Is MELD useful in evaluating the surgical risk in liver transplantation candidates?
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Adult↗
Biomedical subjects
A de la Fuente
Publications and source records attributed to A de la Fuente.
Intact Medtronic and Carpentier Edwards S.A.V.: clinical and hemodynamic outcomes over 13 years.
UNLABELLED: We report on 215 consecutive patients with isolated aortic replacement of which 91 received an Intact Medtronic (IM) prosthesis and 124 a Carpentier Edwards SAV. (CE). More than 50% of patients were over 70 years old. Follow-up was complete for 95% of patients. Mean follow-up was 6.04 years (16 days-13 years); a total of 1244 patient-years (IM 6.61years, 590 patient-years, CE 5.95 years, 670 patient-years). RESULTS: the following results are expressed for IM and CE groups respectively. Early mortality: 3.3% and 8.13%. Late mortality: 23 and 27 patients. Survival at 13 years: 53.31+/-7.63% and 47.47+/-7.9%. Major thromboembolism: 0.34% and 0.30% per patient-year. SVD: 0.16% and 0.14% per patient-year. Endocarditis: 0.33% and 0.29%. Re-operation: 0.5% and 0.44%. Over 95% of patients are re-operation free at 13 years. CONCLUSION: Intact and Carpentier valves had similar durability and clinical/hemodynamic results. Both have proved excellent aortic valve substitutes in elderly patients.
Adult↗
Transcription of the Escherichia coli dcw cluster: evidence for distal upstream transcripts being involved in the expression of the downstream ftsZ gene.
Escherichia coli strains VIP596 and VIP597 have been constructed to compare the amount of transcription of the ftsZ gene derived from proximal promoters in the ddlB-ftsZ region with that originating in the upstream regions of the dcw cluster. Both strains have in common a beta-galactosidase reporter fusion located at the ddlB locus, but differ in that VIP597 has a transcription terminator Omega interposon located downstream from lacZ. In addition, these strains have the ddlB, ftsQ, ftsA and ftsZ genes under the control of the IPTG-inducible promoter P(tac), allowing to control artificially ftsZ expression for normal cell division to take place. When beta-galactosidase activity was measured in VIP596 and VIP597 and compared to the levels measured in strain VIP407, in which the lacZ reporter fusion is located in the ftsZ gene, they were found to account for nearly 66% of the total transcription entering into ftsZ. This result indicates that the reduction in ftsZ transcription observed when the promoters in the ddlB-ftsA region are disconnected from the upstream sequences of the dcw cluster (as observed by Flärdh et al., Mol. Microbiol. 30 (1998) 305-316) in strain VIP490) is the direct consequence of the interruption in the transcription originated upstream and not due to the effect of such sequences on the promoters proximal to ftsZ.
Bacterial Proteins↗
A maternal inherited translocation t(1;22)(q11;p11) in two infertile brothers.
We report two infertile brothers presenting with azoospermia and oligozoospermia. Cytogenetic studies using G-banding and FISH analysis on lymphocyte cultures revealed an autosomal balanced reciprocal translocation t(1;22)(q11;p11) in both males. The same translocation was found in their mother, but not in a third fertile brother and maternal uncle suggesting that this translocation might compromise the male but not the female gametogenesis in this family.
Adult↗
CarboMedics and Monostrut valves: clinical and hemodynamic outcomes in a randomized study.
BACKGROUND AND AIM OF THE STUDY: Our aim was to compare the CarboMedics (CM) and Monostrut (M) mechanical heart valve prostheses in the aortic position. These prostheses have been studied extensively in the past, both have well-defined characteristics, and have not been modified for many years. METHODS: This randomized, prospective study included 200 consecutive patients; 100 received the CM prosthesis and 100 the M prosthesis. Both groups were statistically similar in terms of age, aortic valve lesion, and preoperative clinical and surgical characteristics. Mean follow up was 5.58 years (range: 2 months to 11 years); total follow up was 1095 patient-years (pt-yr) (CM 5.33 years, 528 pt-yr; M 5.85 years, 567 pt-yr). RESULTS: Early mortality rates were 1% in the CM group and 3% in the M group. Late mortality rates were 7% and 9%, respectively. Mean (+/- SD) survival rates at 11 years were 80.51 +/- 7.36% for the CM group and 79.62 +/- 5.59% for the M group. There were no cases of mechanical valve failure in either group. The linearized rates of major thromboembolism were 1.03% and 0.20% per pt-yr for the CM and M groups, respectively; the rates of major bleeding-events were 0.71% and 0.61% per pt-yr, respectively. The rate of paravalvular leak was 0.35% and 0% per pt-yr in the CM and M groups, respectively. Postoperative NYHA class was I-II in 95.83% of CM patients, and in 94.37% of M patients. CONCLUSION: Clinical results with CarboMedics and Monostrut prostheses are highly satisfactory, but no superiority of one valve over the other can be identified.
Adult↗
Characterization and expression of the arginine biosynthesis gene cluster of Streptomyces clavuligerus.
A cluster of genes argCJBDRGH containing most of the arginine biosynthesis genes has been found in Streptomyces clavuligerus after sequencing a 8.3 kb DNA region containing overlapping sequences of two DNA fragments known to contain arginine biosynthesis genes. Subcloning, complementation of E. coli arginine auxotrophic strains and enzymatic assays confirmed the identity of each gene. S1 nuclease mapping studies and Northern hybridization analysis revealed the formation of two large transcripts corresponding to argCJBDR and argGH. The amount of each of these mRNAs is 10 to 44 times higher in a S. clavuligerus argR-disrupted mutant than in the wild type confirming the existence of an ArgR-mediated control of arginine biosynthesis gene expression. A low level constitutive monocistronic transcript of argR was observed in S. clavuligerus cells. Most of the argGH transcript initiating at an adenine 29 nt upstream of the argG initiation codon appears to stop at a termination stem and loop structure present downstream of the argG gene.
Acetyltransferases↗
Repair of left ventricular rupture after mitral valve replacement: use of a Teflon patch and glue.
Rupture of the left ventricular wall is an infrequent but lethal complication after mitral valve replacement. We present the case of a patient in whom such a rupture was successfully repaired in the intensive care unit with a patch of Teflon felt stuck in place with glue.
Aged↗
[Hepatocellular carcinoma associated to porphyria cutanea tarda and hepatitis C virus infection without cirrhosis].
The molecular basis of porphyria cutanea tarda is defective activity of hepatic uroporphyrinogen decarboxylase. A common characteristic is liver dysfunction than goes from cirrhosis to hepatocellular carcinoma. A high prevalence of hepatitis C virus markers has been demonstrated. We study a patient with PCT and hepatitis C virus markers that finally develops to hepatocellular carcinoma without previous cirrhosis. Previous studies with association of PCT and hepatitis C virus markers, have found liver diseases ranging from cirrhosis to hepatocellular carcinoma. The importance of this study is the absence of cirrhosis.
Carcinoma, Hepatocellular↗
[Intraoperative evaluation of the patency of coronary grafts].
Patency of coronary by-pass grafts is a challenge for the surgeon in order to reduce graft obstructions due to technical reasons. We analyze different published methods and show our experience with 1,010 coronary grafts whose flow was measured using a electromagnetic flowmeter. We also show our experience with infra-red angiography. We consider these two methods more practical and feasible than others because it is possible to save between 3 to 4% of the coronary grafts and to make an immediate record and to determine the relative prognosis of the grafts patency.
Coronary Angiography↗
Electrophysiological study of prefrontal neurones of cats during a motor task.
The prefrontal cortex is involved in many processes, some of which are related to motor activity such eye movements and speech. Experimental data exist that suggest that prefrontal cortical activity occurs in relation to attention, short-term memory, affective discrimination, and complex forms of motor behaviour, i.e. anticipatory preparation, motor sequences, programming of speech, etc. We were interested in studying participation of this cortical region in locomotion. For this purpose, recordings were made of unitary activity in the prefrontal cortex of chronically prepared cats walking on an exercise belt that was moving at a speed of 0.1 m/s. From a total of 63 neurones in the prefrontal area from which recordings were made, 37 (59%) changed their activity during locomotion, 28 of which (76%) increased and 9 of which (24%) decreased their frequency of discharge; the remaining 26 units (41%) showed no locomotor-related change in activity. The results obtained show that 59% of prefrontal units are involved in the locomotor process and it is reasonable to assume that their activity contributes to the control of the movements.
Animals↗
Infection of a pacemaker by Brucella melitensis.
We report a case that, to the best of our knowledge, is the only published instance of infection of a pacemaker and its leads by Brucella melitensis. Furthermore, this case suggests that B. melitensis may be able to persist around pacemaker devices despite its having been eliminated from the rest of the body. The patient was a sheep shearer who had just undergone a 45-day course of antibiotic therapy for brucella and had been considered cured on the basis of negative blood cultures.
Animal Husbandry↗
The safety and effectiveness of stepwise and low-dose administration of follicle stimulating hormone in WHO group II anovulatory infertile women: evidence from a large multicenter study in Spain.
PURPOSE: Our goal was to investigate the safety, effectiveness, and feasibility for the practicing physician of stepwise and low-dose administration of FSH in WHO group II anovulatory infertile women. METHODS: Infertile female patients (n = 234) suffering from WHO group II anovulation, and who failed to became pregnant with clomiphene citrate, were included in a multicenter, prospective, clinical study of treatment with a protocol of chronic low-dose and small incremental rises with urinary purified or highly purified FSH. Follicular development was monitored with ultrasonographic scans. RESULTS: The 234 patients received a total of 534 cycles of treatment, for a mean number of 2.3 treated cycles per patient. hCG was withheld in 65 (12.2%) cyles because of no response and in 28 (5.2%) cycles because of hyperresponse. Of the remaining 441 cycles, 419 (95%) were ovulatory, and in 198 (47.3%) of these cycles a single dominant follicle developed. There were 93 pregnancies (39.7% per patient), for a cycle fecundity rate of 17.4%. Cumulative conception rate after two treated cycles was 33.5%. There were 14 (15%) pairs of twins and 10 (10.8%) spontaneous miscarriages. The prevalence of complications was low with no cases of severe OHSS. Basal LH/FSH ratio was significantly higher in the pregnant group of patients than in nonpregnant women. CONCLUSIONS: Stepwise and chronic low-dose administration of FSH is a safe and effective method for treatment of WHO group II anovulatory infertility, mainly in those patients having high LH/FSH ratios.
Adult↗
[Shunt surgery versus disconnection in portal hypertension. A comparative study].
Controversy remains about the best treatment for patients with esophagogastric variceal bleeding. In spite of different therapeutic alternatives and recent progress, such as liver transplantation of TIPS, many patients will finally be treated by standard surgery. With the aim to know the results of surgery in shunting vs non-shunting procedures, we have analyzed a recent and consecutive series of 68 cirrhotics patients operated on for variceal hemorrhage. According to the surgical technique there were three groups: I) 30 patients underwent a total portacaval shunt; II) 18 cases with an azygosportal disconnection; III) 20 patients with a partial portacaval shunt (8-10 mm H-portacaval PTFE graft). All groups were homogeneous considering age, sex etiology, Child-Pugh grade and timing of surgery (elective vs urgent). The complications and mortality rates were similar for the three groups. The overall operative mortality was 10%, and 5% in selected cases (Child-Pugh A-B, non urgent cases). With a follow-up for I, II and III group of 47, 44 and 27 months respectively, chronic encephalopathy have been seen in 61%, 15% and 15% respectively (p < .05). No patient in group I has rebled, and only one case in the II and III groups had a recurrence of hemorrhage. The actuarial three years survival was 76%, 86% and 85% (p NS), and the five year survival was 41% vs 86% for the groups I and II respectively (p < .05). In conclusion, in selected cases, surgery gives excellent immediate and long term results. In patients with variceal bleeding and failure of first line treatments, such as sclerosis or pharmacology, the partial H-portacaval shunt and non-shunting procedures are good alternatives, with low incidence of rebleeding and chronic encephalopathy.
Adult↗
[THe treatment of anal fissures by lateral internal sphincterotomy].
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Adult↗
Case report 866. Pseudotumor of the muscle associated with necrotizing vasculitis of medium- and small-sized arteries and chronic myositis.
A case of polymyositis and localized vasculitis presenting as a muscular pseudotumor of a lower extremity and periostitis several years after the onset of symptoms was reported and the MRI characteristics were described. This imaging modality demonstrated muscle signal abnormalities in several muscle groups and was useful in ruling out the presence of a mass and fatty degeneration of the muscle. The ability of the STIR sequence (Fig. 3D) to show muscle abnormalities and to allow fatty infiltration or degeneration to be ruled out has not been reported before in patients with vasculitic muscle involvement.
Humans↗
Calibrated nasal tip: review of 100 cases.
Asymmetry of the alar cartilages is a common finding in primary rhinoplasty in Caucasian patients. The "delivery" technique provides good exposure of the alar cartilages which allows examination and tailoring in better surgical conditions than those of the "closed" technique and also avoids the "open" nose approach in the majority of rhinoplasty cases.
Anthropometry↗
Left ventricular perforation by a pleural drainage tube. Report of a case with survival.
We present a case of survival as a result of surgical intervention after perforation of the left ventricle during the insertion of a pleural drainage tube. Surgical intervention was facilitated by the fact that the drainage tube responsible for the suspected perforation of the cardiac cavity was clamped and fastened, as opposed to withdrawn. The location of the perforation was established by measuring the pressure curve through the drainage tube.
Drainage↗
Periareolar mastopexy with mammary implants.
We present our experience with using a periareolar mastopexy technique combined with prosthesis implantation to correct mammary ptosis, misplaced areolas, and tuberous hypoplastic breasts. We draw a circle around the areola and deepidermize the skin between them. We enter the glandular tissue and introduce the implant in a submuscular pocket. A purse string suture of nonabsorbable material is used to gather the excess skin. Results were satisfactory in all cases. During the immediate postoperative weeks the shape was flatter and protruded less, but a progressive correction was observed. The tuberous breast could be released and reshaped adequately. Misplaced areolas can also be replaced correctly by drawing the periareolar circle and ellipse in eccentric forms. This technique does not allow great elevation of the areola (no more than 4-5 cm), but it is good and safe for correcting minor to moderate ptosis combined with volume augmentation.
Adult↗