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Biomedical subjects

R Carrillo

Publications and source records attributed to R Carrillo.

At least 19 recordsLinked to original sources
PubMed2006

[Palmoplantar hyperkeratosis associated with losartan].

Losartan belongs to the group of angiotensin II receptor antagonists and is used for the treatment of hypertension and heart failure. It acts in the renin angiotensin system (RAS) by blocking the angiotensin II receptor. There have been several reports on cutaneous side events by angiotensin antagonists due to their effect on the local cutaneous RAS. We review the case of palmoplantar lesions that developed in a patient taking losartan and the subsequent remission after treatment withdrawal. Since these reactions are being increasingly reported and as they can mimic a broad variety of classical skin disorders, they should be considered as the cause of sudden, inexplicable skin eruptions in patients taking angiotensin receptor antagonists.

Antihypertensive Agents↗
PubMed2006

[Familiar glioblastoma presenting as a true multicentric tumor: etiopathogenic and prognostic features].

Familial glioblastoma multiforme is a rather uncommon entity, being in most cases associated to known genetic disorders (as Turcot syndrome, Li-Fraumeni syndrome, neurofibromatosis, etc.). However, familial gliomas have also been described, although less frequently, independently of these genetic syndromes showing some special features regarding its etiology and clinical manifestations. Less than 10% of gliomas may be considered as true multicentric tumours either synchronous or metachronous in clinical presentation. Metachronous glioblastomas have been associated to better prognosis in some studies, with genetic studies having found clear differences among the tumors within same patients. Familial glioblastoma with metachronous presentation is an exceptional disorder. These tumors show special therapeutic implications due to the limitations of radiotherapy once the patient has already irradiated. A variety of non-specific mutations have been found in these patients but true characterization of this disorder remains unclear and will be based on further genetic studies. We present a clinical report on a patient harbouring a familial and metachronous glioblastoma. The main aspects of this entity are reviewed.

Brain Neoplasms↗
PubMed2005

[Akinetic mutism related to hydrocephalus and cerebellar surgery treated with bromocriptine and ephedrine. A pathophysiological review].

Akinetic mutism (AM) is a behavioral disorder characterized by impossibility to move or speak in awake patients. lt has been typically described as a transient disorder following posterior fossa tumour resection. Besides, AM may also appear after recurrent shunt failures in hydrocephalic patients, with no tendency towards improvement, either spontaneously or with shunt revisions. However successful treatment of this second type of AM has been achieved with bromocriptine. We present a patient who developed AM after a posterior fossa surgery complicated by ventriculitis and multiple hydrocephalic events. AM only improved with bromocriptine. We review AM pathophysiology. Although not well known, it appears to be quite different, depending on its cerebellar or hydrocephalic origin. Damage to dentate nucleus or its efferents (mainly of glutamate) should promote AM of cerebellar origin, while damage to paraventricular monoaminergic pathways could explain AM related to repeated shunt failures which has successful response to bromocriptine treatment. However, a more complete study of this disorder is required to ascertain its aetiology.

Akinetic Mutism↗
PubMed2005

[Immunotherapy in high grade astrocytomas: principles and current state].

It is generally accepted that tumour development promotes a systemic response leading to protect the host against cancer. However, tumours may as well elicit a partial immunodeficiency to avoid the development of a complete and active immune response. Since Bloom's first studies on immunotherapy to treat high grade gliomas in 1960, many attempts have been made from different medical specialties to use the immune system as a weapon against a great diversity of cancers. Main objective of this study is to outline the basic features of the immune response inside the Central Nervous System, the strategies employed by astrocytic tumours to evade body defences, and to provide an extended literature review on research on immunotherapy, especially concerning its patho-physiology and the clinical results achieved till date.

Astrocytoma↗
PubMed2004

[Management of recurrent trigeminal neuralgia after failed microvascular decompression].

OBJECTIVE: To evaluate the surgical management of patients with trigeminal neuralgia after failed microvascular decompression. PATIENTS AND METHODS: Between 1993 and 2002, exploration of the posterior fossa was performed in 60 patients with trigeminal neuralgia. Records were analyzed retrospectively for those patients who needed another surgical procedure due to recurrence of pain, describing which procedure was performed, postoperative results and complications, and also the intraoperative findings when posterior fossa reexploration was realized. RESULTS: Eighteen patients had trigeminal neuralgia recurrence requiring a new surgical intervention, that consisted in a fossa posterior reexploration in nine patients and percutaneous radiofrequency termal rhizotomy in the other nine patients. Among the repeat operations, there was negative exploration in 7 patients (77%), and a partial sensory rhizotomy was performed. Most of thermocoagulations (5/9) were performed in old patients or patients with anestesic contraindication for the fossa posterior reexploration. CONCLUSION: Fossa posterior reexploration is an effective and safe surgical attitude in the treatment of recurrent trigeminal neuralgia after failed microvascular decompression. Partial sensory rhizotomy is recommended when the reexploration is negative.

Adolescent↗
PubMed2004

[Progressive deterioration in an elderly patient].

Vasculitis is diagnosed with increasing frequency in the elderly. We hereby present the case of an 84-year-old male, who had weight loss, low-degree fever, anemia and epigastric pain. After 14 days of study with the tentative diagnosis of digestive neoplasia, a progressive renal insufficiency was detected. This clinical picture was secondary to ANCA-positive vasculitis. The case poses the differential diagnosis of non-oliguric acute renal failure (FRA) in elder people and the systematics of the study of renal insufficiency in individuals with previously unknown renal function. Also, this patient's history emphasizes the importance of acute deterioration of renal function as a guiding symptom for orienting the interpretation of clinical data. In the present case, a diagnostic hypothesis based only in the pursue of an occult digestive tumor misguided the attention from the main cause of the disease.

Abdominal Pain↗
PubMed2003

[Analysis of the emergency system of the Spanish neurosurgical services].

OBJECTIVES: 1)To study the alert system (on call duty) in the Spanish neurosurgical departments and main issues of the emergency neurosurgical attention; 2) To establish common sense criteria for a thorough review of the system; 3) To analyse the effects of the current alert system on neurosurgical planning in Spain from the point of view of aging of Spanish neurosurgeons. MATERIAL AND METHODS: An interview containing 11 items related to the main aspects of the alert system was developed. The interview was sent to 51 departments. Answer from 42 of them were received. Neurosurgical departments were categorized in two different patterns to analyse the results: 1 st )according to the size of the staff. Three different types were observed:Type A (more than 10 neurosurgeons);Type B (between 6 and 10), and Type C (less than 6). 2 nd ) according to qualification of the personnel receiving the patient in the emergency area:Type I (the patient is received by paramedic personnel);Type II (trainee sends patient to specialist);Type III (training doctor orders diagnostic procedures) and Type IV (neurosurgeon orders diagnostic procedures and decides next actions). RESULTS: Type A departments :This group is formed by 8 departments. Alerts are always mix (at home or in hospital). There are usually 3 neurosurgeons on call (sometimes 4). Staff personnel is on call duty at the hospital 5 days a month plus 5-6 days at home. In 38% of the hospitals, department is type I-II (the patient is initially attended by paramedic personnel, not responsible for diagnostic or treatment). Surgical emergencies account for 0.54 a day as a rule and 12.75 patients require neurosurgeon's attention every day. In 75% of the hospital the neurosurgeon must also read neuroimaging procedures and suture scalps in 37%. Next day, neurosurgeon on call is off duty almost routinely. Type B :it was formed by 21 services. Alert are always mix (at home or in hospital). There are usually two neurosurgeons on call. Staff personnel are on call 4-5 days a month at the hospital and 5-6 days at home. The patient is initially attended by a doctor starting diagnosis in 85% of the cases (types III and IV).They operate 0.52 times a day,attending 6.19 patients/day as a mean. Neurosurgeon must read neuroimaging procedures in 57%. They do not repair scalps (except for a 5%) and personnel is off duty next day routinely. Type C :Nine (9) departments were grouped under this lining. Staff is always on call at home. There is usually only one neurosurgeon (sometimes two). Staff perform 10-12 alerts at home along the month. In 4 of the departments they must duplicate the number of days as far as there are two of them on-call. Patients are attended initially as type III-IV in 100% of the cases (doctor asks for diagnostic tools and decides therapy in 78%). Neurosurgeon on-call receives 4-5 phone-calls a day. Surgical emergencies account for 0.34 a day and 1.84 patients a day are attended directly by them. They never suture scalps. They seldom are off-duty next day. Aging of the Spanish neurosurgeons (389 interviewed). Most important issues are: 152 neurosurgeons will be 55 yo between 2003 and 2008, so they can ask for leaving on-call duties. 121 neurosurgeons will be 65 yo between 2009 and 2013. CONCLUSIONS: 1 st ) Alert system, mostly in bigger departments, is disproportioned and does not to fit to reality. 2 nd ) Emergency is worse organized in bigger hospitals. Besides, neurosurgeon on-call is not properly consulted. 3 rd ) Almost routinely neurosurgeons are offduty the day after alert in hospital. 4 th ) 152 neurosurgeons are necessary in the next five years to maintain the current system, which is obviously unviable. 5 th ) Most of the finishing trainees (residents) should tolerate "on-call contracts"in bigger departments to sustain the actual system. 6 th )For future planning, Neurosurgical National Committee must offer 20 training places a year to fill jubilees to happen from 2009 on. Finally we believe that the current alert system cannot be maintained any more, so Health Administratt system cannot be maintained any more, so Health Administrations must develop a profound reform. In this sense, the role that Local Neurosurgical Societies must play is essential.

Adult↗
PubMed2001

Yield of mammography in selected patients age < or = 30 years.

BACKGROUND: An outcomes analysis study was performed to quantify the benefit of directed diagnostic imaging of selected very young women (defined as < or = 30 years of age) in our population. Summary results are presented. PATIENTS AND METHODS: Women's Imaging Services were queried for studies performed between April 1, 1997 and December 31, 1998 on women < or = 30 years of age. The authors' referral pathway mandates breast examination by a general surgeon or by the head of Women's Imaging before mammography in all such patients. Studies were excluded if there were reviews of scans performed at other sites. The resulting 142 mammograms were evaluated. RESULTS: Ninety percent of the 142 studies were within normal limits. Only 11 mammograms indicated any required action (7.8%), and only 5 of these merited biopsy. All biopsies revealed benign disease. No carcinomas were detected by biopsy or on clinical follow-up in this cohort of women. These values are congruent with the scarce literature on mammography in this population. CONCLUSIONS: The yield of mammography in the age < or = 30 years population is low.

Adult↗
PubMed2001

Left ventricular geometry and operative mortality in patients undergoing mitral valve replacement.

BACKGROUND: Distortion of left ventricular (LV) shape is often associated with LV dysfunction and is thought to be an independent predictor of survival in patients with coronary disease. HYPOTHESIS: The purpose of this study was to examine the relationship between LV geometry and hospital mortality in patients with mitral regurgitation (MR) undergoing mitral valve surgery. METHODS: A consecutive series of patients (aged 68+/-12 years, 47% men) (n = 149) with MR who underwent cardiac catheterization, left ventriculography, and mitral valve surgery from 1995 to 1996 at Mount Sinai Medical Center was studied. Left ventriculograms, clinical records, and hemodynamics were reviewed. Left ventricular volumes and ejection fraction were calculated using standard techniques. Left ventricular shape in diastole and systole was evaluated using the sphericity index, which is defined as the end-systolic LV volume (x 100) divided by the volume of a sphere whose diameter is equal to the LV long axis. RESULTS: In the patients studied, the etiology of mitral insufficiency was mitral valve prolapse in 40.9%, ischemic heart disease in 40.3%, rheumatic heart disease in 11.4%, and prosthetic valvular dysfunction in 7.4%. The average ejection fraction was 65%+/-17. Systolic sphericity index (SSI) was 36%+/-15 in patients who died, compared with 25%+/-11 in patients who lived (p < 0.001). A multivariate model was constructed using hemodynamic and angiographic indices derived during preoperative cardiac catheterization. Systolic sphericity index (odds ratio = 1.6 for each point increase, p < 0.01) was found to be an independent predictor of postoperative survival in the global population, as well as in patients with coronary disease (p<0.01). CONCLUSION: Left ventricular geometry is an independent angiographic risk factor for survival following mitral valve replacement. Sphericity index is a simple method for assessing LV geometry which should be calculated in patients as part of risk stratification.

Adult↗
PubMed2001

Quantitative trait loci for the monoamine-related traits heart rate and headless behavior in Drosophila melanogaster.

Drosophila melanogaster appears to be well suited as a model organism for quantitative pharmacogenetic analysis. A genome-wide deficiency screen for haploinsufficient effects on prepupal heart rate identified nine regions of the genome that significantly reduce (five deficiencies) or increase (four deficiencies) heart rate across a range of genetic backgrounds. Candidate genes include several neurotransmitter receptor loci, particularly monoamine receptors, consistent with results of prior pharmacological manipulations of heart rate, as well as genes associated with paralytic phenotypes. Significant genetic variation is also shown to exist for a suite of four autonomic behaviors that are exhibited spontaneously upon decapitation, namely, grooming, grasping, righting, and quivering. Overall activity levels are increased by application of particular concentrations of the drugs octopamine and nicotine, but due to high environmental variance both within and among replicate vials, the significance of genetic variation among wild-type lines for response to the drugs is difficult to establish. An interval mapping design was also used to map two or three QTL for each behavioral trait in a set of recombinant inbred lines derived from the laboratory stocks Oregon-R and 2b.

Animals↗
PubMed2000

Inactivation of mitochondrial permeability transition pore by octylguanidine and octylamine.

Mitochondrial permeability transition occurs through a Ca2+-dependent opening of a transmembrane pore, whose identity has been attributed to that of the adenine nucleotide translocase (ANT). In this work, we induced permeability transition by adding 0.5 microM carboxyatractyloside. The process was evaluated analyzing Ca2+ efflux, a drop in transmembrane electric gradient, and swelling. We found that the amphiphyllic cations octylguanidine and octylamine, at the concentration of 100 microM, inhibited, almost completely, nonspecific membrane permeability. Hexylguanidine, hexylamine, as well as guanidine chloride and hydroxylamine failed to do so. The inhibition was reversed after the addition of 40 mM Li+, Na+ K+, Rb+, or Cs+; K+ was the most effective. We propose that the positive charge of the amines interact with negative charges of membrane proteins, more likely the ADP/ATP carrier, while the alkyl chain penetrates into the hydrophobic milieu of the inner membrane, fixing the reagent.

Adenosine Diphosphate↗
PubMed2000

Copper sensitizes the mitochondrial permeability transition to carboxytractyloside and oleate.

Addition of 5 microM copper to rat kidney mitochondria enhances the effect of carboxyatractyloside and oleate on pore opening, in a cyclosporin A-sensitive fashion. The effects of the pair copper-carboxyatractyloside were observed on matrix Ca2+ efflux, mitochondrial swelling and on the transmembrane electric gradient. The effect of Cu2+ emphasizes the importance of membrane thiol groups located, probably, in the ADP/ATP translocase (ANT), on permeability transition. It was also found that Cu2+ does not block the fluorescent label of ANT by eosin 5-maleimide, but abolishes the inhibition by CAT on the labeling. This suggests that the binding of Cu2+ to cysteine residues of ANT promotes a conformational change in the carrier, strengthening the effect of CAT and oleate on membrane leakage.

Animals↗