... Aortitis activa aislada (idiopática) en aneurismas de aorta ascendente: una vasculitis escasa... more ... Aortitis activa aislada (idiopática) en aneurismas de aorta ascendente: una vasculitis escasamente reconocida. Jose Fernando Val-Bernal a , Corresponding author contact information , E-mail the corresponding ... Ambas eran hipertensas y una de ellas era una gran fumadora. ...
Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvan... more Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvant chemotherapy consisting of cisplatin 120 mg/m2 day 1, mitomycin 8 mg/m2 day 1, and vindesine 3 mg/m2 days 1 and 14. Each cycle was repeated every 4 weeks for a total of 1 to 6 cycles (median, 3 cycles). Resection was attempted 4 to 5 weeks after the last course of chemotherapy. Intraoperative radiation therapy (IORT) (10-15 Gy) was delivered during surgery and postoperative external beam radiotherapy (EBRT) (46 Gy) was begun 4 weeks after surgery. Fifty-five patients (25 IIIA, 30 IIIB) were evaluable. Only partial responses occurred (64%), and 29 patients (53%) underwent resection. Complete resection rates were 85% (12/14) and 40% (6/15) in stage IIIA and IIIB, respectively (p = 0.01). In 3 of 29 patients (10%), no tumor was found in the resected specimen. There was one chemotherapy-related death and three postoperative-related deaths. The median survival time was 10 months, and the 5-year survival rate was 29 and 7% for stage IIIA and stage IIIB, respectively (p = 0.3). High complete resection rates and modest increase in 5-year survival have been observed in stage IIIA NSCLC. Although a number of stage IIIB patients can be made technically resectable, the low complete resectability rate reflects the lack of survival benefit in these patients.
From January 1988 to August 1992, 18 patients (pts) with the established diagnosis of non-small c... more From January 1988 to August 1992, 18 patients (pts) with the established diagnosis of non-small cell lung cancer of the superior sulcus have been treated with a multidisciplinary approach, which includes 1-3 cycles of neoadjuvant chemotherapy (MVP or MCP regimens) followed by simultaneous preoperative chemotherapy and external beam irradiation. Radical surgery plus intraoperative radiotherapy (IORT) was planned 4-5 weeks after the end of the preoperative protocol. Tumor stages were IIIA (9 pts) and IIIB (9 pts). Tumor characteristics included rib and vertebral involvement in 15 and 4 pts, respectively. Fatal toxicity was present in 3 pts (16.6%). Resectability rate was 76.4%. Pathologic findings disclosed complete response (pT0) in 70.5% of the surgical specimens and viable tumor (pT+) in 29.5%. With a median follow-up of 24+ months (2-52+), 4-year actuarial local control, and overall survival rates are 91% and 56.2%, respectively. Four-year actuarial overall survival according to pathologic response was 87.5% for pT0 patients and 20% for pT+ patients. We conclude that this regimen promotes a high rate of pT0 as well as better than expected local control and survival rates. The presence of a pT0 specimen seems to correlate with the patient outcome.
Heart failure currently constitutes one of the greatest health problems in the Western world. Its... more Heart failure currently constitutes one of the greatest health problems in the Western world. Its incidence, far from diminishing or even remaining stable, is actually still increasing in association with the aging of the population and its lifestyle. A better knowledge of physiopathological mechanisms has allowed for the development of new therapeutic focal points and lines of research. Nevertheless, its treatment is complex and encompasses a multidisciplinary approach. Patients in an advanced stage still have a very high mortality rate in spite of receiving optimum medical care. The development of new therapeutic techniques that afford a better prognosis has therefore been essential. Of these, and leaving aside surgical treatments, myocardial regeneration by means of cellular therapy, new concepts in tissue engineering and their results, and the applications of new advances in the field of immunomodulation have all recently experienced development. In this article, the aim is to bring the latest concepts in the physiopathology and humoral response of cardiac failure up to date as well as doing the same with the therapeutic approaches in this area.
ABSTRACT Introduction Takayasu disease is a rare form of chronic non-specific large vessel vascul... more ABSTRACT Introduction Takayasu disease is a rare form of chronic non-specific large vessel vasculitis of unknown etiology. It usually affects young adults, and can be fatal in children. The first reported case is presented of ventricular assistance followed by heart transplant in a patient with Takayasu disease. Objectives The case is presented of 15 year old child who presented with chest pain and clinical signs of cardiac failure. His electrocardiogram showed ST-segment elevation in V1-V4, and he was referred for coronariography due to suspicion of acute coronary artery disease. The left main coronary artery was of small caliber and exhibited stenosis in the middle segment. The anterior descendent artery showed a thrombotic occlusion at the proximal segment, and there was a critical lesion in the circumflex branch. There was an interruption of the infrarenal abdominal aorta and common and external iliac arteries. Due to the critical situation of the patient, he was referred to urgent surgical intervention and a double bypass graft was performed without noticing any improvement in the cardiac function. A left ventricular assistance device was therefore implanted. Seventy-two hours later an orthotopic heart transplant was performed. The progress was excellent and the patient was discharged 39 days later. Histopathology studies revealed a chronic arteritis in the coronary arteries and ascending aorta, and a massive left ventricular infarction. Conclusions In a rare disease like Takayasu disease, a clear multidisciplinary and coordinated strategy is needed in order to achieve a successful therapeutic outcome.
ABSTRACT Cardiac regeneration requires a complex cascade of events. There are many factors, most ... more ABSTRACT Cardiac regeneration requires a complex cascade of events. There are many factors, most of them still no clarified, that limit the effectiveness of the stem cell therapy and their translation to the clinic. Cells should graft, survive and functionally integrate to the target organ in order to have a chance to restore its function. As in original tissues, a complex and well defined set of signals, many of them coming from the extracellular matrix, is required for normal cell physiology. The idea of combining principles from cell biology and engineering of biocompatible materials in order to create biologic replacement structures that restore, maintain, or improve tissue function, is at the basis of the tissue engineering and defines a different approach to the cardiac regeneration. Research and development of bioartificial myocardium is of great clinical interest. The rationale for the use of specific biomaterials is to allow the creation of a microatmosphere where the exogenous and endogenous cells find the microenvironment optimal for repair. Biomaterials science gives us important tools to build this extracellular matrix. Functionalized 3D systems can provide the correct environment and act as a delivery system for cells and genes, guiding the therapeutic cells to the functional phenotype. Organ decellularization for bioscaffolds fabrication is a new investigated concept. nanomaterials are emerging as the main candidates to ensure the achievement of a proper instructive cellular niche with good drug release/ administration properties.
ABSTRACT The appearance of functional mitral valve insufficiency in the setting of ischemic or di... more ABSTRACT The appearance of functional mitral valve insufficiency in the setting of ischemic or dilated cardiomyopathy is an indicator of bad prognosis, with increased early and mid-term mortality and morbidity and with a significant decrease in life expectancy. In these patients, the mitral valve is anatomically normal, without organic lesions, and this is why the mechanism of valve regurgitation is complex and can be explained by the changes in the left ventricle geometry. Ischemic cardiomyopathy produces left ventricle remodeling, with increased sphericity and displacement of both papillary muscles. All of these phenomena cause valve leaflet tethering, especially in the posterior leaflet. At present, surgical treatment is the only therapeutic option for these patients in order to treat mitral regurgitation. Diverse surgical strategies have been designed to repair mitral regurgitation and to restore left ventricular geometry. However, at present there is not a definitive surgical solution that can be considered the “gold standard”.
ABSTRACT Epidemiologic studies suggest that the prevalence of heart failure will rise in aging po... more ABSTRACT Epidemiologic studies suggest that the prevalence of heart failure will rise in aging populations, being now recognized as a major and escalating public health problem. It is estimated that health-care expenditure in developed countries consumes 1–2% of the total healthcare budget. Medicine today is seeing very rapid development of new technologies for the prevention, treatment and diagnosis of this disease. Given this trend there is also a risk that demand for care will exceed its supply, because resources in health care are limited. There-fore government, health insurers, and health care providers explore new opportunities for improving effectiveness and efficiency of CHF care. Decision-makers in the health service and health care professionals have to make choices and define strategies on the basis of criteria of safety, efficacy and benefit. Economic evaluations is an important tool in the evaluation of competing healthcare interventions. Economic evaluation aims at offering structured information about the balance between costs and effects of a intervention in comparison to another intervention. Four basic types of economic evaluation studies exist: cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. In deciding which types of evaluation should be used in the analysis, the aim of the analysis is determinative. A new cost-effectiveness analysis will be carried out using a decision analytic model, and the evaluation will be constrained by available evidence. If possible, the incremental cost-effectiveness will be estimated in terms of cost per qAly gained, in addition with the incremental cost-effectiveness ratios (ICERs).
ABSTRACT Stem cell therapy, as a strategy to regenerate injured tissues, has emerged as one of th... more ABSTRACT Stem cell therapy, as a strategy to regenerate injured tissues, has emerged as one of the most promising areas for the treatment of illnesses with low possibilities of treatment. The heart failure, mainly of ischemic ethiology, is one of the diseases that more can benefit from this therapeutic strategy. The aim is to regenerate the muscle, reduce apoptosis, increase the expression of the collagen and get an effective production of new vessels. This approach is undergoing with a variety of myogenic and angiogenic cells: skeletal myoblasts, mononuclear and mesenchymal bone marrow cells, circulating blood-derived progenitors, endometrial or adipose-derived stromal cells, mesothelial cells and induced pluripotent stem cells (iPS). The indications concern patients with ischemic cardiomyopathy, idiopathic dilated cardiomyopathies, Chagas heart disease, ischemic mitral regurgitation and diabetic cardiomyopathy. The approaches for cell delivery are surgical performing in the periinfarct area, intracoronary and endoventricular catheter-based cell delivery. The proposed mechanisms of action are reduction of the size and fibrosis of infarct scars, improvement of myocardial viability, limitation of ventricular remodeling, improvement of ventricular compliance and paracrine effects. However, the clinical results have reported only limited improvement in systolic function and remodeling. The development of strategies for improving cell survival and differentiation should be encouraged, such as preconditioning procedures with cell electrostimulation or by using tissue engineering in order to create a bioartificial myocardium.
ABSTRACT Chronic heart failure is one of the major health care issues. Heart transplantation is t... more ABSTRACT Chronic heart failure is one of the major health care issues. Heart transplantation is the approach for patients in class D. Furthermore, the disproportion between recipients and donnors restricts the number of cardiac transplants and has generated alternative treatments. The hypothesis of Torrent Guasp has achieved that the study of cardiac mechanical action to regain the importance it deserves. This hypothesis has led to revise classic concepts: myocardial band without fixed support points generating a three dimensional reduction. The objective of this article is emphasized the development of the therapeutic strategies designed to integrate biology, new medical technologies and the anatomical model of Torrent Guasp. This edition would like to be a reminder of the crucial contribution to cardiology by Torrent Guasp, in addition to his scientific and personal quality.
ABSTRACT Dilated cardiomyopathy is characterized by ventricular dilatation and progressive depres... more ABSTRACT Dilated cardiomyopathy is characterized by ventricular dilatation and progressive depression of myocardial contractile function. It is a multifactorial disease, on which several mechanisms may contribute to the pathophysiology of this process. Disturbances in both humoral and cellular immunity have been described among these patients. A number of antibodies against various cardiac cell proteins, mainly anti-β1-adrenergic and anti-m2 against acetylcholine, have been identified. Recent data indicate that these cardiac antibodies play an active role in the pathogenesis and may contribute to ventricular dysfunction of these patients. Therefore, removal of cardiac autoantibodies by immunoadsorption may induce hemodynamic improvement in dilated cardiomyopathy patients. Recent open pilot trials have consequently shown that removal of circulating antibodies by immunoadsorption induces improvement of cardiac function and decreases myocardial inflammation. These autoantibodies mainly belong to immunoglobulin G subclass 3 (IgG3). The performance achieved by the use of anti-Ig immunoadsorbents is efficacious enough to remove IgG3 and the rest of the immunoglobulin subtypes. IA is a safe and well tolerated therapeutic option for dilated cardiomyopathy patients.
Small cell lung cancer (SCLC) is considered as high-risk metastatic disease potential at the time... more Small cell lung cancer (SCLC) is considered as high-risk metastatic disease potential at the time of diagnosis, and combined modality therapy with chemotherapy and thoracic external beam irradiation (EBRT) is the treatment of choice. Surgery for patients with SCLC could probably be reserved for stage I disease. Patients with more advanced SCLC are not considered to be surgical candidates and
Journal of the American Academy of Dermatology, 1995
The frequency of skin cancer in organ transplant recipients is high, up to 15%. Our purpose was t... more The frequency of skin cancer in organ transplant recipients is high, up to 15%. Our purpose was to determine the incidence of skin cancer in patients who underwent immunosuppression after heart transplantation and to determine the factors important in the appearance of skin cancer. We studied the frequency of skin cancer in 92 of 111 patients after they underwent heart transplantation between January 1984 and December 1993. At least one cutaneous neoplasm (squamous cell carcinoma and/or basal cell carcinoma) developed in 14 patients (15.2%). The basal cell carcinoma to squamous cell carcinoma ratio was 1:1.5. The skin cancer appeared an average of 31.5 months after transplantation; the average was 36 months for squamous cell carcinoma and 25.3 months for basal cell carcinoma. Cumulative risk rose from 4.3% at 1 year up to 43.8% at 7 years after transplantation. The overall incidence of both types of skin cancer was 45.3 per 1000 posttransplant person-years, with an incidence of 25.8 for basal cell carcinoma and 29.1 for squamous cell carcinoma. Most skin cancers developed between 2 and 3 years after transplantation. All patients were exposed to a significant amount of ultraviolet radiation and had skin type II or III. We did not find a significant association between skin cancer and haplotype HLA-A3, HLA-A11, HLA-DR, and the number of mismatches for HLA-B. We found an increased progressive cumulative incidence of skin cancer in heart transplant recipients for two reasons: (1) immunosuppression and increased exposure to ultraviolet radiation in some patients, and (2) the skin type of certain patients. We emphasize the need for photoprotection in this group of patients and regular skin cancer screening examinations.
The Journal of Thoracic and Cardiovascular Surgery, 2006
The left ventricular ejection fraction improved from 35.5% ± 2.3% (mean ± SEM) before surgery to ... more The left ventricular ejection fraction improved from 35.5% ± 2.3% (mean ± SEM) before surgery to 55.1% ± 8.2% at 12 months (P < .01) in the myoblast group and from 33.6% ± 9.3% to 38.6% ± 11% in the control group. Regional contractility also improved in the myoblast ...
... Aortitis activa aislada (idiopática) en aneurismas de aorta ascendente: una vasculitis escasa... more ... Aortitis activa aislada (idiopática) en aneurismas de aorta ascendente: una vasculitis escasamente reconocida. Jose Fernando Val-Bernal a , Corresponding author contact information , E-mail the corresponding ... Ambas eran hipertensas y una de ellas era una gran fumadora. ...
Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvan... more Sixty-two patients with stage III non-small cell lung cancer (NSCLC) were treated with neoadjuvant chemotherapy consisting of cisplatin 120 mg/m2 day 1, mitomycin 8 mg/m2 day 1, and vindesine 3 mg/m2 days 1 and 14. Each cycle was repeated every 4 weeks for a total of 1 to 6 cycles (median, 3 cycles). Resection was attempted 4 to 5 weeks after the last course of chemotherapy. Intraoperative radiation therapy (IORT) (10-15 Gy) was delivered during surgery and postoperative external beam radiotherapy (EBRT) (46 Gy) was begun 4 weeks after surgery. Fifty-five patients (25 IIIA, 30 IIIB) were evaluable. Only partial responses occurred (64%), and 29 patients (53%) underwent resection. Complete resection rates were 85% (12/14) and 40% (6/15) in stage IIIA and IIIB, respectively (p = 0.01). In 3 of 29 patients (10%), no tumor was found in the resected specimen. There was one chemotherapy-related death and three postoperative-related deaths. The median survival time was 10 months, and the 5-year survival rate was 29 and 7% for stage IIIA and stage IIIB, respectively (p = 0.3). High complete resection rates and modest increase in 5-year survival have been observed in stage IIIA NSCLC. Although a number of stage IIIB patients can be made technically resectable, the low complete resectability rate reflects the lack of survival benefit in these patients.
From January 1988 to August 1992, 18 patients (pts) with the established diagnosis of non-small c... more From January 1988 to August 1992, 18 patients (pts) with the established diagnosis of non-small cell lung cancer of the superior sulcus have been treated with a multidisciplinary approach, which includes 1-3 cycles of neoadjuvant chemotherapy (MVP or MCP regimens) followed by simultaneous preoperative chemotherapy and external beam irradiation. Radical surgery plus intraoperative radiotherapy (IORT) was planned 4-5 weeks after the end of the preoperative protocol. Tumor stages were IIIA (9 pts) and IIIB (9 pts). Tumor characteristics included rib and vertebral involvement in 15 and 4 pts, respectively. Fatal toxicity was present in 3 pts (16.6%). Resectability rate was 76.4%. Pathologic findings disclosed complete response (pT0) in 70.5% of the surgical specimens and viable tumor (pT+) in 29.5%. With a median follow-up of 24+ months (2-52+), 4-year actuarial local control, and overall survival rates are 91% and 56.2%, respectively. Four-year actuarial overall survival according to pathologic response was 87.5% for pT0 patients and 20% for pT+ patients. We conclude that this regimen promotes a high rate of pT0 as well as better than expected local control and survival rates. The presence of a pT0 specimen seems to correlate with the patient outcome.
Heart failure currently constitutes one of the greatest health problems in the Western world. Its... more Heart failure currently constitutes one of the greatest health problems in the Western world. Its incidence, far from diminishing or even remaining stable, is actually still increasing in association with the aging of the population and its lifestyle. A better knowledge of physiopathological mechanisms has allowed for the development of new therapeutic focal points and lines of research. Nevertheless, its treatment is complex and encompasses a multidisciplinary approach. Patients in an advanced stage still have a very high mortality rate in spite of receiving optimum medical care. The development of new therapeutic techniques that afford a better prognosis has therefore been essential. Of these, and leaving aside surgical treatments, myocardial regeneration by means of cellular therapy, new concepts in tissue engineering and their results, and the applications of new advances in the field of immunomodulation have all recently experienced development. In this article, the aim is to bring the latest concepts in the physiopathology and humoral response of cardiac failure up to date as well as doing the same with the therapeutic approaches in this area.
ABSTRACT Introduction Takayasu disease is a rare form of chronic non-specific large vessel vascul... more ABSTRACT Introduction Takayasu disease is a rare form of chronic non-specific large vessel vasculitis of unknown etiology. It usually affects young adults, and can be fatal in children. The first reported case is presented of ventricular assistance followed by heart transplant in a patient with Takayasu disease. Objectives The case is presented of 15 year old child who presented with chest pain and clinical signs of cardiac failure. His electrocardiogram showed ST-segment elevation in V1-V4, and he was referred for coronariography due to suspicion of acute coronary artery disease. The left main coronary artery was of small caliber and exhibited stenosis in the middle segment. The anterior descendent artery showed a thrombotic occlusion at the proximal segment, and there was a critical lesion in the circumflex branch. There was an interruption of the infrarenal abdominal aorta and common and external iliac arteries. Due to the critical situation of the patient, he was referred to urgent surgical intervention and a double bypass graft was performed without noticing any improvement in the cardiac function. A left ventricular assistance device was therefore implanted. Seventy-two hours later an orthotopic heart transplant was performed. The progress was excellent and the patient was discharged 39 days later. Histopathology studies revealed a chronic arteritis in the coronary arteries and ascending aorta, and a massive left ventricular infarction. Conclusions In a rare disease like Takayasu disease, a clear multidisciplinary and coordinated strategy is needed in order to achieve a successful therapeutic outcome.
ABSTRACT Cardiac regeneration requires a complex cascade of events. There are many factors, most ... more ABSTRACT Cardiac regeneration requires a complex cascade of events. There are many factors, most of them still no clarified, that limit the effectiveness of the stem cell therapy and their translation to the clinic. Cells should graft, survive and functionally integrate to the target organ in order to have a chance to restore its function. As in original tissues, a complex and well defined set of signals, many of them coming from the extracellular matrix, is required for normal cell physiology. The idea of combining principles from cell biology and engineering of biocompatible materials in order to create biologic replacement structures that restore, maintain, or improve tissue function, is at the basis of the tissue engineering and defines a different approach to the cardiac regeneration. Research and development of bioartificial myocardium is of great clinical interest. The rationale for the use of specific biomaterials is to allow the creation of a microatmosphere where the exogenous and endogenous cells find the microenvironment optimal for repair. Biomaterials science gives us important tools to build this extracellular matrix. Functionalized 3D systems can provide the correct environment and act as a delivery system for cells and genes, guiding the therapeutic cells to the functional phenotype. Organ decellularization for bioscaffolds fabrication is a new investigated concept. nanomaterials are emerging as the main candidates to ensure the achievement of a proper instructive cellular niche with good drug release/ administration properties.
ABSTRACT The appearance of functional mitral valve insufficiency in the setting of ischemic or di... more ABSTRACT The appearance of functional mitral valve insufficiency in the setting of ischemic or dilated cardiomyopathy is an indicator of bad prognosis, with increased early and mid-term mortality and morbidity and with a significant decrease in life expectancy. In these patients, the mitral valve is anatomically normal, without organic lesions, and this is why the mechanism of valve regurgitation is complex and can be explained by the changes in the left ventricle geometry. Ischemic cardiomyopathy produces left ventricle remodeling, with increased sphericity and displacement of both papillary muscles. All of these phenomena cause valve leaflet tethering, especially in the posterior leaflet. At present, surgical treatment is the only therapeutic option for these patients in order to treat mitral regurgitation. Diverse surgical strategies have been designed to repair mitral regurgitation and to restore left ventricular geometry. However, at present there is not a definitive surgical solution that can be considered the “gold standard”.
ABSTRACT Epidemiologic studies suggest that the prevalence of heart failure will rise in aging po... more ABSTRACT Epidemiologic studies suggest that the prevalence of heart failure will rise in aging populations, being now recognized as a major and escalating public health problem. It is estimated that health-care expenditure in developed countries consumes 1–2% of the total healthcare budget. Medicine today is seeing very rapid development of new technologies for the prevention, treatment and diagnosis of this disease. Given this trend there is also a risk that demand for care will exceed its supply, because resources in health care are limited. There-fore government, health insurers, and health care providers explore new opportunities for improving effectiveness and efficiency of CHF care. Decision-makers in the health service and health care professionals have to make choices and define strategies on the basis of criteria of safety, efficacy and benefit. Economic evaluations is an important tool in the evaluation of competing healthcare interventions. Economic evaluation aims at offering structured information about the balance between costs and effects of a intervention in comparison to another intervention. Four basic types of economic evaluation studies exist: cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. In deciding which types of evaluation should be used in the analysis, the aim of the analysis is determinative. A new cost-effectiveness analysis will be carried out using a decision analytic model, and the evaluation will be constrained by available evidence. If possible, the incremental cost-effectiveness will be estimated in terms of cost per qAly gained, in addition with the incremental cost-effectiveness ratios (ICERs).
ABSTRACT Stem cell therapy, as a strategy to regenerate injured tissues, has emerged as one of th... more ABSTRACT Stem cell therapy, as a strategy to regenerate injured tissues, has emerged as one of the most promising areas for the treatment of illnesses with low possibilities of treatment. The heart failure, mainly of ischemic ethiology, is one of the diseases that more can benefit from this therapeutic strategy. The aim is to regenerate the muscle, reduce apoptosis, increase the expression of the collagen and get an effective production of new vessels. This approach is undergoing with a variety of myogenic and angiogenic cells: skeletal myoblasts, mononuclear and mesenchymal bone marrow cells, circulating blood-derived progenitors, endometrial or adipose-derived stromal cells, mesothelial cells and induced pluripotent stem cells (iPS). The indications concern patients with ischemic cardiomyopathy, idiopathic dilated cardiomyopathies, Chagas heart disease, ischemic mitral regurgitation and diabetic cardiomyopathy. The approaches for cell delivery are surgical performing in the periinfarct area, intracoronary and endoventricular catheter-based cell delivery. The proposed mechanisms of action are reduction of the size and fibrosis of infarct scars, improvement of myocardial viability, limitation of ventricular remodeling, improvement of ventricular compliance and paracrine effects. However, the clinical results have reported only limited improvement in systolic function and remodeling. The development of strategies for improving cell survival and differentiation should be encouraged, such as preconditioning procedures with cell electrostimulation or by using tissue engineering in order to create a bioartificial myocardium.
ABSTRACT Chronic heart failure is one of the major health care issues. Heart transplantation is t... more ABSTRACT Chronic heart failure is one of the major health care issues. Heart transplantation is the approach for patients in class D. Furthermore, the disproportion between recipients and donnors restricts the number of cardiac transplants and has generated alternative treatments. The hypothesis of Torrent Guasp has achieved that the study of cardiac mechanical action to regain the importance it deserves. This hypothesis has led to revise classic concepts: myocardial band without fixed support points generating a three dimensional reduction. The objective of this article is emphasized the development of the therapeutic strategies designed to integrate biology, new medical technologies and the anatomical model of Torrent Guasp. This edition would like to be a reminder of the crucial contribution to cardiology by Torrent Guasp, in addition to his scientific and personal quality.
ABSTRACT Dilated cardiomyopathy is characterized by ventricular dilatation and progressive depres... more ABSTRACT Dilated cardiomyopathy is characterized by ventricular dilatation and progressive depression of myocardial contractile function. It is a multifactorial disease, on which several mechanisms may contribute to the pathophysiology of this process. Disturbances in both humoral and cellular immunity have been described among these patients. A number of antibodies against various cardiac cell proteins, mainly anti-β1-adrenergic and anti-m2 against acetylcholine, have been identified. Recent data indicate that these cardiac antibodies play an active role in the pathogenesis and may contribute to ventricular dysfunction of these patients. Therefore, removal of cardiac autoantibodies by immunoadsorption may induce hemodynamic improvement in dilated cardiomyopathy patients. Recent open pilot trials have consequently shown that removal of circulating antibodies by immunoadsorption induces improvement of cardiac function and decreases myocardial inflammation. These autoantibodies mainly belong to immunoglobulin G subclass 3 (IgG3). The performance achieved by the use of anti-Ig immunoadsorbents is efficacious enough to remove IgG3 and the rest of the immunoglobulin subtypes. IA is a safe and well tolerated therapeutic option for dilated cardiomyopathy patients.
Small cell lung cancer (SCLC) is considered as high-risk metastatic disease potential at the time... more Small cell lung cancer (SCLC) is considered as high-risk metastatic disease potential at the time of diagnosis, and combined modality therapy with chemotherapy and thoracic external beam irradiation (EBRT) is the treatment of choice. Surgery for patients with SCLC could probably be reserved for stage I disease. Patients with more advanced SCLC are not considered to be surgical candidates and
Journal of the American Academy of Dermatology, 1995
The frequency of skin cancer in organ transplant recipients is high, up to 15%. Our purpose was t... more The frequency of skin cancer in organ transplant recipients is high, up to 15%. Our purpose was to determine the incidence of skin cancer in patients who underwent immunosuppression after heart transplantation and to determine the factors important in the appearance of skin cancer. We studied the frequency of skin cancer in 92 of 111 patients after they underwent heart transplantation between January 1984 and December 1993. At least one cutaneous neoplasm (squamous cell carcinoma and/or basal cell carcinoma) developed in 14 patients (15.2%). The basal cell carcinoma to squamous cell carcinoma ratio was 1:1.5. The skin cancer appeared an average of 31.5 months after transplantation; the average was 36 months for squamous cell carcinoma and 25.3 months for basal cell carcinoma. Cumulative risk rose from 4.3% at 1 year up to 43.8% at 7 years after transplantation. The overall incidence of both types of skin cancer was 45.3 per 1000 posttransplant person-years, with an incidence of 25.8 for basal cell carcinoma and 29.1 for squamous cell carcinoma. Most skin cancers developed between 2 and 3 years after transplantation. All patients were exposed to a significant amount of ultraviolet radiation and had skin type II or III. We did not find a significant association between skin cancer and haplotype HLA-A3, HLA-A11, HLA-DR, and the number of mismatches for HLA-B. We found an increased progressive cumulative incidence of skin cancer in heart transplant recipients for two reasons: (1) immunosuppression and increased exposure to ultraviolet radiation in some patients, and (2) the skin type of certain patients. We emphasize the need for photoprotection in this group of patients and regular skin cancer screening examinations.
The Journal of Thoracic and Cardiovascular Surgery, 2006
The left ventricular ejection fraction improved from 35.5% ± 2.3% (mean ± SEM) before surgery to ... more The left ventricular ejection fraction improved from 35.5% ± 2.3% (mean ± SEM) before surgery to 55.1% ± 8.2% at 12 months (P < .01) in the myoblast group and from 33.6% ± 9.3% to 38.6% ± 11% in the control group. Regional contractility also improved in the myoblast ...
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Papers by Jesús Herreros