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Biomedical subjects

A Manrique

Publications and source records attributed to A Manrique.

At least 19 recordsLinked to original sources
PubMed2006

Pancreas preservation with the University of Wisconsin versus Celsior solutions.

INTRODUCTION: The use of Celsior solution for organ preservation has not been thoroughly studied in pancreas transplantation. The aim of this study was to compare University of Wisconsin and Celsior solutions for preservation of pancreas grafts. PATIENTS AND METHODS: From March 1995 to December 2005, 72 patients with type 1 diabetes underwent pancreas transplantation. There were 42 men and 30 women, with a mean age at transplantation of 38.1 +/- 7.5 years (range: 27 to 55 years), and a mean duration of diabetes of 22.5 +/- 6.6 years. Recipients were classified into two groups according to the preservation solution: (A) Celsior (n = 28, 38.9%) and (B) Wisconsin (n = 44, 61.1%). RESULTS: The donor and recipient characteristics were similar in both groups. There were five cases of venous thrombosis in the Wisconsin group and two in the Celsior group (P = NS). The venous drainage technique in the former group was portocaval in 19 patients and portoiliac in 25; in the Celsior group, portocaval in 23 patients and portoiliac in five (P = .001). Enteric drainage was used in 19 patients from the Celsior group and 17 patients from the Wisconsin group (P = .01). Actuarial 2-year graft survival was 74.6% in the Wisconsin group and 77.4% in the Celsior group (P = NS). CONCLUSIONS: No differences were observed in venous thrombosis between the two groups. The lower rate of venous thrombosis with the portocaval technique was related to the type of venous drainage rather than the type of preservation solution. Celsior solution may be considered as good as Wisconsin solution for pancreas transplantation.

Adenosine↗
PubMed2005

Incidence and risk factors of development of lung tumors after liver transplantation.

INTRODUCTION: Lung tumors have been related to tobacco and alcohol. The incidence increases after orthotopic liver transplantation (OLT) especially when it is performed because of alcoholic cirrhosis. PATIENTS AND METHODS: We analyzed the incidence and risk factors for de novo lung tumors among 701 patients who underwent OLT between April 1986 and July 2004, after exclusion of pediatric recipients and adults who died within 2 months after OLT. RESULTS: The incidence of de novo lung tumors was 15 patients (2.1%), including 12 (4.3%) who underwent OLT for alcoholic cirrhosis and 3 (0.7%) for nonalcoholic diseases. There were 14 men and 1 woman of mean age at OLT of 50.8 +/- 9.6 years. Mean time from OLT to lung tumor was 83 +/- 43 months (range, 10-184 months). Thirteen patients (86.6%) were heavy smokers before OLT and 8 (61.5%) continued after OLT; 12 patients (80%) were heavy drinkers before OLT. Ten patients were immunosuppressed with CyA and 5 with tacrolimus. Acute rejection episodes before tumor diagnosis occurred in 6 patients (40%). Two patients underwent thoracotomy, but only one was resected. The remaining 13 patients were unresectable because of locally advanced tumor or metastatic disease. Two unresectable patients received palliative chemotherapy. All patients died with a mean survival from tumor diagnosis, of 5.3 months (range, 3 days to 33 months). CONCLUSION: A significantly higher incidence of lung tumors was observed among patients who underwent OLT for alcoholic cirrhosis, usually diagnosed in advanced stages of poor prognosis and low survival.

Adult↗
PubMed2005

Hepatic vein reconstruction in living donor liver transplantation.

INTRODUCTION: Living donor liver transplantation has emerged as a response to the cadaveric graft shortage, especially for adult recipients. Both right and left liver grafts are widely used, although some technical problems remain unresolved. Herein we describe our technique for reconstruction of the venous outflow in living donor liver transplantation. METHODS: From April 1986 to September 2004, 1012 liver transplantations were performed including 30 living donor liver transplantations between April 1995 and September 2004. We have selected the first 28 cases to ensure a mean follow-up of 21.07 +/- 13.11 months. We transplanted 18 right lobe grafts, 7 left lobe grafts, and 3 left lateral segment grafts. A surgical technique is described herein. RESULTS: No venous outflow obstruction developed among living donor liver transplantation recipients. CONCLUSION: We recommend reconstruction of the hepatic veins in living donor liver transplantation including joining together the three hepatic veins in the recipient to avoid venous outflow obstruction.

Family↗
PubMed2005

Incidence of pancreas graft thrombosis in portoiliac and portocaval venous anastomosis.

BACKGROUND: Pancreas graft thromboses represent more than 70% of all technical failures; multiple risk factors have been implicated. We analyzed the thrombosis rates using portoiliac versus portocaval vein anastomoses. PATIENTS AND METHODS: The series includes 53 patients who underwent pancreas transplantation: 49 simultaneous pancreas-kidney and 4 pancreas after kidney. There were 27 men and 26 women, of mean age of 37.2 +/- 7.0 years. We compared two groups of recipients that were classified according to venous anastomosis: (A) portoiliac (n = 30), and (B) portocaval (n = 23). RESULTS: The recipients did not show significant differences in age, gender, or duration of diabetes mellitus, but body mass index was significantly higher among the portocaval group. A bladder-drained pancreas technique was more frequently performed in the portoiliac group (93% of patients) versus an enteric-drained pancreas in the portocaval group (81%; P < .001). Heparinization was performed in 12 recipients: 11 (36.6%) in the portoiliac group and 1 (4.3%) in the portocaval group (P < .01). Vascular graft thrombosis (venous in six and arterial in one) developed in seven patients (13.2%) all in the portoiliac group (23%) (P < .02). Two-year patient survival was 93% in the portoiliac group and 94% in portocaval group (P = NS). Two-year graft survival was 66.6% in the portoiliac group and 85.9% in portocaval group (P = .07). CONCLUSION: There was no graft thrombosis among patients with a portocaval vein anastomosis.

Adult↗
PubMed2005

Modulation of hepatocyte growth factor plasma levels in relation to the dose of exogenous heparin administered: an experimental study in rats.

INTRODUCTION: Partial liver transplantation has been consolidated to be a valid treatment option. We sought to understand the factors that modulate and may be harnessed to accelerate hepatocyte regeneration. We sought to determine the impact of heparin on m-hepatocyte growth factor (HGF) plasma concentrations. MATERIALS AND METHODS: Sixteen rats were assigned to four groups of four animals each: group A, without heparin; group B, 600 IU/kg; group C, 1000 IU/kg, group D, 1400 IU/kg. Blood samples (0.5 mL) were obtained from each rat at baseline and at 30, 60, 120, and 240 minutes. After the samples were centrifuged to separate supernates from the cell phase they were stored at -20 degrees C in the m-HGF reagent and subsequently tested using enzyme-linked immunosorbent assay. Results were analyzed using SPSS 11.5 statistical software. RESULTS: Among the 16 rats, one died at 110 minutes, just prior to the last extraction. The remaining rats were sacrificed. Mean weight was: 466 +/- 64.24 g with no intergroup differences (P = .149). The comparative results (using Student t test) were: baseline A(1-4) versus A(1-4) 30 minutes: P < .05; baseline A(1-4) versus A(1-4) 60 minutes: P < .05; baseline A(1-4) versus A(1-4) 120 minutes: P = .10 (NS); baseline A(1-4) versus A(1-4) 240 minutes: P = .15 (NS). No significant differences were found among group B: baseline C(1-4) versus C(1-4) 30 minutes and 60 minutes: NS; baseline C(1-4) versus C(1-4) 120 minutes: P < .001; baseline C(1-4) versus C(1-4) 240 minutes: P < .10 (NS). Finally, the results in group D were: baseline D(1-4) versus D(1-4) 30 minutes: NS; baseline D(1-4) versus D(1-4) 60 minutes and 120 minutes: P < .05; baseline D(1-4) versus D(1-4) 240 minutes: P < .0005. When we compared group A to C and D, we detected differences (albeit not when compared to B) with P values = .01. Peak values were obtained at 120 and 240 minutes (225.21 pg/mL and 221.78 pg/mL) among groups C and D. CONCLUSION: Heparin has a positive effect to increase serum HGF concentrations among rats. The effect was dependent on the administered dose and the time elapsed.

Animals↗
PubMed2004

[Section planes for cardiac MRI].

The recent developments of synchronized cardiac MRI are a unique opportunity for the radiology community to integrate cardiac imaging. This educational aticle aims to help radiologists and technicians to obtain cardiac planes comparable to those of cardiac ultrasound and gated SPECT. Of course, cardiac planes described herein for MRI also apply to multi-detector CT.

Aorta, Thoracic↗
PubMed2003

Changes in the incidence and severity of recurrent hepatitis C after liver transplantation over 1990-1999.

BACKGROUND/AIM: Changes in immunosuppression and other factors may have changed the severity of recurrent hepatitis C during recent years. This study sought to establish the changes in incidence and severity of recurrent hepatitis C, and its association with the changes in acute rejection and induction immunosuppressive therapy between 1990 and 1999. PATIENTS AND METHODS: Among 213 liver transplants in HCV-infected recipients, 129 grafts were selected for this study: all grafts with severe recurrent hepatitis C (fibrosis 3-4 in Scheuer's score or fibrosing cholestatic hepatitis), and those grafts without severe recurrence with at least 2 years of follow up. Grafts were divided in 5 groups depending on the year of transplantation to compare recurrent hepatitis C-related variables, AR incidence and induction immunosuppression. RESULTS: Hepatitis-free survival decreased in recent years (p=0.015). The incidence of fibrosing cholestatic hepatitis was higher among 1996-1997 and the 1998-1999 periods (p=0.019). Survival free of severe hepatitis at 1 year follow up was 95% in 1990-1991 and 80% in 1998-1999; however, in the long-term the survival was similar between groups (p=0.933). HCV-related graft survival at 5 years was 93.5% in the 1990-95 period and 82.5% in 1996-99 (p=0.068). Neither AR nor any regimen of induction immunosuppression was associated with changes in the occurrence of recurrent hepatitis C related survival. CONCLUSIONS: Severity of recurrent hepatitis C and HCV-related graft loss after liver transplantation were higher in the second half of the 1990s; however, there was no association with AR or induction immunosuppression.

Disease-Free Survival↗
PubMed2003

Live liver donation: a prospective analysis of exclusion criteria for healthy and potential donors.

INTRODUCTION: Living donor liver transplantation represents a controversial option to increase the donor pool. DESIGN: Prospective and descriptive clinical study. OBJECTIVE: (1) To identify risk factors (exclusion criteria) for live donation; (2) to determine the rate of recipients that benefit from a living donor. METHODS: Between May 1995 (first adult-to-adult living donor liver transplantation in Spain) and November 2002, we evaluated 74 healthy volunteers and performed 12 living donor liver transplants (no donor mortality). RESULTS: All actual donors and volunteers are alive and healthy. After a mean time of 3.2+/-0.5 weeks, 72% of potential donors were considered unsuitable for live donation. Exclusion criteria were grouped in three categories: (primary) donor safety reasons (68%); (secondary): ABO mismatch (17%) and (tertiary): cadaveric graft transplantation (15%). Consequently, just 43.7% of the recipients presenting to us with a potential living donor, did finally benefit from these organs. The mortality rate was 8.3% for 43 recipients presenting with a living donor in comparison to 15% for those who did not (321 recipients between May 1995 and November 2001). CONCLUSIONS: ALDLT can benefit a significant number of recipients on the waiting list (43.7% of those presenting with a donor). The most frequent exclusion criteria concern donor safety, namely, unsuspected chronic liver diseases and unsuspected thrombophilic disorders.

ABO Blood-Group System↗
PubMed2003

Liver transplantation and transjugular intrahepatic portosystemic shunt.

OBJECTIVE: Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study. MATERIALS AND METHODS: Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology. RESULTS: Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate. CONCLUSIONS: In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.

Actuarial Analysis↗
PubMed2003

Impact of Wiener filter in determining the left ventricular volume and ejection fraction using thallium-201 gated SPECT.

Patient morphology, as well as the acquisition and reconstruction parameters, may influence the evaluation of the left ventricular volume (LVV) and left ventricular ejection fraction (LVEF) using gated single-photon emission computed tomography (SPECT). The purpose of this study was to examine the influence of gender and reconstruction filter on the measurement of LVV and LVEF using 201Tl gated SPECT. Using a static torso phantom, a female shape was created by the addition of two saline solution-filled balloons fixed on the anterior rib cage. The following parameters were similar for all acquisitions: 90 degrees dual-head gamma camera; 32 projections; 64x64 matrix (pixel size=6.77x6.77 mm); two 20% energy windows centred at 70 and 167 keV. The following acquisition times were tested: 1.25, 10, 20, 30 and 40 s per projection, leading to a total of 10 successive acquisitions. The effect of over-sampling was tested by 2.5 post-acquisition zooming. All SPECT images were successively reconstructed using filtered back-projection with Butterworth and Wiener filters. The effect of gender and reconstruction filter was also studied in 30 patients (15 males and 15 females) with a low likelihood of coronary artery disease. LVVs were calculated using QGS software. By multivariate analysis, the following factors influenced the accuracy of phantom measurement using QGS software: zooming (F=49, P<0.0001), phantom shape (F=61, P<0.0001) and filter type (F=240, P<0.0001). LVV was underestimated in the female shape phantom, even when using the Wiener filter. In patients, LVV and LVEF measurements were independently influenced by gender (P<0.0001) and filter (P<0.0001), but not by zooming. In conclusion, it was demonstrated that LVV was significantly decreased in the female shape phantom, suggesting a significant impact of breast interposition. This underestimation was minimized by use of the Wiener filter. In patients, the impact of the Wiener filter on the assessment of LVVs and LVEF was powerful, but independent of gender, and failed to correct the underestimation of LVVs and the overestimation of LVEF in females.

Algorithms↗
PubMed2003

[The best of nuclear cardiology and MRI in 2002].

In Nuclear Cardiology, the year 2002 was marked by a great number of studies on the gated-SPECT, which allows joint analysis of left ventricle perfusion and contraction. Even if conventional perfusion tomoscintigraphy confirms its foreground role, notably for prognostic evaluation, the value of the gated-SPECT is particularly significant in all areas of its use: coronary heart disease screening, prognosis evaluation, and myocardial viability assessment. Cavitary tomoscintigraphy allows direct evaluation of the ejection fraction and volumes in both ventricles. This innovative technique has been the subject of a great deal of methodological validation work, and will very likely replace traditional isotopic angiography in the future. At last, the value of MIBG scintigraphy for prognostic evaluation, of cardiac insufficiency has been defined, as has its significance for providing evidence of the effect of betablockers on pre-synaptic sympathetic innervation. The year 2002 has also been very fertile for technological innovations, methodological work, and in clinical studies concerning cardiac MRI. In particular, the significance of MRI for evaluating myocardial viability and the transmural extension of necrosis is now well established. Similarly, MRI is becoming an inescapable element in the assessment of congenital cardiopathy. However, its diffusion on a wider scale will only be possible if there is direct collaboration between cardiologists and radiologists.

3-Iodobenzylguanidine↗
PubMed2002

[The best of 2001. Nuclear cardiology and MRI].

The year 2001 has been very fertile for innovations and developments in the field of cardiac imaging. In Nuclear Cardiology, this year has been marked above all by a very large number of studies on the gated-SPECT, which allows joint analysis of the perfusion and contraction of the left ventricle. The contribution of this technique is recognised as being very significant in all fields using conventional tomoscintigraphy (screening for cardiac disease, evaluations of prognosis and viability,...). Innovation has also been focused in the field of radio-tracers, with studies on the very promising markers of apoptosis or cellular hypoxia. Lastly, much work has been conducted on the gamma-camera, especially to adapt it for imaging with the tracers used in positron emission tomography (PET). This will enable the distribution to all the Nuclear Medicine services of FDG imaging, which is the reference technique for studying myocardial viability. In MRI much work has been carried out on sequences using gadolinium, a vascular contrast agent, in order to identify and localise the sequelae of infarction, even when they are limited to the sub-endocardium. The most spectacular technical innovations were probably in the methods allowing an increase of the recorded signal (SENSE) and in updating the imaging sequences in real time, without apnoea and without ECG synchronisation. But, as every year, significant progress has also been made in MRI angiography of the coronary vessels, and thus in the analysis of myocardial tissue perfusion, with sequences which can be used without the injection of contrast medium.

Gated Blood-Pool Imaging↗
PubMed2001

Early prognosis in severe sepsis via analyzing the monocyte immunophenotype.

OBJECTIVE: To analyze the early discriminative predictive information regarding the immunophenotype components of patients with sepsis, and its potential use as a prognosis tool. DESIGN: Observational prospective clinical study. SETTING: Intensive care unit (ICU) in a University Hospital. PATIENTS: Thirty-five patients admitted with severe sepsis. MEASUREMENTS: Analysis of peripheral blood on admission and 48 h later of the absolute white cell count and the immunophenotype of lymphocyte (CD3, CD3-HLADR, CD4, CD8, CD4/CD8 ratio, CD19, and CD25) and monocyte (CD13, CD13-HLADR, CD14, CD14-HLADR, CD13-CD14, and CD4) subpopulations. RESULTS: Due to its high correlation, the immunophenotypic profile studied at admission and 48 h later showed the same prognosis power regardless of the time of performance. The univariate analysis between groups (survival versus death) confirmed the prognostic significance of the total monocyte count and its subpopulations; significant differences were observed from the beginning only in the CD19 lymphocyte subpopulation. Multivariate analysis was performed using logistic regression with survival as the dependent variable. The final model comprised monocytes beta = 0.002 (P = 0.025) and CD13-HLADR beta = 0.016 (P = 0.029). The monocytes receiver operating characteristic (ROC) area obtained was 0.819 (confidence interval 0.663-0.976 at 95 %), the CD13-HLADR ROC area was 0.810 (confidence interval 0.658-0.963), and the monocytes + CD13-HLADR ROC area was 0.918 (confidence interval 0.807-1.000). CONCLUSIONS: A single blood sample test obtaining the absolute monocyte and CD13-HLADR subpopulation count in the first days of admission could contribute to simplifying the classification of patients with severe sepsis into high- and low-mortality risk.

APACHE↗
PubMed2001

Cardiac malignant lymphoma successfully treated with chemotherapy.

We report the case of an 83-year-old woman with diffuse large B-cell lymphoma located in the right cardiac ventricle revealed by acute congestive heart failure. Complete and long-lasting disappearance of the cardiac tumor was observed with monochemotherapy (cyclophosphamide).

Journal Article↗
PubMed2001

Exercise-induced ST-elevation is related to left ventricular dysfunction but not to myocardial viability in patients with healed myocardial infarction.

BACKGROUND: Exercise-induced ST-segment elevation was proposed as a marker of myocardial viability after a recent myocardial infarction. AIMS: The aim of this study was to evaluate whether exercise-induced ST segment elevation is related to viability or to left ventricular dysfunction in patients with history of old Q wave myocardial infarction. METHODS: Fifty patients (43 men, age 57+/-11 years) were studied 31+/-49 months after a Q wave myocardial infarction. They all underwent stress, reinjection-redistribution, and late redistribution Tl-201 SPECT, completed by equilibrium radionuclide angiography. Viability was defined by defect reversibility or significant (>60%) persistent Tl-201 uptake in dyssinergic segments on late redistribution SPECT. Relative post-exercise and reinjection-redistribution LV volumes were calculated using validated software (QGS). RESULTS: Twenty-one out of 50 patients (42%, G1) had significant stress-induced ST-elevation (>1 mm 80 ms after J point in at least 2 ECG leads with Q wave), and 29/50 (58%, G2) did not. Seventeen out of 50 patients (34%) demonstrated myocardial viability on late redistribution scan. The diagnostic accuracy of exercise-induced ST-elevation was only 52% for viability assessment. Significant LVEF reduction and increased relative LV volumes were observed in G1 compared to G2 (LVEF: 39+/-10% vs. 49+/-11%, P=0.003; post-stress LV volume: 134+/-98 ml vs. 81+/-41 ml, P<0.02; reinjection-redistribution LV volume: 123+/-86 ml vs. 79+/-40 ml; P<0.02). Perfusion defects were similar in G1 and G2 (post-exercise: 38+/-12% vs. 37+/-14%, ns; reinjection-redistribution: 31+/-11% vs. 30+/-11%, ns; late redistribution: 30+/-10% vs. 28+/-11%, ns). CONCLUSION: These results suggest that, in patients with history of myocardial infarction, exercise-induced ST-segment elevation is not related to persistent myocardial viability but is associated to left ventricular dysfunction.

Aged↗
PubMed2001

[Evaluation of the ejection fraction tomoscintigraphy synchronised with an electrocardiogram].

Electrocardiographic gated myocardial scintigraphy (gated SPECT) allows simultaneous evaluation of left ventricular perfusion and contractility. The aim of this study was to assess the impact of the type of tracer and temporal sampling on the measurement of the ejection fraction by gated SPECT. Eighty-six consecutive patients (59 men, 27 women, average age 62 +/- 11 years) with a history of myocardial infarction (anterior N = 50--inferior N = 36) were studied. All had measurement of the isotopic ejection fraction by equilibrium angioscintigraphy and by gated SPECT sampled at 8 (N = 45, 52%) or 16 images/cycle RR (N = 41, 48%). After filtered retroprojection, the ejection fraction was calculated by a validated method (QGS). A better correlation between gated SPECT and equilibrium angioscintigraphy was observed at 16 images/cycle (r = 0.90) compared with 8 (r = 0.80). The Bland-Altman curves showed improved accuracy of the measurement of the ejection fraction by gated SPECT with 16 compared with 8 images/cycles sampling (mean differences of 0.37 +/- 6.06% and 4.3 +/- 7.71%, respectively). Multivariable analysis showed that temporary sampling was the only parameter to significantly affect the difference between the two methods. There was no difference between the use of Thallium and that of 99mTc-sestamibi. Gated SPECT, therefore, provides an accurate measurement of the ejection fraction for routine clinical usage, providing the acquisition is made at 16 images/cycle.

Electrocardiography↗