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Biomedical subjects

A Rodriguez

Publications and source records attributed to A Rodriguez.

At least 163 records · Page 9Linked to original sources
PubMed1994

Obesity.

Although obesity and trauma both are common in the general population, discussion of the care of the critically injured obese patient has been relatively absent. Obesity is associated with significant clinical and occult multisystem disease. Because host factors are key determinants of post-traumatic course and outcome, obesity appears to be a marker of high risk. Obesity should be considered with age, pregnancy, cardiopulmonary disease, and substance abuse as a host factor that has significant post-traumatic ramifications. Only by employing a comprehensive, multidisciplinary approach to the critical care management of such patients will post-traumatic complications be prevented and treated effectively.

Humans↗
PubMed1994

Flail chest as a marker for significant injuries.

The records of 92 patients with flail chest injury treated at a Level I trauma center were analyzed retrospectively. Associated intrathoracic injuries included pulmonary contusion (46 percent) and pneumothorax or hemothorax, or both (70 percent). The incidence of great vessel, tracheobronchial and diaphragmatic injuries was no different from that of a control population with simple rib fractures. Adult respiratory distress syndrome developed in 27 percent of patients with flail chest; 69 percent of all patients required ventilation (mean duration, 22 days). Mean length of hospital stay was 24 days. The mortality rate was 33 percent. We conclude that flail chest serves as a marker of significant intrathoracic injury, highly associated with pulmonary contusion, but even more so with pneumothorax or hemothorax. Flail chest does not seem to be a marker for great vessel, tracheobronchial, or diaphragmatic injuries. The majority of patients (more than two-thirds) will require mechanical ventilation for prolonged periods. Of paramount importance is the recognition of flail chest as a marker of high kinetic energy absorption, resulting in life-threatening thoracic as well as nonthoracic injuries.

Adult↗
PubMed1993

Exacerbation of murine herpes simplex virus-mediated stromal keratitis by Th2 type T cells.

Corneal infection of susceptible mice with HSV-1 causes herpetic stromal keratitis (HSK), which serves as a model of human HSK. To study the properties of the T lymphocytes involved in HSK, susceptible mice were immunized with the synthetic peptide corresponding to the amino terminal of HSV-1-associated glycoprotein D (gD 5-23). A CD4+ long-term T cell line and a clone bearing V beta 8.2 TCR were derived from peptide-primed lymph node cells. These T cells recognize gD 5-23 peptide in the context of I-Ed and require CD4 and LFA-1 for Ag-specific proliferation. Significantly, a truncated peptide gD 15-23 induced vigorous proliferation, indicating that these 9 amino acids constitute an epitope recognized by these T cells. The gD-specific T cells produced IL-4 and used it as the autocrine growth factor and hence belong to the Th2 subtype. Adoptive transfer of gD-specific Th2 cells into susceptible mice increased both the onset and severity of HSK after corneal HSV-1 infection. Injection of gD-specific Th2 cells without HSV-1 infection failed to cause eye damage. In addition, an irrelevant Ag-specific Th2 clone failed to induce similar tissue damage when the corresponding Ag was applied to the eye. These data indicate that the T cell-mediated exacerbation of HSK in these studies is dependent on the specific recognition of gD after corneal HSV-1 infection. Finally, gD-specific Th2 cell transfer also rendered HSK-resistant mice susceptible for HSK, suggesting that the freedom from HSK in resistant mice may primarily be due to their inability to produce the pathogenic Th2 cells. The data collectively implicate an important role for Th2 cells in the induction of HSV-mediated keratitis in mice.

Amino Acid Sequence↗
PubMed1993

Early decrease in minimal luminal diameter after successful percutaneous transluminal coronary angioplasty predicts late restenosis.

Eighty-eight patients underwent serial coronary arteriography before, immediately after, 24 hours after and 7 +/- 2 months after successful percutaneous transluminal coronary angioplasty (PTCA) of 102 lesions. Severity of coronary obstruction was measured using quantitative digital angiography. Three groups of lesions were defined when comparing angiograms recorded immediately after and 24 hours after PTCA: group I--lesions with either no change or < or = 10% increase in arterial diameter stenosis after PTCA (n = 71); group II--lesions with > 10% increase in diameter stenosis after PTCA (n = 19); and group III--patients with total occlusion (n = 12). There were no significant differences in the severity of stenosis before or immediately after PTCA among the 3 groups of lesions. Twenty-four hours after PTCA the diameter stenosis was 14.2 +/- 6.3% in group I, 34.7 +/- 8.1% in group II and 100 in group III (p < 0.0001). At 7.1 +/- 2 months after PTCA the diameter stenosis was 21.2 +/- 16.8% in group I, 61.3 +/- 1.1% in group II, and 98.5 +/- 1.3% in group III (p < 0.0001). Restenosis (> or = 50% stenosis diameter) at follow-up per lesion was significantly greater in group II than in group I (73.6 vs 9.8%) (p < 0.0001). Thus, early angiographic study after successful PTCA stratifies lesions into angiographic subsets with low (group I) and high (group II) risk of coronary restenosis.

Adult↗
PubMed1993

The polymerase chain reaction for the detection of Borrelia burgdorferi in human body fluids.

OBJECTIVE: To analyze clinical fluids for the presence of Borrelia burgdorferi DNA using the polymerase chain reaction (PCR). METHODS: We utilized a modified, nested PCR to detect the presence of Borrelia DNA in 99 samples of serum, urine, cerebrospinal fluid (CSF), or synovial fluid obtained from 44 patients with various stages of Lyme disease and 47 control subjects. Primer specificity was corroborated by examining 2 DNA data banks, testing against DNA from other organisms, and confirming results with a second set of nested primers. RESULTS: Nested PCR was capable of detecting DNA from fewer than 10 organisms in 1 ml of fluid. The specificity of this technique was 96.4%, with a sensitivity of 76.7%. Although the specificity was uniformly high, the sensitivity was dependent upon the body fluid being tested: CSF 100%, urine 100%, synovial fluid 80%, and serum 59%. The rate of false-positive results was 3.6%. CONCLUSION: These data demonstrate the potential utility of PCR in confirming the clinical diagnosis of Lyme disease as well as providing insight into the pathogenesis of various stages of this disorder.

Base Sequence↗
PubMed1993

Post-traumatic transient cortical blindness.

Five patients: three children, one adolescent, and one young adult, examined in an emergency room setting were diagnosed with post-traumatic transient cortical blindness. This syndrome is characterized by transient visual loss, normal pupillary response and normal funduscopic examination following minor head trauma. In each case, vision returned to normal within minutes to hours following injury, leaving no neurological sequelae. Headache, confusion, irritability, anxiety, nausea and vomiting were the most common related symptoms. While the mechanism responsible for the transient blindness is unknown, most authors propose an abnormal vascular response to trauma with resultant transient hypoxia and cerebral dysfunction. The similarity between the symptoms accompanying this syndrome and those seen during a classic migraine attack has led many investigators to suggest a common underlying pathophysiology. The purpose of this report is to highlight the salient clinical features and diagnostic approaches to this syndrome, thereby providing ophthalmologists and emergency room physicians a heightened awareness of this entity and the means to detect it.

Adolescent↗
PubMed1993

Determining malaria effects in rural Colombia.

Good health is an integral component of the quality of human life, a prerequisite for developing human potential and an important determinant of economic development. When a person is ill from a tropical disease in an agricultural economy, a complex interaction between the individual's welfare and the family's welfare is set in motion. So complex are these interactions that few empirical studies exist on this subject and even where they do, empirical quantification of these interactions and economic losses places the analyst in the minefield of valuing time, ability and contribution to economic welfare. Placing monetary values on these commodities is always a little unsatisfactory since dollar values do not adequately reflect the nature of the losses. Secondly, the ill person's struggle to minimize the economic effects of disease on family income will mask its true impact; thirdly, tropical diseases disproportionately affect low-income groups and therefore measuring the income effects of disease amongst these groups will only reach at the earnings effect, and underestimate the economic implications of tropical disease control. Despite these difficulties, quantification of the economic impact of disease is important from a public health point of view. This study is an attempt at such a task, and focuses on the intra-familial struggle to minimize economic losses due to malaria. Using a case-control approach, time-losses and labour reallocations within the household are examined in an attempt to understand the economic consequences of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI): in-hospital results and 1-year follow-up. ERACI Group.

OBJECTIVES: This study was designed to compare freedom from combined cardiac events (death, angina, myocardial infarction) at 1-, 3- and 5-year follow-up in patients with multivessel disease randomized to either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. BACKGROUND: Percutaneous transluminal coronary angioplasty has been an effective approach in patients with coronary artery disease, but its role in patients with multivessel coronary artery disease is still controversial. METHODS: One-hundred twenty-seven patients with multivessel disease and lesions suitable for either form of therapy were randomized to either coronary artery bypass grafting (n = 64) or coronary angioplasty (n = 63). In this study we report the immediate results and freedom from combined cardiac events at 1-year follow-up. RESULTS: Demographic, clinical and angiographic characteristics were similar in both groups. There were no differences in in-hospital deaths, frequency of periprocedure myocardial infarction or need for emergency revascularization procedures between the two groups. At 1-year follow-up, there were no differences in mortality or in the incidence of myocardial infarction between the groups. However, patients treated with coronary artery bypass grafting were more frequently free of angina, reinterventions and combined cardiac events than were patients treated with coronary angioplasty (83.5% vs. 63.7%, p < 0.005). In-hospital cost and cumulative cost at 1-year follow-up were greater for the coronary artery bypass grafting than for the coronary angioplasty group. CONCLUSIONS: No significant differences were found in major in-hospital complications between patients treated with coronary artery bypass grafting or coronary angioplasty. Although at 1-year follow-up there were no differences in survival and freedom from myocardial infarction, patients in the coronary artery bypass grafting group were more frequently free from angina, reinterventions and combined events than were patients in the coronary angioplasty group.

Adult↗
PubMed1993

Radiopharmacological studies of 99mTc-CPI: experience with isolated rat atrial tissue.

Extraction, washout and chemical integrity of technetium(I) hexakis (2-carbomethoxy-2-isocyano propane), (99mTc-CPI) were evaluated in isolated contractile rat atrial tissue. 99mTc-CPI accumulated linearly over time at 32 degrees C with uptakes that were both concentration dependent and temperature sensitive. Uptake rates also increased with contractile strength, indicating a dependence of retention on metabolic status of the tissue. Retention indices showed that percent washout of 99mTc-CPI was much slower than control studies with 99mTcO4. HPLC analysis of retained radioactive products in atrial tissue showed most of the activity present as the 99mTc-CPI complex (75%). These observations in isolated rat atrial tissue help explain the interspecies differences in biodistribution of 99mTc-CPI and support the membrane potential dependent model for uptake and retention of technetium isonitrile complexes.

Animals↗
PubMed1993

A comparison of right and left blunt traumatic diaphragmatic rupture.

Since right blunt traumatic diaphragmatic rupture (BTDR) is reported with increasing frequency, BTDR may be a disease in evolution. Data were collected on 59 left, 16 right, and five bilateral BTDRs at a level 1 trauma center. Patients with right BTDR had lower Glasgow Coma Scale (GCS) scores (p < 0.05), were more likely to be initially in hypovolemic shock, and were admitted directly from the field (p < 0.01). Left and right BTDRs were diagnosed from chest films in 37% and 0% of cases, respectively (p < 0.05). Diagnostic peritoneal lavage results were negative in 16% of left and left of 0% of right BTDRs. For right BTDRs, the liver was more likely to be injured (p < 0.001). The mortality rates were similar and ICU and hospital stays, complications, and duration of mechanical ventilation were similar for early survivors with right and left BTDRs. The clinical signs and symptoms, diagnosis, and surgical findings associated with right and left BTDR are different.

Adolescent↗
PubMed1993

A comparison between a Canadian regional trauma unit and an American level I trauma center.

Although there has been recent comparison of the Canadian and American health care systems, the issue of trauma has received little attention. Data were collected on all adult motor vehicle crash (MVC) victims admitted to the Sunnybrook Trauma Unit (CAN), Toronto, Canada, and the R Adams Cowley Shock Trauma Center (USA), Baltimore, Maryland from July 1986 through July 1990. Similar MVC victims at CAN and USA had equivalent mortality rates with similar discharge dispositions (p = NS), but patients at USA were twice as likely to be admitted to the ICU and had longer ICU stays (p < 0.01). The hospital-based cost for an average MVC patient at CAN was significantly less than for an average patient at USA and professional charges were at least five times greater at USA. This study provides some insight into the differences in trauma care between Canada and the United States.

Accidents, Traffic↗
PubMed1993

Plasma C3d levels and ischemic heart disease in type II diabetes.

OBJECTIVE--To test the hypothesis that the complement system may be activated in patients with type II diabetes and CAD. RESEARCH DESIGN AND METHODS--The plasma C3d concentration was measured in 106 type II diabetic patients and 25 nondiabetic control subjects. The patient group was subdivided according to AER, and the groups were adjusted for age, sex, and known duration of diabetes. For the assignment to a given subgroup, normoalbuminuria was defined as AER < 15 microns/min, microalbuminuria as AER 16-250 micrograms/min, and macroalbuminuria as AER > 250 micrograms/min. The presence or absence of coronary disease was assessed through clinical examination, ECG, and coronary angiography. An RIA system was used for measurement of urinary albumin levels, and the plasma C3d concentrations were measured by ELISA. RESULTS--Within each of the AER-defined subgroups, the plasma C3d levels were significantly higher in patients with IHD than in those without. Thus, in the normoalbuminuric group, plasma C3d levels were 16.3 AU/ml (95% CI 13.9-19) in patients with IHD vs. 11.6 AU/ml (95% CI 10.5-12.7) in those without (P < 0.001). The corresponding data for the microalbuminuric and macroalbuminuric groups were 21.8 (95% CI 18.1-26.3) vs. 13.6 (95% CI 12.3-15.1) and 31.6 (95% CI 24.9-40) vs. 17.5 (13.6-22.6) AU/ml (P < 0.01), respectively. Patients with IHD also had significantly higher plasma C3d levels than normal control subjects, regardless of AER subgroup. A multiple logistic regression analysis demonstrated an association between the plasma C3d concentration and IHD and AER. CONCLUSIONS--Activation of the complement system may play a role in the development of macrovascular disease in type II diabetes.

Albuminuria↗
PubMed1993

The role of Igh-1 disparate congenic mouse T lymphocytes in the pathogenesis of herpetic stromal keratitis.

The corneal destruction associated with herpes simplex keratitis (HSK) is primarily the result of the host's immune response to herpes simplex virus type-1 (HSV-1) infection. We examined the role of T cells and T cell subsets in the pathogenesis of HSK. Naive and immune T cells and HSV-1 immune CD4+ and CD8+ subsets from Igh-1 disparate BALB/c congenic mice were adoptively transferred into athymic BALB/c nude mice, which normally do not develop HSK. The results demonstrated that while the transfer of naive T cells from either HSK-susceptible C.AL-20 (Igh-1d) or HSK-resistant C.B-17 (Igh-1b) mice had little influence on HSK development, transfer of either CD3+ or CD4+ HSV-1 immune T cells from C.AL-20 mice resulted in the development of severe HSK in all of the recipients. Transfer of the same cell populations from C.B-17 mice resulted in the development of only a mild keratitis in 50% of the recipients. Transfer of CD8+ cells from either donor strain did not result in stromal disease in any recipient mouse. These results clearly demonstrate the pivotal role of CD4+ T cells in the development of necrotizing herpes stromal keratitis, and further demonstrate that CD8+ T cells are not essential in HSK development in the BALB/c system.

Animals↗
PubMed1993

The clinical significance of acute hyperamylasemia after blunt trauma.

The clinical value of total serum amylase (TSA) levels measured after blunt trauma remains controversial. To test the utility of this measurement, the authors surveyed the routine admission TSA levels of 4316 adults who were victims of blunt trauma. Most patients (58.2%) had been injured in motor vehicle accidents, and all were admitted directly from the accident scene. Patients were divided into two groups based on the admission TSA level: more than 125 U/L (abnormal) and 125 U/L or less (normal). Of the 4316 patients, 3920 (90.8%) had a normal TSA level upon admission. Hyperamylasemia was associated with a greater injury severity score (ISS) and death rate, a lower admission Glasgow Coma Scale score and an increased incidence of facial fracture, brain injury, pancreatic and hollow-viscus injuries and hypotension (p < 0.01). However, the positive predictive value of an abnormal TSA level for pancreatic and hollow-viscus injuries was 1.5% and 3.0% respectively. Also, most patients with pancreatic (65%) and hollow-viscus (83%) injuries had a normal TSA level. There was no relation between the anatomic grade of pancreatic injury and the TSA level. Acute hyperamylasemia after blunt trauma appears to be a poor predictor of pancreatic and hollow-viscus injuries. Therefore, urgent TSA determinations should not influence the clinical and radiologic evaluation of the blunt trauma victim.

Abdominal Injuries↗
PubMed1993

[Food consumption of school children regarding their social condition. Córdoba, Republic of Argentina].

This report reveals the daily consumption of nourishing food in primary school children coming from the north of Córdoba, Argentina, in relationship with their socio economic status, SES. Four categories were determined according to the place the chief support of the family occupies in the productive system. A 24 hours recall test was applied to obtain nutritional data as well as the weight and method of measure. Differences among the established categories were pointed out by socioeconomic indicators (P < 0.001). Powder and liquid milk ingesta showed statistic differences (P < 0.005), at the same time, the consumption of this food was poor, and it was not being incorporated into the scholarship's diet. The per-capita proportion of meat ingesta was over 100 g, in the whole group. Difference (P < 0.005) were noticed among the SES when the consumption was over 200 g. The consumption of fruits and vegetables is low. On the contrary, it was shown an increase in cereals and legumes ingesta as the SES decreased (P < 0.005). Analyzing the fitness of the diet it was found that the 53% of SES IV children showed calorie shortage whereas the proteins evaluation revealed excess consumption in the 88% of the studied scholarships. Other deficiencies were also found, such as calcium, riboflavin, thiamine, niacin in the whole group. This study also showed statistic differences with respect to the consumption of energy, calcium and ascorbic acid (P < 0.05).

Argentina↗
PubMed1993

Antibody-dependent cellular cytotoxicity against cells infected with herpes simplex virus type 1 in Igh-1 disparate congenic mice.

The mouse Igh-1 locus on chromosome 12 influences herpetic stromal keratitis (HSK) patterns following corneal challenge with herpes simplex virus type 1 (HSV-1). Both cellular and humoral immune mechanisms appear to be important in modulating responses to HSV-1 infections, but the role of antibody-dependent cellular cytotoxicity (ADCC) is unclear. We studied the effector-cell function and antibody in an ADCC assay in Igh-1-disparate mice. Splenocytes from both HSK-susceptible C.AL-20 (Igh-1d) and HSK-resistant C.B-17 (Igh-1b) mice mediated equal amounts of ADCC to HSV-infected cell targets using monoclonal antibodies against HSV-1 glycoprotein D. Natural killer cell activity was significantly greater in C.AL-20 than in C.B-17 splenocytes. IgG2a was less efficient than both IgG1 and IgG2b in mediating ADCC to HSV-1-infected cell targets. The Igh-1 phenotype of the antibody source had no influence on ADCC activity. Our results suggest that the susceptibility of HSK observed in these Igh-1-disparate congenics cannot be explained by qualitative differences in the ADCC activity of effector cells and antibody produced in response to HSV-1 infection.

Animals↗