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Biomedical subjects

J Vilalta

Publications and source records attributed to J Vilalta.

At least 19 recordsLinked to original sources
PubMed1992

[Predictive factors of mortality in severe craniocerebral trauma].

BACKGROUND: The prediction of mortality in severe head injury is of interest for the evaluation of patient prognosis and to also permit therapeutic measures to be considered and improve knowledge of this problem. METHODS: A multiple logistic regression model was developed and validated from the data obtained from a series of 231 patients hospitalized for the above mentioned condition. Seventy-five percent of the patients were used to define the model with the remaining 25% validating the same. RESULTS: The variables included in the model were: intraventricular hemorrhage, odds ratio = 20.4 (confidence interval 95%: 3.56-116); compression of basal cistern and/or of the III ventricle, odds ratio = 11.5 (4.43-29.8); mydriatic pupils in both eyes, odds ratio = 5.71 (1.32-24.6); age, odds ratio = 1.03 (1.01-1.05) and Glasgow scale upon admission, odds ratio = 0.57 (0.43-0.75). The maximum global value of the model (84.9%) corresponded to a sensitivity of 84.5% and specificity of 85.2%. The cut-off point of probability of death was found to be 0.475. In the validation of the model the highest global value (84.2%) was also observed at the cut-off point of 0.475 with a sensitivity of 84.2% and specificity of 84.4%. CONCLUSIONS: The predictive factors of mortality in severe head injury are the evidence of hemorrhage in the cerebral ventricles, mydriasis and a low score on the Glasgow scale. The model presented is useful and valid for carrying out the prediction of mortality at the time of admission and is also easy to apply since the variables used are obtained in the initial examination of the patients with severe head injury.

Adult↗
PubMed1992

[Decrease in the incidence of epidural hematomas surgically treated during coma after a lucid interval. Is this an index of quality of care?].

The level of consciousness prior to surgery has been analyzed in a series of 64 patients suffering epidural hematoma (EDH) who underwent surgery during the period from July 1987 to June 1989. The percentage of cases which underwent surgery in coma after a lucid interval have been compared in different periods of time (1978-80, 1981-82, 1983-84 and July 1987 to June 1989). During the period from July 1987 to June 1989 surgery was performed on: 15 patients (23.5%) in coma from the moment of accident, 8 patients (12.5%) underwent surgery in coma but after a lucid interval and 41 patients (64.1%) were conscious. During the different periods of time the number of patients undergoing surgery in coma after a lucid interval were the following: 1979-80, 9 cases (26.5%); 1981-82, 17 cases (43.6%); 1983-84, 8 cases (20%) and during the last period, 1987-89, 7 cases (15.2%). The difference between the percentage of patients intervened in coma after a lucid interval in the previously referred periods of time was statistically significant (p 0.05).

Coma↗
PubMed1992

[Intraventricular meningiomas].

Eight cases of surgically intervened intraventricular meningiomas are presented. The patients were six males and 2 females with a mean age of 41.7 years (11-70). The length of symptoms was of several months in 6 (75%) of the cases. The most frequent symptoms observed were cephalea and alterations of the upper functions which were presented in six and four cases, respectively. Papilloedema and involvement of long pathways were the most usual findings observed in neurological examination. Diagnosis was made by computerized tomography and angiography in all the cases. Surgery using a transtemporal approach was carried out in six patients and in the other two a parietal-occipital route was used. Two patients were dead and other two presented bilateral amaurosis. The other patients had good postsurgery.

Adolescent↗
PubMed1991

[Psychiatric morbidity in elderly patients admitted to a general hospital. A day-prevalence study].

BACKGROUND: The most common psychiatric diseases in the geriatric population are depression, the acute confusional state or delirium and dementia. METHODS: A prevalence-day study of psychopathology was carried out in the elderly population admitted to the hospital for several medical and surgical conditions. The semistructured psychiatric interview (CIS), cognoscitive miniexamination (MEC) and Zung's depression scale (SDS) were administered. When appropriate, a diagnosis was established following the DSM-III-R criteria. 15% of the overall number of elderly patients were excluded because of severe medical disease or surgical operation on the study day. RESULTS: A 43% prevalence of psychiatric disorders was found. 21% of them had depression and 18% a mental organic disorder with cognitive deficit in the form of dementia (6%), delirium (10%), or both (2%). The depression symptoms were more marked with greater cognitive deterioration, and both were greater with increasing age. In only 10% of the patients considered as psychiatric cases the cooperation of the psychiatric interconsultation team had been requested. CONCLUSIONS: The diagnosis of these diseases (depression, delirium and dementia) is very important because in the elderly population with these disorders a higher morbidity and mortality due to medical causes is found.

Aged↗
PubMed1991

[Symptomatic chronic subdural hematoma. Analysis of 68 cases treated surgically with small craniotomy and placement of a closed drainage system].

Sixty eight cases of chronic subdural hematoma (CSDH) surgically treated (December 1984-December 1988) with twist drill craniostomy (3-4 mm) and application of a closed drainage system (CDS) are reviewed. The patients were distributed in four groups depending on the density of the hematoma: hypodense (36 cases), isodense (6 cases), of mixed density (22 cases) and hyperdense (4 cases). In about one third of patients (25 cases) the duration of symptoms was shorter than one week, in 21 cases it was between one week and one month, and in 22 patients it was longer than one month. 77.95% of cases had a preceding head injury. Headache and motor deficits were the leading symptoms, being present in 43 (63.2%) and 42 (61.7%) cases, respectively. Twelve patients (17.6%) were comatose on admission. Twelve patients required reoperation. Six patients died (8.8%). The preoperative neurological status and associated systemic diseases influenced the outcome. We think that limited craniostomy with CDS is the therapy of choice for symptomatic CSDH.

Aged↗
PubMed1991

[Cerebral contusions. Study of 182 cases].

Clinical cases were selected in which cerebral contusions were the only visible lesions in CT scan on admission over the period from January 1983 and December 1985. The following characteristics were evaluated: Age, sex, conscience level (Glasgow) at admission, early post-traumatic epilepsy, focal signs, lesion mechanism, cranial fracture, as well as CT scan in which specific signs of bad prognosis were analyzed. According to the evolution of conscience level 3 groups of patients were established: Group 1 "no coma", group 2 "coma with lucid interval", group 3 "coma without lucid interval" and were correlated with the previously mentioned characteristics. The highest mean age (59.2 years) appeared in group 2. In 75% of patients in group 3 a traffic accident was the lesion mechanism. Admission CT scan showed that the severity is related to bad prognosis signs (displacement of middle line, lack of 3rd ventricle, and basal cisterns and multiple lesions). Mortality was approximately 70, 80 and 90% whether they had one, two, or three bad prognosis signs at admission CT scan.

Adult↗
PubMed1990

[The Cambridge Mental Disorders of the Elderly Examination. Validation of the Spanish adaptation].

A neurologist and a psychiatrist diagnosed independently, according to DSM-III-R and ICD-10 criteria, to 15 subjects with dementia, 15 with depression and 15 without any of two previous diagnostics. Later, a psychologist held an interview with them by means of the structured interview CAMDEX. The lump levels of agreement between clinical diagnostic and DSM-III-R diagnostic obtained through CAMDEX is of Kappa = 0.63. These levels are increased to one Kappa = 0.76 if we compare the clinical diagnostic with CAMDEX diagnostic according to the ICD-10. On the other hand, we value the outputs of some instruments that are included in the CAMDEX: Mini Examen Cognoscitivo, Mini-Mental State, CAMCOG, Organicity Scale, Blessed Scale and Depressión Scale.

Aged↗
PubMed1990

[The Cambridge Mental Disorders of the Elderly Examination. Study of interobserver reliability].

Three teams formed by psychologists with experience in the administration of structured interviews evaluated by the CAMDEX (The Cambridge Mental Disorders of the Elderly Examination) in a sample of 41 patients for the interrater reliability study. While a psychologist interview patient, the other one observes each patient. The CAMDEX were completed independently by each of the examiners. The results demonstrate an elevated level agreement both for the different scales (p less than 0.001) and for the different diagnostic criteria employed by the CAMDEX (kappa = 0.88 for the DSM-III-R and Kappa = 1 for the ICD-10).

Aged↗
PubMed1989

Diffuse axonal injury after severe head trauma. A clinico-pathological study.

Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude. In this paper we present a group of 24 patients with a severe head injury in whom the postmortem examination demonstrated unequivocal signs of DAI. Widespread axonal retraction balls, located preferentially in the centrum semiovale and internal capsule were the most constant histological finding. We divided the entire series into two subgroups. One group (15 cases), included all the patients in whom the CT scan did not demonstrate mass lesions. In the second group (9 patients) we considered patients with a diffuse axonal injury in whom the CT scan additionally demonstrated a mass lesion (6 acute subdural haematomas, 2 intracerebral and 1 extradural haematoma). The mean age of the entire group was 26 years. Twenty two patients were injured in a road traffic accident, the remaining two fell from a considerable height. All were rendered immediately unconscious on impact. Diffuse brain damage is a common finding in patients with a severe head injury and immediate coma in whom the CT scan does not show mass lesions. Diffuse axonal injury can also appear in connection with a wide spectrum of focal lesions (acute subdural haematoma, basal ganglia haematoma etc.).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Spontaneous cerebellar hematoma. Analysis of 23 cases].

A series of 23 patients with spontaneous cerebellar hematoma is analysed retrospectively. Several degrees of consciousness impairment, and headache occurred in all; 12 patients presented motor deficits among the more important clinical signs. Arterial hypertension (69.5%) and diabetes (34%) stand out in the pathological background, and their association was frequent (30%). Computerized tomography (CT) disclosing severe ventricular dilatation (69.5%) associated or not with intraventricular presence of blood is considered as an unsatisfactory prognosis sign, and indicative for emergency therapy. Emergency external ventricular draining is the best indication for the majority of these cases. Posterior fossa craniectomy for emptying the hematoma may be the indication in severe cases. Death and morbidity in this pathology are high as yet. However, CT contribution for diagnosis is quicker and better than benefits obtained through other methods. Results observed in the present series are illustrative on this statement, when compared to data of other series diagnosed through other methods.

Adult↗