To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to the... more To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to their nutrition and inflammatory statuses. This cross-sectional study evaluated 73 patients using subjective global assessment, 24-hour dietary recall, and markers of inflammation [C-reactive protein (CRP), tumor necrosis factor α, and interleukin 6]. Half the patients had an inadequate micronutrient intake. Compared with dietary reference intakes, malnourished patients had lower intakes of iron (11 mg) and of vitamins C (45 mg) and B6 (0.8 mg). Malnourished and well-nourished patients both had lower intakes of sodium (366 mg, 524 mg respectively), potassium (1555 mg, 1963 mg), zinc (5 mg, 7 mg), calcium (645 mg, 710 mg), magnesium (161 mg, 172 mg), niacin (8 mg, 9 mg), folic acid (0.14 mg, 0.19 mg), and vitamin A (365 μg, 404 μg). Markers of inflammation were higher in malnourished than in well-nourished subjects. Compared with patients in lower quartiles, patients in the highest CRP quartile had lower intakes (p < 0.05) of sodium (241 mg vs 404 mg), calcium (453 mg vs 702 mg), vitamin B2 (0.88 mg vs 1.20 mg), and particularly vitamin A (207 μg vs 522 μg). Among PD patients, half had inadequate dietary intakes of iron, zinc, calcium and vitamins A, B6, C, niacin, and folic acid. Lower micronutrient intakes were associated with malnutrition and inflammation. Patients with inflammation had lower intakes of sodium, calcium, and vitamins A and B2. Micronutrient intake must be investigated in various populations so as to tailor adequate supplementation.
This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-... more This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-stent restenosis (ISR). BACKGROUND Stent restenosis constitutes a therapeutic challenge. Repeat coronary interventions are currently used in this setting, but the recurrence risk remains high.
Background-Low-pressure cardiac tamponade is a form of cardiac tamponade in which a comparatively... more Background-Low-pressure cardiac tamponade is a form of cardiac tamponade in which a comparatively low pericardial pressure results in cardiac compression because of low filling pressure. This syndrome is poorly characterized because only isolated cases have been reported. We conducted a study of its clinical and hemodynamic profiles. Methods and Results-From 1986 through 2004, we evaluated all patients at our institution with combined pericardiocentesis and cardiac catheterization. We identified those patients who fulfilled catheterization-based criteria of low-pressure cardiac tamponade and compared their clinical and catheterization data with those of patients with classic tamponade. A total of 1429 patients with pericarditis were evaluated, 279 of whom underwent combined pericardiocentesis and catheterization. Criteria of low-pressure cardiac tamponade were met in 29, whereas 114 had criteria of classic cardiac tamponade. Patients with low-pressure tamponade less frequently had clinical signs of tamponade, but the rate of constitutional symptoms, use of diuretics, and echocardiographic findings of tamponade were similar in both groups. Patients with low-pressure tamponade showed a significant increase in cardiac output after pericardiocentesis, but they usually had less severe cardiac tamponade compared with patients with classic tamponade. Prognosis was related mainly to the underlying disease.
The cardiocirculatory effects of the commonly used parenteral analgesics, morphine sulfate 15 mg,... more The cardiocirculatory effects of the commonly used parenteral analgesics, morphine sulfate 15 mg, meperidine hydrochloride 100 mg and pentazocine 60 mg, each administered intravenously, were compared in 12 patients with acute myocardial infarction during cardiac catheterization and by echocardiogram. No untoward hemodynamic effects occurred following the administration of morphine or meperidine. In contrast, pentazocine produced significant (p less than 0.01 to less than 0.05) increases in systemic and pulmonary arterial pressures, left ventricular filling pressure, systemic vascular resistance, and systolic and diastolic dimensions; and decreases in left ventricular ejection fraction and mean velocity of circumferential fiber shortening. These deleterious actions of pentazocine appeared due to peripheral vasoconstriction and negative inotropic properties. Further, pentazocine-induced increases in left ventricular preload and afterload increased myocardial oxygen demands. Since this study demonstrates that pentazocine is hazardous in myocardial infarction, morphine and meperidine are the preferred analgesics in this condition.
El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los m... more El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los modelos hidrológicos, en el diagnóstico de la situación real de las cuencas hidrográficas sometidas a fenómenos torrenciales y con problemas para mantener y/o recuperar sus coberturas vegetales; tan necesarias para asegurar el equilibrio dinámico de dichas cuencas. El análisis del geodinamismo torrencial (con frecuencia realizado a través de modelos hidrológicos integrados) y la necesidad de proteger y al mismo tiempo utilizar adecuadamente los recursos hídricos y edáficos de una cuenca, basándose en el mantenimiento de una extensión apropiada de las cubiertas vegetales permanentes en la misma (bosques, matorrales y pastizales) y de manera especial en su cabecera, son dos aspectos fundamentales para asegurarse el equilibrio dinámico de la cuenca y su aprovechamiento sostenido. Ambos se pueden estudiar conjuntamente a través de modelos hidrológicos distribuidos espacio-temporales; que perm...
RESUMEN: El presente artículo pretende reflejar la importancia que tiene una correcta utilización... more RESUMEN: El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los modelos hidrológicos, en el diagnóstico de la situación real de las cuencas hidrográficas sometidas a fenómenos torrenciales y con problemas para mantener y/o recuperar sus coberturas vegetales; tan necesarias para asegurar el equilibrio dinámico de dichas cuencas. El análisis del geodinamismo torrencial (con frecuencia realizado
The potential climatic areas for the distribution of red cedar (Cedrela odorata L.) were obtained... more The potential climatic areas for the distribution of red cedar (Cedrela odorata L.) were obtained in the state of Hidalgo under actual conditions, with meteorological information of 1961-1990 as base line, and under climate change conditions wich were obtained with two models: GFDL-R30 and HadCM3 for two time scenarios (2020 and 2050). The adjustment rates in temperature and rainfall obtained
Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine, Dec 1, 2001
A high number (30%-50%) of reversible defects have been detected early after coronary balloon ang... more A high number (30%-50%) of reversible defects have been detected early after coronary balloon angioplasty. Inadequate luminal enlargement despite a good angiographic appearance has been suggested as a possible mechanism of these perfusion abnormalities, and some reports have shown better coronary flow reserve after coronary stent implantation than after balloon dilatation. The primary objective of this study was to evaluate the frequency of early ischemic defects detected by maximal exercise (plus dipyridamole) with 99m Tc-tetrofosmin SPECT after successful coronary angioplasty with stent implantation. A secondary objective was to determine the prognostic value of these early ischemic defects. Methods: Thirty patients without previous myocardial infarction who successfully underwent 1-vessel coronary angioplasty with stent implantation were studied. Maximal-exercise 99m Tc-tetrofosmin myocardial SPECT, with simultaneous dipyridamole if exercise was suboptimal, was performed at 6 Ϯ 1 d (mean Ϯ SD) after percutaneous transluminal coronary angioplasty. At 8 Ϯ 3 mo, all patients were followed up clinically, and 77% of them underwent follow-up angiography. Results: The percentage of stenosis decreased from 68.5% Ϯ 12.6% of luminal diameter to 9.3% Ϯ 8.8% after stent implantation, and minimal luminal diameter increased from 0.89 Ϯ 0.36 mm to 2.85 Ϯ 0.45 mm. Mild-to-moderate reversible myocardial defects in the territory of the dilated artery were detected in 5 patients (17%), with no angiographic or procedural differences occurring between them and patients without ischemic defects. At follow-up, the target lesion revascularization rates depending on the presence or absence of early ischemic defects were 40% and 8%, respectively (P ϭ 0.18). Angiographic restenosis occurred in 3 of 4 patients who had early ischemic defects and underwent follow-up angiography and in 3 of 19 patients who had no early ischemic defects and underwent follow-up angiography (restenosis rate, 75% and 16%, respectively; P Ͻ 0.05). Conclusion: Coronary angioplasty with stent implantation is associated with a 17% rate of ischemic defects early after the procedure. Patients with early myocardial perfusion defects after coronary stent implantation had a high rate of restenosis.
To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to the... more To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to their nutrition and inflammatory statuses. This cross-sectional study evaluated 73 patients using subjective global assessment, 24-hour dietary recall, and markers of inflammation [C-reactive protein (CRP), tumor necrosis factor α, and interleukin 6]. Half the patients had an inadequate micronutrient intake. Compared with dietary reference intakes, malnourished patients had lower intakes of iron (11 mg) and of vitamins C (45 mg) and B6 (0.8 mg). Malnourished and well-nourished patients both had lower intakes of sodium (366 mg, 524 mg respectively), potassium (1555 mg, 1963 mg), zinc (5 mg, 7 mg), calcium (645 mg, 710 mg), magnesium (161 mg, 172 mg), niacin (8 mg, 9 mg), folic acid (0.14 mg, 0.19 mg), and vitamin A (365 μg, 404 μg). Markers of inflammation were higher in malnourished than in well-nourished subjects. Compared with patients in lower quartiles, patients in the highest CRP quartile had lower intakes (p < 0.05) of sodium (241 mg vs 404 mg), calcium (453 mg vs 702 mg), vitamin B2 (0.88 mg vs 1.20 mg), and particularly vitamin A (207 μg vs 522 μg). Among PD patients, half had inadequate dietary intakes of iron, zinc, calcium and vitamins A, B6, C, niacin, and folic acid. Lower micronutrient intakes were associated with malnutrition and inflammation. Patients with inflammation had lower intakes of sodium, calcium, and vitamins A and B2. Micronutrient intake must be investigated in various populations so as to tailor adequate supplementation.
This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-... more This randomized trial compared repeat stenting with balloon angioplasty (BA) in patients with in-stent restenosis (ISR). BACKGROUND Stent restenosis constitutes a therapeutic challenge. Repeat coronary interventions are currently used in this setting, but the recurrence risk remains high.
Background-Low-pressure cardiac tamponade is a form of cardiac tamponade in which a comparatively... more Background-Low-pressure cardiac tamponade is a form of cardiac tamponade in which a comparatively low pericardial pressure results in cardiac compression because of low filling pressure. This syndrome is poorly characterized because only isolated cases have been reported. We conducted a study of its clinical and hemodynamic profiles. Methods and Results-From 1986 through 2004, we evaluated all patients at our institution with combined pericardiocentesis and cardiac catheterization. We identified those patients who fulfilled catheterization-based criteria of low-pressure cardiac tamponade and compared their clinical and catheterization data with those of patients with classic tamponade. A total of 1429 patients with pericarditis were evaluated, 279 of whom underwent combined pericardiocentesis and catheterization. Criteria of low-pressure cardiac tamponade were met in 29, whereas 114 had criteria of classic cardiac tamponade. Patients with low-pressure tamponade less frequently had clinical signs of tamponade, but the rate of constitutional symptoms, use of diuretics, and echocardiographic findings of tamponade were similar in both groups. Patients with low-pressure tamponade showed a significant increase in cardiac output after pericardiocentesis, but they usually had less severe cardiac tamponade compared with patients with classic tamponade. Prognosis was related mainly to the underlying disease.
The cardiocirculatory effects of the commonly used parenteral analgesics, morphine sulfate 15 mg,... more The cardiocirculatory effects of the commonly used parenteral analgesics, morphine sulfate 15 mg, meperidine hydrochloride 100 mg and pentazocine 60 mg, each administered intravenously, were compared in 12 patients with acute myocardial infarction during cardiac catheterization and by echocardiogram. No untoward hemodynamic effects occurred following the administration of morphine or meperidine. In contrast, pentazocine produced significant (p less than 0.01 to less than 0.05) increases in systemic and pulmonary arterial pressures, left ventricular filling pressure, systemic vascular resistance, and systolic and diastolic dimensions; and decreases in left ventricular ejection fraction and mean velocity of circumferential fiber shortening. These deleterious actions of pentazocine appeared due to peripheral vasoconstriction and negative inotropic properties. Further, pentazocine-induced increases in left ventricular preload and afterload increased myocardial oxygen demands. Since this study demonstrates that pentazocine is hazardous in myocardial infarction, morphine and meperidine are the preferred analgesics in this condition.
El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los m... more El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los modelos hidrológicos, en el diagnóstico de la situación real de las cuencas hidrográficas sometidas a fenómenos torrenciales y con problemas para mantener y/o recuperar sus coberturas vegetales; tan necesarias para asegurar el equilibrio dinámico de dichas cuencas. El análisis del geodinamismo torrencial (con frecuencia realizado a través de modelos hidrológicos integrados) y la necesidad de proteger y al mismo tiempo utilizar adecuadamente los recursos hídricos y edáficos de una cuenca, basándose en el mantenimiento de una extensión apropiada de las cubiertas vegetales permanentes en la misma (bosques, matorrales y pastizales) y de manera especial en su cabecera, son dos aspectos fundamentales para asegurarse el equilibrio dinámico de la cuenca y su aprovechamiento sostenido. Ambos se pueden estudiar conjuntamente a través de modelos hidrológicos distribuidos espacio-temporales; que perm...
RESUMEN: El presente artículo pretende reflejar la importancia que tiene una correcta utilización... more RESUMEN: El presente artículo pretende reflejar la importancia que tiene una correcta utilización de los modelos hidrológicos, en el diagnóstico de la situación real de las cuencas hidrográficas sometidas a fenómenos torrenciales y con problemas para mantener y/o recuperar sus coberturas vegetales; tan necesarias para asegurar el equilibrio dinámico de dichas cuencas. El análisis del geodinamismo torrencial (con frecuencia realizado
The potential climatic areas for the distribution of red cedar (Cedrela odorata L.) were obtained... more The potential climatic areas for the distribution of red cedar (Cedrela odorata L.) were obtained in the state of Hidalgo under actual conditions, with meteorological information of 1961-1990 as base line, and under climate change conditions wich were obtained with two models: GFDL-R30 and HadCM3 for two time scenarios (2020 and 2050). The adjustment rates in temperature and rainfall obtained
Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine, Dec 1, 2001
A high number (30%-50%) of reversible defects have been detected early after coronary balloon ang... more A high number (30%-50%) of reversible defects have been detected early after coronary balloon angioplasty. Inadequate luminal enlargement despite a good angiographic appearance has been suggested as a possible mechanism of these perfusion abnormalities, and some reports have shown better coronary flow reserve after coronary stent implantation than after balloon dilatation. The primary objective of this study was to evaluate the frequency of early ischemic defects detected by maximal exercise (plus dipyridamole) with 99m Tc-tetrofosmin SPECT after successful coronary angioplasty with stent implantation. A secondary objective was to determine the prognostic value of these early ischemic defects. Methods: Thirty patients without previous myocardial infarction who successfully underwent 1-vessel coronary angioplasty with stent implantation were studied. Maximal-exercise 99m Tc-tetrofosmin myocardial SPECT, with simultaneous dipyridamole if exercise was suboptimal, was performed at 6 Ϯ 1 d (mean Ϯ SD) after percutaneous transluminal coronary angioplasty. At 8 Ϯ 3 mo, all patients were followed up clinically, and 77% of them underwent follow-up angiography. Results: The percentage of stenosis decreased from 68.5% Ϯ 12.6% of luminal diameter to 9.3% Ϯ 8.8% after stent implantation, and minimal luminal diameter increased from 0.89 Ϯ 0.36 mm to 2.85 Ϯ 0.45 mm. Mild-to-moderate reversible myocardial defects in the territory of the dilated artery were detected in 5 patients (17%), with no angiographic or procedural differences occurring between them and patients without ischemic defects. At follow-up, the target lesion revascularization rates depending on the presence or absence of early ischemic defects were 40% and 8%, respectively (P ϭ 0.18). Angiographic restenosis occurred in 3 of 4 patients who had early ischemic defects and underwent follow-up angiography and in 3 of 19 patients who had no early ischemic defects and underwent follow-up angiography (restenosis rate, 75% and 16%, respectively; P Ͻ 0.05). Conclusion: Coronary angioplasty with stent implantation is associated with a 17% rate of ischemic defects early after the procedure. Patients with early myocardial perfusion defects after coronary stent implantation had a high rate of restenosis.
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Papers by Juan Angel