Comparison of different sampling methods for the determination of low-level radionuclides in air.

The aim of this work is to check the consistency of results given by different air dust samplers (flow-rates between 2 and 700m(3)/h) and measurement protocols at a single location. The study is focussed on (210)Pb since is the only nuclide that can be easily assessed through all the studied sampler types. Results from high- and mid-volume samplers agreed well to within the associated uncertainties. Gross beta activity from low-volume samplers can be used as a good indicator of the evolution of (210)Pb concentration in air.

Eculizumab treatment of acute antibody-mediated rejection in renal transplantation: case reports.

The occurrence of acute antibody-mediated rejection (AMR), especially in more severe cases, continues to be associated with a poor prognosis for implant survival. Here, we have reported the results of treatment of two patients who developed AMR associated with thrombotic microangiopathy immediately after transplantation. We used a single dose of eculizumab at an early stage jointly with conventional modalities of steroid boluses, plasmapheresis, intravenous immunoglobulin, and rituximab. In both cases, the clinical course was favorable. Eculizumab, a monoclonal antibody with a high affinity for complement protein C5, prevents generation of the final membrane attack complex, blocking this cascade. To date, there are a few reports of the usefulness of eculizumab in AMR. Eculizumab can help to stop endothelial damage, especially in severe cases that show a risk of progression to cortical necrosis, by providing a therapeutic window until the other modalities begin to control the immune response. In our experience, the use of eculizumab can be beneficial in the treatment of AMR.

Cadmium tolerance and antibiotic resistance in Escherichia coli isolated from waste stabilization ponds.

The incidence pattern of cadmium tolerance and antibiotics resistance by Escherichia coli was examined periodically from the samples of water, sludge and intestine of fish raised in waste stabilization ponds in a sewage treatment plant. Samples of water and sludge were collected from all the selected ponds and were monitored for total counts of fecal coliform (FC), total coliform (TC) and the population of Escherichia coli, which was also obtained from the intestine of fishes. Total counts of both FC and TC as well as counts of E. coli were markedly reduced from the facultative pond to the last maturation pond. Tolerance limit to cadmium by E. coli tended to decline as the distance of the sewage effluent from the source increased; the effective lethal concentration of cadmium ranged from 0.1 mM in split chamber to 0.05 mM in first maturation pond. E. coli isolated from water, sludge and fish gut were sensitive to seven out of ten antibiotics tested. It appears that holistic functions mediated through the mutualistic growth of micro algae and heterotrophic bacteria in the waste stabilization ponds were responsible for the promotion of water quality and significant reduction of coliform along the sewage effluent gradient.

[Papillary carcinoma in a thyroglossal duct cyst: report of two cases]. / Carcinoma papilar en quiste del conducto tirogloso: Reporte de dos casos.

Thyroglossal duct cyst is the most common congenital anomaly of thyroid gland development. However, papillary carcinoma is described only in 1-2% of cases and the clinical appearance is indistinguishable from a benign thyroglossal duct cyst. We report two females aged 15 and 27 years consulting for a cervical mass. In both, a solid cystic lesion was found and excised using the Sistrunk procedure. The biopsy disclosed a papillary carcinoma in both. The postoperative evolution of both patients was uneventful.

Treatment of anemia in renal transplantation: impact of a stricter application of hemoglobin targets.

OBJECTIVE: The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach. MATERIALS AND METHODS: The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs. RESULTS: No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 +/- 0.6 vs 1.42 +/- 0.9 mg/dL and 13.7 +/- 1.5 vs 13.7 +/- 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 +/- 1.4 vs 11.9 +/- 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times. CONCLUSIONS: A strict policy on EPO application reduces its use and the rate of patients with "excessive" Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.

Treatment of BK virus-associated nephropathy with Cidofovir in renal transplantation.

BK virus-associated nephropathy (BKVN) has become recognized as an important cause of allograft dysfunction among transplant recipients. Despite reduction in immunosuppression, 30%-40% of recipients progress to allograft loss. Cidofovir is an antiviral agent that has been proposed for treatment of BKVN. We describe the clinical course, renal function, and blood viral measurement in 6 renal transplant recipients with BKVN who were treated with low doses of cidofovir. Administration of cidofovir was associated with clearance of BK virus DNA from blood and stabilization of renal function in 5 cases. These data suggest that cidofovir may be useful as adjuvant therapy for BKVN.

Carcinoma papilar en quiste del conducto tirogloso: reporte de dos casos / Papillary carcinoma in a thyroglossal duct cyst: report of two cases

Thyroglossal duct cyst is the most common congenital anomaly of thyroid gland development. However, papillary carcinoma is described only in 1-2 percent of cases and the clinical appearance is indistinguishable from a benign thyroglossal duct cyst. We report two females aged 15 and 27years consulting for a cervical mass. In both, a solid cystic lesion was found and excised using the Sistrunk procedure. The biopsy disclosed a papillary carcinoma in both. The postoperative evolution of both patients was uneventful.

[Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: report of one case]. / Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico.

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Infección profunda del cuello por Streptococcus grupo B en un paciente diabético: Caso clínico / Retropharyngeal phlegmon caused by a group B Streptococcus in a diabetic patient: Report of one case

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Epidemiology of urinary infections in renal transplant recipients.

Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. We evaluated prospectively all the UTIs in 161 kidney recipients transplanted between July 2003 and July 2005. All patients received prophylaxis with sulfadoxine-pyrimethamine. We excluded asymptomatic bacteriuria. Forty-one patients (25%) suffered at least one UTI episode. Ninety-two episodes of infection were confirmed with an incidence rate of 97 UTI episodes per 100 patient-years. The most common clinical features were uncomplicated acute bacterial cystitis, 71 episodes (77%), and acute pyelonephritis, 21 episodes (23%). Microbiological isolation was confirmed in 58 episodes (63%). Bacterial infections were the most frequent etiologies: gram-negative bacilli in 52 (90%), gram-positive cocci in 4 (7%), fungal in 2 (3%), and one viral BK virus (2%) infection. The causative microorganisms were E. coli as the principal isolated agent in 41 cases (71%), including 10 (24%) that were extended-spectrum betalactamases (ESBLEC). All episodes showed a favorable course. The survival rate of the graft at the end of the study period was 90.7%, and the survival rate of the transplant recipients was 97.5%. The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli (ESBLEC) was the main agent isolated. Uncomplicated UTI, the most frequent post transplantation infection, showed a good prognosis.

Plasmapheresis for the prophylaxis and treatment of recurrent focal segmental glomerulosclerosis following renal transplant.

We evaluated 10 patients with primary focal segmental glomerulosclerosis (FSGS) treated with plasmapheresis (PS) following renal transplantation. Three patients lost their first graft due to FSGS recurrence. In seven patients, PS was indicated as treatment for probable recurrence defined as the onset of proteinuria above 1 g/24 hours. In the remaining three patients, treatment was started in the first week posttransplant as prophylaxis against recurrence. The PS protocol was 17 sessions with the exchange of 2.5 L of plasma for 5% albumin over 10 to 12 weeks. Losartan (25 to 100 mg/d) was given to most patients at the end of PS treatment. The mean follow-up time after PS was 10 months. All patients currently have a functioning graft. A full response to treatment, defined as persistently reduced proteinuria to less than 500 mg/24 hours or the lack of recurrence in prophylactic treatment, was achieved in six patients. Three patients showed a partial decrease in proteinuria (to less than 1 g/24 hours). One patient failed to respond and still has nephrotic range proteinuria. No adverse effects of PS were recorded. A prompt start of PS combined with the use of losartan yields good results in the prophylaxis and treatment of recurrent FSGS following renal transplant in terms of quickly reduced proteinuria. Given the natural course of FSGS, a longer follow-up is needed to estimate the impact of PS on graft survival.

Pharmacokinetics of mycophenolate mofetil in kidney transplant patients with renal insufficiency.

Mycophenolate mofetil (MMF) is an immunosuppressant that is widely used for prophylaxis of rejection in solid organ transplantation. In this study, we examined the effect of renal insufficiency on the pharmacokinetics of MMF, particularly on the free fraction of drug in renal transplant patients. Our study was performed on 10 patients with severe renal insufficiency (creatinine clearance [CrCl] <30 mL/min), and 10 control patients with preserved renal function (CrCl >90 mL/min). All the patients had received a cadaveric donor graft at least 1 year prior and were clinically stable under treatment with MMF and cyclosporine. For each patient, we determined 12-hour areas under the curve (AUC(0-12 h)) for the metabolites: mycophenolic acid (MPA), 7-O-mycophenolic acid glucuronide (MPAG), and the free non-protein-bound fraction of MPA (f-MPA). The two groups were matched for age, sex, and MMF dose. Mean AUC(0-12 h) values for MPA were similar in both groups. The renal insufficiency group showed a significantly increased AUC(0-12 h) for MPAG (1550 +/- 392 vs 3527 +/- 1130 microg.h/mL, P < .001) and increased trough and AUC(0-12 h) values for f-MPA (0.023 +/- 0.02 vs 0.094 +/- 0.07 microg/mL, P = .003, and 0.87 +/- 0.3 vs 1.52 +/- 0.8 microg . h/mL, P = .016, respectively). We proposed that these differences should be taken into account when deciding upon the dose of this drug for the subset of patients with impaired transplant function.

Influence of the current management of renal transplant recipients on the prevalence of anemia and related costs.

The use of mycophenolate mofetil (MMF) and renin-angiotensin system blockers (RAB) to prevent and treat chronic graft nephropathy may affect the incidence of anemia in renal transplant recipients. We compared 2 sets of cadaver-donor recipients, namely those followed at the end of 1995 (group 1; n = 252) versus 2003 (group 2; n = 530) in terms of general characteristics, incidence of anemia (hemoglobin [Hb] < or =13 g/L males, 12 g/L females) or severe anemia (Hb < or =11 g/L males, 10 g/L females) and use cost of treatment with erythropoietin (EPO). Group 2 was significantly older, heavier and longer since grafting. Fifty-seven percent received MMF, 21% received azathioprine, and 5% received rapamycin. In group 1, 83% were given azathioprine. RAB were administered to 35.1% in group 2 versus 14.7% in group 1 (P < .001). Mean blood pressure was identical in the 2 groups, but graft function was worse in group 2 (Cockroft, 62 vs 74 mL/min; P < .001). Mean Hb levels (13.66 + - 3.1 vs 13.82 + - 1.7 g/L) and prevalence of anemia (36.9% vs 34.5%) for groups 1 and 2, respectively, were similar. The rate of severe anemia, however, was lower in group 2 (2.3% vs 8.7%; P < .001). The use of EPO increased from 2.8% (group 1) to 8.7% (group 2; P < .01). In 2003, the cost of EPO was calculated at 1982 Euros/patient-year and 91,150 Euros per year for the whole patient group. Despite accumulation of predisposing factors, the control of anemia in our patients has improved due to the expanded use of EPO. Along with its high cost, EPO therapy has potential positive repercussions on the quality of life and patient prognosis. Therefore, we need to precisely define the optimal use of EPO in renal transplant recipients.

Aspectos clínicos del cáncer de tiroides en la IX Región / Clinical aspects of the thyroid cancer in IX Región

Estudio retrospectivo descriptivo de 96 pacientes operados en el servicio de cirugía del Hospital Regional de Temuco, con diagnóstico de cáncer de tiroides en un período de 13 años, desde enero de 1985 a diciembre de 1997. La forma de presentación más frecuente fue la de bocio uninodular en 43,6 por ciento, la punción citológica tuvo un alto porcentaje de falsos negativos (44 por ciento). En 48 pacientes (50 por ciento) se constató en el intraoperatorio compromiso extratiroideo. El procedimiento quirúrgico de elección fue la tiroidectomía total en 56 casos; el tipo histológico más frecuente fue el cáncer papilar en el 76,6 por ciento de los casos. Tratamiento complementario con yodo 131 se realizó en 54 pacientes, existió seguimiento en el 79 por ciento de los pacientes. La mortalidad total es de 9 pacientes

Fractura de mandíbula tratada con osteosíntesis: experiencia de la Novena Región / Mandible fracture treated with osteosynthesis: experience at IX Región

La reparación definitiva inmediata tanto de las fracturas (Fx) maxilofaciales (MXF), con medios de osteosíntesis (OTS) como de las partes blandas de la cara, son la clave de un buen resultado a corto y largo plazo, tanto en términos funcionales como estéticos. Se realiza un estudio retrospectivo descriptivo del total de pacientes operados con OTS (n=72) en el Hospital Regional de Temuco con diagnóstico de trauma MXF, entre febrero de 1996 y junio de 1998. De éstos, 20 pacientes (28 por ciento) presentaban diagnóstico de Fx de mandíbula, constituyendo el material de estudio. Los métodos de OTS utilizados dan resultados adecuados (alambre o placas), siendo la OTS con placas mejores y más confiables pues requieren menos bloqueo intermandibular postoperatorio

Estudio del ganglio centinela en melanoma maligno: descripción de la técnica y resultados iniciales / Sentinel lymph node malignant melanoma: description of the technic and first results

El manejo profiláctico de los linfonodos regionales en melanoma maligno es un tema controversial. En la actualidad, se reconoce la utilidad de la identificación del primer linfonodo de drenaje a la lesión (ganglio centinela) para definir la conducta respecto a la linfadenectomía profiláctica. La identificación de este ganglio se realiza con los mejores resultados, utilizando la cintigrafía asociada a la tinción con azul de metileno en el intraoperatorio. Se evaluaron nueve pacientes, seis mujeres y tres hombres, con un promedio de edad de 48 años, con lesiones en estadio I y II distribuidas topográficamente de la siguiente forma: extremidad inferior 4, extremidad superior 1, torso 2 y cabeza y cuello 2. Los resultados iniciales del estudio demuestran la validez y la aplicabilidad de la técnica, la que puede producir cambios significativos en el manejo de estos pacientes. El escaso número de pacientes, impide obtener conclusiones con significación estadística en este momento del estudio

Continuous intravenous intradialysis versus intravenous postdialysis erythropoietin therapy in chronic haemodialysis patients: a randomized, controlled, crossover study.

BACKGROUND: Subcutaneous recombinant human erythropoietin seems to be more effective than intravenous administration. Local pain, however, may diminish patient compliance with the subcutaneous route. Recently continuous intravenous intradialysis administration of rHuEpo has been reported to be more efficacious in stimulating erythropoiesis than the usual postdialysis intravenous bolus. METHODS: We conducted a randomized, controlled, crossover study on stable chronic haemodialysis patients to compare the efficacy of continuous intradialysis rHuEpo therapy with intravenous postdialysis administration. Twenty patients were selected and randomly assigned to receive rHuEpo either postdialysis (control phase) or by continuous intradialysis perfusion (slow Epo phase) for 12 weeks. After this period, patients were switched to the alternative method for 12 additional weeks. The erythropoietin dose remained unchanged during the study. Haematocrit was monitored weekly and iron metabolism, serum Epo, and vitamins were measured monthly. Urea kinetics and iPTH measurements were performed every 3 months. RESULTS: Three patients were excluded because of unrelated problems. The final mean haematocrit was unchanged from previous basal values in both phases and no statistical differences were found for any parameter between the groups. No differences were found in iron metabolism nor in urea kinetic parameters. CONCLUSIONS: Continuous intravenous intradialysis administration of rHuEpo is not more effective than an intravenous postdialysis bolus as rHuEpo maintenance therapy in stable chronic haemodialysis patients.

Disecciones cervicales: serie de casos / Neck dissections: cases serial

Se analizan las fichas de 55 enfermos (60 por ciento mujeres y 40 por ciento hombres) sometidos a un total de 63 disecciones cervicales en un lapso de 10 años. Las indicaciones principales fueron cáncer de tiroides (49 por ciento) y cáncer epidermoide (25,5 por ciento). En 47 enfermos la disección fue unilateral (85,5 por ciento) y en 8 (73,6 por ciento). De acuerdo a la extensión la disección fue clasificada como radical en 36 casos (57,2 por ciento), selectiva en 26 (41,3 por ciento) y limitada en 1 (1,5 por ciento). Las estructuras más frecuentemente conservadas en las disecciones modificadas fueron el nervio espinal y músculo esternocleidomastoideo (ECM). Complicaciones intraoperatorias se vieron en 4 enfermos (6,34 por ciento) y postoperatorias en 10 (18,1 por ciento). La moratalidad operatoria fue 3,6 por ciento

Quiste simple yuxtatiroídeo: análisis del posible origen de la lesión / Simple juxtathyroid cyst: analysis of the possible origin of the injury

We report a 34 years old female who presented a simple juxtathyroid cyst. Its content was translucent with a mPTH concentration 30 higher than in blood. This finding lead to the suspicion of a parathyroid cyst; however there were no laboratory evidence of hyperparathyroidism. Two years later and after repeated needle drainages, a surgical cystectomy was made. The immunohistochemical study of the samples was intensely positive for synaptophysis, a parathyroid tissue marker. Surprisingly, thyroglobulin was also found in some cyst wall cells