[Geographic analysis of diabetic nephropathy and renal insufficiency in the primary care, IMSS 2019]. / Análisis geográfico de nefropatía diabética e insuficiencia renal en el primer nivel de atención, IMSS 2019.

Background: In a context where the prevalence of Diabetes Mellitus and Hypertension has increased significantly in recent years, kidney diseases become important for the potential demand for specialized health care and resources required. Objective: To analyze the geographical distribution of Diabetic Nephropathy (DN) and Renal Insufficiency (RI) based on the medical consultations given in first-level units of IMSS during 2019, to identify the medical units with the highest burden of care. Material and methods: Ecological-exploratory study in which indicators were estimated for every thousand persons in relation to medical consultations given by ND and RI according to service time, first-level medical unit (UMF) and representation to analyze the magnitude and geographic distribution at the national level. Results: 45% of medical consultations were by ND and 52.4% by RI. The highest burden per DN was registered in UMF No. 50 Cd. Juarez (Chihuahua) and No. 49 Gabino Barreda (Veracruz Sur), with 1.7 first-time medical consultations and 148.3 subsequent medical consultations per 1,000 persons, respectively. While in UMF No. 40 Manlio Fabio Altamirano and No. 25 Cotaxtla, in Veracruz Norte, the highest burden was for RI, with 4.9 first-time medical consultations and 134.2 subsequent medical consultations per 1000 persons, respectively. Conclusions: The results could contribute to strengthening of medical units where it is necessary and the efficient allocation of resources available to meet the demand for health services of ND and RI in IMSS.

Introducción: en un contexto donde la prevalencia de diabetes mellitus e hipertensión arterial ha aumentado significativamente en años recientes, las enfermedades renales adquieren importancia por la potencial demanda de atención especializada y de recursos en salud que requieren. Objetivo: analizar la distribución geográfica de la nefropatía diabética (ND) y la insuficiencia renal (IR) con base en las consultas otorgadas en unidades de primer nivel del Instituto Mexicano del Seguro Social (IMSS) durante 2019, para identificar las unidades médicas con mayor carga de atención. Material y métodos: estudio ecológico-exploratorio en el que se estimaron indicadores por cada mil derechohabientes en relación a las consultas otorgadas por ND e IR según la ocasión de servicio, la unidad médica familiar (UMF) de primer nivel y la representación. Se utilizó estadística espacial para analizar dichos indicadores. Resultados: el 45% de las consultas otorgadas fue por ND y el 52.4% por IR. La mayor carga por ND se registró en la UMF No. 50 de Cd. Juárez (Chihuahua) y en la No. 49 Gabino Barreda (Veracruz Sur), con 1.7 consultas de primera vez y 148.3 subsecuentes por mil derechohabientes, respectivamente. Mientras que en la UMF No. 40 Manlio Fabio Altamirano y No. 25 Cotaxtla, en Veracruz Norte, la mayor carga fue por IR, con 4.9 consultas de primera vez y 134.2 subsecuentes por mil derechohabientes, respectivamente. Conclusiones: los resultados podrían contribuir al fortalecimiento de las unidades médicas que así lo requieran y en la distribución eficiente de los recursos disponibles para atender la demanda de servicios de salud de ND e IR en el IMSS.

Preeclampsia de presentación grave asociada a hígado graso agudo del embarazo / Severe preeclampsia associated with acute fatty liver of pregnancy / Pré-eclâmpsia grave associada a fígado gorduroso agudo da gravidez

La preeclampsia se puede asociar a una patología poco frecuente como es el hígado graso agudo del embarazo. Se reporta el caso clínico de una paciente de 35 años, tercigesta, cursando embarazo gemelar que presenta preeclampsia con elementos de gravedad, asociada a hígado graso agudo del embarazo. Se realiza diagnóstico y tratamiento precoz de ambas patologías, presentando buena evolución materno-fetal.

Preeclampsia can be associated with acute fatty liver of pregnancy, a rare disease. This report describes the case of a 35-year-old patient, gravida 3, pregnant with twins, who presented with severe pre-eclampsia associated with acute fatty liver of pregnancy. Early diagnosis and treatment of both pathologies was performed, resulting in good maternal-fetal evolution.

A pré-eclâmpsia pode estar associada a uma patologia rara, como o fígado gorduroso agudo da gravidez. Neste relato, apresentamos uma paciente de 35 anos, terciária, em gestação gemelar, apresentando pré-eclâmpsia grave, associada a esteatose hepática aguda na gestação. É realizado diagnóstico e tratamento precoces de ambas as patologias, apresentando boa evolução materno-fetal.

Uso do Bypass Ureteral Subcutâneo no manejo das obstruções ureterais em gatos: revisão de literatura / Use of Subcutaneous Ureteral Bypass in the management of ureteral obstructions in cats - literature review

A obstrução ureteral em felinos é uma afecção, potencialmente fatal e comum na clínica de pequenos animais por levar à restrição do fluxo normal de urina. As principais causas dessa obstrução são ureterólitos (cálculos) que podem ser classificados como simples, mistos ou compostos. Os sinais clínicos da obstrução ureteral não são muito evidentes até que a obstrução seja completa, bilateral ou que haja disfunção do rim contralateral. O diagnóstico da doença é firmado com base nos sinais clínicos, exames complementares como hemograma, bioquímico, radiografia, ultrassonografia abdominal, urinálise e urocultura, uretropielografia retrógrada, pielografia anterógrada, tomografia computadorizada e estudo da taxa de filtração glomerular ureteral. A obstrução ureteral é uma enfermidade que deve ser tratada com emergência, o tratamento deve ser determinado com base no tipo de cálculo presente, os casos mais severos necessitam de intervenção cirúrgica como a técnica bypass para descompressão. O presente artigo é uma revisão sobre a eficácia do emprego do bypass para o tratamento na obstrução ureteral.(AU)

Ureteral obstruction in felines is a potentially fatal and common condition in small animal clinics, as it leads to restriction of the normal flow of urine. The main causes of this obstruction are urolithiasis (renal calculi) which can be classified as: simple, mixed or compound. Clinical signs are not very evident until the obstruction is complete, bilateral, or when occurs a contralateral edge dysfunction. The diagnosis of the disease was settled with the association of clinical signs and the results of complementary tests such as blood count, biochemistry, radiography, abdominal ultrasonography, urinalysis and urine culture, retrograde urethropielography, antegrade pyelography, computed tomography and study of the ureteral glomerular filtration rate. It is an illness that must be treated with emergency, the treatment must be determined based on the type of calculus present, in the most severe cases it must be performed a of surgical intervention such as a bypass technique for decompression. This article is a review of the avaiable information about the effectiveness of bypass usage for treatment of ureteral obstruction in felines.(AU)

The changing impact of pre-liver transplant renal dysfunction on post-transplant survival: results of 2 decades from a single center.

INTRODUCTION AND OBJECTIVES: Renal dysfunction before liver transplantation (LT) is associated with higher post-LT mortality. We aimed to study if this association still persisted in the contemporary transplant era. MATERIALS AND METHODS: We retrospectively reviewed data on 2871 primary LT performed at our center from 1998 to 2018. All patients were listed for LT alone and were not considered to be simultaneous liver-kidney (SLK) transplant candidates. SLK recipients and those with previous LT were excluded. Patients were grouped into 4 eras: era-1 (1998-2002, n = 488), era-2 (2003-2007, n = 889), era-3 (2008-2012, n = 703) and era-4 (2013-2018, n = 791). Pre-LT renal dysfunction was defined as creatinine (Cr) >1.5 mg/dl or on dialysis at LT. The effect of pre-LT renal dysfunction on post-LT patient survival in each era was examined using Kaplan Meier estimates and univariate and multivariate Cox proportional hazard analyses. RESULTS: Pre-LT renal dysfunction was present in 594 (20%) recipients. Compared to patients in era-1, patients in era-4 had higher Cr, lower eGFR and were more likely to be on dialysis at LT (P < 0.001). Pre-LT renal dysfunction was associated with worse 1, 3 and 5-year survival in era-1 and era-2 (P < 0.005) but not in era-3 or era-4 (P = 0.13 and P = 0.08, respectively). Multivariate analysis demonstrated the lack of independent effect of pre-LT renal dysfunction on post-LT mortality in era-3 and era-4. A separate analysis using eGFR <60 mL/min/1.73 m2 at LT to define renal dysfunction showed similar results. CONCLUSIONS: Pre-LT renal dysfunction had less impact on post-LT survival in the contemporary transplant era.

Manifestaciones dematológicas en pacientes con insuficiencia renal crónica, en diálisis perinatal automatizada intermitente / Dermatological Manifestations in Patients with Chronic Renal Failure in Intermittent Automated Peritoneal Dialysis

La enfermedad renal crónica es la vía final común de distintas patologías que afectan al parénquima renal. La prevalencia e incidencia de esta enfermedad se ha incrementado en las últimas décadas de forma exponencial, que la convierte en un grave problema de salud pública a nivel mundial, de acuerdo a su estadio requiere terapia de sustitución renal tipo diálisis peritoneal. La piel y sus anexos son afectados cuando existe un deterioro crónico de la función renal, algunas de las cuales influyen notoriamente en la calidad de vida de estos pacientes. Objetivo: identificar las manifestaciones en piel de los pacientes con enfermedad renal crónica, en diálisis peritoneal. Material y Métodos: estudio no experimental, transversal, descriptivo. Previo consentimiento informado, se evaluó a todos los 87 pacientes en diálisis peritoneal automatizada intermitente, de la sala de Nefrología del Hospital Escuela Universitario, de julio a diciembre del 2017. Se aplicó instrumento obteniendo datos generales, condición metabólica actual, tiempo en diálisis peritoneal y se realizó examen físico en búsqueda de manifestaciones dermatológicas por un dermatólogo, el día que asistieron a su sesión programada de diálisis. Se utilizó el programa estadístico Epi-Info versión 7.2. Resultados: todos los pacientes estudiados tenían al menos 2 manifestaciones dermatológicas, las de mayor frecuencia fueron: xerosis 72(82.8%), palidez 80(81.4%), alteraciones ungüeales 64(73.4%), prurito 56(64.4%), alteraciones pigmentarias 47(54%) y alteraciones en pelo 46(52.9%). Conclusión: la xerosis fuela manifestación más frecuente; no se encontró relación entre xerosis y prurito, ni entre prurito y niveles de azoados, calcio o fosforo. La principal manifestación en uñas fue onicopaquia y en pelo dermatitis seborreica.La incidencia de manifestaciones dermatológicas en pacientes con enfermedad renal crónica fue mayor a la de otros estudios, es importante identificar estos signos y síntomas para realizar diagnósticos tempranos y tratamientos oportunos...(AU)

Monitoring anti-Xa levels in patients with cancer-associated venous thromboembolism treated with bemiparin.

OBJECTIVE: To analyze the relationship between therapeutic (weight-adjusted) dose of bemiparin and anti-Xa activity in patients with venous thromboembolism (VTE) and cancer in comparison with a cohort of patients with VTE without cancer, and its relationship with outcomes. MATERIALS AND METHODS: This is a prospective cohort study that comprised a cohort of patients with cancer-associated VTE and a cohort of non-cancer patients with VTE, all of them treated with bemiparin. The ethics committee approved the study and informed consent was obtained from the patients. RESULTS: One hundred patients were included (52 with cancer and 48 without cancer), with a median follow-up of 9.8 months. Mean anti-Xa activity was 0.89 (± 0.33) UI/mL in oncological patients and 0.83 (± 0.30) UI/mL in non-cancer patients (mean difference - 0.05 95% CI - 0.18; 0.06). A multiple linear regression model showed that anti-Xa peak was associated with the dose/kg independently of possible confounding variables (presence of cancer, age, sex and eGFR-estimated Glomerular Filtration Rate), in a way that for every 1 UI of dose/kg increase, the anti-Xa peak activity increased 0.006 UI/mL (95% CI 0.003; 0.009) (p < 0.001). The predictive capacity of anti-Xa peak in the oncology cohort showed an area under the ROC curve of 0.46 (95% CI 0.24-0.68), 0.70 (95% CI 0.49-0.91) and 0.74 (95% CI 0.44-0.94) for death, first bleeding and recurrence of VTE, respectively, and none was statistically significant. CONCLUSION: In patients with venous thromboembolism treated with bemiparin, anti-Xa levels were not influenced by the presence of cancer.

Juxtarenal Abdominal Aortic Aneurysm: Results of Open Surgery in an Academic Center.

BACKGROUND: The objective of the study is to report our experience with conventional surgery for juxtarenal abdominal aortic aneurysms (JRAs) by evaluating incidence of acute renal failure and perioperative mortality. Secondary objectives are to evaluate general morbidity and the need for permanent postoperative dialysis and to assess the influence on long-term survival of preoperative risk factors and deterioration of perioperative renal function. METHODS: A retrospective cohort study of 110 patients with JRA electively treated by open surgery between March 1992 and March 2018 was made. Data were obtained from clinical records, describing demographics, perioperative variables, and results. Acute kidney injury (AKI) was defined as 50% decrease in glomerular filtration rate or two-fold increase in serum creatinine. Multivariate analysis was performed by logistic regression to establish risk factors for renal failure. The influence of preoperative risk factors and deterioration of perioperative renal function on long-term survival was studied using Cox regression model. Descriptive and inferential statistics were used in the analysis. RESULTS: 110 consecutive patients were treated with an average age of 71 years, 82.7% male; 81% hypertensive and 41% active smokers. 46.3% had stage III or higher preoperative chronic kidney disease. Median diameter of the aneurysm was 5.7 cm. Interruption of bilateral renal flow was required in 73 patients (66.4%) and unilateral in 37 (33.6%). The average renal clamping time was 34.5 min. AKI occurred in 9 patients (8.2%). Two patients (1.8%) required postoperative dialysis, one of them permanent. Median hospital stay was 7 days. Thirty-three patients (30%) had at least one complication. Postoperative mortality was 2.7% (3 patients), two of them developed AKI. Multivariate analysis established a longer operative time and need for renal revascularization as independent risk factors for AKI. In the survival analysis, age, cerebrovascular disease, chronic obstructive pulmonary disease, and perioperative AKI were identified as risk factors for long-term mortality. CONCLUSIONS: JRA open surgical repair can be performed with low morbidity and mortality. Although transient acute renal dysfunction may be relatively frequent, the need for hemodialysis is low. Our study is a reference point to compare with endovascular repair.

Use of symmetric dimeltilarginine renal biomarker in early diagnosis off chronic renal failure in dogs and cats / Uso do biomarcador renal dimetilarginina simétrica no diagnóstico precoce da insuficiência renal crônica em cães e gatos

Kidney disease is commonly found in small animal clinics, but its diagnosis is often late. The research to find sensitive renal biomarkers has been performed in order to provide an early diagnosis allowing appropriate therapy for each patient, as well as improving his quality of life. The renal biomarker  Symmetric Dimethylarginine (SDMA) is presenting perspectives for the diagnosis of kidney disease in dogs and cats, detecting kidney damage when 50% of its function is compromised. This paper performs a review of the use of dimethyartinine in the diagnosis of kidney disease in these animals.

A doença renal é comumente encontrada na clínica de pequenos animais, porém o seu diagnóstico é geralmente muito tardio. Pesquisas por biomarcadores renais mais sensíveis são foco de estudos, pois poderão proporcionar um diagnóstico precoce, permitir o estabelecimento da terapia adequada a cada paciente e melhorar a sua qualidade de vida. O biomarcador renal Dimetilarginina Simétrica (SDMA), tem apresentado resultados significativos em termos de precocidade para o diagnóstico da doença renal, podendo detectar lesão renal quando 50% da função está comprometida. O presente trabalho faz uma revisão da situação atual e perspectivas do emprego da dimetilarginina simétrica para estabelecimento do diagnóstico da doença renal em cães e gatos.

Acute kidney failure following severe viper envenomation: clinical, biological and ultrasonographic aspects

Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. Method: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. Results: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10-2). Conclusion: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.(AU)

Use of symmetric dimeltilarginine renal biomarker in early diagnosis off chronic renal failure in dogs and cats / Uso do biomarcador renal dimetilarginina simétrica no diagnóstico precoce da insuficiência renal crônica em cães e gatos

Kidney disease is commonly found in small animal clinics, but its diagnosis is often late. The research to find sensitive renal biomarkers has been performed in order to provide an early diagnosis allowing appropriate therapy for each patient, as well as improving his quality of life. The renal biomarker  Symmetric Dimethylarginine (SDMA) is presenting perspectives for the diagnosis of kidney disease in dogs and cats, detecting kidney damage when 50% of its function is compromised. This paper performs a review of the use of dimethyartinine in the diagnosis of kidney disease in these animals.(AU)

A doença renal é comumente encontrada na clínica de pequenos animais, porém o seu diagnóstico é geralmente muito tardio. Pesquisas por biomarcadores renais mais sensíveis são foco de estudos, pois poderão proporcionar um diagnóstico precoce, permitir o estabelecimento da terapia adequada a cada paciente e melhorar a sua qualidade de vida. O biomarcador renal Dimetilarginina Simétrica (SDMA), tem apresentado resultados significativos em termos de precocidade para o diagnóstico da doença renal, podendo detectar lesão renal quando 50% da função está comprometida. O presente trabalho faz uma revisão da situação atual e perspectivas do emprego da dimetilarginina simétrica para estabelecimento do diagnóstico da doença renal em cães e gatos.(AU)

First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction.

BACKGROUND: Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. METHODS: This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-ß1), retinol-binding protein (RBP), cystatin C (uCyC), and microalbuminuria (µALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. RESULTS: All urine biomarkers showed significantly higher values at the first month of life (p ≤ 0.009), while NGAL (p = 0.005), TGF-ß1 (p < 0.001), and µALB (p < 0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-ß1 or KIM-1 and NGAL with CyC ([AUC] ≤ 0.934; sensitivity ≤ 92.4%; specificity ≤ 92.8%). CONCLUSIONS: RBP, NGAL, KIM-1, TGF-ß1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.

Preoperative renal dysfunction does not affect outcomes of left ventricular assist device implantation.

OBJECTIVE: Selection criteria for durable left ventricular assist device (LVAD) implantation remain unclear. One such criterion is renal function. In this study we evaluated outcomes of LVAD implantation in patients with preoperative renal dysfunction. METHODS: Patients with implanted LVADs as destination therapy (DT) or bridge to transplantation (BTT) at a single institution between 2006 and 2015 were included. Primary stratification was according to pre-implantation glomerular filtration rate (GFR): >60 mL/min versus <60 mL/min or dialysis dependence. The primary outcome was post-LVAD implantation overall survival. RESULTS: Two hundred thirty-eight patients underwent LVAD implantation during the study period as DT (60%; n = 142) or BTT (40%; n = 96). Reduced GFR was present in 56% (n = 132), with 8% (n = 18) being dialysis-dependent. Normal versus reduced GFR cohorts were well matched except for a higher incidence of coronary artery disease in the patients with reduced GFR (61% vs 48%; P = .04). Mean follow-up was 13.5 ± 17.0 months. Unadjusted and risk-adjusted survival at 1, 3, 6, and 12 months after LVAD implantation were similar between the cohorts for DT and BTT. Rates of transplantation were comparable in BTT patients (61% normal vs 53% reduced GFR; P = .43). Recovery of renal function to a GFR >60 mL/min occurred in 43% (n = 17) and 57% (n = 42) of patients with reduced GFR in the BTT and DT cohorts, respectively, by 1 year post implantation. CONCLUSIONS: Well selected patients with preexisting renal dysfunction can undergo LVAD implantation with acceptable outcomes. Approximately half of LVAD recipients with preimplantation renal dysfunction will recover normal renal function within the first postoperative year. Renal dysfunction alone should not serve as an absolute contraindication to LVAD therapy.

O papel da ecografia vascular no manejo das complicações associadas ao acesso venoso central para hemodiálise em pacientes oncológicos: relato de dois casos e revisão da literatura / The role of vascular echography in the management of complications associated with central venous access for hemodialysis in cancer patients: two case reports and literature review

O implante de cateter venoso central para hemodiálise é comumente realizado em grandes centros e suas complicações estão, por vezes, associadas ao treinamento insuficiente de quem o realiza, mas também às condições clínicas do próprio doente. O presente estudo relata dois casos de intercorrências relacionadas ao uso do cateter de curta permanência para hemodiálise. No primeiro caso, houve inserção inadvertida da cânula na artéria subclávia esquerda e consequente trombose arterial, que foi conduzida conservadoramente, documentando-se uma boa perfusão colateral com ecografia vascular. O segundo caso ilustra o achado incidental de uma trombose venosa séptica central em paciente que havia feito uso do cateter por uma semana, optando-se por tratá-la com antibioticoterapia, anticoagulação plena e controle ecográfico. Em ambos os casos, a intervenção cirúrgica seria de alto risco devido ao prognóstico reservado dos doentes. A ultrassonografia vascular permitiu o monitoramento das situações clínicas e o emprego de terapêutica menos agressiva

Central venous catheter implantation for hemodialysis is commonly performed in large centers and its complications are sometimes associated with insufficient training of those who perform it, but may also be related to the patient's clinical condition. The present study reports two cases of complications related to use of a short-stay catheter for hemodialysis. In the first case, the cannula was inadvertently inserted into the left subclavian artery, causing arterial thrombosis, which was conservatively managed and good collateral perfusion was documented with vascular echography. The second case illustrates an incidental finding of Central Venous Septic Thrombosis in a patient who had used a catheter for a week, which was treated with antibiotic therapy, anticoagulation, and ultrasound control. In both cases, surgical intervention would have been high risk because of the patients' poor prognosis. Vascular ultrasonography enabled monitoring of these clinical situations and use of less aggressive treatments

Doença cística adventicial da artéria radial / Adventitial cystic disease of the radial artery

A doença cística adventicial (DCA) da artéria radial é uma condição rara, com poucos casos descritos na literatura. Relatamos o caso de um paciente do sexo masculino, 62 anos, branco, diabético, hipertenso, com insuficiência renal crônica e indicação para terapia substitutiva renal, em quem foi encontrada uma lesão cística da artéria radial durante operação para confecção de fistula arteriovenosa para hemodiálise. Após a dissecção da artéria radial, ficou evidenciado um importante envolvimento do vaso por uma formação cística. A técnica cirúrgica adotada foi a ressecção do segmento cístico comprometido e preservação da artéria radial. A confecção da fistula arteriovenosa foi realizada com sucesso. O diagnóstico precoce e o tratamento adequado da DCA mostram se eficientes e podem prevenir complicações e recidivas

Adventitial cystic disease (ACD) of the radial artery is a rare condition, with few cases described in the literature. We report the case of a 62-year-old white male with a history of diabetes, hypertension, and chronic kidney disease with indications for renal replacement therapy who was found to have a cystic lesion of the radial artery while undergoing surgical creation of an arteriovenous fistula. The surgical technique adopted was resection of the cystic segment and preservation of the radial artery. Fistula creation was completed successfully. Early diagnosis and appropriate treatment of ACD are effective, and can prevent complications and recurrence.

Hemofagocitosis secundaria a dengue / Hemophagocytosis secondary to dengue fever

La infección por el virus del dengue constituye un problema de salud pública mundial. Causada por un virus de la familia Flaviviridae, presenta un amplio espectro clínico, desde formas asintomáticas frecuentes hasta las formas graves de fiebre hemorrágica y shock por fuga capilar. Existen cuatro serotipos; los serotipos 2 y 3 están asociados a las formas graves de la enfermedad. El diagnóstico definitivo de infección por dengue depende del aislamiento del virus en sangre, de la detección del antígeno viral o el ARN viral en suero o tejido, o detección de anticuerpos específicos. El síndrome hemofagocítico se produce ante la desregulación del sistema inmune que lleva a la activación macrofágica descontrolada, y se manifiesta con alteraciones clínicas, hematológicas, bioquímicas e histológicas. La asociación entre ambas entidades se encuentra descripta como una forma inusual y grave de presentación que responde a la tormenta de citocinas liberadas durante la enfermedad. Presentamos el caso de un paciente adulto con dengue, hemofagocitosis y valores inusualmente elevados de ferritina en sangre que evolucionó favorablemente con tratamiento de soporte.

Dengue virus infection constitutes a major public health problem worldwide. It is caused by a virus belonging to the Flaviviridae family. It produces a wide range of clinical presentations, from asymptomatic infection to severe forms of the disease with hemorrhagic fever or shock secondary to capillary leak syndrome. Four serotypes have been described; serotype 2 and serotype 3 are associated with the most severe forms of the disease. The diagnosis is based on laboratory tests aimed to detect antibodies, viral RNA, or antigens in serum. The hemophagocytic syndrome is generated by a dysfunction of the immune system with clinical, hematological, biochemical and histological manifestations. The association between these two entities is described as an unusual and severe presentation of dengue fever. We present a case of an adult patient with this association and very high blood levels of ferritin, who responded favorably to supportive care.

[Hemophagocytosis secondary to dengue fever]. / Hemofagocitosis secundaria a dengue.

Dengue virus infection constitutes a major public health problem worldwide. It is caused by a virus belonging to the Flaviviridae family. It produces a wide range of clinical presentations, from asymptomatic infection to severe forms of the disease with hemorrhagic fever or shock secondary to capillary leak syndrome. Four serotypes have been described; serotype 2 and serotype 3 are associated with the most severe forms of the disease. The diagnosis is based on laboratory tests aimed to detect antibodies, viral RNA, or antigens in serum. The hemophagocytic syndrome is generated by a dysfunction of the immune system with clinical, hematological, biochemical and histological manifestations. The association between these two entities is described as an unusual and severe presentation of dengue fever. We present a case of an adult patient with this association and very high blood levels of ferritin, who responded favorably to supportive care.

Anesthetic and Perioperative Considerations for Combined Heart-Kidney Transplantation.

OBJECTIVE: To describe detailed perioperative features of combined heart and kidney transplant (HKT). DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: All consecutive HKT recipients aged 18 years and older. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After approval of the Institutional Review Board, the authors studied all consecutive adult patients who underwent HKT between January 2013 and July 2016. Recipient and donor's demographic data, hemodynamic profile, and perioperative data were analyzed. Actuarial survival rate was 57% and 43% for in-hospital and after a mean follow-up of 135 (266) days, respectively. Among patients who required postoperative hemodialysis (n = 4), 75% (n = 3) died during hospital stay. In unadjusted analysis, patients who died had a lower postoperative cardiac index (5.4 [2.7] v 3.2 [1] L/min/m2; p = 0.034) and central venous pressure (11 [5] v 8.5 [3] mmHg; p = 0.032). All patients underwent a nonstaged surgery. When compared with preoperative hemodynamic variables, early postoperative values showed decreased systemic vascular resistance (1,333 [433] dyn/s/cm-5v 595 [176] dyn/s/cm-5; p = 0.028) and higher cardiac output (4.3 [1.4] L/min v 6.7 [3] L/min; p = 0.018). Median hospital stay was 63 (44) days. CONCLUSIONS: Anesthesiologists should be actively involved in perioperative strategies on how to manage these critical patients with severe cardiac and noncardiac comorbidities applying their expertise to HKT procedure.

Manifestações clínicas de pacientes com insuficiência renal crônica e manejo na clínica odontológica ­ revisão de literatura / Clinical manifestations of chronic renal failure patients and management in dental clinic ­ literature review

A insuficiência renal crônica (IRC) é uma doença progressiva que ocorre devido à perda irreversível de néfrons. Suas manifestações orais são frequentes e seu manejo na clínica odontológica necessita de maiores cuidados. O presente trabalho tem como objetivo abordar as principais alterações sistêmicas do paciente renal crônico, bem como a conduta a ser tomada pelo profissional frente às alterações orais e seu manejo na clínica odontológica. Para isso, realizou-se uma revisão de literatura nas bases de pesquisa Science Direct, incluindo os artigos disponíveis em inglês, espanhol e português. Assim como outras condições sistêmicas, a IRC pode causar algumas manifestações orais, como xerostomia, estomatite urêmica, anomalias dentárias, hiperplasia gengival, gengivite, periodontite e alterações ósseas. Essas alterações devem ser levadas em consideração durante o atendimento odontológico, bem como os cuidados prévios ao atendimento destes pacientes. O cirurgião dentista deve conhecer a condição sistêmica dos pacientes e a conduta odontológica a ser tomada no pré, trans e pós-operatório, tendo em vista a complexidade do atendimento e buscando a resolutividade efetiva dos problemas orais (AU).

Chronic renal failure (CRF) is defined as a progressive decline in renal function associated with a reduced glomerular filtration rate. Oral manifestations are common and their management in the dental clinic requires more care. The aim of this work is to show the mainly systemic changes in chronic renal patients as well as actions to be taken by the professional to change their management in oral alterations in odontologic clinic. A systematic literature review was performed in Science Direct databases, including all articles available in full for free in English, Spanish, and Portuguese. Like other systemic conditions, the CRF may cause some oral manifestations, such as xerostomia, uremic stomatitis, dental anomalies, gingival hyperplasia, gingivitis, periodontitis, and bone changes. These changes must be taken into consideration during dental care as well as the prior care to treatment of these patients. The dentist should be aware of the systemic condition of this patient and the dental practice to be taken in the pre and post operatively, in view of the complexity of care to these patients and to search the resolution of effective oral problems (AU).

Intratumor cisplatin nephrotoxicity in combined laser-induced thermal therapy for cancer treatment.

INTRODUCTION: Thermal ablation of tumors by Nd:YAG laser has been growing as a multidisciplinary subspecialty defined as laser-induced thermal therapy (LITT), and has been increasingly accepted as a minimally invasive method for palliation of advanced or recurrent cancer. Previous studies have shown that adjuvant chemotherapy can potentiate laser thermal ablation of tumors leading to improved palliation in advanced cancer patients. OBJECTIVE: Evaluate nephrotoxicity by early markers of renal function in treating head and neck cancer using intra-tumor injections of cisplatin combined with laser-induced thermal therapy (CDDP-LITT). METHODS: Nine patients with recurrent head and neck tumors were treated by CDDP-LITT in order to determine nephrotoxicity related to this synergistic association. Among the tests requested to detect early were creatinine, magnesium, creatinine clearance, serum urea-BUN, type I urine, and proteinuria at 24 hours. RESULTS: Twelve recurrent tumors in nine patients were treated by CDDP-LITT. Pain was the major complaint (four patients), while other symptoms included dysphagia, dyspnea, bleeding, and difficulties in chewing. Fifteen laser procedures were performed and maximal CDDP dose was 50 mg. None of the markers for nephrotoxicity showed changes at these levels of CDDP intra-tumor injections. CONCLUSION: This initial experience with (CDDP-LITT) indicates both safety and therapeutic potential for palliation of advanced head and neck cancer. However, safety and feasibility must be confirmed by longer follow-up and further escalation of CDDP doses in a Phase I study to determine maximum tolerated dose (MTD) and demonstrate tangible benefits for patients. Lasers Surg. Med. 49:756-762, 2017. © 2017 Wiley Periodicals, Inc.