PubMed Health⌕ Search

Biomedical subjects

J de la Peña

Publications and source records attributed to J de la Peña.

At least 19 recordsLinked to original sources
PubMed2000

Different time course of circulating adhesion molecules and hyaluran during hepatic allograft rejection.

BACKGROUND: Inducible adhesion molecules are involved in cell-mediated allograft rejection. In addition, the endothelium is the main target of this process. This study investigated, whether soluble (s) forms of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) are elevated during cellular rejection and whether hyaluran is a useful marker of endothelial function in liver transplantation. METHODS: Serum levels of sICAM-1, sVCAM-1, and hyaluran were determined in 24 controls and 27 hepatic transplant recipients. These patients were divided in two groups: group I, 14 patients without rejection; and group II, 13 patients with rejection. Samples were collected on day 1 and 7 after transplantation, on the day of liver biopsy, and after treatment of the rejection. RESULTS: We found a significant increase in sICAM-1 levels in the postoperative period in the rejection group compared with the non rejection group. It persisted significantly elevated until the diagnosis of rejection was made. In contrast, sVCAM-1 was only significantly elevated in the rejection group when diagnosis of rejection was evident. Hyaluran levels were also significantly elevated in the rejection group at diagnosis of rejection. We noticed a significant decline in sICAM-1, sVCAM-1, and hyaluran levels after successful treatment of rejection. In addition, we observed in the non-rejection group a stable lower levels of hyaluran during the entire postoperative period. CONCLUSIONS: The release of circulating adhesion molecules is a prominent feature coinciding with the first episode of hepatic rejection. Differential patterns of sICAM-1 and sVCAM-1 exist during rejection. In addition, hyaluran levels may be a sensitive marker of liver endothelial cell function in the postoperative period of liver transplantation.

Adult↗
PubMed2000

[Clinical trial to evaluate trospium chloride (Uraplex) effectiveness and tolerance in patients with detrusor instability incontinence and its impact on quality of life].

OBJECTIVE: To determine the efficacy, tolerance and quality-of-life effects of trospium chloride in women with overactive bladder. METHODS: An open, prospective multicenter trial was conducted on 75 women with urinary incontinence from overactive bladder (ICS criteria, urodynamic evaluation). Trospium chloride was administered at a dose of 20 mg twice daily for 8 weeks. Neurological examination and cystometry were performed at the start of the trial. Quality of life was evaluated by analogue visual scales (faces scale) and EUROQOL (health status scale). At the 4th week, urodynamic, clinical, quality-of-life and tolerance evaluations were performed. Clinical and tolerance data and quality of life index were assessed at the 8th week. RESULTS: 8 of the 75 patients did not complete the study. Thus, analysis of the therapeutic efficacy was performed in 67 patients, while description and tolerance analyses were performed for the overall group of patients. Urodynamic parameters significantly improved at 4 weeks: maximum bladder capacity (232.09 ml pre-treatment vs 315.83 ml post-treatment) and first desire to void (100.9 ml pre-treatment vs 156.7 ml post-treatment). Incontinence clinical items also improved. All quality-of-life indixes significantly increased at the 4 and 8 weeks control evaluation. Excellent or very good tolerance was observed in 89.5% of the patients. CONCLUSIONS: The results of the study corroborate the efficacy and tolerance of trospium chloride in the management of overactive bladder in women. Improvement in patient quality of life was also observed.

Benzilates↗
PubMed1999

Severe clinical course of de novo hepatitis B infection after liver transplantation.

The aim of this study is to determine the origin, clinical outcome, allograft histological characteristics, and virological outcome of de novo hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT). We studied 136 hepatitis B surface antigen (HBsAg)-negative liver transplant recipients. HBV DNA was detected by dot-blot hybridization and polymerase chain reaction (PCR). The S gene was sequenced. Hepatitis C virus (HCV) RNA was assessed by PCR. The long-term clinical and histological outcome was determined. Six of 136 HBsAg-negative patients (4.4%) became HBsAg positive after transplantation. The source of HBV infection was reactivation of latent HBV infection in 2 patients and was not identified in 4 patients. Two donors had isolated core antibody. Two of these 6 patients developed acute liver failure related to hepatitis B. The 4 other patients had severe chronic hepatitis related to hepatitis B. All patients had high-level HBV replication. No significant mutations in the S gene were found. These data suggest that de novo hepatitis B infection is not a mild disease and might represent a significant cause of graft dysfunction. This is the first report of fulminant hepatitis caused by de novo hepatitis B infection after OLT.

Female↗
PubMed1999

Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial.

BACKGROUND: To evaluate the safety and efficiency of variceal ligation compared with endoscopic sclerotherapy, 88 patients with cirrhosis with recent variceal bleeding were randomized to undergo either treatment. METHODS: Sclerotherapy was performed using ethanolamine and polidocanol injection at 1, 2, and 3 weeks and every 3 weeks thereafter. The Stiegmann-Goff device was used for variceal ligation at the same intervals. RESULTS: The rate of variceal eradication was the same for both groups, but eradication was accomplished sooner in patients undergoing variceal ligation (5.3+/-1.6 vs. 6.6+/-2.4 endoscopic sessions, p < 0.05) and with fewer complications (19 vs. 6, p < 0.005). The rate of recurrent bleeding was lower in patients treated by ligation (31% vs. 50%, p < 0.05). After eradication, variceal recurrence was more frequent in patients treated by variceal ligation at 1 and 3 years (47% and 92% vs. 23% and 55%, p < 0.01). Portal hypertensive gastropathy was significantly worse in the patients who had variceal ligation (17 patients vs. 6, p < 0.01). Survival and treatment failure were similar in both groups. CONCLUSIONS: Variceal ligation was superior to sclerotherapy in terms of the rate of recurrent bleeding and the occurrence of complications but worse with respect to recurrence of varices and the evolution of portal hypertensive gastropathy. Long-term follow-up studies are required to find out whether there are deleterious effects of variceal ligation.

Esophageal and Gastric Varices↗
PubMed1999

[Prospective study of gastroesophageal reflux after esophageal variceal band ligation].

UNLABELLED: In recent years, variceal ligation has been introduced as an alternative treatment to endoscopic sclerotherapy. AIM: To evaluate the occurrence of excess gastroesophageal reflux in cirrhotic patients with esophageal varices eradicated by band ligation. PATIENTS AND METHODS: Twenty-six cirrhotic patients with esophageal varices underwent band ligation until variceal eradication. pH monitoring was carried out in all patients before inclusion in the eradication program and again at the end. The results were evaluated according to De Meester's criteria. RESULTS: Five patients presented excess gastroesophageal reflux before the beginning of treatment. A further six patients developed excess gastroesophageal reflux after endoscopic treatment. The only factor implicated in the development of excess gastroesophageal reflux was the use of sclerosant at the end of treatment to ensure complete eradication: five of the eight who needed sclerosant developed excess gastrophageal reflux, while only two of the 16 treated without sclerosant did so (p < 0.01). CONCLUSION: Esophageal variceal band ligation does not significantly provoke excess gastroesophageal reflux if sclerosant is not used in the endoscopic technique.

Adult↗
PubMed1998

Pitx2 determines left-right asymmetry of internal organs in vertebrates.

The handedness of visceral organs is conserved among vertebrates and is regulated by asymmetric signals relayed by molecules such as Shh, Nodal and activin. The gene Pitx2 is expressed in the left lateral plate mesoderm and, subsequently, in the left heart and gut of mouse, chick and Xenopus embryos. Misexpression of Shh and Nodal induces Pitx2 expression, whereas inhibition of activin signalling blocks it. Misexpression of Pitx2 alters the relative position of organs and the direction of body rotation in chick and Xenopus embryos. Changes in Pitx2 expression are evident in mouse mutants with laterality defects. Thus, Pitx2 seems to serve as a critical downstream transcription target that mediates left-right asymmetry in vertebrates.

Activin Receptors, Type II↗
PubMed1998

Alcoholic recidivism after liver transplantation for alcoholic cirrhosis.

Liver transplantation (LT) for alcoholic cirrhosis remains controversial. This controversy surrounding LT in alcoholics focuses on the risk of alcohol recidivism and on potential noncompliance with the immunosuppressive regimen, both of which result in graft failure. Our study examined alcohol recidivism after LT by measuring alcohol in urine and its repercussion on the allograft. Forty-four consecutive alcoholic patients and a comparison group of 17 patients receiving LT were included in this study and followed up for a mean of 39.5 +/- 19.6 months. Seven percent (3 of 44) of patients with alcoholic liver disease and 0% of patients in the comparison group admitted to having used alcohol after LT. Alcohol in urine, however, was detected in 18% (8 of 44) of the alcoholic group; therefore the true recidivism rate was higher than the rate admitted. All patients in both groups were compliant with the medications, because the cyclosporine levels were within the therapeutic range in all. On histologic examination the only alcohol-induced lesion found in three of the eight recidivistic patients was steatosis. Therefore, although alcoholic recidivism occurs, it does not seem to affect compliance to treatment profoundly or to compromise graft function. Therefore, LT seems justified for end-stage alcoholic cirrhosis.

Adult↗
PubMed1997

[Prognostic value of lymphatic metastasis in bladder cancer].

OBJECTIVE: The presence of lymph node metastasis in bladder cancer is considered to be a sign of poor prognosis. The present study was performed to analyze the influence of the number of positive lymph nodes on survival and the therapeutic value of lymphadenectomy in pN+patients. METHODS: From January, 1983 to January, 1993, 160 patients aged 39 to 77 years (mean 61.8) underwent radical cystectomy and pelvic lymphadenectomy for carcinoma of the bladder. The records of 122 patients were available for review. The UICC 1978 classification system was used. RESULTS: Cancer-specific mortality was 22.8% (16/70) for pNo patients, 44.4% (4/9) for pN1 patients and 88.9% (16/18) for pN2-4 patients. We obtained the following cancer-specific mortality by stratifying according to T category: 5.4% (2/37) for pNoT1-T3a, 42.4% (14/33) for pNoT3b-T4, 0% (0/2) for pNIT1-T3a, 57.1% (4/7) for pNIT3b-T4 and 88.9% (16/18) for pN2-4T3b-T4. CONCLUSION: The presence of only 1 positive regional lymph node (pN1) appears to worsen patient survival, particularly when the primary tumor is T3b or worse. In these cases cancer-specific mortality after patient discharge increased from 42% for the pNo patients to 57% for the pN1 patients (p > 0.05). Radical cystectomy was highly effective and curative in 95% of T1-T3apNo-1 patients (37/39). The presence of multiple positive lymph nodes carries a very poor prognosis, with 89% of the patients dying at a mean of 12 months.

Adult↗
PubMed1997

Plasma adrenomedullin levels in patients with hepatic cirrhosis.

OBJECTIVE: The role of adrenomedullin in cirrhosis is at present unknown. The aim of this study was to investigate plasma levels of adrenomedullin in cirrhosis. METHODS: We measured plasma adrenomedullin concentrations using radioimmunoassay in 43 patients with cirrhosis (17 in Child-Pugh's class A, 13 in Child-Pugh's class B, and 13 in Child-Pugh's class C) and compared these values with those in 24 age-matched healthy subjects. Renal function, plasma cyclic adenosine monophosphate (cAMP) concentration, plasma renin activity, and plasma aldosterone concentration were measured in each patient. RESULTS: Plasma adrenomedullin levels were increased significantly in patients with cirrhosis compared with healthy subjects. In addition, plasma adrenomedullin values were higher in patients with cirrhosis and ascites than in those without ascites. Moreover, plasma adrenomedullin levels increased in relation to the severity of cirrhosis. Significant positive correlations also were found between adrenomedullin and cAMP concentrations and plasma renin activity or plasma aldosterone concentrations. CONCLUSIONS: Plasma adrenomedullin is increased in patients with cirrhosis compared with healthy subjects. The increase in plasma adrenomedullin levels is related at least in part to the severity of cirrhosis and may contribute to the arteriolar vasodilation in patients with cirrhosis. These effects are related in part to a cAMP-dependent pathway.

Adrenomedullin↗
PubMed1997

[Review of complications of urinary diversions performed during a 6-year period in the era of orthotopic neobladders].

OBJECTIVE: To compare the morbidity of different types of permanent urinary diversion. METHODS: We reviewed the postoperative and longterm complications observed in 85 patients who underwent permanent urinary diversion from December, 1986 to January, 1993: cutaneous ureterostomy (16 pts.), transintestinal incontinent cutaneous ureterostomy (41 pts.), orthotopic neobladder (27 pts.). All patients underwent radical cystectomy for bladder carcinoma. The surgical technique utilized for the construction of the orthotopic neobladders were as follows: Camey 1 (4 cases), Camey II (6 cases), Mainz (2 cases), Hautman (6 cases), detubularized sigmoid (6 cases). We also reviewed and used for comparison 18 augmentation cystoplasties that underwent simple subtotal cystectomy. Augmentation cystoplasty was performed with the sigmoid (n = 8), ileon (n = 5) and ileocecal segment (n = 4). RESULTS: The incidence of postoperative complications was similar for all types of urinary diversion (64.3% for cutaneous ureterostomy, 61% for transintestinal intermittent cutaneous ureterostomy, 59.3% for orthotopic neobladder), although patients with orthotopic neobladders required surgery more frequently (7.1% for cutaneous ureterostomy, 22% for transintestinal cutaneous ureterostomy, 41% for orthotopic neobladder). The incidence of postoperative complications was much lower in patients who underwent augmentation cystoplasty (complications 17.7%; none required surgery). The percentage of longterm complications was 71.4% for cutaneous ureterostomy, 74.2% for cutaneous transintestinal ureterostomy, 86.9% for orthotopic neobladders and 100% for augmentation cystoplasties. The patients who required surgery were 14.3%, 19.3%, 26% and 47%, respectively. Twelve out of 24 patients in whom metalic staples were employed for the construction of the neobladders and cystoplasties developed bladder stones; 78.3% of the patients with orthotopic neobladders showed perfect daytime continence, 65.2% night-time incontinence and 21.7% stress incontinence. The figures for augmentation cystoplasties were 94.1%, 5.9% and 5.9%; 4.3% of patients with orthotopic neobladders and 29.4% of patients with augmentation cystoplasties required self intermittent catheterization. Patients with larger neobladders showed best continence rates. Fifty-three ureters were reimplanted in the orthotopic neobladders of augmentation cystoplasties with the Le Duc technique; 17% developed ureteral stenosis and 15.1% vesicoureteral reflux. CONCLUSION: Patients who undergo permanent urinary diversion have a far from negligible number of postoperative and long-term complications. Orthotopic intestinal neobladders have a slightly higher rate of serious complications than incontinent cutaneous diversions.

Humans↗
PubMed1996

Value of plasma P-selectin for vascular complications in liver transplantation.

Recent data suggest that plasma P-selectin, an adhesion molecule, may be a clinically useful marker for thrombosis. Hepatic vessel thrombosis is one of the most serious complications following liver transplantation. To assess the contribution of the soluble P-selectin to this complication, we measured plasma P-selectin levels in 32 orthotopic liver transplantations, pre-, intra-, and post-operatively. We found that levels of circulating P-selectin were not different between cirrhotic patients and healthy subjects. Of the 32 patients, 8 had vascular complications. We found a significant increase in the plasma P-selectin concentration in the thrombotic group in early postoperative period compared with the non-thrombotic group (p < 0.002). It measurement may facilitate the diagnosis of thrombosis in the early postoperative period after liver transplantation, and therefore the management of these patients.

Adult↗
PubMed1995

Drinking habits and pain in chronic pancreatitis.

To study the role that continuous drinking plays in the pain of chronic pancreatitis, we have examined 67 patients with alcoholic chronic pancreatitis with pain and 29 patients without pain, and we report on their alcoholic habits. Drinking habits played a part 92 (67.6%) of 136 times in patients with pain; in 185 without pain, 86 (46.5%) had continued their drinking habit (p < 0.001). Advanced pancreatic exocrine insufficiency was seen in 27 patients; 11 of them had pain during follow-up, whereas 16 did not. The nondrinker rate was similar in patients with and without pain, whereas among 69 patients with better pancreatic exocrine function, 56 had pain episodes and 13 did not. Alcoholic consumers were significantly more in number in the pain group: 70.4% versus 35% of the no pain group (p < 0.002). Our study shows that drinking alcohol in patients with chronic pancreatitis increased the frequency of painful episodes when there was relatively good pancreatic function, whereas in severe pancreatic insufficiency drinking had less influence on the development of pain.

Abdominal Pain↗
PubMed1995

[Aortic insufficiency secondary to an unruptured congenital aneurysm of the sinus of Valsalva].

Congenital aneurysm of the sinus of Valsalva is an uncommon entity. Its diagnosis is rare in infancy because most cases are asymptomatic. This condition is usually detected in adults as incidental finding or a complication due to aneurysm. We report a five-year-old asymptomatic child, with a congenital unruptured aneurysm of the right sinus of Valsalva. It was diagnosed on two-dimensional and Doppler echocardiography, and confirmed by angiography showing an aortic regurgitation. The aim of this publications is to report another case of this rare condition in pediatric cardiology, which real importance is probably subestimated because of unusual clinical manifestation. Nevertheless, the increasing use of the two-dimensional and Doppler echocardiography will provide much more cases of this entity. Diagnosis and treatment are reviewed as well as bibliography.

Aortic Aneurysm↗
PubMed1992

[The imaging diagnosis of adrenal tumors].

From 1967 to 1991 we have diagnosed and treated 73 adrenal tumors in 63 patients: 12 pheochromocytomas, 24 adrenal cortical adenomas, 15 hyperplasias, 16 carcinomas, 3 myelolipomas, 2 cysts and 1 neuroblastoma. We conducted a retrospective study to analyze the preoperative images obtained by different diagnostic techniques and attempted to correlate tumor size and site with the results of the histological analysis of the surgical specimen. Nephrotomography with pneumoretroperitoneum and IV Nephrotomography were useful in detecting the increase of the size of the gland in 10 of 25 cases submitted to these procedures (40%). Arteriography as second or third technique of choice confirmed the presence of an adrenal tumor in 15 of the 21 cases evaluated by this procedure (70%). US and CT detected 94% (31/33) and 100% (33/33) of the cases, respectively. Fourteen cases were incidentally discovered by CT (7) and US (7). A direct relationship between tumor size and degree of malignancy could be established since the carcinomas had a mean diameter of 7 cm (range 5 to 12 cm). Concerning the histologic nature of the disease, specific images were found in 3 cases of adrenal myelolipoma (hyperechoic on US and of low density similar to fat on CT) and 2 cysts (anechoic with posterior band evidenced on us and liquid on CT). Radioisotopes were also utilized for tumor localization and there was positive uptake of I-131-IMBG in 2 cases of adrenal pheochromocytoma; 1 extra-adrenal (left lateral aortic paraganglioma) and 1 case of malignant adrenal pheochromocytoma with metastasis to the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1991

[Controversies over regional lymphadenectomy in carcinoma of the penis].

Epidermoid carcinoma of the penis, although rare, is a very aggressive tumor type. The presence or absence of inguinal metastasis is an essential prognostic factor. Treatment of these metastases is one of the current controversies in urological practice; i.e., when and to what extent lymphadenectomy should be performed. Of 24 patients with penile carcinoma, 10 had undergone regional lymphadenectomy over the past 8 years at our institution. Following treatment of the primary penile tumor, 6 patients had palpable inguinal nodes that persisted after treatment with antibiotic and antiinflammatory agents for 6 weeks. Of these, 3 had a positive node biopsy. They were submitted to regional lymphadenectomy which revealed node metastasis in 5 cases (2 pN3, 2 pN2 and 1 pN1). The patients with no palpable nodes were closely followed and were submitted to lymphadenectomy when these appeared (3 cases). The fatal outcome of 2 cases (both pN3) prompted us to perform lymphadenectomy prophylactically in the last case, a 40-year-old male with pT2G2 N0 penile cancer. This approach is advocated in patients under 65 with invasive penile carcinoma (pT greater than 1) or a high histological grade of malignancy (G2 and G3).

Adult↗
PubMed1991

[Primary bladder adenocarcinoma: retrospective study of 11 cases and general review].

Eleven cases of primary adenocarcinoma of the bladder are described herein. Eight had a glandular pattern, 1 was papillary and 2 were comprised of signet ring cells (one had areas of colloid carcinoma). One of the cases, originating from the urachus, also showed colloid areas and a glandular pattern. Forty-five percent of the cases were moderately differentiated and the remaining 55% were poorly differentiated. In all cases the tumor had areas of adenocarcinoma in more than 2/3 of its extent. All but two cases revealed muscle layer infiltration at the time of diagnosis. Two patients were submitted to radical cystectomy, lymphadenectomy and Wallace II cutaneous ureteroileostomy, 1 patient underwent partial cystectomy and lymphadenectomy, and 6 were submitted to transurethral resection. Excision of the urachal tumor was by en bloc partial cystectomy. The 5-year survival of patients with infiltrating tumors, excluding the urachal tumor, was 33%, 67% died within the first year of follow-up. The only evaluable case of superficial adenocarcinoma is alive and tumor-free at 94 months. Primary adenocarcinoma of the bladder is an aggressive tumor. Although it may be superficial at the time of diagnosis, it soon develops into an infiltrating tumor if untreated. Treatment and survival depend on tumor stage. Superficial or minimally infiltrating tumors warrant treatment by deep transurethral resection up to the pericystium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗