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Biomedical subjects

J L Merino

Publications and source records attributed to J L Merino.

At least 55 records · Page 3Linked to original sources
PubMed1996

Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators.

BACKGROUND: Some patients with an automatic implantable cardioverter-defibrillator (ICD) suffer multiple appropriate, consecutive, high-energy discharges (MCDs) during follow-up. Such events might represent resistant ventricular arrhythmias and might have prognostic significance. METHODS AND RESULTS: Eighty consecutive patients with an ICD were followed up for up to 82 months (mean, 21 +/- 19 months). Thirty-eight patients had survived an out-of-hospital cardiac arrest and 42 had recurrent ventricular tachycardia. During follow-up, 16 patients had MCD (group A), 26 patients had episodes of single appropriate discharges (group B), and 38 patients had no appropriate discharges (group C). Group A patients had worse functional status (P = .001), lower left ventricular ejection fractions (LVEFs) (P = .001), and lower survival rates (log rank, P = .003) than the remaining two groups of patients. Cox analysis showed LVEF (P = .001) to be an independent predictor of MCD. Independent predictors of death or heart transplant were MCD (P = .001), female sex (P = .001), age (P = .001), history of cardiac arrest (P = .003), and functional status (P = .003). The only independent predictor of total mortality was female sex (P = .002). Independent predictors of cardiac death were MCD (P = .007) and female sex (P = .018). Independent predictors of arrhythmic death were age (P = .001), female sex (P = .02), and MCD (P = .023). CONCLUSIONS: In patients with an ICD, the development of MCD is an independent predictor of cardiac and arrhythmic mortality. If this finding is confirmed in larger studies, it may help to identify patients in whom other therapeutic alternatives, ie, heart transplantation, should be considered during follow-up after ICD implantation.

Aged↗
PubMed1995

Evidence favoring the hypothesis that ventricular arrhythmias have prognostic significance in left ventricular hypertrophy secondary to systemic hypertension.

In the present review 6 lines of evidence will be discussed that suggest a prognostic significance for ventricular arrhythmias in patients with systemic hypertension and left ventricular hypertrophy: (1) in patients with systemic hypertension there is a statistical relation between asymptomatic ventricular arrhythmias and left ventricular hypertrophy; (2) in nonhypertensive left ventricular hypertrophy the prognostic value of ventricular arrhythmias is well known; (3) left ventricular hypertrophy is related to sudden death in patients with systemic hypertension; (4) it is generally acknowledged that ventricular arrhythmias are a frequent cause of sudden death; (5) there is experimental evidence to support the arrhythmic risk of left ventricular hypertrophy; and (6) it has been recently demonstrated that ventricular arrhythmias influence mortality in patients with left ventricular hypertrophy secondary to systemic hypertension. However, whether asymptomatic ventricular arrhythmias are specific markers for more severe sustained arrhythmias, or just markers for a more severe stage of the disease, remains to be determined.

Arrhythmias, Cardiac↗
PubMed1995

Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis.

Percutaneous balloon valvuloplasty has been used with good results to treat rheumatic mitral stenosis. However, its use in degenerative aortic stenosis has shown many limitations. There is little information about balloon valvuloplasty in tricuspid and aortic rheumatic stenosis. This article describes two patients with combined rheumatic mitral, aortic and tricuspid stenosis in which triple percutaneous valvuloplasty was performed in a single procedure.

Adult↗
PubMed1995

Unusual expression of Gaucher's disease: cardiovascular calcifications in three sibs homozygous for the D409H mutation.

Three sisters suffering from an unusual form of Gaucher's disease are described. These patients had cardiovascular abnormalities consisting of calcification of the ascending aorta and of the aortic and mitral valves. Neurological findings included ophthalmoplegia and saccadic eye movements in two patients, and tonic-clonic seizures in the third. The three patients died, two of them after having undergone aortic valve replacement. Tissue was obtained from one of the sibs and fibroblast and liver beta-glucocerebrosidase activity was reduced to 4% and 11% of mean normal values. Genotype analysis indicated that the patient was homozygous for the D409H mutation. It is tempting to relate the phenotype of severe cardiac involvement to the D409H/D409H genotype, although further cases will be needed before this association can be confirmed.

Adolescent↗
PubMed1995

[Radiofrequency ablation of a posteroseptal accessory pathway associated with coronary sinus diverticulum].

The case of a patient with a symptomatic Wolff-Parkinson-White syndrome undergoing attempted radiofrequency catheter ablation of a posteroseptal accessory pathway is described. Coronary sinus venography revealed the presence of a diverticulum attaching near the os. The electrogram recorded from a catheter placed in the narrow neck of the diverticulum revealed a short atrioventricular time during sinus rhythm. The pathway was easily ablated using radiofrequency energy applied in the neck of the diverticulum, after multiple failed attempts at catheter ablation from the endocardial surface of the posteroseptal space. Our report emphasizes the importance of searching for a coronary venous diverticulum in all patients with posterior accessory pathways undergoing catheter ablation.

Adult↗
PubMed1995

[Arteriovenous malformation of the superior mesenteric artery with secondary portal hypertension].

The case of a 60-year-old patient who was repeatedly admitted for ascitic decompensation secondary to hyperflow portal hypertension provoked by congenital arteriovenous malformation of the superior mesenteric artery is presented. Diagnosis was performed by arteriography. Surgical treatment was conducted with total resection of the malformation thereby achieving complete resolution and normalization of portal pressure. The literature is reviewed and the pathophysiologic mechanism as well as the clinical manifestations, diagnosis and treatment are discussed.

Angiography↗
PubMed1995

[The return to work after coronary revascularization].

INTRODUCTION: Work resumption after a therapeutical intervention has been considered as a sensitive indicator of its success. There are some reports analyzing working status after coronary artery revascularization in western countries. However, to our knowledge, similar studies have not been published in Spain. PATIENTS AND METHODS: We studied 210 patients after coronary artery revascularization surgery or percutaneous transluminal coronary angioplasty. Exclusion criteria were age of 65 or more years and female sex gender (n = 64). RESULTS: Working patient rate before and after coronary revascularization was respectively 63.2% and 28.9% for surgery, and 57.1% and 41.4% for percutaneous angioplasty (p = 0.11). None of the former inactive patients, with the exception of one in the surgery group, went back to work after the revascularization procedure. Asymptomatic patients after percutaneous angioplasty had a higher postprocedure working rate than symptomatic ones (58.1% vs 11.1%, p < 0.0001). Patients in the surgery group did not show this relation (30% vs 25%, p = 0.69). CONCLUSIONS: Surprisingly, coronary artery revascularization interventions, mainly coronary surgery, seems to behave in our environment as important determinants of working cessation.

Angioplasty, Balloon, Coronary↗
PubMed1993

Severe chronic autoimmune thrombocytopenic purpura is associated with an expansion of CD56+ CD3- natural killer cells subset.

Recent studies have indicated that autoimmune thrombocytopenic purpura (ATP) patients show immune system alterations that are not restricted to the B-cell compartment, but that also affect T lymphocytes. This report studies the phenotypic characteristics of natural killer (NK) cells in the peripheral blood of ATP patients, as well as their clinical significance in 33 ATP patients with active disease. Ten patients had stable disease (sustained platelet counts > 50,000/microL without the need for treatment), whereas 23 patients had therapy-dependent disease (platelet counts < 50,000/microL). A significant increase in both CD56+ CD3- NK cells and CD56+ CD3+ cytotoxic T lymphocytes was observed in peripheral blood mononuclear cells and in purified CD2+ cells from therapy-dependent ATP patients as compared with ATP patients with stable disease and healthy controls. Moreover, there were more major histocompatibility complex (MHC) class II molecules in the CD56+ CD3- cells from the therapy-dependent patients' peripheral blood preparations than there were in the stable ATP patients' and healthy controls' peripheral blood preparations. This growth in the number of CD56+ CD3- NK cells was statistically higher in patients whose disease was refractory to conventional therapy (corticosteroids and splenectomy). In addition to the CD56+ CD3- NK cells, the percentage of CD3+ T lymphocytes and their proliferative response to phytohemagglutinin (PHA) stimulation were studied in fresh CD2+ preparations from nine patients with stable disease, 22 patients with therapy-dependent disease, and 26 healthy controls. The proliferative response of CD2+ lymphocytes from both groups was similar and significantly defective with respect to that found in healthy controls. In conclusion, clinically severe ATP (therapy-dependent disease) is associated with a significant increase of CD56+ CD3- NK cells, which is particularly marked in patients whose disease is refractory to therapy.

Adolescent↗
PubMed1993

The clinical outcome of autoimmune thrombocytopenic purpura patients is related to their T cell immunodeficiency.

In this work we have furthered the understanding of the alterations of T lymphocytes from 29 patients with active autoimmune thrombocytopenic purpura (ATP) and the clinical significance of their lymphocytes. An increased percentage of in vivo activated (CD25+ and DR+) T lymphocytes was found in ATP patients with respect to that found in 22 healthy controls. The function of these T cells measured as the proliferative response to polyclonal mitogenic signals is heterogeneously impaired in ATP patients. T lymphocytes from 65.5% (19/29) of the ATP patients showed a decreased proliferative response to these mitogenic signals. This functional alteration is associated with a redistribution of the T cell compartment in these patients' peripheral blood since a significant decrease of CD4+ T lymphocytes was found. We have also found that the impairment of the T cell function is different in the diverse clinical situations of the disease. Those with stable, untreated disease showed a marked decrease in the T cell proliferative response to mitogens. Furthermore, those patients who did not respond either to steroids or to splenectomy showed significantly reduced T lymphocyte blastogenesis after phytohaemagglutinin (PHA) stimulation in comparison to that found in responding patients.

Adolescent↗
PubMed1992

Intrafamilial outbreak of Mediterranean spotted fever.

The existence of intrafamilial outbreaks of spotted-fever group rickettsioses has seldom been reported, and their true incidence is not known. We here report the occurrence of Mediterranean spotted fever (MSF) in three members of a family: a boy, his grandmother and his grandfather. The infection resolved uneventfully in the boy, and followed a more protracted course in the two older patients, who suffered complications including drowsiness, clotting defects and acute renal failure. This finding highlights the importance of conditioning factors such as age and associated illnesses in the prognosis of infection due to Rickettsia conorii, and suggests that strict surveillance of individuals at risk of infection is necessary for prompt recognition of the onset of the illness and initiation of antibiotic treatment without delay.

Aged↗
PubMed1991

[Pseudothrombocytopenia: incidence, causes and methods of detection].

A prospective study of 20,761 routine clinical blood specimens was conducted in order to evaluate incidence and causes of pseudothrombocytopenia. All specimens were drawn in outpatient regimen and were analyzed by using the Coulter STKR autoanalyzer. The incidence of pseudothrombocytopenia was 0.15%, values clearly lower than others previously reported in hospitalized patients (1.9%). Of these patients, 72% had EDTA-induced platelet clumping sometimes associated to sodium citrate and 28% had spurious low platelet counts due to large platelets. No other causes of pseudothrombocytopenia were appreciated. It is important to remark that 49% of low platelet counts detected by the Coulter STKR have been due to pseudothrombocytopenia, and this instrument showed normal platelet and leukocyte histogram in 10% of these cases. Although time consuming these results confirm the necessity of preparation and examination of all blood smears presenting thrombocytopenia by automated cell-counting despite normal histograms. This approach would avoid erroneous diagnosis and dangerous medical or surgical therapy. A correlation of pseudothrombocytopenia with age, sex or clinical diagnosis were not found.

Adolescent↗