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J Pérez Calvo

Publications and source records attributed to J Pérez Calvo.

8 recordsLinked to original sources

[Syncope: many studies and few diagnoses?].

INTRODUCTION: Syncope is a frequent disorder shows diagnostic difficulties, so that an important percentage of patients remain without diagnosis after the implementation of diagnostic tests that sometimes are unnecessary. METHOD: A retrospective analysis of the patients admitted during a period of two years because of syncope in an Internal Medicine Service was carried out. RESULTS: Of a total of 2,878 patients hospitalized during the years 1999 and 2000, 79 were admitted because of syncope (2.74%). Forty-five (57%) were men and 34 (43%) were women, with a median age of 68.8 years. Twenty-seven patients (34%) had history of syncope. After a median hospitalization of 9.5 days, the etiological diagnosis was established in 53 (67%) patients: in 25 patients (31.6%) the syncope was mediated by neurological mechanisms, in 16 (20.25%) it was of cardiology origin, in 4 (5.06%) it was of neurological origin and in 8 (10.1%) the syncope was secondary to other causes. In 54 patient (68.8%) at least one cardiology test was carried out (41 Holter, 32 echocardiograms, 6 tilt board tests, 3 maneuvers of massage of the carotid sinus, 3 ergometry studies, 3 electrophysiological studies, 2 coronary angiographies and 3 ventilation perfusion lung gammagraphies). In 51 patient (64%) at least one neurological test was carried out (31 EEG, 42 CT, 2 MNR, 1 Doppler cranial ultrasound and 3 electroneuromyogram). Only 4 of the Holter carried out were diagnostic, as well as 3 of the echocardiograms and only 2 of the CT carried out. No EEG was useful for the etiological diagnosis of the syncope. CONCLUSIONS: There is an excessive utilization of some diagnostic tests (EEG, Holter, cerebral CT), in spite of which in an important percentage of patients with syncope the etiological diagnosis is no done (33%). The use of diagnostic algorithms based on detailed clinical history, physical exploration and assessment of the ECG is proposed, that they would make it possible to issue a diagnostic hypothesis from which there could be begun the diagnostic study with a use as rational as possible of the complementary examinations.

Adolescent↗

[Gronblad-Strandberg syndrome. Report of four cases in one family].

The Grönblad-Strandberg syndrome is a rare congenital hereditary dysplasic disorder of the connective tissue, characterized by a progressive abnormal mineralization and dystrophic calcification of elastic tissue and collagen. This process affects tissues rich in elastic fibers and multiple systems of the organism, the cutaneous, ocular and vascular being the most common. These findings progress through the life of the affected person. We present 4 cases in the same family, with heterogeneous clinic pattern and evolution.

Adult↗

[High-dose chemotherapy with four drugs and peripheral blood progenitor cell autologous transplantation in disseminated breast cancer].

OBJECTIVE: To evaluate the therapeutic efficacy (in terms of overall survival [OS] and progression-free survival [PFS]) of a high-dose chemotherapy protocol including four drugs and peripheral stem cell rescue (PSCR) plus posttransplant G-CSF (filgrastim) in disseminated breast cancer patients. PATIENTS AND METHODS: Fifty-three metastatic breast cancer patients were treated with a four-drug program of high-dose chemotherapy including cyclophosphamide (6 g/m2), thiotepa (500 mg/m2), carboplatin (800-1,600 mg/m2) and mitoxantrone (20-60 mg/m2) with autologous peripheral blood progenitor cell support followed by filgrastim. Most cases (92%) had previously received conventional induction chemotherapy with anthracycline-containing combinations. RESULTS: After a median follow-up of 27 months (range 12-43 months) from transplant, the median survival of the overall group was 25 months, with an OS projected at 43 months of 31%. Patients in complete remission after induction chemotherapy or status NED (no evidence of disease: surgical resection of metastases) presented the best outcome, with a projected PFS of 50% at 43 months. Patients intensified without complete response had a poor outcome. The most important extramedullary toxicity was mucositis. Four patients (7.5%) died as a consequence of treatment (2 with sepsis-associated ARDS, one with venooclussive disease of the liver, one with congestive cardiac failure). CONCLUSIONS: The outcome of metastatic breast cancer patients in complete remission after induction chemotherapy or NED status seems to be good with our high-dose chemotherapy including four drug and PSCR. On the other hand, patients intensified without complete response presented a bad outcome and do not seem candidates for future trials with this therapeutic approach.

Adult↗

[Magnetic resonance in the diagnosis of extent and osseous complications of Gaucher's disease type 1].

OBJECTIVE: To evaluate the usefulness of magnetic resonance (MR) for investigating bone involvement in Gaucher disease type 1 (GD). METHODS: Ten adult patients with the diagnosis of GD type 1 were studied. Weighted sequences were performed in spin-echo (SE) T1 and T2 of 4 body areas: spine, pelvis, hips, and femurs. The patterns of bone infiltration proposed for the study were: homogeneous infiltration (H), non-homogeneous infiltration (NH), and normality (N). Four patients were receiving enzyme replacement therapy. RESULTS: All patients (100%) showed changes associated with infiltration with Gaucher cells. The distribution of patterns was as follows: the homogeneous pattern predominated (60 and 50%, respectively) in spine (6H/2NH/2N) and pelvis (5H/3NH/2N), whereas the non-homogeneous pattern predominated (60% and 80%, respectively) in hips (1H/6NH/3N) and femurs (1H/8NH/1N). As bone complications two cases of hip avascular necrosis were noted, one of them with bilateral involvement, one case with infarcts in femur diaphysis and other case with medullar edema in a bone crisis. CONCLUSION: MR is an excellent technique for detecting medullar bone infiltration and complications in GD type 1.

Adolescent↗

[Occult bladder cancer in incarcerated inguinal hernia. Report of a case and review of the literature].

OBJECTIVE: To describe a case of incarcerated inguinal hernia containing bladder carcinoma. METHODS/RESULTS: A case of urothelial bladder neoplasm presenting with perforation and scrotal abscess is described. The clinical features, incidence and diagnostic aspects are discussed and the literature briefly reviewed. CONCLUSION: The association of malignant tumor and hernia of the abdominal wall is uncommon, particularly those involving the inguinal zone. To our knowledge, only 8 cases have been reported from 1965 to 1995, accounting for 5.3% of all hernia sac-associated tumors. The location of this type of tumor delays diagnosis and the outcome is generally poor.

Aged↗

[Acquired hemoglobin H disease associated with a myelodysplastic syndrome].

Some patients found to have clonal panmyelopathies develop an acquired defect of haemoglobin synthesis clinically similar to haemoglobin H disease. A 58 year-old male diagnosed of simple refractory anaemia developed microcytosis and hypochromia. At the same time, his myelodysplastic syndrome became a refractory anaemia with excess of blasts. 33% of the red blood cells had "golf ball" inclusions after incubation with brilliant cresyl blue. Cellulose acetate electrophoresis revealed an haemoglobin H band. The globin chain synthesis alpha/beta ratio was 0.69. The molecular analysis demonstrated the integrity of both alpha genes in each chromosome. There were no familiar antecedent of haemoglobinopathy.

Anemia, Refractory, with Excess of Blasts↗

[Past, present and future of anti-idiotype vaccination].

Cancer vaccines are conceived as therapeutic tools, in contrast to the prophylactic vaccines used to fight against infectious diseases. Among the most potent therapeutic vaccines, anti-idiotype vaccination is directed against the tumor idiotype, the only well-characterized tumor antigen displayed in neoplastic B-cells. Anti-idiotype vaccines have demonstrated clinical benefit against follicular lymphoma and are currently being evaluated in two different phase III clinical trials. Additional emerging strategies, which include the use of dendritic cells and the production of vaccines via molecular means will surely allow us to draw important conclusions concerning the treatment of cancer patients.

Cancer Vaccines↗