Effect of the brain-death process on acute rejection in renal transplantation.

INTRODUCTION: Growing experimental evidence suggests that the state of brain death (BD) activates surface molecules on peripheral organs by the massive release of macrophage- and T cell-associated cytokines as well as adhesion molecules into the circulation. The question is whether the sequelae of the BD process substantially influences the quality of the donor organ, the ensuing host response, or the ultimate transplant outcome. Our aim was to compare explosive BD with gradual-onset injury in terms of a trigger of the host immune mechanisms accelerating acute rejection processes. MATERIALS AND METHODS: This retrospective study included 149 cadaveric donors whose kidneys were transplanted in to 264 recipients. Exclusion criteria were previous transplants and hyperimmmunized patients. Donor variables were: sex, age, etiology of death, and hemodynamic conditions during the 24 hours prior to death. The recipient variables included, all possible conditions known to induce rejection. RESULTS: Cox analysis revealed the following factors to be predictive of acute vascular rejection: initial immunosuppression without induction (risk ratio [RR] 1.83; 95% confidence interval [CI] 1.02 to 3.25; P = .039) which there was a trend to an impact of a regimen without tacrolimus (RR 1.84; 95% CI 0.85 to 3.98; P = .099), or of recipient age < 30 years (RR 2.17; 95% CI 1.06 to 4.48); P = .053) or lower mean donor blood pressure during the 3 hours prior to death (RR 1.17; 95% CI 1.00 to 1.37; P = .054). CONCLUSIONS: Greater sympathetic activity during brain death produces nonspecific endothelial damage and increases organ immunogenicity, promoting rejection.

[A review of the scientific evidence concerning the clinical application of digital mammography]. / Revisión de la evidencia científica sobre la aplicación clínica de la mamografía digital.

OBJECTIVE: To review the scientific evidence with respect to the use of digital mammography and compare it with analogical mammography in the clinical context. MATERIAL AND METHOD: We searched Medline and EMbase for studies published between 1989 and 2005 that compared the results of digital and analogical mammography in the same group of patients or in two different groups of patients to evaluate their respective diagnostic accuracy (sensitivity, specificity, area under the ROC curve), recall rate, biopsy rate, and exposure to radiation. We reviewed and compared the different methodologies of the studies published. RESULTS: Eight articles and eight presentations at congresses were found. No statistically significant differences were observed between digital and analogical mammography for the detection of breast cancer. Until the publication of the Oslo II (2004) and Digital Mammographic Imaging Screening Trial (2005) studies, the series presented were small and used a variety of methodologies. This made it impossible to appreciate small differences in diagnostic accuracy between the two techniques and to group the, sometimes, contradictory results. Furthermore, these first series did not include follow-up. CONCLUSION: There are no statistically significant differences between the two techniques for diagnostic accuracy, except in women with dense or heterogeneously dense breasts, in those under 50 years of age, and in peri- or pre-menopausal women, in which cases digital mammography is significantly better. These data should be confirmed in longer term studies to enable the effects on the breast cancer mortality rate to be specifically evaluated. Cost-effectiveness studies are important when considering changing techniques.

Revisión de la evidencia científica sobre la aplicación clínica de la mamografía digital / A review of the scientific evidence concerning the clinical application of digital mammography

Objetivo. Revisar la evidencia científica relativa al uso de la mamografía digital (MD) comparándola con la mamografía analógica (MA) en el contexto clínico.Material y método. Se realizó una búsqueda en Medline y Embase de los estudios publicados entre 1989 y 2005, que comparaban resultados de MD y MA en el mismo grupo o en dos grupos de pacientes, valorando la certeza diagnóstica (sensibilidad, especificidad, área bajo lacurva ROC), tasa de rellamadas, tasa de biopsias y exposición a la radiación.Se revisaron y compararon metodológicamente los trabajos presentados.Resultados. Se encontraron 8 publicaciones y 8 presentaciones a congresos. No se han observado diferencias estadísticamente significativas en la detección de cáncer de mama entre MA y MD. Hasta la publicación de los estudios Oslo II y DMIST (Digital Mammographic Imaging Screening Trial) las series eran cortas, lo que no permitía explotar las pequeñas diferencias de certeza diagnóstica entre ambas técnicas y con gran disparidad metodológica, por lo que no se podían agrupar los resultados, en ocasiones contradictorios. No se incluían seguimientos.Conclusión. No hay diferencias estadísticamente significativas en la certeza diagnóstica entre MA y MD, excepto en mujeres con mamas densas o heterogéneamente densas, menores de 50 años y peri o premenopáusicas, donde la MD tiene mejores resultados en un rango significativo.Estos datos deben ser confirmados en estudios a más largo plazo para valorar específicamente los efectos en la mortalidad por cáncer de mama.Son importantes los estudios de coste-efectividad si se pretende una sustitución de la técnica

Objective. To review the scientific evidence with respect to the use of digital mammography and compare it with analogical mammography in the clinical context.Material and method. We searched Medline and EMbase for studies published between 1989 and 2005 that compared the results of digital and analogical mammography in the same group of patients or in two different groups of patients to evaluate their respective diagnosticaccuracy (sensitivity, specificity, area under the ROC curve), recall rate, biopsy rate, and exposure to radiation. We reviewed and compared the different methodologies of the studies published.Results. Eight articles and eight presentations at congresses were found. No statistically significant differences were observed between digital and analogical mammography for the detection of breast cancer.Until the publication of the Oslo II (2004) and Digital Mammographic Imaging Screening Trial (2005) studies, the series presented were small and used a variety of methodologies. This made it impossible to appreciate small differences in diagnostic accuracy between the two techniques and to grup the, sometimes, contradictory results. Furthermore, these first series did not include follow-up.Conclusion. There are no statistically significant differences between the two techniques for diagnostic accuracy, except in women with dense or heterogeneously dense breasts, in those under 50 years of age, and in peri- or pre-menopausal women, in which cases digitalmammography is significantly better.These data should be confirmed in longer term studies to enable the effects on the breast cancer mortality rate to be specifically evaluated. Cost-effectiveness studies are important when considering changing techniques