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Biomedical subjects

J Guarner

Publications and source records attributed to J Guarner.

29 records · Page 2Linked to original sources
PubMed1989

Fungal peritonitis caused by Curvularia lunata in a patient undergoing peritoneal dialysis.

The authors present a case of a patient undergoing continuous ambulatory peritoneal dialysis (CAPD) who developed peritonitis with Curvularia lunata and gram negative Enterobacteriaceae. A review of the literature indicates that human infections caused by Curvularia are uncommon despite the ubiquity of the organism in the environment. In this case, the organism was present in the Tenckhoff catheter, lacking attachment to it, but obstructing the flow. Treatment of fungal peritonitis during CAPD is discussed.

Bacterial Infections↗
PubMed1988

Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.

To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS), we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum, 15.3%; negative predictive value, 60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS, but, because of the test's low sensitivity, it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Suicide by hanging. A review of 56 cases.

Fifty-six consecutive cases of suicide by hanging are reviewed. The data provide some evidence for associations between suicide by hanging and youth, incarceration, black males, and clustering. Evidence was noted of low incidence in females, rarity of white female hangings at home, a preference to hang oneself away from home if there have been previous suicide attempts, and possible seasonal trends which may differ from suicide overall. Thus, aside from the method chosen, hanging victims as a group displayed some differences from suicides in general.

Adult↗
PubMed1987

Primary non-Hodgkin's lymphoma of the heart in two patients with the acquired immunodeficiency syndrome.

We report two cases of primary cardiac lymphoma that developed in patients suffering from the acquired immunodeficiency syndrome. Both cases of lymphoma were histologically aggressive as generally observed in patients with the acquired immunodeficiency syndrome. The lymphoma cells in the center of a tumor nodule obtained from one patient were monoclonal B-cells, whereas those at the periphery showed a polyclonal pattern of staining. It is postulated that this represents a monoclonal lymphoma evolving from a polyclonal B-cell lymphoproliferation analogous to those reported in some cases of lymphoma in immunosuppressed patients infected with Epstein-Barr virus. The lymphoma cells in the other case failed to stain for cytoplasmic immunoglobulins. The possible underlying basis for the increase in incidence of lymphoma in immunodeficiency and the reasons for prevalence of extranodal sites are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Biclonal gammopathy (IgG kappa and IgG lambda) in a patient with non-Hodgkin's lymphoma.

We report a case of non-Hodgkin's malignant lymphoma with biclonal gammopathy (IgG kappa and IgG lambda) involving both serum and urine. Detailed immunologic studies of the tumor disclosed two morphologically indistinguishable clones of cells that were responsible for the production of the two monoclonal immunoglobulins. This, to our knowledge, is the first documented case of a biclonal gammopathy involving a single heavy-chain class with both kappa and lambda light chains in a non-Hodgkin's lymphoma. Lesions resembling lymphomas must not be assumed to be inflammatory simply because the cells express both kappa and lambda antigens.

Aged↗
PubMedDate not supplied

Cytologic detection of Pneumocystis carinii: a comparison of Papanicolaou and other histochemical stains.

Pneumocystis carinii, a common pathogen among immunocompromised patients, has been investigated in cytologic specimens using both the histochemical stains and ultraviolet (UV) fluorescence following Papanicolaou staining. We reviewed 57 pulmonary cytologic specimens obtained from 23 patients and compared the results of specific histochemical stains and Papanicolaou-stained preparations under UV excitation. Specific Pneumocystis fluorescence was observed in 26 of 49 Papanicolaou-stained specimens. Thirty-seven specimens were examined using both histochemical staining and after Papanicolaou UV staining. A comparison of the two techniques showed the Papanicolaou UV technique to have 89% sensitivity and 95% specificity. Cellulosic filters were the most valuable Papanicolaou-stained preparation for Pneumocystis diagnosis. The authors conclude that UV fluorescence of Papanicolaou-stained specimens obtained by noninvasive procedures is a rapid, accurate, and economical method for diagnosing pulmonary Pneumocystis carinii infections.

Biopsy↗
PubMedDate not supplied

Vulvar Paget's disease. Cytologic and immunohistologic diagnosis of a case.

An exfoliative smear from the vagina in a case of vulvar Paget's disease extending into the vagina and urethra was cytologically diagnosed as showing a large cell carcinoma. The malignant cells proved to be Paget cells by comparison of the cytologic specimen with subsequent biopsy specimens and by immunohistochemical studies using antibodies for glandular cytokeratin, epithelial membrane antigen, carcinoembryonic antigen and gross cystic disease fluid protein. These studies demonstrated that the Paget cell is probably of apocrine derivation. Exfoliative cytology and immunohistochemistry of exudative vulvar lesions may be helpful in the identification of Paget cells.

Aged↗
PubMedDate not supplied

[Productivity before and after installing a computerized system in a clinical laboratory].

A laboratory information system was installed on January 1991 in the clinical laboratory of the Instituto Nacional de Cancerologia. Our main objective was to speed up the administrative work and integrate its operations under one management. We evaluated the productivity before (1990) and after installing the system (1992), using the parameters proposed by the College of American Pathologists. In 1990 there were 30,764 patients who underwent 191,070 laboratory studies, resulting in 131 tests/clerk/day and 21 patients/clerk/day. In 1992 these figures were 43,679 patients, 245,280 tests, 168 tests/clerk/day and 30 patients/clerk/day. The productivity indexes showed a 41% increase in the number of patients and of 28% in the number of tests. In addition, the laboratory personnel started activities in teaching and research which had been non existent before, i.e. in 1992 they started three research projects and participated in three national or international scientific meetings. In summary, no additional personnel was required even though there was an increase in the workload, basically due to a more efficient organization of the work when using a computerized system.

Cancer Care Facilities↗
PubMedDate not supplied

[Simplified CD4+ T-lymphocyte count in patients with HIV/AIDS in Mexico].

OBJECTIVE: To study the correlation between ALC and CD4 cell counts and to find alternative ways of counting CD4+ T-lymphocytes. MATERIAL AND METHODS: The double positivity for CD3/CD4 antibodies was measured in 175 consecutive HIV-positive patients using flow cytometry; in these cases a difference was made between counting cells that were positive for both antibodies vs those that were positive only to CD4. ALC and CD4 counts were also compared among 500 subjects infected with HIV, using linear regression analysis and comparing the number of dissimilar cases for counts below 200 cells/microliters and ALC counts lower than 1 500 and 2000 cells/microliters. RESULTS: In the 175 cases measured by the CD3/CD4 antibody combination the mean percent was 13.8% and for total CD4 cells 14.2% (p = NS); the mean difference was 0.4% and the median 0.2%. For the 500 patients the mean ALC was 1 700 cells/microliters and the mean CD4 count was 219 cells/microliters; the correlation coefficient was 0.59. CONCLUSIONS: These data suggest a poor correlation of ALC and CD4 cell counts, thus it is impossible to predict CD4 on the basis of ALC. This is the reason why it is necessary to measure CD4 cells separately. The difference between measuring double positive CD3/CD4 cells vs only CD4 positive cells was not significant. Our data suggest that the use of a single CD4 antibody may cut costs and still produce clinically useful information.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Zidovudine plus didanosine in HIV infected asymptomatic patients previously treated with zidovudine].

OBJECTIVE: To evaluate if the combination of AZT/ddl offered any advantages in surrogate markers among HIV infected asymptomatic patients previously treated with AZT for at least six months. METHODS: We used a prospective cohort of 269 asymptomatic HIV patients with CD4+ cell counts between 200 and 500 cells/microL. They were given didanosine (ddl 400 mg/d) in addition to AZT (500 mg/d) and had received AZT monotherapy for an average of 20 months. End points were progression to AIDS, death, or toxicity. RESULTS: Median CD4+ cell count at the start of the combination therapy was 339 cells/microL which increased at three months to 451 and subsequently declined at 6, 12 and 18 months of followup (medians of 392, 360, 307 cells/microL respectively). Five patients progressed to AIDS, six developed toxicity (myelosuppression, hepatitis or pancreatitis) and 26 had minor side effects that required only dose reduction. CONCLUSIONS: The addition of ddl to patients with prolonged ZDV monotherapy can be useful. CD4+ T cell counts showed a significant increase at 3 months with a gradual subsequent decline to below baseline at 18 months. Adverse effect of the drugs, although frequent, did not stop therapy in most patients.

Adolescent↗