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Biomedical subjects

M Miravitlles

Publications and source records attributed to M Miravitlles.

88 records · Page 5Linked to original sources
PubMed1995

[The use of human gamma globulin in the treatment of common variable immunodeficiency].

BACKGROUND: The indication for treatment with human gammaglobulin in patients with primary hypogammaglobulinemia is well established. Nonetheless, there are no uniform criteria with regard to dose, periodicity and route of administration. METHODS: Twenty-seven patients with common variable immunodeficiency (CVI) who received i.m. or i.v. treatment with gammaglobulin were studied, evaluating the secondary effects, stable levels of IgG achieved, control of symptomatology, clinical evolution and the need for adjuvant therapies. RESULTS: Intravenous administration was more effective than intramuscular administration to achieve higher total IgG serum levels (5.2 +/- 1.2 vs 3.5 +/- 1.6 g/l; p = 0.07) in a shorter period of time (2.1 +/- 1.6 months vs 6.3 +/- 2.8 months; p < 0.01) and with new few secondary effects. The dose and periodicity of the treatment was individualized in each patient on the basis of the needs of consumption and the speed of metabolism of the gammaglobulin, with patients with chronic bronchial suppuration and diarrhea being those requiring the greatest doses (p < 0.0001) and a short interdosis time interval (19.2 +/- 3.1 vs 23.6 +/- 3.6 days; p = 0.01). Treatment with human gammaglobulin allowed the control of recurrent bacterial infection; however, adjuvant treatment with respiratory physical measures and antibiotics were required in patients with chronic bronchial suppuration to avoid progressive alteration of respiratory function. CONCLUSIONS: The administration of human gammaglobulin at adequate doses and frequency is effective to control infection, avoid the development of chronic bronchial disease, alteration of pulmonary function and the appearance of other complications. Intravenous route is safer and produces fewer secondary effects than intramuscular administration with the doses and period of the treatment requiring individualization for each patient.

Adolescent↗
PubMed1994

[Evaluation of replacement therapy in emphysema caused by alpha 1-antitrypsin deficiency].

Assessment of alpha 1-antitrypsin replacement therapy (AAT) for emphysema. Patient characteristics were analyzed along with the possible side effects of the treatment and its efficacy in maintaining appropriate AAT blood levels. Lung function changes were also studied. The treatment protocol began with 4 weekly intravenous doses of 60 mg/kg AAT (Prolastin) and continued with monthly doses of 240 mg/kg. AAT serum levels were measured before each dose. Every 6 months pulmonary function tests (spirometry, plethysmography and CO transfer) were performed. Thirteen patients (mean age 46 yr) have been studied since 1988. Mean initial FEV1 was 0.79 l. Over 250 doses have been infused with no significant side effects reported. AAT levels before treatment in 3 patients were lower than that considered protective (50 mg/dl). Function tests results indicated stabilization of spirometric values in most cases. Diagnosis of AAT deficiency is delayed considerably, meaning that significant functional deterioration takes place before replacement therapy begins. No side effects of treatment have been observed. Until an appropriate interval between doses has been established, each patient's AAT levels must be monitored.

Adult↗
PubMed1994

Scintigraphy, angiography and computed tomography in unilateral hyperlucent lung due to obliterative bronchiolitis.

This study examines the value of different imaging methods in assessing the anatomic structures of unilateral hyperlucent lung due to obliterative bronchiolitis. We studied 9 patients, 5 males and 4 females, suffering from UHL (mean age 49 years). Ventilation-perfusion scan (VPS) and computed tomography (CT) of the chest were performed in all, and conventional angiography or digital substraction angiography (DSA) in 7 patients. The VPS showed the characteristic pattern of a matched ventilation-perfusion defect and considerable air trapping during the washout phase. Conventional angiography and DSA displayed a smaller pulmonary artery on the affected side, with a poor peripheral vasculature. CT displayed a loss of lung volume in all cases, with diminished mean attenuation values, a markedly diminished vasculature and integrity of the main airways. In contrast to other imaging modalities, CT imaged bronchiectasis, which was the cause of the patients' clinical symptoms of bronchorrhea and hemoptysis. We conclude that CT of the chest is the most valuable imaging method for evaluating unilateral hyperlucent lung, particularly in symptomatic patients.

Adult↗
PubMed1993

Diagnostic value of bronchoalveolar lavage in peripheral lung cancer.

A prospective study has been performed to assess the value of the addition of bronchoalveolar lavage (BAL) to the routine bronchoscopic exploration with bronchial washing (BW) and postbronchoscopy sputum (PBS) procedures in the diagnosis of peripheral primary lung cancer not visible through bronchoscope when fluoroscopic guidance is not available. BW, BAL, and PBS were performed in 67 patients with suspected primary lung cancer by peripheral lung lesion on chest radiograph (39 nodules and 28 infiltrates) and nonendoscopically visible lesion. The sequence of procedures was in all cases BW, BAL, and post-bronchoalveolar lavage bronchoaspirate (PBBA). An attempt was made to collect early morning postbronchoscopy samples of sputum (PBS) on 3 consecutive days. BW and PBBA were collected in the same test tube, and the cytologic result was considered as BW diagnostic yield. If there were negative bronchoscopic results, either percutaneous fine-needle aspiration or open-lung biopsy were performed for diagnosis. Fifty-five patients were found to have malignant disease (23 adenocarcinomas, 22 squamous cell carcinomas, six small cell carcinomas, and four bronchioloalveolar cell carcinomas). BAL was positive in 18 of the 55 (33%) carcinomas, and it gave the only positive result in six (11%). BW was also positive in 18 of the 55 (33%), but it gave positive results in only 3 (5%). PBS was positive in 13 of the 43 (30%) patients from whom samples could be spontaneously obtained and were suitable for cytologic examination (not consisting of saliva), and gave the only positive result in three (7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Replacement therapy of emphysema caused by alpha 1-antitrypsin deficiency].

The most common feature of alpha1-antitrypsin (alpha 1 AT) deficiency is pulmonary emphysema, which becomes manifest in the third to fifth life decades in most subjects with PiZZ phenotype. In recent years, replacement therapy with alpha 1 AT from the plasma of blood donors has been developed. We report the protocol of treatment which has begun to be used in our center, now including two patients. We discuss inclusion criteria, the treatment schedules, the adverse side-effects and the future outlook for this type of therapy.

Aged↗
PubMed1990

[Familial microepidemics of tuberculosis].

We report a microepidemic of tuberculosis (TBC) in a family of 12 members, 4 of which were parenteral drug abusers and 3 had anti-human immunodeficiency virus (HIV) antibodies. Four new cases were simultaneously diagnosed in the investigation of the contacts of a patient with extrapulmonary tuberculosis and acquired immunodeficiency syndrome. We review the requirements for the development of these epidemic outbreaks, both in noninfected communities and in the family contacts, where positive anti-HIV antibodies may increase the risk. We emphasize the importance of a systematic study of contacts in these families and the indication of chemoprophylaxis in all those sharing the same household, without age limit.

Acquired Immunodeficiency Syndrome↗