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Biomedical subjects

M Tapia

Publications and source records attributed to M Tapia.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Repeated heart valve replacements: prognosis and results].

In order to determine the prognosis of reoperation for valvular replacement, we reviewed the results of a consecutive series of 124 patients operated in the department between 1974 and 1992 (163 multi redo operations). There were 69 women and 55 men, with a mean age 48 years; 77% of the patients were in functional class III or IV. Operations were performed as an emergency in 30% of cases. Endocarditis was found in 24% of cases and was an important risk factor in this content. The main indications for reoperation were periprosthetic leakage in 28.8% of cases and failure of bioprostheses in 23.7%. The valvular replacement was simple in 61%, double in 32% and triple in 7% of cases. An associated procedure was necessary in 27% of cases. Mechanical devices were implanted in 62.3% of cases. Peroperative mortality was 3% and hospital mortality, mainly from cardiac causes, was 21.7% for the second, 20% for the third and 55.6% for the fourth reoperations. Operative mortality was dependent on the number or reoperations, functional class, emergency surgery, duration of bypass and cross-clamping time. Four per cent of patients were lost to follow-up and 30 patients died secondarily. The actuarial survival rate was 52% at 5 years and 33% at 10 years, actuarial survival rate without valvular complication was 41% at 5 years and 19% at 10 years but the functional results remained good with over 90% of patients in functional class I or II at the end of follow-up.

Adolescent↗
PubMed1994

Scedosporium inflatum infection in immunocompromised haematological patients.

We report four cases of Scedosporium inflatum (S. inflatum) infection in severely immunocompromised haematological patients. Six well-documented cases of S. inflatum disseminated infection in haematological patients have been reported: four in Australia and two in Spain. Their clinical and pathological characteristics are heterogenous, particularly in the Australian cases. However, the clinical and pathological profile emerging from our and other Spanish cases is homogenous and very similar to the clinico-pathological spectrum of other disseminated mycoses, including Aspergillus and S. apiospermum. The optimal treatment of S. inflatum infection is unknown and the outcome in haematological patients is very poor. Eight patients died despite systemic antifungal treatment.

Amphotericin B↗
PubMed1994

[Incidence, clinico-biological characteristics, and clinical course of 1,203 monoclonal gammopathies (1971-1992)].

PURPOSE: To evaluate the incidence of monoclonal gammopathies (MG) in our sanitary district, to determine the associated diseases, and to analyse their clinical course along a period of over 20 years. PATIENTS AND METHODS: The study comprised 1,203 patients with MG, of whom 397 had multiple myeloma (MM) and 806 had non-myelomatous monoclonal gammopathies (NMMG). All patients were diagnosed and followed in the Department of Haematology of the Miguel Servet Hospital, in Zaragoza, between january 1971 and december 1992. The SWOG criteria for MM and those proposed by Kyle for NMMG were followed in all cases. The explorations performed in every patient included physical examination, x-ray skeletal survey, peripheral blood study, bone-marrow aspiration or biopsy, study of liver and kidney function. The protein study carried out in blood and urine included agarose gel electrophoresis and electroimmunofixation. Descriptive statistics and determination of actuarial accumulated risk for the transformation of MG undetermined significance (MGUS) into malignant MG (MMG) were also carried out. RESULTS: Incidence: The yearly incidence of MG remained stable up to 1985 as 25 new cases; from that time on, a 30-40% yearly increase was noticed, this increase being mainly related with NMMG. Distribution: MM included 397 patients (33.0%), while 806 cases (67.0%) had NMMG. In these last were included those MG associated to haematologic malignancies, 139 cases (11.5%) or to other diseases, 286 cases (23.8%), as well as MGUS, 347 cases (28.9%), and in 34 cases the MG acquired a transient character. The mean age in the series was 62.1 years, ranging between 2 and 92, and the M/F ratio was 1.13. IgG was the commonest immunochemical type, 762 cases (63.3%), followed by IgA, 214 cases (17.8%) and IgM, 114 cases (9.5%) Multiple MG appeared in 3.8% of the cases, 64 instances, with monoclonal component present only in urine. Of the MG associated to blood diseases, the highest frequency corresponded to lymphoproliferative disorders (74.8%), and of those MG associated to other disease, neoplasms and liver diseases were the commonest. The second place in frequency corresponded to MGUS, in which a periodical follow-up with median duration of 37.8 months was kept in 93.6% of the cases. Ten patients evolved into MMG within a median of 60 months, having an actuarial accumulated risk of 4.5%, 15% and 26% at 5, 10 and 15 years, respectively. CONCLUSIONS: (1) MG are relatively frequent disorders, representing an important number of interventions for a general haematology department each year. (2) MM is the commonest of all MG, followed by MGUS. (3) The clinical importance of MM lies upon the possibility of evolving into MMG. In this series, ten patients developed MMG within a median of 60 months and having an actuarial risk of 4.5%, 15% and 26%, respectively, at 5, 10 and 15 years.

Female↗
PubMed1994

[Mid-term results of cardiomyoplasty].

Cardiomyoplasty (CMP) is a technique of circulatory assistance using a pediculated latissimus dorsi muscle wrapped around the heart and electrically stimulated during systole. Sixty-four patients, aged 15 to 69 years (average 50.8 +/- 13 years) with cardiac failure underwent CMP between January 1985 and July 1993. The causes of cardiac failure were : ischaemic heart disease (39 cases), dilated cardiomyopathy (18 cases), cardiomyopathy following valvular heart disease (2 cases), cardiac tumours (4 cases) and congenital heart disease (1 case). Twenty-four patients underwent an associated surgical procedure. Intra and postoperative intra-aortic balloon pumping was required in 27 cases. Hospital mortality (before latissimus dorsi stimulation) was 20.3% (13/64 cases). Evaluation of the survivors 12 months after surgery showed an improvement in functional class (1.,5 versus 3.3 before CMP ; p < 0.05), in isotopic ejection fraction (27 +/- 3% versus 17 +/- 6%, p < 0.05) and cardiac index (2.87 +/- 0.63 l/min/m2 versus 2.38 +/- 0.41 l/min/m2, p < 0.05). There was no significant change in cardiac filling pressures. The number of hospital admissions for congestive cardiac failure in operated patients was 0.4 per patient per year, compared with 2.5 per patient per year (p < 0.05) before CMP. The preoperative predictive factors for late mortality were: permanent functional Class IV (NYHA), severe cardiac dilatation (cardio-thoracic ratio greater than 0.60; left ventricular end diastolic dimension > 75 mm), an isotopic left ventricular ejection fraction < 15%, severe biventricular cardiac failure and irreversible pulmonary hypertension. The actuarial 4 year survival rate was 68.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1993

Invasive pulmonary aspergillosis prior to BMT in acute leukemia patients does not predict a poor outcome.

Eight patients with acute leukemia (AL) and invasive pulmonary aspergillosis (IPA) developing during previous antileukemic therapy underwent BMT (autologous in 6 cases and allogeneic 2). IPA was treated prior to BMT with full doses of amphotericin B, associated with surgical resection in three cases. One patient was treated with amphotericin B and itraconazole. Prior to BMT, seven patients had minimal residual pulmonary lesions. All patients received amphotericin B (0.5 mg/kg/day) during the aplastic period prior to engraftment. One patient died of Gram-negative septic shock before engraftment. Seven patients achieved complete hematological engraftment without any evidence of IPA reactivation. Amphotericin B was well tolerated with only minimal transient renal dysfunction in three patients. Later pulmonary complications related to IPA were observed in only one patient who developed a self-limited episode of hemoptysis. One patient died of CMV pneumonitis and two of leukemia relapse. Four patients survive disease-free and without complications related to IPA. We conclude that the reactivation of correctly treated IPA can be successfully prevented in BMT patients by use of prophylactic amphotericin B. With this approach, prior IPA is not a contraindication to BMT.

Adolescent↗
PubMed1992

A simple approach to takedown of a modified Blalock shunt.

We describe a simple and rapid technique for takedown of right-sided modified Blalock shunts involving a blunt approach between the pericardium and the pleura. We have used this method successfully on either side in 47 cases.

Arteriovenous Shunt, Surgical↗
PubMed1992

[Insulinoma and pregnancy. A clinical case].

A case of pregnancy and insulinoma is presented. The diagnosis was confirmed by surgery and histopathology repeated episodes of hypoglycemia was the main clinical manifestation. The pregnancy ended, by cesarean section. A female was born of 2.890 g, and evolutioned in good conditions.

Adult↗
PubMed1991

The interstellar C-H stretching band near 3.4 microns: constraints on the composition of organic material in the diffuse interstellar medium.

To better constrain and quantify the composition of material in the diffuse interstellar medium (ISM), absorption spectra between 3600 and 2700 cm-1 (2.8 and 3.7 microns) have been taken of objects which have widely varying amounts of visual extinction along different lines of sight. The spectra of these objects contain a broad feature centered at approximately 3300 cm-1 (approximately 3.0 microns), attributed to O-H stretching vibrations, and/or a feature near 2950 cm-1 (3.4 microns) attributed to C-H stretching vibrations. The lack of correlation between the strengths of these two bands indicates that they do not arise from the same molecular carrier. The features in the 3100-2700 cm-1 (3.2-3.7 microns) region fall into one of two classes. We attribute the first class of features to material in the diffuse ISM on the basis of the similarity between the band profiles along the very different lines of sight to Galactic center source IRS 7 and VI Cygni #12. Similar features are also reported for Galactic center source IRS 3, Ve 2-45, and AFGL 2179. Higher resolution spectra of the objects OH 01-477 and T629-5, which are known to be M stars, are dominated by a series of narrow bands in this region. These bands are largely due to OH in the stars' photospheres. While the spectra of OH 01-477 and T629-5 are likely to contain C-H absorption from diffuse ISM dust, the strength of the overlapping photospheric OH features presently prevents us from quantifying the depths of the interstellar C-H feature towards these objects. The interstellar feature for Galactic center source IRS 7 has subpeaks near 2955, 2925, and 2870 cm-1 (+/- 5 cm-1), which we attribute to C-H stretching vibrations in the -CH2- and -CH3 groups of aliphatic hydrocarbons. These band positions fall within 5 cm-1 of the values normal for saturated aliphatics. The absence of a distinct band near 2855 cm-1 suggests that the material contains small amounts of electronegative groups like -O-H or -C triple bond N. The relative strengths and profiles of the 2955 and 2925 cm-1 features towards five objects suggests an average diffuse ISM line-of-sight -CH2-/-CH3 ratio of about 2.5, indicating the presence of relatively complex organic materials. The strengths of the subpeaks at 2925 and 2955 cm-1, due to -CH2- and -CH3 groups, respectively, correlate with visual extinction, strongly suggesting that the C-H stretching band is a general feature of the material along different lines of sight in the diffuse ISM. We find average ratios of A nu/tau(2925 cm-1) = 240 +/- 40 and A nu/tau(2955 cm-1) = 310 +/- 90 for the objects we have observed. We deduce that 2.6%-35% of the cosmic carbon in the ISM is tied up in the carrier of this band with the most likely value falling near 10%. The interstellar C-H band is remarkably similar to the feature in lab residues produced by irradiating analogs of dense molecular cloud ices. This is consistent with a model in which the hydrocarbon component in the diffuse interstellar medium consists of complex hydrocarbons containing aliphatic side chains and bridges which are produced in dense molecular clouds and subsequently modified in the diffuse medium.

Astronomical Phenomena↗
PubMed1991

Interstitial 15q deletion without a classic Prader-Willi phenotype.

We report on a newborn boy with pronounced hypotonia, cryptorchidism, minor facial anomalies, congenital heart defect, neurologic anomaly, deafness, renal anomaly, and bifid uvula. The patient has a de novo proximal interstitial deletion of chromosome 15 reaching to band q14, larger than that usually seen in Prader-Willi and Angelman syndromes.

Chromosome Banding↗