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Biomedical subjects

J Garcia

Publications and source records attributed to J Garcia.

At least 487 records · Page 27Linked to original sources
PubMedDate not supplied

Successful management of infertility due to retrograde ejaculation using assisted reproductive technologies: a report of two cases.

Although retrograde ejaculation is a relatively uncommon cause of infertility, it is nonetheless the most common cause of ejaculatory dysfunction. Retrograde ejaculation is characterized by either all or part of the seminal fluid going into the bladder. The initial management of patients with ejaculatory dysfunction is medical therapy. In couples who have failed medical therapy, assisted reproductive techniques using sperm harvested from either the urine or the male reproductive tract would be the ultimate option. We report successful management of two couples, both men with advanced age and complete retrograde ejaculation, by intrauterine insemination in one and in vitro fertilization (IVF) using intracytoplasmic sperm injection (ICSI) in the other using sperm harvested from urine. The cases reported herein suggest that male infertility due to retrograde ejaculation may be successfully treated in men significantly older than the usual reproductive age and that traditional methods of hydration and urine alkalinization allow for the successful recovery of fertile sperm for ART. The selection of the method of ART must be individualized to the needs of each couple based upon both male and female factors.

Adult↗
PubMedDate not supplied

Food surveillance in the Basque country (Spain) I. The design of a total diet study.

A total diet study has been initiated in the Basque country (Spain), the purpose of which is to provide estimates of the average intake of both food contaminants and certain nutrients. The types and quantities of foods that make up the average Basque 'Total Diet' are based on the results of surveys carried out between 1988 and 1990. These surveys have identified the major items in the national diet (91 categories of foods) which are combined for the total diet study, for analysis, into 16 groups of similar foods. Each group is being analysed for selected contaminants of concern which initially are: heavy metals (mercury, lead, cadmium and arsenic), organochlorine pesticides (HCB, HCH (alpha, beta, gamma, delta), DDT (DDE, TDE), dieldrin, aldrin, endrin, heptachlor, heptachlor epoxide, endosulfan and methoxychlor) and selected trace element nutrients (zinc, selenium and iron). In the milk and dairy products groups an assessment of aflatoxin M1 contamination is also being carried out.

Aflatoxin M1↗
PubMedDate not supplied

Oral support measures used in feeding the preterm infant.

BACKGROUND: Evidence that bottle-feeding is a stressor for inefficient preterm infant feeders is seen in untoward changes in the physiologic system and nutritive sucking patterns. OBJECTIVE: To determine whether a therapeutic technique, oral support (cheek and jaw support), would influence the cardiopulmonary functions or nutritive sucking patterns of preterm infants during feeding. METHODS: A crossover repeated measures design was used with 20 preterm infants for a total of 40 bottle-feeding sessions. The Whitney Mercury Strain Gage and a Nonin Cardiopulmonary monitor were used to observe sucking characteristics and cardiopulmonary functions during feeding. RESULTS: Infants not receiving support paused longer (F= 6.37, df= 5, p < .001) and more frequently (F= 5.01, df= 5, p < .001) than supported infants. There were no differences between the groups in the number of sucks and bursts, the burst duration, the stability of the total sucking activity, or the rate of sucking. Oxygen saturation (SaO2) values, heart rate, and respiratory rate did not differ between the groups during feeding. Postfeeding SaO2 levels were lower than prefeeding levels for infants not receiving oral support (t= 0.96, df= 19, p= .03). CONCLUSION: Oral support provided stability for the jaw and fostered the return of the infant's prefeeding SaO2 values, but it did not interfere with cardiopulmonary function during feeding. Further research is needed to determine whether there is a cumulative effect of oral support, and whether it influences state behavior.

Analysis of Variance↗
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A comparative study of low-dose hyperbaric spinal lidocaine 0.5% versus 5% for continuous spinal anesthesia.

BACKGROUND AND OBJECTIVES: Concerns of cauda equina syndrome have discouraged clinicians to use 5% lidocaine for continuous spinal anesthesia. Earlier reports indicated that single-shot spinal lidocaine 0.5% is effective for minor gynecologic and perianal surgery. In the present study, we evaluate the anesthetic and hemodynamic effects of low dose hyperbaric 0.5% lidocaine for continuous spinal anesthesia and compare with those of the 5% lidocaine solution in patients undergoing urologic surgery. METHODS: Spinal anesthesia was induced via an indwelling subarachnoid catheter in 42 elderly male patients (range, 57-84 years) undergoing transurethral prostate and bladder procedures. Patients were randomly assigned to receive an initial 30-mg bolus of hyperbaric lidocaine in the form of either 6 mL of 0.5% solution or 0.6 mL of 5% solution. Additional 30-mg boluses (to a total of 90 mg) were given, if necessary, to establish initial sensory block to T10 or higher and lower limb paralysis. Supplemental doses of 30 mg or less were given during surgery, as needed. Dermatomal level of sensory anesthesia and degree of motor blockade were assessed at regular intervals by a blinded observer. Heart rate and blood pressure (mean systolic and diastolic) values were monitored at regular intervals. RESULTS: Forty patients were studied successfully. Both hyperbaric 0.5% and 5% lidocaine provided adequate surgical anesthesia in 75% (30/40) of patients after a single 30-mg dose. A median peak sensory level of T5 (range, T2-T9) achieved within 11.1 +/- 4.5 minutes in patients receiving the 0.5% solution was significantly higher than the peak sensory level of T7 (range, T4-T12) in the 5% group (P = .043). The duration of surgical anesthesia after a 30-mg dose was similar in both groups--48.1 +/- 12.1 minutes versus 50.8 +/- 16.5 minutes respectively. Of the 30 patients (15 in each group) who received 30 mg initially, 25 required repeat lidocaine dosing through the catheter during surgery. The maximum decrease in heart rate and blood pressure values was within 10% and 20%, respectively, of baseline values in both groups. In the remaining patients (10/40), anesthesia was achieved successfully in five patients in the 0.5% group and three patients in the 5% group after two 30-mg lidocaine boluses (60 mg) and two patients in the 5% group after three 30-mg boluses (90 mg). CONCLUSIONS: Continuous spinal anesthesia produced by 0.5% lidocaine with 7.5% dextrose is as effective as that produced by the 5% lidocaine solution in elderly patients undergoing urologic surgery. An initial 30-mg bolus delivered via indwelling subarachnoid catheter was sufficient to achieve surgical anesthesia for approximately 50 minutes in most patients. Hemodynamic effects of the two lidocaine solutions were also comparable.

Aged↗
PubMedDate not supplied

Expression of bax and p53 proteins in the tumorigenesis and progression of breast carcinomas.

OBJECTIVES: Dysregulation of normal programmed cell death mechanisms plays an important role in the pathogenesis of breast cancer. The purpose of this study was to investigate the role of bax and p53 expression in tumorigenesis and progression of breast carcinoma as well as their relationship with proliferative and apoptotic activity. METHODS: We used immunohistochemical methods and in situ detection of apoptotic cells to examine 30 carcinomas in situ (CIS), 131 invasive breast carcinomas and 45 lymph node metastases. RESULTS: In 25% (33 of 131) of invasive breast carcinomas examined, bax expression was absent, while p53 accumulation was present in 37% (49 of 131). Interestingly, p53 accumulation and loss of bax expression occur in breast CIS as frequently as in invasive breast carcinoma. Thus, in 17% (5 of 30) of CIS bax expression was absent, and 30% (9 of 30) presented nuclear expression of p53. p53 accumulation was related to apoptosis and proliferative activity. However, the protein level of bax was unrelated to all parameters studied, including proliferation and apoptosis of tumor cells. A multivariate analysis of disease-free survival demonstrated that p53 accumulation and bax expression are not significant independent indicators of prognosis in operable breast carcinoma. Our results also show that the proportion of bax- and p53-positive cells does not vary between primary and metastatic tumors. CONCLUSIONS: p53 accumulation and loss of bax expression influence the acquisition of a malignant phenotype but seem to have no further impact on tumor progression.

Adult↗
PubMedDate not supplied

Role of tryptase, eosinophil cationic protein and histamine in immediate allergic reactions to drugs.

20 subjects (8 men, 12 women) with anaphylactic or urticarial reactions after drug intake were evaluated. Tryptase (TRY) and eosinophil cationic protein (ECP) were determined in serum 2 and 24 h after the allergic episode. Histamine was determined in three sequential urine samples. Results indicated that in the group of subjects evaluated, TRY and histamine were elevated, although in not all cases for both markers. With ECP, no clear association was found either at 2 or 24 h after the allergic episode. These results suggested that mast cells participated in the adverse reactions, but a role for eosinophils could not be established. Further studies need to be undertaken to establish the participation of these cells in immediate reactions to drugs.

Adult↗
PubMedDate not supplied

Total parenteral nutrition decreases liver oxidative metabolism and antioxidant defenses in healthy rats: comparative effect of dietary olive and soybean oil.

BACKGROUND: Total parenteral nutrition (TPN) is used for critically ill patients undergoing surgery, after trauma, or during disease conditions that favor oxidative stress. We studied the effect of TPN on liver oxidative metabolism and antioxidant defenses in rats, and we compared the effect of soybean oil- and olive oil-based diets. METHODS: Seven-week-old rats (n = 28) were divided into four groups. Two experimental groups received a TPN solution containing soybean oil (TPN-S) or a mixture of olive/soybean oil, 80/20 (TPN-O), IV for 6 days. Orally fed animals received a solid diet including soybean oil (Oral-S) or olive/soybean oil, 80/20 (Oral-O). The following parameters were measured: DL-alpha-tocopherol, vitamin A, malondialdehyde and thiobarbituric acid reactive substances (MDA-TBARS), and total radical-trapping antioxidant parameter (TRAP) in serum; DL-alpha-tocopherol, vitamin A, glutathione (GSH), and catalase (Cat) activity in liver homogenate; fatty acids from phospholipid, cytochrome P-450 content, NADPH-cytochrome c2 reductase activity in liver microsomes; superoxide dismutase (SOD), glutathione peroxidase (Gpx), glutathione reductase (GR), glutathione transferase (GST), and glucose-6-phosphate dehydrogenase (G6PD) in liver cytosol. RESULTS: The soybean or olive oil diets modified the liver microsomal fatty acid phospholipid composition, but the unsaturation index remained unchanged. TPN specifically increased the saturation of the membrane. The cytochrome P-450 level and the NADPH-cytochrome c2 reductase, SOD, Gpx, Cat, and GST activities were unchanged by soybean oil or olive oil diet but decreased receiving TPN. CONCLUSIONS: In rats, TPN decreased the liver oxidative metabolism and enzymatic antioxidant defenses. This may be related to saturation of the liver microsomal fatty acids.

Administration, Oral↗
PubMedDate not supplied

Plasma phospholipid fatty acids and urinary excretion of prostaglandins PGE1 and PGE2 in infants during total parenteral nutrition, with continuous or sequential administration of fat emulsion.

During total parenteral nutrition, using an identical supply of fat emulsion (350 mg/kg/24 hr) to correct essential fatty acid deficiency in children, the efficacy of two methods of administration was studied: continuous over 24 hr, or discontinuous 3 hr/day. At the beginning of the study, all the infants (1-4 months old) had proven essential fatty acid deficiency. After at least 1 month of one of the two nutritional protocols (continuous or discontinuous), plasma phospholipid fatty acid composition and PGE1 and PGE2 urinary excretion were measured. The results obtained indicate better utilization of the fat emulsion when it is administered almost every day, in continuous infusion over 24 hr (1 g/kg/24 hr of Intralipid 20%).

Alprostadil↗
PubMedDate not supplied

Metabolic utilization of linoleic acid from fat emulsion in infants during total parenteral nutrition.

The metabolic utilization of linoleic acid (C18:2w6) from intravenous (iv) soybean oil emulsion via its conversion to higher homologues and prostaglandin biosynthesis was studied in 21 infants. The infants were of normal birth weight, in good clinical and metabolic condition, and aged from 1-4 months. They all received total parenteral nutrition after birth for more than 1 month; the only lipid was provided by iv Intralipid 20%, at levels approximating 350 mg/kg/24 h of linoleic acid (2.5% of the infants' total daily energy intake). Study of the fatty acids of plasma and erythrocyte phospholipids in these infants, compared to healthy controls of the same age (N = 26), showed that 350 mg/kg/24 hr of C18:2w6 supply resulted in normalization of erythrocyte phospholipid fatty acid distribution. This was particularly true of the higher homologues of C18:2w6 (C18:3w6, C20:3w6, and C20:4w6). This suggested that delta 6 and delta 5 desaturation activities are normal in these conditions with this C18:2w6 supply. These results were confirmed by the study of 24-hr urinary excretion of prostaglandins PGE1 and PGE2. With 350 mg/kg/24 hr of C18:2w6 supply their urinary levels were not significantly different from those observed in normal children of the same age receiving an equivalent oral C18:2w6 intake.

Erythrocytes↗
PubMedDate not supplied

Fatty acid composition of adipocyte membrane phospholipids and stored triglycerides in infants receiving total parenteral nutrition.

Fatty acid (FA) composition of membrane phospholipids (PL) and stored triglycerides (TG) from adipose tissue was studied in eight infants aged 1 to 4 months receiving total parenteral nutrition (TPN) since birth. During this period, essential fatty acid (EFA) intake consisted exclusively of soybean oil emulsion administered by intravenous route (Intralipid 20%) representing 301 +/- 88 mg/kg/24 hr of linoleic acid and 58 +/- 18 mg/kg/24 hr of alpha-linolenic acid, or 2.3 +/- 0.6% and 0.4 +/- 0.1%, respectively, of total energy intake. The results were compared with those of eight control infants of the same age receiving orally a normal milk diet with an intake of 660 +/- 260 mg/kg/24 hr of linoleic acid and 101 +/- 35 mg/kg/24 hr of alpha-linolenic acid, or 4.5 +/- 0.7% and 0.7 +/- 0.3%, respectively, of total energy intake. Although their EFA intake was significantly lower (p less than 0.01) and administered only parenterally, after 1 to 4 months the infants receiving TPN still had a membrane phospholipid FA pattern of adipose tissue which was not significantly different from that of normal children of the same age. In stored adipocyte TG, the percentage of linoleic acid was significantly lower (p less than 0.01) in infants receiving TPN. This is probably of nutritional importance as at this stage of life the child builds up its stores of EFA. The proportion of the other fatty acids in adipocyte TG was not significantly modified.

Adipose Tissue↗
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Sinonasal undifferentiated carcinoma invading the orbit.

Sinonasal undifferentiated carcinoma (SNUC) is an infrequent tumor described by Frierson et al. in 1986. Since its initial description, fewer than 100 patients have been reported. We present a case of a SNUC invading the orbit in a 57-year-old woman, for which the findings are documented by CT scan, light and electron microscopy.

Carcinoma↗
PubMedDate not supplied

Determination of inflammatory markers in allergic reactions to drugs.

Serum tryptase (Tryp) and eosinophil cationic protein (ECP) and urine N-methylhistamine (N-MH) were quantitated in a group of 13 subjects who had experienced immediate allergic reactions to different drugs. Results indicated that both Tryp and N-MH were involved and the levels were related to the severity of the reaction. Results of serum ECP levels failed to provide relevant information concerning the participation of eosinophils in immediate reactions to drugs.

Adolescent↗
PubMedDate not supplied

The anemia of chronic renal failure. Overview and early erythropoietin experience.

One of the most important deficiency states associated with chronic renal failure is profound anemia. While it has been possible to identify differing types of anemia in patients receiving dialysis support, and thus correct the secondary causes, most patients continue to exhibit symptoms and signs of the anemic state. This review of the anemias associated with renal failure explores the diagnostic and therapeutic possibilities that may help the physician in evaluating the anemic patient with chronic renal failure. Also described is the early clinical experience with a new genetically engineered hormone, recombinant human erythropoietin (r-HuEPo), which has been under investigation for nearly two years at The Cleveland Clinic Foundation as part of a multi-center trial. An orderly approach to the anemic patient with renal dysfunction is suggested, and conjectures about the impact of newer therapies are made.

Anemia↗
PubMedDate not supplied

Serum magnesium concentration is an independent predictor of parathyroid hormone levels in peritoneal dialysis patients.

BACKGROUND: Parathyroid hormone (PTH) is a cardinal factor in the pathogenesis of bone disease in the dialysis population. The spectrum of renal osteodystrophy has been reported to have changed during the past years, and adynamic bone disease has emerged as the most common bone disorder in these patients. Continuous ambulatory peritoneal dialysis (CAPD) is considered a risk factor for the development of this condition, and furthermore, the adynamic bone lesion is associated with a state of relative hypoparathyroidism (hypo-PTH). Calcium, vitamin D, and phosphorus play a key role in the control of parathyroid gland function in uremic patients. However, magnesium may also be able to modulate PTH secretion in a way similar to calcium. OBJECTIVE: The aims of this study were (1) to analyze the serum Mg concentration in a large group of CAPD patients, (2) to study the relationship between serum Mg and PTH levels, and (3) to investigate whether this relationship is independent of other factors, such as calcium, phosphorus, and calcitriol, that regulate parathyroid function. PATIENTS AND METHODS: We studied 51 stable patients, aged 23-77 years, under maintenance CAPD for more than 6 months (range 8-48 months). Calcium carbonate was used as a phosphate binder in all patients, and 9 subjects also received aluminum hydroxide. No patient had been previously treated with vitamin D. Biochemical parameters were prospectively evaluated over 6 months, and the mean values were computed. RESULTS: The mean serum Mg was 1.08 +/- 0.19 mmol/L, and hypermagnesemia, defined as a Mg level higher than 1.01 mmol/L, was found in 30 patients (59%). Thirty-one subjects (60%) had an intact PTH (iPTH) level lower than 120 pg/mL and were diagnosed as having relative hypo-PTH. Except for the values of iPTH and alkaline phosphatase, the only difference between the two groups was the serum Mg concentration, which was significantly higher in patients with hypo-PTH (1.16 +/- 0.15 mmol/L vs 0.91 +/- 0.14 mmol/L; p< 0.001). Furthermore, iPTH levels were lower in patients with hypermagnesemia than in subjects with normal serum Mg (69 +/- 49 pg/mL vs 190 +/- 89 pg/mL, p < 0.001). There was a significant correlation between serum Mg and PTH levels (r= -0.70, p< 0.01). After controlling for the effect of other variables by partial correlation analysis, a significant positive association between P and PTH (r= 0.25, p < 0.05), and a negative relationship between Mg and PTH (r= -0.57, p < 0.001) were evident. A forward stepwise multiple regression analysis showed that only P and Mg predicted PTH values (multiple r = 0.59, p < 0.001). CONCLUSIONS: Hypermagnesemia and hypoparathyroidism are frequent in CAPD patients. There is a significant inverse relationship between serum Mg concentration and iPTH levels. Furthermore, this association is independent of the most important factors regulating parathyroid gland function (calcium, phosphorus, and calcitriol). These results suggest that hypermagnesemia may have a suppressive effect on PTH synthesis and/or secretion. Therefore, elevated serum Mg levels may play a role in the pathogenesis of adynamic bone disease.

Adult↗