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Biomedical subjects

C Nunez

Publications and source records attributed to C Nunez.

At least 19 recordsLinked to original sources
PubMed1999

Fludarabine-based preparative protocol for unrelated donor cord blood transplantation in children: successful engraftment with minimal toxicity.

Unrelated umbilical cord blood (UCB) is a new source of hematopoietic stem cell (HSC) for allogeneic transplantation. The optimal conditioning for UCB transplant has not been defined. Intensive immunosuppression is frequently employed because of the higher risk of graft failure. Fludarabine monophosphate is shown to be an effective agent for facilitating allogeneic HSC engraftment. We have recently encountered three children who were not ideal candidates for 'conventional' conditioning protocols. TBI followed by fludarabine and melphalan were used for transplant preparation. The UCB units were one HLA-antigen (n = 1) and two HLA-antigen mismatched with the recipients. All three patients engrafted successfully. There was mild extramedullary toxicity. Two patients are alive with complete chimerism 8 and 20 months after transplant. A fludarabine-based protocol may be considered for selected cases of UCB transplants.

Adolescent↗
PubMed1998

Garcinia cambogia (hydroxycitric acid) as a potential antiobesity agent: a randomized controlled trial.

CONTEXT: Hydroxycitric acid, the active ingredient in the herbal compound Garcinia cambogia, competitively inhibits the extramitochondrial enzyme adenosine triphosphate-citrate (pro-3S)-lyase. As a citrate cleavage enzyme that may play an essential role in de novo lipogenesis inhibition, G cambogia is claimed to lower body weight and reduce fat mass in humans. OBJECTIVE: To evaluate the efficacy of G cambogia for body weight and fat mass loss in overweight human subjects. DESIGN: Twelve-week randomized, double-blind, placebo-controlled trial. SETTING: Outpatient weight control research unit. PARTICIPANTS: Overweight men and women subjects (mean body mass index [weight in kilograms divided by the square of height in meters], approximately 32 kg/m2). INTERVENTION: Subjects were randomized to receive either active herbal compound (1500 mg of hydroxycitric acid per day) or placebo, and both groups were prescribed a high-fiber, low-energy diet. The treatment period was 12 weeks. Body weight was evaluated every other week and fat mass was measured at weeks 0 and 12. MAIN OUTCOME MEASURES: Body weight change and fat mass change. RESULTS: A total of 135 subjects were randomized to either active hydroxycitric acid (n = 66) or placebo (n = 69); 42 (64%) in the active hydroxycitric acid group and 42 (61%) in the placebo group completed 12 weeks of treatment (P = .74). Patients in both groups lost a significant amount of weight during the 12-week treatment period (P<.001); however, between-group weight loss differences were not statistically significant (mean [SD], 3.2 [3.3] kg vs 4.1 [3.9] kg; P = .14). There were no significant differences in estimated percentage of body fat mass loss between treatment groups, and the fraction of subject weight loss as fat was not influenced by treatment group. CONCLUSIONS: Garcinia cambogia failed to produce significant weight loss and fat mass loss beyond that observed with placebo.

Adult↗
PubMed1998

Characterisation of two human dendritic cell-lines that express CD1a, take-up, process and present soluble antigens and induce MLR.

Dendritic cells (DC) are bone marrow derived cells present in diverse tissues and organs including the skin, mucosae and blood. DC have a capital role in the afferent pathway of the immune response because of its role in up-take, processing and presenting antigens to immune cells. Human DC are usually identified by the expression of surface CD1a and HLA-DR. Despite the significant recent developments for in vitro generation of DC derived from blood by using cytokines like GM-CSF and IL-4, the studies on DC and specially on human Langerhans cells (LC) have been hampered by the laborious isolation procedure and the small yield of cells obtained by the various methods of isolation used so far. Therefore, a priority has been a search for monoclonal dendritic cell-lines with LC characteristics in order to facilitate the research in this area. The present study reports on the generation of two stable, self-replicant, adherent, dendritic, CD1a+, HLA-DR , CD45RO , CD23/FcERII+ cell-lines that up-take and process soluble antigens but also inducing MLR and antigen-dependent T-cell response.

Antigen Presentation↗
PubMed1998

Clinical and genetic analysis of a distinct autosomal dominant spinocerebellar ataxia.

OBJECTIVE: To characterize a distinct form of spinocerebellar ataxia (SCA) clinically and genetically. BACKGROUND: The SCAs are a genetically heterogeneous group of neurodegenerative disorders affecting the cerebellum and its connections. The mutations for SCA1, 2, 3, 6, and 7 have been identified and shown to be due to expansion of a CAG repeat in the coding region of these genes. Two additional SCA loci on chromosomes 16 and 11 have been designated SCA4 and SCA5. However, up to 20% of individuals with autosomal dominant forms of ataxias cannot be assigned any of these genotypes, implying the presence of other unidentified genes that may be involved in the development of ataxia. METHODS: We ascertained and clinically characterized a six-generation pedigree segregating an autosomal dominant trait for SCA. We performed direct mutation analysis and linkage analysis for all known SCA loci. RESULTS: The mutation analysis excludes SCA1, 2, 3, 6, and 7, and genetic linkage analysis excludes SCA4 and SCA5 (multipoint location scores < -2 across the candidate region). Clinical analysis of individuals in this family shows that all affected members have dysarthria, gait and limb ataxia, and nystagmus. No individuals have major brainstem or long-tract findings. Analysis of age at disease onset through multiple generations suggests anticipation. CONCLUSION: This pedigree represents a genetically distinct form of SCA with a phenotype characterized by predominantly cerebellar symptoms and signs.

Adult↗
PubMed1997

Aspergillus in cytology specimens: a review of 45 specimens from 36 patients.

OBJECTIVE: To assess the clinical significance associated with the identification of fungal elements consistent with Aspergillus in cytology specimens. MATERIALS AND METHODS: For all cytology specimens with reported fungal elements consistent with Aspergillus, reported over a 9 yr and 8 mo period at The Cleveland Clinic Foundation, the patient's medical charts were reviewed with particular attention to underlying disease, presentation, treatment, and clinical course. Cytology results were compared with available microbiologic cultures and tissue specimens in all of the patients. RESULTS: Forty-five cytology specimens with Aspergillus fungal forms, from 36 patients, were identified. Twenty-six patients had concurrent specimens sent for culture in whom II grew Aspergillus species (10 Aspergillus fumigatus), eight grew organisms other than Aspergillus, and seven were no growth. A total of 16 patients (44%) were treated with antifungal treatment (Amphotericin B). Treatment with Amphotericin B was significantly associated with a concurrent growth of Aspergillus species (9/11 patients with Aspergillus culture positive vs. 7/25 patients without a positive culture for Aspergillus, P value = 0.004 (ODDS ratio = 11, 95% confidence interval:#1.6-104, 2-tailed Fisher exact test.) CONCLUSIONS: The presence of fungal forms consistent with Aspergillus in cytology specimens is neither specific nor sensitive for significant infection due to Aspergillus. Treatment with Amphotericin B is more likely to be instituted when a concurrent clinical specimen grows Aspergillus species in culture.

Adult↗
PubMed1993

Pelvic washings for cytologic analysis in endometrial adenocarcinoma.

The adoption of surgical staging into the management of endometrial adenocarcinoma has permitted improved accuracy in the study of prognostic variables in patients with limited disease. In an effort to resolve the current controversy about the importance of pelvic washings for cytologic analysis in endometrial cancer, 270 consecutive patients with neoplasms histologically limited to the uterus were studied. Fourteen patients (5.2%) were found to have positive results. Cytologic results correlated with tumor grade (P < .02) and depth of myometrial penetration (P < .02). Multivariate analysis indicated age 70 years or greater (P < .002), outer-third myometrial invasion (P < .004) and positive washings (P < .02) to predict survival. The probability of five-year survival in the total group was 0.85, which decreased to 0.67 in patients with positive washings. Despite statistical significance as a prognostic variable, the overall clinical utility of peritoneal cytology in planning postoperative adjuvant therapy in this series was limited by its correlation with other prognostic factors and overall low rate of positivity. Conclusions regarding effective adjuvant therapy for positive washings could not be drawn due to the smaller number of patients with abnormal results and the variety of treatments employed.

Adenocarcinoma↗
PubMed1992

Adrenal carcinosarcoma presenting in a woman with clinical signs of virilization. A case report with immunohistochemical and ultrastructural findings.

An adrenal carcinosarcoma is reported in a 29-year-old female presenting with clinical signs of virilization. This is the first reported case of a functioning adrenal carcinosarcoma in the English language literature. The tumor measured 12.5 cm in greatest dimension, weighed 610 g, and consisted of large areas of typical adrenal cortical carcinoma that was, however, interspersed with multiple foci of sarcoma. Rhabdomyosarcomatous elements were identified and confirmed both immunohistochemically and ultrastructurally. After radical resection, the patient received adjuvant mitotane therapy but developed rapid local and metastatic recurrence. Systemic chemotherapy was unsuccessful, and the patient died 8 months after surgery.

Adrenal Cortex Neoplasms↗
PubMed1992

Comparison of cisternal and lumbar CSF examination in leptomeningeal metastasis.

We compared cisternal and lumbar CSF examination in 14 patients suspected of having leptomeningeal metastasis from cancer. Malignant cells were present in 12 patients--in both cisternal and lumbar CSF in nine patients and only in cisternal CSF in three. Cisternal CSF cytologic examination should be considered in patients suspected of having leptomeningeal metastasis if lumbar CSF is nondiagnostic.

Adult↗
PubMed1991

Early brain metastases in endometrial carcinoma.

Endometrial carcinoma is the most common invasive neoplasm of the female genital tract. Yet, intracranial metastases are rare and usually associated with widespread disease. We report three patients with endometrial carcinoma and early brain metastases, two with unsuspected endometrial carcinoma presenting with neurologic symptoms and one who developed neurologic symptoms on the day of hysterectomy. Histologically, one tumor was a clear cell carcinoma and two were endometrial adenocarcinoma. In tumors with a mixture of nuclear grades, the most undifferentiated portion metastasized. Two tumors displayed vascular invasion and deep myometrial invasion. Only one had positive estrogen receptors. Intracranial metastases can occur early in the course of endometrial carcinoma. They are associated with aggressive high-grade neoplasms with deep myometrial and vascular invasion.

Adenocarcinoma, Papillary↗
PubMed1989

A micro ELISA for the diagnosis of cerebral cisticercosis.

A micro ELISA for cysticercosis in the central nervous system was evaluated in 24 patients and compared with indirect hemagglutination. CSF ELISA results were positive in 17 of 20 patients (sensitivity 85%), whereas CSF indirect hemagglutination was positive in only 14 patients (sensitivity 70%).

Brain Diseases↗
PubMed1989

Transbronchial needle aspiration for histology specimens.

Fine-gauge (22-G) transbronchial needle aspiration (TBNA) has significantly added to the diagnostic yield of FOB, and in some institutions has become routine in staging bronchogenic carcinoma. Cytologic examination of the specimen obtained by n228G TBNA, however, has several limitations. The mediastinal aspirate can be contaminated by tumor cells from respiratory secretions, giving false positive diagnoses of unresectability. The diagnosis of benign conditions can seldom be made. Using 18-G TBNA, we can obtain specimens for histologic examination from paratracheal, peribronchial, and carinal areas by FOB. Both 18-G and 22-G TBNA were performed in 34 patients with radiographic abnormalities involving mediastinal or hilar areas. Tissue for histologic examination was obtained in 17 patients (50 percent) using 18-G TBNA and was diagnostic in 11 (32 percent), including three patients with benign conditions. The overall diagnostic yeild of 18-G TBNA was 41 percent (14/34 patients), increasing the yield of FOB from 50 percent to 58 percent. There were no false positive results and few minor complications. 18-G TBNA is effective in obtaining tissue for histologic examination and diagnosing benign conditions. In selected cases this technique increases the diagnostic yield of FOB.

Adenocarcinoma↗
PubMed1989

Increasing the accuracy of fine-needle biopsy for thyroid nodules.

Fine-needle biopsy (FNB) is a valuable technique to use in the evaluation of thyroid nodules; however, false-negative and false-positive results do occur. At Sinai Hospital of Detroit (SHD) (Mich), a criterion was established for adequacy of an FNB specimen (ie, at least six clusters of benign cells on each of two slides prepared from separate aspirations) in an attempt to reduce the rate of false-negative diagnoses attributable to inadequate sampling. To evaluate the SHD criterion, 20 "problem" cases were selected from the SHD files and were reviewed by pathologists from three other institutions in a blind study. A total of 80 diagnoses were rendered (four institutions each reviewing 20 cases). Seven false-negative diagnoses were rendered, three of which were made in cases that did not meet the SHD criterion for adequacy. An additional three false-negative diagnoses on inadequate FNB specimens were made by a physician who asked not to be identified. Implementation of the SHD criterion may reduce the frequency of false-negative diagnoses. A separate study was undertaken to determine the number of FNB aspirations necessary to obtain satisfactory specimens. One hundred adequate FNB specimens from SHD files were reviewed. In 77% of cases the first two to four aspirations were adequate, but 23% of the time six to eight aspirations were necessary to obtain adequate material.

Adenocarcinoma↗
PubMed1987

Experience with pelvic washings in stage I and II endometrial carcinoma.

Pelvic washings for cytologic analysis have become an accepted diagnostic procedure in the management of endometrial carcinoma. A retrospective study was performed in 163 consecutive patients with FIGO Stage I and II endometrial carcinoma to assess the significance and value of the washings. Abnormal results were obtained in 5.5% of patients. Patients with FIGO grade 3 lesions were significantly most likely to have abnormal washings (P less than 0.05). Significant association was not observed with stage, depth of myometrial invasion, extrauterine spread, histologic subtype, prior hormone usage, or hormone receptor status. Multivariant analysis indicated that, for Stages I and II combined and for Stage I alone, FIGO grade 3 was most predictive of poor survival (P less than 0.01). The postoperative therapy of only 2 patients (1.2%) was altered by the results of the pelvic washings and only one of these patients has survived. No patients have had recurrent disease (median follow-up 31 months) in the peritoneal cavity with negative washings unless two or more other adverse prognostic factors were present. It is concluded that pelvic washings have a limited role in the clinical management of Stage I and II endometrial carcinoma.

Carcinoma↗