Biomedical subjects
Publications and source records attributed to J Cruz.
It is frequently shown by the specialist, the relation exists between an obstructive septal deviation and the bad function of the Eustachian tube. Nasal physiopathology, as regulator of the tubaric function has been established as a controversial subject during the past two decades. This research demonstrates the relation between the septal deviation and tubaric pathology.
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Clinical outcome was analyzed among a group of 39 consecutive patients with coronary artery disease, left ventricular (LV) ejection fractions less than 30% and arrhythmias that required an automatic implantable cardioverter defibrillator (AICD) in an attempt to better define the role of the device in patients with severely depressed LV function. Twenty-nine (74%) were survivors of out-of-hospital cardiac arrest and 10 (26%) had ventricular tachycardia that was refractory to electrophysiologically guided antiarrhythmic therapy. The study group had the following demographic characteristics: 90% were men, mean age was 64 years (range 41 to 79) and mean LV ejection fraction was 21 +/- 4%. Concomitant pharmacotherapy included antiarrhythmic drugs 31 (79%), vasodilators in 22 (56%) and digoxin in 20 (51%). There was no statistical difference in baseline characteristics between survivors and nonsurvivors. Patients were followed for a mean of 24 months (range 2 to 72) from implantation. The difference between actuarial survival--77% at 1 year and 72% at 2 years--and projected survival without the AICD (patients who survive without appropriate device discharge)--30% at 1 year and 21% at 2 years--was significant (p less than 0.01 and less than 0.05 at 1 and 2 years, respectively). This study suggests that the AICD improves survival in patients with coronary artery disease despite severely depressed LV function.
A new index of cerebral hemodynamics, cerebral hemodynamic reserve (CHR), was evaluated in 12 comatose adults with severe, acute, traumatic, diffuse swelling of the brain, who underwent continuous monitoring with a fiberoptic catheter of the saturation difference in arteriojugular oxyhemoglobin. CHR was assessed as the ratio of changes in global cerebral oxygen extraction to changes in cerebral perfusion pressure (CPP) as a result of spontaneous increases in intracranial pressure (ICP). During the course of hyperventilation (Pco2 in the range of 20 mm Hg) for ICP control below 20 mm Hg, 34 observations were made over the initial 48 hours postinjury. Despite normal CPP, in 25 of the observations (73.5%), ICP elevations to the range of 20 mm Hg were associated with compromised CHR, as evidenced by decreases in jugular oxygenation directly attributed to the ICP increases. In the remaining nine observations (26.5%), CHR was preserved, as evidenced by no changes or increases in jugular oxygenation when ICP increased. The CHR improved on the second day, suggesting an improved tolerance of the cerebral hemodynamics to ICP increases. Before the ICP elevations, in most of the observations, the global cerebral blood flow was estimated as being optimally decreased (by hypocapnia), in relation to cerebral oxygen consumption. This was reflected by the occurrence of baseline normalized cerebral oxygen extraction. It is concluded that in this group of patients, under circumstances of profound hyperventilation, ICP elevations within the normal CPP range may result in decreased cerebral oxygenation, even when the normal CPP would imply otherwise. It is suggested that CHR assessment may provide information regarding the status of intracranial "tightness," insofar as cerebral circulation and oxygenation are concerned.
An analysis of the possible late effects in 15 children of mothers with Hodgkin Disease, who were given combined chemotherapy during pregnancy, including five who were in the first trimester of development, was conducted. None of the newborns were found to have congenital abnormalities during birth. The 15 children, ranging in ages between 4 to 17, are alive, showing both normal physical and psychomotor development, as well as normal laboratory and cytogenetic results. The thirteen mothers who were in complete remission as a result of the chemotherapy used at recommended dosages and at accepted intervals, are alive and without any evidence of the illness, considering them as cured. Based on these results, pregnancy should not be considered as a contraindication for the adequate treatment of Hodgkin's disease, since those fetuses who received cytotoxic agents in utero, did not show a greater incidence of congenital malformations and have not shown any evidence of side-effects due to the chemotherapy.
The effectiveness of intermittent coronary sinus occlusion was compared to a new non-electrocardiogram-synchronized coronary sinus retroperfusion system in terms of ability to reduce myocardial infarct size. In 40 anesthetized, open-chest pigs the left anterior descending coronary artery was occluded for 4 h and then reperfused for 1 h. In the arterial group, the coronary sinus was intermittently occluded (5 s inflation, 5 s deflation) with retroperfusion of arterial blood at 60 mL/min during balloon inflation. In the venous group, the protocol was identical to the arterial group except that venous blood was retroperfused at the same flow rate during balloon inflation. In the intermittent coronary sinus occlusion group, the coronary sinus was similarly occluded, but there was no active retroperfusion. In the control group, no intervention was performed. In the three experimental groups, retroperfusion was maintained throughout the 4 h occlusion period. Infarct size, assessed by tetrazolium staining and expressed as a percentage of the in vivo area at risk, was greater in control animals (86.3 +/- 7.5%) compared to either arterial (44.1 +/- 12.9%; P less than 0.001) or venous groups (57.7 +/- 15.5%; P less than 0.001) but not compared to the intermittent coronary sinus occlusion group (78.0 +/- 10.2%; not significant). Active retroperfusion with arterial blood did not achieve significantly greater salvage compared to active retroperfusion with venous blood (not significant), although both produced significantly greater salvage than intermittent coronary sinus occlusion (P less than 0.03). Mean coronary sinus pressure was 56.1 +/- 25.4, 38.8 +/- 5.6 and 17.1 +/- 6.4 mmHg in the arterial, venous and intermittent coronary sinus occlusion groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
A polyethylene glycol conjugate of L-asparaginase (PEGLA) was administered to 21 patients with refractory non-Hodgkin's lymphoma. The dose given was 2,000 mu/m2 intramuscularly every 2 weeks. Eligibility required at least one prior trial of chemotherapy and ambulatory performance status. At entry, all patients had measurable lesions and documented disease progression. The median age of the patients was 61 years; 18 (86%) were ambulatory with minimal symptoms, 12 patients (57%) had 3 or more prior regimens, and 13 (62%) had stage IV disease. Histologic subtype was low grade in 11 patients (52%), intermediate in 7 (33%), high grade in 2 (10%) and unclassifiable in one (5%). There were two partial responses (11%) noted (95% confidence interval of response of 1-30%). Eleven patients (52%) were removed from study due to disease progression. Nine patients (43%), required removal for toxicity (7 for protracted nausea and vomiting and 2 for confusion). One patient died of sepsis while on study but this was not considered drug related. Almost one third of patients complained of fatigue or loss of appetite. Nausea and vomiting occurred in approximately half the patients and was moderate to severe in 9. Diarrhea and abdominal pain were also noted in one-third of those treated. Changes in the partial thromboplastin time and fibrinogen were noted in most patients but resulted in no bleeding complications. In this trial, PEGLA displayed modest activity in a heterogenous group of patients with progressive non-Hodgkin's lymphoma.
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One hundred seventy-two patients with advanced breast cancer were randomized to receive oral standard-dose megestrol acetate (MA), 160 mg/d or high-dose MA, 800 mg/d. All but two patients had one prior trial of tamoxifen therapy for either metastatic disease (74%) or as adjuvant treatment (26%). Pretreatment characteristics were similar for both arms. High-dose MA resulted in a superior complete plus partial response rate (27% v 10%, P = .005), time to treatment failure (median, 8.0 v 3.2 months, P = .019), and survival (median, 22.4 v 16.5 months, P = .04) when compared with standard-dose therapy. These differences remained significant after adjustment for other covariates. Thirty-four patients were given high-dose MA after failure of standard-dose MA treatment, and none responded. Weight gain was the most distressing side effect, with 13% of standard-dose and 43% of high-dose patients gaining more than 20 lbs. Four major cardiovascular events occurred in patients receiving high-dose treatment and one in patients given standard doses. Other toxicity was modest. High-dose MA may represent a significant improvement in secondary endocrine therapy for advanced breast cancer patients refractory to initial endocrine treatment, but its use on a regular basis should be reserved until these results are confirmed by other clinical trials.
Global cerebral oxygenation, perfusion pressure, and expired pCO2 were continuously monitored in 10 adults with acute severe closed head trauma. Cerebral oxygenation was monitored by fiberoptic catheter oximetry, which allowed simultaneous measurements of arterial and jugular bulb oxyhemoglobin saturation. Intracranial pressure levels over 20 mm Hg were recorded several times in all patients, in spite of sedation, muscle paralysis, and profound hyperventilation. Intracranial hypertension was frequently associated with oligemic cerebral hypoxia, identified as abnormally low jugular oxygen saturation in the presence of normal arterial oxygenation. Intracranial hypertension was then managed with intravenous administration of mannitol boluses, which yielded simultaneous decreases in intracranial pressure and increases in cerebral oxygenation to highly statistically significant levels. Monitoring cerebral oxygenation was clinically useful because it allowed identification of impaired cerebral oxygenation even when cerebral perfusion pressure was normal. It is therefore proposed as a new monitoring technique, to supplement conventional monitoring of cerebral perfusion pressure.
This pilot program was designed to help medical students improve their ability to respond to the psychological needs of cancer patients and their families. Third-year students on the hematology/oncology rotation were offered a series of seminars dealing with the psychological and social impact of cancer on patients and their families. The goal of these seminars was to help the students develop working knowledge, understanding, and skills for dealing with cancer patients and families. The seminars used didactic input, videotaped interactions, and guided discussion. Experienced counselors, with the help of an oncologist, led the seminars. Findings from this pilot program suggest that medical students can benefit from specific training in the psychosocial aspects of cancer.
During a five year period, 69 patients were treated for carcinoma of the liver (seven primary tumors and 62 metastatic tumors) with 5-fluorodeoxyuridine (5-FUDR) administered through a hepatic artery (n = 62) or portal vein (n = 3) implantable infusion pump. Ten patients proved to have previously unsuspected extrahepatic nodal metastases at laparotomy for pump insertion. 5-FUDR was given in 14 day cycles for three months. At the end of that period and at three month intervals thereafter (mean follow-up time of 18 months, a range of one to 60 months), patients were evaluated with roentgenograms of the chest, liver function tests, carcinoembryonic antigen levels, radionuclide scans and computed tomography. Thirty-five patients had a partial response, nine had stabilization of the disease and 25 had progression of the disease (five during therapy, who were given mitomycin C). Median regression was 6.8 months (a range of three to 18 months). Six of the 35 partial responders, three of the nine patients with stabilization and ten of the 25 patients with progression had extrahepatic visceral disease. Survival time averaged 18.4 months (a range of five to 60 months) for the partial responders, 12.6 months (a range of two to 40 months) for patients with stabilization and seven months (a range of one to 17 months) for those with progression of the disease.
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The rate of urinary protein excretion (Uprot.V) was evaluated in 20 patients with massive proteinuria caused by various histopathological types of glomerular disease. Measurements were made during five consecutive periods: period A (overnight bed rest) and periods B, C, D and E corresponding to normal everyday upright physical activity. Mean Uprot.V was significantly lower during period A (8.2 +/- 1.3 mg/min, mean +/- SEM) than during all the periods of physical activity (11.8 +/- 1.8 mg/min). For 5/20 patients, physical activity induced a mean percent increase of 340 +/- 200% and for 11 an increase of 51 +/- 7% was observed. Only in 4 patients was the rate of urinary protein excretion unaffected or decreased on the average by -20 +/- 9% during physical activity.
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Global cerebral hemodynamic and metabolic variables were assessed in twenty-eight adults with acute brain trauma. Systemic hemodynamics was also evaluated in twenty-one of the patients at that time. Up to six variables were simultaneously assessed, including systemic arterial pressure (SAP), intracranial pressure (ICP), expired or arterial carbon dioxide tension (PECO2, PaCO2), arterial, jugular bulb, and pulmonary artery oxyhemoglobin saturation percents (SaO2, SjO2, SvO2). All subjects having developed severe intracranial hypertension (SICH), those having also sustained systemic hypoxia presented with signs of neurological deterioration, significantly different from the hypoxic-free cases.
Defective acute regulation of hepatic glycogen synthase by glucose and insulin, caused by severe insulin deficiency, can be corrected in adult rat hepatocytes in primary culture by inclusion of insulin, triiodothyronine, and cortisol in a chemically defined serum-free culture medium over a 3-day period (Miller, T. B., Jr., Garnache, A. K., Cruz, J., McPherson, R. K., and Wolleben, C. (1986) J. Biol. Chem. 261, 785-790). Using primary cultures of hepatocytes isolated from normal and diabetic rats in the same serum-free chemically defined medium, the present study addresses the effects of cycloheximide and actinomycin D on the chronic actions of insulin, triiodothyronine, and cortisol to facilitate the direct effects of glucose on the short-term activation of glycogen synthase. The short-term presence (1 h) of the protein synthesis blockers had no effect on acute activation of glycogen synthase by glucose in primary hepatocyte cultures from normal rats. Normal cells maintained in the presence of cycloheximide or actinomycin D for 2 and 3 days exhibited unimpaired responsiveness to glucose activation of synthase. The protein synthesis inhibitors were effective at blocking the restoration of glucose activation of synthase in diabetic cells in media which restored the activation in their absence. Restoration of glycogen synthase phosphatase activity by insulin, triiodothyronine, and cortisol in primary cultures of diabetic hepatocytes was also blocked by cycloheximide or actinomycin D. These data clearly demonstrate that restoration of acute glycogen synthase activation by glucose and restoration of glycogen synthase phosphatase activity in primary cultures of hepatocytes from adult diabetic rats are dependent upon the synthesis of new protein.
Alcohol acts and scenes from a sample of 122 hours of prime-time television programs aired in the fall of 1984 were studied. Approximately 80% of the 116 episodes studied contained one or more appearances of alcohol. The appearance of alcohol on dramatic series was especially high with 9 of 10 episodes containing some verbal or visual reference to alcohol. Alcohol was ingested on 60% of all the programs. Overall, the sample contained 10.65 drinking acts per hour. Dramas, comprising 56% of the sample hours, accounted for most alcohol behavior--11 drinking acts per hour. Put in audience terms, a regular viewer of dramas would be likely to see more than 20 drink acts per evening.