Transplant Renal Artery Stenosis Revascularization: Common Distal External Iliac Bypass.

Stenosis proximal to transplant renal artery anastomoses are complications leading to allograft dysfunction. This study was aimed to evaluate a novel surgical approach to renal allograft revascularization, taking into consideration the length of time elapsed since transplantation. We describe an arterial bypass using a polytetrafluoroethylene (PTFE) graft from the common iliac artery (proximal to the renal artery implantation) to the external iliac artery (distal to the renal artery implantation) that allows the adequate revascularization of both the transplant kidney, as well as the lower extremity. This technique provides several advantages when compared with previously described procedures to revascularize a transplanted kidney with an iliac artery stenosis proximal to the allograft implantation site. Benefits of this technique include (1) no need to repair the stenosis, (2) no need to take down and redo the arterial anastomosis, (3) no need to perform a dissection around the renal hilum of the transplanted kidney, (4) no requirement to address the anastomosis transfer, and (5) no need to perfuse the kidney with preservation fluid at the time of repair and/or (6) avoidance of potential injury to the renal parenchyma and/or hilum during dissections. Adequate perfusion of the organ, as well as of the lower extremity was verified by serial Doppler duplex ultrasound evaluations. Hence, we describe a novel revascularization technique in instances of kidney transplant and lower extremity ischemia.

Angiotensin II type 2 receptor agonist, compound 21, prevents tubular epithelial cell damage caused by renal ischemia.

During ischemic acute kidney injury (AKI), loss of cytoskeletal integrity and disruption of intercellular junctions are rapid events in response to ATP depletion. Angiotensin II type 2 receptor (AT2R) is overexpressed in injury situations and its stimulation by angiotensin II (AngII) is related to beneficial renal effects. Its role on ischemic AKI has not been deeply studied. The aim of the present study was to investigate whether pretreatment with the AT2R agonist, C21, prevents ischemic renal epithelial cell injury. Studies in a model of 40 min of renal ischemia followed by 24 h of reperfusion (IR) in rats demonstrated that C21 pretreatment attenuated renal dysfunction and induced better preservation of tubular architecture. In addition, we studied the expression of Rho GTPases, RhoA and Cdc42, since they are key proteins in the regulation of the actin cytoskeleton and the stability of epithelial intercellular junctions. IR downregulated RhoA and Cdc42 abundance in rat kidneys. C21 pretreatment prevented RhoA reduction and increased Cdc42 abundance compared to controls. We also used an in vitro model of ATP depletion in MDCK cells grown on filter support. Using immunofluorescence we observed that in MDCK cells, C21 pretreatment prevented the ATP depletion-induced reduction of actin in brush border microvilli and in stress fibers. Moreover, C21 prevented membrane E-cadherin reduction, and RhoA and Cdc42 downregulation. The present study describes for the first time a renoprotective effect of the AT2R agonist, C21, against AKI, and provides evidence supporting that stimulation of AT2R triggers cytoprotective mechanisms against an ischemic event.

Aeroallergen sensitization in wheezing children from rosario, Argentina.

BACKGROUND: Wheezing is a highly frequent symptom in infants and children. Its major causes are respiratory infections and bronchial asthma. In this context, allergen sensitization plays an important role, and it can be detected by a skin prick test, a safe and effective technique that can be easily performed on any age-group. To assess the prevalence of aeroallergen sensitization in a pediatric population with recurrent episodes of wheezing. MATERIALS AND METHODS: Cross-sectional study that evaluated 100 patients, 50 (50%) girls and 50 (50%) boys, from 6 months to 10 years. These children had consulted frequently at the Allergy and Immunology Division of the Eva Perón School Hospital due to recurrent episodes of wheezing. Skin prick test were performed on all of them and also on 20 healthy children. RESULTS: Overall, 58% of the patients presented sensitization to dust mite, 13% to pollen, 9% to epithelium, 8% to fungi, 6% to cockroach, and 1% to soybean hull. Overall, 60% of the patients were positive to at least one of the extracts, and we observed a significant and gradual increase in the frequency of sensitization in older age-groups (P < 0.005). This increase persisted when analyzing separately the dust mite group and the pollen group. None of the cases presented any adverse local or systemic reaction during the procedure or the following 24 hours after the procedure. The 20 individuals in the control group turned out negative when tested. CONCLUSIONS: This study found high aeroallergen sensitization prevalence in a pediatric population with recurrent episodes of wheezing examined in the Allergy and Immunology Division of the Eva Perón School Hospital, which is in the southern area of the province of Santa Fe in Argentina.

Obesidad infantil y su asociación con síntomas de asma / Pediatric asthma and its asociation with asthma symptoms

Fundamento. La obesidad y el asma son enfermedades crónicas de prevalencia mundial en aumento. Numerosos estudios muestran asociación positiva entre ellas; sin embargo, en la infancia los resultados publicados son contradictorios. Objetivo. Valorar la asociación entre síntomas de asma bronquial y obesidad en niños. Lugar de aplicación. Escuelas primarias de la ciudad de Rosario. Diseño. Estudio observacional de corte transversal. Población. 1.081 niños, 50,7% de sexo masculino, con edades comprendidas entre 5 y 13 años. Método. Se utilizaron cuestionarios validados para asma y mediciones directas de peso y talla. Resultados. Se observaron promedios significativamente mayores de percentilos de IMC en los niños que manifestaron síntomas de asma alguna vez en la vida o en los últimos doce meses y diferencias significativas en la prevalencia de síntomas de asma en la actualidad en las distintas categorías de percentilos de IMC. Se encontró mayor prevalencia de síntomas de asma en la actualidad en niños y adolescentes obesos al compararlos con el resto. Conclusión. Este estudio de una muestra representativa de niños de la ciudad de Rosario nos sugiere la existencia de una asociación positiva entre obesidad y síntomas actuales de asma, independientemente del sedentarismo, sexo y nivel de actividad física.

Relación entre índice de masa corporal y severidad del asma bronquial en adultos / Relation between body mass index and y asthma severity in adults

Racionalidad. La obesidad y el asma son enfermedades crónicas cuya prevalencia se halla en constante crecimiento en las últimas décadas a nivel mundial. La prevalencia de síntomas de asma es mayor entre sujetos con sobrepeso y obesidad. Objetivo. Estudiar la asociación entre obesidad, valorada como índice de masa corporal (IMC) y severidad del asma en adultos jóvenes de la localidad de Rosario. Material y Métodos. Estudio obsevacinal de corte transversal que incluyó a 151 pacientes asmáticos adultos, 123 femeninos (81,5%), con edades comprendidas entre 18 y 63 años (x=±8,86). Para la categorizacion de los IMC se emplearon los valores de referencia de la OMS: bajo peso (<18,5 kg/m2), peso normal (18,5 a 24,9 kg/m2), sobrepeso 25 a 29,9 kg/m2) y obesidad (>30 kg/m2); y para el diagnótico y categorizacion de severidad de asma, la guía de GINA. A los pacientes se los dividió en dos grupos: grupo A, que incluyó a pacientes con asma persistente moderado y severo; grupo b, compuesto por pacientes con asma persistente leve e intermitente. Se evaluó la influencia potencial de variables de confusión tales como reflujo gastroesofágico (RGE), sexo, actividad física y rinitis. Resultados. Se encontraron significativa diferencias significativas entre el IMC de mujeres (21,83 kg/m2) y varones (25,39 kg/m2) (p<0,00001). Los pacientes con mayor severidad mostraron medias de IMC significativamente incrementadas (p<0,005). Los pacientes con sobrepeso y obesidad, tuvieron un mayor grado de severidad de asma en comparación con pacientes de peso normal o disminuido (OR=3,35; IC95%: 1,34-8,53; p<0,01). Los análisis estratificados mostraron que la severidad del asma es mayor entre sujetos con IMC elevados, independientemente del sexo, la presencia de reflujo, de rinitis alérgica y del nivel de actividad física...