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P Llamas

Publications and source records attributed to P Llamas.

At least 19 recordsLinked to original sources
PubMed2004

[Prothrombotic factors in stroke].

INTRODUCTION: Factor V Leiden and prothrombin 20210A polymorphisms are the most common mutations related to deep vein thrombosis, however their relationship with stroke is debated. This paper studies the possible relationship between both entities. MATERIAL AND METHODS: A case-control study was conducted during 27 months to study their association. A total of 312 stroke cases were included, 73 were under 60 years. Control group was obtained from blood donors. Factor V Leiden and prothrombin 20210A polymorphism prevalence was studied. Results were analyzed according to the age and the type of stroke (TOAST classification, 1993). RESULTS: Factor V Leiden was not related to stroke in the general population (OR: 0.65; 95 % CI: 0.18-2.27). The study according to age did not show any association (younger than 60 years: OR: 1.12; 95 % CI: 0.21-5.90; older than 60 years: OR: 0.50; 95 % CI: 0.11-2.14). However, prothrombin 20210A polymorphism OR in cases under 60 was OR: 2.92; 95 % CI: 0.71-11.92 suggesting a possible association between this mutation and stroke. There was no association in the general population (OR: 2.0; 95 % CI: 0.63-6.29) or in people over 60 (OR: 1.73; 95 % CI: 0.51- 5.83). The analysis according to stroke subtype did not show any association in the distribution of any of the polymorphisms studied. CONCLUSION: This study suggests that prothrombin 20210A polymorphism may play a role in stroke under 60 years of age. Factor V Leiden does not seem to be related to stroke.

Factor V↗
PubMed2004

[Reticulocyte response after immediate withdrawal of recombinant human erythropoietin in chronic hemodialysis patients].

UNLABELLED: The sudden interruption of recombinant human erythropoietin (rHuEPO) in end-stage renal disease (ESRD) patients leads to rapid anemization. The mechanisms of this phenomenon are, however, insufficiently understood. The present study examined the response to immediate rHuEPO withdrawal in dialysis patients. METHODS: 10 chronic hemodialysis (HD) patients regularly receiving rHuEPO were studied. rHuEPO was stopped and reinitiated after 7 days. Reticulocyte profile, haemoglobin and haematocrit were measured at 0, 7 and 15 days. As a complementary study, and with the purpose of analyzying whether uremia was a relevant factor, 10 non-uremic male Wistar rats were treated with rHuEPO. After two weeks, rHuEPO was withdrawn in 5 animals, and continued for 7 additional days in the remainder. The same variables than in the human study were determined. RESULTS: Changes in reticulocyte subtypes from baseline to day 7 were: total 18.2 +/- 0.9 vs 14.3 +/- 1.8% (p < 0.06); high-fluorescence (HFR): 2.6 +/- 0.4 vs 0.75 +/- 0.2 (p < 0.001); medium-fluorescence (MFR): 13.0 +/- 1.1 vs 6.6 +/- 0.9% (p < 0.02); and low-fluorescence (LFR): 84.2 +/- 1.4 vs 92.7 +/- 1% (p NS). The baseline pattern was recovered upon 7 days of rHuEPO reinitiation (p NS). Mean hemoglobin and hematocrit decreased by day 14 (p < 0.02) in spite of rHuEPO reinitiation at day 7. In non-uremic rats, changes were similar to that in the ESRD patients. CONCLUSION: rHuEPO induces changes in the reticulocyte pattern, consisting in a reduction of immature reticulocytes. These changes appear to be independent of the presence of uremia. Accordingly, complete rHuEPO withdrawal in HD patients will cause a rapidly-developing anaemia due to an alteration in the reticulocyte maturation series; therefore, sudden rHuEPO interruption should be avoided whenever is possible. As a collateral application, the specific changes described herein have potential use for detecting illegal administration of rHuEPO.

Aged↗
PubMed2003

DYS19 and DYS390 Y-STR polymorphism in the Iberian Peninsula: a multivariate analysis.

Genetic polymorphism of two Y-specific short tandem repeats (DYS19 and DYS390) was investigated in six populations from the Iberian Peninsula (Andalusia, Castilla-La Mancha, Castilla-Leon, Extremadura, Galicia and South East Spain) comprising a total of 895 unrelated and native individuals, and a complete database of DYS19 and DYS390 allele frequency distributions in 34 world-wide populations collected from literature was analysed. DYS19 and DYS390 polymorphism was screened by automated fluorescence analysis of PCR-amplified labelled sample fragments performed with and ABI PRISM 377 Genetic Analyser. The degree of population differentiation was analysed using the STP Test to calculate G Statistic values. Correspondence Analysis based on the allelic frequencies of each locus and combining both was performed using the NTSYS-PC version 1.70 computer package. The diversity of the genetic profiles of gene frequencies suggests an important population heterogeneity in the Iberian Peninsula as a whole (DYS390 being particularly evident), which is corroborated after statistical analyses (G = 139.8457, p = 1.7822 x 10(-14) for DYS19, G = 116.0293, p = 4.6845 x 10(-12) for DYS390). However, multivariate analysis indicates a well defined cluster of the populations of the Central region, and sets them apart from the positions within which peripheral Iberian Peninsula populations are distributed. The Galician population shows trends which bring it closer to the positions throughout which European Atlantic populations are distributed. The results shown by the Central Iberian Peninsula seem to lend support to a model of settlement population stocks which came from the region of Castilla-Leon after the Islam invasions, whereas in the South-East populations the genetic record of Middle Eastern populations is still present, a consequence of the expansion of Islam in Southern Europe in the Middle Ages.

Alleles↗
PubMed2001

Report of three cases of circulating heparin-like anticoagulants.

Clinically significant endogenous circulating heparin-like anticoagulant activity has been associated with hematological malignancies, liver damage, and other pathological conditions. The source of high plasma concentrations of endogenous heparin-like anticoagulants is poorly understood. We report three cases of circulating heparin-like anticoagulants in three patients with hematological malignancies: CLL, multiple myeloma, and T-prolymphocytic leukemia. The severity of bleeding in our patients ranged from severe epistaxis and deep-site hematoma to bleeding of biopsy site and occasional ecchymosis.

Aged↗
PubMed2001

Atypical chronic graft-versus-host disease following interferon therapy for chronic myeloid leukaemia relapsing after allogeneic BMT.

We report a 54-year-old woman who received interferon alpha for haematological relapse of Ph-positive CML, 7 years after allogeneic BMT from an HLA-identical brother. Eighteen months after relapse, cytogenetic and molecular remission was achieved. She received interferon therapy for 25 months and it was discontinued when she developed skin lesions on her face and trunk, dysphagia and fever with respiratory failure and bilateral patchy airspace consolidation of the lung without microbiologic findings. Histologic features showed discoid lupus erythematosis, oesophagitis with pseudomembranes and a mixed pattern of lymphocytic bronchiolitis involving the alveoli and interstitial spaces all compatible with chronic GVHD. The patient was commenced on immunosuppressive therapy with complete clinical and radiological resolution. The available evidence supports an atypical presentation of chronic GVHD and suggests a role for interferon alpha in the pathogenesis of GVHD. To the best of our knowledge, this is the first case reported of severe chronic GVHD occurring during the course of interferon therapy for relapsed CML.

Antineoplastic Agents↗
PubMed2000

Fluorescence in situ hybridization evaluation of minimal residual disease on stem-cell harvests.

The usefulness of fluorescence in situ hybridization (FISH) analysis to detect minimal residual disease (MRD) in autologous bone marrow and peripheral blood stem-cell harvests has been tested in three patients with hematologic malignancies. Conventional cytogenetics and FISH were used to characterize the leukemic clones identifying the specific chromosomal abnormalities (monosomy 7 in a myelodysplastic patient and trisomy 8 in two acute myeloid leukemic patients). Such analysis was useful to monitor the MRD persistent after treating these patients with intensive chemotherapy. The myelodysplastic patient underwent eight peripheral blood-stem cell harvests in which FISH detected the persistence of monosomy 7 cells, precluding their use for autologous transplantation. This patient relapsed and died. In two acute myeloid leukemia patients who underwent an autologous marrow harvest, FISH did not show a significant proportion of trisomy 8 cells. Nevertheless, autologous transplantation was not performed, owing to an insufficient CD34 cell content in the harvests. One of these patients relapsed with the reappearance of trisomy 8 and died. The other patient, on the contrary, is alive in complete remission 3 years after the bone marrow harvest. The usefulness and applicability of MRD quantification in stem-cell harvests is discussed on the basis of the sensitivity of the methodology applied.

Adolescent↗
PubMed1998

Left main coronary artery patch angioplasty: midterm experience and follow-up with spiral computed tomography.

BACKGROUND: Patch angioplasty is an alternative surgical technique in cases of left main coronary artery stenosis. We report our experience with this technique, with particular mention of the use of spiral computed tomography for the follow-up of our patients. METHODS: In this retrospective study we analyzed the results obtained in all 7 patients (3 women and 4 men) who were operated on with this technique in our institution between July 1992 and August 1994. Five consenting patients also underwent graft patency assessment with spiral computed tomographic imaging. RESULTS: The operation was uneventful in all patients and there were no hospital deaths. Two patients required reoperation (1 of them dying at reoperation), 1 because of restenosis of the graft and 1 because of the presence of a new stenosis in the proximal anterior descending coronary artery. The remaining 5 patients were asymptomatic after 51 +/- 2 months. Spiral computed tomographic images were artifacted and of poor quality. CONCLUSIONS: Patch angioplasty of the left main coronary artery can be a valuable therapeutic method in selected cases. Conventional spiral computed tomography is not an optimal noninvasive method for the assessment of graft patency.

Adult↗
PubMed1998

Hemostasis and blood requirements in orthotopic liver transplantation with and without high-dose aprotinin.

BACKGROUND AND OBJECTIVE: Several factors seem to lead to considerable bleeding and transfusion requirements during orthotopic liver transplantation (OLT) and postoperatively, but hyperfibrinolysis appears to be the most important factor. Aprotinin, a broad-spectrum serine protease inhibitor, has been shown to inhibit hyperfibrinolytic states. DESIGN AND METHODS: A non-randomized, controlled clinical trial was performed to assess the efficacy of aprotinin in 20 consecutive OLT procedures (group A). The results obtained were compared with the findings in two groups of patients who did not receive aprotinin: one control group (C1) consisting of the 20 consecutive recipients who underwent OLT immediately prior to group A, and a second control group (C2) consisting of the 30 consecutive recipients undergoing OLT immediately after group A. Twenty-three hemostatic parameters were studied in group A and C1 and the blood product requirements were compared in all three group. RESULTS: We observed a markedly reduced fibrinolysis in group A during the non-hepatic and reperfusion phases demonstrated by reduced tissue-type plasminogen activator (t-PA), alpha 2 antiplasmin-plasmin complex (APP) and D dimer levels and an increase in antiplasmin activity compared to C1 group (p < 0.05). In vitro experiments showed aprotinin to have an antiplasmin effect. The intraoperative transfusion of units of RBC and fresh frozen plasma (FFP) was significantly diminished in group A (8.1 and 16.7 U, respectively) when compared with groups C1 (20.4 and 36.0 U) and C2 (13.0 and 28.0 U) (p < 0.05); there was also a significantly greater number of patients not requiring intraoperative platelet transfusion in group A (p < 0.05). During the first 5 postoperative days, the number of patients in group A who did not require RBC transfusion was significantly larger than in groups C1 and C2 (p = 0.04). INTERPRETATION AND CONCLUSIONS: In this study, the inhibition of fibrinolysis associated with the prophylaxis with aprotinin, administered in high doses by continuous intravenous infusion, appears to reduce the need for blood product transfusion during the OLT procedure.

Adolescent↗
PubMed1998

Persistent polyclonal B lymphocytosis with multiple bcl-2/IgH rearrangements: a benign disorder.

The appearance of a chronic B lymphocytosis is usually associated with the existence of an underlying monoclonal malignant condition. However, a few cases of persistent polyclonal B cell lymphocytosis (PPBL), presented in young asymptomatic women with an uneventful course, have been reported in recent years. In these PPBL cases, since the lymphocytes usually display an anomalous morphology, a false diagnosis of a neoplastic chronic lymphoproliferative syndrome can be easily made. We report a typical case of PPBL that presents multiple bcl-2 rearrangements, the typical finding of follicular lymphomas. A review of different causes of benign non neoplastic lymphocytosis with special steadiness in changes in the lymphoid subsets will be made.

Adult↗
PubMed1998

Clinical experience with the Carpentier-Edwards supra-annular porcine bioprosthesis implanted in the aortic position.

BACKGROUND AND AIMS OF THE STUDY: Between 1st January 1988 and 30th June 1996, a total of 165 patients (115 males, 50 females; mean age 66.8 years) underwent isolated aortic valve replacement with Carpentier-Edwards supra-annular porcine bioprostheses in our unit. Our clinical experience with this device is reported. METHODS: In this retrospective study, mortality and complications observed in these patients were analyzed. Complications appearing with a non-biased time-course were expressed by means of linearized rates. Actuarial analysis was performed using the Kaplan-Meier method. RESULTS: Cumulative follow up was 551.2 patient-years, with a mean follow up of 3.5 years per patient. The hospital mortality rate was 6.7%. Linearized rates (events per 100 patient-years) and actuarial probabilities of freedom from the different complications at 8.5 years follow up, respectively, were: late mortality, 4.5 and 58.6%; valve-related mortality, 1.1 and 82.6%; thromboembolism, 1.3 and 92.7%; prosthetic endocarditis, 0.5 and 97.4%; non-structural dysfunction, 0.5 and 94.7%; structural deterioration, 0.5 and 91.6%; reoperation, 0.5 and 94.2%. Actuarial freedom from any valve-related mortality or morbidity at 8.5 years was estimated at 66.3%. CONCLUSIONS: The Carpentier-Edwards supra-annular bioprosthesis, when implanted in the aortic position, presents a low rate of valve-related complications at this length of follow up. However, the limited life expectancy of our patients undergoing aortic valve replacement with bioprostheses (usually elderly subjects) may overshadow the potential good performance of this device.

Aged↗
PubMed1998

Conventional cytogenetics and FISH evaluation of chimerism after sex-mismatched bone marrow transplantation (BMT) and donor leukocyte infusion (DLI).

BACKGROUND AND OBJECTIVES: Sensitive and quantitative cytogenetic methods to better assess the biological significance of post-BMT chimerism have been recently developed. In this study, we compared the results of chimerism analysis and evolution employing conventional cytogenetics and fluorescence in situ hybridization (FISH) in 16 patients after sex-mismatched BMT, and in 5 patients after donor lymphocyte infusion (DLI) to treat post-BMT relapse. DESIGN AND METHODS: FISH studies were performed using separate digoxigenin labeled centromeric DNA probes for the X (pDMX1) and Y (DYZ1/DYZ3) chromosomes. To this purpose, different types of samples were used: bone marrow (BM) and peripheral blood (PB) slides processed for conventional cytogenetics, and routine BM and PB smears. RESULTS: Results of chimerism studies performed on different types of samples showed no significant differences. No significant differences in the ability to identify the sex of each cell with both pDMX1 and DYZ1/DYZ3 probes were found and the results obtained from independent experiments showed a high linear correlation. Chimerism analysis by FISH showed initial mixed chimerism after BMT in 10 patients. Seven of these patients were also studied by conventional cytogenetics and 2 of these showed mixed chimerism. Seven of the former 10 patients evolved to complete donor chimera. 6 patients showed cytogenetic or hematologic bone marrow relapse, 3 of which were preceded by mixed chimaerism as revealed by FISH studies. FISH studies permitted an easy and accurate monitorization of the response to DLI in 5 relapsed patients, showing an increase in the proportion of donor cells in 4 patients as they reached a new complete remission. INTERPRETATION AND CONCLUSIONS: Both FISH and conventional cytogenetics are quantitative methods to assess chimerism. However, FISH is more sensitive, accurate and can even be applied on routine BM and PB smears. Furthermore, its combination with immunophenotyping approaches to quantify chimerism on cell subpopulations, will help to clarify post-BMT chimerism significance.

Adolescent↗
PubMed1997

Management of thrombotic microangiopathy following allogeneic transplantation: what is the role of plasma exchange?

Thrombotic microangiopathy (TMA) is an infrequent but serious complication of allogeneic transplantation. The success rate of plasma exchange (PE) reported in the treatment of this entity is a controversial subject. We report the outcome of 10 patients with TMA post-allogeneic transplantation after treatment with PE. Two out of the 10 patients have not responded, five had a partial response, but died of acute GVHD or interstitial pneumonitis, and three have responded and recovered. Our study suggests that there are different degrees of TMA severity. Only mild multifactorial cases with no severe hemolysis (LDH activity <1000 U/l) may be fully resolved with PE.

Adolescent↗
PubMed1997

Intracardiac extension of intravenous leiomyomatosis. A case report.

Intravenous leiomyomatosis spreading through the inferior vena cava to the right heart is a rare neoplasm. We report the case of a patient with a uterine leiomyoma which through a right uterine vein progressed along the inferior vena cava up to the right ventricle. She was successfully operated, carrying out a total resection in two surgical stages. Surgical technique considerations are discussed.

Diagnosis, Differential↗