共查询到20条相似文献,搜索用时 15 毫秒
1.
Elisabeth Boerr María AndersJosé Mella Emilio QuiñonezNicolás Goldaracena Federico OrozcoLucas Mccormack Ricardo Mastai 《Gastroenterologia y hepatologia》2013
Introduction
The aim of the present study was to investigate the impact of the Model for End-stage Liver Disease (MELD) on transplantation costs.Material and methods
We included all patients who received a liver transplant for end-stage liver disease between 2006 and 2010. The study period encompassed the day of transplantation until hospital discharge. The patients were classified into two groups: those with a MELD score of 6-19 and those with a score of 20-40.Results
The mean MELD score at transplantation was 19.2 ± 7.0 (mean ± SD). The mean cost per procedure in the study period was USD 33,461 per patient (range 21,795-104,629). The cost of transplantation was USD 30,493 ± 8,825 in patients with a MELD score of 6-19 and was USD 36,506 ± 15,833 in those with a score of 20-40; this difference was statistically significant (P = .04). In a stepwise logistic regression analysis, the only independent predictor of high cost was having a MELD score of 20 (OR 11.8; CI 1.6-87). In the linear regression model, the most important predictor of cost was the length of hospital stay (r2 = 43%).Discussion
Our results demonstrate that the MELD score directly affects transplantation costs. We suggest that reimbursement systems compensate the distinct financing bodies according to the severity of the underlying disease, evaluated with the MELD. 相似文献2.
Alberto Fernandez-Atutxa Mercedes Vergara Montserrat Gil Blai Dalmau Mireia Miquel Jordi Sanchez-Delgado Meritxell Casas 《Gastroenterologia y hepatologia》2013
Triptans are a class of drugs with proven efficacy in the acute treatment of migraine headache. The first component of these drugs was sumatriptan, with various derivatives subsequently emerging. Until now, there has only been one reported case of liver toxicity with zolmitriptan. We now present a case of hepatotoxicity related to another drug in this group: rizatriptan. 相似文献
3.
Antonio Ríos Ana López-Navas Marco Ayala-García María José Sebastián Anselmo Abdo-Cuza Laura Martínez-Alarcón Ector Jaime Ramírez Gerardo Muñoz Juliette Suárez-López Roberto Castellanos Beatriz González Miguel Ángel Martínez Ernesto Díaz Pablo Ramírez Pascual Parrilla 《Gastroenterologia y hepatologia》2012
Introduction
Hospital professionals are an opinion group that influences the general population.Objective
To analyze attitudes to living donor liver transplantation (LDLT) among non-medical professionals working in Spanish and Latin American hospitals and to determine the variables that influence these attitudes.Material and method
A random sample, stratified by department, was selected from non-medical staff in the “International Donor Collaborative Project”: there were three hospitals in Spain, five in Mexico and two in Cuba. Attitudes were evaluated through a validated, anonymous, self-administered questionnaire.Results
There were 951 non-medical professionals: 277 from Spain, 632 from Mexico and 42 from Cuba. A total of 86% (n = 818) were in favor of related living donation and 31% (n = 299) were in favor of unrelated living donation. This attitude was associated with the following: country (Mexico 88%, Cuba 83%, Spain 81%) (p =0.016), female sex (p =0.026), having experience of donation and transplantation (p =0.001), having a favorable attitude to donation (P <0.001), considering the possibility of needing a transplant (P <0.001), being in favor of living kidney donation (P <0.001), being willing to accept a transplant from a living donor if necessary (P <0.001), discussing donation and transplantation with the family and partner (P <0.001), carrying out pro-social activities (P <0.001), believing that one's religion was in favor of donation and transplantation (P<0.001), and not worrying about bodily mutilation after donation (P <0.001).Conclusions
Attitudes toward related LDLT among non-medical staff in various Spanish, Mexican and Cuban hospitals are favorable. In 86% of those surveyed, this attitude was not influenced by classical psychosocial factors. 相似文献4.
Laura García-Jurado Itziar Oyagüez Miguel Ángel Casado Cristina Tural Juan González-García Enrique Ortega Juan Antonio Pineda 《Enfermedades infecciosas y microbiología clínica》2012
Introduction
The assessment of liver fibrosis is crucial for taking therapeutic decisions in patients infected with HIV/AIDS coinfected with HCV, because it allows the prognosis of the disease and the prioritization of hepatitis C treatment in these patients.Methods
A discrete events model simulation (DEMS) and a Markov model have been developed to represent the evolution of liver fibrosis to cirrhosis in patients coinfected with HIV/HVC. The model evaluated two alternatives for the diagnosis and monitoring of these patients, transient elastography performed annually and liver biopsy performed every seven years. The models have been developed under Health Care System perspective and only considered direct medical costs (disease treatment and health state costs). One-way sensitivity analyses were carried out to assess the impact of parameters with higher uncertainty. A discount rate of 3% was applied.Results
Base case analysis shows that the diagnosis and monitoring of patients with transient elastography is a dominant strategy compared with to liver biopsy, resulting in greater life expectancy at lower cost. The sensitivity analysis performed confirmed the robustness of these results.Conclusion
Transient elastography has proved to be a dominant strategy compared to liver biopsy in the diagnosis and monitoring of liver fibrosis in patients coinfected with HIV/HCV in Spain. 相似文献5.
Susana Sagredo Javier Brahm Mario Uribe Verner Codoceo Gladys Smok 《Gastroenterologia y hepatologia》2013
Non-alcoholic fatty liver disease is common among morbidly obese people. Bariatric surgery is increasingly used in this population to control weight but is not free of risks. We present the case of a 28-year-old morbidly obese woman who underwent gastroplasty with intestinal resection and a gastro-jejunal anastomosis. Eleven months later, and with a weight reduction of 35%, the patient developed acute liver failure. A biopsy showed severe steatohepatitis and fibrosis. After prolonged hospital stay and management that consisted of support measures, nutritional assistance, N-acetyl cysteine, zinc and vitamin E, liver function was restored. A follow-up biopsy showed marked regression of the initial findings. Bariatric surgery has many beneficial effects. However, even with the most up-to-date techniques, complications can occur. Familiarity with these complications is important for their prevention and treatment. 相似文献
6.
Hemoptysis is symptomatic of potentially serious and life-threatening chest disease and requires urgent evaluation and treatment. The aim of this study was to evaluate the hemostatic efficacy of endobronchial application of Ankaferd Blood Stopper® (ABS) solution in patients with hemoptysis. 相似文献
7.
Alejandra Ochoa Palominos Luis Ibáñez SamaniegoMaría-Vega Catalina Rodríguez José Pajares DíazGerardo Clemente Ricote 《Gastroenterologia y hepatologia》2013
Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism,characterized by copper accumulation in the liver and brain. This rare entity, which has a broad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilson's disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment. 相似文献
8.
Patricia Ruiz Cuesta Antonio José Hervás MolinaJuan Jurado García María Pleguezuelo NavarroValle García Sánchez Luis L. Casáis JuanenaCarmen Gálvez Calderón Antonio Naranjo Rodríguez 《Gastroenterologia y hepatologia》2013
Introduction
Pneumatic dilation and surgical myotomy are currently the procedures of choice to treat achalasia. The selection of one or other treatment depends on the experience of each center and patient preferences.Background and aims
To review the experience of pneumatic dilation in patients with achalasia in our center.Material and methods
We included all patients with a clinical, endoscopic and manometric diagnosis compatible with achalasia who underwent pneumatic dilation in a 19-year period. All dilations were routinely performed with a Rigiflex® balloon, usually at pressures of 250, 250 and 300 mm Hg in three inflations of one minute, each separated by one minute. The success of the dilation was assessed on the basis of the patient's symptoms, the number of sessions, the need for surgery, and the presence of complications.Results
A total of 171 patients were included, 53.2% men and 46.8% women, with a mean age of 51.53 ± 17.78 years (16-87 years), from June 1993 to October 2012. A 35-mm balloon was used in 157 patients, a 30-mm balloon in 9 patients and a 40-mm balloon in 7 patients. A single dilation session was required in 108 patients, two sessions were required in 56 patients, with a mean time between the first and second sessions of 25.23 ± 43.25 months (1-215 months), and 3 sessions were required in 7 patients with a mean time between the second and third sessions of 6.86 ± 5.33 months (1-15 months). Outcome after dilation was successful in 81% of the patients. Of the 140 responders, 121 had complete response (complete disappearance of symptoms without recurrence) and 19 partial response (initial disappearance of symptoms with subsequent reappearance). Surgery (Heller myotomy) was required in 15.8% of the patients. Perforation occurred in 4 of the 171 patients as a complication of the technique; these perforations were satisfactorily resolved, two by conservative treatment and two by surgery. There was no mortality associated with the technique or its complications.Conclusions
In our series, pneumatic dilation had a high success rate. In most patients, a single session was required and the complications rate was low. These results show that this technique is safe and effective in these patients, avoiding a large number of surgical interventions. 相似文献9.
Reversibility of liver fibrosis with immunosuppressive therapy (IT) has been described in autoimmune hepatitis (AIH)
Objective
To compare initial fibrosis and fibrosis after IT in patients with AIH.Methods
A total of 54 patients were admitted with positive ANA or AML antibodies, or both, elevated IgG immunoglobulins and who met international criteria for a diagnosis of AIH. The mean age was 39 years (range 13-65) and there were 47 women (87%). Two liver biopsies were taken: one at diagnosis and another at a mean of 28 ± 8 months after initiation of IT with prednisone and azathioprine. The degree of inflammation (0-18) and fibrosis (0-6) according to Ishak score was compared between the initial and the follow-up biopsy.Results
Fibrosis decreased from 2.9 ± 0.3 to 2.2 ± 0.3 (p = 0.005) and histological activity index from 6.8 ± 0.45 to 2.6 ± 0.2 (P < .001). In subgroups, fibrosis decreased from 3.6 ± 0.4 to 1.4 ± 0.3 (P < .001) in 22 patients (41%), was unchanged in 27 (50%) and increased in five (9%). There were seven patients with histological cirrhosis at IT initiation. After IT, four showed a reduction in Ishak score (achieving scores of 0-3). Transaminase values were not associated with histological improvement.Conclusion
Fibrosis in patients with AIH significantly improved with IT, emphasizing the importance of studying the prognostic factors associated with this favorable response. 相似文献10.
Diego García-Compeán Joel O. Jáquez-Quintana José A. González-González Fernando J. Lavalle-González Jesús Z. Villarreal-Pérez Hector J. Maldonado-Garza 《Gastroenterologia y hepatologia》2013
The prevalence of overt diabetes mellitus (DM) in liver cirrhosis is about 30%. However, DM or impaired glucose tolerance can be observed in 90% after an oral glucose tolerance test in patients with normal fasting plasma glucose. Type 2 DM may produce cirrhosis, whereas DM may be a complication of cirrhosis. The latter is known as «hepatogenous diabetes». Overt and subclinical DM is associated with liver complications and death in cirrhotic patients. Treating diabetes is difficult in cirrhotic patients because of the metabolic impairments due to liver disease and because the most appropriate pharmacologic treatment has not been defined. It is also unknown if glycemic control with hypoglycemic agents has any impact on the course of the liver disease. 相似文献
11.
María del Mar Cuesta María del Carmen López Paula Nieto María Luisa Junquera José Antonio Varela Fernando Vázquez 《Enfermedades infecciosas y microbiología clínica》2012
Introduction
The aim of the study was to analyze the implementation of a rapid HIV test in Asturias (Spain).Methods
The study was conducted in two STI Units using the Determine® HIV-1/2 test.Results
A total of 1011 people were tested, of whom 65.3% had never been tested for HIV previously, and 71.4% were heterosexual men. Twenty-one tests were confirmed positive by Enzyme Immunoassay/Western Blot (EIA/WB) assay An increase was observed in the diagnosis of HIV.Conclusion
Awareness campaigns and rapid tests could be effective methods for the early diagnosis of HIV. 相似文献12.
Bernabé Jurado Gámez José Luis Gómez-Chaparro Moreno María Muñoz Calero Julia Ruiz Laguna Luis Muñoz Cabrera Andrés Cosano Povedano Juan López-Barea 《Archivos de bronconeumología》2010
Objective
A prospective study with a consecutive sample and a control group to determine whether protein expression in patients with sleep apnoea-hypopnoea syndrome (SAHS) is different from that of the control group (IAH ≤5).Patients and methods
A total of 32 patients aged between 35 and 60 years who had a polysomnograph performed were included. Patients with an acute or chronic were excluded. The first dimension of the proteomic study was carried out on IPG strips (18 cm, pH 4–7) and the second on SDS-PAGE gels in triplicate for each group. The gels were stained with SYPRO-Ruby (Bio-Rad®), the images obtained with an FX-Imager laser scanner and the spots were analysed using ProteomWeaver v. 4.0 (Bio-Rad®) software. Significant changes between the gels were analysed by replicates and separately, being considered a significant change if the relative intensity of the spots was three times higher or lower than that of the control and if it was observed in 2 of the 3 replicates of each group, with a coefficient of variation of <20%.Results
The patients were divided into 8 subjects per group (control, mild, moderate and severe). The comparison of the gels showed significant differences between the control group and the 3 clinical groups, with significant over-expression being observed in 3 spots, and under-expression in 7 spots in the control group.Conclusion
There are significant changes in protein expression between a control group and patients in different stages of disease. The proteomic study can identify biomarkers associated with the diagnosis and severity of the SAHS. 相似文献13.
Jesús Ruiz Ramos Irene Romero Hernández Patricia Marrero Álvarez María Remedios Marqués Miñana María José Fernández Megía José Luis Poveda Andrés 《Gastroenterologia y hepatologia》2014
Introduction
Antiviral drugs for the treatment of hepatitis C virus (HCV) infections have a large number of interactions. The aim of this study was to describe the interactions of telaprevir, boceprevir and sofosbuvir with immunosuppressive drugs in liver transplant recipients.Methods
A retrospective observational study was performed in liver transplant patients with HCV infection who started treatment with telaprevir, boceprevir or sofosbuvir. Dose, regimens and plasma levels of tacrolimus, cyclosporine and sirolimus before and after antiviral treatment initiation were collected. Average variations in dose, dosing interval and immunosuppressive plasma levels after the start of treatment were calculated.Results
Thirty-five patients were included. In patients treated with telaprevir (n = 18), the cyclosporine dose was reduced by an average of 59.1% (SD = 14.6%), yielding an average reduction of 14.6% (18.8%) in plasma levels. The dose of tacrolimus was reduced by 34.3% (31.7%), increasing the dosing interval by a mean of 73.4 (38.2) hours. After this variation, tacrolimus levels were increased by an average of 59.7% (89.6%).In patients treated with boceprevir (n = 4), tacrolimus started with a reduction of 18.1% (9.8%) of the initial dose and an average increase in the dosing interval of 12.0 (16.9) hours, showing a mean reduction in plasma levels of 37.7% (21.8%). Sofosbuvir therapy (n = 13) showed no significant variations in immunosuppressive drug levels.Conclusions
The interaction of telaprevir and boceprevir with immunosuppressive drugs requires a substantial dose reduction at the beginning of treatment and close monitoring of plasma levels. 相似文献14.
Núñez Martínez Ó Matilla Peña A Merino Rodríguez B Díaz Sánchez A Colón Rodríguez A Ramón Botella E Yepes Barreto I Prieto Martín M Tellado Rodríguez JM Clemente Ricote G 《Gastroenterologia y hepatologia》2011,34(5):322-328
Introduction and objective
Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.Results
We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively.Conclusion
HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis. 相似文献15.
Óscar Núñez Martínez Isabel Marquina Ibáñez Elena Ruiz Bravo-Burguillos Alfonso Encinas Sotillos José Carlos Erdozaín Sosa 《Gastroenterologia y hepatologia》2013
We describe the case of a female patient with a previous diagnosis of primary biliary cirrhosis (PBC) and chronic hepatitis B in inactive phase who developed increased transaminase levels with no evidence of hepatitis B virus reactivation while receiving ursodeoxycholic acid treatment. A liver biopsy showed changes compatible with overlapping autoimmune hepatitis (AIH). Budesonide treatment achieved normalization of transaminase levels. We provide a review of PBC and AIH overlap syndrome and discuss the particular features of this case that led us to this diagnosis, as well as the treatment provided. 相似文献
16.
Rogger Álvaro Bendezú García Marta Casado Martín Marta Lázaro Sáez Gustavo Óliver Patrón Román Alejandra Gálvez Miras Gonzalo P. Rodríguez Laiz Mercedes González Sánchez José Luis Vega Sáenz 《Gastroenterologia y hepatologia》2013
Background
Liver enzyme (LE) elevation is a common finding in routine blood analysis. There is very little information on the most prevalent causes of these alterations in our population. In addition, a number of tests and several visits to the specialist are required to reach a diagnosis. For these reasons, we designed a protocol to streamline the evaluation of patients with LE elevations in a single-act office visit.Methods
From March 2008 until June 2010, we studied all patients with incidental LE elevation (isolated transaminase elevation, combined elevation of alkaline phosphatase [FA] and gamma-glutamyl transpeptidase [GGT], or isolated elevation of GGT) who were referred by their primary care physicians. At the time of referral, a complete biochemistry analysis was performed (LE, viral serology, autoantibodies, ceruloplasmin, iron metabolism, alpha-1-antitrypsin and thyroid hormones) and the patients underwent an abdominal ultrasound scan on the day of the office evaluation by the hepatologist.Results
A total of 427 patients were included in our study. The most common cause of transaminase elevation was non-alcoholic fatty liver disease (NAFLD) (40%), followed by alcohol intake (17%), and hepatitis C virus infection (13%). Elevated GGT levels were most commonly related to NAFLD (30%), closely followed by alcohol intake (27%), and hepatotoxicity (8%). Combined elevation of GGT and FA was associated with NAFLD (21%), alcohol (17%), and hepatotoxicity (11%). Self-limited elevation was seen in 9% of the patients and we could not identify a definite cause in 11%. A definitive diagnosis was reached in 79% of the patients.Conclusions
The single-act office visit has proven to be efficient, yielding a diagnosis in most of the patients. The most common cause of elevated LE was NAFLD. Transaminase elevation must be confirmed before a more thorough work-up is started. 相似文献17.
18.
Antonio A.M. Castro Felipe Cortopassi Russell Sabbag Luis Torre-Bouscoulet Claudia Kümpel Elías Ferreira Porto 《Archivos de bronconeumología》2012
Background
Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients.Methods
Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO2/FiO2 were measured.Results
The group who presented success to the extubation process presented 12.5 ± 2.2 = days in mechan-ical ventilation and the group who failed presented 13.1 ± 2 = days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4 ± 0.08 (0.36-0.44) and 0.5 ± 0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37 ± 0.05 (0.34-0.41; p = 0.0008) and the Pdi/Pdimax was 0.25 ± 0.05 for the success group (0.21-0.28; p < 0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r = 0.55; p = 0.009) and PaO2/FiO2 (r = −0.59; p = 0.005). Patients who presented a high RSRI (OR, 3.66; p = 0.004) and Pdi (OR, 7.3; p = 0.002), and low PaO2/FIO2 (OR, 4.09; p = 0.007), Pdi/Pdimax (OR, 4.12; p = 0.002) and RAW (OR, 3.0; p = 0.02) developed mechanical ventilation extubation failure.Conclusion
Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients. 相似文献19.
Virginia Pajares Alfons Torrego Carmen Puzo Enrique Lerma Maria Àngels Gil De Bernabé Tomás Franquet 《Archivos de bronconeumología》2010
Background and objectives
Transbronchial lung biopsy (TBLB) is a bronchoscopy procedure used to obtain peripheral lung tissue. Small size samples and artefacts lead to variable, and usually poor, diagnostic yield. The use of cryoprobes may enable larger size and better quality biopsy samples to be obtained. The purpose of this study was to evaluate the feasibility of TBLB with cryoprobes and analyse the histological quality of samples obtained.Patients and methods
We selected 10 patients with interstitial lung disease who were suitable for TBLB. A cryoprobe (Erbokryo CA®, Erbe, Germany) was introduced through the bronchoscope work channel. Then, under fluoroscopic control, the cryoprobe was placed in an area of the peripheral lung previously selected according to CT findings. A temperature of −89.5° C was applied for 3 s and the cryoprobe and bronchoscope were removed with the frozen lung sample attached to the probe. The procedure was performed under sedation and the patient was intubated to allow bronchoscope and cryoprobe removal. Safety, duration of the procedure and histological findings has been evaluated.Results
There were 10 patients (64±8 years, 6 males). Procedure length was 35 min. The specimen area was 9.5 mm2 (range 3 to 25 mm2) and the mean number of alveolar spaces was 29.62. No pneumothorax was registered. 6/10 patients had mild post-biopsy bleeding controlled with standard bronchoscopy measures.Conclusions
The use of cryoprobes for TBLB may become an alternative technique to increase diagnostic yield. 相似文献20.
Sergio Moral José F. Rodríguez-PalomaresMartín Descalzo Gerard MartíVíctor Pineda Imanol OtaeguiBruno García del Blanco Artur EvangelistaDavid García-Dorado 《Revista espa?ola de cardiología》2012