Evolution and complications in the immediate postoperative period after pediatric liver transplantation: our experience with 176 transplantations.
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Adolescent↗
Biomedical subjects
C Calvo
Publications and source records attributed to C Calvo.
Atherosclerosis profile and microalbuminuria in essential hypertension.
Whether microalbuminuria (MA) is the result of intrarenal hemodynamic changes induced by increased systemic blood pressure (BP) or a marker of capillary leakiness at the glomerular level that reflects more generalized atherosclerotic vascular damage is still debated. To address this question, 319 patients without diabetes, 154 men and 165 women aged 57 +/- 8.6 years (range, 37 to 73 years), but with essential hypertension (EH) never treated with drugs were enrolled onto the study. Using a multiple linear regression analysis, we analyzed the prevalence of MA and its relationship with BP level as well as with other risk factors for the development of atherosclerosis. MA was present in 40% of the population studied. A univariable analysis of ambulatory BP monitoring measurements showed that only 24-hour systolic BP (P = 0.04), daytime systolic BP (P = 0. 02), and 24-hour daytime and nighttime systolic BP load (P < 0.01) predicted the presence of MA, whereas all BP variability parameters significantly predicted it. Multivariable analysis showed that only a positive family history of hypertension (P < 0.001), BMI (P < 0. 001), glucose (P < 0.001), and 24-hour systolic BP coefficient of variation (P < 0.001) independently predicted MA. In summary, the prevalence of MA in our group of patients with EH was high, presumably as a consequence of the older mean age of the population and the selection criteria. Besides being a marker of concomitant cardiovascular damage, MA was associated with a worse pattern of atherosclerotic risk factors. Although its pathophysiological meaning remains to be completely clarified, MA seems to be more related to other atherosclerosis risk factors and presumably reflects a more diffuse vascular injury.
Adult↗
Characterization of monoclonal antibodies against apolipoproteins A-I and A-II. Epitope expression in LpA-I and LpA-I:A-II particles.
Two monoclonal antibodies (MAbs) against apolipoprotein A-I (apo A-I), 6B9 and FF9B10, and one MAb against apolipoprotein A-II (apo A-II), 3F5, were characterized. To establish the epitope of apo A-I recognized by these antibodies, different experimental approaches were performed. First, competition between MAbs and the related epitopes on the same antigen was performed using double-determinant tests with previously characterized MAbs. Second, competition of different synthetic peptides of apo A-I in solution with apo A-I immobilized to solid phase was carried out. The MAbs against apo A-I (6B9 and FF9B10) appear to recognize discontinuous epitopes located in the amino-terminal region of the apo A-I. In competition experiments MAb 3F5 did not recognize central- or carboxy-terminal peptides of apo A-II. Furthermore, apo A-II was stronger recognized when it was included in HDL or LpA-I:A-II than in its purified form. So the epitope for 3F5 is better expressed in the lipoprotein structure. Finally, to establish the epitopes expression in different antigens in solution, competition of purified apo A-I, apo A-II, LpA-I, and LpA-I:A-II particles or HDL3, with apo A-I or HDL immobilized to solid phase, was carried out. The results showed that both MAbs against apo A-I reacted with poor affinity against free apo A-I, with high and similar affinities against Lp A-I and Lp A-I:A-II lipoparticles and with the highest affinity against HDL3. The MAb 3F5 against apo A-II recognized only LpA-I:A-II and not LpA-I lipoparticles.
Animals↗
Change from conventional haemodiafiltration to on-line haemodiafiltration.
BACKGROUND: On-line haemodiafiltration (HDF) is a technique which combines diffusion with elevated convection and uses pyrogen-free dialysate as a replacement fluid. The purpose of this study was to evaluate the difference between conventional HDF (1-3 l/h) and on-line HDF (6-12 l/h). METHODS: The study included 37 patients, 25 males and 12 females. The mean age was 56.5 +/- 13 years and duration of dialysis was 62.7 +/- 49 months. Three patients dropped out for transplantation, three patients died and three failed to complete the study period. Initially all patients were on conventional HDF with high-flux membranes over the preceding 34 +/- 32 months. Treatment was performed with blood flow (QB) 402 +/- 41 ml/min, dialysis time (Td) 187 min, dialysate flow (QD) 654 +/- 126 ml/min and replacement fluid (Qi) 4.0 +/- 2 l/session. Patients were changed to on-line HDF with the same filtre and dialysis time, QD 679 +/- 38 ml/min (NS), QB 434 +/- 68 ml/min (P < 0.05) and post-dilutional replacement fluid 22.5 +/- 4.3 l/session (P < 0.001). We compared conventional HDF with on-line HDF over a period of 1 year. Dialysis adequacy was monitored according to standard clinical and biochemical criteria. Kinetic analysis of urea and beta2-micro-globulin (beta2m) was performed monthly. RESULTS: Tolerance was excellent and no pyrogenic reactions were observed. Pre-dialysis sodium increased 2 mEq/l during on-line HDF. Plasma potassium, pre- and post-dialysis bicarbonate, uric acid, phosphate, calcium, iPTH, albumin, total proteins, cholesterol and triglycerides remained stable. The mean plasma beta2m reduction ratio increased from 56.1 +/- 8.7% in conventional HDF to 71.1 +/- 9.1% in on-line HDF (P < 0.001). The pre-dialysis plasma beta2m decreased from 27.4 +/- 8.1 to 24.2 +/- 6.5 mg/l (P < 0.01). Mean Kt/V (Daugirdas 2nd generation) was 1.35 +/- 0.21 in conventional HDF compared with 1.56 +/- 0.29 in on-line HDF (P < 0.01), Kt/Vr (Kt/V taking into consideration post-dialysis urea rebound) 1.12 +/- 0.17 vs 1.26 +/- 0.20 (P < 0.01), BUN time average concentration (TAC) 44.4 +/- 9 vs 40.6 +/- 10 mg/dl (P < 0.05) and protein catabolic rate (PCR) 1.13 +/- 0.22 vs 1.13 +/- 0.24 g/kg (NS). There was a significant increase in haemoglobin (10.66 +/- 1.1 vs 11.4 +/- 1.5) and haematocrit (32.2 +/- 2.9 vs 34.0 +/- 4.4%), P < 0.05, during the on-line HDF period, which allowed a decrease in the erythropoietin doses (3861 +/- 2446 vs 3232 +/- 2492 UI/week), (P < 0.05). Better blood pressure control (MAP 103.8 +/- 15 vs 97.8 +/- 11 mmHg, P < 0.01) and a lower percentage of patients requiring antihypertensive drugs were also observed. CONCLUSION: The change from conventional HDF to on-line HDF results in increased convective removal and fluid replacement (18 l/session). During on-line HDF treatment, dialysis dose was increased for both small and large molecules with a decrease in uraemic toxicity level (TAC). On-line HDF provided a better correction of anaemia with lower dosages of erythropoietin. Finally, blood pressure was easily controlled.
Adult↗
Apolipoprotein E polymorphism in elderly Chilean people with Alzheimer's disease.
As a part of the WHO Age-Associated Dementia Project, Chile has been participating in a cross-national survey on dementia frequency and determinants since 1989. In the present study, apolipoprotein E (ApoE) polymorphism genotypes have been compared in 95 patients with Alzheimer's disease (AD) (mean age 80.7; 95% CI 79.2-82.2, range 66-97) and 187 healthy people (mean age 78.2; 95% CI 77.2-79.2, range 65-93). Isoelectric focusing and immunoblotting with anti-human ApoE polyclonal antibody were used to determine the distribution of ApoE genotypes. Dementia was diagnosed according to DSM-III-R and ICD-10 clinical criteria. The diagnosis of probable or possible AD was made according to the NINCDS-ADRDA criteria. The ApoE allele frequencies in healthy people were calculated to be epsilon2 = 0.07, epsilon3 = 0.74 and epsilon4 = 0.19. In the probable AD disease group, the frequencies were epsilon2 = 0.08, epsilon3 = 0.52 and epsilon4 = 0.40. The odds ratio (OR) for epsilon4 carriers compared with non-epsilon4 carriers was estimated to be 2.9 (95% CI 1.7-5.1). Taking the genotype epsilon3/epsilon3 as the reference group, the OR for the epsilon4/epsilon4 genotype was estimated to be 12.8 (95% CI 3.9-47.6) and for epsilon3/epsilon4 subjects it was 2.4 (1.3-4.5). These results support the association between ApoE epsilon4 allele with late-onset AD in a Chilean population.
Aged↗
Paediatric life support instructors courses in Spain. Spanish Paediatric and Neonatal Resuscitation Group.
Between October 1996 and February 1998 we have provided five PLS instructors courses for 127 physicians. The instructor course takes 20-24 h over in 3 days, with 20-36 students per course. Theory classes last 5 h and practical stations between 14 and 18 h. Theory classes include: types and organisation of paediatric courses, resuscitation material, methodology of education, didactic methods, and methods of evaluation. The practical classes include techniques of oral expression, resuscitation material, and methodology, and evaluation of basic life support, airway and ventilation, venous and intraosseous access, diagnosis and treatment of arrythmias, neonatal resuscitation and advanced resuscitation. At the end of the course the students perform an anonymous written evaluation of the course with scores between 1 (very bad), 2, 3, 4 and 5 (very good). Theoretical aspects practical classes, methodology, and organisation of the PLS instructors courses are considered satisfactory by the students. We conclude that PLS instructors courses are important for assuring the uniformity and quality of paediatric life support courses.
Cardiopulmonary Resuscitation↗
[Investigation needs on carotenoids in Latin America].
Many recent papers show the important role of bioactive phytochemicals to maintain a good health status. Among them the carotenoids are the best known. About 637 have been described and possibly 70 of them could have an important role in human health, 16 have been found in human brain in high amounts. Most of the studies have found relations between the carotenoids and chronic non-communicable diseases like several types of cancer, atherogenic disease and some degenerative pathology of the eye. This relation is mediated by genes and age. Studies of carotenoids are of scientific and economic interest for Latin America as many tropical products are high sources of these compounds. Therefore the first task is to analyze them and iniciate some evaluation on its metabolic availability. A coordinated regional work is proposed, in which 40 or 50 fruits and vegetables are analyzed in terms of the seven carotenoids most related to human health. At the same time it will be important to start epidemiological studies that will compare groups with different levels of consumption of fruits and vegetables and make chronic disease risk analysis. In some countries of the Latin American region, with the support of FAO and INFOODS, some courses and meetings are taking place so that in a short time period the carotenoid composition of the important regional foods will be completed and a carotenoid regional food composition table be published.
Antioxidants↗
[Achilles tendon size by high resolution sonography in healthy population. Relationship with lipid levels].
BACKGROUND: Sonography is a useful technique for the study of the Achilles tendon, and specially in the detection of tendon xantomas. Normal sonographic size is not well established, and is essential in the clinical diagnosis of monogenic familial hypercholesterolemia (FH). Possible relationship between Achilles tendon size and plasma lipid concentrations in normolipidemic population is not known. SUBJECTS AND METHODS: The antero-posterior Achilles tendon diameter (ATD) was measured with high resolution sonography in 100 healthy subjects, 50 males and 50 females, 20-70 years old, 10 subjects for each decade of age and sex. ATD was correlated with age, gender, body mass index, physical activity and lipid and apolipoprotein B plasma concentrations. RESULTS: The ATD was significantly higher in males than in females, 5.32 (standard desviation [SD] 0.48) mm versus 4.91 (SD 0.47) mm (p < 0.01). In the multivariate analysis, ATD of males was positively associated with total plasma cholesterol (TC) level (p < 0.01). The ATD in females was positively associated with weight (p < 0.01). CONCLUSIONS: Normal ATD has been defined. Its range is relatively narrow and different in both sexes. Similarities in the histology between vascular and tendinous intersticium probably explain the relationship found between Achilles tendon and TC. Achilles tendon size could be a simple marker of lipid deposition in tissues.
Achilles Tendon↗
Reduction of QT and QTc dispersion during long-term treatment of systemic hypertension with enalapril.
We report, in conjunction with other findings, the evolution of the dispersion of QT and QTc in patients who for the last 7 years have been treated with enalapril for systemic hypertension with left ventricular (LV) hypertrophy. Twenty-four essential hypertensive patients who had received no previous treatment took enalapril (20 mg twice daily) for 7 years. In a pretreatment placebo phase and 8 weeks and 1, 3, 5, 6, and 7 years after the start of therapy, cardiovascular parameters were determined by two-dimensional guided M-mode echocardiography, and the QT interval and corrected QT interval (QTc) and their dispersions were obtained from amplified standard 12-lead electrocardiograms. Therapy rapidly reduced blood pressure (BP) from 156/105 mm Hg to normal values; at 7-year follow-up, BP was 130/84 mm Hg (p <0.001 with respect to the placebo phase). LV mass index decreased progressively until at 5-year follow-up the reduction had reached 39% (p <0.001), after which neither LV mass index nor any structural parameter underwent any further significant change. LV pump function was also significantly better after 7 years of treatment. During this time, QT and QTc decreased significantly, as did the dispersion of both QT (from 61+/-21 to 37+/-14 ms) and QTc (from 67+/-27 to 41+/-16 ms). We conclude that long-term enalapril treatment of hypertensive patients with LV hypertrophy not only induces marked regression of LV mass and improved LV systolic function, but also reduces the dispersions of QT and QTc, which probably reduces the likelihood of ventricular arrhythmias and improves prognosis.
Adult↗
Increased activity of lecithin:cholesterol acyltransferase during short-term oral estrogen progestin replacement therapy in a group of postmenopausal women.
The aim of the study was to assess the short-term effect of estrogen-progestin therapy on the plasma level of lecithin: cholesterol acyltransferase ([LCAT] EC 2.3.1.43), a key enzyme in the cholesterol reverse-transport process. The trial included 21 women with at least 6 months of menopause, which was confirmed by anamnesis, physical evaluation, and follicle-stimulating hormone (FSH) determination. Women receiving pharmacological treatment or who had any kind of endocrine disorder were excluded. In addition, we evaluated and confirmed normal Papanicolaou and mammography tests in all 21 women included in the trial. They received conjugated equine estrogen 0.625 mg daily, plus cyclic medroxyprogesterone acetate (5 mg daily) for 12 days each month. Plasma levels of LCAT, cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apoB, and apoAI were evaluated before and after 1 and 3 months of therapy. Pretherapy and posttherapy results were analyzed statistically by Wilcoxon's rank-sum test for paired samples. No significant changes were observed either for body mass index or for blood pressure. A significant increase in plasma LCAT activity was found at the first and third month posttherapy (P < .005). In addition, after 3 months of therapy, HDL-C significantly increased (P < .005), in contrast to the significant decrease detected in total cholesterol (P < .025), LDL-C (P < .005), cholesterol to HDL-C and LDL-C/HDL-C ratios (P < .005). Triglyceride levels did not show significant modification. In conclusion, our results indicate that short-term estrogen-progestin therapy produces a significant increase in plasma LCAT activity, as well as beneficial changes in the lipid profile, in postmenopausal women.
Adult↗
HLA-DQ2-negative celiac disease in Finland and Spain.
Genetic susceptibility to celiac disease (CD) is strongly associated with DQA1*0501 and DQB1*02 (= DQ2). To study whether CD patients without DQ2 share other MHC class II or TNF alleles, we screened DQ2-negative patients in Finland and Spain. Twelve of 84 (14%) Finnish patients and 13 of 189 (6%) Spanish patients were negative for DQ2. We observed that all but two of altogether 25 DQ2-negative patients had the DR4 DQ8 haplotype, or either DQA1*0501 or DQB1*02 alone. Also, all but three were positive for DRB4*01. The only patients without any of these alleles were both positive for DR 13. There was a clear difference between Finland and Spain: Ten (83%) of the 12 Finnish DQ2-negative patients but only five (38%) of the 13 Spanish patients had DRB1*03, DQA1*03, DQB1*0302 (= DQ8) alleles. Of the Spanish patients, eight (62%) had DQB1*02 without DQA1*0501 and three (23%) had DQA1*0501 without DQB1*02. None of the TNF, TAP, or DPB1 alleles was found to be significantly associated with CD. Our results indicate that in addition to the DQ2 heterodimer, the other major risk alleles for CD are DR4 DQ8, and either DQA1*0501 or DQB1*02 alone. Patients without these alleles appear to be very rare, only two (0.7%) were identified in altogether 253 patients tested.
Adolescent↗
Fecal coliform-related bacterial and coliphage populations in five lakes of southeastern Spain.
Aerobic heterotrophic bacteria, fecal and total coliforms, fecal streptococci and coliphages were isolated from five protected lakes in the Antequera area of Spain over the time from January to March (1994-96). The water samples contained large number of heterotrophic bacteria (mean counts 0.2 to 5.0 x 10(7) cfu per 100 ml). Most of the lakes contained fecal streptococci and a relationship between streptococci and salinity of the water samples was established. Coliphages were isolated from lakes containing fecal coliform and these bacteria were taxonomically identified as E. coli. Coliform bacilli do not seem to be an adequate indicator of fecal pollution for these ephemeral small lakes.
Animals↗
Reference values of gastric intramucosal pH in children.
To determine the reference values of gastric intramucosal pH (pHi) by tonometry in paediatric patients, we studied 17 children (nine males, eight females) with no systemic or gastrointestinal disease, aged six months to 12 years undergoing minor reconstructive surgery. Following anaesthetic induction a sigmoid tonometry catheter was inserted (Tonometrics, Inc.) into the stomach of the patients under direct vision. All children were normoventilated and were haemodynamically stable. After an equilibration period of 30 min, gastric pHi was calculated by applying the Henderson-Hasselbalch equation on the PCO2 obtained with the tonometer and the bicarbonate from the arterial blood gas analysis. The mean gastric pHi in our patients was 7.35 +/- 0.06 (SD). The normal pHi in the general population is estimated to be 7.31-7.40, with a confidence interval of 99%. No correlation was found between pHi and arterial pH, bicarbonate or base excess. Under conditions of normal ventilation and haemodynamic stability, healthy children during general anaesthesia have gastric intramucosal values similar to those of adults.
Blood Chemical Analysis↗
An immunoenzymatic procedure for human apo B-containing particles quantification using monoclonal antibodies.
The present report describes a new monoclonal antibody-based enzyme immunoassay (ELISA) for the quantification of apolipoprotein (apo) B-containing particles in plasma. Native low-density lipoprotein (LDL) and a reference serum were utilized to prepare the standard curve. Three different antibodies to apo B-100--4A6E3, 6A10B10, and 2D9--all produced in our laboratory, were examined. The apparent affinity constants of the monoclonal antibodies (MAbs) 4A6E3, 6A10B10, and 2D9 were 2.9 x 10(9), 1.74 x 10(9), and 0.63 x 10(8), respectively. The standard curve was generated for an apo B-LDL range of 0.1 to 4.0 microg/ml. Evaluating the concentration of apo B-containing particles in plasma may allow for a more accurate assessment of the risk of coronary artery disease.
Antibodies, Monoclonal↗
Quality of life and calcium channel blockade with nifedipine GITS versus amlodipine in hypertensive patients in Spain. Gastrointestinal Therapeutic System.
OBJECTIVE: Compliance with hypertension treatment is affected by treatment-related factors (complexity, side effects), efficacy and compound-specific effects that impact on quality of life. This study examined the differences in quality of life produced by two once-daily calcium channel blockers using different delivery systems: nifedipine gastrointestinal therapeutic system (GITS) and amlodipine. DESIGN: This was a double-blind, double-dummy, randomized clinical trial comparing nifedipine GITS (30 mg) and amlodipine (5 mg) for 24 weeks following a placebo run-in. Clinical, laboratory evaluations and quality-of-life data were assessed at screening, baseline randomization and three times during active therapy. SETTING: The study was conducted in 13 medical clinics in Spain. PATIENTS: The sample comprised 430 screened and 356 randomized patients with mild to moderate hypertension (diastolic blood pressure 95-114 mmHg). MAIN OUTCOME MEASURES: Change in systolic and diastolic blood pressure and in health-related quality of life were the main outcome measures. RESULTS: There were no significant differences between active treatment groups in the blood pressure changes (systolic blood pressure: nifedipine GITS -15.5 mmHg; amlodipine -15.7 mmHg). Spontaneous adverse events consistent with calcium channel blockage were not different. The nifedipine GITS group improved in all quality-of-life measures except Sexual Symptom Distress and showed a significantly greater improvement than amlodipine in overall Quality of Life (P< 0.05), General Perceived Health (P < 0.026) and its subscale Vitality (P < 0.019). The amlodipine group declined in overall Quality of Life, General Perceived Health, Vitality and Sleep Disturbance, and significantly in Sexual Symptom Distress (P < 0.045). However, this group improved in self-reported Cognitive Functioning (P=0.036), Mental Acuity (P < 0.005) and Detachment/disorientation (P=0.01). CONCLUSIONS: These results suggest compound-specific effects on quality of life that may be due to differences in the delivery system. Nifedipine GITS is short-acting (2 h half-life) and is delivered continuously over a 24 h period, while amlodipine has a half-life of 40 h, which may produce more sustained low-level effects. While a more beneficial profile was observed for nifedipine, amlodipine demonstrated potential positive effects on cognitive functioning.
Adolescent↗
[Improvement in diastolic function in hypertensive patients with left ventricular hypertrophy with inhibitors of the angiotensin converting enzyme].
An open and multicentric study was conducted with 66 patients with mild to severe diastolic arterial hypertension and echocardiographic left ventricular hypertrophy, the evolution of diastolic function, by means of doppler transmitral flow echocardiography, under treatment with ramipril, an angiotensin converting enzyme inhibitor, at a dose of 2.5 and 5 mg/day, or combined with a diuretic, after three and six months of treatment. Despite not obtaining the tensional control in all patients, a decrease in the mass, both in absolute values and mass index, was obtained. This decrease was observed both in male and female patients from the first three months, which went on until the sixth month, thus suggesting an independent action of the hemodynamic load decrease for the obtention of this effect. There was also a change in the ventricular geometry with a displacement of patients from concentric enlargement to normal, remodelling and eccentric enlargement. The diastolic function improved both for the early and for the late maximal filling velocity, relationship between both, and deceleration time, although the time during which this improvement occurred was different for each parameter, thus indicating the different influence of the dynamic and structural factors on these parameters. No correlation was found between the improvement in diastolic function and hypertrophy regression. We can conclude that ramipril is useful for the control of the left ventricular hypertrophy and diastolic function, irrespective of arterial tension values.
Aged↗
[Vasculitis affecting the kidney: analysis of 18 patients].
OBJECTIVE: Eighteen patients who were judged to have systemic vasculitis (1990 American College of Reumathology criteria) affecting the kidney, from January 1988 to August 1996, were reviewed. METHOD: We analyzed characteristics of clinical, biochemical, histopathological features, the interval between the onset of the symptoms to a diagnosis of disease, treatment and overall outcome. RESULTS: The principal mode of presentation of the vasculitis is general, renal and pulmonary symptoms. The discovery of ANCA has improved the diagnostic procedure in patients with these diseases. Renal biopsy facilitates early diagnosis, prognosis and treatment. The renal lesion typically shows a segmental necrotizing glomerulonephritis and extracapillary proliferation forming crescent. CONCLUSIONS: The systemic vasculitis with renal involvement carries a poor prognosis and high mortality. A variety of treatment has been employed, but their precise role in the management of these vasculitis is still being elucidated.
Aged↗
Plasmatic amino acids in kidney transplantation in children.
We studied the evolution of plasma amino acid levels in children with chronic kidney failure after undergoing a renal transplantation. Plasma amino acid profile was studied in 10 children just before surgery, at admission in paediatric intensive care unit and 4, 8, 12, 24, 48 and 72 h after transplantation. Previous to the graft, plasma levels of glutamic acid (p < 0.01), hydroxyproline (p < 0.01), citrulline (p < 0.01) and arginine (p < 0.05) were significantly increased, whereas plasma levels of serine (p < 0.01), glutamine (p < 0.03), threonine (p < 0.01), tyrosine (p < 0.01), valine (p < 0.01), leucine (p < 0.01), tryptophan (p < 0.01), branched amino acids (BCAA) (p < 0.01), aromatic amino acids (AAA) (p < 0.01) and essential amino acids (EAA) (p < 0.01) were decreased in relation to control children. The amino acid profile evolution run parallel to the settle down of renal function parameters. Within 72 h after surgery, even before in some cases, all amino acids except tryptophan and arginine reached normal levels.
Adolescent↗