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Biomedical subjects

J Fernández-Llamazares

Publications and source records attributed to J Fernández-Llamazares.

At least 19 recordsLinked to original sources
PubMed2004

Screening for occult cancer in patients with acute deep vein thrombosis or pulmonary embolism.

Patients with acute venous thromboembolism have an increased risk for occult malignancy. Limited screening for these malignancies has become common practice but little is known about its usefulness. This is a prospective cohort follow-up study in consecutive patients with acute venous thromboembolism. All patients underwent a routine clinical evaluation for malignancy, if negative, followed by a limited diagnostic work-up consisting of abdominal and pelvic ultrasound and laboratory markers for malignancy. Clinical follow-up was conducted to detect screening failures. The routine clinical evaluation was performed in 864 patients and revealed malignancy in 34 (3.9%) of them. Among the remaining 830 patients the limited diagnostic work-up revealed 13 further malignancies. During follow-up, cancer became symptomatic in 14 patients who were negative for cancer at screening (sensitivity of limited diagnostic work-up, 48.1%). Malignancies that were identified by the limited diagnostic work-up were early stage in 61% of cases vs. 14% in cases occurring during follow-up. Most patients with occult cancer had idiopathic venous thromboembolism and were older than 70 years. A limited diagnostic work-up for occult cancer in patients with venous thromboembolism has the capacity to identify approximately one-half of the malignancies. Identified malignancies were predominantly in an early stage.

Acute Disease↗
PubMed2000

Evaluating the outcome of severe head injury with transcranial Doppler ultrasonography.

The authors conducted a study to determine the value of transcranial Doppler (TCD) ultrasonography in evaluating the outcome of severely head injured patients and to correlate the TCD values with those obtained from intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring. The authors conducted a prospective study of 125 patients with severe head injury (Glascow Coma Scale scores of less than 9) who underwent TCD ultrasonography according to the standard technique of insonating the middle cerebral artery (MCA) and measuring the mean blood flow velocity and pulsatility index within the first 24 hours of admission. The ICP and CPP values, as well as other clinical, analytical, and neuroimaging data, were also recorded. After 6 months, outcome was evaluated using the Glasgow Outcome Scale. Moderate disability and complete recovery were considered "good" outcome; death, vegetative state, and severe disability were considered "poor." In 67 patients (54%) good outcome was demonstrated whereas in 58 (46%) it was poor. The mean blood flow velocity of the MCA in patients with good outcome was 44 cm/second; in those with poor outcomes it was 36 cm/second (p < 0.003). The mean PI in cases of good outcome was 1 whereas in poor outcome was 1.56 (p < 0.0001). The correlations of ICP and CPP to PI were statistically significant (r2 = 0.6; p < 0.0001). When performed in the first 24 hours of severe head injury, TCD ultrasonography is valid in predicting the patient's outcome at 6 months and correlates significantly with ICP and CPP values.

Adolescent↗
PubMed1998

Endotoxin contamination may be responsible for the unexplained failure of human pancreatic islet transplantation.

Clinical transplantation of human islets has a disappointingly low rate of success. We report here the identification of a possible causative factor: endotoxin present in the collagenase preparations used to disperse the pancreatic tissue before islet purification and transplantation. Supporting evidence includes (1) detection of unexpectedly high levels of endotoxin in most collagenase solutions currently used to digest human pancreases; (2) demonstration that supernatants generated during islet separation are able to induce the inflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha) in macrophages; and (3) induction of IL-1, IL-6, and TNF-alpha in the islets during the separation procedure. Cytokine expression was assessed by reverse transcription-polymerase chain reaction and, for TNF-alpha, confirmed by enzyme-linked immunoabsorbent assay. It is proposed that endotoxin and locally induced cytokines carried over with the graft activate the endothelium and promote lymphomonocytic infiltration of grafted islets and surrounding liver tissue favoring primary nonfunction and early rejection. These results also have implications for the numerous experimental procedures that use collagenase, and they point to possible ways to improve islet preparation and transplantation protocols.

Adolescent↗
PubMed1998

[Primary gastrointestinal lymphomas: response to eradicative therapy and prognostic factors in 52 patients].

BACKGROUND: To analyze the response to eradicative therapy and prognostic factors in 52 patients with primary gastrointestinal lymphoma (PGIL) diagnosed at a single institution in a 13 year period. PATIENTS AND METHODS: The main clinical, biological and evolutive data were recorded. Pathologic diagnosis of PGIL was made according to the Working Formulation. Clinical stage was determined by the Ann Arbor system modified by Mushoff. The results of therapy as well as the influence of such characteristics on complete remission (CR), disease-free survival (DFS) and overall survival (OS) were studied. RESULTS: Mean age of the series was 53 years (SD 15). Thirty patients were males. HIV infection preceded PGIL diagnosis in 10 cases. Seventeen had bad performance status (ECOG 2-4) and 30 B symptoms. The PGIL localization was gastric in 31 cases and 29 had a low grade malignant lymphoma. B phenotype was demonstrated in 98% and 22 patients presented advanced stages (IIE2-IV). Treatment was radical surgery followed by intensive chemotherapy in 32 cases, intensive chemotherapy alone in 17, and surgical resection in 3. CR was obtained in 34 patients and 6 of them relapsed. The projected DFS from CR at 9 years was 72% and OS was 26%. CR and survival were not influenced by PGIL localization and treatment type. The main unfavourable prognostic factors were advanced stage (CR and OS), B symptoms (DFS and OS) and advanced ECOG score (CR, DFS and OS). Previous HIV infection had an independent prognostic influence on both CR and OS. CONCLUSIONS: In patients with PGIL, the achievement of CR, DFS and survival have been independent of the type of eradicative treatment used. Performance status, B symptoms and clinical stage have been the main prognostic factors. HIV infection carried an independent prognostic significance.

Adult↗
PubMed1998

Band erosion in patients who have undergone vertical banded gastroplasty: incidence and technical solutions.

OBJECTIVES: To study the incidence of band erosion in patients who have undergone vertical banded gastroplasty and to describe the reparative techniques used. DESIGN: A retrospective review case series. SETTING: A university hospital-based tertiary referral center. PATIENTS: Two hundred fifty consecutive morbidly obese patients who underwent vertical banded gastroplasty between 1987 and 1995. MAIN OUTCOME MEASURES: The development of band erosion into the stomach, reparative surgical techniques, and long-term weight loss control. RESULTS: Band erosion developed in 7 (2.8%) of the patients. Two patients had symptoms 1 month after undergoing forced endoscopy. Six patients required reoperation. The operative findings included 2 cases of "external" band erosion through the lesser curvature into the stomach and 4 cases of "internal" band erosion through the circular staple line. The surgical techniques used for repair depended on the radiological and endoscopic data and on the operative findings; the techniques included conversion into a gastric bypass, band replacement after the creation of a new stoma, and gastroplasty plus distal gastric bypass. There were no complications, and adequate long-term weight loss was achieved in all but 1 of the patients who underwent reoperation. CONCLUSION: Band erosion may be corrected using appropriate surgical techniques to allow for adequate long-term weight loss in patients who have undergone vertical banded gastroplasty.

Adult↗
PubMed1997

[Survey of residents on their satisfaction after obtaining a hospital post].

BACKGROUND: To evaluate the degree of satisfaction of the resident physicians in an university hospital by the election of the speciality and the hospital, after the takeover of the workplace and in the course of their period of residence. SUBJECTS AND METHODS: An anonymous questionnaire was distributed to the 164 residents of the hospital to know the concordance between the initial expectations of the residents and the degree of current satisfaction, about the specialty and the chosen hospital. RESULTS: 149 out of 164 residents (90.8%) answered the survey. In what is referring to the elected speciality, 57% (85 residents) expressed to be satisfied or very satisfied by their election; 22% (33 residents) felt indifferent, and 21% (31 residents) were unsatisfied or very unsatisfied. In what concerns to the chosen hospital, 43% (64 residents) were satisfied or very satisfied; 29% (43 residents) indifferent, and 28% (42 residents) were unsatisfied or very unsatisfied. With respect to the degree of satisfaction by the exercise of the profession at the moment of accomplishing the survey, 98% (143/149) of the residents answered, and of these, 30% (43 residents) expressed to be satisfied or very satisfied; 28% (40 residents), indifferent, and 42% (60 residents), unsatisfied or very unsatisfied. In the degree of satisfaction influenced in a statistically significant way the group of speciality chosen (medical, surgical or central services) after the examination and the moment of accomplishing the survey; the number of order of the residents examination; to have or not to have a speciality wished before of the residents examination, and the year of residence underway. CONCLUSIONS: The degree of satisfaction of the resident physicians by the election of the speciality and of the hospital is relatively low. This fact outlines the suitability of the election system of the specialty.

Adult↗
PubMed1993

[Advanced double gastric neoplasm].

Gastric cancer, shows a 14% incidence of multiplicity when stomachs obtained from gastrectomies are studied carefully. That's explained by the fact that near all multiple gastric neoplasias are early cancers, and a lot of them aren't diagnosed preoperatively. We present a rare case of multiple gastric cancer where both tumors were advanced and represented different types of neoplasia under Lauren's classification. Both tumors where diagnosed preoperatively.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Syngeneic islet transplantation into seminal vesicles of diabetic rats.

Pancreatic islet transplantation has been proposed as an attractive option for the treatment of type I diabetes. Transplantation into different sites has been investigated, among them those that are immuno-logically privileged (e.g., thymus, uterus, brain, anterior eye chamber, and testicle). Because of their characteristics, seminal vesicles could be considered as immunologically privileged organs, but there is no worldwide experience that can confirm it. The purpose of the present study is to assess the viability and functionality of islet transplantation into seminal vesicles of diabetic rats. One hundred ninety inbred adult male syngeneic Lewis rats were used as donors (n = 72), receptors (n = 36), and controls(n = 11). Diabetes was chemically induced through a single intraperitoneal injection of streptozotocin. Groups of 1200 purified islets were introduced in the right seminal vesicle of diabetic rats. Diabetic control rats were sham transplanted. Body weight and glycemia were monitored every 2 d. Of transplanted rats, 16.7% achieved a good function due to islet engraftment, while 30.6% achieved a partially good response, and 52.7% were considered as nonresponding. This is the first report about islet transplantation into seminal vesicles of diabetic animals. Our results indicate that islet transplantation into rat seminal vesicles is technically possible, and that islets can function normally after engraftment into the wall of the seminal vesicle.

Animals↗