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Biomedical subjects

F Gimeno

Publications and source records attributed to F Gimeno.

At least 19 recordsLinked to original sources
PubMed1996

Subacute occlusion, bleeding complications, hospital stay and restenosis after Palmaz-Schatz coronary stenting under a new antithrombotic regimen.

OBJECTIVES: This study was designed to evaluate the effect of an antithrombotic regimen without full early anticoagulation on subacute occlusion, bleeding, hospital stay and restenosis after elective coronary stenting. BACKGROUND: Subacute occlusion is a major limitation of stenting. Aggressive antithrombotic therapy is not fully prophylactic against this complication, carries risk of bleeding, prolongs hospital stay and reduces cost-effectiveness. METHODS: We studied 110 consecutive patients (121 lesions) who underwent elective Palmaz-Schatz stenting. Intravenous heparin was given only during the procedure. After stenting, patients took aspirin, dipyridamole, dextran, warfarin and low molecular weight heparin (enoxaparin, 40 mg subcutaneously daily, stopped when an international normalized ratio of 2 to 3 was achieved). The first 52 patients (group A) underwent coronary angiography 24 h after stenting, and hospital stay was extended until an international normalized ratio of 2 to 3.5 was achieved. The remaining 58 patients (group B) were discharged 24 h after stenting. Clinical and angiographic follow-up were performed 1 and 6 months after stenting for all patients. RESULTS: In group A the activated partial thromboplastin time remained normal (30 +/- 6.2 s [mean +/- SD]) during enoxaparin administration, and hospital stay was 9.1 +/- 4.3 days. In group B hospital stay was 27 +/- 8 h. No major cardiac events occurred within the first month in patients from both groups. At 1 and 30 days all stented lesions remained patent. Only two patients (1.8%, 95% confidence interval [CI] 0.32% to 7%) developed bleeding. At 6 months, the restenosis rate was 22% (95% CI 15% to 30%). CONCLUSIONS: After coronary stenting with optimal angiographic results, this new antithrombotic regimen prevented subacute stent occlusion and bleeding, with a brief hospital stay. No detrimental effect on the previously reported restenosis rate was observed.

Adult↗
PubMed1995

Use of intracavitary interferon-alpha-2b in the prophylactic treatment of patients with superficial bladder cancer.

BACKGROUND: The evolution of superficial transitional cell carcinoma (TCC) of the bladder poses a clinical management problem due to its tendency to recur after initial transurethral resection (TUR). Natural Killer (NK) cells are a distinct subset of lymphocytes that possess the ability to lyse tumor cells without prior sensitization in a nonmajor histocompatibility-restricted fashion. These cytotoxic cells constitute a relevant barrier against the local growth and systemic dissemination of neoplastic diseases. METHODS: The immunomodulatory effect, after TUR of the tumor, of the prophylactic treatment with intravesical instillations of interferon-alpha-2b (IFN-alpha-2b) upon the NK activity of peripheral blood mononuclear cells (PBMNC) in 17 patients with superficial TCC of the bladder was analyzed using a 4-hour 51sodium chromate (51Cr)-release cytotoxicity assay against both NK-sensitive, or K562, and NK-resistant, or JY, tumor target cells. RESULTS: There were no significant modifications of the NK activity of PBMNC during the 3 months of IFN-alpha-2b intracavitary treatment (P > 0.05). However, with respect to their levels before treatment, NK activity in PBMNC at 3 months posttreatment was enhanced significantly in the 14 patients who showed no sign of tumor recurrence in the 12 months of follow-up (P < 0.01). Six months after finishing the intracavitary IFN-alpha-2b instillations, the PBMNC NK activity in these patients had returned to the levels found before initiating the therapy (P > 0.05). This temporary enhancement of the PBMNC NK activity was not found in three patients with evidence of tumor recurrence at some time during the 12 months after treatment. In similar experimental conditions, significant enhancement of the NK activity in PBMNC was not observed in nine patients with superficial bladder TCC who were treated with intracavitary instillations of mitomycin C (MMC) after the TUR of the tumor and who were free of recurrence of the disease at 1 year of follow up. CONCLUSION: The prophylactic intracavitary treatment of superficial bladder TCC with IFN-alpha-2b may induce an immunomodulatory effect in the NK activity of PBMNC that appears to be associated with the clinical evolution of the disease.

Administration, Intravesical↗
PubMed1995

Non-surgical treatment of ectopic pregnancy in the sole remaining tube.

We reported on three successive cases of intrauterine term pregnancy obtained in patients with an ectopic gestation in their solitary remaining tube who were treated by three different non-surgical conservative methods: parenteral methotrexate, local injection of methotrexate combined with systemic administration, and expectant management respectively. The opposite tube had been removed because of previous tubal ectopic pregnancy. The cases, which were at a high risk of repeated ectopic implantation, are unequivocal proof of intact function of a tube after conservative non-surgical procedures for ectopic pregnancy. Thus, our report adds further evidence favouring the feasibility, the safety and fertility potential of these procedures for selected unruptured tubal gestations.

Chorionic Gonadotropin↗
PubMed1994

Respiratory resistance measured by flow-interruption in a normal population.

Data on reference values of total respiratory resistance (Rint) in healthy people are limited. The aim of this study was to examine the relationship between Rint and gender, height, weight, age and smoking habits. The instrument used was the Jaeger Pneumoscope with a flow interruption device. The method is based on transient interruption of airflow at the mouth for a brief period during which alveolar pressure equilibrates with mouth pressure. Measurement of mouth pressure is used to estimate alveolar pressure prior to interruption. The ratio of this to the flow prior to interruption gives airway resistance. The Rint data were correlated with height, weight, age, gender and smoking habits in 172 healthy subjects. They had a normal lung function (VC, FEV1) and no signs of pulmonary disease. The important determining factor for the value of the Rint were height and age. The mean Rint of 172 subjects was 0.38 +/- 0.17 kPa.1-1.s. The average within-subject variability of repeated measurements of Rint expressed as coefficient of variation was 14.4 +/- 6.9%. Reference equation and normal values for Rint in a healthy population are related to height and age. The measurements were obtained with a commercially available interruption technique.

Adolescent↗
PubMed1993

Signet-ring cell adenocarcinoma of bladder.

Three cases of signet-ring cell adenocarcinoma of the bladder are presented: a primary vesical adenocarcinoma, a metastatic one, and a signet-ring cell adenocarcinoma of the urachus. A review of the literature found 69 additional reports of primary signet-ring cell adenocarcinoma, 20 of urachal signet-ring carcinoma, and 4 of the metastatic variety. The pathogenesis, clinical, and histologic findings, prognosis, and management are discussed.

Adenocarcinoma, Mucinous↗
PubMed1993

Effect of intramuscular administration of thiazinamium and inhaled histamine on forced inspiratory volume in 1 s.

Twenty-one patients with symptoms suggestive of asthma were evaluated clinically by allergy skin tests, pulmonary function, and histamine inhalation challenge. In addition to the forced expiratory manoeuvres (FEV1), forced inspiratory manoeuvres (FIV1), were performed before and after intramuscular administration of thiazinamium (Multergan), a bronchodilator with markedly anticholinergic properties. The same lung function parameters (FEV1 and FIV1) were obtained before and after histamine inhalation challenge. The response after bronchodilatation in litres of FEV1 2.42 +/- 1.12 to 3.27 +/- 0.98 (mean +/- SD) was much larger than in FIV1 3.44 +/- 1.35 to 4.05 +/- 1.14 (p < 0.05). After histamine inhalation the observed decrease in FEV1 (2.65 +/- 0.99 to 2.06 +/- 0.89) was not so great as in FIV1 (3.76 +/- 1.09 to 2.90 +/- 1.15) (p < 0.02). These results suggest that patients often have more difficulty with inspiration rather than expiration.

Adolescent↗
PubMed1993

Plethysmographic parameters in the assessment of reversibility of airways obstruction in patients with clinical emphysema.

Slow inspiratory vital capacity (IVC) and forced expiratory volume in 1 s (FEV1) before and after an inhaled beta-agonist are widely used to detect reversible airflow limitation in patients with chronic obstructive lung disease. The measurement of airways resistance (Raw) during quiet breathing with the body plethysmograph is less frequently used. It may well be of importance in clinical emphysema where measurement of FEV1 is confounded by the collapse of the bronchi, which does not occur when measuring Raw during quiet breathing. We assessed whether Rrs, in addition to IVC and FEV1, can be used to gain a better insight into the reversibility with 400 micrograms of fenoterol in patients with clinical emphysema. We studied a group of 51 patients (9 women and 42 men; mean [+/- SD] age, 64.7 [7.7] years) who had a clinical diagnosis of emphysema. Significant reversibility was identified by spirometry (IVC, FEV1) and body plethysmography (Raw) in 20 patients (39 percent). Inspiratory vital capacity alone identified reversibility of airflow limitation in 11 patients (22 percent). In 5 patients (10 percent), the postbronchodilator improvement was seen exclusively in the Raw measurement. In the remaining patients, absence of improvement in spirometric and plethysmographic parameters was found. Subjective improvement occurred to the same extent in patients whose Raw and IVC improved. We concluded that Raw gives important information about the reversibility of airways obstruction in patients with clinical emphysema. Therefore, we suggest that tests during quiet breathing should be part of the routine examination of airways obstruction in patients with "irreversible" obstruction by conventional spirometry.

Administration, Inhalation↗
PubMed1993

Variability of forced oscillation (Siemens Siregnost FD 5) measurements of total respiratory resistance in patients and healthy subjects.

The reproducibility of total respiratory resistance (Rrs) measured with a simplified forced oscillatory method (Siemens Siregnost FD 5) was measured and compared with that of slow inspiratory vital capacity (IVC) and forced expiratory volume in one second (FEV1). The former technique has the advantage that assessment of bronchial obstruction can be made without a forced maneuver, which may be difficult in patients with chronic obstructive pulmonary disease (COPD). We used the criteria proposed by the American Thoracic Society for the diagnosis of COPD. Pulmonary function tests (IVC, FEV1 and Rrs) were measured in seven healthy subjects and in two groups of patients with COPD. First one technician performed six measurements of IVC, FEV1 and Rrs in all subjects during a period of 90 minutes on the same day. Second to evaluate intraindividual variability the measurements were performed on ten subsequent days. The median interval (range) between the first and last measurements in days was 38 (20-186). The mean +/- SD coefficient of variation (CV) Rrs in patients was 15.7% +/- 5.0% and in normals, 10.8% +/- 3.2%. There was less variation in the FEV1 value of 11.0% +/- 6.2% and normals, 2.2% +/- 1.0%; and IVC, 6.9% +/- 5.0% and normals, 2.4% +/- 0.7%. There is no correlation between age and CV. It is concluded from the study that oscillatory Rrs has a larger coefficient of variation within one patient than FEV1 or IVC. If Rrs is used for longitudinal follow-up in COPD patients, we suggest that variations less than 26% (mean +/- 2 SD) can be considered the result of "spontaneous" variation in lung function.

Adult↗
PubMed1992

Intestinal tuberculosis in AIDS.

The radiological appearance of intestinal tuberculosis (IT) in six patients with AIDS is presented. Involvement of the ileocecal segment (five cases), cecum (four cases), and duodenum (one case) was seen on computed tomographic (CT) or barium studies. There were no significant differences in radiological manifestations of IT among patients with or without AIDS, but all six patients had an advanced stage of their disease at the time of diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Comparison of histamine and acetylcholine for use in bronchial challenge testing in atopic and nonatopic subjects with chronic airways obstruction: a review of 180 cases.

A retrospective study was performed to evaluate the diagnostic yield for bronchial hyperresponsiveness from histamine and acetylcholine challenge tests. The records of 180 cases from the last 10 years were analysed. They were selected because their hyperresponsiveness to inhaled histamine or acetylcholine was equal or less than 32 mg.ml-1. Increasing doses of histamine and acetylcholine were given up to a maximum of 32 mg.ml-1 according to the method of de Vries et al. [3]. The challenges were accomplished on two separate days. The provocative dose of agonist causing a 20% fall in FEV1 (PC20) was noted. The interrelationships between smoking history, objective markers of allergy, patient's complaints, histamine and acetylcholine responsiveness were examined. Separate statistical analyses are presented for atopic and nonatopic subjects with chronic airways obstruction. More subjects had a measurable PC20 with acetylcholine than with histamine (43 vs. 16 subjects, p < 0.0001). Using the chi 2 test, the relationship between PC20 histamine and PC20 acetylcholine was similar in smokers and nonsmokers, and in atopics and nonatopics. It is concluded that for an equal molar basis, acetylcholine evokes a higher frequency of bronchus obstruction than histamine in patients.

Acetylcholine↗
PubMed1992

Comparison of three normal breathing techniques to assess reversibility of airway obstruction.

Measurement of forced expiratory volume in one second (FEV1) is generally used to assess airway obstruction. Function tests during normal breathing are used as complementary tests as well as alternatives. Studies have been done comparing the esophageal pressure method with body plethysmography, and respiratory acoustical impedance with body plethysmography. We have not found any other studies comparing all three methods in the same subject. It is not clear whether those tests contribute to the assessment of reversibility of airways obstruction. We addressed the following questions: (1) How does the response of FEV1 to an inhaled beta agonist (400 micrograms fenoterol) relate to the response of lung function tests during normal breathing? (2) Are values obtained with three normal breathing techniques comparable in assessing severity of obstruction? We collected these data in 17 patients. A significant correlation was found between airway resistance measured with any of the three methods. The scatter was large, both before and after bronchodilation. The reversibility by the three methods expressed as absolute values (before and after inhalation) were comparable. In order of preference it appears that acoustical impedance is to be preferred to esophageal pressure because of less discomfort to the patient, and to body plethysmography because of the lower cost of the apparatus. Acoustical impedance can be used to assess acute changes in bronchomotor tone.

Adult↗
PubMed1992

Forced oscillation technique. Reference values for total respiratory resistance obtained with the Siemens Siregnost FD5.

Total respiratory resistance (Rrs) was measured by the application of a sine wave of airflow to the mouth at an oscillation frequency of 10 Hz. The instrument used was the Siemens Siregnost FD5. The Rrs data were correlated with height, age, sex, and weight in 73 patients and 29 healthy subjects. The patients took part in a rehabilitation program for restoration of their locomotion function. Both groups had normal lung function (VC, FEV1) and no signs of pulmonary disease. The only important determining factor for the value of the Rrs was height. The mean Rrs of 102 subjects was 0.29 +/- 0.08 kPa.1-1.s. Other studies gave values between 0.23 +/- 0.05 and 0.32 +/- 0.10 kPa.1-1.s.

Adult↗
PubMed1990

Effect of theophylline on cortisol plasma concentrations in patients with chronic obstructive pulmonary disease.

To further understand the therapeutic action of theophylline, we investigated, in a randomized double-blind crossover study, the effects of a 4-day treatment with two different dosage regimens of theophylline on the circadian rhythm of cortisol plasma concentrations in seven COPD patients. Both theophylline regimens resulted in plasma concentrations in the therapeutic range (more than 7.5 mg/l). No significant differences between placebo and the active trial periods in the circadian rhythm of cortisol secretion were found. These results suggest that cortisol secretion is not influenced by therapeutic plasma concentrations of theophylline.

Aged↗
PubMed1989

Chronopharmacodynamics and kinetics after symmetric and asymmetric multiple theophylline doses in patients with chronic obstructive pulmonary disease.

In a randomized double-blind crossover study, the effects of 4 days of symmetric or asymmetric dosing with sustained-release theophylline (Sabidal-SR) were compared with placebo in ten patients with chronic obstructive pulmonary disease in a stable state. The doses were 450 mg b.i.d. and 270 mg plus 630 mg, respectively. Special attention was paid to circadian rhythms in pharmacokinetics and pharmacodynamic effects, during 24 h of measuring. The peak plasma theophylline concentrations at night with a symmetric dosage were lower than with an asymmetric dosage: 11.5 mg/l (+/- 3.8) and 13.6 mg/l (+/- 4.4), respectively. Both theophylline regimens caused a significant increase in vital capacity (8%) and in forced expiratory volume in one second (15%), and also a decrease of specific viscous work of breathing (49%). There were no significant differences in pharmacodynamic effects between the symmetric and asymmetric dosing regimen. An exception was the heart rate, that increased significantly only with an asymmetric dose. We found no correlation between the theophylline plasma concentration and the changes in lung function and heart rate. Theophylline had no influence on subjective findings of the patients, nor on the oxygen saturation of the blood during sleep.

Absorption↗
PubMed1988

A placebo-controlled comparison between the bronchodilatory effects of ipratropium bromide inhaled as a dry powder and by metered dose inhaler in chronic obstructive pulmonary disease.

A placebo-controlled study was performed to compare the effect of the inhalation of ipratropium bromide as a powder (capsule = 40 micrograms) and by pressurized aerosol (two puffs of 20 micrograms; ie, 40 micrograms). Fifteen patients (nine males and six females) with chronic obstructive pulmonary disease were studied in a double-blind crossover comparison of the two different modes of administration. The VC, FEV1 and viscous work of breathing time-response curves were almost identical, indicating bronchodilation. We conclude that in patients with chronic obstructive pulmonary disease, the powder inhalation was not more effective than the pressurized aerosol. It could, however, be offered as an alternative to patients with poor hand-lung coordination. The patients tolerated the two modes of administration without difficulties: no local irritation or coughing was observed.

Administration, Inhalation↗