Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.

Pharmacovigilance of patients with multiple myeloma being treated with bortezomib and/or thalidomide

In order to evaluate the main adverse effects of drug protocols using bortezomib and/or thalidomide for the treatment of multiple myeloma, we conducted a prospective study. Data were collected through interviews, clinical observation, and from hospital records. A total of 59 patients were included. There was a predominance of females, 36 (61%) vs 23 (39%) males, and of whites, 49 (83.1%) vs 10 (16.9%) blacks. Age ranged from 40 to 94 years, with a median of 65 years (SD=11.6). Regarding staging at diagnosis, 27 (45.7%) patients were in stage III-A, with 12 (20.3%) patients having serum creatinine ≥2 mg/dL. The main adverse effects in the bortezomib treatment group (n=40) were: neutropenia (42.5%), diarrhea (47.5%), and peripheral neuropathy in 60% of cases, with no difference between the iv (n=26) and sc (n=14) administration routes (P=0.343). In the group treated with thalidomide (n=19), 31.6% had neutropenia, 47.4% constipation, and 68.4% peripheral neuropathy. Neutropenia was associated with the use of alkylating agents (P=0.038). Of the 3 patients who received bortezomib in combination with thalidomide, only 1 presented peripheral neuropathy (33.3%). Peripheral neuropathy was the main adverse effect of the protocols that used bortezomib or thalidomide, with a higher risk of neutropenia in those using alkylating agents. Improving the identification of adverse effects is critical in multiple myeloma patient care, as the patient shows improvements during treatment, and requires a rational and safe use of medicines.

Biopsia muscular em miastenia grave.Estudo histoquimico e morfometrico de 4 casos. / Muscular biopsy in myasthenia gravis. Histochemical and morphometric study of 4 cases

Miastenia grave e doenca neuromuscular caracterizada por excessiva fatigabilidade da juncao muscular e envolve, particularmente, musculos inervados por nervos cranianos. Acredita-se que o defeito esteja localizado na juncao neuromuscular. Os autores estudaram os achados histoquimicos e morfometricos em 4 pacientes com miastenia grave mostrando que as fibras do tipo II eram significativamente menores que as fibras do tipo I

Polineuropatia por parathion. Estudo clinico, eletrofisiologico e histologico de um caso. / Polyneuropathy caused by parathion: clinical, electrophysiologic and histologic studies of a case

Estudamos um paciente com quadro clinico rebelde, produzido por intoxicacao pelo parathion. Foi observado um fenomeno miotonico transitorio, nao descrito na literatura revisada. A constatacao de cifras de AchE eritrocitaria baixas e de colinesterase plasmatica normais, indicou que era portador de deficit congenito de AchE, esclarecendo-se a evolucao cronica do seu quadro. O fenomeno miotonico associado ao quadro clinico, eletrofisiologico, histologico e bioquimico fazem deste paciente um modelo clinico, de etiologia conhecida, da discutida sindrome de Isaacs

Miopatia miotubular: estudo clinico, etrophysiological and histological study so. / Myotubular myopathy: clinical,elecof a case

Sao apresentados os resultados dos exames clinicos, eletrofisiologicos e do estudo do ponto motor, da imunofluorescencia, da histoquimica e da ultramicroscopia da biopsia muscular de um caso de miopatia miotubular. Sao discutidos estes resultados em relacao aos achados de 56 casos desta molestia consignados na literatura ate 1978, sendo cada enfase a etiopatogenia