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Biomedical subjects

G Castellano

Publications and source records attributed to G Castellano.

At least 19 recordsLinked to original sources
PubMed1999

Painful supernumerary phantom arm following motor cortex stimulation for central poststroke pain. Case report.

In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient's parietal lobe, precipitating perception of the phantom limb. To the authors' knowledge this is the first reported case of its kind.

Cerebrovascular Disorders↗
PubMed1998

G proteins are involved in the suppression of collagen alpha 1 (I) gene expression in cultured rat hepatic stellate cells.

We analyse the role of the G proteins in regulating collagen gene expression by measuring collagen alpha 1(I) mRNA levels in cultured hepatic stellate cells in basal conditions and after stimulating or inhibiting the major intracellular signalling pathways. Stimulation of Gs protein and adenylyl cyclase or the addition of 8Br-cAMP to the cells led to a decrease in collagen alpha 1(I) mRNA levels, while blocking protein kinase A abolished this effect. Blocking Gi protein, phospholipase A2 and C, calcium channels and calmodulin resulted in a significant increase in collagen mRNA levels. PKC stimulation led to a marked decrease in these levels. These results suggest that collagen gene expression is inhibited by a number of intracellular pathways. A Gs and a pertussis toxin-sensitive G protein seem to initiate cellular response. Transcription factors, acting in these pathways, must be identified. However, it seems that they do not need to be synthesised.

Adenylyl Cyclases↗
PubMed1998

Lipoprotein changes in patients with chronic hepatitis C treated with interferon-alpha.

OBJECTIVE: The aim of this study was to evaluate the effects of interferon-alpha therapy on the lipid profile of patients with chronic hepatitis C. METHODS: In 36 consecutive patients with chronic hepatitis C, fasting lipoproteins were evaluated prospectively at baseline, 1, 3 and 6 months during interferon-alpha therapy and 3 months after the end of treatment. RESULTS: During interferon-alpha therapy, there was a progressive increase in total and very low density lipoprotein (VLDL)-triglycerides, VLDL-cholesterol and a sustained raise in apolipoprotein (apo) B. In parallel, there was a reduction in high density lipoprotein (HDL)-cholesterol and apo A1 levels. In contrast, total and low density lipoprotein (LDL)-cholesterol and lipoprotein (a) levels remained essentially unchanged during interferon-alpha therapy. Three patients developed chylomicronemia, two of them with severe hypertriglyceridemia, although none of them presented with pancreatitis. Chylomicronemia and severe hypertriglyceridemia were more common in patients with basal triglycerides above 200 mg/dl. Nineteen patients responded to interferon-alpha therapy, but their lipid profile did nor differ from that of nonresponders. Three months after the end of interferon-alpha therapy lipid changes subsided, although VLDL and HDL-cholesterol and apo B did not reach basal levels. CONCLUSION: In patients with chronic hepatitis C, interferon-alpha therapy is associated with an increase of total and VLDL-triglycerides, VLDL-cholesterol and apo B, and a decline of HDL-cholesterol and apo A1. The development of chylomicronemia and severe hypertriglyceridemia in some cases makes mandatory a close monitoring of triglycerides during interferon-alpha therapy, particularly among patients with increased triglycerides at baseline.

Adult↗
PubMed1998

Esophagitis dissecans superficialis (esophageal cast) complicating esophageal sclerotherapy.

Esophagitis dissecans superficialis is a rare and benign condition that involves the formation of an esophageal cast. This disorder has been described in association with a variety of etiologic factors. We report a case of an esophageal cast in a patient included in a program of sclerotherapy of varices. We discuss the possible relationship existing between sclerotherapy and the development of esophagitis dissecans superficialis.

Aged↗
PubMed1998

Fibrosing cholestatic hepatitis in hepatitis C virus-infected renal transplant recipients.

Severe hepatitis C virus (HCV)-related fibrosing cholestatic hepatitis leading to early liver failure has been reported only exceptionally. Of 259 HCV-infected renal transplant (RT) patients in one hospital unit, four (1.5%) are described, representing the first series of this particular post-RT disease. Patient mean age was 55.7 yr. Three were men. All had pretransplant, hepatitis B surface antigen-negative and were anti-HCV antibodies positive. Three of them showed pretransplant mild liver enzyme abnormalities, and all received kidneys from HCV-negative donors. All were on steroids, cyclosporine, and azathioprine (AZA). The clinical pattern appeared early after RT (mean, 11.5 mo). In three patients, hyperbilirubinemia (6.5 to 20 mg/dl) and high alkaline phosphatase levels (428 to 859 IU/L) were observed. Also, in all subjects, high gamma glutamyl transpeptidase levels (639 to 4270 IU/L), mild aspartate aminotransferase and alanine aminotransferase abnormalities, and serum HCV RNA were observed. Liver biopsy revealed diffuse fibrosis, leukocyte infiltrates, and different degrees of cholestasis, with typical signs of HCV hepatitis in only one patient. Two patients developed subfulminant liver failure and died 2 and 3 mo after biopsy, respectively. One patient also suffered hepatic failure, receiving a liver transplant. The fourth is alive on dialysis awaiting a combined kidney and liver transplant. It is concluded that fibrosing cholestatic hepatitis is a new, early, and severe complication after RT in HCV(+) patients, which appears in patients with ongoing HCV infection under AZA therapy, despite a nonaggressive immunosuppressive protocol. Both HCV and AZA could play a concurrent role in the pathogenesis of this severe complication after RT.

Adult↗
PubMed1998

Liver cirrhosis and mortality by abdominal surgery. A study of risk factors.

AIM: To determine the mortality-related factors in cirrhotic patients who underwent nonderivative abdominal surgery. PATIENTS AND METHODS: We retrospectively reviewed the clinical charts of 63 patients (38 men, 25 women) with liver cirrhosis and abdominal surgery. Patients who underwent surgical derivative procedures for portal hypertension and/or hepatic resection for hepatic tumor were excluded. The study population was divided in patients who died (Group 1) and alive patients (Group 2). Thirteen (21%) patients died and the other 50 (79%) had an uneventful course. We compared the clinical and analytical parameters between both groups. Multivariate analysis was performed for the variables with predictive value. RESULTS: Prothrombin time and the presence of hepatic encefalopathy showed statistical significance in the univariate analysis (p < 0.05 and p < 0.01, respectively). However, in multiple logistic regression analysis serum bilirrubine value was associated with mortality rate (Odds ratio 1.65, 95% CI, 0.97-1.14; p = 0.064). Emergency surgery was required more frequently in patients of group 1 than in those of group 2, but the difference did not achieve statistical significance. CONCLUSIONS: In the present study, the serum bilirrubine value, the prothrombin time and the presence of hepatic encefalopathy were associated with mortality of cirrhotic patients who underwent non-derivative abdominal surgery. The lack of significance of other factors (albumin, nutrition, infections and urgent surgery) could be due to the small number of patients in our series.

Abdomen↗
PubMed1998

[Gaucher's disease suspected by abdominal echography findings].

Abdominal ultrasonographic findings of Gaucher's disease had been reported, but a specific pattern has not been described. We report here a patient with an abdominal sonographic pattern which was concluded to be strongly suggestive of Gaucher's disease: solid focal splenic lesions with different patterns (hypoechoic, hiperechoic and mixed nodules associated with hypoechoic irregular areas) and bright liver and spleen echo pattern with posterior beam attenuation. Gaucher's disease was subsequently confirmed by determination of leukocyte beta-glucosidase activity and mutations of glucocerebrosidase gene.

Abdomen↗
PubMed1997

Diffuse fatty liver in familial heterozygous hypobetalipoproteinemia.

A 34-year-old man had asymptomatic hepatomegaly, slightly increased serum alanine aminotransferase and gamma-glutamyl transpeptidase levels, and a sonographic pattern suggesting diffuse hepatic steatosis. Liver biopsy revealed fatty change in 25% to 50% of hepatocytes. The patient also had low serum levels of cholesterol and triglycerides and met clinical, biochemical, and familial diagnostic criteria of heterozygous hypobetalipoproteinemia. We could not relate his hepatic steatosis to any already known cause of fatty liver and could only attribute it to heterozygous hypobetalipoproteinemia. Familial heterozygous hypobetalipoproteinemia should be ruled out in patients with unexplained hepatic steatosis.

Adult↗
PubMed1997

Influence of viral genotype and level of viremia on the severity of liver injury and the response to interferon therapy in Spanish patients with chronic C infection.

BACKGROUND: We wanted to investigate the influence of viral genotype on the severity of liver injury and response to interferon and whether the level of viremia differs in accordance with genotype, severity of liver disease, and response to interferon in patients with hepatitis C virus (HCV) infection. METHODS: We studied 118 patients with HCV-related liver disease. HCV genotypes were determined with a line probe assay, and serum HCV RNA levels with a competitive reverse transcription polymerase chain reaction assay. RESULTS: HCV type 1b was the most prevalent genotype (88%). It was present in 100% of cirrhotic patients, with or without hepatocellular carcinoma (HCC), but only in 78% of patients with chronic hepatitis (P < 0.001). The response to interferon was better in patients infected with non-1b HCV genotypes (P = 0.002). In a multivariate analysis non-1b HCV genotypes and a low hepatic fibrosis correlated with a favorable response to interferon. Among patients with chronic hepatitis those infected with HCV type 1b were older (P < 0.001), and age was the only independent factor associated with HCV type 1b. Viremia levels differed neither between genotypes nor in response to interferon and was significantly lower in patients with cirrhosis and HCC. CONCLUSIONS: HCV 1b was associated with more severe liver disease and a worse response to interferon therapy. Non-1b genotypes and a lower liver fibrosis were the only independent predictors of a favorable response to interferon. Levels of HCV viremia differed neither among different genotypes nor in response to interferon and decreased with advanced liver disease.

Aged↗
PubMed1997

Assessment of the usefulness of endoscopic signs in Helicobacter pylori associated gastritis.

OBJECTIVE: To determine whether endoscopic signs exist to establish the presence of Helicobacter pylori, which may be used markers of infection in the absence of gastroduodenal peptic lesions. METHODS: A prospective study was carried out in 150 consecutive patients, all symptomatic, who presented endoscopic evidence of gastritis and in whom the absence or presence of H. pylori was undetermined at the time of the study. A quantitative assessment was made of the three types of lesions previously associated with the presence of H. pylori on endoscopy: nodules, erosions, and red patches in the antrum. Biopsy samples were taken for the microbiological and histological studies; a positive result in either study was considered to indicate infection by H. pylori. RESULTS: Of the 150 patients studied, 115 (76%) presented H. pylori infection. No significant differences existed with respect to the clinical findings or the distribution according to sex. The mean age of infected patients was 49 years, being lower in the nodular group (p = 0.008) and higher in the group presenting erosions (p < 0.05); this fact suggests that the endoscopic findings may differ depending on the moment of infection. Evidence of antral nodules was observed in 15 patients, 11 of whom (73%) showed positively for H. pylori; the sensitivity was 9.5% and the positive predictive value was 0.73. Of the 17 patients presenting erosions, 16 were positive for H. pylori (93.8%); the sensitivity was 13% and the positive predictive value was 0.94. Red patches were detected in 63 patients, 48 of whom (76%) were positive for H. pylori; the sensitivity was 48% and the positive predictive value was 0.76. These three patterns did not coincide in any of the patients, for an overall sensitivity and specificity of 70.5% and 80.6%, respectively (p < 0.05). CONCLUSION: The sensitivity and specificity of the set of lesions assessed were high as no two overlapped; when the lesions were dealt with individually, however, the sensitivity was low, showing a low negative predictive value, making it necessary the use of standard detection measures, although in the presence of nodules and/ or erosions the existence of H. pylori infection is practically the norm.

Adolescent↗
PubMed1997

[Eosinophilic cholecystitis: an infrequent cause of cholecystectomy].

Eosinophilic cholecystitis is a rare form of cholecystitis. Histologically, it is characterized by a dense, transmural leukocyte infiltrate composed of more than 90% eosinophils. The etiology remains obscure, although it had been associated with allergies, parasites, hypereosinophilic syndromes, eosinophilic gastroenteritis, cholelithiasis, and acalculous cholecystitis. Here we report an eosinophilic cholecystitis gallstone-associated case, the only one with this histopathologic diagnosis among 5,537 cholecystectomies made in our hospital in the last years.

Aged↗
PubMed1996

Antimitochondrial antibody-negative chronic nonsuppurative destructive cholangitis. Atypical primary biliary cirrhosis or autoimmune cholangitis?

We investigated whether autoimmune cholangitis (AC) has specific features that constitute an entity other than primary biliary cirrhosis (PBC). We compared clinical, laboratory, and liver biopsy features; response to treatment; and the follow-up of two groups of patients. The first group comprised seven patients with AC criteria-PBC with negative antimitochondrial antibodies (AMAs) and positive antinuclear antibodies (ANAs)-termed the PBC AMA-negative group; the second was made up of another seven PBC patients with positive AMA, labeled the PBC AMA-positive group. We found that the PBC AMA-negative group had, besides negative AMAs and positive ANAs, a significantly higher incidence of asthenia, a higher and earlier incidence of liver failure, and higher ANA titers and serum immunoglobulin G levels than the PBC AMA-positive group. There were no significant differences in the other laboratory tests, although the PBC AMA-negative group showed higher serum bilirubin and aminotransferase and lower serum alkaline phosphatase and immunoglobulin M levels. Liver histological data were similar in both groups. Patients in the PBC AMA-negative group, with more markedly abnormal liver tests, responded to immunosuppressive therapy. We concluded that patients with criteria for PBC but with negative AMAs and positive ANAs have a few specific features that fall between PBC and autoimmune chronic hepatitis. This finding suggests that these patients have a different disease, for which autoimmune cholangitis seems to be an appropriate name.

Adult↗
PubMed1996

[Direct percutaneous endoscopic jejunostomy, variation of the technique of gastrostomy].

Percutaneous endoscopic gastrojejunostomy is a percutaneous endoscopic gastrostomy derived technique, that is widely employed. However it has a high incidence of mechanic complications. Percutaneous endoscopic jejunostomy direct access, improves these problems and allows to apply this technique in patients with previous gastric resection or with other gastric diseases that contraindicate percutaneous endoscopic gastrostomy. We describe, for the first time in our country, a direct percutaneous endoscopic jejunostomy placement.

Gastrostomy↗
PubMed1995

Propofol analgesia in central pain: preliminary clinical observations.

Propofol, an intravenous general anaesthetic, has been reported to relieve some forms of pruritus at subhypnotic doses. We assessed its effectiveness in 32 patients with several kinds of non-malignant chronic pain, in a placebo-controlled, double-blind study. We found that central pain, but not neuropathic pain, is at least partially controlled by propofol at subhypnotic doses, without major side-effects. In particular, allodynia associated with central, but no neuropathic, pain has been completely controlled. Propofol analgesia leads to renormalization of brain metabolism as seen on single photon emission computed tomography. We conclude that propofol may help in the diagnosis of central pain, particularly in unclear cases, and also in treatment. Possible mechanisms of action are discussed.

Adult↗