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Biomedical subjects

F Arias

Publications and source records attributed to F Arias.

At least 37 records · Page 2Linked to original sources
PubMed1995

Mitomycin, cisplatin, and vindesine followed by radiotherapy combined with cisplatin in stage III nonsmall cell lung cancer: long-term results.

PURPOSE: To assess the tolerance, response rate, pattern of failure, and long-term survival of patients with unresectable nonsmall cell lung cancer treated with one cycle of induction chemotherapy followed by concurrent cisplatin and radiotherapy. METHODS AND MATERIALS: From 1986 to 1988, 45 patients with histologically proven nonsmall cell lung cancer clinical Stage III (29 IIIA and 16 IIIB) were included in this study. Patients received one cycle of Mitomycin C 10 mg/m2 day 1, Cisplatin 120 mg/m2 day 1, and Vindesine 3 mg/m2 days 1, 8, 15, and 22, by i.v. bolus injection. Radiotherapy was started within 4-6 weeks after completion of chemotherapy, with a total tumor dose of 60 Gy, at 2 Gy/day. Cisplatin, 20 mg/m2/day by i.v. continuous infusion was administered for days 1-5 of radiation treatment. RESULTS: The main toxic acute effects were nausea-vomiting grade 1-3 in 38 patients (85%). Ten patients (22%) developed esophagitis grade 3. Leukopenia grade 1-2 was observed in 18 patients (40%), grade 3 in 12 (27%), and grade 4 in 4 (9%). Three patients (6.6%) died by granulocytopenia and sepsis. A bronchoscopic proven complete response was achieved in 9 patients (21.5%) and partial response in 28 patients (67%). With a minimum follow-up of 65 months, overall median survival was 13 months, 2-year survival was 21%, and 5-year survival was 7%, with no statistical difference between Stage IIIA and IIIB. Median survival of patients with complete response was 23.2 months, and 5-year survival was 33%. CONCLUSION: This treatment scheme produced a severe toxicity and in spite of a high response rate, long-term survival is poor, similar to previous studies with radiotherapy alone.

Adult↗
PubMed1995

In utero sonographic diagnosis of vesicoureteral reflux by percutaneous vesicoinfusion.

Vesicoureteral reflux affects approximately 1% of newborns. Although most affected children show only sonographic evidence of renal pelvic dilatation, others may show overt hydronephrosis, indistinguishable from that seen in fetuses with obstructive uropathy. Hydronephrosis secondary to fetal vesicoureteral reflux cannot be differentiated on ultrasound examination from that resulting from lower obstructive uropathy with or without reflux. As renal damage from vesicoureteral reflux may occur in up to 70% of cases, early identification and possible in utero treatment of these fetuses may be warranted. We report a sonographic technique, vesicoinfusion, for diagnosis of vesicoureteric reflux in utero. The accurate identification of vesicoureteral reflux in utero may have important diagnostic, prognostic and therapeutic implications.

Abortion, Therapeutic↗
PubMed1995

Comprehensive ultrasound examination in a private perinatal practice.

A retrospective review of the types of patients seen and the accuracy of the diagnosis made was undertaken for patients referred for comprehensive ultrasound examination in a large private perinatal practice. A review of the perinatal ultrasound database, neonatal intensive care database, and hospital charts was done in 1338 patients referred to the perinatal ultrasound laboratory for comprehensive ultrasound examination during a 2-year period. Accuracy of the ultrasound diagnosis and relationships between structural anomalies seen on ultrasound examination and perinatal outcome was undertaken. Positive and negative predictive values for the ultrasonic diagnosis were 82% and 98%, respectively. There were 19 (1.4%) false-positive diagnoses and 38 (2.8%) false-negative diagnoses. There was a high correlation between structural anomalies and chromosomal anomalies, with 15 of the 87 infants (17.2%) with structural anomalies also having chromosomal anomalies. The accuracy of ultrasonic diagnosis for comprehensive examinations in a large private perinatal practice compared favorably with previous reports in the literature. The information presented in this study should be helpful to obstetric centers with similar patient populations.

Congenital Abnormalities↗
PubMed1994

Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications.

OBJECTIVE: The purpose of this study was to determine the accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of fetal outcome in pregnancies at high risk for fetal and neonatal morbidity and mortality. STUDY DESIGN: A prospective controlled nonrandomized study was conducted in the high-risk pregnancy unit of a teaching hospital. The control group was formed by 20 healthy women with uncomplicated singleton pregnancies and healthy children delivered at term. The study group consisted of 115 women referred to the high-risk pregnancy unit because of a variety of pregnancy complications. Longitudinal evaluation of the control group and cross-sectional evaluation of the study group were carried out at different gestational ages by means of duplex Doppler ultrasonography. The main outcome measures were fetal growth retardation, preterm birth, and neonatal morbidity. RESULTS: The middle-cerebral-to-umbilical-artery ratio remains relatively constant (mean +/- SD 1.33 +/- 0.19) between 27 and 37 weeks. A cutoff value of 1.0 (sensitivity 57.9%, specificity 75.6%, false-positive rate 24.4%) was selected from the receiver-operator characteristic curve analysis. This cutoff value successfully identified a population at significant risk of fetal growth retardation (relative risk 3.07, 95% confidence interval 1.73 to 5.45, exact two-tailed p = 0.0009) and severe neonatal morbidity (Mann-Whitney U = 463.5, two-tailed p = 0.03). The middle-cerebral-to-umbilical-artery ratio was not useful in the prediction of preterm birth. CONCLUSIONS: A middle-cerebral-to-umbilical-artery ratio of < or = 1.0 identifies a subgroup of patients at high risk for fetal growth retardation and severe neonatal morbidity.

Adult↗
PubMed1994

Delayed delivery of multifetal pregnancies with premature rupture of membranes in the second trimester.

OBJECTIVE: Premature rupture of membranes in multifetal gestations during the second trimester has an ominous prognosis and the majority of the fetuses die after preterm delivery. STUDY DESIGN: We used cervical cerclage, tocolysis, and antibiotic therapy after vaginal delivery of the fetus with ruptured membranes in eight patients with multifetal pregnancies to extend the intrauterine life and improve the outcome of the remaining fetuses. RESULTS: Survival of six fetuses was achieved in five of the eight pregnancies (four originally twins and one originally triplets). The mean +/- SD gestational age of the fetuses first delivered was 19.6 +/- 2.6 weeks, and it was 26.7 +/- 6.8 weeks in the fetuses with delayed delivery (exact two-tailed p = 0.01). The mean +/- SD birth weight of the fetuses delivered first was 306 +/- 149 gm and it was 1029 +/- 947 gm for the fetuses who had delayed delivery (exact two-tailed p = 0.05). The mean +/- SD prolongation of pregnancy was 48.8 +/- 42.06 days (range 8 to 114 days). CONCLUSIONS: Intervention with tocolysis, antibiotics, and cervical cerclage after delivery of the first fetus is a reasonable option for some patients with multifetal pregnancies and premature rupture membranes in the second trimester.

Adult↗
PubMed1994

Vectors of cutaneous leishmaniasis in north-central Venezuela.

An entomological survey was undertaken from January 1991 to February 1992 in El Ingenio, Miranda State, Venezuela, an endemic area of cutaneous leishmaniasis: prevalence of 10.7 cases per 100,000 inhabitants. A total of 4863 female sandflies (Phlebotominae) of fourteen species were collected in Shannon traps, then dissected and examined for leishmanial infections. Lutzomyia ovallesi (85.4%) and Lu. gomezi (11.2%) were the predominant anthropophilic species of sandfly. Fifty-one (1.19%) Lu.ovallesi and two (0.47%) Lu.gomezi had natural infection with Leishmania promastigotes. Identification of the parasites was done by using the polymerase chain reaction (PCR) and DNA hybridization. Two isolates from Lu.gomezi and forty-nine from Lu.ovallesi were typed as Leishmania braziliensis and three of the latter reacted with Le.mexicana also. This is the first report of Lu.gomezi with parasites typed as Le.braziliensis. We concluded that Lu.ovallesi is the primary vector of cutaneous leishmaniasis in the north-central area of Venezuela and Lu.gomezi should be regarded as an additional vector.

Animals↗
PubMed1994

[HIV and blood donors: past, present and future].

PURPOSE: To evaluate the changes in the spectrum of HIV-positive blood donors along seven years. PATIENTS AND METHODS: The municipal Blood Bank of Caracas Federal District examined 193,796 blood donors between 1986 and 1992. Anti-HIV antibodies were determined by the following methods: Ortho HIV-Elisa Test System (59.5% of the samples), Abbott Recombinant HIV-EIA (28.6%), Vironostika HIV Microelisa System-Organon Teknika (2.1%), Bio-Test anti-HIV Recombinant Elisa (2.1%), and Recombigen (env and gag) HIV Cambridge Biotech (7.7%). Results confirmation was performed with Biotech/Dupont HIV-I Western Blot Kit, Chiron Riba HIV 216 Test System and Inno-Lia HIV 1/2 Ab immunogenetics SA. RESULTS: Slow but progressive increase of positive results was seen in the blood donors along the years, from 0.05% in 1986 to 0.31% in 1992. Higher prevalence was seen in males (p < 0.001), although absolute increase in the number of positive females was found by 1992 (p < 0.05). According to their type, 80.6% of the donors were patient-related (RD), 13% attended mobile blood-drawing units (MU) and 6.4% were VD (p < 0.001), with a trend to increase amongst DR and decrease amongst MV. The majority of the positive donors pertained to homo-or bisexuals (60.5%), although they showed progressive decrease, whereas the positive findings increased in the promiscuous heterosexual group and amongst those having contacts with persons at risk. CONCLUSIONS: High prevalence of HIV-positive donors is found, the expected figure for 1995 being 0.37% if the present trends are maintained. Thus, a better selection of blood donors is recommended by means of careful enquiries, the use of optimal reagents capable of shortening the window period, deferring people at risk from blood donation, and promoting altruistic voluntary donation of blood.

Adolescent↗
PubMed1993

Neoadjuvant chemotherapy and radiotherapy in locally advanced esophagus carcinoma: long-term results.

PURPOSE: A prospective study with neoadjuvant chemotherapy and radiotherapy in patients with locally advanced esophagus carcinoma for evaluating: toxicity, response rate, pattern of recurrence, and survival after a long follow-up. METHODS AND MATERIALS: Between 1983-1988, 40 patients with locally advanced squamous cell carcinoma of the thoracic esophagus were entered into a prospective trial of neoadjuvant chemotherapy and radiotherapy. Eight patients (20%) were Stage II and 32 patients (80%) were Stage III, according to American Joint Committee staging criteria. Neoadjuvant chemotherapy consisted of two cycles with cisplatin (120 mg/m2 day 1), vindesine (3 mg/m2 days 1, 8, 15, and 22) and bleomycin (10 mg/m2 days 3 to 6). Second cycle was initiated on day 29. Radiation therapy was administered 2-4 weeks after completion of chemotherapy, with a total dose on tumor of 60 Gy. RESULTS: Two patients died from treatment-related toxicity. Complete response was observed in 20 patients (53%) and symptomatic improvement in 31 patients (82%). The median survival was 11 months, with an actuarial survival at 1 year of 45%, 3 year 20%, and 5 years 15%. Significantly (p < 0.05) longer survival was observed in patients with Stage II (median survival 18 months) vs. Stage III (median survival 10 months). The pattern of failure was predominantly local/regional (62%). CONCLUSION: This treatment scheme is an effective and tolerable regimen but long-term survival was poor.

Adult↗
PubMed1993

Maternal placental vasculopathy and infection: two distinct subgroups among patients with preterm labor and preterm ruptured membranes.

OBJECTIVE: Our aim was to find out whether patients delivered preterm because of preterm labor or preterm premature rupture of membranes can be categorized according to clinical characteristics and placental pathologic findings. STUDY DESIGN: We performed a case-control study of 105 patients who were delivered preterm, 42 because of preterm labor and 63 because of premature rupture of membranes, and 105 patients who were delivered at term after uncomplicated pregnancies. RESULTS: Maternal placental vascular lesions were present in 14 (34.1%) patients with preterm labor, 19 (35.1%) patients with premature rupture of membranes, and 9 (11.8%) control patients (odds ratios 3.8 and 4.0, 95% confidence intervals 1.3 to 11.1 and 1.5 to 10.8, p = 0.0065 and 0.0022, respectively). Infection of the products of conception was found in 16 patients (38%) with preterm labor, 23 patients (36.5%) with premature rupture of membranes, and 19 control patients (18%) (odds ratios 2.7 and 2.6, 95% confidence intervals 1.1 to 6.6 and 1.2 to 5.6, p = 0.017 and 0.01, respectively). Patients with maternal placental vasculopathy had significantly different characteristics compared with those of infected patients. CONCLUSIONS: It is possible to identify two subgroups of patients among those who are delivered preterm because of preterm labor or premature rupture of membranes, one with infection of the products of conception and another with maternal placental vasculopathy.

Case-Control Studies↗
PubMed1993

A comparison of the accuracy of the TDx-FLM assay, lecithin-sphingomyelin ratio, and phosphatidylglycerol in the prediction of neonatal respiratory distress syndrome.

OBJECTIVE: To ascertain whether the TDx-FLM assay is a better predictor of neonatal respiratory distress syndrome (RDS) than the lecithin-sphingomyelin ratio (L/S) and phosphatidylglycerol (PG). METHODS: Amniotic fluid samples of 140 women requiring assessment of fetal lung maturity and delivering within 72 hours of amniocentesis were analyzed by the three methods. The accuracy in predicting RDS was assessed by conventional statistical techniques. RESULTS: The TDx-FLM test had a better sensitivity (89.6 versus 48.2%; relative risk [RR] 3.9, 95% confidence interval [CI] 1.35-11.23, P = .001) and negative predictive value (96.4 versus 86.8%; RR 0.36, 95% CI 0.12-1.04, P = .02) than the L/S. However, the L/S had a better specificity (89.1 versus 73.8%; RR 0.64, 95% CI 0.49-0.82, P = .005) than the TDx-FLM assay. The PG test had a predictive ability similar to that of the TDx-FLM assay. However, there was no significant difference in the overall accuracy of the three tests, and the areas under the receiver-operating characteristic curves for the L/S and TDx-FLM (0.80 and 0.87) were similar. CONCLUSIONS: The TDx-FLM assay performs similarly to the L/S and PG tests in the prediction of RDS and is quantitative, rapid, and reproducible.

Albumins↗
PubMed1993

A randomized trial of extra-amniotic saline infusion plus intracervical Foley catheter balloon versus prostaglandin E2 vaginal gel for ripening the cervix and inducing labor in patients with unfavorable cervices.

OBJECTIVE: To compare the efficacy of extra-amniotic saline solution infusion plus an intracervical Foley catheter balloon versus 2.85 mg prostaglandin (PG) E2 vaginal gel in ripening the cervix, inducing labor, and achieving vaginal delivery in patients at term with an unfavorable cervix. METHODS: A randomized study of the two methods was performed in 112 patients with a Bishop score of 5 or less. RESULTS: Extra-amniotic saline infusion plus intracervical Foley catheter balloon was more effective than PGE2 vaginal gel in causing cervical ripening (relative risk [RR] 2.5965, 95% confidence interval [CI] 1.7277-3.9022, exact two-tailed P = .000001) and in inducing labor (RR 4.3333, 95% CI 1.7223-10.9026, exact two-tailed P = .0000181). However, the final delivery outcome was an equally high number of cesarean deliveries (26 of 56, or 46.4%) for both methods. Maternal and neonatal complications were minimal and not significantly different. CONCLUSIONS: Extra-amniotic saline infusion with a Foley catheter was more effective than 2.85 mg PGE2 vaginal gel in ripening the cervix and inducing labor. These advantages did not translate into a large number of vaginal deliveries, indicating that factors other than cervical ripening may be responsible for the high incidence of cesarean in patients with an unfavorable cervix.

Administration, Intravaginal↗
PubMed1993

Analysis of factors determining the selection of repeated cesarean section or trial of labor in patients with histories of prior cesarean delivery.

We investigated the motivation behind procedures in 241 patients with prior cesarean births; 120 had elective repeat cesarean sections and 121 had vaginal birth after cesarean section (VBAC). Patients were of similar age, gravity and parity, but significantly more patients in the repeat cesarean group had their initial surgery because of failure to progress in labor; significantly more patients in the VBAC group had their initial cesarean section because of fetal distress. The main factors behind the decision to attempt VBAC were patient's desire (81.0%), patient's desire and physician's advice (12.4%) and physician's advice (6.6%). The main factors behind the decision to have repeat cesarean sections were medical or obstetric indication (45.8%), patient's desire (31.6%), patient's desire and physician's advice (9.1%) and physician's advice (13.3%). We conclude that it will be difficult to substantially decrease the present rate of repeat cesarean births, and that preventive efforts should be directed toward decreasing the incidence of primary cesarean deliveries.

Adult↗
PubMed1992

[Arterial hypertension in the adolescent: its possible relation to the salt taste threshold].

The purpose of the study was to define the relationship between the salt intake and the levels of arterial blood pressure in adolescent people. Seventy-eight youngs between 12 and 18 years old with diastolic/systolic blood pressure above 95 percentile formed the hypertensive group; a similar population with the same characteristic (age, sex, race, weight and height) with normal blood pressure were selected as a control group. The salt taste threshold was carried out through tasting a saline solution in different concentrations, till it could be distinguished as salted. Moreover, 45 hypertensive adolescent were follow-up for 12 weeks under a hiposodic diet and consequently a new salt taste threshold was done. The results showed that the control group had a salt perception under 80 mg %, instead the hypertensive group showed a higher threshold (above 160 mg %). Those hypertensive adolescent which were followed for 12 weeks changed its pattern in this way: in 24, a lesser perception was observed with a reduction in their blood pressure in 11 of them. These findings suggest that hypertensive adolescent had an elevated threshold for salt, usually above 160 mg % and the test should be helpful for the identification of a subgroup "salt-sensible".

Adolescent↗