[Ethical implications of Do-Not-Resuscitate orders]. / Implicações éticas das ordens de não ressuscitar.

UNLABELLED: Do-Not-Resuscitate (DNR) orders are those orders that direct non-initiation of cardiopulmonary resuscitation in the event of cardiopulmonary arrest. PURPOSE: To evaluate ethical implications of DNR orders in the clinical pratice. METHODS: The authors reviewed critically the major ethical issues associated with DNR orders, mainly focusing their risks and benefits, and the application of the Personalistic's view in this orders. RESULTS: Reaction to the widespread use of this orders is not universally positive, and concerns about its possible overuse and abuse have been raised. DNR orders alone can not resolve the complex problem of the terminally ill, patients and the therapeutic futility. CONCLUSION: From the Personalistic's point of view, in all instances, the physician must remain aware that her primary duty is to hold the patient's dignity.

Actions of Crotalus durissus terrificus venom and crotoxin on the isolated rat kidney.

Many studies have reported the occurrence of lethal acute renal failure after snakebites. The aim of the present investigation was to determine alterations in renal function produced by Crotalus durissus terrificus venom and crotoxin as well as the histological alterations induced by these venoms. Isolated kidneys from Wistar rats weighing 240 to 280 g were perfused with Krebs-Henseleit solution containing 6 g% of previously dialyzed bovine serum albumin. The effects of Crotalus durissus terrificus venom and crotoxin were studied on glomerular filtration rate (GFR), urinary flow (UF), perfusion pressure (PP) and percentage sodium tubular transport (%TNa+). The infusion of Crotalus durissus terrificus venom (10 microg/ml) and crotoxin (10 microg/ml) increased GFR (control80 = 0.78 +/- 0.07, venom80 = 1.1 +/- 0.07, crotoxin80 = 2.0 +/- 0.05 ml g(-1) min(-1), P<0.05) and UF (control80 = 0.20 +/- 0.02, venom80 = 0.32 +/- 0.03, crotoxin80 = 0.70 +/- 0.05 ml g(-1) min(-1), P<0.05), and decreased %TNa+ (control100 = 75.0 +/- 2.3, venom100 = 62.9 +/- 1.0, crotoxin80 = 69.0 +/- 1.0 ml g(-1) min(-1), P<0.05). The infusion of crude venom tended to reduce PP, although the effect was not significant, whereas with crotoxin PP remained stable during the 100 min of perfusion. The kidneys perfused with crude venom and crotoxin showed abundant protein material in the urinary space and tubules. We conclude that Crotalus durissus terrificus venom and crotoxin, its major component, cause acute nephrotoxicity in the isolated rat kidney. The current experiments demonstrate a direct effect of venom and crotoxin on the perfused isolated kidney.

[Evaluation of the sensitization power of Montenegro skin test]. / Avaliação do poder sensibilizante da reação de Montenegro.

The Montenegro skin test, used to diagnose cutaneous leishmaniasis, is now being considered to detect immunogenicity after vaccination. In this study, we evaluated the ability of this test to induce immune response and IFN-g production in subjects not previously exposed to Leishmania. The Montenegro skin test was performed using antigens of L. amazonensis produced by our laboratory (group I) or by FIOCRU-RJ (group II). At day 30, 33% of the subjects from group I and 42% from group II were positive, compared to 67% from group I and 50% from group II at day 90. IFN-y was detected in 56 % of subjects from group I and 17% from group II at day 30 (169+/-309 and 11+/-36pg/ml) and in 67% from group I and 58% from group II by day 360 (69+/-107 and 18+/-20pg/ml). These data demonstrate that the Montenegro skin test induces not only a delayed hypersensitivity reaction, but also IFN-y production.

[Recurrent bronchopneumonia and Morgagni hernia]. / Broncopneumonias de repetição versus hérnia de Morgagni.

The Morgagni hernia occurs behind the sternum and is a rare diaphragmatic defect although the late diagnosis may result in important clinic symptoms and poor prognosis. The authors present a case report of a child with 11 months and respiratory symptoms with chronic pulmonary infections and several hospitalizations without etiologic diagnosis. The conclusion was for the early Morgagni hernia diagnosis and the prevention of chronic complications.

Glycerol as substrate for biomass and ß-carotene production byRhodotorula lactosa.

Glycerol was used as the sole carbon and energy source for growingRhodotorula lactosa. The maximum biomass yield (0.53 g/g substrate) was obtained after 20 h with 21.5 g glycerol/l; growth was inhibited with 28.0 g glycerol/l and cell morphology was changed. At this time, the cells were not pigmented. After 48 h of cultivation, ß-carotene was at 1.8 mg/g dry cells, yielding 22.0 mg/l. When cells were grown for 20 h, washed, suspended in distilled water and aerated for 24 hours, more ß-carotene (2.66 mg/g dry cells or 28.0 mg/l of the original culture) was produced. Cell protein content after 48 h was 36 to 38% (w/w) before extraction and 45 to 47% (w/w) for acetone-extracted cells.