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J Pujol

Publications and source records attributed to J Pujol.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Delirium in an elderly population admitted at a general hospital].

BACKGROUND: Delirium is an organic mental disorder frequently seen in elderly patients admitted to hospital for medical or surgical diseases. The prevalence, triggering factors, the relationship with prior existence of dementia and the evolution of delirium were studied. METHODS: One hundred eight elderly patients admitted to the Internal Medicine, General Surgery and Traumatology Departments of the Hospital Clínic i Provincial in Barcelona, Spain were randomly selected with clinical evaluation being performed following the DSM-III-R diagnostic criteria. Likewise a structured clinical interview (CAMDEX) was carried out, and the establishment of delirium, the possible causes and its evolution were evaluated. RESULTS: Eighteen of the elderly patients studied presented delirium at some time during hospital stay. Of these patients 15 had previously been clinically diagnosed with dementia. These patients did not require longer hospital stay than those not presenting dementia. The most frequent etiology was surgery and fever due to an infectious process. In addition to etiologic treatment, 12 of the patients also received symptomatic treatment with a neuroleptic drug (haloperidol). CONCLUSIONS: Most of the elderly who have presented delirium admitted in a general hospital had been diagnosed with dementia during hospital stay thus indicating the high comorbidity of the two entities. In many cases it is important to carry out symptomatic in addition to etiologic treatment to achieve rapid reversibility of the disorder.

Aged↗
PubMed1995

[Study of cerebral activity with functional magnetic resonance].

BACKGROUND: Functional magnetic resonance is a new imaging method which allows the incruent observation of human cerebral activity. The authors describe their method of functional magnetic resonance and the results of cerebral activation. METHODS: A total of 364 functional sequences were performed in 52 volunteers with a magnetic resonance system of 1.5 Tesla. A gradient echo sequence with a long echo time sensitive to the changes in oxygenation of venous blood was used. Different cortical areas were stimulated by visual, motor and language maneuvers and by complex mental operations. RESULTS: Different cerebral areas representative of different levels of cerebral functional complexity were consistently activated and reproduced. Experiments of activation of primary cerebral cortex (visual and motor), premotor regions, specific area of language and areas of cortical association for cognitive operations are described. CONCLUSIONS: Functional magnetic resonance imaging is a sensitive method for the observation of cerebral activity and provides functional images with great spatial and temporal resolution. This may be useful in both clinical and basic investigation.

Adult↗
PubMed1995

Prothrombotic state and signs of endothelial lesion in plasma of patients with inflammatory bowel disease.

Recent investigations suggest that microthrombi formation in bowel capillaries could be a determinant factor in inflammatory bowel disease (IBD) pathogenesis. To evaluate the implication of the hemostatic system during these thrombotic events, we analyzed plasmatic values of prothrombotic state markers, physiologic inhibitors of coagulation, and endothelial lesion markers in 112 IBD patients. We found an increase in thrombin-antithrombin complexes and a decrease in antithrombin III, probably due to consumption, demonstrating an increase in thrombin generation. High levels of D-dimer reflect increased fibrin formation, but there is no correlation between thrombin generation markers and D-dimer, possibly suggesting the presence of inadequate fibrinolysis. Levels of tissue factor pathway inhibitor were higher in patients than in controls. Nine patients with Crohn's disease (35% of our sample) had levels of this marker under 70% (range 37-69%). Von Willebrand factor values were increased and those of thrombomodulin only in active patients. Most of the changes were detected in patients with inflammatory activity, and there were no differences between ulcerative colitis and Crohn's disease. In conclusion, these results support the hypothesis that there is an endothelial lesion with sustained coagulation activation in IBD patients.

Adult↗
PubMed1995

Abnormalities of the Bereitschaftspotential and MRI pallidal signal in non-encephalopathic cirrhotic patients.

In cirrhotic patients, even in the non-encephalopathic state, MRI may show an increased signal in globus pallidus in T1-weighted sequences, the clinical significance of which is still poorly characterized. A dysfunction of the motor circuit of the basal ganglia might be predicted if the increased MRI signal expressed alterations in the globus pallidus activity. We compared the Bereitschaftspotential (BP) in 15 non-encephalopathic cirrhotic patients and 15 age-matched controls and found that the amplitude of the early component and the peak negativity of the BP before the electromyogram onset were significantly reduced in the patient group. The intensity of the pallidal signal was related to the plasma ammonia level but the amplitudes of the BP were not related to the pallidal signal or to ammonia. These findings indicate that a defective activity of the cortical areas implicated in the preparation of movement, not specifically related to the pallidal signal, can be present in cirrhotic patients, even in the non-encephalopathic state.

Adult↗
PubMed1995

The role of prefrontal regions in the Stroop task.

The Stroop is a classical paradigm that presumably involves the inhibition of automatic responses and is frequently used to assess the frontal lobe functions. We investigated the effect of discrete prefrontal lesions in a Stroop task. A sample of 32 patients with frontal lesions were matched with normal controls by sex, age and years of education. Significant differences between patients and controls were found for errors but not for reaction time. Regression analysis showed that the region most related to errors was the right prefrontal lateral cortex. Left lobectomies did not impair the Stroop performance. Our results favour the role of the right prefrontal cortex in sustained attention, and disagree with the conception of the left prefrontal cortex having a role in the inhibition of verbal automatic responses.

Adult↗
PubMed1995

A randomized study of bolus fluorouracil plus folinic acid versus 21-day fluorouracil infusion alone or in association with cyclophosphamide and mitomycin C in advanced colorectal carcinoma.

From May 1988 to June 1992, 129 eligible patients suffering from measurable advanced colorectal cancer were enrolled in a randomized study comparing bolus fluorouracil plus leucovorin (FU-FA); continuous fluorouracil infusion (FU-cont); FUcont plus cyclophosphamide and mitomycin C (FUMIC). FU-FA consisted of weekly fluorouracil (FUra) bolus (600 mg/m2) 1 hour after the initiation of a 2-hour infusion of 500 mg/m2 of leucovorin, for 6 weeks every 8 weeks. FUcont patients were planned to receive 400 mg/m2/day FUra infusion, for 21 days every 28 days. In FUMIC patients, FUcont was associated with weekly cyclophosphamide bolus (300 mg/m2) and monthly mitomycin C bolus (10 mg/m2). Quality of life was evaluated using six linear analogue scales, completed by the patient. Accrual in the FUMIC arm was stopped after the 25th patient because of toxicity. The response rates were 22 of 48 (45.8%) with FUcont and 13 of 52 (25%) with FU-FA (P = .048). Progression-free survival (median: 8 v 4.4 months; P = .0026) and overall survival (median: 12.9 v 9.6 months; P = .028) were significantly greater for the FUcont arm compared with the FU-FA arm. Toxicity was observed in 62% of the FUcont patients (grade 3-4: 10%), mainly hand-foot syndrome, diarrhea, mucositis, and mainly gastrointestinal in 69% of the FU-FA patients (grade 3-4: 11.6%). Linear analogue scales exploring quality of life, available for the first 6 months, gave similar scores in FU-FA and FUcont patients. We conclude that this FUcont schedule, achieving high FUra dose-intensity, offers significant advantages, in terms of response and survival, over weekly FUra plus leucovorin.

Adenocarcinoma↗
PubMed1995

Multiple familial pilomatricomas: a cutaneous marker for Gardner syndrome?

A 40-year-old man and his 6-year-old only son had numerous, firm papulonodular lesions on their faces. Their medical histories were unremarkable and no family consanguinity was recorded. Surgical excision of several lesions was performed on each patient. All the lesions were solid tumors with the characteristic histopathologic features of pilomatricoma. A gastrointestinal radiologic and fibroscopic survey disclosed numerous adenomatous colonic polyps in the father. Additional studies revealed that he also had minor dental abnormalities, a small osteoma on the right mandible, and unilateral, ocular, pigmented retinal macules. The diagnosis of multiple adenomatous colonic polyposis was established only after the well-known association of pilomatricoma-like changes in epidermal cysts in patients with Gardner syndrome was considered. Possibly, multiple familial pilomatricomas could be considered a cutaneous marker of Gardner syndrome.

Adult↗
PubMed1995

Persistence of MRI hyperintensity of the globus pallidus in cirrhotic patients: a 2-year follow-up study.

We investigated the long-term persistence and short-term stability of globus pallidus (GP) hyperintensity on T1-weighted MRI in 19 cirrhotic patients. After a mean interval of 25.8 months, the hyperintensity of the GP persisted in 17 patients. Hyperintensity disappeared in two patients with hepatocarcinoma, indicating that hyperintensity can revert to normal in circumstances other than liver transplants. Ten patients participated in a 6-month study with repeated evaluations of GP signal intensity, plasma ammonia levels, and selected neuropsychological tests. The GP signal was fairly stable during the follow-up, and the variables considered maintained significant relationships. GP hyperintensity appears as a stable indicator of the functional status of cirrhotic patients.

Adult↗
PubMed1995

Motion of the cerebellar tonsils in Chiari type I malformation studied by cine phase-contrast MRI.

We studied the effects on CSF dynamics at the foramen magnum and the clinical significance of the abnormal tonsillar motion in 14 patients with Chiari type I malformation and 14 control subjects using cine phase-contrast MRI. Dynamic MRI consisted of axial and sagittal cine phase-contrast sequences. CSF and tonsillar motion were qualitatively and quantitatively evaluated, and the subarachnoid space at the foramen magnum measured. In Chiari patients, cine phase-contrast MRI detected the abnormal pulsatile motion of the cerebellar tonsils, which produced a selective obstruction of CSF flow from the cranial cavity to the spine. The amplitude of the tonsillar pulsation and the severity of the arachnoid space reduction were associated with the symptom of cough-strain headache, but not with the presence of syringomyelia. The finding of abnormal valve dynamics of the cerebellar hernia revealed by cine phase-contrast MRI conforms to the pathophysiologic mechanisms suggested in pressure register studies and opens a new possibility in the presurgical assessment of Chiari patients with exertional symptoms.

Adult↗
PubMed1993

When does human brain development end? Evidence of corpus callosum growth up to adulthood.

To locate structural changes in the brain accounting for the increasing effectiveness in cognition and skills that occurs at the final stage of behavioral development, we attempted to determine the age at which the corpus callosum completes its active growth period. We assessed the growth rate of the corpus callosum by measuring its area twice on midsagittal magnetic resonance imaging scans separated by a 2-year interval, in a series of 90 subjects with a wide range of ages. We observed an increase in the size of the corpus callosum as long as human mentation expands, up to the middle 20s. Clinical and experimental data about the corpus callosum, together with the present findings, suggest that the corpus callosum is part of the highest order-latest maturing neural network of the brain.

Adolescent↗
PubMed1993

MRI pallidal hyperintensity and brain atrophy in cirrhotic patients: two different MRI patterns of clinical deterioration?

In cirrhotic patients, even in a stable nonencephalopathic state, MRI may show cerebral atrophy and increased signal in globus pallidus on T1-weighted sequences. We investigated the relationship between cerebral atrophy and increased pallidal signal and the clinical status of 30 cirrhotic patients. We found a weak association between the two MRI findings. There were different patterns of clinical variables related to the imaging findings. Performance on motor tasks involving speed correlated with the pallidal signal and plasma ammonia levels but not with atrophy. Test results for memory and frontal-premotor function were associated with brain atrophy but not with the pallidal signal or with ammonia.

Aged↗
PubMed1993

Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure.

Hyperintense globus pallidus on T1-weighted MRI is present in most patients with advanced liver disease. We evaluated the relationship between the signal intensity of the globus pallidus and clinical or laboratory data of 77 patients eligible for liver transplantation. There was a significant correlation between the intensity of the signal and the Child-Pugh score (as indication of severity of liver disease), presence of postural tremor, previous episodes of variceal bleeding or hepatic encephalopathy, prothrombin activity, serum aspartate and alanine aminotransferase, bilirubin, and the indocyanine green (ICG) hepatic clearance, a very sensitive marker of liver function. The multivariate analysis disclosed that the ICG hepatic clearance and previous episodes of variceal bleeding were independently associated with the signal intensity in the globus pallidus. MRI repeated in 21 patients 10 to 20 months after transplant showed a disappearance of the lesion in all cases. We conclude that the hyperintense globus pallidus is secondary to the severity of the liver disease, and is reversible when liver function returns to normal.

Adult↗