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G Miño

Publications and source records attributed to G Miño.

At least 37 records · Page 2Linked to original sources
PubMed1996

Effectiveness of daily low-dose cotrimoxazole prophylaxis for Pneumocystis carinii pneumonia in liver transplantation--an open clinical trial.

Pneumocystis carinii pneumonia (PCP) is an important infection in the setting of liver transplantation. Without prophylactic measures, the incidence of PCP reached 30% in our first 10 liver transplant patients. All patients but one, who had concomitant invasive aspergillosis, recovered with intravenous cotrimoxazole. We therefore prospectively studied, in an open clinical trial, the efficacy and safety of prophylaxis with daily low-dose cotrimoxazole (480 mg) in 60 patients. The incidence of PCP dramatically decreased to 1.7% (P<.01). Treatment was well tolerated, and discontinuation of therapy was only necessary in two patients with leukopenia. Nevertheless, the number of episodes of leukopenia was similar in both groups. Cotrimoxazole prophylaxis was not associated with increased nephrotoxicity. An overall benefit in the incidence of bacterial infection was not observed. We conclude that daily low-dose cotrimoxazole is effective and safe for prevention of PCP after liver transplantations.

Adult↗
PubMed1996

[Familial transmission of hepatitis C virus].

OBJECTIVE: To establish the prevalence of antibodies to hepatitis C virus (HCV) among relatives and other persons cohabiting with HCV carriers, as an indication of the risk of intradomestic transmission. EXPERIMENTAL DESIGN: A transversal study of series of clinical cases. A questionnaire was applied to the index cases (IC) and contact cases (CC), differentiating sexual contacts (SC) from non sexual contacts (NSC). PATIENTS: One hundred and sixty four IC and 533 CC were included. Information on parenteral risk factors, type of sexual relationship, period of exposure, and other epidemiological variables was obtained. Antibodies to HCV (HCV-Ab) were determined by 2nd generation ELISA. RESULTS: In eighty eight IC (53.6%) no parenteral risk factors were found. In 99 IC (62.8%) a liver biopsy showed chronic hepatitis or cirrhosis. Twelve CC (2.25%) turned out to be HCV-Ab (+), a ratio above that found in our city (0.3%, p < 0.001), however the comparison should be taken with caution. No significant differences were found with respect to several epidemiological variables, including type of sexual relationship, and socioeconomic indicators, between CC HCV-Ab (+) and (-). Stage of liver disease in the IC and relationship between IC and CC did not increase the risk of being HCV-Ab positive. In HCVAb positive CC a higher proportion of parenteral risk factors (p < 0.001), elevated ALT (p < 0.001) and sharing of personal tools (p < 0.01) were observed. CONCLUSIONS: Intrafamiliar transmission of HCV is poorly documented and it is related to the presence of parenteral risk factors. The actual prevalence of HCVAb in a general population is unknown, rendering difficult to make definite conclusions.

Adolescent↗
PubMed1995

Importance of surveillance mycobacterial cultures after liver transplantation.

The routine use of isoniazid prophylaxis after liver transplantation is a controversial issue because the benefits must be weighed against the risk of hepatotoxicity. We decided not to institute isoniazid prophylaxis but to study the efficacy of a surveillance mycobacterial program. One hundred patients were included in the protocol. Sputum and urine samples were processed before transplantation and on days 15, 30, 60, 90, 12, 150, and 180 for acid-fast stain and culture. One case of tuberculosis was promptly identified and successfully treated. Cases of tuberculosis with negative surveillance cultures were not identified. Our approach indicates that surveillance mycobacterial cultures can permit rapid identification of tuberculosis after liver transplantation and it is an alternative for groups who questioned isoniazid prophylaxis.

Adult↗
PubMed1995

[A low prevalence of antibodies to the hepatitis C virus in stable heterosexual couples].

The prevalence of antibodies against the hepatitis C virus (HCV Ab) was studied in a group of 126 stable heterosexual couples of HCV Ab carriers. Only 1.59% of the couples was positive with no significant differences observed with regard to the prevalences seen in donors from the same area. The HCV Ab positive couples had shared toiletry articles but no other risk factors were detected. The authors conclude that the sexual transmission of the HCV is scarce.

Adolescent↗
PubMed1995

[Prognostic factors in severe acute pancreatitis. Univariate and multivariate study].

OBJECTIVES: The aim of this study was to analyze the prediction of mortality in patients with severe acute pancreatitis. PATIENTS AND METHODS: In a retrospective study 43 patients with severe acute pancreatitis were included. All patients required ICU admittance and surgical treatment. We evaluated severity according to Ranson's criteria, APACHE II score, CT scan classification (Hill), intraoperative findings (Vankemmel's classification) and number of organs failure. We performed a univariant and multivariant statistic study with lineal discriminant analysis. RESULTS: The overall mortality was 46.5%. Ranson's score and APACHE II did not correlate with mortality. Hill's classification did not reach significance either. However, only the Vankemmel's classification and the number of organs failure had statistic value (p < 0.01). After lineal discriminant analysis, the association of more than 4 Ranson's criteria, APACHE II up to 9 points, grades IV and V in Hill's classification and 4 organs failure had a predictive value for mortality. CONCLUSIONS: In our limited experience the Vankemmel's classification and the number of organs failure had a predictive value for mortality in patients with acute pancreatitis. The association of more than 4 Ranson's criteria. APACHE II up to 8 points, grades IV-V in Hill's classification and 4 organs failure disclosed poor prognosis.

APACHE↗
PubMed1995

[Asymptomatic carriers of HBsAg: is a follow-up necessary?].

We evaluated the clinical and epidemiological data of 142 HBsAg carriers. This prospective trial is part of a program of study and follow-up in HVB patients. The median age was 34.58 years old, males 56.3%. The average follow-up was 32.4 months. Complete clinical history, routine analysis, liver function tests, alfa-fetoprotein, serology for HVB, HCV and HDV and abdominal ecography were done in all patients. DNA-HVB was done only in special cases. Patients with less than 6 months of follow-up were excluded. The 118 remaining carriers were classified into two groups, depending on ALT values. Group 1 (normal ALT): included 98 carriers, 3 of them developed an active chronic hepatitis that was treated with interferon. A small CHC was diagnosed in another patient and it was resected. Group 2 (elevated ALT): included 20 carriers, only 9 of them agreed to biopsy and we found severe hepatic lesions in 4 of them. No group presented coinfection with HCV or HDV. No patient died. We conclude that the study and follow-up of asymptomatic HBsAg carriers permits an early diagnosis and treatment of the complications of this pathology (chronic hepatitis, CHC, etc); in our study, three patients developed chronic hepatitis, successfully treated with interferon, and one small size CHC was diagnosed in another patient. The study of relatives permits also detect subclinic liver disease and facilitates vaccination to prevention transmission of this infection.

Adolescent↗
PubMed1994

Recurrent fulminant liver failure caused by hepatitis B virus after liver transplantation.

We report a 44-year-old man who received a liver graft because of fulminant liver failure due to hepatitis B virus. Nine months later a new episode of acute hepatitis B followed a fulminant course and led to another transplantation. The patient died due to invasive aspergillosis and multiorgan failure 3 weeks after the second transplant. This case reveals that hepatitis B virus reinfection may also occur after transplantation in patients with fulminant hepatitis B and under immunosuppression circumstances. Although immunoprophylaxis with hepatitis B hyperimmune globulin may prevent hepatitis B reinfection, it does not guarantee complete protection even in patients presumed to have low risk of reinfection. Finally, this case confirms the high risk of fungal infections in patients with fulminant liver failure and the need to establish early antifungal therapy.

Adult↗
PubMed1994

[Hepatic confluence tumors: results and quality of life according to the type of treatment].

We analyzed survival rate and quality of life according to the treatment modality in 52 patients with hilar tumors. Six of them underwent resection (11.5%); 4 without hepatectomy, one left hepatectomy and one trisegmentectomy. The remaining 46 patients were treated by: radiologic external-internal drainage (12), placement of percutaneous endoprostheses (14), surgical intubation (18), and cholangioanastomoses to segment III in 2. Prognostic factors (PITT and A.P.A.C.H.E. II), survival time and quality of life were analyzed. Survival and comfort index were significantly better (p < 0.001) in the resection group than in the palliation one. Among palliative procedures percutaneous endoprostheses and surgical intubation offered better quality of life (p < 0.001) than radiologic external-internal drainage. We conclude that resection improves survival and offers better quality of life than palliative procedures. Our results suggest that resection during laparotomy should be attempted in order to improve results in the treatment of hepatic confluence tumors.

Adult↗
PubMed1994

[Self-expanding metallic endoprostheses in the palliative treatment of biliary obstructions in nonresectable carcinoma of the head of the pancreas].

OBJECTIVE: A study of immediate and long-term results with the self-expandable metallic stent (Wallstent), in the treatment of biliary obstruction in 25 patients with non resectable carcinoma of the head of the pancreas was carried out. Stent placement was successful in all patients. RESULTS: Complication rate was 4% (n = 1); one patient had venous bleeding after percutaneous catheter placement. There was no procedure related mortality (30-day mortality); hospital stay was 6, 7 days (2-12). Average survival was 6 months (+/- 2.97). Average patency of the initial stent lasted 5 months (+/- 2.01); comfort index was 83%. Five patients required re-admission. Late complications were cholangitis in 2 and stent occlusion in 4. Disimpaction in one patient and placement of additional stent (PAL-MAZ) in the remaining 3 patients were performed. One patient required surgical treatment; hepaticojejunostomy was performed. Elapse time between prostheses placement and stent occlusion was 3.4 months (2-4.5). CONCLUSIONS: We conclude that metallic stent placement has low morbidity without mortality and provide good quality of live. The most frequent late complication was prostheses obstruction.

Cholestasis↗
PubMed1994

[Long-term results of the surgical treatment of chronic pancreatitis].

We analized the long-term results after surgical treatment in 41 patients with chronic pancreatitis. Twenty one of them underwent resection: 19 pancreaticoduodenectomy (11 Whipple procedure and 8 Traverso Longmire); total pancreatectomy (1) and near-total pancreatectomy (1). In the remaining 20 patients a drainage procedure was carried out: Puestow-Duval (5); Partington (7); double derivation: pancreatic and biliar (5); triple derivation: pancreatic, biliar, gastric (2) and Nardi procedure+quisteduodenostomy in one patient. The following were evaluated: persistent pain; chronic alcoholism; nutrition status; exocrine function (syntomatic steatorrea, use of pancreatic enzyme preparation and fecal determination of glucide, protids and lipids) and endocrine function (glucose and insulin levels and glucose oral test). Surgery failed to relieve pain in 15.6% of the patients; failures were associated chronic alcoholism (p < 0.05); 18 patients (44%) required oral pancreatic enzymes. There weren't significant differences between resection and drainage procedures regarding the exocrine function. However, endocrine function was significantly worse (p < 0.05) after pancreaticoduodenectomy than after drainages procedures. Among the late, the endocrine function was better after Partington operation than after the Puestow-Duval.

Adult↗
PubMed1994

Prediction of further hemorrhage in bleeding peptic ulcer.

OBJECTIVE: To obtain a simple mathematical model able to estimate early the risk of further hemorrhage in bleeding peptic ulcer. METHODS: A prospective study was conducted on 1567 patients admitted for acutely bleeding peptic ulcer. Ten readily available variables were tested for association with further hemorrhage, and then a logistic regression analysis was carried out. RESULTS: Further hemorrhage occurred in 312 (20%) patients. The univariate analyses showed age over 65 yr, male sex, alcoholism, associated disease, hematemesis, endoscopic bleeding stigmata and shock, and blood urea over 90 mg/dl at admission to be significantly associated with continuous hemorrhage or rebleeding (p < 0.05 to p < 0.001). When these were assessed in a multivariate logistic regression analysis, the best fitted model (likelihood ratio test = 9.9; p = 0.5) included four independent variables. Bleeding stigmata (p < 0.001; odds ratio = 3.1), shock (p < 0.001, odds ratio = 2.5), hematemesis (p < 0.001; odds ratio = 1.6) and age over 65 (p = 0.04); odds ratio = 1.3) were associated with high risk of further hemorrhage. CONCLUSIONS: Bleeding stigmata and changes in hemodynamics are confirmed as the most relevant predictors of further hemorrhage. When they are considered with hematemesis and age altogether, other clinical features loss importance for prognosis. By taking advantage of the joint influences of these variables, accuracy of prognosis improves with respect to that obtained when they are considered as individual risk factors.

Aged↗
PubMed1993

Efficacy of the heater probe in peptic ulcer with a non-bleeding visible vessel. A controlled, randomised study.

A controlled, randomised study was performed to evaluate the efficacy of treatment with heater probe in the prevention of rebleeding from peptic ulcer with a non-bleeding visible vessel. One hundred and one patients were randomised into two groups: patients to be treated by heater probe (n = 51) and controls without active treatment (n = 50). In the heater probe group rebleeding occurred in five patients (10%) v 13 (26%) in the control group (p = 0.03), with a comparative risk of 0.38 in favour of the heater probe group. The difference in proportions of successful treatment for each group was 16.2% in favour of the heater probe (95% CI = 2 to 31%). Haemorrhage directly related to heater probe treatment occurred in four patients. In three of them bleeding was easily controlled by further heater probe pulses. There were no other complications and no death in the heater probe group. One patient in the control group died of pulmonary embolism. No significant differences in the length of stay in hospital, blood transfusions, surgical rates, or death were found; the design of the study, however, precluded an adequate assessment of these variables, because the heater probe was an optional rescue treatment when high surgical risk patients rebled. These results suggest that the heater probe is an effective and safe procedure in the prevention of recurrent haemorrhage in peptic ulcer with a non-bleeding visible vessel.

Adult↗
PubMed1993

Role of endoscopic retrograde cholangiopancreatography in liver transplantation.

Biliary tract complications develop in 5-10% of patients undergoing liver transplantation. They should be differentiated from other causes of graft dysfunction. The role of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis and treatment of these patients is analyzed in a series of 116 liver transplant patients. Nine patients (7.8%) were suspected to have biliary complications, and only four of them required immediate surgery because of early accidental T-tube removal and biliary tract stricture. The remaining five patients could be satisfactorily diagnosed and managed by ERCP which showed bile casts in the common bile duct in one case, and bile leaks in four cases, all of them being successfully resolved after endoscopic papillotomy. There were no complications related to the procedure. ERCP and endoscopic papillotomy is the technique of choice for diagnosis and treatment of biliary tract complications after liver transplantation.

Adolescent↗
PubMed1991

Somatostatin versus Sengstaken balloon tamponade for primary haemostasia of bleeding esophageal varices. A randomized pilot study.

In this study we evaluate the efficacy of somatostatin (ST) versus balloon tamponade (BT) in controlling bleeding from esophageal varices. Forty-four consecutive patients with active variceal bleeding were randomly assigned to treatment with a continuous infusion of ST at 250 micrograms/h after an initial bolus of 50 micrograms (group A) or to treatment with BT (group B). Five cases were excluded from the final analysis because of methodological issues. Nineteen patients were allocated to group A and twenty to group B. No differences in age, sex, alcohol intake, severity of bleeding or liver failure were found between the groups. Initial haemostasia within the first 4 h of treatment was obtained in 14 (74%) of the patients receiving ST and in 12 (60%) of those receiving BT. Three patients in group A and two in group B had early rebleeding. Bleeding was controlled over a 24-h period or until elective sclerotherapy could be performed in 11 (58%) and 10 (50%) of the patients, in groups A and B, respectively. One BT-treated patient developed aspiration pneumonia. No complications were observed in patients treated with ST. No significant differences in initial haemostasia, definite control of bleeding or complications were found between the two groups. In this study, somatostatin infusion was found to be as effective as Sengstaken BT in controlling acute variceal bleeding until an elective session of endoscopic sclerotherapy could be performed. However, larger studies are still needed to confirm this theory.

Adult↗
PubMed1991

[The cost effectiveness of hemorrhage units].

Gastrointestinal bleeding units appear as an alternative to intensive care units in the management of patients with gastrointestinal bleeding. Their hospitalization advantages and economic impact, however, are poorly evaluated. A survey was done among 176 Spanish general hospitals over 100 beds. Forty-four percent of the 176 hospitals answering the questionnaire had a protocol for the management of patients with gastrointestinal bleeding. Results from our survey show that gastrointestinal bleeding units are regarded as either useful (53%) or necessary (41%) by most hospitals, and should be equipped to provide intermediate-type care (88%). To the vast majority of hospitals, patient care is paramount to evaluate the yield of gastrointestinal bleeding units; in contrast, cost-efficiency analysis is relevant to only 31%, whereas the combination of cost efficiency and research is relevant to 61% of hospitals. Mean hospital charges for patients in our gastrointestinal bleeding unit, which has an occupancy rate of 95%, are 53% higher than those for regular inpatients, and 64% lower than those for patients in the intensive care unit.

Cost-Benefit Analysis↗