Evaluation of Expanded Criteria Donors Using the Kidney Donor Profile Index and the Preimplantation Renal Biopsy.

The increasing comorbidity of kidney transplant (KT) donors make it necessary to develop scores to correctly assess the quality of kidney grafts. This study analyzes the usefulness of the preimplantation biopsy and the Kidney Donor Profile Index (KDPI) as indicators of KT survival from expanded criteria donors (ECD). Retrospective study of KT in our center between January 2010 to June 2019 who received a kidney from an ECD and underwent a preimplantation biopsy. 266 KT were included. Graft survival was categorized by KDPI quartiles: Q1 = 86%, Q2 = 95%, Q3 = 99% and Q4 = 100%. KT from KDPI Q1 presented better survival (p = 0.003) and Q4 donors had worse renal function (p = 0.018) and poorer glomerular filtration rate (3rd month; p = 0.017, 1st year; p = 0.010). KT survival was analyzed according to KDPI quartile and preimplantation biopsy score simultaneously: Q1 donors with biopsy score ≤3 had the best survival, especially comparing against Q3 with a biopsy score >3 and Q4 donors (p = 0.014). In multivariable analysis, hyaline arteriopathy, glomerulosclerosis, and KDPI Q4 were predictors for graft survival. High KDPI and a greater histological injury in the preimplantation biopsy, especially glomerular and vascular lesions, were related to a higher rate of KT loss from ECD.

Acute Kidney Injury and Urinary and Histopathological Disorders in Kidney Transplant Patients with SARS-CoV-2 Infection.

BACKGROUND: Acute kidney injury (AKI) is a manifestation of SARS-CoV-2 infection. The evidence in kidney transplant (KT) is limited, as there are scarce data about the histologic features in graft biopsies of these patients. MATERIAL AND METHODS: A retrospective cohort study of KTs with SARS-CoV-2 infection from August 28, 2020, to April 23, 2021. We collected the incidence of AKI and the presence of urinary and histopathological disorders. Both groups were compared (AKI vs no AKI). Immunohistochemical and reverse transcription-polymerase chain reaction studies were performed on the anatomopathological samples. RESULTS: In our study, 72 KTs had SARS-CoV-2 infection and, among them, 27 patients (35.1%) developed AKI related to increased severity and a worse evolution of the infection, defined by a greater presence of pneumonia (P < .001), hospitalization (P < .001), admission to the intensive care unit (P < .001), the need for ventilation support (P < .001), and continuous renal replacement therapy (P < .001). In the multivariable analysis, pneumonia behaved as an independent predictor for AKI development (P = .046). No differences were observed between proteinuria a month before and after infection (P = .224). In addition, 5 patients showed microhematuria and 2 patients presented transient glycosuria without hyperglycemia. Of the 5 kidney biopsies performed, 1 biopsy (20%) showed positive reverse transcription polymerase chain reaction for SARS-CoV-2. CONCLUSIONS: AKI is a frequent and potentially serious complication in KT patients. Occasionally it could be accompanied by abnormalities in the urinary sediment. Of 5 biopsied patients, 1 patient had positive reverse transcription polymerase chain reaction in renal tissue, which suggests the systemic spread of the virus and the tropism for the renal graft.

Nasolabial cyst: report of a case with extensive apocrine change.

The nasolabial cyst is a rare condition of the midline with an uncertain pathogenesis. This case report describes a 44-year-old woman in which the clinicopathologic findings were consistent with nasolabial cyst. On histologic examination, extensive apocrine change was noticed. To our knowledge, this feature has not been mentioned in previous papers. In addition, cases reported during the last decade are summarized.

Salivary gland heterotopia in the lower neck: a report of five cases.

Heterotopic salivary gland tissue (HSGT) represents an uncommon lesion, usually presenting as a discharging sinus in the base of the neck. Diagnostic criteria and embryogenesis of this entity still remain unclear. For the purpose of clarifying both subjects, all lateral cervical anomalies undergoing surgery during a 12-year period were examined. Histological study showed salivary tissue in 10 out of 119 patients. However, only 5 of them accomplished HSGT criteria. This study presents the second largest series to date of undisputed HSGT in the lower neck. Both accessory glands and branchial cleft anomalies should be distinguished from this lesion. Neoplastic transformation in HSGT, although extremely rare, should also be considered.

[Evaluation of the variability of rapid diagnosis of infection by Chlamydia trachomatis using direct immunofluorescence]. / Evaluación de la variabilidad del diagnóstico rápido de infección por Chlamydia trachomatis mediante immunofluorescencia directa.

The interobserver and intraobserver agreement between two microscopists was independently assessed in a blind fashion to evaluate the reproducibility of the results of the quick diagnosis of Chlamydia trachomatis infection with direct immunofluorescence. The study was carried out in two phases, and 604 samples of cervical and urethral exudate from patients seen at a center for the prevention and therapy of sexually transmitted diseases were evaluated. The two observers had a kappa index of agreement between them of 0.41, with 95% confidence intervals (95% Cl) of 0.31-0.51, while their agreement within themselves was 0.78 (95% Cl: 0.65-0.91) for the first observer and 0.61 (95% Cl: 0.47-0.75) for the second one. After discussion of the data and analysis of the reasons of disagreement, the evaluation was repeated. In this second phase, both interobserver and intraobserver agreement were substantially improved. The kappa index was 0.71 (95% Cl: 0.61-0.80) for the former, whereas regarding the latter the first observer had a kappa index of 1 (95% Cl: 0.86-1.13) and the second observer an index of 0.82 (95% Cl: 0.61-0.80). It was concluded that the test may have problems in its practical performance if the microscopists are not previously trained with systematic programs for the evaluation of results.

[Lingual abscess with atypical clinical presentation]. / Absceso lingual con presentación clínica atípica.

Lingual abscesses have become extremely rare since the discovery of antibiotics, with only about 200 cases reported in the last 160 years. Diagnosis on the basis of clinical symptoms alone is quite difficult. Imaging studies are essential for the diagnosis of lingual abscesses and for their differentiation from related pathologies with similar clinical symptoms. We report a case of lingual abscess with otherwise unremarkable clinical findings that was diagnosed by CT scan. The etiology, pathophysiology, bacteriology, diagnosis, and treatment of these uncommon infections is discussed.

[Heterotopic brain tissue in the pharynx]. / Tejido cerebral heterotópico en la faringe.

The presence of heterotopic brain tissue in the head and neck region is exceptional. Most reported cases have been observed in the nasal region and are called nasal gliomas. The case of a 10-month-old boy with heterotopic brain tissue on the soft palate and nasopharynx is reported. Surgical treatment was successful and no complications or recurrences have been observed in 7 years of follow-up. The main pathogenic theories and nomenclature are analyzed.

[Branchial cysts with heterotopic salivary tissue in the upper third of the neck]. / Quistes branquiales con tejido salival heterotópico en el tercio superior del cuello.

The presence of heterotopic salivary gland tissue (HSGT) in rather uncommon in the neck. Usually it has been located in its lower third. HSGT in the upper neck is believed to be a rare entity. Two cases of HSGT in the upper neck are presented, with a review of their clinical and histopathological characteristics. The embryologic derivation of salivary tissue and close association with the branchial apparatus are discussed. The possibility of neoplastic transformation must always be considered in these uncommon lesions.

[Thyroid nodules: factors suggestive of malignancy]. / Nódulos tiroideos: factores sugerentes de malignidad.

The evaluation and management of thyroid nodules is a common problem in medicine. In a review of 250 cases of thyroid disease seen at the 12 de Octubre Hospital (Madrid, Spain), 191 cases of solitary nodules and multinodular goiter were analyzed. The clinical findings, complementary studies, and postoperative histology were analyzed to determine the parameters most closely related to malignant thyroid processes. The overall rate of malignancy was 22.5%. Major clinical factors associated with malignancy were fixation to deep structures, cervical lymph node enlargement, and paralysis of the vocal cords. None of the complementary tests was absolutely reliable in excluding malignancy, but fine needle aspiration biopsy, in spite of its limitations, was the best diagnostic tool. Surgery is indicated if the benignity of a nodule cannot be confirmed.

[Naso-alveolar cysts. A report of 10 new cases and a review of the literature]. / Quiste nasoalveolar. Aportación de 10 nuevos casos y revisión de la literatura.

Nasoalveolar cysts, also known as Klestadt's or nasolabial cysts, are uncommon midfacial lesions. Ten cases treated at the 12 de Octubre University Hospital are reported, describing the most relevant clinical and pathological findings are reported. The main theories of the origin of these developmental, non-odontogenic cysts are discussed. A review of the literature is included.

[Prognostic factors in pediatric myringoplasty. A review of 90 cases]. / Factores pronósticos en las miringoplastias infantiles. Revisión de 90 casos.

Although tympanic membrane perforations continue to be a significant source of otologic morbidity in the pediatric population, myringoplasty in children still elicits debate. The records of 76 patients under 18 who underwent 90 myringoplasties at the 12 de Octubre University Hospital (Madrid, Spain) over a recent 8-year period were reviewed. The overall short-term surgical success rate was 64.8%. The overall success rate evaluated at least one year after surgery was 58%. The audiological threshold improved in 68% per cent of successful cases. Surprisingly, females had lower graft take rates than males. The outcome of surgery was unrelated to age at operation, duration, mechanism, size, and location of the perforation, or condition of the opposite ear.

[Granular cell tumor: an infrequent cause of dysphonia in childhood]. / Tumor de células granulares: una causa poco frecuente de disfonía en la infancia.

Granular cell tumors (GCT) are rare and usually benign tumors whose histogenesis is debated. The skin, subcutaneous tissues, and mucosae of the head and neck are areas of predilection for GCT. Laryngeal involvement is uncommon, but may create diagnostic and therapeutic problems when it occurs. Laryngeal GCT are decidedly uncommon in children, only 17 cases having been reported in the literature. A case of GCT of the larynx in an 11-year-old girl is reported. The presenting symptom was hoarseness. The macroscopic tumor and hoarseness disappeared after chemotherapy (EVAIA) for Ewing sarcoma of the knee.

[Response of cartilaginous neoplasms of the larynx to surgery and alternative therapies]. / Comportamiento de las neoplasias cartilaginosas de la laringe frente al tratamiento quirúrgico y las terapéuticas alternativas.

Three primary cartilaginous tumors of the larynx are reported: two chondrosarcomas (including an undifferentiated chondrosarcoma with prolonged survival) and one chondroma. The need for accurate histological staging, only possible after surgery, is emphasized. Surgery is teh preferred initial treatment.

[Primary nasal sinus malignant melanomas]. / Melanomas malignos primarios nasosinusales.

Primary malignant melanoma of the mucosa of the nasal and paranasal sinuses is rare, difficult to treat, and usually has a poor prognosis. Seven cases, six women and one man (mean age 76.5 years), were treated at the Hospital 12 de Octubre (Madrid, Spain) during the period 1982-1994. The presenting symptoms, diagnostic evaluation, morphology, therapeutic modalities, histological evaluation, and clinical course were reviewed. Three patients were treated surgically and three received palliative irradiation. All had local recurrence or distant metasfases within 15 months after concluding treatment. The seventh patient refused treatment.

[Juvenile giant nasopharyngeal fibroma: the hinge maxillotomy approach]. / Fibroma nasofaríngeo juvenil gigante: maxilotomía en bisagra, una vía de abordaje.

A giant juvenile nasopharyngeal fibroma in a 29-year-old male was removed by hinge maxillotomy. The diagnosis and treatment of these tumors is discussed.

Monitoring programme on cadmium, lead and mercury in fish and seafood from Valencia, Spain: levels and estimated weekly intake.

The study was carried out to determine the current levels of mercury, cadmium, and lead in fish and seafood from the market of Comunitat Valenciana, Spain. Levels of total mercury ranged from 0.02 to 3.15 mg kg⁻¹ w.w. (average = 0.073 mg kg⁻¹ w.w.). Cadmium concentrations ranged from 0.003 to 0.66 mg kg⁻¹ w.w. (average = 0.27 mg kg⁻¹ w.w.) for seafood, and between 0.003 and 0.71 mg kg⁻¹ w.w. (average = 0.01 mg kg⁻¹ w.w.) for marine fish. Concerning lead, concentrations from 0.02 to 0.36 mg kg⁻¹ w.w (average = 0.04 mg kg⁻¹ w.w.) were found in fish, and from 0.02 to 1.02 mg kg⁻¹ w.w. in seafood (average = 0.147 mg kg⁻¹ w.w.). The levels found were, in general, lower than maximum levels proposed by European legislation. The estimated weekly intake of mercury, cadmium and lead through fish and seafood consumption was found to be about 43%, 10% and 3% of the established provisional tolerable weekly intake, respectively.

Modelo experimental de embriopatía por ácido retinoico en ratas para el estudio de las malformaciones craneofaciales / Experimental model of retinoid embryopathy in rats for craneofacial malformations study

El objetivo de este trabajo es demostrar que la exposición de ratas gestantes al ácido retinoico induce malformaciones craneofaciales a sus embriones. Se trataron 45 ratas hembra Sprague-Dawley con 125 mg/Kg de ácido all-trans-retinoico en el día 10 de gestación, produciéndose malformaciones craneofaciales en el 100 por ciento de los embriones. Se realizó un estudio morfológico de los defectos craneofaciales. Nuestros datos confirman la hipótesis de que el ácido retinoico altera el desarrollo craneofacial. Un defecto en la migración de las células de la cresta neural podría explicar esta alteración (AU)

Malformaciones craneofaciales inducidas por nitrofén: modelo experimental en ratas / Nitrofen induced craniofacial malformations: experimental model in rats

El objetivo de este trabajo es demostrar que la exposición al nitrofen de ratas gestantes induce malformaciones craneofaciales a sus embriones. Se trataron 45 ratas hembra Sprague-Dawley con 100 mg/Kg de nitrofén en el día 9,5 de gestación, produciéndose hernia diafragmática en el 50 por ciento de los embriones. Se eligieron aleatoriamente 40 embriones con hernia diafragmática. Se realizó un estudio morfológico de los defectos craneofaciales, encontrando fisuras faciales (2,5 por ciento), malformaciones (5 por ciento) e implantación baja de los pabellones auriculares (20 por ciento), apéndices faciales (2,5 por ciento) y malformaciones nasales (38 por ciento). Nuestros datos apoyan la hipótesis de que el nitrofén altera el desarrollo craneofacial.Un defecto en la migración de las células de la cresta neural podría explicar esta alteración (AU)

Quistes branquiales con tejido salival heterotópico en el tercio superior del cuello / Branchial cysts with heterotopic salivary tissue in the upper third of the neck

La existencia de tejido salival heterotópico (TSH) en el cuello es bastante infrecuente. Generalmente se ha descrito en su tercio inferior, el TSH en el tercio superior es una rareza. Se presentan dos casos de TSH en la parte superior del cuello, revisando sus características clínico-patológicas. Se discute el origen embrionario del THS y su asociación con las anomalías del aparato branquial. La posibilidad de malignización debe siempre tenerse en cuenta en estas raras lesiones (AU)

The presence of heterotopic salivary gland tissue (HSGT) in rather uncommon in the neck. Usually it has been located in its lower third. HSGT in the upper neck is believed to be a rare entity. Two cases of HSGT in the upper neck are presented, with a review of their clinical and histopathological characteristics. The embryologic derivation of salivary tissue and close association with the branchial apparatus are discussed. The possibility of neoplastic transformation must always be considered in these uncommon lesions (AU)

El uso del teléfono en pacientes con implante coclear / Telephone use in cochlear implanted patients

El uso del teléfono supone un reto importante para los pacientes con implante coclear ya que pueden aparecer distintas limitaciones que deberán superar: falta de apoyo visual, la eliminación de las frecuencias agudas en la señal telefónica, ruido ambiental, interferencias de los teléfonos móviles con el procesador externo del implante, la ansiedad producida ante un interlocutor que muchas veces es desconocido, etc. El propósito de este estudio es analizar el uso que los pacientes implantados en el Hospital Universitario La Paz hacen del teléfono y averiguar cuáles son los aspectos que presentan una mayor dificultad, así como su posible solución para mejorar su percepción de las conversaciones telefónicas. También realizamos una comparativa de las interferencias que los pacientes sufren con diferentes modelos de móvil, con el fin de descubrir cuáles son los terminales mas recomendados para minimizar dichas interferencias. Con este fin se envió un cuestionario a 21 pacientes implantados con un COMBI 40+ de MED-EL. Todos los pacientes del estudio utilizaban el teléfono fijo en alguna medida y, un porcentaje de ellos (66,7 por ciento), también el móvil. Los modelos de telefonía móvil más modernos parecen ser los más recomendables para estos pacientes, ya que producen menos interferencias con el implante (AU)