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Biomedical subjects

F Tato

Publications and source records attributed to F Tato.

At least 19 recordsLinked to original sources
PubMed2005

[Behaviour of vancomycin with the new techniques in haemodialysis].

UNLABELLED: When using high convection dialysis techniques it arouses the necessity of considering the suitability of the regular protocols when administrating drugs, such as vancomycin. OBJECTIVES: To confirm if the usual guideline of vancomycin is efficient in patients undergoing treatments with acetate free biofiltration (AFB) and haemodiafiltration on-line (on-line). To propose an alternative guideline of administration. MATERIAL AND METHODS: 13 patients treated with AFB or On-line. 10 of them used filters of polysulfone and 3 of them of AN69. First part: 6 patients were administered 1 g iv during the last hour of dialysis. Second part: 7 patients were given a loading dose of 30 mg/kg iv with a reinforcement of 500 mg post-dialysis. The blood levels of the antibiotic were monitorized during the week following the administration. OUTCOMES: During the first phase it was noticed a decrease of 41% in the serum level of vancomycin during dialysis, conditioning subtherapeutic levels in the 83% of the patients until the end of the study. As for the second phase, therapeutic non-toxic levels were maintained during the whole study. The existence of a post-dialysis rebound of the 21 % was confirmed. A bigger clearance of vancomycin was obtained with the On-line technique rather than with AFB (176 vs 135 ml/min). We find a strong correlation between the decrease of the antibiotic and the volume ultrafiltrated with the On-line technique. CONCLUSIONS: The usual guideline of vancomycin may not be enough with the new convective dialysis techniques. A guideline based on a loading dose of 30 mg/kg and a reinforcement of 500 mg at the end of each dialysis could be adequate. The antibiotic clearance with the On-line technique is probably made by convective transport.

Anti-Bacterial Agents↗
PubMed2002

[Value of MR angiography in follow-up after cruro-pedal bypass surgery].

Patients after crural or pedal revascularization need a consequent surveillance to prevent graft failure. We compared the results of the clinical examination including duplexscanning with contrast-enhanced magnetic resonance angiography (MRA). 26 bypass grafts were evaluated for potential stenosis in five locations. Using both techniques, 93 of 109 locations were classified identically. 10 of 16 locations which were categorized differently were reviewed angiographically (DSA). In contrast to duplexscanning, MRA detected 3 high grade stenosis, which had to be dilatated percutaneously. MRA should be used regularly in surveillance programs of distal bypass grafting.

Adult↗
PubMed2001

Physicians' attitudes towards voluntary reporting of adverse drug events.

At the time a new drug is placed on the market, information on its therapeutic effect and toxicity is limited. Because of its simplicity and widespread use, the voluntary reporting by clinical physicians is the main method for detecting rare or unexpected adverse drug events (ADEs). However, the usefulness of this method may be compromised if the reporting rate is low. We present the results of a questionnaire-based case-control study carried out among 692 physicians from Galicia (north-west region of Spain), in which we assessed their attitudes and opinions towards ADEs. In general, the Galician physicians think it is difficult to link a given ADE with a drug (P < 0.05) and have very heterogeneous opinions on the fact that very severe ADEs are known before the drug is commercialized. They globally disagree with the proposal that ADE reporting should be renumerated and the fact that ADE reporting can be risky for the physician. Some of the beliefs concerning ADEs are incorrect. It is crucial to improve the training of the physicians through active educational strategies based on personal contact.

Adult↗
PubMed2001

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Influence of physicians' attitudes on reporting adverse drug events: a case-control study.

BACKGROUND: Voluntary physician reporting of adverse drug events (ADEs) in among their patients remains the single most important source of information on serious and rare ADEs. Yet, substantial under-reporting exists and the factors producing its causes are unclear. OBJECTIVES: The objectives of the study are to: (1) identify the practitioner's demographic and professional characteristics associated with ADE reporting; and (2) identify knowledge, attitudes, and opinions associated with ADE reporting. DESIGN: Case-control study. SUBJECTS: Physicians within the National Health Service in Galicia (Northwestern Spain). The 194 case doctors are those who reported at least one ADE to the regional drug surveillance center between 1991 and their enrollment in the study. The 498 controls were randomly selected among the remaining physicians. All were interviewed using a mail questionnaire. MAIN OUTCOME MEASURES: We used logistic regression to determine the ADE reporting odds ratio. RESULTS: The response rate was 63.7%. The probability of reporting ADEs increases with increasing volume of prescriptions and decreases with increasing patient load. The following attitudes are associated with a smaller probability of reporting: (1) belief that really serious adverse drug events are well documented by the time a drug is marketed; (2) belief that it is nearly impossible to determine if a drug is responsible for a particular adverse event; (3) only reporting an adverse drug reaction if one is sure that it is related to the use of a particular drug; and (4) belief that the one case an individual physician might see cannot contribute to medical knowledge. CONCLUSIONS: Some physician attitudes regarding ADEs are associated with underreporting.

Adult↗
PubMed1998

[Ascending varicose vein phlebitis--classification and therapy].

Ascending varicophlebitis can cause pulmonary embolism by entering the deep venous system. Classification into four stages permits a differentiated therapeutic strategy: if the thrombus reaches or enters the deep venous system, immediate surgery consisting of crossectomy, resection of the saphenous vein, radical excision of all varicosed veins and ligature of insufficient perforating veins are indicated.

Aged↗
PubMed1997

An algorithm for the design of epidemiologic studies applied to drug surveillance.

Spontaneous reporting of adverse drug reactions (ADRs), although commonly used, is of limited efficacy for the establishment of causation, and must be complemented by more rigorous epidemiologic studies. This article presents a decision algorithm that could be used as a tool in the selection of the most appropriate study design to investigate the causal relationship between a given ADR and a drug. It is based on the incidence of the ADR, on the objective of the study--determination of all the adverse effects of a given drug, or all the drugs increasing the risk of occurrence of a given adverse event--and on the funds available to the researcher.

Algorithms↗
PubMed1997

Determinants of plasma HDL-cholesterol in hypertriglyceridemic patients. Role of cholesterol-ester transfer protein and lecithin cholesteryl acyl transferase.

Hypertriglyceridemic patients commonly have low levels of HDL cholesterol. Elevated triglycerides per se may be one cause of low HDL levels, but other factors also may be involved. The current study was designed to define the role of cholesterol-ester transfer protein (CETP) in causation of a low HDL cholesterol in hypertriglyceridemic patients; in addition other factors-lecithin cholesterol acyl transferase (LCAT), hepatic triglyceride lipase (HTGL), and lipoprotein lipase (LPL)-were examined. Plasma activities of CETP and LCAT were measured in 137 male patients with moderate hypertriglyceridemia (plasma triglycerides [TGs] 200 to 500 mg/dL and LDL cholesterol < 160 mg/dL). Results were compared with those from 50 normolipidemic men of similar age and body habitus. In addition, lipase activities in postheparin plasma were measured in 118 of the subjects with hypertriglyceridemia. The activities of CETP and LCAT were 17% (P < .01) and 7% (P < .05), respectively, higher in the hypertriglyceridemic group than in control subjects. By stepwise regression analysis CETP appeared to contribute 15.2% and LCAT 9.8% to variation in HDL-cholesterol levels. Activities of LPL and HTGL together contributed an additional 14.1% to HDL-cholesterol variation. In contrast, levels of plasma TG accounted for only 5.4% of the variation. There were no differences in relative contributions of these parameters in patients with and those without coronary heart disease. This study indicates that several factors contribute to the variation in HDL-cholesterol levels in hypertriglyceridemic patients, and five factors-CETP, LCAT, HTGL, LPL, and triglyceride levels-account for almost half of this variation.

Aged↗
PubMed1997

Phenotypic variation in patients heterozygous for familial defective apolipoprotein B (FDB) in three European countries.

A glutamine-for-arginine substitution at amino acid position 3500 of apolipoprotein B (apo B) causes synthesis of LDL with reduced binding affinity to the LDL receptor (LDLR). The associated clinical syndrome has been named familial defective apolipoprotein B- 100 (FDB). In 205 FDB patients from Germany (n = 73). The Netherlands (n = 87), and Denmark (n = 45), we tried to assess determinants of variation in lipid concentrations. Besides age, sex, and geographic origin, variation in the LDLR gene was the most powerful determinant of variation in total cholesterol and LDL cholesterol levels. Polymorphic variation in the LDLR gene (SfaNI, exon 2; Nco I, exon 18) was associated with total cholesterol (TC) and LDL cholesterol (LDL-C) variation in women (SfaNI: P = .04 and .03 for TC and LDL-C, respectively; Nco I; P = .003 and .006, respectively), whereas the Ava II (exon 13) and the Pvu II (intron 15) polymorphisms were not. Combined information from all three LDLR exon polymorphisms showed that subjects with at least one S + A + N + allele had 13% to 20% higher TC than non-S + A + N + subjects (P = .02 [TC, men]; P = .01 [LDL-C, men]; P = .005 [TC, women]; and P = .004 [LDL-C, women]) and, together with age and geographic origin, accounted for 20% (women) and 19% (men) of the variation in LDL-C. The expected association of the apo E genotypes (e3e2, e3e3, and e3e4) with cholesterol concentrations was seen in S + A + N + but not in non-S + A + N + subjects and in P-P- but not in P + P + or P + P- subjects. With regard to clinical expression, FDB patients had lower TC and LDL-C levels and a lower prevalence of cardiovascular disease than 101 Danish patients with familial hypercholesterolemia.

Adult↗
PubMed1996

Effectiveness of low-dose crystalline nicotinic acid in men with low high-density lipoprotein cholesterol levels.

BACKGROUND: Hypoalphalipoproteinemia (low serum concentration of high-density lipoprotein cholesterol [HDL-C]) is a common pattern of dyslipidemia associated with coronary heart disease. High doses of nicotinic acid effectively raise HDL-C levels in this condition, but they are commonly accompanied by side effects. The efficacy of low doses of nicotinic acid that may produce fewer side effects has not been adequately studied. OBJECTIVE: To determine the effects of low-dose nicotinic acid on HDL-C levels in patients with hypoalphalipoproteinemia. METHODS: Forty-four men with low HDL-C levels (< 1.03 mmol/L [< 40 mg/dL]) entered the study. Twenty-four patients otherwise had normal lipid levels, and 20 were moderately hypertriglyceridemic (range of plasma triglyceride levels, 2.82 to 5.64 mmol/L 250 to 500 mg/dL). The trial consisted of 3 phases; each phase lasted 8 weeks. The first phase was diet only (30% fat diet); in the second phase, crystalline nicotinic acid was added at 1.5 g/d; and in the third phase, the dose was increased to 3 g/d. RESULTS: Of the 44 patients who entered the study, 37 completed the low-dose phase (1.5 g/d); the remaining patients were withdrawn because of side effects to nicotinic acid. Four other patients who completed the low-dose phase were excluded from the higher dose phase because of side effects that developed when they were receiving the low dose. Ten other patients withdrew during the high-dose phase because of side effects. In both groups, responses to nicotinic acid therapy tended to be dose-dependent. For both groups, the higher dose generally produced a greater reduction in apolipoprotein B-containing lipoproteins and a greater rise in HDL-C levels. However, for both groups, the low dose of nicotinic acid gave an average 20% increase in HDL-C levels. CONCLUSIONS: A low dose (1.5 g/d) of crystalline nicotinic acid causes an average 20% increase in HDL-C levels and significantly lowers triglyceride levels in both normolipidemic and hyperlipidemic patients with low HDL-C levels. Although the changes induced by this dose are less than those that can be achieved by a higher dose, the lower dose is better tolerated. Nicotinic acid may be useful in combined drug therapy for secondary prevention of coronary heart disease, and if higher doses cannot be tolerated, use of a lower dose should still be useful for producing a moderate rise in HDL-C levels in patients with hypoalphalipoproteinemia.

Crystallization↗
PubMed1995

Bimodal distribution of cholesteryl ester transfer protein activities in normotriglyceridemic men with low HDL cholesterol concentrations.

Increased plasma activities of cholesteryl ester transfer protein (CETP) theoretically could lower HDL cholesterol levels due to enhanced transfer of cholesteryl esters from HDL to apo B-containing lipoproteins. To determine whether high CETP activities are associated with isolated hypoalphalipoproteinemia, CETP activities were measured in 109 adult men with HDL cholesterol < 35 mg/dL, plasma triglycerides < 200 mg/dL, and LDL cholesterol < 160 mg/dL; the results were compared with those of 50 normolipidemic (HDL cholesterol > 40 mg/dL) male subjects. CETP activities were assayed in vitro and expressed as the percent of [3H]cholesteryl ester transferred from HDL3 to LDL during a 16-hour incubation. In addition, postheparin plasma activities of lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) were determined in 71 patients with a low HDL cholesterol level. Distributions of CETP activities were unimodal in control subjects (mean +/- SD, 23.1 +/- 5.0%), but they were bimodal in the low-HDL patients. Among the latter, 27 patients had elevated CETP activities (40.8 +/- 4.6%), whereas 82 patients had CETP activities that overlapped the normal range (26.14 +/- 7.6%). Low-HDL patients with normal CETP activities had 20% lower LPL activities (P = .01), 25% higher HTGL activities (P = .03), and 63% lower LPL/HTGL ratios (P < .001) than those of low-HDL patients with increased CETP activity. Furthermore, mean LPL and HTGL activities in the low-HDL patients with elevated CETP activities were in the normal range. Another important distinction between the two subgroups with low HDL was that the subgroup with high CETP activity had only a 30% prevalence of coronary heart disease compared with a 70% prevalence in the subgroup with normal CETP activity (P < .01). These findings suggest that elevated CETP activity may be a significant factor in causing low HDL cholesterol levels in a distinct subgroup of normolipidemic patients with low HDL cholesterol levels.

Adult↗
PubMed1985

myc and src oncogenes have complementary effects on cell proliferation and expression of specific extracellular matrix components in definitive chondroblasts.

The effects of the avian viral oncogenes src and myc were compared for their ability to alter the differentiated phenotype and the proliferative capacity of definitive chondroblasts. As previously demonstrated, viruses carrying the src oncogene suppressed the synthesis of the chondroblast-specific products, type II collagen and cartilage-specific sulfated proteoglycan. In contrast, infection with MC29 and HB1 viruses, which carry the myc oncogene, did not suppress the synthesis of these normal differentiated cell products, but the infected cells exhibited an increased proliferative potential. The MH2 virus, which carries both the myc and mil oncogenes, both induced the suppression of these chondroblast-specific products and increased cell proliferation. The implications of these results for cooperation between oncogenes and the multi-oncogene models for neoplastic transformation are discussed.

Animals↗
PubMed1981

Effects of right stellate ganglion stimulation on regional myocardial blood flow and ischemic injury in dogs.

The effects of right stellate ganglion stimulation (RSGS) on regional myocardial blood flow (RMBF) and epicardial ST-segment elevation were investigated in the normal and ischemic myocardium of anesthetized dogs. In the non-ischemic areas and despite the augmentation of cardiac work resulting from the increase in heart rate and in myocardial contractile force, RSGS induced no significant changes in RMBF or in the endo/epi ratio. However, after suppression by atenolol of its chronotropic and inotropic effects, RSGS significantly increased the calculated coronary resistance and reduced RMBF, and combined atenolol + phenoxybenzamine treatments abolished these effects. In the ischemic areas, RSGS had no effect on RMBF, endo/epi and I/NI ratios but increased ST-segment elevation, an effect abolished by atenolol. We conclude that (1) during RSGS, alpha-adrenoreceptor-mediated coronary vasoconstriction contributes to oppose beta 1-myocardial stimulation effects on RMBF and endo/epi ratio, (2) further elevation of ST-segment by RSGS is due to enhancement of oxygen requirements by beta 1-adrenoreceptor stimulation.

Animals↗
PubMed1980

Left stellate stimulation: regional myocardial flows and ischemic injury in dogs.

The effects of left stellate ganglion stimulation (LSGS) on regional myocardial blood flow (RMBF) and epicardial S-T segment were investigated in the normal and ischemic myocardium of anesthetized dogs. In nonischemic myocardium LSGS decreased calculated coronary resistance, increased RMBF, and reduced the endocardial-to-epicardial (endo-to-epi) ratio. These effects were reversed after atenolol (1 mg/kg) and abolished after combined atenolol and phenoxybenzamine (3 mg/kg) treatments. In ischemic myocardium LSGS did not change RMBF but increased S-T segment. However, after atenolol, LSGS increased ischemic RMBF and the ischemic-to-nonischemic areas flow ratio (reverse coronary steal phenomenon), these effects being abolished by phenoxybenzamine. We conclude that 1) LSGS increases RMBF and decreases endo-to-epi ratio in nonischemic areas by beta 1-adrenergic stimulation through metabolic autoregulation, 2)beta 1-adrenergic blockade in nonischemic areas unmasks alpha-adrenergic vasoconstriction inducing a redistribution of flow towards ischemic areas, and 3) further elevation of S-T segment by LSGS is due to oxygen requirements enhancement by beta 1-adrenoceptors stimulation.

Animals↗
PubMed1980

Target antigens for antibodies and complement at the cell surface of RSV-transformed fibroblasts.

Using cells transformed by Rous sarcoma virus (RSV), an RNA tumour virus whose genetic and structural composition is fully known, the virus-induced surface antigens acting as targets for antibodies and complement were studied. Among the virus structural proteins, only the envelope antigen gp85, but not the core group-specific proteins or reverse transcriptase, were able to mediate immune lysis in the 51Cr-release assay. The group-specific antigenic determinants of gp85 were predominantly involved. The virus-induced cell surface antigen (VCSA), specific for transformation, was the only other molecule effective. Since different cells express either of these antigens, further support is given to the non-identity of virus structural antigens and VCSA.

Animals↗