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R Aller

Publications and source records attributed to R Aller.

At least 55 records · Page 3Linked to original sources
PubMed2001

Disturbed synthesis of insulinlike growth factor I and its binding proteins may influence renal function changes in liver cirrhosis.

Insulinlike growth factor-1 (IGF-1) is an anabolic hormone synthesized by the liver upon stimulation by growth hormone (GH). IGF-1 exerts important effects on renal hemodynamics and renal sodium handling. The bioactivity of this hormone is influenced by its binding proteins (BP) of which IGF-BP3 favors retention in the capillary lumen while IGF-BP1 facilitates the transport to the target tissues. IGF-BP1 modulates the actions of IGF-1 on target cells including renal tubules. Although a number of reports have dealt with disturbances of the IGF-1/IGF-BP system in cirrhosis, no studies have yet addressed the relationship between alterations in this system and renal function changes in cirrhosis. In the present study we have included 20 patients with cirrhosis and 10 healthy subjects (control group). As compared with the controls, patients showed lower circulating levels of IGF-1 and IGF-BP3, higher IGF-BP1 levels, and a tendency to higher insulinemia and GH values. The index IGF-1 x IGF-BP1/IGF-BP3 (IGF-1-IGF-BP index, reflecting the accessibility of circulating IGF-1 to target cells) was higher in patients with ascites. IGF-1 directly correlated with renal blood flow (P < 0.05), with IGF-BP3 (P < 0.001) and inversely with the Pugh's score (P < 0.02). A negative correlation was found between IGF-1-IGF-BP index and fractional sodium excretion (P < 0.01) and between IGF-BP1 and urinary sodium excretion (P < 0.02). Our findings support the hypothesis that the disturbance of the IGF-1/IGF-BP axis may be related to the degree of renal vasodilation and renal sodium retention in cirrhotic patients.

Female↗
PubMed2001

Nutritional treatment for acquired immunodeficiency virus infection using an enterotropic peptide-based formula enriched with n-3 fatty acids: a randomized prospective trial.

OBJECTIVE: Dietary counseling and intervention based on application of conventional criteria have been ineffective in preventing the progressive weight loss associated with HIV infection. The aim of the study was to compare the progression of clinical and nutritional indicators during nutritional supplementation with or without an enterotropic peptide-based formula enriched with n-3 fatty acids. DESIGN: Randomized trial. SETTING: Tertiary care. SUBJECTS: Ninety-one patients were screened for the study. Twenty-three did not meet the inclusion criteria, therefore 74 patients were randomized. Of these, 38 were randomized to group I (standard formula) and 36 were randomized to group II supplementation (enterotropic peptide-based formula enriched with n-3 fatty acids). INTERVENTIONS: Group I received standard enteral formula and group II received a enterotropic peptide-based enteral formula. The volume was the same (3 cans/day, 236 ml per can). In both groups enteral supplementation were recommended in conjunction with a registered dietitian under a dietary counseling program based on standard nutrition principles. Patients received a prospective serial assessment of nutrition status, nutritional intake with 24 h written food records, GI symptoms, immune function, anthropometric status and intercurrent health events including infections and hospitalization. These determinations were performed at baseline and at 3 months. RESULTS: Treatment with both supplements resulted in a significant and sustained increase in weight (3.2% in group I and 3.1% in group II); this increase was mostly due to fat mass (12.8% in group I) and (7.5% in group II). Total body water and fat free-mass remained unchanged. CD4 counts remained stable in group I, while a significant increase was detected in group II (576+/-403 vs 642+/-394 cells/mm(3); P<0.05). After the 3 month period CD4 counts remained higher in group II. Hospitalization events (infections) were also followed during the 3 month period. Group II had fewer hospitalizations than group I, but no statistical differences were found. CONCLUSIONS: Oral nutritional supplements for a 3 month period were well tolerated and resulted in body weight gain in HIV-infected patients. Supplement-enriched formula, with peptides and n-3 fatty acids, increased CD4 count.

Adolescent↗
PubMed2001

[Anabolic steroids and gynecomastia. Review of the literature].

Gynaecomastia is a common situation, with a proliferation of glandular component of male breast secondary to an imbalance in sexual hormones in mammary tissue. A main cause of gynaecomastia is anabolic steroids consumption. Few studies have been performed in patients with high consumption of anabolic steroids, showing a high prevalence (52%). In this article we present a case of bilateral gynaecomastia secondary to anabolic steroids intake, with a partial response to tamoxifen. In summary, a patient with sportive habits and gynaecomastia, an early suspicious diagnosis is anabolic steroid intake. After suppression of anabolic steroid intake and treatment with tamoxifen, a high remission rate can be achieved. If gynaecomastia persisted, surgery is a good option.

Adult↗
PubMed2001

[Nutritional status in HIV infected patients].

OBJECTIVES: Nutritional assessment in HIV infected patients must be a main objective in the treatment of this disease. The main objective of our work was to study the nutritional status with biochemical and anthropometrical parameters in a group of HIV infected patients. MATERIAL AND METHODS: A total of 119 patients were evaluated. In all patients the next parameters were assessed: age, sex, treatment with anti-retroviral drugs, performed an anthropometric evaluation (weight, height, tricipital skinfold, arm circumference, arm muscular circumference and body mass index) and biochemical evaluation (albumin, prealbumin, transferrin, total proteins, triglycerides, cholesterol, lymphocytes and count of CD4). RESULTS: Patients had an average age 37.9 +/- 9.9 years, weight 64.5 +/- 13.2 kg and body mass index 22.5 +/- 3.5. The values of total proteins, albumin, prealbumin y transferrin were all normal, only patients with AIDS had low levels of transferrin (262.5 +/- 49.2 mg/dl vs 277.8 +/- 87.5; p < 0.05). Percentil distribution of anthropometric parameters showed a deep depletion in muscular protein compartment, 53.1% of patients had skinfold under P 50, 91.8% had arm circumference under P 50, and 91.8% arm muscular circumference under P 50. High levels of triglycerides were detected in 30.5%, these levels are related with the HIV phase and the number of antiretroviral drugs. CONCLUSION: Nutritional status in HIV infected patients is good in our population, only a deep depletion in muscular proteic compartment was detected. Transferrin was decreased in AIDS patients. High levels of triglycerides were secondary to the number of antiretroviral drug taking by patients.

Adult↗
PubMed2000

Effect of cerivastatin on serum cholesterol levels in patients with type 2 diabetes mellitus.

The incidence of coronary heart disease (CHD) is greatly increased in overweight diabetic patients. Modification of dietary intake and weight loss improve hypercholesterolaemia. However, cholesterol goal levels are not achieved in several patients under this treatment. The aim of our study was to evaluate the effect of Cerivastatin, an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A reductase, in patients with type 2 diabetes mellitus. A population of 40 diabetic type 2 outpatients were analyzed in a prospective way. The mean+/-SD age was 60.7+/-11.6 years, with a diabetes duration of 8.5+/-6.6 years. All patients were treated with cerivastatin (0.2 mg once a day) for 6 months. Weight HbAlc fasting blood glucose, urine microalbuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were measured at the beginning of the study and again after 3 and 6 months of treatment with cerivastatin. An improvement in lipid levels was achieved, with a significant decrease in LDL-cholesterol (27.7%), total cholesterol (21.4%), triglycerides levels (10.4%) and a significant increase in HDL-cholesterol levels (8.3%) (P<0.05). Cardiovascular risk ratios such as; total cholesterol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol improved during treatment, decreasing 11.3% and 30%, respectively (P<0.05). Low incidence of side effects was demonstrated. In summary, cerivastatin improved lipid control in patients with type 2 diabetes, with a low incidence of side effects.

Aged↗
PubMed2000

Hematology analyzers.

Explore the source record for details and available documents.

Clinical Laboratory Information Systems↗
PubMed1999

[Helicobacter pylori and digestive hemorrhage due to duodenal ulcer: the prevalence of the infection, the efficacy of 3 triple therapies and the role of eradication in preventing a hemorrhagic recurrence].

BACKGROUND: To report the prevalence of Helicobacter pylori in patients with bleeding duodenal ulcer and to verify the effect of eradication on hemorrhage recurrence. To evaluate the efficacy on H. pylori eradication and on ulcer healing of three one-week triple therapies and to compare their efficacy with that of a dual therapy. PATIENTS AND METHODS: One-hundred and eleven patients with bleeding duodenal ulcer not taking gastroerosive drugs were prospectively studied. At endoscopy, biopsies from gastric antrum and body were obtained (haematoxylin-eosin), and a 13C-urea breath test was also performed. Both diagnostic methods were repeated one month after completing one of the following treatments (randomized study): omeprazole (20 mg/12 h), amoxycillin (1 g/12 h) and clarithromycin (500 mg/12 h) (OAC, n = 27); omeprazole (20 mg/12 h), clarithromycin (500 mg/12 h) and metronidazole (500 mg/12 h) (OCM, n = 27); lansoprazole (30 mg/12 h), amoxycillin (1 g/12 h) and clarithromycin (500 mg/12 h) (LAC, n = 27); and lansoprazole (30 mg/12 h) and clarithromycin (500 mg/8 h) (LC, n = 27). The first three therapies were administered for one week, and LC for two weeks. Once eradication was confirmed no antisecretory therapy was administered. A breath test was performed in the follow-up at 6 months and at one year. RESULTS: The prevalence of H. pylori infection was 97.3% (95% CI: 92-99%). Five patients were lost from the study during follow-up. The eradication efficacy (intention-to-treat) was: OAC, 89% (72-96%); OCM: 93% (77-98%); LAC, 93% (77-98%), and LC, 70% (51-84%). Overall triple therapy efficacy was higher than that of dual therapy (91% vs 70%; p < 0.05). Thirteen patients needed a 2nd or 3rd therapy, and eradication success was finally achieved in all cases. The type of therapy was the only variable which influenced on H. pylori eradication (OR: 4.5; 95% CI: 1.4-14%; p < 0.01) and H. pylori eradication was the only variable which influenced on ulcer healing (OR: 4.7; 95% CI: 1.2-19%; p < 0.05). The yearly reinfection rate was 2.8% (0.9-7.8%). No hemorrhage recurrences occurred during the one year follow-up period. CONCLUSIONS: H. pylori prevalence in bleeding doudenal ulcer is almost 100%. These patients will be spared of hemorrhage recurrence at least for one year if infection is eradicated. Therefore, eradication therapy is the therapy of choice, and maintenance therapy with antisecretory drugs is no longer needed. One-week triple therapies with a proton pump inhibitor and two antibiotics (clarithromycin plus amoxycillin or metronidazole) have a high efficacy in patients with bleeding duodenal ulcer.

Anti-Bacterial Agents↗
PubMed1999

Diagnosis and grading of intrapulmonary vascular dilatation in cirrhotic patients with contrast transesophageal echocardiography.

BACKGROUND/AIMS: The use of transesophageal contrast echocardiography (TOCE) in the diagnosis of intrapulmonary vascular dilatation (IVD) and hepatopulmonary syndrome (HPS) needs to be studied. We tested the specificity of TOCE using traditional criteria and the value of a new method based on TOCE, a grading scale and a selected contrast. METHODS: 1) Several solutions were tested and two were selected: 20% mannitol and 0.9% saline. 2) 71 cirrhotic patients and 20 controls were studied. Left atrium opacification with contrast was classified into 6 degrees by TOCE. Mild and significant IVD were considered in relation to results in controls. Patients were studied with saline and mannitol-TOCE. Results were compared to transthoracic contrast echocardiography (TTCE), to gas exchange abnormalities and to Child class. RESULTS: The reproducibility of TOCE grading was excellent, (Kappa >0.9). IVD detection using TTCE, mannitol-TOCE and saline-TOCE was 29.5%, 55% (25% mild and 30% significant), and 45% (38% mild and 7% significant), respectively. The best agreement with TTCE (reference method) was obtained with mannitol-TOCE, using significant IVD as the cut point. By this criterion, 18% reached the criteria of HPS using TTCE and 22% using mannitol-TOCE. Patients with IVD by TTCE had non-significant changes in gas exchange determinations. Patients with significant IVD by saline TOCE had lower mean PaO2 levels (67.3+/-14 vs. 79.5+/-11 mm Hg, p<0.05) than patients without IVD. Patients with significant IVD by mannitol TOCE had higher mean AaPO2 (29.3+/-14 vs. 19.7+/-9 mm Hg; p<0.005) and lower mean PaCO2 levels (30.1+/-4.4 vs. 33.4+/-4.8 mm Hg; p<0.05) than patients without IVD. Severity of IVD by TOCE correlated to Child class (r = 0.43; p<0.001). CONCLUSIONS: The presence of contrast in the left atrium cannot be a criterion of IVD when TOCE is used. Our semi-quantitative scale has proved to be feasible and reproducible, presenting a good agreement with TTCE, and has shown better correlation with gas exchange abnormalities and Child class. Saline TOCE appears to be more specific in the detection of hypoxemic patients with IVD, but mannitol TOCE adds sensitivity.

Adult↗
PubMed1999

Improvement in lipid and haemostasis patterns after Helicobacter pylori infection eradication in type 1 diabetic patients.

Helicobacter pylori has been implicated in the cardiovascular risk of diabetic patients. The aim of our study was to investigate whether the Helicobacter pylori infection plays a role in the lipid and haemostasis patterns of type 1 diabetic patients. Twenty nine patients with type 1 diabetes mellitus and H. pylori infection were enrolled (Chlamydia pneumoniae negative). The H. pylori infection status was assessed by serology and urease breath test. In all patients levels of total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol, lipoprotein (a) (Lpa) C reactive protein (CRP), fibrinogen, thrombin/antithrombin III complex (TAT), plasminogen activator inhibitor type 1(PAI-1), tissue plasminogen activator (t-PA) and von Willebrand antigen were measured. All patients were evaluated before and after H. pylori eradicating treatment with amoxicillin, clarithromycin and omeprazole. Twenty two patients were eradicated and seven remained infected. In H. pylori eradicated patients, HDL cholesterol increased (59.7+/-18.9 mg/dl vs 65.2+/-15. 9 mg/dl, P << 0.05), after treatment. After H. pylori eradication, the levels of CRP and TAT decreased (48+/-0.7 ng/l vs 3.3+/-0.4 ng/l;P << 0.05), (27.7+/-44.7 microg/ml vs 2.1+/-1.4 microg/ml, P << 0.05), respectively. The decrease in TAT was higher in the group of H. pylori (+) patients with higher levels of TAT (TAT >> 20 ng/ml, 92.8+/-41.6 ng/ml vs 1.9+/-2.0 ng/ml, P << 0.005; TAT 4Eth 20 ng/ml; 10.1+/-5.2 ng/ml vs 2.2+/-0.6 ng/ml, P << 0.05). These changes did not occur in patients without H. pylori eradication. Eradication of H. pylori infection in type 1 diabetic patients modifies some parameters of lipid and haemostasis patterns, (increase of HDL-cholesterol, reduction of Lpa and decrease of CRP and TAT) and so contributes to improvement of cardiovascular risk factors in these patients.

Adult↗
PubMed1999

Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography.

The aim of this study was to study the prevalence of hepatopulmonary syndrome (HPS) in cirrhotic patients, comparing the results obtained using contrast transthoracic echocardiography (CTTE) and contrast transesophageal echocardiography (CTEE) in the demonstration and grading of pulmonary vasodilatation (PV). We also analyzed the correlation between gas-exchange abnormalities and PV when it was demonstrated with both techniques. The prevalence of PV and HPS with CTEE in the 88 cirrhotic patients was 28% and 22%, respectively, and with CTEE, 42% (P < 0.05) (middle PV: 35% and significant PV: 7%) and 30% (P < 0.05), respectively. Fifty-six percent of patients diagnosed with PV and with CTTE presented with hypoxemia as did 49% using CTEE (83% of patients with significant PV had hypoxaemia). PaCO2 and diffusing capacity of CO were significantly more decreased in patients with PV than in patients without PV when CTEE was employed. We conclude that CTEE is superior to CTTE in the diagnosis and grading of PV in the diagnosis of HPS in cirrhotic patients, being more sensitive and presenting a better correlation with gas-exchange abnormalities. Given its high sensitivity, CTEE should be carried out in all patients with suspicion of HPS and normal or uncertain CTTE.

Aged↗
PubMed1999

Collagenous colitis in Spain: a report of nine new cases.

BACKGROUND: collagenous colitis is a clinicopathological entity that causes chronic watery diarrhea. The patients are predominantly women in the sixth or seventh decade of life. Radiological and endoscopic studies are usually normal or nonspecific. It is diagnosed by the presence in colonic biopsies of a thickened subepithelial band of collagen and an inflammatory infiltrate in the mucosa. METHODS: 9 cases diagnosed in our hospital and 18 previously described in Spain have been reviewed. RESULTS: all the cases showed chronic watery diarrhea. In 17 patients symptoms were present since at least one year before diagnosis. Five of the 27 patients had been taking nonsteroidal antiinflammatory drugs. Rheumatological and autoimmune diseases were found in 6 patients. Colonoscopy was normal or showed nonspecific findings except in one of our patients, in which aphthous ulcers and pseudomembranes were found. Different treatments had been employed, including antidiarrheal agents, sulfasalazine, 5-ASA and omeprazole. CONCLUSIONS: collagenous colitis is uncommon but should be considered in patients with long-standing chronic watery, nonbloody diarrhea. Collagenous colitis is probably more common than we think, as biopsies are not usually taken in cases of chronic diarrhea with normal endoscopic findings.

Adult↗