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Biomedical subjects

E Carreras

Publications and source records attributed to E Carreras.

At least 127 records · Page 7Linked to original sources
PubMed1993

Interstitial pneumonitis after BMT: 15 years experience in a single institution.

Data from 311 patients with hematological malignancies who received an autologous, allogeneic or syngeneic BMT in a single institution were analyzed. Interstitial pneumonia (IPn) was observed in 58 patients. Two years actuarial probability of IPn was 26.8%. In 50% of cases CMV was detected. In 23 patients (39.7%) IPn was considered idiopathic. The median time from BMT to IPn was 63.5 (range 7-720) days. Patients submitted to allogeneic BMT had a significantly higher risk of developing IPn than patients receiving syngeneic or autologous BMT (34.1% vs 16.7% and 4.9%, respectively; p = 0.0006). Among 230 patients receiving allogeneic transplant, factors with a higher risk for IPn in univariate analysis were: age over 20 years, CML, alloimmunized donor, previous splenectomy, acute and chronic GVHD. When the analysis was restricted to patients with a CMV-associated IPn, all factors except alloimmunization maintained their significance. Multivariate analysis showed that only acute GVHD (p < 0.0001) and a diagnosis of CML (p < 0.001) in the whole group of allogeneic transplants, and acute GVHD (p < 0.001) and splenectomy (p < 0.003) in CMV-associated IPn, maintained their significance. These results are discussed within the frame work of the clinical application of BMT.

Adolescent↗
PubMed1993

Transjugular liver biopsy in BMT.

With the aim of evaluating liver disturbances after BMT in 76 patients, the hepatic venous pressure gradient was measured and a transvenous liver biopsy was performed through the jugular vein. Catheterization was successful in 71 patients (93%). In 11 cases the procedure was performed twice, yielding a total number of 82 studies. In five (6%) liver biopsies were non-evaluable. Complications were rare (7%), minor and reversible. As a result of this procedure, the diagnosis was modified in 45%, with both the diagnosis and treatment being modified in 30% of patients. Veno-occlusive disease (VOD) was histologically demonstrated in 15 out of 26 patients (58%) in whom this complication was suspected and in two out of 33 (6%) in whom it was not. Acute GVHD of the liver was confirmed in 15 out of the 35 patients (43%) in whom this complication was suspected and in four of 24 (17%) in whom it was not. The hepatic venous pressure gradient was significantly higher in VOD than in liver GVHD. Whereas 14/17 (82%) patients with VOD had a gradient pressure higher than 9 mmHg, no patient with GVHD had a gradient above this value. We conclude that transjugular liver biopsy is an effective, safe, and useful technique to evaluate BMT related liver dysfunction.

Biopsy↗
PubMed1992

Chronic systemic candidiasis in acute leukemia.

In the past few years a new syndrome of invasive Candida infection, the so-called hepatosplenic or chronic systemic candidiasis (CSC), has been recognized with increasing frequency in neutropenic patients. From January 1985 to December 1990, ten of 305 acute leukemia (AL) patients treated at our institution were diagnosed as having CSC. In contrast, during the same period this type of Candida infection was not observed in any patient with hematological diseases other than AL treated in our center, including 277 patients who underwent bone marrow transplantation. All patients with CSC had fever and hepatomegaly, and five complained of abdominal pain. Seven patients had neutrophilic leukocytosis and six an increased serum alkaline phosphatase activity. Abdominal computed tomography and ultrasound study showed typical lesions in eight and seven patients, respectively. In four patients a laparoscopy-guided needle liver biopsy displayed yellowish nodules on the liver surface, and the histologic study revealed large granulomas with yeasts and pseudohyphae. All patients were given amphotericin B (mean: 4.6 g, range: 1-12.5 g) and 5-fluorocytosine, and five received fluconazole. No patient died as a direct consequence of CSC and in six the infection resolved. Finally, once controlled, the infectious complication did not preclude subsequent intensive antileukemic therapy, including bone marrow transplantation.

Adolescent↗
PubMed1992

Polycythaemia vera following non-Hodgkin's lymphoma.

A patient with non-Hodgkin's lymphoma (NHL) who developed polycythaemia vera (PV) is reported. Diffuse large-cell NHL was diagnosed and he was subsequently treated with combination chemotherapy including high dose cyclophosphamide and procarbazine. Four and a half years after chemotherapy splenomegaly developed, coincidently with the appearance of high Hb values, RBC and platelet counts. The screening tests for PV were consistent with this diagnosis, while the search for lymphoma activity was negative. To the best of our knowledge, the present case represents the first well-documented instance of PV following NHL.

Humans↗
PubMed1992

Autologous hemopoietic reconstitution after fetal liver infusion in patients with bone marrow failure: consequence or coincidence?

In the past 4 years we have treated four patients with a total of 19 fetal liver infusions (FLI). Two cases of refractory anemia with excess blasts in transformation (RAEB-t) were conditioned with cyclophosphamide and total body irradiation (1400 cGy) and were treated with FLI. In spite of such intensive conditioning, one patient recovered autologous hemopoiesis 3 weeks later, remaining in remission 4 years after this procedure. The second patient died with aplastic marrow on day 154, and the third suffered from severe aplastic anemia refractory to several types of conventional treatment. After FLI and without previous conditioning therapy a partial fetal engraftment was documented. This was transient and followed by autologous hemopoietic recovery and cure of the disease. The fourth patient had bone marrow failure in the setting of a severe pneumonia following autologous bone marrow transplantation. Ten days after FLI the hematological parameters dramatically improved and the pneumonia resolved. Autologous reconstitution of hemopoiesis was demonstrated. These experiences suggest that FLI might stimulate autologous hemopoiesis. This therapeutic approach may be useful to treat bone marrow failure when there is no response to first-line therapy. In hematologic malignancies with an indication for stem cell transplantation, other sources such as allogeneic or autologous bone marrow seem preferable to fetal liver cells.

Adolescent↗
PubMed1990

Prenatal diagnosis of intrapericardial teratoma.

A case of intrapericardial teratoma diagnosed by ultrasound before birth is described. Planning for delivery and immediate neonatal intensive management allowed successful cardiac surgery, full resection of the tumour and full recovery.

Adult↗
PubMed1990

A possible specific receptor for 3-beta-androstanediol in the human sebaceous gland.

Dihydrotestosterone (DHT) does not seem to be the active specific metabolite of testosterone in hypertrophic sebaceous glands of subjects affected by male pattern baldness (MPB) and several results indicate that probably 3-beta-androstanediol (beta DIOL) could be an active form of testosterone in those glands. Cytosol and serum from several patients affected by MPB and subjected to hair autotransplantation, was incubated with both beta DIOL and 3-alpha-androstanediol (alpha DIOL). Binding patterns indicate that alpha DIOL binds to cytosolic proteins probably due to the contaminating sex hormone binding globulin (SHBG), whereas beta DIOL exhibits an atypical binding process in cytosol in the presence of high concentrations of non radioactive beta DIOL. This binding increases progressively up to 2 pmol/mg protein at the limit solubility conditions for the non radioactive steroid. This pattern is not observed in serum from the same patients, where the binding of beta DIOL is typically restricted to the SHBG. These results strongly suggest the existence of a specific beta DIOL-binding protein in the hypertrophic sebaceous glands and explain the lack of specific receptor for DHT in these tissues.

Alopecia↗
PubMed1990

[Adult acute lymphoblastic leukemia: preliminary results of the LAL-86 protocol].

The preliminary results of the LAL-86 protocol applied to 43 patients diagnosed of acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LL) between May 1986 and April 1989 are reported. Induction treatment consisted of one or two courses of vincristine, daunorubicin, prednisone, cytosine arabinoside and 6-thioguanine combination therapy. This phase was followed by consolidation treatment, in which VM-26, cyclophosphamide, BCNU and L-asparaginase were added to the former agents. Central nervous system prophylaxis was done with intrathecal methotrexate. Patients under 45 years of age with HLA identical sibs were subjected to allogeneic bone marrow transplantation (BMT) in the first complete remission (CR); when no HLA-identical sibs were available patients were randomised into autologous BMT or maintenance therapy. The remaining patients received maintenance chemotherapy. CR was achieved in 34 ALL patients (79%), 5 were refractory to treatment and 4 died during remission induction. Allogeneic BMT was carried out in 6 cases, autologous BMT in 3, and the remainders received chemotherapy. When performing this review, 7 patients had relapsed and the actuarial probability of 2-year duration of CR was 70%. Sixteen patients have died with a two-year disease-free survival probability of 60%. The preliminary results of the LAL-86 protocol are encouraging, but greater number of patients is needed, as well as a longer follow-up, to assess the effect of chemotherapy and compare these findings to the results of autologous or allogeneic BMT in the first RC.

Actuarial Analysis↗
PubMed1989

[Bone marrow autotransplant: preliminary results in 20 patients with acute leukemia].

The results of bone marrow autograft (BMAG) in 20 patients with acute leukemia (AL) consecutively treated from October 1985 and May 1988 are reported. The follow up was continued until November 1988. The mean age of the patients was 20 years (range 10-48) and their diagnoses were acute myeloblastic leukemia (AML) in 12 and acute lymphoblastic leukemia (ALL) in 8. The preparation for BMAG included cyclophosphamide and whole body radiation in all cases. The procedure was carried out in the first complete remission (CR-1) in 5 patients, in CR-2 in 11, in CR-3 in 2, and in CR-4 in another 2. Two patients died as a direct consequence of BMAG, 11 relapsed and 7 are alive and free from relapse. The likelihood of survival free from prolonged illness was calculated as 24% for the whole series, 60% for the cases of BMAG in CR-1 and 50% for the group of patients with AML. The results were poor in the cases of BMAG carried out for AL in an advanced stage. On the basis of these results the experience of other authors with this therapeutic modality is reviewed, and its current indications are discussed.

Adolescent↗
PubMed1989

Hypertriglyceridemia in bone marrow transplant recipients: another side effect of cyclosporine A.

The incidence and duration of hypertriglyceridemia (HTG) associated with allogeneic HLA-identical bone marrow transplantation (BMT) were investigated in 38 patients with normal triglyceride levels (TG) before BMT and without any evidence of prior liver disorder. Twenty-two (58%) patients developed HTG. The median of TG peak values was 350 mg/dl (range 215-908) and the median actuarial time for HTG appearance was 7 weeks (range 1-12). Among several variables analysed (age, sex, hyperglycemia, total parenteral nutrition, treatment with methylprednisolone, estrogens or cyclosporine A) only cyclosporine A administration was significantly associated with HTG development.

Adolescent↗
PubMed1989

Total body irradiation in bone marrow transplantation: fractionated vs single dose. Acute toxicity and preliminary results.

The usefulness of total body irradiation (TBI) plus chemotherapy as a preparative regimen prior to bone marrow transplantation has been widely documented. However, the procedure can be highly toxic. Fractionated and low dose rate TBI has been said to enhance therapeutic ratio by increasing normal tissue tolerance and increasing leukemic cell kill. We report here the acute toxic effects and preliminary results on 2 consecutively groups of patients, treated with bone marrow transplantation (BMT) for leukemia or multiple myeloma, and conditioned by 2 TBI regimens. Group A patients received 10 Gy-Co-60 single dose of TBI plus 120 mg/kg of cyclophosphamide over a period of 2 days (8 Gy lungs). Group B received 12 Gy Co-60 of TBI in 6 fractions (2/day), (8 Gy lungs) plus 120 mg/kg of cyclophosphamide over a period of 3 days. The acute toxic effects recorded were similar in both groups. Only a 40% vs 0% (P = 0.02) incidence of parotiditis in groups A and B favors fractionation. Other results obtained to date are as follows: an incidence of interstitial pneumonitis of 39% and 31% (ns); relapses of 10% and 20% (ns), and mortality of 55% and 60% for each group respectively. An interesting finding was that IP was associated with acute grade II-IV graft vs host disease in 87% and 100% of cases of group A and B, respectively. We conclude that fractionated TBI is at least as effective as single dose TBI as a conditioning regimen; however, only randomized trials would allow definitive conclusions.

Adolescent↗
PubMed1988

Influence of different indwelling lines on the measurement of blood cyclosporin A levels.

We studied in vivo and in vitro the possible influence of the indwelling line on the measurement of cyclosporin A (CSA) levels. CSA levels measured in samples taken from the catheter lumen used for CSA administration were significantly higher than those taken either from a second lumen or from a peripheral vein. Reversible fixation of the drug to the catheter walls might explain this alteration. The degree of fixation varies for different types of plastic material.

Bone Marrow Transplantation↗