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Biomedical subjects

C Aguirre

Publications and source records attributed to C Aguirre.

At least 73 records · Page 4Linked to original sources
PubMed1994

Protein binding of itraconazole and fluconazole in patients with chronic renal failure.

The serum protein binding of itraconazole and fluconazole, new triazole antifungal agents, has been investigated in vitro in the serum of healthy volunteers and in patients with chronic renal failure (predialysis). Protein binding was determined by ultrafiltration. Concentrations of both alpha 1-acid glycoprotein (AAG) and albumin were measured in all serum samples. The protein binding of itraconazole showed no significant changes in patients with chronic renal failure when compared to healthy volunteers (96.64 +/- 0.99% vs. 96.85 +/- 0.33%). In contrast, fluconazole protein binding was significantly increased in the same patients (22.91 +/- 6.15% vs. 12.51 +/- 2.37%; p < 0.001). In addition, whereas albumin levels in the latter patients were significantly decreased (p < 0.001), their AAG levels were found to be significantly elevated with respect to control subjects (p < 0.001). While no correlation was established between itraconazole protein binding and albumin or AAG concentrations, a significant correlation was found between fluconazole protein binding and AAG levels (r = 0.72; p < 0.001). Fluconazole protein binding was found to be independent of albumin concentrations. In vitro carbamylation of serum protein with potassium cyanate caused no changes in the protein binding of fluconazole or itraconazole. We conclude that the binding of itraconazole by serum proteins is not altered in diseases involving changes of AAG or albumin concentrations. However, fluconazole protein binding may be altered in disease states associated with increased AAG concentrations.

Adult↗
PubMed1994

[Experience with the use of stomach in bladder reconstruction].

Bladder reconstruction with a gastric portion, as an alternative to other intestinal segments, has gained popularity lately. We have used a vascularized gastric segment for bladder replacement in 20 patients aged 3 to 77 years old, between 1990 and 1993. The surgical indication was due to a severe radiation cystitis in 11 cases, neurogenic bladder in 4, urinary diversion in 4 and cystectomy due to bladder cancer in 2. In 18 cases, associated surgical procedures were performed. Mild complications occurred in 3 cases and no patient died. Postoperative evolution has been excellent. Sixteen patients maintained a normal miction and 4 required self performed urethral intubation. It is concluded that stomach is a good alternative for bladder reconstruction. We are employing it with higher frequency in our practice due to the technical simplicity and the physiological advantages of its use. The metabolic acidosis secondary to ionic absorption that occurs with the use of other intestinal segments, specially in patients with renal failure, is avoided. Also, it facilitates surgical procedures in patients with severe abdominal radiation damage.

Adolescent↗
PubMed1993

[Hepatitis C virus antibodies in hospital personnel].

BACKGROUND: The discovery of the hepatitis C virus (HCV) largely responsible for the non A non B hepatitis, and the antiHCV antibody allows epidemiologic data and risk factors of infection related to the same to be known. The aim of the authors was to know the prevalence of the antiHCV in health care staff in relation with a group of extrahospitalary workers. METHODS: A transversal seroepidemiologic study was carried out in physicians, nurses and auxiliaries with seniority of more than one year in the medical, surgical, emergency, and ICU departments and laboratories of the general hospital of reference (1200 beds). RESULTS: Of the 874 participants (93% of the candidates) 19 (2%) had HCV antibodies detected by ELISA; with positive RIBA II and positive LIA test in 14 (1.6%) of them. In 11 sera ARN of HVC was detected by PCR. Of 547 extrahospitalary workers of the control group, 2 (0.4%) had positive markers against HCV (p < 0.05). The GPT of the seropositive individuals was normal in four and equal to or less than 70 U/l in six. Seven cases (50%) also had serologic data of contagion with HCV. In 10 (1.1%) of the health care staff no risk factor other than hospitalary work was found. CONCLUSIONS: Working in departments attending HCV carriers represents an increase in risk which must be taken into account with regard to accidental exposure to fluids of patients admitted to these areas.

Adult↗
PubMed1993

Biotechnology in the Andean Group: common policies and instruments.

Although applications of biotechnology have taken a slower pace than initially anticipated, they certainly hold potentials for contributing to the social welfare and economic growth of all nations. Aware of such potentials, the andean countries (Bolivia, Columbia, Ecuador, Peru and Venezuela) individually and collectively, within their economic integration process, are making efforts to develop this new technology area. At the national level, science and technology policies and strategies are being revamped to create an appropriate environment for the development and application of biotechnology and several projects are under execution. These efforts still need, however, further political support and investment. In 1969 the andean countries established an economic integration agreement (the Cartagena Agreement), which included technology as one of its main concerns. For 22 years conceptual and operational developments have taken place creating joint capabilities in many technology areas, including biotechnology. In the last two years the pace has slowed down and is not accompanying national efforts. This is particularly serious as no country can by itself fully develop biotechnology. In spite of current difficulties the Andean Group is well placed to accelerate the development of biotechnology through the application of existing policies and legislation at communitarian level.

Biotechnology↗
PubMed1993

Open, randomized therapeutic trial of six antimicrobial regimens in the treatment of human brucellosis.

This report describes the results of six antimicrobial regimens used for the treatment of brucellosis in an open, randomized study performed over two periods (1980-1983 and 1984-1987). In the first period, rifampicin and doxycycline were used for 4 weeks, trimethoprim-sulfamethoxazole for 6 months, and doxycycline for 6 weeks. During the second period, we used streptomycin for 2 or 3 weeks together with doxycycline for 6 weeks and rifampicin with doxycycline for 6 weeks. Comparison of the results showed the following: (1) no statistically significant findings were revealed when the different regimens were compared and (2) the regimens containing streptomycin yielded statistically more favorable results than those consisting of rifampicin and monotherapy when the patients treated with rifampicin were compared with those taking streptomycin and those receiving single-agent therapy. No significant differences were observed between monotherapeutic regimens and those including rifampicin.

Adolescent↗
PubMed1993

[Extracorporeal lithotripsy by shock waves: results in 185 patients].

Extracorporeal shock wave lithotripsy has become the treatment of choice of nephrolithiasis with surgical indication. Our unit is managing urinary tract stones using the Sonolith 3000 lithotritor since April 1991. The procedure is performed in ambulatory patients and requires analgesia and mild sedation. We report the experience in the treatment of the first 185 patients. In 87% of them, the stones disappeared completely, 8.7% of patients were left with residual fragments without indication of further treatments and in 4.3% the procedure failed. There was no mortality. In 13 occasions, obstructive complications at the distal ureter were produced by the stone fragments that required ureteroscopy in only three patients and 11 patients had severe renal colic. We conclude that this procedure is safe and effective in the treatment of urinary tract stones.

Adolescent↗
PubMed1993

Netilmicin kinetics in urology.

Plasma kinetics of netilmicin, an aminoglycoside antibiotic was studied in 62 patients undergoing urologic surgery. Despite the use of a standard 100 mg-dose, no toxic levels were achieved except in one patient. A poor correlation was found between netilmicin plasma elimination constant and creatinine clearance (r = 0.34, p = NS). We can conclude that the prediction of netilmicin plasma concentrations is not possible using only demographic patient's data. The monitoring of netilmicin levels should be performed in long-term treatments but not in 4-dose regimes such as in urologic prophylaxis.

Adult↗
PubMed1993

[Laparoscopic nephrectomy: report of 2 cases].

Laparoscopic surgery has become very popular in general surgery. Its most significant advantages for patients are a better postoperative comfort and fast return to work. We report two young female patients with a gynecologic cancer in whom a laparoscopic nephrectomy was performed. The surgical procedure and the post operative recovery were uneventful. These promising results show that laparoscopic surgery is applicable in traditional urologic procedures.

Adult↗
PubMed1993

[Insulin resistance: a frequent phenomenon in clinical practice].

This review is focused on the diagnostic, clinical and therapeutic aspects of insulin resistance relevant to the clinician. The observed phenomenon of the wide variability of insulin sensitivity in clinically healthy subjects is discussed; qualitative and quantitative aspects of the methodologies currently used for the assessment of insulin sensitivity in the clinical setting are dealt with, as well as their applicability to day-to-day clinical care. The medical consequences of hyperinsulinemia, including dyslipidemia, hypertension coronary artery disease and ovarian hyperandrogenism are likewise discussed. A panoramic view of the various clinical presentations of insulin resistance is also offered, including clinical elements for suspicion, as well as an account of the prevalent, less-prevalent and rare disorders harboring the phenomenon of insulin resistance. The final topic of the review is a novel discussion on the therapeutic possibilities in insulin resistance disorders, including treatment with hormones and antihormones.

Adolescent↗
PubMed1993

Unchanged protein binding of penbutolol in renal insufficiency: a possible role of carbamylation.

The effect of in vitro carbamylation of serum protein with potassium cyanate on protein binding of penbutolol, a basic agent exclusively bound to alpha 1 acid glycoprotein (AAG), was investigated. Carbamylation of serum resulted in a weak increase on free fraction of penbutolol (4.45 +/- 0.54% before carbamylation vs 5.66 +/- 0.40% after; p < 0.025). Parallelly, potassium cyanate added to pure AAG and incubated for 90 min induced carbamylation of this protein (38 mumoles of 14C cyanate incorporated per gram of protein). A study in serum from patients with chronic renal disease (pre and postdialysis) showed no changes in protein binding of penbutolol, although AAG levels were significantly higher. However, Scatchard [1949] plot for penbutolol binding to serum from renal patients (both pre and postdialysis) showed a decrease in affinity constant (nKa = 11.13 x 10(5) M-1 in healthy volunteers, vs 5.56 x 10(5) M-1 in patients before dialysis and 4.57 x 10(5) M-1 after dialysis). We concluded that carbamylation of serum AAG in uremic patients could explain, in part, the absence of changes in protein binding of any basic drugs in this pathological condition. It appears that a decreased affinity constant could balance the effect of increased AAG levels.

Adult↗
PubMed1993

[Disease caused by Mycobacterium kansasii in patients with HIV infection].

BACKGROUND: To describe the clinical features and response to therapy in Mycobacterium kansasii disease among HIV infected patients, an increasing problem in our setting. METHODS: A retrospective survey of all charts from patients with HIV infection with Mycobacterium kansasii infection recorded between April 1985 and December 1991. RESULTS: A total of 13 patients were identified. All of them had clinically significant respiratory tract samples with a definite M. kansasii isolation. Only three had disseminated disease. In all but two cases, CD4 cell count at diagnosis time was lower than 200/mm3. Chest X-ray films showed interstitial pattern (8 cases) or alveolar condensation (3 cases) and lung cavities were seen in 4 patients. All patients with lung disease and one with disseminated disease responded well to anti-tuberculous therapy. CONCLUSION: Mycobacterium kansasii produces disease in advances stages of HIV-induced immunosuppression. The most common primary location is pulmonary, but disseminated forms can also be seen. The infection can be controlled with standard anti-tuberculous therapy.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Use of magnetic resonance in the diagnosis of neuro-cryptococcosis in the acquired immunodeficiency syndrome: study of 4 patients].

Neuro-cryptococcosis is a common opportunistic infection in AIDS or HIV infected patients. From a series of 10 neuro-cryptococcosis the four of them studied by magnetic resonance (MR) are reported. In AIDS patients a high suspicion of opportunistic infection of the CNS is needed as exemplified by two of the four patients who only presented cephalalgia. The other two patients suffered additional symptoms and signs of meningeal and CNS involvement, such as nuchal rigidity, cranial nerve palsies, papilloedema, gait ataxia and dismetria. Diagnosis was achieved (confirmed) by a positive culture, serology or indian ink test in CSF. CT scan did not contribute to the diagnosis and management of the patients. In contrast MR, showed in three of them a peculiar pattern of small, confluent, high-signal lesions, roughly symmetrically placed in the basal ganglia and the internal capsule. They probably correspond to the dilated Virchow-Robin spaces through which torulae migrate from the subarachnoid space.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Transurethral thermotherapy in prostatic adenoma].

Microwave thermotherapy is considered to be an alternative to conventional surgical treatment of benign prostatic hyperplasia (BPH). Our initial experience of the first six months shows this technique has achieved objective improvement of the symptoms and uroflowmetry, as well as a significant reduction of postmicturition residual urine. It carries a minimal morbidity, no mortality and has permitted recovery of micturition in over 90% of the patients with urinary retention.

Aged↗
PubMed1992

[Current diagnosis of renal cancer: clinical experience with 71 cases].

The diagnosis of renal cell carcinoma was frequently delayed due to the anatomic location of kidneys. Recently, the development of echographic imaging techniques has drastically changed this situation. In this retrospective review of 71 patients with renal cell carcinoma, the diagnosis was made incidentally during a routine abdominal ultrasound examination in 49% of cases. These patients, has lower stage and smaller tumors than symptomatic patients. Among the latter, hematuria was the principal presenting symptom. The early diagnosis of renal cell carcinoma allows more conservative surgical procedures and has a favorable effect on long term survival.

Adult↗
PubMed1992

[Renal oncocytoma: 4 cases].

Oncocytomas are tumors characterized by cells with an eosinophilic cytoplasm. Renal oncocytomas were described in 1942. Among 46 consecutive patients operated on for renal tumors, oncocytomas were found in 4 (8.7%). In spite of a supposedly benign nature, renal oncocytoma cannot be adequately differentiated from renal adenocarcinoma by imaging techniques. Therefore, we recommend radical surgery as the treatment of choice in these patients.

Adenoma, Oxyphilic↗
PubMed1992

[Endocarditis caused by Lactobacillus].

Endocarditis due to Lactobacillus is rare. Its main features were a subacute course and greater difficulties for achieving a complete recovery even using appropriate antimicrobial therapy with serum levels above MIC. We present one case of Lactobacillus endocarditis in a patient with allergy to penicillin, due to a vancomycin-resistant strain. She was successfully treated with clindamycin and gentamicin. We emphasize the need and importance of sensitivity tests and antibiotic tolerance when choosing an optimal treatment for this infection.

Adult↗
PubMed1992

[Cryptococcal meningitis and AIDS. Clinical description of 10 patients].

We have studied 10 patients with cryptococcal meningitis and AIDS. Nine of them were intravenous drug users and four have been previously diagnosed of AIDS. In 60% of them cryptococcal meningitis was the first opportunistic infection, and as group represented only 6.3% of our 158 patients with AIDS on the same period. The most common symptoms were: malaise (100%), headache (80%), fever (60%), meningeal signs (50%). Two of them had focal neurological disease. CSF culture and serum cryptococcal antigen test were positive in 90%, the Indian ink in 77% and blood cultures in 30% of the cases, while indian ink preparation did it in 77%. MRI showed bilateral small lesions, deeply located, in 3 cases; it was also useful to prove optical tract lesions in a patient with blindness as a result of cryptococcal meningitis. We had treatment successes in 80% of the cases, all patients being treated with amphotericin B, alone in 4 and amphotericin B plus fluorocytosine in 6. Two patients died within the first 2 weeks. Maintenance therapy with fluconazole was effective and well tolerated, with 3 patients dying from causes other than cryptococcal meningitis. We recorded a survival rate over 12 months in 33% of patients.

Acquired Immunodeficiency Syndrome↗