Abstract Introduction Pulmonary hypertension (PHT) is associated with greater posttransplant mortality. In the last few years, many vasodilator drugs have been developed and some patients have ...therefore been transplanted. However, conflicting data exist regarding the impact of reversible PHT on posttransplant outcomes. The aim of this study was to determine the evolution of our transplanted patients with reactive PHT and the causes of right cardiac insufficiency and perioperative mortality. Material and Methods We performed a retrospective analysis of 39 consecutive heart transplant recipients from January 2005 to December 2006. We analyzed significant pretransplant PHT, the percentage of emergency transplants, surgical technique, as well as ischemia and extracorporeal circulation times. Results Before transplantation, significant PHT was present in 12 patients (30.8%), all of whom had a positive acute vasoreactivity test or response to oral treatment with pulmonary vasodilators. A nonsignificant tendency to increased posttransplant mortality was observed among patients with pretransplant PHT. We observed a significant increase in mortality in patients with prolonged operative times, over the third percentile, odds ratio (OR) for ECC of 21% ( P = .001) and OR for prolonged ischemia time of 9.5% ( P = .022). However, mortality did not increase significantly in cases of emergent transplantation ( P = .08) or in the use of the Shumway bicaval surgical technique ( P = .9). Conclusions There seemed to be a slight tendency to increased mortality among patients with reversible HTP, suggesting that high-risk patients need closer monitoring but are not absolutely contraindicated for transplantation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The purpose of this study was to evaluate the temporal bone findings in individuals with cochlear nerve aplasia.
Retrospective case review.
Two individuals with unilateral profound deafness caused by ...aplasia of the cochlear nerve were identified. The temporal bones were processed, and the cochlear elements were quantified.
Histopathologic study of the temporal bones from these individuals demonstrate that a fully formed cochlea and normal-appearing organ of Corti can occur in the absence of the spiral ganglion and cochlear nerve. Cochlear nerve aplasia can occur in both a narrow or a normal-sized internal auditory canal.
These findings suggest that the development of the cochlea and organ of Corti are not dependent on the presence of the cochlear nerve and spiral ganglion. The entity of cochlear nerve aplasia in the presence of a normally formed cochlea must be considered when evaluating individuals as candidates for cochlear implantation.
Abstract Introduction Invasive estimation of pulmonary pressure is part of the usual protocol prior to heart transplantation. The aim of this study was to compare the results of 2 different ...vasodilators, nitric oxide (NO) and prostacyclin, in an acute vasodilator test (AVT) for patients with pulmonary venous hypertension. Materials and Methods From January 2000 to December 2006, 94 right-sided heart catheterizations were performed in our center within pretransplantation evaluations. AVT was performed if the mean pulmonary artery pressure (mPAP) >35 mm Hg or if the pulmonary vascular resistance (PVR) was >4 Wood units (WU). Epoprostenol was administered to 40 patients, NO to 6 patients, and both agents to 8 patients. Results A significant decrease in both mPAP and PVR was shown with maximum doses of epoprostenol, with an average variation of 8.96 mm Hg in mPAP ( P < .001) and 3.26 WU in PVR ( P < .001). An increased cardiac output (CO) was observed with epoprostenol, with a mean difference of 1.9 L/min ( P < .001) at maximum compared with baseline doses. A tendency for the mPAP and PVR to decrease was also observed with maximum NO doses, with mean decreases of mPAP and PVR of 5.62 mm Hg and 1.14 WU, respectively. A tendency for CO to decrease was observed with NO (0.75 L/min; P = .039). Conclusions In our experience, NO is the best drug for AVT due to its pulmonary tree selectivity. A study with epoprostenol was complementary; both drugs can be used in these patients prior to heart transplantation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The uptake of cadmium (Cd) was analyzed for six different perennial plant species growing in a wooded pasture of the Swiss Jura Mountains, where the soils are geogenically enriched in Cd (4.58mg·kg−1 ...on average (n=36); maximal value: 16.3mg·kg−1). The six selected plants — Hypericum maculatum (Hypericaceae), Alchemilla xanthochlora (Rosaceae), Cynosurus cristatus (Poaceae), Ranunculus acris (Ranunculaceae), Dactylis glomerata (Poaceae) and Acer pseudoplatanus (Sapindaceae) — show variable Cd contents among the species and among individuals from the same family (Poaceae). Average Cd concentrations in the selected plants are in the 2–6mg·kg−1 range and exceed the maximal Cd concentration tolerated in vegetal feed for animals, which is established at 1mg·kg−1. High Cd concentrations in the soil result in a reduction of Cd accumulation in the shoots and a corresponding increase in the roots. This implies that Cd transfer coefficients from the soil/rhizosphere to the plant are inversely proportional to the total Cd concentrations in soils and do not depend on plant species but instead on soil type. Sequential chemical extractions reveal that variations in Cd distribution between the bulk soil and the corresponding rhizospheric soil occur mainly in the Cd-bearing phases, which are exchangeable, bound to carbonates, and associated with organic matter. This is principally due to the incorporation of root exudates, which modify pH and redox conditions of the rhizosphere. Elevated Cd concentrations in the shoots of A. xanthochlora (up to 8mg·kg−1), C. cristatus (9mg·kg−1) and H. maculatum (3mg·kg−1) may represent a long-term hazard for livestock and human health since these plants are used either by grazing cattle or for medicinal purposes. On the contrary, R. acris, A. pseudoplatanus, and especially D. glomerata show lower Cd concentrations and are of minor concern with regards to their environmental impact.
•Soils on Bajocian carbonate geogenically enriched in Cd in western Switzerland•Cd fractionation between bulk and rhizospheric soils may increase bioavailable Cd.•Cd in shoots of A. xanthochlora, C. cristatus and H. maculatum is up to 3–13mg·kg−1.•Cd transfer to plants depends on Cd content in soils and type of soil.•Plants may represent a long-term hazard for animals and human health.
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Abstract Background A recent study proposed a risk index (McCluskey index) based on 7 parameters to identify the transfusion needs of patients during surgery and in the first 24 hours postoperation. ...The initial objective of our study was to validate this predictor for blood product transfusions. Patients and Methods We undertook a retrospective, observational study of all liver transplant patients between January 1, 2005 and December 31, 2006. The following variables were recorded for each patient: age, gender, patient comorbidity, biochemical values prior to liver transplantation, and transfusion needs. Results Comparing the transfusion needs of those patients with scores <5 with those of scores ≥5, we observed significant differences in terms of the use of red blood cell concentrates, plasma, and platelets, both during the first 24 hours and in the total number. The index sensitivity was 80% (95% confidence interval CI: 71.23–88.76), with a specificity of 84.21% (95% CI: 67.81–100), where the positive predictive value was 95.52% (95% CI: 90.57–100.4) and the negative predictive value was 50% (95% CI: 32.67–67.32). Conclusion The McCluskey index showed sufficient sensitivity and specificity to predict which patients will require a massive transfusion.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In kidney and liver transplantation, sirolimus therapy has been shown to be comparable to cyclosporine in a head-to-head comparison, but it results in better preservation of renal reserve. In heart ...transplantation, information about the use of sirolimus is limited. We present the results of the progressive conversion from cyclosporine to sirolimus in a series of 8 heart transplant patients in whom renal dysfunction developed. The baseline creatinine level was 2.4 ± 0.5 mg/dL, and plasma levels of cyclosporine were within the therapeutic range. After the introduction of sirolimus, the creatinine level fell within the first month to 1.76 ± 0.2 mg/dL, or mean decrease of 0.6 ± 0.25 mg/dL (
P < .05). After 3 ± 2.2 months the improvement continued (1.69 ± 0.2 mg/dL). In 1 patient sirolimus was withdrawn during the first 24 hours, because of gastric intolerance. No patient developed an opportunist infection, allograft rejection, or important hematologic disorder. We conclude that sirolimus appears to be effective in heart transplant patients to improve renal function.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Area under the curve (AUC) limited sampling strategies have been proposed to improve the efficiency of mycophenolic acid (MPA), treatment of the transplanted patient. Our objective was to develop a ...model in the initial phase of the transplantation that explains the variability in the pharmacokinetic behavior of MPA in the immediate posttransplant period, following treatment with mycophenolate mofetil (MMF) in adult liver transplantation.
One hundred ten pharmacokinetic simplified sampling profiles were collected, including four samples over a 6-hour postdose interval, in over 60 patients treated with cyclosporine or tacrolimus, MMF, and steroids, combining Daclizumab in more than a third of the patients. For an enzyme-multiplied immunoassay technique method was established for MPA estimates. The correlation between the AUC and the plasma concentration points was established using a multiple linear regression with various equations for three different pharmacokinetic groups.
The maximum mean values of MPA AUC and predose concentration (C0h) (20.8 ± 11.8 and 2.3 ± 1.8, respectively) were reached on the third day. The single sample showing the greatest correlation with the MPA AUC was the one collected after 3 hours (
r
2 = 0.575); 59.1% of profiles displayed a single peak with more than half showing a tmax ≥ 3 hours.
This profile analysis during the first few weeks highlighted the problems in determining therapeutic targets. Profiles showing a double peak revealed the marked influence of the enterohepatic cycle on MPA concentrations during the initial phase.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The La Noria area lies in the northern part of the polydeformed Acatlán Complex, (southern Mexican Mixteca terrane), and the rocks record the following sequence of events: (i) Early–Middle Ordovician ...deposition of the volcaniclastic El Epazote and Las Calaveras units; (ii) late Middle Ordovician intrusion of the 467
±
16 Ma megacrystic, peraluminous, rift-related granitoids; (iii) late Devonian, D
1, greenschist facies deformation; (iv) intrusion of the Los Malpasos leucogranite and associated minor intrusions; (v) Middle Mississippian, D
2, dextral N–S deformation also under greenschist facies metamorphic conditions; and (vi) undated D
3 kink band development. U–Pb LA-ICPMS detrital zircon ages: (a) the El Epazote unit yielded: a mean
206Pb/
238U age from the youngest five concordant
206Pb/
238Pb age of 488
±
10 Ma, with other age peaks at ca. 506, ca. 1077, and ca. 1779 Ma and a few concordant Neoproterozoic ages: and (b) the Las Calaveras unit yielded a mean
206Pb/
238U age from the sixteen youngest detrital zircons of 466
±
10 Ma with other population age peaks ca. 1111, and ca. 1753 Ma. These data imply that granitoid intrusion was roughly synchronous with deposition of some of the host rocks. Whereas sources for most of the detrital zircons may be found in either the Acatlán and Oaxacan complexes, Laurentia or Gondwana, a Neoproterozoic source is most likely in Amazonia. The rocks record three low-grade deformational episodes: (i) D
1 produced a weak compositional banding and/or schistosity (S
1) under greenschist facies conditions; (ii) D
2, also occurred under greenschist facies conditions, and developed tight to isoclinal folds (F
2) in S
1 and an axial planar spaced-cleavage (S
2) that is co-planar with S
1; and (iii) D
3 produced reverse and conjugate kink bands (F
3) that deform the S
1/S
2 composite foliation. The leucogranite and related dikes that intrude the complex record only the latter two deformational events. Ca. 330 Ma
40Ar/
39Ar muscovite plateau ages probably closely post-date the D
2 event. D
1 may be correlated with early Carboniferous deformation elsewhere in the Acatlán Complex. On the other hand, the initial
40Ar/
39Ar steps at ca. 300, 220 and 172 Ma probably indicate thermal disturbances below 300 °C during the Permo-Carboniferous, Triassic and Jurassic, respectively. Whereas the Ordovician history of the plutons and volcano-sedimentary units coincides with the lifespan of both the Iapetus and Rheic oceans, the Late Paleozoic–Early Mesozoic deformation better reflects closure of the Rheic Ocean and convergence tectonics on the paleo-Pacific margin following the amalgamation of Pangea.
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