Papers by Andres Cardenas
Journal of Hepatology, 2015
Please cite this article as: Cárdenas, A., Riggio, O., Correction of hyponatremia in cirrhosis: T... more Please cite this article as: Cárdenas, A., Riggio, O., Correction of hyponatremia in cirrhosis: Treating more than a number!, Journal of Hepatology (2014), doi: http://dx.
Clinical Liver Disease, 2013
The American Journal of Gastroenterology, 2002
Current Gastroenterology Reports, 2002
Cirrhosis: A practical guide to management, 2015
ABSTRACT Bacterial infection becomes the leading cause of death in patients with cirrhosis. This ... more ABSTRACT Bacterial infection becomes the leading cause of death in patients with cirrhosis. This susceptibility is explained by the paradoxical association of an immune defect in the clearance of bacteria and an overexpression of pro-inflammatory mediators responsible of sepsis-related organ failure. Bacterial infections must be suspected and screened in front of all decompensations of cirrhosis. Spontaneous bacterial peritonitis (SBP) and urinary tract infection are the most frequent type followed by pneumonia, skin and soft tissue infection, spontaneous bacteremia, and catheter-related infections. The prompt initiation of an adequate antibiotherapy is the key point of the management. Broad use of long-term quinolones for prophylaxis and increase of invasive procedure contributes to the development of multiresistant bacteria. The choice of adequate empiric antibiotic becomes a challenge, particularly in nosocomial infections. The administration of intravenous albumin can prevent the development of organ failure at least in the case of SBP. Sepsis-related organ failures are associated with a very poor outcome in cirrhotic patients. Multiple prophylactic strategies are effective to prevent bacterial infection in high-risk cirrhotic patients.
Hyponatremia, 2013
ABSTRACT Hyponatremia is a common complication in patients with cirrhosis that is related to impa... more ABSTRACT Hyponatremia is a common complication in patients with cirrhosis that is related to impairment in the renal capacity to eliminate solute-free water. The main pathogenic factor associated with hyponatremia is a non-osmotic hypersecretion of vasopressin which acts in the V2-receptors in the renal collecting ducts. A decrease in serum sodium concentration is associated with an increased risk of hepatic encephalopathy. Hyponatremia is associated with poor prognosis in patients with cirrhosis. There is evidence that hyponatremia also represents a risk factor for liver transplantation, as it is associated with an increased frequency of complications and a decreased short-term survival after transplantation. Classical treatment of hyponatremia is based on fluid restriction, but is poorly effective. The current pharmacological approach to hyponatremia has advanced with vaptans, a new family of drugs which antagonize V2-receptors in the renal collecting ducts. Short-term treatment with vaptans is associated with an increase in serum sodium concentration and improvement in health-related quality of life. Nevertheless, information on the use of vaptans in cirrhosis is limited and further long-term studies are needed.
Chronic Liver Failure, 2010
Patients with cirrhosis frequently develop disturbances in body fluid regulation that result in a... more Patients with cirrhosis frequently develop disturbances in body fluid regulation that result in an increase in the volume of extracellular fluid which accumulates as ascites and/or edema (1).
American Journal of Gastroenterology, 2002
Journal of Hepatology, 2002
Alimentary Pharmacology & Therapeutics, 2004
Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume re... more Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2–3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5–8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1–2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5–10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic portosystemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation.
SUMMARY Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid v... more SUMMARY Patients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5-10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic porto- systemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation.
Gastrointestinal Endoscopy, 2007
Clavien/Medical Care of the Liver Transplant Patient, 2012
Journal of Hepatology, 2000
Sixty patients with rektory or recidivant ascites (Child-Pugh class B: 42, C: 18) were randomized... more Sixty patients with rektory or recidivant ascites (Child-Pugh class B: 42, C: 18) were randomized to receive TIPS (29 pts) or large volume paracentesis (3 1 pts) and followed for 45 It 16 and 44 f 18 months, respectively. In patients in whom pamcentesis failed (i.e., inability to remove the ascites or need for more than 1 large volume paracentesis per week) the TIPS was offered. Re.&s. The shunts were successllly placed in all but one patient. ParacentesisfailedinlOpatientswhorsceivedTIPS5.5f4 months a&r randomization. The 1 and Z-year intention-to-treat probability of survival was 69 and 58 percent in the shunted and 52 and 32 percent in the paracentesis patients (P = 0.11). A multivariate &x's proportional hazard model including relevant pre&eatment covariables showed an independent significant improvement of survival by the TIPS Q = 0.023). Complete response (absence of ascites) was achieved in 87 percent of the shunted and 32 percent of the paracentesis patients (P = 0.006). Both groups had a similar occurrence of hepatic encephalopathy. Conclusions. Our study recommends the use of the transjugular intrahepatic portosystemic shunt for treatment of refractory and recidivant ascites. This treatment prolongs survival and relieves from ascites.
McDonald/Evidence-Based Gastroenterology and Hepatology, 2010
Gastrointestinal Endoscopy - GASTROINTEST ENDOSCOP, 2007
Clavien/Medical Care of the Liver Transplant Patient, 2012
Clinics in Liver Disease, 2014
Obesity Surgery, 2008
Background Anastomotic strictures after bariatric surgery are a frequent complication that requir... more Background Anastomotic strictures after bariatric surgery are a frequent complication that requires endoscopic management, but the optimal technique for dilation remains to be determined. The aim of this study was to evaluate the safety and efficacy of dilation with Savary–Gilliard bougies (SGB) in morbidly obese patients treated with laparoscopic Roux-en-Y gastric bypass (RYGBP). Patients and Methods Retrospective review of prospectively collected data from a series of 474 consecutive patients with laparoscopic bariatric surgery. Four-hundred twenty four of these patients (90%) underwent a laparoscopic RYGBP. A total of 24 patients were referred for anastomotic stricture dilation with SGB from January 1998 to December 2006. Results A total of 24/424 patients (6%) developed a stricture that was successfully dilated with SGB. Patients were 17 females (71%) and seven males (29%) with a mean age of 41 ± 11 years (range 24–63) and a mean BMI of 48 ± 6 (range 40–69). The time between RYGBP and the appearance of stricture-related symptoms ranged from 29 to 154 days (mean, 69 days). The mean number of dilations was 1.6 ± 0.6. The majority of patients required one (n = 11; 46%) or two (n = 12; 50%) dilations and only one patient required three dilations. During the initial dilation, a final diameter of 11 ± 1.7 mm (range 7–12.8 mm) was achieved. In all cases, there was complete resolution of symptoms. There were no complications. Conclusions Dilation with SGB is an effective, safe, and durable method for managing anastomotic strictures after laparoscopic RYGBP.
The American Journal of Gastroenterology, 2007
In clinical medicine, several tests that are commonly performed (i.e., physical exams, x-rays, or... more In clinical medicine, several tests that are commonly performed (i.e., physical exams, x-rays, or endoscopy) rely on a degree of subjective interpretation by observers. A limitation for clinicians is the concept of agreement between two observers that is present and beyond chance. Clinical decisions based on the presence or absence of a finding in a diagnostic test (i.e., size of esophageal varices on endoscopy) are commonly reached depending on the agreement between observers. Observations that measure the agreement between two or more observers should include a formula that takes into account the fact that observers will sometimes agree or disagree by chance. The kappa statistic corrects for this chance agreement and lets the reader know how much of the agreement beyond chance the reviewers achieve. Kappa is widely used to measure interobserver variability, that is, how often two or more observers agree in their interpretations. A kappa of 1 indicates perfect agreement, whereas a kappa of 0 indicates agreement equivalent to chance. A limitation of kappa is that it is affected by the prevalence of the finding under observation.
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Papers by Andres Cardenas