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Biomedical subjects

E Zapata

Publications and source records attributed to E Zapata.

At least 19 recordsLinked to original sources
PubMed2006

Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations.

BACKGROUND: The risks and benefits of coxibs, non-steroidal anti-inflammatory drugs (NSAIDs), and aspirin treatment are under intense debate. OBJECTIVE: To determine the risk of peptic ulcer upper gastrointestinal bleeding (UGIB) associated with the use of coxibs, traditional NSAIDs, aspirin or combinations of these drugs in clinical practice. METHODS: A hospital-based, case-control study in the general community of patients from the National Health System in Spain. The study included 2777 consecutive patients with endoscopy-proved major UGIB because of the peptic lesions and 5532 controls matched by age, hospital and month of admission. Adjusted relative risk (adj RR) of UGIB determined by conditional logistic regression analysis is provided. RESULTS: Use of non-aspirin-NSAIDs increased the risk of UGIB (adj RR 5.3; 95% confidence interval (CI) 4.5 to 6.2). Among non-aspirin-NSAIDs, aceclofenac (adj RR 3.1; 95% CI 2.3 to 4.2) had the lowest RR, whereas ketorolac (adj RR 14.4; 95% CI 5.2 to 39.9) had the highest. Rofecoxib treatment increased the risk of UGIB (adj RR 2.1; 95% CI 1.1 to 4.0), whereas celecoxib, paracetamol or concomitant use of a proton pump inhibitor with an NSAID presented no increased risk. Non-aspirin antiplatelet treatment (clopidogrel/ticlopidine) had a similar risk of UGIB (adj RR 2.8; 95% CI 1.9 to 4.2) to cardioprotective aspirin at a dose of 100 mg/day (adj RR 2.7; 95% CI 2.0 to 3.6) or anticoagulants (adj RR 2.8; 95% CI 2.1 to 3.7). An apparent interaction was found between low-dose aspirin and use of non-aspirin-NSAIDs, coxibs or thienopyridines, which increased further the risk of UGIB in a similar way. CONCLUSIONS: Coxib use presents a lower RR of UGIB than non-selective NSAIDs. However, when combined with low-dose aspirin, the differences between non-selective NSAIDs and coxibs tend to disappear. Treatment with either non-aspirin antiplatelet or cardioprotective aspirin has a similar risk of UGIB.

Adult↗
PubMed2006

MRI and endoscopic ultrasonography in the staging of gastric cancer.

OBJECTIVE: to determine the diagnostic precision of endoscopic ultrasounds (EUS) and magnetic resonance imaging (MRI) in the preoperative staging of gastric cancer. METHODS: a prospective, blind study was carried out in 17 patients diagnosed with gastric cancer (GC) using endoscopic biopsy from November 2002 to June 2003. Patients underwent preoperative MRI and EUS. The reference test used was pathology, and laparotomy for non-resectable cases. RESULTS: MRI (53%) was better than EUS in the assessment of gastric wall infiltration (35%). MRI (50%) was also superior to EUS (42%) for N staging. After pooling stages T1-T2 and T3-T4 together, results improved for both MRI (67 and 87.5%, respectively) and EUS (67 and 62.5%, respectively) (p < 0.05). N staging--lymph node invasion--results were correct in 50% for MRI as compared to EUS (42%). In classifying positive and negative lymph nodes EUS was superior to MRI (73 versus 54%). CONCLUSIONS: MRI was the best method in the assessment of gastric wall infiltration. EUS was superior to MRI for T1 staging, and in the assessment of lymph node infiltration.

Aged↗
PubMed2005

[Type III glycogen storage disease associated with hepatocellular carcinoma].

Type III glycogen storage disease is a hereditary disorder with autosomal recessive transmission. It is characterized by accumulation of abnormal glycogen in the liver and, in 80% of patients, in muscle. The liver can also show fibrosis and sometimes cirrhosis. Until 2000, 9 cases of cirrhosis had been published, 3 of which showed associated hepatocarcinoma. We present the case of a 31-year-old woman, diagnosed in childhood with type III glycogen storage disease, who 30 years after onset developed a hepatocellular carcinoma with portal thrombosis in the context of advanced cirrhosis. This is the first case to be reported in the Spanish literature of type III glycogen storage disease associated with hepatocellular carcinoma.

Adult↗
PubMed2003

[Liver alterations due to alpha-1-antitrypsin deficiency in adults. Study of 5 patients and analysis of the cases reported in the Spanish literature].

BACKGROUND: To determine the epidemiological characteristics of liver disease secondary to alpha-1-antitrypsin deficiency and associated processes in the Spanish population. PATIENTS AND METHOD: We reviewed the medical records of adults with liver abnormalities due to alpha-1-antitrypsin deficiency diagnosed between 1981 and 2001 in the Hospital Donosti in San Sebastian (Spain) as well as the cases published in the literature before 1999. Diagnosis was based on clinical and biochemical data, imaging tests and/or liver biopsy and/or necroscopy together with serum values of alpha-1-antitrypsin and phenotyping. RESULTS: Fifty cases of liver disease secondary to alpha-1-antitrypsin deficiency (45 from the literature and 5 from our hospital) were included. There were 34 men and 16 women aged between 18 and 77 years. Fifteen (30%) had relatives with alpha-1-antitrypsin deficiency. Hepatitis and/or neonatal cholestasis were confirmed in 4 and alcoholism was confirmed in 17. Of the series, 8 (16%) had portal fibrosis and 29 (58%) had cirrhosis. Cirrhosis was mainly macro-micronodular and was decompensated in 48% of the cases. Of the patients with cirrhosis, 12 were ZZ homozygotes and 12 were heterozygotes, mainly MZ and SZ. The most frequent associated process was respiratory disease (emphysema and/or chronic bronchitis) in 25 of the 50 cases (50%). CONCLUSIONS: The presence of cirrhosis in alpha-1-antitrypsin deficiency is low, approximately 2.2/100,000 for ZZ homozygotes. Age at diagnosis of cirrhosis or fibrosis was more than 50 years. The male-to-female ratio was 2 to 1. In one-third of the patients alcohol could have been a coadjuvant or aggravating factor in the liver disease. No differences were found between homo- and heterozygote phenotypes in patients with cirrhosis. The most frequently associated processes were respiratory diseases due to alpha-1-antitrypsin deficiency.

Adolescent↗
PubMed1983

Current therapeutic practice in the management of acute severe asthma.

In a prospective study we have documented the treatment administered to patients before and during attacks of acute severe asthma, including cases managed at home by the general practitioner and those treated in hospital. In the course of 1 year, 261 consecutive episodes were studied. Five patients required artificial ventilation but there were no fatalities. In 28 patients (11.8%) no regular maintenance therapy was being taken before the index attack, and in 72 (30.3%) no regular treatment with a beta 2-adrenergic bronchodilator. Childhood asthmatics were receiving less maintenance therapy than adults, with the exception of cromoglycate. An increased dose of a beta 2-adrenergic bronchodilator was taken prior to medical consultation in 64.7% as the attack developed, but an increased dose of oral steroids in only 19.3%. The general practitioners gave intravenous steroids in 53 cases (61.6%), but rarely combined this with a bronchodilator. However, when a combination of a bronchodilator and intravenous steroids was given, there was a significant reduction in the need for hospital admission. In hospital the majority of patients received intravenous steroids as well as a nebulized beta 2-adrenergic bronchodilator and an intravenous xanthine bronchodilator, but one-third were not given oxygen. Sedatives were rarely used. Differing treatment patterns emerged when contrasting childhood with adult episodes, whether managed inside or outside hospital. Comparisons are made between the treatment observed in practice and that currently recommended for optimal treatment, and the implications are discussed.

Acute Disease↗
PubMed1983

Acute severe asthma: factors that influence hospital referral by the general practitioner and self-referral by the patient.

We describe a prospective study of 261 consecutive episodes of acute severe asthma occurring in 232 patients in 1 year. Sixty-seven episodes were treated at home by a selected group of 34 general practitioners, 148 episodes were treated in hospital following referral from general practitioners and 46 episodes were treated in hospital after self-referral, not having been seen by a general practitioner. All patients recovered fully. Comparisons between these groups of patients showed that those selected for hospital admission had higher pulse rates, lower peak expiratory flow rates and more severe grades of attack than those treated at home. Children were more likely to be admitted to hospital, as were patients living near to hospital, or those who were already receiving hospital outpatient supervision. There were self-referrals in all age groups. Several factors which influence the decision on admission, including the speed of onset and severity of the episode, justify some shift of the primary care role from the general practitioner to the hospital. If self-referral is to be encouraged there is a need for agreement on the types of patient and the nature of the attack that are best suited to this type of management.

Acute Disease↗
PubMed1982

The speed of onset and severity of acute severe asthma.

The speed of onset of attacks of acute severe asthma was prospectively studied in a total of 261 consecutive episodes. 82% of these episodes involved patients with 'extrinsic' asthma and 28% involved children. The speed of onset of an attack was rapid (defined as less than 24 hours) in 46% of episodes and was less than one hour in 13%. Rapid-onset attacks occurred more frequently in younger patients and were no more or less severe than attacks of slower evolution. Comparison of different measures of severity in our patients showed statistically significant but low correlations. Objective measures seemed no better than simple clinical assessment with the Jones index. We discuss the significance of these correlations and the place of emergency admission services for attacks of acute severe asthma of rapid speed of onset.

Acute Disease↗
PubMed1980

Isocyanate-induced asthma in a car factory.

In a car factory employing 203 women machinists making seat covers more women complained of respiratory symptoms after the introduction of a new seat cover fabric, cropped nylon backed with flame-bonded polyurethane foam (CNPF). 68 women working in the trim shop were studied on the first day back at work after a week's holiday and then at the end of a working week; the incidence of wheezing and/or shortness of breath was greater than expected but there was no difference between peak flow rates. A second study of 192 of the 203 women working in the trim shop confirmed this recent increase in incidence of asthmatic symptoms and showed that significantly more machinists who had worked with this new fabric had a reduced peak flow rate than machinists who had not. Asthma developed in one subject when she was working in the factory sewing CNPF, when she was handling this fabric in the challenge cabinet in the laboratory, and on challenge with toluene di-isocyanate in the laboratory. Airways resistance increased in 3 other workers after exposure to CNPF in the laboratory. Low concentrations (between 0.0003 to 0.003 ppm) of toluene di-isocyanate were found in the air around this fabric. 4 of 9 women with symptoms had IgE antibodies to toluene di-isocyanate.

Asthma↗