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Biomedical subjects

G Rábago

Publications and source records attributed to G Rábago.

At least 19 recordsLinked to original sources
PubMed2006

[Heart transplant].

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

Actuarial Analysis↗
PubMed2006

[Cardiac and vascular homograft valves transplant].

The advances in the manipulation of human tissues, the development of cryobiology, paediatric cardiac surgery, the impossibility of obtaining an ideal prosthetic cardiac valve and the surgical treatment of cardiovascular infections have revived interest in the use of homografts. The donors of these homografts can be: a) Live donors: aortic and pulmonary valve of the recipient of a heart transplant; b) Multiorgan donors with a diagnosis of death according to neurological criteria, whose heart is rejected for heart transplant; c) Cadaver donors with asystolia of less than 8 hours. Homograft cardiac valves are the substitute of choice in aortic valve endocarditis, patients with counter-indications for anticoagulation, reconstruction of the outflow tract of the right ventricle, aortic valve replacement in children and young adults through the Ross operation, and an optional indication is the aortic valve and/or rising aorta replacement in patients over 60 years of age. Although there are not sufficiently broad series of homogratfs with arterial substitutes, with respect to the number of patients and time of evolution, the results suggest that this can benefit patients with vascular infection, immunodepressed patients or complex patients whose technique during the operation might require a homograft.

Adult↗
PubMed2006

[Cell transplant and regenerative therapy with stem cells].

One of the fields of medicine that has raised the most expectations in recent years is cell therapy with stem cells. The isolation of human embryo cells, the apparent and unexpected potentiality of adult stem cells and the development of gene therapy lead us to imagine a hopeful future for a significant number of diseases that are at present incurable. In this article we will sketch out the panorama of stem cell research, describing the main achievements in this field as well as some of the questions that await an answer. In spite of the great expectations, it is essential that we maintain a critical and realistic spirit when it comes to analysing the scientific advances in this area.

Adult Stem Cells↗
PubMed2003

Different expression of MMPs/TIMP-1 in human atherosclerotic lesions. Relation to plaque features and vascular bed.

BACKGROUND: Proteolytic imbalance might determine arterial remodeling and plaque destabilization in atherosclerotic vessels. The aim of this study was to examine differences in the patterns of metalloproteinases (MMPs) and MMP inhibitor (TIMP-1) expression in advanced human atheromas, both in relation to the plaque features and the vascular bed involved. METHODS AND RESULTS: Immunohistochemistry for MMP-1, -3, -9 and TIMP-1 as well as the collagen content were measured in vascular sections from patients undergoing peripheral revascularization (carotid n=11, femoral n=23) and aorto-coronary bypass surgery (mammary arteries n=20, as controls). Increased expression of all MMPs was detected in atherosclerotic as compared with control sections (P<0.01). Aneurysmal plaques showed a significant increase of MMP-1 and-3 and a reduction in total collagen (P<0.05) in relation to occlusive lesions. Calcification areas in atherosclerotic plaques were consistently associated with increased TIMP-1 expression (P<0.01). Finally, MMP-9 expression was higher in occlusive lesions from carotid than femoral arteries (P<0.01). CONCLUSIONS: Aneurysm lesions expressed higher MMP-1 and-3 expression than occlusive plaques, and MMP-9 was mainly detected in carotid as compared with femoral arteries. TIMP-1 was associated with arterial calcification. These differences in the MMPs/TIMP-1 expression might determine the evolution of advanced atherosclerotic plaques and contribute to its vulnerability.

Aged↗
PubMed2003

Platelet dysfunction in cardiopulmonary bypass: an experimental comparative study between a centrifugal and a new pulsatile pump.

The aim of this investigation was to study the effect of a new pulsatile pump for extracorporeal circulation (ECC) on platelet count and platelet function with respect to a Biomedicus centrifugal pump. Thirteen pigs, 8 in the pulsatile group (PG) and 5 in the centrifugal group (CG), underwent a partial extracorporeal circulation lasting 3 h. The animals were sacrificed 3 h post-ECC. The platelet study was both quantitative (platelet count) and qualitative (platelet function analysis) by assessing the closure time (CT) with a PFA-100 system. The decrease in platelet number from basal to 3 h post ECC was only significant in CG (p = 0.009). The platelet function was impaired in both groups, but the value of CT with col/ADP increased significantly only in CG (p < 0.001). The increase of CT with col/EPI was greater in CG (p = 0.07) than in PG (p = 0.2). The results indicated that the new pulsatile pump preserves platelets quantitatively and qualitatively well compared to a Biomedicus pump.

Acid-Base Equilibrium↗
PubMed2000

Thoracoabdominal aortic aneurysm repair in cardiac transplant recipients.

We present here two cases of asymptomatic thoracoabdominal aortic aneurysms that were successfully operated on in heart transplant patients 8 and 23 months after transplantation. Thoracoabdominal aortic aneurysm was present prior to transplantation in one patient. In the other patient only the abdominal aortic aneurysm was found before transplantation. Indications for transplantation were ischemic and valvular cardiomyopathy. Surgical aortic aneurysm repair was performed with the standard technique. Both patients were discharged from the hospital. The possible contributing factors to the development and enlargement of aortic aneurysms and perioperative assessment are also discussed. Radiologic surveillance is warranted in any heart transplant recipient with abdominal or thoracoabdominal aortic aneurysms because of the more rapid aneurysm expansion.

Aortic Aneurysm, Abdominal↗
PubMed1999

Combined surgical approach for sarcoma lung metastasis with atrial involvement.

A 20-year-old patient, who had been treated for a femur sarcoma with pulmonary metastases 8 years before, arrived at our institution with a new metastatic hilar lung nodule. During the standard lobectomy procedure an unexpected atrial invasion by the tumor was discovered. Intraoperative transesophageal echocardiography (TEE) showed a big pediculated tumor in the atrium. Cardiopulmonary bypass (CPB) was required in order to safely resect the atrial wall with the tumor. The atrial defect was repaired with a pericardial patch. Postoperative course was uneventful. After 14 months, the patient is asymptomatic and free of disease.

Adult↗
PubMed1999

Chronic aneurysm of the descending thoracic aorta presenting with right pleural effusion and left phrenic paralysis.

A 62-year-old man was admitted to the emergency department with chronic dysphagia and lower back pain. Chest radiography revealed a wide mediastinal shadow and an elevated left diaphragm, which proved to be secondary to left phrenic paralysis. The patient was diagnosed with an aneurysm of the descending thoracic aorta and was admitted to the hospital. After the patient was admitted, the aneurysm ruptured into the right chest. The patient underwent an emergency operation to replace the ruptured segment with a synthetic graft. Postoperative recovery and follow-up were uneventful. This report describes an unusual presentation of a thoracic aortic aneurysm. Hemidiaphragmatic paralysis caused by compression of the phrenic nerve is an unusual complication that, to our knowledge, has not been previously reported.

Aortic Aneurysm, Thoracic↗
PubMed1998

Coronary angioplasty and stenting following heart transplantation with older donors. Is this a rational approach?

The shortage of ideal donor hearts has led to an extension of the classical donor criteria of age. Higher incidence of focal coronary artery disease has been found in this older donor population requiring conventional angioplasty therapy. The authors present two patients with early coronary angiogram post transplantation, requiring angioplasty and stent in the lesions found.

Adult↗
PubMed1997

Long survival of a patient with paratesticular rhabdomyosarcoma with inferior vena cava involvement.

A 13-year-old boy with a paratesticular embryonal rhabdomyosarcoma and a large thrombus into the inferior vena cava reaching the suprahepatic vein is presented. We used cardiopulmonary bypass with deep hypothermic circulatory arrest to realize a complete exeresis of the tumor and thrombus, followed by systemic chemotherapy and radiotherapy. Ten years later the patient is alive and doing well without any sequelae.

Adolescent↗
PubMed1996

Heart-lung transplantation in situs inversus.

Reconstruction was accomplished in a 2 heart-lung recipients with situs inversus resulting in a left-sided systemic venous atrium. We created a large common atrium that was closed on the left side, leaving an atrial cuff on the inferior right quadrant. To this we anastomosed the donor right atrium, which had been opened laterally between the cavae. This resulted in some clockwise rotation of the ventricles and anterior positioning of the apex. The right pulmonary veins passed superior to the atrial anastomosis and posterior to the donor right atrium. Cardiopulmonary function was excellent in both cases.

Adolescent↗
PubMed1991

Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease.

Echinococcal infection of the heart is rare. The preoperative findings, with special attention to two-dimensional echocardiography (2DE), of six patients with cardiac echinococcosis and their surgical and pathological correlations are reported. Cardiac hydatid cysts (HCs) were located in the cardiac apex in three patients, in the upper part of the interventricular septum extending towards the anterior aspect of the heart in one and in the postero-superior right atrial wall in another patient. The remaining patient had multiple intrapericardial cysts. In three patients the cysts presented as well defined, rounded, echolucent masses within the myocardial wall bulging into the cardiac chambers. In two patients, the cysts had ruptured into a cardiac chamber with loss of the characteristic 'cystic' appearance; these cysts presented as an echogenic or solid mass protruding into a cardiac chamber. Finally, another patient had one HC with echolucent appearance and another HC in a different location with echogenic appearance; this last cyst corresponded to a degenerated HC. In two cases the cyst showed a loculated internal aspect. In one patient the myocardial segment involved by the cyst had a dyskinetic movement. In all six patients, 2DE accurately demonstrated the location and morphological details of the cardiac cysts, permitted recognition of the ruptured and/or degenerated cysts and was superior to thoracic computed tomography and angiography in the preoperative assessment of these patients. Nuclear magnetic resonance imaging (one patient) gave no further information to that obtained by 2DE. We conclude that 2DE is the technique of choice for an early diagnosis of this rare entity.

Adult↗
PubMed1991

Mechanical cardiac valve thrombosis. Is thrombectomy justified?

To determine the incidence and results of the treatment offered to acute thrombotic obstructions of mechanical valvular prostheses, we have reviewed a series of 3,637 consecutive hospital survivors who, between January 1970 and September 1990, underwent single mitral or aortic and double mitroaortic valve replacements (MVR, AVR, and DVR, respectively). The cumulative follow-up in these patients was 22,783 years (mean, 7.2 years; range, 0.6-19 years). Sixty-five patients (24 MVR, 13 AVR, and 28 DVR) experienced 72 thrombotic prosthetic obstructions (42 mitral and 41 aortic prostheses) at a mean interval of 3.4 years (range, 0.6-14 years) after the operation. The actuarial prosthetic thrombosis free estimates were 96 +/- 0.9% for MVR, 97 +/- 0.9% for AVR, and 96 +/- 0.8% for DVR (all NS). Mortality associated with prosthetic thrombosis was 25% (four in the MVR group, five in the AVR group, and seven in the DVR group). Fifty-seven patients (22 MVR, 12 AVR, and 23 DVR) underwent a total of 62 reoperations, with a hospital mortality of 17% (two MVR, four AVR, and four DVR). In 37 of the latter patients (20 MVR, three AVR, and 14 DVR), we performed valve replacement (31 mitral prostheses and 14 aortic prostheses), with a hospital mortality of 16% (six of 37) and only one case of subsequent rethrombosis (actuarial rethrombosis free estimate, 96 +/- 3.6%). Conversely, five of the 27 patients (actuarial rethrombosis free estimate, 41 +/- 20%) (two MVR, 11 AVR, and 14 DVR) (seven mitral prostheses and 21 aortic prostheses) whose prosthetic valves were debrided developed rethrombosis during follow-up (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗