Biomedical subjects
C del Rio
Publications and source records attributed to C del Rio.
CD4+ T-lymphocyte variations in patients with advanced human immunodeficiency virus infection and counts below 100 cells per microliter.
Variability in CD4+ T-lymphocyte measurements has been described for both normal and human immunodeficiency virus (HIV)-infected persons. Clinical protocols use CD4+ cell counts as surrogate markers for disease progression or response. In this study, we determined the variability of CD4+ T-lymphocytes below 100 cells/microl when measured less than 7 days apart. Two consecutive lymphocyte subset measurements were performed in 55 patients using CD3/CD4 antibodies in a flow cytometer (Epics Profile II). Specimens were collected between 8:00 and 10:00 am within the same week. Data from the first and second measurements were compared. The average total lymphocyte count on the first measurement was 1,064 (360-2,853), and on the second 1,162 (320-2,223; P = 0.07); the percentage CD4 was 1.76 (0-8) on the first, and on the second 1.98 (0-9; P = 0.3); the absolute CD4 cell count on the first measurement was 16.6 (0-57) and on the second 22.8 (0-93; P = 0.01). Statistically significant differences were found between the first and second absolute CD4 T-lymphocytes but not in the CD4 percentage. These differences probably are due to variations in total lymphocyte count. For research protocols, repeating CD4+ cell determinations within a short period is advisable, to ensure a homogeneous population. On the other hand, for day-to-day patient follow-up, a combination of clinical criteria and both percentage and absolute CD4+ cell counts should be used to make treatment decisions, because repeating CD4 cell measurements can be very costly.
Double-barreled wet colostomy: a safe and simple method after pelvic exenteration.
UNLABELLED: The clinical and functional outcome of ureteric division to the distal segment of a loop colostomy: the double-barrelled wet colostomy have been analysed. METHODS: 13 patients (8 female and 5 male, age 37 to 72 years) underwent pelvic exenteration with double-barrelled wet colostomy. The primary tumour included endometrial (n = 6), rectal (n = 1), anal (n = 1), cervical (n = 2), prostatic (n = 1) and bladder (n = 2). Indications for pelvic exenteration were locally advanced disease, recurrence and severe radiation or surgical damage. Six patients had pre-existing colostomy, and three had a Bricker ureteroileal diversion. The double-barrelled-wet colostomy technique consisted in anastomosing both ureters to a colon segment 25 cm distal to the loop colostomy. There was no operative mortality. Complications included one urinary leak which closed with conservative management and one case of recurrent episodes of pyelonephritis which finally required nephrectomy. Intravenous urography in the remaining patients showed good flow through the ureters to the conduit with no reflux. Postoperative plasma electrolytes, urea and creatinine were normal from day seven onwards. Urodynamic studies in four patients showed efficient contraction of the colon conduit with pressure levels similar to those in the colon proximal to the colostomy. In five cases biopsies of the conduit were taken at 3 and 16 months; no dysplasias were found. Four patients died due to disease progression. The overall mean survival was 41.2 months. The remainder are currently disease-free, maximum followup period being 19 months. Double-barrelled wet colostomy is a safe and simple technique with low morbidity. The patient needs to carry only one stoma and functional results are good.
The use of oral fluid to determine HIV-1 prevalence rates among men in Mexico City.
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Interaction between CCK and opioids in the modulation of the rectocolonic inhibitory reflex in rats.
The effects of cholecystokinin octapeptide (CCK-8) as well as the involvement of opioid system were evaluated in rectal distension (RD)-induced colonic motor inhibition in rats. Rats were surgically prepared with electrodes implanted on the proximal colon, and a catheter was implanted in lateral ventricle of the brain. RD was performed by inflation (0.0-1.6 ml) of a balloon rectally inserted. RD 1.6 ml of induced an inhibition of the colonic spike bursts (3.1 +/- 0.5 per 5 min vs. 8.1 +/- 0.4 before RD). Intracerebroventricular but not intravenous injection of CCK-8 and A-71623 (50 and 100 ng/kg) reduced the RD-induced colonic motor inhibition, whereas A-63387 was ineffective. PD-135,158 (10 micrograms/kg icv) suppressed the inhibitory reflex caused by RD. Devazepide (100 micrograms/kg icv) had no effect in this reflex function. Devazepide (1 microgram/kg), naloxone (0.1 mg/kg), and nor-binaltorphimine (nor-BNI; 10 mg/kg) reversed the blocking effect of CCK-8, whereas PD-135,158 (0.1 microgram/kg) and naltrindole (1 mg/kg) have no effect. In conclusion, CCK-8 acts on central alimentary cholecystokinin receptors to modulate the RD-induced inhibition of colonic motility through pathways involving activation of endogenous kappa-receptors.
Non-Hodgkin's lymphomas in patients with human immunodeficiency virus infection. Presence of Epstein-Barr virus by in situ hybridization, clinical presentation, and follow-up.
The authors studied all patients with serologic evidence of human immunodeficiency virus (HIV) infection and malignant non-Hodgkin's lymphoma (NHL) that presented at a single hospital from 1982 to 1989. Sixteen patients were identified, all white homosexual men with a mean age of 38.2 years. Lymphoma was the initial presentation of HIV infection in 37.5%. Sixty-two percent of the cases had a high-grade NHL, 31% had intermediate-grade, and 6% (one patient) had a low-grade lymphoplasmacytoid lymphoma. Extranodal involvement was present in 43.7%, with the gastrointestinal tract and liver being the most common sites. Actuarial survival was increased by treatment with methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin (MACOP-B). Colorimetric in situ hybridization identified Epstein-Barr virus (EBV) in nine of the 14 cases hybridized. A statistically significant association of EBV with diffuse small noncleaved type (i.e., Burkitt's-like) (six of six) compared with other morphologic types (three of eight) was found (P = 0.025).
Composite Hodgkin's and non-Hodgkin's lymphoma in a patient with acquired immune deficiency syndrome. In-situ demonstration of Epstein-Barr virus.
A 44-year-old man infected with human immunodeficiency virus had Hodgkin's disease, mixed cellularity, and malignant non-Hodgkin's lymphoma, diffuse large cell type. Colorimetric in-situ hybridization showed the Epstein-Barr virus (EBV) genome in the cells of the large cell non-Hodgkin's lymphoma and in the Reed-Sternberg cells and reactive lymphocytes of the Hodgkin's lymphoma. These results suggest that EBV may play a similar causative role in both neoplasms. This colorimetric method of hybridization, yielding results within 8 hours, is applicable to archival material and will be useful in further epidemiologic work associating EBV and lymphoid proliferations and malignancies.
Catastrophic thrombosis of porcine aortic bioprostheses.
Hemodynamically critical thrombotic stenosis of porcine bioprosthetic valves in the aortic position without thrombotic predisposition is rare. Two patients at our institution abruptly manifested thrombotic stenosis of porcine bioprosthetic valves in the aortic position within 3 months of implantation without apparent predisposing factors. Clinicians should consider this rare but catastrophic complication in the appropriate setting.
Comparison of mechanical and standard hand instrumentation techniques in curved root canals.
The original and postinstrumentation shapes of the mesial root canal system of 12 mandibular molars were compared after being instrumented with a mechanical handpiece and a hand instrumentation technique. Area of dentin removed and amount and direction of transportation were evaluated in relation to degree of root canal curvature. Pre- and postinstrumentation measurements were taken of the root canal system in the cervical, middle, and apical thirds. The mechanical handpiece removed dentin and transported the root canal more than the hand instrumentation in the cervical and apical thirds. Both techniques transported to the distal in the cervical third and to the mesial in the apical third. In the middle third, the mechanical handpiece transported more to the mesial and the hand instrumentation more to the distal. Degree of root canal curvature had no influence on the amount of dentin removed or transportation of the root canal.
The fine structure of acquired immunodeficiency syndrome encephalopathy.
Involvement of the central nervous system with the human immunodeficiency virus is thought to underlie the clinical and pathologic features of acquired immunodeficiency syndrome (AIDS) encephalopathy. Although morphologic, immunocytochemical, and molecular data point to predominant human immunodeficiency virus infection of multinucleated and mononuclear macrophages, neuroglial and other cells are thought to be involved as well. Electron microscopic studies of biopsy tissue that might further define the neuropathologic changes have been limited. The opportunity to study well-preserved biopsy tissue from a 38-year-old man with the acute onset of dementia and AIDS encephalopathy prompted this report. Human immunodeficiency virus was seen budding from the surface of multinucleated and mononuclear cells with morphologic features of macrophages; a rare astrocyte process showed evidence of viral infection as well. Macrophages were noted within the walls of blood vessels and in intimate contact with lymphocytes within the neuropil. Notably rare were tubuloreticular inclusions, interferon-related cytoplasmic structures commonly found in systemic endothelial cells and lymphocytes in AIDS. Their relative scarcity may signify reduced interferon production in AIDS encephalopathy.
Meningococcemia in identical twins: changes in serum susceptibility after rifampin chemoprophylaxis.
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Sputum examination in the diagnosis of Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome.
To examine the role of sputum examination in the diagnosis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome (AIDS), we conducted a prospective study of 30 patients with AIDS or suspected AIDS. Sputum was obtained just prior to bronchoscopy by spontaneous cough (20 patients) or by induction with a saline nebulizer (ten patients). Pneumocystis carinii was diagnosed by bronchoalveolar lavage in 13 of the 30 patients; two of these patients had P carinii organisms identified in sputum specimens (sensitivity of sputum, 15.3%; negative predictive value, 60.7%). A cost-analysis study demonstrated that sputum examination is not cost effective when the sensitivity is below 24%. We conclude that P carinii can be diagnosed from expectorated sputum in patients with AIDS, but, because of the test's low sensitivity, it cannot be recommended in the routine evaluation of patients with AIDS and pulmonary complaints.
Severe diarrhea in pneumococcal bacteremia: croupous colitis.
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Effects of instrumentation with a chelating agent on the periapical seal of obturated root canals.
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Acute human immunodeficiency virus infection temporally associated with rhabdomyolysis, acute renal failure, and nephrosis.
A previously healthy 29-year-old homosexual man presented with a 4-day history of fever, malaise, sore throat, and bleeding gums. Rhabdomyolysis, acute renal failure, and nephrotic range proteinuria were also present. The patient was found to have acute human immunodeficiency virus (HIV) infection confirmed by the presence of HIV antigen in his serum and subsequent evolution of an HIV antibody profile typical of acute seroconversion. A kidney biopsy revealed acute tubular necrosis and mesangioproliferative glomerulonephritis, with tubuloreticular inclusions. In the presence of otherwise unexplained acute renal failure, rhabdomyolysis, or new onset nephrotic syndrome, acute HIV infection should be considered in the differential diagnosis.
pS2 negativity in postmenopausal women with ER+PgR+ infiltrating ductal breast carcinoma is associated with reduced hormone dependence and increased proliferation and aneuploidy of the tumors.
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Genetic variation in Pneumocystis carinii isolates from different geographic regions: implications for transmission.
To study transmission patterns of Pneumocystis carinii pneumonia (PCP) in persons with AIDS, we evaluated P. carinii isolates from patients in five U.S. cities for variation at two independent genetic loci, the mitochondrial large subunit rRNA and dihydropteroate synthase. Fourteen unique multilocus genotypes were observed in 191 isolates that were examined at both loci. Mixed infections, accounting for 17.8% of cases, were associated with primary PCP. Genotype frequency distribution patterns varied by patients' place of diagnosis but not by place of birth. Genetic variation at the two loci suggests three probable characteristics of transmission: that most cases of PCP do not result from infections acquired early in life, that infections are actively acquired from a relatively common source (humans or the environment), and that humans, while not necessarily involved in direct infection of other humans, are nevertheless important in the transmission cycle of P. carinii f. sp. hominis.