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Biomedical subjects

M Alonso

Publications and source records attributed to M Alonso.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Variation in medical practice. Apropos of the use of CAT and NMR in INSALUD].

OBJECTIVE: In this study the variability on the utilization of nuclear magnetic resonance (NMR) and computerized tomography (CT) scan among hospitals and provinces in the INSALUD (Spanish National Health System) is evaluated as well as the role of the availability of resources in the variability. METHOD: Data on availability of resources, its use and the reference population for each hospital were obtained from the Specialized Care Information System (SIAE) for the years 1996-1997. The units of analysis were the hospitals and the provinces in the INSALUD territory. The independent variables were the ratio of technologies and professional per inhabitant. Also the waiting list and the economical level of the province were used. Data analysis included the extremal quotient and multiple linear regression. RESULTS: The ratio of the highest to lowest rate of CT and NMR use is 15 and 27 among hospitals and 3 and 4 among provinces, respectively. The number of neurosurgeons, number of CT apparatus, waiting list for CT and rate of NMR use, all standardized per population, explains 61% of CT variability among hospitals. Among provinces, the number of CT apparatus explains 31% of all variability. For NMR use among hospitals, the number of neurosurgeons, number of orthopedic surgeons and CT use, all variables standardized per population, explains 42% of variability. The amount of equipment is not associated with NMR rate among provinces. CONCLUSIONS: The variation found in the INSALUD territory for the two procedures is high and ecologically associated to the availability of resources. It would be convenient to perform an observational study to confirm the findings and evaluate the possible contribution of inappropriate use to the variation.

Databases, Factual↗
PubMedDate not supplied

Role of hippocampal signaling pathways in long-term memory formation of a nonassociative learning task in the rat.

Long-term habituation to a novel environment is one of the most elementary forms of nonassociative learning. Here we studied the effect of pre- or posttraining intrahippocampal administration of drugs acting on specific molecular targets on the retention of habituation to a 5-min exposure to an open field measured 24 h later. We also determined whether the exposure to a novel environment resulted in the activation of the same intracellular signaling cascades previously shown to be activated during hippocampal-dependent associative learning. The immediate posttraining bilateral infusion of CNQX (1 microg/side), an AMPA/kainate glutamate receptor antagonist, or of muscimol (0.03 microg/side), a GABA(A) receptor agonist, into the CA1 region of the dorsal hippocampus impaired long-term memory of habituation. The NMDA receptor antagonist AP5 (5 microg/side) impaired habituation when infused 15 min before, but not when infused immediately after, the 5-min training session. In addition, KN-62 (3.6 ng/side), an inhibitor of calcium calmodulin-dependent protein kinase II (CaMKII), was amnesic when infused 15 min before or immediately and 3 h after training. In contrast, the cAMP-dependent protein kinase (PKA) inhibitor Rp-cAMPS, the mitogen-activated protein kinase kinase (MAPKK) inhibitor PD098059, and the protein synthesis inhibitor anisomycin, at doses that fully block memory formation of inhibitory avoidance learning, did not affect habituation to a novel environment. The detection of spatial novelty is associated with a sequential activation of PKA, ERKs (p44 and p42 MAPKs) and CaMKII and the phosphorylation of c-AMP responsive element-binding protein (CREB) in the hippocampus. These findings suggest that memory formation of spatial habituation depends on the functional integrity of NMDA and AMPA/kainate receptors and CaMKII activity in the CA1 region of the hippocampus and that the detection of spatial novelty is accompanied by the activation of at least three different hippocampal protein kinase signaling cascades.

Animals↗
PubMedDate not supplied

Phase II trial of oral tegafur and folinic acid with mitoxantrone as first-line regimen in patients with metastatic breast cancer.

BACKGROUND: Tegafur acts as a deport form of 5-fluorouracil when administered orally for long periods of time since it is an active drug in metastatic breast cancer, with response rates of 29-44%. Biochemical modulation with folinic acid and the addition of mitoxantrone could increase the efficacy of tegafur in patients with metastatic breast cancer. METHODS: A prospective phase II trial in patients with previously untreated metastatic breast cancer was carried out. The scheme consisted of mitoxantrone, 12 mg/m2 intravenous day 1, oral tegafur, 750 mg/m2/day divided in three equal doses, and leucovorin 15 mg/8 h orally for days 1-21, given in a 4-week schedule. None patient had received chemotherapy for metastatic breast cancer, although 16 patients had received previous adjuvant chemotherapy. RESULTS: Thirty-four patients were included. Objective responses were achieved in 20 of 32 patients assessable for response, with 1 complete response and 19 partial responses. The objective response rate was 62.5% (95% confidence intervals, 48-76%). The median duration of response was 10 months. Grade III-IV toxicity according to WHO criteria was digestive (nausea/vomiting) in 12.5%, diarrhea in 25% and stomatitis in 25% of patients. Other toxicities were low. Eight patients required dose-reduction. CONCLUSIONS: We achieved a significant response rate with the scheme, which was administered on an outpatient basis. It seems to be safe and effective as first-line treatment in metastatic breast cancer, with a short median response duration. The size of the trial does not permit definitive conclusions, and the role of biochemical modulation of tegafur in combination with mitoxantrone remains to be defined.

Administration, Oral↗
PubMedDate not supplied

Helicobacter pylori infection with parietal cell antibodies in children and adolescents with insulin dependent diabetes mellitus.

One hundred and seventy-seven patients with insulin dependent diabetes mellitus (IDDM) diagnosed at the pediatric age were investigated for the presence of gastric parietal cell autoantibodies (PCA). The objective was to evaluate the prevalence of PCA seropositivity and to know whether Helicobacter pylori could be a reason for a higher presence of PCA in IDDM children and adolescents. Twelve of 177 patients (6.77%; confidence interval: 3.1-10.3) had detectable PCA. Gastric pathology was studied in eight of these patients and in seven patients without PCA. Diagnosis of H. pylori infection was made on antral biopsies. None of the patients had an atrophic gastritis. Six of the eight patients with PCA had gastric mucosa colonization by H. pylori and/or chronic gastritis. According to these results, we suggest that H. pylori can be the cause of the presence of PCA positive results in diabetic children and adolescents, and diabetic patients with detectable PCA should be screened for H. pylori.

Adolescent↗
PubMedDate not supplied

Diagnostic value of serological markers for celiac disease in diabetic children and adolescents.

OBJECTIVE: To determine the accuracy of antigliadin and antiendomysium antibodies for the diagnosis of celiac disease in diabetic children and adolescents with and without digestive symptoms. STUDY DESIGN: 177 children and adolescents with IDDM aged 15.4 +/- 5.4 years (mean +/- SD). Antigliadin (ELISA) and antiendomysium (IFI) antibodies were measured in 177 and 35 patients, respectively. RESULTS: Seven of 177 patients (3.9%; 95% confidence interval: 1.1-6.7) had celiac disease. The specificities of antiendomysium antibodies test (83%), IgA-antigliadin antibodies test (80%) and IgG-antigliadin antibodies test (90%) and the positive predictive values of these antibodies (55-75%) were lower than those obtained with the combined determination of these antibodies (100%). Negative antibodies and normal mucosa in one determination did not rule out the development of celiac disease later. CONCLUSIONS: The combined determination of antigliadin and antiendomysium antibodies is the test of choice in screening for celiac disease in diabetic patients. The yearly investigation of these antibodies is a reliable method for detecting silent celiac disease in this population.

Adolescent↗
PubMedDate not supplied

EEG coherences in patients with brain lesions.

EEG coherence between all pairwise combinations of the 10/20 system was studied in two groups: control subjects and patients with space-occupying brain lesions. Coherence was separately computed for the delta, theta, alpha and beta bands. Comparisons between both groups showed highly significant differences in all bands. In the patients with lower coherence values, these differences were mainly in the alpha band. When intra-hemispheric coherences between controls and patients with left hemispheric lesions were compared, significant differences were observed only in the left hemisphere. Comparisons between controls and patients with lesions in the right hemisphere also showed significant differences only in the injured hemisphere. In patients, paired t tests between the values of the intra-hemispheric coherence in the left hemisphere and the corresponding values in the right hemisphere demonstrated that lower coherences were confined to the damaged hemisphere. Our conclusion is that in the presence of lesions disrupting cortex and adjacent white matter the coherence between this area and the remaining cortical areas is lower than normal due to impairment of the fibers that connect the damaged area with the rest of the brain.

Adolescent↗
PubMedDate not supplied

[The production of a latex immunoglobulin conjugate for the diagnosis of Gardnerella vaginalis].

To obtain an anti-Gadnerella vaginalis latex globulin, specific immunosera to reference strain (ATCC 14018) and to a clinical isolation strain pool were produced. These immunosera were characterized using PAGE-SDS and immunoblotting where a close antigenic relation between the clinical isolation strains and the reference strain was observed. The latex globulin conjugates obtained from these 2 immunosera were evaluated in vitro with a resulting level of detection of 10 ufc/mL of Gardnerella vaginalis. These two conjugates were also evaluated in clinical samples and compared with the 6 vaginalis culture and the criteria considered for diagnosing bacterial vaginosis. The anti-strain pool (II) latex globulin conjugate turned out to be more sensitive and specific than anti-G. vaginalis ATCC strain (I) latex globulin.

Animals↗
PubMedDate not supplied

[Costs of chronic dialysis in a public hospital: myths and realities].

In this study regular dialysis treatment costs during 1998 and 1999 in a public hospital, which is responsible for a population of 178,000, has been analysed. Hemodialysis (HD) and peritoneal dialysis (PD) costs have been differentiated and compared with those of external providers. The best technical and productive efficiency of both treatments have been estimated by analyzing the "treatment cost/human resources of the community utilized" relationship. The HD treatment costs per patient per year were 20,343 and 18,871 euros in 1988 and 1,999, respectively, lower than the costs reported in other studies. In 1999 these costs were similar to those of external providers and lower than the PD treatment costs (23,295 euros). HD retains its advantage even after costs of erythropoietin, hospital admissions and transport are included. In the hospital studied, the best technical efficiency in HD would be reached with 64 patients on treatment (17,851 euros per patient per year) and in PD with 48 patients (21,167 euros per patient per year). If we take into account our population characteristics and consider a patient distribution of 70% on HD and 30% on PD, the best productive efficiency would be reached with 56 patients on HD (17,916 euros per patient per year) and 24 patients on PD (21,813 euros per patient per year). HD confers the greatest economic and social benefits on the population supplied by the hospital since it provides the community with more jobs than PD in relation to treatment costs while the two yield the same clinical results. In conclusion, HD in a public hospital, at least in our environment, may be efficient and competitive with HD from external providers and it may be more efficient and provide a bigger economic and social profit for the population serviced by the hospital than PD, at least while the current supply systems for this treatment in our country are maintained.

Adult↗
PubMedDate not supplied

[Dimethyl sulfoxide in the treatment of interstitial cystitis].

The paper presents the results obtained with endovesical dimethylsulphoxide in the treatment of interstitial cystitis in 30 women. Up to 80% patients showed clinical improvement with an average of 10 installations. Volume of maximal vesical capacity was increased in 24 patients (80%), the increase being greater than 100 cc in 10 cases. Presently, 24 (80%) patients remain under treatment, 14 with one instillation monthly and 10 once every six months. Six patients are fully asymptomatic without treatment after an average symptoms-free interval of 32 months. Since this is directly related to a decrease both in pain and miction frequency, the increase in vesical capacity appears to be a good improvement index. Dimethylsulphoxide in neither a healing nor a definite therapy but it seems to be effective in the management of this unknown disease.

Administration, Intravesical↗
PubMedDate not supplied

[Value of parenteral nutrition in total gastrectomy for cancer. A prospective study].

A prospective study is presented in which the impact of total parenteral nutrition (TNP) was analyzed in a group of 27 patients that underwent total gastrectomy due to gastric carcinoma (TGGC). Patients were randomly divided into two groups: Group I was formed by 15 patients and was treated systematically with TPN during the immediate postoperative period (POTPN). Group II was formed by 12 patients who were treated with conventional serum therapy during the immediate postoperative period. TPN was administered if enteral nutrition was not viable and/or patients presented complications. Both groups were similar regarding age, sex, previous illness, previous nutritional status (Preop PNI) and surgical technique used in GI transit reconstruction. Morbidity and mortality rates, nutritional status (PNI 5 days postop) and mean hospital stay were analyzed in both groups. Likewise, a retrospective comparison was made between the results obtained from this trial and those from a group of 44 patients with gastric carcinoma who underwent TGGC at our hospital a decade earlier and did not received TPN during the immediate postoperative period on a routine basis. When both series and Groups I and II were compared significant differences in mean hospital stay were observed in favor of Group I treated with routine TPN in the immediate postoperative period. There were no differences in the mortality rate when all groups were compared. It was concluded that TPN was useful in patients undergoing TGGC because it reduced postoperative mortality rate, decreased mean hospital stay and showed good cost/effectiveness correlation.

Aged↗
PubMedDate not supplied

IgA1, IgA2 or secretory piece containing antigliadin antibodies in the sera of coeliac patients.

A study was made of the gliadin antibodies containing secretory piece (SP) found in 73 sera samples obtained from 38 children with coeliac disease (CD); simultaneously an intestinal biopsy was carried out. In 32 cases the mucosa was flat and the remaining 41, following a gluten-free diet, had a normal intestinal histology. Thirty chronic non-coeliac gastrointestinal patients and 22 normal children were used for a control. An enzymoimmunoassay technique with monoclonal IgA1 and IgA2, and SP polyclonal antibodies was used. The antigliadin antibodies containing SP in serum were above normal limits in 24/32 (75%) active CD patients, but also in 22/41 (54%) patients with normal biopsy and in 20/30 (66%) chronic non-coeliac gastrointestinal patients. There was a multivariant correlation (p less than 0.002) among antigliadin, ovoalbumin and lactoglobulin antibodies containing SP. These results are probably due to non-specific intestinal damage. Nevertheless, antigliadin antibodies containing SP in the sera of gluten-free CD cases lasted longer than antiovoalbumin and antilactoglobulin antibodies. The IgA1 antigliadin antibodies were increased in 19/30 (64%) of active CD patients and 0/8 of inactive CD patients (p less than 0.0005). Nevertheless IgA2 antibodies were increased in only 2/30 (7%) of active CD patients (p less than 0.05). According to this study the IgA antigliadin antibodies in serum are the result of a systemic response, although another interpretation could be that gliadin mainly stimulates IgA1 subclass antibodies in the gut.

Antibodies↗
PubMedDate not supplied

[Leiomyoma of the rectum. A diagnostic and therapeutic dilemma].

A case is reported of leiomyoma of rectum, a rare tumor since it is detected in 2 of 3000 rectal tumors. It occurs principally in patients between 40 and 50 years. The tumor is submucosal, is difficult to diagnose and biopsy is often valueless since it does not involve the tumor mass. The interest of the present case is that trans-rectal ultrasound imaging of the leiomyoma was performed. Differential histologic diagnosis between benign and malignant forms is a dilemma, these tumors being of slow growth with a marked tendency for recurrence and malignant degeneration. Treatment should always be surgical, with local resection if histology has excluded malignancy, followed by periodic surveillance. Radical surgery is indicated in malignant forms or for local recurrence of benign tumors.

Adult↗