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Moonen A, Annese V, Belmans A, Bredenoord AJ, Bruley des Varannes S, Costantini M, Dousset B, Elizalde JI, Fumagalli U, Gaudric M, Merla A, Smout AJ, Tack J, Zaninotto G, Busch OR, Boeckxstaens GE. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy. Gut 2016; 65:732-9. [PMID: 26614104 DOI: 10.1136/gutjnl-2015-310602] [Citation(s) in RCA: 229] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/01/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking. DESIGN 201 newly diagnosed patients with achalasia were randomly assigned to PD (n=96) or LHM (n=105). Before randomisation, symptoms were assessed using the Eckardt score, functional test were performed and quality of life was assessed. The primary outcome was therapeutic success (presence of Eckardt score ≤3) at the yearly follow-up assessment. The secondary outcomes included the need for re-treatment, lower oesophageal sphincter pressure, oesophageal emptying and the rate of complications. RESULTS In the full analysis set, there was no significant difference in success rate between the two treatments with 84% and 82% success after 5 years for LHM and PD, respectively (p=0.92, log-rank test). Similar results were obtained in the per-protocol analysis (5-year success rates: 82% for LHM vs. 91% for PD, p=0.08, log-rank test). After 5 years, no differences in secondary outcome parameter were observed. Redilation was performed in 24 (25%) of PD patients. Five oesophageal perforations occurred during PD (5%) while 12 mucosal tears (11%) occurred during LHM. CONCLUSIONS After at least 5 years of follow-up, PD and LHM have a comparable success rate with no differences in oesophageal function and emptying. However, 25% of PD patients require redilation during follow-up. Based on these data, we conclude that either treatment can be proposed as initial treatment for achalasia. TRIAL REGISTRATION NUMBERS Netherlands trial register (NTR37) and Current Controlled Trials registry (ISRCTN56304564).
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Affiliation(s)
- An Moonen
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
| | - Vito Annese
- Head of Gastroenterology, Department of Emergency, AOU Careggi, Florence, Italy
| | - Ann Belmans
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, KU, Leuven, Belgium
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Bertrand Dousset
- Department of GI and Endocrine Surgery, Hôpital Cochin, Paris, France
| | - J I Elizalde
- Department of Gastroenterology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Uberto Fumagalli
- Upper GI Surgery, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | | | - Antonio Merla
- Division of Gastroenterology, IRCCS, "Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Andre J Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Tack
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
| | - Giovanni Zaninotto
- Department of Academic Surgery, St Mary's Hospital, Imperial College, London, UK
| | - Olivier R Busch
- Gastrointestinal Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Guy E Boeckxstaens
- Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium
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Pinazo MJ, Lacima G, Elizalde JI, Posada EJ, Gimeno F, Aldasoro E, Valls ME, Gascon J. Characterization of digestive involvement in patients with chronic T. cruzi infection in Barcelona, Spain. PLoS Negl Trop Dis 2014; 8:e3105. [PMID: 25144648 PMCID: PMC4140677 DOI: 10.1371/journal.pntd.0003105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/08/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Digestive damage due to Chagas disease (CD) occurs in 15-20% of patients diagnosed as a result of peristaltic dysfunction in some endemic areas. The symptoms of chronic digestive CD are non-specific, and there are numerous confounders. Diagnosis of CD may easily be missed if symptoms are not evaluated by a well trained physician. Regular tests, as barium contrast examinations, probably lack the necessary sensitivity to detect early digestive damage. METHODS 71 individuals with T. cruzi infection (G1) and 18 without (G2) coming from Latin American countries were analyzed. They were asked for clinical and epidemiological data, changes in dietary habits, and history targeting digestive and cardiac CD symptoms. Serological tests for T. cruzi, barium swallow, barium enema, an urea breath test, and esophageal manometry were requested for all patients. PRINCIPAL FINDINGS G1 and G2 patients did not show differences in lifestyle and past history. Fifteen (21.1%) of G1 had digestive involvement. Following Rezende criteria, esophagopathy was observed in 8 patients in G1 (11.3%) and in none of those in G2. Manometry disorders were recorded in 34 G1 patients and in six in G2. Isolated hypotensive lower esophageal sphincter (LES) was found in sixteen G1 patients (23.9%) and four G2 patients (28.8%). Achalasia was observed in two G1 patients. Among G1 patients, ineffective esophageal motility was seen in six (five with symptoms), diffuse esophageal spasm in two (one with dysphagia and regurgitation), and nutcracker esophagus in three (all with symptoms). There were six patients with hypertonic upper esophageal sphincter (UES) among G1. Following Ximenes criteria, megacolon was found in ten G1 patients (13.9%), and in none of the G2 patients. CONCLUSIONS The prevalence of digestive chronic CD in our series was 21.1%. Dysphagia is a non-pathognomonic symptom of CD, but a good marker of early esophageal involvement. Manometry could be a useful diagnostic test in selected cases, mainly in patients with T. cruzi infection and dysphagia in whose situation barium swallow does not evidence alterations. Constipation is a common but non-specific symptom that can be easily managed. Testing for CD is mandatory in a patient from Latin America with constipation or dysphagia, and if diagnosis is confirmed, megacolon and esophageal involvement should be investigated.
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Affiliation(s)
- María-Jesús Pinazo
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gloria Lacima
- Gastrointestinal Motility Unit, Gastroenterology Department, Hospital Clinic, Barcelona, Spain
| | | | - Elizabeth-Jesús Posada
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Fausto Gimeno
- Radiology Department, CDIC, Hospital Clínic, Barcelona, Spain
| | - Edelweiss Aldasoro
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | | | - Joaquim Gascon
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic i Provincial/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Llach J, Bordas JM, Almela M, Pellisé M, Mata A, Soria M, Fernández-Esparrach G, Ginès A, Elizalde JI, Feu F, Piqué JM. Prospective assessment of the role of antibiotic prophylaxis in ERCP. Hepatogastroenterology 2006; 53:540-2. [PMID: 16995457] [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: 05/11/2023]
Abstract
BACKGROUND/AIMS Despite the existence of published recommendations, various studies of antibiotic prophylaxis have reached conflicting conclusions, and controversy exists regarding the role of antibiotic prophylaxis in ERCP. The aim of this study was to analyze the efficacy of the intramuscular administration of clindamicine and gentamicine before ERCP. METHODOLOGY Sixty-one consecutive patients referred for ERCP were prospectively randomized to receive either clindamicine 600mg and gentamicine 80mg, both intramuscularly one hour before the ERCP (group I; 31 patients) or not (group II; 30 patients). Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 7 days after endoscopy to detect the development of infectious complications. RESULTS Only 7 cultures from 7 patients were positive. Four were obtained post-ERCP (two patients in group I and two in group II) and the remaining three before endoscopy. The post-ERCP isolated bacteria were: Streptococcus mitis, Peptoestreptococcus anaerobious, Moraxella spp and Escherichia coli. Two patients, one from each group, developed post-ERCP cholangitis that were solved with medical treatment. CONCLUSIONS Our findings indicate that ERCP induce bacteremia in a small group of patients and suggest that prophylactic administration of clindamicine plus gentamicine does not reduce the incidence of bacteremia and cholangitis, and do not support the routine use of prophylactic antibiotics prior to ERCP.
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Affiliation(s)
- J Llach
- Endoscopy Unit, Institut Clinic de Malalties Digestives, and Microbiology Department, Hospital Clinic i Provincial, IDIBAPS, Spain.
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Soriano A, Castells A, Lacy AM, Ayuso C, Ayuso JR, Conill C, Delgado S, Fuster J, García-Valdecasas JC, Ginès A, Martín M, Maurel J, Miquel R, Mollà M, Vilana R, Castellví-Bel S, Elizalde JI, Piñol V, Pellisé M, Biete A, Gascón P, Piqué JM. [Evaluation of the efficacy and efficiency of a multidisciplinary unit for the treatment of patients with colorectal cancer]. Gastroenterol Hepatol 2002; 25:579-84. [PMID: 12459118 DOI: 10.1016/s0210-5705(02)70319-1] [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] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Because of the increased complexity of the diagnostic-therapeutic approach to colorectal cancer (CRC), these patients should be managed in specialized multidisciplinary units. The aim of this study was to evaluate the efficacy and efficiency of a CRC unit (CRCU) in the diagnostic-therapeutic management of these patients. PATIENTS AND METHODS Two groups of 50 patients with colon cancer treated in our center before and after the implementation of the CRCU were selected. Fulfillment with the protocol in terms of tumoral staging, surgical and adjuvant treatment, follow-up, interval until treatment, hospital stay, morbidity and early mortality, and the overall duration of the diagnostic-therapeutic process was analyzed. In addition, clinical workload was evaluated and a cost-minimization analysis was performed. RESULTS The CRCU reduced the interval until surgery (20.3 12.0 vs 28.0 20.4 days; p = 0.05), hospital stay (9.8 7.7 vs 14.5 9.3 days: p = 0.01), the time to the start of adjuvant treatment (29.4 10.2 vs 39.7 19.8 days; p = 0.03) and the overall duration of the process (60.4 23,8 vs 82.1 46.1 days; p = 0.05), representing a saving of 978.85 E per patient. This improvement took place despite an increase in clinical workload (24% in 5 years in relation to the number of admissions) and had no effect on morbidity (26 vs 24%; NS) or immediate mortality (6 vs 4%; NS). CONCLUSION Specialized multidisciplinary units increase the efficacy and efficiency of the management of patients with CRC.
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Affiliation(s)
- A Soriano
- Servicios de Gastroenterología. Institut de Malalties Digestives. Hospital Clinic. IDIBAPS. Universitat de Barcelona. Spain
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Llach J, Bordas JM, Elizalde JI, Enrico C, Ginès A, Pellisé M, Mondelo F, Piqué JM. Sphincterotomy in the treatment of biliary leakage. Hepatogastroenterology 2002; 49:1496-8. [PMID: 12397716] [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
BACKGROUND/AIMS Endoscopic procedures such as sphincterotomy and endobiliary stenting have proved useful to solve postoperative bile leakage. We have assessed the outcome of a series of such patients initially treated with endoscopic sphincterotomy, having reserved stent placement for treatment failures only. METHODOLOGY Twenty-five consecutive patients referred for endoscopic assessment of postoperative bile leaks and fistulas after cholecystectomy (n = 15), orthotopic liver transplantation (n = 9) and hepatic resection due to cystic hydatid disease (n = 1) underwent endoscopic retrograde cholangiopancreatography and sphincterotomy using a standard papillotome. Sphincterotomy was followed by stone extraction using a Dormia basket if common bile duct lithiasis were present. RESULTS Bile leaks healed early after endoscopic sphincterotomy in 22 out of 25 patients (88%). Common bile duct stones were also retrieved in 6 of these patients. Bile duct stenosis due to surrounding pancreatic inflammation was demonstrated in two of the patients in which sphincterotomy failed to stop bile leakage. CONCLUSIONS Endoscopic sphincterotomy alone should at present be considered a highly effective treatment to resolve postsurgical bile leaks unless bile strictures are present.
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Affiliation(s)
- J Llach
- Endoscopy Unit, Gastroenterology Department, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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Elizalde JI, Piqué JM, Moreno V, Morillas JD, Elizalde I, Bujanda L, De Argila CM, Cosme A, Castiella A, Ros E. Influence of Helicobacter pylori infection and eradication on blood lipids and fibrinogen. Aliment Pharmacol Ther 2002; 16:577-86. [PMID: 11876713 DOI: 10.1046/j.1365-2036.2002.01202.x] [Citation(s) in RCA: 29] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND An association between Helicobacter pylori infection and heart disease has been suggested. A potential mechanism may be inflammation-induced atherogenic changes of lipoproteins, but epidemiological studies have provided conflicting results. METHODS In a prospective multicentre study, 830 patients submitted for endoscopy and H. pylori testing were evaluated. Of the 686 H. pylori-positive patients, 487 received and 199 did not receive eradication treatment. Serum lipids and plasma fibrinogen were measured at baseline in all patients and 3 months later in those initially positive for H. pylori. RESULTS H. pylori had no influence on baseline lipid or fibrinogen levels. Increases in high-density lipoprotein cholesterol were observed in 368 patients who received eradication treatment and in 193 untreated patients: 0.06 mmol/L (P=0.000) and 0.07 mmol/L (P=0.009), respectively. Similar minor increases in total cholesterol and triglycerides occurred in both groups. Lipid changes were related to symptom relief and a reduction in smoking. Eradication therapy was associated with a minor decrease in plasma fibrinogen irrespective of the resolution of infection. CONCLUSIONS H. pylori has no influence on blood lipids or fibrinogen. Both the eradication of infection and symptomatic treatment without eradication are associated with minor lipid changes related to symptom relief and lifestyle modifications. Thus, the inflammatory changes associated with H. pylori are unlikely to affect lipoprotein or fibrinogen metabolism.
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Affiliation(s)
- J I Elizalde
- Gastroenterology Department, Institut Malaties Digestive, Hospital Clínic, Barcelona, Spain
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Elizalde JI, Piñol V, Bessa X, Saló J, Soriano A, Feu F, Castells A. [Role of echoendoscopy in diagnostic and therapeutic strategies in gastrointestinal oncology]. Gastroenterol Hepatol 2002; 25:60-9. [PMID: 11835875 DOI: 10.1016/s0210-5705(02)70242-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J I Elizalde
- Servei de Gastroenterología, Institut de Malalties Digestives, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Hospital Clínic, Barcelona, Spain
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Llach J, Elizalde JI, Guevara MC, Pellisé M, Castellot A, Ginès A, Soria MT, Bordas JM, Piqué JM. Endoscopic injection therapy in bleeding Mallory-Weiss syndrome: a randomized controlled trial. Gastrointest Endosc 2001; 54:679-81. [PMID: 11726841 DOI: 10.1067/mge.2001.119874] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [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: 12/19/2022]
Abstract
BACKGROUND Endoscopic injection is widely used in the therapy of bleeding gastroduodenal ulcers, but its role in the management of bleeding Mallory-Weiss tears has not been properly assessed. METHODS Sixty-three patients undergoing emergency endoscopy in whom there was a high index of suspicion that a Mallory-Weiss tear was the source of bleeding were randomly assigned to undergo endoscopic injection therapy (epinephrine and polidocanol) or no endoscopic therapy in 2 university-affiliated hospitals. Rates of recurrent bleeding, transfusion requirements, complications, mortality, and length of hospital stay were determined for both groups of patients. RESULTS Bleeding recurred in 8 patients in the control group versus only 2 in the endoscopic treatment group (25.8% vs. 6.2%, p < 0.05). Hospital stay was longer for the control group (5.5 +/- 0.2, median 6.0, range 2.0-8.0 days vs. 3.4 +/- 0.2, median 3.0, range 2.0-6.0 days; p < 0.001). There was a trend toward a higher transfusion requirement after endoscopy in the control group versus the patients treated by injection (0.9 +/- 0.2, median 0.0, range 0.0-4.0 units vs. 0.2 +/- 0.1, median 0.0, range 0.0-2.0 units; p = 0.09). No complications or adverse events caused by endoscopic injection were noted. Two patients in the control group died of causes unrelated to bleeding. CONCLUSIONS Endoscopic injection therapy is a useful option in the management of patients with Mallory-Weiss syndrome at high risk for recurrent bleeding.
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Affiliation(s)
- J Llach
- Endoscopy Unit, Gastroenterology Department, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, and Hospital Insular de Gran Canaria, Barcelona, Catalonia, Spain
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Agustí M, Elizalde JI, Adàlia R, Martínez-Pallí G, García-Valdecasas JC, Piqué JM, Taurà P. The effects of vasoactive drugs on hepatic blood flow changes induced by CO2 laparoscopy: an animal study. Anesth Analg 2001; 93:1121-6. [PMID: 11682379 DOI: 10.1097/00000539-200111000-00011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Laparoscopic surgery is associated with systemic and splanchnic hemodynamic alterations. Recent data suggest that small-dose dobutamine may attenuate the reduction in splanchnic blood flow associated with increments in intraabdominal pressure. We conducted this study to analyze the effects of dopamine and dobutamine on the hepatic circulation in this setting. Twenty-one pigs were anesthetized and mechanically ventilated. A flow-directed pulmonary artery and carotid artery catheters were inserted. Perivascular flow probes were placed around the main hepatic artery and the portal vein. CO2 was insufflated into the peritoneal cavity to reach an intraabdominal pressure of 15 mm Hg. After 60 min, animals received dopamine (5 microg x kg(-1) x min(-1); n = 8), dobutamine (5 microg x kg(-1) x min(-1); n = 8), or saline (n = 5) for 30 min. Pneumoperitoneum induced significant increases in heart rate, mean arterial pressure, and systemic vascular resistance, with decreases in cardiac output and hepatic artery and portal vein blood flows. Dobutamine infusion, in contrast to dopamine, corrected, at least in part, cardiac output, systemic vascular resistance, and hepatic artery blood flow alterations, but neither drug restored total hepatic blood flow. IMPLICATIONS Hepatic blood flow decreases during laparoscopic surgery. A small-dose infusion of neither dobutamine nor dopamine corrects the total hepatic blood flow impairment, but the former is able to restore the hepatic arterial blood supply in an animal model mimicking this condition.
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Affiliation(s)
- M Agustí
- Department of Anesthesia (URSC), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Bessa X, Elizalde JI, Boix L, Piñol V, Lacy AM, Saló J, Piqué JM, Castells A. Lack of prognostic influence of circulating tumor cells in peripheral blood of patients with colorectal cancer. Gastroenterology 2001; 120:1084-92. [PMID: 11266372 DOI: 10.1053/gast.2001.23245] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [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: 01/11/2023]
Abstract
BACKGROUND AND AIMS Circulating tumor cells in peripheral blood may be detected using high-sensitivity molecular techniques in several types of solid neoplasms, but their significance in colorectal cancer is controversial. The aim of this study was to assess the prognostic value of carcinoembryonic antigen (CEA) messenger RNA (mRNA) detection in peripheral blood samples from patients with colorectal cancer. METHODS Peripheral vein blood samples from 95 consecutive patients with histologically confirmed colorectal carcinoma were obtained immediately before surgery to determine the presence of circulating tumor cells by use of a reverse-transcription polymerase chain reaction targeting CEA mRNA. Endpoints of the study were disease-free and overall survival. Results are referred to the whole series and, more importantly, to the 68 patients who underwent surgery for cure. RESULTS After a median follow-up of 42 months, 19 of 68 patients (28%) operated on for cure had tumor relapse. In addition, 50 of 68 patients (73%) were alive. The probability of disease-free and overall survival was dependent on lymph node metastases and degree of differentiation, but not on the presence of circulating tumor cells (disease-free survival: relative risk, 1.00; 95% confidence interval [CI], 0.39-2.22, P = 0.99; overall survival: relative risk, 0.91, 95% CI, 0.34-2.43; P = 0.84). Similar results were obtained when all 95 patients with colorectal cancer were analyzed (disease-free survival: relative risk, 1.11; 95% CI, 0.63-1.95; P = 0.71; overall survival: relative risk, 1.21; 95% CI, 0.63-2.30, P = 0.55). CONCLUSIONS Preoperative detection of blood circulating tumor cells by means of reverse-transcription polymerase chain reaction of CEA does not have prognostic significance in patients with colorectal cancer.
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Affiliation(s)
- X Bessa
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Catalonia, Spain
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Bessa X, Castells A, Lacy AM, Elizalde JI, Delgado S, Boix L, Piñol V, Pellisé M, García-Valdecasas JC, Piqué JM. Laparoscopic-assisted vs. open colectomy for colorectal cancer: influence on neoplastic cell mobilization. J Gastrointest Surg 2001; 5:66-73. [PMID: 11309650 DOI: 10.1016/s1091-255x(01)80015-9] [Citation(s) in RCA: 31] [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] [Indexed: 01/31/2023]
Abstract
Laparoscopic surgery for treatment of colorectal cancer has been suggested to enhance tumor dissemination. Recently, molecular techniques have been developed to detect micrometastatic disease in patients with solid tumors, with a higher accuracy than cytologic or immunohistochemical approaches. This study was undertaken to investigate the potential harmful effects of laparoscopic-assisted colectomy on neoplastic cell mobilization in patients with resectable colorectal cancer. Fifty patients with nonmetastatic colorectal cancer were randomly assigned to laparoscopic-assisted (LAC, n = 26) or open (OC, n = 24) colectomy. Peripheral venous blood samples were obtained preoperatively, immediately after tumor removal, and 24 hours later. In 10 patients from each treatment group, portal blood and peritoneal fluid samples were also obtained before and after resection. Neoplastic cells were detected by means of reverse transcriptase-polymerase chain reaction targeted to carcinoembryonic antigen (CEA) transcription. CEA mRNA was detected in peripheral venous blood samples from 35 of 50 colorectal cancer patients preoperatively. Among those 15 baseline-negative patients, four experienced conversion 24 hours after tumor resection (2 [33%] of 6 in the LAC group vs. 2 [22%] of 9 in the OC group; NS). At that time point, clearance of CEA mRNA expression was observed in 14 of the 35 baseline-positive patients (9 [45%] of 20 in the LAC group vs. 5 [33%] of 15 in the OC group; NS). In addition, only one patient in the LAC group with baseline-negative CEA mRNA expression experienced portal blood conversion after tumor removal, although his peripheral blood level remained negative. Finally, baseline peritoneal fluid CEA mRNA expression was never detected, but one patient in each group became positive postoperatively. These results confirm that preoperative and perioperative mobilization of neoplastic cells is a frequent occurrence in patients with colorectal cancer, but the surgical approach (LAC vs. OC) does not seem to be a determining factor.
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Affiliation(s)
- X Bessa
- Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigacious Biomèdiques August Pi y Sunyer, University of Barcelona, Villaroel 170, 08036 Barcelona, Catalonia, Spain
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Bessa X, Piñol V, Elizalde JI, Castells A. [Cyclooxygenase-2 (COX-2) in digestive cancer. Therapeutic implications]. Gastroenterol Hepatol 2000; 23:483-90. [PMID: 11149225] [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: 02/18/2023]
Affiliation(s)
- X Bessa
- Servei de Gastroenterologia, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, Universitat de Barcelona
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13
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Agustí M, Elizalde JI, Adàlia R, Cifuentes A, Fontanals J, Taurà P. Dobutamine restores intestinal mucosal blood flow in a porcine model of intra-abdominal hyperpressure. Crit Care Med 2000; 28:467-72. [PMID: 10708185 DOI: 10.1097/00003246-200002000-00030] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effects of dopamine and dobutamine administration on the systemic and mesenteric (macro- and microvascular) circulatory disturbances induced by intra-abdominal hyperpressure. DESIGN Prospective, randomized study. SETTING Animal research laboratory in a university hospital. SUBJECTS Twenty-five pigs of either gender, weighing 30-35 kg. INTERVENTIONS Animals were anesthetized, and their lungs were mechanically ventilated. Pulmonary artery flotation and carotid artery catheters were inserted for hemodynamic monitoring and blood sampling. A perivascular flow probe was placed around the superior mesenteric artery, and a laser Doppler probe was positioned in the lumen of the ileum to measure arterial and intestinal mucosal blood flows, respectively. CO2 was insufflated into the peritoneal cavity to reach an intra-abdominal pressure of 15 mm Hg, and 60 mins later, animals received dopamine (5 microg/kg/min; n = 10), dobutamine (5 microg/kg/min; n = 10), or saline (n = 5) for 30 mins. MEASUREMENTS AND MAIN RESULTS Peritoneal CO2 insufflation induced significant increases in heart rate, arterial pressure, and systemic vascular resistance with concomitant decreases in cardiac output and superior mesenteric arterial and intestinal mucosal blood flows. Although dobutamine infusion reversed the decrease in cardiac output, it failed to restore superior mesenteric artery blood flow; however, intestinal mucosal blood flow returned to baseline levels. Dopamine also attenuated the decrease in cardiac output, but it had no beneficial effect on splanchnic hemodynamic variables. CONCLUSIONS Low-dose infusion of dobutamine, but not dopamine, corrects the intestinal mucosal perfusion impairment induced by moderate increases in intra-abdominal pressure.
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Affiliation(s)
- M Agustí
- Department of Anesthesia, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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14
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Salas A, Panés J, Rosenbloom CL, Elizalde JI, Anderson DC, Granger DN, Piqué JM. Differential effects of a nitric oxide donor on reperfusion-induced microvascular dysfunction in diabetic and non-diabetic rats. Diabetologia 1999; 42:1350-8. [PMID: 10550420 DOI: 10.1007/s001250051449] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS/HYPOTHESIS Diabetes is associated with a high incidence of ischaemic disease and impaired nitric oxide responses. Therefore, the aim of the present study was to assess the effect of nitric oxide on ischaemia/reperfusion (I/R)-induced microvascular responses in an experimental model of diabetes. METHODS Leucocyte-endothelial cell interactions were studied in mesenteric venules after superior mesenteric artery occlusion (10 min), at 10 and 30 min of reperfusion in control and streptozotocin-induced diabetic rats. An oxidant-sensitive fluorochrome was used to measure oxidant production during reperfusion. P-selectin and ICAM-1 expression were quantified at 10 and 30 min of reperfusion respectively, using radiolabelled monoclonal antibodies. The transcription of ICAM-1 mRNA was determined by northern blot. The effect of spermine NONOate, given locally, on all variables studied, was assessed in additional experiments. RESULTS Ischaemia/reperfusion induced an enhanced leucocyte accumulation and oxidant production in diabetic animals. Moreover, I/R enhanced endothelial P-selectin expression in both groups of animals, whereas it only up regulated ICAM-1 endothelial expression and mRNA expression in diabetic rats. Spermine NONOate abrogated to a similar extent leucocyte adhesion and emigration in control and diabetic animals, although the mechanisms underlying this protective effect appear to be different. In control rats Spermine NONOate effectively prevented P-selectin up regulation, whereas in diabetic rats NO appreciably attenuated the rapid up regulation of ICAM-1 by preventing its transcription. CONCLUSIONS/INTERPRETATION Expression of ICAM-1 is rapidly increased in diabetic, but not control, animals exposed to I/R. The increased endothelial cell adhesion molecule expression, leucocyte-endothelial cell adhesion and oxidant stress induced by I/R in diabetic rats are significantly attenuated by exogenous NO. [Diabetologia (1999) 42: 1350-1358]
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Affiliation(s)
- A Salas
- Department of Gastroenterology, Digestive Diseases Institute, Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain
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15
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Abstract
Reactive oxygen metabolites (ROMs) have been implicated in the pathogenesis of the inflammatory response to ischemia/reperfusion (I/R), which is exacerbated in diabetes. This study revealed an increased (P < 0.01) ROMs production in mesenteric tissue (measured using the oxidant-sensitive fluorochrome dihydrorhodamine 123) after I/R in control and diabetic rats, with larger increments (P <0.0001) observed in the latter group, that was associated with an increased inflammatory response measured by intravital microscopy. Either xanthine oxidase inhibition, superoxide scavenging, ICAM-1 immunoneutralization, or blockade of platelet-activating factor or leukotrienes effectively reduced leukocyte recruitment and ROMs production in control and diabetic rats. Moreover, neutrophils from diabetic rats showed an enhanced production of ROMs in vitro in basal and stimulated conditions. We conclude that the oxidative stress during reperfusion is markedly enhanced in diabetes and this appears to result from increased leukocyte recruitment and a higher capacity of diabetic leukocytes to generate ROMs in response to stimulation.
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Affiliation(s)
- A Salas
- Gastroenterology Department, Institut Clínic de Malalties Digestives, IDIBAPS, Hospital Clínic, Barcelona, Spain
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16
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Calvet X, Feu F, Forné M, Montserrat A, Elizalde JI, Viver JM, Gali N, Domínguez J. [The evaluation of a new immunoenzyme analysis for the detection of Helicobacter pylori infection in stool samples]. Gastroenterol Hepatol 1999; 22:270-2. [PMID: 10410445] [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: 02/13/2023]
Abstract
BACKGROUND Detection of bacterial antigen in stool specimens (HpSAT) is a new promising tool for diagnosing Helicobacter pylori infection. OBJECTIVE To evaluate diagnostic accuracy of HpSAT in the diagnosis of Helicobacter pylori infection. PATIENTS AND METHODS We evaluate the presence of Helicobacter pylori infection by the rapid urease test and the 13C-urea breath test in endoscopic biopsies. Patients who were positive for both tests were considered to have Helicobacter pylori infection. Patients negative for both tests were considered free of infection. The presence of Helicobacter pylori infection was also determined in stool specimens by means of HpSAT. RESULTS The sensitivity of HpSAT was 92.8%, the specificity 92.3%, the positive predictive value 98.1% and the negative predictive value 75%. CONCLUSIONS HpSAT is a reliable tool for diagnosing Helicobacter pylori infection.
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Affiliation(s)
- X Calvet
- Servicio de Medicina Interna, Corporació Sanitària del Parc Taulí, Sabadell, Barcelona.
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17
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Sans M, Panés J, Ardite E, Elizalde JI, Arce Y, Elena M, Palacín A, Fernández-Checa JC, Anderson DC, Lobb R, Piqué JM. VCAM-1 and ICAM-1 mediate leukocyte-endothelial cell adhesion in rat experimental colitis. Gastroenterology 1999; 116:874-83. [PMID: 10092309 DOI: 10.1016/s0016-5085(99)70070-3] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.3] [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: 12/13/2022]
Abstract
BACKGROUND & AIMS The molecular mechanisms responsible for leukocyte recruitment in experimental colitis are poorly understood. The aims of this study were to measure expression of endothelial intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) and to determine their role in leukocyte recruitment in experimental colitis. METHODS Rats with trinitrobenzene sulfonic acid (TNBS)-induced colitis and control rats were studied 1, 7, or 21 days after treatment. ICAM-1 and VCAM-1 expressions were measured by the double radiolabeled antibody technique. Leukocyte-endothelial cell interactions were determined in colonic venules by fluorescence intravital microscopy. Therapeutic effects of treatment with anti-VCAM-1 antibodies were also assessed. RESULTS Colonic endothelial ICAM-1 was constitutively expressed and did not increase in colitic animals. In contrast, constitutive expression of VCAM-1 was low but markedly increased (6-fold) 1 and 7 days after induction of colitis. Increased colonic expression of VCAM-1 paralleled macroscopic damage score, myeloperoxidase activity, and increased leukocyte adhesion in colonic venules. The latter was significantly decreased by immunoneutralization of ICAM-1 and completely abrogated by immunoneutralization of VCAM-1. Long-term administration of anti-VCAM-1 antibody resulted in significant attenuation of colitis. CONCLUSIONS Induction of colitis in rats by TNBS is followed by up-regulation of endothelial VCAM-1. VCAM-1 and constitutive ICAM-1 are major determinants of leukocyte recruitment to the inflamed intestine.
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Affiliation(s)
- M Sans
- Department of Gastroenterology, Institut d'Investigacions Biomédiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
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18
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Gómez J, Elizalde JI, Marco F, Bordas JM, Piqué JM, Jiménez de Anta MT. [Typification of strains of Helicobacter pylori by the detection of the cagA gene and subtypes of the vacA gene]. Enferm Infecc Microbiol Clin 1999; 17:171-5. [PMID: 10365510] [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] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Helicobacter pylori infection is probably the most common chronic bacterial infection in the world. The consequences of infection are pathologies like peptic ulcer, chronic gastritis, gastric cancer and gastric MALT lymphoma. The aim of this study was to detect the vacuolating cytotoxin gene (vacA) type, the cytotoxin-associated gen (cagA) of H. pylori isolates and study their association with the vacuolising activity. MATERIAL AND METHODS Gastric biopsy specimens were obtained from dyspeptic patients. Isolates were further genotypically typed by PCR. RESULTS All strains studied were vacA+ and 55% were cagA+. All cytotoxic strains were cagA+, subtype vacA s1/m1 and corresponded to patients with peptic ulceration. The cagA- strains (11) corresponded to subtype s2/m2. We didn't demonstrate vacuolising activity on subtypes s1/m2 and s2/m2. CONCLUSIONS A high genetic diversity exists among strains in our environment. The subset of bacteria, vacA s1/m1/cagA+, is associated with vacuolising activity in culture cells (tox+).
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Affiliation(s)
- J Gómez
- Servicio de Microbiología, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Provincial, Facultad de Medicina, Universidad de Barcelona
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19
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Llach J, Elizalde JI, Bordas JM, Gines A, Almela M, Sans M, Mondelo F, Pique JM. Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower intestinal endoscopy. Gastrointest Endosc 1999; 49:214-7. [PMID: 9925701 DOI: 10.1016/s0016-5107(99)70489-x] [Citation(s) in RCA: 32] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients who have prosthetic heart valves, previous history of endocarditis, and surgically constructed systemic-pulmonary shunts or conduits should receive prophylactic antibiotics before colonoscopy. The usefulness of this approach in cirrhotic patients remains unknown. The present study prospectively assesses the incidence of bacteremia in these patients. METHODS Lower intestinal endoscopy was performed in 58 cirrhotic patients. Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 72 hours after endoscopy to detect the development of infectious complications. RESULTS Only 6 cultures from 6 patients were positive. Four were obtained post-endoscopy and the remaining 2 before colonoscopy but the corresponding post-endoscopy samples were negative. All organisms recovered were normal skin flora. All patients, including those with positive cultures, remained asymptomatic during the 72 hours after the procedure. CONCLUSIONS Our findings indicate that lower intestinal endoscopy does not induce bacteremia in cirrhotic patients with or without ascites in the absence of gastrointestinal bleeding and do not support the routine use of prophylactic antibiotics in these patients.
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Affiliation(s)
- J Llach
- Endoscopy Unit, Institut Clinic de Malalties Digestives, and Microbiology Department, Hospital Clinic I Provincial, IDIBAPS, Universitat de Barcelona, Spain
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20
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Vásconez C, Elizalde JI, Llach J, Ginès A, de la Rosa C, Fernández RM, Mas A, Santamaría J, Bordas JM, Piqué JM, Terés J. Helicobacter pylori, hyperammonemia and subclinical portosystemic encephalopathy: effects of eradication. J Hepatol 1999; 30:260-4. [PMID: 10068106 DOI: 10.1016/s0168-8278(99)80072-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [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/AIMS An involvement of Helicobacter pylori in the development of hepatic encephalopathy in cirrhotic patients has been proposed, but data confirming such an association are lacking. This prospective study aimed to assess whether ammonia levels and indicators of subclinical portosystemic encephalopathy were influenced by H. pylori status in a series of 62 cirrhotic patients. The effects of H. pylori eradication on such parameters were also investigated. METHODS Fasting blood ammonia levels, mental state, number connection test, flapping tremor, and EEG tracings were recorded at baseline, and in H. pylori-positive patients (as diagnosed by rapid urease test and 14C-urea breath test) these parameters were reassessed 2 months following eradication therapy. RESULTS In this series of non-advanced cirrhotic patients, the prevalence of H. pylori infection was 52%. No significant differences were observed between H. pylori+ and H. pylori- cases with respect to fasting venous blood ammonia concentration (47+/-24 vs. 43+/-22 micromol/l) or to the remaining parameters assessing portosystemic encephalopathy. In addition, H. pylori eradication failed to induce any significant variation in either fasting blood ammonia levels (from 45+/-23 to 48+/-26 micromol/l) or neurologic disturbances. CONCLUSION These results indicate that H. pylori infection is not a major contributing factor to either fasting blood ammonia levels or parameters assessing subclinical portosystemic encephalopathy in patients with non-advanced liver cirrhosis.
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Affiliation(s)
- C Vásconez
- Institut de Malalties Digestives, Hospital Clinic, Institut d'Investigacions Biomèdiques, August Pi i Sunyer, Universitat de Barcelona, Spain
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21
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Salas A, Panés J, Elizalde JI, Casadevall M, Anderson DC, Granger DN, Piqué JM. Mechanisms responsible for enhanced inflammatory response to ischemia-reperfusion in diabetes. Am J Physiol 1998; 275:H1773-81. [PMID: 9815085 DOI: 10.1152/ajpheart.1998.275.5.h1773] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the present study was to assess the role of lipid mediators and adhesion molecule expression in exacerbation of ischemia-reperfusion-induced inflammatory response in diabetes. Leukocyte-endothelial cell interactions were studied in mesenteric venules by intravital microscopy. Endothelial expression of intercellular adhesion molecule (ICAM)-1 was measured by the double-radiolabeled monoclonal antibody technique, and beta2-integrin expression was measured by flow cytometry. Ischemia-reperfusion elicited significantly larger increases in leukocyte adhesion and emigration in diabetic rats that were prevented by a platelet-activating factor (PAF)-receptor antagonist or a leukotriene synthesis inhibitor. Leukotriene B4 (LTB4) superfusion induced similar leukocyte recruitment in diabetic and control rats, whereas PAF elicited larger increases in diabetic rats. CD11a, but not CD11b, expression was higher in leukocytes from diabetic animals. Endothelial ICAM-1 in mesentery and in intestine did not differ between diabetic and control rats. These results indicate that diabetes is associated with an enhanced response to ischemia-reperfusion that depends on both PAF and leukotrienes. An increased sensitivity to PAF, along with an increased CD11a expression, may account for the exaggerated inflammatory response to ischemia-reperfusion in diabetes.
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Affiliation(s)
- A Salas
- Gastroenterology Department, Hospital Clínic, Barcelona 08036, Spain
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22
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Llach J, Bordas JM, Nieto I, Landaeta J, Elizalde JI, Mondelo F, Gines A, Salmeron JM, Mas A, Teres J, Rodes J. Endoscopic sclerotherapy to arrest uncontrolled variceal bleeding in cirrhotic patients with high surgical risk. Hepatogastroenterology 1998; 45:2181-5. [PMID: 9951890] [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: 02/10/2023]
Abstract
BACKGROUND/AIMS In 20-50% of patients bleeding from esophageal varices, conservative procedures fail to obtain hemostasis and prevent early recurrence. METHODOLOGY We retrospectively analyzed the efficacy and safety of endoscopic sclerotherapy in 66 cirrhotic patients with high surgical risk and persistence or recurrence of variceal bleeding in spite of adequate medical treatment (somatostatin and/or balloon tamponade). RESULTS Emergency sclerosis controlled bleeding in 46 out of 66 patients (70%). The remaining 20 patients underwent additional procedures to arrest the hemorrhage, and 6 died because of massive bleeding. Early rebleeding occurred in 5 patients (10%). The mortality within 2 days, 1 week, and 6 weeks was 9%, 17% and 32%, respectively. Death was attributed to hemorrhage in 9 cases. Sclerotherapy was associated with complications in 9 patients (14%). CONCLUSION These results suggest that emergency sclerotherapy is a safe and effective procedure in cirrhotic patients with high surgical risk and persistence or recurrence of bleeding after conservative hemostatic procedures.
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Affiliation(s)
- J Llach
- Gastroenterology Department, Institut Clinic de Malalties Digestives, University of Barcelona, Spain
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23
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Elizalde JI, Moitinho E, García-Pagán JC, Cirera I, Escorsell A, Bandi JC, Jiménez W, Bosch J, Piqué JM, Rodés J. Effects of increasing blood hemoglobin levels on systemic hemodynamics of acutely anemic cirrhotic patients. J Hepatol 1998; 29:789-95. [PMID: 9833917 DOI: 10.1016/s0168-8278(98)80260-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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: 01/13/2023]
Abstract
BACKGROUND/AIMS In experimental portal hypertension, blood hemoglobin levels have been shown to influence the hyperdynamic circulatory state. The aim of this study was to assess the hemodynamic effects of increasing hemoglobin concentration in human portal hypertension. METHODS Sixteen cirrhotic patients recovering from a variceal bleeding episode were randomly assigned to receive two units of packed red cells or 500 ml of a protein solution. Systemic and portal hemodynamics, and rheological and hormonal parameters were measured at baseline and after expansion. RESULTS Both groups were similar with respect to the degree of liver failure, severity of the bleeding episode, activation of the endogenous vasopressor systems, and hemodynamic parameters. The administration of either erythrocytes or a protein solution prompted a similar increase in total blood volume and suppression of vasopressor systems. Both groups of patients experienced similar increases in wedged hepatic venous pressure. Hepatic venous pressure gradient was not significantly modified but tended to increase in erythrocyte-transfused patients. Cardiopulmonary pressures increased, but this increment was significant in the non-blood-transfused patients only. Cardiac output decreased in erythrocyte-transfused patients, while it increased in the group receiving a protein solution. Red blood cell transfusion resulted in an increase in systemic vascular hindrance (resistance/blood viscosity), whereas the administration of a protein solution prompted a decrease in this parameter, thus reflecting true vasoconstriction and vasodilation, respectively. CONCLUSIONS An increase in blood hemoglobin in acutely anemic cirrhotic patients attenuates their hyperdynamic circulation beyond viscosity-dependent changes, an effect which might be counteracted by the effects on portal venous pressure gradient.
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Affiliation(s)
- J I Elizalde
- Gastroenterology Department, Institut Clínic de Malalties Digestives, Hospital Clínic, Universitat de Barcelona, Spain
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24
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Elizalde JI, Gómez J, Ginès A, Llach J, Piqué JM, Bordas JM, Marco F, Terés J. Biopsy forceps disinfection technique does not influence Helicobacter pylori culture. Am J Gastroenterol 1998; 93:1450-2. [PMID: 9732923 DOI: 10.1111/j.1572-0241.1998.461_q.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 12/11/2022]
Abstract
OBJECTIVES Culturing Helicobacter pylori (Hp) has a low sensitivity rate, and is affected by factors such as the number of biopsies, transport, and culture conditions. Hp detection is also influenced by omeprazole, antibiotics, bismuth salts, or benzocaine use. Disinfection procedures based on glutaraldehyde are highly effective in eliminating any Hp contamination of endoscopic equipment. However, the possibility that some residual glutaraldehyde present in biopsy forceps after decontamination could affect Hp viability has not yet been investigated. METHODS Antral specimens from 25 patients with active gastric or duodenal ulcer obtained with three forceps (sterilized with ethylene oxide, glutaraldehyde, or glutaraldehyde-phenolate) were streaked on appropriate media, and results of culture evaluated. RESULTS Helicobacter pylori was isolated in 17 patients. Positivity of culture was independent of the way the forceps were sterilized, and the number of colonies (mean +/- SD) was similar for the three types of forceps (475 +/- 312, 533 +/- 242, and 550 +/- 225 colony-forming units [CFUs] for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate, respectively). Moreover, the incubation time since isolation was also similar (6.0 +/- 1.3, 5.8 +/- 1.2, and 5.7 +/- 1.2 days for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate disinfected forceps, respectively). CONCLUSION The use of glutaraldehyde to sterilize biopsy forceps is not responsible for the false-negative results of Hp culture.
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Affiliation(s)
- J I Elizalde
- Department of Gastroenterology, Hospital Clínic i Provincial, University of Barcelona, Catalonia, Spain
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25
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Ardite E, Panés J, Miranda M, Salas A, Elizalde JI, Sans M, Arce Y, Bordas JM, Fernández-Checa JC, Piqué JM. Effects of steroid treatment on activation of nuclear factor kappaB in patients with inflammatory bowel disease. Br J Pharmacol 1998; 124:431-3. [PMID: 9647464 PMCID: PMC1565427 DOI: 10.1038/sj.bjp.0701887] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Nuclear factor kappB (NFkappaB) is a transcription factor that controls several genes important for immunity and inflammation. The aim of this study was to assess if activation of NFkappaB plays a role in the pathogenesis of inflammatory bowel disease (IBD), and whether steroid treatment affects NFkappaB activation. Activation of NFkappaB was analysed in colon biopsy samples of 13 patients with active IBD (8 Crohn's colitis, 5 ulcerative colitis) by electrophoretic mobility-shift assays, under basal conditions and 3 weeks after treatment with 0.75 mg kg(-1) day(-1) prednisolone. The presence of interleukin-8 mRNA in biopsies was assessed by RT-PCR. A specific NFkappaB band was present in all nuclear extracts from inflamed mucosa, whereas the band was barely detectable in uninflamed colonic mucosa. NFkappaB bands were super-shifted by antibodies against p50 subunit, whereas antibodies against p65, p52, c-Rel, or Rel B did not modify the mobility of the band. Increased interleukin-8 mRNA was detected at the same sites of NFkappaB activation. Steroid-induced healing of colonic inflammation was associated with disappearance of NFkappaB from nuclear extracts. These results support the notion that NFkappaB plays an important role in the pathogenesis of IBD, and that blockade of NFkappaB activation is one of the mechanisms by which steroids suppress the inflammatory cascade in IBD.
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Affiliation(s)
- E Ardite
- Consejo Superior Investigaciones Científicas, Barcelona, Spain
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26
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Elizalde JI, Hernández C, Llach J, Montón C, Bordas JM, Piqué JM, Torres A. Gastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow. Crit Care Med 1998; 26:827-32. [PMID: 9590311 DOI: 10.1097/00003246-199805000-00011] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether gastric intramucosal acidosis is associated with a decreased gastric mucosal blood flow in mechanically ventilated patients. DESIGN Prospective, clinical investigation. SETTING University hospital intensive care unit. PATIENTS Seventeen mechanically ventilated patients with stable hemodynamic status. INTERVENTIONS Gastric tonometry and endoscopic assessment of mucosal blood flow. MEASUREMENTS AND MAIN RESULTS Six patients had gastric intramucosal acidosis (intramucosal pH [pHi] of 7.24 +/- 0.06), whereas the remaining 11 patients had pHi values within the normal range (7.44 +/- 0.01). No differences were found between intramucosal acidotic and nonacidotic patients with respect to their general and hemodynamic characteristics. Patients with intramucosal acidosis had a lower gastric mucosal blood flow, as assessed by laser-Doppler flowmetry, than nonacidotic patients (1.4 +/- 0.1 vs. 2.1 +/- 0.2 volts, respectively; p < .05). Reflectance spectrophotometry disclosed that patients with low gastric pHi had also a significantly (p < .05) lower hemoglobin content index (61 +/- 4 arbitrary units) than patients with normal pHi (81 +/- 3 arbitrary units), whereas oxygen saturation index was similar for both groups. CONCLUSION Our results support the hypothesis that gastric mucosal hypoperfusion underlies the development of intramucosal acidosis in mechanically ventilated patients.
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Affiliation(s)
- J I Elizalde
- Serveis de Gastroenterologia, Departament de Medicina, Hospital Clínic, Universitat de Barcelona, Spain
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27
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Bataller R, Sans M, Escorsell A, Elizalde JI, Bosch J, Rodés J. Esophageal variceal bleeding caused by hypoplasia of the portal vein in a patient with the Klippel-Trenaunay syndrome. Am J Gastroenterol 1998; 93:275-6. [PMID: 9468262 DOI: 10.1111/j.1572-0241.1998.270_5.x] [Citation(s) in RCA: 11] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The case of a patient affected by Klippel-Trenaunay syndrome presenting with esophageal variceal bleeding caused by hypoplasia of the vena porta is reported. Hemostasis was achieved by performing a proximal spleno-renal shunt. We discuss the likely association of this mesodermal development abnormality and vascular disorders of the portal vein.
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Affiliation(s)
- R Bataller
- Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain
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28
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Elizalde JI, Panés J. [New concepts on pathogenic mechanisms of Helicobacter pylori infection]. Gastroenterol Hepatol 1998; 21 Suppl 1:2-7. [PMID: 9549195] [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: 02/07/2023]
Affiliation(s)
- J I Elizalde
- Servicio de Gastroenterología, Institut Clínic de Malalties Digestives, Barcelona
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29
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Abstract
BACKGROUND AND STUDY AIMS Hemorrhage is one of the most common severe complications after endoscopic sphincterotomy (ES) and the mortality after surgical treatment can be as high as 50%. We prospectively evaluated the effect of injection treatment in nine patients with appreciable hemorrhage after ES. PATIENTS AND METHODS Bleeding was detected immediately after ES in five patients and 48, 72, 120 and 216 hours after the procedure in the remaining four. Patients were treated with a combined injection of epinephrine and polidocanol (1-3 and 3-6 ml, respectively) into the bleeding site. RESULTS Treatment was effective in arresting hemorrhage in all cases. Two patients had abnormal clotting tests, which emphasizes the importance of identifying risk factors for hemorrhage before ES. No patient required operation and there were no late complications related to the injection during a mean follow-up period of six months. CONCLUSIONS Our results suggest that bleeding after sphincterotomy can be safely and effectively controlled by a combined epinephrine and polidocanol injection, thereby avoiding operation.
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Affiliation(s)
- C Vásconez
- Gastroenterology Department, Hospital Clinic i Provincial, Barcelona, Spain
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30
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Méndez A, Casadevall M, Wachter CH, Elizalde JI, Del Rivero M, Heinemann A, Holzer P, Quintero E, Piqué JM. Gastric mucosal blood flow regulation in response to different stimuli. Dig Dis Sci 1997; 42:1873-9. [PMID: 9331150 DOI: 10.1023/a:1018807009266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 02/05/2023]
Abstract
We compared changes in gastric mucosal blood flow (GMBF) and left gastric artery blood flow (LGABF) in response to pharmacological, physiological, and pathological stimuli. GMBF and LGABF were measured by the hydrogen gas clearance and perivascular ultrasonic transit time techniques, respectively, under baseline conditions and following intravenous infusion of vasopressin or pentagastrin, isovolemic hemodilution, or gastric perfusion with HCl-taurocholate. Blood flow changes following vasopressin or hemodilution were significantly larger in the left gastric artery than in the gastric mucosa. In contrast, the increment in blood flow associated with pentagastrin-stimulated acid secretion was significantly greater in the gastric mucosa than in the extramural artery. Barrier disruption with acid-taurocholate induced similar changes in both measurement sites. The gastric hyperemia induced by either mechanism was significantly attenuated by blockade of NO synthesis. These data demonstrate that although functional changes in GMBF are primarily supported by changes in blood flow at the extramural gastric arteries, the gastric mucosal microvasculature is also under the influence of independent local control mechanisms.
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Affiliation(s)
- A Méndez
- Department of Gastroenterology, University of La Laguna in Tenerife, Spain
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31
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Elizalde JI, Gómez J, Panés J, Lozano M, Casadevall M, Ramírez J, Pizcueta P, Marco F, Rojas FD, Granger DN, Piqué JM. Platelet activation In mice and human Helicobacter pylori infection. J Clin Invest 1997; 100:996-1005. [PMID: 9276716 PMCID: PMC508274 DOI: 10.1172/jci119650] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Extracts of Helicobacter pylori (HP) have been shown to induce leukocyte adhesion in mesenteric venules, but the effects of HP infection on gastric microvessels are unknown. Inflammatory cell interactions in the gastric microcirculation were studied by intravital videomicroscopy in mice inoculated with either saline or fresh isolates of HP. Platelet aggregates were detected and quantified in murine portal blood, while endothelial P-selectin expression was determined using the dual radiolabeled mAb technique. Platelet activation and aggregation were studied in HP-infected patients and controls by measuring the platelet-aggregate ratio and platelet P-selectin expression. HP infection induced a marked increase in the flux of rolling leukocytes and the appearance of platelet and leukocyte- platelet aggregates in murine gastric venules. The HP-induced rolling and platelet aggregate formation was abrogated by mAbs against L- or P-, but not E- selectin. Endothelial cell expression of P-selectin was not altered, but platelet P-selectin expression was enhanced in HP-infected mice. Circulating platelet aggregates and activated platelets were also detected in HP-infected patients. These findings indicate that platelet activation and aggregation contribute to the microvascular dysfunction and inflammatory cell recruitment associated with HP infections.
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Affiliation(s)
- J I Elizalde
- Department of Gastroenterology, Hospital Clínic i Provincial, University of Barcelona, 08036 Barcelona, Spain
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32
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Cirera I, Elizalde JI, Piqué JM, Feu F, Casadevall M, Goldin E, Terés J, Bosch J, Rodés J. Anemia worsens hyperdynamic circulation of patients with cirrhosis and portal hypertension. Dig Dis Sci 1997; 42:1697-702. [PMID: 9286236 DOI: 10.1023/a:1018861415259] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/05/2023]
Abstract
This retrospective cohort study was aimed at investigating the effects of anemia on the hemodynamic disturbances associated with portal hypertension. In all, 202 consecutive nontreated portal-hypertensive patients referred for evaluation to our Hepatic Hemodynamic Laboratory were included. Compared to the nonanemic patients, anemic cirrhotic patients had an increased cardiac output (7.9 +/- 1.9 vs 7.1 +/- 2 liters/min, P < 0.01), and a decreased mean arterial blood pressure (82 +/- 11 vs 94 +/- 13 mm Hg, P < 0.0001) and systemic vascular resistance (838 +/- 235 vs 1102 +/- 356 dyn/sec/cm5, P < 0.0001). Similar results were obtained when Child A or Child B-C patients were analyzed separately. Multivariate logistic regression disclosed that hemoglobin concentration, in addition to age, sex azygos blood flow, and albumin concentration, was an independent factor influencing the degree of systemic vasodilation in cirrhotic portal-hypertensive patients. This study discloses that anemia worsens the hyperdynamic circulation associated with portal hypertension. Since hemoglobin concentration may change with time, this parameter should be taken into account when evaluating hemodynamics in portal-hypertensive patients.
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Affiliation(s)
- I Cirera
- Gastroenterology Department, Hospital Clinic i Provincial, University of Barcelona, Spain
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33
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Elizalde JI, Clemente J, Marín JL, Panés J, Aragón B, Mas A, Piqué JM, Terés J. Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia. Transfusion 1997; 37:573-6. [PMID: 9191816 DOI: 10.1046/j.1537-2995.1997.37697335150.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Equilibration of hemoglobin concentration after transfusion has been estimated to take about 24 hours, but some studies have shown that earlier measurements reflect steady-state values in persons who have not bled recently. This study was aimed at assessing the changes over time in hemoglobin concentration after transfusion in acutely anemic patients because of recent bleeding. STUDY DESIGN AND METHODS Thirty-two normovolemic patients recovering from an acute bleeding episode who were no longer thought to be bleeding and who received a 2-unit red cell transfusion were studied. At baseline and 15, 30, 60, and 120 minutes and 24 hours after transfusion, hemoglobin concentration and hematocrit values were measured. RESULTS The administration of 2 units of packed red cells elicited a 24-hour increase of 22.4 +/- 6.8 g per L in hemoglobin concentration. Hemoglobin values were not different at any of the defined posttransfusion times. Hematocrit levels experienced similar changes over time. Agreement between 15-minute and 24-hour values was excellent, as only 6 percent of patients exhibited a clinically significant difference (> 6 g/L) between the hemoglobin measurements. CONCLUSION Hemoglobin and hematocrit values rapidly equilibrate after transfusion in normovolemic patients who are recovering from an acute bleeding episode. This fact would allow a rapid assessment of the effects of transfusion and of the recurrence of bleeding in patients remaining at risk.
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Affiliation(s)
- J I Elizalde
- Gastroenterology Department, Hospital Clínic i Provincial, University of Barcelona, Spain
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34
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Bataller R, Salmerón JM, Muñoz JE, Obach V, Elizalde JI, Mas A, Tolosa E, Terés J. [Pyloric stenosis complicated by Wernicke-Korsakoff syndrome]. Gastroenterol Hepatol 1997; 20:131-3. [PMID: 9162533] [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: 02/04/2023]
Abstract
The Wernicke-Korsakoff syndrome (WKS) is a picture of oculomotor alterations, ataxia and confusion presented in chronic alcoholics. It has more rarely been described in non alcoholic patients with malnutrition. The case of a patient with ulcerous peptic disease of long evolution who consulted for a picture compatible with WKS following clinical manifestations of repeated vomiting secondary to complete pyloric stenosis is presented. The peculiarity of the picture and the convenience of prevention in malnourished patients receiving intravenous glucose sera is discussed.
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Affiliation(s)
- R Bataller
- Hospital Clinic i Provincial, Departament de Medicina, Universitat de Barcelona
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35
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Goldin E, Ardite E, Elizalde JI, Odriozola A, Panés J, Piqué JM, Fernández-Checa JC. Gastric mucosal damage in experimental diabetes in rats: role of endogenous glutathione. Gastroenterology 1997; 112:855-63. [PMID: 9041247 DOI: 10.1053/gast.1997.v112.pm9041247] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Spontaneous gastric damage occurs in diabetic rats, but the mechanism is unknown. The aim of this study was to assess the role of glutathione metabolism and gastric mucosal blood flow (GMBF) in the development of such spontaneous gastric damage. METHODS Mucosal damage, GMBF, glutathione metabolism, and lipid peroxidation were measured in the stomach of diabetic and control rats. RESULTS Spontaneous gastric damage occurred in fasted diabetic rats 4 weeks after streptozotocin administration or pancreatectomy. This was accompanied by a 50% decrement in mucosal content of glutathione; 48 hours after streptozotocin, the decrement of glutathione was only of 25% and no gastric damage was observed. Fed diabetic rats (4 weeks after streptozotocin) had normal glutathione levels and no damage; however, a 30% glutathione depletion achieved by buthionine-sulfoximine administration promoted significant damage. Gastric glutathione synthetic rate, levels of adenosine triphosphate, oxidized glutathione, and malonyldialdehyde were similar in all groups, whereas cysteine concentration was reduced in fasted diabetic animals. Exogenous cysteine attenuated the gastric damage. GMBF was not influenced by diabetes. CONCLUSIONS Spontaneous gastric damage in fasted diabetic rats seems to be related to glutathione depletion as a result of limited availability of cysteine and not to increased glutathione oxidation. GMBF changes are not involved.
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Affiliation(s)
- E Goldin
- Gastroenterology Department, Hospital Clinic, University of Barcelona, Spain
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36
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Elizalde JI. [Ebrotidine]. Gastroenterol Hepatol 1997; 20:65-7. [PMID: 9072206] [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: 02/04/2023]
Affiliation(s)
- J I Elizalde
- Servicio de Gastroenterología, Hospital Clínic i Provincial, Barcelona
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37
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Goldin E, Casadevall M, Mourelle M, Cirera I, Elizalde JI, Panés J, Casamitjana R, Guth P, Piqué JM, Terés J. Role of prostaglandins and nitric oxide in gastrointestinal hyperemia of diabetic rats. Am J Physiol 1996; 270:G684-90. [PMID: 8928799 DOI: 10.1152/ajpgi.1996.270.4.g684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the study was to characterize the gastric and mesenteric vascular changes induced by diabetes and the implication of endothelial [nitric oxide (NO) and prostaglandins] and humoral (glucagon) factors in such changes. Diabetes was induced in rats by a single streptozotocin injection. Four weeks later, gastric mucosa, left gastric artery, and superior mesenteric artery blood flows were measured using hydrogen gas clearance and perivascular ultrasonic flowmeter techniques, respectively, in anesthetized and fasted diabetic and control rats. Blood pressure, hematocrit, blood volume, and blood viscosity were also measured. Left gastric (41 +/- 6 vs. 25 +/- 4 ml.min-1.100 g-1) and superior mesenteric artery blood flows (83 +/- 8 vs. 65 +/- 4 ml.min-1.100 g-1) were significantly higher in diabetic than in control rats. The increased blood flow in the left gastric artery was distributed to a hypertrophic mucosa in diabetic rats; therefore, the blood flow per 100 g tissue in the gastric mucosa was not significantly different in diabetic compared with control rats. Pretreatment with indomethacin reduced both increase gastric and mesenteric flows of the diabetic rats to the same levels as in control rats. NG-nitro-L-arginine methyl ester decreased gastric blood flow in a dose-dependent manner and to a similar extent in diabetic and control rats. In contrast, an increased sensitivity to the higher doses of the NO inhibitor was observed in the mesenteric vascular bed of diabetic rats. Glucagon reduction achieved by somatostatin infusion did not influence either gastric or mesenteric blood flow in diabetic rats. In summary, the present study revealed an increase in gastric and mesenteric arterial blood flows in streptozotocin-induced diabetic rats. The gastrointestinal hyperemia seems to be due, at least in part, to the increased demand of a hypertrophic mucosa and is mediated primarily by endogenous prostaglandins. Increased vascular sensitivity to NO may also contribute to the mesenteric vasodilation.
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Affiliation(s)
- E Goldin
- Gastroenterology Department, Hospital Clínic, University of Barcelona, Spain
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38
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Elizalde JI, Castells A, Planas R, Rodríguez-Iglesias MP, Bruix J, Brú C, Saló J, Boix J, Gassull MA, Terés J, Rodés J. [Prevalence of hepatocellular carcinoma in cirrhotic patients with with portosystemic shunt. Cohort analysis]. Gastroenterol Hepatol 1996; 19:189-93. [PMID: 8665355] [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: 02/01/2023]
Abstract
The development of hepatocellular carcinoma is frequent in patients with hepatic cirrhosis of any etiology. Despite the suggestion that portosystemic shunt may increase the risk of developing this neoplasm there are scarce clinical evidence to confirm this suggestion. The present cohort study was aimed at analyzing the follow up data of 232 patients included in 3 prospective randomized controlled studies in which the efficacy of shunt procedures (group I: portocaval or splenorenal anastomosis) versus techniques other than shunt (group II: esophageal transection or variceal sclerosis) in the treatment of upper-6I bleeding secondary to rupture of esophageal-gastric varices were compared. After a mean follow up of 50 months, no differences were observed between the two groups in relation with the prevalence of hepatocellular carcinoma (group I: 17%; group II: 12%; relative risk: 1.41 [CI 95%: 0.72 - 2.75]; p = 0.41) or the actuarial probability of developing this neoplasm (group I: 2% at 2 years, 21% at 5 years; group II: 7% at 2 years, 14% at 5 years; p = 0.42). The results of this analysis suggest that the performance of portosystemic shunt does not increase the risk of developing hepatocellular carcinoma in patients with hepatic cirrhosis.
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Affiliation(s)
- J I Elizalde
- Servicio de Gastroenterología, Hospital Clínic i Provincial, Barcelona
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39
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Affiliation(s)
- R Bataller
- Endoscopy Section, Clinic i Provincial Hospital, University of Barcelona, Spain
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40
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Bataller R, Llach J, Salmerón JM, Elizalde JI, Mas A, Piqué JM, Brullet E, Terés J, Bordas JM, Rodés J. Endoscopic sclerotherapy in upper gastrointestinal bleeding due to the Mallory-Weiss syndrome. Am J Gastroenterol 1994; 89:2147-2150. [PMID: 7977231 DOI: 10.1111/j.1572-0241.1994.tb07755.x] [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: 09/28/2023]
Abstract
OBJECTIVES Therapeutic endoscopic techniques have changed the need for emergency surgery in gastrointestinal bleeding episodes. However, there is only little information about endoscopic therapies in severe gastrointestinal bleeding due to the Mallory-Weiss syndrome. The aim of this clinical study was to assess the usefulness of early endoscopic examination and sclerotherapy for severe or recurrent bleeding due to the Mallory-Weiss syndrome. METHODS We studied all 50 cases of gastrointestinal bleeding secondary to the Mallory-Weiss syndrome seen in 2175 consecutive emergency endoscopic examinations performed in a University Hospital over a 3-year period. Endoscopic sclerotherapy (1/10000 adrenaline + 1% polidocanol) was performed in all patients with active bleeding or visible vessel at endoscopic examination. The remaining patients were medically treated. RESULTS Active bleeding or a visible vessel were found in 13 patients; definitive hemostasis was obtained in all cases with sclerotherapy. The remaining 37 patients were successfully treated by conservative therapy. On admission, the severity of the hemorrhagic episodes was significantly higher in patients treated with sclerotherapy than in those who did not require this procedure. An esophageal perforation, successfully managed by conservative means, was the only complication recorded in the subset of patients undergoing sclerotherapy. CONCLUSIONS Severe bleeding due to Mallory-Weiss syndrome can be successfully treated by sclerotherapy. Early endoscopic examination is an accurate procedure in identifying patients who do not require sclerotherapy.
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Affiliation(s)
- R Bataller
- Section of Endoscopy, Hospital Clinic i Provincial, University of Barcelona, Spain
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41
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Abstract
Portal hypertensive gastropathy has been related to portal hypertension and is a recognized cause of iron deficiency anemia. Although this gastric mucosal lesion has been occasionally described in extrahepatic portal hypertension, its clinical significance and histological features are not well established. We report a case of chronic anemia due to portal hypertensive gastropathy in a patient with splenic vein thrombosis, and suggest that the cure of gastric lesions in this condition may be obtained by splenectomy.
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Affiliation(s)
- J I Elizalde
- Gastroenterology Unit, Hospital Clínic i Provincial, Medical School, University of Barcelona, Catalonia, Spain
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42
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Elizalde JI, Salmerón JM, Mas A, Bruguera M. [Severe acute hepatitis caused by hepatitis A virus]. Med Clin (Barc) 1994; 102:479. [PMID: 8208004] [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: 01/29/2023]
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43
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Elizalde JI, Escorsell A, García-Pugés A, Navarro S, Bataller R, Terés J. [Isolated rectal Kaposi's sarcoma]. Rev Esp Enferm Dig 1993; 84:399-401. [PMID: 8129997] [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: 01/28/2023]
Abstract
We report a case of isolated rectal Kaposi's Sarcoma in a homosexual man with active Human Immunodeficiency Virus infection. Although gastrointestinal tract affection is not infrequent, it is usually associated with the existence of skin lesions. A few cases of noncutaneous gastrointestinal Kaposi's Sarcoma have been described, but no one affecting only the rectum. This is a diagnostic possibility in patients with Human Immunodeficiency Virus infection and rectal symptoms.
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Affiliation(s)
- J I Elizalde
- Servicio de Gastroenterología, Hospital Clínic i Provincial, Barcelona
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