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BACKGROUND: Pulmonary arterial hypertension (PAH) may complicate both portal hypertension (Po-PAH) and HIV infection (HIV-PAH). These two conditions, however, frequently coexist in the same patient (HIV/Po-PAH). We evaluated clinical, functional, hemodynamic characteristics and prognostic parameters of these three groups of patients. METHODS: We included patients with Po-PAH, HIV-PAH and HIV/Po-PAH referred to a single center. We compared clinical, functional and hemodynamic parameters, severity of liver disease [Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease-Na (MELD-Na) scores], CD4 count and highly active antiretroviral therapy (HAART) administration. Prognostic variables were identified through Cox-regression analysis. RESULTS: Patients with Po-PAH (n = 128) were the oldest, patients with HIV-PAH (n = 41) had the worst hemodynamic profile and patients with HIV/Po-PAH (n = 35) had the best exercise capacity. Independent predictors of mortality were age and CTP score for Po-PAH, HAART administration for HIV-PAH, MELD-Na score and hepatic venous-portal gradient for HIV/Po-PAH. CONCLUSIONS: Patients with HIV/Po-PAH are younger and have a better exercise capacity than patients with Po-PAH, have a better exercise capacity and hemodynamic profile compared to patients with HIV-PAH, and their prognosis seems to be related to the hepatic disease rather than to HIV infection. The prognosis of patients with Po-PAH and HIV-PAH seems to be related to the underlying disease.
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BACKGROUND: Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a substantial proportion of patients deemed not operable in whom other treatment strategies are available: medical therapy and balloon pulmonary angioplasty (BPA). We aimed to compare different CTEPH treatment strategies effect in a real-world setting. METHODS: All patients with CTEPH referred to our centre were included. We compare the short-term clinical, functional, exercise and haemodynamic effect of medical therapy (irrespective of subsequent treatment strategies), PEA and BPA (irrespective of previous/subsequent treatment strategies); we also describe the long-term outcome of the different patient groups. RESULTS: We included 467 patients (39% were treated only with medical therapy, 43% underwent PEA, 13% underwent BPA and 5% were not treated with any therapy). Patients treated only with medical therapy were the oldest; compared to patients undergoing PEA, they had a lower exercise capacity, a higher risk profile and gained a lower haemodynamic, functional and survival benefit from the treatment. Patients undergoing BPA had a lower haemodynamic improvement but a comparable functional, exercise and risk improvement and a similar survival compared to patients undergoing PEA; their survival is anyway better than patients undergoing only medical treatment. Untreated historical control patients had the worst survival. CONCLUSIONS: We confirm the superiority of PEA compared to any alternative treatment in CTEPH patients and we observe that BPA, in patients deemed not operable or with persistent/recurrent PH after PEA, leads to a better outcome than medical therapy alone.
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El carcinoma de la vesícula biliar sigue siendo una enfermedad infrecuente a pesar del notorio incremento de la patología del órgano en los últimos veinte años. En nuestro servicio fueron intervenidos 4.023 pacientes por afecciones de la vesícula biliar, con una incidencia del 0,22% inferior a la bibliografía consultada. La totalidad de los casos se dieron en el sexo femenino, siendo más notorio de como se exhibe en las estadísticas mundiales. La alta tasa de mortalidad, así como el escaso tiempo de sobrevida coincide con lo mostrado por otros autores.
Gallbladder carcinoma is still a rare disease despite the noticeable increase in the pathology of this organ in the last twenty years. At our Hospital, 4,023 patients underwent gallbladder surgery, with an incidence of 0.22 per cent, lower than the incidence found in the literature reviewed. All cases occurred in females, quite different from the facts shown in global statistics. The high mortality rate and the limited survival time match the numbers shown by other authors.
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Humanos , Neoplasias da Vesícula Biliar , Carcinoma , Colelitíase , Vesícula BiliarRESUMO
El control de la tensión arterial y del volumen del liquido extracelular (VLEC) es un objetivo primordial de la hemodiálisis. La concentración de Na+ en el baño de diálisis es una herramienta que puede utilizarse para conseguir este objetivo. Objetivo: Corroborar si la reducción de Na+ en el baño de diálisis, logra reducir la ganancia de peso inter diálisis. Resultados: Se realizó un estudio prospectivo, longitudinal y experimental, tomando 3 períodos estacionales idénticos, de 3 meses cada uno (diciembre-enero- febrero), durante 3 años consecutivos. Analizado el período 2008/2009 (Na+: 136 mEq/L) respecto del período 2006/2007 (Na+:138 mEq/L), se observó una reducción neta global promedio de 530g (p < 0.003) en la GPPI. Realizando el mismo análisis del período 2007/2008 (Na+ : 37 mEq/L ) respecto del período 2006/2007 (Na+ :138 mEq/L), se observó una reducción neta global promedio de 616g (p < 0.015). Conclusión: Se observó una reducción franca y significativa en la ganancia de peso promedio inter diálisis con la reducción de 2 mEq/L en el baño de diálisis, Con la reducción de 1 mEq/L se observó una reducción promedio similar aunque con una mayor variabilidad entre pacientes.
Introduction: Blood pressure and extracellular fluid (ECF) volume control is a major objective in hemodialysis. Na+ concentration in the dialysis bath is a tool that can be used in order to meet this objective. Objective: To check if Na+ reduction in the dialysis bath can reduce interdialysis weight gain. Results: A prospective, longitudinal, and experimental study considering 3 identical seasonal periods of 3 months each (December-January-February) was carried out during 3 consecutive years. When analyzing the 2008/2009 period (Na+: 136 mEq/L) with regard to the 2006/2007 period (Na+: 138 mEq/L), an average global net reduction of 530g (p < 0.003) was observed in the interdialysis average weight gain. When performing the same analysis for the 2007/2008 period (Na+ : 137 mEq/L) with regard to the 2006/2007 period (Na+: 138 mEq/L), an average global net reduction of 616g (p < 0.015) was observed. Conclusion: A clear and significant reduction was observed in the inter-dialysis average weight gain with the 2 mEq/L reduction in the dialysis bath. With the 1 mEq/ L reduction, a similar average reduction was observed although it showed greater inter-patient variability.
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Humanos , Diálise Renal , Sódio , Diálise , Pressão Arterial , Líquido IntracelularRESUMO
Estudio analítico, longitudinal y prospectivo de tres años de duración. Se incluyen 79 fístulas arteriovenosas y se estudian las variables edad, sexo, patología de base, antecedentes de DBT/HTA, tiempo en dialisis, tipo de FAV, semiología, tiempo de maduración y tiempo de duración...