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Biomedical subjects

G Ramirez

Publications and source records attributed to G Ramirez.

At least 91 records · Page 5Linked to original sources

Acute interstitial nephritis associated with chronic active hepatitis.

Chronic active hepatitis has been associated with renal abnormalities and immune-mediated glomerulonephritis or vasculitis. We report a case of acute reversible renal failure due to renal interstitial infiltration by lymphocytes, plasma cells, and neutrophils. The acute renal failure responded to the administration of prednisone. It is possible that interstitial nephritis is commonly associated with acute and chronic hepatitis.

Acute Disease

Immunopathology of rheumatic pericarditis.

Immunologic mechanisms have been implicated in the endocarditis, myocarditis, and arthritis of acute rheumatic fever. However, pericarditis, a major manifestation of acute rheumatic fever with a clinical incidence of 5-10%, has not been studied. We have evaluated a patient who had this febrile disease with arthritis and pericarditis. Pericardial tissue showed extensive deposition of IgG, IgM, and C3 both on the pericardial surface and within the walls of pericardial blood vessels. Our findings of immunoglobulins and complement within the inflamed pericardium suggest an immune-mediated mechanism for the pericarditis of acute rheumatic fever.

Adult

Renal artery thrombosis: a cause of reversible acute renal failure.

Acute renal failure can be produced by interruption of the arterial blood supply. We describe a case of acute renal failure that developed owing to thrombosis of the renal artery of the only functioning kidney. This thrombosis occurred in an artery that was stenosed probably by an arteriosclerotic plaque. The blood flow was re-established successfully by the passage of the catheter into the thrombosed artery and intra-balloon dilation of the stenosis.

Acute Kidney Injury

Evaluation of the hypothalamic hypophyseal adrenal axis in patients receiving long-term hemodialysis.

Several alterations are present in the hypothalamic hypophyseal regulation of many hormones in patients with chronic renal failure. Evaluation of the hypothalamic hypophyseal adrenal axis in these groups of patients demonstrated normal levels of plasma cortisol. Dexamethasone suppression is abnormal after administration of 1 mg of oral dexamethasone, but normal after 3 mg. Dexamethasone blood levels were lower than the control after administration of 1 mg of oral dexamethasone. A dexamethasone metabolic clearance showed a similar half-life between the patients and controls. Oral absorption study showed poor absorption of the drug. Therefore, there is a problem of gastrointestinal absorption producing the abnormal dexamethasone suppression test in patients with renal failure. Results of metyrapone tests were normal. Corticotropin stimulation tests elicited a normal response. Insulin-induced hypoglycemia does not produce an increment in plasma cortisol or adrenocorticotropic hormone levels.

Adrenocorticotropic Hormone

Renal pathology in patients with rheumatoid arthritis.

We studied 76 patients with rheumatoid arthritis who had autopsies performed at the University of Utah and Salt Lake Veterans Administration Medical Center. The most common pathological finding in the kidney was interstitial fibrosis (46%) and internal proliferation of the arterioles in the absence of hypertension (54% of the cases). Renal amyloidosis was only found in 7% of the patients. Azotemia (creatinine above 2 mg/dl) was found in 9% of the patients but was not clinically significant. In addition uremia was not a frequent cause of death in patients with rheumatoid arthritis.

Adult

Serum calcium in blood pressure regulation during hemodialysis.

Frequent hypotensive episodes developed in a 56-year-old man, who was receiving long-term hemodialysis therapy, at the time he had a uremic pericardial effusion. During dialysis with an inadvertent calcium infusion, however, the mean blood pressure (BP) was sustained and even rose from 93 to 133 mm Hg. During continued dialysis to restore the serum calcium level from a peak of 17.4 to 12.0 mg/dL, mean arterial pressure decreased back to 93 mm Hg. In contrast, BP had fallen in three of six preceding dialysis treatments and five of nine subsequent dialysis treatments, all at the same ultrafiltration rate. This report suggests the importance of serum calcium to BP regulation during hemodialysis.

Blood Pressure

Vindesine. A phase II trial in advanced breast cancer patients.

A phase II trial of vindesine (VDS), a new vinca alkaloid, has been carried out in 40 patients with metastatic breast cancer. Patients entered in the study had been previously treated with an average of two chemotherapy regimens. Treatment was given as a weekly I.V. bolus of VDS at 3 mg/m2. The response rate in 31 evaluable patients was 19%, i.e., one complete response (CR), four partial responses, and one improvement in osseous disease (IMP). In 36 patients evaluable for toxicity, neurological and hematological toxicity was most significant. Half the patients treated had received previous vincristine therapy; this factor did not appear significant with regard to toxicity or response to VDS.

Adult

Phase II study of dibromodulcitol in colorectal, kidney, and other carcinomas.

In a phase II study dibromodulcitol (DBD), an alpha-omega dibrominated hexitol, was used to treat 99 previously treated patients with colon, rectal, kidney, and other tumors. Six patients were ineligible and 10 patients were nonevaluable for response. Aside from thrombocytopenia toxicity was moderate. Twenty-three patients had platelet nadirs of less than 50,000/mm3 and there were three thrombocytopenic-associated drug deaths. One of 21 rectal and 1 of 13 kidney cancer patients entered a remission. All but seven patients had received previous treatment with one or more cytotoxic agents. Previously treated patients with colorectal and kidney cancer appear to be resistant to DBD.

Aged

Solubilization of 20S acetylcholinesterase from the chick central nervous system.

The ionic detergent sodium cholate, in the presence of 1 M NaCl, solubilizes a 20S acetylcholinesterase from chick retina and other brain tissues previously extracted with a buffered solution containing 1% Triton X-100 and 1 M NaCl. This 20S acetylcholinesterase appears to be a tailed form of the enzyme which, upon collagenase digestion, is converted to a 22S (mainly) form. This finding suggests that the vertebrate central nervous system does contain asymmetric, collagen-tailed forms of acetylcholinesterase, as is the case in skeletal muscle and cholinergic ganglia.

Acetylcholinesterase

Epidermotropism in melanoma.

Multiple malignant melanocytic lesions developed in a 54-year-old man 4 years after a primary malignant melanoma (Clark level IV) had been excised and 2 months after taking L-Dopa for Parkinsonism. Several of the recurrent lesions that showed junctional melanocytic components were considered primary melanomas and it was suggested that L-Dopa was responsible for malignant transformation of nevi and for rapid progression of the disease. The case was re-examined and on recent evidence it is likely that these lesions were epidermotropic metastases and that L-Dopa played no part in the progress of this unusual tumor.

Epidermis

Hypertension screening and treatment with angiotensin inhibitors. Saralasin and captopril.

The number of studies in the literature on diagnostic and therapeutic uses of angiotensin antagonists has been increasing geometrically. Nearly 1,000 publishsd items deal with saralasin alone, although neither saralasin nor captopril is yet approved for general use or widely available. Reports to date represent only a fraction of the eventual situations in which these agents are likely to help the researcher and clinician. Food and Drug Administration approval of both agents is pending, and both are expected to be available soon. Consequently, the practitioner will want to become familiar with their usefulness, especially to screen for secondary forms of hypertension and to treat moderate to severe primary or secondary hypertension.

Angiotensin II

Combination chemotherapy for soft-tissue sarcomas: a phase III study.

A total of 144 patients with advanced sarcomas were entered into a randomized prospective protocol with four treatment arms utilizing different combinations of chemotherapeutic agents. Of these, 120 patients (83%) were judged acceptable. Treatment 1: actinomycin-D (Act-D), 0.01 mg/kg IV, days 1--5; phenylalanine mustard (L-PAM), 4 mg PO, days 1--10 every six weeks. Treatment 2: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, days 1--10; vincristine, 1 mg IV, days 1, 8, 15, 22, 29, 36, repeat every six weeks. Treatment 3: Act-D, 0.01 mg/kg IV, days 1--5; L-PAM, 4 mg PO, DAYS 1--10; NSC-1026, 200 mg/kg IV, days 1--6. Treatment 4: Adriamycin, 0.4 mg/kg IV, days 1, 2, 3, 8, 9, 10, then 2XWK starting day 15 (max. 1,200 mg). There was a provision that upon progression of the disease in the first three treatment regimens, patients would be crossed over to Treatment 4. Responses were as follows: 1 - Partial Response (PR) 1/25; No Change (NC) 9/25 (36%). gF2 - NC 17/26 (65%). 3 - NC 13/25 (52%). 4 - Complete Response (CR) 1/41; PR 6/41; (15%); NC 27/41 (66%). Clearly Treatment 4 was the best arm, with a 17% response rate and an initial progression rate of 17%. The only other response was a partial in 1. The difference is statistically significant (H = 17.247, P = 0.0006). If the responders to Adriamycin were analyzed without crossovers, the response rate would be 22% (6/27). (H = 14.079, P = 0.003). Median times to progression were 12.5, 8.7 weeks for 1 and 2, and 5 weeks for 3 and 4. There was no significant difference in the median survival times among the four treatment arms. It appears that Adriamycin as a single drug is superior to the drug combinations and would probably be even more effective used in combination with known active agents.

Antineoplastic Agents

Travelers' diarrhea among U.S. Army troops in South Korea.

A prospective study of diarrhea was conducted among 98 U.S. Army soldiers during their first six weeks in South Korea. Diarrhea developed in 54 (55%) of 98 soldiers and had a mean duration of five days. Infections with Salmonella, Shigella, Vibrio, enterotoxigenic Escherichia coli, enteroviruses, and intestinal parasites were uncommon. Four (8%) of 50 soldiers with documented diarrhea, two (6%) or 32 with a history of diarrhea, and one (3%) of 29 who denied gastrointestinal symptoms had serologic evidence of a recent rotavirus infection. The etiology of diarrhea among U.S. soldiers who had recently arrived in South Korea differed from the etiology among travelers in warmer climates, where enterotoxigenic strains of E. coli were responsible for the majority of cases. Further efforts are needed to define other enteric pathogens in the etiology of diarrhea among new arrivals in different parts of the world.

Diarrhea