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Biomedical subjects

R Aller

Publications and source records attributed to R Aller.

At least 91 records · Page 5Linked to original sources
PubMed1997

Spontaneous bacterial peritonitis: clinical study, microbiological findings and clinical course.

One hundred and forty-four episodes of spontaneous bacterial peritonitis (SBP) treated in our service between July 1988 and September 1995 were studied retrospectively to assess the clinical presentation, microbiological findings, possible pathogens, treatment and course. Ascites, abdominal pain and fever were the most common symptoms. Only 3.5% of cases were asymptomatic. The outcome was fatal in 12 (8.33%). Among the factors analyzed, only a prothrombin time of less than 35% correlated significantly with a higher mortality rate (60% and 8.33%, respectively; p < 0.01). Ascitic fluid culture was positive in 43.05% of cases; significant differences existed between these patients and those with negative ascitic fluid culture with respect to clinical findings or course. Gram-negative microorganisms were those most frequently isolated (48.38%). Treatment was initiated within 12 hours in 77.7% of the patients, between 12 and 72 hours in 11.8% and later in 10.41%. Intravenous cefotaxime was administered in 86.1% of cases and other drugs or drug combinations in only 13.9%; the mortality rate was much lower with cefotaxime (2.4% vs 45%; p < 0.01).

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PubMed1997

[Spontaneous peritonitis caused by ascitic fluid with Candida albicans].

Two cases are reported of spontaneous ascitic fluid Candida albicans peritonitis in two patients with liver cirrhosis secondary to HBV. In non of the two cases was there evidence of findings associated with secondary peritonitis, where ascitic fluid Candida infection has usually been reported.

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PubMed1996

[Helicobacter pylori, gastric ulcer and non-steroidal anti-inflammatory agents].

BACKGROUND: The aim of this study was to describe the prevalence of Helicobacter pylori infection in patients with gastric ulcer in addition to study its relationship with the ingestion of non steroid antiinflammatory drugs (NSAIDS). METHODS: One hundred sixty-one patients (mean age 54 years, 70% males) in whom gastric ulcer was endoscopically demonstrated were studied. Biopsies of the antrum and gastric body (hematoxillin-eosin, Gram staining and culture) were obtained during endoscopy. RESULTS: H. pylori was detected in 83% (CI = 78-89%) of the cases. In the patients not taking NSAIDS positivity was 87% (CI = 81-93%) while in those with NSAIDS this was only 63% (CI = 43-79%) (p = 0.008). The percentage of patients without H. pylori infection or NSAIDS intake represented 11% (CI = 6-16%). On multivariant analysis the only variable correlated with H. pylori infection was NSAIDS intake (OR = 0.25; CI = 0.09-0.66; chi 2 model = 7.27; p = 0.007) while the remaining variables (sex, age, smoking, alcohol and ulcer site) did not show a significant correlation. The percentage of chronic gastritis was higher (p < 0.001) in H. pylori positive patients in comparison with those who were uninfected (97% versus 67% in the antrum and 78% versus 41% in the gastric body). CONCLUSIONS: The prevalence of infection by Helicobacter pylori in patients with gastric ulcer is greater in those without non steroid antiinflammatory drug (NSAIDS) intake in comparison with those who have this history. The percentage of patients without H. pylori infection or NSAIDS ingestion was very low (11%), and thus it may be deduced that these elements represent pathogenic factors of major importance in gastric ulcer disease since the appearance of this entity in the absence of both is infrequent.

Adult↗
PubMed1996

Spontaneous bacterial peritonitis. Clinical and microbiological study of 233 episodes.

We made a retrospective study of 233 episodes of spontaneous bacterial peritonitis that were treated at our Service between January 1980 and September 1996 in order to analyze the clinical presentation, microbiological data, possible pathogenic factors, treatment, and evolution of this clinical entity. Ascites, abdominal pain, and fever were the most frequent symptoms. Only 3.43% of the episodes developed asymptomatically. Thirty-six episodes resulted in the patient's death (15.45%) and, of all the factors analyzed, only a prothrombin time of < 35%, bilirubin > 8 mg/dl, and serum creatinine > 2.1 mg/dl were statistically correlated with a higher death rate. The culture of the ascitic fluid gave a positive result in 47.6% of the cases, whereas no clinical differences were noticed between these patients and those with negative results. The most frequently isolated microorganisms turned out to be Gram negative (49.54%). A proportion of 71.24% of the episodes were treated with cephotaxime (i.v.), whereas 28.76% were treated with other drugs or pharmacological combinations. The death rate was much lower with cephotaxime (4.81% vs. 41.79%, p < 0.01%).

Abdominal Pain↗
PubMed1996

[Erradicating treatment of Helicobacter pylori with lansoprazole and amoxicillin in duodenal ulcer patients].

OBJECTIVE: To study the efficiency of the combination lansoprazole and amoxicillin on the eradication of Helicobacter pylori and duodenal ulcer healing. METHODS: Twenty-nine duodenal ulcer patients infected with H. pylori were prospectively studied (mean age, 46 +/- 11 years, 90% males). During endoscopy biopsies were obtained from gastric antrum and body for histologic examination (H & E); a urea breath test with 13C was also performed. Therapy with lansoprazole 30 mg/12 h and amoxicillin 500 mg/6 h for two weeks was prescribed. One month after completing therapy another endoscopy was performed (with biopsies obtained from gastric antrum and body) and again a urea breath test performed. Eradication was defined as the absence of H. pylori by both diagnostic methods. RESULTS: Eradication was achieved in 48% of patients (n = 14). Ulcer healing was obtained in 62% of cases (n = 18). When eradicating therapy was successful the percentage of healing reached 100%, versus 27% in those patients with persisting infection (p < 0.001). In patients with eradication obtained an histological improvement was noted both at gastric antrum and body, whereas when therapy failed no significant changes were observed. In all cases compliance with therapy was completed, and in no patient were secondary effects observed. CONCLUSION: The association of lansoprazole and amoxicillin at the administered doses has a low efficiency on H. pylori eradication in duodenal ulcer patients. Further studies are warranted to definitely assess the eradicating efficiency of such combination and also to determine the optimal dose of its components, the minimal duration of therapy and the ideal moment for its administration.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1993

A clinical laboratory information systems survey. A challenge for the decade.

In 1990, the College of American Pathologists Informatics Committee surveyed 14,785 laboratorians for their experiences with a clinical laboratory information system. A 16.25% response rate was achieved, representing 2402 questionnaires that were analyzed. Despite the perceived satisfaction of the clinical laboratory information system users with more expensive systems, no economy of scale was demonstrated with increasing system cost through either laboratory staff reduction or increased number of specimens per day. The strongest predictors of system satisfaction were (1) vendor success measured by number of installations and (2) a selection process that involved the pathologist/laboratory director and included a formal request for proposal. The need for integration of clinical laboratory information systems with hospital information systems, as well as the universal adoption of standard productivity terminology, including work load units, was evident.

Clinical Laboratory Information Systems↗
PubMedDate not supplied

The effect of liver transplantation on circulating levels of estradiol and progesterone in male patients: parallelism with hepatopulmonary syndrome and systemic hyperdynamic circulation improvement.

The correction of hepatopulmonary syndrome (HPS) after liver transplantation (LT) remains controversial. The aims of our study were to: 1) analyze whether LT reverses HPS; 2) note any relationship between HPS and the systemic hemodynamic disturbance; and 3) note changes in circulating sex hormones and the possible association with pulmonary and systemic hemodynamic changes. Systemic hemodynamic parameters, cardiac output and systemic vascular resistance (SVR), sex hormones, and intrapulmonary vasodilatation assessed by contrast transesophageal echocardiography, and gas exchange abnormalities were investigated in 19 patients with advanced cirrhosis prior to and 6 months (176.8+/-30 days) after LT. LT was followed by a marked reduction in cardiac output (6.6+/-1.7 vs 3.5+/-0.5 l/min; p<0.001) and SVR (1039+/-460 vs 1978+/-294 dyn x sec x cm(-5); p<0.005). Before LT, circulating estradiol and progesterone levels were invariably elevated (66+/-22 pg/ml and 1.8+/-1.1 ng/ml, respectively, normal values <31 pg/ml and 0.35 ng/ml, respectively), and dropped after LT (28+/-12 pg/ml p<0.001 and 0.38+/-0.2 ng/ml; p<0.001, respectively). Seventeen of 19 patients had intrapulmonary vasodilatation and increased alveolar-arterial oxygen difference, thereby fulfilling diagnostic criteria for HPS. Patients with HPS presented higher cardiac output (p<0.05), lower SVR (p<0.01), and higher progesterone and estradiol levels than patients without HPS (p<0.05). LT produced normalization of intrapulmonary vasodilatation in all patients. LT normalized hyperdynamic circulation and is a useful therapeutic option in patients with HPS. Normalization of sex hormone levels after LT suggests that they could play a pathogenic role in the development of HPS.

Blood Gas Analysis↗
PubMedDate not supplied

Total homocysteine levels relation with chronic complications of diabetes, body composition, and other cardiovascular risk factors in a population of patients with diabetes mellitus type 2.

OBJECTIVE: The significance of hyperhomocysteinemia in type 2 diabetes is further complicated by the multiple ways of considering impaired renal function and vitamin status. The aim of our study was to analyze the relationship between total homocysteine (tHcy) in a population of type 2 diabetic patients and chronic complications. We also analyzed the relationship between tHcy and the body composition of these patients and other cardiovascular risk factors. DESIGN: In a cross-sectional study, a total of 155 patients with diabetes mellitus attending in our diabetes service (90 females/65 males) were enrolled in a consecutive way. MATERIAL AND METHODS: All enrolled patients underwent the following examinations: (i) biochemical cardiovascular risk factors including total cholesterol, triglyceride, lipoprotein (a), low-density lipoprotein (LDL-cholesterol), high-density lipoprotein (HDL-cholesterol), glucose, HbA(1c), fibrinogen, homocysteine, vitamin B12, folate, and microalbuminuria; and (ii) fat mass assessed by body mass index, weight, percentage of fat mass, and tricipital skinfold. RESULTS: Patients were divided in two groups (Group I: tHcy> or =15 micromol/l; Group II: tHcy<15 micromol/l). Smoking habit was similar in both groups. A prevalence of cerebrovascular accident was present in 3.3% in the total group. This prevalence was not different in both groups (7.4% vs. 2.3%; ns) (OR 3.3; 95% CI 0.49-19.68). The prevalence of coronary heart disease in the total group was 5.8% without statistical differences between groups (3.5% vs. 6.3%; ns) (OR 0.57; 95% CI 0.065-4.53). Concerning macrovascular complications, only peripheral vascular disease prevalence was higher in Group I (16% vs. 3.1%; P<0.05; OR 5.33; 95% CI 1.18-21.5). A prevalence of nephropathy was higher in Group I (93.3% vs. 12.8%; P<0.05; OR 7.15; 95% CI 2.9-17.9). No statistical differences were detected in prevalence of retinopathy (global group 41.9%) (42.5% vs. 40.9%; ns) (OR 1.75; 95% CI 0.78-3.9). Also, peripheral neuropathy was similar in both groups (7.1% vs. 6.5%; ns) (OR 1.1; 95% CI 0.15-8.2). No correlation was detected among homocysteine and anthropometric parameters (body mass index, weight, percentage of fat mass, fat mass, and tricipital skinfold). Elevated levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure were detected in Group I. CONCLUSION: The present study shows that elevation of plasma tHcy levels in type 2 diabetic patients is associated with a higher prevalence of peripheral arteriopathy and nephropathy. Our data suggest that hyperhomocysteinemia is not associated with fat mass but it is associated with high levels of fibrinogen, lipoprotein (a), microalbuminuria, and blood pressure levels.

Aged↗
PubMedDate not supplied

Effect on quality of life with a new insulin injection device in elderly patients with diabetes mellitus type 2.

OBJECTIVE: The aim was to investigate the efficacy, safety, and satisfaction of a new insulin injection device in elderly subjects with type 2 diabetes on suboptimal glycemic control with two doses of insulin NPH alone. RESEARCH DESIGN AND METHODS: This study was a prospective no-blind study performed. We selected 25 patients (13 men and 12 women) with type 2 diabetes, only treated with two doses of NPH insulin (injection pen device) for more than 6 months, who did not achieved optimal glycemic control. Additional inclusion criterion was age 55 to 75 years (mean 65.6+/-8.6). All subjects were required to be able to comply with the protocol and carry out home blood glucose monitoring. RESULTS: HbA1c decreased significantly from 7.8% to 7.6% (P<.05) (2.6% decreased from baseline), and breakfast and lunch preprandial glucose controls decreased significantly. Significant decrease was detected in breakfast and dinner postprandial glucose level. Taken the patients as a whole, insulin dose change significantly (29.8+/-10.9 to 28+/-10.8 Ul/day; P<.05). The number of hypoglycemic events during the 3-month treatment was similar than before treatment with Innolet (2.3+/-3.9 to 1.4+/-2.6 events; ns). The summary results indicated significantly improvement satisfaction questionnaire before 23.9+/-9 points and after 34.5+/-6.5 insulin injection device (P<.05). CONCLUSION: Innolet improved glycemic control and satisfaction in a group of elderly patients with diabetes mellitus type 2 previously treated with pen devices.

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PubMedDate not supplied

[A comparison of 2 reference tables in nutritional anthropometric assessment].

OBJECTIVES: The valuation of nutritional state of an individual is necessary to performed a correct diagnostic approach and therapy in each case. This valuation can be performed by biochemical or anthropometric methods. In our country two tables of anthropometric values are used (Alastrue et al. and Frisancho et al.). The aim of our work was to compare the utility of both tables in the nutritional valuation of a urban and rural population of Valladolid. MATERIAL AND METHODS: A total of 110 patients were valued biochemically and anthropometrically, presenting 65.5% pathology tumoral, with a 61.41 +/- 16.73 year old half age. RESULTS: Tricipital pleat classified the patients in a similar way (agreement 76.5%, kappa 0.68), however the muscular circumference of the arm didn't classify the patients in a same way (agreement 23%, kappa 0.02). in the correlation analysis among anthropometrics and biochemical parameters, positive correlations were detected between tricipital pleat and the index of corporal mass with the glucemia and cholesterol values. Positive correlations were also detected between the muscular circumference of the arm and urea and potassium levels. CONCLUSION: The anthropometric parameters are useful for the nutritional valuation of these patients but it is necessary to keep in mind the possible variations that can exist in function of the used tables. For it Would be useful that each geographical area and each group of pathologies even had its own table of percentiles in its normal population's function.

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PubMedDate not supplied

[Usefulness of postoperative support by enteral nutrition of patients with epidermoid carcinoma of the larynx].

RATIONALE: At the present time, artificial nutrition has made great strides and enteral nutrition has become the first choice delivery method. The purpose of our paper is to analyze the usefulness of this type of nutrition in the post-operative care of patients with larynx tumours. METHODS: A total of 38 patients were studied, with an average age of 63.2 +/- 10.2 years. On average, in the post-operative period until oral nutrition was restored enteral nutrition lasted for 10.6 +/- 4.9 days. A biochemical and anthropometric assessment of the nutritional condition was effected at the time of admission and 7-10 days into the nutritional treatment. RESULTS: During the post-operative period, no anthropometric changes were detected; the analytical variation, however, showed an improvement on the first review of pre-albumen (12.5 +/- 5.1 mg/dl versus 18.7 +/- 7.9 mg/dl; p < 0.05) and transferrin (132.1 +/- 35 mg/dl versus 159.7 +/- 38 mg/dl; p < 0.05). The nutritional feed using continuous perfusion was gradually increased from the first 24 hours of post-operative care until the pre-established theoretical requirements of the patients were met using polymeric formulas supplemented by soluble and insoluble fibre, presenting very few secondary effects: 13% of diarrhoeas and no cases of aspiration. All of the patients tolerated an oral diet when discharged. The average direct cost (nutrilinea, nasogastric tube and nutrition formulas) for enteral nutrition was 4,723 +/- 1,600 pesetas per day. CONCLUSION: Enteral nutrition is effective in the post-operative care of patients with tumour of the larynx, improving their nutritional biochemistry parameters and allowing easy transition to oral nutrition, with presentation of few side effects and all for low cost.

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