Acute and fulminant Budd-Chiari syndrome in a well-anticoagulated patient with primary antiphospholipid syndrome.
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Acenocoumarol↗
Biomedical subjects
A Gil
Publications and source records attributed to A Gil.
[Secreting villous adenoma. Diagnosis and treatment].
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Adenoma, Villous↗
Peritoneal carcinomatosis of colorectal origin. Current treatment. Review and update.
Colorectal cancer is the most frequent tumor of the digestive tract. The high incidence of abdominal dissemination; the poor prognosis of these patients, with median survival consistently ranging from 5 to 9 months in all studies of peritoneal carcinomatosis from colorectal cancer; the failure of adjuvant systemic chemotherapy treatment with a maximal survival of 18 months despite the development of new cytostatic drugs, and new combinations of use, make it crucial to search for and develop new treatment strategies. We review the principles of Sugarbaker s treatment protocol, which involves the combination of maximum cytoreductive radical oncological surgery for the treatment of all macroscopically disseminated disease with maximum perioperative intraperitoneal intensification chemotherapy to treat residual microscopic disease. We present the results of several scientific papers, all of them phase II studies with more than 10 patients treated, published in the medical literature by the main groups working in this line of treatment, together with the only phase III study reported and published so far, and finally the results of a recently reported retrospective international multicenter study. With this new alternative therapeutic approach, overall mean survival is 40% at 36 months, and 20% at 5 years. Based on these results, this new therapeutic approach is proposed as the treatment of choice for these unfortunate patients.
Antineoplastic Agents↗
[The present state of esophageal laparoscopic surgery].
Laparoscopic surgery has changed the therapeutic approach in the most frequent esophageal diseases. With the excellent results in the control of symptoms and the low associated morbidity, surgical treatment is increasingly indicated in benign esophageal pathology as a superior alternative to a chronic and less efficient medical treatment. For the hiatus hernia and gastroesophageal reflux, Nissen's fundoplication by laparoscopy is the technique of choice. The best results in the treatment of achalasia are obtained with Heller's laparoscopic myotomy. This growing experience includes the resection of tumours of the esophagus combining thoracoscopy and laparoscopy with similar results to those of open surgery.
Esophageal Achalasia↗
[Laparoscopic bariatric surgery: proximal gastric bypass].
The spectacular increase in the prevalence of obesity in our society and the significant complications and comorbidities that it gives rise to have stimulated the interest of scientists and public in this pathology. Surgical treatment is at present the only efficient and lasting treatment for morbid obesity and in many cases it appreciably improves, and even definitively cures, associated complications such as the case of diabetes or hypertension. Amongst the different techniques of bariatric surgery, the gastric bypass (GBP) seems to be definitively establishing itself, since it offers an excellent balance between loss of weight (>70% of the excess), surgical risk and subsequent quality of life. The possibility of carrying out this technique employing a laparoscopic approach has improved its acceptance by doctors and patients while it has made it possible to reduce morbidity and mortality, length of hospital stay and costs. Proximal GBP is carried on those patients with an BMI <60 Kg/m2; for BMI >60 Kg/m2 the GBP employed is denominated distal. Between October 2003 and November 2005, our centre performed 55 laparoscopic proximal Roux-en-Y gastric bypasses via laparoscopy. These involved 42 women and 13 males with an average age of 44 years. The average BMI was 43.5 (35-55.8). The average basal weight was 116.15 Kg. There was no peroperative mortality, nor reinterventions. The BMI after 12 months was 28.4. The average basal weight was 74.2 Kg. Laparoscopic Roux-en-Y proximal gastric bypass is a safe and efficient technique for the treatment of morbid obesity.
Adult↗
[Spanish adaptation of the European Guide to Cardiovascular Prevention (I)].
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Cardiovascular Diseases↗
Burden of hospitalizations attributable to rotavirus infection in children in Spain, period 1999-2000.
The aim of this study is to provide estimates on the incidence of rotavirus infection requiring hospitalization in children <or=5 years of age during the 1999-2000 period in Spain and the associated direct cost of these hospitalizations. Hospital admissions attributable to rotavirus were estimated by using data on confirmed laboratory reports of rotavirus and hospital admissions due to acute gastroenteritis. During the study period a total of 32541 cases of pathogens responsible for acute gastroenteritis were reported to the microbiological information national system (SIM) and 14.0% were rotavirus. The proportion of laboratory-confirmed rotavirus cases was extrapolated to the total number of hospitalizations for acute gastroenteritis in children <or=5 years of age. An annual incidence of 1.0 hospital admissions attributable to rotavirus per 1000 persons <or=5 years of age was found, although during the winter season it reached 2.5 hospitalizations per 1000. Overall, the estimated annual number of days of hospitalization attributable to rotavirus was 8742 days that results in a cost of 3.6 million per year.
Acute Disease↗
On statistical relationship of solar, geomagnetic and human activities.
Data of galactic cosmic rays, solar and geomagnetic activities and solar wind parameters on the one side and car accident events (CAE) in Poland on the other have been analyzed in order to reveal the statistical relationships among them for the period of 1990-2001. Cross correlation and cross spectrum of the galactic cosmic ray intensity, the solar wind (SW) velocity, Kp index of geomagnetic activity and CAE in Poland have been carried out. It is shown that in some epochs of the above-mentioned period there is found a reliable relationship between CAE and solar and geomagnetic activities parameters in the range of the different periodicities, especially, 7 days. The periodicity of 7 days revealed in the data of the CAE has the maximum on Friday without any exception for the minimum and maximum epochs of solar activity. However, the periodicity of 7 days is reliably revealed in other parameters characterizing galactic cosmic rays, SW, solar and geomagnetic activities, especially for the minimum epoch of solar activity. The periodicity of 3.5 days found in the series of CAE data more or less can be completely ascribed to the social effects, while the periodicity of 7 days can be ascribed to the social effect or/to the processes on the Sun, in the interplanetary space and in the Earth's magnetosphere and atmosphere.
Accidents, Traffic↗
Sunflower oil does not protect against LDL oxidation as virgin olive oil does in patients with peripheral vascular disease.
BACKGROUND & AIMS: The aim of this study was to compare the in vivo effects of a diet rich in virgin olive oil or sunflower oil on the lipid profile and on LDL susceptibility to oxidative modification in free-living Spanish male patients with peripheral vascular disease. METHODS: A total of 20 Spanish male subjects diagnosed with peripheral vascular disease were randomly divided into two groups (n = 10) receiving different supplements, virgin olive oil and sunflower oil for 4 months. RESULTS: The adaptation of patients to the experimental supplements was demonstrated since plasma and LDL fatty acids composition reflected dietary fatty acids. No differences in triglycerides, total cholesterol, LDL-cholesterol or HDL-cholesterol concentrations were found between the groups of patients. A significantly higher LDL susceptibility to oxidation was observed after sunflower oil intake in comparison with virgin olive oil, in spite of an increase in LDL alpha-tocopherol concentration in sunflower oil group. CONCLUSIONS: The results of the present study provide further evidence that sunflower-oil-enriched diets does not protect LDL against oxidation as virgin olive oil does in patients with peripheral vascular disease.
Aged↗
Evolution of the interaction of a new chemical entity, eflucimibe, with gamma-cyclodextrin during kneading process.
The aim of this study was to enhance the low solubility of eflucimibe, a new chemical entity which can be used as medicine to treat dyslipidemiae, by complexation with gamma-cyclodextrin. The complex was prepared using kneading method. The interaction evolution was studied during process by comparison of the semi-solid and physico-chemical states of the product. The evolution of the semi-solid state was followed by torque measurement when the evolution of physico-chemical state was studied by differential scanning calorimetry, infrared spectroscopy and by determination of the drug solubilisation profile. The interaction, which occurs during the process, is characterised by a modification of the product consistency and by a disappearance of the drug endothermic peaks, a disappearance of a drug spectral band and a widely improvement of the drug solubilisation profile. Indeed, after complete interaction, the drug quantity solubilised in specific conditions increased about 44-fold compared to those of untreated drug. Moreover, the comparison of the physico-chemical and semi-solid states during kneading process clearly shows that when the interaction takes place, a solidification of the paste occurs. The results of these works suggested that the formation of new solid phase allows an enhancement of the solubility of eflucimibe.
Anilides↗
The role of transjugular intrahepatic portosystemic shunt prior to abdominal tumoral surgery in cirrhotic patients with portal hypertension.
INTRODUCTION: Major abdominal surgery can be contraindicated in some cirrhotic patients because of severe portal hypertension. The present study reports our experience of three patients with abdominal tumours prepared for surgery by transjugular intrahepatic portosystemic shunts (TIPS) in order to reduce portal hypertension and the risk of intraoperative bleeding. PATIENTS AND METHODS: Three patients with cirrhosis and portal hypertension diagnosed with a right colon carcinoma, an adenocarcinoma of pancreas and a gastric and sigmoid synchronic tumours in the same patient. Because portal hypertension was the leading cause of surgical contraindication, neoadjuvant TIPS placement was proposed before surgery. RESULTS: TIPS placement was performed without intra-procedure complications. An average reduction of 18 mmHg was achieved in portosystemic gradients. The planned operations were performed with a delay of 14-45 days after TIPS without intraoperative bleeding. Complications occurred in one patient without operative mortality. CONCLUSION: TIPS placement allows a pre-operative portal decompression in cirrhotic patients with portal hypertension and abdominal tumours that require surgical treatment. This procedure reduces the risk of bleeding by reducing the portosystemic gradient and the varices around the tumoral area. This procedure is less invasive than conventional shunt surgery, but it is not free of complications and should be performed by experienced interventional radiologists on selected patients. This is still an experimental indication of TIPS which efficacy must be confirmed in larger series.
Abdominal Neoplasms↗
Exogenous nucleosides modulate the expression of rat liver extracellular matrix genes in single cultures of primary hepatocytes and a liver stellate cell line and in their co-culture.
BACKGROUND & AIMS: We have previously reported the antifibrotic effect of dietary nucleotides in cirrhotic rats. In this work, we used primary rat hepatocytes, a liver stellate cell line (CFSC-2G) and co-cultures of both cell types to investigate the effects of exogenous nucleosides on the gene expression of various extracellular matrix components and on markers of liver function, and to ascertain whether the effects found in vivo are due to CFSC-2G, hepatocytes, or are the consequence of cell-cell interactions. RESULTS: Nucleosides enhanced fibronectin, laminin, and alpha1(I) procollagen levels in CFSC-2G and hepatocytes, as well as collagen synthesis and secretion in CFSC-2G. In contrast, nucleosides lowered fibronectin, laminin and alpha1(I) procollagen levels, and decreased collagen synthesis in co-cultures. Matrix metalloproteinase-13 content and collagen secretion increased in co-cultures incubated with nucleosides. Albumin increased in hepatocytes and co-cultures incubated in the presence of nucleosides. CONCLUSIONS: Nucleosides modulate the production of extracellular matrix in single cultures of hepatocytes and of CFSC-2G, and in co-cultures. This effect seems to be regulated at the translational level. The opposite behavior of single cultures and co-cultures is probably due to the fact that the latter model reproduces many of the physical and functional relationships observed in vivo between hepatocytes and stellate cells.
Animals↗
Hormones regulating lipid metabolism and plasma lipids in childhood obesity.
OBJECTIVE: To review the mechanisms by which leptin, insulin and adiponectin influence lipid metabolism and plasma lipids in obesity, as well as to describe the associations between these hormones in prepubertal children. METHOD: Revision of relevant papers published in the last 5 y related to the interactions of leptin, insulin and adiponectin, with special emphasis on those reporting potential mechanisms by which these hormones regulate lipid metabolism and plasma lipids. We also provide original results concerning the relationships found between plasma lipids and leptin, and insulin and adiponectin in prepubertal obese children. RESULTS: Recent data in the literature shed new light to explain the effects of both leptin and adiponectin in the regulation of lipid metabolism in peripheral tissues. Activation of the AMP-dependent kinase pathway and subsequent increased fatty acid oxidation seems to be the main mechanism of action of these hormones in the regulation of lipid metabolism. In addition, we have found that insulin plasma levels are positively associated to leptin but negatively correlated with adiponectin in obese children. Adiponectin is negatively associated to plasma lipid markers of metabolic syndrome but positively related to HDL-cholesterol, whereas insulin and leptin show opposite patterns. These results support the effect of adiponectin in increasing insulin sensitivity and decreasing plasma triglycerides. CONCLUSION: Leptin, insulin and adiponectin are associated hormones that regulate lipid metabolism in childhood. Adiponectin appears to be the missing link to explain the alterations in lipid metabolism and plasma lipids seen in obesity.
Adiponectin↗
Expression of HLA-G in inflammatory bowel disease provides a potential way to distinguish between ulcerative colitis and Crohn's disease.
In addition to being involved in nutrient uptake, the epithelial mucosa constitute the first line of defense against microbial pathogens. A direct consequence of this physiological function is a very complex network of immunological interactions that lead to a strong control of the mucosal immune balance. The dysfunction of immunological tolerance is likely to be a cause of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn's disease (CD). HLA-G is a non-classical major histocompatibility complex (HLA) class I molecule, which is highly expressed by human cytotrophoblast cells. These cells play a role in immune tolerance by protecting trophoblasts from being killed by uterine NK cells. Because of the deregulation of immune system activity in IBD, as well as the immunoregulatory role of HLA-G, we have analyzed the expression of HLA-G in intestinal biopsies of patients with UC and CD. Our study shows that the differential expression of HLA-G provides a potential way to distinguish between UC and CD. Although the reason for this differential expression is unclear, it might involve a different mechanism of immune regulation. In addition, we demonstrate that in the lamina propria of the colon of patients with UC, IL-10 is strongly expressed. In conclusion, the presence of HLA-G on the surface of intestinal epithelial cell in patients with UC lends support to the notion that this molecule may serve as a regulator of mucosal immune responses to antigens of undefined origin. Thus, this different pattern of HLA-G expression may help to differentiate between the immunopathogenesis of CD and UC.
Biopsy↗
[Spanish adaptation of the European Guidelines on Cardiovascular Disease Prevention].
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Advisory Committees↗
[Abdominal aortic injury as a complication of laparoscopic cholecystectomy].
A 58-year-old woman with a history of high blood pressure and cesarean section by median laparotomy underwent elective laparoscopic cholecystectomy under general anesthesia. After initiation of pneumoperitoneum, hemodynamic instability developed (blood pressure 75/40 mm Hg, heart rate 47 beats/min) and resolved after volume replacement and administration of vasoactive drugs. The rest of the procedure was completed without further adverse events. After extubation, the patient was transferred to the anesthetic recovery ward, where she tended to hypotension that was unresponsive to volume replacement, with a hematocrit of 18% and hemoglobin concentration of 6.9 g/dL. Hemoperitoneum was suspected, and an emergency median laparotomy revealed 300 cc of blood in the peritoneal cavity, a large hematoma putting pressure on retroperitoneal structures, and 2 infrarenal aortic lesions (anterior and posterolateral). During the reoperation the patient required multiple transfusions and vasoactive drugs to maintain hemodynamic stability. Recovery in the postanesthetic care unit was uneventful. After transfer to the ward, on the 20th day after surgery she developed septic shock with intraabdominal fluid requiring surgical drainage and admission to the intensive care unit. Abdominal aortic injury during laparoscopic surgery usually occurs upon introduction of trocars for initiating pneumoperitoneum. The technique must be performed correctly and monitored properly to assure early detection of adverse events associated with high mortality.
Aorta, Abdominal↗
Extension of the Dubinin-Astakhov equation for evaluating the micropore size distribution of a modified carbon molecular sieve.
A new method for the characterization of the pore size distribution of microporous solids is applied on data obtained for activated carbon molecular sieve samples. In this method, based on the Dubinin-Astakhov equation, a simple numerical algorithm is used for the reconstruction of the micropore size distribution from the integral equation that represents the experimental nitrogen adsorption isotherm. The results are compared with the ones obtained on the basis of the well-known Horvath-Kawazoe method. The samples used in this study come from a carbon molecular sieve that has been treated with solutions of concentrated HNO3 at various temperatures and with solutions of H2O2 of various concentrations.
Journal Article↗
Primary ovarian trabecular carcinoid tumour: a case report with an immunohistochemical study and a review of the literature.
INTRODUCTION: Primary ovarian carcinoid tumours are uncommon neoplasias. There are distinct histological types with different behaviours: insular, trabecular, mucinous and mixed. The trabecular subtype is very rare and unlike other carcinoid subtypes, it is characterised by the absence of a clinical carcinoid syndrome and has been related with a better prognosis than the others. No distant metastases have yet been reported. CASE REPORT: We present a case of a 76-year-old woman diagnosed with a left ovarian tumour. She underwent a radical hysterectomy with bilateral salpingo-oophorectomy and regional lymph node clearance. Histology revealed an ovarian trabecular carcinoid tumour and no adjuvant treatments were performed. The patient is alive and free of disease 70 months following diagnosis. DISCUSSION: Immunohistochemical staining for p53 protein, and a comparative study with other subtypes of ovarian carcinoid tumours (insular and mucinous) is discussed in this report.
Aged↗