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Biomedical subjects

C Molina

Publications and source records attributed to C Molina.

At least 73 records · Page 4Linked to original sources
PubMed1990

Ventricular arrhythmias and left ventricular myocardial function in chronic chagasic patients.

To study the relationship of complex ventricular arrhythmias to the presence and extent of myocardial damage, 556 chronic chagasic patients were submitted to an extensive protocol, including left ventricular cineangiography and Holter monitoring, and properly classified according to clinical, electrocardiographic and hemodynamic findings. Stages of the clinical-hemodynamic classification corresponded to increasing degrees of myocardial damage, age, prevalence and complexity of ventricular arrhythmias. Myocardial damage (particularly left ventricular dilatation) was the most important clinical factor linked to the presence of complex ventricular arrhythmias. A clear difference in terms of ventricular function was found only when arrhythmias were grouped into simple (Lown grades I and II) and complex (grades III and IV) forms. It is recommended that any classification for chagasic patients must be based on signs of myocardial involvement, instead of clinical or electrocardiographic findings alone. Evaluation should include accurate determination of left ventricular myocardial function, along with the search for the presence of complex ventricular arrhythmias and abnormalities of conduction.

Adult↗
PubMed1989

Intrahepatic cholestasis of pregnancy in twin pregnancies.

To clarify whether the increase in estrogen levels occurring during twin pregnancies (TP) is associated with a greater risk of developing intrahepatic cholestasis of pregnancy (ICP), we followed up 62 consecutive patients with TP and compared them with single pregnancies delivered in our hospital during 1 year. The prevalence of ICP was significantly higher in twin than in single pregnancies (20.9% versus 4.7%, respectively; P less than 0.001). Urinary estriol excretion was also significantly higher in twin compared to single pregnancies, although no quantitative differences were detected in TP with or without ICP. In multiparous patients with a proband TP affected by ICP, the disease recurred only in further TP, emphasizing the important role that estrogens seem to play in the pathogenesis of ICP. In contrast, in multiparous patients with a proband single pregnancy affected by ICP, the disease occurred in 70.5% of their other single pregnancies, suggesting the presence of a metabolic predisposition in these cases. However, in both groups of multiparous women a notable number of single pregnancies were not affected by the disease, supporting the postulate that the pathogenesis of ICP is multifactorial and that some as yet unidentified environmental factor needs to be present in order to develop the disease and also to modulate its expressivity.

Alanine Transaminase↗
PubMed1989

[Left ventricular mechanics in Chagas' disease and dilated cardiomyopathy: echocardiographic study].

For purposes of studying left ventricular mechanics, 184 chronic chagasic and 85 primary cardiomyopathy patients were submitted to an extensive invasive (LV cine, right and left cardiac catheterization and coronarography) and non-invasive protocol. The afterload, (mean wall stress), the contractile status (ejection fraction and circumpherential shortening) and the degree of hypertrophy (mass index) were assessed by M mode echocardiography. There was a very early increase of afterload in 8% of chagasic patients without evidences of LV myocardial involvement in the left cineventriculogram (group I-A). This increased afterload was accompanied by signs of inadequate hypertrophy in 15% of patients with early segmental myocardial damage (group IB). In contrast, ejection fraction and % circumpherential shortening were depressed only in patients with clinical evidences of congestive heart failure. Dilated primary CM patients showed similar findings, except for a more evident depression of contractility in those cases without signs of congestive heart failure (group II) and more hypertrophy than equivalent group III chagasic patients. Measurements of mean systolic wall stress and mass index are valuable parameters for identification of those patients with early increased after-load and inadequate hypertrophy which could benefit from the administration of oral vasodilators.

Adult↗
PubMed1989

[Clinical and paraclinical differences between chronic Chagas' cardiomyopathy and primary dilated cardiomyopathies].

With the purpose of establishing clinical and paraclinical differences among chronic chagasic (MCh) and primary dilated cardiomyopathies (MCDP), 96 MCh and 104 MCDP patients with abnormal ECG were submitted to a study protocol which included clinical history, routine laboratory serology for Chagas' diseases, resting ECG, Chest-X-rays, and cardiac catheterisation. Patients with congestive heart failure (CHF) had common clinical and para-clinical findings. However, chagasic patients without CHF showed more prevalence of RBBB and LAH, complex ventricular arrhythmias and more left ventricular dilation while primary dilated cardiomyopathy patients with CHF had predominantly LBBB, simple ventricular arrhythmias, atrial fibrillation and less LV dilation than MCh patients. In order to establish the prognostic value of these findings and response to modern medical therapy, prospective studies on these two groups of patients are needed.

Cardiomyopathy, Dilated↗
PubMed1988

Role of cardiac atria in the human renal response to changing plasma volume.

We examined the role of cardiac atria in the renal response to sequential volume expansion and contraction, during and directly following water immersion. In immersed healthy volunteers (group 1, n = 9) atrial diameter, plasma levels of atrial natriuretic peptide (ANP), and natriuresis increased, whereas renal vascular resistance (RVR) and filtration fraction declined. Each parameter changed in an opposite direction postimmersion. An analysis of transglomerular dextran transport suggests that transglomerular hydraulic pressure difference (delta P) changed in parallel with filtration fraction. Baseline atrial diameter, plasma ANP, RVR, and filtration fraction were significantly elevated in nine recipients of denervated cardiac allografts (group 2). Atrial diameter and plasma ANP changed in parallel with group 1 during and after immersion. However, corresponding reciprocal changes in RVR were smaller and filtration fraction remained constant throughout. From transglomerular dextran transport, we compute that delta P increased progressively during and after immersion, suggesting predominant efferent arteriolar tone. The postimmersed state was associated also with enhanced sodium retention despite sixfold higher plasma ANP than in group 1. These findings are consistent with an effect of cardiac denervation to leave unopposed efferent sympathetic nervous traffic to the kidney. They suggest that the latter is an important modulator of the renal response to changing plasma volume in humans.

Atrial Function↗
PubMed1988

Enzymatic determination of serum neuron-specific enolase in small cell lung cancers. Utility of the serum neuron-specific enolase/serum nonneuronal enolase ratio.

Increasing interest is shown in the determination of the serum neuron-specific enolase for the diagnosis and the follow-up studies of small cell lung cancers. We report results obtained by an enzymatic procedure that permits the simultaneous determination of the neuron and nonneuron-specific enolase and the calculation of the ratio of these two components. The utility of this ratio which characterizes elevations of the serum neuron-specific enolase from a poor or rich source of this component was tested in 38 patients with small cell lung carcinoma and in 57 subjects suffering from other bronchogenic cancers. The control group consisted of 37 blood donors and 56 patients with respiratory disease. For the diagnosis, the sensitivity and the specificity of the enzymatically determined neuron-specific enolase compared well with published results obtained by radioimmunoassay and enzymoimmunoassay. The use of the ratio clearly increases the specificity of the test, since only 5.3 percent of false positive results are found when bronchogenic tumors other than small cell carcinoma are studied. The sensitivity was 76 and 100 percent in diagnosis of limited and extensive forms, respectively. The use of this ratio in the follow-up of the patients and for the determinations in hemolyzed samples is set out.

Adult↗
PubMed1987

Clinical, histochemical, and ultrastructural correlation in septal endomyocardial biopsies from chronic chagasic patients: detection of early myocardial damage.

In order to recognize early signs of myocardial damage, histologic, histochemical, and ultrastructural studies were performed on septal endomyocardial biopsy tissue obtained from 79 chronic chagasic patients and from 18 patients with atypical chest pain (control group). Abnormal biopsy findings were recognized in 9 of 16 (60%) chagasic patients with no clinical evidence of myocardial damage. In cases of segmental asynergy only, biopsies were abnormal in 18 of 19 patients. When signs of advanced myocardial damage were evidenced by clinical examination or ECGs, all biopsies were abnormal. Mitochondrial, nuclear, and cell membrane irregularities were consistent findings. A peculiar dilatation and filling of the T tubule system with a glycoprotein-like substance and a remarkable increase in monoamine oxidase activity were observed early in the disease and progressed in magnitude and frequency as myocardial damage became more evident by other diagnostic methods. Septal endomyocardial biopsy is a sensitive method for detection of early myocardial damage in chronic chagasic patients. Based on these findings, a modification of the currently used classification is proposed.

Adult↗
PubMed1987

Regulation and role of guanylate cyclase-cyclic GMP in vascular relaxation.

Three classes of vasodilators mediate their effects through the activation of guanylate cyclase and the increased synthesis of cyclic GMP. Nitrovasodilators such as nitroglycerin, nitroprusside, hydroxylamine, azide, etc. result in the generation of the nitric oxide free radical that activates the cytosolic (soluble) isoenzyme form of guanylate cyclase. These agents have been useful in increasing cyclic GMP synthesis in numerous model systems and these effects are independent of extracellular calcium. The increased synthesis of cyclic GMP and the activation of cyclic GMP-dependent protein kinase result in the altered phosphorylation of many smooth muscle proteins including the dephosphorylation of myosin light chain, which is associated with vascular and tracheal smooth muscle relaxation. These latter effects may result from cyclic GMP decreasing cytosolic free calcium concentrations and the activity of myosin light chain kinase. Another class of vasodilators, designated endothelium-dependent vasodilators, includes a long list of agents such acetylcholine, histamine, A23187, ATP, thrombin, etc. that relax vessels only when the endothelium is intact. These agents result in the increased endothelial synthesis and/or release of a factor(s) designated endothelial-derived relaxant factor (EDRF), the structure of which is unknown. This labile factor also activates the soluble isoenzyme form of guanylate cyclase in the smooth muscle resulting in cyclic GMP accumulation and the same cascade of events as above. There is evidence that even under basal, non-stimulated conditions there is EDRF release that influences vascular tone due to the increased synthesis of cyclic GMP. A third class of vasodilators, atrial natriuretic factor (ANF) or atriopeptins, includes a family of peptides that are produced in cardiac atria and other tissues and influence cardiovascular volume and dynamics by causing natriuresis, diuresis, vasodilation and decreased renin, aldosterone and vasopressin secretion. These peptide hormones also increase cyclic GMP synthesis in vascular, renal, adrenal and other tissues. These effects are mediated through specific ANF receptors that couple to and activate the membrane (particulate) isoenzyme form of guanylate cyclase and increase cyclic GMP-dependent protein kinase activity. There are two ANF receptor subtypes in most cells and tissues that are 130,000 and 66,000 daltons. The ANF receptor of about 130,000 daltons, designated receptor ANF-R1 copurifies with particulate guanylate cyclase through numerous procedures and may be part of the membrane-associated guanylate cyclase complex.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗