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E Meroño

Publications and source records attributed to E Meroño.

At least 19 recordsLinked to original sources
PubMed2001

[Comparison of dobutamine echocardiography and rest-redistribution 201-thallium SPECT in the assessment of myocardial viability taking PET as gold standard].

BACKGROUND AND AIM: To compare Tl-201 SPECT and dobutamine stress echocardiography for the detection of myocardial viability in patients with severe left ventricular dysfunction using metabolic imaging by positron emission tomography as the standard reference. MATERIAL AND METHODS: We studied 25 consecutive patients with severe coronary artery disease and left ventricular dysfunction that underwent two different diagnostic modalities for evaluating myocardial viability: stress echocardiography with incremental doses of dobutamine from 5 up to 40 g/kg/min in 3 min stages, and 201 Tl SPECT using a rest-redistribution protocol with delayed images obtained at 4 hours. Fluorodeoxyglucose uptake by PET was used as the gold standard. Viability criteria were as follows, for 201Tl SPECT imaging: normal uptake at rest and presence of redistribution in the delayed images, for dobutamine stress echocardiography: sustained improvement and biphasic response. RESULTS: Sensitivity of thallium redistribution was 46%, for normal uptake, plus redistribution 82%, 34% for dobutamine biphasic response and 58% for sustained improvement plus biphasic response. Specificity of biphasic response was 82% and that of redistribution 67%. Stepwise logistic regression indicated that biphasic wall motion response during dobutamine stress echocardiography (2.01 CI 95%; 1.10 to 3.99) and the presence of redistribution plus normal uptake at rest with thallium imaging (2.68 CI 95%; 1.42 to 5.13) were the best predictors of viability. These results were the same when both techniques were analyzed together. CONCLUSIONS: Biphasic wall motion response during dobutamine stress echocardiography and the normal uptake plus presence of redistribution with thallium imaging were the best pre

Cardiotonic Agents↗
PubMed2001

99mTc-MIBI scintimammography as a complement of the mammography in patients with suspected breast cancer. A multicentre experience.

The aim of this work has been to evaluate the clinical usefulness of 99mTc-MIBI scintimammography, used as a complement to mammography, in the study of patients with suspected breast cancer. We performed prone breast scintigraphy in 253 patients (268 lesions) with suspected breast cancer. The size and degree of the suspected breast cancer was evaluated by mammography. Diagnosis was established by biopsy. Malignancy was diagnosed in 155 lesions and benign diseases in 113. The results of the scintimammography were a sensitivity of 91%, a specificity of 71%, PPV=81% and NPV=85%. In lesions smaller than 1 cm, sensitivity and specificity were 57% and 100%; in lesions with a diameter of between 1 and 2 cm, these figures were 90% and 72% respectively, and in lesions of more than 2 cm the sensitivity was 99% and the specificity 50%. On mammography, 155 lesions were considered as having a high suspicion of malignancy, whilst 72 were indeterminate and 41 had a low probability. In lesions with a low or indeterminate suspicion of malignancy on mammography, the sensitivity and NPV of the scintimammography were 97% and 98%. Scintimammography is a useful technique in the study of lesions where breast cancer is suspected. Scintimammography results are closely related to tumour size and the degree of mammographic suspicion. Scintimammography can be useful where mammography identifies lesions with a low or indeterminate suspicion of malignancy.

Journal Article↗
PubMed1999

[Acute hepatitis E in Spain].

Hepatitis E virus (HEV) is the worldwide leading cause of non-A non-B enterically transmitted hepatitis, and affects most commonly the population in developing countries. Cases outside this area, are nearly always imported, although apparent local acquisition has been occasionally reported. We assisted three patients with acute HEV hepatitis, confirmed by the presence of serum anti-HEV IgM. One of them did not report travelling outside of Spain in the previous years. HEV has to be included in the differential diagnosis of acute non-A non-B non-C hepatitis, even in cases in which an exposure in endemic areas cannot be recalled.

Acute Disease↗
PubMed1998

Chronic pancreatitis.

Explore the source record for details and available documents.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1998

[Elective noninvasive test in the diagnosis of coronary disease in the aged].

BACKGROUND AND PURPOSE: The purpose of this study was to determine the best noninvasive test to diagnose coronary artery disease in the elderly. PATTERNS AND METHODS: We conducted a study on 56 elderly patients (> 65 years) with chest pain and no previous history of coronary artery disease. They underwent exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 microgram/kg/min and atropine when it was necessary), dobutamine MIBI-SPECT and coronary angiography. RESULTS: Angiography detected significant coronary artery disease in 41 patients. All tests used in this study had a similar sensitivity (conclusive exercise stress test 87%, dipyridamole echocardiography 83%, dobutamine echocardiography 80% and MIBI-SPECT 87%; p = NS). Coronary angiography did not identify significant lesions in 15 patients. Specificity of conclusive exercise stress test, dipyridamole and dobutamine echocardiography was similar (75%, 100% and 93% respectively; p = NS). However, the specificity of stress echocardiography was higher than that of scintigraphy (100% vs 66%; p = 0.02 for dipyridamole echocardiography and 93% vs 66%; p = 0.07 for dobutamine echocardiography). Diagnostic accuracy of each test was similar. CONCLUSIONS: Exercise stress test remains the non invasive diagnostic test of choice to detect coronary disease in the elderly. If this test is inconclusive, both stress echocardiography and isotopic studies are useful, although the specificity of stress echocardiography is higher than that of scintigraphy.

Aged↗
PubMed1998

[A Spanish multicenter scintigraphic study of the breast using Tc 99m MIBI. Report of results].

UNLABELLED: The aim of this work has been to study, with a homogenous method, a wide sample of patients with breast cancer suspicion, in order to evaluate the real clinical usefulness of the scintimammography with MIBI-99mTc. METHODS AND MATERIAL: We have studied by way of prone scintimammography 388 patients (418 lesions) with breast cancer suspicion. In the mammography the size and degree of breast cancer suspicion was evaluated. Diagnosis was established by biopsy. RESULTS: 247 lesions were diagnosed as breast cancer and 171 as benign diseases. She results of the scintimammography were sensitivity 90%, specificity 70%, PPV 81% and NPV 83%. In palpable lesions sensitivity and specificity were 94% and 61%, and in non-palpable lesions 75% and 81% respectively. In 264 lesions mammographic breast cancer suspicion was establish. 13 of the 14 FN results were obtained in lesions with a high malignancy suspicion. In lesions with a low or indeterminate suspicion, sensitivity and NPV of the scintimammography were 97% and 98%. CONCLUSIONS: Scintimammography has a high sensitivity but a relatively low specificity in the study of lesions with breast cancer suspicion. Scintimammography could be a good complement of the mammography in lesions with a low or indeterminate suspicion of malignancy.

Adult↗
PubMed1997

[A non-invasive test choice for the diagnosis of coronary disease in women].

BACKGROUND AND PURPOSE: Regarding coronary heart disease, women have often been excluded from clinical trials. Current practical recommendations are thus based on studies in men. To identify the non invasive technique of choice in detecting coronary artery disease in women, a study with different diagnostic tests has been undertaken. METHODS: Exercise stress test, dipyridamole echocardiography (0.84 mg/kg), dobutamine echocardiography (up to a total dose of 40 micrograms/kg per minute and atropine if necessary), MIBI-SPECT during dobutamine infusion and coronary angiography, were performed in 40 consecutive women with chest pain and no previous history of coronary artery disease. RESULTS: The four tests had similar sensitivity: exercise stress test (80%; CI 95%, 52-94), dipyridamole echocardiography (80%; CI 95%, 56-93), dobutamine echocardiography (80%; CI 95%, 56-93) and scintigraphy MIBI-SPECT (85%; CI 95%, 61-95). The specificity of dipyridamole echocardiography (100%; CI 95%, 83-100) and dobutamine echocardiography (90%; CI 95%, 67-98) was higher than that of exercise stress test (50%; CI 95%, 22-78) and MIBI-SPECT (65%; CI 95%, 41-84). The positive predictive values of dipyridamole and dobutamine echocardiography were 100% and 88% respectively. CONCLUSIONS: The feasibility of exercise stress test in women is inferior to that of the other techniques. The sensitivity of the four tests to diagnose coronary artery disease is similar. The specificity of dipyridamole echocardiography and dobutamine echocardiography is higher than that of exercise stress test and MIBI-SPECT. Stress echocardiography can be considered the non invasive technique of choice for diagnosing coronary artery disease in women.

Aged↗
PubMed1996

[Pain and jaundice secondary to hemobilia resolved by ERCP and endoscopic sphincterectomy].

We report the case of a patient with hemobilia resulting from a liver biopsy where the performance of the endoscopic sphincterectomy solved the jaundice and the pain of the patient. ERCP has been used previously in the diagnosis of biliary and pancreatic tumors that manifested themselves as an hemobilia. The therapeutic utilization of endoscopic sphincterotomy had been described rarely in this type of bleedings. We recommend endoscopic retrograde cholangiopancreatography and sphincterotomy in the cases of hemobilia with severe abdominal pain resulting from the accumulation of clots inside the biliary tract.

Abdominal Pain↗
PubMed1996

[The endoscopic Nd-YAG laser treatment of the "watermelon stomach"].

The watermelon stomach is a vascular malformation at the gastric antrum which is responsible for chronic bleeding. We report here nine patients (5 females and 4 males) referred to our Department from December 1990 to May 1995 with ferropenic anemia resulting from chronic gastrointestinal bleeding and with the diagnosis of watermelon stomach. The mean age at presentation was 52 years (range, 29-80). Seven patients required periodic blood transfusions and the remaining patients therapy with iron compound. All patients were treated with photocoagulation of antral lesions with Nd-YAG laser applied endoscopically. In all patients an almost complete disappearance of endoscopic lesions was achieved and during the 19-month follow-up period (range, 2-54) no patient required blood transfusions or iron therapy. No secondary complications from therapy were noted.

Adult↗
PubMed1996

[Management of choledocholithiasis in patients undergoing laparoscopic cholecystectomy].

The development of laparoscopic cholecystectomy has rekindled the issue of management of choledocholithiasis. A number of options exist including pre or postoperative endoscopic sphincterotomy (ERCP-ES), laparoscopic common duct exploration or open common duct exploration. We present here our experience with the management of choledocholithiasis in patients treated with laparoscopic cholecystectomy. From January 1991 to January 1995, 900 patients underwent laparoscopic cholecystectomy. 71 ERCP were carried out in 71 patients with suspicion or evidence of choledocholithiasis. Common duct stones were detected in 44 patients. Preoperative ERCP was done in 56 patients, with suspicion of choledocholithiasis, based on clinical, laboratory or ultrasonographic findings. 29 of these patients (51.7%) had common duct stones, that were successfully removed by endoscopic sphincterotomy. One patient suffered mild pancreatitis and a second one had transient hyperamylasemia. Postoperative ERCP was performed in 15 patients. Indications for ERCP were the evidence of common duct stones in intraoperative cholangiography in 7 cases, and clinical or laboratory suspicion of choledocholithiasis, 3 months to 3 years after laparoscopic cholecystectomy. Stones were detected in 100% of the patients. In 11 patients (73.3%), the stones were extracted by endoscopic sphincterotomy and 4 patients underwent open common duct exploration. Two patients had transient hyperamylasemia. ERCP is a safe and effective method for detection and treatment of common duct stones. ERCP prior to laparoscopic cholecystectomy in patients suspected of having choledocholithiasis, is safe and offers with good results. Rutinary intraoperative cholangiography is recommended, for the detection of unsuspected choledocholithiasis and as an effective treatment (postoperative-ERCP, open or laparoscopic common duct exploration) can be chosen depending on surgeon's skills and patient's characteristics.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1995

[Echocardiography and MIBI-SPECT scintigraphy during dobutamine infusion in the diagnosis of coronary disease].

BACKGROUND AND PURPOSE: Dobutamine, an adrenergic agonist, has been combined with echocardiography and scintigraphy with MIBI-SPECT to detect coronary artery disease. Our purpose has been to compare echocardiography and MIBI-SPECT scintigraphy during dobutamine infusion for diagnosing coronary artery disease. METHODS: Both tests and coronary angiography have been performed on 72 consecutive patients with chest pain and no previous history of coronary artery disease. Dobutamine had administered up to 40 micrograms/kg/min. Atropine was given when necessary. MIBI was injected at peak stress. Echocardiographic continuous monitoring and SPECT images were carried out. Positivity was defined as: 1) echocardiographic: wall motion abnormalities of new onset, and 2) scintigraphic: dobutamine-induced perfusion abnormalities. RESULTS: Coronary artery disease was demonstrated in 49 patients. Echocardiography was positive in 37 of them (sensitivity of 75%) and MIBI-SPECT in 43 (sensitivity of 88%; p = NS). Specificity was higher with echocardiography (22/23, 96%) than with scintigraphy (16/23, 69%, p = 0.02). Accuracy was 82% for both tests. More patients with multivessel disease were detected by scintigraphy (61% versus 35%; p = 0.09). Agreement between tests was as follows: 1) results: 77% (kappa = 0.53); 2) segments: 86% (kappa = 0.65), and 3) artery diseased: 90% (kappa = 0.84). CONCLUSIONS: Echocardiography and MIBI-SPECT in combination with doubtamine are useful techniques to detect coronary artery disease. Diagnostic accuracy is similar with both tests.

Adrenergic beta-Agonists↗
PubMed1994

[Training in diagnostic and therapeutic ERCP].

Training in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography procedures is difficult and tedious. Currently, there is no consensus on how to plan and put it into practice. We believe that training in these procedures must be included in the training program of the gastroenterology resident, since the efficiency of these methods (both diagnostic and therapeutic) in biliopancreatic disease including their clinical, social and economic benefits are beyond doubt. Training in diagnostic endoscopic retrograde cholangiopancreatography should be planned for about 3 months including at least 100 procedures under supervision of an experienced endoscopist; on the other hand, training in the therapeutic aspects needs, in our opinion, a longer period, perhaps and additional 3 to 6 month period, although this goal is difficult to achieve in the 4-year program of a gastroenterology resident. A frequent performance of the techniques is required to acquire competence. In this paper, we emphasize the ideal conditions that, must be fulfilled to achieve an appropriate training in the diagnostic and therapeutic aspects of endoscopic retrograde cholangiopancreatography.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

[Adult patients with clinically suspected or known biliopancreatic pathology in whom ERCP is not indicated: the 10 most frequent situations].

Endoscopic retrograde cholangiopancreatography is an invasive endoscopic technique widely used in the diagnosis and eventual therapeutic procedures of many biliopancreatic conditions. While endoscopic retrograde cholangiopancreatography indications are well known, it is not the same in those patients with clinically suspected or known biliopancreatic entities in whom endoscopic retrograde cholangio-pancreatography is not indicated because it will not add valuable information with the potential of changing the previous diagnosis or therapy. Ten very common clinical situations in which this technique is not indicated are presented; among them idiopathic abdominal pain, some pancreatic carcinomas, chronic pancreatitis and pancreatic pseudocyst, and some patients awaiting conventional or laparoscopic cholecystectomy. We acknowledge that some aspects of this paper are controversial.

Adult↗
PubMed1993

[The palliative treatment of esophageal tumors with the laser (Nd-YAG). The results of an initial experience].

Palliative treatment of esophagus tumors leads to a remarkable improvement of dysphagia allowing oral feeding, prolonging the survival period and improving patient's quality of life. We have treated 30 patients with such tumors, who had previously been discarded for surgical therapy, with Nd-YAG laser through endoscopy. The procedure could be ended, so the dysphagia improved remarkably, in 23 patients (77.7%). Survival mean length was 7,3 months (range: 2,5-22 months) in eleven patients who already died when this study was finished, and 6,5 months (range: 2,5-10 months) in the remaining 12 patients. Five patients required the implant of a esophageal prosthesis as result of a proneness of the tumor to produce stenosis again. Follow-up visits were done regularly every 1 to 1.5 months. In summary best results were obtained on medial and distal thirds of the esophagus, where dilatation previous to laser therapy is easier, obtaining an important improvement of dysphagia. If the tumor has a localization in the upper part of the esophagus or if it has its origin in the stomach and later on it invades cardias, both cases pose more difficulties to the treatment with laser, which determines the results, so another alternative technique to feed the patient may be used.

Adenocarcinoma↗