Gingival neoplasms: a multicenter collaborative study of 888 patients in Brazil.

BACKGROUND: To evaluate the prevalence and clinicopathological features of a large series of gingival neoplasms in Brazil. MATERIAL AND METHODS:  All gingival benign and malignant neoplasms were retrieved from the records of six Oral Pathology Services in Brazil, during a 41-year period. Clinical and demographic data, clinical diagnosis, and histopathological data were collected from the patients' clinical charts. For statistical analysis, the chi-square, median test of independent samples and the U Mann-Whitney tests were used, considering a significance of 5%. RESULTS:  From 100,026 oral lesions, 888 (0.9%) were gingival neoplasms. There were 496 (55.9%) males, with a mean age of 54.2 years. Most cases (70.3%) were malignant neoplasms. Nodules (46.2%) and ulcers (38.9%) were the most common clinical appearance for benign and malignant neoplasms, respectively. Squamous cell carcinoma (55.6%) was the most common gingival neoplasm, followed by squamous cell papilloma (19.6%). In 69 (11.1%) malignant neoplasms, the lesions were clinically considered to be inflammatory or of infectious origin. Malignant neoplasms were more common in older men, appeared with larger size, and with a time of complaint shorter than benign neoplasms (p<0.001). CONCLUSIONS:  Benign and malignant tumors may appear as nodules in gingival tissue. In addition, malignant neoplasms, especially squamous cell carcinoma, should be considered in the differential diagnosis of persistent single gingival ulcers.

A Survival Analysis of Living Donor Kidney Transplant.

BACKGROUND: Superior patient and graft survival rates have been attributed to living donor kidney transplant (LDKT) when compared to deceased donor transplantation. The aim of this study was to assess graft survival in a population of LDKT in the last 14 years and the potential impact of some clinical features. METHODS: A retrospective observational study was conducted, reviewing the records of all patients undergoing LDKT in one center from January 1, 2004, to December 31, 2017. Survival data were evaluated by Kaplan-Meier, log rank test, and Cox regression. RESULTS: Two hundred seventy-seven LDKT were performed. The median follow-up time was 4 (0-13) years. Graft loss was observed in 9% of patients; 4 patients died. The overall survival was 97% at year 1, 94% at year 5, and 83% at years 10 and 13. We found a significantly worse graft survival in patients with early vascular complications that required surgical intervention (P = .00) ≥3 HLA MM (P = .01), ≥1 HLA-DR MM (P = .04) and female recipients (P = .01). The negative impact of ≥1 HLA-B MM on survival was borderline (P = .05). After excluding early graft losses secondary to vascular events, ≥1 HLA-A MM and rejection have also implicated a negative impact on survival (P = .04 and .01, respectively). In the multivariate analysis, these variables were still related to inferior survival. CONCLUSIONS: We observed a good overall graft survival (>80% after 13 years). Possible factors related to poor outcomes suggested by this study were early vascular complications; HLA mismatches; rejection; and, with less certainty, female recipients.

Lower airway flow influences peak nasal inspiratory flow in school-aged children.

BACKGROUND: Rhinitis and asthma frequently coexist. Peak nasal inspiratory flow (PNIF) objectively evaluates nasal obstruction. Lower airway flow's impact on PNIF has seldom been analysed in children. We aimed to study the associations between PNIF and: 1)forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in children with allergic rhinitis and asthma and healthy controls; 2)allergic rhinitis and asthma control subjective evaluation. METHODS: Sequential assessments of PNIF before and after nasal decongestion and spirometry with bronchodilation test were performed in 65 children (6-12 years) with allergic rhinitis and asthma, and 24 gender, age-matched healthy controls. The Control of Allergic Rhinitis and Asthma Test in children (CARATkids) was used for control assessment. Associations were investigated by multiple linear regression models. RESULTS: Baseline and decongested PNIF correlated with baseline and post-bronchodilation FEV1 and PEF, observed independently of rhinitis and asthma diagnosis. The best model for PNIF included PEF, age and gender. No association was found between PNIF and CARATkids scores, except for nasal obstruction self-report. CONCLUSION: In school-aged children, besides age and gender, PEF values should ideally be known to interpret PNIF values. PNIF can be complementary to subjective control assessment in children with allergic rhinitis and asthma.

Participation of osteoclastogenic factors in immunopathogenesis of human chronic periapical lesions.

BACKGROUND: Chronic periapical lesions (CPLs) are common lesions of the oral cavity and are the result of caries, tooth fracture, iatrogenic causes, or factors causing contamination and pulp necrosis. Inflammatory cells participate in the expansion of CPLs by releasing factors that stimulate or inhibit osteolytic activity. The objective of this study was to investigate the participation of RANKL, TNF-α, cathepsin K, IL-33, and OPG in the development of radicular cysts (RCs) and periapical granulomas (PGs). METHODS: Paraffin-embedded sections of 30 RCs and 22 PGs were submitted to immunohistochemistry. RESULTS: Immunoexpression of the proteins studied was observed in the epithelium and capsule of RCs, as well as in connective tissue of PGs. The expression of the osteoclastogenic factors studied differed significantly in RCs and PGs (P < .001), with lower expression of OPG in RCs. In PGs, the lowest expression was observed for cathepsin K. Comparison of the 2 lesions showed a similar participation of RANKL and IL33, while a significant difference was observed for OPG (P < .001), TNF-α (P = .002), and cathepsin K (P = .016). No association of the expression of the proteins with lesions size was observed. CONCLUSIONS: This study demonstrated the participation of RANKL, TNF-α, IL-33, cathepsin K, and OPG in the development of RCs and PGs, with emphasis on the highest immunoreactivity of cathepsin in RCs and TNF-α and OPG in PGs. OPG possibly determines the slower growth of PGs compared to RCs.

Conversion From Twice-Daily to Once-Daily Tacrolimus in Stable Kidney Graft Recipients.

INTRODUCTION: Immunosuppression has a pivotal role in kidney transplantation. The new prolonged-release formulation of tacrolimus was developed to provide a more convenient once-daily dosing to improve patient adherence. METHODS: We selected 60 stable kidney transplant recipients who underwent tacrolimus conversion in our unit. Conversion was made on a 1 mg:1 mg basis in 66.7% of patients (n = 40) and on a 1 mg:1.1 mg basis in the remaining 33.3% (n = 20). Clinical and analytical data at conversion and postconversion was analyzed retrospectively to evaluate the efficacy and safety of conversion from tacrolimus twice-daily to once-daily formulation. RESULTS: A significant reduction in tacrolimus blood levels requiring an increase in tacrolimus daily dose was observed postconversion. Postconversion tacrolimus blood level reduction >25% was significantly higher in the conversion group 1 mg:1 mg basis (P = .004). In patients converted 1 mg:1 mg, female sex and higher tacrolimus level at conversion were significant risk factors for a reduction >25% in tacrolimus blood levels after conversion. No significant change was detected between mean glomerular filtration rate at conversion (57 mL/min) and at 3, 6, and 9 months postconversion. CONCLUSIONS: Once-daily tacrolimus at similar doses to the twice-daily formulation is an efficient and safe treatment option. Conversion made on 1 mg:1.1 mg basis seems advantageous at least in some patients.

The influence of fetal growth restriction on cardiovascular health among adolescents in Brazil: a retrospective cohort study.

OBJECTIVE: To investigate whether fetal growth restriction is associated with changes in cardiovascular risk factors later in life. DESIGN: A retrospective cohort study. SETTING: Tertiary-care hospital serving urban population from the Brazilian Northeast. PARTICIPANTS/PATIENTS: 172 adolescents aged 10-20 years were evaluated for the effects of fetal growth restriction on anthropometric measurements, blood pressure, lipids and fasting glucose and flow-mediated brachial artery dilatation. INTERVENTION: The adolescents' birth weight and their gestational age at birth were used to identify fetal growth restriction according to the 10th percentile and divided between exposed (<10th percentile) and not exposed (≥10th percentile). The Student-t test or the Mann-Whitney test and chi-square were used. The significance level was considered to be 0.05. MAIN OUTCOME MEASURE(S): Current Anthropometric, metabolic and endothelial measures of subjects. RESULTS: The majority of the current anthropometric, metabolic and endothelial measures did not differ between groups. The unexposed group had a higher hip circumference (89.1 cm) and higher total cholesterol (196.4mg/dL) than those exposed (85.4 cm, 136.9mg/dL, respectively) (P=0.04). CONCLUSIONS: In the sample studied, no association was found between fetal growth restriction and changes in cardiovascular risk factors in adolescents.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A3 and COL4A4 mutations and clinical characterization of 25 families.

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in >50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A5 mutations and clinical characterization of 22 families.

Alport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies.

Kidney transplantation across a positive crossmatch: a single-center experience.

BACKGROUND: Kidney transplantation is the treatment of choice for end-stage renal disease, with improved mortality and quality of life compared with dialysis. Desensitization protocols have allowed kidney transplantation of highly sensitized patients, who have a lower probability to receive a matching kidney from a deceased or living donor. The aim of this work was to analyze the post-transplantation period of highly HLA-sensitized patients with positive flow cytometry crossmatch against donor cells. METHODS: Following an observational, retrospective design, we investigated 16 highly sensitized patients who underwent kidney or kidney-pancreas transplantation, assessing the impact of desensitization protocols and investigating treatment-related complications, graft function, antibody-mediated rejection (AMR) rate, and graft and patient survivals. RESULTS: We studied 16 patients with positive flow cytometry crossmatch, who were divided into 2 groups based on whether they were submitted to a desensitization protocol or not. Patients who were desensitized underwent transplantation in later years, had higher immunologic risk (panel reactive antibody peak 62% vs 33%; P = .038), higher percentage of 2nd kidney transplant (75% vs 25%; P = .066), and higher percentage of donor-specific anti-HLA antibodies identified (P = .028). A majority of patients were desensitized with high-dose intravenous immunoglobulin and plasmapheresis, and 5 patients received rituximab. Acute AMR rate was of 38%, and rituximab was associated with fewer episodes of AMR. Only 1 patient had graft failure, due to chronic humoral rejection, and the remaining maintained good graft function (mean serum creatinine value of 1.33 mg/dL). No patient died and few complications related to immunossupression were observed. CONCLUSIONS: Desensitization protocols were safe and allowed kidney transplantation in highly sensitized patients that probably would never undergo transplantation and gave the opportunity of living-donor transplant to patients with anti-HLA antibodies against the donor.

Predictive factors of graft-censored failure in pediatric kidney transplantation.

Kidney transplantation in children has shown steady improvement in graft survival outcome over the last decades. Using data obtained from the transplantation registry of our center between 1984 and 2012, we assessed the independent determinants of graft failure using the Cox proportional hazards regression. Altogether, 128 recipients younger than 18 years of age at the time of kidney transplantation and who had >3 months graft survival were studied. During 9.95 years of medium follow-up, 27 censored graft failures occurred. Censored graft survival rates at 5, 10, 15, and 20 years post-transplantation were 93%, 82%, 70%, and 63%, respectively. Studied factors included recipient and donor age, recipient gender, dialysis vintage, donor/recipient cytomegalovirus (CMV) serology, panel-reactive antibody percentage, human leukocyte antigen mismatching, previous transplantation number, donor type (deceased vs living donation), cold ischemia time, induction therapy with antithymocyte globulin, occurrence of acute tubular necrosis, and development of acute rejection. Using univariate analysis, the significant predictors for graft-censored failure were adult donor (P < .001), recipient age (P = .035), human leukocyte antigen mismatching (P = .025), antithymocyte globulin induction (P = .03), and development of acute rejection (P < .001). Two factors independently predicted graft-censored failure in multivariate analysis. The odds ratios for graft failure in patients with acute rejection and in children who received an organ of an adult were 3.744 and 4.962, respectively. Pediatric recipients should receive the first priority for allografts from pediatric donors and acute rejection should be meticulously prevented.

Keratocystic odontogenic tumour arising as a periapical lesion.

AIM: To document a case of a keratocystic odontogenic tumour (KOT) involving the apical region in the maxilla mimicking a periapical lesion of endodontic origin. SUMMARY: Benign and malignant tumours, including odontogenic lesions, can be erroneously diagnosed as periapical radiolucencies. KOTs mimicking periapical lesions of endodontic origin are uncommon, especially when the lesions involve the maxilla. This article describes a 55-year-old man with a well-delimited, oval-shaped, radiolucent lesion, occupying the middle and apical third of teeth 22 and 23. After 30 days, the clinical and radiographic findings remained unchanged and the patient was referred for surgical removal of the lesion. Clinical, radiographic and histopathological features are also discussed and compared with current literature.

Kidney transplantation in type 2 diabetic patients: a matched survival analysis.

BACKGROUND: Diabetes mellitus (DM) is the most prevalent cause of kidney failure. Some concerns have been raised about the kidney transplantation (KT) results in diabetic patients. Therefore, we compared outcomes between diabetic and non-diabetic KT patients. METHODS: We included all KT performed in type 2 diabetic patients in our center from July 1983 to December 2009 with graft survivals beyond 3 months. Nondiabetic controls were individually matched with diabetic patients with respect to gender, age, year of transplantation, number of donor HLA mismatches, and dialysis vintage. The two groups were compared concerning patient and graft survivals, delayed graft function (DGF), and prevalence of acute rejection episodes (ARE). RESULTS: The 62 diabetic and 62 nondiabetic patients had a mean follow-up after KT of 102 ± 64 months. Diabetic patients and controls were similar for the matched variables. Death censored graft survivals of diabetics versus nondiabetics were 70% and 83% at 5 years and 54% and 71% at 10 years, respectively (P = .13). Patient survivals at 5 and 10 years were 69% and 50% for diabetic versus 96% and 84% for nondiabetic patients, respectively (P < .001). The prevalence of ARE and DGF did not differ (chi-squared test, P = .12). Multivariate Cox's proportional hazards analysis revealed DM (hazard ratio [HR] 7.72; P = .001) and viral hepatitis (HR = 4.18; P = .02) to correlate with reduced patient survival. CONCLUSION: Survival of diabetic patients after KT was reduced but death-censored graft outcomes were similar compared with matched nondiabetic patients. Concerns about graft survival should not prevent KT for diabetic patients with kidney failure.

Cardiovascular risk factors and events in pancreas-kidney transplants.

Cardiovascular and cerebrovascular disease (CCVD) are major causes of morbidity and mortality among patients with diabetes. Strict control of treatable risk factors that contribute to atherosclerosis is important to reduce the risk of stroke, myocardial infarction, and peripheral arterial disease. Simultaneous pancreas-kidney transplantation (SPKT) may significantly improve these risk factors in patients with type 1 diabetes. We studied 103 SPKT from our center with both organs functioning for metabolic and hypertensive control; body mass index (BMI); immunosuppression; and CCVD events. The 53 females/50 males showed a mean age of 35 ± 6 years, diabetes for 24 ± 6 years, and on dialysis for 31 ± 23 months. The follow-up ranged from 6-142 months. Mean value of last creatinine clearance was 76 ± 24 mL/min, all 103 SPKT were insulin-independent with mean glycemia = 81 ± 10 mg/dL and hemoglobin A1c (HbA1c) = 5.3% ± 0.4%. All of them were under tacrolimus treatment; 9.7% also with sirolimus but 67% steroid-free. According to the National Cholesterol Education Program Adult Treatment Panel 3 criteria, 4 patients showed a fasting glucose > 100 mg/dL; only one, HbA1c > 5.6%. Hypertension was recorded in 38.5%; low high-density lipoprotein cholesterol in 19.4%; hypertriglyceridemia in 7.8%; BMI > 30% in only 2 patients; 21.4% were prescribed statins. We registered cardiovascular events in 7 patients (6.8%). Patients with steroid treatment showed higher triglycerides (122 ± 53 vs 90 ± 36 mg/dL; P = .001) and more often tended to be hypertensive (41.2% vs 37.7%, P = .073) compared with those free of these drugs. Hypertension was associated with an higher BMI (24.1 ± 2.8 vs 22.3 ± 2.9 kg/m(2), P = .002). BMI > 25% was associated with higher total cholesterol (195 ± 47 vs 169 ± 28 mg/dL, P = .015) and low-density lipoprotein cholesterol (116 ± 40 vs 96 ± 27 mg/dL, P = .003). Among our SPKT the prevalences of CCVD and metabolic syndrome were low. Hypertension was the most frequent single factor. Obesity was rare. In patients on steroids, hypertriglyceridemia was more prevalent and hypertension tended to be more frequent. Hypertensive patients showed a higher BMI, which correlated with a worse lipid profile. Steroid withdrawal, whenever possible, may be important to achieve metabolic goals and minimize cardiovascular risk.

Pregnancy after kidney transplantation: graft, mother, and newborn complications.

An important benefit associated with kidney transplantation (KT) in women of childbearing age is increased fertility. We retrospectively evaluated the complications associated with 24 pregnancies among our KT over 28 years. In particular, we examined the evolution of serum creatinine as well as maternal and fetal complications. To assess the impact on graft survival, our control group included women without pregnancy who were matched for age at KT, year of KT, and follow-up time. Most women (79.2%) were primiparous. All were prescribed a calcineurin inhibitor, which in 75% of the cases was cyclosporine. Overall, 45.8% had prior hypertension, only one of whom remained on the previous antihypertensive regimen. The drugs most often used were nifedipine and methyldopa. The median age at time of KT was 24.16 (interquartile range [IQR] 21.33 to 29.72) years and at delivery, 28.39 (IQR 25.59 to 33.88) years. The average interval between KT and delivery was 4.5 ± 2.7 years (range, 1 to 10 years). Maternal complications were anemia (n = 16), graft pyelonephritis (n = 6), preeclampsia (n = 6), de novo proteinuria > 1 g/d (n = 3), or gestational diabetes mellitus (n = 2). There was no acute rejection episode or opportunistic infection. The fetal complications included delayed intrauterine growth (n = 8), preterm deliveries (n = 13), or congenital enzymatic deficit (n = 1). One case was a twin pregnancy. The average gestational age was 35.2 ± 3 weeks, and the mean birth weight 2318.2 ± 597.1 grams. In 16 pregnancies, deliveries were performed by caesarean section. The median serum creatinine at 1 month before conception was 1.20 (IQR 0.97 to 1.37) mg/dL and at 1 year after delivery it had tended to increase to 1 to 20 (IQR 1.03 to 1.50) mg/dL. Death-censored graft survival did not differ from the control group. In conclusion, pregnancy after KT may be associated with serious maternal and fetal complications. We did not observe an increased risk of graft loss.

Noncutaneous neoplasms after kidney transplantation: analysis at single center.

Malignancy is the third most cause of death among kidney transplantation recipients after cardiovascular events and infection. The aim of this study was to investigate the types of and risk factors for cancer excluding skin lesions among kidney transplantation (KT) patients in Portugal. We studied retrospectively the 1695 patients who underwent KT between 1983 and 2009. Malignancies post-KT were considered if diagnosed at least 1 year after KT. The results were compared with a group of cancer free patients. During the follow-up period to June 2010, which included a median duration of 118.49 months (interquartile range 53.34 to 182.46), 60 patients (3.5%) developed 66 malignancies, which were the cause of death in 17. Compared with patients without cancer, the affected ones were older (P < .001), and had a longer duration of graft function (P = .002). There were no significant differences regarding gender, follow-up time, actue rejection episodes, donor type, number of KT, immunosuppressive regimen. The most frequent malignancy was colorectal cancer (21.2%), followed by malignant lymphoma (16.7%) and breast cancer (13.6%). The mean age of patients at diagnosis was 53.9 ± 11.5 years. The average time for development of a cancer was 8.3 ± 5.7 years with 42.4% detected between 1 and 5 years. In total, 16 patients were converted to sirolimus. Patient survival was significantly lower among subjects with cancer; censored graft survival was significantly higher in this group. A multivariate logistic regression analysis identified risk factors for malignancy post-KT to be recipient age and duration of follow-up. In conclusion, our data showed a significant number of tumors that generally not described to be higher lesions among KT. We achieved an early diagnosis and a lack of impact on death-censored graft survival.

Quality of life assessment in a living donor kidney transplantation program: evaluation of recipients and donors.

BACKGROUND: Quality of life (QOL) in donors before and after living kidney donor transplantation (LKDT) has been an important concern. Investigation of these issues in related recipients is not as common. Since 2002, a protocol of psychosocial evaluation for donors and recipients was included in the living kidney donation program. We sought to evaluate QOL in donors and recipients, before and after transplantation, and to compare the 2 groups. METHODS: Before and after transplantation, 35 recipients and 45 donors completed a Sociodemographic Questionnaire and Short-Form 36 Health Survey Questionnaire (SF-36). The Wilcoxon test, Mann-Whitney test, and logistic regression were applied. RESULTS: Before transplantation, recipients had lower QOL values than donors for all dimensions (P < .05), with the exception of Mental Health. After transplantation, they had higher values (P < .05) for every dimension on the SF-36. Among donors, there were no significant changes. Physical function and social function were considered poorer by donors versus recipients (P < .05). CONCLUSIONS: In this LKDT program, more females were donors and fewer were recipients. Most of donors were siblings. All donors were related (the Portuguese law pertaining to unrelated donation was enacted in 2007). QOL was significantly poorer among recipients before surgery. After surgery, QOL significantly improved in recipients and was not poorer in donors. LKDT improved recipients' lives and did not affect donors' negatively.

Analysis of the frequency and nature of hyaline ring granulomas in inflammatory odontogenic cysts.

AIM: To determine the prevalence of hyaline ring granulomas (HRGs) in a large case series of inflammatory odontogenic cysts, and to investigate the nature of these structures. METHODOLOGY: All records from the patients diagnosed with inflammatory odontogenic cysts between January 1970 and April 2009 were reviewed. Histologic sections were evaluated by light microscopy and cases with HRGs for which sufficient biological material was available were submitted to histochemical analysis (Masson's trichrome) and immunohistochemistry (CD34, CD68 and collagen IV). RESULTS: Twenty-two (3.3%) of the 661 cases of inflammatory odontogenic cysts diagnosed during the study period presented HRGs. The relative frequency of HRGs was higher amongst residual radicular cysts (6.1%), followed by paradental cysts (5.6%) and radicular cysts (3.0%). HRGs appeared as roughly circular homogeneous/fibrillar masses in 14 (63.6%) cases and as round structures enclosing amorphous material in 3 (13.6%) cases. Most (77.8%) roughly circular homogeneous/fibrillar masses were positive for collagen, whereas all (100.0%) round structures enclosing amorphous material were negative for this protein. Immunohistochemistry showed that most mononucleated cells and all multinucleated giant cells were positive for CD68, but negative for CD34, in all cases. In addition, collagen IV immunostaining was negative in amorphous structures and weakly positive in homogeneous/fibrillar masses. CONCLUSIONS: The present results suggest a very low frequency of HRGs in inflammatory odontogenic cysts and support the hypothesis that these structures arise from the implantation of foreign material, most likely food particles of plant or vegetable origin. The diverse microscopic features of HRG possibly represent different developmental stages of this structure.

A comparison between serum creatinine and cystatin C-based equations for estimation of graft function.

BACKGROUND: Accurate monitoring of estimated glomerular filtration rate (GFR) is essential for an optimal management of kidney transplant (KT) patients. We aimed to compare the predictive performance of creatinine- and cystatin C-based GFR with creatinine clearance (CCr) in a 24-hour urine collection as the reference test. METHODS: GFR was calculated using cystatin C-based equations (Le Bricon, Stevens) and two creatinine-based equations [Cockcroft-Gault (CG), modification of diet in renal disease (MDRD)]. We enrolled 173 KT recipients. Bias, precision, and accuracy of each equation were determined. Kappa statistics evaluated the concordance between the reference test and GFR formulas in classifying patients according graft function (CCr <60 or ≥60 mL/min/1.73 m2). RESULTS: Patients (108 males) had a mean age of 48.6 ± 12.2 years and a median posttransplant time of 6.8 years. Mean CCr was 69.3 ± 19.9 (range: 32.1-105.2) mL/min/1.73 m2. The cystatin C-based equations estimates (Le Bricon, Stevens) had the highest accuracy (83.8% and 87.9% within 30% of CCr result, respectively). Precision of Le Bricon, Stevens, and MDRD was similar (around 13.5 mL/min/1.73 m2)) and much better than CG (22.5 mL/min/1.73 m2). The lowest bias was seen in Le Bricon (-1.2 mL/min/1.73 m2), followed by CG, Stevens, and MDRD (-2.6, -9.5, -16.5 mL/min/1.73 m(2), respectively). Kappa coefficient was higher in cystatin C-based equations (0.53) in contrast with CG (0.48) and MDRD (0.40). Stevens had a high sensitivity (90.8%) and low specificity (66.7%) and, conversely, Le Bricon had 64.6% sensitivity and 87.0% specificity. CONCLUSIONS: Cystatin C-based equations showed a better predictive performance of graft function than creatinine-based equations. The role of cystatin C in graft function monitoring deserves further investigation.

Hyperuricemia in adult renal allograft recipients: prevalence and predictors.

BACKGROUND: Hyperuricemia is a common complication after kidney transplantation that may adversely affect graft survival. OBJECTIVE: Our aim was to determine the prevalence of hyperuricemia in a sample of adult kidney graft recipients and to investigate its predictors. METHODS: A total of 302 patients were included in the study. We used univariate analyses to compare clinical characteristics between the hyper-and normouricemic groups. We used multivariate adjusted logistic regression to detect independent predictors of hyperuricemia. Hyperuricemia was defined as serum uric acid ≥6.5 mg/dL in women and ≥7.0 mg/dL in men or allopurinol use. RESULTS: The patients had a mean age of 49.6 ± 13.4 years, a median posttransplantation time of 7.6 years, and a mean estimated glomerular filtration rate (eGFR) of 51.9 ± 18.46 mL/min. The prevalence of hyperuricemia was 42.1% (n = 127). Hyperuricemic patients were predominately male (P = .004), older (P = .038), and with lower eGFR (P < .001). They also had a higher prevalence of hypertension (P = .001), dyslipidemia (P = .004) and proteinuria (P = .001). Multivariate adjusted regression model showed as significant predictors of hyperuricemia: male gender (odds ratio [OR], 2.46; P = .002); impaired renal function (OR 1.33 for every 10 mL/min reduction in eGFR; P < .001), higher body weight (OR 1.09 for every 1 kg/m(2) increase of body mass index; P = .044), prednisolone use (OR 2.12; P = .035), and cyclosporine versus tacrolimus use (OR 2.44; P = .039). CONCLUSIONS: The prevalence of posttransplant hyperuricemia was high, particularly in patients with classical cardiovascular risk factors and lower eGFR. However, our findings suggest that modifiable immunosuppression options could play a role in its management.