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Biomedical subjects

J M Ribera

Publications and source records attributed to J M Ribera.

At least 109 records · Page 6Linked to original sources

[Granulocytic sarcoma: a study of 5 cases].

Granulocytic sarcoma (GS) is a solid tumor of extramedullary localization constituted by immature precursors from the granulocytic series. GS may be diagnosed in different malignant blood diseases involving the granulocytic series, acute non lymphoblastic leukemia (ANLL) being the most frequent, followed by myelodysplastic syndromes (MDS) and chronic myeloproliferative syndromes, specially chronic myeloid leukemia (CML) in blastic crisis. Although the diagnosis of GS is suspected with conventional cytologic and anatomopathologic studies, histochemical staining and immunohistochemical techniques are often required for definitive diagnosis. Five cases (4 males, 1 female; age range 22-77 years) diagnosed with GS in one center over a period of nine years (1984-1993) are described. The GS were located in the lymph nodes, the jaw, paravertebral region, gallbladder and retroperitoneum, respectively. Two patients had refractory anemia with excess of blasts (RAEB). Three patients had ANLL; in one GS constituted the form of relapse, in another GS presented at the time of diagnosis and in the remaining patient GS preceded the diagnosis of ANLL. All the patients died from 2 to 8 months after diagnosis of GS with no response to treatment being observed. Immunohistochemical study of the tumor was performed in 4 patients, being positive for lysozyme and the monocytic MAC-387 monoclonal antibody. Immunocytochemical study of the tumor blasts was carried out with positivity for CD15 being observed. Although uncommon, GS should be suspected in patients with ANLL or MDS with tumors of any localization and at any time during its evolution. Immunocytochemical and immunohistochemical studies are of great value to differentiate GS from other tumors, particularly anaplastic non Hodgkin's lymphomas.

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[Primary extralymphatic non-Hodgkin's lymphomas: the response to treatment and prognostic factors in 73 patients].

BACKGROUND: The aim of the present study was to determine the prognostic factors for treatment response, relapse-free survival (RFS) and overall survival (OS) in a series of 73 patients with primary extranodal lymphomas (PEL). METHODS: All the patients diagnosed with PEL in one center from January 1984 to December 1993 were studied. The Working Formulation was used for histologic classification and the stage was determined according to the Ann Arbor classification modified by Mushoff. Age, sex, localization of the lymphoma, the presence of B symptoms, the existence of bulky disease, human immunodeficiency virus (HIV) infection, the main hematological and biochemical parameters, the histologic grade of malignancy, the immunologic phenotype and stage were reported. Univariate and multivariate analyses of prognostic factors for complete response (CR), RFS and OS were carried out. RESULTS: The most frequent localization of PEL was the gastrointestinal tract (43 cases). Fourteen cases had HIV infection. CR was obtained in 37 out of the 55 patients (67%) of whom 8 (21%) had relapsed. Serum LDH level was the main prognostic factor for CR attainment (p = 0.01). The variables which negatively affected RFS were the presence of HIV infection (p = 0.02), advanced age (p = 0.018) and the existence of B symptoms (p = 0.02). OS was shorter in patients with high LDH levels (p = 0.004) and more aggressive histologic subtype (p = 0.0002). CONCLUSIONS: The prognostic factors observed in the patients with primary extranodal lymphomas are the same as those found in nodal non Hodgkin's lymphomas. The stage is not a factor of bad prognosis if chemotherapy is included in the treatment.

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Long-term outcome of coronary angioplasty in elderly patients with post-infarction angina.

The long-term clinical and angiographic outcome of 76 elderly (> or = 65 years) patients undergoing coronary angioplasty (PTCA) (83 lesions attempted) for post-infarction angina (PIA) (group I) was compared with that of 83 elderly patients undergoing PTCA (105 lesions) for stable angina (group II). Age (70 +/- 4 years), gender (70% male) and major demographic variables were similar in both groups. The mean left ventricular ejection fraction was 56 +/- 14% in group I vs 67 +/- 14% in group II (P < 0.01). In group I, PTCA was performed more frequently for lesions located in the right coronary artery (35% vs 18%, P < 0.01) and less frequently in the left circumflex artery (12% vs 26%, P < 0.05). Although the percentage of lesions with thrombi was higher in group I (16% vs 2%, P < 0.001), the rate of angiographic success was similar in both groups: 94% (78/83 lesions) in group I vs 93% (98/105) in group II (ns). PTCA was successful in 67 patients (88%) in group I and in 74 (89%) in group II (ns). The rate of major complications was also similar in both groups (4%). Restenosis occurred in 36% vs 31% of the lesions in groups I and II respectively (mean time to angiographic follow-up 7 +/- 2 months) (proportion of cases with a repeat angiography: 79% in group I and 72% in group II). Restenosis was asymptomatic in 57% vs 50% of the patients respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

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[Non-Hodgkin's lymphomas in patients with human immunodeficiency virus infections. Clinicopathologic characteristics, treatment response and prognosis in 40 patients].

BASIS: Non-Hodgkin lymphoma (NHL) is one of the commonest neoplasms appearing in subjects infected by the human immunodeficiency virus (HIV). The purpose of this work was to analyse the clinical and laboratory characteristics, along with the clinical course, response to therapy and prognosis in a series of 40 patients with NHL and HIV infection treated in a single institution between 1985 and 1993. METHODS: The following variables at onset were analysed: age, sex, risky behaviour, NHL location, presence of "B" symptoms, haemoglobin value, platelet count, total number of lymphocytes and CD4-positive lymphocyte count, erythrocyte sedimentation rate, LDH levels, serum albumin, beta 2-microglobulin, NHL type and staging. The following variables during follow-up were also examined: treatment administered, achievement of remission and remission duration, date of relapse and death or date of the last control, relapse-free survival (RFS) and overall survival (OS). A multivariate study of the prognostic factors associated to the achievement of remission, RFS and OS were carried out as well. RESULTS: The frequency of NHL amongst the HIV-positive subjects was 4.4%. Thirty cases had high-grade lymphoma, 20 were stage IV and 33 had extranodal locations. Anaemia was the commonest blood impairment and CD4-positive lymphocyte count was below 0.2 x 10(9)/L in 72% of the cases. Twenty-eight patients with systemic NHL received chemotherapy (CHOP in 25 instances, MACOP-B in 3), and of them 6 were alive, 5 in maintained remission, as for this paper's writing. The median RFS was 7 months and the median OS was 11 months. Increased serum LDH was associated with lesser probability of attaining both remission (p = 0.03) and RFS (p = 0.03). Response to therapy was the main factor in determining survival (p = 0.002); after excluding such factor, increased serum LDH and low serum albumin rates correlated negatively with OS (p = 0.004 and p = 0.007, respectively). CONCLUSIONS: HIV-positive patients, when affected by NHL, usually have high-grade lymphoma, frequently in advanced stages and with extra-nodal involvement. They show poor response to therapy. Increased serum LDH level is the main prognostic factor.

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[Marrow hypoplasia associated with congenital dyskeratosis. Case report].

Congenital dyskeratosis is a rare disease involving ectodermal derived tissues and presenting bone-marrow hypoplasia as a complication in one half of the cases. A 25 year-old male is presented who at age 12 showed retarded development with shortness of the 4th finger of his left hand, anomalous implantation of teeth, hyperpigmented skin and hyperkeratosis on his knees, hands and feet. He had anaemia (Hb 92 g/L) and leucopenia (2.7 x 10(9)/L) with neutropenia (0.34 x 10(9)/L) and his bone-marrow showed hypoplasia, especially affecting granulopoiesis. The cytogenetic studies were normal. No treatment was given, and a haematological re-evaluation performed 13 years later showed no significant quantitative changes. Decreased number of myeloid and megakaryocytic colonies were present in the bone-marrow cultures. The clinical and laboratory characteristics of the bone-marrow aplasia associated to congenital dyskeratosis are commented, stress being laid on its differentiation from other constitutional forms of aplasia, especially Fanconi's anaemia.

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Isochromosome 17q as a sole anomaly: a distinct myelodysplastic syndrome entity?

We report four patients with myelodysplastic syndrome (MDS) with isochromosome i(17q) as the sole chromosomal anomaly. One patient was classified as refractory anemia (RA) and three as refractory anemia with excess of blasts (RAEB). All four patients shared several features such as male sex, advanced age, severe anemia, as well as a bone marrow with myeloproliferative characteristics: hypercellularity, prominent baso- and eosinophilia, and marked increase of micromegakaryocytes. We suggest that patients with i(17q) as the sole chromosomal anomaly may identify a distinct MDS with characteristics between MDS and chronic myeloproliferative disorders (CMPD).

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Percutaneous transluminal coronary angioplasty for post-infarction angina in elderly patients.

To assess the short-term outcome of percutaneous coronary angioplasty (PTCA) for post-infarction angina in elderly patients, we have retrospectively evaluated the results of 88 procedures of PTCA (98 lesions attempted), performed for post-infarction angina (PIA), in 84 patients of > or = 65 years (elderly group), and compared the results obtained with those of 165 PTCAs (200 lesions attempted) in 161 patients of < 65 years old with PIA (young group). Angiographic success was obtained in 91 (93%) vs. 181 (91%) of lesions attempted in the groups, respectively. Complete revascularization was achieved in 54 (61%) patients treated in the elderly group vs. 106 (65%) in the young group. PTCA success was obtained in 78 (89%) procedures vs. 147 (89%) of both groups. No patients required emergency coronary surgery, two patients (2%) had a reinfarction in the elderly group vs. five patients (3%) in the young group, and two patients died (one in the elderly and one in the young group). In conclusion, PTCA for PIA in elderly patients provides a high clinical success rate with a low frequency of complications, similar to the results obtained in young patients.

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