[Lambda light chain deposition disease without renal involvement].
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Aged↗
Biomedical subjects
F Pérez
Publications and source records attributed to F Pérez.
Fine-needle aspiration cytology of columnar-cell carcinoma of the thyroid: report of two cases with cytohistologic correlation.
The columnar-cell variant of papillary carcinoma is a rare tumor of the thyroid, associated with aggressive behavior, early visceral metastasis, and a rapidly fatal course. In this report we present the fine-needle aspiration cytologic findings of two examples of this variant of papillary carcinoma with cytohistologic correlation. In the smears, clusters, monolayered sheets, and scattered papillary fronds of tumor cells were present. The tumor cells were columnar and exhibited overlapping and stratification of the nuclei. In the first case the tumoral cells showed round nuclei with finely granular chromatin pattern, small nucleoli and vacuolated-appearing cytoplasm. The malignant cells in the second case presented oval to elongated nuclei with stippled chromatin, inconspicuous nucleoli and indistinct cytoplasmic borders. It is important to distinguish this tumor from the common thyroid papillary carcinoma because of its much more aggressive behavior.
Adult↗
HMG-CoA reductase inhibition by atorvastatin reduces neointimal inflammation in a rabbit model of atherosclerosis.
OBJECTIVES: To study the effect of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA)-reductase inhibitor atorvastatin on the potential mechanisms involved in the recruitment of monocytic cells into the vessel wall. BACKGROUND: Inhibitors of HMG-CoA-reductase reduce cardiovascular mortality though the mechanisms yet elucidated. Most ischemic events are secondary to disruption of atherosclerotic plaques highly infiltrated by macrophages. METHODS: Atherosclerosis was induced in the femoral arteries of rabbits by endothelial damage and atherogenic diet for 4 weeks. Then, animals were switched to standard chow and randomized to receive either no treatment or atorvastatin (5 mg/kg/d) and killed after 4 weeks. RESULTS: Atorvastatin induced a significant reduction in serum lipids and in lesion size. Arterial macrophage infiltration was abolished by the treatment, and monocyte chemoattractant protein-1 (MCP-1) was significantly diminished in the neointima and in the media. Nuclear factor kappa-B (NF-kappaB) was activated in the 60% of the lesions, both in macrophages and vascular smooth muscle cells (VSMC), of the untreated group while only in 30% of the atorvastatin group. NF-kappaB activity was also lower in the uninjured aorta and liver of treated compared with untreated rabbits. In cultured VSMC, MCP-1 expression and NF-kappaB activity induced by tumor necrosis factor alpha were downregulated by atorvastatin. CONCLUSIONS: In a rabbit atherosclerosis model, atorvastatin diminishes the neointimal inflammation, and this could contribute to the stabilization of the atherosclerotic plaque. This may be an additional explanation for the reduction of acute ischemic events in patients treated with statins.
Animals↗
[Laparoscopic feeding gastrostomy: an alternative to the nasogastric tube].
Dysphagia is common in head and neck cancer and feeding becomes difficult. Nasogastric tubes cannot by placed in some patients and are poorly tolerated in others. However, endoscopic laparotomy techniques have advanced to a point in which they allow feeding gastrostomies to be used, which are non-aggressive, well-tolerated and a satisfactory alternative for patients with contraindications for upper endoscopy.
Deglutition Disorders↗
[Prenatal diagnosis. II. Importance of ultrasonographic markers in prenatal diagnosis of chromosome abnormalities].
The Medical Genetic Unit of the University of Zulia (MGUUZ) has developed a Prenatal Diagnosis Program (PDP) since January-1993, in which Genetic Risk Factors are determined in couples who request prenatal genetic counseling. In this program, different prenatal diagnostic procedures are performed to detect congenital defects during intrauterine life. One of these procedures is the Fetal Sonogram (FS). FS is a non invasive technique which permits the prenatal diagnosis of many genetic dysmorphic syndromes. Through the search of abnormal specific characteristics in the fetus, chromosomopathies may be suspected. These findings are named "Echosonographic Markers of Chromosomal Abnormalities" (EMCA). During three years (January-1993 to December-1996), patients attended in the PDP included 321 pregnant women in which 312 FS were performed. Abnormal outcomes were 22 (17 with isolated congenital malformations and 5 with EMCA). Only one fetus with chromosome abnormality (46,XX21q-) could not be detected by FS. The goals of this paper are: 1) to report 5 patients with sonographic markers suggestive of chromosomal abnormalities and 2) to show the FS usefulness in prenatal diagnosis of chromosompathies. We conclude that, in the search of the EMCA the FS should be offered systematically to all pregnant women without recognizable genetic risk. They are the main group with optimal reproductive age and in consequence, with the possibility of having a relatively major number of conception outcomes with congenital defects, with or without chromosomic etiology. The majority of those defects can be detected by FS and could allow us to select the patients in which the use of an invasive prenatal diagnostic procedure could be justified.
Adolescent↗
[Bacteremia in patients undergoing chronic hemodialysis in a 16-year period].
OBJECTIVE: To determine the incidence of bacteremia among patients on hemodialysis, the responsible microorganisms and to describe the predisposing and prognostic factors. METHODS: A retrospective analysis was conducted of 85 episodes of bacteremia occurred from 1979-1994; the episodes involved 71 patients (male/female ratio: 27/44) with a mean age of 58 years (29-80). RESULTS: Eighty-seven microorganisms were recovered, which included 61 grampositive cocci (67% Staphylococcus aureus), 25 gramnegative bacilli (52% Escherichia coli) and 1 anaerobe. The mean incidence was 3.1/100 patients on hemodialysis/year (range: 1.1-8.3), higher in patients with interstitial and cystic renal disease. In 52% of cases an intravascular source was detected, associated with vein access for hemodialysis (in 91% there were inflammatory signs at the fistula). In 16 cases (19%) no portal of entry was detected and in the remaining patients the portal of entry had an extravascular origin. Eighty patients received antibiotic therapy and 35 patients required the substitution of the vein access. Thirteen patients died (15%) as a result of bacteremia. The mortality rate was higher among patients developing shock (50%), endocarditis (75%) and in those who had remained for longer than 1,000 days on hemodialysis (45%). Bacteremia accounted for the third known cause of death on dialysis, and was responsible for 11% of deaths occurred during the time of the study. CONCLUSIONS: Bacteremia among hemodialysed patients was mainly associated with Staphylococcus aureus infections at the vascular access. Bacteremia was the direct responsible for 11% of deaths occurred on dialysis.
Adult↗
Maintenance of the threshold/maximum heart rate quotient in swimmers.
The anaerobic threshold (AT) was calculated in 23 swimmers by field methods: MADER (MM) and modified exponential MADER (EM) and laboratory methods: SKINNER (SM), ROBERGS (RM), CONCONI (CM), and ventilatory (VM). Two types of test were designed. The first in a swimming pool (test 1), performing four series of increasing intensity swims, and the second on a cycle ergometer increasing until exhaustion (test 2). In both tests the heart rate (HR) was recorded in beats per minute by telemetry. Despite the different HR at the AT: 180.0 +/- 2.7 (MM), 179.1 +/- 2.4 (EM), 166.0 +/- 2.9 (SM), 157.0 +/- 2.8 (RM), 167.6 +/- 2.7 (VM) and 168.8 +/- 2.2 (CM), and the different maximum HR (HRmax) in the two tests: 201.6 +/- 2.0 in Test 1 and 188.5 +/- 1.6 in Test 2; the percentage HR in the AT/HRmax proved to be similar for all the methods except RM (88.0%-89.2%). The mechanism of organic control in progressive exercise can therefore have, in this test, a "threshold" zone at a given percentage of the maximum capacity of adaptation, both when the exercise is carried out in a pool and also on a cycle ergometer.
Adaptation, Physiological↗
[Lipoprotein lipase gene polymorphism in non-insulin-dependent diabetics: preliminary study].
BACKGROUND: Lipoprotein lipase plays a crucial role in plasma lipoprotein metabolism. Several lipoprotein lipase gene polymorphisms have been found associated with lipid levels, premature atherosclerosis and cardiovascular disease. AIM: To investigate, in the Chilean population, the genotype distribution of lipoprotein lipase polymorphisms and its possible association with lipid levels and obesity. PATIENTS AND METHODS: Hind III and Pvu II polymorphism was determined in 45 non-insulin-dependent diabetic patients and in 52 non diabetic controls from Santiago, Chile. RESULTS: Hind III (+/+) polymorphism had a higher frequency in diabetics as compared to controls (0.6 and 0.29 respectively, p = 0.009). The frequency of heterozygous distribution was higher in non diabetic subjects. Controls and diabetics had comparable gene frequencies for the Pvu II genotype distribution. Analyzing the impact of these polymorphisms on plasma lipid levels, Hind III (+/+) genotype was associated with high levels of total cholesterol and triglycerides in both groups. The heterozygote (+/-) or homozygote (-/-) state for Hind III was effectively associated with high levels of HDL cholesterol levels, as compared to the (+/+) genotype. There was no relationship between these genotypes and body mass index and waist to hip ratio. CONCLUSIONS: An association between genetic variation at the lipoprotein lipase locus with high levels of triglycerides and total cholesterol was confirmed. However, no association of these genetic markers with anthropometric measurements was found.
Chile↗
Imipenem therapy of brain abscesses.
The efficacy of imipenem versus standard chemotherapy (both in addition to neurosurgery) in the treatment of brain abscess was compared in a retrospective study. Cure was obtained in 52 of 60 (86.7%) patients in the standard group, and in 15 of 15 (including 5 patients with multiple brain abscesses) in the imipenem group. Cure without neurosurgery was observed in 2 of 60 (3.3%) and 3 of 15 (20%) of the cases, respectively (p = 0.08). Levels of imipenem in blood, cerebrospinal fluid, and brain pus were above the minimum inhibitory concentrations of most of the abscess isolates. Side effects of imipenem were rare and tolerance was excellent. Imipenem monotherapy (3-4 g/day) for five weeks seems a reasonable therapeutic choice for treatment of bacterial brain abscesses.
Adolescent↗
Therapy of brain abscess with imipenem--a safe therapeutic choice?
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Adult↗
[Atrial rupture secondary to infarction. Echocardiographic diagnosis].
A 70 year old male was admitted to the hospital 3 days after suffering one episode of ischemic chest pain. On admission he complained of non-productive cough, pleuritic pain, cardiomegaly I/IV and sinus tachycardia. Later on, he developed frequent auricular prematurities and flutter. The cardiac enzymes were elevated confirming the diagnosis of myocardial necrosis. One echocardiogram showed an important pericardial effusion. Color Doppler, high flow velocity from the lateral wall of the left atrium towards the apex, above the mitral valve. The transesophageal echocardiogram clearly showed the presence of a pathological communication at this level. One month later, a nodular image compatible with an organized thrombus was observed at the same level, sealing the rupture site.
Aged↗
[Incidence of insulin-dependent diabetes mellitus in Santiago, Chile (1990-1993)].
The aim of this study was to determine IDDM incidence in the Metropolitan Region of Chile, during the period 1990-1993 as part of the Multinational Project for Childhood Diabetes (WHO DIAMOND Project Group). The studied population was 1499.784 inhabitants. All children in whom the diagnosis was made between January 1, 1990 and December 31, 1993 were included. We used a retrospective and prospective search and confirmation method, using as data sources public and private hospitals and medical records of Pediatricians. The Juvenile Diabetes Foundation was used as a secondary data source. All cases had at least two confirmation sources. A total of 176 new cases (90 male) were diagnosed in the study period, with an annual incidence of 2.92/100,000 for females and 2.95 for males. The group of children from 10 to 14 years old had the highest incidence rate (4.9/100,000), specially in women (5.25/100,000). The yearly incidence was 1.31 in 1990, 2.71 in 1991, 2.93 in 1992 and 3.7/1000,000 in 1993. It is concluded that the Metropolitan Region has one of the lowest incidences of IDDM in Latin America, although it increased along the study years.
Adolescent↗
[Insulin-dependent diabetes mellitus in Santiago, Chile: the role of immunogenetic and environmental factors].
The role of HLA class II alleles in the genetic susceptibility to develop insulin-dependent diabetes mellitus (IDDM) was examined by means of PCR and oligospecific probes in 63 IDDM children and 74 controls subjects. In diabetic patients we found a significant increase in the alleles frequency DR3, DR4, DQB1*0302 and DQA1*0301 compared to the control group, where the most prevalent alleles were DR2, DR14 (DRB1*1402), DQA1*0101 and DQA1*0201. All the risk genotypes in the diabetic group were similar than in other caucasian groups: DR3/DR4-DQB1*0201/0302-DQA1*0301/0501 and DR4/DR4-DQB1*0302/0302-DQA1*0301/0301. The homozygote character no asp57 conferred an absolute risk (AR) of 3.87 and the marker Arg52 an AR of 5.78/100.000 bab year. The homozygosis for both markers (no Asp57 + Arg52) had an AR of 7.56/100.000 bab year. Regarding environmental factors associated with IDDM, our population under study showed a low prevalence of infectious agents (mainly mumps and rubella, specifically associated with IDDM) and a high prevalence of effective breast-feeding (over 3 months). These factors could be exercising a protector role in the development of IDDM. The factors that appear to be important in the low incidence of IDDM in Santiago de Chile are: the low prevalence of infectious agents related to IDDM, the high percentage of breast-feeding children in the population, the reduced frequency of susceptible molecules as DR3, DQB1*0201 (compared to other caucasian groups) and the presence of protective genotypes related to DR13 and DR14 observed in the non diabetic children.
Adolescent↗
[Genetic predisposition to develop insulin-dependent diabetes mellitus. A population study in Santiago and Temuco, Chile].
Insulin-dependent diabetes mellitus (IDDM) is strongly associated with particular HLA-DQ alpha/beta markers in white population. The heterodimers conformation composed of a DQ alpha chain with an arginine at residue 52 (Arg52) combined to a DQ beta chain lacking an aspartic acid at residue 57 (non Asp57) increase markedly the risk to develop IDDM. To confirm this association, 63 IDDM patients from Santiago de Chile registry, 20 IDDM patients from Temuco registry and 74 unrelated healthy non diabetic control subjects were studied. With polymerase chain reaction (PCR) and sequence specific oligonucleotide probes the individuals were typed for their HLA-DQA1 and DQB1 alleles, their DQA1/DQB1 genotype and heterodimers conformation were compared. In diabetic population both markers Arg52 homocygote and non Asp57 homocygote were markedly increased regard to control subjects (R/R: 0.76 and 0.85 vs 0.33; ND/ND: 0.78 and 0.75 vs 0.50, p < 0.05). A high relative risk (RR) was determined for both homocygote markers in IDDM groups. Arg52 DQ alpha (R)/non Asp57 DQ beta (ND) heterodimers were strongly associated with susceptibility to IDDM. A high RR was observed in patients with four susceptibility DQ heterodimers (RR1: 13.7 in IDDM-Santiago and RR2: 18.6 in IDDM-Temuco, p < 0.00003). The HLA-DQ alpha/beta markers and their risk heterodimers are increased in our diabetic population and could be considered as susceptibility markers to develop IDDM.
Adolescent↗
Magnetic phase diagram of Y2CuO4: Weak ferromagnetism and metamagnetic transition.
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Journal Article↗
Survey of bacteraemia in a Spanish hospital over a decade (1981-1990).
The aetiology, epidemiology and in-vitro antibiotic susceptibility of bacteraemic isolates in a Spanish hospital, over a decade (1981-1990), were reviewed. A total of 4363 possible episodes were microbiologically confirmed (incidence: 15.7 cases per 1000 admissions). A slight increase in the number of Gram-positive cocci and anaerobes over the last 4 years was found. The most frequent species (annual range) were: Escherichia coli (13.5%-18.9%), Staphylococcus aureus (10.5%-17.8%), Klebsiella spp. (3.0%-9.4%), Enterococcus faecalis (3.0%-8.2%), Pseudomonas aeruginosa (2.5%-5.8%) and Streptococcus pneumoniae (1.8%-5.6%). Males were more affected than females (ratio 1.7:1). The portal of entry was known in 2126 episodes, of which the most frequent were urinary and gasto-intestinal tracts (24.4% and 19.4% respectively). Bacteraemia was associated with rapidly and ultimately fatal underlying diseases in 7.2% and 15.1% of the cases respectively. The hospital location of patients was: medical ward 46.0%, surgical ward 22.7%, paediatric ward 16.9%, and intensive care unit 14.4%.
Adolescent↗
[Lipoprotein (a) and other risk factors in Chilean children with type I diabetes mellitus].
AIMS: To study serum Lp(a) levels and other metabolic cardiovascular risk factors in children with type I diabetes mellitus (DM) in comparison with sex and age matched nondiabetic children. To determine the influence of diabetes control on serum lipoprotein (a) concentrations. DESIGN: Transversal observational study. TARGET POPULATION: diabetic group: 70 type I DM children without microalbuminuria and no macro-microvascular nor neurological complications, aged from 8 to 15 years; 30 boys, 40 girls. Mean duration of type I DM was 8 +/- 4 years. Non diabetic group: composed by 123 healthy children with no family history of DM, aged from 8 to 15 years, 53 boys, 70 girls. METHODS: The lipids profile include: total cholesterol (TC) and triglyceride (TG), cholesterol high-density lipoproteins (C-HDL) cholesterol very-low-density lipoproteins (C-LDL) and cholesterol low-density lipoproteins (C-LDL). ApoAI, APOAII and ApoB, Lp(a) and fructosamine. RESULTS: Fructosamine concentration in diabetic children was 340 +/- 108 uM/1 in 240 +/- 25 uM/l nondiabetic children. Lp(a) serum levels did not significantly differ among both groups 17 +/- 16 mg/dl in diabetics 19 +/- 18 mg/dl in controls. Multivariate analysis showed that in the diabetic children the worsening of metabolic control as reflected by fructosamine, was positively correlated with the increase in total Lp(a) serum concentration. CONCLUSIONS: In children aged 8-15 years with uncomplicated IDDM lasting less than 15 years duration, Lp(a) serum levels are positively correlated with the poorest metabolic control.
Adolescent↗
[Lipoprotein (a), atherosclerosis, and diabetes mellitus].
Diabetes mellitus is associated with a three to fourfold increased risk for coronary artery disease and diabetic patients frequently have an abnormal plasma lipid profile. Lately, lipoprotein (a) has received attention as an important independent risk factor for cardiovascular disease. This lipoprotein is elevated in patients with type II diabetes mellitus and there may be an association between the metabolic control of these subjects and its levels. In this review the main features of lipoprotein (a) and its relationship to the fibrinolytic system and atherosclerosis are reviewed.
Arteriosclerosis↗