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Biomedical subjects

G Ramirez

Publications and source records attributed to G Ramirez.

At least 145 records · Page 8Linked to original sources

Cardiac arrhythmias on hemodialysis in chronic renal failure patients.

A high incidence (40%) of cardiac arrhythmias was found in patients while on dialysis. This incidence was significantly higher than on nondialysis days. A comparison study of patients with significant cardiac arrhythmia and patients with cardiac arrhythmia was made. There was no difference in the echocardiogram, total body potassium, plasma renin activity, aldosterone, catecholamines, serum sodium, potassium and calcium between the two groups. Significant alkalinization occurred in all patients at the end of dialysis. Blood levels of total PTH and C peptide were higher in the arrhythmic patients versus the nonarrhythmic patients. No explanation was found as to why patients developed arrhythmias or what differentiated the two groups.

Adult

Aggressive combined modality therapy for advanced local-regional breast carcinoma.

Thirty-two women with advanced local regional breast carcinoma, including nine patients with histologically diagnosed inflammatory cancer, were entered on a prospective pilot study. They were treated aggressively with initial surgery, two courses of induction chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil, +/- prednisone, +/- tamoxifen (CMF [P] [T]), local-regional radiotherapy, and then maintenance chemotherapy with CMF(P) (T) alternating with doxorubicin, vincristine, +/- tamoxifen (AV[T]). The patients have been followed for 19-70 months from the time of mastectomy and their actuarial three-year survival is 65% with a median survival that has not yet been reached. Median disease-free survival (time to progression) is currently 29.5 months. Women whose gross disease could not be totally resected surgically had shorter disease-free survivals than those rendered surgically free of disease (p = 0.01). Clinically evident cardiotoxicity was seen in 25% of the patients and was felt to be primarily due to the combination of doxorubicin and radiation therapy. It was significantly more common (Plt less than 0.05) in patients with left chest irradiation (seven of 18 women) as opposed to those with right-sided irradiation (one of 14).

Adult

Cobalt therapy prophylaxis of recurrence of T1 bladder cancer.

Eighteen patients with T1 transitional cell carcinoma of the urinary bladder were submitted to transurethral resection of the tumor, followed by Cobalt therapy (5,500 rads to the pelvis and 6,500 rads to the bladder in six weeks). The recurrence rate at three years follow-up was 33% (6/18). Recurrence of transitional cell carcinoma of the urinary bladder is a well known condition in stage O and A, even when low grade is present. Recurrence rates at one year as high as 84% (Loening et al., 1983) are reported in the current literature. In recent years many studies have been performed which were oriented to the use of intravesical chemotherapy in order to reduce the recurrence rate (Adolphs and Bastian, 1983; Huland, 1983; Loening et al., 1983; National Bladder Cancer Collaborative Group A, 1977; Rodriguez and Caserta, 1983; Zincke et al., 1983) of this tumor. We started a protocol on treatment of the transitional cell carcinoma of the urinary bladder in 1963. The protocol calls for transurethral resection of the tumor followed by Cobalt therapy. This is an interim report on stage T1 (stage A) with such a treatment.

Adult

Hemolytic uremic syndrome after Campylobacter-induced diarrhea in an adult.

Campylobacter fetus subspecies jejuni is a recognized pathogen of the gastrointestinal (GI) tract resulting in a spectrum of illness from mild gastroenteritis to severe colitis with bloody diarrhea. Campylobacter is also being recognized as capable of producing systemic illness. Furthermore, antibody response, hypocomplementemia, and bacteremia with enterotoxic organisms have been described. Many of the clinical features, both local (le, in the GI tract) and systemic, parallel those of Shigella. Since the hemolytic uremic syndrome (HUS) may be produced by the effect of endotoxins or the immunocomplex on vascular endothelium in susceptible patients, it is expected that this syndrome may follow Campylobacter enteritis as it does Shigella enteritis. We, therefore, believe Campylobacter jejuni enteritis should be considered as one of the causative agents capable of inducing the HUS.

Age Factors

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