Acyclovir therapy of severe chickenpox in an adult renal transplant patient.
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Biomedical subjects
Publications and source records attributed to C Prieto.
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In our series of RT three cases of diffuse NRH of the liver were found. This rare entity is characterized by nodules of regenerative hepatocytes distributed throughout the liver without fibrosis. The incidence was 12.5% and probably is underestimated. Clinically, hepatomegaly, moderate thrombopenia and an elevation of GGT were present, but no case was previously suspected. NRH can lead to PH, and we should think of this entity in the differential diagnosis of PH following RT.
We reviewed the evolution of FENa in the EPP (first 4 weeks) in a group of CyA-treated patients as well as Aza-treated patients who did not present with acute rejection during this period of time. The CyA-treated patients showed lower values of FENa than did Aza-treated patients. Values of FENa below 1% were found in 51% of CyA- and 0% Aza-treated patients (P less than .01) before RFR. The finding of low FENa values was accompanied by more prolonged oliguric and RFR phases. Furthermore, the lower the level of FENa, the higher the prolongation of renal failure. We concluded that FENa values could probably be an index of CyA nephrotoxicity in the EPP.
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Two open-circuit respiration chambers intended for use in energy metabolism research with pigs and small ruminants (goats and sheep) have been built. The respiration plant is air-conditioned, the temperature and the relative humidity in the chambers can be regulated from about +10 to 31 degrees C and from 45 to 90% relative humidity. The flowmeters operate on the basis of pressure differences. CH4, CO2 and O2 are analysed according to physical principles. Several calibration tests of the whole system were carried out with satisfactory results. A detailed description of the respiration facility is presented.
The role of the tonic inhibitory effect of dopamine on aldosterone secretion has been investigated in 10 patients with chronic renal failure (CRF) on hemodialysis, in 8 normotensive renal transplant recipients (Tx) with normal renal function and in 8 normotensive volunteers (NV). The following tests were performed: the response of plasma aldosterone (PA) to metoclopramide administration; the response of plasma prolactin (PRL) to TRH administration, and the changes induced by Lisuride (a dopaminergic agonist, on the values of PA and PRL). The basal values of PA and PRL were higher in CRF than in NV and Tx. The inverse was true for plasma renin activity (PRA) values. The response of PA and PRL to metoclopramide showed blunted increases in CRF when compared to NV, in the absence of changes of PRA, cortisol and potassium. After TRH administration, PRL increase in CRF was also inferior. Lisuride induced a decrease of both PA and PRL both in CRF and NV. In Tx, basal values of PA and PRL were similar to NV. Nevertheless, the response to metoclopramide and TRH were partially blunted when compared to that of NV. These results point to the existence of a deranged dopaminergic regulation of aldosterone secretion in end-stage renal failure patients. The alterations are partially corrected by a well-functioning kidney graft.
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Two open-circuit respiration chambers for small animals (rats, poultry and rabbits) have been built at the Estación Experimental del Zaidín. The respiration facility is air-conditioned, the temperature and the relative humidity in the chambers can be regulated from about +15 to +30 degrees C and from 60 to 90%, respectively. The air flow is determined by the differential pressure principle, CO2 measurement is by the infra-red technique and O2 analyser is of the paramagnetic type. The present work describes the technical details of the respiration plant and the calibration procedures of the whole system.
The participation of renal prostaglandins in the nephrotic syndrome has been investigated by the measurement of the urinary excretion of prostaglandin E2 (PGE2), renal function and the renin-angiotensin-aldosterone system before, during and after the administration of indomethacin in a group of patients diagnosed as having chronic idiopathic glomerulonephritis with and without nephrotic syndrome. Our results indicate increased renal production of PGE2 in nephrotic patients. This contributes to the maintenance of renal function, probably by counteracting an activated renin-angiotensin system and could be accompanied by a simultaneous and deleterious enhancement of the degree of proteinuria. Nevertheless, the participation of angiotensin II in this last even cannot be excluded.
A description of a selective ventilation distribution circuit (S.V.D.C.). The use of this circuit is illustrated by the description of 5 cases where the following were applied: 1 - the measurement of tidal volume of pressures for each lung during the respiratory cycle; 2 - regulation of tidal volumes to be as appropriate as possible for the patient; 3 - the application of different degrees of PEEP for each lung. This circuit is easy to construct and manipulate. It is connected to the patient via a double lumen endotracheal tube (Carlens) and uses only one respiratory.
A circuit for selective ventilation distribution (S.V.D.C.) is described. The use of the circuit is illustrated with five cases in which it was used. S.V.D.C. allowed: 1) Measurement of individual lung tidal volumes and pressures during the respiratory cycle. 2) Adjustment of the tidal volumes of both lungs in the most appropriate way for the patient. 3) Application of different degrees of PEEP to each lung. The circuit is easily built and managed, the patient is connected to it by a double lumen endotracheal tube (Carlens tube); the circuit requires only one respirator.
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A wide spectrum of congenital anomalies may affect the upper gastrointestinal tract, including anomalies of the esophagus (e.g., atresia, fistulas, webs, duplications, vascular rings), stomach (e.g., congenital gastric outlet obstruction, duplications), and duodenum (e.g., atresia, annular pancreas, duplications, malrotation). The evaluation of affected patients can require multiple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to help determine the optimal diagnostic procedure. Neonates with complete gastric or upper intestinal obstruction do not usually require further radiologic evaluation after radiography: Barium studies are usually contraindicated, and complementary procedures (e.g., ultrasound [US], computed tomography [CT]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an increasing number of applications. CT and magnetic resonance imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity. They are especially useful in demonstrating esophageal duplications and vascular rings as well as associated abnormalities. However, the decision to perform a given imaging examination should be considered carefully to avoid inconvenience or unnecessary radiation exposure to the patient or delays in surgical correction. Quality control programs should be in place to ensure safe, effective radiologic practice through use of up-to-date equipment and good imaging technique.
Congenital anomalies of the gastrointestinal tract are a significant cause of morbidity in children and, less frequently, in adults. These abnormalities include developmental obstructive defects of the small intestine, anomalies of the colon, anomalies of rotation and fixation, anorectal anomalies, and intestinal duplications. Neonates with complete high intestinal obstruction do not usually require further radiologic evaluation following radiography, whereas those with complete low obstruction should undergo a contrast material enema examination. An upper gastrointestinal series must be performed in all patients with incomplete intestinal obstruction because management is different in each case. In low intestinal obstruction, ultrasonography (US) may help differentiate between small bowel obstruction and colonic obstruction. In addition, US can help correctly identify meconium ileus and meconium peritonitis and is useful in the diagnosis of enteric duplication cysts. In malrotation and anorectal anomalies, computed tomography (CT) and magnetic resonance (MR) imaging can provide superb anatomic detail and added diagnostic specificity. Intestinal duplications manifest as an abdominal mass at radiography, contrast enema examination, or US. At CT, most duplications manifest as smoothly rounded, fluid-filled cysts or tubular structures with thin, slightly enhancing walls. At MR imaging, the intracystic fluid has heterogeneous signal intensity on T1-weighted images and homogeneous high signal intensity on T2-weighted images. Familiarity with these gastrointestinal abnormalities is essential for correct diagnosis and appropriate management.
Isotretinoin is a drug obtained from retinoid acid, often used for the treatment of different types of acne. The way it acts on the dermo-epidermis has not been clearly described. Different studies reporting a relation, proportional or inverse, between isotretinoin and the occurrence or reactivation of an inflammatory bowel disease (IBD) have been found in the literature. Although there are several hypotheses about how this substance can affect the bowel mucous in the pathogenesis of the disease, none of them are definitive. We present a new case where the mentioned relation was evident. Therefore we suggest that when a patient treated with this isomer presents symptoms suggesting IBD, an endoscopic procedure should be performed in order to rule out inflammatory mucous changes.
We present the case of an 85 year old male who was admitted to hospital with abdominal pain and jaundice. Different explorations were performed for this reason, with a mass observed in his 2nd duodenal portion. Histological study showed that it was a duodenal gangliocytic paraganglioma. The clinical characteristics of this infrequent tumour are described and we review the diagnosis and treatment.
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