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Biomedical subjects

J F Garcia

Publications and source records attributed to J F Garcia.

At least 19 recordsLinked to original sources
PubMed2001

Diagnostic accuracy of compression ultrasonography for the detection of asymptomatic deep venous thrombosis in medical patients--the TADEUS project.

We assessed the accuracy of venous compression ultrasonography (CUS) for the detection of asymptomatic deep vein thrombosis in 122 consecutive patients, with a mean age of 69 years, who were hospitalised in an internal medicine unit. All included patients had CUS within 48 h of admission. Twelve out of 17 patients with a positive CUS underwent phlebography, as the others withdrew their consent, whereas the remaining 105 patients with a negative serial CUS testing were clinically followed-up at 3 months. We found that CUS had a sensitivity and a specificity of respectively 1 (95% CI, 0.73 to 1) and 1 (95% CI, 0.96 to 1) for the detection of asymptomatic deep vein thrombosis. Kappa-coefficients for intra-observer and inter-observer agreements were respectively 0.88 and 0.56. We concluded that venous compression ultrasonography, performed as described, fulfils requirements of a screening test that could be available for prophylactic clinical trials or epidemiological researches.

Aged↗
PubMed2000

Detection and differentiation of Leptospira spp. serovars in bovine semen by polymerase chain reaction and restriction fragment length polymorphism.

In view of the importance of venereal transmission of bovine leptospirosis, the objective of the present study was to apply the polymerase chain reaction (PCR) to 26 serovars of Leptospira interrogans, L. borgpetersenii, L. santarosai, L. noguchii and L. biflexa, to determine the detection threshold in semen samples and to evaluate the possibility of differentiation among serovars using 19 restriction endonucleases. The results showed that all serovars were amplified and the detection threshold in semen samples of a bull was 100 bacteria/ml. Using endonucleases we could classify the 26 serovars into eight groups. The present results show that PCR is a method of great potential for the detection of Leptospira spp. at bovine artificial insemination centers.

Animals↗
PubMed2000

Sonographic evaluation of digital annular pulley tears.

OBJECTIVE: To evaluate the sonographic (US) appearance of digital annular pulley (DAP) tears in high-level rock climbers. DESIGN AND PATIENTS: We performed a retrospective analysis of the US examinations of 16 high-level rock climbers with clinical signs of DAP lesions. MRI and surgical evaluation were performed in five and three patients respectively. The normal US and MRI appearances of DAP were evaluated in 40 and three normal fingers respectively. RESULTS: Nine of 16 patients presented a DAP tear. In eight subjects (seven with complete tears involving the fourth finger and one the fifth finger), US diagnosis was based on the indirect sign of volar bowstringing of the flexor tendons. Injured pulleys were not appreciated by US. Tears concerned the A2 and A3 in six patients and the A3 and A4 in two patients. A2 pulley thickening and hypoechogenicity compatible with a partial tear was demonstrated in one patient. MRI and surgical data correlated well with the US findings. Four patients had tenosynovitis of the flexor tendons but no evidence of pulley disruption. US examinations of three patients were normal. In the healthy subjects US demonstrated DAP in 16 of 40 digits. CONCLUSION: US can diagnose DAP tears and correlates with the MRI and surgical data. Because of its low cost and non-invasiveness we suggest US as the first imaging modality in the evaluation of injuries of the digital pulley.

Adult↗
PubMed2000

[Unusual course of a pulmonary artery catheter through a persistent superior vena cava] .

We report the unusual course of a pulmonary artery catheter through a persistent left-sided superior vena cava. After left subclavian vein cannulation and downward left-sided paramediastinum course, the Swan-Ganz catheter enters the right pulmonary artery. Haemodynamic monitoring was consistent with the diagnosis of septic shock developed by this 56-year-old woman, after cephalic duodenopancreatectomy. Persistent left-sided superior vena cava occurs in 0.5% of the population and 5-10% of patients with congenital heart diseases. It drains into the right atrium through the coronary sinus in 92% of cases and is associated with an absent right superior vena cava in 20% of cases. The left-sided superior vena cava persists when the caudal part of the left anterior cardinal vein does not degenerate. A persistent left superior vena cava may be medically relevant during implantation of pacemaker leads or radiofrequency ablation, during cardiac surgery for placement of a retrograde coronary sinus cardioplegia catheter and during transjugular intrahepatic portosystemic shunt placement.

Angiography↗
PubMed2000

Cloning and functional expression of a Boophilus microplus cathepsin L-like enzyme.

A cysteine proteinase gene homologous to cathepsins L genes was isolated from a B. microplus cDNA library. The precursor protein deduced from the nucleotide sequence contains 332 amino acid residues consisting of a signal sequence (pre-region), a pro-region and a mature proteinase. The DNA fragment coding for the proenzyme was cloned and expressed using the E. coli expression vector pMAL-p. The recombinant protein (MBP+PROCP) once activated is able to hydrolyze synthetic substrates as well as protein substrates like hemoglobin, vitellin and gelatin. Its optimal enzymatic activity on both fluorogenic and protein substrates was found to occur at an acidic pH. Expression of the proteinase gene was tested by RT-PCR with tick larvae RNA. Detection of amplified sequences indicates that the gene is expressed at this stage of the tick life cycle and the molecule is therefore potentially a target for chemotherapy or an immunogen in a vaccine.

Animals↗
PubMed2000

Predictors of atopy in HIV-infected patients.

BACKGROUND: Some studies have reported an increase of atopy in HIV-infected (HIV+) patients, but the cause still remains unclear. OBJECTIVE: To determine the prevalence of atopy in HIV+ patients and to investigate its predictors. METHODS: Seventy-four HIV+ hospitalized patients (46 of them with AIDS) were studied prospectively for the presence of atopy, based on immediate hypersensitivity to common allergens by prick test. Serum immunoglobulins, specific IgE, lymphocyte subsets, and the expression of low affinity IgE receptor (CD23) on B cells were determined. RESULTS: Thirty-one percent of patients presented IgE values greater than 150 ku/L (39% of patients without AIDS and 26% of AIDS patients; P = .23) and 47% showed an increase (> or = 2%) in the percentage of CD23+ B cells. Non-AIDS patients had higher IgE values than AIDS patients (346 +/- 605 versus 175 +/- 276; P = .16). Atopy prevalence was higher in non-AIDS than in AIDS patients (28% versus 11%; P = .06). Specific IgE agreed with positive prick test in 58% of cases. Multivariate analysis showed that a personal history suggestive of allergic disease and IgE > 150 ku/L were predictors of atopy, while gender, risk group, CD4+ T cells, CD23 expression on B cells, and AIDS were not associated. CONCLUSIONS: HIV+ patients present a higher prevalence of atopy in early stages of HIV infection than general population. Since allergic reactions could accelerate HIV-infection by increasing type 2 cytokines, it is important to evaluate the atopic state in HIV+ patients with IgE > 150 ku/L or with suggestive allergic history in order to prevent it.

Adult↗
PubMed2000

Clinical and economic impact of a pharmacist-intervention to promote sequential intravenous to oral clindamycin conversion.

A multicentre, prospective, controlled study compared the clinical efficacy, safety and economic impact of a pharmacist intervention to promote sequential intravenous to oral clindamycin conversion. A total of 473 patients receiving intravenous clindamycin for at least 72 hours were included in the study. Two groups were established: an intervention group (204 patients) in which an informative sheet recommending the sequential treatment was provided, and a control group (269 patients). Clindamycin was prescribed for respiratory infections in 38.9% and for prophylaxis in surgery in 25.4% of the patients (71% were contaminated surgery). No difference between groups regarding sex, infection severity, health status or clinical progress was observed. Both the step-down treatments after 72 hours of intravenous clindamycin and the change to the oral route later on, were significantly increased with the intervention (p < 0.001, p < 0.001 respectively). No significant differences between both groups were found in the number of patients with adverse effects associated with the i.v. therapy, although the incidence tended to be lower in the intervention group (49/204 intervention versus 85/269 control, p = 0.07). Compliance with the recommended clindamycin dosing regimen was significantly higher in the intervention group, in which 1.3 days reduction of intravenous therapy provided an average cost savings of PTA5246 (95% CI 2556-7935) per treatment. A higher reduction of 1.7 days was achieved in those patients candidates for switch therapy on the third day of intravenous clindamycin. A sequential program with clindamycin may provide a cost-effective alternative to conventional therapy and the introduction of an information sheet is a cost-effective strategy to promote it.

Administration, Oral↗
PubMed2000

Spontaneous apparent clinical resolution with histologic persistence of a case of extramammary Paget's disease: response to topical 5-fluorouracil.

An 86-year-old woman presented with a 3-year history of an erythematous axillary lesion, which was histologically confirmed to be extramammary Paget's disease (EMPD) confined to the epidermis and adnexa. Surprisingly, spontaneous clinical regression occurred in the lesion, but Paget's cells persisted within the epidermis and adnexa on histologic examination. One year of intermittent topical chemotherapy with 5-fluorouracil resulted in ulcers that were interpreted as EMPD and completely excised. Histologic examination showed a complete absence of Paget's cells. To our knowledge, only one previous report investigated apparent spontaneous clinical resolution with histologic persistence of EMPD. We emphasize that topical 5-fluorouracil cannot be considered a safe treatment modality for EMPD, but it may be useful in certain cases in which the extent of the lesions, or the general condition of the patient, advise against surgery or radiotherapy.

Administration, Topical↗
PubMed1999

Detection of leptospires in bovine semen by polymerase chain reaction.

OBJECTIVE: In view of the considerable importance of venereal transmission of bovine leptospirosis, the objective of the present study was to compare the polymerase chain reaction (PCR), culture/isolation and serology to detect leptospire infection in bovine semen. DESIGN: Blood for serologic examination and semen for bacterial culture and PCR were collected from 20 bulls at artificial insemination centres in Brazil. Each animal was sampled twice for serology. RESULT: Forty-five percent (9/20) of the serum samples collected showed agglutinin titers to serovar hardjo in the first sample and 25% (5/20) had agglutinin titers to serovar hardjo in the second sample. Eighty percent (16/20) of semen samples were positive by PCR. Leptospires could not be isolated from any of the semen samples examined. CONCLUSION: Polymerase chain reaction can be a method of great potential for the detection of leptospires at artificial insemination centres.

Animals↗
PubMed1999

[Congenital aneurysm of the trunk of the pulmonary artery].

A case of congenital aneurysm of the main pulmonary artery incidentally discovered following blunt chest trauma is reported. This anormaly is rare and the authors will emphasize the plain radiographic and MRI findings. The etiology and evolution of this entity are not well known.

Adult↗
PubMed1999

Idiopathic carpal tunnel syndrome. Clinical, electrodiagnostic, and magnetic resonance imaging correlations.

BACKGROUND: Although carpal tunnel syndrome is diagnosed primarily on clinical grounds, a number of investigations can be helpful in confirming the diagnosis and providing therapeutic orientation. Electrodiagnostic testing is the most widely used method in everyday practice but can be inconclusive or inconsistent with the clinical findings. Magnetic resonance imaging is useful in such cases. OBJECTIVES: To compare the diagnostic usefulness of electrodiagnostic testing and magnetic resonance imaging in patients with carpal tunnel syndrome. PATIENTS AND METHODS: Thirty-three cases of clinically-defined carpal tunnel syndrome in 20 patients were investigated by electrodiagnostic testing and magnetic resonance imaging. The nerve entrapment was categorized as mild, moderate, or severe based on clinical and electrodiagnostic findings. Structures evaluated on magnetic resonance imaging scans were the median nerve, the flexor retinaculum, the flexor tendons, the fat lying deep to the tendons, the thenar compartment, and the carpal bones. RESULTS: Bowing of the transverse carpal ligament, high signal from the median nerve on T2 images, and median nerve enlargement were found in 70%, 57%, and 55% of cases, respectively. Bowing of the transverse carpal ligament is a cause of mechanical compression, whereas the other two signs reflect injury to the median nerve. High signal from the median nerve was associated with more severe clinical and/or electrodiagnostic abnormalities. CONCLUSION: When electrodiagnostic abnormalities suggest more severe disease than expected or are otherwise discordant with clinical findings, demonstration by magnetic resonance imaging of high median nerve signal and/or median nerve enlargement may help to select those patients most likely to benefit from surgical treatment.

Adult↗
PubMed1999

[Intrathyroid parathyroid adenoma].

Parathyroid adenomas are embedded within thyroid tissue in about 2-5% of cases. Intrathyroid parathyroid adenomas are easily detected at US. As such, US should be performed prior to surgical intervention.

Adenoma↗
PubMed1999

[Clinical, electrophysiological and MRI correlations in carpal tunnel syndrome].

UNLABELLED: Even though diagnosis of carpal tunnel syndrome is mainly based on clinical findings, other examinations are often useful for confirmation and management. The most useful of these examinations is EMG. However, EMG may be inconclusive and MRI may then be helpful. The indications for MRI in patients with carpal tunnel syndrome will be reviewed. METHOD: 20 patients with a total of 33 clinically suspected cases of carpal tunnel syndrome (CTS) underwent EMG and MRI evaluation. Clinical and EMG findings identified three groups of patients based on degree of deficit: mild, moderate, and severe. The following structures were evaluated at MRI: median nerve, retinaculum, retrotendinous fat, flexor tendons, thenar space, and muscles and bones of the wrist. Surgery was performed for 19 wrists. RESULTS: Only retinacular bowing and increased T2W signal intensity within the median nerve were significantly related to the diagnosis of CTS (sensitivity of 70% and 57% respectively). Retinacular bowing indicates increased "pressure" within the compartment (mechanical compression of the nerve) and increased T2W signal of the median nerve indicates nerve suffering. These findings correlated well with more severe cases based on clinical and EMG findings. CONCLUSION: In cases where there is discordance between clinical and EMG findings, MRI is helpful to identify patients who would benefit from surgical intervention.

Adult↗
PubMed1998

Clinical outcome in diffuse large B-cell lymphoma is dependent on the relationship between different cell-cycle regulator proteins.

PURPOSE: The goal of this work was to perform a comprehensive exploration of the relationship between the clinical outcome of diffuse large B-cell lymphoma (DLBCL) and the expression of a panel of tumor suppressor and oncogenic proteins, which includes some cell-cycle regulator proteins involved in the p53 pathway. PATIENTS AND METHODS: To this end, we collected the clinical data of 141 patients with DLBCL and immunohistochemically analyzed diagnostic tumoral tissue from each patient for the presence of Ki67 (MIB1, Immuno-tech, Marseille, France), bcl2, p53, p21/WAF1, MDM2, and retinoblastoma (Rb) proteins. RESULTS: The results show that several proteins are associated with some of the clinical traits analyzed. Multivariate analysis showed that an extended overall survival (OS) time was associated with low growth fraction, high Rb protein, and low MDM2 expression, as well as with known clinical parameters. The probability of inducing a complete remission (CR) was only associated with clinical parameters, although univariate study showed that a low growth fraction was associated with a higher probability of inducing a CR. Univariate study of disease-free survival (DFS) showed that tumors with high bcl2 expression and nodal origin have a shorter DFS time, although multivariate study only confirmed the adverse effect of bcl2 expression. CONCLUSION: Taking all these results into consideration, it seems that although the overall outcome for patients with DLBCL is decided by a combination of different clinical and biologic variables, the expression of some of these cell-cycle regulator proteins appears to be specifically associated with the different clinical features of tumors.

Adolescent↗
PubMed1998

[Anisakiasis, rare pseudotumor colonic involvement. Apropos of a case].

History taking should search for intake of raw or uncooked fish in patients with acute abdominal symptoms. The colon is an uncommon localization of anisakiasis. We describe the case of a 31-year-old man with acute abdominal pain whose abdominal CT scan showed a pseudotumoral formation of the colon. History taking and endoscopic ablation gave the diagnosis of anisakiasis. Whole worm extraction led to restituo ad integrum or the colonic wall.

Abdominal Pain↗