PubMed Health⌕ Search

Biomedical subjects

J M Ribera

Publications and source records attributed to J M Ribera.

At least 127 records · Page 7Linked to original sources
PubMed1993

Electron microscopic identification of parvovirus virions in erythroid and granulocytic-line cells in a patient with human parvovirus B19 induced pancytopenia.

In this short report we describe a patient with human parvovirus B19 (HPV B19)-induced transient pancytopenia. Parvovirus virions were seen by electron microscopy in both erythroid and granulocytic precursors. Erythroid cells are not the only targets in these cases. We draw attention to this disorder so that physicians involved with hematological disorders and transplantation be more aware of this infection.

Adult↗
PubMed1993

[Acute basophilic leukemia with an intense erythroblastic reaction].

A patient is presented who had acute basophilic leukaemia with intense erythroblastic reaction. The patient, a 66 year-old man, complained of general malaise, increased abdominal perimeter and melena. Leucocytosis, as well as severe anaemia and thrombocytopenia, were found in his peripheral blood. Basophils were present in all maturation stages, along with 7% blast-cells showing basophilic stippling, and there were 210 erythroblasts per 100 white cells. Erythropoietic hyperplasia (75%) was found in the bone-marrow aspirate, without dyserythropoietic signs; the PAS-stain reaction was negative. Of the non-erythroid cells, 63% were basophils and 34% blast-cells, some of them showing basophilic stippling plus metachromasia for tholuidin-blue, positivity for omegaexonuclease and negativity for peroxidase stains. The diagnosis of acute basophilic leukaemia was confirmed upon demonstration of basophilic stippling in the ultrastructural study of the blast-cells. The patient developed acute liver failure and renal insufficiency which led him to death. The basis of the diagnosis of acute basophilic leukaemia is discussed, as well as the differential diagnosis with other conditions presenting with basophilia and the probably reactive erythroblastic increase appearing in this case.

Aged↗
PubMed1993

[Splenic lymphoma with circulating villous lymphocytes. Study of 6 patients].

PURPOSE: Splenic lymphoma with circulating villous lymphocytes (SLCVL) is a rare chronic B-type lymphoproliferative disorder, few series having been reported thus far. The major clinical, cytological, immunophenotypic and ultrastructural features, as well as the course and treatment of six cases seen in three hospitals of the Barcelona area in six years are reported herein. METHODS: The criteria of Melo et al were followed for the diagnosis of SLCVL. The clinical manifestations at onset and the morphology of lymphocytes from blood and bone-marrow (aspiration and biopsy samples) were analysed. The samples were subjected to cytochemical (acid phosphatase and L-tartaric acid inhibition), immunophenotypic (alkaline immunophosphatase and immunofluorescence) and ultrastructural studies. The histologic study of the spleen of those patients who underwent splenectomy was also performed. RESULTS: The median age of the series was 63 years (range: 45-86). Five of the patients were women. Anaemia was the commonest clinical finding at onset, and splenomegaly was found in all cases. Villous lymphocytes were found in both peripheral blood, 3% to 85%, and bone-marrow, 31% to 70%; they showed diffuse positivity to acid phosphatase stain, this being inhibited in all cases by L-tartaric acid. None of the patients had associated monoclonal gammopathy. Bone-marrow biopsy was performed in five occasions, showing nodular infiltrative pattern in three cases, interstitial in one and diffuse pattern in another. Nodular infiltration was seen in the white pulp of spleen, with no involvement of the red pulp. The ultrastructural study of villous lymphocytes from peripheral blood or bone-marrow disclosed short, slim villi with narrow bases, no lamellar ribosomal complexes being found. Mature B-type lymphocyte proliferation was present in all instances, showing positivity for surface immunoglobulin; monoclonal antibody CD25 was negative in all cases. Three patients underwent splenectomy, and the remainders received no treatment. The expected survival at three years was 80%. CONCLUSIONS: SLCVL is a rare B-cell chronic lymphoproliferative disorder with recognised morphologic and immunophenotypic characteristics that make it distinguishable from other B-type lymphoproliferative diseases especially hairy cell leukaemia. Its clinical course is chronic and it has good prognosis. Response to splenectomy is usually favourable, although remission of the disease is not achieved.

Actuarial Analysis↗
PubMed1993

Ph-positive chronic myeloid leukemia mimicking essential thrombocythemia and terminating into megakaryoblastic blast crisis: report of two cases with molecular studies.

Two patients with chronic myeloid leukemia (CML) presenting with the hematologic features of essential thrombocythemia (ET) are reported. At diagnosis they showed extremely high platelet counts (4985 and 2800 x 10(9)/l, respectively) and moderate leukocytosis (21 and 17 x 10(9)/l, respectively). In both cases, in addition to the Philadelphia chromosome (Ph), a rearrangement within the major breakpoint cluster region on chromosome 22 was demonstrated, with the breakpoint in the 3' extreme. In patient 1 the disease initially responded to radioactive phosphorus and hydroxyurea, but during the evolutive course a progressive increase in the white blood cell counts was noted, reaching values typical of the chronic phase of CML, and the patient eventually died from blast crisis 45 months after diagnosis. In patient 2, although good control of the platelet counts was achieved with hydroxyurea, the disease also evolved into a blast crisis four months after diagnosis. In both cases monoclonal antibodies and electron microscopy studies demonstrated the megakaryocytic nature of the blast cells. The above features are not consistent with the present and similar cases being Ph-positive ET. Instead, they should be regarded as a special form of CML characterized by a marked protagonism of the megakaryocytic component.

Aged↗
PubMed1993

[Evaluation of the System 9000-AX autoanalyzer].

PURPOSE: The aim of this study was to evaluate the haematologic autoanalyser System-9000 AX (Serono-Baker Diagnostics), which provides 15 parameters of red, white and platelet series and three histograms showing the cellular distribution curves according to the volume of each series. MATERIAL AND METHODS: The accuracy, precision, linearity, carry-over, effective speed and the effect of sample storage on results were studied. Moreover, the leucocyte differential count (LDC), false positive and negative results of the automated differential count and sensitivity, specificity and efficiency of LDC were analysed and compared with conventional methods: a Coulter VCS analyser and a Coulter S-Plus STKR. RESULTS: The accuracy of the results of three haematologic series was very good. In the LDC, the results for the middle and big cells were better in comparison with the manual method (r > 0.80) than the Coulter VCS, (r = 0.28 and 0.48 respectively). The percentage of LDC revisions and the false negative was higher in hospitalized patients than in outpatients (28.14 and 8.46% versus 12.56 and 2.18%). The most common anomalies were the left deviation, monocytosis and eosinophilia. The results of sensitivity, specificity and efficiency were greater than 80% in all cases, except for the sensitivity and efficiency of hospitalized patients, because of the greater number of false negatives. Precision and linearity were excellent in all the parameters studied. No significant contamination was observed among the samples (low carry-over percentage). The samples were stable for 24 hours at 4 degrees C. CONCLUSION: The System 9000 AX is a reliable analyser, which is fast and easy to operate. These characteristics allow this analyser to be a very useful tool for laboratories that require a rapid testing of samples.

Blood Cell Count↗
PubMed1992

[Primary gastrointestinal lymphoma: a study of 25 cases].

BACKGROUND: The digestive tract constitutes the most frequent localization of the extranodular non Hodgkin's lymphoma. The chief clinical and histological characteristics were analyzed as were the evolution and response to treatment of 25 patients diagnosed with primary gastrointestinal lymphoma (PGIL) in one center over a period of eight years. METHODS: To establish the diagnosis of PGIL the Dawson criteria were used and the state was determined by the Ann-Arbor classification modified by Musshoff. To histologically classify of the PGIL the Working Formulation was followed. The influence of the clinical, histological characteristics and the state of the obtention of complete remission (CR), the survival free period of the disease (SFD) and global survival (GS) were analyzed. RESULTS: The mean age of the series was 56 years (standard deviation 15 years) (12 males). The most frequent localization was gastric followed by the small intestine and the large intestine. Abdominal pain and weight loss were the most frequent clinical manifestations in the PGIL, regardless of its site. In 12 patients the PGIL was of an intermediate grade of malignancy, 8 were of low grade and 5 of high grade. The state was IE in 11 patients, IE1 in 9 and IIE2 in 5. The most used treatment was radical surgery followed by polychemotherapy. Complete remission was obtained in 15 patients and 2 recurred. The foreseen SFP at 7 years was 69% of the cases and GS was 53%. In IE state patients was most frequently obtained and GS was also more prolonged in these patients. CONCLUSIONS: In the present series the gastric localization of patients with primary gastrointestinal lymphoma was more frequent than intestinal localization. The HNL of intermediate and high grades of malignancy predominated those of low grade. The prognosis of patients with primary gastrointestinal lymphoma in a IE state was more favorable than the remaining patients. In turn, surgery constituted a good option in the initial treatment of patients with primary gastrointestinal lymphoma.

Adult↗
PubMed1992

[Unexpected hypoglycemia in hospitalized patients].

We analyze 40 episodes of unsuspected hypoglycemia (glycemia < or = 3.30 mmol/l) in 36 in patients during seven months in a tertiary hospital. Only 22% of them were diabetics, the rest had other risk-factors such as malnutrition (47%), infections (47%), liver diseases (22%), renal failure (19%) or neoplasias (17%). Only 14% of the subjects had symptoms related to hypoglycemia, and only 27% received treatment. There were no significative differences between those patients over 65 years and the younger ones. Hypoglycemia was not the apparent cause of death in any of the patients, but hospital mortality of these patients was 25%, and it was related with the number of risk factors. We conclude that hypoglycemia in hospitalized patients is often unnoticed, as it appears with diseases other than diabetes, and that it is related with a high mortality in patients with severe diseases.

Aged↗
PubMed1992

[Plasma cell leukemia. Study of 6 patients].

PURPOSE: To analyse the clinico-biological characteristics, the clinical course and the response to therapy in a group of patients with plasma cell leukaemia (PCL). MATERIAL AND METHODS: Out of a total number of 107 patients diagnosed of multiple myeloma (MM) between 1983 and 1991, 6 were found to meet the criteria for PCL (prevalence: 5.6%). This was primary in 2 cases and secondary in the remaining 4. The M/F ratio was 2/1 and the median age was 63 years (range: 57-69 years). RESULTS: Two patients had bone pain and two others weight loss at the onset of PCL. The outstanding haematological findings were increased ESR, normocytic-normochromic anaemia and thrombocytopenia, which were present in all cases. The percentage of peripheral blood plasma cells was between 29 and 70, and the bone marrow aspirate showed plasma cell infiltration over 40% in all cases. Serum M component was found in 5 patients, with decreased values of the polyclonal immunoglobulins; the remaining patient had non-secretory MM. Renal insufficiency was present in 3 patients at diagnosis. Three of the 4 patients with secondary PCL had been previously given combination chemotherapy and the remainder had received melphalan and prednisone. The period between the diagnosis of MM and the development of PCL ranged between 1 and 21 months (median 15 months). Three patients were treated with the M-2 protocol and the others received only supportive therapy. Transient partial response could be achieved in only one case with chemotherapy. All the patients have died, the actuarial survival median being 1 month (range, 1-7 months). Three patients died of infection, 2 of renal insufficiency and one of heart failure after acute myocardial infarction. CONCLUSION: The poor prognosis of PCL was confirmed, along with the scarce response to therapy of these patients.

Aged↗
PubMed1992

[Previous history of gastrectomy in the aged: a malnutrition with malignant aspect].

Between 1979 and 1986 a prospective study was performed on 15 gastrectomized (Billroth II) patients, who were above 65 years old, with evidence of clinical malnutrition as defined by anthropometric criteria. Gastrectomy had been performed between 2 and 55 years before the study (29 +/- 12.87 years). In twelve patients weight loss was observed ranging from 5.85 and 11.91 kg in a mean period of 12.7 months immediately prior to admission. In 8 cases the initial diagnosis was of malignancy, in 2 cases of severe anemia, and in 1 case of severe malnutrition. Intestinal malabsorption (IMB) was observed in 5 cases and intestinal bacterial overgrowth (IBO) in 2 cases, and both diagnosis in 4 cases using stool fat test and D-xylose test for the diagnosis of IMB and urine determination of Urican for the diagnosis of IBO. In two patients the test were normal and they could not be performed in two other. In 3 patients malignancy could not be observed however one of them presented IMB and the other IMB and IBO. We conclude that gastrectomy when performed in earlier ages can cause malnutrition at an older age, provoking a sudden malnutrition suggestive of malignancy. Most of these patients present IMB and/or IBO. Since IBO can cause irreversible mucosal damage, it is discussed whether this could be the cause of this clinical picture.

Aged↗