A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine... more A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by use of oral contraceptives. Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who ever used oral contraceptives. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure, or with the passage of time from either initial or most recent exposure. An observed increase in risk in current users of oral contraceptives was not considered likely to represent a causal relationship.
Journal of cardiovascular pharmacology and therapeutics, 2008
Rosuvastatin was tested on rat aortic rings in the presence and absence of K(+) channel blockers,... more Rosuvastatin was tested on rat aortic rings in the presence and absence of K(+) channel blockers, mevalonic acid, and inhibitors of nitric oxide, prostaglandins, or endothelial-derived hyperpolarizing factor synthesis. The direct vascular effects of rosuvastatin were then evaluated by obtaining dose-response curves. Rosuvastatin relaxed aortic rings with and, to a lesser degree, without endothelium. Under both these conditions this effect was partially inhibited by L-NAME, tetraethylammonium, apamin + charybdotoxin (only administered together), or mevalonic acid. The combination of L-NAME with any of the other 3 treatments completely inhibited the effect of rosuvastatin, but indomethacin, clotrimazol, glibenclamide, charybdotoxin, or apamin alone had no effect. Therefore, the relaxation induced by rosuvastatin, even in the absence of endothelium, is partially related to 2 different mechanisms, one that is isoprenoid dependent and NO mediated and the other that is tied to the opening...
Patterning events during early eye formation determine retinal cell fate and can dictate the beha... more Patterning events during early eye formation determine retinal cell fate and can dictate the behavior of retinal ganglion cell (RGC) axons as they navigate toward central brain targets. The temporally and spatially regulated expression of bone morphogenetic proteins (BMPs) and their receptors in the retina are thought to play a key role in this process, initiating gene expression cascades that distinguish different regions of the retina, particularly along the dorsoventral axis. Here, we examine the role of BMP and a potential downstream effector, EphB, in retinotopic map formation in the lateral geniculate nucleus (LGN) and superior colliculus (SC). RGC axon behaviors during retinotopic map formation in wild-type mice are compared with those in several strains of mice with engineered defects of BMP and EphB signaling. Normal RGC axon sorting produces axon order in the optic tract that reflects the dorsoventral position of the parent RGCs in the eye. A dramatic consequence of disrupting BMP signaling is a missorting of RGC axons as they exit the optic chiasm. This sorting is not dependent on EphB. When BMP signaling in the developing eye is genetically modified, RGC order in the optic tract and targeting in the LGN and SC are correspondingly disrupted. These experiments show that BMP signaling regulates dorsoventral RGC cell fate, RGC axon behavior in the ascending optic tract, and retinotopic map formation in the LGN and SC through mechanisms that are in part distinct from EphB signaling in the LGN and SC.
The role of mammography in the evaluation of male patients presenting with breast disease is cont... more The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.
Chemical investigation of the leaves of Waltheria brachypetala Turks (Sterculiaceae) resulted in ... more Chemical investigation of the leaves of Waltheria brachypetala Turks (Sterculiaceae) resulted in the isolation of quinolinone alkaloids, waltherione-A, waltherione-B (N-methylwaltherione-A), 8-methoxyflindersine, and the cyclic peptide alkaloid waltherine. The inhibition of activity of acetylcholinesterase (AChE) by the alkaloids was evaluated. Waltherione-A, waltherione-B and waltherine showed significant activity.
Vibrio fischeri form a mutualism in which vibrios inhabit a complex light organ within the squid ... more Vibrio fischeri form a mutualism in which vibrios inhabit a complex light organ within the squid host. A host-mediated daily expulsion event seeds surrounding seawater with symbiotically capable V. fischeri that environmentally colonize newly hatched axenic Euprymna juveniles. Competition experiments using native and non-native Vibrio have shown that this expulsion/re-colonization phenomenon has led to cospeciation in this system in the Pacific Ocean; however, the genetic architecture of these symbiotic populations has not been determined. Using genetic diversity and nested clade analyses we have examined the variation and history of three allopatric Euprymna squid species ( E. scolopes of Hawaii, E. hyllebergi of Thailand, and E. tasmanica from Australia) and their respective Vibrio symbionts. Euprymna populations appear to be very genetically distinct from each other, exhibiting little or no migration over large geographical distances. In contrast, Vibrio symbiont populations contain more diverse haplotypes, suggesting both host presence and unidentified factors facilitating long-distance migration structure in Pacific Vibrio populations. Findings from this study highlight the importance of how interactions between symbiotic organisms can unexpectedly shape population structure in phylogeographical studies.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2002
The advance of today's medicine could be linked very closely to the history of computers through ... more The advance of today's medicine could be linked very closely to the history of computers through the last twenty years. In the beginning the first attempt to build a computer was trying to help us with mathematical calculations. This has changed recently and computers are now linked to x-ray machines, CT scanners, and MRIs. Being able to share information is one of the goals of the future. Today's computer technology has helped a great deal to allow orthopaedic surgeons from around the world to consult on a difficult case or to become a part of a large database. Obtaining the results from a method of treatment using a multicentric information study can be done on a regular basis. In the future, computers will help us to retrieve information from patients' clinical history directly from a hospital database or by portable memory cards that will carry every radiograph or video from previous surgeries.
Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpo... more Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpose of this study was to examine the use of endovascular grafts as an alternative to aortobifemoral bypass in patients with advanced aortoiliac occlusive disease at high risk. Endovascular grafts were placed in 23 limbs in 22 patients with TransAtlantic Inter-Society Consensus document (TASC) type C and D lesions. All procedures were performed in the operating room, and images were obtained with portable digital fluoroscopy. Surgical exposure of the ipsilateral common femoral artery was performed to enable safe closure of 9F to 12F sheath sites and to facilitate ipsilateral interventions in the distal external iliac artery. Concomitant infrainguinal outflow procedures were performed in 6 patients. Twenty of 22 patients were men; mean patient age was 63.2 +/- 3.2 years. Indications for intervention were rest pain in 12 of 23 limbs and tissue loss in 9 of 22 limbs. Risk factors included hostile abdomen or pelvis in 8 patients, coronary artery disease in 11 patients, end-stage renal disease in 3 patients, and severe chronic obstructive pulmonary disease in 3 patients. Each patient received a mean of 1.6 grafts. Initial technical success was 95.2%, with one technical failure. There was no 30-day mortality. All patients experienced at least one grade improvement per Society for Vascular Surgery reporting standards. Primary patency at 24 months was 84.2% +/- 8.0%, with a limb salvage rate of 95.3% +/- 5.0%. Mean (+/- SD) ankle brachial index improved from 0.49 +/- 0.22 to 0.87 +/- 0.26 (P <.001). Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.
The purpose of this report is to present the MRI features of subcutaneous fat necrosis (SFN) and ... more The purpose of this report is to present the MRI features of subcutaneous fat necrosis (SFN) and the natural history of this process. We have seen 12 patients with SFN, one case of which was confirmed histopathologically. In six patients, a follow-up MRI study was performed. MRI findings were very similar in all of the cases: small, linear, and spiculated lesions with one or two components: a globular area yielding high signal intensity on T1-weighted images, intermediate to high signal intensity on fast SE T2-weighted images and focal signal void on short-inversion -time inversion recovery (STIR) sequence, corresponding to an area of fat necrosis; and a laminar starred component, with low signal intensity on T1 and fast SE T2-weighted images and high signal intensity on the STIR sequence, corresponding to reactive fibrous tissue. The follow-up MRI study of six patients showed either disappearance (n = 2) or decrease in size (n = 3) of the globular component; in one patient, no change was observed. A less prominent decrease of the laminar component also was seen in five patients. One patient did not present any change in this laminar component. The most characteristic MRI findings of this lesion are the high signal intensity areas on T1-weighted images, their small size (< 3 cm), their linear spiculated shape with both laminar and globular components, and no contrast enhancement after injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) injection. We believe that the location, size, morphology, and MRI signal intensity of SFN may allow its differentiation from other types of soft tissue lesions.
An epizootic in juvenile turbol reared on a farm located in the Rla de Vigo, Galicia, Northwest S... more An epizootic in juvenile turbol reared on a farm located in the Rla de Vigo, Galicia, Northwest Spain, is described. The diseased turbot did not display unusual swimming behaviour; the external signs of the disease were abdominal distension and haemorrhagie in the peritoneal cavity. Microbiological analysis of the diseased fish revealed the presenee, in pure culture in all the organs and lesions examined, of a bacterium whieh was characterized biochemically as Vibrio splendidus biotype 1. The virulenee tests showed that the V. splendidus biotype 1 isolate was pathogenic for rainbow trout (LD30: 2-2 x 10'') and also for turbot (LD5,,: 12 X lO-*). The treatment of the fish using flumequine incorporated into the
Background: In spite of the progress made m the prevention of transfuslon-traxlsmltted refections... more Background: In spite of the progress made m the prevention of transfuslon-traxlsmltted refections over the last years, these still occur It was considered that mfecnon by hepatms B (HBV) and C (HCV) vtruses could be a major problem m Uruguay, especmlly among high-risk mdlwduals, such as muln-traxlsfused panents Objectives: To assess the prevalence of HBV and HCV mfecnon among mulntransfused Uruguayan panents and the tmpact of serological screening, to evaluate the role of number of transfusions and other potentml risk factors for the acqmsmon of HBV and HCV mfecnon Study design: Cross-secnonal study of HCV axmbodles, HBV surface axmgen (HBsAg) and HBV core axltlbodles (HBcAc) m 409 multi-transfused patients Results: Of 409 patients studied, 147 (35 9"/,,) received blood products due to acute bleeding, 118 (28 9"/,,) were hemato-oncologlcal, 75 (18 3"/,,) hemophflmcs, 64 (15 6"/,,) were on hemodmlys~s, and 5 (1 2"/,,) suffered sickle cell anemm Prevalence of HCV ax~t~body was 12 7"/,, Of the HCV-posmve patients, 45 were hemophflmcs, for a prevalence rate of 60 0% The prevalence rates for hemodmlys~s and acute bleeding patients were 6 3"/,, and 2 0%, respectively Prevalence of HBsAg was 1 0%, 16 6"/,, of subjects were positive for HBcAc The prevalence rates of HBcAc were 48 0%, 15 0% and 3 1% among hemophahacs, acute bleeding and hemodmlys~s patients, respectively There was a dtrect relatlonsh~p between the number of products transfused and prevalence of both hepatitis C ant~bodles and HBcAc H~gher prevalence of HCV and HBcAc was observed among the group of patients who received trax~sfus~ons before the systematic screening of blood donors Conclusions: Exposure to blood transfusions was the mmn risk factor for HCV and HBV mfect~on The systematic serological screemng of blood donors was h~ghly effective m reducing trax~sfuslon transmitted refections '4' 2005 Elsevier B V All rights reserved I~'evwotds HCV, HBV, Transfusion, Blood transmlssmn 1590-8658 $ see front matter ,c, 2005 Flsevler B V All rights reserved L L@ez et al / lownal q/'Chntcal l'ttologv 34 Suppl 2 (2005) $69 $74 $73
The vesical diverticulum (VD) consists of a cavity formed by herniation of the bladder mucosa thr... more The vesical diverticulum (VD) consists of a cavity formed by herniation of the bladder mucosa through the muscular wall joined by a constricted neck to the bladder cavity proper.' The VD tends to occur in areas of congenital weakness of the muscular wall, and for that reason it is most common in the region around the ureteral meati or in the posterolateral surface of the bladder.2-4
Anaplasma and related Ehrlichia spp. are important tick-borne, Gram-negative bacterial pathogens ... more Anaplasma and related Ehrlichia spp. are important tick-borne, Gram-negative bacterial pathogens of livestock and humans that cause acute infection and disease and can persist. Immunization of cattle with an Anaplasma marginale fraction enriched in outer membranes (OM) can provide complete protection against disease and persistent infection. Serological responses of OM vaccinees to the OM proteome previously identified over 20 antigenic proteins, including three type IV secretion system (T4SS) proteins, VirB9-1, VirB9-2, and VirB10. Subsequent studies showed that these three proteins also stimulated CD4 ؉ T-cell responses in OM vaccinees. The T4SS, composed of a complex of proteins spanning the inner and outer membranes of certain bacteria, is an important virulence factor but is relatively unexplored as a vaccine target. The goal of this study was to determine if additional T4SS proteins are immunogenic for animals immunized with the protective OM fraction of A. marginale. T4SS proteins expressed by in vitro transcription and translation were screened for stimulating proliferation of T cells from OM vaccinees, and immunogenic proteins were expressed as recombinant proteins in Escherichia coli and their immunogenicity was verified. VirB2, a putative VirB7, VirB11, and VirD4 were immunogenic for OM vaccinees expressing several common major histocompatibility complex (MHC) class II haplotypes. VirB2 is encoded by multiple genes that share a conserved central region, and epitope mapping revealed T-cell epitopes in this region. The discovery of novel immunogenic T4SS proteins recognized by outbred individuals with common MHC haplotypes further justifies evaluating the T4SS as a potential vaccine candidate for pathogenic bacteria.
Bioluminescence is widespread among many different types of marine organisms. Metazoans contain t... more Bioluminescence is widespread among many different types of marine organisms. Metazoans contain two types of luminescence production, bacteriogenic (symbiotic with bacteria) or autogenic, via the production of a luminous secretion or the intrinsic properties of luminous cells. Several species in two families of squids, the Loliginidae and the Sepiolidae (Mollusca: Cephalopoda) harbor bacteriogenic light organs that are found central in the mantle cavity. These light organs are exceptional in function, that is, the morphology and the complexity suggests that the organ has evolved to enhance and direct light emission from bacteria that are harbored inside. Although light organs are widespread among taxa within the Sepiolidae, the origin and development of this important feature is not well studied. We compared light organ morphology from several closely related taxa within the Sepiolidae and combined molecular phylogenetic data using four loci (nuclear ribosomal 28S rRNA and the mitochondrial cytochrome c oxidase subunit I and 12S and 16S rRNA) to determine whether this character was an ancestral trait repeatedly lost among both families or whether it evolved independently as an adaptation to the pelagic and benthic lifestyles. By comparing other closely related extant taxa that do not contain symbiotic light organs, we hypothesized that the ancestral state of sepiolid light organs most likely evolved from part of a separate accessory gland open to the environment that allowed colonization of bacteria to occur and further specialize in the eventual development of the modern light organ.
Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have... more Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), gamma-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Prospective, multicentered, double-blind, randomized controlled trial. Intensive care units of five academic and teaching hospitals in the United States. We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (approximately 2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine... more A case-control study of cervical carcinoma in situ was conducted in Santiago, Chile, to determine whether risk of this condition is altered by use of oral contraceptives. Responses to a standardized questionnaire were compared in 133 hospitalized cases and 254 age-matched controls selected from the same screening program through which the cases were detected. After controlling for the possible confounding influence of a variety of indices of sexual behavior, socioeconomic status, and prior cytological smears, no increase in risk was found in women who ever used oral contraceptives. No trend of increasing or decreasing risk was seen in relation to duration of use, up to more than 6 years of exposure, or with the passage of time from either initial or most recent exposure. An observed increase in risk in current users of oral contraceptives was not considered likely to represent a causal relationship.
Journal of cardiovascular pharmacology and therapeutics, 2008
Rosuvastatin was tested on rat aortic rings in the presence and absence of K(+) channel blockers,... more Rosuvastatin was tested on rat aortic rings in the presence and absence of K(+) channel blockers, mevalonic acid, and inhibitors of nitric oxide, prostaglandins, or endothelial-derived hyperpolarizing factor synthesis. The direct vascular effects of rosuvastatin were then evaluated by obtaining dose-response curves. Rosuvastatin relaxed aortic rings with and, to a lesser degree, without endothelium. Under both these conditions this effect was partially inhibited by L-NAME, tetraethylammonium, apamin + charybdotoxin (only administered together), or mevalonic acid. The combination of L-NAME with any of the other 3 treatments completely inhibited the effect of rosuvastatin, but indomethacin, clotrimazol, glibenclamide, charybdotoxin, or apamin alone had no effect. Therefore, the relaxation induced by rosuvastatin, even in the absence of endothelium, is partially related to 2 different mechanisms, one that is isoprenoid dependent and NO mediated and the other that is tied to the opening...
Patterning events during early eye formation determine retinal cell fate and can dictate the beha... more Patterning events during early eye formation determine retinal cell fate and can dictate the behavior of retinal ganglion cell (RGC) axons as they navigate toward central brain targets. The temporally and spatially regulated expression of bone morphogenetic proteins (BMPs) and their receptors in the retina are thought to play a key role in this process, initiating gene expression cascades that distinguish different regions of the retina, particularly along the dorsoventral axis. Here, we examine the role of BMP and a potential downstream effector, EphB, in retinotopic map formation in the lateral geniculate nucleus (LGN) and superior colliculus (SC). RGC axon behaviors during retinotopic map formation in wild-type mice are compared with those in several strains of mice with engineered defects of BMP and EphB signaling. Normal RGC axon sorting produces axon order in the optic tract that reflects the dorsoventral position of the parent RGCs in the eye. A dramatic consequence of disrupting BMP signaling is a missorting of RGC axons as they exit the optic chiasm. This sorting is not dependent on EphB. When BMP signaling in the developing eye is genetically modified, RGC order in the optic tract and targeting in the LGN and SC are correspondingly disrupted. These experiments show that BMP signaling regulates dorsoventral RGC cell fate, RGC axon behavior in the ascending optic tract, and retinotopic map formation in the LGN and SC through mechanisms that are in part distinct from EphB signaling in the LGN and SC.
The role of mammography in the evaluation of male patients presenting with breast disease is cont... more The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.
Chemical investigation of the leaves of Waltheria brachypetala Turks (Sterculiaceae) resulted in ... more Chemical investigation of the leaves of Waltheria brachypetala Turks (Sterculiaceae) resulted in the isolation of quinolinone alkaloids, waltherione-A, waltherione-B (N-methylwaltherione-A), 8-methoxyflindersine, and the cyclic peptide alkaloid waltherine. The inhibition of activity of acetylcholinesterase (AChE) by the alkaloids was evaluated. Waltherione-A, waltherione-B and waltherine showed significant activity.
Vibrio fischeri form a mutualism in which vibrios inhabit a complex light organ within the squid ... more Vibrio fischeri form a mutualism in which vibrios inhabit a complex light organ within the squid host. A host-mediated daily expulsion event seeds surrounding seawater with symbiotically capable V. fischeri that environmentally colonize newly hatched axenic Euprymna juveniles. Competition experiments using native and non-native Vibrio have shown that this expulsion/re-colonization phenomenon has led to cospeciation in this system in the Pacific Ocean; however, the genetic architecture of these symbiotic populations has not been determined. Using genetic diversity and nested clade analyses we have examined the variation and history of three allopatric Euprymna squid species ( E. scolopes of Hawaii, E. hyllebergi of Thailand, and E. tasmanica from Australia) and their respective Vibrio symbionts. Euprymna populations appear to be very genetically distinct from each other, exhibiting little or no migration over large geographical distances. In contrast, Vibrio symbiont populations contain more diverse haplotypes, suggesting both host presence and unidentified factors facilitating long-distance migration structure in Pacific Vibrio populations. Findings from this study highlight the importance of how interactions between symbiotic organisms can unexpectedly shape population structure in phylogeographical studies.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2002
The advance of today's medicine could be linked very closely to the history of computers through ... more The advance of today's medicine could be linked very closely to the history of computers through the last twenty years. In the beginning the first attempt to build a computer was trying to help us with mathematical calculations. This has changed recently and computers are now linked to x-ray machines, CT scanners, and MRIs. Being able to share information is one of the goals of the future. Today's computer technology has helped a great deal to allow orthopaedic surgeons from around the world to consult on a difficult case or to become a part of a large database. Obtaining the results from a method of treatment using a multicentric information study can be done on a regular basis. In the future, computers will help us to retrieve information from patients' clinical history directly from a hospital database or by portable memory cards that will carry every radiograph or video from previous surgeries.
Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpo... more Aortobifemoral bypass is the standard therapy for complex aortoiliac occlusive disease. The purpose of this study was to examine the use of endovascular grafts as an alternative to aortobifemoral bypass in patients with advanced aortoiliac occlusive disease at high risk. Endovascular grafts were placed in 23 limbs in 22 patients with TransAtlantic Inter-Society Consensus document (TASC) type C and D lesions. All procedures were performed in the operating room, and images were obtained with portable digital fluoroscopy. Surgical exposure of the ipsilateral common femoral artery was performed to enable safe closure of 9F to 12F sheath sites and to facilitate ipsilateral interventions in the distal external iliac artery. Concomitant infrainguinal outflow procedures were performed in 6 patients. Twenty of 22 patients were men; mean patient age was 63.2 +/- 3.2 years. Indications for intervention were rest pain in 12 of 23 limbs and tissue loss in 9 of 22 limbs. Risk factors included hostile abdomen or pelvis in 8 patients, coronary artery disease in 11 patients, end-stage renal disease in 3 patients, and severe chronic obstructive pulmonary disease in 3 patients. Each patient received a mean of 1.6 grafts. Initial technical success was 95.2%, with one technical failure. There was no 30-day mortality. All patients experienced at least one grade improvement per Society for Vascular Surgery reporting standards. Primary patency at 24 months was 84.2% +/- 8.0%, with a limb salvage rate of 95.3% +/- 5.0%. Mean (+/- SD) ankle brachial index improved from 0.49 +/- 0.22 to 0.87 +/- 0.26 (P <.001). Endovascular grafting to treat advanced aortoiliac occlusive disease can be accomplished with good clinical outcome and acceptable short-term patency. This endovascular technique can be a viable alternative to conventional surgical revascularization in patients with advanced aortoiliac occlusive disease at high risk.
The purpose of this report is to present the MRI features of subcutaneous fat necrosis (SFN) and ... more The purpose of this report is to present the MRI features of subcutaneous fat necrosis (SFN) and the natural history of this process. We have seen 12 patients with SFN, one case of which was confirmed histopathologically. In six patients, a follow-up MRI study was performed. MRI findings were very similar in all of the cases: small, linear, and spiculated lesions with one or two components: a globular area yielding high signal intensity on T1-weighted images, intermediate to high signal intensity on fast SE T2-weighted images and focal signal void on short-inversion -time inversion recovery (STIR) sequence, corresponding to an area of fat necrosis; and a laminar starred component, with low signal intensity on T1 and fast SE T2-weighted images and high signal intensity on the STIR sequence, corresponding to reactive fibrous tissue. The follow-up MRI study of six patients showed either disappearance (n = 2) or decrease in size (n = 3) of the globular component; in one patient, no change was observed. A less prominent decrease of the laminar component also was seen in five patients. One patient did not present any change in this laminar component. The most characteristic MRI findings of this lesion are the high signal intensity areas on T1-weighted images, their small size (< 3 cm), their linear spiculated shape with both laminar and globular components, and no contrast enhancement after injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) injection. We believe that the location, size, morphology, and MRI signal intensity of SFN may allow its differentiation from other types of soft tissue lesions.
An epizootic in juvenile turbol reared on a farm located in the Rla de Vigo, Galicia, Northwest S... more An epizootic in juvenile turbol reared on a farm located in the Rla de Vigo, Galicia, Northwest Spain, is described. The diseased turbot did not display unusual swimming behaviour; the external signs of the disease were abdominal distension and haemorrhagie in the peritoneal cavity. Microbiological analysis of the diseased fish revealed the presenee, in pure culture in all the organs and lesions examined, of a bacterium whieh was characterized biochemically as Vibrio splendidus biotype 1. The virulenee tests showed that the V. splendidus biotype 1 isolate was pathogenic for rainbow trout (LD30: 2-2 x 10'') and also for turbot (LD5,,: 12 X lO-*). The treatment of the fish using flumequine incorporated into the
Background: In spite of the progress made m the prevention of transfuslon-traxlsmltted refections... more Background: In spite of the progress made m the prevention of transfuslon-traxlsmltted refections over the last years, these still occur It was considered that mfecnon by hepatms B (HBV) and C (HCV) vtruses could be a major problem m Uruguay, especmlly among high-risk mdlwduals, such as muln-traxlsfused panents Objectives: To assess the prevalence of HBV and HCV mfecnon among mulntransfused Uruguayan panents and the tmpact of serological screening, to evaluate the role of number of transfusions and other potentml risk factors for the acqmsmon of HBV and HCV mfecnon Study design: Cross-secnonal study of HCV axmbodles, HBV surface axmgen (HBsAg) and HBV core axltlbodles (HBcAc) m 409 multi-transfused patients Results: Of 409 patients studied, 147 (35 9"/,,) received blood products due to acute bleeding, 118 (28 9"/,,) were hemato-oncologlcal, 75 (18 3"/,,) hemophflmcs, 64 (15 6"/,,) were on hemodmlys~s, and 5 (1 2"/,,) suffered sickle cell anemm Prevalence of HCV ax~t~body was 12 7"/,, Of the HCV-posmve patients, 45 were hemophflmcs, for a prevalence rate of 60 0% The prevalence rates for hemodmlys~s and acute bleeding patients were 6 3"/,, and 2 0%, respectively Prevalence of HBsAg was 1 0%, 16 6"/,, of subjects were positive for HBcAc The prevalence rates of HBcAc were 48 0%, 15 0% and 3 1% among hemophahacs, acute bleeding and hemodmlys~s patients, respectively There was a dtrect relatlonsh~p between the number of products transfused and prevalence of both hepatitis C ant~bodles and HBcAc H~gher prevalence of HCV and HBcAc was observed among the group of patients who received trax~sfus~ons before the systematic screening of blood donors Conclusions: Exposure to blood transfusions was the mmn risk factor for HCV and HBV mfect~on The systematic serological screemng of blood donors was h~ghly effective m reducing trax~sfuslon transmitted refections '4' 2005 Elsevier B V All rights reserved I~'evwotds HCV, HBV, Transfusion, Blood transmlssmn 1590-8658 $ see front matter ,c, 2005 Flsevler B V All rights reserved L L@ez et al / lownal q/'Chntcal l'ttologv 34 Suppl 2 (2005) $69 $74 $73
The vesical diverticulum (VD) consists of a cavity formed by herniation of the bladder mucosa thr... more The vesical diverticulum (VD) consists of a cavity formed by herniation of the bladder mucosa through the muscular wall joined by a constricted neck to the bladder cavity proper.' The VD tends to occur in areas of congenital weakness of the muscular wall, and for that reason it is most common in the region around the ureteral meati or in the posterolateral surface of the bladder.2-4
Anaplasma and related Ehrlichia spp. are important tick-borne, Gram-negative bacterial pathogens ... more Anaplasma and related Ehrlichia spp. are important tick-borne, Gram-negative bacterial pathogens of livestock and humans that cause acute infection and disease and can persist. Immunization of cattle with an Anaplasma marginale fraction enriched in outer membranes (OM) can provide complete protection against disease and persistent infection. Serological responses of OM vaccinees to the OM proteome previously identified over 20 antigenic proteins, including three type IV secretion system (T4SS) proteins, VirB9-1, VirB9-2, and VirB10. Subsequent studies showed that these three proteins also stimulated CD4 ؉ T-cell responses in OM vaccinees. The T4SS, composed of a complex of proteins spanning the inner and outer membranes of certain bacteria, is an important virulence factor but is relatively unexplored as a vaccine target. The goal of this study was to determine if additional T4SS proteins are immunogenic for animals immunized with the protective OM fraction of A. marginale. T4SS proteins expressed by in vitro transcription and translation were screened for stimulating proliferation of T cells from OM vaccinees, and immunogenic proteins were expressed as recombinant proteins in Escherichia coli and their immunogenicity was verified. VirB2, a putative VirB7, VirB11, and VirD4 were immunogenic for OM vaccinees expressing several common major histocompatibility complex (MHC) class II haplotypes. VirB2 is encoded by multiple genes that share a conserved central region, and epitope mapping revealed T-cell epitopes in this region. The discovery of novel immunogenic T4SS proteins recognized by outbred individuals with common MHC haplotypes further justifies evaluating the T4SS as a potential vaccine candidate for pathogenic bacteria.
Bioluminescence is widespread among many different types of marine organisms. Metazoans contain t... more Bioluminescence is widespread among many different types of marine organisms. Metazoans contain two types of luminescence production, bacteriogenic (symbiotic with bacteria) or autogenic, via the production of a luminous secretion or the intrinsic properties of luminous cells. Several species in two families of squids, the Loliginidae and the Sepiolidae (Mollusca: Cephalopoda) harbor bacteriogenic light organs that are found central in the mantle cavity. These light organs are exceptional in function, that is, the morphology and the complexity suggests that the organ has evolved to enhance and direct light emission from bacteria that are harbored inside. Although light organs are widespread among taxa within the Sepiolidae, the origin and development of this important feature is not well studied. We compared light organ morphology from several closely related taxa within the Sepiolidae and combined molecular phylogenetic data using four loci (nuclear ribosomal 28S rRNA and the mitochondrial cytochrome c oxidase subunit I and 12S and 16S rRNA) to determine whether this character was an ancestral trait repeatedly lost among both families or whether it evolved independently as an adaptation to the pelagic and benthic lifestyles. By comparing other closely related extant taxa that do not contain symbiotic light organs, we hypothesized that the ancestral state of sepiolid light organs most likely evolved from part of a separate accessory gland open to the environment that allowed colonization of bacteria to occur and further specialize in the eventual development of the modern light organ.
Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have... more Recent studies in animal models of sepsis-induced acute respiratory distress syndrome (ARDS) have shown that a low-carbohydrate, high-fat diet combining the anti-inflammatory and vasodilatory properties of eicosapentaenoic acid (EPA; fish oil), gamma-linolenic acid (GLA; borage oil) (EPA+GLA), and antioxidants improves lung microvascular permeability, oxygenation, and cardiopulmonary function and reduces proinflammatory eicosanoid synthesis and lung inflammation. These findings suggest that enteral nutrition with EPA+GLA and antioxidants may reduce pulmonary inflammation and may improve oxygenation and clinical outcomes in patients with ARDS. Prospective, multicentered, double-blind, randomized controlled trial. Intensive care units of five academic and teaching hospitals in the United States. We enrolled 146 patients with ARDS (as defined by the American-European Consensus Conference) caused by sepsis/pneumonia, trauma, or aspiration injury in the study. Patients meeting entry criteria were randomized and continuously tube-fed either EPA+GLA or an isonitrogenous, isocaloric standard diet at a minimum caloric delivery of 75% of basal energy expenditure x 1.3 for at least 4-7 days. Arterial blood gases were measured, and ventilator settings were recorded at baseline and study days 4 and 7 to enable calculation of PaO2/FIO2, a measure of gas exchange. Pulmonary neutrophil recruitment was assessed by measuring the number of neutrophils and the total cell count in bronchoalveolar lavage fluid at the same time points. Clinical outcomes were recorded. Baseline characteristics of 98 evaluable patients revealed that key demographic, physiologic, and ventilatory variables were similar at entry between both groups. Multiple bronchoalveolar lavages revealed significant decreases (approximately 2.5-fold) in the number of total cells and neutrophils per mL of recovered lavage fluid during the study with EPA+GLA compared with patients fed the control diet. Significant improvements in oxygenation (PaO2/FIO2) from baseline to study days 4 and 7 with lower ventilation variables (FIO2, positive end-expiratory pressure, and minute ventilation) occurred in patients fed EPA+GLA compared with controls. Patients fed EPA+GLA required significantly fewer days of ventilatory support (11 vs. 16.3 days; p = .011), and had a decreased length of stay in the intensive care unit (12.8 vs. 17.5 days; p = .016) compared with controls. Only four of 51 (8%) patients fed EPA+GLA vs. 13 of 47 (28%) control patients developed a new organ failure during the study (p = .015). The beneficial effects of the EPA+GLA diet on pulmonary neutrophil recruitment, gas exchange, requirement for mechanical ventilation, length of intensive care unit stay, and the reduction of new organ failures suggest that this enteral nutrition formula would be a useful adjuvant therapy in the clinical management of patients with or at risk of developing ARDS.
A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brot... more A 57-year-old woman with syncope was admitted. She had a family history of sudden death: two brothers had died suddenly at the age of 47. Transesophageal echocardiography showed numerous prominent trabeculations and deep intertrabecular recesses in the anterior and lateroapical zones. Isotopic left ventricular ejection fraction was 46%. Cardiac catheterization showed coronary arteries with no angiographic lesions. A prominent trabecular zone and deep intertrabecular recesses were seen in the anterior wall on left ventriculography. Right ventriculography was normal. The diagnosis of isolated noncompaction left ventricular myocardium was established. Continuous 24-h electrocardiographic registry showed episodes of polymorphic ventricular tachycardia. Programmed ventricular stimulation performed at the right ventricular apex with up to three extrastimuli failed to induce ventricular arrhythmias. Treatment with beta blockers was initiated, but short runs of polymorphic ventricular tachycardia persisted. A dual-chamber automatic implantable defibrillator was implanted. We discuss the physiopathology of the arrhythmia. It appears that several factors could be responsible for the malignant arrhythmias in this entity.
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Papers by Jorge Lopez