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Biomedical subjects

J Figueras

Publications and source records attributed to J Figueras.

At least 19 recordsLinked to original sources
PubMed1997

Medical management of selected patients with left ventricular free wall rupture during acute myocardial infarction.

OBJECTIVES: This study sought to evaluate the effects of prolonged rest and blood pressure control on survival of patients in whom left ventricular free wall rupture (LVFWR) was strongly suspected. BACKGROUND: Left ventricular free wall rupture in myocardial infarction is often fatal, and only a few patients may undergo operation. However, survival without surgical repair has not yet been evaluated. METHODS: Eighty-one consecutive patients with a first transmural acute myocardial infarction in Killip class I or II who presented with acute hypotension due to cardiac tamponade, with electromechanical dissociation (EMD) in 72, were prospectively evaluated. Patients with early recovery were managed with prolonged bed rest and blood pressure control with beta-blockade as tolerated. RESULTS: Forty-seven patients died within 2 h of acute tamponade, and autopsy in 21 showed LVFWR in all. In 15 others, an emergency surgical repair resulted in 2 survivors. The remaining 19 patients, 10 with EMD, had early recovery with dobutamine and colloid solution, and 15 required pericardiocentesis. Shortly thereafter, these 19 patients still showed a paradoxic pulse > or = 20 mm Hg, relevant pericardial effusion (24 +/- 7 mm [mean +/- SD]) and comparable elevation of right and left ventricular filling pressures (15.8 +/- 3.9 and 15.9 +/- 3.8 mm Hg, respectively). Subsequent management included bed rest (8.2 +/- 4.8 days) and control of systolic blood pressure (< or = 120 mm Hg) with beta-adrenergic blocking agents as tolerated (n = 12). Four patients died, and autopsy in three revealed a rupture that was sealed in two. A sealed rupture was also seen at thoracotomy in 2 other patients who, like the remaining 13, survived for 52.5 +/- 35.2 months. CONCLUSIONS: Long-term survival of selected patients with prompt hemodynamic recovery after LVFWR is possible without surgical repair. Prolonged bed rest and blood pressure control are likely to contribute favorably to their initial outcome.

Adrenergic beta-Antagonists↗
PubMed1997

Survival after liver transplantation in cirrhotic patients with and without hepatocellular carcinoma: a comparative study.

Cumulative recurrence after surgical resection for hepatocellular carcinoma (HCC) is very high. Several retrospective analyses have shown that liver transplantation was more effective than resection for patients with HCC at early tumor stages. Consequently, in January 1990, we decided to prospectively indicate orthotopic liver transplantation (OLT) as the first surgical treatment for small, localized HCC in cirrhotic patients without nodal involvement independently of the degree of liver function. The aim of this prospective cohort study was to analyze prognosis, recurrence rate, and survival after liver transplantation in patients in whom the main indication was HCC with cirrhosis. Thirty-eight patients in whom the main indication for liver transplantation was HCC and hepatic cirrhosis were compared with 136 transplantations because of cirrhosis without tumor, performed in our unit from January 1990 to December 1995. HCC arising in noncirrhotic livers and those incidently discovered after OLT were excluded from the study. Chemoembolization using doxorubicin, lipiodol, and Gelfoam was performed before OLT in 31 patients with good liver function. There were no differences in gender, but HCC patients were older (57 +/- 7 vs. 50 +/- 10 years [P < .001]). Liver function was better in HCC (Child-Pugh score: 6.9 +/- 2 vs. 8.6 +/- 1.8; P < .001), and hepatitis C virus antibody was positive in 31 (82%) vs. 51 (37%) (P < .007). Seven tumors had bilobar involvement (18%). Capsule was present in 22 (58%). The mean size of the tumor was 3.4 +/- 2 cm. Seventeen tumors (45%) were larger than 3 cm, and 4 (11%) were larger than 5 cm. The average number of nodules was 2 +/- 1. The tumor-node-metastasis stage of the tumors was pT1 in 6 patients (16%), 11 were pT2 (29%), 12 were pT3 (31%), and 9 were pT4 (24%). Seven patients were retransplanted in the HCC group (18%) and 19 (14%) in the nontumor group (not significant). Tumor recurrence was detected in three patients (8%). One, 3-, and 5-year survival rates were 82% vs. 79%, 75% vs. 71%, and 63% vs. 68%, respectively, for patients with and without HCC, and no differences were found between the two groups (P = .84). Survival was significantly reduced in patients with a macroscopic vascular invasion and tumors greater than 5 cm in diameter. Recurrence and mortality after liver transplantation in cirrhotic patients with carefully selected HCC are similar to the results in cirrhotic patients without tumor.

Adult↗
PubMed1997

Pulmonary perfusion scintigraphy in the evaluation of the severity of bronchopulmonary dysplasia.

OBJECTIVE: The objectives of this study were to analyze the changes in pulmonary perfusion in bronchopulmonary dysplasia (BPD) and to assess the advantages of this method in evaluating the severity of BPD. PATIENTS AND METHODS: The study group was made up of 10 children with BPD, matched with a control group of 12 children. The criteria for matching were birth weight, gestational age and need for ventilation for more than 3 days. Clinical and roentgenographic scoring systems were applied on the 21st day of life. At 6 months of corrected age, clinical evolutive severity was evaluated and a pulmonary perfusion scintigraphy using technetium-99 was performed in each child. The scintigraphic findings were classified in five categories ranging from normal to severely affected, depending on the degree and localization of perfusion abnormalities. Another score was obtained by assigning a value from 1 to 5 to each pulmonary lobe, depending on the concentration of the tracer. RESULTS: The study of clinical, roentgenographic and evolutive scores always showed higher values in children with BPD, with good correlation between methods (P < 0.001). In the BPD group, abnormal lung perfusion patterns were more frequent and more severe (P < 0. 05), the lobe scoring was higher (P < 0.05), and a lower count rate was found (P < 0.01). CONCLUSION: Pulmonary scintigraphy is a useful technique in evaluating the severity of BPD.

Bronchopulmonary Dysplasia↗
PubMed1997

Acoustic stimulation in hypoxic-ischemic encephalopathy: heart rate analysis.

Two groups of 30 term newborns (normal and anoxic) were analyzed to study the influence of anoxia in the heart rate. The experiment consisted in a polygraphic EEG register before, during and after an acoustic stimulus. In basal conditions of active sleep, the heart rate in the asphyctic newborn was higher than in the normal group. The acoustic stimulation caused a transitional tachycardia. The variability of the heart rate was smaller in the asphyctic group. The basal heart rate varied in relation to the grade of Hypoxic-Ischemic Encephalopathy (HIE) and there was also a difference in the capacity of response to acoustic stimulation between the moderate HIE group and the normal group.

Acoustic Stimulation↗
PubMed1997

Neonatal outcome in women treated for the antiphospholipid syndrome during pregnancy.

The aim of this study was to determine the neonatal outcome in women with well-characterized antiphospholipid syndrome treated during pregnancy with low-dose aspirin. We compared 38 babies born after 36 pregnancies of 33 women diagnosed as having antiphospholipid syndrome with a group of 38 control infants matched for the same gestational age at birth. In all 76 newborns we studied the maternal events associated with the antiphospholipid syndrome, mothers' treatment and neonatal data. All mothers with antiphospholipid syndrome were treated with low-dense aspirin. Prednisone was only prescribed due to maternal complications and heparin in a case of thrombosis. No significant relation was found between maternal treatment and neonatal complications. The prematurity rate in these newborns was high 14% and the neonatal mortality (5.8%) was only associated with extreme prematurity (p < 0.001). In our population the overall rate of neonatal complications was higher than in the general population, but when compared with a similar group of newborns no significant differences were found. Our results suggest that primary antiphospholipid syndrome appears to be improved by low-dose aspirin treatment, with a high rate of neonatal survival (95%). Except for prematurity and its potential associated complications, fetal and neonatal outcome is very favourable and no significant relation between maternal treatment and neonatal pathology has been detected.

Anti-Inflammatory Agents↗
PubMed1997

Structure and composition of freshwater microbial mats from a sulfur spring ("Font Pudosa", NE Spain).

Different types of microbial mats developing on the wall on a non-thermal sulfur freshwater spring have been studied. Both, light and electron microscopy as well as HPLC analysis of photosynthetic pigments revealed their structure and composition. Prokaryotic chlorophylls and carotenoids helped in the taxonomical assignment of the main photosynthetic groups. "Inverted position" mats (Mat-I) were dominated by Chromatiaceae; they were located closed to the water outlets (0.3 mM sulfide). "Normal position", that is, cyanobacterial-covered mats (Mat-II and Mat-IV), developed elsewhere on the stone walls at lower sulfide concentrations. A third type of mat (Mat-III), covered by chemolithotrophic bacteria, was distinguishable at the water-air interface, strongly attached to the walls of the spring. Up to six physiological types of microorganisms have been recognized: cyanobacteria, Chromatiaceae, purple nonsulfur bacteria. Chlorobiaceae, Chloroflexaceae, and chemolithotrophic bacteria. Cyanobacteria Lyngbya-like, Oscillatoria-like and Pseudanabaena sp. were found. The diversity of Chromatiaceae (six morpho-/pigment types of the genus Chromatium, plus two non identified Chromatiaceae, named PB1 and PB2 were observed) was noticeable. Chemolithotrophic bacteria were represented by the genera Beggiatoa and Thiothrix. Finally, small numbers of Chloroflexus-like bacteria and Chlorobium limicola were found in all the studied mats.

Carotenoids↗
PubMed1996

Repeated 15-minute coronary occlusions in pigs increase occlusion arrhythmias but decrease reperfusion arrhythmias that are associated with extracellular hypokalemia.

OBJECTIVES: We sought to evaluate the effects of repetitive 15-min coronary occlusions followed by 45-min reperfusions on the incidence of occlusion and reperfusion arrhythmias in pigs. BACKGROUND: Brief 2- to 5-min coronary occlusions seem to exert a protective effect on occlusion and reperfusion arrhythmias. However, because clinical ischemic episodes are often longer, it would be appropriate to assess whether such protection also occurs when longer cycles of occlusion-reperfusion are produced. METHODS: Three to four cycles of 15-min coronary occlusions with 45-min reperfusions were performed in 34 pigs, and changes in ST segment and incidence of ventricular arrhythmias were assessed. Plasma potassium ion concentrations in eight pigs and blood gas in six were measured from blood from the ischemic area during reperfusion. RESULTS: Repetitive occlusions were associated with a progressively higher ST segment elevation and a higher incidence of ST segment alternans (p < 0.001) and ventricular fibrillation (VF) (p < 0.01). However, during repetitive reperfusions, normalization of the ST segment was increasingly faster, the incidence of VF was progressively reduced (p < 0.03), and there was progressively less severe regional acidosis ([mean +/- SD] 7.06 +/- 0.12 vs. 7.26 +/- 0.06, p < 0.05) and hypokalemia (1.9 +/- 0.7 vs. 2.3 +/- 0.4 mEq/liter, p = NS). CONCLUSIONS: The progressive electrocardiographic deterioration and increasing incidence of ventricular arrhythmias during repetitive 15-min occlusions in pigs suggest increasing metabolic derangement. However, the progressively faster normalization of the ST segment and the reduced incidence of ventricular arrhythmias during reperfusion suggest an increasingly faster restoration of the metabolic and ionic balance.

Acid-Base Equilibrium↗
PubMed1996

Setting priorities, can Britain learn from Sweden?

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.

Advisory Committees↗
PubMed1996

The deleterious effect of donor high plasma sodium and extended preservation in liver transplantation. A multivariate analysis.

The aim of this study was to analyze the donor risk factors associated with second orthotopic liver transplantation (reOLT) and graft loss after OLT within 1 month. A total of 649 OLTs performed in 11 centers in Spain during the period from 1992 to 1993 were analyzed retrospectively. Eleven donor and recipient variables were studied. Biochemical evolution of the OLT, biliary and arterial complications, patient status (alive, retransplanted, or dead), and follow-up were also recorded. Bivariate study demonstrated that extended preservation ( > 12 hr) was associated with increased biliary complications (P = 0.02), and lower prothrombin time (P = 0.04). In a logistic model regression for biliary complications, ischemia > 12 hr was an independent risk factor (odds ratio = 2.2, 95% confidence interval [CI] = 1.1-4.3). The multivariate Cox proportional model of potential risk factors showed that only urgent reOLT (relative risk [RR] = 2.7, 95% CI = 1.4-5.4) was independently associated with higher 30-day mortality. Donor plasma sodium > 155 mmol/L (RR = 1.4, 95% CI = 1.0-2.2) and incompatible ABO graft (RR = 3.2, 95% CI = 1.3-7.9) were independently associated with increased rate of reOLT before 30 days. Donor plasma sodium > 155 mmol/L (RR = 2, 95% CI = 1.1-3.6) and incompatible graft (RR = 3.3, 95% CI = 1.4-8.2) were independently associated with graft loss (death or reOLT) before 1 month. We conclude that cold ischemia should be kept less than 12 hr in order to avoid biliary complications. Donors over 60 years old or with plasma sodium > 155 should be carefully evaluated before OLT.

Adolescent↗
PubMed1996

Reliability of electromechanical dissociation in the diagnosis of left ventricular free wall rupture in acute myocardial infarction.

The reliability of electromechanical dissociation (EMD) in diagnosing acute left ventricular free wall rupture (LVFWR) was assessed in 479 consecutive patients with acute myocardial infarction (AMI). EMD was the mechanism of death in 193 patients, 140 without heart failure (group A, 74%), and 53 with heart failure (group B, 26%). Autopsies performed on 121 patients with EMD showed LVFWR in 81 (95%) of 85 from group A and in 7 (17%) of 36 from group B. Of the 106 patients without EMD (group C) autopsied, 5 (4.7%) had LVFWR. Excluding the eight patients with associated septal rupture, LVFWR occurred in 79 (95.2%) of 83 patients from group A, 4 (12.1%) of 33 from group B, and 2 (1.9%) of 103 from group C. Predictive accuracy of EMD for LVFWR in group A was 95% but only 17% in group B. Moreover, in 13 consecutive cases with a first AMI without heart failure and EMD, emergency surgery demonstrated LVFWR in all. Thus EMD has a highly predictive accuracy in diagnosing LVFWR in patients with a first AMI without overt heart failure.

Aged↗
PubMed1996

Additional elevation of the ST segment: a possible early electrocardiographic marker of experimental myocardial reperfusion.

OBJECTIVE: To analyze the early electrocardiographic changes during experimental coronary reperfusion after 1 to 4 h of coronary occlusion. METHODS: Recordings of epicardial and endocardial DC electrograms were performed in 35 open-chest pigs during coronary occlusions of 1 to 4 h duration followed by 1 h of reperfusion. RESULTS: During occlusion, maximal ST segment elevation was reached between min 10 and 30 which was followed by and a steady decline. During the first 30 min of reperfusion, however, there was a further elevation of the ST segment with a peak at 5 min. Thus, values at the end of occlusion and at 5 min of reperfusion were: (a) group with 1 h occlusion (n = 11), 15.5 +/- 7 and 37.4 +/- 11.4 mm, P < 0.005; (b) group with 2 h occlusion (n = 6), 10.2 +/- 4 and 24.7 +/- 9.4 mm, P < 0.03; (c) group with 3 h occlusion (n = 6), 7.5 +/- 3 and 16.8 +/- 5.6 mm, P < 0.03; and (d) group with 4 h occlusion (n = 12), 6.4 +/- 2.4 and 17.0 +/- 8.9 mm, P < 0.01. In 9 animals from the group with 1 h occlusion, a second cycle of 1 h occlusion and reperfusion also showed re-elevation of ST segment during reperfusion, although to a lesser extent than the first one (from 10.0 +/- 4.9 to 16.3 +/- 7.1 mm, P < 0.01). CONCLUSIONS: Thus, our findings provide experimental evidence of an additional and paradoxical ST segment elevation as the earliest electrocardiographic sign of coronary reperfusion after 1 to 4 h of coronary occlusion. These observations may help to improve the interpretation of early electrocardiographic changes during thrombolysis in acute myocardial infarction.

Animals↗
PubMed1996

Predisposing factors and prognostic value of sustained monomorphic ventricular tachycardia in the early phase of acute myocardial infarction.

OBJECTIVES: The purpose of the study was to analyze the factors that favor the occurrence of sustained monomorphic ventricular tachycardia in the early phase (< 48 h) of acute myocardial infarction and to establish its prognostic implications. BACKGROUND: Sustained monomorphic ventricular tachycardia early in the course of an acute myocardial infarction is an uncommon arrhythmia, and its significance has not been specifically studied. METHODS: The clinical characteristics and prognosis of sustained monomorphic ventricular tachycardia were studied in 21 (1.9%) of 1,120 consecutive patients admitted to the coronary care unit with a diagnosis of myocardial infarction. RESULTS: Patients with sustained monomorphic ventricular tachycardia had a larger infarct on the basis of peak creatine kinase, MB fraction (CK-MB) isoenzyme activity (435 +/- 253 IU/liter vs. 168 +/- 145 IU/liter, p < 0.001) and higher mortality rate (43% vs. 11%, p < 0.001). By logistic regression analysis, independent predictors of sustained monomorphic ventricular tachycardia were CK-MB (odds ratio [OR] 11.8), Killip class (OR 4.0) and bifascicular bundle branch block (OR 3.1). Moreover, sustained monomorphic ventricular tachycardia was itself an independent predictor of mortality (OR 5.0). Compared with patients with ventricular fibrillation, those with sustained monomorphic ventricular tachycardia had a worse Killip class (Killip class > I: 63% vs. 30%, p < 0.05), higher CK-MB activity (430 +/- 260 IU/liter vs. 242 +/- 176 IU/liter, p < 0.01) and higher arrhythmia recurrence rate (31% vs. 4%, p < 0.01). During the follow-up period, 5 (42%) of 12 survivors in the sustained monomorphic ventricular tachycardia group died of cardiac-related causes. Recurrence of ventricular tachycardia was seen in two patients (17%). CONCLUSIONS: Sustained monomorphic ventricular tachycardia during the first 48 h of myocardial infarction is a sign of extensive myocardial damage and an independent predictor of in-hospital mortality.

Adult↗
PubMed1996

Hepatocellular carcinoma: iodized-oil CT TNM classification.

OBJECTIVE: We conducted a prospective study to determine the efficacy of iodized-oil enhancement in CT for preoperative assessment of the T factor of the TNM classification in patients with hepatocellular carcinoma (HCC). SUBJECTS AND METHODS: Iodized-oil CT was performed as a part of preoperative staging in 28 patients with HCC. We determined the radiologic T factor. Pathologic correlation was obtained after orthotopic liver transplantation (n = 25) or autopsy (n = 3), and the histologic T factor was determined. RESULTS: The sensitivity of iodized-oil CT accurately distinguishing between stage-T4 tumors and tumors in stages T1-T3 was 88% (7/8) with a positive predictive value of 100% (7/7). CONCLUSION: Iodized-oil CT is useful for preoperatively assessing the T factor of the TNM classification in HCC, and it improves the accuracy of radiologic staging. Iodized-oil CT can help to better patients with HCC for orthotopic liver transplantation.

Adult↗
PubMed1996

[Pheochromocytoma, acute myocardial infarction and silent postprandial ischemia].

We report the case of a 70 years-old patient admitted for an acute anterior myocardial infarction and who subsequently presented postprandial episodes of astenia, dyaphoresis and arterial hypertension associated with re-elevation of the ST segment and positivization of T waves in the precordial leads, without chest pain. These episodes were interpreted as silent postprandial myocardial ischemia. A coronary angiography demonstrated a single vessel disease with a severe and proximal stenosis of the left descending coronary artery which was successfully dilated during angioplasty. However, the postprandial episodes persisted and re-estenosis was ruled out in a repeated coronary angiogram. A stress thallium myocardial scintigraphy was negative. Complementary tests documented the existence of a pheochromocyctoma and the refered postprandial symptoms did not recur after removal of the tumor. Thus, the persistence of postprandial episodes of myocardial ischemia associated with severe hypertension and dyaphoresis in the absence of a significant coronary stenosis, may possibly be related to a concomitant coronary and systemic vasoconstriction secondary to the adrenal tumor.

Adrenal Gland Neoplasms↗
PubMed1996

[NO and NO2 concentration curves in mixtures for clinical use].

Inhaled nitric oxide (NO) allows us to achieve selective pulmonary vasodilatation. The purpose of the present experimental study was to determine the concentrations of NO and NO2 produced by mixing two well-known and variable flows of 100% oxygen and 800 ppm NO, in a low or normally humid environment, as well as in a humid one. The mixture of NO and N2 is introduced by means of a standard low-flow blender (0.2 to 1 liter/minute) in the inspiratory tube of a ventilator at a distance of about 20 cm from the connection with the artificial lung. In order to obtain a humid circuit, we used a humidifier servocontrolled at a temperature of 36 degrees C. The concentration of NO and NO2 are continually determined by means of chemiluminescence in the expiratory tube at about 5 cm from the connection with the artificial lung. The study consisted of three parts: elaboration of the curves of NO and NO2 in low humidity (34 measurements), validity of the corresponding curves of NO in low humidity (80 new measurements) and elaboration of the curves of NO and NO2 in a humid circuit (32 measurements). We found that the concentrations of NO in low humidity follow a lineal equation, except for the flows lower than 10 L/min. Flows between 10-15 L/min reached concentrations of NO between 6-60 ppm. The concentrations of NO2 in low humidity produced some parallel curves, and exceptionally overcame the toxic figure of 5 ppm. The curves are valid only with flows higher than 10 L/min. Humidity does not influence the NO concentrations, while it diminishes NO2 concentrations 1.4 times.

Administration, Inhalation↗
PubMed1995

Early morning reduction in ischemic threshold in patients with unstable angina and significant coronary disease.

BACKGROUND: The objective of this study was to investigate in patients with unstable angina and significant coronary stenosis (> 70%) whether or not the morning peak of myocardial ischemia is associated with a reduction in the ischemic threshold. The morning increased incidence of ischemic episodes in stable angina appears to be attributable to a coincidence of several factors. Patients with unstable angina who remain at bed rest, however, also present a similar morning increased incidence of ischemia, but its mechanisms are not completely understood. METHODS AND RESULTS: The ischemic threshold was assessed by atrial pacing at 7 to 8 AM and at 12 to 1 PM in 46 patients. In the 34 with a positive pacing response (ST segment shift > 1.0 mm), ischemic threshold was lower at 7 to 8 AM than at 12 to 1 PM (131 +/- 16 versus 139 +/- 15 beats per minute, P < .001), whereas in the remaining 12 patients, the pacing response was negative. Moreover, 4 patients presented ST segment elevation during pacing in the morning but only 1 at noon and at a higher threshold. Baseline heart rate and diastolic blood pressure were higher at noon than in the morning (81 +/- 16 versus 76 +/- 13 beats per minute, P < .01, and 87 +/- 11 versus 82 +/- 10 mm Hg, P < .05). CONCLUSIONS: The morning lowering of ischemic threshold in the absence of increases in baseline blood pressure or heart rate suggests that a reduced coronary vasodilator capacity or an increased coronary tone may favor the increased incidence of ischemic events during this interval.

Angina, Unstable↗