Bilateral single ectopic ureter.
A case of single bilateral ureteral ectopia is presented. Patient underwent bilateral ureteral reimplantation with right ureteral tailoring, with a satisfactory result.
Child, Preschool↗
Biomedical subjects
A Gutierrez
Publications and source records attributed to A Gutierrez.
Reduction of blood pressure retards the progression of chronic renal failure in man.
The effect of blood pressure reduction on the progression rate of chronic renal failure (CRF) was studied in 28 patients with CRF of diverse aetiology entering a prospective study (observation time 7-24 months, mean 16 months). Endogenous creatinine clearance was 12-66 ml/min (mean 30 +/- 3 ml/min). We aimed to keep the blood pressure below 160/90 mmHg. Dietary protein was not restricted. The progression rate of CRF was assessed from the regression coefficients of the regressions of creatinine clearance and the inverse of s-creatinine, respectively, on time. Progression rate and the means of all recordings of mean arterial blood pressure (MAP) and urinary protein excretion, respectively, in each patient during the prospective phase were compared with retrospective data from the proceeding period (observation time 4-25 months, mean 19 months). The patients received various combinations of antihypertensive drugs including diuretics, beta-blockers and vasodilatory drugs. In 19 patients MAP decreased from 109 +/- 2 to 102 +/- 2 mmHg (group I), whereas MAP increased from 105 +/- 2 to 108 +/- 2 mmHg in nine patients (group II). In group I proteinuria was significantly lower (P less than 0.05) and the progression of CRF was approximately 50% slower (P less than 0.01) in the prospective phase than in the retrospective phase; no changes were observed in group II. Calculated for all patients, significant correlations were observed between the change in MAP and the change in progression rate and protein excretion, respectively. These results indicate that lowering of blood pressure results in decreased proteinuria and retardation of the progression of CRF irrespective of the aetiology.
Adult↗
What is the role of controls in an outpatient department on progression of renal disease?
Evidence that protein restriction retards the progression of chronic renal failure in man is mostly derived from anecdotic data and retrospective studies with inappropriate controls and inferior methodology for evaluating renal function. Data from a prospective randomized study in Stockholm demonstrate that more frequent clinical follow-ups without changing the dietary intake of protein significantly retards the progression of renal failure and that the degree of retardation is correlated to improvement in blood pressure control.
Blood Pressure↗
Synthesis of some derivatives of 1-ethyl-6-fluoro-1,4-dihydro-4-oxo-7-(piperazin-1-yl)-3-quino linecarbo xylic acid (norfloxacin) as potential antibacterial agents.
Twelve new fluoroquinolones, structurally related to norfloxacin, have been synthesized in order to investigate the effect of substituents at the secondary nitrogen of the piperazine ring on antimicrobial activity. The new substances (carbamates, isoureas, guanidines, ureas and cyanamides) tested on a variety of gram-positive and gram-negative organisms showed lower activity than the model compound.
Anti-Bacterial Agents↗
Patient-related factors influencing the plasma acetate concentration during haemodialysis.
In 44 adult patients, 16 men and 28 women, with chronic renal failure who were dialysed under uniform conditions (Dialyser area 1.2 m2, blood flow 200 ml/min, dialysate flow 500 ml/min, dialysis fluid acetate concentration 35 mmol/l) we determined the plasma acetate concentration after 1 h of haemodialysis (1H-Ac) and 3 h of dialysis (3H-Ac). 1H-Ac was significantly lower than 3H-Ac in both male and female patients, and both mean values were significantly greater in males than in females. 3H-Ac showed a negative correlation with body surface area, serum creatinine before dialysis, and serum albumin, respectively. Using multivariate analysis, body surface area and serum creatinine showed the strongest significant combination of independent variables (R = 0.66), and accounted for 43% of the total variance in 3H-Ac. Sex, age, serum albumin and haematocrit did not further contribute to explaining the variance in 3H-Ac independently of body surface area and serum creatinine. Assuming that serum creatinine to some extent reflects the generation rate of creatinine and thus the muscle mass of the patients, our findings suggest that the rate of metabolism of acetate is proportional to the body size and that acetate is metabolised to a large extent in skeletal muscle. Accordingly, malnutrition with muscle-wasting may lead to slow metabolism of acetate and possibly to exaggerated acetate-related side-effects.
Acetates↗
Cervico-endometrial cytology and physiological aspects of the post-partum mare.
After parturition, Thoroughbred mares were mated at the first post-partum oestrus (N = 24) or at a subsequent oestrus (N = 12). All mares were examined daily for: oestrous detection, palpation per rectum of the genital tract, vaginoscopic examination and cervico-endometrial cytology. Pregnancy diagnosis was carried out at Days 18, 35 and 45 after mating. An identical first service conception rate of 50% was found in both groups. The number of neutrophils followed a descending profile to only scattered cells at the first post-partum oestrus and in Group II mares remained at this very low level during the period of study. The percentage of histiocytes and eosinophils increased on Days 10 and 17, and 5 and 6 post partum, respectively. The percentage of lymphocytes remained low and constant during the period of study. Bacterial flora decreased from Days 2 to 9 and increased from Days 13 to 17 post partum. Cellular necrosis and erythrocytes decreased and ciliocytopholia increased as mares approached the first post-partum oestrus. A positive correlation was found between amount, colour, viscosity and turbidity of secretions and all cellular types, ciliocytopholia, cellular necrosis and bacterial flora. The number of neutrophils was positively correlated with the percentage of eosinophils, bacterial flora and cellular necrosis but had a negative association with the presence of ciliocytopholia. Two mares that did not re-establish cyclic ovarian activity after parturition had delayed uterine involution. Mares not conceiving at the first post-partum oestrus exhibited a more prolonged presence of cellular necrosis and erythrocytes and an increased presence of bacterial flora and lymphocytes as compared to mares conceiving at this period.
Animals↗
Determination of histidine, 1-methylhistidine and 3-methylhistidine in biological samples by high-performance liquid chromatography. Clinical application of urinary 3-methylhistidine in evaluating the muscle protein breakdown in uraemic patients.
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3-Mercaptopropionic Acid↗
The contribution of median-ulnar communications in diagnosis of mild carpal tunnel syndrome.
In six patients with characteristic symptoms of carpal tunnel syndrome, electrophysiologic studies were normal, except for an initial positive deflection of the thenar muscle action potential with median nerve stimulation at the elbow but not at the wrist. This phenomenon is only seen with coexistent carpal tunnel syndrome and median to ulnar nerve communication and suggests carpal tunnel syndrome is present in these patients. As normal electrophysiologic studies occur in carpal tunnel syndrome (up to 8%) and median to ulnar communications are common (15%-31%), this observed finding is of practical clinical importance in the diagnosis of mild carpal tunnel syndrome despite otherwise normal electrophysiologic studies.
Carpal Tunnel Syndrome↗
Rectification of the remnants of the leaflets--a new surgical technique to avoid periprosthetic leaks in aortic valve replacement.
During the last 12 years, we have used a modified suture technique for aortic valve replacement in 450 patients in order to avoid periprosthetic leaks. There were 420 survivors, and reoperation for periprosthetic leaks was necessary in no instance. The "secret" of our technique consists of the uniform distribution of the tensile forces among all sutures, eliminating uneven stresses that favors tearing of the tissues or rupture of the stitches.
Adolescent↗
Almost total absence of the left ventricular myocardium with dextro-transposition of the great arteries.
The term parchment heart is used to describe partial to nearly complete loss of ventricular myocardium. We report the first case of transposition of the great arteries with almost total absence of left ventricular myocardium. The latter was not recognized and the child underwent Mustard's operation at four months of age. He died on the operating table. At necropsy, the left ventricular wall was 1 mm in thickness; microscopic examination revealed few myocardial fibers within edematous connective tissue.
Heart Defects, Congenital↗
Progression of chronic renal failure in man is retarded with more frequent clinical follow-ups and better blood pressure control.
In 17 patients with chronic renal failure (creatinine clearance 12-66 ml/min) who entered a prospective study, clinical and laboratory check-ups were made once a month. This was much more frequent than during the preceding 2-year period. The progression rate of renal failure evaluated from the change with time in the reciprocal of serum creatinine and creatinine clearance, respectively, was significantly slower after entering the study than before, without any dietary intervention having been instituted. The retardation of progression was associated with improved blood pressure control. We conclude from this study that the frequency and presumably the quality of the clinical check-ups, especially with regard to control of hypertension, may favorably influence the progression of chronic renal failure, independently of the protein intake. This may have important implications for the design of randomized studies, aimed at assessing whether a lowering of protein intake may retard progression.
Adult↗
Autonomic dysfunction in non-diabetic terminal uraemia.
R-R variations in the ECG were studied as a sign of autonomic dysfunction in 44 non-diabetic patients with terminal uraemia treated with intermittent haemodialysis. A severe impairment of this parasympathetic vagal reflex was found though there were only mild signs of diffuse polyneuropathy. No acute effect was associated with haemodialysis. There was no correlation between either the R-R variations and the polyneuropathy-index or the total dialysis time. Patients with chronic glomerulonephritis, pyelonephritis and polycystic kidney disease were equally affected.
Adolescent↗
Thromboprophylactic effect of ticlopidine in arteriovenous fistulas for haemodialysis.
When constructing arteriovenous fistulas for haemodialysis in chronic renal failure patients, one of the main problems is still their clotting tendency. Ticlopidine is an effective inhibitor of platelet aggregation. In this randomized double-blind study placebo or ticlopidine 250 mg twice daily was given to chronic uremic patients up to 4 weeks after construction of an arteriovenous fistula. 42 patients were recruited and 36 completed the trial. The fistula clotted in 8 patients on placebo and in 2 patients on ticlopidine. The difference is significant. This effect was achieved without an increased frequency of side effects compared with placebo. It is concluded that ticlopidine has a function as a thromboprophylactic drug in chronic uremic patients.
Adult↗
Determination of histidine and 3-methylhistidine in physiological fluids by high-performance liquid chromatography.
High-performance liquid chromatography based on pre-column derivatization of histidine and 3-methylhistidine with o-phthalaldehyde-mercaptoethanol has been used to determine these amino acids in small volumes of plasma and urine. The elution is performed in 45 min on a 5-micron Resolve C18 column by a multi-step gradient. The eluted analytes are measured with a fluorescence detector which provides detection limits of less than 1 pmol per 20-microliter injection. The correlation between concentration and the integrated area of amino acids gives a linear relationship between 10 and 150 pmol per injection. Some preliminary results from patients with chronic renal failure under variation of diet are presented.
Amino Acids↗
Fracture of the outlet strut of a Björk-Shiley mitral prosthesis: emergency operation with survival.
A case is presented in which the outlet strut of a Björk-Shiley mitral prosthesis (convexo-concave, 60 degree orifice opening) fractured 10 months postoperatively. Emergency reoperation was successful.
Adult↗
Unusual penetrating craniocerebral injury.
We report a 29-year-old patient who was operated on for a penetrating craniocerebral injury caused by an underwater fishing harpoon. It had penetrated through the roof of the left orbit, upward toward the calvaria. The patient was immediately operated upon and the foreign body was easily removed through a small left parietal craniectomy. In spite of the spectacular appearance of the injury on admission to the hospital, neurological impairment before and after the operation was minimal.
Adult↗
[Eosinophilic fasciitis (Shulman's syndrome)].
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Adult↗
G6PD Ciudad de la Habana: a new slow variant with deficiency found in a Cuban family.
A new G6PD variant has been detected in a Cuban male and there is no evidence of associated hematological abnormalities. The main characteristics of this variant, moderate deficiency, slow electrophoretic mobility, increased utilization of the substrate analogues, and a different chromatographic behavior, indicate that it is a variant that has not been previously described.
Child↗