Biomedical subjects

L Castillo

Publications and source records attributed to L Castillo.

At least 55 records · Page 3Linked to original sources

PubMed1999

Risk factors for human T cell lymphotropic virus type II infection among the Guaymi Indians of Panama.

To examine risk factors for human T cell lymphotropic virus type II (HTLV-II) infection, a case-control study was conducted among the Guaymi Indians of Panama. In females, HTLV-II seropositivity was associated with early sexual intercourse (</=13 vs. >15 years; odds ratio [OR], 2.50; 95% confidence interval [CI], 1.11-6.14) and number of lifetime sex partners. One partner increased risk of seropositivity by 30% (OR, 1.30; CI, 1.05-1.64), and risk increased with number of partners. Similar risk was associated with number of long-term sexual relationships. Among males, intercourse with prostitutes was associated with HTLV-II seropositivity (OR, 1.68; CI, 1.04-2.72). These data support a role for sexual transmission in HTLV-II infection. Association of seropositivity with primary residence in a traditional village (OR, 3.75; CI, 1.02-15.38) and lack of formal education (0 vs. >6 years [OR, 3.89; CI, 1.67-9.82]) observed in males may reflect differences in sexual practices associated with acculturation.

Adolescent↗

PubMed1999

Ondansetron and droperidol in the prevention of postoperative nausea and vomiting.

We have performed a prospective, randomized, double-blind clinical study to assess the efficacy of ondansetron, droperidol, or both, in preventing postoperative emesis. We studied 242 patients undergoing biliary or gynaecological surgery under general anaesthesia. Shortly before induction of anaesthesia, patients received: saline i.v. (group I, n = 62); droperidol 2.5 mg i.v. (group 2, n = 60); ondansetron 4 mg i.v. (group 3, n = 57); or droperidol 2.5 mg with ondansetron 4 mg i.v. (group 4, n = 63). Nausea occurred in 45%, 37%, 32% and 29% (P = 0.234) and vomiting in 23%, 17%, 9% and 5% (P = 0.016) of patients in groups 1, 2, 3 and 4, respectively, during the first 24 h. Groups 2 and 4 had greater sedation scores than group 1 during the first 3 h (P < 0.01). We conclude that both droperidol and ondansetron showed a significant antiemetic effect, ondansetron was not significantly better than droperidol, and the combination of droperidol and ondansetron was better than droperidol but no better than ondansetron alone.

Adolescent↗

PubMed1999

Nasal endoscopic repair of cerebrospinal fluid rhinorrhea.

The surgical management of Cerebro-spinal Fluid (CSF) rhinorrhea has been modified these last years due to the improvement of endoscopic sinus surgery techniques allowing the treatment of selective dural tears by the endonasal route. Over a period of 6 years, 27 patients with CSF rhinorrhea were operated on by the endonasal approach under optical guidance. CSF rhinorrhea was due, in 20 cases, to surgical iatrogenic trauma, in 4 cases to head injury, and in 1 case it was secondary to a conservative medical treatment of a pituitary adenoma. In 2 cases the cause was unknown. The average follow-up in this series was 24.7 months. The technique used was successful in 22 patients (81.5%). Considering these results and others reported in the literature, we think the use of the endonasal approach with optical guidance should always be considered as a valuable alternative to open surgery and should be discussed in all cases of CSF rhinorrhea with neurosurgeons.

Adult↗

PubMed1999

[Chronic sinusitis in patients infected by HIV: therapeutic strategies].

Chronic sinus pathology is a frequently encountered disease in HIV infected patients. The responsible bacterial agents and management are yet to be settled. The authors report the results of a retrospective study led in the unit of Head and Neck Surgery of the University Hospital of Nice. 25 patients where HIV holders and had a sinus pathology which had lasted more than 6 weeks, despite one or several antimicrobial drug administrations. Clinical and CT scan data are detailed as well as pathology results of the samples harvested during sinus surgery (bacteria free 32%, Pseudomonas aeruginosa 32%, Streptococcus pneumoniae 16%, Staphylococcus aureus 16%, Hemophilus influenzae 16%, anaerobic agents 16% and Toxoplasma gondii 4%). All patients underwent surgery (antral puncture with maxillary sinus drainage 17, functional endoscopic sinus surgery 8). Results where gathered at 4 months with 76% of relapse (100% in patients with less than 200/mm3 CD4 cells). In conclusion empiric antimicrobial drug therapy will be expected to be also effective on Pseudomonas aeruginosa, the surgical management being most often deceiving and leading to relapse especially when considering the frequency of bilateral morbidity and the level of CD4 cell below 200/mm3.

Adult↗

PubMed1999

[Ventilatory support in patients with acute disease of the central nervous system].

Patients with severe head injury are prone to pulmonary complications that result in hypoxemia or hypercarbia, which could worsen their neurological condition. A rational ventilatory approach requires a good knowledge of respiratory and neurological pathophysiology. Airway management is of prime importance in neurological patients. Prophylactic chronic hyperventilation in head trauma is no longer recommended since it could impair cerebral perfusion, although transient hypocarbia could be of benefit to some patients. The use of low or moderate positive and expiratory pressure levels apparently improves oxygenation without worsening intracranial pressure. Ventilatory management should be closely monitored and adjusted to hemodynamic, respiratory and neurological status to achieve a good outcome.

Acute Disease↗

PubMed1999

[Transcranial cytokine gradient and intestinal permeability in acute severe brain injury].

BACKGROUND: Acute brain injury is associated with a bimodal hypermetabolic state probably caused by cytokine secretion and high hormone and catecholamine concentrations. In a first stage, the brain would produce these substances and afterwards, another production source, most probably the splanchnic territory, would perpetuate the hypermetabolic state. AIM: To investigate the cytokine production source and to assess intestinal permeability in acute brain injury in the absence of cerebral ischemia and systemic oxygen deficit. PATIENTS AND METHODS: Arterial systemic and cerebral venous bulbar interleukin 1 beta and interleukin 6 levels were measured during the first seven days of evolution in 15 patients with acute brain injury. Serum lactate, the oxygen/lactate ratio, gastric intramucosal pH and intestinal permeability using the lactulose/mannitol test were also assessed in the same period. RESULTS: High arterial and venous interleukin 1 beta and interleukin 6 levels were detected. A positive gradient for interleukin 6 levels was detected throughout the study period with normal intramucosal pH, lactate and oxygen/lactate ratio. There was also an early impairment of intestinal permeability in these patients. CONCLUSIONS: High arterial and venous cytokine concentrations were detected in patients with acute brain injury. The positive gradient for interleukin 6 suggests a brain origin for this cytokine. Intestinal permeability is also altered in these patients.

Adult↗

PubMed1999

[Acute effect of dobutamine and amrinone on hemodynamics and splanchnic perfusion in septic shock patients].

BACKGROUND: Vasoactive drugs used in the reanimation of septic patients, can modify splanchnic perfusion. AIM: To compare the effects of dobutamine and amrinone on gastric intramucosal pH (pHi), lactate levels and hemodynamics in surgical patients with compensated septic shock. PATIENTS AND METHODS: Fourteen postoperative patients with abdominal sepsis and compensated septic shock (pHi < 7.32 or lactate > 2.5 mmol/l) were studied in a prospective, randomized, unblinded study. Patients were randomized to receive (Group 1, n = 7) dobutamine at 5 micrograms/Kg/min or (Group 2, n = 7) amrinone at 5 micrograms/Kg/min. Hemodynamic data, arterial lactate and pHi were measured before and 30, 60 and 120 minutes after starting drug infusion. RESULTS: Both drugs were associated with a decrease in lactate levels. Dobutamine infusion, but not amrinone, increased gastric pHi, as well as cardiac index and oxygen delivery. CONCLUSIONS: An improvement in gastric pHi associated with an increase in oxygen delivery, was observed with dobutamine. Amrinone showed no effect at the fixed, low dose used in the study.

Acidosis, Lactic↗

PubMed1999

[Systemic inflammatory response syndrome: is it comparable with severe sepsis?].

BACKGROUND: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. AIM: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. PATIENTS AND METHODS: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. RESULTS: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. CONCLUSIONS: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.

APACHE↗

PubMed1998

Use of methylene blue in patients with refractory septic shock: impact on hemodynamics and gas exchange.

PURPOSE: The purpose of this study was to assess the acute effects of methylene blue, an inhibitor of nitric oxide synthesis, on hemodynamics and gas exchange in patients with refractory septic shock in a prospective clinical trial at medical and surgical intensive care units in a tertiary university hospital. PATIENTS AND METHODS: Prospective, sequential study of 10 consecutive patients admitted with severe septic shock of diverse causes and unable to achieve an adequate arterial pressure despite the use of at least two vasoactive drugs. Six of them also developed acute lung injury. All received 1 mg/kg intravenous bolus of methylene blue. Hemodynamic and respiratory parameters were measured at baseline and at 30, 60, 120, and 180 minutes after the bolus injection. RESULTS: Systolic, diastolic, mean arterial blood pressure, and systemic vascular resistance increased significantly in all patients, whereas no significant changes were observed in cardiac output, oxygen consumption, or oxygen extraction ratio. Gas exchange remained unaffected in patients with acute lung injury. CONCLUSIONS: Methylene blue had an acute vasopressor effect in patients with refractory septic shock, and it was not deleterious on respiratory function.

Adult↗

PubMed1998

[Transplantation of fetal dopaminergic cells simultaneously to the corpus striatum and pars reticularis of the substantia nigra in hemi-parkinsonian rats].

INTRODUCTION: Transplantation of foetal dopaminergic cells has been extensively used as restorative treatment for Parkinson's disease. OBJECTIVE: This study was carried out to determine the survival, modifications in rotatory activity induced by D-amphetamine and total content of dopamine in the striatal and nigra regions of hemiparkinsonian rats which had had foetal mesencephalic cells simultaneously transplanted to the striatum and pars reticularis of the substancia nigra. MATERIAL AND METHODS: The study was done using adult male Wistar rats weighing 200-250 gms. The following experimental groups were formed, depending on the site of transplant: St: transplant to striatum (n = 2); SNr: transplant to SNr (n = 20), ST + Snr; transplant to striatum and SNr simultaneously n = 20; and control (lesion with no transplant) n = 20. We studied the rotatory activity induced by D-amphetamine 1, 2, 3 and 6 months after transplantation. After this time the rats were deeply anaesthetized and randomly allocated for morphological study or biochemical determination of the total dopamine content in the St and SNr using the HPLC technique. RESULTS: Study of conduct showed no significant differences in rotatory activity induced by D-amphetamine between the groups with intrastriatal transplants, but there was a difference between these and the SNr and control groups. Biochemical analysis showed that striatal DA content was significantly greater in the ST for the groups with intrastriatal transplants. The content of substancia nigra DA was significantly greater in the SNr of the ST + SNr group, followed by the ST group. Morphometric study showed differences, which were not significant, between ST transplanted animals and significant differences between the SNr transplanted group with a significant increase in survival of the SNr of the ST + SNr group. CONCLUSIONS: These results suggest a positive effect due to intrastriatal transplants compared to survival following intranigral transplants.

Adrenergic Agents↗

PubMed1998

Nutrition and shock in pediatric patients.

Critically ill patients, including those in shock, often present with significant metabolic derangement in protein and energy metabolism characterized by: increased protein breakdown which is not suppressed by protein or energy intake; reprioritization of protein synthesis with increased synthesis of acute-phase proteins; decreased synthesis of structural proteins; and high protein turnover. In addition, there is also glucose and lipid intolerance. Adequate nutritional and metabolic support of the critically ill child under these conditions is a challenging endeavor. Traditionally, critically ill children have received nutritional requirements based on those of healthy children despite the fact that the critically ill population is physiologically and metabolically different. Furthermore, nutritional requirements in healthy children are largely based on limited data. With emerging knowledge of non-nutritional functions of nutrients, adequacy of nutritional support and requirements will eventually depend on the goals to be achieved: nutritional, physiologic, and/or pharmacologic.

Adolescent↗

PubMed1998

[Extracranial trigeminal schwannomas with middle temporal fossa development].

Schwannomas of trigeminal nerve account for 0.07% to 0.36% of all intra-cranial tumors. We report three observations about Jefferson's type D tumors, mainly extra-cranial with only small intra-cranial extension, concerning two men and one woman, who were respectively 36, 60 and 63 years old. Two of them presented with facial pain and hypoesthesia in the same territory. The third one developed a diplopia. In all cases, CT scanner analysis evidenced a large hypodense tumor extending in the infratemporal fossa. Temporal lobe and cavernous sinus were pushed aside by the intra-cranial extension. Tumors were hypo intense in T1-weighted image with significant enhancement after gadolinium injection. One of the tumors was a cystic form and in that case, an hyper signal in T2-weighted image was detected in the middle of the lesion. A combined subtemporal and transmaxillary approach was performed in 2 cases. In the third case, the removal of the tumor was only performed by a transmaxillary approach. In this series, there was no surgical mortality. One patient presented a postoperative residual painful anesthesia. In conclusion, extra-cranial schwannomas with intra-cranial extension are specially rare lesions. The most common early symptoms are facial neuralgia, facial hypoesthesia or diplopia. Neuroradiologic investigations, including CT and MRI evidence the precise anatomic site of the lesions. With the help of these techniques, total surgical tumor removal is possible in the majority of cases.

Adolescent↗

PubMed1998

[Simultaneous transplantation of fetal mesencephalic cells to the striatum and globus pallidus of rats with lesions induced by 6-hydroxydopamine].

INTRODUCTION: Studies of neural transplants in experimental models of Parkinson's disease have concentrated their attention on ectopic transplants of foetal mesencephalic cells to denervated striatum. However, the external globus pallidus has recently been shown to play an important part in the physiopathology of this disease. OBJECTIVE: Bearing in mind the importance of loss of extra-striatal dopamine in the genesis of the clinical signs found in parkinsonism, the objective of this study was to evaluate the effect of foetal mesencephalic transplantation to the globus pallidus of hemiparkinsonian rats. MATERIAL AND METHODS: Following conventional transplantation methodolgy, suspensions of cells from the ventral mesencephalum of rat embryos (E-14) were implanted. The tissue was grafted into the striatum, pallidum-striatum and pallidum areas of rats with unilateral lesions of the striatonigral bundle. One, two, three and six months after transplantation, the rotatory activity induced by D-amphetamine was evaluated. The rotatory behaviour induced by apomorphine was evaluated at three months. Motor ability of the front legs was evaluated in all experimental groups three months after transplantation using the 'ladder test'. RESULTS: In the experimental groups in which a transplant was made to the globus pallidus there was a significant reduction (p < 0.01) in rotatory activity induced by D-amphetamine and by apomorphine as compared with the non-transplanted groups. CONCLUSIONS: Transplants of foetal dopaminergic cells survive in the globus pallidus of hemiparkinsonian rats and can improve the rotational activity induced by dopaminergic agonists.

Adrenergic Agents↗

PubMed1998

[Cerebral metabolic monitoring experience in critical neurological patients].

BACKGROUND: Cerebral metabolic monitoring in critical neurological patients allows the assessment of neuronal tissue response to injury and to plan the best therapy to correct each critical brain situation. AIM: To evaluate the usefulness of cerebral metabolic monitoring in patients with acute cerebral injury. PATIENTS AND METHODS: A retrospective analysis of 29 patients with acute brain injury, in whom a catheter was located in the bulb of the jugular vein to perform a cerebral metabolic monitoring. These patients were compared with others that were not subjected to this monitoring. The evolution at six months of follow up was assessed using the Glasgow outcome score, considering a favorable evolution when this score was 4 or greater. RESULTS: Patients with an hyperemic state on admission or after optimization of therapy did not have hospital mortality, and 73% had Glasgow outcome score of 4 or greater at six months of follow up. On the other hand, 50% of those with hypoperfusion or global ischemia died during hospitalization and 72% had a Glasgow outcome score of 3 or less at six months. Patients not subjected to cerebral metabolic monitoring behave as those with hypoperfusion or global ischemia. CONCLUSIONS: Cerebral metabolic monitoring is an useful tool to optimize the management of patients with acute cerebral injury, and those patients with an hyperemic cerebral state have the best prognosis.

Adolescent↗

PubMed1998

[Cardiac manifestations of primary hypothyroidism. Determinant factors and treatment response].

INTRODUCTION AND OBJECTIVES: Previous studies have not fully established the magnitude and determinant factors of cardiac manifestations of primary hypothyroidism. This study was aimed to assess the effects of thyroid deficiency on cardiac performance and structure. PATIENTS AND METHODS: We studied by echocardiography 19 patients with overt and 23 with subclinical hypothyroidism, and 21 control subjects. Patients were restudied one year after L-thyroxine therapy. Systolic function was assessed by the observed/predicted fractional shortening ratio. The predicted fractional shortening was calculated from the inverse relation of fractional shortening to end-systolic stress (p < 0.0001) in normal subjects. RESULTS: The observed/predicted fractional shortening ratio was lower (p = 0.043) and left ventricular mass was higher (p = 0.028) in overt hypothyroidism than in subclinical hypothyroidism and control subjects. By multivariate analysis, fractional shortening ratio was related to thyroxine levels (p = 0.0002), systemic vascular resistance (p = 0.0001) and age (p = 0.0009), and left ventricular mass was related to thyroxine levels (p = 0.0004) and weight (p = 0.0001). Pericardial effusion was observed in 37% of patients with overt hypothyroidism and 9% of patients with subclinical hypothyroidism (p = 0.03), and was mainly related to TSH levels (p = 0.0098). Hormone replacement therapy increased systolic function in overt hypothyroidism. Left ventricular mass did not change after therapy. Pericardial effusion disappeared in all patients. CONCLUSIONS: Primary hypothyroidism produces a decrease in myocardial contractility and an increase in left ventricular mass, both related to the severity of hormone deficiency. Pericardial effusion is mainly related to thyrotrophin plasma levels. Most of cardiac manifestations of hypothyroidism reverse with L-thyroxine therapy.

Adolescent↗

PubMed1997

[The obtaining of neural cell suspensions. Their application in neurobiological studies].

INTRODUCTION: Techniques of intracranial grafting have become powerful tools used in the study of the mechanisms of regeneration and plasticity taking place in the central nervous system (CNS). Suspensions of foetal neural cells have been successfully used as intracerebral grafts in deep regions of the brain. OBJECTIVE: The objective of this paper is to describe the methodology used by our group to obtain and prepare suspensions of cells from different parts of rat embryo brain (midbrain, striatum and septum) used for experimental transplants in animal models. MATERIAL AND METHODS: We give a detailed description of the steps involved in the preparation of tissue in the form of a suspension of cells. These steps include the obtention of tissue at the optimum stage of development, dissection of the donor tissue, enzymatic treatment and mechanical dissociation until a suspension of cells is obtained. Viability counts showed a high percentage (more than 95%) of viable cells in the suspensions thus obtained. Cellular viability is affected by different factors and is a prerequisite for good survival of the graft. CONCLUSION: The methodology described permits obtention of suspensions of foetal neural cells which are optimal for use in studies both in vitro and in experimental transplants.

Animals↗

PubMed1997

[Malignant nasosinusal melanomas. Review of the literature apropos of 12 cases].

Malignant melanoma with primary onset in the nasal cavity and paranasal sinuses remains a scarcely encountered malignancy and we report 12 cases of our own experience from 1991. These mucosal melanomas occur mainly in the elderly and present most commonly as a one sided airway obstructive syndrome with often bleeding in the nasal cavity. No sex or race ratio is found. Histological examination of the surgical specimen has been made easier since the use of immunohistochemical studies. The original site of onset is commonly located at the inferior part of the nasal cavity but in many cases, it is noted several sites of tumor localization. Despite well conducted treatment the prognosis remains quite deceiving and significantly poor. In our study, the 4-year actuarial survival was 26%. The 5-year survival rate ranges in the literature from 10% to 40%. Short and long term follow-up show an important rate of recurrence (local and lymph node metastases as well as distant metastases). The insidious evolution of the malignancy usually happens during the first year. Computed tomography and MRI are essential in the evaluation of tumor extension. The treatment is based on the combination of surgery and radiotherapy: Surgery is practised first and must ensure sufficient excision of the tumor without minimal functional or aesthetic damage in this complex region. This surgery is based on surgical approaches to the midface known as Lateral rhinotomy and midfacial degloving. When there is cervical lymph node involvement at the time of diagnosis it is suitable to treat it, even in case of recurrence. Complementary high dose radiation is required to treat tumors which could not undergo surgery and also as adjuvant therapy after removal of the mass.

Aged↗

PubMed1997

Analysis of retinoic acid receptor beta expression in normal and malignant laryngeal mucosa by a sensitive and routine applicable reverse transcription-polymerase chain reaction enzyme-linked immunosorbent assay method.

Retinoic acid receptor beta (RAR-beta) seems to be a useful intermediate marker in trials of retinoids, and the aim of this work was to describe a fast, sensitive, and routine applicable method to measure RAR-beta expression in tumor biopsies. We developed a new technique combining reverse transcription-PCR with a colorimetric ELISA detection of amplification products. The principle of this nonradioactive method is based on digoxigenin labeling of PCR products during amplification. Amplified DNA is hybridized with a biotinylated capture probe. The generated hybrid is immobilized on a streptavidin-coated microtiter plate, and detection is performed with the use of an antidigoxigenin peroxidase conjugate. We applied this method to quantify the expression of RAR-beta and an internal control (beta2 microglobulin) in laryngeal tumors. We found a detection threshold at 50 pg of PCR products, which represents a 100-fold improvement when compared to the detection limit of ethidium bromide detection. The method was reproducible (intra- and interassay reproducibilities at 7 and 5%, respectively). We used this technique for determining RAR-beta expression in 20 patients with laryngeal carcinoma and in 20 patients without cancer. The data show that the value of the RAR-beta:beta2 microglobulin ratio is decreased in tumoral versus nontumoral specimens (P = 0.0012), which is consistent with previously published results.

Adult↗