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Biomedical subjects

J García

Publications and source records attributed to J García.

At least 19 recordsLinked to original sources
PubMed1998

Significance of angiographic coronary dissection after cutting balloon angioplasty.

We studied 2 groups of patients with (n = 14) and without (n = 42) minor coronary dissections following cutting balloon angioplasty. Patients with a minor dissection had a longer length of lesion, higher percentage of stenosis, and greater acute gain after angioplasty; at 6-month follow-up both groups had a similar net gain and restenosis rate, suggesting that minor dissection after cutting balloon angioplasty has no influence on restenosis.

Adult↗
PubMed1998

[Heart rate variability during the first 24 hours of acute myocardial infarction].

BACKGROUND: To evaluate the heart rate variability (HRV) during the first 24 h after a myocardial infarction (MI), and to study its relationship with other clinical variables and in-hospital follow-up. PATIENTS AND METHODS: 101 patients (age < 80 years) with MI in sinus rhythm were prospectively studied. A Holter monitoring was performed during the first 24 h. The heart rate (HR), standard deviation of RR intervals (SDRR) and the histogram at different levels were analyzed, as well as the mean and standard deviation of RR intervals in an early 5 min record. The results were compared with the clinical characteristics and the in-hospital outcome of the patient. RESULTS: HRV was lower in women, hypertensives and patients who did not receive thrombolytic agents. In patients without heart failure, inferior MI's had lower HR and higher HRV than anterior MI's (SDRR: 52.8 [20.6] and 42.2 [16.9], respectively; p < 0.05). HRV was significantly decreased as Killip group increased, as well as in patients who developed late heart failure. The development of ventricular tachycardia or fibrillation was associated to a low HRV in the 24 h analysis (SDRR: 30.2 [15.6] for the 6 patients with VF/VT vs 46.8 [20.1] for the rest; p < 0.05), as well as in the early 5 min record (29.8 [14.8] and 50.8 [35.8], respectively; p < 0.05). CONCLUSIONS: During the first 24 h after MI the HRV is related to some clinical variables and to MI location (higher in inferior MI). Patients who develop heart failure or ventricular arrhythmias before hospital discharge have a higher HR and a significantly decreased HRV.

Aged↗
PubMed1998

[Initial results with the Multi-Link coronary stent].

INTRODUCTION AND OBJECTIVES: The Multi-Link intracoronary stent is a balloon-expandable stainless steel stent with an interconnected ring structure designed to provide a high degree of compressive resistance while preserving longitudinal flexibility. We present the results of our initial experience with the implantation of this stent. PATIENTS AND METHODS: From May 1996 to April 1997, 124 Multi-link stents were implanted in 97 patients. Mean age 62.2 +/- 11 years. All patients included had a coronary artery diameter > 2.7 mm. Clinical presentation includes stable angina in 20, unstable angina in 72, and myocardial infarction in 5 patients. According to the ACC/AHA classification 6 lesions were type A, 72 type B and 19 type C. The implantation of the stent was for "de novo" lesions in 85 patients and for restenosis in 12. Patients were treated after the procedure with a combination of aspirin and ticlopidine, except six of them who received aspirin and acenocumarol. 16 patients were treated additionally with Abciximab. The degree of stenosis was determined by quantitative angiography. RESULTS: The delivery of the stent was successful in all patients. The degree of stenosis before the procedure was 79.6 +/- 13.1%, and after the stent deployment was 17.7 +/- 11.4%. Three patients presented a non-Q-wave myocardial infarction, two patients had a subacute stent thrombosis, one of them died due to heart failure. During a follow-up of 4.7 +/- 2.6 months five patients were readmitted with recurrent angina (4 due to restenosis and one for vessel occlusion) and one patient with heart failure after myocardial infarction died suddenly three weeks after the dilatation. CONCLUSIONS: The Multi-Link stent was implanted successfully in all patients with a low incidence of complications, showing at the follow-up a reduced rate of clinical restenosis.

Coronary Disease↗
PubMed1998

Clinical results of AcrySof intraocular lens implantation.

PURPOSE: To analyze the clinical results of AcrySof intraocular lens (IOL) implantation. SETTING: San Juan University Hospital, Alicante, Spain. METHODS: This retrospective study comprised 100 patients with cataract 81 without previous eye pathology and 19 with previous eye pathology (i.e., diabetes, traumatic cataract, central corneal leukoma, glaucoma). Phacoemulsification technique depended on the type of cataract. Mean follow-up was 9 months. RESULTS: Best corrected visual acuity was 20/40 or better in 11.52% of patients with preoperative eye pathology and in 100% of those without pathology. CONCLUSION: Implantation of AcrySof IOLs did not result in complications or adverse reactions in our series, indicating that its use is safe in small incision cataract surgery.

Acrylates↗
PubMed1998

Collection of peripheral blood progenitor cells for autografting with low-dose cyclophosphamide plus granulocyte colony-stimulating factor.

BACKGROUND AND OBJECTIVE: The combination of high or intermediate-dose cyclophosphamide (CY) plus granulocyte colony-stimulating factor (G-CSF) is useful to mobilize hematopoietic progenitor cells to peripheral blood, but the patients require hospitalization. The aim of this study was to evaluate the efficiency of low-dose CY plus G-CSF (5 ug/kg/day s.c.) as an outpatient treatment in order to collect enough progenitor cells for hematopoietic rescue in autologous peripheral blood transplantation (APBSCT). DESIGN AND METHODS: We analyzed twenty-eight consecutively treated patients with lymphoma or multiple myeloma. The number of CD34+ cells in blood samples was determined from day +7. Leukapheresis (LKP) began when the absolute number of CD34+ cells in peripheral blood was > 2500/mL and the apheresis product was assayed for mononuclear cells (MNC), granulocyte-macrophage colony-forming units (CFU-GM), total nucleated cells (tNC) and CD34+ cells. RESULTS: Twenty-eight outpatients with advanced hematologic malignancies (13 non-Hodgkin lymphoma, NHL; 10 Hodgkin's disease, HD; and 5 multiple myeloma, MM), median age 44 years (range 23-65) received a single dose of CY (1.5 g/m2 i.v. day 0) followed by G-CSF (5 ug/kg/day s.c.) from day +1 to the end of LKP. Considering patients who had successful mobilization (64%), a median of 7.1 x 10(6)/kg CD34+ cells (range 3.5-11.9), 5.7 x 10(5)/kg CFU-GM (range 1.5-9.2), 4.4 x 10(8)/kg MNC (range 1.9-7.9) were collected. Treatment was well tolerated and none of these patients was hospitalized due to neutropenic fever. Only one patient received two packed red blood cells following chemotherapy. Autologous peripheral blood stem cell transplantation (APBSCT) has been performed in 18 patients (64%). The mean number of days to achieve > 0.5 x 10(9) PMN/L and > 20 x 10(9) PLT/L was 12 (10-17) and 12.6 (8-24), respectively. INTERPRETATION AND CONCLUSIONS: Considering a pre-established threshold of 2.5 x 10(6)/kg CD34+ cells to proceed to APBSCT, the mobilization therapy was successful in 64% of the patients but was unsuccessful in 10 patients (5 NHL, 4 HD and 1 MM). Hematopoietic recovery was complete and stable in all patients. Low-dose CY plus G-CSF is efficient to collect enough PBSC for hematopoietic rescue after myeloablative therapy in patients with lymphoprolipherative disorders or multiple myeloma.

Adult↗
PubMed1997

High-titer retroviral vectors containing the enhanced green fluorescent protein gene for efficient expression in hematopoietic cells.

Retroviral vectors constitute the most efficient system to deliver and integrate foreign genes into mammalian cells. We have developed a producer cell line that yields high titers of amphotropic retroviral vectors carrying the enhanced green fluorescent protein (EGFP) gene, a codon humanized, red-shifted variant of the green fluorescent protein (GFP) gene, which can be used as a selectable marker. We have used a hybrid vector that has been shown to efficiently drive gene expression in hematopoietic cells. Virtually all murine and human cell lines and primary human hematopoietic cells tested were transduced with varying efficiency after incubation with vector-containing supernatants. Human CD34(+) cells obtained from cord blood or aphereses products were transduced using a protocol that involves daily addition of vector-containing supernatants for 6 consecutive days. At day 6, up to 16% of the cells expressed EGFP, as assessed by flow cytometry. Sorted EGFP-expressing cells were able to produce fluorescent hematopoietic colonies. EGFP's main advantages are its fast flow cytometry determination and the possibility of cell sorting and simultaneous evaluation of the transduction efficiency along with other phenotypic markers.

3T3 Cells↗
PubMed1997

Molecular characterization of the Entamoeba histolytica enolase gene and modelling of the predicted protein.

Entamoeba histolytica obtains its energy mainly from glucose fermentation. Enzymes involved in this pathway could be potential targets for antiparasite drugs. Here we report the molecular characterization of the E. histolytica enolase gene (Ehenl-I), which in a single copy is located on the 1.6 Mb chromosome. It is transcribed into a 1.4 kb mRNA which starts 13 nucleotides upstream of the ATG start codon. The sequence TATAAG, at -31, interacted with nuclear proteins suggesting that it has a TATA box function. Protein modelling allowed us to identify a putative specific region that differs from human enolase and could be a good target for the design of novel drugs against E. histolytica.

Amino Acid Sequence↗
PubMed1997

Patterns of uveitis as a guide in making rheumatologic and immunologic diagnoses.

OBJECTIVE: To describe the patterns of clinical presentation in a series of 407 patients with uveitis and to establish the relationship between these patterns and the final diagnosis. METHODS: Patients were referred to the Uveitis Clinic of a tertiary hospital from January 1992 to January 1996. All patients received a complete ophthalmologic examination, and a general clinical history was obtained. The current International Uveitis Study Group classification system was used for anatomic classification. To establish the final diagnosis of the most common entities causing uveitis, current diagnostic criteria were used. A discriminant analysis, with diagnostic grouping as the outcome variable and the clinical presentation features as discriminating variables, was performed. RESULTS: With our classification system, 66.5% of the cases could be correctly classified according to the clinical pattern and morphologic findings. By diagnostic groups, discriminant analysis showed that 75% of patients with Behçet's disease, 77.1% of those with spondylarthropathy (including inflammatory bowel disease), 33.3% of those with sarcoidosis, 97.9% of those with toxoplasmosis, 85.7% of those with Vogt-Koyanagi-Harada syndrome, 100% of those with herpes, and 50.4% of those with idiopathic uveitis were correctly classified. In the miscellaneous group, which included disease entities with fewer than 5 cases, 42.9% were correctly classified. CONCLUSION: Rheumatologic evaluation of the patient with uveitis can be more cost-effective if the referring ophthalmologist follows the classification system described herein, allowing a tailored approach in which only specific and necessary diagnostic tests are used.

Adolescent↗
PubMed1997

Role of S4 segments and the leucine heptad motif in the activation of an L-type calcium channel.

Basic residues in the S4 segments of voltage-dependent channels and leucines within the heptad repeat motif in the S4-S5 region of Shaker potassium channels have been shown to have important influences on activation. Here we have compared the relative importance for activation of S4 arginines (mutated to neutral or negative residues) in each of the four repeats of a chimeric L-type calcium channel. Significant effects on midpoint potential and time constant of activation were produced by mutations in repeats I and III but not in repeats II and IV. Leucine or isoleucine mutations in repeats I and III had the same effect on the voltage dependence of calcium channel activation as the mutations at equivalent positions in the Shaker channel, indicating that the heptad motif plays a fundamental role in channel activation.

Amino Acid Sequence↗
PubMed1997

[Prosthetic endocarditis and splenic abscess caused by Clostridium clostridiformis].

We report the first case of Clostridium clostridiformis endocarditis in a 71 year old man with an aortic prosthetic valve. He was febrile with left upper quadrant pain and left lower lobe infiltrate in chest X ray. The diagnosis was made by gram-positive bacilli grown from three blood cultures. Transthoracic and transesophageal echocardiogram showed a paraaortic abscess. A computed tomographic scan of the abdomen revealed a large splenic abscess. He received penicillin G 4 million units every 4 hours intravenously. A successful percutaneous drainage guided computed tomographic scan was performed. The patient remained febrile and a new computed tomographic scan of the abdomen revealed residual splenic abscess. A splenectomy was performed. The patient defervesced on the second day of surgery and remained afebrile during the remainder of his hospitalization. He has returned for medical follow-up and two years later the patient is asymptomatic.

Abscess↗
PubMed1997

[Cardiac pathology of extracardiac origin (II). The cardiac repercussion of amyloidosis and hemochromatosis].

Although rare, amyloidosis and hemochromatosis are the infiltrative diseases in which the heart is more frequently involved. The most common clinical presentation is heart failure with hemodynamic features of restrictive heart disease in cardiac amyloidosis. The diagnosis is often made because of symptoms of other organ involvement, although sometimes cardiac symptoms may be the initial manifestation. The non-specific clinical presentation and the low prevalence of these cardiomyopathies make the diagnosis difficult if the clinician does not suspect it. Once symptoms develop, the evolution is fast. Usually, the unsatisfactory and ineffective treatment of amyloidosis and hemochromatosis contribute to the poor prognosis. The indication of cardiac transplantation in advanced cases is questionable because of the high recurrence of the illness.

Amyloidosis↗
PubMed1997

Gender and social differences in adolescent sexuality and reproduction in Nicaragua.

PURPOSE: The aim of this research was to study gender and social differences in adolescent sexuality and reproduction, as reflected in age at first intercourse and age at first pregnancy, as a basis for future interventions in the municipality of León, Nicaragua. METHODS: In a community-based cross-sectional study including 7789 households, all women aged 15-49 years (n = 10,867) were interviewed about socioeconomic, sexual, and reproductive issues. A random subsample of men (n = 388) and women (n = 413) aged 15-49 years was interviewed in more detail about sexual patterns and reproduction. RESULTS: The median age at first intercourse for women and men was 17.8 and 16.2 years, respectively. Women's average latency period to end of first pregnancy was 22 months. There was a significant tendency to start active sexual life later among today's girls aged 15-20 years, compared to the groups 21-27, 28-35, and 36-49 years old. A similar trend was found in age at first pregnancy. These secular trends were not found among men. Age at first pregnancy for current adolescents was lower among those having less formal education. CONCLUSIONS: The short latency period between first sexual intercourse and end of first pregnancy, probably reflecting lack of access to counseling and contraception, is worrying in light of the growing sexually transmitted disease/human immunodeficiency virus threat. The secular trend of later start of reproduction, however, is a positive sign which partly may be an effect of increasing education in the Nicaraguan society.

Adolescent↗
PubMed1997

Umbilical cord blood transplantation from unrelated donors in an adult weighing 90 kilograms. Role of immunosuppression in engraftment.

A 40-year-old male weighing 90 kilograms was diagnosed with acute myeloblastic leukaemia M5a which was resistant to chemotherapy. Neither a related nor an unrelated HLA-compatible bone marrow donor could be found. A unit of cord blood was found with an HLA compatibility of four out of six loci, and was infused after conditioning with cyclophosphamide, total body irradiation and antilymphocyte globulin. The infused cord blood had 0.98 x 10(7) nucleated cells per kilogram. On day 35 after infusion the patient was considered to have graft failure. A second unit of cord blood was found, and after 3 days of antilymphocyte globulin, it was infused (day 41). The course was complicated by severe hypoxia and bilateral interstitial pulmonary infiltrates, and the patient was treated with high doses of methylprednisolone. On day 58 the leukocyte count increased to 3 x 10(9)/l, and there was total chimerism of the first cord blood unit infused. Two weeks later leukocyte counts decreased progressively and the patient died of a disseminated fungal infection. We discuss the importance of the number of nucleated cells per kilogram of body weight infused, and the role of intensive immunosuppression in engraftment of cord blood transplantations in adults.

Adult↗
PubMed1997

Efficient peripheral blood stem cell mobilization with low-dose G-CSF (50 microg/m2) after salvage chemotherapy for lymphoma.

We compared the use of low-dose G-CSF (50 microg/m2/day), following salvage chemotherapy, for mobilization of PBSC with the results obtained in a comparable historical control group who received a standard dose of G-CSF (5 microg/kg/day, approximately 200 microg/m2/day). Thirty adult patients with relapsed or refractory lymphoma were treated with ifosfamide, VP-16, intermediate-dose Ara-C, methylprednisolone (IAPVP-16) and G-CSF 5 microg/kg/day (group A, n = 15) or 50 microg/m2/day (group B, n = 15) from day 6 until the end of leukaphereses. The duration of neutropenia and thrombocytopenia were equal in both groups. A median of two (1-3) leukaphereses were performed in both groups to harvest >3.5 x 10(6)/kg CD34+ cells. The numbers of circulating CD34+ cells on the first day of leukocyte recovery were similar in both groups in those patients mobilized after a first cycle of IAPVP-16. The numbers of circulating CD34+ cells were similar in patients mobilized after a first and after a second IAPVP-16 in group A. In the low-dose group (group B), however, the numbers of circulating CD34+ cells were significantly lower in those mobilized after a second than after a first course. Additionally, the product of the first leukapheresis contained significantly fewer CD34+ cells in those mobilized after a second course only in group B, with no differences in group A. Nevertheless, the final products harvested did not differ in the content of MNC, CFU-GM and CD34+ cells, suggesting that these differences are not clinically important. These results indicate that the use of low-dose G-CSF (50 microg/m2/day) is as effective as 5 microg/kg/day in accelerating neutrophil recovery and mobilizing CD34+ cells after a first cycle of IAPVP-16 salvage chemotherapy, resulting in a substantial decrease in costs, while more heavily pretreated patients may require higher doses of G-CSF for an equivalent mobilization.

Adolescent↗
PubMed1997

Pentoxifylline, ciprofloxacin and prednisone failed to prevent transplant-related toxicities in bone marrow transplant recipients and were associated with an increased incidence of infectious complications.

TNF-alpha (Tumor necrosis factor-alpha) is involved in many immunological and inflammatory processes, and might be expected to play an important role in the development of BMT-related complications. Triple therapy (pentoxifylline, ciprofloxacin and prednisone) with known anti-TNF activity was tested in 37 patients undergoing a hematopoietic progenitor transplant (HPT). A control group of 16 patients with similar characteristics was selected among consecutive patients receiving a HTP in a neighboring center who did not receive anti-TNF prophylaxis. Major transplant-related complications were registered (VOD, acute GVHD, infectious episodes, renal failure and mucositis) and survival status. TNF plasma concentrations were determined by ELISA, and pentoxifylline plasma concentrations were determined by HPLC. Among patients treated with pentoxifylline (PTX), ciprofloxacin and steroids, no difference in the mean survival time was observed compared with the control group. The incidence of procedure-related death up to day +35 was 11% in the study group and 6% in the control group. In spite of a tendency to a lower incidence of mucositis there was a higher incidence of infections (positive blood cultures) in the study group (49%) than in the control group (16.7%) (P = 0.16). This difference achieved statistical significance in patients receiving an allogeneic HPT (P = 0.05). It is likely that the use of steroids in the early period after transplant increases infectious episodes and makes control of GVHD difficult. The combined administration of steroids with pentoxifylline and ciprofloxacin has not proved beneficial in preventing mucositis, renal failure, VOD or GVHD, or in improving patient survival.

Adolescent↗
PubMed1997

Immunomagnetic bone marrow purging in children with acute lymphoblastic leukemia.

Autologous bone marrow transplantation (ABMT) offers a therapeutic alternative for children with poor prognosis acute lymphoblastic leukemia (ALL) who lack an HLA-matched sibling donor. The most common cause of treatment failure after ABMT in these patients is leukemia relapse. We have developed an ex vivo autologous marrow purging program for children with ALL using an immunomagnetic method. BM purging has been performed in 37 children with ALL (31 B-lineage ALL and 6 T-lineage ALL) following an indirect method, using panels of mouse monoclonal antibodies (MAbs) directed against B or T cell antigens, Dynabeads M-450 (Dynal) coated with sheep antimouse (SAM) antibodies, and the MaxSep Magnetic Cell Separator (Baxter). Purging efficiency has been assessed by flow cytometry. Considering the limit of detection of target cells 0.1%, the median depletion was 2.0 log (range 0.8- > 2.8 log) for the B-lineage ALL and 2.7 (range 2.2- > 2, 9 log) for the T-lineage ALL patients. Twenty-seven patients have been autografted (6 in first complete remission, CR, 13 in second CR, and 8 in third or subsequent CR). Engraftment has been satisfactory in all of them, reaching levels of 500 neutrophils/mm3 and 20,000 platelets/mm3 after a median of 17 (range 12-39) and 30 (range 13-96) days post-ABMT, respectively. In summary, our results show that this immunomagnetic procedure achieves high levels of target cell depletion and can be safely applied to bone marrow purging in childhood ALL patients.

Adolescent↗