[Unusual form of initiation of diabetes mellitus in patient with treatment refractory arterial hypertension].
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Adult↗
Biomedical subjects
R Núñez
Publications and source records attributed to R Núñez.
Synthesis, characterization, and dynamic studies of 12-vertex eta5-ruthenium(II) closo-phosphine complexes with monoanionic [10-L-nido-7-R-7,8-C2B9H9]- ligands.
Ruthenacarborane complexes of formula [3-H-3,3-(PPh3)2-8-L-closo-3,1,2-RuC2B9H10)] (L = SMe2 (2a), SEt2 (2b), S(CH2)4 (2c), SEtPh (2d)) and [1-Me-3-H-3,3-(PPh3)2-8-L-closo-3,1,2-RuC2B9H9)] (L = SMe2 (2e), SEt2 (2f)) were prepared by reaction of the respective monoanionic charge-compensated ligands [10-L-nido-7,8-C2B9H10]- and [7-Me-10-L-nido-7,8-C2B9H9]- with [RuCl2(PPh3)3]. Similary, complexes [3-H-3,3,8-(PPh3)3-closo-3,1,2-RuC2B9H10)] (4a) and [3-H-3,3-(PPh3)2-8-PPh2Me-closo-3,1,2-RuC2B9H10)] (4b) were prepared from the corresponding phosphonium ligands. The reaction is done in one pot by reacting the ligand with the Ru(II) complex in a 1.5:1 ratio. All compounds have been fully characterized by multinuclear NMR spectroscopy, and the molecular structures for 2a and 4a have been elucidated by single-crystal X-ray diffraction analysis. The Ru(II) atom in this complex is on the open face of the monoanionic charge-compensated ligand adopting a pseudooctahedral coordination. Formally, three positions are supplied by the C2B3 open face, two PPh3 groups occupy two other positions, and a hydride fulfills the remaining one. The hydride complexes were generated with no special reagent. They result from a dehalogenation in the presence of ethanol.
Journal Article↗
[Validation study of a polygraphic screening device (BREAS SC20) in the diagnosis of sleep apnea-hypopnea syndrome].
OBJECTIVE: To validate the BREAS SC20 (Breas Medical AB, Mölnlyke, Sweden) polygraphic screening device, comparing it with conventional polysomnography (PSG), in the diagnosis of sleep apnea-hypopnea syndrome. A validity study of the diagnostic test was carried out at the sleep clinic of a tertiary hospital. PATIENTS AND METHODS: Seventy patients clinically suspected of sleep apnea-hypopnea syndrome and treated at the sleep laboratory of the Hospital Txagorritxu, Vitoria, Spain, from November, 2001 until August, 2002 were consecutively enrolled in the study. Patient characteristics, comorbidities, and results on the Epworth sleepiness scale were recorded. The apneahypopnea index (AHI) per hour of sleep was determined by PSG; the respiratory events index (REI) per hour of screening was determined by the polygraphic screening device. RESULTS: Sixty studies were valid (77% were men; mean [SD] age: 51.6 [13.2]; body mass index: 30.3 [5]; AHI: 31.0 [27.6]). The intraclass correlation coefficient between the AHI by PSG and the manual REI was 0.92. The mean difference between the AHI and the manual REI was 2.92 (9.75). The area under the receiver operating characteristic curve was 0.924 for the cut point AHI >or =5. The optimal cut point for an AHI > or = 5 was 3.6 in the REI (98% sensitivity). The respiratory screening device correctly classified 90% to 95% of the patients. CONCLUSIONS: The BREAS SC20 is a valid system for identifying patients clinically suspected of sleep apnea-hypopnea syndrome.
Adult↗
[Testicular and epididymal appendages. Contribution about it's embryology and pathogenesis].
OBJECTIVE: The testicular appendages are structures with biologic activity and with the possibility to become ischaemic or to degenerate before determined stimulus. Laterly, we have seen an apparent increase in our cases of torsion of testicular appendages. The said, together with the questions about embriology and pathogenesis of this structures, encourage us to do this work. PATIENTS AND METHODS: 1- Retrospective clinical study of patients operated of torsion of testicular appendages, from January 1984 to December 2001. We asses age, year of operation and clinical features. 2- Prospective clinical study of patients operated of torsion of testicular appendages, between March 1999 and March 2000. We asses age, time of evolution, degree of ischaemia, nutritional status, sexual maturity stage and testicular volume. 3- Inmunocytochemical study of testicular and epididymal appendages. We identified the oestrogen receptors. RESULTS: There is a meaningful increase in the yearly incidence of ischaemia of testicular appendages. The mean age of the patients was 9.3 +/- 2.5 years, similar alone of the study. In the patients of group 2, the mean time of evolution was 49.2 +/- 46.6 hours. The appendages showed oedema and several degrees of ischaemia in the absence of torsion (14/21). The body mass index was 19.5 +/- 3.7, and 90% of patients had stages I and II of Tanner. The mean of testicular volume was 2.1 +/- 1.6 ml. By means of inmunocytochemical study we identified oestrogen receptors in 7 of all testicular appendages studied and absence of oestrogen receptors in all epididymal appendages. CONCLUSIONS: The clinical syndrome of the acute scrotum in the majority of cases is due to oedema and ischemia of the appendages, in absence of torsion, probably related to its enlargement in response to hormonal stimulation, at least in some grade, in prepubertal boys. The difference found, related to oestrogen receptors, suggest a different origin for testicular and epididymal appendages.
Child↗
[FGD PET in a patient with pseudofractures from osteomalacia].
We present the case of a 42 year old man, with a history of multiple fractures and generalized pain for two years. A three phase bone scan, demonstrated multiple fractures involving the ribs, both ankles and feet. After going through a battery of tests which included an FDG PET scan (to exclude an occult malignancy), the patient was diagnosed with osteomalacia and hyperparathyroidism. The FDG PET scan, demonstrated multiple foci of increased FDG uptake throughout the axial skeleton, in a pattern highly suggestive of pseudofractures, rather than osseous metastases.
Adult↗
Proton mediated partial degradation of closo-dicarbaboranes.
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Journal Article↗
Contribution of the nido-[7,8-C2B9H10]- anion to the chemical stability, basicity, and 31P NMR chemical shift in nido-o-carboranylmonophosphines.
The icosahedral dicarboranes and their decapitated anion, 1-R'-1,2-C(2)B(10)H(10) (closo) and [7-R'-7,8-C(2)B(9)H(10)](-) (nido), exert a distict influence at the alpha position of substituents attached to the cage carbon atom. The closo fragment is electron-withdrawing while the nido anion is electron-releasing. These effects are studied by (31)P NMR, phosphorus oxidation, and phosphorus protonation in [7-PR(2)-8-R'-7,8-C(2)B(9)H(10)](-) species. The (31)P NMR chemical shift dependence is related to the R alkyl or aryl nature of [7-PR(2)-8-R'-7,8-C(2)B(9)H(10)](-). No direct relationship to the nature of the R substituent on the nido-carboranylmonphosphine toward oxidation has been found. The basicity of the nido-alkylcarboranylmonophosphines is the highest while the lowest corresponds to the nido-arylcarboranylmonophosphines. Interpretation can be carried out qualitatively by considering the electronic properties of the cluster and the nature of the R groups. The influence of R' is less relevant. Confirmation of the molecular structure of the oxidated and protonated nido-carboranylmonophosphine compounds was obtained by X-ray diffraction analysis of [NBu(4)][7-P(O)Ph(2)-8-Ph-7,8-C(2)B(9)H(10)] and [7-PH((i)Pr)(2)-8-Me-7,8-C(2)B(9)H(10)].
Journal Article↗
Coalescence of liquid drops by surface tension.
The merging of two mercury drops at very low kinetic energy is observed using fast, digital, and analog imaging techniques. Sequences showing the time evolution of the overall-surface shape as well as an amplified view of the contact region are shown. Qualitative and quantitative comparisons with computations of the Navier-Stokes equation with a free surface are made. In the model, the surface is tracked by a marker-chain method.
Journal Article↗
[Severe caustic injuries of the esophagus: when to replace the esophagus].
From June 1985 to May 1998, 20 patients have been treated in our hospital by esophageal dilatations due to serious esophageal caustic stenosis. A retrospective analysis of these 20 patients was performed, evaluating age, sex, causative agent, number and time of dilatations, iatrogenic esophageal perforations, gastroesophageal reflux (GER) and psychological and social consequences. Follow-up has ranged from 1.5 to 14.5 years (mean = 8.07 years). The mean age at the time of accidental swallow was 42.2 months. The causative agent was dishwashing detergent in 11 patients and caustic soda in 9 patients. The mean of dilatations needed was 19.1 and the average duration of dilatations was 24.7 months. Seven patients had esophageal perforation during dilatation and none of them required surgical treatment. All patients had improvement of swallowing and an easier esophageal dilatation afterwards. Oral contrast studies demonstrated distortion of the esophago-gastric junction in the majority of patients. Ten patients were screened for GER with 24-hour esophageal pH monitoring in the first year postburn and it was pathological in 5. Antireflux surgery was carried out in 4 patients with a conspicuous improvement following surgery. Dilatations proved successful in 16 patients in less than two years, and in more than two years in 3 patients. The authors conclude that the majority of children with esophageal caustic stenosis can be managed successfully by esophageal dilatations, even with dilatation periods longer than two years or when an esophageal perforation occur during the procedure. The paramount importance of early diagnosis and treatment of GER is stressed.
Burns, Chemical↗
[Colonic aganglionosis with ileal involvement. Ileocolic plasty].
During 1994 through 1999, we have treated five patients (3 boys, 2 girls) with total colonic aganglionosis (TCA) and ileal involvement. In three of them we performed a diverting ileostomy in the neonatal period and at the age of four and five months respectively in the remaining two patients, due to intestinal obstruction. In these two last patients a diagnosis of Hirschsprung's disease was made by anorectal manometry and rectal biopsies in the neonatal period. During laparotomy, a cutaneous ileostomy was created in all patients at the distal end of normal ileum, which was 30 to 110 cm (mean = 71 +/- 37 cm) from the ileocecal valve. After operation, a short bowel syndrome developed in three patients causing fluid and nutritional problems that required prolonged total parenteral nutrition (TPN). The definitive operative repair is performed at 4.5 to 14 months (mean = 8 +/- 3.7 months) by a 12 to 20 cm side-to-side ileocolostomy created between the ileum and aganglionic ascending color (Boley procedure) and ileorectal primary anastomosis (Rehbein procedure) using a circular stapler. Rectal dilatation, irrigation of the colon with saline, loperamide hydrochloride and resincholestyramine were begun in all patients postoperatively. Oral antibiotic prophylaxis, was given to the three patients who suffered from SBS. Oral feedings with semielemental diet were tolerated once stools were semiformed and TPN was discontinued at 8 to 34 days (mean = 21 +/- 1.7 days). postoperatively. After the definitive operation, enterocolitis developed in two patients, requiring one of them a short hospitalization during the episode. A possible explanation for the low incidence of enterocolitis in this series is the systematic postoperative use of irrigations of the colon with saline in all patients. These five patients have been followed-up for growth, development, bowel habit and continence. Follow-up has ranged from 15 to 62 months (mean = 32.2 +/- 19.2 months). Presently, all patients in this series have full enteral feeding and one to three bowel movements per day, with formed or semiformed stools. No patients is incontinent of stool. The patient's body weights (74 to 93%) and heights (89 to 92%) for their age were below average (four patients) or within normal range (one patient). Hemoglobin levels are within normal range in all patients. One patient has iron deficiency and another one has serum ferritin concentration below normal. Three patients have folic acid deficiency. Vitamin B12 absorption is normal in all patients. Although we can not conclude this is a better procedure than others, with is use we have obtained satisfactory results, with an excellent survival, scanty morbidity, a rapid return of bowel function and continence, and an acceptable physical development. During long-term follow-up, patients mus be evaluated for iron and folic acid deficiency.
Child↗
Incidence and characterization of secondary myelodysplastic syndromes following autologous transplantation.
BACKGROUND AND OBJECTIVE: Secondary myelodysplastic syndromes (sMDS) and secondary acute myeloid leukemias (sAML) have been observed after conventional chemo/radiotherapy and autologous hematopoietic stem cell transplantation. The aim of the present study was to analyze Spanish experience regarding the incidence and characteristics of sMDS and sAML following autologous transplantation. DESIGN AND METHODS: We obtained information from 7 institutions which perform autologous transplantation in Spain. Data from 1,081 and 1,411 patients who had received allogeneic and autologous transplantation, respectively, were available. RESULTS: None of the allografted patients had developed a sMDS/sAML so far. Thirteen cases of sMDS/sAML following autologous transplantation were reported. The mean age of these 13 patients at the time of transplantation was 40 years (range 16-58). Five had non-Hodgkin's lymphoma, 6 had Hodgkin's disease, 1 had acute myeloblastic leukemia and 1 had multiple myeloma. The crude overall incidence of sMDS/sAML was 0.9%. The incidence did not differ according to the source of progenitor cells (1% and 0.8% for bone marrow and peripheral blood, respectively). Cytogenetic analysis showed clonal abnormalities in 11 of the 13 cases. Patients with sMDS/sAML had received more doses of alkylating agents than non-sMDS patients (p = 0.0015). The median time between transplantation and diagnosis of sMDS/sAML was 28 months (range 1.5-63). This time was significantly longer for patients who received bone marrow than for those who received peripheral blood (45 versus 18 months, p = 0.01). Median overall survival after diagnosis of sMDS/sAML was 13 months. INTERPRETATION AND CONCLUSIONS: The crude incidence of sMDS/sAML in our series was similar to other published incidences. We did not find any difference in incidence between patients who had received bone marrow or peripheral blood; however, the medi an time elapsed between transplantation and sMDS diagnosis was shorter when peripheral blood was infused. Higher doses of alkylating agents were associated with the appearance of sMDS/AML.
Acute Disease↗
[Usefulness of anorectal manometry in the neonatal diagnosis of Hirschsprung disease].
During 1992 through 1998 anorectal manometry studies have been carried out on 32 newborn, with age between 48 hours and 28 days and weight range of 1,400 and 4,200 g at the test moment. The test has been prescribed due to a retard in meconial evacuation in the 32 patients, moreover, 13 out of them also presented an intestinal obstruction or subobstruction. The anorectal manometry is carried out with a probe especially designed by us for newborn and a Hellige polygraph. Presence or absence or rectoanal inhibitory reflex (RAIR) is assessed. The test is repeated after one and three weeks from the first study in the cases of RAIR absence. A barium enema was carried out in case of RAIR absence. The RAIR was present in 20 out of the 32 newborn, which allowed the exclusion of Hirschsprung's disease (HD) in these patients. Of the remaining 12 patients, in 11 it was shown the absence of RIAR in the first anorectal manometry study, making it possible the early diagnosis of HD in 9 patients and transient functional obstruction of the colon in 2 newborns. This former diagnosis was corroborated by the findings of the enema, which showed a small left colon and by the presence of RAIR in a later anorectal manometry control. There was a doubtful case in the first study, showing later the absence of RAIR. The first enema in 10 newborn with HD was considered normal in 3 cases and with transitional zone in 4 newborns and microcolon in 1 case.
Hirschsprung Disease↗
Parenteral administration of different amounts of branch-chain amino acids in septic patients: clinical and metabolic aspects.
OBJECTIVE: To study the effects of a total parenteral nutrition solution changing branch-chain amino acid concentrations and/or nitrogen supply on protein metabolism, length of stay, and mortality rate; and to evaluate the unique metabolic status of sepsis that leads to a search for specific total parenteral nutrition formulas. DESIGN: Prospective, randomized, and multicenter study. SETTING: Intensive care units (ICUs) in seven university hospitals. PATIENTS: Sixty-nine septic patients. MEASUREMENTS AND MAIN RESULTS: The patients were randomized into three groups according to the total parenteral nutrition administered. Group A (n = 22) and B (n = 25) patients received 1.5 g of amino acids/kg/day with a nonprotein ratio of 100:1 calories/g of nitrogen, and a varying branch-chain amino acids percentage (group A [23%); group B [45%]). Group C patients were treated with 1.1 g/kg/day of amino acids with a nonprotein ratio of 140:1 calories/g of nitrogen and 45% branch-chain amino acids. All diets were isocaloric. Prealbumin, retinol-binding protein, nitrogen balance, and plasma amino acid profiles (24 amino acids) were determined at baseline and after 3, 7, and 11 days of total parenteral nutrition. The length of stay and the mortality rate in the ICU were recorded. At baseline (preparenteral nutrition), no differences in age, gender, severity of the condition, or clinical chemistry were found between the groups. Prealbumin and retinol-binding protein increased in groups B (p < .004, p < .002, respectively) and C (p < .001, p < .002, respectively). Plasma arginine increased significantly in group C (p < .05), and plasma valine (p < .0001, p < .04, respectively), leucine (p < .005, p < .03, respectively), and isoleucine (p < .001, p < .0001, respectively) increased significantly in groups B and C. The length of stay in the ICU did not change between the groups. The mortality rate in groups B and C was less than in group A (p < .03). CONCLUSIONS: Our results suggest that the branch-chain amino acids-rich formulas (45%) show a beneficial effect in septic patients.
Amino Acids↗
[Pancreatic pseudocyst. Review of 22 cases].
The management of 22 children with pseudocyst of the pancreas presenting over a 15-year period at three pediatric Hospitals is reviewed. The mean age of patients was 7 years being more common in boys (17:5). Ninety one per cent were due to trauma, while in 9% the cause was unknown. Vomiting (81.8%), abdominal pain (77.2%), a mass (72.7%), fever (31.8%) and anorexia (31.8%) were the most frequent findings. The diagnosis was confirmed by finding hyperamylasemia (elevated in 72.7% of cases), by barium meal and ultrasound. Operative treatment included external drainage in 4 children, cystgastrostomy in 9, cystjejunostomy in 6, and excision in 1. One patient was successfully managed nonoperatively and another had spontaneous gastric drainage. There were no deaths or significative complications in this series.
Abdominal Pain↗
[Management of fecal continence disorders after surgery of anorectal malformations].
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Child↗
Idiopathic eosinophilic synovitis. Case report and review of the literature.
Eosinophilia of synovial fluid is an uncommon condition. The majority of the reported cases are associated to diseases such as rheumatoid arthritis, parasitic disease, hypereosinophilic syndrome, Lyme disease, and allergic processes as well as hemarthrosis and arthrography. Presently there are only four cases of eosinophilic synovitis with unknown cause. We are reporting a patient with oligoarthritis of the knees, massive eosinophilia, and Charcot-Leyden crystals in synovial fluid without associated cause. We review the clinical and biological features of eosinophilic synovitis and discuss its pathogenesis.
Adolescent↗
[Effects of several methods of thoracic drainage on respiratory function].
UNLABELLED: The object of this study was to verify the influence on the pulmonary function of the pleural space ampliation with pleural drainage tube underwater seal, with several volumes or with variables negative pressures. We performed 42 New Zealand white rabbits of both sexes with an average age of 57 +/- 9.31 days and an average weight of 1720 +/- 181 g. The experimental protocol consisted of study group: P1 (n = 14) was performed a unilateral thoracostomy at the 5th. Intercostal space and P2 (n = 14) with bilateral pleural drainage. The pleural drainage tube (drain trocart ORX Vygon number 8) connected at small bottle (Fp), with 35 ml of extrapleural volume and at big bottle (FG) with 3940 ml of extrapleural volume and vacuum suction of various negative pressures (-5, -10, -15 and -20 cm H2O). CONTROL GROUP: C1 (n = 7) with unilateral pleural drainage clamped and C2 (n = 7) with bilateral pleural drainage clamped. Anesthesia was induced with ketamine hydrochloride (7.5 ml/Kg) and propionilpromazyne (1.5 ml/Kg) intramuscular cocktail and after maintained with bolus injection of 1/4 induction dose. We studied the mortality, the the fluctuations of drain hydrostatic column, heart rate (FC), respiratory rate (FR) and blood gas tensions, after cannulation of right jugular vein and during the different phases of experimental design. Venous blood samples were obtained for pO2, pCO2 and pH measurements were repeated at 5' in both groups. The 50% of animals died in the P2 group during the drainage pleural of FG. The fluctuation of column of Fp was similar in both groups: P1 = 6.39 +/- 1.0, with a decrease of 0.64 +/- 0.23 and P2 = 6.37 +/- 1.29, with a decrease of 0.63 +/- 0.28, respectively. The vacuum suction of pleural cavity may produce a FR fall which recovery fast. The bilateral pleural drainage with negative pressures produced decreases of pCO2 and pO2. There is not modifications of Acid Base Balance in the experimental groups. We concluded that during bilateral pleural underwater seal connected a FG, because the increase of extrapleural space may produce a high mortality and a fall of respiratory rate with fast recovery. Also the pleural suction improved the CO2 diffusion into the alveolus. There is not modifications of pO2 in P1 group or decrease in the P2 group.
Animals↗
Comparative neurotransmitter reuptake and anticholinergic potencies of the 8-hydroxy metabolites of clomipramine.
We hypothesize that 8-hydroxy-clomipramine (8-OH-CMI), the major hydroxy metabolite of clomipramine (CMI), may have antidepressant properties with less anticholinergic potency than CMI. We compared the potencies of 8-OH-CMI and CMI for inhibition of serotonin and norepinephrine reuptake and the potencies of these compounds for blockade of muscarinic receptors. We also compared the antimuscarinic potencies of desmethylclomipramine (DCMI) and 8-hydroxy-desmethylclomipramine (8-OH-DCMI). We found that 8-OH-CMI inhibits the uptake of serotonin and norepinephrine to the same extent as CMI and that 8-OH-CMI has far less antimuscarinic potency than CMI. We also found that 8-OH-DCMI has about one-tenth the antimuscarinic potency of DCMI. Since the therapeutic efficacy of CMI may be related to its effect on the reuptake of neurotransmitters, and since the extent of clinical anticholinergic effects of tricyclic antidepressants has been shown to be related to their in vitro antimuscarinic potencies, these results raise the possibility that 8-OH-CMI may be an analogue of CMI with fewer anticholinergic side effects than the parent compound.
Animals↗