[Study of arterial blood gases in liver cirrhosis with and without ascites]. / Estudio de la gasometría arterial en cirrosis hepática con y sin ascitis.

OBJECTIVE: The study of the disturbances of arterial gases and the changes in the arterial pH which are present in patients with liver cirrhosis and ascites and their modification after the disappearance of ascites by treatment. EXPERIMENTAL DESIGN: Open study,with protocol and prospective, to evaluate the changes in measurement of the arterial gases and acid-base, parameters in matching groups of patients. PATIENTS: We include 24 patients, 15 males and 9 females, without preliminary or cardio-respiratory pathology age range between 37 and 77 years, average of 56.8 years, all of them diagnosed of liver cirrhosis of different etiologies and with important ascites. All of them finished the study. RESULTS: In patients with liver cirrhosis and ascites a fall in the PaO2 and in the PaCO2 was demonstrated the pH in the upper limit of the normality compatible with hypoxemia and respiratory alkalosis. After the disappearance of the ascites, a significant improvement in the PaO2 (p < 0.05), without any changes in the PaCO2 and pH values was apparent. CONCLUSIONS: In patients with liver cirrhosis, with or without ascites, hyperventilation is present, that can be multifactorial in origin, but which really has an unknown cause. We have found no relationship with the circulating levels of progesterone.

[Influence of liver cirrhosis with and without ascites on ventilatory mechanics]. / Influencia de la cirrosis hepática con y sin ascitis sobre la mecánica ventilatoria.

BACKGROUND: The thoracic cavity plays an important role in the mechanical ventilatory function, and the alteration of some of its structures, such as those which occur in decompensated cirrhosis of the liver, for example the presence of ascites and muscle atrophy, directly influence its normal function. METHODS: In the present study we have evaluated the ventilatory function and respiratory muscular tension by means of the calculation of volumes, flows and resistances of the airways, and also the maximum inspiratory and expiratory pressures (Pimax, Pemax). PATIENTS: One hundred patients with liver cirrhosis and ascites without associated respiratory illness, mean age 57 +/- 15 years (range 32-80), were studied. We evaluated the respiratory function before and after the disappearance of the ascites. RESULTS: A restrictive pattern was evident, and various parameters were altered. The most affected being that of the reserve expiratory volume. No associated bronchial obstruction was observed. Respiratory muscular tension was decreased in both the Pimax and the Pemax. With the disappearance of the ascites we found an improvement in the affected parameters, but this did not reach normality. CONCLUSION: In liver cirrhosis associated with ascites, the most common respiratory pattern, is a decrease in ventilatory function of a restrictive type, and also a decrease in the respiratory muscular tension. These alterations improve after the resolution of the ascites.

[Immunity and malnutrition in alcoholic liver diseases]. / Inmunidad y malnutrición en hepatopatías alcohólicas.

Assessment of immunity was performed in 150 patients with alcoholic liver disease (15 steatosis, 30 hepatitis and 105 cirrhosis: 34 in grade A, 34 in grade B and 37 in grade C, according to Child-Pugh classification). This assessment was based on the total lymphocyte count and a delayed hypersensitivity skin multiple test. Likewise, nutritional status of patients was studied using anthropometric and biochemical parameters (triceps skinfold thickness, arm muscle circumference and serum albumin). The association between alcoholic liver disease, malnutrition and immunity was analyzed. The results show that lymphopenia and disorders in cell-mediate immunity were more common in those patients with cirrhosis, increasing the number of anergic patients while the degree of hepatocellular insufficiency worsens (8.8% in grade A, 11.8% in grade B and 32.4% in grade C). Although there where significantly more alterations of delayed cutaneous hypersensitivity in cirrhotics with malnutrition (hypoergy: 55.2% and anergy: 37.9%) than in those well nourished (hypoergy: 23.7% and anergy: 10.5%, p < 0.01), lymphopenia didn't show differences between these groups. We think that immunity mus'nt be considered a parameter in nutritional assessment.

[Prognosis of patients with irritable intestine syndrome. A prospective study with 1 year follow-up]. / Pronóstico de los pacientes con síndrome del intestino irritable. Estudio prospectivo con seguimiento de un año.

An analysis was made of the prognosis over a one-year follow-up period of a consecutive series of 86 out patients with irritable bowel syndrome (SII) who were treated randomly with an antispasmodic (otilonium) or a tranquilizer (clobazam), and the existence of factors, mainly psychological, that could worsen it was determined with the Zung anxiety test and the Hamilton depression scale. We confirmed that irritable intestine syndrome is a chronic disease, with a mean course of 13 +/- 12.5 years at the time of consultation. A large proportion of patients had permanent problems (58.1%) and did not experience important changes in the intensity of symptoms throughout evolution (68.6%). Although most improved initially with the treatment instated (76.7%), the improvement was rarely complete (11.8%). A year after beginning treatment, 61.6% were the same or worse than before the index consultation. In the group of patients with a good course, the proportion of those that correctly followed medical treatment and of those who had experienced more or less lengthy asymptomatic periods before consultation was significantly larger. In the group of patients with poor evolution, the scores on the Zung anxiety test and Hamilton depression scale were significantly higher than in those who evolved favorably. Neither consultation of a specialist nor the treatment used in this study seem to have contributed to an evident improvement in the prognosis.