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Biomedical subjects

C Jimenez

Publications and source records attributed to C Jimenez.

At least 73 records · Page 4Linked to original sources
PubMed1994

Clinical significance of exit-site infections due to Xanthomonas in CAPD patients: a comparison with Pseudomonas infection.

We have assessed the clinical significance of exit-site infections secondary to Xanthomonas maltophilia in continuous ambulatory peritoneal dialysis (CAPD) patients, and compared them with episodes due to Pseudomonas. The study was a retrospective survey of all episodes of Xanthomonas and Pseudomonas-related exit-site infections (ESI) in all patients treated in our unit between 1984 and 1992. Thirteen episodes of Xanthomonas-related ESI were observed in eight patients and 17 episodes of Pseudomonas-related ESI were seen in 15 patients. Xanthomonas-related ESI was frequently associated with other microorganisms, while Pseudomonas-related ESI was not (66% versus 5%, P < 0.02). Only one episode of Xanthomonas-related ESI resulted in peritonitis and subsequent catheter removal, after 15 months of resistant colonization. Another case was considered to be chronic and indolent, as the Xanthomonas-related ESI continued after 23 months of local treatment. The other 11 episodes were resolved either without treatment or with an antibiotic cream after 7-120 days. However, all but two episodes of Pseudomonas-related ESI required intravenous antibiotics (usually ceftazidime); seven patients developed peritonitis, and 11 required surgical catheter manipulation (five external cuff extrusion, and six catheter removal) (1/13 Xanthomonas-related versus 11/17 Pseudomonas-related ESI, P < 0.03). Most Xanthomonas-related ESI do not lead to peritonitis, and constitute a mild condition, easily treatable without parenteral antibiotics or catheter replacement. The appearance of other associated organisms and the favourable evolution with local treatment suggest a saprophytic behaviour for Xanthomonas in our CAPD patients. On the contrary, Pseudomonas-related ESI is usually severe, requires parenteral antibiotics, frequently leads to peritonitis, and requires catheter replacement.

Adult↗
PubMed1994

Cell populations present in the nocturnal peritoneal effluent of patients on continuous ambulatory peritoneal dialysis and their relationship with peritoneal function and incidence of peritonitis.

OBJECTIVE: To study the relationship between peritoneal effluent cells and infection rate and to relate this population with functional characteristics. DESIGN: Prospective, longitudinal, and comparative study. SETTING: Outpatient continuous ambulatory peritoneal dialysis (CAPD) unit of a university medical center. PARTICIPANTS: Seventy-one uninfected patients, treated for 0-156 months on CAPD, in stable condition were studied (33 female, 38 male). INTERVENTIONS: Nocturnal peritoneal effluent (NPE) was drained with EDTA (2.5 mmol/L) at 37 degrees C and centrifuged at 2500 rpm for 9 minutes. MEASUREMENTS: Accumulated peritoneal inflammation days/year and ultrafiltration/diffusion (mass transfer coefficients (MTCs) for small molecules) capacities were recorded. Cellular count (cells/night) was performed using a Neubauer chamber. Macrophage function was assessed by cytochemical (lysosomal enzyme content: ANAE, beta-glucuronidase, acid phosphatase) and immunohistochemical procedures (expression of membrane antigens, CD4, 11b, 11c, 14, 16, 25, 35, and 71). RESULTS: The macrophage is the most frequently appearing cell in the NPE. Cell count decreases over time on CAPD (from 20 x 10(6) to 5 x 10(6) after the first year). Intrapatient variability was low, but interpatient differences were marked. Mesothelial cell count remained stable over time (0.25-0.5 x 10(6)). Four of our patients showed a "transforming" change in these cells. Previous incidence of peritonitis and values of functional measurements did not correlate with cell count or expressions of macrophage function (lysosome enzyme content and percentage of cells expressing different membrane antigens). CONCLUSION: There is difficulty interpreting the results on peritoneal effluent cells and their relationship with the incidence of peritonitis and functional characteristics of the peritoneum. No definite conclusions can be drawn other than the great interpatient and intrapatient variability. The presence of abnormal peritoneal cells with undetermined origin and function suggests the need for periodic studies of peritoneal effluent cells on long-term CAPD patients.

Cell Count↗
PubMed1994

Moncrief's technique for peritoneal catheter placement: experience of a CAPD unit.

A decrease in the peritonitis rate and the incidence of catheter exit-site/tunnel (E/T) infection are the most important factors affecting the permanent peritoneal catheter in continuous ambulatory peritoneal dialysis (CAPD) patients. Moncrief et al. have introduced a novel methodology (two phases) for peritoneal catheter placement (7.8). The most relevant characteristic is that the external portion remains buried on the subcutaneous tissue (sterile environment) during the healing process. After four to six weeks, the catheter is brought out through a small incision (0.5 cm) distal 2 cm from the subcutaneous cuff, and peritoneal dialysis may be initiated. The data available, presented by Moncrief et al., show a lower incidence of peritonitis rate and E/T infection with this implantation technique, when compared with a classic technique. The aim of this study is to learn if the placement of a peritoneal catheter with Moncrief's methodology decreases the incidence of complications related to peritoneal catheters. We treated 29 patients (group C) with the conventional procedure and 25 patients (group M) with the Moncrief technique. Follow-up was similar for both groups (C = 12.2 +/- 7.9 months vs M = 11.1 +/- 6.1 months, NS). The time buried was 3.23 +/- 0.9 weeks (2-5). Eleven patients completed four weeks with the catheter buried subcutaneously (group M-4). The incidence of E/T infection was similar for groups C and M, and lower in group M-4 (p < 0.05). The number of catheters free of infection was less in group C (31%) than in group M (46%) and M-4 (67%) (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

CAPD for treatment of ESRD patients with ascites secondary to liver cirrhosis.

The treatment of cirrhotic patients with ascites and end-stage renal disease (ESRD) is complex. Continuous ambulatory peritoneal dialysis (CAPD), as a continuous therapy, represents an alternative to hemodialysis-associated hemodynamic intolerance. We report our experience with 5 cirrhotic patients with ascites who were treated by CAPD. Three had been transferred from hemodialysis (HD) for intolerance. The hemodynamic tolerance was excellent in all patients, and solute and water peritoneal transport were increased over the normal range in all cases. Morbidity was principally related to liver disease. Peritoneal protein losses, initially high, decreased over time. Serum albumin was within the low normal range. The incidence of peritonitis was higher than usual in these patients; episodes caused by gram-negative bacteria, streptococci and listeria, were predominant. The cause of death was not CAPD-related. In our experience, CAPD should be the treatment of choice for cirrhotic patients with ascites who require dialysis.

Adult↗
PubMed1993

Developmental expression and androgen regulation of 24 kDa secretory proteins by the murine epididymis.

Two peptides with a molecular weight of 24 kDa and a P(i) of 8.4-8.8 were found to be synthesized and secreted specifically by the caput epididymis of adult male mice under androgen control. The peptides can interact with spermatozoa. In the present study, the developmental pattern of [35S]-methionine-labelled proteins synthesized by the murine caput epididymis at 10, 20, 30 and 40 days of age were studied using two-dimensional polyacrylamide gel electrophoresis (2D PAGE) and autoradiography. Active synthesis of the 24 kDa proteins was detected in the epididymis from 20 days of age, but secretion of the two peptides was only observed from 30 days of age onwards. To determine whether androgens influenced the active expression of 24 kDa proteins in the developing epididymis, their effect on [35S]-methionine incorporation into proteins was assessed using 2D PAGE. Mice were either castrated, castrated then testosterone injected or simply testosterone injected at 10, 20, 30 or 40 days of age. Androgen control of 24 kDa protein expression was also studies in vitro in epididymal organ culture over a 10-day period, with or without testosterone. Androgens were not involved in the initiation of synthesis of the 24 kDa proteins from days 10 to 20, as shown by in-vivo and in-vivo experiments. However, androgens appeared to be essential for maintaining synthesis and secretion of the proteins from 20 days of age onwards. Administration of excessive testosterone was only able to increase secretion of the 24 kDa proteins in intact male mice aged 40 days.

Animals↗
PubMed1993

Peritoneal resting is beneficial in peritoneal hyperpermeability and ultrafiltration failure.

Ultrafiltration failure (UFF) is one of the most frequent causes of continuous ambulatory peritoneal dialysis (CAPD) dropout and is a common consequence of peritoneal hyperpermeability secondary to inappropriate regeneration of mesothelial cells. In this paper we present the results of 25 peritoneal resting periods of 4 weeks in 16 patients who showed UFF. The mean duration of CAPD was 44 +/- 22 months. All patients had been free of peritonitis for at least 3 months when included in the peritoneal resting trial. UFF was always defined as a long-lasting decrease of UF capacity such that dry weight could no longer be achieved by CAPD. The former incidence of peritonitis was 3.9 +/- 2.3 episodes. Results compared to the preresting data: urea MTC (mass transfer coefficient) decreased from 24.9 +/- 6.8 to 21.0 +/- 6.1 (p < 0.05), creatinine MTC from 16.5 +/- 6.0 to 13.8 +/- 4.0 (p < 0.05), and UF increased from 493.8 +/- 278.0 to 881.3 +/- 388.1 (p < 0.001). The response in terms of UF in patients with low permeability ultrafiltration (creat MTC less than 13) was heterogeneous and lower than in patients with criteria of hyperpermeability (greater than 13): 720 +/- 396 to 1150 +/- 533 (NS) versus 491 +/- 310 to 808 +/- 205, respectively. Simultaneously, creatinine MTC did not change in the former group (10.2), while hyperpermeability patients showed a remarkable decrease (19 +/- 5 to 15 +/- 2, p < 0.05). In conclusion, peritoneal resting is a useful tool in the management of ultrafiltration failure in CAPD patients, primarily in those with peritoneal hyperpermeability.

Adult↗
PubMed1993

[Course and treatment of infantile asthma in our milieu].

We studied the clinical evolution and therapeutic approach of 50 children who were treated at the Emergency Room for an asthmatic crisis. We observed a high frequency of early onset of asthma before one year of age (n:16), constant symptoms between the crisis (n:34) and previous admissions before the present crisis (n:34) and previous admissions before the present crisis (n:16). Most cases did not have a family doctor. In 16 cases, the present crisis had four or more days of duration. We observed a frequent administration of suboptimal doses of bronchodilator and antiinflammatory drugs. These results show a non satisfactory treatment of infantile asthma.

Absenteeism↗
PubMed1993

An analysis of adequacy of dialysis in a selected population on CAPD for over 3 years: the influence of urea and creatinine kinetics.

Adequacy of dialysis is addressed to minimize the negative consequences of underdialysis. The results of the NCSD demonstrated that urea kinetic modelling (UKM) is a useful tool in the measurement of adequacy of dialysis: Kt/V values of 1 are considered adequate to prevent complications when daily protein intake is appropriate. For CAPD no similar prospective studies exist, and consequently there is no information comparable to that for haemodialysis. Preliminary data have communicated controversial results about the usefulness of UKM for CAPD prescription. On the other hand creatinine kinetics has been proposed as an alternative to UKM to define adequacy of dialysis on CAPD. However, these results should be considered preliminary because of the small size of the series and the short observation period. The objective of this paper is to study the role of these two kinetic models in defining adequacy of dialysis in a long-term, selected CAPD population. We have studied 56 patients treated for at least 3 years on CAPD (3-11 years; mean observation period 5 years; 3996 patient-months). Urea kinetic model (UKM) (urea weekly (W) Kt/V and NPCR) and creatinine kinetics (Efficacy number (EN) and K) were determined annually. According to the present data we can conclude that Kt/V is an appropriate tool for defining adequacy in patients on CAPD. Values of weekly Kt/V greater than 1.7-1.8, with NPCR more than 1 g/kg/day, assure an adequate clinical outcome. Conversely, values on the Kt/V scale less than 1.7 entail a greater rate of complications. Our data also confirm that maintaining a serum albumin > 536-551 mumol/l (3.7-3.8 g/dl) is related to lower morbidity and mortality, and should be a major objective for CAPD patients. Consequently a relationship between dose of dialysis in terms of urea mass balance and protein nutrition can be established. After 5 years on CAPD, when all residual renal function is generally lost, Kt/V values in excess of 1.9 are difficult to achieve. Based on currently available information, we do agree with the interest of performing a prospective study on adequacy of dialysis based on the urea kinetic model in CAPD, which definitely defines its role. On the other hand, creatinine kinetics did not show sufficient discriminative capacity in terms of adequacy of dialysis. EN and Kt of creatinine values in the lower range (4.5-6 and less than 45-50 1/week respectively) were not necessarily associated with a poorer clinical outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

Renal tubular dysgenesis: a not uncommon autosomal recessive syndrome: a review.

Renal tubular dysgenesis is a recently recognized autosomal recessive condition characterized by short and poorly developed proximal convoluted tubules, leading to oligohydramnios, Potter sequence, and neonatal respiratory failure. We report an additional 9 cases from one pediatric center, suggesting that this syndrome is not as rare as was previously thought. Normal amniotic fluid volumes in affected pregnancies prior to the 22nd week of gestation have been documented, compromising early prenatal diagnosis. Late second trimester sonographic demonstration of oligohydramnios, with structurally normal kidneys, should suggest this diagnosis and the need for detailed post-mortem pathological examination.

Female↗
PubMed1992

Characterization and hormonal regulation of 24 kDa protein synthesis by the adult murine epididymis.

The pattern of labelled proteins synthesized and secreted in vitro by the adult mouse epididymis was studied by one- and two-dimensional polyacrylamide gel electrophoresis. The presence of a major 24 kDa protein synthesized and secreted in a tissue-specific manner by the caput epididymidis was detected. For this molecular weight, two-dimensional analysis indicated several proteins including two polypeptides (pI 8.4 and 8.8) whose expression is under androgenic control. Partial amino acid sequence analysis showed a complete N-terminal identity between these two peptides. A polyclonal monospecific immune serum was raised against the two proteins. Only purified immunoglobulins precipitated them, showing that immunological affinity is restricted to these two proteins in the epididymis. Indirect immunofluorescence assay revealed specific binding of antibodies on the acrosomal region of spermatozoa isolated from the caput, corpus or cauda epididymides. Testicular spermatozoa were not labelled under the same conditions. To investigate the physiological role of androgens in the synthesis and secretion of the 24 kDa proteins, tissue slices of epididymides from adult mice which had been castrated, or castrated then injected with testosterone were incubated with [35S]methionine. Castration and testosterone replacement kinetics revealed that alterations in 24 kDa protein synthesis follow immediately upon androgenic privation and replacement.

Animals↗
PubMed1991

Familial renal-hepatic-pancreatic dysplasia and Dandy-Walker cyst: a distinct syndrome?

Ivemark et al. first described sibs with renal-hepatic-pancreatic dysplasia (RHPD) (Ivemark BI, Oldfelt V, Zetterström R (1959): Acta Pediatr Scand 48: 1-11). Subsequent reports of affected individuals have described additional malformations and syndromes associated with RHPD. In this paper we describe 2 sibs with RHPD in association with Dandy-Walker cyst (DW). Through an examination of the pattern of associated malformations seen in RHPD we argue that RHPD-DW is a distinct monogenetic syndrome, and not an association.

Abnormalities, Multiple↗
PubMed1991

Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity.

The purpose of this study was to determine whether meconium-stained amniotic fluid is a marker for microbial invasion of the amniotic cavity. Amniocentesis was performed on 707 patients presenting with preterm labor and intact membranes. Meconium-stained amniotic fluid was present in 4.2% (30/707) of patients with preterm labor. The prevalence of positive amniotic fluid cultures was significantly higher in women with meconium-stained amniotic fluid than in women with clear fluid (33% [10/30] vs 11% [75/677]; p = 0.001; odds ratio = 4.01; 95% confidence interval = 1.6 to 9.4). Patients with meconium-stained amniotic fluid were also more likely to have failed tocolysis and delivered a preterm neonate more frequently than patients with clear fluid (83% [25/30] vs 38% (258/677); p = 0.0001; odds ratio = 8.1; 95% confidence interval = 2.9 to 24.4). We conclude that meconium-stained amniotic fluid is a risk factor for microbial invasion of the amniotic cavity and preterm delivery in women with preterm labor and intact membranes.

Amniotic Fluid↗
PubMed1991

Specific distribution of messenger ribonucleic acids for 24-kilodalton proteins in the mouse epididymis as revealed by in situ hybridization: developmental expression and regulation in the adult.

Specific mRNAs for 24-kDa proteins specific to the caput epididymidis were quantified by filter hybridization, and cellular distribution was assessed by in situ hybridization of tissue sections. Messenger RNAs were detectable in 10-day-old animals, rapidly increased in quantity between 15 and 20 days, and reached a maximum at 40 days of age. The marked increase in concentration of mRNAs could be associated with the increase in epididymal testosterone content. Near 26 days of age, specific perinuclear and basal localization of mRNAs occurred in the principal cells of segment I, and a wide cytoplasmic distribution was observed in segment II. In the adult, mRNA levels decreased by 50% 3 days after castration and became undetectable within 30 days. Administration of testosterone to castrated mice caused an increase in mRNA levels, which reach almost normal levels after 3 days of treatment. Nevertheless, the particular organization of segment 1 was not restored. A similar observation was made after hemicastration or ligation of the efferent duct on the operated side. If expression of the mRNAs appears to be mostly under androgenic control, other testicular factors may be involved in the regulation of mRNA distribution in segment I.

Androgens↗
PubMed1991

Plasma atrial natriuretic peptide and vasopressin during thermal dehydration in supine posture.

After 30 minutes spent in an upright posture six healthy male subjects underwent two 130-minute experiments in a supine posture, the first in thermoneutral conditions (TC) and the second, 15 days later, in a hot environment (HE) in order to obtain a water loss of 2.5% body weight. In thermoneutral conditions, the supine posture induced plasma volume expansion, resulting in slightly lowered plasma vasopressin (AVP) levels and higher plasma atrial natriuretic peptide (ANP) levels, compared to the values obtained in the upright posture (P less than 0.05). During hot environment, the sweating-induced dehydration led to a significant reduction of plasma volume expansion and to an increase in rectal temperature and plasma osmolality (P less than 0.05). Plasma vasopressin levels were higher at the end of the heat exposure (P less than 0.05) but natriuretic peptide levels did not change, compared to the values observed in the upright posture. These data suggest that plasma volume reduction induced by thermal dehydration may limit the natriuretic peptide release, which occurs after changing from the upright to a supine position.

Adult↗
PubMed1991

Sequence homology of androgen-regulated epididymal proteins with glutathione peroxidase in mice.

The M53 cDNA for Mr 24,000 androgen-regulated secretory proteins of the mouse caput epididymidis previously reported has been sequenced. This clone presents a 5'-incomplete open reading frame of 525 base pairs. The 3'-untranslated region of 946 base pairs contains a repetitive DNA element of the rodent B1 family just between two canonical polyadenylation signals AATAAA, upstream of the poly(A) track. The deduced amino acid sequence for the Mr 24,000 proteins reveals significant homologies of 66.6, 66, 65.2, 63.1 and 64.5% with mouse, rat, man, bull and rabbit cloned selenium-dependent glutathione peroxidases, respectively. The present results emphasize previous studies performed in numerous laboratories suggesting that the major protective system against oxidative damage in mouse spermatozoa could be an enzyme similar to glutathione peroxidase.

Amino Acid Sequence↗
PubMed1990

Apparent Smith-Lemli-Opitz syndrome in a child with a previously undescribed form of mucolipidosis not involving the neurons.

A diagnosis of Smith-Lemli-Opitz syndrome was made shortly after birth in a small-for-dates infant, on the basis of a characteristic face, penoscrotal hypospadias, bilateral postaxial hexadactyly, and bilateral syndactyly of toes 2-3. The clinical course was marked by failure to thrive, severe delay, refractory myoclonic jerks beginning at age 2 months, and increasing hepatosplenomegaly. He developed corneal clouding and increased gingival hypertrophy and died at age 18 weeks. Autopsy disclosed widespread storage of mucopolysaccharides and lipids within the macrophages and, to a lesser extent, parenchymal cells, of all organ systems. There was extensive demyelination of the cerebral white matter, and dystrophic calcification in the cerebrum, cerebellum, and brainstem. There was no evidence of primary neuronal involvement in the storage. Although the chance concurrence of 2 uncommon diseases is rare, a causal link between the clinical anomalies and the storage disorder cannot be argued convincingly on the basis of one case. Careful pathologic studies of other children who die with clinical signs compatible with Smith-Lemli-Opitz syndrome are indicated.

Brain↗
PubMed1990

Infection and labor. VI. Prevalence, microbiology, and clinical significance of intraamniotic infection in twin gestations with preterm labor.

The purpose of this study was to establish the prevalence, microbiology, and outcome of microbial invasion of the amniotic cavity in twin gestation presenting with preterm labor and intact membranes. Amniocenteses were performed on both sacs of 46 women with twin gestations, preterm labor, and intact membranes. Indigo carmine was injected to ensure sampling of both amniotic sacs. Amniotic fluid was cultured for aerobic and anaerobic bacteria, Mycoplasma hominis, and Ureaplasma urealyticum. A positive amniotic fluid culture of at least one sac was noted in 10.8% (5/46) of patients admitted in preterm labor and in 11.9% (5/42) of women delivered of preterm neonates. Of the five patients with microbial invasion of the amniotic cavity, three had microorganisms isolated from both sacs. The presenting sac was involved in all cases, supporting an ascending route for microbial invasion of the amniotic cavity in twin gestation. Polymicrobial infection was found in three of the eight amniotic sacs with positive cultures. In two cases different organisms were isolated from each sac. All patients with positive amniotic fluid cultures were delivered of preterm infants within 48 hours of amniocentesis. Patients with positive amniotic fluid cultures presented with preterm labor at an earlier gestational age and with more advanced cervical dilatation than did women with negative amniotic fluid cultures. Clinical evidence of chorioamnionitis subsequently developed in two of five women with positive amniotic fluid cultures. The interval between amniocentesis and delivery was shorter in women with positive amniotic fluid cultures than in women with negative amniotic fluid cultures (median: 3.5 vs 168 hours, p less than 0.0001). Infants born to women with microbial invasion of the amniotic cavity had a lower median birth weight and a higher incidence of respiratory distress syndrome than those born to women with negative amniotic fluid cultures (birth weight: 1085 vs 1975 gm, p = 0.024; respiratory distress syndrome: 37.5% vs 8.3%, p = 0.04).

Amniotic Fluid↗