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García-Aguado R, Charco Mora P, Cortiñas Díaz J, Ortiz de la Tabla González R, Viñoles Pérez J, Planas Roca A, Pérez Cajaraville J, Valero R, Massó Lago E, López A, Fabregat López J, Santos P, López Alvarez S, Zaballos JM, Cuchillo Sastriques JV, Panadero Sánchez A. [Recommendations for managing the difficult airway using supraglottic devices in the adult patient undergoing ambulatory surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:439-453. [PMID: 20857640 DOI: 10.1016/s0034-9356(10)70271-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Valero R, Gracia I, Hurtado P, Carrero E, Fàbregas N. Incidence and early diagnose of venous air embolism in neurosurgical patients operated on sitting position. Eur J Anaesthesiol 2010. [DOI: 10.1097/00003643-201006121-00404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benlian P, Donadille B, Bouché C, Vincent Dejean C, Valero R, Dufernez F, Sapin V, Paye F, Bouchard P. P222 COMPOSITE DEFICIENCY OF THE LIPOLYTIC COMPLEX IN PREGNANCY-INDUCED MAJOR HYPERTRIGLYCERIDEMIA. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70289-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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López AM, Valero R, Brimacombe J. Insertion and use of the LMA Supreme⢠in the prone position. Anaesthesia 2010; 65:154-7. [DOI: 10.1111/j.1365-2044.2009.06185.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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80
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Mañalich R, Paez G, Valero R, Manyalich M. IRODaT: the International Online Registry for Organ Donation and Transplantation 2007. Transplant Proc 2010; 41:2030-4. [PMID: 19715825 DOI: 10.1016/j.transproceed.2009.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE IRODaT, an international registry for organ donation and transplantation, presents preliminary data reports on global trends on a regular basis and at various times of the year. The purpose of this report was not only to present statistics, but also to make organ donation effectiveness rates a useful tool to reveal similarities between various countries on an international level. MATERIALS AND METHODS The IRODaT database produced this report for 2007 thanks to early reporting performed by professionals in coordination and transplant services from 49 countries. The countries were grouped as follows: countries with >200 total donors countries with 50 to 200 donors, and countries with <50 donors. RESULTS The percentages of deceased and living donors according to the total number of donors from the 49 countries showed that countries performing >200 effective donation procedures yearly in 2007 showed a clear positive trend when compared for number of living donors, donors per million inhabitants, and number of transplantable organs per donor. CONCLUSIONS The results obtained through this new presentation of the IRODaT provide a quick, clear, and illustrative view of organ donation activity in various countries.
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Macho J, Valero R, Cordero E, Enseñat J, González J, Sánchez M, Fernández C, Caral L, Ferrer E. Videoangiografía intraoperatoria con verde de indocianina durante la cirugía de aneurismas cerebrales. Experiencia inicial en 10 intervenciones quirúrgicas. Neurocirugia (Astur) 2010. [DOI: 10.1016/s1130-1473(10)70122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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López AM, Valero R, Pons M, Anglada T. A reply. Anaesthesia 2009. [DOI: 10.1111/j.1365-2044.2009.06093_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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83
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Borrat X, López A, Ojeda A, Valero R. [Using the CTrach Laryngeal Mask Airway in the awake patient with an expected difficult airway]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:445-448. [PMID: 19856691 DOI: 10.1016/s0034-9356(09)70425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The method of choice for managing the expected difficult airway is tracheal intubation with an awake patient breathing spontaneously. The CTrach Laryngeal Mask Airway (LMA) is a modified version of the Fastrach LMA that incorporates a fiberoptic system that provides a view of the glottis during ventilation and intubation. We describe 2 cases of intubation in which the CTrach device was used in patients breathing spontaneously. In both cases difficult intubation was foreseen. The CTrach LMA facilitates management of the airway in these circumstances. It is well tolerated and enables a clear view of the airway and permits assisted ventilation when necessary.
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Paez G, Valero R, Manyalich M. Training of Health Care Students and Professionals: A Pivotal Element in the Process of Optimal Organ Donation Awareness and Professionalization. Transplant Proc 2009; 41:2025-9. [DOI: 10.1016/j.transproceed.2009.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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85
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López AM, Valero R, Pons M, Anglada T. Awake intubation using the LMA-CTrach in patients with difficult airways. Anaesthesia 2009; 64:387-91. [PMID: 19317703 DOI: 10.1111/j.1365-2044.2008.05797.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We studied 21 patients with known difficult airways who underwent awake tracheal intubation using the LMA CTrach. Patients were given midazolam, atropine, a continuous infusion of remifentanil and topical lidocaine applied to the oropharyx. We limited the number of insertion attempts to three and the time to adjust the view to 5 min. In case of failure, we performed awake fibreoptic tracheal intubation. We found insertion of the device was successful and well tolerated in all patients. Vocal cords could be seen immediately in nine patients and following corrective manoeuvres in 10 patients. Tracheal intubation was successful in 20 patients: 19 cases under direct vision and in one blindly. In one patient with undiagnosed lingual tonsil hyperplasia, tracheal intubation was impossible using the device. No patient had an unpleasant recall of the procedure. We conclude that the LMA CTrach is easy to use, well tolerated and suitable for awake orotracheal intubation in patients with known difficult airways.
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Salvador L, Hurtado P, Valero R, Tercero J, Carrero E, Caral L, Ferrer E, Fábregas N. [Importance of monitoring neuroendoscopic intracranial pressure during anesthesia for neuroendoscopic surgery: review of 101 cases]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:75-82. [PMID: 19334655 DOI: 10.1016/s0034-9356(09)70336-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The aim of this study was to describe monitoring, anesthetic management, and risk factors for complications in neuroendoscopic surgery. PATIENTS AND METHODS Patients who underwent neuroendoscopy between 1994 and 2003 under general anesthesia, with monitoring of intracranial pressure from inside the neuroendoscope, were studied retrospectively. In some patients, the blood flow rate in the middle cerebral artery was monitored using transcranial Doppler ultrasound. Information was collected related to surgical procedure and the development of complications. RESULTS Of 101 patients included in the study, transcranial Doppler ultrasound images were available for 20. In 75 patients neuroendoscopic intracranial pressure exceeded 20 mm Hg. Forty-five percent of the patients with available transcranial Doppler ultrasound images showed episodes of reduced diastolic flow rate in the middle cerebral artery during ventricular irrigation. Hemodynamic instability was associated with higher neuroendoscopic intracranial pressures (P < .05). An increase of more than 30 mm Hg in neuroendoscopic intracranial pressure was associated with more postoperative complications, the most common of which was delayed awakening. Procedures that were more complicated than a simple ventriculostomy were performed in 58% of the cases. Mean (SD) neuroendoscopic intracranial pressures in such cases were higher (50.5 [30.9] mm Hg vs 31.8 [25.1 mm Hg] in the simpler procedures) and the postoperative complication rate was higher (P = .003). CONCLUSIONS Neuroendoscopic surgery can causes increases in neuroendoscopic intracranial pressure that are associated with disturbances in cerebral blood flow and complications. This situation demonstrates the importance of monitoring intracranial pressure and cerebral blood flow.
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Valero R, Mayoral V, Massó E, López A, Sabaté S, Villalonga R, Villalonga A, Casals P, Vila P, Borràs R, Añez C, Bermejo S, Canet J. [Evaluation and management of expected or unexpected difficult airways: adopting practice guidelines]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:563-570. [PMID: 19086724 DOI: 10.1016/s0034-9356(08)70653-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Pujol R, Gracia I, Valero R, Fàbregas N. [Low bispectral index values in an awake patient: an artifact to take into consideration]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2008; 55:455-456. [PMID: 18853692 DOI: 10.1016/s0034-9356(08)70625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Valero R, Rodrigo E, Piñera C, Arias M. [HIV-associated nephropathy without decline of renal function]. Nefrologia 2008; 28:655-656. [PMID: 19016643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Hurtado P, Valero R, Fernández S, Alcón A, Fábregas N. [Neuroanesthetic practice in Catalonia. Results of a survey done on 2003]. Neurocirugia (Astur) 2007; 18:492-495. [PMID: 18094908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Health system planning requires the precise knowledge of the activity performed. We present the neuroanesthesic activity results in Catalonia during 2003. METHODS A prospective and cross-sectional survey was performed for 14 randomised days during 2003. All hospitals practicing anaesthesia in Catalonia took part in the survey. Data on characteristics of patients, anaesthetic techniques and type of procedure were included. RESULTS 6909 neuroanesthetic procedures performed in Catalonia in 2003 (95% IC 6022-7847), a 1.28% of total surgical activity. A 74% of procedures were done in the public hospitals and a 26% in private hospitals. Patients mean age was 48 years old (95% IC 45.5-50.6). Scheduled procedures were 79.7%. The most frequent interventions were: Spine surgery 40.1 %; craniotomies for tumour resection 24.1%, for haemorrhage o trauma 7.2% and for aneurysms or AVM surgery 2.3%; ventricular shunts 2.6%. Mean duration of craneotomies for tumour resection was 287 -/+95 min. All patients were distributed postoperatively in a conventional recovery room (55.8 %), in a monitored care unit (19.2%) or in an intensive care unit (24.9 %). Craniotomy patients were admitted to an intensive care unit (41.6%), a monitored care unit (33.7%) or a conventional recovery room (24.7%). CONCLUSIONS About seven thousand Neurosurgical procedures were performed in Catalonia in 2003, in public (73.6%) and private (26.4%) hospitals. Spine surgery and craniotomies for tumour resection were the most frequently performed interventions. Craniotomy patients were mainly submitted to an ICU or a Monitored care unit.
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Hurtado P, Valero R, Fernández S, Alcón A, Fábregas N. Intervenciones neuroquirúrgicas en Cataluña: Resultados de una encuesta anestésica durante 2003. Neurocirugia (Astur) 2007. [DOI: 10.4321/s1130-14732007000600005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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92
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López AM, Valero R, Pons M, Salvador L, de Riva N, Gomar C. [Clinical comparison of the reusable LMA Classic laryngeal mask and the disposable Soft Seal mask in adult patients]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2007; 54:462-468. [PMID: 17993094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To compare the clinical behavior of the disposable Soft Seal laryngeal mask to the behavior of the reusable LMA Classic mask. METHODS Patients were randomly assigned to 2 groups in which either the LMA Classic or the Soft Seal mask would be used. We assessed time required for positioning and number of attempts, seal pressure, fiberoptic bronchoscopic image, and complications. The masks were inserted by 2 anesthesiologists who were inexperienced in the use of laryngeal masks. We also compared compliance of the cuff in the laboratory. RESULTS Sixty patients were enrolled. There were no differences in time required for insertion or number of attempts (first-try success, 83%). The mean (SD) seal pressure was greater in the Soft Seal group at 23 (4) cm H2O than in the LMA Classic group at 20 (4) cm H2O. There were no significant differences in the fiberoptic bronchoscopic images, ventilation, incidence of intraoperative complications, presence of blood on the cuff (LMA Classic, 6 out of 30 vs Soft Seal, 11 out of 29), or postoperative sore throat. In 3 patients in the Soft Seal group the laryngeal mask had to be replaced by an orotracheal tube. Cuff compliance in the laboratory was lower for the LMA Classic than for the disposable mask for all sizes assessed. CONCLUSIONS Although the results suggest that the clinical behavior of the 2 masks is similar, the LMA Classic allowed for effective airway management in all of the cases assigned to it, whereas management was effective in 90% of the cases in which the Soft Seal mask was used. The inflatable cuff of the Soft Seal is more compliant in vitro and it provides a higher airway seal pressure than does the LMA Classic.
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Cano A, Rouzier C, Monnot S, Chabrol B, Conrath J, Lecomte P, Delobel B, Boileau P, Valero R, Procaccio V, Paquis-Flucklinger V, Vialettes B. Identification of novel mutations in WFS1 and genotype-phenotype correlation in Wolfram syndrome. Am J Med Genet A 2007; 143A:1605-12. [PMID: 17568405 DOI: 10.1002/ajmg.a.31809] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mutations in the WFS1 gene have been reported in Wolfram syndrome (WS), an autosomal recessive disorder defined by early onset of diabetes mellitus (DM) and progressive optic atrophy. Because of the low prevalence of this syndrome and the recent identification of the WFS1 gene, few data are available concerning the relationships between clinical and molecular aspects of the disease. Here, we describe 12 patients from 11 families with WS. We report on eight novel (A214fsX285, L293fsX303, P346L, I427S, V503fsX517, R558C, S605fsX711, P838L) and seven previously reported mutations. We also looked for genotype-phenotype correlation both in patients included in this study and 19 additional WS patients that were previously reported. Subsequently, we performed a systematic review and meta-analysis of five published clinical and molecular studies of WFS1 for genotype-phenotype correlation, combined with our current French patient group for a total of 96 patients. The presence of two inactivating mutations was shown to predispose to an earlier age of onset of both DM and optic atrophy. Moreover, the clinical expression of WS was more complete and occurred earlier in patients harboring no missense mutation.
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Salvador L, Valero R, Carrero E, Caral L, Fernández S, Marín JL, Ferrer E, Fábregas N. Cerebrospinal Fluid Composition Modifications after Neuroendoscopic Procedures. ACTA ACUST UNITED AC 2007; 50:51-5. [PMID: 17546545 DOI: 10.1055/s-2007-973823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Normal saline solution is currently used as the ventricular irrigation fluid during neuroendoscopic procedures. The aim of this study is to determine the alterations in the cerebrospinal fluid (CSF) composition after neuroendoscopic interventions. Twenty nine patients who underwent a neuroendoscopic procedure under general anaesthesia were studied. Temperature inside the cerebral ventricle was measured and samples of CSF were taken to determinate oxygen and carbon dioxide partial pressures, pH, base excess, ionised calcium, standard bicarbonate, glucose, sodium, potassium, magnesium, total calcium, proteins, chlorine and osmolality before initiating the irrigation and after the neuronavigation. Patient demographics, neuronavigation time, total fluid volume used and temperature of the irrigation solution and complications that appeared in the first 24 hours were collected. Mean age of the patients was 42+/-18 years. The mean neuronavigation time was 21.5+/-15.4 minutes. The mean amount of saline solution used for irrigation was 919.6+/-994.7 mL. All the values studied in the CSF, except osmolality, showed significant variations. There was a significant correlation between the CSF variation of pH, oxygen and carbon dioxide partial pressures, base excess, standard bicarbonate, glucose and total calcium with respect to the total volume of irrigation solution, but not with respect to the neuronavigation time. A cut-off point of 500 mL of irrigation solution (sensitivity 0.7; specificity 0.87) was related with a CSF pH decrease greater than 0.2. The use of saline as irrigation solution during neuroendoscopic procedures produces important changes in CSF.
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Valero R, Rodrigo E, Ruiz JC, González-Cotorruelo J, Lastra P, López-Rasines G, Fernández F, Sánchez M, Arias M. [Abscess colon diverticular disease produced for Actinomyces israelii in a renal transplant recipient]. Nefrologia 2007; 27:511-513. [PMID: 17944591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
We present the case of a 53 years old man with a cadaveric kidney transplant under cyclosporin A and prednisolone therapy. Clinical transplant course was uneventful until 15 years after transplant, when he was admitted in our hospital with fever and a perirenal mass of unknown origin. Cyclosporin A was removed and a left sided colon was carried out and a abscess colon diverticular disease produced for Actinomyces israelii was diagnosed. The development was satisfactory after medical and surgical treatment.
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Hurtado P, Valero R, Fernández S, Alcón A, Fábregas N. Intervenciones neuroquirúrgicas en Cataluña. Resultados de una encuesta anestésica durante 2003. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70257-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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97
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Rodríguez L, Salvador L, Valero R, Carrero E, Fontanals J, Fàbregas N. [Behaviour of near-infrared cerebral oximetry readings during percutaneous carotid angioplasty]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2006; 53:633-8. [PMID: 17302077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Transluminal percutaneous carotid angioplasty and stenting (CAS) carries a risk of cerebral ischemia, hemorrhage, or edema due to relative hyperemia and hemodynamic instability during and after the procedure. Noninvasive monitoring of near-infrared regional cerebral oxygen saturation (SrO2) offers an indirect way to estimate cerebral blood flow. OBJECTIVE To evaluate the behaviour of SrO2 during CAS and the usefulness of this variable for continuous monitoring of cerebral blood flow variation and neurological status. MATERIAL AND METHODS Prospective study of 25 patients scheduled for unilateral CAS under monitored anesthesia care. SrO, and other hemodynamic and clinical data were recorded. A change in SrO2 (deltaSrO2) of 15% or more in comparison with the baseline value and lasting more than 30 seconds was considered clinically significant. Neurological complications in the first 24 hours were also registered. RESULTS Baseline SrO, ranged from 51% to 75%. With administration of papaverine SrO2 values increased by a mean (SD) of 5.6% (6%) (P<.05 vs baseline). They decreased during angioplasty, -2.5% (5.7%) (P<.05 vs baseline), increased after 5 minutes, and fell again at 30 minutes to a level 3% (6.54%) above baseline. Two patients showed signs of elevated intracranial pressure after the procedures and also had ASrO2 readings exceeding 15%; measures to lower arterial hypertension reduced SrO2 in these patients. CONCLUSION High interindividual variability of absolute SrO2 values has been confirmed. SrO, fluctuates with maneuvers that change cerebral blood flow in the same way. Changes can precede the onset of other clinical signs.
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Fernandez-Fresnedo G, de Francisco A, Ruiz JC, Cotorruelo JG, Alamillo CG, Valero R, Castañeda O, Zalduendo B, Izquierdo MJ, Arias M. Relevance of Chronic Kidney Disease Classification (K/DOQI) in Renal Transplant Patients. Transplant Proc 2006; 38:2402-3. [PMID: 17097948 DOI: 10.1016/j.transproceed.2006.08.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The National Kidney Foundation has developed guidelines for diagnosis and classification of chronic kidney disease (CKD) but it is not known whether they are applicable to renal transplant patients. This study analyzed the prevalence, the complications, and the influence of the CKD stage on the presence of complications in 506 stable transplant recipients. The mean age of the patients was 52.9 +/- 12 years, 34% were men, and the mean time after transplantation was 9.56 +/- 6.18 years. CKD was present in 90.3% with 9.9% were in CKD stages 4 or 5 with glomerular filtration rates lower than 30 mL/min per 1.73 m(2). The prevalence of anemia, phospho-calcium metabolism disorders, hypertriglyceridemia, and hypertension increased with the stage of CKD. We concluded that CKD and the complications of CKD were highly prevalent in renal transplant recipients. The classification of renal transplant patients by CKD stage may help clinicians to identify patients at increased risk and to target appropriate therapy to improve outcomes.
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Valero R, Fernández-Fresnedo G, Sanz de Castro S, Arias M. [Arterial thrombosis in minimal lesion nephrotic syndrome]. Nefrologia 2006; 26:286-7. [PMID: 16808272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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100
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Palomar R, López-Hoyos M, Pastor JM, Fernández-Fresnedo G, Rodrigo E, Ruiz JC, Cotorruelo JG, Valero R, Castañeda O, San Segundo D, Arias M. Impact of HLA Antibodies on Transplant Glomerulopathy. Transplant Proc 2005; 37:3830-2. [PMID: 16386554 DOI: 10.1016/j.transproceed.2005.10.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The influence of humoral rejection on the development of chronic allograft nephropathy (CAN) is controversial, especially in relation to transplant glomerulopathy. The aim of our study was to analyse the influence of anti-HLA antibodies on the development of transplant glomerulopathy (cg0, cg1, cg2, and cg3; Banff'97). We selected all renal transplants patients from 1975 to 2003 who had a functioning graft for at least 6 months and a clinically indicated graft biopsy with CAN and chronic glomerular changes (case group). We studied the presence of anti-HLA antibodies (Ab) in the last serum taken while the graft was functioning and divided them into three groups according to the severity of glomerular lesions. We also selected 52 contemporary and comparable cases without transplant glomerulopathy (control group). A total of 77 case had transplant glomerulopathy: 39 cg1, 29 cg2, and 9 cg3. Pretransplant Ab titers and number of previous blood transfusions were higher among the subgroup with the most severe glomerulopathy. Patients who developed posttransplant anti-HLA Ab more frequently showed transplant glomerulopathy. Serum creatinine and proteinuria were higher among cases with chronic glomerulopathy, and more grafts were lost in that group. Thus, the presence of HLA-Ab is a key factor in the development of transplant glomerulopathy and chronic allograft rejection.
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