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Biomedical subjects

J Cruz

Publications and source records attributed to J Cruz.

At least 109 records · Page 6Linked to original sources
PubMed1993

Renal toxicity mediated by continuous infusion of recombinant interleukin-2.

Interleukin-2 (IL-2), a potent lymphokine with antitumoral activity, was used in continuous intravenous infusion for 5 days (18,000,000 IU/m2/day) in 9 treatment cycles in 5 patients with metastatic colorectal carcinoma. During the infusion, patients received aggressive fluid replacement titrated by invasive hemodynamic monitoring, aiming at a stable central volemia. Body weight went up an average of 4.5 kg in 5 days, mean arterial blood pressure dropped slightly from day 1 to day 5 (105.4 +/- 11.6 to 86.1 +/- 12.5 mm Hg, p < 0.05), systemic vascular resistance decreased from 1304.7 +/- 242.1 to 871.7 +/- 237.2 dyn/s/cm-5 (p < 0.05), with stable pulmonary capillary wedge pressure, cardiac output and central venous pressure. The urinary output significantly dropped from 1.9 +/- 1.2 to 0.2 +/- 0.1 ml/min (p < 0.05) with very significant rises in serum creatinine from 76.0 +/- 28.3 to 242.2 +/- 144.9 mumol/l (0.86 +/- 0.32 to 2.47 +/- 1.64 mg/dl) and N-acetyl-beta-D-glucosaminidase urinary activity from 4.97 +/- 5.0 to 23.0 +/- 12.1 U/l, and significant decrement of creatinine clearance (1.86 +/- 0.65 to 0.29 +/- 0.27 ml/s or 111.5 +/- 38.9 to 17.1 +/- 16.6 ml/min) and urinary sodium (113.8 +/- 78.3 to 9.0 +/- 6.7 mmol/l). Urine sediment evolved from normal at day 1 to 9.0 +/- 3.7 epithelial cells/mm3 and 6.9 +/- 3.6 brown casts/mm3 (p = 0.001). We concluded that cancer treatment with IL-2 in continuous infusion, even with stable hemodynamics, induces an acute renal failure in most patients treated.

Acute Kidney Injury↗
PubMed1993

[Cerebral hemometabolism: from isolated measurements to monitoring and therapy].

An overview is presented on historical and multivariate aspects of cerebral hemometabolism. This involves a full multivariate approach, from blood pressure to cerebral metabolism. From isolated measurements, to monitoring and management, a comprehensive overview of cerebral hemometabolism is addressed, from its inception to current days, up to a new concept, the cerebral hemodynamic reserve. A multivariate functional diagram is proposed, to summarize the multivariate interrelationships of cerebral hemometabolism. A generic proposition is made for studies of truly normal cerebral hemometabolism in children, for subsequent clinical applications. Another proposition is made for multivariate cerebral hemometabolic monitoring, in a broad variety of circumstances of predominantly global changes in intracranial dynamics, both in animal and clinical research.

Adult↗
PubMed1993

On-line monitoring of global cerebral hypoxia in acute brain injury. Relationship to intracranial hypertension.

Global cerebral oxygenation, perfusion pressure, and expired CO2 tension were continuously monitored in 69 adults with acute severe closed brain trauma. Cerebral oxygenation was assessed by continuous fiberoptic monitoring of jugular bulb oxyhemoglobin saturation, in conjunction with continuous monitoring of arterial oxyhemoglobin saturation. Jugular desaturation associated with arterial desaturation (hypoxemic cerebral hypoxia) was evaluated and managed. A total of 121 episodes of combined arterial and jugular desaturation were documented, 76 in the presence of gross abnormalities identified on chest roentgenograms. Prolonged episodes that did not respond promptly to treatment occurred 32 times in 12 patients, usually after the initial 72 hours posttrauma. The remaining 89 episodes promptly responded to treatment and occurred predominantly within the initial 72 hours. Profound but brief desaturation was not associated with neurological deterioration, while profound and prolonged desaturation was accompanied by significant decreases in Glasgow Coma Scale scores, even though intracranial pressure levels were not significantly different in these two groups. Global cerebral hypoxia that does not respond promptly to treatment appears to be independently deleterious to neurological function in severely head-injured patients.

Acute Disease↗
PubMed1993

[The circadian profile of ventricular extrasystole].

STUDY OBJECTIVE: to determine the existence of circadian variability (CV) of single ventricular premature beats (VPBs) and study its relationship with the heart rate variation; to compare sub-groups of patients (Pts) with and without antiarrhythmic therapy and with ischemic cardiopathy versus a free structural cardiopathy group. DESIGN: retrospective study. PATIENTS AND METHODS: the CV of VPBs was analyzed by Holter monitoring in 147 Pts, 93 male and 54 female with a mean age of 59 +/- 14.6. Seventy seven Pts were not taking antiarrhythmic drugs while 70 were doing it: Amiodarone 23, Propafenone 30, B-Blockers 9, Quinidine and Disopyramide 7, Flecainide 1. Sixty five Pts had ischemic cardiopathy and 37 were free of any structural abnormality. The selection criteria consisted in: 1--more than 100 VPBs/24h; 2--distribution over more than 12 hours; 3--absence of any hour with more than 35% of the total VPBs in the recording. Data were presented in a percentage form and the results evaluation was made by using single and two-harmonic regression models. MAIN RESULTS: a CV was found to the single VPBs, with minimum values during the nocturnal period and maximum values in the morning, with a significant adjustment to the two-harmonic regression model, defined by the equation y = 4.2 - Q,559 sen (2 pi T/24) - 0.604 cos (2 pi T/24) - 0.417 sen (4 pi T/24) + 0,272 cos (4 pi T/24) (p < 0.001). A strong positive correlation was observed between VPBs and heart rate variability (r = 0.95; p < 0.001). The sub-groups of Pts, whether taking antiarrhythmic drugs or not, also showed a CV with a statistically significant two-harmonic regression pattern, with a major morning increase of VPBs in the antiarrhythmic group. The free structural cardiopathy sub-group displayed a best adjustment to the single harmonic regression model while the ischemic group exhibited a two-harmonic regression pattern. CONCLUSIONS: a significant circadian variability of VPBs with a bi-modality expression was determined. The majority of the analyzed sub-groups showed the same kind of variation. A strong positive correlation with the heart rate variability was observed.

Age Factors↗
PubMed1993

[Prognostic factors in typhoid perforation].

This retrospective study evaluated 112 patients who had undergone surgery by typhoid perforation at the Belen Hospital, Trujillo, Peru, from 1967 trough 1990 in order to identify by univariate analysis the combination of factors predictive of postoperative morbidity and mortality. All the patients had one or more of the following diagnostic criteria: bacteriologic, serologic, anatomopathologic and surgical. The surgical procedures performed were: simple closure (n = 70), intestinal resection in conjunction with primary anastomosis (n = 6), intestinal resection plus ileostomy (n = 33), whilst peritoneal drainage operations were used in 3 cases. The following parameters were evaluated: age, sex, length of history, length of perforation, low intestinal hemorrhage, leukocyte count, type of peritoneal fluid and number of perforations. The operative mortality rate for all patients was 21.4% and morbidity rate was 80.4%. Significant differences in morbidity were only found in patients with perforations over 48 hours (p < 0.05). Analysis of post-operative mortality: length of perforation over 48 hours (p < 0.001), presence of hematochezia (p < 0.01), leukopenia (p < 0.05), fecaloid peritoneal fluid (p < 0.05) or the evidence of 3 or more intestinal perforations (p < 0.05). We concluded that a surgeon must take into account all of these factors to lead to satisfactory results.

Adolescent↗
PubMed1993

Cerebral oxygenation. Monitoring and management.

A comprehensive overview is presented on cerebral hemodynamics and metabolism in intensive care, with emphasis on cerebral oxygenation monitoring and management. From blood pressure to the most recently introduced concept of cerebral hemometabolism, cerebral hemodynamic reserve, concepts, variables, and findings are addressed. Integrated cerebral hemodynamics and metabolism, that is, cerebral hemometabolism, is discussed beyond cerebral perfusion pressure and blood flow. Monitoring and management of cerebral oxygenation and related variables are emphasized, in terms of current and potential future applications.

Blood Pressure↗
PubMed1992

Effect of delay in retroperfusion therapy on infarct size reduction.

Retroperfusion of arterial blood through the coronary sinus reduces infarct size if therapy starts immediately after coronary artery occlusion. To determine if a new system of non-electrocardiogram-synchronized retroperfusion is able to reduce infarct size after delays consistent with clinical use, anesthetized pigs were subjected to 4 hours of left anterior descending coronary artery occlusion followed by 1 hour of reperfusion. Retroperfusion of arterial blood commenced immediately after occlusion of the left anterior descending coronary artery in the no-delay group (n = 10) and after a 1-hour (n = 10) and a 2-hour (n = 8) delay in two other groups. In the control group (n = 10), no therapy was used. In all groups, retroperfusion of arterial blood was terminated after 4 hours of occlusion of the left anterior descending coronary artery. Infarct size, expressed as a percentage of the in vivo area at risk (+/- the standard deviation), was smaller in the no-delay group (44.1 +/- 12.9) and marginally smaller in the 1-hour delay group (71.0 +/- 9.8) compared with controls (86.3 +/- 7.5) (p < 0.05). Infarct size in the 2-hour delay group (75.0 +/- 10.7) was not significantly different from controls. Mean coronary sinus pressure (+/- the standard deviation) was 56 +/- 25 mm Hg, 39 +/- 9 mm Hg, and 47 +/- 9 mm Hg in the no-delay, 1-hour delay and 2-hour delay groups, respectively. Thus, this new retroperfusion system limits infarct size by 50% if it is started immediately after coronary occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

Continuous monitoring of cerebral oxygenation in acute brain injury: multivariate assessment of severe intracranial "plateau" wave--case report.

A case of acute closed brain trauma is presented in which, for the first time, a full spectrum of multivariate physiologic abnormalities was clearly documented in association with a severe posttraumatic intracranial "plateau" wave and clinical signs of tentorial herniation. Prompt therapeutic measures proved effective, ultimately contributing to a favorable outcome.

Adult↗
PubMed1992

Continuous monitoring of cerebral hemodynamic reserve in acute brain injury: relationship to changes in brain swelling.

A new concept of cerebral hemodynamic and metabolic physiology, cerebral hemodynamic reserve (CHR), was evaluated in 20 comatose adults with acute traumatic brain swelling who were undergoing continuous monitoring of the arteriojugular difference in oxyhemoglobin saturation, along with cerebral perfusion pressure and expired PCO2. The CHR was measured as the ratio of relative (percent) changes in cerebral oxygen extraction to relative changes in cerebral perfusion pressure during spontaneous increases in intracranial pressure. In patients with initially severe brain swelling, the CHR was more frequently abnormal (compromised) on the first day, and tended to improve on the second day. In patients with initially moderate brain swelling, the CHR was more frequently normal (preserved) on the first day, but tended to become compromised on the second day if the brain swelling exacerbated. It is concluded that cerebral hemodynamic reserve abnormalities very closely associate with signs of increased intracranial "tightness" on computed tomographic scans of the head. Cerebral hemodynamic reserve could therefore become an important guide in the functional evaluation and management of acute brain swelling (focusing on cerebral oxygenation and perfusion pressure) in a variety of predominantly diffuse acute intracranial disorders.

Adult↗
PubMed1992

Lack of relevance of the Bohr effect in optimally ventilated patients with acute brain trauma.

The relationship between jugular bulb oxyhemoglobin saturation (SjO2) and oxygen tension (PjO2) during hyperventilation was prospectively evaluated in 37 adults with acute brain injuries. Hyperventilation was optimized in all patients, based on measured values of the arteriojugular oxyhemoglobin saturation difference, or cerebral extraction of oxygen (CEO2). Most patients initially had variable CEO2 values, in 578 observations carried out in the acute phase. Overall, there was a strong positive correlation between SjO2 and PjO2 at all levels of arterial pH. In 31 (5.3%) of the 578 observations, where the arterial pH was greater than 7.6, the SjO2 was disproportionally higher than the PjO2, despite a good SjO2-PjO2 correlation (moderate Bohr effect). In only 5 of these 31 observations (0.8%) did the SjO2 and PjO2 largely change in opposite directions (marked Bohr effect) during profound hypocapnia. The present findings support the current practice of continuous or intermittent SjO2 monitoring and management, and of optimized hyperventilation for control of intracranial hypertension, provided that hyperventilation is optimized according to the CEO2 values. Only on rare occasions (arterial pH greater than 7.6) is it advisable to replace SjO2 measurements by those of PjO2, because the latter is not affected by the Bohr effect.

Adult↗
PubMed1992

Evaluation of three immunoassays for detection of Chlamydia trachomatis in urine specimens from asymptomatic males.

The performances of three commercially available immunoassays (Chlamydiazyme/Antibody Blocking Assay [Abbott Diagnostics, Abbott Park, Ill.], IDEIA [Analytab Products, Plainview, N.Y.], and Microtrak EIA [Syva Co. Palo Alto, Calif.]) were evaluated for the detection of Chlamydia trachomatis in urine specimens from asymptomatic males. Assay results were compared with direct specimen immunofluorescence (DFA) analysis of urine sediment (Syva Microtrak; Syva Co.), which was chosen as the study confirmation assay. An overall Chlamydia prevalence of 7% (24 of 340) was found in our study population, with peak incidences occurring in the adolescent (8 of 93 specimens) and young adult (11 of 146 specimens) age groups. Sensitivity and specificity data among the Chlamydiazyme, IDEIA, and Microtrak enzyme immunoassays (EIAs) were determined to be 79.1 and 99%, 91.7 and 98%, and 95.8 and 99%, respectively. The Microtrak EIA and IDEIA products demonstrated sensitivities and specificities equal to or greater than those claimed for urine specimens. The diagnostic accuracies of these assays on asymptomatic subjects, along with the ease of this collection method, suggest a role for these products as screening tools. The sensitivity of the Chlamydiazyme assay was lower than that claimed previously in symptomatic patients, with 5 of 24 positive specimens demonstrating false-negative results. In those cases, centrifugation of the original immunoassay aliquot material and then DFA examination confirmed specimen positivity. Urine immunoassay screening in combination with DFA confirmation (which was chosen because it has antibody epitopic specificity different from that of the primary assay) provides a high degree of diagnostic precision. The use of noninvasive collection methods could result in greater testing compliance among asymptomatic males and, subsequently, could reduce the incidences of both symptomatic and silent chlamydial infections.

Adolescent↗
PubMed1992

Vaccinia virus-specific human CD4+ cytotoxic T-lymphocyte clones.

Vaccinia virus-specific cytotoxic T-lymphocyte (CTL) clones were established from a healthy donor, who had been immunized with vaccinia virus vaccine, by stimulation of peripheral blood lymphocytes with UV-inactivated vaccinia virus antigen. The phenotype of all of the clones established was CD3+ CD4+ CD8- Leu11-. We used a panel of allogenic vaccinia virus-infected B-lymphoblastoid cell lines and demonstrated that some of the clones recognized vaccinia virus epitopes presented by human leukocyte antigen (HLA) class II molecules. Monoclonal antibodies specific for either HLA-DP or HLA-DR determinant reduced the cytotoxicity of specific clones. The HLA-restricted cytotoxicity of the clones is vaccinia virus specific, because vaccinia virus-infected but not influenza virus-infected autologous target cells were lysed. Using vaccinia virus deletion mutants, we found that some of the CTL clones recognize an epitope(s) that lies within the HindIII KF regions of the vaccinia virus genome. These results indicate that heterogeneous CD4+ CTL clones specific for vaccinia virus are induced in response to infection and may be important in recovery from and protection against poxvirus infections.

CD4 Antigens↗
PubMed1992

IgA nephropathy: acute renal failure, acute tubular necrosis, and features of postinfectious acute glomerulonephritis.

From 1976 to 1987 on our Nephrological Unit, 57 patients with IgA nephropathy (IgAN) proven by renal biopsies were found. Three of those presented with acute tubular necrosis (ATN) and glomerulitis, without extrarenal predisposing cause in two; and showed, as prominent manifestation, a severe acute renal failure syndrome (ARFS), needing dialytic treatment. All three had hematuria, which was macroscopic in two and microscopic in one. Thus the prevalence of the association of glomerulitis and ATN was about 5.2%. There was complete recovery of renal functions in all three patients, but the usual symptomatology of IgAN. Two patients presented polymorphonuclear neutrophils infiltration of glomerular capillaries and in one of them, electron-dense deposits on the epithelial side of glomerular basement membrane ("humps") were observed, as well as those identified in the mesangial area. The glomerular polymorphonuclear neutrophils infiltration and endothelial cells proliferation (cases 1 and 3), the presence of "humps" (case 1), high antistreptolysin O (ASO) titers (cases 1 and 2), and low serum complement levels (case 1), suggest the possibility that antigens able to cause postinfectious glomerulonephritis (streptococcal or not) could induce in some individuals, by another immunopathogenetic route, mixed histopathological and clinical features of IgAN and postinfectious glomerulonephritis.

Acute Disease↗