Effect of Cytomegalovirus Infection on Survival of Older Kidney Transplant Patients (D+/R+): Impact of Valganciclovir Prophylaxis Versus Preemptive Therapy.

BACKGROUND: Kidney transplant patients with D+/R+ serology can be treated with either prophylaxis or preemptive valganciclovir. The older transplant population suffers severe immunosenescence, especially patients with latent cytomegalovirus (CMV) infection (R+). They are more likely to develop indirect CMV effects. Likewise, many patients have significant cardiovascular comorbidity, which makes them more sensitive to these indirect effects. The aim of this study was to evaluate the incidence of CMV viremia and indirect effects on survival, comparing prophylaxis (V) against preemptive (P) valganciclovir in an older kidney transplant population. METHODS: We analyzed the data of 233 recipients from 2002 (age, >55 years; D+/R+) with ≥6 months of follow-up. The patients were divided into 2 groups: 167 (71.7%) in the V group and 66 (28.3%) in the P group. RESULTS: The incidence of CMV infection in the P group was 32% versus 6% in V group. Patients with CMV viremia showed worse survival values than patients without viremia (log rank P = .031). Five-year survivals were 74% vs 88%, respectively. Cox regression showed that the adjusted effect of CMV infection on overall survival was a significant risk (hazard ratio [HR], 2.07; 95% CI, 1.003-4.29). Patients with CMV viremia showed worse cardiovascular survival than patients without viremia, with 5-year survivals of 79% vs 94%. Cox regression showed that the adjusted effect of CMV infection was a significant risk (HR, 2.62). CONCLUSIONS: CMV infection has a detrimental effect on the survival of older patients. Valganciclovir prophylaxis induces a protective effect against CMV infection and could improve survival of older patients with cardiovascular comorbidities.

Malt lymphoma as first clinical presentation of a celiac disease.

We report a case of a 35 year-old-woman who suffered from abdominal pain and weight loss. Asymptomatic celiac disease was discovered and complicated with a MALT Lymphoma in the jejunum. This is an uncommon combination because lymphoma that arises in the presence of enteropathy is commonly from T lymphocytes. Also because it normally appears in patients with long standing celiac disease who report a recrudescence of the abdominal symptoms.

[Epididymal malacoplakia in a heart transplant recipient: clinico-pathologic study of a case]. / Malacoplaquia epididimaria en un paciente con trasplante cardíaco: estudio clínico-patológico de un caso.

OBJECTIVES: An unusual case of malacoplakia is described and the literature reviewed. METHODS/RESULTS: We report on a patient on immunosuppression due to heart transplantation who developed malacoplakia of the epididymis. Patient history and treatment are discussed, with special reference to the differential diagnosis between this condition and tumors.

[Veno-occlusive liver disease due to intake of Senecio vulgaris tea]. / Enfermedad venooclusiva hepática por ingestión de infusiones de Senecio vulgaris.

Veno-occlusive liver disease (VOLD) is a cause of portal hypertension by non thrombotic obstruction of hepatic venous drainage attributed to multiple etiologies (toxic, irradiation, antineoplastic, conditioning for bone marrow transplantation). One case of VOLD in a senile patient due to continuous two year consumption of Senecio vulgaris tea is reported. This compound, which has a high pyrrolizidine alkaloid content induced a subacute course of portal hypertension and death. The clinicopathologic features of VOLD and the etiopathogenesis in relation to the pyrrolizidine alkaloids present in Senecio vulgaris are discussed. The need for considering the history of medicinal plant ingestion in patients under portal hypertension studies are strongly recommended as is the advice regarding the possible dangers involved in the inappropriate use of remedies provided by herbalists.

[Male with sudden-onset dementia associated with long lasting diarrhea as manifestations of Whipple's disease]. / Varón con demencia de aparición brusca, asociada a diarrea de larga evolución como manifestaciones de la enfermedad de Whipple.

A case of a 55-year old male with Whipple's disease who consulted for dementia (aggressivity, memory loss of recent events, sleep rhythm disturbances) is presented. Furthermore, the patient had referred changes in intestinal movement four years beforehand in addition to erratic arthralgias. Response to treatment (trimethoprim-sulfamethoxazole for one year) was favorable with resolution of both the neurologic and gastrointestinal pictures. The radiologic alterations of this entity are reviewed and suggest that this disease should be considered as a cause of dementia.

[Acute renal failure associated with 5-aminosalicylic acid in inflammatory bowel disease]. / Insuficiencia renal aguda asociada a ácido 5-aminosalicílico en la enfermedad inflamatoria intestinal.

A case of acute renal failure with characteristics of interstitial nephritis associated to treatment with mesalazine (5-ASA bound to resin) in a 26-year old patient with a 7-year history of Crohn's disease is presented. The patient had been previously treated with 5-ASA with no alterations in renal function being observed. Renal failure became manifest several days after initiation of maintenance therapy with 5-ASA during the latest outbreak of intestinal inflammatory disease and disappeared upon suppression of the drug.

Liver lipid composition and intravenous, intraperitoneal, and enteral administration of intralipid.

We studied the variations arising in plasma and liver lipids after intravenous (i.v.), intraperitoneal (IP), and intragastric (IG) administration of a fat overdose on the order of 4 g.kg-1 body wt.day-1 in the form of Intralipid (ITL) 20% to 33 New Zealand rabbits for 15 days. The control group was submitted for surgery but did not receive an ITL supplement. The results show weight gain in all animals and normal liver enzyme values. There was an increase in plasma lipids in groups supplemented by the parenteral route (i.v. and IP), and fatty acids showed a similar distribution, in terms of percentages, to that for ITL. In liver tissue, there was an increase in the fractions related to ethanolamine and a decrease in phospholipids of choline and serine. In the i.v. group, neutral lipids predominated compared with other groups. The livers of all supplemented animals (i.v., IP, and IG) showed a higher content of stearic and linoleic acid and a reduction in oleic acid. Study with optical microscopy showed a microvacuolization affecting the three areas of the hepatic acini in the i.v. group, seen with electron microscopy as vacuoles lacking membranes and surrounded by mitochondria. In conclusion, there is an increase in hepatic steatosis in parenteral groups and a greater deposit of neutral lipids in the i.v. group, related to the administration route, without biochemical signs of liver dysfunction.

[Immunoproliferative disease of the small intestine. Report of a case]. / Enfermedad inmunoproliferativa del intestino delgado. A propósito de un caso.

We report one case of immunoproliferative small intestinal disease with two rare characteristics. Firstly, the detection of monoclonal IgA-Kappa in serum and in the intestinal infiltrate and secondly, the advanced age of the patient at diagnosis. We checked up on Spanish literature and found an important number of patients that were diagnosed at such an age. We suggest that this disease may appear in elderly people in developed countries.

Portoenterostomy diversion. Experimental study in antireflux technique.

Ascending cholangitis was induced in dogs by performing a biliodigestive Roux-Y anastomosis. Then two valvular antireflux mechanisms were performed on separate groups of these dogs with the aim of preventing the onset of ascending cholangitis. One was performed by a laterolateral plicature at the intestinal anastomosis and the other by invagination of the mucosa in the nonworking loop that had been anastomosed to the bile duct. All the dogs underwent analytic tests over a period of 3 months and histopathologic tests at the end of the study period. Results showed cholangitis and pericholangitis in the liver biopsy specimens of the group with no antireflux valve, to a lesser degree in the group with laterolateral plicature, and almost none in the animals with the invaginated valve.

[Omental graft, without devascularization, in the hepatic hilum. Experimental study]. / Injerto de epiplón, sin desvascularizar, en hilio hepático. Estudio experimental.

Epiploon grafts were made into the resected hepatic hilum of dogs with the aim of creating anastomosis between the intrahepatic and epiploic lymphatic systems. Various hepatic enzymes were observed over a three month period, and then a histopathological study of the grafted area was made. This type of graft was also applied to rabbits, after tying off the common hepatic duct, and the histopathological study made fifteen days after. The results show no lymphatic anastomosis between the liver and the grafted epiploon. So we would not advise using this type of technique to drain intrahepatic cholestasis in biliary atresia, at least not as the procedure of choice.