CineCT platform for in vivo and ex vivo measurement of 3D high resolution Lagrangian strains in the left ventricle following myocardial infarction and intramyocardial delivery of theranostic hydrogel.

Myocardial infarction (MI) produces acute changes in strain and stiffness within the infarct that can affect remote areas of the left ventricle (LV) and drive pathological remodeling. We hypothesized that intramyocardial delivery of a hydrogel within the MI region would lower wall stress and reduce adverse remodeling in Yorkshire pigs (n = 5). 99mTc-Tetrofosmin SPECT imaging defined the location and geometry of induced MI and border regions in pigs, and in vivo and ex vivo contrast cine computed tomography (cineCT) quantified deformations of the LV myocardium. Serial in vivo cineCT imaging provided data in hearts from control pigs (n = 3) and data from pigs (n = 5) under baseline conditions before MI induction, post-MI day 3, post-MI day 7, and one hour after intramyocardial delivery of a hyaluronic acid (HA)-based hydrogel with shear-thinning and self-healing properties to the central infarct area. Isolated, excised hearts underwent similar cineCT imaging using an ex vivo perfused heart preparation with cyclic LV pressurization. Deformations were evaluated using nonlinear image registration of cineCT volumes between end-diastole (ED) and end-systole (ES), and 3D Lagrangian strains were calculated from the displacement gradients. Post-MI day 3, radial, circumferential, maximum principal, and shear strains were reduced within the MI region (p < 0.04) but were unchanged in normal regions (p > 0.6), and LV end diastolic volume (LV EDV) increased (p = 0.004), while ejection fraction (EF) and stroke volume (SV) decreased (p < 0.02). Post-MI day 7, radial strains in MI border zones increased (p = 0.04) and dilation of LV EDV continued (p = 0.052). There was a significant negative linear correlation between regional radial and maximum principal/shear strains and percent infarcted tissue in all hearts (R2 > 0.47, p < 0.004), indicating that cineCT strain measures could predict MI location and degree of injury. Post-hydrogel day 7 post-MI, LV EDV was significantly reduced (p = 0.009), EF increased (p = 0.048), and radial (p = 0.021), maximum principal (p = 0.051), and shear strain (p = 0.047) increased within regions bordering the infarct. A smaller strain improvement within the infarct and normal regions was also noted on average along with an improvement in SV in 4 out of 5 hearts. CineCT provides a reliable method to assess regional changes in strains post-MI and the therapeutic effects of intramyocardial hydrogel delivery.

Hallazgos en imágenes de tórax en una intoxicación aguda con paraquat: reporte de un caso / Findings on thorax images in acute paraquat poisoning: case report

Resumen El Paraquat es un herbicida ampliamente utilizado para el control de las malezas en Chile. Su ingesta determina una alta probabilidad de mortalidad dado su inherente toxicidad mediante la producción de radicales libres, que afectan a múltiples órganos, principalmente los pulmones; a esto se suma la falta de un tratamiento efectivo. Se presenta el caso clínico de un hombre de 18 años que en un intento suicida consume 50 mL de paraquat (200 g/L), con desenlace fatal. La presentación clínica depende la cantidad de Paraquat ingerida y los hallazgos radiológicos descritos varían según la temporalidad del cuadro e, inclusive, podrían determinar el pronóstico.

Paraquat is an herbicide widely used for weed control in Chile. Its intake determines a high probability of mortality because of its inherent toxicity through the production of free radicals. Multiple organs are affected, mainly the lungs; to this is added the lack of effective treatment. We present the clinical case of an 18-year-old man who in a suicidal attempt swallows 50 mL of paraquat (200 g/L), with a fatal outcome. The clinical presentation depends on the amount of Paraquat ingested. Radiological findings described vary according to the temporality of the condition and could even determine the prognosis

CT perfusion measurement of postictal hypoperfusion: localization of the seizure onset zone and patterns of spread.

PURPOSE: Seizures are often followed by a period of transient neurological dysfunction and postictal alterations in cerebral blood flow may underlie these symptoms. Recent animal studies have shown reduced local cerebral blood flow at the seizure onset zone (SOZ) lasting approximately 1 h following seizures. Using arterial spin labelling (ASL) MRI, we observed postictal hypoperfusion at the SOZ in 75% of patients. The clinical implementation of ASL as a tool to identify the SOZ is hampered by the limited availability of MRI on short notice. Computed tomography perfusion (CTP) also measures blood flow and may circumvent the logistical limitations of MRI. Thus, we aimed to measure the extent of postictal hypoperfusion using CTP. METHODS: Fourteen adult patients with refractory focal epilepsy admitted for presurgical evaluation were prospectively recruited and underwent CTP scanning within 80 min of a habitual seizure. Patients also underwent a baseline scan after they were seizure-free for > 24 h. The acquired scans were qualitatively assessed by two reviewers by visual inspection and quantitatively assessed through a subtraction pipeline to identify areas of significant postictal hypoperfusion. RESULTS: Postictal blood flow reductions of > 15 ml/100 g-1/min-1 were seen in 12/13 patients using the quantitative method of analysis. In 10/12 patients, the location of the hypoperfusion was partially or fully concordant with the presumed SOZ. In all patients, additional areas of scattered hypoperfusion were seen in areas corresponding to seizure spread. CONCLUSION: CTP can reliably measure postictal hypoperfusion which is maximal at the presumed SOZ.

Estudio de componentes hemolinfáticos de Rhodnius prolixus y Triatoma maculata alimentados con diferentes fuentes sanguíneas / Study of hemolymphatic components of Rhodnius prolixus and Triatoma maculata fed on different blood sources

RESUMEN Introducción: Tradicionalmente, Rhodnius prolixus ha sido considerado el principal vector, mientras que Triatoma maculata resulta ser un vector secundario de Trypanosoma cruzi en el medio rural venezolano. En este trabajo se provee información de interés acerca de los componentes bioquímicos y del sistema inmune, humoral y celular, de la hemolinfa de R. prolixus y T. maculata alimentados sobre gallina y rata. Metodología: los insectos provenían de una colonia del laboratorio, mantenida a una temperatura de 27-29ºC, 50% de humedad relativa y ocho horas luz/día. Se analizó la hemolinfa de adultos alimentados sobre gallina y rata. Se observaron los hemocitos mediante microscopía óptica y electrónica de transmisión. Resultados: los parámetros bioquímicos de glucosa, lípidos y proteínas fueron afectados de forma distinta en R. prolixus y T. maculata según la fuente alimenticia. T. maculata presentó mayores niveles de actividad lítica de lisozima. Se observaron cuatro poblaciones de hemocitos (prohemocitos, plasmatocitos, granulocitos y oenocitos), cuyas características y medidas están acorde a lo reportado por otros autores sobre la subfamilia Triatominae. T. maculata presentó mayor número de prohemocitos y oenocitos que R. prolixus. Conclusiones: En su hemolinfa, R. prolixus y T. maculata son afectados distintamente en los componentes bioquímicos (glucosa, lípidos y proteínas) e inmunes, tanto humorales (lizosima) como celulares (prohemocitos, oenocitos), según sean alimentados sobre gallina y rata. Esto pone de manifiesto de la alimentación sobre uno de los componentes de la competencia vectorial, como lo es el sistema inmune propio de la hemolinfa de los insectos.

ABSTRACT Introduction: Traditionally, Rhodnius prolixus has been considered the main vector, while Triatoma maculata remains to be a secondary vector of Trypanosoma cruzi in the Venezuelan rural habitat. In this work, interesting information about the biochemical and immune (humoral and cellular) aspects of the hemolymph of R. prolixus and T. maculate, feeding on hen and rat, are presented. Methodology: Hemolymph was extracted from adult insects, maintained at 2729 °C with 50% of relative humidity and 8/16 (Light/Dark) hours, and fed on hen and rat. Hemocytes were observed by optical and transmission electron microscopy. Results: Biochemical parameters (glucose, lipids and proteins) varied in both species according to the food source. T. maculata presented higher levels of lysozyme lytic activity. Four hemocytes populations were observed by optical and transmission electron microscopy (prohemocytes, plasmocytes, granulocytes and oenocytes), exhibiting characteristics and measurements in accordance with previous literature related to the Triatominae subfamily. T maculata presented more prohemocytes and oenocytes than R. prolixus. Conclusions: On their hemolymph, R. prolixus and T. maculata are distinctly affected in their biochemical (glucose, lipids and proteins) and immune components, both humoral (lysozyme) and cellular (prohemocytes, oenocytes), depending on whether they were fed on hens or rats. Our results show that the food source affects the immune system of triatomines, and subsequently, their vectorial capacity may be compromised as well.

Delta-like protein 1 in the pituitary-adipose axis in the adult male mouse.

With the aim of studying delta-like protein 1 (DLK1) with respect to the relationship between adipocyte leptin and adenohypophyseal hormones, we carried out an immunohistochemical study analysing the presence of receptors for these hormones in the pituitary and adipose cells of male wild-type (WT) mice (Dlk1+/+ ) compared to knockout (KO) mice (Dlk1-/- ). The mRNA expression of these molecules was also determined using the reverse transcriptase-polymerase chain reaction. The results obtained showed that, in WT adipose cells, all of the adenohypophyseal hormone receptors were present, with a higher mRNA expression for growth hormone (GH) receptor and thyroid-stimulating hormone (TSH) receptor. Of the total cells in the anterior pituitary lobe, 17.09±0.9% were leptin receptor (LEPR) immunoreactive (-IR), mainly in GH-IR and prolactin (PRL)-IR cells (41.5±3.8%; 13.5±1.7%, respectively). In Dlk1-/- mice, adipocyte cells showed a significant increase in the TSH receptor mRNA expression level. Moreover, the percentage of LEPR-IR GH cells showed a statistically significant increase compared to controls, from 41.5±3.8% to 53.1±4.0%. By contrast, only 3.0±0.6% of LEP-IR anterior pituitary cells were detected in Dlk1 KO mice, as opposed to 6.8±1.1% observed in WT mice. The results suggest that relationships exist between adipocytes and pituitary GH, PRL and TSH cells, in addition to an influence with respect to the synthesis and release of pituitary leptin, particularly in PRL cells.

Validation of models with constant bias: an applied approach / Validación de modelos con sesgo constante: un enfoque aplicado

Objective. This paper presents extensions to the statistical validation method based on the procedure of Freese when a model shows constant bias (CB) in its predictions and illustrate the method with data from a new mechanistic model that predict weight gain in cattle. Materials and methods. The extensions were the hypothesis tests and maximum anticipated error for the alternative approach, and the confidence interval for a quantile of the distribution of errors. Results. The model evaluated showed CB, once the CB is removed and with a confidence level of 95%, the magnitude of the error does not exceed 0.575 kg. Therefore, the validated model can be used to predict the daily weight gain of cattle, although it will require an adjustment in its structure based on the presence of CB to increase the accuracy of its forecasts. Conclusions. The confidence interval for the 1-α quantile of the distribution of errors after correcting the constant bias, allows determining the top limit for the magnitude of the error of prediction and use it to evaluate the evolution of the model in the forecasting of the system. The confidence interval approach to validate a model is more informative than the hypothesis tests for the same purpose.

Objetivo. Presentar extensiones al método estadístico para validar modelos basado en el procedimiento de Freese cuando el modelo presenta sesgo constante (SC) en sus predicciones e ilustrar el método con datos provenientes de un modelo mecanístico inédito para la predicción de ganancia de peso de bovinos. Materiales y métodos. Las extensiones fueron la prueba de hipótesis y error máximo anticipado para el planteamiento alternativo y el intervalo de confianza para un cuantil de la distribución de los errores. Resultados. El modelo evaluado presentó SC, una vez eliminado y con un nivel de confianza del 95%, la magnitud del error no sobrepasa 0.575 kg. Por lo que el modelo validado puede usarse para predecir la ganancia de peso diaria de bovinos, aunque requerirá un ajuste en su estructura con base a la presencia de SC para incrementar la exactitud en sus pronósticos. Conclusiones. El intervalo de confianza para el cuantil 1-α de la distribución de los errores una vez que se corrige el sesgo constante, permite determinar una cota superior para la magnitud del error de predicción y usarla para evaluar la evolución del modelo en predicción del sistema. El enfoque de intervalos de confianza para validar un modelo es más informativo que las pruebas de hipótesis para el mismo propósito.

Pseudoquiste pancreático fistulizado a vía biliar principal / Fistula formation between a pancreatic pseudocyst and the biliary tree

Introduction: Fistula formation between a pancreatic pseudocyst and the biliary tree is uncommon. Clinical case: We report a 71 years old female who developed a pancreatic pseudocyst secondary to a biliary acute pancreatitis. After eight weeks of evolution, the patient was operated due to the size of the pseudocyst and the presence of symptoms. During the operation, a fistula between the cyst and the biliary tree was found. It was successfully excluded performing a choledochostomy with a Kehr tube and pseudocyst drainage. The patient had an uneventful postoperative evolution and imaging studies at the moment of discharge, one month after the operation, did not show a residual cavity...

Introducción: Los pseudoquistes pancreáticos pueden desarrollarse tras episodios de pancreatitis, pudiendo originar diversas complicaciones como infección, hemorragia, fenómenos compresivos o fístulas pancreáticas. En el caso de estas últimas, la comunicación de un pseudoquiste pancreático a la vía biliar es una rareza, existiendo hasta la fecha sólo 19 casos reportados en la literatura. Caso clínico: Presentamos el caso de una paciente de 71 años que desarrolló un pseudoquiste pancreático posterior a pancreatitis aguda biliar y que debido a su tamaño y síntomas se decide el tratamiento quirúrgico a las 8 semanas. Durante la cirugía se diagnostica una fístula entre el pseudoquiste y la vía biliar principal, realizándose exclusión exitosa con coledocostomía con sonda Kehr, colecistectomía y drenaje del pseudoquiste, debido a la imposibilidad de derivación al tubo digestivo por friabilidad de su pared. La paciente evoluciona favorablemente, siendo dada de alta al mes de la cirugía. El control con imágenes previo al alta revela la desaparición del pseudoquiste, sin cavidad residual...

Role of the non-canonical notch ligand delta-like protein 1 in hormone-producing cells of the adult male mouse pituitary.

To better understand the role of the non-canonical Notch ligand delta-like protein 1 (DLK1), in hormone-producing cells, we studied the cell distribution and subcellular localisation of DLK1 in the pituitary of male adult 129/SvJ mice, and analysed the variations in the hormone-producing cells associated with the lack of this gene in Dlk1 knockout mice. The results obtained showed the presence of DLK1-immunoreactive (ir) cells in all hormone-producing cells of the anterior pituitary. Immunoelectron microscopy showed DLK1-ir in the rough endoplasmic reticulum and inside secretory vesicles, suggesting that DLK1 is released together with pituitary hormones. Moreover, we found that prolactin (PRL)-DLK1-ir cells are in intimate contact with follicle-stimulating hormone (FSH)-ir-DLK1-negative cells. In Dlk1 knockout mice, we detected a significantly lower number of gowth hormone (GH)-ir cells, a reduction in the FSH and PRL immunostaining intensity, and a significant decrease in FSH mRNA expression compared to wild-type mice. An increase in pituitary GH mRNA expression and serum leptin levels was also found. These findings provide evidence supporting several regulatory functions of DLK1 in the pituitary gland.

Asociación entre recuento bacteriano en la bilis y desarrollo de morbilidad postoperatoria en pacientes con colangitis aguda / Association between bile bacterial count and postoperative complications aniong patients with acute cholangitis

Background: Bacterial colonization of bile is common in patients with bile duct obstruction, even in the absence of clinical signs of sepsis. Aim: To determine the association between bile bacterial count and postoperative complications in patients with bile duct obstruction. Material and Methods: A bile bacterial count was performed to patients with acute cholangitis caused by biliary stones, operated between 2004 and 2006. Post operative complications and length of hospital stay were recorded in these patients. Results: Fifty four patients aged between 25 and 95 years (34 females) were studied. The most common bacteria found, were Escherichia coli in 32 cultures (50 percent), followed by Klebsiella pneumoniae in 6 cultures (9 percent). In 45 cases the bacterial load was over 10(5) colony forming units (CFU)/ml. Among patients with and without complications, 68 and 69 percent had a bacterial load over 10(5) CFU/ml, respectively (p = NS). A multivariate analysis showed an association between platelet count and prothrombin time with the incidence of complications. Conclusions: In this series of patients with acute cholangitis, no association between bile bacterial count and postoperative complications was observed.

Introducción: La colonización bacteriana de la bilis parece ser frecuente en pacientes con obstrucción de la vía biliar ya sea con o sin signos de sepsis. Objetivos: Determinar asociación entre el recuento bacteriano en la bilis de pacientes con colangitis aguda (CA) y el desarrollo de complicaciones postoperatorias; y, determinar asociación entre variables fisiológicas y desarrollo de complicaciones en el mismo grupo. Material y Método: Reporte preliminar de estudio de cohorte de pacientes con CA litiásica, intervenidos quirúrgicamente en los servicios de cirugía y urgencias del Hospital Regional de Temuco en el período diciembre de 2004 a noviembre de 2006. Se realizó cultivo cuantitativo y se registraron variables clínicas y de laboratorio al ingreso. Se efectuó medición de complicaciones postoperatorias, estancia hospitalaria y evolución de los pacientes. Se aplicó estadística descriptiva y posteriormente análisis univariado y multivariado. Resultados: Se estudió un total de 54 pacientes, 34 (63 por ciento) fueron de género femenino y 20 (37 por ciento) de género masculino, con una mediana de edad de 68 años (25 a 95 años). El germen más frecuentemente aislado fue Escherichia coli en 32 cultivos (50 por ciento), seguido por Klebsiella pneumoniae en 6 cultivos (9 por ciento). De los gérmenes aislados 45 (82 por ciento) tenían cargas bacterianas sobre 10(5) UFC/ml. De los pacientes que presentaron alguna complicación 68 por ciento tenían cargas bacterianas superiores a 10(5) UFC/ml y de los pacientes que no presentaron complicaciones 69 por ciento tenían cargas bacterianas inferiores a 10(5) UFC/ml (p = 0,513). En el análisis univariado se encontró asociación entre desarrollo de complicaciones y las variables frecuencia cardíaca, creatinina, recuento de plaquetas y tiempo de protrombina. Con el análisis multivariado se determinó asociación entre desarrollo de complicaciones y las variables recuento de plaquetas y tiempo de protrombina (OR: 4,35 y 4,58)...

Cirugía laparoscópica electiva en enfermedad diverticular. Un estudio comparativo con la cirugía convencional / Elective laparoscopic surgery in diverticular disease. A comparative study with conventional operative surgery

BACKGROUND: Elective surgery in diverticular disease (DD) consists classically in performing an open sigmoidectomy. Laparoscopic surgery of the colon can have results that are comparable to those of open surgery. AIM: To compare the results of laparoscopic and conventional surgery for DD. MATERIALS AND METHODS: Retrospective review of preoperative, operative and postoperative variables of patients operated by laparoscopic surgery between the years 2000 and 20002. These results were compared with those of patients treated with conventional surgery in the same period. RESULTS: Thirty nine patients, mean age 59 years old, were operated via laparotomy and 18 patients, mean age 47 years old, were treated with laparoscopic surgery. Both groups were comparable in gender, amount of previous laparotomies, type of surgery performed and American Society of Anestesiologists classification. The operative time was significantly higher in the laparoscopic surgery group (230 v/s 130 min), but the opioid requirements, stay in an intensive surgical care ward, postoperative ileus and hospital stay were significantly shorter in the laparoscopic group. Eleven percent of the patients included in the laparoscopic group and 31 per cent of the patients treated with operative surgery had complications (p = 0.07). The length of the excised colon, the degree of inflammation and treatment costs were comparable. CONCLUSIONS: Laparoscopic surgery in DD is feasible, safe, requires less analgesia and allows a faster recovery of post-operative ileus and a lower hospital stay.

[Cerebral hemorrhage and angiopathy amyloid]. / Hemorragias cerebrales y angiopatía amiloidea.

BACKGROUND: Cerebral amyloid angiopathy is considered pathogenic in non traumatic cerebral lobar hemorrhages. AIM: To study the frequency of cerebral amyloid angiopathy in brains of patients dying of non traumatic cerebral hemorrhages. MATERIAL AND METHODS: Thirty seven brains from patients, 25 men and aged 65 +/- 10 years old, with cerebral hemorrhages (14 lobar, 18 in basal ganglia and 5 in cerebellum or brainstem) were studied. As controls, the brains of 30 subjects, 14 men and aged 64 +/- 16 years old, dying of non neurological causes were studied. Deep and cortical vessels were stained with hematoxylin eosin, Gomori, Thioflavin T and Bodian. Definitive cerebral amyloid angiopathy was diagnosed when amyloid deposition was observed in the media of vessels. RESULTS: Twenty six out of 32 patients dying of cerebral hemorrhage and 3 of 21 controls had chronic hypertension. Cerebral amyloid angiopathy was present in 19 of 37 brains of patients with cerebral hemorrhage and 13 of 30 control brains. In patients with hypertension, vascular changes independent of the location and volume of amyloid deposition, were observed. Such changes were dilatation, tortuousness, thickening of walls specially in muscular and adventitia and hyaline degeneration. Thirteen brains with hemorrhage had fibrinoid necrosis and 10 had microaneurysms. CONCLUSIONS: In this series of patients, cerebral amyloid deposition was unspecific and its role in the pathogenesis of cerebral hemorrhages was not confirmed. Hypertension was associated with vascular degenerative changes that can lead to cerebral hemorrhages.

The presence of Helicobacter pylori in nonoperated duodenal ulcer patients compared to patients late after highly selective vagotomy.

There are many recent studies that clearly suggest that Helicobacter pylori (HP) is an etiological agent for duodenal ulcer disease (1-3). Randomized trials have shown that duodenal ulcers treated by omeprazole or H2 blockers heal faster if HP is eradicated concurrently (4-6). Besides, several studies have demonstrated that eradication of HP significantly reduces duodenal ulcer relapses (7-9). Patients followed up to 7 years after eradication of HP demonstrated that 92% remained HP negative, with only 3% recurrence (10). Highly selective vagotomy has been the treatment of choice for duodenal ulcer patients who are candidates for surgical therapy (11, 12). The late results have shown an approximately 10% recurrence rate 8 to 10 years after surgery (13, 14). We hypothesized that in these asymptomatic cases after HSV, HP probably will exist in a minor proportion of cases, similar to what happens after successful medical antiulcer therapy. Therefore the purpose of the present study was to determine the HP status at the antrum in a group of nonoperated duodenal ulcer patients compared to a group submitted to highly selective vagotomy many years prior to the actual study.

[Endoscopic location of squamous columnar mucosal changes in patients with different degrees of pathologic gastroesophageal reflux]. / Localización endoscópica del cambio de mucosa escamoso-columnar en pacientes con diferentes grados de reflujo gastroesofágico patológico.

BACKGROUND: There is little information about the precise location of the squamous columnar mucosal junction in the Chilean population. AIM: To study endoscopically, the location of the squamous columnar mucosal junction in patients with esophageal disease. PATIENTS AND METHODS: The location of the squamous columnar mucosal junction was prospectively studied by endoscopy in 347 subjects with normal upper gastrointestinal endoscopy, 117 patients with chronic gastroesophageal reflux without esophagitis, 117 patients with erosive esophagitis, 63 patients with short Barret's esophagus and 28 patients with an extensive Barret's esophagus. RESULTS: No differences in the mucosal junction location were observed between controls and patients with gastroesophageal reflux or erosive esophagitis. In patients with Barret's esophagus, the junction was more proximal. In women, the junction was three cm more proximal than in men, probably due to their shorter stature. CONCLUSIONS: Women have a more proximal squamous columnar mucosal junction than men.

[Intestinal obstruction caused by peritoneal carcinomatosis due to signet ring cell carcinoma of the breast]. / Obstrucción intestinal por carcinomatosis peritoneal debida a carcinoma mamario de células en anillo de sello.

The signet ring variant of lobular mammary carcinoma is aggressive and metastasis to serosal surfaces. We report a 46 years old woman presenting with an intestinal obstruction due to a peritoneal carcinomatosis secondary to a signet ring cell carcinoma of the breast. After surgery, the patient received chemotherapy (5-fluorouracil, adriamycin, cyclophosphamide and tamoxifen). A satisfactory response, with regression of peritoneal carcinomatosis and a good quality of life, was achieved. The patient is alive after 2 years of diagnosis.

[Hypocalciuria in pre-eclampsia]. / Hipocalciuria en preeclampsia.

Recent studies have associated preeclampsia with hypocalciuria, nevertheless others do not show association. We proposed to determinate if this association exists, so we studied 25 term pregnancies patients (13 normotensives, 7 transient hypertension and 5 preeclamptic). We did not find significative differences in the hematocrit, serum calcium, serum creatinine, platelets count and the 24 hour diuresis between these groups. The serum uric acid was significative lower in the normotensive group (3.5 +/- 0.8 mg/dl) than in the preeclamptic group (4.9 +/- 0.89 mg/dl) (mean +/- SD) (p < 0.05). The 24 hour calciuria was lower in the preeclamptic group (121 +/- 78 mg/24 hours) than in the normotensive (256 +/- 71 mg/24 hours) and transient hypertension group (229 +/- 93 mg/24 hours) (p < 0.05). We measured the creatinine clearance and the fractional excretion of calcium in the transient hypertension and the preeclamptic groups, there was significative difference only in the fractional excretion of calcium (2.5 +/- 0.8% and 1.1 +/- 0.8% respectively) (p < 0.05). All the patients had a good clinical evolution, so the arterial pressure returned to normal values in a mean period within 7 days in both groups. There were 3 newborn who were small for gestational age (1 in the transient hypertension and 2 in the preeclamptic group). The difference we found in the 24 hour calciuria and the fractional excretion of calcium agree with the finds of other authors, further prospective studies are needed to understand the physiology and pathophysiology of calcium metabolism in normal, transient hypertension and preeclamptic pregnancy.

Potassium supplementation lowers blood pressure and increases urinary kallikrein in essential hypertensives.

In order to eludicate possible mechanism(s) involved in the blood pressure reduction induced by potassium (K) supplementation, we studied the changes of BP and of some of its regulatory systems, including levels of urinary kallikrein (UKal)--an index of renal kallikrein production. Twenty-four untreated essential hypertensives, with a basal BP of 147/96 +/- 13/7 mmHg and normal renal function, received in crossover, double-blind, randomised fashion, 64 mmol KCl or placebo during two periods of 4 weeks each. At the 4th week of potassium supplementation systolic, diastolic and mean BPs decreased by 6.3 +/- 2 (P less than 0.01), 3.0 +/- 2 and 4.1 +/- 2 (P less than 0.05) mmHg respectively for the supine position, and 5.0 +/- 2, 4.0 +/- 2 (P less than 0.05) and 4.0 +/- 1 (P less than 0.05) mmHg for the standing position. Urinary potassium (K) increased from 55 +/- 4 to 123 +/- 6 mmol/24 hours (P less than 0.001) and UKal from 692 +/- 69 to 1052 +/- 141 mU/24 hours (P less than 0.01). Serum K rose from 3.8 +/- 0.1 mEq/l to 4.1 +/- 0.1 mmol/l (P less than 0.001) and PRA from 0.77 +/- 0.12 to 0.99 +/- 0.14 ng/ml/h (P less than 0.05). Correlations were observed between UKal and urinary K (r = 0.44, P less than 0.0001); between differences in UKal and urinary K and in UKal and urinary Na (r = 0.50, P less than 0.0005 and r = 0.48, P less than 0.001 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)