Biomedical subjects
Publications and source records attributed to M Arias.
We present a patient with top-of-the-basilar syndrome that was preceded by hemiballismus and progressed to coma and tetraplegia. Magnetic resonance imaging showed extensive infarction in the basilar artery territory. Cerebral angiography confirmed basilar artery obstruction. The patient died in spite of anticoagulation therapy.
BACKGROUND: Pyomyositis is a purulent infection involving the skeletal muscle. Although it was initially described in tropical countries, is it ever more frequently found in warm climates. METHODS: A review of the clinical histories of the admission of patients in the Internal and Infectious Medicine Units over the period from May 1992 to April 1994 (1818 admissions) was carried out analyzing those in whom the diagnosis was of pyomyositis. This diagnosis was performed by clinical data and radiologic and microbiologic confirmation. RESULTS: Five patients diagnosed with pyomyositis were found. Of the five cases, four were men with ages ranging from 27 to 64 years. In most of the cases more than one muscle group was involved and only two cases showed predisposing factors (history of injury and DM). The existence of abscesses was shown by echography in 3 cases and by CAT in 2 cases. Staphylococcus aureus was the most frequently isolated microorganism. The five patients underwent medical treatment and surgical treatment was also performed in 2 achieving satisfactory evolution. CONCLUSIONS: Imaging techniques (echography and CAT) effectively contribute to the diagnosis of pyomyositis. Medical treatment, associated with surgery in some cases, achieved satisfactory evolution. The incidence of pyomyositis is probably greater than what has been recognized to date.
Pseudotumour cerebri is the name of a syndrome characterized by headache and papilloedema, with normal cerebral CT/MR studies and CSF with a high pressure and normal laboratory findings. We describe four patients who fulfilled the diagnostic criteria of this condition (including normal 0.5T MR studies). They all had cerebral angiograms showing minor abnormalities localized to the level of the superior longitudinal sinus. All improved on treatment with anticoagulants and steroids. In view of these findings we consider that in cases of pseudotumour cerebri without a clear aetiological factor, an angio MR study should be done, or if this technique is not available, a cerebral angiogram should be done, to exclude cerebral venous drainage defects.
A study is made of the morphological characteristics of the endodermic cells of the stage 5 chick embryo by means of in vitro cell culture techniques. The scanning electron microscope revealed that the endodermic cells in cultures were rounded, tended to be smooth and had few blebs and microvilli. Regarding cell projections typical of culture cells, such as filopodia, lamellipodia and pseudopodia, there was a noteworthy scarcity after 12 h growth, although greater cellular activity was observed at 24 h, characterized by the presence of filopodia and an ability of the cells to form clusters on the substratum. These facts show the morphological and adhesion movements of the endodermal cells studied to be related mainly with the presence of filopodia as the most abundant cell projections.
An ultrastructural study of the different stages of pre-implantation in sheep was carried out, analysing the changes brought about mainly in the morula and blastocyst stages. The analysis of the embryos obtained showed a series of common characteristics in all stages, most noticeable being the presence of a high number of vesicles distributed in a uniform way in the cytoplasm, and also the presence of numerous electron-dense mitochondria in many varied forms. The most important ultrastructural modifications took place at the 16-cell stage and affected, principally, the nucleus, which presented numerous condensations of chromatin distributed along the nucleoplasm. The nucleoli adopted a reticular morphology, abandoning the compact aspects presented in the previous stage. These changes might be involved in the synthesis of embryonic RNA, and, accordingly, in the activation of the genome of this species. These data indicate that this stage is critical to the embryonic development and might be related to the blockage produced in the development of cultivated sheep embryos at the point of transition from 8 to 16 cells. Nevertheless, it should be pointed out that the first signs of modifications in the aspect of the nucleus are observed at the four-cell stage, being characterized by the appearance of vacuolated areas in the nucleolus, indicating the first signs of embryonic nucleic activity, which would anticipate the main change in the control of the protein synthesis.
We studied 17 large families affected by adult dominant polycystic kidney disease (ADPKD). Ultrasonographic analysis was performed on all the family members. DNA microsatellite markers closely linked to PKD1 on 16p13.3 were analysed, and linkage of the disease to this locus was determined. Families showing a negative linkage value were evaluated for linkage to the PKD2 locus on 4q. Five of the 17 families showed negative linkage for the 16p13.3 markers. In these families significant linkage to 4q was obtained. Renal cysts developed at an earlier age in PKD1 mutation carriers, and end stage renal failure occurred at an older age in people affected with PKD2. Analysis of large families with ADPKD in a Spanish population indicates that this is a genetically heterogeneous disorder, but mutations at only two loci are responsible for the development of the disease in most if not all the families. Clinicopathological differences between both forms of the disease occur, with subjects with ADPKD2 having a better prognosis than those with mutations at PKD1.
BACKGROUND: This investigation compared the effectiveness and cross-cultural applicability of behavioural family management (BFM) and standard case management in preventing exacerbation of symptoms and relapse in schizophrenia. METHOD: Forty low-income Spanish-speaking people with a diagnosis of schizophrenia were randomly assigned to receive standard case management or behavioural family management after stabilisation with neuroleptic medication. RESULTS: Survival analyses indicated that among the less acculturated patients BFM was significantly related to greater risk of exacerbation of symptoms. Among the more acculturated patients, risk of exacerbation could be predicted by medication compliance but not by type of intervention. In analyses of symptom severity and functional status at 1-year follow-up, the level of patient acculturation was found to be significantly related to various measures of treatment outcome. CONCLUSION: Sociocultural factors affect responses to different types of intervention. The results did not support earlier findings of a beneficial effect of BFM when applied to a socioculturally diverse population.
We report a rare case of acute respiratory failure in a previously asymptomatic patient showing clinical signs of inferior cranial nerve palsy together with weakness and muscular atrophy of the upper limbs. Magnetic resonance imaging revealed Arnold-Chiari malformation associated with platybasia, basilar impression, syringomyelia and Klippel-Feil syndrome. Episodes of apnoea required tracheostomy and recurred upon tentative closure of the tracheostome, but remitted upon decompression of the posterior fossa. This case involved both obstructive mechanisms and dysfunction of the respiratory centre. Patients with respiratory failure not explained by pulmonary pathology should be checked for underlying neurological disease.
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We studied urinary epidermal growth factor (uEGF) in kidney transplant patients with normal and elevated serum creatinine, in cardiac transplant patients with normal serum creatinine, and in patients with chronic renal failure. Patients with chronic renal failure had the lowest uEGF levels. uEGF was reduced in normally functioning kidney transplant patients. If the kidney graft was failing, this reduction was more marked. Cardiac transplant patients had normal uEGF. The type of immunosuppressive therapy did not influence the uEGF excretion. Kidney function and kidney tissue mass appeared to be the most important factors in uEGF excretion.
Changes in parathyroid hormone (PTH) during hemodialysis have been explained by the influence of ionized calcium changes on PTH secretion. In this study we have investigated the influence of dialysis membranes of different permeability on PTH changes during hemodialysis. Five chronic renal failure patients underwent three consecutive hemodialysis sessions with cuprophane (CUP) polysulfone (PS) and polyacrylonitrile (PAN). Two hours of isolated ultrafiltration were followed by 3 h dialysis. A significant decrease in carboxy terminal PTH (COOH PTH) was observed with PAN (p < 0.05) but not with CUP or PS. Intact PTH decreased (p < 0.001) with all three membranes, following a significant increase in ionized calcium (p < 0.001). Sieving coefficients for COOH PTH were significantly lower with CUP than with PS (p < 0.05) or PAN (p < 0.001). Intact PTH sieving coefficients were near zero for all three membranes. COOH PTH and intact PTH clearance rates were significantly higher with PAN (p < 0.001) than with PS or CUP, either in isolated ultrafiltration or with dialysis fluid. Thus PTH changes during hemodialysis do not only depend on the increase in calcium but also on the nature of the dialysis membrane. Adsorption of PTH to the PAN membrane surface explain the high PTH clearance rates achieved with this filter.
OBJECTIVE: To study the possible renal toxicity of longterm treatment with nonsteroidal antiinflammatory drugs (NSAID), in a population of patients with rheumatic diseases. METHODS: Comparative study of 104 patients treated for more than 2 years with NSAID and 123 healthy controls, nonusers of these drugs. After fasting during 12 h the following tests were performed in both groups: urinalysis, creatinine clearance, osmolar clearance, negative free water clearance, and urinary excretion of sodium. RESULTS: In the patient group the urinary pH was higher than in the controls (5.9 +/- 0.7 versus 5.2 +/- 0.6 p < 0.05) and in addition, they had an impaired renal concentration capacity, as it is shown by a significant decreased urinary density (1018.6 +/- 4.7 vs 1026.3 +/- 5.4 in the controls p < 0.05), a decreased urinary osmolality (502.1 +/- 150.7 vs 661.6 +/- 157.6 mOsm/ml p < 0.001), a lower osmolar clearance (1.26 +/- 0.25 ml/min vs 1.83 +/- 0.4 ml/min p < 0.001) and an increased free water clearance (-0.21 +/- 0.40 ml/min vs -0.98 +/- 0.41 ml/min, p < 0.001). This renal impairment was related to the cumulative intake of NSAID: CONCLUSION: The longterm treatment with NSAID is able to produce a subclinical renal dysfunction, consistent with the early stages of analgesic nephropathy.
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We describe 21 patients affected by neuronal migration disorders. The main clinical manifestations were epilepsy, hemiparesis with hemiatrophy and psychomotor retardation. The neuronal migration disorders most frequently diagnosed were various forms of heterotopia and schizencephaly. Magnetic resonance imaging was more sensitive and specific that computed tomography in the diagnosis of these disorders. Schizencephaly correlates well with hemiparesis and hemiatrophy, as does nodular heterotopia with focal epilepsy and diffuse neuronal migration disorders with severe encephalopathies.
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A case of transmission of a glioblastoma multiforme from the donor to a kidney transplant recipient in the absence of previous ventriculosystemic shunt is described. The recipient was a 48-year-old woman who developed a fever with no other associated symptoms 17 months posttransplant. Physical examination revealed a large nonpulsatile mass on the upper graft pole. Histopathologic examination showed a highly cellular neoplasm with fusiform and globoid cells, a high grade of nuclear pleomorphism and mitosis, necrosis with pseudopalisading, and vascular proliferation. Immunohistochemistry of the cells showed them to contain glial fibrillary acidic and S-100 proteins, consistent with a glioblastoma multiforme. We conclude that the risk of tumor transmission from donors with primary central nervous system tumors to kidney transplant recipients, is real and should be considered when evaluating a graft mass in such patients.
The structural and non-structural proteins induced by African horsesickness virus serotype 4 (AHSV-4) in infected Vero cells were analysed by SDS-PAGE. Twenty-two virus-induced polypeptides were detected in infected cells by comparison with the polypeptides of mock-infected cells, of which four major (VP2, VP3, VP5 and VP7) and three minor (VP1, VP4 and VP6) structural proteins and four non-structural proteins (P58, P48, P21 and P20) were shown to be virus-coded, as deduced from electrophoretic and antigenic studies of purified virions and infected cells. The proteins that elicit the major antibody responses both in vaccinated and naturally or experimentally infected horses were shown to be three structural proteins, VP2, VP5 and VP7, and the four major non-structural proteins, P58, P48, P21 and P20, as deduced by radioimmunoprecipitation and immunoblotting assays. The cross-reactivity between AHSV-4 and sera obtained from horses experimentally infected with seven other serotypes was also determined. The results showed that VP5, VP7, P48, P21 and P20 are conserved and can be used to diagnose the infection of any of these eight serotypes.