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Biomedical subjects

C Galeano

Publications and source records attributed to C Galeano.

At least 19 recordsLinked to original sources
PubMed2006

Conversion from calcineurin inhibitors to everolimus in kidney transplant recipients with malignant neoplasia.

Cancer has been reported to be more common among kidney transplant recipients than waiting-list patients or the general population. Use of anticalcineurin agents and azathioprine are relevant risk factors. Nine renal allograft recipients (seven men and two women) of mean age 67.6 (55-77) years and mean time after transplantation of 30.7 (58-216) months were switched to everolimus-based immunosuppression because of the presence of biopsy-proven malignancies (eight patients) or neurological tacrolimus toxicity (one patient). One patient with posttransplant lymphoproliferative disease also received chemotherapy with a good evolution at 6 months. He showed an initial increase in the protein to creatinine ratio (peak 3.3 mg/mg at 3 months) that was controlled by increasing the enalapril dose. One patient with skin cancer and severe atheromatosis (baseline SCr 2.5 mg/dL, creatinine clearance 17 mL/min, and protein to creatinine ratio 3.2 mg/mg), had cyclosporine and everolimus overlapped for 25 days, showing a continued poor evolution requiring dialysis initiation at 3 months after switch. The other six patients with recurrent skin cancers had good cancer evolution, with no new skin tumors and regression of skin lesions in three, including not biopsied actinic keratosis. Sudden switching from calcineurin inhibitors to everolimus is safe and may be used in long-term transplant recipients with malignancies. In patients with advanced chronic nephropathy this approach appeared to be less beneficial.

Aged↗
PubMed2006

Mycophenolate mofetil tolerability and dose changes in tacrolimus-treated renal allograft recipients.

Mycophenolate mofetil (MMF) reduces acute rejection episodes (AREs) and may be associated with better renal graft survival than azathioprine. However, MMF-related adverse events are frequent; dose reduction or even withdrawal are quite common. Between 1999 and 2003, 115 renal transplantation patients were treated with tacrolimus, MMF, and steroids. An observational study was undertaken until graft loss (n = 7), death with a functioning graft (n = 2), or October 31, 2005 (mean follow-up-50 months). We assessed MMF dose reductions due to adverse events with the possible consequences on AREs and graft function. Treated acute ARE occurred in 11.3% of recipients, all of which were steroid-responsive. The median MMF initial daily dose was 1000 mg. In 44 patients (38.3%), the MMF dose was not changed; in 48 (41.7%) it was reduced; and in 23 (20%), withdrawn. The causes for dose modification were diarrhea (n = 33, 28.7% of all patients), leukopenia (n = 22, 19.1%), both of these (n = 7, 6.1%), or other events (n = 9, 7.8%). No AREs were attributed to MMF dose changes. Tacrolimus blood levels were higher at 3 years and serum creatinine values at 4 years among patients with dose changes (8.43 +/- 2.42 vs 7.37 +/- 2.23 ng/mL; P = .051 and 1.75 +/- 0.71 vs 1.48 +/- 0.38 mg/dL; P = .038, respectively). The need for MMF dose reduction or withdrawal was frequent in our patients with diarrhea or leukopenia during treatment with tacrolimus, MMF, and steroids. These adverse event-related changes were not associated with AREs, but produced deleterious effects on long-term graft function.

Creatinine↗
PubMed2005

Lumbar bone mineral density after kidney transplantation: a three-year prospective study.

Osteopenia is a common complication after transplantation. However, prospective long-term studies are scarce and most were performed in patients on cyclosporine and high-dose steroids. In 65 patients with functioning grafts, 41 males and 24 females, 50 on tacrolimus-based immunosuppression and 15 on cyclosporine-based immunosuppression, bone mineral density (BMD) was measured in the lumbar spine (L2-L4) and femoral neck (FN) using dual X-ray absorptiometry (DEXA) in the first month after transplantation (baseline) and at 1, 2, and 3 years. At baseline, BMD was similar to the control population both in L2-L4 (z score = -0.421) and in FN (z score = -0.518). During the follow-up, 3 types of patterns were identified: BMD increased in L2-L4 in 25 patients (38.5%), remained stable in 20 patients (30.8%), and decreased in 20 patients (30.8%). BMD losses appeared mainly during the first year (0.964 +/- 0.162 baseline; 0.904 +/- 0.161 at 1 year, 0.886 +/- 0.140 at 3 years; analysis of variance [ANOVA] P < .001). However, the improvement was maintained throughout the follow-up (0.860 +/- 0.176 g/cm2 at baseline; 0.901 +/- 0.161 at 1 year; 0.954 +/- 0.178 at 3 years; ANOVA P < .001) and there was a parallel increase of BMD in FN (0.712 +/- 0.144 at baseline; 0.744 +/- 0.249 at 1 year; 0.826 +/- 0.184 at 3 years; ANOVA P < .01). There were no differences between both groups in graft function, intact parathyroid hormone (iPTH) levels, number of postmenopausal women, or steroid doses. About one third of patients had bone loss during the first year after transplantation. We were unable to identify any risk factor for this complication in patients on low-dose steroids.

Absorptiometry, Photon↗
PubMed2005

Wisconsin and Celsior solutions in renal preservation: a comparative preliminary study.

The aim of this study was to evaluate the efficacy of the Celsior (C) solution for flushing and cold storage of cadaveric renal allografts. Among 177 cadaveric renal allografts harvested and transplanted in our unit, 138 were preserved with the University of Wisconsin (W) solution and 39 with the C solution. The mean age of the recipients was 48.1 +/- 13.5 years, including 107 men and 70 women. The immunosuppressive regimens were tacrolimus-based (n = 118) or cyclosporine-based (n = 59). Grafts perfused with W solution were obtained from older donors than those perfused with C solution (42.3 +/- 16.9 vs 38.1 +/- 12.5 years; P = .017) and had been transplanted to older recipients (49.5 +/- 14.4 vs 43.3 +/- 13.0 years; P = .017). The prevalence of delayed graft function (DGF) was similar in the 2 groups (39.1% in the W group vs 23.7% in the C group; P = .097), as well as the incidence of primary nonfunction grafts (5.8% vs 2.7%; P = .427). The serum creatinine value at 1 month was significantly higher among grafts preserved with W versus solution (1.9 +/- 0.9 vs 1.5 +/- 0.5 mg/dL; P = .000) as well as at 12 months (1.63 +/- 0.5 vs 1.35 +/- 0.4 mg/dL; P = .003). There were no differences in graft survival at 12 months (97% C group vs 88% W group; P = .069). Our results showed that C solution was equivalent to W solution with respect to DGF and primary function of kidneys. The differences in renal function may have been due to differences in donor and recipient ages.

Adenosine↗
PubMed1993

[Guidance for the obstetrician encountering a multiple pregnancy].

A retrospective review of multiple birth of higher order delivered at the Obstetric Clinic of University of Rome "La Sapienza" from 1982-1991 was performed. Comparison was made between this group (study group) and other published data. Since 1982 there has been more liberal use of abdominal delivery. Of the 25 multiple pregnancies, 17 were delivered by cesarean section (CS) and 8 by vaginal delivery. The corrected mortality rate in the study group was 19.2% (5/26) for vaginal delivery and 17.5% (10/57) for CS. Indication for CS was: elective (35%), fetal (18%) and maternal (47%). The main neonatal complications resulted from prematurity, and maternal noted complication were post-partum hemorrhage necessitating hysterectomy in one patient. The preferable mode of delivery cannot be stated dogmatically.

Adult↗
PubMed1992

[Clinical evaluation of an immunological test for premature rupture of the fetal membranes (ROM check test)].

Commonly used methods for detecting amniotic fluid in the vagina include research LA cells, ferning, nitrazina paper, ultrasound and dye injection. These methods are difficult to interpret or invasive. We have tested a new method which detects a fetal isoform of fibronectin in vaginal secretion when amniotic fluid is present. Clinical trials demonstrate the sufficient reliability in detecting amniotic fluid in the vagina of women with rupture of amniotic membranes.

Amniotic Fluid↗
PubMed1989

Action of clonidine on micturitional reflexes in decerebrate cats.

We explored the urodynamic action of clonidine (preferential alpha 2-agonist) and yohimbine (preferential alpha 2-blocker) in decerebrate cats. These animals retain catecholaminergic fibers from the complex of the locus coeruleus to the spinal cord and have synergic and faster micturition cycles than normal cats. Twenty-nine male cats were made decerebrate at intercollicular level under ether anesthesia. Voiding, vesical, urethral and blood pressures, and the EMG of the external sphincter-pelvic floor and leg muscles were studied. Preparations with the urethrovesical junction opened and closed were used. Control activity was characterized by two types of vesical pressure waves: (1) low frequency, high intensity, and (2) high frequency, low intensity. Type-2 preceded Type-1 waves. Clonidine caused: (A) reduction of Type-1 and enhancement of Type-2 Pves waves; (B) diminution of vesical capacity; (C) facilitation of external sphincter relaxation; (D) inhibition of skeletal muscle activity; (E) systemic hypotension and bradycardia. Yohimbine inhibited clonidine's actions. When injected alone, it inhibited vesical and increased sphincteric activities. It also produced systemic hypertension and enhanced crisis of autonomic dysreflexia. The overall effect of clonidine on urodynamics in acute decerebrate cats was to bring about an active, small (normotonic) bladder with urinary frequencies. We suggest that clonidine: (1) inhibited Type-1 waves by inhibiting cellular activity in the locus coeruleus. As a result, the vesico-vesical contraction long loop reflex was abolished; (2) facilitated Type-2 waves by inhibiting inhibitory interneurons in the sacral parasympathetic center. As a result, the vesicovesical contraction short loop reflex was facilitated.

Adrenergic alpha-Agonists↗
PubMed1988

Experimental allergic encephalomyelitis: a neurourological study.

To assess the neurourological disturbances produced by the perivascular inflammatory process in the acute phase of experimental allergic encephalomyelitis, we carried out a controlled study. Forty-six New Zealand male rabbits were inoculated with an encephalitogenic preparation. Twenty-seven of them developed neurological deficits in an average of 9.3 days postinoculation. A sample of 19 subjects was used as a control. The subjects were studied within 2 days after the manifestation of the first sign of encephalomyelitis. An average of eight successive cystosphincterograms were recorded. Their entire central nervous system was removed intact and suspended in 10% neutral buffered Formalin solution for 2 weeks, then cut into segments, embedded in paraffin, and finally stained with hematoxylin-eosin and Luxol Fast Blue. The results demonstrated a significant reduction of mean vesical capacity, maximum urethral pressure, and mean urethral pressure in the group with encephalomyelitis. Furthermore, we found a significant negative correlation between the average number of cellular perivascular infiltrates in the spinal sacral segment and urethral pressures. The results showed a significant negative correlation between supreamesencephalic inflammation and mean vesical capacity.

Animals↗
PubMed1988

Increased blood concentration of des-Arg9-bradykinin in experimental allergic encephalomyelitis.

Experimental allergic encephalomyelitis (EAE) is a delayed cell-mediated autoimmune reaction to myelin basic protein. The neuropathology of this acute inflammatory process is characterized by cellular infiltration of the perivascular nervous parenchyma which increases the blood-brain barrier permeability. There is good evidence for an activation of the kallikrein-kinin system during inflammation. In order to assess blood concentrations of kinins in a group of 21 New Zealand rabbits in the acute phase of EAE and a group of 12 normal controls, we performed a sensitive and specific radioimmunoassay. All subjects in the encephalomyelitic group were inoculated with 0.05 ml of an antigenic preparation. They all developed neurological deficits on average 30 days later and within 4 days 10 ml of arterial blood were withdrawn for radioimmunoassay of kinins. On the same days their central nervous system was dissected and prepared for staining and histological study. We demonstrated a significant difference in bradykinin blood concentration between the encephalomyelitic (170.6 pg/ml) and the control (245.8 pg/ml) groups. There is also a significant difference in des-Arg9-bradykinin blood concentration between the encephalomyelitic (168.0 pg/ml) and the control (96.1 pg/ml) groups. These results suggest an activation of circulating carboxypeptidases involved in the transformation of bradykinin into des-Arg9-bradykinin during EAE.

Animals↗
PubMed1986

Blood levels of kinins in experimental allergic encephalomyelitis.

The pathology of acute experimental allergic encephalomyelitis is characterized by perivascular cellular infiltrates in the central nervous system. Our hypothesis is that this immuno-pharmacological process can activate the circulating and tissular kallikrein-kinin systems. We studied 21 New Zealand rabbits inoculated with a homogenate of guinea-pig spinal cord in complete Freund's adjuvant. Each animal underwent radioimmunoassay for arterial blood bradykinin, des-Arg9-bradykinin and des-Phe8-des-Arg9-bradykinin during the acute or subacute clinical phase of encephalomyelitis. Immediately after blood sampling, all animals had their complete central nervous system dissected out and prepared for staining and histological study. The number of hematoxylin-eosin-stained perivascular cellular infiltrates was counted at eight levels of the central nervous system, from the hypothalamic to sacral spinal segments. We demonstrated a positive significant (P less than or equal to 0.02) correlation (r = 0.55) between the number of perivascular cellular infiltrates and blood level of the biologically active kinin bradykinin.

Animals↗
PubMed1984

Effect of enkephalin on the micturition cycle of the cat.

The effect of the synthetic opiate [D-Ala2, Me-Phe4]-leu-enkephalin ( DAMLE ) on the micturition cycle of the cat was studied. In vivo assays were performed with young male cats under two different conditions: 1) decerebrated cats (D-cats), with an intercollicular transection of the brainstem, and 2) spinal cats (S-cats), with a spinal transection between C5-C6. In vitro studies were carried out on bladder strips taken from adult male cats. The D-cats showed two types of voiding patterns: the first type (I) was characterized by a smooth wave of pressure and an incomplete emptying of the bladder; the second type (II) began like the type I, but ended with a series of small contractions accompanied by small jets of liquid, resulting in the complete emptying of the bladder. DAMLE inhibited vesical contractions and completely inhibited voiding in D-cats at doses equal or superior to 250 micrograms/kg i.v.; no effect was noted with lower doses. Vesical contractions were hardly affected in S-cats, even at high doses (greater than 350 micrograms/kg i.v.). DAMLE did not affect electrically induced contractions of isolated bladder strips. Naloxone not only antagonized the inhibitory effects of DAMLE , but also induced per se a contraction of the bladder. These results indicate that enkephalinergic neurons are involved in the central neural circuitry of the micturition cycle in the cat, with an inhibitory effect at the level of either the ascending spinal pathways or the pontine Barrington 's center.

Animals↗
PubMed1984

Vesicourethral motility following acute spinal cord transection in the cat.

The cause of urinary retention during the phase of spinal shock is still uncertain. In the cat with intact spinal cord, reflex voiding shows a coordination between the longitudinal and circular urethral muscles, the detrusor and the periurethral striated muscles. After transection of the spinal cord in cervical and/or thoracic segments, 26 of 28 cats failed to void. An incoordination between longitudinal, circular, detrusor and periurethral striated muscles was noticed simulating a urethro-urethral and urethrovesical dyssynergia. The 2 cats that voided 6 hours after the cord section showed a return of synergism between longitudinal, circular, detrusor and periurethral striated muscles. The conventional pharmacologic manipulation used during the early period following spinal cord transection, bethanechol chloride and phentolamine, failed to achieve proper bladder emptying because it did not correct the dyssynergic pattern.

Animals↗
PubMed1983

New approach to study of voiding cycle in cat. Preliminary report on pharmacologic studies.

The effect of autonomic active agents were studied on 23 anesthetized cats. The parameters recorded were circular and longitudinal urethral muscles, and bladder muscle contractions and relaxation as well as intravesical pressure during voiding cycles. Cholinergic stimulant (bethanechol) and blockage (atropine) excited or inhibited the bladder muscle and minimally affected the urethra. Alpha-adrenergic stimulant (norepinephrine) in nonatropinized animals produced mild stimulation on the bladder, and longitudinal-circular urethral muscle synergia appeared to be inadequate. In atropinized animals norepinephrine produced the reverse effect, causing marked inhibition. Alpha blockade (phentolamine) disinhibited the receptors mainly in the bladder and improved the urethral synergia. Beta stimulant (isoproterenol) inhibited the bladder and urethral muscles, and beta blockade (propranolol) stimulated the bladder and urethral muscles.

Animals↗
PubMed1983

Bladder and urethral dynamics in multiple sclerosis-like animal model.

Multiple sclerosis-like disease was induced in 18 rabbits by immunization with guinea pig spinal cord. The urodynamic studies conducted in the immunized rabbits showed a significantly lower maximal urethral pressure and a lower bladder capacity than those in the control group. We compared the urodynamic, clinical and histopathological parameters in the immunized rabbits. We conclude that the rabbit is an acceptable model for studying the bladder and urethral dynamics during various phases of experimental allergic encephalomyelitis (multiple sclerosis-like disease).

Anesthetics↗