Liver transplanted patients with donors older than 60 years require more hospital resources.

BACKGROUND: The increasing utilization of organs from older donors to fulfill the increasing demand for transplantation has been associated with an increased complication rate and shorter graft survival. Nevertheless, few studies have evaluated the impact of these donors on resource utilization. We sought to evaluate hospital resource utilization during the first year after liver transplantation among patients receiving a liver from a donor >60 years versus a younger donor. METHODS: This prospective study evaluated 149 consecutive liver transplantations performed in our center between 2000 and 2005. We divided the patients into 2 groups according to the donor's age; group A <60 and group B, ≥ 60 years. The follow-up was for the first year. Herein we have reported data related to resource utilization, such as number and length of stay hospitalizations, length of ICU stay; surgical and diagnostic procedures including ultrasounds, cholangiography, computed tomography or magnetic resonance imaging, as well as external consultations. RESULT: Group B patient required a greater number of hospitalizations (2.7 ± 2.4 vs 1.7 ± 1.5; P = .006), and a longer length of initial stay (37.5 ± 20.9 vs 27.8 ± 17.5 days; P = .012). There were no differences between groups concerning diagnostic and surgical procedures or external consultations. CONCLUSION: Patients transplanted from donors >60 years required more hospital resources in the first year after transplantation.

Superoxide anion and nitric oxide in high-grade esophagitis induced by acid and pepsin in rabbits.

It has been proposed that free radicals are involved in the pathogenesis of esophageal mucosal damage induced by acid and pepsin. Recent data have suggested that nitric oxide (NO) is involved in the mucosal defense of the esophagus and that superoxide anion plays a minor role in low-grade esophagitis. To study the role and potential interaction of NO and superoxide anion in an experimental model of high-grade esophagitis, acidified pepsin was perfused (45 min/12 hr) for five days in rabbits with different agents to modulate the generation of these radicals. Measurements included both macroscopic and microscopic mucosal damage, superoxide anion generation, NO synthase mucosal activity, and peroxynitrite formation. High-grade esophagitis was associated with mucosal superoxide anion generation. Treatment with exogenous superoxide dismutase completely prevented mucosal damage. The perfusion of acidified pepsin in the lumen of the esophagus was initially associated with increased NO synthase mucosal activity but decreased with the progression of damage. Generation of peroxynitrites was present in those cases with severe damage. Treatment with NO-modifying agents did not induce consistent modification of mucosal damage. It is concluded that superoxide anion is involved in the induction of high-grade esophagitis and that it interacts with nitric oxide to generate peroxynitrite radicals in this model. Superoxide dismutase but not NO-donor-modifying agents might have a therapeutic role in preventing severe esophageal mucosal damage induced by acid and pepsin.

Nitric oxide and superoxide anion in low-grade esophagitis induced by acid and pepsin in rabbits.

It has been suggested that free radicals are involved in esophagitis. To study the role and potential interaction of superoxide anion and nitric oxide (NO) in low-grade esophagitis, we perfused acidified pepsin (30 min every 12 hr) for seven days in rabbits treated with different agents to modulate the generation of these radicals. Measurements included macroscopic and microscopic damage, superoxide anion generation, mucosal nitric oxide synthase activity, and peroxynitrite formation. Low-grade esophagitis was associated with increased nitric oxide synthase mucosal activity and mucosal damage was dose-dependently increased by treatment with the NO synthase inhibitor NG-nitro-L-arginine. Superoxide anion was scarcely generated in the mucosa, but this was not accompanied by any change in the activity of mucosal superoxide dismutase. Treatment with superoxide dismutase did not improve mucosal damage. Generation of peroxynitrites was not detected. In conclusion, nitric oxide is involved in the mucosal defense of the esophagus against acid- and pepsin-induced damage. Superoxide anion generation seems irrelevant in the induction of low-grade esophagitis and not sufficient to interact with nitric oxide to generate measurable mucosal peroxynitrite radicals.

Renal invasive aspergilloma: unusual infection in AIDS.

Invasive aspergillosis is a devastating infection that mainly affects immunocompromised hosts. Nevertheless it is not a common infection in AIDS probably due to specific immune aspects. Even more rare in this group of patients is infection limited to the kidney without dissemination as occurred in our case reported here. He had heroin addiction, AIDS in advanced stage C3, neutropenia and received antifungal prophyllaxis as predisposing factors to aspergillosis. Despite correct therapy with Amphotericine B and drainage of one of the abscesses, he died due to antibiotic side-effects and persistence of not-drained contralateral abscess. Our experience supports the fact that we should have a high index of suspicion for fungal aetiology in kidney infection in AIDS patients with predisposing factors discussed in the text, in order to make early diagnosis and to establish prompt aggressive antifungal therapy supported by drainage of fungus collections, or even nephrectomy if required.

[Salmonella enteritidis multifocal infection of the central nervous system. Efficacy of new cephalosporins]. / Infection multifocale du système nerveux central à Salmonella enteritidis. Efficacité des nouvelles céphalosporines.

Focal central nervous system infections, as abscess and empyema, due to Salmonella species are unusual. Even more unusual is the association of cerebral abscess, subdural empyema and epidural abscess we report in the present work. This infection appeared in our patient soon after a brain astrocytoma removal and was treated with cefotaxime and gentamicin during three weeks. In spite of documented genus susceptibility to the drugs the infection relapsed in few days. It was definitely cured with ceftazidime alone for six weeks. Third-generation cephalosporins are good alternatives in uncommon infections and specially in central nervous system salmonellosis, as resistances of this genus to classical drugs are lately increasing.