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M Adrados

Publications and source records attributed to M Adrados.

At least 19 recordsLinked to original sources
PubMed2005

[Gastrointestinal inflammatory fibroid polyps. Clinical characteristics and follow-up in a series of 26 patients].

INTRODUCTION: Inflammatory fibroid polyp (IFP) is a protuberant lesion, located near the muscularis mucosae and composed of a proliferation of fusiform cells and conjunctive fibers surrounding capillaries and a variable inflammatory infiltrate. It is believed to be a poorly controlled inflammatory repair response. Our aim was to study the clinical, pathological and follow-up characteristics of a series of patients with IFP. PATIENTS AND METHOD: We studied 26 IFPs from 25 patients (16 women and 9 men) registered between 1985 and 2001 in a specific register of 3 centers in the city of Gerona (Spain). The variables analyzed were age, sex and clinical presentation, IFP localization and size, mucosal characteristics and associated disease, as well as follow-up information. Routine statistical analyses were performed. RESULTS: IFPs were antral in 16 patients, ileal in 7, jejunal in 2 and colonic in the remaining patient. Size determined whether they were symptomatic (35 +/- 13.6 mm) or asymptomatic (8.4 +/- 6.3 mm). Gastric polyps were significantly smaller than intestinal polyps. Symptomatic polyps (5 out of 16 gastric polyps and 9 out of 10 intestinal polyps) predominated in women and occurred at a significantly lower age than asymptomatic polyps (59.2 versus 74.1 years). Most gastric IFPs were associated with chronic atrophic gastritis while only one ileal polyp was associated with Meckels diverticulum. The mean length of follow-up was 60.6 months and, except in one patient who underwent incomplete resection, no recurrences of IFP were observed. CONCLUSION: IFP is a heterogeneous entity, depending on age at presentation, sex, size and location in the digestive tract. IFP does not recur after resection. The association of gastric IFP and chronic atrophic gastritis could suggest a modulatory effect of the mucosa on IFP growth.

Adult↗
PubMed2004

[Progressive deterioration in an elderly patient].

Vasculitis is diagnosed with increasing frequency in the elderly. We hereby present the case of an 84-year-old male, who had weight loss, low-degree fever, anemia and epigastric pain. After 14 days of study with the tentative diagnosis of digestive neoplasia, a progressive renal insufficiency was detected. This clinical picture was secondary to ANCA-positive vasculitis. The case poses the differential diagnosis of non-oliguric acute renal failure (FRA) in elder people and the systematics of the study of renal insufficiency in individuals with previously unknown renal function. Also, this patient's history emphasizes the importance of acute deterioration of renal function as a guiding symptom for orienting the interpretation of clinical data. In the present case, a diagnostic hypothesis based only in the pursue of an occult digestive tumor misguided the attention from the main cause of the disease.

Abdominal Pain↗
PubMed1999

Absence of p53 gene mutations in hepatocarcinomas from a Mediterranean area of Spain. A study of 129 archival tumour samples.

The incidence of p53 gene abnormalities in human hepatocellular carcinoma (HCC) varies in different geographical areas, being higher in regions where hepatitis virus infection and dietary exposure to aflatoxin B1 are the most common aetiological agents. These mutations are less frequently encountered in Europe, although some studies have reported p53 protein overexpression in up to 45% of cases analysed. We have analysed 129 tumour samples of primary malignant hepatic neoplasms recovered from paraffin blocks processed in two pathology laboratories in a Mediterranean area of Spain (Valencia and Gerona). Among 14 cases in which p53 immunohistochemistry expression proved positive, 5 stained in more than 50% of the cell nuclei. By PCR-SSCP analysis we could detect the complete sequence from exon 5 through 8 in 70 cases and part of this region in the remaining cases, but no mutations were found. We found no relationship with the clinical stage, tumour stage or clinical outcome. We conclude that p53 gene alterations are not a major event in the malignant transformation of hepatic cells in this region of the Mediterranean. The variable incidence of p53 gene alterations in other geographical areas may reflect a different genetic background for the aetiology of HCC.

Aged↗
PubMed1998

[Efficacy of ritonavir in HIV positive patients pretreated with nucleoside analogues].

The virologic and immunologic efficacy of ritonavir, an HIV protease inhibitor, was examined in 14 HIV-infected patients with a mean CD4+ cell count of 183 x 10(6)/l at baseline. All had been exposed to nucleoside analogs for longer than 6 months; and ritonavir was added to previous ongoing antiretroviral drugs. A mean reduction of 1.5 logs was seen in plasma viral load 4 weeks after began ritonavir, and 9 (64.3%) of 14 patients achieved undetectable levels (< 4,000 HIV-RNA copies/ml). A mean increase of 222 x 10(6) cells was observed in the CD4+ count. Nine (64.3%) individuals reported side effects, although they did not force to stop the medication. In conclusion, the addition of ritonavir seem to be a reasonable alternative strategy in patients with advanced HIV disease and heavy previous exposure to nucleoside analogs.

Adult↗
PubMed1998

[Combined antiretroviral therapy for prevention of vertical HIV-1 transmission].

A 25-year old woman with rapid HIV disease progression had been receiving zidovudine (ZDV) for two years, when she became pregnant. She had a high viral load and carried out zidovudine-resistant viral strains. For these reasons, and with the main objective to maximally reduce viremia, the association of DDI to ZDV was introduced a few weeks before delivery. The virological follow-up for one year has confirmed the lack of HIV infection in the child. Combined antiretroviral therapy during the last weeks of pregnancy might be considered for the prevention of vertical transmission of HIV in cases of high risk of newborn infection, without adding relevant toxicity.

Adult↗
PubMed1997

Visceral leishmaniasis in patients infected with the human immunodeficiency virus.

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Quantification of viremia in patients infected with human immunodeficiency virus with different degrees of immunosuppression].

BACKGROUND: Many of the therapeutical decisions related to patients infected with human immunodeficiency virus (HIV) are taken considering the CD4+ lymphocyte count. The recent availability of procedures which quantitate the number of viral particles in peripheral blood has disclosed that viremia degree is the best predictor of HIV disease progression. Nevertheless, the proportion of subjects who despite a normal CD4+ lymphocyte count, have a high viremia and a high risk of short term progression to AIDS is not well known. PATIENTS AND METHODS: Plasma viremia was investigated in 120 adults subjects with a known time of HIV infection. Fifty-two patients had a CD4+ lymphocyte count > 500 x 10(6)/l (CDC group 1), 42 had a number of CD4+ lymphocytes ranging from 200 and 500 x 10(6)/l (CDC group 2), and 26 had a count < 200 x 10(6)/l (CDC group 3). None of the patients was receiving antiretroviral treatment or had intercurrent infections at the time of the study. RESULTS: Mean values of viremia showed an inverse significant relationship with the CD4+ lymphocyte count. In CDC group 1 subjects the distribution of viremia was as follows: low (< 3,000 copies of HIV RNA/ml) in 16 (30.8%), intermediate in 20 (38.4%), and high (> 30,000 copies of HIV RNA/ml) in 16 (30.8%). In eight subjects from CDC group 1, the duration of HIV infection was less than 5 years. In contrast, in patients from CDC group 3, viremia was high in 17 (65.4%), intermediate in 9 (34.6%), and none of them had a low degree viremia. In CDC group 2 patients, viremia was high in 14 (33.3%), intermediate in 20 (47.6%), and low in 8 (19.1%). CONCLUSION: There is an inverse correlation between the viremia degree and the CD4+ lymphocyte count among HIV-positive patients. Nevertheless, there can be a high viremia in absence of low CD4+ lymphocyte count, particularly among subjects with HIV infection for less than 5 years, in whom an early therapeutical intervention might be warranted.

Adult↗
PubMed1996

[Ribavirin treatment in patients with chronic hepatitis C refractory to interferon-alpha].

Four patients with chronic hepatitis C who did not respond to treatment with alpha interferon were treated with oral ribavirin at a dose of 1.000-1.200 mg/day for 6 months. A marked, although transitory, decrease was observed in the transaminase values which returned to pre-treatment values on termination of the same. Normal transaminase values were only obtained at some point in the treatment in two patients. Ribavirin was well tolerated with very slight anemia being detected in all the cases. These results, which are superposable to those of other authors who have studied the effects of this antiviral agent in chronic hepatitis C, suggest that ribavirin may play a role in the treatment of this disease. Given the existing data, this role would be one of a drug associated with interferon with which it may have a synergic action rather than as a monotherapy.

Adult↗
PubMed1996

[Tuberculous hepatosplenic abscess, human immunodeficiency virus infection and multiresistant tuberculosis].

BACKGROUND: Tuberculosis (TB) with liver and/or spleen abscess (HSA) formation in HIV-positive patients is uncommon. PATIENTS AND METHODS: One hundred and thirty-seven HIV positive patients with TB were studied from January 93 to June 95. Patients with tuberculous HSA were enrolled in the study. Diagnosis was obtained by recovery of Mycobacterium tuberculosis in clinical specimens and the presence of hypoechogenic lesions in liver and/or spleen. RESULTS: M. tuberculosis isolates were resistant to some of the usual drugs in 51 patients. Twenty of these patients had HSA (39%) and in 18 patients the antibiotic sensitivity testing showed resistance to isoniazid, rifampin, ethambutol, and streptomycin. The remaining 86 patients had episodes of TB with drug-susceptible microorganism and only three patients had HSA (3%) (p < 0.001). The 23 patients with tuberculous HSA had a mean CD4+ lymphocyte count of 33 x 10(6) cells/L (2-111) and 7 had a previous episode of TB. The abdominal echography showed hepatosplenomegaly in all cases. Abscesses were located at the liver in 12 patients (52%), spleen in 18 (78%) and both organs in 7 (30%). In 16 cases a corticosteroid therapy was indicated. In the 3 patients with susceptible TB and HSA the clinical course was good. The 20 patients with resistant TB died. CONCLUSION: Abdominal TB in HIV-positive patients and HSA formation appears to be more common in severely immunosuppressed patients, with resistant TB and its mortality rate is high. The response to therapy with antituberculous drugs is slow and sometimes the administration of corticosteroids is necessary for the resolution of symptoms.

Abdominal Abscess↗
PubMed1994

[Serum activity of the lactate dehydrogenase enzyme in patients with human immunodeficiency virus infection].

FOUNDATION: Many patients with infection by the HIV show an increase in the levels of the lactodehydrogenase (LCH) enzyme. In most of these cases, such increase has been associated to the presence of pneumonia by Pneumocystis carinii. In order to analyze other possible causes of this increase, we conducted a study in which the clinical, analytical and immunological condition of a group of HIV+ patients with increased levels of LDH was compared to another group whose values were within normal limits. MATERIAL AND METHODS: The clinical records of 200 patients with HIV infection were retrospectively reviewed. The patients were divided into two groups depending if their LDH values were greater than (group A) or lower than (group B) the upper limit considered as normal in our laboratory (230-460 UI/L). Group A included 150 patients and Group B, 50. RESULTS: Both groups were similar with respect to age, sex risk group for HIV infection, hemoglobin level, platelet count and renal function. The number of patients fulfilling AIDS criteria was significantly greater (p < 0.05) among those with LDH above 460 UI/L. Leukocytes and lymphocytes CD4+ values were significantly greater (p < 0.05) among group B. The diseases more frequently diagnosed in group A were: tuberculosis in 41 cases (27%), pneumonia by P. carinii in 31 (21%), bacterial pneumonia in 19 (13%), disseminated disease by cytomegalovirus in 14 (9%) and by Mycobacterium avium in 12 (8%). Among the patients with increased LDH, their levels were similar in the patients with tuberculosis, pneumocystosis and in the patients with AIDS and those which were in the first stages of the HIV infection. CONCLUSION: The increase in LDH among the patients with HIV infection in the era of the prophylaxis against P. carinii must be carefully interpreted. Greater levels of this enzyme are little specific, but have a high sensitivity in the case of tuberculosis and pneumocystosis.

Adult↗
PubMed1993

Spontaneous pneumothorax in patients with the human immunodeficiency virus: study of eight cases.

OBJECTIVE: To evaluate the risk factors and the natural history of spontaneous pneumothorax in patients with human immunodeficiency virus infection (HIV). METHODS: We studied eight HIV infected patients with spontaneous pneumothorax. Variables assessed included sex, age, risk factor for HIV infection, use of Pneumocystis carinii pneumonia prophylaxis, total and CD4 positive lymphocyte count, previous history of Pneumocystis carinii pneumonia or pulmonary tuberculosis, chest X-ray film, presence of simultaneous opportunistic infection, partial pressure of oxygen in arterial blood gas determination and clinical outcome. RESULTS: The patients were predominantly male and intravenous drug abusers. Mean age was 28 years (range: 21-44). Five patients had acquired immunodeficiency syndrome, 2 oral candidiasis and one asymptomatic HIV infection. Three had previously had Pneumocystis carinii pneumonia and six a concurrent opportunistic infection. No one was receiving aerosolized pentamidine prophylaxis. The pneumothorax was bilateral in two cases. Chest tube evacuation was required in seven, and six patients died. Only two patients without opportunistic infection were discharged. CONCLUSIONS: We conclude that spontaneous pneumothorax is a serious problem with high mortality in patients with advanced human immunodeficiency virus infection. Previous or active Pneumocystis carinii pneumonia appear to be a risk factor for developing pneumothorax. It seems to be independent of aerosolized pentamidine use.

AIDS-Related Opportunistic Infections↗