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Biomedical subjects

P Villanueva

Publications and source records attributed to P Villanueva.

At least 19 recordsLinked to original sources
PubMed2001

Spontaneous pneumothorax: pragmatic management and long-term outcome.

We prospectively considered 65 patients admitted for a spontaneous pneumothorax (SP) to describe the pragmatic management of SP, the first recurrence-free interval after medical therapeutic procedure and to specify the first recurrence risk factors over a 7-year period in these patients treated medically. The treatment options were observation alone (9%), needle aspiration (6%), small calibre chest tube (Pleurocatheter) drainage (28%) or thoracic tube drainage (49%), and pleurodesis with video-assisted thoracic surgery procedure (8%). Duration of the drainage and length of hospital stay were shorter in the Pleurocatheter group than in the thoracic tube group (P < 0.01). Among the 47 patients (72%) with a first SP and treated medically, nine patients (19%) had a first homolateral recurrence (FHR) during a mean follow-up of 84+/-13 months. Recurrence-free intervals ranged from 1 to 24 months (mean +/- SD: 9.3+/-8.4 months). FHR cases were more frequent in the Pleurocatheter group (P < 0 04). Analysis of potential risk factors showed that the patient's height and a previous homolateral SP episode are independent recurrence risk factors.

Adolescent↗
PubMed2000

Characterization of US poison centers: a 1998 survey conducted by the American Association of Poison Control Centers.

A 1998 survey of all 73 US poison centers, including 52 certified centers and 21 noncertified centers, is presented. Despite a continued decline of the number of poison centers operating in the US, the volume of calls has steadily increased. In 1997 these centers handled 3.65 million telephone consultations, including 2,475,010 human poison exposure cases, 134,646 animal poison exposures, and 1,036,148 information calls. Nearly the entire US population had access to a poison center (99.9%), although only 78.5% of the US population was served by a certified center. Certified poison centers handled 83.6% of human poison exposure cases reported to US poison centers. Calls to certified centers were twice as likely to be handled by staff who were certified as specialists in poison information. On average, poison center utilization was 9.2 human exposure consultations/1,000 population. Total national poison center expenses approached $81 million. The average cost/human exposure case was $33.30 in certified centers, a substantial savings when compared with the alternative of emergency department management. State governments provided the single largest source of funding. Poison center funding remains unstable, with 41% of centers reporting a possible or definite budget reduction anticipated in the next budget year. In the past 5 y, 47.9% of centers faced threat of closure. Center certification and increased public education activity, especially the distribution of poison prevention materials and number of media contacts, were associated with greater utilization of the poison center in the region served.

Computers↗
PubMed1999

Body position effects on EMG activity of the temporal and suprahyoid muscles in healthy subjects and in patients with myogenic cranio-cervical-mandibular dysfunction.

This study was conducted in order to determine the effects of body position on integrated electromyographic (IEMG) activity of anterior temporal and suprahyoid muscles. The study was performed on 15 patients with myogenic cranio-cervical-mandibular dysfunction (CMD) and 15 healthy subjects. IEMG recordings at rest and during swallowing of saliva and maximal voluntary clenching were performed by placing surface electrodes on the anterior temporal and suprahyoid muscles in the following body positions: standing, seated, supine, and lateral decubitus position. Insignificant changes in IEMG activity of both muscles were observed upon variations in the body position. Insignificant differences in IEMG activity were observed between patients with myogenic CMD and healthy subjects. A pattern of higher IEMG at rest and during swallowing of saliva was observed in the suprahyoid muscles than in the anterior temporal muscles, whereas during maximal clenching activity, an opposite pattern was observed. Results of the present study seem to suggest that for the anterior temporal and suprahyoid muscles there is no specific body position that could be relevant to initiate and/or to perpetuate a craniomandibular dysfunction.

Adult↗
PubMed1999

Hydroxyapatite cement in craniofacial trauma surgery: indications and early experience.

BACKGROUND AND OBJECTIVES: Reconstruction of the nonstress-bearing portions of the craniofacial skeleton has recently utilized several alloplastic compounds. One such recent compound is hydroxyapatite cement (HAC)--a calcium-phosphate-based product. Its chemical structure consists primarily of calcium phosphate, as does human bone, and this similarity in the mineral structure renders it biocompatible. METHODS AND MATERIALS: Based on clinical indications for HAC, the authors have classified acquired craniofacial defects into four types. This article presents 5 clinical cases with craniofacial fractures, sustained in various accidents, in which hydroxyapatite cement was used to prevent cranial deformities or to reinstate contour. RESULTS AND/OR CONCLUSIONS: Complications were encountered in some of these cases, but all patients healed without any secondary complications. While the short-term experience using hydroxyapatite cement in craniofacial trauma surgery has been favorable, long-term studies in humans are required to validate the safety and efficacy of this product.

Adolescent↗
PubMed1997

Bilateral craniotomies for blunt head trauma.

Development of delayed or recurrent intracranial hematomas requiring reexploration or a secondary craniotomy is well known. Patients with bilateral pathology requiring bilateral craniotomies as the initial emergency operative intervention, however, are uncommon. The lack of available literature and the large volume of head trauma seen at our institution prompted us to analyze the retrospective data on blunt head injury requiring bilateral craniotomies. Twenty patients underwent bilateral craniotomies at the University of Miami/Jackson Memorial Medical Center between January 1986 and June 1994. Ages ranged from 18 to 85 years. Mechanism of injury included motor vehicle crash (n = 4), pedestrian hit by automobile (n = 4), assault (n = 8), fall from height (n = 3), and unknown (n = 1). Epidural hematomas, acute subdural hematomas, contusions, and intracerebral hematomas were seen in varying combinations. The preoperative Glasgow Coma Scale (GCS) score ranged from 4 to 14, with a mean of 8.8 (+/-0.82 SE). Sixteen of the 20 patients survived and were discharged from the hospital. The survivors' Rancho Los Amigos Scale score on discharge ranged from 2 to 8, with a mean of 6.1 (+/-0.45 SE). A Fisher's exact test was performed to compare the outcome between the patients with mild (GCS score 13-15) to moderate (GCS score 9-12) head injury and those with severe (GCS score 4-8) head injury. It showed a statistically higher frequency of death in the severe category (p < 0.05). In conclusion, the outcome of patients with bilateral pathology requiring emergency bilateral craniotomy at initial treatment correlated well with their GCS scores at initial presentation.

Adolescent↗
PubMed1997

Cellular immune correlates of clinical severity in oral lichen planus: preliminary association with mood states.

OBJECTIVES: We investigated cellular immune and psycho-immune dysfunctions in patients with erosive and non-erosive oral lichen planus (OLP) lesions. METHODS: Patients with erosive or non-erosive OLP were screened at the UCLA Dental Clinic. The profile of mood states (POMS) was administered. T lymphocyte subpopulations were monitored by dual fluorescence. T lymphocytes were stimulated with phytohemagglutinin (PHA) for assessment of markers of activation by flow cytometry and of interleukin (IL)-2 production by ELISA. Plasma cortisol and neopterin levels were assessed by radioimmunoassay. RESULTS: Circulating T cells that express the cluster of differentiation no. 4 (CD4+) but devoid of the CD45RA marker, and POMS score were significantly associated (r = 0.83, P < 0.05) in the patients we studied. We found a significantly higher (P < 0.05) per cent and absolute lymphocyte numbers of circulating CD4+CD45RA- cells in the OLP patients with erosive lesions, compared to OLP patients with non-erosive lesions. The ratio of CD4+ CD45RA+ over CD4+CD45RA- cells was significantly (P < 0.05) biased toward the CD4+CD45RA- subpopulation in OLP patients with erosive lesions (ratio = 0.19 +/- 0.09) compared to patients with non-erosive OLP lesions (ratio = 0.47 +/- 0.15). The expression of CD54, but not that of CD69, was significantly blunted (P < 0.05) in OLP patients following CD3+ cell stimulation. IL-2 production and plasma neopterin were normal in these patients. There was no correlation between plasma cortisol and T cell populations. CONCLUSIONS: We find fine differences in psycho-immune interactions between patients afflicted with non-erosive OLP lesions compared to those with erosive OLP lesions.

Adult↗
PubMed1997

[Bilateral asymmetric degeneration of the striatum as a cause of senile hemiballism].

We report the case of an 82-years old woman with sporadic acute hemiballism associated with bilateral striatal degeneration of non vascular origin which was most severe in the side contralateral to the hemiballism. The patient's neuropathological lesions resembled those of patients with senile chorea. Although hemiballism has never been described as an isolated manifestation of primary degeneration of the striatum, it may so occur in elderly patients with hemiballism.

Aged↗
PubMed1996

[Moderate asthma in adults: diagnosis and management in general medical practice].

Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

Administration, Inhalation↗
PubMed1995

Alcohol modulation of human normal T-cell activation, maturation, and migration.

We are interested in the characterization of the effects of alcohol on human T-cell activation, maturation, and migration, because this cell population is crucial in the initiation, regulation, and propagation of cellular immunity. We and others have described the effects of both acute and chronic exposure of human immune cells to ethanol (EtOH) in vitro. Herein, we briefly, review these reports and expand this body of literature with the inclusion of new data recently obtained in our laboratory. We confirm the blunting effects of EtOH on the production of interleukin-2 and mitogen proliferative response following T-cell mitogen stimulation, and on the expression of membrane markers of activation. We show that EtOH significantly alters the expression of the CD4 cell-associated marker of activation, CD26. We report the effect of EtOH on the expression of the homing receptor CD62L by CD4+ cells, and on their ability to adhere by a CD18-mediated process to a defined cellular substratum. Furthermore, we demonstrate the effects of EtOH and EtOH and beta-endorphin pretreatment on the activation of CD4+ lymphocytes endowed with the homing receptor CD62L.

Alcoholic Intoxication↗
PubMed1995

Immunotoxicity of cocaethylene.

This report describes the response of normal human T cells to stimulation in vitro in the presence of nano-micromolar concentrations of cocaethylene. Thymidine incorporation by concanavalin A-stimulated peripheral blood mononuclear cells was generally blunted by cocaethylene, albeit to different degrees depending upon the donor tested. The formation of concanavalin A-induced blast cells was decreased by increasing concentrations of cocaethylene. The production of interleukin-2 was also blunted in a dose-dependent fashion by cocaethylene, and this outcome was more consistently observed in stimulated peripheral blood mononuclear cells, compared to unseparated whole blood preparations. An inverse dose dependence was obtained in relation to the response of blast cells to recombinant human interleukin-2 in the presence of cocaethylene. These lines of evidence, taken together with our preliminary studies aimed at testing the effect of cocaethylene on the expression of certain membrane markers of activation (i.e., interleukin-2 receptor, transferrin receptor, serine aminopeptidase IV) and the expression of the proliferating cell nuclear antigen (cyclin PCNA), suggest that cocaethylene modulates relatively early events following T cell stimulation probably related to the interleukin-2 system.

Cells, Cultured↗
PubMed1995

[Diagnostic and therapeutic strategies in exacerbations of chronic bronchitis in city practice].

The consensus conference convened by the French Language Society for Infectious Disease at Lille in 1991 stressed the fact that two germs were most often the cause of exacerbation in chronic bronchitis (Streptococcus pneumoniae and Haemophilus influenzae) and that antibiotic therapy was the "safe solution" and that the first intention treatment should be either penicillin A, a first generation cephalosporin or a macrolide for the first 8-10 days. A chest x-ray was recommended if there was the slightest doubt about co-existing parenchymal disease with a reevaluation around the 7th day and a prescription of penicillin A plus a beta-lactamase inhibitor or a second or third generation cephalosporin in case of failure. The aim of this study was to assess the diagnostic and therapeutic attitudes of general practitioners when faced with exacerbation in chronic bronchitis in an adult of 60 without severe signs and to find out the antibiotic of first choice and also the antibiotic to be used if the first treatment failed. One hundred doctors were drawn at random from a list of general practitioners in Bordeaux. They were requested to reply to a questionnaire on the strategy of first choice antibiotic and the means of reassessment of the treatment after it had been instituted and the strategy used when faced with a patient who did not improve after the initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1995

[Presumed transudative pleural effusion?].

We report a case of recurrent transudative pleural effusion. The initial cardiovascular investigations failed to determine its cause. The catheterization showed a "dip-plateau" suggesting a restrictive cardiomyopathy. Endomyocardial biopsy finally proved a cardiac amyloidosis.

Aged↗
PubMed1994

Salivary IgE in allergic patients and normal donors.

A prospective study was conducted on 73 allergic patients and 14 normal volunteers in order to measure the IgE concentration in both serum and saliva, and analyze salivary IgE according to the characteristics of the allergic disease. IgE was more frequently detected in saliva from allergic patients than from normal subjects, but its concentration was not significantly higher in the allergic group. The IgE concentration in saliva was not related to serum IgE or to the type of syndromes of the allergic disease, but increased with the symptoms during the pollen season in patients suffering from pollen-induced rhinitis and conjunctivitis.

Adolescent↗
PubMed1994

[Treatment of severe asthmatic crisis. Evaluation of international guidelines].

Acute asthma can sometimes be severe and potentially life threatening. International guidelines have defined both characteristics of these severe attacks and the associated therapeutic instructions. The efficacy and feasibility of these recommendations were evaluated in 15 asthmatic patients who were admitted to hospital because a severe asthma attack. These patients fulfilled the criteria of severity defined by a British experts conference in the international guidelines published in 1990 in the British Medical Journal. A first line treatment was given to all the patients and included both systemic corticosteroids and inhaled beta 2-agonists. In case of failure, beta 2-agonists were given intravenously and oxygen was administered as required. Monitoring was carried out between the admission and the 8th hour using the following criteria: peak expiratory flow (DP), respiratory frequency (FR), and heart rate (FC). Both DP and FR significantly improved from 196 +/- 79 to 292 +/- 104 l/min (p < 0.01) and from 27.5 +/- 5.5 to 23.7 +/- 5.6 (p < 0.02), respectively. FR remained unchanged (97 +/- 13 vs 98 +/- 13; ns). There was a favourable outcome in all cases. beta 2-agonists administered intravenously were only necessary in two patients for whom no predictive factor could be determined. It is concluded that international guidelines are applicable to severe acute asthma. Inhaled route for beta 2-agonist is sufficient for the majority of patients presenting with the criteria defining severe acute asthma unless life threatening symptoms are present.

Adolescent↗
PubMed1994

[Dysphagia as the only manifestation of inclusion body myositis].

We report a 72-year-old woman with dysphagia as the only manifestation of inclusion body myositis (IBM). Although electrophysiological examination revealed subclinical abnormalities in limb muscles, dysphagia was the only symptom 4 years after the onset of the disease. Muscle biopsy showed rimmed vacuoles and cytoplasmic inclusions together with lymphocytic inflammation. IBM must be included in the differential diagnosis of isolated dysphagia.

Aged↗
PubMed1993

[Rheumatoid arthritis. Therapeutic efficacy of methotrexate and its hepatotoxic effects].

The efficacy and toxicity (specially hepatic) of methotrexate in low doses (7.5 mg/week) was prospectively assessed in 21 patients with rheumatoid arthritis refractory to treatment with gold or penicillamine, during two years. Three patients were prematurely withdrawn from the protocol. A fast and significant improvement of RA was observed during the first six months, which tapered thereafter. Erythrocyte sedimentation rate decreased from 51.5 +/- 20.1 to 27.7 +/- 11.5 mm/h (p < 0.05). A rise in serum transaminases, always raising to less than twice the normal value, was observed in 75% of patients in some moment of the follow up. Hepatic scintigraphy did not show significant changes. Hepatic histological alterations were mild and no changes were observed after two years of treatment. The main secondary effects were moderate and transitory gastrointestinal and hematological disturbances. The prednisone dose was decreased from 6.8 +/- 2.6 to 4.8 +/- 1.9 mg/day at twelve months. There were no withdrawals due to drug toxicity. It is concluded that methotrexate proved to be efficacious in the treatment of rheumatoid arthritis refractory to conventional treatments. Its secondary effects, although frequent, were discrete and transitory and there were no changes in liver histology.

Adult↗