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Biomedical subjects

F Rodríguez de Castro

Publications and source records attributed to F Rodríguez de Castro.

At least 55 records · Page 3Linked to original sources
PubMed1994

Specific skin tests in subjects with chronic bronchitis exposed to pigeons.

We have studied the diagnostic reliability of the specific skin tests done in 30 subjects who presented with chronic bronchitis (CB) as the only clinical manifestation related to exposure to pigeons and in 21 subjects with CB and known risk factors. Additionally, two control groups were included (24 asymptomatic subjects exposed and sensitized to pigeons and 10 subjects not exposed and not sensitized to pigeons). The skin prick tests with pigeon serum were negative in all the subjects tested. The intradermal skin tests showed an immediate positive reaction in 16 of the 30 CB-affected patients and in six of the control group of exposed asymptomatic subjects (chi square: 3.376) (P < 0.1; nearly significant); after 6 h, a positive reaction was recorded in 14 of the CB-affected patients and in three subjects of the control group (chi square: 5.187) (P < 0.005). A delayed reaction was seen in 10/30 CB patients and in only three of the 24 subjects of the control group (chi square: 2.218) (nonsignificant). In the group of the 21 CB patients with known risk factors and not sensitized to pigeons, only two patients showed immediate skin reactivity; the remaining readings were negative. Lastly, in the control group of 10 unexposed, nonsensitized subjects, the intradermal skin tests in the different readings were negative. Our results show that although the skin tests with pigeon serum have low sensitivity, they can be a useful supplement in distinguishing cases of CB attributable to chronic pigeon exposure from those cases attributable to another cause, especially in the consideration of immediate and late readings.

Adolescent↗
PubMed1994

Value of DNA analysis in addition to cytological testing in the diagnosis of malignant pleural effusions.

BACKGROUND: Aneuploidy appears to be a highly specific marker for cancer, and measurement of cellular DNA content by flow cytometry is rapid and reliable. This study was undertaken to determine if the addition of DNA analysis improved the sensitivity of cytological diagnosis of malignancy in pleural fluid. METHODS: Pleural effusions from 92 patients were studied by cytological examination and flow cytometry. RESULTS: In 41 patients the final diagnosis was malignancy, there were 40 cases of benign effusions including 22 with pleural tuberculosis, and in the remaining 11 patients with biopsy proven cancer the presence of malignant cells was not found by cytological and histological means in the pleural fluid. Aneuploidy and cytological malignancy were found in 14 samples. There were seven cases with abnormal flow cytometry and negative cytological results. In 12 patients the cytological test results were positive but DNA analysis was normal. Thirty six samples of fluid were both diploid and cytologically negative. Of the 22 tuberculous effusions seven contained aneuploid cells. The sensitivity of DNA and cytological analysis was 51.2% and 63.4%, respectively. The specificity of DNA analysis was 74.5%. CONCLUSIONS: DNA analysis of cells in malignant pleural effusions is both less sensitive and specific than the cytological diagnosis. Flow cytometric analysis is not recommended for routine use in the diagnosis of pleural effusions.

Adolescent↗
PubMed1994

Value of ELISA using A60 antigen in the serodiagnosis of tuberculosis.

This study was set in a general, university hospital in the Canary Islands, with the objective to evaluate an enzyme-linked immunosorbent assay (ELISA) using A60 in the serodiagnosis of tuberculosis. IgG antibody to A60 was determined in 205 patients with active disease [149 culture-positive patients with pulmonary tuberculosis (positive sputum smear 94, negative sputum smear 55) and 56 patients with extrapulmonary tuberculosis], 20 patients with inactive disease, 22 patients with lepromatous leprosy, and 51 controls. The mean levels of anti-A60 antibodies were significantly higher in patients with active disease as compared with controls or patients with inactive disease. Differences were also found between tuberculous patients with pulmonary and extrapulmonary disease. In patients with pulmonary disease, significant differences were detected between smear-positive and smear-negative patients. The overall sensitivity of the test (cutoff 240 ELISA units) was 52.2%. The highest sensitivity was found among smear-positive patients with pulmonary tuberculosis (67%) and the lowest among those with extrapulmonary tuberculosis (32.1%). We conclude that ELISA for the measurement of IgG antibody to Mycobacterium tuberculosis antigen A60 could be of interest, specially in smear-negative cases and extrapulmonary tuberculosis.

Adult↗
PubMed1994

Usefulness of microscopic examination of intracellular organisms in lavage fluid in ventilator-associated pneumonia.

STUDY OBJECTIVE: To assess the usefulness of quantification of bronchoalveolar lavage (BAL) cells containing intracellular organisms (ICO) in the diagnosis of ventilator-associated pneumonia. DESIGN: The reliability of cytologic analysis in comparison with the protected specimen brush (PSB) and BAL quantitative cultures has been assessed in a prospective study. SETTING: An intensive care unit of a tertiary-referral teaching hospital. PATIENTS: A total of 33 ventilated patients with suspected pneumonia based on clinical grounds and radiographic findings. INTERVENTIONS: All patients underwent fiberoptic bronchoscopy within the first 24 h after clinical suspicion of pneumonia. Specimens were obtained by PSB and BAL and were processed for quantitative cultures using standard methods. Two 0.5-ml samples of resuspended original BAL fluid were centrifuged and stained with Gram and modified May-Grünwald-Giemsa for differential cell counts and percentage of cells with ICO. RESULTS: Pneumonia was the final diagnosis in 16 (49 percent) of the 33 patients. In 14 (42 percent) patients, pneumonia was excluded and in the remaining 3 the diagnosis was uncertain. Twelve of the 16 patients with pneumonia had their conditions diagnosed by PSB, 14 by BAL, and 10 by quantification of ICO. Only one patient's condition was diagnosed exclusively by cytologic examination. There were no false-positive results with any of the diagnostic techniques. CONCLUSIONS: Microscopic identification of ICO in cells recovered by BAL allows early and accurate diagnosis of pneumonia in mechanically ventilated patients. However, the sensitivity of this technique is lower than with either PSB or BAL.

Adolescent↗
PubMed1994

Anaphylaxis due to limpet ingestion.

BACKGROUND: The limpet, phylum Mollusca, is one of the most frequent sea mollusks in the Canary Islands. Limpet IgE hypersensitivity reactions have been described. OBJECTIVE: To describe six patients with anaphylactic reactions due to limpet ingestion and to demonstrate by in vivo methods and by in vitro techniques specific IgE responses. METHODS: Six subjects who developed severe bronchospasm 30 to 120 minutes after eating limpets were included in the present study. The antigenic material for the in vivo and in vitro studies was an extract of cooked limpet prepared in our laboratory. Skin prick tests were performed in all patients using commercially available aeroallergens, mollusk, and crustacean extracts; the same skin tests were performed using the extracts prepared in our laboratory. Specific IgE by CAP and RAST and CAP inhibition studies were also performed. Limpet contamination by mites was excluded through a commercial ELISA using monoclonal antibodies. RESULTS: All patients had positive skin prick tests to D. pteronyssinus and cooked limpet extract and weak reactivity to cockroach and raw limpet extract. Specific IgE to mites and cooked limpet extract was also found using CAP and RAST techniques, respectively. The possible existence of common epitopes between limpet and D. pteronyssinus was excluded by CAP inhibition studies. Finally, no significant mite concentration was detected in the cooked limpet extract analyzed by a commercially available ELISA. CONCLUSIONS: Limpet is a potentially dangerous allergen specially in patients sensitized to D. pteronyssinus.

Adolescent↗
PubMed1994

[The usefulness of elastin fibers as a diagnostic marker in ventilator-related pneumonia].

The diagnosis of nosocomial pneumonia is especially difficult in intubated patients due to the low specificity of their clinico-radiological signs. The objective of this study was to evaluate the usefulness of basing diagnosis on elastin fibers (EF) in bronchoaspirate (BAS) as an indication of pneumonia in mechanically-ventilated (MV) patients. Forty-seven MV patients suspected of having nosocomial pneumonia were studied prospectively. Fiber bronchoscopy was carried out on all patients and samples were obtained using a protected catheter brush (PCB) and bronchoalveolar lavage (BAL). A purulent sample of BAS was also examined, after addition of 40% KOH, to determine the presence of EF. EF was found in 15 patients, 11 of whom had pneumonia while 3 more had necrotizing pneumonia (sensitivity 52%, specificity 85%). Ten of the 17 microorganisms isolated in the cases of EF positive pneumonia were gram negative, although the germ found most often was S. aureus. There were no differences in the prognosis for pneumonia patients who were EF positive and those who were EF negative. In conclusion, once necrotizing pneumopathology has been ruled out, the presence of EF in BAS may offer reasonable support for firm diagnosis in some MV patients with pneumonia.

Adolescent↗
PubMed1994

[Asymptomatic polymyositis with pulmonary disease].

We present the case of a medium-aged patient with a alveolo-interstitial pulmonary affection after 5 months of evolution, characterized by cough and progressive dyspnea accompanied by sustained febricula, slight constitutional syndrome and dermatological and articular manifestations. It was finally concluded that the patient had a polymyositis, relating form of affection a secondary interstitial pneumopathy. The aim of this study has been to highlight a rare case of diffuse interstitial disease in the context of a polymyositis in which we obtained an excellent therapeutical response, as well as to make some considerations regarding its etiology and its clinical and pathological expression.

Female↗
PubMed1993

Comparative efficacy of bronchoalveolar lavage and telescoping plugged catheter in the diagnosis of pneumonia in mechanically ventilated patients.

The relative efficacy of telescoping plugged catheter (TPC) and bronchoalveolar lavage (BAL) in the diagnosis of pneumonia in mechanically ventilated patients has been compared in 45 subjects suspected of having pneumonia because of the presence of clinical and radiographic criteria. Diagnosis of pneumonia was strongly suggested in 25 of the 45 patients, and definitely confirmed in 10 of them. The diagnostic threshold to assess a quantitative bacterial culture as positive was a growth on BAL of > or = 10(5) cfu/ml and on TPC of > or = 10(3) cfu/ml. The BAL specimen cultures established the diagnosis in 19 cases (76 percent). In the remaining six patients, this technique did not permit the assessment of the diagnosis, which was established by other procedures (TPC, blood cultures, clinical outcome, or autopsy). False-positive results were not found. Sensitivity and specificity for BAL cultures were 76 percent and 100 percent, respectively. Telescoping plugged catheter established the presence of pneumonia in 16 patients (64 percent). Combining both techniques, the sensitivity increased up to 88 percent, maintaining specificity of 100 percent. In summary, BAL has a greater sensitivity than TPC in the diagnosis of pneumonias in mechanically ventilated patients. However, they are procedures that can complement each other.

Adolescent↗
PubMed1993

Relationships between characteristics of exposure to pigeon antigens. Clinical manifestations and humoral immune response.

An extensive clinical study has been performed on pigeon breeders in the Canary Islands. Three hundred forty-three subjects have participated in this study through the filling of a clinical and epidemiologic questionnaire. A venous blood sample was also taken from each fancier for a further serologic analysis. Detection of specific IgG antibodies was made by an indirect enzyme-linked immunosorbent assay (ELISA) using pigeon serum as antigenic material. Twenty-nine (8 percent) breeders fulfilled the "classic" pigeon breeders' disease (PBD) criteria. One hundred six (31 percent) had rhinitis, 62 (19 percent) had immediate bronchial symptoms, and 51 (15 percent) suffered from chronic bronchitis. A significant level of specific IgG was detected in 139 (40 percent) cases. Rates were correlated with pneumonitis symptomatology (p < 0.001) and with chronic bronchitis (p < 0.05). There was a significant association between the number of pigeons and the level of sensitization (p < 0.001). Finally, a statistical relationship between the intensity of exposure and specific IgG response was also found (p < 0.001). Titers of specific IgE could not be related either to the reported symptomatology in the questionnaire or to any of the exposure parameters analyzed.

Adolescent↗
PubMed1991

[Epidemiology of tuberculosis in the Gran Canary Island].

BACKGROUND: The aim of the present study was to obtain information about tuberculosis (TB) in our area that might contribute to assess the status in Spain. METHODS: A meticulous case finding was carried out during 1988 in all the hospitals of the Gran Canaria island. RESULTS: 214 cases were found (rate 32.2) and 77% were admitted to hospitals. In 160 (74%) the involvement was pulmonary and in 82 (37%) it was extrapulmonary. Mean age was 34 years (range 1-84) and 62% were younger than 40 years. 69% were males. Complete data were obtained in 183 cases (85%). 56% were smokers, 34% alcoholic abusers, 15% drug abusers (35% parenteral) and 4% homosexuals. 26% had some risk factor for TB; 14 of them had been infected by the HIV (8 had AIDS). In 64% there was a diagnostic delay longer than one month. Out of the 214 cases, the diagnosis was made by direct microscopy and/or culture in 110 (51%), by consistent pathological findings in 41 (19%), with some of these studies but with negative results in 35 (16%) and only with clinical and radiological criteria in 28 (13%). 96 (60%) of the pulmonary cases had cavitation. The most common therapeutic schedule (84%) was the recommended 9-month regimen. In 54% no recommendation for the investigation of contacts was made. CONCLUSIONS: In the authors' area, the prevalence of TB is higher than in developed countries. It is more common in middle aged individuals, many diagnoses are still made without bacteriologic studies and in a high number of cases investigation of contacts is not carried out.

Adolescent↗
PubMed1991

Reliability of the bronchoscopic protected catheter brush in the diagnosis of pneumonia in mechanically ventilated patients.

OBJECTIVE: To assess the usefulness of the telescoping plugged catheter in the diagnosis of nosocomial pneumonia. DESIGN: Prospective study. PATIENTS: A total of 103 ventilated patients with suspected pneumonia were prospectively studied over 20 months. RESULTS: The quantitative cultures of the protected brush specimen detected pulmonary bacterial infection (greater than 10(3) cfu/mL) in 49 (47.5%) patients. Subsequent follow-up confirmed pneumonia in 41 patients; in only one patient was a positive protected brush specimen culture established as a false-positive result. There were 54 patients with less than 10(3) cfu/mL and the diagnosis was excluded in 36 of them. We identified eight patients with false-negative protected brush specimen cultures. The results obtained by this technique allowed us to modify treatment in 49 (47.5%) patients. CONCLUSIONS: The telescoping plugged catheter demonstrated significant bacterial infection in a relatively small proportion of patients in whom bacterial lung infection was suspected. This technique can be safely performed and is a sensitive and specific method to establish the cause of pneumonia, thus allowing specific treatment and the avoidance of inappropriate antibiotic therapy.

Adolescent↗
PubMed1991

[The usefulness of the double-light telescopic catheter in the diagnosis of bacterial pneumonia in patients under mechanical ventilation].

Fifty-eight patients who presented clinical criteria of pneumonia (fever, leukocytosis, purulent tracheo-bronchial secretions, and lung infiltrate of recent appearance in X-ray) were prospectively studied in order to determine the cost effectiveness [correction of rentability] of quantitative culture of bronchial secretions by means of a telescopic catheter (TC) in the diagnosis of bacterial pneumonia in patients under mechanical ventilation. In 25 patients (43%) a positive culture was obtained above 10(3) UFC/ml, confirming the pneumonia diagnosis in 17 cases and detecting a false positive result in one patient. In no case with a count less than 10(3) UFC/ml pneumonia diagnosis could be confirmed, being this diagnosis excluded in 24 of 33 patients with a count lower than 10(3) UFC/ml. These results suggest that the presence of fever, purulent tracheobronchial secretions and lung infiltrate in an intubated patient under mechanical ventilation does not indicate the presence of pneumonia in a high percentage of cases and that CT scan can identify those patients who require antimicrobial treatment, and this avoiding its use in patients who do not need it, with the resulting decrease in morbidity and high cost.

Bacteria↗