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Biomedical subjects

J Gallardo

Publications and source records attributed to J Gallardo.

At least 19 recordsLinked to original sources
PubMed2004

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.

BACKGROUND: An inadequate response to initial empirical treatment of community acquired pneumonia (CAP) represents a challenge for clinicians and requires early identification and intervention. A study was undertaken to quantify the incidence of failure of empirical treatment in CAP, to identify risk factors for treatment failure, and to determine the implications of treatment failure on the outcome. METHODS: A prospective multicentre cohort study was performed in 1424 hospitalised patients from 15 hospitals. Early treatment failure (<72 hours), late treatment failure, and in-hospital mortality were recorded. RESULTS: Treatment failure occurred in 215 patients (15.1%): 134 early failure (62.3%) and 81 late failure (37.7%). The causes were infectious in 86 patients (40%), non-infectious in 34 (15.8%), and undetermined in 95. The independent risk factors associated with treatment failure in a stepwise logistic regression analysis were liver disease, pneumonia risk class, leucopenia, multilobar CAP, pleural effusion, and radiological signs of cavitation. Independent factors associated with a lower risk of treatment failure were influenza vaccination, initial treatment with fluoroquinolones, and chronic obstructive pulmonary disease (COPD). Mortality was significantly higher in patients with treatment failure (25% v 2%). Failure of empirical treatment increased the mortality of CAP 11-fold after adjustment for risk class. CONCLUSIONS: Although these findings need to be confirmed by randomised studies, they suggest possible interventions to decrease mortality due to CAP.

Adolescent↗
PubMed2003

An electronic tongue using potentiometric all-solid-state PVC-membrane sensors for the simultaneous quantification of ammonium and potassium ions in water.

The simultaneous determination of NH(4)(+) and K(+) in solution has been attempted using a potentiometric sensor array and multivariate calibration. The sensors used are rather non-specific and of all-solid-state type, employing polymeric (PVC) membranes. The subsequent data processing is based on the use of a multilayer artificial neural network (ANN). This approach is given the name "electronic tongue" because it mimics the sense of taste in animals. The sensors incorporate, as recognition elements, neutral carriers belonging to the family of the ionophoric antibiotics. In this work the ANN type is optimized by studying its topology, the training algorithm, and the transfer functions. Also, different pretreatments of the starting data are evaluated. The chosen ANN is formed by 8 input neurons, 20 neurons in the hidden layer and 2 neurons in the output layer. The transfer function selected for the hidden layer was sigmoidal and linear for the output layer. It is also recommended to scale the starting data before training. A correct fit for the test data set is obtained when it is trained with the Bayesian regularization algorithm. The viability for the determination of ammonium and potassium ions in synthetic samples was evaluated; cumulative prediction errors of approximately 1% (relative values) were obtained. These results were comparable with those obtained with a generalized regression ANN as a reference algorithm. In a final application, results close to the expected values were obtained for the two considered ions, with concentrations between 0 and 40 mmol L(-1).

Journal Article↗
PubMed2001

Pulmonary mass and multiple lung nodules mimicking a lung neoplasm as amiodarone-induced pulmonary toxicity.

Amiodarone is an effective anti-arrhythmic agent. However, during long-term therapy, patients can develop severe adverse pulmonary reactions that are potentially life-threatening. A case of amiodarone-induced pulmonary toxicity is presented in a 78-year-old woman. She developed dyspnea and a pulmonary mass with associated multiple lung nodules mimicking a lung cancer following 5 years of treatment with amiodarone for atrial fibrillation. After drug withdrawal, and without any additional treatment, clinical and radiological improvement was observed, and radiological findings resolved completely within 6 months.

Journal Article↗
PubMed2001

[Gemcitabine in the treatment of 4 patients with cholangiocarcinoma].

Cholangiocarcinoma is a biliary tree cancer of unknown etiology, whose symptoms are unspecific and is usually detected in advanced stages. Surgery continues to be the only curative therapy. Median survival in patients with inoperable tumors ranges between 5 and 8 months. There are few studies on the effects of chemotherapy, with a very small response. We report four patients with advanced cholangiocarcinoma, treated with gemcitabine 1000 mg/m2, weekly for 3 weeks every 28 days. There was a stabilization of tumor size and symptoms were alleviated. Toxicity was low and there was a probable prolongation of survival.

Aged↗
PubMed2001

[MALT lymphoma of the bladder. Report of a case].

OBJECTIVE: To describe and discuss primary malignant lymphoreticular proliferative tumors of the bladder. METHODS: A case of a 70-year-old woman with hematuria, dysuria, malaise and 5-kg weight loss is presented. RESULTS: Pelvic ultrasound examination showed an 8 x 7 x 8 cm solid and cystic mass adjacent to the bladder and uterus. Cystoscopic biopsy disclosed a low grade B cell non-Hodgkin lymphoma. Disappearance of the mass was achieved with 6 cycles of chemotherapy and radiotherapy. Four years thereafter the patient remains free of disease. CONCLUSIONS: Primary malignant lymphoma of the bladder is uncommon. The anatomopathological study is essential to differential diagnosis from other diseases. The response to chemotherapy and radiotherapy are excellent and permits bladder preservation.

Aged↗
PubMed2000

Advanced germ cell tumors in male patients.

Germ cell tumors (GCTs) in male patients are particularly important in oncology because the impact of a cure in the young patient population is significant. Patients with poor-risk tumors by the international classification system have about a 50% likelihood of long-term survival. No randomized trial has proved a chemotherapy regimen to be superior to that of four courses of combination bleomycin, etoposide, and cisplatin. Ongoing research is evaluating the role of high-dose chemotherapy and hematopoietic stem cell transplantation as initial therapy in patients with intermediate-risk and poor-risk GCT. Newer agents such as gemcitabine and paclitaxel have shown promise and may be incorporated in future chemotherapeutic regimens. We review the major prognostication systems, areas of research directed at improving treatment outcome, and approaches that will improve understanding and management of these neoplasms in the future.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

[Efficacy of gemcitabine in the gallbladder cancer. Initial experience in 4 cases].

Surgery continues to be the only curative therapy for gallbladder cancer, but useful in very few patients. Mean survival of patients with gallbladder cancer, that are out of the reach of surgery, is 3 months. The few clinical trials of chemotherapy for this disease, report very low success rates. We report four patients with advanced gallbladder cancer, treated with gemcitabine in an intravenous dose of 1000 mg/m2, given in 30 min, once a week during three consecutive weeks, every 28 days. There was a partial response that lasted 40.3 23.2 weeks with a mean survival of 59.75 17 weeks. One patient survives without evidences of disease after 17 months of the diagnosis of an advanced cancer. In all patients, symptoms were alleviated, functional status and quality of life improved. Toxicity was mild and did not require reduction in doses or delay in therapy. Therefore, this medication deserves further investigation for the treatment of gallbladder cancer.

Adenocarcinoma↗
PubMed1999

Prostacyclin: its pathogenic role in essential hypertension and the class effect of ACE inhibitors on prostaglandin metabolism.

Angiotensin-converting enzyme inhibitors (ACEI) block degradation of bradykinin, and bradykinin stimulates prostacyclin synthesis. Therefore, we set out to determine whether the effects of ACE inhibitors on prostaglandin production in essential hypertensive patients are class effects or are dependent on ACE inhibitor structure. In addition, we studied whether hypertensives show an impaired capacity to synthesize vasodilator prostaglandins. To address these questions, we compared the effects of captopril (sulfhydryl-containing inhibitor), enalapril and ramipril (carboxyl-containing inhibitors) and fosinopril (phosphoryl-containing inhibitor) on blood pressure and urinary excretion of 6-keto-prostaglandin (PG) F1-alpha (the breakdown product of prostacyclin) in 44 mild-to-moderate essential hypertensive subjects before and 8 weeks after administration of an ACEI. We also studied prostacyclin excretion in 15 normotensive healthy controls. Levels of urinary 6-keto-PGF1-alpha (pg/ml) were measured by specific radioimmunoassay. Hypertensive subjects showed a lower excretion of 6-keto-PGF1-alpha than normotensive controls (212+/-147 vs 353+/-98 pg/ml, p < 0.001). All ACEI induced a significant decrease in MAP and increased the rate of excretion of the prostacyclin metabolite: C, 211+/-200 to 338+/-250 pg/ml, p < 0.05; E, 202+/-133 to 296+/-207 pg/ml, p < 0.05; R, 205+/-127 to 342+/-211 pg/ml, p < 0.05; F, 235+/-128 to 347+/-241 pg/ml, p < 0.05. In hypertensives (n = 44) the decrease in blood pressure correlated negatively with the rise in 6-keto-PGF1-alpha excretion (r = -0.51, p < 0.001). These data suggest that impaired prostacyclin biosynthesis in hypertensive patients could account for haemodynamic changes leading to the hypertensive state. Moreover, the hypotensive mechanisms of ACEI may be mediated by an increase in prostacyclin production; this effect seems to be class-dependent.

6-Ketoprostaglandin F1 alpha↗
PubMed1999

[Non-invasive mechanical ventilation in patients with severe stable COPD].

BACKGROUND: The benefits of non-invasive mechanical ventilation (NIMV) in hypercapnic patients with severe stable COPD remain controversial mainly due to their unknown mechanisms. AIM: To assess the clinical and physiological benefits of a 3 weeks period of intermittent NIMV and their underlying mechanisms in COPD patients. PATIENTS AND METHODS: Twelve patients (10 male) prospectively recruited (age 65 +/- 3 years, FEV1 27 +/- 2% predicted, PaO2 46 +/- 2 mmHg, PaCO2 55 +/- 2 mmHg) were submitted to NIMV using a commercially available system (BiPAP) 3 h a day, 5 days a week for 3 weeks. Arterial blood gases, 6 min walking distance, dyspnea (Mahler's scale), breathing pattern, PIMax, ventilatory drive (P0.1) and the impedance of the respiratory system (P0.1/V1/T1) were measured before and after NIMV. RESULTS: A significant improvement in PaO2, PaCO2, PIMax, dyspnea and exercise capacity was observed in addition to a trend for VT to increase and for respiratory rate (RR) to decrease. The impedance of the respiratory system showed a significant reduction. Ventilatory drive, normalized for PaCO2 levels, did not change. Improvement in PaCO2 was related to an increase in Vp whereas a significant association between the reduction in RR and the fall in respiratory system impedance was also found. CONCLUSIONS: Our study supports previous data demonstrating that NIMV improves clinical and physiologic parameters in advanced stable COPD and suggest that the underlying mechanism is a reduction in the inspiratory load. A randomized clinical trial is needed to confirm that this mechanism is operative.

Aged↗
PubMed1998

[MALT lymphoma of the bladder: report of a case].

Primary malignant lymphomas of the bladder are infrequent. We report a 70 year old woman presenting with hematuria, dysuria, malaise and a 5 kg weight loss. Pelvic ultrasound examination showed a 8 x 8 x 8 cm solid and cystic mass adjacent to the bladder and uterus. Cystoscopic biopsy disclosed a low grade B cell non Hodgkin lymphoma. She was treated with 6 cycles of chemotherapy with disappearance of the mass. Two years after admission, the patient is free of disease.

Aged↗
PubMed1998

[Pharyngeal tuberculosis: a clinical case].

A case of pharyngeal tuberculosis secondary to pulmonary tuberculosis is reported. The importance of biopsy for the histopathological and microbiological diagnosis is emphasized.

Humans↗
PubMed1996

[Tropisetron for the prevention of nausea and vomiting during chemotherapy: multicenter clinical study].

The antiemetic effect of tropisetron was studied in 97 cancer patients (67 men, 30 women) receiving cisplatin in doses of 75 mg/m2 or higher. On 279 chemotherapy cycles studied (max 6 per patient) 5 mg of tropisetron was administered once a day i.v on day 1 and p.o. on days 2 to 6. Efficacy preventing vomiting and nausea was measured in 24 hour period as: complete control O episodes, major control 1 to 2 episodes, minor control 3 to 4 episodes and no control 5 or more episodes. Satisfactory vomiting control (complete and major) was 69%, 63%, 82%, 88%, 96% and 96% in days 1 to 6 of cycle 1. Satisfactory nausea control (complete and major) for the same days was 70%, 66%, 72%, 85%, 92% and 97%. Similar data was obtained for the subsequent cycles. Complete vomiting control was obtained in 47%, 35%, 56%, 72%, 81% and 84% and for nausea in 42%, 39%, 48%, 64%, 81% and 87%. 19 patients presented adverse effects (19.6%). Only 2 headache episodes had a definite relation with the antiemetic drug. 12 patients discontinued the medication; 6 due to drug inefficacy, 2 to illness unrelated to the drug, 1 to lack of collaboration, and 3 due to other reasons. We conclude that tropisetron allows satisfactory control of acute and delayed vomiting in a high percentage of patients treated with high doses of cisplatin. The drug does not have significant secondary effects. Tropisetron administration in only one daily dose implies an evident advantage and a treatment cost reduction.

Adolescent↗