M A Suárez Pinilla

Hospital Clínico Universitario Lozano Blesa, Zaragoza, Caesaraugusta, Aragon, Spain

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Publications (20)26.18 Total impact

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    ABSTRACT: Background and objective Diabetes mellitus is a cardiovascular risk factor that promotes the development of endothelial injury, which is fundamental in the physiopathology of ischemic heart disease. Therefore, investigation of markers indicating the presence of endothelial injury in diabetic patients would be useful. Patients and method We performed an observational study of 25 patients with ischemic heart disease and coronary atherosclerosis, diagnosed by coronary angiography, whose only cardiovascular risk factor was diabetes mellitus (group I). There were 2 control groups, one with 10 diabetic controls without ischemic heart disease or other cardiovascular risk factors (group II) and another group with 17 healthy controls (group III). Activity of von Willebrand factor (vWf) antigen, as a marker of endothelial injury, was compared among the groups. Student's t-test, the x2 test, the coefficient of correlation, and multiple regression analysis, with a 95% confidence interval, were used in the statistical analysis. Results Diabetic patients had highervWf levels than healthy controls. Diabetic patients with coronary atherosclerosis had higher vWf levels than diabetics without vascular complications. There was a correlation between vWF and fibrinogen concentrations in group I. Conclusions vWf is a risk factor for the development of endothelial injury in diabetics and is also a marker of risk for the development of vascular complications in these patients.
    Endocrinología y Nutrición 11/2007; 54(9). DOI:10.1016/S1575-0922(07)71486-9
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    ABSTRACT: Introduction Coronary atheromatosis is a chronic process in which inflammatory phenomena and subclinical activation of the hemostasis occur. Patients and methods Observational study, conducted in a group of 30 patients diagnosed of coronary atheromatosis by angiography, and a control group of 15 healthy subjects with no cardiovascular risk factors. Standard coagulation study and subclinical hemostatic activity, using the fragment 1 + 2 of prothrombin and the thrombinantithrombin complex were compared between both groups. Student's-t, Wilcoxon's-T and chisquare tests, correlation coefficient and analysis of multiple regression, with an confidence interval of 95%, were used as statistical tools. Results The study group presented higher levels of the fragment 1 + 2 of prothrombin and thrombin-antithrombin complex, with a standard coagulation study within the reference range. Conclusions Patients with coronary atheromatosis present subclinical activation of blood hemostasis not detectable by standard coagulation studies.
    Clínica e Investigación en Arteriosclerosis 04/2005; 17(2). DOI:10.1016/S0214-9168(05)73318-0
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    ABSTRACT: Thoracic trauma is often associated with polytrauma. Because mortality is high, the search for prognostic tools is useful. A total of 108 patients with blunt thoracic trauma, 73 of whom had multiple injuries, were studied in an intensive care unit (ICU). The variables named as potential predictors of outcome were the need for mechanical ventilation, duration of ventilation, and high positive end-expiratory pressure (PEEP); the presence of rib fractures, pulmonary contusion, pleural involvement (hemo- and/or pneumothorax), or lung infection; the need for emergency surgery; mean duration of ICU stay, and age. We also studied whether or not the mortality rate was higher in polytrauma patients. Student t and chi2 tests (95% confidence level) and multiple regression analysis (Hosmer-Lemeshow goodness of fit) were used to analyze the results. The need for mechanical ventilation, radiographic evidence of pulmonary contusion, emergency surgery, and hemodynamic instability were risk factors for increased mortality. Higher risk of mortality was not demonstrated for patients with multiple injuries. For patients in need of mechanical ventilation, high PEEP was a predictor of poor prognosis. The presence of the aforementioned predictors (mechanical ventilation, high PEEP, pulmonary contusion, emergency surgery, and hemodynamic instability) indicate serious injury to the lung parenchyma, which is the main determinant of outcome for patients with thoracic trauma.
    Archivos de Bronconeumología 12/2004; 40(11):489-94. DOI:10.1016/S1579-2129(06)60363-7 · 1.82 Impact Factor
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    ABSTRACT: Introducción: El traumatismo torácico suele producirse en el contexto de un politraumatismo. La mortalidad elevada de esta patología hace lógica la investigación de marcadores pronósticos. Pacientes y métodos: Estudio sobre 108 pacientes ingresados en una unidad de cuidados intensivos, con traumatismo torácico cerrado, de los cuales 73 fueron politraumatizados. Analizamos, como marcadores pronósticos, la necesidad de ventilación mecánica, su duración, la presión positiva máxima final de la espiración, las fracturas costales, la contusión pulmonar, las alteraciones pleurales (hemo y/o neumotórax), la sobreinfección respiratoria, la inestabilidad hemodinámica, la necesidad de cirugía urgente, así como la estancia media y la edad. Estudiamos si fue mayor la mortalidad en los politraumatizados. Se emplearon como herramientas estadísticas las pruebas de la t de Student y de la ?2 (intervalo mínimo de confianza del 95%), y se realizó un análisis de regresión logística (bondad de ajuste test de Hosmer-Lemeshow). Resultados: La necesidad de ventilación mecánica, la presencia radiológica de contusión pulmonar, la cirugía urgente y la inestabilidad hemodinámica comportan mayor mortalidad. No se demuestra mayor mortalidad en los enfermos politraumatizados. En los pacientes con ventilación mecánica, la presión positiva máxima final de la espiración requerida es un indicador de mayor mortalidad. Conclusiones: Los marcadores positivos indican una mayor lesión en el parénquima pulmonar, lesión que es el determinante principal de la evolución de los pacientes con traumatismo torácico.
    Archivos de Bronconeumología 01/2004; 40(11). DOI:10.1157/13067569 · 1.82 Impact Factor
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    ABSTRACT: Mechanical ventilators are often used in critically-ill patients with acute respiratory insufficiency. We aimed to assess the reliability of four commonly used ventilators. This experimental study assessed four Bio-Tek VT-2 ventilators set for different levels of impedance and compliance in comparison with a tester. We gathered data on differences between the ventilators and the tester for volumes supplied and end-expiratory pressures. Statistical significance was determined using a Student-t test (95% confidence interval) and a coefficient of variation was calculated to study variation over time in parameters programmed. Error margins were calculated and applied for each ventilator. For situations in which compliance and impedance are similar to those of patients with chronic obstructive pulmonary disease and acute respiratory distress syndrome, there were differences in tidal volumes measured by the ventilators monitors and those actually supplied at the end of the breathing circuits, although the differences are only slightly greater than the error margins. The coefficients of variation were not significant at any of the compliance and impedance levels studied. In situations of low compliance and/or high impedance, tidal volumes supplied by ventilators and volumes shown on the monitors are different, although the differences are small and hardly exceed the ventilators acceptable error margins. The coefficient of variation indicated that the parameters set remain highly stable over time.
    Revista espanola de anestesiologia y reanimacion 01/2003; 49(10):522-8.
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    ABSTRACT: Objetivo. Tras una parada cardiorrespiratoria (PCR), pueden producirse fenómenos de anoxia cerebral (AIC). Proponemos emplear el Doppler transcraneal (DTC), en función de los resultados de velocidad de flujo cerebral encontrados, como herramienta pronóstica de los casos de PCR. Método. Estudio prospectivo de 19 pacientes que sufrieron PCR y necesitaron maniobras de soporte vital avanzado. Tras estabilizar la situación clínica y valorar el estado neurológico, se realizó DTC isonando ambas arterias cerebrales medias, y se consignaron los valores de la arteria que tuviera tanto la mayor velocidad media (VM) como el menor índice de pulsatilidad (IP). Posteriormente, se hizo un electroencefalograma (EEG) como prueba de confirmación diagnóstica de AIC. Aplicamos la prueba de la t de Student y el coeficiente de correlación (intervalo mínimo de confianza del 95%) como herramientas de análisis estadístico. Resultados. En 15 pacientes en los que el EEG y la evolución clínica fueron compatibles con AIC, el DTC demostró una tendencia a mantener una VM elevada, con un bajo IP. En los 4 pacientes en los que ni el EEG ni la evolución clínica fueron diagnósticos de AIC, el DTC obtuvo valores de VM e IP normales, existiendo diferencias significativas respecto a los 15 pacientes con AIC. Conclusiones. La existencia de un patrón DTC con alta VM y con tendencia a bajo IP, tras un episodio de PCR que requiera maniobras de soporte vital avanzado, se asocia a un mal pronóstico neurológico, con la existencia de AIC.
    Medicina Intensiva 01/2003; DOI:10.1016/S0210-5691(03)79901-X · 1.24 Impact Factor
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    ABSTRACT: A relationship between Central Nervous System and coagulation has been known since the work by Goodnight et al5. When an encephalic injury occurs tissue damage causes the release of thromboplastin-related producís, mainly the Tissular Factor. This release produces an activation of the coagulation system specially through its extrinsic path. With this physiopathologic basis we attempt to improve the knowledge of this relation by performing a prospective study at the Intensive Care Unit of our Hospital. The study included 67 patients with cranioencephalic trauma alone, with an average Glasgow coma scale score of 10 and a control group consisting of 40 healthy subjects. Two peripheral vein blood extractions were performed, at admission and 24 hours later. Global coagulation parameters (prothrombin time, activated partial thromboplastin time, platelet count and fibrinogen), hypercoagulability markers (prothrombin fragments F1+2 and thrombin-antithrombin complex (TAT)) and thrombolisis markers (D-dimer) were determined. Our results show that early after head trauma an increase in fragments F1+2, TAT and Ddimer occur. After the first 24 hours a significant decrease in hypercoagulability markers levels is detected. Modification of the global coagulation parameters was also detected. In conclusion, early after a cranioencephalic trauma a simultaneous state of hypercoagulability and thrombolysis occur which may have the purpose of improving the hemostatic balance.
    Neurocirugia (Asturias, Spain) 01/2003; DOI:10.1016/S1130-1473(03)70530-2 · 0.32 Impact Factor
  • Revista Clínica Española 12/2002; 202(11):623. · 1.31 Impact Factor
  • Revista Clínica Española 01/2002; 202(11):623. DOI:10.1016/S0014-2565(02)71164-8 · 1.31 Impact Factor
  • Revista Clínica Española 01/2001; 200(12):697-8. · 1.31 Impact Factor
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    ABSTRACT: Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzymatic profiles of creatine kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship. In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p < 0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatine kinase (p < 0.0001) as well as for the MB (p < 0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demonstrated by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p < 0.0001). In relation with gammagraphy, values of K1 higher or equal to 0.19 for the creatine kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion. We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.
    Revista Espa de Cardiologia 09/1998; 51(9):740-9. · 3.34 Impact Factor
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    ABSTRACT: Several studies point out the importance of what is called rescue angioplasty or fibrinolysis (FB) when thrombolysis has been ineffective in acute myocardial infaction (AMI). Therefore, it is necessary to make use of new methods to asses reperfusion and to safely establish that such a treatment has not been effective. We present a work which is based on the assessment of patients with acute coronary heart disease: AMI patients treated with FB (N = 48), without FB (N = 15), unstable angina (N = 9); after determining cardiac imaging gammagraphies 99mTc-isonitrile-single-photon emission computed tomography (MIBI-SPECT) pre and post treatment, to assess myocardium at risk (MR), salvage (MS) and the existence or not of gammagraphic reperfusion. Unstable angina patients show a myocardial perfusion that is similar to AMI patients. However, in the case of unstable angina, perfusion is practically of a 100% 48 hours later, having almost completely saved the myocardium at risk (MS/MR = 81.5% +/- 27.7%), and with a non-existent residual myocardium (3.2% +/- 5.8%). In AMI patients treated with FB the salvage myocardium was higher [8.3 vs 3.0; p < 0.05). Considering that an improvement in perfusion defect (MS/MR)] higher than 30% can be viewed as an effective reperfusion, we can see that all the patients with unstable angina show reperfusion, the percentage in the AMI group treated with FB being 45.8%, and the percentage in the AMI group under conventional treatment being just 6.7%. Gammagraphy with 99mTc-MIBI-SPECT at admission allowed assessing regional perfusion in AMI patients during the early stage of their evolution. With a second exploration we could determine the amount of salvage myocardium and the existence of secondary reperfusion to FB treatment.
    Revista Española de Medicina Nuclear 01/1998; 17(4):283-93. · 0.89 Impact Factor
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    ABSTRACT: Introduction Several studies point out the importance of what is called rescue angioplasty or fibrinolysis when thrombolysis has been ineffective in acute myocardial infarction. Therefore, it is necessary to make use of new non-invasive methods to asses reperfusion and to safely establish that such a treatment has not been effective. Patients and method We present a work which is based on the assessment of patients with acute myocardial infarction treated with or without fibrinolysis. After determining cardiac enzimatic profiles of creatin kinase and MB isoform (time course, peak, appearance rate constant time-activity: K1). With cardiac imaging gammagraphies 99mTc-isonitrile- single-photon emission computed tomography pre and post treatment after to calculating myocardium at risk, salvage and relationship. Results In patients treated with fibrinolysis, the salvage myocardium was higher (8.3% vs 3.0%; p < 0.05). Considering that an improvement in perfusion defect (salvaged myocardium/myocardium at risk) higher than 30% can be viewed as an effective reperfusion, we can see that the percentage in the group treated with fibrinolysis being 45.8%, and the percentage in the group under conventional treatment being just 6.7%. Patients with acute myocardial infarction treated with fibrinolysis show much shorter start of rise-peak time and pain-peak time, all this with very significant differences for the creatin kinase (p < 0.0001) as well as for the MB (p < 0.001). Patients with reperfusion show a rapid increase in activity enzymatic, as demostred by the pain-peak time variable and the appearance rate constant time-activity (K1), with very significant differences in the latter (p < 0.0001). In relation with gammgraphy, values of K1 higher or equal to 0.19 for the creatin kinase and 0.14 for the MB isoform, achieved a sensibility of 83% and 91%, and a specificity of 85% and 80% respectively, to asses reperfusion. Conclusion We think that cardiac imaging gammagraphy with isonitriles as well as as determination of the appearance rate enzymatic constant time-activity, can be useful in monitoring treatment with fibrinolysis in infarction patients. New studies are needed to assess these same aspects, with a lesser number of enzymatic determinations.
    Revista Espa de Cardiologia 01/1998; 51(9):740–749. DOI:10.1016/S0300-8932(98)74817-1 · 3.34 Impact Factor
  • M I Ostabal, M A Suárez Pinilla, C Sanz Sebastián, A Millastre
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    ABSTRACT: We realized a retrospective study of all the patients who developed a nosocomial meningitis after to admitted to the Intensive Care Unit of our hospital, during the last five years. Nosocomial meningitis was found in 3.29% of the neurologic patients. The most frequent causes of the meningitis was the external ventricular drainage (14.8%), post-neurosurgical (0.8%) and head injury (0.0007%). The causative bacterias were stafilococo, S. pneumoniae, K. pneunomiae and P. aeruginosa. The mortality was of the 39.06%.
    Revista de neurologia 04/1996; 24(127):265-7. · 0.93 Impact Factor
  • Medicina Clínica 06/1995; 104(18):717-8. · 1.25 Impact Factor
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    ABSTRACT: In the last five year, 198 critic patients developed acute renal failure, requiring hemodialysis in the hospital. We realized a descriptive study and analyzed the factors that were statistically associated with higher mortality: a surgical etiology, clinic criteria for the inicial of hemodialysis, respiratory failure, hemodynamic inestability, hepatic insufficciency, disseminated intravascular coagulacion and oliguric or anuria. The sepsis and the cardiorrespiratory complications were the cause of mortality most important. The 14% of the surviving requiring continue in the programs of hemodyalisis.
    Anales de medicina interna (Madrid, Spain: 1984) 01/1995; 11(12):584-7.
  • Revista Espa de Cardiologia 02/1983; 36(5):383-90. · 3.34 Impact Factor
  • Revista Clínica Española 10/1980; 158(6):289-95. · 1.31 Impact Factor
  • Revista Clínica Española 05/1980; 157(1):7-14. · 1.31 Impact Factor
  • Revista Clínica Española 02/1980; 156(2):85-92. · 1.31 Impact Factor