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Biomedical subjects

D Maldonado

Publications and source records attributed to D Maldonado.

At least 19 recordsLinked to original sources

Expiratory muscle endurance in middle-aged healthy subjects.

To evaluate expiratory muscle endurance in middle-aged healthy subjects using incremental as well as constant expiratory loads, 14 healthy volunteers (51 +/- 16 years) were submitted to a specific endurance test, which was performed breathing against a threshold valve, and was divided into two parts. In part I, the load was progressively increased (50 g each 2 min) until task failure occurred. The mean mouth pressure generated against the highest load held for at least 60 sec was defined as the maximal expiratory sustainable pressure (Pth(max)). In part II, each subject breathed against a constant submaximal expiratory load (80% Pth(max)) until task failure occurred (expiratory endurance time or Tth(80)). Both parts of the test were repeated 24-48 h later. Progressive expiratory loading induced a linear increase in mouth expiratory pressure and the Pth(max) obtained was 141 +/- 43 cm H(2)O, representing 74 +/- 28% of the maximal expiratory pressure (PE(max)). Under constant loads, the Tth(80) was 17 +/- 9 min. At the end-point of both parts, the tension time index for expiratory muscles was dramatically increased (>0.25), and both EMG central frequency and PE(max) were decreased with no changes in maximal inspiratory pressure or inspiratory capacity. Extreme dyspnea was present in most of the subjects but no complications were observed. The endurance of expiratory muscles can be easily assessed in healthy subjects using this method, which has acceptable reproducibility and tolerance.

Airway Resistance↗

[Giant aneurysms of the pulmonary artery and peripheral venous thrombosis (Hughes-Stovin syndrome): regression with immunosuppressant therapy].

We report the case of a young Afro-Caribbean patient who complained of dry cough and low-grade fever. A chest film upon admission showed bilateral hilar masses in the lungs, which a CT scan with contrast medium confirmed were giant aneurysms of the pulmonary artery. The most relevant past history was deep venous thrombosis six months before admission. Hughes-Stovin syndrome was diagnosed and treatment was started with prednisolone and azathioprine. A scan 6 months after treatment ended showed the aneurysms had disappeared. Hughes-Stovin syndrome is characterized by pulmonary artery aneurysms and peripheral deep venous thromboses. Severe lung complications can include hemoptysis and thromboses inside the aneurysms. Hughes-Stovin syndrome has been considered a variety of BehCet's disease.

Adult↗

Effects of changing diagnostic criteria on the risk of developing diabetes.

OBJECTIVE: The American Diabetes Association (ADA) has recommended that the fasting plasma glucose (FPG) level used to diagnose diabetes be changed from 7.8 mmol/l (the level recommended by the National Diabetes Data Group [NDDG] in 1979) to 7.0 mmol/l. We examined the impact of this change on rates of progression to overt diabetes from different levels of FPG. RESEARCH DESIGN AND METHODS: Using the laboratory database of Mayo Clinic, we assembled a cohort of 8,098 nondiabetic Olmsted County residents 40 years of age or older on 1 July 1983. Subjects were followed for a median of 9 years. RESULTS: Among 7,567 individuals with follow-up FPG data, 778 (10.3%) progressed to ADA diabetes and 513 (6.8%; P < 0.0001) progressed to NDDG diabetes. The risk of developing ADA diabetes was 7, 19, and 39% for individuals with initial FPG values in the ranges of <5.6, 5.6-6.0, and 6.1-6.9 mmol/l, respectively. For progression to NDDG diabetes, the respective risks were 3, 11, and 25%. A clear gradient of risk was observed within the "normal" range of FPG (<5.6 mmol/l). Among the 793 individuals who developed ADA diabetes, 222 (29%) developed NDDG diabetes simultaneously and 291 (37%) developed NDDG diabetes later. In all FPG subgroups, progression to ADA diabetes occurred approximately 7 years sooner than progression to NDDG diabetes. CONCLUSIONS: The baseline level of FPG is a major predictor of an individual's risk of developing diabetes. The proposed change in the diagnostic criteria for diabetes will lead to earlier diagnosis among individuals who are destined to develop the disease.

Adult↗

Woodsmoke exposure and risk for obstructive airways disease among women.

OBJECTIVE: To investigate if exposure to firewood smoke and other indoor pollutants is a potential risk factor for obstructive airways disease (OAD) among women in Bogota in whom cigarette smoking and other known risk factors may not be the most frequent. DESIGN AND SETTING: We conducted a hospital-based case-control study to identify risk factors for OAD among women in Bogota. An interview was conducted using a modified questionnaire recommended by the American Thoracic Society for epidemiologic studies. PATIENTS: We compared 104 OAD cases with 104 controls matched by hospital and frequency matched by age. ANALYSIS: The odds ratio (OR) was used as the basic statistic to evaluate risk. Multivariate analysis (MA) was conducted by the Mantel-Haenszel procedure and by logistic regression. MAIN RESULTS: Univariate analysis showed that tobacco use (OR = 2.22; p < 0.01), wood use for cooking (OR = 3.43; p < 0.001), passive smoking (OR = 2.05; p = 0.01), and gasoline use for cooking (OR = 0.52; p = 0.02) were associated with OAD. Trends for years of tobacco use and years of wood cooking were present (p < 0.05). After MA, variables remained significant except gasoline use. CONCLUSIONS: This study showed that among elderly women of low socioeconomic status in Bogota, woodsmoke exposure is associated with the development of OAD and may help explain around 50% of all OAD cases. The role of passive smoking remains to be clarified. This work may set the basis for interventional studies in similar settings.

Adult↗

[The endovascular treatment of hemoptysis].

We studied 18 patients, 9 women and 9 men, ranging in age from 18 to 76 years. The main symptom was hemoptysis and the underlying pathology was tuberculosis, actinomycosis, lung cancer, metastatic carcinoma and systemic lupus. Nonsurgical patients, with recurrent hemoptysis or massive bleeding were selected. The embolization substances were spongostan, avitene (R) and PVA; they all produce temporary as well as persistent hemostasis. The procedure was successful in 16 patients. In two patients the embolization was not performed, one for technical reasons and the other because the vessel to be treated was the source of an anterior spinal artery. It is considered that the endovascular treatment constitutes an alternative for hemoptysis, even during the acute period, mainly in the management of nonsurgical patients.

Acute Disease↗

Prostaglandin E1 activates a chloride current in Jurkat T lymphocytes via cAMP-dependent protein kinase.

Patch-clamp studies have identified a cAMP-dependent Cl- conductance in lymphocytes that is defectively regulated in cystic fibrosis. In this study we used 125I efflux and whole-cell patch-clamp studies to investigate whether prostaglandin E1 (PGE1), an agonist that generates intracellular cAMP in Jurkat T lymphocytes, activates a Cl- conductance. Stimulation of T cells by externally applied PGE1 stimulated 125I efflux and activated a slowly developing membrane current. When external and internal Cl- were about equal, the current reversed at about zero mV, but when external Cl- was lowered from 157 to 7 mM the reversal potential shifted 75 mV in the positive direction, demonstrating that the current carrier was Cl-. In addition, the current was blocked by 10 microM 5-nitro-2(3-phenylpropylamino) benzoic acid (NPPB), a potent Cl- channel blocker. A membrane-permeable cAMP analog mimicked the effect of PGE1, whereas intracellular application of a cAMP antagonist Rp-cAMP blocked the effect of PGE1. Addition of purified catalytic subunit of cAMP-dependent protein kinase (PKA) plus ATP to the recording pipette also activated a similar current, whereas internally applied Walsh inhibitor, the synthetic peptide inhibitor of PKA, blocked the PGE1 effect. These results suggest that PGE1, acting through PKA, activates a Cl- current in Jurkat T cells.

Alprostadil↗

Hypertension and acculturation in elderly Mexican Americans: results from 1982-84 Hispanic HANES.

The purpose of our study was to describe the relationship between acculturation and hypertension in elderly Mexican Americans. Two age groups, 55-64 and 65-74, were examined from data provided in the Hispanic Health and Nutrition Examination Survey (HHANES). The prevalence of hypertension among subgroups of different acculturation was ascertained based on the modified Cuellar Acculturation Scale. Each age group was also stratified using the HHANES poverty index, with those above the index compared to those below. A stepwise logistic regression was performed among the variables of poverty, gender, age, and acculturation in relation to hypertension. The results indicate that acculturation and age are stronger predictors of hypertension than poverty in elderly Mexican Americans, with acculturation being a stronger predictor among those age 55-64. Factors related to acculturation may have a stronger influence on the prevalence of hypertension in older Mexican Americans than differences related to socioeconomic status.

Acculturation↗

Prolactin responsiveness to TRH in amenorrheic women with and without galactorrhea.

Sixty women were given intravenous injection of 200 microgram TRH to assess its diagnostic potential as a stimulus to PRL release. Following the administration of TRH, there was a prompt increase in serum PRL to 614.6%, to 296%, to 282.1%, and 34% in normal women, amenorrheic patients, non tumoral galactorrheic cases, and patients with pituitary tumors respectively. The TRH response above baseline of PRL levels was statistically significant in all groups, but the women with pituitary tumors which showed a blunted response. The per cent of increment of PRL levels after TRH was similar in amenorrheic women regardless the presence or not of galactorrhea; this increase was significantly greater than in patients with pituitary tumors (p less than 0.01). The per cent of increment above baseline of PRL was significantly greater in menstruating women than in amenorrheic patients (p less than 0.001). In basis of present data: 1) there is a diminished PRL secretion after TRH in amenorrheic women regardless the presence of galactorrhea or hyperprolactinemia; 2) a blunted response to TRH in hyperprolactinemic women may be indicative of a pituitary tumor.

Amenorrhea↗

Gracilis muscle transplant for correction of traumatic anal incontinence: Report of a case.

We report a case of traumatic anal incontinence successfully treated by the transplant of a gracilis muscle sling, using the technique described by Pickrell et al. in 1952. Although gracilis muscle transplant has been used in the treatment of congenital anal incontinence, its use in traumatic cases has not been widely accepted. Instead, many techniques offering uncertain results have been employed. We believe that Pickrell's technique is a worthwhile procedure in the presence of traumatic anal incontinence, particularly with noniatrogenic large perineal wounds, and that establishment of a temporary colostomy immediately after the injury, together with use of surgical steel sutures and antibiotics, is very helpful in averting posttransplant infection.

Adolescent↗