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1.
Transplant Proc ; 44(9): 2570-2, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23146457

RESUMO

BACKGROUND: Following liver transplantation, acute kidney injury (AKI) and chronic kidney disease occur in 20%-50% and 30%-90% of patients, respectively. Basiliximab, a chimeric monoclonal antibody, is highly effective to prevent rejection in organ transplant recipients, particularly among patients with renal dysfunction who benefit from delayed introduction of calcineurin inhibitors. OBJECTIVE: The objective of this study was to measure the immunosuppressive effect of basiliximab and its impact on renal failure, lengths of hospital and intensive care unit (ICU) stays and prevalence of infection. METHODS: From January 2010 through December 2011, we performed a controlled, nonrandomized study comparing two different immunosuppressive regimens: Group I, 36 transplantation on 34 patients, tacrolimus and corticosteroids de novo with mycophenolate mofetil in cases of renal failure; and Group II, 33 transplantation in 33 patients, corticosteriods and mycophenolate mofetil de novo with basiliximab on day 0 and day 4, and inception of tacrolimus on day 3. RESULTS: Basiliximab patients (Group II) showed a significantly lower incidence of renal failure requiring replacement therapy (3.03% vs 25%; P = .014). The incidence of acute cellular rejection episodes treated with corticosteriod boluses was also significantly lower (3.03% vs 25%; P = .014). Bacterial, fungal, and cytomegalovirus infection rates were lower in Group II, although the differences were not significant. Similarly, Group II patients had an insignificantly shorter average stay in the hospital (25.9 vs 40.06 days) and the ICU (5.9 vs 8.17 days). CONCLUSIONS: Basiliximab administration with delayed introduction of calcineurin inhibitors may be an effective strategy to reduce post-liver transplantation AKI requiring renal replacement therapy.


Assuntos
Injúria Renal Aguda/prevenção & controle , Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Fígado/imunologia , Proteínas Recombinantes de Fusão/uso terapêutico , Injúria Renal Aguda/epidemiologia , Corticosteroides/uso terapêutico , Anticorpos Monoclonais/efeitos adversos , Basiliximab , Inibidores de Calcineurina , Distribuição de Qui-Quadrado , Doenças Transmissíveis/epidemiologia , Quimioterapia Combinada , Feminino , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/efeitos adversos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação , Transplante de Fígado/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Proteínas Recombinantes de Fusão/efeitos adversos , Fatores de Risco , Tacrolimo/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
5.
Blood Coagul Fibrinolysis ; 12(3): 193-9, 2001 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-11414633

RESUMO

Factor VII (FVII) plasma levels in patients with liver disease may be below the normal range. However, no data are available on FVII expression in liver biopsies from patients with liver diseases other than cirrhosis. We have analyzed the expression of FVII by in situ hybridization in liver biopsies from 50 patients in comparison with the procoagulant activity of FVII, and with the plasma levels as activated FVII (FVIIa) and FVII antigen. The level of FVIIa was significantly lower in stage 4 liver fibrosis patients than in the remaining ones (P < 0.05). The percentage of hepatocytes expressing FVII was significantly lower in stage 4 liver fibrosis patients (4.1+/-1.3%) than in stage 3 (22.7+/-6.1%), stage 2 (31.5+/-6.1%), stage 1 (43.7+/-8.2%) and stage 0 patients (63.8+/-4.4%) (P < 0.001). These percentages correlated inversely in a statistically significant way with the histological activity index and the liver function tests. We have demonstrated that the FVIIa plasma levels in patients with chronic liver disease other than cirrhosis may be below the normal range in the absence of blood coagulation impairment. The percentage of hepatocytes expressing FVII decreases as the severity of liver damage increases.


Assuntos
Fator VII/biossíntese , Regulação da Expressão Gênica , Transtornos Hemorrágicos/etiologia , Hepatopatias/metabolismo , Fígado/metabolismo , Adulto , Idoso , Fatores de Coagulação Sanguínea/análise , Doença Crônica , Fator VII/genética , Fígado Gorduroso/metabolismo , Feminino , Hepatite B/metabolismo , Hepatite C/metabolismo , Hepatócitos/metabolismo , Humanos , Hibridização In Situ , Cirrose Hepática/metabolismo , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina , Índice de Gravidade de Doença
6.
J Virol ; 74(17): 7936-42, 2000 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10933701

RESUMO

To study the existence of GB virus C/hepatitis G virus (GBV-C/HGV) variants with different tropism, we have analyzed the heterogeneity and quasispecies composition of GBV-C/HGV isolated from in vitro-infected peripheral blood mononuclear cells (PBMC) and from sera, livers, and PBMC from two chronically infected patients. For this purpose, the GBV-C/HGV 5' noncoding region (5'NCR) was amplified by reverse transcription-PCR and the amplified products were cloned and sequenced. These analyses showed that the master 5'NCR sequences isolated from the in vitro-infected PBMC and from the PBMC isolated from the patient whose serum was used as the inoculum were identical but different from that of the inoculum. Furthermore, phylogenetic analysis revealed that all PBMC sequences grouped together into a branch which was separate from those of the inoculum. For one of the two chronically infected patients, all the sequences from the PBMC and one from the liver clustered into a single branch while the sequences from the serum and all the other liver sequences grouped together in the other branch. For the other patient, the sequences from the serum and PBMC and three sequences from the liver grouped together into one branch, while the remaining five sequences from the liver were separated in a different cluster. In conclusion, our results support the existence of different GBV-C/HGV variants with different tissue tropism.


Assuntos
DNA Viral/genética , Flaviviridae/classificação , Hepatite Viral Humana/virologia , Adulto , Sequência de Bases , Doença Crônica , DNA Viral/análise , Flaviviridae/genética , Flaviviridae/imunologia , Humanos , Soros Imunes , Leucócitos Mononucleares/virologia , Fígado/virologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA
7.
Cytokine ; 12(8): 1248-52, 2000 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10930306

RESUMO

Cytokines modulate general and virus infection-related host immune responses. We have investigated cytokine responses in chronic renal disease patients with regard to haemodialysis and hepatitis C virus (HCV) infection. Compared with healthy subjects with normal renal function (n=15), non-dialyzed/renal disease individuals without HCV infection (n=11) showed increased production of tumour necrosis factor (TNF)-alpha, interleukin (IL-)6, IL-10, interferon (IFN-)gamma and IL-12 by blood mononuclear cells (P<0.05). These inflammatory cytokine responses were abolished in haemodialysis patients (n=37;P<0.05), except for IL-12. This hyporesponsiveness in haemodialysis patients was more evident in stimulatory conditions, as shown by the consistent inhibition of IFN-gamma production, and the failure of exogenous IFN-gamma to prime for IL-12 inducibility (P<0.01). The disturbed cytokine response appeared to focus in the T-helper lymphocyte phenotype 1 (Th(1)) because the stimulation of IL-6 and IL-10 (Th(2)phenotype cytokines) was not impaired. The pattern of response was similar among haemodialysis patients with (n=24) or without (n=13) HCV infection. However, HCV-positive haemodialysis patients had a blunted TNF-alpha response (P<0.05) and failed to increase the stimulated IFN-gamma and IL-12 production (P<0.01) compared with chronic hepatitis C patients without renal disease (n=25). On the contrary, IL-10 stimulation was higher in HCV-positive haemodialysis patients (P<0.01). These results disclose the presence in haemodialysis patients of markedly abnormal general and HCV infection-related cytokine responses; the inhibitory alterations appear to affect predominantly the stimulated responses via the Th(1)subset and its relationship with monocyte response with possible pathogenic and therapeutic implications.


Assuntos
Citocinas/biossíntese , Hepatite C/metabolismo , Nefropatias/metabolismo , Diálise Renal , Doença Crônica , Feminino , Hepacivirus , Hepatite C/etiologia , Hepatite C/imunologia , Humanos , Nefropatias/complicações , Nefropatias/imunologia , Masculino , Uremia/etiologia , Uremia/metabolismo
8.
J Hepatol ; 32(6): 1019-25, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10898323

RESUMO

BACKGROUND/AIMS: There are no data about the influence of handling conditions of liver biopsies on the integrity of viral RNAs. We studied the influence of the time delay between obtaining and freezing the liver biopsy on the stability of intrahepatic positive and negative hepatitis C virus RNA (HCV-RNA) strands. METHODS: Liver samples from 30 anti-HCV patients were included. For each case, one portion of the liver biopsy (first sample) was immediately frozen (20-28 s), while the other section (second sample) was kept at room temperature (1-30 min) before freezing. Each experimental time point was performed in triplicate using liver samples from three different patients. Semi-quantitative analysis of the positive and negative HCV-RNA strands and of the al-antitrypsin mRNA was performed by a Tth-based reverse-transcription polymerase chain reaction. RESULTS: A significant time-related decrease in both positive (r=-0.8412, p=0.001) and negative (r=-0.8539, p=0.001) HCV-RNA strand titres was found in the second liver fractions. There were no appreciable changes in RNA titres in those samples frozen after less than 3 min. The RNA titres decreased in all but two samples incubated for 4-30 min. Thus, 3/15 (20%) and 7/11 (64%) of these samples lost positive and negative HCV-RNA strands, respectively. Alpha-1-antitrypsin mRNA titres decreased significantly (r=-0.8935, p=0.01) in those samples kept at room temperature for more than 4 min. CONCLUSION: Freezing of liver samples immediately after extraction is crucial to avoid false negative HCV-RNA detection results, especially for the antigenomic RNA strand.


Assuntos
Congelamento , Hepacivirus/genética , Fígado/química , Fígado/patologia , RNA Viral/análise , Biópsia , Humanos , RNA Mensageiro/análise , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sensibilidade e Especificidade , Fatores de Tempo , alfa 1-Antitripsina/genética
9.
Blood Coagul Fibrinolysis ; 11 Suppl 1: S95-9, 2000 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10850572

RESUMO

Patients with liver cirrhosis and diminished prothrombin activity (PA) have decreased levels of factor (F)VII coagulation activity (FVII:C) and an increased bleeding tendency. Whether this is also true of cirrhotic patients with normal PA is unknown. This study measured FVII:C levels in such patients and investigated the correlation between altered FVII:C levels and bleeding tendency. Fifteen of 41 patients (37%) had decreased FVII:C levels. Of these, the Child-Pugh score of liver function was A (n = 9), B (n = 5) and C (n = 1), compared to A (n = 25) and B (n = 1) in patients with normal FVII:C values (chi2 = 8.88, P = 0.012). Bleeding time was significantly prolonged in 9/15 patients (60%) with impaired FVII:C activity, compared to 3/26 (12%) patients with normal FVII:C values (relative risk: 5.2, 95% CI: 1.7-16.6; P = 0.003). In conclusion, liver cirrhosis patients may show impaired FVII:C levels despite normal PA. In those with decreased FVII:C activity, prolonged bleeding time is hypothesized to arise from an alteration in platelet activation due to FVII deficiency and diminished platelet count. Bleeding risk should be evaluated, regardless of platelet count, before these patients are subjected to invasive diagnostic or surgical procedures.


Assuntos
Fator VII/metabolismo , Hemorragia/etiologia , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Protrombina/metabolismo , Adulto , Idoso , Coagulação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco
10.
Cytokine ; 12(2): 165-70, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10671303

RESUMO

Granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered subcutaneously to 45 chronic hepatitis C patients, randomly assigned to receive 0.5, 1 or 2 microg GM-CSF/kg b.w. daily/6 weeks (n=30), or no treatment (n=15). Alanine transaminase (ALT) values normalized in four out of 10 (40%) patients administered 2 microg GM-CSF [1 cleared hepatitis C virus (HCV) RNA] but in none given 0.5 or 1 microg or untreated controls (P=0.0079). Following 4 weeks of rest, patients received 5 million units of interferon (IFN)alpha2b every other day/6 months, alone (n=30), or combined with 2 microg GM-CSF/daily for 3 months (n=15). At treatment end, ALT levels in patients administered the combination normalized more frequently than in those given monotherapy (73% vs 47%, P=0.089). Viraemia decreased significantly in 11/15 (73%) patients administered GM-CSF/IFNalpha2b combination (mean log HCV RNA copies/ml+/-SEM: 4.13+/-0.40 vs 5.29+/-0.23;P=0.011), and in 20/30 (67%) receiving IFNalpha2b monotherapy (4.27+/-0.28 vs 5. 31+/-0.14;P=0.004); 27% and 20% of patients given the combination and monotherapy, respectively, cleared HCV RNA. One patient in each regime had a sustained response after 12 months. 2', 5'-Oligoadenylate synthetase activity (2-5AS) increased during GM-CSF therapy (P=0.033 with the 2 microg dose). 2-5AS increased more in the GM-CSF/IFN-alpha2b combination than with IFNalpha2b monotherapy (P<0.02). GM-CSF provoked a skin reaction at the injection site, accompanied by moderate and reversible rises in eosinophil and leucocyte counts. In summary, daily s.c. GM-CSF administration is safe and shows effects against HCV; the GM-CSF/IFNalpha2b combination has an additional-but transient-antiviral activity in chronic hepatitis C.


Assuntos
Antivirais/uso terapêutico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Adolescente , Adulto , Idoso , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Toxidermias/etiologia , Quimioterapia Combinada , Feminino , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Fator Estimulador de Colônias de Granulócitos e Macrófagos/efeitos adversos , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , Viremia/tratamento farmacológico
11.
Am J Pathol ; 154(6): 1877-81, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10362814

RESUMO

It has not been completely elucidated whether the liver injury induced by the hepatitis C virus (HCV) is due to direct cytopathic damage or to an immune-mediated response against HCV-infected hepatocytes. In this work, we have determined the percentage of HCV-infected hepatocytes, the histological activity index, and the viremia levels in chronically HCV-infected patients with different grades of liver injury to investigate any possible correlation between them. For that purpose, liver biopsies from 27 patients with HCV chronic hepatitis were analyzed by in situ hybridization. This technique revealed that the percentage of infected hepatocytes ranged from 0.04% to 83.6%. Regarding the viremia levels, HCV RNA concentration ranged from 1.8 x 10(3) to 1.4 x 10(6) genome copies/ml. A significant correlation (r = 0.54; P = 0.003) between the percentage of infected hepatocytes and the viremia levels was found. In contrast, no correlation was observed between the percentage of HCV-infected hepatocytes or the viremia levels and the histological activity index. In conclusion, we have shown that the HCV viremia reflects the extent of the infection in the liver and that the liver injury in chronic HCV infection is not directly related to either the number of infected hepatocytes or the serum HCV RNA concentration.


Assuntos
Hepacivirus/patogenicidade , Hepatite C Crônica/patologia , Hepatite C Crônica/virologia , Biópsia , DNA Viral/metabolismo , Feminino , Genótipo , Hepacivirus/isolamento & purificação , Humanos , Hibridização In Situ , Masculino , RNA Viral/sangue , Análise de Regressão , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Carga Viral
12.
J Virol ; 73(5): 4052-61, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10196301

RESUMO

GB virus C (GBV-C), also known as hepatitis G virus, is a recently discovered flavivirus-like RNA agent with unclear pathogenic implications. To investigate whether human peripheral blood mononuclear cells (PBMC) are susceptible to in vitro GBV-C infection, we have incubated PBMC from four healthy blood donors with a human GBV-C RNA-positive serum. By means of (i) strand-specific reverse transcription-PCR, cloning, and sequencing; (ii) sucrose ultracentrifugation and RNase sensitivity assays; (iii) fluorescent in situ hybridization; and (iv) Western blot analysis, it has been demonstrated that GBV-C is able to infect in vitro cells and replicate for as long as 30 days under the conditions developed in our cell culture system. The concentration of GBV-C RNA increased during the second and third weeks of culture. The titers of the genomic strand were 10 times higher than the titers of the antigenomic strand. In addition, the same predominant GBV-C sequence was found in all PBMC cultures and in the in vivo-GBV-C-infected PBMC isolated from the donor of the inoculum. GBV-C-specific fluorescent in situ hybridization signals were confined to the cytoplasm of cells at different times during the culture period. Finally, evidence obtained by sucrose ultracentrifugation, RNase sensitivity assays, and Western blot analysis of the culture supernatants suggests that viral particles are released from in vitro-GBV-C-infected PBMC. In conclusion, our study has demonstrated, for the first time, GBV-C replication in human lymphoid cells under experimental in vitro infection conditions.


Assuntos
Flaviviridae/fisiologia , Leucócitos Mononucleares/virologia , Sequência de Bases , Western Blotting , Células Cultivadas , Meios de Cultura , DNA Viral , Flaviviridae/genética , Flaviviridae/imunologia , Genoma Viral , Humanos , Hibridização in Situ Fluorescente , Dados de Sequência Molecular , RNA Viral , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Sensibilidade e Especificidade , Análise de Sequência de RNA
13.
Rev Esp Enferm Dig ; 89(3): 174-85, 1997 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-9141899

RESUMO

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).


Assuntos
Peritonite/diagnóstico , Idoso , Bactérias/isolamento & purificação , Cefotaxima/uso terapêutico , Cefalosporinas/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Estudos Retrospectivos , Fatores de Tempo
14.
Eur J Gastroenterol Hepatol ; 8(12): 1165-8, 1996 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8980934

RESUMO

OBJECTIVE: To determine the seroprevalence of Helicobacter pylori infection in healthy individuals in Spain and its relationship with different epidemiological features. PATIENTS AND METHODS: The study was conducted on a large group of healthy individuals without ulcer disease antecedents or other gastrointestinal disease; moreover, information, was obtained on symptoms attributable to the gastrointestinal tract, smoking, alcohol consumption, non-steroidal anti-inflammatory drug (NSAID) use as well as the presence of peptic ulcer disease antecedents among first-degree relatives. The H. pylori infection status was ascertained by immunoglobulin G (IgG) antibody determination, using a quantitative enzyme-linked immunosorbent assay. RESULTS: Three hundred and eighty-one individuals (138 males and 243 females) were included in the study (mean age: 34.3 +/- 12.9 years; range: 5-77). Two hundred and two individuals (53%) were positive for H. pylori IgG antibodies. A consistent increase in H. pylori infection seroprevalence with increasing age was observed. No association was observed between H. pylori infection and consumption of alcohol, NSAID use or smoking. On the other hand, the presence of digestive symptoms and peptic ulcer disease antecedents among first-degree relatives were associated with a higher prevalence of infection in a given individual (P < 0.05). CONCLUSION: H. pylori infection seroprevalence in healthy individuals in Spain is similar to that in countries with high socio-economic standards and other Western countries. Digestive symptoms and previous antecedents of peptic ulcer disease in first-degree relatives were associated with a higher prevalence of Helicobacter pylori infection.


Assuntos
Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Fatores Etários , Anticorpos Antibacterianos/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Helicobacter pylori/imunologia , Humanos , Masculino , Úlcera Péptica/genética , Prevalência , Estudos Soroepidemiológicos , Espanha/epidemiologia
16.
Rev Esp Enferm Dig ; 88(6): 403-8, 1996 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-8755320

RESUMO

AIM: To describe the prevalence of Helicobacter pylori infection in patients with gastric adenocarcinoma, and compare it with that of patients with chronic gastritis. METHODS: Fifty-four patients with endoscopically diagnosed gastric cancer (later confirmed histologically as gastric adenocarcinoma), and 60 patients with histologic chronic gastritis were studied. Age and sex distribution was similar in both groups. At endoscopy biopsy specimens were taken from antrum and body (H&E stain, Gram stain and culture). RESULTS: H. pylori was found in 95% (95%CI = 86-98%) of patients with chronic gastritis, and in 41% (CI = 29-54%) of patients with gastric adenocarcinoma (p < 0.001). H. pylori was present in malignant tissue in 13% (CI = 6-24%) of cases, a significant lower (p < 0.01) percentage than in the gastric antrum and body. CONCLUSION: The prevalence of H. pylori infection diagnosed by microbiologic and histologic methods in patients with gastric adenocarcinoma (41%) is significantly lower than in patients with chronic gastritis, its premalignant lesion. H. pylori was present less frequently in malignant tissue than in endoscopically normal mucosa.


Assuntos
Adenocarcinoma/complicações , Gastrite/complicações , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Neoplasias Gástricas/complicações , Fatores Etários , Idoso , Doença Crônica , Estudos Transversais , Feminino , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Antro Pilórico/microbiologia , Fatores Sexuais , Estômago/microbiologia
18.
Rev Esp Enferm Dig ; 88(1): 3-8, 1996 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-8615998

RESUMO

AIM: To study basal pepsinogen I levels in patients with duodenal ulcer and in subjects with normal endoscopy, depending on Helicobacter pylori status. METHODS: One-hundred and one patients with duodenal ulcer and 74 controls with normal endoscopy were studied. Mean age and gender distribution were: 46 vs 42 years, and 74% vs 43% males, respectively. At endoscopy biopsies from the gastric antrum and body were obtained for histologic (H&E) and microbiologic (Gram and culture) study. Basal levels of serum pepsinogen I were measured (RIA). RESULTS: Among the subjects with a normal endoscopy, those with H. pylori infection had higher pepsinogen I levels (m +/- SD) than non-infected patients (77 +/- 27 vs 62 +/- 28 ng/ml; p < 0.05). Basal levels in duodenal ulcer patients were 107 +/- 38 ng/ml, higher (p < 0.001) than in the group with normal endoscopy (both with and without H. pylori). In multivariate analysis pepsinogen I levels were correlated with H. pylori infection (regression coef.= 17; SE= 8.1), duodenal ulcer (regr. coef.= 22; SE= 5.8) and smoking habit (regr. coef.= 24; SE= 5.2). CONCLUSION: Basal pepsinogen I levels were significantly higher in duodenal ulcer patients than in H. pylori infected subjects with normal endoscopy. The lowest levels corresponded to non-infected patients. Therefore, an additional factor other than H. pylori infection is likely involved in the hyperpepsinogenemia classically reported in duodenal ulcer patients.


Assuntos
Úlcera Duodenal/sangue , Infecções por Helicobacter/sangue , Helicobacter pylori , Pepsinogênios/sangue , Adulto , Idoso , Interpretação Estatística de Dados , Úlcera Duodenal/diagnóstico , Endoscopia , Feminino , Gastrite/sangue , Gastrite/diagnóstico , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
19.
Rev Esp Enferm Dig ; 87(2): 99-107, 1995 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-7748715

RESUMO

UNLABELLED: Hypergastrinemia has long been considered an important factor in the pathophysiology of duodenal ulcer. Moreover, H. pylori infection has been reported in virtually all duodenal ulcers. AIM: To demonstrate the influence of H. pylori eradication on the basal levels of serum gastrin in patients with duodenal ulcer. METHODS: Seventy-six patients with endoscopically proved duodenal ulcer were prospectively studied. At endoscopy three biopsy samples each were taken from duodenal bulb, gastric antrum, corpus and fundus. Two samples from every location were submitted for conventional histological examination and the other for microbiological examination (Gram staining and culture). Endoscopy was repeated one month after the end of therapy, when endoscopy samples were again obtained from the gastric antrum and corpus. Basal levels of gastrin were measured both at initial and repeat endoscopies. Different therapeutic regimes were used: Amoxycillin/Clavulanate plus omeprazole or ranitidine, and triple therapy. RESULTS: H. pylori eradication was associated with a significant histological improvement (p < 0.001), both in antrum and corpus. In those patients with eradicated H. pylori the differences in basal gastrin levels both at diagnosis and after therapy were 45.4 +/- 11 pg/ml and 36.7 +/- 10 pg/ml, respectively; these differences were statistically significant (p < 0.001). When eradication was not achieved differences were not significant. The area under the ROC curve constructed from the different cutoff points for the gastrin decreases was 0.68 (EE 0.06). CONCLUSION: H. pylori eradication in patients with duodenal ulcer was associated with a significant decrease in basal levels of serum gastrin. Although the verification of such a decrease doesn't have an optimal relationship between sensitivity and specificity, it could be an aid as a useful non-invasive method to monitor the efficiency of therapy, both in H. pylori eradication and in the resolution of the associated gastritis. This procedure is also associated with early results and a low cost.


Assuntos
Úlcera Duodenal/sangue , Úlcera Duodenal/microbiologia , Gastrinas/sangue , Helicobacter pylori/isolamento & purificação , Adulto , Idoso , Úlcera Duodenal/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
20.
Dig Dis Sci ; 39(9): 1994-9, 1994 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8082509

RESUMO

Bronchobiliary fistula is a rare condition, defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the development of such a communication. Biliary lithiasis is one of those and is perhaps the one most amenable to endoscopic management. We describe a case of bronchobiliary fistula secondary to the development of choledocholithiasis in a cholecystectomized patient. The clinical suspicion was raised by the presence of bilioptosis (bile-stained sputum), and the diagnosis established by endoscopic retrograde cholangiopancreatography. The patient was submitted to endoscopic sphincterotomy and stone extraction, achieving frank clinical alleviation. This case gives us the chance to review bronchobiliary fistulas secondary to biliary lithiasis, placing particular emphasis on the opportunities of endoscopic management.


Assuntos
Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Cálculos Biliares/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Esfinterotomia Endoscópica
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