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Demal TJ, Detter C, von Kodolitsch Y, Mariscalco G, Gatti G, Peterss S, Büch J, Onorati F, Perrotti A, Fiore A, Pettinari M, Dell'aquila AM, Pol M, Field M, Vendramin I, Rinaldi M, Lega JR, Juvonen T, Onorati F, Quintana E, Pinto AG, Nappi F, Di Perna D, Reichenspurner H, Biancari F, Conradi L. Predictor Analysis for Acute Type A Aortic Dissection in Small Aortic Diameters. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- T. J. Demal
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | - C. Detter
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
| | | | | | - G. Gatti
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - S. Peterss
- LMU Klinikum München, München, Deutschland
| | - J. Büch
- LMU Klinikum München, München, Deutschland
| | | | - A. Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - A. Fiore
- Hôpital Henri-Mondor Ap-Hp, Créteil, France
| | | | | | - M. Pol
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - M. Field
- Liverpool Cardiovascular Surgery, Liverpool, United Kingdom
| | | | | | - J. R. Lega
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - T. Juvonen
- University of Helsinki, Helsinki, Finland
| | | | | | - A. G. Pinto
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F. Nappi
- Centre Cardiologique du Nord, Saint-Denis, Paris, France
| | - D. Di Perna
- University of Reims Champagne-Ardenne, Reims, France
| | | | | | - L. Conradi
- University Heart and Vascular Center Hamburg, Hamburg, Deutschland
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Causa-Andrieu P, Nicola R, Lipsich F, Adri D, Gomez M, Pol M, Wernicke A, Saraniti G, Chacon CRB. Characterization of Ovarian Granulosa Cell Tumors using Magnetic Resonance Imaging. Med Res Arch 2022; 10:10.18103/mra.v10i6.2813. [PMID: 36276660 PMCID: PMC9583456 DOI: 10.18103/mra.v10i6.2813] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To identify the MRI features that aid in the characterization of ovarian granulosa cell tumors. MATERIALS AND METHODS 11 MR pelvis of an adult woman with pathology-proven ovarian granulosa cell tumors with surgical pathology.We evaluated the patient's age, Ca-125, size, laterality, and with MRI features such as indirect signs (i.e., thickened endometrium > 0.9 cm), morphology (cystic, solid-cystic, or solid), subacute hemorrhage, T2 signal (low or intermediate-to-high), restricted diffusion (B values: 0, 50, 1000 sec/mm3/ADC), and dynamic enhancement (intense or similar to myometrium). Also, the presence of ascites, peritoneal implants, or adenopathy. RESULTS The final cohort included 11 women with a surgical-pathological diagnosis of granulosa cell tumors. The median age was 52.4 years (range, 17-80). The Ca-125 level was with a median within normal limits. The median size was 9.4 cm. Most cases were unilateral (81.8%) and more frequent on the left (54.5%). MRI ANALYSIS 36.4% had endometrial thickening. Ovarian granulosa cell tumors were polymorphous: cystic (54.6%), mixed solid-cystic (9.1%), and solid (36.3%). Most GC had intermediate to high signal on T2 (90.9%), restricted diffusion (81.8%), intense enhancement (81.8%), and 36.4% had intraparenchymal bleeding. 9.1% had associated implants/adenopathy/ascites at diagnosis. CONCLUSION The MRI features characteristic of ovarian granulosa cell tumors were the polymorphous morphology, an intense enhancement to the myometrium, restricted diffusion, and the presence of intraparenchymal hemorrhage.
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Affiliation(s)
| | - Refky Nicola
- Roswell Park Comprehensive Cancer Center, United States
| | | | - Daniel Adri
- Radiology Service. Hospital Italiano de Buenos Aires, Argentina
| | | | - Melina Pol
- Pathology Service. Hospital Italiano de Buenos Aires, Argentina
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Rinflerch AR, Volonteri VI, Roude MC, Pagotto LV, Pol M, Mazzuoccolo LD. Trends in melanoma incidence at Hospital Italiano de Buenos Aires, 2007-2016. An Bras Dermatol 2021; 97:115-117. [PMID: 34799140 PMCID: PMC8799841 DOI: 10.1016/j.abd.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/02/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Adriana Raquel Rinflerch
- Instituto de Biología Subtropical CONICET, Universidad Nacional de Misiones, Misiones, Argentina; Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - María Cecilia Roude
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Laura Vanina Pagotto
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Melina Pol
- Servicio Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Buday J, Albrecht J, Podgorná G, Mareš T, Le T, Čapek V, Mahrík J, Pol M, Raboch J, Anders M. Seizure threshold manipulation in electroconvulsive therapy via repetitive transcranial magnetic stimulation. A novel way of augmentation? Brain Stimul 2020; 13:1631-1638. [DOI: 10.1016/j.brs.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
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Glinka J, Calderón F, de Santibañes M, Hyon SH, Gadano A, Mullen E, Pol M, Spina J, de Santibañes E. Early pancreatic cancer in IgG4-related pancreatic mass: A case report. World J Gastrointest Surg 2019; 11:443-448. [PMID: 31879536 PMCID: PMC6912071 DOI: 10.4240/wjgs.v11.i12.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/18/2019] [Accepted: 11/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND IgG4-related disease can manifest diversely, including autoimmune pancreatitis and IgG4-related cholangiopathy. We are reporting a very unusual cause of pancreatic cancer triggered in a previously unknown IgG4-related disease.
CASE SUMMARY A 75-year-old man was diagnosed with a 43 mm × 33 mm pancreatic head tumor after consulting for abdominal pain and jaundice. A pancreaticoduodenectomy was carried out uneventfully, and the histopathology report showed an early stage of acinar-cell pancreatic cancer. The patient reconsulted on the 30th postoperative day with fever, jaundice and asthenia. Magnetic resonance cholangiopancreatography evidenced an extense bile duct stricture. A percutaneous biliary drainage proved to be ineffective, even after exchanging it with larger bore drainage. Reviewing the surgical specimen, features compatible with IgG4-related disease were observed. Consequently, empiric treatment with steroids was initiated achieving excellent results.
CONCLUSION IgG4-related disease may cause chronic inflammation of the pancreas and can condition pancreatic malignancies.
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Affiliation(s)
- Juan Glinka
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Francisco Calderón
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Martín de Santibañes
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Sung Ho Hyon
- Department of General Surgery, Image Guided Minimally Invasive Surgery Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Adrián Gadano
- Hepatology Section, Hospital Italiano Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Eduardo Mullen
- Department of Surgical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Melina Pol
- Department of Surgical Pathology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Juan Spina
- Department of Radiology, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
| | - Eduardo de Santibañes
- Department of General Surgery, Hepato-bilio-pancreatic Unit, Hospital Italiano de Buenos Aires, Buenos Aires C1181ACH, Argentina
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Kolk H, Krijgsveld KL, Linssen H, Diertens R, Dolman D, Jans M, Frauendorf M, Ens BJ, Pol M. Cumulative energetic costs of military aircraft, recreational and natural disturbance in roosting shorebirds. Anim Conserv 2019. [DOI: 10.1111/acv.12546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H. Kolk
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
- Centre for Avian Population Studies Wageningen The Netherlands
| | | | - H. Linssen
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
| | - R. Diertens
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
| | - D. Dolman
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
| | - M. Jans
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
| | - M. Frauendorf
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
- Centre for Avian Population Studies Wageningen The Netherlands
| | - B. J. Ens
- Centre for Avian Population Studies Wageningen The Netherlands
- Sovon‐Texel Sovon Dutch Centre for Field Ornithology Texel The Netherlands
| | - M. Pol
- Department of Animal Ecology Netherlands Institute of Ecology (NIOO‐KNAW) Wageningen The Netherlands
- Centre for Avian Population Studies Wageningen The Netherlands
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Pagano Boza C, Gonzalez-Barlatay J, Ugradar S, Pol M, Premoli EJ. Syringocystadenocarcinoma papilliferum with orbital invasion: a case report with literature review. Ther Adv Ophthalmol 2019; 11:2515841419844087. [PMID: 31065626 PMCID: PMC6487760 DOI: 10.1177/2515841419844087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/21/2019] [Indexed: 11/16/2022] Open
Abstract
We present a case of Syringocystadenocarcinoma papilliferum that originated in the eyelid and extended into the orbit. These tumors are very rare and have the potential to metastasize. A literature review of all the previous cases has been compiled from the Medline, EMBASE, and PubMed databases. We found that the majority of cases present on the head and neck and up to 17% of cases showed metastatic progression. This is the first case to show orbital involvement and highlights the need to remain vigilant with such lesions, as they have a tendency to become aggressive.
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Affiliation(s)
- Carla Pagano Boza
- Oculoplastics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Shoaib Ugradar
- Division of Orbital and Ophthalmic Plastic Surgery, Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA
| | - Melina Pol
- Pathology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Jorge Premoli
- Oculoplastics Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Pollari F, Biancari F, Pol M, Vogt F, Santarpino G, Fischlein T, Pfeiffer S. Sapien XT versus Sapien 3 Prosthesis: Preliminary Results of a Meta-analysis. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571489] [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: 10/22/2022]
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Chaneton L, Bontá M, Pol M, Tirante L, Bussmann L. Milk lactoferrin in heifers: Influence of health status and stage of lactation. J Dairy Sci 2013; 96:4977-82. [DOI: 10.3168/jds.2012-6028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 05/03/2013] [Indexed: 11/19/2022]
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Ensing K, Pol M, De Zeeuw RA. Radioreceptor assays of ipratropium bromide in plasma and urine. J Pharm Biomed Anal 2009; 6:433-9. [PMID: 16867389 DOI: 10.1016/0731-7085(88)80010-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/1985] [Revised: 03/05/1986] [Indexed: 11/25/2022]
Abstract
Ipratropium bromide (Ipbr) is a frequently used quaternary anticholinergic administered by inhalation in the treatment of chronic obstructive lung diseases. Hardly any pharmacokinetic data are available, which can be useful in the optimisation of anticholinergic therapies. Hence, a radioreceptor assay (RRA) for Ipbr has been developed. The RRA is based on the competition between (3)H-N-methylscopolamine chloride ((3)H-NMS) and Ipbr for binding to lyophilised muscarinic receptors from calf brains. The assay has been optimised in respect of incubation conditions and extraction by ion-pair formation with sodium picrate. Detection limits of the drug were 5 ng ml(-1) in urine and 500 pg ml(-1) in plasma, after extraction of 2-ml samples. The method is applicable to monitoring the drug in plasma and urine after therapeutic dosing.
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Affiliation(s)
- K Ensing
- State University, Department of Toxicology, A. Deusinglaan 2, 9713 AW Groningen, The Netherlands
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Abstract
The objective of this study was to analyze relationships between usage of antimicrobial drugs on dairy farms and results of antimicrobial susceptibility testing of mastitis pathogens. Exposure to selected antimicrobial drugs (n = 10) was standardized by calculation of the number of defined daily doses used per cow. Farms (n = 40) were categorized based on amount of antimicrobial exposure: organic (no usage); conventional-low usage (conventional farms not using or using less than or equal to the first quartile of use of each compound); and conventional-high usage (conventional farms using more than the first quartile of a particular compound). The minimum inhibitory concentration (MIC) of selected antimicrobial drugs was determined using a commercial microbroth dilution system for isolates of Staphylococcus aureus (n = 137), coagulase-negative staphylococci (CNS, n = 294), and Streptococcus spp. (n = 95) obtained from subclinical mastitis infections. Most isolates were inhibited at the lowest dilution tested of most antimicrobial drugs. Survival curves for Staph. aureus and CNS demonstrated heterogeneity in MIC based on the amount of exposure to penicillin and pirlimycin. For CNS, farm type was associated with the MIC of ampicillin and tetracycline. For Streptococcus spp., farm type was associated with MIC of pirlimycin and tetracycline. For all mastitis pathogens studied, the MIC of pirlimycin increased with increasing exposure to defined daily doses of pirlimycin. The level of exposure to most other antimicrobial drugs was not associated with MIC of mastitis pathogens. A dose-response effect between antimicrobial exposure and susceptibility was observed for some pathogen-antimicrobial combinations, but exposure to other antimicrobial drugs commonly used for prevention and treatment of mastitis was not associated with resistance.
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Affiliation(s)
- M Pol
- Department of Dairy Science, University of Wisconsin, Madison 53706, USA
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Abstract
The objective of this study was to develop a method to quantify antimicrobial drug usage and treatment practices on conventional and organic dairy farms that had been recruited to represent a broad spectrum of potential exposure to antimicrobial drugs. Data on disease prevalence and treatment practices of organic (n = 20) and conventional (n = 20) farms were obtained during a farm visit using a survey instrument. A standardized estimate of antimicrobial drug usage was developed using a defined daily dose (DDD) of selected compounds. Density of antimicrobial drug usage was expressed as the number of DDD per adult cow per year. Differences in prevalence and management of selected diseases between conventional and organic farms were identified. The overall estimated prevalence of selected diseases was greater for conventional farms compared with organic farms. Organic farmers reported use of a variety of nonantimicrobial compounds for treatment and prevention of disease. Conventional farmers reported that penicillin was the compound most commonly used for dry cow therapy and cephapirin was most commonly used for treatment of clinical mastitis. On conventional farms, the estimated overall exposure to antimicrobial drugs was 5.43 DDD per cow per year composed of 3.58 and 1.85 DDD of intramammary and parenteral antimicrobial drugs, respectively. Of total intramammary antimicrobial drug usage, treatment of clinical mastitis contributed 2.02 DDD compared with 1.56 DDD attributed to the use of dry cow therapy. Of total parenteral treatments, the distribution of exposure was 0.52 (dry cow therapy), 1.43 (clinical mastitis treatment), 0.39 (treatment of foot disease), 0.14 (treatment of respiratory disease), and 0.32 (treatment of metritis) DDD. For treatments of foot infections (0.33 DDD), respiratory infections (0.07 DDD), and metritis (0.19 DDD), the mean density of ceftiofur usage was significantly greater compared with other compounds.
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Affiliation(s)
- M Pol
- Department of Dairy Science, University of Wisconsin, Madison 53706, USA
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Levendag P, Nijdam W, Noever I, Braat C, Pol M, Schmitz P, Boer de M, Jansen P. 102 Late normal tissue sequelae and performance status with brachytherapy or surgery in tonsillar fossa and soft palate tumors. Can we be more selective? EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90135-2] [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: 10/26/2022] Open
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English AW, Eason J, Pol M, Schwartz G, Shirley A. Different phenotypes among slow/beta myosin heavy chain-containing fibres of rabbit masseter muscle: a novel type of diversity in adult muscle. J Muscle Res Cell Motil 1998; 19:525-35. [PMID: 9682139 DOI: 10.1023/a:1005360526559] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/08/2023]
Abstract
Difference in the phenotype of different mammalian muscle fibres are usually attributed to differences in the expression of the product of different myosin heavy chain (MyHC) genes, which are known as isoforms. We studied differences in phenotype among fibres containing a single MyHC isoform (slow/beta) of the masseter muscle of adult rabbits. Four different monoclonal antibodies to slow/beta MyHC were used to stain serial sections from muscles in males and females. All antibodies recognize a single band on immunoblots and stain the same set of fibres in rabbit postcranial muscles. However, differential staining was observed in the masseter muscles. Antibody BA-D5 reacts with the most fibres, antibody A4.951 reacts with a subset of these fibres, and antibody A4.840 reacts with a subset of these fibres, and antibody A4.840 reacts with a subset of A4.951-positive fibres. Antibody S58 reacts only with an even smaller subset of fibres. Even though differential staining using four antibodies might allow for the expression of as many as 15 different staining patterns, or patterns, or phenotypes, only four were observed on > 99% of over 30 000 fibres studied. In females, nearly 40% of the fibres stain exclusively with antibody BA-D5, while in males, fewer than 8% of the fibres express this phenotype. The proportions of fibres of the other phenotypes do not differ so strikingly with gender. We conclude that an epitope diversity exists among muscle fibres in the adult rabbit masseter and that it is not necessarily a consequence of differences in gene expression. We feel that it is a regulated process and that, at least for some phenotypes, this regulation may be hormonally influenced.
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Affiliation(s)
- A W English
- Department of Cell Biology, Emory University School of Medicine, Atlanta, Georgia, USA.
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Muga R, Tor J, Solsona L, Villanueva C, Pol M, Jacas C, Sabriá M, Rey-Joly C, Foz M. [Immunoglobulin A and human immunodeficiency virus type 1 infection in parenteral drug abuse addicts]. Med Clin (Barc) 1991; 96:361-3. [PMID: 2046411] [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: 12/30/2022]
Abstract
BACKGROUND To evaluate the usefulness of serum immunoglobulin A (IgA) as a prognostic marker of human immunodeficiency virus type 1 (HIV-1) in parenteral drug abusers (PDA). METHODS The serum IgA levels and HIV-1 antibodies were assessed in 374 PDAs admitted for infective diseases or for treatment of addiction. RESULTS The prevalence of HIV infection was 70%; the frequency of serum IgA above the upper normal limit (440 mg/dl) was 8% in seronegative and 4% in seropositive subjects (NS). The IgA levels in the 274 seropositive subjects, classified for infective stages, were significantly higher in those fulfilling the criteria for acquired immunodeficiency syndrome (AIDS) or AIDS related complex (group IV) than in asymptomatic subjects (group II) or in those with generalized lymphadenopathy (group III) (p less than 0.01). CONCLUSIONS Serum IgA levels in PDAs with HIV infection may be a useful marker of progression to AIDS.
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Affiliation(s)
- R Muga
- Unidad de Enfermedades infecciosas (Servicio de Medicina Interna), Hospital Germans Trias i Pujol, Badalona, Barcelona
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Abstract
Galactorrhea, caused by hyperprolactinemia can successfully be treated by bromocriptine. Continuous long-term use of this drug is not always desirable or possible because of side-effects. In cases of hyperprolactinemia with severe galactorrhea, where surgical or radiological therapy is not possible and long-term treatment with bromocriptine is not acceptable, subcutaneous mastectomy might be considered as an ultimate solution.
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