementary venous supply (right kidney). All the animals developed venous thrombosis and, consequently, irreversible renal failure.

Gangrenous cystitis induced by giant bladder calculus

Abstract: Presentation of one case of gangrenous cystitis or vesical gangrene induced by the presence of a large vesical calculus in a patient with neurogenic bladder. Remarks on the patho-etiology, symptoms and treatment of this rare entity entailing a truly surgical emergence.

Transesophageal echocardiography study of the left atrium and the mitral valve plane after heart transplantation

Abstract: To assess the anatomy of the left atrium and mitral plane after heart transplantation, we performed a transesophageal echocardiographic study to 37 consecutive transplant patients. After heart transplantation no patient was under anticoagulant treatment and no case of atrial fibrillation was documented. The transesophageal approach allowed us to measure the left atrial free wall suture which was: less than 15 mm in 14 patients, between 15 and 25 mm in 16 patients, and more than 25 mm in 7 patients. In those patients with a left atrial free wall suture greater than 15 mm, blood flow turbulences within the "niche" underneath the protruding suture as well as blood flow acceleration at the rim of that suture were noted. In 4 patients a "pseudoaneurysm" of the interatrial septum was observed. Two patients had mitral valve prolapse. Mitral regurgitation was noted in 17 patients (46%) by color Doppler transesophageal echocardiography and graded as mild in 15 patients and moderate in 2 cases. In 16 patients (43%) spontaneous echo contrast within the left atrium was detected by transesophageal echocardiography. Both major and minor axis as well as left atrial area in patients with and without dynamic echoes were, respectively: 72.5 +/- 12.2 mm vs 56.9 +/- 5.9 mm (p < 0.001), 48.3 +/- 7.1 mm vs 39 +/- 7.9 mm (p < 0.001), and 35.4 +/- 7.1 cm2 vs 24.4 +/- 5.2 cm2 (p < 0.001). Atrial thrombi were not detected. After a mean follow-up of 15 +/- 10.7 months there was no arterial thromboembolism in patients with spontaneous contrast.(ABSTRACT TRUNCATED AT 250 WORDS)

[Echo-Doppler duplex combined with intracavernous injection of prostaglandin E1 in the diagnosis of impotence].

Abstract: Sixty-two patients that had consulted for impotence were evaluated by intracavernal injection of prostaglandin E1 and duplex echo-Doppler. The internal diameter and the mean flow of the cavernosal arteries were determined by echo-Doppler in the flaccid state. Thereafter 20 micrograms of PGE 1 was injected intracavernously and the erectile response was evaluated clinically after 5 to 15 minutes. Another Doppler evaluation was performed during tumescence to study the changes of the internal diameter and the mean flow increase of the cavernal arteries. Twenty-nine patients (46.7%) achieved normal erection after intracavernal PGE 1 and the Doppler study was normal in all but 2 patients (3.2%). The remaining 33 patients (53.1%) failed to achieve normal erection following intracavernal injection of PGE 1. The Doppler study, however, was normal in 7 of these patients (11.2%), which indicates venous leak to be the underlying cause of impotence. There were minor complications (19.3%) presented a small hematoma at the site of injection and 12.9% referred moderate pain at the time of injection) and no patient has a sustained erection for more than 3 hours. The hemodynamic mechanisms and the current concepts relative to the neurologic aspects of erection are discussed. We believe duplex echo-Doppler combined with intracavernal PGE 1 to be a very reliable method in the diagnosis of impotence of a vascular origin. It can distinguish those patients that cannot achieve erection following intracavernal PGE 1 with a normal arterial tree whose impotence can be ascribed to venous leak.

Management of pancreatic lesions in urologic surgery

Abstract: Surgical trauma of the pancreas cauda can occur when the renal hilum is dissected during left radical nephrectomy, mainly when normal anatomy is altered by the tumoral or inflammatory pathology. This lesion can be appreciated during the surgical procedure or else a pseudocyst or pancreatic fistula can become evident post-operatively. The urologist's knowledge of what the correct management both intra-operatively and postoperatively of this pathology should include will lessen the significant morbidity it implies. Presentation of a series of 6 patients presenting pancreatic trauma during left radical nephrectomy. Comments on the pathophysiology of this disorder, intra-operative management and post-operative treatment, specifically emphasizing the use of Total Parenteral Nutrition and Momatostatin IV.

In vitro differentiation of myxoid liposarcomas maintained in organ culture system.

Abstract: Liposarcoma falls into the differential diagnosis of myxoid malignant mesenchymal tumors. On the other hand, its relation with white or brown fat is controversial. Two cases of liposarcoma have been studied by organ culture, a method which provides cell and tissue redifferentiation in vitro. Both cases developed successively cytoplasmic glycogen granules and lipid droplets as well as a single lipidic vacuole in the late phase of cultivation as a marker of fat differentiation. Our results support the possibility of identifying myxoid liposarcomas as well as their origin from white fat tissue.