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Biomedical subjects

E Prats

Publications and source records attributed to E Prats.

At least 19 recordsLinked to original sources
PubMed2001

Impact of a hospital-based home-care program on the management of COPD patients receiving long-term oxygen therapy.

STUDY OBJECTIVES: To analyze the influence of a hospital-based home-care program (HCP) on the management of patients with COPD receiving long-term oxygen therapy. DESIGN AND SETTING: Randomized, controlled study in a 1,000-bed university hospital. INTERVENTION: The HCP applied to patients in the intervention group (HCP group) consisted of a monthly telephone call, home visits every 3 months, and home or hospital visits on a demand basis. Patients in the control group were given conventional medical care. MEASUREMENTS: Pulmonary function data, gas exchange, use of hospital resources (emergency department visits, admissions, and hospital stay) and the cost of medical assistance were investigated in both groups before and after 1 year of study. Quality of life was analyzed using the chronic respiratory questionnaire in the first 40 consecutive patients included in the study. Survival throughout the study was also assessed. RESULTS: One hundred twenty-two patients were enrolled in the study, and 94 patients (46 in the HCP group and 48 in the control group) completed the 1-year follow-up period: 83 patients (88%) were men, and mean (+/- SD) age was 68 +/- 8 years. During the follow-up period, there was a highly significant decrease in the mean number of emergency department visits (0.45 +/- 0.83 vs 1.58 +/- 1.96; p = 0.0001) and also a significant decrease in hospital admissions (0.5 +/- 0.86 vs 1.29 +/- 1.7; p = 0.001) and days of hospital stay (7.43 +/- 15.6 vs 18.2 +/- 24.5; p = 0.01) in the HCP group. Patients in the intervention group required a total of 221 home visits (mean per patient, 4.8 +/- 0.8) and 69 hospital visits (mean per patient, 1.5 +/- 1.07). In spite of the cost of the program, cost analysis showed a total saving of 8.1 million pesetas ($46,823) in the HCP group, mainly due to a decrease in the use of hospital resources. There was no difference in pulmonary function, gas exchange, quality of life, and survival between the two groups. CONCLUSIONS: Hospital-based home care is an effective alternative to hospital admission. It reduces the use of hospital resources and the cost of health care.

Aged↗
PubMed2001

[The scintigraphy of somatostatin receptors in the carcinoid tumor].

UNLABELLED: This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT). MATERIALS AND METHODS: We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients. RESULTS: Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively. CONCLUSIONS: The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

Adult↗
PubMed2000

[Treatment with (131)I of toxic multinodular goiter. Assessment of a fixed dose protocol].

OBJECTIVE: Present the results of treatment with 131I in a cohort of 119 patients diagnosed of toxic multinodular goiter (TMG) from a specific geographic area who had been treated with fixed doses of isotopes (555 MBq). The indication for the administration of the 131I was hyperthyroidism correction in all of the cases. MATERIAL AND METHODS: 111 of the 119 patients treated were women (93%) and 8 were men (7%) and their ages ranged from 38 to 88 years. The follow-up periods were always greater than one year (1.78 +/- 1.05 years). Treatment with thyroid medication was discontinued in all of the patients at least 7 days prior to the administration of the isotope. RESULTS: 93 (78.1%) of the 119 patients remained euthyroidic, 10 (8.4%) presented hypothyroidism, 11 (9.2%) hyperthyroidism and 5 (4.2%) had sub-clinical levels of hyperthyroidism at the end of the follow-up period. No statistically significant relationship were found between hypothyroidism, gender and previous administration of thyroid medication. CONCLUSIONS: The use of 131I is an alternative to the treatment of TMG produced hyperthyroidism. The fixed doses of 555 Mbq that we propose are comfortable, make it unnecessary for the patients to travel in extensive geographic areas and produce a low rate of hypothyroidism. In our opinion, the differences in the iodine content of the diets that continue to exist are one of the factors that could influence in the differences in results observed in the different series, although other factors, such as the size of the goiter and the heterogeneity of the radioisotope uptake can contribute to the variations found in our patients.

Adult↗
PubMed2000

[The effects of enalapril on exercise capacity and right ventricular function in patients with chronic cor pulmonale].

BACKGROUND: Chronic cor pulmonale (CPC) in patients with chronic obstructive pulmonary disease (COPD) is a predictor of mortality. ACE inhibitors (ACEIs) improve the symptoms and reduce mortality of left ventricular or congestive failure, however their long term use in patients with CPC has not been tested. The aim of this study is to assess the effect on exercise tolerance and cardiorespiratory function of long term administration of enalapril in patients with CPC. METHODS: Placebo-controlled, double blind, randomized study. 28 patients (24 men and 4 women, mean age of 68.11 +/- 7.78, range 51-79) with CPC and without exacerbation of their respiratory symptoms at baseline were double blind randomised to receive enalapril or placebo for 6 months, added to their previous therapy. Respiratory function test, exercise tolerance ("six minutes walking test") and isotopic ventriculography were performed at baseline and at the end of the study. RESULTS: At baseline there were no differences in FEV1, FVC, FEV1/FVC and exercise tolerance. Both placebo and enalapril were well tolerated. At the end of the study, patients taking enalapril increased their exercise tolerance an 8.9% (19 m) vs 4.7% (33 m) in the placebo group (p 0.44; 95 percent confidence interval, -41.10 to 91.99). RVEF improved a 6.4% with enalapril but worsened a 7.09% in placebo group (p 0.15; 95 percent confidence interval, -12.87 to 2.10). CONCLUSIONS: Long term administration of enalapril do not improve neither exercise tolerance, nor right ventricular (RV) function, although given in increasingly doses is well tolerated and might prevent further worsening in RV systolic function.

Aged↗
PubMed1999

Mytilus edulis histone gene clusters containing only H1 genes.

We isolated five different phage clones containing histone gene clusters with up to five H1 genes per phage clone from a Mytilus edulis genomic library. Among these H1 genes, nine gene types coding for five different H1 proteins have been identified. All H1 histone genes were located on repetitive restriction fragments with only slightly different sizes. The H1 coding regions show highly related sequences, suggesting that the multitude of H1 genes has evolved by gene duplication events. Core histone genes could not be found on these five Mytilus edulis genome fragments.

Amino Acid Sequence↗
PubMed1999

Mammography and 99mTc-MIBI scintimammography in suspected breast cancer.

UNLABELLED: The aim of this work has been to evaluate whether a diagnostic protocol based on the joint use of mammography and 99mTc-methoxyisobutyl isonitrile (MIBI) scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. METHODS: We performed prone scintimammography in 90 patients with suspected breast cancer, involving 97 lesions. In all patients, the diagnosis was established by way of biopsy. On mammography, we evaluated the degree of suspicion of malignancy and the size of the lesion (smaller or larger than 1 cm in diameter). RESULTS: The results of only 41 of the biopsies indicated malignancy. On mammography, 20 lesions (of which 1 was breast cancer) were considered to be of low suspicion of malignancy, 31 (of which 4 were breast cancer) as indeterminate and 46 (of which 36 were breast cancer) as high. Fourteen lesions (2 low probability, 2 indeterminate and 10 high) were smaller than 1 cm, whereas 83 (18 low probability, 29 indeterminate and 36 high) were larger. The sensitivity, specificity, positive predictive value and negative predictive value of scintimammography were 85%, 79%, 74% and 88%, respectively. Scintimammography was positive in all cases of breast cancer that initially had a low or indeterminate suspicion of malignancy according to mammography, as well as in 30 cases of breast cancer that initially were highly suspicious. Six false-negative scintimammography studies were obtained in lesions with a high suspicion of malignancy. CONCLUSION: We propose a diagnostic protocol with a biopsy performed on lesions that have a high suspicion of malignancy as well as those with low or indeterminate suspicion that are smaller than 1 cm or with positive scintimammography results. This would have reduced the total number of biopsies performed by 34%. More importantly, there would have been a 65% reduction in number of biopsies performed in the low and indeterminate mammographic suspicion groups. All 41 cases of breast cancer would have been detected.

Adult↗
PubMed1999

Clinical applications of radiolabeled blood elements in inflammatory bowel disease.

This work discusses the main clinical features of inflammatory bowel disease (IBD) and the methods to obtain an accurate diagnostic. Nuclear medicine procedures are deeply analyzed, with special emphasis in those where clinical experience is larger and that are available for clinical practice in most countries. In the opinion of the authors 99mTc-HMPAO is the first choice agent, while 111In-oxine could be considered as the gold standard for evaluation of new agents. In the context of IBD, the WBC scintigraphy is useful for its diagnosis (early and accurate) and the evaluation of disease extension (whole bowel examination, without patient preparation and negligible risk). The evaluation of disease severity deserves further experiences.

Antibodies, Monoclonal↗
PubMed1999

[Scintigraphy with 99MTc-HMPAO labeled leukocytes and computed tomography in the diagnosis of vascular graft infection. A comparative study].

The purpose of this work was to compare the results obtained with a scitigraphy using 99mTc-HMPAO labeled leukocyte and a computed tomography (CT) in the diagnosis of vascular graft infection (VGI). We carried out 22 studies with both scintigraphy and CT in 20 patients with vascular grafts with VGI suspicion. One patient had two grafts, thus a total of 23 grafts were analyzed. In addition, 6 control studies were performed. The persistent increase in leukocyte uptake in the graft area was considered as evidence of VGI and the scintigraphy with HMPAO-99mTc labeled leukocytes. For the CT, the presence of perigraft fluid and/or gas collection in the graft bed was also considered to be evidence of VGI. The total number of VGI was 12. The VGI diagnosis was confirmed by culture in all cases. The sensitivity and specificity of the scintigraphy in the diagnosis of VGI was 100%, while the CT has a sensitivity of 58% and specificity of 91%. Five grafts presented pseudoaneurysm in distal aorto-bifemoral graft anastomosis. All theses cases were detected with CT and only one patient with pseudoaneurysms showed scintigraphic evidence of VGI. In addition, both techniques detected two soft tissue infections associated with cutaneous fistulae, one case of abdominal abscess and another of acute diverticulitis. The scintigraphy was also pathologic in one infection of the surgical wound while that the CT was negative. In conclusion, although both techniques are useful to evaluate patients with suspicion of VGI, the scintigraphy with 99m-Tc-HMPAO labeled leukocytes has been shown to be more sensitive than the CT in the assessment of patients with VGI suspicion.

Aged↗
PubMed1999

[Gammagraphy of somatostatin receptors in an ACTH secreting thymic carcinoid].

Ectopic ACTH secretion represent 10 to 15% in the causes of Cushing's syndrome. Carcinoid tumor of the thymus is a rare neoplasm and is currently believed to arise from population of thymic cells of neural crest origin. We present the case of a 43-year-old man with a corticotropin hormone (ACTH) secreting thymus carcinoid. 111In-octreotide scintigraphy demonstrated an intense uptaken on the lesion. The surgical specimen measured 17 x 18 x 18 cm and weighed 1. 25 kg. Postoperatively the patient was treated by chemotherapy and radiotherapy. A follow-up 111In-octreotide scintigraphy was normal. Very few scintigraphic images of these lesions have been published in the literature. Somatostatin receptor scintigraphy can be successful in the detection and follow-up of ACTH-secreting neuroendocrine tumors.

Adrenocorticotropic Hormone↗
PubMed1999

[131I-treatment of the autonomous toxic nodule. Assessment of a fixed dose protocol].

Ninety six patients diagnosed of toxic thyroid adenomas received fixed doses of 131I (555MBq) for treatment of hyperthyroidism. The inclusion and exclusion criteria, the patient's characteristics and the advantages of the fixed doses are described. The hypothyroidism rate found at the end of the mean follow-up period (2.46 +/- 1.72 years) which was 27.08% significantly lower to that observed in patients treated for Graves-Basedow disease, is pointed out. No differences were found in the hypothyroidism rate when the patients were differentiated by sex or when this situation was related to pretreatment with the antithyroid drugs. The extensive differences in the hypothyroidism rates observed between the different series that have been published and the variability in the doses administered leads us to think that factors other than the dose of 131I may be responsible for this post-therapeutic hypothyroidism.

Adenoma↗
PubMed1998

[antineutrophil cytoplasmic autoantibodies in inflammatory bowel disease].

BACKGROUND: The aim of the present study was to determine the prevalence and diagnostic usefulness of antineutrophil cytoplasmic antibodies (ANCA) in a Spanish population of patients with inflammatory bowel disease from the province of Tarragona. PATIENTS AND METHODS: One hundred and fifty-six sera obtained from 116 patients with inflammatory bowel disease (75 ulcerative colitis and 41 Crohn's disease) and 40 healthy controls were tested using an indirect immunofluorescence assay. RESULTS: ANCA were detected in 65% of patients with ulcerative colitis but in only 12% of patients with Crohn's disease (p < 0.01), and 2.5% of control subjects (p < 0.01). The overall sensitivity of the test for the diagnosis of ulcerative colitis was 65% with a specificity of 88% and a positive predictive value of 91%. Among patients with ulcerative colitis there was no relationship between the presence or titre of ANCA and the duration, the clinical course, the extent, the disease activity or the need for medical treatment. CONCLUSIONS: In the population studied, ANCA occur more commonly in ulcerative colitis than in Crohn's disease, as reported in other populations. Their determination in patients with inflammatory bowel disease may be useful to differentiate ulcerative colitis from Crohn's disease.

Adult↗