Publications (3)3.05 Total impact
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Article: Hemodynamic effects of chronic smoking in liver cirrhosis: a role for adrenomedullin.
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ABSTRACT: To evaluate the effect of smoking on the hemodynamic status of liver cirrhosis and several vasoactive substances. Hemodynamic, blood gases values, liver parameters, and several vasopressors and vasodilators substances were measured in consecutive inpatients diagnosed of liver cirrhosis divided into two groups: smokers and nonsmokers. Nineteen smoking cirrhotic patients and 13 nonsmoking cirrhotic patients were studied. Both groups showed similar age, Child--Pugh and model for end-stage liver disease indexes. Smokers had higher levels of hemoglobin and lower partial pressure of arterial oxygen, FEV1/FVC %, cardiac output and total vascular resistance than nonsmokers. Plasma level of adrenomedullin was independently higher in nonsmoking cirrhotic patients than in smokers. In contrast with smoking cirrhotic patients, nonsmoking cirrhotic patients show an increased systemic vasodilation, which could depend on higher plasmatic levels of adrenomedullin.European journal of gastroenterology & hepatology 03/2010; 22(5):513-8. · 1.66 Impact Factor -
Article: N-terminal pro-B-type natriuretic peptide predicts the burden of pulmonary embolism.
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ABSTRACT: In acute pulmonary embolism (PE), brain natriuretic peptides are markers of right ventricular dysfunction and they could point out the size of the occluded pulmonary vessel. N-terminal pro-B-type natriuretic peptide (BNP) was measured in 93 consecutive outpatients diagnosed with acute PE by means of helical computed tomography. Central PE was diagnosed when thrombotic material was seen in the main trunk or right or left main branches of the pulmonary artery, and peripheral PE was diagnosed when thrombi were seen exclusively in segmental or subsegmental arteries. Central PE occurred in 51 (55%) patients and peripheral PE in 42 (45%). Plasma level of pro-BNP greater than 500 ng/L was independently associated with central PE. The area under the receiver operating characteristic curve was 0.753 (CI 95% 0.700-0.806), sensitivity 0.82 (CI 95% 0.69-0.91), specificity 0.67 (CI 95% 0.50-0.79), positive predictive value 0.75 (CI 95% 0.61-0.85), and negative predictive value 0.76 (CI 95% 0.58-0.87). Six (6%) patients died, 3 from PE, 2 from brain hemorrhage, and 1 from advanced gallbladder cancer. N-terminal pro-BNP level was greater than 500 ng/L in all patients who died. The area under receiver operating characteristic curve for death was 0.712 (CI 95% 0.635-0.789), sensitivity 0.10 (CI 95% 0.04-0.22), specificity 1 (CI 95% 0.88-1), positive predictive value 1 (CI 95% 0.51-1), and negative predictive value 0.42 (CI 95% 0.32-0.53). Preliminary data suggest that N-terminal pro-BNP levels higher than 500 ng/L could serve as indicator of the burden of PE and perhaps as a predictor of death.The American Journal of the Medical Sciences 03/2009; 337(2):88-92. · 1.39 Impact Factor -
Article: Tratamiento ambulatorio de la trombosis venosa profunda: comparación con tratamiento en hospitalización de pacientes de un registro histórico
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ABSTRACT: Antecedentes. El tratamiento ambulatorio de la trombosis venosa profunda (TVP) se ha propuesto como un método seguro y coste efectivo, bien completamente ambulatorio o como un patrón mixto de hospitalización corta seguido de tratamiento ambulatorio. Material y métodos. Análisis descriptivo de cohortes sobre nuestra experiencia de tratamiento completamente ambulatorio de pacientes con TVP durante el periodo 2003 y 2004, recogiendo las proporciones de hemorragia mayor, complicaciones (definidas como nuevo embolismo pulmonar, re-extensión de la TVP o necesidad de ingreso hospitalario relacionado con TVP) y muerte por todas las causas. Comparamos con una cohorte de pacientes históricos de tratamiento en hospitalización correspondientes al año 2002. Resultados. Durante el periodo indicado se trataron ambulatoriamente 184 pacientes. Presentaron hemorragia mayor 3% (IC 95% 1-6,57), complicaciones 5% (IC 95% 2,41-9,37) de los pacientes y la tasa de mortalidad fue de 4% (IC 95% 1,68-7,99). Se evitaron 844 estancias hospitalarias. Los 109 pacientes históricos presentaron hemorragia en 8% (IC 95% 4-15), odds ratio 0,22, complicación 4% (IC 95% 1,18-9,68), odds ratio 1,28 y muerte 11% (IC 95% 6-18,8), odds ratio 0,31. Conclusiones. El tratamiento completamente ambulatorio de la TVP puede ser tan seguro como el realizado en hospitalización evitándose estancias hospitalarias innecesarias.Anales del sistema sanitario de Navarra, ISSN 1137-6627, Vol. 32, Nº. 1, 2009, pags. 35-42.
