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Biomedical subjects

J M Prieto

Publications and source records attributed to J M Prieto.

48 records · Page 3Linked to original sources
PubMedDate not supplied

[Pentoxifylline: is it useful in multiple sclerosis?].

INTRODUCTION: Pentoxifylline (PTX) is a phosphodiesterase inhibitor which has been found in studies in vitro to inhibit the production of Th-1 cytokines. It has been postulated that it might be used as a possible coadjuvant treatment for interferon in patients with multiple sclerosis. This would also reduce the potential side effects of interferon. OBJECTIVE. To show the efficacy of PTX in reducing the side effects of interferon, and in the functional improvement of these patients. PATIENTS AND METHODS: We studied 18 patients with remitting-relapsing multiple sclerosis over a period of 18 months; nine patients were given PTX and interferon 800 mg/day simultaneously, and nine patients were treated with interferon alone. The clinical condition was evaluated every three months using the Expanded Disability Status Scale (EDSS) and the Neurological Score (NRS) scales. RESULTS: We found no statistical improvement in the clinical course of EDSS and NRS in either group of patients after treatment for 18 months. The patients treated with PTX have fewer secondary effects due to interferon (fever and myalgia) during the first three months, but these differences between the groups subsequently disappear. In two patients PTX caused transient gastralgias and nauseas. CONCLUSIONS: PTX may be useful as a coadjuvant drug with interferon during the first three months of treatment since some of the side effects of interferon may thus be reduced. However, there seems no justification for using PTX for a longer period since there is no functional improvement.

Adult↗
PubMedDate not supplied

[Spinal epidural abscess secondary to pharyngeal trauma due to food].

INTRODUCTION: In recent years the incidence of spinal epidural abscesses has increased. Early diagnosis is very important, since once neurological deficit has become established this is often permanent. The commonest aetiological agent is Staphylococcus. Pain and fever are often the only symptoms before acute neurological deterioration. CASE REPORT: A 76 year old hypersensitive, diabetic man presented complaining of pain and a sensation of warmth in both arms. He had no fever or other symptoms. Some three weeks before admission to hospital a fish bone had become stuck in his pharynx, causing a purulent lesion there. This was treated with antibiotics. Cervical MR showed a mass at the level of C4 C5, compatible with epidural abscess. Following drainage and antibiotic treatment he recovered, with no sequelas. Staphylococcus was isolated from the purulent fluid. CONCLUSIONS: The possibility of epidural infection must be remembered in patients with fever and nerve root pain. Early diagnosis and suitable treatment, combining both surgery and prolonged treatment with antibiotics, are essential to prevent permanent neurological damage.

Aged↗
PubMedDate not supplied

[Intercellular communication in the astrocyte culture as a measure of therapeutic efficacy in multiple sclerosis treated by interferon].

INTRODUCTION: Measurement of therapeutic efficacy in multiple sclerosis depends on the clinical and magnetic resonance findings on follow up. There are no biological markers. Measurement of interleukins and other markers of inflammation has not proved useful in the follow up of these patients. The response of astrocytes to mediators of inflammation gives rise to modification in their capacity for intercellular communication. OBJECTIVE: To find whether culture of astrocytes in serum from patients with multiple sclerosis at different clinical stages and on different treatments gives rise to modification in intercellular communication. PATIENTS AND METHODS: Astrocytes were cultured in serum from three patients with an untreated acute clinical episode of multiple sclerosis, and the results compared with those obtained after serum culture when the patients had been treated with interferon for a year. RESULTS. In astrocyte culture using serum from patients with an acute episode of multiple sclerosis, but not on treatment with interferon, there was a statistically significant reduction in intercellular communication as compared to astrocytes cultured with serum from these same patients treated with interferon for one year (*p< 0.05; **p< 0.01). CONCLUSION: Measurement of the modifications in intercellular communication on astrocyte culture may be used as a marker for inflammatory activity in the serum of patients with multiple sclerosis, and therefore as an index of therapeutic efficacy.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Interferon beta in multiple sclerosis].

INTRODUCTION AND METHOD: The mechanism of action of interferons We do not know in the multiple sclerosis but, although exist discrepancies in relation to their degree of effectiveness, fundamentally the dose to use and the administration route, the three available ones have proven to be effective in the reduction of the number of the bouts. We reviewed the more important clinical tests made with three interferons in the remitent recurrent (RR) forms, the isolated neurologic syndromes and the secondary progressive (SP) forms of the disease and reviewed the comparative studies between interferons. CONCLUSIONS: The three interferons are well tolerated although the intramuscular form produces less skin effects; in the RR forms the number of bouts are reduced in significant form. Only the study with 1a intramuscular was demonstrated effectiveness in the SP forms and with the subcutaneous IFN b 1b exists discrepancies between the European and the American studies. The early treatment with subcutaneous IFN b 1a slow down the evolution of the disease. Except in relation to the side effects, there are not evidence that the dose and the administration route are important in the effectiveness in the long term.

Antiviral Agents↗
PubMedDate not supplied

[Cerebral atrophy in multiple sclerosis patients treated periodically with boluses of methylprednisolone].

INTRODUCTION: In the last years advances in the treatment of the remittant and secondary progressive forms of the multiple sclerosis (MS) have taken place. In the primary progressive forms (PP) the side effects of potentially useful drugs prevent their use; in some studies an improvement of the evolution with the intravenous administration of periodic pulses of methylprednisolone (MP) has been observed. OBJECTIVE: To evaluate if periodic pulses of intravenous MP injected every 4-6 weeks increase the degree of cerebral atrophy of the patients with PP MS. PATIENTS AND METHODS: We studied 11 patients with PP MS treated during 33 months with periodic pulses of intravenous MP. The degree of cerebral atrophy was evaluated in axial cuts of 10 mm of studies of magnetic resonance with the indices of Evans, bicaudate, bifrontal, frontal spears and bithalamic. The statistical evaluation of the results was made applying the test of Wilcoxon-Mann-Whitney. RESULTS: There are not statistically significant differences in the degree of cerebral atrophy with any of the used indices. CONCLUSIONS: Periodic pulses of intravenous MP do not accelerate the cerebral atrophy in patients with progressive forms of multiple sclerosis.

Adult↗
PubMedDate not supplied

[Experience in the treatment of multiple sclerosis with interferon beta in Galicia].

OBJECTIVE: To analyze the experience in daily clinical practice of interferon-beta (IFN-beta) treatment in relapsing-remitting (RR) and secondary progressive (SP) multiple sclerosis (MS) in Galicia (Spain). PATIENTS AND METHODS: Patients with RR-MS and SP-MS treated with IFN-beta1a and 1b between 1995 and December/2000, analyzing demographic and clinical data. RESULTS: 313 patients were included, with a mean age of 38.2 years. A total of 296 patients (94.6%) were clinically defined MS and 17 (5.4%) were laboratory supported (Poser criteria); 84.6% of the patients were RR and 15.4% were SP. The mean duration of the disease prior to treatment was 7.06 years. Betaferon was used in 52.4% patients (115 RR-MS and 47 SP-MS), Avonex in 26% and Rebif in 21.6%. Relapse rate was reduced in 68.8% for the RR-MS for Betaferon-treated patients, 73.3% for Avonex treated and 35.7% for Rebif-treated patients. Betaferon reduced relapse rate in 50% for SP-MS. The global EDSS remained stable during IFN-beta treatment. During treatment, 33% of Betaferon, 60.5% of Avonex and 54.5% of Rebif-treated patients remained relapse-free. Treatment was suspended in 12.9% of Betaferon, 6.2% of Avonex, and 3% Rebif-treated patients. The most frequent causes of treatment suspension were increase in disability and in relapse count. CONCLUSIONS: The present study supports the benefits of IFN-beta treatment in RR MS and SP MS in daily clinical practice, with reduction in relapses count and incapacity, good over-all tolerance and low incidence of serious adverse side-effects.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Time evolution of TNF-alpha, VCAM-1, IL-4, IL-10, neopterin and CD-30 in patients treated with interferon].

INTRODUCTION: Interferon (IFN) diminishes the outbreaks of multiple sclerosis (MS) and slows down its progression. Follow-up of patients is performed using clinical and resonance imaging parameters, and no biological markers are available that allow us to determine its efficiency. AIMS: 1. To discover the effects of IFN on the serum levels of TNF-alpha, IL-4, IL-10, VCAM-1, neopterin and CD-30 in patients with MS; 2. To determine how these modifications evolve over time; 3. To find out the clinical value of its determination in isolation. PATIENTS AND METHODS: We studied 19 patients with MS who were clinically stable and undergoing IFN therapy. Samples were obtained every 3 months over a 2.5 year period and always immediately before injecting the drug. The ELISA method was used to determine interleukins. RESULTS: Serum levels of neopterin, CD-30 and VCAM-1 were not modified, TNF-alpha levels oscillated regardless of the clinical status of the patient and IL-4 and IL-10 had a significant serum peak at 9-12 months after beginning treatment. CONCLUSIONS: The existence of a significant IL-4 and IL-10 peak between 6 and 12 months of therapy indicates that IFN reaches its possible immunomodulatory effect after several months and, therefore, a poor initial clinical response must not be a reason for discontinuing medication. The specific determination of the serum levels of IL is not useful in following up patients treated with IFN.

Adult↗
PubMedDate not supplied

[Seasonal variations in the outbreaks in patients with multiple sclerosis].

INTRODUCTION: It has been suggested that there is an environmental factor at play in the aetiology and pathogenesis of multiple sclerosis (MS) that acts as an essential component of the disease process, and a number of studies also point to a relationship between the seasons of the year and the appearance of outbreaks. AIMS: Our aim was to study the possible relation between seasonal variations and the appearance of outbreaks in patients with relapsing-remitting forms of MS. PATIENTS AND METHODS: We studied 31 patients over the period between 1997 and 2002 and calculated the monthly and quarterly rate of incidence of outbreaks. The statistical evaluation of the results was performed by applying the Chi-squared test. RESULTS: We observed a higher incidence of outbreaks in the summer months (more in June) and a lower incidence in winter (less in December), with statistically significant differences. CONCLUSIONS: In our patients, outbreaks of MS are related to seasonal variations, with a higher number in the warmer months and fewer in the colder months.

Adult↗
PubMedDate not supplied

[Adding lamotrigine to the treatment of epilepsy which is difficult to control].

We studied the effect of adding Lamotrigine to the medication of 36 patients with refractory epilepsy (ten with Lennox-Gastaut syndrome and ten with partial epilepsy with or without secondary generalization), who were resistant to optimized treatment with other drugs and who suffered at least four attacks per month. Lamotrigine was administered progressively, the final dose varying between 25 and 400 mg per day, the average being 192.3 mg. Lamotrigine was suspended in four cases (11%) as a result of behavioural abnormalities; three further patients showed slight secondary effects; no exanthemata were observed. The average age of the 32 patients who continued with treatment was 36.25 years and the average duration of epilepsy was 22.41 years. Average follow-up time was 26.9 weeks. In the case of two patients (5.55%) the attacks disappeared during follow-up time; 25 patients (69.4%) experienced at least a 50% objective reduction in the number of attacks. In no case was treatment suspended for lack of effect. Two patients gave up other drugs and continued monotherapy using Lamotrigine. In nine of the ten Lennox-Gastaut syndrome patients the frequency of attacks went down by more than 50% and in seven such cases by more than 75%.

Adolescent↗