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J Castillo

Publications and source records attributed to J Castillo.

At least 145 records · Page 8Linked to original sources
PubMed1998

Timing for fever-related brain damage in acute ischemic stroke.

BACKGROUND AND PURPOSE: The association between hyperthermia and early neurological deterioration, increased morbidity, and mortality in acute ischemic stroke is well known. However, the timing at which the cerebral lesion may be aggravated by high temperature has not been firmly established. The aim of this study was to determine the prognostic value of body temperature measured at different times after onset of stroke. METHODS: Axillary temperature was recorded every 2 hour hours for 72 hours in 260 patients with a hemispheric cerebral infarction of <24 hours' duration. A potential infectious focus was examined in all patients with hyperthermia (temperature >37.5 degreesC in any of the assessments). Stroke severity was quantified with the Canadian Stroke Scale on admission. The relationship between the highest temperature recorded in each 6-hour interval from stroke onset and stroke outcome (Canadian Stroke Scale and Barthel Index at 3 months) or infarct volume was evaluated by correlation analyses. The importance of the time at which hyperthermia was first detected was assessed by logistic regression analysis. RESULTS: During the first 72 hours, 158 patients (60.8%) had hyperthermia, and in 57.6% of them an infectious cause was identified. Mortality rate at 3 months was 1% in normothermic patients and 15.8% in hyperthermic patients (P<0.001). The correlation coefficients between the final infarct volume, Canadian Stroke Scale and Barthel Index scores at 3 months, and each temperature recording decreased progressively over time from symptom onset. Hyperthermia initiated within the first 24 hours from stroke onset, but not afterward, was independently related to larger infarct volume (odds ratio [OR]=3.23, 95% CI=1.63 to 6.43; P<0.001) and higher neurological deficit (OR=3.06, 95% CI=1.70 to 5.53; P<0. 001) and dependency (OR=3.41, 95% CI=1.69 to 6.88; P=0.002) at 3 months. The infectious origin of hyperthermia was not associated with poorer outcome or greater infarct volume. CONCLUSIONS: The relationship between brain damage and high temperature is greater the earlier the increase in temperature occurs. However, only body temperature within the first 24 hours from stroke onset is associated with poor outcome and large cerebral infarcts.

Aged↗
PubMed1998

[Time for cerebral damage due to hyperglycemia in acute ischemia].

INTRODUCTION: Hyperglycemia increases morbimortality in cerebral infarcts. In animal models, this relationship is only seen during the initial moments of cerebral ischaemia. The time needed in humans for cerebral damage to occur due to hyperglycemia is not known. MATERIAL AND METHODS: We included 194 patients admitted within 24 hours of the start of their first clinical episode of cerebral hemisphere infarction. The glucemia was determined on admission and after 24, 48 and 72 hours. The neurological defect was evaluated on the Canadian scale on the seventh day. The volume of the infarct was determined on a second CT scan done between the fourth and seventh days after the episode. RESULTS: There was a positive association between the volume of the infarct and the glycemias on admission and after 24 hours, but this was not seen in later determinations. The difference in scoring, on the Canadian scale, on the seventh day, between patients with glycemias above or below 120 mg/dl decreased from the time of admission up to the time samples were taken 72 hours later. However, statistical significance persisted during the whole period studied. Nevertheless, in a logistic regression model, the glycemia on admission was the only determination associated with the Canadian scale on the seventh day (OR = 1.02; IC 95% = 1.01-1.02). CONCLUSIONS: There is a clear association between hyperglycemia and the worst stage of the infarct, and this is most intense in the first hours after onset of the clinical features.

Acute Disease↗
PubMed1998

[Comparison of hypertensive and non-hypertensive lacunar infarcts].

INTRODUCTION: Arterial hypertension and hypohyalinosis of the arterias perforantes are said to be the commonest cause of lacunar infarcts, although other etiological factors and anatomo-pathological lesions are described more and more frequently. We designed a study to compare the clinical topographic and prognostic characteristics of patients with hypertensive and non-hypertensive lacunar infarcts. MATERIAL AND METHODS: We selected 51 patients with lacunar infarcts: in 23 (45%) arterial hypertension was the only etiological factor recognized. In 28 (55%) other risk factors (16 diabetes mellitus, 17 cardiopathy, 8 hyperlipemia, 13 cigarette smoking and 11 alcoholism) were seen. We evaluated the form of presentation, the type of infarct and whether this was associated with headache. The degree of defect was determined on admission using the Canadian scale. The size of the infarct was measured on CT or RM, using whichever measurement was greater. The evolution of the condition was determined on the Canadian scale and the index of Barthel after three months. RESULTS: Age and sex distribution was similar to both groups. Motor hemiparesia was the commonest lacunar syndrome and the distribution was similar. There was no difference in form of onset, association with headache or neurological defect between the hypertensive and non-hypertensive lacunar infarcts. The topographical distribution, the presentation of single or multiple lesions, the size of the infarcts and the prognosis were similar in both groups. CONCLUSIONS: Lacunar infarcts, whether hypertensive or not, show no differences regarding clinical, neuro-radiological or evolutionary characteristics.

Aged↗
PubMed1998

[Magnesium in cerebrospinal fluid in acute cerebral ischemia: its relation to glutamate neurotoxicity].

INTRODUCTION: In animal models it has been shown that there is an increase in tissue magnesium concentration during cerebral ischemia. We studied the changes in magnesium levels in the cerebrospinal fluid (CSF) during the acute phase of cerebral ischemia. MATERIAL AND METHODS: We included 95 patients with first ischemic cerebral infarcts admitted to hospital within the first 24 hours and also 37 controls. CT scan was done on admission and between four and seven days later (when the volume of the infarct was determined). The neurological defect was evaluated on the Canadian scale on admission, after 48 hours, on the seventh day and after three months. The CSF magnesium concentration was determined using a colorimetric method and the glutamate by HPLC. RESULTS: The CSF magnesium concentrations were significantly higher in the patients than in the controls (2.6 +/- 0.6 mmol/l vs 2.2 +/- 0.6 mmol/l p = 0.0001). The magnesium concentration was higher in the larger infarcts (Pearson's coefficient = 0.2901, p = 0.0043), and in those presenting greater neurological defects after 48 hours (Spearman's coefficient = -0.4649, p < 0.0001). The magnesium concentration was not related to the presence of early signs on the initial CT scan and the Canadian scale rating on admission. The concentration of magnesium was significantly correlated with that of glutamate (Pearson coefficient = 0.7735, p < 0.0001). CONCLUSIONS: The levels of magnesium in the CSF were satisfactorily related to the volumes of the infarct and the intensity of the neurological defect. However, this association was late, occurring more than 48 hours after onset of the condition.

Acute Disease↗
PubMed1998

[Hospital mortality in ischemia: influence of two vascular risk factors].

INTRODUCTION: Acute cerebrovascular disease is a serious neurological problem. Mortality is between 6% and 30%. Most studies are in agreement that advanced age, type of ictus, size of lesion and clinical deterioration are factors determining mortality. However, its relationship to vascular risk factors is not completely clear. OBJECTIVE: To analyze the repercussion of different vascular risk factors on mortality during the acute phase of ictus. PATIENTS AND METHODS: We studied all patients with ictus admitted to the Servicio de Neurología of the Hospital Xeral de Galicia de Santiago de Compostela over a period of 3 years (n = 915). We recorded vascular risk factors and analyzed the causes of mortality whilst in hospital. RESULTS: Hospital mortality due to ictus was 16.8%. Mortality was 14.5% in cerebral infarct, 23.2% in intracerebral haemorrhage and 19.4% in subarachnoid haemorrhage. A total of 20.8% of the patients died of neurological causes, 24.7% of vascular causes, 26% due to infection and of uncertain causes in the remaining 28.6%. There was a neurological cause of death in 46.1% of the patients with subarachnoid haemorrhage, 25.5% with intracerebral haemorrhage and 14.8% with cerebral infarcts. Vascular risk factors associated with greater mortality were age (p < 0.001) and a history of cardiopathy (p < 0.05). CONCLUSIONS: Vascular risk factors which indicated worse prognosis were: age, type of ictus and a history of cardiopathy.

Aged↗
PubMed1998

[Morbidity due to intracerebral hemorrhage].

INTRODUCTION: Intracerebral hemorrhage (HIC) represents 10-30% of all stroke. Epidemiological studies have shown factors associated with its high mortality, but those which might lead to lower morbidity are little known. OBJECTIVE: To find the factors which may influence the functional state of a series of patients with intracerebral hemorrhage. PATIENTS AND METHODS: We made a prospective study of 203 patients with intracerebral hemorrhage. We recorded vascular risk factors, arterial blood pressure, laboratory and neuroimaging parameters obtained on admission. The functional condition when discharged from hospital was evaluated on the Rankin Scale, in three categories: independent (Rankin 0-1), partially dependent (Rankin 2-3) and totally dependent patients (Rankin 4-5). RESULTS: There was a 23.2% death rate. Of the 156 patients who survived, at the time of hospital discharge 35.8% had a score of 0-1, 50.6% a score of 2-3 and 13.4% a score of 4-5 on the Rankin Scale. Age (p < 0.005), hyperglycaemia (p < 0.05) and size of hemorrhage (p < 0.05) were associated with increased morbidity. CONCLUSIONS: The functional condition on hospital discharge was better in younger patients with lower levels of glycemia on admission and smaller hematomas on CT.

Adult↗
PubMed1998

[Clopidogrel].

Explore the source record for details and available documents.

Clopidogrel↗
PubMed1998

[Drug allergy in a population of surgical patients].

OBJECTIVES: To determine the prevalence of drug allergies in a population of surgical patients. To establish a clinical classification of events as being very or not very likely to be allergic reactions. To detect which drug groups are associated with greater incidence of anaphylactic reaction and to analyze the severity of such reactions. PATIENTS AND METHODS: Epidemiological study. During a preoperative interview, patients were asked if they were aware of the existence of any episode of allergy to drugs. If a patient answered yes, a specific data collection questionnaire on allergies was completed. Based on signs and symptoms described by the patient, reactions were classified as indicating high likelihood of allergy, low likelihood of allergy, or as being of unknown origin. RESULTS: We questioned 1,218 patients (754 women/464 men), of whom 159 (13.05%) reported being allergic to drugs. The total number of drugs employed was 212 (1.34 drugs/patient). Antibiotics (54.7%), nonsteroidal anti-inflammatory drugs (NSAIDs) (19.3%), radiological contrast media (6.1%) and local anesthetics (4.7%) were the substance groups most often mentioned. We classified 74.5% of the reactions as indicating high likelihood of allergy, 19.8% as indicating low likelihood, and 5.6% to be of unknown origin. The skin was involved in 72.1% of the reactions that were highly likely to have been caused by allergy; 6.9% of these reactions involved the respiratory tract, 4.4% the circulatory system, 12% the skin plus respiratory tract, and 4.4% the skin plus respiratory and circulatory systems. The most severe reactions (16.4%) were associated with radiological contrast media (36.4%), NSAIDs (33.3%) and intravenous administration (38.1%). Signs of latex allergy were seen in 0.4% and signs of allergy to hair dyes in 0.9%. All allergy tests were negative in all these patients. CONCLUSIONS: Drug allergy is reported by 13% of patients. It is highly likely that 74.5% of reactions are due to allergy. Antibiotics are the most frequently implicated drugs, followed by NSAIDs. The most serious reactions are caused by radiological contrast media and NSAIDs. Intravenous administration causes the most serious reactions.

Adolescent↗
PubMed1997

Progression of ischaemic stroke and excitotoxic aminoacids.

BACKGROUND: Mechanisms involved in progression of stroke are little understood. Studies in animals have shown an association between neuronal death mediated by excitatory aminoacids and deterioration in focal cerebral ischaemia. We looked for an association between concentrations of glutamate and glycine in plasma and cerebrospinal fluid (CSF) and early progression in a prospective study of 128 patients with acute ischaemic stroke. METHODS: Of 556 consecutive admissions to our emergency unit, 128 eligible patients with ischaemic stroke were included in our study. Blood and CSF samples were taken within the first 24 h from stroke onset when cerebral oedema had been excluded on a previous cranial computed tomography. Ischaemic stroke was judged to be in progression if the Canadian stroke scale score (1.5 = maximum neurological deficit, 10 = no deficit) fell by 1 or more points during the first 48 h after inclusion. Glutamate and glycine concentrations in plasma and CSF were measured by high-performance liquid chromatography. The effect of plasma and CSF glutamate concentrations on progression was analysed by logistic regression. FINDINGS: 43 (33.6%) patients had progressing ischaemic stroke. Concentrations of glutamate and glycine in plasma and CSF were higher in patients with progressing stroke than in those with stable cerebral infarcts (p < 0.0001). There was a significant linear correlation between CSF and plasma concentrations of glutamate (r = 0.79, p < 0.001). The positive predictive value of a plasma glutamate concentration of more than 200 mumol/L for progression of ischaemic stroke was 97% (95% CI 85-100). Glutamate concentrations of more than 200 mumol/L in plasma and of more than 8.2 mumol/L in CSF were independently and significantly associated with progression of neurological deficit (26.1 [6.9-98.6] and 40.9 [7.6-220], respectively). INTERPRETATION: Early neurological progression of acute ischaemic stroke is associated with high concentrations of glutamate in blood and CSF. Measurement of plasma glutamate may be useful for the early detection of those patients with acute stroke who will deteriorate during 48 h after onset.

Aged↗
PubMed1997

Synthetic-peptide-based enzyme-linked immunosorbent assay for screening human serum or plasma for antibodies to human immunodeficiency virus type 1 and type 2.

A synthetic-peptide-based enzyme-linked immunosorbent assay (EIA) capable of screening for antibodies to both human immunodeficiency virus type 1 (HIV-1) and HIV-2 has been developed for use in blood banks and diagnostic laboratories. Microtiter wells are coated with two synthetic peptides, one corresponding to the highly conserved envelope region of HIV-1 and another corresponding to the conserved envelope region of HIV-2. Overall, sensitivity was 100% in 303 individuals diagnosed with AIDS and 96 individuals diagnosed with AIDS-related complex, 14.8% in a study of 500 high-risk group members, 99.9% in 600 EIA repeatedly reactive (RR)-HIV-1 Western blot (WB)-positive repository specimens, and 100% for 222 geographically diverse HIV-1 specimens and 216 confirmed HIV-2-positive specimens evaluated. The specificity was determined to be 99.72% for a total of 13,004 serum and plasma samples from random volunteer donors evaluated across five blood banks. Forty donors who were found to be EIA RR-WB indeterminate but nonreactive on the United Biomedical, Inc., test (UBI HIV 1/2 EIA) were prospectively followed as an additional measure of specificity. None of the 40 low-risk cases evolved into a positive WB pattern at follow-up. The sensitivity and specificity of this new assay are comparable to those of other Food and Drug Administration-licensed HIV-1 and HIV-1-HIV-2 assays that are currently available in the United States. The UBI HIV 1/2 EIA affords laboratories another choice in the detection of antibodies for HIV-1 and HIV-2 with a test based on an alternative antigen format.

AIDS Serodiagnosis↗
PubMed1997

Duration of glutamate release after acute ischemic stroke.

BACKGROUND AND PURPOSE: High levels of glutamate in plasma and cerebrospinal fluid (CSF) have been demonstrated in patients with acute ischemic stroke. The duration of this excitatory amino acid release has not been studied, and therefore the window of opportunity of treatment with glutamate antagonists is unknown. The aim of this investigation was to study the duration of the glutamate increase in patients with stable and progressing ischemic stroke. METHODS: Glutamate in CSF was measured by high-performance liquid chromatography in 184 patients with an acute cerebral infarction of less than 24 hours' duration and in 43 control subjects. RESULTS: Among the 120 patients with stable ischemic stroke, median glutamate levels were significantly lower- and within the reference range of control subjects-in those patients studied 6 to 24 hours from onset of symptoms than in patients studied in the first 6 hours (3 [range, 2 to 10] versus 5 mumol/L [range, 2 to 17]; P < .0001). In 64 patients with progressing ischemic stroke, glutamate concentrations measured at any time interval during the first 24 hours from onset were significantly higher than in the stable stroke and control groups. CONCLUSIONS: The presence of glutamate increase in the CSF cannot be documented for greater than 6 hours in stable ischemic stroke. The sustained elevation of glutamate observed in progressing stroke suggests that the window to prevent neurological deterioration may be wider.

Acute Disease↗
PubMed1997

[Efficacy of ondansetron in the prevention of nausea and vomiting after laparoscopic cholecystectomy].

To assess the efficacy of 4 mg of intravenous ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV) in cholecystectomy, a type of surgery that is highly emetic. A random, double blind, placebo controlled study of 40 women over 18 years of age who were scheduled for non urgent laparoscopic cholecystectomy under general anesthesia. The patients were assigned to two groups to receive ondansetron (n = 23) or placebo (n = 17). Premedication and anesthesia were similar for all. The severity of PONV in the first 24 hours after surgery was recorded. There were no significant differences between the two groups with respect to biological characteristics or other factors that might influence the presentation or severity of PONV. The percentage of PONV-free patients was significantly higher in the ondansetron group than in the control group (73.91 and 11.76%, respectively; p < 0.001). Intravenous administration of 4 mg ondansetron is significantly superior to placebo for PONV prophylaxis after laparoscopic cholecystectomy.

Adult↗
PubMed1997

[Systemic autoimmune diseases with neurocutaneous alterations].

Autoimmune diseases depend on the pathologic activation of cellular clones, potentially harmful, against soft tissues. They can be classified into systemic and organ-specific diseases. In the systemic subtype, in which the abnormal hyperactivity is not as specific, the most remarkable component of the clinical syndrome is frequently the presence of neurological and/or cutaneous manifestations. This article reviews the major pathogenic mechanisms involved in the principal systemic autoimmune conditions including connective tissue diseases (rheumatoid arthritis, systemic lupus erythematosus, polimyositis, dermatomyositis, scleroderma, mixed connective tissue disease, Sjögren's syndrome, overlap syndromes) and vasculitic syndromes (nodous polyarteritis, giant cell arteritis. Wegener's granulomatosis. Behçet disease, microscopic polyarteritis, cryoglobulinemia) as well as their clinical manifestations, focused mainly on neurocutaneous characteristics.

Autoimmune Diseases↗
PubMed1997

[Admission to a hospital with a stroke: the situation at the present time].

OBJECTIVE: Patients with ictus spend a long time in hospital. This is partly to the fact that it is a severe condition. In which complications frequently develop, in elderly patients with social problems due to their subsequent disability. Also this prolonged hospital stay may be the result of misconceptions as to the object of hospitalization in cases of stroke. DEVELOPMENT: Whether to admit to hospital for stroke depends on the type of hospital, availability of other centres for chronic cara and the existence of satisfactory social services. During the acute phase of the illness, medical and neurological stability of the process is necessary together with minimization of cerebral damage. Hospital stay may be prolonged to study other secondary medical conditions and because of the uncertain prognosis using evolutionary criteria. This cases additional medical complications in these patients. Findings of the 'Grupo de Estudio de Enfermedades Cerebrovasculares de la SEN', show that prolonged hospital stay in cases of intracerebral haemorrhage cannot be justified by either the severity of the clinical picture, the mortality whilst in hospital or the functional capacity of the patient. CONCLUSION: The objectives of hospitalization in cases of ictus must be defined to optimize care, reduce complications and improve use of health care resources.

Cerebral Hemorrhage↗
PubMed1997

[Potential and real drug interactions in critical care patients].

OBJECTIVES: To detect potential drug interactions occurring during treatment of critically ill patients and to evaluate the real clinical and analytical repercussions of such interactions. PATIENTS AND METHODS: Seventy consecutive patients in a six-bed medical-surgical intensive care unit (ICU) were studied prospectively over a period of five months. The pharmacological department of the hospital provided the drugs through a computerized unit dosing system, using a program that gave warnings of possible drug interactions as each patient's treatment was entered. Interactions were cataloged according to clinical importance following the criteria of Hansten. The repercussions were evaluated by clinical and analytical monitoring. RESULTS: On hundred two potential interactions were detected in 44.3% of patients (1.5 interactions per patient). In 6 patients (19.3%) analytical alterations were observed but only 2 (6.4%) of them presented clinical manifestations. Most of the interactions were cataloged as being of moderate clinical importance. Digoxin was the most frequently implicated drug. The number of drugs administered per patient was 14.7 and patients receiving the most drugs were the most likely to experience and interaction. We found a significant correlation (p < 0.05) between the number of interactions and age, APACHE III score, length of ICU stay and number of drugs administered. CONCLUSIONS: The frequently of drug interactions in critically ill patients can be high, given the large number of drugs they receive. Although the real clinical repercussions of interactions are few, physicians should watch for them and the act appropriately.

Critical Care↗