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R Monforte

Publications and source records attributed to R Monforte.

At least 19 recordsLinked to original sources
PubMed2005

[Global systems for monitoring cerebral hemodynamics in the neurocritical patient: basic concepts, controversies and recent advances in measuring jugular bulb oxygenation].

Because of the importance of hypoxic/ischemic phenomena in head-injured patients, brain monitoring in these patients should be complemented by systems providing information on cerebral blood flow and metabolism. Indirect estimations of cerebral blood flow have been obtained from blood extracted from the jugular bulb, as a special bedside application of the Fick's principle to the brain. In the last few years, the use of jugular oximetry techniques has become routine in centers treating head-injured and other neurocritical patients such as those presenting subarachnoid hemorrhage or malignant middle cerebral artery infarction. The experience acquired in the use of these techniques, as well as the introduction of new neuromonitoring systems, have deepened our understanding of the information gained and have enabled more precise definition of their indications and limitations. This review describes the basic concepts underlying the use of jugular oximetry techniques in the neurocritical patient. We also explain the reasons why several variables derived from jugular blood such as arterio-jugular differences of lactate (AVDL) or the lactate-oxygen index (LOI) do not provide accurate information on brain metabolism.

Brain↗
PubMed1996

High amplitude contractions in the middle third of the oesophagus: a manometric marker of chronic alcoholism?

BACKGROUND: Oesophageal motor abnormalities have been reported in alcoholism. AIM: To investigate the effects of chronic alcoholism and its withdrawal on oesophageal disease. PATIENTS: 23 chronic alcoholic patients (20 men and three women; mean age 43, range 23 to 54). METHODS: Endoscopy, manometry, and 24 hour pH monitoring 7-10 days and six months after ethanol withdrawal. Tests for autonomic and peripheral neuropathy were also performed. Motility and pH tracings were compared with those of age and sex matched control groups: healthy volunteers, nutcracker oesophagus, and gastro-oesophageal reflux disease. RESULTS: 14 (61%) alcoholic patients had reflux symptoms, and endoscopy with biopsy showed oesophageal inflammation in 10 patients. One patient had an asymptomatic squamous cell carcinoma. Oesophageal motility studies in the alcoholic patients showed that peristaltic amplitude in the middle third was > 150 mm Hg (95th percentile (P95) of healthy controls) in 13 (57%), the ratio lower/ middle amplitude was < 0.9 in 15 (65%) (> 0.9 in all control groups), and the lower oesophageal sphincter was hypertensive (> 23.4 mm Hg, P95 of healthy controls) in 13 (57%). All three abnormalities were present in five (22%). Abnormal reflux (per cent reflux time > 2.9, P95 of healthy controls) was shown in 12 (52%) alcoholic patients, and was unrelated to peristaltic dysfunction. Subclinical neuropathy in 10 patients did not effect oesophageal abnormalities. Oesophageal motility abnormalities persisted at six months in six patients with ongoing alcoholism, whereas they reverted towards normal in 13 who remained abstinent; reflux, however, was unaffected. CONCLUSIONS: Oesophageal peristaltic dysfunction and reflux are frequent in alcoholism. High amplitude contractions in the middle third of the oesophagus seem to be a marker of excessive alcohol consumption, and tend to improve with abstinence.

Adult↗
PubMed1995

Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol.

OBJECTIVE: To assess autonomic and peripheral nervous system function in patients with chronic alcoholism. DESIGN: A cross-sectional study. PATIENTS: A consecutive sample of 107 alcoholic patients and 61 controls. MAIN OUTCOME MEASURE: For autonomic assessment, heart rate variations during deep breathing and Valsalva maneuver and on standing were measured. Blood pressure response to standing up and to sustained handgrip were also evaluated. For assessment of the peripheral nervous system, an electrophysiologic examination was performed. RESULTS: Alcoholic patients exhibited reduced heart rate variability compared with controls (P < .01, on all parasympathetic tests), whereas no differences in the mean values of the blood pressure responses between both groups were found. Twenty-six patients (24.3%) had criteria of autonomic neuropathy, and 34 (32%) had electrophysiologic criteria of peripheral neuropathy. None of the controls exhibited criteria of autonomic neuropathy, and only one had criteria of peripheral neuropathy. The estimated total lifetime dose of alcohol correlated inversely with the parasympathetic indexes (r = -.48 to -.51; P < .001 on all parasympathetic tests) and the sensory potential amplitudes of upper and lower limbs (r = -.43; P < .001, both limbs). Finally, a significant correlation between autonomic and peripheral neuropathies was observed (P = .01). By contrast, these lesions were not related to age, nutritional status, or other alcohol-related diseases. CONCLUSIONS: Autonomic and peripheral neuropathies are common among hospitalized alcoholic patients. Alcohol appears to be toxic to autonomic and peripheral nerves in a dose-dependent manner.

Adolescent↗
PubMed1993

Regional cerebral blood flow-SPECT in chronic alcoholism: relation to neuropsychological testing.

To determine the prevalence of central nervous system damage due to ethanol, we evaluated 40 asymptomatic chronic alcoholics and 20 age-matched controls. Studies included neuropsychological testing, brain 99mTc-HMPAO SPECT, and morphometric analysis by CT scan. In the qualitative analysis, 30 of the 40 alcoholics showed hypoperfused areas on SPECT scan. In the semiquantitative analysis, alcoholics exhibited significant reduction in regional cerebral blood flow (rCBF) ratio of all brain lobes compared to controls (p < 0.001). The rCBF ratio was mainly reduced in frontal lobes (65%). Only 11 alcoholics showed significant frontal lobe atrophy in the morphometric analysis; most also had abnormalities on SPECT scan. Alcoholics exhibited significant impairment of frontal tasks and visuospatial skills. Frontal test impairment was independently related to both frontal atrophy and hypoperfusion. In a group of ten alcoholics in whom another SPECT scan was performed after 2 mo of ethanol abstinence, rCBF ratio of the frontal lobes normalized in eight, without frontal atrophy. In patients without frontal atrophy, reduced rCBF ratio of the anterior portion of the frontal lobes correlated negatively with frontal test results (r = -0.6535, p < 0.001). A significant negative correlation between cerebral perfusion and the amount of ethanol consumed in the month prior to study was observed (r = -0.6289, p < 0.001). In conclusion, asymptomatic chronic alcoholics frequently showed reversible frontal lobe hypoperfusion, which is related to recent ethanol intake, reflects brain function impairment and is independent of brain atrophy.

Adult↗
PubMed1992

Microvascular changes in skeletal muscle in idiopathic inflammatory myopathy.

Open deltoid muscle biopsy specimens from patients with idiopathic adult dermatomyositis, paraneoplastic dermatomyositis, childhood dermatomyositis, and idiopathic polymyositis, and from control patients were studied. Qualitative and morphometric capillary analysis by phase and electron microscopy was carried out. In the morphologic analysis the most striking difference was the presence of capillary damage and a higher capillary depletion in dermatomyositis as well as a higher capillary density in polymyositis. By electron microscopy, capillaries from patients with dermatomyositis showed mainly microtubuloreticular structures, loss of endothelial plasma membranes, and the appearance of abnormal cytoplasmic organelles. In contrast, capillaries from patients with polymyositis exhibited only minimal changes. By morphometric analysis, muscle capillaries in dermatomyositis had a significantly higher mean endothelial thickness than those in polymyositis. Finally, a significant topographic association between capillary damage and muscle fiber changes was observed only in patients with dermatomyositis. On the other hand, paraneoplastic dermatomyositis showed fewer structural and morphometric capillary changes than the other forms of dermatomyositis. We conclude that dermatomyositis is characterized by microvascular alterations that are absent in polymyositis. The topographic proximity of capillary changes to muscle fiber injury suggests that capillary damage may play a role in the pathogenesis of the muscle lesions observed in patients with dermatomyositis.

Capillaries↗
PubMed1991

Abnormal sympathetic skin response in alcoholic subjects.

Although the impairment of autonomic function has been described in alcoholic subjects, there is no evidence for such a dysfunction to be due to damage of autonomic centers or peripheral small caliber fibers. To investigate the function of peripheral fibres of the autonomic nervous system, we have carried out an electrophysiological study of the sympathetic skin response (SSR) in the hands and feet in 70 alcoholic and in 33 non-alcoholic subjects. In the hand, SSR recordings were done simultaneously in the palm and finger tip by stimulating the median nerve at the wrist. A conventional electrophysiological study performed in the same patients was used to classify them according to the presence or absence of electrophysiological criteria for peripheral polyneuropathy (ECPN). In analyzing the results of the SSR test, we found absent responses in the finger tip with present responses in the palm in 18 patients, 13 of them with ECPN. Absent responses in the feet were observed in 37 patients, 28 of them with ECPN. From our findings, it is concluded that alcoholics suffer from a dysfunction of sympathetic sudomotor activity due to axonal involvement of the most distal segments of the nerves.

Adolescent↗
PubMed1990

[Hypothyroid myopathy. A clinical and histologic prospective study of 19 patients].

Nineteen patients with primary hypothyroidism were prospectively studied before starting replacement therapy with thyroid hormones. Most patients had mild to moderate muscle symptoms: generalized muscle weakness, myalgia and cramps, and increased serum levels of muscle enzymes. In two patients these features were the motive for consulting the physician. The patients with muscular features had significantly higher plasma levels of lactic dehydrogenase and aldolase than asymptomatic patients. The major histological muscle findings were atrophy of type II fibers, abnormalities in the oxydative pattern of muscle cells, and glycogen deposition. In the biochemical investigations an increased muscle glycogen with reduced activity of the glycolysis and glucogenolysis enzymes were found. The patients with more marked histological abnormalities had lower levels of thyroid hormones, but the differences did not reach significant values. Five patients in euthyroid status after 12 months of therapy underwent a new biopsy. Although the remaining clinical and laboratory parameters had returned to normal, some of the histological muscle abnormalities persisted. This finding leads to the suspicion that the lack of thyroid hormones may induce irreversible structural damage in skeletal muscle.

Adult↗
PubMed1990

Persistent low C3 levels associated with meningococcal meningitis and membranoproliferative glomerulonephritis.

Recurrent meningococcal meningitis is usually related to terminal complement factor deficiencies (C5-C8); however it is not frequent with isolated primary C3 deficiency. Similarly, membranoproliferative glomerulonephritis has been described in association with primary C3 deficiencies and the presence of C3 nephritic factor. We present a case of an 18-year-old woman with relapsing meningococcal meningitis in whom membranoproliferative glomerulonephritis and persistent low serum C3 levels were found. A detailed immunological study was performed, but no other abnormalities in the complement components were found. C3 Nef was also negative. Moreover, the familiar complement studies showed an asymptomatic C4 deficiency in her mother and borderline C3 levels in her sister. The presence of persistent low serum C3 levels in the absence of other immunological abnormalities suggests that this is the cause of the relapsing meningococcal infections and the glomerular disease of this patient. We suggest that a complement deficiency, including isolated C3 deficiency, should be ruled out in all cases of relapsing meningitis. Further, the possibility of glomerular disease should be carefully considered in these patients.

Adolescent↗
PubMed1990

High ethanol consumption as risk factor for intracerebral hemorrhage in young and middle-aged people.

We examined the prevalence of high ethanol intake, hypertension, and other risk factors for intracerebral hemorrhage in a case-control study of 24 young and middle-aged patients with intracerebral hemorrhage. We recorded ethanol consumption, history of hypertension, liver disease, cigarette smoking, and mild or severe coagulation disorder in each case of intracerebral hemorrhage and in 48 control patients matched by sex and age. In univariate matched analyses, the frequencies of high ethanol intake (p = 0.009), hypertension (p = 0.05), and coagulation disorder (p = 0.05) were higher in the cases than in the controls. After controlling for possible confounding factors, we found that high ethanol intake and hypertension were the only independent risk factors for intracerebral hemorrhage (p = 0.02 and p = 0.05, respectively). The hemorrhagic lesion found in cases with a high ethanol intake tended to be located in the cerebral lobes (p = 0.01), contrasting with the typical basal ganglia location of hypertensive hematomas (p = 0.009). We conclude that chronic, high ethanol intake should be considered as an important risk factor for lobar hematomas in young and middle-aged people.

Adult↗
PubMed1990

Immunohistochemical analysis of the immune reaction in the nervous system in paraneoplastic encephalomyelitis.

We examined frozen sections of frontal cortex, medulla, and dorsal root ganglia from a patient with small-cell lung cancer and paraneoplastic encephalomyelitis, involving the medulla and dorsal root ganglia, with a panel of antibodies reactive for IgG, IgM, C3, B cells, T cells, T cell subsets, macrophages, and class I and II (HLA-DR) major histocompatibility complex (MHC) antigens. We detected an antineuronal antibody (anti-Hu) in the serum and CSF of the patient and found deposits of IgG in the periphery of some neurons in dorsal root ganglia. The infiltrates were almost exclusively T cells with a predominance of CD8-positive cells. Neurons did not express class I or II MHC antigens. Satellite cells in the dorsal root ganglia from the patient and controls were HLA-DR-positive. These data indicate that CD8-positive T cells predominate in the inflammatory infiltrates of paraneoplastic encephalomyelitis. IgG deposits may be relevant in the damage of the sensory neurons.

Antibodies, Monoclonal↗
PubMed1990

Myasthenia gravis after allogeneic bone marrow transplantation: report of a new case and pathogenetic considerations.

A 21-year-old caucasian man with T acute lymphoblastic leukemia underwent a bone marrow transplantation (BMT) and developed classic myasthenia gravis (MG) 46 months later. The association of almost all published cases with HLA B35 is discussed, as are the clinical aspects suggesting that BMT survivors are at risk for developing MG as part of the spectrum of chronic graft-versus-host disease.

Adult↗
PubMed1989

[A community outbreak of Legionnaires' disease in Barcelona: clinical and microbiological study].

In February and March 1989 a community-acquired outbreak of legionnaires' disease developed in Barcelona, involving at least 56 patients (48 males and 8 females) with a mean age of 60 years (range 22-87). 70% were smokers, 20% alcohol abusers, 50% had chronic bronchitis and 20% were immunologically depressed. The most common signs and symptoms were: fever (100%), features of lung condensation (77%), cough (51%), stupor (27%), diarrhea (18%), thoracic pain (18%, hyponatremia (53%), increased serum level of hepatic enzymes (44%) or CK (37%), and renal failure (21%). Radiological involvement was bilateral in 30% of cases. In most patients the diagnosis was made by seroconversion (70%). Late seroconversion (between 4 and 14 weeks) was seen in 20 patients, whose age was significantly higher than that of patients with early seroconversion (p less than 0.02). All cases were caused by Legionella pneumophila serogroup 1. Forty-six patients (81%) were admitted to the hospital and 10 (18%) required tracheal intubation. Although all received erythromycin, seven patients died. Hypoxemia, leukopenia, hyponatremia and renal failure were associated with a higher mortality rate. However, after multivariate analysis renal failure appeared as the only independent prognostic variable. Finally, it was concluded that in the community-acquired outbreaks of pneumonia Legionella pneumophila infection should be ruled out.

Adult↗
PubMed1989

[Legionellosis].

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Humans↗