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Biomedical subjects

J Morera

Publications and source records attributed to J Morera.

At least 55 records · Page 3Linked to original sources
PubMed1997

Electron microscopic microanalysis of bronchoalveolar lavage: a way to identify exposure to silica and silicate dust.

OBJECTIVES: The diagnostic implications of finding non-fibrous inorganic particles in bronchoalveolar lavage (BAL) fluid has not been fully assessed. The aim of this study has been to measure the silica and non-fibrous silicates in BAL fluid from populations with different exposures to inorganic dust, and to find whether such measurement is useful for diagnostic purposes. MATERIALS AND METHODS: BAL samples from 19 subjects with only environmental exposure to inorganic dust (group A, mean (SD) age 50.7 (15.2)), 23 subjects with normal chest x ray films exposed to silica or silicates at work (group B, mean (SD) age 52.0 (12.4)), and 15 subjects with a previous diagnosis of silicosis (group C, mean (SD) age 68.0 (6.5)) were studied. Absolute and relative cell counts were found, and the samples were prepared for microanalysis by electron microscopy (EM). Firstly, semiquantitative x ray microanalysis was performed to find the level of silicon (Si) (peak/background Si) and this was followed by microanalysis of individual particles by EM. Variables related to the level of Si detected were assessed with multivariate analysis. RESULTS: Detected levels were higher in group B (2.09, 95% confidence interval (95% CI) 1.56 to 2.82) and C (1.50, 95% CI 1.07 to 2.12) than in group A (0.87, 95% CI 0.66 to 1.16) (P < 0.05, Dunett t test). A first multivariate analysis showed that exposure to silica or silicates was the only determinant of the level of Si expressed as log peak/background Si, when adjusted for age, sex, smoking habit, and cell count. A second multivariate analysis with microanalysis of individual particles as an independent variable showed the silica count to be the main predictor of detected concentration of Si. Silica and non-aluminium silicates together explain 55.5% (R2) of the variation in detected levels of Si. CONCLUSIONS: Detected levels of Si in BAL fluid depend on silica count and are higher in subjects with exposure to inorganic dust at work, but will not discriminate between exposed subjects with and without silicosis. Because semiquantitative x ray microanalysis does not accurately define exposure to non-silica inorganic particles, this measurement must be followed by EM microanalysis of individual particles in most cases, especially when exposure to silicates or metal dust is suspected.

Adult↗
PubMed1997

Pancoast's syndrome due to chronic pneumonia by Pasteurella multocida.

Infectious causes of Pancoast's syndrome are extremely rare. We describe the case of a patient with Pancoast's syndrome due to chronic pneumonia resulting from Pasteurella multocida. The patient was not immunosuppressed and had had no contact with animals. The diagnosis was made by transthoracic needle aspiration and institution of therapy with cefuroxime-axetil resulted in resolution of his symptoms.

Adult↗
PubMed1997

[Analysis of the situation of Valencian neurology by the Commission of Analysis of the Quality of Valencian Neurological Society].

INTRODUCTION: The Comision de Analisis de la Calidad de la Sociedad Valenciana de Neurologia has made a proposal of Neurology care requirements, based on the findings of various studies done in this region. There studies suggest that there should be a proportion of 3 neurologists per 100,000 inhabitants. METHOD: An analysis of requirements was made, based on evaluation of the public health service, private practice and trainee specialists (MIR) regarding this problem. The need for emergency neurological attention, and the place of a hierarchy and a system for referral was also considered. RESULTS: It was calculated that 109 neurologists are required, 11 in Castellon, 63 in Valencia and 35 in Alicante. This would mean a proportion of 2,66 neurologists per 100,000 inhabitants in Castellon, 2,90 in Valencia and 2,70 in Alicante. The total figure for the whole Community would be 2,82 per 100,000 inhabitants. CONCLUSIONS: At the present time neurological care is expensive, since a lack of specialists means waiting lists, poor patient care and high costs due to inappropriate use of technical resources.

Emergency Medical Services↗
PubMed1996

[Acute lipoid pneumonia. Report of 2 cases].

Lipoid pneumonia is a chronic infiltrative pulmonary process secondary to continued aspiration of exogenous lipids (laxatives and nasal drops). On occasions, an acute form of lipoid pneumonia which may lead to respiratory failure may be observed coinciding with accidental massive aspirations of lipidic material. Two cases of acute lipoid pneumonia secondary to paraffin aspiration in << fire eaters >> are presented.

Accidents, Occupational↗
PubMed1996

Maximum inspiratory and expiratory pressures have no daytime variation in healthy men.

The variation of maximal respiratory pressures (Pimax and Pemax) in healthy subjects were studied on the same day in 16 non-smoking healthy men (age 26.2 +/- 3.2 years). The Pimax and Pemax were obtained on three occasions (8 a.m., 2 p.m. and 9 p.m.) within the same day. There were no differences between readings for Pimax and Pemax values.

Adult↗
PubMed1996

Detection of Legionella pneumophila serogroup 1 antigen in nonconcentrated urine and urine concentrated by selective ultrafiltration.

We evaluated a commercially available radioimmunoassay technique for detecting the soluble antigen of Legionella pneumophila serogroup 1 using concentrated and nonconcentrated urine. Concentration was achieved by selective ultrafiltration. The sensitivity of the technique was 60.9% for nonconcentrated urine and 80.4% for concentrated samples, with 100% specificity in both cases.

Antigens, Bacterial↗
PubMed1996

Sarcoidosis: chest radiograph screening of familial contacts.

On the basis of the hypothesis that sarcoidosis might be a transmissible disease, we thought a study of the familial contacts of known cases, as is done in tuberculosis, might reveal asymptomatic cases. In order to assess the efficiency of chest radiographs in detecting asymptomatic sarcoidosis in such contacts, we carried out a cross-sectional study. The population studied consisted of 66 index cases of sarcoidosis who were self-selected by their agreeing to take part in the study. Criteria were established with regard to the size of the family to be studied, along with three grades of intensity in the relationship between the index cases and their respective contacts. 976 familial contacts over 14 years of age, from grandparents to grandchildren of the index cases were identified, including nonconsanguineous contacts. 496 close contacts were asked to take part in the survey. Among these contacts there were 2 with a previous sarcoidosis, a prevalence of 4/1,000. 239 of these 496 contacts agreed to radiograph screening. Among those screened, no new cases of sarcoidosis were detected. We concluded that at present in our environment, with a low incidence and good prognosis, routine screening of relatives is not indicated. Nevertheless, longitudinal epidemiological studies designed to ascertain the pattern of transmission of the disease and including chest radiograph screening in a population with a high incidence of the disease could be of interest.

Adult↗
PubMed1996

Evaluation of the use of three different devices for nocturnal oxygen therapy in COPD patients.

OBJECTIVE: To determine whether transtracheal catheter and reservoir nasal cannula contribute to maintaining adequate oxygen saturation during sleep, and to calculate the oxygen saving they allow compared to nasal prongs. DESIGN: A prospective study in which patients were randomly assigned to either nasal prongs or oxymizer device prior to transtracheal oxygen delivery. Arterial oxygen saturation was then monitored by a finger pulse oximeter during 8 h of sleep. SETTING: Pulmonary ward of 'The Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona/Spain)'. PATIENTS: Fourteen stable hypoxemic (PaO2 50 +/- 6.9 mm Hg; PaCO2 51.5 +/- 9.3 mm Hg) COPD patients (FVC 44 +/- 19%; FEV1 26.5 +/- 11.5%; FEV1/FVC 44.9 +/- 9.7%) already receiving oxygen therapy at home. MEASUREMENTS: Pulmonary function test was performed. The lowest flow required to obtain an SaO2 at or above 88% for over 95% of the sleep time was determined for each type of oxygen delivery. Patients were not switched to the next type of oxygen delivery device until 3 reliable pulse oximetries had been obtained. The percentage of oxygen savings was calculated. Awake PaO2 was measured in patients using nasal prongs and transtracheal catheter while continuing to inspire oxygen at the same flow rate as when asleep. RESULTS: As expected, no differences were found in SaO2 measurements for the three types of oxygen delivery. Oxygen savings were 48.65% for the oxymizer device and 52.87% for the transtracheal catheter. Awake PaO2 was significantly higher (p < 0.04) in patients with nasal prongs than in those with transtracheal catheter at the flow rate required when asleep. CONCLUSIONS: The oxymizer device and transtracheal oxygen delivery benefit hypoxemic COPD patients reducing oxygen use during sleep by around 50%. Higher PaO2 levels were necessary to prevent nocturnal SaO2 decreases in patients with nasal prongs than in patients with transtracheal oxygen delivery. Oxygen-conserving devices are reliable and advisable methods for nocturnal oxygenation.

Aged↗
PubMed1996

Acoustic analysis of snoring sound in patients with simple snoring and obstructive sleep apnoea.

Snoring, a symptom which may indicate the presence of the obstructive sleep apnoea syndrome (OSA), is also common in the general population. Recent studies have suggested that the acoustic characteristics of snoring sound may differ between simple snorers and OSA patients. We have studied a small number of patients with simple snoring and OSA, analysing the acoustic characteristics of the snoring sound. Seventeen male patients, 10 with OSA (apnoea/hypopnoea index (AHI) 26.2 events x h(-1)) and seven simple snorers (AHI 3.8 events x h(-1)), were studied. Full night polysomnography was performed and the snoring sound power spectrum was analysed. Spectral analysis of snoring sound showed the existence of two different patterns. The first pattern was characterized by the presence of a fundamental frequency and several harmonics. The second pattern was characterized by a low frequency peak with the sound energy scattered on a narrower band of frequencies, but without clearly identified harmonics. The seven simple snorers and two of the 10 patients with OSA (AIH 13 and 14 events x h(-1), respectively) showed the first pattern. The rest of the OSA patients showed the second pattern. The peak frequency of snoring was significantly lower in OSA patients, with all but one OSA patient and only one simple snorer showing a peak frequency below 150 Hz. A significant negative correlation was found between AHI and peak and mean frequencies of the snoring power spectrum (p<0.0016 and p<0.0089, respectively). In conclusion, this study demonstrates significant differences in the sound power spectrum of snoring sound between subjects with simple snoring and obstructive sleep apnoea patients.

Acoustics↗
PubMed1996

[Efficacy and tolerance of the treatment of tuberculosis in the aged].

We analyzed 55 confirmed cases of tuberculosis in patients over 65, a sample that amounted to 9% of all patients seen in our practice over a period of 5 years. Mean age was 72.4 and the male/female ratio was 4/1. The most frequently associated diseases were tobacco addiction (49%), chronic obstructive pulmonary disease (33%), alcoholism (25%) and prior diagnosis of tuberculosis (20%). Lung involvement was the most common clinical presentation (76%), followed by pleural (9%) and skeletal (7%) involvement. The clinical picture was non specific, with 13% remaining asymptomatic. Cough was the most frequent symptom (45%) and unilateral apical fibrosis with ulceration was the most frequent radiological finding. Pleural discharge and cavitation were demonstrated in 14 and 22%, respectively. Scarring was visible on X-rays in 44%. The tuberculin test was positive in 88% of the cases in which it was performed. Mean delay in diagnosis was 3.4 months; 62% were diagnosed by sputum test, 11% by culture, and 27% histology. In 4% death was directly caused by tuberculosis. Three patients withdrew from treatment, in one case treatment failed, and there was one relapse detected at follow-up. We observed adverse side effects in 33%, and found no statistically significant differences between the 2 therapeutic protocols used (2 months RHS/7 months RH and 2 months RHZS/4 months RH). The incidence of tuberculosis among the elderly is low in our practice and the entity behaves much as it does in the rest of the adult population. Both the efficacy and tolerance of treatment can be considered optimal.

Adult↗
PubMed1996

[Pleural tuberculosis: analysis of 105 cases].

BACKGROUND: We present the results of a retrospective study with patients diagnosed of tuberculous pleuritis (TP) to offer a view and a perspective of this entity in our area. METHODS: We reviewed 105 cases of TP according to age, tuberculous risk factors, clinical onset, tuberculin test, chest roentgenogram, pleural fluid analysis (ADA, LDH, glucose and proteins) and pleural biopsy, and the evolution or sequels of the pleural effusion after a specific treatment. RESULTS: TP was a disease of younger patients (62% less than 30 years old) with tuberculous risk factors (34.3%), positive tuberculin test (81%) and an acute or subacute onset (88.5%). The pleural effusion was unilateral (98.1%), small-sized (61%), with pulmonary infiltrates in the 22.4%. All of the effusions were exudates with the exception of a transudative case. The levels of LDH, glucose and ADA were increased and the white cell counts below 6000/mm2, predominantly mononuclear. ADA was below 40 U/L in the 17% of cases. Pleural biopsy established the diagnosis in the 92.2% and the diagnosis was obtained in the 98.6% when we associated the analysis of ADA, pleural fluid and pleural biopsy. Specific treatment was accompanied with a good response. CONCLUSIONS: Our findings supported that TP maintained the predilection for younger patients with tuberculous risk factors. The clinical onset, radiographies, pleural fluid analysis and the utility of all diagnostic examinations were similar to other previous studies with the exception of few atypical cases. We confirmed a good prognosis with a correct treatment.

Adolescent↗
PubMed1996

Epidemiology of sarcoidosis in Catalonia: 1979-1989.

For the purpose of estimating the incidence rate and clinico-epidemiological characteristics of sarcoidosis in Catalonia (a country comprising the provinces of Barcelona, Tarragona, Lleida and Girona, with a total population of 6 million people), we did a retrospective study of new cases diagnosed in the country's qualified hospitals during 1979 and the three-year period from 1986 to 1988. The annual incidence rate in the province of Barcelona was 1.2/100,000 in 1979 and 1.5/100,000 in 1988. 245 cases were diagnosed in Catalonia in the three-year period covering 1986-88, the annual incidence rate being 1.36/100,000 inhabitants. We describe here the characteristics of this series of 245 cases (which is the first one representative of the whole of Catalonia), and compare them with those of other series published previously. We conclude that the incidence of sarcoidosis in our country is one of the lowest in Europe, with no significant variations observed over ten years. The most relevant clinico-epidemiological characteristics are its clear predominance in women (3:1), and the high frequency of Löfgren's syndrome (48% of cases), whose incidence is significantly higher in springtime.

Adolescent↗
PubMed1996

[Factors associated with pleural thickening in pleural tuberculosis. Review of 99 cases].

OBJECTIVE: To analyze which factors were related to the development of pleural thickening in pleural tuberculosis (PT). METHODS: We reported 99 patients diagnosed as having PT separated into two different groups according to the presence of radiographic pleural thickening after completing the treatment: normal chest roentgenogram (group 1) or pleural thickening (group 2). We compared: clinical history, chest radiography, pleural fluid analysis, microbiological studies and effects of the treatment. RESULTS: 35 cases in group 1 (35.35%) and 64 in group 2 (64.45%). All the compared results did not differ between the two groups, excluding a higher incidence of febrile cases, increased white cell count and decreased relative percentage of pleural lymphocytes in group 1, and increased number of cases with hemoptysis, positive sputum cultures in patients with parenchymal infiltrates, relative percentage of pleural lymphocytes and decreased white cell count in group 2. CONCLUSIONS: We reported an elevated incidence of residual pleural thickening, but it is unlikely that all the cases could have any clinical significance. We didn't confirm a characteristic pattern. Our findings suggested that a different reaction related or not to the hypersensitivity, rather than the inflammatory response to infection was the responsible for the fibrosis.

Adolescent↗
PubMed1995

[The Kveim-Siltzbach test in sarcoidosis].

BACKGROUND: The Kveim-Siltzbach test has been widely used in the diagnosis of sarcoidosis. This reactive is currently available in the authors' hospitals. Previous experience with this test in the same centers was reviewed to know its diagnostic usefulness. The present is the first series described in Spain. METHODS: From 1977 to 1988 the Kveim-Siltzbach test was performed in 79 patients diagnosed or suspected of having sarcoidosis. The study was carried out as cooperation of the validation process of sarcoid spleen suspensions (lots K12, K12 1/2, K32, K41, K42, K42 1/2 and K50 of the Colindale antigen) prepared in the Standards Laboratory for Serological Reagents in the Royal Brompton Hospital in London. RESULTS: The results of test positivity were determined following the criteria established by Siltzbach. The global sensitivity of the Kveim-Siltzbach test was 78% (CI 95% = 67.8-86.9). Positivity ranged from 84% in subacute sarcoidosis to 61% in chronic sarcoidosis (p = 0.08). Likewise, it was higher in patients with radiologic stage I (84%) and II (81%) with respect to stage III (62%) or the cases with exclusive extrathoracic sarcoidosis (stage 0) (57%) (p = 0.11). No association was found between the Kveim-Siltzbach test positivity and the elevation in serum values of the angiotensin-converting enzyme (p = 0.575). CONCLUSIONS: In the present study the Kveim-Siltzbach test showed high sensitivity in the diagnosis of sarcoidosis. This fact, together with the high specificity observed in other studies, makes the test a very useful tool for the non-invasive diagnosis of sarcoidosis.

Acute Disease↗
PubMed1995

[Transtracheal catheter and liquid oxygen: 5 years of experience].

We studied clinical tolerance, complications, change in pulmonary function test results, arterial gasometrics, hemoglobin (Hb), 6 minute stress tests (6 wt) and subjective perception of dyspnea assessed on a visual analog scale (VAS) in a group of 18 patients (17 with obstructive disease and one with restrictive disease). These patients had previously been enrolled in a home oxygen therapy (HOT) program to deliver continuous oxygen therapy through nasal prongs, and had accepted portable oxygen therapy delivered by transtracheal catheter (TTC) from 1988 until 1993. Tolerance was good, there were no lethal complications of TTC, and excellent compliance with the prescribed HOT was achieved. Lung function test results worsened, while Hb and PaO2 improved and significant oxygen savings (50%) were achieved. The 6 wt test results had not worsened at the end of the first year but did so significantly at the end of the third year, in spite of a relative preservation of lung function. Dyspnea assessed on a VAS was not seen to worsen. We conclude that tolerance of the method was good and that no relevant complications occurred. HOT by TTC did not prevent worsening of bronchial obstruction. Oxygenation of patients was better, as shown by the decrease in Hb and the improvement in PaO2 at the end of the first year of monitoring. Changes in 6 wt showed that in order to achieve greater benefit from HOT by TTC, patients should follow a pulmonary rehabilitation program.

Aged↗
PubMed1995

Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush.

The lower airways of asymptomatic chronic obstructive pulmonary disease (COPD) patients can be colonized by bacteria, mainly Haemophilus influenza, Streptococcus pneumoniae, and Moraxella catarrhalis. However, the role of lower airway bacteria in stable and exacerbated COPD has not been well defined. To determine the importance of lower airway bacterial infection in COPD we studied 40 outpatients with stable COPD (Group A: age 61.1 +/- 9.9 yr; [mean +/- SD]; FEV1/FVC 51.7 +/- 12.5) and 29 outpatients with exacerbated COPD (Group B: age 63.4, SD 9.0 yr; FEV1/FVC 52.0, SD 9.6), using the protected specimen brush (PSB) for microbiology sampling. Group A consisted of outpatients with stable COPD having normal or near-normal chest X-rays, with clinical indications for performing fiber-bronchoscopy (pulmonary nodule, remote hemoptysis); Group B consisted of patients with exacerbated COPD who voluntarily accepted lower airway microbiology sampling. To avoid contamination by upper airway flora the PSB was used for bacterial sampling in all the cases and concentrations > or = 1,000 colony-forming units/milliliter (CFU/ml) were considered positive. Results were as follows: Group A: Lung function data in outpatients with stable COPD were lower than the reference values for this population (FVC 2.97 +/- 1.02 L, FVC% 71.4 +/- 22.4, FEV1 1.59 +/- 0.79 L, FEV1% 51.2 +/- 23.0). Positive PSB cultures were obtained in 10 of 40 cases (25%), mainly of H. influenzae and S. pneumoniae. Two of 40 cases had positive cultures at concentrations > or = 10,000 CFU/ml (5.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗