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Biomedical subjects

J Santamaria

Publications and source records attributed to J Santamaria.

At least 55 records · Page 3Linked to original sources
PubMed1994

The low risk cardiac patient: an opportunity for cost containment.

The pressure to maintain high standards in the face of diminished medical funding has promoted a search for a low risk group of patients seen in cardiac practice in whom diagnostic and therapeutic technologies can be kept to a minimum. This study reports experience in a single cardiology practice in which all patients had a history taken, a clinical examination performed, and most had an electrocardiogram. Thereafter investigation and treatment was tailored to the individual patient's need. A retrospective study of 113 patients revealed that 93 (82%) had high risk characteristics prior to their death: cardiac failure; unstable coronary heart disease; clinical or laboratory evidence of poor systolic function of the left ventricle or inoperable coronary artery disease; elective major surgery; evidence of poor prognosis due to non-cardiac disease. In contrast, only 124 (21%) of 588 consecutive patients seen in consultation had high risk characteristics. The prevalence adjusted mortality ratio of high to low risk cases was 17.4/1 and in one third of cases, high risk status was less than 6 months duration. In a prospective study, 144 cases were classified at high risk and 373 at low risk. Three year survival rates were 74 and 91% respectively (p < 0.0001). 46 (12.3%) of the 373 patients initially at low risk subsequently developed clinical features which permanently placed them in the high risk category. The 3 year survival in the low to high risk converters was 47% compared with 97% survival in those remaining at low risk throughout the period of observation (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed1994

Blood transfusion has no effect on colorectal cancer survival. A population-based study.

This study was conducted to evaluate the impact on survival of perioperative blood transfusion in a series of 698 colorectal cancer patients undergoing radical surgery. Patients were identified, and follow-up was carried out by the local population-based cancer registry. Data on blood transfusion was obtained by record linkage with the files of the blood banks operating in the area covered by the registry. Prognostic factors were age, Dukes stage and topography of the primary tumour. Relative risk (RR) for Dukes B patients was 1.53 [95% confidence interval (CI) 0.94-2.50] and for Dukes C, 3.57 (95% CI 2.22-5.75) when compared with Dukes A patients. For the left colon, RR was 0.96 (0.61-1.52) and for the rectum 1.87 (1.22-2.86) when compared with the right colon. When adjusting for these factors and excluding operative mortality, RR for transfused patients was 1.16 (95% CI 0.87-1.55). It is concluded that blood transfusion does not adversely affect survival in colorectal cancer patients.

Adult↗
PubMed1994

Pediatric analgesia and sedation.

Sedation and analgesia are essential components of the ED management of pediatric patients. Used appropriately, there are a number of medications and techniques that can be used safely in the emergency care of infants and children. Emergency physicians should be competent in the use of multiple sedatives and analgesics. Adequate equipment and monitoring, staff training, discharge instructions and continuous quality management should be an integral part of the ED use of these agents.

Analgesia↗
PubMed1993

Absence of REM sleep, altered NREM sleep and supranuclear horizontal gaze palsy caused by a lesion of the pontine tegmentum.

A 27-year-old woman with a mass lesion confined to the pontine tegmentum had absence of rapid eye movement (REM) sleep and abnormal nonrapid eye movement (NREM) sleep with no sleep spindles when the sole neurologic manifestation was a bilateral supranuclear horizontal gaze palsy. This study suggests that the tegmentum nuclei associated with REM sleep generation in humans and the pathways that control horizontal eye movements are closely related. Furthermore, these findings indicate that bilateral damage of the pontine tegmentum is necessary for REM sleep abolition. Interruption of connections between the tegmentum of the pons and the reticular nuclei of the thalamus could be the cause of the absence of sleep spindles.

Adult↗
PubMed1993

Association of C4B deficiency (C4B*Q0) with erythema nodosum in leprosy.

A considerable number of studies have postulated significant associations between susceptibility to the different clinical manifestations of leprosy and the MHC. In this investigation, the association between the MHC class III complement proteins C2, BF, C4A and C4B and leprosy in a patient population of Southern Brazil was studied. A total of 109 non-related leprosy patients was investigated; 73 presented with lepromatous leprosy (LL), 46 of them had the immunopathological reaction of erythema nodosum (ENL), the remaining 36 were tuberculoid, borderline and indeterminate leprosy (TIBL) patients. The control group included 172 healthy individuals matched with the patients according to their ethnic and geographical origin. C2, BF, C4A and C4B allotypes were determined by standard technologies including Western blots for C2 and C4 variant alleles with monoclonal and polyclonal antibodies. Non-expressed ('silent') C4 alleles in hemizygously deficient individuals were estimated semiquantitatively on the basis of the C4A and C4B isotype ratio and by the MASC ('minimal chi-square') method. The results showed a significantly elevated presence of the non-expressed C4B allele (C4B*Q0) in the LL and ENL patient groups in comparison with the controls. The most significant difference was observed in the ENL group when compared with the controls. In addition, all patients who were homozygously C4B-deficient had ENL, and most of them had the BF*F1 allele. The comparison between LL patients with and without ENL also showed a statistically significant difference in the presence of C4B*Q0, indicating that C4B deficiency itself is associated with ENL. The relative risk of LL patients with the C4B*Q0 allele suffering from ENL was 5.3 compared with LL patients without C4B*Q0. Since immune complexes (IC) are considered to be the pathogenic cause of ENL, our findings indicate that C4B deficiency may play an important role in the abnormal immune response against Mycobacterium leprae and in the lack of IC clearance, leading to ENL reactions. Individuals with this allele seem to be at a higher risk of developing pathological immune reactivity in lepromatous leprosy.

Adult↗
PubMed1993

Prothrombotic and antithrombotic factors are elevated in patients with type 1 diabetes complicated by microalbuminuria.

Increased urinary albumin loss in patients with Type 1 diabetes is associated with accelerated atherosclerosis. Prothrombotic factors known to be associated with cerebrovascular and coronary artery disease in the general population, antithrombotic factors, were studied in 52 patients with Type 1 diabetes and varying urinary albumin loss and 24 non-diabetic control subjects. Fibrinogen increased from 2.5 g l-1 (95% confidence interval 2.3-2.8) in control subjects and 2.8 g l-1 (2.6-3.0) in diabetic patients without microalbuminuria to 3.1 g l-1 (2.7-3.5) with microalbuminuria (p < 0.005 vs control; p < 0.001 vs without microalbuminuria). Factor VIIc increased from 81% (75-86% in non-diabetic control subjects and 84% (78-90%) in diabetic patients without microalbuminuria to 103% (89-117%) with microalbuminuria (p < 0.005 vs control; p < 0.05 vs without microalbuminuria) and 118% (86-150%) with albuminuria (p < 0.005 vs control and p < 0.001 vs without microalbuminuria). Levels of the antithrombotic factors protein C, protein S, and antithrombin III also rose in the diabetic patients with evidence of renal damage. Elevation of prothrombotic factors has been associated with increased risk of microvascular disease, whereas elevation of antithrombotic factors has no known protective effect. Therefore, this pattern of alteration of haemostatic factors in diabetic renal disease may contribute to the increased risk of vascular disease associated with both microalbuminuria and albuminuria.

Adult↗
PubMed1993

A busy urban geriatric day hospital: analysis of one year's activity.

Lightburn Geriatric Day Hospital is a 30-place unit sited adjacent to Geriatric Assessment and Rehabilitation wards and three miles from the local district general hospital in east Glasgow. The service serves an urban population of 25,000 persons aged 65 or more. During 1991 a data capture form was used to prospectively record Day Hospital referral patterns and activity. There were 731 new patient referrals, accounting for a total of 5,780 patient attendances. Thirty-eight per cent of new patients attended without prior screening (unscreened General Practitioner (GP) referrals). Booked occupancy was 85.5%, actual occupancy 76%. The average period of attendance was three weeks (median number of attendances: 7) and 18% of attenders required in-patient care. Specific after-care arrangements were made for 85% of patients on discharge from day hospital. Low rates for re-attendance (within three months of day hospital discharge) and chronic attendance (more than three months) as well as favourable responses from surveys of both GPs and patients suggest effective use of the Day Hospital resource, but more direct measures of Day Hospital effectiveness are required.

Aged↗
PubMed1992

Recurrent hypersomnia in two adolescent males with Asperger's syndrome.

Two individuals with Asperger's syndrome, a rare pervasive developmental disorder, developed recurrent episodes of hypersomnia and abnormal behavior (Kleine-Levin syndrome) during adolescence. The possible etiological role of developmental structural brain anomalies and the differential diagnosis of recurrent hypersomnia and abnormal behavior in patients with pervasive developmental disorders are discussed.

Adolescent↗
PubMed1991

Visitors' perceptions of continuing care.

One hundred and sixty-one replies (72% response rate) to a questionnaire sent to regular visitors of elderly continuing care patients showed that 73% of the visitors were first degree relatives. Sixty three per cent visited more than once per week, and were more likely to do so when the distance travelled was less than five miles (p less than 0.01) and the cost under pounds 2.00 (p less than 0.01). The physical surroundings and nursing care were rated as adequate or better by 80% and 92% respectively. Numbers of nurses were rated as inadequate by 44% and numbers of physiotherapists as inadequate by 46%. Increasing the numbers of nurses was suggested as the measure that would most improve the patients' quality of life. To facilitate visiting, continuing care units should be sited close to the community they serve.

Attitude to Health↗
PubMed1990

Cervical magnetic stimulation.

We stimulated the cervical region with a 9-cm-diameter magnetic coil on centered on the spinous processes in 21 normal subjects. We obtained maximal amplitudes with clockwise coil current in right-sided upper extremity muscles and counterclockwise coil current in left-sided upper extremity muscles. Optimal stimulation sites for biceps, triceps, and abductor digiti minimi were C-3 or C-4, C-4 or C-5, and C-4, C-5, or C-6, respectively. The latencies of the muscle responses varied little in the same subject in spite of marked amplitude changes due to suboptimal position of the coil or submaximal stimulator output. In abductor digiti minimi, the amplitude of the muscle response on cervical magnetic stimulation was 9 to 100% of the supramaximal amplitude on wrist electrical stimulation. We established normal values for latency, amplitude, and interside differences for the above 3 upper extremity muscles. The findings were reproducible, and the latencies obtained with large coils from different manufacturers in the same subjects were comparable. We found no advantage in bipolar recording over tendon-belly montage. Comparison of magnetic and electrical needle root stimulation in the same subjects showed that the magnetic stimulus was more proximal in biceps and triceps, and that the site of excitation was approximately the same in abductor digiti minimi. Indirect assessment of the longitudinal site of excitation based on F-wave minimal latency indicated that excitation occurred within millimeters of the emergence of axon of the peripheral motor neuron.

Adult↗
PubMed1989

Complement activation in Brazilian pemphigus foliaceus.

Brazilian pemphigus foliaceus is an autoimmune blistering skin disease of man that has a very high incidence in a confined geographical distribution. Rocket immunoelectrophoresis of plasma showed increased levels of complement fragments, C4d and Ba, indicating activation of complement through both the classical and the alternative pathways. Less sensitive methods such as CH50, total C3 and C4 did not demonstrate this activation, and immune complex measurements were within normal range. While complement may not be absolutely necessary for the development of skin lesions, our longitudinal studies show that activation of complement is at its highest during the most active phase of the disease.

Acute Disease↗
PubMed1989

Are HLA class II genes controlling susceptibility and resistance to Brazilian pemphigus foliaceus (fogo selvagem)?

In order to investigate the possible association between Brazilian pemphigus foliaceus and HLA, we studied 48 patients and 74 matched controls, all Brazilian Caucasoids, for HLA-A,B,C; DR1 to DRw8 and DQw1 to DQw3. The frequencies of DR1, DR4 and B16 were significantly increased, while DR7 was significantly decreased among the patients. Furthermore DQw2, likewise the DR specificities associated with it - DR3 and DR7 - never occurred among the patients in the absence of the susceptibility markers DR1, DQw1 or DR4, DQw3. Acting on these findings, we suggest that at least two MHC-class II genes are involved in the pathogenesis of Brazilian pemphigus foliaceus: at least one gene, associated to DR1,DQw1 and to DR4,DQw3, confers susceptibility and at least one gene, associated to DR7,DQw2 and DR3,DQw2, confers resistance. The susceptibility gene(s) seem(s) to be epistatic to or dominant over (if allelic) the resistance gene(s). Both are dominant over other alleles at their locus (or loci).

Adolescent↗
PubMed1989

Giant-cell arteritis presenting with ipsilateral hemiplegia and lateral medullary syndrome.

We describe the clinical and anatomopathological findings in an 85-year-old male presenting with a lateral medullary syndrome and ipsilateral hemiplegia (Opalski's syndrome) due to giant-cell arteritis of the vertebral artery. Other common associated symptoms of the disease were absent, and the erythrocyte sedimentation rate was only of 30 mm/h. This case emphasizes that limited intracranial giant-cell arteritis may present rarely as a stroke.

Aged↗
PubMed1989

Magnetic stimulation of the human motor cortex: facilitation and its relationship to a visual motor task.

Transcranial magnetic stimulation of the motor cortex can evoke motor responses in small hand muscles. This response can be facilitated by a background muscle contraction of the target muscle, resulting in an enhanced compound muscle action potential (CMAP) with a shorter onset latency. A number of intracortical mechanisms may account for this facilitatory effect, including, in part, direct input from visual to motor cortex. We studied the facilitation produced by a visual-motor task and compared those results with the facilitation produced by the same task without the visual cues. No differences in facilitation of amplitude or latency were observed. This suggests that there is no direct influence exerted by the visual cortex upon those elements of the motor cortex activated by a tangential magnetic stimulus, i.e., corticocortical and corticospinal neurons and their processes. Also, the large majority of facilitation (90%) was produced by a very small background voluntary contraction (less than 5% of maximum), indicating that any mild-to-moderate contraction of the target muscles will produce a consistent response for clinical measurements.

Electromyography↗
PubMed1988

Complement and antibody deposition in Brazilian pemphigus foliaceus and correlation of disease activity with circulating antibodies.

Brazilian pemphigus foliaceus is a blistering skin disease endemic to central and southern areas of South America. In this study of skin biopsy specimens from 14 patients we present evidence that complement and immunoglobulins were present by direct immunofluorescence in the epidermal intercellular spaces in all patients. Eight of 14 patients had granular deposits of C3 in the basement membrane zone. By indirect immunofluorescence, serum samples from all 19 patients tested demonstrated the presence of circulating IgG autoantibody. Autoantibodies deposited in the intercellular spaces in titers ranging from 1:10 to more than 1:1280, and the titers drastically decreased during treatment. This is the first study to demonstrate complement deposition in the skin in Brazilian pemphigus foliaceus.

Adolescent↗