Biomedical subjects
V Cuervas-Mons
Publications and source records attributed to V Cuervas-Mons.
[70% hepatectomy and portacaval termino-lateral anastomosis as an experimental model of fulminating hepatic insufficiency].
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Effect of colistin on reduction of biliary flow induced by endotoxin in E. coli.
In order to evaluate whether an antiendotoxin agent can inhibit the action of endotoxin of Escherichia coli on biliary flow, we used 18 models of isolated perfused pig liver divided into four groups: (A) five perfused livers (control), (B) five perfused livers with 2 mg/100 ml of endotoxin added, (C) five perfused livers with 2 mg/100 ml of endotoxin added and treated with 1,500,000 IU of colistin, and (D) three perfused livers with 1,500,000 IU of colistin with no endotoxin. The livers were isolated and perfused according to a technique previously described by our laboratory. The viability of the perfusions was controlled by means of the mitochondrial respiration test. Transaminase and LDH levels were measured in the perfused circuit. A significant reduction of the biliary flow was found in the group with endotoxin of Escherichia coli (P less than 0.002). There was no reduction of biliary flow after addition of 1,500,000 IU of colistin (P less than 0.001). No significant changes were observed in the other parameters measured, and no increase of the bile flow was observed in the colistin group. From our results we conclude that colistin is an inhibitor in vitro of the diminished biliary flow induced by endotoxin of Escherichia coli.
[Spontaneous peritonitis due to Clostridium perfringens in three patients with cirrhosis (author's transl)].
Three cases of spontaneous peritonitis due to Clostridium perfringens in cirrhotic patients with a fatal outcome are reported. The diagnosis was made clinically in two patients and by post-mortem examination in the third. One patient had elevated values of serum alpha-fetoprotein. These cases are compared with three other reported cases in the literature. Blood cultures were negative in the three patients, a fact that lends support to the theory of transmural migration of bacteria. In the authors' experience C. perfringens is the third most frequent agent responsible for spontaneous peritonitis in cirrhosis, preceded by E. coli and Streptococcus and followed by Klebsiella, a surprising fact given the scarce number of reported cases. Routine abdominal paracentesis is recommended in any cirrhotic patient with ascites, followed by appropriate antibiotic treatment whenever positive cultures are obtained. The efficacy of treatment is probably doubtful. The literature on antibiotic treatment of spontaneous peritonitis in cirrhosis is reviewed.
[Hyporeninemic hypoaldosteronism. Case report and attempt at pathophysiological classification (author's transl)].
A 75 year-old male presented with hyperkalemia unexplained by a moderate renal insufficiency, low basal levels of aldosterone and renin with a subnormal response to walking and saline depletion, and normal glucocorticoid function. The hyperkalemia was corrected by fluorocortisone administration. The concept of hypoaldosteronism is reviewed, defining it as an isolated aldosterone deficiency and thus excluding the combined deficiency of cortisol and aldosterone and the suprarenal enzyme deficits that simultaneously involve mineralocorticoid and glucocorticoid synthesis. Depending on the presence or absence of alterations of the renin-angiotensin axis, this infrequent syndrome can be pathophysiologically classified as low, normal or high renin hypoaldosteronism. The characteristic features of each type are described, and emphasis is made on the need for a high index of suspicion when unexplained hyperkalemia is present in order to perform the appropriate tests to confirm or rule out hypoaldosteronism.
Plasma cell dyscrasia with polyneuritis and dermato-endocrine alterations. Report of a new case outside Japan.
A new syndrome has been described comprising polyneuropathy, oedema, hyperpigmentation and thickening of the skin, gynaecomastia in males and amenorrhoea in females, monoclonal gammopathy, papilloedema and diabetes. There is frequent osteosclerosis with or without plasmacytoma, hepatosplenomegaly and polycythaemia. There is a good response to corticosteroids, immunosuppressive drugs and occasionally to excision or irradiation of the plasmacytoma. This syndrome was first described in Japan, and is still seen predominantly there, and only occasionally in other areas. An example in a 51-year-old Spanish female is described: she had a spectacular response to prednisone and melphalan. The aetiopathogenic possibilities are discussed.
Adult liver transplantation: an analysis of the early causes of death in 40 consecutive cases.
One hundred twenty-nine adult patients who received an orthotopic liver transplantation and survived at least 24 hr after surgery were evaluated. During the period of follow-up, 48 of the 129 patients (37%) died. Only 40 of these 48 patients died at our institution and were included in this study. Seventeen of the 40 deaths (42.5%) occurred during the first month after orthotopic liver transplantation and 30 of the 40 deaths (75%) occurred during the first 60 days post-orthotopic liver transplantation. Death was related to infection in 21 cases (52.5%), to multiorgan failure in 8 (20%) and to uncontrollable rejection in 3 (7.6%). The remaining eight deaths (20%) were attributed to a variety of other causes. Eleven of the 21 deaths related to infection (52%) occurred during the first month after orthotopic liver transplantation. Bacterial sepsis was the leading cause of death and accounted for 17 of the 21 deaths (81%) in which infection was present at the time of death. The most frequently isolated bacteria were Pseudomonas and other enteric Gram-negative bacilli. Three patients had complete occlusion of the hepatic artery of the grafted liver. Six patients developed massive infarction of the liver despite patent vascular anastomoses. Histological signs of rejection were seen in 9 of the 31 patients autopsied (29%), but in only 3 of these (9.6%) was rejection the principal cause of death. The biliary anastomoses were patent in all 31 cases examined at autopsy.
Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation.
Twenty-seven clinical and laboratory data and the subsequent clinical course of 93 consecutive adult patients who underwent orthotopic liver transplantation for various chronic advanced liver diseases were analyzed retrospectively to assess the risk factors of early major bacterial infection and death after the procedure. Forty-one patients (44%) had early major bacterial infection during hospitalization for orthotopic liver transplantation. The mortality rate was 70.7% in patients with early major bacterial infection and was 7.7% in patients without early major bacterial infection (p less than 0.001). Total serum bilirubin, total white blood cell count and polymorphonuclear cell count, IgG (all p less than 0.05) and plasma creatinine level (p less than 0.001) were higher in patients that developed early major bacterial infection than in those who did not. By step-wise discriminant analysis, the strongest risk factor for early major bacterial infection was the serum creatinine level, which achieved an accuracy of 69% for a creatinine level greater than 1.58 mg per dl. Seven variables (ascites, hepatic encephalopathy, elevated white blood and polymorphonuclear cell count, decreased helper to suppressor T cell ratio and elevated plasma creatinine and bilirubin levels) were associated with a significant increased risk for death. A step-wise discriminant analysis of these seven factors resulted in the demonstration of serum creatinine as the greatest risk factor for mortality. A preoperative serum creatinine either less than or greater than 1.72 mg per dl accurately predicts survival or death, respectively, in 79% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)
Induction of peripheral chimerism in an allogenic model of small bowel transplantation with intrathymic inoculation of donor-derived cells.
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Incidence and outcome of de novo malignancies after liver transplantation.
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[Consensus document on indications for liver transplantation. 2002].
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Oral care planning and handling of immunosuppressed heart, liver, and kidney transplant patients.
In order to provide dentists with specific guidelines regarding appropriate oral treatments for transplant patients, their timing, and the prophylactic steps that must be taken in their handling, a two-phase study was undertaken. In the first phase, the effectiveness of an initial oral hygiene training and motivation program was evaluated by statistical testing of the observed differences in gingival overgrowth and plaque and gingivitis scores between a study group and a control group, each consisting of 46 heart and liver transplant patients. Significantly higher scores were observed in the control group. In the second phase, the effectiveness of a set of prophylactic measures was tested in 530 periodontal treatments and 380 dental treatments, applied in 120 heart, liver, and kidney transplant patients who showed no significant complications. It was concluded that all transplant patients should be monitored by a dentist, and that the recommended procedure is effective in preventing oral treatment complications.
Combined transplantation of heart and liver from two different donors in a patient with familial type IIa hypercholesterolemia.
A 12-year-old child with terminal ischemic heart disease as a result of homozygotous familial type IIa hypercholesterolemia received an orthotopic heart transplant and, 21 days later, an orthotopic liver transplant. Six months after heart transplantation, the patient is asymptomatic and evidences normal liver function and cholesterol levels; there are no signs of heart rejection. To our knowledge, this is the first instance of two-step heart-liver transplantation with organs from different donors.
Septic arthritis by Salmonella enteritidis after heart transplantation.
A 13-year-old boy underwent orthotopic heart transplantation for end-stage idiopathic dilated cardiomyopathy. Immunosuppressive therapy consisted of cyclosporine, azathioprine, prednisone, and antithymocyte globulin. Endomyocardial biopsies revealed persistent moderate rejection, which was treated aggressively. In the sixth week, septic arthritis by Salmonella enteritidis developed. We discuss our management of this exceptional complication and the poor results obtained because of superimposed cytomegalovirus infection.
[Pyogenic liver abscess. A descriptive study of 35 cases].
Thirty-five patients with pyogenic hepatic abscess (PHA) attended over 13 years in a general hospital were studied. The aim of the study was to know the usefulness of the performance of opaque enema in patients with cryptogenic PHA and the prognosis of the patients treated with only antibiotics. The most frequent clinical and analytical manifestations were fever and leukocytosis. Other less frequent findings were abdominal pain, hepatomegaly and elevated alkaline phosphatase and aspartate aminotransferase levels. One third of the patients presented radiologic alterations at the base of the right hemithorax. Colon studies in the patients with cryptogenic PHA performed to discard another origin of the abscess demonstrated very low profitability. Abdominal echography showed adequate sensitivity (0.85) in the diagnosis of PHA and allowed percutaneous drainage to be performed in most of the cases. The patients who were treated with only antibiotics presented a significantly worse prognosis than those treated with antibiotics and drainage (p = 0.03). Drainage of the PHA also allowed a decrease in the length of fever duration.