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Biomedical subjects

J Castillo

Publications and source records attributed to J Castillo.

At least 127 records · Page 7Linked to original sources
PubMed1995

Genetic markers: association study in migraine.

Eleven genetic markers were typed in 112 unrelated patients with migraine (50 with aura, 62 without aura) and compared with a random sample of healthy individuals. No significant differences were found for the ABO and Rh systems, acid phosphatase 1, phosphoglucomutase 1, adenosine deaminase, haptoglobin, transferrin, alpha-1-antitrypsin, and D1S80. Strong associations between the group of patients with migraine and group-specific component GC 1F-1F and esterase-D ESD 2-2 phenotypes were observed. These associations raise the possibility that a molecular genetic factor for migraine may exist in or near the Group Component (chromosome 4) and Esterase D (chromosome 13) loci, and represent a first comprehensive step in the eventual localization and isolation of the migraine genes.

Adolescent↗
PubMed1995

Adenosine deaminase activity in the CSF of patients with aseptic meningitis: utility in the diagnosis of tuberculous meningitis or neurobrucellosis.

We assayed 229 CSF samples from 180 adults with meningitis of different etiologies for adenosine deaminase activity (ADA) and evaluated the usefulness of this assay in the differential diagnosis of aseptic meningitis. Cases of meningitis were classified as tuberculous meningitis (TBM), pyogenic meningitis, viral meningitis, self-resolving aseptic meningitis without a specific diagnosis, meningitis associated with other infections, and neoplastic meningitis. We also tested 117 CSF specimens for which parameters were normal. We chose a cutoff point of 10 IU/L on the basis of our results and found elevated ADA levels in 50% of the patients with TBM (no differences between patients with AIDS and those who did not have AIDS were observed). Among samples from patients with aseptic meningitis, we observed high ADA levels in only two of five of the patients with neurobrucellosis. Therefore, we concluded that in cases of aseptic meningitis, a CSF ADA level of > or = 10 IU/L has a sensitivity of 48%, a specificity of 100%, a positive predictive value of 1, and a negative predictive value of 0.91 as a diagnostic criterion for TBM or neurobrucellosis. ADA levels were also > 10 IU/L in 30% of the patients with pyogenic meningitis, but this diagnosis was easily excluded on other grounds.

Adenosine Deaminase↗
PubMed1995

Amino acid transmitters in patients with headache during the acute phase of cerebrovascular ischemic disease.

BACKGROUND AND PURPOSE: The pathophysiology of headache occurring at stroke onset is unknown. Migraine and ischemia share an excessive release of neuroexcitatory amino acids. Inhibitory amino acids also may be implicated in both diseases. We investigated whether fluctuations of these amino acids occur in headache accompanying cerebral infarction. METHODS: We studied 100 patients with infarction in the territory of the middle cerebral artery. Neurological impairment was assessed using the Canadian Neurological Scale and Barthel Index. Size of infarction was determined with CT. Twenty-eight patients developed headache. Glutamate, aspartate, and taurine were quantified in blood and cerebrospinal fluid (CSF) within 24 hours of stroke onset with cationic exchange chromatography. RESULTS: Stroke subtypes, size of infarct on CT, and clinical scales were similar in patients with and without headache. Plasma glutamate level was 321.14 +/- 149.53 mumol/L in patients with headache and 233 +/- 107.23 mumol/L in those without headache (P < .005). Glutamate in CSF was higher in patients with headache (4.6 +/- 1.49 mumol/L) than in patients without headache (3.11 +/- 1.18 mumol/L) (P < .001). Aspartate concentrations in plasma and CSF were similar in both groups. Taurine concentrations in plasma were 103.10 +/- 52.82 mumol/L and 177.49 +/- 90.92 mumol/L in headache and nonheadache patients, respectively (P < .001). Taurine levels in CSF were 5.42 +/- 2.42 mumol/L in patients with headache and 9.27 +/- 5.31 mumol/L in those without headache (P < .001). No significant correlation was found between amino acid levels in plasma or CSF and size of infarction. CONCLUSIONS: Amino acid neurotransmitters play a role in the pathophysiology of headache that occurs at the onset of stroke. The ischemic penumbral area, more than the infarction itself, may cause a state of cortical hyperexcitability that would be responsible for the cortical release of amino acids and the induction of headache by altering pain perception mechanisms.

Adult↗
PubMed1995

Delay in neurological attention and stroke outcome. Cerebrovascular Diseases Study Group of the Spanish Society of Neurology.

BACKGROUND AND PURPOSE: Despite efforts to reduce the delay between stroke onset and new interventional treatments, no studies have analyzed the repercussions of early neurological attention on the clinical outcome of stroke patients. METHODS: Data were obtained from 721 patients admitted consecutively for a transient ischemic attack or stroke to the neurology departments of 18 Spanish hospitals that followed the same diagnostic and therapeutic guidelines in the acute phase. Factors assessed were age, sex, Canadian Stroke Scale score on admission, previous Barthel Index, and delay before attention by the first physician, by emergency services, by a neurologist, and before hospitalization. Patients' outcomes were classified as good (Barthel Index > 60) or poor (Barthel Index < or = 60 or in-hospital death) depending on patient's functional capacity on discharge. The individual contribution of each of these variables on clinical outcome was estimated with logistic regression analysis. RESULTS: Patients in worse neurological condition on admission presented earlier to the first physician, emergency department, and neurologist. The mortality rate was not significantly modified by early or late presentation at the different medical stages. Logistic regression analysis revealed that the relative risk of poor outcome in patients seen by the neurologist after the first 6 hours from symptom onset was 5.6 (95% confidence interval, 3.4 to 9.2) (P < .0001). Multiple linear regression analysis showed that the delay before the patient received neurological attention correlated positively with the duration of hospitalization (P < .0001). The delays before the patient was seen by the first physician or the emergency department and before hospitalization were not independently related to clinical outcome or length of hospitalization. CONCLUSIONS: Early neurological attention in acute stroke is related to better functional outcome and shorter hospitalization.

Age Factors↗
PubMed1995

Failure of talc pleurodesis is associated with increased pleural fibrinolysis.

Diffuse pleural inflammation and fibrin deposition following the instillation of the sclerosing agent is considered necessary for a successful pleural symphysis. We hypothesized that an impairment in fibrin formation or an increased endopleural fibrinolysis would lead to failure of pleurodesis. To investigate changes in the pleural coagulation/fibrinolysis balance, we studied 75 consecutive patients who underwent thoracoscopy. Fifty-four of these patients with malignant pleural effusions and four with a benign recurrent effusion underwent thoracoscopic talc pleurodesis. Another four patients with malignancy and 13 with benign effusions had no talc poudrage performed and were included as a control group. Serial determinations of thrombin-antithrombin III complex (TAT), plasminogen activator inhibitor (PAI), and D-dimer were made in pleural fluid samples taken at the beginning of thoracoscopy (baseline), immediately after thoracoscopic biopsies had been done (postbiopsy), 3 h after thoracoscopy--either with talc poudrage or without--and 24 and 48 h after the procedure, as well as in cases of recurrence of effusions (farline). Successful pleurodesis was obtained in 42 of 52 patients who could be evaluated (81%), and failure was seen in 10. Strong activation of coagulation and production of PAI was observed in all groups, including the control (no talc) group. Fibrinolytic activity (as expressed by D-dimer levels) showed a clear decline 24 h after talc poudrage in patients with a good outcome of pleurodesis, as oppossed to those with bad results and to the control group, and returned to the baseline by 15 d. We conclude that increased pleural fibrinolytic activity is associated with failure of pleurodesis, despite significant inhibitory activity of PAI in all groups.

Antithrombin III↗
PubMed1995

Blood dyscrasias with carbamazepine and valproate: a pharmacoepidemiological study of 2,228 patients at risk.

OBJECTIVE: The purpose of this study was to determine the occurrence of leukopenia and other blood dyscrasias associated with psychiatric use of carbamazepine and valproate. METHOD: Rates of WBC counts of 3,000-4,000/mm3 (moderate leukopenia) and < 3,000/mm3 (severe leukopenia), platelet counts of < 100,000/mm3, and hematocrit < 30% were identified among 2,228 treated patients at risk among 11,720 patients admitted to McLean Hospital over 4 years (1989-1993). Patients who received carbamazepine or valproate and had a blood dyscrasia not associated with a relevant medical condition were compared to patients treated with imipramine or desipramine. RESULTS: Of 977 patients treated with carbamazepine, 2.1% experienced leukopenia (16 moderate cases, five severe). Time to 50% risk was 16 days, and recovery occurred within about 6 days after carbamazepine was stopped. For 1,251 patients given valproate, the occurrence of leukopenia was 0.4% (three moderate cases, two severe). The occurrence of leukopenia in 1,031 patients given the tricyclic antidepressants was 0.3% (two moderate cases, one severe). The observed occurrence of moderate leukopenia with carbamazepine was 6.9 and 7.3 times higher than that with valproate and antidepressants, respectively. CONCLUSIONS: Severe blood dyscrasias were uncommon in psychiatric patients given carbamazepine and were about as rare with valproate as with imipramine or desipramine. Most important, in this cohort of 2,228 patients exposed to carbamazepine and valproate, there were no life-threatening cases.

Adolescent↗
PubMed1995

[POEMS syndrome. A case report].

A 48 years old male is reported. He presented with lower limb progressive and severe polyneuropathy, hypertrichosis, endocrinological alterations (hypothyroidism and hypogonadism) and organomegaly (hepatosplenomegaly and lymphadenopathies). This syndrome was associated with an osteosclerotic myeloma. The patient died two months after admission.

Hepatomegaly↗
PubMed1995

[Prolonged sedation with midazolam in critically ill patients undergoing artificial ventilation].

OBJECTIVES: To analyze the dose of midazolam needed for induction and maintenance of sedation, as well as its hemodynamic repercussions in critically ill patients requiring mechanical ventilation. PATIENTS AND METHODS: We studied 20 adult patients requiring mechanical ventilation for respiratory failure in the intensive care unit. An induction dose of 1 mg/min midazolam was given until the patient became drowsy (eyes closed but opened again) and this level of sedation was maintained by continuous intravenous perfusion. We calculated induction dose, maintenance dose and their correlation with age, weight, general state (APACHE-II index), liver function, hematocrit and blood chemistry. RESULTS: The induction dose was 4.76 +/- 3.4 mg and correlated with weight and plasma albumin levels. The maintenance dose of 6.4 +/- 3.97 mg/h did not correlate with any of the parameters studied. A statistically significant reduction in arterial pressure was observed. CONCLUSIONS: The sedation dose of midazolam in critically ill patients is related to weight and plasma albumin levels. Recovery time is related to mean maintenance dose.

APACHE↗
PubMed1995

[Bilateral choroidal metastases of pancreatic carcinoma].

Pancreatic adenocarcinoma represents 2 to 5% of all the carcinomas. It is the fourth largest cause of death from cancer. It gives rise to metastasis of the liver, kidney, brain, etc. But choroidal metastasis are infrequent. We present the case of a male aged 45 years, who presented bilateral choroidal metastasis of pancreatic carcinoma.

Choroid Neoplasms↗
PubMed1995

[Prevalence of viral hepatitis in candidates for orthopedic surgery].

OBJECTIVES: To study the prevalence of positive serology results for hepatitis B and C viruses among patients scheduled for elective orthopedic surgery, to establish risk groups and to assess the economic cost involved in testing patients in such groups. PATIENTS AND METHODS: We performed a retrospective study of 1090 preoperative charts for patients awaiting elective orthopedic surgery between November 1993 and January 1995. Variables recorded were age, sex, physical status, history of alcoholism or addiction to injected drugs, associated disease (liver disease, chronic kidney failure and hemodialysis, and coagulation disorders), history of blood products transfusion, preoperative liver enzymes and blood levels of AcVHC and AgVHB as determined by enzyme immunoassay. RESULTS: Mean age was 51.8 (SD 17.5). Women predominated, accounting for 60.6% of the sample. ASA I and ASA II patients accounted for 84.9%, 72 (6.61%) had had previous transfusions, 51 (4.6%) suffered liver disease, 4 (0.36%) had coagulation disorder, 5 (0.45%) were receiving hemodialysis for chronic kidney failure, and 5 (0.45%) admitted having injected drugs. We discovered alterations in preoperative liver enzyme levels in 116 (10.6%) cases. Sixty-five (5.96%) were positive for AcVHC and 13 (1.19%) were positive for AgVHB. Factors that predicted positive results for hepatitis C and B were liver disease, previous administration of blood products, chronic kidney failure requiring hemodialysis, drug addiction and high preoperative liver enzyme levels. Serologic testing for viruses performed on patients in this risk group would have detected 76.6% of the positive cases, resulting in savings of 90% of the cost of indiscriminate testing. CONCLUSIONS: We believe that patients with histories of liver disease, blood product transfusion, chronic kidney failure with hemodialysis or drug addiction, or with high liver enzyme levels should be tested for hepatitis B and C before surgery.

Adult↗
PubMed1994

Colorectal adenocarcinoma: quality of the assessment of lymph node metastases.

PURPOSE: We have studied 193 cases of colorectal adenocarcinoma from a population-based register to determine the minimum number of lymph nodes to be examined to provide an accurate assessment of the presence of nodal metastases. METHODS: The mean total number of lymph nodes identified per surgical specimen was 11 +/- 6.8 (range, 1-36) using traditional dissection. One hundred eighteen specimens (61 percent) were classified as Dukes B. Seventy-five (39 percent) had lymph node metastases (Dukes C) with a mean of 3.3 +/- 4.7 positive lymph nodes per specimen. With binomial distribution we calculate the probability to find at least one positive node in a sample size n with a determined proportion of positive nodes. RESULTS: The error probability in the ganglionar assessment by traditional dissection was 0.05 with 6 examined lymph nodes and 0.01 with 10 examined nodes. CONCLUSION: We must provide the pathologist with a minimum of six examined lymph nodes per surgical specimen for an optimal Dukes B assessment.

Adenocarcinoma↗
PubMed1994

Plasma monoamines in tension-type headache.

Clinical and pharmacological data suggest a derangement of central monoaminergic systems in tension-type headache. Biochemical evidence has been rarely recognized. These findings may relate with pathophysiological mechanisms of headache or with underlying depression. We measured platelet-rich plasma serotonin and plasma catecholamines (norepinephrine, epinephrine, and dopamine) in 30 patients with tension-type headache and in 20 healthy controls, using High-Pressure Liquid Chromatography. We studied differences between groups and the relation between biochemical parameters and clinical indices evaluating duration and severity of headache and depression. Platelet serotonin levels in tension headache patients were higher than in controls (P < 0.001). Plasma catecholamine levels were lower in patients than in controls (P < 0.001 for epinephrine and dopamine, and P < 0.05 for norepinephrine). There was a positive correlation between dopamine levels and duration of history of headache (r = 0.55, P < 0.05). A negative correlation between epinephrine levels and severity of headache was observed (r = 51, P < 0.01). No correlations were found between monoamine levels and severity of depression. Our results add to the evidence of alterations of monoaminergic central systems in tension-type headache patients. These alterations seem to be independent from the underlying depression and related to the pathophysiologic mechanisms of headache.

Adult↗
PubMed1994

Role of cardiopulmonary exercise testing and the criteria used to determine disability in patients with severe chronic obstructive pulmonary disease.

The aim of this study was to evaluate the precision and variability with which resting pulmonary function tests (resting PFTs) can be used to predict the capacity in exercise, and the usefulness of the different measurements of pulmonary function in the evaluation of impairment/disability in patients with chronic obstructive pulmonary disease (COPD). We studied 78 patients with stabilized COPD (FEV1 45.1 +/- 17.1%). Of these, 39 suffered severe impairment according to the resting PFTs. Both the group with severe impairment (maximal oxygen consumption [VO2,max]: 16.22 +/- 5 ml/kg/min; maximal minute ventilation [VEmax]: 31.87 +/- 7.1 L/min; maximal heart rate [HRmax]: 133.8 +/- 10.9 beats/min) and the group with nonsevere impairment according to the resting PFTs (VO2max: 22.55 +/- 7.9 ml/kg/min; VEmax: 42.11 +/- 10.9 L/min; HRmax: 138 +/- 13.7 beats/min) showed ventilatory limitation during exercise. FEV1 was the most prevalent criterion for the determination of severe impairment (FEV1 < 40%), and was the variable best correlated to VO2max (r = 0.52 with VO2max as absolute value and r = 0.54 with VO2max expressed as a percentage of the reference value), but the resting PFTs were not predictive of exercise performance including patients with severe COPD. Evaluation of working capacity (based on VO2max) revealed a significant number of inaccurate predictions among the results of the resting PFTs. Sensitivity and specificity analysis were used to compare the different criteria used to evaluate the severity of disability. They reveal that the classification will be different according to the criteria used.(ABSTRACT TRUNCATED AT 250 WORDS)

Disability Evaluation↗
PubMed1994

Neurologic factors predict a favorable valproate response in bipolar and schizoaffective disorders.

The hypothesis that neurologic factors influence the response to valproate (divalproex sodium) in bipolar and schizoaffective disorders was tested. In 115 predominantly lithium-refractory inpatients, neurologic findings were recorded, and blind raters assessed valproate response from the medical record. Patients with a seizure history were much more likely to have a robust response to valproate (70%), when compared with patients without such history (34.6%). History of head injury and abnormal electroencephalographic findings also tended to be more common in those patients with good response. Overall, the group of patients with any neurologic abnormality exhibited a significantly higher rate of good response to valproate (43.6%) than did the neurologically normal group (24.3%). Bipolar or schizoaffective patients with abnormal neurologic features may represent a distinct subtype of illness and appear to be good candidates for valproate therapy.

Bipolar Disorder↗
PubMed1994

[Prognostic factors in spontaneous intracerebral hemorrhage].

The introduction of etiological, diagnostic and therapeutical factors have modified the knowledge on the evolutive behaviour of spontaneous intracerebral hemorrhages (ICH). Mortality and morbidity associated to spontaneous ICH were assessed using as independent variables clinical and neuroimage factors obtained upon admission of the patients. We studied 228 patients with spontaneous ICH selected from a data bank of 277 patients with non-traumatic ICH. During the first 24 hours, we assessed several clinical factors (arterial hypertension, Glasgows Neurological Scale and Barthels Scale) and TC images (size, location, extension of bleeding to ventricles, edema and atrophy). Thirty-one per cent of the patients died during the first 2 months. The multiple linear regression study showed that mortality was related to variables of the Glasgows Neurological Scale upon admission, extension to ventricles, size of ICH and perilesional edema, whereas the morbidity was only related to the size of the hemorrhage. Severity of the clinical affection, extension of the bleeding to ventricles, size of the hemorrhage and presence of perilesional edema, but not arterial hypertension, were the main factors affecting mortality at two months of spontaneous ICH.

Adolescent↗