Biomedical subjects

C Jimenez

Publications and source records attributed to C Jimenez.

114 records · Page 7Linked to original sources

PubMedDate not supplied

Liver recipients undergoing hepatic transplantation and subsequent retransplantation: a comparison between clinical characteristics.

BACKGROUND/AIMS: In order to establish a rational strategy for organ distribution and optimal patient management, we postulate it is mandatory not only to understand the pathophysiology of failing grafts but also to better recognize the baseline clinical characteristics of the recipients shortly before receiving a second liver allograft. METHODOLOGY: Between March 1986 and December 1997, 1061 patients underwent 1087 orthotopic liver transplantation at three Hospitals in Madrid (122 retransplants). RESULTS: Mean follow-up was 36 months (range, 1-90), 40.6% of the recipients were alive and survival at 1, 3 and 5 years was 62%, 53%, and 46%. Almost 50% of the recipients were UNOS 1 before retransplantation. In comparison to p-OLT (15% UNOS 1), it is clearly shown that the retransplants have been performed in the sickest patients with more adverse prognostic indicators (higher AST, bilirubin, creatinine serum levels, higher Child-Pugh score, higher rate of ascites and lower serum levels of albumin and prothrombin activity). CONCLUSIONS: Liver retransplantation is acceptable and significant differences in recipients' baseline characteristics suggest an impact on lower survival.

Adolescent↗

PubMedDate not supplied

Increased response to subcutaneous erythropoietin on type I diabetic patients on CAPD: is there a synergistic effect with insulin?

OBJECTIVE: To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/week) by the hemoglobin (Hb) increment with respect to the basal level. PATIENTS: Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. RESULTS: The two groups showed similar mean baseline hemoglobin levels (7.4 D-I and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8 +/- 9.7 U/kg/g Hb increment) compared to nondiabetic (55.8 +/- 128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. CONCLUSIONS: According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.

Adult↗

PubMedDate not supplied

Liver transplantation with a twenty-four hour delay and an initial low dose of cyclosporine.

BACKGROUND/AIMS: Cyclosporine A based immunosuppression protocols have improved the results of liver transplantation. However, there is no general agreement concerning the most appropriate initial dose of cyclosporine or the precise moment we should start its administration. MATERIALS AND METHODS: Two cyclosporine A administration procedures in liver transplantation were analyzed by means of a prospective study using 91 consecutive patients and dividing them into two groups: Group A: 50 consecutive transplants in which cyclosporine was started since the surgery at 4 mg/kg/day, and Group B: the following 41 consecutive transplants in which cyclosporine was started 24 hours after transplantation at 2 mg/kg/day. RESULTS: Cyclosporine levels were higher in Group A in the first month (without significant differences). There were differences in the need for hemodialysis (14% vs 0%, p < 0.01), in the length of time (h) on mechanical ventilation (147.5 +/- 36 vs 48.7 +/- 15.7, p < 0.05) and in the time (d) spent in intensive care (10.5 +/- 1.6 vs 6.5 +/- 0.8, p < 0.05). There were no differences in the incidence of acute rejection, arterial blood pressure, septic and neurological complications, or in the actuarial survival rate for patients and grafts at 36 months. CONCLUSIONS: Delayed administration of cyclosporine simplifies the treatment of patients in the first 24 hours, it has several beneficial features and does not appear to be associated with a high acute rejection rate. On the basis of these results, our group has adopted delayed and low-dosage cyclosporine procedure.

Creatinine↗

PubMedDate not supplied

Infantile hemangiopericytoma of the musculoskeletal system: case report and literature review.

Infantile hemangiopericytoma is an uncommon cause of a soft-tissue mass in the neonatal period. Only 86 of these tumors have been reported in the literature. Thirty of these were located in the extremities. This review presents a case of infantile hemangiopericytoma localized to the knee in an 8-month-old infant. Current literature suggests that the majority of these lesions are benign, and surgical excision is curative. Recurrence and metastatic disease rarely occur. Because 30-50% of infantile hemangiopericytomas occur in the extremities, orthopaedic surgeons should be aware of and familiar with this tumor.

Extremities↗

PubMedDate not supplied

Effects of intraoperative blood transfusion on postoperative complications and survival after orthotopic liver transplantation.

BACKGROUND/AIMS: Massive blood transfusion related to the coagulation disorders occurring during the anhepatic and reperfusion phases, remains a serious problem during orthotopic liver transplantation. To analyze the influence of intraoperative blood transfusion on postoperative complications, and survival and to identify the preoperative variables associated with greater intraoperative bleeding, 100 orthotopic liver transplantations, carried out on adults, were reviewed in our center. METHODOLOGY: Patients were grouped into three categories according to intraoperative blood volume transfused; group A, 1.5 or less blood volumes transfused; group B, > 1.5 and < 3 volumes used and group C, 3 or more volumes given. RESULTS: Group C patients had a higher incidence of upper abdominal surgery (p < 0.01 between groups C and A. and p<0.05 between groups C and B); higher values of postoperative total bilirubin and SGOT, and lower prothrombin activity. Acute rejection and steroid-resistant episodes per patient occurred less commonly (p <0.01 between groups C and A) and so did chronic rejection (p <0.05 between groups C and B). Higher infection rate, and gastrointestinal and intraabdominal complication rates were also noticed in groups C and B (p < 0.01 and p < 0.05 respectively). Patient survival rates were lower in group C (p < 0.05 between groups C and A). CONCLUSIONS: It was concluded that previous upper abdominal surgery was the only preoperative factor associated with massive blood transfusion. Poor graft function during the first days after transplant, higher incidence of infections, higher incidence of gastrointestinal and intraabdominal complications, and lower rejection episodes and survival for patients receiving intraoperatively large amounts of blood can be expected.

Adult↗

PubMedDate not supplied

Orthotopic liver transplantation in 4 patients with portal hypertension and non-cirrhotic nodular liver.

BACKGROUND/AIMS: Non-cirrhotic nodular liver may occasionally be associated with portal hypertension, with complications such as ascites, bleeding esophageal varices and sometimes hepatic encephalopathy. Four patients treated with transplantation are hereby described. METHODOLOGY: All 4 patients had orthotopic transplantation. Cyclosporine based immunosuppression was used in all patients. RESULTS: The first patient had nodular regenerative hyperplasia in the resected native liver and in the graft seven years after the transplant, what could be considered as recurrence of the disease. There were two more cases of nodular regenerative hyperplasia; one of them was diagnosed 9 years before transplantation, but he developed progressive liver failure. The fourth patient had chronic renal failure and a nodular liver. His general condition and fear of untreatable ascites after a portosystemic shunt, prompted us to perform a liver-kidney transplantation. CONCLUSIONS: Portal hypertension associated with non-cirrhotic nodular liver disease can be, in general, successfully treated with medical and endoscopic measures, or in certain more serious cases with portosystemic shunting. Nevertheless, there are certain cases where liver insufficiency, associated diseases or the unawareness of the pathological diagnosis determines a liver transplantation.

Adult↗