Biomedical subjects
Publications and source records attributed to A García.
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The use of a low-cost microcomputer in the clinical study of left ventricular diastolic function is described. Both left ventricular filling and compliance were studied by means of the simultaneous recording of left ventricular pressure and an echocardiogram displaying ventricular dimensions. A program was written to calculate ventricular volume every 40 msec and a volume-time diagram was obtained. The raw curve was smoothed with a second degree polinomial. The rate of change of ventricular volume (dV/dt) was obtained. Simultaneous left ventricular volume and pressure were plotted. The diastolic, exponential portion of the pressure-volume loop was used to calculate an index of ventricular stiffness at zero volume. It is concluded that a simple microcomputer, when conveniently programed, is able to perform the time-consuming mathematical operations involved in the clinical assessment of left ventricular diastolic function.
UNLABELLED: The aim of this study is to demonstrate that blockade by bupivacaine of nociceptors located at the same level than the anterior tonsillar pillar, can reduce the pain in the postoperative period following tonsillectomy, thus, making easier the recovery of these patients at home. For this purpose, fifty children aged 2 to 13 years old, are studied. A double blind study is performed distributing the children randomly in two groups. One group is infiltrated prior to surgery with 1 cm3 of bupivacaine 0.25% + epinephrine 1:200,000 in three points of the anterior tonsillar pilla, while the other group is infiltrated with normal saline. The pain in the immediate postoperative period (60 minutes) is classified in five categories by a visual pain scale (scored 1-10). Short term postoperative (7 days) is also classified in five categories by a scale (scored 1-10) based in the information provided by the mother. Statistical analyses of the data is performed considering the statistical significance of the correlations obtained from the Chi2 and Student's tests. CONCLUSION: pre-incisional infiltration in the anterior tonsillar pillar with bupivacaine in the tonsillectomy will cause a remarkable reduction in the intensity of the postoperative pain.
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In this paper we report the clinical and electrophysiological study of a patient with suprascapular nerve entrapment. The patient was initially diagnosed as having shoulder pain due to tendinitis, since his job involved continuous loading of the affected shoulder with heavy weights. Later, clinical exploration revealed wasting of the supra and infraspinatus muscles. Electrophysiological study confirmed the diagnosis of a neuropathy of the suprascapular nerve at the level of the coracoid notch, which improved with conservative treatment. This case report stresses the importance of suprascapular nerve entrapment as a causal factor for shoulder pain; it has an occupational origin which should be taken into account in the differential diagnosis of shoulder pain syndromes.
In 110 adult selected patients, 87.1% female (average age 38.2 years, range 16-72) with symptomatic, severe mitral stenosis eligible for surgery, we performed balloon catheter transvenous mitral commissurotomy (BCTMC) as alternative treatment. Inoue's catheter was utilized in 80 cases (72.7%), and the double-balloon technique in 30 (27.3%). The procedure was successful in 102 patients (92.7%, 2nd attempt in 5 cases), with optimal results in 96 (87.3%); and it was unsuccessful in one patient for a technical difficulty. Complications occurred in 3 cases due to perforation of a cardiac chamber (2.7%); and 4/106 patients developed severe mitral insufficiency (3.8%). The mitral valve area increased from 1.09 +/- 0.27 to 2.6 +/- 0.87 cm2 (p < 0.0001); the diastolic mitral gradient decreased from 18.9 +/- 5.9 to 3.6 +/- 2.8 mmHg (p < 0.0001); similar reduction was obtained in mean left atrial pressure from 26.2 +/- 6.5 to 12.5 +/- 4.2 mmHg (p < 0.0001), and mean pulmonary artery pressure from 38 +/- 17 to 26.2 +/- 10.4 mmHg (p < 0.005). New mitral insufficiency appeared or increased in more of one grade in 12/106 patients (11.3%), and it was not detectable in 86/106 patients. During long-term follow-up (average 10.4 months, range 5 to 24), all patients (100 cases) improved their functional class (83.1% asymptomatic), and maintained their 2D echocardiographic mitral valve area. In conclusion BCMTC is the treatment of choice for selected cases of acquired symptomatic mitral stenosis, with immediate and long term results comparable to surgical commissurotomy.
The present study deals with the evaluation of the effectiveness of the measures employed in the control of Triatoma infestans, the vector of Trypanosoma cruzi infection (Chagas' disease), in the IV region of Chile through a serological follow up program. For this reason, a serological survey has been carried out in 2,783 children, from 0 to 10 years, who live in rural high endemic areas of the region. The sera were tested using an indirect hemagglutination test (IHAT) and ELISA techniques with results agreeing in 99.9% of the samples. In children with positive serology xenodiagnosis was performed and blood samples from the corresponding mothers were submitted to serology for Chagas' disease. These additional tests should allow to distinguish between congenital infection and vectorial transmission. It was observed that vectorial transmission of T. cruzi was interrupted in some localities where entomological control has been applied for 10 years, or lowered in those which have been submitted to desinsectations in the last 5 years. On the other hand, a relatively high prevalence of the infection has been detected in some localities. These results suggest an apparent increase of vectorial transmission, indicating the need of readjusting the dwellings insecticide sprayings activities to improve the measures against the vector.
BACKGROUND: Allogeneic stem cell transplantation is being increasingly used to treat young patients with poor-prognosis low-grade lymphoproliferative disorders. We report our single-center experience. PATIENTS AND METHODS: Six adults (four with advanced chronic lymphocytic leukemia, one follicular center cell lymphoma and one mantle cell lymphoma) underwent allogeneic stem cell transplantation (SCT). Five received bone marrow while one received peripheral blood stem cells. Donors were HLA-identical siblings in five cases and an HLA-haploidentical sibling in one. The conditioning regimen included in five cases cyclophosphamide, TB1 and high-dose chlorambucil, without the latter in the patient with follicular lymphoma. RESULTS: Five patients successfully engrafted, while the patient who received the haploidentical marrow suffered primary graft failure. There were two cases of grade 2 acute GVHD and one limited chronic GVHD. Four patients are alive in complete remission (CR) with a follow-up of 17+ to 118+ months. Additionally, there is no evidence of residual disease by immunologic and molecular techniques in three cases, while one patient has residual disease assessed by molecular methods. CONCLUSIONS: These results suggest that allogeneic SCT can achieve prolonged remissions in advanced chronic lymphoproliferative disorders.
BACKGROUND AND METHODS: Human infections caused by Listeria monocytogenes often present as sporadic cases without any epidemiological relationship among them; however they also appear as outbreaks that are usually detected by an increase in the number of cases diagnosed by hospitals of the geographic area. Between December 1991 and May 1993, twenty four cases of listeriosis were detected in three hospitals of Las Palmas de Gran Canaria; and they were classified as an outbreak. Our report describes its clinical, epidemiological and microbiological aspects. RESULTS AND CONCLUSIONS: Twenty four cases of listeriosis were diagnosed, 12 occurred in pregnant women or neonates (5 and 7 respectively) and 12 in non pregnant adults. All adult infections were community-acquired. The incidence rate was, for the epidemic area, 76.3 cases per million population during the period considered (18 months). Among non pregnant adults, 9/12 patients had some underlying disease and 9/12 presented CNS affection (meningitis and/or cerebritis). In the group of pregnant women, 4 cases occurred in the second trimester and fetal loss was caused; one case was detected in the third trimester and four weeks later the patient delivered an unaffected infant. All cases of neonatal listeriosis presented as early-onset sepsis. Of the 24 strains of L. monocytogenes, 21 were serotype 4, two were serotype 1 and one was not typeable. Strains from 12 patients were available for epidemiological analysis, seven of which corresponded to the same pattern and there were three more different patterns.
Cysteinyl leukotrienes are important mediators of asthma, and inhibition of their effects may represent a potential breakthrough in the therapy of allergic rhinitis and asthma. Strategies for inhibition of cysteinyl leukotriene receptors and inhibition of 5-lipoxygenase activity. The leukotrienes antagonists, with particular reference to asthma and allergic rhinitis, is reviewed in this paper. In studies in asthmatic patients, these compounds can inhibit bronchoconstriction in response to exercise, aspirin and allergen. Results from clinical studies using receptor antagonists, such as LY-171883, SK&F-104353, ICI-204219, ONO-1078, MK-751, MK-0679, demonstrate beneficial effects, with improvement in symptoms and forced expiratory volume in one second (FEV1), and a reduction in the use of beta 2-adrenergic relief medication. NZ-107 was studied for its effect on airway inflammation caused by intratracheal injection of LTB4 or IL-5, or by inhalation of PAF, and by cell activation. Analysis of the BAL fluid revealed that both induced eosinophilia and neutrophilia were suppressed. Surprisingly, although PAF and superoxide generation were inhibited in macrophages and eosinophils, NZ-107 had no effect on neutrophil activation. U-75302 was studied in guinea pigs and inhibited LTB4 induced chemotaxis of eosinophils in vitro and antigen-induced lung eosinophilia in vivo. Further studies are needed to clarify the exact mechanism by which these compounds provide beneficial effects.
We haven't been using continuous veno-venous hemodiafiltration in our unit as an extrarenal depuration technique since 1991. With this work we want to provide our experience in what we call controlled ultrafiltration, technique which we have been using more frequently in the last two years and which consists on using the venous bomb of double head for ultrafiltration (UF) extraction, managing to obtain a more accurate control of it. The development of this technique has allowed us to obtain a higher control of the patient, reduce the risk of hypothermia and reduce the nursing burden. We show the procedure of priming, connection, disconnection and the necessary material, as well as the advantages and specific care we perform in our unit.
This article reviews the literature on the effects of leukotrienes in asthma. In particular, the ability of recently developed synthesis inhibitors to attenuate the asthma causing effects of leukotrienes is examined. MEDLINE (1966-1996), EMBASE (Excerpta Medica; 1974-1996), and other biomedical and drug directory databases were searched to identify English-language articles (basic science, clinical trial research, and review articles) and abstracts of conference proceedings on biosynthesis inhibitors for leukotrienes and related terms. Leukotrienes are endogenous molecules formed by the breakdown of a membrane constituent, arachidonic acid, via the 5-Lipoxygenase enzyme pathway. This pathway ultimately produces several species of leukotrienes with various biologic activities, including generalized inflammatory effects associated with asthma: increased vascular permeability, enhanced mucous production, and decreased mucociliary transport. The biosynthesis inhibitors for leukotrienes attenuated the response to inhaled leukotrienes and allergen challenges (MK-0591; MK-886; AA-681; A-64077; ZD-2138). These agents produced beneficial effects in cold, exercise (A-64077) and aspirin-induced asthma (A-64077; ZD-2138), as well as clinical asthma. Many of these medications appear to be effective in the treatment of asthma (BAYX-1005; MK-0591; MK-886; AA-681; A-64077; ZD-2138; U-60257; FR-110302; BI-6239; A-78773; ABT-761; L-746530; L-699333; ZM-230487). Further clinical research is needed to determine which patients would benefit most from their use.
Chagas' disease is a parasitic zoonosis with high prevalence in Chile. It is distributed in rural and periurban section in the northern most seven out of thirteen regions in which the country is divided, and affects about 142,000 individuals dispersed in most of the 165 counties sited in the chagasic zone. Triatoma infestans--intradomiciliary species--is the main and practically exclusive vector of Trypanosoma cruzi. Diverse tools may be utilized in order to interrupt the domestic cycle of transmission of T. cruzi: health education, housing improvement and elimination of vectors by dwelling insecticide sprayings. This last resource has received priority in Chile in the last 12 years. To evaluate the effectivity of the programs for eliminating T. infestans a serological study for Chagas' disease--comprising 8,767 children less than 10 years old from 27 rural counties insecticide sprayed in the last 12 years--was carried out. A global total of 125 (1.4%) children resulted positive, figure significantly lower than 5.4% found in 1982-1990 in the same age group. Distribution by regions of positive individuals showed a decrease of prevalence in each of them: III Region, from 9.8 to 1.0%, IV Region, 7.2 to 2.0%, V Region, 5.2 to 1.9%, and Metropolitan Region, 1.4% to 0.6. Even though positive children have still been found in 46.7% of localities of the studied counties, it is possible to affirm that the vector control programs have been effective and must be maintained, and increased in those localities with T. cruzi infection in children under 10 years of age, with the general aim of eradicate Chagas' disease transmission in Chile before 2000.
The absorption, distribution and excretion of E-4716, a novel antihistamine, were studied in rats and dogs after single-dose oral or intravenous administration of [14C]E-4716. Radioactivity was rapidly and efficiently absorbed from the gastrointesanal tract after oral administration, and biphasic plasma concentration-time profiles were observed in both species. In rats, oral absorption was linear within the dose range studied, and no differences in administration route or doses were observed in elimination. Elimination was approximately twice as fast in dogs as in rats. No sex differences in elimination were observed in dogs. Radioactivity was widely distributed in rats, and levels in brain, eyes, fat and testes were lower than those in plasma. Excretion was mainly by feces in rats and by urine in dogs, showing species differences. After oral administration in rats, unchanged drug was rapidly absorbed and the absolute bioavailability was only 20%, suggesting an important first-pass effect.