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Biomedical subjects

Gerard Espinosa

Publications and source records attributed to Gerard Espinosa.

23 records · Page 2Linked to original sources
PubMed2002

Vascular involvement in Behçet's disease: relation with thrombophilic factors, coagulation activation, and thrombomodulin.

PURPOSE: Thrombosis, usually venous, occurs in 10% to 25% of patients with Behçet's disease, but its pathogenesis is poorly understood. We evaluated parameters of hemostasis and their relation with thrombosis in a series of patients with Behçet's disease. SUBJECTS AND METHODS: We studied 38 patients with Behçet's disease (13 with venous thrombosis), 38 patients with venous thrombosis without thrombophilia, and 100 control subjects. Levels or presence of protein C, protein S, antithrombin, methylenetetrahydrofolate reductase C677T, factor V Leiden, prothrombin gene G20210A, antiphospholipid antibodies, plasminogen, tissue-type plasminogen activator (tPA), type-1 tPA inhibitor (PAI-1), PAI-1 4G/5G polymorphism, prothrombin fragment 1+2, plasmin/alpha(2)-antiplasmin complexes, thrombomodulin, and activated factors VII and XII were determined. RESULTS: There were no deficiencies in protein C, protein S, antithrombin, or factor V Leiden in the patients with Behçet's disease, nor was there evidence of most other thrombotic abnormalities. Compared with control subjects, however, the Behçet's disease group had elevated mean (+/- SD) levels of prothrombin fragment 1+2 (2091 +/- 1323 pmol/L vs. 804 +/- 398 pmol/L, P <0.001), plasmin/alpha2-antiplasmin complexes (410 +/- 220 microg/L vs. 214 +/- 92 microg/L, P <0.001), and thrombomodulin (37 +/- 24 ng/mL vs. 27 +/- 10 ng/mL, P <0.001). These levels did not differ between patients with or without thrombosis. CONCLUSIONS: Thrombophilic factors do not seem to explain most thromboses in Behçet's disease. There is increased thrombin generation, fibrinolysis, and thrombomodulin in Behçet's disease, but these abnormalities are not related to thrombosis.

Adolescent↗
PubMed2002

Trends in illicit drug emergencies: the emerging role of gamma-hydroxybutyrate.

BACKGROUND: Previously used as a general anesthetic, gamma-hydroxybutyrate is now used as a recreational drug. Not surprisingly, an increasing number of acute overdose cases requiring emergency medical care have been reported and described, especially in the United States. OBJECTIVES: To determine the number and percentage of gamma-hydroxybutyrate overdoses over a 15-month period and to describe the clinical hallmarks and course of this new drug in overdose. METHODS: All toxicological emergencies, including those caused by illicit drug consumption, were recorded for 15 months in an urban public hospital emergency department. Accurate toxicological history was obtained from the patients and, if gamma-hydroxybutyrate was suspected, confirmation was performed by urine mass spectrometry. The study data were compared with data recorded in the same emergency department in 1989. RESULTS: The total number of toxicological emergencies attended in our emergency department have remained unchanged during the last decade, with a significant decrease in number of opiate overdoses and an increase in the number of cocaine, amphetamine, and gamma-hydroxybutyrate overdoses. During the study period, 104 gamma-hydroxybutyrate overdoses presented to the emergency department (3.1% of all toxicological emergencies), ranking second in illicit drugs requiring emergency consultation. The profile of a patient with gamma-hydroxybutyrate intoxication is well defined: a young individual (23 +/- 5 years), male (64%), emergency department presentation on weekends (90%), with simultaneous ethanol consumption (73%) and ingestion of additional illicit drugs (86%), decrease of consciousness being the main complaint in all cases [16% with Glasgow Coma Scale (GCS) = 3]. Complete recovery without sequelae occurred in all cases. CONCLUSION: Health authorities must be aware of the hazards of recreational gamma-hydroxybutyrate, and physicians must be cognizant of this recent cause of coma among youths presenting to the emergency departments.

Adolescent↗
PubMed2002

Catastrophic antiphospholipid syndrome: proposed guidelines for diagnosis and treatment.

The term "catastrophic" antiphospholipid syndrome (APS) was introduced to define an accelerated form of APS resulting in multi-organ failure. Although patients with the catastrophic form represent less than 1% of all patients with APS, they are usually in a life-threatening medical situation that requires high clinical awareness. In this article, we propose guidelines for the diagnosis and treatment of patients with catastrophic APS, based on the cumulated published experience of 130 cases with this syndrome. We believe that it is essential that this syndrome should be diagnosed early and treated aggressively. The combination of high doses of heparin and corticosteroids plus intravenous gamma globulins or plasmapheresis is proposed as the treatment of choice in patients with this severe condition. In addition, preventive measures in patients with APS may be effective to avoid the development of catastrophic APS. We recommend that these proposed guidelines be tested in future prospective, collaborative studies to assess clearly the real prevalence and the best therapy for this life-threatening condition.

Journal Article↗