Integration of membrane processes for the recovery and separation of polyphenols from winery and olive mill wastes using green solvent-based processing.

Winery and olive mill industries generate large amounts of wastes causing important environmental problems. The main aim of this work is the evaluation of different membrane separation processes like microfiltration, ultrafiltration, nanofiltration, and reverse osmosis for the recovery of polyphenols from winery and olive mill wastes in aqueous solutions. Membrane processes were tested separately in a closed-loop system, and by an integration in a concentration mode sequential design (open-loop). Feed flow rate was varied from 1 to 10 mL min-1, and permeate samples were taken in order to measure the polyphenols concentration. The separation and concentration efficiency were evaluated in terms of total polyphenol content, and by polyphenols families (hydroxybenzoic acids (HB), hydroxycinnamic acids (HC), and flavonoids (F)), using high performance liquid chromatography. Results showed that MF and UF membranes removed suspended solids and colloids from the extracts. NF was useful for polyphenols separation (HB rejections were lower than for HC and F: HB rejections of 50 and 63% for lees filters and olive pomace extracts, respectively), and RO membranes were able to concentrate polyphenols streams (86 and 95% rejection from lees filters and olive pomace, respectively). Membranes sequential designs for lees filters and olive pomace extracts, using a selective membrane train composed by UF, NF and RO membranes, were able to obtain polyphenol rich streams and high-quality water streams for reuse purposes.

Benefits of preserving residual renal function in peritoneal dialysis.

Residual renal function (RRF) is of paramount importance in patients with end-stage renal disease, with benefits that go beyond contributing to achievement of adequacy targets. Several studies have found that RRF rather than overall adequacy (as estimated from total small solute removal rates) is an essential marker of patient and, to a lesser extent, technique survival during chronic peritoneal dialysis (PD) therapy. In addition, RRF is associated with a reduction in blood pressure and left ventricular hypertrophy, increased sodium removal and improved fluid status, lower serum beta(2)-microglobulin, phosphate and uric acid levels, higher serum hemoglobin and bicarbonate levels, better nutritional status, a more favorable lipid profile, decreased circulating inflammatory markers, and lower risk for peritonitis in PD. As compared with conventional hemodialysis, PD is associated with a slower decrease in RRF. This highlights the usefulness of strategies oriented to preserve both RRF and the long-term viability of the peritoneal membrane. Several factors contributing to the loss of RRF have been identified and should be avoided. Renoprotective drugs and new glucose-sparing, more biocompatible PD regimes may prove useful tools to preserve RRF and peritoneal membrane function in the near future.

Sarcoptic mange in red deer from Spain: improved surveillance or disease emergence?

Concern about emerging diseases has risen in recent years, and multihost situations have become increasingly relevant for wildlife management and conservation. We present data on Asturias, northern Spain, where 80 mangy red deer (Cervus elaphus) have been found since the beginning of the epizootic in chamois (Rupicapra pyrenaica parva) in 1993. We combine field and necropsy data with the results of a serosurvey using an in-house ELISA test to evaluate if deer mange due to Sarcoptes scabiei is an emerging disease in this area. The mean number of deer mange cases per year was 5, with a maximum of 16. No significant relationship was detected between monthly temperatures, rainfall or number of days with snow cover and the annual number of sarcoptic mange cases in red deer. Only 4 mangy red deer (5%) were detected outside the limits of scabietic chamois distribution during the same year, and all were less than 2500 m away from that limit. The longest distance reported between two consecutive mangy deer locations was 18 km. Mange cases were significantly more frequent in stags than in hinds and in adults than in juvenile deer. The time of the first mange detection in chamois in each sector, year with minimum number of chamois recorded, year with maximum chamois population decline rate and chamois density offered no significant correlation with red deer mange cases appearance moment and frequency. In the mange affected area, ELISA testing of 327 blood samples from hunter-harvested deer without obvious mange-compatible lesions revealed only 4 seropositive animals. All 83 sera from hunting preserves without clinical cases yielded negative ELISA results. According to these epidemiological data mange does not seem to threaten red deer populations in Asturias. However, continued monitoring of deer health and ELISA testing for sarcoptic mange is advisable.

Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o «EODD»: «Every Other Day Dialysis») versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones / Control of hypertension with different hemodialisis schedules

El aumento de la frecuencia de las sesiones de hemodiálisis garantiza un mejor control del volumen extracelular y de la hipertensión arterial, hechos que pueden reducir la mortalidad relacionada con patología cardiovascular entre la población en hemodiálisis. Describimos la evolución de la hipertensión arterial, en función de las necesidad de administración de fármacos antihipertensivos, en una población prevalente de 38 pacientes que iniciaron el esquema de hemodiálisis en días alternos sin descanso de 72 h de fin de semana, y la comparamos con 140 pacientes asimismo prevalentes que eran tratados en dos esquemas convencionales, previamente utilizados, con descanso de fin de semana y tres sesiones semanales de 4 y de 5 horas respectivamente; todos los pacientes habían permanecido durante más de 6 meses en hemodiálisis. El 68,4% (26/38) de los pacientes del esquema alterno presentaba hipertensión arterial al inicio del esquema alterno y tras 16,1 meses de permanencia media en el esquema solo mantuvieron medicación el 7,9% de ellos (3/38) con reducción en dos de los tres pacientes restantes (p < 0,001). Los 25 pacientes que cesaron o redujeron la medicación antihipertensiva lo hicieron en una media de 100 ± 15 días. La frecuencia final de hipertensión en diálisis alterna fue inferior a la que presentaban los 84 pacientes prevalentes con esquema de 4 horas x 3 sesiones x semana (60,7%) (p < 0,002) y a la de los 56 pacientes prevalentes con esquema de 5 horas x 3 sesiones x semana (25%: p = 0,065). Las diferencias entre las ganancias medias de peso entre sesiones con y sin fin de semana, los descensos medios del peso seco, las medias de tensión arterial y la frecuencia de hipotensiones, entre los pacientes en el esquema alterno y los del esquema con fin de semana y 3 sesiones de 4 horas durante la misma, alcanzaron diferencia significativa (p < 0,05). Estos mismos datos comparados con el mismo esquema pero con sesiones de 5 horas fueron mejores pero sin alcanzar significación estadística. El gasto farmacéutico en medicación antihipertensiva se redujo en un 87%. Nuestros resultados, empleando el esquema de hemodiálisis en días alternos sin descanso de 72 horas, apoyan experiencias previas (Lecce, Columbia) que consiguen controlar el peso seco tras hacer desaparecer el exceso de volumen acumulado en el fin de semana posibilitando unas tasas adecuadas de ultrafiltración, minimizando la aparición de hipertensión y de los síntomas de intolerancia en hemodiálisis, tan frecuentes en el esquema convencional

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients. We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-otherday dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4hoursx3xweek and 5hoursx3xweek. All three groups received hemodialysis treatment for more than 6 months. A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 ± 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4hx3xweek schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5hx3xweek schedule. There is a significant difference (p < 0,05) between EODD and 4hx3xweek schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5hx3xweek schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences (Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions

Colour vision defects in asymptomatic carriers of the Leber's hereditary optic neuropathy (LHON) mtDNA 11778 mutation from a large Brazilian LHON pedigree: a case-control study.

AIMS: To determine if asymptomatic carriers from a previously identified large pedigree of the Leber's hereditary optic neuropathy (LHON) 11778 mtDNA mutation have colour vision deficits. METHODS: As part of a comprehensive analysis of over 200 members of a large Brazilian LHON pedigree spanning seven generations, colour vision tests were obtained from 91 members. Colour vision was tested one eye at a time using the Farnsworth-Munsell 100 (FM-100) hue colour vision test. The test was administered under uniform conditions, taking into account: ambient light levels, daylight colour temperature of 6700 kelvin, and neutral uniform background. Tests were scored using the FM-100 MS-Excel computer scoring program. Defects were determined and categorised as tritan, deutan, or protan. Categorisation of each dyschromatopsia was based on review of demonstrated axis computer generated plots and age adjusted error scores which coincided with Verriest 95% confidence intervals. Only the axis with the greatest magnitude error score was used to classify the defect. 55 of the 91 test subjects were LHON mtDNA 11778 J haplotype mutation carriers, proved by mtDNA analysis. The remaining 36 subjects were age matched non-blood relatives (off pedigree), who served as controls. RESULTS: 27 of 55 carriers (49.10%) were shown to have colour vision defects in one or both eyes. 13 of the 27 (48%) abnormal tests in the carrier group were tritan defects and the remaining 14 (52%) were deutan defects. Nine of the 27 (33%) abnormals in the carrier group were identified as having bilateral defects. Six of these were deutan, and the remaining three were tritan dyschromatopsias. Only six of the 36 (16.66%) age matched controls were found to have any type of dyschromatopsia. Five (83.3%) of these were deutan defects. The remaining one was a tritan defect. The difference between the two groups using a chi(2) test with one degree of freedom was statistically significant with a p value less that 0.001. CONCLUSIONS: Until now, LHON has always been characterised by a sudden, devastating vision loss. Asymptomatic carriers, those without vision loss, were considered unaffected by the disease. It now appears that asymptomatic carriers of the LHON mutation are affected by colour vision defects and may manifest other subtle, yet chronic, changes.

[Control of arterial hypertension by means of a regimen of hemodialysis on alternate days (HDAA or EODD: "Every Other Day Dialysis") versus 2 conventional regiments of 4 and 5 hours per session 3 times a week with 72 hours without sessions during the weekends]. / Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o EODD: "Every Other Day Dialysis") versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones.

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients.We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-other-day dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4 hours x 3 x week and 5 hours x 3 x week. All three groups received hemodialysis treatment for more than 6 months.A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 +/- 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4h x 3 x week schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5h x 3 x week schedule. There is a significant difference (p < 0,05) between EODD and 4h x 3 x week schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5h x 3 x week schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences(Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions.

[Systemic arterial hypertension in primary chronic glomerulonephritis: prevalence and its influence on the renal prognosis]. / Hipertensión arterial en las glomerulonefritis primarias crónicas biopsiadas: prevalencia e influencia en el pronóstico renal.

UNLABELLED: Nowadays, glomerulonephritis is one of the most common causes of End-stage Renal Disease and starting point of dialysis in Spain. Several factors may influence negatively in this prognosis; among them, we may show up the systemic arterial hypertension. Though its prevalence in the glomerulonephritis is considered higher than in other nephropathies, with variations among series, probably due to difference in ages, in geographical areas, in histological types, in time on evolution of the nephritis ... and because it is difficult to distinguish if the hypertension is a consequence of the nephritis or a consequence of the renal failure that can be present in several cases. In the same way, its negative influence in the renal prognosis may be influenced more by this renal failure, which can be its cause when it is quite severe, than by the hypertension itself. Our aims were to analyse, on the one hand the prevalence of hypertension in the 394 patients diagnosed of primary glomerulonephritis by means of a renal biopsy during two decades in the Bay of Cadiz, as well as its influence in the renal prognosis since the moment of the diagnosis, even with the absence of severe renal failure. We gathered demographic, clinical, analytical and histological data, as well as the situation of the renal function and the survival period of it at the end of each patient study. For the analysis prognosis and renal survival, Kaplan-Meier curves and the long-rank test were used. Of the 394 patients, 247 are men and 147 are women, with an average age of 36.7 +/- 17.7 years old. The global prevalence of hypertension was 39%, with a higher frequency in older patients. The gathered rate of renal survival for hypertensive patients was 54%, 28%, 20% and 4% at 5, 10, 15 and 20 years respectively; while for non-hypertensive patients, it was 83%, 75%, 66% and 62% for the same periods of time (p < 0.001). This worse tendency for hypertensive patients is observed too in each particular histological type, especially in the IgA nephropathy and membranous nephropathy. These results were the same for the patients who did not have severe renal failure in the moment of the biopsy. CONCLUSIONS: Hypertension is a common fact in the primary glomerulonephritis, which also conditions, in an important way, the renal prognosis itself in a long term, from the moment of diagnosis and even before the existence of a significant renal failure.

[Study of the biopsied nephrotic syndrome for 20 years in the Cadiz Bay Area: histological correspondence, renal prognosis and clinical prognostic factors]. / Estudio del síndrome nefrótico biopsiado durante 20 años en la bahía de Cádiz: correspondencia histológica, pronóstico renal y factores clínicos que influyen en el mismo.

AIMS: To analyse the histological correspondence, the renal survival and the clinical prognostic factors in the nephrotic syndrome for more than 20 years in our environment as well as the influence of the nephrotic proteinuria in the renal survival in the different histological particular types of glomerulonephritis. PATIENTS AND METHODS: Among the 542 primary and secondary glomerulonephritis diagnosed by kidney biopsy for two decades in the Cadiz Bay Area, we selected 242 patients whose clinical presentation and the biopsy indication was the nephrotic syndrome. Statistics methods: means +/- typical deviation, percentiles, percentages, Kaplan-Meier curves, long-rank test, student's t-test, chi-square analysis and Cox proportional hazards model test. RESULTS: 242 patients with nephrotic syndrome (44.66% out of the total of glomerulonephritis), average age of 39.15 +/- 18 years old. Average proteinuria 6.75 +/- 4.53 g/day. ETIOLOGY: membranous nephropathy (33.85%), lupus nephritis (14.46%), minimal change disease (11.57%), focal segmental glomerulosclerosis (10.33%), renal amyloidosis (9.95%). 33%, 45%, 63% and 72% of the patients with nephrotic syndrome developed to the End-stage Renal Disease and starting point of dialysis in 5, 10, 15 and 20 years respectively. After the multivariate model, the age older than 60 years old, the high levels of proteinuria and the coexistence with hypertension or renal failure, in the moment of diagnosis, showed to be independents clinical prognostic factors. The nephrotic proteinuria had a negative influence in the prognosis in the different histological types, especially in the IgA nephropathy and the lupus nephritis. CONCLUSIONS: The nephrotic syndrome is the main indication of the renal biopsy in our environment. In general, as an independent group, its development is slowly progressive to the End-stage Renal Disease, having the possibility of being also conditioned by certain clinical factors present in the moment of the biopsy. The presence of nephrotic proteinuria is also a negative factor in the progression in many of the glomerulonephritis.

[Darbepoetin in the treatment of the renal anaemia in the patient undergoing peritoneal dialysis previously treated with epoetin alfa]. / Darbepoetina alfa en el tratamiento de la anemia del paciente en diálisis peritoneal previamente tratado con epoetina alfa.

INTRODUCTION: In 2002, it was contraindicated the use of epoetin alfa by a subcutaneous way to avoid the risk of the pure red cell aplasia in chronic renal failure patients. This forced to change the prescription in the way it was supplied, which was especially problematic in predialysis and peritoneal dialysis, as treating out-patients, that is why it was necessary to change to epoetina beta o darbepoetin, where this contraindication was not established, in order to continue using this way. The darbepoetin has an average lifetime longer than the epoetin. Its efficacy and security have been well studied, especially in pre-dialysis and haemodialysis, but little less in peritoneal dialysis. AIMS: To evaluate our experience about the efficacy and security of darbepoetin alfa, by a subcutaneous way, in our programme of peritoneal dialysis, after the conversion of the patients previously treated with epoetin alfa. PATIENTS AND METHODS: 35 patients. 7 analytical and clinical controls are evaluated, 2 before and 5 after the conversion, with an interval of 6 weeks. Statistics methods: means +/- typical deviation, medians, distribution of frequencies, Wilcoxon test and Friedman test. RESULTS: The change into darbepoetin alfa has been successful in maintaining stable haemoglobin levels in patients in peritoneal dialysis, without meaningful changes in the mean levels of haemoglobin before and after the conversion. The percentage of patients with haemoglobin in the rank 11-13 g/dl (85%) has been higher with the darbepoetin, probably due to the dose increment in the patients with previous levels of haemoglobin less than 11 g/dl. The dosages might have been widely separated (7.5 +/- 3 vs 9.2 +/- 3.2 days). The darbepoetin has been well tolerated, without any important adverse effects. CONCLUSIONS: The conversion of epoetin alfa into darbepoetin alfa in peritoneal dialysis was simple, effective, secure and well tolerated.

[Benefits of every other day dialysis (EODD) without rest for 72 hours in patients with symptomatic cardiovascular disease]. / Beneficios de la hemodiálisis en días alternos sin descanso de 72 horas (EODD: every other day dialysis) en pacientes con enfermedad cardiovascular sintomática.

With the purpose to improve the clinical situation of nine hemodialysis patients who suffer from severe cardiovascular disease and are highly symptomatic after weekends without dialysis because of fluid overload, their dialysis schedule was changed from 5 hours in 3 sessions per week to 4 hours every other day sessions (EODD), avoiding 72 hours of interdialitic weekend period. In each patient, during 38 sessions previous to starting the EODD (stage 1: 3 months) and the 38 sessions in EODD, which followed the first month of this dialysis regime (stage 2), the frequency of the next incidences was registered (ratio in 348 sessions, in every stage, of this patients group): presence of dysnea and/or hypertension pre dialysis session, pre or intra dialysis angor, emergency sessions with hypotension and sessions without achieving predetermined dry-weight. During the EODD stage, sessions, with dysena, hypertension and pre or intra dialysis angor were reduced in 80% (p < 0.001); the incidence of sessions with hypotensive episode or sessions without achieving dry-weight decreased in a third. All patients experimented a considerable improvement in their clinical situation. In addition, the whole group reduced dry-weight and later regained it without presenting symptoms which had motivated EODD schedule. EODD schedule improves the clinical situation in patients with cardiopathy who would not do so when following previous schedule (which includes 48 hours without dialysis).

Darbepoetina alfa en el tratamiento de la anemia del paciente en diálisis peritoneal previamente tratado con epoetina alfa / Darbepoetin in the treatment of the renal anaemia in the patient undergoing peritoneal dialysis previously treated with epoetin alfa

Introducción: En el año 2002 se contraindicó el empleo de epoetina alfa víasubcutánea para minimizar el riesgo de aplasia pura de células rojas. Esto obligóa un cambio de prescripción en su vía de administración, lo que fue especialmenteproblemático en prediálisis y diálisis peritoneal, por tratarse de pacientesambulatorios, siendo necesario cambiar a epoetina beta o darbepoetina, en lasque no se estableció esta contraindicación. La darbepoetina tiene una vida mediasuperior a la epoetina. Su eficacia y seguridad han sido bien estudiadas, sobretodo en prediálisis y hemodiálisis, pero menos en diálisis peritoneal.Objetivos: Analizar nuestra experiencia en cuanto a la eficacia y seguridad deltratamiento con darbepoetina alfa por vía subcutánea para la corrección de laanemia renal en los pacientes del programa de diálisis peritoneal tratados previamentecon epoetina alfa.Material y métodos: Treinta y cinco pacientes en diálisis peritoneal. Se analizanlos parámetros analíticos y los acontecimientos clínicos en 7 controles, 2 antes y5 después de la conversión a darbepoetina, con intervalos de 6 semanas. Estadística:Medias ± ds, medianas, frecuencias, tests de Wilcoxon y Friedman.Resultados: El cambio a darbepoetina alfa ha sido efectivo para mantener valoresde hemoglobina estables en los pacientes en diálisis peritoneal, sin cambiossignificativos en los niveles medios de hemoglobina antes y después de la conversión.El porcentaje de pacientes con hemoglobina en el rango 11-13 g/dl (85%)ha sido mayor con la darbepoetina, probablemente como consecuencia del incrementode la dosis en aquellos pacientes con niveles de hemoglobina previosmenores de 11 g/dl. Aunque no fue objetivo inicial, las dosis han podido ser distanciadas(7,5 ± 3 vs 9,2 ± 3,2 días). La darbepoetina ha sido bien tolerada, sinefectos adversos importantes.Conclusiones: La conversión de epoetina alfa a darbepoetina alfa en diálisis peritonealfue sencilla, eficaz y segura

Introduction: In 2002, it was contraindicated the use of epoetin alfa by a subcutaneousway to avoid the risk of the pure red cell aplasia in chronic renal failurepatients. This forced to change the prescription in the way it was supplied,which was especially problematic in predialysis and peritoneal dialysis, as treatingout-patients, that is why it was necessary to change to epoetina beta o darbepoetin,where this contraindication was not established, in order to continue using thisway. The darbepoetin has an average lifetime longer than the epoetin. Its efficacyand security have been well studied, especially in pre-dialysis and haemodialysis,but little less in peritoneal dialysis.Aims: To evaluate our experience about the efficacy and security of darbepoetinalfa, by a subcutaneous way, in our programme of peritoneal dialysis, after theconversion of the patients previously treated with epoetin alfa.Patients and methods: 35 patients. 7 analytical and clinical controls are evaluated,2 before and 5 after the conversion, with an interval of 6 weeks. Statisticsmethods: means ± typical deviation, medians, distribution of frequencies, Wilcoxontest and Friedman test.Results: The change into darbepoetin alfa has been successful in maintainingstable haemoglobin levels in patients in peritoneal dialysis, without meaningfulchanges in the mean levels of haemoglobin before and after the conversion. Thepercentage of patients with haemoglobin in the rank 11-13 g/dl (85%) has beenhigher with the darbepoetin, probably due to the dose increment in the patientswith previous levels of haemoglobin less than 11 g/dl. The dosages might havebeen widely separated (7.5 ± 3 vs 9.2 ± 3.2 days). The darbepoetin has beenwell tolerated, without any important adverse effects.Conclusions: The conversion of epoetin alfa into darbepoetin alfa in peritonealdialysis was simple, effective, secure and well tolerated

Beneficios de la hemodiálisis en días alternos sin descanso de 72 horas (EODD: Every other day dialysis) en pacientes con enfermedad cardiovascular sintomática / Benefits of every other day dialysis (eodd) on dialysis patients with symptomatic cardiovascular disease

Con el objetivo de mejorar la situación clínica de un grupo de nueve pacientes enhemodiálisis con patología cardiovascular severa, que mantenía síntomas causadospor expansión de volumen con mala tolerancia al fin de semana sin diálisis, cambiamosla pauta de tres sesiones semanales de 5 horas con descanso de fin de semanapor el régimen de hemodiálisis en días alternos con sesiones de 4 horas sin descansode 72 horas en el fin de semana.En cada paciente, durante las 38 sesiones del esquema primitivo previas al inicio dela diálisis alterna (fase 1: 3 meses) y en las 38 sesiones del esquema alterno (fase 2)que siguieron al primer mes de su inicio se registraron las frecuencias por sesión de lasincidencias siguientes: presencia de disnea y/o hipertensión arterial antes de la sesión,angor pre o intradiálisis, sesiones urgentes no programadas, sesiones con hipotensióny sesiones sin lograr el peso seco.Los resultados se expresan en porcentaje de incidencias en 348 sesiones del grupode pacientes en cada fase de los dos esquemas de diálisis.En la fase de hemodiálisis en días alternos las sesiones del grupo con disnea, hipertensióno angor se redujo en un 80% (p < 0,001); las sesiones con al menos una hipotensióny aquellas en las que no se alcanzó el peso seco disminuyeron en un tercio.Todos los pacientes experimentaron una mejoría clínica importante y bajaron elpeso seco para recuperarlo posteriormente sin reaparición de los síntomas que motivaronel cambio de esquema.La hemodiálisis en días alternos es un sistema que mejora la clínica de los pacientescon patología cardiovascular respecto al esquema de 5 horas en 3 sesiones semanalescon dos días sin diálisis

With the purpose to improve the clinical situation of nine hemodialysis patients whosuffer from severe cardiovascular disease and are highly symptomatic after weekendswithout dialysis because of fluid overload, their dialysis schedule was changed from5 hours in 3 sessions per week to 4 hours every other day sessions (EODD), avoiding72 hours of interdialitic weekend period.In each patient, during 38 sessions previous to starting the EODD (stage 1: 3months) and the 38 sessions in EODD, which followed the first month of this dialysisregime (stage 2), the frequency of the next incidences was registered (ratio in 348 sessions,in every stage, of this patients group): presence of dysnea and/or hypertensionpre dialysis session, pre or intra dialysis angor, emergency sessions with hypotensionand sessions without achieving predetermined dry-weight.During the EODD stage, sessions, with dysena, hypertension and pre or intra dialysisangor were reduced in 80% (p < 0.001); the incidence of sessions with hypotensiveepisode or sessions without achieving dry-weight decreased in a third.All patients experimented a considerable improvement in their clinical situation. Inaddition, the whole group reduced dry-weight and later regained it without presentingsymptoms which had motivated EODD schedule.EODD schedule improves the clinical situation in patients with cardiopathy whowould not do so when following previous schedule (which includes 48 hours withoutdialysis)

Influencia de la reacticivad cardiovascular sobre la discriminación del latido cardíaco: implicaciones en la detección precoz de síntomas / Influence of cardiovascular reactivity on heartbeat discrimination: implications for symptom precocious detection

Una respuesta metabólicamente exagerada en personas jóvenes ante situaciones de estrés es considerada como un marcador de riesgo de una futura hipertensión. Asimismo, los autores que investigan las diferencias individuales en la percepción de síntomas consideran que una mayor percepción visceral puede estar asociada con un mejor reconocimiento de síntomas en aquellas personas que padecen enfermedades crónicas con manifestaciones sutiles o vagas, como por ejemplo, la hipertensión esencial. En consecuencia, este estudio examina la relación entre reactividad cardiovascular y percepción del latido cardiaco. Una muestra de 42 sujetos participó en dos sesiones experimentales: en la primera de ellas realizaron una tarea evocadora de reactividad cardiovascular, en la segunda una tarea de discriminación del latido cardiaco mediante el método de los estí- mulos constantes. La reactividad cardiovascular fue definida como la diferencia en puntuación entre una condición de línea base y la condición de tarea. Las variables fisiológicas en las que se midió la reactividad cardiovascular fueron el periodo cardiaco (PC), la presión arterial sistólica (PAS) y la presión arterial diastólica (PAD). Si bien en el total de la muestra se encontraron diferencias significativas en todas las variables fisiológicas entre la condición de línea base y la condición de tarea, el grupo que logró discriminar el latido cardiaco no mostró una reactividad cardiovascular más elevada que el grupo que no logró discriminarlo, al menos en cuanto al periodo cardiaco y a la presión arterial se refiere (AU)

An overstated metabolic response to stressful situations in young persons is considered to be an indicator of hypertension risk. Likewise, some authors suggest that individual differences in symptom perception could be linked to visceral perception. A major visceral perception is usually associated with better symptoms recognition in those persons who experience chronic diseases with subtle or vague manifestations, as for example, the essential hypertension. This study is focused on the relation between cardiovascular reactivity and heartbeat perception. Forty two subjects performed two experimental sessions: the first one was an active coping computerized stress task; the second one, a heart beat discrimination task. Physiological variables used to measure cardiovascular reactivity, defined as difference scores between baseline and task condition, were: cardiac period, systolic and diastolic blood pressure. There were significant differences in all physiological variables between baseline and task, but the group of good heart beat discriminators did not show cardiovascular reactivity scores higher than the group that was unable of heart beat discrimination, at least as cardiac period and blood pressure are concerned (AU)

[Diagnostic accuracy of frequency doubling perimetry]. / Precisión diagnóstica de la perimetría de duplicación de frecuencia.

PURPOSE: To evaluate the capacity of Frequency Doubling Perimetry (FDP) to classify normal subjects and patients with glaucoma. TYPE OF STUDY: cross sectional. 54 glaucoma patients (mean age 65 S.D. 9.3 years) and 54 normal subjects matched in age (64.2 S.D. 9.8 years) were examined. Normal subjects showed an intra-ocular pressure (IOP) of 21 mmHg, a glaucomatous optic nerve and a glaucomatous standard perimetry. One eye per patient was selected at random. All were examined using FDP C-20-5 and N-30 programs. Sensitivity, specificity and receiver operating feature curves (ROC) for N-30 parameters were calculated. A quantitative correlation with standard perimetry (Pearson) was calculated as well. RESULTS: Sensitivity and specificity for C-20-5 resulted in 74% and 96% respectively and 88% and 92% respectively for N-30. ROC area for mean deviation was 0.85 and 0.93 for the standard pattern deviation. Standard deviation in the FDP pattern showed a strong linear correlation with the Humphrey 24-2 standard deviation pattern (r(2)= 0.76, P<0.001). CONCLUSIONS: The FDP N-30 could classify normal and glaucoma subjects with a high sensitivity and specificity. There was strong correlation between FDP and standard perimetry parameters.

Precisión diagnóstica de la perimetría de duplicación de frecuencia / Diagnostic accuracy of frequency doubling perimetry

Objetivo: Evaluar la capacidad de la Perimetría de Duplicación de Frecuencia (FDP) para clasificar sujetos normales o glaucomatosos. Método: Diseño: estudio transversal. Se examinaron 54 sujetos con glaucoma (edad media 64,5 D.S. 9,3 años) y 54 sujetos normales empatados para la edad (64,2 D.S. 9,8 años). Los sujetos normales tenían presión intraocular (PIO) 21 mmHg, nervio óptico glaucomatoso y perimetría estándar glaucomatosa. Se seleccionó aleatoriamente un ojo de cada sujeto. Todos fueron examinados con los programas C-20-5 y N-30 de la FDP. Se calcularon la sensibilidad y especificidad de cada programa, las curvas de características operativas (ROC) para los índices del N-30, y la correlación cuantitativa con la perimetría estándar mediante el test de Pearson. Resultados: Los valores de sensibilidad y especificidad para el programa C-20-5 fueron del 74 por ciento y 96 por ciento, respectivamente, y para el N-3O, del 88 por ciento y 92 por ciento, respectivamente. El área ROC para la desviación media fue de 0,85, y para la desviación estándar del patrón (DEP), 0,93. Se obtuvo una correlación lineal significativa entre los índices DEP del N-30 y desviación estándar de la media del Humphrey (r2= 0,76, p<0,001). Conclusión: El programa N-30 de la FDP clasificó los casos normales y los glaucomas con elevada sensibilidad y especificidad. Se obtuvo una elevada correlación entre los índices de la FDP y de la perimetría estándar (AU)

Corneal sensation after laser in situ keratomileusis.

PURPOSE: To report the time course for the return of corneal sensation following laser in situ keratomileusis (LASIK). SETTING: University-based retractive surgery practice. METHODS: Twenty-eight eyes of 18 patients having LASIK were evaluated. Preoperative and postoperative corneal sensation at the nasal flap hinge, at the central cornea, and within the temporal flap edge were measured before and after LASIK for a 3 week period using the Cochet-Bonnet esthesiometer (Luneau). RESULTS: Corneal sensation initially decreased in all 3 positions of the flap measured after LASIK; the greatest decrease was in the central cornea. Near preoperative corneal sensation returned by 3 weeks. The degree of sensation loss did not appear to correlate with the ablation depth. CONCLUSION: Corneal sensation is significantly decreased for approximately 2 to 3 weeks after LASIK, centrally greater than nasally at the flap hinge or temporally within the flap edge, but it generally returns to near the preoperative level by 3 weeks postoperatively.

Total skin electron beam therapy followed by adjuvant psoralen/ultraviolet-A light in the management of patients with T1 and T2 cutaneous T-cell lymphoma (mycosis fungoides).

PURPOSE: Patients with mycosis fungoides [cutaneous T-cell lymphoma (CTCL)] may benefit from adjuvant therapy after completing total skin electron beam therapy (TSEBT). We report the results for T1/T2 CTCL patients treated with adjuvant oral psoralen plus ultraviolet light (PUVA) with respect to overall survival (OS), disease-free survival (DFS), salvage of recurrence, and toxicity. METHODS AND MATERIALS: Between 1974 and 1993, TSEBT was administered to a total of 213 patients with CTCL. Records were reviewed retrospectively, and a total of 114 patients were identified as having T1 or T2 disease. Radiotherapy was provided via a 6-MeV linac to a total of 36 Gy, 1 Gy/day, 4 days/week, for 9 weeks. Beginning in 1988, patients were offered adjuvant PUVA within 2 months of completing TSEBT. This was started at 0.5-2 J/m2, 1-2 treatments/week, with a taper over 3-6 months. Therapy then continued once per month. There were 39 T1 and 75 T2 patients. Six T1 (15%) and eight T2 (11%) patients were treated with adjuvant PUVA. A further 49% of the 114 patients received adjuvant systemic therapy, 3% received spot external beam, 4% received adjuvant ECP, 2% received topical nitrogen mustard, 22% received a combination of therapies exclusive of PUVA, and 9% received no adjuvant therapy. Patients were balanced in all subgroups based on pre-TSEBT therapy. The median age of the cohort was 58 (range 20-88), with a median follow-up time of 62 months (range 3-179). RESULTS: Within 1 month after completing of TSEBT, 97% of T1, and 87% of T2 patients had achieved a complete remission. Stratified by adjuvant therapy, none of six T1 and one of eight T2 patients who received adjuvant PUVA failed within the first 3 years after completion of TSEBT. A total of 43% of the T1 and T2 patients receiving other or no adjuvant treatment failed within the same time course. The 5-year OS for the entire cohort was 85%. Those who received PUVA had a 5-year OS of 100% versus a 5-year OS for the non-PUVA group of 82% (p < 0.10). The 5-year DFS for the entire cohort was 53%. Those who received PUVA had a 5-year DFS of 85% versus a 5-year DFS for the non-PUVA group of 50% (p < 0.02). By T stage, those with T1 receiving PUVA exhibited no relapses, whereas those with T1 not treated with PUVA had a crude relapse rate of 36%. Median DFS was not reached at 103 months for the T1 adjuvant PUVA patients versus 66 months for the non-PUVA patients (p < 0.01). For those with T2, crude relapse rates were 25% and 55%, respectively, with DFS of 60 (median DFS not reached) and 20 months (p < 0.03). The 5-year DFS for patients salvaged with PUVA was 50%. Toxicity of adjuvant and salvage PUVA therapy was acceptable, with only two patients requiring a reduction in PUVA dosage. CONCLUSION: PUVA can maintain remissions in patients with CTCL after TSEBT. There is a significant benefit in DFS but no statistically significant improvement in OS. Prospective, randomized data are needed to confirm these results. PUVA is also effective as a salvage therapy after TSEBT in early-stage patients with recurrence, with acceptable toxicity.

Searching for a predictive peripherical biological model in parasuicidal behaviour.

The aim of this study was to identify possible peripheral biological markers (both lipidic and hormonal) which can be easily used for the early detection of parasuicidal behaviour and to propose a predictive biological model of such behaviour. A case-control analytical study was undertaken at least 3 months after attempted suicide. Study was made of 128 patients who presented at the University General Hospital of Oviedo (Spain) with signs of self-intoxication. Lipidic and hormonal profiles were measured under basal conditions and comparison was made with a control group of healthy volunteer donors obtained from the Oviedo General Hospital blood bank. A discriminant analysis was later made with the aim of establishing a predictive biological model. This included the following variables: cholesterol, HDL-C, LDL-C and cortisol. Sensitivity and specificity were 62.5% and 65.6%, respectively. Replication and improvement of this model, through other prospective studies, could lead to the use of serum cholesterol and cortisol levels as inexpensive and readily available markers of suicide risk.