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Biomedical subjects

F J Barbado

Publications and source records attributed to F J Barbado.

At least 37 records · Page 2Linked to original sources
PubMed1992

Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series.

Comparison was made of the aetiology and methods of diagnosis in two series of patients meeting the classic criteria of pyrexia of unknown origin during 1968-1981 and during 1982-1989 seen in the Department of Internal Medicine at La Paz University Hospital, Madrid, Spain. There was a statistically significant decrease in the percentage of infections and an increase in neoplasms and connective tissue disorders in the second series. The percentage of patients diagnosed by laparatomy was similar in both series but the diagnosis yield at laparotomy was greater in the second period. Pyrexia of unknown origin continues to be a condition which can defy clinical expertise in in spite of advances in diagnostic techniques.

Adolescent↗
PubMed1991

Rheumatic manifestations in 556 patients with human immunodeficiency virus infection.

We studied in retrospect the rheumatic manifestations of 556 patients with human immunodeficiency virus (HIV) infection. Eighty percent were men. Eighty-six percent were intravenous drug abusers (IVDAs), 9% homosexual, 3% partners of high-risk persons having the infection, 0.4% hemophiliacs, and 2% had no known risk factors. We found rheumatic disorders in 63 (11%) patients. The most frequent findings were myalgias and/or arthralgias (4.5%; one patient had an inflammatory myopathy), skeletal infections (3.6%), and arthralgias (1.6%). Reiter's syndrome and seronegative arthritis were present only in 0.5%, and HIV-associated arthritis and vasculitis in 0.4%, respectively. Skeletal infections were caused predominantly by Staphylococcus aureus (60%) and Candida albicans (20%). All these patients were IV drug abusers whose clinical features were similar to those previously described in skeletal infections of non-HIV-infected IVDAs. Comparing these data with other studies composed primarily of homosexual men where Reiter's syndrome is the predominant rheumatic disorder, we conclude that the type of rheumatic complaint is more related to the risk factors than to HIV itself.

Adolescent↗
PubMed1991

[AIDS: clinical and necropsy correlation. Analysis of 45 patients].

We have reviewed the autopsies performed on 45 AIDS patients who died in our hospital until June 1989, comparing the post-mortem diagnosis with those made while the patient was alive and in his last hospital admission. Bacterial pneumonia, CMV infection and atypical mycobacteria were the diseases most frequently unnoticed. On the contrary, HIV encephalitis and pulmonary mycosis were the disease with the greatest number of non confirmed clinical diagnosis. The routine performance of necropsy studies to AIDS patients permits to know the most prevalent infections in our environment and should improve the diagnostic precision.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Successful zidovudine therapy for HIV-related severe thrombocytopenia. Report of a sustained remission.

Five patients, two homosexuals and three drug abusers, with HIV-related severe thrombocytopenia, four of whom had also bleeding episodes, experienced a full remission of thrombocytopenia after 1,200 mg/day zidovudine treatment. None of the patients had acquired immunodeficiency syndrome (AIDS) or AIDS-related complex. Platelet counts began an upward trend at the end of the 3rd week and reached values higher than 140 x 10(9)/l towards the end of the 8th week of treatment. Patient's platelets remained stable after more than 4 months of active treatment. This is the first report of zidovudine-induced long-term remission of HIV-associated severe thrombocytopenia.

Acute Disease↗
PubMed1990

Additional predictive value of serum unsaturated vitamin B12 proteins in multiple myeloma.

The distribution of serum cobalamin-binding proteins was studied in 30 patients with low-grade multiple myeloma and in 26 patients with high-grade myeloma. The mean total cobalamin concentration (holotranscobalamin I and II) was similar in both groups of patients. We found a marked rise in total unsaturated binding cobalamin capacity mainly due to an increase in apotranscobalamin II (apo-TC II) in patients with high-grade myeloma. There was also a positive correlation between serum beta-2-microglobulin (B2M) and apo-TC II in myeloma patients. Our results indicate that pretreatment measurement of serum apo-TC II could supplement B2M as a prognostic guide.

Aged↗
PubMed1990

[Prolonged course fever as presentation form of Crohn's disease].

3 cases of Crohn's disease whose first manifestation was fever preceding intestinal symptoms, 3, 12, and 36 months respectively, the intestinal symptoms, are presented. Apart from fever, one of our cases had multiple extraintestinal symptoms these being of pancreatic, hepatic, mucocutaneous, bone and ocular origin. We insist on the heterogeneous onset of the disease which forced the clinician to maintain this disease on the long list of prolonged febrile illnesses causes.

Adolescent↗
PubMed1989

[Systemic vasculitis as a cause of fever of unknown origin].

A prospective clinical study (1974-1988) was carried out in 33 patients with several types of systemic vasculitis (SV) presenting as fever of unknown origin (FUO) according to the 1961 Petersdorf and Beeson's criteria. Histological confirmation, either from biopsy or necropsy, was available in all cases. The types of SV with FUO were: panarteritis nodosa (PAN) (14 cases), giant cell arteritis (GCA) (13 cases), and overlapping polyangiitic syndrome (OPS) (6 cases). In PAN, the clinical features associated with fever at the onset of the disease were remarkably nonspecific: constitutional symptoms (85%), arthromyalgia (50%), nonspecific abdominal pain (28%), and irritative cough (28%). In the whole course of the cases of GCA a significantly smaller frequency of presentation of local arterial symptoms and polymyalgia rheumatica (p less than 0.01) was found in the subgroup of patients with FUO than in those without it. As regard laboratory data, a higher increase of serum alkaline phosphatase (p less than 0.05) was found in the cases of PAN and OPS with FUO. Striated muscle biopsy and arteriography were the most useful investigations in the diagnosis of PAN. The study that gave the diagnosis in the cases of GCA was temporal artery biopsy.

Female↗
PubMed1989

[Pulmonary thromboembolism: clinical characteristics and diagnostic and therapeutic approaches].

In the present study the variability and diagnostic meaning of clinical features and common laboratory investigations were evaluated in a series of 220 patients with pulmonary thromboembolism (PTE) diagnosed by clinical means. The patients were classified into the two following groups: group I consisted of 102 critical patients admitted to an intensive care unit; group II consisted of 118 less-severely ill patients admitted to an ordinary hospital ward. Although clinical and laboratory features were nonspecific, the association of thrombotic risk factors in 88% of the patients permitted us to suspect the diagnosis of PTE within the initial three days in 71%. Chest radiogram was normal in 48%, ECG was normal in 32%, and contrast phlebography did not demonstrate phlebothrombosis in 16.4% of cases. The presumptive diagnosis was earlier (4 +/- 2 days) in group I than in group II patients (8 +/- 5 days) (p less than 0.01), and there was a significantly higher frequency of thoracic symptoms, hypoxemia, hypocapnia and radiologic and electrocardiographic abnormalities in group I patients. Chest radiogram and ECG were normal in only a small minority of these patients (9 and 7%, respectively). Overall mortality rate was 9.4% (20 patients, 14 from group I and 6 from group II). In 10 patients, all from group I, death took place within the first 72 hours after the diagnosis.

Adult↗
PubMed1989

[Usefulness of temporal artery biopsy: analysis of 100 cases].

We have evaluated 100 biopsies of temporal artery carried out in the Hospital La Paz from 1972 to 1986. On the basis of the histological result and the final diagnosis we divided the patients in five groups: I, temporal arteritis/polymyalgia rheumatica with positive biopsy, 11 cases; II, temporal arteritis without polymyalgia symptoms and with positive biopsy, 16 cases; III, temporal arteritis with negative biopsy, 7 cases; IV, polymyalgia with negative biopsy, 14 cases; and V, other diagnoses, 43 cases. The number of diagnoses of temporal arteritis/polymyalgia rheumatica has increased throughout the recent years, although the positive biopsies/overall biopsies ratio has remained constant. Certain symptoms such as claudication, headache, amaurosis and Raynaud's phenomenon have a high predictive value of a positive result, but their sensitivity is low. In the 25 patients with polymyalgia, biopsy was positive in 11, out of which 4 did not have features of temporal arteritis. Biopsy was positive in 4 out of the 9 patients in whom it was repeated in the contralateral side. The diagnostic yield was higher in those cases in whom it was indicated for classical temporal arteritis symptoms, but we emphasize that there was a 19% positive rate in patients who presented with fever of unknown origin, while it was only 5.5% in those in whom a constitutional syndrome was being evaluated. We conclude that the use of temporal biopsy should be more widespread, as its cost is low and it has no side effects; therefore, it can achieve a great benefit for the patient with a shorter and less expensive hospital stay.

Adolescent↗
PubMed1989

[Evaluation of the carbohydrate metabolism in the drug addict].

A prospective study to determine the carbohydrate metabolism in 23 intravenous drug users (IVDU) was carried out. 13 of them had no infection complications (group A), while the other 10 had acute associated infectious (group B). Both groups showed basal glycemia, insulin and glycosylated hemoglobin levels, similar to the control determinations. There were no correlations between these parameters and the hepatic function test alterations or the immunological changes in the IVDU. Our results showed that there were no alterations in the carbohydrates metabolism of the IVDU with a normal nutritional state, in spite of the well-known hypoglycemic effects of opiates in the experimental animal mode.

Adolescent↗
PubMed1989

[Natural history of HIV infection].

There are several questions still unanswered about the infection caused by HIV. Therefore, any account of the disease's natural history should be approached with caution. However, our current knowledge allows us to depict a sequence of situations, starting with the acute infection. After acquisition of infection, patients go through a variable duration silent phase (asymptomatic infection), some of them developing persistent generalized lymphadenopathy. An unknown percentage of both groups will eventually progress toward AIDS (infections final stage). In this paper we dealt with the above topics, following the CDC suggestion, and we try to answer the following questions: Is it possible to eliminate the virus? How many infected patients will evolve towards AIDS? When? Is it feasible an individualized prognosis?

Acquired Immunodeficiency Syndrome↗