Produção e composição do leite de vacas em pastagem de capim-elefante (Pennisetum purpureum) suplementado com diferentes fontes de carboidratos / Milk production and composition of dairy cows grazing elephantgrass (Pennisetum purpureum) supplemented with different sources of carbohydrates

Avaliaram-se os efeitos da silagem de grãos úmidos de milho e da substituição parcial ou total de milho seco por polpa de citrus sobre a produção e a composição do leite de vacas mantidas em pastejo de capim-elefante, manejado intensivamente. Foram utilizadas 12 vacas da raça Holandesa, "de alta cruza" distribuídas em quatro tratamentos, em delineamento do tipo quadrado latino. Todas as vacas receberam concentrados que diferiram nas fontes de carboidratos: milho-grão seco moído, polpa de citrus mais milho grão seco moído, polpa de citrus e silagem de grãos úmidos de milho. Não foi detectada diferença (P>0,05) na produção de leite total, de leite corrigido para gordura (LCG 3,5) e para sólidos (LCS) entre tratamentos. Vacas que receberam milho-grão seco e silagem de milho de alta umidade apresentaram maior porcentagem de proteína e sólidos totais no leite (P<0,05), e as que receberam polpa de citrus, maior porcentagem de gordura (P<0,01). As que consumiram silagem de grãos úmidos apresentaram menor valor de nitrogênio ureico no leite (P<0,05). A ausência de resposta positiva ao processamento do milho pode ser razão do potencial de produção do sistema em pasto e do estresse calórico sofrido pelos animais. Em critérios de pagamento do leite em que a composição não tem valor econômico definido, qualquer uma das fontes de carboidratos testados no presente estudo pode ser utilizada.

Twelve Holstein dairy cows were assigned to one of four treatments in a 4x4 latin square design. Cows grazed Elephant grass and were supplemented with different concentrates which differed in the carbohydrate source as follows: ground dry corn (MG), citrus pulp plus ground dry corn (MP), citrus pulp (PC), and high moisture corn (MU). There was no difference (P>0.05) between treatments neither in total milk production corrected for 3.5 percent nor in milk production corrected for solids. Cows fed ground dry corn and high moisture corn showed higher levels of milk protein and milk total solids (P<0.05) and cows fed citrus pulp showed higher levels of milk fat (P<0.01). Cows that consumed high moisture corn showed lower levels of milk urea nitrogen (P<0.05), indicating that they used nitrogen more efficiently. The lack of positive statistical response in cows consuming high moisture corn could be caused by the production potential of grazing systems as well as by heat stress. For milk payment criteria without considering composition, any carbohydrate source tested may be used for feeding.

Determination of renal function in long-term heart transplant patients by measurement of urinary retinol-binding protein levels

Significant improvements have been noted in heart transplantation with the advent of cyclosporine. However, cyclosporine use is associated with significant side effects, such as chronic renal failure. We were interested in evaluating the incidence of long-term renal dysfunction in heart transplant recipients. Fifty-three heart transplant recipients were enrolled in the study. Forty-three patients completed the entire evaluation and follow-up. Glomerular (serum creatinine, creatinine clearance measured, and creatinine clearance calculated) and tubular functions (urinary retinol-binding protein, uRBP) were re-analyzed after 18 months. At the enrollment time, the prevalence of renal failure ranged from 37.7 to 54 percent according to criteria used to define it (serum creatinine > or = 1.5 mg/dL and creatinine clearance <60 mL/min). Mean serum creatinine was 1.61 ± 1.31 mg/dL (range 0.7 to 9.8 mg/dL) and calculated and measured creatinine clearances were 67.7 ± 25.9 and 61.18 ± 25.04 mL min-1 (1.73 m²)-1, respectively. Sixteen of the 43 patients who completed the follow-up (37.2 percent) had tubular dysfunction detected by increased levels of uRBP (median 1.06, 0.412-6.396 mg/dL). Eleven of the 16 patients (68.7 percent) with elevated uRBP had poorer renal function after 18 months of follow-up, compared with only eight of the 27 patients (29.6 percent) with normal uRBP (RR = 3.47, P = 0.0095). Interestingly, cyclosporine trough levels were not different between patients with or without tubular and glomerular dysfunction. Renal function impairment is common after heart transplantation. Tubular dysfunction, assessed by uRBP, correlates with a worsening of glomerular filtration and can be a useful tool for early detection of renal dysfunction.

Heterogeneity of glomerular perfusion and filtration induced by epinephrine and norepinephrine

The role of catecholamines in the distribution of intrarenal blood flow and in single-nephron glomerular filtration rate (SNGFR) was evaluated in anesthetized Wistar rats by the Hanssen technique. Epinephrine (EPI) and norepinephrine (NOR) were infused to produce elevations of 20-30 mmHg in mean arterial pressure. Superficial and juxtamedullary nephron perfusion and filtration were determined by the presence of Prussian blue dye. In the control group, 100 per cent of the nephrons presented a homogeneous pattern of perfusion and filtration. In contrast, a heterogenous distribution of the dye was found even in the larger arteries (arciform and radial), indicating variable perfusion and filtration in both superficial and juxtamedullary nephrons. The effects of EPI and NOR were also evaluated in the superficial cortex by the micropuncture technique in two additional groups of Munich-Wistar rats. Mean SNGFR was 27 per cent and 54 per cent lower in the EPI-and NOR-treated groups, respectively. No change in mean intraglomerular hydraulic pressure was observed after EPI or NOR infusion in spite of a highly scattered pattern, indicating an important variability in perfusion along the superficial cortex, and/or different sensitivity of the pre-and post-glomerular arterioles. The present data suggest that EPI and NOR may affect intrarenal hemodynamics by modifying perfusion and filtration in both superficial and juxtamedullary glomeruli and not by shifting blood folow from superficial to juxtamedullary nephrons. The heterogenous pattern of perfusion was a consequence of differential vasoconstriction along the intrarenal arteries, probably due to different density and/or sensitivity of the adrenergic receptor subtypes present in the intrarenal vascular tree.

Spirocerca lupi induced acute myelomalacia in the dog. A case report

Cäo macho, sem raça definida, de 3 anos de idade, foi atendido no Serviço de Neurologia por apresentar paraplegia de início súbito. Ao exame clínico-neurológico constatou-se uma síndrome medular toracolombar estando os membros pélvicos com paralisia espástica e com ausência de sensibilidade dolorosa profunda. Enquanto os exames radiográficos näo evidenciavam nenhuma anormalidade, as alteraçöes do líquor indicavam necrose ou hemorragia medular. O RIFI para Toxoplasmose foi de 1:1024. O exame bacterológico do líquor foi negativo. Devido à falta de resposta ao tratamento, o animal foi sacrificado. Na necrópsia encontraram-se hemorragias no segmento medular compreendido entre T8-T11. No exame histopatológico constatou-se a presença de um exemplar fêmea imaturo de Spirocerca lupi no tecido nervoso causando mielomalácia hemorrágica e consequentemente o quadro de paraplegia

Assessment of glomerular filtration rate utilizing subcutaneously injected Cr-EDTA

1. 51Cr-EDTA injected with lidocaine and epinephrine, as a subcutaneous button, is slowly absorbed, and a plasma level that is relatively stable can be maintained for a time sufficient to permit measurement of the renal clearance of EDTA, which is a measure of glomerular filtration rate (GFR). We studied this procedure in 32 normal volunteers and 24 patients with different glomerulopathies, comparing EDTA and creatinine clearances. In 20 patients these measurements were also compared with inulin clearance. 2. Creatinine clearance overestimates GFR due to tubular secretion of creatinine. This secretion is present even in patients with significantly reduced glomerular filtration rates. As a consequence, the lower the GFR the higher the overestimation will be. 3. A good correlation was obtained between the 51Cr-EDTA and inulin clearance: y(EDTA) = 4.21 + 0.88 x (inulin), r = 0.98. The procedure is simple to perform, and the radiotracer utilized is significantly less expensive than iothalamate

Farmacocinética da ciclosporina e de seus metabólicos em pacientes submetidos a transplante renal / Pharmacokinetics of cyclosporine and its metabolites in patients undergoing kidney transplantation

A farmacocinética da ciclosporina demosntra grande variaçäo inter e intra-individual e profundas mudanças säo, freqüentemente, observadas após o transplante renal. OBJETIVO. analisar seriadamente a farmacocinética da ciclosporina e de seus metabólitos através da determinaçäo de sua concentraçäo sanguínea, em pacientes submetidos a transplante renal. MÉTODOS. Foram realizados 70 estudos em 29 pacientes, sendo 26 antes e 44 após o transplante renal. Em cada estudo a curva de absorçäo foi analisada mediante a determinaçäo da concentraçäo sanguínea da ciclosporina, utilizando radioimunoensaio com anticorpos monoclonais específicos (RIE-MoSP) e inespecíficos (RIE-MoNP), em 17 amostras colhidas após a sua administraçäo oral ou endovenosa (0; 0,5; 1; 2; 3; 4; 5; 6; 7; 8; 9; 10; 12; 16; 20; 23; 24h). Resultados. A área sob a curva da concentraçäo sanguínea de ciclosporina em funçäo do tempo (AUC), a biodisponibilidade (F), a concentraçäo máxima (Cmax) e as concentraçöes sanguíneas obtidas 12 e 24 horas após a sua administraçäo (C12 e C24), determinadas com RIE-MoSP, foram inferiores àquelas encontradas com RIE-MoNP, enquanto a depuraçäo (CL) e o volume de distribuiçäo (Vd) foram maiores. A meia-vida de eliminaçäo foi semelhante utilizando os dois métodos (t1/2). A absorçäo seguiu uma cinética de ordem zero, sendo observada uma correlaçäo inversa entre a dose de ciclosporina e a AUC/dose (r = 0,55, RIE-MoSP e r = 0,42, RIE-MoNP). A fraçäo de absorçäo (F) variou entre 18 por cento e 68 por cento (RIE-MoSP), sendo superestimada quando determinada com RIE-MoNP (38 por cento a 100 por cento), conseqüência da extensa metabolizaçäo na primeira passagem pelo intestino e fígado...

ß2 microglobulina (ß2M) sérica na monitorizaçäo do transplante renal / Serum ß2 microglobulin (ß2M) following renal transplantation

Apesar da melhora na sobrevida do enxerto em pacientes transplantados renais, ocorrida nos últimos dez anos, a rejeiçäo continua sendo uma causa importante de perda de enxerto. Vários testes laboratoriais têm sido estudados na tentativa de se identificar um método näo invasivo que possibilite o diagnóstico precoce de rejeiçäo em pacientes transplantados renais. OBJETIVO. Avaliar a utilidade da monitorizaçäo da ß2 microglobulina sérica no período inicial pós-transplante. Métodos. foram estudados em 20 receptores de transplante renal (10 doadores vivos relacionados e 10 doadores cadáveres), o comportamento diário dos níveis séricos da ß2M e correlacionados com a sua evoluçäo clínica e laboratorial. RESULTADOS. Pacientes que apresentaram boa funçäo renal no pós-operatório imediato e näo mostraram rejeiçäo aguda, precocemente, evoluíram com queda dos níveis de ß2M que se estabilizaram em níveis de 3,7 mg/L no 4§ dia pós-transplante. A sensibilidade de ß2M para o diagnóstico de rejeiçäo aguda foi muito boa (87,5 por cento), mas sua especificidade foi baixa (46 por cento). Nos oito pacientes que näo apresentaram boa funçäo renal, inicialmente, a monitorizaçäo dos níveis de ß2M mostrou-se capaz de diferenciar pacientes com necrose tubular aguda (NTA) sem complicaçöes, de portadores de NTA evoluindo com rejeiçäo ou nefrotoxicidade por CSA. Conclusäo. A monitorizaçäo dos níveis séricos de ß2M näo acrescenta benefício nítido para o diagnóstico de rejeiçäo aguda em pacientes com boa funçäo renal inicial. Contudo, em pacientes evoluindo para NTA, esta monitorizaçäo mostrou-se útil para identificar episódios de rejeiçäo aguda e nefrotoxicidade por CSA

Specific and nonspecific aspects of humoral immune response in leprosy

1. We have studied some generic and specific aspects of the humoral immune response in 96 patients with leprosy (29 paucibacillary and 67 multibacillary individuals). We determined serum immunoglobulins (IgM, IgG and IgA), CH50, C1q, C3 and C4, circulating immune complexes (CIC), C-reactive protein (CRP), rheumatoid factor (RF) and antinuclear antibodies. No specific pattern of general humoral immune changes could be observed. 2. The specific immune response was studied by the detection of specific IgM anti-M. leprae antibodies. An immunoradiometric assay (IRMA) and an ELISA were compared for clinical effectiveness. IRMA showed greater sensitivity for the serodiagnosis of leprosy as compared to ELISA (88.1 percent vs 58.2 percent for multibacillary patients and 20.7 percent vs 10.3 percent for paucibacillary leprosy patients). Specificity was 96 percent for IRMA and 97 percent for ELISA. 3. Our results indicate that nonspecific changes in the humoral immune response are of little value in assessing leprosy patients and that immune assays for the detection of specific anti-M. leprae antibodies may be of value in the diagnosis, study and follow-up of these patients

IgA secretoria na urina de criancas portadoras de infeccao do trato urinario (ITU) e diferentes estados nutricionais: seguimento de 12 meses

Com o objetivo de estudar as variacoes da IgA secretoria (IgAs) durante o curso evolutivo da infeccao do trato urinario (ITU), determinaram-se (empregando-se ELISA) a concentracao da IgAs (mg/1) e o seu indice de excrecoes (mg IgAs/g creatinina) na urina de 60 criancas (36 meninos e 24 meninas), de 3 meses a 5 anos de idade. Em todos foi diagnosticada esta infeccao atraves do metodo por dip-slide (Urotube - Roche). Os microrganismos foram isolados e identificados por testes bioquimicos, sendo aE.coli responsavel por 60 por cento das infeccoes, seguida do Proteus mirabilis (27 por cento ), Klebsiella pneumoniae (12 por cento ) e pseudonomas aeruginosa (2 por cento ). Foram estudados quatro grupos de criancas de acordo com o estado nutricional, avaliados pelos percentis do peso e estatura em relacao ao sexoe idade: euforicas (E), com estatura baixa e peso normal (EB), desnutridas moderadas (DM) e graves (DG). As medianas da concentracao e do indice de excrecao da IgAs em cada grupo foram respectivamente: 1.50 e 2.50 (E), 1.10 e 2.89 (EB), 1.20 e 3.25 (DM) e 1.15 e 3.96 (DG). Nao houve diferenca significante quanto aos parametros da IgAs entre os estados nutricionais. Apos a cura, ocorreu significante reducao da IgAs urinaria, o que nao aconteceu com aquelas criancas que permaneceram com a infeccao ou eram recidivistas. Os presentes resultados sugerem que criancas desnutridas sao capases de desenvolver resposta imune local com aumentoda IgAs durante a ITU. E ainda, apos a cura, apresentam reducao significante da IgAs, enquanto aquelas que novamente se infeccionam ou manten a bacteriuria ou a IgAs permanece elevada. No entanto, sao necessarios estudos prospectivos, a longo prazo, identificando os anticorpos locais especificos contra os antigenos do microrganismo infectante, com vistas a avaliar a intensidade e a especificidade da resposta imune local .

Otimizaçäo do uso da ciclosporina em transplante renal / Optimization of the use of cyclosporin in renal transplantation

Avaliamos retrospectivamente estratégias empregadas na otimizaçäo do uso clínico da ciclosporina (CSA) em transplante renal. Baseado na incidência de rejeiçäo aguda nos primeiros 15 dias do transplante, a administraçäo oral da CSA foi superior à infusäo endovenosa constante, apesar dos relatos divergentes na literatura. A falta de monitorizaçäo do nível sanguíneo da CSA e o uso de doses diferentes de esteróides podem ser responsáveis pelo encontro de tais resultados. A minitorizaçäo do nível sanguíneo de CSA foi útil no diagnóstico diferencial de rejeiçäo aguda (RA) e nefrotoxicidade por CSA (NTX), definindo faixas de concentraçäo sangüínea ideais onde o risco de desenvolvimento de algum tipo de disfunçäo foi menor. Esta "faixa terapêutica" ficou entre 200 e 400ng/mL, quando foi utilizado radioimunoensaio tricidado com anticorpo policlonal (PC-CSA-H3), e entre 100 e 250ng/mL, utilizando RIA com anticorpo monoclonal específico (ME-CSA-H3), observando-se uma correlaçäo com um r=0,82 entre os dois métodos em 122 determinaçöes simultâneas. Alteraçöes histológicas encontradas nas biópsias renais de pacientes com RA näo foram diferentes daquelas obtidas de pacientes com NTX, antes ou após 90 dias de transplante. Concluímos que, por näo dispormos, no momento, de um único método com elevada sensibilidade, especificidade e valor preditivo, a monitorizaçäo do nível sanguíneo de CSA associada à biópsia renal é a melhor forma de reduzir a incidência de disfunçäo do enxerto, assegurando uma maior sobrevida, a longo prazo

Renal disease in the elderly: etiology and evolution of 24 cases

We retrospectively analyzed the histological data, clinical presentations, and outcome of 24 patients aged 60 years or older at the initial evaluation for renal disease. The study setting was a referral-based nephrology clinic at a tertiary care center. Twenty-three out of the 24 patients had a mean follow-up of 16 months (range 3-48). Their mean age was 65 years (range 60-75). The most common histological diagnoses were crescentic glomerulonephritis (GN) (n = 4), membranoproliferative GN (n = 4), diffuse endocapillary proliferative GN (n = 3), and minimal change (n = 3). Clinical presentation included renal insufficiency in 16 patients, the nephrotic syndrome in 8 patients (associated in 4 with decreased renal function), and hematuria with subnephrotic rang proteinuria in 4 cases. Ten out of the 23 patients developed end-stage renal disease (ESRD). Median serum creatinine at presentation in the group that developed ESRD was significantly higher than in the group that did not develop ESRD (490 vs 270 mumol/l; p < 0.05). Seven patients died, 5 of whom had developed ESRD. A variety of renal diseases affect the kidneys of the elderly; prognosis was unfavorable in about half of the patients in this series. Larger prospective studies are needed to clarify the natural history of GN in the elderly.

Immunoassays of secretory IgA and secretory component

1. A sandwich-type enzyme-linked immunosorbent (ELISA) is described for quantitation of secretory IgA (sIgA) in human serum, as well as an ELISA and a radioimmunoassay (RIA) for measurement of secretory component (SC) is human serum. Samples were reduced and alkylated prior to the measurement of SC. 2. Healthy individuals (N = 53) presented low levels of SC (median, 0.9 mg/l). The protein levels were significantly elevated when compared with the controls, in sera of women during the second (N = 31; median, 1.5 mg/l) and third (N = 35; median, 2.4 mg/l) and acute viral hepatitis (N = 25; median 2.4 mg/l). SC levels of women in the first trimester of pregnancy (N = 24; median, 0.5 mg/l) did not differ from the controls. 3. sIgA levels were also significantly elevated when sera of women in the third trimester of pregnancy (N = 41; median, 25.4 mg/l) and sera of patients with alcoholic cirrhosis (N = 32; median, 75.0 mg/l) or acute viral hepatitis (N = 38; median, 28.5 mg/l) were compared with controls (N = 49; median, 9.0 mg/l). women in the first (N = 25; median, 7.7 mg/l) and second (N = 29; median, 10.2 mg/l trimester of pregnancy did not present levels statistically different from the controls. 4. The results obtained for SC by RIA and ELISA were positively correlated (rs = 0.88; P < 0.001). sIgA levels determined by ELISA were also positively correlated with the results of RIA-SC(rs = 0.77;P<0.001) or ELISA-SC (rs = 0.79; P < 0.001). 5. The assays described are specific, relatively simple to perform, and can be useful for the study of the secretory system

Exposure to hydrocarbons and rapidly progressive glomerulonephritis

1. A case-control study of the relationship between the regular exposure to hydrocarbons and rapidly progressive glomerulonephritis (GN) was carried out in Säo Paulo, Brazil. Regular exposure was defined as 1 h or more weekly for 3 consecutive months or longer. We studied 17 patients with rapidly progressive renal failure and biopsy-proven crescentic GN and 34 matched hospital controls. 2. We found an incrased risk of rapidly progressive GN associated with exposure to organic solvents (relative risk = 5.00; 95% confidence interval = 1.14 to 22.00). The frequency of exposure to solvents was 52.9% among the patients and 17.7% among the control subjects (P < 0.05). However, no statically significant increased risk was detected in those patients who had been exposed to fuels (relative risk = 3.25; 95% confidence interval = 0.76 to 13.89); the proportion of exposure to fuels was 47.1% among the patients and 20.6% among the control subjects. 3. Renal histologic findings suggest that immune complex mediated injury as well as a direct glomerular toxic effect may participate in the pathogenesis of rapidly progressive GN associated with hydrocarbon exposure

Microalbuminuria, arterial blood pressure and retinopathy in insulin dependent diabetes

In order to evaluate the relationship between urinary albumin excretion, arterial blood pressure and diabetic retinopathy in insulin dependent diabetics we examined 55 patients without clinical proteinuria and whose disease had started before the age of 30. Each patient was asked to collect at least one overnight timed urine sample for albumin analysis by an ELISA method. Normoalbuminuria was defined as urinary albumin excretion (UAE) of < 20 mug/min (n = 32) and microalbuminuria as 21-200 mug/min (n = 23). Patients with microalbuminuria showed higher levels of blood pressure, serum creatinine and glicosylated haemoglobin as compared to normoalbuminuric patients. Significant correlation was observed between diastolic blood pressure and UAE (r = 0.52; p < O.001).Preproliferative and proliferative diabetic retinopathy was detected in 9 patients (l6.4 per cent). All of them had diabetes for more than 10 years, elevated UAE and diastolic blood pressure equal or higher than 85 mmHg. In our population of insulin dependent diabetics we found a high prevalence of microalbuminuria which is considered to be predictive of the latter development of diabetic nephropathy. Microalbuminuria is associated with elevated blood pressure and diabetic retinal lesions. We conclude that urinary albumin excretion should be monitored in patients with insulin dependent diabetes to detect those who should be considered at risk of developing nephropathy and retinopathy.

Determinacao simultanea de quatro anticonvulsivantes por cromatografia liquida de alta pressao (HPLC). / Simultaneous determination of four anticonvulsant drugs by high pressure liquid chromatography (HPLC)

Sao revistas as indicacoes de monitorizacao terapeutica dos quatro anticonvulsivantes de maior aplicacao na pratica medica diaria em nosso meio e e descrito um metodo simples,sensivel e preciso de quantificacao destas drogas em soro ou plasma, por cromatografia liquida de alta pressao.O metodo permite a determinacao simultanea de fenobarbital, fenitoina, carbamazepina e primidona, que sao perfeitamente separados dos componentes normais do plasma e de outros medicamentos eventualmente presentes na amostra. A eluicao foi monitorizada em 241 nm e a concentracao de cada uma das drogas foi calculada pela relacao entre as alturas dos picos destas com a dos respectivos padroes. Os resultados foram comparados com os obtidos por enzima-imunoensaio, apresentado os seguintes coeficientes de correlacao: fenobarbital r = 0,990, fenitoina r=0,993, carbamazepina r = 0,994 e primidona r=0,992. Algumas outras drogas foram analisadas no sentido de avaliar eventuais interferencias

Determinacao simultanea de fenobarbital, fenintoina e carbamazepina no soro por cromatografia liquida de alta pressao. / Simultaneous high pressure liquid-chromatography determinations of phenobarbital, diphenylhydantoin and carbamazepine in serum

Descrevemos um metodo pratico, sensivel e preciso para a determinacao simultanea de fenobarbital, fenitoina e carbamazepina, tres dos mais utilizados anticonvulsivantes, por cromatografia liquida de alta pressao. Estes tres compostos sao perfeitamente separados dos componentes do soro normal e de outros anticonvulsivantes eventualmente presentes na amostra e quantificados pela absorcao em 214 nm. O metodo mostrou-se util pequeno volume de soro necesario (100 microlitro), pela simplicidade e rapidez do procedimento. Os resultados foram comparados com os obtidos por enzima-imunoensaio, obtendo-se os seguintes coeficientes de correlacao: fenobarbital r = 0, 994 e carbamazepina r = 0,993

Casos em foco: edema angioneurotico hereditario. / Case report: hereditary angioneurotic edema

Os autores descrevem o caso de uma menina de 3 anos portadora de edema angioneurotico hereditario, assim como comentam alguns aspectos etiopatogenicos, clinicos e terapeuticos dessa doenca