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Biomedical subjects

L Castillo

Publications and source records attributed to L Castillo.

At least 73 records · Page 4Linked to original sources
PubMed1996

[Adequacy of the pharmacologic treatment to the recommendations of a performance protocol in hypercholesterolemia in primary care].

OBJECTIVE: To evaluate whether hypolipaemiant treatment in patients with hypercholesterolaemia (HC) corresponds to the recommendations in a primary care diagnosis and treatment protocol. DESIGN: Descriptive observational study. SETTING: Primary care centre. PATIENTS: 304 patients whose long-term prescription records recorded hypolipaemiant drugs. RESULTS: Average age was 62.7 and 198 were women. 176 presented simple HC and 125 mixed dyslipaemia. 46 had a history of ischaemic cardiopathy. Pre-treatment LDL-cholesterol (LDL-c) was recorded for 224; 168 of them had 2 or more cardiovascular risk factors. Of the 202 who had a record of post-treatment LDL-c, 163 were at level III of risk, which went down to 47 at 6 months. The values before and after medication were as follows: total cholesterol (TC) 290.3 mg/dl and 246.2 mg/dl; LDL-c 207.8 mg/dl and 166.0 mg/dl; HDL-cholesterol 50.5 mg/dl and 53.1 mg/dl; and triglycerides (TG) 156.1 mg/dl and 133.6 mg/dl. Mean reduction of TC and LDL-c was greater in the patients treated with statins that in those treated with fibrates. Decrease in TG was greater with fibrates. CONCLUSIONS: Treatment was initiated when LDL-c figures were over the limit specified in the protocol. In most cases this was because of the accumulation of cardiovascular risk factors.

Adult↗
PubMed1996

Twenty-four-hour intravenous and oral tracer studies with L-[1-13C]phenylalanine and L-[3,3-2H2]tyrosine at a tyrosine-free, generous phenylalanine intake in adults.

The daily rates of whole-body phenylalanine oxidation and hydroxylation were determined in young men receiving [1-13C]phenylalanine and [2H2]tyrosine via primed, constant intravenous (n=3) or oral (n=5) infusion for 24 consecutive hours (12-h fast followed by 12-h fed period), and given a generous phenylalanine (100 mg.kg-1.d-1), tyrosine-free, but otherwise adequate L-amino acid-based diet for 6 d before the tracer study. Our hypothesis was that subjects would be in whole-body phenylalanine equilibrium. Estimates of the daily rates of phenylalanine oxidation (phe-ox) and hydroxylation (phe-OH) were significantly higher for the subjects receiving the oral compared with intravenous tracer (P<0.01 for both comparisons), with the estimates of phe-ox obtained with oral tracer during the 12-h fast period being close to those predicted from similar 24-h leucine kinetic studies. The precision of the agreement between the measured 24-h rates of phe-ox and phe-OH compared with the predicted daily rates by extrapolation from the last hour of the 12-h fast and fifth hour of the fed period was poor. From the 24-h data, daily phenylalanine balances were estimated to be positive for both the intravenous and oral tracer protocols, although it was less positive for the oral tracer group. These results imply that the [13C]phenylalanine probe underestimated whole-body irreversible loss of phenylalanine, and suggest that daily phenylalanine balance in earlier 24-h phenylalanine-tyrosine tracer studies at low phenylalanine intakes may have been overestimated. Studies involving [13C]tyrosine as tracer will be required to further assess whole-body aromatic amino acid balance.

Administration, Oral↗
PubMed1996

A two-dimensional electrophoretic analysis of latex peptides reacting with IgE and IgG antibodies from patients with latex allergy.

Latex proteins from nonammoniated natural rubber latex were investigated for their reactivity with antibodies in the sera of patients with spina bifida and health care workers with allergy to latex. Immunoblots of two-dimensional electrophoresis were used to compare the reactivity of various polypeptides against IgE, IgG, and subclasses of IgG. A total of 79 polypeptides showed reactivity with IgG and IgE antibodies from different patients. IgG showed reactivity with all the 79 polypeptides, while IgE reacted with 56 allergens. IgG2 reacted with the least number of proteins, while IgG4 reacted with the largest number of polypeptides. Several antigens were identified as significant due to their reactivity with antibodies in latex-allergic patients. Four proteins reacted with IgE, IgG1, IgG3 and IgG4 of only spina bifida patients with latex allergy, while one other protein reacted only with health care workers. Thus, these relevant latex peptides may be isolated, purified, and used in various assays for more reliable diagnosis of latex allergy.

Adolescent↗
PubMed1996

[Extracorporeal respiratory assistance. Experience in the treatment of severe acute respiratory failure].

Acute respiratory distress syndrome (ARDS) secondary to systemic injury has a high mortality. Symptomatic treatment with mechanical ventilation, PEEP and high levels of inspired oxygen is effective for most of the patients. When ventilatory support fails in reversing hypoxemia, extracorporeal respiratory assistance has been advocated as a temporary treatment until lung repair occurs. We described our experience in eleven patients (9M, 2F, 41 +/- 16 yo) with severe ARDS refractory to conventional treatment and expected to die if not assisted with extracorporeal oxygenation. All patients required invasive monitoring; seven needed continuous renal therapy because of concurrent renal failure. Venous-venous percutaneous cannulation and systemic anticoagulation were performed and extracorporeal oxygenation and CO2 removal started with blood pump flows of 20 to 30% of patient cardiac output. Improved oxygenation and decreased CO2 levels were immediately observed in 10/11 patients. One patient failed to have reversal of hypoxemia because recirculation and died shortly after initiation of extracorporeal therapy. Plasma leak syndrome and bleeding were observed in 3 and 2 patients respectively. Extracorporeal assistance was maintained for 52 +/- 34 h (19-134). Five (45%) patients were weaned off the pump and two (18%) survived and were discharged. Despite the high cost, extracorporeal respiratory assistance, when applied to selected patients, can reverse hypoxia and may save some previously unsalvagable patients, allowing them to return to a normal life.

Acute Disease↗
PubMed1996

[Prolonged inhalation of nitric oxide in adult respiratory distress syndrome in a case].

Inhalation therapy with nitric oxide has been suggested as beneficial in the adult respiratory distress syndrome, however there are few reports of its prolonged use. We report a patient with a chronic lymphocytic leukemia that developed an adult respiratory distress syndrome with severe hypoxemia, refractory to conventional therapeutic measures, during the course of a septic shock. The patient received nitric oxide (19 ppm) improving arterial oxygen saturation and allowing the reduction of FiO2 to 40%. The patient died five days later due to a multiple organ failure.

Aged↗
PubMed1996

Arginine: new and exciting developments for an "old" amino acid.

Arginine (2-amino-5-guanidino pentanoic acid) was shown in 1895 by Hedin to be present in the proteins of horn. Metabolic nitrogen balance studies, conducted in 1957 by Rose in human adults and in 1959 by Snyderman and coworkers in young infants revealed that a dietary source of this amino acid was not an obligatory requirement for growth and maintenance of nitrogen homeostasis in healthy individuals. Hence, it was initially classified as a non-essential (dispensable) amino acid and, perhaps, for reasons of this classification arginine did not receive the earlier attention it now deserves, in relation to an understanding of the nutritional biochemistry and physiology of its metabolism in humans subjects. However, there is currently a considerable interest in the cellular and tissue functions, as well as clinical, therapeutic significance, of arginine. In this paper we review the multiple functions of arginine, including its role in the L-arginine-nitric oxide pathway, cellular regeneration, immune function, protein synthesis and protein breakdown. We then consider some in vivo aspects of the physiology of arginine metabolism, which varies greatly among eukaryotes, with particular reference to humans. Against this background, studies of arginine in the nutrition of humans under various pathophysiological conditions are reviewed briefly. Finally, a new, updated concept for the metabolic basis for the "conditional essentiality" of arginine is proposed.

Arginine↗
PubMed1996

[Systemic leptospirosis as a cause of multiple organ failure. Report of a case].

Leptospirosis is a world-spread zoonosis that is incidentally acquired by humans. It causes a diphasic febrile illness in which the Weil syndrome is its severest form, with renal, hepatic, clotting and central nervous system involvement. We report a 73 years old male, that was admitted to an intensive care unit with multiple organ failure due to leptospirosis. The clinical picture initially resembled a sepsis due to biliary tract obstruction and was operated, not finding a biliary tract obstruction. Considering the history of a fall to sewed waters, leptospirosis was suspected and treatment with penicillin was started, obtaining a full recovery of the patient.

Abdominal Pain↗
PubMed1996

Complications of endoscopically guided sinus surgery.

The authors reviewed a series of 553 consecutive patients who underwent endoscopically guided sinus surgery. Major complications occurred in six patients (2.2%). There was one death due to incorrect positioning of the frontal drain. One patient developed a cerebrospinal fluid leak which had to be closed with an osteomucosal graft. Two patients who developed severe bleeding after removal of the nasal packing, needed ligation of the sphenopalatine artery and the internal maxillary artery, respectively. Two patients developed a complete stenosis of the nasolacrimal duct, necessitating a dacryocystorhinostomy. Minor complications occurred in 36 patients (13.4%). These included damage to the lamina papyracea (n = 11), severe bleeding after removal of the nasal packing treated conservatively (n = 6), intranasal mucosal adhesions (n = 17), and atrophic rhinitis (n = 2). The aetiology, prevention and treatment of complications during and after sinus surgery are also discussed.

Adolescent↗
PubMed1996

[New strategies in the surgery of primary hyperparathyroidism].

Although a remarkable pathology in terms of morbidity and life expectancy, primary hyperparathyroidism remains nonetheless a poorly recognized state despite highly suggestive clinical polymorphism, reliable biological signs and performing imaging for localisation. Through a retrospective study of a series of 129 patients surgically treated for primary hyperparathyroidism over a period of 12 years, helped by a review of the literature, we are able to propose an adapted surgical strategy for every different clinical aspect of this pathology (adenoma, benign hyperplasia, carcinoma). This strategy is guided by specific pre-operative findings and the Sestamibi scintigraphy.

Adenoma↗
PubMed1996

[Inhibition of the nitric oxide pathway in refractory septic shock].

AIM: To assess the acute effects of methylene blue infusion, an inhibitor of nitric oxide synthesis, on hemodynamic parameters in patients with refractory septic shock. PATIENTS AND METHODS: Fourteen patients admitted to intensive care units with septic shock of diverse etiologies and unable to maintain median arterial pressures over 60 mm Hg with the use of at least 2 vasoactive drugs, were studied. All received a 1 mg/kg bolus of methylene blue Hemodynamic parameters were measured before and 30, 60, 120 and 180 min after the bolus. RESULTS: Systolic and diastolic blood pressure and systemic vascular resistance increased in all patients. There were no significant changes in cardiac output, oxygen consumption or extraction. CONCLUSIONS: Methylene blue has an acute pressor effect in patients with septic shock.

Adult↗
PubMed1996

[Patients with acute adult respiratory distress syndrome: effects of inhaled nitric oxide on gas exchange and hemodynamics].

BACKGROUND: Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. AIM: To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome. PATIENTS AND METHODS: Twelve patients with adult respiratory distress syndrome, were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. RESULTS: At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIO2 ratio from 89 +/- 32 to 111 +/- 43 mm Hg and a 16% reduction of lung shunting (Qs/Qt). CONCLUSIONS: Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome.

Administration, Inhalation↗
PubMed1995

Response of failing canine and human heart cells to beta 2-adrenergic stimulation.

BACKGROUND: Failing human hearts lose beta 1- but not beta 2-adrenergic receptors. In canine hearts with tachypacing failure, the ratio of beta 2- to beta 1-adrenergic receptors is increased. The present study was designed to determine whether heart failure increases sensitivity to beta 2-adrenergic stimulation in isolated canine ventricular cardiomyocytes and to verify that myocytes from failing human ventricles contain functional beta 2-adrenergic receptors. METHODS AND RESULTS: Myocytes from healthy dogs, dogs with tachypacing failure, and human transplant recipients were loaded with fura 2-AM and subjected to electric field stimulation in the presence of zinterol, a highly selective beta 2-adrenergic agonist. Zinterol significantly increased [Ca2+]i transient amplitudes in all three groups. The failing canine myocytes were significantly more responsive than normal to beta 2-adrenergic stimulation. We also measured isotonic twitches, indo-1 fluorescence transients, and L-type Ca2+ currents in healthy canine myocytes. Zinterol (10(-5) mol/L) elicited large increases in the amplitudes of simultaneously recorded twitches and [Ca2+]i transients. Zinterol also increased L-type Ca2+ currents in the normal canine myocytes; this augmentation was abolished by 10(-7) mol/L ICI 118,551. cAMP production by suspensions of healthy and failing canine myocytes was not increased by zinterol (10(-9) to 10(-5) mol/L), nor did 10(-5) mol/L zinterol elicit phospholamban phosphorylation. CONCLUSIONS: Failing human ventricular cardiomyocytes contain functional beta 2-adrenergic receptors. Canine myocytes also contain functional beta 2-adrenergic receptors. The canine ventricular response to beta 2-agonists is increased in tachypacing failure. Positive inotropic responses to beta 2-stimulation are not mediated by increases in cAMP or cAMP-dependent phosphorylation of phospholamban.

Adrenergic beta-Agonists↗
PubMed1995

Plasma arginine and leucine kinetics and urea production rates in burn patients.

We measured plasma arginine and leucine kinetics and rates of urea production (appearance) in 12 severely burned patients (mean body surface burn area, 48%) during a basal state (low-dose intravenous glucose) and while receiving routine, total parenteral nutrition ([TPN] fed state) including an L-amino acid mixture, supplying a generous level of nitrogen (mean, 0.36 g N.kg-1.d-1). The two nutritional states were studied in random order using a primed 4-hour constant intravenous tracer infusion protocol. Stable-nuclide-labeled tracers were L-[guanidino-13C]arginine, L-[1-13C]leucine, [18O]urea, and NaH13CO3 (prime only), with blood and expired air samples drawn at intervals to determine isotopic abundance of arginine, citrulline, ornithine, alpha-ketoisocaproate ([KIC] for leucine), and urea in plasma and 13CO2 in breath. Results are compared with data obtained in these laboratories in healthy adults. Leucine kinetics (flux and disappearance into protein synthesis) indicated the expected higher turnover in burn patients than in healthy controls. Mean leucine oxidation rates are also higher and compared well with values predicted from urea production rates, provided that urea nitrogen recycling via intestinal hydrolysis is taken into account. The plasma urea flux was also higher than for normal subjects. Arginine fluxes as measured in the systemic whole body, via the plasma pool, were correspondingly higher in burned patients than in healthy controls and were in good agreement with values predicted from leucine-KIC kinetics. However, systemic whole-body arginine flux measured via the plasma pool was only 20% of the arginine flux estimated from the urea flux plus the rate of protein synthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Development of highly specific monoclonal antibodies for the diagnosis of Vibrio cholerae 01.

We report here the development of two monoclonal antibodies, termed 5G8 and 5C12, belonging to the IgM and IgG1 class, respectively, suitable for the identification of Vibrio cholerae 01 in clinical and environmental samples. The specificities of the monoclonals were evaluated by ELISA and indirect immunofluorescent microscopy of microorganisms normally present in stool samples and with two bacterial panels. One panel included 72 potentially antigenically related bacterial strains and the second panel included 20 pathogenic bacterial strains involved in diarrhea cases. The results of these extensive analyses indicate that monoclonal antibodies 5G8 and 5C12 are highly specific and suitable for the clinical diagnosis of Vibrio cholerae 01 in human stool samples by indirect immunofluorescent microscopy. Although the antigenic sites recognized by these antibodies were not identified in this study, the observation of Western blot patterns suggested that 5G8 and 5C12 monoclonal antibodies bind to LPS epitopes, a good structural marker for the detection of V. cholerae 01 because it is present in all bacterial cell walls.

Animals↗