50 results on '"F. Escuin"'
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2. Prophylaxis and Treatment of Cytomegalovirus Infection Postrenal Transplantation in Two Madrid Units
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E. Fernández-Tagarro, J. Pascual, C. Galeano, Y. Amezquita, Argentina Fernández, F. Escuin, C. Jiménez, R. Sánchez Villanueva, and R. Marcén
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Adult ,Male ,Human cytomegalovirus ,medicine.medical_specialty ,Congenital cytomegalovirus infection ,Cytomegalovirus ,Kidney Function Tests ,Antiviral Agents ,Gastroenterology ,Asymptomatic ,Serology ,Pharmacotherapy ,Liver Function Tests ,Betaherpesvirinae ,Internal medicine ,medicine ,Humans ,Valganciclovir ,Ganciclovir ,Aged ,Monitoring, Physiologic ,Transplantation ,biology ,business.industry ,Middle Aged ,Viral Load ,biology.organism_classification ,medicine.disease ,Kidney Transplantation ,Surgery ,Spain ,Cytomegalovirus Infections ,Chemoprophylaxis ,Female ,Virus Activation ,medicine.symptom ,business ,Blood Chemical Analysis - Abstract
Introduction Complete prevention of cytomegalovirus (CMV) disease continues to be an unresolved problem in renal transplantation. Materials and Methods From January 2005 to May 2006, we implemented a protocol for early detection and preemptive treatment of CMV infection as detected by antigenemia or polymerase chain reaction determined every 2 weeks during the first 3 months posttransplant and monthly thereafter. Prophylaxis was given to all CMV-negative patients who received CMV-positive kidneys and to those who received polyclonal or monoclonal antibody induction therapy. Results Among 100 transplants, 15 subjects received prophylaxis due to poly- or monoclonal antibody induction and/or negative recipient serology using a mean valgancyclovir dose of 485 ± 276 mg/d for an average duration of 129 days. After completion of the prophylaxis four patients (26.6%) required preemptive therapy for asymptomatic virus reactivation; the mean dose of drug in these patients had been 450 ± 275.56 mg, with a treatment time that was significantly shorter than those not suffering reactivation (91.75 vs 143.45 days). In addition, preemptive therapy was given for virus reactivation in seven patients, for illness with mild viral syndrome in two, with moderate illness and positive pretransplantation serology in one. The average treatment time was 79 days and the mean dose was 375 mg. Conclusion In those not at risk, CMV infections occurred among 11.7% of patients in our early detection program. Prophylaxis for at-risk patients should continue for more than 3 months to prevent reactivation.
- Published
- 2009
3. [Orthotopic renal transplant: our experience]
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R, De Gracia, C, Jiménez, F, Gil, F, Escuin, A, Tabernero, A, Sanz, and L, Hidalgo
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Adult ,Male ,Treatment Outcome ,Humans ,Kidney Failure, Chronic ,Female ,Middle Aged ,Atherosclerosis ,Kidney Transplantation - Abstract
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.To review the indication, surgical technique and outcome of the ORT at our hospital.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.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).ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.
- Published
- 2008
4. The influence of hepatitis B and hepatitis C virus infection in the recipient on late renal allograft failure
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D. Sanz-Guajardo, B. Domínguez-Gil, José M. Morales, F. Escuin, and J. Fernández
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medicine.medical_specialty ,HBsAg ,Time Factors ,Hepatitis C virus ,medicine.disease_cause ,Gastroenterology ,Liver disease ,Hepatitis B, Chronic ,Orthohepadnavirus ,Internal medicine ,medicine ,Humans ,Renal Insufficiency ,Retrospective Studies ,Hepatitis B virus ,Transplantation ,biology ,business.industry ,Hepatitis C ,Hepatitis B ,Hepatitis C, Chronic ,Middle Aged ,biology.organism_classification ,medicine.disease ,Kidney Transplantation ,Hepadnaviridae ,Nephrology ,Immunology ,business ,Follow-Up Studies - Abstract
Background. Chronic liver disease is one of the most important complications after renal transplantation. Hepatitis B and mainly hepatitis C are the more frequent causes of liver disease. Although there are controversial results, in some series, hepatitis B and hepatitis C are associated with lower graft and patient survival. Patients and methods. A total of 3365 adult patients who received a renal transplant in 1990 (N ¼ 824), 1994 (N ¼ 1075) and 1998 (N ¼ 1466) with a functioning graft after the first year were included. Fifty-one (2.1%) with positive HbsAg were diagnosed with hepatitis B at transplantation; 488 (16.9%) presented positive anti-hepatitis C antibodies and were diagnosed with hepatitis C virus (HCV) infection and 25 patients (0.8%) were diagnosed with concomitant hepatitis B virus (HBV) and HVC infection. Demographic, immunosuppression, survival figures and post-transplant and follow-up data of these patients and negative HBV and HVC patients were recorded. Results. The overall prevalence of HBV in the recipients was 2.1%. Patient survival was lower and liver disease was the main cause of death in HBVpositive patients. However, in the multivariate analysis the presence of positive HbsAg did not have an independent risk factor for graft loss and patient death. This finding was similar in patients with concomitant HBV and HVC infection. Graft and patient survival were lower in HCV-positive patients and liver disease was the main cause of death. Interestingly, proteinuria and serum creatinine were risk factors for graft loss and patient death. Fortunately, prevalence of HCV in the recipients significantly decreased from 29% in 1990 to 10% in 1998. Conclusions. In the last decade in Spain, HBV infection in the recipients, showing an overall prevalence � 2%, did not influence graft and patient survival. However, HCV infection in the recipient was associated with lower graft and patient survival, although the prevalence of HCV clearly decreased from 29% in 1990 to 10% in 1998.
- Published
- 2004
5. A comparative survey on the incidence of kidney graft primary vascular thrombosis among CAPD and haemodialysis patients
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L. Hortal, G Del Peso, Rafael Selgas, M. Perez Fontan, A. Rodriguez Carmona, F. Escuin, A. M. Fernández, Antonio Martinez, M. Lanuza, J. Pérez Contreras, and M. D. Albero
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Transplantation ,Kidney ,medicine.medical_specialty ,medicine.anatomical_structure ,Nephrology ,business.industry ,Incidence (epidemiology) ,medicine ,Vascular thrombosis ,business ,Surgery - Published
- 1996
6. Contents, Vol. 36, 1984
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Naoshi Kohrogi, Elisa Minelli Bertazzoni, P. Coruzzi, Rene Pelleya, L. Sánchez-Sicilia, P. Gómez-Fernández, J.S. Pierce, Keiichi Ito, Kimiyoshi Tsuji, Arthur H. Cohen, A.B. Geers, R. Selgas, J.T. Daugirdas, A. da Costa e Suva, Amin A. Nanji, Kazuro Kanatsu, Harry J. Ward, M. D’Amicone, Tetsuya Miyajima, W.J.F. van der Vijgh, Hiroki Tuchida, Takashi Kuwahara, O. Giardini, M.E. Martínez, M. Taccone-Gallucci, R. Lubrano, R. Coppo, C. Canavese, Jerry L. Newton, J.G. Martinelli, J.C. Netelenbos, Giovanni Panzetta, Jugoro Takeuchi, B. Basolo, A. Montero, James R. Oster, F.A.R. Neves, A. Vercellone, German Ramirez, A. Jonash, Hidehiko Kashiwabara, Frank H. Anderson, R.C.J. Ribeiro, E.J. Dorhout Mees, Toshio Doi, G. Ricciardi-Tenore, H. Boichis, D.J. Leehey, P.S.S. Beraldo, B. Seegal, G.P. Segoloni, Satoshi Akabane, C.U. Casciani, Patoula V. Caralis, Carl D. Brueggemeyer, E. Rossi, A. Borghetti, David C. Kem, G. Koren, U. Ruberto, F. Escuin, Minoru Kawamura, D. Bandino, Shigeo Tomura, J.M. Calatrava, L.O. Simpson, L. Musiari, L. Sánchez Agudo, S. Talarico, M. Aladjem, R.H. Albuquerque, P. Lips, Hideo Shishido, Shunichiro Sakurai, A. Novarini, M.J.M. Jongen, Guido O. Perez, S. Lamon, Wayne A. Border, Yoshihiro Hamashima, G. Piccoli, M.R. Bulzomi, I. Silvi, Koichi Ogino, H.A. Koomans, G.P. Campos, T.S. Ing, Hiroyuki Nagai, and J. Militiano
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Traditional medicine ,business.industry ,Medicine ,business - Published
- 1984
7. Peritoneal Mass Transfer in Patients on long Term CAPD
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Maria Salinas, Martínez Me, Ana Rodríguez-Carmona, Rafael Selgas, L. Sanchez-Sicilia, M. Perez-Fontan, C. Rinon, F. Escuin, and Jorge Martínez-Ara
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030232 urology & nephrology ,Urology ,Peritonitis ,General Medicine ,medicine.disease ,Peritoneal dialysis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Peritoneum ,Nephrology ,medicine ,In patient ,030212 general & internal medicine ,Dialysis (biochemistry) ,business - Abstract
Continuous contact of the peritoneum with the dialysis solution during CAPD and peritonitis may produce changes in the peritoneal masstransfer properties. In 35 patients who have been on CAPD for 1–34 months, we have studied the effect of time on CAPD, and peritonitis on mass transfer coefficients (MTC) of urea, creatinine, uric acid, inulin and parathormone (PTH). Even though the mean values of the whole group showed no statistically significant changes, in six patients, the MTCs of some solutes did show significant changes (increase or decrease). Similarly peritonitis produced a varying effect on the MTC of some patients but they counteracted each other, hence the absence of significant effect in mean whole-group values. We have concluded that the permeability of the human peritoneum is highly individual and, in some patients, mass transfer properties of the peritoneum should be assessed periodically in order to make appropriate adjustments in the dialysis schedule.
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- 1984
8. Mycobacterium chelonei Peritonitis Due to Hematogenous Dissemination in a Continuous Ambulatory Peritoneal Dialysis Patient
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E. Huarte, Eduardo Fonseca, Rafael Selgas, A. Aquella, F. Contreras, F. Escuin, and J. Muñoz
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Adult ,Mycobacterium Infections ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Continuous ambulatory peritoneal dialysis ,Mycobacterium chelonei ,Lumen (anatomy) ,Peritonitis ,medicine.disease ,Surgery ,Peritoneal dialysis ,Peritoneal Dialysis, Continuous Ambulatory ,Nephrology ,Sepsis ,Humans ,Medicine ,Female ,In patient ,Hemodialysis ,business - Abstract
Renal failure patients have been found to have a special susceptibility to Mycobacterium infections. In patients undergoing peritoneal dialysis, Mycobacterium chelonei peritonitis, due to penetration through the peritoneal catheter lumen, has been described. In our report, we described a case of disseminated M chelonei infection that began in a Thomas hemodialysis prosthesis and finally resulted in peritonitis of hematogenous origin. The diagnostic and therapeutic peculiarities are discussed.
- Published
- 1987
9. Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis
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L. Sanchez-Sicilia, Rafael Selgas, A. Montero, Gómez-Fernández P, Martínez Me, Calatrava Jm, F. Escuin, and L. Sánchez Agudo
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Adult ,Male ,medicine.medical_specialty ,business.industry ,Continuous ambulatory peritoneal dialysis ,Diaphragm ,Middle Aged ,urologic and male genital diseases ,Respiration Disorders ,female genital diseases and pregnancy complications ,Frequent use ,Peritoneal Dialysis, Continuous Ambulatory ,medicine ,Respiratory muscle weakness ,Humans ,Female ,Intensive care medicine ,business ,Peritoneal Cavity ,Peritoneal Dialysis ,Inspiratory Capacity ,Muscle Contraction ,Uremia - Abstract
The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of this therapeutic modality. The effects of CAPD on pulmonary function are one of the aspects currently under study. Based on previous data suggesting the existence of extrapulmonary ventilatory restriction in uremic patients under CAPD, we have studied in these patients the respiratory muscle function as expressed in the maximal inspiratory pressure (MIP) and assessed the impact of the infusion of 2 liters of dialysis fluid into the peritoneal cavity on both MIP and the pulmonary volumes. Uremic patients evidenced significantly lower MIP values as compared with healthy controls. The filling of the peritoneal cavity induced, both in the supine and in the sitting position, a restrictive effect and an increase in the inspiratory capacity. We conclude that uremic patients under CAPD evidence a respiratory muscle dysfunction of as yet unclear cause. Our findings further suggest that the infusion of 2 liters of dialysis fluid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.
- Published
- 1984
10. Peritoneal membrane failure as a determinant of the CAPD future. An epidemiological, functional and pathological study
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E, Huarte-Loza, R, Selgas, A R, Carmona, M E, Martinez, J, Muñoz, M P, Fontan, O, Ortega, F, Escuin, and L S, Sicilia
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Male ,Kinetics ,Peritoneal Dialysis, Continuous Ambulatory ,Creatinine ,Humans ,Urea ,Female ,Middle Aged ,Peritoneum ,Peritonitis ,Uric Acid - Published
- 1987
11. Vaccination against hepatitis B in renal dialysis units: short or normal vaccination schedule?
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V, Carreño, I, Mora, F, Escuin, L, Sánchez Sicilia, V, Alvarez, S, Casado, J M, Alcázar, L, Hernando, J C, Porres, and J L, Carrasco
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Adult ,Male ,Viral Hepatitis Vaccines ,Hemodialysis Units, Hospital ,Immunization, Secondary ,Humans ,Female ,Hepatitis B Antibodies ,Middle Aged ,Hepatitis B ,Immunization Schedule ,Follow-Up Studies - Abstract
Three I.M. injections of hepatitis B vaccine (Merck SharpDohme) were administered, according to the recommended schedule (0, 1, 6 mos), to seronegative individuals of one renal dialysis unit (33 patients, 58 health care personnel) and, according to a shorter regimen (0, 1, 3 mos), in another unit of similar characteristics (30 patients, 53 health care personnel). Staff members and renal patients received, respectively, 20 y 40 mcg of vaccine per injection. In the early vaccination phase, the two regimens did not lead to a difference in seroconversion rates nor in anti-HBs titers. After a 9-month surveillance, lower seroconversion rates, although not significant, were observed with the accelerated regimen among staff members (84.2%) and renal patients (79.2%) as compared with 93% and 87.5%, respectively, following the normal schedule. At the same time, anti-HBs titers were significantly lower (p less than 0.001) in the staff (316 RIA U) and patients (93 U) vaccinated according to the short regimen than in their respective counterparts (4196 and 1047 U) assigned to the normal schedule. A fourth dose of vaccine given to subjects with low and no anti-HBs titers significantly increased seroconversion and anti-HBs levels, although with little success among the former non-responders.
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- 1985
12. [Central hypoventilation as a cause of hypoxemia during hemodialysis. Effects of acetazolamide administration]
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P, Gómez Fernández, J, Conesa, A, Sanz, R, Selgas, J L, Miguel, F, Escuin, F, García, and L, Sánchez Sicilia
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Acetazolamide ,Adult ,Male ,Oxygen ,Renal Dialysis ,Partial Pressure ,Humans ,Female ,Hypoventilation ,Carbon Dioxide ,Middle Aged ,Carbonic Anhydrase Inhibitors ,Hypoxia - Published
- 1983
13. Peritoneal functional parameters after five years on continuous ambulatory peritoneal dialysis (CAPD): the effect of late peritonitis
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R, Selgas, J, Muñoz, S, Cigarran, P, Ramos, K, L-Revuelta, F, Escuin, and J L, Miguel
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Male ,Time Factors ,Adrenergic beta-Antagonists ,Ultrafiltration ,Bacterial Infections ,Middle Aged ,Models, Theoretical ,Peritonitis ,Peritoneal Dialysis, Continuous Ambulatory ,Creatinine ,Hypertension ,Humans ,Kidney Failure, Chronic ,Urea ,Female ,Prospective Studies ,Peritoneum - Abstract
Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 +/- 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 +/- 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring less than 36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occurring greater than 36 months since initiation) induced a decrease in urea-MTC (22.3 +/- 6 to 15.8 +/- 3.9, p less than 0.05), creatinine-MTC (9.4 +/- 3.1 to 7.4 +/- 2.5, p less than 0.05), and a corresponding increase in UF (1.25 +/- 0.4 to 1.4 +/- 0.3, mL/min, p less than 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.
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- 1989
14. [Adult Fanconi syndrome following the ingestion of degraded tetracycline. Presentation of a case]
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F, Escuin Sancho, C M, García Aparicio, S, García Signes, F, Picazo Córdoba, A, Luna Morales, P, López Fernández, and J, Olivares Martín
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Adolescent ,Drug Stability ,Humans ,Female ,Tetracycline ,Fanconi Syndrome - Published
- 1981
15. [Parathormone as a uremic toxin. Possible effect on respiratory muscle function in uremia]
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P, Gómez-Fernández, L, Sánchez Agudo, J M, Calatrava, M E, Martínez, F, Escuin Sancho, R, Selgas, and L, Sánchez Sicilia
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Adult ,Male ,Parathyroid Hormone ,Muscles ,Humans ,Female ,Middle Aged ,Respiration Disorders ,Respiratory Function Tests ,Uremia - Published
- 1984
16. [Prevention of peritonitis in continuous ambulatory peritoneal dialysis. Comparative study of 2 different protocols of training and bag changing]
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R, Selgas, M, Pérez-Fontán, J L, Miguel, A, Rodríguez-Carmona, M S, Zuzuarregui, F, Escuin, O, Ortega, J, Conesa, E, Huarte, and L, Sánchez Sicilia
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Male ,Patient Education as Topic ,Peritoneal Dialysis, Continuous Ambulatory ,Humans ,Female ,Peritonitis ,Staphylococcal Infections ,Peritoneal Dialysis - Published
- 1984
17. [Medium-term experience with continuous ambulatory peritoneal dialysis in the treatment of terminal chronic renal insufficiency]
- Author
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R, Selgas, M, Pérez-Fontán, A, Rodríguez Carmona, J, Conesa, P, Gómez, O, Ortega, J L, Miguel, M A, Torre, F, Escuin, and C, Riñón
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Adult ,Chronic Kidney Disease-Mineral and Bone Disorder ,Male ,Adolescent ,Blood Pressure ,Middle Aged ,Peritonitis ,Nutrition Disorders ,Hospitalization ,Peritoneal Dialysis, Continuous Ambulatory ,Evaluation Studies as Topic ,Humans ,Kidney Failure, Chronic ,Female ,Child ,Peritoneal Dialysis ,Aged - Published
- 1984
18. Peritoneal functional parameters after five years on continuous ambulatory peritoneal dialysis (CAPD): the effect of late peritonitis
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S. Cigarran, F. Escuin, J. Muñoz, Rafael Selgas, P. Ramos, J. L. Miguel, and K. L-Revuelta
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Peritoneal permeability ,medicine.medical_specialty ,Long term dialysis ,business.industry ,medicine.medical_treatment ,Continuous ambulatory peritoneal dialysis ,030232 urology & nephrology ,Peritonitis ,General Medicine ,medicine.disease ,Surgery ,Peritoneal dialysis ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Peritoneum ,Nephrology ,Functional stability ,medicine ,030212 general & internal medicine ,business - Abstract
Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 ± 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 ± 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring 36 months since initiation) induced a decrease in urea-MTC (22.3 ± 6 to 15.8 ± 3.9, p < 0.05), creatinine-MTC (9.4 ± 3.1 to 7.4 ± 2.5, p < 0.05), and a corresponding increase in UF (1.25 ± 0.4 to 1.4 ± 0.3, mL/min, p < 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.
19. Subject Index, Vol. 36, 1984
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B. Basolo, James R. Oster, W.J.F. van der Vijgh, German Ramirez, Hiroki Tuchida, Jerry L. Newton, Kazuro Kanatsu, J.G. Martinelli, Yoshihiro Hamashima, S. Talarico, M. Aladjem, P. Coruzzi, Arthur H. Cohen, R.H. Albuquerque, David C. Kem, G. Koren, J.S. Pierce, G.P. Segoloni, Hidehiko Kashiwabara, H.A. Koomans, D.J. Leehey, Patoula V. Caralis, M.J.M. Jongen, Guido O. Perez, S. Lamon, A. Vercellone, Frank H. Anderson, G.P. Campos, U. Ruberto, M. D’Amicone, C. Canavese, R.C.J. Ribeiro, T.S. Ing, L.O. Simpson, A.B. Geers, Amin A. Nanji, J.C. Netelenbos, L. Musiari, J.T. Daugirdas, A. Novarini, J.M. Calatrava, M.E. Martínez, Elisa Minelli Bertazzoni, Giovanni Panzetta, H. Boichis, Hideo Shishido, M. Taccone-Gallucci, Naoshi Kohrogi, Toshio Doi, L. Sánchez Agudo, Jugoro Takeuchi, Hiroyuki Nagai, Takashi Kuwahara, A. Montero, P.S.S. Beraldo, Satoshi Akabane, O. Giardini, Shunichiro Sakurai, Harry J. Ward, A. Jonash, Shigeo Tomura, I. Silvi, C.U. Casciani, Minoru Kawamura, J. Militiano, D. Bandino, E.J. Dorhout Mees, A. Borghetti, P. Lips, Wayne A. Border, Koichi Ogino, R. Selgas, F. Escuin, G. Ricciardi-Tenore, G. Piccoli, M.R. Bulzomi, Carl D. Brueggemeyer, R. Coppo, Keiichi Ito, A. da Costa e Suva, E. Rossi, Tetsuya Miyajima, R. Lubrano, Rene Pelleya, P. Gómez-Fernández, Kimiyoshi Tsuji, L. Sánchez-Sicilia, B. Seegal, and F.A.R. Neves
- Subjects
Index (economics) ,business.industry ,Statistics ,Medicine ,Subject (documents) ,business - Published
- 1984
20. Pretransplant IgA-Anti-Beta 2 Glycoprotein I Antibodies As a Predictor of Early Graft Thrombosis after Renal Transplantation in the Clinical Practice: A Multicenter and Prospective Study.
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Morales JM, Serrano M, Martinez-Flores JA, Gainza FJ, Marcen R, Arias M, Escuin F, Pérez D, Andres A, Martínez MA, Maruri N, Alvarez E, Castañer JL, López-Hoyos M, and Serrano A
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- Cohort Studies, Delayed Graft Function immunology, Follow-Up Studies, Graft Survival, Humans, Immunoglobulin A metabolism, Predictive Value of Tests, Prognosis, Prospective Studies, Risk, Survival Analysis, Thrombosis, beta 2-Glycoprotein I immunology, Delayed Graft Function diagnosis, Kidney pathology, Kidney Transplantation
- Abstract
Background: Graft thrombosis is a devastating complication after renal transplantation. We recently described the association of anti-beta-2-glycoprotein-I (IgA-ab2GP1) antibodies with early graft loss mainly caused by thrombosis in a monocenter study., Methods: Multicenter prospective observational cohort study., Setting and Participants: Seven hundred forty patients from five hospitals of the Spanish Forum Renal Group transplanted from 2000 to 2002 were prospectively followed-up for 10 years., Outcomes: Early graft loss and graft loss by thrombosis., Measurements: The presence of IgA anti-B2GP1 antibodies in pretransplant serum was examined using the same methodology in all the patients., Results: At transplantation, 288 patients were positive for IgA-B2GP1 (39%, Group-1) and the remaining were negative (Group-2). Graft loss at 6 months was higher in Group-1 (12.5 vs. 4.2% p < 0.001), vessel thrombosis being the most frequent cause of early graft loss, especially in Group-1 (6.9 vs. 0.4% p < 0.001). IgA-aB2GP1 was the most important independent risk factor for graft thrombosis (hazard ratio: 13.83; 95% CI: 3.17-60.27, p < 0.001). Furthermore, the, presence of IgA-aB2GP1 was associated with early graft loss and delayed graft function. At 10 years, survival figures were also lower in Group-1: graft survival was lower compared with Group-2 (60.4 vs. 76.8%, p < 0.001). Mortality was significantly higher in Group-1 (19.8 vs. 12.2%, p = 0.005)., Limitations: Patients were obtained during a 3-year period (1 January 2000-31 December 2002) and kidneys were only transplanted from brain-dead donors. Nowadays, the patients are older and the percentage of sensitized and retransplants is high., Conclusion: In a prospective observational multicenter study, we were able to corroborate that pretransplant presence of IgA-aB2GP1 was the main risk factor for graft thrombosis and early graft loss. Therefore, a prospective study is needed to evaluate the efficacy and safety of prophylactic anticoagulation to avoid this severe complication.
- Published
- 2018
- Full Text
- View/download PDF
21. Cytomegalovirus infection after kidney transplantation and long-term graft loss.
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López-Oliva MO, Flores J, Madero R, Escuin F, Santana MJ, Bellón T, Selgas R, and Jiménez C
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- Adult, Antiviral Agents therapeutic use, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections etiology, Cytomegalovirus Infections prevention & control, Female, Ganciclovir administration & dosage, Ganciclovir analogs & derivatives, Ganciclovir therapeutic use, Graft Survival, Humans, Immunosuppressive Agents adverse effects, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Phosphoproteins blood, Postoperative Complications drug therapy, Postoperative Complications etiology, Postoperative Complications prevention & control, Proportional Hazards Models, Reoperation, Retrospective Studies, Risk Factors, Tissue Donors, Valganciclovir, Viral Matrix Proteins blood, Virus Activation, Cytomegalovirus Infections epidemiology, Kidney Transplantation adverse effects, Postoperative Complications epidemiology
- Abstract
Background: Despite the use of prevention strategies, cytomegalovirus (CMV) infection is the most common viral complication after renal transplant and its impact on long-term outcomes is still open to debate., Objective: To evaluate the incidence of CMV infection and disease during the use of prevention strategies in our centre and to analyse the association between CMV infection and long-term patient and graft survival and other potentially clinical events related with CMV., Methods: We reviewed the medical records of 377 recipients of kidney transplants performed between January 1998 and December 2008. Kaplain-Meier survival curve analysis was performed to analyse graft and patient survival by CMV infection/disease and Cox proportional hazards regression was used to identify factors associated with CMV infection/disease, graft loss and mortality., Results: The incidence of CMV infection was 34.7% and CMV disease was 9.5%. Patient and graft survival was significantly lower in patients with CMV infection/disease. CMV infection/disease was associated with a higher risk of graft loss (HR 1.91, 95% CI 1.09-3.36, p=0.023), but not with a higher mortality (HR 1.29, 95% CI 0.7-2.38, p=0.4)., Conclusion: CMV replication after renal transplant is a risk factor for long-term graft loss but not mortality. Prevention strategies decrease post-transplant CMV infection and disease., (Copyright © 2017 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2017
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22. Mineral metabolism disorders, vertebral fractures and aortic calcifications in stable kidney transplant recipients: The role of gender (EMITRAL study).
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Torres A, Torregrosa V, Marcen R, Campistol JM, Arias M, Hernández D, Fernández C, Esforzado N, Paschoalin R, Pérez N, García AI, Del Amo M, Pomés J, González Rinne A, Marrero D, Pérez E, Henríquez F, Díaz JM, Silva I, López V, Perello M, Ramos D, Beneyto I, Cruzado JM, Martínez Castelao A, Bravo J, Rodríguez M, Díaz C, Crespo J, Anaya F, Rodríguez ML, Cubero JJ, Pascual P, Romero R, Andrés Belmonte A, Checa MD, Jiménez C, Escuin F, Crespo M, Mir M, Gómez G, Bayes B, González MJ, Gutiérrez A, Cuberes M, Rodríguez Benoit A, García T, Llamas F, Ortega A, Conde JL, and Gómez Alamillo C
- Subjects
- Aged, Albuminuria etiology, Aorta, Abdominal, Aortic Diseases etiology, Calcinosis etiology, Cross-Sectional Studies, Cyclosporine adverse effects, Female, Humans, Hyperparathyroidism, Secondary etiology, Hyperparathyroidism, Secondary metabolism, Immunosuppressive Agents adverse effects, Male, Middle Aged, Parathyroid Hormone blood, Risk Factors, Spinal Fractures etiology, Tacrolimus adverse effects, Vitamin D Deficiency complications, Aortic Diseases metabolism, Calcinosis metabolism, Kidney Transplantation, Minerals metabolism, Postoperative Complications metabolism, Sex Factors, Spinal Fractures metabolism
- Abstract
Background and Objectives: The relationship between mineral metabolism disorders, bone fractures and vascular calcifications in kidney transplant recipients has not been established., Method: We performed a cross-sectional study in 727 stable recipients from 28 Spanish transplant clinics. Mineral metabolism parameters, the semi-quantification of vertebral fractures and abdominal aortic calcifications were determined centrally., Results: Vitamin D deficiency (25OHD3<15ng/ml) was more common in female recipients at CKD-T stages I-III (29.6% vs 44.4%; p=0.003). The inverse and significant correlation between 25OHD3 and PTH was gender-specific and women exhibited a steeper slope than men (p=0.01). Vertebral fractures (VFx) with deformity grade ≥2 were observed in 15% of recipients. Factors related to VFx differed by gender; in males, age (OR 1.04; 95% CI 1.01-1.06) and CsA treatment (OR: 3.2; 95% CI: 1.6-6.3); in females, age (OR 1.07; 95% CI: 1.03-1.12) and PTH levels (OR per 100pg/ml increase: 1.27; 95% CI: 1.043-1.542). Abdominal aortic calcifications were common (67.2%) and related to classical risk factors but not to mineral metabolism parameters., Conclusions: Vitamin D deficiency is more common among female kidney transplant recipients at earlier CKD-T stages, and it contributes to secondary hyperparathyroidism. Prevalent vertebral fractures are only related to high serum PTH levels in female recipients., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)
- Published
- 2016
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23. The Natural History of Kidney Graft Cortical Microcirculation Determined by Real-Time Contrast-Enhanced Sonography (RT-CES).
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Jiménez C, López MO, Ros A, Aguilar A, Menendez D, Rivas B, Santana MJ, Vaca MA, Escuin F, Madero R, and Selgas R
- Subjects
- Calcineurin metabolism, Calcineurin Inhibitors toxicity, Creatinine blood, Female, Graft Rejection, Humans, Kidney Cortex pathology, Kidney Cortex physiology, Kidney Function Tests, Male, Middle Aged, Necrosis, Predictive Value of Tests, Ultrasonography, Contrast Media, Kidney Cortex blood supply, Kidney Cortex diagnostic imaging, Kidney Transplantation adverse effects, Microcirculation
- Abstract
Background: Kidney transplantation is the therapy of choice for end-stage kidney disease. Graft's life span is shorter than expected due in part to the delayed diagnosis of various complications, specifically those related to silent progression. It is recognized that serum creatinine levels and proteinuria are poor markers of mild kidney lesions, which results in delayed clinical information. There are many investigation looking for early markers of graft damage. Decreasing kidney graft cortical microcirculation has been related to poor prognosis in kidney transplantation. Cortical capillary blood flow (CCBF) can be measured by real-time contrast-enhanced sonography (RT-CES). Our aim was to describe the natural history of CCBF over time under diverse conditions of kidney transplantation, to explore the influence of donor conditions and recipient events, and to determine the capacity of CCBF for predicting renal function in medium term., Patients and Methods: RT-CES was performed in 79 consecutive kidney transplant recipients during the first year under regular clinical practice. Cortical capillary blood flow was measured. Clinical variables were analyzed. The influence of CCBF has been determined by univariate and multivariate analysis using mixed regression models based on sequential measurements for each patient over time. We used a first-order autoregression model as the structure of the covariation between measures. The post-hoc comparisons were considered using the Bonferroni correction., Results: The CCBF values varied significantly over the study periods and were significantly lower at 48 h and day 7. Brain-death donor age and CCBF levels showed an inverse relationship (r: -0.62, p<0.001). Living donors showed higher mean CCBF levels than brain-death donors at each point in the study. These significant differences persisted at month 12 (54.5 ± 28.2 vs 33.7 ± 30 dB/sec, living vs brain-death donor, respectively, p = 0.004) despite similar serum creatinine levels (1.5 ± 0.3 and 1.5 ± 0.5 mg/dL). A sole rejection episode was associated with lower overall CCBF values over the first year. CCBF defined better than level of serum creatinine the graft function status at medium-term., Conclusion: RT-CES is a non-invasive tool that can quantify and iteratively estimate cortical microcirculation. We have described the natural history of cortical capillary blood flow under regular clinical conditions.
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- 2016
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24. Pretransplant CD8 T-cell response to IE-1 discriminates seropositive kidney recipients at risk of developing CMV infection posttransplant.
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López-Oliva MO, Martinez V, Buitrago A, Jiménez C, Rivas B, Escuin F, Santana MJ, Selgas R, and Bellón T
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- Adult, CD4-Positive T-Lymphocytes immunology, CD4-Positive T-Lymphocytes virology, Cytomegalovirus Infections epidemiology, Cytomegalovirus Infections prevention & control, Epitopes immunology, Female, Humans, Interferon-gamma immunology, Interferon-gamma metabolism, Longitudinal Studies, Male, Middle Aged, Phosphoproteins immunology, Preoperative Period, Prospective Studies, Risk Assessment methods, Risk Factors, Viral Matrix Proteins immunology, CD8-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes virology, Cytomegalovirus Infections immunology, Immediate-Early Proteins immunology, Kidney Transplantation adverse effects
- Abstract
Background: Cytomegalovirus (CMV) infection is an ongoing clinical problem in solid-organ transplantation (SOT). Pretransplant CMV serology is currently the only tool for assessing the risk of CMV infection, although cellular immune responses driven by CMV-specific CD4 and CD8 T lymphocytes are important for controlling viral replication. Therefore, the analysis of CMV-specific T cells may be useful for estimating the risk of infection., Methods: This is a prospective study of patients with kidney transplants and no prophylactic treatment for CMV replication. CD4 and CD8 T-cell responses to the major CMV pp65 and IE-1 antigens in 15 seropositive patients at intermediate risk of CMV infection were investigated, according to current algorithms. Intracellular flow cytometry was employed to determine IFN-γ production as a functional readout. The response was analyzed in pretransplant samples and prospectively at 1 and 6 months and at 1 year posttransplant., Results: It was observed that the CD8 responses to IE-1 antigen were practically absent pretransplant in patients who developed CMV infection posttransplant. Within the group of patients free of infection, CD8 responses to IE-1 were detected more frequently and were significantly higher (P=0.0083). In a receiver operating characteristics curve analysis (AUC=0.929; P=0.010; 95% CI: 0.078-1.0), low CD8 responses to IE-1 (≤0.05%) pretransplant predicted the development of CMV infection under the immunosuppressive regime after transplant with 100% specificity and 85.7% sensitivity., Conclusions: Assessment of IE-1-specific CD8 T-cell frequencies pretransplant may be a useful tool for identifying seropositive SOT patients at risk of developing CMV infection posttransplant.
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- 2014
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25. Pretransplant peritoneal dialysis relative to hemodialysis improves long-term survival of kidney transplant patients: a single-center observational study.
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López-Oliva MO, Rivas B, Pérez-Fernández E, Ossorio M, Ros S, Chica C, Aguilar A, Bajo MA, Escuin F, Hidalgo L, Selgas R, and Jiménez C
- Subjects
- Adult, Age Factors, Female, Follow-Up Studies, Graft Rejection complications, Humans, Male, Middle Aged, Preoperative Period, Recurrence, Renal Dialysis, Retrospective Studies, Survival Rate, Thrombosis complications, Time Factors, Graft Survival physiology, Kidney Failure, Chronic surgery, Kidney Transplantation methods, Peritoneal Dialysis
- Abstract
Background: Kidney transplantation is the best option for the treatment of end-stage renal disease in terms of survival and quality of life. These results can be influenced by the pretransplant dialysis modality. The aim of this study was to evaluate whether the pretransplantation dialysis modality influences patient and allograft survival beyond 10 years and examine the potential risk factors associated with the outcomes., Methods: We conducted an observational, retrospective, single-center clinical study that included 236 patients [118 undergoing peritoneal dialysis (PD) and 118 undergoing hemodialysis (HD)] who proceeded to transplantation during the period December 1990-2002. Donor and recipient data were collected from our hospital's clinical registries. The follow-up period extended to the patient's death, the loss of the allograft, or loss to follow-up. The end date of the study was set at March 2012., Results: In the multivariate analysis, the long-term patient survival rate was higher for the PD group than for the HD group [HR = 2.62 (1.01-6.8); p = 0.04]; however, the allograft survival rate was not significantly different between the two groups [HR = 0.68 (0.41-1.10); p = 0.12]., Conclusion: Pretransplantation dialysis modality is associated with long-term patient survival, with outcomes favoring peritoneal dialysis over hemodialysis. However, the pretransplant dialysis modality does not influence long-term graft loss risk.
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- 2014
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26. [Complications associated with renal graft biopsy in transplant patients].
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Tapia-Canelas C, Zometa R, López-Oliva MO, Jiménez C, Rivas B, Escuin F, Yébenes L, and Selgas R
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- Biopsy, Needle adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications epidemiology, Retrospective Studies, Kidney pathology, Kidney Transplantation, Postoperative Complications etiology
- Abstract
Background: Percutaneous biopsy of renal grafts is a diagnostic method for the assessment, management and clinical monitoring of renal transplant, so it is necessary to know its complications. There are few data in the literature regarding complications from biopsies in renal grafts., Objective: To evaluate the rate of complications in renal graft biopsies performed at our centre., Patients and Method: We performed a retrospective observational study, including data from patients who underwent renal graft biopsies from January 2000 to September 2012. Major complications were defined as: anemia requiring blood transfusion, intraparenchymal arteriovenous fistula or arterial bleeding requiring embolisation, nephrectomy, other surgery and exitus. And as minor complications: anemia without blood transfusion, intraparenchymal arteriovenous fistula without embolisation, haematomas or perirenal collections, hematuria and fever. Kidney biopsies were performed with ultrasound guidance and automatic devices., Results: We performed 390 kidney graft biopsies. 49 complications occurred. 22 were major: 12 per anemia that required blood transfusion, 6 requiring embolisation (5 arteriovenous fistulae and 1 arterial bleeding), 2 exitus, 1 trasplantectomy and 1 surgery (haematoma). 27 were minor: 12 perirenal collections, 9 arteriovenous fistulae without embolisation, 3 hematuria, 2 anemisation without blood transfusion and 1 fever., Conclusions: The rate of complications related to renal graft biopsy observed in our centre is similar to those described for native kidneys, therefore we believe it remains a safe and effective technique, and an important diagnostic tool.
- Published
- 2014
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27. Risk factors for graft loss and mortality after renal transplantation according to recipient age: a prospective multicentre study.
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Morales JM, Marcén R, del Castillo D, Andres A, Gonzalez-Molina M, Oppenheimer F, Serón D, Gil-Vernet S, Lampreave I, Gainza FJ, Valdés F, Cabello M, Anaya F, Escuin F, Arias M, Pallardó L, and Bustamante J
- Subjects
- Adult, Age Distribution, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Survival Rate, Time Factors, Graft Rejection epidemiology, Kidney Transplantation mortality
- Abstract
Background: To describe the causes of graft loss, patient death and survival figures in kidney transplant patients in Spain based on the recipient's age., Methods: The results at 5 years of post-transplant cardiovascular disease (CVD) patients, taken from a database on CVD, were prospectively analysed, i.e. a total of 2600 transplanted patients during 2000-2002 in 14 Spanish renal transplant units, most of them receiving their organ from cadaver donors. Patients were grouped according to the recipient's age: Group A: <40 years, Group B: 40-60 years and Group C: >60 years. The most frequent immunosuppressive regimen included tacrolimus, mycophenolate mofetil and steroids., Results: Patients were distributed as follows: 25.85% in Group A (>40 years), 50.9% in Group B (40-60 years) and 23.19% in Group C (>60). The 5-year survival for the different age groups was 97.4, 90.8 and 77.7%, respectively. Death-censored graft survival was 88, 84.2 and 79.1%, respectively, and non death-censored graft survival was 82.1, 80.3 and 64.7%, respectively. Across all age groups, CVD and infections were the most frequent cause of death. The main causes of graft loss were chronic allograft dysfunction in patients <40 years old and death with functioning graft in the two remaining groups. In the multivariate analysis for graft survival, only elevated creatinine levels and proteinuria >1 g at 6 months post-transplantation were statistically significant in the three age groups. The patient survival multivariate analysis did not achieve a statistically significant common factor in the three age groups., Conclusions: Five-year results show an excellent recipient survival and graft survival, especially in the youngest age group. Death with functioning graft is the leading cause of graft loss in patients >40 years. Early improvement of renal function and proteinuria together with strict control of cardiovascular risk factors are mandatory.
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- 2012
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28. Results of renal re-transplant in Spain (1990-2002).
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Guirado L, Ruiz JC, Andrés A, Rengel M, Escuin F, Ortega F, Romero R, Díaz JM, Beneyto I, and Morales JM
- Abstract
Background. Renal re-transplants are increasing in number, due to many first renal transplant patients coming back to dialysis treatment. There are controversial opinions about the evolution of these re-transplanted patients. The aim of our study is to analyse the prognosis of patients and grafts under a renal re-transplant.Methods. This was a retrospective study of 579 renal re-transplants realized in 15 Spanish different centres in the years 1990, 1994, 1998 and 2002 including all renal re-transplants realized in the above-mentioned centres during the same periods.Results. During the follow-up period, 8.81% of patients died. The actuarial patient survival was 85% at 10 years and 80% at 15 years. Principal reasons of death were the same as normal for the renal transplanted patient: cardiovascular (30.77%), infectious (13.46%) and neoplastic (13.46%). During the period of follow-up, 28.6% of the grafts were lost. The actuarial graft survival was 75% at 10 years and 58% at 15 years. Causes of graft loss are very similar to those described in literature.Conclusion. Renal re-transplant is a kind of substitute renal treatment with excellent clinical results that allow to take it as a first-order modality of treatment when the first renal transplant has failed.
- Published
- 2010
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29. Trough tacrolimus concentrations in the first week after kidney transplantation are related to acute rejection.
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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
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30. Prophylaxis and treatment of cytomegalovirus infection postrenal transplantation in two Madrid units.
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Fernández A, Amezquita Y, Fernández-Tagarro E, Escuin F, Jiménez C, Sánchez Villanueva R, Galeano C, Pascual J, and Marcén R
- Subjects
- Adult, Aged, Blood Chemical Analysis, Cytomegalovirus physiology, Female, Ganciclovir analogs & derivatives, Ganciclovir therapeutic use, Humans, Kidney Function Tests, Liver Function Tests, Male, Middle Aged, Monitoring, Physiologic, Spain, Valganciclovir, Viral Load, Virus Activation, Antiviral Agents therapeutic use, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections prevention & control, Kidney Transplantation adverse effects
- Abstract
Introduction: Complete prevention of cytomegalovirus (CMV) disease continues to be an unresolved problem in renal transplantation., Materials and Methods: From January 2005 to May 2006, we implemented a protocol for early detection and preemptive treatment of CMV infection as detected by antigenemia or polymerase chain reaction determined every 2 weeks during the first 3 months posttransplant and monthly thereafter. Prophylaxis was given to all CMV-negative patients who received CMV-positive kidneys and to those who received polyclonal or monoclonal antibody induction therapy., Results: Among 100 transplants, 15 subjects received prophylaxis due to poly- or monoclonal antibody induction and/or negative recipient serology using a mean valgancyclovir dose of 485 +/- 276 mg/d for an average duration of 129 days. After completion of the prophylaxis four patients (26.6%) required preemptive therapy for asymptomatic virus reactivation; the mean dose of drug in these patients had been 450 +/- 275.56 mg, with a treatment time that was significantly shorter than those not suffering reactivation (91.75 vs 143.45 days). In addition, preemptive therapy was given for virus reactivation in seven patients, for illness with mild viral syndrome in two, with moderate illness and positive pretransplantation serology in one. The average treatment time was 79 days and the mean dose was 375 mg., Conclusion: In those not at risk, CMV infections occurred among 11.7% of patients in our early detection program. Prophylaxis for at-risk patients should continue for more than 3 months to prevent reactivation.
- Published
- 2009
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31. Sublingual administration of tacrolimus in a renal transplant patient.
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Romero I, Jiménez C, Gil F, Escuin F, Ramirez E, Fudio S, Borobia A, and Carcas A
- Subjects
- Administration, Sublingual, Biological Availability, Female, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents pharmacokinetics, Middle Aged, Tacrolimus adverse effects, Tacrolimus pharmacokinetics, Immunosuppressive Agents administration & dosage, Kidney Transplantation, Tacrolimus administration & dosage
- Abstract
Tacrolimus is used in renal and other organ transplantations for immunossupression therapy. Bioavailability of enterally administered tacrolimus is poor, and further reduced by gastrointestinal failure or enteral nutrition. In these situations, intravenous administration is necessary to prevent treatment failure. However, intravenous administration should be done in a continuous manner and it has been implicated in anaphylaxis, torsades de pointes, cardiac arrhythmia and other serious adverse events. Also it is more expensive than other routes of administration. Sublingual administration of tacrolimus has been used in some cases, and literature reports show that it provides therapeutic tacrolimus levels in lung and liver transplant recipients. Here, we report a first case of sublingual administration of tacrolimus in kidney transplantation.
- Published
- 2008
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32. [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
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33. Posttransplant diabetes mellitus in renal allograft recipients: A prospective multicenter study at 2 years.
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Marcén R, Morales JM, del Castillo D, Campistol JM, Serón D, Valdés F, Anaya F, Andrés A, Arias M, Bustamante J, Capdevila L, Escuin F, Gil-Vernet S, Gonzalez-Molina M, Lampreave I, Oppenheimer F, and Pallardó L
- Subjects
- Adrenal Cortex Hormones therapeutic use, Adult, Body Mass Index, Drug Therapy, Combination, Female, Follow-Up Studies, Humans, Immunosuppressive Agents therapeutic use, Incidence, Male, Middle Aged, Postoperative Complications epidemiology, Prospective Studies, Time Factors, Transplantation, Homologous, Diabetes Mellitus epidemiology, Kidney Transplantation adverse effects
- Abstract
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.
- Published
- 2006
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34. The influence of hepatitis B and hepatitis C virus infection in the recipient on late renal allograft failure.
- Author
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Morales JM, Domínguez-Gil B, Sanz-Guajardo D, Fernández J, and Escuin F
- Subjects
- Follow-Up Studies, Hepatitis B, Chronic epidemiology, Hepatitis C, Chronic epidemiology, Humans, Middle Aged, Retrospective Studies, Time Factors, Hepatitis B, Chronic etiology, Hepatitis C, Chronic etiology, Kidney Transplantation adverse effects, Renal Insufficiency etiology
- Abstract
Background: Chronic liver disease is one of the most important complications after renal transplantation. Hepatitis B and mainly hepatitis C are the more frequent causes of liver disease. Although there are controversial results, in some series, hepatitis B and hepatitis C are associated with lower graft and patient survival., Patients and Methods: A total of 3365 adult patients who received a renal transplant in 1990 (N = 824), 1994 (N = 1075) and 1998 (N = 1466) with a functioning graft after the first year were included. Fifty-one (2.1%) with positive HbsAg were diagnosed with hepatitis B at transplantation; 488 (16.9%) presented positive anti-hepatitis C antibodies and were diagnosed with hepatitis C virus (HCV) infection and 25 patients (0.8%) were diagnosed with concomitant hepatitis B virus (HBV) and HVC infection. Demographic, immunosuppression, survival figures and post-transplant and follow-up data of these patients and negative HBV and HVC patients were recorded., Results: The overall prevalence of HBV in the recipients was 2.1%. Patient survival was lower and liver disease was the main cause of death in HBV-positive patients. However, in the multivariate analysis the presence of positive HbsAg did not have an independent risk factor for graft loss and patient death. This finding was similar in patients with concomitant HBV and HVC infection. Graft and patient survival were lower in HCV-positive patients and liver disease was the main cause of death. Interestingly, proteinuria and serum creatinine were risk factors for graft loss and patient death. Fortunately, prevalence of HCV in the recipients significantly decreased from 29% in 1990 to 10% in 1998., Conclusions: In the last decade in Spain, HBV infection in the recipients, showing an overall prevalence approximately 2%, did not influence graft and patient survival. However, HCV infection in the recipient was associated with lower graft and patient survival, although the prevalence of HCV clearly decreased from 29% in 1990 to 10% in 1998.
- Published
- 2004
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35. Posttransplant CD30 (Ki-1)-positive anaplastic large cell lymphoma. Report of a case with presentation as a pleural effusion.
- Author
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Jiménez-Heffernan JA, Viguer JM, Vicandi B, Jiménez-Yuste V, Palacios J, Escuin F, and Gamallo C
- Subjects
- Antigens, CD analysis, Biopsy, Needle, Fatal Outcome, Herpesvirus 4, Human isolation & purification, Humans, Immunophenotyping, Kidney Transplantation adverse effects, Lymphoproliferative Disorders etiology, Male, Middle Aged, Ki-1 Antigen analysis, Lymphoma, Large-Cell, Anaplastic chemistry, Lymphoma, T-Cell chemistry, Pleural Effusion diagnosis
- Abstract
Background: Posttransplant lymphoproliferative disorders (PTLDs) are almost always of B-cell derivation and have a strong association with Epstein-Barr virus (EBV). Only rare cases of CD30 (Ki-1)-positive anaplastic large cell (ALC) lymphomas in transplant recipients have been described. EBV has been studied in few of these cases. Pleural effusion is an uncommon clinical manifestation of both PTLDs and CD30-positive ALC lymphoma., Case: A 60-year-old, male renal transplant recipient presented with fever and pleural effusion. Cytologic examination of the effusion revealed a large cell lymphoma. Immunocytologic studies disclosed a T-cell phenotype. Subsequently a cutaneous lesion and an accessory spleen were observed, and cervical lymphadenopathies developed. Fine needle aspiration of lymph nodes confirmed the presence of lymphoma. Histologic and immunohistochemical studies of the lymph nodes, skin and accessory spleen revealed the presence of CD30-positive, T-cell, ALC lymphoma. No EBV DNA was detected by polymerase chain reaction analysis. Despite chemotherapy, the patient died seven months after the initial cytologic diagnosis of lymphoma., Conclusion: CD30-positive ALC lymphomas are an uncommon variant of PTLDs that should be considered in the differential diagnosis of neoplastic disorders arising in immunosuppressed patients. Cytology and immunocytochemistry are useful diagnostic procedures for their early detection.
- Published
- 1997
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36. A comparative survey on the incidence of kidney graft primary vascular thrombosis among CAPD and haemodialysis patients.
- Author
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Escuin F, Del Peso G, Pérez Fontán M, Rodriguez-Carmona A, Martínez A, Lanuza M, Hortal L, Fernández AM, Albero MD, Pérez Contreras J, and Selgas R
- Subjects
- Adult, Cohort Studies, Humans, Spain epidemiology, Thrombosis epidemiology, Kidney Transplantation adverse effects, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Renal Dialysis adverse effects, Thrombosis etiology
- Published
- 1996
37. [Parathormone as a uremic toxin. Possible effect on respiratory muscle function in uremia].
- Author
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Gómez-Fernández P, Sánchez Agudo L, Calatrava JM, Martínez ME, Escuin Sancho F, Selgas R, and Sánchez Sicilia L
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Muscles physiopathology, Respiratory Function Tests, Uremia complications, Uremia physiopathology, Parathyroid Hormone metabolism, Respiration Disorders etiology, Uremia metabolism
- Published
- 1984
38. [Leukocyte kinetics during hemodialysis: increase of leukocyte aggregation and chemotactic activity of the serum as etiologic factors in intradialytic leukopenia].
- Author
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Gómez-Fernández P, Sanz Guajardo A, Conesa Vicente J, Escuin Sancho F, Montero García A, Fontán G, and Sánchez Sicilia L
- Subjects
- Cell Aggregation, Chemotaxis, Leukocyte, Female, Humans, Male, Leukocytes physiology, Leukopenia etiology, Membranes, Artificial, Renal Dialysis adverse effects
- Published
- 1984
39. [Medium-term experience with continuous ambulatory peritoneal dialysis in the treatment of terminal chronic renal insufficiency].
- Author
-
Selgas R, Pérez-Fontán M, Rodríguez Carmona A, Conesa J, Gómez P, Ortega O, Miguel JL, Torre MA, Escuin F, and Riñón C
- Subjects
- Adolescent, Adult, Aged, Blood Pressure, Child, Chronic Kidney Disease-Mineral and Bone Disorder, Evaluation Studies as Topic, Female, Hospitalization, Humans, Male, Middle Aged, Nutrition Disorders etiology, Peritonitis etiology, Kidney Failure, Chronic therapy, Peritoneal Dialysis adverse effects, Peritoneal Dialysis, Continuous Ambulatory adverse effects
- Published
- 1984
40. [Prevention of peritonitis in continuous ambulatory peritoneal dialysis. Comparative study of 2 different protocols of training and bag changing].
- Author
-
Selgas R, Pérez-Fontán M, Miguel JL, Rodríguez-Carmona A, Zuzuarregui MS, Escuin F, Ortega O, Conesa J, Huarte E, and Sánchez Sicilia L
- Subjects
- Female, Humans, Male, Patient Education as Topic, Peritoneal Dialysis, Continuous Ambulatory methods, Peritonitis microbiology, Staphylococcal Infections prevention & control, Peritoneal Dialysis adverse effects, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritonitis prevention & control
- Published
- 1984
41. [Adult Fanconi syndrome following the ingestion of degraded tetracycline. Presentation of a case].
- Author
-
Escuin Sancho F, García Aparicio CM, García Signes S, Picazo Córdoba F, Luna Morales A, López Fernández P, and Olivares Martín J
- Subjects
- Adolescent, Drug Stability, Female, Humans, Fanconi Syndrome chemically induced, Tetracycline adverse effects
- Published
- 1981
42. Mycobacterium chelonei peritonitis due to hematogenous dissemination in a continuous ambulatory peritoneal dialysis patient.
- Author
-
Selgas R, Muñoz J, Aquella A, Huarte E, Fonseca E, Escuin F, and Contreras F
- Subjects
- Adult, Female, Humans, Sepsis etiology, Mycobacterium Infections etiology, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritonitis etiology, Sepsis complications
- Abstract
Renal failure patients have been found to have a special susceptibility to Mycobacterium infections. In patients undergoing peritoneal dialysis, Mycobacterium chelonei peritonitis, due to penetration through the peritoneal catheter lumen, has been described. In our report, we described a case of disseminated M chelonei infection that began in a Thomas hemodialysis prosthesis and finally resulted in peritonitis of hematogenous origin. The diagnostic and therapeutic peculiarities are discussed.
- Published
- 1987
- Full Text
- View/download PDF
43. Respiratory muscle weakness in uremic patients under continuous ambulatory peritoneal dialysis.
- Author
-
Gómez-Fernández P, Sánchez Agudo L, Calatrava JM, Escuin F, Selgas R, Martínez ME, Montero A, and Sánchez-Sicilia L
- Subjects
- Adult, Diaphragm physiopathology, Female, Humans, Inspiratory Capacity, Male, Middle Aged, Muscle Contraction, Peritoneal Cavity, Peritoneal Dialysis adverse effects, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Respiration Disorders etiology, Uremia therapy
- Abstract
The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of this therapeutic modality. The effects of CAPD on pulmonary function are one of the aspects currently under study. Based on previous data suggesting the existence of extrapulmonary ventilatory restriction in uremic patients under CAPD, we have studied in these patients the respiratory muscle function as expressed in the maximal inspiratory pressure (MIP) and assessed the impact of the infusion of 2 liters of dialysis fluid into the peritoneal cavity on both MIP and the pulmonary volumes. Uremic patients evidenced significantly lower MIP values as compared with healthy controls. The filling of the peritoneal cavity induced, both in the supine and in the sitting position, a restrictive effect and an increase in the inspiratory capacity. We conclude that uremic patients under CAPD evidence a respiratory muscle dysfunction of as yet unclear cause. Our findings further suggest that the infusion of 2 liters of dialysis fluid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.
- Published
- 1984
- Full Text
- View/download PDF
44. [Evaluation of nutritional parameters in uremic patients treated by hemodialysis].
- Author
-
Pérez Fontán M, Selgas R, García López F, Rodríguez Carmona A, Ortega O, Conesa J, Escuin F, and Sánchez Sicilia L
- Subjects
- Adult, Aged, Dietary Fats metabolism, Dietary Proteins metabolism, Female, Humans, Male, Middle Aged, Uremia metabolism, Diet, Nutrition Disorders etiology, Renal Dialysis adverse effects, Uremia complications
- Published
- 1984
45. Angiomyelolipoma associated with bilateral adrenocortical hyperplasia and hypertension.
- Author
-
Escuin F, Gomez P, Martinez I, Pérez-Fontan M, Selgas R, and Sanchez-Sicilia L
- Subjects
- Adrenal Gland Neoplasms pathology, Child, Female, Humans, Hyperplasia pathology, Lipoma pathology, Adrenal Gland Neoplasms complications, Adrenal Glands pathology, Hypertension complications, Lipoma complications
- Abstract
We report a case of adrenal myelolipoma associated with adrenocortical hyperplasia and hypertension. Although several endocrine derangements have been described in association with myelolipomas, we have found no reports of its association with adrenocortical hyperplasia.
- Published
- 1985
- Full Text
- View/download PDF
46. Peritoneal membrane failure as a determinant of the CAPD future. An epidemiological, functional and pathological study.
- Author
-
Huarte-Loza E, Selgas R, Carmona AR, Martinez ME, Muñoz J, Fontan MP, Ortega O, Escuin F, and Sicilia LS
- Subjects
- Creatinine metabolism, Female, Humans, Kinetics, Male, Middle Aged, Peritoneum pathology, Peritonitis etiology, Peritonitis physiopathology, Urea metabolism, Uric Acid metabolism, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritoneum physiopathology
- Published
- 1987
- Full Text
- View/download PDF
47. Peritoneal functional parameters after five years on continuous ambulatory peritoneal dialysis (CAPD): the effect of late peritonitis.
- Author
-
Selgas R, Muñoz J, Cigarran S, Ramos P, L-Revuelta K, Escuin F, and Miguel JL
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Bacterial Infections physiopathology, Creatinine metabolism, Female, Humans, Hypertension physiopathology, Male, Middle Aged, Models, Theoretical, Peritonitis physiopathology, Prospective Studies, Time Factors, Ultrafiltration, Urea metabolism, Bacterial Infections etiology, Kidney Failure, Chronic therapy, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritoneum physiology, Peritonitis etiology
- Abstract
Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 +/- 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 +/- 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring less than 36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occurring greater than 36 months since initiation) induced a decrease in urea-MTC (22.3 +/- 6 to 15.8 +/- 3.9, p less than 0.05), creatinine-MTC (9.4 +/- 3.1 to 7.4 +/- 2.5, p less than 0.05), and a corresponding increase in UF (1.25 +/- 0.4 to 1.4 +/- 0.3, mL/min, p less than 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.
- Published
- 1989
48. Vaccination against hepatitis B in renal dialysis units: short or normal vaccination schedule?
- Author
-
Carreño V, Mora I, Escuin F, Sánchez Sicilia L, Alvarez V, Casado S, Alcázar JM, Hernando L, Porres JC, and Carrasco JL
- Subjects
- Adult, Female, Follow-Up Studies, Hemodialysis Units, Hospital, Hepatitis B immunology, Hepatitis B Antibodies analysis, Humans, Immunization Schedule, Immunization, Secondary, Male, Middle Aged, Viral Hepatitis Vaccines adverse effects, Hepatitis B prevention & control, Viral Hepatitis Vaccines administration & dosage
- Abstract
Three I.M. injections of hepatitis B vaccine (Merck Sharp & Dohme) were administered, according to the recommended schedule (0, 1, 6 mos), to seronegative individuals of one renal dialysis unit (33 patients, 58 health care personnel) and, according to a shorter regimen (0, 1, 3 mos), in another unit of similar characteristics (30 patients, 53 health care personnel). Staff members and renal patients received, respectively, 20 y 40 mcg of vaccine per injection. In the early vaccination phase, the two regimens did not lead to a difference in seroconversion rates nor in anti-HBs titers. After a 9-month surveillance, lower seroconversion rates, although not significant, were observed with the accelerated regimen among staff members (84.2%) and renal patients (79.2%) as compared with 93% and 87.5%, respectively, following the normal schedule. At the same time, anti-HBs titers were significantly lower (p less than 0.001) in the staff (316 RIA U) and patients (93 U) vaccinated according to the short regimen than in their respective counterparts (4196 and 1047 U) assigned to the normal schedule. A fourth dose of vaccine given to subjects with low and no anti-HBs titers significantly increased seroconversion and anti-HBs levels, although with little success among the former non-responders.
- Published
- 1985
49. Hemolytic uremic syndrome in a patient with gastric adenocarcinoma: partial recovery of renal function after gastrectomy.
- Author
-
Ortega Marcos O, Escuin F, Miguel JL, Gómez Fernández P, Pérez Fontán M, Selgas R, and Sanchez Sicilia L
- Subjects
- Adenocarcinoma surgery, Adult, Gastrectomy, Hemolytic-Uremic Syndrome therapy, Humans, Male, Stomach Neoplasms surgery, Adenocarcinoma complications, Hemolytic-Uremic Syndrome etiology, Stomach Neoplasms complications
- Abstract
We report on a patient with gastric adenocarcinoma and severe renal failure caused by hemolytic uremic syndrome with predominantly vascular involvement. Evolution was favorable with partial recovery of renal function after tumor excision and administration of fresh plasma. Although microangiopathic hemolytic anemia is frequently associated with solid tumors, the appearance of a typical hemolytic uremic syndrome with carcinoma is exceptional.
- Published
- 1985
50. [Central hypoventilation as a cause of hypoxemia during hemodialysis. Effects of acetazolamide administration].
- Author
-
Gómez Fernández P, Conesa J, Sanz A, Selgas R, Miguel JL, Escuin F, García F, and Sánchez Sicilia L
- Subjects
- Adult, Carbon Dioxide blood, Female, Humans, Male, Middle Aged, Oxygen blood, Partial Pressure, Acetazolamide, Carbonic Anhydrase Inhibitors, Hypoventilation complications, Hypoxia etiology, Renal Dialysis adverse effects
- Published
- 1983
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