RESUMO
Low-grade proteinuria and systolic hypertension (SHT) are risk factors for allograft failure. Both are dynamic variables and their relationship is not independent. We have simultaneously analyzed the effects of proteinuria and SHT on graft outcomes in 805 adult Kidney Transplant Recipients and impact of their changes over time. Proteinuria and systolic blood pressure (SBP) were recorded for years 1 and 3 posttransplantation. Subjects with proteinuria >1 g/day were excluded. Patients were divided into groups based on proteinuria (Absent(A) <150 mg/day or low-grade(P)150 mg-1 g/day) and blood pressure (Normotensive-SBP <140 mmHg or hypertensive-SBP ≥ 140 mmHg). Graft survival was assessed in all four groups over 10 years by multivariate analysis. At the three annual time points (Year 1, 2 and 3) hypertensive patients with proteinuria had the worst graft survival. Patients with persistent proteinuria between years 1-2 and 2-3 had the poorest graft survival with an improvement if proteinuria regressed (P-A), especially in the Hypertensive group. The impact of proteinuria was highest in persistently hypertensive patients between years 1-3. Thus both proteinuria and SHT were associated with poor graft survival and the combination of the two led to the worst outcomes. Importantly, SHT was associated with significantly worse outcomes in patients with proteinuria. Patient cohort with SHT and low-grade proteinuria represent a selective group that might benefit from intervention.
Assuntos
Transplante de Rim , Proteinúria/fisiopatologia , Pressão Sanguínea , Sobrevivência de Enxerto , Humanos , Estudos Longitudinais , Estudos RetrospectivosRESUMO
In this work, nanostructured LnxCe(1-x)O2-δ (Ln: Gd and Pr; x = 0.1 and 0.2) spheres were synthesized by microwave assisted hydrothermal homogeneous co-precipitation and their properties were characterized by synchrotron radiation XRD, X-ray absorption near-edge spectroscopy (XANES) and scanning and high-resolution electron microscopy (SEM and HRTEM). In situ XRD and XANES experiments were carried out under reducing and oxidizing conditions in order to investigate the redox behaviour of these materials. The nanostructured mixed oxide spheres were found to have a cubic crystal structure (Fm3m space group). The spheres were composed of nanoparticles with an average crystallite size of about 10 nm. The Ln(0.1)Ce(0.9)O2-δ compositions exhibited the highest specific surface area (⼠60 m(2) g(-1)). In situ XRD experiments showed an increase in lattice parameters upon reduction, which was attributed to the reduction of Ce(4+) and Pr(4+) cations to Ce(3+) and Pr(3+), which have larger radii, and to the associated increase in VO concentration. This increase in lattice parameters was considerably more pronounced for PrDC than GDC, and was explained by the considerably larger change in ionic radius for Pr upon reduction. XANES absorption experiments at the Ce and Pr L3-edge showed that the changes observed upon reduction of the Pr-containing samples resulted mostly from the formation of Pr(3+) rather than Ce(3+), and supported the previously reported proposal that Pr(3+) has a stabilizing effect on Ce(4+).
RESUMO
BACKGROUND: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. METHODS: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. RESULTS: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7% vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ± 20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10%, 11 to 49% and higher than 50% expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). CONCLUSION: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.
Assuntos
Bioprótese , Procedimentos Cirúrgicos Cardíacos/métodos , Próteses Valvulares Cardíacas , Ventrículos do Coração/cirurgia , Remodelação Ventricular , Animais , Procedimentos Cirúrgicos Cardíacos/mortalidade , Bovinos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , PericárdioRESUMO
BACKGROUND: Myocardial infarction might result in dilated left ventricle and numerous techniques have been described to restore the original left ventricle shape and identify tools for late survival assessment. The aim of this study is to compare our experience with a modified Dor procedure using a rigid prosthesis to the septal anterior ventricular exclusion procedure (SAVE) for left ventricle restoration. The EuroScore index for prediction of late follow up survival was evaluated. METHODS: We evaluated 80 patients who underwent left ventricle restoration between 1999 to 2007 and eight patients were excluded with incomplete data. A modified Dor procedure with rigid prosthesis (MD group) was performed on 53 patients and 19 underwent the septal anterior ventricular exclusion procedure (SAVE group). The patients were classified according their left ventricle shape as type I, II or III. Kaplan-Meier and Cox proportional hazard ratio regressions analysis were performed to assess survival after both techniques and expected surgical mortality using EuroScore index ranking after 12 years of follow up. RESULTS: The operative mortality was comparable in both groups ranked by EuroScore index. The groups were comparable for all clinical data, except the MD group had more patients using intra-aortic balloon pumps before surgery, (5.7 percent vs. 0; P<0.01). Kaplan Meier analysis by left ventricle shape showed comparable survival for all patients, with slightly higher survival for type I. Kaplan Meier analysis of all death showed equivalent survival curves for both techniques after 12 years of follow up (71.5 ± 12.3 vs. 46.6 ±20.5 years; P=0.08). Kaplan Meier analysis of EuroScore index for all patients showed a difference between the three ranked categories, i.e., 0 to 10 percent, 11 to 49 percent and higher than 50 percent expected surgical mortality after 12 years of follow up (70.9 ± 16.2 vs. 67.5 ± 12.7 vs. 53.0 ± 15.5; P=0.003). CONCLUSION: The MD procedure showed consistent ejection fraction improvements after long term follow up. Survival was comparable for all ventricular types and for the MD and SAVE procedures. The EuroScore index is a useful index for late survival assessment of ventricular restoration techniques.
INTRODUÇÃO: O infarto do miocárdio pode levar à dilatação do ventrículo esquerdo e numerosas técnicas têm sido descritas para remodelar o ventrículo ao seu formato original. O objetivo deste estudo foi comparar nossa experiência com a cirurgia de Dor modificada, usando prótese rígida, com a técnica de exclusão septal ventricular anterior (SAVE). Foi avaliado também o EuroScore como índice preditivo da mortalidade tardia. MÉTODOS: Avaliamos 80 pacientes que foram submetidos a remodelamento ventricular entre 1997 e 2007. Oito pacientes foram excluídos por dados incompletos. A cirurgia de Dor modificada (grupo MD) foi constituída por 53 pacientes e 19 no grupo com exclusão septal anterior (grupo SAVE). Os pacientes foram classificados de acordo com o formato do ventrículo como tipo I, II ou III. Curvas de sobrevivência de Kaplan-Meier e regressão de Cox foram utilizadas para analisar a sobrevida nas duas técnicas e a mortalidade esperada foi avaliada utilizando o EuroScore para a mortalidade operatória e após 12 anos de seguimento. RESULTADOS: A mortalidade operatória foi comparável nos dois grupos quando avaliados pelo EuroScore. Os grupos foram comparáveis quanto a dados clínicos, com exceção, que o grupo MD apresentava maior número de pacientes com balão intra-aórtico no pré-operatório (5,7 por cento vs. 0; P<0,01). A curva actuarial considerando o formato dos ventrículos foi comparável avaliando-se todos os pacientes, sendo que o formato tipo I apresentou discreta melhor sobrevida após 12 anos de seguimento. As técnicas MD e SAVE demonstraram sobrevidas semelhantes após 12 anos de seguimento (71,5 ± 12,3 vs. 46,6 ±20,5 por cento; P=0,08). Avaliando o EuroScore para todos os pacientes, observamos que nas categorias utilizadas, ou seja, 0-10 por cento; 11-49 por cento e maior que 50 por cento de mortalidade esperada, a sobrevida após 12 anos de seguimento foi diferente (70,9 ± 16,2 vs. 67,5 ± 12,7 vs. 53,0 ± 15,5; P=0,003). CONCLUSÃO: A técnica MD demonstrou melhora consistente da fração de ejeção no seguimento tardio. As duas técnicas apresentaram sobrevida comparáveis. O EuroScore pode ser um índice útil para avaliação da sobrevida tardia.
Assuntos
Animais , Bovinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bioprótese , Procedimentos Cirúrgicos Cardíacos/métodos , Próteses Valvulares Cardíacas , Ventrículos do Coração/cirurgia , Remodelação Ventricular , Procedimentos Cirúrgicos Cardíacos/mortalidade , Métodos Epidemiológicos , PericárdioRESUMO
Integrins are heterodimeric receptors composed of alpha and beta transmembrane subunits that mediate attachment of cells to the extracellular matrix and counter-ligands such as ICAM-1 on adjacent cells. beta2 integrin (CD18) associates with four different alpha (CD11) subunits to form an integrin subfamily, which has been reported to be expressed exclusively on leukocytes. However, recent studies indicate that beta2 integrin is also expressed by other types of cells. Since the gene for beta2 integrin is located in the region of human chromosome 21 associated with congenital heart defects, we postulated that it may be expressed in the developing heart. Here, we show the results from several different techniques used to test this hypothesis. PCR analyses indicated that beta2 integrin and the alphaL, alphaM, and alphaX subunits are expressed during heart development. Immunohistochemical studies in both embryonic mouse and chicken hearts, using antibodies directed against the N- or C-terminal of beta2 integrin or against its alpha subunit partners, showed that beta2 integrin, as well as the alphaL, alphaM, and alphaX subunits, are expressed by the endothelial and mesenchymal cells of the atrioventricular canal and in the epicardium and myocardium during cardiogenesis. In situ hybridization studies further confirmed the presence of beta2 integrin in these various locations in the embryonic heart. These results indicate that the beta2 integrin subfamily may have other activities in addition to leukocyte adhesion, such as modulating the migration and differentiation of cells during the morphogenesis of the cardiac valves and myocardial walls of the heart.
Assuntos
Antígenos CD18/metabolismo , Diferenciação Celular/fisiologia , Movimento Celular/fisiologia , Regulação da Expressão Gênica no Desenvolvimento/fisiologia , Morfogênese/fisiologia , Animais , Antígenos CD18/genética , Embrião de Galinha , Embrião de Mamíferos , Feminino , Coração/embriologia , Camundongos , Miocárdio/metabolismo , GravidezRESUMO
Integrins are heterodimeric receptors composed of á and â transmembrane subunits that mediate attachment of cells to the extracellular matrix and counter-ligands such as ICAM-1 on adjacent cells. â2 integrin (CD18) associates with four different á (CD11) subunits to form an integrin subfamily, which has been reported to be expressed exclusively on leukocytes. However, recent studies indicate that â2 integrin is also expressed by other types of cells. Since the gene for â2 integrin is located in the region of human chromosome 21 associated with congenital heart defects, we postulated that it may be expressed in the developing heart. Here, we show the results from several different techniques used to test this hypothesis. PCR analyses indicated that â2 integrin and the áL, áM, and áX subunits are expressed during heart development. Immunohistochemical studies in both embryonic mouse and chicken hearts, using antibodies directed against the N- or C-terminal of â2 integrin or against its á subunit partners, showed that â2 integrin, as well as the áL, áM, and áX subunits, are expressed by the endothelial and mesenchymal cells of the atrioventricular canal and in the epicardium and myocardium during cardiogenesis. In situ hybridization studies further confirmed the presence of â2 integrin in these various locations in the embryonic heart. These results indicate that the â2 integrin subfamily may have other activities in addition to leukocyte adhesion, such as modulating the migration and differentiation of cells during the morphogenesis of the cardiac valves and myocardial walls of the heart.
Assuntos
Animais , Embrião de Galinha , Feminino , Camundongos , Gravidez , /metabolismo , Diferenciação Celular/fisiologia , Movimento Celular/fisiologia , Regulação da Expressão Gênica no Desenvolvimento/fisiologia , Morfogênese/fisiologia , /genética , Embrião de Mamíferos , Coração/embriologia , Miocárdio/metabolismoRESUMO
BACKGROUND: Heart failure is a common and often fatal disease. Numerous animal models are used to study its aetiology, progression and treatment. This article aims to demonstrate two minimally invasive models of congestive heart failure in a rabbit model and a precise method to assess cardiac performance. METHODS: Fifty New Zealand White rabbits underwent cervicotomy incision and were then divided into three groups. Aortic regurgitation (AR group) was induced in 17 animals by catheter lesion through the right carotid artery, proximal aortic constriction (AC group) was created in 17 animals by metallic clip placement in the ascending aorta through a neck incision, while 16 animals served as controls (CO group). Eight weeks later, myocardial function and contractility indices were assessed by sonomicrometry crystals. Hearts were then collected for morphometric measurements and left ventricular tissues were subjected to immunohistochemical analysis of fibrosis, necrosis and apoptosis. Statistical analysis was by analysis of variance (ANOVA) with a Dunnett's post hoc test or by Kruskal-Wallis test with Dunn's post hoc test as appropriate, with significance at p< or =0.05. RESULTS: The model of aortic regurgitation indicated early stages of heart failure by volume overload with increased end-diastolic and end-systolic volumes, stroke volume, cardiac output and pressure-volume loop areas. The elastance was higher in the control group compared with that in the AC and AR groups (131.00+/-51.27 vs 88.77+/-40.11 vs 75.29+/-50.70; p=0.01). The preload recruitable stroke work was higher in the control group compared with that in the AC and AR groups (47.70+/-14.19 vs 33.87+/-7.46 vs 38.58+/-9.45; p=0.01). Aortic constriction produced left ventricular concentric hypertrophy. Fibrosis appeared in both heart failure models and was elevated by aortic constriction when compared with that in controls. Necrosis and apoptosis indices were very low in all the groups. Clinical signs of congestive heart failure were not present. CONCLUSIONS: The two heart failure models we describe were relatively simple to create and maintain, minimally invasive, accurate, inexpensive and, importantly, had a low mortality rate. These models rapidly induced deterioration of contractility indices and onset of fibrosis, the hallmarks of early myocardial dysfunction associated with heart failure. Sonomicrometry assessments were able to detect early contractility changes prior to clinical signs.
Assuntos
Modelos Animais de Doenças , Insuficiência Cardíaca/etiologia , Animais , Insuficiência da Valva Aórtica/complicações , Apoptose , Feminino , Fibrose , Insuficiência Cardíaca/patologia , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/patologia , Hemodinâmica , Masculino , Contração Miocárdica , Necrose , CoelhosRESUMO
This is the first study of comparative phylogeography involving closely related species of Neotropical bats of the family Phyllostomidae. We compared patterns of geographical variation within the five species of fruit-eating bats currently recognized in the genus Carollia using the complete mitochondrial cytochrome-b gene. Our results suggest that the combined effect of the uplift of the Andes and the Panamanian land bridge has been as important for bats as for terrestrial mammals in shaping present-day biodiversity in the New World tropics. Species in this genus can be arranged in two highly supported clades, with a deep subdivision within each that corresponds well to differences across the Andes. We found three congruent phylogeographical patterns across species in this genus. First, the closer relationship between samples from western Ecuador and those from Central America, compared with populations east of the Andes in C. brevicauda, C. castanea and C. perspicillata. Second, the likelihood of a similar timing in South America for the arrival and diversification of C. brevicauda and C. perspicillata from their Central America ancestors. Third, the expansion of C. perspicillata and C. sowelli into northwestern Central America in the relatively recent past. Using a molecular clock, with rates ranging from 2.3 to 5% per 10(6) years, diversification within Carollia would have occurred over the last 1-4.5 Myr. These estimates agree well with the last rise of the Northern Andes and the Panama isthmus.
Assuntos
Quirópteros/genética , Evolução Molecular , Geografia , Filogenia , Animais , Sequência de Bases , América Central , Primers do DNA , DNA Mitocondrial/genética , Dados de Sequência Molecular , Análise de Sequência de DNA , América do SulRESUMO
A nonimmune American acquired an infection of Plasmodium vivax Type 1 malaria in Brazil in 1994. After returning to the U.S.A., he had a primary attack followed by 3 relapses. The primary attack and first 2 relapses were treated with a standard regimen of chloroquine, followed by 14 days of primaquine (15 mg/day). Following the third relapse, the primaquine treatment was extended to 28 days. No further relapses occurred. The lack of response to primaquine by this strain may recommend it as a suitable candidate for chemotherapeutic study if it can be adapted to an animal model. Anopheles quadrimaculatus mosquitoes infected by feeding on the patient during the first relapse were used to establish the strain in Aotus and Saimiri monkeys. Monkeys supported well the development of long-lasting parasitemia. Anopheles freeborni, Anopheles stephensi, and Anopheles gambiae mosquitoes were readily infected by feeding on the monkeys and by membrane feeding on diluted blood. Monkey-to-monkey transmission was obtained via the bites of infected mosquitoes and the intravenous injection of sporozoites dissected from salivary glands. This parasite is designated as the Brazil I/CDC strain of P. vivax.
Assuntos
Antimaláricos/farmacologia , Aotidae/parasitologia , Malária Vivax/parasitologia , Plasmodium vivax/efeitos dos fármacos , Primaquina/farmacologia , Saimiri/parasitologia , Animais , Anopheles , Antimaláricos/uso terapêutico , Brasil , Cloroquina/farmacologia , Cloroquina/uso terapêutico , Modelos Animais de Doenças , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Insetos Vetores , Malária Vivax/tratamento farmacológico , Malária Vivax/transmissão , Masculino , Parasitemia/tratamento farmacológico , Parasitemia/patologia , Parasitemia/transmissão , Primaquina/uso terapêutico , RecidivaRESUMO
PIP: Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.^ieng
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Amenorreia , Aleitamento Materno , Serviços de Planejamento Familiar , Grupos Focais , Conhecimento , Lactação , Métodos , Inquéritos Nutricionais , População Urbana , América , Bolívia , Coleta de Dados , Demografia , Países em Desenvolvimento , Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , América Latina , Fenômenos Fisiológicos da Nutrição , População , Características da População , Período Pós-Parto , Reprodução , Pesquisa , América do SulRESUMO
BACKGROUND: Akathisia is a common side effect of traditional neuroleptic drugs and is associated with medication refusal and impulsive behavior. While our previous experience indicates that clozapine is effective in treating persistent akathisia, two controlled studies indicate vastly different prevalence rates of akathisia (7% vs. 40%) in patients receiving clozapine. METHOD: We used the Barnes Rating Scale for Drug-Induced Akathisia to estimate the prevalence of akathisia in patients receiving stable doses of clozapine alone (N = 29) in a state hospital. Measurements were also made of manifest psychopathology (Brief Psychiatric Rating Scale) and tardive dyskinesia (Abnormal Involuntary Movement Scale). RESULTS: Two patients (6.8%) receiving clozapine were rated as having akathisia. Only 4 (28.6%) of the 14 subjects with a history of moderate-to-severe tardive dyskinesia on traditional neuroleptic drugs continued to show current evidence of tardive dyskinesia, and in 10 patients (71.4%) there was no evidence of the syndrome (p < .002). In the 4 subjects with tardive dyskinesia there was amelioration to a milder form of the syndrome. There were no new cases of tardive dyskinesia among clozapine-treated subjects. CONCLUSION: These data support the low prevalence of akathisia in patients receiving stable doses of clozapine monotherapy. There is further support that clozapine has an ameliorating effect on tardive dyskinesia associated with traditional neuroleptic drugs. These and other data indicate the need for a controlled trial of clozapine in patients experiencing persistent and disabling akathisia on traditional neuroleptic drugs.
Assuntos
Acatisia Induzida por Medicamentos/epidemiologia , Clozapina/efeitos adversos , Adulto , Acatisia Induzida por Medicamentos/etiologia , Acatisia Induzida por Medicamentos/prevenção & controle , Antipsicóticos/efeitos adversos , Clozapina/uso terapêutico , Discinesia Induzida por Medicamentos/epidemiologia , Discinesia Induzida por Medicamentos/etiologia , Discinesia Induzida por Medicamentos/prevenção & controle , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Prevalência , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/tratamento farmacológicoRESUMO
The authors present a 10-item clinician-rated symptom rating scale for delirium. Compared to demented, schizophrenic, and normal control groups, 20 delirious subjects scored significantly higher on the scale, which quantitates multiple parameters affected by delirium. The scale can be used alone or in conjunction with an electroencephalogram and bedside cognitive tests to assess the delirious subject.
Assuntos
Delírio/psicologia , Testes Neuropsicológicos , Adulto , Idoso , Transtornos Cognitivos/psicologia , Demência/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Psicometria , Encaminhamento e Consulta , Psicologia do EsquizofrênicoRESUMO
Se presenta una revision de los diversos estados de desarrollo morfologico, fisiologico, metabolico y endocrinologico del rinon. Durante el desarrollo del embrion y en el periodo fetal temprano, las funciones excretoras, asi como de homeostasis hidrica y electrolitica, son manejadas principalmente por las membranas placentarias, actuando el amnios como reservorio de los productos de desecho. Despues que se establece la circulacion fetal se inician, tanto el flujo sanguineo renal, como la filtracion glomerular, los cuales se incrementan a medida que avanza el embarazo; los glomerulos que se desarrollan en primer termino son los de la zona yuxtamedular. El desarrollo de la funcion tubular es mas tardio que la glomerular. Este desequilibrio glomerulotubular persiste hasta el periodo de neonatal temprano. La capacidad limitada del neonato para concentrar, pero adecuada para diluir la orina, se correlaciona bastante bien con la composicion organica del neonato: expansion del volumen extracelular y relativa hipotonicidad intracelular. Se concluye que en el individuo normal, las necesidades homeostaticas del organismo se correlacionan adecuadamente con la funcion renal presente en las diversas etapas del desarrollo
Assuntos
Gravidez , Recém-Nascido , Animais , Feto , Homeostase , Testes de Função RenalRESUMO
The purpose of this study was to determine the acute effects of albumin infusion on blood volume and renal function in preterm infants with RDS and low total serum protein values. Ten infants (gestational age 28 to 36 weeks, body weight 0.88 to 2.46 kg) were given albumin 1 gm/kg (as 25% iv solution) over a ten-minute period. Within ten minutes after infusion was completed, total serum protein concentration, colloid osmotic pressure, and blood volume rose significantly while hematocrit fell from their preinfusion levels (P < 0.0005). Mean arterial blood pressure showed a smaller and less clear-cut increase (P < 0.05). Creatinine clearance rose significantly with infusion; even though preinfusion clearances correlated poorly with gestational age (r = 0.43), postinfusion clearances correlated well (r = 0.92). No significant rises in urinary flow rate Uosm/Posm, or free-water clearance were observed. These results indicate that albumin infusion acutely increases both blood volume and glomerular filtration in premature infants with RDS.
Assuntos
Albuminas/farmacologia , Volume Sanguíneo/efeitos dos fármacos , Rim/efeitos dos fármacos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Albuminas/administração & dosagem , Pressão Sanguínea , Proteínas Sanguíneas/análise , Idade Gestacional , Taxa de Filtração Glomerular/efeitos dos fármacos , Hematócrito , Humanos , Recém-Nascido , Pressão OsmóticaRESUMO
The usual treatment for recurrent syndrome of inappropriate secretion of antidiuretic hormone has been fluid restriction. Recently White and Fetner described an adult with SIADH successfully managed with lithium carbonate. Described here is a child with recurrent SIADH who was diagnosed as having an acute hyponatremic episode and who then relapsed twice in a two-month period while chronic fluid restriction was attempted. He has now been maintained on 300 mg/day of lithium carbonate and is asymptomatic with normal serum sodium concentration and urine osmolalities. Lithium appears to be effective in the management of recurrent SIADH and may allow control in a patient who cannot comply with long-term fluid restriction.
Assuntos
Lítio/uso terapêutico , Vasopressinas/deficiência , Criança , Humanos , Masculino , Doenças da Hipófise/tratamento farmacológico , Neuro-Hipófise/metabolismo , Recidiva , Síndrome , Vasopressinas/metabolismoRESUMO
A cryptococcal primary pulmonary lymph node complex has been demonstrated at autopsy or after thoracotomy in 1% of the cases of cryptococcosis. Stepwise microscopic examination of hilar lymph nodes should reveal a more frequent incidence of this rare but now well-documented complex. Nine examples of the cryptococcal complex are extant, including three herewith reported from the files of the Armed Forces Institute of Pathology. Four of these complexes developed in apparently normal persons and five in those hypersusceptible to infection because of neutropenia, diabetes, renal insufficiency, or corticosteroid therapy. The complexes in the normal persons were circumscribed granulomas and represented first-infection cryptococcosis similar to first-infection tuberculosis. There was a chronic course and a good prognosis with surgical resection. The complexes in the compromised hosts were predominantly acute diffuse pneumonias and large diffuse lesions of the lymph nodes, and were interpreted as first-infection cryptococcosis with massive spread facilitated by the compromised state. All these compromised patients died within a few weeks.