Biomedical subjects
Publications and source records attributed to J Pascual.
We present a proven case of Creutzfeldt-Jakob disease with severe involvement of white matter and cerebellum. Serial CT showed a unique pattern consisting of discrete cerebral and cerebellar atrophy, diffuse white matter hypodensity, and progressive enlargement of lateral and fourth ventricles.
Intravenous lidocaine successfully controlled convulsive status epilepticus in eight patients. Lidocaine was administered, as a diazepam substitute, to elderly patients with chronic obstructive lung disease and to those patients unresponsive to the stated doses of intravenous diazepam. Although transient disappearance of seizures was noted after an initial dose of 100 mg, infusion of 200 mg was necessary to effectively control status. Continuous lidocaine infusion (3.5 mg/kg/h) was used in one case with good results. Undesirable side effects were not seen. The basic mechanisms for possible anticonvulsant action are reviewed. Lidocaine seems to be an effective and safe drug in convulsive status epilepticus. We suggest that lidocaine may be used as a first-line drug, as a diazepam substitute, in the treatment of convulsive status epilepticus in patients in whom respiratory depression is undesirable and in those who do not respond to intravenous diazepam.
Compartment syndrome is a condition in which increased pressure within a limited space compromises tissue perfusion with the development of rhabdomyolysis. The causes can be physical, such as the pressure exerted on an anatomical region, or it can be associated with the consumption of illegal drugs, especially heroin. In this latter case, toxic and immunological mechanisms are involved in the physiopathology. Acute renal failure develops in 30% of cases of rhabdomyolysis. Its treatment includes efficient volume replacement, forcing urinary alkalinization and the administering of furosemide and mannitol, with certain precautions. No benefit has been shown in dopamine. When a heroin addict patient shows a clinical pattern of tumescence of his extremities, with or without a period of unconsciousness, the presence of compartment syndrome is to be suspected.
In this work we present our experience with a seven-day protocol of i.v. dihydroergotamine (DHE) in the treatment of 6 patients (7 treatments) suffering from intractable transformed migraine. All of them were admitted to hospital and treated for one week with a protocol which included DHE doses between 0.5-1 mg/8 h. One patient did not respond. The remaining 6 became free of pain in under 48 hours after the beginning of treatment. This positive effect remained for between 15 days and 3 months. All patients experienced adverse events; however, these were slight and ceased when the DHE dose was reduced. DHE is an effective and quick option for the short-term treatment of patients with severe transformed migraine resistant to other medications.
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BACKGROUND: Almotriptan, the most recent drug of the triptan family, has shown good efficacy and tolerability profile in clinical trials. OBJECTIVE: To assess almotriptan's tolerability and effectiveness in the setting of routine clinical practice. PATIENTS AND METHODS: 1,643 patients diagnosed of migraine according to IHS criteria were recruited by 317 neurologists in the TEA 2000 study. Patients were instructed to report data on migraine attacks in a diary for a three months follow-up period. Data from 4,253 migraine attacks were obtained. RESULTS: The incidence of adverse events was 0.02 per migraine attack (3,9 % of patients). Subjective clinical improvement after 30 minutes (33.2 y 37.1 %), pain improvement after 2 hours (65.5 % and 70.2 %), pain free response after 2 hours (26.6 % and 29.2 %), recurrence between 2 and 24 hours (21.2 % and 17 %) and a complete response by 24 hours (18.6 % and 22.9 %) were found. These results were obtained in both "intention to treat" and "per protocol" analyses, being even much better when only low pain intensity attacks were considered. CONCLUSIONS: The TEA 2000 study results demonstrate good effectiveness and excellent tolerability profile of almotriptan 12.5 mg in the daily clinical neurological practice. The results of this study confirm those obtained in clinical trials carried out before almotriptan was introduced into the market and that it is a good therapeutic choice for the symptomatic treatment for migraine attacks.
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Although surgery remains the standard treatment for benign prostatic hyperplasia there has been a rise in the number of available drugs for this condition. The current drug therapies appear to be useful for symptomatic short-term treatment, particularly for those patients unfit or unwilling to undergo surgical intervention. Further evaluation of the long-term effects of these treatments and their role in early disease is required, but drug therapy is likely to play a more important part in the management of this condition in the future.
The aim of this prospective study was to determine the etiologic factors leading to stroke in a group of young adults. We studied 95 patients aged 50 years or under who were admitted with the diagnosis of stroke over a 2-year period. These patients underwent complete clinical and laboratory assessment for stroke. The etiology was established in 73 (76.8%) out of 95 cases. Arterial hypertension, embolism and atherosclerosis were found to be the most frequent causes in patients with ischemic stroke, whereas hypertension and aneurysm rupture were the most prevailing etiologies in patients with hemorrhagic stroke. Miscellaneous causes represented one fourth of all cases of the series. Coagulation abnormalities occurred in some patients, but in these cases there were also other well established causes. Paradoxical embolism was not observed. This study corroborates the importance of thorough diagnostic evaluation to establish an accurate diagnosis.
Although sumatriptan has proven effective in treating migraine symptoms, there have been no studies comparing this drug with non-steroid anti-inflammatory drugs (NSAIDs) and ergotamine compounds under ideal dosage and delivery conditions. Our study aimed to establish the objective and subjective effects of treatment of severe migraine attacks with subcutaneous sumatriptan in a series of patients who were resistant to or intolerant of NSAIDs or ergotamine derivatives. Twenty-three patients were treated for a total of 140 attacks of migraine (mean +/- SD = 6 +/- 4 attacks). In 26% of the patients and in 23% of the attacks the response to sumatriptan was inadequate, while the response was clearly positive in 74% of the patients and in 77% of the attacks. More than half the patients responded within the first 30 min after injection of the drug. In 52% side effects were reported, although none were severe. Side effects continued with the same intensity or decreased in 91% of the patients in the course of the study. No patient considered treatment with sumatriptan worse than treatment with ergotamines or NSAIDs, while 86% and 91% labelled sumatriptan as "better" or "much better" than NSAIDs and ergotamines, respectively. Eighteen (78%) stated that they would continue using sumatriptan for future migraine attacks. Finally, most considered price to be a factor to be taken into consideration in deciding whether to inject the drug indiscriminately.(ABSTRACT TRUNCATED AT 250 WORDS)
Chronic daily headache appears in migraine patients due to chronic consumption of analgesics-ergotamine. This entity was considered intractable without hospital admission. Our aim was to study the response of this headache to an outpatient treatment protocol. The therapeutic protocol included: 1. Oral information to the patient about the role of analgesics in the chronification of the headache; 2. Abrupt withdrawal of analgesics-ergotamine; 3. Administration of naproxen as symptomatic medication, and 4. Prophylactic treatment. After 2.5 months of treatment we evaluated both the frequency and the intensity of pain episodes as well as analgesic consumption. Thirty patients (8.6% of the outpatient consultations) suffered from chronic daily headache secondary to chronic analgesic abuse. Twenty five were females and 5 were males, their mean age +/- SD being 43 +/- 11 years. The mean +/- SD number of units of analgesics-ergotamine taken per week was 28 +/- 12. Three patients exclusively abused analgesics, the remainder either ergotamine, caffeine and various analgesics (18) or caffeine or several analgesics not containing ergotamine (9). In 29 patients the response was positive. Twenty (67%) showed an excellent improvement (> 75%) in frequency and intensity and completely gave up analgesics. The remaining nine (30%) improved moderately (50-75%). Only 3 patients in this group carried on taking analgesics. One patient showed no improvement. Our work confirms the epidemiological magnitude of chronic daily headache and shows that this is a treatable entity on an outpatient basis combining the abrupt withdrawal of analgesics-ergotamine, and their replacement by naproxen, with prophylactic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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This article gathers the results and conclusions derived from a survey performed by the Work Group of the SEEIUC dedicated to the development of the Professional Certificate in Intensive Care. The survey was carried out with the aim of obtaining the opinion of nursing professionals who work in Intensive Care Units, about the training and requirements which are necessary to work in these units. The questionnaires were sent to all the members of the SEEIUC and to a great number of mixed, surgical, trauma and coronary ICUs all over the country. Among the opinions which were collected, the following ones must be pointed out: specific nursing knowledgement is necessary to work in Intensive Care; experience is essential to acquire confidence and good command of the job; nursing professionals need mechanisms which help their professional development; and the Certificate Programme is accepted as a valid system which certificates professional competence.