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Biomedical subjects

D P Garcia

Publications and source records attributed to D P Garcia.

At least 19 recordsLinked to original sources
PubMed2001

Diagnostic usefulness of CD23 and FMC-7 antigen expression patterns in B-cell lymphoma classification.

CD23 and FMC-7 are normal B-cell antigens used during diagnostic immunophenotyping of suspected lymphoproliferative disorders, but the diagnostic usefulness of antigenic expression patterns of simultaneous 2-color staining and flow cytometric analysis has not been reported. We evaluated the FMC-7 and CD23 expression pattern in 201 cases of B-cell lymphoma from tissue biopsy specimens by multiparameter flow cytometry. The CD23-/FMC-7+ pattern was the most common pattern in large cell, mantle cell, and marginal zone lymphomas. The CD23 and FMC-7 antigen, along with the CD5 coexpression pattern, permitted accurate classification of all 71 cases of small lymphocytic, mantle cell, and marginal zone types of lymphoma. The widest variation of patterns was with follicular cell lymphoma, although most cases expressed the CD23 +/-/FMC-7+ pattern (+/-, partial or minor subset expression). The CD23 and FMC-7 antigen expression pattern was predictive of subtypes in more than 95% of lymphoma cases and could narrow the differential diagnosis in the remaining cases. We conclude the flow cytometric CD23/FMC-7 expression pattern achieved by dual staining facilitates accurate and reproducible classification of B-cell lymphomas and has diagnostic usefulness.

Algorithms↗
PubMed2000

Insulin, chemotherapy, and the mechanisms of malignancy: the design and the demise of cancer.

The endogenous molecular biology of cancer cells involves autocrine and paracrine secretion of insulin and insulin-like growth-factors I and II, which subserve energy production and growth stimulation, respectively, in these cells. These activities confer on cancer its malignant potential, working as they do autonomously, free from higher levels of integrated control. Taking advantage of cancer's mechanisms of malignancy by employing exogenous insulin as a biologic response modifier, it is possible to potentiate the cytotoxic effects of chemotherapeutic agents for improved treatment of cancer. A synergy between certain membrane and metabolic effects of insulin on cancer cell molecular biology increases anticancer drug efficacy, and it does so with reduced doses of the drugs, enhancing their safety. This treatment strategy has been applied abroad over the last five decades with very promising clinical results.

Antineoplastic Agents↗
PubMed1997

[Sublingual isosorbide-5 mononitrate during coronary arteriography. Comparison with sublingual nitroglycerin].

PURPOSE: To evaluate the effect of sublingual isosorbide-5 mononitrate (ISMN) and nitroglycerin (NTG) on luminal diameter of epicardial coronary arteries, mean arterial pressure and deleterious effects. METHODS: Fifty patients were submitted to cardiac catheterization and coronary arteriography, at baseline, and 5 min after sublingual administration of ISMN, group A (GA) or NTG, group B (GB). RESULTS: Reference vessel diameter increased in both groups, without statistical significance. In GA and GB, a decrease (1.66 mmHg) and an increase (0.79 mmHg) in mean arterial pressure, respectively, were demonstrated (p = 0.123). There were no deleterious effects with the use of these drugs. CONCLUSION: Sublingual ISMN is an alternative to administration of NTG during coronary arteriography, and represents a therapeutic alternative to ischemic heart disease treatment.

Administration, Sublingual↗
PubMed1997

[Excimer-laser angioplasty for the treatment of restenosis after Wiktor and Gianturco-Roubin stent placement. A new therapeutic alternative].

We report the use of excimer-laser angioplasty for the treatment of Wiktor and Gianturco-Roubin in-stent restenosis of in two patients. Case 1-a 48-year-old man presented unstable angina five months after Wiktor stent was deployed in right coronary artery. Cardiac catheterization revealed stenosis (95%) within the stent. Case 2-a 65-year-old man presented stable angina four months after Gianturco-Roubin stent was deployed in left anterior descending artery. Cardiac catheterization revealed stenosis (80%) within the stent. Excimer-laser angioplasty within the stent reduced the stenosis to 19% and 30%, respectively. The patients recovered and currently, six months post-procedure, are free of chest pain, and cardiac catheterization revealed stenosis to 30% and 35%, respectively, within the stent. Therefore, the procedure was an effective means of treating restenosis after coronary stent placement, and a prospective comparison of excimer-laser angioplasty and other management alternatives to in-stent restenosis is needed.

Aged↗
PubMed1996

[Analysis of elastic retraction in the 1st 15 minutes after coronary balloon angioplasty].

PURPOSE: To determine the time course of elastic recoil (ER) in the first 15min after successful percutaneous transluminal coronary angioplasty (PTCA). METHODS: One hundred and fifty four patients, with stable or unstable angina were successfully submitted to PTCA. Coronary angiography was undertaken shortly after balloon deflation and repeated 5, 10 and 15 min thereafter. Quantitative coronary angiography was performed with the aid of an eletronic caliper. We calculated the minimal luminal diameter (MLD) and elastic recoil in all angiograms. RESULTS: The average artery's reference diameter was 3.09 +/- 0.61mm and the maximal balloon diameter was 2.95 +/- 0.52mm. MLD before the procedure was 0.65 +/- 0.42mm reaching 2.23 +/- 0.55mm immediately after dilatation (p < 0.0001), and decreasing to 2.09 +/- 0.47mm at 5min (p < 0.0001), 2.01 +/- 0.47 at 10min (p < 0.0001) and to 1.91 +/- 0.56mm at 15min (p < 0.0001). ER increased during the 1st 15min after PTCA, averaging 34.29 +/- 20.40%. In the group of patients whose balloon/artery relationship was < or = 1, the total ER was 0.90 +/- 0.74mm at 15min and 1.20 +/- 0.50mm when the ratio was > 1 (p < 0.0001). We noted that ER in the group of patients with residual stenosis ranging from 30 to 50% at the immediate angiogram after PTCA was greater than in the group whose residual stenosis was less than 30%. CONCLUSION: ER is a dynamic and progressive phenomenon taking place within the 1st 15 min after a successful PTCA. Total ER was 34.29 +/- 20.40% at 15min and was greater when balloon/artery relationship was > 1. Residual stenosis ranging from 30 to 50% in the control immediately after the procedure is a predictive factor of greater ER in the 15min following PTCA.

Angina Pectoris↗
PubMed1996

[Coronary artery perforation with rotational coronary atherectomy].

The authors describe a rare case of circumflex coronary artery perforation during rotational coronary atherectomy complicated with cardiac tamponade and good outcome. The possible causes of perforation are discussed and the burr oversize (burr/artery ratio was 0.58) was refused. Shortening and artery plicature (accordeon effect) might have been the cause of this event. Quantitative measurement was made in order to strengthen this hypothesis. It is emphasized the importance of selecting lesions that should be submitted to rotational coronary atherectomy.

Atherectomy, Coronary↗
PubMed1995

[Prevalence of residual shunt after closure of patent ductus arteriosus with Rashkind umbrellas].

PURPOSE: To determine the prevalence of residual left-to-right shunt in patients submitted to closure of patent ductus arteriosus with use of Rashkind double-disc ductal occluding device, analyzing predictive factors that determine short and long-term prevalence of residual shunt. METHODS: Thirteen patients were submitted to percutaneous closure of patent ductus arteriosus with use of Rashkind double-disc device. Ten patients were male with mean age of 5.7 years. A 12mm diameter device was used in 7 cases and a 17mm device in the remaining six patients. All patients had clinical, radiological and echocardiographic follow up, after 24h, 1 month, 6 months and one year after the procedure. Morphology and length of the ductus arteriosus and the presence of residual shunt after 15 min, 24h and one year after the procedure, were correlated. RESULTS: In one case, embolization of the device to the pulmonary artery determined the in success of the procedure. Residual shunt was present in 75% of the patients after 15 min of the procedure, in 33.3% after 24h, in 25% after 1 month and 6 months and in 16.6% after 1 year. The most important and isolated predictive factor leading to a high prevalence of residual shunt after 24h and after 1 year of the procedure was the presence of ductus arteriosus diameter > or = 4.5mm at the site of its insertion in the pulmonary artery. CONCLUSION: Prevalence of residual left-to-right shunt decreases over the time, with a low incidence after one year follow-up. A higher incidence of residual shunt at 24h and 1 year after the procedure occurred in the cases where the diameter of the ductus arteriosus was > or = 4.5mm, at the site of its insertion in the pulmonary artery.

Adolescent↗
PubMed1994

Radiographic imaging studies in pediatric chronic sinusitis.

BACKGROUND: The diagnosis of chronic sinusitis is dependent on the radiographic evidence of sinus disease. METHODS: We evaluated the performance of radiographs and computed tomographic (CT) scans for the examination of the paranasal sinuses of 91 patients of both sexes, ranging in age from 2 to 17 years, who had chronic upper respiratory tract symptoms for at least 3 months. The CT scan findings were categorized as no disease; minimal disease, and mild, moderate, and severe sinusitis. RESULTS: Fifty-eight patients (63%) had chronic sinusitis: CT scan abnormalities were minimal in 17%, mild in 19%, moderate in 21%, and severe in 43%. There was a statistically significant correlation between rhinorrhea (r = 0.25, p = 0.01), cough (r = 0.27, p = 0.009), and the severity of sinus abnormality as determined by CT scan. Clinical presentation in the mild, moderate, and severe sinusitis groups (p < 0.05) was significantly different from that of the no disease group, whereas the minimal disease group had subclinical presentation (p = 0.11). Clinically significant chronic sinusitis often occurred at multiple sites: 44% of patients had pansinusitis, 50% had disease involvement of at least two sinuses, and 6% had disease in a single sinus. When sinus radiographs were compared with CT scans (n = 70 cases), radiographs could not identify minimal disease. For clinically significant sinusitis, sinus radiographs detected disease in 1 of 5 (20%) frontal sinuses, 0 of 12 (0%) sphenoidal sinuses, and 17 of 31 (54%) ethmoidal sinuses. With the minimal criteria of 40% to 50% opacification or fluid level filling of the maxillary antrum, radiographs detected disease in 37 of 49 (75%) cases. The sensitivity and specificity for a Waters view to confirm clinically significant chronic sinusitis without specifying the sites and severity were acceptable at 76% and 81%, respectively. When limited sinus CT scans were compared with full CT evaluation (n = 49 cases), limited studies detected 5 of 5 (100%) frontal, 9 of 11 (82%) sphenoidal, 14 of 19 (73%) ethmoidal, and 39 of 40 (97%) cases of maxillary sinusitis. The overall agreement was 88%. CONCLUSIONS: A single Waters view is an acceptable part of the initial evaluation of pediatric chronic sinusitis; however, a limited CT scan is a better alternative.

Adolescent↗
PubMed1994

[Laser coronary angioplasty. Critical analysis of the first patients].

PURPOSE: To evaluate the success rate and complications, as well as the technical difficulties involved catheter laser coronary angioplasty, making evident the unsuccessful cases. METHODS: Twenty eight patients were treated with laser from August to November, 1993. The treatment was complemented with balloon angioplasty. Lesions were complex: 10 (36%) were type B and 18 (64%), type C. Concerning the obstruction grade, 18 (64%) were > or = 95%. Laser generator CVX 300(TM) Spectranectics as well as Extreme(TM) and Vitesse(TM) catheters with 1.4, 1.7 and 2.0mm in diameter, concentric and excentric, were used. Laser procedure success was defined as a reduction > 20% in the obstruction grade. The procedure success was attended when the residual stenosis was < 50% after a 15-minute observation, after balloon complementation. RESULTS: The unsuccess rate with laser catheter (Lc) was 34% (10 lesions) of which 3 cases were solved by other methods, 5 were not successful because of anatomic difficulties in surpassing the lesion and, in the two others the success criterium in the reduction of the obstruction grade of the coronary artery was not achieved, although the lesion surpassing was possible with the use of balloon catheter. The final success reached 89% (21 lesions). The procedure complications were a case of thrombosis, a perforation accompanied by a myocardial infarction and another myocardial infarction (non-Q wave), all with good outcome. CONCLUSION: The use of laser in the treatment of coronary artery obstructive lesions is a viable method. Nonetheless, more experience is necessary to demonstrate its actual value, optimizate the results and may be reduce restenosis rate.

Adult↗
PubMed1994

[Coronary angioplasty in chronic occlusion of 9 and half years. Use of laser with a new catheter for recanalization].

A chronic total occlusion lasting 9.5 years, was successfully treated with a Prima (TN) Laser catheter, of Spectranectics. The authors report a case of a fifty seven year old male that suffered an inferior myocardial infarction 9.5 years ago. Although the morphological characteristics of the lesion seemed easy to pass through the obstruction with the guide wire, the balloon dilatation was not possible because of the hardness of a chronic lesion lasting that long. The intervention was concluded successfully in another opportunity using the laser catheter with certain facility. This case, reported as the first one in Latin America, rises new possibilities and increases the success rate of coronary angioplasty of total chronic occlusions. We hope that in the following cases we will be able to reach the same result, widening the indications of coronary angioplasty.

Angioplasty, Balloon, Coronary↗
PubMed1994

Cockroach allergy in Kentucky: a comparison of inner city, suburban, and rural small town populations.

The cockroach has been reported as a major allergen in inner city asthmatic patients. The retrospective chart review of 799 patients tested over a 10-year period (1981-1991) derived from a private allergy practice and a university allergy clinic is reported. Patients from both groups were divided geographically by home zip codes into inner city, suburban, or rural small town populations. Criteria for positive skin tests were wheal greater than 5 mm for prick and greater than 10 mm for intradermal tests with flare. Overall, 36.9% (295/799) of all patients surveyed were positive by either prick or intradermal skin testing. Cockroach reactivity was observed in 38.6% (95/246) of the private patients tested with 36.2% (200/553) of the university patients showing positive results. The inner city populations in both groups of patients were similar with 43.7% and 40.3% of the private and university patients, respectively, testing positive, with an overall positivity of 41% for all inner city patients. Inner city and rural small town populations for both study groups demonstrated almost identical reactivity with 41% and 43% overall positivity, respectively. Of the suburban group, 37.5% of the private patients and 28.8% of the university patients had reactive skin tests results with an overall rate of positivity of 30.1%. This rate (30.1%) is significantly less than the rate for either inner city (41.0%, P < .05) or rural small town (43.6%, P < .01) populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Chronic sinusitis among pediatric patients with chronic respiratory complaints.

We examined the prevalence of chronic sinusitis among children who presented to allergy clinics with chronic (> or = 3 months) respiratory symptoms. Ninety-one patients, ranging from 2 to 17 years of age with 62% male and 72% white, completed the study. Fifty-nine percent of patients had positive skin test results, and 25.3% had chronic asthma. Paranasal sinuses were examined by coronal sinus computed tomographic scan. Sixty-three percent (58 to 91) had chronic sinusitis, 5.5% (5 of 91) had concha bullosa, 1% (1 of 91) had foreign body, and 19% (19 of 91) had deviated nasal septums. Among symptoms of sneezing, nasal congestion, postnasal drip, coughing, wheezing, rhinorrhea, and headache, no single symptom was an acceptable predictor of abnormality on computed tomographic scan examinations. Combining the symptoms of moderate to severe rhinorrhea and cough with minimum sneezing had a specificity of 95% and a sensitivity of 38% in predicting the presence of chronic sinusitis. Allergic rhinitis (p = 0.27), mild deviated nasal septum (p = 0.11), unobstructive concha bullosa (p = 0.13), and passive exposure to cigarette smoke (p = 0.53) were not risk factors associated with sinus abnormalities. Age (r = 0.30, p = 0.004) in pediatric patients with chronic respiratory symptoms was the single risk factor significantly associated with abnormalities on sinus computed tomographic scan. Seventy-three percent of children 2 to 6 years of age, 74% of children 6 to 10 years of age, and 38% of children older than 10 had chronic sinusitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗