Biomedical subjects
Publications and source records attributed to C Ortiz.
Three cases of lymphomas with splenomegaly onset, without peripheric adenopathies, which required laparotomy to be diagnosed, are discussed. One of the cases was a primary splenic lymphoma and the other two were associated with reactive hemophagocytosis. Other malign lymphoproliferative processes of predominant splenic onset are discussed.
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The naturally occurring peptidyl protease inhibitor leupeptin (N-acetyl-L-leucyl-L-leucyl-L-argininal) has been prepared labeled with 13C at the argininal carbonyl. 13C chemical shift data for the trypsin-leupeptin inhibitor complex in the pH range 3.0-7.6 reveal the presence of two pH-dependent covalent complexes, suggestive of two interconverting diastereomers at the new asymmetric tetrahedral center created by covalent addition of Ser195 to either side of the 13C-enriched aldehyde of the inhibitor. At pH 7 two signals are observable at delta 98.8 and delta 97.2 (84:16 ratio), while at pH 3.0 the latter signal predominates. In the selective proton 13C-edited NOE spectrum of the major diastereomer at pH 7.4, a strong NOE is observed between the hemiacetal proton of the inhibitor and the C2 proton of His57 of the enzyme, thus defining the stereochemistry of the high pH complex to the S configuration in which the hemiacetal oxygen resides in the oxyanion hole. pH titration studies further indicate that the 13C chemical shift of the S diastereomer follows a titration curve with a pKa of 4.69, the magnitude of which is consistent with direct titration of the hemiacetal oxygen. Similar pH-dependent chemical shifts were obtained by using CPMAS 13C NMR, providing evidence for the existence of the same diastereomeric equilibrium in the solid state.
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Five members of a family of eight, including the father and four daughters, presented with symptoms previously attributed to the superior mesenteric artery syndrome. The four daughters also had radiographic studies supporting that diagnosis. This familial clustering raises the possibility of a genetic predisposition to this symptom and radiographic complex.
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A nephrology consultation was called on 100 adult patients of 1,635 (6.1%) patients with human immunodeficiency virus (HIV) infection seen between 1982 and 1987 at the University of Miami/Jackson Memorial Medical Center. Renal disease was observed in all groups of patients with a risk factor for HIV infection with a lesser incidence, however, among homosexuals. Intravenous drug (IVD) use and possibly race appear to be important factors in the development of renal complications. Renal disease was the dominant clinical feature in eight asymptomatic HIV carriers and in 34 patients with AIDS-related complex (ARC) who had not developed the opportunistic infections and/or malignancies associated with acquired immunodeficiency syndrome (AIDS). Ninety-one percent of consultations were requested for evaluation of proteinuria and/or renal failure. Nephrotic range proteinuria, in excess of 3 g/24 h, was present in 52 patients, and was less prevalent in homosexuals than in other groups at risk. Renal failure (serum creatinine greater than or equal to 5 mg/dL), initially present in 32 patients, eventually developed in 69 and improved in only 18 of them. A renal biopsy, obtained for work-up of nephrotic syndrome (22 patients) or renal insufficiency (3 patients), uncovered a picture of focal and segmental glomerulosclerosis in all 25 instances. Overall, 76 patients are dead, seven are lost to follow-up, and 17 are alive, of whom eight (four HIV carriers, two patients with ARC, and two with AIDS) are on maintenance hemodialysis with a mean survival time of 217 days.
Fifty-one adults with HIV infection, including 20 chronic hemodialysis patients with superimposed HIV infection and 31 patients with HIV-associated nephropathy requiring chronic maintenance hemodialysis were followed to evaluate survival on outpatient dialysis in relation to the clinical stage of the HIV infection. Regardless of when they contracted the infection, AIDS patients who required maintenance hemodialysis had a poor prognosis. All 17 patients who developed AIDS died after a mean of 93 +/- 32 days on hemodialysis (median 30 days; range 2 to 540 days). On the other hand, 12 asymptomatic HIV carriers were alive after a mean follow-up on chronic hemodialysis of 488 +/- 75 days (median 420 days; range 142 to 850 days); and five hemodialyzed patients with ARC were alive after 564 +/- 191 days (median 420 days; range 150 to 1230 days). The data confirm the lack of effectiveness of maintenance hemodialysis for prolonging life in patients with AIDS. This dismal prognosis was evident whether renal failure antedated HIV infection or whether it was HIV-associated. In asymptomatic HIV carriers and in patients with ARC, however, maintenance hemodialysis provides meaningful, long-term life support.
We carried out a prospective 2-year study on the transmission of human immunodeficiency virus (HIV) infection in a chronic dialysis unit with a high prevalence (11%) of the infection. Only 1 of 45 HIV-negative patients seroconverted, and this was related to the administration of contaminated blood. We conclude that current Centers for Disease Control criteria are sufficient to prevent transmission of HIV infection in dialysis units.
The study asked how do elderly veterans who fail to keep appointments in the General Medicine and Surgery Out-Patient Clinics in the San Juan, VA Hospital differ from those who do not. Three hypothesis were formulated: 1. Elderly patients who fail to keep appointments have other medical alternatives in non-VA facilities. 2. Elderly patients who fail to keep appointments have a longer waiting time between appointments. 3. Elderly patients who are given appointments in various clinics within a short period of time fail to keep appointments. A sample of fifty-three elderly veterans from the Medical Out-Patient Clinics was drawn. A face-to-face structured interview was used to collect the data. The interview was designed to obtain socio-demographic characteristics, use of clinics, and recommendations to improve services. A percentage analysis was used to point out differences and similarities. The findings supported the hypothesis that patients who failed to keep appointments not only used private non-VA facilities, but also had the financial resources to pay for them. Data confirmed that those who failed to keep appointments have to wait a longer time between appointments. Patients who failed to keep appointments considered them too infrequent which resulted in forgetting the appointments.
Bronchoscopic examination to diagnose lung metastases has not been as rewarding as in primary lung cancer. Despite a lower expected yield, we believe the procedure has value in certain patients, ie, those with clinical findings of endobronchial disease. To determine better the value of bronchoscopy in this population, we retrospectively reviewed records of patients at five community teaching hospitals over a 66-month period. These patients all underwent fiberoptic bronchoscopy. They had a history of prior nonpulmonary malignancy and an abnormal chest roentgenogram suspicious for recurrent malignant disease, or they presented with abnormal chest roentgenographic findings and further evaluation showed the lung disease to be metastatic. Bronchoscopy for metastatic lung disease was most likely diagnostic in patients with primary colorectal cancer (79 percent) and breast cancer (57 percent), and least likely in patients with genitourinary tract cancer (33 percent). Hemoptysis, signs of local airway obstruction, or a roentgenogram showing either atelectasis or diffuse lung disease especially favored a positive biopsy. Bronchoscopy is a valuable diagnostic procedure in selected patients with metastatic lung disease.
It is believed that mice do not express cutaneous basophil hypersensitivity because they have few or no basophils. We have looked for these cells in peripheral blood smears of C3H/He, DBA/2, C57BL/6, and Balb/c mice before and after a series of foreign protein injections, a treatment known to induce basophilia. We found 0.2 and 1.5% basophils in the untreated C3H/He and DBA/2 mice and no basophils in the untreated C57BL/6 and Balb/c mice. Basophilia of 2--10% was found in the treated mice of the four strains. We noticed that the microscopic appearance of the mouse basophils differs from that in other species. These results indicate that basophils may be as frequent in mice--believed not to express cutaneous basophil hypersensitivity--as they are both in man and guinea pigs--known to express this entity. Since the mouse basophils have a distinct morphology, different from that of other species, it is possible that they may not have been noticed in routine skin preparations.
In a controlled, randomized prospective clinical trial the utility of intravenous hyperalimentation (IVH) in the administration of and tolerance to chemotherapy was tested. The conclusions reached were 1) IVH is safe with a tolerable infection rate; 2) infectious complications correlate significantly with the nutritional status of the patient, with the presence of IVH being only a secondary factor; 3) IVH may be used to rehabilitate patients nutritionally, even those on intensive chemotherapy; 4) the ability to deliver chemotherapy to patients seems to be improved by IVH, especially in malnourished patients in a late stage of disease.
Brain compression with subdural air causes pulmonary hypertension and noncardiogenic pulmonary edema (A. B. Malik, J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 335-343, 1977). To see whether air emboli to the lungs rather than brain compression caused these findings, anesthetized dogs received intravenous air infusions, subdural air infusions, or brain compression from balloons inflated in the subdural space. Subdural air and intravenous air resulted in similar vascular responses. Pulmonary artery pressure (Ppa) increased 160% (P less than 0.01) and pulmonary venous pressure transiently rose 13 +/- 5 Torr (P less than 0.05) without an increase in left atrial pressure or cardiac output (Q). The end-tidal PCO2 fell 55% (P less than 0.01) and the postmortem weight of the lungs increased 55% (P less than 0.05). Brain compression with a subdural balloon instead of air only caused a 20% rise in Ppa and Q without pulmonary edema. Thus, pulmonary air emboli rather than brain compression accounts for the edema and pulmonary hypertension caused by subdural air. Catheters in pulmonary veins and the left atrium showed that air emboli cause transient pulmonary venous hypertension as well as a reproducible form of noncardiogenic pulmonary endema.
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