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Biomedical subjects

J Castillo

Publications and source records attributed to J Castillo.

At least 199 records · Page 11Linked to original sources
PubMed1994

Colorectal adenocarcinoma: quality of the assessment of lymph node metastases.

PURPOSE: We have studied 193 cases of colorectal adenocarcinoma from a population-based register to determine the minimum number of lymph nodes to be examined to provide an accurate assessment of the presence of nodal metastases. METHODS: The mean total number of lymph nodes identified per surgical specimen was 11 +/- 6.8 (range, 1-36) using traditional dissection. One hundred eighteen specimens (61 percent) were classified as Dukes B. Seventy-five (39 percent) had lymph node metastases (Dukes C) with a mean of 3.3 +/- 4.7 positive lymph nodes per specimen. With binomial distribution we calculate the probability to find at least one positive node in a sample size n with a determined proportion of positive nodes. RESULTS: The error probability in the ganglionar assessment by traditional dissection was 0.05 with 6 examined lymph nodes and 0.01 with 10 examined nodes. CONCLUSION: We must provide the pathologist with a minimum of six examined lymph nodes per surgical specimen for an optimal Dukes B assessment.

Adenocarcinoma↗
PubMed1994

Plasma monoamines in tension-type headache.

Clinical and pharmacological data suggest a derangement of central monoaminergic systems in tension-type headache. Biochemical evidence has been rarely recognized. These findings may relate with pathophysiological mechanisms of headache or with underlying depression. We measured platelet-rich plasma serotonin and plasma catecholamines (norepinephrine, epinephrine, and dopamine) in 30 patients with tension-type headache and in 20 healthy controls, using High-Pressure Liquid Chromatography. We studied differences between groups and the relation between biochemical parameters and clinical indices evaluating duration and severity of headache and depression. Platelet serotonin levels in tension headache patients were higher than in controls (P < 0.001). Plasma catecholamine levels were lower in patients than in controls (P < 0.001 for epinephrine and dopamine, and P < 0.05 for norepinephrine). There was a positive correlation between dopamine levels and duration of history of headache (r = 0.55, P < 0.05). A negative correlation between epinephrine levels and severity of headache was observed (r = 51, P < 0.01). No correlations were found between monoamine levels and severity of depression. Our results add to the evidence of alterations of monoaminergic central systems in tension-type headache patients. These alterations seem to be independent from the underlying depression and related to the pathophysiologic mechanisms of headache.

Adult↗
PubMed1994

Role of cardiopulmonary exercise testing and the criteria used to determine disability in patients with severe chronic obstructive pulmonary disease.

The aim of this study was to evaluate the precision and variability with which resting pulmonary function tests (resting PFTs) can be used to predict the capacity in exercise, and the usefulness of the different measurements of pulmonary function in the evaluation of impairment/disability in patients with chronic obstructive pulmonary disease (COPD). We studied 78 patients with stabilized COPD (FEV1 45.1 +/- 17.1%). Of these, 39 suffered severe impairment according to the resting PFTs. Both the group with severe impairment (maximal oxygen consumption [VO2,max]: 16.22 +/- 5 ml/kg/min; maximal minute ventilation [VEmax]: 31.87 +/- 7.1 L/min; maximal heart rate [HRmax]: 133.8 +/- 10.9 beats/min) and the group with nonsevere impairment according to the resting PFTs (VO2max: 22.55 +/- 7.9 ml/kg/min; VEmax: 42.11 +/- 10.9 L/min; HRmax: 138 +/- 13.7 beats/min) showed ventilatory limitation during exercise. FEV1 was the most prevalent criterion for the determination of severe impairment (FEV1 < 40%), and was the variable best correlated to VO2max (r = 0.52 with VO2max as absolute value and r = 0.54 with VO2max expressed as a percentage of the reference value), but the resting PFTs were not predictive of exercise performance including patients with severe COPD. Evaluation of working capacity (based on VO2max) revealed a significant number of inaccurate predictions among the results of the resting PFTs. Sensitivity and specificity analysis were used to compare the different criteria used to evaluate the severity of disability. They reveal that the classification will be different according to the criteria used.(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMed1994

Neurologic factors predict a favorable valproate response in bipolar and schizoaffective disorders.

The hypothesis that neurologic factors influence the response to valproate (divalproex sodium) in bipolar and schizoaffective disorders was tested. In 115 predominantly lithium-refractory inpatients, neurologic findings were recorded, and blind raters assessed valproate response from the medical record. Patients with a seizure history were much more likely to have a robust response to valproate (70%), when compared with patients without such history (34.6%). History of head injury and abnormal electroencephalographic findings also tended to be more common in those patients with good response. Overall, the group of patients with any neurologic abnormality exhibited a significantly higher rate of good response to valproate (43.6%) than did the neurologically normal group (24.3%). Bipolar or schizoaffective patients with abnormal neurologic features may represent a distinct subtype of illness and appear to be good candidates for valproate therapy.

Bipolar Disorder↗
PubMed1994

[Prognostic factors in spontaneous intracerebral hemorrhage].

The introduction of etiological, diagnostic and therapeutical factors have modified the knowledge on the evolutive behaviour of spontaneous intracerebral hemorrhages (ICH). Mortality and morbidity associated to spontaneous ICH were assessed using as independent variables clinical and neuroimage factors obtained upon admission of the patients. We studied 228 patients with spontaneous ICH selected from a data bank of 277 patients with non-traumatic ICH. During the first 24 hours, we assessed several clinical factors (arterial hypertension, Glasgows Neurological Scale and Barthels Scale) and TC images (size, location, extension of bleeding to ventricles, edema and atrophy). Thirty-one per cent of the patients died during the first 2 months. The multiple linear regression study showed that mortality was related to variables of the Glasgows Neurological Scale upon admission, extension to ventricles, size of ICH and perilesional edema, whereas the morbidity was only related to the size of the hemorrhage. Severity of the clinical affection, extension of the bleeding to ventricles, size of the hemorrhage and presence of perilesional edema, but not arterial hypertension, were the main factors affecting mortality at two months of spontaneous ICH.

Adolescent↗
PubMed1994

[Essential and symptomatic trigeminal neuralgia].

We present the principal differential characteristics of neuralgia of symptomatic and idiopathic trigeminus. Out of 39 consecutive patients with neuralgia of trigeminus evaluated clinically and with neuroimage study, we find recognizable pathology in 10 (3 arterio-venous malformations, 1 dolichoestasia of basilar artery, 3 tumors, 3 multiple sclerosis). Symptomatic neuralgia occurs in patients with lower average age and is accompanied by atypical symptoms or abnormal neurological signs and is no different from idiopathy as a response to pain from medical treatment. Painful affectation of the trigeminus requires the realization of complementary explorations aiming to dismiss associated neurological pathology.

Adult↗
PubMed1994

Concurrent use of clozapine and valproate in affective and psychotic disorders.

BACKGROUND: This pharmaco-epidemiologic study was undertaken to determine if the combination of clozapine and valproate poses an increased risk of blood dyscrasias, liver function abnormalities, or other side effects and to develop dosing guidelines when the combination is utilized. METHOD: The charts of 55 patients receiving clozapine and valproate concurrently between May 8, 1989, and May 8, 1992, were reviewed to determine the indication for and length of time on each medication, abnormalities in liver function test results, blood cell dyscrasias, seizures, nausea, vomiting, sedation, sialorrhea, and enuresis. In addition, the efficacy of the combination was measured. RESULTS: The combination of clozapine and valproate was efficacious and well tolerated in the majority of patients. Major adverse effects such as blood dyscrasias or seizures were not experienced by the study population. The side effect that led to discontinuation of the combination most frequently was sedation. CONCLUSION: The combination of clozapine and valproate is safe and efficacious.

Adult↗
PubMed1994

Concomitant use of valproate and carbamazepine in bipolar and schizoaffective disorders.

From pharmacy records, the authors identified 17 consecutive patients who were treated with carbamazepine and valproate simultaneously. Twelve patients were diagnosed with bipolar disorder, manic or mixed types; four patients received a diagnosis of schizoaffective disorder, manic type; and one had major depression and posttraumatic stress disorder. All 12 bipolar patients had a moderate to marked response to the combination drug treatment, whereas all 4 schizoaffective patients failed to respond. Only two patients had minor side effects. The authors conclude that the combination of valproate and carbamazepine is usually well tolerated and that it can be effective in bipolar patients who have previously failed to respond to anticonvulsant monotherapy.

Adult↗
PubMed1994

[Changes in neuroexcitatory amino acids during and between migraine attacks].

We studied changes in plasma levels of neuroexcitatory amino acids during and between migraine attacks in 16 patients with migraine without aura, 11 with aura and 21 controls. Glutamic acid levels between attacks were 1.027 +/- 0.60 and 0.890 +/- 0.41 mg/dl in migraine patients without and with aura, respectively; during attacks the levels were 0.535 +/- 0.23 and 0.601 +/- 0.20 for the same patients. The concentration of glutamic acid in the control group was 0.980 +/- 0.64 mg/dl. Aspartic acid levels between attacks in patients without and with aura were 0.179 +/- 0.04 and 0.167 +/- 0.03 mg/dl. Concentrations during attacks were 0.129 +/- 0.02 and 0.119 +/- 0.02 mg/dl for the same patients. Plasma levels of aspartic acid for controls were 0.146 +/- 0.03 mg/dl. We found no significant variations in neuroexcitatory amino acids between migraine attacks in patients with an without aura; changes took place only during attacks, possibly related to the mechanisms of the spreading depression process.

Adult↗
PubMed1993

Magnetic resonance imaging of muscles in myotonic dystrophy.

The MR findings in 27 patients with myotonic dystrophy were compared with those observed in 11 patients with other muscular dystrophies: six with limb-girdle dystrophy, three with facioscapulohumeral muscular dystrophy and two with Becker-type muscular dystrophy. Clinical status was graded into 10 stages. The MR study was performed at the medium third of the thigh, with a slice thickness of 7.5 mm (TR: 750/TE: 25 for T1; TR: 2200/TE: 30/90 for DP/T2). Muscle signal intensity was evaluated with a four-point grading scale using subcutaneous fat as a reference. Statistical analysis was done using the Mann-Whitney-Wilcoxon's test and simple linear regression. In the myotonic dystrophy group, 81.4% of the patients showed an abnormal signal at the crural muscle level, adopting a semilunar shape around the anteroexternal side of the femur. The presence and intensity of this hyperintense signal correlated positively with the duration of disease (r = 0.54) and the clinical stage (r = 0.69). Of the 11 patients with other muscular dystrophies, only three (27.2%) showed hyperintense signal at the crural muscle level. MR imaging of patients with muscle disease may contribute to the in vivo study of muscular dystrophy, its differential diagnosis and the detection of asymptomatic patients.

Adolescent↗
PubMed1993

Neuroexcitatory amino acid levels in plasma and cerebrospinal fluid during migraine attacks.

A current hypothesis for migraine suggests that neuroexcitatory amino acids may participate in the triggering of attacks. To investigate this possibility we measured glutamic and aspartic acid level in plasma and cerebrospinal fluid (CSF) of patients with common and classic migraine during attacks, making comparisons with controls suffering stress. Plasma levels of amino acids in migraine patients were lower than in controls. CSF concentrations of glutamic acid were higher in migraineurs than in controls. Our results suggest an excess of neuroexcitatory amino acids in the CNS of migraine patients during attacks, possibly favoring a state of neuronal hyperexcitability.

Adult↗
PubMed1993

Platelet-rich plasma serotonin levels in tension-type headache and depression.

We measured platelet-rich plasma (PRP) serotonin in patients suffering from tension-type headache, before and after treatment with amitriptyline, comparing them with a healthy control group and patients with untreated depression. We evaluated the severity of headache and depression in each group. PRP serotonin levels were higher in patients with headache than in controls and depressed patients. We observed a fall of PRP serotonin in patients with tension-type headache to similar levels after treatment as the depressed group. This fall was correlated with the improvement of headache but not with depression scales. Our data suggest that the rise of platelet serotonin levels in tension-type headache is related to pain and not depression.

Adult↗
PubMed1993

Taurine levels in plasma and cerebrospinal fluid in migraine patients.

Taurine is the amino acid with the highest concentration in the human body. Its physiologic functions are not yet well understood. As a neurotransmitter or neuromodulator it may display inhibitory functions. We have measured taurine levels in plasma and cerebrospinal fluid of migraine patients during attacks, comparing them with controls. Patients with migraine had significantly higher concentrations than controls. No sex or age influence over the amino acid levels were observed. Plasma taurine levels in patients with classic migraine correlated negatively with severity of headache. Central taurine liberation during migraine crisis may be due to spontaneous depolarization or a defensive reaction in the context of cerebral homeostatic processes.

Adolescent↗
PubMed1993

Catecholamine levels in plasma and CSF in migraine.

There is clinical and pharmacological evidence of the existence of sympathetic dysfunction in migraine. Adrenaline and noradrenaline concentrations were determined in plasma and CSF of patients during attacks of common or classic migraine, comparing them with controls suffering from stress. Plasma noradrenaline levels were significantly lower in the patients with common migraine than in controls (p < 0.05). Other catecholamine levels in plasma and CSF in both migraine groups were only slightly lower than in controls. Our results suggest that central sympathetic dysfunction exists in patients with migraine.

Adult↗
PubMed1993

Pneumocystis carinii pneumonia in patients without predisposing illnesses. Acute episode and follow-up of five cases.

Pneumocystis carinii pneumonia (PCP) is described almost exclusively in immunocompromised hosts. This report describes our experience with acute episodes and the follow-up of five patients with PCP who had no known predisposing conditions. The average follow-up period was 3.6 years (range, 2.6 to 4 years). Lymphocyte subpopulations (CD4, CD8, and CD4:CD8), serum immunoglobulins (IgG, IgM, and IgA), and serologic studies for human immunodeficiency virus were carried out on all patients at least twice, both at the beginning and the end of the follow-up. None of the patients presented compatible data with AIDS or any other identifiable risk factors. We conclude that PCP can occur in patients who apparently do not have immunosuppression.

Acute Disease↗
PubMed1993

[Size of incision and induced astigmatism in cataract surgery].

A study was carried out of postoperative astigmatism in three groups of 50 eyes which had had cataracts removed by phacoemulsification or by planned extracapsular removal through incisions of 3.5-4 mm, 7-7.5 mm, and 10-11 mm respectively. No statistically significant differences were observed in the average number of cases of astigmatism found 100 days after the operation in the patients in whom incisions of 10-11 mm (1.82 +/- 0.95 Dp) and 7-7.5 mm (1.78 +/- 0.90 Dp) were made. Appreciable differences were discovered when these two groups were compared with cases in which small incisions had been used and who presented a lower degree of astigmatism (1.02 +/- 0.59 Dp). To ensure less postoperative astigmatism after phacoemulsification, the size of the incision should be modified as little as possible during the insertion of the intraocular lens.

Adult↗
PubMed1992

Predictors, mechanisms and outcome of severe mitral regurgitation complicating percutaneous mitral valvotomy with the Inoue balloon.

During 241 consecutive percutaneous mitral valvotomy (PMV) procedures performed with the Inoue balloon, 16 patients (6.6%) developed severe mitral regurgitation (MR). Baseline clinical, echocardiographic (Doppler mitral valve area and Wilkins' score) and hemodynamic data were not different from those of patients without this complication. Severe MR occurred during the first inflation in 7 patients and after several stepwise inflations in 9. Although maximal balloon size was similar in both groups, unusual indentations and subvalvular inflations were more frequently observed in patients who developed severe MR. Early mitral valve replacement was required in 6 patients. All of them had a leaflet rupture either along the midportion (2 patients), along a commissure (4 patients), or both. Commissural calcium was present in 5 valves and 5 also had severe subvalvular involvement that had been underestimated by echocardiography. Of the 10 nonsurgically treated patients, 4 had chordal rupture by echocardiographic criteria, whereas in the remaining 6 the precise mechanism of MR could not be determined. During follow-up (11.4 +/- 4 months, range 1 to 30), 1 patient required surgery for symptoms and the remaining 9 were symptomatically improved and free of left ventricular dilatation. In conclusion, severe MR complicated 6.6% of PMV procedures with the Inoue balloon, and its mechanism was leaflet or chordal rupture. Although one third of the patients required early mitral surgery, most of the remaining obtained midterm symptomatic benefit.

Adult↗