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Biomedical subjects

F Pardo

Publications and source records attributed to F Pardo.

At least 55 records · Page 3Linked to original sources
PubMed1998

Repair of ventral hernias with expanded polytetrafluoroethylene patch.

BACKGROUND: Operations for large and recurrent abdominal hernias have a high associated recurrence rate, although it is lower when prosthetic material is used. Expanded polytetrafluoroethylene (ePTFE) seems to be the best tolerated prosthetic material in surgery. METHODS: A series of 45 ventral hernias repaired using ePTFE for closure or reinforcement of the herniorrhaphy has been evaluated prospectively. Thirty-six were midline incisional hernias and nine were transverse or pararectal ventral hernias. There were 13 recurrent ventral hernias and three defects were operated as an emergency procedure. The patch was sutured to the anterior aponeurosis with a running non-absorbable suture. Some other kind of intra-abdominal procedure was undertaken in 12 cases. RESULTS: ePTFE was well tolerated. Complications occurred in five patients. Major complications were found in three patients: cutaneous necrosis requiring a myocutaneous flap; and infection of the prosthesis (primary, and secondary to enterocutaneous fistula due to diverticulitis, both requiring removal of the patch). Mean follow-up was 39 months and hernia recurrence occurred in only one patient. CONCLUSION: This clinical experience shows that ePTFE is a very reliable prosthetic material for the repair of abdominal wall hernias.

Adult↗
PubMed1998

Liver transplantation in cirrhotic patients over 60 years of age.

Although life expectancy in Spain is above seventy years, age over sixty is considered a relative contraindication for liver transplantation (LT) in most centers. The aim of this study was to assess the outcome of LT in patients over sixty years of age comparing them to patients under that age. From January 1992 to August 1995, 61 cirrhotic patients underwent LT at our institution; of them, 43 (group I) were younger than 60 years (mean +/- SEM: 51.9 +/- 0.9 years, range: 37-59) and 18 patients (group II) were 60 years or older (64.1 +/- 0.7, range: 60-71). Main pre-transplant variables (sex, etiology of liver disease, presence of hepatocarcinoma, Child-Pugh's score and renal function) were similar in both groups. The follow-up (median and range) for group I was 28 and 3-47 months, and for group II 16.5 and 3-48 months. Actuarial survival rates at one and four years post-LT were respectively 88.3% and 85.6% for group I, and 87.8% and 87.8% for the group II (p = n.s.). There were no differences between both groups regarding the incidence of rejection, major infections, neurologic complications, renal failure, pathological bone fractures, diabetes mellitus or hypertension. Nevertheless, cardiovascular complications were significantly more frequent in group II (p = 0.002) although they were not the cause of death. In conclusion, our results show that the outcome of LT in patients over sixty years old is comparable to that observed in patients under that age. LT should not be contraindicated on the only basis of an age greater than 60 years.

Adult↗
PubMed1998

Preoperative chemotherapy followed by esophagectomy compared with surgery alone in the treatment of squamous cell carcinoma of the esophagus.

The aim of this study is to assess the effect of concomitant preoperative radio-chemotherapy in the treatment of epidermoid esophageal cancer. We studied a total of 45 patients, divided into two groups. Group I consisted of 20 patients diagnosed with epidermoid esophageal cancer who had been treated initially with esophagectomy. Group II consisted of 25 patients treated with preoperative radiotherapy and two cycles of chemotherapy (cisplatin and 5-fluorouracil), one at the beginning and the other at the end of the radiation treatment, on whom an esophagectomy was subsequently performed. The clinical characteristics were similar in both groups. In group II, there were 12 cases (48%) with absence of tumor in the esophageal wall, three of which had node involvement. The operative mortality was similar in both groups (10% and 8% respectively). The only significant difference found in the postoperative complications was the incidence of anastomotic leak; but this was related to the different esophagectomy techniques used rather than the type of therapy. A decrease in the number of patients with tumor recurrence was observed in Group II, especially where the local component was concerned. The best actuarial survival rate at five years was in patients with no presence of tumor after neoadjuvant treatment (44.4%). However, the radio-chemotherapy seems not to have had any benefit in cases with node involvement.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Patterns of failure and long-term results in high-risk resected gastric cancer treated with postoperative radiotherapy with or without intraoperative electron boost.

BACKGROUND: To evaluate the possible role of adjuvant radiotherapy in the management of high-risk resected gastric carcinoma. METHODS: From 1982 to 1993, 62 patients surgically resected of a primary gastric cancer with adverse pathological features (serosal and/or regional lymph node involvement) were treated with postoperative radiotherapy with (Group I) or without (Group II) intraoperative electron boost to the surgical bed and coeliac axis (IORT). RESULTS: After a median follow-up of 75.6 months (range 4-120+) for IORT patients and 91.2 months (range 6-149+) for non-IORT patients, overall relapse rates for Group I and Group II patients were 44.5% and 48.6% and local-regional relapse rates were 11.1% and 20%, respectively. Actuarial survival rates projected at the maximum follow-up were 41% and 38% in Groups I and II, respectively. CONCLUSIONS: This retrospective analysis suggests a beneficial effect of adjuvant external radiotherapy in promoting local-regional control in high-risk resected gastric cancer.

Adult↗
PubMed1997

Hemostatic markers in surgery: a different fibrinolytic activity may be of pathophysiological significance in orthopedic versus abdominal surgery.

Without prophylaxis, patients subjected to major abdominal surgery have a risk of deep vein thrombosis of approximately 30%, while the rate varies between 40% and 60% in orthopedic surgery. The reasons for this discrepancy are not completely understood. The present study was designed to compare the pre- and postoperative behavior of different coagulation and fibrinolysis parameters in patients undergoing both types of surgery, receiving low molecular weight heparin prophylaxis. Samples were taken before operation and on postoperative days 1, 3, and 7. The following parameters were assessed: prothrombin fragment 1 + 2, thrombin-antithrombin III complexes, fibrinopeptide A, tissue plasminogen activator, plasminogen activator inhibitor, plasmin-alpha 2-antiplasmin complexes, and fibrin degradation products. We found a significant increase in the clotting markers postoperatively compared with preoperative values (P < 0.05), both in abdominal and orthopedic surgery, indicating a marked hemostatic activation which remained until postoperative day 7. A significant increase in plasminogen activator inhibitor (P < 0.01) and a decrease in tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes was also observed early after operation. The plasminogen activator inhibitor activity decreased, while tissue plasminogen activator and plasmin-alpha 2-antiplasmin levels increased significantly on days 3 and 7 (P < 0.05). Fibrin degradation products significantly increased throughout the postoperative period (P < 0.01). Preoperatively, we found higher plasminogen activator inhibitor activity and lower tissue plasminogen activator and plasmin-alpha 2-antiplasmin complexes (P < 0.05) in patients undergoing hip replacement compared with abdominal surgery. Fibrin degradation products were also significantly lower on postoperative day 3 in patients undergoing hip replacement (P < 0.01). We suggest that the lower preoperative fibrinolytic activation observed in patients undergoing orthopedic surgery compared with abdominal surgery might have pathophysiological consequences. Our results also indicate that the hemostatic activation persists beyond the 7th postoperative day despite prophylaxis.

Abdomen↗
PubMed1997

Genetic history of cystic fibrosis mutations in Italy. I. Regional distribution.

Earlier analysis of the Italian population showed patterns of genetic differentiation that were interpreted as being the result of population settlements going back to pre-Roman times. DNA disease mutations may be a powerful tool in further testing this hypothesis since the analysis of diseased individuals can detect variants too rare to be resolved in normal individuals. We present data on the relative frequencies of 60 cystic fibrosis (CF) mutations in Italy and the geographical distribution of the 12 most frequent CF mutations screened in 3492 CF chromosomes originating in 13 Italian regions. The 12 most frequent mutations characterize about 73% of the Italian CF chromosomes. The most common mutation, delta F508, has an average frequency of 51%, followed by N1303K and G542X, both with average frequencies around 5%. Multivariate analyses show that the relative frequencies of CF mutations are heterogeneous among Italian regions, and that this heterogeneity is weakly correlated with the geographical pattern of non-DNA 'classical' genetic markers. The northern regions are well differentiated from the central-southern regions and within the former group the western and eastern regions are remarkably distinct. Moreover, Sardinia shows the presence of mutation T338I, which seems absent in any other European CF chromosome. The north-western regions of Italy, characterized by the mutation 1717-1G-->A, were under Celtic influence, while the north-east regions, characterized by the mutations R1162X, 2183AA-->G and 711 + 5G-->A, were under the influence of the Venetic culture.

Cystic Fibrosis↗
PubMed1997

Increased arterial intima-media thickness in childhood-onset growth hormone deficiency.

Very little is known about the atherosclerotic risk in patients with childhood-onset growth hormone deficiency (GHD). Such data may be relevant to reconstructing the natural course of the cardiovascular abnormalities associated with GHD. To this end, the intima-media thickness (IMT) of the carotid arteries and the vascular risk factors were evaluated in 14 childhood-onset GHD patients (age 25 +/- 1 yr, BMI 22 +/- 0.6 Kg/m2) and in 14 age-, sex-, and BMI-matched control subjects. IMT was greater in GHD patients (0.83 +/- 0.06 and 0.81 +/- 0.06 mmol/L for the right and left carotid artery) than in controls (0.64 +/- 0.03 and 0.64 +/- 0.04 mmol/L, P < 0.01 and P < 0.02, respectively). Serum total and lipoprotein cholesterol, and serum total triglycerides did not differ between the two groups. However, a significant increase in low density lipid triglycerides was present in GHD patients (0.27 +/- 0.02 mmol/L) compared with controls (0.19 +/- 0.01; P = 0.007). No difference was found in plasma fibrinogen and serum Lp(a) levels. Plasma glucose and insulin concentrations were similar in GHD and control subjects both in the fasted state and after an oral glucose load. In conclusion, young patients with childhood-onset GHD show an increased IMT in the absence of clear-cut abnormalities of the classic vascular risk factors. This suggests a role for GH deficiency per se in increasing the atherosclerotic risk.

Adolescent↗
PubMed1997

Giant megalo-ureter and duplex kidney in an asymptomatic adult.

An abdominal mass was palpated in an asymptomatic adult during a routine medical check-up. Ultrasonography and computed tomography scan diagnosed a simple renal cyst, a mesenteric cyst and a seminal vesicle cyst. At laparotomy a complete ureteral duplication and a giant ectopic megalo-ureter were diagnosed. Other complications were ruled out in the follow-up. Ureterectomy without heminephrectomy was performed and the patient remains asymptomatic 5 years after surgery.

Abnormalities, Multiple↗
PubMed1997

[Clinical and epidemiologic study of meningococcal meningitis in the health region of Santiago de Compostela (1990-1997)].

BACKGROUND: The aim of this study was to determine the clinico-epidemiologic characteristics of meningitis caused by Neisseria meningitidis. METHODS: A retrospective study was performed of the bacterial meningitis with LCR positive cultures for Neisseria meningitidis from January 1990 to 31 March, 1997. To calculate the rate of incidence data from the 1990 population census were used corresponding to a population of 465,786 inhabitants per year attended in our hospital. RESULTS: A growth was observed in the strains of N. meningitidis in 61 LCR, representing 30% of all positive LCRs. Thirty-three strains belonged to serogroup B (54%) and 28 of serogroup C (46%). Ninety-one point nine percent of the cases were found in patients under the age of 20. The annual rates of incidence ranged from 2.3 cases/100,000 inhabitants in 1990 to 3.4 cases/100,000 inhabitants in 1996 with a slight decrease between these two dates. In patients under the age of 15 years, the rates of incidence ranged from 12.3/100,000 in 1990 to 13.4 per 100,000 inhabitants in 1996. In the remaining years the rates decreased with a minimum of 2.2 cases/100,000 inhabitants. The incidence for N. meningitis serogroup C ranged from 0 to 0.9 cases/100,000 inhabitants between 1990 and 1995. In 1996 the rate increased up to 2.6 cases/100,000 inhabitants. The rate of mortality was 6.6% and sequelae 8.7%. Since 1995 strains with decreased sensitivity to penicillin have been isolated, with percentages ranging from 20% to 56.25%. All strains remained sensitive to third generation cephalosporins and rifampicin. CONCLUSIONS: Neisseria meningitidis remains the most frequent etiologic agent of acute bacterial meningitis. The increase in serogroup C strains and the ever more frequent appearance of strains with decreased resistance to penicillin are confirmed, as is the persistence of high levels of endemia in our medium.

Adolescent↗
PubMed1996

A preliminary study of growth hormone in the treatment of dilated cardiomyopathy.

BACKGROUND: Cardiac hypertrophy is a physiologic response that allows the heart to adapt to an excess hemodynamic load. We hypothesized that inducing cardiac hypertrophy with recombinant human growth hormone might be an effective approach to the treatment of idiopathic dilated cardiomyopathy, a condition in which compensatory cardiac hypertrophy is believed to be deficient. METHODS: Seven patients with idiopathic dilated cardiomyopathy and moderate-to-severe heart failure were studied at base line, after three months of therapy with human growth hormone, and three months after the discontinuation of growth hormone. Standard therapy for heart failure was continued throughout the study. Cardiac function was evaluated with Doppler echocardiography, right-heart catheterization, and exercise testing. RESULTS: When administered at a dose of 14 IU per week, growth hormone doubled the serum concentrations of insulin-like growth factor I. Growth hormone increased left-ventricular-wall thickness and reduced chamber size significantly. Consequently, end-systolic wall stress (a function of both wall thickness and chamber size) fell markedly (from a mean [+/-SE] of 144+/-11 to 85+/-8 dyn per square centimeter, P<0.001). Growth hormone improved cardiac output, particularly during exercise (from 7.4+/-0.7 to 9.7+/-0.9 liters per minute, P=0.003), and enhanced ventricular work, despite reductions in myocardial oxygen consumption (from 56+/-6 to 39+/-5 ml per minute, P=0.005) and energy production (from 1014+/-100 to 701+/-80 J per minute, P=0.002). Thus, ventricular mechanical efficiency rose from 9+/-2 to 21+/-5 percent (P=0.006). Growth hormone also improved clinical symptoms, exercise capacity, and the patients' quality of life. The changes in cardiac size and shape, systolic function, and exercise tolerance were partially reversed three months after growth hormone was discontinued. CONCLUSIONS: Recombinant human growth hormone administered for three months to patients with idiopathic dilated cardiomyopathy increased myocardial mass and reduced the size of the left ventricular chamber, resulting in improvement in hemodynamics, myocardial energy metabolism, and clinical status.

Adult↗
PubMed1996

[Resistance of Mycobacterium tuberculosis in the province of Castellón].

We conduced a cross-sectional study to determine the prevalence of resistant mycobacteria in our setting. All patients in whom M. tuberculosis had been isolated in cultures of clinical samples (119) between January 1992 and December 1993 took part in the study. Canetti's method of percentages was used for the study of sensitivity to the following drugs: isocyanide, rifampicin, streptomycin, ethambutol and para-aminosalicylic acid. Overall resistance of M. tuberculosis was 9.24%. Specifically, we found resistance to isocyanide in 5.9%, to streptomycin in 4.20%, to rifampicin in 5.04% and to ethambutol in 1.68%. Resistance was primary in 7% and secondary in 21.05%; 2% showed primary resistance to isocyanide, 1% to isocyanide and rifampicin, 2% to streptomycin, 1% to ethambutol and 1% to streptomycin and rifampicin. These resistance indices are in keeping with those published for other areas of Spain.

Adolescent↗
PubMed1996

Further evidence that infection is an infrequent cause of first trimester spontaneous abortion.

A previous cohort study found no clinical evidence that infection occurred more often in subjects experiencing pregnancy loss compared with those experiencing successful pregnancy [Simpson et al. (1996) Hum. Reprod., 11, 668-672]. Given these surprising findings, we conducted a similar analysis on another cohort also followed prospectively. Using couples practising natural family planning for conception or contraception, information on clinical evidence of infection was gathered beginning with week 5 of gestation. Information on fever and signs of overt infection was specifically sought by interview and physical examination. Frequencies of urinary, vaginal and other infections in subjects experiencing pregnancy loss were 11.1, 9.5 and 8.7% respectively, not significantly different from rates in subjects having liveborns (10.1, 10.2 and 10.3% respectively). Thus, no association between clinical infection and early pregnancy loss (< or = 16 weeks) was observed. Cohort studies utilizing biologically based assays are awaited because extant data do not provide evidence that clinically evident infections play major roles in first trimester pregnancy losses.

Abortion, Spontaneous↗