Activación de la respuesta inmune innata y específica en los pacientes con sindrome urémico hemolítico: papel dual a traves de la paticipacion en los mecanismos pagogenicos y protectores / Activation of innate and specific immune responses in hemolytic uremic syndrome (HUS)-patients

The central role of the immune system is the preservation of the health against several pathogenic microbes and injury agents. However, on special conditions defensive mechanisms triggered towards the foreign agent can damage the host. Clinical and experimental evidence indicate that inflammatory reaction triggered by the main components of Shiga toxin (Stx)-producing Escherichia coil (STEC), participate in the evolution to the complete form of HUS. When children are diagnosed of HUS, they present evidence that have suffered a very strong and early inflammatory response. These features include: the presence of a marked neutrophilia, the polymorfonuclear leucocytes (PMN) are "deactivated or exhausted" and the monocytes are differentiated towards an inflammatory phenotype (CD14-reduced and CD16-enhanced membrane expression). In addition, HUS-patients show a marked reduction in the absolute and relative number of leucocytes carrying the receptor (CX3CR1) for the chemokine "Fractalkine" (FKN, CX3CL1), which are the classic monocytes and Natural Killer cells (NK). All these cells express a high cytotoxic potencial. The chemokine FKN is expressed in endothelial and epithelial renal cells, and is involved in the pathogenic mechanism of different nephropathies. Noteworthy, we found a significant correlation between the severity of the renal damage (as days of anuria) and the alterations described above. Finally, the protective role of specific immune response, mainly through the antibody production with Stx-neutralizing capacity, is discussed.

Tratamento das fraturas cominutivas da diáfise do fêmur pela técnica de placa em ponte: amostragem-casuística / Treatment of comminuted fractures of diaphyse of the femur by bridging plate technique: sampling and case study

Foram acompanhados dez pacientes que apresentavam fratura cominutiva da diáfise do fêmur; oito do sexo masculino, dois do sexo feminino, subdivididos nos tipos IV e V da classificaçäo de Winquist & Hansen, sendo três casos de fraturas abertas por projétil de arma de fogo (PAF). Todos tratados cirurgicamente com osteossíntese pelo método de placa em ponte. Observou-se consolidaçäo em 100 porcento dos casos e os resultados considerados excelentes em 40 porcento, bons em 50 porcento e regulares em 10 porcento. Näo observamos resultado ruim nesta amostragem. Considerou-se, portanto, näo obstante a casuística limitada, método relevante e efetivo no tratamento das fraturas femorais com elevado grau de cominuiçäo