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Biomedical subjects

J Figueras

Publications and source records attributed to J Figueras.

At least 109 records · Page 6Linked to original sources
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↗
PubMed1997

The prophylactic effect of aprotinin on intraoperative bleeding in liver transplantation: a randomized clinical study.

Fibrinolysis has been recognized as an important cause of intraoperative bleeding during orthotopic liver transplantation (OLT). Several investigators have used prophylactic administration of aprotinin in patients to inhibit fibrinolysis and to decrease transfusion requirements, morbidity, and mortality. Nevertheless, the role of aprotinin in this situation is not yet clear. The goal of this study was to determine the effects of prophylactic administration of aprotinin on intraoperative bleeding and blood requirements, and on hemostatic changes during OLT. Eighty consecutive patients were included in a double-blind, prospective study and were randomized in two groups. In group A (n = 39), an initial dose of 2 x 10(6) kallikrein inactivator units (KIU) of aprotinin was administered in the induction of anesthesia followed by infusion of 5 x 10(5) KIU/h until the end of the procedure. The control group (n = 41) received an identical volume of saline solution. The majority of the operations were performed with vena cava preservation (piggy-back technique) without venovenous bypass. During the anhepatic phase, a significant increase in levels of tissue plasminogen activator, thrombin-antithrombin complexes (TAT) and D-dimers (DD) was noted in both groups. A significant increment of TAT was observed in group A during reperfusion. The remaining hemostatic parameters were similar in both groups. Intraoperative requirements of packed red cells, fresh-frozen plasma (FFP), platelets, and cryoprecipitate were similar in the two groups. Our results suggest that prophylactic administration of aprotinin is not useful in reducing bleeding and blood product requirements during OLT.

Adolescent↗
PubMed1997

Vascular occlusion in hepatic resections in cirrhotic rat livers: an experimental study in rats.

The aim of this study was to evaluate the tolerance of normothermic liver ischemia with different degrees of hepatic function in cirrhotic rats. Liver cirrhosis was induced by administering carbon tetrachloride (CCl4) in water solution to male Wistar rats. Hepatic function was graded using the plasma levels of antithrombin III, albumin, and bilirubin and the presence of ascites. Rats were distributed in four groups: noncirrhotic (control group), compensated cirrhosis (group A), decompensated cirrhosis (group B), and decompensated cirrhosis with ascites (group C). Groups A, B, and C were significantly different in all four parameters studied (P < .003). Subtotal liver ischemia was performed for periods of 0, 30, 45, 60, and 75 minutes. At the end of the procedure, the nonischemic lobes were resected. Postoperative evolution of alanine aminotransferase, aspartate aminotransferase, and bilirubin levels was also recorded. Survival rates after the same periods of ischemia were statistically different (P < .05): control group, 7 of 7 after 45 minutes (100%), 7 of 7 after 60 minutes (100%), and 4 of 9 after 75 minutes (44%); group A, 7 of 7 after 45 minutes (100%) and 1 of 7 after 60 minutes (14%); group B, 7 of 7 after 0 minutes (100%), 5 of 7 after 30 minutes (71%), and 1 of 7 after 45 minutes (14%); and group C, 0 of 5 after 0 minutes (0%) and 1 of 7 after 30 minutes (14%). No differences were found in the postoperative course of transaminases. However, bilirubin levels found 24 hours and 7 days after ischemia were significantly greater in cirrhotic rats, and this was directly related to the degree of hepatic insufficiency (P < .001). Histological examination of the livers exposed to CCl4 showed features of liver cirrhosis with ductal proliferation. The ischemia time tolerated by cirrhotic rat livers is shorter than the time tolerated by normal rats. Tolerance to hilar vascular occlusion depends on the degree of hepatic insufficiency. Rats with decompensated cirrhosis and ascites do not tolerate any surgical procedure.

Alanine Transaminase↗
PubMed1997

Pulmonary perfusion scintigraphy in the evaluation of the severity of bronchopulmonary dysplasia.

OBJECTIVE: The objectives of this study were to analyze the changes in pulmonary perfusion in bronchopulmonary dysplasia (BPD) and to assess the advantages of this method in evaluating the severity of BPD. PATIENTS AND METHODS: The study group was made up of 10 children with BPD, matched with a control group of 12 children. The criteria for matching were birth weight, gestational age and need for ventilation for more than 3 days. Clinical and roentgenographic scoring systems were applied on the 21st day of life. At 6 months of corrected age, clinical evolutive severity was evaluated and a pulmonary perfusion scintigraphy using technetium-99 was performed in each child. The scintigraphic findings were classified in five categories ranging from normal to severely affected, depending on the degree and localization of perfusion abnormalities. Another score was obtained by assigning a value from 1 to 5 to each pulmonary lobe, depending on the concentration of the tracer. RESULTS: The study of clinical, roentgenographic and evolutive scores always showed higher values in children with BPD, with good correlation between methods (P < 0.001). In the BPD group, abnormal lung perfusion patterns were more frequent and more severe (P < 0. 05), the lobe scoring was higher (P < 0.05), and a lower count rate was found (P < 0.01). CONCLUSION: Pulmonary scintigraphy is a useful technique in evaluating the severity of BPD.

Bronchopulmonary Dysplasia↗
PubMed1997

Severe mitral regurgitation complicating acute myocardial infarction. Clinical and angiographic differences between patients with and without papillary muscle rupture.

AIMS: To assess the differential clinical and angiographic characteristics of patients with severe mitral regurgitation related (n = 31) or unrelated (n = 16) to papillary muscle rupture complicating acute myocardial infarction. METHODS AND RESULTS: The clinical and angiographic features of patients with myocardial infarction and severe mitral regurgitation were evaluated. Patients with papillary muscle rupture were older (67 vs 60 years, P < 0.005) and had a lower rate of diabetes (7% vs 38%, P < 0.005) and of previous angina or infarction (24% vs 50%, P < 0.05). Frequency of inferior infarction was high and comparable in both groups (papillary muscle rupture, 72% vs non-papillary muscle rupture, 88%, ns) whereas in-hospital rate of angina/infarct extension prior to mitral regurgitation, also high, tended to be higher in patients without than in those with papillary muscle rupture (67% vs 39%, ns). Incidence of multivessel disease tended to be higher in patients without papillary muscle rupture (87% vs 56%, P < 0.06) and they had a lower ejection fraction (46 +/- 15 vs 61 +/- 14%, P < 0.03), whereas the culprit artery was mainly the right or the circumflex coronary artery in both groups (papillary muscle rupture, 100% vs non papillary muscle rupture, 93%, ns). Valve replacement was performed earlier in patients with papillary muscle rupture (1 (1; 14) vs 25 (5; 45) days, median, P < 0.002) but was associated with a similar mortality (papillary muscle rupture 11/24, 46% vs non-papillary muscle rupture, 7/15, 47%, ns). The main cause of death was cardiogenic shock in patients without papillary muscle rupture (5/7, 71%), and respiratory insufficiency--sepsis in those with papillary muscle rupture (7/11, 64%). CONCLUSIONS: Severe mitral regurgitation in myocardial infarction with or without papillary muscle rupture is mostly related to inferior infarction and often follows reinfarction, particularly in non-papillary muscle rupture cases. The main contributors to surgical mortality appear to be respiratory insufficiency in patients with papillary muscle rupture and cardiogenic shock, facilitated by a lower ejection fraction, a higher frequency of diabetes and more extensive coronary disease, in patients without papillary muscle rupture.

Aged↗
PubMed1997

Acoustic stimulation in hypoxic-ischemic encephalopathy: heart rate analysis.

Two groups of 30 term newborns (normal and anoxic) were analyzed to study the influence of anoxia in the heart rate. The experiment consisted in a polygraphic EEG register before, during and after an acoustic stimulus. In basal conditions of active sleep, the heart rate in the asphyctic newborn was higher than in the normal group. The acoustic stimulation caused a transitional tachycardia. The variability of the heart rate was smaller in the asphyctic group. The basal heart rate varied in relation to the grade of Hypoxic-Ischemic Encephalopathy (HIE) and there was also a difference in the capacity of response to acoustic stimulation between the moderate HIE group and the normal group.

Acoustic Stimulation↗
PubMed1997

Neonatal outcome in women treated for the antiphospholipid syndrome during pregnancy.

The aim of this study was to determine the neonatal outcome in women with well-characterized antiphospholipid syndrome treated during pregnancy with low-dose aspirin. We compared 38 babies born after 36 pregnancies of 33 women diagnosed as having antiphospholipid syndrome with a group of 38 control infants matched for the same gestational age at birth. In all 76 newborns we studied the maternal events associated with the antiphospholipid syndrome, mothers' treatment and neonatal data. All mothers with antiphospholipid syndrome were treated with low-dense aspirin. Prednisone was only prescribed due to maternal complications and heparin in a case of thrombosis. No significant relation was found between maternal treatment and neonatal complications. The prematurity rate in these newborns was high 14% and the neonatal mortality (5.8%) was only associated with extreme prematurity (p < 0.001). In our population the overall rate of neonatal complications was higher than in the general population, but when compared with a similar group of newborns no significant differences were found. Our results suggest that primary antiphospholipid syndrome appears to be improved by low-dose aspirin treatment, with a high rate of neonatal survival (95%). Except for prematurity and its potential associated complications, fetal and neonatal outcome is very favourable and no significant relation between maternal treatment and neonatal pathology has been detected.

Anti-Inflammatory Agents↗
PubMed1997

Changes in TcPCO2 regarding pulmonary mechanics due to pneumotachometer dead space in ventilated newborns.

The aim of this study was to analyze the effect of added dead space on PaCO2 after application of a pneumotachometer during the measurement of pulmonary mechanics. The study was based on 24 observations of TcPCO2 changes during the measurement of pulmonary function in 9 newborns subjected to mechanical ventilation. All newborns remained stable during the 23 minutes of the test. The introduction of a low dead space pneumotachometer (1.7 mL) for 10 minutes led to an increase in TcPCO2 of 5.40 +/- 2.66 mm Hg, from 39.76 +/- 8.69 to 45.17 +/- 9.22. Pulmonary mechanics indexes that correlated with the percentage of CO2 increase were peak inspiratory flow and expiratory time/time constant. When the pneumotachometer was removed, TcPCO2 fell but remained 0.99 +/- 2.13 mm Hg above basal TcPCO2. Final TcPCO2 tended to relate negatively with the minute volume. We conclude that this transient increase in PaCO2 should be born in mind in neonates with a high basal level and can be prevented by maintaining a long expiratory time and a high minute volume.

Blood Gas Monitoring, Transcutaneous↗
PubMed1997

Structure and composition of freshwater microbial mats from a sulfur spring ("Font Pudosa", NE Spain).

Different types of microbial mats developing on the wall on a non-thermal sulfur freshwater spring have been studied. Both, light and electron microscopy as well as HPLC analysis of photosynthetic pigments revealed their structure and composition. Prokaryotic chlorophylls and carotenoids helped in the taxonomical assignment of the main photosynthetic groups. "Inverted position" mats (Mat-I) were dominated by Chromatiaceae; they were located closed to the water outlets (0.3 mM sulfide). "Normal position", that is, cyanobacterial-covered mats (Mat-II and Mat-IV), developed elsewhere on the stone walls at lower sulfide concentrations. A third type of mat (Mat-III), covered by chemolithotrophic bacteria, was distinguishable at the water-air interface, strongly attached to the walls of the spring. Up to six physiological types of microorganisms have been recognized: cyanobacteria, Chromatiaceae, purple nonsulfur bacteria. Chlorobiaceae, Chloroflexaceae, and chemolithotrophic bacteria. Cyanobacteria Lyngbya-like, Oscillatoria-like and Pseudanabaena sp. were found. The diversity of Chromatiaceae (six morpho-/pigment types of the genus Chromatium, plus two non identified Chromatiaceae, named PB1 and PB2 were observed) was noticeable. Chemolithotrophic bacteria were represented by the genera Beggiatoa and Thiothrix. Finally, small numbers of Chloroflexus-like bacteria and Chlorobium limicola were found in all the studied mats.

Carotenoids↗
PubMed1997

[Complete congenital atrioventricular block. Prenatal diagnosis and perinatal management].

OBJECTIVE: To describe our experience in prenatal diagnosis and perinatal management of congenital atrioventricular heart block, as well as pacemaker treatment in the neonate. MATERIAL AND METHODS: A total of 13 fetuses are included. The diagnosis of atrioventricular dissociation was established by Doppler heart rate sample in the right atrium to show the atrial activity while the sample in the Aorta reflected the ventricular heart rate. Gestational age at diagnosis, ventricular heart rates, autoimmune maternal pathology, maternal blood tests for autoantibodies antiRo+, congenital structural heart disease, fetal hydrops, maternal medical treatment, perinatal results and pacemaker neonatal implantation are described. RESULTS: Gestational age at diagnosis ranged between 22 and 32 (mean 27.6) weeks. Ventricular heart rates ranged between 32 to 80 (mean 54) beats/min. AntiRo+ antibodies were detected in 5 mothers, and clinical systemic lupus erythematosus was found in only one. Four had congenital heart disease (2 ventricular inversion and corrected TGA, 1 complete atrio-ventricular canal and 1 tricuspid atresia). Signs of heart failure and hydrops were detected in 9 fetuses. Treatment with beta-metasona and ritodrine was administered to 7 mothers when the ventricular heart rate dropped below 60 beats/min. Intrauterine fetal death occurred in 3 fetuses with structural congenital heart disease and hydrops. Delivery was performed by cesarean section in 8 preterm fetuses (one them a twins), 3 spontaneous deliveries at term and 3 stillbirth. Postnatal pacemaker implantation was carried out in 9 newborns (3 cases with unicameral temporal right ventricle electrode and 6 cases with permanent bicameral electrodes implanted through the subclavian vein and DDD pacemaker). Follow-up of the bicameral pacemaker group was satisfactory. CONCLUSION: Persistent fetal bradycardia is the first sign to diagnose prenatal complete atrioventricular heart block. Echocardiography asses fetal haemodynamic status and may detect signs of fetal deterioration. Hydrops and further drop in the ventricular heart rate warrant urgent cesarean section and pacemaker management of the newborn.

Female↗
PubMed1996

Repeated 15-minute coronary occlusions in pigs increase occlusion arrhythmias but decrease reperfusion arrhythmias that are associated with extracellular hypokalemia.

OBJECTIVES: We sought to evaluate the effects of repetitive 15-min coronary occlusions followed by 45-min reperfusions on the incidence of occlusion and reperfusion arrhythmias in pigs. BACKGROUND: Brief 2- to 5-min coronary occlusions seem to exert a protective effect on occlusion and reperfusion arrhythmias. However, because clinical ischemic episodes are often longer, it would be appropriate to assess whether such protection also occurs when longer cycles of occlusion-reperfusion are produced. METHODS: Three to four cycles of 15-min coronary occlusions with 45-min reperfusions were performed in 34 pigs, and changes in ST segment and incidence of ventricular arrhythmias were assessed. Plasma potassium ion concentrations in eight pigs and blood gas in six were measured from blood from the ischemic area during reperfusion. RESULTS: Repetitive occlusions were associated with a progressively higher ST segment elevation and a higher incidence of ST segment alternans (p < 0.001) and ventricular fibrillation (VF) (p < 0.01). However, during repetitive reperfusions, normalization of the ST segment was increasingly faster, the incidence of VF was progressively reduced (p < 0.03), and there was progressively less severe regional acidosis ([mean +/- SD] 7.06 +/- 0.12 vs. 7.26 +/- 0.06, p < 0.05) and hypokalemia (1.9 +/- 0.7 vs. 2.3 +/- 0.4 mEq/liter, p = NS). CONCLUSIONS: The progressive electrocardiographic deterioration and increasing incidence of ventricular arrhythmias during repetitive 15-min occlusions in pigs suggest increasing metabolic derangement. However, the progressively faster normalization of the ST segment and the reduced incidence of ventricular arrhythmias during reperfusion suggest an increasingly faster restoration of the metabolic and ionic balance.

Acid-Base Equilibrium↗
PubMed1996

Setting priorities, can Britain learn from Sweden?

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.

Advisory Committees↗
PubMed1996

The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis.

The aim of this study was to analyze the donor risk factors associated with second orthotopic liver transplantation (reOLT) and graft loss after OLT within 1 month. A total of 649 OLTs performed in 11 centers in Spain during the period from 1992 to 1993 were analyzed retrospectively. Eleven donor and recipient variables were studied. Biochemical evolution of the OLT, biliary and arterial complications, patient status (alive, retransplanted, or dead), and follow-up were also recorded. Bivariate study demonstrated that extended preservation ( > 12 hr) was associated with increased biliary complications (P = 0.02), and lower prothrombin time (P = 0.04). In a logistic model regression for biliary complications, ischemia > 12 hr was an independent risk factor (odds ratio = 2.2, 95% confidence interval [CI] = 1.1-4.3). The multivariate Cox proportional model of potential risk factors showed that only urgent reOLT (relative risk [RR] = 2.7, 95% CI = 1.4-5.4) was independently associated with higher 30-day mortality. Donor plasma sodium > 155 mmol/L (RR = 1.4, 95% CI = 1.0-2.2) and incompatible ABO graft (RR = 3.2, 95% CI = 1.3-7.9) were independently associated with increased rate of reOLT before 30 days. Donor plasma sodium > 155 mmol/L (RR = 2, 95% CI = 1.1-3.6) and incompatible graft (RR = 3.3, 95% CI = 1.4-8.2) were independently associated with graft loss (death or reOLT) before 1 month. We conclude that cold ischemia should be kept less than 12 hr in order to avoid biliary complications. Donors over 60 years old or with plasma sodium > 155 should be carefully evaluated before OLT.

Adolescent↗