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Biomedical subjects

M Romero

Publications and source records attributed to M Romero.

At least 127 records · Page 7Linked to original sources
PubMed1993

Factors determining late success after mitral balloon valvulotomy.

Mitral balloon valvulotomy (MBV) has proved to be an effective method in the treatment of patients with mitral stenosis. Although several factors determining an optimal immediate result have been described, there is little information regarding long-term follow-up, as well as factors influencing late success after MBV. This study analyzes 350 patients (mean age 46 +/- 12 years) treated by MBV who were clinically followed up between 6 months and 6 years. At least 1 echo-Doppler follow-up study was obtained in 298 patients 28 +/- 14 months after MBV; hemodynamic reevaluations were performed in 66 patients after 23 +/- months. Late success was considered if the patient was in functional class I to II and free of major events (death, restenosis and valve surgery). Restenosis was defined as a 50% loss of initial gain with regard to valve area by echocardiography, which was confirmed hemodynamically. After a mean follow-up of 38 +/- 15 months, 296 patients (84%) remained in functional class I to II, without surgery or the need for an increase in medical treatment. The 5-year Kaplan-Meier survival rate was 94 +/- 1%, whereas restenosis, valve surgery and major event-free probability were 90 +/- 3%, 91 +/- 2% and 85 +/- 2%, respectively. Multivariate study (Cox regression model) identified the presence of sinus rhythm (p < 0.001) and the absence of calcium at fluoroscopy (p < 0.003) as the only independent factors of late success.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Use of psychotropic drugs during pregnancy. A report of the international co-operative drug use in pregnancy (DUP) study. Collaborative Group on Drug Use in Pregnancy (CGDUP).

Drug Use in Pregnancy (DUP) is an international epidemiological survey of drug use in pregnancy conducted from 1988 to 1990 in 148 maternity wards, representing the general delivery practices of 22 countries. Data on exposure of pregnant women to psychotropic drugs, the indications for their use and their correlation with maternal characteristics are reported. Of the 14,778 women interviewed, 520 (3.5%) reported 562 courses of psychotropic drugs. Benzodiazepines (BDZ) accounted for the greatest number of the exposures (444/520 women); neuroleptics and antidepressants were prescribed to tiny minorities of women (83 and 17 respectively), mostly in those few countries were the overall prevalence of use of those drugs was highest. Throughout the majority of the other countries, overall rates were in the low range and were rather heterogeneous. With the exception of small clusters of "unexpected" indications, prescriptions of BDZ were found to be consistent with the target symptoms of anxiety and insomnia; chronic use was reported in 31/444 women. The study was not targeted to the detection of malformations; no suspected clustering was found, however, among the 130 women exposed during the first trimester of pregnancy. The collaborative network now established provides a framework for periodically replicated surveillance to monitor the evolution of this field of knowledge and care in order to provide reliable information for women and society.

Adolescent↗
PubMed1993

Serial angiographic observations after successful directional coronary atherectomy.

This study focuses on the early and late angiographic evolution observed in 82 patients with coronary artery disease who were successfully treated by directional coronary atherectomy (DCA) without adjunctive balloon angioplasty. Qualitative inspections and quantitative measurements were obtained from a selected angled-view projection in the following conditions: (1) before treatment; (2) immediately after treatment; (3) the day after atherectomy; (4) 1 month after; and (5) 6 months after. The appearance of the treated segment 24 hours after the procedure did not differ in 79 patients from that observed immediately after DCA; silent total occlusion occurred in two patients, and one had an aneurysm at the site of resection (all three patients were excluded from the analysis). At the 1-month study restenosis developed in 3 (3.6%) patients; the remaining 76 had identical appearances, with no evidence of renarrowing of the lumen. However, from 1 to 6 months after the procedure restenosis developed in 35 of the remaining 76 (46%) patients, and 41 patients were free of restenosis and symptoms. These findings, which show that early elastic recoil does not occur after successful DCA, are different from the changes observed after balloon angioplasty. At the 1-month observation restenosis is an infrequent but possible phenomenon (3.8%). From this point the healing of the arterial wall leads to no or mild renarrowing (late success); an exaggerated proliferative response produces restenosis.

Adult↗
PubMed1993

Intracoronary ultrasound assessment of directional coronary atherectomy: immediate and follow-up findings.

OBJECTIVES: This study was conducted to assess the relations among intracoronary ultrasound, angiographic and histologic data obtained from patients with coronary artery disease successfully treated by directional coronary atherectomy. In addition, it was designed to elucidate whether some aspects of intravascular ultrasound or pathologic findings could predict a propensity to restenosis. BACKGROUND: Intracoronary ultrasound is a useful technique in guiding and assessing atherectomy. However, there is little information about the characterization of the different types of coronary plaques and the changes observed in them after resection. Furthermore, the follow-up ultrasound appearance of previously treated lesions remains undepicted. METHODS: Fifty-two patients (54 +/- 10 years old) were studied. All were successfully treated by atherectomy with the aid of intracoronary ultrasound guidance. Qualitative and quantitative ultrasound and angiographic variables were derived before and after resection. Quantitative histologic morphometric information was also obtained from the specimens. In 22 patients, a follow-up echoangiographic reevaluation was performed 6 +/- 4 months later. RESULTS: Echogenic plaques had a higher collagen and calcium content, whereas echolucent plaques had an increased level of fibrin, nuclei and lipids. Ultrasound plaque reduction after atherectomy was greater in echolucent (76 +/- 21%) than in echogenic plaques (60 +/- 18%; p < 0.05). That reduction correlated with the weight of the resected material (r = 0.62; p < 0.01). At follow-up study, 13 of 22 patients had angiographic and ultrasound evidence of restenosis. Most recurrent lesions had a stenotic three-layer appearance. The incidence of restenosis of primary lesions treated with atherectomy was higher in echolucent (100%) than in echogenic (33%) plaques. Similarly, a higher proportion of nuclear content in the resected material was observed in patients who developed restenosis (2.1 +/- 0.7%) than in patients who had late success after atherectomy (1.2 +/- 0.6%). CONCLUSIONS: Our findings suggest that echolucent plaques are easier to resect than are echogenic plaques but frequently develop restenosis. In contrast, the resection of echogenic plaques, although often incomplete, is associated with better long-term results.

Atherectomy, Coronary↗
PubMed1993

Is there still an avoidable fraction of post-operative thromboembolic complications with heparin prophylaxis? The results of a case-control surveillance. Collaborative Group on Heparin Prophylaxis in Surgery (S.E.P.E.C.).

A case-control multicenter study was set up in 68 general and specialistic wards in Italian regional hospitals in order to assess whether underuse of heparin prophylaxis may account for at least a fraction of the thromboembolic events still occurring in surgical patients. 100 cases with clinically relevant thromboembolic or hemorrhagic events occurring during hospitalization for major surgery and 200 controls were identified. Controls were selected among patients not presenting any of the events under study during the same period of observation and were matched with cases for age, sex, and type of surgery. The results of the study suggest that heparin use in routine conditions of care closely reflects the "consensus" knowledge, patients at higher risk (specifically orthopedic surgical patients, those with varicose veins or with preoperative bed rest longer than 3 days) being treated more frequently with heparin. Absence of heparin prophylaxis does not appear to represent a specific risk factor for the occurrence of index events (OR 0.73, 95% CI = 0.42-1.26). Despite the higher rates of heparin exposure, the presence of varicose veins is associated with a statistically significant increase in the risk of postoperative complications (OR 2.23, 95% CI = 1.07-4.65). This study indicates that among known pre- and peri-operative risk factors only varicose veins may be unprotected by the current prophylaxis practice.

Adult↗
PubMed1992

Trypanosoma cruzi 5S rRNA genes: molecular cloning, structure and chromosomal organization.

To further study the ribosomal RNA genetic system in Trypanosoma cruzi, the 5S rRNA gene family was characterized. We found that this gene family is reiterated about 1600 times per diploid nuclei and is mostly organized as a tandem repeat of 481 base pairs. These gene clusters were assigned to two chromosomes of about 1500 and 1400 kilobase pairs. We found that the 5S rRNA-coding region is comprised of 120 nucleotides, and contains the well-known internal control regions of eukaryotic RNA polymerase III. The two gene-spacer regions analysed exhibit a putative signal for transcription termination and six sites homologous to the consensus sequence for the binding of transcription factor Sp1.

Animals↗
PubMed1992

[An analysis of the obligatory reporting of meningitis in a pediatric area].

AIMS: To find out the validity, reliability and quality of the epidemiological information which comes from the System of Statutory Declarations. The example used is the incidence of Meningitis. DESIGN: Descriptive study of the coverage of the Declaration, with the help of the EDO (Illnesses requiring a Statutory Declaration) index, of the pediatric (up to 14 years old) cases of meningitis attended in our Area between 1984 and 1989. We analysed how the Declaration had been filled in and the agreement between the information gathered through the notification system and clinical records. SITE. The whole network of epidemiological vigilance: hospitals, provincial epidemiological services and primary care services. PATIENTS: All the cases of child meningitis (120 cases) seen in the Mother and Child Hospital in our area between 1984 and 1989. MAIN MEASUREMENTS AND RESULTS: The meningitis declaration covered 47.5% of the total number of cases seen. In the cases declared, the diagnosis of meningococcal meningitis on the EDO index was 89.5%, whereas the rate in the clinical reports was only 20%. Thus agreement in the diagnosis does not exceed what could be produced by chance (Kappa = 2.5%; p = NS), as agreement for all diagnoses is 7.1%. CONCLUSIONS: Our results demonstrate a low level of declaration, poor standard of compliance and scant agreement between the Statement of Declaration and the clinical report. The validity and reliability of this information is extremely low and suggests a need to re-consider the usefulness of this vigilance system for health-service practice, especially in Primary Health Care.

Adolescent↗
PubMed1992

Increased expression of natural-killer-associated and activation antigens in multiple myeloma.

The expression of both natural-killer (NK)-associated and activation antigens was studied by flow cytometry in the peripheral blood of 47 untreated multiple myeloma (MM) patients. A significant increase in both absolute and relative numbers of CD57 positive cells as well as in the proportion of CD16 and CD11b cells was observed in patients with MM, specially in those in early stages of the disease (clinical stages I and II), suggesting a possible surveillance mechanism in response to an emerging malignant clone. Additional double stainings showed that strong CD16+ NK cells coexpress the CD56, CD11b, and CD2 antigens, while they lacked CD3, CD5, and WT31 antigens. Moreover, the previously reported increase in CD8 cells present in MM would be mainly due to a subset of CD8 cells that coexpress the CD57 Ags. The expression of activation antigens, especially CD38, was increased in peripheral blood lymphocytes of MM patients, the differences reaching statistical significance both in absolute and relative numbers in those cases with high numbers of CD16 NK cells and thus suggesting that these cells are functionally activated. These results reveal the existence of an increase in NK and activated cells in the peripheral blood of myeloma patients that may reflect a host's immunological mechanism in an attempt to modulate tumor cell growth.

ADP-ribosyl Cyclase↗
PubMed1992

Peripheral stent recovery after failed intracoronary delivery.

The Palmaz-Schatz stent can be successfully deployed in most patients. However, in a small percentage of instances a systemic embolism of the stent has been reported. In the present article we describe an easy and fast method of stent capture when detachment from the balloon has happened (pulling back the stent-loaded balloon into the guiding catheter or femoral sheath). In this situation we propose the use of the coronary guide-wire "as a guide" to capture coaxially the lost stent. This method allows for continuing the procedure without removal of the femoral sheath.

Aged↗
PubMed1992

Effects of morphine on isolated right atria of the rat.

1. The present study describes the effects of morphine in the absence or presence of naloxone or atropine in the isolated right atria of the rat. 2. Morphine significantly decreased the auricular chronotropism. 3. The maximal effect was 10 +/- 1.0%. 4. Similar results were obtained in reserpinized animals (13 +/- 0.2% maximum). 5. Naloxone (5 x 10(-7) or 5 x 10(-6) M) did not change the inhibitory effects induced by morphine. 6. The maximal effect obtained with morphine in the presence of atropine (5 x 10(-7) M) was 9 +/- 0.1% similar to that obtained with morphine alone. 7. These results suggest that opioid or vagal mechanisms may not be involved in the cardiac inhibitory effects induced by morphine.

Animals↗
PubMed1992

Lymphoid subsets and prognostic factors in multiple myeloma. Cooperative Group for the Study of Monoclonal Gammopathies.

In a uniform series of 170 untreated myeloma patients (MM) we investigated the distribution of T cell subsets in peripheral blood (PB) and their relationship with the most relevant disease characteristics, including survival. CD4 cells were significantly decreased both in percentage and absolute numbers (P less than 0.0001). On the other hand, the CD8 cells only showed a slight increase in relative numbers. Upon correlating the abnormalities in the distribution of T cells with other clinical and biological disease characteristics the most remarkable correlation was with survival. A low number of CD4 cells (less than 700 x 10(6)/l) was associated with both an advanced clinical stage and a shorter survival (20 v. 43 months, P = 0.01). Moreover, a significant correlation also exists between the decrease in CD4 cells and both high beta 2-microglobulin (beta 2M) levels and anaemia. On the other hand, no relationship was found with the type of M-component nor with the plasma cell phenotype. Finally multivariate analysis showed that the number of CD4 cells add independent prognostic information to other well-established tests for the assessment of disease outcome in patients with multiple myeloma.

Age Factors↗
PubMed1992

Divided Palmaz-Schatz stent for discrete coronary stenosis.

This article shows the findings observed in a group of 7 patients with short coronary lesions who were treated by a divided (7 mm length) coronary Palmaz-Schatz stent, in trying to match the length of the stent to that of the treated segment. All of the patients were male and had a mean age of 59 +/- 5 years; 6 had unstable and 1 stable angina. The angiographic length of the lesion was 4.3 +/- 1 mm. The divided stent was successfully deployed in all cases and remained in place without complications. The clinical condition stabilized and all 7 patients were symptom-free 6 months post-hospital discharge. At angiographic follow-up studies, performed before discharge and at 2 and 6 months later, there were no significant changes in the resultant minimal lumen diameter. The stented segment and surrounding areas remained smooth and without intraluminal defects. These observations suggest that a 7 mm length stent is effective in avoiding elastic recoil of discrete coronary lesions. This reduced length could be helpful in: 1) decreasing exposed metallic surface, 2) increasing deliverability and 3) preventing the origin of nearby side-branches to be covered by a standard 15 mm length stent.

Adult↗