Duplex guided dialysis access interventions can be performed safely in the office setting: techniques and early results.

OBJECTIVE: To determine the utility of duplex guided angioplasty for hemodialysis access maturation and maintenance. DESIGN/MATERIALS/METHODS: Between January 2008 and June 2009, 223 office-based duplex-guided hemodialysis access angioplasty procedures were performed in 125 patients. Two hundred eight of the accesses were autogenous. The most common indication for intervention was maturation failure (104 cases). Other indications included pulsatility, low access flow, decreased flow and infiltration. Procedures were performed in the office using topical and local anesthesia. Volume flow (VF) was recorded prior to introducer insertion (baseline) and post intervention. RESULTS: Technical success was achieved in 219 cases (98.2%). Minor complications occurred in 21 cases (9.4%). Immature autogenous AV accesses had a median baseline VF of 210 mL/min. Median final VF for these autogenous AV accesses was 485 mL/min. The VF increased by 131%. Dysfunctional autogenous AV accesses and nonautogenous AV accesses had a median baseline VF of 472 mL/min. Median final VF was 950 mL/min. The VF increased by 101%. CONCLUSIONS: Duplex guided dialysis access angioplasty can be performed safely and effectively in the office setting. It offers the advantage of treating the patient without radiation or contrast as well as the assessment of the hemodynamic effects of intervention.

[Study of hypertensive very elderly population admitted to a regional hospital]. / Estudio de la población hipertensa muy anciana ingresada en un hospital comarcal.

OBJECTIVES: To analyse the characteristics of the hospitalized very elderly people (age equal or superior to 80 years) with hypertension (HT). PATIENTS AND METHODS: Prospective study including the patients with HT who need hospitalization in our medical institution. Data collected were: demographic, clinical parameters, factors of vascular risk, hygienic-dietetic strategies, pharmacological treatment, cause of hospitalization, and biochemical determinations. RESULTS: There were included 92 very elderly patients (71 women); they represent 14 % of total hospitalized people. Two third parts had not realized academic studies, being 60 % of rural origin. Almost the half (41 %) was diabetic, and 27 % had dyslipidemia. Overall 62 % had 4 or more factors of cardiovascular risk. The hospitalization was related to the HT in the half of the cases, and 61 % had already previously some cardiovascular event. The lifestyle modifications more frequent were: not to smoke (95 %), no alcohol (81 %), and diet without salt (75 %). Diuretics were the most frequent anti-hypertensive agent used. The global mortality was two times superior to the hypertensive population < 80 years in the same period. CONCLUSIONS: The very elderly hypertensive patients of our study are fundamentally women, of rural origin and without academic studies. The above mentioned hospitalization is attributable directly to the HT in the half of the cases. They are a population of high cardiovascular risk, with previous events cardiac and cerebral-vascular. They confess to realize frequently the hygienic-dietetic strategies recommended. The diuretics are the anti-hypertensive agents most used for the HT. Since it was of waiting for the mortality in this group it is high.

[Cognitive slowing in asymptomatic individuals who are seropositive for human immunodeficiency virus type 1]. / Enlentecimiento cognitivo en sujetos seropositivos asintomáticos al virus de inmunodeficiencia humana tipo 1.

INTRODUCTION: Reaction time (RT) is thought to be the most suitable measure to detect cognitive deficits in neurologically asymptomatic human immunodeficiency virus type I (HIV-1) infected individual since cognitive slowing is the earliest signal of cognitive-motor disorder related to HIV-1 infection. There is evidence suggesting that the greater the degree of central processing demands required by a task, the more likely that it will be sensitive to the effect of HIV-1 infection. Such statement suggests that the RT deficits exhibited by HIV-1 infected individuals at initial stages could be caused by the slowing of central information processing mechanisms. AIM: To assess the relationships between demands of central information processing and RT in HIV-1 seropositive individuals. SUBJECTS AND METHODS: 50 neurologically asymptomatic HIV-1 individuals were compared with 34 seronegative controls on four discriminative RT tasks of different levels of central processing demands except by the motor response requirements. RESULTS: Seropositive group was slower in RT and performed worse on the higher demanding task. On the lesser demanding tasks no differences in RT nor in accuracy were observed. For the task demanding sensory coding efforts seropositive individual were slower but achieved the same level of accuracy. CONCLUSIONS: Even when these results point to that RT slowing in HIV-1 asymptomatic individuals emerged with the increase in cognitive demands, the fact that RT slowing without accuracy declining can also appear in some tasks demanding sensory processing, preclude ruling out a peripheral deficit as the locus of the RT slowing in these subjects.

Primary mesenteric liposarcoma of jejunum: presentation like a cystic mass.

This report describes a rare case of intra-abdominal liposarcoma in a 67-year-old woman. The patient presented at Internal Medicine Unit in May 2004, to study of thyroid pathology. The clinical examination was normal, except for the finding of an asymptomatic mass in the abdomen. The patient knew the existence of tumor since time ago, but she confesses to have only occasional discomfort. In the abdominal ultrasonography a solid mass with large cystic component was detected but relation with other organs was not clear. Computed tomography revealed the presence of a mass with solid and cystic components, in contact with small intestine in the left side of abdomen. A complete resection of tumor arising from mesentery of jejunum was performed successfully with end to end anastomosis. The gross specimen was lobulated and measured 8.5 x 7.5 cm. The histopathology analysis showed proliferating lipoblasts with irregular nuclei on a myxoid background, with plexiform vascular pattern, characteristics belongs to myxoid type liposarcoma. The patient is alive and well one year after removal of tumor. The uncommon site and the exceptional cystic morphology of tumor are discussed, and so it must be included the primary mesenteric liposarcoma in the differential diagnosis of intra-abdominal tumors with cystic large areas.

Lipid peroxidation and aluminium effects on the cholinergic system in nerve terminals.

In the present study, we analyzed how aluminium and oxidative stress induced by ascorbate/Fe(2+) affect the mechanisms related with the cholinergic system in a crude synaptosomal fraction isolated from rat brain. [(3)H]Choline uptake, [(3)H]acetylcholine release, membrane potential and Na(+)/K(+)-ATPase activity were determined in the presence or in the absence of aluminium in control conditions and in the presence of ascorbate (0.8 mM)/Fe(2+) (2.5 micro M). The extent of lipid peroxidation was measured by quantifying thiobarbituric acid reactive substances (TBARS). Under oxidizing conditions aluminium increased the formation of TBARS by about 30%, but was without effect when the synaptosomal preparation was incubated in the absence of oxidants. Additionally, aluminium potentiated the inhibition of the high-affinity [(3)H]choline uptake observed following lipid peroxidation and had the same effect on the Na(+)/K(+)-ATPase activity. [(3)H]Acetylcholine release induced by 4-aminopyridine, and membrane potential were not significantly affected under oxidizing conditions, either in the absence or in the presence of aluminium. We can conclude that aluminium, by potentiating lipid peroxidation, affects the uptake of choline in nerve endings. This effect, occurring during brain oxidative injury, might contribute to the cholinergic dysfunction and neuronal cell degeneration known to occur in Alzheimer's disease.

Lipid peroxidation facilitates aluminum accumulation in rat brain synaptosomes.

Aluminum, a metal without redox capacity in biological systems, potentiates the stimulation of lipid peroxidation induced by Fe2+. In this study the interactions between aluminum and oxidative stress induced by ascorbate (0.8 mM)/Fe2+ (2.5 microM) in synaptosomes isolated from rat brain were investigated. The amount of Al3+ in aluminum solutions was calculated according to the Zatta protocol (Zatta et al., 1995), and lipid peroxidation was measured by quantifying thiobarbituric acid-reactive substances (TBARS). In synaptosomes under oxidizing conditions the addition of 11 microM Al3+ increased the formation of TBARS. In synaptosomes incubated in the absence of oxidants no significant differences were found between the levels of lipid peroxidation of synaptosomes incubated in the absence or in the presence of aluminum. In the presence of an oxidizing system aluminum accumulation was significantly increased twofold in synaptosomes. Data suggest that the facilitation of aluminum accumulation during brain oxidative injury might contribute to aluminum neurotoxicity and neuronal cell degeneration.

[Effect of adenosine on P50 and its relation to 2,3-diphosphoglycerate]. / Efecto de la adenosina sobre la P50 y su relación con el 2,3-difosfoglicerato.

The effects of increasing doses of intravenous adenosine upon the dissociation haemoglobin curve (DHC) and its relation to the intraerythrocytic level of 2,3-diphosphoglyceric acid (2,3-DPG), were studied in 17 anesthetized dogs. The DHC moved significantly to the left in all dogs except at the dose of 120 micrograms/kg/min which induces a displacement to the right. These changes in the DHC were parallel to the intraerythrocytic levels of 2,3-DPG. We conclude that adenosine modifies the DHC, shifting it generally to the left, and that this effect seems to be related to a change in the intraerythrocytic level of 2,3-DPG.