Biomedical subjects
Publications and source records attributed to M Alonso.
The microsurgical reattachment of a penis following self-amputation by a psychiatric patient is discussed. This is the 15th case reported in the literature. We have reviewed the previous reports and outline the management of penis amputation. The importance of using microsurgical techniques in order to achieve better functional and cosmetic results is discussed.
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A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided.
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Viral-dual infections in fish are of interest to aquaculture practices but they are rarely described and studied. Several methods were applied in this work to demonstrate a case of coinfection in a reared rainbow trout (Oncorhynchus mykiss) population. Inoculation in cell cultures and cross-neutralization tests were the standard procedures that made it possible to isolate and identify a birnavirus, the infectious pancreatic necrosis virus (IPNV), and suspect of a second virus. Western blotting with both polyclonal and monoclonal antibodies, and reverse transcriptional-polymerase chain reaction (RT-PCR) demonstrate coexistence of both, IPNV and a rhabdovirus.
An immunoperoxidase assay for the serological diagnosis of Babesia bigemina was developed. The antigen slides were prepared from B. bigemina-infected blood and stored at -20 degrees C. One hundred and sixty five sera were tested, comparing the immunoperoxidase assay to the indirect fluorescent antibody test. A coincidence of 95% was observed between both tests. For the immunoperoxidase assay, a relative sensitivity of 94.8%, a relative specificity of 95.5%, and a positive predictive value of 96.8% were calculated. The results demonstrated the efficacy of this technique for detecting antibodies to B. bigemina.
We have performed a suprapyloric antrectomy with anterior pylorotomy and truncal vagotomy in 106 patients with chronic duodenal ulcer between 1975 and 1990. Follow-up was carried out in 94 patients, during a mean time of 6 years. We have had no postoperative mortality and no long-term recurrence. The percentage of Visick I patients is similar to that after truncal vagotomy and antrectomy. We, therefore, believe that this procedure is safe and can be performed when an antrectomy is mandatory to avoid the operative morbidity and mortality of classic antrectomy.
The results of laboratory investigations in concerning 15 patients suspected of mitochondrial disease (MD) are presented. Our purpose is to provide an outline of the investigative modalities that support the clinical suspicion and have been found to be useful in the diagnosis. Five clinical groups were studied including 5 exercise intolerances (2 with inflammatory myopathy), 3 with myopathies (1 with dilated cardiomyopathy), 2 with progressive external oftalmoplegia (1 associated with cerebellar ataxia+epilepsy+hypertrophic cardiomyopathy+pes cavus), 4 with encephalopathies (3 with myoclonic encephalopathies with ataxia and dementia and 1 with epilepsy and tremor), and 1 with metabolic acidosis and cardiomyopathy. We used the following categories of investigative procedures: clinical phenotype analysis including pedigree study, neurophysiological tests, bicycle ergometric evaluation, neuroimaging, microscopic study of skeletal muscle biopsy, post-mortem examination, biochemical assays and molecular genetic studies. EMG showed myopathic changes in 5 cases, features of neuropathy in 2, mixed myopathic and neuropathic pattern in 1 and nonspecific changes in 3. EMG was normal in 3 patients. The most common skeletal muscle abnormalities were variation in fiber size (60%), lipid inclusions (33.3%), oxidative subsarcolemmal aggregates (26.7%) and ragged-red fibers (26.7%). Electron microscopy revealed mitochondrial abnormalities in 8 out of 14 patients' muscle biopsies, and in myocardiac and hepatic tissues of another. Site of biochemical defect was located in 12 patients. Complex I defect in 6, complexes I+IV deficiencies in 3, complex II defect in 1, complex IV deficiency in 1, complexes II+IV deficiencies in 1, and complex III defect in 1. In 2 patients the biochemical defect was not located. Mitochondrial DNA alterations were not found in 7 investigated patients. The clinical spectrum of MD has become increasingly wider. After the clinica suspicion, the diagnosis depends up on the appropriate use of skeletal muscle biopsy, biochemical investigations and molecular genetic techniques. Conventional EMG and automatic measurement of the electromyogram are particularly helpful in confirming the clinical suspicion in patients with predominantly central nervous system disease or in cases in which clinical signs are few.
An enzyme-linked immunoassay (ELISA) is described for the detection of antibodies to Babesia bovis using a partially purified antigen. The optimum conditions required to perform the test were determined and 210 serum samples were comparatively tested using ELISA and indirect immunofluorescence (IFA) tests, finding a diagnostic coincidence of 96.1%, a relative sensitivity of 96%, and a relative specificity of 96.4%.
Babesia bovis is the blood parasite causing the highest morbidity and mortality of cattle in Cuba. Thus a control program based on immunization with a vaccine using an attenuated strain of the parasite was developed. For this purpose, a virulent B. bovis strain was isolated and then attenuated by the traditional method in which biological characteristics, proteolytic activity and vector transmissibility were studied. The protection conferred by the vaccine was measured by vaccinating cattle which then was challenged with a heterologous strain. In order to assess postvaccination accident risks, 2603 cattle were vaccinated and those showing clinical signs of babesiosis were treated. A study of cost-benefit was performed in a herd where frequent outbreaks of babesiosis occurred; prevalence and clinical case incidence in vaccinated and nonvaccinated animals were determined. Vaccinated animals survived to challenge whereas two control animals died. In 2% of the vaccinated animals less than 6 months of age, postvaccination accidents occurred, whereas in older animals this index was higher (p < 0.001). The cost-benefit study showed a rate of approximately $10 pesos (national currency) for each peso invested due to the high mortality caused by the parasite. Until an effective, killed vaccine is available, vaccination with live vaccines is advantageous to prevent bovine babesiosis.
Lymphoceles are a complication of renal transplantation surgery. The source of this lymphatic collections is the lymph draining through the lymphatic vessels located in the transplanted kidney sinus and surrounding the iliac vessels of the receptor. The main etiological factor is the surgical technique used when dissecting these structures for graft placement. Several factors have been suggested as favouring their occurrence, acute rejection being highlighted as one. This paper reviews a series of 517 renal transplantations performed in our service, with a lymphocele incidence of 5.2% (28). Using a log regression model, the influence of age, sex, time in dialysis, presence of tubular acute necrosis in the graft following placement, acute rejection and immunological regime, for the appearance of lymphocele were analyzed. Age and lack of acute tubular necrosis were the only two factors selected by the model. Also, clinical signs and symptoms as well as therapy instituted were analyzed, emphasizing that puncture-drainage and instillation of iodine povidone was 100% effective.
We have previously described that a mAb directed against a surface dimer (Kp43) expressed by NK cells was able to regulate cell proliferation, enhance the cytotoxicity of IL-2-activated NK cells, and activate phospholipase D. In this work we have analyzed the ability of the anti-Kp43 mAb to regulate the production of TNF-alpha. Our results show that the stimulation of IL-2-activated NK cells with soluble anti-Kp43 mAb or its F(ab')2 activated the secretion of the cytokine, inasmuch as this effect is associated with the induction of cellular aggregation. The intensity of the Kp43-mediated stimulation varied among different IL-2-activated NK cell samples. Even in those instances where the anti-Kp43 mAb alone could not detectably enhance TNF-alpha production, it displayed a synergistic effect combined to a soluble anti-CD16 mAb, which on its own did not efficiently activate cytokine production. The anti-Kp43 mAb also cooperated with a phorbol ester, although it did not modify the TNF-alpha production triggered by a Ca2+ ionophore. The anti-Kp43-mediated effect, which required the preactivation of cells with IL-2, was inhibited by cycloheximide and actinomycin D and was associated with an increase in the levels of TNF-alpha-specific mRNA. It is noteworthy that the Kp43-mediated production of TNF-alpha was partially inhibited by anti-CD18, anti-CD11a and anti-ICAM-1 mAb that blocked LFA-1-dependent cellular interactions, which impaired NK cell aggregation and, moreover, was dependent on the presence of extracellular Mg2+, thus suggesting that the leukocyte integrin is involved in the activation process triggered through Kp43.
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To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.
In a group of patients with space-occupying brain lesions, CT measurements were correlated with absolute power (AP) and relative power (RP) of the delta, theta, alpha and beta EEG bands, calculated from the raw EEG potentials (EEGp) and from the Laplacian estimates also called "current source densities" (CSD). Rank correlations were calculated between the number of abnormal values in each band and the following CT measures: volume of the lesion and of the edema, density of the edema, percentage of ventricular collapse and midline shift. Abnormal spectral values are those which are significantly higher than the norm for the same age, in the delta and theta bands, and significantly lower in the alpha and beta bands. Spectral parameters obtained from the CSD showed higher correlations with CT measures than those calculated from the EEGp. In the Laplacian, all CT measures had a significant correlation with delta AP. Theta AP was significantly correlated with the volume and density of the edema, as well as with midline shift. Significant correlations were also observed with delta and alpha RP. However, changes in RP were considered to be a consequence of the increase in delta AP. Canonical correlation analyses between AP and RP calculated from EEGp or CSD and the first 3 CT measures showed that the volume of the lesion was only correlated with delta AP and RP. The volume and density of the edema showed a significant correlation with delta, theta and alpha AP calculated from EEGp and only with theta and alpha AP in the Laplacian. Since the EEGp tends to produce a more extensive and diffuse picture of abnormality, whereas the Laplacian acts as a spatial filter emphasizing local sources over distant sources, we concluded that edema is related not to delta activity, but to the theta and alpha power.
Total plasma fatty acids were analysed in 75 first trimester pregnant women, 32 second trimester pregnant women, 27 women at delivery and 38 non-pregnant women. Eleven fatty acids were studied by capillar gas chromatography SP-column. Compared with non-pregnant women, in the first trimester there was a significant percentual increase in palmitic, palmitoleic, stearic and docosahexaenoic acids, whereas linoleic and eicosapentaenoic percentually decreased. Between the first and second trimester a significant increase in the proportion of palmitic acid and a significant percentual decrease in arachidonic acid was detected. Between the second trimester and delivery the aforementioned changes were more marked. Between the second trimester and delivery there was also a significant percentual increase in oleic and linolenic acids, whereas the proportions of stearic, linoleic, dihomogammalinolenic and docosahexaenoic acids significantly decreased. It is suggested that the intake in polyunsaturated fatty acids should be increased during pregnancy, specially in the third trimester.
Forty-three coeliac children, ranging from 1 year and 3 months to 14 years and 9 months, were studied. Twenty-eight patients were in an active phase of the disease, and 15 were in remission. The criteria of coeliac disease (CD) activity were established according to the results of IgA anti-endomysial antibodies (IgA-AEm). Interleukin 2 receptor (IL-2R) and CD4 and CD8 antigens were measured in serum samples by an ELISA technique using two noncompetitive monoclonal antibodies. Antigliadin antibodies of IgG (IgG-AGA) and IgA (IgA-AGA) classes were also measured. The AEm-positive coeliac patient group showed values of 1,860 +/- 948 U/ml for IL-2R, 430 +/- 228 U/ml for CD8, and 36.8 +/- 25.1 U/ml for CD4. AEm-negative patients showed values of 980 +/- 436 U/ml, 350 +/- 243 U/ml, and 24.1 +/- 20 U/ml, respectively. IL-2R levels were the only ones significantly elevated (p < 0.005) in the active coeliac group. On the other hand, IgG-AGA and IgA-AGA were both clearly increased (p < 0.001). IL-2R levels in active coeliac patients correlated with CD4 levels (p < 0.05), but not with CD8, IgG-AGA, and IgA-AGA levels. We also found a surprising negative correlation between AEm antibodies of IgA2 class with both IL-2R (r = 0.471; p < 0.05) and CD8 (r = 0.616; p < 0.05). The results show that in CD there is a lymphocyte activation affecting mainly CD4+ cells and not correlated with serum AGA levels, suggesting an independence of both immunological phenomena and probably with different locations of origin.
The various parameters which interact in the epizootiology of babesiosis and anaplasmosis and which it is necessary to obtain in a survey are analysed and the two diseases compared. Where no data are available from Latin America and the Caribbean, the references from Australia and the United States of America are discussed. The two principal objectives of a study on the epidemiology of babesiosis and anaplasmosis are: to determine the risk of occurrence to understand the relevant factors leading to outbreaks. The first objective is relatively simple to achieve for both diseases by calculating the animal inoculation rate (h) at a determined age and the critical value of h for enzootic stability. The second objective requires exhaustive and complex studies. For babesiosis epidemiology, studies of the tick infection rate, cattle infestation rate, genetic composition of cattle, acaricides, stocking rate, climatic data and other factors are necessary. Anaplasmosis epidemiology cannot be satisfactorily explained by considering it purely as a tick-borne disease. Difficulties to be overcome include the great diversity of haematophagous Diptera in Latin America, and the scarcity of data on the capacity of these insects as anaplasmosis vectors and their feed preferences on cattle.