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Biomedical subjects

A Torres

Publications and source records attributed to A Torres.

At least 451 records · Page 25Linked to original sources
PubMed1994

Prognostic significance of serum CA 125 antigen assay in patients with non-small cell lung cancer.

BACKGROUND: The serum levels of CA 125 tumor-associated antigen in patients with lung cancer have been previously related to TNM stage, histologic type, and survival rate. In the current study, the prognostic information provided by the CA 125 antigen assay was analyzed. METHODS: Preoperative serum of CA 125 antigen was determined in 137 patients with non-small cell lung cancer. The assay was performed by means of a solid-phase enzyme-immunoassay test. The influence of CA 125 serum level on postoperative outcome was studied by a multivariate analysis, performed with Cox's proportional hazards regression model. RESULTS: Patients whose initial CA 125 level was higher than 15 U/ml had a 3.25-fold greater likelihood of relapse (95% confidence interval [CI], 1.7-6.21) (P < 0.001) and a 4.27-fold greater likelihood of deaths (95% CI, 2.42-7.55) (P < 0.001) due to cancer than patients with lower values. For patients with serum levels over 15 U/ml, the 36-month survival rate posttreatment was lower (67% versus 20%) (P < 0.001), as was the disease-free rate (64% versus 13%) (P < 0.001). After adjustment for TNM stages, histologic type, sex, and age, patients with CA 125 values over 15 U/ml continued exhibiting higher risk of relapse (hazard ratio, 2.2; 95% CI, 1.04-4.69) (P = 0.04) and higher risk of death (hazard ratio, 2.42; 95% CI, 1.29-4.54) (P = 0.006). CONCLUSIONS: CA 125 is an independent prognostic factor of survival and tumor relapse in non-small cell lung cancer. The preoperative serum level of CA 125 antigen is inversely correlated with the outcome figures. The authors suggest that CA 125 be included in any future multifactorial analysis of survival.

Adenocarcinoma↗
PubMed1994

Utility of selective digestive decontamination in mechanically ventilated patients.

OBJECTIVE: To assess selective digestive decontamination for preventing nosocomial pneumonia and mortality in mechanically ventilated patients. DESIGN: Prospective, randomized, placebo-controlled, double-blind study. SETTING: Respiratory intensive care unit of a 1000-bed teaching hospital. PATIENTS: 80 patients receiving mechanical ventilation for more than 72 hours. INTERVENTIONS: Patients received selective digestive decontamination using polymyxin E, tobramycin, and amphotericin B through a nasogastric tube and also topically in the oropharynx; control patients received placebo. All patients received intravenous cefotaxime for 4 days or other systemic antibiotics if required. MEASUREMENTS: Bacteriologic surveillance (three times a week) was done by quantitatively culturing tracheal aspirates, pharyngeal swabs, and gastric juice. The diagnosis of pneumonia was based on quantitative cultures of protected specimen brush samples (> or = 10(3) CFU/mL [colony forming units/mL]) or bronchoalveolar lavage fluid (> or = 10(4) CFU/mL) and autopsy findings. RESULTS: Bronchial, oropharyngeal, and gastric colonization by gram-negative bacilli and Candida species was lower in the selective digestive decontamination group compared with the placebo group. Nonsignificant differences were found in the incidence of nosocomial infections (28% compared with 37%; odds ratio, 0.66; 95% CI, 0.35 to 1.25) and nosocomial pneumonia (18% compared with 24%; odds ratio, 0.7; CI, 0.33 to 1.46) and in the crude mortality rate (31% compared with 27%; odds ratio, 1.21; CI, 0.63 to 2.34) when comparing digestive decontamination with placebo, respectively. CONCLUSIONS: Selective digestive decontamination in our mechanically ventilated patients significantly decreased the colonization rate of gram-negative bacilli and of Candida species but not of Staphylococcus aureus. It did not decrease the incidence of nosocomial pneumonia, mortality, length of stay, or the duration of mechanical ventilation.

Adult↗
PubMed1994

Plasma renin activity in chagasic patients with and without congestive heart failure.

Chagasic patients with advanced heart disease have fluid retention-dependent symptoms. Since fluid retention is mostly dependent on the renin-angiotensin-aldosterone system, chagasic patients with congestion related symptoms should have activation of the renin-angiotensin-aldosterone system. The purpose of this investigation was to determine the plasma renin activity baseline values of chagasic patients with and without congestive heart failure. Twenty-eight patients with positive serology for Chagas' disease were studied. Nineteen patients were asymptomatic (functional class I New York Heart Association) and nine were symptomatic (functional classes II-IV). Cardiac catheterization and ventricular cineangiography were performed on 20 patients. The symptomatic patients had significantly higher plasma renin activity levels (4.11 +/- 1.03 ng/ml/h) than the asymptomatic patients (1.08 +/- 0.11 ng/ml/h, P < 0.001) and the normal sedentary controls (1.65 +/- 0.22 ng/ml/h, P < 0.05, mean +/- S.E.). The plasma renin activity baseline values of the asymptomatic and symptomatic patients correlated directly with the baseline heart rate (r = 0.77, P < 0.0001). The symptomatic patients had larger ventricular volumes, moderately depressed ejection fractions and increased left ventricular end-diastolic pressures. The plasma renin activity baseline values also correlated directly with the left ventricular diastolic pressures (r = 0.70, P < 0.0006) and with the left ventricular diastolic (r = 0.66, P < 0.001) and systolic volumes (r = 0.67, P < 0.001). These results indicate that chagasic patients with fluid retention-dependent symptoms and hemodynamic evidence of left ventricular systolic dysfunction have activation of the renin-angiotensin-aldosterone system.

Adult↗
PubMed1994

Apical left ventricular aneurysms and cardiac parasympathetic innervation in Chagas' heart disease.

Left ventricular apical aneurysms are present in Chagasic patients who have normal cardiac parasympathetic innervation. Cardiac parasympathetic abnormalities are found, in later stages of the disease, when diffuse myocardial damage and ventricular dilatation are already present. The apical region of the left ventricle is also affected in several acute and chronic non-Chagasic cardiac diseases. Therefore, thinning of the left ventricular apex, with aneurysm formation, may be a non-specific myocardial sequelae, secondary to myocardial damage.

Chagas Cardiomyopathy↗
PubMed1994

Association between protein intake and 1-y weight and height gains in Bangladeshi children aged 3-11 y.

We examined 1-y weight and height gains among 238 rural Bangladeshi children aged 3-11 y old to address the hypothesis that dietary protein composition is associated with growth velocity. Energy-adjusted total protein and energy-adjusted protein from sources other than cereal (animal, pulses, and vegetables) were associated with higher weight gains, after adjustment for age, sex, land ownership, diarrhea, acute respiratory infections, other fevers, nutritional status at the beginning of the study, and average body mass index of the mother [daily intake of energy-adjusted noncereal protein (beta +/- SE): 14.2 +/- 6.4 g.y-1.g-1, P = 0.03; total protein: 13.1 +/- 6.3 g.y-1.g-1, P = 0.04; and protein as percent of energy intake: 39.5 +/- 20.2 g.y-1.% of energy from protein-1, P = 0.05]. These findings are compatible with the hypotheses that protein intake may be a limiting factor for weight gain in this population, or that higher protein intake from animal sources (mostly fish) and legumes (lentils and peas) may be accompanied by higher intakes of limiting micronutrients.

Anthropometry↗
PubMed1994

Adynamic bone disease with negative aluminium staining in predialysis patients: prevalence and evolution after maintenance dialysis.

Aplastic bone disease (ABD) is a common form of renal osteodystrophy and is characterized by a defect in bone matrix formation and mineralization without an increase in osteoid thickness. The prevalence and pathogenesis of ABD in predialysis patients is largely unknown. We prospectively studied 92 unselected predialysis patients with a creatinine clearance < 10 ml/min/1.73 m2 and a mean age of 45 +/- 2 years (61 M, 31 F). None of the study patients had received any form of vitamin D therapy, and CaCO3 was the primary phosphate binder. Aplastic bone disease was observed in 30 (32%) patients. Stainable bone aluminium surface was < 3% in all ABD patients. Patients with ABD were older (52 +/- 3 versus 42 +/- 2 years; P < 0.01) and had reduced serum intact PTH compared to non-ABD patients (199 +/- 25 versus 561 +/- 87 pg/ml; P < 0.001). Patients with diabetes mellitus showed lower PTH values (179 +/- 31 versus 432 +/- 62 pg/ml; P < 0.001) and a lower incidence of advanced hyperparathyroidism bone lesions (16% versus 46%; P < 0.05) than non-diabetic patients. However, diabetes was not clearly associated with low bone turnover disease (56% in diabetics versus 41% in non-diabetics; P = 0.1). A second bone biopsy was obtained in eleven ABD patients after a period of 16.6 +/- 2.2 months on maintenance dialysis with a dialysate calcium of 7 mg/dl. Bone histology was unchanged in 10 patients, and one evolved to mild hyperparathyroidism. Trabecular bone volume did not change (22.7 +/- 1.7 versus 20.7 +/- 1.7%), and the stainable bone aluminium surface remained < 3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Autoimmune haemolytic anaemia presenting 9 years prior to Castleman's disease.

Castleman's disease (CD) is a rare disease of unknown aetiology and pathogenesis. We present an unusual case of abdominal CD in whom the first manifestation was an autoimmune haemolytic anaemia presenting 9 years before the diagnosis. The Coombs test became negative 2 months after surgical resection of the mass, suggesting that the mass was the source of the autoantibody. CD may be present in autoimmune haemolytic anaemia in patients with no evidence of any other disease.

Adult↗
PubMed1994

Lymphoid blast crisis at the onset of chronic myelogenous leukaemia: molecular evidence.

A patient with a typical haematological pattern of acute lymphoblastic leukaemia with BCR and IgH rearrangements was brought into complete remission by treatment. A few weeks later she developed the typical peripheral and bone marrow pattern of chronic myelogenous leukaemia (CML) with persistence of the BCR rearrangement and disappearance of the IgH rearrangement, suggesting that this case is an example of CML presenting in blast crisis without a detectable chronic phase.

Adult↗
PubMed1994

Terminating the physician-patient relationship.

BACKGROUND: This continues our series of articles addressing the many medicolegal aspects that impact the practice of dermatology. Because the physician-patient relationship is the cornerstone of every medical malpractice action, the proper termination of that relationship is very important. METHODS: A format of an initial discussion of legal concepts followed by hypotheticals and a review of actual cases was chosen to enhance interactive learning. The subject matter is based on a review of medico-legal literature and actual recorded case law. RESULTS: Once a physician-patient relationship has been established, improper termination of that relationship may constitute abandonment. CONCLUSION: Any termination of the physician-patient relationship must be reasonable in view of the patients' access to alternate medical care and medical problems and should be properly communicated to the patient.

Dermatology↗
PubMed1994

The prevalence and patterns of dental caries in Labrador Inuit youth.

OBJECTIVES: This study was undertaken to examine the prevalence of dental caries in Inuit (Eskimo) youth aged 5-22 years. METHODS: Both tooth-oriented indices and child-oriented caries patterns were recorded in a field study conducted in 1991 in Nain and Hopedale, Northern Labrador. Seventy-eight percent (N = 347) of all school-children in these two locations were examined by a single examiner. RESULTS: Three percent of the population were caries free and 88 percent of those with caries experience had untreated dental decay. The mean combined dmft and DMFT per child for all ages was 6.85, while the mean combined dmfs and DMFS was 15.72. About 38 percent of subjects had pit and fissure caries; 2 percent had hypoplastic lesions; 4 percent had faciolingual caries; 31 percent had molar-approximal caries and 22 percent had faciolingual and molar-approximal caries, the most destructive caries pattern. About 68 percent of the 5-6-year-olds and 26 percent of the 15-22-year-olds experienced the most destructive pattern of decay in their primary and permanent dentitions, respectively. CONCLUSIONS: Preventive measures should start well before the age of 5 years. Describing caries patterns according to the dentition type complemented the traditional indices.

Adolescent↗
PubMed1994

Computer-assisted CT-guided stereotactic biopsy and brachytherapy of brain tumors.

From March 1991 to September 1993, 26 patients (aged 4-78 years) with brain tumors (4 glioblastoma multiforme, 10 nonglioblastoma multiforme, 1 mixed oligoastrocytoma, 2 carniopharyngiomas, 2 meningiomas and 7 metastases) were treated with stereotactic techniques at the Centro Internacional de Restauración Neurológica, La Habana, Cuba. A total of 28 stereotactic surgical procedures were performed with no operative mortality; they included biopsies in all cases, 1 stereotactic microsurgical resection and 12 permanent implants of 192Ir, followed by external beam fractionated radiation therapy (40-60 Gy). The present paper shows that the combined use of a stereotactic approach, a comprehensive and reliable stereotactic dosimetric planning system, stereotactic brachytherapy with 192Ir and complementary percutaneous radiation treatment constitutes a promising strategy for brain tumor management.

Adolescent↗
PubMed1994

Idiopathic pulmonary-renal syndrome with antiproteinase 3 antibodies.

In this report, we describe a patient who developed acute renal failure and fatal pulmonary hemorrhage. Autopsy examination revealed pauci-immune necrotizing glomerulonephritis and pauci-immune hemorrhagic alveolar capillaritis. No evidence of granulomatous inflammation or vasculitis other than capillaritis was found in either lungs or kidneys. In addition, histopathologic examination of the upper respiratory tract, liver, spleen, digestive tract, and skeletal muscle was completely normal. The patient's serum sample disclosed antiproteinase 3 antibodies with an immunofluorescence titer of 1:1,600. Although there have been reports of patients with pulmonary-renal syndrome in association with antiproteinase 3 antibodies in the absence of a well-known vasculitic disease, we have not so far seen a case documented by a detailed autopsy study such as is presented here. In view of our findings and those of some other reports on this clinicopathologic condition, we suggest that this might represent a distinct form of vasculitis with exclusive capillary involvement.

Aged↗
PubMed1994

Validation of different techniques for the diagnosis of ventilator-associated pneumonia. Comparison with immediate postmortem pulmonary biopsy.

To assess the accuracy of clinical parameters for the diagnosis of ventilator-associated (VA) pneumonia, as well as the diagnostic value of several invasive techniques, such as protected specimen brush (PSB), bronchoalveolar lavage (BAL), fiberoptic bronchial aspirates (FBAS), and percutaneous lung needle aspiration (PLNA), we compared the results of these techniques with the histopathology of immediate postmortem pulmonary biopsies, considered the "gold standard" reference test. We studied 30 mechanically ventilated patients (age 52 +/- 21 yr; mechanical ventilation period 9 +/- 7 days) who died in an intensive care unit. All patients received prior antibiotic treatment. The following procedures were performed immediately after death: bilateral PSB, BAL, FBAS, and PLNA, as well as bilateral minithoracotomies to obtain pulmonary biopsies as close as possible to the area sampled with the other techniques. According to the histopathology 18 patients had pneumonia and 12 did not. The presence of fever (sensitivity 55%, specificity 58%), purulent secretions (sensitivity 83%, specificity 33%), and chest radiograph infiltrates (sensitivity 78%, specificity 42%) could not differentiate in all instances presence from absence of pneumonia. Quantitative bacterial cultures of lung biopsies using 10(3) cfu/g as a cutoff point had low sensitivity (40%) and low specificity (45%) and could not differentiate the histologic absence or presence of pneumonia. Considering the histopathology of pulmonary biopsies as a gold standard, we found the following sensitivities for PSB, BAL, FBAS, and PLNA: 36, 50, 44, and 25%. The specificities were 50, 45, 48, and 79%, respectively. The sensitivities and specificities of different invasive techniques are much lower than those reported in clinical studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1994

Effects of PEEP on VA/Q mismatching in ventilated patients with chronic airflow obstruction.

Recent work in patients with acute respiratory failure (ARF) due to exacerbation of chronic airflow obstruction (CAO) suggests that application of low degrees of positive end-expiratory pressure (PEEP) can improve rather than impair respiratory mechanics, because PEEP replaces intrinsic PEEP (PEEPi). However, the impact of PEEP on pulmonary gas exchange has not been fully investigated. We designed this study to examine the effects of PEEP and those of PEEPi on ventilation/perfusion (VA/Q) mismatching in mechanically ventilated patients with CAO. Eight patients were studied under four conditions: (1) during controlled mechanical ventilation with the ventilatory setting established by the attending physicians (PEEPi-100%), according to standard criteria; (2) after application of PEEP amounting to 50% (PEEP-50%), and then (3) to 100% (PEEP-100%) of the original PEEPi; and finally, (4) after reduction of PEEPi to 50% of the initial value (PEEPi-50%), obtained by increasing expiratory time and decreasing respiratory rate and tidal volume. Respiratory mechanics, hemodynamics, respiratory blood gases, and VA/Q distributions were measured during each ventilatory mode. At low values of PEEP (PEEP-50%) no changes in respiratory mechanics nor in hemodynamics were observed, but PaO2 moderately increased (from 103 +/- 25.2 to 112 +/- 29.6 mm Hg) and PaCO2 slightly decreased (from 42 +/- 3.7 to 40 +/- 3.3 mm Hg) essentially because of an increase in the mean VA/Q ratio (first moment) of both flood flow (Q, from 0.65 +/- 0.28 to 0.78 +/- 0.29) and ventilation (V, from 4.02 +/- 1.55 to 4.93 +/- 2.00) distributions (p < 0.05, each).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes.

All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. MRSA-infected persons were more likely to have received steroids before developing infection (relative risk [RR] = 3.45, 95% confidence interval [CI] = 1.38-8.59), to have been ventilated > 6 d (RR = 2.03, 95% CI = 1.36-3.03), to have been older than 25 yr (RR = 1.50, 95% CI = 1.09-2.06), and to have had preceding chronic obstructive pulmonary disease (RR = 2.76, 95% CI = 0.89-8.56) than MSSA-infected patients. MSSA-infected persons were more likely than MRSA-infected patients to have cranioencephalic trauma (RR = 1.94, 95% CI = 1.22-3.09). All patients with MRSA VAP had previously received antibiotics, compared with only 21.1% of those with MSSA infection (p < 0.000001). The incidence of empyema was similar in both groups; nevertheless, the presence of bacteremia and septic shock was more frequent in the MRSA group. Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Distribution of antigen in cattle infected with rinderpest virus.

Five Holstein heifers (approximately 8 months of age and weighing 225-275 kg) were inoculated subcutaneously with 1,000 TCID50 of rinderpest virus, virulent Kabete O strain. They become clinically ill 2 to 5 days post-inoculation, with fever (40 C to 41.5 C), conjunctivitis, and diarrhea. All were euthanatized when moribund at 6 days postinoculation. The following tissues were collected in formalin, embedded in paraffin, and subsequently subjected to histopathologic and immunohistochemical examination: tongue, buccal mucosa, soft palate, esophagus, rumen, abomasum, duodenum, jejunum with and without Peyer's patch, ileum, cecum, proximal colonic lymphoid patch, spiral colon, eyelid, gall bladder, spleen, tonsil, trachea, lungs, and numerous lymph nodes. Immunohistochemical examination was accomplished using a primary rabbit anti-rinderpest antibody, and either a peroxidase-diaminobenzidine or alkaline phosphatase-Vector Red detection substrate system. In the lymph nodes, spleen, and tonsil, depletion of lymphocytes from all areas was extensive, with antigen most prominent in persisting reticular cells throughout the tissues. In the intestine, necrotizing and ulcerative changes in the mucosa were extensive and widespread. Damage was most severe in areas overlying lymphoid patches. In both small and large intestine, antigen was distributed predominantly in epithelial cells, histiocytic cells in the lamina propria, and in remaining reticular cells of lymphoid patches. In oral mucosa, there were multiple ulcerations and numerous multinucleate syncytial cells, both containing and without antigen. Lungs and trachea had subtle yet consistent necrosis of epithelial cells, with antigen often distributed in a circumferential manner in epithelium of bronchioles.

Animals↗