Biomedical subjects
Publications and source records attributed to A Madrazo.
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OBJECTIVE: Myopathies are entities that mainly involve striated muscle. In Duchenne's muscular dystrophy (DMD) there have been reported smooth muscle alterations in the pre-oral phase of swallowing, in gastric emptying, and pseudoobstruction. Nevertheless, esophageal motility alterations are not concluding. The objective of this work was to determine if there are motor esophageal alterations in this patients, and if this alterations are related to the clinical manifestations of disease. STUDY DESIGN: Nine consecutive patients with DMD (mean age 8, range 6-11 years; males) were evaluated, comparing clinical and manometric findings. RESULTS: Esophageal manometry alterations were found in all patients, mainly simultaneous non-peristaltic waves (60.86%) of diminished amplitude, in both striated and smooth muscle. Seventy seven percent presented with upper and lower gastrointestinal symptoms (dysphagia, regurgitation, epigastric pain, constipation, and distention). No correlation was found between esophageal motility alterations and gastrointestinal symptoms, nor with the clinical stage of disease in accordance to Brook (r = 0.27). CONCLUSION: These results show that patients with DMD present esophageal motor disorders in both striated and smooth muscle, as well as upper and lower gastrointestinal symptoms. Specialized motility studies could yield a better understanding of disease, and, possibly with adequate treatment, provide for a better quality of life in children with DMD.
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The increase of HLA-DR3 and complotype SCO1 previously found in Mexican mestizo adults with E. histolytica amoebic abscess of the liver, was also found in Mexican mestizo children of either sex with the same disease, when compared to the healthy control population (adults and/or children) of the same ethnic and socioeconomic background. This HLA and complotype pattern was not found in Mexican Mestizo patients with amoebic rectocolitis. No linkage disequilibrium was found between these and the other MHC determinants tested in this survey. Thus, HLA-DR3 and SCO1 may constitute primary, independent risk factors, not for any kind of amoebic tissue invasion (i.e. amoebic rectocolitis), but specifically for amoebic liver abscess, irrespective of age or sex. The possibility of linkage disequilibrium with other factors (i.e. the TNF family) within or close to the MHC that were not tested in this study, is discussed. Children with amoebic liver abscess revealed a significant increase in HLA-DR5, and the absence of HLA-DR6 when compared to adults with amoebic liver abscess, suggesting that at least in this ethnic group these class II HLA traits may contribute to some of the peculiarities of pediatric amoebic liver abscess as opposed to the adult version of this disease. HLA-DR3, SCO1, but also HLA-DR5 and HLA-DR6 have all been associated with certain forms of immune-dysfunction, and may thus contribute to some of the clinical and immunological features of this parasitic disease.
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The management of aortoenteric fistulas is complex and demanding. The purpose of this review is to present a case of ilioappendiceal fistula and to review its proper management.
A 36-year-old female with a six-year history of Crohn's disease of the anus and colon was found to have in situ cloacogenic carcinoma of the anus after having undergone total proctocolectomy for massive bleeding. This case further supports the association between Crohn's disease of the gastrointestinal tract and its potential for malignant degeneration.
There is considerable similarity in the morphologic expression of radiation nephritis in man and in the rat. In both species the cellular structures as well as intercellular substances are affected. The most sensitive elements are the tubular epithelium, glomerular endothelium, the glomerular mesangium, and subendothelial and endomysial basement membranes in the arterial walls. The characteristic separation of cells from basement membranes in the glomeruli and tubules is probably due to the damage of both the cells and the membranes. Subsequent degeneration of muscle cells in the arterial media and deposition of fibrin lead to fibrinoid necrosis and thrombosis. Within the range of 1500 to 10,000 rads the nature of radiation changes remains the same irrespective of dose. Higher doses merely accelerate and aggravate the lesions and increase the frequency of severe arterial damage.
Biopsy specimens of the myocardium for electron microscopical study were taken from patients who were having surgical operations for correction of aortic and mitral valve lesions. Ultranstructural changes characteristic of hypertrophy and ischemia were found in the left ventricles of groups with aortic and mitral lesions. The severity of the cardiomyopathy was greater in hearts that had aortic lesions than in those that had mitral lesions. Both groups, however, displayed degenerative changes to an extent not readily appreciated or expected when their clinical histories and catheterization data were obtained.
Radiation nephritis is a process of necrosis, atrophy and sclerosis that follows exposure of the kidney to ionizing radiation. Experimental studies with electron microscopy demonstrate that this process begins as degeneration of the glomerular endothelium and the tubular epithelium, and their basement membranes, leading to collapse of these structures and the development of interstitial fibrosis. Rather late and complicating events are necrosis and thrombosis of arteries and arterioles, contributing to the destruction of the renal parenchyma. The process is the same with large doses (5,000 to 10,000 rads) and with medium doses (1,000 to 3,000 rads), the only difference being the extent and the speed with which the lesions develop and the frequency of arterial necrosis.
Citrobacter diversus is a gram-negative rod member of the Enterobacteriacease family. A patient is described from whom this organism was isolated twice in pure culture from empyema fluid. Our isolates of Citrobacter diversus were resistant to ampicillin and carbenicillin and sensitive to cephalothin. Citrobacter diversus should be distinguished from Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae. This organism joins Streptococcus pyogenes, bacteroids species, anaerobic streptococci and Escherichia coli as a cause of slight pneumonia with extensive empyema.
The villous component of nine colonic polyps (three pure villous adenoma and six mixed adenomatous and villous adenomas) was studied by light and electron microscopy. Normal colonic mucosa was used for control. The predominant cell was an undifferentiated epithelial cell resembling those of the base of the crypts of normal colonic mucosa. A minority of these cells differentiated toward goblet cells and absorptive cells. Interdigitations of the plasma membrane with enlarged intercellular spaces were frequently observed, possibly related to the loss of water and electrolytes in some of these tumors, suggesting an analogy to renal tubular plasma membrane changes in kalliopenic nephropathy. Numerous membrane-bound, inter and intracellular "inclusion bodies" representing degenerated lymphocytes and epithelial cell organelles were commonly found. Viral inclusions were not detected in this material. The possibility that the inclusion bodies observed in villous adenoma may represent lysosome-modified vesicles, secondary to absorption of protein and surface mucosubstances appears unlikely.
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In the rat, radiation injury to a kidney results in severe glomerular lesions, with only a moderate increase in proteinuria. The proteinuria, however, was found to be nonselective. There was no relationship between the degree and selectivity of the proteinuria. No change in the gross chemical composition of the glomerular basement membrane obtained from the irradiated kidney was observed when compared with the GBM of a) untreated control kidneys, b) kidneys obtained from sham operated rats, c) unilaterally nephrectomized and d) control kidneys of irradiated animals. In conclusion, no correlation could be established between the morphologic alterations of the glomerulus and the chemical or permeability characteristics of the membrane.
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An early embryo at stage 5 of development is presented. The specimen's estimated age of about ten days makes it one of the youngest human products of conception on record. As such, it provides information on the earliest phases of human development.
Over a six-month period from December 1973 to June 1974, isolations of Citrobacter diversus were obtained from nine patients at Grace Hospital. Our initial experience was with a patient who developed pneumonitis and a massive fatal empyema due to this organism. Seven of the nine patients were 50 years of age. Three patients had an underlying malignancy. Four patients experienced significant clinical infections. Isolations in three patients were considered to be commensal, and two isolations were of indeterminate significance. Our Citrobacter diversus isolates, which can be confused with Escherichia coli, were uniformly resistant to ampicillin and carbenicillin and sensitive to the cephalosporins, tetracyclines, and gentamicin. These results agree with previous reports. Citrobacter diversus appears to be capable of causing serious clinical disease. Patients most at risk are elderly compromised hosts and infections are usually hospital acquired.