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Biomedical subjects

J J Gonzalez

Publications and source records attributed to J J Gonzalez.

At least 19 recordsLinked to original sources
PubMed1999

Branched chain amino acids decrease tardive dyskinesia symptoms.

RATIONALE: Prior studies had suggested (a) that a lessened ability to clear ingested forms of the large neutral amino acid (LNAA), phenylalanine (Phe), was associated with having tardive dyskinesia (TD), and (b) that greater availability of a group of LNAA, the branched chain amino acids (BCAA), concomitant with the lower availability of Phe to the brain are associated with a decrease in TD symptoms. The present study was then conducted to test whether increasing the daily intake of the BCAA would decrease the symptoms of TD. METHODS: A 2-week trial of a BCAA medical food administered three times a day was conducted in nine men with long neuroleptic treatment histories. Frequency counts of TD movements were collected by videotape throughout the trial and these tapes were analyzed in blind random sequence for both patient and time for TD symptom level changes subsequent to completion of the trial. Plasma levels of the LNAA were also collected throughout the trial. RESULTS: A statistically significant decrease in the level of TD symptoms was observed for the sample. The symptom changes were also clinically significant in that six of the nine subjects had symptom decreases of at least 58%, with all subjects having a decrease of at least 38%. BCAA administration increased plasma BCAA concentrations and BCAA/LNAA ratios and decreased plasma Phe concentrations and the Phe/LNAA ratio. Analyses indicated a strong significant correlation between the percent increase in the plasma BCAA values at the first administration and the percent improvement in TD over the trial in eight of the nine subjects. CONCLUSIONS: The BCAA show promise as a treatment for TD. The decrease in TD symptoms seen in the trial may have been modulated by the BCAA treatment-induced increased availability of the BCAA and decreased availability of Phe to the brain.

Amino Acids, Branched-Chain↗
PubMed1999

Improved survival in patients with acute myocarditis using external pulsatile mechanical ventricular assistance.

BACKGROUND: Acute myocarditis remains a disease with a variable clinical course, from full ventricular recovery to complete heart failure; to date, few cases have been reported that describe the efficacy of temporary mechanical ventricular assistance for its treatment. METHODS: We evaluated the voluntary world registry with the use of an external pulsatile ventricular assist device (the ABIOMED BVS 5000 [BVS]) for acute myocarditis to determine the impact of mechanical ventricular assistance on outcome. Variables analyzed included patient demographics, serum chemistries, and overall hemodynamics prior to BVS, while on BVS support, and after BVS explanation. Postoperative parameters included re-operation, bleeding, respiratory failure, renal failure, and infections, neurologic, or embolic events. RESULTS: Eighteen patients in the ABIOMED world registry underwent BVS implantation for myocarditis; 11 (61.1%) had complete pre-operative and hemodynamic data for analysis. Patients were supported for 13.2 +/- 17.0 days, after which time 7 (63.6%) patients survived to explanation of the device and 2 (18.2%) underwent transplantation. Elevated admission serum chemistries (blood ureanitrogen [BUN], creatinine, transaminases) and hemodynamics (central venous pressure [CVP], mean pulmonary arterial pressure [PAP], pulmonary capillary wedge pressure [PCW], cardiac index [CI], all normalized during the period of device support. Estimated ejection fractions in the 7 explanted patients ranged between 50 to 60% at routine evaluation 3 years after device removal. CONCLUSIONS: Temporary mechanical ventricular assistance represents an efficacious therapy for acute myocarditis in patients with hemodynamic decompensation despite maximal medical therapy. Failure to achieve full ventricular recovery while on device support still allows for other surgical alternatives, including implantation of a long-term implantable ventricular assist device, or cardiac transplantation.

Acute Disease↗
PubMed1998

Laparoscopic ventral and incisional hernia repair.

Incisional hernia repair poses a difficult problem for the general surgeon because of the high incidence of recurrence (50%) and a reported 10% infection rate. Use of a mesh by the anterior approach to replace or reinforce the defect has marginally reduced the recurrence rate, but not the infection rate, especially in obese patients. With the evolution of minimally invasive surgery, we thought that a potential was present to reduce the postoperative stay, lessen pain, and decrease the incidence of both recurrence and infection. From February 1991 through February 1998, a total of 176 patients with complicated umbilical and incisional hernias have been repaired; the follow-up has been from 1 to 84 months. The complication rate was 5.1%, with an infection rate of 1.7% and a 1.1% incidence of recurrence. Seventeen patients had combined procedures, including cholecystectomy, inguinal hernia repair, and antireflux procedures.

Adult↗
PubMed1995

Dyslexia and corpus callosum morphology.

OBJECTIVE: There is evolving evidence that developmental dyslexia is associated with anomalous cerebral morphology in the bilateral frontal and left temporoparietal regions. This study examined the morphology of the corpus callosum, as possible deviations in other important structures are poorly understood in this behaviorally diagnosed syndrome. DESIGN: Magnetic resonance imaging scans were obtained from children with developmental dyslexia and from matched control children. Morphometric measurements were examined to determine if regional differences existed in the corpus callosum between these two groups of children. SETTING: Magnetic resonance imaging studies were completed at Athens (Ga) Magnetic Imaging. PATIENTS AND OTHER PARTICIPANTS: Sixteen developmental dyslexic children (mean age, 9.7 years) and a matched sample of children who were diagnosed as being normal were examined by using a reliable comprehensive diagnostic process. MAIN OUTCOME MEASURES: Using a midsagittal magnetic resonance imaging scan, corpus callosum morphology was evaluated by segmenting the corpus callosum into five regions of interest. RESULTS: Analysis of the corpus callosum revealed that the anterior region of interest (the genu) was significantly smaller in the dyslexic children. Significant correlations existed between reading achievement and the region-of-interest measurements for the genu and splenium. Measured intelligence, chronologic age, and gender were not related to region-of-interest measurements of the corpus callosum. Consistent with previous studies, the dyslexic individuals were characterized by significant psychiatric comorbidity, particularly attention-deficit disorder with and without hyperactivity. Reported familial left-handedness also distinguished the dyslexic children. CONCLUSIONS: Subtle neurodevelopmental variation in the morphology of the corpus callosum may be associated with the difficulty that dyslexic children experience in reading and on tasks involving interhemispheric transfer.

Child, Preschool↗
PubMed1993

Increasing mammography utilization: a controlled study.

BACKGROUND: Despite the effectiveness of breast cancer screening for women older than 50 years of age, only about one third of these women in the United States receive annual mammography. PURPOSE: This study was designed to determine if a community-wide intervention could increase use of mammography screening for breast cancer. Secondary end points were determination of changes in women's knowledge and attitudes toward mammography and physicians' self-reported screening practices. METHODS: We conducted a controlled study from January 1987 through January 1990 in two eastern North Carolina communities--New Hanover County (the experimental community) and Pitt County (the control community). Before development and implementation of the intervention program in New Hanover County and after the program had been in operation for 1 year, 500 women of ages 50-74 years and all primary-care physicians in each community were interviewed by telephone. In these interviews, we determined the use of mammography for breast cancer screening and the knowledge and attitudes about it. We also established the number of screening mammograms performed in 1987 and 1989 in each county and reviewed medical records to determine the percentage of women the physicians had referred for mammograms. RESULTS: The percentage of women who reported receiving a mammogram in the previous year increased from 35% to 55% in the experimental community and from 30% to 40% in the control community (difference of differences, 10%; P = .03 after adjustment for race, education, age, and having a regular doctor; 95% confidence interval, 1%-18%). Increases were greater in New Hanover County regardless of age, race, income, and education. However, the increase was less for Black women than for White women, both overall and in most demographic subgroups. The total number of mammograms performed increased 89% in the experimental community and 45% in the control community. Women's knowledge about mammography changed little, but the intention to get a mammogram increased 30% in New Hanover County, compared with a 17% increase in Pitt County--a statistically significant difference (P < .01). Physician reports and medical record reviews in the two communities showed similar increases in the number of mammograms ordered. CONCLUSIONS: A community-wide effort to increase use of breast cancer screening was successful, but more work must be done to reach the National Cancer Institute's goal of annual mammograms for 80% of women of ages 50-74.

Age Factors↗
PubMed1993

Attention deficit-hyperactivity disorder and asymmetry of the caudate nucleus.

The neurologic basis of attention deficit-hyperactivity disorder (ADHD) is poorly understood. Based on previous studies that have implicated metabolic deficiencies in the caudate-striatal region in ADHD, we employed magnetic resonance imaging to investigate patterns of morphology of the head of the caudate nucleus in normal and ADHD children. In normal children, 72.7% evidenced a left-larger-than-right (L > R) pattern of asymmetry, whereas 63.6% of the ADHD children had the reverse (L < R) pattern of asymmetry of the head of the caudate nucleus. This reversal of normal asymmetry in ADHD children was due to a significantly smaller left caudate nucleus. The reversal in asymmetry of the head of the caudate was most notable in ADHD males. These results suggest that normal (L > R) morphologic asymmetry in the region of the caudate nucleus may be related to asymmetries observed in neurotransmitter systems implicated in ADHD. The behavioral symptoms of ADHD may reflect disinhibition from normal levels of dominant hemispheric control, possibly correlated with deviations in asymmetric caudate-striatal morphology and deficiencies in associated neurotransmitter systems.

Acetyltransferases↗
PubMed1993

Lipid level differences and hypertension effect in blacks and whites with type II diabetes.

We sought to determine whether lipid levels in black patients with type II diabetes with and without hypertension differ from those in white patients. Lipid levels were screened in 207 blacks and 103 whites with type II diabetes visiting a weekly diabetes clinic in a southeastern US regional community hospital. Levels of high- and low-density lipoprotein cholesterol were significantly higher in blacks than in whites: 1.30 +/- 0.34 vs 1.05 +/- 0.27 mmol/L (P < .001) and 3.73 +/- 1.23 vs 3.31 +/- 1.11 mmol/L (P = .01), respectively; triglycerides were higher in whites: 3.90 +/- 4.58 vs 1.96 +/- 1.51 mmol/L (P < .001). White hypertensive women had higher cholesterol and triglyceride levels and lower high-density lipoprotein cholesterol levels than white normotensive women (adjusted for age); no differences existed between black hypertensive and normotensive women when we adjusted for age. Seventy-two percent of blacks and 85% of whites had an abnormal lipid value (P = .01). Phenotype distribution was significantly different: 58.7% of blacks with abnormal lipids were in phenotype IIA (elevated low-density lipoprotein cholesterol with normal triglycerides), and 16.7% in IVA and B combined (elevated triglycerides) (P < .001), whereas whites were 17.0% and 52.3%, respectively. Blacks demonstrated a different dyslipidemia compared to whites. The contrasting effect of hypertension on triglyceride and cholesterol levels in white women with diabetes compared to black women suggests a racial difference in the relationship between hypertension and lipids among patients with diabetes.

Adult↗
PubMed1991

Mammography and age: are we targeting the wrong women? A community survey of women and physicians.

To determine mammography use among women with a broad range of ages, the authors surveyed women aged 30 to 74 years and physicians practicing primary care in two eastern North Carolina counties. Twenty-five percent of women in their 30s had ever had a mammogram, and 34% intended to have one in the coming year. From 45% to 52% of women in their 40s, 50s, and 60s had ever had a mammogram, and 55% to 57% intended to have one in the next year. Thirty-seven percent of women aged 70 to 74 years had ever had a mammogram, and 40% intended to have one in the following year. Nineteen percent of physicians reported screening nearly all women aged 30 to 39 years, and 14% screened few women aged 50 to 74 years. Younger women were more worried about breast cancer than older women and assessed their risk as higher, attitudes that were generally associated with higher mammography utilization. These community surveys suggest that mammography use may be excessive among younger women; older women continue to be underscreened.

Adult↗
PubMed1989

Nurse-initiated health promotion prompting system in an internal medicine residents' clinic.

Although cure of many diseases depends on early detection, screening schemes have been difficult to implement in busy clinic environments. We describe the testing of a nurse-initiated prompting system for six health promotion and disease prevention procedures in an internal medicine residents' clinic at a university-affiliated community program. Maneuvers investigated were breast examination, pelvic examination and Pap smear, rectal examination in men, mammogram, stool guaiac test, and blood glucose determination. A nurse reviewed the charts and used a list in the front of each chart to prompt residents in the experimental group. Residents in the control group were not prompted. A significant improvement (P less than .05) in performance was seen in the prompted group. Performance of rectal examination and mammograms improved most, increasing from 41% to 93% and 18% to 64%, respectively. There were no significant changes in the control group. This simple nurse-initiated prompting system improved the performance of health promotion and disease prevention maneuvers.

Adult↗
PubMed1989

Large cell lymphoma presenting as a coronal penile lesion.

Although the majority of penile malignancies are primary epithelial carcinomas, consideration of secondary involvement, especially from lymphoma, is important, since there are alternatives to the standard therapeutic approach of penile amputation.

Aged↗
PubMed1988

Allergic reactions to vespids: comparison of sensitivities to two species in a Mediterranean area.

We have studied a group of twenty-seven patients who suffer allergic reactions to vespids stings. Specific IgE antibodies to venom extracts from Polistes gallicus and Vespula germanica were measured by RAST, and the crossreactivity between the two venoms was compared using the RAST inhibition technique. We concluded that, in southern Spain, sensitization to P. gallicus was more prevalent than that to V. germanica, with 44% of the subjects in this study reacting to P. gallicus compared with 33% to V. germanica. However, there was a considerable degree of crossreactivity between the two species. It is evident that Polistes is an important species in this area; however, both in Spain and other Mediterranean countries, V. germanica venom is used almost exclusively for diagnosis and immunotherapy.

Adolescent↗
PubMed1988

A case of chronic neutrophilic leukemia with original chromosomal abnormalities.

We report a new case of the unusual myeloproliferative syndrome chronic neutrophilic leukemia (CNL) that met all the criteria generally required for the diagnosis of this entity. The patient presented abnormalities in platelet function not previously reported that may explain the bleeding tendency observed in these patients. The study of neutrophil function suggested also defective mobility and intracellular bactericidal activity. The chromosomal study revealed original abnormalities consisting of multiple chromosomal ruptures and figures. The disease was controlled with busulfan. After 20 months, the patient died of sepsis. An autopsy was performed confirming the diagnosis and ruling out the existence of a cause of a leukemoid reaction, such as cancer or granulomatous disease.

Aged↗
PubMed1988

Smoking cessation counseling by resident physicians in internal medicine, family practice, and pediatrics.

Residents in primary care specialties care for many patients who smoke cigarettes, but little is known about their smoking cessation counseling (SCC). We surveyed 309 residents (72 family practice, 171 internal medicine, and 66 pediatrics residents) in 13 programs to determine their practices, knowledge, attitudes, and training in SCC. More than 90% thought physicians are responsible for SCC, the majority routinely took smoking histories, and 80% attempted to motivate patients to quit smoking. However, 25% or fewer reported discussing obstacles to quitting, setting a quit date, prescribing nicotine gum, scheduling follow-up visits, or providing self-help materials. Family practice residents used more SCC techniques (1.8) than did internal medicine (0.8) and pediatrics (0.1) residents. Only 54% of residents reported recent SCC training and 13% reported formal SCC training. Recent training correlated with the number of counseling techniques used. Residents in primary care specialties report positive attitudes but inadequate practice and training in SCC.

Attitude of Health Personnel↗
PubMed1987

[Interferon therapy in acute lymphatic leukemia and hepatitis B in childhood].

1. The use of interferon in hepatitis B will bring about a favourable course of the disease, which is reflected in a normalisation of liver function tests. 2. The concentration of surface antigens is distinctly reduced, with a lower titre remaining for a longer period of time. 3. The level of the dosage chosen seems to be optimal. However, treatment has to be continued for a period of several months, probably for about 1 year. 4. In childhood the side-effects of interferon are minimal, they are restricted to febrile reactions. 5. In our investigations no sure hematological deviations could be identified in the treatment with interferon. 6. The study must be complemented by analysing further antigens, such as E antigen, allowing the course of disease to be characterised more distinctly. 7. In order to give a final assessment of the therapy the observation of patients must be continued after terminating the treatment, the histological improvement in the further course having to be confirmed by liver biopsies.

Child↗
PubMed1985

Abnormal thyrotropin and prolactin levels in untreated corticotropin deficiency.

A patient with isolated corticotropin deficiency demonstrated hyperresponsiveness of both thyrotropin and prolactin after protirelin stimulation. Following glucocorticoid replacement therapy, responses decreased to normal. Since true primary hypothyroidism may occur in association with cortisol-deficient states, it is necessary to reserve final evaluation until after glucocorticoid replacement. The finding of combined thyrotropin and prolactin hyperresponsiveness to protirelin suggests a related glucocorticoid feedback function.

Adrenocorticotropic Hormone↗