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Biomedical subjects

J Sala

Publications and source records attributed to J Sala.

At least 55 records · Page 3Linked to original sources
PubMed1995

Improvement in survival after myocardial infarction between 1978-85 and 1986-88 in the REGICOR study. (Registre GIroní del COR) registry.

Aspirin, intravenous nitrates and fibrinolysis were being used by 1986 in Girona, Spain. These combined factors should be reflected in myocardial infarction patients' outcome. We assessed changes in 28-day and 3-year survival after a first myocardial infarction between 1978-85 and 1986-88 in the REGICOR (Registre GIroní del COR) registry. This included 1216 consecutive patients with a first transmural myocardial infarction (834 in 1978-85 and 372 in 1986-88). Their 28-day and 3-year mortality rates were 14.6% and 8.8% respectively. Although patients admitted in the second period were more frequently hypertensive and diabetic, a history of angina was less common in patients admitted between 1978 and 1985. After adjusting for diabetes, hypertension, age, and sex, the relative risk of 28-day mortality of those admitted in the second period was 0.65 (95% confidence interval 0.42-0.99). The lower severity, as measured by Killip class of patients in the second period, was the main (confounding) variable responsible for this protective effect. Three-year mortality of those surviving 28 days in 1978-85 (8.3%) did not differ from 1986-88 (8.3%). In the second study period hospitalized patients with myocardial infarction in Girona, Spain showed a better 28-day survival. It is possible that therapeutic and diagnostic refinements, together with other factors not controlled in the present study, have resulted in such an improvement. However, 3-year mortality remained unmodified among those surviving 28 days.

Adult↗
PubMed1995

Human mitochondrial DNA variation and the origin of Basques.

The hypervariable segment I of the control region of the mtDNA (positions 16024-16383) was PCR-amplified from mouth scrape and hairs and sequenced in 45 unrelated individuals of pure matrilineal Basque descent. Twenty-seven different sequences were found, of which 21 are unique to the Basques. The allelic partition observed, together with resampling experiments, suggested that much more variation remained to be discovered. The mean pairwise difference in number of nucleotides between individuals was 3-15, a very low value. Moreover, the number of steps for the most parsimonious tree is very low compared to the number of different sequences. Both findings suggest that the Basque population was founded by a few lineages that diverged in a short time span. The number of nucleotide differences between individuals was shown not to be influenced by the distance between their birthplaces, thus validating the sampling strategy used a posteriori. The pairwise difference distribution agreed well with the three-parameter model proposed by Rogers & Harpending (1992). The parameter estimates found for the Basques implied that a demographic expansion (or perhaps two, given the bimodal shape of the distribution) took place sometime between 14500 and 42000 BP which is in agreement with archaeological data. Our sample was compared to other populations for which D-loop sequences were available through the Nei & Miller (1990) distance. In a neighbour-joining tree, all the Caucasoid samples, including the Basques, appeared tightly clustered, whereas African samples were the most distant to the Caucasoids and also the most heterogeneous. Although classical markers, such as blood groups and protein polymorphisms, clearly separate the Basques (and the Sardinians) from other European populations, this distinctiveness was not found using D-loop sequences.

Base Sequence↗
PubMed1995

[Congenital urethral diverticulum].

Presentation of two cases of congenital diverticula of the bulbar urethra. The objective of this paper is to discuss the etiopathogenic theories, sings and symptoms, current diagnostic methods and therapeutic indications, and to conclude that this type of diverticula do not present a florid symptomatology, endoscopy being the best diagnostic and therapeutic method. Finally, a review of the literature is made based on two clinical cases.

Adult↗
PubMed1994

Characteristics of Myocardial Infarction Episodes in Two Distant Communities: From the REGICOR Registry in Girona, Spain and the MITI Registry in Greater Seattle, USA.

Background: The objective of the study is to compare patient characteristics and outcome after myocardial infarction (MI) between two geographically and socially different communities. Methods/Results: The study was designed as an ecological comparison between a 1-year hospital registry of consecutive MIs in Seattle (1,400,000 inhabitants and a predominantly urban and suburban distribution) and nine hospitals in Giroma (500,000 inhabitants in a predominantly rural distribution). Hospitalization rates for MI are higher in Seattle (standardized rates of 2.5/1000 for men and 0.8/1000 for women) than in Girona (1.5/1000 for men and 0.2/1000 for women). In both registries men under age 60 accounted for 45.5% of cases. Women accounted for 25% of all MI episodes in Seattle and for only 16% in Giromi. Treatment with thrombolytic and beta-blocking drugs was twice as common in Seattle hospitals as in Girona. Hospital mortality in tertiary care hospitals was similar in both registries, but mortality in local hospitals (having no coronary care unit) in Giroma was significantly higher than other hospital mortality rates for MI. Conclusions: The higher in-hospital mortality rate may in large part be explained by the absence of a coronary care unit. However, the dispersion of Girona's population and the lack of specific programs to provide emergent specialized care to possible MI patients may also contribute to the higher in-hospital mortality rate in Girona.

Journal Article↗
PubMed1994

Influence of gender in acute and long-term cardiac mortality after a first myocardial infarction. REGICOR Investigators.

The effect of gender and other clinical variables on short-term and long-term cardiac mortality after a first transmural myocardial infarction (MI) was assessed in a population-based hospital register. A cohort of 1216 consecutive patients (1023 men and 193 women), 25-74 years old admitted to the only reference hospital with a coronary care unit at Girona, Northeastern Spain, were recruited for 1978 to 1988 and followed-up for a mean period of almost 5 years (3-12 years). Compared with men, women had a relative risk (RR) of 1.56 (95% confidence interval (CI) of 0.99-2.48) of dying in the acute phase of MI after adjusting for age, MI location, presence of severe arrhythmias, diabetes and hypertension. However, when additionally adjusting for severity (Killip class), women presented a RR of 1.11. Age and hypertension were independent risk factors for acute mortality. Women surviving the acute period of MI showed a RR of 1.37 (CI 0.97-1.92) for long-term mortality, that was only slightly modified by Killip class during hospital stay (RR = 1.27). Age and diabetes were independent risk factors for long term mortality. It is concluded that women have a 56% excess risk for early mortality after a first transmural MI than men mainly explained by a higher severity.

Adult↗
PubMed1994

Combined portal and pulmonary hypertension in sarcoidosis.

A case is reported of a 48-year-old man previously diagnosed as having mitral valvular disease, who was admitted for evaluation of chronic cor pulmonale. Seven years before admission, an intraoperative liver biopsy had shown multiple noncaseating granulomas. The further course was characterized by progressive chronic intrahepatic cholestasis and portal hypertension. Right heart catheterization revealed a mean pulmonary artery pressure of 43 mm Hg and a normal wedge pressure (5 mm Hg). A perfusion lung scan was normal. Open lung biopsy demonstrated noncaseating granulomas and extensive pulmonary fibrosis. To our knowledge, only one case of sarcoidosis with combined portal and pulmonary hypertension has previously been described.

Humans↗
PubMed1994

[The mechanism producing nausea during ventriculography performed with ioxaglate: the implications of a randomized study].

INTRODUCTION: The mechanism of ioxaglate-induced nausea has not been fully elucidated. Recent studies have demonstrated that serotonin is one of the principal neurotransmitters of emesis in humans. On the other hand, the greater capacity of ioxaglate to stimulate vomiting has been ascribed to its great ability to inhibit cholinesterase. METHODS: To determine if oral metoclopramide (a serotonin receptor-blocker) is effective in the prophylaxis of ioxaglate-induced nausea during left ventriculography, 637 of 711 consecutive eligible patients were included in a prospective study. Patients were randomized to receive, 60-90 minutes before the procedure, either diazepam 10 mg p.o. (control group [n = 315]) or diazepam 10 mg p.o. plus metoclopramide 10 mg p.o. (metoclopramide group [n = 322]). RESULTS: The two randomized groups were similar in relation to baseline clinical and hemodynamic characteristics. Nausea was documented in 103 patients (16.1%) with similar incidence in the two groups (control group: 16.8%, metoclopramide group: 15.5%; p = NS). Nausea duration was also similar (56 +/- 63 s vs 52 +/- 63 s; p = NS). When patients with and without nausea were compared, the following variables showed a significant difference between the two groups: male gender (86% vs 76%; p < 0.05), age (53 +/- 10 yrs vs 56 +/- 9 yrs; p < 0.05) and body surface area (1.84 +/- 0.2 m2 vs 1.78 +/- 0.1 m2; p < 0.01). Stepwise multiple regression analysis identified low age (p = 0.02) and male gender (p = 0.06) as independent predictors of nausea. The incidence of nausea was 24% in males < or = 45 yrs vs 9% in females > 45 yrs (p < 0.05). CONCLUSIONS: Prophylaxis with oral metoclopramide did not reduce the incidence of ioxaglate-induced nausea during left ventriculography. This data do not support a role of serotonin in the production of nausea by ioxaglate. Low age an male gender are independent predictors of nausea apparition during left ventriculography. A cholinergic mechanism is probably involved in the capacity of ioxaglate to stimulate vomiting.

Administration, Oral↗
PubMed1994

[Penetrating aortic ulcer: clinical and angiographic characteristics].

BACKGROUND: "Penetrating aortic ulcer", an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows haematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta. METHODS: To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection. RESULTS: Clinical and hemodynamic variables were similar in both compared groups. In the group of patients with penetrating ulcer mean age was 58 +/- 6 years, previous hypertension was observed in 6 patients and the penetrating ulcer was located in the ascending aorta in 6 cases. In comparison to patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4 +/- 0.8 vs 1.7 +/- 0.6; p < 0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%; p < 0.001). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer. CONCLUSIONS: Penetrating aortic ulcer can also affect middle age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of angiographic confirmatory evidence of dissection with suggestive clinical history, should raise the possibility of penetrating aortic ulcer.

Aortic Diseases↗
PubMed1993

Myocardial infarction in Girona, Spain: attack rate, mortality rate and 28-day case fatality in 1988. Regicor Study Group.

This study was conducted to establish the attack rate, mortality rate and 28-day case-fatality rates of acute myocardial infarction (AMI) occurring in Girona, Spain, between October 1987 and September 1988. The study was carried out using a population register of AMI, and took place in one central hospital, and eight county hospitals in Girona (in the autonomous community of Catalonia, northeast Spain). Subjects comprised 222 fatal cases selected from 4069 death certificates, and 210 non-fatal cases from hospital records, among subjects aged between 25 and 74 years (reference population 263,778). The age standardized attack rate was 105.6 per 100,000 inhabitants in the age group 35-64 (193.6 in men and 17.6 in women). The age standardized mortality rate was 36.3 per 100,000 inhabitants in the age group 35-64 (63.1 among men and 9.9 among women). The age standardized 28-day case-fatality was 34.6% in men and 50.1% in women in this same age group. Attack and mortality rates of AMI in a region of Spain are presented for the first time. These rates are lower than in other developed countries, nevertheless the 28-day case-fatality is similar to that of these countries.

Adult↗
PubMed1992

[Sudden cardiac death in the counties of Girona].

BACKGROUND: Data on sudden cardiac death in Spain in scarce. Mortality rates from sudden cardiac death occurring in six counties of Girona (including urban, industrial, and rural areas) between October 1987 and September 1988 were assessed. METHODS: From a total of 1,573 deaths in residents of the studied area aged between 25 and 74 years, 222 cases with a suggestive diagnosis of sudden cardiac death were selected. Data that confirmed the diagnosis and the time elapsed from the initial clinical symptoms and death were obtained by inquiring physicians who signed the death certificates, relatives or witnesses and by reviewing the hospital records. RESULTS: Of a total of 137 deaths of cardiac origin, there were 107 cases of sudden cardiac death (which occurred within 24 hours after the onset of symptoms). The mortality rate of sudden death of cardiac origin was 37.5 per 100,000 inhabitants, that was significantly higher among men (67.8 in men and 15.4 in women). The mortality rate showed a statistically significant increase in the older age groups (28.4 per 100,000 inhabitants in the age group of 45-54 years, 69 in the group of 55-64 years, and 129.7 in the group of 65-74 years). Death occurred within the first hour after the onset of symptoms in 59 patients, 17 of whom were admitted to a hospital. Only 35% of the total 107 patients were treated in hospital. CONCLUSIONS: Mortality rate of sudden cardiac death in Girona is low. Few patients dying from sudden cardiac death could have medical care.

Adult↗