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Chastek B, Carrera A, Landis C, Snyder D, Abedinzadeh L, Bancroft T, Nesheim J, Kennelly M, Staskin D. Real-World Adherence to and Persistence with Vibegron in Patients with Overactive Bladder: A Retrospective Claims Analysis. Adv Ther 2024; 41:2086-2097. [PMID: 38520502 PMCID: PMC11052770 DOI: 10.1007/s12325-024-02824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Vibegron is a β3-adrenergic receptor agonist approved for overactive bladder (OAB). This analysis assessed real-world adherence and persistence with vibegron in patients with OAB, along with demographics and clinical characteristics associated with adherence and persistence. METHODS This retrospective study used the Optum Research Database to identify patients treated with vibegron from April 2021 to August 2022 (identification period). Patients had ≥ 60 days of continuous pharmacy coverage in a commercial or Medicare Advantage plan following the index fill (follow-up). Adherence was assessed as proportion of days covered (PDC) from index to end of follow-up and was defined as PDC ≥ 80%. Persistence was measured as days to discontinuation of therapy (30-day gap) or end of follow-up. Data for adherence and persistence are presented descriptively. Characteristics associated with adherence and persistence were analyzed using multivariable models among patients with medical and pharmacy benefits during the 90 days before index (baseline). RESULTS Overall, 9992 patients had a vibegron claim during the identification period; 9712 had ≥ 2 months of follow-up. Mean (SD) age was 74.2 (10.7) years; 68.2% were female. Mean (SD) PDC was 0.64 (0.34). Median (95% confidence interval) persistence was 142 (132-153) days. Of the 5073 patients who were ≥ 18 years old with continuous baseline pharmacy and medical benefits ≥ 90 days before index, 2497 (49.2%) were adherent. Patients were more likely to be adherent and persistent if they received a greater days' supply for the index fill and had baseline medication count ≥ 6. Patients were more likely to discontinue if their index copay was > $45. CONCLUSION Nearly half of the patients initiating vibegron were adherent. Factors associated with adherence and persistence were more likely to be related to prescribing practices than patient characteristics. These results suggest it may be best to follow up with patients approximately 4 to 5 months after initiating treatment with vibegron.
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Affiliation(s)
| | - Adam Carrera
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA.
| | | | - Daniel Snyder
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | - Laleh Abedinzadeh
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - Jeffrey Nesheim
- Sumitomo Pharma America, Inc. (Formerly Urovant Sciences, Inc.), 84 Waterford Dr, Marlborough, MA, 01752, USA
| | | | - David Staskin
- Tufts University School of Medicine, Boston, MA, USA
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Wang J, Ritchey ME, Reynolds K, Carbonneau M, Carrera A, Goti N, Horn JR, Girman CJ. Assessment of Codispensing Patterns of Mirabegron and Prespecified CYP2D6 Substrates in Patients with Overactive Bladder. Drugs Real World Outcomes 2023; 10:439-446. [PMID: 37219800 PMCID: PMC10491567 DOI: 10.1007/s40801-023-00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Patients with overactive bladder (OAB) experience sudden, intense urges to urinate, which may include urge urinary incontinence and nocturia. Pharmacotherapy includes β3-adrenergic receptor agonists such as mirabegron; however, mirabegron contains a label warning for cytochrome P450 (CYP) 2D6 inhibition, making coadministration with CYP2D6 substrates require monitoring and dose adjustment to avoid unintended increases in substrate concentration. OBJECTIVE To understand the codispensing patterns of mirabegron among patients using ten predefined CYP2D6 substrates with and before mirabegron dispensing. METHODS This retrospective claims database analysis used the IQVIA PharMetrics® Plus Database to assess codispensing of mirabegron with ten predefined CYP2D6 substrate groups identified on the basis of medications most frequently prescribed in the United States, those with high susceptibility to CYP2D6 inhibition, and those with evidence for exposure-related toxicity. Patients had to be ≥ 18 years old before initiation of the CYP2D6 substrate episode that overlapped with mirabegron. The cohort entry period was November 2012 to September 2019, and the overall study period was 1 January 2011 to 30 September 2019. Comparisons of patient profiles at dispensing were made between time periods with and before mirabegron use in the same patient. Descriptive statistics were used to assess the number of exposure episodes, total duration of exposure, and median duration of exposure of CYP2D6 substrate dispensing with and before mirabegron. RESULTS CYP2D6 substrate exposure periods totaling ≥ 9000 person-months were available before overlapping exposure to mirabegron for all ten CYP2D6 substrate cohorts. Median codispensing duration for chronically administered CYP2D6 substrates was 62 (interquartile range [IQR] 91) days for citalopram/escitalopram, 71 (105) days for duloxetine/venlafaxine, and 75 (115) days for metoprolol/carvedilol; median codispensing duration for acutely administered CYP2D6 substrates was 15 (33) days for tramadol and 9 (18) days for hydrocodone. CONCLUSIONS In this claims database analysis, the dispensing patterns of CYP2D6 substrates with mirabegron displayed frequent overlapping of exposure. Thus, a need exists to better understand the outcomes experienced by patients with OAB who are at increased risk for drug‒drug interactions when taking multiple CYP2D6 substrates concurrently with a CYP2D6 inhibitor.
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Affiliation(s)
| | | | - Kamika Reynolds
- CERobs Consulting, LLC, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Adam Carrera
- Urovant Sciences, 5281 California Ave, Suite 100, Irvine, CA, 92617, USA.
| | - Noelia Goti
- Urovant Sciences, 5281 California Ave, Suite 100, Irvine, CA, 92617, USA
| | - John R Horn
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
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Duperrouzel C, Martin C, Mendell A, Bourque M, Carrera A, Mack A, Nesheim J. Healthcare and economic burden of anticholinergic use in adults with overactive bladder: a systematic literature review. J Comp Eff Res 2022; 11:1375-1394. [PMID: 36354285 DOI: 10.2217/cer-2022-0160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: To determine the economic burden associated with anticholinergic medication use in adults with overactive bladder (OAB) in the USA. Methods: A systematic literature review was conducted to identify articles assessing healthcare resource utilization (HCRU) and costs associated with anticholinergic use in adults with OAB. Results: From the 34 articles identified, increased anticholinergic burden, switching anticholinergic treatments and potentially inappropriate anticholinergic use were associated with increased HCRU and/or costs. However, studies comparing patients with OAB receiving anticholinergics to individuals with untreated OAB or without OAB reported a mix of increases and decreases in HCRU and costs. Conclusion: Additional controlled studies assessing the economic impact of anticholinergics in OAB are needed and may enable optimization of economic and potentially patient outcomes.
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Morro-Martí M, Llusá-Pérez M, Forcada-Calvet P, Carrera A, Mustafa-Gondolbeu A. Anatomía Aplicada a La Cirugía de Los Tendones Extensores. Rev Iberoam Cir Mano 2019. [DOI: 10.1055/s-0039-1691778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
La anatomía de los tendones extensores de los dedos es muy variable en el dorso de la mano y la formación del aparato extensor en los dedos, junto con la musculatura intrínseca de la mano, es muy compleja. Su conocimiento preciso es imprescindible para la comprensión de la fisiopatología de las lesiones de esas estructuras y su tratamiento. Además, se tratan de lesiones muy frecuentes debido a su localización subcutánea en todo su recorrido, pero especialmente en los dedos.En el dorso de la muñeca, los tendones extensores se distribuyen en seis correderas osteofibrosas muy bien delimitadas.En los dedos, los tendones extensores extrínsecos se unen con la musculatura intrínseca de la mano (músculos interóseos y lumbricales), para formar el complejo aparato extensor. Sus componentes principales son la bandeleta central encargada de la extensión IFP y las bandeletas laterales que se acaban uniendo formando en tendón terminal responsable de la extensión IFD. Además, se encuentran unas fibras de conexión en las articulaciones MCF e IFP, las bandeletas sagitales y los ligamentos retinaculares transversos respectivamente, que unen el aparato extensor a la cara anterior del dedo manteniéndolo en eje sobre la cara convexa de las articulaciones.
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Affiliation(s)
- M.R. Morro-Martí
- Departamento de Anatomía y Embriología Humana, Laboratorio de Macro-Micro Disección y Anatomía Quirúrgica, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
- Servicio COT, Hospital Clínic de Barcelona, Barcelona, Barcelona, Spain
| | - M. Llusá-Pérez
- Departamento de Anatomía y Embriología Humana, Laboratorio de Macro-Micro Disección y Anatomía Quirúrgica, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
- Servicio COT, Hospital Clínic de Barcelona, Barcelona, Barcelona, Spain
| | - P. Forcada-Calvet
- Servicio COT, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - A. Carrera
- Unidad de Anatomía, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - A. Mustafa-Gondolbeu
- Departamento de Anatomía y Embriología Humana, Laboratorio de Macro-Micro Disección y Anatomía Quirúrgica, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
- Servicio COT, Hospital Clínic de Barcelona, Barcelona, Barcelona, Spain
- Servicio COT, Hospital Universitario Arnau de Vilanova, Lleida, Spain
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Carrera A, Sherring J, McNally L, Lowe P, Cunningham PH. P15.05 Performance evaluation of the aptima hiv-1 quant dx assay for detection of hiv-1 in plasma and dried blood spots (dbs). Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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McNally L, Carrera A, Sherring J, Cunningham PH. P17.01 Performance evaluation of the genexpert hiv-1 quant assay for detection of hiv-1 in plasma. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The authors evaluated the photographic Brückner test for its ability to detect the main causes of amblyopia. One hundred four patients divided into four groups underwent this test: Group I, small deviation esotropia; Group II, large deviation esotropia; Group III, anisometropia; and Group IV, healthy controls. The results show high sensitivity (82%), specificity (91%), and accuracy (84%), indicating that this test could be a potential way to mass-screen pre-verbal and pre-school children to facilitate early detection of the main causes of amblyopia, when treatment is still possible.
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Affiliation(s)
- A Carrera
- Department of Ophthalmology, University of Valladolid, Valladolid, Spain
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Alonso A, Bahillo A, de la Rosa R, Carrera A, Durán RJ, Fernández P. Measurement procedure to assess exposure to extremely low-frequency fields: a primary school case study. Radiat Prot Dosimetry 2012; 151:426-436. [PMID: 22456991 DOI: 10.1093/rpd/ncs026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
How to correctly measure the exposure of general public to extremely low-frequency (ELF) radiation is a key issue for ELF epidemiological studies. This paper proposes a measurement procedure to accurately assess the exposure of people to electric and magnetic field in the frequency band from 5 Hz to 100 kHz in buildings and their premises. As ELF radiation could be particularly harmful to children, the measurement procedure is focused on exposure to ELF in schools. Thus, the students' exposure to ELF fields can be assessed by correlating the ELF measurements to the hours of school activity. In this paper, the measurement protocol was applied to study the ELF exposure on students from García Quintana primary school in Valladolid, Spain. The campaign of measurements for ELF exposure assessment in this primary school was of great interest for the Regional Council of Public Health because of the social alarm generated by the presence of a significant number cancer cases in children.
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Affiliation(s)
- A Alonso
- Department of Signal Theory and Communications and Telematic Engineering, University of Valladolid. Paseo de Belén 15, 47011, Valladolid, Spain
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Carrera A, McClements PL, Watling C, Libby G, Weller D, Brewster DH, Carey FA, Fraser CG, Steele RJC. Negative screening colonoscopy after a positive guaiac faecal occult blood test: not a contraindication to continued screening. Colorectal Dis 2012; 14:943-6. [PMID: 21981347 DOI: 10.1111/j.1463-1318.2011.02849.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM In guaiac faecal occult blood test (gFOBT) screening at least 50% of positive individuals will have a colonoscopy negative for colorectal neoplasia. The question of continuing screening in this group has not been addressed. METHOD Data on participants aged 50-69 years with a positive gFOBT result and a negative colonoscopy were followed through the biennial screening pilot conducted between 2000 and 2007 in Scotland. RESULTS In the first screening round, 1527 colonoscopies were negative for neoplasia. 1300 were re-invited in the second round, 905 accepted, and 157 had a positive gFOBT result, giving a positivity rate of 17.4%. Colonoscopy revealed 20 subjects with adenoma and six with invasive cancer. In the third screening round 1031 were invited for a third time and 730 accepted: 55 had a positive gFOBT test, giving a positivity rate of 7.5%. In this group, six colonoscopies revealed adenomas but there were no cancers diagnosed. In the third screening round, 108 individuals had had two positive gFOBT results and two subsequent negative colonoscopies. Eighty-four were invited for a third gFOBT, 66 accepted and 19 (25.6%) had a positive result none of whom had an adenoma or carcinoma. CONCLUSION These data indicate that a negative colonoscopy following a positive gFOBT is not a contraindication for further screening, although this is likely to have a low yield of neoplastic pathology after two negative colonoscopies.
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Affiliation(s)
- A Carrera
- Department of Surgery, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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10
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Sala Blanch X, López AM, Carazo J, Hadzic A, Carrera A, Pomés J, Valls-Solé J. Intraneural injection during nerve stimulator-guided sciatic nerve block at the popliteal fossa. Br J Anaesth 2009; 102:855-61. [PMID: 19420006 DOI: 10.1093/bja/aep097] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exact location of the needle tip during nerve stimulation-guided peripheral nerve blocks is unknown. Using high-frequency ultrasound imaging, we tested the hypothesis that intraneural injection is common with nerve stimulator-guided sciatic nerve (SN) block in popliteal fossa. METHODS Forty-two patients scheduled for hallux valgus repair were studied. Sciatic block at the popliteal fossa was accomplished using nerve stimulation. When a motor response was elicited at <0.5 mA (2 Hz, 0.1 ms), 40 ml of local anaesthetic (LA) was injected. Using ultrasound (Titan, Sonosite, 5-10 MHz), the diameters and area of the SN were measured before and after the injection. The presence of nerve swelling and proximal or distal diffusion of LA were also assessed. Intraneural injection was defined as nerve area (NA) increase of > OR =15% and one or more additional ultrasonographic markers (nerve swelling, proximal-distal diffusion within epineural tissue). Clinical neurological evaluation was performed 1 week after the block. RESULTS Post-injection NA increase > OR =15% was seen in 32 (76%) patients [0.54 (SD 0.19) cm(-2) vs 0.76 (0.24) cm(-2); P<0.05]. Nerve swelling with fascicular separation was observed in 37 (88%) patients; proximal and distal diffusion of LA were present in six (14%) and 14 (38%) patients, respectively. Intraneural injection criteria were met in 28 (66%) patients. Greater NA increase was present in patients with fast block onset [61 (45) vs 25 (33)%; (Dif 35% 95% CI 61-9%); P<0.05]. No patient developed neurological complications. CONCLUSIONS Intraneural (subepineural) injection is a common occurrence after nerve stimulator-guided SN block at the popliteal fossa, yet it may not inevitably lead to neurological complications.
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Affiliation(s)
- X Sala Blanch
- Department of Anesthesiology, Hospital Clinic, Universitat de Barcelona, C/Villarroel 170, Barcelona 08036, Spain.
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Carrera A, Nielsen IB, Carçabal P, Dedonder C, Broquier M, Jouvet C, Domcke W, Sobolewski AL. Biradicalic excited states of zwitterionic phenol-ammonia clusters. J Chem Phys 2009; 130:024302. [PMID: 19154023 DOI: 10.1063/1.3054292] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Phenol-ammonia clusters with more than five ammonia molecules are proton transferred species in the ground state. In the present work, the excited states of these zwitterionic clusters have been studied experimentally with two-color pump probe methods on the nanosecond time scale and by ab initio electronic-structure calculations. The experiments reveal the existence of a long-lived excited electronic state with a lifetime in the 50-100 ns range, much longer than the excited state lifetime of bare phenol and small clusters of phenol with ammonia. The ab initio calculations indicate that this long-lived excited state corresponds to a biradicalic system, consisting of a phenoxy radical that is hydrogen bonded to a hydrogenated ammonia cluster. The biradical is formed from the locally excited state of the phenolate anion via an electron transfer process, which neutralizes the charge separation of the ground state zwitterion.
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Affiliation(s)
- A Carrera
- University of Buenos Aires, Ciudad Universitaria, 3er piso, Pab. II, 1428 Buenos Aires, Argentina
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Ballesteros JR, Carrera A, Méndez A, Forcada P, Morro MR, Llusá M. Variaciones anatómicas de la muñeca y mano en imágenes. Rev Iberoam Cir Mano 2007. [DOI: 10.1055/s-0037-1606701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Dada la complejidad de la cirugía en la mano y la frecuente aparición de variaciones anatómicas en este territorio, que se apartan de las descripciones de los clásicos atlas o libros de texto, pretendemos mostrar en imágenes y describir distintas variaciones anatómicas de la muñeca y mano en disecciones realizadas y fotografiadas durante los últimos 10 años en la sala de disección del Departamento de Anatomía y Embriología Humana (Facultad de Medicina, Universidad de Barcelona) en 100 especímenes. Las variaciones se han clasificado según su componente anatómico: arterias, nervios, tendones y músculos. Se ha realizado una descripción breve de la variación. La intención es llamar la atención sobre la posibilidad de la existencia de variaciones anatómicas a nivel de los diferentes componentes de la mano, para así evitar posibles lesiones durante los abordajes de la muñeca y de la mano.
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Affiliation(s)
- J. R. Ballesteros
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
- Hospital Clínic de Barcelona
| | - A. Carrera
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
| | - A. Méndez
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
| | - P. Forcada
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
- Hospital Arnau de Vilanova. Lleida
| | - M. R. Morro
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
- Hospital Clínic de Barcelona
| | - M. Llusá
- Laboratorio de Macro-Microdisección y Anatomía Quirúrgica, Departamento de Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Barcelona
- Hospital Vall d’Hebrón. Barcelona
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Morros C, Pérez-Cuenca MD, Sala-Blanch X, Carrera A. [Endoscopic anatomy of the axillary brachial plexus: examination of cadavers and implications for anesthesia]. Rev Esp Anestesiol Reanim 2007; 54:268-73. [PMID: 17598716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To identify the structures of the brachial plexus using fiberoptic techniques, determine the most useful approach, and visualize the introduction of instruments used in anesthesia. MATERIAL AND METHODS Formalin-treated a ndcryopreserved cadavers were studied with a 4-mm fiberoptic endoscope, an arthroscope for small joints, and nerve-stimulation needles through which a catheter could be introduced. The arm and elbow were dissected to isolate the humeral artery and the medial, radial, and cubital nerves. The fiberoptic endoscope was advanced along each nerve until the axilla, where the neurovascular structures of the plexus were identified. The axilla was punctured with a nerve stimulation needle and the catheter was passed through the needle while its movement was observed with the fiberoptic endoscope. Then, the axilla was punctured with the arthroscope as if it were the needle. RESULTS In cryopreserved and formalin-treated cadavers, the fiberoptic endoscope could be passed as far as the axilla by following the medial nerve but not by following the cubital or radial nerves. We were able to identify the humeral artery and medial nerve in the axilla and to observe entry of the needle and progression of the catheter. The arthroscope could be introduced in the axilla as if it were a needle and the humeral artery and medial nerve could be identified. CONCLUSIONS The inside of the neurovascular bundle of the brachial plexus can be visualized using afiberoptic endoscope advanced from the elbow or using an arthroscope introduced in the axilla. Although we are a long way from being able to see what we are doing, this is a first step towards direct visualization of the major structures of the axillary brachial plexus.
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Affiliation(s)
- C Morros
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Midat Cyclops Mutual, Barcelona.
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García Páez JM, Carrera A, Jorge E, Millán I, Cordón A, Rocha A, Maestro M, Castillo-Olivares JL. Hysteresis of a biomaterial: influence of sutures and biological adhesives. J Mater Sci Mater Med 2007; 18:715-24. [PMID: 17136602 DOI: 10.1007/s10856-006-0009-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Accepted: 12/30/2005] [Indexed: 05/12/2023]
Abstract
We studied the changes in energy consumption of samples of calf pericardium, when joined or not joined by sutures and adhesives, by means of hysteretic cycles. Sixty-four samples were subsequently subjected to tensile stress until rupture. An overlapping suture sewn in the form of a rectangle presented an acceptable mean resistance to rupture of over 10 MPa, although lower than the mean values in an unsutured control series where the mean resistance surpassed 15 MPa. The contribution of an acrylic adhesive to the resistance to rupture was negligible. The sutured samples that were reinforced with adhesives and had not been subjected to hysteretic cycles prior to rupture showed an anisotropic behavior. This behavior appeared to be lost in all the samples that underwent hysteretic cycles. We found an inflection point in the stress/strain curve following the stepwise increase in the load, with a value greater than and proximate to the final load applied. This inflection should be analyzed by means of microscopy. Finally, the mathematical relationship between the energy consumed and the stress applied, the strain or deformation produced and the number of cycles of hysteresis to which the samples were subjected was established as the ultimate objective of this study. The bonding systems provoked a greater consumption of energy, with the greatest consumption corresponding to the first cycle in all the series assayed. An equation relating the energy consumption in a sample to the number of hysteretic cycles to which it was subjected was obtained. Its asymptote on the x-axis indicates the energy consumption for a theoretical number of cycles, making it possible to estimate the durability of the sample.
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Affiliation(s)
- J M García Páez
- Servicio de Cirugía Experimental, Clínica Puerta de Hierro, Madrid, Spain.
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Landin L, Cavadas P, Navarro C, Carrera A, Fontdevila J, de Francia S, Berenguer B. Comparative anatomy of the facial/scalp flap of a range of mammals. J Plast Reconstr Aesthet Surg 2007. [DOI: 10.1016/j.bjps.2007.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Di Paolo N, Garosi G, Carrera A, Monaci G, Sansoni E, Romolini V, Gaggiotti E, Nicolai GA. Evaluation of exercise testing for subjects with isolated proteinuria and/or hematuria of unclear significance. Eur J Intern Med 2007; 18:135-40. [PMID: 17338966 DOI: 10.1016/j.ejim.2006.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 08/28/2006] [Accepted: 09/19/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND A frequent problem that family doctors face is the meaning of small quantities of blood or protein in urine samples. Patients with this problem are often either neglected or referred to specialists for complex, expensive, and often invasive diagnostic procedures. Exercise testing has never been considered in nephrology, except for some attempts in diabetic patients. METHODS We report on a study conducted over 12 years with patients referred for slight hematuria and/or proteinuria to determine whether exercise testing could be a diagnostic aid in some or all of them. We performed exercise testing using a treadmill preceded and followed by urine analysis, with a kidney biopsy within 10 days. Of the 94 patients enrolled in the study, only those with a positive exercise test turned out to have parenchymal nephropathy. At the end of the study, we simplified the quantification of exertion, dispensing with the treadmill and drastically reducing the number of urinary parameters considered. RESULTS In patients with histological evidence of kidney damage, most of the variables increased significantly after the test. Statistical analysis also showed that determination of proteinuria and hematuria alone guaranteed maximum predictability. We found that it is also possible to simplify the quantification of effort/exertion and to drastically reduce the number of urinary parameters and still obtain significant results. CONCLUSIONS Exercise testing provides useful information about the significance of microhematuria and proteinuria, reducing the number of cases that need to be referred to specialists. The method needs to be validated in other studies, but our results suggest that family doctors could use simple dipsticks to screen the many cases of microhematuria or proteinuria observed in daily practice. The method seems useful in eliminating doubts and unnecessary diagnostic costs.
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Affiliation(s)
- N Di Paolo
- Nephrology, Dialysis, and Transplantation DPT, University Hospital of Siena, Viale Bracci, 53100 Siena, Italy
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Lamas C, Carrera A, Proubasta I, Llusà M, Majó J, Mir X. The anatomy and vascularity of the lunate: considerations applied to Kienböck’s disease. ACTA ACUST UNITED AC 2007; 26:13-20. [PMID: 17418764 DOI: 10.1016/j.main.2007.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 12/14/2006] [Accepted: 01/14/2007] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to assess the anatomy and vascularity of the lunate. The genesis of lunatomalacia requires some combination of vascular risk and mechanical predisposition. The findings will be correlated with the major existing theories of the cause of Kienböck's disease. METHODS We studied 27 cadaver upper limbs using latex injection and the Spalteholz technique. We investigated the blood supply to the lunate. In 24 wrists we evaluated the incidence and distribution of anatomic features, arthrosis, and soft tissue lesions. We correlated the lunate morphology and ligaments disruptions with the arthritic changes. RESULTS The lunate morphology results as classified by Antuña-Zapico were five type I (20.8%), 18 type II (75%) and one type III (4.2%). The lunate was found to have a separate facet for the hamate in 11 cases (45.8%). The most common size of the facet was found to be 3 mm (range, 3-6 mm). Arthrosis was identified with most frequency in the radius (88.2%) and lunate (94.1%). The triangular fibrocartilage complex was found torn in 58.3%, the lunotriquetral interosseous ligament was torn in 20.8% and the scapholunate interosseous ligament (SLIL) was torn in 54.2% of the wrists. There was a correlation between the presence of arthrosis at the hamate and the presence of a lunate facet (P=0.027) and a correlation between the presence of a tear in the SLIL and arthrosis in the scaphoid (P=0.002). The nutrient vessels entered the lunate through the dorsal and volar poles in all the specimens. The dorsal intercarpal and radiocarpal arches supply blood to the lunate from a plexus of vessels located directly over the lunate's dorsal pole. Vessels entered the dorsal aspect of the lunate through one to three foramina. One to five nutrient vessels were observed entering the volar pole through various ligament insertions, including the ligament of Testut-Kuentz (radio-scapho-lunate (RSL) ligament) and the radiolunate triquetrum ligament (or dorsoradial carpal ligament) and ulnar lunate triquetral ligament. CONCLUSIONS The lunate had consistent dorsal and palmar arteries entering the bone in all the specimens. The blood supply and foramina number is greater in the volar pole of the lunate than the dorsal pole. The lunate blood supply comes from different ligaments. In the etiopathogeny of Kienböck's disease it is possible that an acute or chronic, traumatic or non-traumatic injury of the vessel bearing ligaments, particularly because of their structure and the location of the RSL ligament, may have an important role in the appearance of lunate necrosis.
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Affiliation(s)
- C Lamas
- Hand Unit and Upper Extremity, Department of Orthopedic Surgery, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
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Carrera A, Echenique V, Zhang W, Helguera M, Manthey F, Schrager A, Picca A, Cervigni G, Dubcovsky J. A deletion at the Lpx-B1 locus is associated with low lipoxygenase activity and improved pasta color in durum wheat (Triticum turgidum ssp. durum). J Cereal Sci 2007. [DOI: 10.1016/j.jcs.2006.07.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Martín Tobalina J, Crespo Misas MJ, Alonso O, Carrera A, Martín E. [Mastocytosis and anesthesia: a case report]. Rev Esp Anestesiol Reanim 2006; 53:521-2; author reply 523-4. [PMID: 17125024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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21
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Llusa M, Soldado F, Carrera A, Pacha D, Morro R, Méndez A. Nervus Communicans Fibularis Pedicled Graft: Anatomic Description and Clinical Application. J Reconstr Microsurg 2006. [DOI: 10.1055/s-2006-949133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sala Blanch X, Domingo Triadó V, Bargalló X, Carrera A. [Intraneural sciatic nerve puncture in the popliteal fossa demonstrated by ultrasound]. Rev Esp Anestesiol Reanim 2006; 53:269-70. [PMID: 16711506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- X Sala Blanch
- Servicio de Anestesiología y Reanimación, Hospital Clinic, Universidad de Barcelona.
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Palazzuoli A, Lenzi C, Iovine F, Carrera A, Nuti R. A case of acute heart failure associated with Guillain-Barré syndrome. Neurol Sci 2006; 26:447-50. [PMID: 16601940 DOI: 10.1007/s10072-006-0531-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Accepted: 12/27/2005] [Indexed: 11/28/2022]
Abstract
Guillain-Barré syndrome (GBS) is a disease of the peripheral nervous system, which is caused by aberrant immune responses directed against some components of peripheral nerves. GBS is rarely accompanied by cardiovascular involvement. We describe a case of acute neuropathy complicated by sudden heart failure and left ventricular dysfunction which had a presumably neurogenic origin. Pathogenesis of acute heart failure is probably due to transitorial stunned myocardium and neurogenic cardiac injury. We show a rare case of transitorial and acute cardiac dysfunction by echocardiography and laboratory markers of heart failure.
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Affiliation(s)
- A Palazzuoli
- Institute of Internal Medicine and Metabolic Diseases, Section of Cardiology, Ospedale Le Scotte, University of Siena, Italy.
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Abstract
AIM To determine circulating transferrin receptor levels (sTfR) in Type 2 diabetic patients to evaluate whether serum ferritin reflects iron body stores or inflammation in diabetic population. METHODS A total of 84 consecutive Type 2 diabetic patients and 60 healthy subjects matched by age and gender were included in this case-control study. Ferritin concentration was measured by a turbidimetric method and sTfR concentration were determined by nephelometry. RESULTS Diabetic patients have higher serum ferritin levels than control subjects [114 ng/ml (12-831) vs. 74 ng/ml (11-697); P = 0.006]. However, no differences in sTfR concentrations were observed between both groups [1.27 mg/l (0.69-2.47) vs. 1.24 mg/l (0.77-2.80); P = NS]. A negative correlation between ferritin and sTfR concentration was detected in control subjects but not in diabetic patients. CONCLUSIONS Serum ferritin levels are increased in Type 2 diabetic patients in the absence of a reciprocal decrease of sTfR. This finding suggests that elevated ferritin levels in Type 2 diabetes are mainly as a result of inflammatory mechanisms rather than iron overload.
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Affiliation(s)
- C Hernández
- Diabetes Research Unit, Division of Endocrinology, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
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Merino-Sanjuán M, Carrera A, Monte E, Jiménez-Torres NV. Adsorption of methotrexate and calcium leucovorin onto cholestyramine in vitro. Int J Pharm 2004; 278:283-91. [PMID: 15196633 DOI: 10.1016/j.ijpharm.2004.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2003] [Revised: 03/03/2004] [Accepted: 03/13/2004] [Indexed: 11/18/2022]
Abstract
Methotrexate (MTX), an antimetabolite of folic acid, is a drug widely used in the treatment of different types of cancer. When high doses are administered, it is necessary to interrupt its action by administering calcium leucovorin (CaL). The main pathway of MTX and CaL elimination in humans occurs through the kidney, but about 10% is excreted in the faeces via the bile. Drugs, foods and sorbents in intestinal lumen modify MTX and CaL reabsorption. Individual and simultaneous studies on the adsorption of MTX and CaL from aqueous phosphate buffer by cholestyramine were carried out in order to calculate the adsorption process of MTX and CaL to cholestyramine, and to characterize the influence of CaL in the adsorption of MTX to cholestyramine and vice versa. The Langmuir binding isotherms determined in buffer solutions at pH 6 indicated a greater (12.58%) adsorption capacity of cholestyramine (1.43 mmol of drug/g of resin) than at pH 7 (1.25 mmol of drug/g of cholestyramine). The affinity constant of MTX to cholestyramine was a 45.27% higher (6.67 mM(-1)) than the affinity constant of CaL to the resin (3.65 mM(-1)). Results from simultaneous assays indicate that a displacement of the MTX bound to cholestyramine by CaL is not foreseeable. The results suggest that cholestyramine may be a potentially useful adjunctive therapy in the treatment of an overdose of MTX. Consequently, cholestyramine may be of clinical value in patients who develop early renal function impairment whilst undergoing MTX therapy.
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Affiliation(s)
- M Merino-Sanjuán
- Departamento Farmacia y Tecnología Farmacéutica, Faculty of Pharmacy, Universidad de Valencia, Avda. Vicente Andrés Estellés s/n 46100 Burjassot (Valencia), Spain.
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Palazzuoli A, Calabria P, Vecchiato L, Quatrini I, Carrera A, Bruni F, Puccetti L, Pastorelli M, Pasqui AL, Auteri A. Plasma brain natriuretic peptide levels in coronary heart disease with preserved systolic function. Clin Exp Med 2004; 4:44-9. [PMID: 15598085 DOI: 10.1007/s10238-004-0037-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We evaluated the circulating levels of brain natriuretic peptide (BNP) in stable angina, unstable angina, and myocardial infarction relating hormone levels to extension of coronary disease and number of vessels involved after angiographic examination. We studied 86 patients consecutively undergoing angiographic coronary examination and echocardiographic evaluation for coronary heart disease. These included 15 control subjects (group 0), 21 with stable angina (group I), 26 with unstable angina (group II), and 24 with non-Q myocardial infarction (group III). Patients with heart failure, a history of myocardial infarction, or recent myocardial damage with electrocardiographic S-T elevation were excluded. BNP levels in patients with unstable angina and myocardial infarction were significantly increased with respect to the group with stable angina (P<0.01). There were no differences between the groups with unstable angina and myocardial infarction. Analysis of peptide levels in relation to the number of involved vessels demonstrated a significant increase in patients with three-vessel disease compared with subjects with one or two vessels involved (P<0.03); among subjects with mono-vessel disease, patients with left descendent anterior stenosis had a more-marked BNP elevation than subjects with stenosis in other regions (P<0.01). Hence, BNP levels appear to be elevated in coronary disease, especially in acute coronary syndromes, even in the absence of systolic dysfunction. BNP levels also seem to be related to the severity of coronary atherosclerosis and number of vessels involved. BNP could prove a novel marker for risk stratification, not only in heart failure but also in coronary heart disease.
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Affiliation(s)
- A Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Ospedale le Scotte, Viale Bracci, I-53100 Siena, Italy.
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Cosme A, Ojeda E, Torrado J, Carrera A, Castiella A, Zapata E. [Liver alterations due to alpha-1-antitrypsin deficiency in adults. Study of 5 patients and analysis of the cases reported in the Spanish literature]. Gastroenterol Hepatol 2003; 26:251-6. [PMID: 12681119 DOI: 10.1016/s0210-5705(03)70349-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To determine the epidemiological characteristics of liver disease secondary to alpha-1-antitrypsin deficiency and associated processes in the Spanish population. PATIENTS AND METHOD We reviewed the medical records of adults with liver abnormalities due to alpha-1-antitrypsin deficiency diagnosed between 1981 and 2001 in the Hospital Donosti in San Sebastian (Spain) as well as the cases published in the literature before 1999. Diagnosis was based on clinical and biochemical data, imaging tests and/or liver biopsy and/or necroscopy together with serum values of alpha-1-antitrypsin and phenotyping. RESULTS Fifty cases of liver disease secondary to alpha-1-antitrypsin deficiency (45 from the literature and 5 from our hospital) were included. There were 34 men and 16 women aged between 18 and 77 years. Fifteen (30%) had relatives with alpha-1-antitrypsin deficiency. Hepatitis and/or neonatal cholestasis were confirmed in 4 and alcoholism was confirmed in 17. Of the series, 8 (16%) had portal fibrosis and 29 (58%) had cirrhosis. Cirrhosis was mainly macro-micronodular and was decompensated in 48% of the cases. Of the patients with cirrhosis, 12 were ZZ homozygotes and 12 were heterozygotes, mainly MZ and SZ. The most frequent associated process was respiratory disease (emphysema and/or chronic bronchitis) in 25 of the 50 cases (50%). CONCLUSIONS The presence of cirrhosis in alpha-1-antitrypsin deficiency is low, approximately 2.2/100,000 for ZZ homozygotes. Age at diagnosis of cirrhosis or fibrosis was more than 50 years. The male-to-female ratio was 2 to 1. In one-third of the patients alcohol could have been a coadjuvant or aggravating factor in the liver disease. No differences were found between homo- and heterozygote phenotypes in patients with cirrhosis. The most frequently associated processes were respiratory diseases due to alpha-1-antitrypsin deficiency.
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Affiliation(s)
- A Cosme
- Servicio de Aparato Digestivo. Hospital Donosti. San Sebastián. Guipúzcoa. Spain
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29
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Cosme A, Ojeda E, Torrado J, Carrera A, Castiella A, Zapata E. [Liver alterations due to alpha-1-antitrypsin deficiency in adults. Study of 5 patients and analysis of the cases reported in the Spanish literature]. Gastroenterol Hepatol 2003. [PMID: 12681119 DOI: 10.1157/13045199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To determine the epidemiological characteristics of liver disease secondary to alpha-1-antitrypsin deficiency and associated processes in the Spanish population. PATIENTS AND METHOD We reviewed the medical records of adults with liver abnormalities due to alpha-1-antitrypsin deficiency diagnosed between 1981 and 2001 in the Hospital Donosti in San Sebastian (Spain) as well as the cases published in the literature before 1999. Diagnosis was based on clinical and biochemical data, imaging tests and/or liver biopsy and/or necroscopy together with serum values of alpha-1-antitrypsin and phenotyping. RESULTS Fifty cases of liver disease secondary to alpha-1-antitrypsin deficiency (45 from the literature and 5 from our hospital) were included. There were 34 men and 16 women aged between 18 and 77 years. Fifteen (30%) had relatives with alpha-1-antitrypsin deficiency. Hepatitis and/or neonatal cholestasis were confirmed in 4 and alcoholism was confirmed in 17. Of the series, 8 (16%) had portal fibrosis and 29 (58%) had cirrhosis. Cirrhosis was mainly macro-micronodular and was decompensated in 48% of the cases. Of the patients with cirrhosis, 12 were ZZ homozygotes and 12 were heterozygotes, mainly MZ and SZ. The most frequent associated process was respiratory disease (emphysema and/or chronic bronchitis) in 25 of the 50 cases (50%). CONCLUSIONS The presence of cirrhosis in alpha-1-antitrypsin deficiency is low, approximately 2.2/100,000 for ZZ homozygotes. Age at diagnosis of cirrhosis or fibrosis was more than 50 years. The male-to-female ratio was 2 to 1. In one-third of the patients alcohol could have been a coadjuvant or aggravating factor in the liver disease. No differences were found between homo- and heterozygote phenotypes in patients with cirrhosis. The most frequently associated processes were respiratory diseases due to alpha-1-antitrypsin deficiency.
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Affiliation(s)
- A Cosme
- Servicio de Aparato Digestivo. Hospital Donosti. San Sebastián. Guipúzcoa. Spain
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García Páez JM, Carrera A, Herrero EJ, Millán I, Rocha A, Cordón A, Téllez G, Maestro M, Calero P, Castillo-Olivares JL. Mechanical behavior of chemically treated ostrich pericardium subjected to uniaxial tensile testing: influence of the suture. J Biomed Mater Res 2002; 62:73-81. [PMID: 12124788 DOI: 10.1002/jbm.10266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The mechanical behavior of sutured ostrich pericardium was studied by uniaxial tensile testing. One hundred forty-four tissue specimens were assessed: 96 sutured samples (48 in which a centrally located suture was placed at an angle of 90 degrees with respect to the longitudinal axis, whereas in the remaining 48, a centrally located suture was placed at a 45 degrees angle to the longitudinal axis, in sets of 12 samples each, sewn with sutures made of Gore-Tex, nylon, Prolene, or silk), and 48 unsutured controls. Each group of 24 samples sewn at one angle or the other with the different suture materials was assayed together with a corresponding control group of 12 unsutured samples. The mean tensile strengths in the unsutured controls ranged between 30.16 MPa and 43.42 MPa, whereas those of the sutured sets ranged from 14.68 MPa to 21.91 MPa. The latter presented a statistically significant loss of resistance (p < 0.01) when compared with the unsutured tissue samples. The angle of the suture with respect to the longitudinal axis influenced the degree of shear stress produced by the suture, as well as the behavior of the different suture materials used. The set of samples sewn with Prolene appeared to be that most sensitive to changes in the angle of the suture, whereas tissue sewn at a 45 degrees angle with Gore-Tex presented lower shear stress values in comparison with samples in which the other three materials were used. A method of tissue selection based on morphological and mechanical criteria was used to ensure the homogeneity of the results in such a way that the coefficients of determination (R2) for the stress/strain curve fitting equation ranged between 0.888 and 0.995. This excellent fit made it possible, applying regression analysis, to predict the mechanical behavior of a specimen by determining that of a contiguous tissue sample. Thus, it should be possible, at least theoretically, to characterize the behavior of a specific region or zone of the biomaterial. In conclusion, ostrich pericardium exhibits strong resistance to rupture, even when sutured. The selection method used ensures the homogeneity of the samples and, thus, of the results. The angle of the suture with respect to the longitudinal axis, where the load is centered, determines the shear stress produced by the suture and the mechanical behavior of each suture material.
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Affiliation(s)
- J M García Páez
- Servicio de Cirugía Experimental, Clínica Puerta de Hierro, Madrid, Spain.
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García Páez JM, Jorge E, Rocha A, Castillo-Olivares JL, Millan I, Carrera A, Cordon A, Tellez G, Burgos R. Mechanical effects of increases in the load applied in uniaxial and biaxial tensile testing. Part II. Porcine pericardium. J Mater Sci Mater Med 2002; 13:477-483. [PMID: 15348600 DOI: 10.1023/a:1014710504963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The mechanical behavior of porcine pericardium was analyzed to compare it with that of calf pericardium employed in valve leaflets for cardiac bioprostheses. Forty samples of pericardium were subjected to uniaxial tensile testing, 20 as controls and 20 exposed to loads increasing stepwise from 0.5 to 1.5 kg and to 3 kg, and thereafter to rupture, with a return to zero load between each new increment. Another 20 samples were used in biaxial tensile tests involving the application of loads increasing stepwise (to 0.5, 1.5, 3 and 5 kg) until rupture with a zero-load interval before each increment. The ultimate stresses were very similar, showing no statistically significant differences when compared in terms of type of assay, controls and study samples or region of pericardial tissue being tested. In the stepwise biaxial assays, the mean stresses at rupture were also very homogeneous. Using morphological and mechanical criteria for sample selection, it was possible to obtain mathematical fits for the stress/strain relationship, with excellent coefficients of determination. The relationship between the area under the stress/strain curve and the load applied or the strain observed was also studied in the biaxial assay as an equivalent to the cycles of hysteresis produced in the test. The increment in the area under the curve (the energy consumed) may be a good parameter for assessing the changes in the collagen fiber architecture of the pericardial tissue, changes that may help to detect early failure.
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Affiliation(s)
- J M García Páez
- Servicio de Cirugía Experimental, Clínica Puerta de Hierro, Madrid, Spain
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García Páez JM, Jorge E, Rocha A, Maestro M, Castillo-Olivares JL, Millan I, Carrera A, Cordon A, Tellez G, Burgos R. Mechanical effects of increases in the load applied in uniaxial and biaxial tensile testing: Part I. Calf pericardium. J Mater Sci Mater Med 2002; 13:381-388. [PMID: 15348613 DOI: 10.1023/a:1014388618649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The authors analyzed the mechanical behavior of the calf pericardium employed in the construction of valve leaflets for cardiac bioprostheses. Forty samples of pericardium were subjected to uniaxial tensile testing, 20 as controls and 20 exposed to loads increasing stepwise until rupture, with a return to zero load between each new increment. Another 20 samples were used similarly in biaxial tensile tests involving loads increasing stepwise until rupture, again returning to zero load between steps. The ultimate stresses in the uniaxial study were very similar and were not influenced by the region of pericardial tissue being tested or the increments in load to which the tissue was exposed. The mean stresses at rupture in the stepwise biaxial assays were significantly greater (p<0.01). Using morphological and mechanical criteria for sample selection, it was possible to obtain mathematical fits for the stress/strain relationship in both types of assays, with excellent coefficients of determination (R (2)>0.90). In uniaxial tests in which the selection criteria were not applied, the correlation improved as the load increased, a phenomenon that did not occur in the biaxial studies. The values varied throughout the different cycles, adopting exponential forms when the strain was greatest. These variations, which demonstrate that the increase in the energy consumed is a function of the stress applied and of the strain produced, should be good parameters for assessing the changes in the collagen fiber architecture of pericardial tissue subjected to cyclic stress, and may help to detect early failure.
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Affiliation(s)
- J M García Páez
- Servicio de Cirugía Experimental, Clínica Puerta de Hierro, Madrid, Spain
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Garcia Páez JM, Jorge-Herrero E, Carrera A, Millán I, Rocha A, Calero P, Cordón A, Salvador J, Sainz N, Méndez J, Castillo-Olivares JL. Chemical treatment and tissue selection: factors that influence the mechanical behaviour of porcine pericardium. Biomaterials 2001; 22:2759-67. [PMID: 11545310 DOI: 10.1016/s0142-9612(01)00019-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Calcification and mechanical failure are the major causes of the loss of cardiac bioprostheses. The chemical treatments used to stabilize the tissue employed are considered to play a fundamental role in the development of these two phenomena, although the problem is multifactorial and the underlying causes are yet to be fully identified. Currently, there is an ongoing search for chemical treatments capable of reducing or eliminating the process of calcification while preserving the mechanoelastic characteristics of the tissue. One of the approaches to this effort is the elimination of the phospholipid component from the biological tissue employed in prosthesis construction. There is evidence that this component may be responsible for the precipitation of calcium salts. The present study compares two delipidating chemical treatments involving chloroform/methanol and sodium dodecyl sulfate (SDS) with the use of glutaraldehyde (GA) alone. For this purpose, porcine pericardial tissue was subjected to tensile strength testing employing a hydraulic simulator. A total of 234 samples were studied 90 treated with GA, 72 treated with chloroform/methanol and 72 treated with SDS. The mean breaking strength was significantly higher in the samples treated with GA (between 43.29 and 63.01 MPa) when compared with those of tissue treated with chloroform/methanol (29.92-42.30 MPa) or with SDS (13.49-19.06 MPa). In a second phase of the study, selection criteria based on morphological and mechanical factors were applied to the pericardial membranes employing a system of paired samples. The mathematical analysis of the findings in one fragment will aid in determining the mechanical behavior of its adjacent twin sample. In conclusion, the anticalcification chemical treatments tested in the experimental model conferred a lesser mechanical resistance than that obtained with GA. On the other hand, the utilization of paired samples was found to be useful in the prediction of the mechanical behavior of porcine pericardial tissue. Nevertheless, in order for our method of selection to be considered the most adequate approach, it will be necessary to validate these findings in dynamic studies involving a real, functional model.
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Affiliation(s)
- J M Garcia Páez
- Services of Preventive Medicine, Puerta de Hierro Clinic, Madrid, Spain
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Páez JM, Jorge-Herrero E, Carrera A, Millán I, Rocha A, Calero P, Cordón A, Sainz N, Castillo-Olivares JL. Ostrich pericardium, a biomaterial for the construction of valve leaflets for cardiac bioprostheses: mechanical behaviour, selection and interaction with suture materials. Biomaterials 2001; 22:2731-40. [PMID: 11545307 DOI: 10.1016/s0142-9612(01)00014-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The mechanical behavior of ostrich pericardium was studied for the purpose of assessing its utility in the construction of bioprosthetic cardiac valve leaflets. The tissue was tested biaxially using a hydraulic simulator that subjected it to increasing stress until rupture. One hundred eighty trials were performed, 36 with unsutured pericardium and four series of 36 trials each with pericardium sutured with silk, Prolene, nylon or Gore-Tex. The samples were tested in pairs from three different pericardial regions. One sample from each pair (the predictive specimen) was assessed according to morphological and mechanical criteria, while the other (the predicted or selectable specimen) was subjected only to morphological analysis. The findings show that ostrich pericardium treated with glutaraldehyde according to standard methods has an excellent resistance to rupture in biaxial testing, withstanding stresses of up to 100 MPa, and never lower than 30 MPa. Its resistance to rupture is lowered by suturing, a loss that is less pronounced when silk sutures are used. The results with Gore-Tex are very homogeneous and the elastic behavior of the pericardium/suture unit appears to be similar to that of unsutured tissue, suggesting that the interaction between the two biomaterials is minor. Similar results were observed in the series sutured with Prolene and nylon. The use of paired samples makes it possible to closely estimate the mechanical behavior of the tissue in a given zone by determining that of its mate. The statistical study shows that this estimation is not conditioned by the suture employed, thus validating this approach and providing more precise criteria for tissue selection.
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Affiliation(s)
- J M Páez
- Servicios de Medicina Preventiva, Clinica Puerta de Hierro, Madrid, Spain
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García Páez JM, Jorge-Herrero E, Carrera A, Millán I, Rocha A, Cordón A, Salvador J, Sainz N, Méndez J, Castillo-Olivares JL. A new method for selecting calf pericardium for use in cardiac bioprostheses on the basis of morphological and mechanical criteria. J Mater Sci Mater Med 2001; 12:665-671. [PMID: 15348235 DOI: 10.1023/a:1011252022303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The durability of existing calf pericardium bioprostheses is limited by phenomena such as mechanical stress and calcification, the factors most frequently implicated in valve failure. Varying the preferred direction of the collagen fibers influences the mechanical behavior of the pericardial membrane. Given this possible variation, a strict control of the selection of the biomaterial employed in the construction of valve leaflets is essential, but a reliable method of selection has yet to be established. This study describes the development of a new system of in vitro selection involving a hydraulic simulator that reproduces the mechanical behavior of pericardial membranes subjected to the stress of continuous flow. By combining morphological criteria such as thickness and homogeneity with those of mechanical behavior, and by selecting paired samples from different parts of the pericardium, we obtained excellent mathematical fits. Linear regression analysis provided the mode of predicting the tensile strength in a given sample when this value had been determined in its twin. The upper zones of calf pericardium, corresponding to either right or left ventricle but at a distance from ligamentous structures, showed the best mean results at rupture (60 MPa) and permitted the most reliable prediction. The expected stress for an elongation of 30% was 1.12 MPa, as was previously observed, with a 95% confidence interval of between 1.11 and 1.14 MPa. These trials, together with the careful selection of the pairs, should help to establish definitive selection criteria.
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Affiliation(s)
- J M García Páez
- Services of Preventive Medicine, Puerta de Hierro Clinic (Clínica Puerta de Hierro), Madrid, Spain
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36
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García Páez JM, Carrera A, Herrero EJ, Millán I, Rocha A, Cordón A, Sainz N, Mendez J, Castillo-Olivares JL. Influence of the selection of the suture material on the mechanical behavior of a biomaterial to be employed in the construction of implants. Part 1: Calf pericardium. J Biomater Appl 2001; 16:47-67. [PMID: 11475359 DOI: 10.1106/gnct-31pt-jhkj-fpx5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A hydraulic stress simulator was employed to study the mechanical behavior of the calf pericardium used in the construction of cardiac valve leaflets. One hundred eighty pairs of tissue samples were subjected to tensile testing to rupture. One of the two samples from each of 144 pairs (four series of 36 pairs each) was sutured with commercially available threads made of nylon, silk, Prolene or Gore-Tex, while the other sample in each of these pairs was left unsewn. The remaining 36 pairs were employed as controls in which neither of the two samples was subjected to suturing. The sutured tissue samples showed a significant decrease in tensile strength at rupture (range: 11.81 to 26.04 MPa) when compared with unsutured samples (range: 39.38 to 87.96 MPa; p < 0.01). The application of morphological and mechanical selection criteria to maximize the homogeneity of the samples provided excellent fit with respect to the stress/strain curves. This method made it possible to carry out a predictive study of the mechanical behavior of a sutured sample, based on that observed in the corresponding unsutured fragment. The interaction of the different suture materials with the pericardial tissue was also assessed by comparing the mechanical behavior of the sutured samples with that of the control samples. At stresses of less than 0.8 MPa, samples sewn with Gore-Tex were found to show the least difference with respect to the controls, indicating that this material presented the lowest degree of interaction with the pericardium. In conclusion, the degree of the loss of resistance to tearing of the sutured samples is of no value in the selection of the optimal suture material. The selection process applied makes it possible to predict the mechanical behavior in response to suturing of a given unsewn tissue specimen by determining that of its sutured mate. The similarity between the findings in samples sewn with Gore-Tex and in the unsutured controls indicates a lesser degree of interaction between the suture material and the pericardium employed in the construction of cardiac valve leaflets.
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Affiliation(s)
- J M García Páez
- Clínica Puerta de Hierro de Madrid, Servicio de Cirugía Experimental and Medicina Preventiva, Spain.
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37
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García Páez JM, Carrera A, Herrero EJ, Millán I, Rocha A, Cordón A, Sainz N, Mendez J, Castillo-Olivares JL. Influence of the selection of the suture material on the mechanical behavior of a biomaterial to be employed in the construction of implants. Part 2: Porcine pericardium. J Biomater Appl 2001; 16:68-90. [PMID: 11475360 DOI: 10.1106/3jxm-utpn-pxtg-72dt] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Using a hydraulic stress simulator, the mechanical behavior of the porcine pericardium used in the construction of cardiac valve leaflets was characterized following the same procedure employed with calf pericardium in Part 1 of this study. One hundred fifty pairs of tissue samples were subjected to tensile testing to rupture. One of the two samples from each of 120 pairs (four series of 30 pairs each) was saturated with commercially available threads made of nylon, silk, Prolene or Gore-Tex, while the other sample in each of these pairs was left unsewn. The remaining 30 pairs were employed as controls in which neither of the two samples was subjected to suturing. The sutured tissue samples showed a significant decrease in tensile strength at rupture (range: 11.61 to 21.22 MPa) when compared with unsutured samples (range: 50.80 to 89.45 MPa; p < 0.01). When these results were compared with their equivalent in calf pericardium, no significant differences were observed (the mean values at rupture in calf pericardium ranged between 211.61 MPa and 26.04 MPa). Again, the application of morphological and mechanical selection criteria to ensure the homogeneity of the samples provided excellent fit with respect to the stress/strain curves. The interaction of the different suture materials with the pericardial tissue was also assessed by comparing the mechanical behavior of the sutured samples with that of the control samples. At the working stress of a cardiac valve leaflet, 0.250 MPa, samples sewn with Gore-Tex were found to show the least difference in behavior with respect to the controls, indicating that this material presented the lowest degree of interaction with the pericardium. In conclusion, the suture clearly has deleterious effects on the resistance of both calf and porcine pericardium, which showed no statistically significant differences in terms of resistance to rupture when their respective sutured or unsutured samples were compared, except in the case of porcine pericardium sewn with silk, which presented lower resistance to rupture in all the zones studied. These findings suggest that the hypothesis that porcine pericardium is less resistant is erroneous. The Gore-Tex suture also presented a lower degree of interaction with the porcine pericardium, with values similar to the working stress of a cardiac valve leaflet. This methodology and the results should be evaluated in dynamic studies, such as fatigue testing, that not only confirm the resistance of the material but establish the durability of the samples being assayed.
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Affiliation(s)
- J M García Páez
- Clínica Puerta de Hierro de Madrid, Servicio de Cirugía Experimental and Medicina Preventiva, Spain.
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38
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Garcia Páez JM, Jorge-Herrero E, Carrera A, Millán I, Rocha A, Salvador J, Mendez J, Téllez G, Castillo-Olivares JL. Porcine pericardial membrane subjected to tensile testing: preliminary study of the process of selecting tissue for use in the construction of cardiac bioprostheses. J Mater Sci Mater Med 2001; 12:425-430. [PMID: 15348282 DOI: 10.1023/a:1011201104225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The durability of cardiac bioprostheses is limited fundamentally by structural failure due to mechanical fatigue and calcification. In the present report, we analyze, using an in vitro hydraulic simulator to test tensile strength, the mechanical behavior of porcine pericardium for the purpose of establishing the criteria for selecting the biomaterial, taking into account both morphological criteria (thickness and homogeneity of the specimens) and mechanical criteria (stress at breaking point), using the epidemiological model of paired samples. The stress at breakage was found to range widely from 24.07 MPa to 100.29 MPa, although we observed no statistically significant differences when comparing the mean results in the different regions and zones of the pericardium being studies. The application of the selection criteria in the present series resulted in an excellent mathematical fit in terms of the stress/elongation (R2 > 0.95), making it possible to establish, by means of linear regression, the prediction of the tensile strength in one zone on the basis of the values observed in its paired specimen.
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Affiliation(s)
- J M Garcia Páez
- Servicios de Cirugia Experimental, Clínica Puerta de Hierro, Madrid, Spain
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Abstract
During routine dissection a subclavius posticus muscle was found on the left side of a male cadaver. This muscle arose from the upper margin of the scapula and transverse scapular ligament, inserted in the superior side of the first rib cartilage, and was innervated by a small branch from the suprascapular nerve. The anatomical relationships of the supernumerary muscle with the brachial plexus and the subclavian artery is suggestive of a possible cause of the thoracic outlet syndrome and therefore of clinical significance.
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Affiliation(s)
- P Forcada
- Department of Morphological Sciences, University of Barcelona, Barcelona, Spain
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García Páez JM, Carrera A, Cordón A, Jorge-Herrero E, Rocha A, Salvador J, Méndez J, Castillo-Olivares JL, Millán I, Sainz N. Uniaxial and biaxial tensile strength of calf pericardium used in the construction of bioprostheses: biomaterial selection criteria. J Biomater Appl 2000; 15:47-64. [PMID: 10972159 DOI: 10.1106/77v6-pmk9-duh4-llr8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Using morphological and mechanical criteria and applying a method involving paired samples that is widely employed in epidemiology, we obtained an excellent prediction of the mechanical behavior of the calf pericardium used in the construction of cardiac bioprostheses. The method of selection employed in this study may be a highly useful tool for guaranteeing the mechanical resistance of calf pericardium, with a very low level of error.
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Affiliation(s)
- J M García Páez
- Servicio de Medicina Preventiva, Clínica Puerta de Hierro, Madrid, Spain
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Ramírez-Torres MA, Carrera A, Zambrana M. [High incidence of hyperestrogenemia and dyslipidemia in a group of infertile men]. Ginecol Obstet Mex 2000; 68:224-9. [PMID: 10902292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The aim of this paper is to describe metabolic and endocrine alterations in the male, partners of infertile couples. One hundred and six consecutive men were taken in order to analyze their serum samples. Each serum sample was analyzed by duplicate for luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), free-testosterone (T), 17 alpha-hydroxyprogesterone (17OHP), androstenedione (A), dehydroepiandrosterone-sulphate (DHEA-S), prolactin (PRL), insulin, glucose, total cholesterol and triclylcerides. The data analysis evidenced different metabolic or endocrine alterations in the group. A dysplipidemia incidence of 65% was found (isolated hypercholesterolemia, isolated triglyceridemia or both), where 80% of these patients were younger than 40 years. There was no correlation with obesity, overweight any endocrine alteration and the type of sperm alterations. There was a positive correlation between E2 and FSH (r = 0.67, p < 0.0001) in the group of 106 patients, which remained significant in the group of hyperestrogenic men (n = 27, r = 0.68, p < 0.0001), but not in men with normal serum estrogen levels (n = 79, r = 0.10, NS). Other alterations: obesity in 18%, overweight in 30.2%, diabetes mellitus 4.7%, glucose intolerance 15%, hypertension 26% (14/53), hypergonadotropic hypogonadism 3.8% (one of them with an Emty Sella syndrome). Unexpectedly only nine patients (8.4%) out of the 106 consecutive patients recluted did not have any of the metabolic or endodrine abnormalities here described. These are more significant since 83% of the patients are younger than 40 years. The most interesting non previously described finding was the positive correlation observed between E2 and FSH when estradiol levels exceeds 50 pg/mL.
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Affiliation(s)
- M A Ramírez-Torres
- Departamento de Endocrinología, Instituto Nacional de Perinatología, Secretaría de Salud, México, D.F
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42
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Zarza R, Pujades A, García J, Alvarez R, Carrera A, Estella J, Morey M, Remacha A, Pérez-Lungmus G, Nomdedeu B, Sánchez J, Gastearena J, Bureo E, Vives Corrons JL. [Molecular study of red cell pyruvate kinase deficiency in 15 patients with chronic hemolytic anemia. Group of Erythropathology of Hematology and hemotherapy Association of Spain (HHAS)]. Med Clin (Barc) 1999; 112:606-9. [PMID: 10374175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Identification of RBC pyruvate-kinase (PK) gene mutations by polymerase chain reaction (PCR) and single strand conformation polymorphism (SSCP) followed by PK gene sequencing in positive cases has been assessed and the results obtained with a preliminary study of 15 unrelated patients of Spanish origin are presented. PATIENTS AND METHODS Patients have been classified into two different groups: group 1, propositus (15 cases), and group 2, relatives of the patients included in group 1 (10 males and 5 females). In group 1, a PCR was followed by SSCP and sequencing, and in group 2, the PCR was followed by digestion with specific restriction endonucleases (PCR-ER). RESULTS Group 1: from 15 patients included in the study 2 were identified as homozygous, 4 as heterozygous and 9 as compound heterozygous. In this group, were identify 26 affected alleles with 11 different mutations: T1456 10 alleles (38.6%), T721 3 alleles (11.6%), A1010, C514, C1015 and T1223 2 alleles (7.7%), and C1070, A1291, T1508, A1595 y T1675 one allele. Relatives from 8 out of 15 patients from group 1 showed the following pattern: homozygous (one case), heterozygous (10 cases), compound heterozygous (2 cases) and normal (2 cases). CONCLUSIONS SSCP procedure followed by direct gene sequencing in positive cases is fast and simple enough to allow the identification of PK deficient variants, avoiding the need of biochemical characterisation of semipurified deficient enzyme, which is more cumbersome and time consuming. In addition, the PCR-ER method is a very useful tool for screening of the most frequent molecular variants, as well as, for the detection of the carrier condition of this enzymopathy (family studies).
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Affiliation(s)
- R Zarza
- Departamento de Hematología, Hospital Clínic i Provincial, Barcelona
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43
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Zarza R, Alvarez R, Pujades A, Nomdedeu B, Carrera A, Estella J, Remacha A, Sánchez JM, Morey M, Cortes T, Pérez Lungmus G, Bureo E, Vives Corrons JL. Molecular characterization of the PK-LR gene in pyruvate kinase deficient Spanish patients. Red Cell Pathology Group of the Spanish Society of Haematology (AEHH). Br J Haematol 1998; 103:377-82. [PMID: 9827908 DOI: 10.1046/j.1365-2141.1998.01013.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The PK-LR gene has been studied in 12 unrelated patients with red cell pyruvate kinase deficiency and hereditary nonspherocytic haemolytic anaemia (CNSHA). The entire codifying region of the R-type PK gene and the flanking intronic regions were analysed by single-stranded conformation polymorphism (SSCP) followed by direct sequencing of abnormal DNA. 10 different mutations were identified in 22/24 alleles at risk. Eight of these were missense mutations that caused the following single amino acid changes: G514C (172Glu-Gln), G1010A (337Arg-Gln), G1015C (339Asp-Gln), T1070C (357Ile-Thr), C1223T (408Thr-Ile), G1291A (431Ala-Thr), C1456T (486Arg-Trp) and G1595A (532Arg-Gln). Two were nonsense mutations: G721T (241Glu-Stop) and C1675T (559Arg-Stop). 7/22 alleles demonstrated the same C1456 --> T mutation. The study of the polymorphic site at nucleotide (nt) 1705 performed in all cases disclosed a 1705 C/C mutation in 10 and a 1705 A/C mutation in three. This is the first report on the presence of several different L-type PK gene mutations within Spanish population. Furthermore, from the PK gene mutations found, six were unique and not previously described (1015C, 1070C, 1223T, 1291A, 1595A and 1675T) and one (C1456T) seems to be predominant in Spain. Interestingly, no case with the 1529A mutation commonly found in Northern European populations was present here.
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Affiliation(s)
- R Zarza
- Haematology Department of Hospital Clinic i Provincial, Barcelona, Spain
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44
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Pons B, Carrera A, Nerín C. Speciation of ionic alkyllead compounds in human urine by gas chromatography-mass spectrometry after butylation through a Grignard reaction. J Chromatogr B Biomed Sci Appl 1998; 716:139-45. [PMID: 9824226 DOI: 10.1016/s0378-4347(98)00319-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
One analytical procedure for the determination of ionic alkyllead in human urine has been studied. The system consists of the extraction of Me3Pb+, Et3Pb+ and Pb2+ at pH 9.0 with diethyldithiocarbamate to an organic phase. Then, the ionic compounds are butylated with BuMgCl and the final organic solution is analyzed by GC-MS-SIM. The elimination of both foam and gels in the extraction step and the general procedure for the urine are discussed. The recovery of compounds ranges from 105.1% for Me3Pb+ to 97.2% for Et3Pb+ using hexane as extracting agent and detection limits are 18.4 pg/ml of Me3Pb+ and 19.2 pg/ml of Et3Pb+ in urine. The speciation of ionic alkylleads in the urine of a petrol station worker showed a value of 27.9 pg/ml of Me3Pb+ in urine and Et3Pb+ was below the detection limit.
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Affiliation(s)
- B Pons
- Departmento Química Analítica, Universidad de La Rioja, Logroño, Spain.
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45
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Koob GF, Rocio M, Carrera A, Gold LH, Heyser CJ, Maldonado-Irizarry C, Markou A, Parsons LH, Roberts AJ, Schulteis G, Stinus L, Walker JR, Weissenborn R, Weiss F. Substance dependence as a compulsive behavior. J Psychopharmacol 1998; 12:39-48. [PMID: 9584967 DOI: 10.1177/026988119801200106] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A compulsion to take a drug combined with a loss of control in limiting intake is the defining feature of substance dependence or addiction, and is the conceptual framework for the criteria of substance dependence or addiction outlined by the World Health Organization and the American Psychiatric Association. However, defining exactly what constitutes loss of control and compulsive drug taking at the level of animal models is a daunting task, and it is clear that no validated animal model exists for the whole syndrome of addiction. The present discussion redefines loss of control as a narrowing of the behavioral repertoire toward drug-seeking behavior and suggests that there are many sources of reinforcement that contribute to this behavioral focus on drug seeking. Evidence is presented demonstrating separate animal models for many of these sources of reinforcement as well as for most of the criteria for substance dependence. Evidence is also presented showing that the brain neurochemical systems involved in processing drug reward are altered by chronic drug exposure to contribute additional sources of reinforcement. Challenges for the future involve not only elucidation of the neurobiological substrates of the different behavioral components of addiction, but better animal models of these components with which to effect such studies.
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Affiliation(s)
- G F Koob
- Department of Neuropharmacology, The Scripps Research Institute, La Jolla, CA 92037, USA.
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Vives Corrons JL, Zarza R, Aymerich JM, Boixadera J, Carrera A, Colomer D, Corbella M, Castro M, Crespo JM, Del Arco A, Erkiaga S, Font L, González I, Juncá J, Lausin A, Manrubia E, Martín Núñez G, Murga MJ, Oliva E, Pérez de Mendiguren B, Pujades MA, Remacha A, Rovira A, Villegas A. [Molecular analysis of glucose-6-dehydrogenase deficiency in Spain]. Sangre (Barc) 1997; 42:391-8. [PMID: 9424740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE G6PD deficiency is the most frequent enzymopathy-producing genetic polymorphism in humans. Up to now, over 400 putative variants of G6PD have been distinguished on the basis of biochemical characterization of the deficient enzyme. Analysis of the G6PD gene has made possible a precise classification of the G6PD molecular variants by identification of about 80 different point mutations causing much of the phenotypic heterogeneity. In the Spanish population, the analysis of G6PD has led to the identification of 15 different point mutations that underlay the phenotypic heterogeneity of G6PD previously reported by biochemical analysis. The purpose of the study has been to identify the genetic mutation responsible of the G6PD deficiency and to improve the knowledge of its genetic homogeneity. PATIENTS AND METHODS From 50 Spanish males with G6PD deficiency 34 came from out consultation and 16 from the Spanish Study Group on Red Cell Pathology (GEHBTA-Eritropatología) The methods employed included screening of prevalent mutations by ER-PCR, SSCP-PCR, genetic segmentation and biochemical characterization of the deficient enzyme. RESULTS In 31 cases the mutations were characteristic of the four most frequent polymorphic variants found in Spain (G6PD A-376G/202A, G6PD Mediterranean 563T G6PD Union 1360T and G6PD Seattle 344C). Since these mutations either create or abolish a specific site recognized by a restriction endonuclease (RE), they can be rapidly detected by RE digestion of a PCR-amplified product (PCR-RE). In patients where none of these mutations were present (17 cases), the G6PD gene was subjected to PCR single-strand conformation polymorphism (PCR-SSCP) analysis combined with direct PCR-sequencing. By using this procedure, 9 new mutations have been identified, five of them have been also found in other geographical areas and were associated with favism (G6PD A-376G/968C, G6PD Santamaria 376G/542T, G6PD Aures 143C and G6PD Chatham 1003A) or chronic haemolytic anaemia (G6PD Tomah 1153C). The other four mutations are unique and not reported so far: Three of them are associated with favism (G6PD Málaga 542T, G6PD Murcia 209G and G6PD Valladolid 406T) and one with chronic haemolytic anaemia (G6PD Madrid 1155G). The remaining eight cases are under study. CONCLUSION The present study confirms the marked genetic heterogeneity of G6PD deficiency in Spain and demonstrate that the PCR-RE analysis is an easy tool for rapid diagnosis of the molecular defect in subjects with the common forms of G6PD deficiency. Furthermore the fact that G6PD A-376G/202A is the most common variant within Spanish population and the finding of G6PD Aures 43C and G6PD Santamaría 76G/542T, who are polymorphic in Algeria is consistent with a significant gene flow from Africa to Europe through Spain.
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Affiliation(s)
- J L Vives Corrons
- Hospital Clinic i Provincial, Laboratorio Central de Hematología, Barcelona
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47
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Carrera A, Moos J, Ning XP, Gerton GL, Tesarik J, Kopf GS, Moss SB. Regulation of protein tyrosine phosphorylation in human sperm by a calcium/calmodulin-dependent mechanism: identification of A kinase anchor proteins as major substrates for tyrosine phosphorylation. Dev Biol 1996; 180:284-96. [PMID: 8948591 DOI: 10.1006/dbio.1996.0301] [Citation(s) in RCA: 238] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Signal transduction pathways regulate various aspects of mammalian sperm function. When human sperm were incubated in a medium supporting capacitation, proteins became tyrosine-phosphorylated in a time-dependent manner. This phosphorylation was inhibited by genistein, a protein tyrosine kinase inhibitor. Phosphorylation was also reduced when sperm were incubated either in the presence of increasing concentrations of extracellular Ca2+ or in a medium containing the Ca2+ ionophore A23187. This Ca2+-induced dephosphorylation was calmodulin-dependent, suggesting that calcineurin was involved. In this regard, the calcineurin inhibitor deltamethrin inhibited the Ca2+ ionophore-induced dephosphorylation. A limited number of Mr 80,000-105,000 polypeptides were the most prominent phosphotyrosine-containing proteins present in human sperm. Unlike mouse sperm, which contains a tyrosine-phosphorylated isoform of hexokinase, a phosphotyrosine-containing hexokinase in human sperm was not detected. Most of the tyrosine-phosphorylated proteins were Triton X-100-insoluble and were localized to the principal piece of the flagellum, the region where the cytoskeletal fibrous sheath is found. Prominent phosphotyrosine-containing proteins of Mr 82,000 and 97,000 were identified as the human homologues of mouse sperm AKAP82, the major fibrous sheath protein, and pro-AKAP82, its precursor polypeptide, respectively. These proteins are A Kinase Anchor Proteins, polypeptides that sequester protein kinase A to subcellular locations. Taken together, these results suggest that protein tyrosine phosphorylation may be part of a signal transduction cascade(s) regulating events pertaining to capacitation and/or motility in mammalian sperm and that an interrelationship between tyrosine kinase and cAMP signaling pathways exists in these cells.
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Affiliation(s)
- A Carrera
- Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, Philadelphia 19104-6080, USA
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Bermejo B, Olona M, Serra M, Carrera A, Vaqué J. [Prevalence of iron deficiency in the female working population in the reproductive age]. Rev Clin Esp 1996; 196:446-50. [PMID: 8927761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Iron deficiency is particularly common among women in child-bearing age. The early detection and institution of an appropriate therapy can prevent the development of anemia. OBJECTIVE To study the prevalence of iron deficiency among women in child-bearing age (in the setting of periodic health visits) and the associated risk factors. SAMPLE AND METHODS A cross-sectional observational study was undertaken with 322 women in child-bearing age. An hemogram and serum ferritin levels were obtained on the same day when an interview was carried out to obtain data on general personal details, gynecological-obstetrical antecedents, diet, sports, and blood donations. Iron deficiency was defined as a serum ferritin concentration lower than 25 ng/ml. RESULTS The prevalence of iron deficiency was 47.5%. In the multivariate analysis, factors significantly influencing on prevalence were: a copious menstruation blood loss (OR = 4.64, CI 2.22-9.68), a body mass index higher than 25 (OR = 0.49; CI 0.27-0.89) and maternity (OR = 2.08; CI 1.12-3.84). The likelihood associated with chi square goodness-of-fit was 0.08. DISCUSSION The prevalence of iron deficiency detected is high; although there are clear associated risk factors, the goodness-of-fit was poor; therefore, for predictive purposes it is not possible to delineate a group in a special risk for iron deficiency.
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Affiliation(s)
- B Bermejo
- Servicio de Medicina Preventiva y Epidemiología, Hospitals Vall d'Hebron, Barcelona
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Reyes-Fuentes A, Chavarría ME, Carrera A, Aguilera G, Rosado A, Samojlik E, Iranmanesh A, Veldhuis JD. Alterations in pulsatile luteinizing hormone and follicle-stimulating hormone secretion in idiopathic oligoasthenospermic men: assessment by deconvolution analysis--a clinical research center study. J Clin Endocrinol Metab 1996; 81:524-9. [PMID: 8636262 DOI: 10.1210/jcem.81.2.8636262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
To investigate the nature of neuroendocrine disturbances of the hypothalamo-pituitary-gonadal axis in idiopathic male infertility, we studied 14 infertile men with oligoasthenozoospermia (OLIGO) and 15 age-, body mass index-, and community-matched euspermic controls by blood withdrawal at 10-min intervals for 12 h to encompass basal (8-h) and exogenous GnRH-stimulated (4-h) pulsatile release of LH and FSH (by immunoradiometric assay) as well as testosterone (by RIA). Deconvolution analysis was used to estimate endogenous LH and FSH half-lives, secretory burst frequency, amplitude, duration, and mass. OLIGO men exhibited normal serum concentrations of total, free, and percent dialyzable testosterone and estradiol, but distinct dynamic alterations within the LH and FSH axes; namely (P < 0.05), 1) a prolonged half-life of LH (OLIGO, 95 +/- 19 min; control, 80 +/- 9.3 min) and a reduced half-life of FSH (OLIGO, 260 +/- 79 min; control, 320 +/- 93 min); 2) a low LH, but normal FSH, secretory burst frequency (OLIGO, 12 +/- 3.4; control, 15 +/- 3.0 LH pulses/day); 3) a decreased serum testosterone peak frequency (OLIGO, 16 +/- 4.3; control, 21 +/- 3.2 peaks/day); and 4) an amplified mass of LH (1.1- to 1.3-fold higher in OLIGO) and FSH (2.4- to 2.7-fold higher in OLIGO) secreted per burst basally as well as after GnRH injection. These disturbances were readily distinguishable from the neuroendocrine dysregulation described in other states of male hypogonadotropism (e.g. uremia, fasting, and aging).
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Affiliation(s)
- A Reyes-Fuentes
- División de Investigación Biomédica, Instituto Nacional de Perinatología, Mexico D.F., Mexico
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Carrera A, Fernández-Guisasola J, Herrero E, Maseda J. [Experience with the first 10 cases of percutaneous tracheostomy carried out at the recovery unit]. Rev Esp Anestesiol Reanim 1995; 42:233-5. [PMID: 7676094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The indications for percutaneous tracheostomy (PT) are the same as those for conventional tracheostomy. First described in 1969, PT has gradually become more widely used. We analyze the first 10 cases in which the procedure was performed in our postoperative intensive care unit. PT was performed in 10 patients admitted to the postoperative intensive care unit needing tracheostomy, following the procedure of Cook (Bjaeverskov, Denmark). Complications appearing during the procedure or later in the study period were recorded. All 10 PT procedures were successful. The mean time was 11.9 min (+/- 5.9). Minor complications developed in 5 patients. In 3 of these, the problems were technical (stylete slipping out, cannula hitting the endotracheal tube, and difficult insertion of a prepared cannula). The other 2 complications were small hemorrhages in the tracheostomy. No episodes of hypoxemia occurred during PT. The only late complication was a tracheostomy infection in a patient. In our experience PT is a useful alternative to conventional tracheostomy. The technique is easy to learn and performed quickly. Complications that develop do not affect the ultimate success of threaten patient stability.
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Affiliation(s)
- A Carrera
- Servicio de Anestesiología y Reanimación, Clínica Puerta de Hierro, Madrid
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