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Biomedical subjects

R Esteban

Publications and source records attributed to R Esteban.

233 records · Page 13Linked to original sources
PubMed1977

[Diagnostic value of anti-mitochondria antibodies].

The histological lesions found in patients with hepatic disease and positive anti-mitochondrial antibodies (AMA) by immunofluorescence were compared with those in 10 subjects of the same age and sex with negative AMA. The majority of the patients with positive AMA were suffering from primary biliary cirrhosis, the diagnosis being based upon the histological appearance (Stage 1 of Scheuer's classification: 40%) or the presence of clinical signs of cholestasis with a compatible histological appearance (40%). None of the remaining patients (20%) with positive AMA nor the 10 individuals with negative AMA showed histological signs suggestive of primary biliary cirrhosis. The absence of certain clinico-biological factors, with the exception of Stage 1 histology, gives a high degree of value to a high level of AMA in the diagnostic of PBC.

Adult↗
PubMedDate not supplied

Hepatitis B virus replication in acute hepatitis B, acute hepatitis B virus-hepatitis delta virus coinfection and acute hepatitis delta superinfection.

To evaluate the effect of hepatitis delta virus on the level of replication of hepatitis B virus and to assess the clinical significance that such an effect might have on the final outcome of the infection, the serological profile of hepatitis B virus DNA was investigated in 153 patients with acute or chronic hepatitis B virus infection with or without associated delta infection. Serum hepatitis B virus DNA was detected in 57% of patients with acute hepatitis B, 67% of those with acute hepatitis B virus-hepatitis delta virus coinfection and 25% of HBsAg carriers with hepatitis delta virus superinfection during the first week after the onset of symptoms. Patients with acute hepatitis B and those with acute hepatitis B virus-hepatitis delta virus coinfection did not differ significantly with respect to the serological profile of hepatitis B virus DNA and final clinical outcome. Within the group of HBsAg carriers with hepatitis delta virus superinfection, all patients who were initially negative for hepatitis B virus DNA developed chronic hepatitis delta virus infection, whereas 3 of the 4 patients with active hepatitis B virus infection at the time of superinfection showed transient inhibition of hepatitis B virus replication followed by termination of hepatitis delta virus infection in two patients. Therefore, although delta virus may inhibit the replication of hepatitis B virus among chronic HBsAg carriers, this effect is not readily apparent among patients with hepatitis B virus-hepatitis delta virus coinfection.

Acute Disease↗
PubMedDate not supplied

Hepatitis D virus RNA in acute delta infection: serological profile and correlation with other markers of hepatitis D virus infection.

To evaluate the profile of hepatitis D virus replication and the corresponding immunoresponse after acute hepatitis D virus infection, sera from 50 patients with acute hepatitis D (36 with acute hepatitis B virus-hepatitis D virus coinfection and 14 HBsAg carriers with hepatitis D virus superinfection) were investigated for the presence of hepatitis D virus RNA and other serological hepatitis D virus markers. During the first week after onset of symptoms, hepatitis D virus RNA was detected by spot hybridization with a similar frequency among patients with coinfection (64%) and those with superinfection (71%). The presence of hepatitis D virus RNA in the first serum sample correlated with that of circulating hepatitis D antigen in both groups of patients. The presence of hepatitis D virus RNA was transient and its clearance paralleled that of serum hepatitis D antigen among patients with coinfection, so that 1 month after the onset of symptoms serum hepatitis D virus RNA was no longer detectable in any of these patients. Conversely, serum hepatitis D virus RNA was still present in 78% of those with superinfection, all of whom developed chronic liver disease, thus suggesting that the persistence of hepatitis D virus RNA in the serum for more than 4 weeks might indicate progression to chronicity. In nine of the 14 patients (64%) with hepatitis D virus superinfection progressing to chronicity, hepatitis D virus RNA was persistently detected throughout the follow-up, whereas in five patients it was detected occasionally. In four superinfected patients hepatitis D virus RNA and hepatitis B virus DNA were detected simultaneously in serial samples, thus suggesting that, at least during early stages of chronic hepatitis D virus infection, both viruses may replicate at the same time.

Acute Disease↗
PubMedDate not supplied

What to do when standard therapy fails.

An important group of patients with chronic hepatitis C do not respond to interferon (IFN) therapy. Compared with untreated patients with chronic hepatitis C, non-responders have a higher percentage of cirrhosis, are more frequently infected by genotype 1 and usually have a viral load above 2 x 106 copies/ml. Also, patients with cirrhosis have lower life expectancy and higher risk of clinical complications, and therefore, are most in need of effective treatment strategies. There is no evidence that the re-treatment of non-responders with a standard regimen of IFN or more prolonged IFN therapy achieves a sustained biochemical or virological response. Between 20% and 40% of non-responder patients treated with IFN therapy for more than two years had an hepatic improvement in liver histology associated with a decrease in hepatitis C virus-ribonucleic acid levels. In contrast, combination therapy with IFN and ribavirin for six months now results in sustained response rates between 6% and 29% depending on the viral genotype and the presence or absence of cirrhosis. Patients infected with genotype 2 and 3 have a higher probability of achieving a sustained virological response than those infected by genotype 1. Currently, different studies are underway to determine whether high-dose IFN and/or induction therapy combined with ribavirin for more prolonged periods of time could increase the sustained response rate in non-responders. No other drugs appear to be efficacious in these patients, except the combination of IFN, ribavirin and amantadine which has shown interesting results in a preliminary trial but they need to be confirmed in further studies. These findings suggest that combination therapy is beneficial and can be recommended for some non-responder patients until other new therapies are available.

Amantadine↗
PubMedDate not supplied

Symptoms of chronic arterial insufficiency correlate with absolute ankle pressure better than with ankle: brachial index.

BACKGROUND: Doppler-based measurement of the ankle: brachial index (ABI) has long been regarded as the standard by which to objectively quantify the degree of lower extremity arterial occlusive disease, but this method fails to account for the contribution of systemic blood pressure to actual limb perfusion. We hypothesized that the absolute blood pressure would be a better predictor of the severity of symptoms of chronic occlusive disease than the ABI. EXPERIMENTAL DESIGN: retrospective comparative study. SETTING: university inpatient/outpatient vascular laboratory. PATIENTS: 1396 evaluable patients out of 2436 total consecutive patients referred with suspected lower extremity arterial occlusive disease. MEASURES: comparison of absolute ankle and digital pressures and ABI according to severity of symptoms of chronic lower extremity ischemia using three-way analysis of variance (ANOVA), likelihood ratios, and receiver operator characteristic (ROC) curves. RESULTS: The symptoms of tissue ulcer/gangrene, rest pain, and gangrene were characterized by differences in absolute pressures in the great toe (47 +/- 42 mmHg vs 55 +/- 40 mmHg vs 62 +/- 33 mmHg [mean +/- SD], F = 19.05, p < 0.001) and ankle (92 +/- 53 mmHg vs 98 +/- 44 mmHg vs 106 +/- 37 mmHg, F = 12.91, p < 0.001), but not by the ABI (0.71 +/- 0.33 vs 0.68 +/- 0.34 vs 0.71 +/- 0.28, F = 1.24, p > 0.05). ROC curves confirmed absolute digital pressure (area under curve [AUC] = 0.628) and absolute ankle pressure (AUC = 0.607) to be superior to ABI (AUC = 0.572). CONCLUSIONS: The severity of symptoms for peripheral vascular disease correlate better with absolute pressure measurement than with ABI.

Aged↗
PubMedDate not supplied

[System e in acute hepatitis B].

HBeAg and Ab are investigated by simple radial immunodiffusion in dextrane following Magnius. 14 patients (28%) were HBeAg positive and 2 patients HBeAb positive (4%). HBsAg subtyping was ad in 6 cases and ay in further 5. No relation was found between both determinants and HBeAg. Six of the 10 patients with HBeAg in their sera developed chronic liver disease o fulminant hepatitis, while only 3 of the 21 HBeAg negative controls did so (p less than 0.05). HBeAg is a marker of the evolution of virus B hepatitis.

Antibodies, Viral↗
PubMedDate not supplied

[Quantitative determination of HBV-DNA in chronic hepatitis B: comparison of three methods].

The aim of this study was to evaluate a technique of quantitative determination of DNA-HBV in serum, bDNA Quantiplex, in a series of 90 patients with chronic HBV infection: 75 with chronic hepatitis B (24 HBeAg positive and 51 with anti-HBe) and 15 asymptomatic carriers of HBV (anti-HBe positive). The results were related to DNA-HBV determination by hydridation techniques in dot-blot and PCR. DNA-HBV was detected by the Quantiplex bDNA technique in 61 (81%) of the 75 patients with chronic hepatitis B, in 24 (100%) of the 24 HBeAg positive patients and in 37 (72%) of the 51 anti-HBe positive (p < 0.05) patients and in none of the asymptomatic HBV carriers. The median of DNA-HBV concentration was 4,000 pg/ml in the hepatitis HBeAg and 71 pg/ml in the ati-HBe positive (p < 0.05). A significant relation was observed between the ALT value and the DNA-HBV concentration (p < 0.05). DNA-HBV by dot-blot was positive in 22 (29%) of the chronic hepatitis B and in none of the asymptomatic HBV carriers. DNA-HBV was not observed by dot-blot in 39 patients positive for DNA-HBV by the Quantiplex bDNA technique. DNA-HBV by PCR was identified in 65 (87%) of the chronic hepatitis B and in one of the asymptomatic HBV carriers. The sensitivity of the Quantiplex bDNA technique (98% versus the PCR technique) is much greater than that observed with dot-blot. In conclusion, the determination of DNA-HBV by the Quantiplex bDNA technique may be considered a good method for evaluating the viremia and degree of viral replication in patients with chronic hepatitis B.

DNA, Viral↗