RESUMO
Es sabido que la detección precoz de la arterosclerosis coronaria disminuye el riesgo de infarto. Con tal motivo se estudiaron 104 pacientes, de 52 años de edad promedio, mediante radioscopia TV. De acuerdo a los resultados de la calcificación coronaria CC y al número de territorios involucrados se clasificaron los pacientes en varios grupos, concluyendo que la radioscopia TV es un método de alta sensibilidad, bajo costo, rapidez y seguridad para la detección de CC
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Calcinose/diagnóstico , LDL-Colesterol , Doença da Artéria Coronariana/diagnóstico , Diagnóstico por Imagem , Hiperlipidemias/diagnóstico , Lipoproteína(a) , Ecrans Intensificadores para Raios X/estatística & dados numéricos , Calcinose , Calcinose/etiologia , LDL-Colesterol/efeitos adversos , LDL-Colesterol/sangue , Doença da Artéria Coronariana , Doença das Coronárias , Doença das Coronárias/sangue , Doença das Coronárias/diagnóstico , Diagnóstico por Imagem , Hiperlipidemias/sangue , Hiperlipidemias/complicações , Lipoproteína(a)/efeitos adversos , Lipoproteína(a)/sangueRESUMO
Es sabido que la detección precoz de la arterosclerosis coronaria disminuye el riesgo de infarto. Con tal motivo se estudiaron 104 pacientes, de 52 años de edad promedio, mediante radioscopia TV. De acuerdo a los resultados de la calcificación coronaria CC y al número de territorios involucrados se clasificaron los pacientes en varios grupos, concluyendo que la radioscopia TV es un método de alta sensibilidad, bajo costo, rapidez y seguridad para la detección de CC (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doença da Artéria Coronariana/diagnóstico , Calcinose/diagnóstico , Ecrans Intensificadores para Raios X/estatística & dados numéricos , Hiperlipidemias/diagnóstico , Lipoproteína(a)/diagnóstico , LDL-Colesterol/diagnóstico , Diagnóstico por Imagem/estatística & dados numéricos , Doença da Artéria Coronariana/diagnóstico por imagem , Calcinose/etiologia , Calcinose/diagnóstico por imagem , Diagnóstico por Imagem , Doença das Coronárias/diagnóstico , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/sangue , Hiperlipidemias/complicações , Hiperlipidemias/sangue , LDL-Colesterol/efeitos adversos , LDL-Colesterol/sangue , Lipoproteína(a)/efeitos adversos , Lipoproteína(a)/sangueRESUMO
BACKGROUND & AIMS: Different parameters are considered predictors of bleeding and death in alcoholic cirrhosis. The aim of this study was to establish the prognostic value of a prospective and sequential evaluation of portal pressure, variceal size, and Pugh's score in portal-hypertensive patients with alcoholic cirrhosis but no previous bleeding. METHODS: Thirty patients were evaluated for 42 +/- 5 months (median, 39 months). After baseline studies, 30 patients underwent an additional evaluation (follow-up 1; median, 10 months), 20 patients a second evaluation (follow-up 2; median, 25 months), and 13 patients a third evaluation (follow-up 3; median, 45 months). No prophylactic treatment for bleeding was given. End points were bleeding and/or death. RESULTS: Seventeen patients died, and 10 patients bled. At follow-up 1, portal pressure decreased both in survivors and nonbleeders (from 18.7 +/- 1.0 to 15.2 +/- 1.3 mm Hg [P < 0.01] and from 18.9 +/- 0.8 to 16.5 +/- 1.0 mm Hg [P < 0.05], respectively). On multivariate analysis (Cox model), portal pressure at follow-up 1 had the best prognostic and independent value for both bleeding and survival. Subsequent studies showed similar trends. CONCLUSIONS: Measurements of portal pressure provide unique prognostic information for predicting portal hypertensive-related bleeding and mortality in patients with alcoholic cirrhosis.
Assuntos
Veias Hepáticas/fisiopatologia , Hipertensão Portal/fisiopatologia , Cirrose Hepática Alcoólica/fisiopatologia , Pressão Venosa , Adulto , Consumo de Bebidas Alcoólicas , Cateterismo , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/patologia , Feminino , Hemodinâmica , Hemorragia/etiologia , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/mortalidade , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Prospectivos , Análise de SobrevidaRESUMO
The long-term hemodynamic and renal effects of propranolol were compared with those of propranolol plus isosorbide dinitrate in 44 portal-hypertensive alcoholic cirrhotic patients. Eight control patients, 8 patients receiving propranolol and 14 patients receiving propranolol plus isosorbide dinitrate were hemodynamically evaluated. Renal function was studied in a fourth group of 14 patients receiving propranolol plus isosorbide dinitrate. Portal pressure decreased more (p < 0.05) with combined therapy (-21.6%, from 19.5 +/- 4.8 to 15.4 +/- 4.3 mm Hg) than with propranolol alone (-12.5%, from 19.9 +/- 1.2 to 17.4 +/- 1.8 mm Hg). Serum urea and creatinine levels, plasma sodium concentration, urine volume and urinary sodium excretion showed nonsignificant changes in all groups studied. Combined therapy induced a significant (p < 0.05) decrease in plasma renin activity (from 4.42 +/- 4.7 to 1.59 +/- 1.9 ng/ml/hr) and nonsignificant reductions in plasma aldosterone concentration and creatinine clearance. None of the eight patients with ascites or history of ascites not receiving isosorbide dinitrate showed evidence of impairment in renal sodium metabolism during the study period. In contrast, 8 of the 14 patients (57%) with ascites or history of ascites receiving isosorbide dinitrate showed impairment in renal sodium metabolism (p < 0.01), as reflected by the development or worsening of ascites and the need of higher diuretic requirements. Long-term combined administration of propranolol plus isosorbide dinitrate is superior to propranolol alone in the pharmacological treatment of portal hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hemodinâmica/efeitos dos fármacos , Hipertensão Portal/tratamento farmacológico , Hipertensão Portal/fisiopatologia , Dinitrato de Isossorbida/uso terapêutico , Rim/fisiopatologia , Propranolol/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Quimioterapia Combinada , Feminino , Seguimentos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Rim/efeitos dos fármacos , Testes de Função Renal , Circulação Hepática/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resistência Vascular/efeitos dos fármacosRESUMO
Ketanserin, a 5-hydroxytryptamine-2 receptor blocker, has been shown to decrease portal pressure in recent acute hemodynamic studies that have been performed both in experimental animals and portal hypertensive patients. The present study was designed to investigate the effects of chronic oral administration of ketanserin in portal hypertensive patients with cirrhosis. The mean baseline hepatic venous pressure gradient in the 13 patients with alcoholic cirrhosis who completed the study was 15.7 +/- 2.7 mmHg. It decreased significantly to 13.3 +/- 2.0 mmHg (p less than 0.001) after ketanserin was administered at a mean dose of 51 mg per day for a mean period of 32 days. This 14.6% reduction in hepatic venous pressure gradient resulted mainly from a decrease in mean wedged hepatic venous pressure (from 22.2 +/- 4.0 to 20.1 +/- 3.6 mmHg) and was accompanied by significant decreases in cardiac index (18.8%) and in mean arterial pressure (8.1%). However, changes in cardiac index or in mean arterial pressure were not predictive of modifications in the hepatic venous pressure gradient. Eight of 16 patients entered in the study developed side effects, the most significant being a reversible portosystemic encephalopathy, which occurred in three patients who had poor liver function. This study confirms evidence in favor of a role for 5-hydroxytryptamine in portal hypertension and adds a new group of agents for the chronic treatment of portal hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Hemodinâmica/efeitos dos fármacos , Hipertensão Portal/tratamento farmacológico , Ketanserina/uso terapêutico , Cirrose Hepática Alcoólica/tratamento farmacológico , Administração Oral , Adulto , Feminino , Humanos , Hipertensão Portal/fisiopatologia , Ketanserina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Hepatic blood flow was measured in 10 cirrhotic patients by a constant infusion of Indocyanine Green (ICG) and details of the technique are analysed. A decrease in total hepatic blood flow (0.777 +/- 0.38 l/min.) was found in most of the patients. Different variations in hepatic blood flow were observed in three patients after the administration of Cimetidine (300 mg IV). The response in hepatic blood flow in another patient in whom a peritoneo-jugular valve (Le Veen shunt) was inserted in analysed.
Assuntos
Cimetidina/farmacologia , Verde de Indocianina , Circulação Hepática/efeitos dos fármacos , Cirrose Hepática/fisiopatologia , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Derivação PeritoneovenosaRESUMO
La determinacion del flujo sanguineo hepatico fue efectuada en pacientes portadores de hepatopatia cronica. Se utilizo um metodo de infusion continua con verde de indocianina, cuya tecnica se detalla.Los resultados basales en 10 pacientes y ejemplos de aplicacion de la tecnica son analizados. La correlacion del flujo sanguineo hepatico con otros elementos contribuye a definir de mejor manera el perfil hemodimico de las hepatopatias cronicas
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Humanos , Masculino , Feminino , Cimetidina , Circulação Hepática , Cirrose Hepática , Verde de IndocianinaRESUMO
La determinacion del flujo sanguineo hepatico fue efectuada en pacientes portadores de hepatopatia cronica. Se utilizo um metodo de infusion continua con verde de indocianina, cuya tecnica se detalla.Los resultados basales en 10 pacientes y ejemplos de aplicacion de la tecnica son analizados. La correlacion del flujo sanguineo hepatico con otros elementos contribuye a definir de mejor manera el perfil hemodimico de las hepatopatias cronicas
Assuntos
Adulto , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Cimetidina , Verde de Indocianina , Circulação Hepática , Cirrose HepáticaRESUMO
Hepatic blood flow was measured in 10 cirrhotic patients by a constant infusion of Indocyanine Green (ICG) and details of the technique are analysed. A decrease in total hepatic blood flow (0.777 +/- 0.38 l/min.) was found in most of the patients. Different variations in hepatic blood flow were observed in three patients after the administration of Cimetidine (300 mg IV). The response in hepatic blood flow in another patient in whom a peritoneo-jugular valve (Le Veen shunt) was inserted in analysed.