Steroids withdrawal after 3 months of successful renal transplantation using a tacrolimus- and mycophenolate-based immunosuppression.
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Adolescent↗
Biomedical subjects
J Marco
Publications and source records attributed to J Marco.
Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue.
BACKGROUND AND STUDY AIMS: Postoperative fistulae occur frequently in standard surgical practice, but there is no general agreement on how to treat them. We summarize here our experience with endoscopic treatment. PATIENTS AND METHODS: Postoperative digestive fistulae resistant to conservative treatment, in 15 patients, are retrospectively reviewed. Our series included two internal fistulas: (one rectovesical, and one high-output pleuroesophagic), and 13 external fistulas (one low-output gastrocutaneous, two low-output esophagocutaneous, seven low-output enterocutaneous, and three high-output enterocutaneous). After failure of conservative treatment, the fistulas were endoscopically located and 2 - 4 ml of reconstituted fibrin glue, Tissucol 2.0 at 37 degrees C, was injected through a catheter. RESULTS: The mean age of the patients was 61.2 years (38 - 86), and 60 % were men. Of the fistulas, 26.6 % were of the high-output type. The mean healing time was 16 days (5 - 40), and a mean of 2.5 sessions per patient were required (1 - 5). Complete sealing of fistulas was achieved in 86.6 % of cases; (87.5 % of the low-output and internal fistulas, and 55 % of the high-output fistulas). After follow-up ranging between 2 months and more than 3 years, only one of the sealed fistulas reopened. No complications were encountered. Overall mortality was 13.3 % (two out of 15), but in only one patient was this related to clinical deterioration because of the persistence of the fistula. CONCLUSIONS: We think that conservative treatment should not be prolonged beyond 14 days and that endoscopic treatment should be performed at that stage. Endoscopic sealing treatment achieves a very high success rate, without complications and at a lower cost. It could probably reduce the hospital stay, and avoid some unnecessary surgical interventions. Appropriate multicenter randomized trials are needed to confirm these results.
Adult↗
Inhibitory effect of ghrelin on insulin and pancreatic somatostatin secretion.
OBJECTIVE: Ghrelin is a 28 amino acid residue peptide identified in both human and rat stomach and which acts as an endogenous ligand for the GH secretagogue receptor (GHS-R) and stimulates GH release. GHS-Rs are expressed in a number of tissues, including the pancreas, and ghrelin-like immunoreactivity is present in peripheral plasma, where its levels increase during fasting and decrease after food intake. The relationship between nutritional status and circulating ghrelin concentrations prompted us to investigate the effect of this peptide on pancreatic hormone secretion. METHODS: The study was performed in the isolated rat pancreas perfused in situ. Insulin, glucagon and somatostatin were measured by radioimmunoassay. RESULTS: Addition of 10 nM ghrelin to the perfusate significantly reduced the insulin response to the secretagogues glucose, arginine and carbachol, which act on the B-cell via different mechanisms, as well as the somatostatin response to arginine. Ghrelin was without effect on the glucagon output induced by this amino acid. At a lower concentration (2 nM) ghrelin was also found to inhibit glucose-induced insulin release. CONCLUSION: These findings support the proposal that the inhibitory effect of ghrelin on insulin release constitutes a tonic regulation of the B-cell, contributing to restrain its secretory activity in the state of food deprivation. On the other hand, the inhibition of pancreatic somatostatin release by ghrelin suggests a blocking effect of this hormone on the widely distributed D-cell population.
Animals↗
[Acute respiratory insufficiency as onset form of Lambert-Eaton's syndrome associated with pulmonary small cell carcinoma].
The Lambert-Eaton myasthenic syndrome is a rare disorder of neuromuscular transmission, usually presenting as a paraneoplastic process associated with a small cell lung cancer. Recently, respiratory muscular impairment has been described in these patients. Acute respiratory failure as a presenting symptom has been reported in few cases. We present a case of acute ventilatory failure as the first manifestation of Lambert-Eaton myasthenic syndrome associated with small cell lung cancer and discuss the main features of this disease, including its treatment. The Lambert-Eaton myasthenic syndrome should be considered in cases of unexplained acute respiratory failure and clinical evidence of neoplasic disease. We thought that electromyographic studies could reveal the real involvement of respiratory muscles, including diaphragm, in this condition.
Acute Disease↗
Long-term (> or =8 years) outcome after Palmaz-Schatz stent implantation.
The purpose of this single-center study was to evaluate the long-term (> or =8 years) outcome of Palmaz-Schatz intracoronary stenting and to identify independent predictors of outcome. Although short-term results of Palmaz-Schatz intracoronary stenting have been promising, with a reduction in both angiographic restenosis and clinical cardiac events up to 3 years, longer-term follow-up has not been established. We analyzed clinical outcome in 426 consecutive patients at least 8 years after coronary stenting. Demographic, clinical, and procedural predictors of restenosis, survival, and event-free survival, defined as freedom from death, myocardial infarction (MI), and coronary revascularization (target stented site, target vessel, and any revascularization) were analyzed. Before discharge, 28 patients (6.6%) sustained at least 1 major cardiovascular event: 3 deaths (0.7%), 18 MIs (4.2%), and 17 repeat revascularizations. Surviving patients were followed for 8.9 years (interquartile range 8.4 to 9.4). After discharge, 59 patients (13.9%) died, 47 (11.1%) sustained an MI, and 188 (44.4%) underwent coronary revascularization. The 8-year event-free survival (freedom from death, freedom from death/MI/target-stented site revascularization, and freedom from death/MI/any coronary revascularization) was (mean +/- SE) 0.86 +/- 0.01, 0.62 +/- 0.03, and 0.47 +/- 0.02, respectively. Unstable angina, lower left ventricular ejection fraction, and saphenous vein graft stenting were found to be independent predictors of death during follow-up. Hypertension, unstable angina, multivessel disease, and multiple stent implantation were found to be independent predictors of the composite of death/MI/any coronary revascularization during follow-up. This study provided a useful assessment of very long-term outcome in survival, event-free survival, and predictors of major cardiac events 8 to 10 years after Palmaz-Schatz stent implantation.
Coronary Angiography↗
Unprotected left main coronary artery stenting: correlates of midterm survival and impact of patient selection.
BACKGROUND: The study served to present the in-hospital and six-month clinical outcome and also the long-term survival data of a consecutive series of patients undergoing stenting for unprotected left main coronary artery (LMCA) disease. METHODS: Revascularization with coronary bypass surgery has been generally recommended for treatment of left main coronary stenosis. Improvements in angioplasty and coronary stent techniques and equipment may result in the wider applicability of a percutaneous approach. A total of 92 consecutive patients underwent unprotected LMCA stenting between March 1994 and December 1998. For the initial 39 patients (group I) angioplasty was performed only when surgical revascularization was contraindicated. The remaining 53 patients (group II) also included patients in whom surgery was feasible. Patients were followed for 7.3 +/- 5.8 months (median 239 days; range 49 to 1,477 days). RESULTS: Compared to group I, group II patients had higher left ventricular ejection fraction (60 +/- 12% vs. 51 +/- 16%, p < 0.01), less severe LMCA stenosis (68 +/- 12% vs. 80 +/- 10%, p < 0.001), lower surgical risk score (13 +/- 7 vs. 20 +/- 7, p < 0.001), and had angioplasty more often performed via the radial approach (88% vs. 23%, p < 0.001) with smaller guiding catheters (6F: 49% vs. 15%; 8F: 2% vs. 77%, p < 0.001). The procedural success rate was 100%. In-hospital mortality was 4% (4 deaths, 3 cardiac). During follow-up there were six deaths, 13 patients required repeat percutaneous transluminal coronary angioplasty (4 LMCA), and two required coronary artery bypass graft surgery. Estimated survival (+/- SEE) was 89 +/- 6.3% at 500 days and 85 +/- 12% at 1,000 days post-stenting. Overall mortality was 3.8% in group II and 20.5% in group I (p < 0.02). CONCLUSIONS: Coronary stenting can be performed safely in high-risk individuals with acceptable intermediate-term outcome. It may be feasible to broaden the application of this technique in selected patients needing revascularization for left main coronary disease.
Aged↗
Identification of two subgroups of mantle cell leukemia with distinct clinical and biological features.
INTRODUCTION: Mantle cell leukemia (MCLeu) has been considered as a leukemic form of mantle cell lymphoma (MCL). However, the presence of certain features rarely observed in MCL, such as transformation to prolymphocytic leukemia (PLL) or indolent clinical course, suggests that MCLeu may represent a distinct disorder. METHODS: Seven cases of MCLeu with t(11;14)(q13;q32) and BCL1-IGH gene rearrangement were ascertained among 140 newly diagnosed chronic B-cell lymphoproliferative disorders with leukemic expression. Comparative genomic hybridization, FISH for specific gene loci, and immunological studies were preformed in them. RESULTS: In comparison with CLL, MCLeu cases had low immunological scores < or =2 with respect to B-CLL (P<0.0001). Expression of CD38 was absent in 43% of MCLeu and in 44% of B-CLL. Comparative genomic hybridization analysis identified genomic imbalances in 86% of MCLeu with a similar pattern than in MCL: gains of 3q, 8q involving MYC gene and 15q, and losses of 6q, 9p, 13q and 17p affecting P53 gene. Differently from MCL and CLL, genomic loss of 8p was frequently detected in MCLeu (83%). Although clinical presentation of MCLeu was indistinguishable from CLL, all patients but one had disease progression within three years. According to the immunologic and genomic profiles, two distinct subgroups of MCLeu were defined: one related to PLL, showing CD38-, deletion of P53, and MYC amplification and another which corresponds to a leukemic form of classical MCL, presenting with CD38+ and normal P53 and MYC status. CONCLUSION: MCLeu and MCL are closely related disorders, as they show similar genomic and molecular patterns. However, the deletion of the short arm of chromosome 8 may represent a specific marker for MCLeu. Two distinct subgroups of MCLeu may also be distinguished according to the immunologic and genomic cell profiles.
ADP-ribosyl Cyclase↗
Effect of leptin on insulin, glugacon and somatostatin secretion in the perfused rat pancreas.
We have investigated the effect of rat leptin as well as the 22-56 fragment of this molecule on pancreatic hormone secretion in the perfused rat pancreas. In pancreases from fed rats, leptin failed to alter the insulin secretion elicited by glucose, arginine or tolbutamide, but inhibited the insulin response to both CCK-8 and carbachol, secretagogues known to act on the B-cell by increasing phospholipid turnover. This insulinostatic effect was also observed with the 22-56 leptin fragment. In pancreases obtained from 24-hour fasted rats, no effect of leptin on carbachol-induced insulin output was found, perhaps as a consequence of depressed B-cell phospholipid metabolism. Leptin did not influence glucagon or somatostatin release. Our results do not support the concept of leptin as a major regulator of B-cell function. Leptin inhibition of carbachol-induced insulin output might reflect a restraining effect of this peptide on the cholinergic stimulation of insulin release.
Animals↗
Inhibition of insulin release by urotensin II--a study on the perfused rat pancreas.
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Animals↗
Molecular typing by pulsed-field gel electrophoresis of Spanish animal and human Listeria monocytogenes isolates.
A total of 153 strains of Listeria monocytogenes isolated from different sources (72 from sheep, 12 from cattle, 18 from feedstuffs, and 51 from humans) in Spain from 1989 to 2000 were characterized by pulsed-field gel electrophoresis. The strains of L. monocytogenes displayed 55 pulsotypes. The 84 animal, 51 human, and 18 feedstuff strains displayed 31, 29, and 7 different pulsotypes, respectively, indicating a great genetic diversity among the Spanish L. monocytogenes isolates studied. L. monocytogenes isolates from clinical samples and feedstuffs consumed by the diseased animals were analyzed in 21 flocks. In most cases, clinical strains from different animals of the same flock had identical pulsotypes, confirming the existence of a listeriosis outbreak. L. monocytogenes strains with pulsotypes identical to those of clinical strains were isolated from silage, potatoes, and maize stalks. This is the first study wherein potatoes and maize stalks are epidemiologically linked with clinical listeriosis.
Animal Feed↗
Selective amylin inhibition of the glucagon response to arginine is extrinsic to the pancreas.
Amylin, a peptide hormone from pancreatic beta-cells, is reported to inhibit insulin secretion in vitro and in vivo and to inhibit nutrient-stimulated glucagon secretion in vivo. However, it has been reported not to affect arginine-stimulated glucagon secretion in vitro. To resolve if the latter resulted from inactive peptide (a problem in the early literature), those experiments were repeated here with well-characterized peptide and found to be valid. In isolated perfused rat pancreas preparations, coperfusion with 1 nM amylin had no effect on arginine-, carbachol-, or vasoactive intestinal peptide-stimulated glucagon secretion. Amylin also had no effect on glucagon output stimulated by decreasing glucose concentration from 11 to 3.2 mM or on glucagon suppression caused by increasing glucose from 3.2 to 7 mM. Amylin at 100 nM had no effect in isolated islets in which glucagon secretion was stimulated by exposure to 10 mM arginine, even though glucagon secretion in the same preparation was inhibited by somatostatin. In anesthetized rats, amylin coinfusion had no effect on glucagon secretion stimulated by insulin-induced hypoglycemia. To reconcile reports of glucagon inhibition with the absence of effect in the experiments just described, anesthetized rats coinfused with rat amylin or with saline were exposed sequentially to intravenous L-arginine (during a euglycemic clamp) and then to hypoglycemia. Amylin inhibited arginine-induced, but not hypoglycemia-induced, glucagon secretion in the same animal. In conclusion, we newly identify a selective glucagonostatic effect of amylin that appears to be extrinsic to the isolated pancreas and may be centrally mediated.
Amyloid↗
Acute psychosis after CPAP treatment in a schizophrenic patient with sleep apnoea-hypopnoea syndrome.
A 52-yr-old man with a residual phase of schizophrenia developed sleep apnoea-hypopnoea syndrome (SAHS). After five days of continuous positive airway pressure (CPAP) treatment, the patient developed an aggressive mood with incoherence, prominent hallucinations and agitation, and attempted to hit his relatives. He was finally admitted to the hospital with an acute psychotic episode. Withdrawal of CPAP, and neuroleptic treatment controlled the episode, and clinical symptoms of SAHS reappeared 10 days later. Schizophrenia associated to sleep apnoea-hypopnoea syndrome has rarely been reported, but, to the authors' knowledge, the induction of a psychotic episode by continuous positive airway pressure treatment in a patient with sleep apnoea-hypopnoea syndrome and coexisting schizophrenia has never been previously reported.
Acute Disease↗
[The importance of hydrostatic valves in the treatment of adult chronic hydrocephalus].
BACKGROUND AND OBJECTIVE: Earlier designs of hydrocephalus valves, focusing on a reduction of the problem of overdrainage, were proved to be insufficiently. Since the middle of the 90's hydrostatic valve, constructions are available, which should solve this problem. The objective of the study was to evaluate, whether these gravitational shunts would indeed reduce the percentage of overdrainage in shunted patients. METHODS: In 51 patients clinical evaluation and MRI was performed pre- and in regular intervals postoperatively. 21 received a Dual-Switch valve, 14 a programmable Codman Hakim plus Shuntassistent and 6 a combination of a conventional valve with Shuntassistent. RESULTS: Over 90% of the patients had clear and persisting (over 24 months) clinical benefit from shunting. Only one suffered for some days after shunt implantation from headache in the upright position. No other clinical or imaging hints were given on an overdrainage. The ventricular size was unchanged in patients with a normal pressure hydrocephalus after shunting. In patients with occlusive hydrocephalus only a few showed a significant reduction of the ventricular wide. CONCLUSION: Gravitational shunts seem to decrease the overdrainage linked to the treatment of chronic hydrocephalus in shunted patients, therefore its use should be standardised when treatment chronic hydrocephalus.
Adult↗
[Guidelines for basic and advanced cardiopulmonary resuscitation of children. Commission for Cardiopulmonary Resuscitation of the Spanish Society for Anesthesiology and Resuscitation].
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Age Factors↗
[Fever of unknown origin in HIV positive patients].
OBJECTIVES: To describe the clinical presentation of FUO in patients infected with HIV and to asses the diagnostic usefulness in this population of several test usually recommended in the study of FUO. PATIENTS AND METHODS: We studied the clinical charts of all patients with HIV that required admission to our Hospital during a 23-month period. FUO was defined according to Petersdorf's modified criteria. Fifty-four patients fulfilled study criteria during the entry period. RESULTS: A cause of fever was identified for 48 patients (89%). Tuberculosis, disseminated atypical mycobacteriosis and Leishmaniasis can explain 68% of them. Examination of bone marrow aspirates, lymph node aspirates and biopsy, and culture of clinical specimens for mycobacteria were the procedures with the highest diagnostic yield. CONCLUSIONS: Mycobacterial infection should be considered as a first-line diagnosis in HIV-patients with FUO. It is possible to predict the diagnosis of tuberculosis infection with a high level of confidence (90.5%) through a logistic regression model based on easily obtainable parameters.
AIDS-Related Opportunistic Infections↗
Effects of sodium tungstate on insulin and glucagon secretion in the perfused rat pancreas.
Both the direct effect of sodium tungstate on insulin and glucagon secretion in the perfused rat pancreas, and the insulin response to glucose and arginine in pancreases isolated from tungstate-pretreated rats were studied. Infusion of tungstate stimulated insulin output in a dose-dependent manner. The insulinotropic effect of tungstate was observed at normal (5.5 mM), and moderately high (9 mM) glucose concentrations, but not at a low glucose concentration (3.2 mM). Tungstate-induced insulin output was blocked by diazoxide, somatostatin, and amylin, suggesting several targets for tungstate at the B-cell secretory machinery. Glucagon release was not modified by tungstate. Pancreases from chronically tungstate-treated rats showed an enhanced response to glucose but not to arginine. Our results indicate that the reported reduction of glycemia caused by tungstate administration is, at least in part, due to its direct insulinotropic activity. Furthermore, chronic tungstate treatment may prime the B-cell, leading to over-response to a glucose stimulus.
Amyloid↗
Effect of aspirin and ticlopidine on plasma tissue factor levels in stable and unstable angina pectoris.
Patients with unstable angina have an increased activation of the coagulation system. Aspirin and ticlopidine given in combination may potentiate each other by the combination of different action mechanisms and may reduce the risk of coronary occlusion and clinical instability. Plasma tissue factor (TF) levels collected into the stenotic coronary artery may be an index of TF expression within the vasculature. In 160 patients undergoing angioplasty for a 81+/-5% coronary lesion, we measured TF in blood samples collected from a vein and from the coronary ostium. Immediately after and 10 minutes after the dilation procedures the samples were withdrawn also beyond the lesion. Heparin 150 U/kg was given as an anticoagulant. All patients were pretreated with 250 mg/day of aspirin. One hundred twenty patients were randomly assigned to receive 24, 48, or 72 hours of ticlopidine treatment (250 mg/twice daily). TF levels did not increase during angioplasty but there was a significantly higher TF expression in unstable than in stable patients, irrespective of the invasiveness of debulking procedures. When ticlopidine was given for 72 hours, TF levels were similar to normal laboratory values both in stable and unstable patients. This combined antiplatelet pretreatment may be of benefit in unstable angina patients, with a favorable cost/benefit ratio.
Angina Pectoris↗
Nine-year follow-up of balloon-expandable Palmaz-Schatz stent in patients with single-vessel disease.
The long-term effects of intracoronary stents in human are unknown. This is the first 9-year follow-up report of single-vessel-disease patients treated with the Palmaz-Schatz stent. Between March and December 1989, out of the 107 patients undergoing Palmaz-Schatz stent implantation, 71 (66%) had single-vessel disease. The average age of these patients was 58+/-9 years and 79% were men. At 9 years, follow-up was obtained for 90.1% and major adverse clinical events consisted of 4 deaths giving a global survival rate of 95.8%, 7 myocardial infarction, 3 bypass surgeries, and 16 repeat percutaneous revascularization procedures. The 9-year event-free survival rate was 60%, and 81.7% of the patients were free from death, myocardial infarction, and bypass surgery. Multivariate analysis showed that the only predictive factor of major adverse clinical events was the presence of diabetes mellitus (P<0.004). Cathet. Cardiovasc. Intervent. 50:170-174, 2000.
Adult↗