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Biomedical subjects

J Fernandez

Publications and source records attributed to J Fernandez.

At least 145 records · Page 8Linked to original sources
PubMed1991

Left ventricular pseudoaneurysm with hemoptysis.

A 53-year-old man who had previously undergone resection of a left ventricular aneurysm was admitted because of hemoptysis. Preoperative evaluation with computed tomographic scan and cardiac catheterization demonstrated a pseudoaneurysm of the inferior ventricular wall measuring 16 cm in diameter with protrusion into the left hemithorax. The neck of the pseudoaneurysm was a defect in the ventricular wall extending from the base of the mitral valve annulus to the insertion of the posterior papillary muscle. Operative repair was performed using an albumin-coated, low-porosity Dacron patch.

Heart Aneurysm↗
PubMed1991

Hypertrophy of nodules of Arantius and aortic insufficiency: pathophysiology and repair.

Aortic insufficiency (AI) due to fibrosis and thickening of the nodules of Arantius in the otherwise normal aortic valve was found in 11 adults (age range, 41 to 65 years) between 1976 and 1988. Nine had concomitant mitral stenosis; 2 had coronary artery disease. In 6 patients AI was graded 3+ or greater; in 5 it was less than 3+. Correction of AI and restoration of cuspid flexibility and apposition by shaving the hypertrophied nodules was accomplished in all, with postrepair AI graded as 1+ or less. There was one hospital death, a patient who had prior mitral operation. Mean follow-up was 68 +/- 56 months. Only 1 patient had late (6 years) recurrent serious (3+) AI. Nine continued to have 1+ or less AI, based on echocardiography or catheterization (n = 6) or on physical examination performed at a mean of 74 months. We conclude that thickening of the nodules of Arantius may cause AI. Long-term correction can be accomplished by sculpturing of the involved cusps.

Adult↗
PubMed1991

Percutaneous transluminal subclavian angioplasty in a patient with postoperative angina.

Subclavian artery stenosis is a rare cause of angina in patients who have undergone coronary revascularization using the internal mammary artery. The traditional approach to this problem is surgical revascularization of the subclavian artery with a bypass graft. We report the successful treatment of a patient with this condition using percutaneous transluminal subclavian artery angioplasty, obviating an additional surgical procedure.

Aged↗
PubMed1991

Actuarial survival and other events following valve surgery in octogenarians: comparison with an age-, sex-, and race-matched population.

From January 1973 to December 1989, 54 patients over 80 years of age underwent an intracardiac repair which included a cardiac valve operation. There were 21 males and 33 females. Mean age at operation was 82 years, range 80-89 years. Fifty-two patients (96%) were in New York Heart Association functional class III or IV preoperatively. Six patients had undergone previous valve surgery (11%). There were eight hospital deaths (14.8%). Risk factors for hospital death included older age at repair (p = 0.008), increased total cardiopulmonary bypass time (p = 0.06), and, possibly, smaller aortic valve prosthesis (p = 0.10). All 46 hospital survivors were followed up at a mean of 28.8 months after hospital discharge. There were 11 late deaths (23.9%), occurring at a mean of 32.3 months postoperatively. Survival analysis indicated that increased age (p = 0.06) and increased pulmonary artery diastolic pressure preoperatively (p less than 0.07) were multivariate risk factors for overall mortality. Actuarial survival at 5 years was 44%, with no difference from survival in an age-, sex-, and race-matched population. We conclude that octogenarians in the modern era have good chance for survival following valvular surgery. As hazards for full anticoagulation were low in this series, if valve repair is not feasible, we presently recommend the use of mechanical valves in the elderly to reduce the requirement for late reoperation due to bioprosthesis degeneration.

Actuarial Analysis↗
PubMed1991

Determination of IgE antibodies to Polistes dominulus, Vespula germanica and Vespa crabro in sera of patients allergic to vespids.

The study was undertaken to investigate the presence of IgE antibodies to Polistes dominulus (PD), Vespula germanica (VG) and Vespa crabro (VC) in a large group of sera belonging to patients sensitized to Vespids in Spain. RAST values showed that although the majority of patients had IgE antibodies to PD, VG and VC, there was a marked predominance of PD. These results were related to the distribution of the insect in the areas where the sera were obtained. Due to geographical and insect distribution differences, the whole area was divided into three zones: Central, East and South. Comparison of the positive RAST values obtained indicated that, although the positivity to PD predominated over VG and this over VC, there were significant differences in percentage positivities to each vespid in the different regions studied. The results of the RAST absorption studies indicated that in most instances patients were originally sensitized to one vespid and were RAST positive to the other venoms due to cross-reactivity. Only in a minority of cases were coexisting antibodies to two insects present. These results show that PD and VG are the important vespids followed to a lesser extent by VC. This study provides relevant information concerning insect distribution sensitivity in a European country.

Animals↗
PubMed1991

Differences in serum IgE antibody activity to benzylpenicillin and amoxicillin measured by RAST in a group of penicillin allergic patients.

To determine the influence of the acyl side chain on the IgE antibody specificity of the two most common penicillins inducing allergic reactions in our community, benzylpenicillin (BP) and amoxicillin (AX), IgE positive sera from a group of 24 patients allergic to penicillin were studied. RAST was determined in parallel to benzyl penicilloyl-polylysine (BPO-PLL) and amoxicilloyl-polylysine (AX-PLL) in each serum, and values greater than an established coefficient of variation of 15% were considered as different for either of the haptens used (BP and AX). 16 sera proved to be more positive to BP (Group A), six to AX (Group B) and in two IgE was positive to both haptens with a similar value (Group C). RAST titration concentration effect curves and RAST inhibition studies with a pool of sera from each group (A, B, C) and individual sera showed that most of them were more specific for either BPO or AX, a minority being of similar value to both. These findings indicate that the side chain structure of penicillins is relevant in the constitution of the antigenic determinant, although in some instances the common chemical structure of betalactam is recognised mainly by the IgE antibodies. The clinical relevance of these data needs to be established.

Amoxicillin↗
PubMed1991

The cryopreserved stented pulmonary homograft valve in the tricuspid position.

This study was designed to evaluate the early phase events occurring in a stented pulmonary homograft valve implanted in the tricuspid position. A human pulmonary homograft was sterilized in antibiotic solution for 48 hours and cryopreserved in liquid nitrogen (-176 degrees C). Following thawing and trimming, the pulmonary valve was mounted on a Dacron cloth-covered Delrin stent and implanted into the tricuspid position in 3-month-old sheep, for a mean of 95 +/- 5 days. Seven animals were studied. Morphological assessment indicated good structural tissue preservation despite a decrease in viable fibroblasts noted in the distal part of the leaflets. The collagen fibers remained unchanged, and no tissue calcification was found. Viability of the mounted homograft was evaluated using an in vitro tissue culture method, and the viable cells underwent chromosomal analysis to identify whether they originated from the donor or host. Cells with 56 chromosomes, a number intrinsic to sheep cells, were cultured from the donor recipient junctional area. Hemodynamic and angiographic data, which were collected at the time of both implantation and explantation, revealed no functional deterioration of the implanted valve over 3 months. At the time of explantation, six of the seven valves were competent and no cusp retraction or thickening was noted. The seventh valve had deteriorated due to endocarditis. We conclude that stented cryopreserved pulmonary homografts may be useful as bioprostheses in the tricuspid position.

Animals↗
PubMed1991

Natural history of islet cell antibodies during the clinical period of type 1 diabetes. High titres at diagnosis are associated with longer persistence.

The natural history of islet cell antibodies (ICA), using standardized Juvenile Diabetes Foundation (JDF) units, was studied for two years in 64 type 1 (insulin dependent) diabetic patients, aged 7-45 years prospectively from clinical onset. While ICA were present among 44/64 (68.8%) of the newly diagnosed patients, only 9.3% remained positive at 24 months. The only factor which showed significant predictive value for ICA survival was high initial JDF ICA titres: Maximal persistence of ICA was observed in patients with 80 JDF units at diagnosis (100% at 12 and 24 month). This persistence was lower in patients with 40 JDF units at diagnosis (77% at 12 month, 40% at 24 month) and the lowest for patients with 5 JDF at diagnosis (14% at 12 month, 0% at 15 month). 14/20 (70%) of patients negative for the ICA test at diagnosis became positive during follow-up, but always with a low titre (5-10 JDF units) and for a short period (3-6 months). It is concluded that initial titre is the most important variable in predicting the maintenance of ICA during the first two years of clinical type 1 diabetes.

Adolescent↗
PubMed1991

Guild structure of larval trematodes in the snail Helisoma anceps: patterns and processes at the individual host level.

Factors that influenced the infracommunity structure of trematodes parasitizing the pulmonate snail Helisoma anceps were studied over a 15-mo period; the guild included 8 species of parasites. Infracommunities were depauperate, with double patent infections observed in only 7 of 1,485 infected snails; a total of 4,899 was examined. Halipegus occidualis-Haematoloechus longiplexus was the most common dual infection. Both species share the same definitive host and, in both cases, eggs are the infective stage for the snail. Switches and losses of infections in individual snails were observed, suggesting the occurrence of dynamic interactions within the guild. A dominance hierarchy was constructed based on field observations and experimental infections. Echinostomatids were dominant; species without rediae in their life cycles were subordinates. Halipegus occidualis (which has rediae) was intermediate in dominance. Spatial and temporal heterogeneity in the distribution and abundance of trematode infective stages indicate that not all the snails have the same probability of becoming infected. Habitat structure, behavior of the definitive host, the nature of the infective stages, and snail population dynamics (mortality, recruitment, and size structure) generated spatial and temporal heterogeneity in this system. As a consequence, predictions of the probabilities of interspecific interactions based on an analysis of observed and expected frequencies of multiple infections could be inappropriate unless the potential sources of heterogeneity are considered.

Animals↗
PubMed1991

The component community structure of larval trematodes in the pulmonate snail Helisoma anceps.

Factors that affected the component community structure of larval trematodes in the pulmonate snail Helisoma anceps in Charlie's Pond, North Carolina, were studied over a 15-mo period using a multiple mark-recapture protocol. Patent infections of 8 species were observed in 1,485 of 4,899 snails examined. Reproductive activity, population size, and survival rate of the snail population were estimated to evaluate the extent of resource availability for the parasites. Antagonistic interactions between trematode species that occurred at the infracommunity level had a neglible effect on the composition and structure of the component community. The patterns observed at this level were related to temporal heterogeneity in the abundance of infective stages (mostly miracidia), differential responses of trematode species to the diverse and constantly changing distribution of snail size and abundance, differential mortality of snails infected with certain trematode species, constant recruitment of 1 trematode species over time, and the existence of predictable disturbances such as the complete mortality of the host population and recruitment of a replacement population during a 6-8 wk period. The last factor operated as a reset mechanism for this snail-trematode system once each year. A model of patch dynamics, with snails as patch resources, best explains the organization and dynamics of this system.

Animals↗
PubMed1991

[Pilomatrix carcinoma. A new case].

We present a new case of Pilomatrix Carcinoma after having review the 22 cases previously published. The tumor arisen in a 74 years old male, in the left preauricular region. The lesion was excised with wide margins. A year after there is not any evidence of recurrence or metastases.

Aged↗
PubMed1990

Aortic valve repair for aortic stenosis in adults.

The stenotic aortic valve was surgically repaired in 48 adults, 21 women and 27 men, aged 38 to 83 years. Five had congenital aortic stenosis (AS), with a mean aortic valve gradient and area of 58 +/- 23 mm Hg (standard deviation) and 0.54 +/- 0.13 cm2, respectively; 32 had senile AS with a mean aortic valve gradient and area of 43 +/- 20 mm Hg and 0.98 +/- 0.41 cm2; and 11 had rheumatic AS with a mean aortic valve gradient and area of 59 +/- 24 mm Hg and 0.47 +/- 0.15 cm2. Only 6 patients underwent isolated aortic valvoplasty, 11 underwent concomitant mitral valve procedure, and 34 underwent concomitant coronary revascularization. Repair consisted of decalcification in 33 patients and decalcification as well as commissurotomy in 15 patients. There were three hospital deaths, none related to the aortic valve. Only 2 patients (both rheumatic) did not improve clinically. During follow-up (mean, 64 +/- 41 months) aortic valve restenosis developed in 24% (10 patients, 3/5 congenital, 4/11 rheumatic, and 3/32 senile) at a mean of 64 +/- 28 months. Postoperative Doppler echocardiographic assessment of 21 patients with senile AS at 1.1 +/- 2.7 and 18.1 +/- 1.4 months showed significantly lower aortic valve gradient and improved area in comparison with preoperative values. At 36 +/- 2.7 months, aortic valve gradient and area were not significantly different than preoperative values, and at 58.5 +/- 2.6 months aortic valve gradient was 1.41 (p = 0.07) times the preoperative value. At 7 years, actuarial freedom from aortic valve-related symptoms of the patients with senile AS was 87%. We conclude that in select patients aortic valve repair results in excellent relief of AS. Late restenosis is expected and more likely to occur in the valves with congenital and rheumatic disease than in those with senile disease.

Adult↗
PubMed1990

Alterations of the Cl-/NaCO3- anion exchanger in erythrocytes of uraemic patients.

We have studied the transport activity of the erythrocyte anion exchanger by measuring the DIDS-sensitive Li+ influx in fresh red blood cells incubated in HCO3- medium. In addition, the amount of erythrocyte band 3 protein was determined by electrophoretic analysis. The study was performed in twenty uraemic patients on chronic haemodialysis (12 males and 8 females, mean age 47.9 years), and in 20 healthy controls (10 males and 10 females, mean age 44.7 years). Mean time on haemodialysis was 63.9 months (range 6-170 months). The DIDS-sensitive Li+ influx was decreased in erythrocytes from uraemic patients as compared to erythrocytes from controls (619.6 +/- 34.1 vs 761.2 +/- 36.6 mumol/l cell x h, P less than 0.01). The content of band 3 protein was decreased in erythrocytes from uraemic patients as compared to erythrocytes from controls (30.01 +/- 0.39 vs 32.12 +/- 0.48%, P less than 0.01). These results indicate that the Cl-/NaCO3- anion exchanger is altered in erythrocytes from uraemic patients in chronic haemodialysis, and suggest that the regulation of ion content may be compromised in the red blood cells of these patients.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗