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Biomedical subjects

A Madrid

Publications and source records attributed to A Madrid.

At least 19 recordsLinked to original sources
PubMed2001

Effects of short-term citicoline treatment on acute cocaine intoxication and cardiovascular effects.

RATIONALE: The majority of pharmacotherapies proposed for cocaine dependence have been marginally effective and frequently have undesirable side effects. We recently demonstrated that short-term treatment with citicoline decreased self-reported desire to use cocaine in crack cocaine users. OBJECTIVE: The present study was conducted to assess the safety of citicoline in combination with cocaine by investigating whether cocaine-induced cardiovascular and behavioral effects and cocaine plasma levels are altered by citicoline pretreatment. METHODS: Eight healthy male and female volunteers who used cocaine on an occasional basis participated in this randomized, placebo-controlled, three-visit study. During all three visits, subjects received an acute intranasal dose of cocaine (0.9 mg/kg) and were continuously monitored for the ensuing 3.5 h. The first visit involved no pretreatment, and visits 2 and 3 were preceded by a 4-day pretreatment period of either citicoline (1 g/day) or placebo. RESULTS: Citicoline pretreatment did not alter the cardiovascular, physiologic, or subjective effects of acute cocaine. CONCLUSIONS: Although citicoline did not block the acute subjective effects of cocaine in a laboratory environment, the combined use of citicoline and a moderate dose of intranasal cocaine presented no added risk of cardiovascular effects. Further study is necessary to determine whether this medication (which is currently used to treat strokes) will be a useful adjunct to treat cocaine dependence.

Adult↗
PubMed2001

Comparison of defibrillation thresholds using monodirectional electrical vector versus bidirectional electrical vector.

BACKGROUND: Currently, two main lead configurations are used for implantable cardioverter-defibrillators (ICD). One generates a monodirectional electrical vector by using the can surface as an active part (hot can) together with a right ventricular defibrillation coil. The other one (TRIAD) produces a bidirectional electrical vector by adding a proximal defibrillation electrode on the same lead. The purpose of this prospective study was to determine whether there is a difference between these configurations in terms of the acute defibrillation threshold (DFT). The secondary objective was to evaluate the possible sequential effect of successive arrhythmia induction and defibrillation shocks on the final DFT value. METHODS: In 44 patients (37 males, 7 females, mean age 59.18 +/- 12.05 years; mean ejection fraction 35.21 +/- 11.69%), a Hot Can Ventak family ICD (Guidant, St. Paul, MN, USA) was implanted in a left pectoral pocket. During the implant procedure, step-down to failure DFT testing was performed twice in each patient using the two different above-mentioned configurations: the bidirectional and the monodirectional. The first configuration to be tested was determined by a 1:1 randomization by center. RESULTS: The step-down DFT protocol was followed in 35 patients. The average DFT was 8.6 +/- 4.0 J for TRIAD and 10.4 +/- 4.3 J for the monodirectional (p = 0.009) lead configuration; this represents a 16.3% decrease in the DFT using a bidirectional configuration. Furthermore, no relationship between the final DFT and the number of ventricular fibrillation inductions and shocks received was observed, confirming the secondary objective. CONCLUSIONS: Compared to the monodirectional electrical vector, the bidirectional electrical vector is clearly more beneficial for the patient.

Adult↗
PubMed2000

Clinical predictors of acute response with quetiapine in psychotic mood disorders.

BACKGROUND: In controlled studies of patients with schizophrenia, the atypical antipsychotic quetiapine, 300 mg/day, has been shown to be as effective in the treatment of positive and negative symptoms as haloperidol. However, little is known about the efficacy of quetiapine in patients with psychotic mood disorders. The purpose of this study was to assess the efficacy of quetiapine in the treatment of psychotic mood disorders in comparison with nonaffective psychotic disorders and identify clinical factors associated with quetiapine response. METHOD: In a naturalistic setting, by reviewing medical records, we assessed response to quetiapine and factors associated with response to quetiapine in 145 consecutive patients newly treated with the drug at a nonprofit academic psychiatric hospital. These patients had received a discharge diagnosis of bipolar disorder (manic, mixed, or depressive type), major depression with psychotic features, schizophrenia, schizoaffective disorder (bipolar or depressive type), delusional disorder, or psychosis not otherwise specified (NOS) according to DSM-IV criteria. RESULTS: Patients with a diagnosis of bipolar disorder, manic, mixed, or depressed and schizoaffective disorder, bipolar type displayed higher response rates (> 74%) compared with patients with schizophrenia. However, this finding did not achieve statistical significance. A diagnosis of major depression with psychotic features (p = .02) and longer duration of illness (p = .03) were associated with less chance of responding. CONCLUSION: Quetiapine may be a useful alternative or adjunctive treatment for patients with bipolar and schizoaffective disorders.

Adult↗
PubMed1999

Comparison of verapamil versus felodipine on heart rate variability in hypertensive patients.

OBJECTIVE: We evaluated the effect of two calcium channel blockers, verapamil and felodipine, on heart rate variability in hypertensive patients. DESIGN: Time and frequency domain measures of heart rate variability were obtained from 24 h Holter recording in 25 previously untreated hypertensive patients without left ventricular hypertrophy, before and after 3 months of verapamil slow-release treatment (240 mg once daily) or felodipine extended-release treatment (10 mg once daily). RESULTS: Blood pressure values decreased with both drugs. Measures of heart rate variability, comparable at baseline in the two groups, were unchanged after felodipine. After verapamil, the average RR interval, the square root of the mean of the squared differences between all adjacent normal RR intervals (r-MSSD) and the percentage of differences between all adjacent normal RR intervals > 50 ms (pNN50), measures of vagal modulation of heart rate, increased (from 735 +/- 67 to 827 +/- 84 ms, P < 0.001; from 30 +/- 10 to 44 +/- 15 ms, P < 0.001; and from 3 +/- 2 to 7 +/- 6%, P < 0.01, respectively) and were higher than after felodipine. The coefficient of variation, a measure that compensates for heart rate effects, increased only after verapamil (from 5.8 +/- 1.3% to 6.6 +/- 1.0%; P < 0.05). High frequency power and its coefficient of component variance, both representing the vagal modulation of heart rate, increased after verapamil (from 5.33 +/- 0.29 to 5.80 +/- 0.27 In units, P < 0.001 and from 1.9 +/- 0.3 to 2.2 +/- 0.25%; P < 0.05). Finally, the low to high frequency power ratio, an indicator of sympathovagal balance, with a high value suggesting a sympathetic predominance, decreased after verapamil (from 2.16 +/- 0.41 to 1.36 +/- 0.35; P < 0.001), confirming the improvement in vagal modulation of heart rate. CONCLUSION: In hypertensive patients, despite a comparable anti-hypertensive effect, verapamil, but not felodipine, has favourable effect on cardiac autonomic control.

Aged↗
PubMed1999

Medical assessment. Its role in comprehensive psychiatric evaluation.

This article describes the role of a medical evaluation in the overall developmental assessment of a young child. General guidelines for conducting the evaluation and practical issues to consider in dealing with young children and their families are provided. To illustrate these points, hypotonia and failure to thrive, two broad categories of pathology with numerous potential underlying medical causes, are addressed specifically. The involvement of genetics in developmental pathology is also outlined in some detail. Finally, issues to be aware of when considering pharmacologic management of psychiatric symptoms in young children are discussed.

Child, Preschool↗
PubMed1998

Clinical predictors of acute response with olanzapine in psychotic mood disorders.

BACKGROUND: In controlled studies of patients with schizophrenia, the atypical antipsychotic olanzapine has been shown to be more effective in the treatment of positive and negative symptoms compared with haloperidol at doses of 10 mg/day. However, little is known about the efficacy of olanzapine in patients with psychotic mood disorders. The purpose of this study was to assess the efficacy of olanzapine in the treatment of these psychotic mood disorders in comparison with nonaffective psychotic disorders and to identify clinical factors associated with olanzapine response. METHOD: In a naturalistic setting, by reviewing medical records, we assessed response to olanzapine and factors associated with response to olanzapine in 150 consecutive patients newly treated with the drug at a nonprofit academic psychiatric hospital. RESULTS: Patients displaying a moderate-to-marked response to olanzapine were more likely to be younger; be female; receive a diagnosis of bipolar disorder; and have a shorter duration of illness, shorter length of stay prior to olanzapine, and longer duration of trial. CONCLUSION: Olanzapine may be a useful alternative or adjunctive treatment for patients with bipolar disorder.

Adolescent↗
PubMed1998

[Restenosis and remodeling after percutaneous transluminal carotid angioplasty].

INTRODUCTION: The characteristics of restenosis and remodeling after carotid percutaneous transluminal angioplasty (PTA) were badly known. OBJECTIVE: To describe these characteristics in our series of carotid PTA. PATIENTS AND METHODS: A total of 78 cases of PTA for symptomatic > 70% atherosclerotic stenosis of the extracranial internal carotid artery, were selected from our series of PTA if follow-up was > 12 months. All of them were followed with extracranial continuous-wave Doppler. RESULTS: Restenosis of any degree was found in 17 cases (21.79%) and always asymptomatic. A restenosis > or = 70% was found in 5 cases (6.4%). Restenosis was mainly found in cases without residual stenosis nor dissection after PTA (p = 0.002). Restenosis was found in 16 cases (94.11%) in the first 6-months, with no progression thereafter. Remodeling of residual stenosis was frequent (17 cases; 53.11%) and found mainly during the first month after PTA. Its incidence was highest in patients with dissection treated with heparin. In cases with restenosis, remodeling was infrequent, incomplete and occurred after 18-24 months. CONCLUSIONS: 1. Significant restenosis after PTA due to myointimal proliferation, was infrequent. All cases were asymptomatic, under antiplatelet treatment. A new interventional procedure might not be necessary. 2. Complete remodeling was frequently found after 1-month control, mainly in arteries with some residual stenosis and dissection after PTA.

Adult↗
PubMed1997

Angina-induced protection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart?

OBJECTIVES: The present study examined whether angina 48 h before myocardial infarction provides protection in adult and elderly patients. BACKGROUND: The mortality rate for coronary artery disease is greater in elderly than in young patients. In experimental studies, ischemic preconditioning affords an endogenous form of protection against ischemia-reperfusion injury in adult but not in senescent hearts. Angina before myocardial infarction, a clinical equivalent of experimental ischemic preconditioning, has a protective effect in adult patients. It is not known whether angina before myocardial infarction is also protective in aged patients. METHODS: We retrospectively verified whether antecedent angina within 48 h of myocardial infarction exerts a beneficial effect on in-hospital outcomes in adult (< 65 years old, n = 293) and elderly (> or = 65 years old, n = 210) patients. RESULTS: In-hospital death was more frequent in adult patients without than in those with previous angina (10% vs. 2.6%, p < 0.01), as were congestive heart failure or shock (10.7% vs. 3.3%, p < 0.02) and the combined end points (in-hospital death and congestive heart failure or shock) (20.7% vs. 5.9%, p < 0.0003). In contrast, the presence or absence of previous angina before acute myocardial infarction in elderly patients seems not to influence the incidence of in-hospital death (14.4% vs. 15.2%, p = 0.97), congestive heart failure or shock (11.0% vs. 11.9%, p = 0.99) and the combined end points (25.4% vs. 27.1%, p = 0.89). Logistic regression analysis models for in-hospital end points show that previous angina is a positive predictor in adult but not in elderly patients. CONCLUSIONS: The presence of angina before acute myocardial infarction seems to confer protection against in-hospital outcomes in adults; this effect seemed to be less obvious in elderly patients. This study suggests that the protection afforded by angina in adult patients may involve the occurrence of ischemic preconditioning, which seems to be lost in senescent patients.

Adult↗
PubMed1997

Dysfunction of implantable defibrillators caused by slot machines.

The electrogram storage is a feature offered by the last generation of defibrillators, which enables the physician to establish whether the sensed episode and the electrical therapy delivered by the device was appropriate. The incidence of electromagnetic interferences may be higher than initially suspected with the latest generation of defibrillators. Such interference was documented in 4 out of 100 patients over a 24-month period. The electrical interference occurred in all four of them, while they were playing with slot machines. In the RR interval history, irregular QRS sensing of variable frequency was documented in some episodes. The intervals were irregular and nonphysiological satisfying the rate cut-off criteria in an intermittent and nonsustained way. There may be high risk of electromagnetic interference between slot machines and defibrillators. Our experience calls for a warning to all defibrillator patients and, perhaps some regulatory intervention.

Adult↗
PubMed1997

[Subacute combined degeneration of the spinal cord: manifestations of esophageal epidermoid carcinoma].

INTRODUCTION: Subacute combined degeneration of the spinal cord associated with vitamin B12 deficit is well known. However a paraneoplastic induced cyanocobalamin malabsorption responsible for either subacute combined degeneration of the spinal cord, has not been reported. Moreover, the possibility of either subacute combined degeneration of the spinal cord may be manifestation of a cancer, it's unknown. CLINICAL CASE: We present the case of a 73-year-old woman with cutaneous paleness and clinical manifestations of a subacute combined degeneration of the spinal cord. Laboratory analysis showed a megaloblastic anemia and Schilling test showed cyanocobalamin malabsorption corrected by intrinsic factor. Anti-intrinsic factor antibodies were positive. Chronic atrophic gastritis and immunological diseases associated with pernicious anemia or with anti-intrinsic factor positive, were excluded. A hidden esophageal squamous cell carcinoma was discovered. Necropsy confirmed both, subacute combined degeneration of the spinal cord and esophageal carcinoma in the absence of chronic atrophic gastritis. CONCLUSIONS: Anti-intrinsic factor antibodies were the only found factor which could explain cyanocobalamin malabsorption. A esophageal squamous cel carcinoma was discovered. In our case, vitamin B12 malabsorption had a paraneoplastic origin mediated by anti-intrinsic factor antibodies. Subacute combined degeneration of the spinal cord may be the manifestation of a hidden esophageal squamous cell carcinoma.

Aged↗
PubMed1996

Morvan's fibrillary chorea: remission after plasmapheresis.

We evaluated the effects of plasmapheresis in two patients with Morvan's fibrillary chorea, one of whom had sigmoid carcinoma, with oligoclonal bands in the cerebrospinal fluid, and modifications of the lipid-oxidative muscle pattern. The use of plasmapheresis in the treatment of Morvan's fibrillary chorea has not been reported previously and in our patients improved the symptoms markedly.

Aged↗
PubMed1996

[Plus-minus eyelid syndrome of vascular origin].

The association of unilateral ptosis and contralateral palpebral retraction named as "palpebral plus-minus syndrome" by Gaynard et al is an infrequent finding. Most cases described are of peripheral origin and secondary to muscle pathology or neuromuscular union. Cases secondary to central lesions are exceptional. We present the case of a female patient who developed palpebral plus-minus syndrome as a result of a vascular lesion with presumably mesencephalic localization.

Aged↗
PubMed1995

Subjective assessment of allergy relief following group hypnosis and self-hypnosis: a preliminary study.

Self-hypnosis was taught to 34 self-identified allergy patients who attended two training classes. They practiced on their own and were questioned two months later. Seventy-six percent of the subjects reported they felt an improvement in their symptoms; 86% of those who were medicated decreased their medicines. Practice was clearly related to reported improvement. "Feeling hypnotized" was not related to improvement.

Adolescent↗