HIV-1 infection and cognitive impairment in minority groups.
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AIDS Dementia Complex↗
Biomedical subjects
M Concha
Publications and source records attributed to M Concha.
HIV-1 infection and intravenous drug use: longitudinal neuropsychological evaluation of asymptomatic subjects.
A previous baseline cross-sectional comparison of cognitive performance of a group of AIDS-free, HIV-seropositive intravenous drug users with seronegative control intravenous drug users revealed no significant differences attributable to HIV. We now present longitudinal follow-up results from the same cohort of 160 intravenous drug users. There were no differences in performance by serostatus group at either 6- or 12-month follow-up visits, although differences by age and education were observed. Improvement in performance secondary to practice effects was comparable in both serostatus groups. These findings confirm that chronic intravenous drug use may be associated with a wide range of neuropsychological deficits, but there is no evidence that such preexisting deficits interact with HIV infection to produce additional cognitive impairment in otherwise asymptomatic intravenous drug users. Together with results from other high-risk groups such as homosexual/bisexual men and hemophiliacs, these results confirm that neurocognitive abnormalities during the presymptomatic stages of HIV infection are rare, regardless of the route of acquisition of the virus.
Adult↗
Myocardial damage following coronary bypass surgery: assessment with antimyosin antibody uptake.
To assess the role of 111In antimyosin antibody (AbAm) in the delineation of myocardial damage following coronary bypass surgery, we studied 51 consecutive patients who underwent coronary surgery, 27 of whom had a history of prior myocardial infarction. All patients underwent a diagnostic protocol comprising: (1) 99Tcm pyrophosphate (PYP) and AbAm injection 48 h after surgery (AbAm imaging 24 and 48 h post-injection) (myocardial/background and myocardial/lung ratios were obtained respectively from the computer image); (2) Radioimmunoassay (RIA) serum CK-B levels from samples obtained immediately before surgery, and 24 and 48 h later; (3) clinical and ECG follow-up. Twenty-five patients showed positive AbAm studies, 10 had positive PYP images, and 21 had CK-B levels above normal limits at 24 h. One patient with abnormal AbAm, PYP and CK-B studies had new Q waves on the ECG after surgery. This patient was considered to have sustained a peri-operative myocardial infarction. The large number of positive AbAm studies probably reflects myocardial damage frequently associated with coronary bypass surgery.
Antibodies↗
Spontaneous clinical and hemodynamic improvement in patients on waiting list for heart transplantation.
Heart transplantation is currently the most effective therapy for patients with severe heart failure due to dilated cardiomyopathy, although long-term survival without transplantation has been described in a few patients. We have identified five patients with severe heart failure who experienced a significant clinical and hemodynamic improvement while they were waiting for heart transplantation. At initial assessment, all five patients were symptom-class 4; left ventricular end-diastolic pressure was 33 +/- 4 mm Hg, left ventricular ejection fraction was 0.20 +/- 0.01, left ventricular end-systolic volume was 130 +/- 3 ml/min/m2, and cardiac index was 2.1 +/- 0.1 L/min/m2. These patients showed a marked improvement at two to ten months after initial assessment, while they were waiting for a donor heart. After a follow-up of 10 to 31 months (mean follow-up, 20 months), the five patients were still alive and their clinical and hemodynamic condition remained stable. On the contrary, survival was less than 15 percent at six months for the remaining patients with indications for heart transplantation but in whom transplant could not be performed because of the existence of contraindications or lack of donors; all these patients were dead at 18 months after initial assessment. The five patients who developed spontaneous favorable outcome showed a trend to have higher serum sodium values, shorter symptomatic history, lesser need for intravenous inotropic support, and better response to medical therapy than the other patients. Our findings suggest that some patients with transplants could have experienced a sustained and spontaneous clinical and hemodynamic recovery with medical therapy alone, although it seems currently difficult to identify patients with this favorable outcome.
Adult↗
[Spontaneous remission in a patient with long-term idiopathic dilated myocardiopathy].
The case of a patient with long-term idiopathic dilated cardiomyopathy, functional class IV, very depressed left ventricular ejection fraction (13%) and history of severe dyspnea for more than four years, who experienced an spontaneous clinical and hemodynamic recovery (functional class I, left ventricular ejection fraction 51%) while being on waiting list for heart transplantation is reported. The patient remains in good clinical condition after a follow-up of two years.
Cardiomyopathy, Dilated↗
Cellular and subcellular distribution of 2,4-dinitrophenyl groups in mouse epidermis and regional lymph nodes after epicutaneous application of 2,4-dinitrofluorobenzene.
The cellular and subcellular distribution of 2,4-dinitrophenyl (DNP) groups in the epidermis and regional lymph nodes of the mouse was investigated after epicutaneous application of 2,4-dinitrofluorobenzene (DNFB) to sensitized and non-sensitized mice. The peroxidase-antiperoxidase method and the immunogold technique were used to visualize the DNP groups at both light and electron microscopic levels. The highest intensity of immunolabelling was found on tonofilaments of keratinocytes present in the upper layers of the epidermis. On the other hand, in vitro experiments showed that DNFB has the capacity to bind keratin which, together with immunocytochemistry, suggests that this molecule may be one of the skin protein carriers for DNFB. In addition, intense immunostaining for DNP was observed in the Golgi area of some epidermal Langerhans cells. Cells immunoreactive to DNP were also observed in the marginal sinus of cervical lymph nodes 6, 12 and 24 h after challenge. Immunoelectron microscopy revealed immunoreactive DNP groups in phagosomes of Langerhans cells at this site. The present findings support the hypothesis that the hapten DNFB penetrates passively into the cytoplasm of Langerhans cells, concentrates in the Golgi area and, during the migration of Langerhans cells to the lymph nodes, it is probably processed in the lysosomes before its presentation to T lymphocytes.
Animals↗
Anesthesia for elective cardioversion: a comparison of four anesthetic agents.
Elective cardioversion is a short procedure performed under general anesthesia for the treatment of cardiac dysrhythmias. Selection of the anesthetic agent is important, because a short duration of action and hemodynamic stability are required. Forty-four patients scheduled for elective cardioversion in the coronary care unit were studied prospectively. All patients were randomly assigned, according to the last digit of their clinical record number, to receive one of the four anesthetic agents studied: group 1, 12 patients who received 3 mg/kg of sodium thiopental; group 2, 10 patients who received 0.15 mg/kg of etomidate; group 3, 12 patients who received 1.5 mg/kg of propofol; and group 4, 10 patients who received 0.15 mg/kg of midazolam. All patients also received 1.5 micrograms/kg of fentanyl 3 minutes before induction. All four drugs provided satisfactory anesthesia for cardioversion and there were no major complications. Midazolam produced a more prolonged duration of effect and more interindividual variability. Propofol was associated with hypotension and a higher incidence of apnea, and its duration of action was similar to that of etomidate or thiopental. Etomidate produced myoclonus and pain on injection; however, it was the only agent that did not decrease arterial blood pressure. Thiopental reduced blood pressure but otherwise seemed an appropriate anesthetic for this procedure. In conclusion, all four anesthetic agents were acceptable for cardioversion, although their pharmacological differences suggest specific indications for individual patients.
Adult↗
[Myocardial revascularization and complete correction of tetralogy of Fallot in an adult. A case report].
The case is reported of a 62 year-old male having a clinical history of grade II dyspnoea from 9 year ago and recently showing grade II angina. He had presented mild cyanosis. Suspecting the existence of coronary arteriosclerosis, and with the clinical diagnosis of tetralogy of Fallot based particularly on two-dimensional and M-mode echocardiography, and angio-hemodynamic study was made which confirmed the presence of congenital heart disease and also revealed significant coronary lesions of the circumflex and right coronary arteries. The patient underwent surgery which involved complete correction of the tetralogy of Fallot and the placing of two aortocoronary grafts onto the circumflex and right coronary arteries. Favorable progress was noted both immediately after operation and 6 months later. Although cases have been described of Fallot disease associated with acute myocardial infarction, we believe that this is the first time a patient has undergone myocardial revascularization at the same time as undergoing complete correction of the congenital heart disease.
Coronary Artery Bypass↗
Aberrant right subclavian artery associated with common carotid trunk. A rare cause of vascular ring.
We have reviewed four cases of incomplete vascular rings caused by the presence of a common carotid trunk from which arose both carotid arteries associated with an aberrant right subclavian artery. The patients were aged between 3 and 9 months. All patients presented with recurrent respiratory tract infections. Three patients showed signs of malnutrition and failure to thrive caused by episodes of bronchial aspiration from extrinsic compression of the oesophagus. One patient presented with dyspnoea induced by feeding and another had stridor. A common carotid trunk associated with an aberrant subclavian artery was confirmed in all cases. No other associated anomaly was observed in any patient. Ligature and section of the anomalous right subclavian artery was performed in all patients. The low incidence of this type of vascular ring, its physiopathological mechanism and surgical management are discussed.
Carotid Arteries↗
[Use of non radioactive probes to assess gene copy numbers and for the diagnosis of molecular diseases].
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Biotin↗
[Nontraumatic deaths associated with a natural catastrophe. The experience of the earthquake in Chile 1985].
We analyzed causes of death before and after the March 1985 earthquake in Valparaíso, Chile. Causes of death were obtained from death certificates. Apart from death directly due to trauma during the earthquake, a significant increase was observed in deaths due to accidents (+51), cardiovascular disease (+38), malnutrition (+13) and psychiatric disorders (+13). Retired males over age 65 were most affected.
Adolescent↗
A comparison of repair and replacement for mitral stenosis with partially calcified valve.
From January 1978 to December 1987 we operated on 135 patients with calcified mitral stenosis. In 60 patients a conservative operation was performed (group I). Nine patients required mitral annuloplasty associated with the commissurotomy. The other 75 patients underwent mitral valve replacement (group II). In 37 patients a mechanical prosthesis was used and in 38 a biologic one. The patients given mitral valve replacement had a more heavily calcified valve than those undergoing a conservative procedure. Twenty-one patients (12 from group I and 13 from group II) required associated tricuspid annuloplasty. The mean follow-up time was 69.1 months (1 months to 10 years). There were no significant differences between the two groups in terms of operative death (0% and 4%, respectively), postoperative functional class, actuarial survival rate at 10 years (84% and 96%, respectively), and probability of freedom from thromboemboli at 10 years (98% and 96%, respectively). However, the probability of freedom from reoperation at 10 years significantly favored the conservative surgery group (84% and 69%, respectively, p less than 0.01). Finally, the probability of freedom from complications at 10 years was also significantly higher in the conservative surgery group (82% and 64%, respectively, p less than 0.005). Because of these results we believe that conservative surgery is, at present, a better alternative than mitral valve replacement for patients with partially calcified mitral stenosis.
Actuarial Analysis↗
Interaction of cibacron blue and anilinonaphthalenesulphonate with lipoproteins provides a new means for simple isolation of these plasma proteins.
The selective interaction of serum proteins with immobilized Cibacron Blue and the binding properties of the dye anilinonaphthalenesulphonate has been used to separate albumin and lipoproteins by affinity chromatography. The novel binding of anilinonaphthalenesulphonate to lipoproteins from the sera of lamprey, fish and mammals provides a simple procedure for the isolation of these plasma proteins, and permit preparation of specific antisera, tools particularly relevant for evolutionary and clinical studies.
Anilino Naphthalenesulfonates↗
Tropical spastic paraparesis in Colombia.
A high-incidence focus of tropical spastic paraparesis (TSP) occurs on the South Pacific coast of Colombia. Of 55 patients studied, 52 (94.5%) had IgG antibodies to the human T-cell lymphotropic virus type I (HTLV-I) in serum and/or cerebrospinal fluid. Control groups did not show similar high positivity. Our results suggest that HTLV-I or other antigenically related retroviruses may be the cause of TSP in Colombia. Similar clinical, laboratory, and epidemiological findings have been reported in widely remote geographical regions of the world, with very similar clinical pictures of TSP in all high-incidence regions. The demonstration of IgG antibodies in serum and cerebrospinal fluid of patients with TSP in the Caribbean and Seychelles Islands, southern Japan, and the Ivory Coast indicate that the HTLV-I retrovirus could be the cause of this "tropical" myeloneuropathy.
Adolescent↗
Epidemiology of tropical spastic paraparesis in Columbia and associated HTLV-I infection.
The clinical syndrome earlier designated as paraparesia espástica del Pacífico is an isolated form of tropical spastic paraparesis (TSP) that was reported in 1981 in the southern Pacific lowlands of Columbia in and near Tumaco. The clinical features are similar to those of TSP reported in Jamaica, Martinique, the Seychelles, and the Ivory Coast of Africa and resemble also those clinical features of the human T-lymphotropic virus type I (HTLV-I)-associated myelopathy described in southern Japan. Since HTLV-I infection is closely associated with TSP, we conducted a case-control study to evaluate the role of HTLV-I-associated risk factors among patients from the endemic focus in Tumaco, Colombia, and the seroprevalence rates of this virus in other geographical areas of the Pacific Colombian lowlands with and without TSP. From our seroprevalence study of antibodies to HTLV-I among TSP index patients, matched controls, household contacts (first- and second-degree relatives), and healthy controls from these areas, we found a strong association between HTLV-I and TSP. Also, there is a high seroprevalence of HTLV-I among sexual partners of patients and to a lesser extent among their offspring and other relatives some of whom had an early mean acquisition of antibodies to HTLV-I. Heterosexual promiscuity and other close interpersonal contact may play an important role in the transmission of TSP in the Pacific lowlands of Colombia.
Adolescent↗
Ultrastructural characteristics of the contact zones between Langerhans cells and lymphocytes.
The present work was carried out to look for the ultrastructural substrate of the contact zones between Langerhans cells and lymphocytes. A high resolution electron microscopic analysis of the contact zones between Langerhans cells and lymphocytes was performed. The material used for this study was obtained from experimental contact dermatitis in mice, and human cervical squamous carcinoma and mycosis fungoides. Three types of cell-cell binding were found. Type I is a junction-like structure characterized by the presence of intercellular bridges. It is suggested that this contact might represent a fixation mechanism between the two cells. Type II is characterized by a glycocalyx-glycocalyx continuity. An immunological function--recognition and antigen presentation--is proposed for this type of contact. Type III is a septilaminar tight contact area which seems to be a gap junction. It is suggested that all these types of physical contact might be the morphological expression of interaction between antigen presenting cells and lymphocytes.
Animals↗
Biochemical hypothyroidism and myocardial damage in organ donors: are they related?
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Brain Death↗
[Congenital fistula between the left subclavian artery and the innominate vein. A rare cause of intractable insufficiency in the newborn infant].
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Arteriovenous Malformations↗