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Biomedical subjects

A Morales

Publications and source records attributed to A Morales.

At least 217 records · Page 12Linked to original sources
PubMed1992

Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer.

Intravesical therapy with bacillus Calmette-Guerin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Compared to intravesical chemotherapy, instillations with BCG provoke more local and systemic reactions. In addition to the commonly induced granulomatous inflammatory changes in the bladder, which produce irritative symptoms, this therapy may cause systemic side effects varying from mild malaise and fever to, in rare instances, life-threatening or fatal sepsis. We report the incidence and varieties of toxicities in 2,602 patients treated with intravesical BCG. Side effects are classified according to local and systemic toxicity. Treatment options vary according to the severity of toxicity from delaying or withholding instillations to treatment with antituberculous drugs for up to 6 months. In general, 95% of the patients have no serious side effects. Recognition of risk factors, particularly traumatic catheterization or concurrent cystitis, that result in systemic BCG absorption, as well as the prompt and appropriate treatment of early side effects should significantly decrease the incidence of severe toxicity.

Administration, Intravesical↗
PubMed1992

Dose-response of bacillus Calmette-Guerin in the treatment of superficial bladder cancer.

Although bacillus Calmette-Guerin (BCG) has been recognized as an effective therapy for superficial bladder cancer, dose-response studies are not available. Such studies are important because the administration of the vaccine is not devoid of significant side effects when the standard dose of 120 mg. is used. It has been speculated that smaller doses may be equally effective but carry fewer side effects. A controlled study comparing 2 doses of BCG was conducted as an initial step to explore this possibility. A total of 97 patients with a diagnosis of superficial (stages TIS, Ta and T1) bladder cancer was assigned to receive either 60 or 120 mg. BCG intravesically weekly for 6 weeks. The higher dose resulted in a better response for stages TIS, Ta (for prophylaxis of recurrence) and T1. However, the differences were not statistically significant. When stage TIS and Ta tumors coexisted, a significantly better response was recorded for the high dose. The overall success for the 2 treatments was 67% and 37% for the high and low doses, respectively. These differences reached statistical significance (p less than 0.02). Side effects were significantly less in number and severity in patients receiving the smaller dose of the vaccine.

BCG Vaccine↗
PubMed1992

Development of a radioreceptor assay to measure glucocorticoids.

We have developed a radioreceptor assay to measure glucocorticoids. The assay employs the partially purified 95-kDa receptor isolated from human liver and purified by size fractionation on high-performance liquid chromatography (HPLC). In the assay [3H]prednisolone competes with steroids (endogenous and exogenous) for binding to the receptor. Bound and free are separated by treatment with charcoal. The between-day precision [% coefficient of variation (CV)] at concentrations of 9.4, 18.7, and 69.9 micrograms/L prednisolone is 16.6, 9.3 and 4.5%, respectively. Specificity studies revealed that hydrocortisone, deoxycorticosterone, 4-pregnene-17 alpha,21-diol-3,20-dione, 17 alpha-hydroxyprogesterone, corticosterone and beta-hydroxyprogesterone all compete with [3H]prednisolone for binding to the receptor. Prednisone and 6 alpha-methyl prednisolone displace [3H]prednisolone to only a minor degree. The assay has been used to assess "glucocorticoid activity" in children with rheumatic diseases treated with prednisolone.

Charcoal↗
PubMed1992

Use of a radioreceptor assay in the assessment of cushingoid features in patients with juvenile rheumatic diseases.

A marked variation has been observed in severity of cushingoid appearance in patients with rheumatic diseases (RD) following steroid administration. We studied ten children with RD to determine if a relationship exists between cushingoid features and an individual's steroid activity as measured by prednisolone equivalents using a radioreceptor assay. Cushingoid features were clinically assessed by a "cushing score" according to the method of Bergrem. Patients were assigned to either the cushingoid (C) or noncushingoid (NC) group at study entry according to their cushing score. Blood was drawn prior to prednisone ingestion and then at 30, 60, 90, 120, 240, and 360 minutes and each sample was assessed for prednisolone equivalents and also for free and total cortisol. Group comparisons of dose-adjusted area under curve (AUC) and peak response are reported. Cushingoid patients had higher plasma prednisolone equivalents (PE) than noncushingoid patients as measured by peak PE and AUC. The PE.6 h/L average AUC for C patients was 248 micrograms PE.6 h/L versus 134 micrograms PE.6 h/L for NC patients. This nearly twofold difference was also noted between mean peak values (C 82 micrograms/L vs. NC 44 micrograms/L). Spearman correlations of Cushing scores with these two parameters indicated significant (p less than 0.05) relationships. A patient's Cushing score correlated best with peak response (rs = 0.78) and also with AUC (rs = 0.72). Measurement of plasma peak PE or AUC could be valuable for individualizing steroid dosing in children with RD.

Adolescent↗
PubMed1992

Chronic vagus nerve stimulation increases the latency of the thalamocortical somatosensory evoked potential.

The Neurocybernetic Prosthesis (NCP) is a pacemaker-like device that has been designed to provide chronic intermittent vagus nerve stimulation. It is currently under study for the treatment of refractory partial onset epilepsy, and preliminary studies have indicated that partial onset seizures are improved by this therapy. The mechanisms by which it exerts its antiepileptic effect are not well understood. Although there are extensive pathways to the forebrain from the nuclei of the vagus nerve, the evidence that the NCP alters neural transmission outside the vagal system is limited. We prospectively examined somatosensory and brain stem auditory evoked potentials (BAEPs) in three patients receiving NCP implantation to determine if changes in these studies occur as a result of chronic vagus nerve stimulation. The results demonstrate a significant prolongation of the cervicomedullary to thalamocortical potential (N13-N20) interval on somatosensory evoked potential (SSEP) studies following activation of the device. No other significant changes were seen on SSEP or BAEP in the NCP implanted patients or normal controls. The findings suggest that chronic vagus nerve stimulation does alter neuronal networks outside of the brain stem vagus system, and may potentially provide a means to clinically monitor and titrate this therapy.

Adult↗
PubMed1992

A descriptive study of epilepsy in the district of El Salvador, Chile, 1984-1988.

To describe the epidemiological characteristics of epilepsy in a northern area of Chile, an investigation was conducted in four localities in the province of Copiapó (population of 17,694). Based on 314 cases of active epilepsy, the prevalence per 1000 at June 30, 1988 was 17.7. The average annual incidence for the period 1984-1988 was 113 per 100,000. Partial seizures were the most frequent type of seizure diagnosed (54.1%). Antecedents considered as possible etiological factors were found in 29.9% of cases. According to age of onset, 64.6% had their first attack before 15 years. Middle and low socioeconomic classes had higher prevalence rates of epilepsy. We compare our results with previous Latin-American studies.

Adolescent↗
PubMed1992

From the 19th to the 21st centuries: BCG in the treatment of superficial bladder cancer.

In superficial bladder cancer, bacillus Calmette-Guérin (BCG) is effective in the prevention of tumour recurrences, in the destruction of papillary lesions and, particularly, in the eradication of carcinoma in situ. In comparative trials BCG is superior to chemotherapeutic agents. Recent statistics indicate that though the incidence of bladder cancer continues to increase, the mortality has begun to diminish. The use of BCG has been implicated as an important contributor to this change. The exact mechanisms of action of this anticancer agent remain obscure, but clarification should lead to the development of new, safer and more effective agents. Thus, BCG, an anachronism from the early days of tumour immunology, may lead cancer immunotherapy into the next century.

BCG Vaccine↗
PubMed1992

[Peptic ulcer and endoscopic signs of portal hypertension in patients with primary biliary cirrhosis].

BACKGROUND: Controversies exist on the prevalence of peptic ulcer and on the relationship between the presence of portal hypertension associated lesions in the upper gastrointestinal tract and the histological and functional stages of primary biliary cirrhosis AIM: To evaluate the prevalence of peptic ulcer and endoscopic signs of portal hypertension in subjects with primary biliary cirrhosis. PATIENTS AND METHODS: A retrospective study based on upper gastrointestinal endoscopies in 36 patients with primary biliary cirrhosis and 45 subjects with chronic active hepatitis. SETTING: Gastroenterology Center, Hospital Clínico, University of Chile, Santiago. MAIN RESULTS: No differences were demonstrated between the two groups for the prevalence of peptic ulcer (11% in primary biliary cirrhosis vs 13% in chronic active hepatitis). Esophageal varices were found in 5 of 16 patients (31%) in prefibrotic stages of primary biliary cirrhosis compared with 10 of 20 (50%) in whom fibrosis or cirrhosis were noted; NS. Endoscopic signs suggesting hypertensive gastropathy were present in 2 patients with early primary biliary cirrhosis (13%) and in 5 (25%) in advanced stages. CONCLUSIONS: Peptic ulcer is not more prevalent in patients with primary biliary cirrhosis than in those suffering from chronic active hepatitis. Esophageal varices and endoscopic stigmata of portal hypertension induced changes in gastric mucosa can be observed in early stages of primary biliary cirrhosis.

Endoscopy, Gastrointestinal↗
PubMed1992

Immunotherapy for superficial bladder cancer. A developmental and clinical overview.

Superficial bladder cancer is one of the few solid human malignancies in which immunotherapy has been proved to be effective. Bacillus Calmette-Guérin was the vaccine which opened the door for this innovative approach. In an era of remarkable achievements in biotechnology, it is truly amazing that this throwback to the Stone Age of tumor immunology has not yet been replaced by a more (or equally) effective substitute. Potential candidates are already on the horizon and deserve a comprehensive evaluation. They must show not only that they are devoid of significant adverse effects but that they possess, beyond a doubt, superior antineoplastic activity. Even more remarkable is that one of the oldest vaccines still in use could emerge in a new role as an effective antineoplastic agent. Bacillus Calmette-Guérin has demonstrated an uncanny capacity for effectiveness as therapy for human diseases. Its protective effect against tuberculosis is well recognized, and its contribution to cancer therapy is widely known. A new and increasing repertoire has recently been presented: two separate groups of researchers have employed the vaccine successfully as a vehicle to express antigen-encoded genes from other pathogens. The exciting aspect of these recent studies resides in the demonstration that the altered vaccine is able to induce humoral and cell-mediated immune responses to the recombinant antigens, including the human immunodeficiency virus (HIV). Thus, BCG once more attracts enormous interest from the scientific community for its versatility and potential as a therapeutic agent.

Adjuvants, Immunologic↗
PubMed1991

Induction of controlled prostatic tissue necrosis by bacille Calmette-Guérin derivatives.

Intraprostatic administration of live bacille Calmette-Guérin (BCG) in humans has been found to produce tumor necrosis; unfortunately, the number of severity of complications have made its clinical use prohibitive. Previous studies have shown that soluble and microparticulate components present in the supernatants obtained after centrifugation of a reconstituted BCG preparation exhibit similar immunogenicity to the one shown by live bacteria. The supernatants, however, are not associated with disseminated infection of the progressive regional tissue destruction observed with the use of viable vaccine. Experiments were conducted to determine the effect of intraprostatic injection of BCG and its supernatants. Adult dogs, after positive conversion to protein purified derivative (PPD), were randomly assigned to three groups. Under direct vision and with digital rectal control, intraprostatic injections of various agents were given as follows: group I, normal saline; group II, live BCG; group III, 200 micrograms of BCG supernatants. Two months later the animals were sacrificed, and the prostates removed in toto and submitted for a thorough histological examination. Extensive but variable tissue necrosis was noted in groups II and III. No histological alterations were present in group I. The histological picture of the animals receiving BCG supernatants conclusively demonstrated circumscribed necrosis of the gland. Side effects and complications were present in animals receiving live BCG but conspicuously absent in the ones receiving supernatants. The observed effectiveness and safety of BCG supernatants for intraprostatic administration in an experimental system may lead to a simple, safe, and efficacious therapeutic modality for localized carcinoma of the prostate in humans.

Animals↗
PubMed1991

Case report 674: Well-differentiated lymphocytic lymphoma with skeletal involvement.

We report the case of a man with generalized osteosclerosis secondary to well-differentiated lymphocytic lymphoma. This finding is considered to be exceptional in this type of lymphoma, especially when other organs were not found to be involved. A year after the diagnosis was established the patient appeared to be in relatively good health. The radiological pattern showed no change from the original studies, nor was there any evidence of neoplastic involvement in any other location.

Aged↗
PubMed1991

Benign fibro-osseous lesions in Paget's disease of the jaws.

A clinicopathologic study of five patients with Paget's disease of the jaws is reported. All patients had well-documented cases of osteitis deformans with polyostotic involvement. Histologic studies of facial bones could be performed because surgery was necessary for either cosmetic or functional reasons. Three specimens consisted of maxillary bone, and two were mandibular. Microscopically, all cases showed multiple and irregular fibroproliferative lesions containing mineralized structures intermingled with bone characteristic of Paget's disease. The purpose of this article is to present these fibro-osseous lesions in relation to Paget's disease of the jaws and to emphasize their close resemblance to other benign fibro-osseous lesions of the jaws, especially cementifying and ossifying fibroma, and florid osseous dysplasia.

Adult↗
PubMed1991

Release of cytoplasmic apical protrusions from principal cells of the cat epididymis, an electron microscopic study.

Epididymides of captive normal adult cats were studied by light and transmission electron microscopy. Release of apical portions of principal cells occurred by a process of pinching-off. The membrane-bound bodies (spherules) formed were then found in the epididymal lumen. We postulate that this represents an apocrine secretion process. Such phenomenon were present in all segments of the epididymis, whether caput, corpus, or cauda. Rows of microvesicles similar to those described in other species were also observed between microvilli. The mechanism of formation of spherules and microvesicles seemed to be formed by a different mechanism.

Animals↗
PubMed1991

The characterization of a bio-assay of erectile function in a rat model.

The investigation of biological phenomena in impotence using an animal system requires a determination of the erectile capabilities of the animal. Rats respond reliably to apomorphine by the exhibition of a phenomenon of erections and yawns. This property has been used to form the basis of a bio-assay of erectile integrity in the rat. We compared rats treated with placebo alone, sham operated rats, rats rendered surgically impotent and castrated rats with and without testosterone. Rats did not respond to placebo. The sham operated rats remained normal in all measured respects (2.66 erections/rat/30 minutes). Surgically impotent rats yawned normally but had no erections. Castrated rats did not have erections and had diminished yawning (3.21 yawns/rat/30 minutes vs. 7.7 for controls p less than .001) but responded normally after testosterone administration. The bio-assay is useful as a standard test of erectile function in the rat.

Animals↗
PubMed1991

Characterization of Leishmania colombiensis sp. n (Kinetoplastida: Trypanosomatidae), a new parasite infecting humans, animals, and phlebotomine sand flies in Colombia and Panama.

Characterization of Leishmania colombiensis sp.n. is presented, which on the basis of biological and molecular criteria, appears to be a new member of the L. braziliensis complex. A total of nine isolates of the new parasite were made in Colombia and Panama between 1980 and 1986: two from human cases of cutaneous leishmaniasis, six from phlebotomine sand flies, and one from a sloth. Although most closely related to L. lainsoni, L. colombiensis sp.n. is clearly distinguishable from other members of the genus by its reactivity with monoclonal antibodies, isoenzyme electrophoresis, and restriction endonuclease fragment patterns of kinetoplast DNA (k-DNA).

Adult↗
PubMed1991

Value of urologic investigation in a targeted group of women with recurrent urinary tract infections.

According to the conclusions of clinical studies, excretory urography and cystoscopy are of no value in managing the majority of women who have a history of recurrent urinary tract infection (UTI). Of 475 women with recurrent UTIs, 186 were prospectively targeted for evaluation by cystoscopy and ultrasonography or excretory urography from selection criteria based on the degree of complicating factors, to determine the value of urologic investigation. Thirty-nine patients had significant detectable abnormalities, and 20 of them required surgical intervention. Definite indications for urologic evaluation include hematuria (gross hematuria and persistent microscopic hematuria between infections), pyelonephritis and a presentation that is not typical for simple uncomplicated UTIs (obstructive symptoms, infection with urea-splitting bacteria, clinical impression of persistent infection or urinary calculi). Diabetes itself does not warrant urologic evaluation. The findings from this study suggest that cystoscopy and upper urinary tract evaluation do play a role in the management of a selected group of women with UTIs.

Adult↗