Effects of long-term propranolol and octreotide on postprandial hemodynamics in cirrhosis: a randomized, controlled trial.

BACKGROUND & AIMS: Postprandial increases in portal pressure may influence esophageal variceal rupture. The effects of chronic propranolol and octreotide (100 and 200 microg subcutaneously in a single dose) on postprandial hemodynamics were evaluated. METHODS: FIRST STUDY: 36 cirrhotic patients were studied at baseline and 30 and 60 minutes after a standard meal and then treated with propranolol (139 +/- 9 mg/d during 39 +/- 2 days). SECOND STUDY: After baseline measurements, patients were randomized into 3 groups: (1) placebo, (2) octreotide (100 microg), or (3) octreotide (200 microg) (n = 12 for each group). Thirty minutes postinjection a new baseline was established and measurements were repeated 30 and 60 minutes after the meal. RESULTS: First study: Baseline portal pressure was 18.1 +/- 1.2 mm Hg, 30 and 60 minutes after the meal it was 21.5 +/- 0.8 mm Hg and 20.5 +/- 0.8 mm Hg, respectively (both P < 0.01 vs. baseline). Cardiac index (CI) was 4.5 +/- 0.2, 4.8 +/- 0.2, and 4.9 +/- 0.2 L x min(-1) x m(-2), respectively (both P < 0.05 vs. baseline). Peripheral vascular resistance was 1012 +/- 56, 902 +/- 51 (P = NS), and 884 +/- 49 dynes x sec x cm(-5) (P< 0.05 vs. baseline), respectively. Second study: Propranolol and placebo did not blunt postprandial increase in portal pressure. Octreotide (100 microg) partially ameliorated postprandial increase in portal pressure. Octreotide (200 microg) significantly enhanced the portal hypotensive effect of propranolol and blunted the postprandial increase in portal pressure. CONCLUSIONS: Octreotide blunts postprandial increase in portal pressure not prevented by long-term propranolol administration.

Factores de riesgo y factores pronósticos en el accidente cerebrovascular hemorrágico (ACVH) en nuestra población: análisis estadístico / Risk factors and prognostic factors of intracerebral hemorrhages: a statistical analysis

Se realizó un estudio estadístico retrospectivo en pacientes con ACVH tratando de determinar factores de riesgo y factores pronósticos de esta enfermedad que permitan tomar medidas de prevención adecuadas para nuestra población. Se estudiaron 91 pacientes con ACVH primario divididos en dos grupos, hipertensos (HT) y no hipertensos (no HT), en relación al registro de presión arterial de ingreso. Se analizaron diferentes parámetros: sexo, edad, antecedentes de hipertensión arterial e ingesta de medicación antihipertensiva, localización del hematoma, score de Glasgow, tiempo transcurrido entre la aparición de los síntomas y la consulta a nuestra institución, evolución, sobrevida, valores de presión arterial sistólica y diastólica de ingreso. Se analizaron los diferentes parámetros entre sí para cada grupo en particular y luego se correlacionaron entre HT y no HT. Se establecieron factores de riesgo (HT, sexo, edad) y factores pronósticos (localización del hematoma, Glasgow) estadísticamente significativos en pacientes con ACVH