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Biomedical subjects

M Melero

Publications and source records attributed to M Melero.

18 recordsLinked to original sources
PubMed1995

Idiopathic dialysis ascites in the nineties: resolution after renal transplantation.

The incidence of idiopathic dialysis ascites seems to have decreased since the introduction of more effective techniques for control of fluid overload and uremia in chronic hemodialysis patients. Most of the patients reported so far had some predisposing factor, such as malnutrition or sustained fluid overload. We report a case of idiopathic dialysis ascites in a young well-nourished woman with an excellent control of fluid overload and in whom biocompatible dialyzer membranes and volumetric controlled ultrafiltration had been used since her onset of chronic dialysis. Extensive studies excluded the existence of an underlying cause for ascites. Ascitic fluid had the characteristics of an exudate, and a peritoneal biopsy specimen showed chronic nonspecific inflammatory changes. Massive ascites persisted for 6 months, requiring repeated paracentesis, until the performance of a successful renal transplantation. Coinciding with the recovery of renal function, a dramatic disappearance of ascites was observed.

Adult↗
PubMed1995

[Malignant peritoneal mesothelioma. An infrequent cause of prolonged fever syndrome and leucocytosis in a young adult].

Peritoneal mesothelioma is a rare neoplasia usually associated with exposure to asbestos. The incidence in the population not in contact with asbestos is of one per million per year. The disease is most common in males over the age of 40, with signs and symptoms of neoplasic disease together with abdominal pain and ascitis with or without a palpable abdominal mass. We report the case of a young male without a history of exposure to asbestos who presented with prolonged fever, leukocytosis and a septated peritoneal exudate. With a presumptive diagnosis of peritoneal tuberculosis, the patient received empirical antituberculosis treatment. Because the clinical picture persisted and microbiological studies remained negative, a second exploratory laparotomy was performed which demonstrated the presence of a malignant epithelial peritoneal mesothelioma.

Adult↗
PubMed1995

[Afebrile infections in adult patients with acute leukemia].

Characteristics of afebrile infection episodes among adult patients with acute leukemia are here described. Afebrile episodes represented 14.3% of all infections. They significantly differed from the febrile episodes because: 1) they prevailed among patients with granulocyte count greater than 500/mm3 (p < 0.001); 2) they often involved patients in complete remission (p < 0.0002); 3) they affected more frequently the kidney and urinary tract than febrile infections (p = 0.0005) and 4) they lacked lung involvement (p < 0.01). The rate of documented infections by cultures, cytology or serological tests was not different between both infection types. Observed mortality during afebrile episodes was threefold less than febrile infections; this difference, however, did not reach statistical significance. In conclusion, afebrile infection in acute leukemia is a distinct clinical entity, unlike febrile infection.

Adolescent↗
PubMed1994

[Neurologic complications by cocaine abuse].

Argentina is facing an increase in cocaine use by adolescents and young adults from every socioeconomic background. It is calculated that up to 10% of all cocaine passing through this country is locally sold and consumed. Nevertheless, local information describing common cocaine-related neurological events is scarce. From August 1988 to March 1993, 13 patients were evaluated with neurological disease associated with cocaine abuse. Among these 13 patients (Table 1), the mean age was 29; 70% were men. Patients most commonly used the nasal route (snorting). Concomitant abuse of other intoxicants, especially alcohol, was frequent (85%). The major neurological complications included one or more seizures (n = 7), ischemic stroke (n = 2) (Fig. 1-2), hemorrhagic stroke (n = 2) associated with arteriovenous malformation (Fig. 3a-b), memory disturbances (n = 1) and paroxysmal dystonia (n = 1). Psychiatric complaints were present in all patients. Mortality was not observed. There was no correlation between the appearance of complications and the amount of cocaine used, or prior experience with this drug. Only one of the 7 patients with seizures had a previous history of seizures. All had generalized tonic-clonic seizures, and one had concomitant absence episodes. Cocaine modulates central neurotransmitters and has direct cerebrovascular effects. The neurological complications appear to be related to cocaine hyperadrenergic effects, striatal dopaminergic receptor hypersensitivity and perhaps vasculitis. Structural changes in the brain of long-term cocaine abusers could explain the persistence of neurologic symptoms after drug withdrawl.

Adolescent↗
PubMed1994

L-dopa malabsorption in a parkinsonian patient with Strongyloides stercoralis duodenitis.

We report a parkinsonian patient initially responding to L-dopa who developed a severe loss of drug efficacy due to Strongyloides stercoralis duodenitis. The patient was put on mebendazole and metronidazole, and the parasitosis abated, allowing L-dopa reduction by 33%. Our patient illustrates the advisability of searching for Strongyloides stercoralis when L-dopa malabsorption is suspected in Parkinson's disease.

Aged↗
PubMed1992

[Tuberculosis in patients with lymphomas].

In a period of ten years (1980-1989) 6 patients, out of 506 cases of lymphoma, presented an active tuberculosis (1.18%). Five of them had Hodgkin disease in an advanced stage, with predominance of the nodular sclerosis histologic subtype; one had a non Hodgkin lymphoma. Clinical presentation of TBC was mostly focal with a predominance of extra pulmonary involvement (cervical tuberculous lymphadenitis); disseminated disease only appeared in the non Hodgkin lymphoma patient. There was no difference in the severity of the infection when it appeared either before or after multiagent therapy of the hematologic malignancy. There was clinical suspicion of TBC in all of the pulmonary forms of the disease; lymph node tuberculosis, without drainage of caseous material, was a finding related to the routine culture of lymphatic tissue. In biopsy material, in which Mycobacterium tuberculosis was isolated, neither epithelioid cell granulomas with caseation necrosis nor acid-fast bacilli were histopathologically documented. No mortality due to tuberculous infection was registered in this group. TBC prevalence in these lymphoma patients was 1185.7 per 100,000; compared with the prevalence of this disease in the general population (52.3 per 100,000) a significant difference is demonstrated (p < 0.0001) and it is related to Hodgkin lymphoma.

Adolescent↗
PubMed1991

Hepatitis delta virus RNA detection in chronic HBsAg carriers with and without HIV infection.

Hepatitis delta virus (HDV) RNA detection was carried out, using a full-length HDV RNA probe, in serum of 43 patients with chronic HDV infection. Among them, 30 cases (70%) were HDV RNA-positive. With respect to other HDV markers, serum HDAg (detected by immunoblot) was found in 33 patients (77%) and IgM anti-HD in 29 (67%). A similar percentage of HDV RNA-positive patients with and without circulating hepatitis B virus (HBV) DNA (32.5 vs. 37%, respectively) was found. Antibodies against the human immunodeficiency virus (HIV) were detected in 15/43 subjects studied. The presence of HDV RNA was significantly higher (p less than 0.05) in anti-HIV-seropositive cases (93%) than in the HIV-seronegative ones (57%). Moreover, simultaneous HDV and HBV replication was found more frequently (60 vs. 18%, p less than 0.05) and at higher levels among the anti-HIV-positive patients than in the rest. In addition, in most of the anti-HIV-positive subjects, HDV RNA and HBV DNA were constantly positive during a whole year of follow-up.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Detection of antibody to calmodulin in chronic viral hepatitis: lack of correlation with virus replication and hepatocellular damage.

We have analyzed the presence of IgG and IgM anti-calmodulin antibodies (anti-CaM) by ELISA in patients with chronic hepatitis due to B, delta and C viruses as well as in patients with other liver diseases. The specificity of the assay was demonstrated by preadsorption of positive serum with calmodulin (CaM) but not with myosin light chain. Among 164 patients with chronic viral hepatitis (B, delta and C) and 50 with non-viral hepatitis, 27 and 26%, respectively, had auto antibodies against CaM. There was a significantly increased frequency (37%) of these auto-antibodies in chronic delta infection as compared to that (21%) of patients with chronic B hepatitis (p less than 0.05). An intermediate incidence of anti-CaM, (24%) was found in chronic C infection. The frequency of anti-CaM was not related to the level of hepatitis B virus (HBV) or hepatitis delta virus (HDV) replication. A high occurrence of anti-CaM in the presence of liver membrane antibody (p less than 0.03) was observed. During follow-up of patients with chronic delta-hepatitis, the presence of anti-CaM was consistently observed, when the isotype was IgM, but transiently when it was IgG. The occurrence of anti-CaM correlated neither with ALT levels nor with histological diagnosis. Antibodies to CaM, are present in liver diseases especially in chronic delta-hepatitis, and do not play a pathogenic role on hepatocellular damage.

Adolescent↗
PubMed1991

[Hepatic fascioliasis. Uncommon cause of prolonged febrile syndrome with hypereosinophilia and hypodense images on computed tomography of the liver].

A 40 year old man was admitted with prolonged fever, hypereosinophilia, increased serum levels of cholestasis enzymes and low density masses in the hepatic computed tomography (CT). A liver needle biopsy was performed under CT control. Neoplastic, pyogenic or amoebic etiology were excluded. Stool parasitologic examination was also negative. A diagnosis of hepatic fasciolasis was based on the finding of operculate eggs in duodenal juice obtained by duodenal aspiration. The patient was successfully treated with triclabendazole (10/mg/kg/single dose). The purpose of this communication is to emphasize 1) that prolonged fever with hypereosinophilia and focal lesions in hepatic CT suggest the presence of fasciola hepatica which must be investigated particularly in duodenal juice; 2) the CT aspects of this disease; 3) that triclabendazole, a benzimidazolic compound, is a new therapeutic possibility acting on immature and adult forms of the parasite in the liver.

Adult↗
PubMed1991

[Adjunctive treatment with hyperbaric oxygen in a patient with rhino-sinuso-orbital mucormycosis].

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.

Adult↗
PubMed1990

Detection of HDV-RNA by PCR in serum of patients with chronic HDV infection.

In this paper, we studied the usefulness of polymerase chain reaction (PCR) in HDV-RNA detection. Using serial dilutions of serum samples of known concentrations of HDV-RNA, PCR was 10,000-times more sensitive than slot-blot hybridization. PCR was used for the detection of HDV-RNA in 33 serum samples negative to HDV-RNA by conventional slot-blot hybridization. HDV-RNA was detected in 18/33 (54%) of the samples included in this study using PCR. When positivity to a viral genome was related to other viral replication markers, it was found that among the 18 patients positive to the viral genome, 13 (72%) had hepatitis delta antigen in the liver, and five (28%) were negative. In conclusion, HDV-RNA detection by gene amplification is 10,000-times more sensitive than slot-blot hybridization, and allows the detection of viral replication in patients without other viral replication markers.

Alanine Transaminase↗
PubMed1989

Bacterial cavernous sinus aneurysm treated by detachable balloon technique.

We describe a patient who developed bilateral cavernous sinus septic thrombosis secondary to a suppurative lesion on the left cheek. Despite clinical improvement, left oculomotor symptoms recurred suddenly. A carotid artery aneurysm within the cavernous sinus was diagnosed by means of magnetic resonance imaging and confirmed by digital angiography. Follow-up angiograms showed an initial decrease in the aneurysm size, with subsequent enlargement. A latex contrast-filled balloon was successfully placed within the aneurysm, preserving the carotid parent artery blood flow. Our case illustrates the usefulness of the detachable balloon technique in the treatment of bacterial aneurysms of the cavernous sinus as an alternative treatment to carotid artery ligation.

Adult↗
PubMed1989

[Infrequent clinical manifestations in a patient with eosinophilic granuloma].

We report the case of a 54 year old male with diabetes insipidus and diabetes mellitus who developed, twenty years later, signs of hypogonadotropic hypogonadism, secondary adrenal insufficiency and primary hypothyroidism with positive serum antithyroglobulin antibodies. At that time, an osteolytic lesion on the left temporal bone was localized by radiologic studies. A bone biopsy confirmed the diagnosis of eosinophilic granuloma. Laboratory tests also showed anemia, hypergammaglobulinemia and accelerated eritrosedimentation rate which constitute atypical manifestations of this rare disease in adults. The probable etiopathogenic mechanisms are discussed: while some authors have described an autoimmune primary defect, others have suggested a primary viral infection as the cause of Hand-Schuller-Christian disease. The association of direct and indirect evidence of immunologic alterations in our patient is suggestive of an autoimmune origin.

Diabetes Complications↗