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Biomedical subjects

A Valls

Publications and source records attributed to A Valls.

At least 19 recordsLinked to original sources
PubMed2002

[Thalamic spectroscopy using magnetic resonance in autism].

OBJECTIVE: To evaluate the cerebral metabolic changes in paediatric patients using proton magnetic resonance spectroscopy. PATIENTS AND METHODS: We studied 31 patients diagnosed as having autism (autistic group) using cerebral magnetic resonance and hydrogen spectroscopy, together with 15 patients without autism (control group). The groups were sub divided according to age: 0-3 years, 4-7 years and 8-13 years. The morphology of the brain was studied using magnetic resonance and hydrogen spectroscopy of the thalamus. In each case we evaluated the presence of morphological changes in the brain and the concentrations of the cerebral metabolites N acetyl aspartate(NAA), choline (Cho) and creatinine (Cr) by measuring the coefficients NAA/Cr, NAA/Cho and Cho/Cr coefficients, and also any anomalous concentrations of other metabolites. RESULTS: No morphological changes were seen in the brains studied. There was no significant increase in minor metabolites in any of the groups studied. Significant differences in the NAA/Cho and NAA/Cr coefficients between the control and autistic groups were only seen in the oldest subgroup (8-13 years), but in the other groups the differences were not significant. The results in the sub group of older autistic children are similar to those of the younger subgroups in both autistic and control groups. CONCLUSION: The spectroscopic findings showed similar recordings in the control group and in the autistic group up to the age of 7 years with reduced thalamic NAA in autistic patients older than this. This suggests interruption and regression in the process of neuronal maturity, in which the thalamus also plays a part.

Adolescent↗
PubMed2000

[Determinants of contractile reserve in the infarction area. A quantitative study using dobutamine in contrast left ventriculography].

AIM: The aim of this study was to relate the contractile reserve in infarction segments to the dysfunction at rest and to the residual coronary stenosis. METHODS: The study group consisted of 95 patients with a first myocardial infarction. Contrast left ventricular at baseline and after dobutamine infusion at 7.5 microg/kg/min and coronary angiograms were performed. The centerline method was used to quantify the extent of dysfunction (percentage of chords with dysfunction in the territory of the infarction artery) and its maximum severity (maximum units of standard deviation [SD] below the normal wall motion reference). Reduction of dysfunction extent with dobutamine was measured. RESULTS: On increasing baseline dysfunction severity, both the magnitude of the response to dobutamine ( 2 SD 3 SD 4 SD +/- 5 SD [n = 15] = 9+/-13%, > 5 SD [n = 13] = 3+/-4%, p = 0,0001), and the number of patients with a significant (> or =15%) positive response ( 2 SD 3 SD 4 SD 5 SD = 0%, p<0,0001) decreased. There were no differences in dobutamine improvement among the subgroups with (n = 84) or without (n = 11) significant stenosis in the infarction artery (18+/-15 vs. 16 +/-18%), or between the subgroups with a patent (n = 76, 18+/-19%) or occluded (n = 19, 11+/-11%) artery. CONCLUSIONS: Dobutamine response is related to dysfunction severity in the infarction area: when the severity is 5 (high negative response prevalence), dobutamine testing does not seem indicate. The existence of residual coronary stenosis does not attenuate contractile reserve at low dobutamine doses.

Cardiotonic Agents↗
PubMed1999

[Multicenter double-blind clinical trial comparing sucralfate vs placebo in the prevention of diarrhea secondary to pelvic irradiation].

BACKGROUND: Sucralfate has been used in the prophylaxis of acute enteric toxicity induced by radiation therapy of pelvic organs. The aim of the study was to demonstrate the efficacy of sucralfate in the prevention of the acute enteric toxicity induced by pelvic irradiation in cancer patients, compared with placebo, in a multicentric double-blind randomised clinical trial. PATIENTS AND METHOD: One hundred and twenty patients, with a localised pelvic cancer, 18 to 80 years old, with a Karnofsky index of 80% or more, and "normal" defecation habits (3-10 defecations/week), undergoing whole pelvic irradiation, were included. The duration of the study was 7 weeks, with weekly controls. The first week all patients received placebo. In the second week the patients were randomised into two groups: sucralfate (61 patients, 2 g/tid p.o. before meals) and placebo (59 patients). Radiotherapy started at the beginning of the third week and lasted until the end of the study. All patients received 45-50 Gy total dose (1.8-2 Gy/day, 5 days/week) with the "box technique". The main variables were the number of stools per week and the number of loperamide pills per week. RESULTS: The number of stools per week showed no differences between groups. By the contrary in the group intention to treat (120 patients) and per protocol (100 cases) the percentage of diarrhoeal stools per week showed a statistical significance in favour of sucralfate: (p < 0.05) and (p < 0.03) respectively, concerning the evolution of this variable from the baseline (first week) to the end of the pelvic radiotherapy (seventh week). Furthermore, the consumption of loperamide was significantly lower in the sucralfate group (p < 0.001). CONCLUSION: Sucralfate is effective in the preparation of acute enteric toxicity induced by pelvic irradiation.

Adolescent↗
PubMed1999

Autologous bone marrow transplantation for high risk acute lymphoblastic leukemia: clinical relevance of ex vivo bone marrow purging with monoclonal antibodies and complement.

Herein we describe our experience with 75 consecutive autologous BM transplants for patients with high-risk ALL, with special attention to the clinical impact of BM purging. Fifty-two patients received purged BM using monoclonal antibody (MoAb) cocktails and complement, and 23 patients received untreated BM. The distribution of prognostic factors was similar in both groups. Hemopoietic reconstitution was adequate and did not differ in the two groups. Transplant-related mortality was 9.6% and 13% in 'purged' and 'unpurged' groups. Median follow up was 11 months (2-71) and overall actuarial probability of disease-free survival (DFS) at 5 years was 40% (53% relapse probability). We found a beneficial effect of purging in patients over 15 years of age and in patients needing more than 1 month to reach CR1. Patients in CR1 receiving purged marrow had a longer DFS and a lower relapse probability (52% vs 12%, P = 0.02 and 35% vs 86%, P = 0.005, respectively) which were related to the efficacy of the purging procedure (more or less than one log of depletion). In further CR, no advantage of purging has been found. Our data strongly suggest the clinical relevance of BM purging in autologous BMT in high-risk ALL patients and support the need for prospective randomized studies.

Adult↗
PubMed1998

Granulocyte colony-stimulating factor administered as a single intraperitoneal injection modifies the lethal dose95/30 in irradiated B6D2F1 mice.

Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic growth factor that stimulates the proliferation of progenitor myeloid cells. We have previously demonstrated that recombinant human G-CSF (rhG-CSF) significantly improves survival of lethally irradiated B6D2F1 mice when administered as a single intraperitoneal dose of 1 mg/kg 2 hours after a lethal dose (LD)95/30 irradiation. In our model, rhG-CSF is also able to modify the LD95/30 in irradiated animals and 1.1 has been found to be the dose modification factor (the ratio of LD95/30 for mice treated with rhG-CSF to that for control animals).

Animals↗
PubMed1997

Transcranial magnetic stimulation as a prognostic tool in stroke.

Our aims were to evaluate the prognostic usefulness of magnetic motor evoked potentials (MMEPs) in ischemic stroke, to study the evolution of MMEP abnormalities and the relationships between MMEP abnormalities and infarction topography. We prospectively analyzed 50 consecutive ischemic stroke patients who were followed up to 1 year. MMEPs were recorded 1, 3, 30 and 90 days after stroke and we measured amplitudes and latencies/central motor conduction times (CMCTs) of MMEPs from hypothenar, biceps brachiallis, gastrocnemius and quadriceps. Univariate and multivariate analyses of the clinical and MMEPs data were performed. Patients with Rankin 0-3 at 1 year had had acutely MMEPs with shorter latencies and higher amplitudes than patients with Rankin 4-5 or deceased patients. Increased blood pressure correlated with increased survival, whereas increased heart rate and hyperglycemia correlated with increased mortality. The variables infarction size on second CT, age, and first day CMCT-S1 correctly classified 1 year outcome on discriminant analysis. The inclusion of MMEPs values increased the probability of correct classification from 76% to 84%. We conclude that in patients with nondisabling strokes MMEPs may have an independent value in the prediction of prognosis, increasing the accuracy of prognosis calculations made employing clinical and laboratory data. Topography of lesions should be considered when analyzing MMEP abnormalities after stroke.

Aged↗
PubMed1997

Serum levels of G-CSF, IL-3, IL-6 and GM-CSF after a single intraperitoneal dose of rhG-CSF in lethally irradiated B6D2F1 mice.

The objective of this study was to assess the pharmacokinetics of rhG-CSF after a single intraperitoneal injection 2 h post-TBI in B6D2F1 lethally irradiated mice and to analyze the effect of rhG-CSF on the endogenous response of interleukin-3 (IL-3), interleukin-6 (IL-6) and granulocyte-macrophage colony-stimulating factor (GM-CSF) in these animals. For comparison, these cytokine serum levels have also been measured in nonirradiated mice. The serum concentrations of rhG-CSF in irradiated mice were higher than in nonirradiated mice at all time points during the first 60 min after injection. Furthermore, rhG-CSF administration failed to induce detectable endogenous serum levels of IL-3, IL-6 and GM-CSF, at least in the 72-hour period after administration of the rhG-CSF. The radioprotective effect of rhG-CSF in lethally irradiated mice is not mediated by an increase in endogenous serum levels of these three cytokines.

Animals↗
PubMed1996

[Survival in patients with sick sinus syndrome and artificial pacemaker. Determining clinical factors].

INTRODUCTION AND OBJECTIVE: The hypothesis that ventricular pacing is the most important factor in the survival of patients with Sick Sinus Syndrome remains controversial. The aim of this report was to determine independent clinical variables to predict survival in paced SSS patients. METHODS: Retrospective, nonrandomized study of 153 patients with a mean age of 69 +/- 11 years, who received an initial pacemaker for Sick Sinus Syndrome between 1980 and 1994: 65 physiologic pacing (32 dual chamber, 33 atrial) and 88 ventricular pacing mode. After a maximum follow up of 177 months (median 57 months) the end point was total mortality. RESULTS: Total mortality was 21%. Using univariate analysis, single chamber ventricular pacing, age > or = 70 years and NYHA > or = 2, was associated with a higher risk for total mortality (4 times increased risk for ventricular pacing compared to other pacing modalities). Independent predictors using multivariate analysis were: 1) NYHA > or = 2 (p < 0.05). 2) Coronary artery disease (p < 0.01). 3) Chronic obstructive pulmonary disease (p < 0.05) and 4) Gender (p < 0.05). CONCLUSIONS: Mortality in patients with the Sick Sinus Syndrome is strongly predicted by preimplant baseline clinical variables. Our data indicate that the role of ventricular pacing mode remains inconclusive. A large, randomized study is necessary to confirm these results.

Age Factors↗
PubMed1996

Kaposi's sarcoma after autologous bone marrow transplantation for multiple myeloma.

We report a case of Kaposi's sarcoma in a patient who underwent autologous bone marrow transplantation (ABMT) for multiple myeloma. Four months after ABMT he presented with numerous asymptomatic, dark blue and purplish macules and nodules on the trunk and lower extremities. Biopsy revealed the typical histologic pattern of Kaposi's sarcoma. The patient died due to disseminated Kaposi's sarcoma while in complete remission of his hematologic malignancy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

[Allogenic bone marrow transplantation in multiple myeloma. Analysis of 12 consecutive cases].

BACKGROUND: Allogeneic bone marrow transplantation (BMT) is the only potentially curative treatment in multiple myeloma (MM). METHODS: From january 1986 to december 1993, 12 cases (10 males and 2 females) underwent BMT in the authors' institution. The mean age of the series was 39 years (range 23-49). The situation of the myeloma on initiation of the conditioning was: complete remission (CR) in 2 cases, objective response in 5 cases, partial response in 1 case and treatment resistance in 4 cases. The conditioning schedule included cyclophosphamide (120 mg/kg) and total body irradiation (10-14 Gy) with or without melfalan at high doses in 11 patients and busulfan (16 mg/kg) and cyclophosphamide (120 mg/kg) in 1 case. The prophylaxis of graft versus host disease (GVHD) was carried out with methotrexate and cyclosporine A (CsA) in 7 cases, CsA plus prednisone in 2 cases and 3 patients received CsA plus bone marrow partially depleted of T lymphocytes by elutriation. RESULTS: The situation of the myeloma with regard to response following transplantation was: unevaluable in 1 case, resistant in 1 case, objective response in 2 cases and CR in 8 cases. Seven out of the 10 patients at risk presented grades II-IV GVHD. Four of the 8 patients who were in CR following transplantation died due to post transplant complications and 2 out of the 6 relapsed 9 months after the transplant while 2 remain in CR at 5 and 8 years after the transplant, respectively. Nine patients died due to infection in 2 cases, GVHD and infection in 4 cases, GVHD and hemorrhage in 1 case and progression and infection in 2 cases. Of the 3 surviving patients, 1 relapsed at 14 months after the transplant and two remain in CR at 5 and 8 years post transplantation. CONCLUSIONS: Bone marrow transplantation conditioning gives place to a high number of complete remission in multiple myeloma. However, the incidence of acute grade II-IV graft versus host disease and mortality due to complications related to the transplantation are very high. Nonetheless, a proportion of patients may achieve curation with bone marrow transplantation.

Adult↗
PubMed1994

[Half-body irradiation. Palliative efficacy and predictive factors of response in 78 procedures].

BACKGROUND: Assessment of palliative effect of hemibody irradiation (HBI) and response-related factors. METHODS: Analysis of prospective collected data of 78 procedures on 71 patients with multiple symptomatic bone metastases, treated with 6 Gy (upper half-body) or 8 Gy (lower half-body) HBI in single fraction. Clinical improvement was quantified by self-evaluation on a visual analogic scale (SVAS) before HBI, and at 24, 48 and 72 hours, at 7 days, and at each monthly control until patient's death. Univariate analysis included: sex, Karnofsky's index, tumor origin, histology, HBI dose, and SVAS before treatment. For statistical purposes the significance level was 0.05. RESULTS: Complete (37.5%) or partial responses were observed in 72/78 (92.3%) procedures, 80% appearing during the first 72 hours. Difference between mean SVAS, before and after treatment (7.7 +/- 1.5 vs 2.8 +/- 2.5), was statistically significant (p < 0.001). A mean response duration of 101 days over a mean overall survival of 141 days implies the 70% of expected patient's life span. Any analyzed prognostic factor does not correlate significantly with HBI response. CONCLUSIONS: HBI is a powerful palliative treatment in patients with multiple symptomatic bone metastasis.

Aged↗
PubMed1994

[The prognostic factors of early mortality in bone marrow transplantation in patients with chronic myeloid leukemia].

INTRODUCTION: The use of bone marrow transplantation (BMT) in leukemia treatment is associated with high early morbid-mortality rates. Therefore, to identify morbid-mortality risk factors in this setting can be useful to improve therapeutic ratio. METHODS: We studied 15 variables in 46 patients with chronic myeloid leukemia (CML) treated with cyclophosphamide, total body irradiation (TBI) and allogeneic BMT. A multivariant analysis with an unconditional logistic regression model was used. RESULTS: Variables found to be related with early mortality included general state of health and acute graft versus host disease. Patients with a Karnofsky index (KI) between 60% and 80% had a higher risk of early death than those with a KI between 90 and 100%. Patients who developed severe (grade II-IV) acute graft versus host disease (AGVHD), had a relative risk of 15.62 (IC 95%: 3.16-77.34) compared with those who do not. Time between diagnosis and BMT contributed to the creation of the mathematical model without reaching statistical significance. CONCLUSIONS: In this series and in the range of the parameters analysed, general state of health according to KI, and the appearance of severe AGVHD are the variables related with a higher risk of early mortality.

Acute Disease↗
PubMed1994

Outpatient total body irradiation for bone marrow transplantation.

Five selected patients entering a BMT program were included in a prospective feasibility study to evaluate the tolerance to total body irradiation (TBI) on an outpatient basis. Four fractions of 3 Gy in 4 consecutive days (8 Gy lung total dose) were given. Ondansetron 8 mg/8 h orally was used without sedation as anti-emetic regimen. After each treatment dose, patients went home where they remained in close telephone contact with the BMT team. After the last TBI fraction, patients were hospitalized and treated with cyclophosphamide 60 mg/g/day for 2 consecutive days. The outpatient TBI regimen was well tolerated in four cases. Only one patient presented with nausea and vomiting after the second treatment day. She was admitted to the hospital and treated with chlorpromazine. During the conditioning and hematological recovery period, no complications related to the outpatient TBI could be identified. We conclude that TBI can be given on an outpatient basis with safety. Additionally, it represents a cost saving of US$ 1160 per patient.

Adult↗
PubMed1993

Risk factors for early mortality in allogeneic bone marrow transplantation. A multivariate analysis on 174 leukaemia patients.

Allogeneic bone marrow transplantation in patients with leukaemia is an aggressive therapeutic procedure which implies high early mortality. Current opinion trends attribute the greater part of the procedure toxicity to the preparative regimen. The results of a multivariate analysis on data of 174 leukaemia patients conditioned with total body irradiation (TBI), 10-12 Gy, single dose or fractionated, and lung shielding at 8 Gy, plus chemotherapy: cyclophosphamide 120 mg/kg, before or after TBI, are presented. The variables statistically related with early mortality are age, Karnofsky index (KI) and acute graft-versus-host disease (GvHD). No variable depending on radiotherapy reached the significance level. The relative risk of early mortality for patients older than 26 years, in bad general condition (KI < 90%), or developing acute severe (grades II-IV)GvHD, is 3.99, 5.68, and 6.71, respectively. We conclude that in the range of TBI schedules analysed, radiation therapy is not an important factor in early death, but acute severe GvHD, or recipient's bad general condition are factors to be improved by bone marrow transplantation teams if they want to improve the therapeutic index of the procedure.

Adolescent↗