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Biomedical subjects

D Sigulem

Publications and source records attributed to D Sigulem.

At least 19 recordsLinked to original sources
PubMed1998

A retrospective study of kidney transplant recipients from living unrelated donors.

Due to the shortage of cadaveric organs, kidneys from living unrelated donors (LUD) are increasingly being used for transplantation. The long-term outcome for LUD recipients is not completely known. This study was undertaken to evaluate the long-term graft survival in LUD recipients and compare it with that of cadaver donor allograft recipients. Three hundred and sixty-four LUD and 3881 cadaveric kidney recipients were evaluated using data obtained through the Brazilian Renal Transplant Registry. Transplants performed between January 1, 1987, and June 30, 1996, were eligible for analysis. Graft and patient survival were estimated by the Kaplan-Meier method. Sixty percent of the LUD were from spouses. The median duration of follow-up was 23.8 mo (0 to 117.2 mo). Patient survival rates were not significantly different for LUD and cadaveric kidney recipients (69% [95% confidence interval (CI), 61.9 to 76.1%] versus 73.2% [71 to 75.4%] at 5 yr; 69% [61.9 to 76.1%] versus 60.6% [55.1 to 66.1%] at 9.6 yr). Graft survival rates for recipients of LUD allografts were similar to those for cadaveric kidneys at 5 yr (50.1% [43.2 to 57%] versus 50.4% [48.1 to 52.8%]) and higher, although not significantly, at 9.6 yr (45.7% [37.7 to 53.7%] versus 32.7% [26.4 to 39%], respectively, P = 0.14). In a multivariate analysis using the Cox proportional hazards regression model, after adjusting for recipient age, race, history of previous transplantation, and year of transplantation, the risk of graft failure was 16% (95% CI, -3% to 31%) lower for LUD than cadaveric recipients. We conclude that LUD are an excellent alternative to cadaveric kidney donors. The long-term patient and graft survival rates for recipients of LUD allografts are at least as good as those for recipients of cadaveric kidneys.

Adult↗
PubMed1996

Acceptance for chronic dialysis treatment: insufficient and unequal.

BACKGROUND: Evidence suggests that a number of end-stage renal disease (ESRD) patients die without receiving dialysis. We investigated and compared ESRD patients who died without receiving treatment and those who were accepted for dialysis. METHODS: All patients starting chronic dialysis in 1991 in the city of Sao Paulo and prospectively registered in the Health Secretariat files were studied. From death certificates we obtained data from all patients dying with an underlying cause associated with chronic renal failure. Medical records from a sample of patients who died without receiving dialysis were reviewed. RESULTS: Of 2127 patients, 1582 (74.7%) received dialysis and 545 (25.6%) did not. The best chance of being dialysed occurred in the 20-29 age group. The age groups with the least chance of receiving dialysis were 0-9 years and over 79 years old. The odds ratio (95% Cl) of not receiving dialysis was 12.42 (6.63-23.82) times greater for patients over 60 years old compared to those aged 10-19 years. Patients with renal failure due to congenital diseases, chronic pyelonephritis, unknown cause, and hypertension were less likely to receive dialysis than those with glomerulonephritis or diabetes. CONCLUSIONS: Our results suggest that many ESRD patients die without receiving dialysis. Age and cause of renal disease influence the chance of being accepted for treatment. Restrictions of treatment need to be corrected to guarantee that maintenance dialysis will be accessible to ESRD patients.

Adolescent↗
PubMed1995

Comparative study of intensive care unit (ICU) performance.

It is possible to evaluate ICU performance using severity-of-illness systems, but are these systems objective enough to draw comparison between different units? A software was developed to allow data collection and calculation of the score APACHE II [1] and administrative hospital indicators. To provide homogeneity, all data were collected following the same protocol and verified by one author.

APACHE↗
PubMed1995

Educational program on ophthalmology.

To minimize the learning problems, related to the present teaching method, we developed the Educational Program on Ophthalmology, that offers an interactive and self-controlled way of learning, through the multimedia and hypertext (hypermedia) resources to the students. The software has 200 images (pictures and photos), 40 minutes of digitized voice (.WAV), 50 minutes of video animation (.AVI) and more than 200 links. The first evaluation demonstrated a great interest from the medical graduated students, who feel motivated with the utilization of the software.

Animals↗
PubMed1992

Kidney transplantation from living unrelated donors.

OBJECTIVE: To compare patient and graft survival of recipients of kidneys from living, unrelated donors (LUDs); cadaveric donors; and living, related donors (LRDs) matched for zero (mismatched), one, or two (identical) haplotypes. DESIGN: Cohort study. SETTING: Sixty-three renal transplantation centers affiliated with the Brazilian Transplantation Registry (accounting for more than 95% of the transplantation activity in Brazil). PATIENTS: Patients having renal transplantation between January 1987 and March 1991. Of 2892 patients, 165 (6%) received transplants from LUDs; 964 (33%), from cadaveric donors; 183 (6%), from zero haplotype, HLA-matched LRDs; 1259 (44%), from one haplotype-matched LRDs; and 321 (11%), from two haplotype-matched LRDs. MEASUREMENTS: Patient and graft survival. Patients were followed for an average of 15.8 months. RESULTS: After adjustment for age, race, diagnosis of primary disease, history of previous transplantation, cyclosporine use, and number of transplants from LUDs per center, patient survival did not differ statistically for recipients of kidneys from LUDs and recipients of cadaveric kidneys (risk ratio [RR], 1.16; 95% Cl, 0.68 to 1.98). Little difference was seen between the adjusted death rate for recipients of zero haplotype-matched LRDs and recipients of cadaveric kidneys (RR, 1.13; Cl, 0.69 to 1.87). Similarly, in a multivariate analysis, recipients of kidneys taken from LUDs and zero haplotype-matched LRDs had a risk for graft failure that did not differ statistically from that of cadaveric kidney recipients (RR, 0.74; Cl, 0.45 to 1.22 and RR, 0.82; Cl, 0.53 to 1.25, respectively). CONCLUSIONS: Graft survival for recipients of kidneys from LUDs is similar to that from zero haplotype-matched LRDs and is at least as good as that achieved with cadaveric transplants.

Adolescent↗
PubMed1990

Survival analysis of 1563 renal transplants in Brazil: report of the Brazilian Registry of Renal Transplantation.

Little is known about renal transplantation activity in developing countries. The objective of this study was to evaluate patient and graft survival among the different types of renal transplant recipients in Brazil. The study population consisted of 1563 patients receiving renal grafts for the first time between 1 October 1987 and 31 December 1989 in 49 transplant centres in Brazil. Data were prospectively collected through individual patient questionnaires. Of the 1563 transplantations performed, 1051 (67%) were from living donors, 467 (30%) from cadaver donors, and 45 (3%) unspecified. A total of 963 (62%) transplants came from living related donors (10% HLA-identical, 45% HLA-haploidentical and 6% HLA-distinct). Among the transplant recipients, only 7% were more than 55 years old, 5% were younger than 15 and 4% had diabetes mellitus. Blacks accounted for 24% of patients receiving transplants. An immunosuppressive regimen, including cyclosporin was used in 75% of cadaver kidney recipients, in 42% of living donor kidney recipients; and in 43% and 75% of HLA-haploidentical and HLA-distinct living related donor recipients, respectively. At 2 years, patient survival for living donor and cadaver donor transplant recipients was 89% and 80% respectively, and graft survival was 76% and 61% respectively. Patient survival for recipients of HLA-identical, haploidentical, and distinct living related donor kidneys was respectively 94%, 90%, and 81% at 2 years, and graft survival was 90%, 75%, and 65% respectively. Graft survival for recipients of HLA-distinct living related donor and non-related donor kidneys compared to cadaver donor kidneys was not significantly different at 2 years (63% vs 61%, P greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The risk approach in preschool children suffering malnutrition and intestinal parasitic infection in the city of São Paulo, Brazil.

The association between parasitic infection and malnutrition in preschool children in the city of São Paulo, was studied according to degree of malnutrition, age, and income. Associations were assessed by risk analysis. Higher risks of malnutrition were found in children above 24 months of age infected with Ascaris, Trichuris or with more than three different parasites. The presence of more than three parasites per child affected nutritional status independently of income level. It is suggested that more attention should be given to intensity and chronicity of intestinal parasitic infection.

Brazil↗
PubMed1987

Effects of cyclosporin on renal microcirculation.

To evaluate renal microcirculation during acute cyclosporin (CsA) administration (50 mg/kg, i.v.), seven euvolaemic Munich-Wistar rats were studied. CsA infusion caused a significant decrease in total glomerular filtration rate (GFR) (0.96 +/- 0.04 vs 0.47 +/- 0.07 ml/min) and in single-nephron GFR (SNGFR) (27.90 +/- 3.4 vs 14.02 +/- 3.5 nl/min). The efferent arteriolar resistance increased substantially (P less than 0.05) while the afferent resistance rose moderately. Consequently, there was an increase (P less than 0.05) in mean glomerular capillary hydraulic pressure (PGC), from 45 +/- 1 to 55 +/- 4 mmHg, together with an important decrease in mean glomerular plasma flow rate (QA), from 100 +/- 17 to 44 +/- 13 nl/min. Since tubular hydraulic pressure was maintained unaltered, an elevated transglomerular hydraulic pressure difference was observed (P less than 0.05). The lower values of SNGFR were accounted for by both the decrease in QA and in the glomerular ultrafiltration coefficient (Kf). The latter was reduced from 0.096 +/- 0.03 to 0.031 +/- 0.010 nl/sec per mmHg (P less than 0.05) by CsA. Additionally, three groups of Munich-Wistar rats were previously treated with captopril (2 mg/kg per h, i.v.), verapamil (20 micrograms/kg per min, i.v.) or indomethacin (2 mg/kg, i.v.). Both captopril and verapamil minimised the renal effects of CsA, with a decline of approximately 25% instead of approximately 50% on GFR and RPF. Thus CsA infusion caused a decline on SNGFR due to an important reduction in QA and Kf with an impressive increase on arteriolar resistance, a mark of angiotensin II stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

The effect of Collins' solution on the function and structure of isolated proximal convoluted tubules from rabbit kidneys.

Proximal convoluted tubules (PCTs) from rabbit cortical slices were perfused after preservation in Collins' solution with the in vitro microperfusion technique. Under these conditions, after maneuvers of in vitro preservation, the following findings were observed: Tubules were best preserved, functionally and morphologically, when bathed with Collins' solution peritubularly. Tubular preservation was inadequate when the Collins' solution contacted only the luminal or luminal and peritubular sides. These observations indicate a difference in the reactions of various cellular sides to the preservation process, suggesting that during preservation of the whole kidney, there are differences in the preservation of the various tissues of the organ.

Animals↗
PubMed1985

Renal accumulation of 99mTc-DMSA in the artificially perfused isolated rat kidney.

In order to investigate aspects of the renal handling of 99mTc-DMSA, 68 isolated rat kidneys were artificially perfused. The experimental groups were: Group 1 (no. = 32)-oxygenated filtering kidneys; Group 2 (no. = 29)-oxygenated non-filtering kidneys; Group 3 (no. = 7)-anaerobic non-filtering kidneys. We conclude that the 99mTc-DMSA complex is strongly bound to albumin, is not filtered and is removed from perfusion fluid through the renal peritubular capillary route and that this occurs by an active process which depends upon aerobic metabolism. This process has a high capacity and is not inhibited by probenecid.

Animals↗
PubMed1982

Tetracaine, procaine and verapamil inhibition of fluid absorption in isolated perfused rabbit proximal convoluted tubules.

1. We determined the effect of local anesthetic and antiarrhythmic drugs which putatively increase cytosolic Ca2+ activity on fluid absorption (JV) by the isolated perfused proximal convoluted tubule of the rabbit. 2. Rabbit proximal convoluted tubules were perfused in vitro with an ultrafiltrate of modified Krebs-Henseleit solution containing 6.5 g/dl bovine albumin. 3. JV was measured before and after the addition of 2 mM tetracaine, 1 mM procaine or 5 microM verapamil, and after removal of the drugs from the bathing solution (recovery period). 4. All the drugs studied significantly inhibited JV in a reversible manner. 5. The data are consistent with the view that these drugs decreased the rate of fluid absorption in the proximal convoluted tubule by increasing cytosolic Ca2+ activity.

Absorption↗
PubMed1978

Starvation---an interesting model for the study of the renin-angiotensin-aldosterone system.

Five obese subjects were studied during prolonged starvation. Then renin aldosterone system and urinary aldosterone excretion were studied during prolonged starvation and refeeding in five obese subjects. An uniform increase in aldosterone urinary excretion was observed in all subjects studied. A progressive increase in renin plasma activity was found in all patients along the starvation period with a striking additional increase after refeeding. The possible factors involved are discussed.

Adolescent↗
PubMedDate not supplied

[Nutritional assessment of chronic renal patients in hemodialysis programs. A multicenter study].

The food intake and the nutritional status of 100 chronic renal failure patients on maintenance hemodialysis in 10 facilities in the city of São Paulo were studied. The average food intake obtained through 3 days of dietary diaries showed a caloric intake of 26.6 +/- 10kcal/kg/day (mean +/- SD), 24% below the minimum daily caloric intake recommendation and a protein intake of 1.03 +/- 1.4g/kg/day which averaged the minimum recommended for chronic renal patients on hemodialysis. The average intakes of calcium (418.6 +/- 294.9mg), phosphate (813.5 +/- 335.2mg) and iron (10.5 +/- 4.9mg) were also low. Mean serum albumin was 3.9 +/- 0.7g/dl and only 3.1% of the patients had albumin levels below 3.0g/dl. There was no difference between the real and ideal body weight. On the other hand 69% of women and 25% of men had the triceps skin fold (TSF) in the 5th percentile while 24% of women and 79% of men exhibited values of the muscle arm circumference (MAC) in the same percentile. Moreover there were inverse and significant correlations between the time on dialysis and TSF for women (r = -0.19) and the time on dialysis and MAC for men (r = -0.16). This study shows that our patients on hemodialysis have a poor food intake, with marked reduction of fat and muscle stores. The undernourished state observed tended to be more pronounced with the duration of the dialysis treatment and could influence negatively on the morbidity and mortality of these patients.

Adult↗