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Biomedical subjects

X Bosch

Publications and source records attributed to X Bosch.

At least 163 records · Page 9Linked to original sources
PubMed1998

Hypercalcemia due to endogenous overproduction of 1,25-dihydroxyvitamin D in Crohn's disease.

Hypercalcemia may occur in various granulomatous diseases. Two patients with Crohn's disease who had hypercalcemia, hypercalciuria, and excessively high serum levels of 1,25-dihydroxyvitamin D [1,25(OH)2D] are described. Both had numerous noncaseating, epithelioid granulomas in bowel biopsy samples. A direct correlation was observed between serum 1,25(OH)2D levels and both serum and urinary calcium concentrations. Also, calcium and 1,25(OH)2D levels strongly paralleled the clinical activity of disease. Prompt therapy with prednisone in the patient who had symptomatic hypercalcemia and with prednisone and mesalamine in the other patient without hypercalcemic symptoms led to normalization of calcium and serum 1,25(OH)2D levels, but 25-hydroxyvitamin D [25(OH)D] levels remained unchanged. Four months after discharge, recurrence of Crohn's disease symptomatology together with an increase in calcium and serum 1,25(OH)2D levels was observed in 1 patient; after increasing the prednisone dose, levels decreased and rapid clinical resolution was noted. These cases appear to be the first reported instances of hypercalcemia in patients with Crohn's disease. Excessive synthesis of 1,25(OH)2D may have been inhibited by an action of corticosteroids on the 1alpha-hydroxylation of 25(OH)D in the activated macrophage of Crohn's granulomas. Crohn's disease should be added to the list of granulomatous diseases responsible for 1,25(OH)2D-mediated hypercalcemia.

Adult↗
PubMed1998

[Optimization of thrombolytic treatment in acute myocardial infarct: the role of new fibrinoselective drugs and their combination with new antithrombotics].

Although reperfusion therapy is well recognized as the mainstay of treatment of acute myocardial infarction, mortality of myocardial infarction is still high, thrombolytic treatment remains underutilized and, usually, applied too late. Additionally, most of the patients do not experience optimal reperfusion because of the suboptimal flow rate in the infarct-related artery, abnormal microvascular flow, and reocclusion of the infarct-related artery. Strategies to enhance the results of reperfusion therapy include, expanding the population of potential candidates, earlier treatment, and newer methods to improve infarct-related artery flow rates. In this sense, new thrombolytic agents, and combination therapies with or without addition of more potent and specific new antithrombotic agents are being extensively investigated. Also, it is important to promote studies of ancillary treatments to reduce reperfusion injury, which may be one cause of decreased microvascular flow. Although aspirin and heparin have been the conventionally used agents for inhibiting thrombin and platelet function, newer agents such as hirudin or hirulog and inhibitors of the platelet glycoprotein IIb-IIIa receptors are becoming available, and their clinical application will increase in the future.

Acute Disease↗
PubMed1998

[Improvement in the treatment of acute myocardial infarct by the establishment of a thrombolysis unit in a cardiology servic].

INTRODUCTION AND OBJECTIVES: Lack of available beds in the coronary care unit, makes time to thrombolysis still too long. Although fibrinolytic therapy is administered in the emergency department in most hospitals, mean in-hospital delay continues to be long. Our purpose was to improve the treatment of these patients and to evaluate if this delay could be shortened by creating a thrombolysis unit for the treatment of patients with acute myocardial infarction. METHODS: A thrombolysis unit in the cardiology department was set up to treat patients with acute myocardial infarction who couldn't be admitted directly in the coronary care unit because of lack of available beds. Time to treatment in both groups of patients were compared. RESULTS: Two hundred twenty-five patients with acute myocardial infarction and ST-segment elevation were included: 86 (38%) of them were admitted to the thrombolysis unit and the other 139 (62%) to the coronary care unit. There were no differences in baseline characteristics or in the pre-hospital delay between both groups. Time from hospital admission to thrombolysis was 59 minutes in patients treated in the thrombolysis unit versus 70 minutes in those treated in the coronary care unit (p < 0.001), and time from the admission to both units to fibrinolytic therapy was of 20 minutes versus 30 minutes respectively (p < 0.0001). There were no differences between both groups in the incidence of complications. CONCLUSIONS: In-hospital delay in thrombolysis remains too long. Implementation of a thrombolysis unit in the cardiology department shortens this delay and offers the possibility to treat patients with acute myocardial infarction at least as well as in the coronary care unit, without dependence on the availability of free beds in this unit.

Coronary Care Units↗
PubMed1998

Recurrent ischemia after thrombolysis: importance of associated clinical findings. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-plasminogen activator] for Occluded Coronary Arteries.

OBJECTIVES: We sought to assess the incidence and clinical relevance of examination data to recurrent ischemia within an international randomized trial. BACKGROUND: Ischemic symptoms commonly recur after thrombolysis for acute myocardial infarction. METHODS: Patients (n = 40,848) were prospectively evaluated for recurrent angina and transient electrocardiographic (ECG) or hemodynamic changes. Five groups were developed: Group 1, patients with no signs or symptoms of recurrent ischemia; Group 2, patients with angina only; Group 3, patients with angina and ST segment changes; Group 4, patients with angina and hemodynamic abnormalities; and Group 5, patients with angina, ST segment changes and hemodynamic abnormalities. Baseline clinical and outcome variables were compared among the five groups. RESULTS: Group 1 comprised 32,717 patients, and Groups 2 to 5 comprised 20% of patients (4,488 in Group 2; 3,021 in Group 3; 337 in Group 4; and 285 in Group 5). Patients with recurrent ischemia were more often female, had more cardiovascular risk factors and less often received intravenous heparin. Significantly more extensive and more severe coronary disease, antianginal treatment, angioplasty and coronary bypass surgery were observed as a function of ischemic severity. The 30-day reinfarction rate was 1.6% in Group 1, 6.5% in Group 2, 21.7% in Group 3, 13.1% in Group 4 and 36.5% in Group 5 (p < 0.0001); in contrast, the 30-day mortality rate was significantly lower (p < 0.0001) in Groups 1, 2 and 3 (6.6%, 5.4% and 7.7%, respectively) than in Groups 4 and 5 (21.8% and 29.1%). CONCLUSIONS: Postinfarction angina greatly increases the risk of reinfarction, especially when accompanied by transient ECG changes. However, mortality is markedly increased only in the presence of concomitant hemodynamic abnormalities.

Aged↗
PubMed1998

Laparoscopy to correctly diagnose and treat Crohn's disease of the ileum.

A 27-year-old woman with a past history of pulmonary tuberculosis presented with right iliac fossa pain and low-grade fever. She was empirically treated for Crohn's disease despite undergoing multiple investigations that failed to provide a strongly suspected diagnosis. After 3 days of therapy, her symptomatology aggravated, and signs suggestive of intestinal obstruction developed. Placing the patient in the left lateral decubitus position before sterile draping, intracorporeal laparoscopy was performed, and Crohn's disease involving the terminal ileum but sparing its most distal 25 cm was confirmed. During the procedure, creeping mesenteric fat, a characteristic feature of Crohn's disease, was seen. Also, some adhesions in the right iliac fossa and a firm 3-cm inflammatory mass were found. Both division of mesentery along with terminal ileum resection and ileocolonic anastomosis were successfully performed intracorporeally, without need to convert to open surgery. In select cases of right iliac fossa pain in which diagnostic and therapeutic results are inconclusive or equivocal, laparoscopy can be useful to correctly diagnose and treat inflammatory bowel disorders such as Crohn's disease. Moreover, we suggest that intracorporeal laparoscopic surgery can be effective in the treatment of these conditions even in some cases with intestinal complications such as inflammatory masses and adhesions.

Adult↗
PubMed1998

Antineutrophil cytoplasmic antibodies in primary Sjögren's syndrome: prevalence and clinical significance.

OBJECTIVE: To evaluate the prevalence of cytoplasmic (c) and perinuclear (p) antineutrophil cytoplasmic antibodies (ANCA) in patients with primary Sjogren's syndrome (SS), and to correlate the presence of ANCA with extraglandular and immunological manifestations related to SS. METHODS: In a cross-sectional study, we included 82 consecutive patients (75 female and seven male; mean age 61 yr; range 33-87 yr) attending our unit. All patients fulfilled four or more of the diagnostic criteria for SS proposed by the European Community Study Group in 1993. Extraglandular manifestations such as arthralgia and/or arthritis, Raynaud's phenomenon, autoimmune thyroiditis, peripheral neuropathy, renal involvement and cutaneous vasculitis were also recorded. Serum samples were examined by indirect immunofluorescence (IIF) and by ELISA using as substrates myeloperoxidase (MPO) and proteinase 3 (PR3). RESULTS: ANCA were detected in nine (11%) patients: seven had pANCA and two an atypical pattern. These two atypical ANCA became cANCA when paraformaldehyde fixation was applied. ELISA findings showed that two patients had antibodies against MPO, and no patient had antibodies to PR3. The most common extraglandular manifestations in the ANCA-positive patients were articular involvement in six (66%) patients, peripheral neuropathy in five (55%), Raynaud's phenomenon in four (44%) and cutaneous vasculitis in four (44%). Of the four patients with cutaneous vasculitis and ANCA, two had a mononuclear inflammatory vascular disease (MIVD) in the biopsy specimen. When compared with patients without ANCA, those with these antibodies had a higher prevalence of cutaneous vasculitis (44% vs 8%, P = 0.01), Raynaud's phenomenon (44% vs 8%, P = 0.01) and peripheral neuropathy (55% vs 7%, P < 0.001). CONCLUSION: ANCA positivity can be found in patients with primary SS and its detection is associated with the presence of clinical manifestations attributable to vascular involvement (cutaneous vasculitis, peripheral neuropathy and Raynaud's phenomenon).

Adult↗
PubMed1998

The association between Crohn disease and the myelodysplastic syndromes. Report of 3 cases and review of the literature.

We report 3 patients who developed Crohn disease and myelodysplastic syndrome concurrently and review 9 previously reported cases of this association. Demographic and clinical features, treatment, and outcome are presented from previous reports and our own 3 cases. Of the 12 patients, 8 were men, and the mean age was 68.8 years (range, 28-83 yr). The geographic origin was heterogeneous. Pancytopenia was found in 5 patients, anemia in 5, and bicytopenia in 2. The classification types of myelodysplastic syndrome were variable. The marrow karyotype was reported in 10 patients: it was abnormal in 5, with chromosome 20 abnormalities in 3. Crohn disease and myelodysplasia were diagnosed simultaneously in 5 patients, whereas Crohn disease antedated myelodysplasia in 4 patients (interval, 8 mo-30 yr) and myelodysplasia antedated Crohn disease in 3 patients (interval, 2 mo-4 yr). Signs and symptoms of Crohn disease improved in most patients upon specific medical treatment. However, the outcome of myelodysplastic syndrome was not favorable in 10 of 11 patients in whom it was reported, with 4 deaths due to myelodysplasia-related complications. Notably, the activity of myelodysplasia in 1 of our own patients paralleled the clinical activity of Crohn disease, and hematologic abnormalities of the myelodysplasia resolved upon successful treatment of the Crohn disease, thus strengthening the hypothesis of a pathogenetic link between the disorders. The possibility of myelodysplastic syndrome should be considered in patients with Crohn disease over the age of 50 years who have peripheral blood cytopenias. Likewise, a diagnosis of Crohn disease should be considered in patients with myelodysplastic syndrome who develop gastrointestinal symptoms such as chronic and/or bloody diarrhea. In patients with such an association, the possibility of improvement of the myelodysplasia upon successful therapy of Crohn disease should not be ruled out.

Aged↗
PubMed1998

[The Sociedad Española de Cardiología on the Internet: current resources and future prospects. The Internet Committee of the Sociedad Española de Cardiología].

The Internet can help physicians to identify needed clinical information quickly providing continued medical education. Internet also improves medical information of the non-medical population. Researchers have quick access to library catalogs, Medline and other important databases from the most recognized research centers. Furthermore, it can put physicians in ready contact with other specialists for communication and consultation, facilitates administrative procedures of multicenter studies and accelerates editorial processes of biomedical journals. Since its creation, the website of the Spanish Society of Cardiology has evolved rapidly to the present model, providing different kinds of services to its members including faster communication, information from national and international societies and congresses, earlier access to the full content of Revista Española de Cardiología and to a variety of graphic resources and of continuing education. Nowadays, the website of the Spanish Society of Cardiology is consulted by one thousand visitors a week, even at weekends. The degree of activity increases from 3 h P.M. with a peak from 11 h P.M. to 1 h A.M. In the near future, our website will incorporate its own courses of continuing medical education with on-line evaluation and credit granting, will give support to multicenter studies and will initiate the publication and discussion of clinical cases of interest.

Cardiology↗