Collagen type IV-related nephropathies in Portugal: pathogenic COL4A3 and COL4A4 mutations and clinical characterization of 25 families.

Pathogenic mutations in genes COL4A3/COL4A4 are responsible for autosomal Alport syndrome (AS) and thin basement membrane nephropathy (TBMN). We used Sanger sequencing to analyze all exons and splice site regions of COL4A3/COL4A4, in 40 unrelated Portuguese probands with clinical suspicion of AS/TBMN. To assess genotype-phenotype correlations, we compared clinically relevant phenotypes/outcomes between homozygous/compound heterozygous and apparently heterozygous patients. Seventeen novel and four reportedly pathogenic COL4A3/COL4A4 mutations were identified in 62.5% (25/40) of the probands. Regardless of the mutated gene, all patients with ARAS manifested chronic renal failure (CRF) and hearing loss, whereas a minority of the apparently heterozygous patients had CRF or extrarenal symptoms. CRF was diagnosed at a significantly younger age in patients with ARAS. In our families, the occurrence of COL4A3/COL4A4 mutations was higher, while the prevalence of XLAS was lower than expected. Overall, a pathogenic COL4A3/COL4A4/COL4A5 mutation was identified in >50% of patients with fewer than three of the standard diagnostic criteria of AS. With such a population background, simultaneous next-generation sequencing of all three genes may be recommended as the most expedite approach to diagnose collagen IV-related glomerular basement membrane nephropathies.

Collagen type IV-related nephropathies in Portugal: pathogenic COL4A5 mutations and clinical characterization of 22 families.

Alport syndrome (AS) is caused by pathogenic mutations in the genes encoding α3, α4 or α5 chains of collagen IV (COL4A3/COL4A4/COL4A5), resulting in hematuria, chronic renal failure (CRF), sensorineural hearing loss (SNHL) and ocular abnormalities. Mutations in the X-linked COL4A5 gene have been identified in 85% of the families (XLAS). In this study, 22 of 60 probands (37%) of unrelated Portuguese families, with clinical diagnosis of AS and no evidence of autosomal inheritance, had pathogenic COL4A5 mutations detected by Sanger sequencing and/or multiplex-ligation probe amplification, of which 12 (57%) are novel. Males had more severe and earlier renal and extrarenal complications, but microscopic hematuria was a constant finding irrespective of gender. Nonsense and splice site mutations, as well as small and large deletions, were associated with younger age of onset of SNHL in males, and with higher risk of CRF and SNHL in females. Pathogenic COL4A3 or COL4A4 mutations were subsequently identified in more than half of the families without a pathogenic mutation in COL4A5. The lower than expected prevalence of XLAS in Portuguese families warrants the use of next-generation sequencing for simultaneous COL4A3/COL4A4/COL4A5 analysis, as first-tier approach to the genetic diagnosis of collagen type IV-related nephropathies.

Combined effects of acute exercise and hypoxia on memory.

No previous studies have evaluated the potential combined effects of acute exercise and acute hypoxia exposure on memory function, which was the purpose of this study. Twenty-five participants (Mage = 21.2 years) completed two laboratory visits in a counterbalanced order, involving 1) acute exercise (a 20-min bout of moderate-intensity exercise) and then 30 min of exposure to hypoxia (FIO2 = 0.12), and 2) exposure to hypoxia alone (FIO2 = 0.12) for 30 min. Following this, participants completed a cued-recall and memory interference task (AB/AC paradigm), assessing cued-recall memory (recall 1 and recall 2) and memory interference (proactive and retroactive interference). For cued-recall memory, we observed a significant main effect for condition, with Exercise + Hypoxia condition having significantly greater cued-recall performance than Hypoxia alone. Memory interference did not differ as a function of the experimental condition. This experiment demonstrates that engaging in an acute bout of exercise prior to acute hypoxia exposure had an additive effect in enhancing cued-recall memory performance.

Cardiac surgery in infective endocarditis and predictors of in-hospital mortality. / Cirurgia cardíaca na endocardite infeciosa e preditores da mortalidade intra­hospitalar.

INTRODUCTION: Infective endocarditis (IE) is a serious disease with significant in-hospital mortality (15-30%) despite advances in medical and surgical therapy. AIMS: To perform a clinical characterization of patients undergoing cardiac surgery for IE and to identify factors that predict in-hospital mortality. METHODS: We retrospectively analyzed 145 patients with IE admitted between January 2006 and October 2017. RESULTS: The median age was 72 years. IE was acquired mainly in the community (69%), and involved the native aortic valve in 54% of patients, biological prosthetic valves in 22.1% and mechanical valves in 10.3%. Staphylococcus spp. (31.0%) were the most frequent etiological agents. Cardiac surgery was emergent in 29 patients, urgent in 108, and elective in eight. The main indications were heart failure (57.9%), large vegetations (20%), systemic embolism (17.2%) and valve dysfunction (15.2%). Overall, biological valves were implanted in 62.1% of patients and mechanical valves in 37.2%. A total of 19 patients (13.1%) died. Predictors of mortality were preoperative atrial fibrillation and lower left ventricular ejection fraction, postoperative severe valve regurgitation associated with cardiogenic shock, sepsis, septic shock associated with cardiogenic shock, cardiac tamponade, need for renal replacement therapy and, although without statistical significance, emergent surgery. CONCLUSIONS: There is a need for better indicators to enable early identification of surgical candidates for IE, implementation of a heart team, and better surgical strategies, including more rapid intervention, more specific postoperative care, and optimal antibiotic therapy.

Draft Genome Sequence of Streptomyces sp. Strain C8S0, Isolated from a Highly Oligotrophic Sediment.

Streptomyces spp. are prolific bacteria producing bioactive metabolites. We present the draft genome sequence of Streptomyces sp. strain C8S0, which was isolated from a highly oligotrophic sediment from the Cuatro Cienegas Basin (Mexico). The whole-genome assembly comprised 6,898,902 bp, with 18 biosynthetic gene clusters, including those for nonconventional terpenes, nonribosomal peptides, and polyketides.

Connective tissue biomatrix: its isolation and utilization for long-term cultures of normal rat hepatocytes.

A new procedure is introduced for the isolation of connective tissue fibers, called biomatrix, containing a significant portion of the extracellular matrix (basement membrane components and components of the ground substance). Biomatrix isolated from normal rat liver contains >90% of the tissue's collagens and all of the known collagen types, including types I and III and basement membrane collagens. The purified collagenous fibers are associated with noncollagenous acidic proteins (including fibronectins and possibly small amounts of glycosaminoglycans). Procedures are also described for preparing tissue culture substrates with these fibers by either smearing tissue culture dishes with frozen sections or by shredding the biomatrix into small fibrils with a homogenizer. The biomatrix as a substrate has a remarkable ability to sustain normal rat hepatocytes long-term in culture. The hepatocytes, which on tissue culture plastic or on type I collagen gels do not survive more than a few weeks, have been maintained for more than 5 mo in vitro when cultured on biomatrix. These cells cultured on rat liver biomatrix show increased attachment and survival efficiencies, long-term survival (months) and retention of some hepatocyte-specific functions.

Angiotensin-converting enzyme inhibitors after renal transplantation.

The blockade of the renin-angiotensin-aldosterone system may limit the progression of graft dysfunction in patients receiving kidney transplantations. We retrospectively evaluated the safety and efficacy of angiotensin-converting enzyme inhibitors (ACEI) in renal allograft recipients. Fifty-seven cadaveric kidney recipients (58% of recipients), were prescribed an ACEI (lisinopril). The indications for ACEI were isolated proteinuria (1 patient), erythrocytosis (6 patients), and arterial hypertension (50 patients). The choice of an ACEI for blood pressure control was due to presence of left ventricular hypertrophy (2 patients), mild proteinuria (4 patients), and high hemoglobin (4 patients). There was a significant reduction in the mean arterial pressure after 1 month (P = .0004) and 1 year (P = .0002) of therapy. Overall, the estimated glomerular filtrate rate (eGFR), calculated using the Cockcroft-Gault equation, remained unchanged. Among patients who had serum creatinine values above 2.0 mg/dL at the beginning of ACEI therapy, there was a significant rise in eGFR from 39.3 +/- 13.2 to 44.1 +/- 16.8 mL/min after 6 months (P = .01), and 43.3 +/- 17.3 mL/min after 1 year (P = .04). In patients with erythrocytosis, the hemoglobin showed a significant and sustained reduction after 1 month (P = .004) and 1 year (P = .001). Six patients suspended ACEI owing to adverse events: cough (n = 4), worsening of graft function (n = 1), and hypotension (n = 1). Six patients required erythropoiesis-stimulating agents. No patient suspended treatment owing to hyperkalemia. In conclusion, ACEI were well tolerated, safe, and effective antihypertensive agents in kidney graft recipients. They seemed to have some beneficial effect in preserving GFR in patients with worse graft function.

Hypothesized mechanisms through which acute exercise influences episodic memory.

Emerging research demonstrates that exercise is favorably associated with several cognitive outcomes, including episodic memory function. The majority of the mechanistic work describing the underlying mechanisms of this effect has focused on chronic exercise engagement. Such mechanisms include, e.g., chronic exercise-induced neurogenesis, gliogenesis, angiogenesis, cerebral circulation, and growth factor production. Less research has examined the mechanisms through which acute (vs. chronic) exercise subserves episodic memory function. The purpose of this review is to discuss these potential underlying mechanisms, which include, e.g., acute exercise-induced (via several pathways, such as vagus nerve and muscle spindle stimulation) alterations in neurotransmitters, synaptic tagging/capturing, associativity, and psychological attention.

Increased use of catheters as vascular access: is it justified by patients' clinical conditions?

BACKGROUND: Over the last years many technical improvements have been made in hemodialysis treatment. Vascular access (VA) still remains an important problem. Although the use of indwelling vascular catheters is discouraged, in Europe there is an increasing use of them. The K/DOQI Guidelines recommend a native arteriovenous fistula (AVF) as VA of choice. As reported by DOPPS, there is considerable geographic variation in the distribution of type of VA used amongst hemodialysis patients. The aim of this study was to evaluate the time patients in four European countries have to wait before undergoing their first surgery for VA (AVF or graft). METHODS: All incident patients admitted to HD clinics located in Turkey, Italy, the UK and Portugal of the European FME clinics network between October 1, 2002 and September 30, 2004 were considered. Data were gained from the Clinical Database EuCliD. RESULTS: 2,152 patients (males 55.9%, mean age 62.5+/-15.7 years, diabetics 27%) were selected. Italy and Portugal had a higher proportion of elderly patients. At time of admission, the proportion of patients starting dialysis with AVF ranged between 23% and 60% from Turkey to Italy respectively. Patients with an indwelling catheter at admission are expected to undergo VA surgery as soon as possible. After 3 months of follow-up, about 75% of all patients had undergone surgery, however in the UK less than 50% of the patients had had a VA procedure. Overall, males have significantly higher probability of undergoing surgery, whilst elderly patients have a lower probability (27% and 14% respectively). CONCLUSION: Significant differences exist between countries in the time interval from referral to creation of VA. Health care system related problems seem to be the major reason to explain such differences. Patients in the UK have longer waiting times than the other countries studied.

Percutaneous transluminal renal angioplasty in management of atherosclerotic renovascular hypertension: results in 100 patients.

The long-term effect of percutaneous transluminal renal angioplasty (PTRA) on blood pressure and renal function was assessed in 100 consecutive patients with atherosclerotic renovascular hypertension. Technical success rates (complete plus partial) of a first PTRA averaged 76.2%, 74.1%, and 67.7% for the unilateral (n = 42), bilateral (n = 27), and solitary (n = 31) groups, respectively. Of the technical successes, 59% (43/73) experienced sustained blood pressure benefit (mostly amelioration) during a mean follow-up period of 29 months. Rates of blood pressure benefit were similar in the three groups. Ostial lesions comprised the majority of blood pressure benefit failures. Repeat angioplasty in 14 patients resulted in a 71% technical success rate and a 50% blood pressure benefit rate during a mean follow-up period of 22 months. Long-term stability of mean serum creatinine level was observed after technically successful angioplasty in all three groups. Acute renal insufficiency, which was reversible in all but one patient, complicated 26% of the procedures. Mechanical complications occurred in 14% (20/145) of the arteries acted on; surgical intervention was required in five patients. The mortality rate was 2%. These results suggest that angioplasty is effective in both the long-term management of renovascular hypertension and the preservation of renal function in a large fraction of patients with atherosclerotic renovascular hypertension.

Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass.

BACKGROUND: With the evolution of anesthesia and surgical procedures, fast track extubation has gained an increased interest, mainly based on the possibility of reducing health costs seemingly without compromising patient care. AIM: To compare two groups of patients submitted to a non-fast track extubation and a fast track extubation protocol after coronary artery bypass graft surgery with cardiopulmonary bypass, regarding their times of ventilation and intubation and their complication rates in the postoperative period. METHODS: During the year of 1998, 323 sequential patients scheduled for isolated coronary artery bypass graft surgery with cardiopulmonary bypass were enrolled in the study. Fifty-nine patients were excluded due to preoperative use of emergent mechanical and/or inotropic hemodynamic support, low body mass index (< or =18-20 kg/m(2)), reoperations for acute surgical complications, off-pump coronary artery bypass graft surgery, severe respiratory disease, recent myocardial infarction (< or =7 days) and absence of relevant data. Previous myocardial infarction (> or =7 days), prophylactic intraaortic balloon pump and use of postoperative vasoactive drugs were not exclusion criteria. We compared 76 patients sequentially submitted to anesthesia by one of the authors with a fast track extubation protocol and 188 patients sequentially submitted to anesthesia by others in the same period and using a conventional anesthetic protocol. RESULTS: Demographic data, previous medical and cardiac history, preoperative medication and operative data were all similar between the two groups. The mean ventilation and intubation times were significantly shorter in the fast track extubation group than in the non-fast track extubation patients (30 min vs. 7 h and 50 min vs. 8 h, respectively). Forty-two percent of patients in the fast track extubation group were extubated on arrival at the intensive care unit. Morbidity and mortality were similar in both groups. CONCLUSIONS: The study shows that a very fast track extubation protocol may be safely implemented in patients submitted to coronary artery bypass graft surgery with cardiopulmonary bypass.

Gliomatosis cerebri: findings with computed tomography and magnetic resonance imaging.

Gliomatosis cerebri (GC), is a rare neoplastic disease (less than 150 cases reported in the literature) with a diffuse, widespread proliferation of neoplastic glial cells in the brain, generally affecting both hemispheres and involving the gray and white matter [1-3]. Less commonly, the cerebellum, the brain stem and the medulla can be affected. Histologic evaluation reveals neoplastic astrocytes with varying levels of differentiation. Perineuronal and perivascular spread of tumor infiltration is observed. Demyelination can be found in the affected areas. A well-preserved underlying neuroanatomic architecture is considered characteristic [2]. Clinical signs vary and are non-specific, including changes in the mental state and headaches, followed by focal motor deficits and convulsive episodes [4]. The prognosis is poor, ranging from weeks to some years after the manifestation of the symptoms. Steroids may be useful in the short term, but chemotherapy is of little value and radiotherapy of questionable benefit. The literature was reviewed and the radiological pattern of three new cases of GC is reported. In two cases the diagnosis was achieved ante-mortem.

Diffuse axonal injury with or without an evacuated intracranial hematoma in head injured patients. Are they different lesions?

The general classification of head injury proposed by Marshall et al., based on admission CT scan findings, might mask a group of patients who have Diffuse Brain Injury (DI) in addition to intracranial haematomas. The aim of this study was to assess possible differences in outcome with respect to the level of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) between a group of patients with DI: III-IV (Marshall's classification) after the evacuation of an intracranial haematoma (group A) and another group with DI: III-IV in the absence of a mass lesion (group B). We prospectively studied 129 patients with isolated and closed severe head injury (GCS < 9). In group A (n = 61), the median percentage of hours with ICP > 20 mmHg and CPP < 70 mmHg was 42.8 and 18, respectively and 17 (28%) survived with GOS 4-5. In group B (n = 68), median values of 20 and 5.5 hours were obtained for ICP > 20 and CPP < 70 respectively, whilst 39 (57.3%) survived with favourable outcomes. When we analysed the effects of the DI: III-IV in both groups of patients, we found that the differences in percentage of time with ICP > 20 and CPP < 70 were statistically significant (p < 0.01) and patients in group A had a higher morbidity and mortality (p < 0.05). This study has demonstrated that the levels of ICP, morbidity and mortality in patients with DI: III-IV and an evacuated mass lesion were higher than in patients with DI: III-IV without a mass lesion.

Vascular access for dialysis in the elderly.

Although not taken in consideration as a special issue in current guidelines, vascular access in the elderly deserve specific recommendations as they are quickly enlarging as a group, with particularly high vascular access morbidity and failure rate. Hemodynamic and endothelial mechanisms of access failure are reviewed and tentative strategies to increase the prevalence of durable native arteriovenous fistulas are analysed.

[DNA and proteins in the liver of rats fed with corn: the importance of expressing the concentration of liver proteins in relation to DNA]. / DNA y proteínas en el hígado de ratas alimentadas con maíz: importancia de expresar la concentración proteínas hepáticas en función del DNA.

Variations in liver DNA and protein content were studied in rats fed common corn (diet I) and in another group of rats fed a diet made of corn starch ("maicena"), "chuño" (dried potato), sugar and fat (diet II). The results were compared with those from a control group fed a balanced diet with adequate protein. Diets were administered after weaning, for a period of 90 days. Animals on diets I and II showed an increase in the DNA concentrations per g of liver. Liver protein concentration was expressed in three forms: as mg of protein per g of liver, mg of protein per mg of DNA and mg of protein in the total liver weight. Animals raised on diet II had a decrease in liver protein, which was evident regardless of the way of expressing the results. On the other hand, in rats raised on corn (diet I), the results expressed as mg of protein per g of liver did not show a decrease in liver proteins, while the other two ways of expressing the results demonstrated a decrease in liver protein. It seems that the most trustworthy way to express liver protein concentration is as mg of protein per mg of DNA. The importance of expressing the results of liver protein concentrations as a function of DNA is emphasized and its usefulness demonstrated and discussed.

[Urea cycle enzymes in rats fed with corn]. / Enzimas del ciclo de la urea en ratas alimentadas con maíz.

Activities of five urea cycle enzymes, carbamyl phosphate synthetase, ornithine transcarbamylase, argininosuccinate synthetase, argininosuccinase and arginase, were measured in liver of rats fed two types of diet: diet I: raw common corn and, diet II: made of a mixture of corn starch ("maicena"), "chuño (dried potato), sugar and fat. The activities obtained were compared with those of a group of control rats fed a balanced diet with an adequate protein content. Diets were administered after weaning, through an experimental period of 90 days, and enzymatic activities were measured at regular intervals during this time. Animals raised on diet I as well as those raised on diet II, showed low activity of the five urea cycle enzymes, but the decrease of enzymatic activity was more pronounced and appeared earlier in animals raised on diet II. Carbamyl phosphate synthetase and argininosuccinate synthetase, the two synthetases of this cycle, decreased earlier and in a greater degree than the other three enzymes in animals raised on these two types of diet.

[Idiopathic edema, tubular metabolism of water and sodium]. / Edema idiopático, metabolismo tubular de água e sódio.

PURPOSE: To look for intrinsic changes in renal tubular water and sodium metabolism in idiopathic edema (IE), independent of the underlying hormonal and vascular defects. DESIGN: Prospective controlled study in patients with edema referred to a nephrology clinic. PATIENTS: Ten female patients with IE were compared with a control group of 4 healthy women. MEASUREMENTS AND RESULTS: Patients and controls were submitted to a base-line test of water loading and lithium clearances, after 12 hours supine position, to study renal tubular handling of Na and H2O in different nephron sites and 5 h water excretion capacity. Patients were then randomized in 2 groups, both receiving standard treatment during 2 months (low-salt diet--70 to 90 mEq of Na per day, stopping diuretics and laxatives, elastic stockings). Group B received in addition carbidopa/levodopa 25/100--3 tabs/day and captopril 6.25 mg q 8 h. At the end of this 2 months period the base-line tests were repeated. We registered a good clinical response, with an average a.m. weight reduction of 2.8 kg and a decrement of the a.m. to p.m. weight gradient from 2.42 +/- 0.3 kg pre-treatment to 0.6 +/- 0.1 kg afterwards. From the several measurements obtained, only global FENa and Proximal Fraccional Reabsorption of Na were significantly different between patients and controls (0.87 +/- 0.09% vs 2.1 +/- 0.2%, p less than 0.001 and 77.4 +/- 2.9% vs 64.0 +/- 3.5%, p = 0.02 respectively), with no difference in distal Na and H2O reabsorption or water excretion capacity. Two months treatment only partially corrected global FENa, and there were no differences in the clinical and physiological effects between the 2 therapeutic groups. CONCLUSIONS: 1--In the absence of orthostatism, H2O and Na metabolism is similar between IE patients and healthy controls, only with an increased selective proximal Na reabsorption in patients. 2--Standard non-pharmacologic therapy was a clinical success, but didn't correct the physiological defect of excessive proximal sodium reabsorption. Treatment results were not improved by pharmacologic intervention.

[Hydro-electrolyte changes induced by transurethral prostatic resection]. / Alterações hidro-electrolíticas induzidas por ressecção prostática transuretral.

Transurethral resection prostatectomy (TURP) has been associated with severe hyponatremia due to massive absorption of bladder irrigation fluid (IF). TURP was performed in 41 patients using Sorbitol-Mannitol IF (Group A) and in 6 patients using distilled water (Group B). Six other patients were operated upon using surgical procedures identical in time and type of anesthesia to TURP (Group C). The three groups were studied with the same protocol that included blood collected before (time I), immediately after (time II) the procedure and 1 hour later (time III). Serum sodium decreased significantly in the 3 groups from time I to time II, an average of 3.4 mEq/l with Mannitol-Sorbitol, 2.3 mEq/l with distilled water, and 4.4 mEq/l in group C. Osmolality did not change significantly between the 3 times of collection and Osmolar Gap only increased from time I to II in the Sorbitol-Mannitol group. In conclusion, mild decrements in serum sodium with no clinical relevance are a common post-TURP finding, but should not be greater than in other similar general surgery without bladder irrigation. Hyposmolality did not constitute a problem.

[Consequences of the correction of post-transplantation hypophosphatemia on mineral metabolism]. / Consequências no metabolismo mineral da correcção da hipofosfatemia pós-transplante.

AIM: To study the effect of the correction of post-transplantation Hypophosphatemia on mineral metabolism. PATIENTS: 15 patients with renal transplants for 3 to 12 months, Serum Creatinine "177 micmol/1, were treated with oral phosphorus (P) for persistent hypophosphatemia. METHODS: 3 periods of blood and urine collection at intervals of 3 weeks. T1 under basal treatment with oral P, T2 after 3 weeks off medication with P, Ca, or P binders. T3 3 weeks after going back on oral P supplements. RESULTS: Serum P dropped from T1 to T2 (1.03 +/- 0.03 mmol/L to 0.83 +/- 0.03 mmol/L, p "0.0001), rising again in T3 to 1.06 +/- 0.03 mmol/L. From T1 to T2, PTHi decreased from 95.4 +/- 8.7 to 66.8 8.9pg/ml), osteocalcin rose from 3.8 +/- 1.2 to 16.6 +/- 2.3ng/ml (p<0.001) and 25-Vit D rose from 16.7 +/- 1.9 to 21.4 +/- 2.1 ng/l (p<0.001), with the reversal of these changes from T2 to T3 when serum P increased once again. There was a significant correlation between serum P and PTHi and serum P and 25-Vit D. There were no significant variations of the serum Ca, Alk. Phosph., ICTP and CaFE values in the three periods. CONCLUSIONS: 1-Serum P never dropped below 0.55 mmol/L, which had no clinical consequences, 2- When the P dropped, PTHi also dropped and osteocalcin and 25-Vit D rose, without any major variation in bone catabolism, 3- Correction of hypophosphatemia may delay recovery from secondary hyperparathyroidism.

[Mesenteric ischemia in hemodialysis]. / Isquemia mesentérica no hemodialisado.

Eighteen hemodialysis patients with the diagnosis of mesenteric ischemia (MI), admitted to the Renal Service in the last 5 years, were retrospectively reviewed. All patients, 10 males and 8 females, average age 66.3 +/- 8.6 years, were complaining of acute abdominal pain without other specific clinical or laboratorial findings, had their diagnosis confirmed during laparatomy, with ischemic involvement of the ileocecal/ascendant colon area in 14 cases and the small bowel in 4. Noteworthy was the high incidence of previous dialysis-induced hypotensive episodes (10/18), the presence of leukocytosis (13/18), the high average hemoglobin level of 9.4 gr/dl, and the constant finding of non-occlusive MI. Average time in-hospital was 15.4 days (2 to 30) and the mortality--88% (16 patients). The growing incidence of MI mostly of the non-occlusive type, and its grim prognosis, calls for an early diagnosis of functional ischemic colitis, and the adoption of preventive action to avoid bowel infarction.