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Biomedical subjects

P Llamas

Publications and source records attributed to P Llamas.

At least 19 recordsLinked to original sources
PubMed1997

Management of thrombotic microangiopathy following allogeneic transplantation: what is the role of plasma exchange?

Thrombotic microangiopathy (TMA) is an infrequent but serious complication of allogeneic transplantation. The success rate of plasma exchange (PE) reported in the treatment of this entity is a controversial subject. We report the outcome of 10 patients with TMA post-allogeneic transplantation after treatment with PE. Two out of the 10 patients have not responded, five had a partial response, but died of acute GVHD or interstitial pneumonitis, and three have responded and recovered. Our study suggests that there are different degrees of TMA severity. Only mild multifactorial cases with no severe hemolysis (LDH activity <1000 U/l) may be fully resolved with PE.

Adolescent↗
PubMed1997

Intracardiac extension of intravenous leiomyomatosis. A case report.

Intravenous leiomyomatosis spreading through the inferior vena cava to the right heart is a rare neoplasm. We report the case of a patient with a uterine leiomyoma which through a right uterine vein progressed along the inferior vena cava up to the right ventricle. She was successfully operated, carrying out a total resection in two surgical stages. Surgical technique considerations are discussed.

Diagnosis, Differential↗
PubMed1996

Restriction endonuclease in situ digestion (REISD) and fluorescence in situ hybridization (FISH) as complementary methods to analyze chimerism and residual disease after bone marrow transplantation.

The efficiency of restriction endonuclease in situ digestion (REISD) with Sau3A to analyze chimerism and residual disease (RD) has been tested before and after an allogenic bone marrow transplant (BMT) in an acute lymphoblastic leukemia (ALL) patient. The combined results obtained with REISD and FISH using the appropriate probes for detecting chromosome rearrangements have proven to be useful for the identification and quantification of both the hemopoietic chimerism achieved after BMT and the RD persistent in the patient. The sensitivity of REISD has been determined to be around 95%, i.e., similar to that obtained by FISH. REISD with Sau3A was particularly useful in the analysis of chimerism since this enzyme revealed the polymorphic status of constitutive heterochromatin in human chromosome 3 and thus allowed discrimination of cells derived from donor and recipient. The method itself seems promising since neither a donor/recipient sex mismatch nor a cytogenetic disease marker are needed for its application.

Adult↗
PubMed1996

Improving chimaerism quantification in bone marrow transplant recipients by image processing and analysis after restriction endonuclease in situ digestion (IPA-REISD).

Restriction endonuclease in situ digestion (REISD) with Sau3A of human metaphase chromosomes and interphase nuclei produces a conspicuous banding pattern involving pericentromeric regions of chromosomes 9 and 3. Constitutive heterochromatin of chromosome 9 is never digested by this enzyme while that of chromosome 3 is polymorphic, giving rise to three possible karyotypes: homozygous digested (3--), homozygous undigested (3++) or heterozygous individuals (3+-). Discrimination of this polymorphism between donor and recipient cells constitutes a rapid sex-independent method to monitor quantitatively the chimaerism achieved after bone marrow transplantation. An image processing and analysis (IPA)-assisted procedure which resolves residual fluorescent regions in metaphase chromosomes or interphase nuclei after REISD has been developed. IPA-REISD has interesting advantages over the basic REISD method by allowing a rapid, objective and precise discrimination of the polymorphism in large cell samples.

Bone Marrow↗
PubMed1995

[Efficacy of various treatments in the management of idiopathic thrombocytopenic purpura in the adult].

PURPOSE: To evaluate the ITP treatment modalities and their results in a series of 30 adult patients. PATIENTS AND METHODS: 30 patients, age 15-74, were diagnosed of ITP in our institution between 1988 and December 1991. We defined the ITP as: mild (platelets > or = 50 x 10(9)/L and < or = 120 x 10(9)/L), moderate (platelets 25-50 x 10(9)/L) and severe (platelets < or = 25 x 10(9)/L). Treatment was initiated when the platelet count reached a level < 50 x 10(9)/L. Initial therapy was oral prednisone or methyl-prednisolone in all patients. In 12 unresponsive patients the treatment included splenectomy. Patients who fail steroid therapy and splenectomy received additional lines of therapy, that included: vincristine (n = 2), vinblastine (n = 1), danazol (n = 5), anti D immunoglobulin (n = 6), methotrexate (n = 2), intravenous immunoglobulin (n = 3). RESULTS: Complete remission was obtained in 19 patients with a follow-up of 3 to 55 months (median, 30 months). Partial remission was achieved in 4 patients, that was sustained for 9 to 39 months (median, 22.5 months) after initial therapy. One unresponsive patient died of infection. Six mild ITP patients did not require therapy with a follow-up of 14 to 56 months (median, 33.1 months). CONCLUSION: In adult patients with mild ITP, therapy is not required. Steroid therapy remains the initial therapeutic choice for moderate and severe ITP. In unresponsive patients useful alternative choices are splenectomy, danazol, anti D immunoglobulin and methotrexate.

Adolescent↗
PubMed1986

Relation between power spectrum time course during ventricular fibrillation and electromechanical dissociation. Effects of coronary perfusion and nifedipine.

To relate the evolution of ventricular fibrillation (VF) to the haemodynamic recovery after cardioversion, we characterized the differences in the ECG power spectrum (PS) time course, among different types of VF: under control conditions, with previous administration of nifedipine and on cardiopulmonary bypass (CPB). In the first few seconds VF showed a PS with a narrow peak between 8 and 15 Hz and its higher harmonics, suggesting some organization and regularity. In the following 40 seconds, the arrhythmia accelerated slightly, maintaining an organized spectrum. Afterwards, the PS became slow and irregular, losing its initial characteristics after 60 seconds. Conversely, VF on CPB maintained its organized PS, over a prolonged period. Previous administration of 0.32, 0.64 mg kg-1 of nifedipine maintained the initial characteristics of the PS for 90 and 150 seconds. Similar results were obtained with previous autonomic blockade. In another group of dogs, defibrillation was performed after successive periods of VF, to study electromechanical dissociation (EMD). In all control dogs, EMD was observed after 90 seconds of VF. Pretreatment with nifedipine postponed EMD until 120-150 seconds and was not observed in dogs on CPB. The PS time course during VF seems a reliable method of analyzing and quantifying the different types of VF. It could be related with the onset of EMD, reflecting the metabolic alterations that happen during VF. Nifedipine could delay the ischaemic effects during VF and increase the possibility of successful cardiac resuscitation.

Animals↗
PubMed1982

Mitral valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura.

We report the management of a patient with chronic idiopathic thrombocytopenic purpura and mitral valve disease. Although a two-stage approach was planned (splenectomy followed by mitral valve replacement one month later), the patient developed medically-resistant heart failure, and splenectomy plus mitral valve replacement were performed during the same operation. The platelet count at operation was 20,000/mm3. Platelet transfusion, used at the end of cardiopulmonary bypass, was considered no longer necessary in the postoperative period, as the platelet count quickly increased after the first postoperative day. The postoperative course was uneventful. Though we believe the two-stage surgical approach is preferable, our case shows that open-heart operations and splenectomy can be successfully performed simultaneously in patients with idiopathic thrombocytopenic purpura.

Blood Transfusion↗