[Neurological complications of renal transplant]. / Complicaciones neurológicas del trasplante renal.

Advances in surgical procedures and new immunosuppressor therapies have improved the outcome of renal grafts. However, these changes have been accompanied by infectious, neoplastic and neurologic complications. The purpose of this study was to determine the incidence of neurologic complications among 542 patients receiving a renal transplant (from living or cadaveric donors) at CEMIC between 1970 and 1996. Neurologic complications occurred in 43 patients (8%) as follows: 8 meningitis (1.5%), 8 acute confusional syndrome (1.5%), 7 encephalitis (1.3%), 7 cerebrovascular accidents (1.3%), 6 convulsions (1.1%), 3 tumors (0.5%), 3 femoral nerve lesion (0.5%), and 1 epidural lipomatosis (0.1%). Etiologic agents most commonly observed in meningitis were: Cryptococcus neoformans, Listeria monocytogenes and Mycobacterium tuberculosis. Major difficulties arose in the diagnosis of encephalitis. Diagnosis of the above complications required clinical astuteness and repeated bacteriologic, serologic and imaging studies.

Effects of a copper-bearing intrauterine device on the ovarian function, body weight gain and pregnancy rate of nulliparous heifers.

A copper-bearing intrauterine device (IUD), designed to cause a slight distention of the uterus, was inserted through the cervix into each uterine horn of 230 heifers; an additional 230 heifers served as the control group. Blood was drawn at 0, 1, 2, 20 and 120 d for progesterone and testosterone assays. The heifers were checked twice daily for estrus and examined at 0, 60 and 120 d for weight gain. Thereafter they were bred over a 120-d period. The IUD caused anestrus in 98% of the heifers, with a daily weight gain 25.5 % higher than in the control heifers. Moreover, the device was 100% effective in preventing pregnancy. At 20 and 120 d after IUD insertion progesterone levels averaged 0.7 ng/ml, which was 4 to 5 times lower than in the control animals, suggesting a failure in ovulation or in corpus luteum (CL) formation due to the IUD. Simultaneously, testosterone values were increased up to 8 times in IUD-treated heifers, reaching a mean concentration of 163 pg/ml. Associated histological evaluations of the ovaries from UD-treated heifers revealed the presence of 2 or more cysts per ovary, with marked hyperthecosis in many antral follicles in which the granulosa cell layers were either thinned or lacking. The results suggest that the action of the copper-releasing IUD used in this study resulted in high contraceptive efficiency but also in disturbance of ovarian function. Our findings further raise the possibility of a cause and effect relationship between hyperandrogenism and the higher body weight gain observed in heifers treated with the IUD.

[Liver histology in chronic hemodialysis patients infected with hepatitis C virus]. / Histología hepática en pacientes hemodializados crónicos infectados con el virus de la hepatitis C.

Liver biopsies were analyzed in 21 patients with chronic renal failure (CRF) who tested positive for Hepatitis C Virus (HCV), using Elisa II and/ or PCR. The study included 14 men and 7 women, the average age being 41 years old (range: 20-65). The average span of time under dialysis was 64 months (range: 12-192). Hbs ag. was positive in six patients. Patients underwent biopsy for showing persistent rise of transaminase for more than 6 months. The modified Knodell Index was used to grade hepatic lesions. All biopsies showed chronic hepatitis, of which 2 were associated with cirrhosis. Eight patients were infected with mild chronic hepatitis, ten were infected with moderate chronic hepatitis, and only three patients had a severe lesion. Fibrosis was mild in 13 cases, moderate in 6, and 2 had cirrhosis. Chronic Hepatitis C characteristic lesions analysis showed lymphoid nodules in 6 cases (29%), ductal epithelium lesions in 7 (33%), and steatosis in 7 (33%). Chronic HCV infection in our patients seems to have histologic characteristics similar to those reported in HCV positive non CRF patients.

Anticuerpos anti-citoplasma de polimorfonuclear neutrófilo en granulomatosis de Wegener, en otras enfermedades autoinmunes y en pacientes hemodializados / Anticytoplasm antibodies of polymorphonuclear neutrophils in Wegener's granulomatosis, other autoimmune diseases and in patients under hemodialysis

Las vasculitis sistémicas son un grupo heterogénio de enfermedades caracterizadas por infiltración inflamatoria y necrosis de la pared vascular. Anticuerpos contra citoplasma de polimorfonuclear neutrófilo (ANCA-C y ANCA-P) fueron descriptos como marcadores serológicos de algunas de estas afecciones y de ciertos tipos de glomerulonefritis. La presencia de ANCA se investigó en el suero de 182 pacientes. En 16/17 con Granulomatosis de Wegener (G.W.) (critérios ACR) se encontró ANCA, 14 de ellos con imagen C (en 10 asociada a imagem P) y en los dos restantes, imagem P solamente (p < 0,001, comparando con los otros grupos estudiados). La presencia de estos anticorpos se asoció con la atividad clínica de la enfermedad (p, 0,01). El único paciente ANCA-C positivo fuera de este grupo tenía estonosis subglótica como única manifestación clínica con histología inespecífica, ANCA-P se encontró, además, en 6 por ciento de los casos con Enfermedades del Tejido Conectivo estudiados, y en 6/66 de la Unidad de Diálisis, lo cual sugiere que un mecanismo relacionado al ANCA puede ser el responsable de la nefropatía en aproximadamente el 10//de los pacientes en hemodiálisis crónica. Los resultados obtenidos indican que la investigación de ANCA puede ser un elemento de ayuda útil para el diagnóstico y monitoreo de la actividad clínica en la G.W

[Anticytoplasm antibodies of polymorphonuclear neutrophils in Wegener's granulomatosis, other autoimmune diseases, and in patients undergoing hemodialysis]. / Anticuerpos anti-citoplasma de polimorfonuclear neutrófilo en granulomatosis de Wegener, en otras enfermedades autoinmunes y en pacientes hemodializados.

Systemic vasculitis are an heterogeneous group of diseases characterized by inflammatory infiltration and necrosis of blood vessel walls. Antineutrophil cytoplasmic antibodies (ANCA) with different immunofluorescent patterns (C or P) have been described as serological markers of some of these diseases and some types of glomerulonephritis. The presence of ANCA by immunofluorescence on normal fixed polymorphonuclear neutrophils was investigated in 182 patients. Results are depicted in Table 1. ANCA was present in 16/17 (94%) patients with Wegener Granulomatosis (W.G.) (ACR criteria) (p < 0.001). In 14 out of the 16 (82%), the pattern was ANCA-C (associated in 10 with ANCA-P) and only ANCA-P was observed in the remaining two. The presence of ANCA was associated with active disease: 15/16 samples of active patients and 3/9 of inactive patients were ANCA positive (p < 0.01). Among the other groups, ANCA-C was detected in only one patient with isolated subglottal stenosis. The specificity of ANCA-C for W.G. was 99%. ANCA-P was also detected in 3/49 (6%) patients with connective tissue disorders and in 3/63 (5%) patients in chronic hemodialysis with exclusive or predominant renal disease of unknown etiology. Three additional ANCA positive patients with known diagnosis (2 W.G. and 1 Systemic Lupus Erythematosus) were also in hemodialysis in the same unit. Thus, an ANCA related mechanism may be involved in the pathogenesis of approximately 10% of cases undergoing this procedure. None of 45 sera submitted for the detection of antinuclear antibodies were ANCA positive. Detection of ANCA (especially C pattern) may be of help in the diagnosis of W.G. and in monitoring clinical activity of the disease.