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M Anguita

Publications and source records attributed to M Anguita.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Digitalis poisoning from medicinal herbs. Two different mechanisms of production].

Two cases of digitalis toxicity due to uncontrolled ingestion of medicinal herbs are presented. The first of them was caused by oleander (Nerium oleander); digoxinemia levels were very high in this patient (4.44 ng/l), who presented many brady- and tachyarrhythmias. These arrhythmias disappeared when digoxinemia returned to normal values. The second patient had atrial fibrillation with slow ventricular rate, severe hypokalemia (2.1 mEq/l) and normal digoxinemia levels. He was taking medicinal herbs for a cold, with sorbitol between its components. Sorbitol may be similar to mannitol and glycerol (osmotic diuretic drugs) when taken at high doses. Uncontrolled ingestion of medicinal herbs is not safe, and severe poisoning can occur.

Adult↗
PubMedDate not supplied

[Listeria monocytogenes endocarditis in a patient with mitral prosthesis, left auricular thrombus and adenocarcinoma of the colon].

A case of Listeria monocytogenes endocarditis in a patient with mitral prosthetic valve, left atrial thrombus and colonic adenocarcinoma is reported. Vegetations were not demonstrated by transesophageal echocardiography and the clinical course was benign and without complications. Cure was achieved with antibiotic therapy, and surgery was not required. These features suggest that atrial thrombus could be the source of infection.

Adenocarcinoma↗
PubMedDate not supplied

Influence on survival after heart transplantation of contraindications seen in transplant recipients.

Fifty-seven patients underwent heart transplantation at our hospital between April 1986 and April 1991. In an attempt to assess the result of and the influence of contraindications seen in transplant recipients before transplantation on the outcome after transplantation, we have analyzed six of these "relative" contraindications: (1) age over 55 years (21% of patients); (2) pulmonary hypertension (pulmonary vascular resistance of more than 5 Wood units, and/or transpulmonary gradient of more than 12 mm Hg; 26% of patients); (3) renal failure (serum creatinine level of more than 2 mg/dl, and/or creatinine clearance of less than 35 ml/min; 11% of patients); (4) active infection (9% of patients); (5) diabetes mellitus (7% of patients); and (6) critical/unstable clinical condition before transplantation (25% of patients). An overall "risk score," obtained by adding one point for each contraindication, was also analyzed. Risk score was 0 (the "ideal" recipient) in 38% of patients, 1 in 25% of patients; 2 in 23% of patients; and 3 or more in 14% of patients. Actuarial survival was significantly lower for patients over 55 years of age (45% versus 68% at 18 months; p less than 0.05), for patients with elevated pulmonary vascular resistance (38% versus 72%; p less than 0.01), and for patients with kidney failure (16% versus 70%; p less than 0.01). On the contrary, survival at 18 months was not significantly different for patients with or without diabetes mellitus (50% versus 63%; not significant [NS]), active infection (60% versus 63%; NS), or critical/unstable condition (45% versus 69%; p less than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Pacing requirements after orthotopic heart transplantation: incidence and related factors.

To assess the incidence of severe bradyarrhythmia and pacing requirements after orthotopic heart transplantation, as well as the possible causal mechanisms, we have reviewed our experience on 52 consecutive transplant patients. The overall incidence of bradyarrhythmia requiring pacing for at least 24 hours after transplantation was 27% (14 patients). The conditions of three of them required pacing for less than 1 week; the conditions of the other 11 patients (21%) required pacing for more than 1 week. Normal sinus rhythm resumed in all but four patients within 3 weeks; a permanent pacemaker was implanted in these four patients (7.6% of all 52 patients and 28% of patients requiring temporary pacing). Late complete heart block associated with acute rejection developed in two patients whose conditions required implantation of a permanent pacemaker. The age and sex of the recipient and donor were similar for patients with or without bradyarrhythmia. The percentage of patients with or without bradyarrhythmias taking amiodarone before transplantation (57% and 46%, respectively), total ischemic time (133 +/- 33 and 123 +/- 37 minutes, respectively), and cardiopulmonary bypass time (117 +/- 17 and 132 +/- 65 minutes, respectively) were not significantly different for either group of patients. The initial temperature of cardioplegic solution for organ storage and the preimplantation myocardial temperature were, however, significantly lower in patients whose conditions required pacing immediately after transplantation than in those whose conditions did not require pacing (5.3 +/- 1.7 degrees C versus 6.5 +/- 1.5 degrees C, p less than 0.05, and 3.9 +/- 1.6 degrees C versus 5.7 +/- 2.6 degrees C, p less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Noninvasive radioisotopic diagnosis of acute heart rejection.

In a prospective protocol for noninvasive diagnosis and follow-up of acute heart rejection 162 examinations were performed in 36 patients who underwent heart transplantation. The follow-up period ranged from 15 days to 44 months. The protocol comprised multiple gated acquisition ventriculography with albumin labeled with 99mTc (740 MBq), acquired using a forward/backward by thirds framing mode, 32 frames/cycle, and 10 million total counts. Parameters of left ventricular diastolic function were analyzed. Antimyosin antibody labeled with indium 111 (74 MBq) was injected, and myocardium/lung uptake ratios were obtained at 48 hours in counts per pixel. Endomyocardial biopsy was performed in all patients within 48 hours. The results were evaluated by comparison of mean values of each parameter and global and individual correlation analysis in relation to the presence or absence of rejection and treatable (moderate or severe) or nontreatable (mild or absent) rejection. Antimyosin and diastolic function parameters showed significant differences (p less than 0.001) between patients with and without rejection and between patients with treatable and nontreatable rejection. Global correlation with biopsy existed (p less than 0.05) for antimyosin (r = 0.75), average filling rate (r = 0.61), and peak filling rate (r = 0.56). Individual correlation exhibited significance in all patients only for antimyosin (r = 0.78 to 0.98). In eight patients average filling rate also showed significant correlation (r = 0.65 to 0.88). In conclusion, these results provide a noninvasive diagnosis of cardiac allograft rejection episodes and allow an accurate selection between treatable and nontreatable rejection. Individual patient follow-up is possible with antimyosin. The study of diastolic function is also useful in this setting.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Brucellar pericarditis: 2 different forms of presentation for an unusual etiology].

Two cases of Brucella melitensis pericarditis are reported. Pericardial involvement was the first and almost only manifestation of brucellosis in the first patient while in the second, a significant pericardial effusion was discovered on a routine echocardiogram performed in a patient with clinically florid brucellosis. Some etiopathogenic aspects of this uncommon etiology are discussed.

Adolescent↗
PubMedDate not supplied

[Acute myocardial infarct in persons over 70. The results and differential characteristics].

Distinctive features of patients over 70 years with acute myocardial infarction (AMI) are studied. Between May 1988 and April 1989, 420 patients with AMI were admitted to our hospital; 118 of them (28.5%) were older than 70 years. In this group of patients, proportion of woman was higher (36 vs 16%, p less than 0.001), while incidence of smoking and hypercholesterolemia was lower (41 vs 64%, p less than 0.001; and 15 vs 29%, p less than 0.05). There was no differences in other risk factors, prior history of coronary heart disease (angina, AMI, coronary surgery), or general features of AMI (location, proportion of painless AMI, non-Q-wave AMI, evolved AMI, initial admission to coronary care unit or general ward, time from the beginning of symptoms to admission, residual ejection fraction). The incidence of severe complications was superior between older patients: shock, 17 vs 7% (p less than 0.05); Killip class III/IV, 30 vs 13% (p less than 0.001); and fascicular blocks: 26 vs 16% (p less than 0.05). Hospital mortality was also higher in older patients, 25.5 vs 14% (p less than 0.01). No patients older than 70 years received fibrinolytic therapy, and only one underwent coronary artery surgery (22% and 15%, respectively, in younger patients). Coronary arteriography, exercise test, radionuclide ventriculography and Holter monitoring were also performed before discharge in a lesser proportion in older patients. We conclude that mortality and severe complications were higher between patients over 70 years with AMI. We think that mortality could be decreased by a more aggressive management in, at least, selected groups of older patients with AMI.

Aged↗
PubMedDate not supplied

Septic arthritis by Salmonella enteritidis after heart transplantation.

A 13-year-old boy underwent orthotopic heart transplantation for end-stage idiopathic dilated cardiomyopathy. Immunosuppressive therapy consisted of cyclosporine, azathioprine, prednisone, and antithymocyte globulin. Endomyocardial biopsies revealed persistent moderate rejection, which was treated aggressively. In the sixth week, septic arthritis by Salmonella enteritidis developed. We discuss our management of this exceptional complication and the poor results obtained because of superimposed cytomegalovirus infection.

Adolescent↗
PubMedDate not supplied

Repetitive nontreated episodes of grade 1B or 2 acute rejection impair long-term cardiac graft function.

BACKGROUND: Episodes of grade 1B or 2 acute heart rejection are usually not treated, and most of them resolve spontaneously. METHODS: With the aim to assess long-term outcome in patients with repetitive nontreated episodes of low-grade (1B, 2) acute rejection, we have studied 141 heart transplant recipients in whom the evolutive pattern of acute rejection during the first 6 months after transplantation could be determined. RESULTS: Forty-four patients (31%) had only grade 0 or 1A acute rejection episodes (pattern A); 23 patients (16%) had three or more episodes of grade 1B or 2 acute rejection without 3A or more advanced rejection (pattern B); 48 patients (34%) had one or two episodes of grade 3A, 3B, or 4 acute rejection only during the first 6 months after transplantation (pattern C); and 26 patients (19%) had three or more episodes of grade 3A, 3B, or 4 acute rejection (pattern D). Overall mortality was 11%, 26%, 19%, and 46% for patients with patterns A, B, C, and D, respectively. No difference was found among patterns with regard to incidence of graft atherosclerosis. Left ventricular ejection fraction at 1 year after transplantation was significantly lower (p < 0.05) for patients with pattern B (50% +/- 5% versus 59% +/- 7%, 59% +/- 11%, and 56% +/- 6% for patterns A, C, and D, respectively); cardiac index also was lower for patients with pattern B than for those with pattern A (3.6 +/- 0.6 versus 4.1 +/- 0.6 L/min/m2, p < 0.05). CONCLUSIONS: Although mortality was higher for patients with more severe episodes of acute rejection, only repetitive nontreated episodes of grade 1B or 2 rejection significantly impaired long-term graft function.

Female↗
PubMedDate not supplied

Visceral Kaposi's sarcoma without mucocutaneous involvement in a heart transplant recipient.

Kaposi's sarcoma has been occasionally reported in heart transplant recipients, but its occurrence without mucocutaneous involvement is extremely rare. In these uncommon cases, the tumor can be indistinguishable from opportunistic infections, making diagnosis difficult. The case of a patient in whom visceral Kaposi's sarcoma was diagnosed by necropsy 6 months after heart transplantation is reported.

Abdominal Neoplasms↗
PubMedDate not supplied

Heart transplantation in Spain: the Spanish National Registry of Heart Transplantation (1984-1992).

The first heart transplantation in Spain was performed in 1984. Since then, 950 patients had undergone heart transplantation in our country as of December 1992. Data from all these 950 patients have been reported to the Spanish National Registry of Heart Transplantation since its inception in 1989. Follow-up is complete for all patients. Mean age of recipients was 46 +/- 14 years; 86% were male patients. Almost 50% of all heart transplant procedures were performed in 1991 (232 patients, 6 per million persons) and 1992 (254 patients, 6.6 per million). Twelve centers have performed heart transplantations in Spain. Of the 950 procedures, 907 (95%) have been orthotopic, 6 (0.6%) heterotopic, 16 (1.7%) heart-lung transplantations, and 21 (2.7%) retransplantations. Mortality on waiting list was 8% in 1991 and 5.2% in 1992. Idiopathic (47%) and ischemic (37%) cardiomyopathy were the two main causes leading to transplantation. Mean recipient age has increased from 38 years in 1985 to 50 in 1992; 50% of all patients who underwent transplantation in 1992 were older than 50 years of age, with 11% older than 60 years of age. Actuarial survival was 74% at 1 year and 63% at 6 years, which is similar to that of the International Society for Heart and Lung Transplantation Registry. One-year survival increased from 61% for patients receiving transplants in 1985 to 77% for those who received transplants in 1992. One-month mortality decreased from 23% in 1985 to 12% in 1992.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Results of heart transplantation in recipients with active infection.

Although active infection in the recipient is generally considered to be an absolute contraindication for heart transplantation, seven of our first 104 transplant patients (6.7%) had active severe infection within the week before transplantation. Because of unstable clinical condition of these recipients, heart transplantation was performed when an adequate donor was offered, in spite of infection. Patients were managed with cyclosporine as the only immunosuppressive therapy during the first week after transplantation. Mortality rate and incidence of acute rejection were not different for these seven patients than for the remaining 97 patients.

Adolescent↗
PubMedDate not supplied

A randomized study comparing deflazacort and prednisone in heart transplant patients.

Prednisone is widely used by most heart transplantation units despite its frequent side effects. Deflazacort, an oral synthetic steroid with fewer side effects, has been successfully used in patients after heart transplantation, but a prospective study comparing deflazacort and prednisone in transplant patients is lacking. We have carried out, in the last year, a prospective trial of deflazacort versus prednisone involving 35 consecutive heart transplant patients. Two of these patients died perioperatively (surgical mortality, 5.7%), and another two were excluded from the protocol because of diabetes mellitus in one patient and active infection before transplantation in the other patient. Thus 31 patients were enrolled in the 3-month study. All of them were treated with antithymocyte globulin, 10 mg/kg/day for 3 days after transplantation, azathioprine, and cyclosporine; patients were randomly assigned groups: 15 patients to receive deflazacort therapy, 1.5 mg/kg/day, and 16 patients to receive prednisone therapy, 1 mg/kg/day, starting the first day after transplantation. Steroids were rapidly tapered, reaching the maintenance dose at 2 to 3 weeks after transplantation (prednisone, 0.15 mg/kg/day; deflazacort, 0.25 mg/kg/day). Both groups were similar in terms of age, gender, ABO identity, serum cyclosporine levels, azathioprine dosage, and pretransplantation serum glucose and lipids levels. Seven endomyocardial biopsies were performed on each patient, at 1, 2, 3, 5, 7, 10, and 13 weeks after transplantation. Incidence of acute rejection was similar between prednisone and deflazacort groups; 33% of patients receiving prednisone therapy and 42% of patients receiving deflazacort therapy had one episode of 3A or higher rejection (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Influence of heart transplantation on the natural history of patients with severe congestive heart failure.

In an attempt to study the influence of heart transplantation on the natural history of patients with severe congestive heart failure, we have reviewed our experience with 240 consecutive patients who were New York Heart Association class IV or III/IV, who had left ventricular ejection fraction less than 35%, who were younger than 65 years of age, and who were assessed for heart transplantation in our hospital since May 1986. Mean age was 47 +/- 12 years. Left ventricular ejection fraction was 20% +/- 6%. Eighty-seven percent were male. New York Heart Association class was IV in 88% and III/IV in 12%. The cause was ischemic heart disease in 35% of patients, valvular heart disease in 13% of patients, and primary dilated cardiomyopathy in 52% of patients. At initial assessment, heart transplantation was considered to be not indicated in 30% of patients, indicated in 51% of patients, and contraindicated in 19% of patients. During a follow-up of 13 +/- 13 months (2 to 64 months), 110 patients underwent transplantation (46%). Posttransplantation actuarial probability of survival was 70% at 3 years. Three-year probability of survival free from transplantation was significantly lower for patients older than 55 years of age (p < 0.05), for those with left ventricular ejection fraction less than 20% (p < 0.05), ischemic causes (p < 0.05), New York Heart Association class IV (p < 0.001), and indication/contraindication for transplantation (p < 0.001); no difference was noted for gender.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Preliminary experience with deflazacort, a new synthetic steroid with fewer undesirable side effects, in heart transplant patients.

Prednisone is widely used by most heart transplant units, despite its frequent side effects. Deflazacort, a new oral synthetic steroid with fewer side effects, has not been studied in heart transplant patients. Our initial experience with 26 heart transplant patients in whom prednisone was replaced by deflazacort at 11 +/- 11 months after transplantation is reported. After the switch to deflazacort, a significant decreased was noted in glycemia, total cholesterol, and LDL-cholesterol (p < 0.001). No difference was noted in severity or frequency of rejection and infection between patients being treated with deflazacort and another 26 patients who continued to be treated with prednisone over a comparable period of time after transplantation.

Adult↗