Biomedical subjects
Publications and source records attributed to R Palma.
Overdose of paracetamol is associated to varying degrees of hepatic necrosis and may lead to severe hepatic failure. In this paper, we report 2 patients with paracetamol overdose for suicidal purposes who were successfully treated using the antidote N-acetyl-cysteine orally. A brief analysis of the literature follows.
The clinical records and the ultrasound findings of 48 patients studied because of a presumptive diagnosis of acute appendicitis in a one-year period were reviewed. Ultrasound examination was performed using graded compression and high resolution probes when acute appendicitis was suspected and the clinical history or physical examination was unclear. The ultrasound findings were correlated with the clinical course or surgical and pathological findings. This procedure was useful in the diagnosis of acute appendicitis, with 84.6% sensibility and 95.5% specificity. Predictive value for positive results was 95.7% and 84% for negative results. These figures agree with results previously communicated in the literature. It is concluded that high resolution ultrasonography is useful in the differential diagnosis of atypical acute appendicitis.
To establish the epidemiology of viral hepatitis B (HBV) infection in hospital staff the sera of 2462 workers and 176 professional nursing students were examined. The prevalences of HBsAg and anti-HBs among the workers were 4.5 and 42.2% and among the students were 2.3 and 15.3%, respectively. The risk of infection showed a correlation with the profession of the hospital workers, the various jobs carried out in different departments, age, and the number of working years. The anti-hepatitis vaccination with HBVax and HEVAC-B vaccines was used on 142 professional students and 996 hospital workers. Five years after the beginning of the vaccine cycle the percentage of responders observed among the students was 75 (HBVax) and 79% (HEVAC-B). Among the hospital staff the response registered was 66 and 71%, respectively. The best recorded response among the youngest subjects suggests that the anti-hepatitis vaccination should be obligatory for hospital workers at the beginning of their working period or professional training.
Intrahepatic cholestasis of pregnancy is characterised by clinical and biochemical fluctuations and further diagnostic tools are required. The aim of this study was to investigate serum copper and copper oxidase during the course of intrahepatic cholestasis of pregnancy (ICP). Twenty eight ICP patients and twenty healty pregnant women were included. Routine liver tests, fasting serum bile acids (FSBA), serum copper and serum copper oxidase were measured. In ICP, serum copper was significantly higher than in controls (274 +/- 49 micrograms/dl vs 176 +/- 34 micrograms/dl, p less than 0.001). Copper oxidase rose in ICP (78 +/- 15 mg/dl) different than healthy pregnant women (64 +/- 8 mg/dl); p less than 0.02. In contrast to marked oscillations in FSBA, serum copper remained elevated during the follow-up with only minor fluctuations and no correlation was demonstrated between changes in FSBA and those noted in serum copper (r:0.17, NS). At labor, a significant rise in serum copper was demonstrated in ICP (from 251 +/- 50 micrograms/dl to 297 +/- 55 micrograms/dl, p less than 0.01) and in controls (from 168 +/- 34 to 192 +/- 42 micrograms/dl, p less than 0.01). This increment in serum copper was associated with a peak in serum copper oxidase activity. Serum copper and copper oxidase are elevated in ICP and may be considered as adjuvant diagnostic tests. Disturbances in copper metabolism reported in this study are consistent with the hypothesis that normal pregnancy is associated with a mild cholestasis effect and ICP represent a form of improperly controlled response.
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1 Study I evaluated the absorption of oxprenolol in the ileum, compared to jejunum, in healthy volunteers by an intestinal perfusion technique. Around 80 mg of drug were delivered as a saline solution directly in the small bowel. 2 Samples taken 30 cm distally to the site of perfusion showed that 63% of perfused oxprenolol was absorbed in the jejunum and 48% in the ileum; the differences were significant. 3 The plasma concentration-time profiles were similar for the two perfusions. The AUC and Cmax values of free and conjugated oxprenolol for the jejunal perfusion were significantly lower than those of ileum. They showed large but consistent intersubject variations in the two treatments. 4 Study II investigated, using the same technique, the influence of nutrients and digestive secretions on jejunal absorption and systemic availability of this drug. A saline (in treatments A and B) or a nutrient (in treatment C) solution containing oxprenolol was perfused into the jejunum below a balloon either inflated (A) or deflated (B and C). 5 The disappearance rate of oxprenolol from the jejunum was unaffected by endogenous secretions. The mean amount of drug absorbed along a 30-cm jejunal segment accounted for 52 (A) and 57% (B) of the total amount perfused. The intestinal absorption rate was markedly increased in the presence of nutrients (mean amount absorbed 96% for C). 6 The change in the rate of disappearance from the intestine had no effect on the systemic availability of oxprenolol (mean AUC values 8740, 8250 and 8020 nmol l-1 h for A, B and C, respectively) or its elimination from plasma.(ABSTRACT TRUNCATED AT 250 WORDS)
The influence of bile salts and lipids on the intestinal absorption of griseofulvin has been studied in 11 healthy male volunteers by the intestinal perfusion technique. The drug in a nutrient solution (Realmentyl) was perfused into the second part of duodenum at 5 ml/min. Intestinal samples were taken continuously at 1 ml/min, 20 cm (at the angle of Treitz) and 45 cm distal to the perfusion point. To study the effect of lipids on griseofulvin absorption, the drug was perfused with solutions A and B, of which B contained a total lipid and caloric load three times that of A. The influence of bile salts on griseofulvin absorption was examined by perfusing the drug on Day 1 with bile salts and again on the following day after bile salt depletion. Bile salts and a varying quantity of lipid perfusate had no significant influence on the duodeno-jejunal griseofulvin absorption rate per cm of intestine. Lipids, however, may still play a role in griseofulvin absorption along the entire intestine.
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The effect of the presence of food in the intestinal lumen on fluid transport by an intestinal loop isolated from nutrients is debatable and seems to be species dependent. The aim of the present study was to investigate this effect in humans. Fluid and ion transport by a 30-cm-long jejunal loop was measured by the perfusion of a plasmalike electrolyte solution below an occlusive balloon inflated at the angle of Treitz. At the same time, the duodenum was infused at the papilla by saline (control period) or one of the following solutions (test period): protein hydrolysate, starch hydrolysate, lipids, or mixed nutrients. The four solutions (pH 7; 300 mosmol/L; 540 kcal/L) were infused in 6 normal subjects in a randomized order. In 6 further subjects, two other loads of intraduodenal lipids (120 and 1080 kcal/L) were tested according to a similar protocol. Blood samples were taken serially for radioimmunoassays of gastrin, secretin, cholecystokinin, pancreatic polypeptide, gastric inhibitory polypeptide, vasoactive intestinal polypeptide, motilin, and somatostatin. Intraduodenal mixed nutrients, proteins, and lipids significantly reduced water and ion jejunal net absorption or induced a net secretion (without dose-effect relationship for lipids) and stimulated plasma cholecystokinin, pancreatic polypeptide, and gastric inhibitory polypeptide. Intraduodenal lipids also stimulated circulating levels of gastrin and vasoactive intestinal polypeptide. Intraduodenal sugars did not change jejunal fluid and ion transport and significantly increased plasma gastric inhibitory polypeptide. Covariance analysis showed transjejunal fluid movements to be linked with plasma levels of cholecystokinin. We conclude that an intraduodenal mixed meal exerts a secretory effect on a jejunal loop isolated from the nutrients and that this effect is due to the lipid and protein content of the meal; our data are compatible with a mediation of this phenomenon by cholecystokinin.
The effect of three concentrations of high-methoxy apple pectin (5, 10, and 15 g), on solid-liquid meal digestion was studied in 12 healthy men by the gastrointestinal intubation technique. The gastric emptying of water and carbohydrates is significantly reduced only after 10 and 15 g pectin. The changes in gastric pH are similar for pectin-free and pectin-containing meals. Cumulative lipase and trypsin outputs are not significantly different with and without pectin. When gastric uronic acid concentration is above 6 g/l, the duodenal absorption of carbohydrates is significantly reduced (p less than 0.001). The mean blood glucose levels with 10 and 15 g pectin are significantly higher than the control values at 180 min (p less than 0.05). Pectin does not modify serum concentrations of secretin, cholecystokinin (CCK), vasoactive intestinal polypeptide (VIP), gastric inhibitory polypeptide (GIP), and somatostatin but serum motilin and gastrin levels are below the control values after high fiber meal.
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The early appearance of cholesterol gallstones is very common in Chile. To elucidate the mechanisms involved in this phenomenon, the size of the bile acid pool and the secretion of biliary lipids were studied in two groups of young women with normal weights and radiologically functioning gallbladders: nine with cholesterol gallstones and 14 healthy volunteers. The bile acid pool was similar in control and gallstone patients. The secretory rates of bile acids and phospholipids were comparable and significantly correlated in both groups. On the other hand, cholesterol output was higher in gallstone patients. In controls there was a significant correlation between the output of bile acids and cholesterol, but no correlation was found in the gallstone group. This study suggests that cholesterol hypersecretion into the bile is a major factor in the pathogenesis of cholesterol gallstone disease in young Chilean women with normal weights.
The relationship between changes in intestinal lactase activity and monosaccharide uptake was studied in rats of different ages using the technique of intestinal everted sacs. In the postweaning period there is a sharp decrease in the rate of glucose and galactose uptake by the small intestinal mucosa. This change occurs simultaneously with a decrease in lactase activity in the tissue. The kinetic analysis showed a lower Vmax for monosaccharide uptake in the 50-days-old rats as compared with the fifteen-days-old animals, with no change in the apparent Kt. The addition of Tris+ (40 mM) to the incubation media was found to produce a decrease in Vmax for monosaccharide uptake only in the suckling rats but not in the 50-days-old animals; the K1 remained unchanged. Tris+, at the concentration used had previously been shown to completely inhibit lactase activity in homogenates of small intestinal mucosa. These observations lead us to postulate the lactase in the suckling rat might possess a translocating role for sugar, in addition to its hydrolytic function. The decrease in sugar uptake after weaning could be explained by the disappearance of this role.
A description of the preliminary steps in establishing a food and nutrition surveillance system in a country of Central America is presented in outline. The system will provide the basis for policy formulation, program planning, and evaluation. It is organized on the basis of the participation and resources of seven national agencies and will operate at the local, regional, and central level.
Biliary lipid composition was determined in fasting gallbladder bile of 12 young and 12 elderly asymptomatic Chilean women with normal weights and recent, normal cholecystograms. The proportion of biliary cholesterol and the lithogenic index were significantly higher in elderly females. Moreover, supersaturated bile was present in 8.3% of the young and in 41.7% of the older women studied. Obesity enhances the saturation of bile in older females: lithogenic bile was found in 100% of 4 elderly, obese women with radiologically normal gallbladders. The bile acid pool and cholic acid metabolism were studied in 5 young and 4 older normal females. Both groups showed similar values of bile acid pool, cholic acid synthesis, and turnover. These results indicate that aging per se modifies the proportions of biliary lipids in Chilean women, and provide a partial explanation for the frequency of gallstones observed among them. The increment in the lithogenic index of gallbladder bile with age takes place without significant changes in bile acid metabolism, suggesting that the canalicular secretion of cholesterol increases with aging.