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Biomedical subjects

A Torres

Publications and source records attributed to A Torres.

At least 469 records · Page 26Linked to original sources
PubMed1994

Arterial oxygenation does not predict the outcome of patients with acute respiratory failure needing mechanical ventilation.

One hundred and eighteen patients consecutively submitted to mechanical ventilation during a one year period, and admitted to the Respiratory Intensive Care Unit of the Hospital Clinic of Barcelona, were prospectively studied in order to define the importance of hypoxaemia as a predictor of mortality. Using a discriminant multivariate analysis, the following variables were selected as the best predictors of outcome: 1) the number of associated complications (NAC) on admission; 2) the simplified acute physiologic score (SAPS); 3) oxygenation index (PAO2-AaPO2)/PAO2 + 0.014 positive end-expiratory pressure (PEEP); and 4) the age of the patients. Using these predictors, 84% of the patients were accurately classified as survivors or as nonsurvivors. The partial contribution of each predictor to the model was also assessed using a logistic regression, by eliminating each single predictor and each possible pair of predictors. Using this means of analysis, the NAC and SAPS were the only predictors of mortality. The inclusion of short-term mechanically-ventilated patients did not bias the accuracy of prediction.

Aged↗
PubMed1994

Peculiarities of the thyroid gland structure (with special reference to the presence of ganglion cells).

We have performed a study on the comparative structure of the thyroid gland in several species of mammals (rat, cat, dog, lamb, pig, cow, and man). We have described the structural differences among them, paying special attention to the distribution of connective tissue, the intrafollicular and parafollicular cells. In the thyroid gland, we can confirm the existence of nerve cells, either isolated or forming vegetative ganglions in the interfollicular spaces, in some of the species studied, especially in the rat and the dog.

Animals↗
PubMed1994

Double think and double talk.

The public health debate on population growth and child mortality continues, fuelled by the hypothesis that in allowing more children to survive until reproductive age, programmes such as the Diarrhoeal Diseases Control Programme of the World Health Organization contribute to long-term human misery by overburdening the carrying capacity of the planet. A significant part of the solution put forward is to withhold public health services to children in developing countries. This argument is here refuted on socioeconomic, ethical and humanitarian grounds. An alternative approach is offered, which takes into account the economic and social obligations of the industrialized nations.

Child Health Services↗
PubMed1994

The use of Food and Drug Administration--approved medications for unlabeled (off-label) uses. The legal and ethical implications.

Physicians increasingly use Food and Drug Administration (FDA)-approved drugs (medication) for unlabeled (off-label) indications. The ethical and legal implications of these actions are not always clear. In this article, I examine the common law and federal statutory regulations concerning this issue and also explore some of the ethical and financial issues involved.

Beneficence↗
PubMed1993

Circannual rhythm in the effects of stress on the humoral immune response of the rat.

Among the seasonal immunological changes that have been observed are increase in spring-summer and decrease in autumn-winter humoral response, in unstressed subjects. In rats we show that, relative to controls, stress increased the antibody response to sheep red blood cells in July-August, and decreases it from September throughout February. We concluded, therefore, that stress reinforces the basic annual rhythm of this type of response.

Animals↗
PubMed1993

Mutations of low-density-lipoprotein-receptor gene, variation in plasma cholesterol, and expression of coronary heart disease in homozygous familial hypercholesterolaemia.

Variation in plasma-cholesterol concentration and the expression of coronary heart disease in patients with homozygous familial hypercholesterolaemia (FH) is well documented, but the underlying reasons for variation are not clearly defined. Because FH is caused by mutations at the low-density-lipoprotein-gene locus, we compared plasma-cholesterol concentrations in 21 FH homozygotes with either the greater than 10 kb deletion (promoter region and exon 1) (11 subjects) or the exon 3 missense (trp66-->gly) mutation (10 subjects) of the low-density-lipoprotein gene. Subjects with the greater than 10 kb deletion had a higher mean plasma-cholesterol concentration than those with the exon 3 mutations (26.7 vs 16.1 mmol/L; p = 0.000006), and there was no overlap in individual plasma-cholesterol concentrations between subjects in the two groups. Although the frequency of coronary heart disease was similar in the two groups, age-of-onset was earlier in subjects with the greater than 10 kb deletion (p = 0.059). Also, coronary deaths were more frequent (p = 0.044) and occurred at an earlier age (p = 0.009) in subjects with the greater than 10 kb deletion. Our results provide evidence that there is less variation in plasma-cholesterol concentrations among FH homozygotes when they are subdivided into groups according to low-density-lipoprotein-receptor-gene defect. Furthermore, differences in plasma-cholesterol concentrations are reflected in the severity of coronary heart disease expression.

Adolescent↗
PubMed1993

Prevention of raised low-density lipoprotein cholesterol in a patient with familial hypercholesterolaemia and lipoprotein lipase deficiency.

Raised low-density lipoprotein (LDL) cholesterol is believed to predispose to development of atherosclerosis and coronary heart disease. Increased plasma LDL concentrations and premature coronary heart disease are present in familial hypercholesterolemia (FH), and the enzyme lipoprotein lipase (LPL) seems to have a key role in production of LDL. We describe a unique French Canadian individual who is both heterozygous for FH and homozygous for LPL deficiency (FH/LPL). In this patient, LDL cholesterol was strikingly low compared with both his FH (0.65 vs 5.84 mmol/L) and normolipidaemic (2.77 mmol/L) age-matched relatives despite the defect of LDL-receptor-mediated removal. No LDL peak was present in the cholesterol profile of the FH/LPL-deficient subject, as determined by density-gradient ultracentrifugation. Our results suggest that most LDL particles, in vivo, originate from triglyceride-rich lipoproteins, that LPL plays a vital part in this process, and that absence of LPL activity protects FH subjects against the increase in LDL cholesterol.

Adolescent↗
PubMed1993

Detection of antibodies to Candida albicans germ tube as a possible aid in diagnosing systemic candidiasis in bone marrow transplant patients.

Indirect immunofluorescence assays to detect antibodies to Candida albicans blastospore and germ tube were performed in sera of 29 bone marrow transplant patients. Antibodies to germ tube were present in the sera of six patients, in four of whom a Candida albicans infection was highly probable, while in the other two patients it was not possible to determine the previous course. No healthy blood donors had these antibodies. On the other hand, detection of antibodies to Candida albicans blastospore showed low specificity in the diagnosis of systemic candidiasis. These preliminary findings suggest that the detection of antibodies to Candida albicans germ tube may be an important aid in the diagnosis of systemic candidiasis in bone marrow transplant patients.

Adolescent↗
PubMed1993

Identification of glucagon receptors in human adipocytes from a liposarcoma.

The presence of glucagon receptors on human adipocytes has not yet been described. In this work we present an exceptional case of glucagon binding to human adipocytes taken from a malignant tumor of adipose tissue of a patient with a liposarcoma. Binding analysis revealed that the total number of glucagon receptors on liposarcoma-cells was 99,000 and the apparent receptor affinity (ED:50) was 5 x 10(-9) M. Despite the presence of these specific receptors, glucagon was unable to induce a lipolytic response, or to activate the adenylate-cyclase system in these liposarcoma-cells. Whether the induction of glucagon receptors is a specific process of the tumor biology remains to be elucidated.

Adipose Tissue↗
PubMed1993

Cardiac autonomic control mechanisms in Chagas' heart disease. Therapeutic implications.

According to the neurogenic theory of Chagas' heart disease, the cardiac parasympathetic abnormalities of chagasic cardiac patients are due to a selective destruction of the cardiac parasympathetic neurons. Trypanosoma cruzi would selectively destroy the cardiac vagal neurons, during the acute stage of the disease. However, these cardiac parasympathetic abnormalities are found mainly in chagasic patients who are in very advanced stages of the disease. Furthermore, the extent of cardiac parasympathetic involvement correlates with the degree of left ventricular dilation. Cardiac parasympathetic abnormalities, and a reciprocal sympathetic hyperactivity are also present in non-chagasic cardiac patients. Modern medical treatment, with sympatholytic drugs, prevents ventricular dilatation and prolongs life in these non-chagasic cardiac patients. Consequently, if chagasic cardiac patients have ventricular dilatation-related parasympathetic abnormalities; it is of the utmost importance to ask: first, do they also have a progressive activation of their neurohumoral systems?; and second, would they benefit from sympatholytic drugs?.

Autonomic Nervous System↗
PubMed1993

Ablation of irreversibly rejected renal allograft by embolization with absolute ethanol: a new clinical application.

Surgical allograft nephrectomy has been the conventional therapy for removing failed kidney allografts when clinical manifestations of graft intolerance appear. However, removal of a transplanted kidney is an extensive surgical procedure. On the other hand, transcatheter vascular embolization (TVE) has proven useful in ablating organs and could be applied to renal transplant ablation. The aim of this study was to present the results of TVE for the treatment of graft intolerance syndrome (GIS) in failed allograft kidneys. Transcatheter vascular embolization was performed in 14 allograft recipients (33 +/- 13 years of age; 10 men and four women) affected by GIS after irreversible kidney allograft failure. Graft intolerance syndrome was diagnosed by fever (93%), hematuria (50%), graft pain (36%), flu-like symptoms (29%), and increased graft size (29%). Absolute ethanol (0.1 mL/kg body weight) was injected in the allograft artery, and in seven patients a stainless steel coil was left in the renal artery following ethanol injection. All patients showed clinical disappearance of the GIS. No major complication occurred, although a postembolization syndrome of pain, fever, hematuria, numbness, and paresthesia of the affected area appeared in 11 of the 14 patients. After 2 to 56 months of follow-up no late complications occurred, with the exception of a graft abscess formation in one patient after 6 months of embolization. Subsequent transplantectomy was uneventful. In conclusion, TVE is a safe and effective method for kidney graft ablation, and it may become an alternative treatment for GIS following irreversible rejection.

Adult↗
PubMed1993

Tissue-specific modulation of insulin receptor mRNA levels in a patient with a phaeochromocytoma.

We have observed that the expression of the insulin-receptor gene is regulated in a tissue-specific manner in a patient with a phaeochromocytoma. Our results indicate that insulin receptor mRNA levels are decreased in adipose tissue and increased in both liver and skeletal muscle as compared with the corresponding values in the same tissues of a control patient. These findings provide the first evidence that insulin receptor mRNA levels may be modulated in vivo by high levels of catecholamines.

Adipose Tissue↗
PubMed1993

Pseudocyst of the auricle.

BACKGROUND: Pseudocyst of the auricle is a benign swelling of the ear characterized by collection of fluid within an unlined intracartilaginous cavity. The etiology and pathogenesis of this disorder remain unknown. Various forms of management have been described in several case reports and small series. OBJECTIVE: Description of a surgical procedure for successful management of pseudocyst of the auricle. METHODS: Case report of a patient who declined nonsurgical treatment options following failed management with aspiration. RESULTS: The described procedure resulted in cure of the pseudocyst with good cosmetic outcome. CONCLUSION: Pseudocyst of the auricle can be successfully managed by surgical excision of the anterior wall of the cyst.

Adult↗
PubMed1993

Establishing the physician-patient relationship.

BACKGROUND: This is the first in a series of articles written to address the many medicolegal issues that impact the practice of dermatology. The topic of establishing the physician-patient relationship was chosen as the starting point since it is the cornerstone of every medical malpractice action. 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 medicolegal literature and actual recorded case law. RESULTS: A physician-patient relationship may be established whether or not there is actual physical contact between the physician and patient, there is gratuitous advice, or there is an academic purpose. CONCLUSION: The key in determining whether a physician-patient relationship has been established is whether the patient reasonably relied upon advice given or had an expectation of treatment.

Dermatology↗