Biomedical subjects
C Quereda
Publications and source records attributed to C Quereda.
Visceral leishmaniasis in renal transplant patients.
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Stroke in adult polycystic kidney disease.
In order to assess the incidence of acute cerebrovascular events, 142 patients with adult polycystic kidney disease were retrospectively reviewed. Fourteen patients (9.8%) had 19 cerebral attacks. Six patients (4.2%) had intracranial haemorrhage attacks (three ruptured intracranial aneurysms and three cerebral haemorrhages). Ischaemic events occurred in nine patients (five cerebral infarctions and four transient ischaemic attacks). Patients with ischaemic attacks had a better outcome than patients with haemorrhagic events even when transient ischaemic attacks were excluded. Patients with ruptured intracranial aneurysms were younger. Cerebral complications are an important cause of morbidity and mortality in patients with adult polycystic kidney disease. They can prove disabling prior to or after dialysis and transplantation.
In situ demonstration of Epstein-Barr virus in intravenous drug abusers with generalized lymphadenopathy.
We have studied by the in situ hybridization method the presence of Epstein-Barr virus (EBV) DNA genome in lymph node tissues from 11 patients with persistent generalized lymphadenopathy. Using a biotinylated EBV DNA probe, we demonstrated EBV nucleic acid in scattered germinal centre cells in eight of the 11 cases. Our results suggest that EBV is not a determinant factor in the pathogenesis of this lymphadenopathy, but support its possible implication in B cell malignant transformation in cases of AIDS-associated lymphoma.
Hemodynamic changes in the dog connected to a dialysis circuit: influence of the body temperature.
Eighteen sessions in 9 mongrel dogs were carried out to know the hemodynamic effects produced by body temperature variation, when blood passes through a dialysis circuit with a Cuprophan dialyzer, without dialysate contact. The decrease of 2 degrees C in body temperature caused a decrease in heart rate and cardiac index (-8.6 and -17.6%, respectively) without significant changes in blood pressure. The increase of 2 degrees C in body temperature increased the heart rate, the cardiac index and the first derivative of ventricular pressure (+14.8, +17.3 and +27.8%, respectively) with a decrease of 13.6% in the systemic vascular resistance. Blood pressure did not change significantly. We conclude that the dog maintains the hemodynamic stability by two different mechanisms: when body temperature rises, by increasing the cardiac index; when body temperature decreases, by increasing the systemic vascular resistance.
Colorimetric nonisotopic method for in situ hybridization detection of cytomegalovirus in renal allograft biopsies.
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[Acute cholecystitis caused by Candida albicans].
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[Prevalence of Chlamydia pneumoniae infection among pneumonias in a sample of Spanish hospital population].
BACKGROUND: The importance of Chlamydia pneumoniae as a cause of respiratory tract infection in humans has been shown recently. There is no data in Mediterranean countries about C. pneumoniae infection. METHODS: We tested acute and convalescent serum collected from 103 Spanish pneumoniae patients from 1979 to 1987. The microimmunofluorescent test (MIF) with C. pneumoniae and other Chlamydia antigens to exclude cross reactions was used. Serological evidence of current infection was a fourfold rise in IgG antibody titer o titer 1/6 in the IgM serum fraction in the MIF test. RESULTS: The mean age of the patients was 52 years (typical deviation 18, with an age range of 13 to 83) and 75% were male. Serological data of recent infection was found in four of the 103 patients and 59 had antibodies in the IgG fraction indicative of previous infection. CONCLUSIONS: These finding show that C. pneumoniae is associated with pneumonia in Spain and that there is a wide contact with this agent in the patient population with lower respiratory tract infection.
Joint manifestations of Lyme disease in Spain.
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Evidence that addition of azathioprine improves renal function in cyclosporine-treated patients with allograft dysfunction.
Several approaches have been attempted to manage renal allograft dysfunction in cyclosporine-prednisone (CsA-Pred)-treated patients. Conversion to conventional therapy and perioperative triple drug have been associated with high rates of acute rejection episodes, infections, or neoplasms. We report our experience in delayed addition of azathioprine (1-2 mg/kg/day) to CsA/Pred protocol in three groups of patients. Group I (n = 9) had chronic renal function deterioration due to chronic rejection; group II (n = 10) had repeated or severe acute rejection episodes despite adequate CsA levels; and group III (n = 8) had CsA toxicity despite drug tapering. In group I, serum creatinine (SCr) had risen from 2.2 +/- 0.9 to 2.9 +/- 0.7 mg/dl over the 6 months prior to Aza addition (P less than 0.05), renal function declining at a rate of -0.14 +/- 0.12 Cr-1/year. In the 6-month post-Aza, renal function improved at a rate of 0.06 +/- 0.06 Cr-1/year and during the entire follow-up at a rate of 0.04 +/- 0.12 Cr-1/year (P less than 0.05) with stable CsA levels (288 +/- 167 vs. 251 +/- 172 ng/dl, NS). In group II response was worse, though the rate of declining renal function prior to Aza (-0.10 +/- 0.10 Cr-1/year) was almost stopped after Aza. In group III there was very good response to Aza addition, as 7 out of 8 patients improved graft function (baseline SCr 2.5 +/- 0.7 mg/dl vs. 1.9 +/- 0.6 mg/dl at last follow-up, P less than 0.05), with significantly decreased CsA levels (480 +/- 97 vs. 268 +/- 120, P less than 0.05). One patient from group II died from pneumonia, and 6 patients (1 from group I and 5 from group II) lost their grafts. Fifteen patients improved graft function, and 9 worsened after addition of Aza. The bad-responders had significantly higher SCr at baseline compared with the good-responders (3.8 +/- 1.8 vs. 2.7 +/- 0.6 mg/dl, P less than 0.01). Amelioration of chronic graft dysfunction can be achieved by delayed addition of Aza to CsA-Pred in patients with chronic rejection or CsA toxicity. This is accompanied by low rate of acute rejection, good patient and graft survival, and low rate of infections. A worse outcome can be seen in patients with high-baseline SCr levels, suggesting the need for addition of Aza in the initial chronic graft dysfunction.
Nonenzymatic glycosylation of hemoglobin and total plasmatic proteins in end-stage renal disease.
In order to ascertain whether there are abnormalities of nonenzymatic glycosylation in uremia, the levels of nonenzymatically glycosylated hemoglobin (GHb), and total plasmatic glycosylated proteins (PGP) were studied using the thiobarbituric acid (TBA) method, a procedure not interfered with by carbamylation. Total hemoglobin A1 (HbA1) and the A1c fraction were also determined by ion exchange chromatographic methods. Sixty-six end-stage renal disease patients (29 nondiabetic and 8 diabetic uremic patients on conservative treatment, 29 nondiabetic hemodialysis patients) and 56 controls (32 nonuremic diabetic patients and 24 healthy controls) were studied. High levels of GHb and total PGP were found in the nondiabetic uremic group on conservative treatment with all the methods used, but the persistence of high chromatographically determined HbA1 levels in hemodialysis patients contrasts with the results obtained with the other techniques, which showed lower values on hemodialysis. Nondiabetic uremic patients with abnormal oral glucose tolerance curves had significantly higher levels of TBA-determined GHb and PGP. Uremic diabetic patients had the highest glycosylation levels of all the studied groups. We conclude that there is an abnormal nonenzymatic glycosylation of proteins in uremia, independent of carbamylation reactions and partially corrected by hemodialysis.
End-stage renal disease in a patient with amyloidosis secondary to acne conglobata.
The clinical profile of a patient with a 15 years' evolution of acne conglobata developing systemic amyloidosis with severe renal involvement is described, and the possible influence of suppurative skin foci surgical excision on the rapid progression to terminal renal failure is discussed. This etiological cause of secondary amyloidosis has rarely been reported as a cause of end-stage renal disease.
Thrombotic microangiopathic nephropathy in scleroderma and lupus anticoagulant.
A 47-year-old woman with overlap scleroderma-polymyositis syndrome and positive circulating lupus anticoagulant developed scleroderma nephropathy, characterized by rapidly progressive renal failure caused by thrombotic microangiopathy with widespread thrombi in small arteries and glomeruli. The possible relationship between lupus anticoagulant and the development of thrombosis at the small renal vessels level with the triggering of the scleroderma crisis is discussed.
[Imipenem-cilastatin cure of meningitis caused by Acinetobacter calcoaceticus].
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[Autochthonous amebic liver abscess in a heterosexual man with human immunodeficiency virus infection].
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Concomitant tuberculous and staphylococcal osteomyelitis.
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Epidemiology of symptomatic hypotension in hemodialysis: is cool dialysate beneficial for all patients?
A prospective study on hypotension in hemodialysis was performed in 60 nondiabetic patients at two different dialysate temperatures during 12 months. A 37 degrees C bath (3,723 sessions) was used and after the first 6 months the temperature was changed to 35 degrees C (4,019 sessions). The prevalence of symptomatic hypotension was 15.3% and it was closely correlated with the presence of other symptoms. The most affected populations were women, patients over 55 years of age, patients with low body surface area and patients with a cardiovascular disease. A slight but significant decrease of symptomatic hypotension was seen by using a 35 degrees C dialysate (16.4 vs. 14.3%, p less than 0.01). In patients with frequent hypotension (in up to 30% of sessions), cool dialysate significantly reduced the incidence of the symptom (44.2 vs. 34.1%, p less than 0.001). These results were obtained in spite of a greater interdialysis weight gain at low temperature (2 +/- 0.6 vs. 1.9 +/- 0.7 kg, p less than 0.001). We consider that low-temperature dialysis is a simple, useful and economic procedure, especially for highly symptomatic patients. The association of cooling dialysate with higher sodium concentration, bicarbonate and special membranes could reduce dialysis symptoms dramatically.
Clinical features and prognosis of adult polycystic kidney disease.
To appraise the prognosis of adult polycystic kidney disease (APKD), 107 patients (58 male and 49 female) were studied retrospectively. The mean age at the time of diagnosis was 45.9 years (ages ranging from 18 to 83 years). Ninety-eight patients had symptomatic APKD. At diagnosis, 30 of these patients had normal renal function, and 68 presented with chronic renal failure (serum creatinine higher than 1.5 mg/dl). Nine of the 107 patients were asymptomatic. Hypertension was the most common feature in symptomatic APKD, present in 51% of these patients as initial manifestation, and was observed in 46% of the patients with normal renal function. Forty of the 107 patients (37%) went into end-stage renal disease (ESRD) at a mean age of 52.7 years. The probability of being alive and not having ESRD, estimated using a time-to-event analysis, was 74% by the age of 50, 51% by the age of 58 and 37% by the age of 70 years. Thus, the prognosis for patients with APKD is better than some reports suggested some years ago.