Detection of human papillomavirus in nonmelanoma skin cancer lesions and healthy perilesional skin in kidney transplant recipients and immunocompetent patients.

BACKGROUND: The influence of human papillomavirus (HPV) on the development of nonmelanoma skin cancer (NMSC) is a topic of debate. HPV types from the beta genus (HPV-ß) have been most frequently associated with the development of skin cancer. OBJECTIVES: To analyze the prevalence and range of HPV types in NMSC lesions and healthy perilesional skin in immunodepressed and immunocompetent patients and to evaluate the influence of various clinical factors on the prevalence of HPV in skin cancer. METHODS: Nested polymerase chain reaction and sequencing were used to detect HPV in 120 NMSC samples obtained by biopsy from 30 kidney transplant recipients and 30 immunocompetent patients. In all cases, a sample was taken from the tumor site and the surrounding healthy skin. Potential confounders were assessed and the data analyzed by multivariate logistic regression. RESULTS: HPV DNA was detected in 44 (73.3%) of the 60 samples from immunodepressed patients and in 32 (53.3%) of the 60 samples from immunocompetent patients (adjusted odds ratio, 3.4; 95% CI, 1.2-9.6). In both groups of patients, HPV was more common in healthy perilesional skin than in lesional skin. HPV-ß was the most common type isolated. CONCLUSION: We found a wide range of HPV types (mostly HPV-ß) in the skin of kidney transplant recipients and immunocompetent patients with skin cancer.

The role of new immunosuppressive drugs in nonmelanoma skin cancer in renal transplant recipients.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is the most common malignancy in patients who have received a solid organ transplant. Multiple factors are involved in the onset of posttransplant NMSC. OBJECTIVES: To analyze the relationship between new immunosuppressive drugs and the onset of NMSC in renal transplant recipients. METHOD: This was a combined retrospective and prospective observational study in which we studied 289 patients who received a kidney transplant between January 1996 and December 2010 at Hospital Universitario Doctor Peset in Valencia, Spain. RESULTS: Seventy-three patients (25.2%) developed 162 NMSCs over a median follow-up of 72 months. There were no statistically significant differences in the onset of NMSC on comparing different induction therapy strategies involving monoclonal and polyclonal antibodies. NMSCs occurred less frequently in patients treated with mammalian target of rapamycin (mTOR) inhibitors than in those treated with other immunosuppressive regimens, although the differences were not statistically significant. Three of 5 patients with recurrent NMSC who were switched from calcineurin inhibitors to mTOR inhibitors developed additional NMSCs despite the change. CONCLUSIONS: Induction therapy with monoclonal and polyclonal antibodies in renal transplant recipients is not associated with an increased risk of NMSC. While mTOR inhibitors are associated with a lower risk of posttransplant NMSC, it remains to be determined whether a switch to these drugs is useful in the management of patients who develop multiple NMSCs.

[Hyperbaric bupivacaine: a randomized double-blind trial of different doses with or without fentanyl for cesarean section under spinal anesthesia]. / Estudio aleatorio, doble ciego sobre la utilización de diferentes dosis de bupivacaína hiperbara con o sin fentanilo, en cesáreas con anestesia subaracnoidea.

OBJECTIVES: To compare the effects of spinal anesthesia with different doses of hyperbaric bupivacaine with or without fentanyl in patients undergoing cesarean section. MATERIAL AND METHODS: Prospective study enrolling 50 ASA 1-2 patients undergoing cesarean section, randomized to 5 treatment groups. Groups A, B, C, and D received 15 microg of fentanyl and group X received no fentanyl. The doses of hyperbaric bupivacaine given in each group were as follows: 10 mg in Group A, 11 mg in group B, 12 mg in group C, 13 mg in group D, and 14 mg in group X. RESULTS: Patients in groups A and B had greater hemodynamic stability than patients in groups C, D, or X (P < 0.05). The incidence of hypotension was 70% in group C and 80% in groups D and X. The sensory block reached level T4 in groups D and X and the motor block was complete in all cases. Postoperative analgesia lasted longer in group D with a mean (SD) duration of 202 (25) minutes than in group X with a mean duration of 194 (19) minutes. Assessment on a visual analog scale was under 3 in all groups except group A, where 2 patients required administration of propofol. CONCLUSIONS: Acceptable operative conditions with a low incidence of hypotension are provided with an 11 mg dose of hyperbaric bupivacaine.