Biomedical subjects

B Fraile Gómez

Publications and source records attributed to B Fraile Gómez.

8 recordsLinked to original sources

PubMed2001

[Experience with cadaver renal transplant with ex situ reconstructed arteries].

OBJECTIVE: To review our experience with cadaveric kidney transplantation with ex situ reconstruction of damaged renal artery. METHODS: To obtain a minimum follow-up of 5 years, 20 cases treated from January 1989 to December 1994 were retrospectively reviewed. The control group comprised 73 patients that had received an "ideal" graft during the same period. Both groups were similar for all the variables that could influence graft outcome. RESULTS: Both groups showed similar results for incidence of NTA, rejection episodes, creatinine values, surgical complications or reoperations. However, a strong trend (25% of the cases) to develop renal artery stenosis was found (p = 0.052). These latter cases were diagnosed by the onset of arterial hypertension that was difficult to control and were treated conservatively by percutaneous angioplasty with good functional results in 100% of the cases, although 80% required more than one session. This complication, however, did not lead to graft failure. CONCLUSIONS: Renal grafts with arteries damaged during procurement or as a result of pathological changes, such as arteriorclerosis or aneurysm, are useful after bench reconstruction before transplantation. However, the greater trend to develop symptomatic arterial stenosis that has been observed makes it convenient to look for this complication routinely during follow-up. If diagnosed and treated early, it does not influence the graft outcome. The therapeutic approach is first by percutaneous transluminal angioplasty and if it fails, then by open surgery.

Adolescent↗

PubMed2000

[Cadaver kidney grafts from donors over 60 years of age should be considered as suboptimal].

Considering the scarcity of organs for transplantation, one possible solution is the use of grafts from aged donors (over 50 years). We have reviewed our experience in the case of kidney transplantation considering the period from 1989-1994 in order to attain a minimum follow-up of 36 months. We compare three groups: donors aged between 50-60 years (n = 32), donors aged over 60 years (n = 25) and a control group formed by donors of "ideal" ages. The results show that kidneys from donors over 60 years evidence, as compared to the control group, a higher incidence of acute tubular necrosis (p = 0.032), significantly higher blood creatinine levels in all the intervals considered, and a graft survival which is 14% less at 12 months and 40% less at 36 months (p = 0.0009). These differences are most probably to be attributed to the changes caused in these organs by advancing age and by previous pathological situations, as we have not detected a higher incidence of immunologic or surgical complications.

Age Factors↗

PubMed2000

[Experience with kidney transplantation with children as donors].

OBJECTIVE: To analyze the results achieved with transplantation of children kidneys to adult recipients. METHODS: The results achieved with transplantation of children cadaver kidneys (< 15 years) from 1989 to 1994 over a follow-up period of at least 36 months were reviewed. Patients (n = 43) were stratified into group A (13 grafts from donors < or = 6 years), group B (30 grafts from donors > 6 years) and group C (control group), which comprised 73 patients who received grafts from donors of an ideal age during the same time period. All three groups were similar for variables considered to influence the results of transplantation, except for the higher incidence of hypotension in group B. RESULTS: The number of episodes of rejection was three-fold higher in group A than in the control group (p = 0.019). A higher incidence of surgical complications, principally vascular complications (arterial thrombosis, renal rotation), was found in group A versus the control group (p = 0.039). When the grafts transplanted en bloc from donors under 12 months were excluded from the analysis, the incidence of vascular or urological surgical complications in group A was not found to be higher than that of the control group. No difference was found for mean length of stay, renal function (creatininemia), graft or patient survival for the three groups. CONCLUSIONS: Grafts from donors more than 6 years old showed a similar behavior as those from donors of an ideal age. Furthermore, single kidneys from donors aged more than 12 months can be transplanted with excellent results. It is necessary to have a larger series to confirm and explain the high incidence of acute rejection in grafts from donors less than 6 years old.

Adolescent↗

PubMed1996

[Renal transplantectomy].

OBJECTIVES: Renal transplantation is currently the treatment of choice for most of the cases with end-stage renal failure. However, approximately 35% present failure of graft function within 5 years post-transplantation. The need for graft removal, which is infrequently discussed in the literature, and the surgical technique employed are discussed. METHODS: From September, 1976 to December, 1994, we have performed 877 renal transplants; of these, 145 (16.5%) required removal. The literature is reviewed, with special reference to the indications for graft removal and the different surgical techniques employed. RESULTS: Our data show that 42% of non-functioning renal transplants required removal at some time. No complications arising from conservative management were observed in the remaining 58%. Graft failure due to acute or early acute rejection invariably necessitated removal; thereafter transplant nephrectomy was uncommon. There were no deaths from failed grafts maintained in situ in this series. CONCLUSIONS: Like other authors, our approach is to leave the graft in situ with or without low doses of corticosteroids. Transplant nephrectomy is reserved for the symptomatic cases. For cases requiring nephrectomy less than three months post-transplantation, we utilize the extracapsular approach; thereafter we utilize the subcapsular technique.

Blood Loss, Surgical↗

PubMed1990

[Extracorporeal lithotripsy under echographic monitoring].

A total of 1,241 calculi corresponding to 1,000 patients were treated with the piezoelectric EDAP-LTO1 lithotriptor. All but 1% of the calculi could be localized by ultrasonic imaging. Stone localization was easily achieved in 80% and with some difficulty in 19% of the cases. All patients had a minimum follow-up of 3 months. Stone fragmentation was accomplished in 91% of pyelic, 86% of upper, 55% of mid, 90% of lower caliceal, and 37% of staghorn calculi. Fragmentation was achieved in 4 of 5 calculi in the lumbar ureter and 5 of 11 calculi in the pelvic ureter that were treated in situ. The material and method for extracorporeal shock wave lithotripsy using ultrasonic imaging are described. The advantages and disadvantages of ultrasound versus radiologic stone localization are discussed.

Evaluation Studies as Topic↗

PubMedDate not supplied

[Impact of transplantectomy of the first graft on the clinical course of cadaver renal retransplantation].

PURPOSE: At the present time a number of prediction factors on the outcome of second cadaver renal transplants are known, in particular the influence of recipient response to the first graft. However, we do not know if retaining or removing the non-functioning organ has any repercussion on subsequent transplants. This is the object of the present study. MATERIAL AND METHODS: A retrospective study was carried out on the clinical records of 80 patients who had undergone a second cadaver renal transplant under CyA between 1985-1995 at Hospital 12 de Octubre. Data on the characteristics and outcome of the first and second transplants were collected, plus those concerning the recipient and donor. These variables were used to construct a multivariant analysis model of graft survival. The nephrectomy of the non-functioning graft was only carried out when absolutely necessary (n = 58). RESULTS: The multivariant analysis showed that the nephrectomy of the non functioning graft did not modify the risk of recipient sensitization or the probability of developing acute or chronic rejection of the second graft. However, it reduced the risk of losing this second graft at medium or long term significantly (p = 0.009). CONCLUSIONS: These data constitute the first solid argument in favor of elective nephrectomy in candidates for a second cadaver renal transplant. Nevertheless, a more thorough study should be carried out of the immunological mechanism involved before recommending this as a general procedure.

Adult↗

PubMedDate not supplied

[HLA compatibility and antigenic re-exposure. Impact on the clinical course of cadaver kidney transplantation].

OBJECTIVES: A number of prediction factors on the outcome of cadaver renal transplants have been recognized, particularly the influence of recipient response to the first graft. However, the influence of HLA compatibility and of repeated recipient and donor antigen mismatches remain a controversy. The importance of the foregoing on the survival of the second renal graft is analyzed in this study. METHODS: The clinical records of 80 patients who had undergone a second cadaver renal transplantation from 1985 to 1995 at the Hospital 12 de Octubre (Madrid, Spain) were reviewed. Data on the recipient, donor and graft characteristics and outcome of the first and second transplants were collected for multivariate analysis of graft survival using the Cox regression method. The importance of the overall HLA compatibility and of each HLA locus, and the effect of antigenic re-exposure on the survival of the second renal graft were analyzed. RESULTS: The multivariate analysis showed a significant increase of the survival of the second graft when there were at least three compatible antigens between donor and recipient (p = 0.02). Compatibility of the HLA-A and DR loci appeared to improve the outcome, although the differences were not statistically significant. However, a significant improvement in the survival of the second cadaver renal allograft was found for repeated HLA mismatches between the recipient and donors (p = 0.006). CONCLUSIONS: Our data corroborate the benefits of assigning renal grafts according to the degree of HLA compatibility also for the second renal transplant. Furthermore, our data show that re-exposure to previous mismatched antigens need not be hazardous for the second renal transplant in the cyclosporine era.

Adult↗

PubMedDate not supplied

[Clinical study of a phytosterol extract of Prunus arborea and 3 amino acids: glycine, alanine and glutamic acid].

We have carried out a therapeutic study on "Tebetane compuesto", by applying it to one hundred patients, whose pathologies, prostatic adenoma, prostatitis and postadenomectomy sequelas, come within the field of action of the product, as shown by other authors. The particular feature of "Tebetane compuesto" is that it is a non-hormonal product, which contributes to the fact that it may be used in high doses without producing harmful effects on the patient. We have found no cases of intolerance or side effects, which we feel makes it superior to other similar products. To be specific, in the case of prostatitis, "Tebetane compuesto" has proved to be effective in 94 per 100 of the patients treated, making it a highly reliable product for use by the specialist or general practitioner. We feel, on the other hand, that the inclusion in the formula of "Tebetane compuesto" of the three aminoacids has led to a considerable reduction in the duration of the treatments of these patients, with the resulting financial saving involved.

Aged↗