Search PubMed⌕ Search

Biomedical subjects

J Figueras

Publications and source records attributed to J Figueras.

At least 19 recordsLinked to original sources
PubMed1998

[Usefulness of the genetic study in the diagnosis of medullary carcinoma of the thyroid].

Germ-line mutations in the RET proto-oncogene are associated with multiple endocrine neoplasia type 2A (MEN 2A) and with familial medullary thyroid carcinoma (FMTC). Detection of these mutations allows the identification of the affected kindred members, who will develop medullary thyroid carcinoma (MTC) in 100% of cases. We studied 24 patients of two kindreds (MEN 2A and FMTC). Basal calcitonin levels and pentagastrin-stimulated calcitonin were measured in all patients. The RET mutations were detected by DNA analysis. The RET mutations were identified in 14 patients. Two of them had been operated in the past, 2 refused operation and 4 were living abroad. In the 6 remaining, only one showed a thyroid mass, basal calcitonin was normal in all patients except one, and pentagastrin-stimulated calcitonin was negative in 2 patients. Total thyroidectomy was performed in all cases. Histology showed C-cell hyperplasia in all patients and MTC in 5 of them. In MEN 2A and FMTC DNA analysis allows the identification of RET mutation carriers, in which presymptomatic thyroidectomy allows and improvement in survival.

Adult↗
PubMed1998

Comparison of ventricular septal and left ventricular free wall rupture in acute myocardial infarction.

Patients with ventricular septal (VS) rupture (n = 96) or left ventricular (LV) free wall rupture (n = 97) during acute myocardial infarction had comparable clinical, angiographic, and electrocardiographic features, suggesting similar underlying mechanisms, although the 2 groups differed in the rate of bundle branch block, complete atrioventricular block, atrial fibrillation, and culprit artery. In 20 patients, LV rupture followed VS rupture, which underscores the need for early surgery.

Aged↗
PubMed1998

Successful transplantation of organs retrieved from a donor with enterococcal endocarditis.

We report on a patient with an extensive cerebral infarction secondary to enterococcal endocarditis that, in spite of adequate antibiotic treatment, evolved to brain death. The patient was evaluated as a potential organ donor; renal and liver function were normal and both liver and kidneys appeared normal on ultrasonographic examination. When negativity of serial blood and urine cultures was ascertained, liver and kidneys were retrieved for transplantation. The organs were transplanted into three recipients with good results after 14 months of follow-up. All of the recipients received antibiotic prophylaxis against Enterococcus faecalis. None of them has presented infectious complications to date. This case emphasizes that patients with enterococcal endocarditis may be potential organ donors provided both donor and recipients are adequately treated. This is especially important when organs are urgently needed.

Adult↗
PubMed1998

[Prognosis of patients with angina pectoris or silent ischemia: exercise 99mTC-MIBI SPECT].

INTRODUCTION AND OBJECTIVES: Although different reports have compared the extent of the myocardial ischemia in patients with or without angina during exercise test, there have been few publications which have studied their prognosis. The aim of this study is to analyze the prognostic value of the presence of angina during 99mTc-MIBI SPECT in patients with proven coronary artery disease without previous myocardial infarction. PATIENTS AND METHODS: We studied 82 patients prospectively with at least one coronary stenosis > 70% and with reversible perfusion defects in 99mTc-MIBI SPECT (long protocol). Twenty two of these patients had angina during exercise test. The extension of ischemia was quantified on SPECT and the severity of coronary stenoses on coronary angiography. The mean follow-up period was 3.2 years. RESULTS: The angina patients showed a significantly lower coronary reserve (exercise duration: 6.3 min vs 8 min; p = 0.03), a lower maximal O2 consumption (5.8 METs vs 6.2 METs; p = 0.04), a higher rate of ST depression > 1 mm (64% vs 19%; p = 0.006) and a higher degree of ST depression (0.9 mm vs 0.4 mm; p = 0.01) than those patients without angina. There were no significant differences in the extent of ischemia in SPECT or in the angiographic severity of coronary disease between either groups. During the follow-up period the presence of severe complications (myocardial infarction or death) tended to be higher (27% vs 17%; NS) in patients with angina and the indication of surgical revascularization was also significantly higher (50% vs 17%; p = 0.002) in this group. CONCLUSIONS: Presence of angina during 99mTc-MIBI SPECT portends a higher risk of medium and long term complications, mainly due to surgical revascularization.

Angina Pectoris↗
PubMed1998

Relevance of delayed hospital admission on development of cardiac rupture during acute myocardial infarction: study in 225 patients with free wall, septal or papillary muscle rupture.

OBJECTIVES: We analyzed the possible relation between the presence of a hospital admission delay (> or =24 h), undue physical effort or recurrence of anginal pain, alone or in combination, with the development of free wall rupture (FWR), septal rupture (SR) or papillary muscle rupture (PMR) in patients with an acute myocardial infarction (AMI). BACKGROUND: Physical activity as a trigger of FWR in AMI remains controversial, and its contribution to SR or PMR remains unknown. Moreover, the role of ischemia or reinfarction as an additional cause of rupture has not been explored. METHODS: The incidence of hospital admission delay > or =24 h with maintenance of some ambulatory activity and the incidence of postinfarction angina were analyzed in consecutive patients with a first AMI with (n = 225) or without rupture (n = 1,012 [control group]) over different time periods. RESULTS: An admission delay > or =24 h occurred in 27 (27.6%) of 98 patients with FWR, 47 (47.0%) of 100 with SR and 14 (51.9%) of 27 with PMR but in only 81 (8%) of 1,012 control patients (p < 0.0001). Information on undue in-hospital effort preceding rupture was available for 111 patients and was present in 17 (32.7%) of 52 with FWR, 9 (18.4%) of 49 with SR and 3 (30%) of 10 with PMR versus only 76 (7.5%) of 1,012 control patients (p < 0.001). Information on postinfarction anginal pain was available for 114 patients with rupture and occurred in 30 (56.6%) of 53 with FWR, 30 (60%) of 50 with SR and 4 (36.4%) of 11 with PMR versus 120 (11.9%) of 1,012 control patients (p < 0.0001). Mean age and incidence of male gender, hypertension, absence of heart failure, single-vessel disease or occlusion of the infarct-related artery were comparable among the groups with FWR, SR or PMR. CONCLUSIONS: Delayed hospital admission or undue in-hospital physical activity appears to increase the risk of rupture in patients prone to this complication (i.e., a first transmural AMI, absence of overt heart failure and advanced age); recurrence of ischemia/infarction emerges as a potential additional trigger in a proportion of these patients.

Age Factors↗
PubMed1998

Fasting and postprandial ischemic threshold in patients with unstable angina with and without postprandial angina at rest.

BACKGROUND: Postprandial angina develops within minutes after a meal in patients with unstable angina, but the clinical characteristics of these patients and why it develops in only some of those with advanced coronary artery disease remain largely unknown. A severely reduced coronary reserve associated with postprandial increases in heart rate could be a contributory mechanism. METHODS: The clinical and angiographic characteristics of 277 patients with unstable angina with (23) or without (254) postprandial angina were analyzed. The coronary reserve was also analyzed by measuring the ischemic threshold by atrial pacing in a fasting state in all patients and 15 minutes after a 900-calorie meal in 54. RESULTS: Patients with postprandial angina were older, more likely to be women, and had a higher incidence of hypertension and three-vessel disease than those without (p < 0.005) and had a lower fasting ischemic threshold (131.8 [SD 13.0] vs 147.5 [SD 23.4] beats/min, p < 0.0001). However, 67 of the 79 patients with the lowest fasting thresholds (< or =130 beats/min) (84.8%) had no postprandial angina. Moreover, among patients with and without postprandial angina who were matched for age, sex, and extent of coronary disease, the ischemic threshold was also lower in those with postprandial angina (p < 0.005) and there were no differences in left ventricular end-diastolic pressure or volume. Postprandial pacing was positive in 37 patients but postprandial ischemic threshold was comparable to fasting threshold (132 [SD 14] vs 132 [SD 16] beats/min). Moreover, in the 10 patients who experienced in-hospital postprandial angina, heart rate during postprandial angina was similar to nonpostprandial angina (93.1 [SD 14.7] vs 90.3 [SD 17.6]) and lower than the fasting ischemic threshold (132.0 [SD 10.8] beats/min, p < 0.0001). CONCLUSIONS: Thus postprandial angina tends to occur among elderly and hypertensive patients with advanced coronary disease and severely reduced ischemic threshold. The fact that the postprandial ischemic threshold was clearly higher than the heart rate attained during postprandial angina suggest that factors others than increases in heart rate account for postprandial angina. Furthermore, the lack of a decline in the postprandial ischemic threshold suggests that, in the absence of postprandial angina, there is not a consistent postprandial change in coronary tone or that the increases in myocardial oxygen demands due to increased myocardial contractility-wall tension do not seem to play a major role in postprandial ischemia.

Adult↗
PubMed1998

Liver transplantation in hepatitis C. A Spanish multi-centre experience.

OBJECTIVE: The purpose of this retrospective survey was to determine the prevalence and outcome of hepatitis C virus (HCV) infection in cirrhotic patients undergoing liver transplantation (OLT) in Spain in 1992. METHODS: Post-OLT HCV infection was defined by anti-HCV (second-generation ELISA) and/or PCR. Patients were divided into groups A (HCV-positive pre-OLT: n = 124, 46%) and B (HCV-negative pre-OLT: n = 145, 54%). RESULTS: HCV infection was more prevalent in patients originally diagnosed as having non-A non-B cirrhosis (97%) and cryptogenic cirrhosis (79%) than in patients with cholestatic or metabolic diseases. Group A patients were older (53.3+/-7.9 versus 47.6+/-9.7; P< 0.05) and had a higher prevalence of hepatocellular carcinoma (22% versus 4%, P< 0.05). Post-OLT HCV infection was 99% in group A versus 4% in group B (P< 0.05). Histological hepatitis developed in 39% (66% in group A versus 14% in group B, P< 0.05) with similar follow-up. Chronic rejection occurred in 6% (3% in group A versus 8.5% in group B, P= 0.07). Retransplantation rate (overall 8%) and two-year patient survival did not differ between groups (79% versus 72%). Graft survival was higher in group A (74% versus 65% at 2 years, P= 0.04). CONCLUSIONS: HCV-cirrhosis represented the most frequent indication for OLT in Spain in 1992. While HCV recurrence was universal, de novo acquisition was rare. HCV accounted for most post-OLT hepatitis (87%), but was not associated with chronic rejection, nor with a higher retransplantation rate. Patient survival was not different in HCV patients compared to a control group after a follow-up of 2-3 years. Therefore, at present, HCV-cirrhosis is an acceptable indication for OLT.

Adolescent↗
PubMed1998

The incidence of breastfeeding in our environment.

AIMS: To establish the incidence of breastfeeding and its persistence after three and six months; to identify the factors which might modify attitudes towards breastfeeding. METHODS: An interview, administered to mothers of term born infants of adequate weight for gestational age, after a delivery of one sole foetus, between 1st March and 31st May 1997. Mothers were asked about: previous pregnancies, children and type of feeding; during this pregnancy, their intentions regarding feeding; supervision of pregnancy, and the information received regarding breastfeeding; their work situation, and educational level. Questions regarding the neonatal period referred to the kind of lactation initiated, information received, and the use of a pacifier and supplements. A two-part poll was conducted by telephone after 3 months and after 6 months, enquiring about what kind of feeding was used, the reason for change (if any), who had provided information regarding the change, degree of satisfaction, and work situation. Three hundred and twenty-nine polls were completed, accounting for 70% of the births. RESULTS: During pregnancy, 91% of mothers had intended to breastfeed, and this figure was maintained at birth. A trend towards breastfeeding was observed: 74% of those who had fed earlier children artificially started breastfeeding this time, compared with 7% of mothers who changed from breastfeeding to artificial feeding. After three months, 57% of mothers continued to breastfeed their child, and 24% after six months. High educational level exerted a positive influence on the duration of breastfeeding (OR = 1.7; p = 0.03) and the giving of supplements had a negative effect (OR = 0.4; p = 0.04). The fact that mothers work outside the home did not modify the duration of breastfeeding. CONCLUSIONS: The rate of breastfeeding is high (91%). Among mothers with previous children, there is a greater trend to change from artificial feeding to breastfeeding (74% vs 7%; p < 0.002). The mother's educational level is the most important positive factor, and the early giving of supplements the most important negative factor.

Attitude↗
PubMed1998

Helical CT versus CT arterial portography in the detection of hepatic metastasis of colorectal carcinoma.

OBJECTIVE: The study is a prospective comparison of helical CT with nonhelical CT arterial portography (CTAP) in the detection of liver metastases from colorectal carcinoma, using surgical and histologic findings as the gold standard. SUBJECTS AND METHODS: Thirty-five patients with colorectal carcinoma and suspected liver metastases were prospectively examined with helical CT and CTAP before surgery. In nine cases, surgery was not performed. In the remaining 26 patients, imaging results were correlated with surgical and pathologic findings. Three radiologists prospectively assessed metastatic involvement with both techniques. The results were compared with pathologic and surgical findings on a lesion-by-lesion basis. In a second phase, three radiologists not directly concerned in the design of the study independently assessed metastatic involvement of the liver as revealed on helical CT and CTAP on a segment-by-segment basis with a five-level scale of confidence. Results were analyzed by receiver operating characteristic methods. RESULTS: The results of the histologic study disclosed 50 metastatic lesions. Helical CT had a sensitivity of 76% (38/50) and a positive predictive value of 90%. CTAP had a sensitivity of 74% (37/50) and positive predictive value of 69%. Receiver operating characteristic analysis revealed a greater area under the curve (Az index), 0.96, for helical CT than for CTAP (0.86). Differences were statistically significant (p < .001). CONCLUSION: Helical CT is superior to nonhelical CTAP in the detection of hepatic metastases from colorectal carcinoma.

Adult↗
PubMed1998

[Resection as elective treatment of hilar cholangiocarcinoma (Klatskin tumor)].

A retrospective analysis of our experience in the treatment of hiliary cholangiocarcinoma or Klatskin tumor was performed with the aim of evaluating the morbi-mortality and prognosis of its treatment to thereby determine the usefulness of the different therapeutic options. From 1989 to 1997, 51 patients diagnosed with hiliary cholangiocarcinoma were treated in our hospital. Surgery was indicated in 16 with curative aims (group I) while palliative treatment with percutaneous biliary drainage was indicated in 35 (group II). Biliary resection was carried out in 8 patients being associated with hepatic resection in 4 (group IA) and in 8 patients undergoing liver transplantation (group IB). Clinico-epidemiologic data and hospital stay were similar in all the groups. The frequency of complications was similar in groups I and II although the frequency of cholangitis (49%) in group II was noticeable. The percentage of readmissions was also greater in group II (12 vs 46%, respectively; p = 0.03) with prosthesis obstruction being the most frequent cause. Accumulated survival at 1, 2, and 3 years in group I was 84, 64 and 48% with a median survival of 33 months, while in group II the median survival was of 6 months with no patient surviving more than 2 years (p = 0.0001). When groups IA and IB were compared, greater frequency of complications in groups IA (100 vs 37%; p = 0.002), similar frequency of readmissions (87 vs 75%; p = NS), median survival greater in group IB (12.5 months vs 48 months) and significantly higher actuarial survival in group IB (48% in 2 years vs 83% to 2 years; p = 0.02) was observed. In conclusion, surgery is the treatment of choice in hiliary cholangiocarcinoma whenever possible, given the greater survival without a significant increase in morbimortality. Likewise, we consider that liver transplantation is a useful option in the treatment of patients with cholangiocarcinoma type IV of Bismuth.

Adult↗
PubMed1998

[Is surgery for portal hypertension a contraindication for liver transplantation?].

INTRODUCTION: Orthotopic liver transplantation (OLT) is the only curative treatment for hepatic cirrhosis and is the most effective in the control of portal hypertension. The aim of this study was to analyze whether greater morbi-mortality is observed in patients undergoing liver transplantation with previous surgery for portal hypertension with respect to patients not having undergone this surgery. MATERIALS AND METHODS: Different variables were analyzed in 2 groups of transplanted patients: one of 18 patients who had previously undergone surgery for portal hypertension and another group of 54 patients without this previous surgery. RESULTS: The following factors were studied: mean operative time and length of anahepatic phase, intraoperative consumption of concentrates of erythrocytes, fresh frozen plasma, units of platelets and cryoprecipitates, days of mechanical ventilation, stay in the ICU and total postoperative stay. No significant differences were observed (p < 0.05) in any of these factors or in survival. DISCUSSION: On analysis of the difficulty of surgical technique, postoperative evolution and survival and based on the variables described it may be concluded that previous surgery for portal hypertension does not only not contraindicate posterior liver transplantation, but rather may be useful in patients with an adequate hepative reserve presenting variceal hemorrhage since posterior transplantation does not present a worsened prognosis.

Adult↗
PubMed1997

Comparison of patients with and without papillary muscle rupture during acute myocardial infarction.

Seventeen of 31 patients with papillary muscle rupture (PMR) were admitted with a >24-hour delay since onset of acute myocardial infarction (AMI) in contrast to 81 of 1,012 with AMI without cardiac rupture; in 8 of 11 patients with in-hospital PMR it was preceded by new anginal pain in 5 and/or by strenuous exercise in 4; mortality was higher in those with anterior PMR, previous infarction, or 3-vessel disease than in those without PMR. Thus, persistence of physical activity before or during hospitalization, as well as postinfarction ischemia/infarct extension, appear to be relevant triggers of PMR, whereas mortality is more often associated with existence of a previous infarction, 3-vessel disease, and/or anterior PMR.

Aged↗
PubMed1997

Results of using the recipient's splenic artery for arterial reconstruction in liver transplantation in 23 patients.

BACKGROUND: Arterial reconstruction is essential in liver transplantation. In some patients there may be an inadequate flow as a result of stenosis, intimal dissection, or anomalies of the hepatic artery. METHODS: This study analyzes our experience with 23 patients in whom arterial anastomosis was performed using the splenic artery due to the inadequacy of the hepatic artery. During the same period an aortoiliac conduit was used in 12 liver transplantations due to the same problem. RESULTS: No splenic infarction, pancreatitis, or other related complications were found. Artery thrombosis developed in only two patients in the aortoiliac conduit group. One- and three-year patient actuarial survival were 78% vs. 80% and 72% vs. 80%, respectively, for the splenic artery group and the aortoiliac conduit group. CONCLUSIONS: Anastomosis with the splenic artery is an alternative in liver transplantation and is particularly suitable when splenomegaly is present.

Anastomosis, Surgical↗
PubMed1997

Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction.

OBJECTIVES: This study sought to evaluate the effects of prolonged rest and blood pressure control on survival of patients in whom left ventricular free wall rupture (LVFWR) was strongly suspected. BACKGROUND: Left ventricular free wall rupture in myocardial infarction is often fatal, and only a few patients may undergo operation. However, survival without surgical repair has not yet been evaluated. METHODS: Eighty-one consecutive patients with a first transmural acute myocardial infarction in Killip class I or II who presented with acute hypotension due to cardiac tamponade, with electromechanical dissociation (EMD) in 72, were prospectively evaluated. Patients with early recovery were managed with prolonged bed rest and blood pressure control with beta-blockade as tolerated. RESULTS: Forty-seven patients died within 2 h of acute tamponade, and autopsy in 21 showed LVFWR in all. In 15 others, an emergency surgical repair resulted in 2 survivors. The remaining 19 patients, 10 with EMD, had early recovery with dobutamine and colloid solution, and 15 required pericardiocentesis. Shortly thereafter, these 19 patients still showed a paradoxic pulse > or = 20 mm Hg, relevant pericardial effusion (24 +/- 7 mm [mean +/- SD]) and comparable elevation of right and left ventricular filling pressures (15.8 +/- 3.9 and 15.9 +/- 3.8 mm Hg, respectively). Subsequent management included bed rest (8.2 +/- 4.8 days) and control of systolic blood pressure (< or = 120 mm Hg) with beta-adrenergic blocking agents as tolerated (n = 12). Four patients died, and autopsy in three revealed a rupture that was sealed in two. A sealed rupture was also seen at thoracotomy in 2 other patients who, like the remaining 13, survived for 52.5 +/- 35.2 months. CONCLUSIONS: Long-term survival of selected patients with prompt hemodynamic recovery after LVFWR is possible without surgical repair. Prolonged bed rest and blood pressure control are likely to contribute favorably to their initial outcome.

Adrenergic beta-Antagonists↗
PubMed1997

Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: a comparative study.

Cumulative recurrence after surgical resection for hepatocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with HCC at early tumor stages. Consequently, in January 1990, we decided to prospectively indicate orthotopic liver transplantation (OLT) as the first surgical treatment for small, localized HCC in cirrhotic patients without nodal involvement independently of the degree of liver function. The aim of this prospective cohort study was to analyze prognosis, recurrence rate, and survival after liver transplantation in patients in whom the main indication was HCC with cirrhosis. Thirty-eight patients in whom the main indication for liver transplantation was HCC and hepatic cirrhosis were compared with 136 transplantations because of cirrhosis without tumor, performed in our unit from January 1990 to December 1995. HCC arising in noncirrhotic livers and those incidently discovered after OLT were excluded from the study. Chemoembolization using doxorubicin, lipiodol, and Gelfoam was performed before OLT in 31 patients with good liver function. There were no differences in gender, but HCC patients were older (57 +/- 7 vs. 50 +/- 10 years [P < .001]). Liver function was better in HCC (Child-Pugh score: 6.9 +/- 2 vs. 8.6 +/- 1.8; P < .001), and hepatitis C virus antibody was positive in 31 (82%) vs. 51 (37%) (P < .007). Seven tumors had bilobar involvement (18%). Capsule was present in 22 (58%). The mean size of the tumor was 3.4 +/- 2 cm. Seventeen tumors (45%) were larger than 3 cm, and 4 (11%) were larger than 5 cm. The average number of nodules was 2 +/- 1. The tumor-node-metastasis stage of the tumors was pT1 in 6 patients (16%), 11 were pT2 (29%), 12 were pT3 (31%), and 9 were pT4 (24%). Seven patients were retransplanted in the HCC group (18%) and 19 (14%) in the nontumor group (not significant). Tumor recurrence was detected in three patients (8%). One, 3-, and 5-year survival rates were 82% vs. 79%, 75% vs. 71%, and 63% vs. 68%, respectively, for patients with and without HCC, and no differences were found between the two groups (P = .84). Survival was significantly reduced in patients with a macroscopic vascular invasion and tumors greater than 5 cm in diameter. Recurrence and mortality after liver transplantation in cirrhotic patients with carefully selected HCC are similar to the results in cirrhotic patients without tumor.

Adult↗