Free omental graft without vascular microanastomosis in the cutaneous wound healing of rabbits

ABSTRACT This study aims to evaluate the influence of free omental graft without vascular microanastomosis (FOGWVA) on experimental skin healing in rabbits. Through celiotomy, a 9cm2 free omental fragment was collected in 36 rabbits, with subsequent production of a deep linear cutaneous wound in the dorsal midline measuring 3cm. In 18 animals from the omental group (OG), the omental fragment collected was fixed subcutaneously with six simple interrupted stitches using a 4-0 polyamide thread. In both treated and control (CG) groups, intradermal dermorrhaphy was performed with 4-0 polyamide thread. Experimental wounds were clinically evaluated every day. Each of the groups was divided into three subgroups of 6 animals each for histopathological evaluation on the 7th, 14th, and 28th days of postoperative. In the OG wounds, the increase in volume (omentum activation) stood out after the second postoperative day. Macroscopy showed an organic reaction to the graft on day 7, with a progressive reduction in addition to neovascularization towards the omental graft. The intense presence of mononuclear cells and collagen deposition on day 7 demonstrated an accelerated process of tissue remodeling and repair. The FOGWVA omental graft remained viable and positively influenced the cutaneous healing of the experimental wounds in rabbits.

High-Urgency Renal Transplantation for Patients With Vascular Access Failure: A Single-Center Experience

In the face of access failure for renal replacement therapy or severe complications despite or due to dialysis, high-urgency renal transplant (HU-RT) allocation is possible. Vascular access failure patients have multiple comorbidities and a higher risk of cardiovascular and thrombotic events. Thus, it is presumed that graft and patient survivals might be worse for these patients. The aim of this paper was to analyze the characteristics and outcomes of HU-RT patients due to access failure for renal replacement therapy when comparing them to a population of deceased-donor renal transplant (DDRT) patients. We analyzed data from our Renal Transplantation Unit from January 2006 to April 2017. In this period, 374 patients had a renal transplant. Of these, 11 patients received a high-urgency deceased-donor renal transplant (HU-DDRT). Compared with patients who had a DDRT, HU-DDRT patients were predominantly female (54.5% vs 43.5%, P = .007) and younger (41.6 ± 7.9 vs 49.4 ± 11.8, P = .031). HU-DDRT patients were not significantly more sensitized than DDRT (14.1 ± 27.4 vs 13.5 ± 24.1, P = .935), and had a comparable number of HLA mismatches (3.4 ± 1.4 vs 3.6 ± 1.2, P = .343). Despite the higher incidence in hypertensive (90.9 vs 73.5%, P = .196) and diabetic patients (27.3% vs 15.7%, P = .305) in the HU-DDRT group, this difference was not statistically significant. The percentage of retransplantation was similar in both groups (9.1% vs 7.2%, P = .808). Donor sex, age, and baseline serum creatinine were similar between the groups. There was an increased proportion of expanded criteria donors in HU-DDRT (54.5% vs 25.1%, P = .028). There were no differences in cold or warm ischemia time nor in serum creatinine at discharge or during the first 2 years of follow-up. In both groups, a similar proportion of patients experienced acute rejection episodes. Comparable to DDRT patients, HU-DDRT patients had a high proportion of graft survival at the 1-year follow-up (90.9% vs 93.1%, P = .777). At a 2-year follow-up, graft survival was lower in the HU-DDRT group (81.8% vs 91.5%, P = .267). Mean follow-up for both groups was comparable (78.5 ± 46.7 vs 68.4 ± 40.8 months, P = .424). Overall, graft loss occurred in approximately 36.4% of HU-DDRT patients and 20.9% of DDRT patients (P = .219). Both groups had an overall mortality rate of around 9%. The differences were not statistically significant due to the limited number of patients. More comorbidities and reportedly worse cardiovascular prognosis of access failure (AF) patients and use of expanded criteria donors did not negatively reflect in worse short-term outcomes in our cohort, which highlights the importance of HU-RT in prolonging the survival of AF patients.

Acute kidney injury in HIV-infected patients: a critical review

Acute kidney injury (AKI) is characterized by a rapid decline of renal function associated with worse outcomes. The purpose of the authors is to perform a critical review of the incidence, risk factors, pathogenesis and outcome of AKI in HIV-infected patients. Human immunodeficiency virus (HIV)-infected patients have an increased risk of developing AKI, to which contribute both HIV-dependent and HIV-independent factors as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlights the need for identification of patients at risk, creation of prevention strategies and management. HIV-infected patients have an increased risk of developing AKI, to which both HIV-dependent and HIV-independent factors contribute, as well as the nephrotoxicity of drugs used. The increased risk of AKI in HIV-infected patients and its negative impact on prognosis highlight the need for identification of patients at risk, creation of prevention strategies and management.

Acquired erythropoietic uroporphyria secondary to myelodysplastic syndrome with chromosome 3 alterations: a case report

Congenital erythropoietic porphyria is a rare autosomal recessive disease caused by a deficiency of uroporphyrinogen III synthase, owing to mutations in UROS in chromosome 10. Occasionally, patients show a mild, late-onset disease, without germline UROS mutations, associated with haematological malignancies. We report a 65-year-old patient with photosensitivity, overexcretion of porphyrins and thrombocytopenia. Bone marrow analysis gave a diagnosis of myelodysplastic syndrome (MDS) with the presence of a derivative chromosome 3, possibly due to an inversion including 3q21 and 3q26 break points. After allogeneic stem-cell transplantation, complete remission of MDS and uroporphyria was achieved. To our knowledge, this is the first reported case of acquired erythropoietic uroporphyria associated with MDS, with chromosome 3 alterations.

Induction immunosuppressive therapy in renal transplantation: does basiliximab make the difference?

The optimal prophylactic induction immunosuppressive therapy to prevent renal transplant rejection remains controversial. Recently, basiliximab efficiency has been reported in several studies. We sought to evaluate the efficiency of induction immunosuppressive therapy with basiliximab in renal transplantation in our unit based upon the acute rejection rate, patient and graft survivals, first hospital admission length, and incidence of infectious or malignant complications during 4 years of follow-up. We retrospectively evaluated the outcome of two groups of renal transplant recipients treated with triple immunosuppressive therapy (cyclosporine, mycophenolate mofetil, and prednisolone) without (group 1, 149 patients) or with (group 2, 104 patients) induction immunosuppression with basiliximab. The two groups did not differ in demographic characteristics, number of hypersensitized patients, cold ischemia time, or donor age. The group receiving basiliximab displayed a significantly lower acute rejection rate (7.6% vs 24%, P = .001) and shorter first hospital admission (14.4 +/- 8 vs 19.5 +/- 11 days). There was no difference in graft or patient survival, death due to sepsis, or incidence of posttransplant malignancies. Although there was no difference in graft or patient survival, immunosuppressive induction therapy with basiliximab yielded a significant reduction in the acute rejection rate.

Mycophenolate mofetil: ten years' experience of a renal transplant unit

Mycophenolate mofetil (MMF) use in renal transplantation has allowed a significant decrease in early acute rejection rates. We retrospectively evaluated the incidence of acute rejection episodes, renal function at the first year posttransplant, patient and graft survivals, cytomegalovirus (CMV) infection rate, influence of the degree of sensitization, and number of MHC antigen mismatches on graft survival in two groups of patients receiving either MMF or azathioprine. Group 1 included 149 patients receiving cyclosporine, MMF, and prednisolone; group 2 included 191 patients receiving cyclosporine, azathioprine, and prednisolone. The two groups did not differ in terms of age, sex, degree of sensitization (expressed as percentage of antibodies reactive to panel), MHC mismatch number, cold ischemia time, donor age, or anti-thymocyte globulin induction. In group 1 (MMF) there was a significant decrease in early acute rejection rate (19% vs 57%, P < .0001), longer graft survival at 10 years (92% vs 75%, P = .006), and higher rate of CMV infection (22% vs 12%, P = .004). Renal function at the first year posttransplant and patient survival during follow-up did not differ between the groups. The degree of sensitization influenced graft survival in group 2. The number of MHC mismatches did not influence graft survival in either group. With MMF, there was a significant reduction in early acute rejection rate, a significant increase in graft survival at 10-year follow-up, and diminished impact of the degree of sensitization on graft survival.

[Posterior reversible encephalopathy syndrome (PRES) and chronic kidney disease]

Posterior reversible encephalopathy (PRES) is a recently described syndrome, defined by clinical and neuroimaging features. Chronic kidney disease patients may be especially vulnerable to this syndrome because they are frequently exposed to several of its possible causes, including uremia and hypertension. In its most severe form, PRES can manifest clinically as seizures, coma or death. However, if properly diagnosed and treated, this syndrome can be completely reversible. Therefore, neuroimaging methods, especially brain magnetic resonance is fundamental for its diagnosis because it shows brain edema in characteristic pattern, and excludes causes of seizures or coma. An important example is the case of a young hypertensive chronic kidney disease patient on peritoneal dialysis, brought to the emergency room comatous with generalized tonic-clonic seizures; the cerebral magnetic resonance imaging features were impressive. Anti-hypertensive therapy and hemodialysis allowed complete recovery. The reversibility of this syndrome depends on timely diagnosis and therapy and therefore it should be kept in mind in the differential diagnosis of seizures. or coma in chronic kidney disease patients.

[Quality perceived by outpatients at the pharmaceutical care clinic]

OBJECTIVE

To know the satisfaction degree manifested by outpatients presenting in the hospital pharmacy department pharmaceutical care clinic, and to identify organizational improvement items.

METHOD

A survey with 8 close-ended questions and 1 open-ended question was designed where patients recorded their suggestions or comments on the service provided. A sample size of 591 surveys was estimated, which allowed to estimate parameters of interest with a 95% confidence interval and a +/- 5% accuracy, adjusting by a 40% potential losses percentage.

RESULTS

Overall response rate was 70%; 23.6% of patients considered that finding the PD was difficult or very difficult. Waiting time was normal for 51.8%, but long or excessive for 18.4% of patients. Fifty-six percent of individuals considered the information received useful or very useful, and 81.1% considered that staff friendliness was good or very good. Care timetable was inadequate for 18.1%; 47.7% pointed out that the attending pharmacist did not identify him or herself. Overall satisfaction extent was 7.51 (of 10). A plan for improvement activities was designed and implemented regarding: care timetable, pharmacy department signaling, and general information on clinic matters.

CONCLUSIONS

The survey allowed to identify organizational weaknesses. Overall score was very satisfactory, yet improvable. Future surveys are required for result comparisons and continual improvement assessment.

Effects of mouse ovarian tissue cryopreservation on granulosa cell–oocyte interaction

BACKGROUND

Current ovarian tissue cryopreservation protocols have yet to be assessed in terms of somatic-germ cell interaction. Accordingly, post-thaw analysis of antral follicles can yield relevant data on the disruption of the granulosa-oocyte interface.

METHODS

We compared fresh mouse ovarian tissue with tissues that had been either cryopreserved using dimethylsulphoxide (DMSO) or glycerol as cryoprotectants, or exposed to such cryoprotectants without freezing. The assessed parameters were: number of immature oocytes retrieved per ovary, allocation of the oocytes to different classes regarding antral follicle size and oocyte-granulosa cell adhesion, and the relative density of transzonal processes containing filamentous actin (TZPs-Act).

RESULTS

Although cryopreservation reduces the average number of oocytes retrieved per ovary, it increases the relative distribution of granulosa-free oocytes while decreasing that of granulosa-enclosed ones. Additionally, a post-thaw decrease in TZPs-Act density was recorded. This decrease was also observed after cryoprotectant exposure without freezing, although at a lower level. For the assessed parameters, DMSO was more effective than glycerol as a cryoprotectant.

CONCLUSIONS

In situ cryopreservation of granulosa-oocyte complexes with current protocols disrupts the granulosa-oocyte interface. The different patterns of granulosa cell adhesion and interaction in oocytes derived from different-sized antral follicles further suggests that the granulosa-oocyte interface may be developmentally regulated.

Severe infections after allogeneic peripheral blood stem cell transplantation: a matched-pair comparison of unmanipulated and CD34+ cell-selected transplantation

BACKGROUND AND OBJECTIVES

T-cell depletion of the graft delays immune recovery following allogeneic peripheral blood stem cell transplantation (PBSCT), but it is not clear whether it actually increases the risk of severe infections after the transplant.

DESIGN AND METHODS

We have compared the occurrence of severe infections following 162 CD34+ cell-selected allogeneic PBSCT and 162 unmanipulated PBSCT (CD34+ and UM groups, respectively) from HLA-identical siblings.

RESULTS

The probability of infection-related mortality (IRM) was 22% in the UM group and 31% in the CD34+ group (log-rank, p=0.2). In multivariate analyses only the use of fluconazole prophylaxis showed a protective effect on IRM in the whole set of patients, while in both transplant groups the most significant factor was the development of moderate-to-severe graft-versus-host disease (GVHD). The probability of developing cytomegalovirus (CMV) infection was 42% in the UM group and 59% in the CD34+ group (p=0.002), with no differences in CMV disease (10% and 9%, respectively). Multivariate analysis of CMV infection identified three variables associated with a higher risk in the whole set of patients: CMV positive serostatus, CD34+ transplant group and recipient age above 40 years. The development of moderate-to-severe GVHD was a significant factor only in the UM group. Disseminated varicella-zoster virus infection was more common in the CD34+ group (19% and 12%, p=0.05), as were early (< 30 days post-transplant) severe bacterial infections (28% vs 14%, p=0.002). Invasive fungal infections and pneumonias of unknown origin did not differ between groups.

INTERPRETATION AND CONCLUSIONS

Our results do not show a significant increase in the risk of dying from an opportunistic infection with CD34+-PBSCT, but the risk of CMV infection is increased, with no differences in CMV disease or mortality attributable to CMV. There is an additive effect on IRM of developing moderate-to-severe GVHD (acute or chronic) following CD34+-PBSCT, and in this subset of patients maximum efforts for the prevention and early treatment of opportunistic infections should be pursued.

Tetraplegic ambulation with the ORLAU swivel walker: a case report

The ORLAU Swivel Walker which had previously been used by children with spina bifida. has been modified so that it is now being successfully used by spinal cord paralysed patients. This is a case study of a C7 traumatic tetraplegic patient who has used the ORLAU swivel walker for 5 years.

Inhomogeneous integral equation approach to pair and triple correlations in a glass-forming simple liquid

A simple model of glass-forming liquid modeled via Dzugutov's pair potential is studied by means of the triplet hypernetted chain approximation as formulated by Attard [P. Attard, J. Chem. Phys. 93, 7301 (1990)]. This system, which is known to be mostly dominated by microscopic icosahedral ordering, eludes a correct description in terms of classical two-body integral equation theories. However, it is found here that the simple hypernetted chain approximation when applied at the three-particle level can yield a correct semiquantitative description of both the pair and triplet structure of the supercooled state, capturing features which escape more sophisticated closures implemented on the two-particle level.

[Different etiology of thyrotoxicosis as a function of previous prevalence of goiter]

BACKGROUND

The high incidence of goiter is believed to modify the characteristics and etiology of thyrotoxicosis. The aim of the present was to study the etiologic types and clinical characteristics of thyrotoxicosis of patients from two areas of different endemic goiter.

METHODS

Two hundred twelve patients (184 women and 28 males) were studied with clinical and analytical data of thyrotoxicosis. The patients were consecutively seen in the endocrinology units of two different hospitals over the last 4 years. One hundred eight patients pertained to the area of the Xeral Hospital in Lugo (inland zone) and 104 pertained to the area of the Juan Canalejo Hospital from La Coruña (coastal zone). The clinical data of thyrotoxicosis, thyroxin concentration and thyroid gammagraphies were evaluated.

RESULTS

The different etiological types were: Graves disease (GD): Lugo: 20 (19%), La Coruña 57 (55%; p less than 0.001). Toxic multinodular goiter (TMG): Lugo 53 (49%), La Coruña 29 (28%; p less than 0.001). Toxic adenoma (TA): Lugo 23 (21%), La Coruña 13 (13%). Hyperthyroidism by iodine: Lugo: 8 (7%), La Coruña 3 (3%). Other diagnosis: Lugo: 4 (3%), La Coruña 2 (2%). Although the frequency of thyrotoxicosis was much greater in women the percentage distribution of the etiologic types was similar in the two sexes. Symptoms were more frequent in patients with GD with respect to TMG. The presence of auricular fibrillation was more frequent in patients with TMG (38%) than in those presenting GD (4%; p less than 0.01).

CONCLUSIONS

Toxic multinodular goiter is the most common cause of thyrotoxicosis in the zones of high endemic goiter. On lowering endemic goiter the percentage of TMG is lowered and that of Graves disease is raised. The symptomatology of thyrotoxicosis is more evident in GD with relation to other etiologic types, but auricular fibrillation is more frequent in TMG. The high prevalence of toxic nodular goiter and hyperthyroidism by iodine suggests the important pathogenic role of the increase of the ingestion of iodine in the form of iodized salt or drugs with iodine.

Contrasting features of insulin dependent diabetes mellitus associated with neuroectodermal defects and classical insulin dependent diabetes mellitus

The Wolfram, or DIDMOAD, syndrome is a rare congenital disease that is associated with diabetes insipidus, insulin dependent diabetes mellitus of an early onset, bilateral optic atrophy and deafness. Urological disorders are usually present as well. We have studied nine patients belonging to five different families. All of the family members were HLA typed (including DR), and islet cell as well as antinuclear antibody determinations were carried out. Although individuals with insulin dependent diabetes mellitus are very prone to have either HLA-DR3 or -DR4 antigens, none of our patients had DR3 antigens and only one was DR4 positive. On the other hand, three of our patients were typed as HLA-DR2 positive. This antigen is uncommon in classical insulin dependent diabetes. In one of the families, the affected siblings did not share the same HLA haplotype. Islet cell and antinuclear antibodies were not found in any of the cases and six of the patients had a small, but significant, insulin secretory reserve. On the basis of some of the clinical features it was also possible to further distinguish between the DIDMOAD syndrome and the classical insulin dependent diabetes mellitus. The differences encountered between classical and DIDMOAD insulin dependent diabetes mellitus--the presence/absence of HLA linkage, HLA-DR2, -DR3 and -DR4 associations, islet cell or antinuclear antibodies, the tendency to ketosis and diabetic retinopathy--indicate that their etiopathogenies are triggered by distinct mechanisms.

Familial hypocalciuric hypercalcemia. Report of a new family

We report a new family with familial hypocalciuric hypercalcemia (FHH) composed by 55 living members. Of 38 studied, 10 have been found to be affected by FHH. Differences between FHH and primary hyperparathyroidism are emphasized; lack of clinical features, relative hypocalciuria for the concomitant hypercalcemia and low phosphate excretion index. The PTH and urinary cAMP are normal. It is noteworthy that the disease is benign. None of our patients have undergone surgery, and all of them are asymptomatic.

[Tuberculous pleural effusion and pleural effusion secondary to non-specific bacterial infection: biochemical differential diagnosis (author's transl)]

The authors study 14 different analytical parameters in the pleural fluid in order to recognize differential biological criteria, helping to establish an etiologic diagnosis in patients with suggestive clinical symptoms and biological data of an infectious process. In a group of 38 patients with bacterial exudative pleural effusion (22 of tuberculous origin and 16 secondary to non-specific bacterial infection), the following parameters were analyzed: total proteins, acid glucoprotein, X1, antytripsin, CDH, acid phosphatase, amylase, cholinest, copper, iron, pCO2, pO2 pH, glucose, and cholesterol. The results of amylase, copper, pCO2, pO2 and pH determinations in the pleural fluid show statistical significant differences between the tuberculous cases and the patients with non-specific infections. Lastly, the authors mention the minimal biological criteria necessary to confirm the tuberculous or non-specific bacterial etiology of a pleural fluid, stressing the value of the levels of cholinesterase, copper, pO2 and pH as differential data.

[Value of the measurement of gases in the diagnosis of pleural effusion (author's transl)]

Determination of pH and measurement of pCO2 and pO2 have been systematically included in the study of 183 patients with pleural effusion. According to selective etiologic criteria the effusions were divided into four categories: those of cardiac origin (42), non-specific infectious (14), tuberculous (22) and neoplastic (20). A pH inferior to 6.30 seemed to be characteristic of non-tuberculous pleural effusion, and in these circumstances an associated pCO2 greater than 135 mm Hg and pO2 less than 21 mm Hg were noticed. Results in tuberculous and neoplastic cases were similar, pO2 being the only differential datum (pO2 less than 49 mm Hg and pO2 greater than 52 mm Hg, respectively). Overall results are compared to those obtained in the subgroup of pleural effusions of cardiac origin. Determination of pH, pO2 and pCO2 in pleural effusions may help to identified the etiology of this condition, specially when associated to analysis of other parameters of the aspirated fluid.