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Biomedical subjects

A Cruz

Publications and source records attributed to A Cruz.

171 records · Page 10Linked to original sources
PubMedDate not supplied

[Headache following dural puncture in pregnant patients at term. Comparative study with non-obstetric patients].

OBJECTIVES: To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients. PATIENTS AND METHODS: A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced. RESULTS: Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups. CONCLUSIONS: The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.

Adolescent↗
PubMedDate not supplied

[Postoperative mental confusion in the elderly with hip fracture. Perioperative risk factors].

OBJECTIVE: To determine the incidence of postoperative mental confusion and perioperative risk factors in elderly patients with femoral neck fractures. PATIENTS AND METHODS: A prospective study of patients 65 years of age or older undergoing surgery for hip fracture with intradural anesthesia between March 1992 and August 1993. Although the total number of cases came to 162, only 50 patients were enrolled in the study: the rest were excluded mainly because of mental deficits presenting before surgery. Folstein's Mini-Mental State test was used to assess mental function. Risk factors analyzed were classified as preoperative, intraoperative (in the operating room and the recovery room) or postoperative (hospital ward). RESULTS: Eleven (22%) patients showed signs of postoperative mental confusion. Simple analysis revealed a correlation between mental confusion and ASA (p = 0.01), neuropsychiatric history (p = 0.03) and preoperative hemoglobulin, red blood cell and urea nitrogen levels (p = 0.02). Multifactorial discriminant analysis indicated that patients with low red cell counts before surgery, high urea nitrogen and neuropsychiatric histories were more predisposed (p = 0.004) to mental confusion. CONCLUSIONS: A high incidence of postoperative mental confusion is associated to pre-surgical factors. We therefore suggest that greater preventive and therapeutic efforts be directed preferably to preparation before surgery, especially in patients at high risk.

Aged↗
PubMedDate not supplied

Fungal allergens from important allergenic fungi imperfecti.

Occurrence of several fungal species in the environment seems to be related to hypersensitivity disorders in humans. Fungal allergen studies reported in the literature are reviewed regarding to Aspergillus, Alternaria, Penicillium and Cladosporium genera. In this paper, we study by means of in vivo (Skin Prick Test) and in vitro (RAST and immunoblotting) the classical question of the best source of allergenic material using a population of asthmatic patients sensitized to different mould genera. In Alternaria alternata, RAST values are considerably higher in metabolic extracts (culture filtrate) than in somatic ones (myceliar). In Alternaria alternata and Penicillium chrysogenum, low molecular weight allergens (< 30 kDa) show higher IgE-binding activity in culture filtrate extracts. In Aspergillus fumigatus we find some relevant allergens in the mycellium. Different fractions have also been used in skin tests and culture filtrate extracts showing higher potency than myceliar ones, what is in agreement with the former results. We found in Penicillium chrysogenum that the 67 kDa allergen, similar to what described by Shen et al (1991), showed inespecific binding to anti-IgE conjugate used in the development of the immunoblotting technique. Whether or not this component could be a major allergen is discussed. We discuss about the importance of the biology of fungi in the sensitization and development of mould allergy.

Allergens↗
PubMedDate not supplied

[A resurgence of rheumatic fever. New causes or old attitudes?].

Bearing in mind that in the last years there has been an increase in rheumatic fever episodes, the authors evaluate the cases recently observed in the department. The data of 3 children born and living in Portugal, the first known outbreak of rheumatic fever observed between June 93 and March 94, were examined. One case presented polyarthritis, another polyarthritis and carditis and the third chorea and carditis. In just one case was the diagnosis of rheumatic fever considered in the beginning, and over-all, failures in the diagnosis and treatment of tonsillitis, and in echocardiographic diagnosis were detected. In view of these examples, the authors conclude that the increasing incidence and morbidity of rheumatic fever is more probably due to forgetfulness of old attitudes than to new causes. Delay in the diagnosis and errors in secondary prophylaxis may influence long term results.

Child↗
PubMedDate not supplied

Erosive azotemic osteoarthropathy of the hands in chronic ambulatory peritoneal dialysis and hemodialysis.

OBJECTIVE: We studied the prevalence and significance of erosive azotemic osteoarthropathy (EAO) and its relationship with other osteoarticular abnormalities of dialysis-associated arthropathy (DAA). METHODS: 112 patients undergoing maintenance dialysis were studied: 63 hemodialysis (HD) and 49 continuous ambulatory peritoneal dialysis (CAPD). X-ray of the hands, shoulders, pelvis and cervical spine were examined for destructive spondyloarthropathy (SDA), bone cysts (BC), EAO and subperiosteal resorption. Beta 2-microglobulin (beta 2-m) and PTH were also measured. RESULTS: Fifteen patients (13%) had EAO, usually in several joints of the hands, DIPs being the most frequently affected. Both patients on HD and those on CAPD had EAO, although the prevalence was higher in the HD group, 12 (19%) vs. 3 (6%). Patients with EAO were older (p < 0.05) and had more carpal tunnel syndrome (CTS) (p < 0.05) and BC (p < 0.01). Only 3 out of 15 patients with EAO had severe secondary hyperparathyroidism (sHPTH) (PTH > 500), while 9/15 had neither radiologic nor laboratory evidence of sHPTH. No differences were found regarding the duration of dialysis, or beta 2-m or PTH level. CONCLUSION: EAO is not related to sHPTH and should be included within the spectrum of the clinical manifestations of DAA. Due to its location and radiologic picture, it is possible that etiologic factors leading to primary osteoarthritis may play a role in the development and evolution of EAO.

Adult↗