Utilidad de la relación aclaramiento de creatinina-índice de resistencia de la ecografía Doppler renal como predictor de rechazo agudo en riñones trasplantados / Usefulness of the association between doppler ultrasound resistance index and creatinine clearance as a predictor of acute rejection in kidney transplant

Objetivo: Analizar la utilidad de la asociación del índice de resistencia (IR) en las arterias arcuatas renales con el aclaramiento de creatinina (Cl Cr) para predecir el rechazo agudo del riñón trasplantado. Materiales y métodos: Se realizó un estudio prospectivo de una cohorte de 87 pacientes que fueron sometidos a una biopsia renal por alteraciones clínicas de la función renal. Se les midió el IR junto con el Cl Cr mediante el método de modificación de la dieta en la enfermedad renal. Resultados: La sensibilidad de la asociación IR mayor de 0,7 y Cl Cr 0-30 fue del 53,3% (intervalo de confianza [IC] de 95%: 34,3-71,7%) y la especificidad del 98,2% (95% IC: 90,4-100%). El área bajo la curva fue de 0,758 (95% IC: 0,665-0,85), el likelihood ratio positivo de 22,9 (95% IC: 4,16-214), el likelihood ratio negativo de 0,475 (95% IC: 0,324- 0,685), el odds ratio de 62,9, el valor predictivo positivo de 94,1% (95% IC: 71,3- 99,9%) y el valor predictivo negativo de 79,1% (95% IC: 68,3-88,4%). Conclusión: La asociación IR mayor de 0,7 y Cl Cr 0-30 demostró ser útil para confirmar la posibilidad de rechazo renal agudo, al tener una buena especificidad (98,2%) a pesar de su baja sensibilidad (53%).

Objective: To determine the usefulness of the association between the resistance index (RI) values in renal arcuate arteries and creatinine clearance (Cr Cl) levels in order to predict or detect acute rejection in a kidney transplant patient. Materials and methods: A prospective study was conducted on a cohort of 87 patients who were subjected to a kidney biopsy due to clinical changes in renal function. The RI was measured, and Cr Cl levels determined using the modification of diet in renal disease formula. Results: The sensitivity of an RI association higher than 0.7 and a Cr Cl 0-30 was 53.3% (95% confidence interval [CI]: 34.3-71.7%), with a specificity of 98.2% (95% CI: 90.4-100%). The area under the curve was 0.758 (95% CI: 0.665-0.85), the positive and negative likelihood ratio was 22.9 (95% CI: 4.16-214) and 0.475 (95% CI: 0.324-0.685), respectively. The odds ratio was 62.9, and the positive and negative predicted value was 94.1% (95% CI: 71.3-99.9%) and 79.1% (95% CI: 68.3-88.4%), respectively. Conclusion: The RI association higher than 0.7- Cr Cl 0-30 showed to be useful to detect the possibility of acute renal rejection, with its good specificity (98.2%), although with a low sensitivity (53%).

[Asymptomatic carriers of hydatidosis: epidemiology, diagnosis, and treatment]. / Portadores asintomáticos de hidatidosis: epidemiología, diagnóstico y tratamiento.

Until a short time ago, hydatidosis was considered a pathology that could only be resolved surgically. However, in recent years progress has been made with the epidemiology, diagnosis, and treatment of the disease, and new information on the natural history of hydatidosis has helped define new criteria for its treatment. It is now known that as many as 67% of the carriers of liver cysts who are asymptomatic remain so throughout their lives. This situation produces special results in immunologic testing. Enzyme-linked immunosorbent assay (ELISA) has a sensitivity of 63% and a specificity of 97% with asymptomatic carriers, while the double diffusion arc 5 test (DD5) achieves a sensitivity of only 31% with the same population. On the other hand, imaging studies based on ultrasonography have become the method of choice to detect asymptomatic carriers. Ultrasonography studies are 49% to 73% more sensitive than serological tests, and they can even be used as a part of epidemiological surveillance systems and to monitor control programs. Treatment schemes have also been modernized. Treating asymptomatic carriers chemotherapeutically with albendazole produces favorable results in as many as 69% of cases, while such minimally invasive surgical treatments as puncture-aspiration-injection-reaspiration (PAIR) reduce average cyst volume by as much as 66%. These factors have made it possible for hospital services in the province of Río Negro, Argentina, to establish a treatment scheme for asymptomatic carriers. It is based on the monitoring of small cysts (type Ia on the modified Gharbi scale); initial treatment with albendazole, followed by PAIR if there is no response, in larger or more complex cysts (types Ib, II, and III); and follow-up of inviable or dead cysts (types IV and V).

Quiste hidatídico hepático complicado: ruptura a la cavidad peritoneal / Complicated hepatic hydatid cyst: rupture into abdominal cavity

Antecedentes:La ruptura traumática de un quiste hidatídico hepático en la cavidad abdominal es infrecuente. Objetivo: Comunicar una observación, mostrando la sintomatología, metodología diagnóstica, conducta terapéutica y la evolución postquirúrgica. Lugar de realización: Servicio de Cirúgia General de Hospital Público. Diseño: Análisis de un caso clínico.Población: Paciente sexo femenino, 8 años, atendida por dolor abdominal, secundario a un traumatismo. Diagnóstico: quiste hidatídico hepático roto en la cavidad peritineal. Cirugía: Tratamiento del quiste(Mabit-Lagrot)y lavado de cavidad. Resultados: Buena evolución postquirúrgica. Tratamiento médico con albendazol. Actualmente asintomática

Quiste hidatídico hepático complicado: ruptura a la cavidad peritoneal / Complicated hepatic hydatid cyst: rupture into abdominal cavity

Antecedentes:La ruptura traumática de un quiste hidatídico hepático en la cavidad abdominal es infrecuente. Objetivo: Comunicar una observación, mostrando la sintomatología, metodología diagnóstica, conducta terapéutica y la evolución postquirúrgica. Lugar de realización: Servicio de Cirúgia General de Hospital Público. Diseño: Análisis de un caso clínico.Población: Paciente sexo femenino, 8 años, atendida por dolor abdominal, secundario a un traumatismo. Diagnóstico: quiste hidatídico hepático roto en la cavidad peritineal. Cirugía: Tratamiento del quiste(Mabit-Lagrot)y lavado de cavidad. Resultados: Buena evolución postquirúrgica. Tratamiento médico con albendazol. Actualmente asintomática