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Biomedical subjects

G Sanz

Publications and source records attributed to G Sanz.

At least 109 records · Page 6Linked to original sources
PubMed1990

R 75251, a new inhibitor of steroid biosynthesis.

R 75251, a new imidazole derivative, inhibited the conversion of androgens to estrogens, of progestins to androstenedione and testosterone, and of 11-deoxycorticosterone to corticosterone in human placenta microsomes, subcellular fraction of rat testis, bovine adrenocortical mitochondria, in cultured rat granulosa, testicular and adrenal cells, respectively. In vitro, no effect on cholesterol synthesis and cholesterol side-chain cleavage was found at concentrations up to 10 microM. In rat granulosa cells, no effect on progesterone production was detected. In vitro, no effect on steroid radioligand binding was observed. In male volunteers, a single dose of 300 mg of R 75251 significantly lowered plasma testosterone and estradiol for 24 hours and increased plasma concentration of 17 alpha-hydroxyprogesterone and progesterone. As compared with ketoconazole high dose (600 mg b.i.d), R 75251 (300 mg b.i.d) was at least as efficacious as inhibitor of testosterone synthesis when studied during ACTH stimulation. In contrast to ketoconazole, R 75251 did not significantly affect circulating adrenal androgen levels in male volunteers. Precursors of gluco- and mineralocorticoids such as 11-deoxycortisol and 11-deoxycorticosterone accumulated more than after ketoconazole administration. The data show that the cytochrome P450-dependent aromatase, 17-hydroxylase/17,20-lyase, and 11-hydroxylase are the target enzymes for R 75251.

Adrenocorticotropic Hormone↗
PubMed1990

Does low-dose aspirin prevent aortocoronary vein bypass graft occlusion? The Spanish Group for Aortocoronary Bypass Follow-up (GESIC Study).

Although the importance of antiplatelet treatment in preventing early bypass occlusion has been clearly recognized, questions regarding the optimal drug regimen remain. To study the efficacy of low-dose aspirin, alone or in combination with dipyridamole, 927 consecutive patients were enrolled in a multicenter, randomized, double-blind, placebo-controlled trial comparing aspirin, 50 mg t.i.d., aspirin, 50 mg t.i.d. plus dipyridamole, 75 mg t.i.d., and placebo. Both aspirin and aspirin plus dipyridamole reduced the occlusion rate of distal anastomoses, but only aspirin plus dipyridamole reduced the number of patients with at least one occluded graft. Logistic regression analysis identified distal vessel diameter, bypassed artery, graft type, and postoperative antiplatelet treatment as independent predictors of graft patency.

Aged↗
PubMed1990

Risk stratification and prognosis of patients with recent onset angina.

We prospectively assessed coronary artery disease and natural history in a series of 104 patients (99 males, mean age 52 +/- 8 years) admitted with recent onset angina (defined as a history of angina of less than 1 month duration). Coronary angiography showed one-vessel disease in 31, two-vessel disease in 22 and three-vessel disease in 14; 37 patients had normal coronary arteries. After a mean follow-up of 36 (range 1 to 52) months, one patient died, 13 sustained a myocardial infarction and 21 underwent surgery. The univariate analysis showed four of 12 clinical features derived from clinical history and data from CCU (exertional angina (P less than 0.001), and recurrence of angina (P less than 0.05)) to be associated with the presence of coronary artery disease. These clinical features were termed clinical risk characteristics. Three-year probability of medical events (death or acute myocardial infarction) for patients with 0-1 clinical risk characteristics was 0 and that of combined events (need for revascularization with or without a preceding medical event) 0.11, whereas patients with 2 or more risk characteristics had probabilities of 0.27 and 0.49, respectively. Multivariate analysis identified the number of clinical risk characteristics as the only independent predictor of medical events (P less than 0.002) and a positive thallium stress test (P less than 0.0001), the number of clinical risk characteristics (P less than 0.002) and the number of involved arteries (P less than 0.002), as independent predictors of combined events.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Does left ventricular aneurysm influence survival after acute myocardial infarction?

To test whether left ventricular aneurysm independently influences survival after acute myocardial infarction, a series of 386 consecutive men aged 60 years or less, were followed up for 57 (40-100) months. Catheterization was performed 1 month following the infarct. Aneurysm, defined as a diastolic outward bulging with akinetic or dyskinetic systolic motion, was diagnosed in 52 patients (13.5%). Mortality was higher (29% vs 14%; P less than 0.02) in patients with left ventricular aneurysm; their probability of survival at 60 months was 75% vs 90% in patients without aneurysm. Cox regression analysis for the whole population identified ejection fraction, bifascicular block, number of diseased vessels and angina after infarction as the only independent predictors of survival; when adjusted for these variables, differences in mortality between patients with and without aneurysm were no longer significant. To investigate further the role of aneurysm in survival, the 52 patients presenting with left ventricular aneurysm were matched with 52 of the remaining 334 patients according to the following baseline variables: ejection fraction, number of diseased vessels, left ventricular end-diastolic pressure, and bifascicular block. The survival curves of these two subsets were similar (mortality rates of 75% and 82%, respectively). Cox regression analysis of the whole cohort of 104 patients selected bifascicular block and the number of diseased vessels, but not left ventricular aneurysm, as independent predictors of outcome.

Follow-Up Studies↗
PubMed1990

Bone marrow biopsy in myelodysplastic syndromes: morphological characteristics and contribution to the study of prognostic factors.

Ten characteristics of bone marrow (BM) biopsies in paraffin sections, obtained at diagnosis from patients with myelodysplastic syndromes (MDS) classified according to the FAB criteria, were analysed to identify both the most relevant morphologic data and any possible influence on survival. Agreement between two observers was obtained for 94% of the data. BM cellularity was increased in 63% of the cases and was higher in refractory anaemia with excess of blasts (RAEB). RAEB in transformation (RAEB-t) and chronic myelomonocytic leukaemia (CMML) (P = 0.001). Dysmegakaryopoiesis and dyserythropoiesis were present respectively in 83% and 72% of the cases, with slight differences among the FAB subtypes. Abnormal localization of immature precursors (ALIP) was found in more than half of the cases and somewhat more frequently seen in the RAEB + RAEB-t + CMML group (P = 0.07). Eosinophilia, plasmacytosis and reticulin fibrosis were evident in 26%, 18% and 47% of the cases respectively. Cellularity (P = 0.006), eosinophilia (P = 0.009) and, to some extent, dysmegakaryopoiesis (P = 0.07) bore a certain relationship with survival on univariate analysis. The presence of ALIP was not seen to affect the outcome. Multivariate analysis showed that the cellularity and presence of dysmegakaryopoiesis, in BM biopsy, added significant independent prognostic information to that achieved with age, platelet count and proportion of blast cells in BM aspirate, three variables with proven prognostic value in MDS patients. Using a regression model including these five characteristics we have stratified the patients into low, intermediate and high-risk groups with different survivals (P = 0.00001). The present findings show that BM biopsy is able to provide both morphological characteristics and information about the prognosis of survival, and should thus be included in the initial evaluation of MDS.

Adult↗
PubMed1990

Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Español para el Seguimiento del Injerto Coronario (GESIC)

To analyze the efficacy of low-dose aspirin in preventing early aortocoronary vein graft occlusion, 1,112 consecutive patients were enrolled in a multicenter, randomized, double-blind, placebo-controlled trial comparing 50 mg t.i.d. aspirin, 50 mg aspirin plus 75 mg t.i.d. dipyridamole, and placebo. All patients received 100 mg q.i.d. dipyridamole for 48 hours before surgery, and assigned treatment was started 7 hours after surgery. Vein graft angiography was performed in 927 patients (83%) within 28 days of surgery (mean, 10 days). Aspirin plus dipyridamole significantly (p = 0.017) reduced the occlusion rate of distal anastomoses from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%, which approached statistical significance (p = 0.058). Furthermore, only aspirin plus dipyridamole reduced (p = 0.01) the number of patients with occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole, 24.3%). Mediastinal drainage was slightly higher (p = 0.04) in the aspirin plus dipyridamole group (713 +/- 456 ml) than in the other two groups (placebo, 670 +/- 437 ml; aspirin, 629 +/- 337 ml), but hospital mortality (average, 4.6%) and early reoperation (average, 3.9%) rates were similar among the three groups. Thus, low-dose aspirin plus dipyridamole safely improves early saphenous vein aortocoronary graft patency; this effect is an added benefit to a preoperative regimen of dipyridamole.

Aged↗
PubMed1989

Chronic myelomonocytic leukemia--clinicobiological characteristics: a multivariate analysis in a series of 70 cases.

In a series of 70 patients diagnosed according to the FAB criteria, 42 clinical and biological disease characteristics were analyzed in order to identify significant prognostic factors by means of univariate and multivariate analysis. The univariate analysis identified ten parameters associated with poor prognosis: Symptoms of anemia, WBC over 10 x 10(9)/l, presence of blast cells, myeloid precursors or erythroblasts in peripheral blood (PB), high bone marrow (BM) cellularity, severe dysthrombopoiesis, percent of blast cells in BM and high serum levels of bilirubin and LDH. The Cox proportional hazards regression method revealed that the combination of high leukocyte counts and BM percentage of blast cells had the strongest predictive relation to survival length (p = 0.002 and p = 0.060 respectively). A new multivariate analysis treating the presence of myeloid and erythroid precursors in PB as a single variable selected only this as the most significant prognostic factor (p = 0.001). Both regression models allowed us to discriminate two significantly different risk groups of patients.

Actuarial Analysis↗
PubMed1989

[Hemodynamic effect of isosorbide-5-mononitrate in acute cardiac insufficiency secondary to myocardial infarct].

The hemodynamic effects of IS-5-MN were studied in 18 patients with acute myocardial infarction (AMI) complicated with left ventricular failure. Before treatment, 13 patients were in Forrester's hemodynamic class II and 5 in class IV. Hemodynamic monitoring was performed for 3 days, and the following parameters were measured: heart rate (HR), blood pressures (BP), right atrial (RAP), pulmonary artery and pulmonary capillary (PCP) pressures, cardiac index (CI), systemic (SVR) and pulmonary (PVR) vascular resistances, and coronary perfusion pressure (CPP). Patients with clinical symptoms of acute pulmonary edema or systolic BP (BPs) less than 90 mmHg were not included. Twenty mg of 5-IS-MN per os were administered every 8 h. Hemodynamic measurements and IS-5-MN plasma levels were obtained in basal conditions and 1/2, 1, 2, 6 and 8 h after the first and seventh dose of IS-5-MN. A significant decrease of systolic and diastolic BPs, RAP, PCP, SVR and PVR was observed after 1/2 of IS-5-MN administration and was maintained through the study, while CI and CPP increased and HR remained unchanged. The hemodynamic effect was maintained after the seventh dose, with a further decrease of the following parameters: BP, RAC, PCP and PVR. However, 2 patients were withdrawn from the study due to severe symptoms of heart failure. One patient presented headache. IS-5-MN plasma levels were identified after 1/2 h, with a peak level after 1 h, and were similar after the seventh dose. A significant correlation was found between the IS-5-MN levels and the delta RAP and delta PCP after the seventh dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

Significance of Q-wave regression after transmural acute myocardial infarction.

A total of 313 consecutive patients was studied to assess the prevalence and prognostic implications of Q-wave loss after transmural acute myocardial infarction. Heart catheterization, including single-plane left ventriculography and selective coronary arteriography, was performed before hospital discharge. After a mean follow-up of 65 (1 to 100) months, 34 patients (11%) lost their Q waves. The time interval from the acute event to the first electrocardiogram showing Q-wave disappearance was 14 (1 to 32) months. Peak creatine kinase value was significantly higher in patients who retained their Q waves than in those who lost them (1,121 +/- 813 vs 779 +/- 464 IU, respectively, p less than 0.05). Severity of coronary artery disease, as judged by the number of diseased arteries and the number of arteries with total or subtotal occlusion, was similar in both groups. However, patients showing Q-wave regression had lower left ventricular end-diastolic pressure, higher ejection fraction and fewer abnormally contracting segments than their counterparts (12 +/- 6 vs 15 +/- 7 mm Hg, p less than 0.05; 53 +/- 11 vs 44 +/- 14%, p less than 0.001; 1 +/- 1 vs 2 +/- 1 segments, p less than 0.001, respectively). In addition, no patient with normalized electrocardiogram presented with left ventricular aneurysm. Although differences in mortality, nonfatal reinfarction and new onset of angina between the 2 groups were not significant, congestive heart failure was prevalent among patients with permanent Q waves (23 vs 6%, p less than 0.05). Our findings suggest that Q-wave loss after AMI may be related to a smaller infarct size.

Cardiac Catheterization↗
PubMed1988

Acute promyelocytic leukemia. Therapy results and prognostic factors.

From December 1976 to July 1986, 34 patients with acute promyelocytic leukemia (APL) were treated with daunorubicin (DNR) alone and simultaneous supportive therapy with low-dose heparin, platelet transfusions, and fresh frozen plasma. Two consecutive maintenance therapy regimens were employed in patients who achieved complete remission (CR): (1) a classical maintenance with methotrexate and 6-mercaptopurine, with DNR plus methyl-GAG re-inductions; (2) from 1982 an intensive sequential combination therapy regimen was administered. CR was achieved in 23 patients (68%). Only one patient had leukemic resistance. Other failures were a consequence of post-chemotherapy complications. A multivariate logistic regression analysis has been performed to evaluate the prognostic importance on response to remission induction of 25 patient and disease characteristics at diagnosis. The significant variables in decreasing order of significance were: serum albumin level, fever at diagnosis, serum creatinine level, and age. The median duration of remission and survival by Kaplan-Meier analysis were projected to be 24 and 25 months, respectively. Relapses occurred in 11 of 23 CR patients. Nine patients remained in the first remission from 5+ to 37+ months. Short-term (CR) and long-term results (duration of remission and survival) in APL treated for induction with DNR alone were similar to those obtained in other subtypes of acute myeloblastic leukemia by intensive combination chemotherapy.

Adolescent↗
PubMed1988

Predictors of non-fatal ischemic events after myocardial infarction.

We characterize predictors of reinfarction and angina in 403 consecutive men aged 60 years or less who underwent heart catheterization within one month (18 +/- 6 days) after a qualifying myocardial infarction. Angiography showed obstructive lesions (greater than or equal to 50% diameter reduction) in 380 patients. One-, two- and three-vessel disease was found in 143 (36%), 139 (35%) and 98 (29%) patients, respectively. After 57 months of follow-up there were 60 deaths (12%), 41 patients (10%) sustained a new infarction and 210 (52%) had angina. Cox regression analysis selected the number of diseased vessels as the only independent 'predictor of reinfarction; independent predictors of angina were the number of diseased vessels and a history of angina prior to the qualifying infarction. Risk stratification showed the probability of reinfarction at 6 years to be significantly lower (P less than 0.001) in patients with one-vessel disease (12%) than in those with two- (30%) and three-vessel disease (37%). Similarly the probability of angina was also lower (P less than 0.001) in patients with one-vessel disease (51%) as compared to those with two- (72%) and three-(74%) vessel involvement. Thus multi-vessel disease is the main predictor of new non-fatal ischemic events after myocardial infarction.

Angina Pectoris↗
PubMed1988

Synthesis, affinity and specificity of 18F-setoperone, a potential ligand for in-vivo imaging of cortical serotonin receptors.

Setoperone, a piperidine derivative known for its potent serotonin and moderate dopamine receptor blocking properties was labelled with the positron emitter 18F using a nucleophilic substitution on the nitro derivative. The general pattern of the in-vivo and in-vitro rat brain distribution of this new radioligand was consistent with the mapping of serotonin (5HT2) and dopamine (D2) receptors. The cortical binding of 18F-setoperone was selectively inhibited by ketanserin and not by sulpiride. The affinity of the radiofluorinated ligand for the serotonin receptors was in the nanomolar range (Kd = 0.7 nM).

Animals↗