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Manuel López-Cano

Publications and source records attributed to Manuel López-Cano.

6 recordsLinked to original sources
PubMed2006

Experience with starting tacrolimus postoperatively after transsternal extended thymectomy in patients with myasthenia gravis.

BACKGROUND: Thymectomy is a standard treatment of myasthenia gravis (MG). Immunomodulating agents are frequently given during the post-thymectomy latency period until complete remission is fully consolidated, but serious side effects is a relevant clinical problem for patients on long-term immunomodulating treatment. OBJECTIVE: To assess the effectiveness of starting tacrolimus in the immediate postoperative period in MG patients undergoing transsternal extended thymectomy, with complete stable remission (CSR) as the primary outcome of the study. METHODS: Forty-eight MG patients received tacrolimus, 0.1 mg/kg per day b.i.d. (started 24 h after thymectomy) and prednisone 1.5 mg/kg/day. Histologically, 34 patients had hyperplasia, 20 thymic involution, and 14 thymoma. Of the 48 patients, 40 completed 1 year of tacrolimus therapy, 38 completed 2 years, 27 completed 3 years, 21 completed 4 years, and 9 more than 5 years. Mean dose of tacrolimus was 4.9 mg/day (range 2-8 mg/day) with a mean plasma drug concentration of 7.6 ng/mL (range 7-9 ng/mL). Prednisone could be withdrawn after the first year in 93.7% of patients and at 2 years in 100%. RESULTS: The mean follow-up was 24.4 months, SD 17.3 (range 6-60 months). Improvement of muscular strength and decrease of anti-AChR antibodies were statistically significant (p < 0.001) shortly after operation. CSR was obtained in 33.4% of patients, pharmacological remission in 62.6%; 4% of patients had minimal symptoms. None of the patients with thymoma achieved CSR. The estimated median follow-up to obtain a CSR was 37.9 months (95% confidence interval [CI] 26.4-49.5 months). The overall crude CSR rate was 33.4%, with 47% for non-thymoma patients. The probability to achieve CSR at 3 years was 67% for the non-thymomatous group. CONCLUSIONS: Long-term immune-directed treatment with tacrolimus to improve the effectiveness of thymectomy in MG is feasible and was associated with a high rate of CSR in patients without thymoma.

Adolescent↗
PubMed2005

[Idiopathic pneumoperitoneum].

We report the case of a 48-year-old man who was admitted to the intensive care unit for acute respiratory distress. After discharge, the patient showed massive pneumoperitoneum. None of the complementary investigations provided information on the cause. The patient underwent surgery but no intraoperative diagnosis was reached. We believe that this case is of interest since pneumoperitoneum is a frequent entity that often leads to emergency laparotomy. The cause is usually perforation, although in a substantial proportion of cases the pneumoperitoneum is non-surgical, or idiopathic.

Humans↗
PubMed2003

[Predictors of survival in patients with myasthenia gravis and thymoma].

BACKGROUND AND OBJECTIVE: Myasthenia Gravis (MG) and Thymoma have different clinical evolutions and survival. There are few studies grying to describe the prognosis factors in patients with both thymoma and MG. We have evaluated all patients with thymoma and associated MG who were treated in our unit in order to identify possible predictors of survival. PATIENTS AND METHOD: There were 108 patients with thymoma and associated MG treated at our center from 1967 to 2000. All data were analyzed by multivariate Cox regression analysis, which allowed quantification of the independent predictive value of prognostic indicators. RESULTS: Median follow-up was 10 years. Mortality was 35.2% (38 patients). In 14 (36.8%) cases, death was related to MG, and 6 (15.8%) patients died from a cause directly related to thymoma. Cox regression analysis found a predictive value for both an age older than 55 years and the need for tracheostomy during the postoperative period. CONCLUSIONS: In our series of patients with thymoma and associated MG, age older than 55 years and the need for postoperative tracheostomy were independent predictors of poorer overall survival.

Adolescent↗
PubMed2003

Clinical and pathologic predictors of outcome in thymoma-associated myasthenia gravis.

BACKGROUND: Myasthenia gravis is by far the most common paraneoplastic syndrome of thymomas. There is little information regarding the influence of clinical variables and thymoma-associated factors on biologic development of myasthenia gravis. The aim of the study was to determine independent predictors of clinical outcome in thymoma with myasthenia gravis. METHODS: We studied 108 patients with thymoma-associated myasthenia gravis undergoing removal of the mediastinal mass between 1967 and 2000. Clinical and pathologic variables associated with clinical outcome of myasthenia were assessed by multivariate Cox regression analysis. RESULTS: Patients were followed for a mean period of 10 years (9 months to 33 years). A total of 38 patients died (35.2%), in 14 cases (37%) because of myasthenia gravis and in 6 (16%) because of recurrence of thymoma. With respect to clinical outcome of myasthenia gravis, at the end of the follow-up period, the rate of remission was 16% (n = 17). Of the 91 patients in whom remission was not achieved, 55 had no symptoms with immunosuppressive medication and 36 had symptoms with medication. CONCLUSIONS: In patients with thymoma-associated myasthenia gravis, well-differentiated thymic carcinoma (Müller-Hermelink system), age more than 55 years, and interval from the onset of symptoms to thymectomy of less than 1 year were found to be independent predictors of nonremission of myasthenia gravis after thymectomy.

Adolescent↗