ExPRESS Shunt Surgery for Glaucoma with Post-Traumatic Aniridia.

A 76-year-old male presented with post-traumatic aphakia and aniridia in the right eye. The ocular pressure was 24 mmHg despite treatment with mixed eyedrops of timolol 0.5% and dorzolamide, brimonidine 0.1%, and Latananoprost 0.005%. The glaucomatous cup excavation was 0.8. Because it was his only eye, we informed him of the possibility of the Ex-PRESS implant as a possible prevention measure of possible postoperative hypotony. Seidel, hypotony, and choroidal detachment were not observed in the postoperative period. In the first two postoperative months, the pressure remained at 14 mmHg. The ocular pressure reached 20 mmHg at three months, so he was treated with mixed eyedrops of timolol 0.5% and brimonidine 0.1%. The ocular pressure decreased to 12 mmHg and remained at that level at the 10-month follow-up. The absence of serious postoperative complications suggest that this procedure may be an alternative in selected situations, such as for our patient.

Parathormone secretion in peritoneal dialysis patients with adynamic bone disease.

The prevalence of low-turnover lesions in patients undergoing peritoneal dialysis (PD) is high. Our aims are to evaluate the prevalence of adynamic bone disease (ABD) in PD patients, analyze risk factors, and define the association of serum parathyroid hormone (PTH) levels measured under different plasma calcium concentrations with this lesion. Fifty-seven patients were studied by bone biopsy (BB). ABD was found in 63.2%, and 36.8% showed high-turnover bone disease (HTBD). Patients with HTBD had a lower prevalence of diabetes, younger age, lower accumulated oral calcium salt intake, and greater calcitriol doses, serum osteocalcin level, and ultrafiltration than patients with ABD. Both mean baseline PTH levels from the previous year and PTH level at time of BB were greater in patients with HTBD than those with ABD (357 +/- 267 pg/mL versus 89 +/- 67 pg/mL; 390 +/- 337 pg/mL versus 88 +/- 78 pg/mL, respectively; P < 0.05). However, the magnitude of the increase from baseline serum PTH levels in response to hypocalcemia was greater in patients with ABD than in those with HTBD (166.4% +/- 134% versus 83.5% +/- 73.6%; P < 0.05). We found that PTH levels less than 150 pg/mL in patients with ABD showed a sensitivity of 91. 6%, specificity of 95.2%, and positive predictive value (PPV) of 97%. In the HTBD group, PTH levels greater than 450 pg/mL had a specificity and PPV of 100%. Our data confirm that ABD is the most prevalent lesion in PD patients, and PTH secretion capacity is maintained in these patients. The definitive diagnosis and management strategies for many patients requires a BB, especially when HTBD is unlikely.

[Renal transplantation in patients with HIV infection]. / Trasplante renal en pacientes infectados por el VIH.

The prevalence of human immunodeficience virus (HIV) infection among patients under renal replacement therapy varies, with estimates of 1% for Europe and 1.5% for the United States. Survival in HIV infected individuals receiving renal replacement therapy has improved since the introduction of high activity antiretroviral therapy (HAART). Current experience in renal transplantation in HIV-infected patients in the United States indicates that the three-year survival rate is similar to that of HIV-negative transplant recipients, with virological and immunological control of the infection by HAART and no increase in the number of opportunistic infections or tumors. The criteria for selecting renal transplantation candidates in this population are the following: no aids-defining events, CD4 cells > 200 cells/.l and undetectable viral load under HAART. In Spain, where most of these patients are former drug abusers, a two-year period of abstinence from cocaine and heroine abuse is also required, although patients can be participating in the methadone program. The main problems in the post-transplantation period have been interactions between HAART and immunosuppressive drugs, management of hepatitis C virus (HCV) coinfection and the high rate of acute rejection. To date, seven such renal transplantations have been performed in Spain, with favorable patient and graft survival and no progression to aids.