Angiomiolipoma renal y complejo esclerosis tuberosa: resultados a largo plazo en seguridad y eficacia de terapia con everolimus / Renal angiomyolipoma and tuberous sclerosis complex: long-term safety and efficacy outcomes of Everolimus therapy

Introducción: El angiomiolipoma renal (AMLr) es una manifestación frecuente del complejo de esclerosis tuberosa (CET), estableciéndose, recientemente, el tratamiento con everolimus, como opción terapeútica novedosa, alternativa y no invasiva; sin embargo, existen datos limitados en la vida real y a largo plazo, por ello, el análisis de nuestra experiencia, en materia de seguridad y eficacia, aporta un valor añadido.Material y métodosSe realiza un análisis descriptivo de nuestra experiencia en pacientes con AMLr bilaterales gigantes, en el contexto de CET, tratados con 10 mg por vía oral de everolimus diario, durante una mediana de 71,5 meses. Evaluamos los parámetros como: tasa y duración de la respuesta; reducción del volumen renal y las lesiones; prevención de complicaciones, toxicidad presentada y causa.ResultadosConfirmamos la efectividad del tratamiento en cuatro pacientes jóvenes, con AMLr renales bilaterales, múltiples, de 12 (5 a 19) cm de diámetro máximo como mediana, desde junio del 2013 hasta la actualidad, con una reducción continua del tamaño de las lesiones, descenso del 30% del volumen, en el 75% al sexto mes y del 50% en la mitad de los sujetos después dos años, permaneciendo aún en respuesta. No se presentaron complicaciones como sangrado o deterioro del filtrado glomerular a largo plazo, con un perfil de seguridad favorable, sin interrupciones y con efectos adversos no acumulativos leves a moderados, en su mayoría durante el primer año de tratamiento.ConclusiónEverolimus es una opción terapéutica segura y eficaz para el AMLr y para diversas manifestaciones del CET, que se reproduce en la vida real, con seis años de seguimiento. (AU)

Introduction: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy.Material and methodsDescriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause.ResultsWe confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment.ConclusionEverolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up. (AU)

Renal angiomyolipoma and tuberous sclerosis complex: long-term safety and efficacy outcomes of Everolimus therapy. / Angiomiolipoma renal y complejo esclerosis tuberosa: resultados a largo plazo en seguridad y eficacia de terapia con everolimus.

INTRODUCTION: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy. MATERIAL AND METHODS: Descriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause. RESULTS: We confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment. CONCLUSION: Everolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up.

Safety of nivolumab in metastatic renal cell carcinoma patients: A real-life experience in a Spanish urology setting. / Seguridad de nivolumab en pacientes con carcinoma de células renales metastásico: experiencia española en urología en la práctica clínica real.

INTRODUCTION AND OBJECTIVES: Nivolumab is an immunotherapy agent that has been an approved treatment for previously treated patients with advanced renal cell carcinoma (RCC). Experience in real-life settings, especially regarding immune- related adverse events, is scarce. We present our experience with reference to the safety of nivolumab in patients with metastatic RCC (mRCC) treated in 9 hospitals in Spain. MATERIAL AND METHODS: Retrospective, multicentre study of patients with mRCC treated with nivolumab between 2016 and 2018. Data on baseline socio-demographic and clinical characteristics and drug-related adverse events were collected. RESULTS: The mean age of the 26 patients included was 63.7±11.5 years; 96% were ECOG 0-1 and 78% had favourable or intermediate MSKCC risk scores; 73% had the clear cell histological subtype and 30% metastatic disease. Median follow-up was 9 months (range 1-14). All patients experienced an adverse event at different grades, with fatigue, fever and anaemia being the most common (27%). Grade 3 adverse events occurred in 23% of patients. Adverse reactions led to treatment suspension in 3 patients (11%). CONCLUSION: In the real-life clinical setting, nivolumab shows favourable outcomes, similar to those reported by other studies.

The emotion: A crucial component in the care of critically ill patients.

BACKGROUND: The acquisition of experience is a major concern for nurses in intensive care units. Although the emotional component of the clinical practice of these nurses has been widely studied, greater examination is required to determine how this component influences their learning and practical experience. OBJECTIVE: To discover the relationships between emotion, memory and learning and the impacts on nursing clinical practice. RESEARCH DESIGN: This is a qualitative phenomenological study. The data were collected from open, in-depth interviews. A total of 22 intensive care unit nurses participated in this research between January 2012 and December 2014. Ethical considerations: The School of Nursing Ethics Committee approved the study, which complied with ethical principles and required informed consent. FINDINGS: We found a clear relationship between emotion, memory and the acquisition of experience. This relationship grouped three dimensions: (1) satisfaction, to relieve the patient's pain or discomfort, give confidence and a sense of security to the patient, enable the presence of family members into the intensive care unit and provide family members with a realistic view of the patient's situation; (2) error experience, which nurses feel when a patient dies, when they fail to accompany a patient in his or her decision to abandon the struggle to live or when they fail to lend support to the patient's family; and (3) the feel bad-feel good paradox, which occurs when a mistake in the patient's care or handling of his or her family is repaired. CONCLUSION: Emotion is a capacity that impacts on nurses' experience and influences improvements in clinical practice. Recalling stories of satisfaction helps to reinforce good practice, while recalling stories of errors helps to identify difficulties in the profession and recognise new forms of action. The articulation of emotional competencies may support the development of nursing ethics in the intensive care unit to protect and defend their patients and improve their relationships with families in order to maximise the potential for patient care.

Effect of creatine malate supplementation on physical performance, body composition and selected hormone levels in spinters and long-distance runners.

PURPOSE: The aim of the study was to determine whether creatine malate (CML) supplementation results in similar ergogenic effect in sprinters and long-distance runners. The other goal was to compare changes in body composition, physical performance and hormone levels after six-week training in athletes, divided into subgroups supplemented with creatine malate or taking placebo. RESULTS: Six-week supplementation combined with physical training induced different effects in athletes. Significantly higher increases in relative and absolute peak power and total work (p < 0.05) were found in sprinters compared to other groups. Except for growth hormone, post-exercise venous blood serum hormone levels exhibited no statistically significant differences in athletes. After CML loading period, a significant increase in growth hormone was found in the group of sprinters. CONCLUSIONS: A significant ergogenic effect was found in sprinters, which was reflected by the increase in anaerobic exercise indices and morphological indices and elevated growth hormone level, after graded exercise testing. The significant increase in the distance covered during graded test was only observed in supplemented long-distance runners, whereas no significant changes in maximal oxygen uptake, relative peak power and relative total work were noticed. This could be caused by later anaerobic threshold appearance in exercise test to exhaustion.

Simulación del desempeño profesional, recurso didáctico en docencia de Ciencias del Deporte / Simulation of professional performance, didactic tool in teaching Sport Sciences

La implantación del Espacio Europeo de Educación Superior y su vinculación con la actividad laboral, ha permitido la aplicación de una metodología basada en la simulación del desempeño profesional, que ofrece la posibilidad no sólo de adquirir conocimientos, sino también aplicarlos, analizarlos y tomar decisiones practicando. El alumnado mediante una metodología constituida en cinco etapas secuenciales, diseñadas para la inmersión en situaciones cercanas a la realidad profesional, ha construido sus propios aprendizajes, ha diseñado nuevos planteamientos didácticos y finalmente ha realizado una puesta en común. Los resultados muestran la implicación del alumnado y la adquisición de aprendizajes mediante la conexión entre las aplicaciones prácticas y la posible futura realidad profesional. La simulación ha permitido adquirir competencias en la elaboración y análisis de propuestas aplicadas y el desarrollo de competencias transversales relacionadas con toma de decisiones, trabajo autónomo y en equipo, aspectos determinantes en el éxito profesional de los futuros egresados (AU)

The implantation of the European Higher Education Area and its linkage with the future job of the student has permitted the application of a methodology based on the simulation of professional skills, which offers the possibility not only to acquire knowledge but also to apply, analyze and take decisions practicing. Students, through a methodology consisting of five sequential phases in situations close to the professional reality, have built their own learning, have designed new teaching approaches and finally shared their results. The results show the implication of students on the learning process by connecting practical applications and possible future professional reality. The simulation has allowed students to acquire skills in the design and analysis of applied proposals and the development of generic skills related to decision making, autonomous and team work, determining factors in the career success of future graduates (AU)

Initial experience with abiraterone acetate in patients with castration-resistant prostate cancer.

OBJECTIVE: To describe the results obtained in 25 males with metastatic castration-resistant prostate cancer (MCRPC) treated with abiraterone (AA). A comparative analysis of abiraterone effectiveness and safety between our results and data published in the literature was conducted. MATERIAL AND METHOD: Bi-institutional prospective analysis of 25 consecutive patients with MCRPC undergoing treatment with abiraterone, with a mean follow-up 7.9 (3-15) months was carried out. Treatment effectiveness and safety analyses regarding baseline characteristics of patients (age, prior treatments, basal PSA, performance status, pain, metastasis) were conducted. RESULTS: At 13.6 months of follow-up, the overall survival is 80% (CI 95%: 11.8-15.4). Clinical and radiological-free progression survival is 9.5 ± 1 months (CI 95%: 7.7-11.3) and biochemical response is 6.8 ± 1 months (CI 95%: 5-8.7). Only the treatment with chemotherapy impaired significantly the response time to AA [6.4 months for radiological-free progression survival (CI 95%: 4.2-8,6) and 4.3 months for biochemical-free progression survival (CI 95%: 2.6-6)]. The incidence of adverse drug events was 36%, all of them grade 1-2/4 and, in no case, suspension or reduction of the dose of AA was needed. CONCLUSIONS: The treatment with AA has been effective in our series, with a tolerability considerably higher than what other studies published.

Pre-chemotherapy abiraterone acetate. A proposal of a treatment algorithm in castration resistant prostate cancer.

CONTEXT: Prostate cancer treatment remains a challenge for the urologist. Medical control in locally advanced or metastatic prostate cancer is usually performed with LHRH analogues and/or antiandrogens. Different treatments have been proposed when there is biochemical and clinical progression of the disease and other new ones have changed the patients' perspective and life expectancy. OBJECTIVE: This review has aimed to establish the current role of Abiraterone Acetate in the treatment of castration-resistant prostate cancer and facilitate decision-making by the Urologist by means of a Treatment Algorithm. ACQUISITION OF THE EVIDENCE: A search of current evidence on Abiraterone treatment in patients with castration- resistant metastatic prostate cancer was performed in PubMed, mainly analyzing those studies designed as clinical trials. In addition, we reviewed and updated the role of hormone therapy and androgen receptors in prostate cancer. EVIDENCE SYNTHESIS: There are currently basically two clinical trials that demonstrate the effectiveness of Abiraterone in metastatic prostate cancer compared to placebo. The study COU-AA 302 shows a clear benefit with Abiraterone prior to chemotherapy in patients with castration-resistant prostate cancer, this making it possible to establish an algorithm for initial treatment that facilitates decision-making by the urologist. CONCLUSION: Abiraterone is a pre-chemotherapy treatment option in selected patients with castration resistant metastatic prostate cancer, although it is necessary to improve the cost and to design more multicenter clinical trials to optimize the cost/benefit ratio.

Cirugía de puerto único transumbilical con instrumentos laparoscópicos convencionales en riñón en herradura / Transumbilical Single Port Surgery With Conventional Laparoscopic Instruments in Horseshoe Kidney

Introducción: La cirugía laparoscópica está teniendo una evolución natural a disminuir la agresión quirúrgica sobre la pared abdominal, sin merma de los resultados curativos y funcionales. Aunque en desarrollo, la cirugía monopuerto ha supuesto un avance en este sentido. Material y métodos: Presentamos la primera cirugía de pielolitectomía laparoscópica por puerto único en riñón en herradura, usando instrumentos rígidos convencionales. Paciente de 18 años con IMC de 19 que en las pruebas de imagen (urograma y tomografía computarizada) presenta un riñón en herradura con litiasis coraliforme izquierda y discreta ectasia calicial. Se extrae la litiasis mediante acceso umbilical con artilugio monopuerto e instrumentos rígidos convencionales. Resultados: La cirugía se completó sin complicaciones. El tiempo quirúrgico fue 110 min y el sangrado 50 cc. Al abrir el sistema urinario hubo extravasación de orina purulenta que condicionó fiebre en el postoperatorio de 38 ◦C. Durante la intervención se colocó catéter doble J por abordaje percutáneo. Fue dada de alta al tercer día de estancia. Conclusión: El acceso laparoscópico monopuerto para la cirugía de pielolitectomía en un riñón en herradura es una alternativa razonable. El uso de instrumentos convencionales rígidos facilita el desarrollo de esta cirugía con una buena triangulación, sin conflicto de manos y seguridad para el paciente (AU)

Introduction: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. Material and methods: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. Results: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 ◦C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. Conclusion: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney isa reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient (AU)

Transumbilical single port surgery with conventional laparoscopic instruments in horseshoe kidney.

INTRODUCTION: Laparoscopic surgery is following a natural course as it decreases surgical aggression on the abdominal wall without undermining the curative and functional results. Although it is still being developed, single port surgery has meant an advance in this sense. MATERIAL AND METHODS: We present the first single port laparoscopic pyelolithectomy surgery in horseshoe kidney, using conventional rigid instruments. The case of an 18-year old patient with BMI of 19 in whom the imaging tests (urogram and computed tomography) showed a horseshoe kidney with left coralliform lithiasis and discrete calyceal ectasia is presented. The lithiasis was extracted using umbilical access with single port device and conventional rigid instruments. RESULTS: The surgery was performed without complications. Surgery time was 110 minutes and bleeding 50 cc. On incision of the urinary system, there was purulent urine extravasation that conditioned fever of 38 °C in the post-operatory period. During the intervention, a double J stent was placed via percutaneous approach. The patient was discharged on the third day of hospitalization. CONCLUSION: Single port laparoscopic access for pyelolithectomy surgery in horseshoe kidney is a reasonable alterative. The use of conventional rigid instruments facilitates the performance of this surgery with good triangulation, without conflict regarding hands and safety for the patient.

Using machine learning techniques and genomic/proteomic information from known databases for defining relevant features for PPI classification.

In modern proteomics, prediction of protein-protein interactions (PPIs) is a key research line, as these interactions take part in most essential biological processes. In this paper, a new approach is proposed to PPI data classification based on the extraction of genomic and proteomic information from well-known databases and the incorporation of semantic measures. This approach is carried out through the application of data mining techniques and provides very accurate models with high levels of sensitivity and specificity in the classification of PPIs. The well-known support vector machine paradigm is used to learn the models, which will also return a new confidence score which may help expert researchers to filter out and validate new external PPIs. One of the most-widely analyzed organisms, yeast, will be studied. We processed a very high-confidence dataset by extracting up to 26 specific features obtained from the chosen databases, half of them calculated using two new similarity measures proposed in this paper. Then, by applying a filter-wrapper algorithm for feature selection, we obtained a final set composed of the eight most relevant features for predicting PPIs, which was validated by a ROC analysis. The prediction capability of the support vector machine model using these eight features was tested through the evaluation of the predictions obtained in a set of external experimental, computational, and literature-collected datasets.

Daily consumption of milk enriched with fish oil, oleic acid, minerals and vitamins reduces cell adhesion molecules in healthy children.

BACKGROUND AND AIMS: Several studies have suggested that polyunsaturated fatty acids, vitamins and minerals have beneficial effects on lipid profile and systemic inflammation in adults. METHODS AND RESULTS: We examined the effects of a daily intake of milk enriched with longchain polyunsaturated fatty acids, oleic acid, carbohydrates, vitamins, minerals and low in saturated fatty acids (SFAs) for 5 months, on several cardiovascular (CVD) risk biomarkers in healthy children aged 8-14 years. In a randomized double-blind placebo-controlled trial, a total of 107 children of both genders were assigned to two study groups: 1) a supplemented group (SG, n=53) who consumed 0.6 L/day of an enriched dairy product, and 2) a control group (CG, n=54) who consumed 0.6 L/day of standard whole milk. Both groups consumed the dairy drinks for 5 months, in addition to their usual diet. Serum levels of adhesion molecules as indices of vascular endothelial cell activation were assessed in both groups at 0 and 5 months as well as white blood cell counts, lipid profile, serum proteins, total serum calcium, 25-OH vitamin D, glucose, insulin and adiponectin. In the enriched dairy drink supplemented group, adhesion molecules E-selectin and ICAM-1 as well as lymphocyte levels decreased while plasma docosahexaenoic acid (DHA) and serum calcium concentrations increased. In the control group, serum total protein, transferrin, total cholesterol, HDL-cholesterol and adiponectin concentrations decreased. CONCLUSION: The consumption of a milk enriched with fish oil, oleic acid, minerals and vitamins reduced indices of endothelial cell activation in the studied group of healthy children.

Desensitization protocol using bortezomib for highly sensitized patients awaiting heart or lung transplants.

The use of bortezomib in combination with other desensitization therapies like plasmapheresis, IVIG, and rituximab has allowed the decrease of antibody levels during treatment in some patients. However, all patients described here have experienced rebound effects to the same or higher levels than the ones before therapy was started. Unfortunately, no donors became available to some of these patients when their antibodies were at lower levels. Three out of the four patients presented had adverse reactions to bortezomib which include nausea, vomiting, diarrhea, myalgias and severe neuropathy. In one patient (pre-heart transplant patient #1) we noticed that some clones were selectively more susceptible to the treatment with bortezomib than others. We will continue antibody monitoring in this patient and hopefully the possibility is there, even though the overall PRA is not reduced, that certain clones will be affected and no longer produced antibody allowing these patients a wider selection of acceptable donors.

Results of liver transplantation at the Cuban Center for Medical and Surgical Research.

From July 4, 1999, when a liver transplantation program was started in Cuba, to December 30, 2007, we performed 125 procedures in 115 patients. The most frequent reasons for transplantation were cirrhosis caused by hepatitis C virus (29%) and alcoholic cirrhosis (17.2%). Two patients received simultaneous liver-kidney transplants. Sixty-seven patients were males, and the patient ages ranged from 12 to 74 years. The average surgical time was 6 hours, and cold ischemia time was 4 to 14 hours. The average blood consumption was 1630 mL; 2900 mL of plasma and 8 units of platelets were used in 7 cases. Immunosuppression was mainly cyclosporine, mycophenolate mofetil, and prednisone. Acute cellular rejections were treated in almost all cases with 3 doses of methylprednisolone. The most frequent complications were biliary (15%), hepatic arterial thrombosis (6%), postsurgical bleeding (8%), acute cellular rejection (20%), and ductopenic rejection (2%). The overall 1-year survival was 74.7%.

La urología preilustrada. De la urología del Real Colegio de Cádiz a la de la Veneranda Tertulia / Urology before illustration. From the Urology of the Royal College of Cadiz to that of the «veneranda» gathering

El estudio de la actividad urológica del occidente andaluz se encuentra contenido en las «Observaciones» impresas y manuscritas de las Memorias de la Regia Sociedad de Medicina Sevillana y en aquellas pertenecientes al Real Colegio de Cirugía de Cádiz. Comprende un período que abarca desde 1693 hasta el primer tercio del siglo XVIII. Se consolida la Veneranda Tertulia, Felipe V concede «Cédula Real»; es el 1º de Octubre de 1701. Inicia su andadura Médico-Quirúrgica la «Regia Sociedad de Medicina y demás Ciencias de Sevilla». Hay que recordar que toda la cirugía andaluza y especialmente la de Cádiz (a través del Real Colegio de Cirugía) estuvo presente en la Regia Sociedad. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili y otros muchos fueron fundacionales de este extraordinario acontecimiento. La formación quirúrgica y, por ende, la urológica tenía su raíz y fundamento en los anfiteatros anatómicos, (Sevilla 1731) y (Cádiz 1728) definidos «impíos» por la Iglesia. José Celestino Mutis (1750-53) y Pedro Fernández Castilla (1741) aíslan a la Universidad de este nuevo movimiento. Hubo una intensa relación entre Cirujanos de la Armada y la Regia Sociedad, siendo socios desde su fundación: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). Siendo el principal protagonista Luis Montero, verdadero paradigma con proyección hacia la centuria siguiente, de influencia netamente francesa junto con Ramos, ambos alumnos de Beaumond, anatómico de reconocido prestigio (AU)

The study of the urological activity in the Andalusian occident is contained in the printed and handwritten «Observations» of the records of the Royal Society of Medicine of Seville and the Royal College of Surgery of Cadiz. They encompass the period from 1693 to the first third of the 18th century. By the first of October 1701, the «Veneranda» gathering consolidates and Philip V gives the «royal warrant». The «Royal Society of Medicine and Other Sciences of Seville» starts its medical-surgical path. It should be reminded that all the Andalusian surgery and specially the one from Cadiz (through the Royal College of Surgeons) was present in the Royal Society. Ordoñez de la Barrera, Sánchez Bernal, Fray Ambrosio de Guibeville, Juan Lacombe, Pedro Virgili and many others were founders of this extraordinary event. Surgical training and, by extension, urological training had their root and basement in the anatomical amphitheaters (Seville 1731 and Cadiz 1728), which were considered ungodly by the Church. José Celestino Mutis (1750-53) and Pedro Fernandez Castilla (1741) excluded the university from this new movement. There was and intense relationship between Navy surgeons and the Royal Society, being members since its foundation: Guibeville (1719); Sánchez Bernal (1719); Gregorio Arias (1729); Gaspar de Pellicer (1729); Lacombe (1730); Fernández Castilla (1741); Calero (1789). The main protagonist was Luis Montero, real paradigm with projection to the next century, having a neat French influence altogether with Ramos, both of them being Beaumond's alumni (an anatomist of recognized prestige) (AU)

Molecular typing of Staphylococcus aureus clinical isolates by pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec type determination and dissemination of antibiotic resistance genes.

Pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of genomic DNA as well as staphylococcal cassette chromosome mec (SCCmec) typing for mecA-carrying isolates were used to study the distribution of clonal types among 177 Staphylococcus aureus clinical isolates recovered in a Spanish hospital between 2000 and 2003. Five major clonal types (P1 to P5) were identified by PFGE, with one of them (P1) comprising the majority of strains (47.5%). According to SCCmec typing, SCCmec type IVA was the most prevalent type, showing increasing prevalence in the hospital setting with respect to other pandemic clones. One SCCmec pattern was detected in different PFGE types, which demonstrates that the latter is a major discriminative typing method. Three novel SCCmec elements or variants were found, each in a different PFGE type. Oxacillin (methicillin)-resistant and -susceptible S. aureus (MRSA and MSSA, respectively) strains were detected showing identical PFGE patterns, suggesting horizontal transfer of mecA to MSSA and/or mecA deletion from MRSA. Persistence of several S. aureus clones throughout the years within the same hospital environment was also observed.

First 100 liver transplants at the medico-surgical research center (CIMEQ).

In July 1999 we began a liver transplant program that to October 2005 has included 100 liver transplants in 92 patients, eight retransplants, and two combined liver and kidney grafts. Twelve transplants were in pediatric patients, who showed a 92% survival rate in the first year. Fifty-four percent of the patients were male and 46% female. The most frequent etiologies of cirrhosis were 27% hepatitis virus C, 18% alcoholic, 13% cryptogenic, and 11% autoimmune. In 95% of the patients, we preserved the retrohepatic vena cava. The bile duct was reconstructed with a Kehr tube in 46% of patients with 31% using end-to-end suture with a tutor and 15% an end-to-end suture without a tutor. A hepaticojejunostomy was performed in 8%. The immunosuppression included cyclosporine (Neoral) or Prograf combined with mycophenolate mofetil or mycophenolate sodium and steroids. The most frequent biliary complications were local anastomosis leaks (6%) and stenosis (10%). The overall 1-year survival rate was 72%.

Management of the sensitized cardiac recipient: the use of plasmapheresis and intravenous immunoglobulin.

Previously, we reported that the combination of plasmapheresis (PP) and intravenous immunoglobulin (IVIg) allow sensitized patients to undergo orthotopic heart transplantation (OHT), even across a positive crossmatch. In the current study, the effect of that combination, PP+IVIg, on survival of a larger group of such recipients is investigated. The latter group (I) consisted of 35 sensitized patients who received PP+IVIG together with standard immunosuppressive drugs. Rejection was seen in 11 patients, findings strongly suggestive of a vascular (humoral) being identified in five of those cases. Four deaths occurred, two of them in the immediate post-operative period, one after almost six months, and one after almost two yr post-OHT. Follow-up range 4.5 months to 7.8 yr post-OHT (average=1.1 yr). Patient survival was analyzed after generation of a Kaplan-Meier plot. Comparison with a control OHT group (II) given standard immunosuppressive drugs only (N=276) showed enhanced survival of group I (p=0.0414 by log-rank test). We conclude that the combination of PP and IVIG (i) is associated with declines in T- and B-percent-reactive antibody and in crossmatch positivity, and (ii) is very useful in the management of the sensitized cardiac patient undergoing OHT, often allowing a successful outcome to transplantation in the face of a positive crossmatch.