The usability of daytime and night-time heart rate dynamics as digital biomarkers of depression severity.

BACKGROUND: Alterations in heart rate (HR) may provide new information about physiological signatures of depression severity. This 2-year study in individuals with a history of recurrent major depressive disorder (MDD) explored the intra-individual variations in HR parameters and their relationship with depression severity. METHODS: Data from 510 participants (Number of observations of the HR parameters = 6666) were collected from three centres in the Netherlands, Spain, and the UK, as a part of the remote assessment of disease and relapse-MDD study. We analysed the relationship between depression severity, assessed every 2 weeks with the Patient Health Questionnaire-8, with HR parameters in the week before the assessment, such as HR features during all day, resting periods during the day and at night, and activity periods during the day evaluated with a wrist-worn Fitbit device. Linear mixed models were used with random intercepts for participants and countries. Covariates included in the models were age, sex, BMI, smoking and alcohol consumption, antidepressant use and co-morbidities with other medical health conditions. RESULTS: Decreases in HR variation during resting periods during the day were related with an increased severity of depression both in univariate and multivariate analyses. Mean HR during resting at night was higher in participants with more severe depressive symptoms. CONCLUSIONS: Our findings demonstrate that alterations in resting HR during all day and night are associated with depression severity. These findings may provide an early warning of worsening depression symptoms which could allow clinicians to take responsive treatment measures promptly.

Using wireless rumen sensors for evaluating the effects of diet and ambient temperature in nonlactating dairy goats.

Sixteen Murciano-Granadina dairy goats, provided with wireless rumen sensors for pH and temperature, were used to assess the rumen environment variations produced by extreme forage to concentrate diets (experiment 1) and climatic conditions (experiment 2). To avoid the interference of feed intake, goats were fed at maintenance level. Rumen sensors were inserted by surgery and programmed to collect and store rumen pH and temperature every 30min. In experiment 1, 8 dry goats (38.6±2.3kg of body weight) in tiestalls were divided into 2 groups and fed at maintenance level with 2 diets varying in forage-to-concentrate ratio [high forage (HF) 70:30; low forage (LF) 30:70] according to a crossover design. Diets were offered once daily for 4h and tap water (4 L, 9.8±0.4°C) was offered for only 30min at 6h after feeding. Rectal temperatures were recorded 3 times during the day. Rumen pH fell immediately after feeding, reaching a nadir depending on the diet (HF=6.35±0.07 at 11h after feeding; LF=6.07±0.07 at 6h after feeding) and being on average greater (0.31±0.06) in HF than LF goats. No diet effects were detected in rectal (38.2±0.1°C) and ruminal (38.9±0.1°C) mean temperatures, which were positively correlated. Rumen temperature dramatically changed by feeding (1.4±0.1°C) and drinking (-3.4±0.1°C), and 2h were necessary to return to the fasting value (38.2±0.1°C). In experiment 2, 8 dry goats (43.9±1.0kg of body weight) were kept in metabolic cages, fed a 50:50 diet and exposed to 2 climatic conditions following a crossover design. Conditions were thermoneutral (TN; 20 to 23°C day-night) and heat stress (HS; 12-h day at 37°C and 12-h night at 30°C). Humidity (40±5%) and photoperiod (light-dark, 12-12h) were similar. Goats were fed at maintenance level, the feed being offered once daily and water at ambient temperature was freely available. Intake, rectal temperature, and respiratory rate were recorded 3 times daily. Despite no differing in dry matter intake, rumen pH was lower in HS than in TN goats (-0.12±0.04). On the contrary, rumen temperature (0.3±0.1°C), rectal temperature (0.4±0.1°C), respiratory rate (77±5 breaths/min), and water intake (3.2±0.7 L/d) had a greater increase in HS than TN, which might indicate an altered microbial fermentation under high temperature conditions. In conclusion, wireless bolus sensors proved to be a useful tool to monitor rumen pH and temperature as affected by different feeding and climatic conditions.

ESX-1-induced apoptosis is involved in cell-to-cell spread of Mycobacterium tuberculosis.

Apoptosis modulation is a procedure amply utilized by intracellular pathogens to favour the outcome of the infection. Nevertheless, the role of apoptosis during infection with Mycobacterium tuberculosis, the causative agent of human tuberculosis, is subject of an intense debate and still remains unclear. In this work, we describe that apoptosis induction in host cells is clearly restricted to virulent M. tuberculosis strains, and is associated with the capacity of the mycobacteria to secrete the 6 kDa early secreted antigenic target ESAT-6 bothunder in vitro and in vivo conditions. Remarkably, only apoptosis-inducing strains are able to propagate infection into new cells, suggesting that apoptosis is used by M. tuberculosis as a colonization mechanism. Finally, we demonstrate that in vitro modulation of apoptosis affects mycobacterial cell-to-cell spread capacity, establishing an unambiguous relationship between apoptosis and propagation of M. tuberculosis. Our data further indicate that BCG and MTBVAC vaccines are inefficient in inducing apoptosis and colonizing new cells, correlating with the strong attenuation profile of these strains previously observed in vitro and in vivo.

Thermographic variation of the udder of dairy ewes in early lactation and following an Escherichia coli endotoxin intramammary challenge in late lactation.

A total of 83 lactating dairy ewes (Manchega, n=48; Lacaune, n=35) were used in 2 consecutive experiments for assessing the ability of infrared thermography (IRT) to detect intramammary infections (IMI) by measuring udder skin temperatures (UST). In experiment 1, ewes were milked twice daily and IRT pictures of the udder were taken before and after milking at 46 and 56d in milk (DIM). Milk yield was 1.46 ± 0.04 L/d, on average. Detection of IMI was done using standard bacterial culture by udder half at 15, 34, and 64 DIM. Twenty-two ewes were classified as having IMI in at least one udder half, the others being healthy (142 healthy and 24 IMI halves, respectively). Four IMI halves had clinical mastitis. No UST differences were detected by IMI and udder side, being 32.94 ± 0.04°C on average. Nevertheless, differences in UST were detected for breed (Lacaune - Manchega=0.35 ± 0.08°C), milking process moment (after - before=0.13 ± 0.11°C), and milking schedule (p.m. - a.m.=0.79 ± 0.07°C). The UST increased linearly with ambient temperature (r=0.88). In experiment 2, the UST response to an Escherichia coli O55:B5 endotoxin challenge (5 µg/udder half) was studied in 9 healthy Lacaune ewes milked once daily in late lactation (0.58 ± 0.03 L/d; 155 ± 26 DIM). Ewes were allocated into 3 balanced groups of 3 ewes to which treatments were applied by udder half after milking. Treatments were (1) control (C00, both udder halves untreated), (2) half udder treated (T10 and C01, one udder half infused with endotoxin and the other untreated, respectively), and (3) treated udder halves (T11, both udder halves infused with endotoxin). Body (vaginal) temperature and UST, milk yield, and milk composition changes were monitored by udder half at different time intervals (2 to 72 h). First local and systemic signs of IMI were observed at 4 and 6h postchallenge, respectively. For all treatments, UST increased after the challenge, peaking at 6h in T 0055 (which differed from that in C00, C01, and T10), and decreased thereafter without differences by treatment. Vaginal temperature and milk somatic cell count increased by 6h postchallenge, whereas lactose content decreased, in the endotoxin-infused udder halves. Effects of endotoxin on lactose and somatic cell count values were detectable in the infused udder halves until 72 h. In conclusion, despite the accuracy of the camera (± 0.15°C) and the moderate standard errors of the mean obtained for UST measures (± 0.05 to 0.24°C), we were unable to discriminate between healthy and infected (subclinically or clinically) udder halves in dairy ewes.

Simplified risk-prediction for benchmarking and quality improvement in emergency general surgery. Prospective, multicenter, observational cohort study.

BACKGROUND AND AIMS: Emergency General Surgery (EGS) conditions account for millions of deaths worldwide, yet it is practiced without benchmarking-based quality improvement programs. The aim of this observational, prospective, multicenter, nationwide study was to determine the best benchmark cutoff points in EGS, as a reference to guide improvement measures. METHODS: Over a 6-month period, 38 centers (5% of all public hospitals) attending EGS patients on a 24-h, 7-days a week basis, enrolled consecutive patients requiring an emergent/urgent surgical procedure. Patients were stratified into cohorts of low (i.e., expected morbidity risk <33%), middle and high risk using the novel m-LUCENTUM calculator. RESULTS: A total of 7258 patients were included; age (mean ± SD) was 51.1 ± 21.5 years, 43.2% were female. Benchmark cutoffs in the low-risk cohort (5639 patients, 77.7% of total) were: use of laparoscopy ≥40.9%, length of hospital stays ≤3 days, any complication within 30 days ≤ 17.7%, and 30-day mortality ≤1.1%. The variables with the greatest impact were septicemia on length of hospital stay (21 days; adjusted beta coefficient 16.8; 95% CI: 15.3 to 18.3; P < .001), and respiratory failure on mortality (risk-adjusted population attributable fraction 44.6%, 95% CI 29.6 to 59.6, P < .001). Use of laparoscopy (odds ratio 0.764, 95% CI 0.678 to 0.861; P < .001), and intraoperative blood loss (101-500 mL: odds ratio 2.699, 95% CI 2.152 to 3.380; P < .001; and 500-1000 mL: odds ratio 2.875, 95% CI 1.403 to 5.858; P = .013) were associated with increased morbidity. CONCLUSIONS: This study offers, for the first time, clinically-based benchmark values in EGS and identifies measures for improvement.

68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use.

OBJECTIVE: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. MATERIAL AND METHODS: Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT. All patients were referred to 68 Ga-PSMA-11 PET/CT. PROTOCOL: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. RESULTS: The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL). One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. CONCLUSION: 68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Alemtuzumab induction in kidney transplantation: clinical results and impact on T-regulatory cells.

Alemtuzumab (ALT), a humanized monoclonal anti-CD52 antibody, was introduced in solid organ transplantation as an induction agent. ALT associated with anticalcineurins has provided a low incidence of acute rejection episodes (ARE) and potential tolerogenic properties. We analyzed the clinical outcomes and effects on peripheral Treg of renal transplant recipients treated with ALT. Six-month data on kidney alone or kidney combined with pancreas or liver patients treated with ALT and tacrolimus (TAC) in standard doses were compared with those on renal transplant recipients of similar demography who were not treated with ALT. We evaluated patient and graft survivals, ARE incidence, hematological parameters, renal function, adverse events, and CD4+CD25+FoxP3+ T cells in peripheral blood. Demographics of recipients, donors, and transplants were similar in both groups. Mean HLA mismatch was slightly greater among ALT-treated patients (3.5 vs 2.5). No combined transplantation was performed in the ALT-untreated group. Patient and graft survivals were 100% without rejection or serious infections in both groups. ALT-treated recipients showed anemia and leukopenia in 3 patients as well as severe lymphopenia in 5 recipients, who partially recovered on day 90. Final mean plasma creatinine was 1.4 mg/dL, while calculated creatinine clearance was approximately 65 mL/min in both groups. Mean Treg cell percentage was higher among ALT-treated recipients than the comparative group or healthy controls (P < .05). In conclusion, renal transplantation results obtained using ALT with rigorous immunosuppressive therapy were excellent; serious adverse events and acute rejection were absent. The effect of the increased proportion of Treg cells must be evaluated with longer observation.

An approach to an acute emotional stress reference scale. / Aproximacion a una escala de referencia de estres emocional agudo.

INTRODUCTION: The clinical diagnosis aims to identify the degree of affectation of the psycho-physical state of the patient as a guide to therapeutic intervention. In stress, the lack of a measurement tool based on a reference makes it difficult to quantitatively assess this degree of affectation. AIM: To define and perform a primary assessment of a standard reference in order to measure acute emotional stress from the markers identified as indicators of the degree. SUBJECTS AND METHODS: Psychometric tests and biochemical variables are, in general, the most accepted stress measurements by the scientific community. Each one of them probably responds to different and complementary processes related to the reaction to a stress stimulus. The reference that is proposed is a weighted mean of these indicators by assigning them relative weights in accordance with a principal components analysis. RESULTS: An experimental study was conducted on 40 healthy young people subjected to the psychosocial stress stimulus of the Trier Social Stress Test in order to perform a primary assessment and consistency check of the proposed reference. The proposed scale clearly differentiates between the induced relax and stress states. CONCLUSIONS: Accepting the subjectivity of the definition and the lack of a subsequent validation with new experimental data, the proposed standard differentiates between a relax state and an emotional stress state triggered by a moderate stress stimulus, as it is the Trier Social Stress Test. The scale is robust. Although the variations in the percentage composition slightly affect the score, but they do not affect the valid differentiation between states.

TITLE: Aproximacion a una escala de referencia de estres emocional agudo.Introduccion. El diagnostico clinico persigue identificar el grado de afectacion del estado psicofisico del paciente como orientacion hacia la intervencion terapeutica. En el estres, la falta de un instrumento de medicion por comparacion con una referencia dificulta la valoracion cuantitativa del nivel de afectacion. Objetivo. Definir y hacer una primera validacion de un patron de referencia para la medida del estres emocional agudo a partir de marcadores identificados como indicadores del nivel. Sujetos y metodos. En general, las medidas mas solidas y aceptadas de estres por la comunidad cientifica son los test psicometricos y las variables bioquimicas. Cada uno de ellos responde probablemente a procesos distintos y complementarios de la reaccion frente a un estimulo estresante. La referencia que se propone es una media ponderada de estos indicadores, asignandoles pesos relativos de acuerdo con un analisis de componentes principales. Resultados. Para una primera aproximacion y verificacion de coherencia de la referencia propuesta, se ha utilizado un estudio experimental con una muestra de 40 jovenes sanos sometidos al estimulo estresante psicosocial del Trier Social Stress Test. La escala propuesta diferencia netamente entre los dos estados con distintos niveles de estres inducido. Conclusiones. Aceptando la subjetividad de la definicion, y a falta de una validacion posterior con nuevos datos experimentales, el patron propuesto diferencia entre un estado de relax y uno de estres emocional generados con un estimulo estresante moderado, como es el Trier Social Stress Test. La escala es robusta, ya que variaciones en la composicion porcentual repercuten ligeramente en la puntuacion, pero no en la diferenciacion valida entre estados.

Pediatric renal transplantation: 13 years of experience--report from the Chilean Cooperative Multicenter Group.

Between 1989 and 2002, 178 renal transplants were performed in 168 pediatric patients in Chile. The mean age was 10.9 +/- 3.7 years (range 1 to 17.9). End-state renal disease etiologies were: congenital renal hypoplasia/dysplasia, chronic glomerulonephritis, and reflux nephropathy. Seventy received a graft from a living donor (LD), and 108 from a cadaveric donor (CD). Only 9% received antibody induction. Acute rejection episodes were reported in 76 patients: 38% in LD recipients and 48% in CD recipients (P = NS). One-, 3-, and 5-year graft survivals were 88%, 84%, and 76%, respectively, for LD and 86%, 79%, and 68% for CD recipients. Actuarial graft survival was significantly better among those patients with serum creatinine < 1 mg/dL at 1 year posttransplant compared with those with creatinine > 1 mg/dL (P < .05). The graft survival rate has improved from the first period (1989 to 1996) to the second period (1997 to 2002); (P = .05). Patient survival rates at 1, 3, and 5 years were 98%, 98%, and 98%, respectively, for LD, and 95%, 94%, and 94% for CD. Global height/age Z-score decreased from -0.7 at birth to -1.5 when dialysis started, and to -2.4 at the time of transplantation. The Z-score height/age at 1, 3, and 5 years posttransplantation was -2.25, -2.24, and -2.5. No significant differences were observed in transplant outcomes comparing patients younger than 7 years with those older ones. In conclusion, pediatric renal transplant has been performed in Chile with acceptable morbidity. The patient and graft survivals are similar to the reported international experience. In the last period there was a significant improvement in graft survival.

Towards an objective measurement of emotional stress: Preliminary analysis based on heart rate variability.

This paper presents a study performed in 25 young healthy subjects measuring the evolution of heart rate variability (HRV) indices during emotional stress. Acute emotional stress was generated with a modified version of Trier Social Stress Test (TSST). The TSST comprises several tasks which include a memory test, anticipation of stress, public exposition, and an arithmetic task. Each task has different demanding conditions, carrying subjects' emotional stress to different states. An autogenic relaxation was done before TSST. Significant differences in HRV indices were observed in the arithmetic and memory task with respect to the relaxation stage. In particular during the arithmetic task, mean heart rate increased 22% (p-value <0.00001) the power in the very low frequency band increased 47% (p-value <0.00001 and normalized power in the low frequency (LF) band increased 19% (p-value <0.04). These results support a sympathetic activation during these tasks.

Multiparametric monitoring of ischemia-reperfusion in rat kidney: effect of ischemic preconditioning.

BACKGROUND: Microelectrode technology is a promising tool for monitoring kidney ischemia and the changes induced by its therapeutic management. Ischemic preconditioning, that is, brief ischemic periods before sustained ischemia, has been shown to protect several organs, including the kidney, from ischemia-reperfusion injury. We tested whether the effect of preconditioning could be appraised by real-time measurement of parameters representative of tissue hypoxia. METHODS: In a sample of pentobarbital-anesthetized and mechanically ventilated rats, we studied the effect of renal ischemic preconditioning (10-min ischemia and 10-min reflow interval) on subsequent ischemia-reperfusion (45 min and 60 min). Renal tissue electrical impedance, extracellular pH, and potassium concentration [K+] were measured continuously by implanted microelectrodes. RESULTS: Ischemia induced an early, rapid rise in extracellular potassium and impedance module, followed by a phase of slower increase, whereas pH decreased rapidly, reaching a plateau. Preconditioning treatment did not cause significant changes in interstitial pH and [K+] but increased ischemic tissue impedance. During reperfusion, the three variables recovered progressively; however, after a decline, electrical impedance showed a clear postischemic increase. This rise was suppressed by preconditioning. CONCLUSIONS: Real-time measurement of any of the three parameters showed capability for early detection of ischemia. In contrast with findings in myocardial tissue, preconditioning in the kidney did not increase potassium cell loss during ischemia or improve ischemic acidosis or tissue impedance. Electrical impedance increased for a second time during reperfusion, indicating the presence of a postischemic cellular edema; concealing this episode was the most noticeable effect of the preconditioning treatment.

Experience with lymphoceles after renal transplantation.

Of 215 patients who underwent renal transplantations at the Mayo Clinic, six (2.8 percent) developed perirenal lymphoceles. Diagnosis was made between 5 weeks and 14 months after operation. In all six patients, renal function decreased and eventually a lower quadrant abdominal mass developed. Ipsilateral leg edema, fluid retention, and development of diastolic hypertension should also increase suspicion as to the possibility of lymph collection in the perirenal space. Excretory urography with tomography delineated the lymphocele in each instance; B scan ultrasound may be an additional valuable diagnostic tool. Drainage procedures readily restored normal renal function and, in one instance, drainage also restored the blood pressure to normal. Percutaneous needle aspiration seems to be a temporary measure only, and marsupialization is the preferred definite procedure.

Canine kidney preservation for 24 to 72 hours. Use of intracellular-like perfusate.

For universal application and usefulness, methods of renal preservation need simplification. Recent studies using initial brief perfusion with, and storage in, an intracellular, hyperosmolar type of perfusate have suggested the feasibility of this simple method. In the present study, 49 nephrectomized dogs received 16, 19 and 14 renal autografts preserved for 24, 48, and 72 hours, respectively, by this simple method. Long-term survivors in the three groups were seven of 16, ten of 19, and seven of 14, with return to normal or near-normal function. This method of preservation offers promise for wide clinical application in the near future.

Minimally invasive silicon probe for electrical impedance measurements in small animals.

It is commonly accepted that electrical impedance provides relevant information about the physiological condition of living tissues. Currently, impedance measurements are performed with relatively large electrodes not suitable for studies in small animals due to their poor spatial resolution and to the damage that they cause to the tissue. A minimally invasive needle shaped probe for electrical impedance measurements of living tissues is presented in this paper. This micro-probe consists of four square platinum electrodes (300 microm x 300 microm) on a silicon substrate (9 mm x 0.6 mm x 0.5 mm) and has been fabricated by using standard Si microelectronic techniques. The electrodes are not equally spaced in order to optimise the signal strength and the spatial resolution. Characterisation data obtained indicate that these probes provide high spatial resolution (measurement radius <4 mm) with a useful wide frequency band going from 100 Hz to 100 kHz. A series of in vivo experiments in rat kidneys subjected to ischemia was performed to demonstrate the feasibility of the probes and the measurement system. The impedance modulus and phase were measured at 1 kHz since this frequency is sufficiently low to permit the study of the extracellular medium. The extracellular pH and K+ were also simultaneously measured by using commercial miniaturised Ion Selective Electrodes. The induced ischemia period (45 min) resulted in significant changes of all measured parameters (Delta/Z/ approximately 65%; DeltapH approximately 0.8; DeltaK+ approximately 30 mM).

Plasma insulin and glucose levels after renal transplantation.

Plasma insulin and glucose levels were measured before and for twenty-four hours after operation in 13 patients who had undergone renal transplantation, 4 who had undergone bilateral nephrectomy, and 5 who had undergone donor nephrectomy. Postoperative hyperglycemia was noted in all patients, but the hyperglycemia was much greater after renal transplantation. Peripheral insulin antagonism rather than decreased insulin secretion appeared to account for the hyperglycemia. The peripheral insulin antagonism was largely due to surgical stress, but intravenous immunosuppressive medications contributed to the exaggerated hyperglycemia, hyperinsulinemia, and insulin antagonism observed in the transplant patient.

Surgical technic in en bloc bilateral cadaveric nephrectomy for transplantation.

En bloc bilateral cadaveric nephrectomy for transplantation has some advantages over excision of each kidney separately. There is also an advantage of single cannula perfusion through the aorta for two kidneys, especially when multiple renal arteries are present. The anatomic vascular variants are important, as are the incision and the approach to the suprarenal aorta and the lumbar venous drainage of the kidney.

120-hour 5-fluorouracil (5-FU) continuous infusion (CI) plus BCNU in advanced colorectal cancer.

Seventy-five previously untreated patients with measurable advanced colorectal cancer were treated with 5 fluorouracil 1,000 mg/m2 as a 24-hour intravenous (i.v.) continuous infusion during days 1-5 and 28-32 every cycle, plus 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), 200 mg/m2 i.v. bolus on day 1, all given every 8 weeks up to 6 cycles. Median Karnofsky performance status (KPS) was 100. Sites of disease at entry were mainly the abdomen (45%) and liver (33%). All patients were evaluable for response and survival. There were two complete responses and seven partial responses (PR) for an overall response rate of 12% (95% confidence limits: 5-20%). Four out of 25 patients with liver metastases alone had PR. Stabilization was seen in 40 patients (53%). Median time to progression was 9.3 months and overall median survival was 12.5 months, whereas median survival for patients with liver metastases alone was 16 months. Toxicity was mild except for 8% with WHO grade 4 mucositis. Only KPS had statistical significance in the multivariate analysis of prognostic factors. It is concluded that this regimen is relatively active and well tolerated in patients with advanced colorectal cancer.

Vascular anastomosis techniques in renal transplants.

In our series of 250 RT's 192 (76.8%) from living donors and 58 (23.27%) from cadaver donors, there were 207 (88.8%) kidneys with a single renal artery, 40 (16%) with a double artery and 3 (1.2%) with a triple artery. End to side anastomosis to common iliac vessels was the most frequently used technique for kidneys with a single renal artery (52%). Extracorporeal renal surgery was performed on 83.7% of kidneys with multiple arteries. There were 32 (12.8%) complications with 6 (2.4%) unsuccessful RT's due to technical reasons. The actuarial survival of patients and grafts after 5 years from live donors was 87% and 69% and from cadaver donors was 78% and 46%, respectively.

[Size of breast cancer at the time of initial diagnosis]. / Extensión del cáncer de mama en el momento del diagnóstico inicial.

BACKGROUND: To observe whether patients with breast cancer of an epithelial strain consult physician with a less advanced disease, the patients attended by the Valencian Interhospital Group were studied between January 1981 and December 1990. METHODS: The same diagnosis of disease spread (anamnesis, physical examination, blood analysis and imaging techniques of the thorax, bones and liver) was carried out in all cases. Surgical techniques and histopathologic criteria were homogenous throughout the study. The classification used was that of the International Union Against Cancer of 1987. Histopathologic correlations were studied. RESULTS: Seven hundred seventy-nine patients with a mean age of 57.3 years (range: 24-85) were studied. A statistically significant (S) progressive reduction in the size of the tumor was observed (p less than 0.003) with the percentage of stage II progressively increasing and stage IIIa (more advanced disease than stage II) parallelly diminishing (p less than 0.0019) (S). In patients over the age of 55 this diminution was not observed. To the contrary, more advanced stages (stage IIIb--locally advanced, and stage IV--metastatic disease) were presented than in younger women (p = 0.000) (S). There is a direct correlation between the size of the tumor, the degree of tumoral differentiation and lymphatic metastases. CONCLUSIONS: Patients under the age of 55 spontaneously and progressively consult the physician with a less advanced breast cancer. This is expected to have beneficial effects on survival. It is suggested that primary medicine may play a fundamental role in making women more aware of breast cancer, particularly those over 55 years of age regardless of early detection campaigns.

Results in laparoscopic living donor nephrectomy: a multicentric experience.

OBJECTIVE: Renal transplantation is the most successful therapy to improve survival and quality of life for patients with end-stage renal disease. Living donors have been used as an alternative to reduce the stay on the waiting list. Laparoscopic living donor nephrectomy has become the standard procedure for renal transplantation. Minimally invasive surgery involves less postoperative pain with less analgesic requirements allowing shorter hospital stay for the donor. MATERIAL AND METHODS: We retrospectively analyzed demographic and intraoperative data and surgical complications for 46 patients who underwent laparoscopic living donor nephrectomy between March 2001 and March 2011. RESULTS: Mean donor age was 41 years. Mean operative time was 170 ± 45 minutes. The average cold ischemic time was 40 minutes and warm ischemic time was 26 minutes. Twenty-one patients were donors for pediatric receptors. Fourty patients underwent left laparoscopic nephrectomy, the other 6 patients underwent right laparoscopic nephrectomy due to vascular anatomic variant. Right laparoscopic nephrectomy was converted in 1 case (2.2%) due to renal vein laceration without donor morbidity and without compromise of graft function. Renal function at the second day post donor nephrectomy was measured using serum creatinine averaged 1.2 mg/dL with a mean increase of 0.4 mg/dL from baseline, with normalization after 30 days. No patient required blood transfusion, and there were no immediate surgical complications, infections, or mortality. One patient developed an incisional hernia in relation to the site of kidney removal. The mean hospital stay was 5 ± 1 days. CONCLUSIONS: Laparoscopic nephrectomy in our experience is a safe technique without postoperative morbidity or mortality. It is associated with low levels of pain, early discharge and early return to physical activity and work, good sense of aesthetic results, and long-term graft function comparable to traditional nephrectomy and cadaveric grafts.