Biomedical subjects
Publications and source records attributed to F Anaya.
We analyzed the function and outcome of 16 kidney transplants performed in our hospital from non-heart-beating donors who were harvested at other hospitals. The cold ischemia times were longer and the delayed graft function rates higher. However, graft function was no different from that of kidneys from heart-beating donors. This experience has encouraged us to use this type of donor to reduce the transplant waiting list.
The purpose of this study was to investigate the incidence and risk factors for the development of diabetes mellitus after kidney transplantation (PTDM). A total of 1783 nondiabetic renal allograft recipients transplanted from January 2000 to December 2002 were included. Diabetes was diagnosed following American Diabetes Association criteria. While 1276 patients were treated with tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids, 507 patients received cyclosporine-ME (CsA), MMF, and steroids. PTDM incidence at 6, 12, and 24 months was 14.2%, 12.8%, and 13.3%, respectively. Cumulative incidence during the follow-up was 21.6%. Only 121 of the diabetic patients (47.6%) at 6 months remained diabetic at 24 months. Furthermore, 60 patients of 116 patients on insulin at 6 months (51.7%) remained on treatment at 24 months. The cumulative incidence of PTDM was similar in the two immunosuppressive treatments (19.7% on CsA-MMF vs 22.3% on Tac-MMF; P = NS). However, at 24 months, 14 of 50 diabetic patients on CsA-MMF (28%) and 74 of 161 patients on Tac-MMF (45.9%) were on insulin treatment (P < .05). By Cox regression analysis, age older than 60 years (RR 1.61; 95%CI 1.28-2.04; P < .001), body mass index (BMI) > 30 kg/m2 at transplantation (RR 1.66; 95%CI 1.27-2.16; P < .001), and immunosuppression with Tac (RR 1.30; 95%CI 1.02-1-66; P = .033) were associated with PTDM. In conclusions, the incidence of PTDM at 24 months in immunosuppressive protocols including MMF is about 22%, and it is associated with older age, increased BMI, and immnunosuppression with Tac.
Secundary tumors of the paranasal sinus are very uncommon with only one hundred cases reported in the literature up to 2001. The commonest site of the primary tumor is the kidney. The maxillary sinus is most often involved. The Sphenoid sinus is the rarest site. We report a rare case of metastasis to the sphenoid sinces from a transitional cell bladder tumor in a 69-year-old man who died after treatment with chemotherapy and we also review the liteature.
The incidence of cryptococosis ranges from 0.4-5.8% in renal transplant. Meningitis is the principal clinical manifestation, frequently with a subacute curse. In renal transplantation recipients, disseminated cryptococcosis appears as the more frequent presentation. We report a case of a 32 years old woman renal transplant recipient who presents altered mental status, headache and tremor during the month before her assessment to our hospital. Microbiological study was performed in cerebrospinal fluid and cryptococcus was isolated. She was treated with amphotericin B and 5 flucytosine. She developed refractory increased intracranial pressure and a lumboperitoneal derivation was necessary. Cryptococcosis must be considered as cause of meningitis in patients with renal transplant. The early diagnosis and treatment are fundamental due to high mortality of this pathology.
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Hypertension is highly prevalent after renal transplantation and has been associated with lower graft survival. Optimum management of post-transplant hypertension remains to be defined. Losartan, a potent, orally active and selective non-peptide blocker of the angiotensin subtype 1 receptor, could represent a useful drug for treating post-transplant hypertension. Recently, a prospective study of 12 weeks treatment with losartan has showed a satisfactory control of arterial hypertension associated with a decrease in proteinuria in this high-risk group of renal transplant patients. A retrospective study was performed to review the role of losartan as a renoprotective agent (evaluating blood pressure and proteinuria) in renal transplant recipients in a long-term follow-up. A total of 150 transplant recipients were included in the study. None of the patients had a serum creatinine >3 mg/dl, or suspected renal artery stenosis, or other severe concomitant diseases. The indication for losartan therapy was hypertension, proteinuria and/or post-transplant erythrocytosis. The values of blood pressure, results of fasting haematology, blood chemistry and total proteinuria in 24-h urine samples were recorded at the time of initiation of losartan therapy, 6 and 3 months before the start, and at 3, 6, 12, 18 and 24 months thereafter. A tendency analysis by linear regression comparing two slopes before and after treatment was realized. A decrease in mean blood pressure and proteinuria, from 106.7+/-0.9 to 98.2+/-2.1 mmHg and from 1253.9+/-188 to 91.2+/-33.7 mg/24 h, P<0.05, respectively, was observed after introduction of losartan. A progressive increase in creatinine clearance was observed after the third month of losartan treatment. No significant changes were seen in haematocrit or serum potassium levels. We can conclude that a progressive decrease in mean arterial pressure associated with a decrease in proteinuria was observed during long-term follow-up. Based on the capacity of losartan to improve renal function, this drug could be decisive for the treatment and prevention of chronic allograft nephropathy.
Branisella boliviana, from the Late Oligocene of Salla, Bolivia, is the oldest fossil platyrrhine monkey discovered. To date, several fossil specimens of Branisella have been obtained, but most of them are fragmentary dentitions, so the animals craniodental morphology is still obscure. During the 1996 field season a pair of upper and lower jaw fragments and another nearly complete mandible were recovered. These new fossil materials reveal the following morphological features in Branisella: 1) P(2) is much smaller than P(3,4), whereas P(2) is relatively small but probably sexually dimorphic; 2) the zygomatic arch protrudes smoothly posterolaterally from the maxillary bone, as in extant Callicebus; 3) the mandibular arcade is nearly V-shaped and the symphysial angle, which is formed by the horizontal plane and the anterior face of mandibular symphysis, is about 40 degrees, i.e., it neither leans as far anteriorly as in callitrichines nor does it stand as vertically as Cebus; 4) upper and lower molars wore down rapidly in life, suggesting a herbivorous diet and the possibility of terrestriality; and 5) dental eruptive sequence is the same as in extant Aotus. As a whole, the dentition of Branisella is very similar to that of Proteopithecus from the Late Eocene of Fayum, Egypt, except in the lower canine morphology, suggesting a close phyletic relationship between them. The origin and early diversification of platyrrhine monkeys might have occurred on the African continent before crossing the Atlantic Ocean.
BACKGROUND: In endemic areas, visceral leishmaniasis has been identified as an opportunistic infection in patients with derangements in their cellular immune system. METHODS: We report a renal transplant patient with visceral leishmaniasis. We also reviewed the previously published cases of 17 organ transplant recipients with this parasitic disease. RESULTS: Visceral leishmaniasis occurred a median time of 8 months after transplantation, and the clinical picture was characterized by fever, splenomegaly, and blood cytopenias. Leishmaniae were detected in bone marrow in 16 of 18 patients and diagnostic serology results were found in 8 of 10 tested patients. Pentavalent antimonials were used to treat 16 patients, five of which developed pancreatitis. Five of 18 patients died, including two untreated patients. Relapses of visceral leishmaniasis occurred in 4 of 13 survivors. CONCLUSIONS: In endemic areas, visceral leishmaniasis may complicate the clinical course of organ transplantation and can have fatal consequences, particularly when untreated.
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During the 1992 and 1993 field seasons, several new specimens of Branisella boliviana, the oldest fossil platyrrhine, were discovered in the late Oligocene deposits at Salla, northwestern Bolivia. The new materials are two maxillary fragments and seven mandibular fragments, including P3 and P2, neither of which have previously been recovered. All new and previously reported materials, including the holotype and referred specimens, were apparently recovered from the same horizon, called the Branisella zone (MacFadden et al. [1985] J. Geol. 93:223-250; MacFadden [1990] J. Hum. Evol. 19:7-21. The crown morphology of the newly discovered upper and lower premolars suggests that Branisella has a close affinity with callitrichines. A detailed examination of all molar specimens suggests that "Szalatavus attricuspis," which was recovered at Salla in 1981 and described as a new genus by Rosenberger et al. (1991), is a junior synonym of Branisella. The Branisella-like upper molar, in which a small hypocone is preserved on the poorly developed distolingual cingulum, is a shared-derived character with callitrichines and does not correspond to the primitive state for platyrrhine phylogeny. The ancestral upper molar morphotype for platyrrhines should have a moderate to large hypocone and a well developed talon area.
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METHODS: Five patients with a family history of hypercholesterolemia were treated for one year with double filtered technique of LDL-apheresis: heterozygotic in four patient and homozygotic in one. All patients presented documented cardiovascular disease and had been treated unsuccessfully with lipid lowering drugs. RESULTS: Plasmatic cholesterol was significantly reduced from 463.8 +/- 60.9 mg/dl to 326.36 +/- 36 mg/dl at 6 months after treatment and 347.56 +/- 68.1 mg/dl at 12 months (p < 0.05). LDL was also reduced from 407.92 +/- 69.39 mg/dl to 294.04 +/- 62.02 mg/dl and 296.6 +/- 82.42 mg/dl respectively (p < 0.05) and Apo B was reduced from 291.84 +/- 28.97 mg/dl to 224.5 +/- 47.11 mg/dl at 6 and 12 months respectively, without significant modifications of other lipidic parameters and without adverse events. CONCLUSIONS: LDL-apheresis is a therapeutic approach effective in the reduction of total plasmatic cholesterol, in conjunction with to LDL and APO B in patients refractory to lipid lowering agents.
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