[Endothelial dysfunction in renal transplantation].
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Clinical Trials as Topic↗
Biomedical subjects
M Crespo
Publications and source records attributed to M Crespo.
Cyfra 21.1, TPS and SCC in squamous cell carcinoma of larynx.
BACKGROUND: Serologic tumor markers are actually a valuable tool for diagnosis, management and follow up in some cancer types. The concentrations of Cyfra 21.1, SCC and TPS has been analysed in several groups of head and neck tumors, but exclusively in larynx there are no studies concerning this subject. AIMS: The purpose of the present study was to assess the expression of serum fragments of cytokeratins (CK's) 18/19, and squamous cell carcinoma antigen (SCCA) in a same group of patients with squamous cell carcinoma of larynx, and correlate the results with tumor localisation, T, stage, histology, presence of regional metastasis, and smoking habits. METHODS: Forty six patients treated at the Department of Otorhinolaryngology, Porto Center of the Portuguese Institute of Oncology were enrolled in the study. Blood samples were obtained before treatment, and determinations effectuated using standard commercial available kits. RESULTS: Although serum concentrations of Cyfra 21.1, TPS and SCC were not significantly elevated in patients with laryngeal cancer, more expressive levels namely for TPS were observed in advanced supraglotic and metastasis tumors independent of the differentiation degree.
Antigens, Neoplasm↗
Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non- Pneumocystis carinii pneumonia in AIDS patients.
The aim of this study was to assess the value of high-resolution CT in distinguishing between Pneumocystis carinii and non- Pneumocystis carinii pneumonia (PCP) in patients HIV-positive and high risk to have PCP. We performed a prospective study in 30 patients with <200 CD4 lymphocytes, clinical symptoms of pulmonary disease and chest X-ray non-conclusive for pulmonary infection. Evaluated CT findings included ground-glass opacities, reticulation, tree-in-bud appearance, consolidation, cystic lesions, bronchiectasis and lymphadenopathies. The diagnosis of "examination suggestive of PCP" was applied to cases showing a diffuse or predominant ground-glass pattern in the upper fields, associated or not with reticulations and small cystic lesions. The sensitivity, specificity, positive predictive value and negative predictive value of high-resolution computed tomography (HRCT) for the diagnosis of PCP was 100, 83.3, 90.5 and 100%, respectively. Pneumocystis carinii pneumonia was not demonstrated in any of the cases classified as "examination not suggestive of PCP". Significant small airway disease was not observed in any of the PCP cases. We conclude that HRCT is a reliable method for differentiating PCP from other infectious processes in HIV-positive patients and a good method to rule our PCP. Its inclusion in the diagnostic algorithm of lung infections is justified in these patients.
AIDS-Related Opportunistic Infections↗
Adenocarcinoma of the esophagogastric junction: could the characteristics of adjacent intestinal metaplasia help in the understanding of biopathogenesis?
We report a case of early adenocarcinoma arising in foci of intestinal metaplasia (IM) at a normal-appearing gastroesophageal junction (GEJ). The tumor infiltrated the submucosa without nodal involvement (T1N0). Non-neoplastic mucosa adjacent to neoplasia had foci of incomplete IM with a band-like CK20 positivity of the surface epithelium and a diffuse CK7 staining of both superficial and deep glands. There were histological features of reflux esophagitis as well as chronic non-atrophic, Helicobacter pylori-related pangastritis, without IM, at the extensively assessed gastric mucosa. In this case, the CK7/20 pattern of IM adjacent to neoplasia, the demonstration of reflux esophagitis, and the absence of IM in the stomach favor the theory that the pathogenesis of IM and associated adenocarcinoma of the GEJ is related to gastroesophageal reflux rather than H. pylori infection.
Adenocarcinoma↗
Pharmacokinetic interaction between nevirapine and rifampicin in HIV-infected patients with tuberculosis.
To determine whether rifampicin reduces serum concentrations of nevirapine and whether nevirapine modifies serum concentrations of rifampicin, levels of these agents were determined at steady state by high-performance liquid chromatography in 10 HIV-infected patients with tuberculosis. The median area under the curve (AUC) 0-12h of nevirapine before and after rifampicin was 56.2 and 32.8 microg/ml per hour, respectively ( p =.04). This represents a 31% reduction in serum nevirapine concentrations. The C(max) decreased from 5.6 to 4.5 microg/ml ( p =.04), which represented a 36% reduction. A 21% decrease in the C(min) was not statistically significant. Exposure to rifampicin did not significantly differ between those patients who were receiving and were not receiving nevirapine. However, our study shows that rifampicin reduces serum exposure to nevirapine. The clinical implications for this reduction remain to be established. Given that the lowest trough serum concentration of nevirapine exceeded by more than 40 times the protein binding adjusted median infective dose (IC(50)) of wild-type HIV in all patients, we suggest that there is no need to increase nevirapine dosage when it is given with rifampicin.
Anti-HIV Agents↗
[Dyspepsia-related quality of life. Spanish adaptation and validation of the questionnaire Dyspepsia-Related Health Scale].
BACKGROUND: Dyspepsia affects about 25 % of the population and may cause an important decrease in quality of life. The aim of this work was to perform a Spanish validation and adaptation of the questionnaire DRHS (Dyspepsia Related Health Scale), a tool that assesses dyspepsia-related quality of life. PATIENTS AND METHOD: The study was carried out in 234 subjects, 163 with symptoms of dyspepsia and 71 health volunteers. Two rheumatologists, 2 general practitioners, 1 gastroenterologist, 1 clinical pharmacologist, 1 pharmacoepidemiologist and 1 psychologist were involved in the work. The process of adaptation and validation included translation and re-translation, pilot study in 16 patients, dimensionality, reliability and validity (of content, of construct, convergent, predictive and discriminative). RESULTS: The mean age was 49.1 years (SD: 18) and 60.7 % were females. The between-judges agreement rate of Hambleton and Rovinelli, which evaluates the content validity, was lower than 0.41. The construct validity assessed by the factorial analysis of responses showed that each subscale may be considered unidimensional in both health volunteers and individuals with dyspepsia. Reliability was satisfactory (Cronbach's alpha = 0.92) and stability of measures (test-retest) was excellent with a correlation coefficient of 0.95. The convergent validity, assessed by means of the EuroQoL, was only moderate with a correlation coefficient of 0.54 (p < 0.001). The predictive validity, assessed by administering the questionnaire 12 days after treating dyspepsia, showed a correlation coefficient of 0.47 between the two measures (p < 0.001). There was also a relationship between scores variation and outcome. CONCLUSIONS: The Spanish version of the DRHS, so-called QoL-PEI (questionnaire of quality of life related with problems of stomach and intestine), displays good metric properties and is able to predict the evolution of dyspepsia. The results of this study show that this tool is essentially unidimensional, yet it can be used on a multidimensional form to perform a differentiated assessment of each evaluated case.
Adolescent↗
Comparative analysis of adrenomedullin-like immunoreactivity in the hypothalamus of amphibians.
Adrenomedullin (AM) is a novel neuropeptide with special significance in the mammalian hypothalamo-hypophysial axis. By using an antiserum specific for human AM, we have studied the localization of AM-like immunoreactive (AMi) cell bodies and fibers in the hypothalamus and hypophysis of the amphibians Rana perezi (anuran), Pleurodeles waltl (urodele), and Dermophis mexicanus (gymnophionan). Distinct AMi cell groups were found for each species. In the anuran, six cell groups were localized in the preoptic and infundibular regions, whereas only three and one were found in the urodele and gymnophionan, respectively. A comparative analysis of AMi cells and cells expressing arginine vasotocin (AVT), neuropeptide Y (NPY), and tyrosine hydroxylase (TH) revealed strong differences between species. Thus, colocalization of AVT/AM is most likely to occur in the preoptic magnocellular nucleus of urodeles and it is reflected by the intense AM immunoreactivity in the neural lobe of the hypophysis. Colocalization of NPY/AM seems to be possible in the suprachiasmatic nucleus of anurans. In the gymnophionan, cells containing AVT and NPY are distinct from AMi cells. Only in anurans, the ventral aspect of the suprachiasmatic nucleus possesses a small population of AMi cells that express also TH immunoreactivity and most likely also express NPY. The results strongly suggest that AM in amphibians plays an important regulatory role in the hypothalamo-hypophysial system, as has been demonstrated in mammals. On the other hand, substantial differences have been found between species with respect to the degree of colocalization with other chemical substances.
Adrenomedullin↗
Acute humoral rejection in renal allograft recipients: I. Incidence, serology and clinical characteristics.
BACKGROUND: Acute rejection (AR) associated with de novo production of donor-specific antibodies (DSA) is a clinicopathological entity that carries a poor prognosis (acute humoral rejection, AHR). The aim of this study was to determine the incidence and clinical characteristics of AHR in renal allograft recipients, and to further analyze the antibodies involved. METHODS: During a 4-year period, 232 renal transplants (Tx) were performed at our institution. Assays for DSA included T and B cell cytotoxic and/or flow cytometric cross-matches and cytotoxic antibody screens (PRA). C4d complement staining was performed on frozen biopsy tissue. RESULTS: A total of 81 patients (35%) suffered at least one episode of AR within the first 3 months: 51 had steroid-insensitive AR whereas the remaining 30 had steroid-sensitive AR. No DSA were found in patients with steroid-sensitive AR. In contrast, circulating DSA were found in 19/51 patients (37%) with steroid-insensitive AR, and widespread C4d deposits in peritubular capillaries were present in 18 of these 19 (95%). In at least three cases, antibodies were against donor HLA class II antigens. DSA were not found in the remaining 32 patients but C4d staining was positive in 2 of 32. The DSA/C4d positive (n=18) and DSA/C4d negative (n=30) groups differed in pre-Tx PRA levels, percentage of re-Tx patients, refractoriness to antilymphocyte therapy, and outcome. Plasmapheresis and tacrolimus-mycophenolate mofetil rescue reversed rejection in 9 of 10 recipients with refractory AHR. CONCLUSION: More than one-third of the patients with steroid-insensitive AR had evidence of AHR, often resistant to antilymphocyte therapy. Most cases (95%) with DSA at the time of rejection had widespread C4d deposits in peritubular capillaries, suggesting a pathogenic role of the circulating alloantibody. Combined DSA testing and C4d staining provides a useful approach for the early diagnosis of AHR, a condition that often necessitates a more intensive therapeutic rescue regimen.
Acute Disease↗
Improvement of chronic renal failure after introduction of mycophenolate mofetil and reduction of cyclosporine dose.
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Journal Article↗
[Mycotic pseudoaneurysm caused by Mycobacterium tuberculosis].
Mycobacterium tuberculosis can involve any organ of the body, including the arteries. Usually the mycobacteria infects the arterial wall spreading from a contiguous foci. We report a case of tuberculous pseudoaneurysm involving the iliac artery clinically manifested as fever of unknown origin. The diagnosis relied on abdominal CT-scanning. Tuberculous etiology was confirmed postoperatively by microbiologic and microscopic study. The antituberculous therapy was early started, but the patient died three months later as a consequence of a non-infectious abdominal aortic rupture. Clinicians should consider tuberculous etiology when the diagnosis of mycotic pseudoaneurysm is being entertained.
Aged↗
Thalidomide for the treatment of acquired immunodeficiency syndrome-associated refractory oral ulcers.
A case of severe, oral, not otherwise specified ulcers in a human immunodeficiency virus-infected patient is described. The lesions did not respond to acyclovir, prednisone, pentoxifylline, or foscarnet sodium therapy. Dramatic clinical improvement and progressive ulcer healing were observed after starting oral thalidomide therapy. Clinicians should be aware of the usefulness of thalidomide for the treatment of acquired immunodeficiency syndrome-associated not otherwise specified ulcerations.
Acquired Immunodeficiency Syndrome↗
Patterns of sulfadiazine acute nephrotoxicity.
Sulfadiazine acute nephrotoxicity is reviving specially because of its use in toxoplasmosis in HIV-positive patients. We report 4 cases, one of them in a previously healthy person. Under treatment with sulfadiazine they developed oliguria, abdominal pain, renal failure and showed multiple radiolucent renal calculi in echography. All patients recovered their previous normal renal function after adequate hydration and alcalinization. A nephrostomy tube had to be placed in one of the patients for ureteral lithiasis in a single functional kidney. None of them needed dialysis or a renal biopsy because of a typical benign course. Treatment with sulfadiazine requires exquisite control of renal function, an increase in water ingestion and possibly the alcalinization of the urine. We communicate a case in a previously healthy person, a fact not found in the recent literature. Probably many more cases are not detected. We think that a prospective study would be useful.
AIDS-Related Opportunistic Infections↗
[Guidelines of the Spanish Society of Cardiology for clinical practice in exercise testing].
Most exercise testing is performed in adults with known or suspected ischemic heart disease. In the last few years cardiac imaging techniques have been applied in this field, improving the information obtained with the procedure. However, the exceptions to this rule are emerging rapidly not only in healthy people (asymptomatic individuals, athletes, handicapped people) but also in cardiac patients (advanced congestive heart failure, hypertension, rhythm disorders, congenital heart disease, etc.). All the-se issues justify the need for a multidisciplinary consensus document in Spain. This paper reviews and updates the methodological aspects of the stress test, including those related to oxygen consumption measurements. The main aim of this review was to determine the role of exercise testing in the evaluation of ischemic heart disease as well as the applications of imaging stress testing. The usefulness of this test in other non-ischemic cardiac disorders and in selected subsets of healthy people is also reviewed.
Adult↗
Influence of three different types of hypercalciuria on bone. An experimental study.
The relationship between bone mineral status and hypercalciuria is controversial. The effect on bone composition of different forms of hypercalciuria was studied in female rats made hypercalciuric by 7-week administration of oral furosemide (F, n=12), intraperitoneal 1,25-dihydroxy vitamin D (VD, n=11), or oral ammonium chloride (AC, n=12). Seven untreated rats served as controls (C). Hypercalciuria (mg/100 g per 24 h, mean +/-SEM) of F (4.3+/-0.2), VD (4.1+/-0.4), and AC (3.9+/-0.3) groups was of similar intensity (C rats 1.3+/-0.1, P<0.01). Weight and length gains and serum CO2, sodium, potassium, calcium, and phosphate were no different among the four groups. Bone was studied by dual-energy X-ray absorptiometry of left tibiae. AC rats had significantly less bone area (1.505+/-0.018 cm2) than VD and C (1.602+/-0.020 and 1.587+/-0.019 cm2). Bone mineral content was decreased in F (0.357+/-0.007 g) and AC (0.362+/-0.006 g) compared with VD (0.407+/-0.008 g) and C (0.389+/-0.009 g) groups. Bone mineral density was different between F (0.231+/-0.002 g/cm2) and VD and C rats (0.254+/-0.004 and 0.245+/-0.003 g/cm2), and also between AC (0.240+/-0.003 cm2) and VD rats. In these rat models, hypercalciuria of renal origin (F) and hypercalciuria caused by acid load (AC) adversely impaired bone mass.
Absorptiometry, Photon↗
Neurotoxicity due to imipenem/cilastatin in patients on continuous ambulatory peritoneal dialysis.
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Aged↗
Motivational climate and goal orientations as predictors of perceptions of improvement, satisfaction and coach ratings among tennis players.
One purpose of this work was to study the relationship of goal orientations and the perceived motivational climate created by the coach in relation to 219 competitive Spanish tennis players': a) perceived improvement in different facets of the game, b) satisfaction with their competitive results, overall level of play, and coach, and c) ratings of their coach. The second purpose was to examine whether the dependent variables were best predicted by the perceived situationally emphasized goal structure created by the coach and/or the athletes' dispositional goal perspective. Intermediate (N=70), advanced (N=124), and professional (N=25) level players completed Spanish versions of the TEOSQ and the PMCSQ-2 and items assessing perceived improvement specific to tennis, satisfaction and coach ratings. The results were consistent with the tenets of goal perspective theory and provide further support for the promotion of a task involving atmosphere in sport.
Achievement↗
Immunohistochemical detection of parathyroid hormone-related protein in a cutaneous squamous cell carcinoma causing humoral hypercalcemia of malignancy.
Humoral hypercalcemia of malignancy is a cancer-related hypercalcemia caused by production of humoral factors by malignant cells in patients without bone metastases. Squamous cell carcinomas are the tumors most frequently associated with humoral hypercalcemia of malignancy, and parathyroid hormone-related protein is the main humoral factor implicated. In spite of the fact that normal keratinocytes produce parathyroid hormone-related protein, it is highly unusual for patients with squamous cell carcinomas of the skin to present with humoral hypercalcemia of malignancy. We present a well-documented case of cutaneous squamous cell carcinoma complicated by hypercalcemia in a patient with high levels of plasma parathyroid hormone-related protein and immunohistochemical evidence of high parathyroid hormone-related protein production by the tumoral cells.
Aged↗
[Mediastinal adenopathies and peripheral arteritis].
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Adult↗