Complicaçöes do cateterismo de veia umbilical em recém-nascidos com coto umbilical mumificado / Complications of umbilical vein catheterization in newborn infants with mummified umbilical cords

Os autores realizaram uma avaliação crítica e retrospectiva das complicaçöes com a cateterização de veia umbilical para ex-sanguíneo trasnfusão em recém-nascidos com coto mumificado no período de janeiro de 1983 a dezembro de 1992 no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Estudaram 40 casos de recém-natos, no período assimilado; submetidos à cateterizaçãao de veia umbilical para ex-sanguíneo transfusão. Mantiveram-se os cateteres endovenosos, durante o procedimento de troca, em média 4 horas em 82,5 'por cento' dos casos, administrando-se por meio deles somente sangue e seus derivados. Analisou-se clinicamente o índice de complicaçöes precoces (infecçöes, tromboses) e tardias (hérnia incisional e hipertensão portal ) em 23 recém-nascidos sobreviventes. Revisaram-se as necrópsias de 15 a 17 crianças falecidas (todos falecidos em virtude da doença de base e não ligados ao procedimento) quanto à trombose da veia porta ou outra complicação ligada ao cateterismo. Contrariamente ao relato pela literatura, não foi observado nenhum caso de hérnia incisional ou sinais de hipertensão portal nas crianças sobreviventes e nenhum caso de trombose de veia porta nas autópsias dos recém-natos falecidos. Concluem que o cateterismo de veia umbilical pra o fim exclusivo de ex-sanguíneo transfusão é um procedimento simples, seguro e praticamente isento de complicaçöes.

Fístula aortoentérica primária / Primary aorto-enteric fistula

As fístulas aortoentéricas podem ser primárias ou secundárias. As últimas säo complicaçöes conhecidas de pacientes submetidos a cirurgias reconstrutivas da aorta. Enquanto estas säo relativamente comuns, as fístulas aortoentéricas primárias säo raras. Há cerca de 200 casos publicados na literatura mundial. Relata-se o caso de uma mulher de 71 anos com fístula aortoentérica primária que apresentava sangramento gatrointestinal de repetiçäo. O diagnóstico etiológico foi feito somente durante a cirurgi mediante o achado de um aneurisma aórtico comunicando-se com jejuno, apesar da exaustiva investigaçäo pré-operatória. Alguns aspectos clínicos e cirúrgicos dessa doença säo discutidos.

Peripheral glucose metabolism in patients with chronic renal failure

The present study was designed to determine the effect of chronic renal failure on forearm muscle glucose uptake and oxidation during the postabsorptive state and after an oral glucose challenge. Twelve normal subjects and sixteen patients with chronic renal failure were studied after an overnight fast (12-14h) and for 3h after the ingestion of 75g glucose. Peripheral glucose metabolism was analyzed by the forearm technique to estimate muscle exchange of substrate combined with indirect calorimetry. decreased forearm glucose uptake was observed in uremic patients compared to normal subjects (9l.5 ñ 11,4 vs 154.8 ñ 7.8mg 100 ml forearm -1 3h-1) with diminished nonoxidative glucose metabolism (69.4 ñ 12.1 vs 117.2 ñ 12.8mg 100 ml forearm-1 3h-1). Muscle glucose oxidation did not difer significantly between groups. Both serum free fatty acid levels and lipid oxidation rates were similar in the normal subjects and the uremic patients, and declined in a similar fashion after glucose ingestion. Basal serum insulin levels did not differ significantly between normal and uremic patients, whereas the insulinemic response to glucose load was greater among the patients with chronic renal failure. These data show that resistance occurring in patients with chronic renal failure is accompanied by impaired muscle glucose uptake and nonoxidative glucose metabolism

Hormonal and metabolic study of a case of adiposis dolorosa (Dercum's disease)

A case of a 43-year-old nonobese woman with adiposis dolorosa (Dercum's disease) is reported. Muscle glucose uptake and oxidation before and after ingestion of 75 g of glucose were similar to control group values, although a greater insulin release(16,578 vs 6,242 ñ 1,136 uU/3 h) occurred simultaneously. In vitro studies of abdominal normal and painful subcutaneous adipose tissue of the patient revealed lower responsiveness to norepinephrine and lack of response to the antilipolytic effect of insulin in the painful adipose tissue (0.98 vs 1.43 uM FFA/106 cells at 5.0 uM of norepinephrine). The disease was not correlated with the HLA system and there were no alterations in hormonal secretion at the pituitary, adrenal, gonadal, and thyroid levels. These findings indicate the presence of peripheral insulin resistance in this patient with adiposis dolorosa

Intramitochondrial calcium and magnesium levels in skeletal muscle submitted to total or partial limb ischemia

Sekeletal muscle temperature and mitochondrial content of Ca2 and Mg2+ were measured after 3 h of total or partial limb ischemia in male Wistar rats (250-350g). The decreases in biceps muscle temperature, measured with a needle thermistor (4.4 ñ 0.26-C (31 rats) in partial ischemia (PI, aorta clamp) and total ischemia (TI, hind leg tourniquet), respectively) were consistent with the expected extente of blood flow reduction for the two ischemic conditions. Mitochondrial calcium levels increased after partial ischemia from 2.67 ñ 0.13 (46 rats) to 4.65 ñ 0.38 (12 rats) nmol/mg protein and increased to 7.87 ñ 0.68 (14 rats) after total ischemia (P<0.05). In contrast, mitochondrial magnesium decreased after partial ischemia from 10.14 ñ 0.35 to 8.22 ñ0.28 (13 rats) but increased in the mitochondria of muscle submitted to total ischemia to 12.0 ñ 0.80 (14 rats; P < 0.05). No changes were observed in the number of binding sites for safranine which competes for calcium binding sites on the inner mitochondrial membrane (25.46 ñ 0.38 nmol/mg protein for sham (20 rats) and 25 ñ 0.68 (7 rats) for PI and 25 ñ 0.31 (5 rats) for TI). The data suggest that the greater resistance of rats muscle to total than to partial ischemia may be due at least in part to the increased mitochondrial Mg2+ content

Effect of oral glucose on peripheral muscle fuel metabolism in fasted men

1. The metabolic adaptations of peripheral muscle during a 5-day "modified" fast (daily oral intake of 200 g of glucose)were studied in 12 normal males. the volunteers were studied nintially after receiving a balanced 2,400-Kcal diet for at least 3 days (S1) and then after 5 days of modified fast (S2). The forearm muscle exchange of energy substrate (glucose) and the carbohydrate and lipid oxidation rates in muscle were measured during the postabsorptive state (S1) and after an oral glucose challenge (S2). 2. Glucose intolerance was not observed in either situation. Arterial glucose levels increased from a basal value of 83 mg/100 to 171 mg/100ml in S1 and to 187 mg/100ml in S2 at 30 and 60 min, respectively, and returned to basal values at 180 min in both studies. Increased forearm glucose uptake was observed in S2 compared do S1(131.7 ñ 17.1 vs 92.6 ñ 12.0 mg 100 ml forearm **-1 h**1), with decreased glucose oxidation (23.8 ñ 3.7 vs 30.4 ñ 4.7 mg 100 ml forearm**-1 3h**-1) and increased glucose storage (9.80 ñ 16.6 vs 62.2 ñ 10.8 mg 100 ml forearm**-1 3h**-1) as muscle glycogen. 3. Basal serum free fatty acid (FFA) levels were significantly more elevated in S2 than S1 (1030 ñ 95 vs 657 ñ 59 micron mol/l; P < 0.05zz0 but were markedly reduced by glucose ingestion in both studies (352 ñ 33 (S2) vs 364 ñ 30 (S1) micron mol/l at 120 min). Basal FFA oxidation was similar in both studies (0.091 ñ 0.015 (S1) vs 0.105 ñ 0.019 (S2) mg 100 ml forearm **-1) and decreased significantly 3 after glucose ingestion only in S1 (0.030 ñ 0.010 (S1) vs 0.078 ñ 0.020 (S2) mg 100 ml forearm[[-1 min**-1; P < 0.05). 4. The insilun response to oral glucose was similar in both studies (11,060 ñ 899(S1) vs 11,078 ñ 918(S2) micronU ml**-1 3h**-1, but tjhe peak concentration occurred later (60 min (S2) vs 30 min (S1) and basal levels were significantly lowe in S2 compared to S1 (9.2) ñ 1.7 vs 11.1 ñ 1.5 micronU/ml; P < 0.05)...