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A Parés

Publications and source records attributed to A Parés.

At least 73 records · Page 4Linked to original sources
PubMed1992

Validity of self-reported alcohol consumption in the emergency room: data from the United States, Mexico and Spain.

The validity of self-reported alcohol consumption within 6 hours prior to injury based on breath-analyzer readings obtained at the time of emergency room (ER) admission is compared among probability samples of ER patients in Contra Costa County, California (n = 450), Mexico City (n = 500) and Barcelona, Spain (n = 864). The same questionnaire, study design and methods were used in all three countries to maintain comparability for comparative analyses. The analysis was restricted to those breath analyzed within 6 hours of injury occurrence who reported no drinking following the event. Validity of self-reports was high in all three samples. The proportion of those reporting not drinking prior to injury who had positive breath-analyzer readings was .5% in the U.S., 1.5% in Spain and 3.3% in Mexico. Validity of self-reports was not associated with cause of injury in the United States. In Mexico those injured in motor vehicle accidents or by violence were most likely to deny drinking, while in Spain those injured in violent situations were most likely to report not drinking. Validity of self-reports in these studies is much higher than that found in other U.S. studies, but this may be partly due to the fact that self-reports were obtained after the patient had been breath analyzed.

Adolescent↗
PubMed1992

Reduced spinal and femoral bone mass and deranged bone mineral metabolism in chronic alcoholics.

Prevalence and factors which may influence the development of osteoporosis have been assessed in 32 chronic alcoholic males by measuring the bone mineral density (BMD) of the lumbar spine and femoral neck by dual photon absorptiometry. Serum bone Gla-protein, as an index of bone formation, 25-hydroxyvitamin D, testosterone and cortisol levels were also measured. Eleven patients (34%) had osteoporosis. In seven the lumbar BMD was below the fracture threshold. Lumbar and femoral neck age-matched BMD were below mean normal values in 20 and in 23 patients, respectively. Moreover, the age-matched BMD was significantly lower in the femoral neck (91.7 +/- 14.4%) than in the lumbar spine (100.1 +/- 17.1%) (P < 0.001). Duration of alcoholism was significantly higher in patients with age-matched BMD below 100% than in those with age-matched BMD above 100%. Bone GLA-protein and 25- hydroxyvitamin D were below normal levels in 67% and 56% of patients, respectively. Serum testosterone was normal in all but two patients, and cortisol was within normal values in all patients tested. In addition a direct correlation was found between the days of abstinence before the study and serum levels of bone GLA-protein (r = 0.64, P < 0.001). In conclusion, chronic alcoholics frequently have bone loss of the lumbar spine and femoral neck related with the duration of alcohol intake. The correlation between bone-GLA protein levels and the days of abstinence suggests that alcohol directly depresses bone formation. Likewise, the low levels of vitamin D also support that this deficiency may contribute to the development of osteopenia in chronic alcoholism.

Adult↗
PubMed1991

Quantitative measurement of fibrosis in pancreatic tissue. Evaluation of a colorimetric method.

A colorimetric method has been used to quantify the collagen contained in 23 specimens of pancreatic tissue (11 controls and 12 chronic pancreatitis). The method takes advantage of the selective capacity of Sirius red to stain collagen protein and of rapid green to stain noncollagen protein. The results obtained by this method were compared with those of standard morphometry to determine tissue fibrosis. With the morphometric method, the values of the control group were 6.6 +/- 4.0% (fiber area/total area), and those of chronic pancreatitis 66.0 +/- 19.0% (difference 59.4, 95% confidence interval for difference: 47.2-71.6, P less than 0.001). The values obtained with the colorimetric method were 89.1 +/- 11.6 micrograms collagen/mg total protein in the control group, and 132.7 +/- 25.3 micrograms collagen/mg total protein in the chronic pancreatitis group (difference 43.6, 95% confidence interval for difference: 26.3-61.0, P less than 0.001). A highly significant correlation (r = 0.847; p less than 0.001) was observed between the amount of collagen measured colorimetrically and the degree of fibrosis determined morphometrically. These results demonstrate that the colorimetric method is a reproducible, simple, and rapid technique to quantitate fibrosis in histological preparations of pancreatic tissue.

Alcoholism↗
PubMed1991

Drinking patterns and problems: a comparison of emergency room populations in the United States and Spain.

The association of alcohol consumption and casualties is compared in probability samples of two culturally diverse emergency room populations: Barcelona, Spain (N = 2972) and Contra Costa County, California (N = 3609). Similar methods and data collection instruments were used to breathalyze and interview patients regarding self-reported alcohol consumption 6 h prior to the injury, usual drinking patterns and alcohol-related problems. Breathalyzer reading was positively associated with injury in both Contra Costa and Barcelona, but at the legal level only in Barcelona. Self-reported alcohol intake within 6 h prior to the event was positively associated with injury only among females in Contra Costa. Frequent light drinking was associated with injuries in Barcelona while heavier drinking was associated with injuries in Contra Costa. Little association was found between social consequences of drinking and injuries in either sample, however, the Contra Costa sample reported significantly higher rates of these problems than Barcelona, among moderate and high quantity drinkers. Although few differences were found between the two samples, findings suggest that usual drinking patterns within a culture may influence the association of alcohol and casualties, and future studies should explore these differences by type and cause of injury.

Adolescent↗
PubMed1991

Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial.

The effect of parenteral amino acid administration on nutritional state, liver function and mortality was assessed in patients with severe alcoholic hepatitis. Twenty-eight patients received 2 l/day of a solution of dextrose (65 gm/L) and amino acids (25.8 gm/L) for 1 mo, whereas 26 received only the dextrose solution. All patients were allowed to eat a standard hospital diet. During the month in the hospital, there were six deaths in the treatment group and five deaths in the control group. Nitrogen balance improved in the treated group, but not in the control group. Creatinine-height index, triceps skin fold measurement and levels of serum albumin and prealbumin increased similarly in both groups. Serum retinol binding protein increased more in the treatment group than it did in the control group, and transferrin was increased only in the treatment group. Serum bilirubin, type III amino-terminal procollagen peptide and aminopyrine clearance improved more in the treatment group than in the control group, whereas serum AST and prothrombin time improved in the treatment group but not in the control group. Cumulative 2-yr survival rates from the day of entry into the study were 42% and 38% in the treatment and control groups, respectively. Patients who survived 2 yr and patients in the treatment group who died during the 2-yr follow-up had continued improvement in serum retinol binding protein, transferrin, bilirubin and prothrombin time. These parameters were unchanged in patients in the control group who died during follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Hepatitis C virus infection in patients with nonalcoholic chronic liver disease.

STUDY OBJECTIVE: To determine the prevalence and meaning of antibodies to the hepatitis C virus (HCV) in patients with nonalcoholic chronic liver diseases. DESIGN: Cross-sectional study. SETTING: The liver unit of a referral-based university hospital. PATIENTS: Three hundred and forty-six consecutive patients, including 137 with cryptogenic chronic liver disease, 156 with chronic hepatitis B, 47 with primary biliary cirrhosis, and 8 with persistently abnormal aminotransferase serum levels and normal liver histology. Among patients with cryptogenic liver disease, 41 received blood transfusions before discovery of liver disease and 18 had circulating nonorgan-specific autoantibodies. For comparison, 1495 apparently healthy volunteer blood donors were included in the study. LABORATORY INVESTIGATIONS: The presence of anti-HCV antibodies (anti-HCV) was determined by a recently developed enzyme-linked immunoassay. MEASUREMENTS AND MAIN RESULTS: In patients with cryptogenic liver disease, the prevalence of anti-HCV was 82% (95% CI, 76% to 89%), being higher (P = 0.02) in patients with histories of blood transfusion than in those with unknown sources of exposure. Antibodies to HCV were not detected in patients with antinuclear antibodies at high titer. Among patients with chronic hepatitis B, anti-HCV were found in 11% (CI, 5% to 18%) of those with hepatitis B virus (HBV)-associated DNA in serum and in 29% (CI, 17% to 43%) of those with undetectable HBV replication (P less than 0.05). The prevalence of anti-HCV in blood donors was 1.2% (CI, 1.1% to 1.3%). CONCLUSIONS: Our results indicate that HCV infection probably plays an important etiologic role in cryptogenic liver disease and, in some patients, in chronic hepatitis B. Determining whether anti-HCV are present appears to be useful for differentiating viral from autoimmune chronic liver diseases.

Adolescent↗
PubMed1990

Hepatitis C virus antibodies in chronic alcoholic patients: association with severity of liver injury.

The prevalence of hepatitis C virus antibody and its relationship to the severity of liver disease in chronic alcoholic patients has been assessed, using a recently developed enzyme immunoassay and confirmed by a recombinant immunoblot assay, in 144 patients (mean age +/- S.D. = 44.4 +/- 11.3 yr) who had consumed greater than 80 gm/day ethanol for greater than 5 yr. Hepatic disease was evaluated by clinical and biochemical studies and by liver biopsy when appropriate. In addition, 76 liver biopsy specimens from these patients were analyzed to determine whether liver lesions were similar in alcoholic patients with and without hepatitis C virus antibodies. According to clinical and histological features alcoholic patients were divided into five groups: normal liver (45 patients), fibrosteatosis (20 patients), alcoholic hepatitis (14 patients), cirrhosis (61 patients) and chronic hepatitis (4 patients). Hepatitis C virus antibodies were present in 35 alcoholic patients (24.3%). The prevalence of hepatitis C virus antibodies correlated with the severity of liver injury: 2.2% in patients without liver disease, 20% in those with fibrosteatosis, 41.4% in those with alcoholic hepatitis and 42.6% in those with cirrhosis. Hepatitis C virus antibodies were found in one of the four patients with chronic hepatitis (p less than 0.001). Furthermore, patients positive for hepatitis C virus antibodies with normal liver or fibrosteatosis showed higher serum bilirubin and gamma-globulin concentrations and lower aminopyrine breath test scores than did patients negative for hepatitis C virus antibodies with normal liver or fibrosteatosis. Similar differences between patients with and without hepatitis C virus antibodies were observed in patients with alcoholic hepatitis or cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Factors influencing the development of metabolic bone disease in primary biliary cirrhosis.

The prevalence, type, and factors that may influence the development of bone disease in primary biliary cirrhosis, have been investigated in 20 consecutive patients, who, in addition to liver function tests and mineral and vitamin D metabolism studies, were submitted to a transiliac bone biopsy after tetracycline double-labeling for quantitative histomorphometric examination. Intestinal calcium absorption was also assessed in 16 patients. Seven patients (35%) had reduced bone volume and were considered osteoporotic. Three also had bone mineralization impairment, but did not have criteria for osteomalacia. Bone formation was depressed in 15 patients, and bone resorption was low or normal in 19 cases. Eroded surfaces were reduced in all osteoporotic patients. Duration of primary biliary cirrhosis was significantly longer in patients with osteoporosis (6.3 +/- 0.6 yr) than in those without osteoporosis (2.6 +/- 0.6, p = 0.004). Moreover, osteoporosis was more prevalent in postmenopausal women, and in those who had intestinal calcium malabsorption, which was present in 80% of osteoporotic patients but in only 18% of nonosteoporotic patients (p = 0.03). Osteoporosis and mineralization bone impairment were unrelated to the severity of cholestasis. 25-Hydroxyvitamin D was significantly lower in those patients with intestinal calcium malabsorption. The results of this study indicate that osteodystrophy in primary biliary cirrhosis is characterized mainly by "low-turnover" osteoporosis, which is related to the duration of the liver disease, postmenopausal condition, and calcium malabsorption.

Adult↗
PubMed1989

Comparison of rifampicin with phenobarbitone for treatment of pruritus in biliary cirrhosis.

The anti-pruritic effects of rifampicin (10 mg/kg) and phenobarbitone (3 mg/kg) were assessed in 22 patients with primary biliary cirrhosis in a crossover randomised clinical trial. Each agent was given for 14 days, with a 30-day washout period between treatments. 21 patients completed the course of rifampicin and 18 that of phenobarbitone; rifampicin was withdrawn from 1 patient when anaemia and renal failure developed, whereas 3 patients stopped taking phenobarbitone because of a rash and the 4th merely refused the drug. Rifampicin had a greater anti-pruritic effect than phenobarbitone. The symptom improved in 19 patients taking rifampicin and in 8 taking phenobarbitone, the degree of improvement being greater with rifampicin than with phenobarbitone. Pruritus disappeared in 9 patients receiving rifampicin, and three of them were free of itch when switching over to phenobarbitone. Both drugs were equally effective in inducing hepatic microsomal function but rifampicin has the additional effect of reducing cholestasis. Its anti-pruritic effect should be tested in long-term clinical trials.

Adult↗
PubMed1989

Influence of liver disease on hepatic alcohol and aldehyde dehydrogenases.

The hepatic activities and the isoenzyme patterns of both alcohol dehydrogenase and aldehyde dehydrogenase have been studied in 60 alcoholics with varying degrees of liver damage (from normal tissue or minimal changes to cirrhosis with alcoholic hepatitis) and in 24 nonalcoholics with chronic hepatitis or cirrhosis in order to ascertain their association with liver damage. In alcoholics both alcohol dehydrogenase and low-Km aldehyde dehydrogenase activities decreased proportionally with the severity of liver disease. In contrast, in nonalcoholics, there was a reduction of low-Km aldehyde dehydrogenase activity related to the severity of liver injury, but alcohol dehydrogenase was similar in patients with chronic hepatitis and nonalcoholic cirrhosis. There were no significant changes in total and high-Km aldehyde dehydrogenase activities among the different histologic groups studied, although the lowest activities were observed in patients with more severe liver injury. The prevalence of atypical alcohol dehydrogenase was similar in alcoholic (6.6%) and in nonalcoholic (8.3%) liver disease. All patients exhibited isoenzyme aldehyde dehydrogenase II, whereas isoenzyme I was not detected in 39.5% of the alcoholic patients and in 9.5% of those with nonalcoholic liver disease. The lack of aldehyde dehydrogenase I was observed in cases with the lowest enzymatic activities. These results suggest that the decrease of alcohol and aldehyde dehydrogenase activities in alcoholics is not a primary defect and, therefore, their decrease is secondary to liver damage. It is speculated that the diminution of alcohol dehydrogenase, found particularly in alcoholics, could be due to centrilobular cell necrosis.

Alcohol Dehydrogenase↗
PubMed1989

Alcoholic foamy degeneration in Spain. Prevalence and clinico-pathological features.

Among 389 consecutive chronic alcoholics in whom a liver biopsy was performed for diagnostic purposes, nine patients (2.3%) had histological changes of "alcoholic foamy degeneration" (AFD), characterized by numerous small fat droplets in the swollen hepatocytes of the centrilobular area. In five cases, there were non-specific clinical features, while the other four cases presented acute hepatic decompensation with jaundice and a reduced prothrombin activity. Seven patients had high serum lipid concentrations including hypertriglyceridemia and hypercholesterolemia, which improved after withdrawal of alcohol intake. In conclusion, AFD has a broad clinicopathological spectrum including asymptomatic patients and other cases with severe liver decompensation manifested by jaundice and reduced prothrombin activity. AFD is usually associated with hyperlipemia.

Adult↗
PubMed1988

Esophageal dysfunction in primary biliary cirrhosis.

To investigate esophageal involvement of scleroderma in primary biliary cirrhosis, esophageal, manometry was performed in 18 patients (16 females, two males) with primary biliary cirrhosis and in a control group of 18 subjects matched by age and sex. All patients were screened for clinical manifestations of scleroderma and for the presence of Sjögren's syndrome. Four patients had scleroderma (all of them with Sjörgren's syndrome), nine had Sjögren's syndrome without scleroderma, and five had neither scleroderma nor Sjögren's syndrome. Three patients with scleroderma had aperistalsis and diminished lower sphincter pressure. Five patients with Sjörgren's syndrome without scleroderma also had esophageal manometric disturbances. Furthermore, lower esophageal sphincter pressure (LESP) and distal mean wave pressure (DMWP) were significantly reduced in patients with scleroderma (LESP: 7.5 +/- 1.4 mmHg; DMWP: 29.5 +/- 5.9 mmHg) and in patients with Sjögren's syndrome without scleroderma (LESP: 14.8 +/- 0.8 mmHg; DMWP: 54.3 +/- 7.5 mmHg) compared to controls (LESP: 18.0 +/- 0.7 mmHg; DMWP: 83.9 +/- 5.1 mmHg). By contrast, LESP and DMWP were similar in patients without Sjögren's syndrome (LESP: 17.6 +/- 0.9 mmHg; DMWP: 78.2 +/- 10.9 mmHg) and controls. These results indicate that esophageal motility dysfunction is often present in patients with primary biliary cirrhosis who have scleroderma, and also in those with Sjögren's syndrome without scleroderma, suggesting that some esophageal motor disturbances could be related to association with Sjögren's syndrome.

Esophagus↗
PubMed1988

Analysis of factors predicting early seroconversion to anti-HBe in HBeAg-positive chronic hepatitis B.

To investigate whether data obtained at the time of diagnosis may serve to predict early seroconversion to anti-HBe in chronic hepatitis B virus infection, we have compared the clinical, pathological and virological features of two groups of patients with untreated HBeAg-positive chronic hepatitis B who showed a markedly different outcome. One group (early seroconverters) included 20 patients who developed a typical seroconversion to anti-HBe within the first year of prospective follow-up. The other group (non-seroconverters) was formed by 21 patients who remained seropositive for HBeAg and still had raised aminotransferase serum levels after at least 2 years of follow-up. The serum aminotransferases, the degree of periportal and lobular lesions, the amount of liver fibrosis and the total score index of histological activity were significantly higher but the amount of HBcAg in liver was smaller in early seroconverters. Stepwise logistic regression analysis demonstrated that the alanine aminotransferase serum levels, the Knodell's index of histological activity and the amount of HBcAg in liver had significant value as independent predictors of early seroconversion. Calculation of the probability of seroconversion for individual cases showed marked differences between the two groups of patients, suggesting that early seroconversion to anti-HBe may be predicted in some patients with chronic hepatitis B.

Adult↗
PubMed1988

Urine ethanol assessment: a helpful method for controlling abstinence in alcoholic liver disease.

The usefulness of a urine-alcohol determination in the evaluation of abstinence in alcoholic liver disease has been investigated in 181 patients. Alcohol was tested in morning urine samples collected on a follow-up visit in 103 patients, and the results were compared with those in 78 patients, where three samples were collected within the same week; one in the morning and two in the evening. Although the percentage of urine samples containing alcohol measured in a morning sample was similar to the patients' self-report (31% and 34%, respectively), urine analysis identified an additional 7% of patients who denied alcohol intake. Alternatively, serial urine-alcohol determinations were significantly more effective than patient reports (54% and 35.9%, respectively, P less than 0.01), particularly when urine was collected in the evenings. This difference was due mainly to the reluctance of women to admit drinking (7.4% of positive self reports vs 51% of women with alcohol positive urine samples, P less than 0.001). We conclude that serial measurements of alcohol in urine were useful tests which should be used to complement personal interview in the control of abstinence in patients with alcoholic liver disease.

Ethanol↗