Search

Background: Cystic echinococcosis is a parasitic disease that develops in endemic areas due to the transmission of Echinococcus granulosus. The liver is the organ most affected. The most frequent s...

Título, resumen y palabras clave en español e inglés Resumen basado en el de la publicación Se analiza en qué medida los motivos que llevan a los estudiantes a cursar estudios universitarios a distancia y su sentimiento de autoeficacia académica influyen sobre los resultados que alcanzan. Para ello, a partir de los datos obtenidos con la aplicación de un cuestionario a una muestra de 8655 estudiantes universitarios durante los cursos académicos 2017/2018 y 2018/2019, se ha estimado un modelo de ecuaciones estructurales multigrupo. Los resultados muestran cómo la motivación extrínseca se relaciona negativamente con las tasas de evaluación y de éxito, mientras la motivación intrínseca no ejerce ningún tipo de influencia. El único factor que se asocia positivamente con rendimiento académico es el sentimiento de autoeficacia. Las universidades deben considerar estos resultados a la hora de establecer estrategias dirigidas a incrementar el sentimiento de autoeficacia de los estudiantes, lo cual repercutirá positivamente sobre su rendimiento y motivación. ESP

Introduction Simultaneous pancreas–kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type 1 or type 2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient. Methods Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival. Results Median age of the donors was 28 years and mean age of recipients was 38.8±7.3 years, being 103 males and 72 females. Enteric drainage of the exocrine pancreas was performed in 113 patients and bladder drainage in 62. Regarding post-transplant complications, the overall rate of infections was 70.3%; graft pancreatitis 26.3%; intraabdominal bleeding 17.7%; graft thrombosis 12.6%; and overall pancreas graft rejection 10.9%. The causes of mortality were mainly cardiovascular and infectious complications. Patient survival at 1, 3 and 5-year were 95.4%, 93% and 92.4%, respectively, and pancreas graft survival at 1, 3 and 5-year were 81.6%, 77.9% and 72.3%, respectively. Conclusions In our 20-year experience of simultaneous pancreas–kidney transplantation, the morbidity rate, and 5-year patient and pancreas graft survivals were similar to those previously reported from the international pancreas transplant registries.

Resumen Introduccion El trasplante de pancreas-rinon simultaneo constituye el tratamiento de eleccion en la diabetes tipo 1 o tipo 2 con fallo renal terminal o preterminal (dialisis o predialisis), por ser la unica terapia que consigue el estado euglucemico (insulino-independiente) en el paciente diabetico. Metodos Estudio retrospectivo y descriptivo de una serie de 175 pacientes trasplantados de pancreas-rinon simultaneo entre marzo de 1995 y abril de 2016. Se analizan las caracteristicas de los donantes y receptores, variables perioperatorias e inmunosupresion, morbimortalidad postrasplante, supervivencia del paciente e injerto y factores de riesgo de supervivencia del paciente e injerto. Resultados La mediana de edad de los donantes fue de 28 anos y la media de los receptores, de 38,8 ± 7,3 anos, siendo 103 hombres y 72 mujeres. La derivacion duodeno-enterica se realizo en 113 casos y la duodeno-vesical, en 62. Las tasas de complicaciones postrasplante fueron las siguientes: infeccion global (70,3%), pancreatitis del injerto (26,3%), hemorragia intraabdominal (17,7%), trombosis del injerto (12,6%) y rechazo pancreatico global (10,9%). Las causas de mortalidad fueron fundamentalmente cardiovasculares e infecciosas. La supervivencia del paciente a 1, 3 y 5 anos fue del 95,4, del 93 y del 92,4%, respectivamente, mientras que la del injerto correspondio al 81,6, al 77,9 y al 72,3%, respectivamente, durante el mismo periodo. Conclusiones En nuestra experiencia de 20 anos de trasplante pancreatico-renal simultaneo las tasas de morbilidad y supervivencia del paciente y del injerto a 5 anos son similares a las referidas en los registros internacionales de trasplante pancreatico.

Background and objective Familial amyloid polyneuropathy (FAP) is the most prevalent type of hereditary systemic amyloidosis. It is an autosomal dominant disease characterized by the deposition of an abnormal variant transthyretin. It has a worldwide distribution, with localized endemic areas in Portugal, Sweden and Japan. In Spain there is an endemic focus, located in Mallorca. Liver transplantation is the only curative option for patients with FAP. The aim of this study was to describe the clinical and demographic characteristics of patients transplanted with a diagnosis of PAF. Material and method Six patients with PAF underwent liver transplantation between April 1986 and December 2012. Results The mean age was 57.7 + 16 years, patients of Spanish origin were older than 60 years. All patients had progressive symptoms as mixed polyneuropathy. In 2 patients, combined heart–liver transplants sequentially were performed. Patient survival and graft was 80% at 1, 3 and 5 years. Conclusions The only effective treatment for etiologic PAF is liver transplantation. Early detection is the key to the treatment and control, avoiding the irreversible organ damage.

Resumen Fundamento y objetivo La polineuropatia amiloidotica familiar (PAF) constituye el tipo mas prevalente de amiloidosis sistemica hereditaria. Es una enfermedad autosomica dominante que se caracteriza por el deposito de una variante anomala de la transtiretina. Tiene una distribucion mundial, con zonas endemicas localizadas en Portugal, Suecia y Japon. En Espana hay un foco endemico, localizado en Mallorca. El trasplante hepatico es la unica opcion curativa para los pacientes con PAF. El objetivo de este estudio fue describir las caracteristicas clinicas y demograficas de los pacientes trasplantados con diagnostico de PAF. Material y metodo Se evaluaron 6 pacientes trasplantados por PAF entre abril de 1986 y diciembre de 2012. Resultados La edad media fue de 57,7 + 16 anos, los pacientes de origen espanol eran mayores de 60 anos. Todos los pacientes presentaban sintomas progresivos en forma de polineuropatia mixta. En 2 pacientes se realizo un doble trasplante hepatocardiaco secuencial, efectuandose en primer lugar el trasplante hepatico. La supervivencia del paciente y del injerto fue del 80% a los uno, 3 y 5 anos. Conclusiones El unico tratamiento etiologico eficaz para la PAF es el trasplante hepatico. Una deteccion temprana es la clave para el tratamiento y el control, evitandose el dano organico irreversible.

Simultaneous pancreas-kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type1 or type2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient.Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival.Median age of the donors was 28years and mean age of recipients was 38.8±7.3years, being 103 males and 72 females. Enteric drainage of the exocrine pancreas was performed in 113 patients and bladder drainage in 62. Regarding post-transplant complications, the overall rate of infections was 70.3%; graft pancreatitis 26.3%; intraabdominal bleeding 17.7%; graft thrombosis 12.6%; and overall pancreas graft rejection 10.9%. The causes of mortality were mainly cardiovascular and infectious complications. Patient survival at 1, 3 and 5-year were 95.4%, 93% and 92.4%, respectively, and pancreas graft survival at 1, 3 and 5-year were 81.6%, 77.9% y 72.3%, respectively.In our 20-year experience of simultaneous pancreas-kidney transplantation, the morbidity rate, and 5-year patient and pancreas graft survivals were similar to those previously reported from the international pancreas transplant registries.

Resumen La presion en lista de espera de trasplante hepatico obliga a la exploracion de nuevas fuentes de donacion, siendo la utilizacion de injertos procedentes de donantes despues de muerte cardiocirculatoria una de las que reunen un potencial mas prometedor e interesante. Inicialmente, este recurso ha sido utilizado en Espana a traves de la llamada categoria II de Maastricht, previamente denominada asistolia no controlada tipo II . Diferentes motivos han conducido a reconsiderar la donacion despues de la llamada muerte cardiocirculatoria controlada en el territorio nacional. El fenomeno distintivo en este tipo de donacion es el estres isquemico al que se exponen los organos del donante con sus importantes implicaciones sobre los resultados. Los aspectos particulares de esta modalidad de trasplante hepatico son el objeto de este trabajo.

An increasing pressure on the liver transplant waiting list, forces us to explore new sources, in order to expand the donor pool. One of the most interesting and with a promising potential, is donation after cardiac death (DCD). Initially, this activity has developed in Spain by means of the Maastricht type II donation in the uncontrolled setting. For different reasons, donation after controlled cardiac death has been reconsidered in our country. The most outstanding circumstance involved in DCD donation is a potential ischemic stress, that could cause severe liver graft cell damage, resulting in an adverse effect on liver transplant results, in terms of complications and outcomes. The complex and particular issues related to DCD Donation will be discussed in this review.

Summary The aim of this study was to investigate the effect of risedronate (RIS) on bone loss and bone turnover markers after liver transplantation (LT). Patients with osteopenia or osteoporosis within the first month after LT were randomized to receive RIS 35 mg/week plus calcium 1000 mg/day and vitamin D3 800 IU/day (n = 45) or calcium and vitamin D3 at same dosages (n = 44). Primary endpoint was change in bone mineral density (BMD) 6 and 12 months after LT. Secondary endpoints included changes in serum β-CrossLaps (β-CTX) and procollagen type 1 amino-terminal peptide (P1NP) and fracture rate. Spine X-rays were obtained at baseline and after 12 months. There was no significant difference in BMD changes between both treatment groups at any sites; either at 6 or 12 months. Spine BMD increased in both groups at 12 months vs. baseline (P = 0.001). RIS patients had a significant increase in intertrochanteric BMD at 12 months (P

Retroperitoneal liposarcoma constitutes an uncommon and locally aggressive malignancy. We performed a retrospective analysis of 10 patients (6 males; mean age: 63.2+/-11 years) with histologically proven retroperitoneal liposarcoma seen at our institution between 1999 and 2007. Presence of a palpable abdominal mass was the main symptom at diagnosis. All patients underwent complete surgical resection. Negative microscopic margin was achieved in four cases. Histological analysis revealed the following subtypes: well-differentiated (6 cases), dedifferentiated (two cases), pleomorphic, and myxoid/round cell (one case each). Concomitant resection of adjacent organs was needed in five cases. Half of the patients developed tumor recurrence, mainly limited to the retroperitoneum or abdominal cavity. The mean recurrence-free survival was 43.3 months (95%CI: 25.7-60.8), with 3- and 5-year overall survival rates of 79% and 61%, respectively. Patients undergoing complete resection with clear margins showed a near-significant trend toward increased recurrence-free survival (62.9 vs. 29.3 months; P=0.06).

Because of the organ shortage, non-heart-beating donors have been proposed as a possible source of grafts for orthotopic liver transplantation (OLT). Despite the widespread use of controlled non-heart-beating donors, there are only a few published studies reporting the outcomes with uncontrolled non-heart-beating donors (UNHBDs). A prospective case-control study on adult patients undergoing OLT was designed. We used normothermic extracorporeal membrane oxygenation (NECMO) in all UNHBDs. Matching 2:1 ratio comparison was performed between a study group (UNHBDs) and a brain death donor (BDD) control group. Between January 2006 and March 2008, a total of 60 patients were included: 20 in the UNHBD group and 40 in the control group. The incidence of ischemic cholangiopathy was 5% (n = 1) for the UNHBD group and 0% for the BDD group (P = 0.15). The rate of primary nonfunction was 10% (n = 2) in UNHBD recipients and 2.5% (n = 1) in BDD recipients (P = 0.21), with graft loss in all of them. Three patients were retransplanted in the UNHBD group (15%), 2 of them because of primary nonfunction and 1 because of ischemic cholangiopathy; no patient was retransplanted in the control group (P = 0.012). After a mean follow-up of 330.4 +/- 224.9 days, 1-year cumulative patient survival was 85.5% for the UNHBD group and 87.5% for the BDD group (P = 0.768). One-year cumulative graft survival was 80% in the UNHBD group and 87.5% in the BDD group (P = 0.774). In conclusion, UNHBDs under NECMO are a potential source of organs for OLT with encouraging outcomes potentially comparable to those obtained with BDDs.

In subtotal gastrectomy, at least 75 % of the stomach is resected. The passage is reconstructed using the proximal jejunum either as an omega loop or as a Roux-en-Y reconstruction. Indications: Gastric carcinoma of the intestinal type in the distal part of the stomach Complicated ulcers of the distal part of the stomach and the duodenum

The European Liver Transplant Registry (ELTR) currently allows for the analysis of 44,286 liver transplantations (LTs) performed on 39,196 patients in a 13-year period. After an exponential increase, the number of LTs is plateauing due to a lack of organs. To cope with this, alternatives to cadaveric LT, such as split LT, domino LT, or living-related LT (LRLT) are being used increasingly. They now account for 11% of all procedures. One of the most important findings in the evolution of LT is the considerable improvement of results along time with, for the mean time, a one-year survival of 83%, all indications confounded. The improvement is particularly significant for cancers. This improvement is mainly represented by hepatocellular carcinoma, with a gain of 17% for 5-year survival rate from 1990 to 2000. Increasingly, older donors are used to augment the donor pool and older recipients are transplanted due to improved results and a better selection of patients. More than two thirds of deaths and three quarters of retransplantations occurred within the first year of transplantation. Retransplantation is associated with much less optimal results than first LT. One of the prominent features of recent years is the development of LRLT. LRLT is now performed by almost half of the European centers. As with split LT or domino LT, LRLT aims to provide more patients to be transplanted. Special attention is paid to reducing the risk for the donor, which is now estimated to be 0.5% mortality and 21% postoperative morbidity.

Chronic biliary obstruction with repeated bouts of cholangitis adversely affects quality of life and may lead to secondary biliary cirrhosis with liver failure. We reviewed our experience with chronic biliary complications after surgical treatment of various diseases that at the end needed a liver transplantation. Twelve patients with previous biliary surgery developed secondary biliary cholangitis, secondary biliary cirrhosis, or both. Seven had surgery for liver hydatid disease by Echinococcus granulosus, another four had complicated biliary surgery unrelated to hydatid disease, and one had a history of a traffic accident with liver trauma and hepatectomy with chronic biliary fistula. The repeated cholangitis attacks and in two cases of hydatid disease the development of biliary-bronchial fistulas made these patients' lives miserable. All had had previous surgical procedures that made the transplantation procedure more difficult. Nevertheless, patient survival and graft actuarial survival after liver replacement were 75.0% and 69.2%, respectively, at 5 years.

The most practical measure to augment the available number of liver grafts and thus reduce waiting list mortality is to increase the donor age limit. We hypothesized that with careful selection of old liver donors without age limit it should be possible to obtain good patient and graft survival.The present study comprises 351 adults who underwent liver transplantation. They were divided into three groups according to the age of the liver donors: group 1: 226 recipients of donors60 years; group 2: 75 recipients of donors between 60 and 70 years; and group 3: 50 recipients of donors70 years. A comparative study among the groups was performed.Patient survival rates at 1, 3, and 5 years were, respectively, 81.0, 76.1, and 71.1 % in group 1; 83.8, 74, and 72.2 % in group 2; and 76, 70.0, and 62.9 % in group 3 (P = NS). Graft survival at 1, 3, and 5 years was, respectively, 74.8, 69.0, and 64.1 % in group 1; 82.7, 71.4, and 69.6 % in group 2; and 71.4, 64.8, and 58.3 % in group 3 (P = NS). We analyzed the use of older grafts in recipients with HCV cirrhosis and did not find significant differences in patient and graft survival at 1, 3, and 5 years. In multivariate analysis increased donor body mass index and decreased recipient albumin were associated with lower patient and graft survival.Because patient and graft survival rates are not affected by donor age, well-selected older donor livers can be safely used if they show good function and preharvesting conditions.

A 35-year-old man with a medical history of schizophrenia was presented at the hospital because of abdominal pain and fever. There were evidence of localized peritoneal irritation by exam. His laboratory tests on admission revealed an elevated white blood cell count of 24.700 mm and neutrophilia (88.1%). An abdominal CT scan showed four foreign bodies (Fig. 1), one of them producing a sigmoid colon perforation with pneumoperitoneum. The patient was taken urgently to the operating room for surgery. A FB was found penetrating sigmoid colon (Fig. 2) without intra-abdominal contamination. A primary suture was performed and the patient was discharged to home without any complications. Sigmoid colon perforation due to a foreign body ingestion

We evaluate the 5-year results of a single-centre prospective randomized trial that compared cyclosporine microemulsion (CyA-me) in triple therapy (plus steroids and azathioprine) and Tacrolimus (Tac) in double therapy (plus steroids) for primary immunosuppression. One hundred adult patients undergoing liver transplantation were randomized to receive Tac (n=51) or CyA-me (n=49). Ten patients in group A, and thirty-one patients in group B had their main immunosuppressive agent switched. The switch was much more frequent from CyA-me to Tac (n=31; 62.3%), mainly because of lack of efficacy (n=12; 38.7%). Six of 10 patients were shifted from Tac to CyA-me for side effects. The clinical course of the majority of patients converted from CyA-me to Tac improved clearly after conversion. Donor age and acute rejection (number, severity and rejection free days) had a significative association with lack of efficacy in group B. In these series, the conversion to Tac from CyA-me could be accomplished safely, with an excellent long-term outcome.

The aim of this study was to investigate the effect of risedronate (RIS) on bone loss and bone turnover markers after liver transplantation (LT). Patients with osteopenia or osteoporosis within the first month after LT were randomized to receive RIS 35 mg/week plus calcium 1000 mg/day and vitamin D(3) 800 IU/day (n = 45) or calcium and vitamin D(3) at same dosages (n = 44). Primary endpoint was change in bone mineral density (BMD) 6 and 12 months after LT. Secondary endpoints included changes in serum β-CrossLaps (β-CTX) and procollagen type 1 amino-terminal peptide (P1NP) and fracture rate. Spine X-rays were obtained at baseline and after 12 months. There was no significant difference in BMD changes between both treatment groups at any sites; either at 6 or 12 months. Spine BMD increased in both groups at 12 months vs. baseline (P = 0.001). RIS patients had a significant increase in intertrochanteric BMD at 12 months (P0.05 vs. baseline). Serum β-CTX decreased in both groups (P0.01), with significant differences between groups at 3 months. No significant difference in vertebral fracture incidence was found. After 12 months, BMD improved at lumbar spine and did not change at hip in both groups. Significant differences between both groups were not found. Other factors (calcium and vitamin D replacement, early prednisone withdrawal) seem to have also positive effects in BMD.

Between April 1986 and August 1990, 151 liver transplantations were performed at our institution, 16 (11%) of them in 14 patients with primary hepatic tumors. There were 12 hepatocellular carcinomas, 1 angiosarcoma, and 1 Klatskin tumor. None of the tumors was resectable, and there was no preoperative evidence of extrahepatic tumoral extension. Exploratory laparotomy was performed prior to transplantation in three patients and selective embolization of the tumor in six patients. There was no difference in the intraoperative requirements for blood or plasma in the patients with hepatic tumors when compared with other transplant recipients (28.6 +/- 23.6 units packed red blood cells [PRBC] versus 20.1 +/- 17.8 units PRBC, and 17.9 +/- 12.2 units plasma versus 17.1 +/- 10.5 units plasma, respectively). Extracorporeal venovenous bypass was used in all but one patient. There was no significant differences in the incidence of acute rejection or in the length of hospitalization in these patients when compared with other transplant recipients. All patients received triple immunosuppressive therapy (corticosteroids, azathioprine, and cyclosporin A). Intraoperative mortality was zero. At a mean of 13.3 months' follow-up (range: 1 to 47 months), 2 of 14 patients had died of sepsis and 1 of terminal cirrhosis (autopsies revealed no evidence of tumor recurrence); 3 patients (21%) had recurrences of the tumor (1 in the central nervous system and liver, and the other 2 in the lung). One of the three patients with a recurrent tumor is still alive after 16 months. The remaining nine patients (64%) are still alive.

To assess the efficacy of the Molecular Adsorbent Recirculating System MARS (GAMBRO LUNDIA AB, Europe) in patients with acute liver failure waiting for liver transplantation.Case-control study in a medical-surgical ICU of a referral hospital. Patients admitted to ICU with severe acute liver failure of any etiology were included. Conventional treatment was applied in all cases according to patient's clinical condition. Patients were treated with MARS after the implementation of this therapy in the ICU. Patients without this treatment were the control group.Were included 45 patients (control group: 26, MARS group: 19). Comparison between groups showed only differences in plasma bilirrubin levels in the first 24 hours. ICU mortality was 52.63% in the treatment group and 42.3% in the control group (p = 0.49). In the control group 17 patients (65.4%) received a liver transplant and 11 (57.9%) in the MARS group. ICU mortality was lower for transplanted patients in the study group (27.27% vs. 87.5%) (p = 0.019). Kaplan-Meier survival curves indicate that MARS-treated patients before liver transplantation had better survival.Combination therapy with MARS and liver transplantation seems to be the more effective therapeutic option for patients with severe ALF.

Purpose: Clinical measurement of the accommodative response (AR) identifies the focusing plane of a subject with respect to the accommodative target. To establish whether a significant change in AR has occurred, it is important to determine the repeatability of this measurement. This study had two aims: First, to determine the intraexaminer repeatability of AR measurements using four clinical methods: Nott retinoscopy, monocular estimate method (MEM) retinoscopy, binocular crossed cylinder test (BCC) and near autorefractometry. Second, to study the level of agreement between AR measurements obtained with the different methods. Methods: The AR of the right eye at one accommodative demand of 2.50 D (40 cm) was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18-32 years). The intraexaminer repeatability of the tests, and agreement between them, were estimated by the Bland-Altman method. We determined mean differences (MD) and the 95% limits of agreement [coefficient of repeatability (COR) and coefficient of agreement (COA)]. Results: Nott retinoscopy and BCC offered the best repeatability, showing the lowest MD and narrowest 95% interval of agreement (Nott: -0.10 +/- 0.66 D, BCC: -0.05 +/- 0.75 D). The 95% limits of agreement for the four techniques were similar (COA = +/- 0.92 to +/- 1.00 D) yet clinically significant, according to the expected values of the AR. The two dynamic retinoscopy techniques (Nott and MEM) had a better agreement (COA = +/- 0.64 D) although this COA must be interpreted in the context of the low MEM repeatability (COR = +/- 0.98 D). Conclusions: The best method of assessing AR was Nott retinoscopy. The BCC technique was also repeatable, and both are recommended as suitable methods for clinical use. Despite better agreement between MEM and Nott, agreement among the remaining methods was poor such that their interchangeable use in clinical practice is not recommended.

Background: Clinical measurement of the amplitude of accommodation (AA) provides an indication of maximum accommodative ability. To determine whether there has been a significant change in the AA, it is important to have a good idea of the repeatability of the measurement method used. The aim of the present study was to compare AA measurements made using three different subjective clinical methods: the push-up, push-down, and minus lens techniques. These methods differ in terms of the apparent size of the target, the end point used, or the components of the accommodation response stimulated. Our working hypothesis was that these methods are likely to show different degrees of repeatability such that they should not be used interchangeably. Methods: The AA of the right eye was measured on two separate occasions in 61 visually normal subjects of mean age 19.7 years (range 18 to 32). The repeatability of the tests and agreement between them was estimated by the Bland and Altman method. We determined the mean difference (MD) and the 95% limits of agreement for the repeatability study ( COR) and for the agreement study (COA). Results: The COR for the push-up, push-down, and minus lens techniques were +/- 4.76, +/- 4.00, and +/- 2.52D, respectively. Higher values of AA were obtained using the pushup procedure compared to the push-down and minus lens methods. The push-down method also yielded a larger mean AA than the negative-lens method. MD between the three methods were high in clinical terms, always over 1.75D, and the COA differed substantially by at least +/- 4.50D. The highest agreement interval was observed when we compared AA measurements made using minus lenses and the push-up method (+/- 5.65D). Conclusions: The minus lens method exhibited the best repeatability, least MD (-0.08D) and the smallest COR. Agreement between the three techniques was poor.

Purpose: This study was designed to determine the repeatability of fusional vergence rangesmeasured using the rotary prisms in the phoropter and in free space using the prism bar. The level of agreement between the two methods was also investigated.. Methods: In two separate sessions, negative and positive fusional vergence ranges (NFV and PFV, respectively) were measured at distance and near in 61 young adults (mean age 19.74, S.D. 2.5 years) who were unfamiliar with the methods used. Base-in and base-out blur, break and recovery points were sequentially determined. Both sets of measurements were obtained by the same examiner. At each distance, NFV was determined first and then PFV. The repeatability of the tests and agreement between measurements made with the phoropter rotary prisms and the prism bar were estimated by the Bland and Altman method. Results: For both the phoropter rotary prisms and prism bar, NFV measurements showed better repeatability than PFV at both near and distance. Mean differences recorded for the NFV break and recovery points were non-significant (under 0.5D), while those observed for PFV were generally greater than 2D. When agreement between the two tests was assessed, it was found that break points were higher when determined using the phoropter rotary prisms, while recovery points were generally higher for the prism bar method. In clinical terms, according to the expected values of the NFV and PFV, agreement between the two techniques can be described as fair, because although mean differences were never greater than 5.5D, 95% agreement intervals were as wide as ±8.00D for NFV and ±13.19D for PFV. Conclusions: The two methods used to measure fusional vergences showed fairly good inter- session repeatability for measuring NFV but repeatability was reduced for PFV measurements. The level of agreement observed between the two methods was such that their interchangeable use in clinical practice is not recommended.

Background There is limited information about clinical consequences of respiratory virus infections (RVI) in solid organ transplant recipients. No prospective epidemiological study has been published previously. Methods We selected a cohort of 152 transplant recipients (cardiac, hepatic and renal transplant recipients). Median time from transplantation was 17 months (range 1-50). They were prospectively followed-up for RVI during 7 months (October to April). Clinical and microbiological evaluation (cell culture, shell vial and polymerase chain reaction technique) of each RVI episode was made. Results We detected 81 RVI (0.91 episodes/patient/year). Complications were detected in 15/81 episodes (18.5%): acute bronchitis (10 cases), pneumonia (three cases; 3.7% of RVI episodes) and bacterial sinusitis (2 cases). In 4 of 81 episodes (5%), patients needed hospitalization. A respiratory virus was isolated in 17 of 68 nasopharyngeal samples (six respiratory syncytial virus, six influenza, four picornavirus, one adenovirus). Fever presented an 83% positive predictive value for the diagnosis of influenza virus infection among those with a positive microbiological isolation. There were no episodes of acute rejection coincidentally with RVI. Only 54% of the subjects had been previously vaccinated against influenza. Conclusions Incidence of RVI among solid organ transplant recipients is similar to general population but complications are higher. A relationship between RVI and rejection was not detected. The rate of influenza vaccination was lower than expected. The presence of fever in a transplant recipient with RVI strongly suggests influenza infection.

PURPOSE. The Aniseikonia Inspector 1.1 (AI) is a new software product to measure aniseikonia using red-green anaglyphs. The purpose of this study was to test whether the AI is a valid and reliable test. METHODS. There were two groups of sample subjects: one at risk of aniseikonia, with anisometropia greater than or equal to 1.00 D (n = 29), and a control group (n = 45). The validity was studied by comparing the measured aniseikonia with the aniseikonia simulated with size lenses. The reliability was estimated by the Bland-Altman statistical method. RESULTS. The results showed that the AI underestimated aniseikonia and that the underestimation was greater in the horizontal than in the vertical direction. The reliability was low, with biases that were clinically insignificant, but the 95% limits of agreement were around +/- 2%. The behavior of the test was similar in both groups of subjects. CONCLUSIONS. The reliability of the AI is only moderate, and professionals are therefore warned to use the results of this test with caution.

Purpose. Aniseikonia has been traditionally measured using the New Aniseikonia Test (NAT) based on red/green anaglyphs. This study was designed to establish whether the NAT is a valid and reliable test. Methods. The NAT was tested on three groups of subjects: a control group (n = 45) and two groups of participants at risk of experiencing aniseikonia, those with anisometropia greater than or equal to 1.00 D (n = 29) and those with bilateral pseudophakia (n = 26). The validity of the test was established by comparing the measured aniseikonia with that simulated with size lenses in a double-blind study. Repeatability was evaluated by comparing the results obtained at two different time points. Results. Our results indicate that the NAT underestimates aniseikonia and more so in the horizontal than in the vertical direction. Repeatability was poor, although biases were clinically insignificant. However, the 95% limits of agreement were around ±2%. The behavior of the test was similar in the three groups of subjects. Conclusions. We conclude that the repeatability of the NAT is not very high and recommend that clinicians be cautious when interpreting the results of this test.

BACKGROUND The role of valganciclovir in the prevention of cytomegalovirus (CMV) disease in high-risk seropositive transplant patients is not known. METHODS We prospectively followed 301 seropositive solid organ transplant recipients to assess the efficacy and safety of valganciclovir (VGCV) in the prevention of CMV disease in high-risk patients. Asymptomatic patients with an antigenemia test >or=25 positive cells/2x10(5) polymorphonuclear cells received valganciclovir 900 mg twice a day as preemptive therapy until resolution of antigenemia (minimum 14 days). Additionally, patients treated with antilymphocytic drugs for more than 6 days received prophylaxis with VGCV 900 mg once a day during 90 days. Mean follow-up was 14 months (range 6-20 months). RESULTS Thirty-eight patients received VGCV; 24 as preemptive therapy and 14 due to the use of antilymphocytic drugs. No patient developed CMV disease during the follow-up. Viral load (antigenemia) decreased a mean of 78% from baseline after 7 days of VGCV therapy (P=0.024) and 98% at day 14 (P=0.029). Two patients showed a relapse of the antigenemia test >or=25 positive cells and were successfully treated with a repeated course of VGCV. Leukopenia (

Pancreas transplantation has become an excellent therapeutic procedure for Diabetes mellitus. From 1965 to 1986, 830 patients received pancreas transplantation in the world and these figures were reached every year during the 90's. The characteristics of simultaneous kidney-pancreas transplantation (SPK), indications, operative techniques and complications are shown. The main features of the donors and preoperative study of the recipients to be accepted as candidates are referred. The experience of the Department of General and Digestive Surgery, and Abdominal Organ Transplantation of the Doce de Octubre Hospital with the first 11 SPK on end-stage diabetic renal failure is commented. The age range was 24 and 43 years. Eight patients had diabetic retinopathy. One patient died after 1 year of the transplant. Another patient had portal venous thrombosis and the pancreatic graft was removed. Eight patients live insulin-free and 1 needs moderate doses of insulin. None of the patients died as a consequence of the transplant though 2 of them had Mucor infection.

We report five patients who underwent laparotomy for liver metastasis from breast cancer without extrahepatic spread, with the intention to perform liver resection. All these patients had been subjected to modified radical mastectomy following systemic chemotherapy and periodical consecutive investigations to detect distant spreading. After laparotomy, patients have been regularly followed. Case 1, right trisegmentectomy in a 53-year-old woman, 36.5 months after the mastectomy. In the 17th postoperative month she continues without relapse. Case 2, hepatic artery ligature in a 41-year-old woman, 15 months after the mastectomy. In the 17th postoperative month she died. Case 3, bisegmentectomy (VI-VII) in a 51-year-old woman, 24 months after the mastectomy. In the 17th postoperative month she died. Case 4, exploratory laparotomy in a 51-year-old woman, 91 months after the mastectomy. In the 31th postoperative month she remains alive. Case 5, segmentectomy (IV) in a 59-year-old woman, 112 months after the mastectomy. In the 33th postoperative month she continues without relapse. As a conclusion, the surgical resection of liver metastasis from breast tumors after chemotherapy must be used in selected cases.

Purpose.: To develop a questionnaire (in Spanish) to measure computer-related visual and ocular symptoms (CRVOS). Methods.: A pilot questionnaire was created by consulting the literature, clinicians, and video display terminal (VDT) workers. The replies of 636 subjects completing the questionnaire were assessed using the Rasch model and conventional statistics to generate a new scale, designated the Computer-Vision Symptom Scale (CVSS17). Validity and reliability were determined by Rasch fit statistics, principal components analysis (PCA), person separation, differential item functioning (DIF), and item–person targeting. To assess construct validity, the CVSS17 was correlated with a Rasch-based visual discomfort scale (VDS) in 163 VDT workers, this group completed the CVSS17 twice in order to assess test-retest reliability (two-way single-measure intraclass correlation coefficient [ICC] and their 95% confidence intervals, and the coefficient of repeatability [COR]). Results.: The CVSS17 contains 17 items exploring 15 different symptoms. These items showed good reliability and internal consistency (mean square infit and outfit 0.88–1.17, eigenvalue for the first residual PCA component 1.37, person separation 2.85, and no DIF). Pearson's correlation with VDS scores was 0.60 (P < 0.001). Intraclass correlation coefficient for test–retest reliability was 0.849 (95% confidence interval [CI], 0.800–0.887), and COR was 8.14. Conclusions.: The Rasch-based linear-scale CVSS17 emerged as a useful tool to quantify CRVOS in computer workers.

The scarcity of ideal liver grafts for orthotopic liver transplantation (OLT) has led transplant teams to investigate other sources of grafts in order to augment the donor liver pool. One way to get more liver grafts is to use marginal donors, a not well-defined group which includes mainly donors > 60 years, donors with hypernatremia or macrosteatosis > 30%, donors with hepatitis C virus or hepatitis B virus positive serologies, cold ischemia time > 12 h, non-heart-beating donors, and grafts from split-livers or living-related donations. Perhaps the most practical and frequent measure to increase the liver pool, and thus to reduce waiting list mortality, is to use older livers. In the past years the results of OLT with old livers have improved, mainly due to better selection and maintenance of donors, improvements in surgical techniques in donors and recipients, and intra- and post-OLT management. At the present time, sexagenarian livers are generally accepted, but there still exists some controversy regarding the use of septuagenarian and octogenarian liver grafts. The aim of this paper is to briefly review the aging process of the liver and reported experiences using old livers for OLT. Fundamentally, the series of septuagenarian and octogenarian livers will be addressed to see if there is a limit to using these aged grafts.

A 64-year-old male patient was studied for repeated right basal pneumonia of long duration. A computed tomography scan showed a cholecystitis of concealed evolution. Surgery revealed fistulization toward the thorax, with the passage of multiple calculi of a biliary origin to the chest cavity. We report the first described case to our knowledge of cholecyst-thoracic fistula secondary to cholecystitis of long evolution.

Among 283 orthotopic liver transplantations made during the last 6 years at our institution, 22 (7.77%) were done on 19 patients with unresectable hepatic malignant tumors [hepatocellular carcinoma (17), angiosarcoma (1), and cholangiocarcinoma (1)]. None of them showed extrahepatic invasion, and only one had lymph node involvement. Cyclosporin A, corticosteroids, and azathioprine were administered for 3 months after the procedure, and maintenance therapy involved the first two drugs. Acute rejection rate and hospital stay were not significantly different compared with non–tumoral grafted patients. Three patients were retransplanted, one with uncontrolled acute rejection and two with chronic rejection. Intraoperative mortality was zero. Eight patients (42.1%) were alive at a mean follow-up of 31 months (range, 6–74). Four 22.2%) died with tumor recurrence, three of sepsis, two of respiratory insufficiency, one of hepatitis recurrence with cirrhosis, and one of primary lung neoplasia. If adequately selected, primary liver tumor patients may benefit from liver transplantation. Future research with adjuvant therapies will improve the results. © 1993 Wiley-Liss, Inc.