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Biomedical subjects

M A de Gregorio

Publications and source records attributed to M A de Gregorio.

At least 19 recordsLinked to original sources
PubMed2006

[Endovascular treatment of massive hemoptysis by bronchial artery embolization: short-term and long-term follow-up over a 15-year period].

OBJECTIVE: To present our experience of using arterial embolization for the endovascular treatment of massive hemoptysis along with the results of follow-up over a 15-year period. PATIENTS AND METHODS: A total of 401 patients with hemoptysis were referred to the minimally invasive surgery unit of the Hospital Universitario Lozano Blesa de Zaragoza between April 1989 and September 2004 for diagnosis and possible endovascular treatment. Of those patients, 314 met criteria for massive hemoptysis and treatment was attempted using embolization in 287 (91.4%). The most common cause of hemoptysis was bronchiectasis (n=99, 31.5%), followed by lesions due to tuberculosis (n=57, 18.1%) and chronic bronchitis (n=47, 14.9%). RESULTS: Angiography of the bronchial arteries provided evidence to account for the hemoptysis in 287 patients (91.4%). The affected arteries were satisfactorily embolized in 281 (97.9%). Endovascular treatment was clinically successful in 256 of those patients (91.1%). Embolization had to be repeated during the hospital stay in 19 patients (6.7%) and was effective in 52.6% of those cases. The 6 patients in whom embolization was not satisfactory underwent thoracotomy. The mean follow-up in 201 patients (71.5%) was 2372.5 days (range, 61-5475 days). Eighty patients (28.4%) were lost to follow-up for various reasons and at different points. Recurrence of hemoptysis occurred on 1 or more occasions in 45 patients (22.3%) but only 21 (10.4%) required repeat embolization. Minor complications that did not require treatment were observed in 88 patients (28.0%). CONCLUSIONS: Embolization of bronchial arteries is a nonsurgical treatment that is safe and effective in patients with massive hemoptysis.

Adolescent↗
PubMed2001

Animal experience in the Günther Tulip retrievable inferior vena cava filter.

PURPOSE: To assess the retrievability of the Günther Tulip temporary inferior vena cava filter from a technical viewpoint, and consider the histopathologic changes that occur at the anchoring site of the filter prongs to the vein endothelium in Landrace pigs. METHODS: Twenty-two Günther Tulip retrievable filters were inserted in 22 experimental Landrace pigs via the jugular vein. Device implantation time was 0, 3, 7, 12, 14, 15, 16, 20, 30, 35 and 56 days. Study subjects were divided into two groups. In one group the filter was retrieved percutaneously via the jugular vein whereas in the other group it was removed surgically. The specimens obtained (vena cava and filter) were histopathologically examined. Prior to filter retrieval, a venacavography was obtained in all cases. Degree of retrieval difficulty was rated as follows: no difficulty (N), slight (S), mild (M), high (H) and unretrievable (U). RESULTS: Of the 22 implanted filters, 11 should have been removed percutaneously but this was impossible in three cases (U). In four cases the device was retrieved with no difficulty (N); in two cases the degree of difficulty was mild (M) and in other two it was high (H) and slight (S) respectively. Retrieval difficulties were observed after 16 days. Starting from day 20, there was evidence of fibrosis with thick intimal proliferation and total filter prong involvement, which accounts for the difficulty in retrieving the device. CONCLUSIONS: It is advisable not to exceed a filter retrieval time of 16 days in view of the fibrotic changes reported. It might be necessary to perform a larger study with more animals and with retrieval times between 14 and 20 days.

Animals↗
PubMed2001

Jugular venous malformation in an 8-year-old boy: treatment with endovascular sclerotherapy.

UNLABELLED: An 8-year-old male presented with a mass in the left supraclavicular region first noted 3 months earlier and which gradually became more prominent. Ultrasound showed a lobular, well-delineated hypoechoic lesion which increased in size on Valsalva manoeuvre. Doppler waveform analysis suggested a slow flow vascular lesion. Venography showed a saccular, multilobular venous malformation which connected with the external jugular and subclavian veins. With an angiographic catheter, the venous malformation was treated by endovascular sclerotherapy. Four weeks later, ultrasonography showed a resolution of the lesion. CONCLUSION: Endovascular sclerotherapy appears to be an effective and safe treatment for jugular venous malformation.

Child↗
PubMed1998

Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study.

PURPOSE: To evaluate the usefulness of stent implantation as a palliative treatment in patients with acute colonic obstruction who are not surgical candidates. MATERIALS AND METHODS: Twenty-four patients (eight women, 16 men; age range, 60-98 years) with acute colonic obstruction underwent colonic stent placement. In nine patients, the procedure was considered a primary palliative treatment; seven patients had a previous diagnosis of disseminated neoplastic disease, and two were not surgical candidates because of their poor general condition. In the remaining 15 patients, stent placement was considered the definitive palliative treatment after tumor staging. The mean time of follow-up was 8.4 months (range, 1-24 months) for patients who lived and 6.3 months (range, 1-12 months) for those who died. RESULTS: Stent placement was successful in all patients. Clinical and radiographic findings of bowel obstruction resolved within 24 hours after stent placement in 23 (96%) patients. None of the patients required colostomy for bowel decompression after immediate stent placement. Complications developed in 10 (42%) patients: Two (8%) patients had mild rectal bleeding; three (12%), abdominal pain; two (8%), malpositioning of the stent; two (8%), pseudo-obstructive episodes due to fecal impaction; and one (4%), occlusive tumor ingrowth into the stent lumen. One (4%) patient underwent surgery to resolve stent malfunction due to poor positioning. Two (8.3%) patients--one with malpositioning of the prosthesis and the other with stent occlusion--required a new stent. The remaining complications required no further treatment. The mortality rate at 6 months was 24%. Eight patients were alive at the time this article was written. CONCLUSION: Colorectal stent placement resulted in successful palliation of acute colonic obstruction in patients with disseminated neoplastic disease.

Acute Disease↗
PubMed1997

[Pulmonary artery aneurysm and thrombosis caused by vasculitis in Behçet's disease].

Behcet's disease in a 27-year-old male is described. The patient presented fever, dyspnea and hemoptysis. A chest X-ray revealed right hilar enlargement. Exploratory thoracotomy revealed a pulsating mass in the superior lobar artery consistent with aneurysm. Pulmonary biopsy confirmed necrotizing vasculitis of the tissue consistent with Behcet's disease. Pulmonary arteriography showed and aneurysmatic enlargement of the bifurcation between the mid and righ inferior lobar arteries, with thrombosis of the upper right and lower left lobar arteries. Resolution of symptoms was achieved through treatment with corticoids and azathioprine.

Adult↗
PubMed1997

[Current status and clinical experience in the treatment of tracheobronchial stenoses with self-expanding metallic stents].

The development of symptomatic stenosis in the bronchial tree can lead to high risk asphyxia. The implantation of metallic prostheses (stents) can provide palliative resolution of stenosis and alleviate the acute symptoms of these patients. We assess the efficacy of expandable metallic stents for treating various types of tracheobronchial stenosis. Sixteen Wallstent type expandable metallic prostheses were implanted in 16 patients with tracheobronchial stenosis (12 malignant and 4 benign) in the interventional radiology unit under fluoroscopic and endoscopic guidance. The prostheses were placed correctly and no complications were observed, such that symptoms improved immediately. Three patients with post-intubation stenosis required additional treatment with laser therapy during follow-up examinations. All the patients with malignancies died from the underlying disease, but with open airways and no tracheal symptoms. Metallic prostheses are a valid alternative for palliative treatment of malignant tracheobronchial stenosis.

Adult↗
PubMed1996

Subcutaneous ports in the radiology suite: an effective and safe procedure for care in cancer patients.

The purpose of the study is to present our experience and compare the results of the three types of ports used as a central venous access and performed in the radiology suite. Between March 1989 and November 1993 we performed 288 implantations (100 Implantofix Seldinger, 100 plastic Hickman port, and 88 stainless steel Port-a-cath) for chemotherapeutic treatment on the same number of patients diagnosed as having cancer. In all cases access was obtained via a subclavian vein (the left one in 185 cases and the right one in 103). All the system ports were implanted in the radiology suite. In all cases the procedure was successfully performed. Complications occurred in 26.3% of cases, most notably thrombosis in 13 cases (4.5%) and infection in 12 cases (4.1%). Duration of the port systems placement varied between 17 and 1467 days (a mean of 315 days). A total of 133 systems have been removed to date, 80 (60.%) due to termination of chemotherapy, and 53(40%) for treatment of complications. Significant differences (complications and port duration time) were not observed between the three types of reservoir used. Subcutaneous ports are safe, comfortable, and effective devices for central venous access.

Adolescent↗
PubMed1996

[Drainage of loculated and/or multiloculated pleural effusions using a small caliber catheter and urokinase (pleuro-fibrinolysis)].

The main causes of pleural fluid drainage failure are known to be the formation of fibrin septa, increased viscosity in pleural fluid and inappropriate placement of chest tubes. Reports also tell us that such problems can be solved by using ultrasound as a guide for tube placement and by infusing intrapleural fibrinolytic agents to prevent the formation of septa and reduce the viscosity of pleural fluid. To assess our experience, the role and efficacy of administering intercavitary urokinase (UK) through a small caliber catheter (SCC) implanted with ultrasound guidance as part of the treatment for pleural effusions (PE) that are multiloculated and/or loculated. Fifty multiloculated and/or loculated PE were drained through a pig-tail type SCC between 8.2 and 10 F caliber inserted with ultrasound guidance. The criteria for prescribing the procedure were as follows: PE of any etiology with ultrasound confirmation of fibrin septa and/or multiloculation and absence of contraindication off UK administration. UK was given at a dose of 100,000 i.u. every two hours until disappearance of PE. Before and after treatment the levels of D-dimer were measured in order to monitor pleural fibrinolytic activity. The SCC was properly placed in all patients. UK administration was 366,000 i.u. and time the SCC were in place was 4.7 days. All PEs were initially drained completely. We examined the patients 30 days later, finding that PE had recurred in 2 (4%), resolution was complete and without sequelae in 8 (16%), nearly complete but with slight pleural thickening in 32 (64%) and partial with pleural opacities larger than 2 mm in 8 (16%). Use of SCC and UK (pleural fibrinolysis) is a moderately invasive procedure that is effective and well tolerated and that shortens drainage time, prevents sequelae and is relatively inexpensive for the treatment of PE with fibrin septation and/or multiloculation.

Adolescent↗
PubMed1995

[The long-term clinical and imaging follow-up of inferior vena cava filters. A cross-sectional study].

We carried out a cross-sectional study to assess morphological findings and incidence of complications in 77 inferior vena cava filters (IVC) implanted in 75 patients between April 1990 and January 1994. Follow-up ranged from 3 to 61 months (mean, 38.5 months) and was carried out by telephone interview, clinical examination, X-rays of the ilium/vena cavum and, in some cases, by Doppler sonogram and computed tomography. Findings revealed IVC thrombosis in 38% of patients, edema in the lower extremities in 63.4%, angling > 15 degrees in 8 patients, defective opening in 4, fibrosis of the vena cava with stenosis in 2 and perforation of the IVC in 3. Although our study shows that the incidence of IVC thrombosis after implantation of filters is higher than suspected, its clinical importance is slight.

Adult↗
PubMedDate not supplied

[Percutaneous and surgical gastrostomies: our clinical experience in enteral nutrition].

Percutaneous gastrostomy (PG) was performed on 18 patients and 11 patients were subjected to surgical gastrostomy (SG) in the HCU of Zaragoza from October 1990 to November 1991. Involvement of the high digestive tract was the most common finding: 11 patients had CA of the oesophagus and stomach, 2 suffered from extrinsic pressure of the oesophagus due to metastatic adenopathy of a lung and breast tumour and 9 patients had CA of the larynx with total dysphagia. Another less common indication in our series, although still of great importance, was a severe involvement of the CMS, which made oral nutrition impossible due to functional dysphagia. Due to the long-term nature of this pathology, feeding by nasogastric tube was not considered. This was the case of 4 patients. The duration of enteral nutritional in the patients' home was 112.8 +/- 61 days with PG and 37 +/- 26 days with SG (p: 0.007). The incidence of complications was 33% in PG and 73% in SG, and for both techniques, the most common complication was blockage of the tube. Percutaneous gastrostomy is a simple technique, with no surgical risks involved, but with the benefits of traditional surgical techniques which, despite the small number of cases recorded, has very few complications both with regard to placing and afterwards, and also enables the patient to receive nutrients earlier than would be the case with traditional surgical techniques during prolonged periods at the patient's home.

Aged↗
PubMedDate not supplied

A prospective and immunologic study of factory workers exposed to TDI (toluene diisocyanate).

Thirty factory workers whose annual exposure to TDI amounted to 280 hours were examined. Seven of them had been removed from their jobs for presenting respiratory symptomatology and a further five were removed for presenting bronchial asthma. Their medical histories were consulted and further measures were taken such as a radiological thorax study, total IgE, TDI, MDI and HDI RAST, a basal spirometric study and finally a provocation test. The Rast proved negative in every case. In the spirometric study carried out on the provocation test, four cases showed a significant decrease in the FEV1 over 20% and over 40% in the FMEF and PEFR. There was no connection between the four patients who presented an elevated total IgE and the four who presented a positive provocation test. The provocation test proved negative in five of the seven patients removed from their places of work. Two of the four workers who responded positively to the provocation test remained in their places of work during the TDI foam test without showing any symptoms. The patients who presented symptoms did not appear to present bronchial obstruction during the provocation test. Nonetheless, patients who seemingly had not shown any symptoms presented what appeared to be bronchial obstruction.

Adult↗
PubMedDate not supplied

A study of IgG blocking antibodies in patients affected with respiratory allergy.

The levels of blocking antibodies were studied in 200 patients affected with bronchial asthma and/or allergic extrinsic rhinitis with sensitization to grass pollen and dust mites shown by cutaneous and RAST tests. IgG blocking antibodies were studied using ELISA, in relation to: Immunotherapy treatment duration. The degree of clinical improvement obtained. The conditions, before and after immunotherapy treatment. The conditions, 12-24 months after having completed 3 years of immunotherapy. The results indicate that: A high level of blocking antibodies is reached in the group of patients between 4-7 months of immunotherapy treatment. These patients also reached the stage of the maintenance dosage. There exists a significant and specific response of blocking antibodies in patients treated with specific immunotherapy. There exists a close correlation between symptomatology and the level of blocking antibodies, although this correlation is not perfect. The hyposensitization preparations used did not succeed in maintaining permanently high levels of blocking antibodies once the treatment was completed. ELISA is a good alternative to other more frequently used techniques in measuring blocking antibodies, and it can be used in following patients during the course of immunotherapy.

Asthma↗