Biomedical subjects
Publications and source records attributed to J F Crespo.
A 34-year-old man presented with acute epigastric pain. Laboratory studies disclosed a total eosinophil count 7.7 x 10(9)/l. The pathological diagnosis was eosinophilic gastritis. There was a spontaneous resolution, and no treatment was required. Investigations for allergic disorders gave negative results.
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Forty patients with symptomatic immediate hypersensitvity to egg who did not have atopic dermatitis were evaluated to determine if they continued to remain clinically symptomatic. Each had specific IgE in vitro and positive prick-test to egg. All patients were on an egg elimination diet. During the follow-up an open egg rechallenge was performed along with a determination of egg white-specific IgE by CAP System. The egg white-specific IgE values were higher in the positive challenge group than in the negative one (p < 0.01, Mann-Whitney Test). There was a direct proportional relationship between the levels of egg white-specific IgE and the likelihood of positive challenge. Specific IgE values above 1.20 KUA/L could be adequate grounds for delaying the follow-up of egg challenge.
In order to characterize the profile of inhalant allergen sensitizations in patients with food hypersensitivity, we carried out a screening process using a standard panel of inhalant allergens by SPT. We screened 437 patients (mean age 5.4 years, 4.1 SD) who showed anti-allergen IgE to one or several foods, determined by both SPT and RAST. In each case in which a positive SPT to inhalant appeared, a new individualized search for these allergens was performed by both SPT and Phadezym RAST. We found sensitization to aeroallergens in 272 of the 437 children (62%) with sensitization to foods (52% of all patients were sensitized to pollens, 17% to dermatophagoides, and 26% to animal allergens). The number with sensitization to aeroallergens was proportionally increased in relation to the number of food sensitizations (p < 0.05). Sensitization to pollen allergen were found with higher frequency (p < 0.001) in patients with sensitization to fruits, legumes, and other vegetables (mainly walnuts, chestnuts, melons, or sunflower seeds) than in those sensitive to foods of animal origin. Sensitization to dermatophagoides and animal allergens did not show any special distribution relative to the kind of food sensitization. Seventeen patients with sensitization to egg showed sensitization to avian feathers. This type of sensitization did not appear in the remainder of patients evaluated.
We evaluated the clinical characteristics found in 29 children who showed allergic symptoms after direct and/or indirect contact with fish, from 197 children diagnosed with IgE-mediated fish hypersensitivity. Allergic reactions to fish through ingestion began in most patients (79%) within the first 24 months of life. All the patients showed cutaneous symptoms, either alone or associated with other clinical manifestations. Whiff and hake were the species more frequently implicated in eliciting clinical manifestations upon ingestion. After diagnosis, all patients were placed on a strict fish avoidance diet. During this period of avoidance, 29 patients reported allergic reactions (mean age 5 years, 6 months; SD 4 years, 2 months) after incidental skin contact with fish. Clinical manifestations after touching fish were only cutaneous in 28 of the 29 studied patients. One showed local urticaria with wheezing. The majority reported two or more episodes. Incidental skin contact with fish could play an important role in accidental encounters with fish particles in children on a fish avoidance diet for fish IgE-mediated hypersensitivity. Such exposures could result in immunologic immediate contact reactions and in some cases could lead to systemic reactions (contact urticaria syndrome).
UNLABELLED: Percutaneous treatment of thrombosis of occluded vascular access (VA) for haemodialysis (HD) has been an alternative to surgical and pharmacological treatments, but long term results are not well defined. The aim of our study was to analyse the long term results of percutaneous thrombectomy as a treatment of occluded VA for HD. We conducted a prospective study from june 1995 to april 1999, including 123 consecutive thrombectomies in 64 VA in patients submitted to our hospital because of recent thrombosis of VA for HD. We used two different techniques, hydrodynamic catheter thrombectomy (Hydrolyser) in the 42 first procedures (34.1%), and since october 1996 we used mechanical balloon thrombolysis in the remaining 81 patients (65.9%). Underlying stenoses were evaluated by angiography, and treated by angioplasty. After the procedure, intravenous heparin was administered for 24 hours. The VA were 28 Brescia-Cimino arteriovenous fistulae (30.4%) and 64 PTFE grafts (69.6%). PATIENT CHARACTERISTICS: mean age: 63 +/- 15 years (18-84), previous VA: 3.3 +/- 2.5 (0-9). The mean follow-up was 10.5 +/- 8.6 months (3-35). Percutaneous thrombectomy was able to remove the clots in 120 instances (technical success: 97.5%). After the thrombectomy 15 patients (16.3%) were immediately referred to the surgeon to perform a new VA due to vascular lesions in which percutaneous treatment was not indicated. Thirteen cases (14.1%) showed early thrombosis (< 72 hours). During the follow-up, 27 cases developed thrombosis (30%) and 26 VA were still patent (28.3%). In 23% of perfusion lung scans and in 2 of the 5 angiographies performed after thrombectomy, subsegmentary or segmentary perfusion defects were detected, without clinical significance. There were no relevant undesirable effects related to the technique and no symptomatic pulmonary embolism. In summary, percutaneous thrombectomy, whether hydrodynamic or mechanical, has shown to be an efficacious treatment of VA thrombosis for HD, preserving the VA with satisfactory long-term results.
AIMS: To assess distribution and correlation between serum concentrations of specific IgE for food allergens and clinical symptoms after exposure. PATIENTS AND METHODS: Four hundred and thirty seven allergic children with 1097 sensitizations to food allergens, confirmed by prick-test and/or Phadezym RAST, were evaluated. From these sensitizations, 558 were associated to clinical symptoms after food intake (SFS), demonstrated by clinical history and/or open oral provocation, and 539 were asymptomatic food sensitizations (AFS). RESULTS: In these patients, the most frequent values of serum specific IgE (44%) were found in the 0.7 and 3.5 PRU/ml range, although in 18% of the cases no specific IgE was detected. Some differences in this distribution exist for different groups of food allergen, with predominance of negative results for food of the rosaceae group. On the contrary, specific IgE values higher than 17.5 PRU/ml are predominant for fish allergens. There is a statistically significant correlation (chi 2 p < 0.001) between anti-food allergen specific IgE concentrations and the clinical symptoms occurred after intake, so the serum specific IgE values between 0.35 and 3.5 PRU/ml are present with higher frequency in the AFS, while values higher than 17.5 PRU/ml are found with a statistically significant higher frequency in the SFS. When different food groups are evaluated separately, some mild differences exist. CONCLUSIONS: A statistically significant correlation between anti-food allergen specific IgE concentrations and the clinical symptoms ocurred after intake. Therefore, specific IgE quantitative assessment and its relationship to clinical symptoms may be of great interest in the management of food allergy.
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