RESUMO
The Health Care Financing Administration (HCFA) has developed procedures and criteria now being used by the End Stage Renal Disease Network organizations in the review of facilities and providers to assure the quality and appropriateness of care provided to ESRD patients. This review was mandated by the Omnibus Budget Reconciliation Act (OBRA) of 1986. The consistent application of defined quality review criteria screens throughout the country will provide the foundation for a new era of quality care.
Assuntos
Falência Renal Crônica/terapia , Revisão por Pares/métodos , Qualidade da Assistência à Saúde , Centers for Medicare and Medicaid Services, U.S. , Protocolos Clínicos/normas , Humanos , Objetivos Organizacionais , Organizações de Normalização Profissional/organização & administração , Estados UnidosRESUMO
Pregnant rats received a single administration of 0.5, 1.0, or 2.0 mg/kg of cadmium on day 18 or 20 or gestation. Maternal animals were killed on day 21 and samples of the caudate nucleus from fetal brains were examined using the transmission electron microscope. A 2.0 mg/kg dose of cadmium administered to maternal rats on day 20 of gestation caused the formation of vacuoles in the endothelial cells of capillaries in the fetal brain. Significant endothelial cell vacuolization was not observed in the brain of fetuses from other treatment groups. The vacuoles occurred singly, were spherical in shape, were located adjacent to the intercellular junctions and caused focal distortion of the endothelial cell. Vacuoles were the only ultrastructural alteration observed in the caudate nucleus of fetal brains.
Assuntos
Encéfalo/efeitos dos fármacos , Cádmio/farmacologia , Endotélio/efeitos dos fármacos , Animais , Capilares/ultraestrutura , Núcleo Caudado/irrigação sanguínea , Núcleo Caudado/efeitos dos fármacos , Endotélio/ultraestrutura , Feminino , Troca Materno-Fetal , Microscopia Eletrônica , Gravidez , Ratos , Vacúolos/ultraestruturaRESUMO
Although a transitory maternal zinc deficiency has been shown to result in an increased cadmium-induced fetotoxicity, the results of the present investigation indicated that a maternal zinc deficiency apparently did not affect the placental transfer of cadmium. However, a zinc deficiency did alter the maternal distribution of cadmium. The increased cadmium fetotoxicity associated with a maternal zinc deficiency may be caused by a maternal alteration rather than a direct effect on the fetus. Further study is necessary prior to any definitive statement concerning the effects of a maternal zinc deficiency on cadmium fetotoxicity.
