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J M Arriero

Publications and source records attributed to J M Arriero.

At least 19 recordsLinked to original sources
PubMed2001

Acute psychosis after CPAP treatment in a schizophrenic patient with sleep apnoea-hypopnoea syndrome.

A 52-yr-old man with a residual phase of schizophrenia developed sleep apnoea-hypopnoea syndrome (SAHS). After five days of continuous positive airway pressure (CPAP) treatment, the patient developed an aggressive mood with incoherence, prominent hallucinations and agitation, and attempted to hit his relatives. He was finally admitted to the hospital with an acute psychotic episode. Withdrawal of CPAP, and neuroleptic treatment controlled the episode, and clinical symptoms of SAHS reappeared 10 days later. Schizophrenia associated to sleep apnoea-hypopnoea syndrome has rarely been reported, but, to the authors' knowledge, the induction of a psychotic episode by continuous positive airway pressure treatment in a patient with sleep apnoea-hypopnoea syndrome and coexisting schizophrenia has never been previously reported.

Acute Disease↗
PubMed1999

Perianal disease of tuberculous origin: report of a case and review of the literature.

PURPOSE: A case of anal tuberculosis in an otherwise asymptomatic patient with bleeding anal ulcers is presented. The clinical features of this entity and the problems in differential diagnosis between anal infectious vs. inflammatory diseases are discussed. METHODS: The management and outcome of the case of an adult patient who presented with perianal ulcers is described. RESULTS: On a three-drug antituberculous regimen, symptoms abated, radiographic infiltrates improved, and perianal ulcers healed. CONCLUSION: Anal tuberculosis is an extremely rare disease. A tuberculous origin must be considered when the cause of perianal ulcers is unclear to avoid undesirable delays in the diagnosis and treatment of this disease.

Anus Diseases↗
PubMed1999

[Validation of the Spanish version of the Epworth Sleepiness Scale in patients with a sleep apnea syndrome].

A Spanish version of the Epworth Sleepiness Scale (ESS-Sp) was developed by translation, back-translation, formal discussion, and a meeting of researchers with a group of patients with sleep apnea syndrome (SAS). The translated questionnaire was then tested in 345 patients, 275 with SAS at various levels of severity and 70 without SAS. Significant differences existed between the two groups as to age (53 +/- 11 years versus 47 +/- 13, p < 0.001) and BMI (32 +/- 5 versus 29.5 +/- 5, p < 0.001). Patients with SAS had significantly higher scores (14 +/- 5) than did those without SAS (10 +/- 5) (p < 0.001). Reproducibility was tested in 146 patients (113 SAS and 33 non-SAS), with no significant differences found among patients with SAS (14.9 +/- 5 versus 14.2 +/- 5, p = n.s.); significant differences in BMI were found, however, among the 33 non-SAS patients (12 +/- 5 versus 10 +/- 5, p < 0.01). Total scores and individual item scores were related in both groups. Likewise, each item was related to total score in patients with SAS. Sensitivity to post-treatment changes was assessed in 77 SAS patients, with initial scores of 16 +/- 4 seen to decrease to 4 +/- 3 after continuous positive airway pressure. ESS-Sp scores over 10 were recorded for 85% of patients with SAS: 78% of those with mild SAS, 85% of those with moderate disease and 92% of those whose SAS was severe. Significant inter-group differences were found upon applying a test of variance (p < 0.001). Differences continued to be detected when multiple correlations were looked for, with differences increasing with severity. SAS patients with ESS-Sp level one scores (< 10) had lower apnea-hypopnea indices (AHI) (35 +/- 18 versus 42 +/- 20, p < 0.05), lower desaturation levels (21 +/- 21 versus 34 +/- 28, p < 0.01) and higher minimum saturation (80 +/- 10 versus 75 +/- 12, p < 0.05), with no differences in age or BMI. A significant correlation was found between ESS-Sp score and respiratory variables recorded during polysomnography: AHI, r = 0.23 (p < 0.001); percent time in apnea-hypopnea, r = 0.18 (p < 0.01); desaturation index, r = 0.27 (p < 0.01) and minimum saturation (r = -0.14, p < 0.05). We conclude that the Spanish version of the ESS is equivalent to the original, is reproducible in patients with SAS, sensitive to post-treatment changes and seems to discriminate level of severity, showing correlation with polysomnograph variables.

Adult↗
PubMed1999

Bilateral lymphocytic alveolitis: a common reaction after unilateral thoracic irradiation.

The main aim of the present study was to assess the early diagnostic value of bronchoalveolar lavage (BAL) in radiation-induced lung injury in patients with breast carcinoma. Twenty-six females receiving postoperative radiotherapy for breast cancer were evaluated before and 0, 15, 30, 60, and 180 days after radiotherapy. History, physical examination, chest radiographs, and pulmonary function tests were obtained. BAL, including lymphocyte subsets analysis, was limited to the second evaluation after radiotherapy. A group of 21 healthy females were used as control. Findings after radiotherapy in asymptomatic patients were compared with findings in a group of patients with radiation pneumonitis. Irradiated patients showed a significantly (p<0.01) greater percentage (29.5+/-15.7%) of BAL lymphocytes than controls (6.2+/-3.3%). No statistical differences existed in BAL findings between the irradiated and unirradiated sides of the chest. Percentages of BAL lymphocytes did not differ significantly between patients who developed subsequent pneumonitis (24.5+/-13.5%) and those who did not develop pneumonitis (32.8+/-16.5%). Patients with pneumonitis at the time of BAL had significantly higher (p<0.05) alveolar CD4 subset cells (24.8+/-10.2%) than asymptomatic patients (15.2+/-8.9%). Maximal reductions in total lung capacity (p<0.01), and residual volume (p<0.05) occurred 60 days after irradiation. The early lymphocytic alveolitis induced by unilateral thoracic radiotherapy in most patients with breast cancer is always bilateral and does not predict the subsequent development of radiological evidence of pneumonitis.

Breast Neoplasms↗
PubMed1999

Nocturnal oximetry for the diagnosis of the sleep apnoea hypopnoea syndrome: a method to reduce the number of polysomnographies?

BACKGROUND: Polysomnography (PSG) is currently the "gold standard" for the diagnosis of the sleep apnoea hypopnoea syndrome (SAHS). Nocturnal oximetry (NO) has been used with contradictory results. A prospective study was performed to determine the accuracy of NO as a diagnostic tool and to evaluate the reduction in the number of PSGs if the diagnosis of SAHS had been established by this method. METHODS: Two hundred and seventy five patients with a clinical suspicion of SAHS were admitted to undergo, in the same night, full PSG and NO. Desaturation was defined as a fall in the haemoglobin saturation level (SaO(2)) to lower than 4% from the baseline level and an oxygen desaturation index per hour (ODI) was obtained in each patient with three cut off points: >/= 5 (ODI-5), >/= 10 (ODI-10), and >/= 15 (ODI-15). RESULTS: SAHS was diagnosed in 216 patients (194 men). After withdrawing patients with abnormal lung function (forced expiratory volume in one second (FEV(1)) lower than 80% predicted), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV) of NO were: ODI-5 (80%, 89%, 97%, 48%); ODI-10 (71%, 93%, 97%, 42%); ODI-15 (63%, 96%, 99%, 38%). The accuracy for each ODI was 0.81, 0.75, and 0.70, respectively. If NO had been considered as a diagnostic tool and PSG had been performed only in patients with a negative NO (false negative and true negative) and those with a positive NO and abnormal pulmonary function tests, 135/275 (ODI-5), 156/275 (ODI-10), and 170/275 (ODI-15) PSGs would have been performed, a reduction of 140, 119, and 105, respectively. CONCLUSION: Nocturnal oximetry in patients with suspected SAHS and normal spirometric values permits the institution of therapeutic measures in most patients.

Female↗
PubMed1999

Corynebacterium pseudodiphtheriticum pneumonia in an immunocompetent patient.

Corynebacterium pseudodiphtheriticum is a coryneform and diphtheromorphic bacteria rarely found as a cause of pneumonia in immunocompetent hosts. A case of an immunocompetent patient with C. pseudodiphtheriticum pneumonia is presented. This infection responded well to initial empirical treatment with cefotaxime. Very few cases of pneumonia associated with C. pseudodiphtheriticum have been described in the medical literature, this organism mainly being found in immunocompromised hosts. We report a case of pneumonia in an immunocompetent patient in which C. pseudodiphtheriticum was the only micro-organism isolated.

Aged↗
PubMed1998

[Obstructive sleep apnea syndrome in the Community of Valencia: current situation, study of needs and future prospects].

To analyze the infrastructure needs for diagnosing sleep apnea syndrome (SAS) in the Community of Valencia, we studied available resources and the diagnostic approaches to SAS in departments of pneumology and neurophysiology in 23 of the 25 public hospitals by means of a telephone interview. Only 52% of pneumology departments and 56% of neurophysiology departments studied SAS at any level. Level I study (conventional polysomnography) was performed by 42% of the pneumology departments and 100% of the neurophysiology departments. The remaining pneumology units used nighttime oximetry (a level IV technique). A special unit and trained personnel were available at 40% of hospitals. Home studies were performed by only 17%. Although 2,000 studies are performed annually, only 1,100 are level I and large interdepartmental differences were detected. The average waiting period was 16 months. Relations between pneumology and neurophysiology units were few and only one hospital took an interdisciplinary approach. The ratio of polysomnographs to inhabitants was 0.52/250,000 and the prevalence of nasal continuous positive airway pressure treatment was 36/100,000, lower than in other communities. We conclude that Valencia is understaffed and under-equipped, and that in some cases resources are under-used. Interdisciplinary approaches are scarcely used by the various specialists involved and the waiting lists for diagnostic tests required for prescribing empirical treatment are long. To attend the approximately 100,000 SAS patients estimated to reside in Valencia, it would be necessary to have 14 polysomnograph devices rather than the 8 available now, as well as to increase staff to meet demand and shorten waiting lists.

Adult↗
PubMed1998

Tuberculous pleurisy with or without radiographic evidence of pulmonary disease. Is there any difference?

SETTING: A community teaching hospital in Alicante, Spain. OBJECTIVE: To assess the characteristics of tuberculous pleurisy (TP) in our hospital, and to evaluate the differences between primary and reactivation forms. DESIGN: Between January 1984 and December 1993, all human immunodeficiency virus (HIV)-negative patients with TP were included in the study. From September 1987 onward, patients were prospectively studied. Charts, radiography, pleural fluid findings and diagnostic methods were evaluated. Two groups were distinguished according to chest radiographs: those patients with upper lobe lesions, calcified adenopathy and old pleural thickening were considered reactivation forms. RESULTS: Of the 129 patients (mean age, 31 +/- 18 years), 76% had primary TP and 24% reactivation TP. Differences were found in age (28 +/- 17 vs 40 +/- 18 years, P < 0.01), smoking (43% vs 74%, P < 0.01) and alcohol abuse (23% vs 47%, P < 0.05), weight loss (29% vs 50%, P < 0.05), positive sputum smears and cultures (2% vs 16%, 7% vs 28%, P < 0.01), and number of large effusions (46% vs 26%, P < 0.05), but not in tuberculin reactivity, pleural fluid findings, positive pleural cultures, or presence of pleural granuloma. CONCLUSION: In our setting, TP predominantly affects young adults. Clinical, immunological, and pleural findings are similar to those of patients with classic symptoms of TP. Older age, smoking and alcohol abuse, smaller effusions and sputum yield are differential characteristics of reactivation forms.

Adult↗
PubMed1996

CEA, CA 15-3 and CYFRA 21-1 in serum and pleural fluid of patients with pleural effusions.

The role of tumour marker assays in differentiating malignant from benign pleural effusions is not yet clear. This study was designed to prospectively assess the individual and combined diagnostic utility of three tumour markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3) and cytokeratin 19 fragment (CYFRA 21-1) were determined in 115 patients with pleural effusions (42 malignant and 73 benign). The diagnostic utility of each tumour marker was assessed using accuracy to determine the optimal cut-off point, whilst a logistic regression model was used to obtain the optimal combined test. In serum, every marker showed an individual high specificity (over 97%) for malignancy. The sensitivity of CEA, CA 15-3 and CYFRA 21-1 was 36, 48 and 31%, respectively. In patients without renal failure, the sensitivity of CYFRA 21-1 rose to 53%, while those of CEA and CA 15-3 remained almost unchanged. In pleural fluid, CYFRA 21-1 showed low sensitivity (32%) and specificity (82%), while CEA showed the highest sensitivity (57%). Excluding patients with renal failure, the combined determination in serum of CEA, CA 15-3 and CYFRA 21-1 has a high accuracy (88%), similar to that for CEA plus CA 15-3 in pleural fluid (87%). We conclude that CYFRA 21-1 is useless in pleural fluid and should not be used in serum for patients with renal failure. The combined determination of CEA, CA 15-3 and CYFRA 21-1 in serum may obviate its determination in pleural fluid.

Adolescent↗
PubMed1995

Effect of body position on gas exchange in patients with unilateral pleural effusion: influence of effusion volume.

The objective of this study was to evaluate the effect of lateral body position on gas exchange in patients with unilateral pleural effusion, with special reference to the influence of effusion volume. Thirty consecutive patients with unilateral pleural effusion, without evidence of parenchymal pulmonary involvement, were entered into the study. Arterial blood gas tensions (PaO2, PaCO2) were randomly measured in both right and left lateral decubitus body positions, while breathing room air. To assess the influence of the effusion volume, roentgenographic and functional parameters were used. Among the latter, FVC, FEV1, TLC and RV were determined. The influence of the presence or absence of pleuritic pain on gas exchange was also assessed. There was no significant difference in PaCO2 between right and left lateral decubitus body positions (31.1 +/- 4.2 vs. 31.0 +/- 4.5 mmHg). The differences in PaO2 between the two body positions ranged from 0.5-25 mmHg (mean 9.3 +/- 6.6 mmHg). Mean PaO2 with the normal-side (control) down (PaO2-N) (81.4 +/- 8.5 mmHg) was higher, but without significant statistical difference, than mean PaO2 with the effusion-side down (PaO2-E) (78.0 +/- 12.5 mmHg). PaO2-N was higher than PaO2-E in 22 of 30 patients (conventional), and lower in eight patients (paradoxical). No consistent relationship was found for alterations in PaO2 in different positions with the volume of effusion, either when estimated by a roentgenographic method or when using spirometric or plethysmographic values.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Lung metastases from prostatic carcinoma: orchidectomy-induced remission in two patients.

Two patients with pulmonary metastases from a prostatic carcinoma are described. When first seen by the pulmonary physician, respiratory symptoms were predominant and diagnosis of the primary site was not yet made. Orchidectomy achieved an impressive response with regression of symptoms and radiological lesions within weeks. Since metastatic deposits from prostatic origin may respond promptly to endocrine manipulation, this possibility must be taken into account in the evaluation of any patient with pulmonary metastases of unknown origin.

Adenocarcinoma↗