18 results on '"De Gracia, R."'
Search Results
2. Choque extraarticular de cadera secundario a consolidación viciosa tras fractura-avulsión de la espina ilíaca antero inferior : a propósito de un caso
- Author
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Matellanes Palacios, C., Estrems Díaz, V., Diranzo García, J., Moratalla De Gracia, R., Hernández Ferrando, L., and Brú Pomer, Antonio
- Subjects
musculoskeletal diseases ,UNESCO::CIENCIAS MÉDICAS ,CIENCIAS MÉDICAS [UNESCO] ,musculoskeletal system - Abstract
The anterior inferior iliac spine (AIIS) avulsion fractures are uncommon, caused by a sudden contraction of the rectus femoris muscle with hyperextension of the hip and knee flexion. We present the clinical case of a 32-year-old mansuffering from pain in his right hip for several years with a history of a AIIS avulsion fracture in his childhood. He presented pain with flexion and internal rotation of the right hip. Physical examination and imaging tests revealed an extra-articular hip impingement secondary to a malunited fracture of AIIS. The patient underwent surgery performing AIIS osteoplasty and excision of the ossification by an anterior mini-open approach. After surgery he was able to re-join sports activity. Malunited fracture of AIIS can cause an extra-articular hip impingement in young sports patients. The treatment by surgical excision of the hypertrophic spine through an anterior mini-open approach allows the correction of the deformity and an early reincorporation to sports activities.
- Published
- 2019
3. Hereditary renal amyloidosis associated with a novel mutation in the apolipoprotein AII gene
- Author
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De Gracia, R., Fernández, E.J., Riñón, C., Selgas, R., and Garcia-Bustos, J.
- Published
- 2006
4. Revisión del trasplante renal ortotópico en nuestro centro
- Author
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Carlos Jiménez, Hidalgo L, Fernando López Gil, Angel Tabernero, de Gracia R, Sanz A, and Fernando Escuin
- Subjects
Creatinine ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Urology ,Low molecular weight heparin ,Renal function ,Diverticulitis ,medicine.disease ,Thrombosis ,Surgery ,Catheter ,Stenosis ,chemistry.chemical_compound ,chemistry ,medicine ,business ,Kidney transplantation - Abstract
UNLABELLED Orthotopic renal transplant (ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form. AIM To review the indication, surgical technique and outcome of the ORT at our hospital. MATERIAL AND METHODS The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated. RESULTS Left ORT was performed in three men and two women. Mean patient age was 52+/-5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2.2+/-0.72 mg/dl and 103+/-17.2 mg/dl and at 6 months postoperative were 1.8+/-0.59 mg/dl and 78+/-14 mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1.3 mg/dl and 1.4 mg/dl respectively). CONCLUSION ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.
- Published
- 2007
5. Revisión del trasplante renal ortotópico en nuestro centro: our experience
- Author
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De Gracia, R., Jiménez, C., Gil, F., Escuin, F., Tabernero, A., Sanz, A., and Hidalgo, L.
- Subjects
Orthotopic renal transplant ,Stenosis ,Hemorragia ,Bleeding ,Trasplante renal ortotópico ,Atherosclerosis ,Aterosclerosis ,Estenosis - Abstract
El trasplante renal ortotópico(TRO) es útil en casos de aterosclerosis severa, trasplante heterotópico bilateral, anomalías vasculares pélvicas y en oclusión aórtica, pero no está disponible en todos los centros y sólo se realiza de forma excepcional. Objetivo: Revisar la indicación, técnica quirúrgica y evolución del TRO en nuestro hospital. Material y métodos: Se recogieron todos los casos de TRO realizados desde enero-1990 hasta enero-2007, en total seis casos. Analizamos distintas variables: características demográficas, características del donante, tiempos de isquemia, evolución de función renal y morbi-mortalidad asociada. Resultados: TRO izquierdo se ha realizado en cuatro hombres y dos mujeres. La edad media de los pacientes fue 52±5 años, todos los pacientes recibieron riñones de donante cadáver. La creatinina sérica y urea media al mes fueron 2,2±0,72mg/dl y 103±17,2mg/dl y a los 6 meses fueron 1,8±0,69mg/dl y 78±14mg/dl respectivamente. De forma inmediata todos recibieron profilaxis con heparina de bajo peso molecular pero al alta a dos pacientes se indicó antiagregación, a tres anticoagulación y a uno de ellos se decidió no anticoagular ni antiagregar por presentar historia de sangrados digestivos. Un paciente murió por episodio hemorrágico a nivel del injerto renal a los seis meses del trasplante, estando en tratamiento con dicumarínicos, indicados por trombosis venosa profunda en miembro inferior derecho(MID). La supervivencia al año es del 80% del injerto y del paciente. Sólo dos pacientes requirieron ingreso posterior, uno de ellos por presentar un episodio de diverticulitis y otro por un cuadro de fracaso renal obstructivo que requirió colocación de catéter pig-tail. Cuatro pacientes presentaron estenosis de vasos renales nativos detectada en la resonancia magnética nuclear de control no sintomática. Hay dos pacientes que llevan más de tres años trasplantados con función renal estable(creatinina 1,2 mg/dl y 1,4 mg/dl respectivamente). Conclusión: TRO es una opción adecuada en los pacientes con co-morbilidad aumentada por ateromatosis y que no pueden ser colocados en las fosas iliacas. Orthotopic renal transplant(ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form. Aim: To review the indication, surgical technique and outcome of the ORT at our hospital. Material and methods: The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated. Results: Left ORT was performed in three men and two women. Mean patient age was 52±5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2,2±0,72mg/dl and 103±17,2mg/dl and at 6 months postoperative were 1,8±0,59mg/dl and 78±14mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1,3mg/dl and 1,4mg/dl respectively). Conclusion: ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.
- Published
- 2007
6. [Intravenous immunoglobulin: another therapeutic application]
- Author
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de Gracia R, Carlos Jimenez, Gil F, Escuín F, Castell J, and Sanz A
- Subjects
Adult ,Graft Rejection ,Immunosuppression Therapy ,Humans ,Immunoglobulins, Intravenous ,Female ,Kidney Transplantation - Abstract
Intravenous immunoglobulin (IVIG) has immunoregulatory functions. In renal transplant, IVIG has been used as an immunosupressor agent only during short period of time and frequently associated to others immunosupressor drugs. In renal transplant IVIG has been used to treat refractory rejection but not as maintenance immunosupressor treatment. We report a case in which IVIG was used as principal immunosupressor agent close to low doses of iv methylprednisolone. The patient could not receive anything by oral way during three months, so she only could be treated by intravenous way. It is the first time that IVIG is used as maintenance immunosupressortreatment for a long time (three months) without secondary effects.
- Published
- 2007
7. SPANISH MULTICENTRIC STUDY ABOUT NUTRITION-INFLAMATIONhn WITH MID DILUTION (ENIMID STUDY): PRELIMINARY RESULTS
- Author
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Barril, G, primary, Anaya, S, additional, Vozmediano, C, additional, Celayeta, AO, additional, Novillo, R, additional, Garcia-Bernal, V, additional, Beired, I, additional, Huarte, E, additional, Chacón, JC, additional, Martín, J, additional, Santana, H, additional, Grande, J, additional, Chacon, JC, additional, Garcia, Martin, additional, Sousa, F, additional, J Gago, Martin, additional, Sánchez, R, additional, López-Montes, A, additional, de Gracia, R, additional, Tornero, F, additional, Usón, J, additional, Pousa, M, additional, Cigarran, S, additional, Giorgi, M, additional, Rdez Cubillo, B, additional, Herrero, J, additional, Izdo, MJ, additional, and Abaigar, P, additional
- Published
- 2012
- Full Text
- View/download PDF
8. Epithelial-to-mesenchymal transition of mesothelial cells is an early event during peritoneal dialysis and is associated with high peritoneal transport
- Author
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del Peso, G., primary, Jiménez-Heffernan, J.A., additional, Bajo, M.A., additional, Aroeira, L.S., additional, Aguilera, A., additional, Fernández-Perpén, A., additional, Cirugeda, A., additional, Castro, M.J., additional, de Gracia, R., additional, Sánchez-Villanueva, R., additional, Sánchez-Tomero, J.A., additional, López-Cabrera, M., additional, and Selgas, R., additional
- Published
- 2008
- Full Text
- View/download PDF
9. Revisión del trasplante renal ortotópico en nuestro centro: our experience
- Author
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De Gracia, R., primary, Jiménez, C., additional, Gil, F., additional, Escuin, F., additional, Tabernero, A., additional, Sanz, A., additional, and Hidalgo, L., additional
- Published
- 2007
- Full Text
- View/download PDF
10. Hipertensión arterial compleja
- Author
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de Gracia, R., primary, Torre, A., additional, Pacios, J.C., additional, Coronado, M., additional, García, F., additional, and Selgas, R., additional
- Published
- 2006
- Full Text
- View/download PDF
11. Peritoneal transport in peritoneal dialysis patients is not affected by transitorily successful renal transplantation
- Author
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Ej, Fernández, del Peso G, Bajo A, Carlos Jimenez, de Gracia R, Ros S, and Selgas R
12. [Orthotopic renal transplant: our experience]
- Author
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de Gracia R, Carlos Jimenez, Tabernero A, and Sanz A
- Subjects
Male ,Treatment Outcome ,Humans ,Female ,Middle Aged ,Kidney Transplantation
13. COVID 19 and high pregnancy and perinatal complications in Panama.
- Author
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Sánchez J, Espinosa J, Caballero LC, Campana BS, Quintero A, Luo C, Ng CJ, de Gracia R, and Vigil-De Gracia P
- Subjects
- Infant, Newborn, Female, Humans, Pregnancy, SARS-CoV-2, Cesarean Section, Parturition, Pregnancy Outcome epidemiology, COVID-19 complications, COVID-19 epidemiology, Premature Birth epidemiology, Pregnancy Complications, Infectious epidemiology, Pregnancy Complications, Infectious diagnosis
- Abstract
Objectives: To report the maternal and neonatal results of patients infected with COVID-19 in Panama., Methods: The study is based on the analysis of pregnant women with COVID-19, in five hospitals in the Republic of Panama. The inclusion criteria were: patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those five hospitals and who signed the consent. Data were obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn., Results: Two hundred and fifty-three patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by cesarean section (58%). 26.9% (95% CI 21.3-32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0-9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the cohort and there were four maternal deaths (1.6% - 95% CI 0.6-4.0%)., Conclusions: This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity, and perinatal lethality were also seen.
- Published
- 2022
- Full Text
- View/download PDF
14. Trough tacrolimus concentrations in the first week after kidney transplantation are related to acute rejection.
- Author
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Borobia AM, Romero I, Jimenez C, Gil F, Ramirez E, De Gracia R, Escuin F, Gonzalez E, and Sansuán AJ
- Subjects
- Humans, Immunosuppressive Agents, Kidney Transplantation, Postoperative Complications, Tacrolimus isolation & purification, Graft Rejection therapy, Tacrolimus pharmacology
- Abstract
There is evidence showing the importance of reaching immunosuppressant target concentrations as soon as possible. The aim of this study was to evaluate the relationship between tacrolimus trough concentrations within the first week after transplantation and the rate of acute rejection. In this descriptive-analytic study, we included 57 renal transplant patients receiving tacrolimus as the primary immunosuppressive drug. After univariate analysis, donor age, duration of hospital stay, and creatinine clearance (third month) showed significant differences between rejecters and nonrejecters. In addition, mean tacrolimus trough concentrations on day 5, day 7, mean of days 1-7, and mean of days 5-7 were found to be significantly lower in rejecters (P = 0.009, P = 0.012, P = 0.006, and P = 0.035, respectively). Receiver operating characteristic curve analysis with tacrolimus trough concentrations measured on days 5 and 7 was able to discriminate between patients with and without acute rejection (P = 0.028 and P = 0.048 after Bonferroni correction). The tacrolimus trough concentration with the best sensitivity-specificity balance was 9.3 ng/mL on day 5 and 8.7 ng/mL on day 7. In the Kaplan-Meier analysis, patients with tacrolimus trough concentrations below 9.3 mg/mL on day 5 showed a lower survival time without acute rejection (P = 0.048 after correction) in comparison with patients with tacrolimus trough concentrations above this concentration. After logistic regression, we obtained a model relating rejection with sex, donor age, and tacrolimus trough concentrations on day 5 (P = 0.004). No significant relationship between tacrolimus trough concentrations and delta creatinine clearance from week 1 to month 3 was obtained. These results confirm that tacrolimus trough concentrations during the first week are an important predictor of acute rejection. Therefore, it is critical to reach target blood concentrations of tacrolimus as soon as possible to improve allograft survival.
- Published
- 2009
- Full Text
- View/download PDF
15. In situ kidney insonation with microbubble contrast agents does not cause renal tissue damage in a porcine model.
- Author
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Jiménez C, de Gracia R, Aguilera A, Alonso S, Cirugeda A, Benito J, Regojo RM, Aguilar R, Warlters A, Gómez R, Largo C, and Selgas R
- Subjects
- Animals, Contrast Media, Humans, Kidney injuries, Microbubbles, Risk Assessment methods, Swine, Ultrasonography, Kidney cytology, Kidney diagnostic imaging, Models, Animal, Sonication, Sulfur Hexafluoride adverse effects
- Abstract
Objective: Knowledge and quantification of the microcirculation are very important for estimating the status of an organ. Real-time contrast-enhanced sonography assesses microvascular tissue perfusion. This technique has been proposed as innocuous; however, data from experimental animals (rats) have shown renal interstitial microhemorrhage after the procedure. Therefore, we developed a porcine model to explore potential renal damage that in situ exposure might cause., Methods: Kidneys from 8 anesthetized pigs were surgically exposed. An ultrasound contrast agent (sulfur hexafluoride) was infused through the femoral vein in a continuous perfusion. Destructive ultrasonic flashes were applied with a high mechanical index over only 1 kidney (the contralateral kidney was used as a control). Blinded histologic and laboratory analyses were performed to reveal any lesions., Results: Histologic analysis of the kidney samples showed no evidence of renal damage. Biochemical parameters that could represent renal tissue damage and hemoglobin levels did not change after the microbubble-ultrasound interaction., Conclusions: The ultrasound contrast agent-ultrasound interaction in anesthetized pig kidneys under the output level for the imaging visualization and microbubble destruction used did not cause tissue damage. Our results suggest that this procedure could be used in humans for regular analysis of the kidney microcirculation with minimal risk of tissue damage.
- Published
- 2008
- Full Text
- View/download PDF
16. [Orthotopic renal transplant: our experience].
- Author
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De Gracia R, Jiménez C, Gil F, Escuin F, Tabernero A, Sanz A, and Hidalgo L
- Subjects
- Adult, Atherosclerosis complications, Female, Humans, Kidney Failure, Chronic complications, Kidney Failure, Chronic surgery, Male, Middle Aged, Treatment Outcome, Kidney Transplantation adverse effects, Kidney Transplantation methods
- Abstract
Unlabelled: Orthotopic renal transplant (ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form., Aim: To review the indication, surgical technique and outcome of the ORT at our hospital., Material and Methods: The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated., Results: Left ORT was performed in three men and two women. Mean patient age was 52+/-5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2.2+/-0.72 mg/dl and 103+/-17.2 mg/dl and at 6 months postoperative were 1.8+/-0.59 mg/dl and 78+/-14 mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1.3 mg/dl and 1.4 mg/dl respectively)., Conclusion: ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.
- Published
- 2007
- Full Text
- View/download PDF
17. Peritoneal transport in peritoneal dialysis patients is not affected by transitorily successful renal transplantation.
- Author
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Fernández EJ, del Peso G, Bajo A, Jiménez C, de Gracia R, Ros S, and Selgas R
- Subjects
- Adult, Biological Transport, Creatinine metabolism, Female, Humans, Male, Urea metabolism, Kidney Transplantation, Peritoneal Dialysis, Peritoneum metabolism
- Abstract
Patients returning to peritoneal dialysis (PD) from failed renal transplantation are recognized to be inflamed, and this situation might produce a high peritoneal solute transport status. We wanted to determine if a period of time with a kidney allograft induces a change in peritoneal function. We studied 19 PD patients who had been living with a graft for a mean of 47 +/- 39 months. We studied their peritoneal function upon starting PD (baseline), immediately before transplantation (pre-Tx), and after returning to PD when the graft failed (post-Tx). We analyzed the peritoneal mass transfer coefficients for urea (U-MTAC) and creatinine (Cr-MTAC), the dialysate-to-plasma ratio of creatinine (D/P-Cr), and net ultrafiltration (UF). We observed no significant differences in the various variables pre-Tx and post-Tx. The U-MTAC post-Tx was significantly lower than at PD baseline (25.9 +/- 8 mL/min vs. 20.2 +/- 5 mL/min, p = 0.03). The U-MTAC and Cr-MTAC post-Tx were not correlated with months on a graft or with MTAC values at baseline. In inherent high transporters (Cr-MTAC > or = 11.5 mL/min at baseline, n = 8), we observed a significant reduction in Cr-MTAC post-Tx (15.2 +/- 2 mL/min vs. 10.2 +/- 4 mL/min, p = 0.03). Three of these patients remained high transporters post-Tx. We conclude that peritoneal function upon reinitiating PD after transplantation is similar to function in the pre-transplantation phase; and that a high peritoneal transport status is more prevalent at first initiation onto PD than at return after transplantation, suggesting that inherently high transport is almost exclusively a feature of an intact, predialysis peritoneum.
- Published
- 2006
18. [Endometriosis in the episiotomy scar: a case report and review of the literature].
- Author
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Olmos Cortés A, Núñez Jáurequi P, Hernández L, and De Gracia R
- Subjects
- Adult, Cicatrix complications, Cicatrix surgery, Endometriosis etiology, Endometriosis surgery, Female, Humans, Perineum surgery, Postoperative Complications etiology, Postoperative Complications surgery, Cicatrix pathology, Endometriosis pathology, Episiotomy, Perineum pathology, Postoperative Complications pathology
- Abstract
We hereby present a case of perineal endometriosis at the site of an episiotomy scar. Several considerations are made about its incidence, medical and surgical treatment and risks of this very rare complication in episiotomy scar by revision of the medical literature.
- Published
- 1993
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