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Biomedical subjects

J Pascual

Publications and source records attributed to J Pascual.

At least 343 records · Page 19Linked to original sources
PubMed1989

The dose of propranolol for migraine prophylaxis. Efficacy of low doses.

Although propranolol is still the drug of first choice for migraine prophylaxis, the optimal antimigraine dose of this drug is still unknown. The main aim of our study is to clarify this point. Fifty-three patients suffering from severe migraine attacks were given propranolol at low doses, close to or up to 1 mg/kg body weight daily, for one month. If the patient responded, then treatment was maintained unchanged for a further two months. If the patient did not respond, propranolol was progressively increased until control was obtained. Thirty-nine (73.5%) patients responded to low doses, and 7 of the 17 patients whose dose had been increased, because of poor or absent response, showed improvement. Five patients did not finish the study because of intolerable side effects, which intensified as the dose was increased. Tolerance was not noticed. In addition to confirming the well-known utility of propranolol in migraine prophylaxis, our results show that low doses are effective in controlling serious migraine bouts in many patients. Fewer than a third of patients will need higher doses in controlling migraine attacks.

Adolescent↗
PubMed1989

Failure of mexiletine to control trigeminal neuralgia.

The analgesic effects of lidocaine and tocainide on trigeminal neuralgia have been established. However, both drugs are unpractical: lidocaine can only be used intravenously, and tocainide may exhibit serious haematological side effects. Mexiletine, a structural analogue of lidocaine that can be safely administered by the oral route, was given, as the sole drug, to four patients with active trigeminal neuralgia. After at least seven days on mexiletine they had no clear benefit. The four patients subsequently improved with carbamazepine or phenytoin. Our observations suggest that mexiletine alone is not of value in trigeminal neuralgia.

Adult↗
PubMed1989

Alveolar proteinosis and nocardiosis: a patient treated by bronchopulmonary lavage.

Alveolar proteinosis is a relatively rare disease of unclear pathogenesis associated with opportunistic-infections. Although nocardiosis is the most frequent one, only 22 cases have been reported previously and are reviewed here. We present a patient with alveolar proteinosis with nocardiosis treated as an emergency with bilateral bronchopulmonary lavage and antibiotics. No previous cases of this association have been successfully managed in this way.

Adult↗
PubMed1989

[Spontaneous bacterial peritonitis: clinical, microbiological and clinical course study of 89 episodes].

We have retrospectively studied 89 episodes of spontaneous bacterial peritonitis (SBP) attended at our service with the purpose of analyzing clinical features, microbiologic data and possible etiopathogenic factors, treatment and course. The most frequent symptoms were ascites, abdominal pain and fever. Only 3.3% of episodes were asymptomatic. Twenty-four episodes (26.96%) resulted in death of the patient and only the presence of septic shock and prothrombin time lower than 35% statistically correlated with a higher mortality (100% and 53.8%, respectively, p less than 0.01) of the possible factors analyzed. The culture of ascitic fluid (AF) was positive in 52.8% of the episodes and there were no clinical or time course differences between these cases and those who presented negative culture. The isolated microorganisms were the usual ones in this condition, outstanding 37.5% of gram-positive cocci in monomicrobial SBP. Treatment was initiated within the first 12 hours from admittance in 76.4% of cases, between 12 and 72 hours in 12.3% and after 72 hours in 11.2%. Cefotaxime was given to 47.1% of episodes and 52.9% of patients received ampicillin or cefoxitin plus aminoglycoside; the mortality was lower with the first schedule (11.9% versus 40.4%, p less than 0.01).

Adult↗
PubMed1989

[Interaction of antibodies with cardiac neurotransmitter receptors].

This paper demonstrates that antibodies against neurotransmitter receptors of the cardiac membrane are able to alter the physiology, pharmacology and biochemistry of the target organ. Sera from chagasic patients contain an antibody which binds to beta adrenoceptors of myocardium and modulates their activity. Chagasic IgG simulates a partial beta agonist by increasing contractility and diminishing reactivity to exogenous norepinephrine. Moreover, chagasic IgG inhibits the binding of the specific radioligand to purified cardiac membranes. The interaction of chagasic IgG with beta-adrenoceptors triggers signal transduction resulting in the stimulation of adenylate cyclase with an increased production of cAMP. Stimulation of Ca(++)-ATPase and inhibition of Na+ + K(+)-ATPase are also observed. These enzyme dysfunctions induce modifications of cellular thermodynamic equilibrium that trigger both morphological and functional alterations of the myocardium. Other immune sera can also trigger pharmacologic effects on isolated atria. Immune IgG directed against specific alloantigens and IgG from mice with autoimmune myocarditis are able to recognize the beta adrenergic receptor-coupled adenylate cyclase system and alter the function of target organs. The detection of antibodies against neurotransmitter receptors could be a useful marker during the early stages of development of autoimmune diseases.

Animals↗
PubMed1989

[The modified "pink test" in the diagnosis of hereditary spherocytosis].

Hereditary spherocytosis is still difficult to diagnose in some situations due to the existence of subclinical expressions and the lack of an accurate test with high sensitivity and specificity. Recently, Vettore et al. described the so-called 'Pink test' as an easy method with the highest reproducibility and sensitivity. Herein, we present our experience with the 'Pink test' in the diagnosis of 16 previously diagnosed hereditary spherocytosis patients comparing the results with those obtained in 96 healthy controls, 41 beta-thalassaemias, 9 autoimmune haemolytic anaemias, 8 chronic hemoproliferative syndromes and 2 patients with pyruvate kinase deficiency. We also present a modification of the original 'Pink test' in which a small sample of blood (200 microL) obtained by finger-prick (or heel puncture in newborns and infants) is mixed with the hemolyzing solution of the 'Pink test' within the first three hours after blood drawing. Elevated correlation coefficients (r = 0.75-0.96) between both methods have been obtained comparing the percentage of final haemolysis in 25 healthy controls, 21 beta-thalassaemia minor and 9 hereditary spherocytosis patients.

Adult↗
PubMed1989

[Occipital condyle syndrome: presentation of a case].

We present the clinical features and radiologic findings of a patient with the so-called occipital condyle syndrome (OCS). This clinical picture is originated by the selective metastasization of one of the condyles of the occipital bone. As it was shown in our case, this syndrome may be the presenting feature of a systemic neoplasm. The occipital condyle syndrome must be suspected in front of any patient with the binomial intense unilateral occipital pain that exacerbates with palpation and turning the neck and ipsilateral hemilingual paralysis. We briefly discuss the differential diagnosis of this condition. As conventional radiologic studies may show no abnormalities, plain X-ray examination and computed tomography must selectively study the region of the foramen magnum. The importance of the diagnosis is beyond academic interest; early radiotherapy, as it was the case of our patient, may lead to a substantial symptomatic improvement.

Aged↗
PubMed1988

Alpha 2-adrenoceptors in human forebrain: autoradiographic visualization and biochemical parameters using the agonist [3H]UK-14304.

The regional distribution and biochemical parameters of alpha 2-adrenoceptors in post-mortem human brain tissue were analyzed in autoradiographic and membrane binding studies, using the full agonist, [3H]UK-14304. Autoradiographic visualization of these receptors in the forebrain revealed a heterogeneous anatomical distribution with high levels in the neocortex, ventral hypothalamus, hippocampus and some thalamic nuclei, among others. In membrane binding studies, analyses of saturation curves indicated the presence of a single population of sites for [3H]UK-14304 both in the human and rat brain. There was a good correlation between the density of alpha 2-adrenoceptors obtained by both procedures. [3H]UK-14304 is a feasible ligand to localise and quantify alpha 2-adrenoceptors in human post-mortem material by autoradiographic and membrane binding techniques.

Aged↗
PubMed1988

Cortisol, ACTH, and dexamethasone concentrations in a psychogeriatric population.

Cortisol and adrenocorticotrophic hormone (ACTH) were measured at 2 time points before the administration of 1 mg of dexamethasone (day 1) and 1 time point on the following day (day 2). Thirteen severely depressed elderly patients, 15 patients with Alzheimer-type dementia (ATD), and 16 normal controls were studied. Cortisol was markedly elevated in depressed patients compared with the other subjects in day 1 samples. Following dexamethasone, both the depressed and ATD patients showed a similar elevation of cortisol compared with controls. ACTH concentrations were not significantly different between the groups before dexamethasone, but were significantly higher in both depressed and ATD patients after dexamethasone. More depressed patients than ATD patients exhibited hypersecretion of ACTH after dexamethasone. This implies that ACTH is less responsive to glucocorticoid feedback in elderly depressed patients, which may be a factor in causing hypercortisolemia.

Adrenocorticotropic Hormone↗
PubMed1988

TXB2: cardiostimulant effect that involves beta-adrenoceptor and Na+ + K+-ATPase activity.

The biological properties of Thromboxane B2 (TXB2) on isolated rat heart were studied. Its actions were compared with U-46619 a Thromboxane A2 mimetic compound and with isoproterenol. TXB2 induced a concentration-dependent increase in contractility, that was non-competitively antagonized by propranolol. In addition TXB2 inhibited Na+ + K+-ATPase activity at the same concentrations that influenced the mechanical activity. Inhibition of beta-adrenoceptors efficiently blocked the inhibitory action of TXB2 upon Na+ + K+-ATPase-activity. Isoproterenol simulated the positive inotropic effect and the inhibitory action of TXB2 on Na+ + K+-ATPase-activity. In contrast, U-46619 did not alter the basal dF/dt, neither the enzyme activity. The foregoing results suggest that TXB2 resembles the biological effect of catecholamines-inducing stimulation of myocardial contractility and inhibition of Na+ + K+-ATPase activity.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗