Browsing by Author "Martinez, Nicolas"

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    Embolization of spontaneous portosystemic shunts as treatment for refractory hepatic encephalopathy
    (2022) Benitez, Carlos; Munoz, Ana; Poniachik, Jaime; Ramirez, Felipe; Munoz, Claudia; Cermenati, Tomas; Martinez, Nicolas; Diaz, Pia; Meneses, Luis
    Background: Hepatic encephalopathy (HE) is a common complication of cirrhosis associated with a reduced survival. The presence of high-flux spontaneous porto-systemic shunts can induce HE even in patients with preserved liver function. Aim: To evaluate the effect of spontaneous porto-systemic shunt embolization (SPSE) over HE and its long-term evolution. Material and Methods: Retrospective analysis of 11 patients (91% males) with severe HE non-responsive to medical treatment in whom a SPSE was performed. The grade of HE (employing West Haven score), survival, MELD and Child-Pugh score, ammonia levels, degree of disability (employing the modified Rankin scale (mRs)) were evaluated before and at thirty days after procedure. Results: The most common etiology found was non-alcoholic steatohepatitis (63.6%). A reduction of at least two score points of HE was observed in all patients after thirty days. There was a significant reduction on median (IQR) West Haven score from 3 (2-3) at baseline to 1 (0-1) after the procedure (p < 0.01). Twelve months survival was 63.6%. There was a decrease in median ammonia level from 106.5 (79-165) (ug/dL) to 56 (43-61) after SPSE (p = 0.006). The median mRS score before and after the procedure was 3 (3-5) and 1 (1-2.5), respectively (p < 0.01). Conclusions: According to our experience, SPSE is a feasible and effective alternative to improve HE and functionality of patients with refractory EH.
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    In-hospital mortality after ST-segment elevation myocardial infarction according to reperfusion therapy
    (2008) Prieto, Juan Carlos; Sanhueza, Consuelo; Martinez, Nicolas; Nazzala, Carolina; Corbalan, Ramon; Cavada, Gabriel; Lanas, Fernando; Bartolucci, Jorge; Campos, Pabla
    Background: Primary angioplasty is considered the best repefusion therapy in The treatment of ST-segment elevation))myocardial infarction (STEMI). However, thrombolysis the reperfusion, method most commonly used, due to its wide availability reduced costs and case of administration. Aim To compare in-hospital mortality, in STEMI patients according to repefusion therapy. Material and Methods. Patients admitted to Chilean hospitals participating in the GEMI network,from. 2001 to 2005, with STEMI were included. They were divided in three groups: a) treated with thrombolytics, b) treated with primary angioplasty, c) without reperfusion procedure. In-hospital mortality according to gender, was analized in each group, using a logistic regression method, to assess risk factors associated with mortality. Results: We included 3,255 patients. Global mortality was 9.9% (75% in men and 16.7% in women, p < 0.001). Mortality in patients treated with thrombolytics, was 10.2% (76% in men and 18.7% in women, p < 0.01). The figure for patients treated with primary angioplasty, was 4.7% (2.5% in men and 13% in women, p < 0.01), and in patients without reperfusion, was 11.6% (9.8% in men and in 15.4% women, p < 0.01). In each group women were older, had a higher prevalence of hypertension and a higher percentage of Killip 3-4 infarctions. Logistic regression showed that angioplasty) compared with no repefusion, was associated with a reduced mortality only in men. The use of thrombolytics in women was associated with a higher mortality. Conclusions: Primary angioplasty was the reperfusion therapy associated to the lower mortality in STEMI. Use of thrombolytics in women was associated with a higher mortality rate than in non reperfused women