Asunto(s)
Mediastinitis/tratamiento farmacológico , Sepsis/tratamiento farmacológico , Anciano , Femenino , Fluidoterapia , Hematínicos/uso terapéutico , Humanos , Hidroxocobalamina/uso terapéutico , Mediastinitis/cirugía , Azul de Metileno/uso terapéutico , Resucitación , Vasoplejía/tratamiento farmacológicoRESUMEN
BACKGROUND: Evaluation of coronary artery disease (CAD) is a nonstandardized practice before kidney transplantation. The aim of this study was to assess the adequacy of cardiovascular investigations in relation to cardiovascular outcomes of Middle Eastern patients undergoing renal transplantation. METHODS: Seventy-five consecutive patients with end-stage renal disease in Qatar were prospectively evaluated between April 2005 and March 2008. They subsequently underwent kidney transplantation. Our prespecified protocol utilized noninvasive and/or invasive tests for the evaluation. RESULTS: The median age was 51 years including 68% men, and 87% of patients maintained on dialysis. Overall, 21 (28%) patients showed evidence of CAD, an incidence that was much higher among patients with diabetes (81%). There were 13 (17%) subjects shown to have CAD by coronary angiography in the absence of a background CAD history. The perioperative cardiovascular course was uneventful in the majority of patients except for five who developed acute coronary syndrome without mortality. CONCLUSION: This study confirmed the high incidence of CAD among kidney transplant candidates. Myocardial perfusion testing was not predictive of perioperative cardiac events. The incidence of perioperative cardiac complications was low; five patients (6.6%) developed acute coronary syndrome. This study suggested that kidney transplantation can be performed safely in the majority of patients regardless of age and even among those with prior evidence of CAD.
Asunto(s)
Sistema Cardiovascular/fisiopatología , Trasplante de Riñón , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Qatar , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: Faecal incontinence (FI) is a common disorder involving both the enteric (ENS) and central nervous systems (CNS). The aim of the study is to analyze neurophysiologically the central processing of emotions in children with FI, healthy controls and children with Attention-deficit hyperactivity disorder (ADHD). METHODS: Fourteen children with FI and constipation, nine with non-retentive FI, 15 controls and 13 children with ADHD were examined. The methods included a physical exam, sonography, Child Behavior Checklist, a psychiatric interview and intelligence test. Acoustic evoked potentials were recorded according to standardized methodology. For the event-related potentials, 80 neutral, 40 positive and 40 negative pictures from the International Affective Picture System (IAPS), and 40 pictures depicting faeces were presented. RESULTS: Children with FI had significantly more intense responses for most stimuli over the frontal, central and parietal regions compared to controls. Stool pictures did not evoke stronger responses than other stimuli. Children with constipation elicited stronger responses. Children with ADHD did not differ from controls. Acoustic evoked potentials were comparable in all groups. CONCLUSIONS: Children with FI have increased responses in the processing of emotions. These can be interpreted as a neurobiological vulnerability, possibly due to the association of the ENS and CNS.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Sistema Nervioso Central/fisiopatología , Estreñimiento/fisiopatología , Emociones/fisiología , Encopresis/fisiopatología , Sistema Nervioso Entérico/fisiopatología , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico por imagen , Estudios de Casos y Controles , Sistema Nervioso Central/diagnóstico por imagen , Niño , Trastornos de la Conducta Infantil/diagnóstico , Comorbilidad , Estreñimiento/psicología , Encopresis/psicología , Sistema Nervioso Entérico/diagnóstico por imagen , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Femenino , Alemania , Humanos , Pruebas de Inteligencia , Entrevista Psicológica , Masculino , Examen Físico , Técnicas Proyectivas , UltrasonografíaRESUMEN
The comparative effects of enalapril (E) and nifedipine (N) on renal hemodynamics were assessed in twenty-two moderately hypertensive, cadaveric renal transplant patients who were maintaining stable renal function. Fourteen patients were on cyclosporin (CSA) and eight were receiving azathioprine with prednisolone (AZA). In each patient effective renal plasma flow (ERPF) was determined four times, first baseline, second with E, third as another baseline after a washout period, and fourth with N; and renal vascular resistance (RVR) was derived in each. ERPF and RVR were significantly compromised in the CSA group (202 +/- 55 ml/min and 65 +/- 18 mmHg/ml/min) compared to the AZA group (302 +/- 99 and 43 +/- 15 respectively). During E therapy, RVR further increased in the CSA group to 82 +/- 37 while it decreased in the AZA group to 31 +/- 7 (both changes were significant when compared to their respective baseline values). N, on the other hand, only significantly lowered RVR in the AZA group. Furthermore, two patients, one from each group, developed acute reversible renal failure shortly after E therapy. However, both agents were effective in lowering blood pressure to a comparable degree in both groups. In conclusion, our data showed a somewhat less favourable renal hemodynamic response to short-term enalapril therapy in hypertensive renal transplant patients maintained on CSA. However, the significance of such hemodynamic changes for long-term renal function remains uncertain.