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Biomedical subjects

J Esteban

Publications and source records attributed to J Esteban.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Nocardial keratitis after laser in situ keratomileusis.

PURPOSE AND METHODS: Corneal interface central nodules appeared in a patient who underwent uncomplicated laser in situ keratomileusis (LASIK) retreatment for residual myopia. RESULTS/CONCLUSIONS: Nocardia asteroides keratitis was confirmed by microbiologic studies, which guided treatment. Six months after the appearance of the keratitis, the patient's uncorrected visual acuity was 20/45, and spectacle-corrected visual acuity was 20/40. The postoperative refraction was +0.75 -0.75 X 95 degrees, and slit-lamp examination revealed a clear cornea with a mild rounded scar in the central area. Night halos and starbursts were the main complaints in this patient. The immediate management of lifting the corneal flap for stromal bed scraping, fast microbial identification, and proper treatment was the key for the results in this patient.

Administration, Topical↗
PubMedDate not supplied

A prospective randomised European multicentre study of medium-long run mortality and morbidity comparing acetate-free biofiltration and bicarbonate dialysis.

In recent years, the progressive increase in the mean age of the population entering chronic dialysis treatment has been responsible, on the one hand, for the growing number of patients undergoing regular dialysis, and on the other, for the high number of "critical" patients, both as a result of their age and the presence of concomitant morbidity. Thus, dialysis treatment today is not only aimed at waste removal and water-electrolyte homeostasis, but also at a reduction in morbidity and mortality, and at improving the patients' quality of life, thanks to the use of biocompatible materials and the achievement of good cardiovascular tolerance to treatment. Consequently, diffusive-convective dialysis procedures have been on the increase, since they combine better depuration with the use of biocompatible high-flux membranes. Acetate-free biofiltration (AFB) is a diffusive-convective dialysis procedure which utilises a high-flux membrane, AN69, post-dilution infusion of a sodium bicarbonate solution (NaHCO3), and a dialysate which is completely free of any buffer, and thus also free of acetate, which may have various negative effects on the patient. A number of studies have already shown the better hemodynamic stability and the reduction of intradialytic side-effects during AFB. All these, however, were short-term studies. To verify the beneficial effects of AFB in the long run, a three year multicentre randomised European trial has been proposed to compare bicarbonate hemodialysis (BD), a technique used in nearly 80% of the world's dialysis population, and AFB. The specific aim of the investigation is to verify, in a large number of patients, the results of hemodialysis treatment in terms of morbidity, mortality and quality of life. The study involves 80 hemodialysis units across Italy, France, Germany, Spain, Slovenia and Croatia, with enrollment of about 400 patients considered "critical" for at least one of the following reasons: age, diabetes, dialysis cardiovascular instability. Fifty percent of the patients are to undergo AFB with the AN69 membrane and bicarbonate solution infusion (NaHCO3 145 or 167 mEq/lt), and the other fifty percent are to be treated by BD, with any membrane except the nonmodified cellulosic one. Biochemical, cardiological, and nutritional parameters will be considered throughout the study. Mortality, morbidity both in terms of intra- and interdialysis symptoms - and hospitalisation rate, as well as the patients' quality of life, evaluated by the SF36 questionnaire, will be analysed.

Aged↗
PubMedDate not supplied

[Lhermitte's sign in three oncological patients].

INTRODUCTION: Lhermitte's sign was first described by Pierre Marie and Chatelin in 1917. Lhermitte published his report in 1920 and reviewed this in 1924. This phenomenon is characterized by the occurrence of an electric shock-like sensation going along the spine in a cervico-caudal direction with flexion of the neck, and may also be felt in the upper and lower limbs. Clinical cases. Case 1. A 49 year-old woman diagnosed as having breast cancer and being treated with cisplatin presented with Lhermitte's sign. On physical examination the osteotendinous reflexes were absent but the abdominal cutaneous reflexes were present. There was reduced sensitivity to vibration. Case 2. An 80 year-old man, previously operated on for adenocarcinoma of the colon, without further treatment, presented with progressive weakness of all four limbs and Lhermitte's syndrome. On examination there was obvious weakness of all four limbs, with the sensory level at C3. A cervical MR scan showed a metastasis in the vertebral body of C3 with epidural involvement and compression of the spinal cord. Case 3. A 54 year-old man was being treated by radiotherapy for cancer of the larynx. He presented at the onset of Lhermitte's sign but MR and physical examination were normal. CONCLUSION: Lhermitte's sign is non-specific, although in oncological patients a detailed clinical history and examination should be done seeking data regarding chemotherapy, radiotherapy and spinal compression.

Aged↗
PubMedDate not supplied

[L-arginine-nitric oxide pathway in hemodialysis].

Nitric oxide (NO) is derived from the metabolism of the amino acid L-arginine by NO synthase (NOS). One of the forms of NOS (i-NOS) can be induced by cytokines, bradykinin and endotoxin. During hemodialysis (HD), blood-dialysis membrane interaction can induce production of these mediators. HD can also induce changes of asymmetrical dimethylarginine (ADA), a potent inhibitor of NOS. The aim of this study was to investigate the effect of HD, using cuprophane (C, polyacrilonytrile (PAN) and special polyacrylonitrile (SPAN) membranes, on cellular NOS activity, and changes of plasma tumor necrosis factor (TNF-alpha), bradykinin, ADA and nitrate concentration. Before HD, cellular i-NOS activity was similar with the three membranes. Cuprophane HD induced a significant increase in i-NOS activity from 31 +/- 10 to 48 +/- 12 fmol-1 10(6) cells (p < 0.05). No changes were found in PAN and SPAN HD. The TNF-alpha values increased significantly during HD with C (56 +/- 6 vs 47 +/- 5 pg/ml, p < 0.05). No changes of bradykinin concentration were found during HD. A significant decrease of ADA and nitrate levels was observed during HD with three membranes. No significant correlation was found between percentage increase in i-NOS activity and the changes in other parameters. These findings suggest that HD with bioincompatible membranes can induce activation of cellular i-NOS.

Adult↗
PubMedDate not supplied

[Isolation of Mycobacterium tuberculosis with primary resistance to chemotherapeutic agents in patients with HIV infection].

BACKGROUND: To evaluate the resistance of Mycobacterium tuberculosis in subjects with simultaneous infection by the human immunodeficiency virus. METHODS: Isolation of Mycobacterium tuberculosis was carried out in a University hospital over a period of 7 years with selection of those corresponding to subjects with HIV infection. The isolation of Mycobacterium tuberculosis with resistance to one or more chemotherapeutic drugs was identified and is described herein. RESULTS: A total of 287 subjects were identified having tuberculous disease, 39 (13.59%) of them presented a simultaneous infection by the human immunodeficiency virus. In 4 of the latter (10.26%) Mycobacterium tuberculosis resistant to one or more chemotherapeutic drugs was isolated with the most frequent resistance being to isoniazide (3/4). CONCLUSIONS: A high degree of diagnostic suspicion must be maintained in patients with the human immunodeficiency virus with respect to tuberculosis, not only because of frequent endogenous activation but also because of the danger of in-hospital transmission. The possibility of resistance makes systematic antibiograms in these cases advisable. In these patients recommendations regarding treatment should be followed avoiding shortened or simplified therapeutic periods which have occasionally been demonstrated as ineffective.

Adult↗
PubMedDate not supplied

[Brachial presentation of spinal pseudochoreoathetosis. The result of proprioceptive information being processed in parallel].

INTRODUCTION: The term pseudochoreoathetosis is used to refer to the choreoathetoid movements that are produced by alterations in the proprioceptive sensitivity due to damage it has suffered at some point along its course. Proprioceptive sensitivity is considered to go up as far as the cortex along the posterior cords of the spinal cord, which means that if they are injured in the cervical region there should be a sensory deficit in both the upper (UL) and lower limbs (LL). CASE REPORTS: We describe five cases of transverse myelitis with localised cervical injury that selectively and mainly affected the posterior cords of the spinal cord. In the five patients there was selective involvement of the proprioceptive sensitivity in the UL respecting the LL and pseudochoreoathetoid movements of the limb that has been deafferented for proprioceptive sensitivity. The dissociation between the UL and the LL occurs because the spinocerebellar and spinocervical tracts take the proprioceptive information from the LL in parallel to the posterior cords, which receive the proprioceptive sensitivity from the UL. CONCLUSIONS: At present, the most widely accepted physiopathological mechanism explaining pseudochoreoathetosis consists in a failure in the integration of the sensory-motor afferences in the striatum, which causes faulty sensory-motor integration at this level and gives rise to pseudochoreoathetosis.

Adolescent↗
PubMedDate not supplied

[Acute confusional syndrome of unknown cause. Prospective study in the emergency room].

In a prospective study conducted in the Emergency Area of a general hospital during a period of 6 months, the Neurology Service was consulted in 45 cases of acute confusional syndrome. Twenty nine of these patients had no immediate apparent etiology. Among the studied patients 5 had a subarachnoid hemorrhage, 4 suffered a central nervous system infection, 3 had a cerebral infarction, 3 presented a metabolic encephalopathy, and the remaining patients had variate etiologies. Clinical signs and symptoms were insufficient to establish the diagnosis and in several cases complementary tests were required (cerebral tomography and cerebrospinal liquid examination). Even in these cases the diagnosis could not be obtained in some patients. The clinical implications of the present findings were discussed.

Acute Disease↗