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Biomedical subjects

J Roldán

Publications and source records attributed to J Roldán.

11 recordsLinked to original sources
PubMed2003

[Alcohol intoxication].

Alcohol intoxication is the principal drug addiction in many countries of the world. It affects all age groups, both sexes and almost all social groups. Mortality associated with acute alcohol poisoning on its own is exceptional, but it can be an important factor if it coexists with recreational drugs. It is directly responsible for more than half of traffic accidents. Diagnosis is easy by means of anamnesis and clinical examination, and can be confirmed by determining the level of ethanol in the bloodstream. Supportive care is the best therapy in order to protect the patient from secondary complications. Methanol, or alcohol fuel, is used as a solvent, and can also be found as an adulterant of alcoholic drinks. Poisoning by oral means is the most frequent. Oxidized in the liver through dehydrogenase enzyme alcohol, toxicity is due to its metabolites, formaldehyde and formic acid. The clinical picture basically consists of cephalea, nausea, vomiting, hypotension and depression of the central nervous system. The optic nerve is especially sensitive, with total and irreversible blindness as a possible result. Ethylenglicol is used as a solvent and as an antifreeze; toxicity is due to an accumulation of its metabolites. The clinical picture includes symptoms that are held in common with methylalcohol intoxication. Kidney failure due to tubular necrosis and the deposit of oxalate crystals can occur.

Acute Disease↗
PubMed2001

Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.

Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.

Adult↗
PubMed2000

Clinical management of the patient with pleural effusion.

Pleural effusion is a frequent medical problem with a wide span of different causes. We wish to highlight the clinical management of the patient with pleural effusions but anatomic, physiologic and diagnostic management of the main pleural diseases will also be considered.

Collagen Diseases↗
PubMed1998

[Obstetrical anesthesia in 15 women with myasthenia gravis].

OBJECTIVES: To report our experience in managing anesthesia during obstetric delivery of women with myasthenia gravis (MG) and to review the anesthetic technique of choice for vaginal or cesarean delivery in such cases. PATIENTS AND METHODS: Fifteen pregnancies in 12 patients were recorded between 1980 and 1996; 14 cases were documented. Disease course during pregnancy, delivery and postpartum, the course of pregnancy, the presence of severe neonatal myasthenia and anesthetic treatment during vaginal or cesarean delivery were analyzed. RESULTS: Improvement in MG was observed in 6 cases. No change was seen in 4 patients and 3 worsened. In one woman generalized MG debuted 15 days after delivery. Two neonates were premature and a third suffered severe neonatal myasthenia. Six vaginal deliveries were aided by forceps; 8 deliveries were by cesarean and 1 fetus was aborted. Lumbar epidural anesthesia was employed in 73.33% (5 vaginal deliveries and 6 cesareans) and general anesthesia in 26.66% (1 abortion, 1 vaginal delivery and 2 cesareans). CONCLUSIONS: Continuous lumbar epidural anesthesia is the technique of choice for vaginal as well as cesarean deliveries. The combination of opioids and local anesthetics is considered particularly beneficial for patients, as it allows the motor blockade to be decreased. General anesthesia is only indicated when there is bulbar involvement. Short-acting non depolarizing agents, among them atracurium Besilate, are the muscle relaxants of choice. Succinylcholine is contraindicated. Thanks to current optimization of anesthetic and recovery techniques and administration of non depolarizing muscle relaxants with neuromuscular monitoring, the prognosis for pregnant MG patients has improved considerably.

Adult↗
PubMedDate not supplied

[Thoracic paravertebral blockade: postoperative analgesic effectiveness and plasma concentrations of bupivacaine].

AIMS: To compare the analgesic efficacy of thoracic paravertebral blockade with that of endovenous morphine to measure the plasma levels of bupivacaine and to study the complications derived from both techniques in patients undergoing thoracic or abdominal surgery with unilateral incision. METHODS: Twenty ASA I-II patients allocated to two groups (A and B) of ten patients each were studied. Group A (5 cholecystectomies and 5 thoracotomies) received morphine 0.075 mg/kg i.v. every 3 hours after operation. Group B (5 cholecystectomies and 5 thoracotomies) received thoracic paravertebral blockade 15 ml of 0.37-5% bupivacaine with 1:200.000 adrenaline following tracheal extubation. Analgesia was evaluated according to the visual analogic scale (VAS) with laterality and extension of the blockade being assessed. The plasma levels of bupivacaine were measured by liquid chromatography in 5 patients. Blood pressure, heart rate and respiratory frequency were assessed in both groups. In group B the appearance of pneumothorax or other local complications were noted. The results were statistically analyzed using to the Student's test. RESULTS: The patients in group A presented significantly more pain than those of group B. In these patients analgesia was unilateral. Plasma levels ranged between 0.56 mg/l at 5 minutes of administration and 0.17 mg/l at 240 minutes with a peak of 0.70 mg/l at 10 minutes with all these values being considerably lower those a determined as toxic (2-4 mg/l). No significant differences were found between the values of blood pressure, and cardiac and respiratory frequency of both groups. There were no complications derived from the technique. CONCLUSIONS: Thoracic paravertebral blockade is a very effective postoperative analgesic technique and is superior to that of i.v. morphine in patients undergoing thoracic or unilateral abdominal surgery. Peak plasma levels were much lower than those considered as toxic complications of interest were observed. Therefore, this technique may be considered as an alternative to other blockades such as extradural, interpleural or intercostal.

Abdomen↗