[Splanchnic hemodynamic effects of somatostatin and octreotide in cirrhotic patients. A Doppler ultrasonographic study]. / Efecto hemodinámico esplácnico de somatostatina y octreótido en cirróticos. Estudio con ultrasonografía Doppler.

AIM: Doppler-ultrasound assessment of the splanchnic hemodynamic effects of intravenous somatostatin and octreotide administration. MATERIAL AND METHOD: Forty-five cirrhotic patients with esophageal varices were randomized to receive 1-hour intravenous somatostatin (SOM, 250 mg), octreotide (OCT, 50 mg), or placebo (PLA). In baseline and at 15, 30, 45 and 60 minutes of infusion, mean velocity, congestion index, flow volume and diameter of the portal vein, as well as the superior mesenteric artery resistivity index, were measured. Plasma bradykinine and vasoactive intestinal peptide (VIP) concentrations were also measured at baseline and at 30 and 60 minutes. RESULTS: While placebo caused no changes in any of the venous and arterial parameters, SOM and OCT caused a sustained decrease in portal vein velocity (-19.41 vs. -11.19%) and flow (-22.79 vs. -12.33%), and an increase in the congestion index (+17.5 vs. +7.5%) and resistivity index of the superior mesenteric artery (+7.18 vs. +6.16%) with respect to baseline (p < 0.05). These changes were already evident at 15 minutes and remained unchanged during the time of the study period. With respect to OCT, SOM caused a higher reduction in mean velocity and flow of the portal vein, with no significant differences for congestion index and mesenteric artery resistivity index, both increased by SOM and OCT. Plasma bradykinine and VIP concentrations remained unchanged in the three groups. CONCLUSIONS: At therapeutic doses, intravenous somatostatin and octreotide reduce portal vein velocity and flow, and increase portal vein congestion index and superior mesenteric artery resistivity index. Somatostatin causes a higher portal flow reduction than octreotide in spite of a similar splanchnic arterial effect.

Efecto hemodinámico esplácnico de somatostatina y octreótido en cirróticos. Estudio con ultrasonografía Doppler / No disponible

Objetivo: valoración ultrasonografica Doppler del efecto hemodinámicode la administración intravenosa de somatostatina yoctreótido.Material y método: aleatorizamos a 45 cirróticos con varicesesofágicas para recibir en una hora una infusión intravenosa de somatostatina(SOM, 250 mg), octreotido (OCT, 50 mg) o placebo (PLA).Pretratamiento y a 15, 30, 45 y 60 minutos medimos velocidad media,índice de congestión, volumen de flujo y diámetro de la vena portaademás del índice de resistencia en arteria mesentérica superior.Analizamos las concentraciones séricas de bradicinina y péptido intestinalvasoactivo (VIP) en situación basal y a 30 y 60 minutos.Resultados: respecto de los valores basales tanto SOM comoOCT provocaron un descenso significativo en la velocidad (-19,41vs. -11.19%) y flujo portal (-22,79 vs. -12,33%), con aumento delíndice de congestión (+17,5 vs. +7,5%) y del índice de resistenciaarterial (+7,18 vs. +6,16%) respecto de sus valores basales (p <0,05). Estos efectos eran ya evidentes a los 15 minutos y se mantuvierondurante todo el tiempo del estudio. Los cambios inducidosen la velocidad y flujo portal eran más pronunciados con SOMque con OCT, sin diferencias en el índice de congestión o en el índicede resistencia arterial. Los niveles plasmáticos de bradicininay VIP no experimentaron cambios respecto de sus niveles pretratamientoen ninguno de los grupos.Conclusiones: a dosis terapeúticas, somatostatina y octreotidoreducen la velocidad y flujo portales, incrementando el índicede congestión y el índice de resistencia en la arteria mesentéricasuperior. La somatostatina determina una reducción del flujo venosoportal más marcada que la inducida por octreótido a pesarde un efecto similar sobre la resistencia arterial esplácnica

Aim: Doppler-ultrasound assessment of the splanchnic hemodynamiceffects of intravenous somatostatin and octreotide administration.Material and method: forty-five cirrhotic patients withesophageal varices were randomized to receive 1-hour intravenoussomatostatin (SOM, 250 mg), octreotide (OCT, 50 mg), orplacebo (PLA). In baseline and at 15, 30, 45 and 60 minutes ofinfusion, mean velocity, congestion index, flow volume and diameterof the portal vein, as well as the superior mesenteric arteryresistivity index, were measured. Plasma bradykinine and vasoactiveintestinal peptide (VIP) concentrations were also measured atbaseline and at 30 and 60 minutes.Results: while placebo caused no changes in any of the venousand arterial parameters, SOM and OCT caused a sustained decreasein portal vein velocity (-19.41 vs. –11.19%) and flow (-22.79vs. –12.33%), and an increase in the congestion index (+17.5 vs.+7.5%) and resistivity index of the superior mesenteric artery (+7.18vs. +6.16%) from baseline (p < 0.05). These changes were alreadyevident at 15 minutes and remained unchanged over the study period.With respect to OCT, SOM caused a higher reduction in meanvelocity and flow in the portal vein, with no significant differences forcongestion index and mesenteric artery resistivity index, both increasedby SOM and OCT. Plasma bradykinine and VIP concentrationsremained unchanged in the three groups.Conclusions: at therapeutic doses, intravenous somatostatinand octreotide reduce portal vein velocity and flow, and increaseportal vein congestion index and superior mesenteric artery resistivityindex. Somatostatin causes a higher portal flow reductionthan octreotide in spite of a similar splanchnic arterial effect

Estudio descriptivo de los pacientes ambulatorios con enfermedad hepática por alcohol en nuestro medio / Descriptive study of outpatients with alcohol liver disease in our population

Objetivo: Nos propusimos describir las características demográficas y los hábitos de consumo de alcohol de un grupo de pacientes ambulatorios. Intentamos discernir la influencia de la edad, sexo, habitat y nivel socioeconómico sobre el hábito enólico. Diseño experimental: Nuestro estudio es retrospectivo, de base institucional. Pacientes: 164 pacientes ambulatorios, en seguimiento en nuestras consultas externas de la unidad de Hepatología por enfemedad hepática alcohólica. Resultados: La edad media de inicio fue 18,6 (7,36) años; los años de enolismo medio fueron de 35,4 (13,5) años y el consumo medio de alcohol de 161,2 (116,7) gramos de alcohol/día. Solo en 16 hombres (8 por ciento) se observó un consumo menor de 60 gramos de alcohol al día, y 5 mujeres (35,7 por ciento) consumían menos de 40 gramos de alcohol al día. El consumo de alcohol a lo largo de la vida estuvo correlacionado con el índice de Maddrey al final del estudio (r=+0,407). De igual forma el consumo diario de gramos de alcohol estuvo correlacionado con el aspecto ecográfico del hígado(r=+0,283), apreciándose también correlación de dicha técnica de imagen (r=+0,301) con el Tiempo de Protrombina al inicio del estudio. El porcentaje de pacientes que presentaron al menos un episodio de descompensación de su cirrosis fue del 39 por ciento. Conclusiones: La edad de inicio ronda la mayoría de edad . El consumo de alcohol a lo largo de la vida, estuvo correlacionado con el tiempo de protrombina en la última visita y el aspecto ecográfico del hígado (AU)

[Descriptive study of ambulatory patients with alcohol-related liver disease in our setting]. / Estudio descriptivo de los pacientes ambulatorios con enfermedad hepática por alcohol en nuestro medio.

AIMS: We tried to show the demographic characteristic and alcohol intake habits among our outpatients. We study the influence of age, sex, habitat and socioeconomical status on alcoholic habit. DESIGN: Retrospective and institution based study. Patients. 164 patients who were followed up for alcohol liver disease in our outpatient section. RESULTS: Average age to start drinking alcohol was 18.6 (7.36) years, years of alcoholism were 35.4 (13.5) years, average daily alcohol intake was 161.2 (116.7) grams of pure alcohol. Only 16 men (8%) drank less than 60 grams a day. 5 (35.7%) women drank less than 40 grams a day. Life-cumulative alcohol intake was correlated with Maddrey's score at the end of the study (r = +0.407). Average daily alcohol intake was correlated with ultrasonographic features of the liver (r = +0.283), we appreciated that Prothrombin Time was also correlated with ultrasonographic features of the liver (r = +0.301). The percentage of patients who suffer, at least one decompensation of their disease was 39%. CONCLUSIONS: Average age to start drinking is about legal age. Life-cumulative alcohol intake was related to Prothrombin Time and ultrasonographic features of the liver.

Deflazacort for long-term maintenance of remission in type I autoimmune hepatitis.

OBJECTIVE: most patients with autoimmune hepatitis require long-term treatment, but up to 80% of them will develop collateral effects. The aim of this study was to evaluate the efficacy of deflazacort, an oxazolinic derivative of prednisolone with fewer effects on bone and glucose metabolism, in the maintenance of remission of type I autoimmune hepatitis in patients treated previously with conventional immunosuppressive therapy. METHODS: fifteen patients with type I autoimmune hepatitis were included. All patients had been treated previously with prednisone with or without azathioprine until biochemical remission was obtained and the dose could be reduced. Prednisone was then discontinued and deflazacort was started at a dose adjusted to a ratio of 5 mg prednisone per 7.5 mg deflazacort. The biochemical activity (serum ALT and IgG levels) of liver disease was monitored during a follow-up period of 25.8 +/- 7. 7 months. RESULTS: prednisone therapy was followed by a statistically significant decrease in serum ALT (0P: 386 +/- 345 U/L vs 2M 80 +/- 22 U/L, p < 0.02) and IgG (0P 3029 +/- 1934 mg/dL vs 2M 2064 +/- 933 mg/dL, p < 0.05), from the second month of treatment. After changing to deflazacort no alterations in ALT and IgG serum levels were detected except for a mild, transient increase in serum IgG during the first 3 months. During follow-up, 94% of the patients had normal or slightly increased (less than 50% above normal) ALT levels. The titers of ANA and ASMA remained the same in 82% of the patients, decreased in 12%, and increased in the remaining 6%. During follow-up no patient developed arterial hypertension, diabetes mellitus, or changes in visual acuity. Eight patients, all women, complained of dorsolumbar pain which was not related to osteoporosis. CONCLUSIONS: deflazacort seems to be useful in maintaining remission of autoimmune hepatitis during a prolonged period of follow-up. Future studies should include a histological evaluation of the patients and a prospective comparative analysis of side-effects.

[Zieve's syndrome. A case report]. / Síndrome de Zieve. Descripción de un caso clínico.

We report a case of Zieve's Syndrome that developed after an important alcohol consumption in a 32-yr-old female patient. She was admitted to the hospital with anorexia, asthenia and jaundice. Physical examination showed liver stigmata and hepatomegaly. Laboratory tests demonstrated increased aminotransferase levels, hyperbilirubinemia, hyperlipidemia and normocytic and normochromic anemia with dianocytes in peripheral blood smear. Ultrasonography showed a hyperechoic liver and a liver biopsy showed acute and chronic alcoholic liver disease. Clinical evolution was satisfactory and the therapy consisted of blood transfusion, parenteral fluids, B-complex vitamin and a fatty free diet. Jaundice, hyperlipidemia and haemolytic anemia define Zieve's Syndrome (Z.S.) There is a pathogenetic relationship among the clinical and biological phenomena in this syndrome, whose starter is an acute alcohol intake. Haemolysis is the distinctive feature with respect to the classical acute alcoholic hepatitis, and it is due to erythrocyte's metabolic and osmotic instability in relation to lipids abnormalities. Its clinical resolution precedes the normalization of serum lipids levels. Therapy is similar to that for acute alcoholic hepatitis although sometimes the anemia requires blood transfusion.

[The patient with functional dyspepsia and his/her response to therapy]. / El paciente con dispepsia funcional y su respuesta terapéutica.

We studied during 12 months in the Centro de Especialidades Médicas "Esperanza Macarena" 997 patients with functional dyspepsia (324 males and 673 females) with a mean age of 37.4 and 42.6 years respectively. Patients with any organic disease, including diabetes, were excluded from the study. After completing the study we conclude that patients with functional dyspepsia constitute a large group of patients in gastroenterology clinics, that require multiple diagnostic tests, at great cost and scarce therapeutic successes. Only 36.5 percent of all patients had a good treatment response, most being under 40 years of age and with a relatively high cultural level. Therapeutic response depended on age, sex and social level. The best pharmacological results were obtained with cisapride (10 mg before meals).