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Biomedical subjects

J Millá

Publications and source records attributed to J Millá.

34 records · Page 2Linked to original sources
PubMed1994

Posthypoxic myoclonus in intensive care.

Posthypoxic myoclonus (Lance-Adams' syndrome) is a rare complication of cardiorespiratory arrest. It has a better prognosis than other movement disorders secondary to brain ischaemia. We report a case of posthypoxic myoclonus in a 66-year-old woman after acute myocardial infarction and cardiopulmonary arrest. She had action and intention myoclonus, and these movements were also initiated by acoustic and pain stimuli. The origin of the myoclonus was probably subcortical, and it improved with clonazepam 2 mg t.i.d. We emphasize that early diagnosis is necessary in intensive care units in order to avoid misinterpretation of this syndrome and to start appropriate treatment.

Aged↗
PubMed1991

Statistical modeling of prognostic indices for evaluation of critically ill patients.

OBJECTIVE: To identify the most predictive association of variables from the usual indices of severity of illness by statistical objective analysis. DESIGN: Logistic regression analysis of the different variables of the most important indices. SETTING: A general critical care medicine group practice in a university hospital. PATIENTS: A total of 630 critical care patients age 12 to 87 yrs were evaluated. The most important indices of severity of illness and the corresponding variables were recorded and the patient's course was followed for 3 months after ICU admission. MEASUREMENTS AND MAIN RESULTS: One of our hypotheses was that the inclusion of an excessive number of variables to obtain the most common prognostic indices of mortality in critical care patients results in an underestimation of mortality and a redundancy of prognostic information. We performed a logistic regression analysis using the variables of the currently used indices of critical care prognosis: Acute Physiology Score, Simplified Acute Physiology Score, Acute Physiology Score-II, and Mortality Prediction Model. This mathematical approach resulted in a model of five variables: organ system failure, blood glucose, serum calcium, serum prothrombin activity, and serum osmolality. The score obtained from this model gave accurate prognostic criteria:sensitivity 91.2% and specificity 90%, using a cutoff point of 0.7; sensitivity 86% and, specificity 94%, using a cutoff point of 0.5. CONCLUSIONS: Our results show that suitable statistical management of the discriminant prognostic variables allows reduction of the number of variables of the severity indices currently used, obtaining five more predictive variables.

Adolescent↗
PubMed1982

Acute thallium poisoning: an evaluation of different forms of treatment.

Hemodialysis, forced potassium diuresis, chelating agents per os, and Dithiocarb given intravenously during short periods of time were used for the treatment of acute thallium poisoning (ingestion of 750 mg of thallium sulfate), and the effectiveness of these different therapeutic procedures was analyzed. Chelating agents per os (Prussian blue, Dithiocarb, and Dithiozone) were ineffective in our patient, since fecal excretion of thallium was very low and unmodified by them. Forced potassium diuresis and hemodialysis were very useful therapeutic measures, especially in the first 12 days following ingestion. Dithiocarb perfusion seems to be the most effective method for enhancing urinary thallium excretion. This method might be most useful in the treatment of thallium poisoning if its deleterious effects could be eliminated.

Acute Disease↗
PubMed1981

[Oliguric and non-oliguric renal failure in high risk patient in intensive care units (author's transl)].

Oliguric and non-oliguric acute renal failure was studied in a group of 28 high risk patients in an intensive care unit. Of these, 15 (53.5%) presented oliguric and 13 (46.4%) non oliguric acute renal failure. Causal agents of the renal failure were postoperative in 14 cases, mainly peritonitis; medical in 10 and posttraumatic in 4. Oliguric renal failure was most commonly medical, while non-oliguric renal failure was predominantly postoperative in origin (p less than 0.05). Results of urinalysis indicative of renal failure were similar in both groups: NAO, osmolarity, FeNa, BUN o/p and creatinine o/p, as were degree and course of renal failure, and the appearance of complications and indications for dialysis. There was no significant difference in mortality rate between oliguric (93%) and non-oliguric (85%) patients; total mortality was 89%. The results of this study clearly show that non-oliguric acute renal failure carries the same poor prognosis in high risk patients in intensive care units as do the oliguric forms of the entity.

Acute Kidney Injury↗
PubMed1979

[Acute abdomen due to hemoperitoneum as the first manifestation of a liver tumor. Report of four cases (author's transl)].

Four cases of spontaneous acute hemoperitoneum due to rupture of a liver tumor are presented. The resulting acute abdomen was the first manifestation of the neoplasia. The four tumors corresponded histopathologically to a cavernous hemangioma, a bening adenoma related to anabolizing androgens, and two hepatocarcinomas in cirrhotic livers. All of the patients presented abdominal pain and shock, the characteristics of which are described in this report. One of the patients died due to cardiac arrest before surgical treatment. Emergency surgery was performed on the other three, consisting of left hepatic lobectomy and ligature of the hepatic artery for the hemengioma, and segmented hepatectomy for the adenoma and the hepatocarcinoma. Only the patient with benign tumor survived. Lastly, the authors review the literature, commenting on the clinical, physiopathologic, therapeutic, and prognostic aspects.

Abdomen, Acute↗
PubMed1979

Metabolic acidosis and coma due to an overdose of nalidixic acid.

A case of severe metabolic acidosis and coma after taking 28 g of nalidixic acid is described. After administration of 600 mEq of sodium bicarbonate the patient developed a respiratory alkalosis with secondary tetany. She recovered her state of consciousness nine hours later and the acid-base disturbance resolved after sixty hours.

Acidosis↗