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Biomedical subjects

A Vigil

Publications and source records attributed to A Vigil.

At least 19 recordsLinked to original sources
PubMed2006

Treatment of hirudin overdosage in a dialysis patient with heparin-induced thrombocytopenia with mixed hemodialysis and hemofiltration treatment.

We report a patient who developed type II heparin-induced thrombocytopenia (HIT) and accidentally received a recombinant hirudin (r-hirudin) overdosage. Treatment with hemodialysis (HD) using high-flux polysulfone dialyzer and hemofiltration was performed. Length of treatment was adjusted, monitoring activated partial thromboplastin time (aPTT) to 1.5-2.5 times the mean of the normal range. She developed deep venous thrombosis and occlusion of vascular access. Only after cessation of heparin lock catheter, platelet count began to increase. After one year of treatment with acenocoumarol and additional low-dose r-hirudin, neither bleeding nor thrombotic episodes have been reported.

Aged↗
PubMed2006

[Telemedicine and follow up of peritoneal dialysis patients].

UNLABELLED: Mean-term experience in the use of Telemedicine in Peritoneal Dialisis (PD) patients is limited as well as its cost-benefit. The main objective of this work is to evaluate Telemedicine utility in mean-long term control of stable PD patients, analyzing if the televisit (TV) could substitute 50% of the programed inhospital consults (HC) the time spent in both visit modalities, the quality of patient-personel contact as well as how image and sound have been perceived. Visit resolution was analyzed taking into account the need of HC after a TV; We also have studied if it would be possible to retrain patients in the dialisis technique with telemedicine, and we have checked the patient perceived quality and calculate the real and social costs. METHODS: during 18 months, the system has been implanted to 19 patients with 7 +/- 4 follow up (range 3-17). A Falcon videoconference kit at patient's place was used, connected to the home television set. In the hospital there was a computer with a videoconference card, webcam and software meeting point which permits the control of patient's camera from the hospital. Both are connected by a 3RDSI line system. A monthly programmed HC or TV has been made. If more controls had been required, they have been made by TV Time spent was recorded on each TV and patients and staff questionary were inquired. RESULTS: (a) PATIENTS: mean age 44 +/- 8 years, 13 (68%) male. 12 (63%) had elemental educational level and 7 (37%) mean-superior. 17 (89%) were actively working. The PD technique was: CAPD 6 (32%) and APD13 (68%). (b) Televisits: 103 TV have been made. 22 +/- 9 minutes were spent on each TV less than in the HC, 33 +/- 8 minutes (p < 0.01). There were technical problems related with lines in 21 TV, but only in 4 the connection was not possible. 92 TV (89%) were made on time, 99 (96%) had a good image quality and 96 (93%) had a correct sound. 100% of patients perceived TV as close to HC. In 90 TV (87%) medical treatment was modified. Only in 4 cases (3.9%) patients needed an hospital visit. According to patient's valuation, TV replaced correctly to HC in 97 instances (94%) and in 97 (97%) in staff opinion. In all cases (100%) catheter exit site could be evaluated as well as edema presence. Retraining was possible in all cases. There was a save in nurse's time and patient's time and also, a save in physical hospital space. Initial investment apart, the daily cost increment was scarce (1.5 Euro) taking into account that there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport. CONCLUSION: Telemedicine is useful from the clinical point of view in the mean-term for stable patients in PD. Daily cost increment is scarce and there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.

Adult↗
PubMed1999

Identifying the null subject: evidence from event-related brain potentials.

Event-related brain potentials (ERPs) were recorded during spoken language comprehension to study the on-line effects of gender agreement violations in controlled infinitival complements. Spanish sentences were constructed in which the complement clause contained a predicate adjective marked for syntactic gender. By manipulating the gender of the antecedent (i.e., the controller) of the implicit subject while holding constant the gender of the adjective, pairs of grammatical and ungrammatical sentences were created. The detection of such a gender agreement violation would indicate that the parser had established the coreference relation between the null subject and its antecedent. The results showed a complex biphasic ERP (i.e., an early negativity with prominence at anterior and central sites, followed by a centroparietal positivity) in the violating condition as compared to the non-violating conditions. The brain reacts to NP-adjective gender agreement violations within a few hundred milliseconds of their occurrence. The data imply that the parser has properly coindexed the null subject of an infinitive clause with its antecedent.

Adult↗
PubMed1999

Stab wounds to the back/flank in hemodynamically stable patients: evaluation using triple-contrast computed tomography.

Triple-contrast computerized tomography (3CT) has been proposed as a method to detect high-risk injuries in hemodynamically stable patients with stab wounds (SWs) to the back/flank and to successfully triage patients with low-risk scans into a potentially cost-effective treatment algorithm. The purpose of this study was to retrospectively review our experience with the use of 3CT for diagnostic accuracy of SWs to the back/flank and to evaluate potential decreased length of stay (LOS) in the hospital for patients with low-risk scans and no associated injuries. Seventy-nine hemodynamically stable patients met criteria for inclusion in this review. Fifty-eight 3CTs were performed for initial evaluation, 44 low risk and 14 high risk, and 21 patients underwent mandatory laparotomy. The accuracy of 3CT was found to be 97.9 per cent. The LOS was significantly less in patients who had no associated injuries and a low-risk 3CT (16.5 hours), as compared with all other treatment groups. Hemodynamically stable patients with SWs to the back/flank may be safely triaged using 3CT. Patients with low-risk scans and no associated injuries may be discharged immediately, and those with potential delayed associated injuries should be observed for 6 to 24 hours. This strategy significantly decreases LOS in patients with low incidence of significant injury.

Abdominal Injuries↗
PubMed1995

[Treatment of the diffuse and focal proliferative forms of lupus nephropathy with intravenous cyclophosphamide. Intravenous cyclophosphamide in systemic lupus erythematosus].

The objective is to evaluate the therapeutic effect and toxicity of IV Cyclophosphamide on the evolution of diffuse and focal proliferative forms of lupus nephritis. It's a prospective, descriptive and non-controlled study. We treated 12 patients (M/F = 1:11, aged 30.07 +/- 14.15) diagnosed by renal biopsy with diffuse proliferative (n = 10) and focal (n = 2) lupus nephritis. All patients received IV Cyclophosphamide. A dose of 1 g/sg.m of body surface area was administered monthly for the first three months and each three months until two years. The follow-up was 34 +/- 24.83 months (range 6-67). Seven patients completed two years of treatment with Cyclophosphamide with a further follow-up of 18.71 +/- 12.36 months (range 6-67). Renal function either improved or remained unchanged. Proteinuria, hematuria and immunologic markers decreased or normalized at three years. The patients who finished the period of two years with CFIV remained stable. There were neither infections nor hemorrhagic cystitis. We conclude that with the scheme of CFIV used by us good therapeutics effects will be obtained with minimum secondary toxicity in a follow-up of three to five years.

Adolescent↗
PubMed1993

Gastroparesis: an important cause of hospitalization in continuous ambulatory peritoneal dialysis patients and the role of erythromycin.

Gastroparesis is a disabling complication in diabetic patients. It has been reported as the second most frequent cause of hospitalization in diabetic patients on continuous ambulatory peritoneal dialysis (CAPD). We analyzed infectious and noninfectious complications in our CAPD patients. We included 31 patients (12 diabetics and 19 nondiabetics) with an average time on CAPD of 14 +/- 7 months. The incidence of peritonitis was 1.68 episodes/patient/year in diabetics and 0.84 in nondiabetics. Nine (75%) diabetic patients had peritonitis, 5 (42%) had vomiting, and 4 (33%) had ischemic heart disease. The hospitalization index (days/year) was greater in diabetics: 11.83 +/- 11.36 versus 4.16 +/- 8.84 in nondiabetics (p < 0.05). Vomiting was the first cause of admission in diabetics. We were unable to control severe gastroparesis with cisapride and metoclopramide in 4 patients. Erythromycin, 100 mg/2-L bag of dialysate, improved symptoms in all of them. We concluded that gastroparesis is an important cause of morbidity in CAPD patients. Intraperitoneal erythromycin can improve symptoms if other prokinetic drugs fail.

Cisapride↗
PubMed1992

Adequacy of peritoneal dialysis: does kt/v have the same predictive value as in HD? A multicenter study.

Urea kinetics and the use of KT/V has become a useful tool for assessing adequacy of small solute removal in HD. Clinical data supporting the benefit of urea kinetic analysis in CAPD patients had been lacking. Using the standards of KT/V for hemodialysis, many CAPD patients would be underdialyzed but, most studies show no significant difference in morbidity or mortality between CAPD and HD patients. We studied retrospectively, 102 patients (48 M, 54 F), aged 54.6 +/- 14.8 (range 14-82), on CAPD 24.4 +/- 23.9 months (0-120) from 6 hospitals. Clinical and biochemical parameters, co-morbidity, mortality, and hospital admission rate were registered. During the follow-up (1 year), a significant decrease of residual renal function (Kr) from 1.74 +/- 1.86 to 1.31 +/- 1.67 (p < 0.01) was noticed. The KT/V also decreased from 2.00 +/- 0.47 to 1.89 +/- 0.36 (p < 0.01) without change in BUN or plasma creatinine levels. The normalized protein catabolic rate (NPCR) decreased from 0.98 +/- 0.28 to 0.93 +/- 0.30 (p < 0.05) and serum albumin from 3.7 +/- 0.5 to 3.5 +/- 0.6 (p < 0.001). There was a positive correlation between NPCR and KT/V (r = 0.44, p < 0.05) and between NPCR with serum BUN (r = 0.27, p < 0.05). There was no correlation between KT/V and NPCR neither with hospitalization rate nor clinical symptoms index. The latter, however, showed a positive correlation with the co-morbidity index.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Antikindling effects of locus coeruleus stimulation: mediation by ascending noradrenergic projections.

Electrical stimulation of the noradrenergic locus coeruleus (LC) delays the generalization of partial seizures during amygdaloid kindling by increasing the time spent in the earliest stages of seizure development. To determine whether noradrenergic axons projecting to the midbrain and forebrain are involved in this antikindling effect, we examined the effects of lesions of the dorsal noradrenergic bundle, induced by intracerebral infusions of 6-hydroxydopamine (6-OHDA), on kindling and the antikindling action of stimulation of the LC. Stimulation of the LC during amygdaloid kindling increased the number of afterdischarges (ADs) spent in the early stages of partial seizure and decreased the number of ADs spent in later stages of generalized seizure, as has been described previously. LC-stimulated rats also displayed longer durations of AD during early stages of kindling. The antikindling effect of LC stimulation was blocked by lesions of the dorsal bundle, whereas the facilitatory effects of LC stimulation on generalization and on the duration of AD were unaffected by the lesions. These results suggest that the antikindling action of LC stimulation is mediated by the ascending projections of noradrenergic neurons, presumably through enhanced release of noradrenaline. On the other hand, the facilitatory effects of LC stimulation on the development of later stages of seizure and on the duration of AD appear to be independent of the ascending dorsal bundle.

Afferent Pathways↗
PubMed1990

Transient elevation of amygdala alpha 2 adrenergic receptor binding sites during the early stages of amygdala kindling.

Enhanced noradrenergic neurotransmission retards but does not prevent the development of kindling. We previously reported that locus coeruleus (LC) alpha 2 adrenergic receptor binding sites are transiently elevated during the early stages of kindling development. Since the firing activity of LC noradrenergic neurons is partially regulated via an alpha 2 receptor-mediated recurrent inhibition, the transient elevation in LC alpha 2 receptors could decrease LC activity and consequently facilitate the development of kindling. Transient elevation of alpha 2 receptor binding sites during early stages of kindling may also occur on noradrenergic axon terminals projecting to forebrain sites. Using in vitro neurotransmitter autoradiography techniques, we investigated this hypothesis by measuring specific [3H]idazoxan binding in 5 different areas of rat forebrain at 2 different stages of kindling development. After 2 class 1 kindled seizures, specific [3H]idazoxan binding was elevated significantly in the amygdala, but not in other forebrain regions. No differences in specific [3H]idazoxan binding were observed in any of the 5 brain regions in rats kindled to a single class 5 kindled motor seizure. Saturation of binding experiments indicated that the increase in amygdala [3H]idazoxan binding, following 2 class 1 kindled motor seizures, was due to an increase in the total number of alpha 2 receptor binding sites without a change in the affinity of the binding sites for [3H]idazoxan. Thus, the transient increase in alpha 2 receptors that occurs in the LC in the early stages of kindling also occurs in the forebrain region in which the kindled seizure originates.

Amygdala↗
PubMed1989

Transient elevation of locus coeruleus alpha 2-adrenergic receptor binding during the early stages of amygdala kindling.

Enhancement of noradrenergic neurotransmission retards, but does not prevent, the development of kindling. The firing activity of noradrenergic locus coeruleus (LC) neurons is partially regulated by axon collateral recurrent inhibition mediated via alpha 2-adrenergic receptors. We tested the hypothesis that LC autoinhibitory alpha 2-adrenergic receptors may change during the kindling process thereby altering LC excitability. Specific binding of the alpha 2-adrenergic receptor antagonist [3H]RX781094 (idazoxan) was measured in the LC of rats at 3 different stages of kindling development using in vitro neurotransmitter receptor autoradiography techniques. Specific [3H]RX781094 binding was elevated significantly in rats kindled to two Class 1 kindled motor seizures. No differences in binding were observed in animals kindled to Class 3 or Class 5 kindled motor seizures. Saturation of binding experiments indicated that the increase in binding following two Class 1 kindled motor seizures was due to an increase in the total number of alpha 2-receptors without a change in the affinity of the binding site for [3H]RX781094. The transient increase in number of LC alpha 2-adrenergic receptors is consistent with the idea that noradrenergic neurotransmission inhibits the early progress of kindling development, but then subsequently becomes ineffective in maintaining the inhibition during later stages of kindling development.

Amygdala↗