Outpatient renal needle biopsy of the transplanted kidney: safety profile.

Since May 2005, we began performing renal graft biopsies as outpatient procedures when the patient's condition did not require hospitalization. To evaluate the safety profile of the 137 procedures performed in 111 patients, we performed a retrospective analysis of complications after all biopsies between 4 May 2005 and 6 January 6, 2011. The analysis focused on types of complications as well as needs for hospitalization with length of stay, for blood transfusion or for a further intervention. There were complications in 10.9% of procedures (n = 15) with 8% requiring hospitalization (n = 11). The complications were: gross hematuria (n = 10) including blockage of urinary flow (n = 2) with one subject requiring urologic intervention, and one patient experienced severe pain at the puncture site. Neither renal graft nor patient survival was threatened; there was no hemodynamic decompensation needing blood transfusions. The average hospital stay was 2.27 days (range = 1-8). Outpatient renal biopsies in 111 patients (137 procedures) had an 8% incidence of complications requiring admission and an average length of hospitalization of 2.27 days. Gross hematuria the most frequent problem, in no way compromised patient or graft survival showing it to be a safe outpatient procedure.

Parathyroidectomy for parathyroid carcinoma in renal transplantation.

INTRODUCTION: Hyperparathyroidism (HPT) is a highly prevalent pathology in the chronic renal disease population, which is associated with considerable morbidity, and mortality. The histopathological findings most often reported are solitary adenoma, diffuse hyperplasia, and autonomous hyperplasia. Carcinoma is an unusual cause of primary parathyroid hyperfunction (0.5% to 4% according to data); in renal transplanted patients it is exceptional. We sought to analyze parathyroid gland histology from renal transplant patients in comparison with nontransplanted patients and to report a parathyroid carcinoma case in a renal transplant patient. METHODS: We retrospectively analyzed parathyroidectomies (PTX) and histopathological reports between March 1989 and December 2003. RESULTS: Among 72 PTXs 41 were performed because of primary HPT; 26, secondary HPT; and five, tertiary HPT. Among the 41 primary HPT cases there were two carcinomas (4.88% primary HPT operated patients), one of whom was in a kidney transplant recipient. Among the total number of surgeries, seven were performed in six renal transplant patients, including five diffuse hyperplasia cases; one, nodular hyperplasia with an adenoma focus; and one, parathyroid carcinoma. CONCLUSIONS: Parathyroidectomy indications in the renal transplant population are usually associated with the clinical picture of tertiary HPT, which does not resolve after a functional renal transplant. In spite of this, diffuse hyperplasia, which is associated with secondary HPT, was the most frequent hystological finding. Two carcinomas were observed: one in a renal transplant patient (16.6% parathyroidectomies) and the other in a patient who did not show renal failure. These data coincide with international records.

The G209A mutation in the alpha-synuclein gene in Brazilian families with Parkinson's disease.

A missense G209A mutation of the alpha-synuclein gene was recently described in a large Contursi kindred with Parkinson's disease (PD). The objective of this study is to determine if the mutation G209A of the alpha-synuclein gene was present in 10 Brazilian families with PD. PD patients were recruited from movement disorders clinics of Brazil. A family history with two or more affected in relatives was the inclusion criterion for this study. The alpha-synuclein G209A mutation assay was made using polymerase chain reaction and the restriction enzyme Tsp45I. Ten patients from 10 unrelated families were studied. The mean age of PD onset was 42.7 years old. We did not find the G209A mutation in our 10 families with PD. Our results suggest that alpha-synuclein mutation G209A is uncommon in Brazilian PD families.

Effects of hemorrhage on gastrointestinal oxygenation.

OBJECTIVES: (1) To demonstrate that metabolic parameters are better indicators of tissue hypoxia than regional and whole oxygen consumption (VO(2)). (2) To compare intramucosal pH (pHi) in different gastrointestinal segments. DESIGN: Prospective, interventional study. SETTING: Research laboratory at a university center. SUBJECTS: Fourteen anesthetized, mechanically ventilated dogs. INTERVENTIONS: Twenty milliliters per kilogram bleeding. MEASUREMENTS AND MAIN RESULTS: We placed pulmonary, aortic and mesenteric venous catheters, and an electromagnetic flow probe in the superior mesenteric artery, and gastric, jejunal and ileal tonometers to measure flows, arterial and venous blood gases and lactate, and intramucosal PCO(2). We calculated systemic and intestinal oxygen transport (DO(2)) and consumption (VO(2)), pHi and arterial minus intramucosal PCO(2) (DeltaPCO(2)). Then, we bled the dogs and repeated the measurements after 30 min. Systemic and intestinal DO(2) fell (26.0+/-7.3 versus 8.9+/-2.6 and 71.9+/-17.3 versus 24.6+/-9.6 ml/min per kg, respectively, p<0.0001). Systemic and intestinal VO(2) remained unchanged (5.5+/-1.3 versus 5.4+/-1.3 and 15.7+/-5.0 versus 14.9+/-5.3 ml/min per kg, respectively). Gastric, jejunal and ileal pHi (7.13+/-0.11 versus 6.96+/-0.17, 7.18+/-0.06 versus 6.97+/-0.15, 7.12+/-0.11 versus 6.94+/-0.14, p<0.05) and DeltaPCO(2) (21+/-13 versus 35+/-23, 15+/-5 versus 33+/-16, 23+/-17 versus 38+/-20, p<0.05) changed accordingly. Arterial and mesenteric venous lactate and their difference, rose significantly (1.7+/-0.9 versus 3.7+/-1.4 and 1.8+/-0.8 versus 4.3+/-1.5 mmol/l, 0.1+/-0.6 versus 0.6+/-0.7 mmol/l, p<0.05). CONCLUSIONS: During hemorrhage, systemic and intestinal VO(2) remained stable. However, hyperlactatemia and intramucosal acidosis evidenced anaerobic metabolism. pHi changes paralleled in the three intestinal segments.

End-tidal CO2 pressure determinants during hemorrhagic shock.

OBJECTIVES: To examine the relationship between end-tidal CO2 (PETCO2) and its physiological determinants, pulmonary blood flow (cardiac output, CO) and CO2 production (VCO2), in a model of hemorrhagic shock during fixed minute ventilation. DESIGN AND SETTING: Prospective, observational study in a research laboratory at a university center. SUBJECTS AND INTERVENTIONS: Six anesthetized, intubated, and mechanically ventilated mongrel dogs. Progressive stepwise bleeding. MEASUREMENTS AND RESULTS: We continuously measured PETCO2 with a capnograph, pulmonary artery blood flow with an electromagnetic flow probe, arterial oxygen saturation (SaO2) with a fiberoptic catheter, and oxygen consumption (VO2) and VCO2 by expired gases analysis. Oxygen delivery (DO2) was continuously calculated from pulmonary blood flow and SaO2. We studied the correlation of PETCO2 with CO and VCO2 in each individual experiment. We also calculated the critical point in the relationships PETCO2/ DO2 and VO2/DO2 by the polynomial method. As expected, PETCO2 was correlated with CO. The best fit was logarithmic in all experiments (median r2 = 0.90), showing that PETCO2 decrease is greater in lowest flow states. PETCO2 was correlated with VCO2, but the best fit was linear (median r2 = 0.77). Critical DO2 for PETCO2 and VO2 was 8.0 +/- 3.3 and 6.3 +/- 2.5 ml x min(-1) kg(-1), respectively (NS). CONCLUSIONS: Our data reconfirm the relationship between PETCO2 and CO during hemorrhagic shock. The relatively greater decrease in PETCO2 at lowest CO levels could represent diminished CO2 production during the period of VO2 supply dependency.

Dengue in the State of Rio de Janeiro, Brazil, 1986-1998.

This paper presents epidemiological, laboratory, and clinical data on 12 years of dengue virus activity in the State of Rio de Janeiro from the time the disease was first confirmed virologically in April 1986 through April 1998. DEN-1 and DEN-2 viruses are the serotypes circulating in the state and were responsible for the epidemics reported during the last 12 years. The results published here show both the impact of dengue virus infections on the population and laboratory advances that have improved dengue diagnosis.

[Epidemiology of meningococcal disease in the city of Rio de Janeiro: changes after vaccination against B and C serogroups] / Epidemiologia da doença meningocócica na cidade do Rio de Janeiro: modificações após vacinação contra os sorogrupos B e C.

Meningococcal disease has been a serious public health problem in the city of Rio de Janeiro, with high attack rates among younger children, high case fatality rates, and predominance of serogroup B. In December 1994 the second vaccination drive against B and C meningococcal disease was performed with the objective of protecting children ages 6 months to 13 years. A total of 950 thousand children received 2 doses of vaccine produced by the Finlay Institute of Cuba. In 1995 a change was observed in the disease pattern with a predominance of serogroup C and a higher global attack rate, particularly among children under 1 year of age, teenagers, and young adults. In vaccinated groups the attack rate was lower than in 1994, due to a decrease in serogroup B. No change was observed in the case fatality rate.

Preservación de la oxigenación intestinal en la injuria pulmonar por ácido oleico (AO) / Preservation of the intestinal oxygenation in the lung injury by oleic acid

El síndrome séptico (SS) y el fallo multiorgánico (MOF) se desarrollan frecuentemente en el síndrome de distress respiratorio del adulto (ARDS), incluso cuando el transporte de 02 se mantiene dentro de límites normales. Una explicación para este fenómeno sería el desarrollo de la hipoxia intestinal y la eventual translocación bacteriana, ya que este territorio se considera particularmente susceptible a cambios en la disponibilidad de 02. Nosotros realizamos este estudio, en un modelo experimental canino de ARDS, con el objetivo de descartar la presencia de hipoxia intestinal oculta. Para esto, estudiamos siete perros, anestesiados y ventilados mecánicamente con una Fi02 de 0,50, a los que se les colocaron catéteres en las arterias pulmonar y femolar, para medición de volumen minuto cardíaco (Q) y obtención de muestras sanguíneas. A través de una laparatomía, se colocaron un transductor para medición electromagnética del flujo sanguíneo en la arteria mesentérica superior (Qi), un catéter en la vena mesentérica para extracción de muestras sanguíneas y un tonómetro para medición del pH intramucoso en un asa yeyunal (pHi). Se midieron pH, PC02, P02, Hb y saturación de 02 en las muestras sanguíneas. Se calcularon disponibilidades y consumos de 02 sistémicos e intestinales (D02, V02, D02i y V02i, respectivamente). Luego de las mediciones basales, se inyectaron 0,1 ml/kg de AO. Las mediciones se repitieron a los 30, 60, 90 y 120 minutos. A lo largo del experimento, se evitaron reducciones del Q por la infusión de solución fisiológica. La Pa02 (mediañSE) se redujo significativamente (248ñ11 versus 95ñ5,p<0,01). Sin embargo, D02i, V02i y pHi no sufrieron cambios significativos durante el desarrollo del edema pulmonar. Estos resultados podrían deberse a : 1) la capacidad intestinal de mantener su oxigenación, 2) la injuria no fue de suficiente magnitud y/o duración

Preservación de la oxigenación intestinal en la injuria pulmonar por ácido oleico (AO) / Preservation of the intestinal oxygenation in the lung injury by oleic acid

El síndrome séptico (SS) y el fallo multiorgánico (MOF) se desarrollan frecuentemente en el síndrome de distress respiratorio del adulto (ARDS), incluso cuando el transporte de 02 se mantiene dentro de límites normales. Una explicación para este fenómeno sería el desarrollo de la hipoxia intestinal y la eventual translocación bacteriana, ya que este territorio se considera particularmente susceptible a cambios en la disponibilidad de 02. Nosotros realizamos este estudio, en un modelo experimental canino de ARDS, con el objetivo de descartar la presencia de hipoxia intestinal oculta. Para esto, estudiamos siete perros, anestesiados y ventilados mecánicamente con una Fi02 de 0,50, a los que se les colocaron catéteres en las arterias pulmonar y femolar, para medición de volumen minuto cardíaco (Q) y obtención de muestras sanguíneas. A través de una laparatomía, se colocaron un transductor para medición electromagnética del flujo sanguíneo en la arteria mesentérica superior (Qi), un catéter en la vena mesentérica para extracción de muestras sanguíneas y un tonómetro para medición del pH intramucoso en un asa yeyunal (pHi). Se midieron pH, PC02, P02, Hb y saturación de 02 en las muestras sanguíneas. Se calcularon disponibilidades y consumos de 02 sistémicos e intestinales (D02, V02, D02i y V02i, respectivamente). Luego de las mediciones basales, se inyectaron 0,1 ml/kg de AO. Las mediciones se repitieron a los 30, 60, 90 y 120 minutos. A lo largo del experimento, se evitaron reducciones del Q por la infusión de solución fisiológica. La Pa02 (mediañSE) se redujo significativamente (248ñ11 versus 95ñ5,p<0,01). Sin embargo, D02i, V02i y pHi no sufrieron cambios significativos durante el desarrollo del edema pulmonar. Estos resultados podrían deberse a : 1) la capacidad intestinal de mantener su oxigenación, 2) la injuria no fue de suficiente magnitud y/o duración (AU)

Avaliacao de criancas prematuras ou baixo peso acompanhadas ambulatorialmente no plano especial de pediatria da Maternidade Carmela Dutra. / Evaluation of premature or low birth weight infants followed at the ambulatory in the special pediatric plan at the Carmela Dutra Maternity

As autoras estudaram 112 criancas acompanhadas no plano Especial de Pediatria do Hospital Maternidade Carmela Dutra, que foram prematuras ou baixo peso para a idade gestacional ao nascer, e as analisaram em relacao ao peso e estatura quando atingiram a idade de um ano. Tambem foram avaliados os dados de desenvolvimento motor.A evolucao foi satisfatoria para a maioria das criancas ao se comparar os pesos e alturas com uma tabela para criancas normais brasileiras, o mesmo ocorrendo com o desenvolvimento motor. Apenas um dos gruposbaixo peso feminino-apresentou indices para o peso considerados baixos. Este tambem era o grupo de menor renda familiar