PubMed HealthSearch

Biomedical subjects

F Guerra

Publications and source records attributed to F Guerra.

At least 19 recordsLinked to original sources

In vitro regulation of pericellular proteolysis in prostatic tumor cells treated with bombesin.

Bombesin is a potent inducer of signal trasduction pathways involved in the proliferation and invasion of androgen-insensitive prostatic tumor cells. This study examines the bombesin-mediated modulation of pericellular proteolysis, monitoring cell capability to migrate and invade basement membranes, using a chemo-invasion assay and analyzing protease production. The results suggest that bombesin could modulate the invasive potential of prostatic cell lines regulating secretion and cell-surface uptake of uPA and MMP-9 activation. In fact, in PC3 and DU145 cells but not in LNCaP cells, urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) are induced by bombesin treatment. Bombesin also stimulates cell proliferation and this effect can be inhibited blocking uPA by antibodies and/or uPA inhibitor p-aminobenzamidine. Moreover, HMW-uPA induces cell proliferation in LNCaP cells, which do not produce uPA in the basal conditions, while PC3 and DU145 cell growth is supported by autocrine production of uPA. The increment of uPA activity on the external plasma membrane causes an increased pericellular plasmin activation. This effect is inhibited by antibodies against uPA and by p-aminobenzamidine. Similarly to EGF, bombesin stimulates secretion and activation of MMP-9 and TIMP-1 production. MMP-9 activation can be also obtained by HMW-uPA treatment, suggesting that plasma-membrane-bound uPA can start a proteolytic cascade involving MMP-9. Therefore, in in vitro assays, bombesin is able to modulate pericellular proteolysis and cell proliferation, differently distributing and activating proteolytic activities. This effect can be related to the "non-random" degradation of the extracellular matrix in which membrane uPA-uPAreceptor complexes could start bombesin-induced directional protein degradation during metastatic spread.

Antibodies

Occupational allergy in saffron workers.

Sensitization to the flower of saffron, a plant commonly grown in Spain for commercial purposes, and its clinical significance as an occupational allergen were studied. The prick test and RAST, with saffron pollen, stamen, and pistil extracts, were used to evaluate the cutaneous and specific antibody responses in the studied population. Provocation tests in patients with clinical findings were used to verify the implication of saffron components in these symptoms. Fifty saffron workers were evaluated. Three of them were sensitized to saffron pollen and stamen proteins, giving prick and RAST positive values. One patient presented asthma, showing a positive bronchial provocation test, and two patients rhinoconjunctivitis, showing positive conjunctival provocation tests. Of a general allergic population of 237, 10 patients also presented cutaneous test and IgE positive to saffron. Saffron allergens (from pollen and stamens) were characterized by SDS-PAGE immunoblotting. A relevant allergen of 15.5 kDa with profilinic nature was detected and further purified by high-resolution gel filtration chromatography. No allergenic components were demonstrated in pistils. Cross-reactivity of saffron extracts was evaluated by RAST inhibition with respect to other pollen species commonly causing sensitization in the same area of study. A significant degree of cross-reactivity was demonstrated between saffron and Lolium, Salsola, or Olea. The identification of the protein components involved in the cross-reactions was investigated by blot inhibition.

Adolescent

Human prostatic tumor cells in culture produce growth and differentiation factors active on osteoblasts: a new biological and clinical parameter for prostatic carcinoma.

Prostate cancer (PRCA) cells metastasize to bone with high frequency, inducing typical osteosclerotic lesions. To establish if local stimuli on the bone tissue may derive from metastatic colonies of prostatic origin, we evaluated the biologic activities secreted by human prostatic epithelium and effective on osteoblast-like cells in vitro. Supernatant from short-term tissue cultures of human prostatic tissue samples obtained from PRCA (35 cases) and benign prostatic hyperplasia (BPH, 12 cases) patients were applied to three models of cells with osteoblastic phenotype: two normal [rabbit osteoblasts (OB) and rat periosteal cells (PO)] and one transformed (human osteosarcoma cell line, MG63). Proliferative activity was monitored through enzymatic reduction of tetrazolium salts and expressed as relative mitogenic activities (RMA). Analysis of proliferation and alkaline phosphatase (ALP) activity, a marker of osteoblast function, demonstrates that conditioned media (CM) from PRCA cultures stimulate both growth and activity of osteoblast-like cells to a greater extent compared to CM from BPH. Furthermore, cell growth and activity of osteoblast-like cells are progressively increased by CM derived from patients with stage B (tumor confined within the prostate capsule), stage C (locally invasive tumor), and stage D (invasive tumor with distant metastasis) disease. One of the mechanisms potentially underlying the CM-stimulated effects on bone cells is associated with the urokinase (uPA) enzyme route, whose release progressively increases with the stage of disease. However, antibodies against uPA and p-aminobenzamidine (a low molecular weight urokinase inhibitor) treatment, which both inhibit the proliferative and differentiative effects induced by exogenous urokinase, partially slow down the effects of CM from PRCA tissue cultures, suggesting that additional factors are secreted by prostatic tumor cells in vitro. In conclusion, we show that the mitogenic and differentiative activities for osteoblasts produced by prostatic tumor cells in short-term tissue cultures are related to PRCA stage and may predict the behavior of skeletal metastases in single cases of tumor. In addition, the culture methods used may represent a valid model to study prostatic and bone cellular interactions, which may indicate new therapeutic approaches in metastatic prostate tumors.

Alkaline Phosphatase

Application of new sepsis definitions to evaluate outcome of pediatric patients with severe systemic infections.

No published reports have stratified pediatric patients with systemic infections according to the new sepsis terminology guidelines. In addition little is known about the outcome of sepsis in developing countries. This large 12-year retrospective study evaluated the outcome of 815 infants and children with sepsis managed in a Latin American pediatric intensive care unit. Of these children 171 (21%) had sepsis, 497 (61%) had severe sepsis and 147 (18%) had septic shock. Multiorgan dysfunction was present in 120 (24%) and 77 (52%) patients with severe sepsis and septic shock, respectively. Infection was bacteriologically proved in 212 (26%) cases, with Staphylococcus aureus and Neisseria meningitidis being the most frequent responsible organisms. Three hundred nineteen (39%) patients died. Case-fatality rates were higher in patients with septic shock, multiorgan dysfunction, sepsis caused by Pseudomonas aeruginosa and meningococcemia than in those without these conditions. Although no difference in mortality was detected between culture-proved and culture-negative sepsis, more patients receiving an inappropriate antimicrobial agent died than those treated with an appropriate drug (53% vs. 34%, P = 0.012). We believe that with the use of the new terminology system a more reliable comparison of data from pediatric sepsis studies and of emerging immunomodulating therapeutic modalities can be achieved.

Adolescent

[Absent or reverse diastolic umbilical flow].

We show our experience in the diagnostic and management of 19 pregnancies with absent or reverse diastolic blood flow velocity (ARFV) in the umbilical artery. The presence of ARFV was a rare condition (2.2% of the high risk patients), and it was associated with a poor prognosis shown by the high percentage of fetuses SGD (small for gestational age) (63.2%), malformations and hydrops fetalis (26%) and asphyxiated fetuses, giving a final perinatal mortality rate of 36.8%. In 8 cases (42.1%) the termination or pregnancy was delayed for at least 48 hours, allowing in some cases the administration of corticosteroid. There were significant differences when comparing the groups of survivors and non survivors in relation to the gestational age at the moment of delivery (33.1 +/- 3.4 vs 28.6 +/- 3.8 weeks), malformations (8.3 vs 57.1%) and C-section (91.7 vs 42.9%). Finally, we conclude that the presence of ARFV in the umbilical artery is associated with a critical fetal condition and termination of pregnancy should be considered. In this decision the gestational age and fetal and maternal well being ought to be taken into account when choosing the best moment and route of delivery.

Adult

Effect of sialoadenectomy on medroxyprogesterone-acetate-induced mammary carcinogenesis in BALB/c mice. Correlation between histology and epidermal-growth-factor receptor content.

To evaluate the possible involvement of the salivary glands in the modulation of medroxyprogesterone (MPA)-induced mammary tumorigenesis, 48 sialoadenectomized virgin BALB/c female mice and 47 controls were treated with 40mg MPA depot s.c. every 3 months for 1 year. Mammary tumors developed in 11 sialoadenectomized and in 34 control mice with similar latencies. In both groups, 75% of the tumors were ductal and progestin-dependent (PD) while the remainder were lobular and progestin-independent (PI). Epidermal growth factor (EGF) levels were measured in salivary glands (SG-EGF) and serum (S-EGF) in both groups. MPA induced a significant increase in SG-EGF and in S-EGF that became evident only after 1 month of MPA treatment. No increase in S-EGF was detected in MPA-treated sialoadenectomized mice, indicating that salivary glands are the major source of S-EGF. The presence of EGF receptors (EGF-R) was investigated in ductal PD and PI tumor lines and compared with 8 PI tumor lines of lobular origin. A significant difference in EGF-R content was found between lobular and ductal tumors. No increase in EGF-R was noted when ductal tumors became autonomous. EGF-R did not correlate with tumor growth rate and there was an inverse correlation between EGF-R and steroid receptors. When the effect of sialoadenectomy on tumor growth was tested in vivo in syngeneic transplants of 2 ductal PD, 1 ductal PI and 2 lobular PI mammary adenocarcinomas, it was not found to be significant when compared with the controls. It may be concluded that SG-EGF plays an important role in the induction of mammary adenocarcinomas by MPA, while it has no significant effect on the growth of established tumors.

Animals

Sensitization to sunflower pollen: only an occupational allergy?

Sunflower (Helianthus annuus) pollen sensitization has been reported as an occupational allergy. In this report, the sensitization of the general population living in sunflower-growing areas to Helianthus pollen was studied. Both RAST results in 32 adults with summer symptoms previously diagnosed as allergic to Artemisia pollen, and cross-reactivity studies between H. annuus and other Compositae suggested that H. annuus pollen was the main allergen involved in the hypersensitivity reaction of those patients. Good correlation was found between RAST and SPT to Helianthus and between RAST and conjunctival provocation test to Helianthus. Bronchial challenge tests performed on 8 of the 32 patients confirmed the clinical implication of Helianthus pollen in suspected subjects. Five workers, handling sunflower pollen, who suffered from related symptoms were subjected to the same study, showing lesser wheal areas and lesser specific IgE levels than a non-worker group. Thirteen patients with RAST values > or = class 2 showed 2 IgE-binding fractions at 34.0 and 42.8 kD in 65% of sera and 3 IgE-binding fractions at pI 4.9, 9.6 and 10.2 in 54% of sera. By means of micropreparative high-resolution chromatography, it was possible to purify a 34-kD major allergen. Analysis performed by RAST inhibition with sera from atopic patients and ELISA inhibition with experimental anti-Helianthus rabbit sera demonstrated a cross-reactivity between Helianthus and other Compositae, but low affinity of specific anti-Helianthus antibodies for heterologous antigens. Taking into account the above-mentioned data, and the high prevalence of Helianthus pollen in the atmosphere during harvesting (in spite of its entomophilous character), Helianthus pollen should be considered as an allergenic source to be investigated in the general population living in sunflower-growing regions suffering from seasonal summer allergy.

Agricultural Workers' Diseases

Oral metastasis of renal cell carcinoma. Report of case and critical evaluation of morphologic features for differential diagnosis.

Two clear cell neoplastic lesions of the oral cavity, the first on the cheek and the second on the mucosa of the upper lip, were identified, in a 44 year old otherwise healthy man, 46 and 51 months after left nephrectomy for renal clear cell carcinoma. Basing on this case, unique for the double and limited metastasis of clear cell carcinoma of the kidney in the oral cavity, we discuss about the morphologic criteria usefull in the differential diagnosis of oral cavity clear cell tumors.

Adult

[Sulindac and indomethacin effects on lamb fetuses chronically monitored].

Sulindac and indometacin, both prostaglandins inhibitors, have a similar tocolytic effectiveness, in contrast their fetal effects seem to be different. For specify these differences we compared the effects of the infusion of sulindac with known effects of indometacin. We operated 6 fetal lambs, in which polyvinyl catheters were inserted chronically for continuous measure of heart rate, blood pressure, incidence of fetal breathing movements and arterial pH and gas tension. The fetuses were infused in a 2 hour control period with vehicle, and then with 150 mg of either sulindac or indometacin (in alternate days) for a 6 hour period. There was no change in any variable when sulindac was given, but there was a significant increase in fetal breathing movements with indometacin. The reason for this difference is not clear, and requires further studies. These results added to previous reports supports the hypothesis that sulindac could be a first choice tocolytic drug for treatment of premature labor when no fetal effect is desired.

Animals

[Evaluation of maternal and fetal blood flow indices in intrahepatic cholestasis of pregnancy].

To determine the existence of any change in the blood flow velocity indexes in patients with cholestasis of pregnancy, we studied a total of 51 pregnant women, (normal n = 15; anicteric cholestasis n = 21 and icteric cholestasis n = 15). There was no significant change in the parity, maternal age, gestational age, birth weight and in the apgar score among the groups. There was also no significant change in any of the blood flow indexes determined in the uterine artery, umbilical artery and fetal cerebral artery. We conclude that there are no significant changes in blood flow velocity indexes determined by doppler blood flow analysis in patients with cholestasis of pregnancy.

Adult

[Behavior of flow waves of the uterine and external iliac arteries during labor contractions].

To evaluate the changes of blood flow velocities of the uterine and external iliac arteries, we studied a total of 15 normal full term pregnant, which were in the active phase of labor. The mean maternal age was 21.6 +/- 5.2 years (X +/- SD), the mean parity was 0.6 +/- 0.5, and the mean gestational age was 39.2 +/- 1.1 weeks. All patients had normal deliveries, the newborn weight was 3440 +/- 621 g, and the apgar score was 8.6 +/- 1.6 and 9.0 +/- 0.7 at 1 and 5 min, respectively. In the uterine artery, the systolic/diastolic ratio and the resistance index increased significantly from 1.83 +/- 0.25 to 4.24 +/- 1.55 (p < 0.05) and from 0.46 +/- 0.05 to 0.74 +/- 0.08 (p < 0.01), respectively from the relaxation phase to the contraction phase. In all 15 patients the external iliac artery showed a reverse diastolic flow during uterine relaxation, whereas only 2 of the 14 patients showed this reverse flow during uterine contraction (p < 0.01). Furthermore, the flow velocity was modified with maternal hyperventilation. Finally, we conclude that uterine contraction induced profound changes in the blood flow velocities in the uterine and external iliac arteries. We proposed that these changes could be explained by uterine muscular contractions causing the blood flow to be shunted to areas of less resistance.

Adult

The European-American exchange.

The European-American exchange of infectious diseases was responsible for the demographic havoc of the native population in the New World after 1492. Prior to this date medical writers describe the presence in Spain of viral diseases like influenza, parotitis, smallpox, measles, poliomyelitis, and rabies; there were also rickettsiasis, diphtheria, salmonellosis, plague, tubercolosis, leprosy, malaria, scabies and tinea. In America, before European arrivals, there were no records of human viral diseases, though there were records of rickettsiasis, treponematosis--pinta, yaws and syphilis--leihsmaniasis, amibiasis and perhaps leprosy. With the discovery of America in 1492, Columbus's sailors were contaminated by yaws and spread this disease into Europe. In 1493 influenza, as a zoonosis, was introduced into Santo Domingo and was responsible for the annihilation of the natives of the Antilles in less than a quarter of a century; in 1518 smallpox was also introduced in Santo Domingo and then to the American continent by negro slaves: by the same means measles were introduced in 1531. The previous existence or introduction of other infectious diseases in America is also discussed.

Americas

[Neonatal conjunctivitis caused by Chlamydia trachomatis].

32 newborns with neonatal Chlamydia trachomatis conjunctivitis were reported. Diagnosis was carried out through immunofluorescent monoclonal antibody of conjunctiva scraping staining; 37 conjunctiva samples were taken from same number of newborn patients not responds to topical antibiotic treatment. The sample came out from two different third level institutions with maternal facilities and attending more than five thousand deliveries per year each one of them. Were studied incidence and clinical picture from neonatal C. trachomatis conjunctivitis. Positive immunofluorescent and conjunctive culture of secretion to C. trachomatis in the sample were 86 per cent (32 out of 37). 19 of the newborns acquired Staphylococcus associated to C. trachomatis (59%): nine with S. aureus in six Staphylococcus negative coagulase was isolated and four with the latest two. Out of 32 patients who demonstrated positive cultures to C. trachomatis (86%), 22(69%) were males and ten (31%) were females. Significant proportion of newborns were identified as small for gestational age. 18 of them were born by natural way and 14 by cesarean section. In 16/32 (50%) had interstitial pneumonia by Chlamydia. The main clinical findings were stated as: conjunctiva exudate in different stages including purulent secretion and oedema or inflammation of the ophthalmic conjunctiva. Those newborns where topical therapy did not irradiate the organism and demonstrated clinical picture persistence or relapse and diagnosis of C. trachomatis infection, systemic treatment with erythromycin and topic tetracycline were installed, disappearing all symptoms. Maternal history related to neonatal disease were mainly: endocervical infection, miscarriages and or preterm delivery.

Chlamydia Infections

Failure of Hancock pericardial xenografts: is prophylactic bioprosthetic replacement justified?

The incidence of major valve-related complications was evaluated in a series of patients in whom the Hancock pericardial xenograft was used for aortic (AVR; n = 84), mitral (MVR; n = 17) and mitral-aortic (MAVR; n = 13) valve replacement. At 7 years actuarial survival is 66% +/- 8% after AVR, 64% +/- 13% after MVR, and 41% +/- 15% after MAVR, whereas actuarial freedom from valve-related death is 79% +/- 7% after AVR, 78% +/- 13% after MVR, and 81% +/- 12% after MAVR. Actuarial freedom from thromboemboli and anticoagulant-related hemorrhage at 7 years is 93% +/- 4% and 98% +/- 2% after AVR and 83% +/- 10% and 88% +/- 11% after MVR; no such complications occurred after MAVR. Structural valve deterioration determined at reoperation, at autopsy, or by clinical investigation was observed in 34 patients with AVR (10.0 +/- 0.2%/patient-year), in 10 with MVR (10.6 +/- 3.3%/patient-year), and in 9 with MAVR (16.6 +/- 5.5%/patient-year). After AVR, 19 patients underwent reoperation and 2 died before reoperation; 4 patients with MVR underwent reoperation, and 7 patients with MAVR underwent reoperation and 1 died before reoperation. Seventy-eight percent of the current survivors (13 patients with AVR, 7 with MVR, and 1 with MAVR) have clinical evidence of valve failure. At 7 years actuarial freedom from structural deterioration of the Hancock pericardial xenograft is 25% +/- 7% after AVR, 29% +/- 14% after MVR, and 0% after MAVR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Extended follow-up of the standard Hancock porcine bioprosthesis.

We have reviewed 665 patients in whom the standard Hancock porcine bioprosthesis (HPB) was used for aortic (AVR = 173), mitral (MVR = 437), and mitral and aortic (MAVR = 55) valve replacement in the time interval from 1970 to 1983. After AVR, HPB-related deaths occurred in 24 patients (1.7% +/- 0.4% per patient-year); 11 had thromboembolic episodes (0.8% +/- 0.2% per patient-year), 6 hemorrhages related to anticoagulants (0.4% +/- 0.2% per patient-year), 9 endocarditis (0.7% +/- 0.2% per patient-year), 7 prosthetic leak (0.5% +/- 0.1% per patient-year), and 59 structural deterioration (4.3% +/- 0.6% per patient-year). At 16 years, actuarial survival is 40% +/- 6%, freedom from thromboembolic episodes 89% +/- 4%, from hemorrhages 90% +/- 5%, from endocarditis 94% +/- 2%, from prosthetic leak 95% +/- 2%, and from structural deterioration 36% +/- 6%. After MVR, HPB-related deaths occurred in 64 patients (1.6% +/- 0.2% per patient-year); 68 had thromboembolic episodes (1.7% +/- 0.2% per patient-year), 28 hemorrhages (0.7% +/- 0.1% per patient-year), 12 endocarditis (0.3% +/- 0.1% per patient-year), 9 prosthetic leak (0.2% +/- 0.1% per patient-year), and 158 structural deterioration (4.0% +/- 0.3% per patient-year). At 18 years, actuarial survival is 33% +/- 4%, freedom from thromboembolic episodes 57% +/- 13%, from hemorrhages 81% +/- 6%, from endocarditis 91% +/- 4%, from prosthetic leak 98% +/- 1%, and from structural deterioration 18% +/- 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis

The risk of reoperation in patients with bioprosthetic valves.

The risk of operative mortality in patients undergoing a first reoperation for bioprosthetic failure was assessed in a series of patients reoperated upon during the last two decades (1970-1990). A total of 330 such patients underwent replacement of 351 bioprostheses: 88 had aortic; 221 mitral; and 21 mitral and aortic bioprosthetic replacement. Indication for reoperation was in most cases structural valve deterioration (87%), followed by periprosthetic leak (7%) and endocarditis (6%). The operative mortality was significantly higher in patients who preoperatively were in New York Heart Association Functional Class IV or had a lower left ventricular function, in those reoperated because of prosthetic infection, and in those reoperated on an emergency basis. Structural valve deterioration was associated to a substantially low risk; operative mortality has improved in recent years, regardless of the indication for reoperation, partly due to the increasing experience and improved surgical techniques. Our results indicate that in recipients of bioprosthetic valves, careful follow-up with closer surveillance of valve and cardiac function and earlier prosthetic replacement might contribute to reducing the risk of reoperation.

Adolescent

Humoral immunity in different phases of contact dermatitis.

Although cell-mediated hypersensitivity seems to be the main immunological response of man in contact dermatitis, recent studies suggest the potential involvement of antibody-mediated and basophilic cutaneous hypersensitivity in the physiopathology of this affection. The aim of this work was to contribute data intended to clarify the possible involvement of factors traditionally assigned to humoral hypersensitivity in the pathology of contact dermatitis. For this purpose blood levels of the different immunoglobulins were determined in patients with contact dermatitis. Three phases were considered, namely, one in which the patients showed typical clinical signs (acute phase), another in which the lesions had subsided (intercrisis phase) and a third in which the signs had recurred (acute outbreak). All those patients who concomitantly suffered from or had any personal or family antecedents of type I hypersensitivity were excluded from the study. The results found were compared with those obtained for a control gorup consisting of healthy individuals with no atopic antecedents. No significant differences were found between the results obtained in the three phases. However, the IgE levels of the patients were significantly higher than those of the control group, whereas the differences in the IgE, IgA and IgM levels were insignificant.

Acute Disease

Influence of prosthetic design on durability of the Liotta porcine valve in the mitral position.

From March 1979 to December 1984, the Liotta low-profile porcine bioprosthesis was employed for mitral valve replacement in 71 patients to avoid potential left ventricle-prosthesis mismatch occasionally observed with the standard, high-profile, Hancock porcine xenograft. Follow-up of 61 operative survivors showed at 10 years an actuarial survival of 67% +/- 7%, freedom from thromboemboli of 96% +/- 2%, freedom from structural deterioration of 63% +/- 11% and freedom from all Liotta bioprosthesis-related complications of 53% +/- 10%. Complications related to excessive protrusion of the stent into the left ventricular cavity were eliminated with the Liotta bioprosthesis; the peculiar stent configuration, however, was responsible for an increased rate of structural deterioration requiring reoperation in 10 patients (2.8% +/- 0.9%/patient-year) at a mean interval of 76 +/- 18 months after mitral valve replacement (range, 45 to 106 months). Common findings in all explants were cusp prolapse, cusp tears, and commissural rupture related to various degrees of tissue calcification, constantly leading to severe prosthetic incompetence. As also shown experimentally, such structural changes have been attributed to increased systolic stresses on the closed cusps, favored by excessive reduction of the stent height. Our experience shows that the Liotta bioprosthesis used for mitral valve replacement does not provide any clear-cut advantage over standard porcine bioprostheses and that its long-term durability appears affected by the unique prosthetic design.

Adult