Francisco José Medina

Hospital Universitario de Getafe, Madrid, Madrid, Spain

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Publications (7)8.29 Total impact

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    ABSTRACT: C-reactive protein (CRP) is an independent risk factor for arteriosclerosis, but its role in abdominal aortic aneurysm (AAA) expansion remains not completely verified. There are no data about the prognostic significance of rates of variation of the CRP levels in asymptomatic AAAs. This study investigated the association between plasma CRP levels and AAA diameter and assessed the relationship between the gradient of CRP levels and rates of expansion in asymptomatic AAAs. Plasma levels of high-sensitive CRP (hs-CRP) were measured using a high-sensitivity technique and AAA size was determined by computed tomography in 435 patients with asymptomatic AAAs followed up in our outpatient department. The median hs-CRP level was 4.23 mg/L. The aorta diameter increased in the four groups of patients determined according to hs-CRP quartiles (35 ± 2, 40 ± 3, 49 ± 4, and 58 ± 5 mm; P = .01). The median rate of CRP level variation per year was 1.4 mg/L. Patients with an elevation >1.4 mg/L had an expansion rate of 4.8 mm vs 3.9 mm in those <1.4 mg/L (P < .01). The multivariate age-adjusted logistic model confirmed initial diameter and variation of CRP level were the only factors associated with expansion, with odds ratios (95% confidence intervals) of 6.3 (3.1-7.5) and 3.4 (2.1-5.6). These results confirm a statistical association between AAA diameter and hs-CRP plasma levels. This cohort study corroborates this potential causal association and contributes information about the value of the hs-CRP plasma level gradient as a marker of disease progression and rate of expansion.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 05/2012; 56(1):45-52. · 3.52 Impact Factor
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    ABSTRACT: Flow-mediated dilation of the brachial artery (FMDB) indirectly reflects the action of nitric oxide liberated by the endothelium. In patients with abdominal aortic aneurysms (AAA), the changes in nitric oxide metabolism in close association with inflammation, appear to play a leading role in the aetiopathology of this disease, although it is still not clear. The objective was to study the correlation and behavior of FMDB relative to the aneurysm diameter (AD). To evaluate the relationship between C-reactive protein (CRP) and the FMDB in these patients. To study the correlation and behavior of FMDB relative to the aneurysm diameter (AD). To evaluate the relationship between C-reactive protein (CRP) and the FMDB in these patients. The FMDB value and the CRP were determined in a total of 30 patients with an AAA > or =30 mm, confirmed by computed tomography. The cardiovascular and treatment history was recorded, together with the lipid and renal profile and leucocyte count. The median AD in the sample was 43 mm (25 percentile: 37 mm; 75 percentile: 60 mm). The primary variables of the study, FMDB and CRP, were the only ones that differed statistically when we stratified the sample according to AD quartiles (p < 0.001). There was a negative correlation between the FMDB and the AD (R = -0.78 [p < 0.001]) and a positive one for CRP (0.74 [p < 0.001]). The CRP/FMDB gave an R value of -0.56 (p = 0.001). Endothelium dependent vasodilation has a linear and negative correlation with the AD. The positive correlation between the FMDB and CRP supports the hypothesis that inflammation and endothelial dysfunction are processes associated with the physiopathology of AAA and vary with their growth.
    Annals of Vascular Surgery 08/2010; 24(6):752-7. · 0.99 Impact Factor
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    ABSTRACT: Objectif La dilatation médiée par le flux de l’artère brachiale (FMBD) reflète indirectement l’action du monoxyde d’azote libéré par l’endothélium. Chez les patients ayant un anévrysme de l’aorte abdominale (AAA), les modifications du métabolisme du monoxyde d’azote sont en rapport étroit avec l’inflammation, et jouent un rôle primordial mais encore peu connu dans l’étiopathologie de cette maladie. L’objectif était d’évaluer la relation entre la protéine C réactive (CRP) et la FMBD chez ces patients, et d’étudier la corrélation et le comportement de la FMBD par rapport au diamètre anévrysmal (DA). Méthodes les valeurs de la FMBD et de la CRP ont été déterminées chez un total de 30 patients avec un AAA ≥ 30mm, confirmé par tomodensitométrie. Les antécédents cardiovasculaires et les traitements ont été pris en compte, ainsi que le taux de lipides, la fonction rénale et le nombre de leucocytes. Résultats Le DA médian dans notre échantillon était de 43 mm (25ème percentile : 37 mm ; 75ème : 60 mm). Les variables primaires étudiées, FMBD et CRP, ont été les seules qui ont montrés une différence significative lorsque l’on a classé l’échantillon en quartiles de DA (p < 0,001). Il y avait une corrélation négative entre la FMBD et le DA (R = −0,78 [p < 0,001]) mais une corrélation positive avec la CRP (0,74 [p < 0,001]). Le rapport CRP/FMDB donne une valeur R de −0,56 (p = 0,001). Conclusion La vasodilatation endothélium-dépendante a une corrélation négative et linéaire avec le DA. La corrélation positive entre la FMDB et la CRP supporte l’hypothèse que l’inflammation et la dysfonction endothéliale sont des éléments associés à la physiopathologie des AAA et varient avec leur croissance.
    Annales De Chirurgie Vasculaire. 01/2010; 24(6):820-825.
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    ABSTRACT: To determine whether the increase in plasma levels of C-Reactive Protein (CRP), a non-specific reactant in the acute-phase of systemic inflammation, is associated with clinical severity of peripheral arterial disease (PAD). This is a cross-sectional study at a referral hospital center of institutional practice in Madrid, Spain. A stratified random sampling was done over a population of 3370 patients with symptomatic PAD from the outpatient vascular laboratory database in 2007 in the order of their clinical severity: the first group of patients with mild chronological clinical severity who did not require surgical revascularization, the second group consisted of patients with moderate clinical severity who had only undergone only one surgical revascularization procedure and the third group consisted of patients who were severely affected and had undergone two or more surgical revascularization procedures of the lower extremities in different areas or needed late re-interventions. The Neyman affixation was used to calculate the sample size with a fixed relative error of 0.1. A homogeneity analysis between groups and a unifactorial analysis of comparison of medians for CRP was done. The groups were homogeneous for age, smoking status, Arterial Hypertension HTA, diabetes mellitus, dyslipemia, homocysteinemia and specific markers of inflammation. In the unifactorial analysis of multiple comparisons of medians according to Scheffé, it was observed that the median values of CRP plasma levels were increased in association with higher clinical severity of PAD (3.81 mg/L [2.14-5.48] vs. 8.33 [4.38-9.19] vs. 12.83 [9.5-14.16]; p < 0.05) as a unique factor of tested ones. Plasma levels of CRP are associated with not only the presence of atherosclerosis but also with its chronological clinical severity.
    Clinical Medicine: Cardiology 01/2009; 3:1-7.
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    ABSTRACT: To evaluate the relationship between C-Reactive Protein (hsCRP), a serum marker of inflammation, and endothelial dysfunction in patients with intermittent claudication. Cross-sectional study with stratified sampling on dependent variables of age, genre, hypertension, hyperlipidemia, diabetes, smoking status and ankle-brachial index (ABI) to select 156 patients from a target population of 4,100 patients with claudication. We assessed the flow-mediated arterial dilation (FMAD) as a reporter of endothelial function and plasma levels of hsCRP and fibrinogen. Patients with a FMAD<3% (range for the lowest 5% of healthy subjects) had increased levels of plasma hsCRP (6.3 vs 2.3mg/L; p<0.05) and fibrinogen (351vs 302mg/L; p<0.05) in comparison to those with FMAD>3%. There was a negative correlation between hsCRP and FMAD(r=-0.465; p<0.05). Impaired endothelial dysfunction is association with increased plasma concentrations of inflammatory markers, and both may have a role in the aetiopathogenesis of peripheral arterial disease.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 05/2008; 35(4):480-6. · 2.92 Impact Factor
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    ABSTRACT: We performed a systematic review of the literature on the diagnosis and treatment of secondary aortoenteric fistulas (AEF). A MEDLINE search was performed of articles published in English or Spanish between January 1991 and August 2006. Diagnostic methods, treatment modalities and the results of surgical treatment were analyzed. The most frequent first aortic surgery associated with AEF was repair of abdominal aortic aneurysm (54.31%). The most common form of presentation was gastrointestinal bleeding. Repair through in situ prosthetic replacement had the lowest early mortality rates (8-13.3%) compared with graft excision and extraanatomic revascularization (18.2-44%). AEF is a serious entity and diagnosis requires a high index of suspicion based on clinical findings and indirect data from imaging techniques (computed tomography). The most appropriate therapeutic option continues to be controversial.
    Cirugía Española 01/2008; 82(6):321-7. · 0.87 Impact Factor
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    ABSTRACT: We performed a systematic review of the literature on the diagnosis and treatment of secondary aortoenteric fistulas (AEF). A MEDLINE search was performed of articles published in English or Spanish between January 1991 and August 2006. Diagnostic methods, treatment modalities and the results of surgical treatment were analyzed. The most frequent first aortic surgery associated with AEF was repair of abdominal aortic aneurysm (54.31%).The most common form of presentation was gastrointestinal bleeding. Repair through in situ prosthetic replacement had the lowest early mortality rates (8-13.3%) compared with graft excision and extraanatomic revascularization (18.2-44%). AEF is a serious entity and diagnosis requires a high index of suspicion based on clinical findings and indirect data from imaging techniques (computed tomography). The most appropriate therapeutic option continues to be controversial.
    Cirugia Espanola - CIR ESPAN. 01/2007; 82(6):321-327.