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Biomedical subjects

A Perez

Publications and source records attributed to A Perez.

At least 91 records · Page 5Linked to original sources
PubMed1997

Outcome of gastric restriction procedures: weight, psychiatric diagnoses, and satisfaction.

BACKGROUND: Weight losses following bariatric surgery have varied widely, depending on length of follow-up and various pre-surgical characteristics of patients undergoing surgery. METHODS: One hundred thirty one patients had a detailed presurgical psychiatric evaluation. Patients were assessed clinically for 2 years after surgery and at follow-up a mean of 5.7 years after surgery. RESULTS: Mean presurgical body mass index (BMI) was 52.9 kg/m2; therefore, many patients had 'super obesity'. Two-thirds of the patients were located a mean of 5.7 years after surgery. The mean change in BMI at follow-up was 25% and the mean weight loss was 27%. One-third had excellent or good weight outcomes using the Griffen criteria. Five patients had died by follow-up. There was no relationship between age, gender, or fat content presurgically and weight loss at follow-up, although presurgical weight was associated with greater weight loss at follow-up. Weight regain began 2 years after surgery. There was no relationship between the presence or absence of a presurgical psychiatric diagnosis and weight loss at follow-up. There was also no relationship between the presence of a presurgical psychiatric diagnosis and various mental health parameters at follow-up. Satisfaction with the surgery was marginally associated with weight loss but significantly associated with improved mental and physical health. CONCLUSIONS: Mean weight losses were less than have been previously reported with gastric restriction procedures but the follow-up was longer than usually reported and many patients had 'super obesity' prior to surgery. The implications of 'super obesity' for weight loss are discussed.

Adipose Tissue↗
PubMed1997

Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.

Abortion, Spontaneous↗
PubMed1997

Topical calcitriol (1,25-dihydroxyvitamin D3) treatment of psoriasis: an immunohistological evaluation.

The potent calciotropic hormone calcitriol (1,25-dihydroxyvitamin D3, 1,25(OH)2D3) has been shown to be very effective and safe in the topical treatment of psoriasis. In vitro, 1,25(OH)2D3 inhibits proliferation and stimulates differentiation of human keratinocytes. Increasing evidence suggests an immunoregulatory function of this potent steroid hormone. To further characterize the biological effects of topical calcitriol treatment in psoriasis, we have analyzed immunohistochemically the expression of markers for epidermal proliferation (proliferating cell nuclear antigen=PCNA) and differentiation (transglutaminase K, involucrin, cytokeratin 16), as well as inflammation (CD1a, 55 kDa TNF-receptor, NAP-1/IL-8) in calcitriol-treated psoriatic skin in situ. Our findings strongly support the hypothesis that calcitriol modulates keratinocyte proliferation/differentiation as well as inflammation in human skin in vivo. The immunoreactivity of markers for epidermal proliferation and differentiation, as well as of CD1a and NAP-1/IL-8, changed after 8 weeks of calcitriol treatment almost completely to the pattern characteristic for non-lesional psoriatic skin, while a large number of 55 kDa TNF-receptor positive cells could be found in the dermal compartment.

Administration, Topical↗
PubMed1997

[Scaphoid and lunate palmar divergent dislocation. Apropos of a case].

UNLABELLED: A case of palmar dislocation of the scaphoid and lunate which where dissociated from each other is reported with a 3.5 years follow up. A 32 years old man fell while reading his motorcycle. He landed on his left hand dorsiflexed. There was no skin dilaceration and neuro-vascular status of his hand was intact. X-rays showed a palmar dislocation of the scaphoid and lunate with a large gap between the two bones. The lunate was also completely dissociated from the triquetrum and the capitate. Distal pole of the scaphoid remained in contact with the trapezium. The patient was taken to the operating room, and after unsuccessful closed reduction, an open reduction through a palmar approach was performed. A complete disruption of the anterior capsule was founded and all perilunate ligaments were completely disrupted. Reduction was easy under direct vision, and the anterior capsule was repaired. A non displaced trapezium fracture seen at surgery was fixed with a Kirschner wire. A long arm cast applied for 6 weeks. At 3.5 years follow-up, the patient had an almost full range of motion and no residual pain. Power grip was 25 per cent reduced in comparison with the opposite side. X-rays showed a palmarflexed scaphoid and Magnetic Resonance imaging showed no evidence of avascular necrosis. DISCUSSION: Simultaneous dislocation of scaphoid and lunate as a unit or with a large gap between the two bones are extremely rare injuries. In all cases already reported, results were briefly presented without any available clinical and radiological data because patients were lost for follow-up. In our case report, the anatomy and kinematics of the wrist showed the lack of our initial treatment with a single volar approach, anterior capsular reparation and a long arm cast alone. In fact, at 3.5 years follow up, ligamentous healing was inadequate to control compressive forces across the wrist and the scaphoid volarflexed despite a good alignement in the cast. Although the functional results is good, radiological outcome is far from being good. This case demonstrated that even in early treatment with a good position of carpal bones in the sole cast, healing of the ligamentous system without loosing reduction is difficult. CONCLUSION: In such a case, and with a low rate of avascular necrosis in perilunate dislocations treated early we suggest an open reduction and internal fixation (O.R.I.F.) to prevent carpal instability. We recommend combined volar and dorsal approaches for repairing anterior and posterior ligaments (especially interosseous ligaments on both sides of the lunate), associated with a stabilization of the entire carpum by scapho-lunate, triquetro-lunate, and capito-lunate Kirschner wire fixation.

Adult↗
PubMed1997

Catalase mediates acetaldehyde formation from ethanol in fetal and neonatal rat brain.

Fetal ethanol (E) exposure has well documented deleterious effects on brain development, yet it is uncertain if the neurotoxicity of maternal E consumption is generated by E itself, by its primary metabolite acetaldehyde (AcHO), or both. The current studies present evidence that homogenates of immature rat brains can generate AcHO via a catalase (CAT)-mediated reaction and that AcHO may be produced in vivo by this system. Homogenates of day 19 fetal rat brain were incubated with E (50 mM). When incubated with CAT inhibitors (sodium azide or 3-aminotriazole), AcHO formation was blocked, whereas neither the alcohol dehydrogenase inhibitor, 4-methylpyrazole, nor P-450 inhibitors decreased AcHO production. Three hours after one oral dose of E (4 g/kg) to a pregnant dam (gestation day 19), AcHO levels in fetal brain increased to 14.28 +/- 1.82 nM/g tissue. Baseline CAT activity in day 19 fetal brains was 4.5 times adult values (p < 0.05). Western blot analysis determined that CAT protein level in the day 19 fetal brain exceeded that in adult brain by 2.5 times. One hour after a single dose of E, CAT activity in day 19 fetal brain increased by 8.2 units/mg protein. In 5-day-old neonatal brains during the "third trimester" brain growth spurt, baseline CAT activity was twice the adult values (p < 0.05) and a 2-day in vivo E regimen increased AcHO levels to four times the control values, with a concomitant 1.7-fold increase in CAT activity. This was prevented by administration of a CAT inhibitor (3-amino-1,2,4-triazole). Immunohistochemical staining of neonatal brains exposed to E illustrated the presence of acetaldehyde-protein adducts. We conclude that AcHO is likely produced in rat fetal and neonatal brain via CAT-mediated oxidation of E. This phenomenon may be an important factor in the neurotoxic effects of in utero E exposure.

Acetaldehyde↗
PubMed1996

Further evidence that infection is an infrequent cause of first trimester spontaneous abortion.

A previous cohort study found no clinical evidence that infection occurred more often in subjects experiencing pregnancy loss compared with those experiencing successful pregnancy [Simpson et al. (1996) Hum. Reprod., 11, 668-672]. Given these surprising findings, we conducted a similar analysis on another cohort also followed prospectively. Using couples practising natural family planning for conception or contraception, information on clinical evidence of infection was gathered beginning with week 5 of gestation. Information on fever and signs of overt infection was specifically sought by interview and physical examination. Frequencies of urinary, vaginal and other infections in subjects experiencing pregnancy loss were 11.1, 9.5 and 8.7% respectively, not significantly different from rates in subjects having liveborns (10.1, 10.2 and 10.3% respectively). Thus, no association between clinical infection and early pregnancy loss (< or = 16 weeks) was observed. Cohort studies utilizing biologically based assays are awaited because extant data do not provide evidence that clinically evident infections play major roles in first trimester pregnancy losses.

Abortion, Spontaneous↗
PubMed1996

Induction of vitamin D receptor mRNA expression in psoriatic plaques correlates with clinical response to 1,25-dihydroxyvitamin D3.

Psoriasis is a skin disorder characterized by hyperproliferation of epidermal keratinocytes. 1 alpha,25-dihydroxyvitamin D3 (1 alpha,25(OH)2D3) and its analogs have been shown to inhibit keratinocyte proliferation in vitro and to be therapeutically effective for the treatment of psoriasis. Some patients with psoriasis, however, do not have a favorable response to 1 alpha,25 (OH)2D3 therapy. To evaluate the differential responsiveness to 1 alpha (OH)2D3 treatment, we examined the expression of vitamin D receptor mRNA in psoriatic lesions by reverse transcription-polymerase chain reaction using glyceraldehyde-3-phosphate dehydrogenase as an internal control. In this double-blind clinical trial, we recruited 18 patients who received topical treatment of 1 alpha,25(OH)2D3 (15 microgram/g Vaseline) or placebo on separated psoriatic lesions for 8 weeks. In patients who showed >90% clinical improvements of their psoriatic lesions with 1 alpha,25(OH)2D3 (n=9), an increase of 130+/-37% in vitamin D receptor mRNA level was observed in 1 alpha,25(OH)2D3-treated lesions when compared with the corresponding placebo controls. There was no increase in vitamin D receptor mRNA level in the lesions treated with this drug in patients who did not respond to the treatment. These data suggest that the antiproliferative activity of 1 alpha,25(OH)2D3 is closely associated with the expression of its cognate receptor.

Base Sequence↗
PubMed1996

Overexpression of R domain eliminates cAMP-stimulated Cl- secretion in 9/HTEo- cells in culture.

The intracellular hydrophilic region of the cystic fibrosis transmembrane conductance regulator (CFTR), the R domain, has been postulated to be a regulator of the Cl-channel. Under basal conditions R blocks the channel, but when phosphorylated, R undergoes conformational change to open the channel. Overexpression of R in 9/HTEo- cells, a human tracheal epithelial cell line with adenosine 3',5' -cyclic monophosphate (cAMP)-regulated Cl- conductance due to CFTR, caused reduced basal Cl- conductance and elimination of its response to isoproterenol, but ionomycin-stimulated Cl- efflux was preserved. Cells which overexpressed R showed no downregulation of endogenous CFTR mRNA and had normal cAMP production and protein kinase A (PKA) activity, so R did not act at these levels. Although the precise mechanism by which R affects CFTR conductance is undetermined, these cell lines could be useful in separating the cell biological consequences of impaired Cl- transport from those of mutant CFTR per se.

Base Sequence↗
PubMed1996

Thoracoabdominal pattern of breathing in neuromuscular disorders.

STUDY OBJECTIVE: To assess abnormalities in thoracoabdominal pattern of breathing (TAPB) in neuromuscular disorders during spontaneous breathing, intermittent positive pressure ventilation (IPPV) with and without abdominal (AB) binder, and immediately after IPPV. DESIGN: Repeated measures design: Pre-IPPV spontaneous breathing, IPPV, IPPV with AB binder, and post-IPPV spontaneous breathing. In protocol 1, ventilator pressure was held constant at the individual value habitually adopted in sessions of IPPV. In protocol 2, it was increased stepwise from 5 to 30 cm H2O. SETTING: University hospital, Department of Pediatrics, Intensive Care, and Neuro-Ventilatory Rehabilitation. PATIENTS: Thirty-one patients with spinal muscular atrophy (SMA) and 19 patients with myopathy, mean age (+/- SD) 9.7 +/- 3 years. MEASUREMENTS: Tidal volume (VT), percent thoracic contribution to VT (%RC), the phase angle between the thoracic and the AB volume changes and the labored breathing index, which is an index of asynchrony taking into account both the phase relationships and relative volumes of rib cage and AB compartments. RESULTS: We observed marked abnormalities in TAPB during spontaneous breathing, especially in the SMA group. %RC, labored breathing index, and phase angle displayed nearly normal values during IPPV. IPPV pressures of 25 to 30 cm H2O were necessary to increase %RC above 80%. AB binding decreased VT, but led to larger thoracic volumes, especially in patients with SMA. Thoracic contribution to VT and thoracic volume after IPPV were higher than baseline levels. CONCLUSIONS: The quantitative assessment of TAPB enhances the ability to estimate pulmonary function in neuromuscular disorders, and the efficiency of mechanical ventilation.

Abdomen↗
PubMed1996

Safety and efficacy of oral calcitriol (1,25-dihydroxyvitamin D3) for the treatment of psoriasis.

Plaque-type psoriasis has been successfully treated with oral calcitriol, but there has been no long-term follow-up on the safety and efficacy of this calciotropic hormone for psoriasis. In a single centre study, patients were enrolled in an open trial to evaluate the efficacy and safety of oral calcitriol for psoriasis. Of the 85 patients who received oral calcitriol, 88.0% had some improvement in their disease; 26.5, 36.2 and 25.3%, had complete, moderate and slight improvement in their disease, respectively. The mean baseline psoriasis area severity index score (PASI) of 18.4 +/- 1.0 was reduced to 9.7 +/- 0.8 and 7.8 +/- 1.3 after 6 and 24 months on oral calcitriol therapy. Serum calcium concentrations and 24 h urinary calcium excretion increased by 3.9% and 148.2%, respectively, but were not outside the normal range. Bone mineral density remained unchanged. The clearance of creatinine decreased by 13.4% from baseline during the first 6 months of treatment, and thereafter, remained unchanged after 3 years of follow up. An evaluation of creatinine, inulin and paraaminohypurate (PAH) clearance was performed in eight patients. After 6 months on oral calcitriol, there was a 22.5% decline in creatinine clearance but no significant changes were observed in either inulin or PAH clearance, suggesting that calcitriol alters creatinine metabolism or secretion but does not affect renal function. Oral calcitriol is effective and safe for the treatment of psoriasis.

Administration, Oral↗
PubMed1996

[Surgical approach to the axillary nerve via an anterior trans-coracoid route].

The surgical approach to the circumflex nerve is difficult. Based on an illustrative clinical example, the authors describe a method using a coracoid osteotomy that permits a simplified approach to the circumflex nerve. This trick permits en bloc retraction of the superficial plane of the brachial plexus without sectioning of the muscle and without excessive traction on the musculocutaneous nerve. The stable fixation of the coracoid at the end of the procedure permits early and effective rehabilitation.

Aged↗
PubMed1995

Timing of conception and the risk of spontaneous abortion among pregnancies occurring during the use of natural family planning.

OBJECTIVE: Our purpose was to ascertain the effects of timing of conception on the risk of spontaneous abortion. STUDY DESIGN: To assess these effects, women who conceived while using natural family planning were identified in five centers worldwide between 1987 and 1993. Timing of conception was determined from 868 natural family planning charts that recorded day of intercourse and indices of ovulation (cervical mucus peak obtained according to the ovulation method and/or basal body temperature). Conceptions on days - 1 or 0 with respect to the natural family planning estimated day of ovulation were considered to be "optimally timed," and all other conceptions were considered as "non-optimally timed." The rate of spontaneous abortions per 100 pregnancies was examined in relation to timing of conception, ages, reproductive history, and other covariates with bivariate and multivariate statistical methods. RESULTS: There were 88 spontaneous abortions among 868 pregnancies (10.1%). The spontaneous abortion rate was similar for 361 optimally timed conceptions (9.1%) and 507 non-optimally timed conceptions (10.9%). However, among 171 women who had experienced a spontaneous abortion in a prior pregnancy, the rate of spontaneous abortion in the index pregnancy was significantly higher with non-optimally timed conceptions (22.6%) as compared with optimally timed conceptions (7.3%). This association was not observed among 697 women with no history of pregnancy loss. The adjusted relative risk of spontaneous abortion among women with non-optimally timed conceptions and a history of pregnancy loss was 2.35 (95% confidence intervals 1.42 to 3.89). The excess risk of spontaneous abortion was observed with both preovulatory and postovulatory conceptions. CONCLUSIONS: Overall, there is no excess risk of spontaneous abortion among the pregnancies conceived during natural family planning use. However, among women with a history of pregnancy loss, there is an increased risk of spontaneous abortion associated with preovulatory or postovulatory delayed conceptions.

Abortion, Spontaneous↗
PubMed1995

Value of routine preoperative tests: a multicentre study in four general hospitals.

We have assessed the value of routine preoperative tests in asymptomatic patients and their influence on anaesthetic and surgical decisions. We studied 3131 ASA I and II patients from four general hospitals undergoing elective surgical procedures. A retrospective review of the medical records revealed that 853 (27%) patients had some abnormal test result, of which 465 (15%) were previously unknown and not suspected at the preanaesthetic visit; these comprised 8.6% chest radiographs, 5.6% electrocardiograms and biochemical tests, and 2.9% haematological tests. Perioperative management was altered in only 0.56-0.26% of patients, depending on the particular test. The present study confirms the need for selective and rational ordering of preoperative tests, the basis of which should be the clinical assessment during the preanaesthetic visit.

Anesthesia, General↗