Incidence of contrast-induced nephropathy after a computed tomography scan.

BACKGROUND AND AIMS: The term contrast-induced nephropathy is used to describe acute deterioration of renal function after the intravenous administration of iodinated contrast material. We aimed to estimate the incidence of contrast-induced nephropathy and to analyze the evolution of different biomarkers of renal function in patients who underwent computed tomography with intravenous contrast administration after premedication with oral hydration and N-acetylcysteine. MATERIAL AND METHODS: This prospective observational study included 112 patients with chronic renal failure (glomerular filtration rate (GFR) 30ml-60ml/min/1.73m2) scheduled for computed tomography with intravenous iodinated contrast material. We recorded demographic variables, dose of contrast material, diabetes mellitus, hypertension, and serum hemoglobin. We measured serum creatinine and GFR after premedication and after the CT examination. We summarized variables as means, standard deviations, and percentages. We used the Wilcoxon and Mann-Whitney tests to compare pre- and post-CT values and Pearson's r to analyze correlations. RESULTS: Incidence acute kidney injury: 0.9%; 95%CI: 0.36-1.4. Mean difference between pre- and post-CT creatinine: 0.04; 95%CI: 0.002-0.09, p<0.004. Mean difference between pre- and post-CT GFR: -3.06; 95%CI: -4.66 to -1.47), p<0.001. CONCLUSIONS: The incidence of contrast-induced nephropathy in patients with chronic renal failure and GFR 30ml-60ml/min/1.73m2 is low. The biomarkers of renal function analyzed improve in patients who receive premedication and the minimum dose of contrast material.

Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study.

INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre. METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival. RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups. CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.

Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis.

INTRODUCTION: Portal and mesenteric venous thrombosis is a rare but potentially serious complication after laparoscopic sleeve gastrectomy. There are no consistent studies that prove the safety and effectiveness of oral anticoagulant thromboprophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy. The objective was to evaluate the effect of rivaroxaban on the frequency of portal and mesenteric venous thrombosis and its safety profile after laparoscopic sleeve gastrectomy. MATERIALS AND METHODS: This retrospective analysis of prospectively collected data includes all laparoscopic sleeve gastrectomies performed by a single surgeon at Pontificia Universidad Católica de Chile Hospital between January 2009 and June 2019. All patients received low molecular weight heparin thromboprophylaxis during the whole hospital stay. Between July 2012 and June 2019, patients received additional post-discharge thromboprophylaxis with rivaroxaban. Patient demographics, impaired renal, post-surgical portal and mesenteric venous thrombosis, and bleeding episodes were registered. RESULTS: A total of 516 patients were identified; 95 patients were excluded. Results for 421 patients were analysed: 198 received only intrahospital thromboprophylaxis (group 1) and 223 received additional post-discharge thromboprophylaxis with rivaroxaban (group 2). There was no statistically significant difference between the two groups concerning age, sex and body mass index. In group 1, four cases of portal and mesenteric venous thrombosis were registered and no cases were reported in group 2 (p < 0.05). All cases occurred before 30 days after surgery. No bleeding episodes and no adverse reactions were detected in group 2. CONCLUSIONS: Thromboprophylaxis during the whole hospital stay (two to three days), followed by rivaroxaban 10mg once daily for 10 days after discharge (completing in total 13-14 days of prophylaxis), could reduce cases of post-surgical portal and mesenteric venous thrombosis without an increase in bleeding complications.

Sedentary behaviour patterns and arterial stiffness in a Spanish adult population - The EVIDENT trial.

OBJECTIVE: Arterial stiffness is a contributor to the development of atherosclerosis and cardiovascular disease. The aim of the study was to analyse the relationship between sedentary behaviour and arterial stiffness in a Spanish adult population. METHODS: This cross-sectional study included 1365 subjects belonging to the EVIDENT project. Physical activity and sedentary behaviour were measured objectively over 7 days using ActiGraph accelerometers. Thresholds of 10 consecutive minutes were used to estimate the daily sedentary time in bouts ≥10 min. Each interruption in sedentary time (counts/min ≥100) was considered a break. Arterial stiffness was evaluated using the B-pro device through the following indicators: radial Augmentation Index (rAIx), Ambulatory Arterial Stiffness Index (AASI), and central and peripheral pulse pressure (PP). RESULTS: We found a positive relationship between central and peripheral pulse pressure (office, 24 h, awake and sleep PP) and total sedentary time. These arterial stiffness parameters were also associated with sedentary time in bouts ≥10 min. Significance disappeared in both cases, however, after adjusting for MVPA and breaks per sedentary hour. Adults who reported fewer breaks per sedentary hour (25th percentile < 2 n/day) had higher levels of AASI, awake and sleep PP. CONCLUSIONS: In a medium-sized sample of adult attenders of community clinics our data showed that it seems to be important to avoid prolonged uninterrupted periods of sedentary time.

[Relationship between physical activity and hemodynamic parameters in adults]. / Relación entre la actividad física y parámetros hemodinámicos en adultos.

OBJECTIVES: To analyze the relationship between physical activity, as assessed by accelerometer, with central and peripheral augmentation index and carotid intima media thickness (IMT) in adults. METHODS: This study analyzed 263 subjects who were included in the EVIDENT study. Physical activity was assessed during 7 days using the ActigraphGT3X accelerometer (counts/min). Carotid ultrasound was used to measure carotid IMT. The Sphygmo Cor System was used to measure central and peripheral augmentation index (CAIx and PAIx). RESULTS: Mean age 55.85±12 years; 59.30% female; 26.7 body mass index and blood pressure 120/77mmHg. Mean physician activity counts/min was 244.37 and 2.63±10.26min/day of vigorous or very vigorous activity. Physical activity showed an inverse correlation with PAIx (r=-0.179; P<.01) and vigorous activity day time with IMT(r=-0.174; P<.01), CAIx (r=-0.217; P<.01) and PAIx (r=-0.324; P<.01). After adjusting for confounding factors in the multiple regression analysis, the inverse association of CAIx with counts/min and the time spent in vigorous/very vigorous activity was maintained. CONCLUSION: The results suggest that both physical activity and time spent in vigorous or vigorous activity are associated with the central augmentation index in adults.

Glycemic index, glycemic load, and pulse wave reflection in adults.

BACKGROUND AND AIMS: Diets with a high glycemic index (GI), high glycemic load (GL), or both, increase the risk of cardiovascular disease. This study examined the association of GI and GL in a regular diet with the peripheral augmentation index (i.e., a marker of vascular aging) in a sample of adults. METHODS AND RESULTS: Cross-sectional study. The findings presented in this manuscript are a subanalysis of the EVIDENT study whose purpose was to analyze the relationship between lifestyle and arterial aging. For the sample population, 1553 individuals aged 20-80 years were selected through random sampling from the patients of general practitioners at six health centers in Spain. GI and GL for each patient's diet were calculated from a previously validated, semi-quantitative, 137-item food frequency questionnaire. The peripheral augmentation index corrected for a heart rate of 75 bpm (PAIx75) was measured with pulse-wave application software (A-Pulse CASP). Based on a risk factor adjusted regression model, for every 5 unit increase in GI, the PAIx75 increased by 0.11 units (95% CI: 0.04-0.19). Similarly, for every increase in 10 units in GL, the PAIx75 increased by 1.13 (95% CI: 0.21-2.05). High PAIx75 values were observed in individuals with diets in the third GI tertile (i.e., the highest), and lower PAIx75 values in those with diets in the first tertile (i.e., the lowest), (93.1 vs. 87.5, respectively, p = 0.001). CONCLUSIONS: GI and GL were directly associated with PAIx75 values in adults without cardiovascular diseases regardless of age, gender, physical activity, and other confounders.

Relationship between electrocardiographic left ventricular hypertrophy criteria and vascular structure and function parameters in hypertensive patients.

The objective of this study was to determine the electrocardiographic left ventricular hypertrophy (LVH) criterion that best correlated with vascular structure and function parameters in hypertensive patients. A cross-sectional study involving 347 hypertensive patients was performed. The mean age of the subjects was 54.9±11.8 years, and 61% were male. Electrocardiography was used to detect LVH based on the evaluation of 10 criteria, and we defined the voltage-duration product (VDP) complex criterion. The vascular structure was evaluated according to carotid intima-media thickness (C-IMT), and vascular function was evaluated according to pulse wave velocity (PWV), the ambulatory arterial stiffness index (AASI), the home arterial stiffness index, and the peripheral (PAIx) and central (CAIx) augmentation indices. LVH according to at least some electrocardiographic criteria was recorded in 29.10% of the patients (34.10% of females; 25.90% of males). The vascular structure and function parameters showed higher values in the hypertensive patients with LVH. The criterion most closely correlated with C-IMT was Lewis-VDP (r=0.257); with PWV and AASI, the criterion was the Framingham-adjusted Cornell voltage (r=0.228 and r=0.195, respectively); and with CAIx and PAIx, the criterion was Novacode (r=0.226 and r=0.277, respectively). In the multivariate analysis, the association of the vascular structure and function parameters, the VDP complex (multiple linear regression) and the presence of LVH (logistic regression) disappeared after adjusting for age, sex and antihypertensive drugs. The relationship between the electrocardiographic criteria used to detect LVH in hypertensive patients and the vascular structure and function parameters were fundamentally conditioned by age and antihypertensive drug treatment.

El papel de las venas de la retina en el riesgo cardiovascular / The role of the retinal veins in cardiovascular risk

Objetivo Analizar la relación del calibre de los vasos de la retina con el riesgo cardiovascular estimado en una muestra de sujetos hipertensos. Métodos Seleccionamos 202 pacientes hipertensos de 34 a 75 años. Con un retinógrafo Topcon TRC NW 200 se obtuvieron imágenes digitalizadas de la retina; mediante el software semiautomático AV Index Calculator se midió el grosor de los vasos temporales superior e inferior en una área de 0,5 a 1 diámetros del disco óptico y se calculó el índice arteriovenoso. El riesgo cardiovascular fue estimado con el Framingham-D’Agostino score. Se ha considerado riesgo bajo < 10%; riesgo moderado entre 10-20% y riesgo alto ≥ 20%. Resultados La edad media fue de 59,1 ± 8,4 años, siendo mujeres el 41,6% (84). Los grosores de las arterias y las venas tienden a incrementarse a medida que aumenta el riesgo, mientras que el índice arteriovenoso tiende a disminuir, aunque solo alcanza la significación estadística la diferencia de grosor de las venas entre los 3 grupos de riesgo. El calibre arterial y venoso tiene correlación positiva con el riesgo cardiovascular, aunque solo alcanza la significación estadística con el calibre venoso (r = 0,189; p < 0,010). Esta asociación se mantiene la regresión lineal múltiple, después de ajustar por edad y sexo. Conclusión Los hallazgos encontrados con esta nueva herramienta desarrollada para evaluar los vasos de la retina apoyan el papel más relevante que podría tener la valoración del calibre venoso, y no solo del arterial o el índice arteriovenoso, como se ha visto en estudios previos, en la evaluación del riesgo cardiovascular asociado a las alteraciones de la circulación retiniana (AU)

Objective To analyze the association between retinal vessel caliber and cardiovascular risk estimated in a sample of hypertensive patients. Methods We selected 202 hypertensive patients aged 34 to 75 years. Retinal photographs, obtained by Topcon TRC NW 200, were digitized, and superior and inferior temporal caliber vessel were measured in an area 0.5 to 1 disc diameter from the optic disc with semiautomatic software (AV Index Calculator), followed by calculation of the estimated arteriole/venule index. Cardiovascular risk was estimated through the Framingham-D’Agostino score. Risk was classified as follows: low risk < 10%, moderate risk 10-20%, and high risk ≥ 20%. Results The mean age of the patients was 59.1 ± 8.4 years and 41.6% (84) were women. The caliber of arterial and venous vessels tended to increase with higher cardiovascular risk, while the arteriole/venule index tended to decrease, but the only factor that was statistically significant was differences in caliber among the 3 cardiovascular risk groups. Arterial and venous caliber showed a positive correlation with cardiovascular risk, although this association was significant only for venous caliber (r=.189; P<.010). This association was maintained in a multiple linear regression model after adjustment by age and sex. Conclusion The findings with this new tool, which was developed to evaluate retinal vessels, indicate the importance of assessing venous caliber, and not just the arterial or arteriole/venule index, as in previous studies, when evaluating cardiovascular risk associated with changes in the retinal vessels (AU)

Mortalidad infantil en un hospital de nivel terciario. Limitación de esfuerzo terapéutico, correspondencia clínico-patológica y precisión diagnóstica / Infant mortality in a third level paediatric hospital. therapeutic effort limitation, clinical-pathological agreement and diagnostic accuracy

Objetivo: Analizar la mortalidad en un hospital infantil de tercer nivel y alta complejidad. Material y métodos: Se revisaron los fallecidos en el Hospital Infantil La Paz durante los años 2007, 2008 y 2009. Se analizaron datos epidemiológicos, diagnósticos clínicos y de autopsia y su correspondencia, y si se llegaba a un diagnóstico etiológico definitivo. La limitación del esfuerzo terapéutico y la previsibilidad del fallecimiento también fueron recogidas. Las variables fueron prospectivamente definidas al inicio. Resultados: Se estudiaron 253 fallecimientos (6,08 por mil ingresos). El 43,4% eran menores de 1 mes y el 63,9% menores de un año. La patología neonatal y la hemato-oncológica fueron las causas más frecuentes. Fallecieron en las tres unidades de cuidado intensivo el 87%. Se practicó autopsia a 53% de los fallecidos y se detectó un 7,8% de nuevos hallazgos significativos, aunque solo en un caso podría el tratamiento haber modificado el pronóstico. Limitación de esfuerzo terapéutico y cuidado paliativo se instauró en el 41,9%. El fallecimiento era esperado al inicio del proceso en 83,9%, En 92% se consideró que existía un diagnóstico definitivo y en 86,4% un diagnóstico etiológico de los procesos que condujeron al fallecimiento. Conclusiones: El análisis de la mortalidad hospitalaria permite evaluar la calidad de la asistencia pediátrica y detectar resultados adversos. La autopsia continúa proporcionando información relevante. La limitación de esfuerzo terapéutico y cuidado paliativo es una medida cada vez más frecuente en la edad pediátrica. El número de niños que muere sin diagnóstico etiológico sigue siendo alto(AU)

Objective: To study infant and child mortality in a third level children's hospital treating highly complex patients. Patients and methods: All children dying in the period 2007- 2009 at La Paz Children's Hospital were evaluated. Epidemiological data, autopsy rate, clinical and autopsy diagnoses and their correspondence and the number of, patients with precise final diagnoses were analysed. Therapeutic effort limitation and palliative care were also evaluated as well as if the final result was expected according to the initial disease or clinical condition of the patients. All the variables were prospectively defined at the start of the study period. Results: A total of 253 cases (6.08‰ admissions) were analysed. The two leading causes of death were disorders related to prematurity and low birth weight, and haematology oncology malignant diseases. Most patients (87%) died in an intensive care unit (neonatal or paediatric). During the study period 134 autopsies (53%) were performed, and new clinically significant findings were observed in 12 of these (7.8%) but in only one case the treatment could have possibly modified the prognosis (class I discrepancy). Therapeutic effort limitation and palliative care were implemented in 41.9%. Death was initially expected in 83.9% of cases. An accurate final diagnosis was defined in 92%, and the aetiology of the disease was considered to be identified in 86.4% of all deaths. Conclusions: Hospital mortality analysis is useful to evaluate the quality of the paediatric care and to detect adverse results that could be corrected. Paediatric autopsy continues to provide clinically significant data for paediatricians and families. Therapeutic effort limitation and palliative care is increasingly applied in paediatric end of life care. The number of infants and children dying without a final aetiological diagnosis is still considerably high(AU)

[Infant mortality in a third level paediatric hospital. therapeutic effort limitation, clinical-pathological agreement and diagnostic accuracy]. / Mortalidad infantil en un hospital de nivel terciario. Limitación de esfuerzo terapéutico, correspondencia clínico-patológica y precisión diagnóstica.

OBJECTIVE: To study infant and child mortality in a third level children's hospital treating highly complex patients. PATIENTS AND METHODS: All children dying in the period 2007- 2009 at La Paz Children's Hospital were evaluated. Epidemiological data, autopsy rate, clinical and autopsy diagnoses and their correspondence and the number of, patients with precise final diagnoses were analysed. Therapeutic effort limitation and palliative care were also evaluated as well as if the final result was expected according to the initial disease or clinical condition of the patients. All the variables were prospectively defined at the start of the study period. RESULTS: A total of 253 cases (6.08‰ admissions) were analysed. The two leading causes of death were disorders related to prematurity and low birth weight, and haematology oncology malignant diseases. Most patients (87%) died in an intensive care unit (neonatal or paediatric). During the study period 134 autopsies (53%) were performed, and new clinically significant findings were observed in 12 of these (7.8%) but in only one case the treatment could have possibly modified the prognosis (class I discrepancy). Therapeutic effort limitation and palliative care were implemented in 41.9%. Death was initially expected in 83.9% of cases. An accurate final diagnosis was defined in 92%, and the aetiology of the disease was considered to be identified in 86.4% of all deaths. CONCLUSIONS: Hospital mortality analysis is useful to evaluate the quality of the paediatric care and to detect adverse results that could be corrected. Paediatric autopsy continues to provide clinically significant data for paediatricians and families. Therapeutic effort limitation and palliative care is increasingly applied in paediatric end of life care. The number of infants and children dying without a final aetiological diagnosis is still considerably high.

Parafollicular C-cells of the thyroid are decreased in patients with congenital diaphragmatic hernia.

BACKGROUND: Parathyroid and thymic anomalies related to embryonic neural crest dysfunction have been demonstrated in rats with congenital diaphragmatic hernia (CDH). These rats, like infants with CDH, have conotruncal, facial, and other neurocristal defects. The present study examines whether parafollicular C-cells (CC) of the thyroid, whose embryogenesis is related to that of the parathyroids and thymus, might also be abnormal in babies with CDH. MATERIAL AND METHODS: Autopsy sections of the thyroids of 12 babies dead from CDH and of 11 controls were stained with anti-calcitonin antibodies. Calcitonin-stained areas and the histological distribution of CC within the thyroid gland were assessed. Mann-Whitney tests were used for comparison, with p<0.05 considered significant. RESULTS: The proportion of stained surface to total thyroid surface was significantly smaller in CDH babies than in controls (0.035±0.030% vs. 0.072±0.052%, p<0.05). A normal central CC location was demonstrated in both groups. CONCLUSIONS: Parafollicular thyroid C-cells are deficient in patients with CDH. These findings further support the involvement of neural crest dysregulation in the pathogenesis of CDH and the pertinence of using this experimental model to investigate the human condition. The clinical effects of this anomaly are unknown and probably irrelevant, but they are currently under scrutiny.

Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos / Differences in the CKD-EPI equation with MDRD for the estimation of glomerular filtration in hypertensive patients

Objetivo: Analizar las concordancias en el filtrado glomerular(FG) estimado con las ecuaciones de CKD-EPI y MDRDIDMS en una cohorte de pacientes hipertensos. Métodos: Se incluyeron 478 hipertensos consecutivamente, edad media57,58 años (DE = 12,34), el 68,3% hombres. La estimación del FG se realizó con las ecuaciones de MDRD-IDMS y CKD-EPI, valorando las concordancias entre ellas. Resultados: La estimación de FG con CKD-EPI fue 4,37 ml/min/1,73 m2 (IC 95%, 3,73-4,19) superior al MDRD-IDMS en global y por sexos (hombres3,99; mujeres 5,04). En menores de 65 años la diferencia fue mayor, 6,55 ml/min/1,73 m2 (IC 95%, 5,95-7,15), tanto en hombres(6,07) como en mujeres (6,48). Sin embargo, en mayores de 65 años no se encontró diferencia significativa. El coeficiente de correlación intraclase fue 0,904 (IC 95%, 0,886-0,919), en hombres 0,897 y en mujeres 0,917, y el índice kappa fue 0,848(IC 95%, 0,795-0,889), en hombres 0,845 y en mujeres 0,852.Conclusión: La ecuación de CKD-EPI estima un FG más alto en mayores de 65 años y reclasifica hacia estadio 1 a hipertensos catalogados en estadio 2 por MDRD-IDMS (AU)

Objective: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. Methods: We included consecutively 478 hypertensive patients, 57.58 (SD: 12.34)aged, 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. Results: The estimation of GFR with CKD-EPI was 4.37 (95%:3,73-4,19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females5.04). In patients under 65 years the difference was greater,6.55 (95%: 5,95-7,15) ml/min/1,73 m2 in both men 6.07 and women6.48. However, in over 65 years we found no significant difference. Intraclass correlation coefficient was 0.904 (95%CI:0,886-0,919), 0.897 men and 0.917 women and Kappa index0.848 (95% CI: 0.795-0.889), 0.845 men and 0.852 women. Conclusion: CKD-EPI equation estimated a higher FG in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS (AU)

[Differences between the CKD-EPI and the MDRD equations when estimating the glomerular filtration rate in hypertensive patients]. / Diferencias de la ecuación CKD-EPI con la de MDRD para la estimación del filtrado glomerular en pacientes hipertensos.

OBJECTIVE: To analyze the agreement in glomerular filtration rate (GFR) estimated with CKD-EPI and MDRD-IDMS equations in a cohort of hypertensive patients. METHODS: We included consecutively 478 hypertensive patients, mean age 57.58 yr (SD: 12.34), 68.3% males. The estimation of GFR was performed with MDRD-IDMS and CKD-EPI equations and we analyzed the agreement between them. RESULTS: The estimation of GFR with CKD-EPI was 4.37 (95%:3.73-4.19) mL/min/1,73 m2 higher than MDRD-IDMS, overall and by gender (males 3.99; females 5.04). In patients under 65 years the difference was greater, 6.55 (95%:5.95-7.15) mL/min/1.73 m2 in both men 6.07 and women 6.48. However, we found no significant difference over 65 years. Intraclass correlation coefficient was 0.904 (95% CI:0.886-0.919), 0.897 men and 0.917 women and Kappa index 0.848 (95% CI :0.795-0.889), 0.845 men and 0.852 women. CONCLUSION: CKD-EPI equation estimated a higher GFR in hypertensive patients under 65 years and reclassified in stage 1 patients classified in stage 2 by MDRD-IDMS.

[The increase in the speed of the pulse wave is not associated with elevated central blood pressure in hypertensive patients with kidney disease]. / El aumento de la velocidad de la onda de pulso no seasocia con la elevación de la presión arterial centralen hipertensos con enfermedad renal.

OBJECTIVE: To analyze the relationship between pulse wave velocity (PWV) and central blood pressure evaluated by augmentation index (AIx) in hypertensive patients with kidney disease. METHODS: 406 hypertensive patients with normal renal function and 72 with kidney disease. Arterial stiffness was estimated with the PWV and the AIx. We followed the 2007 European Guidelines of Hypertension criteria to assess the presence or absence of kidney disease. RESULTS: PWV was 8.98 ± 2.15 and 10.17 ± 3.01 m/s (p <0.05) and AIx 30.06% ± 12.46 and 30.23% ± 12.56 (p >0.05) in hypertensive patients with normal renal function and kidney disease, respectively. Multiple regression analysis showed the renal function as an important determinant of PWV, but not AIx. CONCLUSION: In hypertensive patients with renal disease PWV is increased, but not the AIx. We believe that the AIx is not a reliable measure of arterial stiffness in hypertensive patients with kidney disease.

Continuous renal replacement therapy in neonates and young infants during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a therapy that ensures adequate tissue oxygen delivery in patients suffering cardiac and/or respiratory failure that are unresponsive to conventional therapy. During ECMO, it is common to see a decrease in urine output that may be associated with acute renal failure. In this context, continuous renal replacement therapy (CRRT) should be considered. Our aim is to evaluate a pioneer experience in Latin America, related to the use of CRRT in a group of neonatal-pediatric patients during ECMO. We conducted a retrospective review of patients treated with ECMO at our institution between May 2003 and May 2005. Twelve infants were treated with ECMO, six of them also underwent CRRT. The main reasons for CRRT initiation were fluid overload and progressive azotemia. Observed complications were clots in the filter and excessive ultrafiltration. CRRT was successful in fluid management and solute clearance in all patients. Discharge survival rate was 83%, all of them with normal renal function. Concurrent CRRT with ECMO is technically feasible and efficacious in the management of fluid overload and solute clearance. We report the first experience with these therapies in a Latin American neonatal-pediatric ECMO program associated with the Extracorporeal Life Support Organization.

[Thyroid C cells are decreased in experimental CDH]. / Las células C tiroideas están disminuidas en la hernia diafragmática experimental.

BACKGROUND/AIM: Experimental CDH is often associated with malformations of neural crest origin. Several of these features are present in human CDH and therefore likely similar pathogenic mechanisms should be explored. The aim of the present study is to examine whether thyroid C-cells, another neural crest derivative, are abnormal in this rat model. METHODS: Pregnant rats were exposed either to 100 mg of 2-4-dichlorophenyl-p-nitrophenyl ether (nitrofén) or vehicle (controls) on 9.5 day of gestation. Fetuses were recovered on day 21st and the thyroids of those with CDH (68%) were immuno-histochemically stained with anti-calcitonin antibody. The number of positively stained cells per high power field were counted using a computer-assisted image analysis method in at least 5 sections per thyroid. The distribution of the cells within the gland was assessed as well. Comparisons between CDH and control rats were made by non-parametric tests with a significance threshold of p<0.05. RESULTS: The number of c-cells was dramatically reduced in CDH animals in comparison with controls (101.2 +/- 61.3 vs 23.1 +/- 37, p<0.0001). Histology of the thyroid was similar in both groups, but the distribution of positive C-cells within the gland followed an abnormal pattern in CDH rats with the cells tending to be located at the periphery rather than at the core of the lobes. CONCLUSIONS: Nitrofén induces a severe decrease in thyroid C cells accompanied by abnormal distribution patterns. These results add further evidence of the involvement of a neural crest dysregulation as a component of the pathogenesis of experimental CDH. Whether there is or not a clinical counterpart to these findings is still unknown, but the nature of the cardiovascular and craneo-facial malformations in some babies with CDH strongly support further research in this field.

Regresión espontánea tras nefrectomía de carcinoma renal metastásico. Aportación de un caso con confirmación histológica y revisión de la literatura / Spontaneous regression of metastatic renal carcinoma after nephrectomy. Presentation of a case with histologic confirmation

El carcinoma renal suele manifestarse clínicamentede forma tardía, por lo que aproximadamenteun tercio de los pacientes presentan metástasis adistancia en el momento del diagnóstico. En estoscasos, la supervivencia disminuye drásticamente, situándoseen una media de 12 meses. Se han descritoalgunos casos de regresión espontánea (RE) en estetumor, que varían desde regresiones completas yduraderas hasta parciales y temporales. La RE sepresenta entre el 0,4 y el 4% de los pacientes concarcinoma renal mestastásico (CRM). A pesar deestar descritos muchos factores relacionados con esteraro y favorable suceso, no se conoce su verdaderoorigen y no es, por tanto, un evento predecible.Presentamos un caso de RE tras nefrectomía en unpaciente con carcinoma renal, que presentaba metástasispulmonares confirmadas histológicamente yrecidiva local

The clinical manifestations of renal cell carcinomaare often late, so that approximately one third ofthe patients have metastatic disease at the time ofdiagnosis. In this case, the survival rate diminishesdramatically, with an average survival time of 12months. However, some cases of spontaneous regressionhave been reported for this kind of tumor,either complete and permanent or partial and temporary.Spontaneous regression occurs in 0.4-4.0%of the patients with metastatic renal cell carcinoma.Many factors have been proposed as related withthis rare but favorable event, but until now the originremains unknown and no prediction can be made.We present a case of renal cell carcinoma withhistologic confirmation of lung metastases and localrelapse showing a spontaneous regression afternephrectomy