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Biomedical subjects

C Guerra

Publications and source records attributed to C Guerra.

At least 19 recordsLinked to original sources

[Digestive hemorrhage caused by aorto-duodenal fistula. Report of 5 cases].

The aortoduodeonal fistula is a rare condition and has high mortality. We report five retrospective cases of digestive hemorrhage due to an aortoduodenal fistula (4 secondary and 1 primary) between 1986 and 1990. Three of them died. Attention is called to the importance of clinical suspicion and the main diagnostic methods in early diagnosis such as oral endoscopy. We also enhance the importance of emergency surgery for survival.

Aged

Large-volume paracentesis and intravenous saline: effects on the renin-angiotensin system.

Fourteen cirrhotic patients with tense ascites were treated with total paracentesis and intravenous isotonic saline infusion. Standard liver and kidney function tests, plasma renin activity and aldosterone concentration were measured before, at 48 hrs and at 7 days after total paracentesis. The volume of ascites removed was 7.7 +/- 5.6 l (mean +/- S.E.M.). None of the treated patients had clinical complications or significant alterations in liver or kidney function test results. Paracentesis and intravenous isotonic saline infusion were not associated with significant changes in mean plasma renin activity or plasma aldosterone concentration. These results suggest that this therapeutic procedure could be a safe and cost-effective alternative treatment of tense ascites in patients with cirrhosis.

Aged

Assay of free and total tocainide by high performance liquid chromatography (HPLC) with ultraviolet (UV) detection.

A rapid high performance liquid chromatographic (HPLC) method for the determination of tocainide, using N-(2,6-dimethylphenyl)-2-amino-butanimide as an internal standard, was developed. A methylene chloride extraction involving salting out at pH 9.0 was employed. An 85:15 mixture of 0.025M monobasic potassium phosphate at pH 3.0 and acetonitrile was used as the mobile phase. The separation and quantitative analysis of tocainide was performed on a mixed phase column with a 1.0-mL/min flow rate and detection at 210 nm. Separation of tocainide from some of its metabolites required the use of heptane sulfonic acid as an ion-pairing reagent. For the free-drug assay, the specimen was centrifuged through an Amicon Centrifree filter before being processed.

Anti-Arrhythmia Agents

Nonrandom X chromosome inactivation in B cells from carriers of X chromosome-linked severe combined immunodeficiency.

X chromosome-linked severe combined immunodeficiency (XSCID) is characterized by markedly reduced numbers of T cells, the absence of proliferative responses to mitogens, and hypogammaglobulinemia but normal or elevated numbers of B cells. To determine if the failure of the B cells to produce immunoglobulin might be due to expression of the XSCID gene defect in B-lineage cells as well as T cells, we analyzed patterns of X chromosome inactivation in B cells from nine obligate carriers of this disorder. A series of somatic cell hybrids that selectively retained the active X chromosome was produced from Epstein-Barr virus-stimulated B cells from each woman. To distinguish between the two X chromosomes, the hybrids from each woman were analyzed using an X-linked restriction fragment length polymorphism for which the woman in question was heterozygous. In all obligate carriers of XSCID, the B-cell hybrids demonstrated preferential use of a single X chromosome, the nonmutant X, as the active X. To determine if the small number of B-cell hybrids that contained the mutant X were derived from an immature subset of B cells, lymphocytes from three carriers were separated into surface IgM positive and surface IgM negative B cells prior to exposure to Epstein-Barr virus and production of B-cell hybrids. The results demonstrated normal random X chromosome inactivation in B-cell hybrids derived from the less mature surface IgM positive B cells. In contrast, the pattern of X chromosome inactivation in the surface IgM negative B cells, which had undergone further replication and differentiation, was significantly nonrandom in all three experiments [logarithm of odds (lod) score greater than 3.0]. These results suggest that the XSCID gene product has a direct effect on B cells as well as T cells and is required during B-cell maturation.

Alleles

Esophageal strictures: balloon dilation.

One hundred seventy transnasal balloon catheter dilation procedures were performed in 35 patients with esophageal strictures to assess the efficacy and safety of the procedure. On the average, five dilations were required per patient. Depending on the cause of the esophageal stricture, success rates for the technique ranged from 67% to 87%, with success defined as the resolution of dysphagia to both fluids and solids. Three complications, all perforations, were seen; one perforation required surgical repair. No procedure-related deaths were identified in this series. Balloon catheter dilation can be safely applied to esophageal strictures from a variety of causes, with a high degree of clinical success.

Catheterization

Behavior of antithrombin III, determined as protein concentration and biologic activity, in subjects with neoplastic disease.

Antithrombin III (AT III), the primary inhibitor of plasma protease coagulation proteins, was evaluated in groups of patients with different neoplastic disease. When compared with that of 25 health subjects, the mean value of AT III biologic activity was elevated in all groups, significantly in gastrointestinal (p less than 0.02) and lung (p less than 0.001) tumors, lymphoma (p less than 0.02) and in the group with various primary cancers (p less than 0.05). No difference was found between 46 patients tested under chemoradiotherapy and 216 patients who had not undergone therapy for at least 1 month. Four patients with clinical thrombosis had normal ATIII biologic activity. Of the 262 patients studied, 14 had low AT III biologic activity without clinical thrombosis and normal protein concentration. In 71 patients (27%) an excess of immunoassayable protein of 20% or more over biologic activity was found. Double immunoelectrophoresis performed in 5 of these showed for 3 patients an enlarged second are of precipitation. Moreover, no correlation was observed between the activity and protein AT III concentration (r = 0.05). The likelihood of the presence of circulating AT III-protease complexes is discussed.

Antithrombin III

Granulocyte adherence in uremia and hemodialysis.

To evaluate granulocyte function in uremia and hemodialysis we studied granulocyte adherence, an important step in chemotaxis. Our studies demonstrate that patients with severe impairment in renal function had normal granulocyte adherence (72.1 +/- 21 vs. 72.9 +/- 14% controls) while patients with end stage renal disease undergoing hemodialysis (45 +/- 30%) had significant impairment (p less than 0.001). Adherence worsened during dialysis (p less than 0.001) but returned towards the abnormal baseline values at the end of the procedure. There was a significant correlation between adherence and potassium (r=0.77; p less than 0.05) and adherence and sodium-potassium ratio (r=-0.78; p less than 0.05) before and after dialysis. Other factors such as changes in creatinine, urea nitrogen, osmolality, calcium, phosphorus or (H+) did not correlate with adherence. It is concluded that the abnormality in adherence is not the result of the basic disease process but a consequence of dialysis.

Adult

Mycoses caused by Candida lusitaniae.

Candida lusitaniae, a fungus with a low incidence of infection in immunocompetent people, is emerging as an opportunistic pathogen in immunocompromised hosts. This yeast is generally resistant to amphotericin B and may present therapeutic difficulties. C. lusitaniae may be misidentified as one of several other fungal species, including Candida tropicalis, Candida parapsilosis, and even Saccharomyces cerevisiae. As judged by in vitro antifungal susceptibility testing, minimal inhibitory concentrations of antifungal agents other than amphotericin B are achievable, but fungicidal levels are not. When encountered in blood or other body sites, C. lusitaniae should be carefully considered as a potential pathogen.

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