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Introduction EuroTransplant old-to-old program allows patients older than 60 years to receive offers from donors older than 60. The long-term results of kidney transplantation in this model are still under discussion, due to the impaired kidney function of the donor and cumulative diseases in the recipient. Hypothesis Calcineurin-sparing protocols with IL-2 antibody induction (Simulect) may benefit long-term kidney function in these patients avoiding overimmunosuppression. The main outcome measures are: graft function and rejection rate during the first year after transplant. Patients and methods A cohort of 15 consecutive older subjects were prospectively compared with 30 conventional cadaveric kidney transplants. Study patients were induced with Simulect (20 mg, 30 minutes before reperfusion and 4 days after transplantation) and steroids allowing the introduction of CsA to be delayed to the time at which the creatinine is below 3 mg/dL. Conventional patients were immunosuppresed with Tacrolimus (trough 8–12 ng/mL), MMF (1 g/d) and identical steroid tape. The graft and patient survival, kidney function in terms of diuresis, creatinine clearance, rejection episodes and grades were compared between both groups during the first year posttransplantation. Results Except for the age of the donors and recipients in both groups (72 vs 54 in donors, and 67 versus 52 years in recipients), no significant differences were observed. Patient survival rates were 97% in control patients and 100% in the Simulect group. Graft survival was 97% in the control group and 100% in the old-to-old study group. Acute rejection episodes were decreased among study patients (6.6% vs 13.2%), and corticoid sparing protocols were applied in 75% of Simulect patients but only 50% of control patients. All 44 patients and grafts showed excellent kidney function after one year with equal creatinine levels in both groups (mean 1.42). Conclusions Calcineurin free protocols with IL-2 therapy as the main initial suppression allows patients in an old-to-old ET program to have superior results to conventional cadaveric kidney transplants.

During Miocene time, the Andean region between 38° and 39°S was an area where active volcanoes, lakes and rivers formed under a temperate to cold humid climate. The volcanic products and sedimentary deposits which accumulated in lakes and rivers adjacent to the volcanoes constitute the Cura-Mallin Formation. The deep roots of the volcanic chain are represented by middle to late Miocene granitoids which formed a north-south trending belt that separated a marine fore-arc basin (Temuco basin) to the west from the continental sedimentary deposits of the Cura-Mallin Formation to the east. Twenty-three KAr dates ranging between 20 and 11 Ma, constrain the age of the Cura-Mallin Formation to the early to middle Miocene. The alternation of pyroclastic strata and lava flows in the Guapitrio Member of the Cura-Mallin Formation suggests the former existence of strato-volcanoes, whilst the presence of ignimbrites suggests caldera formation. A major lacustrine basin ( >100 km long) represented by some facies of the Rio Pedregoso Member of the Cura-Mallin Formation existed from at least 17.5 ± 0.6 to 13 ± 1.6 Ma. Lacustrine accumulations terminated during the progradation of deltas and infilling of volcanic material. The Cura-Mallin Formation lakes could have been formed, in part, by intra-arc extension, by the damming of rivers caused by volcanic products and/or by the filling of calderas. The occurrence of Gilbert-type delta complexes in the Rio Pedregoso Member may indicate a steep basin margin generated by faulting and/or volcanic accretion.

La persistencia de la cloaca es una de las formas más complejas de las malformaciones anorrectales que se produce en las niñas. El tratamiento es complicado y laborioso, sobre todo cuando el canal común es largo.El objetivo de esta comunicación es subrayar la importancia de la movilización conjunta del seno urogenital tras la separación del recto. La primera maniobra evita la separación del tracto urinario del genital, acortando el tiempo de intervención en más del 60 %. Esto sólo es possible realizarlo en las cloacas con canal común menor de 3 cm. Se presentan los casos de dos niñas intervenidas en el transcurso de los últimos 2 años con esta técnica.Los resultados en cuanto al acortamiento del tiempo quirúrgico fueron significativos pudiéndose realizar en aproximadamente 4 h, la intervención se simplificó de manera importante y los resultados funcionales y estéticos fueron excelentes.Creemos que para obtener buenos resultados en el tratamiento de la cloaca, es necesario establecer un diagnóstico clínico y radiológico preciso, evaluar el orden de preferencia de las necesidades quirúrgicas y elegir la técnica adecuada. Se considera que la mejor opción para aquellos casos cuyo canal común es inferior a 3 cm es la movilización total del seno urogenital, su abocamiento al perineo y la colocación del recto en el complejo esfinteriano anorrectal. : Persistent cloaca is one of the most complex forms of anorectal malformation in girls. Surgical treatment is complicated and laborious especially when the common channel is long.The aim of this report was to emphasize the importance of the joint mobilization of the urogenital sinus after separation from the rectum. This maneuver avoids separation of the urinary tract from the enital tract and reduces operating time by more than 60 %. This is only possible when the common channel of the cloaca is less than 3 cm. We present the cases of two girls treated in the last 2 years with this technique.Operating time was significantly shortened to approximately 4 hours and the procedure was considerably simplified. The functional and cosmetic results were excellent.To obtain good results in the treatment of cloaca, a precise clinical and radiologist diagnosis must be made, surgical needs should be prioritized and the appropriate technique chosen. The best procedure for patients whose common channel is less than 3 cm is total mobilization of the urogenital sinus, subsequently sutured to the perineum, and placement the rectum within the anorectal sphincter complex.