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Biomedical subjects

M A Cumsille

Publications and source records attributed to M A Cumsille.

16 recordsLinked to original sources
PubMed2001

[Prevalence of carotid atherosclerosis in patients with cerebrovascular occlusive disease].

BACKGROUND: Hispanics have a greater incidence of stroke and prevalence of intracranial atherosclerosis than whites. AIM: To study the prevalence of extracranial atherosclerosis among patients admitted to a hospital with an ischemic stroke. MATERIAL AND METHODS: A prospective study in stroke patients admitted to a Neurology ward in a University Hospital. All were subjected to a CT scan, carotid duplex-Doppler ultrasonographic examination with Doppler measurement of blood flow velocity, permeability and plaques. Cardiac emboli were searched with transthoracic and transesophageal echocardiography. RESULTS: One hundred ten patients (39 women), aged 67.5 +/- 11.4 years old were studied. Stroke was atherothrombotic in 46 (41.8%), embolic in 30 (27.3%), lacunar in 27 (24.6%) and of other type in 7 (6.4%). Ninety two patients (84.4%) had high blood pressure, 38% had high cholesterol levels, 35% had a cardiac disease and 26% were smokers. Thirty five subjects (31.8%) had a normal carotid ultrasonography, 46 (41.8%) had mural plaques, 16 (14.5%) had multiple plaques without occlusion, 13 (11.8%) had a partial occlusion and 7 (6.4%) had a total occlusion. Logistic regression analysis disclosed no significant relationship between stroke types and carotid atherosclerosis. Age was the only significant predictor for carotid atherosclerosis. CONCLUSIONS: The prevalence of severe carotid atherosclerosis in this group of stroke patients was less than expected.

Aged↗
PubMed2001

[Prognostic factors in colorectal neoplasm. Multivariate analysis in 224 patients].

BACKGROUND: Staging of colorectal carcinoma has prognostic value and allows to take decisions about adjuvant therapy and follow up. Prognostic factors are not universally accepted and there are different staging classifications. AIM: To assess the prognostic value of clinical and pathological variables in 224 patients subjected to a curative resection of a colorectal carcinoma. PATIENTS AND METHODS: A retrospective analysis of 99 men and 125 women, aged 23 to 91 years old subjected to a curative resection of a colorectal carcinoma and followed up for a mean of 72 months. RESULTS: Global survival at 60 months was 72%. Univariate analysis showed that tumor localization, vascular permeation, wall infiltration and number of involved lymph nodes had an influence on survival. A Cox regression model disclosed tumor localization (colon versus rectum), a carcino-embryonic antigen over 30 ng/ml, vascular permeation, presence of 1 to 4 involved lymph nodes, or 5 or more lymph nodes and the presence of an apical lymph node as variables with significant prognostic value. CONCLUSIONS: Our series confirms the prognostic importance of lymph node involvement. This parameter is incorporated in Jass, GITSG (both modifications of Dukes classIfication) and TNM staging scores.

Adenocarcinoma↗
PubMed2000

Quality of life after the menopause: a population study.

OBJECTIVE: To assess the impact of menopause and some sociodemographic variables on quality of life (QoL). MATERIALS AND METHODS: Four hundred and eighty-one women aged 40-59 years attending the Southern Metropolitan Health Service in Santiago de Chile were studied using the Specific Quality of Life Questionnaire for Menopause from Toronto University. RESULTS: Univariate analysis showed that menopausal women have worse QoL scores than women conserving cycles in the four areas of the questionnaire: They show a 10.6-fold higher risk for suffering vasomotor disorders affecting QoL, a 3.5-fold higher risk for psychosocial impairment, a 5.7-fold higher risk for physical disorders, and a 3.2-fold higher risk for sexual disorders (P < 0.0001). Regarding the influence of social markers (age, marital status, school years, work, number of children and sexual activity), housewives were found to have higher, worse, scores than working women in all test components (vasomotor, 3.11+/-1.90 versus 2.57+/-1.71, P < 0.003; psychosocial, 3.44+/-1.59 versus 2.92+/-1.45, P < 0.0007; physical, 3.45+/-1.36 versus 2.96+/-1.20, P < 0.0001; sexual, 3.63+/-2.23 versus 2.49+/-1.95, P < 0.0001). However, logistic regression demonstrated that the only variable found to cause a significant impairment in QoL was menopause. CONCLUSION: Menopause causes a decrease in quality of life, which is independent from age and other sociodemographic variables.

Adult↗
PubMed2000

Enalapril and prednisone in children with nephrotic-range proteinuria.

The effect of enalapril and low prednisone doses on the urinary protein electrophoretic pattern was studied in 13 pediatric patients with glomerular diseases and steroid-resistant nephrotic syndrome. Enalapril was administered at doses of 0.2-0.6 mg/kg per day for 24-84 months, and prednisone was introduced 2 months later in 11 patients at doses of 30 mg/m2 on alternate days. The urine protein electrophoretic pattern showed a reduction of 80% and 70% in the total protein and albumin, respectively, after enalapril. Total urinary protein decreased from 5.46 to 1.1 g/m2 per day (P<0.001). A marked change from a pattern of non-selective urinary protein loss to an albumin-selective proteinuria was observed. Mean total plasma proteins increased from 4.7 to 5.43 g/dl (P<0.001). Four patients became free of proteinuria 24 months after enalapril was started, but only 2 remained free of proteinuria at 48 months of follow-up. The other 11 patients had persistent albuminuria of between 0.5 and 2.6 g/m2 per day with a selective urinary electrophoretic pattern. No additional decrease was observed after steroids were introduced. A clinical improvement in edema was observed in all children. Three patients developed transient acute renal failure, during the course of an infectious disease; 2 developed peritonitis and 1 pneumopathy. In these patients withdrawal of enalapril was necessary until a complete recovery of renal function was observed. Four patients were hypertensive on admission, achieving normal blood pressure 1 month after enalapril was started. No episodes of systemic arterial hypotension were seen. Creatinine clearance and serum potassium showed no statistically significant change.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

Combitube: a study for proper use.

UNLABELLED: The esophageal-tracheal Combitube((R)) (ETC; Kendall-Sheridan Catheter Corp., Argyle, NY) is a new device designed for difficult airways and emergency intubation. The manufacturer recommends that the ETC model 37F SA be used in patients with a height of between 122 and 152 cm. The aim of this study was to evaluate whether ventilation is effective and reliable in patients taller than 152 cm by using the ETC 37F SA in the esophageal position. Also, we evaluated whether the airway protection is adequate and whether direct intubation of the trachea with the ETC inserted in the esophagus is possible. We studied 25 anesthetized, paralyzed adult patients, 150 to 180 cm in height. Methylene blue was given orally to all patients before anesthesia induction. Under direct vision, a ETC 37F SA was inserted in the esophagus of all patients. The pharyngeal balloon inflation volume was titrated to air leak and cuff pressures were measured. During surgery, a laryngoscope was inserted into the pharynx with the pharyngeal balloon deflated and the laryngoscopic view was evaluated by using the Cormack-Lehane scale. The presence of methylene blue in the hypopharynx was investigated by direct laryngoscopic vision. Ventilation was effective and reliable in all 25 patients who were 150 to 180 cm in height (average 169 +/- 7 cm). In addition, a direct relationship between the pharyngeal balloon volume and patient height was established (P < 0.05), by using linear regression models. The laryngoscopic view of the glottis was adequate to allow direct tracheal intubation. No trace of methylene blue was detected in the hypopharynx. The ETC Model 37F SA may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the ETC in the esophageal position in patients with normal airways. The airway protection appears to be adequate. IMPLICATIONS: The esophageal-tracheal Combitube((R)) Model 37F SA (Kendall-Sheridan Catheter Corp., Argyle, NY) may be used in patients from 122 to 185 cm in height. The trachea could be directly intubated with the Combitube((R)) in esophageal position in patients with normal airways. The airway protection appears to be adequate.

Adolescent↗
PubMed2000

[Secondary ionizing radiation generated by digital and analog coronary cineangiographic equipment: influence of external systems of radiologic protection].

BACKGROUND: Exposure to ionizing radiation is a known hazard of radiological procedures. AIM: To compare the emission of secondary ionizing radiation from two coronary angiographic equipment, one with digital and the other with analog image generation. To evaluate the effectiveness of external radiological protection devices. MATERIAL AND METHODS: Environmental and fluoroscopy generated radiation in the cephalic region of the patient was measured during diagnostic coronary angiographies. Ionizing radiation generated in anterior left oblique projection (ALO) and in anterior right oblique projection (ARO) were measured with and without leaded protections. In 19 patients (group 1), a digital equipment was used and in 21 (group 2), an analog equipment. RESULTS: Header radiation for groups 1 and 2 was 1194 +/- 337 and 364 +/- 222 microGray/h respectively (p < 0.001). During fluoroscopy and with leaded protection generated radiation for groups 1 and 2 was 612 +/- 947 and 70 +/- 61 microGray/h respectively (p < 0.001). For ALO projection, generated radiation for groups 1 and 2 was 105 +/- 47 and 71 +/- 192 microGray/h respectively (p < 0.001). During filming the radiation for ALO projection for groups 1 and 2 was 7252 +/- 9569 and 1671 +/- 2038 microGray/h respectively (p = 0.03). Out of the protection zone, registered radiation during fluoroscopy for groups 1 and 2 was 2800 +/- 1741 and 1318 +/- 954 microGray/h respectively (p < 0.001); during filming, the figures were 15,500 +/- 5840 and 18,961 +/- 10,599 microGray/h respectively (NS). CONCLUSIONS: Digital radiological equipment has a lower level of ionizing radiation emission than the analog equipment.

Adult↗
PubMed1999

[Usefulness of free prostate specific antigen in the detection of prostate cancer].

BACKGROUND: The predictive value of prostate specific antigen for prostate cancer, when levels are between 4 and 10 ng/ml, is low. Within these range of values, some authors recommend the measurement of the free fraction of the antigen to improve its predictive capacity. AIM: To evaluate the predictive value of the free fraction in subjects with prostate specific antigen values between 4 and 10 ng/ml. PATIENTS AND METHODS: One hundred and forty subjects with prostate specific antigen between 4 and 10 ng/ml were evaluated. All were subjected to transcrectal ultrasound examination with biopsies and the free fraction of the antigen was measured by enzyme immuno assay. RESULTS: Cancer was diagnosed in 36 subjects, all others had a benign prostatic hyperplasia. Mean prostate specific antigen values were 7.4 and 7.1 ng/ml in patients with cancer and hyperplasia, respectively. The percentage of free prostatic specific antigen was 9.8 and 19.8% in subjects with cancer and hyperplasia respectively (p < 0.001). Using receiver operating characteristic (ROC) curves, a free prostate specific antigen of 13% was the best cutoff value for predicting prostate cancer. CONCLUSIONS: In subjects with prostate specific values between 4 and 10 ng/ml, the measurement of the free fraction of this antigen can improve the predictive value of this parameter for the detection of prostate cancer.

Adult↗
PubMed1999

[Vascular accesses for chronic hemodialysis in children].

BACKGROUND: The success of a chronic hemodialysis program depends on a good vascular access. AIM: To evaluate the experience with vascular accesses for chronic hemodialysis in pediatric patients. PATIENTS AND METHODS: One hundred fifty-one vascular accesses used in 60 pediatric patients (33 female) coming from 2 hemodialysis (HD) centers were analyzed. RESULTS: The average age of admission to the hemodialysis program was 10 years old (range 1.8-15). Forty percent of accesses were internal arterio-venous fistulae (AVF), 58% were central venous catheters and 2% were grafts. Twenty four patients required a central venous catheter from the beginning since they required immediate dialysis. Twenty patients began dialysis with a permeable AVF and never required another vascular access. Eight small children used a central catheter as the only vascular access and 32 patients required both types of vascular accesses. Eighty-seven catheters were used in 34 patients, of which 77 were temporary and 10 permanent. Seventeen patients needed only one catheter and one girl required 15 catheters. The average life span for AVF was 524 days (20-1277), for temporary catheters 34 days (1-76) and for permanent catheters 73 days (9-147). Two years survival of AVF was 95%. One month survival for subclavian and jugular catheters was 50%. Fifty-six percent of AVF had no complications, 12 failed due to insufficient flow and 24% had a complication. Of the 87 catheters placed, 75% had complications and 22 were electively removed. CONCLUSIONS: Arteriovenous fistula is the vascular access of choice for hemodialysis in pediatric patients. Central venous catheters can become an essential access, specially in small children.

Adolescent↗
PubMed1997

The combination of ursodeoxycholic acid and methotrexate for primary biliary cirrhosis is not better than ursodeoxycholic acid alone.

BACKGROUND/AIMS: Many therapies have been tried in primary biliary cirrhosis. It has been suggested that a combination of ursodeoxycholic acid and methotrexate may offer advantages. Because the benefit and safety of this combination is uncertain, we conducted this prospective, randomized, double-blind, controlled trial. METHODS: Twenty-five patients with well-defined primary biliary cirrhosis were randomly assigned to receive either ursodeoxycholic acid (500 mg/day) plus methotrexate (10 mg/week) or ursodeoxycholic acid plus placebo for a period of 48 weeks. Clinical, biochemical and histologic evolution were assessed. RESULTS: In both groups the clinical response was similar and heterogeneous. In patients of ursodeoxycholic acid alone group, biochemical and histologic changes were comparable to those of patients of ursodeoxycholic acid plus methotrexate at 48 weeks. The addition of methotrexate was not associated with substantial adverse affects. CONCLUSIONS: The use of methotrexate in combination with ursodeoxycholic acid was not followed by an additive benefit over ursodeoxycholic acid alone, nor was substantial toxicity added. Unless larger and longer controlled trials with clinical, biochemical and histologic controls show it to be a safe and effective therapy for primary biliary cirrhosis, ursodeoxycholic acid+methotrexate should not be used as a proven and accepted treatment.

Adult↗
PubMed1997

[Assessment of neurotoxic effects of methyl bromide in exposed workers].

BACKGROUND: Methyl bromide is an aliphatic hydrocarbon derivative used as a pesticide that causes skin, kidney, respiratory, liver and neurological damage. AIM: To assess the neurological and psychiatric damage caused by methyl bromide in exposed workers of seed and fruit export industries in a rural area near Santiago. SUBJECTS AND METHODS: We studied prospectively 15 male middle age workers before and after a fumigation period with methyl bromide, that lasted two to four weeks. According to the initial assessment, 5 of these subjects had a chronic exposure to the chemical. As controls, 10 non exposed workers matched for age, sex and working conditions were studied in two occasions. The evaluation included the WHO Neuro Behavior Core Test Battery, dynamometric and vibrator assessment of peripheral nerve function, the Nothingham test for psychological functioning and Titmus test for visual acuity. Methyl bromide levels were measured in blood and urine. RESULTS: Blood methyl bromide levels increased from 13.3 to 30 mg/dl after exposure. Symptoms that appeared with a higher frequency in exposed workers were insomnia, headache, paresthesiae, mood changes and loss of memory and concentration. In these subjects, the threshold for the Vibraton test increased from 2.4 to 2.85 sec, dynamometry showed a strength reduction in the right side from 51.4 to 47.2 kg and there was an increase in the score for negative auto-perception in the Nothingham test from 11.2 to 13.6. No deterioration in these tests were observed in unexposed workers. CONCLUSIONS: Acute and chronic methyl bromide exposure causes important psychological and neurological derangement.

Adult↗
PubMed1996

[Assessment of the use of statistical methods in health research].

BACKGROUND: Computer use has lead to a great development of statistical methods. AIM: To assess the use of statistical methods in Chilean medical literature. METHODS: Two hundred sixty four papers appeared in Revista Médica de Chile and Revista Chilena de Pediatría between 1983 and 1993 were reviewed. RESULTS: Student's "t", Fisher's, and chi 2 test are the most frequently used statistical methods in 67% of papers. Correlation coefficients are used in 10% of papers. Multivariate methods are seldom used. CONCLUSIONS: Statistical analysis of papers published in Chilean medical journals is restricted to very few methods.

Chile↗
PubMed1995

[Results of the surgical treatment of colorectal cancer: analysis of recurrence and survival in 400 patients].

We analyzed retrospectively the long term survival and recurrence of 400 patients with colorectal cancer operated in a period of 13 years. Kaplan Meier curves were used for survival analysis and Cox's regression for multivariate analysis. Ninety eight percent of 377 surviving patients were followed for a mean period of 34 +/- 36 months (range 12-156). Global recurrence was 32% and higher for rectal than colon cancer. Sixty five percent of recurrences were distant. The main prognostic parameter for recurrence was peritumoral lymph node involvement. The initial tumoral stage was the main prognostic factor for survival. Five years survival probability was 94.4% in stage A, 81.3% in stage B, 63.8% in stage C1, 41.3% in stage C2 and 3.1% in stage D. Preoperative radiation therapy did not improve survival or recurrence. Postoperative radiation therapy prolonged the lapse between surgery and recurrence, without changing overall survival. The prolonged survival of some patients in stage D justifies palliative surgery in this stage.

Adult↗
PubMed1993

The immediate effect of the variation of anteroposterior laterotrusive contacts on the elevator EMG activity.

A unilateral maxillary splint divided into three occlusal blocks was built for eight healthy young adults. The three blocks allowed the anteroposterior location of the laterotrusive contacts to vary and to distribute the occlusal force over equivalent periodontal surfaces. The ipsilateral masseteric and temporalis electromyogram (EMG) activities were recorded with surface electrodes during maximal voluntary clenching. The elevator EMG activity with the anterior occlusal block in place was significantly lower than with the intermediate or posterior blocks. The reduction for both elevators with the intermediate block in place did not show a significant variation in comparison to the posterior block of the three blocks inserted. The elevator activity with the three occlusal blocks did not differ from that recorded with the posterior block alone. Neurophysiologic and biomechanical explanations are given related to this laterotrusive elevator muscular behavior.

Adult↗
PubMed1990

[Intrahepatic cholestasis in pregnancy and perinatal risk].

The main purpose of this study was to analyze the accuracy of severity criteria applied in cholestatic jaundice in pregnancy related to health problems in the newborn. The sample, 209 cases, is formed by the total of hospital patients discharges from the Pathologic Pregnancy Unit. Severe cholestatic jaundice (59.3% of cases) presented early itching and impeding premature delivery as the most frequent severity criteria. We found that the greater number of severity criteria, the worse prognosis for the newborn, as shown by birth weight under 2,500 g and Apgar at the minute of 7 or less. Both differences were statistically significant (p = 0.0001; p = 0.0348). No maternal or perinatal deaths were found. Our conclusions are: 1. Severity criteria used in cholestatic jaundice of pregnancy are valied and 2. Clinical management of cases is appropriate, since the major risk reported (perinatal mortality) was absent and maternal and perinatal morbidity were less than those reported in previous studies.

Birth Weight↗