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A Ordóñez

Publications and source records attributed to A Ordóñez.

At least 19 recordsLinked to original sources
PubMed2006

Is it possible to reduce the number of endomyocardial biopsies with new immunosuppressive drugs?

INTRODUCTION: Using previous immunosuppressive regimens the considerable number of rejections of heart transplantations required routine surveillance myocardial biopsies, particularly during the early months. More effective immunosuppressive regimens would probably allow routine biopsies to be reduced. Our objectives were to assess the incidence of and the time to rejection with a new immunosuppressive protocol, considering the possibility of reducing the number of routine biopsies. MATERIALS AND METHODS: We undertook a retrospective study of patients who had undergone heart transplantation from January 2002 to August 2005 and who received induction therapy with Daclizumab (two doses) and maintenance therapy with tacrolimus + mycophenolate + low doses of steroids. RESULTS: Among 42 patients, 13 (31%) showed myocardial rejection in the first 3 months. All episodes were grade 3A and none had hemodynamic consequences. After 3 months, three patients (7.1%) experienced 3A rejection and 1 (2.4%), grade 4 acute rejection after ceasing medical treatment. Each episode of rejection was predictable, either owing to reduction in immunosuppression therapy or to a previous history of rejection. CONCLUSIONS: The majority of rejection episodes occur in the first 3 months posttransplantation. After that time, the incidence of rejection is less and clinically predictable. Therefore, surveillance biopsies should be limited to the first 3 months, and performed later either in symptomatic patients (with a history of previous rejection) or in those whose immunosuppressive therapy needs to be reduced.

Biopsy↗
PubMed2006

Combination therapy with sildenafil and bosentan reverts severe pulmonary hypertension and allows heart transplantation: case report.

INTRODUCTION: Severe pulmonary hypertension with no response to vasodilators on an acute hemodynamic study is a contraindication to cardiac transplantation. The development of oral pulmonary vasodilators improves the prognosis in these patients. We present the case of a patient whose admission to the waiting list for cardiac transplantation was possible after 6 months of combination therapy with Sildenafil and Bosentan. CASE REPORT: The patient was a 50-year-old man with severe dilated alcohol-induced cardiomyopathy. A pretransplantation study, including a right hemodynamic analysis, revealed irreversible pulmonary hypertension, with 59 mm Hg mean pulmonary artery pressure and 6.4 Wood IU pulmonary vascular resistance, with no response to acute vasodilators with nitric oxide or prostacyclin. Initially, heart transplantation was not possible and the patient started treatment with oral Sildenafil. After 6 months there was no improvement in echocardiographic or hemodynamic parameters, and combination therapy with Bosentan was started. With the combination therapy, the patient progressively improved clinically and hemodynamically, the pressures becoming normal at the sixth month, at which time he was included on the waiting list for a heart transplantation. Eight months later he received a graft with a good posttransplantation course, no right ventricular failure in the acute phase, and absence of pulmonary hypertension on echocardiogrphic and invasive studies. CONCLUSION: Combinations of an oral pulmonary vasodilator with diverse action mechanisms may represent an alternative for patients with irreversible pulmonary hypertension who do not respond to monotherapy.

Antihypertensive Agents↗
PubMed2006

Sirolimus experience in heart transplantation.

INTRODUCTION: Sirolimus is a potent, nonnephrotoxic immunosuppressant with antiproliferative activity in nonimmune cells. Recent data support the conversion in late renal failure secondary to calcineurin inhibitors (CNIs), with limited experience in de novo regimens in patients with predictive factors of postoperative renal impairment. OBJECTIVE: We evaluated our experience of sirolimus-based immunosuppression administered to 25 heart transplant recipients. METHODS: A retrospective analysis of 25 heart transplant recipients who received sirolimus included 17 conversions due to late CNI-related chronic renal dysfunction, six patients with a de novo regimen, and two patients who developed posttransplant pulmonary neoplasms. The conversion from CNI to sirolimus was started with 2 mg, with an average time after transplantation of 78 +/- 43 months and a mean baseline serum creatinine level of 2.1 +/- 0.45 mg/dL. The mean clinical follow-up was 17 +/- 9 months postconversion, and included echocardiography and laboratory studies. In the de novo group successive endomyocardial biopsies were performed during the first semester. RESULTS: Serum creatinine fell from 2.1 +/- 0.45 mg/dL to 1.8 +/- 0.51 mg/dL (P = .012). Mean sirolimus levels were 15 +/- 9 ng/mL (doses 2.2 +/- 0.4 mg). This improvement continued until 3 months (creatinine 1.5 +/- 0.35 P < .01)/sirolimus levels 11.7 +/- 5 ng/mL [1.9 +/- 0.7 mg]), with maintenance at 6 months (1.58 +/- 0.3 mg/dL/14 +/- 4 ng/mL [1.85 +/- 0.7 mg]) and 1-year postconversion (1.53 +/- 0.39 mg/dL; P = .019/10.7 +/- 2.5 ng/mL [1.5 +/- 0.7 mg]). De novo, after a mean follow-up of 13 months (range 3 to 35), sirolimus appeared to increase the incidence of a moderate histological grade of rejection without hemodynamic compromise. Side effects were common (63%), including peripheral edema, skin eruptions, and pericardial effusion. Only one patient discontinued treatment, due to intestinal intolerance. Four patients died during follow-up: two because of lung neoplasms and two because of progressive graft vessel disease. CONCLUSION: Sirolimus improved late CNI-related chronic renal dysfunction. Kidney function was preserved using a de novo CNI-free immunosuppressive regimen for recent cardiac transplant recipients.

Adult↗
PubMed2006

Infections in cardiac transplant recipients: clinical and microbiological characteristics and consequences.

INTRODUCTION: Infections are one of the main complications that cause morbidity and mortality in cardiac transplant recipients. We sought to establish the incidence of infections, identify the predisposing factors and determine their consequences. PATIENTS: A prospective study of 30 patients who received cardiac transplantations in our hospital from July 2003 to May 2005. RESULTS: Of the 30 transplant recipients, 93.3% were men (average age, 48 years); the average age of the women was 53 years. The incidence of infection was 70%: 21 episodes of infection. The main clinical symptoms were bacteriemia (28%), pneumonia (19%), and surgical wound infections (14%). The etiology of the infection, as established in 12 cases (57%), was bacterial (66%), viral (25%), or fungal (9%). The most common microorganisms were cytomegalovirus and coagulase-negative staphylococcus. None of the donors had a history of infection. There was a higher frequency of serious complications, such as renal failure (12.9%), respiratory insufficiency (9.6%), and multiorgan failure (9.6%) among patients with versus without infections (P < .05). The 1-year survival rate of patients with infections was similar to that of patients with no infections (83% vs 88%, P = NS). CONCLUSIONS: The incidence of infections was 70%. Bacteremia, pneumonia, and surgical wound infections occurred most frequently. Cytomegalovirus and coagulase-negative staphylococcus were the most frequent microorganisms. Patients with infections had the most serious complications, but their survival rate was similar to that of patients free of this complication.

Bacteremia↗
PubMed2006

[Application of European Model of Quality in Oncology].

OBJECTIVES: To assess a Medical Oncology Service using a healthcare setting version of the European Foundation for Quality Management (EFQM). To use this tool as training, an opportunity for participation and the base for checking the strategic planning. MATERIAL AND METHODS: We use the EFQM Model adapted to healthcare centers EFQM as the evaluation instrument. It maintains scores and weights, only modifying vocabulary and simplifying that not relevant to the healthcare setting. Exercise was done with the "proform" system. Its advantage is that it uses standard formulas combined with open areas for discussion and presentation of ideas. It uses group sessions for agreement. STUDY PERIOD: 2001 Management. Evaluation was performed in the second term of 2002. RESULTS: 58 strengths and 37 areas of improvement were identified. These elements were used to create a strategic document, which served as the basis for future improvement. The score reached was used as an internal reference to monitor service quality evolution. CONCLUSIONS: The EFQM model is applicable in a Medical Oncology Service, although it would be desirable to have standardized quality indicators that permit a more objective and specific evaluation.

Europe↗
PubMed2005

Biweekly regimen of cisplatin, gemcitabine and vinorelbine for advanced non-small-cell lung cancer.

PURPOSE: Improving chemotherapeutic efficacy in non-small cell lung cancer (NSCLC) will require the development of new strategies to better use currently available agents. To assess the efficacy and safety of a biweekly regimen of cisplatin, gemcitabine and vinorelbine for advanced non-small-cell lung cancer. METHODS: Patients with selected stage IIIb (pleural effusion)/stage IV NSCLC, performance status of 0-2 and normal organ function were eligible. Treatment consisted of cisplatin 100 mg/m(2) on day 1 plus gemcitabine, 1,000 mg/m(2) and vinorelbine 25 mg/m(2) on days 1 and 15 every 28 days. RESULTS: Of the 40 patients enrolled and assessable for response, there were five (12.5%) with confirmed complete response and 14 (35%) with a confirmed partial response for an overall response rate of 47.5%. Nine patients had stable disease while 12 (30%) progressed. Median progression-free survival and overall survival for all patients were 6.3 and 11.1 months, respectively. Toxicity was principally hematologic, with grade 3-4 neutropenia in 30%, and grade 3-4 nausea/vomiting in 22.5%. There were no treatment-related deaths. CONCLUSIONS: The biweekly regimen of cisplatin, gemcitabine and vinorelbine is associated with a high rate of response, lesser toxicity than other three-drug regimens and no benefit of survival. Therefore, the regimen under study may be an appealing alternative when considering other treatment modalities for advanced lung cancer, such as neoadjuvant therapy.

Adult↗
PubMed2005

Release of toxic metals and metalloids from Los Rueldos mercury mine (Asturias, Spain).

The abandoned mercury mining works of "Los Rueldos" are located 20 km from Oviedo, along the northwestern border of the Asturian Central Coal Basin, in an area with intense tectonization. Hg mainly appears as cinnabar, but occasionally metacinnabar and native Hg are present; associated with Hg ore appear As-rich minerals (arsenopyrite, As-rich pyrite, realgar and scorodite). In the spoil heap, Hg content ranges from 14 to 2224 mg kg(-1), and As from 4746 to 62,196 mg kg(-1). Mine drainage and spoil heap leachates show acidic conditions (pH: 2.43-2.50), 2900-4600 mg l(-1) sulphate, 1.4-9.2 mg l(-1) As, 0.03-0.48 mg l(-1) Pb, and 3.6-14 microg l(-1) Hg. According to the analytical data and characteristics of the site, the application of corrective measurements to avoid the dispersion of contaminants in the environment must be considered.

Journal Article↗
PubMed2005

Sirolimus improves renal function in cardiac transplantation.

In kidney and liver transplantation, sirolimus therapy has been shown to be comparable to cyclosporine in a head-to-head comparison, but it results in better preservation of renal reserve. In heart transplantation, information about the use of sirolimus is limited. We present the results of the progressive conversion from cyclosporine to sirolimus in a series of 8 heart transplant patients in whom renal dysfunction developed. The baseline creatinine level was 2.4 +/- 0.5 mg/dL, and plasma levels of cyclosporine were within the therapeutic range. After the introduction of sirolimus, the creatinine level fell within the first month to 1.76 +/- 0.2 mg/dL, or mean decrease of 0.6 +/- 0.25 mg/dL (P < .05). After 3 +/- 2.2 months the improvement continued (1.69 +/- 0.2 mg/dL). In 1 patient sirolimus was withdrawn during the first 24 hours, because of gastric intolerance. No patient developed an opportunist infection, allograft rejection, or important hematologic disorder. We conclude that sirolimus appears to be effective in heart transplant patients to improve renal function.

Antibodies, Monoclonal↗
PubMed2005

Use of oral sildenafil in patients with irreversible pulmonary hypertension not eligible for heart transplantation.

Heart transplantation is contraindicated in patients with acute irreversible pulmonary hypertension (PH), but new drugs are opening up therapeutic possibilities. Sildenafil citrate is a nonselective pulmonary vasodilator that is being used in our hospital to treat several patients with PH and which has allowed the inclusion of 1 patient on the waiting list for heart transplantation. A 20-year-old man with Becker muscular dystrophy was diagnosed at the age of 19 years with dilated cardiomyopathy with severe pulmonary artery systolic pressure (PH = 60 mm Hg). A pretransplantation study, including a right hemodynamic analysis with an acute vasodilator test using intravenous epoprostenol, revealed the irreversible character of the PH. Inasmuch as the administration of dobutamine did not achieve an adequate reduction of PH, oral sildenafil was started (25 mg every 12 hours) as salvage therapy. An echocardiogram obtained 2 months after starting sildenafil therapy showed normal right cavities, previously dilated, as well as minimal protosystolic tricuspid regurgitation without PH. A new right hemodynamic study performed after 4 months showed a reduction in pulmonary vascular resistance, from 8 U to 3.5 U Woods. As a result, the patient has now been included on the waiting list for heart transplantation. The promising example of this patient confirms the necessity to carry out controlled trials to establish definitively the indications for the use of sildenafil in patients with irreversible PH.

Administration, Oral↗
PubMed2005

Comparative study of muromonab-CD3 (OKT3) versus daclizumab (Zenapax) in cardiac transplantation at our center.

Recent studies support the addition of new immunosuppressive drugs as cytolytic induction therapy in cardiac transplantation. We carried out a comparative study comprising 52 patients who had undergone cardiac transplantation at our center. Thirty patients received muromonab-CD3 (OKT3, Janssen-Cilag, The Netherlands) as the induction therapy, whereas 22 patients received Daclizumab (Zenapax, Hoffman-La Roche, Nutley, NJ, USA) instead. All patients received cyclosporine or tacrolimus, mycophenolate, and steroids. Over an average follow-up period of 23.21 +/- 18 months, we analyzed retrospectively the incidence of grade > or = 3A biopsy-confirmed acute rejection episodes, the presence of infectious processes at 1 and 6 months, the occurrence of significant secondary effects, and the necessity to modify the immunosuppressive therapy during the follow-up. The results suggest that daclizumab is linked to a decreased incidence of grade > or = 3A biopsy-confirmed acute rejection and to a reduced necessity to modify the immunosuppressive therapy during the medium-term follow-up.

Antibodies, Monoclonal↗
PubMed2005

Myocardial preservation using Celsior: clinical results in high-risk cardiac transplantation.

Graft failure during the first few days posttransplantation remains one of the main unresolved complications. The objective of this study was to evaluate the influence of Celsior preservation solution on the incidence of early graft failure in high-risk cardiac transplant recipients. A retrospective study was carried out evaluating the cardiac transplants in 179 heart recipients. The patients were divided into 2 groups: (1) Celsior preservation solution (n = 37), and (2) Control solution (n = 142). To evaluate the efficacy of the Celsior solution, a subgroup of transplants from older donors or with ischemia times greater than 4 hours was compared with the other cases. The incidence of early graft failure was lower among the Celsior subgroups with longer ischemia times or of older donors compared with the control groups. We conclude that preservation with Celsior solution in cardiac transplantation is safe and effective. It even has advantages to reduce early graft failure compared with conventional solutions, a benefit that may be more evident in subgroups at high risk for myocardial dysfunction.

Disaccharides↗
PubMed2003

Distribution of heavy metals in the street dusts and soils of an industrial city in northern Spain.

This study characterizes the elemental composition of street dust and soils in Avilés (N. Spain), a medium-size city of approximately eighty thousand inhabitants, where industrial activities and traffic strongly affect heavy metal distribution. A total of 112 samples of street dust were collected within a 7-km(2) area, encompassing residential and industrial sites (ferrous and non-ferrous plants). Elevated geometric mean concentrations of zinc (4,892 microg x g(-1)), cadmium (22.3 microg x g(-1)), and mercury (2.56 microg x g(-1)) in street dust were found in samples located near industrial areas. Two types of anthropic influence were distinguishable: the first and most important one is that related to metallurgical activity and transportation of raw materials for local industries. Secondly, exhaust emissions from traffic are an important source of lead concentration in areas with high vehicular density (geometric mean: 514 microg x g(-1)). The zinc content in the dust samples decreased with the distance from a zinc smelter located in the northern part of the city. The same trend was found for other elements in association with zinc in the raw materials used by the smelter, such as cadmium and mercury. A simultaneous research campaign of urban soils, that involved the collection of 40 samples from a 10-km(2) area, revealed geometric mean concentrations of 376 microg x g(-1) Zn, 2.16 microg x g(-1) Cd, 0.57 microg x g(-1) Hg, and 149 microg x g(-1) Pb, and distribution patterns almost identical to those found for street dust.

Cities↗
PubMed2003

Characteristics and repercussion of varicella-zoster virus infection in cardiac transplant.

Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

Acyclovir↗
PubMed2003

Prevalence of sleep breathing disorders in outpatients on a heart transplant waiting list.

Sleep related periodic breathing with recurrent episodes of apnea and hypopnea is known to occur in patients with heart failure. We investigated the prevalence of sleep related breathing disorders (SRBD) in 14 outpatients on a heart transplant waiting list. All were younger than 60 years and had severe stable heart failure. Three patients (21%) exhibited 10 or more apneas and hypopneas per hour of sleep; these apneas and hypopneas were predominantly of the central type and occurred during Cheyne-Stokes respiration. There were no statistically significant differences between the apneic and non-apneic group in terms of age, left ventricular ejection fraction or pulmonary function tests. The group with SRBD had worse quality of life and less tolerance to exercise.

Adult↗