Showing papers by "Hospital Universitario La Paz published in 1999"
TL;DR: Limited activities of daily living and geriatric problems on admission are the strongest predictive factors of outcome, independent of diagnoses, in elderly patients on discharge and at 6 months.
Abstract: Aim: to investigate which factors predict outcome of elderly patients on discharge and at 6 months. Methods: a prospective study in an acute geriatric ward. Within 48 h of admission, patients were assessed for social factors, geriatric problems, admission diagnoses, medication, function and mental ability. Outcome measures were mortality, length of stay, institutionalization, readmissions and attendance at accident and emergency within 6 months. Results: 353 patients were studied, with a mean age of 81.8 years. Logistic regression analyses showed that variables predicting hospital mortality were Barthel index on admission, pre-morbid disability and polypharmacy. The only variable independently predictive of prolonged stay in hospital was a Barthel score of <45 on admission. Functional disability on admission was predictive of institutionalization on discharge. Variables predicting mortality within 6 months of discharge were Barthel index on admission <65, presence of pressure sores, malnutrition and polypharmacy. Variables independently predictive of institutionalization were mental state and a low pension. Those who took more than five drugs on admission were more likely to attend accident and emergency and be readmitted. Conclusion: limited activities of daily living and geriatric problems on admission are the strongest predictive factors of outcome, independent of diagnoses.
177 citations
TL;DR: The results suggest that the CCR5 receptor plays an important role in RA and may be a suitable target for therapy.
Abstract: Objective
To investigate whether the pathogenesis of rheumatoid arthritis (RA) is associated with the functional chemokine receptor CCR5, which is the primary CC chemokine receptor expressed by T cells in rheumatoid synovium, and its nonfunctional receptor, Δ32CCR5, which is generated by the homozygous 32-basepair deletion (Δ32) in the CCR5 gene.
Methods
The frequency of the CCR5 genotype was compared among 673 patients with RA, 113 patients with systemic lupus erythematosus (SLE), and 815 control subjects. The CCR5 genotype was studied by polymerase chain reaction amplification of the region flanking the Δ32 deletion (Δ32CCR5).
Results
Frequencies of the wild-type CCR5 alleles (0.929, 0.907, and 0.942, respectively) and Δ32CCR5 alleles (0.071, 0.093, and 0.058, respectively) in controls, SLE patients, and RA patients did not differ significantly. However, none of the RA patients had the homozygous Δ32CCR5 genotype, compared with a frequency of 0.009 in controls (P = 0.014 by Fisher's exact test; χ2 = 4.12 with Yates' correction, P = 0.042) and 0.027 in SLE patients (P = 0.003 by Fisher's exact test; χ2= 11.63 with Yates' correction, P = 0.0006).
Conclusion
The results suggest that the CCR5 receptor plays an important role in RA and may be a suitable target for therapy.
155 citations
TL;DR: Computer prediction of protein sorting suggests that the POMT1 product could be an integral protein of the endoplasmic reticulum membrane, and may function as a mannosyl-transferase involved in O-mannosylation of proteins, being the first of such a class found in mammals.
123 citations
TL;DR: In vitro cross-reactivity among mammalian meats appears to be important, while cross- reactivity to poultry is limited indicating mammalian-specific proteins.
Abstract: Background Although meat is a main source of proteins in western diets, little information is available regarding allergy to vertebrate meats or the allergens implicated in these reactions. Objective To evaluate the in vitro IgE antibody response to different vertebrate meats in suspected meat-allergic subjects, as well as the possible role of tropomyosin in meat allergy and to analyze the cross-reactivity between vertebrate meats and the effect of heating on the IgE-binding to meat proteins. Methods Fifty-seven sera from suspected meat-allergic subjects were tested by grid blot to extracts of beef, lamb, pork, venison, chicken, and turkey and to four mammalian tropomyosins of different origins. Results Meat-allergic subjects have IgE antibodies to proteins in different mammalian meats (43/57 subjects); cross-reactivity with avian meat was limited: less than 50% (19/43) of meat positive sera reacted to chicken. In contrast, most of the poultry-positive sera also reacted to different mammalian meats. In general, there was stronger IgE reactivity to raw meats in comparison to cooked meats; an exception was six cases in which IgE reactivity to cooked poultry was stronger. Weak IgE reactivity to tropomyosin was detected in only 2/57 sera tested. Conclusions Suspected meat-allergic subjects have serum IgE directed to meat proteins. In vitro cross-reactivity among mammalian meats appears to be important, while cross-reactivity to poultry is limited indicating mammalian-specific proteins. Although cooking in general denatures meat proteins rendering them less allergenic, in some cases the process of cooking may result in the formation of new allergenic moieties. The muscle protein tropomyosin is not an important vertebrate meat allergen.
89 citations
TL;DR: Thymectomy is a beneficial procedure for MG patients, with a complete clinical remission rate of 46% at 5 years postoperatively in this series, and female patients have better prognosis than men, and the younger the patient the more likely is completeclinical remission.
80 citations
TL;DR: The increased levels of thiol compounds found in rheumatoid arthritis patients may be implicated in the increased incidence of cardiovascular disease found in these patients by means of the toxic effect of homocysteine on endothelium and the increased susceptibility of LDL to oxidation by increased plasma amounts ofThiol compounds such as cysteine.
75 citations
TL;DR: This review provides no convincing evidence that tacrine is a useful treatment for the symptoms of Alzheimer's disease and there is an urgent need for the independent evaluation of the data already existing in the trials but not accessible through published or grouped data.
Abstract: Reason for withdrawal from publication
This review is permanently wirhdrawn. A new review, of individual patient data, is in preparation. In the meantime, for more information on tacrine, readers might refer to Qizilbash N, Whitehead A, Higgins J, Wilcock G, Schneider L, Farlow M. Cholinesterase inhibition for Alzheimer disease: a meta-analysis of the tacrine trials. Dementia Trialists' Collaboration. JAMA. 1998; 280: 20: 1777-82 To view the published versions of this article, please click the 'Other versions' tab.
71 citations
TL;DR: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost.
Abstract: Objective: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. Design: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. Setting: A medical-surgical intensive care unit (ICU) in a university hospital. Patients: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. Measurements and main results: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost–utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12–36). Cumulative mortality was 35 % in the ICU, 50 % in hospital, 75 % at 1 year, and 85 % at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U. S. $ 26 283 and U. S. $ 44 602 in a “best” (cost/QALY calculated for the life expectancy in Spain) and a “worst case scenario” (cost/QALY calculated for a 68-year life expectancy), respectively. Conclusions: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.
70 citations
TL;DR: It is shown that cAMP levels, but not cGMP, are significantly elevated in CSF from patients with DAT compared to those from nondemented controls, which suggests that upregulation of cAMP-signaling pathway is implicated in Alzheimer's disease physiopathology.
69 citations
TL;DR: It is hypothesized that treatment with a sulfur-containing antioxidant such as N-acetylcysteine may provide a new neuroprotective therapeutic strategy for Parkinson's disease.
68 citations
TL;DR: Losartan increased uric acid excretion in hypertensive patients, whilst eprosartan did not Neither AT-1 receptor antagonist substantially modified serum urate concentrations.
Abstract: OBJECTIVE The influence of angiotensin II AT-1 receptor antagonists on uric acid metabolism, and the potential differences among them with regard to this effect, remains to be precisely established. This study was designed to compare the effects of losartan and eprosartan on uric acid metabolism in patients with mild to moderate essential hypertension. DESIGN Randomized, double-blind, parallel-group study in hypertensive patients. SETTING Outpatient clinic. PATIENTS Following a 2- to 3-week single-blind placebo run-in period, 60 patients with sitting diastolic blood pressure > or = 95 and < or = 114 mmHg were randomized. Fifty-eight patients completed the study. INTERVENTIONS Patients were randomized to receive losartan 50 mg or eprosartan 600 mg once daily for 4 weeks. MAIN OUTCOME MEASURES The primary endpoint was the change in the ratio of urinary uric acid/creatinine in the period 0-4 h of a 24 h urine collection after 4 weeks of treatment. Secondary endpoints included 24 h urinary uric acid excretion, as well as serum urate and anti-hypertensive efficacy. RESULTS Mean urinary uric acid/creatinine changes from baseline were 0.14 (day 1) and 0.11 (week 4) for losartan and -0.04 for eprosartan (at both day 1 and week 4; P < 0.01 between groups at both time-points). The mean increase in 24 h urinary uric acid excretion with losartan was 0.7 mmol/24 h (25% increase from baseline) at both day 1 and week 4. No significant difference was observed in the change of serum urate levels versus baseline between both treatment groups after 4 weeks (- 23.4 and - 19.5 micromol/l for losartan and eprosartan, respectively). Patients with hyperuricaemia in both treatment groups showed similar modifications of uric acid metabolism compared with non-hyperuricaemic subjects. Blood pressure control (sitting diastolic blood pressure < 90 mmHg or < 100 mmHg with a decrease of at least 10 mmHg from baseline) was achieved in 22 patients (73%) with eprosartan and in 16 (53%) with losartan. CONCLUSIONS Losartan increased uric acid excretion in hypertensive patients, whilst eprosartan did not Neither AT-1 receptor antagonist substantially modified serum urate concentrations.
TL;DR: The standard information package, used as a patient education program, effectively resulted in patients having a significantly improved level of knowledge and understanding of ESRD and the different treatment options available.
Abstract: ObjectiveTo evaluate the validity of a standard information package, comprising written and audiovisual aids, for end-stage renal disease (ESRD) patients in a pre-dialysis program.Study DesignA mul...
TL;DR: The results indicate that myeloma cells use VLA‐4 to interact with CS‐1/FN, H1/ FN and VCAM‐1 on MM stroma, and that its function can be potentially up‐regulated, enabling higher degrees of cell adhesion to these V LA‐4 ligands, which might influence myelomas cell localization in the bone marrow.
Abstract: The integrin VLA-4 mediates attachment of myeloma cells to multiple myeloma (MM) bone marrow stroma. The alternatively-spliced CS-1 region of fibronectin (FN) and VCAM-1 are main ligands for VLA-4 and are both expressed on MM stroma. The H1 region is present in all FN isoforms and represents an additional binding site for VLA-4. We employed FN fragments FN-H89 and FN-H0, that contain either the CS-1 and H1, or only the H1 sites, respectively, as well as soluble VCAM-1 (sVCAM-1), to characterize VLA-4-mediated adhesion pathways used by myeloma cells to attach to MM stroma. CD38highCD45RA- cells from MM bone marrow, and the myeloma-derived cell lines NCI-H929, IM-9 and RPMI 8226, specifically adhered, by different degrees, to FN-H89, FN-H0 and sVCAM-1, and their VLA-4-dependent adhesion was substantially up-regulated by the anti-beta1 antibody TS2/16, which increases the affinity of VLA-beta1 integrins. Furthermore, VLA-4 function on NCI-H929 cells was enhanced by TS2/16 during adhesion to MM stroma. The alpha4beta7 integrin mediated a small portion of myeloma cell line adhesion to FN-H89, mainly upon integrin activation with Mn2+. These results indicate that myeloma cells use VLA-4 to interact with CS-1/FN, H1/FN and VCAM-1 on MM stroma, and that its function can be potentially up-regulated, enabling higher degrees of cell adhesion to these VLA-4 ligands, which might influence myeloma cell localization in the bone marrow.
Journal Article•
TL;DR: It was concluded that drug challenge may be the gold standard for most childhood reactions that are considered to be allergic, non-life-threatening and drug-related.
Abstract: Patients with drug reactions are often referred to allergists for "allergy". Skin testing and clinical history seem to have a good negative predictive value, however, although drug challenge could be dangerous, it is the only way to confirm the diagnosis. We aimed to demonstrate that most children with a history of non-life-threatening drug reactions do not have a true drug allergy and examined the use of drug challenge in childhood. Patients with reactions were referred to our clinic by pediatricians. In 1 year, 354 reactions were studied in 239 children. Patients were classified according to their positive or negative history of drug allergy. Skin prick testing was done in all cases. Exclusion criteria for challenge included drug anaphylaxis, Stevens-Johnson syndrome, systemic reactions with severe concomitant illness, beta-inhibitor drug therapy or positive skin test to the implicated drug with a positive history. It was found that the beta-lactam antibiotics were involved in 50% of suspected reactions, aspirin in 10% and sulfonamides in 9%. Histories were considered positive only in 25%. Drug challenges confirmed only 4% of all reactions. It was concluded that drug challenge may be the gold standard for most childhood reactions that are considered to be allergic, non-life-threatening and drug-related. Only 4% of these suspected reactions were exclusively caused by drug allergy.
TL;DR: The combination of growth hormone and high-protein diet protects from the damage caused by radiation to the bowel and accelerates its recovery, and this effect does not seem to be mediated through insulin-like growth factor levels.
Abstract: Adequate nutritional support can enhance the protective action of growth hormone in radiation-induced mucositis. Our aim is to address the evolutionary pattern of radiation injury to the small intestine of rats fed a high-protein diet and treated with growth hormone before irradiation. Male Wistar rats were fed a high-protein diet and killed two, four or seven days after irradiation. Animals were given either growth hormone or saline. The combination of growth hormone and high-protein diet reduced mortality, increased mucosal height and crypt proliferation, and reduced apoptosis from day 2 to day 7 after irradiation. Bacterial translocation was increased in rats fed the high-protein formula. Insulin-like growth factor was reduced by radiation and further reduced by the high-protein diet. The combination of growth hormone and high-protein diet protects from the damage caused by radiation to the bowel and accelerates its recovery. This effect does not seem to be mediated through insulin-like growth factor levels.
TL;DR: Although no morphologic findings are specific to MPNST, the above-mentioned cytologic features may suggest, in differentiated cases, its neurogenic differentiation, and immunocytochemical and ultrastructural studies are necessary.
Abstract: Objective To study the cytomorphologic features of malignant peripheral nerve sheath tumor (MPNST), including the epithelioid cell variant, and to establish differential diagnostic features with benign neurogenic tumors and other sarcomas. Study design Cytologic smears from primary, recurrent and metastatic tumors in 10 patients with MPNST were reviewed. Three patients had neurofibromatosis 1 (NF1), and in two others the tumor arose from a preexisting neurofibroma. Immunocytochemical evaluation of S-100 protein was performed in four cases. A complete pathologic study was available in all cases. To assess the validity of morphologic recognition, a blinded study, including eight cases of spindle MPNST among smears from histologically proven schwannomas, synovial sarcomas, leiomyosarcomas, malignant fibrous histiocytomas and liposarcomas, was performed. Results Neurogenic differentiation was recognizable in four cases (differentiated), while the other four (anaplastic) were indistinguishable from other pleomorphic sarcomas. The presence of elongated, slender, often wavy nuclei and less commonly a delicate, fibrillary metachromatic stroma were features suggestive of nerve sheath differentiation. Other cytologic, as well as clinical, features permitted their identification as malignant. Two cases of epithelioid MPNST disclosed large, polygonal to plasmocytoid tumor cells without specific cytologic features. S-100 immunoexpression was positive in two of the four cytologic samples tested. Conclusion Although no morphologic findings are specific to MPNST, the above-mentioned cytologic features may suggest, in differentiated cases, its neurogenic differentiation. On the basis of morphologic features alone, the diagnosis of anaplastic and epithelioid MPNST is not possible, and immunocytochemical and ultrastructural studies are necessary. A specific cytodiagnosis is possible in recurrences, metastases and cases of NF1 or a preexisting neurofibroma.
TL;DR: The main principle underlying the treatment of haemophilic contracture is the restoration of the patient’s lifestyle and mobility, rather than anatomic or radiographic normality.
Abstract: Haemophilic contracture is seen most commonly as an equinus deformity of the ankle, or at the knee or elbow in the form of a flexion deformity. Treatment options are varied, and decision-making is based on the degree of the contracture, its chronicity, the presence of articular subluxation, the patient's ability to participate in treatment, and the available medical facilities. The treatments available fall into four categories: physiotherapy, orthotics, corrective devices, and surgical procedures. Treatment should be primarily by physiotherapy, splintage, and corrective devices. The late or severe case may require surgical correction in the form of soft-tissue procedures. Soft-tissue correction of muscle shorthening may be performed such as lengthening of the Achilles tendon for equinus deformity of the ankle, or hamstring release of the flexor muscles of the knee. Lower femoral osteotomy has been used for correction of flexion deformity at the knee joint. Mechanical distraction using external fixators for treatment of severe knee flexion contractures has been recently reported with satisfactory results. The main principle underlying the treatment of haemophilic contracture is the restoration of the patient's lifestyle and mobility, rather than anatomic or radiographic normality.
TL;DR: A novel gene, TBL2, is identified in the common WBS deletion and has been mapped to mouse chromosome 5 in a region of conserved synteny with human 7q11.23.
Abstract: . Williams-Beuren syndrome (WBS) is a developmental disorder with multi-system manifestations caused by haploinsufficiency for contiguous genes deleted in chromosome region 7q11.2
TL;DR: Estimating absolute numbers of surviving neurons in CA1 in Wistar rats subjected to either 10 or 20 min global ischemia using the Sugio et al. variant of the original four-vessel occlusion model strongly supports that mortality biases the sample.
TL;DR: Sonography and computed tomography are useful in diagnosing duodenal hematoma, in excluding accompanying lesions, and in monitoring resolution with conservative treatment.
Abstract: We present 2 cases of duodenal hematoma. Sonography demonstrated a heterogeneous mass within the duodenal wall in both patients, and neither patient had signs of bowel perforation. CT confirmed the sonographic findings. Sonography and computed tomography are useful in diagnosing duodenal hematoma, in excluding accompanying lesions, and in monitoring resolution with conservative treatment.
TL;DR: The most important fact in patients with haemophilia is the avoidance of recurrent haemarthroses by means of haematological prophylaxis, which is not currently possible in the majority of countries around the world.
Abstract: The most important fact in patients with haemophilia is the avoidance of recurrent haemarthroses by means of haematological prophylaxis. Unfortunately this is not currently possible in the majority of countries around the world. When only on-demand haematological treatment is available, frequent evaluations are necessary for the early diagnosis and treatment of intra-articular bleeding episodes. The typical outcome of these patients is towards the development of chronic synovitis, and later on to haemophilic arthropathy, if the state of synovitis is not promptly and adequately controlled. Once arthropathy develops the functional prognosis is poor, although haemophilic patients use to tolerate very well their tremendous joints destructions. Treatment of these patients should be performed in a comprehensive basis within a multidisciplinary haemophilia unit.
TL;DR: The non-attending group had the following characteristics: unmarried, residing in an urban area, took less precautions not to be discovered, were more critical of the attempt, and the purpose of the attempts was to resolve a conflict.
01 Jan 1999
TL;DR: The data suggest that accumulation of TNF alpha may contribute to the development or maintenance of some neurologic, hematologic, and cardiac complications of uremic syndrome.
Abstract: Tumor necrosis factor alpha (TNF alpha) is usually excreted by the kidney. In dialysis patients, it accumulates. TNF alpha has been implicated in the pathogenesis of malnutrition, diabetic neuropathy, and erythropoietin resistance. We studied TNF alpha plasma levels in 49 stable peritoneal dialysis (PD) patients, with the aim of correlating those levels with the presence and severity of peripheral neuropathy, hypertrophic cardiomyopathy, and anemia. Kt/Vurea' residual renal creatinine clearance (CrC), nutritional markers, and general biochemistry were also determined. The average plasma level of TNF alpha was 67 +/- 32 pg/mL (range: 18.1-156.3 pg/mL; normal value 3-20 pg/mL). No correlation was observed between TNF alpha and KT/Vurea' but a negative correlation with CrC was seen (r: -0.37, p < 0.05). TNF alpha levels were higher in patients with neuropathy as compared to patients with normal results (72.5 +/- 32 pg/mL vs 44 +/- 22 pg/mL, p < 0.05). Patients with neuropathy also showed a lower CrC value (1.5 +/- 1.7 mL/min vs 3.9 +/- 2.6 mL/min, p < 0.01). TNF alpha levels were higher in patients with left ventricular hypertrophy (LVH) with respect to normal individuals (70.4 +/- 32 pg/mL vs 38.5 +/- 20.8 pg/mL, p < 0.05). Patients with severe LVH showed the lowest CrC value. A direct, significant relationship was found between TNF alpha levels and weekly erythropoietin dose (r: 0.41, p < 0.05). Patients with hypertriglyceridemia or taking lipid-lowering agents showed a positive linear correlation between TNF alpha and triglycerides (r = 0.7, n = 14, p < 0.05). These data suggest that accumulation of TNF alpha may contribute to the development or maintenance of some neurologic, hematologic, and cardiac complications of uremic syndrome. Loss of residual renal function conditions an increment in TNF alpha levels. These data continue to add support to the idea that TNF alpha may be considered a uremic toxin.
TL;DR: Judged by the clinical and radiographic criteria results were more satisfactory in the surgical group than in the nonoperative group, although high rates of poor results were encountered in both groups.
Abstract: Twenty-eight patients with displaced intra-articular fractures of the calcaneus treated by open reduction and fixation were compared with 30 patients with similar fractures treated conservatively. Judged by the clinical and radiographic criteria results were more satisfactory in the surgical group than in the nonoperative group, although high rates of poor results were encountered in both groups.
TL;DR: The present paper shows that NAC enhances COX activity in vitro in synaptic mitochondria isolated from young and old mice, suggesting that mitochondrial thiolic groups, which are essentials to oxidative phosphorylation, are impaired by aging.
TL;DR: The diagnosis of HIV-associated CBLL should always be considered if a parotid cystic lesion presents with numerous MGCs, andImmunocytochemical detection of p24 (HIV-1) protein in MGC becomes a very useful diagnostic aid and extends toParotid CBLL many of those pathogenic features ofAIDS infection already noted in other HIV-1-infected, lymphoid oropharyngeal lesions.
Abstract: Background Cystic benign lymphoepithelial lesion (CBLL) is a well-recognized parotid disorder the diagnosis of which can be made on the basis of clinical findings, human immunodeficiency virus (HIV) testing, image studies and fine needle aspiration (FNA). Most aspirations are cystic, and the lesion can be recognized if the triad of foamy macrophages, lymphoid and epithelial (squamous) cells is observed. Cases The authors recently observed FNA cytologic features of two HIV-associated cases that exhibited numerous multinucleated giant cells (MGCs) but failed to show the epithelial component. A subsequent surgical resection was performed in one patient. Similarly to what has been described for nasopharyngeal (adenoid and tonsil) lymphoid tissue of HIV-positive patients, intense immunoexpression of S-100 and p24 (HIV-1) protein was present in MGC. Conclusion The diagnosis of HIV-associated CBLL should always be considered if a parotid cystic lesion presents with numerous MGCs. Immunocytochemical detection of p24 (HIV-1) protein in MGC becomes a very useful diagnostic aid and extends to parotid CBLL many of those pathogenic features of HIV-1 infection already noted in other HIV-1-infected, lymphoid oropharyngeal lesions.
TL;DR: In this article, the authors measured the plasma levels of interleukin-1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), IL-6, and interferon gamma (IFN-gamma) in 25 immunocompetent patients.
Abstract: Cytokines are a group of hormone-like polypeptides that play a variety of regulatory roles in host defense against infection. Because of the possible different involvement of these mediators in bacterial infections and tuberculosis, enzyme immunoassay was used to measure comparatively the plasma levels of the proinflammatory cytokines interleukin-1 beta (IL-1beta), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6) and interferon gamma (IFN-gamma) in 25 immunocompetent patients divided into two groups: in 12 patients clinical and microbiological diagnosis showed a chronic bacterial infection and 13 patients had pleuropulmonar tuberculosis. After resolution of the infectious disorders (> or = 3 months), these measurements were repeated for each patient. High levels of IL-1b, TNF-alpha and IL-6 were observed at study entry, but no significant difference was found between the groups. In contrast, plasma levels (mean +/- SEM) of IFN-gamma were significantly higher in patients with tuberculosis when compared with the bacterial group (0.753 +/- 0.201 vs 0.325 +/- 0.105 IU/ml; P = 0.020). This different pattern of plasma proinflammatory cytokines could be ascribed to a prevaling role of the mediators of so-called Th-1 immune response (IFN-gamma) in host defense against infection with Mycobacterium tuberculosis.
TL;DR: A properly performed soft‐tissue release which achieves balance between the medial and lateral ligamentous structures and posterior capsule can provide stability to the knee with a semiconstrained prosthesis.
Abstract: Encouraging clinical experience has increased the indications for prosthetic knee arthroplasty in haemophiliacs. The medical status, physical disability, age and projected activity levels are the major factors in determining treatment for the patient with unilateral or bilateral haemophilic arthropathy of the knee. In more severely involved knees of patients with haemophilia, flexion contracture is a common deformity. In addition, valgus, external rotation deformity and posterior subluxation of the tibia may exist. The surgeon must have the expertise and experience to correct these deformities sufficiently when performing a total knee arthroplasty. A properly performed soft-tissue release which achieves balance between the medial and lateral ligamentous structures and posterior capsule can provide stability to the knee with a semiconstrained prosthesis. In cases with severe deformity requiring resection of the posterior cruciate ligament a posterior cruciate substituting prosthesis may be necessary.
TL;DR: Surgery provides acceptable rates of cancer control and survival for patients with T3 glottic carcinoma, and older patients, patients with positive neck nodes, and those presenting with dyspnea have worse prognosis.
Abstract: Objectives: To analyze oncologic results, prognostic factors, and consideration of transglottic tumors as a separate entity in 73 patients with T3 glottic carcinoma treated by surgery ± radiation therapy at La Paz University Hospital from 1984 to 1994. Methods: Sixty-four patients underwent a total laryngectomy; neck dissection was performed in 50 patients; 29 patients received postoperative radiotherapy. Results: The 5-year overall survival, cause-specific survival, and relapse-free survival rates were 58.1%, 66.8%, and 63.7%. Univariate analysis revealed prognostic significance for age, dyspnea, initial tracheostomy, and pathologic lymph node status. No difference was found when comparing survival and relapse rates between transglottic and glottic tumors. Conclusion: Surgery provides acceptable rates of cancer control and survival for patients with T3 glottic carcinoma. Older patients, patients with positive neck nodes, and those presenting with dyspnea have worse prognosis. The term transglottic is merely descriptive and has little impact on prognosis. (Otolaryngol Head Neck Surg 2001;124:556-60)