The cytokine profile of women with severe anxiety and depression during pregnancy.

BACKGROUND: Controversial findings regarding the association between pro-inflammatory cytokines and depression have been reported in pregnant subjects. Scarce data about anxiety and its relationships with cytokines are available in pregnant women. To understand the association between anxiety and cytokines during pregnancy, we conducted the present study in women with or without depression. METHODS: Women exhibiting severe depression (SD) and severe anxiety (SA) during the 3rd trimester of pregnancy (n = 139) and control subjects exhibiting neither depression nor anxiety (n = 40) were assessed through the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS). Serum cytokines were measured by a multiplex bead-based assay. Correlation tests were used to analyze the data and comparisons between groups were performed. A general linear model of analysis of variance was constructed using the group as a dependent variable, interleukin concentrations as independent variables, and HDRS/HARS scores and gestational weeks as covariables. RESULTS: The highest levels of Th1- (IL-6, TNF-α, IL-2, IFN-γ), Th17- (IL-17A, IL-22), and Th2- (IL-9, IL-10, and IL-13) related cytokines were observed in women with SD + SA. The SA group showed higher concentrations of Th1- (IL-6, TNF-α, IL-2, IFN-γ) and Th2- (IL-4, and IL-10) related cytokines than the controls. Positive correlations were found between HDRS and IL-2, IL-6, and TNF-α in the SA group (p < 0.03), and between HDRS and Th1- (IL-2, IL-6, TNF-α), Th2- (IL-9, IL-10, IL-13) and Th17- (IL-17A) cytokines (p < 0.05) in the SD + SA group. After controlling the correlation analysis by gestational weeks, the correlations that remained significant were: HDRS and IL-2, IL-6, IL-9, and IL-17A in the SD + SA group (p < 0.03). HARS scores correlated with IL-17A in the SA group and with IL-17A, IL-17F, and IL-2 in the SD + SA group (p < 0.02). The linear model of analysis of variance showed that HDRS and HARS scores influenced cytokine concentrations; only IL-6 and TNF-α could be explained by the group. CONCLUSIONS: We found that the cytokine profiles differ when comparing pregnant subjects exhibiting SA with comorbid SD against those showing only SA without depression.

Colgajo bilobulado en epiteliomas basocelulares nasales / Repair of nasal defects secondary to excision of basal-cell epitheliomas

Background: The repair of defects secondary to excision of basal-cell epitheliomas can be a challenge. Aim: To report the experience with the repair of nasal defects using bilobed flaps. Material and Methods: Review of medical records of 10 patients in whom a basal-cell epithelioma was excised and the nasal defect was repaired using a bilobed flap. Results: In all patients, the flap allowed the repair of the defect using the own patient nasal skin, without complications. Conclusions: The bilobed flap is an excellent technique for the repair of medium size nasal defects secondary to excision of basal-cell epitheliomas.

Objetivo: La nariz es el área corporal con mayor incidencia de epiteliomas basocelulares y la reparación de los defectos secundarios a su resección, puede ser un desafío. El objetivo es presentar nuestra experiencia en la reparación de defectos nasales, empleando colgajos bilobulados. Material y Método: Se realizó una revisión retrospectiva de 10 pacientes con epiteliomas basocelulares nasales en que empleamos este colgajo. Resultados: En todos los pacientes el colgajo bilobulado permitió la reparación del defecto, con la propia piel nasal y sin complicaciones. Conclusiones: Consideramos al colgajo bilobulado como una excelente técnica para la reparación de defectos nasales de mediano tamaño, secundarios a la resección de epiteliomas basocelulares.

Morbimortalidad en pacientes diabéticos en diálisis peritoneal. Experiencia de 25 años en un solo centro / Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre

Objetivos: Describir la experiencia de 25 años de tratamiento con diálisis peritoneal (DP) en un solo centro, comparando la hospitalización, abandono de la técnica y supervivencia entre pacientes diabéticos (DM) y no diabéticos (NoDM) y analizando las diferencias entre diabéticos tipo 1 (DM 1) y tipo 2 (DM 2). Material y métodos: Se incluyen 118 DM (52 años, 74 hombres y 44 mujeres) con, al menos, 2 meses de permanencia en DP y media de 25 ± 20 meses (2-109), divididos en 66 con DM 1 (45 años) y 52 con DM 2 (65 años) y 117 NoDM (53 años, 64 hombres y 53 mujeres), con un tiempo en DP de 29,4 ± 27 meses (2-159). Por el largo período estudiado, en el análisis de hospitalización y de supervivencia se evalúa, además, el seguimiento en dos períodos: 1981 a 1992 (pre-92) y 1993 a 2005 (post-92). Resultados: El 93% de los NoDM y el 75% de los DM fueron autosuficientes para realizar DP (p <0,001) y también el 65% de 44 pacientes ciegos. Han sido sometidos a trasplante el 28% NoDM frente al 15% DM (p <0.001) y no hay diferencia en la transferencia a HD. El 18,6% de los DM frente al 4,3% de los NoDM (p <0.001) presentan cuatro o más factores comórbidos al iniciar DP. La hospitalización (ingresos/año) fue mayor en DM (3,4 frente a 1,8) que en NoDM (p <0,01) y también los días/año (46 frente a 22; p <0,01), sin que exista diferencia entre DM 1 y DM 2. Los ingresos por causas cardiovasculares, infecciones, problemas técnicos e infección peritoneal fueron más frecuentes en DM 2 (p <0,05) que en NoDM y DM 1, pero no los días de ingreso por peritonitis. El 48% de los DM y el 22% de los NoDM fallecen (p <0,001). La supervivencia ajustada a factores de comorbilidad es mayor en NoDM (p <0,001), con la enfermedad cerebrovascular como factor mayor de impacto en la mortalidad de DM. La mortalidad es mayor en DM 2 que en DM 1 y NoDM (p <0,001). La edad (HR 1,052; p <0,001), la condición de DM 2 (HR 1,96; p <0,01) y la enfermedad cerebrovascular (HR 4,01; p <0,001) son los más importantes factores de riesgo. En el período post-92 mejora de manera importante la tasa de hospitalización y la supervivencia de pacientes NoDM y, sobre todo, de DM 1. Conclusión: Los pacientes con DM precisan más frecuentemente ayuda para realizar la DP y presentan más comorbilidad, menor supervivencia y mayor hospitalización que los pacientes NoDM, mientras que es comparable la tasa de abandono de la técnica. La edad y las complicaciones cardiovasculares (sobre todo cerebrales) son los factores implicados en la mayor mortalidad. Los avances tecnológicos y la mayor experiencia de los centros pueden mejorar las expectativas de los DM en diálisis (AU)

Aims: To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed. Patients and methods: One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 64 men, 53 female), with at least 2 months on PD, 25±20 (2-109) and 29.4±27 (2-159) months respectively, were included. Diabetics were divided in 66 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005). Results: 93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented >4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM patients (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). However, DM2 patients admitted to hospital for peritonitis did not spend more days in hospital than Non-DM or DM1 patients. Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM(P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients. Conclusions: DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no difference in HD discontinuation. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience may achieve dialysis outcome improvements in diabetic patients (AU)

[Morbidity and mortality in diabetic patients on peritoneal dialysis. Twenty-five years of experience at a single centre]. / Morbimortalidad en pacientes diabéticos en diálisis peritoneal. Experiencia de 25 años en un solo centro.

AIMS: To describe PD outcomes over 25 years in a single centre, comparing hospitalisation rate, technique withdrawal, and survival between diabetic (DM) and non-diabetic (NonDM) patients. Differences between type 1 (DM1) and type 2 (DM2) diabetics were also analysed. PATIENTS AND METHODS: One hundred and eighteen DM patients (52 year old average, 74 men, 44 female) and 117 Non-DM (53 year old average, 64 men, 53 female), with at least 2 months on PD, 25±20 (2-109) and 29.4±27 (2-159) months respectively, were included. Diabetics were divided in 66 DM1 and 52 DM2. The survival and hospitalisation study was also analysed in two different time periods: before 1992 (1981-1992) and after 1992 (1993-2005). RESULTS: 93% Non-DM and 75% DM were self-sufficient to manage the PD technique (P<.001) as well as 65% of 44 blind patients. 28% of Non-DM and 15% of DM received a renal allograft (P<.001). There was no difference in transfer to haemodialysis. 18.6% of DM and 4.3% of Non-DM patients presented ≥4 comorbid factors on starting PD (P<.001). Hospitalisation (admissions/year) was higher in DM than in Non-DM (3.4 vs 1.8, P<.01) and also hospitalisation length (46 vs 22 days/year, P=.01), without differences between DM1 and DM2. Admissions due to cardiovascular events, infections, technical problems and peritonitis were more frequent in DM2 than in Non-DM and DM1 patients (P<.05). Mortality was 48% in DM and 22% in Non-DM (P<.001). Survival adjusted for comorbidity was higher in Non-DM (P<.001). Cerebrovascular disease was the highest risk factor for mortality in DM. Mortality was higher in DM2 than in DM1 and Non-DM (P<.001). Age (HR 1.052, P=.001), DM2 (HR 1.96, P<.01) and cerebrovascular disease (HR 4.01, P<.001) were the most important risk factors. In the post-1992 period, the hospitalisation rate and survival improved in DM1 and Non-DM patients. CONCLUSIONS: DM patients more often require outside assistance to perform PD and have more comorbidity, lower survival, and higher admissions than Non-DM, but there is no difference in HD discontinuation. Age and cardiovascular comorbidity are the factors involved in mortality. Technological advances and cumulative center experience may achieve dialysis outcome improvements in diabetic patients. 

[Patients on peritoneal dialysis with type 2 diabetes present poorer progress than non-diabetics at the expense of their cardiovascular comorbidity]. / Los pacientes diabéticos tipo 2 presentan peor evolución que los no diabéticos en diálisis peritoneal a expensas de su comorbilidad cardiovascular.

AIM: To describe the characteristics, practice patterns, targets and outcome of the Type 2 diabetic patients (DM 2) in peritoneal dialysis (PD) and to compare them with non-diabetic ones. METHODS: Prospective cohort study of every incident PD patient in a regional public health care system (2003-2006). We prospectively collected baseline data, hospital admissions, peritonitis, transplants, CV events and deaths. Every six months PD prescription data and results on efficacy, anaemia, blood pressure (BP) were collected. RESULTS: DM 2 patients (n = 65) were older and presented a higher rate of previous CV events (60.9% vs. 17.7% p<0001) than non-DM patients (n = 376) and worse BP control at inclusion on PD. There were no differences in dialysis efficacy targets and anaemia management. HOSPITAL ADMISSIONS: DM 2 patients present higher hospitalisation rates 1.1 [0.9-1.4] than NoDM ones 0.6 [0.5-0.7] admissions per year at risk. Survival: DM 2 patients present lower PD-technique survival than No DM ones (870 vs. 1002 days Kaplan-Mayer estimation p = 0.009) and higher annual mortality rate (13.7 vs. 4.1%, p: 0.021) with a crude mortality hazard ratio (HR) of 2.5 [1.1-5.6] after correction by age. However, the best predictive model for mortality by Cox proportional hazards model includes age, existence of previous CV events and forced inclusion on PD and excludes DM 2. The association between DM 2 and CV events ruled out DM 2 from the multivariate risk model. CONCLUSION: Type 2 DM patients had a higher prevalence of previous CV events, and a worse global outcome. Previous CV events may explain part of this risk.

Factores relacionados con la pérdida de función renal residual en diálisis peritoneal / No disponible

La conservación de la función renal residual (FRR) en los pacientes en diálisis tiene una clara influencia en la calidad de vida al contribuir a la depuración de solutos, mantener el equilibrio hídrico, menor grado de anemia, mejor control calcio/fósforo, etc. Pero además, en diálisis peritoneal (DP)el mantenimiento de la FRR ha demostrado influir en la mayor supervivencia de los pacientes, quedando establecido que es sobre todo la FRR y no el aclaramiento peritonealla que ofrece un poder predictívo en la mortalidad del paciente en DP. El estudio de los factores que pueden colaboraren la disminución o pérdida de la FRR una vez iniciada laDP y las medidas que se deben tomar para preservarla, es el objeto de esta revisión. La pérdida de FRR se ha asociado con el estado inflamatorio/nutricional, con la tasa de peritonitis, función renal y tipo de transporte de membrana al inicio de la DP, edad, etiología de la enfermedad renal y comorbilidad acompañante. La enfermedad cardio-vascular previa y la desarrollada durante la DP se han relacionado también con la reducción de la FRR. Sobrecarga hídrica e hipertensión arterial, así como situaciones severas de depleción y determinadas sustancias facilitan el deterioro de la misma, mientras que algunos fármacos como IECAs y ARA II podrían influir en su mejor evolución. Más controvertida está la influencia de la modalidad de DP en la evolución de la FRR, aunque el empleo de la diálisis peritoneal continua ambulatoria parece influir más favorablemente que la diálisis peritoneal automatizada. Lo mismo ocurre con los nuevos líquidos de DP, donde las soluciones más biocompatibles parecen tener un efecto positivo sobre la FRR pero aun no hay evidencia suficiente. Evitar los factores involucrados y aplicar las medidas que han mostrado influir en la conservación de FRR, son decisiones necesarias para mejorar la situación del paciente en DP (AU)

Residual renal function (RRF) contributes to the quality of life of patients on dialysis through the better solutes clearances, fluid removal, less degree of anemia, better calcium-phosphorus control, better nutrition and removal of other uremic toxins. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient survival. This review studies the factors that contribute to the reduction or loss of RRF in PD patients and the medical measures to avoid it. The decline of RRF has been associated with age, inflammation/nutritionstatus, peritonitis rate, renal function and transport type at PD initiation, ESRD aetiology, and associated comorbidity. Cardiovascular disease before and during PD has been related with loss of RRF. Volume overload and high blood pressure on one side, and dehydration and some drugs on the other side, can facilitate the decline of RRF. Use of antihypertensive agents as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers could preserve RRF. Still is on debate the influence of PD modality (manual or automated), with some more arguments for better preservation with continuous ambulatory PD. The employ of more biocompatible solutions seems to have a positive effecton RRF, but more evidence is still needed. Avoiding the mentioned factors and applying preventive measures we can preserve RRF and increase the well-being of PD patients (AU)

[Factors related to loss of residual renal function in peritoneal dialysis]. / Factores relacionados con la pérdida de función renal residual en diálisis peritoneal.

Residual renal function (RRF) contributes to the quality of life of patients on dialysis through the better solutes clearances, fluid removal, less degree of anemia, better calcium-phosphorus control, better nutrition and removal of other uremic toxins. The preservation of RRF is associated with higher patient survival in peritoneal dialysis (PD), and is now accepted that RRF and peritoneal clearance are not of equal value in patient survival. This review studies the factors that contribute to the reduction or loss of RRF in PD patients and the medical measures to avoid it. The decline of RRF has been associated with age, inflammation/nutrition status, peritonitis rate, renal function and transport type at PD initiation, ESRD aetiology, and associated comorbidity. Cardiovascular disease before and during PD has been related with loss of RRF. Volume overload and high blood pressure on one side, and dehydration and some drugs on the other side, can facilitate the decline of RRF. Use of antihypertensive agents as angiotensin- converting enzyme inhibitors and angiotensin receptor blockers could preserve RRF. Still is on debate the influence of PD modality (manual or automated), with some more arguments for better preservation with continuous ambulatory PD. The employ of more biocompatible solutions seems to have a positive effect on RRF, but more evidence is still needed. Avoiding the mentioned factors and applying preventive measures we can preserve RRF and increase the well-being of PD patients.

[Primary central nervous system lymphoma in an immunocompetent patient: report of a case]. / Linfoma primario del sistema nervioso central en una paciente inmunocompetente: Caso clínico.

Primary central nervous system lymphoma (PCNSL) is a rare tumor. It occurs mainly in people aged 50 year-old or older and is more common among men. Immunodeficiency is the only established risk factor for PCNSL. We report a 35 year-old, immunocompetent woman who presented with a two weeks' history of persistent headache. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an expansive lesion in the right thalamus area. Immunohistochemical studies were consistent with the diagnosis of a diffuse large B-cell non-Hodgkin 's lymphoma. The patient was treated with chemotherapy and whole brain radiotherapy, achieving complete remission of the tumor. This case is illustrative of PCNSL and contributes to update its diagnosis, management and prognosis.

Linfoma primario del sistema nervioso central en una paciente inmunocompetente: Caso clínico / Primary central nervous system lymphoma in an immunocompetent patient: Report of one case

Primary central nervous system lymphoma (PCNSL) is a rare tumor. It occurs mainly in people aged 50 year-old or older and is more common among men. Immunodeficiency is the only established risk factor for PCNSL. We report a 35 year-old, immunocompetent woman who presented with a two weeks history of persistent headache. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an expansive lesion in the right thalamus area. Immunohistochemical studies were consistent with the diagnosis of a difuse large B-cell non-Hodgkin 's lymphoma. The patient was treated with chemotherapy and whole brain radiotherapy, achieving complete remission of the tumor. This case is ilustrative of PCNSL and contributes to update its diagnosis, management and prognosis.

[Irbesartan in hypertensive non-diabetic advanced chronic kidney disease. Comparative study with ACEI]. / Irbesartan y enfermedad renal crónica avanzada de causa no diabética. Estudio comparativo con IECAS.

UNLABELLED: Angiotensin-converting enzyme inhibitors (ACEI) have proved an antihypertensive and renoprotective effect with reduction of proteinuria in diabetic and non diabetic nephropathy, but not exempt of side effects in advanced chronic kidney disease (ACKD) patients. Angiotensin receptor blockers (ARB) have emerged as antiproteinuric, renoprotective and cardioprotective therapy. Only a few reports have been published studying ARB effects on non-diabetic ACKD patients. Our aim is to study Irbesartan (ARB) on non-diabetic ACKD patients and compare its effects with ACEI. PATIENTS AND METHODS: Forty three non-diabetic patients at ACKD stage IV NKF-DOQI (CrCl <30 ml/min) were enrolled in a prospective study. Group I: 21 received Irbesartan monodose 150-300 mg/day (63+/-17 y/o, 12 F, 9 M,ClCr 22.1+/-8 ml/m.), Group II: 22 received ACEI (65+/-13 y/o, 8 F, 14 M, CrCl 22.3+/-7 ml/m). Parameters studied: blood pressure (BP), pulse pressure (PP), renal function (CrCl), proteinuria (in patients with proteinuria >or= 0.5 g/d), serum K+ and serum uric acid, at month 0, 3, 6, 9 and 12. RESULTS: At 12 months, BP was controlled in 57% of Group I vs 39% of Group II. Mean systolic BP was decreased from 154/85 to 138/77 in G I, and from 146/85 to 133/77 in GII, with a decrease in 10.7% of mean BP in GI and 8.5% in GII (NS). Irbesartan reduced PP in 7.2% vs 8.3% with ACEI (NS). CrCl reduction with Irbesartan was 0.23 vs 0.21 ml/min/month with ACEI (NS). The antiproteinuric effect was higher with Irbesartan (from 2.1 to 1.3 g/day) vs. ACEI (from 1.35 to 1.33 gr /day), being statistically significant the reduction percentage between the two groups (p >or= 0.041). Serum K+ level do not change in Irbesartan group and increased 10% in ACEI group (p<0.001). Uric acid was decreased by Irbesartan in 17% and increased in 4% by ACEI (p<0.001). CONCLUSIONS: Irbesartan in non-diabetics patients with advanced chronic renal disease, compared with ACEI showed similar blood pressure control and similar effect on chronic kidney disease progression, with higher antiproteinuric effect. On the other side, Irbesartan showed a reduction of serum uric acid, and did not increase serum K+ levels.

Irbesartan y enfermedad renal cronica avanzada de causa no diabetica. Estudio comparativo con IECAS / Irbesartan in hypertensive non-diabetic advanced chronic kidney disease. Comparative study with ACEI

Los inhibidores del enzima de conversion de angiotensina (IECAs) han demostrado un efecto antihipertensivo, renoprotector y antiproteinurico en pacientes con nefropatia diabetica y no diabetica, aunque deben administrarse con precaucion en la enfermedad renal crónica avanzada (ERCA). Los antagonistas de los receptores de angiotensina II (ARA II) muestran un perfil similar a los IECA en la nefropatia diabetica con buena tolerancia (..) (AU)

Angiotensin-converting enzyme inhibitors (ACEI) have proved an antihypertensive and renoprotective effect with reduction of proteinuria in diabetic and non diabetic nephropathy, but not exempt of side effects in advanced chronic kidney disease (ACKD) patients. Angiotensin receptor blockers (ARB) have (..) (AU)

Comparación clinicográfica entre la diabetes pregestacional y gestacional / Clinico-graphical comparison between pregestational and gestational diabetes

El diseño del estudio fue abierto, prospectivo, comparativo y exploratorio. La muestra quedó integrada por 30 pacientes dividida en 2 grupos: grupo 1, pacientes con diabetes pregestacional, y grupo 2, con diabetes gestacional. En el grupo 1 (n = 15), la media de edad de las pacientes fue de 29,87 años. La edad de la gestación tuvo una media de 31,853 semanas. En el grupo 2 (n = 15), la edad de las pacientes tuvo una media de 30,60 años. La edad de la gestación tuvo una media de 32,53 semanas. Para los registros de contractilidad uterina y frecuencia cardíaca fatal (FCF), se utilizó un cardiotocógrafo HP modelo 1350, serie 50 XM. Dentro de las 24 h del ingreso de la paciente, se practicó un registro. El cardiotocograma se repitió durante las 24 h del egreso (alta). La paciente fue su testigo. Al iniciar el registro a la paciente se le tomó una muestra de sangre venosa para determinar la concentración de HbA1c. Se controló la presión arterial, el pulso, la temperatura y la frecuencia respiratoria, además se midieron la circunferencia abdominal, la altura uterina y se auscultaron los latidos fetales. Para el análisis estadístico se utilizó el programa SPSS y la prueba de la t de Student por parejas ordenadas de datos. Análisis comparativo de la FCF basal entre los grupos de diabetes pregestacional y gestacional. En el grupo 1, al ingreso, en la FCF el valor de la media fue de 147,48 lat/min, y al egreso fue de 143 lat/min; el cálculo de p < 0,000 indicó que la diferencia entre medias fue significativa. En el grupo 2, al ingreso, el valor de la media de la FCF fue de 143,94 lat/min, y al egreso, la media fue de 142,26 lat/min; el cálculo de p < 0,000 indicó que la diferencia entre medias fue significativa. Se confrontaron los valores intragrupo de la amplitud de los ascensos transitorios o aceleraciones. En el grupo 1, al ingreso, la media de amplitud fue de 23,72 latidos, y al egreso, de 24,56 latidos; la diferencia entre medias no fue significativa. En el grupo 2, al ingreso, el valor de la amplitud fue: media 20,75 latidos, y al egreso, de 22,19 latidos; la diferencia entre medias no fue significativa. Glucemia: en el grupo 1, al ingreso, la glucosa tuvo una media de 119,27 mg/dl, y al egreso, de 112,20 mg/dl. En el grupo 2, al ingreso, la glucosa tuvo una media de 139,07 mg/dl, y al egreso, de 119,50 mg/dl. HbA1c: en el grupo 1, al ingreso, la media de la concentraciones fue del 7,46%, y al egreso, del 7,354%. En el grupo 2, al ingreso, la media fue del 7,533%, y al egreso, del 6,68%. En el primer grupo, 12 recién nacidos fueron vigorosos, la calificación de Apgar en el primer minuto tuvo un rango de 7-8; 2 productos nacieron deprimidos con calificaciones de 2 y 6; en el quinto minuto 13 recién nacidos fueron vigorosos, con rango de 8-9; el recién nacido que en el primer minuto tuvo calificación de 2 se mantuvo deprimido, en el quinto minuto la calificación fue 5. Segundo grupo: 11 recién nacidos fueron vigorosos, la calificación del primer minuto tuvo un rango de 7-9, y en el quinto, de 8-9 (AU)

A prospective, comparative, open, exploratory study was carried out of a sample of 30 subjects. These were divided into 2 groups. Group I consisted of preexisting diabetes, Group II of those with gestational diabetes. 1. Group I (n = 15). The patients age, have a mean of 29.87 years. The pregnancy age have a mean of 31.853 weeks. 2. Group II (n = 15). The patients age, have a mean of 30.60 years. The pregnancy age have a mean of 32.53 weeks. Uterine Contractility and Fetal Heart Rate registers were carried out with a Hewlett Packard Monitor model 1350, serie 50XM was used. The first study was 24 h before during admission. It was repeated within 24 h of discharge. The patients was her own control. This study lasted 2 h. At the same moment as the collection of these data, a sample of blood was taken to determine the level of HbA1c, blood pressure, pulse rate, temperature and respiratory frequency were also recorded. In addition, the abdominal circumference and uterine height were measured and the fetal heart ascertained. SPSS and Student t test for ordered pairs of data were used for the statistical analysis. A comparative analysis of basal fetal heart rate (FHR) between 2 groups of patients those white preexisting diabetes and those with gestational diabetes. Group I, at admission to hospital the mean of the FHR was 147.48 beats/min. At discharge the FHR registered a mean of 143 beats/min. It we take into account the value of p < 0.000 the difference between means was significant. Group II, at admission the mean value of the FHR was 143.94 beats/min. At discharge the mean of the FHR was 142.26 beats/min. With a value of p < 0.000 the difference between means was significant. A comparative analysis the values of accelerations in the 2 groups was made. Group I, at admission the mean value of the acceleration was 23.72 beats. At discharge 24.56 beats, the difference was not significant. Group II, at admission the mean value of the acceleration was 20.75 beats, at discharge 22.19 beats. The difference was not significant. Glycemia: Group I at admission their glucose registered a mean value of 119.27 mg/dl at discharge, 112.20 mg/dl. Group II, at admission their glucose registered a mean value of 139.07 mg/dl, at discharge 119.50 mg/dl. HbA1c the following readings were obtained: Group I, at admission the HbA1c showed a mean 7.46% at discharge the mean was 7.354%. Group II, at admission the HbA1c had a mean of 7.533% at discharge it was 6.68%. In the first group 12 newborns were vigorous in the first minute, they were judged to be in puntuation 7-8. Two were judged to be puntuation 2 and 6 respectively. In the fifth minute 13 of the children were progressing well, being in puntuation 8 and 9. The child judged to be in puntuation 2 at berth remained in health, in the fifth minute, the puntuation was 5. In the second group 11 of the newborns were judged to be in puntuation 7-9 in the first minute, and puntuation 8-9 in the fifth minute (AU)

[Guidelines of the Spanish Society of Nephrology. Clinical practice guidelines for peritoneal dialysis]. / Guías Sociedad Española de Nefrología. Guías de práctica clínica en diálisis peritoneal.

In Spain and in each of its autonomous communities, the dialysis treatment of chronic renal disease stage 5 is totally covered by public health. Peritoneal dialysis, in any of its modalities, is established as the preferred home dialysis technique and is chosen by high percentage of patients as their choice in dialysis treatment. The Spanish Society of Nephrology has promoted a project of creation of performance guides in the field of peritoneal dialysis, entrusting a work group composed of members of the Spanish Society of Nephrology a with the development of these guides. The information offered is based on levels of evidence, opinion and clinical experience of the most relevant publications of the topic. In these guides, after defining the concept of << peritoneal dialysis>>, the obligations and responsibilities of the sanitation team of the peritoneal dialysis unit are determined, and protocols and performance procedures that try to include all the aspects that concern the patient with chronic renal disease in substitute treatment with this technique are developed. They propose prescription objectives based on available clinical evidence and, lacking this, on the consensus of the experts' opinions. The final aim is to improve the care and quality of the of the patient in peritoneal dialysis, optimizing in this way the survival of the patient and of the technique. In Spain, as in other neighbouring countries, peritoneal dialysis has an incidence and prevalence that is much lower than that of hemodialysis, ranging in the last evaluation by the Spanish Society of Nephrology between 5 and 24% in the different autonomous communities. The great majority of peritoneal dialysis units form part of the public network of the Spanish state, with special representation as a Satellite Unit or Concerted Center related to the public hospital of reference, on which it must depend.

Pure red-cell aplasia induced by anti-erythropoietin antibodies in peritoneal dialysis.

There have been several recent reports of pure red-cell aplasia (PRCA) mediated by anti-erythropoietin antibodies (AEA) in patients with chronic renal failure treated with recombinant human erythropoietin (EPO). Among the factors thought to trigger this mechanism is the subcutaneous administration of EPO. Despite this being the normal route of administration in patients undergoing peritoneal dialysis (PD), to date there has only been 1 described case of PRCA due to AEA in PD. Herein, we report such a case involving a patient in whom a diagnosis of anemia due to PRCA was particularly difficult to make because of concomitant rectal bleeding.

[Thomas' shunt for hemodialysis: dysfunction and its percutaneous treatment]. / Shunt de Thomas para hemodiálisis: disfunción y su tratamiento percutáneo.

PURPOSE: To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). MATERIALS AND METHODS: Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). RESULTS: A total of 61 interventions were performed during the period of follow-up. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a "jet" of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or "flap" at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a "valve" effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0.01 (table II). CONCLUSIONS: Percutaneous treatment of TS dysfunction was proved to be effective in maintaining long-term patency. This type of fistula affords an alternative to tunneled central venous catheters.

Shunt de Thomas para hemodiálisis: disfunción y su tratamiento percutáneo / Thomas hemodialysis shunt: dysfunction and percutaneous treatment

Propósito: Valorar la utilidad del tratamiento percutáneo de las anomalías de la rarna venosa, en la supervivencia de las fístulas externas de Thomas o Shunt de Thomas (ST). Material y método: Dentro de un programa general de vigilancia de la disfunción de las fístulas de hemodiálisis se incluyeron 12 casos de ST, que se siguieron durante 51 meses. La edad media de los pacientes era de 61 años (27-77), el tiempo medio en hemodiálisis de 151 meses (24-300), y el número de accesos previos de 6 (3-9). Las anomalías encontradas se trataron mediante angioplastia (ATP) o trombolisis y ATP. Se analizaron mediante curvas de supervivencia según el método de Kaplan-Meier, la probabilidad de permeabilidad primaria (PI), secundaria (P2) y acumulada (PA). Resultado: Durante el período de seguimiento se realizaron 61 intervenciones. En doce ocasiones (19,7%) la fístula estaba trombosada y en el resto se detectó aumento de la presión venosa, 150 mm de Hg o superior, durante la diálisis. Previa desobstrucción de las fístulas trombosadas con Uroquinsa se realizó fistulografía, detectándose una estenosis corta mayor del 50% en la anastomosis o en la vena adyacente a la anastomosis. Se realizó ATP, tras la que se consiguió el éxito anatómico y funcional en el 100% de los casos. La Pl fue de 58%, 33%, 8% y 0% a seis, doce, veinticuatro, y treinta y seis meses, y la P2 de 100%, 75%, 58% y 25% respectivamente a iguales períodos de tiempo. La PA fue de 100%, 83%, 66%, 50%, 41% y 33%, a seis, doce, veinticuatro, treinta y seis, cuarenta ocho y setenta y dos meses. Al cerrar el estudio seis pacientes seguían dializándose por su fístula, dos habían sido trasplantados, dos habían fallecido y en los dos restantes se había perdido la fístula. Conclusión: El tratamiento percutáneo de la disfunción en los ST, que se lleva acabo de manera ambulatoria, es eficaz para mantener a largo plazo su permeabilidad. Este tipo de fístula puede representar una alternativa a los catéteres venosos centrales tunelizados

Purpose: To assess the usefulness of percutaneous treatment of abnormalities of the venous tree in extending the survival of external Thomas shunts (TS). Materials and methods.:Twelve cases of TS were included in a hemodialysis access fistula dysfunction monitoring program and were followed for up to 48 months. The abnormalities found were treated by percutaneous transluminal angioplasty (PTA) or thrombolysis and PTA. Survival curves and the Kaplan-Meier method were used to calculate the likelihood of primary patency (P1), secondary patency (P2), and overall patency (OP). Results: A total of 61 interventions were performed during the period of followup. On 12 occasions the fistula was thrombosed; in the rest, increased venous pressure to 150 mmHg or higher was detected during dialysis. Fistulography was performed after washing the thrombosed fistulas with urokinase, and revealed one or more of the following angiographic signs: 1) a short reduction of more than 50% in lumen caliber in the femoral vein adjacent to the anastomosis, present in 52% of the cases (fig. 1); 2) imaging a «jet» of contrast material at the site of entry of the shunt into the femoral vein (fig. 2), present in 22% of the cases; and 3) a filling defect or «flap» at the same site, owing to hyperplastic tissue or piece of thrombus adhering to the intima, present in 34% of the cases (figs. 3-5). This last-mentioned finding ordinarily gave rise to a «valve» effect, whereby injection into the venous branch was feasible but aspiration from the venous branch was difficult or impossible. PTA was carried out and attained anatomical and functional success in 100% of cases. PI was 58%, 33%, 8%, and 0% at 6, 12, 24, and 36 months, respectively; P2 was 100%, 75%, 58%, and 25%; respectively, at those same times. The comparison of the PI and P2 curves was statistically significant; p < 0.001 (table 1). OP was 83%, 66%, 50% and 41% at 12, 24, 36 and 48 months. The comparison of the PI surgical and OP curves was statistically significant; p < 0.01 (table II). Conclusions: Percutaneous treatment of TS dysfunction was proved to be effective in maintaining long-term patency. This type of fistula affords an alternative to tunneled central venous catheters

Control de la anemia en hemodiálisis. Base de datos EuCliD (European Clinical Database) en España / Anaemia management in haemodialysis. EuCliD® database in Spain

Nos planteamos evaluar el manejo de la anemia en los centros Fresenius Medical Care de España. Presentamos datos de 4.426 pacientes en hemodiálisis prevalentes en el año 2001 recogidos en la base de datos European Clinical Database (EuCliD®). Evaluamos mediante el índice de respuesta a la Eritropoyetina (IRE): cociente entre dosis de Eritropoyetina (UI/kg de peso/semana) y Hemoglobina (g/dl), la respuesta a la eritropoyetina en función de diferentes variables. Comparamos nuestros resultados con los aparecidos en el estudio ESAM2.El 70 por ciento de la población alcanza una hemoglobina superior a 11 g/dl utilizando dosis de eritropoyetina de 111,9 UI/kg de peso/semana (n = 3.700; SD 74,9).Resultado similar al medido al inicio del ESAM2 donde es del 65 por ciento. La dosis empleada de eritropoyetina es ligeramente superior a la utilizada en el ESAM2 (111,9 UI/kg de peso/semana y 105,5 UI/kg de peso/semana respectivamente), quizá relacionado con la menor proporción de pacientes en tratamiento por vía subcutánea (70 por ciento frente a 79 por ciento) y con la inclusión de pacientes en diálisis peritoneal dentro del estudio ESAM2. Efectivamente según nuestros datos, el IRE es mayor en los pacientes que reciben tratamiento por vía intravenosa en comparación con la vía subcutánea (11,66 y 9,6 respectivamente p 20 por ciento (135 UI/kg de peso/semana frente a 110,52 UI/kg de peso/semana respectivamente, p < 0,005).Observamos también que variables relacionados de forma directa o indirecta con la inflamación como la elevación de proteína C reactiva, la hipoalbuminemia o la elevación de la ferritina, presentan peor respuesta a la eritropoyetina (AU)

Pulmonary diffusing capacity in chronic dialysis patients.

Patients with end-stage renal disease treated by hemodialysis with bioincompatible membranes are exposed during the dialysis period to acute effects on lung microcirculation, which may result in pulmonary fibrosis and diffusion defects in long-standing dialysis. To investigate the occurrence of these possible chronic pulmonary alterations, we determined lung function in patients with chronic renal failure not undergoing hemodialysis and in patients who had been receiving regular hemodialysis both for short and long periods of time. Forty-three patients divided into three groups were studied: 17 patients before dialysis with a mean (SD) creatinine clearance of 14.1 (6.8) ml/min 11.73 m2, 10 patients receiving regular hemodialysis for a period of less than 12 months (mean 6.4 +/- 3.5 months), and 16 patients receiving regular hemodialysis for more than 5 years (mean 8.3 +/- 3.6 years). First-use bioincompatible cellulosic dialysis membranes were used in all the cases. The following parameters were recorded: forced vital capacity (FVC), forced expiratory volume in 1s (FEV1), total lung capacity (TLC), residual volume (RV), carbon monoxide transfer factor (TLCO), accessible lung volume (VA), carbon monoxide transfer factor/accessible lung volume (KCO- that is, TLCO/VA), and arterial blood gases. Patients receiving regular hemodialysis for more than 5 years showed significantly lower values of TLCO and KCO than patients before dialysis and patients receiving regular hemodialysis for less than 12 months. Seventy-five percent of patients on long-term hemodialysis had markedly reduced TLCO or KCO values (below 80% of the reference value) as compared with 17% of patients before dialysis and 10% of patients dialyzed for less than 12 months (P < 0.001). Differences among groups for the remaining parameters were not observed. In conclusion, patients undergoing long-term regular hemodialysis with a bioincompatible membrane showed a selective reduction in pulmonary diffusing capacity possibly due to chronic pulmonary fibrosis.