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Biomedical subjects

R Robles

Publications and source records attributed to R Robles.

At least 145 records · Page 8Linked to original sources
PubMed1994

Choledochoduodenostomy and sphincterotomy in the treatment of choledocholithiasis.

Over a 10-year period, 2610 patients underwent operation for biliary lithiasis. Exploratory choledochotomy was indicated in 591 patients (22.6 per cent). This was followed by simple choledochorrhaphy over a T tube in 240 patients (40.6 per cent), transduodenal sphincterotomy and choledochorrhaphy over a T tube in 126 (21.3 per cent), supraduodenal choledochoduodenostomy in 216 (36.5 per cent), and choledochoduodenostomy and transduodenal sphincterotomy in nine (1.5 per cent). Choledochoduodenostomy was performed if the bile duct was more than 12 mm in diameter. The indication for transduodenal sphincterotomy was the presence of a stone impacted in the papilla and/or papillary stenosis. Six patients developed abdominal abscess and three an external biliary fistula following choledochoduodenostomy. There were four abscesses and two episodes of acute pancreatitis in patients undergoing sphincterotomy. There was no difference in mortality rate between the two groups. After a mean follow-up of 5.6 years, 71.5 per cent of patients who underwent choledochoduodenostomy and 75.2 per cent of those who received transduodenal sphincterotomy were asymptomatic. The remainder suffered from dyspepsia, colicky pain or episodes of cholangitis. Nine patients underwent reoperation for residual calculi (six choledochoduodenostomies, three sphincterotomies).

Adult↗
PubMed1994

Gastrointestinal bezoars.

Of 99 patients with 117 gastrointestinal bezoars, 69 had undergone previous surgery, the most common operation being bilateral truncal vagotomy with pyloroplasty (55 patients). An excessive intake of vegetable fibre was found in 38 patients and poor mastication in 27. Thirty bezoars presented with gastric symptoms and patients had endoscopy as the diagnostic technique; 87 caused symptoms of intestinal obstruction with the diagnosis made by plain abdominal radiography. Medical treatment by enzymic or endoscopic fragmentation was used for 17 of 30 gastric bezoars; surgery was required in the remainder. Intestinal bezoars causing obstruction can be fragmented and 'milked' to the caecum. The stomach should be explored for associated gastric bezoars.

Adolescent↗
PubMed1994

Hepatitis C in liver transplant patients.

The aim of this study was to determine whether infection by the hepatitis C virus (HCV) recurs after orthotopic liver transplantation (OLT) and to define the natural history of post-transplantation chronic hepatitis due to HCV. Of 70 patients, 10 (14.3%) were found to have antibodies to HCV before transplantation. After OLT 14 of the 70 patients (20%) had positive anti-HCV antibodies: 8 of 10 positive pre-OLT (80%) and 6 of 60 negative pre-OLT (10%). Of 14 patients anti-HCV+ post-OLT (57%), developed 8 chronic hepatitis: chronic persistent hepatitis in three patients, chronic lobular hepatitis in three patients and chronic, active hepatitis in two patients. We treated four patients with interferon obtaining normalization of transaminases in three of them after 6 months, but with a severe relapse in two. These results suggest that hepatitis C recurs in a majority, of liver transplant recipients and that morbidity is an important consideration. Interferon treatment of these patients requires further study to obtain conclusive results.

Adolescent↗
PubMed1994

Life quality of patients undergoing liver transplantation.

The aim of this study was to assess the life quality of a group of patients who had undergone liver transplantation using (1) a psychological test to evaluate family relations, work activity, emotional state and social relationships; (2) the quantification of hospital dependence and degree of fitness for work. Included in the study were 32 patients using the following criteria: diagnosis of hepatic cirrhosis and minimum posttransplant follow-up of 6 months. The average age of the study population was 44.8 +/- 10.5 years; there were 23 males and 9 females, with an average follow-up of 15 months. The psychological test used was the Quality of Life Scale (QLS) which consists of 21 items each scoring from 1 to 6 points. The questionnaire was completed before transplantation by all the patients, and after transplantation by 32 patients at 6 months, 20 at 12 months and 12 at 24 months. Hospital dependence was evaluated by the number of admissions and number of days per admission. Lastly, we compared fitness for work before transplantation and at 1 and 2 years after transplantation. The QLS test showed a post-transplant improvement in the four aspects assessed, particularly in the personal aspects (emotions and family) (P < 0.001). Hospital dependence following liver transplantation decreased significantly compared with the pretransplant situation (P < 0.01). Finally, the post-transplant percentage of unfitness for work decreased with time, reaching a significant differences 2 years after transplantation (P < 0.05).

Adult↗
PubMed1994

Lipoprotein changes in small-for-gestational-age infants fed nucleotide-supplemented milk formula.

We determined the effect of supplementing milk formula with nucleotides on plasma lipoproteins in small-for-gestational-age infants: 21 infants were fed a nucleotide-supplemented formula and 20 infants were fed the same nucleotide-free formula. On days 0, 3 and 7 after birth, major plasma lipoprotein fractions were analyzed for apolipoprotein and lipid composition. Compared with the control group, the group receiving nucleotides had increased total apoprotein concentrations in all lipoproteins as well as increased apo A-I in high-density lipoproteins and very low-density lipoproteins, and apo B-100 in very low-density lipoproteins and low-density lipoproteins. Very low-density lipoprotein cholesterol, low-density lipoprotein cholesterol and very low-density lipoprotein triglycerides increased in parallel to the changes in apoproteins. The cholesterol ester to unesterified cholesterol ratio was increased in low-density lipoproteins and, particularly, in high-density lipoproteins. These data support the hypothesis that lipoprotein metabolism in small-for-gestational-age infants is affected by dietary nucleotide supplementation, enhancing lipoprotein synthesis or secretion. Cholesterol esterification capacity paralleled the apo A-I increase, in agreement with the cofactor role of apo A-I on lecithin: cholesterol acyltransferase.

Apolipoproteins↗
PubMed1994

Dietary nucleotides influence lipoprotein metabolism in newborn infants.

Nucleotide supplementation of adapted-milk formulas may be of interest for infant nutrition because nucleotides are involved in the synthesis of proteins and other macromolecules such as phospholipids, and thereby facilitate lipoprotein synthesis. To determine whether dietary nucleotides influence plasma lipoproteins in newborns, we have studied the plasma-lipoprotein concentrations and the composition of the major lipoprotein fractions during the first week of life in two groups of preterm infants fed formulas differing only in their nucleotide content. For comparison, two groups of term infants were studied under the same conditions. Lipoproteins were isolated by density ultracentrifugation, and the lipid and protein content were determined by standard methods; apolipoprotein A-I was determined immunologically. Nucleotide supplementation of formula in preterm infants increased all plasma lipoprotein concentrations. In addition, an increase in the plasma esterification rate was observed. However, total cholesterol concentrations were unchanged. The changes in lipoproteins concentrations were due mainly to an increase in apolipoprotein content. Nucleotides added to formulas affected term-infants' lipoproteins significantly less than to preterm infants. These findings suggest that dietary nucleotides may enhance the synthesis of lipoproteins during the early neonatal period, especially in preterm infants.

Animals↗
PubMed1994

HIV infection, risk behaviors, and depressive symptoms among Puerto Rican sex workers.

This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.

Adolescent↗
PubMed1994

[Quality of life of cirrhotic patients before and after liver transplantation].

In this study we assessed the quality of life of a group of cirrhotic patients who underwent liver transplant using a psychological test to evaluate family relations, work activity, emotional state and social relations. The quantification of hospital dependence and degree of fitness for work, before and after the transplant were also analyzed. 32 patients were included in the study with the diagnosis of hepatic cirrhosis and minimum post-transplant follow-up of 6 months. The average age of the study population was 44.8 +/- 10.5 years; there were 23 males and 9 females, with an average follow-up of 15 months. The psychological test used was the Quality of Life Scale (QLS), which consists of 21 items, each scoring from 1 to 6 points. The questionnaire was completed before the transplant by all the patients, and after the transplant by 32 patients at 6 months, 20 at 12 months and 12 at 24 months. Hospital dependence was evaluated by number of admissions and number of days per admission. Lastly, we compare the rate of unfitness for work before the transplant and at one and two years after the transplant. The QLS test showed a post-transplant improvement in the 4 aspects assessed, specially in the personal aspects (emotions and family) (p < 0.001). Hospital dependence following pre-transplant situation (p < 0.01). Finally, the post-transplant percentage of unfitness for work decreased with time, reaching significant differences 2 years after the liver transplant (p < 0.05).

Adult↗
PubMed1994

Hepatic artery complications after liver transplantation.

We present the arterial complications arising from 100 orthotopic liver transplants (OLT) carried out in 87 consecutive patients. Mean patient age was 42.5 +/- 12.8 years (7-63). There was a predominance of male patients (67%). The most common indications were hepatic cirrhosis (53%) and severe acute hepatitis insufficiency (14%). The donor liver presented 29 arterial malformations, mainly a left hepatic artery arising from the left gastric artery, either as a single or associated anomaly. Only six arterial complications appeared in 4 of the 87 patients. Of these six, four corresponded to arterial thrombosis, and the remaining two to arterial stenosis and a ruptured mycotic aortic aneurysm. Two of the 4 patients had a double arterial complication (one had arterial thrombosis in 2 of the 3 grafts, and the other presented arterial thrombosis and aortic rupture). No arterial complications were related to arterial anomalies in the donor liver. Three of the 4 patients died from the complication. The 1-year actuarial survival rate in our series is 77.5%. In conclusion, arterial complications are infrequent in our series (6%) but do carry a high mortality rate (75%).

Adult↗
PubMed1993

[Liver transplantation for the treatment of type I familial amyloidotic polyneuropathy].

The first liver transplantation carried out in Spain for the treatment of type I familial amyloidotic polyneuropathy (FAP I) is presented. The reason for the operation was based on the liver being responsible for the synthesis of abnormal transtirretin (TTR) constituting the peculiar amyloid of the disease. Following transplantation a rapid and noticeable decrease in abnormal TTR was observed and the evolution of the clinical picture after 18 months of surgery is favorable with progressive improvement of the neurologic symptoms and normal function of the graft. These encouraging results coincide with those of the Swedish group of Umea, the pioneer of this procedure.

Adult↗
PubMed1993

Triplet structure of von Willebrand factor reflects proteolytic degradation of high molecular weight multimers.

High molecular weight (HMW) and low molecular weight (LMW) forms of von Willebrand factor (vWF) were isolated from normal human plasma in the presence of protease inhibitors. HMW and LMW vWF preparations were subjected to reduction of interdimeric disulfide bridges under mild reducing conditions. Following sodium dodecyl sulfate electrophoresis in 3% agarose, the vWF bands were detected by immunoblotting with a polyclonal rabbit anti-vWF antiserum as well as with two monoclonal antibodies directed against epitopes located in the NH2-terminal (MAb 418) or in the COOH-terminal (MAb 9) region of the vWF subunit. Our results suggest that the slowest migrating band of the dimeric triplet set of LMW vWF represents an asymmetric structure composed of an intact subunit to which one NH2-terminal and one COOH-terminal fragment are linked by disulfide bridges. The intermediate band of the first triplet of LMW vWF strongly reacted with MAb 9 but not with MAb 418, indicating that it represents a dimer of COOH-terminal fragments. The fastest migrating band of the same triplet is apparently a dimer of the NH2-terminal fragments because it reacted with MAb 418 but not with MAb 9. Each next higher family of triplets seems to contain one more asymmetric fragment of dimeric size. These results are compatible with a model according to which LMW forms of vWF are derived from HMW vWF by proteolytic cleavage in the circulating blood.

Chromatography, Gel↗