Post-transplant soluble CD30 levels are associated with early subclinical rejection in kidney transplantation.

Several studies have shown association of high pre- or post-transplant levels of soluble CD30 (sCD30) with acute rejection and poor late kidney transplant outcome. Our goal was to investigate whether sCD30 levels at month-3 post-transplant are associated with subclinical rejection, presence of CD30(+) cells within the graft, and expression of immune response genes in peripheral blood mononuclear cells. The study comprised 118 adult first kidney graft recipients, transplanted at a single center, receiving tacrolimus in low concentration. All were submitted to a protocol biopsy at month-3. Subclinical rejection was identified in 10 biopsies and sCD30 levels ≥ 61.88 ng/mL (P = 0.004), younger recipient age (P = 0.030) and non-Caucasian ethnicity (P = 0.011) were independently associated with this outcome. Rare CD30(+) cells were present in only two biopsies. There was a correlation between sCD30 levels and CD30 gene expression in peripheral blood mononuclear cells (r = 0.385, P = 0.043). These results show that high sCD30 levels are independent predictors of graft dysfunction and may contribute to patient selection protocols by indicating those who could benefit from a more thorough evaluation.

Expanding the use of expanded criteria donors in kidney transplantation.

PURPOSE: Although the use of kidney allografts from expanded criteria donors (ECD) has increased in recent years, the reported discard rates are also growing. The influence of ECD characteristics on transplant outcomes is still underevaluated. METHODS: This retrospective study investigated the influence of preimplantation biopsy findings and delayed graft function (DGF) on patient and graft survivals and renal function at 36 months in a cohort of 372 ECD kidney transplant recipients. RESULTS: Patient and graft survivals were 91.6 and 68.9 %. The incidence of biopsy-proven acute rejection was 31 %. There were no differences in patient (88.6 vs. 91.1 vs. 94.7 vs. 78.6 %, p = 0.10) or graft (78.1 vs. 72.2 vs. 60.5 vs. 62.6 %, p = 0.14) survivals and renal function (41.7 ± 25.6 vs. 39.9 ± 29.9 vs. 38.1 ± 30.6 vs. 37.4 ± 29.2 mL/min, p = 0.79) comparing ECD kidneys with mild, moderate, and severe histological changes or with no preimplantation biopsy, respectively. However, severe scored transplants had the worst death-censored graft survival (OR 3.1, 95 % CI 1.4-6.9, p = 0.007). No significant differences in patient (86.2 vs. 83.4 %, p = 0.17) or graft (73.7 vs. 65.9 %, p = 0.06) survivals and renal function (38.9 ± 28.6 vs. 39.9 ± 28.4 mL/min, p = 0.72) were observed comparing patients with or without DGF. Multivariable analysis found diabetes history as the only independent risk factor for graft loss (OR 2.1, 95 % CI 1.3-3.3, p = 0.003) or patient death (OR 3.1, 95 % CI 1.5-5.8, p < 0.001). CONCLUSIONS: Within the limitations of sample size and short follow-up time, in this cohort of ECD kidney transplant recipients the severity of histological changes observed in preimplantation biopsies was independently associated with graft loss.

Severity of the cardiac impairment determines whether digitalis prolongs or reduces survival of rats with heart failure due to myocardial infarction.

BACKGROUND: The aim of the present study was to evaluate if the influence of digitalis on survival depends on the severity of cardiac dysfunction in heart failure (HF). METHODS AND RESULTS: Doppler echocardiogram (DE) parameters were analyzed in 84 Wistar control (C) and 80 Wistar rats treated with 0.1mg/100g/day of digitoxin (D) five days after coronary occlusion. The DE variables correlated with the survival of the animals were: myocardial infarction size, left chamber dimensions, fractional area change and E/A ratio. The animals were observed for up to 280 days. Mortality was worsened in rats in the D group with a myocardial infarction (MI)<37% and with better DE predictors of survival. Digitoxin was found to prolong survival in rats with an MI ≥ 37% and worse DE predictors. CONCLUSION: For the first time our study has shown experimentally that the action of digitalis glycosides can positively or negatively influence survival during treatment of HF. It prolongs survival of those in advanced state and compromises survival when there is less severity of the disease. In fact, the greater benefits occur when digitoxin was used in heightened ventricular dilatations and worse ventricular performance.

Left ventricle radio-frequency ablation in the rat: a new model of heart failure due to myocardial infarction homogeneous in size and low in mortality.

BACKGROUND: The purpose of the current study was to create a model of myocardial infarction (MI) that is homogeneous in size with a low immediate (24 hours) mortality. METHODS AND RESULTS: Male and female rats (n = 256) underwent left ventricle (LV) ablation (Ab) by a radiofrequency current (1000 kHz; 12 watts for 12 seconds) to promote a MI. A transmural MI occurred in all rats. Post-Ab complex arrhythmias were frequent (atrioventricular block, ventricular tachycardia, and fibrillation), which rapidly and spontaneously reverted to sinus rhythm. Among 66 male rats, immediate mortality occurred in 7.5%. Small MI size dispersion was characterized by smaller variability following Ab (x +/- SD: 45 +/- 8%) when compared with coronary occlusion (Oc; 40 +/- 19%). The histopathologic evaluations identified lesions similar to those which occurred following Oc, with scarring complete at 4 weeks. The hemodynamic and Doppler echocardiograms showed comparable increases in LV dimension, end-diastolic pressure, and pulmonary water content 1 and 4 weeks post-MI. Papillary muscle mechanics 6 weeks post-MI had matched inotropic and lusitropic dysfunction. CONCLUSIONS: LV Ab gave rise to a MI within a narrow size limit and with a low immediate mortality. LV Ab resulted in histopathologic evolution, ventricular dilation, and dysfunction, impairment in myocardial mechanics, and congestive outcome that reproduced a MI from Oc.

Adenomiose uterina: ainda um enigma? / Adenomyosis of the uterus: still an enigma?

Observamos 88 casos de adenomiose encontrados em 725 histerectomias realizadas durante um período de 10 anos, em que 76,2 por cento das pacientes tiveram mais de uma manifestaçåo clínica, sendo mais freqüente a associaçåo de sangramento vaginal e algia pélvica. No exame ginecológico, só 56 por cento das pacientes apresentaram útero aumentado de volume. O mioma foi a associaçåo mais comum. O peso médio do útero foi de 168,9g. Embora doença comum, tem diagnóstico ardiloso, merecendo dos ginecologistas discernimento clínico e terapêutico. A histerectomia total abdominal continua o tratamento ideal, nåo havendo resposta a qualquer hormonioterapia

A comparative study of the immunoantigenicity of eight Paracoccidioides brasiliensis isolates

Para se detectar diferenças imuno-antigênicas entre 8 amostras de P. brasiliensis isoladas de diferentes áreas endêmicas (Botucatu: Pb 1, 2 e 3; Säo Paulo: Pb: 18,192 e 265; Venezuela: Pb 9 e 73), estudaram-se: 1. A reatividade antigênica de cada amostra nas reaçöes de imunofluorescência indireta (II) e de imunodifusäo dupla em gel de ágar (ID) contra painel de 20 soros controles positivos para paracoccidioidomicose; 2. A capacidade de induzir resposta imune humoral (medida por imunodifusäo) e celular (medida pelo teste de coxim plantar) em camundongos imunizados com antígenos de cada amostra. Observamos: 1. As amostras Pb 265 e Pb 9 mostraram-se mais reativas na II; 2. Os antígenos das amostras Pb 192 e Pb 73 foram significativamente mais reativas na ID; 3. Estes dados demonstram diferenças de antigenicidade entre estas amostras; 4. A amostra Pb 18 mostrou baixo poder indutor de resposta imune celular e alta capacidade de induçäo de resposta imune humoral em camundongos imunizados, revelando dissociaçäo de sua imunogenicidade. Estas diferenças podem indicar a existência de cepas distintas do fungo ou refletir modificaçöes do parasita no hospedeiro ou durante seu cultivo

Adenocarcinoma colorretal em pacientes com idade inferior a 40 anos: relato de 11 casos / Colorectal adenocarcinoma in patients under 40: report of 11 cases

Säo apresentados os dados clínicos e morfológicos de 11 pacientes portadores de câncer colorretal, com idade inferior a 40 anos, sem lesöes predisponentes. Verificou-se predomínio de mulheres (2,2:1) e de carcinomas pouco diferenciados mucinosos (64%), em fase avançada de evoluçäo (82% em estádio C ou D de Dukes). As lesöes localizaram-se no ceco (5 casos), reto (3), ângulo esplênico (2) e cólon descendente (1). Houve antecedente de exposiçäo a inseticidas em 5 dos 11 pacientes. O câncer colorretal parece estar afetando grupos etários mais jovens, fato que enfatiza a importância de se identificar os fatores de risco e os agentes carcinogenéticos

Bagaçose: relato de um caso / Bagassosis: a case report

Apresenta-se o primeiro caso brasileiro de bagaçose, histologicamente documentado. A imunofluorescência direta da biopsia pulmonar revelou ausência de complexos antígeno-anticorpo. Acredita-se que a patogenia da doença é devida a reaçäo de hipersensibilidade retardada a antígenos de bolores presentes nas fibras do bagaço aspirado

Necrose tubular aguda associada a glomerulonefrite membranoproliferativa / Acute tubular necrosis associated with membrana proliferative glomerulonephritis

Descrevem-se dois casos de glomerulonefrite membranoproliferativa associada à necrose tubular aguda. Ambos os pacientes apresentaram evoluçäo clínica compatível com insuficiência renal aguda secundária à necrose tubular. Säo levantadas duas hipóteses para explicar a lesäo tubular aguda: a) agressäo imunológica via deposiçäo de imunocomplexo a nível tubular e ativaçäo do sistema complemento; b) anóxia tubular conseqüente ao processo inflamatório do capilar glomerular

Rins policísticos e displasia renal na infância: classificaçäo e patogenia / Polycystic kidneys and renal dysplasia in infancy: classification and pathogenesis

O presente trabalho compreende estudo anatomoclínico retrospectivo de 19 casos de crianças portadoras de rins policísticos e displasia renal (18 autópsias e uma biópsia); foram revistos os dados clínicos e a presença de malformaçöes e analisados os achados macro e microscópicos dos rins (classificaçäo de Potter). Os casos foram subdivididos segundo a distribuiçäo e freqüência das malformaçöes observadas, salientando-se a presença de dois grandes distintos sob o ponto de vista morfológico e patogenético: Grupo 1 (oito crianças), apresentando rins policísticos e displásicos (Tipos II e III) associados a malformaçöes sistêmicas múltiplas, ambos provavelmente conseqüentes a um mesmo agente agressor, atuante em diferentes fases da embriogênese e Grupo 2 (sete crianças), apresentando rins policísticos e displásicos (Tipo IV) associados a malformaçöes do trato urinário inferior. Postula-se neste grupo a açäo patogenética da obstruçäo e refluxo vesicoureteral na gênese da lesöes renais