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Biomedical subjects

C Guarner

Publications and source records attributed to C Guarner.

At least 19 recordsLinked to original sources
PubMed1992

Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage.

To assess the efficacy of selective intestinal decontamination with norfloxacin in the prevention of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage, 119 patients were included in a prospective randomized study. Group 1 (n = 60) received norfloxacin orally or through a nasogastric tube, 400 mg twice daily for 7 days beginning immediately after emergency gastroscopy; group 2 (n = 59) was the control group. We found a significantly lower incidence of infections (10% vs. 37.2%; P = 0.001), bacteremia and/or spontaneous bacterial peritonitis (3.3% vs. 16.9%; P less than 0.05), and urinary infections (0% vs. 18.6%; P = 0.001) in patients receiving norfloxacin, as a consequence of decrease in the incidence of infections caused by aerobic gram-negative bacilli. The decrease in mortality observed in the treated group (6.6% vs. 11.8%) did not reach statistical significance. The cost for antibiotic treatment showed a 62% reduction in the treated group compared with the control group. The results show that selective intestinal decontamination with norfloxacin is useful in preventing bacterial infections in cirrhotics with gastrointestinal hemorrhage.

Adult↗
PubMed1992

[Endoscopic cytology in the diagnosis of carcinoma of Vater's ampulla].

An endoscopic cytology procedure was performed in 25 patients with a final diagnosis of carcinoma of the ampulla of Vater. A diagnosis of malignancy was made cytologically in 22 instances, and in 9 patients cytology was the only positive finding before operation. In two cases endoscopic biopsy was positive while the cytologic examination did not confirm the histological diagnosis.

Aged↗
PubMed1992

[The duration of the effect of norfloxacin on the fecal flora in cirrhosis patients].

The aim of the study has been to assess if intermittent treatment with norfloxacin could be able to maintain selective intestinal decontamination in cirrhotic patients in order to prevent bacterial infections. Group I (n = 10, subgroup Ia, n = 5, hospitalized cirrhotics, subgroup Ib, n = 5, outpatient cirrhotics) received 400 mg/24 h norfloxacin 7 days. Group II (n = 5, outpatient cirrhotics) received 400 mg/12 h norfloxacin 7 days. Gram-negative aerobic bacilli of the fecal floral were strongly suppressed in all patients at the end of the treatment, and they totally (Group I) or partially (Group II) recovered the initial concentrations 7 days after the end of the treatment. There were not significant differences between subgroups Ia and Ib. These results suggest that prophylactic treatment with norfloxacin in cirrhotic patients at high risk of infection should be continuous during the period in whom patients must be submitted to selective intestinal decontamination.

Administration, Oral↗
PubMed1992

Systemic prostacyclin in cirrhotic patients. Relationship with portal hypertension and changes after intestinal decontamination.

The total body production of prostacyclin was shown to be increased in cirrhotic patients, suggesting that its synthesis by blood vessels of the systemic circulation is enhanced. However, the mechanism by which the synthesis of systemic prostacyclin is stimulated is not known. The present study investigated the urinary excretion of 2,3-dinor-6-keto-PGF1 alpha, an index of total body prostacyclin synthesis, first, in cirrhotics with portal hypertension (n = 19) as compared with cirrhotics with reduced portal pressure after portacaval shunt surgery (n = 18) and with control noncirrhotic subjects (n = 11), and; second, in cirrhotics before and after intestinal decontamination by oral nonabsorbable antibiotics (n = 9 antibiotic treated patients, n = 10 control nontreated cirrhotics). Control noncirrhotic subjects showed lower urinary excretion of 2,3-dinor-6-keto-PGF1 alpha than both groups of cirrhotics (P less than 0.001). Interestingly, urinary excretion of 2,3-dinor-6-keto-PGF1 alpha was significantly higher in cirrhotics with portacaval shunt than in those with portal hypertension (P less than 0.01). The urinary excretion of 2,3-dinor-6-keto-PGF1 alpha decreased significantly after intestinal decontamination in the antibiotic-treated group (580.1 +/- 232.4 vs. 431.2 +/- 219.2 pg/mg creatinine; P less than 0.05) but not in nontreated patients (543.9 +/- 214.4 vs. 581.2 +/- 281.4 pg/mg creatinine; P = NS). These data suggest that the increased urinary excretion of 2,3-dinor-6-keto-PGF1 alpha observed in cirrhotics is not directly related to portal hypertension itself but to portal blood factors that bypass the liver. Some such factors may be of intestinal bacterial origin.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

Selective intestinal decontamination prevents spontaneous bacterial peritonitis.

In a prospective randomized study, selective intestinal decontamination with norfloxacin was performed during hospitalization in 32 cirrhotic patients with low ascitic fluid total protein levels. The incidence of infections was compared with that in a control group of 31 nontreated cirrhotic patients of similar characteristics. We found a significantly lower incidence of infections [1/32 (3.1%) vs. 13/31 (41.9%); P less than 0.005] and spontaneous bacterial peritonitis [0/32 (0%) vs. 7/31 (22.5%); P less than 0.05] in patients receiving norfloxacin. The lower incidence of extraperitoneal infections [1/32 (3.1%) vs. 7/31 (22.5%); P = 0.052] in the treated group did not reach statistical significance. The incidence of infections [1/28 (3.6%) vs. 9/22 (40.9%); P less than 0.01] and spontaneous bacterial peritonitis [0/28 (0%) vs. 5/22 (22.7%); P less than 0.05] in cirrhotic patients admitted because of ascites was also significantly lower in the treated group. The decrease in the rate of mortality observed in the group undergoing selective intestinal decontamination did not reach statistical significance. These data show that selective intestinal decontamination is useful to prevent spontaneous bacterial peritonitis and extraperitoneal infections in hospitalized cirrhotic patients with low ascitic fluid total protein levels.

Aged↗
PubMed1991

[An analysis of hospital bacterial infections in cirrhotic patients undergoing selective intestinal decontamination].

Cirrhotic patients with ascites and low levels of ascitic fluid C3 and total protein and cirrhotic patients with gastrointestinal hemorrhage are at high risk of infection. Selective intestinal decontamination with oral norfloxacin is useful to decrease the incidence of infections in cirrhotic patients at high risk. This study analyzes hospital acquired bacterial infections in cirrhotic patients with ascites and low levels of total protein in ascitic fluid (n = 53) and cirrhotic patients with gastrointestinal hemorrhage (n = 26), both submitted to selective intestinal decontamination with norfloxacin during the hospitalization. Seven patients developed eight infections (8.8%): three patients with ascites and low levels of total protein in ascitic fluid and four patients with gastrointestinal hemorrhage (5.6% vs 15.3%, pNS). Gram negative bacilli were not isolated in any case, but Gram positive cocci were isolated in seven cases. These results suggest that Gram positive cocci must be empirically covered when infection is suspected in cirrhotic patients submitted to selective intestinal decontamination. The analysis of antibiograms in these infections showed a high sensitivity of Gram positive cocci to amoxycillin and clavulanic acid, which could be used as empirical treatment when infection is suspected in these patients.

Ascites↗
PubMed1990

Selective intestinal decontamination increases serum and ascitic fluid C3 levels in cirrhosis.

Selective intestinal decontamination for 7 days with norfloxacin was performed in 14 cirrhotic patients with ascites and low ascitic fluid total protein. Variations in serum and ascitic fluid of C3 and C4 and ascitic fluid total protein after therapy were compared with those of a control group of 14 untreated patients with similar characteristics. After oral norfloxacin administration, we saw a significant increase of C3 in serum (p less than 0.05) and ascitic fluid (p = 0.01). A significant increase was also observed in ascitic fluid total protein (p less than 0.05) but not in serum and ascitic fluid C4. There were no changes in serum C3, ascitic fluid C3, ascitic fluid C4 or in ascitic fluid total protein in group 2. These data demonstrate that selective intestinal decontamination increases serum and ascitic fluid C3 levels and, therefore, might be useful in preventing spontaneous infections in cirrhotic patients at high risk of infection.

Ascitic Fluid↗
PubMed1990

Injection therapy of bleeding peptic ulcer. A prospective, randomized trial using epinephrine and thrombin.

A prospective randomized trial involving 64 patients with bleeding peptic ulcers was performed to assess the efficacy of two modalities of injection therapy. The inclusion criterion was the presence of active bleeding or a visible vessel at emergency endoscopy. Thirty-two patients were treated with epinephrine (Group A) and 32 with epinephrine plus thrombin (Group B). Permanent hemostasis was achieved in 81.3% Group A, and 84.4% Group B patients, and therapy failures occurred in 18.6% and 15.6%, respectively. Mortality was nil in both groups. There were no differences in the requirement for emergency surgery, or in the number of transfusions in the two groups. A second elective endoscopy was performed in 49 patients between the 3rd and the 5th day after admission, proceeding to a second injection therapy if a visible vessel was still seen. There were no failures among re-injected patients. With one exception, none of the failures occurred in patients in whom a second endoscopy was done. Our results suggest that injection therapy, which is a simple technique, should be considered as the initial treatment of choice in bleeding peptic ulcer. The addition of thrombin to epinephrine does not improve the results of the method. An early second endoscopy and local therapy if a visible vessel is still present, may further improve the results.

Aged↗
PubMed1990

Long term survival and severe rebleeding after variceal sclerotherapy.

Of 197 consecutive patients with cirrhosis admitted because of bleeding from esophageal varices, 133 were included in a prospective study of elective sclerotherapy. We evaluated the incidence of extensive rebleeding and mortality rate. The period of study was 54 months and the mean follow-up period was 21 months. Forty-one patients had severe rebleeding and a majority of the episodes occurred during the first year. Only four patients had more than five sessions of sclerosis when rebleeding occurred. The probability rate for patients to be free of severe rebleeding after 48 months, according to Pugh's classification, was 88 per cent for those with grade A, 50 percent for grade B and 43 percent for grade C. The over-all mortality rate was 38.8 per cent (53 patients), with the highest rate noted during the first year. The mortality rate of patients with severe rebleeding was much higher than that of those who did not rebleed. Kaplan-Meier survival analysis at four years was 52 per cent, and survival rates in relation to Pugh's classification were 73 per cent for A, 53 per cent for B and 34 per cent for C. Differences between the three groups were statistically significant. Therefore, because of the high mortality rate associated with patients with cirrhosis and extensive rebleeding during the first year, it is important to achieve, as soon as possible, eradication of esophageal varices.

Adult↗
PubMed1990

[Spontaneous bacterial peritonitis: a comparative study of 2 methods of ascitic fluid culture].

The sensitivity in the diagnosis of spontaneous bacterial peritonitis of ascitic fluid inoculation in blood culture bottles has been compared with the conventional method. We have analyzed 74 positive ascitic fluid cultures from 64 patients, the samples being processed by both techniques simultaneously. While all the ascitic fluid cultures performed by inoculation in blood culture bottles were positive, in only 42 from the 74 conventional cultures (56, 75%) bacterial growth was detected (p less than 0.001). Nineteen bacterascites were diagnosed by inoculation in blood culture bottles and 10 by the conventional method (p = NS). Gram stain was only positive in 3 spontaneous bacterial peritonitis (6%). We conclude that ascitic fluid inoculation in blood culture bottles improves significantly the sensitivity of the microbiological diagnosis of spontaneous bacterial peritonitis, without increasing the diagnosis of bacterascites.

Ascitic Fluid↗
PubMed1989

Efficacy of ethanolamine and polidocanol in the eradication of esophageal varices. A prospective randomized trial.

A prospective randomized trial has been undertaken to compare the efficacy of two sclerosing agents, Ethanolamine oleate (Et) and Polidocanol (Pl), in the eradication of esophageal varices (EV). Fifty consecutive cirrhotic patients, 22 in the Et and 28 in the Pl group, were included. Clinical data were comparable in both groups. Eradication of the EV was achieved in 81% (18/22) in the Et group and 64.1% (18/28) in the Pl group (p = NS). There was a significant difference in the rate of rebleeding (4 episodes in 3 patients in the Et group and 18 episodes in 13 patients in the Pl group, p less than 0.05). No differences were noted in the number of other complications or mortality. Both sclerosants have proved useful in the eradication of EV, but Et was superior to Pl in the preventation of recurrent bleeding in the course of repeated endoscopic injection sclerotherapy (EIS).

Esophageal and Gastric Varices↗
PubMed1989

[Variation of C3 in ascitic fluid from cirrhotic patients subjected to intestinal sterilization or selective intestinal decontamination].

Patients with liver cirrhosis with ascites and low levels of C3 and Total Proteins in ascitic fluid show a greater predisposition to the development of spontaneous bacterial peritonitis. The variation of C3 and Total Proteins levels in ascitic fluid in two groups of patients with liver cirrhosis was studied. Group I (n = 14) underwent intestinal sterilization (n = 7) or selective intestinal decontamination (= 7). Group II was a control. A statistically significant increase in C3 (p less than 0.01) and Total Proteins (p less than 0.015) levels in ascitic fluid in Group I patients was found. There were no changes in the control group. The incidence of side effects was higher in those patients who underwent intestinal sterilization. Our results suggest that selective intestinal decontamination may be useful as a prophylactic measure against spontaneous bacterial peritonitis in those patients with liver cirrhosis at high risk of infection by increasing the bactericidal capacity of ascitic fluid.

Adult↗
PubMed1988

Low C3 in cirrhotic ascites predisposes to spontaneous bacterial peritonitis.

The risk of developing spontaneous bacterial peritonitis (SBP) in relation to the concentration of C3 in ascitic fluid (AF) has been studied prospectively in 33 patients with cirrhosis of the liver, seven of whom had one or more episodes of SBP during hospitalization. C3 concentrations in the AF of patients who developed infection (9.0 +/- 2.67 mg/dl) were significantly lower than in those who did not (18.26 +/- 8.11 mg/dl) (P less than 0.01). C4 concentrations were similar in both groups. A direct correlation was found between AF C3 and total protein concentrations (P less than 0.001). We conclude that a low C3 concentration in AF may predispose to SBP.

Aged↗
PubMed1988

Endoscopic hemostasis by local injection of epinephrine and polidocanol in bleeding ulcer. A prospective randomized trial.

The present prospective randomized trial has been carried out to assess the efficacy of the endoscopic injection of epinephrine plus polidocanol, in the prompt treatment of upper gastrointestinal bleeding due to peptic lesions. Over a period of one year, 72 patients were admitted to the study. Thirty-six of these underwent endoscopic treatment (group A), while the others received medical treatment (group B). Definitive hemostasis was achieved in 29 patients in group A, and in 21 in group B (p less than 0.05). Seven patients in group A and 12 in group B underwent emergency surgery for persistent or recurrent bleeding (p = NS). Three patients from group B received endoscopic treatment owing to relative surgical contraindications. It was successful in all of them. Patients from group A needed a significantly lower number of units of packed red cells (p less than 0.05). Our results show that it is justified to employ endoscopic injection as the first therapeutic step in upper GI bleeding due to peptic gastroduodenal lesions.

Adult↗
PubMed1986

Determination of 2,3-dinor-6-ketoprostaglandin F1 alpha in urine samples by liquid chromatography and radioimmunoassay.

A method for 2,3-dinor-6-ketoprostaglandin F1 alpha quantification based on high-performance liquid chromatography-radioimmunoassay is described. Samples are acidified to pH 3 and processed through C18 disposable cartridges. The prostanoids are eluted with methyl formate and further separated on a reversed-phase column using acetonitrile-acetic acid-triethylamine buffer (32:68). Studies of the effect of eluent pH were performed in order to optimize resolution and separation of 2,3-dinor-6-keto-PGF1 alpha from other prostanoids. Eluates were collected and assayed by radioimmunoassay using a heterologous system, with 6-keto-PGF1 alpha as radioligand and an antiserum with high cross-reactivity for 2,3-dinor-6-keto-PGF1 alpha. Sensitivity, precision and accuracy of the assay procedure are reported together with the validation of its specificity. The proposed method has been applied to the determination of this prostacyclin metabolite in human urine.

6-Ketoprostaglandin F1 alpha↗