Biomedical subjects
M Lema
Publications and source records attributed to M Lema.
Letter: Hyperosmolar coma treated with intramuscular insulin.
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GC-FID determination of cocaine and its metabolites in human bile and vitreous humor.
Gas chromatography was used in combination with flame ionization detection (GC-FID) to develop a method for determining cocaine and its two metabolites, benzoylecgonine (BEG) and ecgonine methyl ester (EME), in bile and vitreous humor. The method used a 12 m x 0.2 mm i.d. column of 0.33 microm film thickness packed with 5% phenylmethylsiloxane, and proadifen as a reference compound. Drug-free bile and vitreous humor samples were used to prepare solutions of the target compounds at concentrations over the range 0.1-4 microg ml(-1) that were subjected to solid-phase extraction through Bond Elut Certify columns and derivatized with 99:1 (v/v) N,O-bis-trimethylsilyltrifluoroacetamide (BSTFA)/trimethylchlorosilane (TMCS). Calibration graphs were highly linear, with correlation coefficients above 0.99 in all instances. Also, the precision of the method was found to be quite acceptable, with coefficients of variation less than 5% for bile and less than 7% for vitreous humor. The average extraction yields ranged from 73.6% to 91.2% for bile and from 71.5% to 92.2% for vitreous humor. The proposed method was used to analyse 26 samples of bile and as many of vitreous humor from individuals fatally poisoned by cocaine, whether alone or in combination with other drugs. The mean drug levels found were 0.75 and 1.54 microg ml(-1) for cocaine in bile and vitreous humor, respectively, 6.35 and 0.94 microg ml(-1) for BEG, and 2.18 and 0.61 microg ml(-1) for EME.
Combined plasmid and peptide analysis of clinical and environmental Legionella pneumophila strains associated with a small cluster of Legionnaires' disease cases.
Plasmid and peptide analysis was used to characterize Legionella pneumophila strains isolated in the study of a small cluster of cases in hospitalized patients. The isolates from the Denver Veterans' Administration Medical Center could be clearly separated into three groups. Two of the three clinical isolates were found to be plasmidless, as were five of 19 environmental isolates. The patient isolates had plasmid and peptide profiles which were identical to the showerhead isolates to which each patient was exposed. Thus, the data suggest that the patients acquired their disease strains from environmental sites in their particular hospital wing, and that each wing of the building had its own unique flora of Legionella strains. The results also confirm the usefulness of using both these techniques when tracing transmission patterns of nosocomial disease.
Experience with gabapentin for neuropathic pain in the head and neck: report of ten cases.
BACKGROUND AND OBJECTIVES: Gabapentin is an oral antiepileptic agent with an unknown mechanism of action. Recent case reports have suggested that gabapentin may be effective in the treatment of a variety of neuropathic pain states. This report presents baseline and follow-up data on ten patients who were treated with gabapentin when other pharmacologic interventions failed to relieve their neuropathic pain. METHODS: Ten patients referred for treatment of unrelieved neuropathic pain in the head and neck region were included in this study. Baseline and follow-up information included measures of pain intensity and pain quality. All of the patients were started on 300 mg gabapentin three times per day, though daily doses of up to 2400 mg were required for pain relief. RESULTS: Eight of the ten patients had no neuropathic pain on follow-up, whereas the remaining 2 patients reported only partial relief at follow-up. None of the patients complained of side effects. Gabapentin was effective in alleviating steady burning pain as well as lancinating pain and allodynia. CONCLUSIONS: The results suggest that gabapentin may be effective in the management of some cases of neuropathic pain in the head and neck. However, controlled, double-blind longitudinal studies are needed to evaluate this possibility.
[Pentoxifylline: is it useful in multiple sclerosis?].
INTRODUCTION: Pentoxifylline (PTX) is a phosphodiesterase inhibitor which has been found in studies in vitro to inhibit the production of Th-1 cytokines. It has been postulated that it might be used as a possible coadjuvant treatment for interferon in patients with multiple sclerosis. This would also reduce the potential side effects of interferon. OBJECTIVE. To show the efficacy of PTX in reducing the side effects of interferon, and in the functional improvement of these patients. PATIENTS AND METHODS: We studied 18 patients with remitting-relapsing multiple sclerosis over a period of 18 months; nine patients were given PTX and interferon 800 mg/day simultaneously, and nine patients were treated with interferon alone. The clinical condition was evaluated every three months using the Expanded Disability Status Scale (EDSS) and the Neurological Score (NRS) scales. RESULTS: We found no statistical improvement in the clinical course of EDSS and NRS in either group of patients after treatment for 18 months. The patients treated with PTX have fewer secondary effects due to interferon (fever and myalgia) during the first three months, but these differences between the groups subsequently disappear. In two patients PTX caused transient gastralgias and nauseas. CONCLUSIONS: PTX may be useful as a coadjuvant drug with interferon during the first three months of treatment since some of the side effects of interferon may thus be reduced. However, there seems no justification for using PTX for a longer period since there is no functional improvement.
[Spinal epidural abscess secondary to pharyngeal trauma due to food].
INTRODUCTION: In recent years the incidence of spinal epidural abscesses has increased. Early diagnosis is very important, since once neurological deficit has become established this is often permanent. The commonest aetiological agent is Staphylococcus. Pain and fever are often the only symptoms before acute neurological deterioration. CASE REPORT: A 76 year old hypersensitive, diabetic man presented complaining of pain and a sensation of warmth in both arms. He had no fever or other symptoms. Some three weeks before admission to hospital a fish bone had become stuck in his pharynx, causing a purulent lesion there. This was treated with antibiotics. Cervical MR showed a mass at the level of C4 C5, compatible with epidural abscess. Following drainage and antibiotic treatment he recovered, with no sequelas. Staphylococcus was isolated from the purulent fluid. CONCLUSIONS: The possibility of epidural infection must be remembered in patients with fever and nerve root pain. Early diagnosis and suitable treatment, combining both surgery and prolonged treatment with antibiotics, are essential to prevent permanent neurological damage.
[Intercellular communication in the astrocyte culture as a measure of therapeutic efficacy in multiple sclerosis treated by interferon].
INTRODUCTION: Measurement of therapeutic efficacy in multiple sclerosis depends on the clinical and magnetic resonance findings on follow up. There are no biological markers. Measurement of interleukins and other markers of inflammation has not proved useful in the follow up of these patients. The response of astrocytes to mediators of inflammation gives rise to modification in their capacity for intercellular communication. OBJECTIVE: To find whether culture of astrocytes in serum from patients with multiple sclerosis at different clinical stages and on different treatments gives rise to modification in intercellular communication. PATIENTS AND METHODS: Astrocytes were cultured in serum from three patients with an untreated acute clinical episode of multiple sclerosis, and the results compared with those obtained after serum culture when the patients had been treated with interferon for a year. RESULTS. In astrocyte culture using serum from patients with an acute episode of multiple sclerosis, but not on treatment with interferon, there was a statistically significant reduction in intercellular communication as compared to astrocytes cultured with serum from these same patients treated with interferon for one year (*p< 0.05; **p< 0.01). CONCLUSION: Measurement of the modifications in intercellular communication on astrocyte culture may be used as a marker for inflammatory activity in the serum of patients with multiple sclerosis, and therefore as an index of therapeutic efficacy.
[Interferon beta in multiple sclerosis].
INTRODUCTION AND METHOD: The mechanism of action of interferons We do not know in the multiple sclerosis but, although exist discrepancies in relation to their degree of effectiveness, fundamentally the dose to use and the administration route, the three available ones have proven to be effective in the reduction of the number of the bouts. We reviewed the more important clinical tests made with three interferons in the remitent recurrent (RR) forms, the isolated neurologic syndromes and the secondary progressive (SP) forms of the disease and reviewed the comparative studies between interferons. CONCLUSIONS: The three interferons are well tolerated although the intramuscular form produces less skin effects; in the RR forms the number of bouts are reduced in significant form. Only the study with 1a intramuscular was demonstrated effectiveness in the SP forms and with the subcutaneous IFN b 1b exists discrepancies between the European and the American studies. The early treatment with subcutaneous IFN b 1a slow down the evolution of the disease. Except in relation to the side effects, there are not evidence that the dose and the administration route are important in the effectiveness in the long term.
[Cerebral atrophy in multiple sclerosis patients treated periodically with boluses of methylprednisolone].
INTRODUCTION: In the last years advances in the treatment of the remittant and secondary progressive forms of the multiple sclerosis (MS) have taken place. In the primary progressive forms (PP) the side effects of potentially useful drugs prevent their use; in some studies an improvement of the evolution with the intravenous administration of periodic pulses of methylprednisolone (MP) has been observed. OBJECTIVE: To evaluate if periodic pulses of intravenous MP injected every 4-6 weeks increase the degree of cerebral atrophy of the patients with PP MS. PATIENTS AND METHODS: We studied 11 patients with PP MS treated during 33 months with periodic pulses of intravenous MP. The degree of cerebral atrophy was evaluated in axial cuts of 10 mm of studies of magnetic resonance with the indices of Evans, bicaudate, bifrontal, frontal spears and bithalamic. The statistical evaluation of the results was made applying the test of Wilcoxon-Mann-Whitney. RESULTS: There are not statistically significant differences in the degree of cerebral atrophy with any of the used indices. CONCLUSIONS: Periodic pulses of intravenous MP do not accelerate the cerebral atrophy in patients with progressive forms of multiple sclerosis.
[Cerebellar glioblastoma multiforme: a case report].
INTRODUCTION: Cerebellar glioblastoma multiforme (CGM) accounts for less than 1% of all intracranial glioblastomas; it spreads quickly locally, above all towards the brain stem and adjacent leptomeninges, and has a poor prognosis. CASE REPORT: We report the case of a 55 year old patient who presented a continuous feeling of dizziness, instability and sickness, with occasionally vomiting and double vision that had started two months before being admitted to hospital. A physical exploration revealed hypaesthesia of the right side of the face, tactile and algesic hypaesthesia in the left side of the body and nystagmus in the bilateral horizontal gaze. Results of the general physical exploration were normal. A magnetic resonance (MR) brain scan revealed a 3 cm expansive lesion in the middle cerebellar peduncle and right cerebellar hemisphere, which was hypointense in T1 and hyperintense in T2. Administering contrast showed it to be heterogeneous, with irregular annular enhancement, and perilesional edema. Subtotal excision of the lesion was performed and pathological analysis allowed a diagnosis of glioblastoma multiforme to be made; radio and chemotherapy were continued. CONCLUSION: CGM is infrequent and 46.7 years is the mean age of onset. 59% of tumours are located in the hemispheres, they tend to spread locally, and remote metastases have also been reported. Initial clinical manifestations are intracranial hypertension, and gait and balance disorders. Differential diagnosis is provided by MR and includes metastasis, infarction and abscesses. Treatment involves radical surgical excision followed by local radiotherapy. The use of chemotherapy has been reported but its role in the treatment of this entity is still not altogether clear.
[Time evolution of TNF-alpha, VCAM-1, IL-4, IL-10, neopterin and CD-30 in patients treated with interferon].
INTRODUCTION: Interferon (IFN) diminishes the outbreaks of multiple sclerosis (MS) and slows down its progression. Follow-up of patients is performed using clinical and resonance imaging parameters, and no biological markers are available that allow us to determine its efficiency. AIMS: 1. To discover the effects of IFN on the serum levels of TNF-alpha, IL-4, IL-10, VCAM-1, neopterin and CD-30 in patients with MS; 2. To determine how these modifications evolve over time; 3. To find out the clinical value of its determination in isolation. PATIENTS AND METHODS: We studied 19 patients with MS who were clinically stable and undergoing IFN therapy. Samples were obtained every 3 months over a 2.5 year period and always immediately before injecting the drug. The ELISA method was used to determine interleukins. RESULTS: Serum levels of neopterin, CD-30 and VCAM-1 were not modified, TNF-alpha levels oscillated regardless of the clinical status of the patient and IL-4 and IL-10 had a significant serum peak at 9-12 months after beginning treatment. CONCLUSIONS: The existence of a significant IL-4 and IL-10 peak between 6 and 12 months of therapy indicates that IFN reaches its possible immunomodulatory effect after several months and, therefore, a poor initial clinical response must not be a reason for discontinuing medication. The specific determination of the serum levels of IL is not useful in following up patients treated with IFN.
[Seasonal variations in the outbreaks in patients with multiple sclerosis].
INTRODUCTION: It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. AIMS: Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. PATIENTS AND METHODS: We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. RESULTS: We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. CONCLUSIONS: In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months.
[SUNCT syndrome secondary to megadolichobasilar anomaly].
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[Adenine nucleotides in migraine].
Several studies have shown that migraine is associated with an abnormal platelet activation state, characterized by increased plasma levels of platelet BTG and PF4 proteins. Adenine nucleotides are contained in platelets as a part of the dense granules released during platelet activation. In the present study we evaluated the plasma levels of the adenine nucleotides AMP, ADP and ATP during asymptomatic and painful episodes in a group of 50 patients with migraine (common and classical) and a control group. During the painful phases we found a significant reduction in AMP plasma levels, and we did not find significant differences between the control group and the migraine patients in ADP and ATP levels, nor between asymptomatic and painful phases. Our results support the hypothesis that in migraine a hyposecretion of platelet dense granules is present.
[Cervicodorsal diastematomyelia in an adult].
A 44-year-old male had paraparesis which had began at age 20 years; a cleft spinal cord (diastematomyelia) was discovered at cervicodorsal level. The patient had nevus and hypertrichosis in the skin overlying the dysraphic spinal cord malformation. Both computer-assisted myelography and magnetic resonance scan showed the spinal cord segmentation and other associated disorders: bone spicula projecting between the 2 cordal halves, vertebral fusion defect and syringomyelic cavity. We emphasize the rarity of this abnormality in a so high spinal cord level and the onset of symptoms at adult age.
[Metastatic infiltration of the cavernous sinus].
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[Cervical radiculopathy caused by Ewing's tumor].
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