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Rodríguez-Álvarez S, Palazón JM, Dorta RL. Iron Trichloride-Mediated Cascade Reaction of Aminosugar Derivatives for the Synthesis of Fused Tetrahydroisoquinoline-Tetrahydrofuran Systems. ACS Omega 2022; 7:39061-39070. [PMID: 36340113 PMCID: PMC9631894 DOI: 10.1021/acsomega.2c04804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
A method to obtain tetrahydroisoquinolines (THIQs) fused to tetrahydrofuran rings from aminosugar derivatives has been developed. The procedure relies on a key deprotection of benzyl ethers followed by a double-cyclization sequence, using FeCl3 as the sole reagent. This tandem reaction affords the construction of novel fused polycyclic heterocycles with total stereochemical control.
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Rodríguez-Laiz GP, Melgar P, Alcázar-López C, Franco-Campello M, Martínez-Adsuar F, Navarro-Martínez J, Gómez-Salinas L, Pascual S, Bellot P, Carnicer F, Rodríguez-Soler M, Palazón JM, Mas-Serrano P, Almanza-López S, Jaime-Sánchez F, Perdiguero M, de Santiago C, Lozano T, Irurzun J, Pérez E, Merino E, Zapater P, Lluís F. Enhanced recovery after low- and medium-risk liver transplantation. A single-center prospective observational cohort study. Int J Surg 2020; 85:46-54. [PMID: 33338651 DOI: 10.1016/j.ijsu.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND & AIMS Few studies have fully applied an enhanced recovery after surgery (ERAS) protocol to liver transplantation (LT). Our aim was to assess the effects of a comprehensive ERAS protocol in our cohort of low- and medium-risk LT patients. METHODS The ERAS protocol included pre-, intra-, and post-operative steps. During the five-year study period, 181 LT were performed in our institution. Two cohorts were identified: low risk patients (n = 101) had a laboratory model for end-stage liver disease (MELD) score of 20 points or less at the time of LT, received a liver from a donor after brain death, and had a balance of risk score of 9 points or less; medium-risk patients (n = 15) had identical characteristics except for a higher MELD score (21-30 points). In addition, we analyzed the remaining patients (n = 65) who were transplanted over the same study period separately using the ERAS protocol. RESULTS The low-risk cohort showed a low need for packed red blood cells transfusion (median: 0 units) and renal replacement therapy (1%), as well as a short length of stay both in the intensive care unit (13 h) and in the hospital (4 days); morbidity during one-year follow-up, and probability of surviving to one year (89.30%) and five years (76.99%) were in line with well-established reference data. Similar findings were observed in the medium-risk cohort. CONCLUSIONS This single-center prospective observational cohort study provides evidence that ERAS is feasible and safe for low- and medium-risk LT.
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Affiliation(s)
- Gonzalo P Rodríguez-Laiz
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Paola Melgar
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain.
| | - Cándido Alcázar-López
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Mariano Franco-Campello
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Francisco Martínez-Adsuar
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - José Navarro-Martínez
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Luís Gómez-Salinas
- Anesthesiology and Surgical Critical Care, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Sonia Pascual
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Pau Bellot
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Fernando Carnicer
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - María Rodríguez-Soler
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - José M Palazón
- Gastroenterology and Hepatology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Patricio Mas-Serrano
- Pharmacy and Pharmacokinetics, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Susana Almanza-López
- Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Francisco Jaime-Sánchez
- Critical Care Medicine, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Miguel Perdiguero
- Nephrology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Carlos de Santiago
- Transplant Coordination, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Teresa Lozano
- Cardiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Javier Irurzun
- Radiology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Enrique Pérez
- Psychiatry, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Infectious Diseases, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
| | - Félix Lluís
- Hepatopancreatobiliary Surgery and Liver Transplantation, General University Hospital of Alicante (HGUA), And Health and Biomedical Research Institute of Alicante (ISABIAL), Alicante, Spain
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Peris J, Bellot P, Roig P, Reus S, Carrascosa S, González-Alcaide G, Palazón JM, Ramos JM. Clinical and epidemiological characteristics of pyogenic liver abscess in people 65 years or older versus people under 65: a retrospective study. BMC Geriatr 2017; 17:161. [PMID: 28732474 PMCID: PMC5521099 DOI: 10.1186/s12877-017-0545-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To analyse the clinical, epidemiological, microbiological and prognostic differences of pyogenic liver abscess (PLA) in older (≥ 65 years of age) versus younger patients (< 65 years). METHODS Multicentre, retrospective cohort study in all patients with PLA admitted to two Spanish hospitals from January 2000 to January 2014. Cases were divided into two age groups (< 65 years and ≥65 years) for comparison of clinical, epidemiological and microbiological characteristics as well as treatment. RESULTS Of 98 patients analysed, 40 patients were younger than 65, and 58 were aged 65 or older. Significant associations in the older group were found with female sex (adjusted odds ratio [ORa] 9.0; 95% CI 1.4, 56), non-cryptogenic origin (ORa 14.5; 95% CI 1.6, 129), absence of chronic liver disease (ORa 14; 95% CI 1.3, 155), Escherichia coli infection (ORa 7.7; 95% CI 1.03, 58), and incidence of complications (ORa 2.3; 95% CI 1.04, 5.4). Mortality was 8.2% overall, although all deaths occurred in the older group (8/58; 13.8%) (p = 0.02). DISCUSSION Our results are in consonance with other published studies. Older patients with PLA tend to present more anomalies in the biliary tract (Kai et. al, World J Gastroenterol 18: 2948-295, 2012, Rahimian et. al, Clin Infect Dis 39:1654-9, 2004, Seeto, Medicine (Baltimore) 75:99-113, 1996, Kao et.al, Aliment Pharmacol Ther 36:467-76, 2012, Lai et. al, Gastroenterology 146:129-37, 2014), while younger patients are more often male and present more commonly with previous liver disease (especially related to alcohol) and cryptogenic PLA. CONCLUSION In patients aged 65 or older, PLA was more common in women and in those with a history of biliary disease, and E. coli was the most frequent bacterium. Mortality was also higher in the older group.
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Affiliation(s)
- Jorge Peris
- Deparment of Internal Medicine, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Pablo Bellot
- Gastroenterology and Hepatology Service, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - Pablo Roig
- Deparment of Internal Medicine, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Sergio Reus
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - Sara Carrascosa
- Family Medicine Department, Campello Health Centre, El Campello, Alicante, Spain
| | - Gregorio González-Alcaide
- Department of History of Science and Documentation, University of Valencia, Valencia, Valencia, Spain
| | - José M Palazón
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
- Gastroenterology and Hepatology Service, Hospital General Universitario de Alicante, Alicante, Alicante, Spain
| | - José M Ramos
- Department of Clinical Medicine, Universidad Miguel Hernández de Elche, Campus of Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain.
- Department of Internal Medicine, Hospital General Universitario de Alicante Alicante, Alicante, Alicante, Spain.
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León R, Sánchez-Martínez R, Palazón JM, Payá A, Ramos JM, Pinargote H. [Nodular regenerative hyperplasia associated with common variable immunodeficiency and other comorbidities]. Med Clin (Barc) 2015; 146:263-6. [PMID: 26723943 DOI: 10.1016/j.medcli.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/05/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Currently, there are not many data on the evolution of nodular regenerative hyperplasia (NRH) associated or not with underlying diseases and in particular that associated with common variable inmunodeficiency (CVID). Twenty cases of NRH are presented, and the differences between the cases associated with CVID and those related to other diseases are analysed. METHODS Retrospective and descriptive study over a period of 14 years. RESULTS Twelve out of the 20 patients were men; the median age was 51 years. CVID was the main illness associated with NRH. In patients with CVID and NRH, gastrointestinal haemorrhage was more common, all the patients had high gamma glutamyl transferase and alkaline phosphatase and none had altered albumin and bilirubin levels compared to the patients without CVID. On follow-up, 50% of patients with CVID (2/4) had died compared to 33.3% (5/15) without CVID. CONCLUSIONS NRH in patients with CVID seems to have more biochemical data of anicteric cholestasis and portal hypertension and could be associated with lower survival.
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Affiliation(s)
- Rafael León
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España.
| | | | - José M Palazón
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Artemio Payá
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Alicante, España
| | - José M Ramos
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, España
| | - Héctor Pinargote
- Servicio de Medicina Interna, Hospital General Universitario de Alicante, Alicante, España
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Martínez J, Abad-González Á, Aparicio JR, Aparisi L, Boadas J, Boix E, de las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez Ó, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, De-Madaria E. Recomendaciones del Club Español Pancreático para el diagnóstico y tratamiento de la pancreatitis crónica: parte 1 (diagnóstico). Gastroenterología y Hepatología 2013; 36:326-39. [DOI: 10.1016/j.gastrohep.2012.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/14/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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de-Madaria E, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de-Las-Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero EC, Martínez J. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology 2012; 13:18-28. [PMID: 23395565 DOI: 10.1016/j.pan.2012.11.310] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/11/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
Abstract
Chronic pancreatitis (CP) is a complex disease with a wide range of clinical manifestations. This range comprises from asymptomatic patients to patients with disabling symptoms or complications. The management of CP is frequently different between geographic areas and even medical centers. This is due to the paucity of high quality studies and clinical practice guidelines regarding its diagnosis and treatment. The aim of the Spanish Pancreatic Club was to give current evidence-based recommendations for the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. These experts were selected according to clinical and research experience in CP. A list of questions was made and two experts reviewed each question. A draft was later produced and discussed with the entire panel of experts in a face-to-face meeting. The level of evidence was based on the ratings given by the Oxford Centre for Evidence-Based Medicine. In the second part of the consensus, recommendations were given regarding the management of pain, pseudocysts, duodenal and biliary stenosis, pancreatic fistula and ascites, left portal hypertension, diabetes mellitus, exocrine pancreatic insufficiency, and nutritional support in CP.
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Affiliation(s)
- E de-Madaria
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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7
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Martínez J, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, de Las Heras G, Domínguez-Muñoz E, Farré A, Fernández-Cruz L, Gómez L, Iglesias-García J, García-Malpartida K, Guarner L, Lariño-Noia J, Lluís F, López A, Molero X, Moreno-Pérez O, Navarro S, Palazón JM, Pérez-Mateo M, Sabater L, Sastre Y, Vaquero E, de-Madaria E. The Spanish Pancreatic Club recommendations for the diagnosis and treatment of chronic pancreatitis: part 1 (diagnosis). Pancreatology 2012; 13:8-17. [PMID: 23395564 DOI: 10.1016/j.pan.2012.11.309] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Revised: 11/13/2012] [Accepted: 11/18/2012] [Indexed: 12/11/2022]
Abstract
Chronic pancreatitis (CP) is a relatively uncommon, complex and heterogeneous disease. The absence of a gold standard applicable to the initial phases of CP makes its early diagnosis difficult. Some of its complications, particularly chronic pain, can be difficult to manage. There is much variability in the diagnosis and treatment of CP and its complications amongst centers and professionals. The Spanish Pancreatic Club has developed a consensus on the management of CP. Two coordinators chose a multidisciplinary panel of 24 experts on this disease. A list of questions was drafted, and two experts reviewed each question. Then, a draft was produced and shared with the entire panel of experts and discussed in a face-to-face meeting. This first part of the consensus addresses the diagnosis of CP and its complications.
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Affiliation(s)
- J Martínez
- Pancreatic Unit, University General Hospital of Alicante, Spain.
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Mayato C, Dorta RL, Palazón JM, Vázquez JT. Comparison of the conformational properties of carbasugars and glycosides: the role of the endocyclic oxygen. Carbohydr Res 2012; 352:101-8. [DOI: 10.1016/j.carres.2012.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/18/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
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Sempere L, Palazón JM, Sánchez-Payá J, Pascual S, de Madaria E, Poveda MJ, Carnicer F, Zapater P, Pérez-Mateo M. Assessing the short- and long-term prognosis of patients with cirrhosis and acute variceal bleeding. Rev Esp Enferm Dig 2009. [PMID: 19492899 DOI: 10.4321/s1130-01082009000400002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE to evaluate the efficacy of various indicators in predicting short- and long-term survival in patients with cirrhosis and acute variceal bleeding. MATERIAL AND METHODS prognostic indicators were calculated for a cohort of 201 cirrhotic patients with acute variceal bleeding hospitalized in our center, a third-level teaching hospital. The studied variables were: age, sex, etiology of cirrhosis, endoscopic findings, previous variceal bleeding episodes, human immunodeficiency virus (HIV) infection, hepatocellular carcinoma (HCC), infection during episode, and Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores within 24 hours of bleeding onset. Patients were followed up for at least 6 months until death, liver transplantation, or end of observation. RESULTS median follow-up was 66.85 weeks (range 0-432.4). The 6-week, 3-month, 12-month and 36-month mortality rates were 22.9, 24.9, 34.3, and 39.8%, respectively. Age >= 65 years, presence of HCC, CTP score >=10, and MELD score >= 18 were the variables associated with mortality in the multivariate analysis. The accuracy of MELD scores as predictors of 6-week, 3-month, 12-month, and 36-month mortality was better than that of CTP scores (c-statistics: 6 week MELD 0.804, CTP 0.762; 3-month MELD 0.794, CTP 0.760; 12-month MELD 0.766, CTP 0.741; 36 month MELD 0.737, CTP 0.717). CONCLUSION MELD and CTP scores together with age and a diagnosis of hepatocellular carcinoma are useful indicators to assess the short- and long-term prognosis of patients with acute variceal bleeding.
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Affiliation(s)
- L Sempere
- Epidemiology Service, Hospital General Universitario, Alicante, Spain.
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Murcia J, Portilla J, Bedia M, Palazón JM, Sánchez-Payá J, Saiz de la Hoya P, Payá A, Boix V, Merino E, Reus S. [Chronic hepatitis C virus infection and associated liver disease among the inmates of a Spanish prison]. Enferm Infecc Microbiol Clin 2009; 27:206-12. [PMID: 19246126 DOI: 10.1016/j.eimc.2008.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 07/17/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and genotype distribution of chronic hepatitis C virus (HCV) infection in a penitentiary population. The secondary objective was to describe histological findings in liver of the biopsied population, and identify risk factors associated with liver fibrosis and inflammatory activity. METHODS Among 800 inmates, 730 accepted HCV antibody screening and PCR confirmation. Sociodemographic, behavioral, and incarceration-related variables were analyzed. Liver biopsy was offered to individuals with chronic HCV infection. Advanced liver disease was defined as fibrosis 3 and/or an inflammatory activity index score 8). RESULTS HCV antibodies were found in 279 inmates. PCR confirmed HCV infection in 250 inmates, yielding a prevalence of 34.2% (95% confidence interval [CI]: 30.8-37.8). Intravenous drug use was independently associated with HCV infection, odds ratio (OR) 51.7 (95% CI: 31-86). Genotypes were 1a 32.9%, 3 29.7%, 1b 18.4% and 4 17.1%. Fifty-one liver biopsies were performed; advanced liver disease was found in 7 patients (13.7%) based on fibrosis and in 31 patients (60.7%) based on the inflammatory activity index. High AST and ALT levels were associated with advanced liver disease established on both fibrosis and inflammatory activity (P<.05). Lengthy intravenous drug use was associated with inflammatory activity (P=.02; OR 1.2; 95% CI: 1.03-1.7). CONCLUSIONS Persistent HCV infection is highly prevalent among prison inmates and is associated with intravenous drug abuse. HCV genotype diversity is higher in prison inmates than in the general population. Higher transaminase levels are associated with advanced liver disease.
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Affiliation(s)
- José Murcia
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, España
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Zapater P, Francés R, González-Navajas JM, de la Hoz MA, Moreu R, Pascual S, Monfort D, Montoliu S, Vila C, Escudero A, Torras X, Cirera I, Llanos L, Guarner-Argente C, Palazón JM, Carnicer F, Bellot P, Guarner C, Planas R, Solá R, Serra MA, Muñoz C, Pérez-Mateo M, Such J. Serum and ascitic fluid bacterial DNA: a new independent prognostic factor in noninfected patients with cirrhosis. Hepatology 2008; 48:1924-31. [PMID: 19003911 DOI: 10.1002/hep.22564] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
UNLABELLED We tested the hypothesis that the presence of bacterial DNA (bactDNA) in ascitic fluid and serum is associated with decreased survival in patients with cirrhosis. In a prospective, multicenter study, we analyzed the clinical evolution of 156 patients with cirrhosis and ascites (first or recurrence) with lower than 250 polymorphonuclear cells (PMN)/muL, negative ascites bacteriological culture, and absence of other bacterial infections being admitted for evaluation of large-volume paracentesis, according to the presence of bactDNA at admission. Survival, causes of death, and successive hospital admissions were determined during a 12-month follow-up period. BactDNA was detected in 48 patients. The most prevalent identified bactDNA corresponded to Escherichia coli (n = 32/48 patients, 66.6%). Patients were followed for 12 months after inclusion and in this period 34 patients died: 16 of 108 (15%) bactDNA negative versus 18 of 48 (38%) bactDNA positive (P = 0.003). The most frequent cause of death was acute-on-chronic liver failure in both groups (7/16 and 9/18 in patients without or with bactDNA, respectively), although more prevalent in the first month of follow-up in patients with presence of bactDNA (0 versus 4/7). When considering patients with model for end-stage liver disease (MELD) score less than 15, mortality was significantly higher in those with presence of bactDNA. Spontaneous bacterial peritonitis developed similarly in patients with or without bactDNA at admission. CONCLUSION The presence of bactDNA in a patient with cirrhosis during an ascitic episode is an indicator of poor prognosis. This fact may be related to the development of acute-on-chronic liver failure at short term and does not predict the development of spontaneous bacterial peritonitis.
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Affiliation(s)
- Pedro Zapater
- Unidad Hepática, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Alicante, Spain
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Amorós A, Palazón JM, Zapater P, de Madaria E, Pérez-Mateo M. [A cost-effectiveness study of hepatic venous pressure gradient measurement in the secondary prevention of variceal bleeding]. Rev Esp Enferm Dig 2008; 100:416-422. [PMID: 18808289 DOI: 10.4321/s1130-01082008000700007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE variceal rebleeding is common following a first episode of hemorrhage in cirrhotic patients. The objective of this study was to determine the cost-effectiveness of monitoring hepatic venous pressure gradient (HVPG) to guide secondary prophylaxis. METHODS we created a Markov decision model to calculate cost-effectiveness for two strategies: Group 1: HVPG monitoring to decide treatment -when portal pressure was reduced by at least 20 percent or HVPG was less than 12 mmHg after beta-blocker administration, patients received beta-blockers; when portal pressure did not meet these criteria therapy was endoscopic band ligation. Group 2: in this group there was no monitoring of HVPG. Patients with large varices received treatment with beta-blockers combined with EBL; patients with small varices received beta-blockers plus isosorbide mononitrate. RESULTS there was no recurrent variceal bleeding in group 1 for good responders, and for 17% of poor responders. In group 2 a 25% rebleeding rate was detected in patients with small varices and 13% for those with big varices. Overall cost in group 1 was 14,100.49 euros, and 14,677.16 in group 2. CONCLUSIONS HVPG measurement is cost-effective for the secondary prophylaxis of variceal bleeding.
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Affiliation(s)
- A Amorós
- Unidad Hepática y Servicio de Farmacología. Hospital General Universitario de Alicante. Universidad Miguel Hernández, Alicante, Spain.
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Hernández FT, Zapater P, De-Madaria E, Palazón JM, Pascual S, Irurzun J, Such J, Perez-Mateo M, Horga JF. Functional status of beta-2-adrenoceptor in isolated membranes of mature erythrocytes from patients with cirrhosis and oesophageal varices. Vascul Pharmacol 2006; 44:464-8. [PMID: 16624626 DOI: 10.1016/j.vph.2006.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Accepted: 03/08/2006] [Indexed: 01/07/2023]
Abstract
Propranolol is a widely used drug for prophylaxis of variceal bleeding in patients with cirrhosis, but not all patients show an adequate clinical response. This variability may be in relation to beta adrenoceptor activity, but no information is available in this setting. Thirty-nine patients with advanced cirrhosis and presence of oesophageal varices were sequentially included. We studied the function of beta-2-adrenoceptor in isolated membranes of mature erythrocytes obtained from patients by measuring cyclic AMP (cAMP) production before and after isoproterenol. Blood samples obtained from 11 healthy volunteers were used as control. Patients showed a six-fold increase in the mean basal cAMP production as compared to healthy volunteers. Isoproterenol produced a small, non-significantly and highly variable increase in the AC activity in patients compared with controls. cAMP values remain stable after three months of continuous treatment with oral beta-blockers in both groups. Patients without antecedent of variceal bleeding or with an active alcohol intake showed a significantly higher isoproterenol effect. In conclusion, beta-receptor function in human erythrocytes membranes is altered in patients with cirrhosis and oesophageal varices.
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Affiliation(s)
- F T Hernández
- Clinical Pharmacology Unit, Hospital General Universitario, and Departamento de Farmacología and Terapéutica, Facultad de Medicina, Universidad Miguel Hernández, San Juan de Alicante, Spain
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14
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Palazón JM, Such J, Sánchez-Payá J, Company L, de Madaria E, Sempere L, Martínez J, Zapater P, Pascual S, Carnicer F, Pérez-Mateo M. A comparison of two different dosages of somatostatin combined with sclerotherapy for the treatment of acute esophageal variceal bleeding: a prospective randomized trial. Rev esp enferm dig 2006; 98:249-54. [PMID: 16792454 DOI: 10.4321/s1130-01082006000400004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND the association of somatostatin (SMT) with endoscopic therapy in patients with cirrhosis and variceal bleeding significantly improves the control of the bleeding episode, and hemodynamic data have shown that a dosage of 500 mg/h allows a more marked reduction of portal pressure versus the usual dosage of 250 mg/h. AIM to assess if the 500 mg/h dosage is associated with an improved outcome. METHODS sixty-two patients with variceal bleeding were included in the study. Patients were randomized to receive the usual dosage of SMT (group I: 250 mg/h), or a double dosage (group II: 500 mg/h), together with emergency endoscopic sclerotherapy. RESULTS the control of the bleeding episode was similar in both groups of patients. Early rebleeding was less frequent in patients receiving double vs. single dosage of SMT (p = 0.06). When considering patients with advanced liver disease (Child-Pugh B or C) early rebleeding was significantly less frequent in patients receiving the 500 mg/h dose of SMT (39 vs. 13%, p = 0.03). CONCLUSIONS the perfusion of higher doses of SMT (500 mg/h) in association with emergency sclerotherapy in patients with cirrhosis and esophageal hemorrhage significantly decreases the rate of early rebleeding in patients with more advanced stages of liver disease.
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Affiliation(s)
- J M Palazón
- Liver Unit, Hospital General Universitario, Alicante, Spain.
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15
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De Madaria E, Palazón JM, Pérez-Mateo M. [Hemodynamic response to a single dose of intravenous propranolol in the prophylaxis of variceal bleeding]. Gastroenterol Hepatol 2005; 28:658. [PMID: 16373022 DOI: 10.1016/s0210-5705(05)71536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Jover R, Compañy L, Gutiérrez A, Lorente M, Zapater P, Poveda MJ, Such J, Pascual S, Palazón JM, Carnicer F, Ferrandis F, Pérez-Mateo M. Clinical significance of extrapyramidal signs in patients with cirrhosis. J Hepatol 2005; 42:659-65. [PMID: 15826714 DOI: 10.1016/j.jhep.2004.12.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 11/25/2004] [Accepted: 12/01/2004] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Extrapyramidal signs have been described in cirrhosis and there is little information about their clinical significance. The aims of this study have been to investigate the relationship between extrapyramidal signs and cognitive impairment, and what is their influence on quality of life. METHODS 46 patients with cirrhosis were evaluated for cognitive impairment with psychometric tests (Trail-Making Test part A, Grooved-Pegboard, Block-Design, Oral Symbol Digit and Stroop Test) and cognitive evoked potentials (P300). Extrapyramidal signs were evaluated using the UPDRS scale. Health-related quality of life (HRQL) was measured using SF-36 scale and the Chronic Liver Disease Questionnaire (CLDQ). RESULTS Twenty-two patients had extrapyramidal signs, and these patients scored worse in all psychometric tests, except Block-Design. Patients with extrapyramidal signs also showed a longer P300 latency. Moreover, patients with extrapyramidal signs had the worst score in all the HRQL scales used. A multivariate analysis disclosed that the only variable showing an independent relationship to the mental component summary of SF-36 and with CLDQ was UPDRS score. CONCLUSIONS We have found a clear relationship between the presence of extrapyramidal signs and cognitive impairment. Moreover, patients with extrapyramidal signs have worse scores in quality of life scales.
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Affiliation(s)
- Rodrigo Jover
- Department of Gastroenterology-Liver Unit, Hospital General Universitario de Alicante, C/Pintor Baeza, sn, E-03010 Alicante, Spain.
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Martínez J, Sánchez-Payá J, Palazón JM, Suazo-Barahona J, Robles-Díaz G, Pérez-Mateo M. Is obesity a risk factor in acute pancreatitis? A meta-analysis. Pancreatology 2004; 4:42-8. [PMID: 14988657 DOI: 10.1159/000077025] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 12/01/2003] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIMS Obesity has been associated with a worse prognosis in acute pancreatitis. According to some authors, obesity favours the development of local complications, while according to other reports obese patients presented more frequently systemic complications. Few studies find a relationship between obesity and mortality in acute pancreatitis. We conducted a meta-analysis of several reports that evaluate the relationship between obesity and the outcome of acute pancreatitis in order to assess its prognostic role in this disease. METHODS A MEDLINE search was conducted from 1965 to December 2002 with search terms including obesity, body mass index (BMI) and pancreatitis. A total of 12 reports were identified. Of these, only four studies included patients with mild and severe acute pancreatitis and measured obesity by BMI. The end points of the meta-analysis were the severity of acute pancreatitis, local complications, systemic complications and mortality. Obesity was defined when BMI was > or =30 kg/m2. Pooled odds ratio (OR) and confidence intervals (CI) were calculated according to the Mantel-Haenszel method, and heterogeneity was assessed by the multiplicative inverse variance method. RESULTS A total of 607 patients were evaluated. There was no heterogeneity for the variables severity, systemic complications, local complications and mortality among the included studies. Severe AP was significantly more frequent in obese patients (OR 2.6, 95% CI 1.5-4.6). Furthermore, those patients developed significantly more systemic (OR 2.0, 95% CI 1.1-4.6) and local complications (OR 4.3, 95% CI 2.4-7.9). Mortality in obese patients was only slightly higher (OR 1.3, 95% CI 0.5-3.6). CONCLUSION Obesity is a prognostic factor favouring the development of systemic and local complications in this disease. Therefore, it should be used routinely as part of the initial assessment of the severity of a case of acute pancreatitis.
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Affiliation(s)
- J Martínez
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain.
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Francés R, Benlloch S, Zapater P, González JM, Lozano B, Muñoz C, Pascual S, Casellas JA, Uceda F, Palazón JM, Carnicer F, Pérez-Mateo M, Such J. A sequential study of serum bacterial DNA in patients with advanced cirrhosis and ascites. Hepatology 2004; 39:484-91. [PMID: 14768002 DOI: 10.1002/hep.20055] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bacterial translocation is currently considered the main pathogenic mechanism leading to spontaneous bacterial peritonitis in patients with advanced cirrhosis and ascites. However, to the authors' knowledge there is no information regarding the characteristics of this process in humans. The goals of the current study were to pursue partially identified bacterial DNA in blood (what the authors consider molecular evidence of bacterial translocation) through its relative quantification in a 72-hour study period by using real-time polymerase chain reaction (PCR). A consecutive series of 17 patients with advanced cirrhosis and culture-negative, nonneutrocytic ascites were studied. Therapeutic paracentesis was performed at the time of admission, and blood samples were obtained at baseline and every 8 hours in a 3-day period. Bacterial DNA was detected by a PCR-based method, relatively quantified by real-time PCR, and identified by automated nucleotide sequencing. Seven of 17 patients demonstrated the simultaneous presence of bacterial DNA in blood and ascitic fluid at the time of admission. After therapeutic paracentesis was performed, bacterial DNA persisted in the blood for a minimum of 24 hours, and was reported to last as long as 72 hours in some patients. In addition, different patterns of bacterial DNA appearance and clearance from the blood were identified. The nucleotide sequencing process demonstrated that bacteria detected in the first sample were identical to those noted in subsequent detections over time. In conclusion, bacterial translocation is a single-species, dynamic process that appears to develop in a subgroup of patients with advanced cirrhosis.
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Affiliation(s)
- Rubén Francés
- Unidad Hepática Sección de Inmunología, Alicante, Spain
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Betancort JM, Martín T, Palazón JM, Martín VS. Stereoselective synthesis of cyclic ethers by intramolecular trapping of dicobalt hexacarbonyl-stabilized propargylic cations. J Org Chem 2003; 68:3216-24. [PMID: 12688793 DOI: 10.1021/jo0340556] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The intramolecular attack of a hydroxy group on an exo-biscobalthexacarbonyl propargylic cation provides cyclic ethers with six- to nine-membered rings. The scope and limitations of the methodology are described. The reaction is stereoselective when additional stereocenters are present, providing iterative methodology to access ladder-like cyclic ethers.
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Affiliation(s)
- Juan M Betancort
- Instituto Universitario de Bio-Orgánica Antonio González, Universidad de La Laguna, C/Astrofísico Francisco Sánchez 2, 38206 La Laguna, Tenerife, Spain
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Quílez C, Palazón JM, Arenas J, Alonso S, Sánchez J, Belda G, Pérez-Mateo M. Colonic wall thickening in patients with cirrhosis and portal hypertension. Rev Esp Enferm Dig 2003; 95:269-72, 265-8. [PMID: 12828526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To determine the prevalence of colonic wall thickening (CWT) and its relation with other clinical and radiological findings of portal hypertension. EXPERIMENTAL DESIGN Retrospective observational study. The follow-up period was at least 1 year. The colon wall was considered to be thickened when it measured > 6 mm. SUBJECTS The study included 63 patients, what were admitted in Liver Unit of University and General Hospital of Alicante with hepatic cirrhosis who had an abdominal CT scan performed between March 1996 and December 1998. RESULTS 21 (33.3%) patients showed CWT. This finding was particularly associated with the presence of collateral circulation [ OR = 10.3(1.5-100.8)] and portal thrombosis [OR = 12.8(1.4-118.4)] p<0.05. Patients with CWT tended to develop spontaneous bacterial peritonitis (CWT 14.3% vs no CWT 4.8%) [RR = 3(0.5 -16.6)] but this did not reach statistical significance (p= 0.18). CONCLUSIONS A third of the patients with cirrhosis and portal hypertension present colonic wall thickening. This finding is related to radiological features and clinical consequences of portal hypertension.
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Affiliation(s)
- C Quílez
- Unidad Hepática. Hospital General y Universitario de Alicante. Spain
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Such J, Francés R, Muñoz C, Zapater P, Casellas JA, Cifuentes A, Rodríguez-Valera F, Pascual S, Sola-Vera J, Carnicer F, Uceda F, Palazón JM, Pérez-Mateo M. Detection and identification of bacterial DNA in patients with cirrhosis and culture-negative, nonneutrocytic ascites. Hepatology 2002; 36:135-41. [PMID: 12085357 DOI: 10.1053/jhep.2002.33715] [Citation(s) in RCA: 211] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The current pathogenic theory of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites suggests that repeated episodes of bacterial translocation (BT) from intestinal lumen to mesenteric lymph nodes followed by systemic seeding are the key steps for the final development of infectious events. However, most of the episodes of systemic bacterial circulation remain undetected. Therefore, we investigated the hypothetical presence of bacteria in blood and/or ascitic fluid (AF) from patients with cirrhosis and sterile (culture negative) AF by means of bacterial DNA (bactDNA) detection and identification. Twenty-eight consecutively admitted patients with cirrhosis and presence of AF were included in the study. BactDNA was detected using a polymerase chain reaction (PCR)-based method. The corresponding bacteria were identified by nucleotide sequencing of purified PCR products. BactDNA was detected simultaneously in blood and AF in 9 patients (32.1%). DNA sequencing allowed the identification of Escherichia coli (n = 7) and Staphylococcus aureus (n = 2). In all cases, the similarity between the sequence found in AF and blood indicated that the bactDNA present in both locations originated from a single clone (single translocation event). Child-Pugh score and basic hemodynamic, clinical, endoscopic, and biochemical characteristics were similar among patients with or without the presence of bactDNA. In conclusion, we have detected bactDNA in serum and AF in 32% of all patients studied, and this likely represents single clone episodes of translocation and systemic seeding. E. coli is the most frequently identified bacteria.
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Affiliation(s)
- José Such
- Unidad Hepática, Hospital General Universitario, Universidad Miguel Hernández, Campus de San Juan, San Juan de Alicante, C/Pintor Baeza s/n, 03010 Alicante, Spain.
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Martínez J, Palazón JM, Muñoz C, López M, Sánchez-Payá J, Laveda R, Pérez-Mateo M. Endotoxin and anti-endotoxin antibodies in the prognosis of acute pancreatitis. Rev Esp Enferm Dig 2002; 94:406-16. [PMID: 12432837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
AIMS We investigate the behaviour of endotoxin in patients with acute pancreatitis and its relationship with the development of complications. EXPERIMENTAL DESIGN Prospective study. PATIENTS We assessed plasmatic endotoxin and anti-core endotoxin antibodies (EndoCab IgG and IgM) levels on first and third days from admission in patients with acute pancreatitis episodes, classifying them as mild or severe according to Atlanta's criteria. RESULTS Nineteen patients were included, seven with severe pancretitis (36.8%) and twelve with mild pancreatitis (63.2%). Endotoxin levels were similar on first day in both mild and severe pancreatitis, and higher in the latter on third day (p > 0.05). Patients with severe pancretitis had lower EndoCab IgM levels on first and third days from admission (day 1: 18.3 vs 33.3 MU/ml, p < 0.01; day 3: 18.4 vs 33.4 MU/ml, p < 0.05). When analysed separately systemic and local complications, we observed, in the same days, a decrease of EndoCab IgM levels in patients who developed systemic complications (day 1: 18.3 vs 32.7 MU/ml, p = 0.01; day 3: 18.3 vs 35.1 MU/ml, p < 0.01). EndoCab IgG levels were also lower in severe acute pancreatitis in both determinations, but differences weren't significant. CONCLUSIONS EndoCab levels decrease early in severe acute pancreatitis, mainly if systemic complications are present. This antibody depletion is greater for IgM than IgG, and seems to occur earlier than an increase in endotoxemia.
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Affiliation(s)
- J Martínez
- Department of Gastroenterology and Liver Unit, Hospital General Universitario, Alicante, Spain.
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Martínez J, Laveda R, Trigo C, Frasquet J, Palazón JM, Pérez-Mateo M. [Fecal elastase-1 determination in the diagnosis of chronic pancreatitis]. Gastroenterol Hepatol 2002; 25:377-82. [PMID: 12069698 DOI: 10.1016/s0210-5705(02)70269-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The diagnosis of chronic pancreatitis is based on morphological and functional data. To evaluate exocrine function, the secretin-cholecystokinin test is the gold standard but this is invasive and frequently unavailable. Recently, fecal elastase-1 determination has been investigated as an indirect test of pancreatic function. OBJECTIVE To evaluate the diagnostic value of fecal elastase-1 in chronic pancreatitis by comparing it with other indirect methods of evaluating pancreatic function such as the urine pancreolauryl test and fecal chymotrypsin determination. To do this, we analyzed the three diagnostic methods in four groups of patients: group I (14 patients with confirmed chronic pancreatitis); group II (5 patients with recurrent episodes of acute alcoholic pancreatitis; group III (9 patients with non-pancreatic diarrhea); group IV (8 patients with other gastrointestinal diseases). RESULTS Compared with the control groups (groups III and IV), patients in groups I and II presented lower levels of fecal elastase-1 (groups I-II: 88 mcg/g, groups III-IV: 635 mcg/g, p < 0.0001), fecal chymotrypsin (4.3 U/g and 29.3 U/g, respectively, p < 0.0001), and pancreolauryl (14% and 54%, respectively, p < 0,001). In the diagnosis of confirmed chronic pancreatitis (group I) the fecal elastase-1 and pancreolauryl tests showed a sensitivity of 85.6% and 78.5%, respectively. However, in group II, the most sensitive test was the pancreolauryl test (80% versus 60% for the chymotrypsin test and only 40% for the fecal elastase-1 test). In contrast, the fecal elastase-1 test showed the highest specificity (94.1% versus 88.2% for the fecal chymotrypsin test and 81.3% for the pancreolauryl test). CONCLUSION Fecal elastase-1 determination is an effective indirect method in the diagnosis of patients with advanced chronic pancreatitis. However, when the disease is in the early stages, its sensitivity is no greater than that of other indirect tests. The greatest advantage of this test is its high specificity.
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Affiliation(s)
- J Martínez
- Sección de Gastroenterología, Servicio de Medicina Interna, Servicio de Laboratorio, Hospital General Universitario de Alicante, Alicante, Spain
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Griñó P, Pascual S, Such J, Casellas JA, Niveiro M, Andreu M, Sáez J, Griñó E, Palazón JM, Carnicer F, Pérez-Mateo M. Comparison of diagnostic methods for Helicobacter pylori infection in patients with upper gastrointestinal bleeding. Scand J Gastroenterol 2001; 36:1254-8. [PMID: 11761013 DOI: 10.1080/003655201317097083] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accuracy of the most frequently used tests for diagnosing Helicobacter pylori infection in patients with upper gastrointestinal bleeding of peptic origin is determined. METHODS Seventy-eight patients with endoscopically-proven upper gastrointestinal bleeding of peptic origin were included. The presence of H. pylori was considered when observed from the histology or, if negative, when serology and breath test were both positive. Accuracy of the rapid urease test was estimated in accordance with results obtained with other diagnostic methods. RESULTS Lesions causing gastrointestinal bleeding were 56 duodenal ulcers, 13 gastric ulcers, 7 pyloric channel ulcers, 13 acute lesions of the gastric mucosa and 16 erosive duodenitis. H. pylori infection was present in 68 patients (87.2%). Forty-four patients had received non-steroidal anti-inflammatory drugs. The sensitivity/specificity (%) of the diagnostic methods was 48.5/100 for the rapid urease test, 91/77.8 for the breath test, 89.5/80 for serology and 86.3/100 for histology. The prior consumption of proton-pump inhibitors and antibiotics induced false-negative results in the rapid urease test and breath test, with no effect on serology and histology. CONCLUSIONS The prevalence of H. pylori infection in patients with upper gastrointestinal bleeding from peptic lesions is high. Sensitivity of the rapid urease test for diagnosing H. pylori is low in this setting. Cases with negative rapid urease test need the combination of two or more additional tests if diagnosis is to be achieved. Cases with positive rapid urease test do not need further investigation for diagnosis.
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Affiliation(s)
- P Griñó
- Dept. of Internal Medicine, University General Hospital, Universidad Miguel Hernández, Alicante, Spain
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de Vera F, Palazón JM, Botella C, Laveda R, Jover R, Pérez-Mateo M. [Free ascites associated with ventriculoperitoneal shunt in an adult]. Rev Esp Enferm Dig 2001; 93:549-50. [PMID: 11692788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Martínez JF, Palazón JM. [Premalignant conditions, presentation forms, and clinical profile of pancreatic carcinoma]. Gastroenterol Hepatol 1999; 22:451-5. [PMID: 10638043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J F Martínez
- Sección de Aparato Digestivo, Hospital General y Universitario de Alicante
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Quílez C, Palazón JM, Jover R, Martínez R, Chuliá T, Griñó P, Belda G. [Hepatoxicity due to ebrotidine: report of two cases]. Gastroenterol Hepatol 1999; 22:434-5. [PMID: 10592681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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28
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Aparicio JR, Such J, Pascual S, Arroyo A, Plazas J, Girona E, Gutiérrez A, de Vera F, Palazón JM, Carnicer F, Pérez-Mateo M. Development of quinolone-resistant strains of Escherichia coli in stools of patients with cirrhosis undergoing norfloxacin prophylaxis: clinical consequences. J Hepatol 1999; 31:277-83. [PMID: 10453941 DOI: 10.1016/s0168-8278(99)80225-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIM Norfloxacin prophylaxis decreases the incidence of bacterial infections in high-risk cirrhotic patients, but may promote the development of quinolone-resistant gram-negative bacteria in stools, and eventually lead to infections due to these bacteria. The aim of the study was to evaluate the prevalence of quinolone-resistant strains of E. coli in stools on admission, and the characteristics of any nosocomial infections. METHODS Eighty-three consecutively hospitalized cirrhotic patients were included in this prospective study. The presence of quinolone-resistant strains of E. coli in stools on admission, and the characteristics of any nosocomial infections were recorded. RESULTS Fourteen out of 83 patients (16.8%) showed quinolone-resistant E. coli in stools (Group I), and 69 did not (Group II). Thirteen out of 14 from Group I (92.8%) and 17/69 (24.6) from Group II had received primary or secondary prophylaxis with norfloxacin (p<0.001). During hospitalization, 12/12 (100%) of patients from Group I and 25/66 (37.8%) of patients from Group II underwent norfloxacin prophylaxis. Three bacterial infections in patients from Group I, 3 from Group II patients receiving norfloxacin and 16 from Group II patients not receiving norfloxacin were recorded (p<0.05). No infections due to quinolone-resistant E. coli were observed in patients colonized with these bacteria. Treatment with norfloxacin induced the development of quinolone-resistant E. coli in 6/14 (42.8%) patients in a mean time of 18.5+/-9.8 days. CONCLUSIONS The development of quinolone-resistant strains of E. coli is significantly associated with previous administration of norfloxacin prophylaxis. However, in our series this fact is not associated with an increased incidence of quinolone-resistant E. coli or other gram-negative infections.
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Affiliation(s)
- J R Aparicio
- Liver Unit, Hospital General Universitario de Alicante, Spain
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Martínez J, Sánchez-Payá J, Palazón JM, Aparicio JR, Picó A, Pérez-Mateo M. Obesity: a prognostic factor of severity in acute pancreatitis. Pancreas 1999; 19:15-20. [PMID: 10416686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
This study was conducted to assess the prognostic value of obesity in acute pancreatitis and to determine the role played by obesity-associated diseases in the course of the disease. We prospectively studied 49 patients with acute pancreatitis who were divided into three groups according to their body mass index (BMI). There were 22 patients in group I (BMI < or = 25 kg/m2, normal or low weight); 15 in group II (BMI >25 and < or = 29 kg/m2, overweight); and 12 in group III (BMI >29 kg/m2, obese). Other anthropometric parameters also were measured. The severity of pancreatitis was assessed according to the Atlanta classification system. Systemic complications were significantly more common among obese than nonobese patients (p < 0.05). Patients with severe pancreatitis had a higher body-fat percentage, measured by the subscapular skin-fold thickness, and a larger abdominal circumference than patients with mild pancreatitis. Although hypertensive or diabetic patients developed more systemic complications, the multivariate analysis demonstrated that the presence of these underlying diseases did not modify the prognostic role of obesity in acute pancreatitis. We conclude that obesity is a prognostic factor of outcome in acute pancreatitis. Obesity-associated diseases do not vary the prognostic value of obesity. It seems that truncal adiposity is the kind of obesity related to worse outcome of acute pancreatitis.
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Affiliation(s)
- J Martínez
- Department of Internal Medicine, Hospital General Universitario de Alicante, University Miguel Hernández, Spain
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Quílez C, Palazón JM, Chuliá T, Córdoba YC. [Hepatoxicity by enalapril]. Gastroenterol Hepatol 1999; 22:113-4. [PMID: 10193097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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31
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Girona E, Niveiro M, Palazón JM. [Intestinal obstruction secondary to endometriosis of the colon]. Gastroenterol Hepatol 1998; 21:339-41. [PMID: 9808898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Although in most cases it is a benign disorder, it may be aggressive producing local invasion and even metastasis. Endometrial implantation has been reported in many organs including the small and large intestine leading to acute or chronic symptomatology. The clinical picture of intestinal obstruction is due to stenosis produced by the adherences or fibrosis caused by endometrial sloughing. We present a case of intestinal endometriosis with clinical manifestation of obstruction of the colon. This disorder should be included in the differential diagnosis of fertile females presenting intestinal obstruction with no other predisposing factors.
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Affiliation(s)
- E Girona
- Servicio de Aparato Digestivo, Hospital General y Universitario de Alicante
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Quílez C, Martínez J, Gómez A, Trigo C, Palazón JM, Belda G, Pérez-Mateo M. [Chronic elevation of enzymes of pancreatic origin in asymptomatic patients]. Gastroenterol Hepatol 1998; 21:209-11. [PMID: 9644872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic asymptomatic elevation of pancreatic enzymes is a well known entity although little has been reported. In most cases chronic asymptomatic elevation of amylase is due to a salival isoamylase increase or macroamylasemia. However, we have studied 10 cases with an increase in amylases due to pancreatic isoamylase and an increase in the remaining pancreatic enzymes which remained elevated during the follow up period ranging from 2 to 60 months. The amylase values ranged from 186 to 1,600; the lipase from 176 to 3,989, trypsin from 476 to 2,430 and pancreatic isoamylase from 122 to 1,263. In all patients CT and echography were carried out, which discarded structural damage. Nonetheless, an indirect test of pancreatic function presented unexplained pathologic values in 4 out of 10 patients. In conclusion, we suggest that chronic asymptomatic elevation of pancreatic enzymes is of unknown etiology with no associated structural pancreatic pathology demonstrable by the usual study methods.
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Affiliation(s)
- C Quílez
- Sección de Digestivo, Hospital General Universitario, Alicante
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Martínez JF, Palazón JM, Pérez-Mateo M. [Prophylactic antibiotics in acute pancreatitis. Results from a consensus conference]. Rev Esp Enferm Dig 1997; 89:781-5. [PMID: 9424106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pancreatic infection is the leading cause of death from acute pancreatitis. Patients with severe necrotizing pancreatitis are most at risk. Early dynamic computed tomography and percutaneous fine-needle aspiration microbiology of areas of necrosis enable early diagnosis. Several studies has been undertaken in order to investigate the type of bacteria and the concentration reached in pancreatic tissue by different antibiotics. Nevertheless, up to now only three clinical trials of prophylactic antibiotics in acute pancreatitis has been reported. In the IV meeting of the Spanish Association for the Study of the Pancreas, a consensus conference took place with this topic.
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Affiliation(s)
- J F Martínez
- Servicio de Medicina Interna, Hospital General Universitario, Alicante
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Betancort JM, Martín VS, Padrón JM, Palazón JM, Ramírez MA, Soler MA. Stereocontrolled Synthesis of Cyclic Ethers by Intramolecular Hetero-Michael Addition. 5. Synthesis of All Diastereoisomers of 2,3,5,6-Tetrasubstituted Tetrahydropyrans. J Org Chem 1997. [DOI: 10.1021/jo9619241] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Juan M. Betancort
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - Víctor S. Martín
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - José M. Padrón
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - José M. Palazón
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - Miguel A. Ramírez
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - Marcos A. Soler
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
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Ramírez MA, Padrón JM, Palazón JM, Martín VS. Stereocontrolled Synthesis of Cyclic Ethers by Intramolecular Hetero-Michael Addition. 6. A Computational Study of the Annelation to 2,3-Disubstituted Tetrahydropyrans. J Org Chem 1997. [DOI: 10.1021/jo961925t] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Miguel A. Ramírez
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - José M. Padrón
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - José M. Palazón
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
| | - Víctor S. Martín
- Instituto Universitario de Bio-Orgánica “Antonio González”, Universidad de La Laguna, Carretera de La Esperanza, 2, 38206 La Laguna, Tenerife, Spain
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Affiliation(s)
- J M Palazón
- Hospital General Universitario de Alicante, Spain
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Jover R, Zarco A, Palazón JM. Perforation of pancreatic pseudocyst into the colon: another cause of colonic involvement in pancreatitis. Am J Gastroenterol 1996; 91:2653. [PMID: 8947020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Carrión AM, García MF, Carnicer F, Martínez JF, Jover R, Gutiérrez A, Palazón JM, Gómez A. [Malignant schwannoma with an atypical location]. Rev Esp Enferm Dig 1994; 86:775-6. [PMID: 7986622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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41
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Soler MA, Palazón JM, Martin VS. Stereocontrolled synthesis of cyclic ethers by intramolecular hetero-Michael addition. 4. Enantiomeric synthesis of substituted and fused oxepanes. Tetrahedron Lett 1993. [DOI: 10.1016/s0040-4039(00)73937-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Palazón JM, Soler MA, Ramírez MA, Martin VS. Stereocontrolled synthesis of cyclic ethers by intramolecular hetero-Michael addition. 3. Enantiomeric synthesis of highly functionalized and fused tetrahydropyrans. Tetrahedron Lett 1993. [DOI: 10.1016/s0040-4039(00)73936-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casellas JA, Palazón JM, Portilla J, García R, Trigo C. [Macroamylasemia and acquired immunodeficiency syndrome]. Rev Clin Esp 1991; 188:168-9. [PMID: 1723530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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46
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Carnicer F, Palazón JM, Griño E, Sánchez J, Casellas JA, Alvarez B, Jiménez MJ, Gómez A. [Reye's syndrome in adults. Presentation of a new case and review of the literature]. Rev Esp Enferm Apar Dig 1989; 76:689-92. [PMID: 2699055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This is the case of a 29 year-old woman, admitted because of diarrhea and incoercible vomiting; later in the course of the disease she developed signs and symptoms of encephalopathy. The diagnosis of Reye's syndrome was made after death.
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Sillero C, Alonso G, Schwarz A, Palazón JM, De Teresa L. [Pure insular pancreas in the gastric wall diagnosed by endoscopic polypectomy]. Rev Esp Enferm Apar Dig 1978; 52:485-92. [PMID: 653080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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