Plasma levels of kininogen, kallikrein, and prekallikrein were determined in patients with malignant hypertension (MH) and compared to normotensive controls (NC) and patients with mild to moderate essential hypertension (EH). Also, a recently described kinin potentiating factor (KPF) was estimated by dividing the value of kininogen determined by trypsin (Kgn-Try) by that of kininogen determined by human urinary kallikrein (Kgn-HuUk). No significant alterations were detected among plasma values of pre-kallikrein and kallikrein of MH as compared to NC. However, Kgn-HuUK values were significantly lower in MH (1.9 +/- 0.3 micron gLBK/ml) as compared to EH and NC (2.7 +/- 0.1 micron gLBK/ml and 3.0 +/- 0.2 micron gLBK/ml respectively, p less than 0.05). Furthermore, KPF values were also low (p less than 0.05) in MH (1.6 +/- 0.3) when compared with similar values obtained in EH and NC (3.0 +/- 0.2 and 2.8 +/- 0.1, respectively). Adequate control of blood pressure levels for 90 days in MH group caused no significant alterations in plasma levels of kininogen and KPF. It is suggested that diminished kininogen levels as well as a decrease in a kinin potentiation KPF that is generated in plasma by trypsin may be involved in the pathogenesis of human malignant hypertension.

Blood Pressure↗

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[ABO incompatibility in organ transplant. Report of case and review of the literature].

One case of a multiple organs donor that resulted in kidney and heart transplants with inadvertent ABO incompatibility is described. The renal recipients showed the presence of high anti A antibodies titers. The reviewed publications have revealed that the preparation of the receptor with plasmapheresis and splenectomy, before the transplantation may prevent the hyperacute rejection on ABO incompatible organs allografts. In emergency situations, liver transplantation is accepted with ABO incompatible donor without previous treatment.

ABO Blood-Group System↗

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[Estimation of the number of potential organ donors in the city of São Paulo].

BACKGROUND: There is a concept that the small number of transplants is due to the shortage of donors or the refusal of the next of kin to make to donation. In order to evaluate the potential number of donors in São Paulo the autopsies performed at the Forensic Medical Institute (IML) were studied during 1990 and 1991. MATERIAL AND METHOD: The autopsies carried out during 1990 and 1991 were studied. During the same period we also analysed the reports of possible donors received by the organ searching team of the Escola Paulista de Medicina (EPM). RESULTS: During 1990 and 1991, 11601 and 11607 autopsies were respectively carried out (32 autopsies/day). The analysis of 500 autopsies during 10/90 and of 1039 during 05/91 showed that 27% had a traumatic brain injury (TBI) as the sole cause of death and 70% were cared for in a hospital. From 01/90 to 12/91 the organ searching team of the EPM received reports of 296 possible donors. Of the 296 reports, 219 families were contacted and 59% authorized the donation. CONCLUSION: Considering the number of deaths exclusively caused by TBI that passed through any hospital and the rate of donations obtained by our team, there is a number of potential donors in São Paulo sufficient to saturate the working capacity of all teams, if the seeking system is efficient.

Adolescent↗

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[Optimization of the use of cyclosporin in renal transplantation].

Strategies to optimize the use of cyclosporin A (CSA) in renal transplant were analysed retrospectively. Based on the incidence of acute rejection during the first 15 days of transplant, oral dosing achieved adequate immunosuppression earlier than constant intravenous infusion of CSA. The lack of CSA blood monitoring and the use of different steroid doses in this period could be responsible for these conflicting results. The differential diagnosis between acute rejection (AR) and CSA nephrotoxicity (NX) during the first year of transplant was made based on clinical findings, CSA levels and histological evaluation. Therapeutic CSA concentration range between 200 and 400 ng/mL, using radioimmunoassay with polyclonal antibodies, and between 100 and 250 ng/mL, using specific monoclonal antibodies, were found. A correlation of r = 0.82 between these two methods were obtained in 122 simultaneous dosages. Histological abnormalities found in biopsies from patients with AR were not different from those obtained from patients with NX, before and after 90 days of transplant. The conclusion was drawn that the therapeutic CSA monitoring associated with histological evaluation can reduce the incidence of renal dysfunction and promote a long-term and stable graft survival.

Cyclosporine↗

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[Renal artery aneurysm].

Patients with haematuria should be submitted to deep investigative protocol, for a more accurate diagnosis. Thus, we report a case of macroscopic haematuria and the set of complementary examinations that led to the diagnosis of this rare pathological entity. The classification (etiological or morphological), diagnosis, surgical intervention indications and therefore the treatment (embolization or surgical) were pointed out. Accurate diagnosis is obtained through Renal Digitalis Arteriography after the morphological assessment of the normal urinary tract (UGE and renal US) and the evidence of unilateral bleeding (cystoscopy).

Adult↗

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[Sensitivity profile of 147 strains of S. aureus isolated from patients in continuous ambulatory peritoneal dialysis].

Staphylococcus aureus is reported to be the most common organism to cause peritonitis in continuous ambulatorial peritoneal dialysis (CAPD). Staphylococcal nasal carriage is frequently seen in these patients. The authors studied the sensitivity of S. aureus strains isolated from CAPD patients and some close family contacts. Susceptibility of 147 strains of S. aureus to 23 antimicrobial agents were determined based on 348 samples. All strains tested were susceptible to vancomycin. Penicillin resistance was found in nearly all strains. Resistance to rifampicin was seen in just 5% of the strains. A high rate of resistance to ampicillin, amoxicillin, tetracycline, and also to cotrimoxazole, gentamicin, and tobramycin were observed. Cephalosporins and some aminoglycosides (amicacin and netilmicin) have a good in vitro bactericidal activity anti-S. aureus. Knowledge of the susceptibility profile of bacteria frequently isolated at a given hospital ward will provide the basis for a more effective empirical antibiotic treatment in such ward.

Humans↗

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[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↗

PubMedDate not supplied