[Anesthesia in Werner syndrome].
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Adult↗
Biomedical subjects
J L Aguilar
Publications and source records attributed to J L Aguilar.
Bladder involvement of diffuse large B-cell lymphoma diagnosed by a cytological study of the urine.
The diagnosis of lymphoma involvement from the urine sediment has been rarely reported in the literature. We present a 78-year-old woman with diffuse large B-cell lymphoma in whom a relapse of the disease was diagnosed due to the presence of lymphoma cells in the urine. The analysis of urine by flow cytometry demonstrated a clonal B-cell origin, with an identical immunophenotype to that of the initial lymphoma. This case emphasizes the interest of cytological studies of the urine in cases with suspected bladder involvement by lymphoma.
Aged↗
Rapid diagnosis of acute promyelocytic leukemia by analyzing the immunocytochemical pattern of the PML protein with the monoclonal antibody PG-M3.
The fusion protein, promyelocytic leukemia-retinoic acid receptor (PML-RAR)alpha, generated by the t(15;17) translocation has an abnormal cellular distribution with colocalization of RARalpha and PML proteins. We analyzed the immunostaining pattern of PML protein using the PG-M3 monoclonal antibody directed against the amino terminal portion of PML (retained in wild-type PML and PML-RARalpha fusion protein) in the diagnosis of acute promyelocytic leukemia (APL). In addition, we compared this test with other methods for detecting the PML-RARalpha fusion gene. A normal immunostaining pattern was observed in nonmyeloid disorders and in 78 of 111 acute myeloid leukemias (AMLs). A microgranular pattern was observed in 25 AMLs, all corresponding to APL. These results were concordant with the reverse transcriptase-polymerase chain reaction results for PML-RARalpha fusion gene. Only 1 case positive for the PML-RARalpha transcript showed a normal protein pattern by immunocytochemistry. PML immunostaining was helpful to rapidly differentiate 7 cases with borderline characteristics and to obtain the diagnosis in 2 cases with scarce material. The effectiveness and low cost of this technique support its routine use as a first-line procedure in the differential diagnosis of AML.
Antibodies, Monoclonal↗
Anaplastic large-cell lymphoma with rapid evolution to leukemic phase.
Anaplastic large-cell lymphoma (ALCL) is a lymphoproliferative disorder that frequently presents with disseminated disease and extranodal involvement. Rare atypical cells have been detected in the peripheral blood in occasional cases. However, the presence of a prominent leukemic phase is extremely rare in these patients. We describe a patient with a small-cell variant of ALCL of T-cell phenotype, ALK-1 positive, who developed a rapid leukemic phase in association with the progression of the disease. Similar to the nodal biopsy, the predominant cells in bone marrow and peripheral blood were small atypical lymphoid cells. The large tumor cells expressed ALK immunoreactivity with a cytoplasmic and nuclear pattern, whereas some of the small cells showed only a nuclear-restricted pattern of staining. An RT-PCR study detected the NPM-ALK chimeric product in the nodal biopsy and in a peripheral blood sample in the early phase of the disease, but it became negative in a peripheral blood sample obtained after completion of the chemotherapy treatment, suggesting that this assay may be useful in the follow-up of these patients. This case indicates that a prominent leukemic phase may develop in ALCL as a manifestation of tumor dissemination and that it may be composed of a predominant small-cell atypical component.
Adult↗
Bone marrow transplantation for severe aplastic anemia: the Barcelona Hospital Clinic experience.
BACKGROUND AND OBJECTIVE: The outcome of patients with severe aplastic anemia (SAA) has improved considerably over the last decades. Bone marrow transplantation (BMT) is the treatment of choice in young patients who have an HLA-identical sibling donor. This study analyzes the outcome and factors related to survival in patients with SAA receiving BMT in our institution. DESIGN AND METHODS: Between March 1978 and December 1996, 49 consecutive patients received an HLA-identical sibling marrow transplant for SAA. Median age was 21 years (range, 4 to 47) and 15 (31%) were women. Median interval from diagnosis to transplant was 2.6 months (range, 0.5 to 159). Between 1978 and 1982 all patients were conditioned with cyclophosphamide (CY) alone and received methotrexate (MTX) until day 102 as graft-versus-host disease (GvHD) prophylaxis. From 1983 most patients received CY and thoraco-abdominal irradiation (TAI) as the conditioning regimen and cyclosporin A (CSA) as GvHD prophylaxis. RESULTS: Survival probability at 10 years was 55 +/- 7% with a median follow-up for the surviving patients of 8.5 years. The incidences of graft failure, grade II to IV acute GvHD, and chronic GvHD were 21%, 39.5% and 31%, respectively. In multivariate analysis three factors adversely influenced survival: a) age > or = 30 years (p = 0.05); b) > or = 10 transfusion units pre-BMT (p = 0.008); and c) use of long course MTX for GvHD prophylaxis (p = 0.01). One case of squamous-cell carcinoma occurred in a TAI-treated patient 13 years post-transplantation. INTERPRETATION AND CONCLUSIONS: BMT is effective in young patients with SAA who have an HLA-identical sibling donor, particularly if minimally transfused pre-transplant. The introduction of TAI and CSA to our preparative regimen has led to a remarkably increased survival.
Adolescent↗
[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia].
OBJECTIVE: Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization. MATERIAL AND METHOD: One hundred epidural catheters were studied in two groups (A and B) of 50. Group A catheters contained stylettes and the distal ends were open (Vygon). Group B catheters contained no stylettes and had closed distal ends and three side openings (Becton Dickinson). Continuous epidural anesthesia was simulated with half the catheters in each group (25) by touching the distal end of each line with the gloves and later inserting the catheter through a Tuohy needle. All catheters--those used in the simulation as well as the untouched ones--were then examined under a scanning electron microscope. The particles on the internal and external surfaces of the gloves had previously been identified under a microscope and analyzed by X-ray diffraction. RESULTS: Gloves: external glove surfaces carried particles measuring between 3 and 4 mu; their morphology was consistent with calcium carbonate. On internal surfaces we found larger particles, between 11 and 14 mu in diameter, shaped differently and of smooth appearance. Analysis of the latter showed them to contain traces of magnesium and to have characteristics consistent with organic molecules. The particles of one surface were never observed on the other. Catheters: the non-manipulated catheters in both groups contained no free particles matching those described above, whereas the outside surfaces of the catheters in contact with gloves contained particles consistent with those of external glove surfaces. The number of particles per square millimeter of surface was 2,598 (95% CI 2,200 to 2,900) in group A catheters and 2,340 (95% CI 2,000 to 2,600) in the group B catheters (p = NS). The differences in the number of particles adhering to catheters touched by gloves and those that had not been manipulated were statistically significant (p < 0.001). CONCLUSIONS: Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.
Anesthesia, Epidural↗
[Ropivacaine].
This paper describes the pharmacological, pharmacokinetic and pharmacodynamic features of ropivacaine on both an experimental and clinical level. Ropivacaine is an amide-type local anesthetic whose chemical structure is related to that of mepivacaine and bupivacaine and whose duration of effect falls between the two. Ropivacaine is a less potent effector of motor blockade than bupivacaine, and its toxic effects on the central nervous system and myocardial tissue is likewise less. Ropivacaine has been employed for epidural anesthesia and analgesia (including through a caudal approach), for peripheral motor blockade, for local infiltration (in gel form), and for intravenous regional anesthesia in ophthalmologic surgery involving peri- and retrobulbar blockade. Subarachnoid use has not yet been accepted in Spain, although phase IV clinical trials of this application have begun. Concentrations of 2 mg/ml (0.2%) and 7.5 mg/ml (0.75%) and 10 mg/ml (1%) are available in Spain.
Amides↗
[Spanish anesthesiologist in European scientific forums: The European Society of Anesthesiologists and The European Society of Regional Anesthesia].
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Anesthesiology↗
[Hemopoietic progenitor cell transplantation: 20 years' experience at the Hematology School "Farreras-Valentí"/Clinical Hospital of Barcelona].
BACKGROUND: Hemopoietic progenitor cell transplantation (HPCT) is acquiring an increasing role in the therapy for a variety of disorders. In this study, main characteristics and results of HPCT along 20 years are analyzed from the experience of Postgraduate School of Hematology "Farreras-Valentí" at the Hospital Clínic in Barcelona. PATIENTS AND METHODS: Six-hundred ninety-five patients transplanted between June 1976 and January 1996 were analyzed. Median age (range) were 33 (4-63) years. The following aspects were considered: donor type, source or progenitor cells, type of disease and disease-stage at transplantation, transplant related mortality and survival. RESULTS: A total of 714 HPCT were performed (448 allogeneic, 13 isogeneic, 253 autogeneic). Allogeneic HPCT were from an HLA-identical sibling in 408 cases, from other familial donors in 10, and from non-familial donors in 30. Most HPCT from non-familial donors (93%) were performed during the last five years of the study (1991-1995). The source of hemopoietic progenitor cells was bone marrow in 625 instances (88%), peripheral blood in 88 (12%), and fetal liver in one. During more than 15 years, the only source of progenitors was the bone marrow; in contrast, in the last 3 years (1993-1995) transplants using peripheral blood were predominant. Main indications for HPCT were the following: acute leukemias (n = 387) (54%), chronic leukemias (n = 134) (19%), severe aplastic anemia (n = 58) (8%), lymphomas (n = 80) (11%), multiple myeloma (n = 39) (5%) and myelodysplastic syndromes (n = 14) (2%). In patients with hematological malignancies (n = 656), HPCT was performed in first complete remission or in first chronic phase in 321 instances (49%), in subsequent remissions in 144 (22%), and in more advanced stages in the remaining 191 (29%). In the more recent years, a progressive decrease in the number of HPCT for acute leukemia or aplastic anemia was observed, contrasting with an increase in transplants for lymphoma, multiple myeloma and myelodysplastic syndromes. Of note, a significant decrease in transplant related mortality was evident along the years, both after autogeneic HPCT (21% during 1985-1992 and 6% thereafter) (p = 0.001) and after allogeneic transplantation (54%, 44%, and 20% during the periods 1976-1984, 1985-1992 and 1993-1995, respectively) (p = 0.004). The fact translated into an increase in the actuarial probability of survival after allogeneic HPCT (25%, 33% and 58% in the three mentioned periods, respectively) (p = 0.0003), and after autogeneic HPCT (33% in the interim 1985-1992, and 55% in the period 1993-1995) (p = 0.001). CONCLUSIONS: During the last 20 years, HPCT has significantly evolved in aspects such as type of donor, source of progenitor cells and indications. Remarkably, a progressive decrease in transplant related mortality has been observed translating into a improvement in survival after the procedure.
Actuarial Analysis↗
[Magnetic resonance of the spinal cord: a densitometric analysis].
BACKGROUND: Images obtained by magnetic resonance can present changes in a variety of haematologic disorders. The vertebral magnetic resonance signal depends chiefly on the relationship between fatty and cellular components of the haemopoietic bone marrow. A quantitative analysis of signal can be performed either during the magnetic resonance examination or on the computer-stored images. In this work, a densitometric grey-scale method is presented allowing to analyze the signal intensity on printed magnetic resonance images for those cases in which the computer-stored information is lacking. PATIENTS AND METHODS: A comparative study between magnetic resonance signal and the result of the densitometric analysis was carried out in 29 patients with different haematologic disorders. In order to achieve a suitable standardization, an internal control in both measures was used, i.e., the magnetic resonance signal intensity and the grey intensity of an area of spinal cord, respectively, yielding two ratios: magnetic resonance ratio and grey ratio. RESULTS: The precision analysis of the densitometric method gave the following results: within-batch coefficient of variation was 1.78%, between-batch coefficient of variation was 1.94% and overall reproducibility 6.4%. The correlation between magnetic resonance ratio and grey ratio was very high, i.e., 0.98 (p < 0.001). Moreover, the regression line displayed on ideal location since it originated in the point 0 and showed a slope of 45 degrees. CONCLUSION: The densitometric method presented in this paper can be useful for the quantitative analysis of the magnetic resonance signal intensity generated by the haemopoietic bone marrow, for those cases in which the computer-stored information is lacking.
Data Interpretation, Statistical↗
Nimodipine fails to enhance the analgesic effect of slow release morphine in the early phases of cancer pain treatment.
We assessed nimodipine's ability to increase the analgesic effect of morphine in 32 patients suffering from cancer pain in a double-blind, placebo controlled cross-over study. Morphine administration began a few days before the start of the study. The analgesic effects of two combinations were compared: morphine (M) plus placebo (P) and morphine plus 90 mg/24 h of nimodipine (N). The study lasted 8 days, including the wash-out period, and the following sequence of treatments was applied: M + P or M + N on days 1, 2 and 3; only M on days 4 and 5; and M + N or M + P on days 6, 7 and 8. Morphine dose was individualised according to the intensity of the patient's pain and the same dose was maintained throughout the study period. Analgesic response was evaluated using four 10 cm visual analogue scales of quantitative variables for pain intensity, pain relief, sleep quality and mood. A verbal rating of qualitative variables was also scored following validated descriptors of pain in the Spanish language. No significant statistical differences were found in analgesic effect between combined treatment with nimodipine or placebo, as measured on any of the scales. In order to take into account both the short duration of treatment (8 days), and nimodipine's pharmacokinetic characteristics (half-life of 6 h and steady state of 36 h), we compared treatment with nimodipine or placebo on the third day of use, at which time, likewise, there were no statistically significant differences on any of the scales. However, when the same statistical tests were used for comparison of results with pre-treatment baseline values, highly significant differences between mean scores on the scales for pain relief and pain intensity were found. Based on these negative results we conclude that nimodipine given orally at a dose of 30 mg every 8 h does not enhance analgesia when associated with morphine in the early phases of treatment for cancer pain. Our study also gives clear evidence of a placebo effect.
Administration, Oral↗
Bone marrow assessment in B-cell chronic lymphocytic leukaemia: aspirate or biopsy? A comparative study in 258 patients.
To evaluate the relative merits and prognostic value of bone marrow aspirate and bone marrow biopsy in the assessment of bone marrow infiltration in B-cell chronic lymphocytic leukaemia (CLL), two observers independently reviewed the percentage of lymphocytes in bone marrow aspirate (lymphocytic infiltration, LI) and the bone marrow histological pattern (BMP) in 258 patients. The inter-observer reproducibility and agreement was higher for BMP than for LI. BMP was an independent prognostic factor for survival in the whole series, whereas LI only had independent predictive value in stage A patients. In the entire series, disease progression was predicted by either BMP and LI, whereas in stage A patients only by BMP. Regarding low-risk CLL (smouldering CLL or A"1 substage), BMP led to a more reproducible identification of these clinical forms than LI. In conclusion, although both BMP and LI are of value to estimate bone marrow infiltration in CLL and to predict the outcome of the disease, BMP is more reliable and reproducible than LI.
Aged↗
Absence of an early pre-emptive effect after thoracic extradural bupivacaine in thoracic surgery.
We have determined if thoracic extradural block before surgical incision for thoracotomy produces pre-emptive analgesia. Using a double-blind, placebo-controlled, crossover design, 45 patients (ASA II-III) undergoing posterolateral thoracotomy for lung resection were randomized to one of three groups: group 1 received 0.5% bupivacaine and adrenaline 1/200,000 (B+E) 8 ml through a thoracic extradural catheter (tip T3-T5) 30 min before skin incision and saline 8 ml 15 min after skin incision; group 2 received saline 8 ml extradurally before incision and B+E 8 ml after incision; group 3 received saline 8 ml extradurally before and after incision. General anaesthesia was induced and maintained with propofol, alfentanil and atracurium. The alfentanil infusion was stopped before chest closure and fentanyl 50 micrograms in saline 10 ml was given extradurally. Patient-controlled extradural analgesia (PCEA) was commenced with 0.125% bupivacaine, adrenaline 1/400,000 and fentanyl 6 micrograms ml-1 (continuous rate of 2 ml h-1 and supplementary doses of 0.5 ml per 6 min). Visual analogue scale (VAS) scores (recorded at rest, on mobilization and after cough), verbal rating scale (VRS) (recorded at rest), number of successful PCEA demands and complications were measured during the first 48 h after operation. There was no significant difference between groups, either in PCEA requirements (P > 0.21) or in VAS scores (either at rest, during mobilization of the ipsilateral arm of surgery or after cough). No significant differences between groups were found in the VRS. Thoracic extradural block with bupivacaine did not produce an early preemptive effect after thoracotomy.
Adult↗
Incidence and characteristics of lymphoid malignancies in untreated myelodysplastic syndromes.
We have analyzed 1,198 patients with untreated myelodysplastic syndromes (MDS) with two main objectives: (1) to determine the prevalence of lymphoid malignancies (LM) in MDS patients; and (2) to ascertain whether there is some relationship between the MDS subtype and the LM type. In fourteen of 1,198 primary MDS patients (1%) (4 with refractory anemia, 3 with refractory anemia with ring sideroblasts, 2 with refractory anemia with excess of blasts and 5 with chronic myelomonocytic leukemia) a LM was detected. In all cases, the LM was of the B-cell type: 6 cases of chronic lymphocytic leukemia, 5 cases of lymphoplasmacytoid lymphoma, and 3 cases of multiple myeloma. B-cell malignancy did not prevail in any MDS subtype and no correlation was observed between the different varieties of both diseases. In conclusion, in this large series, 1% of the untreated patients with MDS had B-cell malignancy, an association that in most cases is likely to be merely coincidental.
Aged↗
[Gerard W. Ostheimer (1940-1995). In memoriam].
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Anesthesia, Conduction↗
Difficult management of pain following sacrococcygeal chordoma: 13 months of subarachnoid infusion.
We report on a patient suffering severe pain following a long-standing sacral chordoma in whom management of therapy and pain was extremely difficult. Because orally administered morphine was observed to be ineffective in the early stages of treatment, we tried to achieve pain relief by using epidural morphine. This was also unsatisfactory. Intrathecal infusion of morphine and bupivacaine through a catheter inserted at the L2-L3 level was also found to be ineffective; only a segment block was observed. A structural anomaly of the spine was suspected and confirmed by myelography, showing metastasis at L3. Pain relief improved when an infusion of morphine+bupivacaine was employed through a catheter placed at the L4-L5 level below the blockage. A major problem which continued throughout the course of the disease was the daily occurrence of episodes of unbearable sharp pain that required addition of midazolam to the local anesthetic/opioid subarachnoid infusion. The patient received this mixture through an intrathecal port during the last 13 months of life, a gradually increasing dose being necessary. Periods of analgesia were followed by occasional crises of intense sharp pain suggesting incomplete relief. No serious complications or meningitis occurred. This case emphasizes the difficulty in managing pain in this type of cancer.
Bupivacaine↗
Fibroblast function in psoriatic arthritis. I. Alteration of cell kinetics and growth factor responses.
OBJECTIVE: To explore the potential role of fibroblasts in the pathogenesis of psoriasis and its related arthritis. Specifically, we analyzed the cell cycle of psoriatic fibroblasts obtained from skin and synovium by flow cytometry, and we also studied their response to several growth factors. METHODS: Fibroblast cultures were established from normal and psoriatic skin, uninvolved and involved, and synovium. NIH-3T3 cells were also used as indicator cells in some of the experiments. Fibroblasts DNA cell cycle analysis was performed by flow cytometry, and the data was analyzed by using the "Cytologic DNA applications software version 2." In addition, fibroblasts were stimulated with growth factors including epidermal growth factor, transforming growth factor-beta, and platelet derived growth factor. RESULTS: A significant increase of S and G2-M phase values in confluent cultures of psoriatic fibroblasts in both skin and synovium compared to normal fibroblasts was found. Psoriatic fibroblasts also exhibited a greater proliferative response to growth factors compared to normal fibroblasts. CONCLUSION: Data obtained clearly showed a significant intrinsic in vitro alteration in skin and synovium fibroblasts from patients with psoriasis.
3T3 Cells↗
B-type large-cell primary splenic lymphoma with massive involvement of the red pulp.
A B-type large-cell primary splenic lymphoma with massive red-pulp involvement was diagnosed in a 64-year-old woman presenting with malaise, fever, anemia, atypical lymphoid cells in peripheral blood, and splenomegaly. This case differs from most splenic lymphomas both macroscopically and microscopically. At macroscopic examination, the spleen was homogeneously red without tumoral nodules or masses. Microscopically, the cords of the red pulp were extensively invaded by tumor cells maintaining patient sinuses. The white pulp was reduced by expansion of the red pulp. To our knowledge only few additional cases of splenic lymphoma with similar features have been previously described. The differential diagnosis of this unusual form of lymphoma with other lymphoproliferative disorders is briefly discussed.
Antineoplastic Combined Chemotherapy Protocols↗