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Biomedical subjects

M Monreal

Publications and source records attributed to M Monreal.

At least 19 recordsLinked to original sources
PubMed2001

Thrombotic complications of central venous catheters in cancer patients.

Today many patients with cancer have indwelling long-term central venous catheters. Benefits from catheter use include increased ease of administration of either chemotherapy or other drugs. However, these patients are prone to a number of complications, including deep venous thrombosis (DVT) and infection. Two kinds of catheter-related thrombi may develop: sleeve thrombi developing on the outside of intravenous catheters and occlusive DVT. Recent studies have demonstrated that the prevalence of pulmonary embolism in patients with arm DVT is high, and it is close to that observed in cohorts of patients with lower-extremity DVT. Accordingly, some kind of prophylaxis seems to be warranted. Furthermore, patients with confirmed catheter-related DVT should receive long-term anticoagulant therapy.

Arm↗
PubMed2001

Prospective study on the usefulness of lung scan in patients with deep vein thrombosis of the lower limbs.

BACKGROUND: Asymptomatic pulmonary embolism (PE) is a common finding in patients with deep venous thrombosis (DVT) of the lower limbs, but the usefulness of seeking for silent PE in patients with acute DVT has not been evaluated. PATIENTS AND METHODS: This was a prospective study involving consecutive patients with acute symptomatic proximal DVT (confirmed by objective methods) and no clinical suspicion of PE. All patients underwent chest X-ray, ventilation-perfusion lung scan and arterial blood gases on admission, and received anticoagulant therapy. Those with scintigraphic evidence of PE underwent repeated lung scan and blood gases 7 days later. The aim of the study was to assess how many patients with silent PE develop symptoms while on heparin therapy, and in how many of them such symptoms are due to recurrent PE. RESULTS: 946 consecutive patients with acute, proximal DVT had no contraindications to full-dose anticoagulant therapy. Baseline lung scan revealed high-probability defects (silent PE) in 200 (21%). Seven of these 200 patients had symptomatic recurrences during the 7-day study period, and an inferior vena cava filter was inserted. Besides, 6 patients developed PE symptoms, but no new perfusion defects were found on repeated scan. They switched to coumarin therapy, and they did not develop any further complications. CONCLUSIONS: Lung scan in patients with symptomatic DVT and no clinical suspicion of PE may be useful, since some patients with silent PE may develop symptoms while on heparin therapy. Without a baseline scintigraphy all these patients would have been considered to have recurrent PE, and vena cava interruption could have been performed.

Adult↗
PubMed2000

[Clinical analysis of unsuspected pulmonary thromboembolism at the emergency department].

OBJECTIVES: Evaluate the degree of suspicion of pulmonary embolism (PE) in the emergency department (ED). PATIENTS AND METHODS: We analyzed the cases of patients with TEP diagnosed during two years and compared group A (PE suspected) with group B (PE was not initially suspected). RESULTS: 57 cases of PE were admitted from ED. In 14 (25%) of them the PE was not suspected. There were statistically significant differences in the signs of deep venous thrombosis (more prevalent in group A), heart failure, and pleural effusion (more frequent in group B). The alternative diagnosis were mostly heart failure and pneumonia. CONCLUSIONS: The patients with unsuspected PE do not have a different clinical profile. The PE is most of the times confused with heart failure and pneumonia.

Emergencies↗
PubMed2000

Long-term treatment of venous thromboembolism with low-molecular-weight heparin.

Vitamin K antagonists are the most widely used form of long-term treatment of patients with venous thromboembolism (VTE). In certain patients, however, the desire to initiate oral anticoagulant therapy is tempered by concern about the risk of bleeding. In these cases, consideration should be given to alternative forms of treatment. Unfractionated heparin (UFH) may be an alternative, but it requires twice-daily subcutaneous administration, and the dosage must be adjusted after periodic blood tests. Therapy with low-molecular-weight heparin (LMWH) is the likely practical solution to this dilemma. Up to now, four small randomized trials have compared the efficacy and safety of LMWH therapy as an alternative to oral anticoagulants. When the results of the four studies are combined, a significant decrease is found in the bleeding rate in patients receiving LMWH. Two further studies by our group confirm this lower bleeding rate in patients on LMWH therapy. According to these data, we suggest that LMWH could be an alternative to oral anticoagulants in patients who cannot attend the laboratory for prothrombin time monitoring, as well as those who are at high risk for bleeding.

Anticoagulants↗
PubMed2000

Hypercoagulation and hypofibrinolysis in horses with colic and DIC.

Changes in haemostasis in horses with colic were assessed by using specific and sensitive markers of coagulation and fibrinolysis activity. Blood samples from 41 horses with severe colic and from 30 healthy control horses were tested. Diagnosis of DIC was based on the findings of at least 3 of 6 abnormalities: thrombocytopenia, prolonged clotting times (PT and APTT), increased polyclonal FDPs, decreased fibrinogen and decreased AT-III activity. Plasma thrombin-antithrombin III complexes (TAT), monoclonal fibrin degradation products fragment D (D-dimer) and monoclonal fibrinogen degradation products (FgDP) were also tested by using ELISA kits. DIC was diagnosed in 16 of 41 horses with colic. Compared to control and non-DIC colic values, TAT was significantly (P < 0.000) greater in horses with colic and DIC (Control group, mean +/- s.d. 2.6 +/- 2; non-DIC colic group, 7.5 +/- 9, and DIC colic group, 30.9 +/- 36 ng/ml). Also, D-dimer was significantly (P < 0.000) less in the DIC group when compared to control and non-DIC colic values (mean +/- s.d. 677 +/- 119, 682 +/- 220 and 399 +/- 234 ng/ml, respectively). Compared to non-DIC colic values, FgDP was significantly (P < 0.05) lower in the DIC group (363 +/- 111, 437 +/- 230 and 293 +/- 187 ng/ml respectively). Both PT and APTT showed a significant positive correlation with TAT. DIC was more common among nonsurvivors and horses with ischaemic bowel. We conclude that a hypercoagulative state was detected in horses with colic, which was stronger in horses with colic and DIC. Hypofibrinolysis was present only in horses with DIC. Therefore, marked hypercoagulation together with hypofibrinolysis are associated with DIC in horses.

Animals↗
PubMed1999

Influence of critical storage temperatures on degradative pathways of pigments in green beans (Phaseolus vulgaris cvs. Perona and boby).

In this work a study of critical storage temperatures on pigment degradation of green beans (Phaseolus vulgaris, cvs. Perona and Boby) was conducted. In this way, green beans kept better quality at 4 degrees C than either 8 or 12 degrees C, maintaining a bright green color and good texture. Nevertheless, temperatures of 4 degrees C induced chilling injury (CI) after eight days of storage, which became evident when the pods were transferred to 20 degrees C. Cold storage temperatures, 12, 8, and 4 degrees C, produced different changes on the green beans chlorophyll profile. Green beans of both cultivars, Perona and Boby, stored at 4 and 12 degrees C showed a continuous degradation of chlorophyll pigments during storage, while samples stored at 8 degrees C showed an increase of chlorophyll content at the first 15 days. Carotenoid pigments also suffered different changes during cold storage. Perona was the green beans cultivar which maintained the higher level of lutein, mainly when samples were stored at the most suitable temperature (8 degrees C).

Fabaceae↗
PubMed1999

Venous thromboembolism as first manifestation of cancer.

Numerous studies, performed in recent years, have provided the convincing demonstration that the incidence of newly diagnosed malignancy is increased among patients with unexplained venous thromboembolism during the first 6 to 12 months after the thromboembolic event. Among malignancies presenting with venous thromboembolism as a first clinical manifestation, prostate and colorectal cancer are the most commonly identified. Other common sites are cancer of the lung, pancreas, stomach, ovary, brain, and bladder. Extensive screening with computer tomography scanning, gastrointestinal endoscopy, and a number of tumor markers have the potential to detect occult malignancies. However, whether an extensive diagnostic work-up in all patients presenting with unexplained venous thromboembolism is cost-effective still remains to be demonstrated.

Humans↗
PubMed1999

Infusion phlebitis in post-operative patients: when and why.

BACKGROUND: The most common complication of intravenous therapy is infusion phlebitis. This study was done to prospectively assess its frequency in a series of consecutive patients who will undergo surgery, and to identify which variables may predict an increased risk for phlebitis. PATIENTS AND METHODS: 400 consecutive patients who will undergo surgery in a general surgery department were included. Only the first catheter, inserted the day before surgery, was taken into account. Eighteen variables (from the infusion, the catheter and from the patient) were prospectively evaluated for their contribution to the occurrence of phlebitis. RESULTS: 60/400 patients (15%) developed phlebitis, and most of them needed insertion of a further catheter. The univariate analysis showed that patients who developed phlebitis were older, and their pre-operative levels of both blood haemoglobin and neutrophil cound were significantly higher than those in patients who did not develop phlebitis. However, the multivariate analysis only confirmed the association with blood haemoglobin levels: the risk of phlebitis sharply increased in the patients with the highest haemoglobin levels. As to the influence of time on phlebitis development, there was a significant decrease in the day-specific risk, from the 5th day on. COMMENTS: In our series, blood haemoglobin levels were found to be the only variable associated to a higher risk of phlebitis. Besides, in contrast with the recommendations by the Centers for Disease Control, no significant increase in the day-specific risk of phlebitis was found. Thus, a guideline to select the type of catheter to be inserted in an individual patient is suggested.

Adolescent↗
PubMed1999

Infusion phlebitis in patients with acute pneumonia: a prospective study.

STUDY OBJECTIVES: To prospectively assess the relative risk for phlebitis in a series of consecutive patients with pneumonia and to identify risk factors that predict an increased risk for phlebitis. SETTING: Internal medicine department of a tertiary teaching hospital. PATIENTS: Seven hundred sixty-six consecutive patients with acute pneumonia receiving IV therapy. INTERVENTIONS: Only the first catheter was taken into account. There were 308 short lines (a 51-mm, 18-gauge Teflon catheter); 307 midsized lines (a 28-cm, 16-gauge polyvinyl chloride catheter); and 151 long lines (71-cm, 14-gauge plain polyurethane catheter). Eighteen variables were prospectively evaluated in an open, nonrandomized study for their contribution to the occurrence of phlebitis. RESULTS: The overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines, in 41% of patients with midsized lines, and in 10% of patients with long lines, and these catheters remained in place an average (+/- SD) of 3.0+/-2.4 days, 4.6+/-3.4 days, and 7.8+/-6.6 days, respectively. The variables that influenced the development of phlebitis, as determined by multivariate analysis, were the following: type of catheter; blood hemoglobin levels; and IV therapy with either corticosteroids or erythromycin. CONCLUSIONS: According to our data, when the use of a catheter is expected to be required for < or = 36 h, a short line can be used. If a longer duration is expected, a longer line is warranted. Ours is the first study in which the relationship between blood hemoglobin levels and phlebitis has been reported. Because the use of intravascular devices is increasingly common, a more complete knowledge of the factors that influence their acceptance has become essential.

Acute Disease↗
PubMed1998

Platelet count and survival in patients with colorectal cancer--a preliminary study.

In a previous report we found an inverse correlation between pre-operative platelet count (PlC) levels and the risk of post-operative pulmonary embolism in patients undergoing hip surgery. In the present study, we prospectively evaluated the prognostic significance of pre-operative PlC levels on survival in 180 consecutive patients undergoing surgery for colorectal cancer. Other major clinicopathological parameters studied were age, gender, Dukes' stage, duration of surgery, pre-operative haemoglobin levels and transfusion requirements. There were no significant differences in mean pre-operative PlC levels according to tumor stage. Thirty-three patients (18%) died during follow-up (3-23 months, median: 13 months). Univariate analysis (Kaplan-Meier estimates) showed that advanced tumor stage (p < 0.001), duration of surgery (p < 0.05) and a high pre-operative PlC level (p < 0.001) were significantly associated to a poor survival. The multivariate Cox analysis revealed that tumor stage (RR:5.734; 95%C.I.: 2.644-12.44), a high pre-operative PlC level (RR: 2.467; 95%C.I.: 1.117-5.452), and to a lesser extent the patients' age remained independent prognostic variables for mortality. The findings of this preliminary study may be of interest from the point of view of pathogenesis, but also clinically, since they might be used in the decision as to which patients or groups of patients should receive more aggressive therapeutic intervention.

Aged↗
PubMed1997

Effects of cholinergic blockade on nocturnal thyrotropin and growth hormone (GH) secretion in type I diabetes mellitus: further evidence supporting somatostatin's involvement in GH suppression.

To investigate the influence of cholinergic pathways on somatostatin (SS) tone in type I diabetes mellitus, we studied the effect of the muscarinic receptor antagonist pirenzepine ([PZP] 100 mg orally) on spontaneous nocturnal growth hormone (GH) and thyrotropin (TSH) secretion and on their response to GH-releasing hormone (GHRH) in the morning in a group of nine insulin-dependent diabetic patients with poor diabetic control. When the nocturnal period was divided into two phases (11:00 PM to 2:30 AM and 3:00 AM to 6:00 AM), both GH and TSH mean concentrations during the first phase were higher than those seen in the second half of the night following placebo administration (GH, 13.4 +/- 1.1 v 4.15 +/- 0.9 ng/mL, P < .001; TSH, 1.9 +/- 0.21 v 1.57 +/- 0.1 microU/mL, P < .05). Pretreatment with PZP induced a significant reduction of GH secretion (3.17 +/- 1.1 v 13.4 +/- 1.1 ng/mL, P < .001) and TSH secretion (1.61 +/- 0.21 microU/mL, P < .05) in the first phase of the night, accounting for a 64% and 11% reduction in the GH and TSH nocturnal peak, respectively. PZP reduced the GH response to GHRH in the morning (17.9 +/- 2.7 v 36.7 +/- 6.3 ng/mL, P < .05), but did not induce any change in TSH values at that time. A positive relationship (r = .73, P < .01) was observed between the percent reduction of the GH response to GHRH and that of the nocturnal GH peak following PZP administration. PZP caused a significant reduction in glucose levels during the second phase of the night (6.4 +/- 0.92 v 9.81 +/- 0.85 mmol/L, P < .05). These results demonstrate that administration of PZP reduces GH and TSH secretion, providing further support for the involvement of SS in the inhibition of GH secretion induced by cholinergic antagonists in type I diabetics. The inhibitory effect of PZP on GHRH-induced GH secretion may help to predict nocturnal GH behavior following administration of the drug.

Administration, Oral↗
PubMed1997

Heparin in patients with venous thromboembolism and contraindications to oral anticoagulant therapy.

After an initial course of heparin therapy, patients with venous thromboembolism require continuing anticoagulant therapy for several months after hospital discharge to prevent recurrences. For most patients oral anticoagulants are the treatment of choice. However, patients receiving therapy need to participate in frequent and careful laboratory monitoring, and a patient's inability or unwillingness to cooperate in such procedures should contraindicate the use of oral anticoagulants. Oral anticoagulants may also be contraindicated in patients with serious coexisting conditions. Finally, several authors consider the oral anticoagulants should not be administered to elderly people, and when administered to pregnant women, they may be associated with embryopathy. Several trials have demonstrated that subcutaneous heparin may be an acceptable alternative to coumarin. However, the high doses required for continuing prophylaxis have raised concerns about the risks of development of osteoporosis and bone fractures. The recently developed low-molecular-weight heparins constitute a good alternative.

Administration, Oral↗
PubMed1997

Occult cancer in patients with venous thromboembolism: which patients, which cancers.

We have previously demonstrated that patients with idiopathic venous thromboembolism (VTE) have a higher frequency of underlying cancer. Now we present a retrospective analysis of our 5-year experience with a series of 674 consecutive otherwise healthy patients, and a more restricted battery of diagnostic tests. Occult cancer was found in 15 patients during admission. The diagnostic tools which led to suspect occult cancer were: abdominal CT-scan (4 patients); high carcinoembryonic levels (2 patients); and high prostate-specific antigen levels (9 patients). Eight further patients were diagnosed of cancer after discharge. Cancer was more commonly found in patients with idiopathic VTE: 13/105 patients (12%) versus 10/569 patients (2%); p <0.01; O.R.: 7.9 (95% CI: 3.14-20.09). During the same period of time we diagnosed VTE in 147 patients with previously known cancer. When overall considered, VTE was the first sign of malignancy in most patients with prostatic and pancreatic carcinoma. On the contrary, most patients with breast, lung, uterine and brain cancers developed VTE as a terminal event of the disease. At variance with VTE patients and previously known cancer, most patients with occult malignancy were at an early stage. Further studies are needed to confirm whether patients with idiopathic VTE could benefit from screening for occult cancer. Meanwhile, our findings may serve as guidelines for physicians in this field.

Aged↗
PubMed1996

[Diagnostic approach to neoplasms at an internal medicine service].

BACKGROUND: The aim of this study was to investigate the diagnostic behavior of different members of a department of internal medicine towards some neoplasms, analyzing the study times, reasons for suspicion and the number of tests performed and their results. PATIENTS AND METHODS: A retrospective review of the clinical histories of the patients admitted from January 1, 1992 to June 30, 1994 whose diagnosis was a new neoplasm of the digestive tract, lung cancer, cancer of unknown origin or lymphoma was carried out. The total diagnostic study time and the different partial times were measured and confirmed. The causes leading to suspicion of the neoplasms were also analyzed by groups, and finally the efficacy of the different diagnostic tests; either non invasive, oriented at the decision of the definitive test, or invasive (biopsies and fine needle aspiration puncture). RESULTS: The median total study time was 13 days with no differences between the groups. The median time until clinical suspicion was 0 days (interquartile range 0-2), being significantly greater in the digestive neoplasms. Less than half of the total study time corresponded to the clinical work itself (5 vs. 8 days). Suspicion of neoplasms in 49% of the cases arose from radiographic alteration and in 30% from clinical alterations. With regards to diagnostic tests, the value of thorax X-ray as the first exploration, mainly in the lung neoplasms (82.5% of the radiographies showed alterations), the elevated efficacy of computerized tomography, among the non invasive tests and fine needle aspiration puncture among the invasive tests were of note. Definitive diagnosis was achieved in 62% of the cases by biopsy and in 31% by fine needle aspiration puncture. CONCLUSIONS: Not all the time spent in achieving diagnosis of neoplasms is attributable to clinical work, although this may be shortened. To do so, a faster and more adequate use of the tests of greater performance (thorax X-ray, computerized tomography and fine needle aspiration puncture) should be used and performed with greater coordination and cooperation among the clinical technicians and physicians of the different departments.

Adult↗