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Biomedical subjects

J L Arroyo

Publications and source records attributed to J L Arroyo.

At least 19 recordsLinked to original sources
PubMed2000

Allogeneic peripheral stem cell transplantation in a case of hereditary sideroblastic anaemia.

We report on a case of pyridoxine refractory hereditary sideroblastic anaemia (HSA) in a 19-year-old man who underwent peripheral blood stem cell transplantation (PBSCT) from his HLA-identical brother. By using short tandem repeat polymorphism, 100% donor cells were observed in peripheral blood on day +21; bone marrow showed mixed chimaerism from day +21 to day +221, when 100% cells of donor origin were observed. The patient developed extensive chronic graft-versus-host disease with favourable response to treatment. When the haemoglobin range was normal, a programme of phlebotomies reduced serum ferritin levels. Three years after transplantation, the patient has an ECOG rating of 0, with completely normal haemoglobin values (15 g/dl). To our knowledge, this is the first PBSCT reported in a case of hereditary sideroblastic anaemia.

Adult↗
PubMed1994

Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery.

BACKGROUND: Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown to reduce blood loss after this type of surgery. This randomized study was performed to assess the efficacy of DDAVP versus aprotinin in the prevention of bleeding after CPB. METHODS AND RESULTS: One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n = 28) received aprotinin starting with a bolus of 2 x 10(6) KIU followed by a continuous infusion of 0.5 x 10(6) KIU/h until the end of surgery; group B (n = 25) received of DDAVP 0.3 micrograms/kg i.v. on completion of CPB; group C (n = 28) received two doses of DDAVP, the first as in group B and an additional dose 6 hours after surgery; group D (n = 28) received no treatment. There was a marked reduction of postoperative blood loss either at 12 hours (P < .01) or 72 hours (P < .02) in the aprotinin group compared with all other groups, whereas no significant effect was observed in either of the two DDAVP regimens. A significant reduction in the amount of blood used was observed only in the aprotinin group (P < .01). Of the plasma fibrinolytic components assayed, there was a significant reduction of the fibrin degradation product generation in the aprotinin group (P < .001), whereas a significant systemic hyperfibrinolysis was observed in both DDAVP-treated groups and the control group. No side effects related to the study drugs were observed in any patient. CONCLUSIONS: Aprotinin inhibited fibrinolysis; this correlated with a significant reduction of postoperative blood loss and need for blood replacement after CPB. Neither one nor two doses of DDAVP had a beneficial effect. Aprotinin offers a better alternative than DDAVP in the prevention of bleeding after CPB.

Aprotinin↗
PubMed1989

Opioid peptides modulate the organization of vimentin filaments, phagocytic activity, and expression of surface molecules in monocytes.

It is theorized that intermediate filaments are important in the modulation of membrane activity and cell motility; however, their functions are unknown. The assembly and organization of these filaments are under hormonal regulation. We investigated in human monocytes the in vitro effects of Met-enkephalin, Leu-enkephalin, and beta-endorphin on the expression of immunoreactive cytoskeletal vimentin filaments. We simultaneously examined their effect on the phagocytosis of Candida albicans and on the membrane display of surface molecules. The three opioid peptides markedly reduced the expression of vimentin filaments, the phagocytic activity, and the display of HLA-DR molecules at concentrations of 10(-6), 10(-8), and 10(-10) M. On the other hand, the intravenous administration of fentanyl, a synthetic opiate agonist, to patients undergoing surgery induced similar changes in monocytes. In other experiments, 10(-8) M beta-endorphin also decreased the expression of CR3 but did not influence the display of CD13, a surface protein of unknown function. Expression of vimentin filaments correlated directly with the display of HLA-DR antigens and CR3 and with the phagocytic activity. The results of this paper indicate that opiates and opioids, neuropeptides known to be released during stress, can directly depress several monocyte functions. Furthermore, from these data it may be speculated that intermediate filaments may regulate the membrane expression of some surface molecules and the phagocytic process.

Antigens, Surface↗
PubMed1986

The effect of labetalol on urinary prostacyclin secretion during surgery.

The effects of labetalol on the secretion of prostacyclin and plasma-renin activity (PRA) were evaluated, relative to a control group in 24 patients undergoing hip osteotomy. They were randomly assigned to two groups (G-I and G-II) with 12 patients each. Patients allocated to both groups received standard anaesthesia (thiopentone, pancuronium, fentanyl and nitrous oxide). Patients belonging to Group II were given labetalol at a dose of 0.8 mg kg-1. The stable metabolite of PGI2, 6-keto-PGF1 alpha was quantified from urine samples by radioimmunoassay (RIA). Cortisol, PRA and aldosterone were determined from blood samples. A significant increase in 6-keto-PGF1 alpha elimination was observed in G-I. Labetalol administration partially but significantly inhibited this increase. We believe that prostacyclin is involved not through the beta 1 but through the alpha 1 receptors in the secretion of renin.

6-Ketoprostaglandin F1 alpha↗
PubMed1985

The effects of epidural analgesia and conventional anaesthesia on renal excretion of PGE2 during orthopaedic surgery.

The effect of standard anaesthesia (G-I) and epidural analgesia (G-II) on urinary synthesis of PGE2 was compared in two groups of 12 patients each undergoing orthopaedic surgery. This study demonstrates a significant elevation of renal PGE2 in patients undergoing standard anaesthesia during surgery. In marked contrast, with epidural analgesia, the inhibition of renal secretion of PGE2 is apparent. These findings strongly suggest the important role of the sympathetic nervous system in the synthesis of PGE2.

Adult↗
PubMed1979

[Changes in the renin-angiotensin-aldosterone system during open heart surgery. I. Factors involved in renin secretion].

The endocrine, humoral and hemodynamic factors that affect renin secretion are studied during open-heart surgery in a group of 40 patients, 20 with mitral and 20 with aortic valve disease. During the incission period, the PRA (plasma renin activity) increases due to a sympatoadrenergic hyperactivity. These increase is noted also during bypass, and is closely related with the hypotension that extracorporeal circulation produces. It is also discussed the influence of the exclusion of pulmonary circulation, that decreases conversion of angiotensin I to II and catabolism of norepinephrine.

Aldosterone↗
PubMed1976

[Sympathetic-adrenergic and hypophysial response to different anesthesia-analgesia technics].

The authors used techniques of pure anesthesia analgesia with Fentathienyl-Pavulon, or anesthesia and analgesia potentialised with Fentathienyl-Flunitrazepam, or Pentothal-Fentathienyl-Pavulon on various series of patients. The study was oriented on changes in the sympathetico-adrenalin pituitary response, and the use of glucose under the effect of these techniques. There was noted a fall in plasma cortisol levels, a fall in urinary excretion of catecholamines, an increase in growth hormone and better peripheral use of glucose. A comparative study was carried out with similar techniques using morphine, pentazocine or fentanyl.

Analgesia↗
PubMed1975

[Analgesics and neuroendocrine response in heart surgery: III. Metabolic aspects].

A study done in 121 patients undergoing extracorporeal perfusion heart surgery for the correction of valvular cardiopathies. In a first stage, we evaluated, in 77 patients, the influence of different analgesics on renal function, acid-base balance, glucemia and lactic acid. Afterwards we completed our observation with analysis of insulin in 44 patients. We observed no important difference in glomerular filtration rate, urinary output per minute, acid-base equilibrium, or oxigenation, according to administration of the different analgesics. After the glucose overload which the extracorporeal perfusion imposes, we observed a better insulinic response and consequently a faster recuperation of normal levels of glucemia in patients who received Fentathienyl. The lowest response was obtained in patients anesthesized with Pentazocina. In view of these results we can affirm that analysis if the inter-relation between glucose and insulin is a good exponet for evaluation of the grade of analgesic protection, offered by a drug, against nociceptive stimuli triggered by surgery.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Depression of the mononuclear phagocyte system caused by high doses of narcotics].

We evaluated in human monocytes the effect of high doses of alfentanyl on the expression of vimentin filaments, the phagocytic activity and the membrane display of HLA-DR molecules in the subjects undergoing surgery. The study was performed on 30 patients, ASAI-II. The patients received 100 mcg/kg i.v. of Alfentanil and the maintenance of anaesthesia was made with Alfentanil (2-3 mcg/kg/min.). The patients were randomized in two groups. The patients were ventilated with N2O:O2 (1:1) (Group I) or air: O2 (1:1) (Group II). After surgery, all patients of the Group II received Naloxone (0.2-0.4 mg). Central venous blood samples were obtained before induction, one and two hours after induction of anaesthesia and at the end of surgery. Separation of monocytes was performed according to Boyum technique. CD35 and HLA-DR molecules and vimentin filaments were studied by indirect immunofluorescence method using monoclonal antibodies. Percentage of positive cells were read with a cytofluorometer. The phagocytic function of monocytes was determined by ingestion of latex particles. Cortisol and ACTH plasma levels were determined by RIA. High doses of Alfentanyl depress phagocytic function and membrane display of CD35 and HLA-DR molecules in monocyte and induce marked changes in the organization of vimentin filaments in these cells in patients undergoing surgery. This monocytic depression was more marked in the patients ventilated with N2O. In our results there was uninhibition of ACTH and cortisol plasma levels responses to surgical stress by Alfentanil administration. Since the effects of Alfentanil were reversed by Naloxone, an opioid receptor mechanism seems to mediate these events.

Adrenocorticotropic Hormone↗