The cadherin-catenin complex in laryngeal squamous cell carcinoma

Abnormal Wnt signaling and impaired cell–cell adhesion due to abnormal E-cadherin and β-catenin function have been implicated in many cancers, but have not been fully explored in laryngeal squamous cell carcinoma. In this study, β-catenin cellular location and E-cadherin expression levels were analyzed in 16 laryngeal squamous cell carcinomas (LSCCs) (9 glottic and 7 supraglottic) and 11 samples of non-tumoral inflammatory larynx tissue, using immunohistochemical methods. All non-tumoral tissues showed equally strong membranous expression of β-catenin, while cytoplasmic expression was found in only 3 of the 11 samples. By contrast, whereas 8/9 glottic LSCCs exhibited only membranous expression of β-catenin, 6/7 supraglottic LSCCs displayed both membranous and cytoplasmic expression (p = 0.003). Strong E-cadherin staining was observed in 9/11 non-tumoral tissues and 7/9 glottic LSCCs, whereas 4/7 supraglottic LSCCs exhibited weak expression. Reduced membrane expression of E-cadherin and cytoplasmic retention of β-catenin in supraglottic LSCC seems to be related with more aggressive biological behavior which has been described in clinical studies. Further research is required to clarify the involvement of β-catenin in the mechanism associated with malignant transformation in laryngeal tissues.

Weissella ceti sp. nov., isolated from beaked whales (Mesoplodon bidens)

During an investigation into the microbiota of beaked whales (Mesoplodon bidens), nine isolates were obtained from different organs of four animals. The isolates were Gram-positive-staining, catalase-negative, short rod-shaped or coccoid organisms. A phylogenetic analysis based on 16S rRNA gene sequences of these isolates allocated them to the genus Weissella, showing 96.3 % and 96.0 % 16S rRNA gene sequence similarity with Weissella viridescens NRIC 1536Tand Weissella minor NRIC 1625T, respectively. On the basis of phenotypic, physiological and phylogenetic evidence, it is proposed that the new isolates from whales represent a novel species of the genus Weissella, Weissella ceti sp. nov. The type strain of Weissella ceti is 1119-1A-09T ( = CECT 7719T = CCUG 59653T).

Methicillin-susceptible Staphylococcus aureus clone related to the early pandemic phage type 80/81 causing an outbreak among residents of three occupational centres in Barcelona, Spain

In the 1950s an unusually virulent and transmissible penicillin-resistant Staphylococcus aureus clone harbouring Panton-Valentine leukocidin (PVL) genes, known as phage type 80/81 and subsequently identified as multilocus sequence type (ST) 30, emerged and caused serious infections in hospitals and the community. We describe an outbreak of skin infections caused by a PVL-positive, methicillin-susceptible S. aureus (MSSA) strain of ST1472, related to phage type 80/81, in three associated occupational centres. After identification of the first patient an active case-finding strategy was initiated among the three centres. Epidemiological and clinical features were indistinguishable from outbreaks currently caused by community-acquired methicillin-resistant S. aureus. The S. aureus was cultured and identified from nasal swabs and skin lesions by conventional methods; PVL was detected using a PCR assay. Pulsed-field gel electrophoresis and DNA-array-based genotyping were applied to MSSA isolates. MSSA was identified in nasal swabs from 49 of 133 individuals (37%). A single pulsed-field gel electrophoresis pattern, belonging to ST1472 (CC30) and PVL positivity, were detected in 20 individuals, including eight of 18 skin cultures, i.e. 15% of the screened individuals were colonized by the epidemic strain. Nasal and cutaneous decontamination with 5% nasal mupirocin ointment and 2% aqueous chlorhexidine was implemented for all individuals. Patients with active skin infections were treated with a first-generation cephalosporin. General recommendations were made to prevent cross-transmission. No new cases were reported over the following 90 days.

Efficacy and safety of conversion from twice-daily to once-daily tacrolimus in a large cohort of stable kidney transplant recipients

Prolonged-release tacrolimus was developed to provide a more convenient once-daily dosing that could improve patient adherence. We conducted a multicenter, prospective, observational, 12-month study to describe the efficacy, safety and patient preference of conversion from tacrolimus twice-daily to once-daily formulation in stable kidney transplant recipients in routine clinical practice. Conversion was made on a 1 mg: 1 mg basis (1 mg: 1.1 mg in patients with trough levels <6 ng/mL). The study included 1832 patients (mean age (± SD): 50.0 ± 13.4 years; 62.7% male). After conversion, a modest reduction in tacrolimus trough levels, necessitating an increase in daily dose, was observed (mean changes at 12 months of -9.1% and +1.24%, respectively; p < 0.0001). Mean glomerular filtration rate did not change significantly (56.5 ± 19.7 mL/min at conversion vs. 55.7 ± 20.6 mL/min at 12 months). Proteinuria, blood pressure, lipid, hepatic and glucose parameters remained stable. Eight patients (0.4%) had acute rejection and 34 patients (1.85%) discontinued treatment. Almost all patients (99.4%) preferred the once-daily formulation, because of less frequent dosing (66%) and improved adherence (34%). In conclusion, at similar doses to twice-daily tacrolimus, once-daily formulation provided stable renal function, a low acute rejection rate, and good tolerability in stable kidney transplant recipients in the routine clinical practice setting.

Inhibition of hepatitis B virus and human immunodeficiency virus (HIV-1) replication by Warscewiczia coccinea (Vahl) Kl. (Rubiaceae) ethanol extract

The primary objective of this study was to search for natural products capable of inhibiting hepatitis B virus (HBV) replication. The research design, methods and procedures included testing hydro-alcoholic extracts (n = 66) of 31 species from the Venezuelan Amazonian rain forest on the cell line HepG2 2.2.15, which constitutively produces HBV. The main outcomes and results were as follows: the species Euterpe precatoria, Jacaranda copaia, Jacaranda obtusifolia, Senna silvestris, Warscewiczia coccinea and Vochysia glaberrima exerted some degree of inhibition on HBV replication. The leaves of W. coccinea showed a significant antiviral activity: 80% inhibition with 100 µg mL⁻¹ of extract. This extract also exerted inhibition on covalently closed circular deoxyribonucleic acid (cccDNA) production and on HIV-1 replication in MT4 cells (more than 90% inhibition with 50 µg mL⁻¹ of extract). Initial fractionation using organic solvents of increasing polarity and water showed that the ethanol fraction was responsible for most of the antiviral inhibitory activities of both the viruses. It was concluded that Warscewiczia coccinea extract showed inhibition of HBV and HIV-1 replication. Bioassay-guided purification of this fraction may allow the isolation of an antiviral compound with inhibitory activity against both viruses.

Self-expanding plastic stents for the treatment of post-operative esophago-jejuno anastomosis leak. A case series study

OBJECTIVE

Self-expandable plastic stents (SEPS) are increasingly being used for treatment of postoperative esophageal leak. This complication occurs in 4-27% of patients after radical gastrectomy, and has a high mortality rate up to 60%.The aim of this study is to evaluate the efficacy of SEPS (Polyflex®) for treatment of post-operative esophago-jejuno anastomosis leak after radical gastrectomy for gastric cancer.

MATERIAL AND METHODS

During one year period patients who underwent a radical gastrectomy in our hospital for gastric cancer and developed a postoperative anastomotic leak were prospectively included in the study after signing a consent form, and treated with SEPS placement under endoscopic and fluoroscopic control for leak occlusion.

RESULTS

Four patients were included (3 men/1 woman). The mean interval between operation and SEPS placement was 16 days (range: 4-34). SEPS deployment was easily performed in all patients with complete occlusion of esophageal lumen in three patients. In the fourth patient we needed to deploy a second coaxial stent to achieve a complete occlusion of the fistula. SEPS migration did not happen in our series. One patient had already developed a mediastinitis by the time we placed the SEPS and he died 3 days later. Extraction of the SEPS was easily performed 4-8 weeks after deployment.

CONCLUSION

We achieved a complete healing of the anastomotic fistula after radical gastrectomy in 3 out of 4 patients, without major complications related to SEPS. Placement of SEPS is an appealing minimally invasive alternative to surgical repair for patients with postoperative anastomotic leak.

[Coccidioidomycosis in Argentina, 1892-2009]

Clinical cases of coccidioidomycosis are rare in Argentina and are generally found in the large arid precordilleran area of the country. This study aims to perform a retrospective review of all coccidioidomycosis cases documented in the country from 1892 to 2009, and to describe those occurring in the last 4 years. One hundred and twenty eight cases were documented in the 117 year-period. Since the original description of the disease in 1892 until 1939, only 6 cases were registered; between 1940 and 1999, 59 (6-14/10 yrs) and the remaining 63 (49% of total cases) occurred in the last decade. The median age of 34 patients registered in 2006-2009 was 31 years (range: 7-89), male/female ratio was 1.3:1 and 12 patients were immunocompromised. Twenty-six cases were confirmed by direct microscopy and/or culture whereas the remaining ones by serology. All isolates were identified as Coccidioides posadasii. Thirty patients lived in a vast geographic region with epicenter in Catamarca Valley. Between 2006 and 2009, annual disease incidence rates in Catamarca Province increased from historical values below 0.5/100,000 to 2/100,000 inhabitants. Such increase suggests an emergency of coccidioidomycosis in that region.

Effect of microbial loading on the efficiency of cold atmospheric gas plasma inactivation of Salmonella enterica serovar Typhimurium

In recent years the application of cold atmospheric gas plasma (CAP) aimed at the removal of microbial contamination from fresh and minimally processed food has received increased attention. For CAP to be successfully adopted by the food production industry, factors which affect its potential for microbial inactivation must be evaluated. In this study, we examined the effects of initial microbial concentration, present on filter discs, on the inactivation of Salmonella enterica serovar Typhimurium (S. Typhimurium) with nitrogen CAP. It was found that the rate of inactivation of S. Typhimurium is inversely proportional to initial bacterial concentration, with the D-value observed at the highest cell concentration assayed (10(8) CFU/filter) being 14 fold higher than seen at the lowest starting concentration (10(5) CFU/filter). Addition of increasing concentrations of Pseudomonas fluorescens cells to a Salmonella population of 10(5) CFU/filter resulted in an exponential decrease in the rate of killing of the Salmonella cells. However, whilst the addition of heat-killed S. Typhimurium cells to 10(5) CFU/filter live S. Typhimurium cells resulted in a significant decrease in the killing rate, this effect was dose independent. This suggests that although biomass plays a role in the protection against CAP inactivation seen at high cell densities, dead cells and their components released during the heating period are not as effective as viable cells. Fluorescence microscopy showed that, unlike the single dispersed cells observed at low cell densities, at higher cell densities bacteria were present in a multilayered structure. This phenomenon could explain the reduced inactivation by the plasma, since the top layer may present a physical barrier that protects underlying cells. In conclusion, this work clearly shows a link between bacterial cell density and the efficacy of CAP inactivation, making an important contribution to the understanding of this alternative food processing technology, which should be taken into account in both further studies and in the practical application of this technique to the food industry.

Biomass response to environmental factors in two congeneric species of Mullus, M. barbatus and M. surmuletus, off Catalano–Levantine Mediterranean coast of Spain: a preliminary approach

We analyzed the influence of some abiotic variables in the biomass distribution of these species using survey data collected over four years (2006-2009) in the Catalano-Levantine coast of Spain. The preliminary results show that variables such as time (year) and latitude feebly affect the biomass distribution of these species. Depth, by itself, is not as significant as believed, masking the influence of other variables. M. barbatus biomass distribution seems to be especially influenced by salinity and, to a lesser extent, by temperature, while only temperature seems to have a significant effect on the M. surmuletus biomass distribution. These results are consistent with the bathymetric distribution of both species, with M. barbatus showing affinity for low salinity waters and M. surmuletus for warmer waters, which may contribute to the segregation of the species.

[Correction of the complicated pectus excavatum with extracorporeal circulation (ECC) support]

INTRODUCTION

The most serious complication in surgery of the pectus excavatum is the possible cardiac perforation. After its resolution, it is very likely that the relapse of the excavatum will be more severe due to the intense retrosternal fibrosis generated, involving cardiac structures and fixing them to the sternum. Reintervention requires modifications of the usual techniques and special monitoring due to the increased risk of cardiac and large vessel lesions. We present the case of 2 patients with severe pectus excavatum with a previous attempt for correction with cardiac perforation.

CLINICAL CASES

Case 1. A 16 year old male with Haller index 9.9, diagnosed of Ehlers-Danlos syndrome and operated on in neonatal period of cardiac disease, with previous attempt for correction using the Ravitch technique that relapsed and cardiac perforation during it. Case 2. An 11 year old girl, with background of diaphragmatic hernia and cardiac perforation on introducing the Nuss bar at 5 years of age, with Haller index 5.5. Both were operated on under ECC with the collaboration of the Cardiac Surgery Service and cardiac adherences were released after median sternotomy. After it, the Nuss bar was introduced and then sternal closure was performed with reinforced steel wires with titanium plates in the anterior and posterior part.

DISCUSSION

The backgrounds of the cardiac approach complicate the intervention for the correction of the pectus excavatum, with a high risk of cardiac trauma. Counting on the support of the cardiac surgery and the ECC, we achieve an adequate control and prediction of the complications

[Outcome and survival of pediatric Short Bowel Syndrome (SBS)]

INTRODUCTION

SBS is the main cause of intestinal failure (IF) in children and has a high morbility and mortality.

OBJECTIVES

to analyze factors associated with the outcome and survival of SBS children.

METHODS

analytical, descriptive and retrospective study. We include patients with residual bowel length (RBL) ≤ 40 cm. OUTCOME is analyzed in groups: dead (D), adapted (A), parenteral nutrition dependant (NPD), and transplanted (Tx) according to: bowel anatomy, diagnosis, prematurely, year of beginning of IF, duration of IF, cholestasis (CB > 2 mg/dl) and thrombosis. Survival is analyzed with Kaplan Meier.

RESULTS

63 patients were included: RBL x 21 ± 11 cm, preserved colon 46%, prematures 41%, neonatal resection 78%, duration of IF x 0.66 years. 54% had cholestasis (CB x 5.29 ± 2.35 mg/dl) and 25% had thrombosis.

OUTCOME

D 33%, A 27%, PND 30% and Tx 10%. Adapted patients had longer RBL (p 0.001) and more preserved colon (p 0.017). 1 year survival was 86%, 2 years 70% and 3 years 66%. Age at death: x 2.3 years. Causes of death: hepatic failure 62%, lack of venous access 19%, sepsis 10%, others 10%. Factors related to death were shorter RBL (p 0.045), cholestasis (0.049, admittance to the center before 2000 (p 0.02).

CONCLUSIONS

SBS had a high mortality and 1/3 of patients could adapt requiring up to 5 years. Adaptation was in relation to anatomic factors. Mortality was related to.

Oxidative stress and altered mitochondrial function in neurodegenerative diseases: lessons from mouse models

Oxidative stress has been consistently linked to ageing-related neurodegenerative diseases leading to the generation of lipid peroxides, carbonyl proteins and oxidative DNA damage in tissue samples from affected brains. Studies from mouse models that express disease-specific mutant proteins associated to the major neurodegenerative processes have underscored a critical role of mitochondria in the pathogenesis of these diseases. There is strong evidence that mitochondrial dysfunction is an early event in neurodegeneration. Mitochondria are the main cellular source of reactive oxygen species and key regulators of cell death. Moreover, mitochondria are highly dynamic organelles that divide, fuse and move along axons and dendrites to supply cellular energetic demands; therefore, impairment of any of these processes would directly impact on neuronal viability. Most of the disease-specific pathogenic mutant proteins have been shown to target mitochondria, promoting oxidative stress and the mitochondrial apoptotic pathway. In addition, disease-specific mutant proteins may also impair mitochondrial dynamics and recycling of damaged mitochondria via autophagy. Collectively, these data suggest that ROS-mediated defective mitochondria may accumulate during and contribute to disease progression. Strategies aimed to improve mitochondrial function or ROS scavenging may thus be of potential clinical relevance.

Coeliac disease: clinical features in adult populations

INTRODUCTION

coeliac disease (CD) is a chronic disease of the small intestine, which is caused by gluten intolerance, producing malabsorption of nutrients and vitamins. Clinical manifestations of CD in adults are highly variable, including intestinal and extra-intestinal symptoms. The disease may also occur in individuals who are asymptomatic.

OBJECTIVE

our objective is to describe the incidence and clinical manifestations of CD in adults.

MATERIAL AND METHODS

a retrospective study was carried out in patients diagnosed of CD between January 1990 and December 2008. Diagnosis was based on serologic tests and duodenal biopsy, which were compatible with CD in all of them.

RESULTS

sixty eight adult patients were diagnosed of CD in this period. Mean age was 33 (18-65) years and 50 (74%) were women. The clinical manifestations were diarrhoea in 38 (55%), abdominal pain in 27 (40%), loss of weight in 15 (22%), dyspepsia in 13 (19%). Analytical results showed a slight increase of transaminases in 26 (38%), ferropenic anaemia in 33 (48.5%) cases, sub-clinical hypothyroidism in 3 (4.5%) patients, and folic acid deficiency in 16 (23.5%) cases. Almost all patients were diagnosed between 2000 and 2008: 60 (87%). Population-based incidence of CD in adults had increased from 0.7-2/100,000 per year in the nineties to 3.5-10.3/100,000 in the last years.

CONCLUSIONS

CD can appear at any age and with a wide manifestation spectrum, which can be atypical in some cases. Patients with ferropenic anaemia and a negative response to treatment or those with an unexplained increase in transaminases should be screening for CD. Atypical manifestations and low suspect index can delay diagnosis even during years. There is a marked increase in the incidence-rates of CD in adults over time.

[Analysis of brain complexity and mental disorders]

The knowledge of the brain processes underlying mental disorders has significantly increased during the last decades, but in spite of this very important research effort a biological marker is not available for such disorders. For example, neurophysiological techniques (EEG and MEG),have been broadly utilized in the investigation of the most important psychiatric syndromes such as schizophrenia, major depression, bipolar disorder or obsessive/compulsive disorder. The outcomes of some of those neurophysiological studies allowed the building of statistical models with very high sensitivity and specificity, although those models did not reach day-to-day clinical practice. A potential explanation for this situation is an inadequate analysis procedure which might be missing some important quantums of information contained in brain signals. In this vein, new methods of non-linear analysis have been proposed for the investigation of neurophysiological data. Particularly, the analysis of brain signals' complexity has been broadly utilized in the investigation of psychiatric disorders. Parameters of EEG-MEG complexity usually estimate the predictability of brain oscillations and/or the number of independent oscillators underlying the observed signals. More importantly, complexity parameters seem to be sensitive to the temporal components of brain activity, and therefore might reflect the dynamical nature of psychiatric disorders. This paper reviews some of the most relevant studies within this field, especially those focusing on the diagnosis, follow-up and prediction of response to treatment.

Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia

The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococal pneumonia treated either with β-lactam monotherapy or with combination therapy (β-lactam plus fluoroquinolone). Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10, and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on β-lactam monotherapy were compared with those receiving combination therapy. Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with β-lactam monotherapy and those treated with combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 h (p = 0.016). Our data suggest that systemic expression of IL-6 production in patients with PP correlates with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 h.

[Thoracic epidural analgesia vs patient-controlled analgesia with intravenous fentanyl in children treated for pectus excavatum with the Nuss procedure]

BACKGROUND AND OBJECTIVE

Thoracic epidural analgesia and patient-controlled analgesia (PCA) with intravenous fentanyl have both been shown to be effective in pediatric patients treated surgically for pectus excavatum using the Nuss procedure. We compare the efficacy and safety of these techniques.

METHODS

Retrospective study of pediatric cases in which the Nuss procedure was used to treat pectus excavatum between October 1997 and February 2009. Weight, age, sex, and Haller index were analyzed. Pain was assessed every 8 hours on a visual analog scale of 0 to 10 or on a scale based on observation of distress (LLANTO scale). Daily use of analgesics was also recorded. The incidence of catheter-related complications or adverse events of treatment such as nausea, vomiting, and respiratory depression were also noted.

RESULTS

We identified 31 patients in 2 groups: the epidural group (n=22) and the PCA group (n=9). Demographic characteristics, the incidences of complications or adverse events, and mean (SD) pain scores (epidural group, 1.8 [3.8]; PCA group, 2.1 [3.4]; P = .775) were statistically similar in the 2 groups. However, analgesic requirements and the duration of analgesic use in days differed significantly, at 2.9 (1.1) days in the epidural group and 5.9 (1.4) days in the PCA group (P =.001).

CONCLUSIONS

The efficacy and safety of thoracic epidural analgesia is similar to that of PCA with intravenous fentanyl, although the use of epidural analgesia is associated with a markedly shorter duration of requirement for postoperative analgesia.

[Pneumonectomy in children]

BACKGROUND/AIM

Pneumonectomy is seldom indicated in children and its long-term effects are not well known. The aim of the present study was to examine retrospectively the indications and the long-term sequelae in a relatively large cohort of patients treated at our institution.

MATERIAL AND METHODS

We reviewed the charts of children undergoing pneumonectomy between 1969 and 2009 with particular attention to indications, techniques, complications, survival, pulmonary function and spine deformities

RESULTS

Ten patients (M:F=6/4) aged 102 +/- 66 months underwent pneumonectomy for bronchiectasis (4, one with cystic fibrosis), tumors (4, 1 myofibroblastic inflammatory pseudotumor, 1 bronchial carcinoid, 1 primary pulmonary PNET and 1 massive metastasis of osteosarcoma) and malformations (2, 1 pulmonary sequestration and 1 congenital bilobar emphysema). Overall survival was 90% at 5.6 (0.3-23) years. Patients with bronchiectasis improved markedly except the one with cystic fibrosis who died. All children with tumors cured. Four have some degree of scoliosis which is severe in one with malformative costal fusion. All survivors live unrestristricted normal lives. Postoperative respiratory function is well preserved with FVC of 58% (40-70%), FEV1 of 60% (47-84%) and FEV1/FVC of 92% (87-98%) of the theoretical value for their height and weight.

CONCLUSIONS

Pneumonectomy does not affect by itself to the overall survival, and the respiratory function is good and there is no impairment of the quality of life.

Effect of addition of soybean trypsin inhibitor to colostrum on immunological status in goat kids

The aim of the study was to evaluate the influence of soybean trypsin inhibitor (TI) on immunoglobulin G (IgG) serum levels and growth in neonatal goat kids. Twenty-four newborn kids were fed with natural colostrum (group A), and 24 kids received the same colostrum with 1 g of TI per litre (group B). Blood samples were obtained at birth and on days 1, 2 and 4 of life to analyze serum proteins, IgG and haematological parameters. There were no clinical signs of disease and no significant differences in body weight between the groups. Haematological parameters were not affected by treatment. The peak of serum IgG was reached at 24 h of life, but no effects of soybean TI was observed on serum IgG levels. The apparent efficiency of absorption of IgG was similar in both groups (group A 24.5% vs. group B 25.2%, p > 0.05). The addition of TI to colostrum did not change the concentration of serum proteins and their fractions in goat kids. The correlation between serum IgG and gamma-globulin was positive and significant (p < 0.01, r = 0.64) in group A, but not in group B (p > 0.05, r = 0.08), suggesting a negative influence of soybean TI on gamma-globulin absorption. These results show that addition of soybean TI to colostrum did not improve the performance or immunological status in goat kids.

Complete switch to everolimus in long-term kidney transplants: evolution of the renal function

INTRODUCTION

The use of M-tor inhibitors plus withdrawal of anticalcineurins after 3 months of posttransplantation is usually linked to improvements in renal function. The long-term effects of substitution of anticalcineurinis by everolimus remain unknown. The aim in this study was to evaluate the evolution of renal function and the proteinuria after a complete switch of long-term functioning allograft patients to everolimus. We treated 30 renal transplanted patients with everolimus, at a mean time posttransplantation of 123.8 +/- 74.2 months. The 27 patients, including 17 treated with tacrolimus and 10 with cyclosporine, who were controlled for at least 6 months were included in this study. Seventeen of them were diagnosed to display chronic allograft nephropathy (CAN).

RESULTS

The patients with CAN showed a basal creatinine of 1.81 +/- 0.4; with after a year, 1.61 +/- 0.38; and after 2 years, 1.56 +/- 0.49 mg/dL (P < .05). No significant changes were observed among patients without CAN: 1.1 +/- 0.32, 0.97 +/- 0.15, and 0.97 +/- 0.15 mg/dL, respectively. In CAN patients, the protein/creatinine quotient was: basal = 0.30 +/- 0.13, one year = 0.63 +/- 0.68, and 2 years = 0.48 +/- 0.34. In the other patients the values were 0.2 +/- 0.07, 0.73 +/- 0.7, and 0.32 +/- 0.17, respectively, after a late switch to everolimus.

CONCLUSION

The improved renal function occurred mainly in patients with CAN. Patients who did not suffer from it showed a greater rise in proteinuria. Nevertheless, both groups experienced decreased proteinuria after 2 years.

Endourologic implants to treat complex ureteral stenosis after kidney transplantation

OBJECTIVE

To evaluate the safety and efficacy of nitinol stents and the Detour extra-anatomical ureteral bypass graft in treatment of ureteral stenosis after kidney transplantation.

PATIENTS AND METHODS

Eighteen kidney transplant recipients with complex stenosis caused by failure of primary treatment or with high surgical risk or a poorly functioning graft (serum creatinine concentration >2.5 mg/dL) were treated using antegrade percutaneous implantation of nitinol stents (n = 16) or extra-anatomical ureteral bypass grafts (n = 3); 1 patient was treated with both techniques.

RESULTS

Mean (range) follow-up of ureteral stents was 51.2 (3-118) months. Patency rate at last follow-up, resumption of dialysis therapy, or death was 75% (12 of 16 patients). In 4 patients (25%), stent occlusion developed, which was treated using a double-J catheter in 2 patients, stent removal and pyeloureterostomy using the native ureter in 1 patient, and implantation of an extra-anatomical bypass graft in 1 patient. Mean follow-up in patients with extra-anatomical ureteral bypass grafts was 32 (8-64) months. One patient developed a urinary tract infection, and another had encrustation with obstruction.

CONCLUSIONS

Use of nitinol ureteral stents and extra-anatomical ureteral bypass grafts is a safe and effective alternative to surgery for treatment of post-kidney transplantation ureteral stenosis in patients with chronic graft dysfunction, those at high surgical risk, and those in whom previous surgical treatment has failed.

Advances in attention deficit hyperactivity disorder.What does neuroimaging provide us with?

In attention deficit hyperactivity disorder (ADHD) is a multifactorial and clinically heterogeneous disorder that is the result of the combination of environmental, genetic and biological factors. Its high prevalence, added to the high level of maladaptation occurring in the children affected and the elevated comorbidity with other psychiatric disorders have lead to new scientific interest in this disorder. Especially in recent years, there has been a considerable increase in its study using neuroimaging techniques. Structural and functional imaging studies suggest that the ADHD pathophysiology would be conditioned by a dysfunction in the fronto-subcortical pathways, as well as imbalances in the dopaminergic and noradrenergic systems.

Epithelial and pancreatic choristoma in bovine lymph nodes

Lymph nodes from 186 cows were evaluated as part of a bovine tuberculosis eradication programme. The mediastinal lymph nodes of 13 animals contained atypical structures. In 12 cases (6.45%) these consisted of multiple epithelial structures and, in one case, of pancreatic-like tissue. Immunohistochemistry (IHC) revealed that the epithelial structures were consistent with respiratory epithelium and with ectopic pancreatic tissue, respectively. To the best of our knowledge these are the first histological and immunohistochemical descriptions of epithelial and pancreatic choristomas in bovine lymph nodes.