Tratamiento endovascular de un caso de priapismo de alto flujo / Endovascular treatment of a case of high-flow priapism

Objetivo. Presentar nuestra experiencia en un caso de priapismo de alto flujo tratado con éxito mediante laembolización selectiva de la arteria cavernosa. Caso clínico. Varón de 43 años con priapismo de alto flujo secundario aun traumatismo perineal. El tiempo desde la presentación de la sintomatología hasta el momento del tratamiento fue de157 días. El diagnóstico se confirmó mediante ecografía Doppler del pene y angiorresonancia aortoilíaca. En el primermomento fue tratado con una embolización supraselectiva y se utilizó un coágulo autólogo. Tres semanas después de laprimera intervención, el priapismo reapareció. La segunda embolización se realizó con micropartículas de polivinilo y microcoils.A corto plazo, el paciente recuperó la flacidez y la erección del pene. A largo plazo mostró como única secuela unamoderada fibrosis de los cuerpos cavernosos. Conclusiones. La embolización de la arteria lacerada es un procedimientoseguro para tratar el priapismo de alto flujo y proporciona excelentes resultados

Aim. To present our experience in a case of high-flow priapism successfully treated by superselectiveembolization of the internal pudendal artery. Case report. A 43 year-old male with high-flow priapism secondary to aperineal trauma. The time from the filing of the symptoms until the time of treatment was 157 days. The diagnosis wasconfirmed by Doppler ultrasound of the penis and aorto-iliac angioresonance. The first time, it was treated bysupraselective embolization with autologous blood clot. Three weeks after the first intervention, priapism reappeared.The second embolization was performed using polyvinyl microparticles and microcoils. In the short term, the patientregained flaccidity and the erection of the penis. In the long term, the only sequel was a moderate fibrosis of the corporacavernosa. Conclusions. The embolization of the lacerated artery is a safe procedure for treating the high flow priapismand provides excellent results

Tratamiento de las fracturas de odontoides con halo-chaleco / Halo-vest treatment of odontoid fractures

Objetivo. El tratamiento de las fracturas de odontoides es controvertido, y no existe un único método terapéutico universalmente aceptado. El objetivo del presente trabajo es revisar retrospectivamente las fracturas de odontoides tratadas ortopédicamente con halo-chaleco. Material y método. Se estudiaron retrospectivamente 18 pacientes que presentaron una fractura de odontoides y que fueron tratadas en el período 1987-2001 mediante halo-chaleco. La edad media fue de 38 años (rango 16-75 años). El seguimiento medio fue de 5 años (rango 1-15 años). El mecanismo lesional más frecuente fue, en 11 casos, el accidente de tráfico. Según la clasificación de Anderson y D'Alonzo, en 8 casos la fractura fue del tipo III y en 10 casos del tipo II. En todos los casos se realizó un estudio radiográfico estándar y mediante tomografía axial computarizada (TAC) (excepto en 3 casos). La consolidación se documentó mediante radiografía y tomografía simple (en algunos casos mediante TAC). Según la escala de Smiley-Webster, se evaluó: el dolor, la movilidad cervical, el retorno a la actividad y la situación neurológica. Resultados. La tasa global de consolidación fue del 89% (16 casos). En 9 casos se obtuvieron resultados excelentes (50%); en 4, buenos (22,2%); en 3, regulares (16,6%); y en 2, malos (11,1%). Se obtuvieron buenos resultados en 6 casos de fracturas del tipo II (60%) y en 7 casos del tipo III (87,5%). En 7 casos se consiguió mejorar la reducción una media de 6 mm. En 2 casos el desplazamiento inicial hasta la consolidación aumentó 2 mm. Los malos resultados, por fracaso del tratamiento, precisaron de artrodesis cervical posterior mediante la técnica de Brooks y Gallie (11,1%). En 2 de los cinco pacientes mayores de 60 años (40%) fracasó el tratamiento y se precisó de intervención quirúrgica para estabilizar la fractura. Entre las complicaciones más importantes destacaron 5 casos de aflojamiento del halo (27,7%), un caso de neuroma sensitivo y un caso de siringomielia postraumática secundaria. Conclusiones. El tratamiento ortopédico con halo-chaleco nos ha permitido reducir y estabilizar la fractura de odontoides hasta la consolidación en el 89% de los casos, obteniendo un 66,5% de buenos resultados

Purpose. Treatment of odontoid fractures is controversial and there is no single therapeutic method that is universally accepted. The purpose of this paper is to retrospectively review odontoid fractures treated orthopedically with a halo-vest. Materials and methods. Eighteen patients were retrospectively studied who presented with an odontoid fracture; fractures were treated between 1987 and 2001 by means of a halo vest. Mean age was 38 years (range 16-75 years). Mean follow-up was 5 years (range: 1-15 years). The most usual mechanism of injury (11 cases) was a road accident. Eight of the fractures were type III and 3 were type II according to Anderson and D'Alonzo's classification. In all cases but three, a standard and CT-scan imaging study was performed. Incorporation was documented by means of plain x-rays and tomographs (in some cases CT-scans were used). Pain, cervical mobility, return to previous activities and neurological status were assessed using the Smiley-Webster scale. Results. Global incorporation rate was 89% (16 cases). In 9 cases (50%) results were excellent, in 4 (22%) they were good, in 3 (16.6%) they were fair and in 2 (11%) poor. Results were good in 6 cases of type II fractures (60%) and 7 cases of type III fractures (87.5%). In 7 cases it was possible to improve reduction by an average 6 mm. In two cases, initial displacement until incorporation increased by 2 mm. Poor results (11.1%) resulted from treatment failure and required a posterior cervical arthrodesis performed with Brooks and Gallie's technique. In 2 of the 5 patients over 60 (40%), treatment failed and a surgical procedure was required to stabilize the fracture. The most significant complications were 5 cases of halo loosening (27.7%), one case of a sensory nerve neuroma and one case of secondary post-traumatic syringomyelia. Conclusions. Orthopedic treatment with a halo-vest allowed us to reduce and stabilize odontoid fractures up to incorporation in 89% of cases, with 66.5% of good results (AU)

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture.

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon.

Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings.

OBJECTIVE: Our goal in this study was to evaluate by means of MRI the clinical significance of tendon integrity, muscle fatty degeneration, and muscle atrophy in surgically repaired massive rotator cuff tears and to correlate these and other prognostic factors with intraoperative and clinical findings. MATERIALS AND METHODS: Twenty-eight surgically proven massive rotator cuff tears were retrospectively included in the study. Twenty-two patients underwent complete repair, and six patients underwent partial repair. Preoperative and postoperative clinical assessment was performed by using the University of California at Los Angeles score. Preoperative and postoperative MRI studies were evaluated for the presence and extent of rotator cuff tear and for the degree of fatty degeneration and atrophy of the rotator cuff muscles. RESULTS: At a mean 44.4 months' follow-up, 20 patients (71.4%) had a favorable result. A total of 25 patients (89.2%) showed postoperative full-thickness rotator cuff tear, 19 of which were reruptures. A sagittal preoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 100% for predicting a favorable outcome. A coronal postoperative rotator cuff tear of less than or equal to 34 mm showed a specificity of 85.7% and a positive predictive value of 92.9% for predicting a favorable outcome. A postoperative fatty degeneration of infraspinatus muscle less than or equal to 2 had a specificity of 87.5% and a positive predictive value of 90.9% for predicting a favorable outcome. CONCLUSION: Open repair of massive rotator cuff tears may reach a favorable outcome in a significant proportion of patients, despite a high rate of recurrent or residual tears. Oblique coronal sizes of the recurrent or residual tear of less than or equal to 34 mm and postoperative fatty degenerations of infraspinatus muscle of less than or equal to 2 may allow a favorable outcome.

Early intrathoracic migration of Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture: a case report.

We present an unusual case of early migration of three Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture, causing hemothorax. An 85-year-old woman was admitted to the emergency room after casual accident. She was found to have suffered a two-part fracture of the surgical neck of the right humerus. The humeral fracture was treated by closed reduction and percutaneous osteosynthesis with three threaded Kirschner wires, which were bent subcutaneously. Ten days after the accident the patient presented with dyspnea and laterocervical pain. Plain X-rays and complementary CT demonstrated intrathoracic migration of the three Kirschner wires with hemothorax. Two of the wires were seen under the right clavicle and adjacent to the C7 vertebra. The third wire reached the lateral chest wall. Immediate surgery was performed, with withdrawal of the wires and placement of a drainage tube. The patient had an uneventful recovery after surgery. The humeral fracture resulted in a nonunion, which was well tolerated by the patient and was left untreated. The use of Kirschner wires for osteosynthesis of proximal humeral fractures may cause significant thoracic morbidity, even if various prophylactic measures, including the use of threaded wires, subcutaneous bending, and close radiographic follow-up, are adopted. The use of Kirschner wires should anyway be restricted to carefully selected cases, in order to avoid major complications.

Analgesic effect of intra-articular ketorolac in knee arthroscopy: comparison of morphine and bupivacaine.

This prospective study assessed the postoperative analgesic effect of intra-articular ketorolac, morphine, and bupivacaine during arthroscopic outpatient partial meniscectomy. Group 1 patients (n=20) received postoperative injection of 60 mg intra-articular ketorolac, group 2 patients (n=20) 10 cc intra-articular bupivacaine 0.25%, group 3 patients (n=20) 1 mg intra-articular morphine diluted in 10 cc saline, and group 4 patients (n=20, controls) only 10 cc saline. We evaluated the postoperative analgesic effect (period measured from the end of the surgery until further analgesia was demanded), the level of postoperative pain (by visual analog scale 1, 2, 3, 12, and 24 h after surgery), and the need for additional pain medication (during the first 24 h after surgery). The best analgesic effect was in patients treated with intra-articular ketorolac, and this was statistically significant in: postoperative analgesic effect and the need for additional pain medication immediately after surgery, and after 24 h. No complications were found related to the intra-articular treatment. We conclude that 60 mg intra-articular ketorolac provides better analgesic effect than 10 cc intra-articular bupivacaine 0.25% or 1 mg intra-articular morphine.

Open bicondylar Hoffa fracture associated with extensor mechanism injury.

Two cases of open bicondylar Hoffa fracture of the knee associated with extensor mechanism injury are described in two active young patients with multiple fractures. The level of the fracture was determined by the proximal insertion of the posterior cruciate ligament and anterior cruciate ligament in the medial and lateral condyle. The level of the extensor mechanism injury was determined by the degree of flexion of the knee at the moment of impact. No ligament or meniscal tears were found. Open reduction and internal fixation with four lag screws and bone-to-tendon repair of the patellar and quadriceps tendon gave excellent results after more than 2 years of follow-up. The mechanism of injury and the therapeutic implications are discussed, and the literature is reviewed.

Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle.

We evaluated the diagnostic utility of magnetic resonance imaging (MRI) for predicting anterior cruciate ligament (ACL) tears using both quantitative parameters and nonquantitative imaging findings. MRI examinations were retrospectively evaluated in a group of patients with arthroscopically confirmed complete ACL tear and in a control group with arthroscopically confirmed intact ACL. We evaluated multiple MRI features to compare their sensitivity and specificity for detecting ACL tears. Particular emphasis is put on the evaluation of three different quantitative parameters, including a simplified method for measuring the ACL angle. With a threshold value of 45 degrees the ACL angle reached a sensitivity and specificity of 100% for detecting ACL tears. With a threshold value of 0 degrees the Blumensaat angle had a sensitivity of 90% and a specificity of 98%. Finally, a threshold value of 115 degrees gave the posterior cruciate ligament angle a sensitivity of 70% and a specificity of 82%. Discontinuity was found to be the most useful of the ACL abnormalities. Of the secondary findings anterior tibial displacement was the best predictor of ligamentous injury. However, ACL abnormalities and secondary findings, alone or combined, failed to surpass the diagnostic value of the ACL angle for predicting ACL tears. Quantitative parameters are thus good predictors of ACL tears and may increase the overall sensitivity and specificity of MRI. The ACL angle may be confidently measured in a single MRI section and can be considered to be the most reliable quantitative parameter for detecting ACL tears.

Rotura masiva del manguito de los rotadores. Resultados del tratamiento quirúrgico / Massive rupture of the rotator cuff. Results of surgical treatment

Objetivo: Evaluar de forma retrospectiva los resultados clínicos de 25 pacientes diagnosticados de rotura masiva del manguito de los rotadores tratados quirúrgicamente, de forma consecutiva. Pacientes: La serie está compuesta por 13 hombres y 12 mujeres con una edad media de 57 años. La indicación para el tratamiento quirúrgico ha sido el dolor importante después de un período de tratamiento conservador superior a 3 meses. El diagnóstico de rotura masiva se ha realizado en el momento de la intervención quirúrgica cuando el tamaño de la rotura, en su diámetro mayor ha sido = 5 cm. Se han excluido aquellos pacientes con rotura masiva del manguito con excentricidad de la cabeza humeral respecto a la glenoides por subluxación proximal con signos de artropatía secundaria a lesión del manguito. Se ha realizado una descompresión del espacio subacromial a cielo abierto mediante la técnica de Neer y reparación de la lesión después de movilización de los extremos tendinosos siguiendo un proceso sistemático, sutura tendinosa por convergencia de márgenes y sutura al troquíter mediante anclajes óseos. Los pacientes se han evaluado desde el punto de vista clínico mediante la escala de UCLA con un seguimiento mínimo de 1 año. Resultados: Antes de la intervención la puntuación media fue de 11,6; mientras que en la revisión fue de 32,2 (13 resultados excelentes, 8 buenos, 3 regulares y 1 malo). Los 3 pacientes que tenían un antecedente traumático de luxación glenohumeral obtuvieron los peores resultados. Conclusiones: Con el tratamiento quirúrgico de las roturas masivas del manguito de los rotadores puede obtenerse un nivel de resultados satisfactorios parecido a los obtenidos con el tratamiento de lesiones de menor tamaño. (AU)

Antioxidant status in a squirrel monkey (Saimiri sciureus) with chronic pancreatitis and degenerative myopathy.

A squirrel monkey (Saimiri sciureus) presented with wasting, vomiting and diarrhoea. Haematology revealed elevation of creatinine phosphokinase, lactic dehydrogenase, alanine aminotransferase, amylase and lipase, together with azotaemia and hypoalbuminaemia. Prominent findings were chronic pancreatitis with acinar and ductal plugs, granulomatous and necrotizing peripancreatic steatitis, degenerative myopathy, testicular atrophy, candidiasis and bacterial necrotizing glossitis. Antioxidant analyses revealed low concentrations of serum vitamin E (and apparently A), hepatic selenium and hair zinc. Pancreatitis may have caused malabsorption and maldigestion, associated with deficiency of multiple antioxidants.

Efectos sistémicos del implante de partículas de desgaste del polietileno en el hueso. Estudio experimental / Systemic effects of implantation of polyethylene wear particles on bone. Experimental study

Objetivo: Se ha estudiado el efecto que provoca el implante de partículas de desgaste de polietileno de alta densidad sobre los ganglios linfáticos, el hígado y el pulmón de la rata.Diseño experimental: Se ha implantado 1 mg de polvo de polietileno, constituido por una mezcla hetereogénea de partículas de un tamaño entre 1 y 100 micras, en un orificio practicado en la tibia de 16 ratas de la cepa Sprague-Dawley y se han examinado las muestras de los ganglios de la cadena ilíaca y cervical, tejido hepático y pulmonar a los 15 y 60 días de la intervención. El grupo control ha quedado constituido por 16 ratas a las que se ha realizado la misma intervención pero a las que no se han implantado partículas.Resultados: Un gran número de ganglios presentan hiperplasia difusa con un gran infiltrado macrofágico.Estos cambios no se observan en el grupo control. No se han observado partículas de polietileno en el interior de los ganglios linfáticos. No se han detectado cambios patológicos en las muestras de tejido hepático. En la mitad de las ratas que recibieron partículas se han detectado infiltrados inflamatorios peribronquiales y perivasculares en el pulmón, que no se han observado en el grupo control.Conclusiones: Las partículas de desgaste del polietileno provocan cambios patológicos en órganos a distancia de su lugar de implante. El mecanismo fisiopatológico y las consecuencias de estas alteraciones no son aun bien conocidos (AU)

[Bladder amyloidosis: report of 2 cases]. / Amiloidosis vesical: presentación de dos casos.

Two cases of amyloidosis of the bladder are reported: 1) a 45 year old man with haematuria. Cystoscopic examination reveals several tumours in the wall of the bladder. Transuretral resection was performed and histopathological examination revealed primary amyloidosis. Systemic amyloidosis was excluded. He was treated with oral colchicine with success. 2) a 71 year old male with diagnosis of rheumatoid arthritis and systemic amyloidosis visited our hospital with massive haematuria. Transuretral resection was unsuccessful and was necessary surgical ligation of hypogastric arteries.

Amiloidosis vesical: presentación de dos casos / Amyloidosis of the bladder: report of two cases

Presentamos dos casos de amiloidosis vesical: 1) varón de 45 años con clínica de hematurias y hallazgo endoscópico de formaciones tumorales vesicales. Se practicó resección transuretral con el diagnóstico histológico de amiloidosis vesical. Se excluyó mediante biopsia la afectación de otros órganos, siendo tratado con colchicina oral con buen resultado; 2) mujer de 71 años afecta de ami-loidosis sistémica con artritis reumatoide que presentó hematuria masiva tratada con RTU hemos-tática sin éxito, practicándose ligadura quirúrgica de arterias hipogástricas (AU)

Intraosseous neurilemmoma of the radius: a case report.

Neurilemmomas are benign tumors that arise from Schwann cells. They are rarely found on bone. We describe a neurilemmoma in a 45-year-old patient that affected the distal metaphysis of the radius. Only 1 previous case has been described in the literature. We discuss the clinical presentation, the radiographic aspect, particularly the magnetic resonance imaging characteristics, and the microscopic findings.

Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Spanish Group for the Study of Crohn's Disease and Ulcerative Colitis (GETECCU).

OBJECTIVE: Butyrate enemas may be effective in the treatment of active distal ulcerative colitis. Because colonic fermentation of Plantago ovata seeds (dietary fiber) yields butyrate, the aim of this study was to assess the efficacy and safety of Plantago ovata seeds as compared with mesalamine in maintaining remission in ulcerative colitis. METHODS: An open label, parallel-group, multicenter, randomized clinical trial was conducted. A total of 105 patients with ulcerative colitis who were in remission were randomized into groups to receive oral treatment with Plantago ovata seeds (10 g b.i.d.), mesalamine (500 mg t.i.d.), and Plantago ovata seeds plus mesalamine at the same doses. The primary efficacy outcome was maintenance of remission for 12 months. RESULTS: Of the 105 patients, 102 were included in the final analysis. After 12 months, treatment failure rate was 40% (14 of 35 patients) in the Plantago ovata seed group, 35% (13 of 37) in the mesalamine group, and 30% (nine of 30) in the Plantago ovata plus mesalamine group. Probability of continued remission was similar (Mantel-Cox test, p = 0.67; intent-to-treat analysis). Therapy effects remained unchanged after adjusting for potential confounding variables with a Cox's proportional hazards survival analysis. Three patients were withdrawn because of the development of adverse events consisting of constipation and/or flatulence (Plantago ovata seed group = 1 and Plantago ovata seed plus mesalamine group = 2). A significant increase in fecal butyrate levels (p = 0.018) was observed after Plantago ovata seed administration. CONCLUSIONS: Plantago ovata seeds (dietary fiber) might be as effective as mesalamine to maintain remission in ulcerative colitis.

Identification of coherent structures in turbulent shear flows with a fuzzy artmap neural network.

An implementation of a Fuzzy Artmap neural network is used to detect and to identify (recognise) structures (patterns) embedded in the velocity field of a turbulent wake behind a circular cylinder. The net is trained to recognise both clockwise and anticlockwise eddies present in the u and v velocity fields at 420 diameters downstream of the cylinder that generates the wake, using a pre-processed part of the recorded velocity data. The phase relationship that exists between the angles of the velocity vectors of an eddy pattern is used to reduce the number of classes contained in the data, before the start of the training procedure. The net was made stricter by increasing the vigilance parameter within the interval [0.90, 0.95] and a set of net-weights were obtained for each value. Full data files were scanned with the net classifying patterns according to their phase characteristics. The net classifies about 27% of the recorded signals as eddy motions, with the strictest vigilance parameter and without the need to impose external initial templates. Spanwise distances (homogeneous direction of the flow) within the centres of the eddies identified suggest that they form pairs of counter-rotating vortices (double rollers). The number of patterns selected with Fuzzy Artmap is lower than that reported for template matching because the net classifies eddies according to the recirculating pattern present at the core or central region, while template matching extends the region over which correlation between data and template is performed. In both cases, the topology of educed patterns is in agreement.

[Diarrhea, rectorrhagia and colonic ulceration following the ingestion of NSAIDs]. / Diarrea, rectorragia y ulceración colónica tras la ingesta de AINES.

The lower digestive tract, in contrast to the gastroduodenal tract, is infrequently affected by non-steroidal antiinflammatory drugs (NSAID), and rarely referred to in medical literature. We report the case of a 40-year-old man who presented with bloody diarrhea following treatment with NSAID. The fiber gastroscopy was normal. The fiber colonoscopy showed elongated aphthous ulcers with fibrin in the sigmoid colon. Others studies were normal. After withdrawal of NSAID, the patient returned to normal, as did the fiber colonoscopy. The treatment with NSAID has been linked with ulcerative lesions in the lower digestive tract, perforation, bloody lesions, perforation of diverticuli, reactivation of quiescent colitis and stenosis. In spite of this, doubts persist about the frequency of presentation, high risk doses and its pathophysiological mechanism, which probably involves blocking the cyclooxigenase system and the formation of the leukotrienes and free oxygen radicals. Taking into consideration the above factors, more care should be taken in investigating colonic involvement in patients who present with gastrointestinal bleeding following treatment with NSAID.

Factors associated with low values of biochemical vitamin parameters in healthy subjects.

Levels of vitamins A, E, C, B1, B2, B6, B12, folate and beta-carotene were assessed in plasma or whole blood in a group of 114 healthy adults. Biochemical vitamin status was classified into acceptable or suboptimal (moderate or severe). The independent association of various factors with the finding of a suboptimal vitamin status was studied by means of logistic regression analyses. Seventy seven per cent of subjects had suboptimal vitamin status for vitamin B2, 20% for vitamin A, and 84% for beta-carotene. Although few subjects had suboptimal biochemical levels for vitamin E, plasma levels of this vitamin were significantly lower in smokers than in non-smokers (p < 0.01). Likewise, plasma folate levels were significantly related to body mass index and the season of blood sampling (p < 0.05). Old age was protective (OR 0.15; 95% CI 0.03-0.67), whereas current smoking was harmful (OR 3.63; 95% CI 1.09-12.1) for riboflavin status. Age group of 25-59 years was independently associated to a low risk of suboptimal vitamin A status (OR 0.29; 95% CI 0.09-0.88). On the other hand, female sex had a negative effect on plasma vitamin A levels (OR 2.39; 95% CI 0.82-6.92) and smoking had a harmful effect on biochemical beta-carotene status (OR 2.72; 95% CI 0.82-8.99). This cross sectional study provides information about the determinants of vitamin inadequacy, and may be the basis for further pathophysiological studies.

[Transplantectomy today: indications and complications]. / La transplantectomía hoy: indicaciones y complicaciones.

Analysis of the indications for transplantectomy and its complications over a 12-year period. Over a total of 159 failure grafts, we performed 53 transplantectomies (33.3%). The percentage of complications was 16.9%. Three patients died (5.6%) during the more or less immediate post-operative period. In our experience, consistent and prolonged maintenance of immunosuppression should avoid the need for transplantectomy in a high percentage of grafts. Only 15 transplantectomies were made on 104 failure grafts after 6 months (14.4%). Our short but successful experience with embolization of 2 rejected grafts confirms the validity of this conservative alternative versus conventional surgical transplantectomy in selected cases.