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Zapata L, Suárez-Montero J, Flores-Orella M, Morales-Alarcón E, Segarra A, Santos-Rodríguez J. Acute cor pulmonale in patients with acute respiratory distress syndrome due to COVID-19. MEDICINA INTENSIVA (ENGLISH EDITION) 2022; 46:645-647. [PMID: 36088263 PMCID: PMC9449780 DOI: 10.1016/j.medine.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
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Mauduit F, Segarra A, Mandic M, Todgham AE, Baerwald MR, Schreier AD, Fangue NA, Connon RE. Understanding risks and consequences of pathogen infections on the physiological performance of outmigrating Chinook salmon. CONSERVATION PHYSIOLOGY 2022; 10:coab102. [PMID: 35492407 PMCID: PMC9040276 DOI: 10.1093/conphys/coab102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/20/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
The greatest concentration of at-risk anadromous salmonids is found in California (USA)-the populations that have been negatively impacted by the degradation of freshwater ecosystems. While climate-driven environmental changes threaten salmonids directly, they also change the life cycle dynamics and geographic distribution of pathogens, their resulting host-pathogen interactions and potential for disease progression. Recent studies have established the correlation between pathogen detection and salmonid smolt mortality during their migration to the ocean. The objective of the present study was to screen for up to 47 pathogens in juvenile Chinook salmon (Oncorhynchus tshawytscha) that were held in cages at two key sites of the Sacramento River (CA, USA) and measure potential consequences on fish health. To do so, we used a combination of transcriptomic analysis, enzymatic assays for energy metabolism and hypoxia and thermal tolerance measures. Results revealed that fish were infected by two myxozoan parasites: Ceratonova shasta and Parvicapsula minibicornis within a 2-week deployment. Compared to the control fish maintained in our rearing facility, infected fish displayed reduced body mass, depleted hepatic glycogen stores and differential regulation of genes involved in the immune and general stress responses. This suggests that infected fish would have lower chances of migration success. In contrast, hypoxia and upper thermal tolerances were not affected by infection, suggesting that infection did not impair their capacity to cope with acute abiotic stressors tested in this study. An evaluation of long-term consequences of the observed reduced body mass and hepatic glycogen depletion is needed to establish a causal relationship between salmon parasitic infection and their migration success. This study highlights that to assess the potential sublethal effects of a stressor, or to determine a suitable management action for fish, studies need to consider a combination of endpoints from the molecular to the organismal level.
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Joshi R, Hazard RH, Mahesh PKB, Mikkelsen L, Avelino F, Sarmiento C, Segarra A, Timbang T, Sinson F, Diango P, Riley I, Chowdhury H, Asuncion IL, Khanom G, Lopez AD. Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths. BMC Public Health 2021; 21:563. [PMID: 33752622 PMCID: PMC7986549 DOI: 10.1186/s12889-021-10542-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background The majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths. Method We conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs. Results Of the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification. Conclusion Standardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10542-0.
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Oristrell J, Loureiro-Amigo J, Solans R, Valenzuela MP, Monsálvez V, Segarra A, Amengual MJ, Marín A, Feijoo C, Tolosa C. Relapse rate and renal prognosis in ANCA-associated vasculitis according to long-term ANCA patterns. Clin Exp Immunol 2020; 203:209-218. [PMID: 33020895 DOI: 10.1111/cei.13530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/28/2020] [Indexed: 01/30/2023] Open
Abstract
Long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterize these patterns and to determine their prognostic significance. All ANCA determinations performed in two university hospitals during a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, ≥ 5 serial ANCA determinations and AAV diagnosed by biopsy or American College of Rheumatology (ACR) classification criteria. Patients' time-course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. A total of 99 patients [55 with microscopic polyangiitis (MPA), 36 with granulomatosis with polyangiitis (GPA) and eight with eosinophilic granulomatosis with polyangiitis (EGPA)] were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse [hazard ratio (HR) = 3·7, 95% confidence interval (CI) = 1·5-9·1 and HR = 2·9, 95% CI = 1·1-8·0, respectively], independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function [odds ratio (OR) = 5·7, 95% CI = 1·2-26·0]. Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.
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Segarra A, Arredondo KV, Jaramillo J, Jatem E, Salcedo MT, Agraz I, Ramos N, Carnicer C, Valtierra N, Ostos E. Efficacy and safety of bortezomib in refractory lupus nephritis: a single-center experience. Lupus 2019; 29:118-125. [PMID: 31865857 DOI: 10.1177/0961203319896018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Resistant lupus nephritis (LN) has been associated with the persistence of long-lived plasma cells. Preliminary studies identified bortezomib as a potential treatment option for patients with refractory LN. The aim of this study was to analyze the efficacy and safety of bortezomib in the treatment of severe refractory LN. METHODS This retrospective study included 12 female patients diagnosed for the first time with class IV or IV/V LN with acute or rapidly progressive kidney injury (n = 11) and/or severe nephrotic syndrome (n = 1) who showed resistance to induction therapy with cyclophosphamide, steroids, mycophenolate, and rituximab, and were treated with either intravenous or subcutaneous bortezomib plus intravenous dexamethasone. RESULTS All patients with acute or rapidly progressive kidney injury showed a significant reduction in both biochemical and immunological activity after a mean of 6 (minimum 5, maximum 7) weekly cycles of bortezomib regimen, with a significant increase in C3 levels and a significant decrease of anti-ds DNA antibody titers, Systemic Lupus Erythematosus Disease Activity Index score, serum creatinine, and proteinuria. One patient (8.3%) achieved a complete response, and 10 patients (83.4%) achieved a partial response. During follow-up, all these patients maintained partial responses under treatment with mycophenolate and low-dose glucocorticoids. The patient with refractory nephrotic syndrome showed a partial response but relapsed 11 months after the end of bortezomib treatment and was resistant to treatment. A significant decrease in serum IgG levels after initiation of bortezomib treatment was observed in all patients, five of them (41.6%) showed hypogammaglobulinemia (<500 mg/dl), but no patient suffered from opportunistic infections; in only two patients (16.6%) hypogammaglobulinemia persisted at the end of follow-up. Two patients (16.6%) suffered from sensory neuropathy, which led to bortezomib treatment discontinuation. CONCLUSIONS Bortezomib may be an effective option for refractory LN, but close monitoring must be performed for possible adverse events such as peripheral neuropathy and hypogammaglobulinemia.
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Roch M, Rivera-Sanchez L, Segarra A, Montoro JB. CP-067 Effectiveness and safety of rituximab in autoimmune kidney disease after 12 months of follow-up. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Garcia Vives E, Ramentol M, Segarra A, Martínez-Valle F, Loureiro J, Agraz I, Solans-Laque R. AB0639 Influence of Infections on the Prognosis of Anca Associated Vasculitis (AAV). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Vicente N, Pérez M, Gander R, Segarra A, Leganés C, Bueno J. [Congenital portosistemic shunt. Importance of early treatment]. CIRUGIA PEDIATRICA : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE CIRUGIA PEDIATRICA 2015; 28:67-73. [PMID: 27775284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM Congenital portosistemic shunt (CPSS) is an uncommon condition that can cause serious complications such as encephalopathy and liver tumors at risk of malignant degeneration. Occlusion of the shunt by surgery or interventional radiology can prevent and even improve such complications. In some cases, liver transplantation is the only curative option. We describe our experience with this condition. PATIENTS AND METHODS Between 1992 and 2013, eight children (four male and four female) were diagnosed with CPSS (four extrahepatic and four intrahepatic) in our center, of which seven were diagnosed after 2007. The mean age at diagnosis was 5.5 years (1 month-15 years). Five patients had associated comorbidities. RESULTS Five patients had developed hyperammonemia and intellectual impairment, one of those manifested with an onset of coma. Four patients have developed at diagnosis liver tumors, including focal nodular hyperplasia/regenerative nodules (n=3) and adenomas (n=3). One patient with multiple tumors required a hepatectomy owing to compressive symptoms. Two patients, developed malignant degeneration, a child under five years treated with liver transplantation and another in adulthood treated with hepatectomy. In one patient, diagnosed in the neonatal period, the shunt occlusion occurred spontaneously. Direct portography with the occlusion test was performed in five patients, the shunt was occluded with interventional radiology in three cases, surgery in one and liver transplantation in the remaining. CONCLUSIONS The treatment of the SPSC must be early to prevent and even to reverse its complications, avoiding liver transplantation. Currently, interventional radiology is essential in the strategy to follow and treatment of these patients.
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Gander R, Pérez M, Bueno J, Lara A, Segarra A, Martínez MA, Lloret J. [Rupture of a superior mesenteric artery aneurysm in pediatric age: case report and literature review]. CIRUGIA PEDIATRICA : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE CIRUGIA PEDIATRICA 2015; 28:40-44. [PMID: 27775270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Splanchnic artery aneurysms are rare in children. High mortality from rupture justifies its treatment, with various therapeutic options among which stand out surgery and recently, endovascular treatment. CASE REPORT A 11 year old girl presented with abdominal pain and sudden drop in hematocrit. The urgent abdominal CT angiography showed a saccular aneurysm of the superior mesenteric artery (SMA) at 4 cm from the ostium with dissection and active bleeding. A selective angiography was performed which confirmed the dissection. A self-expanding stent was placed in the main trunk of the SMA and a transcatheter coil and onyx embolization of the aneurysm was performed. The control angiogram showed no evidence of residual perfusion of the false lumen and demonstrated proper vascularization of the distal jejunum-ileal branches. Dual antiplatelet therapy with aspirin and dipyridamole was begun. After 24 months of follow-up the patient is asymptomatic. COMMENTS Endovascular treatment of a SMA aneurysm is effective in the pediatric patient, even in emergency situations.
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Camafort M, Vinyoles E, Sobrino J, Domenech M, Segarra A, Riera A, Oller G, Trias F, Coca A. Subclinical cardiac and renal damage among treated patients with masked hypertension: the ESTHEN study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rivera F, Illescas ML, López-Rubio E, Fulladosa J, Poveda R, Baltar J, Fernández-Juárez G, Ballarín J, Oliet A, Vigil A, Lucas J, Sierra M, Frutos MA, García-Frías P, Ramos C, Mérida E, Praga M, Segarra A. Mycophenolate as maintenance therapy for lupus nephritis with impaired renal function. Am J Nephrol 2013; 37:509-17. [PMID: 23689615 DOI: 10.1159/000350756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mycophenolate (MF) is effective as a maintenance therapy after induction therapy in patients with lupus nephritis (LN). However, little is known about its role in patients with impaired renal function. The purpose of this study was to evaluate the efficacy and safety of MF as a maintenance therapy for LN and its association with renal function. METHODS Data were obtained for 56 Spanish patients who were receiving MF as a maintenance therapy for LN. Patients were classified into two groups according to renal function at the initiation of MF treatment: group 1 [estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73 m(2)] and group 2 (eGFR <60 ml/min/1.73 m(2)). The primary endpoints of the study were the rates of renal relapse and responses, and their relationship with baseline renal function. Secondary outcomes were the appearance of side effects during treatment. RESULTS At initiation of MF treatment, the only differences between the groups were for age, hemoglobin levels, anti-DNA antibody titer, proteinuria, and renal function. In group 1 (n = 38), the eGFR was 98 ± 34 ml/min/1.73 m(2) and in group 2 (n = 18) the eGFR was 43 ± 14 ml/min/1.73 m(2). Only 3 cases had an eGFR <30 ml/min/1.73 m(2). No significant differences were observed in the rate of relapse at 6 months (group 1: 20%; group 2: 23%) or at 12 months (group 1: 25%; group 2: 17%). Response rates were also similar in both groups. Side effects were unremarkable. CONCLUSIONS MF is effective and safe as a maintenance therapy for LN both in patients with normal renal function and in those with renal impairment.
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Wu J, Duan S, Li W, Wang Y, Liu W, Zhang J, Lun L, Li X, Zhou C, Zheng Y, Liu S, Xie Y, Cai G, Chen X, Shen P, Li Y, Wang Z, Wang W, Ren H, Zhang W, Chen N, Shimamoto M, Ohsawa I, Suzuki H, Nagamachi S, Shimizu Y, Horikoshi S, Tomino Y, Cox SN, Serino G, Sallustio F, Pesce F, Schena FP, Kalbacher E, Ducher M, Fouque D, MacGregor B, Combarnous F, Fauvel JP, Sarcina C, Ferrario F, Terraneo V, Pani A, Fogazzi G, Visciano GB, De Simone I, Rastelli F, Pozzi C, Kwak IS, Seong EY, Rhee H, Lee DW, Lee SB, Yang BY, Shin MJ, Kim IY, Stangou MJ, Bantis C, Kasimatis S, Skoularopoulou M, Toulkeridis G, Pantzaki A, Papagianni A, Efstratiadis G, Yamada K, Suzuki H, Suzuki Y, Raska M, Huang ZQ, Reily C, Moldoveanu Z, Kiryluk K, Julian BA, Tomino Y, Gharavi AG, Novak J, Camilla R, Coppo R, Bellur S, Cattran D, Cook T, Feehally J, Troyanov S, Roberts I, Vergano L, Morando L, Mizerska-Wasiak M, Maldyk J, Rybi-Szuminska A, Firszt-Adamczyk A, Bienias B, Gadomska-Prokop K, Grenda R, Zajaczkowska M, Stankiewicz R, Wasilewska A, Roszkowska-Blaim M, Zhang X, Xie J, Wang W, Pan X, Guo S, Shen P, Zhang W, Chen N, Soylu A, Ozturk Y, Dogan Y, Ozmen D, Yilmaz O, Kavukcu S, Choi JY, Park GY, Jung HY, Kim KH, Kwon O, Cho JH, Kim CD, Kim YL, Park SH, Berthoux FC, Mohey H, Laurent B, Mariat C, Chen YX, Zhang W, Xu J, Chen N, Bajcsi D, Haris A, Abraham G, Legrady P, Polner K, Ronaszeki B, Balla Z, Rakonczay Z, Ivanyi B, Sonkodi S, Bredin PH, Canney M, Kennedy C, Plant LD, Clarkson MR, Naz N, Hiremath M, Banerjee A, Shah Y, Yuste C, Casian A, Jironda C, Jayne D, Smith R, Lewin M, Jones R, Merkel P, Jayne D, Izzo C, Quaglia M, Radin E, Airoldi A, Fenoglio R, Lazzarich E, Stratta P, Onusic VL, Araujo MJ, Battaini LC, Jorge LB, Dias CB, Toledo-Barros M, Toledo-Barros R, Woronik V, Cirami CL, Gallo P, Romoli E, Mecacci F, Simeone S, Minetti EE, Mello G, Rivera F, Segarra A, Praga M, Quaglia M, Radin E, Izzo C, Airoldi A, Lazzarich E, Fenoglio R, Stratta P, Dias CB, Lee J, Jorge L, Malheiro D, Barros RT, Woronik V, Zakharova EV, Stolyarevich ES, Velioglu A, Guler D, Nalcaci S, Birdal G, Arikan H, Koc M, Direskeneli H, Tuglular S, Ozener C, Guedes Marques M, Cotovio P, Ferrer F, Silva C, Botelho C, Lopes K, Maia P, Carreira A, Campos M, Alharazy S, Kong NCT, Mohammad M, Shah SA, Gafor H, Bain A. Clinical nephrology - IgA nephropathy, lupus nephritis, vasculitis. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hirata M, Tashiro Y, Aizawa K, Endo K, Hirata M, Tashiro Y, Endo K, Aizawa K, Serizawa K, Hirata M, Yogo K, Tashiro Y, Endo K, Cases A, Portoles J, Calls J, Martinez-Castelao A, Munar MA, Segarra A, Samouilidou E, Pantelias K, Petras D, Mpakirtzi T, Pipili C, Chatzivasileiou G, Vasiliou K, Denda E, Grapsa E, Tzanatos H, Shoji S, Inaba M, Tomosugi N, Okuno S, Ichii M, Yamakawa T, Kurihara S, Barsan L, Stanciu A, Stancu S, Capusa C, Bratescu L, Mircescu G, Barsan L, Stanciu A, Stancu S, Capusa C, Mircescu G, Kuo KL, Hung SC, Lee TS, Tarng DC, Nistor I, Covic A, Goldsmith D, Garrido P, Fernandes J, Ribeiro S, Vala H, Parada B, Alves R, Belo L, Costa E, Santos-Silva A, Reis F, Abdulnabi K, Ullah A, Abdulateef A, Howse M, Khalil A, Fouqueray B, Hoffmann M, Addison J, Manamley N, Stamopoulos D, Mpakirtzi N, Afentakis N, Grapsa E, Yu KH, Chou J, Klaus S, Schaddelee M, Kashiwa M, Takada A, Neff T, Galle J, Claes K, Di Giulio S, Guerin A, Herlitz H, Kiss I, Wirnsberger G, Manamley N, Addison J, Fouqueray B, Froissart M, Winearls C, Martinez Castelao A, Cases Amenos A, Torre Carballada A, Torralba Iranzo FJ, Bronsoms Artero JM, Toran Monserrat D, Valles Prats M, Merino JL, Espejo B, Bueno B, Amezquita Y, Paraiso V, Kiss Z, Kerkovits L, Ambrus C, Kulcsar I, Szegedi J, Benke A, Borbas B, Ferenczi S, Hengsperger M, Kazup S, Nagy L, Nemeth J, Rozinka A, Szabo T, Szelestei T, Toth E, Varga G, Wagner G, Zakar G, Gergely L, Kiss I, Exarchou K, Tanahill N, Anthoney A, Khalil A, Ahmed S, Capusa C, Oprican R, Stanciu A, Lipan M, Stancu S, Chirculescu B, Mircescu G, Ferenczi S, Roger S, Malecki R, Farouk M, Dellanna F, Thomas M, Manamley N, Touam M, Chantrel F, Bouiller M, Hurot JM, Raphael T, Testa A, Veillon S, Vendrely B, Masoumi Z, Ahmadpoor P, Ghaderian SMH, Nafar M, Samavat S, Samadian F, Poorrezagholi F, Shahidi M, Riccio E, Visciano B, Capuano I, Memoli A, Mozzillo G, Memoli B, Pisani A. Anaemia in CKD 1-5. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Miyazaki N, Matsumoto J, Alberici F, Palmisano A, Maritati F, Oliva E, Buzio C, Vaglio A, Mjoen G, Norby GE, Vikse BE, Svarstad E, Rune B, Knut A, Szymczak M, Kuzniar J, Kopec W, Marchewka Z, Klinger M, Arrizabalaga P, Silvarino R, Sant F, Espinosa G, Sole M, Cervera R, Gude D, Chennamsetty S, Demin A, Kozlov V, Lisukov I, Kotova O, Sizikov A, Sergeevicheva V, Demina L, Borjesson O, Wendt M, Avik A, Qureshi AR, Bratt J, Miller EJ, Gunnarsson I, Bruchfeld A, Sugiyama K, Hasegawa M, Yamamoto K, Hayashi H, Koide S, Murakami K, Tomita M, Yoshida S, Yuzawa Y, Yew S, Jayne D, Westman K, Hoglund P, Flossman O, Mahr A, Luqmani R, Robson J, Thervet E, Levi C, Guiard E, Roland M, Nochy D, Daniliuc C, Guillevin L, Mouthon L, Jacquot C, Karras A, Kimura Y, Morita H, Debiec H, Yamada H, Miura N, Banno S, Ronco P, Imai H, Shin DH, Famee D, Koo HM, Han SH, Choi KH, Yoo TH, Kang SW, Fofi C, Fofi C, Scabbia L, Festuccia F, Stoppacciaro A, Mene' P, Shimizu A, Fukui M, MII A, Kaneko T, Masuda Y, Iino Y, Katayama Y, Fukuda Y, Kuroki A, Matsumoto K, Akizawa T, Jurubita R, Ismail G, Bobeica R, Rusu E, Zilisteanu D, Andronesi A, Motoi O, Ditoiu V, Copaci I, Voiculescu M, Irazabal MV, Eirin A, Lieske JC, Beck LH, Dillon JJ, Nachman PH, Sethi S, Erickson SB, Cattran DC, Fervenza FC, Svobodova B, Hruskova Z, Janatkova I, Jancova E, Tesar V, Seo MS, Kwon SH, Lee EB, You JY, Hyun YK, Woo SA, Park MY, Choi SJ, Jeon JS, Noh H, Kim JG, Han DC, Hwang SD, Choi TY, Jin SY, Kwon SH, Loiacono E, Loiacono E, Defedele D, Puccinelli MP, Camilla R, Gallo R, Peruzzi L, Rollino C, Beltrame G, Ferro M, Vergano L, Campolo F, Amore A, Coppo R, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Teranishi J, Yamamoto R, Nagasawa Y, Shoji T, Iwatani H, Okada N, Moriyama T, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y, Koo HM, Doh FM, Kim SJ, Kang SW, Choi KH, Han DS, Han SH, Suzuki Y, Matsuzaki K, Suzuki H, Okazaki K, Yanagawa H, Maiguma M, Muto M, Sato T, Horikoshi S, Novak J, Hotta O, Tomino Y, Gutierrez* E, Zamora I, Ballarin J, Arce Y, Jimenez S, Quereda C, Olea T, Martinez-Ara J, Segarra A, Bernis C, Garcia A, Goicoechea M, Garcia de Vinuesa S, Rojas J, Praga M, Ristovska V, Petrushevska G, Grcevska L, Knoop T, Vikse BE, Svarstad E, Bostad L, Leivestad T, Bjorneklett R, Satake K, Shimizu Y, Mugitani N, Suzuki H, Suzuki Y, Horikoshi S, Honda S, Shibuya K, Shibuya A, Tomino Y, Papale M, Rocchetti MT, DI Paolo S, Suriano IV, D'apollo A, Vocino G, Montemurno E, Varraso L, Grandaliano G, Gesualdo L, Huerta A, Bomback AS, Canetta PA, Radhakrishnan J, Herlitz L, Stokes B, D'agati V, Markowitz G, Appel GB, Ristovska V, Grcevska L, Mouna H, Nasr BD, Mrabet I, Ahmed L, Sabra A, Mohamed Ammeur F, Mezri E, Habib S, Innocenti M, Pasquariello A, Pasquariello G, Mattei P, Bottai A, Fumagalli G, Bozzoli L, Samoni S, Cupisti A, Caldin B, Hung J, Repizo L, Malheiros DM, Barros R, Woronik V, Giammarresi C, Bono L, Ferrantelli A, Tortorici C, Licavoli G, Rotolo U, Huang X, Wang Q, Shi M, Chen W, Liu Z, Scarpioni R, Cantarini L, Lazzaro A, Ricardi M, Albertazzi V, Melfa L, Concesi C, Vallisa D, Cavanna L, Gungor G, Ataseven H, Demir A, Solak Y, Biyik M, Ozturk B, Polat I, Kiyici A, Ozer Cakir O, Polat H, Martinez-Ara J, Castillo I, Carreno V, Aguilar A, Madero R, Hernandez E, Bernis C, Bartolome J, Gea F, Selgas R, El Aggan HAM, El Banawy HS, Wagdy E, Tchebotareva N, LI O, Bobkova I, Kozlovskaya L, Varshavskiy V, Golicina E, Chen Y, Gong Z, Chen X, Tang L, Zhou J, Cao X, Wei R, Koo EH, Koo EH, Park JH, Kim HK, Kim MS, Jang HR, Lee JE, Huh W, Kim DJ, Oh HY, Kim YG, Tchebotareva N, Bobkova I, Kozlovskaya L, LI O, Eskova O, Shvetsov M, Golytsina E, Varshavskiy V, Popova O, Quaglia M, Monti S, Fenoglio R, Menegotto A, Airoldi A, Izzo C, Rizzo MA, Dianzani U, Stratta P, Vaglio A, Vaglio A, Alberici F, Gianfreda D, Buzio C. Primary and secondary glomerulonephritis I. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fliser D, Shilo V, Covic A, Besarab A, Provenzano R, Duliege AM, Chen M, Tong S, Francisco C, Gao HY, Polu K, De Francisco AL, Macdougall I, Macdougall I, Schiller B, Locatelli F, Wiecek A, Francisco C, Tang H, Tong S, Chen M, Duliege AM, Polu K, Mayo M, Covic A, Macdougall I, Macdougall I, Casadevall N, Stead R, Taal M, Faller B, Karras A, Chen M, Tong S, Duliege AM, Rowell R, Polu K, Eckardt KU, Locatelli F, Dusilova Sulkova S, Arnaud S, Bruno P, Arnaud G, Dorina V, Eric A, Gerard M, Cases A, Portoles JM, Calls J, Martinez Castelao A, Sanchez-Guisande D, Segarra A, Tsubakihara Y, Tsubakihara Y, Saito A, Saito A, Saito A, Tsubakihara Y, Martinez-Castelao A, Martinez-Castelao A, Cases A, Fort J, Bonal J, Fulladosa X, Galceran JM, Torregrosa V, Coll E, Minutolo R, Cozzolino M, DI Iorio B, Polito P, Santoro D, Manenti F, Nappi F, Feriozzi S, Conte G, De Nicola L, Mikhail A, Provenzano R, Schiller B, Besarab A, Francisco C, Gao HY, Daley R, Tong S, Mayo M, Yang A, Polu K, Macdougall I, Wiecek A, Schiller B, Canaud B, Locatelli F, Yang A, Chen M, Polu K, Francisco C, Gao HY, Tong S, Duliege AM, Provenzano R, Locatelli F, Locatelli F, Provenzano R, Besarab A, Rath T, Yang A, Mayo M, Francisco C, Macdougall I, Bartnicki P, Baj Z, Majewska E, Rysz J, Fievet P, Assem M, Brazier F, Xu X, Soltani ON, Demontis R, Barsan L, Stancu S, Stancu S, Stanciu A, Capusa C, Petrescu L, Zugravu A, Mircescu G, Malyszko JM, Levin-Iaina N, Malyszko J, Glowinska I, Koc-Zorawska E, Slotki I, Mysliwiec M, Mircescu G, Mircescu G, Capusa C, Stancu S, Barsan L, Grabowski D, Blaga V, Dumitru D, Pchelin I, Shishkin A, Kus T, Usalan C, Tiryaki O, Chin HJ, Chae DW, Kim S, Bertram H, Keller F, Rumjon A, Wood C, Wilson P, Khakoo S, Chai MO, Macdougall IC, Nuria GF, Maria Asuncion F, Jose Maria MG, Carmen C, Paloma Leticia MM, Francisco Javier L, Moniek DG, De Goeij M, Yvette M, Diana G, Friedo D, Nynke H, Lezaic V, Miljkovic B, Petkovic N, Maric I, Vucicevic K, Simic Ogrizovic S, Djukanovic L, Cases A, Martinez-Castelao A, Fort A, Bonal J, Fulladosa X, Galceran JM, Torregrosa V, Coll E, DI Giulio S, DI Giulio S, Galle J, Kiss I, Herlitz H, Wirnsberger G, Claes K, Suranyi M, Guerin A, Winearls C, Addison J, D'souza M, Froissart M, Garrido P, Garrido P, Teixeira M, Costa E, Rodrigues-Santos P, Parada B, Belo L, Alves R, Teixeira F, Santos-Silva A, Reis F, Winearls C, Winearls C, DI Giulio S, Galle J, Kiss I, Herlitz H, Wirnsberger G, Claes K, Suranyi M, Guerin A, Addison J, D'souza M, Fouqueray B, Floris M, Conti M, Cao R, Pili G, Melis P, Matta V, Murgia E, Atzeni A, Binda V, Angioi A, Peri M, Pani A, Besarab A, Belo D, Diamond S, Martin E, Sun C, Lee T, Saikali K, Franco M, Leong R, Neff T, Yu KHP, Tiranathanagul K, Praditpornsilpa K, Katavetin P, Kanjanabuch T, Avihingsanon Y, Tungsanga K, Eiam-Ong S, Macdougall IC, Casadevall N, Percheson P, Potamianou A, Foucher A, Fife D, Vercammen E. Renal anaemia - CKD 1-5. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ruiz-Irastorza G, Espinosa G, Frutos MA, Jiménez Alonso J, Praga M, Pallarés L, Rivera F, Robles Marhuenda Á, Segarra A, Quereda C. [Diagnosis and treatment of lupus nephritis]. Rev Clin Esp 2012; 212:147.e1-30. [PMID: 22361331 DOI: 10.1016/j.rce.2012.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Rivera F, Fulladosa X, Poveda R, Frutos MA, García-Frías P, Ara J, Illescas L, López-Rubio E, Mérida E, Carreño A, Ballarín J, Fernández-Juárez G, Baltar J, Ramos C, Pons S, Oliet A, Vigil A, Praga M, Segarra A. Mycophenolate as induction therapy in lupus nephritis with renal function impairment. Am J Nephrol 2012; 35:424-33. [PMID: 22517244 DOI: 10.1159/000337916] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 03/08/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mycophenolate (MF) is effective as induction therapy for lupus nephritis (LN) in patients with normal renal function; however, little is known about its role in patients with impaired renal failure. The purpose of this study was to evaluate the response to MF in LN and its association with baseline renal function. METHODS Data were obtained for 90 patients from 12 Spanish renal units who were receiving MF as induction therapy for LN. Patients were classified into 2 groups: group 1 (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m(2)) and group 2 (eGFR <60 ml/min/ 1.73 m(2)). The primary outcome measure was the percentage of patients who achieved any response and its relationship with initial eGFR. The secondary outcome measures were the percentage of patients who achieved a complete response (CR) or partial response (PR) and the appearance of relapses during treatment and side effects. RESULTS At initiation of MF treatment, there were no differences in the main parameters between group 1 (n = 63; eGFR 87 ± 23 ml/min/ 1.73 m(2)) and group 2 (n = 27; eGFR 44 ± 12 ml/min/1.73 m(2)). Exposure to prednisone and MF was similar. The percentages of patients who achieved a response in groups 1 and 2 were, respectively, 69.2 and 43.8% at 6 months and 81.3 and 73.7% at 12 months. CR was more frequent in group 1, whereas PR was similar in both groups. Four patients relapsed and side effects were unremarkable. CONCLUSIONS MF is effective and safe as induction therapy for LN, and response is even achieved in patients with baseline renal impairment.
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Tchebotareva N, Bobkova I, Kozlovskaya L, Li O, Plaisier E, Terrier B, Lacraz A, Bridoux F, Huart A, Marie I, Launay D, Hummel A, Saint-Martin L, Bonnet F, Belenotti P, Kahn JE, Hinschberger O, Rullier P, Cacoub P, Casian A, Szpirt W, Jayne D, Walsh M, Haris A, Polner K, Aranyi J, Braunitzer H, Meran Z, Kaszas I, Mazanowska O, Koscielska-Kasprzak K, Kaminska D, Penar J, Zabinska M, Dziemianko I, Krajewska M, Klinger M, Marco H, Corica M, Picazo M, Arce Y, Llobet JM, Diaz M, Ballarin J, Kuroki A, Akizawa T, Papasotiriou M, Kalliakmani P, Huang L, Gerolymos M, Goumenos DS, Johnson TS, Ogahara S, Abe Y, Ito K, Watanabe M, Saito T, Saito T, Watanabe M, Ito K, Abe Y, Ogahara S, Nesen A, Topchii I, Semenovylh P, Galchinskaya V, Bantis C, Heering P, Kouri NM, Schwandt C, Rump LC, Ivens K, Nagasawa Y, Iio K, Fukuda S, Date Y, Iwatani H, Yamamoto R, Horii A, Inohara H, Imai E, Ohno H, Rakugi H, Rakugi Y, Sahin OZ, Gibyeli Genek D, Alkan Tasli F, Yavas H, Gurses S, Yeniay P, Uzum A, Ersoy R, Cirit M, Christou D, Molyneux K, Peracha J, Feehally J, Smith AC, Barratt J, Yamamoto R, Nagasawa Y, Shoji T, Katakami N, Ohtoshi K, Hayaishi-Okano R, Yamasaki Y, Yamauchi A, Tsubakihara Y, Imai E, Rakugi H, Isaka Y, Faria B, Vidinha J, Pego C, Garrido J, Lemos S, Lima C, Sorbo G, Lorga E, Sousa T, Yavas HH, Sahin OZ, Ozen KP, Gibyeli Genek D, Ersoy R, Alkan Tasli F, Yucel O, Cirit M, Wada Y, Ogata H, Yamamoto M, Ito H, Kinugasa E, Lundberg S, Lundahl J, Gunnarsson I, Jacobson S, Camilla R, Loiacono E, Dapra V, Morando L, Conrieri M, Bianciotto M, Bosetti FM, Gallo R, Peruzzi L, Amore A, Coppo R, Jeong K, Kim Y, Lee TW, Lee SH, Moon JY, Lee S, Ihm C, Komatsu H, Fujimoto S, Kikuchi M, Sato Y, Kitamura K, Sulikowska B, Johnson R, Grajewska M, Donderski R, Odrowaz-Sypniewska G, Manitius J, Amore A, Camilla R, Morando L, Peruzzi L, Rollino C, Quarello F, Colla L, Segoloni G, Caramello E, Cravero R, Quaglia M, Stratta P, Mazzucco G, Coppo R, Coppo R, Grcevska L, Petrusevska G, Nikolov V, Polenakovic M, Lee KW, Ham YR, Jang WI, Jung JY, Jang DS, Chung S, Choi DE, Na KR, Shin YT, Sulikowska B, Johnson R, Grajewska M, Donderski R, Odrowaz-Sypniewska G, Manitius J, Pasquariello A, Innocenti M, Pasquariello G, Mattei P, Colombini E, Ricchiuti G, Sami N, Cupisti A, Rocchetti MT, Di Paolo S, Tamma G, Lasorsa D, Suriano IV, D'Apollo A, Papale M, Mastrofrancesco L, Grandaliano G, Svelto M, Valenti G, Gesualdo L, Wang C, Li Y, Jia N, Fan J, Vigotti FN, Daidola G, Colla L, Besso L, Segoloni GP, Rocchetti MT, Papale M, Di Paolo S, Vocino G, Suriano IV, D'Apollo A, Grandaliano G, Gesualdo L, Berthoux F, Mohey H, Laurent B, Mariat C, Afiani A, Thibaudin L, Rivera F, Segarra A, Praga M, Vozmediano C, Rivera F, Lopez JM, Hernandez D, Pesickova S, Rysava R, Lenicek M, Potlukova E, Jancova E, Vitek L, Honsova E, Zavada J, Svarcova J, Kalousova M, Trendelenburg M, Tesar V, Li X, Ren H, Zhang W, Pan X, Zhang Q, Chen X, Xu Y, Shen P, Chen N, Hruskova Z, Mareckova H, Svobodova B, Jancova E, Bednarova V, Rysava R, Tesar V, Bobrova L, Kozlovskaya N, Khafizova E, Meteleva N, Shakhnova E, Alsuwaida A, Hussain S, Alghonaim M, AlOudah N, Ullah A, Kfoury H, Lorusso P, Bottai A, Cipollini I, Giorgetti M, Barsotti G, Goplani K, Kaswan K, Gera D, Patel H, Gumber M, Shah P, Vanikar A, Trivedi H, Gluhovschi C, Gluhovschi G, Potencz E, Lazar E, Trandafirescu V, Petrica L, Velciov S, Bozdog G, Bob F, Gadalean F, Vernic C, Cioca D, Bantis C, Heering P, Stangou M, Kouri NM, Schwandt C, Memmos D, Rump LC, Ivens K, Tofik R, Rippe B, Torffvit O, Bakoush O, Silska M, Lipkowska K, Warzywoda A, Soltysiak J, Blumczynski A, Musielak A, Ostalska-Nowicka D, Zachwieja J, Spartalis M, Stangou M, Pliakos K, Oikonomidou D, Pantzaki A, Rizopoulou E, Efstratiadis G, Memmos D, Okino VT, Moyses Neto M, Silva GEB, Vieira Neto O, Romao EA, Coelho EB, Dantas M, Liakou H, Stangou M, Ekonomidou D, Pantzaki A, Patinakis P, Sigounas V, Efstratiadis G, Memmos D, Shvetsov M, Bobkova I, Zheng A, Li O, Chebotareva N, Kamyshova E, Rudenko T, Gelpi R, Navarro I, Ngango L, Poveda R, Goma M, Torras J, Grinyo JM, Fulladosa X, Wang Y, Ivany J, Jardine M, Zhong F, Wang W, Ren H, Xie Y, Huang Q, Chen N, Chiappini MG, Di Girolamo M, Grosso A, Muzi L, Panetta V, Khafizova E, Kozlovskaya N, Bobrova L, Bobkova I, Avdonin P, Gluhovschi C, Gluhovschi G, Potencz E, Lazar E, Trandafirescu V, Petrica L, Velciov S, Bozdog G, Bob F, Gadalean F, Vernic C, Cioca D, Ito M, Kimachi M, Nishio S, Koike T, Choi H, Cho AJ, Jang HR, Lee JE, Huh W, Kim DJ, Oh HY, Kim YG. Clinical Nephrology: primary and secondary glomerulonephritis. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bueno J, Perez-Lafuente M, Venturi C, Segarra A, Barber I, Molino JA, Romero A, Ortega J, Bilbao I, Martinez-Ibañez V, Charco R. No-touch hepatic hilum technique to treat early portal vein thrombosis after pediatric liver transplantation. Am J Transplant 2010; 10:2148-53. [PMID: 20887425 DOI: 10.1111/j.1600-6143.2010.03236.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A 'no-touch' hilum technique used to treat early portal vein complications post-liver transplantation in five children with body weight <10 kg is described. Four patients developed thrombosis and one portal flow absence secondary to collateral steal flow. A vascular sheath was placed through the previous laparotomy in the ileocolic vein (n = 2), inferior mesenteric vein (n = 1) or graft umbilical vein (n = 1). Portal clots were mechanically fragmented with balloon angioplasty. In addition, coil embolization of competitive collaterals (n = 3) and stent placement (n = 1) were performed. The catheter was left in place and exteriorized through the wound (n = 2) or a different transabdominal wall puncture (n = 3). A continuous transcatheter perfusion of heparin was subsequently administered. One patient developed recurrent thrombosis 24 h later which was resolved with the same technique. Catheters were removed surgically after a mean of 10.6 days. All patients presented portal vein patency at the end of follow-up. Three patients are alive after 5 months, 1.5 and 3.5 years, respectively; one patient required retransplantation 18 days postprocedure and the remaining patient died of adenovirus infection 2 months postprocedure. In conclusion, treatment of early portal vein complications following pediatric liver transplantation with this novel technique is feasible and effective.
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Brun N, Bueno J, Pérez M, Venturi C, Giné C, Lloret J, Segarra A, Martínez Ibáñez V, Charco R. [Long term follow-up of bile duct stenosis treated with interventional radiology in pediatric liver transplantation]. CIRUGIA PEDIATRICA : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE CIRUGIA PEDIATRICA 2010; 23:3-6. [PMID: 20578568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The reported incidence of biliary strictures following pediatric liver transplantation has ranged between 5-34%, with a higher incidence in segmental grafts. Currently, percutaneous transhepatic balloon dilatation of biliary strictures is considered as the first line treatment owing to its minimal invasiveness. Between 1995-2006, 20 children who underwent liver transplantation developed biliary complications treated with interventional radiology. 16/20 developed biliary stricture, of whom 10 were treated with percutaneous transhepatic balloon dilatation. The mean age at the procedure was 6.6 years (range 8 m--14 years). The allograft types included whole (n=4), split (n=3), and reduced (n=3) livers. The procedure was performed at a mean time post-transplantation of 2.6 years. All patients are alive with a mean follow-up post-procedure of 24 months (range: 4 months-11 years). Currently, only 4 have a normal appearing biliary tree by imaging techniques and 6 developed stricture recurrence; of whom 3 developed biliary cirrhosis (2 splits, 1 reduced), one patient underwent successful rescue surgery, one was treated again percutaneously, and the remaining was lost to followup. In conclusion, treatment of percutaneous transhepatic balloon dilatation of biliary strictures is effective avoiding surgical correction. However, stricture recurrence in the medium- long term follow-up is frequent, particularly in segmental grafts. [corrected]
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Vano E, Segarra A, Fernandez JM, Ordiales JM, Simon R, Gallego JJ, del Cerro J, Casasola E, Verdu JF, Ballester T, Sotil J, Aspiazu A, Garcia MA, Moreno F, Carreras F, Canis M, Soler MM, Palmero J, Ciudad J, Diaz F, Hernandez J, Gonzalez M, Rosales P. A pilot experience launching a national dose protocol for vascular and interventional radiology. RADIATION PROTECTION DOSIMETRY 2008; 129:46-49. [PMID: 18310098 DOI: 10.1093/rpd/ncn025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The design of a national dose protocol for interventional radiology has been one of the tasks during the European SENTINEL Coordination Action. The present paper describes the pilot experience carried out in cooperation with the Spanish Society on Vascular and Interventional Radiology (SERVEI). A prospective sample of procedures was initially agreed. A common quality control of the X-ray systems was carried out, including calibration of the air kerma area product (KAP) meters. Occupational doses of the radiologists involved in the survey were also included in the survey. A total of 10 Spanish hospitals with interventional X-ray units were involved. Six hundred and sixty-four patient dose data were collected from 397 diagnostic and 267 therapeutic procedures. Occupational doses were evaluated in a sample of 635 values. The obtained KAP median/mean values (Gy.cm2) for the gathered procedures were: biliary drainage (30.6/68.9), fistulography (4.5/9.8), lower limb arteriography (52.2/60.7), hepatic chemoembolisation (175.8/218.3), iliac stent (45.9/73.2) and renal arteriography (39.1/59.8). Occupational doses (mean monthly values, in mSv) were 1.9 (over apron); 0.3 (under apron) and 4.5 (on hands). With this National experience, a protocol was agreed among the SENTINEL partners to conduct future similar surveys in other European countries.
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Segarra A. [Is plasmapheresis more effective than 6-methylprednisolone pulses in the management of patients with vasculitis and severe renal involvement?]. Nefrologia 2008; 28 Suppl 2:6-7. [PMID: 18457546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Margarit C, Asensio M, Iglesias J, Bilbao I, Ortega J, Lazaro JL, Escartin A, Segarra A, Murio JE. Outcome of 28 split liver grafts. Transplant Proc 2003; 35:1812-4. [PMID: 12962805 DOI: 10.1016/s0041-1345(03)00596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Our aim is to present our experience with split liver transplantation. From 1992-2002, 14 livers were split to obtain 28 grafts that were transplanted to 12 adults and 16 children. Ex situ splitting was performed in all cases. The left graft consisted of the left lateral segment (segments II-III) in 11 cases and the left lobe in three, depending on the size of the pediatric recipient. Pediatric recipients were of mean age 3, 4 years; mean weight 13 kg; six emergency cases for fulminant hepatic failure or urgent retransplantation and seven of 10 elective cases for biliary atresia. Postoperative mortality rate was 31% (five cases), including four of six emergency cases and one elective case (10%). The main cause was multiorgan failure. Technical complications were: one arterial thrombosis, one portal vein thrombosis, and four biliary complications. Eleven patients are alive and well. Adult recipients were of mean age 53 years. The indications were hepatocellular carcinoma in six cases, liver cirrhosis of various etiologies in five, and one recurrence of hepatitis C in a graft. Two patients died during the postoperative period from sepsis after retransplantation for primary nonfunction of the split graft and multiorgan failure with sepsis. One-year actuarial survival was 84%. CONCLUSIONS The results of split liver transplantation in elective cases are similar to whole liver transplantation, whereas patient survival among emergency cases is low due to the critical condition of the patients.
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Cortés-Hernández J, Ordi-Ros J, Labrador M, Segarra A, Tovar JL, Balada E, Vilardell-Tarres M. Predictors of poor renal outcome in patients with lupus nephritis treated with combined pulses of cyclophosphamide and methylprednisolone. Lupus 2003; 12:287-96. [PMID: 12729052 DOI: 10.1191/0961203303lu340oa] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lupus nephritis remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus. Although the renal prognosis has improved, the optimal therapeutic regime has not been definitively established, and significant challenges remain in the management of disease progression and recurrent renal relapse. We performed a prospective study to evaluate the outcome of 38 patients with severe lupus nephritis treated with standard cyclophosphamide and methylprednisolone pulse therapy, and to determine the variables associated with poor outcome. Five patients developed end-stage renal disease (ESRD) (13%), 10 (26%) developed persistent proteinuria (> 1 g/24h) and 15 (39%) suffered at least one relapse after 8 years of follow-up. A high chronicity index, interstitial fibrosis (P = 0.04), persistent hypertension (P < 0.0001) and hypocomplementaemia (P = 0.002) after treatment were the major variables associated with ESRD. Tubular atrophy (P = 0.01), persistent hypertension (P = 0.0001) and hypocomplementaemia after treatment (P = 0.0281) were associated with persistent proteinuria. Persistence of anti-dsDNA antibodies and hypocomplementaemia after treatment (P = 0.0118) were associated with renal relapse. Our data suggest that the group of patients with persistence of hypocomplementaemia and raised anti-dsDNA antibodies titres are at high risk of renal relapse and may be candidates for continuation of immunosuppressive treatment. Patients with persistent proteinuria alone or a high chronicity index are less likely to respond to immunosuppression, and strict control of the hypertension may be the best approach.
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Charco R, Margarit C, López-Talavera JC, Hidalgo E, Castells L, Allende H, Segarra A, Moreíras M, Bilbao I. Outcome and hepatic hemodynamics in liver transplant patients with portal vein arterialization. Am J Transplant 2002. [PMID: 12099362 DOI: 10.1034/j.1600-6143.2001.10208.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED Few cases of successful portal vein arterialization in orthotopic and auxiliary liver transplantation have been reported. AIM To evaluate the effect of portal vein arterialization on hepatic hemodynamics and long-term clinical outcome in three patients undergoing liver transplantation. METHODS Two patients with extensive splanchnic venous thrombosis received an orthotopic liver transplant and one with fulminant hepatic failure received an auxiliary heterotopic graft. Portal vein arterialization was performed in all cases. RESULTS One patient died 4 months after transplant and two are still alive. Auxiliary liver graft was removed 3 months post-transplant when complete native liver regeneration was achieved. Immediate post-transplant liver function was excellent in all cases. Only one patient developed encephalopathy and variceal bleeding owing to prehepatic portal hypertension secondary to arterioportal fistula 14 months after transplant. He was successfully treated by embolization of the hepatic artery. Hepatic hemodynamic measurements demonstrated a normal pressure gradient between wedged and free hepatic venous pressures in all cases. Liver biopsy showed acceptable graft architecture in two cases and microsteatosis in one. CONCLUSIONS Liver transplantation with portal vein arterialization is an acceptable salvage alternative when insufficient portal venous flow to the graft is present. The double arterial supply does not imply changes in hepatic hemodynamics, at least in the early months post-transplant.
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